O 070627Z JUL 08
FM AMEMBASSY ADDIS ABABA
TO SECSTATE WASHDC IMMEDIATE 1185
INFO AMEMBASSY ASMARA 
AMEMBASSY DJIBOUTI 
AMEMBASSY NAIROBI 
AMEMBASSY BRUSSELS 
USMISSION GENEVA 
AMEMBASSY LONDON 
AMEMBASSY ROME 
USMISSION USUN NEW YORK 
DEPT OF INTERIOR WASHDC
DEPT OF AGRICULTURE WASHDC
HQ USCENTCOM MACDILL AFB FL
DIA WASHDC
CJTF HOA
NSC WASHDC

UNCLAS ADDIS ABABA 001823 
 
STATE DEPARTMENT FOR DAS AF JSWAN, AF/E, AF/PDPA, OES, AND PRM/AFR 
AFR/AA EGAST, CTHOMPSON 
DCHA/AA MHESS, GGOTTLIEB 
DCHA/OFDA KLUU AND RMT HORN 
DCHA/FFP JDWORKEN, PMOHAN, 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 
ROME FOR FODAG 
BRUSSELS FOR USEU PBROWN 
GENEVA FOR NKYLOH, RMA 
NSC FOR PMARCHAN 
 
E.O. 12958: N/A 
TAGS: EAID PHUM SENV EAGR PGOV ET
SUBJECT: SERIOUS IMPACTS OF FAILED BELG RAINS IN ETHIOPIA 
SUBJECT: ETHIOPIA - USG/HAT - THE 'GREEN FAMINE' IN SNNPR 
 
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SUMMARY 
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¶1. There is a 'green famine' in Southern Nations, Nationalities and 
Peoples Region (SNNPR) as the U.S. Government Humanitarian 
Assistance Team (USG/HAT) observed during their recent field trips 
in Wolyata and Gurage zones in late June. Nutrition programs are 
overwhelmed with patients in the absence of other food aid programs 
such as general rations and supplementary feeding for the moderately 
malnourished.  USAID Office of U.S. Foreign Disaster Assistance 
(USAID/OFDA) partners are battling malnutrition through the network 
of health centers and health posts that manage community based 
therapeutic programs.  More resources will be added to boost their 
ability to deal with the thousands of children in dire 
circumstances.  On a positive note, safety net beneficiaries seem to 
be withstanding the onslaught of the drought so far, but rising food 
prices will eat away at their safety net payments and could soon 
leave them destitute as well.  Overall prospects for recovery are 
grim as populations draw down on precious assets, including seeds 
and livestock, in order to survive.  End Summary. 
 
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A 'GREEN' FAMINE 
----------------- 
 
¶2.  Rains have begun in SNNPR.  The land is green and lush as grass 
sprouts, trees flourish, flowers bloom, and small maize plants poke 
their heads through the earth. Scrawny oxen plod slowly but steadily 
through fields, turning the earth for the planting of teff, barley 
and other long season Meher crops.  But the green is deceptive. The 
maize will not be harvested until at least August or September as 
'green maize' according to local farmers.  Bean plants now emerging 
from the earth will be harvested 3 months from now.  Pepper, the 
local cash crop grown in some areas of Guraghe, will also be 
harvested later in the year.  The main crops of barley and teff will 
be harvQd as late as November and beyond.  Inside the homes there 
is no food, and at the health posts visited recently by USG HAT 
staff, starving children crowded to pick up weekly rations of Ready 
to Use Therapeutic Food (RUTF) such as plumpy nut, BP 100 (high 
energy) biscuits and, in some rare cases, supplementary corn soya 
blend (CSB) and oil.  This is a 'green famine.' 
 
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NUTRITION CRISIS TESTS RESPONDER CAPACITY 
----------------------------------------- 
 
¶3. USG HAT officers visited four USAID/OFDA-funded emergency 
nutrition programs in the Wolayta and Gurage zones of SNNPR over the 
period June 22 - 24 to monitor performance of partners and identify 
additional problems and gaps in program implementation.  NGOs 
implementing programs in this area include GOAL, CONCERN, 
International Medical Corps (IMC), and Samaritan's Purse (SP). 
During the period June 18-19, USG HAT officers also traveled to 
Boricha in Sidama zone SNNPR to monitor the GOAL community based 
therapeutic care (CTC) program and to visit the operation managed by 
MSF/Belgium (not OFDA-funded) in Shashamene (Oromiya region). 
 
¶4. NGOs are following the national nutrition guidelines, which 
prescribe a decentralized model of outpatient therapeutic centers 
based out of health centers and health posts, and a reference 
stabilization center for therapeutic cases with medical 
complications -- usually located at the health center.  Often, 
Outpatient Therapeutic Programs (OTPs) are also located at the 
health center.  Partners IMC and CONCERN have been working closely 
with the Ministry of Health (MOH) over the last few years to build 
capacity in these community-managed nutrition programs, but this 
year is the first real test of the effectiveness of this 
decentralized, government-led strategy. 
 
¶5. From the beginning, there have been problems in undertaking 
sufficient rapid assessments to gain a clear picture of the extent 
of the nutritional crisis. There is disagreement over the number of 
children requiring therapeutic feeding, with the official number put 
at 75,000.  Real numbers may be much more, based on trends noted in 
areas that are accessible, but this has not been verified by 
assessment.  In the areas visited by USG HAT, MOH staff were 
managing both stabilization centers (SC) and OTP sites, but with 
varying degrees of efficiency. 
 
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NUTRITION PROGRAMS GEARING UP - BUT SOME ARE OVERWHELMED BY THE 
NUMBERS IN NEED 
--------------------------------------------- ------- 
 
¶6. The IMC site at Bolossosore was clearly overwhelmed by the 
caseload. There were about 189 children waiting for their weekly 
ration of RUTF at the health center, while another 200 or so 
children waited to be screened. At least half of those were 
obviously severely malnourished, many with stage 3 oedemas. IMC has 
not been able to set up stabilization centers in this area due, they 
said, to lack of resources for staffing and supplies.  Without a 
stabilization center, any cases with complications were advised to 
go to the nearest hospital run by the Catholic Church. However most 
mothers declined to go because they did not have the money to pay 
and IMC did not yet have a memorandum of understanding to pay for 
the medical bills incurred by their patients. USAID/OFDA has agreed 
to provide an additional USD 500,000 immediately to IMC to address 
these problems in all IMC project sites. 
 
¶8. CONCERN, with OFDA funding, has been working intensively on 
enabling the Ministry of Health to handle such crises.  The OTP and 
stabilization center sites visited in Mareko woreda (Koshe town) in 
Gurage zone were not congested.  The team was in place and dealt 
with each child as it arrived at the center, thereby avoiding a 
crush of patients.  CONCERN however has noted that some centers 
cannot handle the caseloads and are ramping up their support to 
train and supervise more health workers and more OTP sites.  CONCERN 
had a vehicle permanently at the health center visited to assist 
with any evacuations to hospital from the stabilization center. An 
agreement with the hospital ensures that referred cases are admitted 
immediately and treated.  CONCERN has resources to provide food for 
caretakers, and this is a critical aspect of the program that 
supports stabilization.  Otherwise, mothers will not stay with their 
children.  USAID/OFDA is providing an additional USD 1.5 million to 
CONCERN to support the expansion of emergency nutrition 
interventions. 
 
¶9. Samaritan's Purse (SP) is implementing CTC as a sub-grant of the 
OFDA-funded rapid response fund to Irish GOAL.  SP has opened CTC 
services in KindoKoisha and Aleba Special Woreda which have been 
identified as Priority One hot spots by the UN and government.  SP 
staff explained that one of the key challenges has been to identify 
trained MoH staff who can open new OTPs in their areas of operation, 
in order to reduce the distances walked by mothers to get services 
and to ensure greater efficiency of the program.  SP's program in 
neighboring Aleba Special Woreda was visited by USG HAT staff in 
previous weeks and was found to be running smoothly, although with 
hundreds of children being served from just one OTP site. 
 
 
¶10. USG HAT visited CTC programs run by Irish-GOAL (funded through 
the USAID/OFDA rapid response grant) in Boricha woreda, Sidama zone 
on June 18 and the Damot Fulassa woreda, Wolayta zone on June 23. 
Between March 24 and June 18, the CTC in Boricha had 2,261 children. 
 One of the stabilization centers had handled 350 cases since April. 
 There were twenty-five patients at the time of the USG HAT visit. 
Health extension workers and community health volunteers are an 
integral part of the GOAL program, providing essential support for 
weighing and measuring children, as well as outreach in the 
communities. 
 
¶11. GOAL's program in new woreda Damot Fulassa of Wolyata zone 
covers 23 kebeles with eight OTPs. The program has already treated 
2,095 patients in all the OTP sites since it opened in April. On 
June 23, 1,308 were registered.  At the time of the visit, there 
were only eight patients in the stabilization center. Patients 
questioned were not in the safety net program, but had been screened 
for the targeted supplementary feeding program (EOS/TSF) as well as 
for a Red Cross targeted feeding program that began in June, 
assisting 8,000 families.  These two programs should have an 
immediate impact on the condition of children in the area.  GOAL 
provides transport for cases being referred to stabilization or 
hospital and supports the hospitals with essential drugs so that 
there is no question about accepting the nutritional cases.  GOAL 
also provides a food ration to caretakers to ensure that mothers 
stay at the stabilization center with their children. 
 
-------------------------------- 
Launch of Supplementary Feeding 
-------------------------------- 
 
¶12. Until now, the lack of supplementary feeding for children under 
five years of age in most programs has been an accelerating factor 
in the number of serious cases of severe acute malnutrition.  The 
Enhanced Outreach Strategy (EOS)/TSF program administered by WFP has 
been sharply criticized since its inception because of delays of up 
to six months between the time children are screened for 
malnutrition and when the rations arrive to address their condition. 
 WFP has been working hard with the government counterparts to 
remedy the situation, conducting screening in April/May, with 
distributions of EOS underway in June. However, a cutback in WFP's 
funding for the EOS program has meant that the number of woredas 
served has been severely reduced.  Now, there are caseloads in only 
32 woredas, instead of over 50 previously served by the EOS in 
SNNPR.  NGOs working in areas where EOS was being carried out are 
urged to link up with WFP and the regional DPPA, in order to ensure 
that OTP graduates are taken up into the EOS program where possible. 
 
 
¶13. In addition to the ongoing EOS, WFP is launching blanket 
supplementary feeding for under 5's in SNNPR as part of the general 
relief ration distribution planned from June onwards. NGOs are also 
purchasing FAMEX (locally made CSB) to distribute to caretakers at 
the stabilization centers, to provide take home rations for OTP 
beneficiaries, and to provide supplementary feeding for graduates 
who are not taken into the EOS.  With this multitude of channels of 
CSB now being lined up for SNNPR, it is inevitable that some 
beneficiaries will be on two or more distributions of CSB.  However, 
the nutrition coordination unit at DPPA, as well as WFP, have 
pointed out that the situation is so critical that a double ration 
to one family is not a matter of concern right now.  The objective 
is to get CSB into communities to bring down the escalating 
malnutrition levels. Given rising rates of malnutrition among the 
over 5 population and even adults, there is simply a need for more 
food in the system. The demand for CSB in the various programs is 
also driving up the price.  WFP reported that prices for FAMEX in 
Addis now range between $783 to $836/MT, up from $433/MT in January 
¶2008. 
 
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Safety Net and Relief Food Distributions 
---------------------------------------- 
 
¶14. The final element of the nutrition package, the general ration, 
is being worked on by DPPA, WFP, the World Bank, with active 
participation in meetings by USAID.  SNNPR is typically a cash 
woreda for safety net activities, but the severity of the crisis, 
exacerbated by inflation of food prices of up to 600 percent, has 
meant that the cash payments are no longer sufficient to meet the 
minimum food requirements of families.  The current strategy for 
safety net beneficiaries is to continue to provide the cash payment 
for the next two cycles (fifth and six 'round' of payments), but to 
add a two month cereal ration as well. For those put onto relief 
rolls in SNNPR, distributions should begin in June and include a 
full ration with CSB for children under five years of age. 
 
¶15. There is a proposed NGO Joint Emergency Operation (JEOP) in the 
works with the Office of Food for Peace.  Twenty-two of the proposed 
woredas are in the SNNPR hot spot areas including Wolayta.  The 
proposal is for a full ration for about 1.76 million in hot spot 
woredas in SNNPR, Oromiya and Somali Regions and now includes CSB 
for blanket supplementary feeding.  It will be critical to 
coordinate this possible JEOP with the CTC and OTP efforts. 
 
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Looking Ahead 
-------------- 
 
¶16. SNNPR is only one region that is in the middle of a major crisis 
that is only likely to get worse, despite heroic efforts by the UN 
and NGOs, supported by donors, to ramp up the food aid and nutrition 
programs. The gap in available food to address the crisis in 
Ethiopia generally means that difficult choices are being made as to 
who gets food and who does not.  Priority One woredas will be 
targeted first, and, in subsequent months, priority 2 relief 
beneficiaries will receive food.  No one believes sufficient food is 
flowing into the drought affected areas to stop the downward spiral, 
but there is hope that efficient food deliveries could start to slow 
down the admissions to therapeutic feeding. T he coming months will 
be telling in this regard and USG HAT will continue to monitor and 
advocate for improved coordination and efficiency within and across 
in all programs. 
 
¶17. The prospects for recovery from this crisis are very worrying. 
Households are borrowing heavily, selling cattle and household 
assets, and eating the precious seeds they need to plant for the 
current agriculture season.  An army worm invasion is spreading 
throughout many agricultural zones and pesticides are not available 
in sufficient quantity to destroy them.  Despite the rainfall 
pounding the earth, and the maize and bean plants emerging from the 
earth, the overall livelihood prospect for the population of SNNPR 
in coming months is dire. 
 
 
YAMAMOTO