DJIBOUTI - USAID FOOD INSECURITY ASSESSMENT

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.

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FOOD SECURITY IN DJIBOUTI
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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.

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MALNUTRITION
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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

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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.

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"MIGRANTS" AT SANKAL
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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.


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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).

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WFP RESPONSE
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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

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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.

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CONCLUSIONS
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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