Breaking down the complex web of malnutrition in Somalia

Against the backdrop of poverty, culture and lack of education, UNICEF and WFP are working to address some of the root causes of malnutrition and strengthen the resilience of communities in southern Somalia.

Mireille Ferrari
Jul 30, 2018 · 5 min read
13-day old, Abdulkadir, in the arms of his 17-year old mother. Photo: WFP/Will Baxter

Muslima greets me with a weary smile when I arrive at her hut at the camp for displaced persons (IDPs) in the sleepy town of Dolow, which sits across from Ethiopia in southwest Somalia. I return her smile with a warm one and a hug, but not too tight — I don’t want to squash the little bundle hidden underneath her clothes.

My smile melts away as Muslima unveils Abdulkadir, her 13-day old newborn son, tiny in her 17-year old arms. His face is gaunt, with eyes and a nose that appear much too big for him, with a tiny torso and a head too big for his body. I breathe in to keep my composure in check.

“Is he breastfeeding?” I ask. Muslima shakes her head and looks down. She pulls aside her top and draws Abdulkadir’s face towards her breast. He begins to cry uncontrollably. “This is what happens when I try,” says Muslima quietly.

Muslima attempts to nurse her son, but he is too weak and unable to latch on. Photo: WFP/Will Baxter

More questions pour out from me: Has your milk come in? What has he been drinking? Were you eating the food rations provided by WFP to treat your malnutrition? Tell me, why haven’t you gone for help?

WFP programme colleague, Abdullahi Sheikh, translates for me: She has milk, but her baby is unable to nurse, so they’ve been giving him sugar water instead… Yes, the mother has been eating the fortified porridge and vegetable oil from WFP, but not much else… She has not gone for help because according to Somali custom, women who have just given birth cannot not leave their home for 40 days.

At the end of it, Abdullahi Sheikh looks sideways at me and says exactly what’s on my mind, “This baby needs help.”

Programme locations in Gedo and Bandadir (Mogadishu), Somalia. Map source: WFP Somalia/VAM

Malnutrition in Somalia is complex and challenging, where cultural norms, lack of education and sheer poverty mean that its root causes are more than just a result of poor food and lack of micronutrients intake. Under a 3-year programme, UNICEF and WFP are working together to address some of those root causes, working closely with communities, implementing partners and government ministries to build the nutrition resilience of the populations in Banadir and Gedo. Since 2011, malnutrition rates in many parts of these two regions have hovered above emergency threshold levels.

Through the combined services and resources of the two agencies, the programme provides support to child growth and development from the womb until five years of age, protects the health of mothers through health and nutrition interventions and provides access to nutrition and Water, Sanitation and Hygiene (WASH) services and behavior change communication. In this first year, the programme will help 109,000 mothers and 205,000 children, comprising 20 percent of the combined populations of the two regions.

Although Dolow’s population is approximately 70,000, close to 70 percent are IDPs. In Somalia, IDPs are one of the most vulnerable groups, with women and children especially susceptible to acute and chronic malnutrition as a result of extreme poverty, lack of access to basic services and frequent exposure to infections and diseases.

Kabasa IDP Camp in Dolow, home to families who have fled their homes as a result of drought, famine or conflict. Photo: WFP/Will Baxter

Take the case of 15-month old Rahmo, whose family moved to an IDP camp in Dolow over a year ago after the last of their livestock perished from the drought. Weak and sickly, in April this year, Rahmo was admitted into UNICEF’s outpatient treatment programme (OTP) for severe malnutrition. After six weeks of successful treatment, she was referred to WFP where she is now being treated for moderate malnutrition.

Measurements of Rahmo’s mid-upper arm circumference (MUAC) show that she is severely malnourished. Photo: WFP/Mireille Ferrari

It turns out that this is not the first time that Rahmo has undergone treatment. She went through the exact same cycle in mid-2017 at a mere 7-months old. Upon her most recent visit to WFP, it was established that even her mother, 29-year-old Sadia Isack Mohamed who still nurses Rahmo, was also malnourished.

Herein lies one of the biggest nutritional hurdles in Somalia — the intergenerational consequences of malnutrition. Maternal malnutrition is linked to undernourishment in-utero, resulting in low birth weight, pre-maturity, and low nutrient stores in infants. These babies may end up stunted and as adults, are likely to have low-birth babies as well. It’s a vicious cycle that needs to be broken.

It’s not long before we rush Muslima and her son to the hospital, where they are immediately checked into the stabilization centre for malnourished children with complications. The staff check Abdulkadir’s weight and height and confirm he is severely malnourished.

In the course of 24 hours, Abdulkadir is given medication together with his mother’s pumped breastmilk. He looks remarkably better, is calm and with gentle coaxing and assistance from the nurses, is finally able to latch onto his mother’s breast, though his sucking reflex has yet to kick in. His jaw muscles need a bit more energy and time, but it’s a good start.

After spending 24 hours at the Dolow Hospital Stabilization Centre, Muslima smiles in the company of her visiting mother and sisters. Photo: WFP/Will Baxter

When Muslima leaves the hospital, she will be enrolled in the joint UNICEF/WFP Mother and Child Health and Nutrition programme, where she will be encouraged to breastfeed Abdulkadir for at least six months and be provided with supplementary food rations to keep up her milk supply and prevent her from being malnourished. She will continue to receive nutrition and sanitation education and be checked upon by community workers who screen and monitor mothers and children under the age of five. Abdulkadir will also be enrolled in the programme and until he turns two, will receive ongoing nutrition support to help his growth and development, and to stave off malnutrition.

The UNICEF/WFP Joint Resilience Programme in Gedo and Bandir in Somalia is funded by the German development agency BMZ, through German development bank KFW and in cooperation with Federal and State Somali Government ministries.

WFP programme colleagues in Dolow, Abdullahi Sheikh and Asia Abdullahi, contributed to this story.

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