R 150949Z JUL 08
FM AMEMBASSY NAIROBI
TO SECSTATE WASHDC 6459
INFO SOMALIA COLLECTIVE
USMISSION UN ROME 
USMISSION USUN NEW YORK 
NSC WASHDC
CJTF HOA
CDR USCENTCOM MACDILL AFB FL

UNCLAS NAIROBI 001732 
 
AIDAC 
 
USAID FOR DCHA/AA MHESS, GGOTTLIEB 
AFR/AA KALMQUIST, EGAST, CTHOMPSON, JCICCARONE 
DCHA/OFDA FOR KLUU, CCHAN, ACONVERY, PMORRIS, KCHANNELL 
DCHA/FFP FOR JBORNS, JDWORKEN, SANTHONY, PMOHAN 
DEPT FOR AF/E AND A/S FRAZER 
 
E.O. 12958:  N/A 
TAGS: EAID PHUM PREL PREF SO
SUBJECT:  SOMALIA - FURTHER NUTRITIONAL DECLINE 
 
REF: Nairobi 1128 
 
 
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SUMMARY 
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¶1.  Increased levels of malnutrition and food insecurity have 
deepened the humanitarian crisis across Somalia.  Chronic emergency 
levels of malnutrition are exacerbated by rising food prices, 
below-normal April-June (gu) rainfall, poor rainfall distribution, 
market disruptions, protracted conflict, and limited humanitarian 
access.  The results of a recent series of nutrition assessments 
indicate that the region is suffering from continued high rates of 
malnutrition, with further deterioration in some areas. 
Humanitarian agencies expect nutrition conditions to further worsen 
during the mid-June to mid-September dry season.  In June, USAID's 
Office of U.S. Foreign Disaster Assistance (USAID/OFDA) provided USD 
2 million to the U.N. Children's Fund (UNICEF) to support innovative 
projects to prevent malnutrition, as well as to augment current 
therapeutic and supplementary feeding programs (reftel) and 
integrate nutrition, health, and water, sanitation, and hygiene 
interventions.  End summary. 
 
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CURRENT SITUATION 
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¶2.  In early July, the U.N. Food and Agriculture Organization's Food 
Security Analysis Unit (FSAU) for Somalia released the results of 11 
nutrition assessments conducted by FSAU, NGOs, and U.N. agencies in 
May 2008 in Shabelle, Gedo, Bakool, Hiran, and Nugal regions.  The 
FSAU report indicated that acute malnutrition rates in central and 
southern Somalia remain persistently high and have further increased 
in some areas.  According to FSAU, a variety of factors are causing 
the poor nutrition situation, including conflict, drought, high 
incidence of diarrhea, poor breast-feeding and weaning practices, 
rising food prices, and insufficient access to clean water, adequate 
health care, and sanitation facilities. 
 
¶3.  FSAU and partners assessed survey participants by region and 
livelihoods group, such as riverine agrarian, pastoralist, 
agro-pastoralist, internally displaced person (IDP), and urban 
dweller.  This approach highlighted the different food security and 
nutritional concerns among the various livelihood groups. 
 
¶4.  The most significant deterioration in nutrition conditions 
occurred in Bakool Region, where the May 2008 assessment identified 
global acute malnutrition (GAM) rates of 24.1 percent and severe 
acute malnutrition (SAM) rates of 3.2 percent, in comparison to 14.3 
percent GAM and 3.4 percent SAM recorded in November 2007.  The FSAU 
report also indicated a deterioration in nutrition levels from 
critical to very critical among riverine and pastoral populations in 
Gedo Region.  The nutrition situation among agro-pastoralists and 
IDPs in the Shabelle regions and among agro-pastoralists in Gedo 
Region remained stable, but critical. 
 
¶5.  Both crude mortality and child mortality rates among riverine 
households in the Shabelle regions and assessed populations in Adale 
District, Middle Shabelle Region, were above the U.N. World Health 
Organization (WHO) alert thresholds of one death per 10,000 
individuals per day and two deaths per 10,000 children under five 
per day, respectively.  The crude mortality and child mortality 
rates in Adale District were 1.31 and 2.43 deaths per 10,000 
individuals per day, respectively.  The crude mortality and child 
mortality rates among riverine Shabelle households were 1.39 and 
2.20 deaths per 10,000 individuals per day, respectively, presenting 
no improvement from previous assessments.  Crude mortality and child 
mortality in other assessed locations remained stable and below the 
WHO alert threshold.  According to UNICEF, water-borne diseases due 
to lack of adequate water, sanitation, and hygiene constitute 20 
percent of mortality among children under five in Somalia. 
 
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MULTIPLE FACTORS, MANY LAYERS TO THE CRISIS 
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¶6.  Local, regional, and global factors are contributing to 
malnutrition in central and southern Somalia.  These factors include 
drought, rising global and local food prices, trade disruptions, 
conflict, and limited access for humanitarian agencies, as well as 
early infant weaning, insufficient breast-feeding, poor infant and 
child-feeding practices, and inadequate access to safe drinking 
water and sanitation facilities. 
 
¶7.  In each assessed community in southern and central Somalia, FSAU 
reported that the lack of dietary diversity, poor child feeding 
practices, and poor water, sanitation, and hygiene conditions were 
associated with high rates of acute malnutrition.  Early 
introduction of complementary foods and early infant weaning, as 
well as inadequate treatment of childhood diseases, are factors 
contributing to malnutrition in children under five years. 
 
¶8.  Drought and food insecurity are also major contributing factors 
to malnutrition in Somalia.  According to the USAID-supported Famine 
Early Warning Systems Network (FEWSNET), approximately 2.6 million 
people in Somalia are experiencing high or extreme food insecurity. 
Relief agencies are preparing for a worst-case scenario in which up 
to 3.5 million food insecure Somalis will require livelihood support 
or emergency assistance by the end of 2008. 
 
¶9.  FEWSNET projects that the poor performance and distribution of 
the recent long rains will result in a below-average cereal harvest. 
 Successive seasons of poor cereal production in key agricultural 
areas, as well as reduced cereal imports, have reduced available 
staple foods and contributed to sharply rising cereal prices.  Since 
April 2008, cereal prices have risen between 35 and 45 percent in 
local markets.  As of June 30, maize prices in the Shabelle regions 
and Juba regions were between 302 and 405 percent higher than the 
five-year average.  Rising global food and fuel prices, as well as 
limited regional food availability, compound the problem. 
 
¶10.  In March and April 2008, FSAU and partners conducted a rapid 
urban food security and nutrition assessment in 27 towns throughout 
Somalia to determine the impact of increased food and non-food 
prices on urban populations.  The assessment concluded that the cost 
of minimum food and non-food commodity expenditures increased 
between 55 and 130 percent from March 2007 to March 2008. FSAU is 
currently repeating the assessment in 60 urban sites throughout 
Somalia, with results expected by late July. 
 
¶11.  In addition, the deteriorating security situation and continued 
targeting of national and international relief workers present 
significant challenges to humanitarian interventions (to be reported 
septel).  According to the U.N. Office for the Coordination of 
Humanitarian Affairs, 82 incidents of looting or attempted looting 
of food aid have occurred to date in 2008.  In late June, CARE 
International, an NGO with a significant role in food distribution, 
suspended all operations in Galgadud, as a result of the abduction 
of a CARE staff member on June 14. 
 
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USAID RESPONSE 
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¶12.  In response to the escalating malnutrition rates, USAID/OFDA is 
working with UNICEF to scale up supplemental and therapeutic feeding 
programs throughout Somalia.  USAID/OFDA has also provided funding 
to Merlin, Mercy USA, and International Medical Corps to initiate 
new and expand existing feeding programs for malnourished children 
in affected regions of central and southern Somalia. 
 
¶13.  In addition, USAID/OFDA provided USD 2 million to UNICEF for an 
innovative, preventative approach to malnutrition in the Shabelle 
regions and Bossaso IDP camp utilizing ready-to-use foods (RUF). 
UNICEF estimates that 30-40 percent of all moderately or severely 
malnourished children in Somalia reside in the Shabelle regions. 
UNICEF plans to reach at-risk children from 6 to 36 months old with 
the preventative RUF product Plumpy-doz, water purification tablets 
for home water treatment, and oral rehydration salts for early 
treatment of diarrhea.  UNICEF also plans to conduct nutritional 
screenings during the distributions and provide hygiene education 
for families, community leaders, and community health workers. 
 
¶14.  USAID's Office of Food for Peace has recently provided an 
additional USD 90 million to CARE and WFP for expanded food aid 
programs (reftel), bringing total fiscal year (FY) 2008 funding to 
approximately USD 200 million compared to USD 35 million in FY 2007. 
 In many parts of South/Central Somalia, WFP is working through 
supplementary feeding centers in collaboration with UNICEF to 
provide family rations and ensure a more integrated approach to 
addressing high malnutrition. 
 
¶15.  USAID/OFDA will closely monitor the success of this integrated 
intervention to determine if it is a cost-effective, replicable 
strategy for potential use in other regions of Somalia.  As 
highlighted by FSAU, UNICEF, WFP, and FEWSNET, the answer to the 
escalating malnutrition rates in Somalia is not food aid alone, but 
rather a coordinated approach by donors, government, and aid 
agencies to improve access to and availability and utilization of 
food, while at the same time increasing access to adequate health 
services, clean water, and sanitation. 
 
 
SLUTZ