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Cablegate: Nutrition and Health Conditions in Somalia Require Urgent

VZCZCXRO0270
RR RUEHRN RUEHROV RUEHTRO
DE RUEHNR #0326/01 0410832
ZNR UUUUU ZZH
R 100830Z FEB 10
FM AMEMBASSY NAIROBI
TO RUEHC/SECSTATE WASHDC 0790
INFO SOMALIA COLLECTIVE
RHEHNSC/WHITE HOUSE NATIONAL SECURITY COUNCIL WASHINGTON DC
RHMFISS/CJTF HOA
RHMFIUU/CDR USCENTCOM MACDILL AFB FL
RUEHRN/USMISSION UN ROME 0019

UNCLAS SECTION 01 OF 05 NAIROBI 000326

AIDAC
SIPDIS
USAID/DCHA FOR SRIECHLE
JBRAUSE
DCHA/OFDA FOR ACONVERY
KCHANNELL
APIYAKA
DCHA/FFP FOR BISHAM
JDWORKEN
SANTHONY
CMUTAMBA
PMOHAN
DNELSON
AFR/EA
STATE FOR AF/E
AF/F AND PRM
USUN FOR DMERCADO
BRUSSELS FOR PBROWN
GENEVA FOR NKYLOH
ROME FOR HSPANOS

E.O. 12958: N/A
TAGS: EAID PHUM PREL PREF SO
SUBJECT: NUTRITION AND HEALTH CONDITIONS IN SOMALIA REQUIRE URGENT
HUMANITARIAN RESPONSE

REF: NAIROBI 0224

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SUMMARY
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1. (U) Humanitarian agencies continue to express
concern over the health and nutrition conditions in
Somalia, noting that a humanitarian response focused
primarily on food assistance is not enough to mitigate a
humanitarian crisis in Somalia. A recent U.N. Food and
Agriculture Organization (FAO) Food Security and
Nutrition Analysis Unit (FSNAU) presentation indicates
that malnutrition and mortality rates in Somalia are
among the highest in the world. Augmented and sustained
support for programs designed to increase access to safe
drinking water, educate women on proper weaning and
feeding practices, provide emergency nutrition
supplements for children with severe acute malnutrition,
provide proper sanitation facilities, and improve access
and quality of healthcare are critical to preventing
increased malnutrition and mortality rates over the next
six months.

2. (SBU) The USAID Office of U.S. Foreign Disaster
Assistance (USAID/OFDA) continues to monitor nutrition
and health conditions in Somalia and maintains a robust
network of U.N. and non-governmental organization (NGO)
partners capable of providing life-saving assistance in
Somalia. However, USAID/OFDA cannot implement an
adequate humanitarian response under current U.S.
Department of Treasury Office of Foreign Asset Control
(OFAC)-related legal restrictions. Emergency food
assistance from the USAID Office of Food for Peace
(USAID/FFP) is a critical component of the humanitarian
response in Somalia, but its effectiveness depends on
sustained support to complementary non-food assistance,
including health, nutrition, water, sanitation, and
hygiene programs. Without crucial non-food assistance,
food assistance alone can not assist communities with
the process of early recovery. End summary.

------------------------------
CURRENT HUMANITARIAN SITUATION
------------------------------

3. (U) On January 29, FSNAU reported that an estimated
3.2 million people will require humanitarian assistance
in Somalia between January and June 2010, representing
approximately 42 percent of the total estimated
population of 7.5 million people and a nine percent
decrease since July 2009 (Ref A). Conflict and
resulting population displacement could offset food
security improvements resulting from an above-normal
harvest in south Somalia. In addition, targeted attacks
against relief staff have resulted in activity
suspension and diminishing access, hindering the
provision of humanitarian assistance to populations in
need. An estimated 1.39 million internally displaced
persons (IDPs) remain the largest single population
group in crisis, representing 44 percent of the 3.2
million people in need of humanitarian assistance in
Somalia, with insecurity continuing to be the primary
cause for displacement.

NAIROBI 00000326 002 OF 005


4. (U) On January 5, the U.N. World Food Program (WFP)
announced an indefinite closure of six offices in
southern Somalia, citing escalating insecurity, attacks
against aid workers, humanitarian staff abductions, and
unacceptable demands from al-Shabaab as obstacles to the
provision of emergency food assistance. WFP plans to
continue working throughout the rest of the country,
including in Mogadishu and the Afgoye corridor, where
the organization provides food assistance to
approximately 1.8 million people.

5. (U) Humanitarian agencies note that escalating
conflict and the recent WFP suspension are likely to
result in increased population movements within Somalia
and across international borders in the coming weeks.
The Office of the U.N. High Commissioner for Refugees
(UNHCR) has not observed a significant increase in
refugee arrivals in Kenya to date in 2010, likely due to
the above-normal harvest in southern Somalia and poor
road conditions resulting from the recent rains.
However, as families deplete food stocks, increased
movement is likely. As a result, UNHCR and WFP are
developing contingency plans to respond to potential
humanitarian needs associated with increased population
movements.

--------------------------
ON-GOING NUTRITION CRISIS
--------------------------

6. (U) In November and December 2009, FSNAU and
partners completed 38 nutritional surveys, conducted 27
urban site assessments, and collected information from
health centers and selective feeding centers in Somalia.
The results confirmed a sustained nutrition crisis in
the country. According to FSNAU, one in six children in
Somalia is acutely malnourished and one in 22 is
severely malnourished, with global acute malnutrition
(GAM) rates of 16 percent and severe acute malnutrition
(SAM) rates of 4.2 percent. While national GAM and SAM
rates have declined slightly compared to FSNAU
assessment results released in September 2009,
malnutrition rates in Somalia remain among the highest
in the world. FSNAU credits successful humanitarian
interventions in areas of central and northern Somalia,
which were designated as critical for nutrition in
September 2009, for the decline in overall malnutrition
rates.

7. (U) Malnutrition rates in areas of south and
central Somalia are significantly above national levels.
According to FSNAU, one in five children in south and
central Somalia is acutely malnourished and one in 20 is
severely malnourished, with GAM and SAM rates of 19
percent and 4.5 percent, respectively. Among IDP
populations, FSNAU reports that one in four children is
acutely malnourished. Countrywide, approximately
240,000 children under five years of age are acutely
malnourished, of which 63,000 are severely malnourished
and at a nine times higher risk of death than well-
nourished children.

8. (U) According to FSNAU, malnutrition is
particularly high in Juba, Gedo, Bakool, Bay, and Hiran
regions. Among pastoralists in Juba Region, FSNAU

NAIROBI 00000326 003 OF 005


reports GAM and SAM rates of nearly 24 percent and 7.5
percent, respectively, likely associated with frequent
disease outbreaks. According to FSNAU, only 5 percent
of pastoralists in Juba Region have access to safe
drinking water and less than 3 percent have access to
adequate sanitation facilities. In Bakool Region and
parts of Gedo Region, high malnutrition rates are likely
associated with inadequate food access, according to
FSNAU. In Bay and Hiran regions, FSNAU reports that
nutritional vulnerability is linked to both disease
outbreaks and food access.

9. (U) FSNAU also found elevated levels of mortality
in Somalia. According to survey results, mortality
rates are at or above emergency threshold levels in
three areas of Somalia. Among pastoral communities in
Middle and Lower Juba regions, survey results indicate a
crude death rate (CDR) of 2.2 and an under five death
rate (U5DR) of 3, significantly above the CDR emergency
threshold of one death per 10,000 people per day and the
U5DR emergency threshold of two deaths per 10,000
children under five years of age per day. FSNAU reports
a 0.9 CDR and a 2 U5DR among pastoralists in central
Somalia and a 1.3 CDR and a 2.3 U5DR among IDPs residing
in the Afgoye corridor. In all three areas, FSNAU
reports that high mortality rates are likely associated
with frequent disease outbreaks.

--------------------------------------------- --------
NON-FOOD AID: A KEY FACTOR IN PREVENTING MALNUTRITION
--------------------------------------------- --------

10. (U) According to FSNAU, a persistent lack of access
to safe drinking water, sanitation facilities, and
adequate healthcare are significant contributing factors
to sustained high levels of malnutrition. FSNAU reports
that 70 percent of the population in Somalia is unable
to access safe drinking water, which predisposes the
population to diarrhea and subsequently interferes with
food absorption. Recent health and nutrition surveys
in Somalia confirm that children with illnesses have a
1.55 times greater risk of developing acute malnutrition
compared to healthy children, with diarrhea posing the
highest risk.

11. (U) According to FSNAU, endemic sub-optimal feeding
practices in Somalia also contribute to a high incidence
of disease and malnutrition rates. FSNAU notes that
early cessation of breastfeeding and the increased use
of dirty or contaminated bottles, both common practices
in Somalia, place children at risk of contracting
diarrhea, which can lead to malnutrition.

12. (U) Inadequate access to health services further
exacerbates humanitarian conditions in Somalia. In
September 2009, FSNAU reported that the sufficient
provision of adequate and accessible health services is
significantly lacking. Where health services are
available, many families are unable to access the
facilities due to distance, security, or economic
constraints, consequently influencing health-seeking
practices. According to FSNAU, information from health
centers indicates that caregivers often use local
healing methods prior to seeking care at a health
facility. By the time an individual reaches a health

NAIROBI 00000326 004 OF 005


facility, it is often too late to provide adequate
treatment.

--------------------------------------------- ----
HUMANITARIAN IMPLICATIONS OF DELAYED USG FUNDING
--------------------------------------------- ----

13. (SBU) Sustained support for health, nutrition,
water, sanitation and hygiene programs, in combination
with improved food access, are critical components of an
appropriate humanitarian response in Somalia. However,
under OFAC-related legal restrictions, USAID/OFDA has
been unable to fund U.N. agencies that have a leading
role in addressing humanitarian needs and providing
life-saving assistance in fiscal year (FY) 2009 the FY
2010. These agencies include the U.N. Children's Fund
(UNICEF), the U.N. World Health Organization (WHO), and
FAO/FSNAU, among many others.

14. (U) FSNAU was started in 1994 with funding from
USAID/OFDA and has received annual USAID/OFDA funding
since FY 2000. FSNAU has provided researchers, decision
makers, and project implementers working in and on
Somalia with vital information on food, nutrition, and
livelihood security for the past sixteen years. The
critical role FSNAU plays in Somalia cannot be
overestimated. FSNAU consistently provides decision-
makers in the humanitarian community with timely and
appropriate information and analysis of conditions in
Somalia. This information enables the humanitarian
community to develop early and appropriate responses to
developing crises, as well as to develop longer-term
strategies for Somalia.

15. (U) There is a direct and visible link between the
research-based analyses provided by FSNAU, which allow
U.N. agencies and NGOs to implement informed and
targeted interventions, and the improved nutritional
status of vulnerable populations in Somalia. FSNAU
relies heavily on USAID/OFDA support. Without
USAID/OFDA funding in FY 2010, FSNAU will be forced to
significantly scale-back staffing, reporting, and
assessments, hampering the ability of the humanitarian
community to mitigate deteriorating humanitarian
conditions in Somalia.

16. (U) UNICEF and WHO also depend on USAID/OFDA
funding for much needed health and nutrition programs,
including the Child Health Days (CHD) campaign, which
provides women and children with critical health
services, including vaccinations. Since re-commencing
in November 2009, UNICEF and WHO have reached more than
288,000 children under five years of age and more than
296,000 women in Mogadishu through the campaign. The
first two CHD campaigns reached approximately 2 million
children under five years of age and more than 1.5
million women of child-bearing age. As of February 4,
UNICEF had received USD 1.75 million of a requested USD
64 million for FY 2010 to maintain life-saving health
and nutrition programs in Somalia.

17. (U) USAID/OFDA support has helped WHO maintain
disease surveillance systems. In Lower Shabelle Region,
WHO is operating 36 sites that provide regular trend
monitoring and early detection and response to disease

NAIROBI 00000326 005 OF 005


outbreaks. In 2009, WHO and partners responded to over
70 rumored outbreaks within 96 hours of initial
reporting. WHO is the only agency that collects and
transports outbreak-related samples from Somalia for
confirmation in Nairobi or other referral laboratory
facilities. WHO has also trained more than 70 workers
in delivering health services and effectively managing
patients with acute watery diarrhea (AWD).

18. (U) Due to improved quality and timeliness of case
management, coordination, training of healthcare
workers, and the provision of standardized emergency
medical supplies, overall AWD case fatality rates in
Somalia have steadily declined since 2007. As of
February 4, WHO had only received USD 2.4 million of a
requested USD 16.6 million for FY 2010 health
activities.

19. (U) In a February 3 meeting between USAID,
including USAID/OFDA and USAID/FFP staff, and the
Somalia Transitional Federal Government(TFG), the
Minister for Higher Education and the Minister of State
for Planning and International Cooperation strongly
noted that additional skills training, specifically for
community health workers and birth attendants, is
urgently needed. Not only would the training increase
livelihood opportunities for a significant portion of
the population, but it would also provide much needed
support to the crumbling health system in Somalia. In
addition, training opportunities along with other forms
of assistance would increase general levels of optimism
in the ability of the TFG to provide social services
thus increasing reliance on, and lessening the level of
confidence in al-Shabaab to provide these same services
and support.

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COMMENT
-------

20. (SBU) The FSNAU assessment results indicate that
health and nutrition conditions have marginally improved
in some areas of Somalia over the past six months.
However, a continued WFP suspension in al-Shabab
controlled areas, depleted food stocks from the above-
average harvest in south Somalia, disease outbreaks, and
increased conflict and resulting population displacement
could cause humanitarian conditions to rapidly
deteriorate. A continued delay of funding to U.N.
agencies will have a direct and adverse affect on USAID
efforts to respond to the dynamic situation in Somalia.
In addition, funding delays will negatively impact U.S.
efforts to develop and implement robust contingency
plans in response to a potential escalation of
humanitarian needs. While food assistance is a critical
component in addressing malnutrition, U.S. humanitarian
efforts must be complemented with non-food humanitarian
assistance in order to be fully effective. Additionally,
a comprehensive and effective humanitarian response
could play a pivotal role in influencing the ever-
changing landscape in Somalia.
RANNEBERGER

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