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Cablegate: Usg Humanitarian Assistance Team: Health and Nutrition

VZCZCXYZ0001
OO RUEHWEB

DE RUEHDS #0053/01 0090514
ZNR UUUUU ZZH
O 090514Z JAN 08
FM AMEMBASSY ADDIS ABABA
TO RUEHC/SECSTATE WASHDC IMMEDIATE 9054
INFO RUEHAE/AMEMBASSY ASMARA 2047
RUEHDJ/AMEMBASSY DJIBOUTI 8844
RUEHNR/AMEMBASSY NAIROBI 3300
RUEHBS/AMEMBASSY BRUSSELS 3029
RUEHGV/USMISSION GENEVA 4101
RUEHLO/AMEMBASSY LONDON 2963
RUEHRO/AMEMBASSY ROME 6320
RUCNDT/USMISSION USUN NEW YORK 7159
RUEHC/DEPT OF INTERIOR WASHDC
RUEHRC/DEPT OF AGRICULTURE WASHDC
RHMFIUU/HQ USCENTCOM MACDILL AFB FL//CCJ2/CCJ5/CCJS//
RHEFDIA/DIA WASHDC
RHMFISS/CJTF HOA
RHEHNSC/NSC WASHDC

UNCLAS ADDIS ABABA 000053

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

SENSITIVE
SIPDIS

E.O. 12958: N/A
TAGS: EAID PHUM SENV EAGR PGOV ET
REF: A) ADDIS ABABA 3642
SUBJECT: USG HUMANITARIAN ASSISTANCE TEAM: HEALTH AND NUTRITION
UPDATE #2


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

1. (U) Summary: Between December 27 and 30, the U.S. Government
(USG) Humanitarian Assistance Team (HAT) in Ethiopia health and
nutrition specialist traveled to Jijiga and Degehabur zones in
Somali Region as part of an initial field visit to assess
humanitarian conditions and evaluate preliminary health and
nutrition reports collected in Addis Ababa. USG HAT staff met with
representatives from the U.N., the Government of the Federal
Democratic Republic of Ethiopia (GFDRE), and non-governmental
organizations (NGOs) operating in Jijiga and Degehabur zones.

2. (U) The absence of reliable health and nutrition data for Somali
Region extends to Degehabur Zone, where no population-based data is
available for 2007, complicating efforts to determine the severity
and magnitude of reports of deteriorating humanitarian conditions.
USG HAT staff report that despite the recent reopening of several
health posts along the main road in Degehabur District since
mid-December, the capacity of health facilities remains low due to
lack of essential medical supplies. In addition, reduced access to
remote areas in Degehabur District and surrounding districts in
Degehabur Zone continues to undermine health service delivery and
humanitarian response efforts. According to USG HAT staff, low
measles coverage and the anticipated increase in the prevalence of
acute malnutrition with the onset of the jilal dry season from
January to April are of significant concern. The focus of
information gathered from the December 27 to 30 field visit is
specific to Degehabur zone and does not necessarily reflect
conditions in other conflict-affected areas of Somali Region. End
summary.

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

3. (SBU) Since June 2007, the combined effect of the loss of health
staff due to conflict and the decreased availability of medical
supplies due to restrictions on movement has negatively affected the
capacity of existing health facilities to provide adequate care in
conflict-affected areas of Somali Region, according to the head of
the Somali Regional Health Bureau (RHB). In addition, health post
closures have undermined health service delivery. The most affected
health facilities are health posts, which typically serve remote
populations, in particular in Degehabur and Fik zones, according to
the RHB.

4. (U) USG HAT staff visited several health posts previously closed
during the conflict that have reopened since mid-December along the
main road between Jijiga and Degehabur and points further south.
However, USG HAT staff report that these posts lack medical supplies
and are staffed by primary health workers with limited training.
The only supplies available are essential drugs provided by the U.N.
Children's Fund (UNICEF). Drugs provided by the GFDRE RHB in July
2007 do not appear to have reached health post destinations,
although USG HAT staff note that it is unclear whether this is due
to poor management and tracking procedures or failed deliveries.

5. (SBU) In addition, USG HAT staff received reports of military
closures and destruction of health facilities in Degehabur District.
In one of the villages visited by USG HAT staff village, health
care staff reported that the health post reopened on December 26,
following seven months of military occupation. However, staff
reported that one room of the two-room facility continues to be
utilized by the military. In a nearby village, health staff
reported that the health post reopened in mid-Decemebr, following
six months of military closure. Health staff reported that their
previous health post along the Degehabur/Degehamedo road had been
closed by the military and subsequently burned along with the
village. USG HAT staff were not able to access this area and unable
to directly confirm the report.

6. (U) Emergency response efforts have also encountered access
restrictions and a lack of clarity regarding bureaucratic procedures
for approval to operate in conflict-affected areas. Medecins Sans
Frontieres/Greece (MSF/Greece) reported that it has taken nearly two
months to receive approval to establish a base in Degehabur
District. However, as of December 29, MSF/Greece remains restricted
to Degehabur town and has not received military approval to access
more remote areas, despite verbal approval from the zonal and
district administrators.

7. (SBU) Required military escorts for vehicles delivering drugs in
conflict-affected areas is delaying the deployment of USAID Office
of U.S. Foreign Disaster Assistance (USAID/OFDA)-funded UNICEF
mobile health, nutrition, and water, sanitation, and hygiene (WASH)
teams in conflict-affected areas of Somali Region. The RHB will
currently not accept a military escort for mobile teams due to
concerns of compromising RHB neutrality. In addition, UNICEF
reported that mobile teams operating in the conflict-affected areas
are now required to submit staff clan affiliations to the GFDRE
Office of the Somali Regional President for review and that approval
is currently pending. Furthermore, UNICEF reports that even if
clearances and issues of military escort are resolved at the
regional level, it is concerned that the process will have to be
repeated at the zonal and district levels.

8. (U) Since September 2007, UNICEF, in coordination with the RHB,
has provided emergency supplies of essential drugs to ten main
targeted health facilities in Somali Region, including the district
hospital in Degehabur Zone. As of December 30, only 24 out of 41
satellite health facilities had received supplies in Somali Region.
UNICEF also reported that many of the satellite health facilities
have not received complete shipments. USG HAT staff confirmed that
health posts in Hurale, Garowe, and Obale villages, Degehabur
District, had received incomplete shipments of UNICEF's emergency
supply of essential drugs.

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

9. (U) The absence of reliable health and nutrition data for Somali
Region extends to Degehabur Zone, where no population-based data is
available for 2007. However, the USG HAT received reports of acute
malnutrition from MSF/Greece operating in Degehabur District, but
cautioned that the information is incomplete and cannot be

generalized for the local population. In mid-December, MSF/Greece
initiated a nutrition screening of children accessing Degehabur
hospital in Degehabur town. As a result, MSF/Greece has admitted 56
patients to a community-based therapeutic care (CTC) program,
including 11 identified with severe acute malnutrition. However,
due to MSF/Greece's inability to provide baseline data, the utility
of this information is limited. In addition, the information only
reflects children accessing the district hospital.

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

10. (U) USG HAT staff note evidence of low measles coverage in
Degehabur Zone, including a 2006 annualized routine immunization
rate of 3.9 percent and limited local health infrastructure
capacity. The Degehabur District hospital is the only health
facility in Degehabur Zone currently providing annualized routine
immunizations. In the context of chronically high levels of acute
malnutrition and an anticipated increase in existing acute
malnutrition levels with the onset of the jilal dry season from
January to April, low coverage has raised concerns for a potential
measles outbreak and its impact on vulnerable populations.

11. (U) According to the Somali RHB, there have been no reports of
suspected measles cases in Degehabur Zone in 2007, and the Acting
Director of the Degehabur District hospital reports no suspected
measles cases from July to December. However, in neighboring Warder
Zone, the RHB reported six suspected measles cases in Warder town
during the week of December 2. The RHB is working with MSF-Holland
to conduct a measles vaccination campaign in Warder town. Blood
samples are currently being tested.

12. (U) USG HAT staff note inconsistent reports regarding the next
measles campaign which, according to UNICEF, is scheduled for the
end of 2008 or early 2009 in the Somali Region. However, the RHB
reports that a measles campaign has not been scheduled. Given
current concerns regarding a potential outbreak, UNICEF is exploring
the possibility of initiating a measles campaign in January or
February 2008 in Somali Region.

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

13. (U) USG HAT staff were unable to access Degahamedo District to
evaluate GFDRE Disaster Prevention and Preparedness Agency (DPPA)
and U.N. World Health Organization (WHO) reports of unconfirmed
cases of acute watery diarrhea, due to security concerns voiced by
the Degehabur zonal administrator.

----------------------------
RECCOMENDATIONS AND COMMENTS
----------------------------

14. (U) To address the increased concerns regarding a potential
measles outbreak in Somali Region, USG HAT staff recommend emergency
health interventions focused on increasing measles coverage. Due to
restricted humanitarian access, an opportunistic measles vaccination

strategy should be developed to maximize measles coverage. This
includes linking measles vaccination with other planned activities,
such as the Enhanced Outreach Strategy (EOS) and UNICEF mobile,
health, nutrition, and WASH teams and coordinating with scheduled
food distributions in order to maximize coverage

15. (U) Until nutrition surveys can be conducted in the
conflict-affected areas of Somali Region to better guide
intervention strategies, collecting screening data should be an
integral part of emergency interventions. This information can then
be used to better identify vulnerable populations.

16. (U) In the coming weeks, the USG HAT will continue to conduct
assessment visits in Somali Region to develop an improved
understanding of humanitarian conditions and inform appropriate
response efforts. End comment.


YAMAMOTO

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