March 1st - May 11th, 2012Food Security and Nutrition

Analysis Unit - Somalia

FSNAU

The FSNAU is managed by FAO and funded by the EC, SIDA, UKAID, DFID, ITALIAN COOPERATION, SDC, UNICEF, UNHCR and CHF

OVERVIEW

FSNAU in collaboration with ACF, Concern, WFP and other partners in April 2012 conducted two nutrition surveys targeting Mogadishu internally displaced persons, and the urban population. Findings show improvements in the situation from the December 2011 survey findings.• Mogadishu IDPs: The nutrition situation is currently at

Critical phase, with global acute malnutrition (GAM, WHZ<-2 or oedema) rate of 16.1%, and severe acute malnutrition (SAM, WHZ<-3 or oedema) rate of 3.7%. The crude death rate (CDR) is 1.4 per 10,000 per day which is elevated above the national median rate of 0.7 per 10,000 per day. Although the results depict a sub optimal situation they reflect a steady improvement from August 2011 when the reference indicators surpassed famine thresholds.

• Mogadishu Urban: The nutrition situation is Serious, with a GAM rate of 10.3%, SAM rate of 1.7%, and CDR of 1.22 per 10,000 per day. The situation shows significant improvements since December 2011 when GAM rate was 21.1% and SAM rate, 5.5%. The CDR also shows improvement from 1.33 per 10,000 per day in December 2011.

• In both the surveys there was no significant difference in malnutrition rates between boys and girls

Nutrition Situation Improves in Mogadishu, but remains Unchanged

in the rest of the Country

THEFOODSECURITY(Source: The FSNAU Food security and Nutrition brief, April 23rd, 2012)

The food security situation in Somalia improved considerably in the post-Deyr (Oct-Dec) 2011/12 compared to last year when famine ravaged many of the southern parts of the country. However, in the April-June 2012 period, 2.51millionpeopleacrossthecountrystill remain in foodsecurityphasesofCrisisorEmergencyas classified earlier this year (Jan’12). Nevertheless, the number of people in Emergency (IPC Phase 4) has reduced, as Juba and Gedo riverine livelihoods have improved from Emergency to Crisis (IPC Phase 3). The contributing factors to these improvements include a sizeable off-season maize harvest (Mar-Apr ‘12) and on-going fishing activities in Juba riverine; and access to labour income for cash crop activities in Gedo riverine. The poor households in Gedo region also have the highest Terms-of-Trade (ToT) between labor and cereals in the country (Mar ‘12). Forecasts for near normal Belg rains in the Ethiopian highlands (mid-March–2nd dekad of June) should ensure availability of irrigation from river water in southern Somalia. Irrigation access will provide the poor riverine population with opportunities for farm labor and own crop production in this Gu season.

The food security situation in the rest of Somalia will remain unchanged up to June 2012, regardless of the performance of the Gu 2012 rains, which is currently projected to be below normal. This is due to the positive effects of favorable Deyr (Oct-Nov ‘11) season and the humanitarian support in the South during the first quarter of the current year. The impact of both factors is reflected by the following: the improved cereal supply in the country; presence of cereal stocks among many of the poor farmers; declining trend in cereal prices and a strengthening purchasing power; reduced cost of living for market-dependent population, which currently include the majority of Somalia’s population; largely sustained good to average livestock conditions; increased kidding/lambing; and improved livestock prices.

Overview 1Nutrition Outlook, May-June 2012 2Mogadishu IDP Nutrition survey findings 3Mogadishu Urban Nutrition survey findings 4Nutrition Situation in :Shabelle and Hiran Regions 5 Gedo and Juba regions 6 Bakool and Bay Regions 7Case study on: Increased Vulnerability of the Huddur Urban population to Acute malnutrition. 7Nutrition Situation in :Northeast and Central Somalia 8 Northwest regions-Somaliland 9

The Deyr (Oct-Dec) 2011/12 season improvements in food security are likely to positively impact on household food access and nutrition through June 2012, irrespective of the performance of the Gu (April-June) 2012 rains, and mitigate the nutrition situation. On the other hand, the health situation reflects deterioration consistent with historical seasonal trends. According to WHO, cases of suspected cholera have increased in South Central Somalia from late March, with Middle Shabelle region mostly affected. There are also increased cases of suspected malaria in Lower and Middle Juba; and suspected measles across Somalia. Health care access therefore is a key driver of the nutrition situation in the May-June 2012 period. Immunization campaigns through the Child Health Days (CHD) initiative kicked off in April in Gedo and Banadir region.

The nutrition forecast for May-June 2012 has taken into perspective the January 2012 situation, historical nutrition trends for the Gu (April-June) season and the prevailing food security and health situation.

• In the north, the forecast depicts a sustained Serious phase except for Nugal Valley and East Golis livelihood zones of Northeast which are likely to remain Critical.

• In central regions, poor rains and increased morbidity levels are likely to aggravate the Serious-Critical situations observed in January 2012.

• In the south, the situation is likely to remain Very Critical except for Lower Shabelle and parts of Middle Shabelle in which improvements are anticipated. Internally displaced persons remain vulnerable due to their heavy reliance on humanitarian and social support, and casual labor opportunities.

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FSNAU Monthly Nutrition Update March-April, 2012

However, the dry Jilaal season (Jan-Mar ’12) was harsh in parts of the North (Coastal Deeh of Bari, Sool Plateau, Nugal Valley, Golis/Guban and pockets of Hawd livelihoods in Togdheer and W. Galbeed regions) where the short rainy season (Oct-Dec ’11) was below normal. In these areas, Gu rains have not yet begun effectively. Therefore, rangeland resources and livestock conditions are below average.

For details, refer to the FSNAU Food security and nutrition brief, at http://www.fsnau.org/downloads/FSNAU-Quarterly-Brief-April-2012_1.pdf

HEALTH SITUATION (Source: WHO Somalia Weekly Health Update, April 1-14)

The proportional morbidity for suspected cholera in South Central Somalia is increasing as noted during week 13 (March 26-April 1). The most affected region for this reporting week was Middle Shabelle. However, WHO and partners observed a general increase in number of cases in Balcad district, Middle Shabelle region. An outbreak investigation team collected four samples that were sent to Nairobi for further investigation in the laboratory. Results are still pending. Health partners have launched response activities in some of the affected areas. Middle Shabelle region is under-served with very few active health facilities.

In South Central Somalia, a WHO investigation team, including an entomologist and laboratory technicians, is looking into the sudden increase of suspected malaria cases in Lower and Middle Juba.

Suspected measles cases continue to be reported from all the three zones of Somalia. During week 13 for South Central Somalia, and week 13 and 14 for Puntland, the number of cases has decreased compared to previous weeks. For week 14, the proportional morbidity for suspected measles increased. Burao district (Togdheer region), which also has the lowest vaccination coverage for the recently conducted Child Health Days, accounts for most of the cases.

The Child Health Days (CHD) initiative kicked off on 10 April in Gedo region as well as Banadir region. Two rounds will be organized in Banadir region, with round one from 14-18 April 2012 and round two from 21-25 April 2012. The number of reported cases of measles has increased in Somaliland. Immunization outreach activities have been started and the number is expected to decrease. The numbers of reported cases, in all zones, need to be assessed against the background of limited or no training, for health workers, on case-definitions of measles.

For details contact deslooverep@nbo.emro.who.int or visit www.

emro.who.int/somaliaSouthern regions: The nutrition situation throughout based on the January 2012 integrated analysis indicated a Very Critical situation, but with considerable improvements from the famine level thresholds six months earlier. A forecast of the situation in February-June 2012 based on historical seasonal trends, disease outbreak patterns, the anticipated food security situation, and access to humanitarian assistance indicates that the nutrition situation is likely to be sustained in Very Critical phase across all of the south, with the exception of Lower Shabelle region, in Critical phase (see back page).

Historical nutrition trends show a varied situation ranging from Serious in Shabelle and Juba pastoralists, to Critical-Very Critical in Bay, Bakool and Hiran regions. Seasonal disease outbreaks and their management, are a major aggravating factor in Juba and Shabelle regions, while access to cereals, livestock products and humanitarian assistance, is a mitigating factor. Current nutrition trends at health facilities and feeding centres indicate that although significantly reduced from the peak of the famine in 2011, the numbers of admissions of acutely malnourished children remain high. Considering that the food security situation across Somalia is likely to remain unchanged through June 2012, the intensity of the disease outbreaks and related humanitarian response are the key driving factors of the nutrition situation in May-June 2012. The latter is a challenge considering the suspension of major humanitarian agencies providing health and nutrition related services.

NorthernandCentralregions: The nutrition analysis in January 2012 indicated a Serious situation in most of the north, with the exception of Hawd of central, Nugal Valley and East Golis (Northeast) livelihood zones where the situation was Critical.

A forecast of the situation in May-June 2012 indicates sustained phases at very best. • The historical trends in northern and central Somalia reflect

a Serious situation in most Gu seasons (2007-2011), except when there are major shocks such as drought and disease epidemics, in which case there is deterioration.

• With the Gu 2012 rains in parts of the north currently average, there is considerable access to water and pasture for livestock which has contributed to increased milk availability. Additionally, there are currently no disease outbreaks. The nutrition situation is therefore likely to remain Serious in these areas.

• In parts of the north and central regions where there are current indications that the rains are poor, livestock body conditions are likely to deteriorate, compromising milk production and household milk access. This is likely to impact negatively on income access and milk consumption, and ultimately on nutrition the situation will remain Serious in these areas.

• Increased morbidity levels in central regions based on the WHO reports, are likely to aggravate the nutrition situation. Considering the ongoing limited response activities, it likely that the nutrition situation will remain at Serious-Critical nutrition phases at best.

IDPs remain vulnerable due to their dependence on humanitarian assistance, income from petty trade and casual labour opportunities that are closely linked with rural and urban livelihoods. The outlook of their nutrition situation therefore remains of concern, as in Deyr 2011. Mogadishu IDPs and urban population groups are therefore likely to remain within the Critical and Serious phases respectively due to access to humanitarian support, while in the north and central regions, the situation is likely to remain worrying, Serious-Very Critical.

NUTRITIONOUTLOOK,MAY-JUNE2012

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FSNAU Monthly Nutrition Update March-April, 2012

In July 2011 during the peak of the food security and nutrition crisis in southern Somalia, the nutrition situation in the Somali capital, Mogadishu was Very Critical, with the IDPs recording amongst the highest acute malnutrition and death rates in the country. By August 2011 famine was declared in the IDPs. In order to closely monitor the perilous nutrition situation in the capital, FSNAU with partners1 conducted monthly nutrition and mortality surveys among the IDPs and urban population. To date, a total of five2 nutrition and mortality surveys have been conducted among the highly vulnerable IDPs and four3 among the urban population. By December 2011, the nutrition situation among the IDPs had improved with key indicators4 dropping to below famine thresholds, mostly attributed to massive humanitarian response. However the situation still remained Very Critical.

FSNAU and partners (ACF, Concern and WFP) conducted food security, nutrition and mortality surveys among the IDPs and urban population, to determine their current nutrition and health situation. The surveys were conducted between 15th – 27th April 2012, in fourteen districts5 in Mogadishu, in fifty clusters randomly sampled per survey. Using a two-stage probability

1 ACF, Concern, WFP, SRCS, Muslim Aid, World Vision, ZamZam, COSVI, INTERSOS and Local Authorities2 Surveys conducted in the following months July, August, October and December 2011 and April 20123 Surveys conducted in the following months April, October and December 2011 and April 20124 Mortality- CDR 2/10,000/day, Acute malnutrition- GAM >30% and food access5 Wadajir, Dharkenley, Hamarweyne, Hamarjabjab, Waaberi, Shibis, A.Aziz, Hodan, Shangani, Bondhere, Yaaqshid, Karan, Holwadag and Wardhigley

proportionate to size (PPS) sampling methodology, a total of 929 and 959 children (6-59 months) were assessed among the IDP and urban population respectively. A total of 598 and 650 households were assessed for mortality among the IDP, and urban population respectively.

SurveyFindingsshowanImprovementintheNutritionSituationoftheIDPandUrbanPopulationintheSomalicapital,Mogadishu

Table 1: Nutrrition Surveys Schedule May-July 2012NUTRITION SURVEYS SCHEDULE

May-July 2012S.No. Livelihood Zone(LZ)/Population Group PERIOD1 Agropastoral LZ (Togdheer & Northwest) July 20122 West Golis /GubanPastoral LZ July 20123 Sool Plateau LZ (Northwest and Northeast) July 20124 Hawd Pastoral LZ (Northwest) July 20125 East Golis/Kakaar Pastoral LZ (Northwest) July 20126 East Golis/Kakaar Pastoral LZ (Northeast) July 20127 Nugal Valley Pastoral LZ (Northwest and Northeast) July 20128 Coastal Deeh LZ (Northeast) July 20129 Hawd Pastoral LZ (Central and Northeast) July 201210 Sool Region Urban LZ July 201211 Sanaag Region Urban LZ July 201212 Bari Region Urban LZ July 201213 Nugal Region Urban LZ July 201214 North Mudug Urban LZ July 201215 Awdal Region Uban LZ July 201216 Woq Galbeed Region Urban LZ July 201217 Togdheer Region Urban LZ July 201218 Margaga IDPs-North Mudug July 201219 Dusamareb IDPs May 201220 Hargeisa IDPs May 201221 Burao IDPs May 201222 Berbera IDPs May 201223 Bossaso IDPs May 201224 Qardho IDPs May 201225 Garowe IDPs May 201226 Galkayo IDPs May 201227 Mogadishu IDPs July 201228 Mogadishu Urban July 2012

Mogadishu IDPs Survey FindingsResults indicate a Critical nutrition situation among the Mogadishu IDPs, with a global acute malnutrition (WHZ scores <-2 or oedema) of 16.1% (13.3-19.5) and a severe acute malnutrition (WHZ scores <-3 or oedema) rate of 3.7% (2.3-5.7). The previous nutrition survey conducted in December 2011 reported GAM and SAM rates of 20.5% (16.6-25.2) and 5.6% (3.8-8.1) respectively. The current results indicate an

NUTRITIONSURVEYSCHEDULE

FSNAU and partner agencies are scheduled to conduct nutrition surveys between May-July 2012, across accessible areas of Somalia to estimate the nutrition situation. Findings from these surveys will be disseminated through the nutrition cluster meeting, and various FSNAU publications.

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Figure 1: Trends in levels of Acute Malnutrition Among the Mogadishu IDPs July 2011- April 2012

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FSNAU Monthly Nutrition Update March-April, 2012

improvement in the overall nutrition phase classification, from Very Critical to Critical (Figure 1) however, the difference is not statistically significant. The 90 days retrospective crude and under five death rates reported are 1.42/10,000/day (1.05-1.92), and 2.80/10,000/day (1.87-4.17), indicating a Critical situation according to WHO classification, however an improvement from the previously reported crude and under five death rates of 2.06/10,000/day, and 5.46/10,000/day. The main causes of death reported through respondent’s recall are diarrhoea, breathing problems and measles.

High morbidity rates predisposes the population to malnutrition. In the preceding nutrition survey (December 2011), a very high proportion (45.7%) of the children assessed had fallen ill two weeks prior to the survey. Currently, the total morbidity rate by recall is 26.3% and although this is still high, it is a significant improvement from December 2011. This is has also been noted in the WHO bulletin, which reports a decrease in the number of measles cases compared to previous weeks.6 The proportion of children reported to have suffered from diarrhoea in the 2 weeks prior to the assessment was 15.0%, while those suffering from pneumonia and measles was 12.6% and 1.2% respectively. The measles immunization and vitamin A supplementation status for the assessed children in the 6 months prior to the assessment is 59.9% and 61.3% respectively. At the time of the assessments, the Child Health Days were ongoing and therefore there is a possibility the immunization status of the population will improve from the rates reported (Table 2).

Mogadishu Urban Survey FindingsThe nutrition situation of the urban population has improved from Very Critical in December 2011 to Serious, with a GAM rate of 10.3% (7.9-13.4) and a SAM rate of 1.7% (0.9-3.1). The preceding nutrition survey conducted in December 2011 reported a GAM and SAM rate of 21.1% (17.1-25.8) and 5.6% (3.5-8.6) respectively, with crude and under five mortality rates of 1.33/10,000/day, and 4.12/10,000/day. Currently, the 90 days retrospective crude and under five death rates reported are 1.22/10,000/day (1.05-1.95), and 1.06/10,000/day (1.68-3.75), a Critical and Serious situation according to WHO classification. The main causes of death reported, by recall, are accident/physical injuries, diarrhoea and measles.

6 Somalia Emergency Weekly Health Update 1-14 April 2012

The morbidity rates in the urban population also showed improvement, compared to the findings from the December 2011 survey when 50% of the children assessed had fallen ill two weeks prior to the survey. The total proportion of children reported to have fallen ill in the current assessment was 25.2%. The proportion of children reported to have suffered from diarrhoea in the 2 weeks prior to the assessment is 10.3%, while those suffering from pneumonia and measles is 3.0% and 2.1% respectively. The measles immunization and vitamin A supplementation status for the assessed children in the 6 months prior to the assessment is 55.5% and 60.5% respectively.

In both the urban and IDPs assessments in Mogadishu town, a higher proportion of boys than girls was acutely malnourished but the difference was not statistically significant. This disparity is likely given the use of the new WHO 2006 sex-differentiated reference standards, which has been observed to discriminatively identify more boys as malnourished than girls. With the new WHO reference standards, a girl of a certain height has to be much lighter than a boy of the same height to meet the WHZ<-2 threshold for acute malnutrition.

Overall, the nutrition situation among the IDPs and urban population in Mogadishu town has improved. The progress is mainly attributed to the humanitarian interventions (nutrition, health and food), decreased morbidity levels and improved food security indicators. There are added labour opportunities arising from increased economic and development activities, consequently improving household income. In the December 2011 food security assessment, the proportion of IDPs with unskilled labour as the main source of income was 35%, this has now improved to 58% according to the April 2012 assessment. Similary among the urban population, the skilled labour increased from 10% to 28%. In addition, the terms of trade have also improved from 12kgs of cereal/day to 13kgs of cereal/day. Moreover the prices of staple food in the town have declined from December to date.

Data from feeding centres7 and the health facilities in the town, have also noted a decrease in the number of acutely malnourished children reported since December 2011. Although the nutrition situation has generally improved, the population still remains highly vulnerable to shocks including persistent conflict resulting in population movements which has a direct impact on the population’s household income and food security situation, and in addition to disease outbreaks such as measles and acute watery diarrhoea. The IDP population relies heavily on humanitarian assistance and any disruption in access to these services may also have an impact on the population.

Chronic underlying factors such as poor childcare and feeding practices, inadequate sanitation facilities and lack of access to safe drinking water remain long term challenges to the health and nutrition well- being of the population. Nutrition surveys scheduled for July 2012 in the IDP and urban population will provide further highlights on the situation

7 ACF

Children in an IDP camp in Mogadishu

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FSNAU Monthly Nutrition Update March-April, 2012

TheNutritionSituationofShabelleandHiranRegions

Location Criteria Missing/ Flagged data

Overall sex ratio

Overall age distribution

Digit Preference score-weight

Digit Preference score-Height SD WHZ Skewness

WHZKurtosis WHZ

Poisson Distribution

Mogadishu Urban April 2012

Category Excellent Excellent Excellent Excellent Excellent Good Excellent Excellent Problematic

Score 0 0 0 0 0 2 0 0 5

Mogadishu IDPs April 2012

Category Good Excellent Problematic Excellent Good Excellent Excellent Excellent Acceptable

Score 5 0 10 0 2 0 0 0 3

SurveyDataQualityThe overall quality of Mogadishu IDP and urban surveys was good as indicated below:Table3:PlausibilityChecks

The nutrition situation in Shabelle regions is likely Very Critical, sustained since the Post Deyr ‘11/12 season, based on the analysis of nutrition screening data from health facilities in the region, in addition to household food security information.

Among the agro-pastoral population, data from health facilities indicates a high number (>30%) of acutely malnourished children, (Figure 2) however a lower (>10%) proportion was recorded among the riverine population. Although the nutrition situation in the region is classified as likely Very Critical, it is anticipated the nutrition situation may improve to Critical levels based on the positive food security indicators. However morbidity (AWD/

Cholera and malaria) and limited humanitarian interventions in the area remain a major challenge. The World Health Organization’s Somalia Emergency Health Update, (April 1-14), has reported increased cases of AWD in Middle Shabelle region. The area has limited health facilities and high morbidity levels, this is likely to have an impact on the nutrition status of the population. The current outlook on the food security situation of the Shabelle regions is positive. This is mainly due to the availability of cereals, increased labour opportunities, better livestock body conditions and milk availability and stable food prices in the region.

Mogadishu IDP (N= 929) Mogadishu Urban (N= 959)Indicator N % (CI) N % (CI)Total number of Clusters assessed 50 50Total number of Households assessed for mortality 598 650Total number of Children assessedMaleFemale

929456473

959497462

Child MalnutritionGlobal Acute Malnutrition (WHO 2006)MaleFemale

150 16.1 13.3-19.5 99 10.3 7.9-13.487 19.1 15.4-23.4 62 12.5 9.3-16.663 13.3 9.7-18.0 37 8.0 5.6-11.3

Severe Acute Malnutrition (WHO 2006)Male Female

34 3.7 2.3-5.7 16 1.7 0.9-3.123 5.0 3.1-8.2 9 1.8 0.9-3.611 2.3 1.0-5.2 7 1.5 0.7-3.4

Oedema 0 0 - 0 0 -Global Acute Malnutrition (NCHS)MaleFemale

143 15.1 12.2-18.7 143 14.7 11.8-18.083 17.8 13.9-22.5 94 18.6 14.8-23.160 12.6 9.3-16.9 49 10.4 7.7-14.0

Severe Acute Malnutrition (NCHS)MaleFemale

26 2.8 1.8-4.3 22 2.3 1.4-3.617 3.6 2.4-5.4 16 3.2 1.8-5.69 1.9 0.8-4.3 6 1.3 0.5-3.1

Severe to Moderate Acute Malnutrition by MUAC (<12.5 cm or oedema) Male Female

102 10.6 7.9-14.0 65 6.6 5.1-8.640 8.4 5.3-12.9 35 6.9 4.7-9.962 12.7 9.1-17.5 30 6.4 4.4-9.2

Severe Acute Malnutrition by MUAC (<11.5 cm or oedema) Male Female

18 1.9 1.0-3.4 12 1.2 0.7-2.37 1.5 0.7-3.3 6 1.2 0.4-3.211 2.3 1.1-4.4 6 1.3 0.6-2.8

Proportion of children Stunted (HAZ<-2)Male Female

154 16.5 12.5-21.5 101 10.5 7.7-14.393 20.1 15.6-25.6 63 12.7 9.3-17.161 12.9 8.7-18.8 38 8.2 5.0-13.1

Proportion of children Underweight (WAZ<-2)MaleFemale

183 19.3 15.2-24.2 106 10.9 8.3-14.3108 23.1 18.2-28.9 75 14.9 11.3-19.575 15.6 10.8-22.0 31 6.6 4.3-9.9

Child Morbidity

Children reported ill in the previous 2 weeks 254 26.3 18.2-34.5 247 25.2 19.7-30.7

Children reported with diarrhoea in 2 weeks prior to assessment 145 15.0 10.1-19.8 101 10.3 7.15-13.5

Children reported with ARI within two weeks prior to assessment 121 12.6 7.4-17.7 29 3.0 1.8-4.2Children reported with febrile illness in 2 weeks prior to assessment 151 15.7 11.9-19.3 127 13.0 9.9-16.1Children reported with suspected measles within one month prior to assessment 12 1.2 0.4-2.06 21 2.1 1.06-3.2Child Immunization status

Children immunized against measles by Recall 591 61.3 53.0-69.5 543 55.5 47.4-63.5

Children reported to have received vitamin A supplementation in last 6 months 578 59.9 50.4-69.4 592 60.5 53.0-68.0

MortalityUnder 5 Death Rate (U5DR) as deaths/10,000/ day* 2.80 1.87-4.17 1.06 0.56-2.00Crude Death Rate (CDR) as deaths/10,000/ day 1.42 1.05-1.92 1.22 0.88-1.69

Table 2: Summary of Results for Mogadishu Nutrition Surveys

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FSNAU Monthly Nutrition Update March-April, 2012

The nutrition situation in Hiran region remains in a sustained likely Very Critical phase, across all livelihoods in the region. Data from health facilities in the region indicates a high proportion (>20%) of acutely malnourished children in all livelihoods, except among the agro-pastoral (>10%). population. Figure 3 illustrates the acute malnutrition trends from health facilities among the pastoral population in Hiran region. Based on historical trends, increased cases of diarrhea are expected in the Gu (April-June) season. Increased morbidity coupled with limited access to appropriate health and sanitation facilities increases the risk of acute malnutrition among the population. The overall food

The nutrition situation in Gedo and Juba regions is likely Very Critical, sustained since January 2012, based on the analysis of nutrition screening data from health facilities and household food access information. Nutrition data in Gedo and Juba regions for the period January to March 2012, indicates a high proportion (>20%) and decreasing trend of acutely malnourished children across the three livelihoods. Data from health facilities among all livelihood zones in the region showed similar trends, Figure 4 illustrates trend among pastoral population. These high numbers of acutely malnourished children are mainly due to an increase in seasonal morbidities.

According to the World Health Organization’s Somalia Emergency Health Update, (April 1-14), there are elevated morbidity levels in Gedo, Lower and Middle Juba regions, with increased cases of malaria, suspected measles and outbreaks of acute watery diarrhea (AWD) or suspected cholera reported in these regions. The number of AWD cases and malaria across Juba and Gedo are expected to increase in the April-June (Gu) season based on historical trends. The long rainy season makes the communities in these regions more vulnerable to diarrhea and malaria due to consumption of contaminated water from the catchments while availability of water creates breeding grounds for mosquitoes, a vector for malaria. Lack of functioning public health facilities and limited humanitarian interventions due to security constraints makes the children more vulnerable to preventable disease like measles and whooping cough.

According to the FSNAU Food security and Nutrition brief, (April 23 2012), the food security situation has improved in Juba and Gedo riverine livelihoods. Therefore, IPC phase for this livelhoods was downgraded from Emergency (IPC Phase 4) to Crisis (IPC Phase 3) for April-June 2012 period. These improvements are attributed to a sizable off-season maize harvest (Mar-Apr ‘12) and on-going fishing activities in Juba riverine; and access to labour income for cash crop activities in Gedo riverine. The poor households in Gedo region also have the highest Terms of Trade (ToT) labor to cereals in the country (Mar’12). Forecasts for near normal Belg rains in the Ethiopian highlands (mid-Mar–2nd dekad of June) should ensure irrigation from river water in southern Somalia. Irrigation access will provide the poor riverine population with opportunities for farm labor and own crop production in this Gu season.

NutritionsituationinGedoandJubaregions

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Figure 2: Malnutrition Trends in Shabelle Agro-pastoral Health Facilities 2011-2012 )

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Figure 3: Malnutrition Trends in Hiran Pastoral Health Facilities 2011-2012

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Figure 4: Malnutrition Trends in Juba Pastoral Health Facilities 2011-2012

security situation in the region is likely to improve, mainly among the riverine population, however it maybe too early to be certain. The improvements are based on timely onset of the Gu rains, which increases prospects of crop production, cereal prices are declining, there is increased agricultural labour opportunities and livestock prices are good and milk availability is high. In addition there is the contribution of food aid interventions by partners. However, there is risk of flooding, if this indeed occurs it will negatively impact the riverine population in both Shabelle and Hiran region. Therefore close monitoring of the food security and nutrition and health indicators remains crucial.

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FSNAU Monthly Nutrition Update March-April, 2012

The nutrition situation in both the pastoral and the agro-pastoral populations in Bakool region indicates a sustained likely Very Critical situation. Data from Bakool health facilities reflects a high (>45 %) and fluctuating trend of acutely malnourished children. Figure 5 shows the trend of acutely malnourished children in the health facilities in agro-pastoral areas in Bakool region. Whereas in March-April 2012, no disease outbreaks have been reported in Bakool, there is an increased number of diarrhoea cases. According to the FSNAU Food security and Nutrition brief, (April 2012), in most parts of Bay and Bakool, Gu rainfall started on time, which was in contrast to earlier rainfall forecasts of delayed onset of the long rainy season. Deyr cereal stocks will last up to June-July 2012 for the majority of households in Bay agro-pastoral areas. However, in the Bakool livelihoods, the poor

TheNutritionSituationforBakoolandBayRegions

Leyla’s MUAC shows malnutrition. FSNAU, 2012

Madina*, 28 is a divorced mother of three children with ages ranging from 10 – 31 months. She is the bread winner for her family and lives in a semi-permanent house locally referred to as cariish in Huddur, Bakool region. Her husband disappeared 7 months ago and is reported to have gone to Yemen through Bossaso.

With limited employment opportunities in the area, Madina derives her income from occasional casual labour such as washing clothes, grinding maize or cleaning houses for better off households. “During this difficult time when there is no family support, my household copes by eating two instead of three meals a day. Three weeks ago, Leyla, the youngest daughter got sick with high fever and diarrhoea. Unfortunately, there is no operational public health facility where I could seek treatment. I also had no money to buy medicine for Leyla”, laments Madina. Madina, who is still breastfeeding her last born child, is severely undernourished with a MUAC measurement of 20.4cm, and so are her children, both with MUAC of <12.5 cm.

According to Madina, all her children started breastfeeding 1-2 days after delivery and continued breastfeeding for 6 months to one year. Only the oldest child has a vaccination card and has received two doses of DPT/OPV and measles. In recent

times, Madina’s income sources have reduced after the armed clashes between opposing armed forces to control Huddur. The resultant blockage of the all the roads to Huddur has negatively affected trade movement, resulting in soaring cereal prices, hence declined household cereal access and income.

Next to Madina’s house there is a lady who sells retail food and household items who gave some food to Leyla. Unfortunately Leyla has had no appetite for any kind of food, causing her condition to worsen. Madina therefore took the child to the private pharmacy where she was diagnosed with malaria. Leyla was given an incomplete dose of anti-malaria drugs and failed to recover. With the help of a volunteer health worker, Madina was referred to a qualified nurse who provided a full dose of (Artisunate+SP) from his own home emergency kit to Leyla. She now shows improvement.

This family exemplifies the typical life of many households and their increased vulnerability to malnutrition. Many households live in the same situation of Madina, where there are no public health facilities, and poor quality of the water, high morbidity, limited employment and income opportunities remain key challenges.

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Figure 5: Bakool Region, Health Facilities 2011-2012

Bakoolhouseholds have already exhausted their stocks and they are increasingly depend on market purchase, gifts or humanitarian assistance. It is important to note that insecurity-related market disruptions have led to reduced food supplies, thereby affecting the nutrition status of the population particularly in Huddur town. Key informant interviews indicate low consumption of milk due to reduced milk production, while food prices are decreasing in the region. With purchase currently reported to be the main means of accessing milk, the nutrition situation is likely to be impacted negatively, and to remain Very Critical.

Casestudyon:IncreasedVulnerabilityoftheHuddurUrbanpopulationtoAcutemalnutrition.

8

FSNAU Monthly Nutrition Update March-April, 2012

A nutrition forecast for February – June 2012 following the Post Deyr ‘11/12 integrated analysis depicted most of the livelihoods in Central and Northeast Somalia as likely to be in a Serious phase based on seasonal health and food security situation, and historical trends. Areas that were in serious nutrition situation such as Sool plateau, Addun and Coastal Deeh are likely to be sustained while areas that were in Critical situation such as East Golis, Nugal valley and Hawd pastoral are likely to improve to Serious levels or sustain Critical situation if a major disease outbreak or natural shock occurs.

The health information systems (HIS) data from health facilities in Northeast and parts of Central Somalia are mostly consistent with the Feb-June projections. Data from the health facilities (Jan-Mar ’12) in East Golis areas namely Ufeyn, Waaciye and Iskushuban record high proportion (>15%) of acutely malnourished children and a stable trend, indicating a likely Critical situation. In Sool plateau, low numbers (<10%) of acutely malnourished children are recorded from the health facilities (Qarhis, Dangaroyo, and Waaciye MCHs) in Jan-Mar ’12 and the stable trends indicate a likely sustained Serious situation. HIS data from the health facilities in Nugal valley namely Sinujiif, Gambool and Waaberi, report high numbers (>10%) of acutely malnourished children but a declining trend, indicating improvement towards Serious levels (Figure 7).

NutritionTrendsinNortheastandCentralSomalia

(Jan-Mar) for Hawd, Addun and Coastal Deeh MCHs. The persistently high numbers of acutely malnourished children in the health facilities is linked to increased morbidity during the Gu ’12 season. According to the World Health Organization’s Somalia Emergency Health Update (April 1-14), 168 cases (4.7%) of AWD, 32 cases (1.0%) of suspected Shigellosis, and 16 cases (0.5%) of suspected measles were reported in WHO sentinel sites in Puntland in the last week of March. AWD, Shigellosis and Measles incidences continued in the first week of April but with lower numbers: 31 cases (0.7%), 23 cases (0.5%) and 68 cases (1.5%) respectively, due to less number sentinel sites reported (33 sites) compared to the previous week (44 sites).With regard to the food security situation, the Jilaal dry season

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Figure 7: Malnutrition Trends in East Golis/ Karkaar LHz Health Facilities (Jan-Mar 2012) 0.0

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Figure 8: Malnutrition Trends in Coastal Deeh LHz Health Facilities (Jan-Mar 2012)

BayRegion

The integrated analysis of data from nutrition surveys conducted in Bay region in October ‘11, in addition to data collected from health and feeding facilities indicated a sustained Very Critical situation. Current data from health information systems (HIS) in the area indicates high (>50 %) numbers but stable trend of acutely malnourished children screened at health facilities (Figure 6). There are no disease outbreaks reported in the livelihood zone, however increased cases of diarrhoea have been observed in the area (WHO health update). The region remains highly vulnerable, as the nutrition situation is still Very Critical and humanitarian access remains severely constrained especially for rural areas.

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Figure 6: Malnutrition Trends in Bay Agro-pastoral Health Facilities 2011-2012

In the Coastal Deeh of Northeast and in the Hawd and Addun pastoral areas of northeast and central Somalia, data from the health facilities show declining trends and numbers of acutely malnourished children in the Hawd (>10%) indicating a likely Serious nutrition situation but increased numbers (>15%) but stable trends of acutely malnourished children in Addun. In Coastal Deeh, health facility data indicates a high proportion (>15%) and a deteriorating trend. Figure 8 shows HIS trends

(Jan-Mar ’12) was harsh in parts of the North (Coastal Deeh of Bari, Sool Plateau, Nugal Valley, Golis/Guban and pockets of Hawd livelihoods in Togdheer and W. Galbeed regions) where the short rainy season (Oct-Dec ’11) was below normal. In these areas, Gu (April-June) rains have not yet begun effectively. Therefore, rangeland resources and livestock conditions are currently below average. Household access to milk and livestock products during this period is likely to impact on the nutrition situation.

The nutrition situation among IDPs in Northeast and Central Somalia towns is unstable and likely to remain in Critical-Very Critical levels due to their vulnerability to food and health access. Nutrition surveys are planned for late May 2012 among the Bossaso, Qardho, Garowe, Galkayo and Dusamareb IDPs and in June-July among other rural livelihood populations.

Nutrition surveys are scheduled in the northeast and central IDPs in May 2012, and in rural and urban livelihoods in July 2012.

9

FSNAU Monthly Nutrition Update March-April, 2012

The Post Deyr ‘11/12 nutrition analysis for Northwest Regions (Somaliland) depicted the February-June nutrition situation outlook for most of the livelihoods as Serious based on seasonality and historical nutrition trends. The integrated nutrition analysis in January 2012 showed a Serious nutrition situation in West Golis/Guba, East Golis, Hawd, Sool Plateau and among the Northwest agro-pastoralist and the situation was projected to remain in the same phase up-to June 2012. The only exception was the population in the Nugal valley livelihood which was classified as Critical and projected to remain in the same phase until June 2012. The projection was based on assumption that there would be no severe shocks such as drought and outbreaks of diseases which significantly aggravate the nutrition situation. The nutrition situation of the displaced population ranged between Serious in Hargeisa to Very Critical in Burao IDP camps.

A review of the nutrition screening and health data as well as the contextual information indicate a stable or improving nutrition situation in all livelihoods in Northwest as compared to Deyr ‘11/12. The data in the last three months (January-March 2012) from all livelihoods indicate varied trends but generally showing stable or improving trends. Specifically, low (<10%) and fluctuating trend of acutely malnourished children is reported in East Golis/Gebbi Valley, stable trends in West Golis and Agro-pastoral, high (>10%) and fluctuating trends in Hawd and Nugal valley and low (<10%) and decreasing trend in Sool plateau. Overall, the nutrition situation in all livelihoods in Northwest regions is likely sustained at Serious levels. The only exception is Nugal valley livelihoods where the situation is likely sustained at Critical levels but available HIS data show a likelihood of improvement which will be confirmed in Gu ’12 assessment. Figure 9 shows trends of acutely malnourished children in Sool plateau livelihood.

NutritionsituationinNorthwestregions-Somaliland

According to the FSNAU Post Deyr ‘11/12 integrated food security analysis, the Agro-pastoral, West Golis/Guban, East Golis and Hawd pastoral livelihoods in the northwest were in Stressphase, while Nugal valley and Sool plateau were inCrisis phase. The food security situation remains largely unchanged though the rangeland and water resources have degraded in most livelihoods in Jilaal season and especially in upper Nugal, Golis/Guban and parts of Sool plateau affecting milk production. Access to milk is reportedly low in all livelihoods but the situation is likely to be reversed by the anticipated livestock calving in mid May and good availability of water and pasture for the livestock in areas where Gu rains has started well. Access to cereals has improved due to decreasing cereal prices and increasing livestock prices given the rising demand for livestock for the coming festive season of Ramadan (June-July). In addition, field reports indicated outbreak of suspected measles since February particularly in Ainabo and Burao districts in Togdheer region and in Awdal region. High morbidity is an aggravating factor to acute malnutrition. However, Child Health Days (CHD) carried out by UNICEF/WHO/MoH and other health partners in March throughout Somaliland is a mitigating factor to morbidity. Of great concern is the lowest vaccination coverage recorded in Burao district during the CHD, while the cases of suspected measles are on increase in the same district according to the WHO health update for April 2012. Figure 10 shows trends of suspected measles in Somaliland as reported in the WHO’s Somalia Emergency Health Update. The nutrition situation among the IDPs in Northwest towns remains unstable and likely to be at Serious to Critical levels due to their vulnerability to food and health access problems but the situation will be confirmed with the planned nutrition assessment in mid May 2012.

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Figure 9: Malnutrition Trends in Sool Plateau Health Facilities January 2011 - March ‘12

Figure 10: Trends of Propotional Morbidity for suspected Measles in Somaliland week 1-14, 2012

10

FSNAU Monthly Nutrition Update March-April, 2012

Recent and forthcoming publications and releases

FSNAU March - April Nutrition Update (Forthcoming), May 2012FSNAU March Climate Data Update, April 2012FSNAU March Market Data Update, April 2012 FSNAU Technical Series Report Post Deyr 2011/12 Nutrition Situation, March 2012FSNAU Technical Series Report, Post Deyr 2011/12 Analysis, March 2012FSNAU Food Security Nutrition Brief, April 2012

NOTE: The above publications and releases are available on the FSNAU website: www.fsnau.org

Swiss Agency for Development and Cooperation SDC

Funding AgenciesTechnical and

Managerial Support

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Kilometers

Projected Trend (January - June 2011)Potential to Improve

Uncertain

Potential to Deteriorate

SOMALIA - ESTIMATED NUTRITION SITUATION

January , 2012 (Based on November/December, 2011 surveys)

P.O. Box 1230 Village Market, Nairobi, Kenya Email: fsauinfo@fsnau.org tel: 254-20-4000000 fax:254-20-4000555 FSNAU is managed by FAOThe boundaries and names on these maps do not imply official endorsement or acceptance by the United Nations. The regional & District boundaries reflect those endorsed by the Government of the Republic of Somalia in 1986.

Food Security and Nutrition Analysis Unit - Somalia http://www.fsnau.org

Swiss Agency for Development and Cooperation SDC

Technical Partner Funding Agencies

The Nutrition Situation is analysed using a range of nutritionindicators from direct and indirect sources from October to December '11: nutritional surveys, health facility data, rapidMUAC assesments, selective feeding centre data, health reports and others

IDP PhaseSeriousCriticalVery Critical

Likely Critical

Likely Very Critical

Data analysis ongoing

Nutrition Situation

Alert

Serious

Critical

Very Critical

Acceptable

Even though the nutrition situation in the South is Very Critical,

there are significant improvements from the famine thresholds

observed in the July-October 2011 period when GAM rates

were in excess of 30%

Note

SOMALIA ESTIMATED NuTRITION SITuATIONJANuARy, 2012

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M. JUBA

W. GALBEED

AWDAL

L. SHABELLE

M. SHABELLE

BANADIR

Hobyo

Eyl

Afmadow

Burco

Qardho

Ceerigaabo

Talex

Galkacyo

Luuq

Iskushuban

Ceel Bur

Bur Hakaba

Hargeysa

Dinsor

Bulo Barde

Xudun

Jariiban

Baardheere

Berbera

Baydhaba

Jilib

Burtinle

Sakow

Ceel Afweyne

Beled Weyne

Garowe

Kismayo

Zeylac

Caynabo

Qandala

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Dhusa Mareeb

Ceel Dheere

Cadale

Ceel Waq

Sablale

Laas Caanood

Bossaaso

Baki

Bu'aale

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Garbaharey

Ceel Barde

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Harardheere

Borama

Lughaye

Aden Yabal

Qoryoley

Bele

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wa

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Goldogob

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HUDUR

BURAO

BAIDOA

GAROWE

BORAMA

BU'AALE

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BOSSASO

ERIGABO

KISMAAYO

LAS ANOD

HARGEYSA

DUSAMAREB

GARBAHAREY

BELET WEYNE

±0 75 150 225 300 37537.5

Kilometers

SOMALIA - ESTIMATED NUTRITION SITUATION

Likely Projections (February - June 2012)

P.O. Box 1230 Village Market, Nairobi, Kenya Email: fsauinfo@fsnau.org tel: 254-20-4000000 fax:254-20-4000555 FSNAU is managed by FAOThe boundaries and names on these maps do not imply official endorsement or acceptance by the United Nations. The regional & District boundaries reflect those endorsed by the Government of the Republic of Somalia in 1986.

Food Security and Nutrition Analysis Unit - Somalia http://www.fsnau.org

Swiss Agency for Development and Cooperation SDC

Technical Partner Funding Agencies

Nutrition projections are based on the current situation, historical trends for the Gu season, food security and climate outlook, disease outbreaks and morbidity trends for the Gu season (2008-2011).

IDP PhaseSeriousCriticalVery Critical

Nutrition Situation

Alert

Serious

Critical

Very Critical

Acceptable

SOMALIA NuTRITION SITuATION OuTLOOKFEBRuARy-JuNE 2012