International Development Committee
Oral evidence: Horn of Africa: Hunger, HC 670
Tuesday 8 November 2022
Ordered by the House of Commons to be published on 8 November 2022.
Members present: Sarah Champion (Chair); Mr Richard Bacon; Mrs Pauline Latham; Chris Law; Kate Osamor; Mr Virendra Sharma.
Questions 1 - 34
Witnesses
I: Mamadou Dian Baldé, United Nations High Commissioner for Refugees (UNHCR) Representative in Ethiopia; and Michael Dunford, Regional Director of Eastern Africa, United Nations World Food Programme.
II: Fouzia Mohamed, Director of Operations, Gargaar Relief Development Organization (GREDO); Mudasser Siddiqui, Ethiopia Country Director, Plan International; Oliver Behn, Director of Operations & Advocacy, Médecins Sans Frontières; and Dr Asma Aweis, Medical Activity Manager at Bay Regional Hospital, Médecins Sans Frontières.
Witnesses: Mamadou Dian Baldé and Michael Dunford
Q1 Chair: The purpose of this session of the International Development Select Committee is to understand better the hunger crisis in the Horn of Africa, including the severity and causes of the crisis, and to look at what the UK could be doing and is doing to help alleviate the hunger crisis. We have two panels. Could I ask the first panel to introduce yourselves for the record?
Mamadou Dian Baldé: Good afternoon and thank you so much for having me. My name is Mamadou Baldé. I am the UNHCR representative in Ethiopia.
Michael Dunford: My name is Michael Dunford. I am the regional director for the World Food Programme based in Nairobi, covering 10 countries across the region, including the Horn of Africa. Thanks very much for the invitation.
Q2 Chair: Thank you. Michael, could you tell us broadly what is the nature and the extent of the hunger crisis in the Horn of Africa?
Michael Dunford: We are facing the worst global food crisis and it is playing out very much in eastern Africa and the Horn today. We estimate that 82 million people are acutely food insecure in the region today. That is up from 51 million this time last year, so a dramatic increase—upwards of 60%. There are four key drivers: the impact of ongoing conflict either in the region or globally; the effects of climate change—the fact that this hearing is taking place during COP27 is very poignant and important—the hangover, for want of a better description, of the covid pandemic, when economies were devastated and people lost livelihoods, and many are still struggling to recover; and, finally, the dramatic increase in costs. That is happening in the UK and globally and it is particularly hurting eastern Africa at the moment. A good example of that is that in the UK or where I am from, Australia, a household will typically spend 10% of their monthly income on food. In this region, that figure is upwards of 40%, 50% or sometimes even 60%, so any increase in the cost of food items is really hurting the ability of households to feed their families.
Q3 Chair: Thank you. I am very minded that people are not saying that a famine is going on. I am also very minded that in 2011 many, many people were dying before a famine was officially declared. Could you tell us a little bit about why it is so difficult to get that declaration and how that impacts the responses to hunger?
Michael Dunford: An excellent question. For a famine to be declared, a number of technical thresholds need to be met, and until such time we are rightfully reluctant to go forward with such a declaration. There is an entity, a famine review committee, as part of the integrated phase cluster approach on food security, which will do the analysis. The first thing we need is the data, and in some countries it is not readily available. Alternatively, there are often challenges with regard to the collection because of food insecurity.
What must be remembered is that at all times we are trying to prevent famine. Although we know that a declaration may see an uptick in funding levels or the attention that is given, we are trying to take every measure possible to prevent famine in the first place. At the moment, we are on the cusp, particularly in a country such as Somalia. There is ongoing data collection to determine the scale of the food insecurity, the mortality rates, the malnutrition rates among children under five, and later this year or early next year that will either confirm what we fear, which is that a famine may be in process, or that we may have delayed it. But that will only happen if we are able to continue the upscaling of our humanitarian response, and without the funding that is almost impossible.
Even if we get the funding, it does not necessarily mean that we can avert a famine. I think that is a very important clarification to make. We are currently facing the worst drought in the region in over 40 years. We are in the middle of the fifth failed rainy season. This is climate change—well, this is climate changed. One thing to remember is that we are never going back to where we have been in the past. This is the most severe drought that we have seen in the region, with 22 million people currently affected. The fear is that until the drought breaks, the numbers affected will continue to grow, their needs will continue to grow, and our ability to keep famine at bay, be it in Somalia, northern Kenya or southern Ethiopia, will become more and more challenging.
Q4 Chair: I want to push you on this. What is the definition of famine? What is the data that you are collecting that enables that declaration to be called? What is the difference?
Michael Dunford: It is the percentage of the population acutely food insecure, it is mortality rates—two per 100,000 on a daily basis—and it is overall malnutrition rates among children under five. Once the various thresholds are hit, that is when a famine will be declared.
Q5 Chair: Today the Minister said that it had reached scale 5, which means that one of those triggers has been met; is that correct?
Michael Dunford: No, IPC 5 is either famine or famine-like conditions. Effectively, what the ongoing data collection will do is confirm whether we have all three criteria above the thresholds necessary to declare a famine. Then it is a question of what scale—how many people are impacted—and how we need to respond to prevent it from continuing.
Q6 Chair: It just feels very frustrating, when we know that people are starving to death, that we are still doing data collection to get the international community to act on prevention.
Michael Dunford: At the moment, we are focusing very much on the response—on how we prevent a bad situation from deteriorating further. There are discussions that we can have, either today or in the future, about what could have been done earlier or what investments need to be made in future to prevent a recurrence, but we knew this was coming. This does not come as a surprise. The Somali Government declared a state of emergency in September last year. The international community has been making concerted noise and advocating for a response for an extended period. Unfortunately, the war in Ukraine came at the worst possible time for the people in the region because, rightfully, that absorbed a lot of attention and a lot of funding.
Chair: Agreed.
Michael Dunford: Funds that could have come to the region were diverted and it took longer for the response to kick in as a result.
Q7 Kate Osamor: Thank you, Michael, for setting out the four key drivers that have caused the hunger crisis in the Horn of Africa. Can you give us your views—you started on this but you did not finish, so I am coming back to you—about the most significant factors that created the hunger crisis in the Horn?
Michael Dunford: Okay, I will break them down. There has been long-standing conflict in the region for an extended period. As we know, al-Shabaab has been present in Somalia for over 30 years. It continues to create a destabilising environment and limits the ability of humanitarians and others to access the particular areas where it has influence. However, what has really accelerated things has been the climate and, as I mentioned, the worst drought in over 40 years.
All the investments in resilience and so on—not to say that they did not work, but by now they have been exhausted. Populations have been forced from their homes because they have lost their livelihoods. They have lost their livestock. They estimate that over 10 million head of livestock died over the last two and a half years. That has been the dramatic driver but then, of course, there has been hyperinflation in the region and the effects of covid.
That layering of vulnerabilities happening simultaneously has created what is a disaster and what will continue to be a disaster, first and foremost until we have substantial rains that allow the drought to break, which would in turn allow populations to return home and recommence their livelihoods. We are still struggling with conflict, not only in Somalia but in northern Ethiopia, Darfur and South Sudan. It is that combination of factors that is making this such a dramatic and challenging set of circumstances to respond to. I hope I have answered the question.
Q8 Kate Osamor: You have. Thank you. Before I move on to Mamadou, can I ask you, Michael, for some context? How many days does the region go without any rain?
Michael Dunford: Typically, there are two rainy seasons: short and long, for want of better descriptions. We are now in the short rains. In a good year it would rain for two to three months. At the moment, this will be a failed rainy season, as have the four previous. The long rains are from March to May or April to June, depending on exactly where. They are the two sources of water for the region throughout the year. The rest of the period is dry. It is not UK weather and it is certainly not current Sydney weather. Without that, your water sources dry up and we see all the negative implications. I am sure Mamadou is going to talk about displacement and what that is doing, forcing people from their homes. I hope that is clear.
Q9 Kate Osamor: Thank you. It is very clear. Mamadou, could you tell the panel what challenges Ethiopia is facing due to the conflict in and around Tigray?
Mamadou Dian Baldé: Thank you again for inviting me. In Ethiopia, we are heading into the fifth season without rain, as Michael just mentioned, and the large segment of the predominantly pastoralist population has depleted the resilience capacity of the livestock, or the livestock has vanished. Agricultural activities without irrigation are really impossible and people say that even if rain began today—and this is not what science is telling us is going to happen—they will need at least a year to get back on their feet. Again, to emphasise, it is not only about responding to the immediate but helping people to be more resilient.
The impact of the drought is deepening every day and driving more and more people into food insecurity, as well as leading more and more people who can afford to leave their places to be displaced internally. As we speak, 4 million livestock have died in Ethiopia since late 2021 and more than 30 million are in a state of emaciation as well as at risk of dying, and we know that the survival of some of the pastoralists depends quite a lot on that livestock.
Before I come specifically to Tigray, two months ago I met Ethiopian women at the border that Michael was referring to between Ethiopia, Somalia and Kenya who told me that they had walked for more than a month in search of water and food sources. They told me that during their travels their donkeys had died from lack of food and water, leaving them to carry their belongings themselves across large distances with their small children. I am going to that same area again on Thursday. Unfortunately, I believe that the situation will not be better. While we have tried to respond in that region, the Somali part of Ethiopia—we have invested in irrigation to some extent thanks to investment from the UK Government and others—we need to do more, and that is my appeal.
When it comes to Tigray specifically, as you know, a peace agreement has been signed. As we speak, discussions are taking place between military commanders. We hope that even though Tigray is not the most affected by the drought—mostly it is other regions of Ethiopia that are affected—the end of the conflict, which is one of the drivers, will help us to access people who are displaced or affected and help them to resume their former lives.
Michael Dunford: I am happy to speak further on Tigray if you would like.
Chair: Sure—thank you.
Michael Dunford: This conflict has been devastating not only for Tigray but for the entirety of northern Ethiopia. Six million people have been affected inside Tigray; overall, 13 million people have been affected if you include Tigray, Amhara and Afar. We have seen a dramatic deterioration in food security across the region. The most recent data we have is from Tigray. It estimates that 89% of the population is food insecure and 47% is acutely food insecure. Our concern is that because of a lack of humanitarian assistance, particularly over the last couple of months but a challenging environment over the course of the last two years, the situation will continue to deteriorate until there is a massive upscaling of humanitarian response.
We are delighted that the peace process has commenced. We are eager to see how that plays out. WFP and other humanitarian actors are on standby. We have commodities, we have capacity to move; we now need a clear signal from both parties, particularly the Ethiopian Government, that we can now recommence. Then it is a question of how we can scale up. We have had staff inside Tigray throughout, many of whom have now been in for an extended period. We have staff who are fresh and ready to go in as soon as we get the flights back on. Then we need to be able to move convoys and we need to have fuel to allow that. We want to see basic services reconnected with the region and it needs to happen now.
Q10 Chair: Could I pause you there? That has quite surprised me. The peace process was announced a week or 10 days ago. I am surprised that that has not had an immediate impact on your ability to get food to where it is needed. So far, you have not seen a change in all the restrictions? The last data we had was that something like one out of every hundred trucks with humanitarian aid was getting through.
Michael Dunford: WFP actually has not had any trucks since 24 August.
Chair: Wow.
Michael Dunford: Up until that time, over the previous three to four months, we had managed to move considerable amounts because we managed to have the agreement of all sides to the conflict. Now, with the ongoing discussions taking place here in Nairobi, first and foremost the military leaders need to agree the fine detail, and then we expect the conversation very quickly to move to how we upscale the humanitarian response. We are hopeful for a breakthrough in the coming days.
Chair: That is shocking, but thank you very much.
Q11 Mr Sharma: What are the key actions that the UK and the international community must take to help prevent famine and tackle hunger in the Horn of Africa?
Michael Dunford: Thanks very much for the question. First and foremost, I would greatly appreciate it if the UK Government showed leadership in making increased levels of funding available, because only with funding can WFP, UNHCR and other actors scale up to the levels required—not only scale up but maintain the levels that are essential to avert the humanitarian catastrophe that is unfolding. So, funding, funding and funding.
Beyond that, I think it is important to show leadership both with regard to advocacy and ensuring that there is a collective response, and also that the Governments understand the expectations of the international community and continue to abide by those expectations.
Mamadou Dian Baldé: I align myself with what was said a bit earlier. We have already seen and are using some of the generous support provided by the UK Government, but much more is needed. A country like Ethiopia, with 20 million people in need of humanitarian support, 4 million of them affected by acute needs that need to be responded to immediately, needs additional support to scale up as well as to respond.
The needs in some parts of the country are more severe than in others. One part is that corner between Somalia, Kenya and Ethiopia. It is the lower part of the Somali region. We do not have all the partners that are necessary to scale up our responses to those pastoralist communities. In those places, we have seen that you can respond to immediate needs while working on medium to longer-term perspectives such as irrigation schemes where UNHCR and WFP, for example, are innovating and working on water systems, for example, as well as resilience.
So, three responses: one, greater funding support from the UK will be extremely important, and that is critical in the region; two, support from the UK to help us invest in medium to longer-term perspectives; and three, solidarity needs to be translated into greater support. As leaders are meeting at COP27 in Sharm el-Sheikh, this region is one where we can show concrete results as well as solidarity.
Q12 Chris Law: Michael, it has been harrowing hearing how appalling the circumstances are on the ground, so I guess this is an appropriate question. How would you describe the UK’s response in the last year to the current hunger crisis in the Horn of Africa? Has the response been adequate?
Michael Dunford: Across the board, we have not yet seen an adequate response. Speaking specifically about the funding that the UK Government have given to WFP, in 2019 the UK Government gave WFP in the region £181.5 million. In 2022 thus far, we have received only £55 million. We appreciate that there has been an overall reduction in ODI and the levels set and we know that, as is the case around the world, there is pressure on domestic budgets. However, unfortunately, the cuts that are playing out are hurting WFP’s ability to respond to the needs in the region at a time when needs are not plateauing but are continuing to grow. What we need to see is not a reduction in funding but an increase in funding just to try to maintain what the requirements are.
To give you a sense of it, this time last year WFP’s operations across the region needed $4.3 billion. Today, that figure is over $6 billion. The US Government are funding us to the tune of 75%; all the other donors drop off dramatically. Again, we appreciate the support we receive, but the bottom line is that we will need continued support from all donors, including the UK, for the remainder of this year into 2023 and probably beyond just to address the current crisis.
Q13 Chris Law: Michael, you said earlier that not only do we need to scale up the response, but even an increase in funding at this stage cannot guarantee anything, and starvation will still come. What would the consequences be if the UK and the international community failed to act to help tackle the hunger crisis in the Horn of Africa?
Michael Dunford: First and foremost, we will see a famine. Unless there is an upscaling of humanitarian support in the food security sector, the health sector, the WASH sector and the nutrition sector, people will die—and people will die at levels that we have not seen in recent history. There is no way of avoiding that, I am afraid. At the moment I have Somalia in my mind, but unless we see upscaling of activities across the region we could see multiple outbreaks of famine. Of course, that is the last thing we want, but that is the reality.
A point that I really want to stress is that this region is not a contributor of greenhouse gases. The change that is happening to the world's climate is not being generated out of the activities and livelihoods of the population who are on the frontline and feeling the brunt of it today. It really speaks to the sense of equity that we have globally not only to look after ourselves but to look after others.
Q14 Chris Law: Thank you. That is incredibly sobering. It is right to put it in the context of climate change and I hope that the UK Government have heard that loud and clear as they are at COP just now.
Mamadou, how would you characterise the UK’s response to the humanitarian crisis in Ethiopia since the outbreak of the conflict in Tigray, and what more fundamentally does the UK need to do?
Mamadou Dian Baldé: First, on the question you asked Michael, this region is hosting 4.9 million refugees and over 12.6 million internally displaced persons. If we do not act, refugees and IDPs who are already affected by the impact of climate change, those who can move forward, further beyond that region, are going to be further impacted. That will not only be an additional trigger for greater insecurity and displacement and instability, affecting states’ capabilities to run themselves, but it will also affect us all. I would say that it is critical also for us to act in terms of displacement.
Another dimension is that a place like that corner between Somalia, Ethiopia and Kenya is already hosting large numbers of refugees. Showing them solidarity by investing in and helping people with immediate responses while looking at medium to longer-term perspectives is critical as leaders are meeting at COP27.
Coming more specifically to the UK, for the past few years we have benefited from support from the UK—more than £25 million—but that ended in 2020, 2021 and 2022 due to all the changes in the UK Government. We have had some support but more is needed. As we speak, to support 900,000 refugees and close to 2 million IDPs we require $335 million, of which only 46% is funded, which can tell you that in terms of basic needs, the needs are great. Lack of funds has reduced by 50% the food rations that are required. Our colleagues at WFP are trying their best and we have been able to receive some additional generous support, so that will increase from 50% to 84%, but more support is required. Michael referred to the US Government’s support, which is our biggest support in the region and we recognise that. We will be appealing to the UK on this.
Coming to Tigray, Michael referred to all the needs that we have today. We do see opportunities for solutions. As part of the UN country team in Ethiopia, we are getting ready for whenever opportunities arise to support and provide humanitarian services—food, water, protection services, education and so on—but we also know that reconstruction and rehabilitation are required in the Tigray region. The UN country team is ready and waiting for signals from Nairobi this week to start working together with our humanitarian partners and development partners in Tigray and Amhara.
Q15 Chris Law: I have a final question for you both. When I ask what more the UK could do, given that funding used to be £181.5 million just a few years ago and is now £55 million, would you say that the bottom line is to restore that budget to where it was before, despite the fact that you need more than that now? Or do you need to see even more than that previous budget of £181.5 million?
Michael Dunford: I would be very happy to see previous levels reinstated. If there are opportunities to take those levels even further, by all means, we would love to have those conversations with the FCDO.
There is more that could be done. First and foremost, we appreciate very much the leadership that the UK Government have shown with regard to the Black sea grain initiative. That is making a difference, both with regard to physical commodities that are arriving from Ukraine and also the message that that is sending to international markets. We saw a reduction in commodity prices when that was first introduced. We saw a blip when we thought that the Russian Government were going to pull out, but those market levels improved again because the Russians have decided to continue. That is a positive development.
We also appreciate the leadership of the UK Government as a major shareholder in various IFIs, particularly the World Bank, making funding and liquidity available for various Governments impacted by the conflicts and the drought. We would encourage that type of enhanced liquidity to continue because, ultimately, we as humanitarians, as the international community, are there to support those Governments. The sooner the host Governments are able to bear increased levels of responsibility and meet the needs of their populations, the sooner the burden on the UN and in turn on our donors is reduced. Any mechanism that can be used to improve the economic situation in many of these countries and to enhance their abilities would be most welcome, and I think the IFIs are a clear example of that.
Finally, there is the opportunity for advocacy, domestically and internationally. When I was in London a few months ago, we met with the DEC. We encouraged it to launch an appeal that would allow the public to make contributions, and I think that would still be very worthwhile at this time. It would also raise awareness of the situation in the Horn today and why this is the responsibility of the international community. It may also create space for the UK Government to make larger contributions.
Q16 Mrs Latham: Michael , what steps, if any, can the UK take to help create a safe environment for the delivery of humanitarian aid in conflict-affected areas and areas that are controlled by non-state actors?
Michael Dunford: That is a very good question. The UK Government have a reputation for being very strong advocates for international humanitarian law and humanitarian principles. We would like to see them continue to make the case as to why humanitarian assistance must be delivered on those principles and why humanitarian actors and their safety and security must always remain sacrosanct. Our independence and the ability for us to operate without intimidation and to scale to meet humanitarian needs in crises is absolutely essential. Certainly, the UK Government have shown strong leadership in this area in the past and we encourage them to continue to do so.
Q17 Chair: A final question from me, and I will start with Michael and then come to Mamadou. What must the UK and the international community do to help prevent another hunger crisis in the Horn of Africa? We seem to keep on being surprised when this happens again and again.
Michael Dunford: We are talking about long-term investments in helping particularly communities, but also host Governments, to better prepare and build resilience to allow populations to better adapt to the changes that are taking place in our climate. It is essential that we meet the needs to save lives today, but we also need to start to prepare to save lives tomorrow, and that is in those longer-term resilience-building development types of activity that the UK has always invested in. The UK, along with all other donors, needs to continue to scale those opportunities. We have proof of concept in concepts such as adaptation and other types of investment, but it is the scalability of those concepts and how to leverage existing resources that is essential.
This crisis will end, ultimately, but because of climate in particular and because of conflict, we know there will be another one. There was a famine in Somalia in 2011. There was another risk of famine in 2017. Now we are on the cusp of a famine in 2022. You can see that those cycles are getting shorter and their severity is increasing, so how are we going to better prepare the populations? That is through those longer-term resilience and development investments. I would love to see the UK Government leading in that area.
Q18 Chair: I think this Committee would love to see that, too. It is one of our sadnesses that all the investment in stabilisation, whether because of health, democracy, conflict or whatever it is, has largely gone because of the cuts. Mamadou, what more could the UK be doing to prevent the next famine, wherever, sadly, it is likely to flare up?
Mamadou Dian Baldé: Thank you very much. It has been extremely helpful to hear from you and, of course, also to have this conversation with Michael.
Just before responding to the question, I want to say in response to the previous one that in a context like Ethiopia, the UK is a very critical partner to the humanitarian country team. The humanitarian country team is a forum where UN organisations, NGOs and some selected embassies come and join us. The UNHCR as the cluster lead agency always appreciates the support of the UK Government for principled humanitarian action blended with pragmatism and applied in a context like this one. We would like to see that support continue and we work on that.
On how to avert another situation, whether a famine or not, I told you earlier that two months ago I met Ethiopian women who were displaced because of the drought in Melkadida at that corner between the three countries. On Thursday I am going back there. I would like to be able to say to them not only that, thanks to support and solidarity from the international community, we have been able to respond to their current need, but that we have been able to invest in water management, agriculture and supporting their own resilience. I think that is what is going to make a real difference—that we invest in their resilience.
Fortunately for us, in a context like the Somali region, because this drought could be anticipated to some extent, we have now a resilience plan that is owned by the regional government of the Somali region. How can we invest in that resilience plan, working on water management and on investing in communities’ resilience so that they can take care of themselves? That for us is the way to go. This is what will really help us to move forward again. The call for solidarity made by the Secretary-General at COP27 is the one; these are the communities that contribute the least to climate change and they are the ones that are suffering the most. I think this is the time for us to show solidarity with the communities.
Chair: Thank you. Thank you both for what you and your organisations do. Mamadou, we are particularly grateful that you recognise the work of our embassy staff and development staff around the world. They do incredibly challenging work in incredibly challenging circumstances and the cuts definitely have not helped with the environment they have to operate in. Thank you both very much for your evidence today.
Witnesses: Fouzia Mohamed, Mudasser Siddiqui, Oliver Behn and Dr Asma Aweis.
Q19 Chair: We are now starting with our second panel, looking at hunger in the Horn of Africa. This is a hybrid session. We are joined by Mudasser and Fouzia down the line, and we will come to you to introduce yourselves in a moment. I will start by asking Dr Asma Aweis and Oliver Behn to introduce themselves and then start with some questions.
Dr Asma Aweis: I am Dr Asma Aweis Abdullah. I am the Medical Activity Manager at the Baidoa Somali mission.
Oliver Behn: My name is Oliver Behn. I am the Director of Operations for the Operational Centre, Amsterdam, which means I am looking after the global portfolio of 27 countries.
Chair: Mudasser, could you introduce yourself and your organisation, please?
Mudasser Siddiqui: Yes. My name is Mudasser Siddiqui. I am the Country Director for Plan International in Ethiopia and I am calling from Addis Ababa.
Chair: Thank you, Mudasser. Thank you for joining us today. Fouzia, could you introduce yourself and your organisation?
Fouzia Mohamed: Thank you for having me. My name is Fouzia Mohamed Ali. I am the Operations Director for GREDO, a national organisation that works in south-central Somalia.
Q20 Chair: Thank you very much. Dr Asma, you are from Somalia. I think you have been working with Médecins Sans Frontières since 2018. Just so that we can get an understanding of what it is like to be a Somalian in a country that sadly keeps having these extreme hunger situations, what is it like? What has it been like to live through it all?
Dr Asma Aweis: As you said, the situation is very dire and critical. That is not new to most of you; you have heard it on the news and seen reports. What I can say—being from Baidoa, being brought up and working in Baidoa itself, seeing patients every day, seeing the refugees coming from different areas—is that the data is not giving justice to the real situation on the ground.
Chair: Tell us what it is, then. Tell us what the real situation is on the ground.
Dr Asma Aweis: We have sets of complex humanitarian emergencies. We have had long-lasting conflicts over decades in Somalia, which have impacted on the health systems and the structures, but we also have financial markets inflation that has impacted on the lives of the people. We also have a lot of displacement, attributed to climate shocks and the failure of the rainy season for the fifth consecutive year. People are doing a lot of in-migration to the towns. In 2022 we have had more than 200,000 people come to Baidoa. This places stress on the existing health systems and the existing humanitarian assistance as well.
On top of that, there is also a reduction in the humanitarian assistance that is provided, due to covid and the cost of covid, and also the funding gaps due to major budgets being transferred to Ukraine-Russia. This has been a lot for a population that went through a famine in 2011, then a drought in 2017, and now poverty and a hunger crisis, and drought again in 2022.
People did not get enough to recover between one catastrophe and the other. That also makes them weak, not just in terms of malnutrition but in terms of other health systems—the primary healthcare system in the town, the vaccines for preventable diseases, the outbreaks that we have. It is almost a cycle of disease and malnutrition, because malnutrition makes them weak and susceptible to infectious diseases. In turn, infectious diseases are leading to a lot of malnutrition as well. It is a cycle that is impacting on the lives of the population, but a lot of factors are contributing to the conditions in Baidoa and the south-west state in general.
Q21 Chair: The previous panel said that in most places 10% of your income goes on food, but in Somalia it is 40% to 50%. How do you budget for that? How do you manage with that? In the UK we are finding our prices going up and up and it is having an immediate effect, but when 40% to 50% of your income goes on food because of the costs and the scarcity, what do you do?
Dr Asma Aweis: More than half of the population earn less than $1 a day. In Baidoa itself, we are hosting the second largest IDPs in the whole of Somalia. That means there is a lot of employment. There is a lot of crop failure and dead livestock, but again there is market inflation. To cope with all this for those who do not even have $1 it is very difficult. That is why you see people coming from their origin, walking days and days without means of transportation, and coming to seek help in terms of humanitarian assistance, help with nutrition and different perspectives that they need. But in the town there is still not enough to get, so it is very desperate. For those who are earning and those who are not earning, for the employed and the unemployed—it has an effect on everyone, but at different levels.
Q22 Kate Osamor: Thank you so much, Dr Asma and Oliver, for being here, and thank you to our panel online.
Dr Asma, you have just painted a very harrowing scene. It is very difficult to hear, but I have to ask you more questions because it is very important that we hear this and we can get this into the report. In your experience, what are the effects of malnutrition on the adult body, so the male, female and child?
Dr Asma Aweis: From our experience from our current programme in Baidoa, we have 20 out-patient nutrition sites where MSF is currently working in Baidoa, which we started in April. From April until now we have admitted more than 17,000 children under five. That basically means every week we are admitting around 600 children under five. But to be honest, this 600—when you screen, like, 700 this week, you will find 600 already admitted into the programme. You will find virtually all are either moderately acutely malnourished or severely malnourished; you will find few children that are normal that can be sent home.
Q23 Kate Osamor: In your experience, are children disproportionately affected by hunger?
Dr Asma Aweis: Yes, children are disproportionately affected but we also realise that mothers—pregnant and lactating women—are the second most vulnerable group. For this reason, we have been advocating for a while, and just days ago we established a service in Baidoa. Even if we establish as MSF and we are doing so much for them, it is a population of about 1.2 million, so what can just one organisation do? There is a lot of need. The most vulnerable groups here are the children, the women and the elderly.
Now we are supporting sexual and reproductive health in the regional hospital. The mothers who are coming to us are impacted not just by malnutrition but by the diseases correlated with it. When you have outbreaks and it is leading to this, it impacts on the outcome for new mothers. We have a lot of low birth weights in our facility, a lot of mortalities that are related to malnutrition but also to other maternal diseases, late arrivals, and the access issue is also impacting on this.
Q24 Mrs Latham: You talked about living on less than $1 a day. We were talking about that with the millennium development goals 22 years ago. If they are still living on less than $1 a day we have not moved far in 22 years and costs have gone up enormously.
However, my question is: with these people who are malnourished, especially the children, is that causing a big problem of stunting? When pregnant mothers have poor nutrition they are going to have stunted babies, and they never catch up. Are you seeing that a result of this at the moment?
Dr Asma Aweis: For sure. In the underweight category we have wasting and stunting in children. It is affecting the productivity of the whole community in general, because it is affecting children in the crucial first 1,000 days from conception to their second birthday. Many children do not reach that day. Those who are lucky reach it stunted. Being stunted means that normally they have not reached their full cognitive capabilities and brain development. It will impact the whole community as these are the assets for their future.
Yes, we see it in our facilities. We see it at first hand in our different programmes in Baidoa, but also in other programmes that we have in Somalia. There is variation from place to place depending on how much people are affected and how much they depend on agriculture.
Q25 Kate Osamor: Dr Asma, you spoke about the work that the organisation is able to do and the people you are able to support. What are the other aid agencies doing in the region to pick up the work that you are not able to pick up?
Dr Asma Aweis: We have a lot of local, national and international organisations in the south-west state of Somalia. As I said, every organisation is trying to do the best that it can live up to. The problem is that the demand is very high and the funds that all these organisations are getting is not equivalent to the disaster that is going on on the ground.
The reason I say the data does not do justice to the situation is that when you see that we have treated 18,000 cholera cases it is just a number, but when you see a mother come in with two babies, one on her lap and one holding her hand, and saying, “Okay, just treat this one,” we say, “No, let me check the other one on your lap,” but she will say, “No, he is okay,” and finally he is dead. He was not okay and she did not know. It is heartbreaking. That is the story of one mother, but it represents many other mothers who could not get access to this facility. That cannot be translated into numbers. It is human life that is on the edge. It is a child that is dying. It is a mother that is going through this.
I am a clinical person in a hospital, so I can tell you from my experience the story of a mother we admitted into our paediatric facility for measles, with her child in the stabilisation centre for nutrition. When they came to Baidoa they had walked 180 km—very far. When they got to Baidoa they were four in number: the father, another child, the mother and the sick child. We did not have an isolation facility for adults; we are running only a paediatric facility, not one for adults. We could not say to a mother who had walked 180 km, “We don’t have a service for you,” so we admitted her to our paediatric facility and the child to the stabilisation centre for malnutrition and measles.
Because of their late arrival and the complications that the child had, the child died two days after admission to the stabilisation centre. The mother died two days after her child. It is the story of a family of four coming to seek help but losing two of their family members and going back. Sometimes they may not get enough time to grieve their losses because of what they are going through. It is linked, and it is very sad that in 2022 people still die from vaccine-preventable diseases and other things that we could prevent, such as malnutrition, cholera or measles.
Q26 Kate Osamor: Yes. Thank you. Lastly—you touched on this slightly—would you say that, in your experience, men and women experience different consequences due to hunger?
Dr Asma Aweis: For sure.
Chair: Should we bring in some of the other panellists?
Kate Osamor: Yes, of course. Everyone is letting Dr Asma speak.
Chair: I know. Well, I am mesmerised, but I suddenly realised—Mudasser or Fouzia, would you like to answer that for us, please?
Fouzia Mohamed: Yes, it does affect differently. We know women are the most affected. They are with the kids—they remain with the kids. Even when fathers try to get employment or some kind of resources far away, the mothers remain with the children. She also tries to walk a long distance when the situation becomes dire, so that she and her kids do not just vanish in the place they are. She has to walk longer distances, with two, three or four kids by herself, and a security situation that does not support her. With all that put together, it is the mothers who take the hit. Yes, the fathers are also affected, but in most cases, as Asma can also say, it is the women who remain with the kids, who take care of them, who walk a long distance with them, who lose their kids on their laps, and who are also affected by the malnutrition and the drought. Sometimes mothers lose their pride. It affects them badly when they cannot feed their kids. As a parent you can feel when you cannot feed your crying baby. That also affects them emotionally and mentally.
Q27 Chris Law: Thank you for your testimony about what it is like at local, family level suffering the grave consequences of malnutrition. I am quite moved by it.
Oliver and Fouzia, what are the long-term consequences of malnutrition for a country’s development? Often when pledges are made or there is a call out to the public for fundraising we think, “Okay, we’ll put the money in,” and three months later it seems to all be fine. That is a public perception sometimes, but the failure is the long-term consequences in a country with malnutrition. I want to hear a little bit about that.
Oliver Behn: At Médecins Sans Frontières our speciality is not the long-term consequences. As a humanitarian organisation, we are very much addressing and working in the acute phase and in acute scenarios. Of course, what we are seeing in places like Somalia or South Sudan or many other places where you have reoccurring crises is that it takes time for the population to recover. The experience that many people had in Europe of how long it takes to recover from covid as a society I think gives us an idea about the strains that populations elsewhere have. If we use that as a measuring stick, I think it becomes clear how much effort is needed afterwards—as colleagues described earlier—to look at the holistic response.
It is the same now with this nutrition crisis. To only look at food aid would not address the crisis. It needs a comprehensive response on food, on health, on nutrition and on water and sanitation to break the cycle, and these investments need to be continued so that it can be built up again.
When Dr Asma and I were talking earlier, she described how the people who are coming to Baidoa have nothing left at home. They have nothing to return to. Long-term investment enables families and communities to rebuild after such a situation, so sustained funding is extremely important. As I said, that needs to happen in a comprehensive way. That would be my not-too-educated answer to that, because that is not really my specialty.
Q28 Chris Law: It is appreciated. Fouzia, can I come to you to answer the same question? What are the long-term consequences of malnutrition on a country’s development and how would we see them if we were there to see for ourselves?
Fouzia Mohamed: What I can say about that is that malnutrition affects the children, and they are the ones who will grow to youths and adults. A kid who goes through that may not even survive to reach his fifth birthday, but even if he does, with all the impacts it has on a child’s health and development, it will have a general contribution: if they have already been malnourished and an immediate response has not reached them, they will not survive the next one. By the next one, they will already be malnourished—they will already not be growing well—so it may not even be possible to make the next one.
We have seen that this is not just a one-time thing; it is a recurring situation with the climate impact. Let me give you a picture. A month or so ago the two main rivers of Somalia dried out. You can imagine that, not having rain for the rain-fed areas, there was no protection at all, and now the rivers have dried up too. Therefore, with all this malnutrition and the health impacts, and with people being uprooted from the communities where they live and call home, any small thing will put them back in an unrecoverable situation.
Q29 Chris Law: I have a follow-up question on that. We heard earlier about the severe cuts in the last two years, but Oliver made the important point that investment needs to be sustained over time, not just to recover but to help rebuild through the devastating losses, malnutrition and all the consequences of that. I assume you support that sustained development, but why do you think the UK and other countries have had such savage cuts and turned away at the most critical time for the Horn of Africa? Why do you think they have turned away in the last year or two in the way that they have? That is for Fouzia.
Chair: We have not directed any questions to Mudasser yet.
Chris Law: Oh, sorry, Mudasser. I had not seen Mudasser on the screen.
Chair: Mudasser, is that something you would be able to respond to?
Mudasser Siddiqui: In terms of the Horn of Africa, I would say that there are a few reasons behind the cuts, and the impact is visible here. We are coming out of the pandemic, we have a cost of living crisis in Europe, and there is the ongoing conflict in Ukraine and Russia, which is having an impact on the traditional donor countries.
Having said that, I think that there is also a bit of donor fatigue creeping in. If you look at the drought situation in the Horn of Africa, its severity and frequency is increasing. We had a big one in 2011. The international community mobilised itself. Then in 2017 the UK took the leadership, £700 million was committed for Somalia, and a global humanitarian conference was organised. A famine was prevented. Here we are again in 2022 discussing it, but the effects started in 2021.
We are seeing the cycle become more frequent, the intensity is increasing, and geopolitics, global economics and the pandemic are resulting in aid cuts. The UK is an example, with aid reduced to 0.5% of GNI, which is significant when it comes to the Horn of Africa. Also, because of the colonial background and the association between the UK and some countries in the Horn of Africa, the UK was traditionally one of the key actors on the ground. At this stage it is not, in aid terms.
Q30 Chair: Mudasser, you work with Plan International and you have worked with ActionAid, two organisations that focus on women and girls. Would you agree with the comments that you have heard so far, that it tends to be women and girls who are facing the brunt of these challenges?
Mudasser Siddiqui: Absolutely. The entrenched gender inequalities that are prevalent in society are resulting in a situation where girls are eating less and girls are eating last. When we did a survey in Somaliland, about one third of girls in certain parts of Somaliland highlighted that, because of this hunger and drought, they are now at increased risk of gender-based violence. We are talking about violence in terms of sexual harassment, domestic violence, and child, early and forced marriages.
A few weeks ago, I was in Borena in southern Ethiopia, which is one of the epicentres for drought in Ethiopia. I spoke to one of the girls there, who highlighted that homeless adolescent girls who are living on the street—those aged 14 to 17, a really critical age group—are particularly vulnerable to sexual and gender-based violence. UN OCHA estimates that 2,000 schools are closed across the country. That means that girls and children who would be in school receiving education and protection are not receiving it any more. Definitely, the gender aspects are very much at play over here, and I would agree with the other panellists.
Q31 Chair: You singled out 14 to 17-year-olds as being particularly vulnerable. My Committee colleague Pauline Latham has changed the law here in the UK to prevent child marriage. Is that what you were referring to? Is that one of the risks that these girls face?
Mudasser Siddiqui: Absolutely. They face the risk of early forced marriage. They face the risk of female genital mutilation because of that. They also face a risk related to trafficking.
Q32 Mr Sharma: My question is to all the panellists. How would you describe the response of the UK and the international community in the last year to the current hunger crisis in the Horn of Africa? Has that response been adequate?
Mudasser Siddiqui: I can start with regard to Ethiopia. If you look at the drought response plan for Ethiopia, the humanitarian actors on the ground estimated that we need $1.5 billion to respond to this crisis. As we speak, we have about $875 million. There has been a lot of generosity from the donor international community but it is not enough. We are talking about almost 20 million people, as Mamadou mentioned earlier, in need of humanitarian assistance.
Particularly on the UK’s engagement, the UK-based civil society organisations have been urging that FCDO and the UK Government should bring their contributions to about £750 million in the current financial year for the entire Horn of Africa. As we speak, they have only been able to provide £97 million. This is the data from the UN financial tracking system as of 3 November. Pledges were made of only £156 million and only £97 million has been disbursed. Clearly, there is a mismatch in what is expected, what is needed, what has been committed and then what has actually been eventually delivered on the ground.
The previous panel spoke about the contribution of the US. In the case of Ethiopia, the US has been by far the biggest donor. The aid budget from its side has been about 70% of the entire response funds that have been mobilised here in this country. On the other hand, the UK’s contribution is about 1.5%. Considering that, as I mentioned earlier, the UK was at the forefront of preventing famine in 2017, clearly there is a lot of room to cover over here.
Fouzia Mohamed: We are very thankful to the UK Government, the British people and UK organisations for tremendously supporting Somalia on the prevention of famine. However, the UK’s support has decreased from 2018 or 2019. When covid-19 came it decreased more—that is understandable: the UK Government have also to address local need, with people not able to work—and then came the Ukraine war, which has also taken the attention of the UK Government.
We knew that the UK was at the forefront, but for those years, for many different reasons—and maybe, since we are very far away from where you can feel what we are going through, that could also have reduced attention. In generally, yes, the UK supports, but during all these years it was always decreasing, for all the reasons that I have mentioned. But even though we are far away, we have that connection—that long relationship—and the UK is one of those countries that we look to when we need support. You are always at the back of our head for where to look for support.
Nowadays, the US Government are picking up where the FCDO cannot do it, but the need is bigger than what one country can cover. We are probably—
Chair: I am going to pause you there because of time. Do the other two panellists have anything to add?
Oliver Behn: There is one thing I would like to add. You have heard a lot in the past hour about the impact of the cuts, so I am not going to talk about that, but there is a second element when it comes to an adequate response. The overall humanitarian system is seemingly failing again to translate money into tangible actions in communities. The chain between talking about it and actually seeing an impact in communities is too long.
As MSF, we have seen this in many places over the past years. Whether these are the agendas around stabilisation or the nexus, when the political agenda, the development agenda and the humanitarian and emergency agendas are brought together, it does not work. The switch you need from development to emergency response is not so easy, and we see a lack of response capacity. We have talked a lot about that in the UN. There are also now critical voices in the UN around whether that nexus approach is working or not.
A concrete example is the situation in north-west Nigeria, where, as MSF, this year we have treated 140,000 children as out-patients for malnutrition and 23,000 children as in-patients with acute malnutrition. The north-west of Nigeria is not even considered by the Government or by the UN as a crisis place. They do not want to put it into the humanitarian response plan of 2023 and are only focusing—for reasons that I do not want to comment on now—on the north-east. But you can imagine with those numbers that this is not just a development issue; this is a really acute crisis with high levels of community violence out of pressures from the climate impact, which is exactly the same as we see in the Horn of Africa, but there is no response. We are literally the only one, from an international perspective, who is responding there to such a massive crisis. Therefore, it is not only about money. There is something more too.
Q33 Chair: Oliver, we are pushed for time, but could I ask you to say a little bit more? You said when humanitarian development and another piece—I cannot remember which one—come together, it does not work to trigger a response. That surprised me. I thought you were going to say the exact opposite.
Oliver Behn: Often, when it comes to a humanitarian crisis, it is politically not convenient for a Government to have a humanitarian crisis in their own country. Sometimes that response or openness to allow access for humanitarian actors is not given. Sometimes there are security issues, and development actors, or those who are working on resilience, are not best equipped to work in insecure environments and reach out into communities and so on, and to be safe there with the staff and deliver assistance as it is needed. Also, the international donor community is not always ready to apply pressure or use leverage in order to allow funding to flow into humanitarian assistance, and wants to keep the development stabilisation agenda going while the acute crisis is happening. It is a wider systemic issue.
This was very clear at the beginning of the Tigray crisis. We have been there from November 2020. It took five to six months for other actors to come in because of the consolidation in the Government, and organisations in Ethiopia largely being development oriented, if we think back to how the country was then. We are not able to switch gears to scale up a large-scale emergency response. When your house is on fire you don’t need somebody who fixes your smoke alarm; you need somebody else.
Chair: I will take and attribute that quote.
Q34 Mrs Latham: We know that COP27 has been meeting this week, so could you all briefly tell me what particular action you would like to see it agree to prevent future food insecurity in the Horn of Africa? Oliver, would you like to start and we will go around?
Oliver Behn: May I go later? I need to think slightly about that question.
Mrs Latham: Yes.
Dr Asma Aweis: It should not just be about the prevention of hunger or food itself; it should be a multi-dimensional approach, because they are linked. If we just think strategically about what we are going to do about food insecurity, hunger and malnutrition, what about the diseases? What about the lack of a primary healthcare system? What about WASH in the community? What about the non-food items that the population needs? What about the settlements and the informal settlements? If we only address one thing, it will lead to the other and then we will be dealing again and again with the same situation.
We need a strategy where we combat all these multi-layered problems integrated as one, in a way that we provide support and funding on the different factors contributing to this crisis—nutrition, health, WASH, non-food items—but also support the local, national and international organisations, because there are many areas that international organisations cannot reach out to. In Somalia, most of the population is on the outskirts, in areas that we cannot reach—not Governments, even the Somali Government itself, and not international NGOs. Here we need strategies where we support the people who can get access—the local organisations and the international organisations—but also prioritise where the need is and put accountability in place. We need to know what is going on now.
To go back to the question whether the international organisations and the UK are doing enough on the ground, we have a lot of TV and press people on the ground—there is a lot of attention on Somalia now. You will find every single press outlet that you would ever imagine on the ground, but you do not see as much action on the ground and that translation.
Chair: I am going to pause you there because we literally only have a couple of minutes.
Mudasser Siddiqui: I have a few points. One would be for the participants there to actually deliver on the now somewhat outdated commitment to $100 billion-worth of investment every year in climate mitigation and adaptation. We are not meeting that target. Most of the increased investment that we have seen recently in climate change adaptation is happening in the developed world rather than in developing countries.
What we also want to see come out of COP is investment in resilience building and adaptation in the Horn of Africa. If we are to work towards preventing the hunger crisis from turning from bad to worse and to ugly, yes, immediate assistance is needed, but if we don’t want to talk about resilience and adaptation we will all be here in three years’ time talking about exactly the same thing, looking at exactly the same situation of how to prevent famine. This is the reality of climate change. This is the reality that we are in, so it is very important that COP27 delegates recognise that.
It is also very important that the delegates over there look at the whole aid architecture—at how funds are disbursed and managed. The local civil society organisations on the ground are usually not on the scene, so it will be important for them to look at that as well.
Mrs Latham: Can we go back to Oliver and then Fouzia?
Oliver Behn: I will keep it very short. Adding to what has been said, it is important to recognise the connection between conflict and the climate crisis. I am not convinced we should talk about “climate change” any more. I think that is a ’90s term. People who are most affected by the climate crisis are often also affected by long-term conflict—sometimes low-level conflict and sometimes high-level conflict—as we see in the Horn and other places. That means that climate funding also needs the ability to respond fast to crisis situations, such as the floods in Pakistan. That also needs to be taken into account at COP, and not just the far-reaching, high-level goals. We could then probably debate how realistic it is that we will achieve them given the mediocre commitment that we are seeing in the implementation.
Fouzia Mohamed: Climate justice is important. A country like Somalia contributes even less than 2%, yet it is impacted by climate change and the climate crisis. Climate justice is important, as is an immediate funding increase to avoid famine, because all this is the impact of climate change. We also need long-term investment. We have seen it coming more frequently, and we need to invest in adaptation and mitigation measures—things like water resources, smart agriculture, youth investment, peacebuilding and good governance, as well as health and nutrition.
Chair: Thank you very much. I have to say that that has been a shocking and depressing session. One of the problems we have is that it has been incredibly difficult to get information from these regions. The fact that you have been able to put the reality out there will really help us challenge that the money is going from the UK Government to where it needs to go most. I would also hope that it encourages the rest of the international community to step up and do their bit. It is only by working in a collaborative way that we are going to both address the immediate crisis and, as you have so eloquently said, try to address the underlying causes once and for all. Thank you all very much for your time.