UNICEF’s Regional Director, Sigrid Kaag, concludes 3-day visit

Sigrid Kaag, UNICEF Regional Director for the Middle East and North Africa has concluded a three-day visit to Djibouti. During her trip Kaag met with the President of the Republic, HE. Ismael O. Guelleh, several members of the cabinet, representatives of NGOs, local associations and communities.
Located at the Southern entrance to the Red Sea, Djibouti shares a border with Ethiopia, Somalia and Eritrea. In Djibouti, extreme poverty affects 42 per cent of the population while 74 per cent are affected by relative poverty.

Ms. Kaag stated during a press conference: “The visit to Djibouti has given me first hand experience of the conditions of women and children in the country, and has provided me with greater insight as to their immediate needs”. She commended Djibouti’s progress towards the Millennium Development Goals (MDGs) especially with regards to a reduction in child mortality rates, as well as increased access to primary education for girls and boys. The Regional Director took note of progress made in gender parity in primary education. At the same time she expressed concerns about remaining disparities between the rural and urban areas in the social sectors.

Ms. Kaag raised the issue of continued high rates of malnutrition, affecting a significant part of the population, and particularly children under the age of five as well as pregnant and lactating women. One child in five is affected by acute malnutrition. UNICEF will support the Government and its partners to further improve food security as well as the nutritional status of vulnerable groups in the country.

“Maternal mortality levels are still too high and UNICEF will work with partners to further reinforce efforts underway” said Ms. Kaag.
UNICEF’s Regional Director for Middle East and North Africa praised Djibouti for its leadership for the eradication of Female Genital Mutilation/Cutting. 
In Djibouti, Ms Sigrid Kaag visited a center which offers services to prevent transmission of HIV from parents to child; therapeutic and supplementary nutrition centers; a counseling center for women affected by violence and a center in a peri-urban area of town where HIV counseling services are offered to the local population as well as migrant workers from neighbouring countries; a newly constructed school in a rural area where girls and boys will for the first time have the opportunity to attend school, starting September 2008.

Data resulting from the 2006 MICS’ survey demonstrate that 13 per cent of children aged 15 to 19 years chew khat, an amphetamine-like stimulant which can produce a mild to moderate psychological dependence. In meetings with government officials as well as representatives of United Nations Agencies, the regional director drew attention to this issue and its impact on children and women. It was agreed that UNICEF would work with the government and partners to formulate a long term programmatic response, building on its capacity in communication for development and its outreach through existing health and education programmes.
 
The Regional Director asked for urgently needed additional funds to respond to the growing food crisis following the drought, and the rise in food prices affecting a population already vulnerable due to poverty and prevailing high rates of malnutrition. UNICEF’s response is included in the United Nations’ Consolidated Appeal which will be launched shortly.

About UNICEF
UNICEF is on the ground in over 150 countries and territories to help children survive and thrive, from early childhood through adolescence.  The world’s largest provider of vaccines for developing countries, UNICEF supports child health and nutrition, good water and sanitation, quality basic education for all boys and girls, and the protection of children from violence, exploitation, and AIDS.  UNICEF is funded entirely by the voluntary contributions of individuals, businesses, foundations and governments.

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The strategies include continued price controls, diversification of food supply sources and increased financing for the agricultural sector. Water infrastructure will be developed along with strategies to address the impact of climate change.

Food aid will also be provided for populations affected by the long drought sweeping across the country, while a system to promote access to technical, scientific tools and resources will be set up to enhance agricultural productivity.

The measures were announced as an early warning agency warned that the prolonged dry season and failed rains from October to February had caused a scarcity of pasture and water for the country's pastoralists.

At the same time, record-high staple food prices had exacerbated food insecurity, leaving many of the pastoralists in need of emergency food aid, the Famine Early Warning Systems (FEWS Net) said in a March update.

In urban areas, where the majority of the population lives, poor households could only buy 68 percent of their daily minimum food requirements due to high inflation rates.

The government, in a statement following a cabinet meeting chaired by President Ismail Omar Guelleh on 15 April, said it would act through an inter-ministerial committee.

The situation, it added, had deteriorated, particularly for the most vulnerable in the rural and peri-urban areas.

According to FEWS Net, food security in Djibouti will, from April to June, be affected by the March to May rains, which are likely to be below normal due to prevailing climatic conditions.

"The rainfall will not enable sufficient regeneration of pasture and browse, and many pastoralists will become highly to extremely food insecure," the agency warned in an update. "The prices of staple foods will also likely increase, causing pastoral terms of trade to deteriorate further."

In February, UN World Food Programme (WFP) spokesman Peter Smerdon said the government had asked UN agencies to help tackle the impact of the drought and high malnutrition rates in the country.

"WFP was asked to distribute food in rural areas for six months from February for a total of 52,000 vulnerable people," Smerdon told IRIN. "WFP needs US$3 million to meet this request."

Djibouti, a poor desert country, is classified by WFP as both a least developed and a low-income, food-deficit country. Eighty-five percent of the total population of about 600,000 is urban, with two-thirds living in the capital, Djibouti.

Food availability has improved in most inland pastoral areas of Djibouti where the July to September rains performed well, the Food Early Warning Systems network (FEWS net) reported.

Both pasture and water were sufficiently available in these inland areas, and livestock body conditions were improving. As a result, milk availability increased and child malnutrition rates were likely to improve temporarily.
 
However, said FEWS net, some local pockets of extremely food insecure households existed, particularly around Hakande, the foothills of Mt Moussa Ali near Doudayo and the Habsou Plateau.

Pastoralists also faced increased costs of staple food. "Households in urban and rural areas are struggling to consume the minimum caloric requirements, and many may become extremely food insecure," it warned. "Cash-or food-for-work programmes or direct food distributions may be needed."

The early warning agency added: "Staple food prices are expected to remain high during the coming months due to high international oil prices, suggesting that poor households need to switch to low-cost regionally available grains such as maize."

Djibouti, a small Horn of Africa country of 600,000, imports all its staple foods.

In a bid to alleviate the problem of perennial water scarcity among poor residents of rural Djibouti, aid donors, the government and a United Nations agency are backing a project to provide clean drinking water to an estimated 25,000 people.

Djibouti, a semi-desert state in the Horn of Africa, experiences frequent drought and most of its water supply is derived from ground water sources, which most poor rural communities have difficulty accessing.

The new project, to be completed in 2008, is funded by the European Union and implemented by the UN Children's Fund (UNICEF) and Djibouti's Ministry of Agriculture. It will boost the capacity of the country's 61 diesel-powered pumps, which break down frequently, with 25 new solar-power pumps, according to Ahmedou Ould Sidi, a water and sanitation specialist with UNICEF in Djibouti.

"The advantage of solar compared to thermal energy is that it is much cheaper and requires less maintenance," Omar Habib, UNICEF communication specialist.

Communities will be empowered to manage and maintain the water project, Habib said. "We want the people to participate and to appropriate these pumping stations. The government’s role in the long term should be as restricted as possible," he added.

The project is expected to benefit the inhabitants of 45 villages and their 40,000 heads of cattle.

"The water supply programme will help to improve the living conditions of many children and women and to the achievement of priority indicators in line with the Millennium Development Goal related to water and sanitation," Aloys Kamuragiye, UNICEF Representative in Djibouti, said in a statement.

According to UNICEF's global estimates, 1.5 million children die every year from diseases associated with lack of access to safe drinking water, inadequate sanitation and poor hygiene.

In June, a famine early warning agency reported that pastoralists in inland areas of Djibouti were finding it increasingly difficult to feed themselves as livestock conditions deteriorated because of the delayed onset of the March-May rains.

The March-May short rains in inland Djibouti began six weeks late, and the rainfall in mid-April was poor. The rains normally provide an important respite from the October to February dry season, especially in the northwest and southeast border pastoral livelihood zones, the Famine Early Warning Systems Network said.

Because of the prolonged dry spell, pasture and water availability are below normal, livestock are showing extreme signs of distress and milk production has plummeted to below normal levels.

Saada Idriss rushed to board the bus but she was preoccupied with the task at hand – vaccinating as many children as possible in two days.

Saada, head of education at the Djiboutian health ministry, explained: “This is different from the two other [previous] campaigns. The goal is to reach more households, farther away, hence the bus."

As part of a national health team that conducted the campaign, she joined colleagues to vaccinate children against poliomyelitis (polio), measles, whooping cough, diphtheria and tetanus – five major diseases that remain potential threats to children under five years old in the Horn of Africa country.

The exercise was organised by the Djibouti ministry of public health with the United Nations Children’s Fund (UNICEF), World Health Organization (WHO), USAID and other partners.

Despite ongoing efforts, said Salah Mohammed, head of the vaccination programme at the health ministry, the threat of disease from neighbouring countries remained – especially Somalia and Yemen, which face the risk of polio.

"Somalia and Yemen registered the reappearance of poliomyelitis and at this moment many Djibouti families flee the scorching heat to head to these countries for the holidays," Salah said. "This vaccination campaign is taking place at the right time and will help prevent contamination of people going on leave."

At Einquilla health centre in Djibouti City, however, some mothers said they would have their children vaccinated at health centres and not in bus caravans. Kadra Osman, a 23-year-old mother, who had brought her nine-month-old daughter, Isir Ali, said: "Even during the other vaccination campaigns, I brought my daughter to the centre; it is more reassuring."

Fatouma Ahmed, 31, who had brought her two-year-old son, said she was scared of the bus campaign. "When we were young, the vaccination campaign was carried out once a year. Now, it is more than three times a year. I fear that these vaccines will make us sick."

The buses, however, rumbled on. Kadidja Djama, a 21-year-old nurse who was riding in one of the buses in Djibouti, said: "It is a short and easy campaign; we will stay near the bus where we have installed our equipment. During the other campaigns, we were the ones moving with our thermos from door to door. It was not easy under this sun and with this heat."

Five-year plan

The campaign is part of a five-year strategy to improve vaccination coverage against diseases such as polio across the country. Last year’s coverage, according to Abdallah Abdilahi Miguil, Djibouti health minister, rose to more than 80 percent although the threat of polio remained serious, especially after cases were reported in neighbouring Somalia.

The polio virus enters the body orally and infects the intestinal lining. It may enter the bloodstream and the central nervous system, causing muscle weakness and often paralysis.

Last year, the UN-backed Global Polio Eradication Initiative launched a campaign to vaccinate more than 34 million children in the Horn of Africa against the virus, covering Djibouti, Eritrea, Ethiopia, Somalia, Sudan, Yemen, parts of Kenya and the Democratic Republic of Congo.

Djibouti has undertaken vaccination initiatives against polio since 1988 and its last reported case of polio was in 1999. Despite logistical constraints, its polio eradication campaign is considered a success, with up to 95 percent of all children in Djibouti City vaccinated.

The five-year programme includes the introduction of vaccines against hepatitis and meningitis, and mandatory health cards for school-going children to show that the child had been vaccinated.

Pastoralists in inland areas of Djibouti are finding it increasingly difficult to feed themselves as livestock conditions deteriorate because of the delayed onset of the March-May rains, a famine early warning agency has reported.

"Milk production is practically non-existent and staple food prices are exceptionally high, further decreasing pastoralists’ already low food access following recurrent years of drought," the Famine Early Warning Systems Network (FEWS Net) said in its latest update on Djibouti released on 5 June.

A recent influx into Djibouti of people fleeing strife in Somalia is expected to further deplete the meagre humanitarian resources available, according to FEWS Net.

The March to May short rains in inland Djibouti began six weeks late, and the rainfall in mid-April was poor. The rains normally provide an important respite from the October to February dry season, especially in the northwest and southeast border pastoral livelihood zones, FEWS Net said.

Because of the prolonged dry spell, pasture and water availability are below normal and livestock are showing extreme signs of distress and milk production has plummeted to below normal levels.

Poor urban residents, whose food access had been severely limited by high prices, have started to feel the effect of water shortages, particularly in Djibouti City and Dikhil. The shortages are likely to aggravate the already poor state of child health and nutrition, according to FEWS Net.

Malnutrition among children younger than five is widespread in Djibouti, where a survey in 2006 showed malnutrition rates well above the emergency threshold, according to the United Nations Children's Fund (UNICEF).

The 2006 Multi-Indicator Cluster Survey attributed the poor nutritional status of Djibouti infants and children mainly to frequent droughts, high unemployment and food prices beyond the means of most poor people in urban and rural areas.

One of the most striking findings was that the global acute malnutrition rate had risen to 20.4 percent against 17.9 percent in 2002, and severe acute malnutrition was 7.1 percent, against 5.9 percent in 2002. The UN World Health Organization considers a global acute malnutrition rate of 15 percent critical.

The effects of the inadequate rainfall are expected to continue at least until the end of July, when the long rains normally begin. The pastoralists’ ability to recover from shocks has been severely weakened over the past decade due to recurrent droughts, smaller herd sizes, chronically high rates of malnutrition and limited trade options, the FEWS Net report said.

An outbreak of cholera that left five people dead in two villages in the Tadjourah region of northwestern Djibouti has been contained, an official with the UN World Health Organization (WHO) said on 29 May.

"No new cases have been reported in the area since 18 May," Djibouti-based WHO medical officer Karim Djibaoui told IRIN. Efforts to bring the outbreak under control included setting up emergency treatment centres in the affected areas, providing clean drinking water and launching a hygiene awareness campaign, he added.

About 76 cases of the disease, including the five fatalities, had been reported in the area in the first two weeks of May.

Cholera is an acute intestinal infection caused by bacteria, spread through the consumption of contaminated water and food. Symptoms include diarrhoea and vomiting, leading to severe dehydration and even death if left untreated.

A Djibouti news agency, Agence Djiboutienne D'Information, said local health officials had linked the latest outbreak in Hangade and Balho localities in Tadjourah to the use of water from a contaminated well by illegal immigrants.

According to WHO, recommended cholera control measures include the hygienic disposal of human faeces, the provision of adequate and safe drinking water, and ensuring the best possible standards of food hygiene, including thorough cooking and avoiding food that may have come into contact with contaminated surfaces.

The Djibouti government has declared a drought in the inland pastoral zones that have witnessed a prolonged dry spell since October.

The worst-affected areas are the Northwest pastoral zone and the Southeast border subzone, although the regions reported some rains in April.

The Djiboutian government, in an appeal for aid, said the drought had affected the livelihoods and food security of the pastoralists, particularly those who did not receive remittances from urban areas and depended solely on livestock.
According to the Famine Early Warning System Network (FEWS Net), the pastoralist areas received poor rains from October to February. "In its appeal, the government emphasised malnutrition rates which are above international thresholds for emergency in both rural and urban areas," it noted.

The situation, FEWS Net added, was aggravated by prices of staple foods that were beyond the reach of poor pastoralists as well as urban households. In addition, an infestation of desert locusts in Arta, Ali-sabieh and Dikhil districts was threatening the limited supply of pasture for the pastoralists.

"The Djiboutian pastoralist lives on the edge even under normal circumstances," the early warning system said. "Any slight climate hazard such as a delay in the onset of the rainy season will have an immediate and direct negative impact on their livelihood and food security."

It noted that the government was trying to take extra policy measures to adjust price fluctuations for the benefit of the poor without affecting the market, and was likely to introduce price controls.

In March, the United Nations World Food Programme (WFP) said an estimated 53,000 people in Djibouti could go without food rations unless funding was found to continue providing food aid.