VZCZCXYZ0006
OO RUEHWEB

DE RUEHDS #0360/01 0440709
ZNR UUUUU ZZH
O 130709Z FEB 08
FM AMEMBASSY ADDIS ABABA
TO RUEHC/SECSTATE WASHDC IMMEDIATE 9533
INFO RUEHAE/AMEMBASSY ASMARA 2120
RUEHDJ/AMEMBASSY DJIBOUTI 8909
RUEHNR/AMEMBASSY NAIROBI 3372
RUEHBS/AMEMBASSY BRUSSELS 3089
RUEHGV/USMISSION GENEVA 4173
RUEHLO/AMEMBASSY LONDON 3022
RUEHRO/AMEMBASSY ROME 6379
RUCNDT/USMISSION USUN NEW YORK 7246
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 000360 
 
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 
 
AIDAC 
SIPDIS 
 
E.O. 12958: N/A 
TAGS: EAID PHUM SENV EAGR PGOV ET
REF:  A) ADDIS 3644  B) ADDIS 0064 
SUBJECT: USG HUMANITARIAN ASSISTANCE TEAM: FIELD VISIT #2 -WATER, 
HEALTH, AND NUTRITION UPDATE 
 
 
------- 
Summary 
------- 
 
¶1.  Between January 2 and 9, U.S. Government (USG) Humanitarian 
Assistance Team (HAT) in Ethiopia staff, traveled to Degehabur and 
Fik zones in Somali Region as part of a second field visit to assess 
the current humanitarian situation, including health, nutrition, and 
water and sanitation conditions.  USG HAT found that shallow wells 
and traditional water harvesting points in areas visited in 
Degehabur and Fik zones continue to provide sufficient quantities of 
water for pastoralists and livestock.  However, the poor performance 
of the 2007 gu and deyr rains in parts of Somali Region have failed 
to fully recharge traditional water points.  USGHAT staff note that 
current reserves are likely to be depleted over the next two months, 
raising water availability concerns during the gap before the start 
of the next rains in April.  USG HAT staff verified that several 
health posts in the area had recently reopened, but noted a lack of 
capacity to provide primary health care services to local 
populations.  While USG HAT staff did not observe any indicators of 
widespread malnutrition in areas assessed in Fik and Degehabur 
zones, UNICEF reports chronically high levels of acute malnutrition 
in Somali Region that exceed U.N. World Health Organization (WHO) 
emergency thresholds.  According to non-governmental organizations 
(NGOs) operating in Fik District, Fik Zone, current levels of severe 
acute malnutrition are consistent with historical levels and the 
majority of cases are a result of pathological causes.  End summary. 
 
 
---------- 
Background 
---------- 
 
¶2.  Between January 2 and 9, USG HAT staff traveled to Degehabur and 
Fik zones of Somali Region as part of a second field visit to assess 
the current humanitarian situation, including health, nutrition, and 
water and sanitation conditions.  USG HAT staff included the team 
leader, Food for Peace officer, safety and security officer, and a 
USAID/Ethiopia Assets and Livelihoods Transition representative. 
Accompanied by U.N. and NGO staff operating in Degehabur and Fik 
zones, USG HAT staff conducted numerous site visits, including 
interviews with local residents and military and government 
officials.  Cyclical droughts, underdevelopment, and limited 
government capacity, exacerbated by an ongoing insurgency, have 
resulted in chronic population vulnerabilities in Somali Region. 
 
----------------- 
Water and Hygiene 
----------------- 
 
¶3.  Access to water in pastoral areas of Degehabur and Fik zones is 
highly dependent on the quality and distribution of seasonal rains. 
The majority of pastoralists and their livestock rely on rivers or 
other natural water points during the wet seasons, and water 
harvesting structures, such as man-made ponds, concrete-lined 
reservoirs referred to as berkas, and shallow wells during the dry 
season. USAID's Office of U.S. Foreign Disaster Assistance 
(USAID/OFDA) recently awarded the International Rescue Committee and 
Save the Children/U.K. (SC/UK) USD 1.7 million for emergency water 
 
activities in Degehabur and Fik Zones and USD 1 million to UNICEF 
for regional emergency mobile health, nutrition, water, sanitation, 
and hygiene teams. 
 
¶4.  USG HAT staff report that shallow wells continue to be 
productive in several areas visited.  In addition, USG HAT staff 
note that the majority of water points visited are protected, 
including covered shallow wells and fenced reservoirs to prevent 
animals from contaminating water sources.  Pastoralists currently 
draw water from hand-dug wells in dry river beds for animals.  USG 
HAT staff did not observe evidence of cross contamination of water 
sources through the use of water points by both humans and 
livestock.  Berkas are a common method of water harvesting in Fik 
and Degehabur zones.  USG HAT staff note that berkas in several 
areas visited, continue to hold water, which residents estimate to 
be sufficient for the two months. 
 
¶5.  USG HAT staff collected information on water usage practices in 
areas visited.  Pastoralists do not treat water for household use to 
improve quality.  Residents interviewed in Hamero town, Hamero 
District, reported drawing an average of 40 liters per day for 
household use for an average family size of six people.  USG HAT 
staff noted that water containers were plentiful and no storage 
issues were reported.  Wait times to draw water from hand pumps did 
not appear excessive and lines of recipients during morning hours 
averaged six to eight people.  USG HAT reported that most of the 
hand pumps visited in the region were installed through previous 
USAID programs and in all areas, except one, pumps were being 
serviced and repaired. 
 
¶6.  USG HAT staff spoke with several pastoralists who reported 
traveling extended distances with camels and donkeys to access 
water.  In Gunagado town, Aware District, in Degehabur Zone, several 
pastoralists reported that some of the remote natural water points 
had dried up earlier than normal as a result of the poor performance 
of deyr rains.  In three locations in Fik Zone, pastoralists 
reported that turbidity and salinity of water from ponds and berkas 
had increased in recent weeks.  According to the November 24 to 
December 14 DPPA Deyr/Karan Needs Assessment an estimated 400,000 
people in Somali region are projected to require water tankering to 
meet basic needs as the January to March jilal dry season continues. 
 However, USG HAT staff did not observe evidence of water tankering 
in areas visited. 
 
¶7.  Hygiene issues were particularly acute in Kasangas village, 
Hamero District, in southern Fik Zone.  Several children displayed 
obvious signs of skin disease, including conjunctivitis.  In 
addition, USG HAT staff report an absence of sanitation facilities 
in the area.  In general latrines were only found in trading centers 
and only a limited number of people interviewed in rural areas 
reported using soap.  USG HAT staff reported that the primary cause 
of morbidity in areas assessed was diarrhea, which Medecines Sans 
Frontieres (MSF)/Switzerland attributed to poor water quality 
aggravated by the onset of the jilal dry season. 
 
------ 
Health 
------ 
 
¶8.  Despite USG HAT confirmation of the recent reopening of several 
health posts in areas visited in Degehabur and Fik zones, USG HAT 
staff report that limited capacity and medical supplies continue to 
undermine the delivery of primary health care services.  Health 
posts visited were commonly staffed by one health care provider, 
possessed few basic medicines, and offered no referral system.  In 
all health facilities visited, USG HAT noted the absence of 
in-patient facilities and laboratory equipment to confirm 
communicable disease, as well as an absence of emergency response 
capacity to treat trauma or the capacity to treat malnutrition 
cases.  USG HAT staff reported an absence of vaccines and 
immunization planning and observed inoperable cold chain equipment 
in two clinics. Health professionals interviewed commonly reported 
major causes of morbidity as diarrhea, upper respiratory infections, 
and malaria.  Health staff did not report any epidemics in the areas 
visited to date. 
 
¶9.  In addition, USG HAT staff report that pervasive military 
presence is undermining local access to health care services in 
Degehabur and Fik zones.  In Hamero town, the clinic was co-located 
next to the military barracks.  According to the clinic nurse, 
people were intimidated from seeking health care assistance due to 
the military presence.  USG HAT did not observe any residents 
seeking health assistance during the visit.  However, the nurse 
reported limited outreach activities in surrounding areas to expand 
health coverage.  The military's co-location and/or proximity to 
health clinics and schools was common in all areas visited.  In 
Kasangas village, Hamero District, the clinic was locked and 
residents reported only sporadic visits from government health care 
providers. 
 
--------- 
Nutrition 
--------- 
 
¶10.  Somali Region experiences chronically high levels of acute 
malnutrition, with global acute malnutrition (GAM) rates that 
consistently exceed the U.N. World Health Organization (WHO) 
emergency threshold of 15 percent by 5 percent or more.  In recent 
years, the provision of emergency food assistance has become a key 
coping strategy for vulnerable populations to maintain nutritional 
levels, particularly during the jilal dry season. 
 
¶11.  The October SC/UK nutrition survey in Fik and Hamero districts, 
Fik Zone, reported GAM rates of 20.8 percent.  MSF/Switzerland 
recently started operations in Fik zone in December 2007.  According 
to MSF/Switzerland, severe acute malnutrition cases appear to follow 
historical trends for the area.  MSF/Switzerland reports that the 
majority of cases treated have resulted from secondary causes, such 
as malaria or diarrhea.  MSF cautioned that there is no capacity in 
Fik Zone to treat malnutrition and that caseloads could increase as 
the dry season progresses. 
 
----------- 
Conclusions 
----------- 
 
¶12.  As of January 9, USG HAT staff report that water access, 
quality, and storage capacity in areas visited during the second 
 
field assessment to Degehabur and Fik zones appear adequate for 
populations and livestock. However, due to the poor performance of 
the gu and deyr rains in parts of Somali region and the onset of the 
dry season, water availability is expected to become an increasing 
concern in the coming months. 
 
¶13.  USG HAT staff report that health clinics have recently reopened 
in several areas assessed.  To date, these health facilities have 
not reported any epidemics or morbidity above historical normal 
levels.  However, local infrastructure capacity to provide 
vaccinations and health surveillance or respond to epidemics and 
cases of malnutrition is extremely low and cannot be counted upon 
should humanitarian conditions decline. 
 
¶14.  The combined effects of the jilal dry season and poorly 
distributed food assistance on food security, as well as the lack of 
local capacity to treat malnutrition, will continue to negatively 
impact local food security and nutrition levels in the region. 
 
 
YAMAMOTO