UNICEF Field Office NEZ Factors Influencing Persisted High Global Acute Malnutrition Among IDP Camps in Puntland Rapid Assessment of IDP settlements of Bosaso, Garowe, Galkayo and Gardo, April 2018 ABBREVIATIONS ANC antenatal Care ARI Acute Respiratory Infections AWD Acute Watery Diarrhea C4D Communication for Development CBO Community Based Organizations CHW Community Health workers EPI Expended Program on Immunization FCS Food Consumption Scores FSNAU Food Security and Nutrition Analysis Unit GAM global Acute Malnutrition HHS Household Hunger Scores IDPs Internally Displaced peoples IEC Information Education Communication ISDP Integrated Services for Displaced Persons IYCF Infant and Young Child Feeding MCHN Maternal and Child Health and Nutrition MDM Medicins De Monde MOH Ministry of Health MSF Medecins Sans Frontieres MUAC Mid Upper Arm circumference NGOs Non-Governmental Organizations NUWACO Nugal Water Company OPD Outpatient Department ORS Oral Rehydration Salt OTP Outpatient therapeutic Program I PNC Postnatal Care PSA Puntland Students Association RI Relief International RR Risk Ratio SAM Severe Acute malnutrition SC Stabilization Center SCI Copying Strategies Index SDRA Social Development and Research Association SIAs supplementary Immunization Activities SRCS Somali Red Crescent society TSFP Targeted Supplementary Feeding Program UNICEF: United Nations Children’s Fund WFP World Food Program WHO World Health Organization WVI World Vision II TABLE OF CONTENTS Table of Contents Abbreviations ............................................................................................................................................. I Table of Contents ..................................................................................................................................... III List of Tables ............................................................................................................................................ IV List of Figures ........................................................................................................................................... IV 1 Introduction .......................................................................................................................................... 1 1.1 Objectives ...................................................................................................................................... 1 2 Data Collection Methods ...................................................................................................................... 2 3 Main Findings and Results .................................................................................................................... 3 3.1 Somalia 2016 IYCN Study .............................................................................................................. 3 3.2 Rapid Assessment of the Bosaso IDPs........................................................................................... 4 3.2.1 Results of Recent Assessments Among Bosaso IDPs ............................................................ 4 3.2.2 Rapid Assessment Summary Findings Among Bosaso IDPs .................................................. 5 3.3 GALKAYO IDPs ............................................................................................................................. 11 3.3.1 Recent Nutrition Assessment Results Among Galkayo IDPs ............................................... 11 3.3.2 Nutrition Causal Analysis Among Galkayo IDPs (SAGE 2014) ............................................. 12 3.3.3 Summary Rapid Assessment findings among Galkayo IDPs ............................................... 12 3.4 Garowe IDPs ................................................................................................................................ 18 3.4.1 Recent Nutrition Assessment Results Among Garowe IDPs ............................................... 18 3.4.2 Summary Rapid Assessment Findings Among Garowe IDPs ............................................... 19 3.5 Gardo IDPs................................................................................................................................... 26 3.5.1 Recent Nutrition Assessment Results Among Gardo IDPs .................................................. 26 3.5.2 Nutrition Casual Analysis Among Gardo IDPs (SAGE 2014) ................................................ 27 3.5.3 Summary for the Rapid Assessment Among Gardo IDPs .................................................... 27 3.5.3.7 Social awareness activities ...................................................................................................... 29 4 conclusion. .......................................................................................................................................... 33 5 Recommendations. ............................................................................................................................. 34 6 References .......................................................................................................................................... 35 7 Annexes ............................................................................................................................................... 36 7.1 Annex I: Rapid Assessment Timelines ......................................................................................... 36 III 7.2 ANNEX II: Nutrition Situation Among Bosaso IDPs ..................................................................... 37 7.3 ANNEX III: Nutrition situation among Galkayo IDPs ................................................................... 38 7.4 Annex IV: Nutrition Situation among Garowe IDP Camps .......................................................... 39 7.5 Annex V: Nutrition Status Among gardo IDPs ............................................................................. 40 7.6 Annex VI: Casual analysis on morbidities among Galkayo and Qardo IDPs. ............................... 41 7.7 Annex VII: Casual analysis on health programs (Galkayo) ......................................................... 42 7.8 annex VIII: Casual Analysis on Water and Sanitation .................................................................. 42 7.9 ANNEX IX: Focus Group Discussions ........................................................................................... 43 7.10 ANNEX X: Key Informants/Observations Check list .................................................................... 45 LIST OF TABLES Table 1: Information Collected during Rapid Assessment among NE IDPs .................................................. 2 Table 2: Status of key IYCN Indicators .......................................................................................................... 3 Table 3: Information collected from Bosaso IDPs during the Rapid Assessment ......................................... 4 Table 4: Summary Responses of FGDs Among Bosaso IDPs during the Rapid Assessment ......................... 7 Table 5: Information collected from Galkayo IDPs during the Rapid Assessment ..................................... 11 Table 6: Summary Responses of FGDs Among Galkayo IDPs during the Rapid Assessment ..................... 14 Table 7:Information Collected from Garowe IDPs During the rapid Assessment ...................................... 18 Table 8: Summary Responses of FGDs Among Garowe IDPs during the Rapid Assessment ..................... 22 Table 9: Information collected from Gardo IDPs During the Rapid Assessment ........................................ 26 Table 10: Summary Responses of FGDs Among Gardo IDPs during the Rapid Assessment ....................... 29 LIST OF FIGURES Figure 1: GAM and SAM trends among Bosaso IDP Camps, 2012 -2017 ...................................................... 4 Figure 2: GAM and SAM trends among Galkayo IDPs, 2012 - 2017 ........................................................... 11 Figure 3: GAM and SAM trends among Garowe IDPs, 2012 to 2017 ......................................................... 18 Figure 4: Garowe OTP Admissions, Jan to Dec 2017................................................................................... 18 Figure 5: GAM and SAM trend among Gardo IDPs, 2012 to 2017 .............................................................. 26 IV 1 INTRODUCTION Internally displaced persons (IDPs) are among the most vulnerable groups with the highest global acute malnutrition (GAM). The alarming high rate of malnutrition among IDPs can be attributed to various complex set of factors and causes that may include: poor housing conditions, poor environmental sanitation, limited awareness on health, nutrition and sanitation issues, inadequate food intake, lack of access to adequate health services, lack of access to clean water, proper sanitation service, poverty, etc. According to a brief paper of Feinstein international center of Tufts University, USA, the prevalence rates of global acute malnutrition (GAM)regularly exceed the emergency threshold of >15 percent of children with acute malnutrition in many countries in emergency situation such as Somalia, despite ongoing humanitarian interventions1 IDPs in the NEZ of Somalia are among those groups with persisted critical acute malnutrition in recent years, where the GAM rate is mostly higher than the emergency threshold of 15 percent. Despite different humanitarian interventions on health, nutrition, food security and sanitation, there is no tangible improvement