VZCZCXRO0231
RR RUEHDE RUEHROV RUEHTRO
DE RUEHDJ #0009/01 0060612
ZNR UUUUU ZZH
R 060612Z JAN 09
FM AMEMBASSY DJIBOUTI
TO RUEHC/SECSTATE WASHDC 9875
RUEHGV/USMISSION GENEVA 0354
RUEHRO/AMEMBASSY ROME 0513
INFO RUCNSOM/SOMALIA COLLECTIVE
RUCNIAD/IGAD COLLECTIVE
RHEHNSC/NSC WASHDC
RHMFIUU/CJTF HOA
RHMFISS/CDR USAFRICOM STUTTGART GE

UNCLAS SECTION 01 OF 04 DJIBOUTI 000009 
 
AIDAC 
SIPDIS 
 
USAID/DCHA FOR MHESS 
DCHA/OFDA FOR KLUU, ACONVERY, KCHANNELL 
DCHA/FFP FOR JBORNS, JDWORKEN, CMUTAMBA, PMOHAN 
AFR/EA 
STATE FOR AF/E AND PRM 
USMISSION USUN NEW YORK FOR DMERCADO 
BRUSSELS FOR PBROWN 
USMISSION GENEVA FOR NKYLOH 
ROME FOR HSPANOS 
 
E.O. 12958:  N/A 
TAGS: EAID PHUM PREL DJ
SUBJECT:  DJIBOUTI - USAID FOOD INSECURITY ASSESSMENT 
 
¶1. SUMMARY.  A USAID team traveled to Djibouti December 15-21 to 
assess food insecurity and malnutrition.  Due to a combination of 
continuing drought and increased food prices, Djibouti's food 
security situation remains precarious, with both a shortage in food 
availability and reduced purchasing power affecting access to 
commodities. November rains have not been adequate to start recovery 
for pastoralists, and the number of vulnerable Djiboutians in need 
of assistance continues to rise.  Malnutrition, while not surveyed 
since 2007, is a continuing problem based on admissions to feeding 
programs.  In response, the UN World Food Program (WFP) is 
increasing its beneficiary numbers and piloting an urban food 
program.  The UN Children's Fund (UNICEF) continues to promote 
malnutrition treatment at the health facility and community level in 
partnership with the Ministry of Health (MOH).  USAID has some 
concerns over WFP's management of food distributions, but recommends 
continued support once they are addressed.  Continued support for 
UNICEF is also recommended.  END SUMMARY. 
 
------------------------- 
FOOD SECURITY IN DJIBOUTI 
------------------------- 
 
¶2. A USAID team consisting of the Office of Foreign Disaster 
Assistance (OFDA) Principal Regional Advisor and Food for Peace 
(FFP) Regional Advisor visited Djibouti December 15-21 to assess the 
food security situation and response.  The team traveled to Dikhil 
and Ali Sabieh districts in the south, and met with government and 
UN officials, and Embassy and USAID staff. 
 
¶3. While there have been some marginal improvements in pasture and 
water with the November seasonal coastal rains (and some unseasonal 
inland showers), they have not been widespread nor significant 
enough to promote any real recovery.  With a gradual but continual 
degradation of coping mechanisms, including increased livestock 
deaths, many pastoralists have been forced to settle in populated 
areas, and the number of vulnerable people continued to rise in 
¶2008. 
 
¶4. The team visited Lac Abbe, Kouta Bouyya, As-Eyla, Sankal, Dikhil, 
Ali Sabieh, and Hol-Hol villages December 16-18.  In the areas 
visited in Dikhil district, there had been no rain since early 2006. 
 Significant numbers of animals had died, and a large number of 
pastoralists facing livestock depletion and destitution had been 
forced to migrate to more populated areas to access services, 
including WFP food assistance. 
 
¶5. The team noted that a number of water points had dried up, and 
that food prices--although down slightly from earlier highs--were 
still exorbitant for many Djiboutians. The terms of trade between 
livestock and cereals had become disastrous for pastoralists: in the 
past, one goat could fetch a sack of rice with change to spare; one 
bag now (when available) would cost four-five goats.  Livestock did 
not appear especially emaciated, but herd size was greatly reduced, 
since many animals had already died. 
 
------------ 
MALNUTRITION 
------------ 
 
¶6. Hard data on current malnutrition levels in Djibouti do not 
exist.  The most recent malnutrition survey was undertaken in 
November 2007 by the Government of Djibouti (GoDJ), UNICEF, and WFP, 
and documented some alarmingly high levels of global and severe 
acute malnutrition (GAM and SAM).  Rates as high as 24.8 percent 
(GAM) and 3.5 percent (SAM) were recorded in northwest Djibouti, 
with other drought-affected areas also hard hit.  The average 
figures for the country as a whole were 16.8 percent (GAM) and 2.4 
percent (SAM).  Since then, the only data available has come from 
screening children who are brought in to health centers, and there 
is a good deal of conjecture over what the rates may be.  Based on 
the 1997 rates, it is estimated that 25,000 children in Djibouti are 
malnourished, but UNICEF believes only about 10,000 are receiving 
treatment due to limited resources and lack of awareness. 
 
¶7. In response, and with support from USAID/OFDA, UNICEF has been 
 
DJIBOUTI 00000009  002 OF 004 
 
 
promoting malnutrition treatment at the health center and community 
level.  UNICEF provides training, equipment, and supplies to MOH 
hospitals and clinics. Inclusion of malnutrition treatment as part 
of the routine activity at health centers is new in Djibouti, and 
UNICEF has made some good progress in getting the MOH to view it as 
a treatable disease.  UNICEF claims mortality from severe 
malnourishment in Djibouti town has dropped from 7.9 percent in 2007 
to 3.3 percent in 2008.  The challenge now is for the MOH to 
complete the application of this approach in the rural areas, and 
ensure the provision of staff and specialized feeding products that 
go with it. 
 
¶8. UNICEF and MOH sensitization of the population about malnutrition 
appears to be having some effect.  In Kouta Bouyya, the team was 
told by village leaders that when there is a suspected malnutrition 
case, it is brought to the attention of one of the community health 
workers (CHWs) who the MOH has started deploying in the rural areas. 
 If the CHW determines that the child is severely malnourished, the 
child is referred to the Dikhil district hospital for treatment.  If 
the child is moderately malnourished, supplemental food and 
counseling is provided to the parents if available.  Although this 
system is not perfect, the villagers are aware of it and know what 
they need to do if they suspect malnutrition.  Unfortunately, the 
sensitization has not reached all the population, and not all cases 
are obvious.  Another weakness in the system is the irregular supply 
of supplementary and therapeutic food commodities, as well as 
nutrients and other requirements. 
 
¶9. At the district hospital in Dikhil, 20 of 72 beds are taken up by 
severely malnourished children receiving inpatient treatment, many 
of them living too far to benefit from the community-based approach 
UNICEF and the MOH are promoting.  The head doctor at the hospital 
said that there has been a marked improvement over the last year, 
since the MOH started taking malnutrition seriously and the support 
of UNICEF commenced.  In 2007, out of 22 cases that completed 
treatment at the hospital, 14 were cured and 8 died; through 
November 2008, they have admitted 76 for treatment, of whom 34 were 
cured and 10 have died (the balance are still in treatment or have 
left the hospital). The head doctor believes that there are many 
victims that are not being reached, but that the health system's 
ability to find and treat them continues to steadily improve. 
 
¶10. To improve malnutrition management, UNICEF would like to perform 
another survey, and to establish a surveillance system within the 
MOH which would provide regular data and assist in the effort to 
bring the presumably high malnutrition rates down.  It will also 
need a regular supply of medicines and specialized commodities for 
treatment. 
 
-------------------- 
"MIGRANTS" AT SANKAL 
-------------------- 
 
¶11. The team visited Sankal, a military outpost at a crossing point 
on the Djibouti-Ethiopia border, to assess the situation of a 
reported 1,500 "migrant" families.  This population is said to 
consist of ethnic Somalis who are from the unmarked and 
loosely-administered border area of Ethiopia, Djibouti, and 
Somaliland. 
 
¶12. According to the village chief, there are 500 families in the 
village, together with another 1,500 migrant families, all of 
nomadic origin.  The migrants arrived six months earlier, reportedly 
due to losing their animals to drought, and hoped to receive 
humanitarian assistance. However, judging by the number of empty 
houses, a substantial number of them appear to have left.  They are 
living in modest conditions in small stone houses with few personal 
possessions.  Water comes from a dirty source just over the 
Ethiopian border.  The MOH has established a temporary health post 
staffed by two nurses, which treats basic ailments and transfers any 
serious cases to the hospital in Dikhil on a daily basis.  The 
nurses said the major health problems in the village are diarrhea 
caused by the dirty water, and malnutrition.  They said in the six 
months the group has been there, 100 people have died as a result. 
 
 
DJIBOUTI 00000009  003 OF 004 
 
 
 
¶13. In a discussion with the migrants, the team noticed some 
reticence to explain who they were, where they came from, and why 
they were in Sankal specifically.  Their representatives said they 
came to this village because of kinship and because of the tradition 
of assistance this provided.  A trip up the hill to the military 
post--with a full view of all the houses in the vicinity--revealed 
that the reticence might have been due to the claim that there are a 
total of 2,000 families in Sankal.  An estimate of the number of 
occupied houses revealed a figure of 200-300, and it is suspected 
that the self-reported number of 2,000 families was an attempt to 
access additional food assistance.  Further, the hospital director 
in Dikhil confirmed that Sankal is not a village at all, just a 
place where hungry nomads can come within Djibouti to be included, 
they hope, in food distributions. 
 
¶14. The morning of the team's visit, WFP had delivered food for 200 
families, and it was clear that this food was going to be 
distributed to all those present by the community distribution team. 
 The WFP food monitor on the scene noted that there were plans to 
increase Sankal's allocation to up to 600 families, but said that 
without increased resources for the district, she would be forced to 
reduce other allocations in Dikhil to provide enough in Sankal. 
While the level of individual need appeared clear, it also appeared 
that WFP would be well-served by re-assessing the population levels 
here.  Regardless of who these people are, they would probably not 
be in Sankal unless they needed the food and medical assistance 
there (although some of their medical problems are caused by the 
dirty water there; an example of the very tough decisions hungry 
people are forced to make). 
 
------------ 
WFP RESPONSE 
------------ 
 
¶15. WFP currently provides food assistance to 80,000 rural 
beneficiaries, up from 53,000 people a few months ago. On the 
ground, WFP allocates commodities for an approved number of 
beneficiaries; the community then distributes the rations in varying 
quantities to meet the needs of all its residents.  WFP staff do not 
regularly monitor these distributions, nor did they--when 
present--take any part in the actual distribution process. 
(Targeting is notoriously difficult in pastoralist communities, 
where sharing is a cultural norm.) 
 
¶16. In Kouta Bouyya, for example, residents received half of a 
50-kilgram bag of grain per family rather than the originally 
allocated full bag; in As-Eyla, three families shared a single 
bag--due ostensibly to significant numbers of pastoralists not being 
present at the distribution but who would receive the food later. 
It was unclear what would happen to these undistributed commodities 
at the conclusion of the distribution. 
 
¶17. The distributions were also disorganized, and WFP should monitor 
more regularly and with a stronger presence to ensure that 
distributions are conducted properly and that any issues are 
reported immediately to the country office.  WFP has a good rural 
presence, with an office, staff and vehicle in each district, but 
needs strengthened monitoring with more robust reporting and 
resolution of issues. 
 
¶18. Dikhil district is unique in Djibouti, in that it has sizable 
numbers of both Somali and Afar residents, and has historically been 
a flashpoint for violence between the groups.  In As-Eyla, a mixed 
rural community, the team noted that only Somali beneficiaries were 
being targeted with food assistance, although the team saw a number 
of Afar households and were provided the names of communities that 
were clearly in need.  It appeared that the Somali village chief and 
the Somali WFP field monitor were under significant pressure to 
support "their" people with limited resources.  An international WFP 
staff member should visit immediately to rectify this situation and 
ensure that distributions are based on need and not/not ethnicity. 
 
¶19. WFP Djibouti currently lacks strong leadership and direction; it 
has had an acting Country Director for the past four months (and 
 
DJIBOUTI 00000009  004 OF 004 
 
 
reportedly for at least another three-four months).  While it has an 
energetic and very capable program officer, she is leaving for 
maternity leave for the next six months.  It even has its former 
program officer (replaced due to performance issues) still sitting 
in Djibouti, continuing to receive all his benefits despite having 
done no work in over one year.  WFP Djibouti urgently needs an 
experienced, francophone country director as well as a strong TDY 
program officer.  It also needs to rid itself of the former program 
officer--who by doing nothing continues to cause stress within the 
office. 
 
¶20. USAID/FFP continues to have questions about the targeting and 
activities of WFP's pilot urban food program, planned to begin in 
February to around 55,000 highly food insecure people in Djibouti 
city.  This complex new pilot activity, WFP's planned rural/urban 
Emergency Food Security Assessment (EFSA) in April, and the 
seriousness of the broader Horn of Africa drought situation, all 
require the strong program management skills of an experienced 
country director and energetic and innovative TDY program officer. 
 
----------- 
CONCLUSIONS 
----------- 
 
¶21. Southwestern Djibouti continues to suffer from drought, 
malnutrition, low food availability, and very poor terms of trade 
for pastoralists, making access to cereals dependent on WFP food 
distributions.  Although there is no reliable data, malnutrition is 
clearly a serious problem.  However, efforts to manage it are having 
a positive impact and, with continued support, should be able to 
reach most of the rural population during 2009. 
 
¶22. WFP is currently meeting the food needs of most vulnerable rural 
Djiboutians.  That said, the team recommends that a new WFP Country 
Director and TDY program officer be positioned as quickly as 
possible.  WFP also needs to ensure more effective distributions 
through stronger field monitoring and reporting/resolution of 
issues.  WFP has noted USAID concerns that As-Eyla could become a 
potential point of conflict if Afar beneficiaries are not included, 
and EA/FFP will follow up to ensure that this point is rectified 
quickly.  As WFP's pipeline is due to break in April, EA/FFP 
recommends that FFP make an appropriate contribution when 
possible--ideally once WFP has shown its commitment to effective 
staffing. 
 
¶23. A modest investment by USAID/OFDA in UNICEF has paid off with an 
actively engaged MOH supported by UNICEF addressing malnutrition 
full on, although more needs to be done to reduce the suspected 
continued high rates and to provide early warning and treatment in 
all rural areas.  It is recommended that USAID/OFDA consider 
continuing support to UNICEF to expand and embed the malnutrition 
program within the MOH, as well as undertake another nutritional 
survey and implement a surveillance system. 
 
SWAN