Drought in the Horn of Africa, 2000

A) Background.

Health condition in Djibouti was precarious even before drought affected it.
In a nutrition survey conducted by the Ministry of Health and WHO in 1995 at Djibouti-ville, among the adults, 8.4% of female and 14.4% of male are found malnourished. In the same survey, among the children under 5, 1% suffer from the acute malnutrition and 31% are chronically malnourished. This was the situation in the urban area. The situation in the rural area is more grave.
Lack of adequate health facilities, high population growth rate of 6%, high infant mortality rate of 114 per 1000 live births, high maternal mortality rate of 570 per 100,000 births, and short life span of female at 49 years old all indicate weak health service infrastructure.
Immunization coverage for measles and DPT (diphtheria, pertussis, tetanus) are 47% and 49% respectively. This is similar coverage to other countries in the Horn of Africa.

B) Problem analysis.

Current drought hit about 100,000 population , 15% the total. It hit hard the rural nomadic and refugee population. The further lowering of the water table will result in the increasing number of water borne diseases. In 1997 and 1998 drought, about 3000 cases of cholera was reported.
Acute respiratory infection (ARI), diarrhoea, fever of unknown origin, skin problem are major reported health problem.
As drought continues, malnutrition will get worse, and ARI and diarrhoea cases will increase.

C). Assessment of response mechanism in place and gaps.

Health system in Djibouti already stretched to the limit. It will not be able to cope in case of large scale outbreak of cholera or measles for example. It is important to strengthen its capacity for disease and nutritional surveillance.

D). Recommended short term action.

1. Rehabilitation of health centre of Dorra (especially tuberculosis ward), the medical center of Obok (mainly the MCH and Immunization ward) and the laboratory service in Ali-Sabieh.

2. Purchase of rehydration supplies such as ORS packets, Ringer lactate solution, antibiotics such as Doxycycline and erythromycin, and other medical supplies to handle about 3000 cholera cases. Alternately, these supplies can be used for the treatment of non cholera diarrhoea cases. These supplies can be stocked specially for Djibouti ville, Dikhil and Ali-Sabieh.