VZCZCXYZ0005
OO RUEHWEB
DE RUEHDS #0213/01 0290448
ZNR UUUUU ZZH
O 290448Z JAN 08
FM AMEMBASSY ADDIS ABABA
TO RUEHC/SECSTATE WASHDC IMMEDIATE 9320
INFO RUEHAE/AMEMBASSY ASMARA 2091
RUEHDJ/AMEMBASSY DJIBOUTI 8885
RUEHNR/AMEMBASSY NAIROBI 3341
RUEHBS/AMEMBASSY BRUSSELS 3065
RUEHGV/USMISSION GENEVA 4143
RUEHLO/AMEMBASSY LONDON 2999
RUEHRO/AMEMBASSY ROME 6356
RUCNDT/USMISSION USUN NEW YORK 7218
RUEHC/DEPT OF INTERIOR WASHDC
RUEHRC/DEPT OF AGRICULTURE WASHDC
RHMFIUU/HQ USCENTCOM MACDILL AFB FL//CCJ2/CCJ5/CCJS//
RHEFDIA/DIA WASHDC
RHMFISS/CJTF HOA
RHEHNSC/NSC WASHDC
UNCLAS ADDIS ABABA 000213
SIPDIS
STATE DEPARTMENT FOR A/S FRAZER, DAS AF JSWAN, AF/E, AF/PDPA, OES,
A/S PRM SAUERBREY, AND PRM/AFR
AFR/AA KALMQUIST, WWARREN, JBORNS, KNELSON,CTHOMPSON
DCHA/AA MHESS, GGOTTLIEB
DCHA/OFDA KLUU, ACONVERY, CCHAN, PMORRIS, KCHANNELL
DCHA/FFP JDWORKEN, PMOHAN, SANTHONY, PBERTOLIN
LONDON, PARIS, ROME FOR AFRICA WATCHER
CJTF-HOA AND USCENTCOM FOR POLAD
USDA/FAS FOR U/S PENN, RTILSWORTH, AND LPANASUK
NAIROBI FOR OFDA/ECARO JMYER, GPLATT, RFFPO NCOX, USAID/EA
ROME FOR AMBASSADOR, OHA, HSPANOS
BRUSSELS FOR USEU PBROWN
GENEVA FOR NKYLOH, RMA
USUN FOR FSHANKS
NSC FOR PMARCHAN
AIDAC
SIPDIS
E.O. 12958: N/A
TAGS: EAID PHUM SENV EAGR PGOV ET
REF: A) ADDIS 3644 B) ADDIS 3642 C) ADDIS 0053 D) ADDIS 0120
SUBJECT: USG HUMANITARIAN ASSISTANCE TEAM FIELD VISIT #3: HEALTH AND
NUTRITON UPDATE
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Summary
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1. Between January 15 and 21, U.S. Government (USG) Humanitarian
Assistance Team (HAT) in Ethiopia staff, traveled to Gode and Korahe
zones in Somali Region as part of a third field visit to assess the
current humanitarian situation, including health and nutrition
conditions. USG HAT staff report that to date no large disease
outbreaks have been reported in the region. However, USG HAT note
that surveillance data is limited and an immediate concern for a
potential outbreak of measles, particularly within the
conflict-affected zones of Fik, Degehabur, Korahe, Gode, and Warder.
In response to laboratory-confirmed cases of measles in Warder and
Gode zones, the U.N. Children's Fund (UNICEF) and the Government of
the Federal Democratic Republic of Ethiopia (GFDRE) Ministry of
Health (MOH) have initiated preparations for an early February
regional measles campaign.
2. USG HAT staff did not observe indicators of widespread
malnutrition in areas visited, but characterized current nutrition
conditions as poor. USG HAT staff note that Somali Region
experiences chronically high levels of acute malnutrition that are
expected to further deteriorate as the January to March jilal season
progresses and as a result of the cumulative impact of the poor
performance of the 2007 rains, disruptions in food assistance, and
ongoing insecurity and commercial trade restrictions. USG HAT staff
emphasize the need for standardized nutritional surveys in the
region to identify vulnerable populations and inform appropriate
response interventions. In addition, USG HAT report that access to
health care remains limited despite reports of improved access to
rural communities and GFDRE authorization of USAID Office of U.S.
Foreign Disaster Assistance (USAID/OFDA)-funded UNICEF mobile health
teams to operate within conflict-affected areas in recent weeks.
End summary.
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MEASLES CONFIRMED - CAMPAIGN PREPARATIONS UNDERWAY
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3. On January 11, UNICEF reported that four measles cases in Kelafo
District, Gode Zone, and one measles case in Warder town, Warder
Zone, had been laboratory-confirmed. To date, the total number of
reported measles cases has been relatively low, but due to the low
measles immunization coverage and concern about increasing levels of
acute malnutrition, USG HAT staff identify a region-wide measles
campaign as a high priority. USG HAT staff report low immunization
coverage throughout Somali Region, including Gode and Korahe zones,
where USG HAT staff note an absence of outreach services in
Kebridehar District, Korahe Zone. The district health officer in
Kelafo estimated measles coverage at 30 percent. In addition, there
is an increased movement of people within the region related to
ongoing insecurity which could facilitate the spread of measles and
other communicable diseases.
4. On January 17, USG HAT staff visited two villages in Kelafo
District, where UNICEF recently reported four confirmed cases of
measles. USG HAT staff report that estimates on the number of
suspected measles ranges from 15 to 50, and that local populations
report that no new cases have occurred since December.
5. On January 16, UNICEF reported that the Somali Regional Health
Bureau had agreed to support a regional measles campaign with a
targeted start date of February 4.
The target age group will be children from 6 to 59 months of age,
and the campaign will include vitamin A supplementation. Access to
the population and community mobilization will likely be key factors
in determining whether or not the proposed campaign is successful.
According to district health officials in Gode, Kelafo, and Denan, a
measles campaign is feasible due to improved security and the
congregation of pastoralists near known water points during the
current dry season. USG HAT staff also note the presence of a
viable cold chain in Kebridehar and Shilambo districts to facilitate
the implementation of a measles campaign, security and access
permitting.
USG HAT staff will continue to monitor progress in campaign planning
and implementation.
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DECLINE IN NUTRITIONAL LEVELS EXPECTED - SURVEYS NEEDED
--------------------------------------------- -------
6. According to district health officers and non-governmental
organization (NGO) staff in areas visited in Gode and Korahe zones
by USG HAT staff, the nutritional status of children is poor but has
not reached a critical stage. In a January 15 meeting with USG HAT
staff, the Gode Zone health official reported no evidence of serious
malnutrition at this time, but expressed concern for the nutritional
status of the elderly and pregnant and lactating women as the
January to March jilal dry season progresses, due to limited food
supplies and prioritization of children feeding practices within the
household. Current conditions are exacerbated by the poor
performance of the 2007 rains, lack of grazing land, disruptions in
food assistance, and ongoing insecurity and commercial trade
restrictions. USG HAT staff note the strong likelihood of a further
and rapid deterioration in the health and nutritional status of
children in the coming months in the absence of nutritional
interventions and improved food aid delivery, particularly to rural
areas.
7. USG HAT staff report limited outreach for nutrition screening
and feeding programs in areas visited. Although health facilities in
Gode, Denan, and Kebridehar districts currently operate treatment
programs for severely malnourished children, there is no systematic
screening mechanism to identify malnourished children in the
community. In Kelafo District, USAID/OFDA implementing partner
Adventist Development and Relief Agency (ADRA) is implementing an
emergency relief community therapeutic care (CTC) program. In
December, ADRA admitted 160 children to the CTC and an additional 87
children between January 1 and 14. ADRA notes that the figures
represent an increase compared to previous months, but attributes
the increase to increased coverage, as opposed to an increase in
malnutrition levels. USG HAT staff recommend the replication of
NGO-operated programs like ADRA's within conflict-affected areas of
Somali Region that are capable of screening and providing treatment
for a large number of children and pregnant and lactating women.
8. The absence of nutritional data for Somali Region continues to
hinder efforts to identify populations at risk and inform
appropriate response actions. Gode Zone health officials report an
absence of recent nutritional assessments and data for Gode Zone.
Currently, information provided through nutritional screenings
conducted by USAID/OFDA-funded UNICEF mobile health, nutrition,
water, sanitation, and hygiene teams represent the only source of
nutrition information in Gode Zone. USG HAT staff emphasize that
mobile health team data is limited and cannot take the place of
standardized nutritional surveys. USG HAT staff recommend close
monitoring of the nutritional situation in order to facilitate the
timely implementation of emergency nutrition interventions if
required, including targeted supplemental feeding programs. In
addition, USG HAT recommend USG advocacy with the GFDRE Disaster
Prevention and Preparedness Agency (DPPA) Emergency Nutrition
Coordination Unit to permit and support standardized nutrition
surveys in Somali Region, particularly within the conflict-affected
areas to identify vulnerable populations and inform relief
programming.
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HEALTH CARE ACCESS REMAINS LIMITED
----------------------------------
9. USG HAT staff report that despite reports of improved
humanitarian access in Somali Region in recent weeks, health care
access remains severely limited, due to a lack of capacity,
staffing, and medical supplies. According to NGO and UNICEF staff
operating in Gode and Korahe zones, access and movement to rural
communities have improved in recent weeks. Medicine du Monde (MDM)
reported no restrictions in accessing MDM health posts in Korahe
Zone. In addition, local NGO Ogaden Welfare and Development
Association (OWDA) noted improved access to rural areas of Denan
District, Gode Zone, although OWDA has not yet restarted outreach
activities.
10. However, overall access to health care remains low, especially
in remote and conflict-affected areas. USG HAT staff report that
many health posts have not received medicines and are either
minimally functional or not functional, regardless of staffing
presence. However, efforts to address health post staffing deficits
are beginning to be addressed through the deployment of newly
trained pastoral health extension workers to a limited number of
health facilities in the region. USG HAT staff also received
reports of continued Ethiopian National Defense Force
(ENDF)-occupation of health posts, including Gabogabo, Nustariq and
Karanbilcinle health facilities in Korahe Zone, according to the
U.N. Office for the Coordination of Humanitarian Affairs (OCHA).
11. In a January 15 meeting with USG HAT staff, the Gode Zone
health official noted his appreciation for UASID/OFDA-funded mobile
health teams operating in Gode Zone, including health team reporting
on rural health conditions. Five mobile health teams have been
active in non-conflict-affected areas of Gode Zone since late
November 2007. In January, the Office of the Somali Regional
President approved an additional nine mobile teams to operate within
conflict-affected areas of Gode and Korahe zones. During the week
of January 14, four of the nine mobile health teams initiated
operations in Denan, Kebridehar, Shilambo and Debowyne districts.
However, three of the four teams had not yet received medicines from
the Regional Health Bureau and were borrowing supplies from the
district health office. USG HAT staff note that mobile health teams
are providing critical basic services to remote areas, but emphasize
the need for improved monitoring and coordination to maximize
effectiveness and prevent duplication in area coverage. In
Kebridehar District, for example, mobile health teams were scheduled
to work in some of the same areas currently being supported by MDM.
In addition, the current number of mobile teams is inadequate to
address coverage needs in the region.
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Conclusion
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13. USG HAT staff characterize current health access and nutrition
conditions in areas of Gode and Korahe zones visited as poor. USG
HAT staff caution that conditions are expected to further
deteriorate as the January to March jilal season progresses. In
response, USG HAT staff emphasize the need for standardized
nutritional surveys in the region to identify vulnerable populations
and inform appropriate response interventions, including targeted
supplemental feeding programs. USG HAT staff also recommend the
expansion and improved monitoring and coordination of mobile health
teams operating in Somali Region to address severe limitations on
health care access, particularly within conflict-affected areas. In
addition, USG HAT staff will continue to monitor progress and
support the implementation and planning of a regional measles
campaign.
YAMAMOT