Technical Series Report No V. 16 February 20, 2009 Nutrition Situation Post Deyr 2008/09 Food Security Analysis Unit - Somalia Box 1230 Village Market Nairobi, Kenya Ph: 254-20-3745734 Fax: 254-20-3740598 Web site: www.fsausomali.org Email: [email protected] Technical and Funding Agencies Managerial Support European Commission Acknowledgement FSAU would like to thank the twenty partner agencies for their participation and support in this seasonal nutrition assessments and analysis. These crucial assessments would not have been possible without the technical participation and timely logistical support provided by our partners. The assessments and inte- grated analysis would not have been possible without the dedication and expertise of the FSAU’s Nairobi and field based nutrition analysts. Participating partners United Nations Children’s Fund (UNICEF), Ministry of Health and Labor (MOHL), Ministry of Health (MOH), World Food Program (WFP), World Health Organization (WHO), Horn Relief, Somalia Red Crescent Society (SRCS), Muslim Aid, Mercy USA, Co-operative Di Svil- lupo International (COSV), AFREC (African Rescue Committee), World Vision International (WVI), International Medical Corps (IMC), Gedo Health Consortium (GHC), CARE, Action Contre La Faim (ACF), Intersos, Merlin, Save the Children (UK), Concern Worldwide, MSFB, MSFH, MSF-CH, COOPI. FSAU Technical Series Report No V. 16 iii Issued February 20, 2009 TABLE OF CONTENTS 1. EXECUTIVE SUMMARY 1 2. NUTRITION ANALYSIS IN SOMALIA 5 3. REGIONAL NUTRITION ANALYSIS 7 3.1 Gedo Region 7 3.2 Lower and Middle Juba Regions 10 3.3 Bay and Bakool Regions 13 3.4 Central Regions 16 3.5 Hiran Region 18 3.6 Lower and Middle Shabelle Regions 19 3.7 Northeast Regions 20 3.8 Northwest Regions 26 3.9 Urban Nutrition Analysis 31 4. DEVELOPMENT OF CASELOAD ESTIMATES OF ACUTELY MALNOURISHED CHILDREN IN SOMALIA 34 5. PLAUSIBILITY CHECKS 36 6. APPENDICES 38 6.1: Somalia Livelihood Zones 38 6.2 Progression of Estimated Nutrition Situation Deyr 06/07 - Deyr 08/09 39 6.3 Somalia Median Estimates of Acute Malnutrition 2001 - 2007 40 6.4 Nutrition Assessment Tools Post Deyr ‘08/09 41 LIST OF TABLES Table 1 Somalia IPC Rural, Urban & IDP Populations in Crisis, Jan – Jun ’ 2009 4 Table 2 Nutrition Situation Categorisation Framework 5 Table 3 Summary of Key Nutrition Findings in Gedo Region 8 Table 4 Summary of Key Nutrition Findings in Middle and Lower Juba 11 Table 5 Summary of Key Nutrition Findings in Bakool Region 15 Table 6 Summary of Key Nutrition Findings in Central Regions 17 Table 7 Summary of Key Nutrition Findings in Hiran Regions 18 Table 8 Summary of Key Nutrition Findings in Middle and Lower Shabelle Regions 20 Table 9 Summary of Key Nutrition Findings in Northeast Regions 22 Table 10 Summary of Key Nutrition Findings in Northwest Regions – Golis, Gagaab, Sool Plateau, Karkaar, Coastal Deeh, Nugal Valley 24 Table 11 Summary of Key Nutrition Findings in Northwest – W. Golis/Guban; Sool Plateau 27 Table 12 Summary of Key Nutrition Findings in Northwest – E. Golis of Sanaag 28 Table 13 Summary of Key Nutrition Findings in Northwest – Hawd, Nugal Valley livelihood zones 29 Table 14 Summary of Key Nutrition Findings in Northwest Agropastoral livelihood zone 30 Table 15 Summary of Key Nutrition Findings in IDPS in Hargeisa, Burao 30 Table 16 Summary of Key Nutrition Findings in Bossaso Urban 32 Table 17 Summary of Nutrition Assessments, October-December 2008 35 Table 18 Plausibility Checks 37 LIST OF MAPS Map 1 Estimated Nutrition Situation, January 2008 2 Map 2 Rural IPC Populations, Jan – Jun ’09 4 Map 3 Urban and IDP IPC Populations, Jan – Jun ’09 4 Map 4 Distribution of Estimated Caseloads of Acutely Malnourished Children, Jan’09 34 FSAU Technical Series Report No V. 16 iv Issued February 20, 2009 LIST OF FIGURES Figure 1 Rates of Global and Severe Acute Malnutrition (WHZ) from surveys conducted in Oct.-Dec.’08 1 Figure 2 Summary of findings from Nutrition Assessments conducted in Gu ’08 and Deyr ’08/09 1 Figure 3(a) Trends in Levels of Acute Malnutrition (WHZ<-2 or oedema) in Gedo Region (1995-2006) 7 Figure 3(b) Trends in Levels of Acute Malnutrition (WHZ<-2 or oedema) in Gedo Region (2007-2008) 7 Figure 4 Trends in Levels of Acute Malnutrition (WHZ<-2 or oedema) in Juba Valley 2001-2008 10 Figure 5 Trends in Levels of Acute Malnutrition (WHZ<-2 or oedema) in Bakool Region 2001-2008 13 Figure 6 Number of admission in the ACF Wajid CBTC 2007-2008 14 Figure 7 Trends in Levels of Acute Malnutrition (WHZ<-2 or oedema) in Bay Region 2000-2008 14 Figure 8 Bay Agro-Pastoral HIS Nutrition Trends for 2008 15 Figure 9 Trends in Levels of Acute Malnutrition (WHZ<-2 or oedema) in Central Regions 2000-2008 17 Figure 10 Trends in Levels of Acute Malnutrition (WHZ<-2 or oedema) in Hiran Region 2000-2008 18 Figure 11 Trends in Levels of Acute Malnutrition (WHZ<-2 or oedema) in Shabelle Valley 2007-2008 19 Figure 12 Trends in Levels of Acute Malnutrition (WHZ<-2 or oedema) in Northeast Regions 2000-2008 21 Figure 13 Trends in Levels of Acute Malnutrition (WHZ<-2 or oedema) in Northwest Regions 2001-2008 26 Figure 14 Kulmiye MCH HIS Nutrition Trends for 2008 27 Figure 15 Badhan MCH HIS Nutrition Trends for 2008 28 Figure 16 Garadag MCH HIS Nutrition Trends for 2008 28 Figure 17 Lasanod Daami MCH HIS Nutrition Trends for 2008 29 SPECIAL ARTICLES Analysis of Nutrition Data (2007-2008) Comparing the New WHO Anthro 2006 Standards and the Nchs 1978 Population References 9 Meta Data Analysis of Nutrition Surveys, 2001-2008 12 Supporting Breastfeeding for a Healthy Family 25 Case Study: A Family in Bossaso Idp Camp, February, 2009 33 FSAU Technical Series Report No V. 16 v Issued February 20, 2009 LIST OF ACRONYMS ARI Acute Respiratory Tract Infections ACF Action Contre La Faim AFLC Acute Food and Livelihood Crisis CARE Canadian Relief Everywhere CMR Crude Mortality Rate (Retrospective) COSV Co-operatione Di Svillupo International CTC Community Therapeutic Care FSAU Food Security Analysis Unit FEWSNET Famine Early Warning System Network GAM Global Acute Malnutrition GHC Gedo Health Consortium HE Humanitarian Emergency HIS Health Information System IDP Internally Displaced persons LQAs Lot Quality Assurance LZ Livelihood Zone MCH Maternal and Child Health Center MOH Ministry of Health MOHL Ministry of Health and Labour MT Metric Tonne MUAC Mid Upper Arm Circumference NCHS National Center for Health Statistics PWA Post War Average SAM Severe Acute Malnutrition SRCS Somalia Red Crescent Societies SD Standard Deviation SFP Selective/Supplementary Feeding Program U5MR Under Five Mortality Rate (Retrospective) WHO World Health Organization of the United Nations WFP World Food Program of the United Nations WHZ Weight for Height Z Scores FSAU Technical Series Report No V. 16 vi Issued February 20, 2009 Forward This nutrition situation technical series report is a new publication of the Food Security Analy- sis Unit (FSAU). The FSAU biannual seasonal technical series reports have always included an integrated analysis of all sectors including nutrition, however given the scale of nutrition infor- mation available, a separate publication was deemed appropriate. Therefore, this report does not replace the seasonal technical series report rather complements it, with a specific focus on nutrition information. The FSAU Post Deyr ’08/09 Technical Series report, will be released in the coming weeks and provides a detailed analysis by region and by sector of the integrated food security situation. FSAU Technical Series Report No V. 16 vii Issued February 20, 2009 1. EXECUTIVE SUMMARY The findings of the FSAU, FEWSNET, and partners’ post Deyr ‘08/09 seasonal assessment confirm that there is an ongoing and sustained Humanitarian Crisis in Somalia, with 43% of the total population of the country, or around 3.2 million people, in need of emergency livelihood and life-saving assistance at least until June 2009. A failed state since the early 1990s, Somalia has had recurring humanitarian emergencies over the last 18 years and is a country characterized by chronically high rates of acute malnutrition above emergency levels, and chronic levels of food insecurity among the rural population. The ongoing humanitarian crisis, however, is unique in that the crisis is widespread; not only are 1.2 million rural people in crisis, nearly two-thirds of those in crisis, or 2 million people, are urban poor and internally displaced populations (IDPs) (Map 2 & 3 and Table 1). One of the driving factors behind the current emergency is a macro-economic crisis, driven by a significantly devalued Somali Shilling and hyperinflation of basic food and non-food items. This macro-economic crisis is exacerbated by months of increased conflict that have internally displaced more than 1 million people throughout the country. Furthermore, the Deyr ‘08/09 season rains (Oct.-Dec. ‘08) were below normal. This not only deepened an already severe ongoing drought and pastoral humanitarian emergency in the central regions, but has resulted in another year of below normal annual cereal production and an overall annual cereal availability deficit of 120,000MT. Nutrition Situation Overview Figure 1: Rates of Global Acute and Severe Acute At least 200,0001 children under five years of age are malnutrition (WHZ) from surveys conducted known to be acutely malnourished in Somalia at the cur-! in Oct.-Dec. ’08 30 rent time, of which 60,000 are estimated to be severely 7"# 89) :);<* => )?>@AB 50C !"# 89) :);<* => )?>@AB .C 25 malnourished. These numbers represent 1 in 6 children executive summary as acutely malnourished and 1 in 20 as severely 20 malnourished, numbers which will have a devastating impact on the long term economic development of the 15 country (Map 4).