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Cablegate: Usg Humanitarian Assistance Team: Health and Nutrition

VZCZCXYZ0000
OO RUEHWEB

DE RUEHDS #3642/01 3651225
ZNR UUUUU ZZH
O 311225Z DEC 07
FM AMEMBASSY ADDIS ABABA
TO RUEHC/SECSTATE WASHDC IMMEDIATE 8973
INFO RUEHAE/AMEMBASSY ASMARA 2031
RUEHDJ/AMEMBASSY DJIBOUTI 8826
RUEHNR/AMEMBASSY NAIROBI 3282
RUEHBS/AMEMBASSY BRUSSELS 3016
RUEHGV/USMISSION GENEVA 4083
RUEHLO/AMEMBASSY LONDON 2950
RUEHRO/AMEMBASSY ROME 6306
RUCNDT/USMISSION USUN NEW YORK 7139
RUEHC/DEPT OF INTERIOR WASHDC
RUEHRC/DEPT OF AGRICULTURE WASHDC
RHMFIUU/USCINCCENT MACDILL AFB FL//CCJ2/CCJ5/CCJS//
RHEFDIA/DIA WASHDC
RHMFISS/CJTF HOA
RHEHNSC/NSC WASHDC

UNCLAS ADDIS ABABA 003642

SIPDIS

AIDAC

SIPDIS

STATE DEPARTMENT FOR A/S FRAZER, DAS AF JSWAN, AF/E, AF/PDPA, OES,
A/S PRM SAUERBREY, AND PRM/AFR
AFR/AA KALMQUIST, WWARREN, JBORNS, KNELSON, CTHOMPSON
DCHA/AA MHESS, GGOTTLIEB
DCHA/OFDA KLUU, ACONVERY, CCHAN, PMORRIS, KCHANNELL
DCHA/FFP JDWORKEN, PMOHAN, SANTHONY, PBERTOLIN
LONDON, PARIS, ROME FOR AFRICA WATCHER
CJTF-HOA AND USCENTCOM FOR POLAD
USDA/FAS FOR U/S PENN, RTILSWORTH, AND LPANASUK
NAIROBI FOR OFDA/ECARO JMYER, GPLATT, RFFPO NCOX, USAID/EA
ROME FOR AMBASSADOR, OHA, HSPANOS
BRUSSELS FOR USEU PBROWN
GENEVA FOR NKYLOH, RMA
USUN FOR TMALY
NSC FOR PMARCHAN

E.O. 12958: N/A
TAGS: EAID PHUM SENV EAGR PGOV ET
SUBJECT: USG HUMANITARIAN ASSISTANCE TEAM: HEALTH AND NUTRITION
UPDATE


-------
SUMMARY
-------

1. Summary: Between December 20 and 26, the U.S. Government (USG)
Humanitarian Assistance Team (HAT) in Ethiopia health and nutrition
specialist met with representatives from the U.N., the Government of
the Federal Democratic Republic of Ethiopia (GFDRE), and
non-governmental organizations (NGOs) in Addis Ababa to discuss
health and nutrition conditions in Somali Region. The current
crisis in Somali Region is taking place against the backdrop of
chronically high levels of acute malnutrition and food insecurity.
The lack of information and comprehensive and reliable health and
nutrition data for the region in 2007 complicates efforts to
determine the severity and magnitude of reports of deteriorating
humanitarian conditions. However, evidence of reduced access and
delivery of essential health services, low measles vaccination
coverage rates, and reports of acute watery diarrhea, particularly
in the conflict-affected zones, are of significant concern. In the
coming weeks, the USG HAT will continue to conduct field visits in
Somali Region to assess and verify information collected from
interviews in Addis Ababa and inform appropriate response efforts.
End summary.

----------
BACKGROUND
----------

2. Cyclical droughts, exacerbated by a rapidly growing population,
endemic poverty, and limited government capacity have resulted in
chronically high levels of acute malnutrition, food insecurity, and
water shortages across Ethiopia, particularly in Somali Region. In
2000 and 2005, the Ministry of Health (MOH) national Ethiopia
Demographic and Health Survey indicated global acute malnutrition
(GAM) rates above the emergency threshold of 15 percent in Somali
Region, at 15.8 percent and 23.7 percent, respectively.

3. According to humanitarian agencies operating in Somali Region,
military operations by the Ethiopian National Defense Forces (ENDF),
as well as insurgent operations by the Ogaden National Liberation
Front (ONLF), have disrupted trade networks, caused delays in food
assistance, and restricted the movement of people and livestock in
Somali Region, leading to increased food insecurity for vulnerable
populations and reports of deteriorating humanitarian conditions.
The November 24 to December 14 GFDRE Disaster Prevention and
Preparedness Agency (DPPA) Deyr/Karan Assessment identified more
than 1.6 million people facing survival and livelihood protection
deficits, including an estimated 730,000 people in need of immediate
food assistance in Somali Region. However, the availability of
comprehensive and reliable health and nutrition for Somali Region is
extremely limited.

---------
NUTRITION
---------

4. The availability of nutrition data for Somali Region in 2007,
particularly in the conflict-affected areas of the five zones under
military operations, is extremely limited and controversial. The

October Save the Children/U.K. (SC/UK) survey in Fik and Hamero
districts, Fik Zone, and the DPPA-led joint DPPA/U.N. rapid
assessment in Fik and Korahe zones conducted from November 29 to
December 4 represent the only nutrition studies conducted in
conflict-affected areas in 2007. However, there is consensus that
nutrition indicators will decline in Somali Region with the onset of
the jilal dry season from January to April, typically associated
with increased malnutrition and exacerbated by the poor performance
of the 2007 gu and deyr rains.

5. The SC/UK nutrition survey indicated GAM rates of 20.8 percent,
exceeding the emergency threshold of 15 percent. The DPPA has
challenged the validity of the results and raised concerns that the
report was not appropriately approved by GDFRE agencies before being
released. The DPPA expressed concerns regarding the selection of
samples areas and the accuracy of GAM and SAM rates as malnutrition
indicators in the Somali Region due to variability in body shape,
suggesting that measures of upper arm circumference (MUAC) were more
appropriate. However, the DPPA also acknowledged that the SC/UK
reported malnutrition rates are not unusual for the Somali Region
due to chronically high levels of acute malnutrition. SC/UK denies
that it failed to follow outlined procedures. In addition, review
of the report by the USG HAT health and nutrition specialist
indicates that SC/UK used standard methodologies typically employed
in Ethiopia. However, DPPA's concerns regarding how areas were
selected cannot be assessed.

6. In response to the October SC/UK survey, the DPPA led a joint
DPPA/U.N. rapid assessment in Fik and Korahe zones in coordination
with the U.N. Children's Fund (UNICEF), the U.N. World Health
Organization (WHO), and the U.N. Office for the Coordination of
Humanitarian Affairs (OCHA). Preliminary results for Fik Zone
conflict with the SC/UK report, finding no evidence of a nutrition
emergency. As a result, DPPA has rejected a planned SC/UK nutrition
program in the area and unofficially stated that no immediate
interventions are required beyond recommendations outlined in the
DPPA Deyr/Karan Assessment. However, the USG HAT health and
nutrition specialist notes that a rapid assessment is not an
appropriate tool to discredit or confirm the results of a nutrition
study.

7. UNICEF has raised serious concerns regarding the objectivity,
methodology, and implementation of the rapid assessment. UNICEF
highlighted that the assessment included only 30 percent of agreed
upon sample areas and that the GFDRE did not permit U.N. staff to
accompany the DPPA to rural areas in Korahe Zone. In addition, the
assessment did not include the standardized assessment focus group
component in Fik Zone. As a result, the assessment did not adhere
to agreed upon parameters, employ standardized methodologies, or
reflect a truly joint assessment, significantly undermining the
validity of the results. The U.N. is holding internal meetings to
determine how best to address these concerns and has not yet
publicly commented on the assessment results.

-------
MEASLES
-------

8. In the context of existing levels of critical malnutrition,

evidence of a low coverage rate for measles vaccinations in the
conflict-affected areas of Somali Region has raised significant
concerns regarding a potential measles outbreak and its impact on
vulnerable populations.

9. In Ethiopia, mechanisms for measles vaccination delivery include
annualized routine immunization through health facilities, the
bi-annual national measles campaign, and the national Enhanced
Outreach Strategy (EOS), which provides high impact child survival
interventions, including nutrition screening, vitamin A
supplementation, de-worming, as well as measles vaccinations. In
addition, targeted localized NGO programs operate in some areas. In
Somali Region, the MOH reported an annualized routine immunization
rate of 14.7 percent in 2006, with lower rates reported in the
conflict-affected zones, including 0 percent in Korahe, 4.7 percent
in Fik, 4.4 percent in Gode, 3.9 percent in Degehabur, and 0 percent
in Warder. There is limited data available on measles coverage in
Somali Region for 2007. However, the October SC/UK nutrition survey
reported measles coverage of 14.7 percent in Fik and Hamero
districts in Fik Zone. According to UNICEF and NGOs operating in
the region, no EOS intervention or measles campaigns occurred in
2007 in Somali Region. The low annualized coverage rates combined
with the absence of a national campaign and EOS interventions in the
region in 2007 suggest significantly low measles vaccination
coverage. (Note: The next national campaign is scheduled for 2008.
End note.)

10. To date in 2007, there have been no reports of a measles
outbreak in Somali Region, although sporadic cases have been
reported. In August 2007, Medecins Sans Frontieres/Belgium reported
treating two cases of measles in Cherti District, Afder Zone.

---------------------
ACUTE WATERY DIARRHEA
---------------------

11. Although restricted access has limited the available data on
acute watery diarrhea (AWD) in Somali Region, humanitarian agencies
have reported unconfirmed cases of AWD in Fik and Degehabur zones.
The DPPA Deyr/Karan assessment noted the presence of AWD in
Degehamedo District, Degehabur Zone, and Segeg and Fik districts,
Fik Zone. Since November, community level reports indicate that AWD
is spreading into rural areas. However, exact numbers of AWD cases
are unavailable as a result of the inability of the Regional Health
Bureau to access affected areas. WHO also reported a suspected AWD
outbreak in Degehamedo District beginning December 1. In addition,
the SC/UK October nutrition survey identified AWD as the leading
cause of mortality in Fik and Hamaedo districts, Fik Zone.

----------------------------------
REDUCED HEALTH ACCESS AND DELIVERY
----------------------------------

12. Despite reports of improved NGO access in some areas, ongoing
military operations in Somali Region continue to significantly
disrupt the delivery of essential health services, restrict
humanitarian access, and delay emergency response efforts.
Insecurity and reduced access have negatively affected existing
health infrastructure and capacity. Across the conflict-affected

areas, humanitarian agencies report a decrease in the number of
functioning health facilities as a result of a reduction in staff
associated with displacement from the conflict.

13. Emergency response efforts have been similarly hindered. The
deployment of USAID Office of U.S. Foreign Disaster Assistance
(USAID/OFDA)-funded UNICEF mobile health, nutrition, water,
sanitation, and hygiene teams continues to be delayed in Somali
Region. Out of a total of 15 teams, only 5 teams had received
military clearance to operate outside of conflict-affected areas in
Gode Zone as of December 27, according to UNICEF.

14. In addition, UNICEF reports that 17 districts in the
conflict-affected zones of Somali Region targeted to receive EOS
services in 2007 have not yet received military clearance to begin
operations. In 2006, EOS interventions served 21 districts within
the five zones under military operations.

15. In response to UNICEF's inability to provide health services to
populations in the conflict-affected areas of Somali Region through
traditional EOS and emergency mobile teams due to military
restrictions, UNICEF, in coordination with the Regional Health
Bureau, initiated a medical health facility restocking program to
improve the availability of medical supplies in affected areas.
Since September, UNICEF has been able to deliver supplies to ten
main targeted health facilities. However, only 14 out of 41
satellite health facilities had received supplies as of December
20.

-----------------------
COMMENTS AND CONLCUSION
-----------------------

16. To address concerns surrounding the limited availability of
health and nutrition data, low measles vaccination coverage rates,
and reports of AWD, particularly in the conflict-affected zones,
increased health and nutrition interventions and targeted surveys of
areas of concern are recommended. Particularly given jilal concerns
of worsening malnutrition rates, the distribution of food assistance
and treatment interventions for underlying causes of malnutrition,
including diarrheal diseases such as AWD, and improved measles
vaccination coverage is critical. In FY 2007 and to date in FY
2008, USAID has provided affected populations in Somali Region with
nearly $39.5 million in emergency nutrition, health, agriculture,
food security, logistics, food assistance and humanitarian
coordination interventions. In the coming weeks, the USG HAT will
continue to conduct field visits in Somali Region to assess the
humanitarian situation and verify information collected from U.N.,
NGO and government partners in Addis Ababa. End comment.

YAMAMOTO

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