Ethiopia: “The population in Dodola lives in a precarious balance”

17 October 2008

Since mid-May, Docotrs Without Borders/Médecins Sans Frontières (MSF) has been responding to an acute nutritional crisis in southern Ethiopia. Even though the teams were recently able to reduce the activities, recent assessments have led MSF to launch new interventions in places which had still received no aid. This is the case for Dodola, in the south of the Oromiya region. Dr Sarah Temmerman, who coordinates the emergency nutritional intervention, tells us about it.

Sarah, what is the situation in Dodola?

We left for Dodola on 3 October. Assessments undertaken in September showed alarming levels of malnutrition in some areas of that district. Another NGO had committed to intervene there, but did not live up to its promises. This is why we had to go there. Our team was made of two logisticians, two nurses, and two doctors, including myself. We found a worrying situation even though a bigger crisis in Dodola had been averted by the few nutritional centres set up by the health authorities.

What did the MSF intervention consist of?

Within two days we contacted the local leaders and set up our base and warehouse. By that time we had also set up a stabilisation centre where severely malnourished children with complications could be treated. Two days later, the team opened four out-patient therapeutic programmes (OTPs) in the most affected areas. After a week we had already enrolled 191 children suffering from severe malnutrition in the programme and 13 had been hospitalised in the stabilisation centre. Most of these 13 children suffered from kwashiorkor, a severe type of malnutrition characterised by the presence of oedemas in the body.

Are the areas where you work difficult to access?

Two out of the four areas are reachable by car and on foot, so that we can easily bring medicines and therapeutic food. But the other two locations, Morke and Gefersa Kara, are far more remote and the trip takes three hours on horse or donkey back. Some days the convoy is made of more than 20 horses and donkeys carrying staff, medicines, crates of therapeutic food and bags of food aid. We leave early in the morning and try to come back before the sun sets. This is a bit of a challenge but it works, also thanks to locals who show us the shortest way.

How is it possible that after more than five months and as the harvest is starting, MSF still finds areas so badly hit by malnutrition?

Sometimes, the authorities request our support. Moreover, by asking our patients where they come from, we can identify new malnutrition hotspots. Actually, the situation varies a lot from one place to the next. I have never seen such a “localised” pattern. You see places where children die of malnutrition and there is a real crisis, just beside spared areas. Some areas in Dodola district are completely isolated. Many people there suffer from lack of food. They live on an extremely precarious balance. The slightest event like illness or bad harvest can make children fall into acute malnutrition. You have to be lucky, it’s the law of survival…

How long will MSF teams stay in Southern Ethiopia?

In most places where we work, the beginning of the harvest and the positive impact of the feeding centres have led to a steep reduction in the number of patients with moderate and severe malnutrition. A decreasing number of children is admitted in our stabilisation centres. We have been able to reduce the size of the team and to close some feeding centres. It seems that the worst has passed. We are even foreseeing a hand-over of our activities to the national health authorities around mid-November. Nevertheless, we need to remain alerted. We will continue to explore new areas and will intervene wherever necessary.

MSF nutritional emergency in Ethiopia

In mid-May MSF started emergency nutritional activities in the Oromiya and Southern Nations and Nationalities People’s (SNNP) regions of Ethiopia, and recently in the northern region of Afar. Initially it took in only severely malnourished patients, mostly children. Since mid-July feeding programmes for moderately malnourished children and their families have also been opened. In these past five months MSF has cared for about 31,000 severely malnourished patients and 48,500 moderately malnourished patients across the different locations. In July MSF also made a targeted food distribution for 12,500 people at risk.