Short and Long Term Consequences of Famine

Transcription

1 Short and Long Term Consequences of Famine Horn of Africa Crisis: Experts Briefing for Humanitarian Workers Context, Challenges and Best Practices Annalies Borrel Monday October 3rd 2011

2 Conceptual Framework for Food and Nutrition Security S H C O C K S A N D H A Z A R D S Food Availability and Markets HIV/AIDS Basic Services Political, cultural, social, security, Gender Agroecological inc Rainfall Reduced Morbidity and Mortality Access to Adequate Quality Food Food intake and Utilization Nutritional Status Child Caring Practices, knowledge Education Health Status inc HIV/AIDS Strategies: Household Food Production, Cash Earning, Gifts, Exchange, Loans and Remittances Improved Development and Productivity Health, Water and Sanitation Natural, physical, Human, Economic and Social Capital/Assets Source: FNC

3 Crude Mortality Rates: Historical Comparison (Deaths/10,000/day) Country CMR* Baseline Thailand (1979) Somalia (1980) Sudan (1985) Ethiopia (1989) Ethiopia (1991) N Iraq (1991) Somalia (1992) Zaire (1994) southern Sudan (1998) Kosovo (1999) Ethiopia (2000) DR Congo (2001) Darfur (2004) Pakistan (2005) Somalia (2011) *Source: U.S. Centers for Disease Control and Prevention

4 Examples of Prevalence of Acute Malnutrition in Recent Humanitarian Crises Country Year Context GAM Remarks Ethiopia (SE) Oct 2009 Chronic insecurity 11.4% ( ) Kenya (NE) Mar 2009 Post-drought 20.5% ) Somalia 2010 Conflict, drought DRC 2009 Conflict, displaced 16% 8.7% ( ) Stunting 26.5% ( ) Low dietary diversity Child separation Uganda 2009 Refugee <5% Anemia 54 79% Afghanistan 2009 Chronic insecurity ) Stunting 55.3% ( ) Somalia 2011 Conflict, drought Variation by livelihood zone Source: Young, Sadler, Borrel 2011

5 U5 MR Relationship between Acute Malnutrition and Mortality Ethiopia Aug Dec % 10.00% 20.00% 30.00% Prevalence of acute malnutrition Source: Borrel and Young

6 Micronutrient Deficiencies

7 Underlying Determinants and Consequences : Food Security Kinship support practices, distorted Coping strategies, reversible Unfavorable terms of trade Poor quality and poisonous foods Labor migration Loss of livelihood - productive assets Markets distorted External credit system Non-reversible coping strategies Long-term resource depletion Distress migration Political factors, conflict, war Displacement, crowding Insurance Mechanisms Adaptive Mechanisms Disposal of productive assets Destitution Increased incidence, susceptibility and severity of communicable diseases, high mortality Adapted: Corbet t1988

8 Coping Strategies: Somalia Coping Strategy Index (CSI), FNSAU Source: Amal Bennaim, 2011

9 Mortality rates among newly arriving Somali refugees Dadaab refugee camps, July--August Period CMR* (95% CI) Pre-departure 0.86 ( ) Journey 1.94 ( ) Postarrival 0.44 ( ) U5MR (95% CI) 2.21 ( ) 3.95 ( ) 1.53 ( ) Median no. of days (IQR) 85 (74--94) 8 (4--18) 24 (16--30) Abbreviations: CMR = crude mortality rate; CI = confidence interval; U5MR = under 5 mortality rate; IQR = interquartile range. * Deaths per 10,000 persons per day. Deaths per 10,000 children aged <5 year per day. Source: Amal Bennaim, 2011

10 Underlying Determinants and Consequences: Behavior Changes Family breakdown Gender-based violence Banditry and civil unrest Abandonment of children Suffocating of children by mothers Households betroth their prepubescent daughters for dowry Children may be sold for labour Women and young girls may be forced to engage in prostitution Source: Adapted from Amal Bennaim, 2011

11 Underlying Determinants and Consequences: Social Care Environment Older sibling and elderly take on caring role Disruptions and loss of community social structures (human capital) Psychological trauma Long term outcomes and increased risks, especially for women Consequences of malnutrition on cognitive development, educational outcomes and productivity

12 Underlying Determinants and Consequences: Public Health Risks Deaths per 10,000 per day Jan Feb March April May June July August Sept October Ajiep, Bahr el Ghazal, southern Sudan, Onset epidemic <5 MR CMR 1998 Source: Borrel and Salama, 1999

13 <5MR and CMR: Deaths/10,000/day Underlying Determinants and Consequences: Public Health Risks Measles MR: Deaths/10,000/day Mortality Trends, Gode District, Ethiopia, December July 2000 <5 MR CMR Measles MR* Intervention Begins Dec-99 Jan-00 Feb Mar Apr May Jun Jul-00 Months * Measles MR: per 10,000 < 14 yrs Source: Salama et al,

14 Sound epidemiological data and interpretation in context of analysis of underlying causes, behavior changes, risks Investment in understanding, communication, advocacy Trends and changes Implications for Response geographic variability by agroecological zones Multi-sectoral platforms for food and nutrition security not only on narrow set of technical nutrition interventions Simultaneous scale-up delivery, monitoring and recovery Humanitarian access Humanitarian principles, SCR1612 Protection Invest in long term goals while meeting immediate needs; strengthening governance structures, policies, social protection frameworks, legal frameworks, resilience of livelihoods, economic recovery Investment in national capacity Comprehensive (functional, technical, infrastructure) Accountable defined results