One year later, helping children survive in the Horn of Africa


July 25, 2012

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  <span class="field-credit">
    Erin Gray/Mercy Corps  </span>
    Mothers bring their hungry children to Mercy Corps' mobile health clinics, where they are evaluated for malnutrition and given vaccines and therapeutic food. Photo: Erin Gray/Mercy Corps
  <span class="field-credit">
    Erin Gray/Mercy Corps  </span>
    Donkeys drink from what's left of a pond. The worst drought in 60 years has parched the land in the Horn of Africa, and the animals that families depend on aren't healthy enough to provide milk for malnourished children. Photo: Erin Gray/Mercy Corps
  <span class="field-credit">
    Bija Gutoff/Mercy Corps  </span>
    Our health teams bring lifesaving supplies and food to remote communities where no other medical care is available. Photo: Bija Gutoff/Mercy Corps
  <span class="field-credit">
    Bija Gutoff/Mercy Corps  </span>
    Little Abdirizaq is so malnourished that his hair has lost color. Photo: Bija Gutoff/Mercy Corps
  <span class="field-credit">
    Bija Gutoff/Mercy Corps  </span>
    Malnourished children receive Plumpy'nut, a therapeutic food that helps them put on weight immediately. Photo: Bija Gutoff/Mercy Corps

You might hear it called a “slow onset” emergency because, unlike the sudden strike of an earthquake, drought builds gradually. But don’t bother telling that to the mothers whose children are hanging on by a thread; slow isn’t the word they would choose. Grueling, they might say. Nerve-wracking. Painful.

The first warnings came from the United Nations Food and Agriculture Organization in November 2010, after autumn rains failed to arrive. Red-soil grasslands baked as hard as concrete. The region hadn’t been this dry in 60 years. By early 2011, 6.3 million people needed emergency help. But it wasn’t until the summer, when the number of people in crisis doubled to 12.3 million, that the general public finally began to pay attention.

By that time Mercy Corps had already launched an emergency response in Kenya, Somalia and Ethiopia, bringing water, food and medical care to those who are most vulnerable: babies, children, orphans, widows, elders.

Now, one year later, we’re still helping the people of the Horn recover. In remote rural Ethiopia, where most people are herders, we’re focusing our efforts on malnourished children and their moms.

Milk from the sky?

Why is malnutrition such a scourge among these families? They depend on their sheep, goats, camels and cattle for everything: milk and meat, labor, income. When the rains don't come, pastures dry up. Animals have nothing to eat. They lose weight, become malnourished, stop having babies, can’t produce milk. Many die. The consequences to humans — especially children, for whom milk is the main protein source — are profound. So even though milk doesn’t really fall from the sky, the link between rainfall and malnutrition is direct and unmistakable.

It takes time for the land to heal from a long, severe drought. It takes time for animals to recover and become fertile again. A drought like the one in the Horn is not only slow to arrive, but slow to depart.

“Even assuming normal rains this season and for the next three rainy seasons,” says Nathan Oetting, director of integrated humanitarian response for Mercy Corps Ethiopia, “it will be the middle of 2013 — at the earliest — before the region produces enough milk for children’s needs.” That means malnourished people will need care for some time.

Mobile clinics bring lifesaving care where the need is greatest

Mercy Corps is currently running eight mobile health clinics that provide exams, triage, food, medicine, vaccines and treatment to babies, children and adults. Each mobile unit is staffed by two or three nurses and two or three health workers; to make sure people continue to get the lifesaving help they need, we’re training local people to take over the program. Our clinics travel to communities where the need is greatest and other care is not available.

They arrive in a jeep stocked with lifesaving supplies: antibiotics, analgesics, cough syrup, deworming medicine, vitamin A (a common deficiency), Plumpy’nut high-protein therapeutic food for infants, fortified corn-soy cereal and cooking oil, as well as soap and mosquito nets.

Since last summer, our mobile health teams in Ethiopia have cared for 37,871 children, distributed food to 63,763 malnourished people and provided immunizations and information to help thousands more survive the drought — and stay healthier beyond that.

Nursing malnourished children back to health

When mothers like Hali, Mona and Zainab show up seeking care for their children, many are deeply worried. Their babies are listless. Their toddlers weigh less than an infant should. Their little ones are frail, sick or both. Our health workers check their condition. All too often, we discover the telltale signs of malnutrition: edema, dry reddish hair like Abdirizaq’s, below-normal upper arm measurements.

A child diagnosed with severe acute malnutrition is given the fortified peanut mixture called Plumpy’nut, which contains essential nutrients and calories in a toothpaste-like squeeze packet that requires no cooking. “It’s sweet,” explains Nate, “so the kids eat it right away.” After their condition improves to moderate acute malnutrition, parents receive vitamin fortified cooking oil and corn-soy cereal to help their kids continue to gain weight and become stronger and healthier.

Quick triage gets the sickest babies to inpatient care center

Our teams triage the most seriously ill little ones, who have other complications like pneumonia or malaria. “Their lives are in danger,” Nate explains, “so they’re immediately referred to one of our emergency stabilization centers.”

Mercy Corps Ethiopia currently runs six such centers — three in Shinile Zone, two in Degehabur Zone and one in Afder Zone, all located in the hard-hit Somali Region of eastern Ethiopia. In these centers the sickest babies are treated as inpatients, with their mothers or fathers close by, until they are strong enough to continue treatment as outpatients.

“They need special care before they can even digest Plumpy’nut,” says Nate. “Our goal is to stabilize them in a few days.” We are training staff and gradually transferring the operation of these centers to local governments, so they can continue to be a lifesaving resource.

A little learning yields a lot of health

Our health teams also teach parents what they can do to keep their children healthier, including exclusive breastfeeding for at least six months. “Many village women don’t know what a huge boost that is for the baby,” says Nate. “We see moms feeding their infants sugar water and tea or, on the other end of the spectrum, adult foods the infant can’t digest. We tell the moms when they eat nutritious foods, the baby gets the benefit in their breast milk.” A mother whose new habits make her baby stronger becomes a powerful example for other moms.

We also teach parents about hygiene, sanitation and the use of mosquito nets to help families avoid common diseases like malaria and bacteria that cause diarrhea.

Rain is good…right?

A sudden downpour on drought-baked land is greeted with joy and relief. But it’s not an instant fix. And rain after a long drought causes new problems: floods and erosion, washed-out roads, waterborne disease.

In Ethiopia, rainwater is collected in birkeds, open ponds that by nature aren’t germ-free. “It’s the storage system they use,” says Nate, “but unfortunately it’s not hygienic. During a drought, animals wander into the empty reservoir and leave feces behind.” Then, after rain, there’s a spike in diarrhea cases, so we shift our focus to treating the illnesses people get from drinking unclean water. “Waterborne sicknesses are especially hard on kids,” Nate adds. “It’s as dangerous as not having enough water.”

Todays’ forecast: not enough rain – and still not enough food

According to USAID’s Famine Early Warning System Network (FEWSNET), spring rains have been disappointing in many areas of the Horn of Africa. Reservoirs remain empty and wells are drying up. Harvests are poor; farmers whose crops depend on irrigation can’t plant due to high fuel and seed prices. Pastures aren’t regrowing. Herders are traveling long distances to find water for their animals. And inflation is pushing up the price of staples like rice and wheat. Emergency levels of food insecurity are expected to persist at least through September. The crisis that generated so much attention a year ago has not gone away.

The most at-risk families are skipping meals, eating smaller and less nutritious meals and borrowing money (at high interest rates) to buy food. In some areas, hungry kids are dropping out of school. Their mothers and fathers are foraging for wild plants to put something, anything in their bellies.

But they’re not facing this crisis alone. “Mercy Corps has been providing health and nutrition support to communities in the Somali Region of Ethiopia since 2008,” said Nate. “No matter how long it takes, we are committed to supporting the full recovery of families hit hard by drought and food shortages. And we will remain their committed partner as they rebuild their lives and livelihoods.“