VZCZCXRO0270
RR RUEHRN RUEHROV RUEHTRO
DE RUEHNR #0326/01 0410832
ZNR UUUUU ZZH
R 100830Z FEB 10
FM AMEMBASSY NAIROBI
TO RUEHC/SECSTATE WASHDC 0790
INFO SOMALIA COLLECTIVE
RHEHNSC/WHITE HOUSE NATIONAL SECURITY COUNCIL WASHINGTON DC
RHMFISS/CJTF HOA
RHMFIUU/CDR USCENTCOM MACDILL AFB FL
RUEHRN/USMISSION UN ROME 0019

UNCLAS SECTION 01 OF 05 NAIROBI 000326 
 
AIDAC 
SIPDIS 
USAID/DCHA FOR SRIECHLE 
JBRAUSE 
DCHA/OFDA FOR ACONVERY 
KCHANNELL 
APIYAKA 
DCHA/FFP FOR BISHAM 
JDWORKEN 
SANTHONY 
CMUTAMBA 
PMOHAN 
DNELSON 
AFR/EA 
STATE FOR AF/E 
AF/F AND PRM 
USUN FOR DMERCADO 
BRUSSELS FOR PBROWN 
GENEVA FOR NKYLOH 
ROME FOR HSPANOS 
 
E.O. 12958: N/A 
TAGS: EAID PHUM PREL PREF SO
SUBJECT: NUTRITION AND HEALTH CONDITIONS IN SOMALIA REQUIRE URGENT 
HUMANITARIAN RESPONSE 
 
REF: NAIROBI 0224 
 
------- 
SUMMARY 
------- 
 
¶1.    (U) Humanitarian agencies continue to express 
concern over the health and nutrition conditions in 
Somalia, noting that a humanitarian response focused 
primarily on food assistance is not enough to mitigate a 
humanitarian crisis in Somalia.  A recent U.N. Food and 
Agriculture Organization (FAO) Food Security and 
Nutrition Analysis Unit (FSNAU) presentation indicates 
that malnutrition and mortality rates in Somalia are 
among the highest in the world.  Augmented and sustained 
support for programs designed to increase access to safe 
drinking water, educate women on proper weaning and 
feeding practices, provide emergency nutrition 
supplements for children with severe acute malnutrition, 
provide proper sanitation facilities, and improve access 
and quality of healthcare are critical to preventing 
increased malnutrition and mortality rates over the next 
six months. 
 
¶2.    (SBU) The USAID Office of U.S. Foreign Disaster 
Assistance (USAID/OFDA) continues to monitor nutrition 
and health conditions in Somalia and maintains a robust 
network of U.N. and non-governmental organization (NGO) 
partners capable of providing life-saving assistance in 
Somalia.  However, USAID/OFDA cannot implement an 
adequate humanitarian response under current U.S. 
Department of Treasury Office of Foreign Asset Control 
(OFAC)-related legal restrictions.  Emergency food 
assistance from the USAID Office of Food for Peace 
(USAID/FFP) is a critical component of the humanitarian 
response in Somalia, but its effectiveness depends on 
sustained support to complementary non-food assistance, 
including health, nutrition, water, sanitation, and 
hygiene programs.  Without crucial non-food assistance, 
food assistance alone can not assist communities with 
the process of early recovery.  End summary. 
 
------------------------------ 
CURRENT HUMANITARIAN SITUATION 
------------------------------ 
 
¶3.    (U) On January 29, FSNAU reported that an estimated 
3.2 million people will require humanitarian assistance 
in Somalia between January and June 2010, representing 
approximately 42 percent of the total estimated 
population of 7.5 million people and a nine percent 
decrease since July 2009 (Ref A).  Conflict and 
resulting population displacement could offset food 
security improvements resulting from an above-normal 
harvest in south Somalia.  In addition, targeted attacks 
against relief staff have resulted in activity 
suspension and diminishing access, hindering the 
provision of humanitarian assistance to populations in 
need.  An estimated 1.39 million internally displaced 
persons (IDPs) remain the largest single population 
group in crisis, representing 44 percent of the 3.2 
million people in need of humanitarian assistance in 
Somalia, with insecurity continuing to be the primary 
cause for displacement. 
 
NAIROBI 00000326  002 OF 005 
 
 
¶4.    (U) On January 5, the U.N. World Food Program (WFP) 
announced an indefinite closure of six offices in 
southern Somalia, citing escalating insecurity, attacks 
against aid workers, humanitarian staff abductions, and 
unacceptable demands from al-Shabaab as obstacles to the 
provision of emergency food assistance.  WFP plans to 
continue working throughout the rest of the country, 
including in Mogadishu and the Afgoye corridor, where 
the organization provides food assistance to 
approximately 1.8 million people. 
 
¶5.    (U) Humanitarian agencies note that escalating 
conflict and the recent WFP suspension are likely to 
result in increased population movements within Somalia 
and across international borders in the coming weeks. 
The Office of the U.N. High Commissioner for Refugees 
(UNHCR) has not observed a significant increase in 
refugee arrivals in Kenya to date in 2010, likely due to 
the above-normal harvest in southern Somalia and poor 
road conditions resulting from the recent rains. 
However, as families deplete food stocks, increased 
movement is likely.  As a result, UNHCR and WFP are 
developing contingency plans to respond to potential 
humanitarian needs associated with increased population 
movements. 
 
-------------------------- 
ON-GOING NUTRITION CRISIS 
-------------------------- 
 
¶6.    (U) In November and December 2009, FSNAU and 
partners completed 38 nutritional surveys, conducted 27 
urban site assessments, and collected information from 
health centers and selective feeding centers in Somalia. 
The results confirmed a sustained nutrition crisis in 
the country.  According to FSNAU, one in six children in 
Somalia is acutely malnourished and one in 22 is 
severely malnourished, with global acute malnutrition 
(GAM) rates of 16 percent and severe acute malnutrition 
(SAM) rates of 4.2 percent.  While national GAM and SAM 
rates have declined slightly compared to FSNAU 
assessment results released in September 2009, 
malnutrition rates in Somalia remain among the highest 
in the world.  FSNAU credits successful humanitarian 
interventions in areas of central and northern Somalia, 
which were designated as critical for nutrition in 
September 2009, for the decline in overall malnutrition 
rates. 
 
¶7.    (U) Malnutrition rates in areas of south and 
central Somalia are significantly above national levels. 
According to FSNAU, one in five children in south and 
central Somalia is acutely malnourished and one in 20 is 
severely malnourished, with GAM and SAM rates of 19 
percent and 4.5 percent, respectively.  Among IDP 
populations, FSNAU reports that one in four children is 
acutely malnourished.  Countrywide, approximately 
240,000 children under five years of age are acutely 
malnourished, of which 63,000 are severely malnourished 
and at a nine times higher risk of death than well- 
nourished children. 
 
¶8.    (U) According to FSNAU, malnutrition is 
particularly high in Juba, Gedo, Bakool, Bay, and Hiran 
regions.  Among pastoralists in Juba Region, FSNAU 
 
NAIROBI 00000326  003 OF 005 
 
 
reports GAM and SAM rates of nearly 24 percent and 7.5 
percent, respectively, likely associated with frequent 
disease outbreaks.  According to FSNAU, only 5 percent 
of pastoralists in Juba Region have access to safe 
drinking water and less than 3 percent have access to 
adequate sanitation facilities.  In Bakool Region and 
parts of Gedo Region, high malnutrition rates are likely 
associated with inadequate food access, according to 
FSNAU.  In Bay and Hiran regions, FSNAU reports that 
nutritional vulnerability is linked to both disease 
outbreaks and food access. 
 
¶9.    (U) FSNAU also found elevated levels of mortality 
in Somalia.  According to survey results, mortality 
rates are at or above emergency threshold levels in 
three areas of Somalia.  Among pastoral communities in 
Middle and Lower Juba regions, survey results indicate a 
crude death rate (CDR) of 2.2 and an under five death 
rate (U5DR) of 3, significantly above the CDR emergency 
threshold of one death per 10,000 people per day and the 
U5DR emergency threshold of two deaths per 10,000 
children under five years of age per day. FSNAU reports 
a 0.9 CDR and a 2 U5DR among pastoralists in central 
Somalia and a 1.3 CDR and a 2.3 U5DR among IDPs residing 
in the Afgoye corridor.  In all three areas, FSNAU 
reports that high mortality rates are likely associated 
with frequent disease outbreaks. 
 
--------------------------------------------- -------- 
NON-FOOD AID: A KEY FACTOR IN PREVENTING MALNUTRITION 
--------------------------------------------- -------- 
 
¶10.    (U) According to FSNAU, a persistent lack of access 
to safe drinking water, sanitation facilities, and 
adequate healthcare are significant contributing factors 
to sustained high levels of malnutrition.  FSNAU reports 
that 70 percent of the population in Somalia is unable 
to access safe drinking water, which predisposes the 
population to diarrhea and subsequently interferes with 
food absorption.   Recent health and nutrition surveys 
in Somalia confirm that children with illnesses have a 
1.55 times greater risk of developing acute malnutrition 
compared to healthy children, with diarrhea posing the 
highest risk. 
 
¶11.    (U) According to FSNAU, endemic sub-optimal feeding 
practices in Somalia also contribute to a high incidence 
of disease and malnutrition rates.  FSNAU notes that 
early cessation of breastfeeding and the increased use 
of dirty or contaminated bottles, both common practices 
in Somalia, place children at risk of contracting 
diarrhea, which can lead to malnutrition. 
 
¶12.    (U) Inadequate access to health services further 
exacerbates humanitarian conditions in Somalia.  In 
September 2009, FSNAU reported that the sufficient 
provision of adequate and accessible health services is 
significantly lacking.  Where health services are 
available, many families are unable to access the 
facilities due to distance, security, or economic 
constraints, consequently influencing health-seeking 
practices.  According to FSNAU, information from health 
centers indicates that caregivers often use local 
healing methods prior to seeking care at a health 
facility.  By the time an individual reaches a health 
 
NAIROBI 00000326  004 OF 005 
 
 
facility, it is often too late to provide adequate 
treatment. 
 
--------------------------------------------- ---- 
HUMANITARIAN IMPLICATIONS OF DELAYED USG FUNDING 
--------------------------------------------- ---- 
 
¶13.    (SBU) Sustained support for health, nutrition, 
water, sanitation and hygiene programs, in combination 
with improved food access, are critical components of an 
appropriate humanitarian response in Somalia.  However, 
under OFAC-related legal restrictions, USAID/OFDA has 
been unable to fund U.N. agencies that have a leading 
role in addressing humanitarian needs and providing 
life-saving assistance in fiscal year (FY) 2009 the FY 
¶2010.  These agencies include the U.N. Children's Fund 
(UNICEF), the U.N. World Health Organization (WHO), and 
FAO/FSNAU, among many others. 
 
¶14.    (U) FSNAU was started in 1994 with funding from 
USAID/OFDA and has received annual USAID/OFDA funding 
since FY 2000.  FSNAU has provided researchers, decision 
makers, and project implementers working in and on 
Somalia with vital information on food, nutrition, and 
livelihood security for the past sixteen years.  The 
critical role FSNAU plays in Somalia cannot be 
overestimated.  FSNAU consistently provides decision- 
makers in the humanitarian community with timely and 
appropriate information and analysis of conditions in 
Somalia.  This information enables the humanitarian 
community to develop early and appropriate responses to 
developing crises, as well as to develop longer-term 
strategies for Somalia. 
 
¶15.    (U) There is a direct and visible link between the 
research-based analyses provided by FSNAU, which allow 
U.N. agencies and NGOs to implement informed and 
targeted interventions, and the improved nutritional 
status of vulnerable populations in Somalia.  FSNAU 
relies heavily on USAID/OFDA support.  Without 
USAID/OFDA funding in FY 2010, FSNAU will be forced to 
significantly scale-back staffing, reporting, and 
assessments, hampering the ability of the humanitarian 
community to mitigate deteriorating humanitarian 
conditions in Somalia. 
 
¶16.    (U) UNICEF and WHO also depend on USAID/OFDA 
funding for much needed health and nutrition programs, 
including the Child Health Days (CHD) campaign, which 
provides women and children with critical health 
services, including vaccinations.  Since re-commencing 
in November 2009, UNICEF and WHO have reached more than 
288,000 children under five years of age and more than 
296,000 women in Mogadishu through the campaign.  The 
first two CHD campaigns reached approximately 2 million 
children under five years of age and more than 1.5 
million women of child-bearing age.  As of February 4, 
UNICEF had received USD 1.75 million of a requested USD 
64 million for FY 2010 to maintain life-saving health 
and nutrition programs in Somalia. 
 
¶17.    (U) USAID/OFDA support has helped WHO maintain 
disease surveillance systems.  In Lower Shabelle Region, 
WHO is operating 36 sites that provide regular trend 
monitoring and early detection and response to disease 
 
NAIROBI 00000326  005 OF 005 
 
 
outbreaks.  In 2009, WHO and partners responded to over 
70 rumored outbreaks within 96 hours of initial 
reporting.  WHO is the only agency that collects and 
transports outbreak-related samples from Somalia for 
confirmation in Nairobi or other referral laboratory 
facilities.  WHO has also trained more than 70 workers 
in delivering health services and effectively managing 
patients with acute watery diarrhea (AWD). 
 
¶18.    (U) Due to improved quality and timeliness of case 
management, coordination, training of healthcare 
workers, and the provision of standardized emergency 
medical supplies, overall AWD case fatality rates in 
Somalia have steadily declined since 2007.  As of 
February 4, WHO had only received USD 2.4 million of a 
requested USD 16.6 million for FY 2010 health 
activities. 
 
¶19.    (U) In a February 3 meeting between USAID, 
including USAID/OFDA and USAID/FFP staff, and the 
Somalia Transitional Federal Government(TFG), the 
Minister for Higher Education and the Minister of State 
for Planning and International Cooperation strongly 
noted that additional skills training, specifically for 
community health workers and birth attendants, is 
urgently needed. Not only would the training increase 
livelihood opportunities for a significant portion of 
the population, but it would also provide much needed 
support to the crumbling health system in Somalia.  In 
addition, training opportunities along with other forms 
of assistance would increase general levels of optimism 
in the ability of the TFG to provide social services 
thus increasing reliance on, and lessening the level of 
confidence in al-Shabaab to provide these same services 
and support. 
 
------- 
COMMENT 
------- 
 
¶20.    (SBU) The FSNAU assessment results indicate that 
health and nutrition conditions have marginally improved 
in some areas of Somalia over the past six months. 
However, a continued WFP suspension in al-Shabab 
controlled areas, depleted food stocks from the above- 
average harvest in south Somalia, disease outbreaks, and 
increased conflict and resulting population displacement 
could cause humanitarian conditions to rapidly 
deteriorate.  A continued delay of funding to U.N. 
agencies will have a direct and adverse affect on USAID 
efforts to respond to the dynamic situation in Somalia. 
In addition, funding delays will negatively impact U.S. 
efforts to develop and implement robust contingency 
plans in response to a potential escalation of 
humanitarian needs.  While food assistance is a critical 
component in addressing malnutrition, U.S. humanitarian 
efforts must be complemented with non-food humanitarian 
assistance in order to be fully effective. Additionally, 
a comprehensive and effective humanitarian response 
could play a pivotal role in influencing the ever- 
changing landscape in Somalia. 
RANNEBERGER