Sitrep: Wajir Emergency 28/05 –10/06/2001 - PFEDA / Page d ...

Sitrep: Wajir Emergency 28/05 –10/06/2001 

Latest 

Developments 

including security 

situation 

Save the Children Situation Report: 

• General Situation and Security 

Not much change on the weather front occurred; Wajir town and 

environs have been enjoying some how cloudy cool days and cooler 

nights and the vegetation seems to have lasted a bit longer. Reports 

from the SFP outreach team (W and N of district) indicate that milk is 

in plenty supply and that both fauna and flora are flourishing. 

The security situation in the North (as reported in the last Sitrep) 

seems to have been contained. So far, both the Garres and Ajuran are 

living peacefully. However, the incident in which a Garre was killed few 

weeks ago in Kunkum is building up tension between the Garres and 

the Boraan in the neighbouring district of Moyale. 

Over the weeks, two persons were killed as a result of eviction of a 

small Somali clan allied to the Ajuran tribe from the West of Wajir. 

They were attacked between Adibohol and Arbajahan villages whilst 

returning to their traditional grazing area near Korondille. The 

emigrates who are originally residents of Wajir West had moved to 

Isiolo district five years ago because of persistent drought in Wajir 

district. Recently, they have been directed by the provincial 

administration to move out of Isiolo district after a long-standing feud 

between Somali pastoralists from Wajir district and the Boraans 

tribesman of Isiolo district in which many lost their lives. Much of the 

trouble around the two districts is of political nature and expected to 

continue probably towards the forthcoming general election. 

The incident reported earlier between Gabra tribesmen from bordering 

Marsabit district and Jibrail sub-clan of Degodia near Arbajahan is still 

simmering up. The Wajir District Commissioner recently made a public 

baraza in Arbajahan to quill the tension after some 109 camels raided 

by the Gabras were returned from Marsabit to their owners in 

Arbajahan. A small contingent of Kenya Army together with combined 

regular and administration police are now stationed near Arbajahan to 

allay fears of revenge attack. 

The use of armed escorts to Arbajahan area is recommended 

nowadays, a measure to be continued until further notice. 

• Cholera outbreak 

The cholera outbreak within Wajir town and surroundings is persisting. 

Sporadic cases are reported from as far as 35 Km from Wajir town to 

the West of the district. 

While the number of cases admitted at CTC is 2-3 daily with no deaths 

reported during this reporting period, the co-ordinating team at the 

district level under the chairmanship of the MOH is aware that the 

1



outbreak is far from over. Three deaths have been reported from the 

bullas around town and recently 1 death was reported from right in the 

town centre. All those who died had diarrhoea and vomiting (D&V) 

suggestive of cholera. 

The UNICEF Somalia team has greatly assisted the Ministry of Health 

especially in the field activities, which include social mobilisation using 

a Cholera video show translated into Somali language inside Wajir 

town and in some villages to the west. 

A training of 200 selected Community leaders from Wajir town and its 

vicinity on social mobilisation for cholera control is on going. The 

training is organised by the MoH public health office and sponsered by 

SC/UNICEF. There are 4 training sessions of 2 days, each for a group 

of 50 participants. The first two groups from Bulla Wagberi, Halane, 

Jogoo, Got-ade and Makoror have completed their training and are 

actively organising themselves to combat the cholera by conducting 

general cleanness and health talks in their communities. 

The District Cholera Co-ordinating Team meets every other day to 

discuss and review the epidemiological data generated by the 

surveillance team and reports from the CTC. The efficiency of the 

team however is greatly affected by the laxity and apathy exhibited by 

the District Public Health Officer. Mr. Fankey who should be the head 

of the surveillance team does very little in support of the decisions by 

the co-ordinating team. 

Suggestions by the Provincial Medical Officer (North Eastern 

Province) to try and use slow release chlorinating methods for the 

wells around Wajir was termed as ‘foreign ideology’ by the above 

Officer and thus was never tried at all. The advice given by any 

organisation represented (UNICEF, SC(UK), MoH members) at the coordinating 

committee is totally ignored. The departure of Dr. Mukhtar 

(the DMO) for a meeting in Garissa where he decided to take a leave 

until July has left the MoH with very poor leadership and dominated by 

a controversial person very much unwilling to co-operate. 

The ineffectiveness of the surveillance team due to poor leadership is 

a major contributing factor to the slow rate at which this cholera 

menace is being contained. 

A total of 24 ORS Centres have been established around the bullas of 

Wajir. The UNICEF Somalia teams who assisted in the establishment 

of the ORS Centres have met a lot of resistance from the surveillance 

team in the process. On the other hand, the communities at the 

various bullas are very receptive to the team and social mobilisation is 

progressing very well with community support. 

There is still no proper mechanism of reporting deaths at the bullas, 

due to a lack of regular reporting from the surveillance teams. 

Unverified information received indicates that the death toll is much 

higher than the deaths recorded in the CTC. The matter has been 

raised at the Co-ordinating meeting by SC (UK). Consequently the 

surveillance team leader has been changed and the CO from Garissa 

has been tasked with the responsibility of leading the surveillance 

2


team. 


No new cases are reported from Tarbaj since the last reporting period. 

This does not however mean that there are no cases. Staff at the local 

health facility manages the few cases that are reported. The health 

facility has been supplied with adequate ringers lactate, doxycycline 

caps and erythromycin tabs & syrup. 

The cumulative numbers of patients with D&V who have gone through 

the Cholera Treatment Centre since the month of April are 207. The 

deaths toll still stand at 11 giving a Case Fatality Rate of 5.3%. Given 

the poor information on fatalities outside the CTC, this death does not 

represent the total number of cholera deaths. 

The management of cases at CTC still needs improvement. Despite 

the very few cases at the ward, the staff does not seem to understand 

the need for the continuous dehydration for patients who are stable 

using ORS. Many times, we find patients sitting idle or drinking bottled 

water brought in by relatives. This has been pointed out at the 

meetings though not much positive change has been observed. The 

SC team on the routine visit to the CTC always makes a point of 

discussing the above issues with the nurses concerned. 

A child of one year old was admitted at the CTC on May 21 st and died 

on the 25th. The child initially presented D&V with chest problems 

suggestive of Pneumonia. The child however was kept at the CTC 

even after the D&V had ceased, instead of being transferred to the 

paediatric ward for further management of the chest complications. 

The above example illustrates the conditions that exist at the CTC 

despite the good number of staff attached to the CTC. The main 

problem is poor supervision by the senior-nursing Officer who should 

be on top of everything but seems to be having problems and/or rather 

feels sidelined by the DHMT. 

The communication between the nurses and the Clinical Officers who 

refer patients from MCH to ward 4 (CTC) seems to be non-existent. 

Inter-ward communication is equally weak. Cases with confirmed 

typhoid have been found to be admitted at the CTC, which beats the 

whole purpose of the CTC as the same patients with typhoid could 

easily contract cholera from the CTC. 

Infection control at CTC has improved since the deployment of one SC 

staff from the former TFC to be in charge of sanitation and infection 

control together with an Officer from Ministry of Health. 

Though MoH at provincial level sent to Wajir 9 MoH staff (2 CO, 4 

nurses and 2 PHO) to support the cholera control efforts in Wajir, 

these people were under-utilised and even left out of most of the 

arrangements made. This situation lead to frustration of some 

members who eventually decided to leave Wajir even without the 

knowledge of their team leader from Garissa who also left on the 8 th of 

June. 

3


Impact on 

Children 

Constraints 

on 

Humanitarian 

Action 

Save the Children 

Response 


The cholera outbreak trend from the data available indicates that more 

adults >15yrs are getting affected unlike before when there were more 

children. 

• Other 

Helena Eversole, the deputy UNICEF Country Rep. visited Wajir for a 

day to check on the cholera response and to arrange for local 

participation in the upcoming UNICEF/GoK Mid-term review of the 

country Master Plans of Operations for Kenya. This MTR is scheduled 

in Wajir from 10-17 June, conducted by an inter-sectoral team from 

Nairobi. She also hosted a dinner in the SC compound where DC, 

OoP Rep. and other government persons were invited as well as 

NGOs based in Wajir. 

The exhibited poor MoH/DHMT commitment and lack of good 

leadership has a negative impact on the livelihood of many vulnerable 

women and children in Wajir district. This is clearly portrayed by the 

persisting cholera epidemic in spite of financial resources and 

technical assistance availed by the humanitarian community (UNICEF, 

SC(UK) and other donors like OFDA). 

The constrained relationship with a member of the DHMT (see higher) 

and the continued fight around issues of accountability with the entire 

DHMT have compromised the efforts to rapidly eradicate the cholera 

outbreak. The suggested approach to this could be to advocate for 

internal changes within the DHMT or a stronger leadership to bring 

things under control. The alternative approach could be moving into 

more community involvement and using them as counterparts with the 

MoH as the technical advisor to the community. While this issue will be 

discussed during the next SC project review meeting, the current 

approach remains to exhaust all possible diplomatic ways to defuse 

the tension and to ensure accountability. 

• Health 

The SC(UK) response during the reporting period has been in the area 

of cholera containment. Along that line SC/UNICEF sponsored a 

training of 200 influential community leaders. They will mobilise their 

community to contain the cholera outbreak through activities like water 

chlorinating, improving of personal hygiene, early detection and 

referral of suspected cases and reporting of deaths attributed to 

diarrhoea and vomiting. 

Also as part of the response to control the cholera epidemic, SC 

continues to provide logistical/medical supplies and allowances to the 

MoH team conducting the surveillance in villages around Wajir. 

4



• Food and Nutrition. 

The two nurses that were recently transferred from the (closed) TFC to 

the SFP team have been working very well, providing treatment and 

immunisation to the children in the targeted Supplementary Feeding 

Programme. Caution has to be exerted however to avoid that their 

presence at the SFP distribution sites displaces the MoH health staff 

currently working at the health centres and outposts. It has been 

emphasised to the SC nurses that they are there to complement and 

assist the MoH health staff, and not serve as a substitute. A mass 

immunisation of the village of Adhibohol (located between Hadado and 

Arbajahan, and home to 15 beneficiaries of the SFP), was proposed 

by the SC(UK) SFP staff recently. This was agreed upon, provided this 

is done in conjunction with MoH health staff from Hadado. This 

relationship needs to be monitored with due attention. 

Another SFP issue that needs to be addressed is the perception of the 

community (mothers, leaders, elders… ) of the SFP. It has long been 

felt by many in SC (UK) that there is little or no sense of community 

ownership of the SFP, but that it is rather seen as an external entity or 

an employment opportunity for the community. This is apparent when 

storage and off-loading fees are demanded by community leaders. 

Francis Battal (Project Manager) and Abdi Araru (Liaison Officer) have 

scheduled a trip to Arbajahan to sort this out with the community there. 

Distribution: 

West 

All sites experience decreasing enrolment numbers due to high levels 

of discharges and defaulters. In Hadado and Arbajahan, there was a 

sharp increase in the number of defaulters, though there were also 

many children in the programme discharged. It is suspected that 

migration of families towards better grazing land is the motivation for 

defaulting in this area. 

The proportion of the enrolled children gaining weight varied 

considerably from site to site, ranging from 56 % to 82 %. The 

proportion of the enrolled children losing weight ranged from 14 to 23 

%. The coverage of measles immunisation, and distribution of 

mebendazole and vitamin A has greatly improved in the west. Among 

the four sites, the proportion of the enrolled children immunised with 

measles ranges from 88 % to 96 %, while the proportion of children 

who have received mebendazole and vitamin A range from 93 % to 

100 %. 

Below is a summary of the current enrolment in the West: 

Location Number Under Fives Total Beneficiaries 

Hadado 19 67 

Arbajahan 65 151 

Griftu 34 98 

Eldas 55 166 

Total in West 173 482 

North 

The week of 4 June was the second distribution week under a new 

5



SFP supervisor, and no major issues or problems were reported. This 

supervisor, however, only oversees the Buna, Korondile, and Ajawa 

distributions, while the Bute distribution is under an additional 

supervisor. 

There were a substantial number of discharges in Buna and Korondile, 

while also some children defaulted. The number of new admissions 

remains low. These statistics are an indication of an improved 

nutritional situation. 


Korondile 30 126 

Ajawa 12 55 

Buna 58 160 

Bute 91 190 

(Bute figures for this week not available yet; figures used in this table 

are of previous Sitrep) 

Total North 161 531 

Central 

The enrolment has remained quite stable in Makaror, with 43 new 

admissions, 38 discharges, 1 death, and 4 defaulters. Thus, there was 

no net gain in the number of children in the programme. Enrolment in 

Wagberi, however, decreased considerably, with 79 children 

discharged from the programme and 6 children defaulting. 

Medical inputs continue from both the SC (UK) nurse and the AMA 

nurse. There is the continued issue, however, of the risk of becoming 

a parallel system in this setting. The search continues for a viable 

solution to this: Will providing medical services at the distribution site 

replace the presence of the district hospital – the same system that SC 

(UK) is trying to build its capacity? Given drug shortages, prohibitive 

costs, and long distances associated with the hospital, won’t the 

presence of such medical services at the distribution undermine the 

ability of the hospital to deliver adequate services? 


Makaror 61 128 

Wagberi 46 121 

Total Central 107 249 

• Other 

Francis Battal joined the Wajir team as the new Project Manager on 

May 26 th , replacing Kevin O’Kane. 

6

Sitrep: Wajir Emergency 28/05 –10/06/2001 - PFEDA / Page d ...

Create successful ePaper yourself

Delete template?

Save as template?