USAID/OFDA ASSESSMENT OF KENYA'S GARISSA

UNCLAS NAIROBI 002438

SIPDIS

AIDAC

SIPDIS

STATE FOR AF/E, EPRATT
USAID/W FOR AA/DCHA, WGARVELINK, LROGERS
DCHA/OFDA FOR GGOTTLIEB, PMORRIS, CGOTTSCHALK,
KCHANNELL
DCHA/FFP FOR JDWORKEN, PMOHAN, DNELSON
AFR/EA FOR JBORNS, JESCALONA
USUN FOR EMALY
ADDIS ABABA FOR JAUGSBURGER
BRUSSELS FOR PLERNER
ROME FOR FODAG
GENEVA FOR NKYLOH
NSC FOR JMELINE, TSHORTLEY

E.O. 12958: N/A
TAGS: EAID KE

SUBJECT: USAID/OFDA ASSESSMENT OF KENYA'S GARISSA
DISTRICT

Summary


1. Although long season rains improved pasture
conditions and water availability in most drought-
affected areas of Kenya, patchy showers in Garissa
District have left many areas dry, impeding recovery
efforts. Water tankering activities continue in
several divisions where residents still face acute
shortages. The UN Children's Fund (UNICEF) reports
that district malnutrition rates are above emergency
levels, but the only facility at present to treat
severe malnutrition is the provincial hospital in
Garissa town. USAID/OFDA has funded CARE to
rehabilitate boreholes, and UNICEF to support
immunization, primary healthcare, nutrition, and water
activities in Garissa. USAID/OFDA recommends continued
support to emergency nutrition, health, and water
interventions in the district. End Summary.

Current Situation


2. Covering 33,681 square km, Garissa District is
located in arid North Eastern Province. The population
is nearly 400,000, including 120,000 Somali refugees in
Dabaab camp. Although successive seasons of drought
have affected all livelihood zones in the district, the
impact has been most severe among pastoral households
that make up 80 percent of the population.
Agropastoralists in Garissa grow primarily
horticultural crops in the river bed areas of the Tana
River. Although less affected by the current
emergency, agricultural yields have declined in the
past year due to drought conditions.


3. Garissa District is included in the Government of
Kenya's (GOK) February Appeal. In April, the GOK
increased the number of food aid beneficiaries in the
district from 109,745 to 120,719, significantly
improving access to food for affected populations.
However, the amount allocated was inadequate and local
officials appealed to the central government to revise
resource allocations.


4. From May 22 to 24, a USAID/OFDA team comprising a
Public Health Advisor and an Information Officer
traveled to Garissa District, accompanied by
International Medical Corps' Country Director, to
follow up on reports of deteriorating health and
nutrition status. The team met with district
representatives from the Arid Lands Resource Management
Project (ALRMP) and the Ministry of Health (MOH) in
Garissa town, and traveled to Bura, Modogashe, and
Balabala divisions to assess conditions.


5. District officials report that long season rains
began falling in most of the district in April, but
showers have been patchy. According to USAID-supported
Famine Early Warning System Network (FEWS NET) and data
from the US Geological Survey, eastern parts of the
district received average to heavy showers while rains
were below average in northern and western divisions,
with some areas receiving only 40 to 80 percent of
normal levels. Although rains replenished some of the
shallow wells in the district, rainfall levels were not
heavy enough for significant improvements in water and
pasture availability. The team confirmed that
conditions in the areas visited were dry with little
pasture and few water sources, and observed tanker
trucks traveling along the Garissa-Modogashe road. The
Arid Lands Office reports that water tankering is
continuing in Shimbirey, Abdi Gab, Ohi, and Alango
villages.


6. According to ALRMP's April Drought Assessment
Report, the onset of rains led to slight improvement in
the availability of forage with substantial
regeneration of browse in parts of the district
receiving heavy rainfall. However, there has been
little sprouting of pasture, exacerbating acute
shortages.

Critical Health and Nutrition Situation


7. In October 2005, UNICEF and the MOH completed a
nutritional survey in Garissa, which found 18.6 percent
global acute malnutrition and 3.1 percent severe acute
malnutrition. In November/December 2005, Medecins Sans
Frontieres/Spain and UNICEF planned to open therapeutic
feeding centers (TFCs) in Modogashe, Balabala, and
Shant-Abak divisions, but were unable to secure
funding. According to UNICEF and the MOH, the number
of malnourished children in the district is likely to
be higher than reported, as the survey was conducted
when residents had been receiving general food rations
for three months. Livestock losses of 50 to 80 percent
in parts of the district have seriously reduced the
availability of milk and milk products, main staples of
the population's diet.


8. The team visited Garissa hospital, the only one in
the district, which serves as the referral hospital for
all of North Eastern Province's nearly 1 million
people. The Hospital Superintendent reports that the
MOH converted one ward of the pediatric unit to a TFC
last year to treat the increasing number of
malnourished children arriving at the hospital. The
hospital TFC remains the only facility in the district
for treatment of severe malnutrition. Although the
Pediatric Unit has a 54-bed capacity, the assessment
team found 64 children on the day of the visit, 34 of
whom were enrolled in the TFC. Enrollment averages 30
cases per month, although admissions reached as high as
60 in February and March. Nine deaths were reported
among the children in the TFC ward in April. The
Superintendent also reported high numbers of
readmissions and default rates, but statistics were not
available.


9. The Superintendent stated that many more children
in the community are likely malnourished, but families
lack knowledge about malnutrition and usually only
bring children to the hospital when they have become
acutely ill with malaria and pneumonia, or are
unconscious. In addition, the road network in the
district is extremely poor and some remote areas are as
far as 600 km from the hospital, thus preventing the
poorest families without resources to pay for
transportation and hospital fees from bringing children
for treatment. Traditional practices also deny
families treatment as they prefer to use traditional
healers and only come to the hospital as a last resort
when other interventions have failed.


10. According to the district MOH official, the
district has 30 health facilities, with 6 not
operational at present due to staff shortages or
infrastructural problems. The team visited health
centers in Bura and Modogashe, and a dispensary in
Dujis. In all areas visited, the major morbidities for
children are malaria, upper respiratory infections, and
diarrheal diseases. The facilities have adequate
supplies of drugs, but lack sufficient staff for
outreach activities or vehicles to transport patients
to the hospital for specialized care. Facilities have
catchment radii of 50 to 80 km, requiring residents to
travel long distances to access health services.


11. Staff in health facilities interviewed by the team
identified several challenges to working in Garissa,
including remote location, difficult living conditions,
low wages, water shortages, extreme heat, malaria risk,
lack of housing, and poor supervision and support.


12. Although the health center staff identified
several serious health and nutrition concerns in the
community, they had limited data on trends or the
numbers affected. The team observed that facilities
appeared to be underutilized, which was confirmed by
nurses in each facility, attributing the communities'
failure to use services to lack of resources and
cultural and religious factors. The fact that health
care staff were all male was a significant obstacle to
providing care to women in the Moslem community. In
addition, pastoralist families were often located in
remote locations and moved frequently, preventing them
from obtaining services on a regular basis. Although
the recent immunization campaign in the district
reached 102 percent for polio and 97 percent for
measles, routine immunization coverage is only 57
percent. It was apparent to the team that very little
community outreach activities are conducted from these
facilities to access the vulnerable hard-to-reach
population.


13. In April, USAID/OFDA provided USD 800,000 to
UNICEF to support immunization, primary healthcare,
nutrition, and water activities in four drought-
affected districts, including Garissa. Additional
plans are underway to support emergency nutrition
activities in the district.

Rains bring limited relief to acute water shortages


14. In all areas visited, local officials and
community members highlighted the lack of water as a
major concern. The main sources of water in the
district are the Tana river, boreholes, Benane springs,
and shallow wells in Modogashe. Rains in some parts of
the district recharged water pans and relieved pressure
on boreholes, some of which were operating 18 hours a
day and prone to frequent breakdowns. Officials noted
that shallow wells along the dry river bed at Modogashe
are getting deeper and yielding less water, increasing
the time required to draw water. USAID/OFDA is
supporting CARE to rehabilitate boreholes and increase
access to water in Dadaab, Jarajila, and Liboi
divisions. In addition, CARE proposes to repair an
additional six boreholes in northern Garissa and
Southern Wajir districts, which will address acute
water needs.

Conclusions/Recommendations


15. According to recent health and nutrition
assessments and observations of the USAID/OFDA team,
the situation for residents in drought-affected areas
of Garissa remains precarious. However, information
regarding services presently available and existing
needs is limited as health care providers have
incomplete data about the affected community and do not
conduct outreach activities to reach the most
vulnerable populations. The assessment team recommends
that USAID/OFDA consider funding the following
additional activities:

a. Support to community-based therapeutic care (CTC)
programs to assist the number of malnourished children
and pregnant and lactating women in the district.
Emphasize CTC's community outreach component to
integrate CTC into existing programs to complement and
strengthen health education, hygiene promotion, water,
sanitation, and livelihood programs.

b. Increase access to water sources as shortages are a
problem across the district. As boreholes are critical
to the area during the two seasonal dry periods,
support activities to rehabilitate boreholes and
maintain functioning ones to make them more productive.
BELLAMY