Situation Report – Horn of Africa Crisis Ethiopia Date: 21 September 2011 Reporting period: 15 - 21 September 2011 Report #10 HIGHLIGHTS Ethiopia Drought Situation Continued increase in suspected Acute Watery Diarrhoea (AWD) cases in Kebridahar (Somali Region) remains a major concern. The past week witnessed the highest number of reported cases since the onset of the outbreak in August. The outbreak is also expanding within Kebridahar woreda. UNICEF is supporting the regional authorities to mobilize additional medical staff, mobile health teams and drugs to the affected locations. This has helped to ensure good case management and reduce case fatality rates to below threshold level. An additional Case Treatment Centre (CTC) has also been established in the outlying kebeles. Kebridahar is the only location where the outbreak has not been contained. The immediate requirement is the deployment of an epidemiologist to better understand how the cases are spreading and WHO has done this. Therapeutic Feeding Programmes (TFP) admission figures for August totaled 24,055 new severe acutely malnourished admissions in Oromiya, SNNP, Tigray, Amhara and Somali regions with a 71.7 per cent reporting rate and 86.9 per cent cure rate. This is a 20 per cent decrease from the July admissions figure (29,360). Preparation for the measles immunization campaign in the Somali Region is progressing well. Support and supervisory staff and the required supplies are in place. The campaign will start on 21 September in priority woredas bordering Somalia. Somali Refugee Situation According to UNHCR, as of 19 September 2011 the total number of Somali refugee population in the four Dollo Ado camps and the transit center stands at 123,749. So far in September, the average number of new arrivals is 160. The mortality rates in Dollo Ado camps remain a concern. The latest data from UNHCR indicate a significant improvement in Kobe with a reduction of CMR from 2.1 per 10,000 day in week 36 to 1.1 per 10,000 in week 37. The under 5 mortality rate has also improved, with a decrease from 8.8 to 4.4 during the same period. In Hilowen camp, the rates deteriorated from 1.7 per 10,000 in week 36 to 1.9 in week 36. The number of measles cases continues to decline while partners wait for the final decision of the Federal Ministry of Health on launching a supplementary measles campaign to target adults up to 30 years of age. Both MHNTs are working in Kobe refugee camps. Both teams have visited 308 households providing health and nutrition services including health education, hygiene and sanitation promotion. Sudanese Refugee Situation (Blue Nile State) The influx of Sudanese refuges seems to have slowed down during the past week. According to UNHCR, as of mid-September, some 11,900 Sudanese refugees have been registered in Benishangul Gumuz. Many Sudanese prefer not to be registered as refugees and continue to move in and out of Ethiopia since the situation in Sudan remains tense. UNICEF has provided six mobile health and nutrition teams (MHNT) to respond to the additional health needs in locations with large Sudanese refugee concentrations. 1/10 EMERGING HUMANITARIAN ISSUES AND NEEDS Ethiopia Drought Situation In the past week, good rains were reported over parts of the Somali Region including Jigiga and Shinille zones (Harshin, Kabribaya and Asha woredas). The Karan rains have replenished water sources in these locations. The onset and performance of the rains in Fik and Degahbur zones is yet to be confirmed. Water trucking in these two zones is on-going but may cease following information on the onset and impact of current rains. In Oromiya, moderate rainfall was received over wide areas with the exception of Borena and East Hararghe Zones. Except Ale woreda in Segen Hizboch zone and Hamer and Dasenech woreda in South Omo zone, all zones in SNNPR received sufficient rains during the past week. In Afar Region, rainfall has been erratic and inadequate in the north and north-eastern areas. Tigray received pockets of moderate rainfall. In the Deyr rain receiving zones of the Somali Region (Gode, Afder, Liban, Korahe, Warder, Degahbur and Fik zones) the availability of pasture is diminishing due to the failure of the previous rainy seasons and the abnormal livestock migration within the region and from Somalia and Kenya to the south-eastern zones of the region. Field reports indicate shoat death (mainly sheep) from Dollo Ado, Dolo-Bay, Charatti and Elkare areas while cattle death is reported in Moyale, Hudet, Dollo-ado and Dolo-bay areas. In Shinille and Jigiga, the milk yield has increased due to pasture and water improvements. According to the Oromiya Regional Disaster Preparedness and Prevention Commission (DPPC) Early Warning report issued this week, five woredas (kurefa Chelle, Melaka Bello, Bedeno, Deder and Meta) in East Hararghe zone are currently facing critical food shortage due to the drought. In Bale and Borena zones, the recurrent moisture stress has seriously affected crop and livestock performance. If the shortage of rain continues, the crop and livestock performance will worsen in the upcoming months and the community will be further dependent on relief assistance. During the past week, suspected AWD cases reported were from four zones in Oromiya and Somali regions (East and West Harghe zones, Shinille and Korahe). The doubling of cases in Kebridahar (Korahe zone in Somali Region) is of major concern. There are now reports of cases in eight kebeles, some of which are constrained by security-related access problems. Overall case fatality rates remain low. Kebridahar woreda is so far the only area where the outbreak is not contained by the current response. Details on number of actual cases are currently not available for public sharing. Health seeking behaviour, supported by health workers who facilitate home treatment is a major challenge for controlling the spread of the disease. The immediate requirement is the deployment of an epidemiologist to better understand how the cases are spreading and WHO has done this. There has been an increase in cases in East and West Hararghe but by the end of the week, fewer new cases were reported. Based on the reports received from the five drought-affected regions (SNNPR, Oromiya, Amhara, Tigray and Somali), 24,055 new SAM cases were admitted in TFP with a 71.7 per cent reporting rate and 86.9 per cent cure rate. This is a 20 per cent decrease compared to July admissions (29,360). SNNPR continues to report significant lower levels of admissions compared to previous months with a 30 per cent reduction from August to September. 2/10 Monthly OTP Admission trend in SNNPR 16000 14000 12000 10000 Admissions 8000 6000 OTP Admission 4000 2000 0 Feb Mar Apr May Jun Jul Aug months Source: Oromiya Regional Health Bureau In Oromiya Region, TFP admissions in August were high in three woredas in Borena; eight in East Hararghe; three in Guji 3 woredas; West Arsi 3 woredas; and Arsi one woreda. Table 1: Admission of children with SAM into TPF sites – August 2011 Admissions Cure rate Death rate Reporting Rate CMR 7,116 92.2% 0.4% 83.6% U5MR 13,038 83.8% 0.3% 71.7% Tigray 396 77.1% 0.5% 24.7% Somali 1,726 87.5% 0.6% 65.8% Amhara 1,779 78.5% 0.3% 49.6% Total 24,055 86.9% 0.3% 66.3% Source: UNHCR At the beginning of July, UNICEF data generated from emergency-affected regions, determined that more than 437,7111 children were affected by various emergencies around the country and would not be able to resume schooling without the support of key actors in the education sector. With schools resuming this week, more updated figures will soon be available. Somali Refugee Situation According to UNHCR, as of 19 September 2011 the total number of Somali refugee population in the four Dollo Ado camps and in the transit center stands at 123,749. So far in September, the average number of new arrivals stands at 160. With a total population of 19,281, Hilowen camp will soon reach maximum capacity of 20,000 people. UNHCR and ARRA are working on opening a new camp, Biramino. The mortality rates in Dollo Ado camps remain a concern. The latest data from UNHCR indicate a significant improvement in Kobe with a reduction of CRM 2.1 per 10,000 day in week 36 to 1.1 per 1 Data compiled from reports received from Somali, Oromiya, Amhara, Tigray, Afar, Gambella, SNNPR. 3/10 10,000 in week 37. The under 5 mortality rate has also improved from 8.8 to 4.4 during the same period. In Hilowen camp, the rates deteriorated from 1.7 per 10,000 in week 36 to 1.9 in week 36. Table 2: CMR & U5MR – Week of 36 (12-18 September) Kobe Hilowen Bokolmayo Melkedida CMR 1.1 1.9 0.1 0.4 U5MR 4.4 6.5 0.2 0.6 Source: UNHCR The number of measles cases continues to decline with partners still waiting for the final decision of FMOH to launch a broad measles campaign to target adults up to 30 years of age. MSH-Holland reported that admissions to the Outpatient Therapeutic Programme (OTP) are still increasing in Hilowen. However, now that large convoys have stopped arriving from the transit center, this trend may decline. UNICEF conducted an initial rapid assessment on Infant and Young Child Feeding in Kobe, Melkedida, Bokolmayo and Hilowen. The assessment concluded that insufficient breast milk was the most common problem reported and that the community has long held traditional belief that hinders healthy infant feeding.