My print column examines the numbers defining the famine in southern Somalia. Humanitarian groups have settled on quantitative definitions of famine, including a mortality rate of at least two people per 10,000 per day, on average. That means some areas with a death rate of between one and two people per 10,000 each day, but pervasive malnutrition, aren’t technically experiencing famine.
By some other standards, such mortality rates do rise to the level of disaster. Sphere, a set of standards for humanitarian emergencies struck by a consortium of aid groups, defines a disaster that demands response as one in which mortality has doubled the baseline rate — which, in sub-Saharan Africa, typically is 0.4 to 0.5 per 10,000. “If we are on the ground in an emergency, in a place where the death rates were 1.5 per 10,000 per day, we would be calling every relative and every person we know to ask them to do something,” said Emmanuel D’Harcourt, senior health director of the aid group International Rescue Committee.
Developers of the numerical definitions — part of the Integrated Food Security Phase Classification, or IPC — say the thresholds were chosen carefully. The chosen threshold value for mortality “was considered to be the one better corresponding to a level of alert corresponding to famine,” said Francois Kayitakire, leader of the Food Security Assessment Action, which is part of the Joint Research Centre’s Monitoring of Agricultural Resources Unit. “Being a consensus figure, the figure does not mean that single experts would not have a different opinion.”
One advantage of the Sphere definitions is that they are flexible, bending to the baseline levels of mortality in the affected region. As it turns out, though, impoverished, war-afflicted Somalia may have such a high baseline mortality rate that the two sets of standards might converge. Medical epidemiologist Peter Salama said the baseline mortality level in the affected regions may be as high as one per 1,000 per day.
The definition uses overall mortality rates, rather than rates of starvation deaths, because such deaths are difficult to identify. “Starvation is rarely if ever a cause of death in a famine,” said Gerald Martone, director of humanitarian affairs for the International Rescue Committee. Instead, malnourished people more easily fall prey to disease. “People actually die of pneumonia, diarrhea” or other conditions, Martone said.
Having precise standards boosts credibility, said Nicholas Haan, global program manager for IPC. “Rather than have standards which could be susceptible to ‘crying wolf,’ it is better to clearly identify meaningful categories of food insecurity,” Haan said.
Getting credible results was crucial before declaring famine in Somalia, said Grainne Moloney, chief technical advisor of the famine-monitoring group Food Security and Nutrition Analysis Unit. The group’s surveys last month were the source of numbers confirming the food crisis had reached famine levels. Interviewers are Somalis from the region in which they work, “and because our staff don’t distribute commodities they are much lower profile than other agencies — we don’t have offices [or] official cars with our logo on it so we work in a low-profile manner and hence we have more access than other agencies,” Moloney said. U.S. Centers for Disease Control and Prevention scientists consulted on the results and reported them in this week’s Morbidity and Mortality Weekly Report.
Moloney plans monthly surveys going forward. “It’s going to cost an extra $800,000 to do five rounds of surveys, 18 surveys each month in eight regions of Somalia,” Moloney said. Nonetheless, “we have to do this” — to monitor the spread of famine and produce credible evidence of its existence.
Before famine was declared, Moloney recalled having “sleepless nights” before deciding in March to issue a release referring to the possibility of “localized famine conditions.” That was strong language for the group, which had never declared famine in its history up to that point, yet the release didn’t have the media impact she expected. Moloney wondered if more specific projections, such as ones that contained estimates of the probability of a famine breakout, might have had a bigger impact. “I think because the language still ambiguous we didn’t get the reaction we thought it might,” she said. “Maybe we need to use different language. It is important we review what happened in the last six months.”
John Scicchitano, program manager at the U.S. Agency for International Development for the Famine Early Warning System Network, or FEWS NET, said the group has explored attaching probabilities to its forecasts. But the underlying numbers used in its forecasting model, such as long-range climate forecasts, can be iffy. “For most of the countries we cover, we get something like this: 25%/40%/35% chance of below normal/normal/above normal rainfall,” Scicchitano wrote in an email. “That’s just one variable, and a low level of confidence, and there are dozens of other variables to consider.”
The famine alerts didn’t yield an outpouring of support, even though the stage just before famine in IPC definitions is described as a humanitarian emergency, Justus Liku, technical advisor to IPC, noted. “The key objective is to arrest the situation early enough and prevent it from becoming a famine,” Liku said. “Unfortunately, the reality is a tendency to act too late, when the situation is very bad.”
There is also a tendency to focus too much on food donations, and not enough on supporting people’s livelihood, such as with jobs, so they can afford food after the donations run out. “Usually that doesn’t hit as strong a chord as saving lives” immediately, lamented Shukri Ahmed, senior economist at the United Nations’ Food and Agriculture Organization.