Download a PDF of this issue - Field Exchange - Emergency ...

Field article
Integrated
Management of
Acute Malnutrition
(IMAM) scale up:
Lessons from
Somalia operations
By Leo Anesu Matunga and Anne Bush
Leo Matunga is currently the nutrition cluster
coordinator for Somalia. He has over 12 years
experience working in nutrition in emergencies in
Somalia, Zimbabwe, Sudan and Pakistan. He has
experience working in government, international
NGOs and UN agencies. He holds a Masters in
Public Health from University of Western Cape, South Africa, a
Masters in Development Studies from Leeds University (UK) and a
BSc in Nutrition Studies from the University of Zimbabwe.
Anne Bush is a freelance consultant, engaged by
the ENN to support write up of this article for the
CMAM Conference. She has over 15 years experience
working in the field of international public
health nutrition in Kenya, Somalia, Tanzania,
Ethiopia, the DR Congo, and Indonesia. She
holds a Masters in Public Health from the London School of
Hygiene and Tropical Medicine and a BSc in Dietetics.
The authors acknowledges the immense contributions of UNICEF
Somalia, WFP Somalia, Ministry of Health officials in the
Government of Somaliland, Ministry of Health officials in
Government of Puntland, Ministry of Health Officials in The
Transitional Federal Government, local and international organisations
working in Somalia and the Nutrition Cluster team.
L Matunga/UNICEF, Somalia, 2011
Brief history and background
Somalia has been in a state of armed
conflict since 1988, and has been without
an effective government since the
fall of Siad Barre in 1991, representing
the longest case of state collapse in
modern times 1 . Two decades after the
collapse of the unified state, Somalia
continues to endure protracted armed
conflict and a major humanitarian
crisis, currently exacerbated by a
severe drought and floods. The recent
failure of the deyr 2010/11 seasonal
rains and the lighter than normal gu
rains has resulted in an estimated 32%
of Somalia’s 7.5 million people being
in need of humanitarian assistance,
including approximately 910,000 internally
displaced persons (IDPs).
Somalia is an arid country of
250,000 square miles, consisting of
three main zones with varied social,
livelihood and economic structures.
These are:
• the North-west zone (NWZ), also
known as Somaliland, comprising
Woq Galbeed, Awdal, Togdheer
and Sool/Sanaag regions
• the North-east zone (NEZ) also
known as Puntland that includes
Bari and Nugal regions
• the South Central zone (SCZ)
comprising Mudug, Galgadud,
Hiran, Bakool, Bay, Shabelle, Juba
and Gedo regions.
Somaliland and Puntland both recognise
themselves as independent states
and are pushing for international
recognition as such. Somaliland and
Puntland border each other across the
contested regions of Sool and Sanaag
and occasional border clashes do
occur. The SCZ, by far the biggest zone
in the country, has an estimated population
of 4,810,837, more than 60% of
the whole country population.
Continued displacement as a result of
the ongoing civil conflict in the SCZ
Acronyms:
BSNP Basic Nutrition Services Package
CAP Consolidated Appeals Process
CERF Central Emergency Response Fund
EPHS Essential Package of Health Services
FSNAU Food Security and Nutrition
Analysis Unit
HIS Health Information Systems
HSS Health System Strengthening
IDP Internally displaced persons
IMAM Integrated Management of Acute
Malnutrition
MCH Maternal and Child Health
MOH Ministry of Health
NWZ North-west zone
NEZ North-east zone
OTP Outpatient Therapeutic Programme
PCAs Programme Cooperation
Agreement
SCZ South Central zone
SC Stabilisation centre
ToT Training of Trainers
TSFP Targeted Supplementary Feeding
Programme
has resulted in IDPs from the epicentre
of the conflict in Mogadishu and
neighbouring areas dispersing over
the country, with many returning to
their ancestral clan homeland.
Although Somalia is formed of a
predominantly single ethnic block, the
elaborate clan system holds the checks
and balances of the country.
The country’s main livelihoods are
pastoral (sheep, goats, camels), agropastoral,
riverine, fishing, urban and
IDP livelihoods. It is estimated that the
country receives roughly in excess of 1
billion dollars in remittances from
diaspora annually.
Southern and central Somalia have
some of the worst social indicators in
the world, with over 43% of the population
living on less than $1/day, 2 as
well as some of the worst rates of
under-five and maternal mortality.
Despite the extensive need, a narrowing
of humanitarian space has made it
virtually impossible for aid organisations
to reach many of the people in
need. 3 The lack of central government
means in effect working with three
different health authorities and to an
extent, involves three different
approaches.
Socio-political operating
environment
Since the collapse of central government
in 1991 and the resulting civil
war, there have been many efforts to
restore a central government in
Somalia without sustained success. In
1991, the NWZ declared the independent
state of Somaliland, with its
governing administration in the capital
Hargesia. The region is
autonomous, holding democratic elections
in 2010, but is not internationally
recognised. The NEZ declared itself as
the autonomous region of Puntland in
1998. Although governed by its administration
in its capital Garowe, it
pledges to participate in any Somali
reconciliation and reconstruction
process that should occur. In South
Central Somalia, political conflict and
violence continue to prevail, despite
attempts to establish and support a
central governing entity.
National nutrition and health
situation – some history
Twenty years of war and insecurity
have had devastating effects on the
nutrition and health status of the
people of Somalia. The combination of
conflict, insecurity, mass displacement,
recurrent droughts and flooding and
extreme poverty, coupled with very
low basic social service coverage, has
seriously affected food security and
1
For a more detailed analysis of the history of
instability and humanitarian access in Somalia,
see Ken Menkhaus (2010). Stabilisation and
humanitarian access in a collapsed state: the
Somali case, 34 Disasters 320 (2010).
2
Mark Bradbury. State-building, Counter-terrorism,
and Licensing Humanitarianism in Somalia.
(Briefing Paper). Sept 2010 Feinstein
International Centre (2010).
3
Human Rights Watch, supra note 9.
27