VZCZCXRO4091
RR RUEHDE RUEHROV RUEHTRO
DE RUEHNR #0369/01 0220851
ZNR UUUUU ZZH
R 220851Z JAN 07
FM AMEMBASSY NAIROBI
TO RUEHC/SECSTATE WASHDC 6855
INFO RUCNSOM/SOMALIA COLLECTIVE
RUEHRN/USMISSION UN ROME 0045
RHEHNSC/NSC WASHDC
RHMFIUU/CJTF HOA
RHMFIUU/CDR USCENTCOM MACDILL AFB FL
RUEKJCS/SECDEF WASHINGTON DC
RUEKJCS/JOINT STAFF WASHINGTON DC

UNCLAS SECTION 01 OF 05 NAIROBI 000369 
 
SIPDIS 
 
AIDAC 
 
USAID/DCHA FOR MHESS, WGARVELINK, LROGERS 
DCHA/OFDA FOR KLUU, GGOTTLIEB, AFERRARA, ACONVERY, 
CGOTTSCHALK, KCHANNELL 
DCHA/FFP FOR WHAMMINK, JDWORKEN 
AFR/AFR/EA FOR JBORNS 
STATE/F FOR ASISSON 
STATE FOR AF/E AND PRM 
STATE/AF/E FOR NGARY 
STATE/PRM FOR AWENDT, MMCKELVEY 
NSC FOR TSHORTLEY 
USUN FOR TMALY 
BRUSSELS FOR PLERNER 
GENEVA FOR NKYLOH 
USMISSION UN ROME FODAG FOR RNEWBERG 
 
SIPDIS 
 
E.O. 12958:  N/A 
TAGS: EAID PREF PHUM PREL SO
SUBJECT:  SOMALIA DART SITUATION REPORT 6 NUTRITION IN 
SOUTHERN AND CENTRAL REGIONS 
 
NAIROBI 00000369  001.2 OF 005 
 
 
SUMMARY 
 
¶1.  In 2006, nutrition surveys revealed high rates of 
malnutrition in Bakool, Bay, Gedo, Lower Juba, and 
Middle Juba, while Hiraan, the Shabelle Valley, and 
parts of central Somalia had slightly better rates.  In 
response, the UN Children?s Fund (UNICEF), the UN 
cluster lead for nutrition, is scaling-up supplemental 
feeding programs and is introducing community 
therapeutic care (CTC) initiatives.  However, UNICEF 
reports that Juba and Shabelle riverine areas and Bay 
Region lack sufficient nutritional program coverage. 
The USG Disaster Assistance Response Team (DART) 
recommends the integration of health, nutrition, 
livelihood, and water, sanitation, and hygiene 
interventions in order to produce sustainable 
achievements in the nutrition sector.  End Summary. 
 
¶2.  The following cable reviews nutritional trends in 
2006, analyzes factors that may affect the food 
security and nutritional status of Somali communities 
in the coming months, and makes recommendations for 
nutrition programs.  The DART is closely monitoring the 
impact of flooding and conflict on nutritional 
indicators as well as the progress of interventions to 
improve malnutrition rates in Somalia. 
 
OVERVIEW OF NUTRITION IN SOMALIA 
 
¶3.  According to the 2007 UN Consolidated Appeals 
Process (CAP), approximately 60,000 children under five 
years of age are in need of nutritional support in 
Somalia, with the majority residing in southern and 
central regions.  Somalia?s nutrition indicators 
continue to be poor following successive years of 
drought, flooding, and conflict.  Technical capacity, 
community support, and the transition of non-government 
supported nutrition programs to a functioning system 
under the Somali Transitional Federal Government (TFG) 
are primary concerns for the nutrition sector. 
 
¶4.  UNICEF is the lead agency coordinating activities 
in the nutrition cluster.  As the lead agency, UNICEF 
monitors and reports on outcomes of nutrition surveys, 
identifies geographic priorities for nutrition support 
services, makes recommendations for nutrition 
assessments and surveys, identifies gaps in nutrition 
interventions, reviews and formulates survey 
guidelines, and establishes nutrition intervention 
policies and priorities.  UNICEF works closely with the 
UN Food and Agriculture Organization?s (FAO) Food 
Security Analysis Unit (FSAU), and other agencies 
providing nutritional support services.  FSAU routinely 
monitors the nutritional status of children through 
formal nutritional surveys as well as through sentinel 
site surveillance, which highlights trends in 
malnutrition levels over time. 
 
¶5.  At the January UN nutrition sector meeting, aid 
agencies reported that the immediate impact of recent 
conflict on the current nutritional situation was 
minimal.  However, the November-December floods are 
expected to have an impact on the availability of food 
resources in the coming months because the high water 
levels destroyed crops, irrigation canals, underground 
food and seed stores, and interrupted transport of 
commercial and relief food. 
 
 
NAIROBI 00000369  002.2 OF 005 
 
 
RECENT NUTRITION STUDIES 
 
¶6.  The emergency thresholds for malnutrition are 
global acute malnutrition (GAM) rates exceeding 15 
percent and severe acute malnutrition (SAM) rates 
greater than 1 percent.  According to UNICEF and FSAU 
nutrition surveillance reports, across the conflict and 
flood-affected regions of southern and central Somalia, 
malnutrition rates of 15 percent and higher persist. 
 
¶7.  In December, a cluster survey conducted by UNICEF, 
FSAU, and the non-governmental organization (NGO) 
International Medical Corps (IMC) in El Barde District 
of Bakool Region showed a GAM rate of 17.7 percent and 
a SAM rate of 3.2 percent, signifying a critical 
situation.  A similar study conducted in the same 
district two years ago showed only slightly lower rates 
of 15.7 percent GAM and 1.3 percent SAM.  While direct 
comparison of the studies is not feasible due to the 
different times of the year the studies were 
undertaken, the rise in GAM and SAM rates indicates a 
trend of increasing acute malnutrition in the region. 
 
¶8.  In February 2006, in Wajid District of Bakool 
Region, Action Contre la Faim (ACF), UNICEF, and FSAU 
conducted a nutrition assessment of 142 children from 
two internally displaced person (IDP) camps in Wajid 
town.  The assessment found 27 percent GAM and 8.6 
percent SAM.  While the assessment sample was small, 
the results did provide alarming information on the 
nutritional status of these IDP children.  In response, 
the UN World Food Program (WFP) commenced food 
distribution, and Medecins Sans Frontieres (MSF)- 
Belgium assisted the severely malnourished through 
their therapeutic feeding program.  Research found that 
many of these families had migrated from Gedo and Bay 
regions during the drought in search of water and 
animal fodder. 
 
¶9.  In Bay Region, FSAU analyzed nutritional data from 
15 sentinel sites that was collected from January 2006 
to June 2006.  Data from these sites indicated a high 
proportion of malnourished children, with GAM rates as 
high as 28 percent in Baidoa, Burakaba, and Berdale 
districts.  While this data is not as accurate as a 
formal nutritional survey, it does provide a picture of 
the ongoing nutritional situation of children under the 
age of five over several months. 
 
¶10.  In March 2006, a formal nutrition survey was 
conducted in northern Gedo Region that showed rates of 
23.8 percent GAM and 3.7 percent SAM.  In May 2006, 
Bardera town in southern Gedo Region was surveyed and 
results indicated a similar situation with rates of 19 
percent GAM and 3.9 percent SAM.  While this data was 
collected at the end of the dry season (after two years 
of poor crop harvest), it does highlight the need for 
nutritional support programs in this region. 
 
¶11.  Lower and Middle Juba regions also have alarming 
malnutrition rates.  The Juba River basin has suffered 
significantly from drought, ongoing inter-clan 
conflict, and a paucity of NGO-supported health and 
nutrition interventions, which is in part due to 
inaccessibility and insecurity.  In May 2006, FSAU and 
UNICEF surveyed Afmadow District, Lower Juba Region, 
and reported 22 percent GAM and 4.2 percent SAM. 
During the same month, MSF-Holland conducted a similar 
 
NAIROBI 00000369  003.2 OF 005 
 
 
nutrition survey in Marere, Middle Juba Region, that 
showed rates of 16.2 percent GAM and 4.2 percent SAM. 
Also during May and just north of the location of MSF?s 
survey, World Vision and UNICEF conducted a nutrition 
survey in Sacco District and found rates of 21.9 
percent GAM and 6.6 percent SAM. 
 
¶12.  In central Somalia, Galgadud District has 
malnutrition rates ranging from 15 to 19 percent GAM 
and Mudug District 10 to 14 percent GAM.  Causes for 
these high rates are consistent with those identified 
in southern regions, while a stronger social support 
system of a more homogeneous clan structure prevents 
these rates from worsening. 
 
¶13.  In 2006, data from the sentinel sites in Hiraan 
and the Shabelle Valley regions show a somewhat better 
picture, indicating lower levels of malnutrition when 
compared with neighboring regions.  These regions had 
GAM rates of less than 10 percent.  In these regions, 
dietary diversity exists; more households consume 
micronutrient-rich foods such as fruits and vegetables, 
and have low morbidity levels, which are linked to 
their healthier nutritional situation. 
 
¶14.  In 2006, the nutritional surveys reviewed indicate 
critical situations in Bakool, Bay, Gedo, Lower Juba, 
and Middle Juba, while Hiraan, the Shabelle Valley, and 
parts of central Somalia had slightly better rates. 
 
CAUSES OF POOR NUTRITION IN SOMALIA 
 
¶15.  Poor diet and the presence of communicable 
diseases contribute to the high malnutrition rates in 
Somalia.  The high disease prevalence is related to 
limited access to preventive and curative health 
services, lack of sanitary facilities, and consumption 
of water from unsafe sources such as rivers, surface 
water, unprotected wells, and water catchments. 
Additionally, poor breastfeeding and weaning practices, 
lack of diversity in diet, and limited consumption of 
fresh fruits and vegetables also contribute to poor 
nutrition. 
 
NUTRITION REPONSE ACTIVITIES 
 
¶16. As the lead nutrition agency, UNICEF is currently 
scaling-up supplemental feeding programs (SFPs) and has 
increased the number of SFPs in Gedo, Bakool, and 
Middle Juba regions through partnerships with local and 
international NGOs.  UNICEF has begun to adopt the CTC 
approach to address severe malnutrition and has 
partnered with a number of local and international NGOs 
to roll out CTC, primarily in southern and central 
Somalia.  CTC allows mothers of severely malnourished 
children to provide ready-to-use therapeutic food to 
their children at home, decreasing the burden that 
residential care brings to the family. 
 
¶17.  IMC, ACF, World Vision, and MSF are some of the 
agencies moving away from the traditional residential 
therapeutic feeding programs to the CTC approach and 
report initial success. 
 
¶18.  According to UNICEF, regions in southern Somalia 
that remain underserved for supplemental and 
therapeutic feeding programs are Juba and Shabelle 
riverine areas and Bay Region. 
 
NAIROBI 00000369  004.2 OF 005 
 
 
 
¶19.  UN agencies and NGOs have recently reported 
difficulties in getting supplies to nutrition programs 
in Somalia due insecurity and the Kenya-Somalia border 
closure.  While in-country stocks are adequate for the 
short-term, unless stocks are replenished soon, 
shortages may occur. 
 
COMPLEMENTARY ACTIVITIES 
 
¶20.  Health, nutrition, livelihood, and water, 
sanitation, and hygiene interventions need to be 
integrated to produce sustainable achievements in the 
nutrition sector.  For example, increasing access to 
safe drinking water will have a direct impact on 
community-level health and nutrition status.  Nutrition 
and health education for mothers on optimal 
breastfeeding, weaning, and basic sanitation practices 
will also affect family nutrition and household health. 
Additionally, increasing access to preventive and 
curative health and nutrition services, including 
vaccination and maternal child health services, helps 
to mitigate high malnutrition rates. 
 
¶21.  While it is too soon to determine the full impact 
that the flooding and conflict have had on food 
security, flood recovery efforts remain a priority for 
the humanitarian community, as these will have a direct 
impact on household food availability.  Recessional 
planting, riverbank rehabilitation (a priority before 
the onset of the long rains in March), desilting of 
wells, decontamination of water points, and rebuilding 
of sanitary facilities are complementary activities 
that will also help to improve the nutritional 
situation in Somalia. 
 
CONCLUSIONS AND RECOMMENDATIONS 
 
¶22.  The DART recommends supporting the closer 
integration of nutrition, health, and livelihood 
initiatives with water, sanitation, and hygiene 
activities to enhance the resilience of vulnerable 
populations. 
 
¶23.  The DART also supports the UNICEF CTC strategy of 
treating severely malnourished children through 
partnerships with local and international NGOs. 
 
¶24.  In 2007, nutrition will continue to be among 
USAID?s Office of U.S. Foreign Disaster Assistance?s 
(USAID/OFDA) funding priorities along with health, 
livelihood, and water, sanitation, and hygiene sectors. 
USAID will prioritize funding of multi-sectoral 
strategies.  An example of a multi-sectoral approach is 
a water, sanitation, and hygiene project that uses 
well-water runoff for community gardens, which enhance 
dietary diversity and provide a source of income for 
women selling produce.  Another successful approach is 
a feeding program that links mothers of malnourished 
infants to income-generation activities. 
 
¶25.  The DART will continue to monitor nutrition 
indicators and support implementing partners in the 
nutrition sector.  The DART will also closely monitor 
nutrition supply stocks and advocate with the UN, the 
TFG, the Government of Kenya, and air transport 
organizations to facilitate the transport of life- 
saving humanitarian supplies. 
 
NAIROBI 00000369  005.2 OF 005 
 
 
 
RANNEBERGER