Humanitarian response inadequate in Horn of Africa crisis.

On a bed in the fi eld hospital run by Médecins Sans Frontières (MSF), an emaciated child, barely more than a stick fi gure, reaches out shakily to its mother’s back for support. But the mother is sitting on the edge of the bed with her back to the child, staring into space. She does not turn around. In the next bed, another refugee, Khadija, holds her 10-month-old son. They are doing slightly better, although the child is so thin he barely looks human, but things have stabilised now, she says. Her son became ill during the trek from Somalia, 17 days on foot, with little food or water. They made the journey after all her family’s animals died. The famine in Somalia that has sent a tide of refugees into the Dadaab refugee camps 100 km across the border in Kenya has recently drawn international attention, but in fact the problem has been building for years, and reached a crucial point months ago. The current drought, the worst in 60 years, was forecast in 2010. By April, 2011, there was a huge increase in the number of refugees piling up on the outskirts of the already overcrowded camps, said Edward Chege, the medical director of the MSF hospital. MSF and others warned the international community that the situation for the new arrivals was reaching a critical point, because the people on the outskirts were receiving insuffi cient water, sanitation, medical care, or shelter. But the response “was inadequate”, said Chege. The number of children receiving therapeutic feeding in the MSF hospital increased from 20 in January this year to more than 130 by July. The grim situation in the tent hospital in the Dagahaley camp, one of the three camps that make up the Dadaab refugee complex, is not expected to get better any time soon. According to a report on Aug 4 by the US Government’s famine alert agency, FEWSNET, the “current humanitarian response is inadequate to meet emergency needs”, and the famine is expected to spread throughout southern Somalia in the coming weeks. A total of 3·7 million people are considered to be food insecure, and most of these are in need of “immediate, lifesaving assistance”. More than 390 000 children are estimated to be acutely malnourished, nearly half of them severely. The agency has called for “extraordinary measures” to deal with the crisis. On Aug 5, WHO warned of a high risk of disease outbreaks in the drought-aff ected areas because of poor sanitation, a lack of clean water, overcrowding in the refugee camps, and the weakened immune systems of malnourished children. 4000 cases of acute watery diarrhoea are a major concern, according to WHO offi cials, both on their own and because they indicate the potential for a cholera outbreak. So far, there have been outbreaks of both visceral leishmaniasis and measles, with more than 17 500 cases of measles reported. The Dadaab camps are receiving an average of 1300 people a day. 6 months earlier the camps were receiving about 10 000 a month, which was already double the average in 2010. Ethiopia is also receiving refugees from Somalia, of which one in three children is acutely malnourished.