Feature No 194
ETHIOPIANS IN THE GRIP OF "GREEN HUNGER"
A week after the launch of WHO's Action Plan against the Horn of Africa Drought, a World Health Organization (WHO) field trip (11-14 June) has found people in the North Omo zone, 8 hours south of Addis Ababa, in the grip of 'green hunger'.
The arrival of sporadic rains in the past two months has covered many of the area's pastures with a patina of vivid green, and the hillsides and lowlands are sprouting young sweet corn plants, flowering sweet potatoes and fragile cereal grass. But the green is a cruel deception. Inside their thatched huts, over 50% of the people in the most drought-stricken districts have nothing left in their pots and baskets. And they will continue to have nothing for three months until, weather permitting, the crops ripen.
Their dire situation is the result of three years of poor rainfall and three consecutive pest-induced failures of the staple sweet potato crop which traditionally wards off the hunger gap between seasons. But it is also exacerbated by one of the highest population densities in Ethiopia which leaves most households with less than half a hectare to feed themselves.
"In other areas, you never see a house without a grain store, but here they have nothing now, just the green stuff," says Dr Kelemu Desta, hospital medical director in Soddo, the area's main town.
The woreda (district) council of Damot Weyde, one of the worst affected areas, estimates that over 110,000 of their 179,000 population need food aid, while a nutrition survey carried out in mid-April by the international nongovernmental organization (NGO) Concern, together with local NGO Wontta, puts global malnutrition of children under five at 26% - almost 10 times 'normal' rates. Of these, 4.3% are suffering from acute severe malnutrition. The survey, carried out using standard WHO methodology over 30 randomized clusters and a representative 960 children with analysis by weight for height and Z-score, also found less than 6% of the population is using their own harvest. 68% of families are eating only one meal a day, while almost two thirds of the entire population is consuming only ensette, or the 'false banana' root that is starchy but nutritionally poor.
As well as global malnutrition in one in four children, the researchers, Mary Corbett, Victor Ferreira, Woranna Dunda and Yohannes Wodajo, found over 75% of the children had been ill, either with fever or with diarrhoea, in the week before the survey and less than 15% had any sign of being immunized against any disease. Eleven children died in the four days it took to carry out the research.
Visiting the farming community of Sore Mashido in nearby Bolosso woreda earlier this week, WHO officials found families, without even false banana left, who have been reduced to boiling grass, mildly narcotic weeds and toxic tree leaves for their children.
In the nearby community of Buge Wanchi, the community head said 68 people, predominantly children under five, have died of starvation in the past month and three to four people are dying now every day. "One household even tried to eat the roots of the real banana, which are inedible, and lost three members from poisoning," said acting health bureau head, Mr Yakub Shanka, who added that what really made him wake up to the scale of the suffering was finding a skeletal baby clamped to the breast of its mother who had just died.
Adult malnutrition, much less death, is a deeply worrying sign, according to Dr Kelemu. "Adults only die of malnutrition when the situation is very bad, and we have started to see adult malnutrition in the hospital." The NGO Concern has just completed a first round of general and supplementary food distribution for children in Damot Weyde and has committed to two months worth of supplies in the hopes that either the harvest or government distributions will come through. But the organization is unable to provide families with full rations and government distributions are slow to arrive here, partly perhaps because the international focus on the 'grey' hunger of the Ogadon.
Working to WHO technical guidelines for emergency treatment of severely malnourished children, the NGO has also set up three therapeutic feeding stations to start helping the 1,100 severely malnourished children which their house-to-house teams have identified so far. They expect to find at least another 700 in coming weeks and are considering opening two more feeding stations, says Concern's paediatrician Dr Therese Martin. "These children are a real challenge to us medically because they are coming in so late, they are immuno-suppressed and highly oedematous - more than 60% of the children are Kwashikor. The green around us is very deceptive. We've had a week of rain and it's brought the short grass out, but it also washed away some of the young corn. In the short term I am positive that what's being done can help but in the long term, the health infrastructure is barely functioning."
WHO adviser Dr Tefarre Wonde, a former minister of health and expert in infectious diseases, says food is an obvious priority, but cicumstances such as those in North Omo clearly show that improved access to healthcare and effective systems of prevention such as nutritional and communicable disease surveillance and rapid treatment must run alongside. "You can't put malnutrition on its own - diseases cause malnutrition and malnutrition causes disease. It's a terrible synergy."
WHO is currently recruiting a nutrition specialist to aid relief workers in drought areas as well as running an emergency updating and training course in surveillance and management of epidemic diseases for health officers from the drought affected zones. It also has two representatives on the newly created Nutrition Taskforce.
From Concern survey in Damot Weyde April 14-19, 2000, population 179,000:
In one month at Concern therapeutic feeding centres:
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