Nutrition Situation Post Gu 2010
The nutrition situation shows a varied picture throughout the country, with improvements in northern areas yet a sustained crisis in South Central areas. From April to July 2010, FSNAU and partners conducted a total of 25 representative nutrition surveys. Of these, 8 reported rates of global acute malnutrition (GAM) <10%, 7 reported rates in the 10-15% range, 7 reported rates in the 15-20% range, with the remaining 3 reporting rates >20%. The median national rate of global acute malnutrition (GAM) is 15.2%, and 2.4% for severe acute malnutrition (SAM). This translates to an estimated 230,000 acutely malnourished children, of whom 35,000 are severely malnourished, representing 1 in 7 and 1 in 42, of all children under 5 years in Somalia. These national rates have indicated a slight reduction from the Deyr ‘09/10 six months ago, when 16% GAM and 4.2% SAM were reported, attributed mostly to improvements in the northern regions, Shabelle and Juba Regions.
For South and Central regions, the area’s most affected by insecurity and limited humanitarian space; median rates are at 16.6% GAM and 4.5% SAM, translating into a caseload estimate of 90% of all the severely malnourished children in Somalia. These rates indicate a slight improvement in the GAM from 6 months ago, when median rates were at 19% GAM, with no change in the rate of SAM.
Milk access remains a driving factor in the nutrition situation among northern pastoralists subject to livestock migration dynamics, which is illustrated in the seasonality in the rates of acute malnutrition amongst this group. However in South Central areas, there are many more factors directly affecting elevated rates of acute malnutrition, including food insecurity caused by natural disasters such as drought and flooding and also economic factors such as increasing food prices, morbidity levels including outbreaks and sub optimal infant and young child feeding practices. For IDPs seasonality also plays an issues in terms of access to labour opportunities e.g. port activities and disease.
Civil insecurity in Mogadishu, Hiran and parts of Central regions of Somalia leading to on-going population displacements, the Gu’10 rainfall failure in Hiran, coastal parts of Central regions the aftermaths of the cyclone in the northeast regions also contribute to the current analysis. Access to health services is of great concern with many carers, opting instead for damaging and sometimes dangerous alternatives to conventional health care through traditional means (See photo). Therefore, a concerted effort to address all these factors, in addition to enhancing household food security and livelihoods, remains crucial for sustainable improvements in the nutrition situation to be realized.
South & Central regions
The nutrition situation shows a varied picture in different parts of South and Central regions. There has been significant improvement in parts of Shabelle attributed mainly to a bumper crop harvest, which provided labor opportunities for poor households and increased access to milk following in-migration of livestock . Similarly in Juba and Gedo pastoralists, the nutrition situation has improved with increased access to milk and livestock products following favorable Gu’10 rains and pastures, and improved livestock body conditions and kidding rates. Though acute watery diarrhea was again reported this season in Shabelle and Juba regions which maintained nutrition rates at Serious levels.
The sustained nutrition crisis in the other livelihoods of South and Central Somalia, currently classified in Critical or Very Critical nutrition phases continues to highlight the impact of years of civil war on the population’s ability to deal with shocks. The widespread lack of access to appropriate health service, safe water and improved sanitation further increase the risk of disease, and many common childhood illness can be fatal. In spite of this year being a bumper harvest in Bay Region for example, it has yet to translate into improved nutrition status as children are fed predominantly on cereal and oil based diet, missing the essential micronutrients and proteins essential for health, growth and development. As mentioned earlier, the highest levels of acute malnutrition are reported in South Central at 16.4% GAM and 4.5% SAM compared to the national rate of 15.2% GAM and 2.4% SAM. Further, the very high stunting of 22 % in the South and Central regions, unchanged from 6 months yet compared to the 8% and 12% reported in the northwest and northeast respectively, continues to illustrate the chronic nature of this crisis (Figure 3). Currently with the reducing humanitarian space, access to nutritional rehabilitation services is also a limiting factor to recovery and the nutrition situation here remains in crisis with a poor outlook for the coming months.
In the northwest regions, there is a mixed picture with notable recovery to Alert from the previous Serious situation in the East Golis Guban and Nugal Valley, and to Serious from Critical in the Toghdeer agro-pastoralists, mainly as a result of in migration of livestock and subsequent increased access to milk. Humanitarian support has also improved since July 2009. The Hawd pastoralists in the northwest are in a sustained Serious nutrition phase, attributed mainly to limited access to milk availability as a result of low calving in camels, sheep and goats. Given the population density, even without Critical or Very Critical rates of acute malnutrition, 21% of all acutely malnourished Somali children reside in the northwest, therefore integrated efforts to meet their needs are key.
In the northeast regions, analysis of the nutrition situation is also providing a mixed picture since January 2010. Improvements to Alert rates of acute malnutrition are now being reported in Nugal Valley, from Serious in the January 2010, with a sustained Alert phase in Sool Plateau. In the East Golis, Guban and Karkaar, the situation has deteriorated to Critical from Serious in January 2010. Sustained Critical rates in the Hawd and deterioration from Critical to Very Critical in the Addun highlight a concerning nutrition situation in the northeast and elevated needs. It is estimated that 3% (excluding the IDPs in the region, also at 3%) of all acutely malnourished children in Somalia reside in the northeast regions.
IDPs continue to be a nutritionally vulnerable group, even in areas of relative peace and improved access in the northern regions. The median GAM rate at 15.3% and SAM rate of 3.2% are slightly higher than the national rates of 15.2% and SAM rate of 2.4%. However the median rates of global acute malnutrition in the IDPs have shown some improvement from the 16.7% GAM and 5.0% SAM reported during the Deyr ’09/10. This is mostly due to improvement in the nutrition situation to Serious in Galkahyo IDPs with a GAM rate >11.3% and a SAM rate > 1.2%, from the Deyr ‘09/10 which showed unacceptably high GAM rate at 23.7% and SAM rate at 6.3%. Similarly, in Garowe IDPs, the situation is Serious with GAM rates of 11.5%. The stunting level at 19.4%, show a slight improvement compared to the Deyr’09/10 median rate of 24.8%, and is similar to the national rate of 18.4%. Nevertheless these levels indicate that 1 in 5 IDP children will not be able to reach their full developmental potential. The window of opportunity for reversal of stunting is up to 2 years, so efforts focused on integrated health and nutrition programmes are key for these children. Of note also is the situation in the Afgooye IDPs which has remained stable with GAM rate of 15.1% and SAM rate of 1.7% in relation to the situation in January 2010 with GAM and SAM of 15.9% and 5.5% respectively, despite the shrinking humanitarian space.
The high levels of nutritional vulnerability is likely to persist in most parts of South Central regions, based on the highlighted aggravating factors, coupled with the prevailing insecurity which limit humanitarian access, and projected below average rains in the coming season, which could limit access to milk and impact on agricultural production. Improved humanitarian access that will ensure a combination of emergency nutrition interventions, adequate integrated humanitarian response and capacity strengthening of current and new nutrition stakeholders remains key in addressing these issues (Figure 2 and Figure 3).