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Cablegate: Serious Impacts of Failed Belg Rains in Ethiopia

O 070627Z JUL 08
FM AMEMBASSY ADDIS ABABA
TO SECSTATE WASHDC IMMEDIATE 1185
INFO AMEMBASSY ASMARA
AMEMBASSY DJIBOUTI
AMEMBASSY NAIROBI
AMEMBASSY BRUSSELS
USMISSION GENEVA
AMEMBASSY LONDON
AMEMBASSY ROME
USMISSION USUN NEW YORK
DEPT OF INTERIOR WASHDC
DEPT OF AGRICULTURE WASHDC
HQ USCENTCOM MACDILL AFB FL
DIA WASHDC
CJTF HOA
NSC WASHDC

UNCLAS ADDIS ABABA 001823

STATE DEPARTMENT FOR DAS AF JSWAN, AF/E, AF/PDPA, OES, AND PRM/AFR
AFR/AA EGAST, CTHOMPSON
DCHA/AA MHESS, GGOTTLIEB
DCHA/OFDA KLUU AND RMT HORN
DCHA/FFP JDWORKEN, PMOHAN, 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
ROME FOR FODAG
BRUSSELS FOR USEU PBROWN
GENEVA FOR NKYLOH, RMA
NSC FOR PMARCHAN

E.O. 12958: N/A
TAGS: EAID PHUM SENV EAGR PGOV ET
SUBJECT: SERIOUS IMPACTS OF FAILED BELG RAINS IN ETHIOPIA
SUBJECT: ETHIOPIA - USG/HAT - THE 'GREEN FAMINE' IN SNNPR

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

1. There is a 'green famine' in Southern Nations, Nationalities and
Peoples Region (SNNPR) as the U.S. Government Humanitarian
Assistance Team (USG/HAT) observed during their recent field trips
in Wolyata and Gurage zones in late June. Nutrition programs are
overwhelmed with patients in the absence of other food aid programs
such as general rations and supplementary feeding for the moderately
malnourished. USAID Office of U.S. Foreign Disaster Assistance
(USAID/OFDA) partners are battling malnutrition through the network
of health centers and health posts that manage community based
therapeutic programs. More resources will be added to boost their
ability to deal with the thousands of children in dire
circumstances. On a positive note, safety net beneficiaries seem to
be withstanding the onslaught of the drought so far, but rising food
prices will eat away at their safety net payments and could soon
leave them destitute as well. Overall prospects for recovery are
grim as populations draw down on precious assets, including seeds
and livestock, in order to survive. End Summary.

-----------------
A 'GREEN' FAMINE
-----------------

2. Rains have begun in SNNPR. The land is green and lush as grass
sprouts, trees flourish, flowers bloom, and small maize plants poke
their heads through the earth. Scrawny oxen plod slowly but steadily
through fields, turning the earth for the planting of teff, barley
and other long season Meher crops. But the green is deceptive. The
maize will not be harvested until at least August or September as
'green maize' according to local farmers. Bean plants now emerging
from the earth will be harvested 3 months from now. Pepper, the
local cash crop grown in some areas of Guraghe, will also be
harvested later in the year. The main crops of barley and teff will
be harvQd as late as November and beyond. Inside the homes there
is no food, and at the health posts visited recently by USG HAT
staff, starving children crowded to pick up weekly rations of Ready
to Use Therapeutic Food (RUTF) such as plumpy nut, BP 100 (high
energy) biscuits and, in some rare cases, supplementary corn soya
blend (CSB) and oil. This is a 'green famine.'

-----------------------------------------
NUTRITION CRISIS TESTS RESPONDER CAPACITY
-----------------------------------------

3. USG HAT officers visited four USAID/OFDA-funded emergency
nutrition programs in the Wolayta and Gurage zones of SNNPR over the
period June 22 - 24 to monitor performance of partners and identify
additional problems and gaps in program implementation. NGOs
implementing programs in this area include GOAL, CONCERN,
International Medical Corps (IMC), and Samaritan's Purse (SP).
During the period June 18-19, USG HAT officers also traveled to
Boricha in Sidama zone SNNPR to monitor the GOAL community based
therapeutic care (CTC) program and to visit the operation managed by
MSF/Belgium (not OFDA-funded) in Shashamene (Oromiya region).

4. NGOs are following the national nutrition guidelines, which
prescribe a decentralized model of outpatient therapeutic centers
based out of health centers and health posts, and a reference
stabilization center for therapeutic cases with medical
complications -- usually located at the health center. Often,
Outpatient Therapeutic Programs (OTPs) are also located at the
health center. Partners IMC and CONCERN have been working closely
with the Ministry of Health (MOH) over the last few years to build
capacity in these community-managed nutrition programs, but this
year is the first real test of the effectiveness of this
decentralized, government-led strategy.

5. From the beginning, there have been problems in undertaking
sufficient rapid assessments to gain a clear picture of the extent
of the nutritional crisis. There is disagreement over the number of
children requiring therapeutic feeding, with the official number put
at 75,000. Real numbers may be much more, based on trends noted in
areas that are accessible, but this has not been verified by
assessment. In the areas visited by USG HAT, MOH staff were
managing both stabilization centers (SC) and OTP sites, but with
varying degrees of efficiency.

--------------------------------------------- -------
NUTRITION PROGRAMS GEARING UP - BUT SOME ARE OVERWHELMED BY THE
NUMBERS IN NEED
--------------------------------------------- -------

6. The IMC site at Bolossosore was clearly overwhelmed by the
caseload. There were about 189 children waiting for their weekly
ration of RUTF at the health center, while another 200 or so
children waited to be screened. At least half of those were
obviously severely malnourished, many with stage 3 oedemas. IMC has
not been able to set up stabilization centers in this area due, they
said, to lack of resources for staffing and supplies. Without a
stabilization center, any cases with complications were advised to
go to the nearest hospital run by the Catholic Church. However most
mothers declined to go because they did not have the money to pay
and IMC did not yet have a memorandum of understanding to pay for
the medical bills incurred by their patients. USAID/OFDA has agreed
to provide an additional USD 500,000 immediately to IMC to address
these problems in all IMC project sites.

8. CONCERN, with OFDA funding, has been working intensively on
enabling the Ministry of Health to handle such crises. The OTP and
stabilization center sites visited in Mareko woreda (Koshe town) in
Gurage zone were not congested. The team was in place and dealt
with each child as it arrived at the center, thereby avoiding a
crush of patients. CONCERN however has noted that some centers
cannot handle the caseloads and are ramping up their support to
train and supervise more health workers and more OTP sites. CONCERN
had a vehicle permanently at the health center visited to assist
with any evacuations to hospital from the stabilization center. An
agreement with the hospital ensures that referred cases are admitted
immediately and treated. CONCERN has resources to provide food for
caretakers, and this is a critical aspect of the program that
supports stabilization. Otherwise, mothers will not stay with their
children. USAID/OFDA is providing an additional USD 1.5 million to
CONCERN to support the expansion of emergency nutrition
interventions.

9. Samaritan's Purse (SP) is implementing CTC as a sub-grant of the
OFDA-funded rapid response fund to Irish GOAL. SP has opened CTC
services in KindoKoisha and Aleba Special Woreda which have been
identified as Priority One hot spots by the UN and government. SP
staff explained that one of the key challenges has been to identify
trained MoH staff who can open new OTPs in their areas of operation,
in order to reduce the distances walked by mothers to get services
and to ensure greater efficiency of the program. SP's program in
neighboring Aleba Special Woreda was visited by USG HAT staff in
previous weeks and was found to be running smoothly, although with
hundreds of children being served from just one OTP site.


10. USG HAT visited CTC programs run by Irish-GOAL (funded through
the USAID/OFDA rapid response grant) in Boricha woreda, Sidama zone
on June 18 and the Damot Fulassa woreda, Wolayta zone on June 23.
Between March 24 and June 18, the CTC in Boricha had 2,261 children.
One of the stabilization centers had handled 350 cases since April.
There were twenty-five patients at the time of the USG HAT visit.
Health extension workers and community health volunteers are an
integral part of the GOAL program, providing essential support for
weighing and measuring children, as well as outreach in the
communities.

11. GOAL's program in new woreda Damot Fulassa of Wolyata zone
covers 23 kebeles with eight OTPs. The program has already treated
2,095 patients in all the OTP sites since it opened in April. On
June 23, 1,308 were registered. At the time of the visit, there
were only eight patients in the stabilization center. Patients
questioned were not in the safety net program, but had been screened
for the targeted supplementary feeding program (EOS/TSF) as well as
for a Red Cross targeted feeding program that began in June,
assisting 8,000 families. These two programs should have an
immediate impact on the condition of children in the area. GOAL
provides transport for cases being referred to stabilization or
hospital and supports the hospitals with essential drugs so that
there is no question about accepting the nutritional cases. GOAL
also provides a food ration to caretakers to ensure that mothers
stay at the stabilization center with their children.

--------------------------------
Launch of Supplementary Feeding
--------------------------------

12. Until now, the lack of supplementary feeding for children under
five years of age in most programs has been an accelerating factor
in the number of serious cases of severe acute malnutrition. The
Enhanced Outreach Strategy (EOS)/TSF program administered by WFP has
been sharply criticized since its inception because of delays of up
to six months between the time children are screened for
malnutrition and when the rations arrive to address their condition.
WFP has been working hard with the government counterparts to
remedy the situation, conducting screening in April/May, with
distributions of EOS underway in June. However, a cutback in WFP's
funding for the EOS program has meant that the number of woredas
served has been severely reduced. Now, there are caseloads in only
32 woredas, instead of over 50 previously served by the EOS in
SNNPR. NGOs working in areas where EOS was being carried out are
urged to link up with WFP and the regional DPPA, in order to ensure
that OTP graduates are taken up into the EOS program where possible.


13. In addition to the ongoing EOS, WFP is launching blanket
supplementary feeding for under 5's in SNNPR as part of the general
relief ration distribution planned from June onwards. NGOs are also
purchasing FAMEX (locally made CSB) to distribute to caretakers at
the stabilization centers, to provide take home rations for OTP
beneficiaries, and to provide supplementary feeding for graduates
who are not taken into the EOS. With this multitude of channels of
CSB now being lined up for SNNPR, it is inevitable that some
beneficiaries will be on two or more distributions of CSB. However,
the nutrition coordination unit at DPPA, as well as WFP, have
pointed out that the situation is so critical that a double ration
to one family is not a matter of concern right now. The objective
is to get CSB into communities to bring down the escalating
malnutrition levels. Given rising rates of malnutrition among the
over 5 population and even adults, there is simply a need for more
food in the system. The demand for CSB in the various programs is
also driving up the price. WFP reported that prices for FAMEX in
Addis now range between $783 to $836/MT, up from $433/MT in January
2008.

----------------------------------------
Safety Net and Relief Food Distributions
----------------------------------------

14. The final element of the nutrition package, the general ration,
is being worked on by DPPA, WFP, the World Bank, with active
participation in meetings by USAID. SNNPR is typically a cash
woreda for safety net activities, but the severity of the crisis,
exacerbated by inflation of food prices of up to 600 percent, has
meant that the cash payments are no longer sufficient to meet the
minimum food requirements of families. The current strategy for
safety net beneficiaries is to continue to provide the cash payment
for the next two cycles (fifth and six 'round' of payments), but to
add a two month cereal ration as well. For those put onto relief
rolls in SNNPR, distributions should begin in June and include a
full ration with CSB for children under five years of age.

15. There is a proposed NGO Joint Emergency Operation (JEOP) in the
works with the Office of Food for Peace. Twenty-two of the proposed
woredas are in the SNNPR hot spot areas including Wolayta. The
proposal is for a full ration for about 1.76 million in hot spot
woredas in SNNPR, Oromiya and Somali Regions and now includes CSB
for blanket supplementary feeding. It will be critical to
coordinate this possible JEOP with the CTC and OTP efforts.

-------------
Looking Ahead
--------------

16. SNNPR is only one region that is in the middle of a major crisis
that is only likely to get worse, despite heroic efforts by the UN
and NGOs, supported by donors, to ramp up the food aid and nutrition
programs. The gap in available food to address the crisis in
Ethiopia generally means that difficult choices are being made as to
who gets food and who does not. Priority One woredas will be
targeted first, and, in subsequent months, priority 2 relief
beneficiaries will receive food. No one believes sufficient food is
flowing into the drought affected areas to stop the downward spiral,
but there is hope that efficient food deliveries could start to slow
down the admissions to therapeutic feeding. T he coming months will
be telling in this regard and USG HAT will continue to monitor and
advocate for improved coordination and efficiency within and across
in all programs.

17. The prospects for recovery from this crisis are very worrying.
Households are borrowing heavily, selling cattle and household
assets, and eating the precious seeds they need to plant for the
current agriculture season. An army worm invasion is spreading
throughout many agricultural zones and pesticides are not available
in sufficient quantity to destroy them. Despite the rainfall
pounding the earth, and the maize and bean plants emerging from the
earth, the overall livelihood prospect for the population of SNNPR
in coming months is dire.


YAMAMOTO

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