November 21, 2008

EMERGENCY DESK: SOUTHERN ETHIOPIA

In May, MSF emergency teams found extremely high numbers of children under age five who were severely malnourished in southern Ethiopia. By May 13, MSF had begun an emergency nutritional intervention that continued to grow along with the increasing numbers of patients.

Ethiopia 2008 © Elena Torta/MSF

In Shashemene, MSF staff treats a child for malnourishment.

In May, Doctors Without Borders/ Médecins Sans Frontières (MSF) emergency teams found extremely high numbers of children under age five who were severely malnourished in southern Ethiopia. By May 13, MSF had begun an emergency nutritional intervention that continued to grow along with the increasing numbers of patients.

Four months later, MSF was operating about 60 nutrition centers for patients with severe, life-threatening malnutrition— several centers with the capacity to treat those also suffering from additional, complicating factors such as malaria or pneumonia. And teams were expanding operations to include outpatient feeding sites for moderately malnourished children and their families.

As of late September, MSF had treated 28,000 severely malnourished and 21,000 moderately malnourished patients. The nutrition situation in some areas had started to stabilize, meaning the numbers of malnourished patients admitted into feeding programs had plateaued or had begun to decline. But that wasn’t the case everywhere. In Tunto town, in the Southern Nations and Nationalities People’s (SNNP) region, the MSF team was still having days when 2,000 hungry people were lining up outside the clinic doors.

A Year Harder Than Usual

Ethiopia 2008 © Anne Yzebe/MSF

People line up at an MSF nutrition center in Tunto, Southern Nations and Nationalities People’s region.

Ethiopia is no stranger to malnutrition; millions of people here receive food aid routinely, when it is accessible. But, a combination of economic and agricultural factors has made this year’s levels of under-nourishment reach rare heights. This can be seen throughout the Oromiya and SNNP regions where MSF nutrition centers have distributed 3,000 tons of food to 40,000 malnourished children and their families.

Zamane, a mother in the SNNP region who came to the MSF clinic in Tunto, watched her child die only two days before. She was there to try to get her surviving two-year-old into the nutrition program.

“My husband is a farmer,” says Zamane. “He grows maize and ginger. Maize is for the family; ginger is to sell. With the income of ginger sales, we normally can buy some additional maize from the market. But this year, the price of ginger is very low and at the same time, the price of maize has risen and has become too expensive. It has become difficult to buy maize to feed the family.”

The rates of severely malnourished children reached approximately 11 percent and even 15 percent of all children under age five in some areas of the SNNP region; nutrition interventions should be started when the rate reaches 3 percent. An unusually large number of older children and adults are also being admitted to the program, another sign that the nutritional situation this year was more serious than previous years. Forty year-old Twados, a farmer, came to the MSF center in Tunto after becoming severely malnourished and unable to help provide for his six children. He was admitted to the outpatient program where he received therapeutic food three times a day and was given food rations to share with his family.

“Without these rations, I’d have nothing to eat,” Twados said. “Before, we could buy food at the market, but the prices have risen too much. Two times I received 50 kilograms (110 pounds) of food aid from the government, but you know, it’s not enough for a family as big as mine. I hope that with the help of God, future harvests will be better and my life will improve.”

“JUST THE TIP OF THE ICEBERG”

Ethiopia 2008 © François Dumont/MSF

Every morning this summer, MSF staff in southern Ethiopia found long lines of people, sometimes up to 2,000, waiting outside the clinics. When the rains came, people stood grimly outside, many barefoot and shivering, some having come from distant regions where there is little if any aid. MSF medical staff performed “rapid screenings” with a MUAC, a medical tool that measures the circumference of the patient’s mid-upper arm and indicates whether he or she is malnourished or in danger of malnutrition.

“The patients in MSF’s care are just the tip of the iceberg,” said Rosa Crestani, MSF emergency coordinator in southern Ethiopia. Other aid organizations are also in the region, working to meet the huge needs that still exist. “But many others are suffering. They have exhausted their food stocks, and right now they depend totally on food aid brought in from elsewhere.”

At the start of this intervention, MSF’s strategy was to treat only the most severely malnourished. These patients are given therapeutic, nutrient-rich, ready-to-use food until they are stabilized. But preventative measures also are necessary to have any impact on peoples’ health and prevent moderately malnourished people from getting worse. In mid-July, MSF began setting up outpatient feeding centers for moderately malnourished children and their families, where they receive biweekly food rations of blended fortified fl ours and cooking oil. This is not the optimum product, but it was the only option available. In Siraro district, a comprehensive approach that includes therapeutic feeding and targeted food distributions had a measurable impact: over four weeks in July and August, the number of patients in MSF’s pro-grams decreased from 1,251 to 971.

While things seem to be improving in many places where MSF has been treating malnourished patients, the situation varies widely area to area due to variations in climate and rainfall; and food costs remain prohibitively high. MSF teams continue to work in southern Ethiopia and are adapting their activities according to people’s needs.