VZCZCXYZ0005
OO RUEHWEB

DE RUEHDS #0213/01 0290448
ZNR UUUUU ZZH
O 290448Z JAN 08
FM AMEMBASSY ADDIS ABABA
TO RUEHC/SECSTATE WASHDC IMMEDIATE 9320
INFO RUEHAE/AMEMBASSY ASMARA 2091
RUEHDJ/AMEMBASSY DJIBOUTI 8885
RUEHNR/AMEMBASSY NAIROBI 3341
RUEHBS/AMEMBASSY BRUSSELS 3065
RUEHGV/USMISSION GENEVA 4143
RUEHLO/AMEMBASSY LONDON 2999
RUEHRO/AMEMBASSY ROME 6356
RUCNDT/USMISSION USUN NEW YORK 7218
RUEHC/DEPT OF INTERIOR WASHDC
RUEHRC/DEPT OF AGRICULTURE WASHDC
RHMFIUU/HQ USCENTCOM MACDILL AFB FL//CCJ2/CCJ5/CCJS//
RHEFDIA/DIA WASHDC
RHMFISS/CJTF HOA
RHEHNSC/NSC WASHDC

UNCLAS ADDIS ABABA 000213 
 
SIPDIS 
 
STATE DEPARTMENT FOR A/S FRAZER, DAS AF JSWAN, AF/E, AF/PDPA, OES, 
A/S PRM SAUERBREY, AND PRM/AFR 
AFR/AA KALMQUIST, WWARREN, JBORNS, KNELSON,CTHOMPSON 
DCHA/AA MHESS, GGOTTLIEB 
DCHA/OFDA KLUU, ACONVERY, CCHAN, PMORRIS, KCHANNELL 
DCHA/FFP JDWORKEN, PMOHAN, SANTHONY, PBERTOLIN 
LONDON, PARIS, ROME FOR AFRICA WATCHER 
CJTF-HOA AND USCENTCOM FOR POLAD 
USDA/FAS FOR U/S PENN, RTILSWORTH, AND LPANASUK 
NAIROBI FOR OFDA/ECARO JMYER, GPLATT, RFFPO NCOX, USAID/EA 
ROME FOR AMBASSADOR, OHA, HSPANOS 
BRUSSELS FOR USEU PBROWN 
GENEVA FOR NKYLOH, RMA 
USUN FOR FSHANKS 
NSC FOR PMARCHAN 
 
AIDAC 
SIPDIS 
 
E.O. 12958: N/A 
TAGS: EAID PHUM SENV EAGR PGOV ET
REF:  A) ADDIS 3644  B) ADDIS 3642  C) ADDIS 0053  D) ADDIS 0120 
SUBJECT: USG HUMANITARIAN ASSISTANCE TEAM FIELD VISIT #3: HEALTH AND 
NUTRITON UPDATE 
 
 
------- 
Summary 
------- 
 
¶1.  Between January 15 and 21, U.S. Government (USG) Humanitarian 
Assistance Team (HAT) in Ethiopia staff, traveled to Gode and Korahe 
zones in Somali Region as part of a third field visit to assess the 
current humanitarian situation, including health and nutrition 
conditions.  USG HAT staff report that to date no large disease 
outbreaks have been reported in the region.  However, USG HAT note 
that surveillance data is limited and an immediate concern for a 
potential outbreak of measles, particularly within the 
conflict-affected zones of Fik, Degehabur, Korahe, Gode, and Warder. 
 In response to laboratory-confirmed cases of measles in Warder and 
Gode zones, the U.N. Children's Fund (UNICEF) and the Government of 
the Federal Democratic Republic of Ethiopia (GFDRE) Ministry of 
Health (MOH) have initiated preparations for an early February 
regional measles campaign. 
 
¶2.  USG HAT staff did not observe indicators of widespread 
malnutrition in areas visited, but characterized current nutrition 
conditions as poor. USG HAT staff note that Somali Region 
experiences chronically high levels of acute malnutrition that are 
expected to further deteriorate as the January to March jilal season 
progresses and as a result of the cumulative impact of the poor 
performance of the 2007 rains, disruptions in food assistance, and 
ongoing insecurity and commercial trade restrictions.  USG HAT staff 
emphasize the need for standardized nutritional surveys in the 
region to identify vulnerable populations and inform appropriate 
response interventions.  In addition, USG HAT report that access to 
health care remains limited despite reports of improved access to 
rural communities and GFDRE authorization of USAID Office of U.S. 
Foreign Disaster Assistance (USAID/OFDA)-funded UNICEF mobile health 
teams to operate within conflict-affected areas in recent weeks. 
End summary. 
 
--------------------------------------------- ----- 
MEASLES CONFIRMED - CAMPAIGN PREPARATIONS UNDERWAY 
--------------------------------------------- ----- 
 
¶3.  On January 11, UNICEF reported that four measles cases in Kelafo 
District, Gode Zone, and one measles case in Warder town, Warder 
Zone, had been laboratory-confirmed.  To date, the total number of 
reported measles cases has been relatively low, but due to the low 
measles immunization coverage and concern about increasing levels of 
acute malnutrition, USG HAT staff identify a region-wide measles 
campaign as a high priority.  USG HAT staff report low immunization 
coverage throughout Somali Region, including Gode and Korahe zones, 
where USG HAT staff note an absence of outreach services in 
Kebridehar District, Korahe Zone.  The district health officer in 
Kelafo estimated measles coverage at 30 percent.  In addition, there 
is an increased movement of people within the region related to 
ongoing insecurity which could facilitate the spread of measles and 
other communicable diseases. 
 
¶4.  On January 17, USG HAT staff visited two villages in Kelafo 
District, where UNICEF recently reported four confirmed cases of 
measles.  USG HAT staff report that estimates on the number of 
suspected measles ranges from 15 to 50, and that local populations 
 
report that no new cases have occurred since December. 
 
¶5.  On January 16, UNICEF reported that the Somali Regional Health 
Bureau had agreed to support a regional measles campaign with a 
targeted start date of February 4. 
The target age group will be children from 6 to 59 months of age, 
and the campaign will include vitamin A supplementation.  Access to 
the population and community mobilization will likely be key factors 
in determining whether or not the proposed campaign is successful. 
According to district health officials in Gode, Kelafo, and Denan, a 
measles campaign is feasible due to improved security and the 
congregation of pastoralists near known water points during the 
current dry season.  USG HAT staff also note the presence of a 
viable cold chain in Kebridehar and Shilambo districts to facilitate 
the implementation of a measles campaign, security and access 
permitting. 
USG HAT staff will continue to monitor progress in campaign planning 
and implementation. 
 
--------------------------------------------- ---------- 
DECLINE IN NUTRITIONAL LEVELS EXPECTED - SURVEYS NEEDED 
--------------------------------------------- ------- 
 
 
¶6.  According to district health officers and non-governmental 
organization (NGO) staff in areas visited in Gode and Korahe zones 
by USG HAT staff, the nutritional status of children is poor but has 
not reached a critical stage.  In a January 15 meeting with USG HAT 
staff, the Gode Zone health official reported no evidence of serious 
malnutrition at this time, but expressed concern for the nutritional 
status of the elderly and pregnant and lactating women as the 
January to March jilal dry season progresses, due to limited food 
supplies and prioritization of children feeding practices within the 
household.  Current conditions are exacerbated by the poor 
performance of the 2007 rains, lack of grazing land, disruptions in 
food assistance, and ongoing insecurity and commercial trade 
restrictions.  USG HAT staff note the strong likelihood of a further 
and rapid deterioration in the health and nutritional status of 
children in the coming months in the absence of nutritional 
interventions and improved food aid delivery, particularly to rural 
areas. 
 
¶7.  USG HAT staff report limited outreach for nutrition screening 
and feeding programs in areas visited. Although health facilities in 
Gode, Denan, and Kebridehar districts currently operate treatment 
programs for severely malnourished children, there is no systematic 
screening mechanism to identify malnourished children in the 
community.  In Kelafo District, USAID/OFDA implementing partner 
Adventist Development and Relief Agency (ADRA) is implementing an 
emergency relief community therapeutic care (CTC) program.  In 
December, ADRA admitted 160 children to the CTC and an additional 87 
children between January 1 and 14.  ADRA notes that the figures 
represent an increase compared to previous months, but attributes 
the increase to increased coverage, as opposed to an increase in 
malnutrition levels.  USG HAT staff recommend the replication of 
NGO-operated programs like ADRA's within conflict-affected areas of 
Somali Region that are capable of screening and providing treatment 
for a large number of children and pregnant and lactating women. 
 
¶8.  The absence of nutritional data for Somali Region continues to 
hinder efforts to identify populations at risk and inform 
appropriate response actions.  Gode Zone health officials report an 
absence of recent nutritional assessments and data for Gode Zone. 
Currently, information provided through nutritional screenings 
conducted by USAID/OFDA-funded UNICEF mobile health, nutrition, 
water, sanitation, and hygiene teams represent the only source of 
nutrition information in Gode Zone.  USG HAT staff emphasize that 
mobile health team data is limited and cannot take the place of 
standardized nutritional surveys.  USG HAT staff recommend close 
monitoring of the nutritional situation in order to facilitate the 
timely implementation of emergency nutrition interventions if 
required, including targeted supplemental feeding programs.  In 
addition, USG HAT recommend USG advocacy with the GFDRE Disaster 
Prevention and Preparedness Agency (DPPA) Emergency Nutrition 
Coordination Unit to permit and support standardized nutrition 
surveys in Somali Region, particularly within the conflict-affected 
areas to identify vulnerable populations and inform relief 
programming. 
 
---------------------------------- 
HEALTH CARE ACCESS REMAINS LIMITED 
---------------------------------- 
 
¶9.  USG HAT staff report that despite reports of improved 
humanitarian access in Somali Region in recent weeks, health care 
access remains severely limited, due to a lack of capacity, 
staffing, and medical supplies.  According to NGO and UNICEF staff 
operating in Gode and Korahe zones, access and movement to rural 
communities have improved in recent weeks.  Medicine du Monde (MDM) 
reported no restrictions in accessing MDM health posts in Korahe 
Zone.  In addition, local NGO Ogaden Welfare and Development 
Association (OWDA) noted improved access to rural areas of Denan 
District, Gode Zone, although OWDA has not yet restarted outreach 
activities. 
 
¶10.  However, overall access to health care remains low, especially 
in remote and conflict-affected areas.  USG HAT staff report that 
many health posts have not received medicines and are either 
minimally functional or not functional, regardless of staffing 
presence.  However, efforts to address health post staffing deficits 
are beginning to be addressed through the deployment of newly 
trained pastoral health extension workers to a limited number of 
health facilities in the region.  USG HAT staff also received 
reports of continued Ethiopian National Defense Force 
(ENDF)-occupation of health posts, including Gabogabo, Nustariq and 
Karanbilcinle health facilities in Korahe Zone, according to the 
U.N. Office for the Coordination of Humanitarian Affairs (OCHA). 
 
¶11.  In a January 15 meeting with USG HAT staff, the Gode Zone 
health official noted his appreciation for UASID/OFDA-funded mobile 
health teams operating in Gode Zone, including health team reporting 
on rural health conditions.  Five mobile health teams have been 
active in non-conflict-affected areas of Gode Zone since late 
November 2007.  In January, the Office of the Somali Regional 
President approved an additional nine mobile teams to operate within 
conflict-affected areas of Gode and Korahe zones.  During the week 
of January 14, four of the nine mobile health teams initiated 
operations in Denan, Kebridehar, Shilambo and Debowyne districts. 
 
However, three of the four teams had not yet received medicines from 
the Regional Health Bureau and were borrowing supplies from the 
district health office.  USG HAT staff note that mobile health teams 
are providing critical basic services to remote areas, but emphasize 
the need for improved monitoring and coordination to maximize 
effectiveness and prevent duplication in area coverage.  In 
Kebridehar District, for example, mobile health teams were scheduled 
to work in some of the same areas currently being supported by MDM. 
In addition, the current number of mobile teams is inadequate to 
address coverage needs in the region. 
 
---------- 
Conclusion 
---------- 
 
¶13.  USG HAT staff characterize current health access and nutrition 
conditions in areas of Gode and Korahe zones visited as poor.  USG 
HAT staff caution that conditions are expected to further 
deteriorate as the January to March jilal season progresses.  In 
response, USG HAT staff emphasize the need for standardized 
nutritional surveys in the region to identify vulnerable populations 
and inform appropriate response interventions, including targeted 
supplemental feeding programs.  USG HAT staff also recommend the 
expansion and improved monitoring and coordination of mobile health 
teams operating in Somali Region to address severe limitations on 
health care access, particularly within conflict-affected areas.  In 
addition, USG HAT staff will continue to monitor progress and 
support the implementation and planning of a regional measles 
campaign. 
 
YAMAMOT