Children bear brunt of health crisis in Horn of Africa drought

As the worst drought in four decades engulfs the Horn of Africa, it’s created the ideal conditions for a massive health crisis for children — from widespread malnutrition to spikes in cases of preventable diseases.

Four consecutive rainy seasons failed — sending Ethiopia, Kenya, and Somalia into crisis. The most recent March to May rainy season appears the driest on record, with a “concrete risk” of an unprecedented fifth failed rainy season in October.

The drought is compounded by conflict, heightened fuel, food, and fertilizer prices due to the war in Ukraine, and the COVID-19 pandemic.

“The most vulnerable in any situation like this …  are children,” Paul Ngwakum, regional adviser for health for eastern and southern Africa at the United Nations International Children's Emergency Fund, told Devex. 

The drought is pummeling many areas with already inadequate health systems. And with each successive year of droughts or flooding that destroys crops and kills livestock, community resilience declines.

“If you have a country with a healthy health care system, it can absorb certain major shocks — manmade or natural disasters,” Djoen Besselink, country director for Somalia and Somaliland at Médecins Sans Frontières, said. “But there's no more resilience from either the people or the health care system to absorb minimal levels of shock, for example, measles, so everything becomes a big outbreak.”

A ‘revolving door’ of hunger

In East Africa, one person is estimated to die every 48 seconds due to the drought. During the 2011 drought in Somalia, an estimated 133,000 children under the age of 5 died. The United Nations warns this could nearly triple as 350,000 severely malnourished children could die in the coming months.

CARE said the number of acutely malnourished children in its facilities in Somalia increased by 60% in the first four months of this year, as compared to the same period last year. Over 770,000 people in the country are displaced by the drought, the majority of whom are women and children.

“People that are displaced are living in precarious conditions, poor sanitation, and it means they're going to get exposed to otherwise preventable diseases,” Ngwakum said.

In Kenya’s semi-arid north, Turkana, which is home to a pastoralist community and the Kakuma refugee camp, is one of the hard-hit spots. The drought happened at a time when the populations were already suffering. Refugees have seen food rations from the World Food Programme significantly reduced in recent years.

According to a WFP spokesperson, monthly rations to refugees in Kenya have reduced to 50% of the minimum food basket because of funding shortfalls and delays in the arrival of commodities. It hasn’t provided a full ration to refugees in Kenya since 2018. And while families also receive cash-based assistance from other organizations, they don’t always spend it on food, Dr. Sila Monthe, health manager at the International Rescue Committee, said.

Turkana hadn’t received rains between January 2021 to when the first short rains came in April, she said.

Food is mainly imported into the region at a high cost, Monthe said, and families skip meals to stretch the food for longer periods of time and often opt to buy less nutritious, but bulky food.

From February, IRC started noticing a high number of children coming to its health facilities with severe malnutrition. “They come in with respiratory complaints, and on doing a nutritional status assessment, that's when we find out they are actually also malnourished,” she said.

In what Monthe described as a typical case, a 14-month-old baby and her mother, who live in the refugee camp, arrived recently at IRC’s clinic with acute watery diarrhea but health workers discovered she was also malnourished. The family’s food rations have dropped by half, which typically lasts until midmonth, with the cash assistance failing to fill the shortfall. The infant's 5-year-old brother previously had malnutrition and the mother is currently pregnant.

“Looking at that family, you already see there are going to be so many issues in the coming year,” Monthe said. “We are hoping to not have to treat the newborn, once the child is delivered.”

MSF conducted a household survey of 300 families in Jubaland, Somalia, and found that 33% had children with global acute malnutrition. 

Treating malnutrition requires expertise but there aren't enough trained health workers to meet the burgeoning demand in Somalia, Hodan Ali, a nurse practitioner, who serves as senior adviser to Mogadishu’s mayor on humanitarian crises, said. “You can actually kill the child, because of the loss of vital nutrients, if you overload them again and then the body crashes.”  

And if a child only eats bread, for example, it weakens the stomach causing diarrhea, Gabriella Waaijman, global humanitarian director at Save the Children, said at a recent news briefing. She said children come to the organization’s clinics, receive therapeutic feeding and medical interventions, but return home where they eat mostly bread.

“And a couple of months later, they end up in our clinics again with exactly the same problem,” she said. “What we're seeing very often is a revolving door.”

The cost of nutritional therapy is expected to rise by 16% in the next six months due to the war in Ukraine driving up costs, Christiane Rudert, UNICEF regional nutrition adviser for eastern and southern Africa, told Devex. This will cost UNICEF $12 million more in commodities alone to treat children with extreme malnutrition in Kenya, Ethiopia, and Somalia. But the humanitarian sector says the response is woefully underfunded. 

Because having malnutrition at a young age impacts a child’s development, Ali said she is concerned about Somalia’s future. “That's the future workforce of the country,” she said.

‘A vicious circle’

“When you're malnourished, it affects your immunity,” Ngwakum said. “Common infections that you would have resisted become more overwhelming. Children get sick easily.”

Many people live in cramped, unsanitary conditions, drinking contaminated water, which leads to acute watery diarrhea and cholera. Somalia reported over 4,300 cases of cholera this year.

And densely packed displacement camps fuel the spread of pneumonia and measles. Somalia has reported more than 8,700 suspected measles cases this year — 82% of which are among children under 5.

This spike in measles is a result of a low immunization rate in Somalia, MSF’s Besselink said.

“When you have measles, you get easily malnourished because you don't eat and you're sick. And when you're malnourished, your body is too weak to fight off a virus or bacteria. Everything is a bit of a vicious circle,” he said.

A child’s body with acute watery diarrhea becomes excessively dehydrated and it can lose vital minerals. “​​That's why you see rapid deaths when people have acute watery diarrhea,” Ali said.

And these diagnoses are typically bundled. “Usually, you end up getting two or three diagnoses that really collapse people's health systems,” Ali said.

The region has pockets of communities with “zero dose” children — those who haven’t received any vaccines, Ngwakum said. Ethiopia has quite a number, he said, adding that the conflict in northern Ethiopia has impacted immunization campaigns throughout the country.

“They were very good before, but recently, they've gone through many issues, including conflict,” Ngwakum said.

And pregnant people are suffering. When they are displaced, they might lose access to antenatal visits, Ngwakum said.

Unhelpful rains

The rains have come in bursts, which provide some relief in replenishing water reservoirs, but sporadic rains are also deadly.

These rains create stagnant waters that malnourished people, with weak immune systems, often drink for lack of other options, Ali said. “People end up using that rainwater when their bodies are so vulnerable and not able to mount the supportive mechanism they need to fight off infection,” she said.  

And the puddles create breeding grounds for malaria-carrying mosquitoes, Ali said.

Millions of livestock have died because of the lack of rain and pasture across the region — and carcasses are everywhere, Ali said. Some people sometimes don’t have the emotional capacity to bury them to prevent a health hazard because of the trauma of losing their livelihood.

“A dead carcass produces all kinds of bacteria and germs that seep into the land,” she said.

Monthe said IRC saw a spike in acute watery diarrhea cases in Turkana, disproportionately affecting malnourished children, following the short rains.

“Whenever we have short rains, we experience an increase in the number of diarrheal cases because we have more stagnant water around the camps and the sanitation situation is not ideal,” she said.