The champions of change at the frontline of the battle against childhood malnutrition
By Mike Pflanz
HARGEISA, Northwest Somalia “Somaliland”, 20 December 2010 – Halima Awali shushed the crowd of boisterous children gathered around her and said, “I was there to bring almost all of these babies into the world”.
Squinting against the fierce noon Somaliland sun, the smiling 60-year-old grandmother added, “Now I am here to make sure all of them stay here”.
Ms. Awali has been, for most of her adult life, a village midwife called upon by the community’s poorest women to help them through childbirth in places far from professional obstetric care.
Now, she has a new role, trained by UNICEF to be at the vanguard of the battle against childhood malnutrition here in Hargeisa, Somaliland’s capital.
Ms. Awali is one of an army of community mobilisers whose job is to keep a close eye on children in their neighbourhoods by carrying out daily door-to-door visits and advising mothers how to keep their families healthy.
In many of the areas that the mobilisers operate, more than a quarter of under-fives are moderately or severely malnourished.
Yet there are few health centres and the condition would likely go undiagnosed for months, leaving children at risk of deadly illnesses which prey on weakened immune systems.
This is the key aim of the community programme – to make sure that children are caught before malnutrition turns into something more serious, needing expensive hospital care beyond the means of most mothers.
The scheme is supported by UNICEF, with funding from the European Commission Humanitarian Aid Department (ECHO), UK Department for International Development (DfID), Governments of Italy, Spain, and Denmark, as well as the Italian and French National Committees for UNICEF, and Somalia Common Humanitarian Fund (CHF). It works alongside the Outpatient Therapeutic Programme which treats children identified by the community teams as malnourished, before they need to go to hospital.
There is widespread lack of knowledge about the benefits of breast-feeding, better diets, hygienic handling of food and generally making a child’s environment as sanitary as possible, Ms. Awali’s colleague Fatuma Gayid says.
“These things were not so much of a problem for our mothers when we were children,” says Ms Gayid, 52, who was also a traditional birth attendant for many years.
“But there were fewer people, we lived in rural areas where there was good pasture, clean water and not so much rubbish which we see now in the towns, even where the children play.
“We used to eat fresh food, now everything is in packets, imported from somewhere.”
These, together, are among the leading causes of malnutrition – especially a lack of hygiene causing recurring diarrhoea which robs children’s growing bodies of vital nutrients.
As they conduct their door-to-door tours through their neighbourhoods, the community mobilisers also give mothers advice on how to avoid the risks, and to keep their children healthy.
Chief among those suggestions is for them to breastfeed their babies from birth to six months, and only then to start slowly to introduce other foods.
Currently, less than 10 per cent of mothers in Somalia exclusively breastfeed their children in their first months of life.
Instead, milk formula, livestock milk or water with sugar added are all given to babies by mothers who think that breast milk is not enough for their children to grow.
“It’s a huge problem,” said Kaltun Hussein, National Health Officer for the Somali Red Crescent Society, which works with UNICEF across Somaliland.
“It’s a social problem, a problem of lack of education, a problem of women thinking that the bottle is civilised and the breast is barbaric. It means babies are exposed to germs from far too young an age.”
For Khadara Ahmed Nur, the recommendation to breastfeed her first child, a son named Mohamed Yusuf, came too late.
“He died when he was six months old,” she said during a visit by Ms. Gayid to check on her two other children.
“I had no knowledge of what to do, my mother told me to feed him water and goat milk, but he fell sick with diarrhoea and he never recovered.
“Now these other children of mine are all breastfed, and they are strong. But I am so sad that I did not know these things when Mohamed was born.”
As Ms. Awali and Ms. Gayid continued their rounds one recent Thursday afternoon, they were greeted by dozens of mothers who before had nowhere to turn for free advice on how to keep their children well.
“At first when she came here offering help, I was not friendly, I thought that I needed no help,” said Tagiallah Mohammed, a mother with 10 children living in Sheikh Nur, on the outskirts of Hargeisa.
As she spoke, she held her three-year-old daughter Hodan as Ms. Awali expertly measured the circumference of her upper arm – a quick way of checking any child’s state of malnutrition. On this occasion, all was well.
“Now we are close friends,” Ms. Mohammed added. “Three times, Hodan has fallen sick, and these ladies have stopped it from becoming much worse. Without them, maybe she would not be with me still today.”