1. (U) POST RESPONSES TO REFTEL, KEYED TO ELEVEN
FACTORS LISTED IN 3 FAH-1 H3721.2-1, FOLLOW:



A. CLIMATE: DJIBOUTI REMAINS ONE OF THE HOTTEST
PLACES ON THE PLANET WHERE CLIMATIC CONDITIONS ARE
VIRTUALLY CONSTANT THROUGHOUT THE YEAR. THIS IS
ESPECIALLY TAXING PHYSICALLY AND IMPOSES KEY HEALTH
CONCERNS THAT EXIST IN FEW OTHER FOREIGN SERVICE POSTS.
AMONG OTHER FACTORS, STAFF MUST BE VIGILANT REGARDING
SMALL, INCREMENTAL CHANGES THAT CAN OCCUR IN PERSONAL
HEALTH STATUS ON A DAILY BASIS, ESPECIALLY FOR SYMPTOMS
RELATED TO HEAT STROKE, DEHYDRATION, AND KIDNEY
MALFUNCTION. MOREOVER, THE EXTREME HEAT LIMITS THE
VOLUME AND TYPE OF OUTDOOR RECREATION AVAILABLE TO
AMERICAN OFFICERS.



B. ISOLATION: DJIBOUTI IS A SMALL COUNTRY IN THE HORN
OF AFRICA THAT LACKS THE INFRASTRUCTURE TO SUPPORT
OPPORTUNITIES TO TRAVEL OUTSIDE TO NEIGHBORING
COUNTRIES ON A ROUTINE BASIS. THE FEW ROADS IN
EXISTENCE ARE POORLY MAINTAINED AND VIRTUALLY
IMPASSABLE DURING RAINY PERIODS. TRAINS ARE UNSAFE FOR
TRAVEL BECAUSE OF AGING CONDITION OF ROLLING STOCK AND
RAILS. ALSO, THE SINGLE RAIL LINE LEADING OUT OF
DJIBOUTI HAS BEEN PLAGUED BY TERRORIST ATTACKS. ONLY
ONE MAJOR INTERNATIONAL CARRIER OPERATES OUT OF
DJIBOUTI, WHILE THREE OTHER REGIONAL CARRIERS OPERATE
INFREQUENT FLIGHTS.



C. ADEQUACY OF IN-COUNTRY TRANSPORT: DJIBOUTI LACKS
SAFE AND RELIABLE IN-COUNTRY PUBLIC TRANSPORT. ROAD
ACCIDENTS ARE ENDEMIC DUE TO A LACK OF A COUNTRYWIDE
VEHICLE INSPECTION SYSTEM AND POOR DRIVING HABITS.
TAXIS IN THE CAPITAL CITY ARE SUBSTANDARD AT BEST AND
USE OF PUBLIC TRANSPORT OUTSIDE OF DJIBOUTI CITY IS
PROHIBITED ON SECURITY AND SAFETY GROUNDS.



D. RECREATION FACILITIES: WITH THE EXCEPTION OF
POST'S SWIMMING POOL, SMALL EXERCISE ROOM AND TENNIS
COURT, FEW RECREATIONAL FACILITIES ARE PRESENT SIMILAR
TO THOSE FOUND AT LARGER POSTS. AS A SEP POST WITHOUT A
MARINE SECURITY DETACHMENT, INITIATIVES AROUND WHICH A
NUMBER OF COMMUNITY ACTIVITIES CAN BE ORGANIZED ARE
ABSENT. ON ITS OWN, POST IS TRYING TO DEVELOP AND
INAUGURATE A "SNACK-BAR" TO ENCOURAGE AND FOSTER
COMMUNITY-BASED ACTIVITIES AND A PLACE FOR MISSION
MEMBERS TO MEET AND DINE TOGETHER. HOWEVER, BRINGING
THIS FACILITY ON LINE OVER THE COMING MONTHS WILL NOT
IMMEDIATELY MITIGATE THE PROBLEM THAT NOW EXISTS. THERE
IS NO FACILITY FOR LARGE-SCALE INDOOR MEETINGS AWAY
FROM THE OPPRESSIVE HEAT. THE AMBASSADOR'S RESIDENCE,
LOCATED ON THE COMPOUND, IS TOO SMALL TO ACCOMMODATE A
SINGLE GATHERING OF AMERICAN STAFF. IN THE "TOWN" OF
DJIBOUTI, LITTLE OR NO PERSONAL ENTERTAINMENT OUTLETS
EXIST, SUCH AS LIVE THEATER OR CINEMAS FEATURING FIRST-
RUN ENGLISH LANGUAGE FILMS. QUALITY RESTAURANTS THAT
MEET MINIMUM U.S. HEALTH STANDARDS ARE FEW. GIVEN THE
PAUCITY OF RECREATIONAL ALTERNATIVES, AMERICAN OFFICERS
ARE LEFT TO THEIR OWN INITIATIVE TO BREAK UP THE
MONOTONY OF THE HOME-TO-OFFICE-TO-HOME ROUTINE. YOUNG,
UNACCOMPANIED OFFICERS ON THEIR FIRST TOUR OF DUTY, ARE
MOST IMPACTED AND THEY COMPRISE THE GREATER VOLUME OF
AMERICAN OFFICER STAFF.



E. HOUSING CONDITIONS: POST HOUSING CONDITIONS ARE
SATISFACTORY. HOWEVER, DUE TO LACK OF CONSTRUCTION
INFRASTRUCTURE IN THE COUNTRY, EXPANDING THE POST'S
HOUSING POOL TO MEET THE GROWING NEEDS OF NEWLY
ASSIGNED OFFICERS HAS BEEN PROBLEMATIC. ASSIGNED
OFFICERS WAITING IN TEMPORARY QUARTERS TO GET INTO
PERMANENT HOUSING IS ONE OF POST'S MOST PRESSING
PROBLEMS. THE FRONT OFFICE HAS PUT "QUALITY OF LIFE
ISSUES" HIGH ON POST MANAGEMENT'S PRIORITY LIST.
NONETHELESS, AS POST GROWS INTO ITS NEW EMBASSY
COMPOUND (NEC) PLANNED FOR CONSTRUCTION IN FY-07,
EXPANDING STAFFING LEVELS WILL KEEP PRESSURE ON
MANAGEMENT TO PROVIDE AN EVER-INCREASING HOUSING POOL
FOR ITS ICASS CLIENTS.



F. UNSANITARY CONDITIONS: DJIBOUTI HAS INHERITED A
FRENCH COLONIAL MUNICIPAL INFRASTRUCTURE THAT HAS NOT
BEEN KEPT IN GOOD REPAIR. CONSEQUENTLY, HUMAN WASTE
DRAINAGE AND TREATMENT IN A CITY BARELY ABOVE SEA LEVEL
PRESENTS A HEALTH PROBLEM CITYWIDE. LEACHING OF WASTE
INTO GROUND WATER IS ALSO A SPECIAL CONCERN IN USG
HOUSING AREAS WHERE OCCUPANTS MUST TAKE SPECIAL CARE TO
BOIL AND FILTER HOUSEHOLD WATER PRIOR TO CONSUMPTION.
MOREOVER, THE CITY LANDSCAPE IS LITTERED WITH SOLID
REFUSE AND THE COUNTRY LACKS AN EFFICIENT WASTE AND
COLLECTION AND DISPOSAL SYSTEM. THESE CONDITIONS ALONE
POSE SPECIAL HEALTH PROBLEMS.



G. LACK OF ESSENTIAL SERVICES: CITY POWER SUPPLY IN
DJIBOUTI IS NOT UP TO MINIMUM STANDARDS. FREQUENT
OUTAGES AND "BROWNOUTS" STRAIN THE EMBASSY'S CAPACITY
TO SUPPLY POWER TO HOUSEHOLDS AND THE WORK PLACE.
PROVISION AND USE OF STAND-BY GENERATORS AT EACH
LOCATION IS A MUST. SURGES IN POWER ARE CONSTANT
REMINDERS OF INADEQUATE POWER LEVELS.



H. LACK OF ADEQUATE MEDICAL/DENTAL CARE: AGAIN, POST
MUST SUBMIT THAT MEDICAL CARE IN DJIBOUTI DOES NOT
APPROACH THE MINIMUM ACCEPTABLE LEVELS FOR SIMILAR CARE
IN THE U.S. OR EUROPE. POST HAS A SMALL HEALTH
TREATMENT FACILITY ON THE EMBASSY COMPOUND STAFFED BY A
TCN HEALTH CARE MANAGER, WITH THE RMO RESIDENT IN SANAA
AND SCHEDULED FOR VISITS TO POST ON A QUARTERLY BASIS.
FOR EMERGENCY CARE, POST MUST RELY ON AN "AS AVAILABLE"
ARRANGEMENT IT HAS ESTABLISHED WITH A FRENCH FACILITY
RESERVED FOR TREATMENT OF FRENCH MILITARY PERSONNEL.
FOR A COMPLETE REPORT ON BASIC MEDICAL CARE AT POST SEE
STATE MED'S WEB SITE ON THE INTRANET.



I. PREVALENCE OF COMMUNICABLE DISEASE: FOLLOWING IS A
REPRESENTATIVE LIST OF DISEASES ENDEMIC TO DJIBOUTI:
COLDS AND RESPIRATORY DISEASES, DIARRHEA, HEPATITIS,
MALARIA, DENGUE FEVER, TUBERCULOSIS, SCHISTOSOMIASIS,
AND HIV/AIDS. MALARIA PROPHYLAXIS IS REQUIRED.



J. UNUSUAL PERSONAL HAZARDS: IN ADDITION TO THOSE
STATED ABOVE, POST OFFERS PARTICULAR CHALLENGES AND
HAZARDS BECAUSE OF ITS UNIQUE LOCATION AS A FOCAL POINT
FOR THE GLOBAL WAR ON TERRORISM. ALTHOUGH, RISK OF
VIOLENT CRIME IS REMOTE, DISPLACED PERSONS FROM
SURROUNDING COUNTRIES CONTINUE TO FIND THEIR WAY TO THE
STREETS OF DJIBOUTI CREATING A POTENTIALLY VOLATILE
ENVIRONMENT. AS STATED ABOVE, THE POOR STATE OF
DJIBOUTI'S TRANSPORT INFRASTRUCTURE PLACES POST
PERSONNEL AT GREATER RISK FROM ACCIDENTS ALONE.



K. EXCESSIVE COST OF TRANSPORTATION FROM POST TO A
SUITABLE RELIEF AREA: TRANSPORTATION COSTS ON THE
SINGLE EUROPEAN CARRIER WHICH SERVICES DJIBOUTI, AIR
FRANCE, COMPARE FAVORABLY TO OTHER CARRIER AIR
TRANSPORT COSTS SERVICING THE SAME ROUTE, OR
ALTERNATIVE RELIEF LOCATIONS OUTSIDE OF THE HORN OF
AFRICA REGION. ON A COST COMPARATIVE BASIS, COST OF
TRAVEL TO AN ALTERNATE RELIEF AREA FAR EXCEED THE COST
OF THE DIRECT ROUTE TO THE PRESENT DESIGNATED R&R
POINT.



2. (U) POST STRONGLY RECOMMENDS REDESIGNATION OF
DJIBOUTI AS ELIGIBLE FOR R&R TRAVEL BASED ON CONTINUING
HEALTH AND WELFARE NEEDS AS OUTLINE ABOVE.
RAGSDALE