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December 23, 2022

We Need to Act Like Health and Hunger Are Related. Because They Are.

Global health experts are sounding the alarm. This time, it’s about the rise in measles, cholera and malaria – and their link to malnutrition. The reasons are complex and context-specific, but the outcomes are far too similar: many communities are moving backwards on public health, particularly among young children.  

29 countries have reported cholera cases so far this year - an increase of nearly 50 percent over the previous five-year average – with a case fatality rate that is 300 percent worse. The demand for cholera vaccines is growing so rapidly that the WHO has warned about shortages.

From Somalia to Haiti to Syria, infections are rising and climate change is creating conditions ripe for cholera’s spread. These issues are even more complex in communities facing chronic hunger, a lack of clean water and sanitation services and the threat of conflict. 

Here in Somalia, health providers have been working to treat more than 11,345 cases of cholera this year, along with a rising number of measles cases amid the ongoing fight against other illnesses.

It is imperative to reach patients in time to provide essential treatment, and to educate, vaccinate and work to eradicate outbreaks. At the same time, we need to address additional factors that affect people’s health, which range from basic nutrition to clean water to maternal mental wellbeing. But this task becomes harder every day. 

an Integrated Approach             

We’re seeing relatively steady, if insufficient, financial support to screen children for malnutrition in Somalia, but there is little donor interest in efforts to expand mobile health services. I believe that is short-sighted, as hunger and health go hand in hand.  

A child who has measles or cholera has a harder time absorbing vital nutrients and is more likely to become malnourished. Hunger makes children more vulnerable to disease and death, too: a malnourished child is up to 11 times more likely to die from even seemingly routine ailments like diarrhea. For a severely malnourished child, measles, pneumonia or cholera can become a death sentence.

Now, as famine looms in Somalia, in seven of our nutrition treatment centers we have seen a 543 percent increase in admissions between January and September 2022 compared to the same period last year. 

According to the latest data just released, by next summer, 8.3 million people across Somalia - about half of the country's population - are expected to experience high levels of acute food insecurity.

With communicable diseases and hunger both on the rise, we can’t afford to treat health and hunger in siloes. Instead, we must prioritise an integrated approach to wellbeing.

What’s more, we can’t wait for parents and their children to come to us, counting on their ability to travel to faraway hospitals. Instead, we must bring holistic services to them.  

Mobile Outreach is Essential 

My team operates more mobile health clinics than any other NGO in Somalia, and we see the benefits of health outreach every day.

For example, as we were setting up a mobile health post in the Elbarde district, an under-serviced rural area, we screened children in the community for malnutrition. In the process, we found a case of measles - the first in the area - and were able to treat the child and accelerate our efforts to prevent further transmission of the highly-contagious disease. 

Now, amid an historic drought that has left 1.8 million children and 184,400 pregnant and breastfeeding women struggling to cope with a severe hunger crisis, we need to expand mobile outreach.

We must scale the extensive network of community-based health workers who are screening and treating malnutrition and compounding health conditions for women and children.

However, donors seem reluctant to finance health infrastructure: organisations and agencies focused on delivering health services in Somalia are reporting a staggering  USD 97.3 million funding gap. 

Growing Needs, Insufficient Funds 

This isn’t the first time funding has fallen short. In 2020, 1.2 million Somalis faced crisis levels of hunger. In 2021, the international community responded both generously and inadequately, meeting 77 percent of the country’s requested total funds, leaving a hunger funding gap of 23 percent. The global community didn’t fully capitalise on the window for anticipatory action. Now, famine threatens communities across the country and funding remains insufficient. 

By the end of this year, an estimated total of 1.6 million Somalis will likely be displaced by drought and conflict. While many people hope their troubles may end when they reach a camp for internally displaced people or refugees, too often the opposite is true.

Displaced people become even more dependent on very limited resources and humanitarian assistance, and their needs - not just for food and water, but for housing, security and new livelihood sources – simply multiply.  

A lack of space and poor sanitation increase disease outbreaks. Food scarcity makes those diseases worse. Already, tens of thousands are living in squalid conditions, sleeping on floors in makeshift tents. And desperate people keep coming to displacement camps and humanitarian stations in search of help.  

Hunger and health require greater coordination  

Nuro Ibrahim Ali, a mother of four, was forced to leave her Goof Gadud Buro Hiraab village after her small herd of livestock died due to drought.

She sought refuge in a displacement camp in Baidoa, nearly 20 miles away. There, a measles outbreak killed many children, and her two- and four-year-olds caught the highly contagious disease. Community health workers came to Nura’s makeshift home and referred her to a nearby mobile clinic.

There, her younger daughter was diagnosed with severe malnutrition and sent to an Action Against Hunger stabilisation centre. This approach saved her life. 

Measles is endemic in Somalia, and with low vaccination coverage and high rates of malnutrition, outbreaks are not uncommon in an average year. This is not an average year: the unprecedented drought and crowded camps have exacerbated disease risk.

Nura and her children were lucky to get needed treatment in time, thanks to the effective combination of community health workers and a mobile health clinic that not only addressed measles, but screened for malnutrition.

It is an approach we need to scale.  

Planing Ahead 

Just as it is more efficient and effective to integrate health and nutrition services, it is better to address hunger before it drives people from their homes. As we deal with today’s crises, we also need to invest in anticipatory action and build our capacity for managing health and hunger as ongoing emergencies. 

Even if the rains return to Somalia, the situation won’t change that quickly. It takes time to replenish the soil. and for people to get out of debt, gain access to seeds and acquire new livestock and farming tools after selling the old ones out of desperation. It takes time for crops and cattle to grow.  

Until then, we need to adopt approaches that can stretch health and humanitarian budgets even further. We are seeing some modest success. As measles cases rose earlier this year in southwest Somalia, a mass vaccination campaign reached 304,400 children under 15 years old, covering more than 96.7 percent of the children targeted.

At the same time, we screened for malnutrition and other illnesses and referred cases to the nearest health centre for treatment. It’s a start.  

With 7.6 million people in Somalia in need of humanitarian assistance - and disease outbreaks rising in countless communities around the world – we must act like health and hunger are related. Because they are, and millions of lives depend on what we do about that fact. 

Dr Hodan Abdullahi Mohamed is a Social and Behavorial Change Coordinator at Action Against Hunger in Somalia. He spent the last six years working in emergency humanitarian settings on health and nutrition programme design, implementation and monitoring.  

Image by Ismail Salad Osman Hajji dirir