The sick often walk day and night for medical help at Yabelo Health Centre in southern Ethiopia. For many it is a wasted trip: the centre, which serves some 103,000 people, has no doctor, electricity, or running water, only a handful of medical supplies, and just four beds.
The nearest doctor is over 100 km away, and for surgery, patients would have to travel more than 300 km. "If they are seriously ill or in need of urgent surgery they will probably die," said Alemu Tuji, a nurse at the centre, which is situated in the remote area of Borena. "Our vehicle has also been broken [down] for the last two months, so they would also have to use a bus to get to a hospital."
Borena Zone, in Oromiya Regional State, is one of the forgotten areas of Ethiopia, and is still reeling from the severe drought that hit the region three years ago. The impact of the drought in the vast arid region bordering Kenya, dependent as it is on both agriculture and livestock, was devastating.
Because almost 80 percent of the livestock died, the Borana, the local ethnic group, lost their only source of income. Almost all their crops – an estimated 98 percent – were destroyed. At the height of the drought, almost one in five of the area's 1.6 million people was suffering from malnutrition. Among vulnerable groups like the elderly the figure was four times as high. Some three-quarters of the population were also dependent on food aid.
But the crippling effects of the drought has had a far more insidious impact on the Borana: because it destroyed their livelihoods, they have been unable to shake off the severe hardship that now has a stranglehold on them.
Today, according to a recent study by the government’s Disaster Prevention and Preparedness Commission, some 60 percent of the population of Borena is still "food insecure" – the highest proportion in the entire Oromiya region.
As a result, the Borana have become more marginalised and dependent on help from the outside world every year. Since the drought, poor rains in the last three years have exacerbated their many problems. Water shortages often force them to wander hundreds of kilometres with their cattle in search of grazing – sparking fierce clashes with rival ethnic groups like the Hamer.
The ethnic conflict – particularly with the Hamer – has also taken a heavy toll on both. Teltele, which is the main town of the area, has a single borehole, with a tiny yield serving more than 54,000 people. In rural areas, women and children often walk overnight to carry water back to their villages. Over-use of water sources by both livestock and people also leads to illnesses and serious waterborne infections.
For families, the threat of disease is acute. In some areas, the vaccination rate against the five main childhood diseases, including measles and diphtheria, is just 8 percent. In the area, only 10 percent of the population is within walking distance of the nearest health facility - which can mean the difference between life and death.
Another serious threat to the Borana is HIV/AIDS – arising in particular by the fact that truck drivers use the Addis Ababa to Kenya highway, which traverses the region, and the presence of several army camps. Borana culture not only accepts promiscuity but actively encourages it. A married woman is expected to take at least one lover, and is encouraged to do so by her husband.
Malaria, however, remains the biggest killer. Two NGOs - the local Action for Development (AFD) and the international agency GOAL - are now joining forces to combat the unremitting impact of the 1999 drought with a four-pronged comprehensive strategy. By joining forces, they say, they can target more areas with a wide-ranging approach using the skills they have both developed in the area. Joint action also means that they do not duplicate each other’s work.
They aim to break the downward spiral that many Borana are now in – and shift the focus from yearly food aid hand-outs by tackling the "root causes of chronic food insecurity". In this context, they are targeting around 84,000 people to improve their health, education and water facilities.
Women and children are being immunised against serious diseases and water access points are being built in some of the most far-flung corners of the region. The NGOs will train about 100 traditional birth attendants, who will radically improve the lot of pregnant mothers and their children.
But - perhaps most importantly - they have devised a "livelihood diversification" scheme by helping the Borana kick-start incomes and escape the cycle of poverty. As more and more Borana look for alternatives to cattle rearing, credit and saving groups and service cooperatives will help them explore new livelihoods and strengthen existing ones. Experience by AFD so far has shown repayment rates of 100 percent, and 58 percent of the people using the money have been women.
"A multi-sectoral approach is essential in Borena. Years of neglect combined with recurrent drought and the recent famine have decimated the asset base of the Borana communities," Catherine Fitzgibbon, the GOAL country director, explained. "Interventions that only address one or a few of the problems facing these groups are unlikely to have much impact. We are aiming to strengthen not only the communities physical and financial asset base but to build the human and social capital of individuals and communities as well."
Alemu Dowa, field coordinator of AFD in Yabelo, said the Borana were "marginalised and forgotten". He said lack of rain had taken a heavy toll. "This is one of the worst areas in the country," he said. "The drought has big consequences for the Borana and has depleted their livestock. They live below the poverty line, "the traditional way of coping is getting worse and worse, and the people are tending to shift from the pastoral way to the alternatives, like trading."
Alemu added that more and more Borana were trying to move away from pastoralism to a more fixed, sedentary lifestyle. "The way of pastoralism goes with rain and pasture and water, and if these elements are getting worse day by day, they want to stop that," he said. "The way they have been living the last 100 or 200 years is becoming non-operative now... A human being wants some kind of outlet where you can see other alternatives."
Alemu said offering food aid or education or health as separate packages would not help. "All the issues are tied in together," he said. "Without education their health problems will continue. Without the chance to escape from the poverty by giving them credit or loans they are stuck and the whole process will continue."
This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions
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