VZCZCXYZ0030
PP RUEHWEB

DE RUEHNR #2438/01 1560820
ZNR UUUUU ZZH
P 050820Z JUN 06
FM AMEMBASSY NAIROBI
TO RUEHC/SECSTATE WASHDC PRIORITY 2190
RUCNDT/USMISSION USUN NEW YORK 6952
RUEHDS/AMEMBASSY ADDIS ABABA 8559
RUEHBS/AMEMBASSY BRUSSELS 1688
RUEHRO/AMEMBASSY ROME 4934
RUEHGV/USMISSION GENEVA 3948
RHEHNSC/NSC WASHDC

UNCLAS NAIROBI 002438 
 
SIPDIS 
 
AIDAC 
 
SIPDIS 
 
STATE FOR AF/E, EPRATT 
USAID/W FOR AA/DCHA, WGARVELINK, LROGERS 
DCHA/OFDA FOR GGOTTLIEB, PMORRIS, CGOTTSCHALK, 
KCHANNELL 
DCHA/FFP FOR JDWORKEN, PMOHAN, DNELSON 
AFR/EA FOR JBORNS, JESCALONA 
USUN FOR EMALY 
ADDIS ABABA FOR JAUGSBURGER 
BRUSSELS FOR PLERNER 
ROME FOR FODAG 
GENEVA FOR NKYLOH 
NSC FOR JMELINE, TSHORTLEY 
 
E.O. 12958:  N/A 
TAGS: EAID KE
 
SUBJECT:  USAID/OFDA ASSESSMENT OF KENYA'S GARISSA 
DISTRICT 
 
Summary 
 
¶1. Although long season rains improved pasture 
conditions and water availability in most drought- 
affected areas of Kenya, patchy showers in Garissa 
District have left many areas dry, impeding recovery 
efforts.  Water tankering activities continue in 
several divisions where residents still face acute 
shortages.  The UN Children's Fund (UNICEF) reports 
that district malnutrition rates are above emergency 
levels, but the only facility at present to treat 
severe malnutrition is the provincial hospital in 
Garissa town.  USAID/OFDA has funded CARE to 
rehabilitate boreholes, and UNICEF to support 
immunization, primary healthcare, nutrition, and water 
activities in Garissa.  USAID/OFDA recommends continued 
support to emergency nutrition, health, and water 
interventions in the district. End Summary. 
 
Current Situation 
 
¶2.  Covering 33,681 square km, Garissa District is 
located in arid North Eastern Province.  The population 
is nearly 400,000, including 120,000 Somali refugees in 
Dabaab camp.  Although successive seasons of drought 
have affected all livelihood zones in the district, the 
impact has been most severe among pastoral households 
that make up 80 percent of the population. 
Agropastoralists in Garissa grow primarily 
horticultural crops in the river bed areas of the Tana 
River.  Although less affected by the current 
emergency, agricultural yields have declined in the 
past year due to drought conditions. 
 
¶3.  Garissa District is included in the Government of 
Kenya's (GOK) February Appeal.  In April, the GOK 
increased the number of food aid beneficiaries in the 
district from 109,745 to 120,719, significantly 
improving access to food for affected populations. 
However, the amount allocated was inadequate and local 
officials appealed to the central government to revise 
resource allocations. 
 
¶4.  From May 22 to 24, a USAID/OFDA team comprising a 
Public Health Advisor and an Information Officer 
traveled to Garissa District, accompanied by 
International Medical Corps' Country Director, to 
follow up on reports of deteriorating health and 
nutrition status.  The team met with district 
representatives from the Arid Lands Resource Management 
Project (ALRMP) and the Ministry of Health (MOH) in 
Garissa town, and traveled to Bura, Modogashe, and 
Balabala divisions to assess conditions. 
 
¶5.  District officials report that long season rains 
began falling in most of the district in April, but 
showers have been patchy.  According to USAID-supported 
Famine Early Warning System Network (FEWS NET) and data 
from the US Geological Survey, eastern parts of the 
district received average to heavy showers while rains 
were below average in northern and western divisions, 
with some areas receiving only 40 to 80 percent of 
normal levels.  Although rains replenished some of the 
shallow wells in the district, rainfall levels were not 
heavy enough for significant improvements in water and 
pasture availability.  The team confirmed that 
conditions in the areas visited were dry with little 
pasture and few water sources, and observed tanker 
trucks traveling along the Garissa-Modogashe road.  The 
Arid Lands Office reports that water tankering is 
continuing in Shimbirey, Abdi Gab, Ohi, and Alango 
villages. 
 
¶6.  According to ALRMP's April Drought Assessment 
Report, the onset of rains led to slight improvement in 
the availability of forage with substantial 
regeneration of browse in parts of the district 
receiving heavy rainfall.  However, there has been 
little sprouting of pasture, exacerbating acute 
shortages. 
 
Critical Health and Nutrition Situation 
 
¶7.  In October 2005, UNICEF and the MOH completed a 
nutritional survey in Garissa, which found 18.6 percent 
global acute malnutrition and 3.1 percent severe acute 
malnutrition.  In November/December 2005, Medecins Sans 
Frontieres/Spain and UNICEF planned to open therapeutic 
feeding centers (TFCs) in Modogashe, Balabala, and 
Shant-Abak divisions, but were unable to secure 
funding.  According to UNICEF and the MOH, the number 
of malnourished children in the district is likely to 
be higher than reported, as the survey was conducted 
when residents had been receiving general food rations 
for three months.  Livestock losses of 50 to 80 percent 
in parts of the district have seriously reduced the 
availability of milk and milk products, main staples of 
the population's diet. 
 
¶8.  The team visited Garissa hospital, the only one in 
the district, which serves as the referral hospital for 
all of North Eastern Province's nearly 1 million 
people.  The Hospital Superintendent reports that the 
MOH converted one ward of the pediatric unit to a TFC 
last year to treat the increasing number of 
malnourished children arriving at the hospital.  The 
hospital TFC remains the only facility in the district 
for treatment of severe malnutrition.  Although the 
Pediatric Unit has a 54-bed capacity, the assessment 
team found 64 children on the day of the visit, 34 of 
whom were enrolled in the TFC.  Enrollment averages 30 
cases per month, although admissions reached as high as 
60 in February and March.  Nine deaths were reported 
among the children in the TFC ward in April.  The 
Superintendent also reported high numbers of 
readmissions and default rates, but statistics were not 
available. 
 
¶9.  The Superintendent stated that many more children 
in the community are likely malnourished, but families 
lack knowledge about malnutrition and usually only 
bring children to the hospital when they have become 
acutely ill with malaria and pneumonia, or are 
unconscious.  In addition, the road network in the 
district is extremely poor and some remote areas are as 
far as 600 km from the hospital, thus preventing the 
poorest families without resources to pay for 
transportation and hospital fees from bringing children 
for treatment.  Traditional practices also deny 
families treatment as they prefer to use traditional 
healers and only come to the hospital as a last resort 
when other interventions have failed. 
 
¶10.  According to the district MOH official, the 
district has 30 health facilities, with 6 not 
operational at present due to staff shortages or 
infrastructural problems.  The team visited health 
centers in Bura and Modogashe, and a dispensary in 
Dujis.  In all areas visited, the major morbidities for 
children are malaria, upper respiratory infections, and 
diarrheal diseases.  The facilities have adequate 
supplies of drugs, but lack sufficient staff for 
outreach activities or vehicles to transport patients 
to the hospital for specialized care.  Facilities have 
catchment radii of 50 to 80 km, requiring residents to 
travel long distances to access health services. 
 
¶11.  Staff in health facilities interviewed by the team 
identified several challenges to working in Garissa, 
including remote location, difficult living conditions, 
low wages, water shortages, extreme heat, malaria risk, 
lack of housing, and poor supervision and support. 
 
¶12.  Although the health center staff identified 
several serious health and nutrition concerns in the 
community, they had limited data on trends or the 
numbers affected.  The team observed that facilities 
appeared to be underutilized, which was confirmed by 
nurses in each facility, attributing the communities' 
failure to use services to lack of resources and 
cultural and religious factors.  The fact that health 
care staff were all male was a significant obstacle to 
providing care to women in the Moslem community.  In 
addition, pastoralist families were often located in 
remote locations and moved frequently, preventing them 
from obtaining services on a regular basis.  Although 
the recent immunization campaign in the district 
reached 102 percent for polio and 97 percent for 
measles, routine immunization coverage is only 57 
percent.  It was apparent to the team that very little 
community outreach activities are conducted from these 
facilities to access the vulnerable hard-to-reach 
population. 
 
¶13.  In April, USAID/OFDA provided USD 800,000 to 
UNICEF to support immunization, primary healthcare, 
nutrition, and water activities in four drought- 
affected districts, including Garissa.  Additional 
plans are underway to support emergency nutrition 
activities in the district. 
 
Rains bring limited relief to acute water shortages 
 
¶14.  In all areas visited, local officials and 
community members highlighted the lack of water as a 
major concern.  The main sources of water in the 
district are the Tana river, boreholes, Benane springs, 
and shallow wells in Modogashe.  Rains in some parts of 
the district recharged water pans and relieved pressure 
on boreholes, some of which were operating 18 hours a 
day and prone to frequent breakdowns.  Officials noted 
that shallow wells along the dry river bed at Modogashe 
are getting deeper and yielding less water, increasing 
the time required to draw water.  USAID/OFDA is 
supporting CARE to rehabilitate boreholes and increase 
access to water in Dadaab, Jarajila, and Liboi 
divisions.  In addition, CARE proposes to repair an 
additional six boreholes in northern Garissa and 
Southern Wajir districts, which will address acute 
water needs. 
 
Conclusions/Recommendations 
 
¶15.  According to recent health and nutrition 
assessments and observations of the USAID/OFDA team, 
the situation for residents in drought-affected areas 
of Garissa remains precarious.  However, information 
regarding services presently available and existing 
needs is limited as health care providers have 
incomplete data about the affected community and do not 
conduct outreach activities to reach the most 
vulnerable populations.  The assessment team recommends 
that USAID/OFDA consider funding the following 
additional activities: 
 
a.  Support to community-based therapeutic care (CTC) 
programs to assist the number of malnourished children 
and pregnant and lactating women in the district. 
Emphasize CTC's community outreach component to 
integrate CTC into existing programs to complement and 
strengthen health education, hygiene promotion, water, 
sanitation, and livelihood programs. 
 
b.  Increase access to water sources as shortages are a 
problem across the district.  As boreholes are critical 
to the area during the two seasonal dry periods, 
support activities to rehabilitate boreholes and 
maintain functioning ones to make them more productive. 
BELLAMY