Summer 2022

Horn of Africa Tips Closer to Famine

– Iris Bollemeijer and Faith Owuor

Two aid workers from International Medical Corps provide an up close look at how Russia's blockade of Ukrainian grain exports is affecting those already experiencing hunger.

The trade ties that link Ukraine—Europe’s biggest grain exporter—with the markets of the Middle East and East Africa have long been valuable for both sides. But, this year, with Ukraine at war and the Horn of Africa in the throes of a multiyear drought and a deepening food security crisis, the stakes involved for each partner could not be higher, because this trade has been severed by a Russian blockade.

In Ukraine, the importance of all this is often overshadowed in the public mind by the bitter war for survival.

Unlike other major grain exporters like India and China, which depend strongly on homegrown crops for their own needs as well as for export income, Ukraine’s agricultural products—which include fertilizers and sunflower oil, in addition to wheat and corn (maize)—mainly end up in foreign countries. Collectively, they provide a significant source of revenue for the country.

This map, courtesy of International Medical Corps, shows the normal route of Ukraine grain during normal times.

In the nations of Somalia and Ethiopia on the Horn of Africa, the loss of their single-largest grain and fertilizer supplier constitutes a disaster—one in a lengthening list of woes to befall them as they struggle to feed their people in the depths of one of the worst food-security crises in recent history.

This year, seasonal rains to water their livestock and nourish their crops failed for the fourth consecutive season, when the April–May rains, called gu, fell far short of normal. Food security conditions in the region are dire—and are expected to deteriorate further.

Shortages of wheat and other grains on global markets have driven up prices to a point that, when they are available, they become unaffordable to farmers and pastoralists struggling to feed their remaining livestock.

With the Russian blockade of Ukraine’s Black Sea ports, and some of the war’s most intensive fighting in areas in and around these ports, it’s hard to imagine how sizable Ukrainian grain exports could leave for the Horn of Africa via the Black Sea anytime soon, says Javed Ali, director of International Medical Corps’ emergency response team operating in Eastern Europe.

As a global humanitarian relief group, our response in Ukraine has a nutrition component, including an infant and young-child feeding program that encourages pregnant and lactating women to breastfeed their children and avoid the heightened risk of infection from dirty bottle-feeding paraphernalia that often are a danger in wartime conditions. But our team there has devoted far more resources to other, more urgent issues, such as ensuring continuity in a health care system that the Russians have attacked repeatedly and with an intensity rarely seen since the Geneva Convention to protect hospitals in times of war was ratified in 1949.

A woman and infant in the mother child room at the Lviv railway station in Ukraine. Shutterstock/Sodel Vladyslav.

Ali believes the biggest single impact of the Russian invasion has been the destruction of Ukraine’s health care infrastructure and the resulting damage that has weakened the country’s network of hospitals and special-needs facilities—all needed now more than ever.

When seasoned humanitarian workers see the camels start dying, it’s an alarm bell. We know something is very wrong.

Among the hundreds of health facilities hit during the first three months of war is the regional blood bank in Ukraine’s second-largest city, Kharkhiv. It survived repeated shelling and was forced to move its operations from the upper levels of a three-story building into the basement, so staff could work through the bombardments to better keep up with the heightened demand for blood.

In the northern city of Chernihiv, Russian shells struck a tuberculosis hospital more than 30 times, destroying the building and requiring the evacuation and relocation of patients to more-crowded temporary accommodations. Though we are refurbishing another building elsewhere in the city that will take patients for the short term, we also are involved in a longer-term solution, serving on a technical team working with the regional government to develop an all-new infectious disease facility for Chernihiv and the surrounding areas, where drug-resistant tuberculosis is endemic.

At the same time, some 4,000 miles south in the Horn of Africa, our teams in Somalia and Ethiopia are engaged in a fight to save lives in a very different all-consuming emergency: addressing a crisis driven by growing food and water shortages that have taken parts of the region to the brink of famine.

By the end of May 2022, fuel prices had risen to a level 15 times higher than when the conflict began in November 2020.

The U.S. government’s Famine Early Warning Systems Network reported in late May that pasture conditions in southern and southeastern Ethiopia were now among the driest on record, leaving an estimated 2.5 million livestock dead between late 2021 and May 2022. Herd sizes were expected to decline further as the births of new animals drop, more succumb to the extreme conditions, and farmers slaughter more of their remaining animals to keep their families alive. Conditions are expected to worsen even further as the dry season persists.

Shortages of wheat and other grains on global markets have driven up prices to a point that, when they are available, they become unaffordable to farmers and pastoralists struggling to feed their remaining livestock. The Russian invasion of Ukraine and blockade of Ukrainian ports have helped drive both grain shortages and higher prices globally. At the same time, prices are rising for other imported products needed to produce crops, such as fuel, fertilizer, and seeds.

In northern Ethiopia, where fighting between national government forces and a regional separatist movement in Tigray have further complicated deteriorating economic conditions, the cost of food more than doubled between May 2021 and May 2022. By the end of May 2022, fuel prices had risen to a level 15 times higher than when the conflict began in November 2020.

In such conditions, International Medical Corps and other groups working to ease the crisis have started distributing limited amounts of cash to preselected families—usually those with pregnant or lactating women and children younger than five, who are considered especially vulnerable to the deteriorating conditions—to enable them to buy food and other essentials. These groups also support these families by providing seeds, fertilizer, and other ingredients needed for so-called kitchen gardens. These food security programs are linked with a nutrition program equipped to treat young children for acute malnutrition.

A Somali mother gives her one-year-old boy ready-to-use therapeutic food at Galkayo Hospital in central Somalia. The food provides vital nutrients children need to recover from malnutrition. The family resides in the Dabagab area, roughly 55 miles from Galkacyo, where the drought had prevented his parents from providing the nutrition needed to sustain a young child’s normal growth. Photo courtesy International Medical Corps.

The COVID-19 pandemic has also worked against poorer families in the region, which once relied on money sent home by relatives working in well-paying jobs overseas in hotels and other service industries in the Middle East and elsewhere. But a drop in business, family, and tourism travel during the pandemic has cut deeply into such jobs, forcing many to return home.

Sometimes migration is the only answer.

As herds and crops decline, a family’s fortunes decline with them. In many Ethiopian and neighboring Somali villages, family mealtimes have dropped from three per day to just one. Instead of coffee with farm-fresh milk, the staple drink has become a strong, bitter tea, drunk black. As wells that once produced year-round go dry, daily treks to find water—often in blistering heat—get longer. Humanitarian relief groups, including ours, now truck water to traditional watering points—a costly but necessary attempt to sustain both people and their animals through the drought. But the growing number of dead cattle and camels littering the roadside in both countries are signs that more is needed.

When seasoned humanitarian workers see the camels start dying, it’s an alarm bell. We know something is very wrong.

Nazrawit Yohannes, our nutrition coordinator in Ethiopia, tells the story of a once-successful farming family in the eastern area of Oromia, not far from the Somalian border, that has been virtually wiped out by the drought. When several of the family’s cows and goats died, the milk that made children’s meals healthy disappeared—as did the cash that the mother earned by selling the remaining milk at the local market.

As conditions worsened, the father left to work as a day laborer in a town more than 100 miles away. He hoped to send money home, but the high cost of living in an urban area exceeded his meager wage. Out of money, the mother walked for miles each day to fetch polluted water to drink and bits of firewood she could sell to put what food she could on the table. The family hit a new low when the children became malnourished, and then sick from drinking unclean water.

Residents of Qarsooni village located in a rural village outside Galkayo draw water from a bladder filled with water we trucked into the area. Courtesy International Medical Corps.

The picture is little different in Somalia, where families also are losing livestock and producing poorer crop yields due in part to shortages of Ukrainian fertilizers caused by the Russian blockade. As a result, these crops fetch less money at local markets—and less food for the family table. There is a sense of despair in many places now.

This downward spiral has left 80 percent of Somalia’s population reliant on humanitarian aid for their survival. But this assistance is running short, and this reality leaves many communities and families facing a heart-wrenching decision: Do they stay put and try to wait out a drought as conditions deteriorate further? Or do they risk a grueling journey to one of the large displacement camps across the border in Ethiopia, where they’ve been told there is food? Either way, it’s a decision fraught with danger.

“Sometimes migration is the only answer,’’ notes our Ethiopian colleague Yohannes: “We managed to help 620,000 people last year in Ethiopia—but there are 15 million affected. We are doing a lot, but this crisis is much bigger than we are.”

Many Somali families head for the Dollo Ado cluster of five displacement camps that house more than 200,000 people in an isolated border district of Ethiopia. Stories shared among refugees arriving there about their horrendous journeys from drought-stricken areas of Somalia are often heartbreaking.

A view overlooking one of the Dollo Ado displacement camps in southeastern Ethiopia. Courtesy International Medical Corps.

We heard a story recently about a mother traveling with her three children—a son about six, a daughter of three, and an infant of about six months—walking from their village in Somalia to Dollo Ado, hoping for relief they had heard awaited them if they could reach the camps. On one of the trek’s final days, after the boy had carried the baby for hours without food or water, a combination of exhaustion, hunger, and dehydration overtook him. He could no longer carry his infant sibling. After some discussion, the mother—her own strength spent—took the baby, placed it on the roadside, gathered her two remaining children, and began once again to walk. The scene was horrific and pitiful—the decision of an exhausted mother reminiscent of Sophie’s Choice.

We hear such stories often when we talk with refugees. We’ve found almost everyone has lost someone—often a child. It’s extremely sad, and for us, there is another tragedy: that in 2022, with immense wealth around the world, a child can die of something as simple as the lack of food and water.

As more families decide to migrate to places like the Dollo Ado camps, and the camps grow more crowded, with little additional funding available, the services for newer arrivals dwindle. A new round of funding to support emergency assistance for Somalia launched by the United Nations in Geneva earlier this year netted just 2 percent of the campaign’s target.

Yet needs continue to grow.

The International Medical Corps’ nutrition coordinator for Somalia, Naomi Mwikali, was reminded of that fact one afternoon in early June, when she returned to her Mogadishu office to find an alert sent by a field team in the city of Galkayo. It said that about 2,000 people had arrived in the area during the past several days, after walking roughly 100 miles from the coastal Hobyo District, mainly to escape drought conditions that had claimed the last of their animals. The group’s leaders had requested latrines, water, food, and shelter as soon as possible—and added that many more families would be arriving in the coming days. But with funding tight, what little food that was available was already rationed.

Where this crisis goes in the coming months remains uncertain. We don’t use the word “famine” because it has a very precise definition—but it’s headed in that direction. As the war in Ukraine grinds on with no immediate end in sight, precious grain remains out of reach that could ease the hunger and the food security crisis for both families and their livestock in the Horn of Africa; we fear that many more people will die.

Iris Bollemeijer and Faith Owuor.

Iris Bollemeijer is an International Medical Corps nutrition adviser whose areas of responsibility include both Somalia and Ethiopia. Faith Owuor is International Medical Corps global adviser for food security and livelihoods. Javed Ali, the International Medical Corps’ director of emergency response, also contributed to this story from Ukraine.

Cover photo: One example of the impact of the prolonged drought in the Horn of Africa, and a lack of grain for livestock. This photo was taken in a rural area near the city of Burao, Somaliland. Photo courtesy World Food Program.