EMERGENCY AND HUMANITARIAN ACTION (EHA)

WEEKLY UPDATE – WHO COUNTRY OFFICE ETHIOPIA

(Week 30, 20 – 26 July 2009)

HIGH LIGHTS: • Rising malnutrition and food insecurity are a growing concern in Ethiopia and according to the

federal Disaster Risk Management and Food Security Sector (DRMFSS), up to 6.2 million

people may require relief food assistance in 2010.

• Increasing admissions to therapeutic feeding programs have been recorded in several regions,

including SNNPR, Oromiya, Somali and Amhara since May 2009.

• According to official reports from the Federal Ministry of Health (FMOH), the unidentified

disease reported last week is confirmed to be cerebro spinal meningitis which claimed 17 lives.

• 629 new cases of AWD and five deaths (CFR of 0.8%) have been reported from 22 districts in

5 regions.

I. GENERAL SITUATION:

a) Political, social, security overview for the week

• The overall security situation in the country remained stable during this week. No major

security incidents involving humanitarian staff members have been reported.

b) Main events of interest/ concern for health (displacements, conflicts, disease outbreaks,

etc.)

Food security and malnutrition

• Field work and data analysis of the Government-led joint inter-agency assessment undertaken

to update humanitarian requirements have been completed. Findings are expected to be

officially announced in the coming weeks. Meanwhile, The Disaster Management and Food

Security Sector presented to donors revised beneficiary food aid needs for the period June to

December 2009. The needs are based on projections and estimations that the population in

need of relief assistance will increase from 4.9 million to 6.2 million people. Consequently,

there is an expected increase of approximately 460,500 mt of relief food, of which there is a

current shortfall of over 300,000 mt. The projections take into consideration the effect of the

overall unfavorable performance of the Belg season coupled by the late start of the Meher

rains, particularly in crop producing areas. The Meher forecast for the north eastern, north and

eastern part of the country is near normal to below normal. This is expected to have an

adverse effect on the overall agricultural production.

• WFP reports that the Disaster Risk Management Food Security Sector (DRMFSS) has begun

allocating the fourth round of relief food in West Hararghe and Arsi zones in Oromiya and in

SNNPR. Out of the current 5.3 million beneficiaries for relief, 2.2 million will be covered by the

Joint Emergency Operation Programme (JEOP) and 2.4 million will be covered through

WFP/DRMFSS (in priority one and two areas). Food for the next round of distributions will be

available only if new contributions materialize. The fifth round (sixth for Somali Region) will

address critical and immediate food needs in August, deep in the hunger season. As of 22

July, DRMFSS has allocated a total of 9,320 MT of assorted food commodities for distribution

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to approximately 690,000 beneficiaries in Afar, SNNPR and Oromiya (Arsi and West

Hararghe) regions.

• Between July and September 2009, WFP is expecting the arrival of 224,618 MT of food, out of

which 131,131 MT will be used for loan repayments to EFSRA and other projects, leaving a

balance of about 93,000 MT for all operations, including food for the relief programme. At

present, one ship is being off-loaded in Berbera port (Somalia/Somaliland), while another ship

carrying 24,501 MT of wheat is expected to arrive in Port Sudan on 25 July 2009. As of 19

July, WFP stocks in Djibouti stood at 133 MT of assorted food commodities, while a third ship

carrying 56,750 MT of wheat is expected to arrive in early August.

• The nutrition situation in Gode continues to be critical. A significant increase in malnutrition

cases was reported during the week. As of 15th. July, a total of 28 severely malnourished

cases (all from Gode town) were reported in the therapeutic feeding unit in Gode hospital. The

number of malnourished children admitted to the hospital this week has, however, decreased

compared to last week (from 25 to 5). A mobile health team, funded by UNICEF, reported a

total of 261 moderate and 44 severe malnutrition cases in East Imey woreda in June, while

another 125 moderate and 15 severe cases were recorded in the first two weeks of July. Most

of these malnourished people reside in villages along the river, where the population depend

on crop production during the rainy season. Furthermore, the mobile health team reported 14

severe malnutrition cases among children less than five years last month in Guradamole

woreda. In response, MSF Belgium is setting up a base in East Imey woreda to provide health

and nutrition services as well as to implement water and sanitation programs. Currently, MSF

Belgium is conducting a rapid needs assessment in East Imey town to assess the situation

while a nutrition survey is scheduled to be undertaken in the coming weeks.

• The United Nations Central Emergency Response Fund (CERF) has allocated $6 million to

Ethiopia from the under-funded window. The allocation represents the second allotment for

Ethiopia in 2009. The funds will be allocated towards the most critical sectors including food

aid, health and nutrition, water and sanitation and agriculture and livestock. The CERF funds

earmarked for Ethiopia are part of some $55 million in allocations made to support

underfunded programmes in emergency situations around the world.

Acute watery Diarrhoea (AWD)

• According to official reports from the

Federal Ministry of Health (FMOH), 629

new cases of AWD and five deaths (CFR

of 0.8%) have been reported from 22

districts in 5 regions (Afar, Somali,

Oromiya, Harari and SNNP) Regions.

The CFR in Afar this week is 1.5%,

Somali 0.5%, Oromia 1.1%, and 0 per

cent in SNNP and Harari Regions.

• From epidemic week 1 to 29, a

cumulative total of 4,883 AWD cases and

106 deaths (CFR 2.2%) have been

reported from 29 districts in 6 regions

(Addis Ababa, Afar, Somali, Oromiya, Harari and SNNP).

Discussion with the migrant daily labourers in Afar,

18 July 2009

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• The major risk factors for the continuous spread is poor water supply and sanitation, large

migrant labour force camped in farms with no health services, water supply and sanitation

facilities.

Influenza A H1N1update

• According to official reports from the Federal Ministry of Health (FMOH), no new cases of

Influenza A H1N1have been reported this week. The UN clinic reported 2 suspected cases to

the FMOH last week which were later confirmed and the total confirmed cases in the country

is now 6 . The national technical working group is updating the National Influenza Pandemic

Preparedness and response plan in view of the current pandemic phase. WHO supported the

orientation of health workers on case management protocols. Daily coordination meetings

continue at the FMoH chaired by the Minister of health with support from WHO.

Cerebro spinal meningitis epidemic

The unknown illness reported from Kelela Woreda of South Wollo Zone in Amhara Region is

found to be cerebro spinal meningitis confirmed by laboratory diagnosis in regional laboratory.

A total of 81 cases and 18 deaths (CFR 22.2%) were reported. A team comprising of the

federal, regional and WHO is deployed to the area and provided technical assistance through

assessment/investigation, gap filling, capacity building and supporting coordination of the

response activities. The team supervised and supported the following activities in the affected

district: mass vaccination of the affected communities, epidemiological investigation with active

case search, community awareness creation on prevention and control activities. No new

cases have been reported this week.

II. ANALYSIS & HEALTH CONSEQUENCES: Health problems & Needs of affected populations. Food insecurity and malnutrition

• Admissions to therapeutic feeding programmes (TFPs) continue to increase in parts of Somali,

Oromiya, Amhara and SNNPR. The increase in Out-patient Therapeutic Programme (OTP)

sites and worsening food security is identified as some of the causes for the increased

admission rates. The trend is anticipated to rise during the peak of the hunger season in the

next two to three months. The continued low reporting rate, delay in supply of Ready-to-Use-

Therapeutic Food (RUTF), and poor quality of RUTF procured locally and inadequate

monitoring of emergency interventions are among the outstanding challenges confronting the

sector. In SNNPR, admissions to Therapeutic Feeding Programmes (TFP) increased by 58.4

per cent from April to May 2009, i.e. from 9,392 cases in treatment to 17,795, with reporting

rates increasing, by 15.4 per cent over the same period. TFP admissions also increased in

Wagehamra, South and North Wollo zones and new woredas in North Gonder in Amhara

Region. In Somali Region, TFP admission increased in May and June, with Gode zone

reporting a particularly critical situation.

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Rabies Acute Watery Diarrhoea (AWD)

• At national level the CFR is above 1% showing the need for improvement in case

management and prevention. CFR in 4 regions (Addis, SNNPR, Oromia and Hareri) in the

past 4 weeks is below the WHO recommended standard of 1 per cent. This is an indication of

improved case management in these regions as WHO continues to provide formative

supervision in the AWD affected districts to improve case management. The situation is

different in Somali and Afar Regions where the CFR is above 2 per cent .

• Currently WHO and partners are supporting training of health personnel, community

awareness creation, supportive supervision, multi sectoral coordination and team deployment

(Health, Water and Agriculture) at kebele level and immediate need for improvement of hygiene

and sanitation at all level, in particular in investment farms and Holy water sites.

• The ongoing kiremt rains are expected to further exacerbate the spread of the disease as

number of community unprotected water sources increase; already a significant rise in the

number of new cases has been recorded since the beginning of June. Critical gaps in the

response include lack of CTC materials and drugs, lack of funds for operational budgets,

inadequate protection of water sources, poor hygiene practices and trained health staff.

Case management in CTCs, Preventative measures in communities also need to be further

strengthened.

• The absence of clean safe water supply, proper sanitation facilities, medical care and very poor

and overcrowded living conditions in the state farms and holy water sites serves as an

appropriate foci of infection for AWD transmission within the regions and other areas of the

country. WHO and partners are addressing this issue at federal and regional level.

National Trend Analysis Shows AWD Cases and Deaths as of 19 July 2009

36 30 28

4 7 14 20

41 38 38 33

134 129115

86 93

53

103

178

222

90

151

353

324

199

589

567579

629

25

0 0 0 1 1 1 0 0 0

5

9

2 1 1 0

4

8 7

03

6

119 9

5

11

50

100

200

300

400

500

600

700

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29

Epidemic Week

AW

D C

ases

0

20

40

60

80

100

120

140

AW

D D

eath

s

Cases Deaths

Analysis: WHO - Ethiopia

EHA/DPC/IDSR - Units

Data Source: FMOH - Ethiopia

Date of Production: July, 2009

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III. ACTIONS (in relation or response to the issues mentioned above):

a) WHO activities (field trips, assessments, gap filling, coordination, information sharing, training, etc.) & needs (Human resources, material, and infrastructure) and other partners support.

Food insecurity and malnutrition

• This week WHO has continued its technical support to regions in responding to food and

nutrition crisis in Ethiopia. WHO in collaboration with EHNRI and UNICEF is preparing the

second half of 2009 health and nutrition requirement. WHO is technically supporting the roll out

of OTP traing cascade and the development of monitoring plan

Acute watery Diarrhoea (AWD)

• WHO continues to provide

technical support to the affected

regions of Somali, Oromia,

SNNPR, Afar and Harari through

provisions of emergency drug kits

to government and NGO partners,

supporting assessment, assist in

monitoring and supervision and

strengthening surveillance

activities. Two Emergency drug

and diarrhoeal kits are provided to

Oromia regional health bureau to

strengthen case management and

save more lives. In addition support

for emergency health response

coordination activities are being supported through information sharing, working together and

sharing plans and resources. WHO continues to provide technical and financial assistance to

both federal and regional health bureaus through funds from the Finish Government in AWD

preparedness and response including nutrition response.

• Joint FMoH/Public Health Emergency Management sector, WHO and UNICEF sent a mission

to Afar and Oromia Region from 16th to 26th. July 2009 and provided technical support and

monitoring AWD outbreak response performance. Accordingly the mission to Afar region

identified the following gaps: poor cases management, poor hygiene and sanitation conditions

and lack of safe water supply.

V. COORDINATION:

• This week, WHO actively participated in the technical officers/UNOCHA, WASH

cluster/MoWR, Nutrition cluster and Ethiopian Humanitarian Country Team (EHCT)/UNDP

meetings held in Addis Ababa.

IEHK and Diarrhoeal disease kits provided to Oromia

regional health bureau this week – July 2009

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• WHO is supporting and facilitating the coordination for the preparedness and response of

influenza A by the UN country team and AWD by the FMOH and the regional health bureaus.

VI. COMMENTS:

• WHO is working effectively in partnership with the FMOH, RHBs and partners in strengthening

capacity of the federal and regions for better health and nutrition response. Currently funds

provided by the Finish Government is supporting WHO emergency response activities.