FSNAU-Nutrition-Technical-Series-Report-Post-Gu-2011

Nutrition Analysis 

Post Gu 2011 

Technical Series Report No VI. 41 

September 28, 2011 

Food Security and Nutrition 

Analysis Unit - Somalia 

Information for Better Livelihood 

Funding Agencies 

Swiss 

Swiss 

Agency 

Agency 

for 

for 

Development 

Development 

and 

and 

Cooperation 

Cooperation 

SDC 

SDC 

FSNAU Technical Series Report No. VI 41 

Issued September 28, 2011

Executive 

ii 



Acknowledgements 

FSNAU would like to thank all our 24 partner agencies for their participation and support in the Gu 2011 seasonal 

nutrition assessments and analysis. 

From April through August 2011, a total of 60 nutrition surveys were conducted based on standard SMART 

methodology. 15 of the nutrition surveys were conducted in August 2011 in the south, as part of the rolling surveys 

to inform on the evolving nutrition situation following the declaration of famine in parts of the south. Additionally, 

about 100 health facilities were visited, and 28 rapid assessments conducted with 1,180 children measured in two 

rural livelihoods; 3,860 children in 23 urban settlements, and 2800 children measured in two IDP settlements. 

Executive Acknowledgement Summary 

iii 

Without the support and expertise of 8 local NGOs, 3 International NGOs, 3 Local Authorities, 8 line Ministries and 

2 UN agencies, this would not have been possible. Special thanks to UNICEF, and the World Food Program, for 

financial and/or technical support; and to the nutrition and health cluster coordinators, and the UNOCHA GenCAP 

Advisor for contributions to this publication. 

A sincere note of appreciation goes to the FSNAU nutrition team based in Somalia who work under very difficult 

conditions yet continue to produce such high quality professional work. Contributions from the FSNAU food security, 

data systems and gender advisory teams are also acknowledged. 

Participating Partners 

United Nations Children’s Fund (UNICEF), World Food Programme (WFP), Ministry of Health (MOH), Ministry of 

Health (MOH Somaliland), Ministry of Agriculture (Somaliland), Ministry of Environment and Rural Development, 

Ministry of Labour and Family Affairs, and NERAD (Somaliland); Ministry of Health (Puntland), Ministry of Women 

Development and Family Affairs (MoWDFA), Ministry of Wildlife, Tourism and Environment (Puntland), Puntland 

State of Water and Energy (PSWEN). Intersos, Medair, Muslim Aid – UK; Somalia Red Crescent Society (SRCS), 

AFREC, New Ways, Murdo, Zam Zam, Asal, Sorrdo, TRG. 

Mahad Sanid 



Executive Table of Contents 

TABLE OF CONTENTS 

1 Executive Summary 1 

2 Cases of Acutely Malnourished Children in somalia 7 

3 Nutrition Analysis in Somalia 11 

iv 

4. REGIONAL NUTRITION ANALYSIS 15 

4.1 Gedo Region 15 

4.2 MIDDLE and LOWER Juba Regions 21 

4.3 Bay and Bakool Regions 26 

4.4 Middle and Lower Shabelle Regions 33 

4.5 hiran region 41 

4.6 Central Somalia: Galgadud and Mudug regions 45 

4.7 Northeast Regions 50 

4.8 Northwest Regions 63 

5 Urban Summary Findings 74 

6 Plausibility checks 76 

7 APPENDICES 81 

7.1 Progression of Estimated Nutrition Situation Gu’07 - Gu 2011 81 

7.2 Nutrition Assessment Household Questionnaire, Gu 2011 83 

7.3. Mortality Questionnaire, Gu 2011 88 

7.4. IDP Nutrition Assessment Household Questionnaire, Gu 2011 89 

7.5. Rapid MUAC Assessment Form 93 

7.6 Rapid Nutrition Assessment Form with Food Security Questions 94 

7.7 Rapid Nutrition Assessment Form without Food Security Questions 95 

7.8 Rapid Data Collection Form 96 

7.9 Urban Assessment Household Questionnaire, Gu 2011 97 

7.10: Somalia Livelihood Zones 100 

List of Tables 

Table 1: Timeline of Activities for Gu 2011 Nutrition Situation Analysis 2 

Table 2: Somalia Integrated Food Security Phase Classification, Population Numbers, Aug - Sep, 2011 8 

Table 3: Cases of Acute Malnutrition in Somalia, by Region, August 2011 9 

Table 4: Nutrition key targets August ’11-February ’12 11 

Table 5. The Nutrition Situation Classification Framework, Draft 7, Jul 2010 13 

Table 6: Summary of Key Nutrition Findings in Gedo Livelihood Zones, July 2011 1 

Table 7: Summary of Key Nutrition Findings in Gedo Livelihood Zones, Gedo Riverine August, 2011 19 

Table 8: Summary of Key Nutrition Findings in Juba Livelihood Zones, July 2011 24 

Table 9: Summary of Key Nutrition Findings in Juba Livelihood Zones, August 2011 25 

Table 10: Summary of Key Nutrition Findings in Bakool Region - July &August 2011 28 

Table 11: Summary of Key Nutrition Findings in Bay Regions- July &August 2011 31 

Table 12: Summary of Key Nutrition Findings in Middle Shabelle Region - July 2011 35 

Table 13: Summary of Key Nutrition Findings in Lower Shabelle Region - July 2011 36 

Table 14: Summary of Key Nutrition Findings in Mogadishu Town and IDPs, April -August 2011 38 

Table 15: Summary of Key Nutrition Findings in Hiran Region, July-August 2011 43 

Table 16: Summary of Key Nutrition Findings in Hiran Region (Agro-pastoral), July-August 2011 44 

Table 17: Summary of Key Nutrition Findings in Hawd, Addun and Coastal Deeh Northeast Regions, July 2011 47 

Table 18: Summary of Key Nutrition Findings in Cowpea Belt Agro-pastoral and Coastal Deeh Livelihood 

zones of Central Region, July 2011 49 

Table 19: Summary of Key Nutrition Findings in Northeast Regions, May - July 53 

Table 20: Summary of Key Nutrition Findings in Hawd, Addun and Coastal Deeh Northeast Regions, July 2011 55 

Table 21: Summary of Key Nutrition Findings in Northeast IDPs, May - June 2011 57 

Table 22: Summary of Key Nutrition Findings in Northeast and Central IDPs, May - June 2011 59 

Table 23: Summary of Key Nutrition Findings in Sool Plateau, Nugal Valley and West Golis/Guban 

Livelihood Zones, July 2011 66 

Table 24: Summary of Key Nutrition Findings in Hawd, East Golis and Agro-pastoral Livelihood Zones, July 2011 68 

Table 25: Summary of Key Nutrition Findings for Hargeisa, Burao and Berbera IDPs May-June 2011 71 

Table 26: Summary of Urban Findings: North West and East; Post Gu 2011, July 2011 75 

Table 27: South and Central Urban MUAC Summary Findings; Post Gu 2011, July 2011 76 

Table 28: Plausibility Checks 78 

Table 29: Summary of Nutrition Assessments, May - July 2011 79 

Table 30: Summary of Nutrition Assessments, August 2011 81 



List of Maps 

Map 1: Somalia Nutrition Situation, January 2011 5 

Map 2: Somalia Nutrition Situation, August 2011 5 

Map 3: Somalia Integrated Food Security Phase Classification, August, 2011 7 

Map 4: 

Distribution of estimated Cases (%) of Acutely Malnourished Children in Somalia by Region, 

based on Prevalence, August 2011 10 

Map 5: Gedo Region Livelihood Systems 15 

Map 6: Juba Regions Livelihood Zones 21 

Map 7: Bay and Bakool Regions Livelihood Zones 26 

Map 8: Shabelle Livelihood Zones 33 

Map 9: Hiran Region Livelihood Zones 41 

Map 10: Central regions Livelihood Zones 45 

Map 11: Northeast Livelihood Zones 50 

Map 12: Northwest Livelihood Zones 63 

Executive Table of Contents Summary 

v 

List of Figures 

Figure 1: Global Acute and Severe Acute Malnutrition, WHO GS < -2 WHZ & < -3 WHZ and /or 

Oedema Gu (June-July 2011) South Somalia 1 

Figure 2: Global Acute and Severe Acute Malnutrition, WHO GS < -2 WHZ & < -3 WHZ and /or 

Oedema Gu (June-July 2011) North/Central Somalia 3 

Figure 3: Crude and Under 5 Death rates in May - August 2011 3 

Figure 4: Trends of AWD and Cholera cases at Banadir Hospital, Mogadishu, WHO September 2011 4 

Figure 5: Median Rates, Median Rates, GAM and SAM (WHO GS) July - August 2011 5 

Figure 6: Median Rates, Stunting, WHO GS, July-August 2011 5 

Figure 7: Proportion of Total Cases of Acutely malnourished children (WHZ

Executive Acronyms 

vi 

AWD 

ARI 

AFLC 

BFI 

CDC 

CDR 

CHD 

CI 

COSV 

FAO 

FSNAU 

FEWSNET 

GAM 

HAZ 

HE 

HIS 

IDP 

INGO 

LZ 

MCH 

MOH 

MT 

MUAC 

NCHS 

NGO 

OTP 

OPD 

PWA 

R 

RR 

SAM 

SC 

SC-UK 

SRCS 

SD 

SFP 

TFC 

TOT 

U5DR 

UNHCR 

UNICEF 

WAZ 

WHO 

WFP 

WHZ 

WVI 

LIST OF ACRONYMS USED 

Acute Watery Diarrhea 

Acute Respiratory Tract Infections 

Acute Food and Livelihood Crisis 

borderline Food Insecure 

Center for Disease Control 

Crude Death Rate 

Child Health Days 

Confidence Interval 

Co-operatione Di Svillupo International 

Food and Agricultural Organization of the United Nations 

Food Security and Nutrition Analysis Unit 

Famine Early Warning System Network 

Global Acute Malnutrition 

Height for Age Z Scores 

Humanitarian Emergency 

Health Information System 

Internally Displaced persons 

International Nongovernmental Organization 

Livelihood Zone 

Maternal and Child Health Center 

Ministry of Health 

Metric Tonne 

Mid Upper Arm Circumference 

National Center for Health Statistics 

Non governmental organisation 

Out Patient Therapeutic Programme 

Out Patient Department 

Post War Average 

Reliability Score 

Relative Risk/Risk Ratio 

Severe Acute Malnutrition 

Stabilization Center 

Save the Children - UK 

Somalia Red Crescent Societies 

Standard Deviation 

Selective/Supplementary Feeding Program 

Therapeutic Feeding Center 

Terms of Trade 

Under Five Death Rate 

United Nations High Commission for Refugees 

United Nations Children’s Fund 

Weight-for-Age Z Scores 

World Health Organization of the United Nations 

World Food Program of the United Nations 

Weight for Height Z Scores 

World Vision International 



Executive Forward Summary 

vii 

Forward 

The FSNAU Post Gu ‘11 Technical Series report (September 2011) is the sixth edition 

of the bi-annual nutrition situation technical series launched by the Food Security and 

Nutrition Analysis Unit (FSNAU) in February 2009. The publication complements the 

FSNAU bi-annual seasonal technical series reports and provides specific focus on 

nutrition information for the last 6 months. 

The FSNAU Post Gu ’11 Food Security and Nutrition Technical Series report will be 

released in the coming week, and provides a detailed analysis by region and by sector, 

of the integrated food security situation. 



Executive 

viii 



1. Executive Summary 

Nutrition Situation Overview 

The complete failure of the October-December 2010 Deyr 

rains and the poor performance of the April-June 2011 Gu 

2011 rains have resulted in the worst annual crop production 

in 17 years, reduced labour demand, below-average 

livestock prices, and excess animal mortality. The decline 

in maize and sorghum availability has subsequently pushed 

local cereal prices to record level high and, in combination 

with reduced livestock prices and wages, substantially 

reduced household purchasing power in all livelihood zones. 

Large-scale displacement and significant limitations 

on humanitarian access have further exacerbated the 

negative food access and health outcomes. 

As a result, the food security and nutrition situation is grim 

across the country, and particularly in the south where 

insecurity hinders humanitarian access to provide the 

much needed support. Pure farmers (riverine livelihood 

zone) and agro-pastoralists in the south are more inclined 

to crop production and therefore sedentary by nature, are 

most affected, as are cattle-rearing pastoralists who have 

experienced significant livestock losses due to lack of browse 

and water. Emergency levels of acute malnutrition and 

mortality persist in cross border refugee camps as 

well. Conditions are especially dire in the new camps in 

southern Ethiopia, where acute malnutrition exceeds 30 

percent and death rates have likely surpassed famine 

threshold of 2/10,000/day, despite adequate stocks of 

food aid. 

From April to August 2011, FSNAU and partners conducted 60 

representative nutrition surveys in Somalia, covering internally 

displaced persons (IDPs), rural, and urban livelihoods zones. 

Of these, 18 were done in the Southern population groups, 

including 2 in the Afgoye & Mogadishu IDPs in July and 

16 in the rural livelihoods , and 16 repeat surveys in the 

same groups in August 2011. Access was not permitted in 

Lower Shabelle to repeat the 2 rural surveys there. In north 

and central regions, nine surveys were conducted in rural 

livelihoods in July 2011, and 17 in IDPs and urban livelihoods in 

May-June 2011. Mogadishu urban population was assessed 

in April 2011. A summary of key findings are provided in tables 

29 and 30. 

Analysis of the findings indicates massive deterioration in 

the nutrition situation across all population groups in the 

south, and considerable decline in the IDP camps and rural 

livelihoods in the north since the Deyr 2010/11 (Maps 1 & 2). 

Southern Regions 

Currently, the global acute malnutrition (GAM) rates indicate 

a Very Critical nutrition situation across the south, and are 

above 30% in all livelihood zones except for the riverine 

(farmers) of Middle Shabelle and Hiran, and pastoralists of 

Hiran and Gedo (Figure 1). 

The alarming situation in the south necessitated follow 

up surveys in the different population groups, in August 

2011, findings of which indicate a persistent Very Critical 

situation with deteriorations in 

• Bay agro-pastoralists: GAM rate of 58.3% (52.1-64.2) 

and SAM rate of 22.1% (18.2-26.5). 

• Mogadishu IDPs: GAM rate of 45.6% (40.5-50.8) and 

SAM rate of 23.0% (19.2-27.2) 

• Afgoye IDPs: GAM rate of 46.0 (40.8-51.3) and SAM rate 

of 24.7% (20.2-29.8). 

Besides the alarming levels of acute malnutrition with GAM 

rates in excess of 30%, the crude death rates in Bay and 

Bakool agro-pastoralists, Lower Shabelle riverine and agropastoralists, 

Afgoye and Mogdishu IDPs also exceed the 

IPC famine and WHO emergency threshold of 2/10,000/day. 

UNFAO/FSNAU and Fewsnet in July 2011 and August 

2011 declared famine in these population groups based 

on the following core food security, nutrition and 

mortality indicators, and in line with the Integrated Phase 

Classification (IPC) of food security: 

• 20% of population in the affected areas unable to 

access food. 

• GAM rate of 30% and above findings from nutrition 

surveys conducted at the time 

• Crude death rate of 2 per 10,000 per day, or above, 

which denotes the WHO emergency threshold 

A summary of findings in South Somalia are provided in 

Figure 1. 

Proportion Acutely Malnourished 

A girl and her newly born sibling, Mogadishu IDPs, 

FSNAU July 2011 

Figure 1: Global Acute and Severe Acute Malnutrition, 

WHO GS < -2 WHZ & < -3 WHZ and /or Oedema 

Gu (June-July 2011) South Somalia 

60 

45 

30 

15 

0 

Gedo Agropast. 

Gedo Riverine 

Hiran Agropast. 

Hiran Pastoral 

Hiran Riverine 

L.Shabelle Agropast. 

L.Shabelle Riverine 

M.Shabelle Agropast. 

M.Shabelle Riverine 

Bakool Pastoral 

Bakool Agropast. 

GAM 

Juba Pastoral 

Juba Agropast. 

Juba Riverine 

Gedo Pastoral 

Bay Agropast. 

Mogadishu IDPs 

Afgoye IDPs 

Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Aug Jul Aug Jul Aug Jul Aug Jul Aug Jul Aug Jul Jul 

SAM 

Executive Summary 

1 



Executive 

2 

Table 1: Timeline of Activities for Gu 2011 Nutrition 

Situation Analysis 

SNo. 

NUTRITION SURVEYS Gu 2011 

Livelihood Zone/Population Group 

PERIOD 

April-August 2011 

1 Lower Shabelle Riverine July 2011 

2 Lower Shabelle Agropastoral July 2011 

3 

July 2011 

Hiran Pastoral 

4 August 2011 

5 Hiran Riverine July 2011 


7 


Hiran Agropastoral 


9 Middle Shabelle Riverine July 2011 


11 Middle Shabelle Agropastoral July 2011 


13 Bay Agropastoral July 2011 


15 Bakool Agropastoral July 2011 


17 Bakool Pastoral July 2011 


19 Juba Pastoral July 2011 


21 Juba Agropastoral July 2011 


23 Juba Riverine July 2011 


25 Gedo Pastoral July 2011 


27 Gedo Agropastoral July 2011 


29 Gedo Riverine July 2011 


31 Mogadishu IDPs July 2011 


33 Afgoye IDPs July 2011 


35 Agropastoral (Togdheer & Northwest) July 2011 

36 West Golis /GubanPastoral July 2011 

37 Sool Plateau (Northwest and Northeast) July 2011 

38 Hawd Pastoral (Northwest) July 2011 

39 

East Golis/Kakaar Pastoral (Northwest 

and Northeast) 


40 

Nugal Valley Pastoral (Northwest and 

Northeast) 


41 Coastal Deeh (Northeast) July 2011 

42 Hawd Pastoral (Central and Northeast) July 2011 

43 Sool Region Urban July 2011 

44 Sanaag Region Urban July 2011 

45 Bari Region Urban July 2011 

46 Nugal Region Urban July 2011 

47 North Mudug Urban July 2011 

48 Hargeisa IDPs End of May – June 2011 

49 Burao IDPs End of May – June 2011 

50 Berbera IDPs End of May – June 2011 

51 Bossaso IDPs End of May – June 2011 

52 Qardho IDPs End of May – June 2011 

53 Garowe IDPs End of May – June 2011 

54 Galkayo IDPs End of May – June 2011 

55 Margaga IDPs-North Mudug End of May – June 2011 

56 Dusamareb IDPs End of May – June 2011 

57 Awdal Region Uban End of May – June 2011 

58 Woq Galbeed Region Urban End of May – June 2011 

59 Togdheer Region Urban End of May – June 2011 

60 Mogadishu Urban April 2011 

Northern Regions 

Analysis of findings from the livelihood based nutrition 

surveys in the north indicates a varied situation. (Figure 2). 

There is deterioration to Very Critical phase in 

• West Golis, where GAM rate is 22.0% (18.9-25.4) and 

SAM rate is 5.0% (3.4-7.4); and 

• Nugal Valley with GAM rate of 23.2% (18.5-28.1) and 

SAM rate of 6.7 (4.4-10.0). 

Similarly, the situation has deteriorated to Critical levels 

in Sool Plateau with GAM rate of 15.9% (13.6-18.4) and 

SAM rate of 4.0% (2.9-5.4). The deterioration is mainly 

attributed to poor access to water, milk and milk products 

following massive livestock losses in Sool and the coastal 

regions, and seasonal out-migration of livestock mainly to 

the Hawd (of Hargeisa) which had water and pasture. The 

health situation is also poor with outbreaks of acute watery 

diarrhea and dengue fever in Wooqoyi Galbeed region, and 

measles in Nugal and Bari regions. Poor access to health 

care services exacerbated by infrastructural constraints 

in Golis and Coastal Deeh are also a limiting factor. The 

situation has been mitigated by active social support in terms 

of in-kind cash, and child health days. 

A Serious situation is sustained in the Northwest agropastoralists, 

East Golis and Hawd pastoral livelihood zone 

of Central/Northeast regions. There is general improvement 

in the nutrition situation in the Hawd of Hargeisa, Togdheer 

and Lasanod to Alert phase mainly due to improved milk 

access from local livestock and in-migration of livestock 

from Nugal Valley and Golis/Guban for water and pasture. 

Central Regions 

The Hawd of Mudug and Galgaduud Regions is in a 

sustained Serious nutrition phase with GAM rate of 14.4% 

(10.9-18.8) and SAM rate of 3.8% (2.4-6.0). Although suboptimal, 

the situation is better compared to the other parts 

of Central regions, mainly due to better but limited access to 

milk and milk products, and on-going humanitarian food and 

health assistance. Addun livelihood zone has deteriorated 

to Critical levels, since the Deyr 2010/11, with a GAM rate 

of 17.8% (13.3-23.6) and SAM rate of 4.1% (2.5-6.7). This 

is likely attributed to poor household food access, and 

limited humanitarian assistance due to security reasons. 

Additionally, acute watery diarrhea outbreak and cholera are 

also reported in Galgaduud and Mudug regions (Figure 2). 

Cowpea belt is likely Critical and the Coastal Deeh likely 

Very Critical mainly due to food in-access resulting from 

total crop failure and massive livestock losses during the 

January-March (Jilaal) period. 



Figure 2: Global Acute and Severe Acute Malnutrition, 

WHO GS < -2 WHZ & < -3 WHZ and /or Oedema 

Gu (June-July 2011) North/Central Somalia 


60 

45 

30 

15 

0 

W.Golis/Guban 

Hawd oF NW 

Agrop. NW - Tog 

Sool Plateau 

Nugal Valley 

E. Golis/Karkaar 

Coastal Deeh/NE 

Hawd of NE/C 

GAM 

Addun NE/C 

SAM 

Hargeisa IDPs 

Burao IDPs 

Berbera IDPs 

Qardho IDPs 

Garowe IDPs 

Galkayo IDPs 

Bossaso IDPs 

Margaga IDPs 

Dhusmareb IDPs 

Figure 3: Crude and Under 5 Death rates in May - Aug 2011 

Death Rate 

22 

20 

18 

16 

CDR U5DR 

14 

12 

10 

8 

6 

4 

2 

0 

Riverine 

Agropastoral 

Riverine 

Agropastoral 

Afgoye 

Mogadishu 

Agropastoral-July 

Agropastoral-Aug 

Agropastoral 

Pastoral-July 

Pastoral-Aug 

Riverine-July 

Riverine-Aug 

Agropastoral-July 

Agropastora-Aug 

Pastoral-July 

Pastoral-Aug 

Riverine 

Agropastoral 

Pastoral 

Riverine 

Agropastoral 

Pastoral 

Hawd Pastoral 

Addun Pastoral 

Coastal Deeh 

West Golis 

Bossasso IDPs 

Galkayo IDPs 

Hargeisa IDPs 

Burao IDPs 

Berbera IDPs 

L. M. IDPS- Bay Bakool M&L Juba Gedo Hiran Central NE/NW NE IDPs NW IDPs 

Shabelle Shabelle South 

Regions 


3 

IDPs 

With the exception of Hargeisa and Berbera IDPs in a 

sustained Serious phase, the nutrition situation has 

deteriorated in all IDP settlements to Critical levels in 

Burao in Northwest, and to Very Critical in Bossaso, 

Qardho, Garowe, Galkayo, Margaga, and Dusamareb in 

the Northeast and Central regions. Bossaso IDP settlement 

reports and GAM rate of 24.4% (20.9-28.3) and SAM rate of 

4.7% (3.2-7.1). Findings from the other IDP settlements are 

illustrated in the Figure 2. Decreased income access for food 

purchase, as a result of seasonal port closure, together with 

high morbidity levels are the underlying factors. 

Death Rates 

Findings on the retrospective Crude Death Rates (CDR) 

across the country depict a varied scenario. In the rural 

and IDP populations in the north and central regions, the 

situation is Alert to Serious based on Sphere standards and 

the WHO thresholds. Hargeisa and Berbera IDPs are within 

acceptable levels with CDR

Executive 

4 

Cases of Acute Malnutrition 

The total cases of acute malnutrition, including those 

in severe state has been obtained by extrapolating the 

prevalence of global and severe acute malnutrition to the 

underfive population for each of the assessed population 

groups. At national level, therefore, the cumulative 

total is approximately 450,000 acutely malnourished 

children, which translates to 30% of the 1.5 million 

Somali Children. Of these, 190,000, or 13% of the 1.5 

million Somali children are severely malnourished. The 

south is worst hit, and currently hosts 336,000 (or 74%) 

of all the malnourished children, 160, 800 of whom 

(84%) are severely malnourished. 

Gender 

Statistical analysis both for the July seasonal and August 

repeat nutrition survey findings shows no significant 

difference between acute malnutrition and sex of the 

child, or with sex of household head. Likewise, there are 

no statistically significant differences between sex of the 

child with morbidity (based on recall), and child feeding 

practices. Nevertheless, across all the surveyed population 

groups, a higher proportion of boys than girls tended to be 

malnourished, necessitating further investigations. Sex 

disaggregated data is provided for each of the surveys 

conducted. 

Median levels of acute malnutrition based on the Gu 2011 

surveys indicate 27.3% in the country, with 34.2% in IDPs 

only, and 35.3% in the south. With regard to stunting, the 

national median rates are 21.1%, with 28.5% in IDPs, and 

23,5% in the south (Figure 5 and 6). 

A mother and child, Afgoye IDPs, FSNAU-July 2011 

Trends of acute watery diarrhoea (AWD)/cholera 

(Source: WHO Weekly Highlights 27 Aug – 2 Sept 2011 & 3-9 Sep 2011) 

Poor sanitation conditions, a shortage of safe water, 

overcrowding and high malnutrition rates mare the perfect 

combination for infectious diseases, such as cholera, to 

spread and increase death rates. The cholera transmission 

season is ongoing. Some areas have received sporadic 

rains, posing a high risk for transmission of waterborne 

diseases, such as AWD. Communities tend to use 

contaminated water for domestic use, hence the high risk 

for sporadic outbreaks. Multiple rumors are currently being 

investigated. 

Confirmed cholera outbreaks are ongoing in Mogadishu 

(Banadir region), the Afgoye corridor. Meanwhile Baidoa 

(Bay region), Xarardere, Bursalah, Godldogob, and Hobyo 

district (Mudug region), Awdhegle and Wanlaweyne district 

(Lower Shabelle region) are under control. Confirmed 

measles and dengue fever cases have been identified in 

Mogadishu (Banadir region). Dengue fever is confirmed 

in Galbeed region of Somaliland. 

According to the WHO Somalia Health Response Update, 

September 3-9, 2011, the outbreaks are likely to escalate 

with the increased displacements (Figure 4). 

A sleeping baby, FSNAU-Mogadishu IDPs- August 2011 

Figure 4: Trends of AWD and Cholera cases at Banadir 

Hospital, Mogadishu 

For details, contact wroffice@nbo.emro.who.int, or Dr. 

Kamran Mashhadi, mashhadik@nbo.emro.who.int 

Source WHO, September 2011 



MOGADISHU 

Kilometers 

MOGADISHU 

SOMALIA - ESTIMATED NUTRITION SITUATION JULY 2010 

SOMALIA - ESTIMATED NUTRITION SITUATION 

August 16th, 2011 

Map 1: Somalia Nutrition Situation, Jan 2011 Map 2: Somalia Nutrition Situation, Aug 2011 

Calula 

BOSSASO 

!( !. Qandala 

Las Qoray/ 

Zeylac 

Badhan Bossaaso 

Lughaye 

ERIGABO 

AWDAL 

!. 

Baki 

Iskushuban 

!( 

Borama 

Berbera 

SANAG 

BORAMA 

Ceel Afweyne 

BARI 

!. 

Sheikh 

W. GALBEED 

Ceerigaabo 

Gebiley HARGEYSA BURAO 

!. ! 

!. !( 

Qardho 

Hargeysa Owdweyne 

Caynabo Xudun 

Bandar Beyla 

Talex 

TOGDHEER 

Burco 

SOOL 

Laas Caanood Garowe 

Buuhoodle !. LAS ANOD GAROWE 

!. 

Eyl 

NUGAL 

Burtinle 

Calula 

BOSSASO 

!. 

Qandala 

Las Qoray/ 

Zeylac 


Lughaye 

ERIGABO 

AWDAL 

!. 

! 

Iskushuban 

Baki 

Borama 

Berbera 

SANAG 

BORAMA 

Ceel Afweyne 

BARI 

!. 

Sheikh 

W. GALBEED 

Ceerigaabo 


!. ! 

! 

!. ! 

Qardho 


Caynabo Xudun 

Bandar Beyla 

Talex 

TOGDHEER 

Burco 

SOOL 


Buuhoodle !. LAS ANOD 

!. 

GAROWE 

NUGAL 

Burtinle 

Eyl 


5 

KENYA 

Goldogob 

Galkacyo 

GALKAYO 

!. 

Cadaado MUDUG 

Hobyo 

Cabudwaaq 

!. DUSAMAREB 

! 

Dhusa Mareeb 

GALGADUD 

BELET WEYNE 

Harardheere 

Ceel Barde Beled !. Weyne 

BAKOOL 

Ceel Bur 

Rab- Xudur 

Dhuure 

!. HUDUR 

HIIRAN Ceel Dheere 

Dolo 

Luuq 

Wajid 

Bulo Barde 

Aden Yabal 

GARBAHAREY Baydhaba 

Jalalaqsi 

!. 

BAIDOA 

Cadale 

Garbaharey 

!. 

Qansax 

Jowhar 

Nutrition Situation 

Dheere 

Wanle Weyne !. 

GEDO 

BAY 

Acceptable 

M. SHABELLE 

Ceel Waq 

Bur Hakaba 

Balcad 

Alert 

Dinsor 

Afgoye 

Baardheere 

! 

"/ ! BANADIR 

Serious 

Qoryoley 

Sakow 

!. 

Critical 

Kurtun Warrey Marka 

M. JUBA BU'AALE 

Very Critical 

Sablale L. SHABELLE 

!. 

Bu'aale Brava 

Likely Critical 

L. JUBA 

Likely Very Critical 

Afmadow 

Jilib 

IDP Phase 

Serious 

Jamaame 

Critical 

KISMAAYO 

Very Critical 

Kismayo !. 

The Nutrition Situation is analysed using a range of nutrition 

indicators from direct and indirect sources from June to 

July '11: nutritional surveys, health facility data, rapid 

MUAC assesments, selective feeding centre data, health reports 

Badhadhe 

and others 

Cadaado MUDUG 

Cabudwaaq 

Hobyo 

DUSAMAREB 

!. 

Dhusa Mareeb 

GALGADUD 

BELET WEYNE 

Harardheere 


BAKOOL 

Ceel Bur 

Rab- Xudur 

Dhuure 

!. HUDUR 


Dolo 

Luuq 

Wajid 

Bulo Barde 

Aden Yabal 



Jalalaqsi 

!. 

Cadale 

Garbaharey 

BAIDOA 

!. 

Acceptable 

Jowhar M. ^ 

Qansax 

SHABELLE 

Dheere 

Wanle Weyne!. 

JOWHAR 

Alert 

GEDO 

BAY 

Ceel Waq 

Bur Hakaba 

Balcad 

Serious 

Dinsor 

Afgoye 

Baardheere 

!( BANADIR 

"/ 

Qoryoley 

Critical 

Sakow 

Kurtun Warrey 

Marka !. 

Very Critical 

M. JUBA BU'AALESablale 

!. 

L. SHABELLE 

Bu'aale Brava 

Likely Serious 

L. JUBA 

Afmadow 

Jilib 



Jamaame 

KISMAAYO 

Hot Spot for Critical 

Kismayo !( !. 

^ 

IDP Phase 

Serious 

Badhadhe 

Critical 

Very Critical 

Projected Trend (July - December 2010) 

Potential to Improve 


indicators from direct and indirect sources from April to 

Uncertain 



Potential to Deteriorate 

and others 

Beled Hawa 

Tayeglow 

Figure 5: Median Rates, Median Rates, GAM and SAM 

(WHO GS) July -August 2011 (Gu ’11) 

Jariiban 

Swiss Agency for Development 

and Cooperation SDC 

Food Security and Nutrition Analysis Unit - Somalia http://www.fsnau.org 

P.O. Box 1230 Village Market, Nairobi, Kenya Email: fsauinfo@fsnau.org tel: 254-20-4000000 fax:254-20-4000555 FSNAU is managed by FAO 

The boundaries and names on these maps do not imply official endorsement or acceptance by the United Nations. The regional & District boundaries reflect those endorsed by the Government of the Republic of Somalia in 1986. 

Technical Partner 

Beled Hawa 

± 

0 37.5 75 150 225 300 375 

Tayeglow 


Galkacyo 

Goldogob 

! 

!. 

GALKAYO 

Jariiban 

Swiss Agency for 

Development and 

Cooperation SDC 



Figure 6: Median Rates, Stunting, WHO GS, 

July-August 2011 (Gu ’11) 

Projected Trend (August - December 2011) 


Uncertain 



40.0 

35.0 

34.2 

GAM 

SAM 

35.3 

30.0 

28.5 

Total Stunting 

Severe Stunting 


30.0 

25.0 

20.0 

15.0 

10.0 

5.0 

27.3 

9.1 

14.2 

20.7 

5.0 

14.4 

3.1 

16.7 16.1 

4.1 4.0 

16.3 

Proportion Stunted 

25.0 

20.0 

15.0 

10.0 

5.0 

21.1 

6.5 

10.7 

20.5 

5.9 

10.0 

1.4 

11.4 

2.6 

14.8 

3.3 

23.5 

8.7 

0.0 

ALL (including 

IDPs) 

IDPs Only 

All Excluding 

IDPs 

NW NE Central (Hawd, 

Addun) 

South 

0.0 

ALL (including 

IDPs) 

IDPs Only 

All Excluding 

IDPs 

NW NE Central 

(Haws&Addun) 

South 

Considerations for the Nutrition Outlook 

for the next 3 months 

The projected trend of the nutrition situation in the coming 

three months (September-November 2011) shows a likely 

deterioration across all population groups in southern 

regions. This is mainly due to the declining household food 

security and health situation (see WHO health update). 

Despite imminent large-scale increase in humanitarian 

response, evidence suggests that food security in agropastoral 

and riverine areas of the south will deteriorate 

further over the coming four months. Famine is therefore 

considered likely by Dec 2011 in agro-pastoral and riverine 

areas of Gedo and Juba, and agro-pastoral areas of Middle 

Shabelle and Hiran. Currently, 25-75 percent of poor 

agro-pastoral households in Gedo and Juba and pastoral 

households in Bakool face famine level of food deficits. 

• Concerns persist regarding pastoral populations in 

northeast and northwest, agro-pastoralists in the 

Cowpea Belt of central, and coastal livelihoods of 

central where half of pastoralists have lost all livestock 

and are destitute. 

• Nevertheless some improvement are expected in 

the pastoral areas of Gedo, Juba, and Bakool due to 

impacts of Deyr 2010 season and the return of camel 

herds, and in the Hawd and Addun zones of Central/ 

Northeast regions due to improved camel conditions. 



Food Security Situation Overview 

Executive 

6 

Key Messages 

• In total currently 4.0 million people are in crisis nationwide 

(Phase 3, 4, 5) with 750,000 people experiencing faminelevel 

outcomes. Out of the total number of people currently 

in crisis 3.0 million are in the South. Tens of thousands of 

people have already died, over half of whom are children. 

• Famine persists in five areas of Somalia, which include 

the Lower Shabelle region, the Bakool agropastoral 

livelihood zone, the agropastoral areas of Middle 

Shabelle region (Balcad and Cadale districts), the 

Afgoye corridor IDP settlement, and the Mogadishu IDP 

community and all livelihoods of Bay region. Famine 

declaration in these areas has been done at different 

times, with the first declaration made on July 20 th in 

Shabelle regions and last declaration made in Bay 

region on September 5 th . The famine declaration is 

based on the following three criteria: at least 20 percent 

of the population has extremely limited access to basic 

food requirements, global acute malnutrition exceeds 

30 percent, and the death rate exceeds 2/10,000/day for 

the entire population. 

• In addition to the five areas where famine has already 

been declared a total of 50,000 people, or 25-75 percent 

of poor agropastoral households in Gedo and Juba and 

pastoral households in Bakool also face famine level of 

food deficits. 

• Measles and Acute Watery Diarrhoea outbreaks continue 

in Southern Somalia especially in Mogadishu IDPs where 

the nutrition and mortality results indicate deterioration 

from the July surveys. 

• Despite, a large-scale increase in humanitarian response, 

evidence suggests that food security in agropastoral and 

riverine areas of the south will deteriorate further over 

the coming four months and Famine is considered likely 

by Decermber 2011 in agropastoral and riverine areas 

of Gedo and Juba, agropastoral of Middle Shabelle and 

Hiran and pastoral areas of Bakool region. 

Current food security outcomes and classification 

• The current crisis in southern Somalia is driven by a 

combination of factors. The total failure of the October- 

December 2010 Deyr rains (secondary season) and 

the poor performance of the April-June 2011 Gu 2011 

rains (primary season) have resulted in the worst annual 

crop production in 17 years, reduced labor demand, 

below-average livestock prices, and excess animal 

mortality. The decline in maize and sorghum availability 

has subsequently pushed local cereal prices to record 

levels and, in combination with reduced livestock prices 

and wages, substantially reduced household purchasing 

power in all livelihood zones. 

• Nutrition survey results indicated the prevalence of acute 

malnutrition and the rate of crude mortality surpassing 

the Famine thresholds in the above-mentioned faminestricken 

areas of Southern Somalia. 

• Large scale displacement and significant limitations 

on humanitarian access due to persisting insecurity 

in southern Somalia have further exacerbated the 

constrained food access and health outcomes in the 

South. 

• In urban areas, sky-rocketing food prices and 

significantly eroded purchasing power are the main 

contributing factors to the current food security crisis. 

585,000 people are estimated in crisis during July- 

December 2011 period. This is an increase from 

January-June 2011 estimate of 475,000 (23% increase). 

• Concerns persist regarding pastoral populations 

in northeast and northwest, agropastoralists in the 

Cowpea Belt of central, and coastal livelihoods of 

central where half of pastoralists have lost all livestock 

and are destitute. 

• Food security outcomes have improved for camel 

pastoralists in Gedo and Juba, and pastoralists in the 

Addun and Hawd zones of Central/Northern regions. 

• Agropastoral areas of Gedo, Juba, Hiran and Middle 

Shabelle, riverine areas of Gedo and Juba, and pastoral 

of Bakool are likely to deteriorate to famine before the 

end of the year. 

For additional information please refer to the FSNAU Post 

Gu 2011 Food Security and Nutrition Technical Report 



SOMALIA INTEGRATED FOOD SECURITY PHASE CLASSIFICATION 

Map 3: Somalia Integrated Food Security 

Rural and 

Phase 

Urban 

Classification, 

Populations: 

August, 

Aug-Sept 

2011 


Magnitude 

Depth 

Who 

Why 

Frequency 

Confidence 

Defining Attributes of Crisis 

Areas in Phase 3, 4 or 5 

Population in Phase (Includes High Risk) 

0-100,000 101,000-500,000 >500,000 

-100% 

Percent population 

in respective phase 

-0% 

Criteria for Social Targeting 

i Livelihood system 

ii Wealth group 

iii Gender 

Key Immediate Causes 

a Drought 

b Floods 

c Tsunami 

d Civil Insecurity 

e Market Disruptions 

f Disease Outbreaks 

g Population Influx 

h Inflation 

i Water Shortages 

Key Underlying Causes 

A Post State Conflict 

B Environmental Degradation 

C Social Marginalization 

Recurrence of Crisis in Past 10 yrs 

Low(1-2yrs), Moderate(3-4), High (>= 5) 

Confidence Level of Analysis 

* Low * * Medium * * * High 

Rural: 135,000 

Urban: 40,000 

i, ii, iii 

a, d, e, g, h, i 

± 

A, C 

High 

* * * 

KENYA 

0 15 30 60 90 120 150 

Kilometers 

Urban 

Rural 

Total 

Ceel Waq 

-100% 

-0% 

Baardheere 

Sakow 

L. JUBA 

Afmadow 

Badhadhe 

Beled Hawa 

Dolo 

GEDO 

#¸ 

Kismayo 

Rural: 

610,000 

Urban: 120,000 

M. JUBA 

i, ii, iii 

a, d, e, f, g, h, i 

A, C 

High 

* * * 

Garbaharey 

#¸ 

Luuq 

Qansax 

Dheere 

Dinsor 

Zeylac 

Lughaye 

AWDAL 

Baki 

Borama 

Rab- 

Dhuure 

Jilib 

Gebiley 

Wajid 

Xudur 

#¸ 

Baydhaba 

#¸ 

Bur Hakaba 

! 

! ! 

Hargeysa 

Ceel Barde 

BAKOOL 

Sablale 

L. SHABELLE 

Bu'aale Brava 

Jamaame 

i, ii, iii 

BAY 

a, d, e, f, g, h, i 

A, C 

Moderate 

* * * * 

Urban 

Rural 

Rural: 290,000 

Urban: 70,000 

Rural: 160,000 

Urban: 50,000 

Total 

-100% 

-0% 

Berbera 

W. GALBEED 

Sheikh 

Tayeglow 

Qoryoley 


Urban 

i, ii, iii 

a, d, g, i 

A, B, C 

Moderate 

* * * 

Rural 

Total 

Owdweyne 

TOGDHEER 

Burco 

#¸ 

Beled Weyne 

HIIRAN 

Bulo Barde 

Jalalaqsi 

#¸ 

Afgoye 

#¸ ! ! 

Ceel Afweyne 

Caynabo 

#¸ 

Cadale 

Dhusa Mareeb 

Ceel Bur 

¹ 

¹ # 

Las Qoray/ 

# 

Badhan 

SANAG 

Ceerigaabo 

Xudun 

Talex 

SOOL 

¹ # 


! 

Cadaado 

#¸ 

Ceel Dheere 

Jowhar M. SHABELLE 

Wanle Weyne 

-100% 

-0% 

Urban 

Rural 

Total 

Rural: 195,000 

Urban: 40,000 

i, ii, iii 

a, d, e, g, h, i 

A, C 

High 

* * * 

-100% 

-0% 

Urban 

Rural 

Total 

Balcad 

-100% 

-0% 

Buuhoodle 

Cabudwaaq 

BANADIR 

Aden Yabal 

Goldogob 

! 

Galkacyo 

¹ # 

NUGAL 

Burtinle 

MUDUG 

Hobyo 

GALGADUD 

Harardheere 

Rural: 80,000 

Urban: 85,000 

i, ii, iii 

a, d, e, g, h, i 

A, B, C 

Low 

* * * 

Jariiban 

i, ii, iii 

a, d, e, f, g, h 

A 

Moderate 

! 

Bossaaso 

Qardho 

Eyl 

Rural:820,000 

Urban:120,000 

* * * 

Urban 

Rural 

Total 

Qandala 

Urban 

BARI 

Rural: 260,000 

Urban: 60,000 

i, ii, iii 

a, d, e, g, h, i 

A, B, C 

Moderate 

* * * 

Rural 

-100% 

-0% 

Calula 

Iskushuban 

Bandar Beyla 

Total 

Current or Imminent Phase 

# 

1A Generally Food Secure 

1B Generally Food Secure 

2 Borderline Food Insecure 

-100% 

-0% 

3 Acute Food and Livelihood Crisis 

4 Humanitarian Emergency 

5 Famine/Humanitarian Catastrophe 

Urban Populations in Humanitarian Emergency 

and Acute Food and Livelihood Crisis 

NOTES: 

For category explanations see http://www.fsnau.org 

Urban 

Rural 

IDP concentrations classified as AFLC, HE and Famine 

Datum: WGS84, Data Source: FSAU, 2007, Admin. layers: UNDP, 1998, 

Updated: Nov, 2007 

Total 

-100% 

-0% 


7 











Table 2: Somalia Integrated Food Security Phase Classification, Population Numbers, Aug - Sep, 2011 

Executive 

8 

Urban in Acute Rural in Acute Urban in Rural 

UNDP UNDP 2005 UNDP 

Food and Food and Humanitarian Humanitarian 

Region 2005 Total Urban 2005 Rural 

Livelihood Livelihood Emergency Emergency 

Population Population Population 

Crisis (AFLC) Crisis (AFLC) (HE) 

(HE) 

North 

Urban in 

Humanitarian 

Catastrophy 

(Famine) 

Rural in 

Humanitarian 

Catastrophy 

(Famine) 

Total in AFLC, 

HE and Famine 

as % of Total 

population 

Awdal 305,455 110,942 194,513 0 0 0 0 0 0 0 

Woqooyi 

Galbeed 

700,345 490,432 209,913 0 0 0 0 0 0 0 

Togdheer 402,295 123,402 278,893 0 60,000 0 0 0 0 15 

Sanaag 270,367 56,079 214,288 25,000 40,000 5,000 30,000 0 0 37 

Sool 150,277 39,134 111,143 20,000 20,000 0 15,000 0 0 37 

Bari 367,638 179,633 202,737 60,000 55,000 0 5,000 0 0 33 

Nugaal 145,341 54,749 75,860 25,000 15,000 0 10,000 0 0 34 

Sub-total 2,341,718 1,054,371 1,287,347 130,000 190,000 5,000 60,000 0 0 16 

Central 0 

Mudug 350,099 94,405 255,694 5,000 60,000 30,000 55,000 0 0 43 

Galgaduud 330,057 58,977 271,080 5,000 70,000 20,000 65,000 0 0 48 

Sub-total 680,156 153,382 526,774 10,000 130,000 50,000 120,000 0 0 46 

South 0 

Hiraan 329,811 69,113 260,698 10,000 45,000 30,000 150,000 0 0 71 

Shabelle 

Dhexe 514,901 95,831 419,070 0 15,000 30,000 240,000 0 75,000 70 

(Middle) 

Shabelle 

Hoose 850,651 172,714 677,937 10,000 70,000 80,000 280,000 0 140,000 68 

(Lower) 

Bakool 310,627 61,438 249,189 20,000 30,000 25,000 90,000 0 80,000 79 

Bay 620,562 126,813 493,749 15,000 0 60,000 255,000 0 155,000 78 

Gedo 328,378 81,302 247,076 15,000 50,000 25,000 75,000 0 10,000 53 

Juba Dhexe 

(Middle) 

238,877 54,739 184,138 0 25,000 25,000 90,000 0 15,000 65 

Juba Hoose 

(Lower) 

385,790 124,682 261,108 10,000 55,000 35,000 90,000 0 15,000 53 

Sub-total 3,579,597 786,632 2,792,965 80,000 290,000 310,000 1,270,000 0 490,000 68 

Banadir 901,183 901,183 - - - - - - 0 

Grand 

Total 

7,502,654 2,895,568 4,607,086 220,000 610,000 365,000 1,450,000 0 490,000 42 

Notes: 

1 Source: Population Estimates by Region/District, UNDP Somalia, August 1, 2005. FSNAU does not round these population estimates as they are the official estimates provided by UNDP 

2 Estimated numbers are rounded to the nearest five thousand, based on resident population not considering current or anticipated migration, and are inclusive of population in High 

Risk of AFLC or HE for purposes of planning 

3 Dan Gorayo is included within Bari Region following precedent set in population data prior to UNDP/WHO 2005 

4 Source UN-OCHA/UNHCR: New IDP updated September, 2010 rounded to the nearest 5,000. Total IDP estimates are based on Population Movement Tracking data which is not 

designed to collect long-term cummulative IDP data 

5 Analysis show that 60% of IDP originates from Mogadishu. To avoid double counting, only IDPs originating from Mogadishu are considered in the overall population in crisis. This is 

because FSNAU does not conduct assessments in Mogadishu and those IDPs from other regions are already considered in the overall IPC analysis. FSNAU does not conduct IDP 

specific assessments to classify them either in HE or AFLC 

6 Actual figure is 2,390,000 rounded to 2,400,000 

7 Percent of total population of Somalia estimated at 7,502,654 (UNDP/WHO 2005) 



2. Cases of Acutely Malnourished Children in somalia 

Between May-August 2011, FSNAU in collaboration with 

partners conducted a total of 60 representative nutrition 

surveys throughout Somalia. 45 of these were done in 

May-July, while 15 were a repeat in the southern regions for 

the purpose of monitoring the evolving nutrition situation in 

the famine prone population groups. With the exception of 

the Coastal Deeh and the Cowpea Belt of Galgaduud and 

Mudug regions in Central Somalia, all population groups 

in the were assessed during this period. Tables 29 and 30 

provide the summary of key findings from these surveys. 

Rather than just presenting the prevailing nutrition situation, 

FSNAU in collaboration with nutrition cluster partners have, 

since 2008, also illustrated the distribution of cases of the 

acutely malnourished children in Somalia. The objective is 

to highlight to response agencies and donors the needs in 

different parts of the countries, rather than just focusing on 

the prevailing situation. In this way, the impact of population 

density in determining response needs is manifested. 

By extrapolating the prevalence rates of acute malnutrition 

in each assessed population group to the total under 

five population during the Gu 2011, cases of acutely 

malnourished children, based on Weight-for-height Z scores 

(WHZ) findings, have been estimated. The cumulative total 

cases at regional level has been obtained by summing up 

the cases from the assessed livelihood and IDP groups. 

For population groups where representative nutrition survey 

data for the whole population forms the main reference, 

reliability of data is high and is ranked as 1 (R=1). Where 

up to date survey data is not available (as in the Coastal 

Deeh and Cowpea Belt of central regions where rapid 

MUAC assessments were conducted in the Gu 2011), 

extrapolation has been made surveys findings from similar 

livelihood zones. Hence for the coastal deeh of Central, the 

results from the coastal deeh of northeast where a survey 

was done, have been used, while for the cowpea belt, the 

results from Middle Shabelle agro-pastoral has been used. 

In this case therefore, the reliability score (R) for the data 

used in the estimation of cases is lower, and reflected as 2 

(R=2). This implies that FSNAU has estimated the current 

cases of malnourished children on the basis of 100% of 

the population children aged below 5 years in Somalia. 

Population figures from the UNDP 2005 settlement survey 

are used as the standard reference for Somalia. (Table 3). 

The integrated analysis and overall phase classification of 

the assessed population is based on the Nutrition Situation 

Classification Framework. (Table 4). 

Analysis of the Post Gu 2011 findings indicates a 

total of 450,000 children as acutely malnourished. 

This translates to 30% of the 1.5 million underfive 

population, and implies 3 in 10 Somali children acutely 

malnourished. This reflects 87% increase in numbers at 

the national level, compared to the deyr 2010/11 when 

241,000 children were malnourished. Of these, 336,000, 

or 74% are located in the southern regions. 

Of the 450,000 children, a total of 190,000 children are 

severely malnourished. At national level, this translates 

to 13% of all Somali children as severely malnourished. 

This reflects 233% increase at the national level, 

compared to the deyr 2010/11 when 57,000 children 

were malnourished. Of the 190,000 severely malnourished 

children, 160,000 are located in the southern regions. 

At regional level, these figures are derived by extrapolating 

the prevalence rate of acute malnutrition to the total under 

five population. (Table 3). 

Table 3: Cases of Acute Malnutrition in Somalia, by Region, 

August 2011 

Region 

Total cases of Total cases of Severe 

Acute Malnutrition Acute Malnutrition 

Shabelle Regions 144700 73500 

Bay 66600 36100 

Lower Juba 30100 13850 

Bakool 29000 10350 

Woq-Galbeed 27900 6300 

Gedo 24600 9150 

Hiran 21900 9150 

Middle Juba 19000 8700 

Togdheer 16000 3600 

Galgadud 12900 3100 

Awdal 12150 2750 

Sanaag 10750 2400 

Bari 8500 1900 

South Mudug 8300 2000 

Sool 6000 1350 

NW IDPs 4000 900 

NE IDPs 3300 700 

Nugal 3000 700 

North Mudug 2750 600 

Total 450,000 190,000 

Hence, with regard to cases of acute malnutrition: 

• Shabelle regions (including Afgoye IDPs and Banadir) are 

host to 32% of all the malnourished children in Somalia, 

Bay regions host 15% and Juba regions, 11% (Map x). 

Hence, Shabelle, Bay and Juba regions are host to 58% 

of all malnourished children in Somalia. 

• For cases of severe acute malnutrition, Shabelle, Bay and 

Juba regions are host to 71% of the 190,000 children in 

the country, with Shabelle/Banadir/Afgoye hosting 39%, 

Bay 19, and Juba regions 12%. 

This illustrates the implication of population density on 

caseloads, as Shabelle/Afgoye/Banadir are most densely 


9 



Executive 

Map 4: Distribution DISTRIBUTION of estimated OF ESTIMATED Cases CASES (%) of Acutely (%) OF Malnourished ACUTELY MALNOURISHED Children in Somalia CHILDREN by Region, (

Figure 7: Proportion of Total Cases of Acutely 

malnourished children (WHZ

3. Nutrition Analysis in Somalia 

Executive 

12 

The April-August (Gu) 2011 Nutrition Situation Analysis 

During the April-August 2011 (Gu 2011) season, FSNAU in 

collaboration with partners undertook 60 nutrition surveys 

aimed at estimating the nutrition situation in the various 

population groups in Somalia. Data management of the 

nutrition surveys involved the use of the standard two stage 

cluster sampling based on SMART recommendations, 

quality assurance during data collection and entry, and 

validation of data quality by running frequencies and 

plausibility checks of core statistical inferences. (Table 5). 

ENA software was used in the analysis of anthropometric 

and mortality data, and Epiinfo software in cross tabulations 

and analysis of non-anthropometric data. (Survey tools are 

provided in Annex 7.2 - 7.9). 

Consistent with the Nutrition Situation Analytical Framework, 

(July 2010 version), interpretation of findings on specific 

indicators, are based on internationally recognized 

thresholds, mainly the UNWHO, Sphere, and FANTA/ 

UNFAO. 

• WHO thresholds have been used to determine the 

cut-offs, and to interpret findings on acute malnutrition, 

stunting, underweight, and death rates. They were also 

used to determine the mid upper arm circumference 

cutoffs for the under fives. 

• SPHERE has been referenced on cut-offs for the 

mid upper arm circumference for pregnant and 

lactating women that aided in estimating prevalence. 

Nevertheless they were limited in providing thresholds 

for interpreting the situation. 

• FANTA/UNFAO protocols have been referenced on 

thresholds on dietary intake, however they are limited 

in guiding on interpretation of the situation. 

• The mean WHZ, are based on a “Review of Nutrition 

and Mortality Indicators for the Integrated Food 

Security Phase Classification (IPC) by Young and 

Jaspars, 2009. 

Where internationally recognized interpretation frameworks 

are not available, for example, MUAC thresholds for the 

under fives, and the adult non-pregnant women, and the 

health information system trends, quartile distributions of 

the meta-data that is available at the FSNAU from x surveys 

has been used. Through the findings from the analyzed 

variables therefore, the situation has been categorized into 

five different phases: Acceptable, Alert, Serious, Critical 

or Very Critical. Where representative nutrition surveys 

have been conducted, the global acute malnutrition (GAM), 

is the core outcome reference indicator, denoting the 

prevalence of acute malnutrition. Nevertheless, a minimum 

of 2 anthropometric indicators (for example GAM and SAM), 

are required to make an analysis and classification of the 

situation into either of the five different phases. Information 

from the season in progress only is used. However historical 

data has been used for overall contextual and seasonal 

trends analysis. 

To provide a 3 month outlook, the immediate and driving 

factors are analyzed, and the convergence of the evidence 

of the projected scenario classified as Stable, Uncertain, 

Potential to Deteriorate or Potential to Improve. This 

information is presented in the Estimated Nutrition Situation 

Map with arrows defined in a separate legend titled Projected 

Trend (September-December 2011 for the post Gu 2011). 

In cartographical presentation, reliability of source of data is 

illustrated through solid color (for survey data which is quite 

reliable, R=1), or through slash marks (when statistically 

representative data is not available, in which case data 

reliability is lower and, R=2). 

The Nutrition Situation Analytical Framework 

The referenced Nutrition Situation Analytical Framework 

provides a summary of thresholds used to interpret findings 

from the various indicators. (Table x). It forms the basis for 

the nutrition situation classification for Somalia, and the 

Estimated Nutrition Situation maps, and as indicated, is 

based on international thresholds (WHO, Sphere and Fanta) 

where available, and contextually relevant analysis where 

these are not available. The July 2010 version of the analysis 

framework, used in the Gu 2011 analysis, has three sections: 

A. Core Outcome Indicators (mainly anthropometry related 

information, and mortality) 

B. Immediate Causes 

C. Driving/Underlying Factors 

D. Twice per year, in line with the seasonal assessments, 

post Gu (April – July) and post Deyr (October- 

December), the nutrition team develops an updated 

nutrition situation analysis at livelihood level, by 

region and by IDP settlement. The overall analysis 

is consolidated into the Estimated Nutrition Situation 

Map. The July 2010 analysis framework below remains 

a working document and will be updated and refined 

as new information and guidance becomes available. 

Although FSNAU-led, the framework has been developed 

over the years through a consultation process involving the 

WHO, UNICEF, WFP, ACF, CONCERN, SCUK, IMC, WV 

and more recently, Medair, DIAL and the Nutrition Cluster 

Support team as well as many nutrition partners in the 

region. The purpose is to have a tool that helps describe 

the nutrition situation with contextual analysis, rather than 

focus on prevalence estimates and thresholds which is 

traditionally the case in nutrition analysis. The July 2010 

version accommodates current research developments, 

and the switch from NCHS 1997 to WHO growth standards. 



Table 5. The Nutrition Situation Classification Framework, Draft 7, Jul 2010 

A. CORE OUTCOME INDICATORS (Anthropometry & Death Rates) 

Reference Indicators Acceptable Alert Serious Critical Very Critical 

Global Acute Malnutrition 1 

(WHO Reference) Reliability (R) =1 

Mean Weight-for-Height Z (WHZ) 

scores (R=1) 

SAM 2 (WHZ and oedema 3 ) 

(WHO to advice on thresholds) R=1) 

-0.40 

5 to 2 yrs 

2 and above, or doubling 

of rate in preceding 

phase. Include main 

causes 

>/=10 or doubling of rate 

in the preceding phase. 

Include main causes 

>15%, Or where there is 

significant increase from 

seasonal trends 

High and increasing 

proportion in the 

preceding 3mths relative 

to >2yr seasonal trends 

Increasing levels with 

increasing trend 

OVERAL NUTRITION SITUATION Acceptable Alert Serious Critical Very Critical 


13 

B. IMMEDIATE CAUSES 


Poor HH Dietary Diversity 

2% rural 

CFR for AWD >1% urban 

AWD – duration exceed >6 wks 

TBC 

Low proportion 

reportedly sick, 

from previous 

months but 

increasing in >2 

mnths based on 


TBC 

High levels and 

stable numbers in 

>2 months based on 


TBC 

High with significant 

Increase in numbers of 

sick children, based on 




Executive 

14 

C. DRIVING FACTORS 


Complementary feeding 15 in addition to 

breastfeeding 

i. Introduction of complementary 

food at 6 mths of age: 

≥95% 80-94% 60-79% 

0-59% 

0-59% 

%introduced 

≥95% 80-94% 80-94% 

0-59% 

0-59% 

ii. Meeting minimum recommended 

≥95% 80-94% 80-94% 

0-59% 

0-59% 

feeding frequency 16 

iii. Dietary diversity17 score 

Breastfeeding (BF) Practices 1 8 

I. Exclusive BF for 6mths 

ii).Continued BF at 1 yr 

iii)Continued BF at 2yr reference 

>90% 

>90% 

>90% 

50-89% 

50-89% 

50-89% 

12-49% 

12-49% 

12-49% 

0-11% 

0-11% 

0-11% 

Measles immunization/Status 

Vitamin A Supplementation Coverage 1 9:1 

dose in last 6 mths 

Population have access i). to a sufficient 

quantity of water for drinking, cooking, 

personal & domestic hygiene–min 15lts pp/ 

day 

ii).Sanitation facilities 

Affected pop with access to formal/informal 

services: health services 

Selective Feeding 20 Programs Available: 

Coverage of TFP /SFP & referral 

systems(Sphere04); 

-Admissions trends (R=3) 

Food Security Situation- current IPC status 

Civil Insecurity 

3 MONTH NUTRITION SITUATION 

OUTLOOK 

>95% 

>95% 

100% 

100% 

Should not be 

necessary 

Should not be 

necessary 

Generally Food 

Secure 

80-94.9% 

80-94.9% 

TBC 

TBC 

Access to 

humanitarian 

interventions 

for most 

vulnerable 

Access 

for most 

vulnerable 

Borderline 

TBC 

TBC 

Reduced access 

to humanitarian 

support for most 

vulnerable 

Acute Food and 

Livelihood Crisis 

4. REGIONAL NUTRITION ANALYSIS 

4.1 Gedo Region 

Gedo Region in Southwest Somalia comprises of six 

districts: Luuq, Dolo, Belet Hawa, Garbaharey, El Wak, 

and Bardera. The region has three main rural livelihood 

zones namely: pastoral, agro-pastoral and riverine (Juba 

riverine pump irrigation). The pastoral livelihood, further 

sub-divided into the Southern Inland and Dawa pastoralists, 

is the most predominant group, accounting for about 64% 

of the rural population in the region. The Dawa pastoral 

livelihood located in northern Gedo is the largest pastoral 

group in the region rearing mainly cattle, sheep goats and 

camel. The Southern Inland pastoral population is located 

in southern Gedo and besides sheep and goats mainly keep 

camel that are more resilient to droughts. The agro-pastoral 

population is divided into Southern agro-pastoral and Gedo 

agro-pastoral high potential (Map 5). 

Map 5: Gedo Region Livelihood Systems 


15 

Gedo is one of the regions in Somalia that has been 

adversely affected for a long time by the cumulative effects 

of extended conflict and recurrent natural disasters. This has 

resulted in the disruption of livelihood systems, including loss 

of livestock and crop failure and culminated in a persistent 

emergency situation for a majority of the population. 

According to the bi-annual FSNAU seasonal food security 

and nutrition analysis, northern Gedo has persistently faced 

a Humanitarian Emergency (HE) crisis since 2004. The 

situation in Northern Gedo has largely been attributed to 

climatic factors whereby poor rain performance/drought 

has contributed to crop failures and death of livestock, 

especially cattle and sheep which are less drought resistant. 

The nutrition situation in the region has also remained poor, 

with most assessments conducted in the region since 1995 

recording Global Acute Malnutrition (GAM) rates above the 

emergency threshold of 15%. Figure 8 indicates the trends 

of acute malnutrition in Gedo region since 2006 (WHO 

reference growth standards, 2006). 

Figure 8: Trend in Levels of acute Malnutrition (WHZ

Executive 

16 

riverine populations in Gedo region. The pastoral and 

riverine population showed a Very Critical nutrition situation, 

a deterioration from the likely Critical levels, while the 

agro-pastoral livelihood indicated a sustained Very Critical 

nutrition situation since Gu’10. The high acute malnutrition 

levels in the region were mainly linked to chronic underlying 

factors including; poor dietary quality, sub-optimal child care 

and feeding practices, and limited access to basic human 

services such as safe water, health and sanitation facilities. 

Current Situation 

Food Security 

The FSNAU Post Gu ‘11 integrated food security phase 

classification, classifies both rural and urban livelihoods 

of Gedo region in AFLC and HE although some portion of 

the rural population is in famine conditions and has about 

174,000 people in crisis (9,000 in Famine, 98,000 in HE 

and 67,000 in AFLC), which is a deterioration from Deyr 

’10/11. This is a 132% increase from Deyr ’10/11, when only 

75,000 people were in crisis. An estimated 9,000 People 

in Gedo agro pastoral high potential are in famine, 23,000 

southern agro pastoral and 24,000 urban are in HE. Other 

livelihoods in crisis include Dawa pastoral and southern 

inland pastoral with an estimated population of 13,000 and 

4,000 respectively. A significant number of populations in 

the above livelihoods have deteriorated to AFLC (23,000 and 

9,000 respectively). This drastic deterioration was mainly 

due to poor Gu’11 rainfall that resulted in crop failure, caused 

deterioration in rangeland resources that consequently 

contributing to high livestock deaths and significant declines 

in livestock market prices. The deteriorating food security 

situation was aggravated by a number of factors, poor 

rainfall performance, reduction of cereal and cash crop 

production in the riverine livelihood, complete crop failure of 

agropastoral livelihoods, depletion of cereal stock balances, 

decreased livestock production and significant decline of 

livestock prices and the subsequently related decrease 

income from crop, milk and livestock product sales 

situation, while the crude and under five mortality rates are 

1.57 (0.76-2.37) and 5.81 (2.66-8.97) respectively indicating 

an alert and emergency situation according to the WHO 

classification. In addition, a comparison of the current GAM 

rates with the previous GAM rates of 26.4% (22.2-31.1) and 

26.7% ( 21.5- 32.8) recorded in December ’10 assessments 

among the pastoral and riverine populations respectively 

indicates a deterioration and Very Critical nutrition situation. 

Though in the same phase, this indicates a statistically 

significant deterioration among the riverine, with no change 

in the pastoral populations. The assessment conducted 

among the agro-pastoral population shows an extremely 

high GAM rate of 51.9% (41.8-61.9) and a SAM rate of 

19.3% (13.9- 26.3) indicating a sustained Very Critical 

nutrition situation but with elevated acute malnutrition levels 

and while the crude and under five mortality rates are 1.67 

(1.14-2.19 ) and 5.29 (3.61-6.96) respectively, indicating an 

alert and emergency situation respectively according to 

the WHO classification . When compared with the nutrition 

assessment conducted in December ’10 when a GAM rate 

of 25.6 % (21.5-29.5) and SAM rate of 6.5% (4.6-9.2) were 

recorded, the current results show a statistically significant 

increase of both the GAM and SAM rates indicating a 

significant deterioration. High GAM rates over 30%, and 

more than 20% of the populations with acute crisis of food 

access in the poor households of the agro-pastoral and 

riverine livelihoods in Gedo are are more likely to face 

famine. Data from the health facilities in Gedo riverine areas 

also indicates high numbers (>30%) and an increasing trend 

of acutely malnourished children (Figure 9). 

Figure 9: HIS Malnutrition Trends in Gedo Riverine 

MCHs - Gu ’11 

Proportion of Children Malnourished 

50.0 

45.0 

40.0 

35.0 

30.0 

25.0 

20.0 

15.0 

10.0 

2011 2010 

2 per. Mov. Avg.(2011) 2 per. Mov. Avg.(2010) 

Nutrition 

The integrated analysis of data from nutrition assessments 

conducted in Gedo in July 2011, and health facilities’ 

data shows a Very Critical nutrition situation among the 

populations in the three livelihood groups in the region. The 

nutrition assessment conducted in the pastoral population 

indicates a GAM rate of 23.8% (20.1-28.0) and SAM rate of 

5.9% (4.1-8.5) indicating a sustained Very Critical nutrition 

situation since Deyr ‘10/11, while the crude and under five 

mortality rates are 1.18 (0.79-1.57 ) and 4.06 (2.47-5.64) 

respectively, indicating an alert and emergency situation 

according to the WHO classification. An assessment 

conducted among the riverine population shows an 

extremely high GAM rate of 48.1% (38.7-57.7) and SAM rate 

of 25.2% (19.1- 32.6), indicating a Very Critical nutrition 

5.0 

0.0 

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 

Data Source: Trocare, SRCS, HIRDA 

Overall, the nutrition situation in Gedo region is Very Critical 

and demonstrates a significant deterioration in all the three 

livelihoods. The concerning nutrition situation is generally 

linked to immediate food shortages as well as underlying 

chronic factors that include: household food insecurity (poor 

dietary quality), inadequate social and care environment 

(sub-optimal child care and feeding practices), and poor 

public health (limited access to basic human services 

such as safe water, health and sanitation facilities), which 

exposes communities to high morbidity and subsequently 

high levels of acute malnutrition. While the immediate factors 

include reduced access to food due to rapid increases in 



food and milk prices, and outbreaks of disease (acute water 

diarrohea- AWD, cholera, malaria, measles and whooping 

cough). These immediate factors are caused by the crop 

failure and poor livestock production following the poor 

Gu ‘11 rainfall performance, which has significantly affected 

household access to cereals, milk and income. In order to 

contain any further deterioration and to address the rising 

rates of malnutrition immediate and long term interventions 

such as rehabilitation of acutely malnourished children, 

and improving food access will be required in the region. 

Preventive measures to improve health service delivery, 

access to safe water and sanitation facilities as also crucial. 

In addition to that addressing poor child care and feeding 

practices are recommended and important for a lasting 

solution. 

Repeat nutrition and mortality survey conducted in August 

2011, among the Gedo riverine population shows a Very 

Critical situation, that is sustained from July’11 GAM rate 

of 48.1% (38.7-57.5) and a SAM rate of 25.2% (19.1-32.6). 

The 90 days retrospective crude (CDR) and under five 

death rates (U5DR) of 0.97 (0.56-1.37) and 2.16 (1.06- 

3.25) respectively indicate Acceptable and Alert situation 

according to WHO classification, a decrease from the rates 

reported in July ’11. 

Gender and nutrition analysis in Gedo Region 

The nutrition assessments conducted in the three 

livelihoods of Gedo revealed a higher proportions of 

acutely malnourished boys than girls were reported in the 

pastoral (30.0% vs 17.1%) and agro-pastoral (61.5% vs 41.9) 

livelihoods respectively, while the proportions of acutely 

malnourished boys and girls are the same in the riverine 

livelihoods (47.8% vs 48.4%). In the pastoral livelihood 19.8% 

of boys compared to 14.5% of girls were stunted; and 38.4% 

of boys as compared to 28.1% of girls were underweight. The 

agro-pastoral livelihood 23% of boys compared to18.1% of 

girls were stunted; and 57.1% of boys as compared to 43.5% 

of girls were underweight. The riverine livelihood 45.2% of 

boys compared to 30% of girls were stunted; and 58.1% 

of boys as opposed to 52.5% of girls were underweight. 

However, there is no significant statistical difference in the 

distribution of acute malnutrition between sexes implying 

that they were equally affected (p>0.05). Higher proportions 

of girls than boys were reportedly ill two weeks prior to the 

assessment in the agro-pastoral livelihoods. The gender 

disaggregated data by sex of the assessed children is 

summarized on Tables 6 and 7. 


17 



Table 6: Summary of Key Nutrition Findings in Gedo Livelihood Zones, July 2011 

Executive 

18 

Gedo Pastoral 

Gedo Agropastoral 

(N=1093, Boys=563, Girls=515) ( N=834, Boys=426, Girls=408) 

Gedo Riverine 

(N=642, Boys=357, Girls=285) 

Indicator Results Outcome Results Outcome Results Outcome 

Child Nutrition Status 

Global Acute Malnutrition (WHZ

Table 7: Summary of Key Nutrition Findings in Gedo Livelihood Zones, Gedo Riverine August, 2011 

(N=1093, Boys=563, Girls=515) 

Indicator Results Outcome 



Executive 

20 

High levels of acute malnutrition 

across the Somalia border 

The Horn of Africa has experienced several consecutive seasons of rain failure which has adversely affected the 

different livelihood systems. Poor rainfall performance has resulted in severe shortage of water and pasture, 

leading to massive deaths of livestock and crop failure. This has constrained household food access in most of 

south Somalia, and resulted in alarming levels of acute malnutrition and mortality. Though all countries in the 

horn of Africa are affected, the severity varies depending on the governing structures and response mechanism 

available in each country. Nutrition and mortality assessments conducted between March and August 2011 in 

the three (Kenya, Ethiopia and Somalia) countries boarder region clearly shows the high level of deterioration in 

the border region while at the same time revealing the severity in Somalia. (Source: FSNAU Nutrition Update, 

May-June 2011). 

Between March-April 2011, two representative nutrition surveys were conducted by UNHCR/MSF in Bokolmayo 

and Melkadida refugee camps in Ethiopia, which host Somali refugees fleeing the drought and civil insecurity 

in Somalia. The two nutrition surveys reported a GAM rates of 33.4% in Bokolmayo, 33% in Melkadida, and a 

SAM rate of 11% in each of the camp, indicating a Very Critical nutrition situation. Further analysis of the data 

indicates differences in the nutrition status based on period of residence in the camps, with new arrivals being 

more acutely malnourished, with GAM rate of 47% and a SAM rate of 23.6%, while the older refugees are slightly 

better, with GAM rate of 29% and a SAM rate of 7.5%. Elevated mortality rates were also reported in Bokolmayo 

refugee camp with respective crude and under five mortality rate of 2.26 and 4.04 per 10,000 per day, indicating 

an emergency situation based on the WHO classification. In Melkadida, the crude and the under five mortality 

rates are 0.78 and 1.47 per 10,000 per day respectively, indicating an alert situation. 

Another representative nutrition survey conducted between April-June 2011 by UNICEF and partners in the 

rural livelihoods of Kenyan districts bordering Somalia indicated a Very Critical nutrition situation and elevated 

mortality. In Mandera West, results showed a GAM rate of 32.6% (27.8- 37.8), while in other parts of Mandera 

and Wajir districts, the GAM rates are over 20%, and SAM rates are over 4%. 

In July 2011, representative nutrition surveys conducted in Gedo and Juba regions of Somalia by FSNAU and 

partners are indicating a Very Critical nutrition situation. Nutrition surveys in the pastoral, riverine and agropastoral 

populations in Gedo Region indicate GAM rate of 23.8% (20.1-28.0), 48.1% (38.7-57.7) and 51.9% (41.8- 

61.9) respectively, and SAM rate of 5.9% (4.1-8.5), 25.2% (19.1- 32.6) and 9.3% (13.9- 26.3) respectively. In Juba 

Region, the nutrition survey findings in the pastoral, riverine and agro-pastoral populations indicate GAM rate 

of 38.9 (34.8- 43.1), 45.9% (38.7-57.7) and 38.9 (34.8- 43.1) respectively and SAM rate of 5.9% (4.1-8.5), 25.2% 

(19.1- 32.6) and 9.3% (13.9- 26.3) respectively. 

In general, these results depict a very severe nutrition situation across the border, which is largely attributed to poor 

household food access. Two consecutive seasons of rain failure have adversely affected the livelihoods systems 

in these regions, leading to sky rocket cereal prices, massive deaths of cattle, sheep and goats as a result of lack 

of pasture and water, while camels have out-migrated in search of browse, limiting milk access to the remaining 

household members. Access to humanitarian health care services, safe water and sanitation facilities in these 

areas, and more so in Somalia remains very limited due to insecurity, leaving the population highly vulnerable 

to diseases, and acute malnutrition. 

A coordinated humanitarian response strategy across the border, coupled with negotiations that will enhance an 

access therefore remains crucial to save life, and to reduce the current internal displacements, and mass-migration 

of people from Somalia to either Kenya or Ethiopia in search of food. 



4.2 MIDDLE and LOWER Juba Regions 

Middle and Lower Juba regions in southern Somalia have 

a total of seven districts namely Sakow, Buale and Jilib 

in Middle Juba, and Jamame, Afmadow, Kismayo and 

Badhadhe in Lower Juba. The two regions have three main 

rural livelihood zones namely: the pastoral (the Southern 

Inland and Southeast Pastoralists), agro-pastoral (Lower 

Juba and Southern Agro-pastoral) and the Riverine 

communities who are purely agriculturist. (Map 6). 

Map 6: Juba Regions Livelihood Zones 


21 

Historical Overview - Post Deyr’10/11 

Food Security 

The food security and nutrition situation in the Juba regions 

has varied over time and has largely been linked to rainfall 

performance and its resultant impacts on the different 

livelihood systems. Heavy rainfall in the Juba regions 

or in the Ethiopian highlands often results in floods that 

devastate crop cultivation, and sanitation facilities in the 

riverine areas, however, the riverine communities’ later 

benefit from recessional cropping from the Desheks and 

fishing opportunities from the flood waters. The agropastoral 

communities, who rely on rain-fed agriculture, 

are totally dependent on rainfall as are the pastoralists, 

whose livelihood is greatly influenced by pasture and water 

availability conditions. 

The Post Deyr ’10/11 integrated analysis showed a generally 

very poor rainfall performance in terms of coverage and 

intensity in the two Juba regions. This adversely affected 

cereal production, then estimated at only 5% and 10% 

of PWA in Middle and Lower Juba regions respectively. 

Similarly, livestock body conditions and production 

significantly declined resulting in reduced access to milk 

and income from sales of milk and livestock. The rise in 

cereal prices and reduced income earning opportunities also 

contributed to the high food insecurity situation experienced 

in these regions. The populations in the urban livelihood was 

classified as either in HE or AFLC, which constitutes 25,000 

in HE and 30,000 in AFLC. The rise in number of people 

faced with food insecurity was linked to the poor Deyr’10/11 

rainfall performance and the ensuing negative impact on the 

livelihood systems. 


The nutrition situation in the Juba regions equally varied 

across livelihoods over time, the pastoral population showed 

more resilience and remained mostly at Serious levels, while 

the nutrition situation of the populations in the riverine and 

agro-pastoral livelihoods fluctuated between Serious and 

Critical levels. The only exception was in 2009 when a Very 

Critical nutrition situation was recorded among the pastoral 

population both in the Gu and Deyr seasons, and among 

the agro-pastoral in the Gu season largely attributed to an 

outbreak of acute watery diarrhoea (Figure 10). 

Figure 10: Trend in levels of Acute Malnutrition (WHZ 

Executive 

22 

Current Situation-Post Gu ’11 

Food Security 

The FSNAU Post Gu ’11 food security analysis shows drastic 

deterioration and classifies rural (Famine,AFLC & HE) and 

urban(AFLC &HE) livelihoods of Juba region in AFLC and 

HE although some portion of the rural population is in famine 

conditions. Currently, 360,000 people are in crisis (34,000 

famine,240,000 in HE and 92,000 in AFLC) which is 100% 

increase from last Deyr ’10/11 (180,000 both rural & urban). 

In Gu’11 rainfall performance was very poor in coverage, 

intensity and distribution. Majority ( 80%) of the affected 

populations comes from the rural livelihoods due to the poor 

performance of Gu ‘11 seasonal rainfall, that brought about 

poor crop harvest in the riverine and agropastoral livelihoods 

and eventually caused livestock deaths in the south east 

pastoral and agro pastoral livelihoods. The FSNAU Post 

Gu ’11 food security analysis shows poor crops harvest as 

a result of Gu’ 2011 rain failure which is estimated as being 

5% of Gu’ 2010, 8% of 5 years Average and 6% of PWA 

when combined for both regions. 

and SAM rates. While the crude and under five mortality 

rates are 1.24 (0.82-1.66 ) and 4.25 (2.75-5.75) respectively, 

indicating an alert and emergency situation according to the 

WHO classification. With high GAM rates over 30%, and 

more than 20% of the populations facing an acute food 

access crisis, the poor households of the agro-pastoral and 

riverine livelihoods in Juba are more likely to face famine. 

Data from the health facilities namely Juba riverine MCHs, 

indicates high numbers (>30%) and an increasing trend of 

acutely malnourished children (Figure 11). 

Figure 11: HIS Malnutrition trends in Juba Riverine 

MCHs 2010-2011 

Proportion of malnourished children 

50.0 

45.0 

40.0 

35.0 

30.0 

25.0 

20.0 

15.0 

10.0 

5.0 

0.0 

2010 2011 

2 per. Mov. Avg.(2010) 2 per. Mov. Avg.(2011) 


Month 

Data Source: Muslim AID UK, MSF and SCRCS 



conducted in Juba regions in July 2011, in addition to health 

and feeding facilities’ information shows a sustained Very 

Critical nutrition situation but with a significant increase in 

the GAM and SAM rates recorded among the populations 

in the three livelihoods in Juba regions. In the agro-pastoral 

livelihood, the nutrition assessment reports a GAM rate 

of 38.9 (34.8- 43.1) and a SAM rate of 17.2 (14.0- 20.9) 

comparing to the previous nutrition assessment conducted 

in December 2011, where a GAM rate of 26.1% (21.9-30.9) 

and a SAM rate of 6.2% (4.6-8.3) were reported. The crude 

and under five mortality rates reported in July 2011 are 1.12 

(0.8-1.45 ) and 4.11 (2.80-5.43) respectively, indicating 


classification. An assessment among the riverine population 

reports a GAM rate of 45.9% (41.5-50.3) and SAM rate of 

21.9(18.9-25.2) a major deterioration comparing from the 

previous GAM rate of 29.7% (24.5-35.4) and SAM rate of 

6.4% (4.6-8.8). The crude and under five mortality rates are 

1.18 (0.84-1.52 ) and 4.66 (3.17-6.15) respectively, indicate 


classification. 

All the three livelihood populations in Juba were indicating 

a sustained Very Critical nutrition situation since Gu ’10. 

However, the nutrition assessment conducted in the pastoral 

population, indicates a GAM rate of 39.5% (35.9-43.2) and 

SAM rate of 18.7% (15.8-21.98.5) which when compared 

to GAM rate of 30.7% (26.1-35.7) and SAM rate of 7.8% 

(5.8-10.5) recorded in December 2010 assessment indicate 

similar Very Critical levels but with a slight decline in GAM 

A rapid MUAC assessment among the Kismayo IDPs 

shows a deterioration from Critical to Very Critical levels 

in July 2011 among the assessed 1,122 and 1,018 children 

from the old and newly arrived IDPs. The assessment of 

the protracted Kismayo IDPs reported a high proportion 

of malnourished children MUAC < 12.5 cm of 24.3% and 

severely malnourished children MUAC < 11.5 cm of 6.1%, 

while the newly arrived IDPs in Kismayo town recorded a 

proportion of acutely malnourished children with MUAC < 

12.5 cm or oedema of 26.4% and severely malnourished 

children MUAC < 11.5 cm or oedema of 11.4%. When 

compared with rapid assessment conducted in Dec’10 

when MUAC < 12.5 cm of 12.5% and MUAC < 11.5 cm of 

0.5% were recorded, these results shows a deterioration 

from Gu ’10 situation. The deterioration are mainly related 

to lack of health services, poor food access, inadequate 

sanitation facilities and safe water. 

In general the nutrition situation among the three rural 

livelihoods in Juba regions and the displaced population in 

Kismayo town is Very Critical. The deterioration is mainly 

attributed to food security related factors, whereby the 

region experienced three consecutive seasonal rainfall 

failure which led to poor crop and livestock production and 

the resulting high cereal prices, low terms of trade, and 

abnormal livestock out-migration. This has contributed to 

reduced access to food (cereal and milk). Furthermore, in 

the Juba region, high morbidity persists, a major risk factor 

to acute malnutrition. The situation is worsened by the gap 

in humanitarian space in the area that usually provide health 

and nutrition services due to the current civil insecurity in 

the area. 



The current precarious nutrition situation in all livelihood 

zones in Juba is also attributed to chronic factors such 

as: poor child feeding and care practices, inadequate 

sanitation facilities and safe water as well as high chronic 

morbidity levels due to limited or poor access to health care 

services. In the short and long term, urgent interventions 

to rehabilitate acutely malnourished children, and enhance 

food access are necessary. Preventive measures to 

improve and sustain food access, nutrition and health 

service delivery, access to safe water and sanitation 

facilities as well as addressing poor child care practices 

are recommended for a lasting solution. 

Repeat nutrition and mortality survey conducted in August 

2011, among the Juba riverine, agro-pastoral, and pastoral 

population indicates a GAM rates of 39.6% (35.4-43.9), 

34.4%(29.8-39.2), and 31.2% (26.1-36.7) respectively, 

the result is very critical situation, and sustained as 

compared to July’11 GAM rates of 45.9% (41.5-50.32), 39 

(34.9-43.2), and 39.4 (35.8-43.2) respectively. The 90 days 

retrospective crude (CDR) 1.76 (1.2-2.32), 1.82 (1.23-2.41), 

and 1.25 (0.77-1.73) respectively and under five death rates 

(U5DR) of 4.22 (2.56-5.87), 4.62, (2.87-6.37) and 2.61(1.32- 

3.88) respectively indicate Alert and an Emergency 

situation a sustained from the reported in July’11. 

Gender and nutrition analysis in Juba Region 

The nutrition assessments conducted in the three livelihoods 

of Juba was recorded a higher proportions of acutely 

malnourished boys than girls in the pastoral (45.8% vs 

33.2%) and agropastoral (45.7% vs 32.6%) livelihoods 

respectively. While high proportions of acutely malnourished 

of boys than girls are also observed in the riverine livelihoods 

(53.8% vs 38 %). In pastoral livelihood 40.7% of boys 

compared to 27.2% of girls were stunted; and 61.8% of 

boys as opposed to 41.1% of girls were underweight. In 

agropastoral livelihood 50.1% of boys compared to34.5% of 

girls were stunted; and 59.3% of boys as opposed to 46.8% of 

girls were underweight. The riverine livelihood 51.4% of boys 

compared to 37.5% of girls were stunted; and 71.% of boys 

as opposed to 49.9% of girls were underweight. However, 

there is no significant statistical difference between the 

sexes showing that they were equally affected (p>0.05). 

Higher proportions of girls than boys were reportedly ill two 

weeks prior to the assessment in the pastoral livelihoods 

while the proportions of girls and boys were similarly affected 

by the acute malnutrition in the agropastoral and riverine 

populations(Table ). The gender disaggregated data by sex 

of the assessed children is summarized on Table 8 and 9. 


23 



Table 8: Summary of Key Nutrition Findings in Juba Livelihood Zones, July 2011 

Executive 

24 

Juba Pastoral 

(N=866, Boys=,428 

Girls=440) 

Juba Agro pastoral 

(N=824, Boys=398, 

Girls=426) 

Juba Riverine 

(N=868, Boys=431, 

Girls=437) 




Table 9: Summary of Key Nutrition Findings in Juba Livelihood Zones, August 2011 

Juba Pastoral 

(N=523, Boys=,248 Girls=275) 

Juba Riverine 

Juba Agro pastoral 

(N=591, Boys=281, 

(N=561, Boys=279, Girls=287) 

Girls=310) 




4 .3 Bay and Bakool Regions 

Map 7: Bay and Bakool Regions Livelihood Zones 

Executive 

26 

Bay and Bakool regions are located in the southwest of 

Somalia. Both regions have two predominant livelihood 

systems; the agro-pastoral, found both in Bay and the 

southern parts of Bakool, and the pastoral found mainly 

in Elberde district of Bakool region (referred herein as 

Bakool Pastoralists) (Map 7). Bakool region comprises of 

five districts namely Huddur (the regional capital), Wajid, 

Tieglow, Rabdure and Elberde. Bay region comprises 

of four districts, namely Baidoa, (the regional capital), 

Qansahdhere, Dinsor and Burhakaba. The two regions have 

a high agricultural potential, with Bay region serving as the 

sorghum basket for Somalia. 

Bay and Bakool regions are characterized by the recurring 

effects of natural and man-made disasters and conflicts. The 

negative factors affecting the area are mainly crop failure 

and loss of livestock, resulting in a continual emergency 

situation for the most of the population. According to the biannual 

FSNAU seasonal analysis, Bakool has persistently 

faced a Acute Food and livelihood Crisis AFLC) or 

Humanitarian Emergency (HE) crisis since Deyr’07/08. 

The situation in Bay and Bakool has largely been attributed 

to unfavorable climatic factors, poor dietary diversity, poor 

water, lack of sanitation facilities and reduced health and 

humanitarian services in the region. The nutrition situation 

in the region has also generally remained poor, the meta 

analysis of data from 2001-2008 in Bay and Bakool regions 

indicates that the median acute malnutrition rates are 18% 

and 15.9% respectively both above the emergency threshold 

of 15%. 

Bakool Region 

Historical Overview Post Deyr ’10/11 

Food Security 

The FSNAU Post Deyr’ 10/11 integrated food security phase 

classification, indicated that the rural population in Bakool 

region was faced with a Humanitarian Emergency (HE) or 

Acute Food and livelihood Crisis (AFLC). Approximately, 

5,000 people were faced with HE and 90,000 people were in 

AFLC in the entire Bakool region. Out of the total in AFLC, 

80,000 were agro-pastoralists (45,000 in Bakool agropastoral 

LZ and 35,000 in Bay-Bakool agro-pastoral low 

potential LZ) while the remaining 15,000 were pastoralists 

(Southern Inland Pastoral). In addition, 30,000 of Bakool’s 

urban populations were faced with either AFLC (5,000 

people) or HE (25,000 people). The Deyr ’10/11 season 

cereal production in Bakool region was only 10% of the PWA 

and 7% of the five-year average (2005-2009) which was the 

second lowest since 1995. These phase classifications were 

linked to the cumulative effect of poor rainfall performances 

and the resulting negative impact on the crop production, 

poor pasture, browsing and water conditions. 


Due to the increased civil insecurity and lack of access to 

most of the area in the region, it was not possible during 

the Deyr ‘10/11 season to conduct representative nutrition 

surveys in any of Bakool’s livelihood zones, however 

rapid MUAC assessments were conducted in 11 villages 

each among the pastoral and agro-pastoral populations . 

Results from the two livelihoods indicated a high proportion 

(>20%) of the assessed children with MUAC

Current situation, Gu’11 

Food security 

The current Gu’11 Integrated Phase Classification identifies 

the rural livelihoods in Bakool region to be in either the 

AFLC, HE or Famine. The total rural population in crisis 

has increased by over 100% from 95,000 in Deyr’10/11 to 

201,000 and 81% of the population are currently faced with 

crisis. Of the total rural populations in crisis in the Bakool 

region 30,000 are in AFLC, 92,000 in HE and 79,000 

in Famine. Similarly an additional urban population of 

25,000 and 22,000 are classified are facing HE and AFLC 

respectively. The food security situation in all livelihoods 

of Bakool region has deteriorated since Gu ’10 due to two 

seasons of consecutive crop failure as well as loss of 

livestock and poor production due to poor pasture, browsing 

and water conditions attributed to failed Deyr ’10/11 and Gu 

’11 rainfall. 


The current post Gu ’11 integrated analysis of data from 

nutrition assessments conducted in Bakool region in July 

2011, the health facility information and targeted feeding 

facilities data indicates a significant deterioration of the 

nutrition situation in both the pastoral and the agro-pastoral 

population. Though the nutrition situation is sustained 

at a Very Critical phase, the GAM rates in the current 

assessments are extremely high surpassing the famine 

threshold of 30%, especially for the agro-pastoral, the worst 

seen in decades. 

The nutrition assessment conducted in the Bakool pastoral 

population in July 2011 by FSNAU and partners indicated 

a GAM rate of 55.9% (50.6-61.2) and SAM rate of 20.4% 

(15.2-26.7) depicting a sustained Very Critical nutrition 

situation, yet a significant deterioration with a considerable 

increase in the proportion of acutely malnourished children. 

In January 2011, the nutrition situation was likely Very Critical 

bassed on integrated analysis of data from rapid MUAC 

assessment conducted in December 2010, and health 

facility trends.The 90 days retrospective crude (CDR) and 

under five death rates (U5DR) of 1.89 (1.60-2.19) and 5.06 

(3.80-6.32) indicate a Critical situations respectively. 

The Bakool agro-pastoral livelihood nutrition assessment 

reports a GAM rate of 45.9% (42.3-49.6) and SAM rate 

of 16.4% (12.9-20.6) indicating a Very Critical nutrition 

situation. This is also a significant deterioration, with 

extremely high increase in the levels of acute malnutrition, 

even when compared to the Deyr‘10/11. The 90 days 

retrospective CDR U5DR of 2.2 (1.7-2.7) and 7.0 (5.2-8.8) 

respectively indicate a Very Critical situation. The crude 

death rate and acute malnutrition has exceeded famine 

thresholds in Bakool agro-pastoral. 

In August 2011, repeat nutrition and mortality surveys were 

conducted among the Bakool agro-pastoral to monitor 

the changing situation. The results reported a GAM rate 

of 41.1% (35.1-47.4) and a SAM rate of 13.1% (10.5-16.2) 

indicating a sustained Very Critical nutrition situation. The 

90 days retrospective crude (CDR) and under five death 

rates (U5DR) of 2.11 (1.40-2.83) and 5.18 (3. 06-7.30) 

respectively indicating a Very Critical situation, with the 

CDR rate still above famine thresholds.Vaccination status 

by recall and Vitamin A supplementation are extremely low 

due to reduced interventions in the area, this can further 

exacerbate the nutrition status of the children in the area . 

Data from health facilities in the livelihood zone reported a 

high (>50 %) and increasing trend of acutely malnourished 

children (Figure 13). There were a unconfirmed outbreak of 

whooping cough and measles in Rabdure and Tieglow. 

Figure 13: HIS Malnutrition Trends in Bakool Agropastoral 

LZ, 2010-2011 

Percent 

100.0 

95.0 

90.0 

85.0 

80.0 

75.0 

70.0 

65.0 

60.0 

55.0 

50.0 

45.0 

40.0 

35.0 

30.0 

25.0 

20.0 

15.0 

10.0 

5.0 

0.0 


Month 

Data Source: RCS, GTZ 

2010 2011 2 per. Mov. Avg.(2010) 2 per. Mov. Avg.(2011) 

In eight of the last nine consecutive seasons, Bakool region 

has been in crisis. Both livelihood zones are affected by 

prolonged drought, however, the Bakool agro-pastoralists 

are the hardest hit. The impact of extremely poor Gu ‘11 

rainfall performance was manifested by crop failure and 

poor livestock production which has significantly affected 

household access to cereals, milk and income. Besides poor 

food access, the deterioration in the nutrition situation in 

Bakool region is also attributed to chronically high morbidity 

levels, further aggravated by inadequate access to basic 

services such as safe water, health and nutrition outreach. 

The situation is worsened by the withdrawal of certain 

humanitarian organizations that provided health and 

nutrition services in the area due to the prevailing civil 

insecurity. The withdrawal of these essential services that 

played both a preventive and rehabilitative role in addressing 

acute malnutrition in the region partly explains the current 

deterioratiion. Immediate large scale food assistance, 

rehabilitation of acutely malnourished children and provision 

of health services and safe water is required urgently to 

prevent the ongoing deaths and livelihoods programs to 

increase food access. Close monitoring of the nutrition 

situation of this population group remains crucial. 


27 



Table 10: Summary of Key Nutrition Findings in Bakool Region - July &August 2011 

Executive 

28 

Bakool Pastoral July11 

(N=270;boys=146;girls=124) 

Bakool agro-pastoral July’11 

(N=244;boys=121;girls=123) 

Indicator Results % Outcome Results % Outcome 


Global Acute Malnutrition (WHO 

2006) 

Boys 

Girls 

Severe Acute Malnutrition (WHO 

2006) 

Boys 

Girls 

55.9 (50.6-61.2) 

65.1 

45.2 

20.4 (15.2-26.7) 

21.9 

18.5 

Very Critical 

Very Critical 

45.9 (42.3-49.6) 

57.9 

34.1 

16.4 (12.9-20.6) 

21.5 

11.4 

Very Critical 

Very Critical 

Bakool agro-pastoral August’11) 

(N=467;boys=241;girls=226) 

41.1 (35.1-47.4) 

50.6 

31.0 

13.1 (10.5-16.2) 

17.4 

8.4 

Very Critical 

Very Critical 

Mean WHZ (WHO, 2006) -1.98±0.95 Critical -1.86±0.92 Critical -1.75±0.97 Critical 

Global Acute Malnutrition (NCHS) 49.3 (44.7-53.9 Very Critical 39.6 (35.1-44.3) Very Critical 37.6 (32.1-43.5) Very Critical 

Severe Acute Malnutrition (NCHS) 15.6 (11.8-20.2) Very Critical 11.0 ( 8.1-14.8) Very Critical 9.4 ( 7.3-12.0) Very Critical 

Proportion with MUAC

Bay Region 

Historical Overview - Post Deyr’10/11 

Food security 

The FSNAU Post Deyr ’10/11 integrated food security 

analysis classified the rural populations in Bay region in 

crisis either in AFLC or HE, indicating deterioration in 

the food security situation of the livelihood. In Bay region, 

54,000 people who were classified as being Borderline 

Food Insecure (BFI) in Gu ’10 was faced in crisis in the 

Deyr’10/11. Of these, 8,000 rural people were faced with 

AFLC (Bay-Bakool agro-pastoral low potential LZ) and 

46,000 urban populations were either in AFLC (43,000) 

or HE (3,000). The rest of the population was classified 

as Borderline Food Insecure (BFI). The overall cereal 

production in Bay was only 8% of the PWA and 7% of the 

five- year average illustrating crop failure. The poor agropastoral 

households in the northern parts of Baidoa and 

Burhakaba districts (the agro-pastoral low potential LZ) who 

were classified as Borderline Food Insecure (BFI) in the Gu 

’10, had deteriorated to Acute Food and Livelihood Crisis 

(AFLC) due to the Deyr ’10/11 season crop failure as well 

as the low recovery of livestock herd sizes. Consequently, 

the overall food security situation in the livelihood had 

deteriorated due to crop failure as well as lack of milk 

availability and poor water conditions attributed to the failed 

Deyr ’10/11 rains this region. 


The Post Deyr ‘10/11 integrated analysis of data from rapid 

MUAC assessments conducted in Bay region in Dec‘10, 

with health and feeding facilities information, indicated a 

sustained likely Very Critical nutrition situation among the 

agro-pastoral population. The vulnerability to high acute 

malnutrition levels in the region was largely attributed to 

chronic high morbidity levels, further aggravated by reduced 

access to humanitarian assistance in terms of safe water, 

health, nutrition, and outreach services (Figure 14). 

Figure 14: Trend in levels of acute malnutrition 

(WHZ< -2 or oedema, WHO 2006) Bay 

region, 2002- 2011 

65.0 

60.0 

55.0 

50.0 

45.0 

40.0 

Current situation, Post Gu’11 

Food security 

The FSNAU Post Gu’11 integrated food security analysis has 

classified the agro-pastoral livelihood zone of Bay region in 

either Famine or HE indicating a deterioration from AFLC/ 

HE in post Deyr’10/11 which is as a result of two successive 

seasons of crop failure. There is a significant deterioration 

in the agro-pastoral (both high potential and low potential) 

livelihood where the population in crisis has increased from 

8,000 in post Deyr ‘10/11 to the current 410,000 peope.. 

Ofthe total in crisis, 157,000 are in Famine and 253,000, in 

HE. In addition, 70,000 of Bay urban populations are either 

in AFLC (16,000 people) or HE (62,000 people). The overall 

food security situation in the livelihoods of Bay region has 

deteriorated due to crop failure as well as lack of milk and 

animal loss attributed to the failed Deyr ’10/11 and Gu’11 

rainfall performance in this region. 


The current Post Gu ’11 integrated analysis of data from 

nutrition assessments conducted in Bay region in July 

2011, health information and targeted feeding facilities 

data indicates a Very Critical situation, with a significant 

deterioration recorded among the agro-pastoral population 

where very high GAM rates (>50%), the worst seen in 

decades, have been reported. A rapid MUAC assessment 

conducted in the area during the post Deyr ’10/11 season 

indicated 18.4% of the assessed children were acutely 

malnourished (MUAC 40%) which provides evidence of the sustained 

poor nutrition situation among this population. 


29 

35.0 

% malnourished 

30.0 

25.0 

20.0 

15.0 

10.0 

5.0 

0.0 

Mar'07 

Qansahdere 

District 

May'02 

Sep'06 

Sep'03 

Mar'07 

May'07 

May'07 

Berdalle District Dinsor District Burhakaba Burhakaba 

Pastoral Agrop 

Nov.'07 

June 09 

Dec-09 

Bay Agro-pastoral 

July'11 

Aug'11 

A repeat nutrition and mortality survey conducted in August 

2011, in the same population shows extremely worrying 

results, with GAM rate of 58.3% (52.1-64.2) and SAM rate 

of 22.1% (18.2-26.5) recorded. The 90 days retrospective 

crude (CDR) and under five death rates (U5DR) of 2.15 

(1.50-2.80) and 6.16 (3.91-8.40) respectively are equally 

worrying, indicating a Very Critical situation and an increase 

from the death rates reported in July’11. The results indicate 



Executive 

30 

Figure 15: HIS Malnutrition trends in Bay Agro-pastoral 

MCHs,2010-2011 

% 

70.0 

60.0 

50.0 

40.0 

30.0 

20.0 

10.0 

0.0 



Data Source: SRCS, DMO 

that the prevalence of acute malnutrition and the rate of 

crude mortality has exceeded Famine thresholds in Bay 

Region. Morbidity levels reported in the two weeks prior 

to the assessment were high at 61.8% and immunization 

status for polio and measles and vitamin A supplementation 

is relatively very low 0.05). 

300 

No of admissions 

250 

200 

150 

100 

The key reference nutrition evidence indicators of the 

analysis on the nutrition phase classification are provided 

in Tables 10 and 11. 

50 

0 


Data Source: COOPI 

Month 



Table 11: Summary of Key Nutrition Findings in Bay Regions- July &August 2011 

Bay agro-pastoral July’11) 

(N=456;boys=233;girls=223) 

Bay agro-pastoral August’11) 

(N=489;boys=263;girls=226) 



Global Acute Malnutrition (WHO 2006) 

Boys 

55 (45.8-64) 

60.9 

Very Critical 

58.3 (52.1-64.2) 

64.6 

Very Critical 

Girls 

48.9 

50.9 

Severe Acute Malnutrition (WHO 2006) 

Boys 

29.8 (22.8-38) 

36.5 

Very Critical 

22.1 (18.2-26.5 ) 

28.5 

Very Critical 

Girls 

22.9 

14.6 

Mean WHZ (WHO, 2006) -2.07±1.15 Critical -2.10±1.13 Critical 


31 

Global Acute Malnutrition (NCHS) 54.8 (44.5-64.7) Very Critical 55.6 (49.6-61.4) Very Critical 

Severe Acute Malnutrition (NCHS) 21.2(15.6-28.1) Very Critical 12.4 ( 9.5-16.1) Very Critical 

36.1 (29.3-43.2) 


Executive 

Case study: A family staring famine in the face 

– Huddur, Bakool region 

32 

Maliya, 36, a mother of four children aged five months to six years, is a home-maker. Her husband Omar, is 

a farmer and part time housing and land broker in Huddur, Bakool Region. Until six months ago, Maliya’s 

family was contented with life as Omar was able to cover their basic needs fairly well. Following the two 

recent seasons of crop failure however, and with the restricted access of humanitarian aid into the area, life 

has become very hard. Omar’s income base has collapsed due to lack of demand for the services he provides, 

leaving the family with neither the income nor food stocks to meet basic needs. The family farm from 

which they normally produce sufficient food for own consumption, has not generated anything in the last 

two seasons due to the drought. Further, the family lost its 30 sheep and goats which provided milk that 

supplemented the family diet, and income through occasional sale of part of the stock. 

The aftermaths of the drought have therefore left 

Maliya’s family with little coping options. 

Initially, the family reduced the number of meals 

consumed daily from three to one. However as 

time passed by, they were compelled to skip a day 

or two without consuming a meal. With Maliya’s 

neighbours facing the same predicament, neither 

kinship nor social support are available option. 

Indeed many families continue to leave Huddur 

for refugee camps across the borders of Kenya and 

Ethiopia to seek support. About six months ago, 

Omar and Maliya considered taking this option, but 

were nevertheless constrained by the distance they 

needed to cover on foot due to lack of money and 

means of transport. For this reason, they resolved to 

A mud house done by Maliya to get her meal on the 

table, FSNAU August 2011. 

split the family into two, with the husband moving to Mogadishu IDP camps with the two older children, 

and Maliya remaining in Huddur with the other two. 

For the last three months, Omar has stayed in Mogadishu and managed to send back to Maliaya, some money 

which he got through casual work in Mogadishu. Unfortunately, during this period, both of his children 

with him got infected with measles, and have since succumbed to death. “Even though I am not widowed, I 

have felt the pain of being a single mother in the absence of my husband and my lost children,” cries Maliya. 

Maliya, with her youngest baby on her back survives on mudding semi-permanent houses (Cariish) at a small 

fee, though the income is not adequate for her needs. Although she received some food from the Zakat al 

Fitri at the end of the Ramadan, this lasted them only for a couple of days. She also recently received some 

assistance from agencies in the area having been identified by the drought committee as a vulnerable person 

in her section. However these are one off acts of assistance which have not been sustainable. 

Beside the sorrow from the loss of her children, Maliya additionally worries about her husband and the 

future of her remaining two children living with her in the current situation, in the event that humanitarian 

assistance does not reach them on time . 



4.4 Middle and Lower Shabelle Regions 

Middle and Lower Shabelle regions rural livelihoods 

comprise of riverine (or pure farmers) and agro-pastoralists 

(Map 8). The riverine population, located within 10 km of 

the Shabelle river cultivates maize, sesame and a variety 

of vegetables and fruits, with limited livestock holdings as 

a result of tsetse fly infestation. The agro-pastoral zone 

extends 20-40 km from the Shabelle River and incorporates 

both cultivation of crop (maize, cowpeas, sesame and fruit), 

and livestock rearing. The agricultural potential, as well as 

the labour and income opportunities in the area makes it 

a haven for seasonal casual work, and also for vulnerable 

populations in when there is a shock. The region has a high 

population density, which is further aggravated by a high 

number of IDPs as a result of the continuing civil insecurity 

in the region. 

Historical Overview - Post Deyr ‘10/11 

Food Security 

According to the FSNAU Post Deyr ’10/11 analysis, the 

food security situation in the Shabelle regions showed 

deterioration as a result of failed crop production and 

poor livestock all due to the poor Deyr rain performance. 

Consequently, in Middle Shabelle, the reported total number 

of people in crisis was estimated at 87,000 of which 17,000 

were in HE (5,000 from Central Agro-pastoral and 12,000 

from Coastal Deeh Pastoral), with an early warning level 

of Watch. The remaining 70,000 people were identified in 

AFLC (5,000 Central Agro-pastoral 12,000 Coastal Deeh, 

11,000 Riverine and 42,000 Southern Agro-pastoral) with an 

early warning level of Watch for Coastal Deeh and Moderate 

Risk to HE for other livelihoods. Most livelihoods of Lower 

Shabelle were in Borderline Food Insecure phase (BFI) with 

an early warning level of Moderate Risk to AFLC except for 

Map 8: Shabelle Livelihood Zones 

Map 11: Shabelle Livelihood Zone Map 

Southern Agro-pastoralists (Walaweyn district) which faced a 

high risk to AFLC. Similarly the food security situation in the 

urban livelihood of both regions also indicated a deterioration 

since the Gu 2010 season. Complete rainfall failure and 

the resultant poor crop production (46% and 23% of PWA 

in Middle and Lower Shabelle respectively), and increased 

cereal prices were the primary reasons for the deteriorating 

trend in the Shabelle regions. The factors that mitigated 

the situation included cash crop production, availability of 

cereal stocks in the regions and some job opportunities from 

agricultural activities for the poor and middle households. 


The post Deyr ‘10/11 integrated nutrition analysis indicated 

that the nutrition situation had significantly deteriorated in 

both the Lower Shabelle and Middle Shabelle populations 

from the previous likely Serious and Alert phases to likely 

Critical. The Alert nutrition situation in the Gu 2010 was 

attributed to previous seasons of increased access and 

consumption of milk and crops (maize rice, sesame and cow 

peas) in the agro-pastoral and riverine areas (Figure 17). 

The agro-pastoral and riverine population reported improved 

dietary diversity and access of fish, fruits and vegetables 

were reported especially among the riverine livelihood 

households. However, the nutrition situation in Adale District 

remained sustained at Critical levels with associated poor 

food security indicators. 


33 

Figure 17: Trends in Levels of Acute Malnutrition 

(WHZ

Executive 

34 

The agro-pastoral areas (Cowpea Belt) of Adale District 

and the neighbouring Adan Yabal districts, had faced 5-6 

consecutive seasonal failures with poor access to milk, 

crops and income. During the Post Deyr ‘10/11 season, 

there was no comprehensive nutrition survey conducted due 

to lack of access, therefore there was no conclusive phase 

classification for the region. However data from the health 

facility surveillance and qualitative information gathered 

depicted signs of deterioration, a likely Critical (GAM rates 

>15%) nutrition situation. The deterioration in the nutrition 

situation of the agro-pastoral and riverine populations 

of Middle Shabelle was then attributed to outbreaks of 

diseases (AWD, cholera, malaria and whooping cough), 

reduced access to food due to high food prices especially 

cereals and milk, in addition to the chronic factors including 

poor child feeding and health care practices and limited 

access to basic services. 

In Lower Shabelle region, rapid MUAC assessments 

conducted in the agro-pastoral (10 sites N=1100) and 

riverine (10 sites N=1100) livelihood zones both indicated 

MUAC 10%. HIS data also 

indicated a high (>20%) and an increasing trend in the 

number of acutely malnourished children. The data depicted 

signs of deterioration and the area was classified as likely 

Critical. The deterioration was also attributed to the high 

morbidity burden, poor dietary diversity to reduced access 

to milk and cereals. Limited interventions, social support 

and application of coping mechanisms helped to mitigate the 

situation. The historical trends in levels of acute malnutrition 

from 2007 to July 2011 is found in figure 11. 

Current Situation, Post Gu ’11 

Food Security 

The current Post Gu ’11 Integrated Phase Classification 

identifies the livelihoods in Middle and lower Shabelle 

regions are in HE and Famine. The significant food security 

deterioration in the Shabelle region is mainly attributed to 

severe food availability and access due to almost total crop 

failure and loss of livestock which is as a result of poor rain 

performance and poor irrigation due to the river level drop. 

The population in Middle and Lower Shabelle have been 

classified in 3 categories of crisis, Famine, Humanitarian 

Emergency and Acute Food and livelihood Crisis (AFLC). 

The food security situation of the urban population has 

also showed a deterioration from the previous season. 

The famine in the region was classified based on the 3 

main indicators, 20% of the population not able to access 

2,100 kcal per day, GAM rates exceeding 30% and crude 

death rate of 2/10,000/day. In Lower Shabelle and Middle 

Shabelle, the population had passed these thresholds, 

indicating a humanitarian catastrophe. 

The drought in the region had led to very poor crop 

production and massive livestock deaths, this also led to the 

mass movement of populations to Mogadishu. Poor rainfall 

performance and the consequent poor crop production (22% 

of PWA in Middle Shabelle and 37% of the PWA in Lower 

Shabelle) coupled with a high increase in cereal prices, 

minimal cereal stocks, and high cost of water and fodder 

are the main factors leading to the deterioration. Continued 

displacements and market disruptions resulting from the 

conflict in Mogadishu, further exacerbate the situation 

especially for the purchase-dependent IDPs who remain 

more highly susceptible to shocks. 


The integrated nutrition situation analysis classified the 

nutrition situation in Middle Shabelle in both the agropastoral 

and riverine livelihood zones as Very Critical. 

Comprehensive nutrition surveys were conducted among 

the two livelihood populations in July 2011, a GAM (WHZ 

score 20%) and increasing trend of 

acutely malnourished children in both the agro-pastoral and 

riverine catchment areas, both in Middle and Lower Shabelle 

regions (Figure 18). 

Figure 18: HIS Malnutrition Trends in Shabelle 

Agropastoral MCHs 2010-2011 


50 

45 

40 

35 

30 

25 

20 

15 

10 

5 

0 

2011 2010 2 per. Mov. Avg.(2011) 2 per. Mov. Avg.(2010) 


Month 

Source: COSV/MSF-S 



Table 12: Summary of Key Nutrition Findings in Middle Shabelle Region - July 2011 

M. Shabelle Riverine (N=746) 

(Boys=391 Girls=355) 

M. Shabelle Agro-pastoral (N=689) 





Boys 

Girls 


Boys 

Girls 

19.6 (16.4-23.2) 

23.6 (16.9-31.9) 

14.2 (9.3-21.2) 

8.2 (5.7-11.6) 

10.1 (5.8-17.0) 

6.8 (3.6-12.7) 

Very Critical 

Very Critical 

35.3 (24.9-47.3) 

36.7 (26.2-48.6) 

37.1 (25.2-50.8) 

17.1(10.3-27.1) 

18.3 (10.4-30.3) 

20.1 (12.6-30.4) 

Very Critical 

Very Critical 

Mean WHZ (WHO, 2006) -0.63 ±1.39 Serious -1.38 ±1.54 Very Critical 

Oedema (N=28)=3.6 (N=8)=1.3 

Global Acute Malnutrition (NCHS) 21.6 (15.0-30.0) Very Critical 36.7(25.4-49.8) Very Critical 

Severe Acute Malnutrition (NCHS) 7.4 (4.3-12.3) Very Critical 

15.3(9.4-24.0) 

Very Critical 


Table 13:Summary of Key Nutrition Findings in Lower Shabelle Region - July 2011 

Executive 

36 

L. Shabelle Agro-pastoral 

(N=799), (Boys=410 Girls=389) 

L. Shabelle Riverine 

((N=804)Boys=395 Girls=409) 

Afgoye IDPs 

(N=951; (Boys=476 Girls=475) 

Indicator Results % Outcome Results % Outcome Results % Outcome 


Global Acute Malnutrition (WHO 

2006) 

Boys 

Girls 

Severe Acute Malnutrition (WHO 

2006) 

Boys 

Girls 

40.6 (34.6-46.8) 

42.0 (35.3-49.0 

39.1 (32.1-46.5) 

20.9 (16.2-26.5) 

22.0 (16.8-28.2) 

19.8 (14.5-26.5) 

Very Critical 

Very Critical 

28.7 (24.4-33.5) 

31.1 (24.7-38.4) 

26.4 (21.5-32.0) 

14.2 (11.6-17.3) 

15.7 (11.4-21.2) 

12.7 (9.5-16.8) 

Very Critical 

Very Critical 

40.7 (34.5-47.2) 

42.9 (35.8-50.2) 

38.5 (32.1-45.4) 

17.7 (13.4-22.9) 

21.4 (16.8-26.9) 

13.9 (9.7-19.5) 

Very Critical 

Very Critical 

Mean WHZ (WHO, 2006) -1.53 ± 1.40 Very Critical -1.22 ±1.29 Very Critical -1.67 ±1.30 Very Critical 

Oedema (N=32)= 4.0 (N=29)=3.6 (N=8)=0.8 

Global Acute Malnutrition (NCHS) 39.2 (33.1-45.6) Very Critical 29.2(25.2-33.7) Very Critical 38.8 (32.5-45.4 Very Critical 

Severe Acute Malnutrition (NCHS) 14.0 (10.3-18.7) Very Critical 10.2 ( 8.1-12.9) Very Critical 11.6 (8.1-16.5) Very Critical 


Afgoye IDPs 

The nutrition situation of the Afgoye IDPs remained classified 

as Very Critical, however a significant deterioration 

has been observed. A nutrition assessment conducted 

among the IDP populations along the Afgoye corridor in 

July 2011 reported a GAM (WHZ score

Table 14:Summary of Key Nutrition Findings in Mogadishu Town and IDPs - April - August 2011 

Executive 

38 

Mogadishu Town 

April 2011 

(N=902; Boys=451 Girls=451) 



(N=870; Boys=430 Girls=440) 


August 2011 

(N=544; Boys=279 Girls =265) 




Boys 

Girls 


Boys 

Girls 

15.2(10.9-20.7) 

15.7 (11.5-21.2) 

14.6 (9.6-21.6) 

1.7(0.9-3.1) 

1.3 (0.6-3.2) 

2.0 (0.9-4.4) 

Critical 

Alert 

39.4 (32.4-46.9) 

41.6 (33.7-50.0) 

37.3 (30.1-45.1) 

15.3(11.6-19.8) 

17.7 (13.0-23.6) 

13.0 (9.5-17.4) 

Very Critical 

Very Critical 

45.6 (40.5-50.8) 

47.3 (40.5-54.2) 

43.8 (36.9-50.9) 

23.0 (19.2-27.2) 

25.4 (19.3-32.7) 

20.4 (15.6-26.2) 

Very Critical 

Very Critical 

Mean WHZ (WHO, 2006) -0.77 ±1.12 Critical -1.61 ±1.25 Very Critical -1.90 ± 1.33 Very Critical 

Oedema (N=1)=0.1 (N=9)=1.0 (N=2)=0.4 

Global Acute Malnutrition (NCHS) 13.1(9.3-18.2) Serious 36.3 (28.9-44.4) Very Critical 43.6 (38.3-49.0) Very Critical 

Severe Acute Malnutrition (NCHS) 0.8 (0.3-2.0) Alert 10.1 (7.0-14.4) Very Critical 13.7 (10.6-17.6) Very Critical 

Proportion with MUAC (

The Nutrition Situation of the Rural Shabelle Regions from February 2007 to July 2011 

This article looks back at the nutrition situation since February 2007, to better understand the factors leading to the current Very 

Critical/ Famine thresholds of nutrition situation, that can be described as a humanitarian catastrophe. Prior to February 2007, the 

nutrition situation in the rural livelihoods of the Shabelle regions was not of concern. As a matter of fact, it was perceived to be in the 

Alert phase, reflecting one of the best in cases in the entire country. Nutrition data collected primarily from health centers and sentinel 

sites up to December 2006 indicated low numbers with a stable trend of acutely malnourished children. Currently, the nutrition situation 

in the Shabelle region is Very Critical, the worst situation reported in the region, with GAM rates ranging between 19.6%-40.6%, and 

appalling SAM rates ranging from 8.2%-20.9%. Additionally, crude death rates reach famine thresholds of >2/10,000/day. 


39 

Year/ 

Season 


Situation 

Gu 2007 Deyr ‘07/08 Gu 2008 Deyr ‘08/09 Gu 2009 Deyr ‘09/10 Gu 2010 Deyr ‘10/11 Gu 2011 

Critical 

All regions 

Critical 

Agro-pastoral 

Serious 

Riverine 

Critical 

Agropastoral 

Serious 

Riverine 

Serious 

All regions 

Critical 

Agro-pastoral 

Serious 

Riverine 

Serious 

Middle 

Shabelle 

Likely 

Serious 

Lower 

Shabelle 

Alert 

Middle Shabelle 

Adale District 

Hot spot Critical 


(Lower Shabelle) 

Likely 

Critical - Hot 

spot for 

Concern 

Likely 

Deterioration 

All regions 

A look back at available 

historical nutrition 

data indicates that the 

nutrition situation in 

Shabelle regions started 

deteriorating from 

February 2007, and 

remains considerably 

fluid, except for slight improvement in the Gu (April-June) 2010 season. The Gu 2010 season illustrated positive food security indicators 

and fewer disease outbreaks. Unfortunately, by the Deyr (September-December) ‘10/11, the likelihood of a deterioration in the nutrition 

situation of the population was imminent. Although slight improvement had been noted in the previous season, inadequate measures 

were in place to mitigate the population from possible recurrent shocks, leaving the population highly vulnerable. Subsequent seasons 

were characterized by poor household food security due to poor rainfall performance and crop production, high cereal prices and 

lack of adequate labor opportunities. Additionally, there were disease outbreaks (measles, AWD, whooping cough and malaria), 

and limited humanitarian interventions in the area following withdrawal of some of the aid agencies from the region. This led to the 

overall decline of the nutrition situation, erasing all gains made during the Gu 2010 season. The table below illustrates the nutrition 

situation in the Shabelle region from Gu 2007, to date, what is evident is that the nutrition situation of the Shabelle region has remained 

worrying since the Gu 2007. 

In the Deyr ’06/07 pockets of nutritional concern were reported in Adale and Jowhar 

towns and Galigudud, Moiko villages following a rapid MUAC assessment. This was 

mainly associated with the effects of the Deyr ‘06/07 floods which exposed the population 

to water borne diseases such as AWD, and resulted in loss of crop. In addition, sharp rates 

of inflation in food and non food items and disruptions in trade and economic activities, 

and a high and increasing concentration of displaced populations fleeing civil conflict in 

Mogadishu, resulted in a sudden onset Humanitarian Emergency affecting more than 30% 

of the population. By February 2007 the cumulative effects of the failed harvest and the 

sudden large displacement of people in the affected areas of Shabelle region exacerbated the 

situation. The post Gu 2007 integrated nutrition situation analysis, classified the nutrition 

Very 

Critical 

All regions 

Did the present major deterioration 

of the nutrition situation in the 

Shabelle regions occur in just one 

or two seasons preceding the Gu 

2011 season, or was it a progressive 

deterioration due to the inability of 

the population to handle cumulative 

shocks affecting the population since 

February 2007 

situation of the Shabelle population as Critical with GAM rates of 17.0% and 17.3% and SAM rate- 4.8% and 4.3% among the riverine 

and agro-pastoral populations respectively. Data from health facilities at the time indicated low but increasing trends of acutely 

malnourished children, as well as increasing incidences of seasonal diseases. In addition to the precarious food security situation at 

the time, the worrying nutrition situation was also attributed to the high civil insecurity that resulted in disrupted livelihoods and 

limited humanitarian access in addition to disease outbreaks. Rapid MUAC (

Executive 

40 

• humanitarian interventions which started after the Gu 2008 season, and mainly comprised of cash and food distributions 

• favorable off season crop harvests. 

Nonetheless, the population remained vulnerable because of high morbidity rates and persistent civil insecurity in the region. As 

a result, the situation deteriorated the following season. Nutrition surveys conducted during the Gu 2009 season classified the 

Shabelle nutrition situation as Critical (GAM- 19.6% (14.6-29.9 SAM- 8.2 (5.7-11.6) among the agro-pastoral population, whilst the 

Riverine population remained in a sustained Serious (GAM- 10.3% (5.4-15.3) SAM- 2.0% (0.1-3.9) nutrition situation. In the following 

Deyr ‘09/10 season, FSNAU was unable to conduct comprehensive nutrition surveys in Lower Shabelle region because of security 

constrains. Nutrition surveys were only conducted among the agro-pastoral and riverine populations of Middle Shabelle region. The 

results of the surveys indicated a Serious nutrition situation in Middle Shabelle Agro-pastoralists with GAM of 12.5% and SAM of 

3.5%, and riverine with GAM of 11.6% and SAM of 4.2%. In Lower Shabelle, integrated analysis of findings from the rapid MUAC 

assessments and data from the health facilities depict a likely Serious. 

In the Gu 2010 season, the nutrition situation in Middle Shabelle improved. Nutrition assessments findings indicated an Alert phase 

with GAM >6.2% and SAM >1.7% (Pr=0.9). In Adale district however, the situation was Critical based on GAM of 16.8% (12.9- 

20.7) and SAM of 2.4% (0.9-3.9). There was still no access to conduct surveys in Lower Shabelle region, however, rapid MUAC 

assessments classified the nutrition situation as sustained likely Serious. The improved 

nutrition situation in Middle Shabelle was mainly attributed to an improved diet following 

increased access to milk and food crops (maize, rice, sesame and cow peas). In addition, no 

disease outbreaks were reported at the time. The area had reverted to the general nutrition 

situation it was known as before the 2007 civil conflict and subsequent humanitarian 

crisis. However, the situation in Adale district was different, a nutrition survey in the 

district indicated the nutrition situation had remained Critical, mainly attributed to 

negative food security indicators. The 5-6 consecutive seasons of poor rainfall in the 

district resulted in reduced access to milk, crops and household income. In Lower Shabelle, 

access remained a major challenge, results from rapid MUAC assessments conducted in 

addition to data analyzed from health facilities indicating a likely Serious phase. 

Security restrictions persisted in the Deyr ‘10/11 season, however according to data from rapid MUAC assessments conducted in 

December 2010, indications of an extreme deterioration in the nutrition situation in the Shabelle regions began emerging. The 

results indicated a likely Very Critical nutrition situation among all the livelihood populations in the Shabelle regions (MUAC 20%). Data from the health facilities also indicated a high and increasing trend of acutely malnourished children. Although the 

reliability of the data was low, insufficient data to make a conclusive classification on the nutrition situation, Shabelle regions was 

highlighted as a hotspot for concern, with a high likelihood that the nutrition situation had deteriorated. Consequently in February 

2011, a rapid MUAC assessment was conducted in the region, and indicated a likely Very Critical nutrition situation with MUAC 

4.5 Hiran Region 

Hiran region comprises of three main livelihood groups: 

the Pastoral (Southern Inland and Hawd pastoral) covering 

Mataban and Mahas districts; and the Agro-pastoral and 

Riverine livelihood systems, both of which cut across 

Beletweyne, Buloburti and Jalalaqsi districts. (Map 9). Like 

many other regions in South Central Somalia, Hiran region 

has not escaped the effects of high intensity civil conflict, 

which has affected people’s means of livelihood. Intermittent 

localised civil conflict, as well as the targeting of aid workers 

in the region, has continued to hinder humanitarian access. 

Map 9: Hiran Region Livelihood Zones 


41 

Historical Overview - Post Deyr ’10/11 

Food security 

The food security situation in Hiran region continued to show 

deterioration during the Deyr ‘10/11 season. All livelihoods 

were identified to be in Humanitarian Emergency (HE), 

with an early level warning of Watch. The post Deyr ‘10/11 

food security analysis estimated 195,000 people to be in 

crisis, approximately 67 percent were in HE and the rest in 

AFLC. The agropastoral livelihood was the worst affected 

with 125,000 people in crisis, followed by the riverine with 

30,000. The situation in the urban areas also deteriorated 

with 35,000 identified to be in crisis (HE and AFLC). The 

deteriorating food security situation was mainly attributed 

to poor rainfall performance resulting in cereal crop failure 

and poor livestock body conditions due to the considerable 

deterioration of pasture and browse which consequently 

affected the household income and food security. The 

reduced levels of social support, high cereal prices, 

reduced livestock herd size and widespread civil insecurity 

and increasing number of IDPs further aggravated the crisis 

in the region. 


In the Deyr ‘10/11 season, FSNAU staff were unable 

to travel and conduct comprehensive nutrition surveys, 

however rapid MUAC assessments conducted in 10 villages 

each among the agro-pastoral and riverine populations 

respectively reported a high proportion >15% of children 

with (MUAC,12.5 cm or oedema) indicating a likely Very 

Critical nutrition situation in the region. In the pastoral 

population, 14.7% of children reported MUAC levels

Executive 

42 


In the Gu 2011 season, three comprehensive nutrition 

surveys were conducted in the Hiran region among the 

pastoral, agropastoral and riverine livelihoods, unlike 

in previous seasons where they relied on rapid MUAC 

assessments. The results of the survey indicate GAM 

rates >20% for all the Hiran livelihood zones, the agropastoral 

population being the hardest hit with a GAM 

of >40%. Data from the HIS facilities in the region also 

indicates high numbers (>20%) and increasing trend of 

acutely malnourished children. Information from feeding 

centres 1 in the area also report an increasing number of 

admissions from January to date. This analysis indicates 

a sustained Very Critical nutrition situation in the entire 

region. The results from the July surveys conducted in Gu 

season indicated a GAM (WHZ Score

Table 15: Summary of Key Nutrition Findings in Hiran Region, July - August 2011 

Hiran Pastoral (N=444) 


Hiran Pastoral (N=315) 


Hiran Riverine (N=570) 


Hiran Riverine (N=401) 


July 2011 August 2011 July 2011 August 2011 

Indicator Results % Outcome Results % Outcome Results % Outcome Results % Outcome 

Child Nutrition Status - - - - - - 

Global Acute 

27.3(24.2-30.6) 

Malnutrition (WHZ

Table 16: Summary of Key Nutrition Findings in Hiran Region (Agro-pastoral) July - August 2011 

Executive 

Hiran Agro-pastoral (N=535) 


July 2011 August 2011 

Hiran Agro-pastoral (N=362) 



44 



) Boys 

Girls 

43.2 (37.7-48.9) 

51.1 (45.0-57.1) 

32.5 (25.6-40.3) 

Very Critical 

44.8 (38.9-50.8) 

57.1 (48.4-65.5) 

32.2 (25.8-39.4) 

Very Critical 

Severe Acute Malnutrition (WHO 2006 

) Boys 

Girls 

16.3 (13.4-19.6) 

20.3 (16.5-24.7) 

11.4 (7.8-16.3) 

Very Critical 

17.7 (14.1-22.0) 

22.5 (17.6-28.4) 

12.8 (8.5-18.8) 

Very Critical 

Mean WHZ (WHO, 2006) -1.66 ±1.08 Very Critical -1.73 ± 1.28 Very Critical 

Oedema (N=1)= 0.2 (N=1)=0.3 

Global Acute Malnutrition (NCHS) 43.6(38.1-49.3) Very Critical 44.6 (38.5-51.0) Very Critical 

Severe Acute Malnutrition (NCHS) 10.5(8.0-13.8) Very Critical 

10.2 (7.8-13.2) 

Very Critical 

Global Acute Malnutrition by MUAC (

4.6 Central Somalia: Galgadud and Mudug 

regions 

Central Somalia comprises of two regions, Galgadud 

and South Mudug. There are four main livelihood zones, 

namely the purely pastoral Addun and Hawd; the fishing and 

pastoral Coastal Deeh and the agro-pastoral Cowpea Belt. 

The Hawd and Addun pastoral livelihoods extend across 

Galgadud, Mudug and southern Nugal regions, while the 

Coastal Deeh extends from the coast of Shabelle through 

Galgadud up to Allula, cutting across the South, Central 

and Northeast zones (Map 10). This section will discuss 

the nutrition situation of the agro-pastoral Cowpea belt and 

Coastal Deeh of Central regions. The Hawd and Addun 

pastoral livelihood zones will be discussed together with the 

other Livelihood zones in the northeast zone. 

Historical Overview - Post Deyr ’10/11 

Food Security 

The FSNAU Post Deyr ’10/11 analysis placed the food 

security situation of Central regions of Somalia in 

Humanitarian Emergency(HE) for the seventh consecutive 

season. The situation deteriorated further in Addun, Coastal 

Deeh and Cowpea Belt livelihoods of Central regions due to 

significant loss of livestock, increased cereal prices following 

poor rainfall performances, in addition to widespread 

civil insecurity, limited humanitarian access and trade 

disruption. Then, 253,000 people in rural and urban areas 

were classified in AFLC, while 131,000 were in HE of whom 

25,000 were pastoral destitute. The proportion of people in 

HE had increased slightly from 25% of the total population of 

Central in Gu ’10 to 28% in Deyr ‘10/11, indicating increased 

severity of the crisis in central Somalia. The number of 

people in crisis also increased by 16% in urban areas from 

43,000 in Gu ’10 to 50,000 in Deyr ‘10/11. Most pastoralists 

in central regions experienced severe water shortages and 

poor pasture conditions, which resulted in poor livestock 

body condition; low conception level and high livestock 

deaths especially in Coastal Deeh and Cowpea Belt agropastoral 

livelihood zones. For instance, the goat prices 

increased by 5% in December,2010 compared to same time 

the previous year due to the low market supply, although 

the ToT between local goat and rice declined slightly by 5% 

due to increase (11%) in rice price in the same period. The 

ToT between labour and cereal also declined both for rice 

and for sorghum due to declining labour wage rates (7%) 

and increased cereal prices then. 


The Post Deyr ‘10/11 integrated nutrition analysis showed 

that the nutrition situation of the Addun and Hawd pastoral 

population in Central and Northeast regions improved 

from the Very Critical and Critical situation respectively in 

the Gu ’10 to a Serious situation, while the Cowpea Belt 

Map 10: Central regions Livelihood Zones 

agro-pastoral livelihood zone remained in a sustained likely 

Critical phase. The apparent improvement then was mainly 

attributed to the impacts of the favourable rains the previous 

Gu ‘10 in the livelihood and humanitarian interventions. 

The nutrition situation of the Coastal Deeh livelihood zone 

however, deteriorated from Serious in Post Gu ’10 to Critical. 

Current Situation- Post Gu ’11 

Food Security 

The FSNAU Post Gu ’11 analysis classifies the Hawd and 

most parts of Addun of Central regions of Somalia in AFLC. 

The rest of the parts of central regions remain in HE for the 

eighth consecutive season. The situation has deteriorated 

in Coastal Deeh and Cowpea Belt livelihoods of Central 

regions due to significant loss of livestock, increased cereal 

prices following poor rainfall performances, poor cowpea 

production due to pests, crop diseases and successive 

poor rainfall in addition to wide spread civil insecurity, 

limited humanitarian access and trade disruption. Currently, 

250,000 people in the rural central population are in crisis, of 

whom 120,000 are in HE. Additionally, 60,000 people in the 

urban Central regions of Mudug and Galgadud are in crisis 

(10,000 in AFLC and 50,000 in HE) constituting 47% of the 

total Central population in crisis. The Central regions have 

experienced increased civil conflict and together with the 

effects of drought have led to increased pastoral destitution, 

and limited humanitarian access especially in Haradhere, 

Eldheer, and Elbur districts. 


The current Post Gu ‘11 integrated nutrition analysis depicts 

either worsening or sustained nutrition situation in all the 

livelihood zones compared to the Deyr ‘10/11 season. The 

nutrition situation remains stable at Serious for the Hawd 

pastoral livelihood. The populations of the Addun and 

Coastal Deeh livelihood zones are all classified in Critical 

nutrition situation, showing a deterioration from Serious in 

the previous season. These deteriorations are predominantly 


45 



Executive 

46 

linked to the limited access to milk, poor dietary diversity 

and disease outbreaks confirmed in these areas, and 

the effects of consecutive poor seasonal performance in 

most livelihood zones as discussed in sections under the 

Northeast livelihoods. The nutrition situation of the cowpea 

agro-pastoral livelihood is in a sustained likely Critical phase 

while the situation has further deteriorated in Coastal Deeh 

of Central regions and is likely Very Critical, from Critical 

levels in Deyr ‘10/11 and Serious levels in Gu ’10. Dusamareb 

IDPs are in a Very Critical nutrition phase. 

Gender: In the Hawd and Addun nutrition assessments 

conducted in the Galgadud and Mudug regions of 

Somalia, a higher proportion of boys than girls are acutely 

malnourished, however, there is no statistical significant 

(Pr10%) and fluctuating trends 

(Jan-July ’11). 

In the July 2011 Addun assessment, the GAM rate was 17.8% 

(13.3-23.6) and the SAM rate was 4.1% (2.5-6.7) with two 

(0.3%) oedema cases reported indicating a Critical nutrition 

situation and a deterioration from the respective GAM and 

SAM rates of 11% (7.7- 15.5) and 2.5% (1.3- 5.1) recorded in 

November 2010. Though not statistically significant, a higher 

number of boys (21.3%) than girls (14.5%) were acutely 

malnourished. The retrospective CDR and U5DR rates are 

0.56 (0.34-0.91) and 1.92 (1.02-3.59) both indicating Alert 

levels. The deaths are also reportedly mainly attributed to 

diarrhoea and measles, and consistent with the outbreaks 

of measles and AWD reported in the area and with high 

morbidity reported from the health facilities. Data from health 

facilities in the Addun pastoral livelihood zone reported a 

high (>15%) and sharply increasing proportion of acutely 

malnourished children (Figure 19) 

Figure 19: HIS Malnutrition Trends in Shabelle 

Agropastoral MCHs 2010-2011 

50 

45 

2011 2010 2 per. Mov. Avg.(2011) 2 per. Mov. Avg.(2010) 

The detailed results of assessments in all the livelihoods 

transcending the Central and NE regions including the Hawd 

and Addun are discussed in the in the sections that follow. 

The results of the key findings are summarized in Table 17. 


40 

35 

30 

25 

20 

15 

10 


conducted in Hawd and Addun Livelihood zones in the 

northeast (Nugal) and central (Mudug and Galgadud) 

regions in July 2011, health and feeding facilities’ information 

shows sustained Serious situation, and deterioration to 

Critical from the Serious levels in Deyr ’10/11 in the Addun 

pastoral livelihood. The nutrition assessment in the Hawd 

reported a GAM rate of 14.4% (10.9-18.8) and a SAM rate of 

3.8 % (2.4-6.0) including three (0.5%) oedema cases. Boys 

(14.6%) and girls (14.2%) were equally affected (Pr

Table 17: Summary of Key Nutrition Findings in Hawd, Addun and Coastal Deeh Northeast Regions July 2011 

Hawd 

(N=576: 309 boys; 267 girls) 

Addun 

(N=583: 286 boys; 297 girls) 

Dusamareb IDPs 

(N=198: 95 boys; 103 girls) 




Boys 

Girls 


Boys 

Girls 

14.4 (10.9-18.8) 

14.6 

14.2 

3.8 (2.4-6.0) 

4.9 

2.6 

Serious 

Alert 

17.8 (13.3-23.6) 

21.3 

14.5 

4.1 (2.5-6.7) 

6.3 

2.0 

Critical 

Alert 

>34.0 (Pr=0.90) 

Very 

>36.9 (Pr=0.90) 

Critical 

>28.5 (Pr=0.90) 

>6.2 (Pr=0.90) 

>7.9 (Pr=0.90) Critical 

>3.1 (Pr=0.90) 

Mean WHZ (WHO, 2006) -0.87±1.11 Serious -0.91±1.20 Serious -1.56±1.19 Critical 

Global Acute Malnutrition (NCHS) 13.7 (10.4-17.8) Serious 18.0 (13.9-23.1) Serious - 

Severe Acute Malnutrition (NCHS) 2.1 (1.0-4.4) 1.5 (0.7-3.5) - 

Proportion with MUAC 21.3 (Pr=0.90) 

Very 

Boys 

6.1 

Serious 8.0 

Serious >14.5 (Pr=0.90) 

Critical 

Girls 

5.6 

7.4 

>24.6 (Pr=0.90) 


Stunting (HAZ30.2 (Pr=0.90) 

Acceptable >29.0 (Pr=0.90) 

>27.6 (Pr=0.90) 

Alert 

>39.9 (Pr=0.90) 

>40.0 (Pr=0.90) 

>36.5 (Pr=0.90) 

Critical N/A - 

Proportion of acutely malnourished registered in SFs 12.0 2.9 N/A 

Child Morbidity & Immunization 

Outbreak –AWD 

and measles 

Critical 

Infant and Young child feeding N=182 N=209 

Proportion still breastfeeding 

Boys - 

Girls - 

Proportion meeting recommended feeding frequencies 

Boys - 

Girls - 

Proportion who reported to have consumed

Executive 

48 

Dusamareb IDPs 

In July 2011, FSNAU conducted a small sample cluster 

survey among IDPs in Dusamareb, including Guriel area 

who have been displaced from South Somalia or pastoral 

destitute from the Central pastoral livelihood zones. The 

GAM and SAM rates of >34.0% (Pr=0.90) and >0.6.2% 

were reported indicating a Very Critical Nutrition Situation 

(Table 12). The 90 days retrospective CDR and U5DR were 

1.85 (1.35-2.34) and 6.57 (4.89-8.26) indicating serious and 

critical levels respectively, according to FSNAU Nutrition 

Situation Classification Framework. This population 

subgroup and many others cropping up in many other 

towns in the Central regions are vulnerable to nutrition, food 

security and other health problems, and require immediate 

interventions. 

The Cowpea Belt Agro-pastoral Livelihood Zone 

The rapid MUAC assessment conducted in July 2011 among 

755 children aged 6-59 months from seven accessible 

villages in the cowpea belt reported acute malnutrition 

(MUAC

Table 18: Summary of Key Nutrition Findings in Cowpea Belt Agro-pastoral and Coastal Deeh Livelihood zones 

of Central Region July 2011 

Cowpea Belt 

(N=755: 369 boys; 386 girls) 

Coastal Deeh 

(N=427: 201 boys; 222 girls) 




Proportion with MUAC (

4.7 Northeast Regions 

Map 11: Northeast Livelihood Zones 

Executive 

50 

The Northeast regions are predominately pastoral with 

seven livelihood zones namely; the Hawd, Addun, Coastal 

Deeh, East Golis, Kakaar/Dharoor Valley, Nugal Valley 

and Sool Plateau. The Hawd and Addun cut across the 

Northeast and Central regions and the East Golis, Sool 

and Nugal valley livelihoods cut across the NE and NW 

regions. (Map 11). 

Historical Overview – Deyr’10/11 

50 

Food Security 

The FSNAU Post Deyr’10/11 integrated food security 

analysis classified the Nugal Valley, East Golis/ Karkaar/ 

Dharoor Valley and Sool Plateau livelihood zones of Bari 

and Nugal regions in sustained AFLC, with high risk to HE, 

indicating a deterioration then from AFLC with moderate risk 

in the previous Gu’10, after experiencing three successive 

seasons of poor rainfall. The Hawd and Addun pastoral 

livelihoods in Nugal and northern Mudug regions remained 

in HE since Deyr ’09/10. There was a significant deterioration 

in the Coastal Deeh of Bari, Nugal and north Mudug regions 

where the population in crisis more than doubled (233% 

increase), with a significant increase of both people in HE 

and AFLC as a result of water shortages, poor rangeland 

conditions and collapsed fishing activities. East Golis of 

Bari region was classified in sustained AFLC with moderate 

risk to HE after the area experienced a third consecutive 

rain failure and reduced frankincense production. The total 

rural population in crisis in Bari, Nugal and northern Mudug 

regions then was estimated at 220,000, of which 9,000 were 

rural destitute and 90,000 were urban. Of the total population 

in crisis then, 190,000 (86%) were in AFLC and 30,000 (14%) 

were in Humanitarian Emergency. 


The Post Deyr ‘10/11 integrated nutrition situation analysis 

indicated an improved nutrition situation in most of the 

livelihood zones compared to the Gu ‘10 season. The 

nutrition situation remained stable at Alert for the Sool 

Plateau and at Serious for the Coastal Deeh livelihood 

zone. The populations of the Hawd and Addun livelihood 

zones showed an improvement from Critical and Very 

Critical respectively to Serious for both livelihoods. The East 

Golis/Karkaar/ Dharoor pastoral population also improved 

from Critical in the previous Gu ’10 season to Serious. A 

deterioration was noted then in the Nugal valley livelihood 

zone where the situation was classified as Serious compared 

to the Alert phase reported in Gu’10. The deteriorations were 

predominantly linked to the abnormal migration resulting in 

family splitting and limited milk availability at the household 

level in the area. The nutrition situation of the IDPs from 

Bossaso was classified as Critical, which illustrated an 

improvement from Very Critical in the Post Gu’10. The 

nutrition situation of the IDPs from Garowe remained 

unchanged at Serious, while the IDPs from Qardho, 

assessed for the first time then, was classified as Serious. 

Current Situation 

Food Security 

The current FSNAU Post Gu’11 integrated food security 

analysis has classified the East Golis/ Karkaar/Dharoor 

Valley in sustained AFLC. The Sool Plateau and Nugal valley 

livelihood zones of Bari and Nugal regions also remain in 

AFLC. The Coastal Deeh livelihood zone which showed 

deterioration from AFLC in the previous season to HE in Deyr 

‘10/11 is classified in a sustained HE. The Hawd and Addun 

Figure 22: Trends in levels of acute malnutrition (WHZ

pastoral livelihoods in Nugal and northern Mudug regions 

that were classified in HE since Deyr ’09/10 are currently 

classified in AFLC, not necessarily due to an improvement 

but because of change in methodology that requires at least 

20% of the population’s targeted wealth group to fall in a 

particular phase. In Addun pastoral livelihood for instance, 

the population in crisis has reduced slightly from 41,000 

(33,000 in AFLC and 8,000 in HE) in Deyr ‘10/11 to 26,000 

(15,000 in AFLC and 11,000 in HE). The Hawd pastoral 

livelihood has however shown a significant decrease in the 

number of people in crisis from 29,000 (21,000 in AFLC and 

8,000 in HE) to 28,000, currently facing AFLC.. Although 

the food security outcomes have improved for the camel 

pastoralists of Hawd and Addun livelihood zones, there are 

persistent deteriorations among the coastal pastoralists 

and other small ruminant pastoralists who have lost most of 

their livestock. Aggravating factors include reduced fishing 

opportunities in the coastal regions, deteriorated rangeland 

and water conditions in the Coastal Deeh, East Golis and 

parts of Addun that received below normal Gu ’11 rains, 

increased food prices in all the livelihoods and widespread 

livestock losses leading to increased destitution, and 

indebtedness. There is however relative peace and easy 

humanitarian access, improved frankincense production in 

the East Golis livelihood as well as improved livestock body 

condition in the Hawd, Sool and parts of Addun that would 

have mitigated the food security situation. 


The Post Gu ‘11 nutrition situation depicts a deteriorated 

nutrition situation in most of the livelihood zones compared 

to the Deyr ‘10/11 season and a sustained situation in two of 

the livelihood zones. The nutrition situation remains stable 

at Serious for the East Golis/Karkar and Hawd pastoral 

livelihoods but with a potential to deteriorate amidst the 

impact of measles, acute watery diarrhoea and cholera 

outbreaks as well as deteriorating food security indicators. 

The populations of Sool plateau, Addun, and Coastal 

Deeh livelihood zones are all classified in Critical nutrition 

phase, showing a deterioration from Alert for Sool plateau, 

and Serious for both Addun and Coastal Deeh pastoral 

population in the previous season. A notable deterioration 

is recorded in the Nugal Valley livelihood zone where the 

situation is classified as Very Critical compared to the 

Serious phase reported in the Gu’10. These deteriorations 

are predominantly linked to the limited access to milk, and 

poor dietary diversity following the effects of consecutive 

poor seasonal performance in most livelihood zones. 

Additionally, disease outbreaks such as AWD and measles, 

were confirmed in these areas by WHO/MOH. The nutrition 

situation is Very Critical for all the IDPs in the Northeast 

and Central regions. 

The nutrition situation among IDPs deteriorated to Critical 

in Bossaso and Galkayo from Serious in Qardho, and 

Garowe in the Post Deyr’10/11. The nutrition situation of 

the IDPs from Margaga, assessed for the first time, is also 

classified as Very Critical. The results are consistent with 

historical data on nutrition surveys conducted among the 

IDP population in the northeast region, which highlights the 

chronic nutritional vulnerabilities. 

Gender: With the exception of Margaga and Garowe IDPs, 

where there is statistical significance, analysis of findings 

from the nutrition assessments conducted in the northeast 

regions of Somalia indicates a higher proportion of boys 

than girls as acutely malnourished, however, there is no 

statistical significance (Pr

Executive 

52 

assessment indicate an Alert situation according to WHO 

classification and deterioration from the Acceptable levels 

of 0.13 (0.05-0.42) and 0.30 (0.51-2.99) of CDR and U5DR 

respectively reported in the December 2010 assessment 

(Table 19). 

Data from the health facilities namely Ufeyn, Waaciye and 

Iskushuban indicate a deterioration with high proportion 

(>15%) of acutely malnourished children and increasing trend 

in four (Mar-Jun ’11) months (Figure 23). 

Figure 23: HIS Malnutrition Trends in Golis/ Karkaar 

LZ (2010-2011) 

Proportion acutely malnourished (%) 

30.0 

25.0 

20.0 

15.0 

10.0 

5.0 

0.0 



Month 

Data Source: MoH; SRCS 

Considering these HIS trends, and the measles outbreak, 

together with worsening food security indicators, the nutrition 

situation among East Golis livelihood population has the 

potential to deteriorate. The population remains vulnerable 

to natural shocks and require close monitoring and the need 

to address the chronic issues affecting the nutrition status 

of the population such as inadequate health and sanitation 

facilities, poor child feeding and care practices and lack 

of adequate safe drinking water, besides the emergency 

interventions aimed at rehabilitating the acutely malnourished 

children is a priority. 

Sool Plateau Livelihood Zone of Northeast 

The nutrition situation of the Sool Plateau of Bari and Nugal 

regions has deteriorated to Critical from the Alert levels 

reported during the post Deyr ‘10/11 integrated nutrition 

analysis. Results from the nutrition survey conducted in July 

2011 report a GAM rate of 15.9% (13.6-18.4), and a SAM rate 

of 4.0% (2.9-5.4), both rates worsening from the December 

2010 GAM and SAM rates of 8.3% (6.0-11.4) and 1.6% (0.8- 

3.1) respectively. Significantly more boys (17.8%) than girls 

(13.7%) were acutely malnourished, a trend observed in 

many assessments in Somalia and the reasons that are yet 

to be investigated though likely linked to the WHO growth 

standards. Data from health information systems (HIS) in 

the area recorded low numbers (

Table 19: Summary of Key Nutrition Findings in Northeast Regions July 2011 

East Golis/Karakaar Livelihood 

Zone 

(N=727: 373 boys; 353girls) 

Sool Plateau Livelihood Zone 

(N=629:337 boys; 292 girls) 

Nugal Valley Livelihood Zone 

(N=582: 307 boys; 275 girls) 

Indicator Results (%) Outcome Results (%) Outcome Results (%) Outcome 



Boys 

Girls 


Boys 

Girls 

12.7 (8.5-16.9) 

12.8 (5.6-20.0) 

12.5 (5.2-20.2) 

1.1 (0.0-2.7) 

1.6 (0.0-3.3) 

0.5 (0.0-1.3) 

Serious 

Acceptable 

15.9 (13.6-18.4) 

17.8 (13.7-22.8) 

13.7 (10.4-17.8) 

4.0 (2.9-5.4) 

4.7 (2.9-7.7) 

3.1 (1.5-6.4) 

Critical 

Alert 

23.2 (18.9-28.20 

25.1 (19.2-32.1) 

21.1(16.2-27.0) 

6.7 (4.4-9.6) 

8.5(5.5-12.9) 

4.7(2.6-8.5) 

Mean WHZ (WHO, 2006) -1.03 Critical -0.73 Serious -1.09±1.18 Alert 

Very Critical 

Critical 


53 

Global Acute Malnutrition (NCHS) 12.5 (4.9-20.0) Serious 15.9 (9.1-14.5) Critical 22.2 (18.2-26.7) V. Critical 

Severe Acute Malnutrition (NCHS) 1.7 (0.0-3.7) Acceptable 2.4 (1.5-3.8) Acceptable 4.8 (3.2-7.1) Serious 


Executive 

54 

A supplementation status, poor water and sanitation and 

limited health facilities accessible to the community. 

Less than 30% of the households reportedly have access to 

sanitation facilities and nearly the entire community (>95%) 

do not have safe drinking water. Therefore, the population 

groups in this livelihood zone needs urgent nutrition and 

livelihood interventions with close monitoring especially in 

light of the worsening food security situation in the area. 

The key findings for East Golis, Sool and Nugal livelihood 

zones are summarized in Table 19. 

Coastal Deeh Livelihood Zone of Northeast 

The nutrition situation of the Coastal Deeh populations 

of the Nugal, Bari and Mudug regions has deteriorated to 

Critical levels according to Post Gu ’11 integrated nutrition 

analysis from Serious in Deyr ’10/11. High morbidity rates 

including measles and AWD outbreak, and a precarious 

food security situation with significant livestock deaths, are 

the main factors attributed to the poor nutrition situation 

affecting the coastal livelihood. 

A nutrition survey conducted in July 2011, reported a GAM 

rate of 17.4 %(13.8-21.6) and SAM rate of 4.2% (2.7-6.4), 

including two (0.3%) oedema cases and indicating a Critical 

nutrition situation. These results are a deterioration from 

the levels recorded in November 2010 when a GAM rate 

of 12.5 % (10.5-14.9) and SAM rate of 2.8% (1.7-4.6) were 

reported indicating a Serious nutrition situation in Deyr 

‘10/11. A higher proportion of assessed boys (19.8 %) were 

acutely malnourished compared to the girls (15.2%) but 

this difference was not statistically significant. A 90-days 

retrospective crude (CDR) and under five death rates (U5DR) 

of 0.78 (0.57-1.35) and 1.15 (0.58-2.25) respectively were 

recorded, indicating Alert levels and a slight deterioration 

from the Acceptable situation with respective CDR and 

U5DR of 0.38 (0.20-0.70) and 1.01 (0.51-2.0) recorded in the 

November 2010 assessment. Data from the health facilities 

in the NE coastal areas also indicated a high (>15%) but 

decreasing number of acutely malnourished children. 

Poor dietary diversity, sanitation and access to health 

facilities in the area remain critical, with more than 20% 

of the assessed households reportedly taking poorly 

diversified diet in the preceding 24 hours of recall; and 

only 55.3% having access to sanitation facilities. The 

rain failure in the Deyr ‘10/11 and now Gu ’11 has led to 

a significant deterioration of livestock body condition and 

deaths resulting in reduced household income, and meat 

and milk consumption. Furthermore, there are low labour 

opportunities from fishing activities due to the presence of 

sea pirates, strong sea tides, poor infrastructure an market 

disruptions, and together with high morbidity, these factors 

remain key in instigating the poor nutrition situation in the 

area. The findings for Coastal Deeh pastoral livelihoods are 

summarized in Table 20. 



Table 20: Summary of Key Nutrition Findings in Hawd, Addun and Coastal Deeh Northeast Regions July 2011 

Hawd 

(N=576: 309 boys; 267 girls) 

Addun 

(N=583: 286 boys; 297 girls) 

Coastal Deeh 

(N=599: 283 boys; 316 girls) 




Boys 

Girls 


Boys 

Girls 

14.4 (10.9-18.8) 

14.6 

14.2 

3.8 (2.4-6.0) 

4.9 

2.6 

Serious 

Alert 

17.8 (13.3-23.6) 

21.3 

14.5 

4.1 (2.5-6.7) 

6.3 

2.0 

Critical 

Alert 

17.4 (13.8-21.6) 

19.8 (14.5-26.3) 

15.2 (11.2-20.3 

4.2 (2.7-6.4) 

4.6 (2.9-7.2) 

3.8 (1.9-7.6) 

Mean WHZ (WHO, 2006) -0.87±1.11 Serious -0.91±1.20 Serious -0.91 ±1.17 Serious 

Critical 

Alert 


55 

Global Acute Malnutrition (NCHS) 13.7 (10.4-17.8) Serious 18.0 (13.9-23.1) Serious 16.7 (13.0-21.2) Critical 

Severe Acute Malnutrition (NCHS) 2.1 (1.0-4.4) 1.5 (0.7-3.5) 2.7 (1.7-4.1) Acceptable 


Executive 

56 

IDPs of the Northeast: Galkayo, Garowe and 

Bossaso 

The nutrition situation of IDPs in the northeast regions, 

has deteriorated in all the assessed settlements with Very 

critical nutrition levels based on surveys conducted in 

June 2011, as this population continues to be vulnerable to 

various shocks including drought in the south, conflict and 

unfavourable market forces. 

Findings from the Bossaso IDPs assessment record a 

GAM rate of 24.4% (20.9-28.3) and SAM rate of 4.7% (3.2 

- 7.1), including five (0.8%) oedema cases indicating a Very 

Critical nutrition situation, and a significant deterioration 

(p26% (Pr.=90%) and SAM rate of >3.3% 

(Pr.=90%) were recorded in June 2010. The retrospective 

crude and under five death rates of 0.89 (0.58-1.37) and 2.23 

(1.20-4.11) indicating Alert and Serious levels respectively 

among the Bossaso IDPs according to the FSNAU Nutrition 

Classification Framework. The seasonal deterioration 

is associated with reduced access to casual labour at 

Bossaso port, out-migration of the better off escaping the 

high temperatures, and reduced fishing activities because 

of the high tides and winds at the sea. The reduced income, 

high cereal prices and interruptions inte hd eleievru of 

humanitarian assistance likely contributed to the very critical 

nutrition situation. Increased influx of new IDPs from south 

Somalia into the urban centres of NE put more pressure on 

the host communities with associated problems of shelter 

and frequent fire outbreaks. However, the targeted food 

distributions for the acutely malnourished and other nutrition 

and health services by the humanitarian organizations and 

the Puntland authority in the area have played a crucial 

mitigating role. The findings of IDPs assessments among 

Bossaso, Garowe and Galkayo IDPs are presented in 

Table 21. 



Table 21: Summary of Key Nutrition Findings in Northeast IDPs May - June 2011 

Bossaso 

(N=611: 306 boys; 305 girls) 

Garowe 

(N=604: 308 boys; 296 girls) 

Galkayo 

(N=612: 290 boys; 322 girls) 




Boys 

Girls 


Boys 

Girls 

24.4 (20.9-28.3) 

27.5 (22.4-33.2) 

21.3 (16.6-26.9) 

4.7 (3.2-7.1) 

4.9 ( 2.8- 8.5) 

4.6 ( 2.7- 7.7) 

Very Critical 

Serious 

20.5 (17.5- 24.0) 

24.4 (19.2-30.3) 

16.6 (13.4-20.3) 

1.8 (0.9- 3.7) 

1.9 (0.7- 5.2) 

1.7 (0.6- 4.5) 

Very Critical 

Acceptable 

20.3 (16.1-25.2) 

24.1 (18.3-31.1) 

16.8 (12.4-22.3) 

4.4 (2.9- 6.6) 

4.8 (2.8- 8.2) 

4.0 (2.4- 6.8) 

Very Critical 

Mean WHZ (WHO, 2006) -1.17±1.10 Critical -1.18±0.98 Critical -1.13±1.02 Critical 

Global Acute Malnutrition (NCHS) 22.7 (19.2-26.7) Very Critical 18.7 (15.9-21.9) Critical 19.8 (15.4-25.1) Critical 

Severe Acute Malnutrition (NCHS) 11.8 ( 0.9- 3.7) Very Critical 0.7 (0.2- 2.3) Acceptable 1.8 ( 1.0- 3.2) Critical 


Executive 

58 

Figure 26: HIS Malnutrition Trends in Bossaso MCHs 

(2010-2011) 

Proportion acutely malnourished (%) 

40.0 

35.0 

30.0 

25.0 

20.0 

15.0 

10.0 

5.0 

0.0 



Month 

Data Source: MoH/SRCS 

Data from health facilities in Bossaso indicated a high 

(>20%) and stable trend of acutely malnourished children 

(Figure 26). 

populations, 18.9% and 12.2% in Bossaso and Garowe IDP 

populations respectively consumed poorly diversified diets, 

comprising of three or fewer food groups, mainly obtained 

through purchase. In the context of rural versus urban 

population, a relatively higher proportion of the assessed 

households among the IDP settlements have access to 

sanitation facilities, with 76.3%, 60.7% and 98.3% of the 

assessed households in the Bossaso, Garowe and Galkayo 

IDP settlements respectively reporting access to some type of 

toilet. Similarly, 69.4%, 53.6% and 99.5% of the households in 

Bossaso, Garowe and Galkayo respectively reported having 

access to safe drinking water, which remains unsatisfactory. 

This may mask the water stress situation as witnessed by 

water trucking as the main source of water following the effects 

of drought in the region. 

IDPs of the Northeast: Qardho and Margaga 

Among the Garowe IDP population, a GAM rate of 20.5% 

(17.5- 24.0) and a SAM rate of 1.8% (0.9- 3.7), including two 

(0.3%) oedema cases and indicating a Very Critical nutrition 

situation. A substantially higher proportion of boys (24.4%), 

than girls (16.6%) were acutely malnourished (Pr>87.5%). 

The results show a significant deterioration from the Serious 

levels reported in December 2010 with GAM and SAM 

rates of 13.3 % (11.0-15.9) and 2.5 % (1.6-3.9) respectively. 

Even then, a significantly higher number of boys (16.6%), 

than girls (10.3%) were acutely malnourished (Pr.>87.5%); 

this finding therefore needs further investigation. These 

are the worst rates recorded among Garowe IDP group, 

which have previously reported stable serious levels in 

three consecutive seasons, due to the mitigating effects 

of interventions including active case finding and referral 

of acutely malnourished children byagencies on the 

ground. Continued displacements from the south and the 

surrounding pastoral destitute have exerted more pressure 

on the host communities and together with limited labour 

opportunities and high food prices have constrained access 

to food and economic resources among the IDPs. 

The results for the Galkayo IDP assessment recorded a 

GAM rate of 20.3% (16.1-25.2) and a SAM rate of 4.4% 

(2.9-6.6) including three (0.5%) oedema cases, indicating 

a Very Critical nutrition situation and deterioration from 

the Critical levels of 16.3% (13.2-20.0) and 2.9% (1.8-4.5) 

for GAM and SAM rates respectively reported in December 

2010. Again, the proportion of boys (24.1%) who were 

acutely malnourished was higher than that of girls (16.8%), 

but the difference was not statistically significant (p>0.05). 

The respective crude and under five death rates of 0.89 

(0.59-1.36) and 1.01 (0.47-2.17) among Galkayo IDPs were 

both indicating the Alert levels according to the FSNAU 

Nutrition Classification Framework. The reported deaths 

were suspected to have mainly been caused by diarrhoea. 

Dietary diversity and household access to food and to 

basic services remain to be the major challenges for most 

displaced populations. Among the three assessed IDP 

Findings from the surveys conducted among the Margaga 

(exhaustive survey) and Qardho (small sample cluster survey) 

IDPs in June 2011, indicate GAM and SAM rates of rates of 

22.7% and 2.9% in Margaga and a GAM rate of >23.8% 

(Pr=0.90) with a SAM rate of >8.2% (Pr=0.90) in Qardho 

(Table 17). The rates depict a Very Critical nutrition situation 

in Margaga IDPs centers, and because this is the first nutrition 

assessment on this recently displaced population, there is no 

data for comparison. The nutrition situation among the Qardho 

IDPs is also Very Critical and consistent with rates observed 

among a similar population in Bossaso. The rates in Qardho 

also show a significant deterioration from the Serious situation 

reported in December 2010 when small sample cluster survey 

results recorded a GAM rate of >10.6% (Pr=0.90) and a SAM 

rate of >2.7% (Pr=0.90) 

These findings indicate considerably high morbidity rates 

(>27%), which have a direct effect on the nutrition status 

of the children. However, for all the five IDP populations, 

vaccination status by recall and Vitamin A supplementation 

are relatively high, yet slightly below the Sphere (2004) 

threshold, with the exception of measles immunization in 

Qardho IDP populations at 70% (Table 12). The high coverage 

of these health programmes is likely due to the impact of the 

child health days (CHDs) carried out by UNICEF and partners 

in June/July 2011. 

Figure 27: Trends in Levels of Acute Malnutrition 

(WHZ

Table 22: Summary of Key Nutrition Findings in Northeast and Central IDPs May - June 2011 

Qardho IDPs 

(N=211: Boys=112, Girls=99) 

Margaga IDPs 

(N=207: Boys= 109, Girls= 98) 




Boys 

Girls 


Boys 

Girls 

>23.8 (Pr=0.90) 

31.3 (22.3-41.9) 

26.3 (16.9-38.5) 

>8.2 (Pr=0.90) 

12.5 ( 7.3-20.5) 

10.1 ( 4.6-20.7) 

Very Critical 

Very Critical 

22.7 

30.3 

14.3 

2.9 

3.7 

2.0 

Very Critical 

Acceptable 

Mean WHZ (WHO, 2006) -1.38±1.19 Critical -1.22±1.06 Critical 

Global Acute Malnutrition (NCHS) 

>25.0 (Pr=0.90) 

Very Critical 21.3 Very Critical 


59 

Severe Acute Malnutrition (NCHS) >2.3 ( Pr=(0.90) Alert 1.4 Acceptable 


24.1 (17.8-31.8) 

Very Critical 

4.3 

3.7 

Alert 

Girls 

22.2 (15.5-30.9) 

5.1 

Proportion with MUAC4.4 ( Pr=0.90) 

Very Critical 0.5 Serious 

Stunting (HAZ24.5 (Pr=0.90) 

34.8 (27.3-43.2) 

Critical 

7.7 

5.5 

Serious 

Girls 

22.2 (13.4-34.5) 

10.2 

Underweight (WAZ30.6 (Pr=0.90) 

40.5 (31.6-50.2) 

Very Critical 

15.0 

17.4 

Critical 

Girls 

29.6 (20.2-41.0) 

29.6 

HIS Nutrition Trends(Jan-Jun’11) N/A Critical N/A - 

Admission trends at TFPs/SFPs (Gedo – Jan-July’10) 

High and Stable admissions 

Critical 

trend 

N/A 

Proportion of acutely malnourished registered in SFs 0 

Child Morbidity & Immunization 

Disease trends (seasonally adjusted) 

Morbidity refers to the proportion of children reported to be ill 

in the 2 weeks prior to the survey 

Immunization Status 

Outbreak – None 

Morbidity-38.4 

Boys- 

Girls- 

Diarrhea -27.5 

Pneuonia-28.9 

Fever-32.7 

Vitamin A –80.1 

Boys-77.7 

Girls-82.8 

Measles – 70.0 

Boys-71.8 

Girls-68.0 

Critical 

Infant and Young child feeding N=80 N=65 

Proportion still breastfeeding 

Boys 

Girls 

58.8 

56.8 

61.1 

Critical 

63.1 

65.7 

60.0 

Proportion meeting recommended feeding frequencies 

Boys 

Girls 

Proportion who reported to have consumed

Executive 

60 

Overall, the nutrition situation is Very Critical among all 

the five IDP populations of Bossaso, Garowe, Qardho, 

and Galkayo in which repeat surveys were conducted 

and is showing significant deteriorations from either 

Serious or Critical levels reported in Deyr ‘10/11, as well 

as among the new Margaga IDP population. The reasons 

for the deteriorations are multiple and are associated with 

deteriorating food security and health related factors. The 

reliance of the IDPs on humanitarian assistance that has 

been insufficient and limited to a small proportion of targeted 

vulnerable households and on the irregular casual labour 

for income to buy food and other none food items makes 

them susceptible to food insecurity and malnutrition. The 

situation is exacerbated by the high food prices and poor 

food access resulting from the effects of drought in the 

region and inability of the host communities to provide social 

support. Interventions to improve and stabilize food access 

and provision of health services are crucial in addressing 

limited food and in tackling the high morbidity levels, thereby 

mitigating the high levels of acute malnutrition. Continued 

and concerted efforts are thus needed to rehabilitate acutely 

malnourished children and prevent further deterioration. 

Gender and nutrition analysis in Northeast Regions 

In most of the nutrition assessments conducted in the 

NE regions of Somalia, a higher proportion of boys than 

girls were acutely malnourished, even though this was not 

statistically significant (Pr

A review of five cases of child deaths in Eil, 

implicates suspected measles 

As Narrated to Mohamed M. Hassan, Fsnau July 2011 

Measles is one of the contributing factors of malnutrition 

and related deaths in Somalia particularly in very 

remote and coastal livelihoods where immunization, 

vitamin A supplementation and breastfeeding levels 

are very negligible and basic services including health 

are insufficient in terms of the capacity of medical 

personnel, operational tools and infrastructure. 


61 

FSNAU and partners conducted seasonal post Gu 

’2011 nutrition assessments, which incorporated both 

nutrition and deaths in the preceding 90 days. The 

purpose was to establish the seasonal malnutrition 

trends, and factors associated with malnutrition as 

well as mortality. Field observations supported a WHO 

report of measles outbreaks in Bari, Nugal and Mudug 

regions. Having discussed with key informants and 

Fawzia, one of the mothers who lost her children to 

suspect of measles in Bedey village – FSNAU July 2011 

Bedey health community, Mohamed Hassan – the FSNAU Field Nutrition Analyst, and the survey team that visited 

Eil in Coastal Deeh were informed of five recent deaths of children aged below five years in Bedey town -a settlement 

for a poor fishing community. The team requested the community elders to lead them into the particular households 

who lost their children in order to carry out a discussion so as to understand the probable factors contributing to these 

deaths. The following paragraphs summarizes the outcome of the examinations conducted in the five households. 

Case 1: 

Faduma, 32, the mother of the first case, told us that her child was 12 months when he passed on. She had visited 

Bossaso Town in April 2011, and one of the families she paid a visit in Bossaso had lost their child due to illness 

suspected to be jaadeco (measles) 1 . When she returned to Eil, her young child became sick and presented measles 

symptoms like cough, red eyes, very high fever, diarrhoea and respiratory infections and eventually died on 5 th June 

2011 after one week of illness. Fadumo is herself not immunized against the tetanus (TT); the mother continued 

breastfeeding her late child up to 12 months but she “did not receive measles vaccine nor Vitamin A capsules”, she said. 

Case 2: 

Fawzia, 23, is mother to the late Halima, who passed on 27 th June 2011, at 10 months. Fawzia said, Halima had 

been taken ill for 18 days before she succumbed to high fever, skin rash and cough – symptoms of measles. “She had 

not received vitamin A supplements nor measles vaccine; she was still breastfeeding at the time she passed away”, 

she said. Her surviving sibling of two and half years was also infected by the same disease but received treatment 

and recovered after the death of Halima. Fawzia completed her 5 doses of TT. 

Case 3: 

Johra, 36, the mother of the third case, has received 3 doses of TT, but her late son (Abdullahi) who died at the age 

of 11 months had not received any of the required immunizations - against polio and measles. Breastfed for the 

first four months only, the late Abdullahi died on 18 th June 2011 with measles symptoms of diarrhoea, deep cough 

with chest in-drawing, white spots in the mouth, red eyes and fever that went on for 10 days. 

Her neighboor, Isha, had three out of her four children (see photo) infected with measles. Two of the children recovered, 

after 22 days of severe illness. However one child, Amina, succumbed to death. 

Case 4: 

Farhia, 30, who had received three doses of TT confirmed that her youngest child, Garad, 10 months, had recently 

died on 21 st June 2011 with cough, skin rash, red eyes and high fever that lasted for 16 days. Garad had been breastfed 

for only four months before the mother conceived another pregnancy. 

1 Measles (Jadeeco): a child with more than three of these signs– fever and, skin rash, runny nose or red eyes, and/or mouth 

infection, or chest infection 



Executive 

62 

Case 5: 

Fatuma, 22, the mother of the fifth case, had not been 

immunized against TT. She reported that her young 

child Ramadan, 9 months, who passed away on 1 st 

July, in the same Bedey village had the following 

symptoms: very severe cough, diarrhea, very high 

fever and unconsciousness. “The child was ill for only 

four days, she had been so emaciated and succumbed.” 

She explained. Asked, if the child had received any 

immunization dosage against measles, the mother said, 

No. “He was delivered at home and the health center 

is very far away, I did not have money to take him to 

hospital.” She said. 

Isha of Bedey Village, with three of her children who 

reportedly had measles. FSNAU, July 2011 

Summary: 

Based on the information from mothers/care takers of these cases, the children suffered from similar symptoms and 

the deaths are likely to have been caused by measles. The cases had not been immunized and measles vaccination 

coverage is very low in the area, health infrastructure is weak, community awareness on immunization is very 

limited and because of the remoteness the disease surveillance and management is wanting. The nutrition survey 

conducted in the Coastal Deeh reported a high rate of acute malnutrition with GAM and SAM rates of 17.4 % 

(13.8-21.6) and 4.2% (2.7-6.4), respectively; and a 90-days retrospective crude (CDR) and under five death rates 

(U5DR) of 0.78 (0.57-1.35) and 1.15 (0.58-2.25) respectively. The deaths in U5s in this assessment and all the other 

livelihood assessments conducted in NE regions were attributed mainly to diarrhoea and measles. The main factors 

contributing to the undernutrition and deaths at the coastal people are low access to both food and health services 

including immunization, as well to recurrent episodes of communicable diseases. 

Measles is a highly contagious disease caused by the measles virus. The measles virus grows in the cells that line the 

back of the throat and lungs and caused by a virus in the paramyxovirus. This fatal disease affects both elementary 

canal and respiratory system causing poor appetite, impaired health condition, sudden fall of nutrition and immunity 

status and eventually death. Therefore any person, who is not immunized against measles or not recovered from 

the disease at a point in their lifetime, is at risk of getting the disease with its associated complications. It can 

be prevented by the combination MMR (measles, mumps, and rubella) vaccine (http://www.cdc.gov/measles) 

and programs have been designed to eliminate measles globally by 2012 (CDC, 2009). The fourth Millennium 

Development Goal (MDG 4) also aims to reduce the under five mortality rate by two thirds between 1990-2015 

(WHO, 2009). Given the potential of measles vaccination to reduce child mortality, and recognizing that measles 

vaccination coverage is a marker of access to child health services, routine measles vaccination coverage is used as 

an indicator of progress towards achieving MDG 4 (WHO, 2009). 

References: 

CDC (2009). Progress Toward the 2012 Measles Elimination Goal -- Western Pacific Region, 1990-2008. MMWR, 

June 26, 58 (24), 669-673. 

Soleman, N., Chandramohan, D., & Shibuya, K. (2006). Verbal autopsy: current practices and challenges. Bull 

World Health Organ., 84(3), 239-245. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16583084. 

WHO (2009). World Health Organization, Fact sheet # 28. 



4.8 Northwest Regions 

The Northwest regions comprise mainly of pastoral 

livelihood zones namely: West Golis, Guban, East Golis/ 

Gebbi Valley of Sanaag region, the Hawd, Sool Plateau 

and the Nugal Valley. In addition, there is an agro-pastoral 

livelihood zone that is sub-divided into two, namely, the 

Agro-pastoral of Awdal and W. Galbeed regions and 

Agro-pastoral of Togdheer region. The livelihood zones 

cut across the five administrative regions of Awdal, W. 

Galbeed, Togdheer, Sool and Sanaag. (Map 12). The East 

Golis, Nugal Valley and Sool plateau also extend to the NE 

regions of Bari and Nugal respectively. 

Map 12: Northwest Livelihood Zones 


63 

Historical Overview Post Deyr ‘11 

Food Security 

The FSNAU Post Deyr ‘10/11 integrated food security 

analysis classified the West Golis/Guban and Agro-pastoral 

regions (Togdheer, Awdal and Galbeed) of the northwest 

as BFI, indicating a stable food security situation in the 

livelihoods compared to the Gu ‘10 season. (Figure 28). The 

Hawd, Nugal Valley and Togdheer livelihood zones were 

also classified as BFI, but with a high risk of deterioration 

to AFLC, while the East Golis (of Sanaag region) was 

classified as AFLC, with a high risk of deterioration to 

Humanitarian Emergency (HE). This indicated a slight 

deterioration of the overall food security situation in the 

livelihoods that was mainly attributed to the poor rainfall 

performance and consequent water and pasture shortage 

that led to reduced livestock production and out-migration. 

Sool Plateau pastoral livelihood zone, despite showing an 

improvement then in the food security indicators following 

the favourable Gu ‘10 season and increased humanitarian 

interventions in the area, remained in HE as a significant 

proportion of the poor population (16,000) remained very 

vulnerable. Overall, the estimated rural population in AFLC 

was 50,000 people, an increase from the Gu ‘10 estimate 

of 18,000 people. The total population in HE was 18,000, 

down from 25,000 people in Gu ‘10. The population of the 

urban poor in AFLC was 37,000, while the number in HE 

was 13,000. 


The Post Deyr ‘10/11 nutrition situation analysis showed a 

mixed picture with slight deterioration in some livelihoods, 

while other areas remained stable compared to the Gu ‘10 

season (Figure 29). The slight deterioration was mainly 

linked to reduced milk access at the household level 

which was as a result of poor livestock production and outmigration 

of many livestock from the zones following poor 

rainfall performance in the respective zones. The nutrition 

situation then remained unchanged at Alert for the Sool 

Plateau while the Hawd, West Golis and agro-pastoral 

livelihood zones remained at Serious. 

The populations of the Nugal Valley and East Golis/ Gebbi 

livelihood zones, showed a slight deterioration from Alert 

in Gu ‘10 to Serious. The nutrition situation of the IDPs 

from Burao and Berbera was classified as Serious, an 

improvement from Critical in the Post Gu ‘10, while for 

Hargeisa IDPs the situation remained unchanged at Serious 

phase. The major risk factors for the populations in the 

region such as inadequate safe drinking water, health and 

sanitation facilities, poor child feeding and care practices, 

in addition to high morbidity rates and a precarious food 

security situation, remain a challenge to the populations in 

the entire region and much more among the IDP settlements. 

Figure 28: Trends in levels of Acute Malnutrition (WHZ

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64 

Current Situation Post Gu ‘11 

Food Security 

The FSNAU Post Gu ‘11 integrated food security analysis 

indicates the West Golis/Guban, Agro-pastoral and Hawd 

of Hargeisa livelihoods in the northwest as BFI, indicating 

a stable food security situation since Gu ‘10 season. The 

population in Hawd of Togdheer, Nugal Valley and East 

Golis (of Sanaag region) livelihoods which were classified 

during the Gu’10 in BFI phase with a high risk, have shown 

deterioration in food security situation and are currently 

facing AFLC. The deterioration of the food security situation 

in these livelihoods is mainly attributed to the poor rainfall 

performance and consequent water and pasture shortage 

since the Deyr’10/11, thus affecting livestock production. 

Sool Plateau pastoral livelihood zone is in a sustained 

HE since Post Deyr ‘09/10. The situation is linked to 

consecutive seasons of poor rainfall performances which 

have decimated the livestock, the sole livelihood asset for 

the population in the area, thereby leaving significant number 

of poor population in destitution and highly vulnerable to 

food insecurity. 


The Post Gu ‘11 integrated nutrition situation analysis shows 

mixed trends in the nutrition situation in Northwest livelihoods 

with most livelihoods showing significant deterioration 

while others indicate either sustained or improved situation 

compared to the Deyr ‘10/11 situation. The nutrition 

situation for the West Golis and Nugal Valley livelihoods 

has significantly deteriorated from Serious phase in Deyr 

‘10/11 to Very Critical levels while that of Sool Plateau 

population has declined to Critical levels from the Serious 

levels in the previous season. The populations in the agropastoral 

and East Golis/Gebbi Valley livelihood zones show 

a sustained Serious nutrition situation since Deyr ‘10/11. 

The deterioration recorded in the respective livelihoods is 

mainly attributed to reduced milk access at the household 

level which resulted from abnormal seasonal livestock 

out-migration patterns, hence reducing milk availability 

and consumption in the area. Elevated morbidity levels, 

including the outbreak of measles, acute watery diarrhoea 

and dengue fever reported in these livelihoods have also 

contributed to the high levels of acute malnutrition. On the 

other hand, the population in the Hawd livelihood illustrates 

the best nutrition situation in the country having improved 

from the Serious levels in Deyr ‘10/11 to the current Alert 

phase. This is attributed to improved milk access following 

positive rainfall performance in the area. The nutrition 

situation of the IDPs from Hargeisa and Berbera towns 

indicate a sustained Serious nutrition situation since Deyr 

‘10/11, while the nutrition situation among the Burao IDPs 

has deteriorated from Serious in Deyr’10/11 to Critical 

levels. The deterioration recorded among the Burao IDP is 

largely linked to seasonal factors that influence malnutrition 

where levels of acute malnutrition peak in the Gu season 

and improve in the Deyr season as was the case in 2010 

seasons. The historical trend of malnutrition in the respective 

livelihoods and IDPs populations is shown in figure 29. The 

Deyr season is associated with increased casual labour from 

the seasonal livestock export boom for annual pilgrimage 

to Gulf states where displaced persons get extra income 

to supplement food and non-food items. These important 

labour opportunities are lacking in Gu seasons hence the 

worsening nutrition situation. Lack of stable livelihood 

systems among the IDPs coupled with irregular access to 

basic services continue to expose this population group 

to risks of malnutrition, ill health and food insecurity. The 

on-going humanitarian assistance should be maintained 

while initiating or expanding services to meet the needs of 

new arrival from Southern Somalia and pastoral drop-out 

destitute. 

Gender: The analysis of the nutrition data in the assessed 

rural livelihoods as well as the IDPs populations of 

the northwest regions, shows no statistical significant 

differences in the distribution of (i) malnutrition, and (ii) 

morbidity cases, between boys and girls. However, across 

all livelihoods and IDP populations, more boys than girls 

were acutely malnourished, stunted and underweight. This 

will need further research. Additionally, there is no statistical 

significant difference between the female and male headed 

household in terms of distribution of acute malnutrition, 

dietary diversity, and access to health or sanitation services. 

Pastoral Livelihood Zones 

West Golis, Nugal Valley and Sool Plateau Livelihood 

Zones 

The current nutrition situation of the West Golis/Guban and 

Nugal Valley pastoral populations is Very Critical, indicating 

a significant deterioration from the Serious levels in Post 

Deyr ’10/11. The results of the nutrition surveys conducted 

in the areas in July ’11 among West Golis population 

indicate a GAM rate of 22% (18.9-25.4) and a SAM rate of 

5% (3.4-7.5) indicating a significant deterioration (p

assessment done in the Nugal Valley livelihood indicated a 

GAM rate of 23.2% (18.5-28.1) and a SAM rate of 6.7% (4.4- 

10.0), showing a significant deterioration compared with a 

GAM rate of 10.3% (7.0-14.8), and a SAM rate of 1.0% (0.4- 

2.3) reported in the November 2010 assessment (p

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66 

Table 23: Summary of Key Nutrition Findings in Sool Plateau, Nugal Valley and West Golis/Guban LZ July 2011 

West Golis/Guban 

(N=844: Boys=437; Girls=407) 

Nugal Valley 

(N=582: Boys=307; Girls=275) 

Sool plateau 

(N=629: Boys= 337; Girls=292) 




East Golis/Gebbi Valley and Hawd Livelihood Zones 

of NW 

The integrated nutrition analysis of East Golis/Gebbi Valley 

population indicates a sustained Serious nutrition situation 

since Post Deyr ‘10/11 but with high likelihood of deterioration. 

A nutrition survey conducted in the area reported a GAM rate 

of 12.7% (8.5-16.9) and SAM rate of 1.1% (0.0-2.7), showing 

similar levels with the December 2010 assessment when 

a GAM rate of 11.1% (8.0-15.1), and a SAM rate of 2.1% 

(1.2-3.9) were reported. However, the prevalent aggravating 

factors including outbreak of measles and acute watery 

diarrhoea, high livestock off take and reduced access to milk 

and income indicate that the nutrition situation is more likely 

to deteriorate in the coming months. On the other hand, the 

analysis of the nutrition situation among the Hawd pastoral 

population depicts the best case in the country, with the 

situation having improved from Serious in Post Deyr ‘10/11 

to Alert levels in the current season. The results of the July 

2011 assessment reported a GAM rate of 6.2% (4.3-8.8) and 

a SAM rate of 0.3% (0.1-1.4) which indicate an improvement 

from a similar assessment in December 2010 when a GAM 

rate of 10.1% (8.0-12.7) and a SAM rate of 1.8% (1.0-3.5) 

were recorded (P10%) and fluctuating proportions of acutely 

A Woman breastfeeding her child in Hargeisa, 

FSNAU July 2011 

malnourished children screened at health facilities. The 

retrospective crude and under five death rates of 0.35 

(0.19-0.62) and 1.22(0.60-2.44) in Hawd and 0.98 (0.54-1.77) 

and 1.44 (0.79-2.61) in East Golis/Bebbi Valley livelihood 

respectively, are all within the Acceptable level according 

to WHO classification. High morbidity in East Golis/Gebbi 

Valley (41.2%) and in Hawd (30.3%) is a key aggravating 

factor to acute malnutrition in these livelihoods. The key 

nutrition findings in these areas which form the basis of 

the analysis in the classification outcome are provided in 

Table 24. 

The chronic issues affecting the nutrition status of the 

population such as poor dietary diversity, inadequate health 

and sanitation facilities, poor child feeding and care practices 

and lack of adequate safe drinking water, remain a challenge 

and require immediate attention, including the expansion of 

interventions aimed at rehabilitating malnourished children 

and improving the diet quality. Close monitoring of the 

nutrition situation remains crucial especially in East Golis/ 

Gebbi valley livelihood where the situation shows a high 

likelihood of deterioration while interventions to prevent the 

worsening of the situation are priority. 

Agro-pastoral Livelihood Zones: Awdal/Galbeed and 

Togdheer Agropastoral 

The Northwest Agro-pastoral zones comprises the Agropastoralists 

of Togdheer, Awdal and Galbeed Regions who 

practice crop farming alongside keeping varied number 

and types of livestock. The integrated nutrition situation 

analysis of the Northwest agro-pastoral populations indicate 

a sustained Serious nutrition situation since Post Deyr 

‘10/11. The nutrition assessment conducted among the 

agro-pastoral population in Northwest regions in July 2011 

reported a GAM rate of 11.5%(8.5-15.4) and SAM rate of 

0.6% (0.2-1.9) indicating a Serious nutrition situation, similar 

to the levels recorded in the December 2010 assessment 

when a GAM rate of 10.4%(7.6-14.1) and a SAM rate of 0.8% 

(0.3-1.9) were reported. The mortality rates from the current 

assessments indicate sustained Acceptable mortality levels 

with CDR of 0.23 (0.12-0.45) and U5DR of 0.53 (0.21-1.38) 

reported which is within the same levels as the CDR of 0.16 

(0.05-0.55) and U5DR of 0.41 (0.10-1.62) reported in the 

December 2010 assessment. High morbidity rates, where 

19.3% of the children assessed had fallen ill during the two 

weeks prior to the survey is the key factor attributing factor 

to the poor nutrition situation affecting the agro-pastoral 

livelihood in the area. Availability of safe water, sanitation 

and health facilities in the area remain limited while child 

feeding practices remain sub-optimal. Provisions of safe 

drinking water, adequate health and sanitation facilities and 

improvement of child care and feeding practices remain 

crucial issues that require immediate interventions. The 

key nutrition findings in these areas which form the basis 

of the analysis in the classification outcome are provided 

in Table 24. 


67 



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68 

Table 24: Summary of Key Nutrition Findings in Hawd, East Golis and Agro-pastoral LZ July 2011 

The Hawd Livelihood Zone 

(N=614: Boys=306; Girls=298) 

East Golis/Gebbi 

(N=726: Boys=373; Girls=353) 

Agro-pastoral Zone 

(N=684:Boys=306; Girls=337) 




IDPs of the North West: Hargeisa, Burao and Berbera 

The integrated nutrition situation analysis of the Northwest 

IDPs indicates a sustained Serious phase among the 

displaced populations in Hargeisa and Berbera IDP 

settlements since Deyr ‘10/11 and a deterioration from 

Serious levels in the Deyr ‘10/11 to Critical levels in the Burao 

population. Figure xx shows trend of acute malnutrition 

2007-2011. The results of a nutrition assessment conducted 

among the IDPs in Hargeisa Town report a GAM rate of 

10.9% (8.1-14.5) and a SAM rate of 2.2% (1.0-5.0) which are 

similar to the GAM rate of 10.8% (8.9-13.0), and the SAM 

rate of 1.5 % (0.8-2.8), reported in the same population in the 

Deyr ’10/11 nutrition assessment. Among the Berbera IDPs, 

an exhaustive nutrition assessment in May ’11 recorded 

GAM and SAM rates of 14.5% and 3.0% respectively, also 

indicating a sustained Serious phase since Deyr’10/11 

when a GAM rate of 14.2% (10.9-18.3) and a SAM rate of 

2.2%(1.2-4.1) were reported (Table 25). 

implementing interventions to cushion the population in the 

evidenced hunger period. 

In the three IDP populations, both crude and underfive 

mortality rates were within the acceptable levels, with the 

respective crude and underfive death rates of 0.56 (0.30- 

0.91) and 2.02 (1.21-3.34) recorded among Burao IDP, 0.37 

(0.19-0.73) and 0.59 (0.22-1.55) among Hargeisa IDPs, and 

0.28 (0.15-0.54) and 0.31 (0.09-1.13) reported among the 

Berbera IDPs. The only exception was alert under five year 

death rate among the Burao IDPs. Morbidity levels are high 

in the three IDP populations, with the reported morbidity in 

the two weeks prior to the assessment ranging from 25.3% 

in Hargeisa to 34.1% in Berbera IDPs. Immunization status 

for polio and measles, and vitamin A supplementation is 

relatively high but below the Sphere recommended coverage 

threshold of 95% . The key nutrition findings in these areas 

which form the basis of the analysis in the classification 

outcome are provided in Table 24. 


69 

Figure 30: Trends in levels of Acute Malnutrition 

(WHZ

Executive 

70 

agro-pastoral livelihoods. These differences will require 

further investigations. The distribution of morbidity by 

the sex of the children showed mixed pattern with some 

assessments such as Sool Plateau showing more boys, 

30.5%, than girls, 26.7% to have been ill while in others 

like Hawd pastoral indicating more girls (32.9%) than boys 

(27.8%) were reportedly ill. The differences were however 

not statistically significant (p>0.05). Similarly, there was 

no statistical difference in child feeding practices of boys 

and girls but mixed trends were observed where in some 

livelihoods more boys than girls were well fed and vice 

versa in others. 

The large majority (>80%) of the households assessed were 

male headed with exception of West Golis where a significant 

number of households (42.7%) were female headed. 

Analysis of the differences of household characteristics 

such as consumption of diversified diets, access to basic 

services such as safe water and sanitation facilities did not 

show a clear pattern where in some livelihoods male headed 

households had better access to these services and the 

opposite was true for other livelihoods. These differences 

were however not statistically significant (P>0.05). Due 

to small proportion of the female headed households, 

existence/or lack of any difference in access between male 

and female headed households may have been obscured. 

The sex disaggregated data of the assessed children, and 

sex of the household head per livelihood is summarized on 

Tables 23, 24 and 25. 

A young girl holding her sibling in Hargeisa 



Table 25: Summary of Key Nutrition Findings for Hargeisa, Burao and Berbera IDPs May - June 2011 

Hargeisa IDPs 

(N= 677:Boys= 354; Girls=323) 

Burao IDPs 

(N=652: Boys=395; Girls=370) 

Berbera IDPs 

(N=542: Boys= 317; Girls=345) 




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72 

Maternal Nutrition Status in northwest 

In the northwest, the proportion of the total, and the severely malnourished pregnant and/or lactating 

women indicates a situation that is likely Acceptable –Serious based on the Sphere MUAC cut-offs of 23.0 

cm, and 21.0 cm, and/or bilateral oedema. The nutrition situation in the non-pregnant and non-lactating 

women is within acceptable levels, based on MUAC cut off of 18.5cm and/or bilateral oedema. 

NW Population Assessed, 


Pregnant and/or Lactating Women 

Non – Pregnant/lactating 

women 

Proportion with 

MUAC

The dynamics of protracted and 

newly arrived IDPs staying in one camp 

As Narrated to FUAAD Hassan, FSNAU, August 2011 


The protracted and newly arrived IDPs though highly vulnerable to food and nutrition insecurity, face varying degrees of 

vulnerability depending on their stage of settlement and adaptation. The two case studies presented herein demonstrate 

the patterns of adaptation of the displaced people showing various challenges faced by new and protracted IDPs. 

73 

Case 1: Protracted IDP household 

Abdi, 45, and wife, Suuban, 35, together with their six children aged between 2-16 years have been staying in Sheik 

Nur IDP camp in Hargeisa since 2002 where they fled Mogadishu. The displacement from Mogadishu was third in 

a series of dislocations, with the first being in 2000, from their original home in Bardhere village in Gedo, to Baidoa 

Town as a result of insecurity. Here they stayed for few months and then fled to Mogadishu when fighting broke out 

in Baidoa. The family remembers with sorrow how their would be seventh child died in 2000 after suffering from 

pneumonia and diarrhoea during their six days trek from Baidoa to Mogadishu. “We really faced a hard situation 

in our journey; we had no food to eat at all. We could not 

get medical help for my 2 year old child who fell sick with 

pneumonia and diarrhoea. My child finally passed away 

soon after reaching Mogadishu. I really feel sad when I 

remember this,” says Abdi Nour. Suubaan is quick to add 

that, “After being hosted for about two years by my uncle, 

who was a businessman in Mogadishu, and things seemed 

fine with us, my uncle was shot dead in a clan revenge 

attack.’’ “This forced us to sell all our remaining assets 

including beddings and utensils to cater for our transport 

cost to Hargeisa. This is how we ended up here,” adds 

Abdi. 

Settling in the camp was not easy because we had nowhere 

to sleep. We therefore crowded in a small shanty made of 

old pieces of clothes, to survive. In the camp, we solicited Abdi’s family in Hargeisa IDP camp 

for help from old inhabitants and well wishers from 

Hargeisa Town who gave us utensils and food. As time progressed, Abdi joined his other colleagues from Southern 

Somalia in search of work and luckily got a carpentry job that paid him US$ 30 a month. This is what he used to 

put up a small hut and to purchase food. The couple explained that they now feel safer, “we are able to cope with life 

through the income from the Abdi’s casual labour. when there is no income we can easily get assistance from other 

community members or get food on credit from the regular shopkeepers who know of our ability to repay”. The family 

further explains that the current increase in food prices is making life difficult but they are somehow finding ways 

to cope. The other challenge the family faces is taking care of the school fees for the children. Amongst their three 

children who attained the school going age, only one goes to school. The family can only afford to take one of the other 

children to a Koranic school where they pay 10,000 Somaliland Shillings (US$ 1.8). “Paying school fees is the major 

challenge we have otherwise we are now proud with our life,” says the mother. The family explains that though their 

life is not the best, whenever they see a newly arrived IDP, they often flash back on their suffering before settling in 

the camp and they feel compelled to do anything possible to assist. “Sometimes when we have nothing to offer them, 

we have to borrow or beg on their behalf,” says Abdi. The family also acknowledges that humanitarian agencies help 

to ease the struggle in the camp by providing food, health services and shelter material. 

Case study 2: Newly Arrived IDP household 

On the other hand, Osman with his wife Iqra together with their four children aged five to ten years arrived in Hargeisa 

IDP camp in May 2011 after fleeing from recent fighting in Mogadishu where they were casual labourers. The 

family is going through what seems to be the typical pattern of displaced persons before they get means of survival. 

The family narrates how they lost their 7- year old daughter from measles. “Because of fighting I could not take my 

daughter who had measles to hospital as I feared being caught up in the fighting, I also did not have money to buy 

medicine from the chemist and I was giving her water, tea with milk and alittle ghee while keeping her warm with 

a blanket. Unfortunately she died after twenty days,” said Iqra. Osman continued by stating that, ”a week after the 

death of my daughter, my own brother was hit by a stray bullet while in his house and died; this forced us to sell our 

few household items to get transport to come to Hargeisa to save our lives”. 



Executive 

74 

After arriving in Hargeisa the family had nothing left 

and they were assisted by Iqra’s sister who had arrived 

in Hargeisa more than a year ago. The sister borrowed 

old bed sheets and cloths which they used to make a 

temporary shelter to start new life. Asked about the life in 

Hargeisa, Osman says that although things are still very 

difficult, they can manage to sleep without fear of stray 

bullets. He further explains that their biggest challenge is 

shelter, getting enough food and medical care especially 

for one of their children who is epileptic and needs 

constant care. “I sometimes manage to get casual labour 

and get money to feed my family but most times there is 

no work and we survive by either reducing food portion 

or skipping meals,” says Osman. Iqra, says that that she 

Osman’s Family with Fuaad Hassan, FSNAU 

Nutrition Analyst, August 2011 

thanks Allah because of the support they are getting from the IDP community that has been living in Hargeisa for 

a longer time, and from her sister, who many a times borrow food on their behalf because they do not know many 

people in the camp. One of their children was identified as acutely malnourished with a MUAC measurement of 12.0 

cm, which was explained to be as a result of inadequate food. Osman is however optimistic with life and says that 

“things will be better for me as we get settled here and my family will be happy one day, Insha Allah” 

Conclusion 

A review of these case studies shows a typical pattern that displaced people go through when they arrive in IDP camps, 

like those in Hargeisa. It reveals that the displaced people come to Hargeisa already traumatised after losing their 

loved ones, and/or under abject destitution after selling everything in their procession to get transport to Hargeisa. 

The newly arrived IDPs also take time before they can establish proper means of survival in the camps and this 

period is crucial for the supporting agencies to implement sufficient measures to meet the dire needs of these people. 

The existence of the social support mechanism where protracted IDPs support new IDPs is good in assisting the 

new arrivals but nevertheless puts additional strain on the scarce resources among the IDPs in these camps. This 

has a potential of putting both the old and new IDP in deficits, for example, where the host IDP have received a 

family ration but must share the same ration between two or more families. In such cases all families end up having 

inadequate food. In addition, the continued influx of IDPs from Southern Somalia has put a lot of constraints on 

the host IDPs that the social support is diminished. Measures to track new IDPs and prompt provision of essential 

assistance including food, shelter and psychosocial support therefore remain crucial. 



5. Urban NUTRITION SITUATION 

In northwest and northeast regions, regional-based urban 

nutrition surveys were conducted in July 2011 and analysis 

conducted based on weight for height Z. This was unlike 

previously when urban nutrition assessment were based 

on rapid MUAC assessment of selected urban centers. 

Northwest 

Results indicate a Serious nutrition situation in urban 

centers in Awdal and Sool region with respective GAM 

rate of 13.8% (10.7-17.6) and 12.4% (8.8-16.0) recorded. 

In the other three region, results indicate an Alert nutrition 

situation with the recorded GAM rates of 7.5%(5.6-14.9) in 

W. Galbeed, 9.7% (6.8- 13.5) in Togdheer and 7.1% (5.2- 

9.6) in Sanaag urban centers. Morbidity, a key aggravating 

factor is high in all urban centers ranging between 8% in 

Sanaag to 15% in Togdheer urban centers. 

Northeast & Parts of Central 

Results indicate a Critical nutrition situation in all the three 

regions with respective GAM and SAM rates of 17.7% (14.5- 

21.5) and 5.3% (3.5-7.8) in Bari; 15.4% (12.4-19.2) and 2.0% 

(1.1-3.4) in Nugal, and 15.5% (12.2-19.4) and 3.7% (1.2-6.2) 

in Mudug urban centers. High morbidity aggravated the 

nutrition situation with rates ranging from 16.8% in Bari to 

20.8% in Mudug of the assessed children reportedly falling 

ill within two weeks prior to the surveys. Although a higher 

percentage of boys were acutely malnourished than were 

girls, the difference was not statistically significant (p>0.05). 

Table xx provides a summary of the urban assessment 

results. 

Gender: In both the northwest and northeast, more boys than 

girls were acutely malnourished. However the difference 

was not statistically significant (P>0.05). Table xx provides 

a summary of the urban results disaggregated by sex. 

South 

In the urban centers of South and parts of Central regions, 

the nutrition situation is likely Very Critical based on rapid 

nutrition assessments conducted using mid upper arm 

circumference (MUAC) and purposive sampling. Findings 

indicate the proportion of children with MUAC < 12.5cm or 

oedema as 15% and above. Additionally, household dietary 

diversity is Very Critical in Bay and Bakool with 50% or 

more of the assessed households reportedly consuming a 

diet comprising of less than four food groups and 55-90% 

of the assessed households are applying severe coping 

strategies, i.e. Skipping entire days without a meal, restricting 

consumption by adults in order for small children to eat, or 

borrowing food or relying on help from friends or relatives. In 

Shabelle, 20% of the assessed urban households consume a 

poorly diversified diet of 3 or less meals a day, while 60% and 

above are reportedly engaged in severe coping strategies. 

A summary of findings on the urban situation in the southern 

regions is provided in Table x. 


75 

Table 26: Summary of Urban Findings: North West and East; Post Gu 2011 

Population Assessed GAM (WHO GS) SAM (WHO GS) MUAC

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76 

Table 27: South and Central Urban Muac Summary Findings; Post Gu 2011 

Total MUAC

6. Plausibility checks 

Guidance for use of the Plausibility checks 

Digit preference DP for weight and height: Indicates how 

accurately children were weighed and when done correctly 

there shouldn’t be any digit preference. This normally occurs 

when enumerators round to the nearest cm/kg or half cm/ 

kg. The signs; +, ++, +++ indicate if there was any DP for a 

number and if it was, mild, moderate or severe, respectively. 

Digit Preference scores for weight and hight are graded 

as; (0-5 Excellent,> 5-10 Good, >10-20 Accept and > 20 

Problematic) 

Standard Deviation (SD) of WHZ: Indicates whether 

there was a substantial random error in measurements. In 

a normal distribution the SD is equal to +1, but should lie 

between 0.8 and 1.2 Z score. SD increases as the proportion 

of erroneous results in the data set increases. 

Skewness of WHZ: This is a measure of degree of 

asymmetry of the data around the mean. A normal 

distribution is symmetrical and has zero skewness and 

should lie between +1 or -1. Positive skewness indicates 

a long right tail and negative skewness indicates a long 

left tail. 

Kurtosis of WHZ: This demonstrates the relative 

peakedeness or flatness compared to a normal distribution. 

The normal distribution has zero kurtosis and surveys 

should lie between +1 and -1. Positive kurtosis indicates a 

peaked distribution while negative indicates a flat one. 

Percent of flag: Flags are measurement that are highly 

unlikely to occur in nature and are therefore highlighted by 

the software. These incoherent measurements should be 

corrected or discarded prior to analysis, 0% flags is ideal but 

should be less that 2-3% of children measured. 

Age distribution: This allows for a view of the 

representativeness of the sample, and should be similar to 

the distribution within the population. Age bias is of particular 

concern for anthropometry. As younger aged (6-29) children 

are more likely to be malnourished than the older age group 

(30-59), this means under representation of the younger age 

group may give a lower prevalence than the actual one and 

vice versa. The age ratio allows a view of this relationship 

and should fall between 0.78 and 1.18 with an ideal falling 

around 1.0. 

Sex ratio: Allows a view of the representativeness of the 

sample and should be similar to the distribution within the 

population. This should not vary too much from the expected 

sex ratio and should fall between 0.8 and 1.2. 

Table 28 provides a summary of findings on plausibility 

checks for nutrition assessments conducted in the Gu ’11. 


77 



Executive 

78 

Table 28: Plausibility checks 

Location 

Northeast IDPs 

Bossaso IDPs 

Garowe IDPs 

Criteria 

Missing/ 

Flagged data 

Overall sex 

ratio 

Overall age 

distribution 

Digit 

Preference 

score-weight 

Digit 

Preference 

score-Height 

SD WHZ 

Skewness 

WHZ 

Kurtosis WHZ 

Poisson 

Distribution 

Category Excellent Excellent Acceptable Excellent Acceptable Excellent Excellent Excellent Excellent 

11-Jun Score 0 0 4 0 4 0 0 0 0 

Category Excellent Excellent Problematic Excellent Good Excellent Excellent Excellent Excellent 

11-Jun Score 0 0 10 0 2 0 0 0 0 

Category Excellent Excellent Problematic Excellent Good Excellent Excellent Excellent Acceptable 

Galkayo IDPs 

11-Jun Score 0 0 10 0 2 0 0 0 3 

Category Excellent Excellent Good Good Good Excellent Excellent Excellent Excellent 

Margaga IDPs 

11-Jun Score 0 0 2 2 2 0 0 0 0 

Category Excellent Excellent Good Excellent Good Good Excellent Excellent Excellent 

Qardho 

Northwest 

11-Jun Score 0 0 2 0 2 2 0 0 0 

Category Excellent Excellent Acceptable Excellent Good Good Excellent Excellent Good 

Hargeisa IDPs 

11-May Score 0 0 4 0 2 2 0 0 1 

Category Excellent Excellent Excellent Excellent Good Good Excellent Excellent Problematic 

Burao IDPs 

11-May Score 0 0 0 0 2 2 0 0 5 

11-May Category Excellent Excellent Good Good Good Good Excellent Excellent Excellent 

Berbera IDPs 

0 0 2 2 2 2 0 0 

Category Excellent Excellent Acceptable Excellent Acceptable Good Excellent Excellent Excellent 

West Golis 

NW Agropastoral 

East Golis 

Hawd-NW 

Sool 

Nugal 

11-Jun Score 0 0 4 0 4 2 0 0 0 

Category Excellent Excellent Excellent Good Acceptable Good Excellent Excellent Good 

11-Jun Score 0 0 0 2 4 2 0 0 1 

Category Excellent Excellent Acceptable Good Good Excellent Excellent Excellent Excellent 

11-Jun Score 0 0 4 2 2 0 0 0 0 

Category Excellent Excellent Excellent Acceptable Acceptable Acceptable Excellent Excellent Excellent 

11-Jun Score 0 0 0 4 4 4 0 0 0 

Category Excellent Excellent Acceptable Excellent Good Good Excellent Excellent Excellent 

11-Jun Score 0 0 4 0 2 2 0 0 0 

Category Excellent Excellent Acceptable Good Acceptable Good Excellent Excellent Excellent 

11-Jun Score 0 0 4 2 4 2 0 0 0 

CENTRAL 

Score Excellent Excellent Excellent Excellent Excellent Good Excellent Excellent Problematic 

Addun 11-Jun Category 0 0 0 0 0 2 0 0 5 

Score Excellent Good Acceptable Excellent Good Excellent Excellent Excellent Excellent 

Hawd 11-Jun Category 0 2 4 0 2 0 0 0 0 

Coastal Deeh Score Excellent Excellent Excellent Excellent Excellent Good Excellent Excellent Excellent 

11-Jun Category 0 0 0 0 0 2 0 0 0 



Table 29: Summary of Nutrition Assessments (May- Jul 2011) 

Region 

Lower 

Shabelle 

Middle 

Shabelle 

Bay 

Bakool 

Middle/ 

Lower Juba 

Gedo 

Hiran 

Livelihood 

Riverine 

Date of 

nutrition and 

mortality 

survey 


N=804 

Agropastoral July 2011 

N=799 

Riverine July 2011 

N=746 

Agropastoral 

Agro pastoral 


N=590 


N=456 

Agro pastoral July 2011 

N=245 

Pastoral July 2011 

N=270 


N=868 

Agropastoral July 2011 

N=825 

Pastoral July 2011 

N=868 

Riverine 

Agropastoral 

Pastoral 


N=642 


N=834 


N=1078 


N=570 

Agropastoral 

Pastoral 


N=531 


N=444 

GAM 

Prevalence 

28.7% 

(24.4-33.5) 

40.6% 

(34.6-46.8) 

19.6% 

(16.4-23.2) 

35.3% 

(24.9-47.3) 

55.0% 

(45.8-63.9) 

>43.6 

(Pr= 0.90) 

>43.6 

(Pr= 0.90) 

45.9% 

(41.5-50.3) 

38.9% 

(34.8-43.1) 

39.5% 

(35.9-43.2) 

48.1% 

(38.7-57.7) 

51.9% 

(41.8-61.9) 

23.8% 

(20.1-28.0) 

20.7% 

(18.4-23.2) 

43.2% 

(37.7-49.8) 

27.3% 

(24.2-30.6) 

SAM 

Prevalence 

14.2% 

(11.6-17.3) 

3.6% oedema 

20.9% 

(16.2-26.5) 

4.0% oedema 

MUAC 

14.1 

(Pr = 0.90) 

>17.3 

(Pr= 0.90) 

21.9% 

(18.9-25.2) 

4.0% oedema 

17.2% 

(14.0-20.9) 

3.2% oedema 

18.7% 

(15.8-21.9) 

2.2% oedema 

25.2% 

(19.1-32.6) 

0.2 % oedema 

19.3% 

(13.9-26.3) 

1.8% oedema 

5.9% 

( 4.1- 8.5) 

0.6% oedema 

9.1% 

(7.2-11.5) 

0.2% Oedema 

16.3% 

(13.4-19.6) 

0% Oedema 

29.0 

(24.3-34.3) 

46.0 

(33.3-59.3) 

12.7 

( 9.0-17.5) 

18.1 

(13.6-23.7) 

33.8% 

(28.3-39.8) 

30.9% 

(26.1-36.2) 

26.1% 

(22.2-30.5) 

35.8% 

(25.5-47.6) 

33.1% 

(25.0-42.2) 

13.3 

(9.2-18.8) 

21.0% 

(18.5-23.8) 

24.2 

(19.9-29.1) 

12.8% 

(10.5-15.6) 22.8 

0.2% Oedema (19.5-26.4) 

MUAC 

Summary of Nutrition Assessments (May- Jul 2011) continued 

Executive 

80 

Region 

Central 

Regions 

Livelihood 

Date of 

nutrition and 

mortality 

survey 


Hawd Pastoral 

N=576 

Addun 

Pastoral 


N=583 

Northern Regions 

GAM 

Prevalence 

14.4% 

(10.9-18.8) 

17.8% 

(13.3-23.6) 

SAM 

Prevalence 

3.8% 

(2.4-6.0) 

0.5% Oedema 

4.1% 

(2.5-6.7) 

0.3% Oedema 

MUAC 

8.2 

>19.8 

(Pr=0.90) (Pr=0.90) 

0.9% oedema 

14.9 

1.8 (0.9- 3.7) 

(12.4-17.7) 

0.3% oedema 

2.3 

(1.3-4.2) 

1.2 

(0.5-1.9) 

0.78 

(0.57-1.35) 

0.98 

(0.54-1.77) 

1.15 

(0.58-2.25) 

1.44 

(0.79-2.61) 

2.0 

( 1.0- 3.9) 

0.89 

0.58-1. 37 

2.23 

1.20-4.11 

>4.4 

(Pr=0.90) - - 

4.6 

(3.1- 6.9) 

0.61 

0.31-1. 19 

1.39 

0.47-4.02 

June 2011 

Margaga IDPs 

N=207 

Galkayo IDPs 

June 2011 

N=612 

22.7 

(Exhaustive) 

20.3 

(16.1-25.2) 

2.9 

(Exhaustive) 

4.4 ( 2.9- 6.6) 

0.5% oedema 

4.3 

16.2 

(12.5-20.6) 

0.5 - - 

1.6 

( 0.9- 3.0) 

0.89 

0.59-1. 36 

1.01 

0.47-2.17 

May 2011 

Hargeisa IDPs 

N=677 

10.9 

(8.1-14.5) 

2.2 ( 1.0- 5.0) 

0.1% oedema 

6.4 

(4.3-9.3) 

1.6 

(0.8-3.3) 

0.37 

0.19-0. 73 

0.59 

0.22-1.55 

North East 

IDPs 

Burao IDPs 


N=652 

19.1 

(14.6-24.5) 

5.6 ( 4.1- 7.7) 

1.2% oedema 

8.1 

(5.5-11.9) 

2.5 

( 1.4- 4.5) 

0.56 

0.30-0. 91 

2.02 

1.21-3.34 

Berbera IDPs 


N=662 

14.5 

(Exhaustive) 

3.0 

0.5% oedema 

5.9 2.3 0.28 

0.15-0. 54 

0.31 

0.09-1.13 



Table 30: Summary of Findings for Surveys conducted in South Somalia in August 2011 

Region Livelihood Date 

Bay 

Bakool 

Agro 

pastoral 

Agro 

pastoral 

August 


N=489 

August 


N=467 

GAM 

Prevalence 

58.3% 

(52.1-64.2) 

41.1% 

(35.1-47.4) 

SAM 

Prevalence 

MUAC 

CEEL WA Q 

" 

BADHAADHE 

" 

CEEL WAQ 

" 

BADHAADHE 

" 

BELET XAAWO 

" 

DOOLOW 

" 

BAARDHE ERE 

" 

AFM ADOW 

" 

BELET XAAWO 

" 

DOOLOW 

" 

LUUQ 

" 

SAAKOW 

" 

BAARDHEERE 

" 

AFMADOW 

" 

Rab Dhuure 

" 

QA NSAX DHEE RE 

" 

DIINSOOR 

" 

JILIB 

" 

JAMAAME 

" 

LUUQ 

" 

SAAKOW 

" 

QANSAX DHEERE 

" 

DIINSOOR 

" 

JILIB 

" 

JAMAAME 

" 

WA AJID 

" 

Rab Dhuure 

" 

WAAJID 

" 

ZEY LAC 

" 

BAKI 

" 

GE BILEY 

" 

CEEL BARDE 

" 

ZEYLAC 

" 

BAKI 

" 

GEBILEY 

" 

CEEL BARDE 

" 

LUGHAYE 

" 

BUUR HA KABA 

" 

QORYOOLEY 

" 

KURTUNWA AREY 

" 

SABLA ALE 

" 

BARAA WE 

" 

TAY EEGLOW 

" 

BERBE RA 

" 

SHEIKH 

" 

OWDWEYNE 

" 

WA NLA WEY N 

" 

BULO BURTO 

" 

BALCAD 

" 

AFGOOYE 

" 

JALALAQSI 

" 

CAYNABO 

" 

BUUHOODLE 

" 

CABUDWAA Q 

" 

CADAADO 

" 

ADAN YABAAL 

" 

CADALE 

" 

CEEL BUUR 

" 

CEEL AFWE YN 

" 

GA LDOGOB 

" 

CEEL DHEER 

" 

XUDUN 

" 

P.O. Box 1230 Village Market, Nairobi, Kenya Email: fsauinfo@fs au.or.ke 

tel: 254-20-3745734 fax:254-20-3740598 

FSAU is managed by FAO. 

The boundaries and names on these maps do not imply official endorsement or acc eptanc e by the United Nations. 

The regional & District boundaries reflect those endorsed by the Government of the Republic of Somalia in 1986. 

LUGHAYE 

" 

BUUR HAKABA 

" 

SABLAALE 

" 

BARAAWE 

" 

40 20 0 40 80 120 160 

Kilometers 

TAYEEGLOW 

" 

QORYOOLEY 

" 

KURTUNWAAREY 

" 

BERBERA 

" 

OWDWEYNE 

" 

WANLA WEYN 

" 

SHEIKH 

" 

AFGOOYE 

" 

BULO BURTO 

" 

JALALAQSI 

" 

BALCAD 

" 

CAYNABO 

" 

BUUHOODLE 

" 

CABUDWAAQ 

CADAADO 

" 

" 

ADAN YABAAL 

" 

CADALE 

" 

CEEL BUUR 

" 

CEEL AFWEYN 

" 

GALDOGOB 

" 

CEEL DHEER 

" 

XUDUN 

" 

BURTINLE 

" 

XARARDHEERE 

" 

BURTINLE 

" 

XARARDHEERE 

" 

LAASQORAY 

" 

LAASQORAY 

" 

TALEEX 

" 

TALEEX 

" 

HOBYO 

" 

HOBYO 

" 

JARIIBAN 

" 

JARIIBAN 

" 

QA RDHO 

" 

QARDHO 

" 

QA NDALA 

" 

EYL 

" 

QANDALA 

" 

EYL 

" 

ISK USHUBA N 

" 

ISKUSHUBAN 

" 

CALUULA 

" 

BANDARB EYLA 

" 

CALUULA 

" 

BANDARBEYLA 

" 

CEEL WA Q 

" 

BADHAADHE 

" 

CEEL WAQ 

" 

BELET XAA WO 

" 

DOOLOW 

" 

BAARDHEERE 

" 

AFM ADOW 

" 

BADHAADHE 

" 

LUUQ 

" 

SAAKOW 

" 

BELET XAAWO 

" 

Rab Dhuure 

" 

QA NSAX DHEE RE 

" 

DIINSOOR 

" 

JILIB 

" 

JAMAAM E 

" 

DOOLOW 

" 

BAARDHEERE 

" 

AFMADOW 

" 

LUUQ 

" 

SAAKOW 

" 

WA AJID 

" 

ZEY LAC 

" 

BAKI 

" 

QANSAX DHEERE 

" 

DIINSOOR 

" 

JILIB 

" 

JAMAAME 

" 

GE BILEY 

" 

CEEL BARDE 

" 

LUGHAYE 

" 

BUUR HA KABA 

" 

QORYOOLEY 

" 

KURTUNWA AREY 

" 

SABLA ALE 

" 

BARA AWE 

" 

TAY EEGLOW 

" 

BERB ERA 

" 

SHEIKH 

" 

OWDWEYNE 

" 

WA NLA WEY N 

" 

BULO BURTO 

" 

BALCAD 

" 

AFGOOYE 

" 

JALALAQSI 

" 

CAYNABO 

" 

BUUHOODLE 

" 

CABUDWAA Q 

" 

CADAADO 

" 

ADAN YABAAL 

" 

CADALE 

" 

CEEL BUUR 

" 

CEEL AFWE YN 

" 

GA LDOGOB 

" 

CEEL DHEER 

" 

P.O. Box 1230 Village Market, Nairobi, Kenya Email: fsauinfo@fsau.or.ke 

tel: 254-20-3745734 fax:254-20-3740598 


The boundaries and names on thes e maps do not imply official endorsement or acceptance by the United Nations . 

The regional & District boundaries reflec t those endorsed by the Government of the Republic of Somalia in 1986. 

Rab Dhuure 

" 

WAAJID 

" 

ZEYLAC 

" 

BAKI 

" 

GEBILEY 

" 

CEEL BARDE 

" 

40 20 0 40 80 120 160 

Kilometers 

LUGHAYE 

" 

BUUR HAKABA 

" 

SABLAALE 

" 

BARAAWE 

" 

TAYEEGLOW 

" 

QORYOOLEY 

" 

KURTUNWAAREY 

" 

BERBERA 

" 

OWDWEYNE 

" 

WANLA WEYN 

" 

SHEIKH 

" 

AFGOOYE 

" 

BULO BURTO 

" 

JALALAQSI 

" 

BALCAD 

" 

CAYNABO 

" 

BUUHOODLE 

" 

CABUDWAAQ 

CADAADO " 

" 

ADAN YABAAL 

" 

CADALE 

" 

CEEL BUUR 

" 

CEEL AFWEYN 

" 

GALDOGOB 

" 

CEEL DHEER 

" 

XUDUN 

" 

BURTINLE 

" 

XARA RDHEERE 

" 

XUDUN 

" 

BURTINLE 

" 

XARARDHEERE 

" 

LAASQORAY 

" 

LAASQORAY 

" 

TALEEX 

" 

TALEEX 

" 

HOBYO 

" 

HOBYO 

" 

JARIIBAN 

" 

JARIIBAN 

" 

QA RDHO 

" 

QARDHO 

" 

QA NDALA 

" 

QANDALA 

" 

EYL 

" 

EYL 

" 

ISK USHUBA N 

" 

ISKUSHUBAN 

" 

CALUULA 

" 

BANDARBEYLA 

" 

CALUULA 

" 

BANDARBEYLA 

" 

7. APPENDICES 

Executive 

82 

7.1 Progression of Estimated Nutrition Situation Gu’07 - Gu 2011 

SOMALIA - ESTIMATED Gu NUTRITION ‘08 SITUATION AUGUST 2008 

12°0'0"N 

9°0'0"N 

6°0'0"N 

3°0'0"N 

El Waq 

Afmadow 

0°0'0" 

Gedo 

Bardera 

Sakow 

L. Juba 

Badhadhe 

Dolo 

Zeylac 

DJIBOUTI 

Awdal 

M. Juba 

Kismayo 

Luuq 

Belet Hawa 

Garbahare 

!( 

43°0'0"E 

Dinsor 

Buale 

Borama 

Qansah Dere 

Rab-Dhuure 

Jilib 

Jamame 

43°0'0"E 

!( 

Woq. Galbeed 

Sheikh 

Gabiley 

Hargeisa !( !( 

Odweine Burco 

Togdheer 

Wajid 

!( 

Bay 

Sablale 

Lughaye 

Baki 

Bakol 

Baidoa 

El Barde 

Hudur 

Bur Hakaba 

Kurtun Warrey 

Tieglo 

Berbera 

Belet Weyne 

Hiran 

Bulo Burti 

Jalalaqsi 

Wanle Weyne Jowhar 

Balad 

Afgoye 

M. Shabelle 

!( 

L. Shabelle 

Banadir !( 

Qoryoley 

Marka !( 

Brava 

± 

Gulf of Aden 

ETHIOPIA 

46°0'0"E 

40 20 0 40 80 120 160 

46°0'0"E 

Kilometers 

El Afwein 

Caynaba 

Abudwaq 

Buhodle 

Dusa Mareb 

Galgadud 

Aden Yabal 

Adale 

El Bur 

El Der 

Sanag 

Xudun 

Goldogob 

Adado 

!( 

Erigavo 

Sool 

Lasanod 

Projected Trend (July - December '08) 


Uncertain 


Food Security Analysis Unit - Somalia http://www.fsausomali.org 

Gu ‘09 

Hobyo 

Galkayo 

Haradhere 

Taleh 

Mudug 

Badhan 

!( 

Garowe 

!( 

Nugal 

Burtinle 

49°0'0"E 

Jariban 

Bosaso 

Bari 

Gardo 

Eyl 

Kandala 

Iskushuban 

Bender Beila 

Indian Ocean 

Alula 

12°0'0"N 

9°0'0"N 

6°0'0"N 

LEGEND 


No data 

Insufficient data but likely 

to be critical 

Alert 

Serious 

Critical 

Very Critical 

IDP Phase 

Serious 

Critical 

Very Critical 

The Nutrition Situation is analysed using a range of 

nutrition indicators from direct and indirect sources 

from July to Dec '08: nutritional surveys, sentinel sites, 

health facility data, rapid MUAC assesments, selective 

feeding centre data, health reports and others 

" 

District Capital 

Coastline 

International Boundary 

Regional Boundary 

District Boundary 

River 

49°0'0"E 

Datum: WGS84, Data Source: FSAU, 2006 

Admin. layers: UNDP, 1998 


3°0'0"N 

0°0'0" 

12°0'0"N 

9°0'0"N 

" District Capital 

6°0'0"N 

3°0'0"N 

El Waq 

Afmadow 

0°0'0" 

Coastline 

Belet Hawa 

Gedo 

Bardera 

Sakow 

L. Juba 

Badhadhe 

Dolo 

M. Juba 

Kismayo 

Zeylac 

DJIBOUTI 

Awdal 

!( 

Luuq 

Garbahare 

43°0'0"E 

Dinsor 

Buale 

Borama 

Qansah Dere 

Rab-Dhuure 

Jilib 

Jamame 

43°0'0"E 

Woq. Galbeed 

Gabiley 

Hargeisa ! 

Wajid 

!( 

Bay 

Sablale 

Lughaye 

Bakol 

Baidoa 

Baki 

El Barde 

Hudur 

Bur Hakaba 

Kurtun Warrey 

Tieglo 

!( 

Odweine 

Deyr ‘08/09 

SOMALIA - ESTIMATED NUTRITION SITUATION JANUARY 2009 




River 

ETHIOPIA 

Berbera 

Sheikh 

!( 

Togdheer 

Afgoye 

Belet Weyne 

Hiran 

Bulo Burti 

Burco 

Jalalaqsi 

M. Shabelle 

Jowhar 

Balad 

! 

L. Shabelle 

Banadir !( 

Qoryoley 

Marka ! 

Brava 

± 


Wanle Weyne 

46°0'0"E 

40 20 0 40 80 120 160 

46°0'0"E 

Kilometers 

Adale 

El Afwein 

Caynaba 

Abudwaq 

Buhodle 

Dusa Mareb 

Galgadud 

Aden Yabal 

El Bur 


El Der 

Deyr ‘09/10 

Sanag 

Xudun 

Goldogob 

Adado 

!( 

Projected Trend (January - July '09) 


Uncertain 


Erigavo 

Sool 

Lasanod 

Hobyo 

Galkayo 

Haradhere 

Taleh 

Mudug 

Badhan 

!( 

Garowe 

!( 

Nugal 

Burtinle 

LEGEND 

49°0'0"E 

Jariban 

Bosaso 

Bari 

Gardo 

Eyl 


Acceptable 

Alert 

Kandala 

Iskushuban 

Bender Beila 

Indian Ocean 

Alula 


to be Alert 

Serious 


to be Serious 

Critical 


to be Critical 

Very Critical 


to be Very Critical 

IDP Phase 

Serious 

Critical 

Very Critical 

12°0'0"N 

9°0'0"N 

6°0'0"N 

3°0'0"N 

0°0'0" 


indicators from direct and indirect sources from July to Dec '08: 

nutritional surveys (Oct-Dec '08), health facility data, rapid 


and others 

49°0'0"E 

Datum: WGS84, Data Source: FSAU, 2006 


SOMALIA - ESTIMATED NUTRITION SITUATION JANUARY 2010 

Alula 


El Waq 

Afmadow 

Belet Hawa 

Gedo 

Bardera 

Sakow 

L. Juba 

Badhadhe 

Major Road 

Coastline 

Dolo 

M. Juba 

Kismayo 

Zeylac 

DJIBOUTI 

Awdal 




River 

!( 

Luuq 

Garbahare 

Dinsor 

Buale 

Borama 

Qansah Dere 

Rab-Dhuure 

Jilib 

Jamame 

± 

Woq. Galbeed 

Wajid 

!( 

Bay 

Sablale 

Lughaye 

Gabiley 

Hargeisa 

Bakol 

Baidoa 

Baki 

ETHIOPIA 

El Barde 

Hudur 

Bur Hakaba 

Kurtun Warrey 

Tieglo 

!( 

Berbera 

Sheikh 

!( 

Odweine Burco 

Togdheer 

^ 

Afgoye 

Belet Weyne 

Hiran 

Bulo Burti 

Jalalaqsi 

M. Shabelle 

Jowhar 

Balad 

L. Shabelle 

Banadir !( 

Brava 

Wanle Weyne 

Qoryoley 

Marka 


Adale 

El Afwein 

Caynaba 

Abudwaq 

Buhodle 

Dusa Mareb 

Sanag 

!( 

Galgadud 

Aden Yabal 

El Bur 

Goldogob 

Adado 

El Der 

Xudun 

Projected Trend (July - December'09) 


Uncertain 


Sool 

Lasanod 

Hobyo 

Erigavo 

Galkayo 

Haradhere 

Taleh 

Mudug 

Badhan 

!( 

Garowe 

!( 

Nugal 

Burtinle 

LEGEND 

Jariban 

Bosaso 

Bari 

!( 

Gardo 

Eyl 


^ 

Acceptable 

Alert 

Serious 

Critical 

Very Critical 

Kandala 

Iskushuban 

Bender Beila 

Indian Ocean 

Hot Spot for Very Critical 

IDP Phase 

Serious 

Critical 

Very Critical 


indicators from direct and indirect sources from Jan to July '09: 

nutritional surveys (Apr-July'09), health facility data, rapid 


and others 


Major Road 

Coastline 

Afmadow 

Belet Hawa 

El Waq 

Gedo 

Bardera 

L. Juba 

Badhadhe 

Sakow 

DJIBOUTI 




River 

Dolo 

Kismayo 

Luuq 

Garbahare 

Dinsor 

M. Juba 

Buale 

Zeylac 

Awdal 

Borama 

Jilib 

!( 

Woq. Galbeed 

Gabiley 

Hargeisa ! 

Rab-Dhuure 

Qansah Dere 

± 

Jamame 

Wajid 

Bay 

Sablale 

Lughaye 

Bakol 

Baidoa 

Baki 

ETHIOPIA 

El Barde 

Hudur 

Bur Hakaba 

Tieglo 

Odweine 

Berbera 

Sheikh 

! 

Burco 

Togdheer 

Belet Weyne 

Hiran 

Bulo Burti 

M. Shabelle 

Balad 

Afgoye 

L. Shabelle Banadir !( 

Qoryoley 


Brava 

Wanle WeyneJowhar 


Jalalaqsi 

Mogadishu 

Abudwaq 

Adale 

El Afwein 

Caynaba 

Buhodle 

Dusa Mareb 

Sanag 

!( 

Galgadud 

El Bur 

Aden Yabal 

El Der 

Xudun 

Goldogob 

Adado 

Projected Trend (January - July 2010) 


Uncertain 


Erigavo 

Sool 

Lasanod 

Hobyo 

Galkayo 

Haradhere 

Burtinle 

! 

Mudug 

Badhan 

Taleh 

Garowe 

LEGEND 

!( 

Nugal 

Jariban 

Bosaso 

Gardo 

Eyl 


Kandala 

Bari 

Acceptable 

Alert 

Serious 

Critical 

Very Critical 

Iskushuban 

Bender Beila 

Alula 

Indian Ocean 


to be Serious 


to be Very Critical 

IDP Phase 

Serious 

Critical 

Very Critical 


indicators from direct and indirect sources from July to 

December '09: nutritional surveys, health facility data, rapid 


and others 


P.O. Box 1230 Village Market, Nairobi, Kenya Email: fsauinfo@fsnau.org 

tel: 254-20-4000000 fax:254-20-5000555 

FSNAU is managed by FAO. 

The boundaries and names on these maps do not imply official endorsement or acceptance by the United Nations. 



P.O. Box 1230 Village Market, Nairobi, Kenya Email: fsauinfo@fsnau.org tel: 254-20-4000000 fax:254-20-4000555 

FSNAU is managed by FAO 





MOGADISHU 

MOGADISHU 

MOGADISHU 

KENYA 


GEDO 

Ceel Waq 

Baardheere 

Sakow 

L. JUBA 

Afmadow 

Badhadhe 

Beled Hawa 

Dolo 

GARBAHAREY 

!. 

Garbaharey 

M. JUBA 

Kismayo 

Luuq 

Qansax 

Dheere 

Dinsor 

Zeylac 

Lughaye 

AWDAL 

Baki !( 

Borama 

Berbera 

BORAMA 

!. 

Sheikh 

W. GALBEED 


!. ! 

!. !( 


TOGDHEER 

Burco 

Ceel Barde 

BAKOOL 

Xudur 

!. HUDUR 

Baydhaba 

BAIDOA 

!. 

Bur Hakaba 

Afgoye 

!( 

"/ 

Qoryoley 

Kurtun Warrey 

Marka !. 

BU'AALESablale 

!. 

L. SHABELLE 

Bu'aale Brava 

Jilib 

Jamaame 

Wajid 

KISMAAYO 

!( !. 

BAY 

Tayeglow 

Gu ‘10 Deyr ‘10/11 

BELET WEYNE 

Beled !. Weyne 

Cabudwaaq 

DUSAMAREB 

!. 

Dhusa Mareeb 

HIIRAN 

Balcad 

BANADIR 

Ceel Afweyne 

Caynabo 

Buuhoodle 

ERIGABO 

!. 

SOOL 

SANAG 

Ceerigaabo 

Laas Caanood 

!. LAS ANOD 

Goldogob 

Galkacyo 

GALKAYO 

!. 

Cadaado 

MUDUG 

GALGADUD 

Harardheere 

Ceel Bur 

Ceel Dheere 

Bulo Barde 

Aden Yabal 

Jalalaqsi 

Cadale 

Jowhar M. ^SHABELLE 

Wanle Weyne!. 

JOWHAR 

Projected Trend (July - December 2010) 


Uncertain 


Xudun 

Garowe 

GAROWE 

!. 

NUGAL 

Burtinle 

Hobyo 

Las Qoray/ 

Badhan 

Talex 

Jariiban 


Alert 

Serious 

Critical 

BOSSASO 

!( !. Qandala 

Bossaaso 

Qardho 

Eyl 

Acceptable 

Very Critical 



BARI 


Hot Spot for Critical 

^ 

IDP Phase 

Serious 

Critical 

Very Critical 

Calula 

Iskushuban 

Bandar Beyla 


indicators from direct and indirect sources from April to 



and others 

KENYA 

SOMALIA - ESTIMATED NUTRITION SITUATION JANUARY 2011 

Zeylac 

Lughaye 

AWDAL 

Baki ! 

Borama 

Berbera 

BORAMA 

!. 

Sheikh 

W. GALBEED 


!. ! 

!. ! 


TOGDHEER 

Burco 

Ceel Afweyne 

Caynabo 

DUSAMAREB!. 

Dhusa Mareeb 

ERIGABO 

!. 

SOOL 

SANAG 

Ceerigaabo 

Laas Caanood 

!. LAS ANOD 

Goldogob 

Galkacyo 

!( !. GALKAYO 

Cadaado 

MUDUG 

Garowe 

!. 

GAROWE 

NUGAL 

Burtinle 

BOSSASO 

!( !. Qandala 

Beled Hawa 

Tayeglow 

Buuhoodle 

Cabudwaaq 

Xudun 

Hobyo 

Las Qoray/ 

Badhan 

Talex 

Jariiban 

Bossaaso 

Qardho 

Eyl 

BARI 

Calula 

Iskushuban 

Bandar Beyla 


83 



Swiss Agency for Development 

and Cooperation SDC 










SOMALIA - ESTIMATED NUTRITION SITUATION 

August 16th, 2011 

Gu ‘11 

Zeylac 

Lughaye 

AWDAL 

Baki ! 

Borama 

Berbera 

BORAMA 

!. 

Sheikh 

W. GALBEED 


!. ! 

!. ! 


TOGDHEER 

Burco 

Calula 

BOSSASO 

!. 

Qandala 

Las Qoray/ 


ERIGABO 

!. 

Iskushuban 

SANAG 

Ceel Afweyne 

BARI 

Ceerigaabo 

! 

Qardho 

Caynabo Xudun 

Bandar Beyla 

Talex 

SOOL 

Buuhoodle 


!. LAS ANOD 

!. 

GAROWE 

NUGAL 

Burtinle 

Eyl 

Galkacyo 

Goldogob 

! 

!. 

GALKAYO 

Jariiban 

Aden Yabal 


Jalalaqsi 

!. 

BAIDOA 

Cadale 

Garbaharey 

!. 

Qansax 

Jowhar 

Dheere 

Wanle Weyne !. 

GEDO 

BAY 

M. SHABELLE 

Ceel Waq 

Bur Hakaba 

Balcad 

Dinsor 

Afgoye 

Baardheere 

! 

"/ ! BANADIR 

Qoryoley 

Sakow 

Kurtun Warrey Marka !. 


L. SHABELLE 

!. 

Bu'aale Brava 

Beled Hawa 

Rab- 

Dhuure 

GALGADUD 

BELET WEYNE 

Harardheere 


BAKOOL 

Ceel Bur 

Rab- Xudur 

Dhuure 

!. HUDUR 


Dolo 

Luuq 

Wajid 

Bulo Barde 

^Aden Yabal Nutrition Situation 


!. 

Jalalaqsi 

Cadale 

Garbaharey 

BAIDOA 

Acceptable 

!. 

Qansax 

Jowhar 

Alert 

Dheere 

Wanle Weyne!. 

GEDO 

BAY 

M. SHABELLE 

Serious 

Ceel Waq 

Bur Hakaba 

Balcad 

Dinsor 

Afgoye 

Baardheere 

!( 

"/ !( BANADIR 

Critical 

Qoryoley 

Sakow 

Kurtun Warrey 

Marka !. 

Very Critical 


L. SHABELLE 


^ 

!. 

Bu'aale Brava 


L. JUBA 

Afmadow 

Jilib 

Not classified due to 

insufficient data 

Jamaame 

Hotspot for Concern/ Likely 

^ 

KISMAAYO 

Deterioration 

Kismayo !( !. 

IDP Phase 

Serious 

Badhadhe 

Critical 

Very Critical 

Projected Trend (January - June 2011) 



indicators from direct and indirect sources from October to 

Uncertain 

December '10: nutritional surveys, health facility data, rapid 



and others 

Cadaado MUDUG 

Hobyo 

Cabudwaaq 

!. 

DUSAMAREB 

Dhusa Mareeb 

GALGADUD 

BELET WEYNE 

Harardheere 


BAKOOL 

Ceel Bur 

Rab- Xudur 

Dhuure 

!. HUDUR 


Dolo 

Luuq 

Wajid 

Bulo Barde 

L. JUBA 

Afmadow 

Jilib 

Jamaame 

KISMAAYO 

Kismayo !. 

Badhadhe 

Tayeglow 


Acceptable 

Alert 

Serious 

Critical 

Very Critical 


IDP Phase 

Serious 


Critical 

Very Critical 


indicators from direct and indirect sources from June to 



and others 

± 

0 37.5 75 150 225 300 375 

Projected Trend (August - December 2011) 


Uncertain 


Kilometers 











7.2 Nutrition Assessment Tools Post Gu 2011 

Executive 

Nutrition Assessment Household Questionnaire, Gu 2011 

NUTRITION ASSESSMENT HOUSEHOLD QUESTIONNAIRE, Gu 2011 

QNO: 

84 

Household Number ______ Date_______________ Team Number ______ Cluster Number ________ Cluster 

Name _______________________ District: __________ 

Q1-7 Characteristics of Household 

Q1. Household size 1 __________ Q2. Number of children less than 5 years (0-59 months) ________ 

Q3a. Household head 1=Male 2=Female Q3b. Highest level of mother’s/caregiver’s education: 0=None 

1= Primary 2= Secondary 3= Tertiary (college/university) 

Q4a .How long has this household lived in this locality 1= Resident 2= IDP6 months 4=Returnee (within the 

last 6 months) 5=Refugee 6=Migrant 

b. Are you hosting any recently (in the last 6 months) internally displaced persons 0= No 1= Yes 

c. If yes, Number of persons ________ 

Q5. How many mosquito nets does the household have 0=none 1=one 2=two 

3=three 

4= 4 or more 

Q6. What was the source of the net 1= NGO 2=Health Centre 3= Purchase 

Q7. What is the household’s main source of income 1= Animal & animal product sales 2= Crop sales/farming 3= Trade 

4= Casual labor 

5= Salaried/wage employment 6= Remittances 7=Self-Employment (Bush products/handicraft) 

8=gifts/ zakat 9= Others, specify ________________ 

Q8-15 Feeding and immunization status of children aged 6 – 59 months in the household. 

First Date of 

Name Birth 

1 

2 

3 

4 

-- /-- /-- 

Q8 

Child Age 

(months) 

(if child is 

more than 

24 months 

old, skip to 

Q11) 

Q9 

Are you 

breastfeeding 

1 

the child 

0= No 

1=Yes 

Q11 

Q10 

How many times did you 

feed the child in the last 

24 hours (besides breast 

milk) 

0=Zero times 

1= 1 time 

2=2 times 

3 = 3 times 

4=-4 times 

5= 5 or more times 

How many times did 

you feed the child 

with milk in the last 

24 hours (besides 

breast milk) 

0=None 

1= 1 time 

2=2 times 

3=-3 times 

4= 4 times 

5= 5 times or more 

Q 12 

Has child 

been provided 

with Vitamin 

A in the last 6 

months 

(show sample) 

0= No 

1=Yes 

Q13 

Has child 

been 

Vaccinated 

against 

measles 

0= No 

1=Yes 

Q14 

No of doses of 

polio vaccine 

given to the 

child orally 

0=none 

1=one 

2=two 

3=three or 

more 

Q15 

Does 

child have 

immunization 

card 

0= No 

1=Yes 

Q16-27 Anthropometry and morbidity for children aged 6 – 59 months in the household 

Q16a 

First 

Name Age 

(month) 

Q16b 

Sex 

Q17 

Oedema 

1=Male 0= No 

2=Female 1=yes 

Q18 

Height 

(cm) 

To the 

nearest 

tenth of 

a cm 

Q19 

Weight 

(kg) 

To the 

nearest 

tenth of 

a kg 

Q20 

MUAC 

(cm) 

To the 

nearest 

tenth of 

a cm 

(≥6 mo) 

Q21 

Diarrhea 2 

in last two 

weeks 

0= No 

1=yes 

Q22 

Pneumonia 

(oof 

wareen/ 

wareento) 3 

in the last 

two weeks 

0= No 

1=yes 

Q23 

Fever 4 

in the 

last 

two 

weeks 

0= No 

1=yes 

Q24 

Suspected 

Measles 5 

in last one 

month 

0= No 

1=yes 

Q25 

Did the 

child 

sleep 

under a 

mosquito 

net last 

night 

0= No 

1=yes 

Q26 

Where did you seek 

healthcare assistance 

when child was sick (If 

yes in Q21 – 24) 

0=No assistance sought 

1=Own medication 

2=Traditional healer 

3=Sheikh/Prayers 

4=Private clinic/ 

Pharmacy 

5= Public health facility 

Q27 

Is the child 

currently 

registered 

in any 

feeding 

centres 

0= none 

1= SFP 

2= TFC/SC 

3= OTP 

4= Other 

1 

2 

3 

4 

1 Number of persons who live together and eat from the same pot at the time of assessment 



28a. Anthropometry (MUAC) for adult women of childbearing age (15-49 years) present at the household 

Sno Name 

1 Mother: 

Age 

(years) 

No of doses 

of Tetanus 

vaccine 

received 

0= None 

1= One 

2= Two 

3=three 

MUAC 

(cm) 

Physiological 

status 

1=Pregnant 

2=Lactating 

(infant

Breakfast Snack Lunch Snack Dinner Snack 

Executive 

86 

When the respondent 8 recall is complete, fill in the food groups based on the information recorded above. For any food groups 

not mentioned, ask the respondent if a food item from this group was consumed. 

1. Cereals and cereal products (maize, ground maize, wheat, white wheat, wholemeal wheat, millet, rice, white grain 

sorghum, red sorghum , spaghetti, bread, chapatti , macaroni, canjera) 

2. Milk and milk products (Fresh/fermented/powdered sheep, goat, cow or camel milk, Cheese (sour milk), condensed 

milk, yoghurt) 

3. Vitamin A rich vegetables and tubers (yellow fleshed pumpkins, carrots, orange sweet potatoes, yellow cassava) 

4. Dark green leafy vegetables (amaranth, kale, spinach, , onion leaf, pumpkin leaves, cassava leaves, dark green 

lettuce) 

5. Other vegetables (tomato, onion, squash, bell pepper, cabbage ,light green lettuce, white radish ) 

6. Vitamin A rich fruits (ripe mangoes, pawpaw, wild fruits such as gob, hobob, berde, isbandlays, kabla, coasta, red 

cactus frui,) 

7. Other fruit (banana, orange, apple, coconut, custard apple, dates, unripe mangoes, grapes, guava, wild fruits and 

100% fruit juices) 

8. Organ meat (liver, kidney, heart or other organ meat) 

9. Meat and Poultry (beef, lamb, goat, camel, wild game, such as Dik Dik, chicken, duck, other birds such as guinea fowl 

and francolin) 

10. Eggs (eggs of chicken, eggs of duck or eggs of other fowl) 

11. Fish (fresh or dried) and other seafood (shellfish) 

Any household 

member 9 

0=No 1= Yes 

12. Legumes, nuts and seeds (cowpeas, beans, lentils , peanut, pumpkin seed, lentil seed, sunflower seed, wild nuts) 

13. White roots and tubers (white potatoes, cassava, arrowroot, white sweet potatoes, or foods made from roots) 

14. Oils and Fats (cooking fat or oil, ghee, butter, sesame oil, margarine) 

15. Sweets (sugar, honey, sweetened soda and fruit drinks, chocolate biscuit, cakes,, candies, cookies, Sugar cane and 

sweet sorghum) 

16. Coffee, tea and Spices (coffee, tea, spices such as black pepper, cardamoms, cinnamon, ginger, nutmeg, cloves, salt. 

Condiments such as ketchup, soy sauce, chilli sauce) 

Q 30b. Total number of food groups consumed 

Q 30c. Did you or anyone in your household eat anything (meal or snack) OUTSIDE of the home yesterday 

Q31 a. 

ii) milk 

In the last three months, what is the main source in the household of: i) staple cereal ______________ 

_______________ (Use codes below) 

1= Own production 2= Purchasing 3=Community Gifts/Donations 4= Food aid 5= Bartering 

6= Borrowing 7= Gathering 

Q31b. How many times did you receive cereal food aid in the last 6 months 0=never 1= once 2= twice 3= three 

times 4= fourth 5= five times 6= six times or more 

Q32 How many meals 3 has the household had in the last 24 hours (from this time yesterday to now) 0= none 1= One 

2=Two 3= Three 4=Four + 

FOOD SECURITY QUESTIONS 

Q33a. What is your current livestock holding and what was it six months ago Please indicate the number of livestock species in respective 

columns: 

1. Currently 

2. Six months ago 

a. Camel b. Cattle c. Sheep/Goat 

Q33b. If your household experienced any livestock death since January this year, please specify how many of your livestock died Please indicate‘0” 

for the species with no death cases. 

1. camel ______ 2. cattle ______ 3. sheep/goat _______ 

Q33c. Please indicate the reason for livestock death: 1= Lack of fodder 

2=Lack of water 3=Diseases 4=Other (specify) ______________________ 

Coping Strategies 

Q 33d. In the past 30 days, if there have been times when people did not have enough food or money to buy food, which of the following coping 

strategies did they use (Select based on relevant livelihood system) 

Pastoralist Livelihood: Indicate type of Pastoralism practiced : 1= Nomadic/mobile 2= Sedentary/settled 

3 A meal refers to food served and eaten at one time (excluding snacks) and includes one of the three commonly known: - breakfast, lunch and supper/dinner 



In the past 30 days, if there have been times when you did not have enough food or money 

to buy food, how often has your household had to: 

a. Reduce home milk consumption and sell more of milk produced 

b. Consume less preferred cereals 

c. Borrow food on credit from another household (Aamah) 

d. Reduce number of meals per day 

e. Reduce the portion size/quantity consumed at meal times (Beekhaamis) 

f. Rely on food donations (gifts) from the clan/community (Kaalmo) 

g. Consume weak un-saleable animals (caateysi) 

h. Send household members to eat (for food) elsewhere 

0=Never (zero times/week) 

1=Hardly at all (

Executive 

Q35a If the household has no access to protected water sources (if the answer to Q34a is 8, 9, 10, 11 or 12), what is the main reason 

0 = Not Available 1 = Distance too far 2= Security Concerns 3 = Cannot afford 4 = Queuing time is too long 

5 = Other reasons (specify) 

Q35b 

If you get your water from a protected water source (if the answer to Q34a is 1, 2, 3, 4, 5, 6 or 7), How many days in the last year month 

were you NOT able to get water from the protected source 1= None 2 = 1-5 days 3 = >5 days 

88 

Q35c What was reason for not getting water 1 = couldn’t afford 2 = source dried up 3 = machine broke down 4 = others 

Q36 What is the average time taken per TRIP to and from the main water source (including waiting and collecting time) 

1 = Less than 30 minutes 2 = 30 to 60 minutes 3 = More than 1 hour 

Q37b 

Most days (on average) how much water do you collect for the household 

Jerican (20 liter) Jerican (5 liter) Drum (200liters) 

Haan (local container with 

capacity of about 12.5 liters) 

Other container 

(specify) 

Total No. of Liters 

No. of containers 

Q38 Is the water for drinking treated and/or chlorinated 4 at the Household level 0 = No 1 = Yes 

Q39 

sun 

If Yes, what is the method of treatment (select more than 1 option if applicable) 

1 = Boiling 2 = Chlorination 3 = Straining/filtering 4 = Decanting/letting it stand and settle 5 = Leaving the water out in the 

6 = Other (specify) 

Q40 Does the family pay for drinking water 0 = No 1 = Yes 

Q41-43 Sanitation and Hygiene (access and quality) 

Q41a What type of toilet is used by most members of the household 

0 = No toilet is available (an open pit/open ground is used) 1 = Household latrine 2 = 

Communal/Public latrine 

3 = Flush toilet 

Q41b If the answer to Q41a is 0, what is the main reason 

1 = Pastoral/ frequent movements 2 = Lack resources to construct 3 = Lack of space to construct 4 = Don’t see the need 

9 = Don’t know 

Q41c If the answer to Q41a is 1,2 or 3 , how many households share/use the same toilet 1= One 2= 2 to 3 3= 4 to 9 4= 10 or 

more 9 = Don’t know 

Q42 When you wash your hands, what substance do you use for hand washing 

0= None (only with water) 1= Soap/Shampoo 2= Sand 3= Ash 4= Plant 

extracts 

Q43 Have you been exposed to information on correct personal hygiene and sanitation practices in the last 3 months (select more than 1 option 

if applicable) 

0= No 1= Yes via mass media 2= Yes via printed media 3 = Ye s v i a i n t e r p e r s o n a l 

communication 4= Yes via group meetings 

Supervisor Checked ____________________________ 

(Footnotes) 

1 Child having received breast milk either directly from the mothers or surrogate mother breast within the last 12 hours 

2 Diarrhea is defined for a child having three or more loose or watery stools per day 

3 ARI asked as oof wareen or wareento. The three signs asked for are chest in-drawing, cough, rapid breathing/nasal flaring and fever 

4 Fever – The three signs to be looked for are periodic chills/shivering, fever, sweating and convulsions 

5 Measles (Jadeeco): a child with more than three of these signs– fever and, skin rash, runny nose or red eyes, and/or mouth infection, or chest 

infection 

6 Respondent refers to the person responsible for food preparation on the recall day. For the child, refer to the mother or caregiver 

7 WHO, 2008. Indicators for assessing infant and young child feeding practices: Conclusion of a consensus meeting held 6-8 November 2007 in 

Washington D.C., USA ;FANTA 2002 Summary Indicators for Infant and Child Feeding Practices; 


9 8 FAO Household Dietary Diversity Tool 

4 Chlorinated water should have a characteristic taste and smell 



7.3. Mortality Questionnaire, June 2011 

Household No: _____ Date: _______ Team No: ____ Cluster No: ____ Enumerator’s Name: ____________ 

2: Sex (1=M; 3: Age 4: Born since 

No. 1: First Name 

2=F) 

(yrs) __ / 3/ 2011 

a) How many members are present in this household now List them. 

5: Arrived since 

__ / 3/ 2011 

6: Reason for 

leaving 

QNO: 

7: Cause of 

death 


89 

b) How many members have left this household (out migrants) since Mar __, 2011 List them 

c) Do you have any member of the household who has died since mar __, 2011 List them 

Codes 

Reason for migration 

1= Civil Insecurity 6= Hospitalised 

2= Food Insecurity 7= In boarding school 

3= Employment 8= Grazing/herding 

4=Divorce/ Married away 9= Other, specify 

5=Visiting 

1= Diarrhoeal diseases 

2= ARI 

3= Measles 

4= Malaria 

5= STD/ HIV/AIDS 

Cause of death 

6= Anaemia 

7= Pregnancy/Birth complications 

8= Accident/ killed/ physical injuries 

9= Hunger/starvation 

10= Other, specify (e.g. still birth) 

Summary* 

Current HH Members 

Arrivals during the Recall period 

Number who have left during Recall period 

Births during recall 

Deaths during recall period 

Total 

U5 

* For Supervisor Only 



Executive 

90 

7.4. IDP NUTRITION ASSESSMENT HOUSEHOLD QUESTIONNAIRE, Gu 2011 

HHNO: 

Household Number ______ Date_______________ Team Number ______ Cluster Number ________ Cluster 

Name _______________________ District: __________ 

Q1-7 Characteristics of Household 

Q1. Household size 1 __________ Q2. Number of children less than 5 years (0-59 months) ________ 

Q3a. Household head 1=Male 2=Female Q3b. Highest level of mother’s/caregiver’s education: 0=None 

1= Primary 2= Secondary 3= Tertiary (college/university) 

Q4a .How long has this household lived in this locality 1= Resident 2= IDP6 months 4=Returnee (within 

the last 6 months) 5=Refugee 6=Migrant 

b. Are you hosting any recently (in the last 6 months) internally displaced persons 0= No 1= Yes 

c. If yes, Number of persons ________ 

Q5. How many mosquito nets does the household have 0=none 1=one 2=two 

3=three 

4= 4 or more 

Q6. What was the source of the net 1= NGO 2=Health Centre 3= Purchase 

Q7. What is the household’s main source of income 1= Animal & animal product sales 2= Crop sales/farming 3= Trade 

4= Casual labor 

5= Salaried/wage employment 6= Remittances 7=Self-Employment (Bush products/handicraft) 

8=gifts/ zakat 9= Others, specify ________________ 

Q8-15 Feeding and immunization status of children aged 6 – 59 months in the household. 

First 

Name 

1 

2 

3 

4 

Date of 

Birth 

-- /-- /-- 

Q8 

Child Age 

(months) 

(if child is 

more than 24 

months old, 

skip to Q11) 

Q9 

Are you 

breastfeeding 

1 

the child 

0= No 

1=Yes 

Q10 

How many times did 

you feed the child 

in the last 24 hours 

(besides breast milk) 

0=Zero times 

1= 1 time 

2=2 times 

3 = 3 times 

4=-4 times 

5= 5 or more times 

Q11 

How many times 

did you feed the 

child with milk in 

the last 24 hours 

(besides breast 

milk) 

0=None 

1= 1 time 

2=2 times 

3=-3 times 

4= 4 times 

5= 5 times or more 

Q 12 

Has child 

been provided 

with Vitamin 

A in the last 6 

months 

(show sample) 

0= No 

1=Yes 

Q13 

Has child 

been 

Vaccinated 

against 

measles 

0= No 

1=Yes 

Q14 

No of doses 

of polio 

vaccine given 

to the child 

orally 

0=none 

1=one 

2=two 

3=three or 

more 

Q15 

Does 

child have 

immunization 

card 

0= No 

1=Yes 

Q16-27 Anthropometry and morbidity for children aged 6 – 59 months in the household 

First 

Name 

1 

2 

3 

4 

Q17 

Q16b 

Q16a 

Sex 

Age 

1=Male 

(month) 

2=Female 

Oedema 

0= No 

1=yes 

Q18 

Height 

(cm) 

To the 

nearest 

tenth of 

a cm 

Q19 

Weight 

(kg) 

To the 

nearest 

tenth of 

a kg 

Q20 

MUAC 

(cm) 

To the 

nearest 

tenth of 

a cm 

(≥6 mo) 

Q21 

Diarrhea 2 

in last 

two 

weeks 

0= No 

1=yes 

Q22 

Pneumonia Q23 

(oof 

wareen/ 

wareento) 3 

in the last 

two weeks 

0= No 

1=yes 

Fever 4 

in the 

last two 

weeks 

0= No 

1=yes 

Q24 

Suspected 

Measles 5 

in last one 

month 

0= No 

1=yes 

Q25 

Did the 

child sleep 

under a 

mosquito 

net last 

night 

0= No 

1=yes 

Q26 

Where did you 

seek healthcare 

assistance when 

child was sick (If 

yes in Q21 – 24) 

0=No assistance 

sought 

1=Own 

medication 

2=Traditional 

healer 

3=Sheikh/ 

Prayers 

4=Private clinic/ 

Pharmacy 

5= Public health 

facility 

Q27 

Is the child 

currently 

registered in 

any feeding 

centres 

0= none 

1= SFP 

2= TFC/SC 

3= OTP 

4= Other 

1 Number of persons who live together and eat from the same pot at the time of assessment 



28a. Anthropometry (MUAC) for adult women of childbearing age (15-49 years) present at the household 

Sno Name 

1 Mother: 

Age 

(years) 

No of doses 

of Tetanus 

vaccine 

received 

0= None 

1= One 

2= Two 

3=three 

MUAC 

(cm) 

Physiological 

status 

1=Pregnant 

2=Lactating 

(infant

Executive 

92 

When the respondent 8 recall is complete, fill in the food groups based on the information recorded above. For any food groups 

not mentioned, ask the respondent if a food item from this group was consumed. 

1. Cereals and cereal products (maize, ground maize, wheat, white wheat, wholemeal wheat, millet, rice, white grain 

sorghum, red sorghum , spaghetti, bread, chapatti , macaroni, canjera) 

2. Milk and milk products (Fresh/fermented/powdered sheep, goat, cow or camel milk, Cheese (sour milk), condensed 

milk, yoghurt) 



lettuce) 


6. Vitamin A rich fruits (ripe mangoes, pawpaw, wild fruits such as gob, hobob, berde, isbandlays, kabla, coasta, red 

cactus frui,) 




9. Meat and Poultry (beef, lamb, goat, camel, wild game, such as Dik Dik, chicken, duck, other birds such as guinea 

fowl and francolin) 



Any household member 9 

0=No 1= Yes 

12. Legumes, nuts and seeds (cowpeas, beans, lentils , peanut, pumpkin seed, lentil seed, sunflower seed, wild nuts) 



15. Sweets (sugar, honey, sweetened soda and fruit drinks, chocolate biscuit, cakes,, candies, cookies, Sugar cane and 

sweet sorghum) 

16. Coffee, tea and Spices (coffee, tea, spices such as black pepper, cardamoms, cinnamon, ginger, nutmeg, cloves, 

salt. Condiments such as ketchup, soy sauce, chilli sauce) 

Q 30b. Total number of food groups consumed 


Q31 a. 

ii) milk 

In the last three months, what is the main source in the household of: i) staple cereal ______________ 

_______________ (Use codes below) 

1= Own production 2= Purchasing 3=Community Gifts/Donations 4= Food aid 5= Bartering 

6= Borrowing 7= Gathering 

Q31b. How many times did you receive cereal food aid in the last 6 months 0=never 1= once 2= twice 3= three 

times 4= fourth 5= five times 6= six times or more 

Q32 How many meals 3 has the household had in the last 24 hours (from this time yesterday to now) 0= none 1= One 

Coping Strategies 


Q 33. In the past 30 days, if there have been times when people did not have enough food or money to buy food, which of the following coping 

strategies did they use (Select based on relevant livelihood system) 

Urban/IDPs Livelihood Group 

In the past 30 days, if there have been times when you did not have enough food or money 

to buy food, how often has your household had to: 

a. Shift to less preferred (low quality, less expensive) foods (from osolo to obo) 

b. Limit the portion/quantity consumed in a meal (Beekhaamis) 

c. Take fewer numbers of meals in a day 


1=Hardly at all (

WATER, SANITATION AND HYGIENE 

Q34-40 Access to water (quality and quantity) 

Q34a What is the household’s main source of drinking water 

Protected sources: 1 = Household connection 

2 = Standpipe (Kiosk/Public tap/Taps connected to a storage 

tank) 3 = Protected Shallow well (covered with hand pump/motorized pump) 4 = Tanker 5 = Spring 

6 = Bottled water 7 = Rooftop rainwater 

Unprotected sources 8 = Berkads 9 = River/stream 10 = Dam/Pond (Balley) 11 = Open Shallow 

well 12 = other (specify) … 

Q35a If the household has no access to protected water sources (if the answer to Q34a is 8, 9, 10, 11 or 12), what is the main reason 

0 = Not Available 1 = Distance too far 2= Security Concerns 3 = Cannot afford 4 = Queuing time is too long 

5 = Other reasons (specify) 


93 

Q35b 

If you get your water from a protected water source (if the answer to Q34a is 1, 2, 3, 4, 5, 6 or 7), How many days in the last year month 

were you NOT able to get water from the protected source 1= None 2 = 1-5 days 3 = >5 

days 

Q35c What was reason for not getting water 1 = couldn’t afford 2 = source dried up 3 = machine broke down 4 = others 

Q36 What is the average time taken per TRIP to and from the main water source (including waiting and collecting time) 

1 = Less than 30 minutes 2 = 30 to 60 minutes 3 = More than 1 hour 

Q37b 

Most days (on average) how much water do you collect for the household 

Jerican (20 liter) Jerican (5 liter) Drum (200liters) 

Haan (local container with 

Other container 

capacity of about 12.5 

(specify) 

liters) 

Total No. of Liters 

No. of containers 

Q38 Is the water for drinking treated and/or chlorinated 4 at the Household level 0 = No 1 = Yes 

Q39 

sun 

If Yes, what is the method of treatment (select more than 1 option if applicable) 

1 = Boiling 2 = Chlorination 3 = Straining/filtering 4 = Decanting/letting it stand and settle 5 = Leaving the water out in the 

6 = Other (specify) 

Q40 Does the family pay for drinking water 0 = No 1 = Yes 

Q41-43 Sanitation and Hygiene (access and quality) 

Q41a What type of toilet is used by most members of the household 

0 = No toilet is available (an open pit/open ground is used) 1 = Household latrine 2 = 

Communal/Public latrine 

3 = Flush toilet 

Q41b If the answer to Q41a is 0, what is the main reason 

1 = Pastoral/ frequent movements 2 = Lack resources to construct 3 = Lack of space to construct 4 = Don’t see the 

need 9 = Don’t know 

Q41c If the answer to Q41a is 1,2 or 3 , how many households share/use the same toilet 1= One 2= 2 to 3 3= 4 to 9 4= 10 or 

more 9 = Don’t know 

Q42 When you wash your hands, what substance do you use for hand washing 

0= None (only with water) 1= Soap/Shampoo 2= Sand 3= Ash 4= Plant 

extracts 

Q43 Have you been exposed to information on correct personal hygiene and sanitation practices in the last 3 months (select more than 1 option 

if applicable) 

0= No 1= Yes via mass media 2= Yes via printed media 3 = Yes via inter personal 

communication 4= Yes via group meetings 

Supervisor Checked ____________________________ 

(Footnotes) 

1 Child having received breast milk either directly from the mothers or surrogate mother breast within the last 12 hours 

2 Diarrhea is defined for a child having three or more loose or watery stools per day 

3 ARI asked as oof wareen or wareento. The three signs asked for are chest in-drawing, cough, rapid breathing/nasal flaring and fever 

4 Fever – The three signs to be looked for are periodic chills/shivering, fever, sweating and convulsions 

5 Measles (Jadeeco): a child with more than three of these signs– fever and, skin rash, runny nose or red eyes, and/or mouth infection, or chest 

infection 


7 WHO, 2008. Indicators for assessing infant and young child feeding practices: Conclusion of a consensus meeting held 6-8 November 2007 

in Washington D.C., USA ;FANTA 2002 Summary Indicators for Infant and Child Feeding Practices; 



4 Chlorinated water should have a characteristic taste and smell 



7.5. Rapid MUAC Assessment Form 

Executive 

94 

Sno 

Sex: 

1=Male 

2=Female 

Age 

(Months) 

Oedema 

1= Yes 

2=No 

MUAC 

cm (1 dp) 

Illness in past 14 days 

No = 0 

If Yes ,specify* 

1=Diarrhoea 

2=Pneumonia 

3=Fever 

4= Measles 


Sno 

Sex: 

1=Male 

2=Female 

Age 

(Months) 

Oedema 

1= Yes 

2=No 

MUAC 

cm (1 dp) 

No = 0 


1=Diarrhoea 

2=Pneumonia 

3=Fever 

4= Measles 



7.6 Rapid Nutrition Assessment Form with Food Security Questions 


Weight and Height Measurement Record Sheet for Children aged 6-59 months 

95 

Region______________ 

Cluster number/Name---------------------- 

Household 

Number 

Current 

total 

Number of 

Household 

members 

Death in the last 90 

days 

>5yrs 0-11 12-59 

months 

Current Livestock 

holdings (please 

indicate total number 

by species) 

livestock death 

from Jan ’11 up to 

Now (please indicate 

number by species) 

Sex: 

months Camel Cattle Shoats Camel Cattle Shoats 1=Male 

2=Female 

Children aged 6-59 months 

Age Oedema 

(Months) 1= Yes Weight Height MUAC 

2=No 



Executive 

96 

7.7 Rapid Nutrition Assessment Form without Food Security Questions 

Weight and Height Measurement Record Sheet for Children aged 6-59 months 

Region______________ 

cluster number/Name---------------------- 

Household 

Number 

Current total 

Number of 

Household 

members 

Death in the last 90 days 

>5yrs 

0-11 

months 

12-59 months 

Sex: 1=Male 

2=Female 

Age 

(Months) 

Children aged 6-59 months 

Oedema 

1= Yes 

2=No 

Weight Height MUAC 



7.8 Rapid Data Collection Form 

Date 

Name of theCluster 

Name of medical person of the team 

Cluster No 

Data collection form for Malaria 

Household No. 

Lat 

Long 

GPS Coordinates 


97 

Age 

Sex 

Did you have 

fever in the 

last two 

weeks 

Do you own a 

net 

Do you use the 

net on a 

regular basis 

Slept 

under net 

last night 

Is the net 

treated with 

insecticide 

RDT result 

No 

Name 

In MONTHS if < 

1 year (indicate 

'mths') 1 = Male 

In YEARS if ≥ 1 2 = 

year Female 1=Yes 2=NO 1=Yes 2=NO 1=Yes 2=NO 

1=Yes 

2=NO 

1=Yes 2=NO 

1=POSITIVE 

2=NEGATIVE 



Executive 

98 

7.9 Urban Assessment Household Questionnaire, Gu 2011 

Household Size __________ Date__________________ Enumerator: ______________________ Name of Urban Center 

_______________ Section: ______________ 

Q 1 Food Consumption & Dietary Diversity 

Twenty four-hour recall for food consumption in the households: The interviewers should establish whether the previous day and night was 

usual or normal for the households. If unusual- feasts, funerals or most members absent, then another day should be selected. 

Q1a Household Food Consumption & Dietary Diversity: Please describe the foods (meals and snacks) that members of your household 

ate or drank yesterday during the day and night at home 1 . Start with the first food or drink of the morning. Include wild foods e.g. game meat, honey, 

fruits, vegetables, leaves. 

Write down all foods and drink mentioned. When composite dishes are mentioned, ask for the list of ingredients. The interviewers should 

establish whether the previous day and night was usual or normal for the households. If unusual- feasts, funerals or most members absent, then 

another day should be selected. 

Breakfast Snack Lunch Snack Dinner Snack 

When the respondent 1 recall is complete, fill in the food groups based on the information recorded above. For any food 

groups not mentioned, ask the respondent if a food item from this group was consumed. 

1. Cereals and cereal products (maize, ground maize, wheat, white wheat, wholemeal wheat, millet, rice, white 

grain sorghum, red sorghum , spaghetti, bread, chapatti , macaroni, canjera) 

2. Milk and milk products (Fresh/fermented/powdered sheep, goat, cow or camel milk, Cheese (sour milk), 

condensed milk, yoghurt) 



lettuce) 


6. Vitamin A rich fruits (ripe mangoes, pawpaw, wild fruits such as gob, hobob, berde, isbandlays, kabla, coasta, 

red cactus frui,) 




9. Meat and Poultry (beef, lamb, goat, camel, wild game, such as Dik Dik, chicken, duck, other birds such as guinea 

fowl and francolin) 



12. Legumes, nuts and seeds (cowpeas, beans, lentils , peanut, pumpkin seed, lentil seed, sunflower seed, wild 

nuts) 



15. Sweets (sugar, honey, sweetened soda and fruit drinks, chocolate biscuit, cakes,, candies, cookies, Sugar cane 

and sweet sorghum) 

16. Coffee, tea & Spices (coffee, tea, spices such as black pepper, cardamoms, cinnamon, ginger, nutmeg, cloves, 

salt. Condiments such as ketchup, soy, chilli sauce 

Q1b. Total number of food groups consumed 


Any household member 2 

0=No 1= Yes 

Q31d. How many meals 2 has the household had in the last 24 hours (from this time yesterday to now) 0= none 1= One 


Q 2. In the past 30 days, if there have been times when people did not have enough food or money to buy food, which of the following coping 

strategies did they use 

1 Include foods prepared inside the home but consumed outside the home 

2 A meal refers to food served and eaten at one time (excluding snacks) and includes one of the three commonly known: - breakfast, lunch and 

supper/dinner 



Urban Livelihood/IDPs Groups 

In the past 30 days, if there have been times when you did not have enough food or money to buy 

food, how often has your household had to: 

a. Shift to less preferred (low quality, less expensive) foods (from osolo to obo) 

b. Limit the portion/quantity consumed in a meal (Beekhaamis) 

c. Take fewer numbers of meals in a day 


1=Hardly at all (

Executive 

100 

Sno 

Sex: 

1=Male 

2=Female 

Age 

(Months) 

Oedema 

1= Yes 

2=No 

MUAC 

cm (1 dp) 


No = 0 


1=Diarrhoea 

2=Pneumonia 

3=Fever 

4= Measles 

(Footnotes) 





7.10: Somalia Livelihood Zones 

DJIBOUTI 


Zeylac 

Lughaye 

AWDAL 

Borama 

Gebiley 

SOMALIA: LIVELIHOOD ZONES 

Baki 

Berbera 

W. GALBEED 

Ceel Afweyne 

Sheikh 

Bossaaso 

Ceerigaabo Las Qoray/Badhan 

Iskushuban 

SANAG 

Calula 

Qandala 

BARI 


101 

Hargeysa 

Owdweyne 

Burco 

TOGDHEER 

Caynabo 

Xudun 

SOOL 

Talex 

Qardho 

Bandar Beyla 

Buuhoodle 

Laas Caanood 

Garowe 

Burtinle 

NUGAL 

Eyl 

ETHIOPIA 

Cabudwaaq 

Goldogob 

Cadaado 

Jariiban 

Galkacyo 

MUDUG 

Hobyo 

Indian Ocean 

Dhusa Mareeb 

KENYA 

GEDO 

Ceel Waq 

Baardheere 

Sakow 

Hagar 

Afmadow 

M. JUBA 

BAY 

BAKOOL 

HIIRAN 

Rab-Dhuure 

Xudur 

Dolo 

Bulo Barde 

Luuq Wajid Tayeglow 

Beled Hawa 

Garbaharey 

Baydhaba 

Qansax Dheere 

Bur Hakaba 

Balcad 

Afgoye 

Dinsor 

"/ 

Qoryoley 


Sablale 

Bu'aale 

Brava 

Jilib 

Ceel Barde 

L. SHABELLE 

MOGADISHU 

GALGADUD 

Beled Weyne 

Ceel Bur 

Jalalaqsi 

Jowhar 

Wanle Weyne 

Ceel Dheere 

Aden Yabal 

Cadale 

M. SHABELLE 

BANADIR 

Harardheere 

Livelihood zones 

Addun Pastoral: Mixed sheep & goats, camel 

Awdal border & coastal towns: Petty trading, fishing, salt mining 

Central regions Agro-Pastoral: Cowpea, sheep & goats, camel, cattle 

Coastal Deeh: Sheep 

Dawo Pastoral: Shoats, cattle, camel 

East Golis Pastoral: Frankinncense 

Fishing 

Gagaab Pastoral: Frankincense 

Guban Pastoral: Sheep, goats & camel 

Hawd Pastoral: Camel, sheep & goats 

Hiran Agro-Pastoral 

Hiran riverine: Sorghum, maize, cattle & shoats 

Juba pump irrigation: Tobacco, onions, maize 

Kakaar-Dharor Pastoral: Sheep, goats, camel 

L. & M. Shabelle Agro-Pastoral Irrigated: Maize/Sorghum & cattle 

L. & M. Shabelle Agro-Pastoral rain-fed: Maize,cowpeas, sesame & cattle 

Lower Juba Agro-Pastoral: Maize & cattle 

North-West Agro-Pastoral: Sorghum, cattle 

North-West Valley Agro-Pastoral: Irrigated vegetables, shoats 

Nugal Valley Pastoral: Sheep & camel 

Potato zone & vegetables 

Shabelle riverine: Maize, fruits & vegetables 

Sool-Sanag Plateau Pastoral: Camel, sheep & goats 

L. JUBA 

Badhadhe 

Kismayo 

Jamaame 

± 

0 20 40 80 120 160 200 

South-East Pastoral: Cattle, sheep & goats 

Southern Agro-Pastoral: Camel, cattle, sorghum 

Southern Juba riverine: Maize, sesame, fruits & vegetables 

Southern coastal pastoral: Goats, cattle 

Togdheer Agro-Pastoral: Sheep, goats & vegetables 

Urban 

West Golis Pastoral: Goats, camel, sheep 

Kilometers 

Bay-Bakool Agro-pastoral Low Potential 

Bakool Agro-pastoral Low Potential 

Bay Agro-pastoral High Potential 

Southern Inland Pastoral: Camel, Sheep & Goats 

Datum: WGS84, Data Source: FSAU, 2009, 



P.O. Box 1230 Village Market, Nairobi, Kenya Email: fsauinfo@fsau.or.ke 

tel: 254-20-3745734 fax:254-20-3740598 






Executive 

102 

8. Glossary of Terms 

Anthropometry The technique that deals with the 

measurements of the size, height, weight, and proportions 

of the human body. 

Baseline data Baseline data represent the situation before 

or at the beginning of a program or intervention. Survey 

data may be compared to baseline data if defined criteria 

for comparison are met (e.g., similar methods and coverage) 

Bias Anything other than sampling error which causes the 

survey result to differ from the actual population prevalence 

or rate. 

Chronic Malnutrition Chronic malnutrition is an indicator 

of nutritional status over time. Chronically malnourished 

children are shorter (stunted) than their comparable age 

group. 

Cluster Sampling Cluster sampling requires the division of 

the population into smaller geographical units, e.g. villages 

or neighbourhoods. In a first step, survey organizers select 

a defined number of units among all geographical units. In a 

second and sometimes third step, households are selected 

within the units using simple random sampling, systematic 

random sampling, or the modified EPI method. 

Confidence interval When sampling is used, any figure 

derived from the data is an estimate of the actual value and 

is subject to sampling errors, i.e., there is a risk that the 

result obtained is not exactly equal to the actual value. The 

estimated prevalence coming out of a sample is therefore 

accompanied by a confidence interval, a range of values 

within which the actual value of the entire population is likely 

to be included. This value is generally 95% in nutrition and 

mortality surveys. This means that we can be 95% confident 

that the true prevalence lies within the given range. 

Crude mortality rate (CMR) Mortality rate from all causes of 

death for a population (Number of deaths during a specified 

period /number of persons at risk of dying during that period) 

X time period. 

Cut-off points The point on a nutritional index used to 

classify or screen individuals’ anthropometric status. 

Design Effect (DE) Cluster sampling results in greater 

statistical variance (see definition below) than simple 

random sampling because health outcomes tend to be 

more similar within than between geographical units (see 

cluster sampling). To compensate for the resulting loss in 

precision, the sample size calculated for simple random 

sampling must be multiplied by a factor called “design 

effect”; A measure of how evenly or unevenly the outcome 

(for example wasting, stunting, or mortality) is distributed in 

the population being sampled. 

Global Acute Malnutrition (GAM) GAM includes all 

children suffering from moderate and severe acute 

malnutrition; percent of children under 5 who have low 

weight-for-height measured by -2 z-scores and with or 

without oedema. 

Growth Monitoring Observation of a child growth over 

time by periodic assessment of his/her weight-for-height 

or weight-for-age. 

Household A group of persons who live together and eat 

from the same pot (i.e. the Household Economy Approach). 

Kwashiorkor Sign of severe malnutrition characterized by 

bilateral oedema. 

Malnutrition State in which the physical function of an 

individual is impaired to the point where he or she can no 

longer maintain adequate bodily performance process such 

as growth, pregnancy, lactation, physical work, and resisting 

and recovering from disease. 

Morbidity A condition related to a disease or illness. 

Oedema An accumulation of excessive extra cellular fluid in 

the body; a distinguishing characteristic of kwashiorkor when 

bilateral. All children with nutritional oedema are classified 

as severely malnourished. 

Outcome Wasting and mortality are examples of outcomes 

measured in surveys. 

Prevalence Proportion of a population with a disease or 

condition of interest at a designated time. 

P-value If you want to know whether there is a significant 

difference between two survey estimates, frequently a 

statistical test is applied and a P value calculated. The P 

value is the probability that the two estimates differ by chance 

or sampling error. 

Recall period A defined period in the past used to 

calculate estimated mortality and/or morbidity rates. 

Reference Population The NCHS (1977) and WHO (2006) 

reference values are based on two large surveys of healthy 

children, whose measurements represent an international 

reference for deriving an individual’s anthropometric status. 

Sample A subset of the total population that should be 

selected at random to guarantee a representation of the 

total population. 

Sample size The size of the sample calculated based on 

objectives of the survey and statistical considerations. 

Sampling error Sampling error is the degree to which a 

sample might differ from the whole target population, e.g., 

how well it represents a target population or total population. 

Sampling error can be quantified (e.g., in a confidence 

interval). 

Sampling frame The list of all the ultimate sampling units 

from which the sample is selected. 

Sampling interval The sampling interval is the total number 

of sampling units in the population divided by the desired 

sample size. 

Sampling unit The unit that is selected during the process of 

sampling; depending on the sampling process the sampling 

unit can be a person, household, cluster, district, etc. 

Severe Acute Malnutrition (SAM) SAM includes 

all children suffering from severe malnutrition; percent of 

children under 5 who have low weight-for-height measured 

by -3 z-scores and with or without oedema. 

Simple Random Sampling The process in which each 

sampling unit is selected at random one at a time from a list 

of all the sampling units in the population. 

Stunting (chronic malnutrition) Growth failure in a child 

that occurs over a slow cumulative process as a result of 



inadequate nutrition and/or repeated infections; stunted 

children are short for their age and may look younger 

than their actual age; it is not possible to reverse stunting; 

measured by the height-for-age index. 

Systematic Random Sampling (SRS) A methodology 

which selects a sampling unit at random, then selects every 

n th household thereafter, where ‘n’ equals the sampling 

interval. 

Underweight Percentage of children under the age of 

five with weight-for-age below -2SD from median weightfor-age 

of reference population. 

Urban town/center (based on UNDP definition/Pre-War 

definition): The regional capital and all the district capitals. 

These urban areas had most of the social amenities such 

as schools, mosques, district hospitals, markets, etc. 

Moreover, there was a greater prospect of the visible 

presence of some sort of local government or administrative 

structures in the regional and district capitals. 

Wasting (1) Growth failure as a result of recent rapid weight 

loss or failure to gain weight; wasted children are extremely 

thin; readily reversible once condition improve; wasting is 

measured by the weight-for-height index. 

Wasting (2) Percentage of children under the age of five 

suffering from moderate or severe wasting (below minus 

two standard deviations from median weight-for-height of 

reference population). Wasting differs from acute malnutrition 

because it does not take into consideration the presence/ 

absence of oedema. 

Z-score Score expressed as a deviation from the mean 

value in terms of standard deviation units; the term is used in 

analyzing continuous variables such as heights and weights 

of a sample. 


103 



Executive 

104 

Report compiled by: 

Abdikarim Ducale 

Abdillahi Warsame 

Fuad Hassan 

Mohamed M. Hassan 

Abukar Yusuf 

Ahono Busili 

Elijah Odundo 

Joseph Waweru 

Louise Masese-Mwirigi 

Mohamed Borle 

Tom Oguta 

Special Contributions: 

Grainne Moloney 

Tamara Nanitashvilli 

Ahono Busili 

Design and Layout 

Barasa Sindani 

Catherine Kimani 

Acknowledgements: 

FSNAU Nutrition Field Team 

Osman Warsame 

Khalif Nouh 

Zainab Jama 

IASC Somalia 

Leo Matunga 

UNICEF/Nutrition Cluster 

Dr. Kamran Mashhadi 

WHO/Health Cluster 

Gucharan Virdee - GenCAP Advisor 

UNOCHA 




The Information Management Process 

105 

Gathering & processing 

• FSNAU has a unique network of 32 specialists all over Somalia, who assess the nutrition and food security situation 

regularly and 120 enumerators throughout the country, who provide a rich source of information to ensure a good 

coverage of data. 

• Nutrition data is processed and analyzed using the Statistical Package for Social Sciences (SPSS), EPInfo/ENA and 

STATA software for meta-analysis. 

• FSNAU developed the Integrated Phase Classification (IPC), a set of protocols for consolidating and summarizing 

situational analysis. The mapping tool provides a common classification system for food security that draws from the 

strengths of existing classification systems and integrates them with supporting tools for analysis and communication 

of food insecurity. 

• Food security information is gathered through rapid assessments as well as monthly monitoring of market prices, 

climate, crop and livestock situations. 

• Baseline livelihood analysis is conducted using an expanded Household Economy Approach (HEA). 

• The Integrated Database System (IDS), an online repository on FSNAU’s official website www.fsnau.org, provides 

a web-based user interface for data query, data import and export facilities from and into MS Excel, graphing, 

spreadsheet management and edit functions. 

Validation of Analysis 

• Quality control of nutrition data is done using the automated plausibility checks function in ENA software. The 

parameters tested include; missing/flagged data, age distribution, kurtosis, digit preference, skewness and overall 

sex ratio. 

• Quality control of food security data is done through exploratory and trend analysis of the different variables 

including checks for completeness/missing data, market price consistency, seasonal and pattern trends, ground 

truthing and triangulation of data with staff and other partner agencies, and secondary data such as satelitte imagery, 

international market prices, FSNAU baseline data, etc. 

• Before the launch of the biannual seasonal assessment results (Gu and Deyr), two separate day-long vetting meetings 

are held comprising of major technical organizations and agencies in Somalia’s Food Security and Nutrition clusters. 

The team critically reviews the analysis presented by FSNAU and challenges the overall analysis where necessary. This 

is an opportunity to share the detailed analysis, which is often not possible during shorter presentations or in the 

briefs. 

Products and Dissemination 

• A broad range of FSNAU information products include, monthly, quarterly and biannual reports on food and 

livelihood insecurity, markets, climate and nutrition, which are distributed both in print and digital formats including 

PowerPoint presentations and downloadable file available on the FSNAU site. 

• Feedback meetings with key audiences enable us to evaluate the effectiveness of our information products. We 

constantly refine our information to make sure it is easily understandable to our different audiences. 

• FSNAU has also developed a three year integrated communication strategy to ensure that its information products 

are made available in ways appropriate to different audiences including, donors, aid and development agencies, the 

media, Somalia authorities and the general public. 

United Nations Somalia, Ngecha Road Campus 

Box 1230, Village Market, Nairobi, Kenya 

Tel: +254-(0)20-4000000/500, Cell: +254-(0)722202146 / (0)733-616881 

Fax: +254-20-4000555 

Email: info@fsnau.org 

Website: www.fsnau.org

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