VZCZCXYZ0005
OO RUEHWEB

DE RUEHDS #0028/01 0080808
ZNR UUUUU ZZH
O 080808Z JAN 08
FM AMEMBASSY ADDIS ABABA
TO RUEHC/SECSTATE WASHDC IMMEDIATE 9015
INFO RUEHAE/AMEMBASSY ASMARA 2043
RUEHDJ/AMEMBASSY DJIBOUTI 8840
RUEHNR/AMEMBASSY NAIROBI 3295
RUEHBS/AMEMBASSY BRUSSELS 3025
RUEHGV/USMISSION GENEVA 4093
RUEHLO/AMEMBASSY LONDON 2959
RUEHRO/AMEMBASSY ROME 6316
RUCNDT/USMISSION USUN NEW YORK 7149
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 000028 
 
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 TMALY 
NSC FOR PMARCHAN 
 
SENSITIVE 
SIPDIS 
 
E.O. 12958: N/A 
TAGS: EAID PHUM SENV EAGR PGOV ET
REF:  A) ADDIS ABABA 3642 
SUBJECT: USG HUMANITARIAN ASSISTANCE TEAM: HEALTH AND NUTRITION 
UPDATE #2 
 
 
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SUMMARY 
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¶1. (U) Summary:   Between December 27 and 30, the U.S. Government 
(USG) Humanitarian Assistance Team (HAT) in Ethiopia health and 
nutrition specialist traveled to Jijiga and Degehabur zones in 
Somali Region as part of an initial field visit to assess 
humanitarian conditions and evaluate preliminary health and 
nutrition reports collected in Addis Ababa.  USG HAT staff met with 
representatives from the U.N., the Government of the Federal 
Democratic Republic of Ethiopia (GFDRE), and non-governmental 
organizations (NGOs) operating in Jijiga and Degehabur zones. 
 
¶2. (U) The absence of reliable health and nutrition data for Somali 
Region extends to Degehabur Zone, where no population-based data is 
available for 2007, complicating efforts to determine the severity 
and magnitude of reports of deteriorating humanitarian conditions. 
USG HAT staff report that despite the recent reopening of several 
health posts along the main road in Degehabur District since 
mid-December, the capacity of health facilities remains low due to 
lack of essential medical supplies.  In addition, reduced access to 
remote areas in Degehabur District and surrounding districts in 
Degehabur Zone continues to undermine health service delivery and 
humanitarian response efforts.  According to USG HAT staff, low 
measles coverage and the anticipated increase in the prevalence of 
acute malnutrition with the onset of the jilal dry season from 
January to April are of significant concern.  The focus of 
information gathered from the December 27 to 30 field visit is 
specific to Degehabur zone and does not necessarily reflect 
conditions in other conflict-affected areas of Somali Region.  End 
summary. 
 
---------------------------------- 
REDUCED HEALTH ACCESS AND DELIVERY 
---------------------------------- 
 
¶3. (SBU) Since June 2007, the combined effect of the loss of health 
staff due to conflict and the decreased availability of medical 
supplies due to restrictions on movement has negatively affected the 
capacity of existing health facilities to provide adequate care in 
conflict-affected areas of Somali Region, according to the head of 
the Somali Regional Health Bureau (RHB).  In addition, health post 
closures have undermined health service delivery.  The most affected 
health facilities are health posts, which typically serve remote 
populations, in particular in Degehabur and Fik zones, according to 
the RHB. 
 
¶4. (U) USG HAT staff visited several health posts previously closed 
during the conflict that have reopened since mid-December along the 
main road between Jijiga and Degehabur and points further south. 
However, USG HAT staff report that these posts lack medical supplies 
and are staffed by primary health workers with limited training. 
The only supplies available are essential drugs provided by the U.N. 
Children's Fund (UNICEF).  Drugs provided by the GFDRE RHB in July 
2007 do not appear to have reached health post destinations, 
although USG HAT staff note that it is unclear whether this is due 
to poor management and tracking procedures or failed deliveries. 
 
¶5. (SBU) In addition, USG HAT staff received reports of military 
closures and destruction of health facilities in Degehabur District. 
 In one of the villages visited by USG HAT staff village, health 
care staff reported that the health post reopened on December 26, 
following seven months of military occupation.  However, staff 
reported that one room of the two-room facility continues to be 
utilized by the military.  In a nearby village, health staff 
reported that the health post reopened in mid-Decemebr, following 
six months of military closure.  Health staff reported that their 
previous health post along the Degehabur/Degehamedo road had been 
closed by the military and subsequently burned along with the 
village.  USG HAT staff were not able to access this area and unable 
to directly confirm the report. 
 
¶6. (U) Emergency response efforts have also encountered access 
restrictions and a lack of clarity regarding bureaucratic procedures 
for approval to operate in conflict-affected areas.  Medecins Sans 
Frontieres/Greece (MSF/Greece) reported that it has taken nearly two 
months to receive approval to establish a base in Degehabur 
District.  However, as of December 29, MSF/Greece remains restricted 
to Degehabur town and has not received military approval to access 
more remote areas, despite verbal approval from the zonal and 
district administrators. 
 
¶7. (SBU) Required military escorts for vehicles delivering drugs in 
conflict-affected areas is delaying the deployment of USAID Office 
of U.S. Foreign Disaster Assistance (USAID/OFDA)-funded UNICEF 
mobile health, nutrition, and water, sanitation, and hygiene (WASH) 
teams in conflict-affected areas of Somali Region.  The RHB will 
currently not accept a military escort for mobile teams due to 
concerns of compromising RHB neutrality.  In addition, UNICEF 
reported that mobile teams operating in the conflict-affected areas 
are now required to submit staff clan affiliations to the GFDRE 
Office of the Somali Regional President for review and that approval 
is currently pending.  Furthermore, UNICEF reports that even if 
clearances and issues of military escort are resolved at the 
regional level, it is concerned that the process will have to be 
repeated at the zonal and district levels. 
 
¶8. (U) Since September 2007, UNICEF, in coordination with the RHB, 
has provided emergency supplies of essential drugs to ten main 
targeted health facilities in Somali Region, including the district 
hospital in Degehabur Zone.  As of December 30, only 24 out of 41 
satellite health facilities had received supplies in Somali Region. 
UNICEF also reported that many of the satellite health facilities 
have not received complete shipments.  USG HAT staff confirmed that 
health posts in Hurale, Garowe, and Obale villages, Degehabur 
District, had received incomplete shipments of UNICEF's emergency 
supply of essential drugs. 
 
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NUTRITION 
--------- 
 
¶9. (U) The absence of reliable health and nutrition data for Somali 
Region extends to Degehabur Zone, where no population-based data is 
available for 2007.  However, the USG HAT received reports of acute 
malnutrition from MSF/Greece operating in Degehabur District, but 
cautioned that the information is incomplete and cannot be 
 
generalized for the local population.  In mid-December, MSF/Greece 
initiated a nutrition screening of children accessing Degehabur 
hospital in Degehabur town.  As a result, MSF/Greece has admitted 56 
patients to a community-based therapeutic care (CTC) program, 
including 11 identified with severe acute malnutrition.  However, 
due to MSF/Greece's inability to provide baseline data, the utility 
of this information is limited.  In addition, the information only 
reflects children accessing the district hospital. 
 
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MEASLES 
------- 
 
¶10. (U) USG HAT staff note evidence of low measles coverage in 
Degehabur Zone, including a 2006 annualized routine immunization 
rate of 3.9 percent and limited local health infrastructure 
capacity.  The Degehabur District hospital is the only health 
facility in Degehabur Zone currently providing annualized routine 
immunizations.  In the context of chronically high levels of acute 
malnutrition and an anticipated increase in existing acute 
malnutrition levels with the onset of the jilal dry season from 
January to April, low coverage has raised concerns for a potential 
measles outbreak and its impact on vulnerable populations. 
 
¶11. (U) According to the Somali RHB, there have been no reports of 
suspected measles cases in Degehabur Zone in 2007, and the Acting 
Director of the Degehabur District hospital reports no suspected 
measles cases from July to December.  However, in neighboring Warder 
Zone, the RHB reported six suspected measles cases in Warder town 
during the week of December 2.  The RHB is working with MSF-Holland 
to conduct a measles vaccination campaign in Warder town.  Blood 
samples are currently being tested. 
 
¶12. (U) USG HAT staff note inconsistent reports regarding the next 
measles campaign which, according to UNICEF, is scheduled for the 
end of 2008 or early 2009 in the Somali Region.  However, the RHB 
reports that a measles campaign has not been scheduled.  Given 
current concerns regarding a potential outbreak, UNICEF is exploring 
the possibility of initiating a measles campaign in January or 
February 2008 in Somali Region. 
 
--------------------- 
ACUTE WATERY DIARRHEA 
--------------------- 
 
¶13. (U) USG HAT staff were unable to access Degahamedo District to 
evaluate GFDRE Disaster Prevention and Preparedness Agency (DPPA) 
and U.N. World Health Organization (WHO) reports of unconfirmed 
cases of acute watery diarrhea, due to security concerns voiced by 
the Degehabur zonal administrator. 
 
---------------------------- 
RECCOMENDATIONS AND COMMENTS 
---------------------------- 
 
¶14. (U) To address the increased concerns regarding a potential 
measles outbreak in Somali Region, USG HAT staff recommend emergency 
health interventions focused on increasing measles coverage.  Due to 
restricted humanitarian access, an opportunistic measles vaccination 
 
strategy should be developed to maximize measles coverage.  This 
includes linking measles vaccination with other planned activities, 
such as the Enhanced Outreach Strategy (EOS) and UNICEF mobile, 
health, nutrition, and WASH teams and coordinating with scheduled 
food distributions in order to maximize coverage 
 
¶15. (U) Until nutrition surveys can be conducted in the 
conflict-affected areas of Somali Region to better guide 
intervention strategies, collecting screening data should be an 
integral part of emergency interventions.  This information can then 
be used to better identify vulnerable populations. 
 
¶16. (U) In the coming weeks, the USG HAT will continue to conduct 
assessment visits in Somali Region to develop an improved 
understanding of humanitarian conditions and inform appropriate 
response efforts.  End comment. 
 
 
YAMAMOTO