The food crisis that is devastating lives and killing children throughout the Horn of Africa is not restricted to the arid lands where media attention and donor dollars are now focused. In informal urban settlements, malnutrition affects thousands of children but remains largely overlooked by an aid community that is not sure when to label an ongoing crisis an emergency.
Over the past five months, Concern Worldwide has recorded a 62 percent increase in cases of severe acute malnutrition (SAM) at clinics it supports in Nairobi slum areas.
"Since we are only reaching 33 percent of the slum population we know there are likely to be lots more people not getting help," said communications manager Elizabeth Wright.
"Everything is sort of combining for a perfect storm," Wright told IRIN. "We're going to be seeing a full-scale nutritional emergency in the urban context. It will be too late."
Peter Hailey from the UN Children's Fund (UNICEF) concurred: "The food crisis, the fuel crisis, and so on are probably affecting people in urban areas more than in the north."
While the 2.3 percent global acute malnutrition (GAM) rate Concern found in many of Nairobi's slums falls well below the emergency threshold of 15 percent, more than 8,600 children under five are acutely malnourished in these areas. By contrast, because of its sparser population, northern Isiolo district's 15.7 percent GAM rate equates to fewer than 3,000 children under five who are acutely malnourished.
"This is not as visible as cattle and goats dying," said Amina Abdulla, programme manager for urban livelihoods and social protection at Concern. "But the crisis is as severe."
In Korogocho, a Nairobi slum, Rabaha Mohammad is responsible for feeding herself and 10 other people who share her rented room. "There are days when we don't have anything to eat, but we might borrow some money or buy food on credit to have something for that day," she said. Mohammad owes her creditors KSh5,000 - more than US$50.
She and her children subsist on one meal a day - some rice with cabbage and tomatoes, and sometimes tea and bread. "They don't complain of hunger much," she said of her children. "They only cry about it once in a while."
Part of the reason malnutrition in slums is paid relatively scant attention is that it rarely reaches the emergency level. In Turkana, 15 percent GAM would translate to 13,000 children. But in Nairobi district, 13,000 malnourished children would reflect just a 3.45 percent GAM rate."Emergency thresholds for malnutrition applied in rural areas are not applicable in poor settlements where population density overrides the health indicators used in rural areas," said Thandie Mwape, a humanitarian affairs officer with the UN Office for the Coordination of Humanitarian Affairs (OCHA).
A 2009 assessment by Oxfam, Concern and CARE found that "the common use of percentage rates over absolute numbers of children is greatly distorting when used for urban slums, as this masks the high numbers of children affected in such densely populated settings".
"If GAM rates in Nairobi's slums reached the internationally recognized emergency threshold of 15 percent, the caseloads would exceed the government's and humanitarian community's capacity to treat and respond," said Wright. She said Concern was working to develop indicators for urban emergencies.
People living in slums are especially vulnerable to food price changes because so much of their income goes on food, and the lack of regular employment makes planning and saving difficult.
To survive the "alarmingly volatile" increases in food prices, said Wright, people have reduced their food intake and turned to negative coping strategies such as engaging in sex work, taking children out of school, or selling assets.
While international assistance is focused on the swelling numbers of refugees and devastated pastoralists, slum conditions often fall far short of the minimum shelter and sanitation standards established for responses to humanitarian crises.
A quarter of Korogocho residents cannot access the 15 litres of water a day suggested by the Sphere Project . Instead of the recommended 45 sqm of total living space, they have on average 12.5 sqm per person.
The 200,000 or so residents have just two government schools and one health facility. They pay five times the usual price for water, according to Concern. They even pay to use a latrine.
"They live in a fixed crisis, day to day," said Wright. "Because there's poverty all the time, it's hard to know when they reach a tipping point."
"Malnutrition in the urban areas of Kenya is there all of the time, it doesn't get the attention it should, and some of the background causes of malnutrition rising in the north are the same in the urban areas," said Hailey. "It's the same general problem of the population in Africa becoming more and more urban and us overlooking all of their basic problems."
"There's never been an interest in the urban areas from a humanitarian perspective," said Concern's Abdulla, explaining that donors are more eager to respond to emergencies, not chronic conditions. "Now with the situation in the north, even getting their ear becomes difficult."
Pauline Wangoi Mungai came to Korogocho 30 years ago, when the place was still being built. She sells vegetables in a small shop on the roadside.
"People used to come and buy a bucket of potatoes," she said. "Now they come with KSh10 [1 cent] and buy one potato."
Mungai said she would probably have to raise the price of her vegetables even more to make a profit. In her 30 years in the slum, she had never seen things so bad. "This is the worst. This is the big one."
Alice* became a sex worker a year ago when she could not make enough money washing clothes and doing casual work to buy food for her children, and could not find any other job.
Alice said "many more" women have turned to sex work since the drought started and food prices went up. With the KSh50 ($0.90) she makes most days, Alice can buy a little rice for herself and her three children, and maybe some water. She has not paid rent in two months. Her children were chased away from school a month ago when the money ran out to pay the fees.
Alice said the baby she held in her arms was crying because she had not been fed all day. Alice has so little food to eat she can no longer produce breast milk.
"Most days we only eat in the evenings," she said. "Before, I could afford to buy flour and cook, but now we have to buy [cooked] rice on the street."
*One name used to protect her identity
- Provided by Integrated Regional Information Networks.
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