Crisis within crisis

Near the town of Dilla, in north-western Somalia, a woman watches over her goats. Of the 200 once in the flock, more than 100 have already died of hunger and thirst. Photo: Arie Kievit/The Netherlands Red Cross

Crisis within crisis

With conflict and ravaged infrastructure complicating the response, the Somalia drought crisis is a case study on the challenges of saving lives in a complex emergency.

AS RIVERS STARTED DRYING UP due to lack of rain and the harvest shrivelled earlier this year, the people whose livelihoods rely on farming and herding livestock were left with no choice but to move closer to water points or urban centres to survive.

“From my herd of almost 300 animals, l only have 30 left. The others died during the drought,” says Abdullahi, who is dependent on proceeds from the sale of livestock to sustain his family. With his remaining animals too weak to sell or be slaughtered for food, he moved his family 25 kilometres north of the town of Garowe, where he hopes to sell sand from a nearby riverbed to support his family.

By Rita W. Nyaga

Rita W. Nyaga is a communications assistant for the ICRC’s Somalia delegation, based in Nairobi, Kenya.

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As the dry spell continued, the population faced the very real possibility of famine and humanitarian organizations had to work hard and fast to avert a disaster like that experienced in 2011 when, according to news reports, more than 250,000 people lost their lives due to extreme hunger. “People are suffering everywhere and the harsh reality is that they all need assistance,” says Dusan Vukotic, the ICRC’s coordinator for relief programmes in Somalia.

As Somalia entered the rainy Gu season that runs from May to June, many areas were still affected by drought, while others began to experience flash floods, which occur regularly during the Hagaa season of short rains from July to September.

In many areas, farmers started tilling their land once again. But even if sufficient rains come, they will not wash away the enduring hardships faced in recent months. Cases of malnutrition among children continued to rise, according to data collected by the Somali Red Crescent Society, and water-borne diseases like cholera were also increasing. With no income from farms or livestock, many people have been left financially ruined.

Humanitarian organizations therefore have been operating in full emergency mode. The crisis has required diligent, intense efforts in order to continue saving lives so that people have at least a chance of rebuilding once the drought finally eases.

A complex, complementary response
Doing so in a situation as complex as the one in Somalia, however, is no simple task. Fortunately, the Somali Red Crescent Society and other Movement partners have long-standing operations in the country and could, therefore, respond in a complementary manner as the drought unfolded, focusing on areas with few if any humanitarian actors on the ground.

The ICRC, for example, has nine established offices in Somalia, six of which have warehousing capacity. The ICRC supports 76 Somali Red Crescent health facilities, more than 40 mobile clinics, four hospitals and two stabilization centres in Biadoa and Kismayo. It is also helps sustain 20 primary healthcare centres, eight Somali Red Crescent Society mobile clinics and 19 outpatient therapeutic centres.

The IFRC and partner National Societies provide support to Somali Red Crescent Society mobile clinics and, from the IFRC offices in Somaliland, organize water, sanitation and hygiene efforts, as well as provide shelter relief items. They also deploy a cholera treatment centre, among other things.

This kind of complementary action — with each component responding where it can in various parts of the country — is one reason that, collectively, the ICRC, the IFRC and the Somali Red Crescent Society have been able to help more than 1 million people during the crisis. Coordination is vital in complex emergencies even as it becomes more challenging, especially when ongoing fighting makes gaining access to people very difficult or impossible.

“Both the donors and the humanitarians have been committed from the outset to providing a comprehensive response,” says Daniel O’Malley, deputy head of the ICRC’s Somalia delegation based in Nairobi, Kenya. “Having said this, we have still witnessed the habitual constraints in terms of coordination, something relatively understandable given the size of the operations and the large number of humanitarian partners involved.”

Don’t blame the rain

Across sub-Saharan Africa, millions of people are not getting enough to eat and thousands are falling sick due to inadequate nutrition and lack of clean water. While the specific causes behind the shortage of food vary in each area, there is one common theme: extended drought is being exacerbated by a host of man-made conditions. In South Sudan and Somalia, for example, the failure of seasonal rains came on top of ongoing conflicts that had already caused the mass displacement of millions and disruption of normal food production. Meanwhile, inadequate infrastructure and other barriers to humanitarian access have made relief efforts extremely challenging. “We can’t just blame the lack of rain for these unfolding tragedies,” said one Movement aid worker recently. In the following stories, we examine the challenge of responding to these multiple, overlapping crises.

Race against time
Another challenge for all humanitarian actors in Somalia has been logistics. “After 30 years of conflict, the country’s infrastructure has been decimated,” he says.

The urgency of containing the malnutrition and cholera crises, as well as the dire need for storing water, meant that critical equipment needed to repair basic infrastructure had to be flown into Somalia from Geneva and Nairobi.

Pumps located at the boreholes started breaking down because they were running for longer periods than usual. Pumps and generators had to be procured by the dozen in order to secure more water, a lifeline to drought-affected people. In addition to repairing boreholes, national ICRC staff constructed hand-dug wells and installed both open storage tanks and temporary water troughs for livestock.

However, even the most essential and urgent functions such as transporting aid supplies have been expensive and at times challenging due to a range of human-made and natural factors: restrictive import rules, bureaucracy in countries through which aid is shipped, roadblocks by armed groups, the general need to take longer routes due to security concerns and, again, weather patterns.

Despite these challenges, the ICRC managed to deliver 440 truckloads of aid and airlift medical supplies to different parts of Somalia. In addition, two boats were purchased to access the isolated Bantu communities in the Bajuni Islands. Having the boats made it easier and more economical to do assessments and monitoring among these communities. “The boats have since been donated to the Somali Red Crescent Society for visits to the Bajunis”, says Gunther Kreissl, the coordinator for ICRC logistics activities in Somalia.

“In the monsoon season, ships reach the port of Bosasso from Mogadishu very slowly and they are very expensive,” he says, adding that some of the smaller transport vessels that the ICRC normally uses refuse to sail during the monsoon season when seas are particularly rough.

At Kismayo General Hospital’s stabilization centre, Fatuma looks on as her five-month-old grandson is weighed. The weight of malnourished children is monitored daily to see how they respond to treatment. Photo: Pedram Yazdi/ICRC

Getting through with cash
At the same time, Movement support for the Somali Red Crescent has allowed it to take advantage of evolving technologies and aid delivery innovations such as electronic mobile banking and data collection — a particular challenge given the constant movement of people as they search for food, water and some form of livelihood.

Use of mobile technology, for collecting epidemiological data and registering and following-up on aid beneficiaries, has allowed the National Society’s volunteers to collect, analyse, monitor and report data in a more timely and accurate way than ever before.

There are many challenges, however. The process entails collecting many types of data across an extensive area in which volunteers face varying obstacles in gaining access to people in need of aid.

On the other hand, cash transfers via telephone banking systems were already in wide use before the current drought struck, enabling the Somali Red Crescent and Movement partners to reach thousands with life-saving support.

Where markets are functioning, cash interventions have been credited with revitalizing local trade, albeit to a small extent, and increasing local resilience. But the degree to which markets can remain open, or be bolstered by cash, depends on whether people feel secure enough to make even the shortest of journeys.

Where phone networks were not available, or when beneficiaries were reluctant to share their phone numbers, cash vouchers were distributed. “The vouchers are exchanged for cash by selected financial service providers,” says Martin Kenny, ICRC cash and market specialist in Somalia.

A member of a Somali Red Crescent Society health team speaks to women about the advantages of breastfeeding, vaccination, proper hygiene and sanitation during a visit by the National Society’s mobile clinic to a village in central Somalia. Photo: Abdikarim Mohamed/ICRC

Working together
Cash transfers have become one platform for improved coordination as many agencies — as well as private sector banks and telecommunications companies — work together to create unified, easier- to-use systems for beneficiaries.

But there are still many challenges getting in the way of smooth coordination. According to some interviewed for this story, the Inter-Agency Standing Committee cluster system has not yet been fully activated in Somalia, so communication and coordination among all sectors of humanitarian aid could be improved.

Under the humanitarian cluster system, relief organizations work in groups known as clusters to share information and coordinate their actions on specific areas of concern, such as shelter or health. In Somalia, some clusters are more active than others. In some cases, the ICRC has had bilateral discussions with various clusters to share the locations of food distribution. This made it possible to avoid overlapping on the ground and ensure the help available reached as many people as possible, and that less-visible needs, including urgent ones, were met.

At the same time, communication channels in Somalia are not always available, further complicating coordination efforts. Fortunately, the long-term presence of the Movement meant that communication with relevant stakeholders and groups with influence on events, including armed actors, has been in place for many years and this helped reinforce the acceptance of Movement efforts in many areas.

Until long-lasting stability comes to the country, however, efforts to make desperately needed, large-scale improvements in Somalia’s transport, agriculture and health sectors that will improve the Somali people’s resilience to future droughts will also remain limited.

At Baidoa regional hospital in southern Somalia, a grandmother watches over her malnourished orphan grandchild. Both live in a camp for displaced people outside of town. Photo: Abdikarim Mohamed/ICRC

When death comes suddenly

At the cholera treatment centre in Baidoa, desperately ill people fill the corridors. Outside, an extra tent has been erected to accommodate the growing number of patients, many of whom are children. When night falls, many sleep outside.

This is just one cholera treatment centre supported by the ICRC. During the height of the emergency, the ICRC also supported the Baardheere treatment centre for a short time and a centre in Kismayo until it was closed due to a decline in the number of patients. These centres provided assistance to some 7,000 people and close to half were children.

Such centres have been critical as cholera can deplete children’s health quickly.

“Cholera comes suddenly and may quickly cause dangerous fluid loss,” says Ana Maria Guzman, ICRC health programme manager for Somalia. “The goal is to replace lost fluids using a simple rehydration solution.’’

Without rehydration, approximately half the people with cholera die. With treatment, the
number of fatalities drops to less than 1 per cent.

Meanwhile, Somali Red Crescent Society volunteers promote proper hygiene habits by making door-to-door visits, educating people about washing hands and other techniques for avoiding infectious disease. They also provide them with water purification tablets.

Still, conditions in many areas, including camps for displaced people, mean people still face an elevated risk of contamination. “Access to safe water and water storage conditions are dramatically below the minimum standard and large numbers of displaced people have extremely limited access to water,” notes Nicolas Boyrie, an IFRC relief delegate. “And, in some instances, the water they do access is contaminated.”

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