Health in the Horn of Africa

Health in the Horn of Africa: a collective response needed
The Lancet, Volume 378, Issue 9791, Page 541, 13 August 2011

"In 1984, the world said 'never again' to famine in Ethiopia. But, 27 years later, famine has revisited the Horn of Africa. Between July 20 and August 3, the UN declared famine in five regions of Somalia. The disaster is expected to spread to all eight regions of the country in 4—6 weeks and is likely to persist until at least December this year.

A famine can be declared only when at least 20% of households in an area face extreme food shortages with a limited ability to cope; acute malnutrition rates exceed 30%; and the death rate exceeds two deaths per day per 10 000 people. Deemed the “worst humanitarian disaster” in the world by António Guterres, the UN High Commissioner for Refugees, it has threatened the lives of 12 million people, and more than 29 000 children younger than 5 years—nearly 4% of children in Somalia—are estimated to have died. Malnutrition was already prevalent in about half of all children younger than 5 years who arrived at UN camps in Somalia, which made them especially susceptible to the complications of diarrhoea and measles. According to WHO, the number of people becoming infected with measles and waterborne diseases is growing at an alarming rate, and cases of severe diarrhoea in Kenya and Ethiopia are a serious concern. Furthermore, hundreds of thousands of refugees from Somalia have fled to neighbouring countries, in particular Kenya and Ethiopia, and the ongoing refugee crisis has raised the risk of diseases associated with crowding such as measles, diphtheria, pertussis, acute respiratory infections, meningococcal disease, and tuberculosis. Additionally, humanitarian organisations reported that women in the refugee camps faced a drastic increase in sexual violence, which has put them at high risk of contracting HIV/AIDS.

The UN is stepping up deliveries of food aid in famine-affected areas, and WHO has led an emergency measles and poliomyelitis vaccination campaign, together with the provision of vitamin A and deworming tablets targeting children younger than 5 years on the Somali—Kenya border. However, in view of the extremely fragile health systems and poor sanitation in these countries, the vicious cycle of hunger, ill health, and poverty makes the situation even more intractable.

There are many factors underlying the famine. The drought, the worst in 60 years, is the initiator of the tragedy. More than 95% of Africa's agriculture is rain-fed, and is therefore susceptible to climate change. On top of that, Somalia faces a security crisis as a result of political conflicts, civil war, and anarchy, which has meant that most of its people have lived in an extremely precarious state since its last national government collapsed in 1991. As the economist William Easterly once commented on Ethiopia's struggles with famine over the past quarter-century: “It's not the rains; it's the rulers.” The toxic politics should perhaps be regarded as the major culprit; the famine is more of a man-made disaster than a natural one.

The international community is also to blame for responding too slowly and neglecting its responsibilities in this preventable disaster. Despite the forecasting of the crisis from the Famine Early Warning Systems Network since November, 2010, the first aid flight did not arrive in Somalia until 8 months later. The UN issued its first appeal on July 20, and by August 3, the appeal was only 44% funded, with an additional US$1·4 billion still required to cover unmet needs. The USA, Europe, and other wealthy donors waited until pictures of starving children and desperate women made the evening news to hand over funds. China, Africa's second largest trading partner after the USA, merely said it would pay “close attention” to the disaster, and only pledged a modest $14 million of food aid on August 5, after US House minority leader, Nancy Pelosi, urged the country to do more.

In an era of advanced agricultural productivity and transportation networks, it is unacceptable that a famine has happened. It is even more unfortunate that Africa is still “a scar on the conscience of the world”, as former UK Prime Minister Tony Blair said 10 years ago. More and longer-term investments in agriculture and health in Africa are needed alongside a collective global response. Notably, China, which experienced one of the largest famines of the 20th century and yet has harnessed 7% of the planet's arable land to feed 20% of the population, should be more of a leader here and show that it has an interest in the welfare of Africa's people. Such a humanitarian disaster must never be allowed to happen again."

Somali famine

The Horn of Africa, a region that includes Somalia, Djibouti, Eritrea and eastern parts of Ethiopia and Kenya, is currently experiencing the worst drought the area has seen in over 60 years. Somalia is the worst-hit country, due to a combination of difficult agricultural conditions, violent conflicts and militant groups that have deprived the country of national stability and any assistance that western aid organizations might be able to provide. Current estimates suggest that 3 million Somalis are on the brink of starvation and over 10 million are at risk across the region.

As a result, tens of thousands of Somalis are evacuating, seeking refuge at refugee camps in neighboring countries. Most are fleeing to Dadaab, the world's largest refugee camp, in eastern Kenya. Dadaab is currently home to nearly 400,000 refugees, but over 1,000 new refugees are arriving from Somalia each day, starving and having traveled for weeks to reach this possible safe-haven. To say this puts a strain on camp resources would be an incredible understatement. To give some perspective, Ali Addeh, a refugee camp in southern Djibouti where I've started some work, is strained by the arrival of 500 new refugees each month.

I feel like Somalia is one of those forgotten corners of the world about which most of us know little other than the Battle of Mogadishu (a.k.a Black Hawk Down), piracy and Islamic militancy (e.g. al-Shabaab). It worries me that a country with this reputation may not be able to receive the assistance it needs in the face of a drought that is as much a natural disaster as any earthquake or cyclone.