Breaking the cycle: drought and hunger in Kenya
2014; Elsevier BV; Volume: 383; Issue: 9922 Linguagem: Inglês
10.1016/s0140-6736(14)60492-x
ISSN1474-547X
Autores Tópico(s)Child Nutrition and Water Access
ResumoAid to Kenya responds to the country's recurrent food crises but it fails to address the underlying infrastructure problems that could prevent such emergencies. Sam Loewenberg reports.In a dried-out riverbed a woman and her young son kneel beside a hand-dug hole in the ground, using plastic canisters to scoop water burbling up through the sand. Several naked children with swollen bellies wait their turn. The improvised well seems to be little more than a puddle, yet an entire community of 600 people depend on it. A hand pumped well is just several hundred metres away, under the shade of palm trees, but the bolts on it are bust. The villagers tried to repair it with palm fronds, but that did not work.Nakujan Ariong, a mother of six, says she knows that the dirty water is not safe to drink, but her family has no alternative. “This is the only water available and that's why we use it”, she tells The Lancet. As she is speaking, a man brings over two camels to drink from the watering hole, which the children have just vacated.It is still early in the year, but already nearly 1·3 million Kenyans are going hungry. In Turkana, in the northwest, the percentage of children younger than 5 years at risk of malnutrition is more than 21%. One woman was arrested for feeding her children the family dog.In Wajir, in the northeast of the country, people are again having to rely on water being trucked to their communities, while water sources dry up and “drought birds” have made an appearance, despoiling local water supplies with faeces. Hungry residents are crossing into Somalia seeking pasture and water.Hunger is an ever-present spectre in much of Kenya, where close to half the population is below the poverty line, and about three-quarters work in subsistence agriculture. Even in 2012, which was considered a good year, an estimated 2 million people did not have enough to eat. An assessment of the 2011 famine in Somalia found that 260 000 people died during the crisis, more than twice what was previously estimated. This underscores the fragile status of many people living in the Horn of Africa, and shows how a lack of preventive action can easily boil over into catastrophe.Yet despite repeated promises by international donors that they want to address the underlying conditions that lead to yearly malnutrition in so much of sub-Saharan Africa, the basic lack of infrastructure—water, sanitation, and roads—at the root of these chronic emergencies remains unaddressed. Meanwhile, climate change, war, and growing populations put increased pressure on dwindling resources. Droughts, which used to come every decade in the region, now occur every few years (video).“What you are seeing is that people are being knocked off their feet by one shock and not quite able to get back on their feet before the next one hits”, says Nicholas Cox, of the Office of US Foreign Disaster Assistance. “So that level of vulnerability remains the same or left unaddressed and so by the time the next shock comes around you have many people that are still in a very vulnerable state…then you can have millions of people tipping over into a crisis.”Although US and European aid agencies are fond of talking about resilience as the new aid paradigm, it begs the question: to what norm are people supposed to bounce back to? Even in a good year, the arid, northern lands where the pastoralists live have poverty rates between 60% and 80%, and there is paltry access to health care, education, energy, water, or financial services.Overall, water and sanitation are arguably two of the most crucial factors in health and nutrition, and yet they are among the least addressed, often falling into the cracks between the humanitarian and development portfolios. “A lot of the analysis has shown in these areas that the drivers of those humanitarian needs are really development issues”, says Cox. “Chronic crises don't really fit into our pre-existing categories and really demand a much more multiyear, but humanitarian-style response, which really doesn't exist within most agencies.”The issue is only becoming more urgent. By 2025, two-thirds of the world's population could be living in “severe water stress conditions”, according to the UN's Food and Agriculture Organization. 783 million people do not have clean water and 2·5 billion lack hygienic sanitation.Fetching water in Wajir can be a labour intensive and inefficient processView Large Image Copyright © 2014 Samuel LoewenbergAttempts to address the issue have faltered. The European Commission (EC) spent more than €1 billion on water and sanitation in sub-Saharan Africa between 2001 and 2010, but the European Court of Auditors found that more than half the projects were either not working or did not have enough funding to be sustainable.“This stinging rebuke must act as a wake-up call for the Commission”, said British Conservative MEP Nirj Deva, vice chairman of the European Parliament's International Development Committee, according to the EurActiv news site.Meanwhile, aid agencies rush from crisis to crisis. In Kenya, for instance, the US Government spent US$68·5 million on providing food and assets to drought-affected Kenyans in the 2013 financial year, but only about $2·2 million on water and sanitation.“To use the most simplistic example, what we've often done is we've treated a malnourished child, but we have returned them back to their household that was food insecure before, and [which] is still food insecure”, says Cox.It is a recurring cycle. In Wajir, the ever-increasing droughts have left people dependent on relief food, Mohamed Bari Jimale, an assistant chief in the Tarbaj district, told The Lancet. “Many people have come to town after they lost all of their livestock. They come here and they wait for NGOs [non-governmental organisations] to bring aid.”Demographics are taking their toll, too, says Calum Mclean, an adviser to the EC. The population in Wajir is doubling every 25 years, and the land reached its capacity for livestock a long time ago. The result is that there is more intensive use of resources, and the area simply cannot sustain so many pastoralists, he says. Malnutrition rates for small children in parts of Wajir have been as high as 30% in recent years.Although food aid helps with the immediate crisis, it does not address the underlying problems. The fundamental issues—poverty, weakened health, loss of livestock, lack of infrastructure—continue even in a relatively good year. The livelihood in the community is livestock, and if the livestock die because of the drought, people become malnourished.Even when there is water, the lack of development makes its collection inefficient and unhygienic. A scene from a watering hole in Wajir is telling: four men bend over a well, singing in unison as they hoist a bag of water from the well below. It is about the size of a large shopping bag. They toss it into the pool of water beneath them (where women are also gathering water for drinking), and another man scoops up a bucket and then pours it into a trench where cows and camels are lined up slurping away.Weak infrastructureAlthough the fertile regions of central and western Kenya have received substantial government investment in infrastructure because of tribal and business ties, the most needy regions—in the north, south, and east—lack the political influence to gain such investment.“A drought is made by God, a famine is made by man”, John Githongo, a former Kenyan Government official turned anti-corruption campaigner tells The Lancet. “Drought is big money for corrupt elite—because it gives you the opportunity to import maize and other staples into the country and make a killing off of the backs of hungry people.”“There is a deliberate lack of preparedness on the part of the elites”, says Githongo. “The Kenyan Government doesn't need international assistance in feeding itself.”Nairobi, for instance, is booming. It is now the most expensive city in Africa, aspiring to become a finance and high-tech hub, and is filled with new construction. The new president, Uhuru Kenyatta, is one of richest men in Africa.Yet coordination between local and national government is a constant problem, one that manifests itself almost yearly in the hunger response. This year, for instance, the government claims to be sending emergency assistance to Turkana, but local officials say it is delayed or not enough. This seems to happen every drought.In the current system, Kenya in effect has to start from scratch every time there is a drought, reallocating development funds for each emergency. This process is slow and inefficient, says James Oduor, the head of the National Drought Management Authority. A permanent drought contingency fund is in the works.The same problem—waiting for an emergency—goes for NGOs and foreign donors, he says: “They wait until the situation is critical, when there are photographs, when there is news, and then they start mobilising resources. By the time the money comes, the damage has already been done.”“We need to tackle the underlying causes”, says Oduor, but with money continually being rerouted for emergencies, the Kenyan Government spends relatively little on long-term development, and much gets eaten up by overheads. His organisation has developed a long-term mitigation plan, but it is only 25% funded.Meanwhile, the lack of infrastructure takes its toll. In Wajir, 60% of shallow wells are contaminated by human faeces, according to a report by the Kenya Medical Research Institute. Waterborne diseases are rampant, and cholera is a constant threat during the rainy season. A proper sewer system would drastically reduce the cases, say local health officials. Currently, many of the main town's community of 100 000 people rely on bucket latrines. A project to build a sewage system stalled over lack of funds.“The biggest limiting factor to agricultural productivity and addressing hunger and overall economic development is the low level of infrastructure”, especially water, says Calestous Juma, a professor of science and technology policy at Harvard University and a former adviser to the Kenyan Government. Infrastructure is a public good and has huge benefits, and therefore needs government funding, he says, noting that only about 4% of sub-Saharan African agriculture is irrigated, compared with 48% in Asia.Simple solutionsIn the courtyard of the Wajir district hospital, chickens root around looking for food. Inside the infant health ward, the walls are filled with murals of frolicking peasants, painted by the Italian prisoners of war who built the hospital during World War 2. There are half a dozen children being treated for severe malnutrition.Hunger is a constant problem in the region, and even in a year without an official drought, they still see children with severe malnutrition, says Mohamed Hussein, a district medical officer. Many of the children have complications like diarrhoea, skin infections, pneumonia, and anaemia. The children generally respond well to treatment, he says. “Malnutrition is not a disability. It is something that you can cure.”That said, congenital malformations also seem to be an increasing problem, says Hussein. Mothers are frequently malnourished themselves and do not get proper prenatal care. Many live in distant rural areas, and only come into the hospital when their children are severely ill.What is needed is greater water availability, agricultural assistance, and roads to provide access to markets, says Hussein. “What can improve the situation is long-term interventions…a donation is not a long-term solution”, he explains. “If you teach the community how to work for themselves in a sustainable long-term project, like business, like crop production, farming, those kind of things can improve the situation.”One of the most underutilised solutions—at least until real infrastructure is built—is water harvesting. This measure is a relatively straightforward solution: setting up a receptacle that captures rainwater. The containers vary in size from a head-high plastic vessel that receives run-off from the corrugated roof of a shack to a so-called water pan, a shallow reservoir the size of a football pitch that gathers water during rainfall, which otherwise simply becomes run-off. A full water pan can provide a community with water for several months.David Lokorio, the chairman of Ataekale village in Turkana, which now has a water pan, says that previously, villagers walked up to 30 km to gather water. Diarrhoea was a constant problem, as were conflicts with neighbouring communities. The condition has decreased since the water pan was put in, he says, although he added that the incidence of malaria seems to have increased, which could be an unintended consequence of having a large standing body of water near the village.The water pan has been such a success, he says, that the village wants to add another that can be used for irrigating farms, growing maize, mung beans, sorghum, fruit trees, and cassava.In a project done by a team of MIT and Harvard economists, villagers in an agricultural part of Kenya were given access to water cisterns to collect rainwater from their roofs. These large plastic vessels were previously unattainable because of lack of credit. The innovation was to use the cisterns as collateral, and it seems to have been successful. Florence Wanjugu Wanjiru, a farmer in the Rift Valley, says that she used to have to go an hour to fetch water, but now with the tank, she has easy access to water and can grow maize, beans, and potatoes and can water her livestock. She is paying back the cost of the tank, about €230 in instalments over 2 years, with milk from her cows.14-month-old Akai Aikeny receives therapeutic feeding at a clinic in TurkanaView Large Image Copyright © 2014 Samuel LoewenbergFood aid relianceBut for most hungry people in Kenya, food aid remains the norm. At a feeding station sponsored by the African Inland Church in Lokichoggio, Turkana, an infant girl in red, Akai Aikeny, sat on the ground under a tree and munched intently on a special fortified peanut paste as her grandmother looked on. At 14 months, she weighed only 8 kg—about 2 kg less than she should. The nurse, Angela Langi, says that the food itself is a test: if the child can eat it they are given a supply and can go home—if they have no appetite or cannot consume it, they are referred to a therapeutic feeding centre. Akai was one of 100 malnourished children receiving the therapeutic feeding that day.About 25% of the children treated at the health centre are infected with HIV, and 30% have diarrhoeal disease. “Despite the fact that if they get treatment [for HIV], if they don't have enough food they get malnourished”, says Langi.If drought kills off livestock, pastoralists lose their sustenance and their savingsView Large Image Copyright © 2014 Samuel LoewenbergNearly the entire population in the area are living below the poverty level and depend on relief food. But the relief food—composed primarily of maize, wheat, oil, flour, and salt—does not provide enough essential nutrients. “That doesn't have enough nutrients to keep children healthy”, says Langi.Cycle of debtEven when drought does not kill, it leaves communities weakened and vulnerable for the next lean season—not only in terms of health, but also financially. During the 2011 drought, there was food assistance, but small children and elderly people still suffered badly, says Osman Abnur, a community elder who was with his animals at a watering hole near Kila Aley village in Wajir. His herd went from 60 to just ten during the drought. Without animals there is no milk for the children, he says. His community is dependent on food assistance, and many pastoralists have gone into debt, which then may roll over to the next lean season.Breaking this cycle is especially important now that droughts are becoming longer and more unpredictable with climate change, making it that much more difficult for pastoralists to rebuild their herds. Aid agencies have begun using cash transfers to help break the cycle of debt. The programmes are designed to head off direct food distributions, and early results have been promising—people spend the money on food, health care, and school fees. The importance of education for poor Kenyans—a way out of poverty—cannot be overstated.At an agricultural project in Turkana, for instance, former pastoralists are now working fields and digging wells. The fields seem to be fertile, but several of those interviewed said that they would prefer to get back to herding their animals. They said they kept little of the harvest, selling most of it to pay for school fees. One father of six said that he sent half of his children to school, while the other half worked on the farm. He chose arbitrarily, he said.The long viewMost aid workers interviewed for this article agreed that what is really needed is a shift from responding to the latest crisis, whether it be precipitated by war, food price spikes, or drought, and instead focusing on longer-term, multiyear projects that will address the underlying issues, such as weak infrastructure, poverty, and lack of access to medical care and markets, which keep these communities so fragile, always on the brink of disaster.As important as water is another basic piece of infrastructure, roads. Roads are catalytic: they connect isolated farmers and pastoralists with markets, enabling them to sell their animals and harvests in a timely manner, and at the same time to import goods more easily—currently, many basics, like petrol, water, and grain, cost 25% or more than they do in urban centres. Roads also expand opportunities for the local populace, which will be key as more and more pastoralists are forced to seek other types of work due to climate change.Long-term commitments for infrastructure also make good economic sense for donors. Multiyear investments, while they may have a substantial up-front cost, are ultimately cheaper than waiting until crises happen and then responding to the emergency, which gets more expensive each time. Additionally, efforts to shore up households before the crisis hits, through efforts like water harvesting, cash transfers, and increased access to markets, should mean that when the inevitable drought does occur, families may be strong enough to cope and their children won't need emergency feeding or medical treatment.The Feed the Future programme, set up by US President Barack Obama in 2010, after a global food price crisis, was supposed to address some of these underlying issues. But it has been slow to get going.The Kenyan Government must also get its own house in order, says Nairobi newspaper The Daily Nation. With inflated government salaries and a heavy foreign debt, “the money left over for roads, schools, and hospitals is small indeed”.Meanwhile, chronic crises have continued to befuddle the aid world, which is institutionally geared to respond to emergencies, primarily distributing emergency food and then abandoning the area once the crisis subsidies, what is known by jaded aid workers as truck and chuck. As one veteran official put it, to deal with the chronic emergencies in Kenya, what the aid and development community really needs is “behaviour change”.SL received grants from the Pulitzer Center on Crisis Reporting and the Nieman Foundation for Journalism at Harvard University for this report. Aid to Kenya responds to the country's recurrent food crises but it fails to address the underlying infrastructure problems that could prevent such emergencies. Sam Loewenberg reports. In a dried-out riverbed a woman and her young son kneel beside a hand-dug hole in the ground, using plastic canisters to scoop water burbling up through the sand. Several naked children with swollen bellies wait their turn. The improvised well seems to be little more than a puddle, yet an entire community of 600 people depend on it. A hand pumped well is just several hundred metres away, under the shade of palm trees, but the bolts on it are bust. The villagers tried to repair it with palm fronds, but that did not work. Nakujan Ariong, a mother of six, says she knows that the dirty water is not safe to drink, but her family has no alternative. “This is the only water available and that's why we use it”, she tells The Lancet. As she is speaking, a man brings over two camels to drink from the watering hole, which the children have just vacated. It is still early in the year, but already nearly 1·3 million Kenyans are going hungry. In Turkana, in the northwest, the percentage of children younger than 5 years at risk of malnutrition is more than 21%. One woman was arrested for feeding her children the family dog. In Wajir, in the northeast of the country, people are again having to rely on water being trucked to their communities, while water sources dry up and “drought birds” have made an appearance, despoiling local water supplies with faeces. Hungry residents are crossing into Somalia seeking pasture and water. Hunger is an ever-present spectre in much of Kenya, where close to half the population is below the poverty line, and about three-quarters work in subsistence agriculture. Even in 2012, which was considered a good year, an estimated 2 million people did not have enough to eat. An assessment of the 2011 famine in Somalia found that 260 000 people died during the crisis, more than twice what was previously estimated. This underscores the fragile status of many people living in the Horn of Africa, and shows how a lack of preventive action can easily boil over into catastrophe. Yet despite repeated promises by international donors that they want to address the underlying conditions that lead to yearly malnutrition in so much of sub-Saharan Africa, the basic lack of infrastructure—water, sanitation, and roads—at the root of these chronic emergencies remains unaddressed. Meanwhile, climate change, war, and growing populations put increased pressure on dwindling resources. Droughts, which used to come every decade in the region, now occur every few years (video). “What you are seeing is that people are being knocked off their feet by one shock and not quite able to get back on their feet before the next one hits”, says Nicholas Cox, of the Office of US Foreign Disaster Assistance. “So that level of vulnerability remains the same or left unaddressed and so by the time the next shock comes around you have many people that are still in a very vulnerable state…then you can have millions of people tipping over into a crisis.” Although US and European aid agencies are fond of talking about resilience as the new aid paradigm, it begs the question: to what norm are people supposed to bounce back to? Even in a good year, the arid, northern lands where the pastoralists live have poverty rates between 60% and 80%, and there is paltry access to health care, education, energy, water, or financial services. Overall, water and sanitation are arguably two of the most crucial factors in health and nutrition, and yet they are among the least addressed, often falling into the cracks between the humanitarian and development portfolios. “A lot of the analysis has shown in these areas that the drivers of those humanitarian needs are really development issues”, says Cox. “Chronic crises don't really fit into our pre-existing categories and really demand a much more multiyear, but humanitarian-style response, which really doesn't exist within most agencies.” The issue is only becoming more urgent. By 2025, two-thirds of the world's population could be living in “severe water stress conditions”, according to the UN's Food and Agriculture Organization. 783 million people do not have clean water and 2·5 billion lack hygienic sanitation. Attempts to address the issue have faltered. The European Commission (EC) spent more than €1 billion on water and sanitation in sub-Saharan Africa between 2001 and 2010, but the European Court of Auditors found that more than half the projects were either not working or did not have enough funding to be sustainable. “This stinging rebuke must act as a wake-up call for the Commission”, said British Conservative MEP Nirj Deva, vice chairman of the European Parliament's International Development Committee, according to the EurActiv news site. Meanwhile, aid agencies rush from crisis to crisis. In Kenya, for instance, the US Government spent US$68·5 million on providing food and assets to drought-affected Kenyans in the 2013 financial year, but only about $2·2 million on water and sanitation. “To use the most simplistic example, what we've often done is we've treated a malnourished child, but we have returned them back to their household that was food insecure before, and [which] is still food insecure”, says Cox. It is a recurring cycle. In Wajir, the ever-increasing droughts have left people dependent on relief food, Mohamed Bari Jimale, an assistant chief in the Tarbaj district, told The Lancet. “Many people have come to town after they lost all of their livestock. They come here and they wait for NGOs [non-governmental organisations] to bring aid.” Demographics are taking their toll, too, says Calum Mclean, an adviser to the EC. The population in Wajir is doubling every 25 years, and the land reached its capacity for livestock a long time ago. The result is that there is more intensive use of resources, and the area simply cannot sustain so many pastoralists, he says. Malnutrition rates for small children in parts of Wajir have been as high as 30% in recent years. Although food aid helps with the immediate crisis, it does not address the underlying problems. The fundamental issues—poverty, weakened health, loss of livestock, lack of infrastructure—continue even in a relatively good year. The livelihood in the community is livestock, and if the livestock die because of the drought, people become malnourished. Even when there is water, the lack of development makes its collection inefficient and unhygienic. A scene from a watering hole in Wajir is telling: four men bend over a well, singing in unison as they hoist a bag of water from the well below. It is about the size of a large shopping bag. They toss it into the pool of water beneath them (where women are also gathering water for drinking), and another man scoops up a bucket and then pours it into a trench where cows and camels are lined up slurping away. Weak infrastructureAlthough the fertile regions of central and western Kenya have received substantial government investment in infrastructure because of tribal and business ties, the most needy regions—in the north, south, and east—lack the political influence to gain such investment.“A drought is made by God, a famine is made by man”, John Githongo, a former Kenyan Government official turned anti-corruption campaigner tells The Lancet. “Drought is big money for corrupt elite—because it gives you the opportunity to import maize and other staples into the country and make a killing off of the backs of hungry people.”“There is a deliberate lack of preparedness on the part of the elites”, says Githongo. “The Kenyan Government doesn't need international assistance in feeding itself.”Nairobi, for instance, is booming. It is now the most expensive city in Africa, aspiring to become a finance and high-tech hub, and is filled with new construction. The new president, Uhuru Kenyatta, is one of richest men in Africa.Yet coordination between local and national government is a constant problem, one that manifests itself almost yearly in the hunger response. This year, for instance, the government claims to be sending emergency assistance to Turkana, but local officials say it is delayed or not enough. This seems to happen every drought.In the current system, Kenya in effect has to start from scratch every time there is a drought, reallocating development funds for each emergency. This process is slow and inefficient, says James Oduor, the head of the National Drought Management Authority. A permanent drought contingency fund is in the works.The same problem—waiting for an emergency—goes for NGOs and foreign donors, he says: “They wait until the situation is critical, when there are photographs, when there is news, and then they start mobilising resources. By the time the money comes, the damage has already been done.”“We need to tackle the underlying causes”, says Oduor, but with money continually being rerouted for emergencies, the Kenyan Government spends relatively little on long-term development, and much gets eaten up by overheads. His organisation has developed a long-term mitigation plan, but it is only 25% funded.Meanwhile, the lack of infrastructure takes its toll. In Wajir, 60% of shallow wells are contaminated by human faeces, according to a report by the Kenya Medical Research Institute. Waterborne diseases are rampant, and cholera is a constant threat during the rainy season. A proper sewer system would drastically reduce the cases, say local health officials. Currently, many of the main town's community of 100 000 people rely on bucket latrines. A project to build a sewage system stalled over lack of funds.“The biggest limiting factor to agricultural productivity and addressing hunger and overall economic development is the low level of infrastructure”, especially water, says Calestous Juma, a professor of science and technology policy at Har
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