By Deborah Underdown, CARE UK

Tasinne, 6 year old Syrian refugee. © 2013 Deborah Underdown/CARE

Ibtisan sits on the floor surrounded by her five children. There is no furniture, just a few cushions scattered about. One girl stands out; she is wearing a bright red woolly hat. Her name is Tasinne and she is 6 years old. Despite having 8-month-old twins to look after, Ibtisan is totally focused on Tasinne. She sits on her mother's lap and cuddles in as close as she can get. Tasinne has cancer.

It wasn't the shelling or bullets that made this mother leave Daraa (one of the areas worst affected by the conflict in Syria) but the fact that she couldn't get any medicine for Tasinne.

"We had been living in constant fear for a year and a half. We were staying in underground shelters and would only leave to get bread; we had to crawl along the streets because it was so dangerous," she explains.

"But when Tasinne got sick we took her to a doctor and they told us she had cancer of the kidney. I knew then that we would have to leave. There are no medical facilities available anymore."

Ibtisan's husband stayed in Syria to try to protect their home. She went Amman, Jordan's capital, where she's living in an apartment that she can't afford. She is already two months behind on rent. Every penny she gets goes towards Tasinne's medical care.

"The chemotherapy costs 200 JD [about $300 USD] a session and I have been told she needs one session a week until July. CARE gave me money to pay for the last two sessions but I don't know how I will pay for the next one," Ibtisan says. "She had a session yesterday and is now suffering from the side effects. I want to take her to the doctor but that will cost more money – what can I do?"

When Tasinne is asked what she would like to be when she grows up she states, "A doctor so I can give out free medicine."

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Gêzim Hoti is the Director of "Health for All," a CARE partner organization in Kosovo. This is his personal account:

Gêzim Hoti is the Director of „Health for All“, a CARE partner organization in Kosovo. Their aim is to challenge the bad health situation of Roma, Ashkali and Kosovo-Egyptian communities in Fushe Kosovoe, home of about 5.000 people. (Photo: CARE/Johanna Mitscherlich)

In Kosovo, most of the so called RAEs – Roma, Ashkali and Egyptians (ethnic minorities amongst the population) – live in separated neighborhoods. Their access to education, health, employment and adequate housing is limited. Most of the families live in small makeshift houses, without running water or sufficient hygiene facilities. The children play in the streets on huge, burning garbage piles. The poor health and hygienic conditions make these neighborhoods a perfect breeding ground for diseases and epidemics.

I am Ashkali myself and know what it is like to grow up at the margins of society. This is why in 2003, I was one of the founders of the organization "Health for All." Our aim is to challenge the bad health situation of RAE communities here in Fushe Kosovoe, home of about 5,000 people.

When we started almost 10 years ago, we had a lot of plans and visions, but little means. Our intentions were good, but our possibilities in terms of capacity, staff and funds were very limited.

However, this changed when we started working with CARE. We really grew up with CARE. The CARE Kosovo staff supported us with almost everything that was needed to build up a strong organization. Most importantly, CARE provided trainings with internationally renowned doctors from Pristina. They taught members of the RAE-community about HIV/AIDS, family planning, that women should not smoke or drink during pregnancy, and they discussed everyday health issues. The participants were then certified as official health educators, who themselves are now responsible for conducting trainings. They also frequently visit families and advise them on health behavior, hygiene standards and prevention.

The project with CARE ended in 2009. But even now, almost four years later, most of the educators are still active. The knowledge is still there. Especially for women, it is important to have safe spaces to talk about sensitive health issues. In the beginning, men in our community were quite reluctant when we brought boxes with condoms to their houses in order to allow for better family planning. Now, a few years later, they drop by voluntarily whenever they have to refill their drawers.

Women also come in when they have questions. Whereas we almost had to track them down in the beginning, they now show up and ask questions quite freely. They just know that we are here in our office to support them. CARE has helped us to achieve all this. We took our first steps with CARE and have never stopped walking since. Even when cases of domestic violence occur, women contact us and we try to act as mediators.

Also, CARE has opened a door for us by connecting us with other RAE-NGOs throughout the Balkans. With combined efforts we are now exchanging ideas and lobbying for our common interests and community needs.

What makes me particularly proud is that some of the women from the community have also started to become educators. Haxhene Gashi, for example, did not know much about health issues when we first visited her. Today, she raises awareness on issues such as symptoms, diseases and hygiene among her neighbors. What we have learned from CARE years ago is still the foundation of our activities today.

Collecting garbage and having fun does not sound like a matching pair? Sixteen-year old Gramos Salihu from Pristina would strongly disagree. He is part of the "Be a Man" club in Kosovo – a group of young men between 13 and 19 years of age. For over a year now, these youngsters have done almost everything together, even collecting garbage. "We organize different campaigns and activities to improve our community," the young man explains. They named the campaign "Let's do it, Kosovo!"

The 16-year old Gramos Salihu from Pristina is part of a "Be a Man"-Club in Kosovo – a group of young men between 13 and 19 years of age. (Photo: CARE)

Around 70 percent of the population of Kosovo is younger than 26. This is a huge opportunity for one of the poorest countries in Europe – but also a challenge. In some places, classes have to be held in shifts because there aren't enough teachers. And once the young people graduate, they compete for jobs.

Nearly 70 percent of the youth are unemployed. There is a strong feeling of frustration and uselessness, and extracurricular activities are rare. And Kosovo is still dominated by chauvinistic behaviors and traditional stereotypes about what it means to be a man.

CARE's "Young Men Initiative" works to overcome these attitudes. The idea is to prevent gender based violence and discriminatory behavior against women and girls by working with teenage boys. They usually learn how to talk and act from their fathers and other male role models. Meeting other young guys and openly discussing their role and challenges in society helps to break barriers and reflect on attitudes and roles. CARE uses the same approach in the whole Balkan region and introduced it to Kosovo in 2010.

The youngsters meet up in the afternoon to play soccer or watch movies. And they come up with joint activities, such as removing garbage from the public park or handing out roses on International Women's Day. At the same time, they take part in workshops to discuss gender roles, violence and sex - topics that are rarely part of the official school curriculum. In small groups they can ask questions about how to use a condom or other personal matters.

The "Be a man" clubs share one common logo in all Balkan countries: A biceps with a brain painted inside, to show that real men don't just use their physical force, they act with their head.

"I changed a lot through the "Young Men Initiative," says Gramos. "Now, I am able to speak about my feelings without feeling ashamed. I really evolved and think more about how I treat other people and what is important in my life."

He likes to talk about the workshops and activities with his friends and family and encourages them to join. "I want everyone to become part of the "Young Men Initiative." He himself is eager to stay a member as long as he can.

 Johanna Mitscherlich, 2012
CARE Deutschland-Luxemburg
Mitscherlich@care.de

By Amy Brenneman

In December, actress Amy Brenneman traveled to Peru with her family and CARE to visit the women and families benefitting from CARE’s maternal and child health and child nutrition programs. The following are her impressions of the experience.

I first became involved with CARE after reading "Half The Sky." I was deeply affected by this book, brilliantly written by Nicholas Kristof and Sheryl WuDunn. The seminal idea is that although the most vulnerable citizens on the planet are women and girls – they depict harrowing stories of human trafficking, wage inequality, domestic abuse and violent chauvinism a la the Taliban – that is also where the global solutions lie: in the future of women and girls. Through micro loans, commitment to education and family planning, miraculous changes can occur. I went to an event for the book sponsored by CARE here in Los Angeles and was deeply inspired to start traveling and observing their work.

Since I have two small children and worked a day job on the television program "Private Practice", I had to wait a number of years to take this trip. Last September I began talking with the CARE folks about where I could go in December, with my family in tow. They suggested seeing programs in the area of Ayacucho, Peru, and I jumped at the chance.

The name of the program I was to observe was called Windows of Opportunity (http://thewindowofopportunity.info/countries/peru/), which focuses on nutrition for pregnant and breastfeeding mothers, as well as their children. I was to be accompanied by Gabby Ayzanoa Vigil, a CARE representative based in Lima and the amazing Dr. Ariel Frisancho Arroyo, who also flew from Lima to act as sounding board and interpreter.

I truly didn't know what to expect. My family and I flew into Lima on a Tuesday, cooled our heels for a day, and then awoke at 3:30 the next morning to catch the 5 am commuter flight to Ayacucho. We were well off the beaten path, tourist-wise. In fact, the previous day in Lima, Peruvians were constantly surprised that we'd ever visit Ayacucho. Cuzco – yes. Machu Picchu, of course. But why would we travel around the world to see scrappy subsistence farmers in a rugged part of their country?

After checking my family into the lovely Plaza Hotel at the center of Ayacucho (also known as Huamanga in the local language Quechua), I climbed into a van with the CARE folks and began a bumpy, mysterious ride to our first stop, the village of Violeta Velasque.

The ride to the village was murky for me. The roads were unpaved, switch-backed and increasingly muddy from the constant rain. It is the rainy season in Peru now, as spring turns to summer. Those of us who flew at o-dark-hundred from Lima dozed. I fell in and out of a traveler's nap, neck snapping against the van seat, with dreams and thoughts co-mingling and interchangeable.  My mind was trying to catch up to where my body now found itself.

We arrived with a jolt to the village square – an empty expanse in front of a church where the rain now steadily droned. Beautiful local women greeted me with flowers, their traditional stovepipe hats keeping them warm. We were shepherded into a community building where three men – the town's leaders – stood rather formally behind card tables. Women and their children lined the sides of the squat building, which had no heating or lighting. The presentation was about to begin.

It had been some time since I had been in a place with no heat, electricity, running water, cars, or – and this is what struck me the most, oddly – glass in the windows. There were few windows and so little light on this gray day, with no lamps to help. The combined effect was medieval. I initially could only make out murky shapes and was grateful for the periodic glare of the video camera. The folks who lived there had no problem, clearly. It was I, so used to incessant noise and utility companies that defy seasons or nightfall, who had to re-discover ancient acuities that modernity had made dull.

The presentation was dignified and cogent. Speaking Quechua (translated first into Spanish and then into English for me) the gentlemen thanked us for coming and CARE for its support. They showed clear, well-detailed posters on the walls, which charted the status of each of the village's 123 souls. There was a legend on the bottom which showed which households had children, gestating mothers, running water, animals – all the details important to this life. Because my trip was focused on Windows of Opportunity, they also showed me charts where each infant and child was periodically and rigorously weighed and measured, so that malnutrition could immediately be red-flagged. The nearest clinic was days away by foot; through CARE's support, Violeta Velasquez had created its own well-baby clinic, and if any babies where not well, they could alert someone who could help.

Later, we visited a home where the mama proudly showed us her clean home and her new stove – not gas as yet, but a woodstove which now had a functioning chimney such that the kitchen no longer filled with smoke. She showed us separate sleeping chambers for herself and her children. Many times during the visits we heard about what a vast improvement this was from the days of one- room sleeping; parents, children, and animals used to crowd into the same sleeping space that they readily admitted was filthy. This mama also ran a small store on the first floor of her home, where villagers could barter for items they could not grow or make.

But what most struck me – and frankly, what I personally related to – was the "Plan Familiar 2012" posted on the kitchen wall. CARE encourages each family – as well as each community – to discern personal goals and strategies for achieving them. There were separate categories for the woman and her husband, and columns for each month of the past year. Neat checks marked accomplished goals; neat notations marked explanations of why they were not.

It was exactly what I do for myself, and what I encourage my children to do.

Here in this village, which on the surface differed so much from my home, we were employing the same strategies to lift ourselves out of vague intentions and discontents, to put pen against paper and say, against seeming insurmountable odds:
"This is who I am.
This is what I want.
And this is how I am going to get it."

In addition to material support, CARE was providing something more essential to the folks of Violeta Velasquez: the self-esteem to achieve what they most desired.

The name Kathmandu sounds like Kadamandu, but the similarities between these two cities in Nepal largely ends there. The former is the country's million-person national capital and a centuries-old hub of culture and commerce. Kadamandu is tiny and remote. Situated in the mountains of remote, far-western Nepal, it is home to only 4,000 people.

On sight, you wouldn’t realize it, but the big city Kadamandu has the most in common with is Mumbai.

Eager to find work to support their families, the men of Kadamandu often leave the village to find work. Three-quarters of them go to India. Tragically, money isn't the only thing the men are bringing back from Mumbai. Separated from their families, many of the men visit brothels. As a result, they're also bringing sexually transmitted diseases to Kadamandu. More than 70 people in Kadamandu have died of HIV/AIDS. As the number of men going to India for work has increased, so has the number of infections, bringing added misery to this already very poor town.

With the help of CARE Nepal, director Ramesh Khadka has produced an award-winning a documentary about what’s happening to the village and how CARE Nepal is responding. “Kadamandu” is an unflinching look at the misery HIV/AIDS has wrought on the community, as well as the bleak economic conditions and severe gender inequality that underpin this tragedy. Last month “Kadamandu” won the award for best documentary at the Kathmandu International Mountain Film Festival.

A trailer for "Kadamandu" is on YouTube and embedded below. An especially powerful scene begins at the two-minute mark.

Notes: Some names have been changed to protect those quoted. Masisi is located in North Kivu Province of the Democratic Republic of the Congo, where heavy fighting has displaced more than 800,000 people so far.

Women recently displaced by fighting pose for a photograph in a school in Nzumu where they have fled to from Sake following fighting between Congolese Government soldiers and rebels near Goma in the Eastern Democratic Republic of Congo on the 24th November 2012. Rebels claimed control of Goma in the eastern Democratic Republic of Congo, causing thousands of people to flee, many of whom had already been displaced by years of fighting.© 2012 Kate Holt/CARE

November 28, 2012

"I am 57 years old and from Kibati, in Masisi. I came to Goma two weeks ago because I needed help. I was born in Masisi and am a farmer there. My husband is also a farmer and we cultivate things like beans and maize and ground nuts.

"I have had 14 children but only four are still alive. The others have died from diseases and one died from fighting. This was about three years ago. It was when the CNDP were fighting with government soldiers. He was 17 years old and there was fighting in our village and he was caught. There wasn't a health center to take him to and he died. During this time three years ago after he was killed, we fled to Goma and stayed in one of the camps and returned to Masisi when the fighting stopped. But since then Masisi has had fighting nearly every day.

"There is a lot of shooting and a lot of violence – much worse than before. In April, we fled to Rutshuru because of the fighting, but when fighting broke out in Rutshuru, we went back to Masisi.

"There are armed groups around us the whole time – they drink and push us around and loot everyone's houses. Two weeks ago, I was farming our beans when we saw armed men walking around the edges of the fields. We knew what they were going to do – everybody knows that when they come to the fields it is to rape women. So we hid in the greenery but they found us. One armed man took me and raped me. There were some other women around and the same thing happened to them so we decided that it was better that we all come to hospital in Goma together, which is why we are here. My husband was very supportive and said that he wouldn't abandon me even with what had happened. I am very lucky that he is so supportive and grateful.

"I have been tested for HIV and tomorrow I will get the tests – it was an armed man and we know that all armed men have HIV so I am worried.

"He was very violent with me and I am in a lot of pain. I will stay here until the pain goes and I feel better and then I must go home. I look after a lot of orphans from my family – children of people who have been killed. I have three from my sister and one of her children's daughters too. They need me to look after them even though I am getting old. All I want now in life is peace – I don't want to be raped again and I don't want to have to keep on running. This war has destroyed us – all we want is to live in peace."

CARE's Response: As soon as access is secured, CARE plans to scale up our emergency response in the areas affected by the recent fighting, in particular by providing shelter to those displaced and assistance to women affected by sexual violence and help to prevent further cases of sexual violence. Our emergency response in other areas, including South Lubero, continues.

Donate Today: Your donation to CARE can help us respond to emergency situations like in DRC and carry out our lifesaving and poverty-fighting work around the world.

By Elizabeth M Campa, MSc
Water, Sanitation and Hygiene Coordinator, CARE Haiti

CARE works around the world with communities to improve water, sanitation and hygiene in order to increase access to latrines, clean water and improved hygiene. Credit: © 2012 Melora Palmer/CARE

I have to go…
I’d like you to try something out for me. This morning when you wake up, you do not have access to a toilet. This might take some mental preparedness as we are so accustomed to always having access to a toilet. And, I'm not talking about remembering your rustic camping forays into the forest...here you'll have to figure out ways to relieve yourself in very public places.

This might be hiding behind a tree, in between cars, pooping into a plastic bag, into a shallow hole in the ground, but not a toilet. You will not have access to toilet paper or water afterwards (and if you do, it is not clean water) to make sure your hands are uncontaminated before you prepare food, take care of your children or conduct day to day activities. And if you do not find a place, no way of relieving yourself, you will have to hold it in for hours, possibly until the sun has set and you are able to go outside your front door and defecate there when everyone else has gone to sleep. Or walk into a dark field or alley where someone might be waiting to attack you knowing that you have to relieve yourself.

Going to the bathroom for 2.5 billion people around the world is about planning and waiting.

November 19, 2012 is World Toilet Day. Presently, over 40% of the world’s population does not have access to a toilet. By the way, I’m not speaking of the pretty white porcelain flushing kind, I mean a hole in the ground dedicated to pooping, also known as a latrine. While we in the developed world might have to think about finding a place to relieve ourselves, we can generally find a toilet in a restaurant, in a gas station, etc. 40% of the world’s population will hold it in for hours until they can find a place that is private enough to relieve themselves. While this is in itself incredibly uncomfortable, for many millions of people, particularly women, this can cause infections and other health complications that could lead to death. It is also a comfort problem in developing countries where there are very high rates of diarrhea due to poor nutrition, health and no access to clean water.

People living in rural areas around the world will go into fields and defecate openly; often contaminating water sources and or the soil around the food they grow making them and their families sick. Even more people, as in the capital of Haiti where I work, a densely populated city, will defecate in the open, again, contaminating water sources used for cooking and bathing.

The more discrete, will poop into a bag, because there is no other option. Some will use a filthy public latrine that might be available but for women, they risk being sexually assaulted as these latrines offer no security, poor lighting and doors that cannot be locked. School children around the world will defecate along the exterior walls of their school because they have no facilities and in turn millions upon millions of children will become infected with intestinal worms contracted from stepping on fecal material with their bare feet. And even more millions of girls will stop going to school all together when they begin to menstruate as they will not have a private place to clean themselves, continuing the vicious cycle of poverty and poor education.

CARE works around the world with communities to improve water, sanitation and hygiene in order to increase access to latrines, clean water and improved hygiene. Working with communities to improve sanitation and access to clean water is about giving back to people their dignity. Access to sanitation and water is a human right. So you see, building a toilet is not only about helping someone relieve themselves, it is about giving back to people their right to education, to better health and to feel safe. Should we not all have access to these basic rights?

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By Yemisi Songo-Williams and Christina Ihle
CARE International in Sierra Leone
Koli Soko Village, Makeni, Bombali District

Receiving a cholera prevention kit. Photo: © 2012 CARE/Tim Freccia

Marie, 75 years old, does not feel well. For the first time in her long life she is affected by cholera, but she knows the signs of the disease very well. Last week she was taking care of her 8-year-old grandson Zechariah, helping him to survive the infection, fighting with him for his young life. Thanks to ORS (oral rehydration solution) treatment, he is feeling better now and plays quietly in front of the house, as if nothing out of the ordinary has just happened to him. Although happy to see their child fully recovered, the family remains fearful for Maria's life. Her body is not as strong as Zechariah's, and she does not seem to have the strength to resist the water-borne disease.

42 people are already infected in the small village of Koli Soko, which is the home of about 2,000 people. Two people have already died; cholera can kill within hours when someone is not strong enough.

Koli Soko has a small health center which provides medical treatment and is managed by the government. But still, the lack of proper drainage and waste disposal systems coupled with heavy rains in the last few days has caused flooding and put the entire community at risk. Maria's son shows us their one and only water source: a small, still pond near the village; it is dirty and teeming with mosquitoes. “It is small, but deep”, he says. “But we are afraid that this water is not safe anymore with so many ill people in the village,” he confesses. But this is their only option.

Maria's neighbors are John and Yebefula, and their two children; Sida, 5, and Moses, 10 months. Yebefula was infected by cholera and was quarantined for five days with Moses. She is feeling better now, but she is afraid for her husband and the children. “I felt like dying in the last days. I just want to do anything to prevent my children from going through this illness.”

The CARE Sierra Leone team is distributing cholera prevention kits containing soap, ORS and purification tablets to the affected families and those at risk in Koli Soko. The team explains to every recipient family how to use the prevention kit, using pictures and demonstrations to make sure that everybody in the family understands that washing hands, using only boiled water and cooking food thoroughly is a matter of survival in these difficult times.

And families do understand. While the team prepares to leave Koli Soko, Yebefula gives her children a long and soapy evening bath using the soap she has just received. Hopefully they will be safe. But many families in Sierra Leone are still waiting to be better equipped in their fight against cholera. CARE in Sierra Leone is mobilizing all efforts to help with emergency aid and to seek long term solutions for villages in need.

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By Yemisi Songo-Williams
CARE International in Sierra Leone
Masongbo Village, Makari Gbanty Chiefdom, Makeni, Bombali District

A previously infected mother. Photo: © 2012 CARE/Tim Freccia

Masongbo Village, in the heart of the Makari Gbanty Chiefdom in Makeni, is the home of over 2,000 people.

At the height of the cholera epidemic, a CARE team distributed cholera prevention kits containing soap, ORS (oral rehydration solution) and purification tablets to 100 at-risk families in this village. By using pictures and demonstrations, the team showed each family how to use the prevention kits and explained the importance of washing hands, using only boiled water and cooking food thoroughly.

Two weeks after the distribution, I went with my CARE colleagues to pay an impromptu visit to the village to check whether our prevention messages were understood and applied by the inhabitants.

On the day we visit, a bustling antenatal clinic session is underway at the community health center that serves both the population in Masongbo and those from the surrounding villages. Mothers hover anxiously over the shoulders of the Maternal and Child Health aid as she weighs each baby.

We are welcomed by a smiling Fatmata, who has recognized the CARE branded vehicle from a distance, and is eager to receive us. Fatmata is a community volunteer and was part of our distribution team. She can easily recite the symptoms of cholera, and knows the ways in which it can be prevented. When asked why she became a volunteer she replies quite simply: "I want to help my community. I have only a little education, but I must use that to help my community."

And she has kept to her word: she has been diligent in sharing this information with members of her village.

There was a high level of awareness across the village on the signs of cholera. Every community member we spoke to could correctly tell us how to recognize the disease, how it could be prevented, how the items in the cholera prevention kit items were used and what to do if the disease was suspected. All the households we tested also had the expected levels of chlorine in their drinking water.

"CARE has done a big job here," beams Fatmata. "You have saved our lives by preventing this disease from coming here. Look, we are changing our habits. See how clean the village is!"

And she is right; the evidence of CARE’s cholera prevention intervention is plain to see. Masongo is a tidy, well-kept village, with garbage-free paths and neat front yards. The air is fresh and clean, with no signs or smells of inappropriate waste disposal or a lack of proper drainage.

"There were no reported cholera cases in Masongbo this year," Fatmata tells us proudly. "And for that, we are very grateful to CARE for teaching us how to change our past habits and live healthily."

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September 5, 2012

Marie-Claire, a 32-year-old single mom, who has arrived from Kasheke two weeks ago with her six kids and one on the way, is grateful for the beans, flour and oil she received from CARE, but is worried that it won’t last for long enough. © 2012 CARE

CARE is on the ground in The Democratic Republic of Congo. When the most recent fighting broke out in April, CARE projected to provide emergency relief to 60,000 people. With the intensification of the crisis, we had already reached 84,000 by early September and we have scaled up our response to cover a total of 180,000 people in need. Today, we are responding in a variety of ways – helping families access food (as you'll read below), delivering essential medicine and supplies, providing emergency psychological services and care for survivors of sexual violence and we will soon distribute shelter kits.

"We heard shooting and when we realized it was coming closer we took our baby and ran." They had no time to take cloths, cooking pots, or any other belongings with them. "I waited for a few hours until the gunfire was gone and then went back to the house to get food, but the village and my house were burnt down," Jean, the 20-year-old father recounts of his flight.

Over the past couple of months, tens of thousands of people have been fleeing similar attacks by rebels in southern Masisi territory in the province of North Kivu in eastern Democratic Republic of Congo (DRC). More than 330,000 people have been displaced in the province alone. Several rivaling armed groups are continuing to create havoc in southern Masisi, where most of the displacement is concentrated right now and CARE is present.

When the CARE team visited the spontaneous displacement camp in Kibabi on a sunny day early September, Jean, his wife and five-month-old baby, it had been three weeks since the family had left their home village Ngululu. They had walked for four days until they arrived in Kibabi where they decided to seek safety and shelter. They collected hay to construct a little hut where the family is staying. With the arrival of more than 2,310 families, more or less 13,860 individuals, the camp has grown into the size of a village.

"I don't know when we will be able to go back home," Jean says as his head is tilted down. "We are cold at night and when it rains, we are not protected because our hut has no plastic sheeting." Temperatures drop to close to zero degrees at night and the rainy season has started in full swing.

Jean continues, "We usually manage to eat [potatoes] once a day.  I work in the fields of the local community, and my wife goes around asking for donations. But it's not every day we eat and we eat very little." Luckily, Kibabi has a natural water source where the displaced collect their drinking water.  

"It came as a relief, when we received food from [CARE]. We've got beans, flour, sugar and some cooking oil. We have shared it with the people around us because not everybody received a voucher to go to the market. We can eat from it for a whole week." Jean's wife took their baby with her and walked for two hours to Rubaya, where the distribution is taking place. It is only the second food assistance in the area since the uprooting started late July.

CARE, through the Dutch Ministry of Foreign Affairs-funded project UMOJA+, and together with local partners has organized a weeklong food distribution for almost 4,000 households, or 24,000 people, through a voucher system. CARE spearheaded the innovative voucher system through which beneficiaries buy their food on the local market, which not only empowers them to choose items they need most, but also supports and safeguards the local economy.

Marie-Claire, a 32-year-old single mom, who arrived from Kasheke two weeks ago with her six children and one on the way, is grateful for the beans, flour, and oil she was able to purchase using vouchers received from CARE. But she's worried that it won't last for long enough.

"We share the food with everybody and when it is finished, we will die just like that," she says with an exhausted voice and fatigue in her eyes. 

Others echo similar sentiments of thankfulness. "Ever since we fled home, I've had difficulties feeding my six children. With the food fair, we finally have something to eat," 47-year-old Charles says with a sign of relief as one of his six kids holds his hand. They left their home village, Buoye, two months ago and took refuge in Katoyi. When Katoyi came under threat of an attack two weeks ago, they decided to pack up again and join the local population as they made their way to Kibabi. They found shelter in a primary school where up to 10 households, about 60 people, are crammed into one, small classroom filled with thick cooking smoke.

"We are going to eat for the first time since we left our home, Katoyi, four days ago," 23-year-old Julienne says as her newborn baby sleeps silently in a cloth tied around her back. Francoise, 30, expresses similarly, "with the food fair, CARE is helping displaced people, children who are suffering of hunger."  She rests on the lawn next to her bags filled with rice and beans to regain some strength before she starts her four-hour walk back to Bukumbirire where she is sheltered in a host family.

As clouds suddenly appear on the sky, wind starts blowing down the hills and chilliness overtakes the place, hundreds of women, children and men continue to stand patiently in line to receive their food coupons, which will allow them and their families to eat for up to two weeks.

CARE has also helped families establish community gardens and has distributed seeds and agricultural tools to thousands of households. CARE provides lifesaving assistance through various emergency projects in North Kivu and has already reached 84,000 people in need since the outbreak of the most recent crisis in eastern DRC. As the food distribution nears its end, UMOJA+ is already planning its next intervention in the area to provide shelter material and latrines.

Receiving a cholera prevention kit. © 2012 CARE/Tim Freccia.

The disease is mostly transmitted by contaminated water sources and foods, and is closely linked to inadequate sanitation. The lack of proper systems for drainage and waste disposal, coupled with heavy rains that cause flooding and contamination of water sources, has left the population increasingly vulnerable to the spread of this waterborne disease that can kill in hours.

The Ministry of Health is collaborating with partners to disseminate health promotion messages about how people can protect themselves and others against the spread of disease. Messages include washing hands properly, using only boiled water, and making sure that food is cooked or washed properly before consumption. Information about how and where to seek help is also being communicated. The government has set up three emergency centers in strategic locations around the city to handle new cases, with all government clinics providing free treatment for cholera.

CARE is mobilizing resources to facilitate comprehensive cholera prevention messaging and activity in five of our operational districts: Bombali, Kambia, Koinadugu, Tonkolili and Western Area.

In collaboration with government health workers, CARE is preparing to:

• Provide information and education via radio discussions and public service announcements;
• Distribute cholera prevention kits to highly-affected and at-risk community members; and
• Conduct trainings on cholera prevention, hygiene and sanitation and community mobilization to community volunteers and existing community structures (including mother-to-mother groups, community health clubs and village savings and loan associations).

CARE also serves on the national Cholera Task Force, which regularly assesses the scale of the epidemic and discusses various resource mobilization strategies.

UPDATE: Cholera cases in Sierra Leone are on the rise. As of August 31, there were 13,934 cases and 232 deaths reported. Read more >

Blog by Deborah Underdown
July 5, 2012

South Sudan 2012. Returnees in Bentiu. Story available 'Returning to South Sudan'. Photo credit: © 2012 Deborah Underdown/CARE

As I arrived in Bentiu in South Sudan and got out of the vehicle I was greeted by my CARE colleagues and a pair of Wellington boots. My trainers were going to be of no use here.

The rainy season has just started but already the roads are a huge challenge. The thick sticky mud makes getting anywhere a long process.

My driver for the day, Hassan (who also happens to manage CARE's water and sanitation programme so is multi-tasking) explains that in the coming weeks, as the rains get worse, it will be almost impossible to travel around. At the same time last year the best mode of transport was a quad motorbike- CARE used one to transport essential medical supplies.

We travel to Bentiu Port that is home to over 300 'returnees'. Since South Sudan's independence in July last year, over 400,000 people have returned to their home country from Sudan. They arrive with little and the journey can take months.

The living conditions of the returnees by the port are the worst I have ever seen.

I met a mother of five, Mayen, who told me that, on her journey to her home country, her seven month old baby girl died of malaria. She is now living with ten people, including her own children, in a shelter with one single bed. The floor is a bed of mud that the children sit and play in. I can't imagine what it will be like when it is also flooded. The fact that they won't even be able to escape the mud and water when they are inside is utterly overwhelming.

Seeing the children sitting on the floor with mud covered hands, the same hands that find their way into children's mouths is worrying. I want to reach out and tell them to keep their hands out of their mouths, as I would with my own niece when she has been crawling around on the  floor back at home in the UK, but what would be the point? It's impossible to get away from the mud and the diseases that it carries, they can't even begin to keep their hands clean. It's so frustrating to know that the likelihood of them getting sick is very high.

CARE has set up a medical facility (it actually backs on to Mayen's shelter). Paul, a clinician working in the facility, told me that waterborne diseases were already increasing with many cases of watery diarrhea and respiratory tract infections. CARE is proving treatment as well as immunizing children against polio, tuberculosis and measles.

The poor roads and already dire living conditions are only set to get worse. CARE is pre-positioning relief items as well as helping returnees in Unity State. We are also helping refugees fleeing conflict and displaced people who are searching for food.

It must be noted that a year of independence isn't a long time in terms of building up capacities and infrastructure. The country's 'to do' list is long, but the Government and aid agencies like CARE are working hard to help the 800,000 people. People just like Mayen and her children, who are in desperate need.

Rio+20 Conference Center. Photo: CARE/Stefan Mielke

By Kit Vaughan CARE's Global Climate Change Advocacy Coordinator
Rio de Janeiro, June 20, 2012

Today it's raining outside, for the first time since I am here in Rio de Janeiro. The heat has broken but the fog remains. Helicopters are circling above us at the UN Conference on Sustainable Development (Rio+20) and security is very tight with police and military everywhere as the world's heads of state begin to arrive. Delegates and participants at Rio+20 now number above 30,000. The atmosphere has picked up, the food courts are full and there is no spare space to sit, charge a laptop or take a break. The media are here with their cameras up and the place is buzzing. But here is the thing: There is little to report about.  Journalists keep asking what the story is. There is a story but it's a very dark one and in our hearts everybody is looking for a ray of sunshine from Rio+20. But there are worrying signs of the very real and severe failure of the negotiations.

The Brazil government and its negotiating team have railroaded the negotiations to finalise an outcome text last night for heads of state to sign-off. But there have been complaints from many countries that the Brazilians have pushed the process too far so it has been stripped of any ambition and substance.  A senior negotiator from the UK delegation team stated that "there is almost nothing left now for the heads of state to negotiate and it's almost a done deal. But the real problem is this isn't a deal that anyway near addresses what we need." From analysing the text it's clear that the deal, as it stands right now, is a black hole of low ambition and little urgency. And we are all worrying that the black hole is gathering pace.

It's not just the Brazilians who bear responsibility. Leaders of the world's major economies came to Rio empty-handed with nothing to offer; no (financial) commitments and a dire lack of leadership. The current outcome text provides no clear targets for reducing climate emissions or reversing environmental degradation, there are no legally binding commitments and - more worrying - no new sources of finance.  Without these elements as a foundation the Rio+20 outcome will be an epic failure on a planetary scale. 

The science is clear: we can't continue to grow our economies by gobbling up and depleting our stocks of natural capital, be it for example fish, carbon or water.  We are undermining the very foundation of our planetary survival and its natural capital. Increasingly the impacts of climate change and resource degradation are severely impacting the world's poorest and most vulnerable people. If we don't urgently tackle climate change as well as other environmental issues we will reverse development gains and lock out future generations from the development choices they so urgently need in order to escape from poverty.

But there is a slim chance to make a huge difference,  if just a few world leaders could demonstrate  bold political leadership and state that they are not happy to commit the planet to an unsustainable future and many millions more people to a future of grinding poverty. Without tackling climate change and poverty reduction there will be no sustainable future. Whether Rio+20 will be game over for the planet remains to be seen. There are two days left until the conference closes on Friday evening. Two days for leaders to act and deliver a roadmap for a sustainable future, and I just hope they have the courage and determination to deliver the future we want rather than the future we can't live with.

Rio+20 Conference Center. Photo: CARE/Stefan Mielke

Most of the delegates and participants at the Rio +20 United Nations Conference on Sustainable Development complain about the long bus rides from the city to the Rio Centro Conference center where most official activities are taking place. By contrast, I have found that the most interesting experiences, and the deepest conversations, I have had in my first five days at Rio have almost all taken place on the buses.  While the official negotiators struggle to make progress at the conference center, tens of thousands of people from all over the world have gathered to share experience and ideas for how to make sustainable development for all, including the poorest and most marginalized members of global society, a reality.

The people with whom I have sat on the bus include: a South Korean professor of natural resources economics; a Swiss radio Journalist; officials from the Ministries of Environment of Ghana and Namibia; a British academic; the leader of a French non-governmental organization; and an idealistic young Canadian promoting spending six months in Brazil. Their interests range from how to engage their communities, whether government, academic or media, in global discussions about and action for a sustainable future, to promoting very concrete solutions and technologies to improve the lives of the poor through solar energy, sustainable agriculture, or low-cost housing. What does such a diverse group of people have in common? These global citizens, and many thousands more, have converged on Rio to express a common sentiment. In short, sustainable development, characterized by greater prosperity, social equity, and environmental sustainability, is not a luxury, but rather a necessity for the survival of our planet and the rights of future generations for a dignified life free of extreme poverty.

The actions of citizens from all over the world, and their passionate commitment to a better future, is perhaps the main sign of hope from this week’s gathering in Rio. Will our political leaders hear the voices of those gathered outside the closed rooms where the negotiations are taking place over the details of a text to be issued by Heads of State and Government at the end of the conference? And will all those gathered in Rio, both political leaders and members of civil society, remember that the 1.4 billion poor in today’s world deserve and expect more from all of us? To achieve the “Future We Want”, which is the theme of Rio+20, urgent and decisive action is required to address the threats that poverty, inequality, environmental degradation, and climate change pose for our common humanity.  No words in any text will be a substitute for such action.

If you want to find out more about the “Where the Rain Falls” project, please visit the website: http://wheretherainfalls.org/

It takes a lot of strength to carry 55 pounds of water for more than four hours across eastern Ethiopia’s arid highlands. It also takes particular strength to change the circumstances that force women to shoulder that burden.

Fatuma Muhammed is strong in both these ways, and more.

The 50-year-old mother of four lives in Muru Geda, a small village in Ethiopia’s chronically-dry East Haraghe zone. Water is so scarce here at women must walk huge distances to reach a small pond or stream. For much of her life, Fatuma spent at least 16 hours a week searching for water; after discussion with her neighbors, she would walk as much as four hours in the direction that held the best promise of a reliable water source, fill her large plastic container and then trudge four hours back home.

In those days, Fatuma’s best-case scenario was that she’d return with 25 liters of water that would last her family of six for three days – that’s less than a liter and a half of water per person per day. The worst-case scenario is difficult for her to discuss.

“If I ever came home without water – or with a container that wasn’t full – it was a big problem. My husband sometimes beat me,” Fatuma recalled. “It isn’t tradition for men to carry water; it falls on women. If men want it, we have to get it. That’s one of our greatest challenges here.”

Another grave challenge is health; even when women like Fatuma find water in this part of Ethiopia, it’s often dirty – open to the elements and shared with animals. When families aren’t aware of simple sanitation practices such as boiling or filtering, they run the risk of debilitating waterborne illnesses such as diarrhea and dysentery. These illnesses are dangerous and even deadly for those with weakened immune systems; three years ago, Fatuma spent 15 days at a local hospital after drinking contaminated water.

Excruciating distances, unreliable sources, the specter of illness and the threat of physical violence – an Ethiopian woman’s responsibility to bring home water both diminishes her dignity and wreaks havoc on her quality of life. That’s why CARE, with funding from the United States Agency for International Development (USAID), created an extensive water system for the area around Fatuma’s home in Muru Geda.

Over the course of five months, we harnessed the flow of a local spring and laid more than 30 kilometers of pipe. This pipe leads to distribution points in five separate villages where women can get clean water from a tap with just a turn of the spigot.  Hundreds of local families participated in the construction of this water system, contributing sand, rocks and hours of hard work.

Today, CARE still provides technical advice for the water system, but we’ve turned daily operations over to the communities the system serves – everything from maintenance to financial management. Households pay a fee of ten cents for 20 liters of fresh water; this money is placed in a bank account for future repairs and system improvements. This account is managed by a water committee consisting of four local men and three women – including Fatuma.

“People in my village nominated me to serve on this committee because I am strong, providing for my family even after my husband died,” she said. “I am resourceful, I have my own business and I can create success for myself and others.”

The committee meets every two weeks to discuss matters such as when water points will be open for use, rationing if the water supply is low, potential conflicts and community feedback. Fatuma is an active and vocal participant in these meetings, especially regarding the challenge she’s been familiar with all her life.

“I have initiated public discussions on how women suffer because of lack of water,” she explained. “We’ve organized as a group, and have gone to local government offices so that people can hear our voices as women.”

For many years, Fatuma Muhammed was strong enough to carry an unbearably heavy load of water for many hours across eastern Ethiopia’s blazing and parched terrain. Today, she’s using that strength to ease the burden for her region’s mothers, sisters and daughters.

I work with members of the US Congress and their constituents to improve our foreign assistance program. While much of CARE's advocacy work involves the US government, our country office colleagues also engage in advocacy with foreign governments. I got a taste of CARE's global advocacy work last week when I was asked to join meetings between CARE, Emory University (a research partner), and the Kenyan Ministries of Education and Public Health and Sanitation in Kisumu, Kenya. The goal of the meeting was to increase the government's investment in successful hygiene and sanitation programs in rural schools.

For the last six years, CARE and Emory University have worked on a program called SWASH +, which builds latrines and hand washing stations in schools. At the moment, the program is only in the Nyganza province, in southwestern Kenya, but CARE hopes that the government will provide the resources to replicate it across the country.

Studies have found that having clean latrines has positive impacts on health and reduces absenteeism, particularly for girls. CARE hopes that future research will prove that adequate sanitation also improves school performance.

In US advocacy, we generally work toward one of three goals: passing legislation, securing funding, or working with the administration to support policies. Once the law is on the books or the budget is completed, we take implementation for granted. We assume that the legislation will be carried out; the funding will arrive.

In Kenya, the end goal of advocacy work is another matter entirely. Here, the formal policies are comprehensive and support many development programs. Education is legally free; all citizens have the right to water and sanitation. But in reality, schools are not always functional; sanitation facilities are inadequate or absent.

The Kenyan ministry officials who joined us in Kisumu were supportive of SWASH +, but Kenya is changing rapidly, and the future of social programs is uncertain. The country has a new constitution. National elections will take place in the next year. After the post-election violence in 2007-2008, Kenyans are unclear as to what will come next.

Yet after debriefing on our advocacy strategy, my CARE Kenya colleagues realized that the tools we need to advocate for effective programs are similar across cultural contexts. Before starting a program like SWASH +, we need to determine key stakeholders in the community and the government. We need to conduct research that determines the effectiveness of programs, and we need to package that research in a way that is clear, succinct, and useful to policy makers. Finally, we need to engage stakeholders throughout the process and to consider them as critical partners.

To find out more about SWASH +, go to www.swashplus.org.

To support programs like SWASH +, call the Capitol Switchboard at 202-224-3121, ask to speak to your member of Congress, and tell him/her to support the Senator Paul Simon Water for the World Act (H.R. 3658).

"I see her growing up and developing physically and I worry," she says. "When you become a mother at a young age, without any other asset available, you live the rest of your life in misery. No mother would like to see her child living in a similar situation."

Maude is attending a meeting at CARE's reproductive health center in the community of Santo, Léogâne. Officials estimate Haiti's devastating January 12, 2010 destroyed 80 to 90 percent of the buildings in Léogâne. This included not only homes but also the infrastructure of the normal life people rely on: markets, schools, government offices, and health clinics.

The earthquake turned Santo into a tent city of almost 10,000 people. CARE quickly moved in to help, distributing delivery kits and supplies for pregnant mothers and newborn babies, and offering counseling sessions to lower the risk of gender-based violence in this traumatized community.

More recently, CARE built the Santo health center, one of two it has constructed so far and one of 10 planned in all. CARE staff and nurses from a nearby hospital offer education on overall sexual health, contraceptive pills and injections, condoms and group informational sessions for men and women on the prevention of gender-based violence.

Maude often brings her daughter to the center because she's determined her daughter will avoid the hard life she has had. At 36, Maude is the mother of eight children.

"I have four children with a man I didn't love," Maude says. "He didn't want to use contraception and I didn't know how to protect myself." Maude eventually got married and had four more children with her husband. She and her husband attend CARE-sponsored sessions at the center because they've agreed they do not want to have more children.

Nurse Marie Kencia Dulorme is preparing a vaccine at one of the women's centre setting up by CARE in Leogane to provide reproductive health and referral services.

"My husband participated in numerous session organized by CARE's staff," Maude says. "He is now aware of the risk I run by multiplying pregnancies and has decided to protect me by using condoms."

Maude's daughter attends sessions on teaching her about birth control, prevention of HIV and other sexually transmitted diseases, as well as classes on preventing gender-based violence. Maude says the classes have relaxed tensions between her and her daughter. Her daughter now understands her worries, she says. And she now has the right words for explaining to her daughter how and why to be cautious.

Maude expresses gratitude for the center, and she is not alone.

"Even when CARE staff is not here, women from Santo who were trained by CARE are inside sharing their knowledge with their peers," says Willio Sainvilus Latagnac, president of the Santo community association. "The community made this space their own and women have their own area where they can discuss their problems, find solutions together, and regain strength."

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GOMA, Democratic Republic of the Congo
Allen Clinton and Jackie Kiernan 

Florance Kwinja picked up her basket filled with corn meal and beans and headed to the market outside of Goma. It's a bus commute the widow and mother of eight never used to think twice about. It was just another chore she did to earn money for her family. But it was anything but routine as the memories of the last time she made the trip two years ago come flooding back.

"We were ambushed by a group of combatants," Florance says. "They held me down and began to rape me, one by one. I was convinced I would die that day. I stopped living." 

In the Democratic Republic of the Congo, rape is routinely used as a weapon of war. Help and justice are hard to find in a country with one of the world's worst poverty rates and mass corruption. To cope with the terror, families regularly flee their home villages. Separated from their families and livelihoods, women and children turn to rummaging for scraps of food and a simple roof to sleep under. Extreme poverty and a loss of dignity have damaging effects in their lives.

Florance, 48, became a widow in 2003 when her house was ransacked and husband, a successful merchant, was killed. Having no savings, she and her children fled their remote village to the town of Goma. Florance worked tirelessly for the next few years to make money to feed and clothe her children. Then the rape happened and she fell into deep depression, an event all too common for women in the Congo. People who Florance considered her friends no longer greeted her. Shamed and scared to return to work, the once proud woman says she could no longer look people in the eyes. When things couldn't seem to get worse, two of her eight children went missing. After three years, Florance didn't think she would ever find them alive.

To understand what is happening here, you have turn back the clock to 1994, when the genocide that claimed nearly one million lives in neighboring Rwanda spilled over into Congo. Since then, the Congolese army, rebels and home-grown militias have been fighting over power and land, which is rich in gold, diamonds and coltan, a sought-after mineral vital to the manufacture of mobile phones and other popular consumer electronics. The result has been the deadliest conflict since World War II. Nowadays the most frequent casualties of war are women. Because women farm the fields and care for children, it's not uncommon to hear that when a woman is raped, her entire family and community are destroyed. Over 82 percent of displaced people turn to host communities and organizations like CARE for support. Only a fraction of families make it to under-funded cramped camps, where they depend on basic aid from the United Nations and other humanitarian groups.

"Women here are in deep pain," says Yawo Douvon, country director for CARE in the Congo. "But it's not just the type of physical pain that can be repaired in a hospital. It's psychological pain that you can't see that takes more time to heal."

Despite there being a constitutional law condemning rape and sexual violence, and newly formed mobile courts that help convict perpetrators, more work is needed to foster representative government and rule of law to bring more perpetrators of human rights violations to justice and ensure the protection of all women. The United Nations Population Fund estimates that 44 percent of perpetrators of sexual violence in the Congo are now civilians.

As women seek support for their plight to overcome gender biases, there are organizations trying to help vulnerable people get back on their feet, including rape survivors and demobilized male combatants. CARE's Espoir de Demain (Hope for Tomorrow) project organizes support groups and teaches people how to make shoes, how to cut hair – skills they can use to earn money and a chance for a whole new life.

Florance jumped at that chance. She signed up to learn to be a hairdresser, a trade almost exclusively reserved for men. Whatever difficulties she would face to break gender barriers, she knew things would change for the better. "It was as if someone had thrown me a rope to help me climb out of a deep, dark hole," she says, explaining that her children would be able to have a "normal life" once she launched her own business. "It's a good business to be in because people always need haircuts."

More importantly, Florance says she chose this trade to stay in one place and not be as vulnerable to potential attackers.
After finishing the training, Florance opened her own business in June, 2011 CARE provided her with a generator, hair cutting supplies, mirrors, lamps and other necessities to get her started. Nervous, with clippers in hand, she says she remembered to cut up instead of down like her instructor showed her when cutting the hair of her first clients. She charges 30 cents for most haircuts but favors braiding hair.

Photo by Allen Clinton

The boy sitting in her chair today was extra special. He is one of Florance's two eldest sons. Both boys had been reunited with her by the Red Cross after years of separation. They have also received skills training through CARE to become a carpenter and plumber.

Hope is not something you'd expect Congo's rape survivors like Florance to still cling to. But they do.

Looking at Florance today you could not recognize her past suffering through the proud smile on her face. She says, "I've had a lot of deception in my life. Clients, visitors and CARE are my new family," People in her neighborhood have begun greeting her again. And Florance, looking them in the eyes, greets them back.

As part of a CARE's emergency response team in Cambodia I've been responding to South-East Asia's worst flooding in a decade.

The Mekong and Tonle Sap rivers have been at emergency flood levels for over a month now and unfortunately 247 people have died and 18 out of 24 provinces in Cambodia have suffered damage with Kandal, Kampong Thom, Prey Veng and Kampong Cham being the worst affected.

Whilst exact numbers are still hard to clarify it's estimated that more than 1.5 million people have been directly affected and more than 46,000 households evacuated.

The impact on livelihoods, especially for poorer rural families is looking dire with early reports suggesting that 405,686 hectares of lush rice fields have been damaged with more than 230,000 hectares reported as potentially destroyed which represents 9.4 per cent of total the crop.

I read a report in a local newspaper yesterday (Thursday 27 October) which said that some evacuated families have started returning home to their flood wrecked villages as the waters slowly recede in along the Mekong River and other parts of the country.

No such luck for Lower Mekong provinces such as Prey Veng, which is one of the worst affected areas. This is where my CARE team is working with people in urgent need of emergency supplies,
Prey Veng has been hit hard with more than 78,000 families across its 12 districts affected. Almost 7,000 families have been evacuated from their homes and 49 people have been reported dead.

In Prey Veng, the flood has affected almost 79,000 hectares of rice paddies and 45,000 hectares are estimated to have been destroyed. Many farmers take out agricultural loans for seeds and fertilizer at the beginning of the growing season, and pay the loan back following harvest. This season, many of these farmers will be significantly in debt. Requests are being received for CARE to provide seeds from fast maturing rice varieties as a matter of urgency, as well as other assistance, so that affected households can replant as quickly as possible.

At this time I believe the three greatest needs for people affected by the floods here in Cambodia are immediate food, water and hygiene and of course restoring livelihoods.

On Thursday 27 October, the CARE team distributed assistance to the most badly affected families in Prey Sneat commune, Prey Veng Province. This was part of a wider program in the same province to support more than a thousand families, who have had their homes destroyed or damaged, lost assets and had their livelihoods placed at risk due to the Mekong floods.

Distributing packages to the 337 families in Prey Sneat meant that families received essential food items, blankets, mosquito nets, hygiene kits and water filters, with nearly 17 tonnes of rice supplied by the World Food Program. Transport and logistics were assisted through a generous donation from Glaxo Smith Kline.

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After a severe food crisis in 2010, women founded an association of grain banks to prepare for times of hardship

Niandou Ibrahim, CARE Niger, October 21, 2011

Moumouni Alkassoum, manager of the union of cereal banks for women of Moujia.Photo Niandou Ibrahim, CARE.

Last year, 20 percent of households in Niger were affected by a devastating food crisis. The village of Moujia, located between the cities of Konni and Tahoua in the center-west of the country, gave a picture of the situation at that times. (see story from 2010)

Drought and parasites had completely destroyed the crops, and in order to survive, people were forced either to migrate or to do menial tasks for little pay. Like in Alhou Abdou's household, made up of six children and his wife, the villagers fought day after day to feed themselves. Even though they decreased the number of meals and portion sizes, they often went hungry.

CARE provided 100 kilograms of grain to Alhou's family through a large-scale programme of free grain distribution, in cooperation with the Niger government and the World Food Programme (WFP).  The other households in the village that were suffering from the food crisis all received the same support. This external aid was combined with the stock from a grain bank that the women of the village had implemented to meet the food needs of the families.

The women's small grain bank had a huge impact on the entire community. Inspired by this victory, and knowing that food crises appear every three years, the women were motivated to expand their idea of an "association of cereal banks" in the region.

The system Matu Masu Dubara ('clever women' in the local Hausa language) is made up of savings and loans groups that are managed by the villagers. These groups enable the creation of multiple village projects in several areas, such as health (providing training and equipment for nurses), education (literacy and awareness about girls' education), environmental protection (growing trees and orchards), food security (creation of village grain banks), and even recently, entering political arenas to elect women to influence local and national decision making processes.

Alhou's wife Hadja belongs to the network of "Tammaha" (hope) groups in Moujia, which started a cereal bank in 2002. The bank served its purpose every year because even in years with good crop yields, more than 60 percent of households cannot meet their food needs with their harvests alone. However, in a year of crisis, like in 2010, the Moujia bank couldn't withstand the high demand for grain.

Hundreds of Mata Masu Dubara women from Niger also started cereal banks in their communities. Under the leadership of these women, 19 other community grain banks in the surrounding areas came together to form an association of banks: a storehouse with enough stock to come to the aid of smaller banks in case of stock shortage caused by a high demand in times of food crisis. "To do this, each of the 20 groups contributed a total of 1,000,000 cfa francs, or 2,100 USD, that was used to buy the start-up stock. CARE, with financing from the Norwegian Agency of Development Cooperation, then helped with the construction of a store and management training for the designated women, who would oversee the operation of maintaining the stock. WFP contributed 27,000 kilograms of cereals. It was a real pooling of resources," explainsMérido Moussa, director of the Matu Masu Dubara women association in Moujia.

Today, the association of Moujia banks provides a permanent stock of supplies in the area. While the market price of a 100 kilogram sack of millet is 19,000 fcfa (40 USD), the village banks can sell it for 18,000 fcfa because the union provides it at a lower cost of 16,000 fcfa.

"The women are so clever," whispers Alhou Abdou, while looking lovingly at his wife. "Normally the grain stock set aside by the women would have been enough to fill the gap left by the poor yields that we're seeing this year. But we're still facing hard times because our brothers had to come home from Libya," he adds solemnly. They had lost their jobs due to the political unrest in North Africa.

As of August 31, 2011, evaluations have shown that the crops will not come full circle in 2,496 farming villages throughout Niger, affecting an estimated population of 2,885,673 men and women. The rate of severe malnutrition among six month to five year old girls and boys is at risk of increasing in 2012.

In addition, the socio-political movements that unfolded in Cote d'Ivoire and Libya affected 200,000 migrants working abroad. The thousands of migrants who returned to Niger between February and September came home to extreme destitution, adding another challenge for vulnerable communities like Moujia. "150 village youth had to flee Cote d'Ivoire and 50 others came home from Libya empty-handed, whereas previously they were the principal source of income for Moujia," confirms Mahamadou Abdou, the Imam of the local mosque.

CARE Niger is committed to respond to the urgent challenges of this situation, while continuing to contribute to the resilience of the households in Moujia and in hundreds of other communities.

Doctors provide medical support, but more assistance is urgently needed

By Mujahid Hussain, Team Leader Lower Sindh, CARE International Pakistan

The monsoon floods of August 2011 have displaced millions of people from their modest huts in the areas of lower Sindh province. After almost three months stranded under open sky, many are still waiting for proper temporary shelter, water, sanitation and healthcare support. The most vulnerable are women and children, who are fighting unprotected from the health risks of exposure to hot sun during the day and mosquitoes at night.

Dr. Tabinda, age 23, female medical officer,  is providing health care services to the floods affected with the mobile health clinic, operated by CARE partner organization. Photo: CARE Mujahid Hussain.

CARE and its partners' health teams are providing primary healthcare and hygiene awareness education to some of the most severely affected people in the remote areas of district Mirpur Khas. This week the team visited a health camp organized by our partner at village Mahar Mohammad Buttar, UC Burghari. We travelled about two hours from Mirpur Khas city by road to reach the village. The road condition was very poor and in some areas it is surrounded by water. The level of water is now receding and some people have started to return to what is left of their nearby homes.

On the way to the camp village we stopped to ask questions in a local community. "We are happy to be going back to the debris of our home instead of sitting in camps on the roads and waiting for relief.  We try to survive with our own saved resources," said 55 year old Mero of village Goth Mitha Baluch.

We reached a village where a health camp had been set up by CARE local partner Takhleeq Foundation. The camp was well organized, with separate facilities for men and women, and with the active involvement of local elders.  Over 350 local people were gathered, including men, women and children, waiting for medical officers' consultation and medications. Four medical officers (two male and two female) were fully engaged in consultations.  In the waiting room staff were leading hygiene awareness sessions, focusing on how to ensure clean water and do hand washing. 

One of the female medical officers is 23-year-old Dr. Tabinda, who has been providing healthcare services in flood-affected areas for the last 15 days. Asked about her motivation, she said: "I am very happy to provide health services to these people. They are deprived, they are poor, and the way they are being neglected is inhuman. This village has a population of 20,000, and they have no health unit available for healthcare." She said she and her colleagues were travelling three to four hours on daily basis to access these remote areas. Yesterday the team had to go on foot for half an hour to conduct camp at another village. "Our motivation is high to serve these needy people, and I am sure to get their prayers." She pointed out one lactating woman sitting with her for treatment and said, "This woman is seven months pregnant.  She is weak, malnourished and shelters-less. She has had severe pain for last seven days, but her family could not afford to bring her to a checkup at Mirpur Khas city."   

Shewa, a 70-year old man, was suffering from fever and being treated by a male medical officer. "We are 16 in my family," he explained: "Five daughters, three sons, six grandsons, my wife and myself, all living in a hut with a cover made of plastic and our clothes. We lost all our standing crops -- cotton, vegetables, rice in the field and now we are looking for food and water to survive.  All our family members are ill, and have come to this camp for treatment. This medical support is blessing on us. My young grandson Rehman is studying in class 3 and he is suffering from malaria fever and not attending school.  If I could get some cash support in future, I will buy some livestock, foods, and construct a new hut for living."

I have experience working in some major disasters in Pakistan such as the disastrous earthquake in Pakistan in 2005 and the floods last year and I know that every disaster victim has different suffering and feelings of hope. But responding to the floods this year in lower Sindh, I witness that people are hopeless and frustrated after waiting for three months to get support. Many of these people will die from malnutrition and water borne diseases if a response cannot be expedited. CARE and other organizations urgently need more funding to support people in need.

Mohamed Maalim Gedi sits cross-legged on a floor of dusty red dirt, aimlessly fiddling with his bare, well-traveled toes. His gaze is towards the ground, but his thoughts are obviously elsewhere. He occasionally reaches out to swipe an insistent fly from the face of one of his young children, five boys. The wooden benches, set in a half circle around him, are filled with other weary travelers. They just arrived in Dadaab, a place of both hope and uncertainty. A large bus, smoke still sputtering from its tail pipe, is parked a few yards away. It is the one that transported him from the border, another group of Somali refugees escaping drought and insecurity. There have been more than 132,000 refugees who have come just since January.

Like so many of his fellow refugees, Mohamed is a pastoralist. His entire livelihood depended on his cattle. When the last one died, he decided it was finally time to escape. "I have lived like this for 20 years," Mohamed says, referring to the frequent drought and worsening security in his home country. "Enough is enough."

So, with his wife and mother, he traveled 500 kilometers via foot and donkey cart from his village of Bu'aale, Somalia to the border town of Dif, Kenya. From there, he arranged for a bus to transport his family for the rest of the journey to Dadaab. Because of limited space, he had to leave behind two of his children, his youngest, 2, and his eldest, 14, with cousins. "I hope the bus that just brought us is going back to get them," Mohamed says. "But I can't be sure."

The reception center is the first safe haven after a long and arduous journey for refugees. In the background, one can hear the shrill, high cry of children. But their cries come not from the hunger but vaccinations against polio, measles, diphtheria and pneumonia. Such vaccinations are unheard of luxuries back in Somalia, and are part of the reason Mohamed made the trip here. He hopes his sick children will get the medical attention they need.

Waiting outside the UNHCR registration tent. Once a refugee is registered, they are entitled to the regular food distribution cycle that CARE manages with food procured by the World Food Programme.

Here at the reception center, Mohamed also has access to clean water and a supply of high-energy biscuits. Because of increased efficiencies in registration, Mohamed and his family will now be registered within a three-day time period, down significantly from previous waiting times when the crisis first hit. After he registers, CARE will provide him with a plastic tarpaulin, kitchen set, soap, blankets, plastic mats and jerry cans and an initial food ration to last until the next regular food distribution cycle. As registered refugees, Mohamed's family will be entitled to a tent from UNHCR an a food ration card so they can join the bi-monthly food distribution cycle run by CARE.

On the fence surrounding the area where CARE distributes initial food rations —servings of wheat flour, Corn Soy Blend (CSB), vegetable oil, corn meal, beans, salt and sugar — hangs a sign in English and Somali. It states: "Services from Agencies are Free; Help Stop Sexual Exploitation and Abuse." CARE and other agencies that work here are continuously working to ensure refugees are aware of services and where to access them. A CARE counselor stands next to the area where new arrivals gather their high energy biscuits. "How was your journey?" she asks a fatigued family of five. She's looking to identify vulnerable populations, such as survivors of gender-based violence, widows, lactating mothers and the ill. She's help "fast-track" them so they can get to immediate help, including medical services and counseling.

As he waits to be called, Mohamed sits with uncertainty weighing on his mind. He has no relatives or friends in the camps, and is unsure of what to expect. "There is a fear of the unknown," he says. "Will I have a place to sleep tonight? Will my children get food and medicine?"

In spite of these reservations, Mohamed says he remains optimistic. "I am hopeful. Hopeful that I will get help for the first time. That, finally, we will have some relief."

He pauses for a few minutes, lost in his thoughts. "A larger question lingers, though," he finally admits. His question is one that countless others have asked, continue to wonder, even after the physical part of their journey is complete. "What's next?"

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Niki Clark
September 20, 2011

Everyone knows that water is necessary to sustain human life. People have survived for weeks, even months, without food, yet even a day without water causes the human body to suffer. Even with its critical importance, water isn't typically something that gets most people excited. That is, unless you're talking to any of the CARE staff working on water and sanitation (WASH) in Kenya at the Dadaab refugee camps. Just hold a 10 minute conversation and you'll understand how easy finding a passion for the subject can be. 

CARE's goal is to provide sufficient quantities of water to the existing and new refugee populations. This includes the maintenance of 20 existing boreholes and over 170 km of pipes.

As the main implementing partner for water production and distribution in Dadaab's three camps and two outlying areas, CARE pumps and distributes approximately 7.5 million liters of water a day, enough to provide all residents with 15 liters of water a day. With almost 500,000 refugees in and around the camps, providing water for the entire population remains a daunting task and extending services to keep up with demand is a constant challenge.

"Dadaab is the third largest city in Kenya," says Timothy Mwangi who helps with CARE's water management. "The coordination and logistics involved in making sure that many people have enough to drink would be difficult in a normal setting. But within the context of a refugee camp, it is even more of a challenge."

CARE is meeting that challenge through a combination of boreholes and water tanks. Currently, CARE maintains 20 boreholes and over 172 kilometers of pipes throughout the camps. These boreholes tap into the reserve of groundwater that sits below Dadaab's surface. In addition, CARE provides potable water through trucking services and water tanks. Each influx area has between one and three tanks, each serving 2,500 people.  CARE also is increasing the number of water points and tap stands in the influx areas and extending water pipes from the existing camp systems.

Resources are tight. Amina Akdi Hassa is the chair of the Dagahaley camp. She serves as a refugee representative and is consulted when decisions regarding Dagahaley services are made. She has lived in Dadaab for nearly 20 years. "Share our problems," she tells visitors. 

One of those problems is storage. While CARE distributes jerry cans to all new arrivals, there often are not enough to transport and store all the water needed. The task of collecting water is time consuming, and often keeps those charged with less time to collect firewood and cook, for example. Community mobilizers employed by CARE spend their days talking with residents like Amina to assess the problems and offer solutions.

In addition to our water production and distribution work, CARE manages all hygiene and sanitation promotion programs in the three main camps — Hagadera, Ifo and Dagahaley — including each camp's influx areas, markets, schools and water points. Refugee "incentive" workers raise awareness around various hygiene issues, including reducing the spread of waterborne diseases through handwashing. These workers go door to door, demonstrating safe hygiene practices and distributing soap.  

Water trucking in camp Dagahaley. Refugees here receive an average of 19 liters of water per day.

To the outside world, it may not seem like the most glamorous of jobs, but the response of the refugees is quite different. When CARE's Public Health Promotion Officer Raphael Muli visits the influx area of Dagahaley, he is immediately surrounded by residents of all ages. Young children crowd, raising their hands, anxious to volunteer for the handwashing demonstration. Raphael flips through a "how-to" picture book walking the children through each step. Then, he hands out bars of soaps, reminding refugees that handwashing is a simple way to reduce the risk of disease. In fact, some studies show that this simple act can decrease diarrheal disease by up to 47 percent in a community. All day long Raphael will repeat this drill, one person in a CARE team of public health officers and community mobilizers. He is greeted enthusiastically everywhere he goes.

Raphael and his colleagues have reached nearly 31,500 refugees living in the influx areas with their public health promotion messaging this year alone. Their goal is to reach 60,000 by the end of the year. With each demonstration and each conversation he holds, his message about the important of water and good hygience becomes clearer to everyone.

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Adulkadir Adbullahi Muya—known by his colleagues simply as Muya—is in a hurry. He hardly has time for a handshake greeting before he is off, his long stride forcing the occasional sprint in attempts to keep up.

Muya is a paracounselor with CARE in the Dagahaley camp of Dadaab Refugee camp. He identifies people in his community who have experience trauma, loss or violence and handles initial consultations.

Paracounselors like Muya are specially trained, identifying the violated and vulnerable within the community and handling initial consultations. He walks this route several times a day, going back and forth between the CARE Counseling office and the drop-in center.

Right now he is headed to meet a new client, someone a CARE community mobilizer told him about. A bus was hijacked on the journey from Somalia to Dadaab. Women were raped; people were burned. The details are fuzzy but he knows it's serious. His pace quickens, his fingers furiously texting, always working, even as he walks. He briefly turns, "Dagahaley is growing and growing," outstretched arms for emphasis. Indeed, it is. The population of Dadaab has more than doubled in just three years.  

We rush past Unity, a primary school CARE runs in Dagahaley, the sing-song chorus of children echoing from the classrooms. Past a lone donkey, munching his way through a burned refuse pile, searching for anything edible. Through shouts of "How are you?," a charming acknowledgement by refugee children of Muya's obviously English-speaking companion. By mud bricks in a yard, past a naked toddler beating an empty jerry liter, applauding himself for the rat-a-tat noise his impromptu drum makes.

A resident of Dadaab since 1991, Muya went back to Somalia in 1997 and after nearly a decade, returned once again, this time bringing his mother. He works with an unceasing determination, often working through lunch breaks in order to squeeze in just one more visit. The pride he holds in serving his neighbors in this way is evident; it comes through in his stance, the way he speaks of his "clients." The sweat beads that form on his brow in this ungodly heat remind me of a musician, just finished with a high-energy performance. It's an accurate impression. In many ways, Muya is a rock star.  

On the way to the drop-in center, Muya walks past the home of one of his current clients. A quick change of plans and Muya walks in the yard, greetings all around. An elderly refugee woman sits on a mat outside her mud hut. I smile softly in her direction but notice her blank eyes, she is blind. A lump grows in her neck glands; multiple hospital visits have answered none of her questions. Muya asks how she's doing, is she in pain, does she need him to make any calls?

"Sometimes I just stop by to say hello," Muya says about his visits. One man he stops to see has a cancerous tumor that is enveloping the back of his head, creating constant pain. His only option is chemotherapy, which he can't afford. But Muya stops by every day, every two days. "I don't want him to lose hope. Maybe one of these days, if I keep referring him to different doctors, reaching out to different people, then maybe someone can intervene and help him. Until then, I'll keep listening, searching for help. I want him to know he hasn't been forgotten." 

As he speaks, another woman walks up, complaining of constant headaches and vision problems. Can he help her? She heard he could. "New clients," Muya says with a smile. "Every day, you get a new client." He jots down her information and refers her to the medical center before he is off again. Muya has his fill of new clients today. He is stopped no less than six times on his way to the drop-in center.

One is a woman who has lived with her condition for six years, four of them in Dadaab. She, too, spends her days sitting outside on a woven mat, not walking except to the latrine, which is fortunately just a couple of feet away. Her arms and legs are thin like twigs, breakable, yet her abdomen is swollen like the belly of a mother on the brink of birth. But this woman isn't pregnant, her eldest is eight. And no one can seem to tell her what's wrong. She asks Muya to photograph her; that maybe he can show the picture to another doctor, one she hasn't seen before, and this one could help. Muya promises to follow up and then heads out.

There are more people to see.

Because the sun is fading, and the drop-in center is still far, Muya calls the daughter of the woman he originally set out to see and asks if he can meet her at the block instead. It is in fact, right next to Muya's block in Dagahaley, so he knows exactly where to go.

Muya with the some of the refugees (including a client, bottom left) with whom he interacts with regularly, not only as a paracounselor for CARE, but as their neighbor and fellow refugee.

The woman's family surrounds her as he makes his way to her house. She lifts her dress, revealing a painful and hideous wound, where the men covered her with paraffin and firewood and set her on fire. It was her punishment for resisting rape. After her bus was hijacked, women were brought into a nearby forest and raped. When she fought back, she was burned. The hijackers stole the bus, and so the woman had to be carried by the other refugees to Dadaab. Luckily—if you could call anything in Dadaab that—her daughter was here and had a mud house to offer. She visited the hospital with her husband, who could just watch as she was attacked, but they couldn't afford the recommended procedure so they returned back to her daughter's home with just pain pills and topical cream. That was two weeks ago. Yesterday, CARE had met with the men on the bus, today the women survivors. They needed to talk through the horror they had witness.

"I still feel the pain," she said, "Like my skin is on fire." When Muya asks her about her other pain, the pain that's will remain after her leg heal, she tells him, "I've accepted what has happened to me. What is disturbing me is my wound, my physical pain. If I can get treatment, and I can't see the scar, I will be able to forget about it."

In a world where violence, loss and death are an everyday norm, this may be true. But Muya will not forget. He gets her details; promising CARE counselors will follow up and ensure that the woman receives both the physical and psychological care she desperately needs. She is not alone, she will not be forgotten.

Muya and the woman part ways, nightfall is approaching quickly and he wants to get in one more visit. He shouts his goodbyes from over his shoulder; like always, he is in a hurry.

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The green trees, cool mountain climate and well-stocked shopping malls of Nairobi are in sharp contrast to the camps in dusty Dadaab. The warm smiles and healthy faces of the Kenyans I meet are very different from the haggard faces of the new arrivals from Somalia I saw lining up for food just a couple of days ago.

Many Kenyans are also suffering in the terrible drought sweeping across the north and east of the country. Today I met with CARE Kenya senior staff who explained how CARE is working to improve the situation in Kenya by investing in communal management of water and pasture. They told me that most of the people affected by the drought are pastoralists who live and move with their herds. In the drought, lack of water and pasture has seen herds decimated and no rain is in sight until September.

In the north-east of the country CARE is supporting people to renew communal management of grazing lands and water pans. Where there was some local rain in April, the water pans still have water and there is still some pasture, but even they are badly off. That’s why CARE is supporting off-take of weak livestock at a reasonable price and the vaccination of stronger animals so they can withstand the drought. This should help herds to recover and people to bounce back if the rains come.

Stephen Gwynne-Vaughan, CARE’s Country Director in Kenya, visited Gafo in late July and saw the difference these investments have made. Water pans that were rehabilitated last year with community labour through CARE’s support still have water. What’s even more encouraging is that the community have managed them well, collecting small fees from users, which have allowed them to clear out the silt this year. If they continue maintenance, these should last for twenty years.

We have also supported district-level planning so that communities and the local government know when to take emergency measures such as de-stocking of livestock. Pastoralists move across the border with Ethiopia, so CARE has worked on both sides to bring communities together so they can make agreements that allow access to pasture for the animals when times are hard.

Gary McGurk, Assistant Country Director of CARE Kenya, explained why CARE will only consider water trucking and food aid in the most dire situations. “Water trucking is expensive and encourages people to stay in places that cannot sustain them rather than moving on with their herds.” By investing in community management of water and pasture, we can reduce pastoralists facing a crisis and needing expensive food hand-outs or water trucking.

But support for such interventions is hard to get. Even though studies show that a dollar invested in preparedness will save on average seven spent on crisis response like food aid, we find it hard to gain funding. With the situation so bad, we now also need to help the many who are in crisis. Tomorrow I will travel to Ethiopia to see how we are doing that there.

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Today, I spoke to a young woman who had walked for twenty days with her two children. They left their home due to the drought which has dried up all drinking water sources.

She was sitting in a makeshift tent made from rough branches and covered in bits of cardboard and scraps of cloth. She and the other new arrivals have taken refuge outside the established camps.
The influx of new arrivals has put great pressure on services in the camps, not least on the water supply. CARE has been providing water to the camps for over twenty years, but with the recent influx we have been really stretched.

Jason Snuggs, CARE Australia’s Water and Sanitation Adviser, has been working with the local team to ramp up water supply. He says, ‘We have been setting up new water tanks and tapstands so that people can easily access the water that we truck in.’

We are also supplying 19 litres of water per day to people as they arrive in Daghaley camp. We are redrilling seven boreholes so they produce more water, increasing storage capacity, and extending the piped water system out from the main camps to the influx areas next to them. This reduces the need for expensive trucking and ensuring we can meet the needs of the 30,000 new arrivals in this camp.

The ongoing drought and conflict in Somalia – where famine has been declared in several districts in the south – means the influx of refugees will probably continue for several months. CARE estimates that over 500,000 people will be in the camps by Christmas. Clearly this is a big challenge. Jason says, “We are increasing water provision in the influx areas and water in the camps to above UNHCR global standards of 20 litres per person a day, and we will keep going until we are sure we can meet the needs of further new arrivals.”

I ask him what the biggest challenge is and there’s no pause in his reply: “Funding is the biggest challenge.” It’s also a challenge to get skilled water and sanitation professionals to work in Dadaab as conditions are hard, even for the staff working there.

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It’s 6.30am on a crisp Nairobi morning. The dawn chorus has just finished and I am standing in the CARE Kenya compound. Abdi, our driver, has just arrived with a broad smile and wearing a bright cap typical for Somalis. I am joined by Alain Lapierre, Director of Emergencies for CARE Canada who has been overseeing the expansion of our activities in the region this past month.

He says the situation in Dadaab is of great concern. People are still arriving in a terrible state. Although the numbers arriving have reduced slightly in the past few days, he believes this is only temporary. CARE is scaling up to meet the needs of an increasing number of refugees. This includes recruiting more national staff and for long-term planning with existing staff, such as Jason Snuggs, CARE Australia’s global WASH Adviser, working at the strategic level to develop plans to cope with the projected influx of people.

As we reach a rendezvous point, three CARE Kenya staff who work in Dadaab join us. They are highly skilled Kenyans working in the construction team. One of them, Oumari, tells me that he has been working for nine months in the searing heat of Dadaab, providing administrative support to the construction team who build and maintain boreholes, latrines and five schools. I ask him how he feels about working in Dadaab. He replies, ”I feel really motivated. We are giving hope to people who had lost hope in life.”

We are now joined by another CARE vehicle packed with field staff and provisions for the camp. There are also vehicles with staff from UNHCR and other NGOs. It’s 6.45am and time to hit the road!

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I have just visited Balich Village in Garissa district, North Eastern Province of Kenya. Inhabitants of Balich belong to the Somali-Bantu community, an ethnic minority which is highly marginalized. The region is experiencing a severe drought, as many other areas in the Horn of Africa currently. According to some estimates, 2.4 million people are affected in the North Eastern Province, where Garissa district is located – this is more than 50 percent of the province’s population. But amidst the drought, there is a glimmer of hope, because in Balich villagers were prepared for the drought. They are able to plant and harvest food and animal feed as they have a functioning irrigation system. But let’s start from the beginning:

Some areas of the North East Province are difficult to reach because very bad roads and long distances of up to 1,000 kilometres, and in those far away places, children, pregnant women and lactating mothers and elderly people are mostly affected. I heard of some men who had to migrate in search of pasture for their livestock or for work in the towns. Women and children staying behind depend on assistance from relatives, the Kenyan government and humanitarian organizations.

As the drought goes on water pumps cannot keep up with the demand. People use it during the day, animals at night. People rely on mechanised pumped water more than ever, and because of the over-usage the pumps often break down. Ground water levels are dropping, and some areas that were once sustained by pumped water now have to be served by expensive water trucking, which can only be a short-term solution. In some villages, pastoralists had to wait for three days to get water for their animals. Some had to walk for 30-40 kilometres to reach water points. Many of their livestock died while looking for water – and that means their source of income has perished. Garissa is mostly a pastoralist area; animals mean everything. One colleague said to me: "Animals are meat, milk, and cash. If they are gone, everything is gone”. Prices of livestock have decreased and often pastoralists have to sell their animals for very unfavourable prices. Once they make it to the market they have to sell their animals at any price offered because they do not have the means to transport them back home. Livestock might even die on the way back, because they are too emaciated. Approximately half a million people and 90 percent of all cattle already migrated out of some areas in search of water, pasture and food. And naturally, these movements cause conflicts.

Resilience is key

However, Balich village showed me a picture of strength and perspective. CARE’s long-term support in Balich has helped people to resist the impacts of the drought and to prepare for times of hardship. CARE assisted the community to plant animal feed and crops by erecting water pumps and canals for better irrigation. Before, fetching water was a dangerous job: “My children are safe now when they get water. Before, they were threatened by crocodiles living in the nearby Tana river”, on woman told me. The key is resilience: empowering vulnerable people to overcome drought without losing all assets. With access to credit facilities, market linkages and a sustainable livestock marketing model, people are able to generate an income and save assets.The CARE projects in Balich show how important Disaster Risk Reduction initiatives are. But it has a side effect: Pastoralists from nearby villages are now increasingly bringing their livestock to Balich, putting pressure on the valuable water sources.

My visit to Balich reiterated what we know in theory and what we need more in practice: emergency support and long-term development initiatives that focus on creating resilience need to go hand in hand. This is the only way to break the hunger-cycle in chronic emergencies. However, funding for emergency is often easier accessible than funding for disaster risk reduction. I hope that the example of Balich shows how much we have achieved and how much money we can actually save when we invest in preparedness.

“It is unfortunate that the rains have decided to not fall for the last two years.” The Kenyan man sitting next to me on the plane to Nairobi has a very poetic choice of language, which makes for a rather stark contrast when you consider what he refers to: His country and the whole region are in the middle of a humanitarian crisis triggered by a severe drought, which is affecting almost 11 million people. And yes, some parts of this region have not seen rainfall in two years. My neighbor continues: “It is all about water. If you don’t have water, you cannot raise animals. And without animals… well, that is their life insurance.”

Touching down in Dadaab the next morning, I remember that friendly voice. The refugee camp in the North of Kenya is now home to more than 400,000 mostly Somali refugees. Their numbers have risen immensely in the last weeks, due to the ongoing drought and insecurity in their own country. The landscape is dry and plain up here, and one wonders how any group of people, let alone such a high number of refugees, can survive in these difficult circumstances.

This is my first time to Dadaab, but weirdly enough, everything seemed very familiar. Maybe that’s a CARE thing: The refugee assistance program for Dadaab is one of our longest humanitarian missions, many colleagues have worked here at one time or another. And for years, we have continuously talked about it to the public, launched appeals and tried to get journalists interested. But now, with an average of more than 1,000 new arrivals every day and extremely high numbers of malnutrition, Dadaab has become something like the epicenter of the current humanitarian crisis in the horn of Africa.

But a walk through Dagahaley, one of the three camps, also shows the impressive efforts by all the agencies on the ground to provide basic services to all these people. We pass by the reception area where CARE distributes food and other relief items to new arrivals, we see trucks delivering water, and visit the service tents – all of this I have heard about before, but it is still a whole different story to see the work with your own eyes and listen to the admirably energetic colleagues explaining their work.

And we meet Amina Akdi Hassa, who serves as chairlady for the camp Dagahaley. She has been living here for 20 years and is a leader and an advocate for her community. “I want the world to know that they should please share our problems with us”, she explains. “We have had five schools here since the 1990’s, but now there are so many more children.”

The people of Dadaab are talking. But is the world listening?

By Sandra Bulling

Green plots of land cover the lush mountains of East Haraghe in Ethiopia. Small brown huts dot the landscape, their owners busy working in the fields. Thick grey clouds hang above the peaks as high as 3,000 meters, seemingly bursting with rain any moment. On a first look, East Haraghe looks like postcard idyll, perfectly suited for agriculture that yields enough crops to sustain the farming families. On a second, the area is the scene of a severe drought. Malnutrition cases East and West Haraghe zones increased steeply in the past months. The reasons: insufficient rainy seasons, high food prices, chronic poverty and a weather phenomenon called La Nina.

The large majority of Ethiopian households, 87 percent, relies on agriculture as source of income and nutrition. A good rainy season brings relief, a failed one desperation. The past twelve months were determined by worry; the Meher rains that usually arrive from June to September in East Haraghe ceased prematurely last year. As a consequence, the complete harvest was lost. The following Belg rains which are scheduled by nature from March to May were delayed for about two months, insufficient in amount and erratic in distribution. For many farmers it was impossible to plant; and those who did are still waiting for their maize to ripen. One month ago, in June, farmer would have normally started to harvest. But instead, people have no food left in their homes. Scientists credit the insufficient rains to La Nina, a weather phenomenon that changes weather patterns and causes drier conditions in East Africa.

Maize porridge, twice a day

Kado Kaso came with her son Sabona to a government run health center in Kurf Chele district. “My son was vomiting, he had diarrhea and could not hold any of the food I fed him”, she says. Sabona was diagnosed as severely malnourished. The three year old has lost his appetite. His feet, legs and eye lids are swollen – characteristic signs of edema, a medical complication of severe malnutrition. He stares into the room, there is no energy left in the little body to play or move around. Sabona arrived one day ago and the therapeutic food provided by CARE has not regained his energy yet.

When the Belg rains began this spring, Kado started to plant barley and beans on her small land. But the rains stopped earlier and all her crops withered. “We have barely anything to eat. During normal years, we eat three meals a day. Now we are lucky if we eat twice a day,” the 30 years old mother says. She takes Sabona into her arms. “We only eat maize porridge, I cannot afford anything else.”

On the bed next to Kado sits Abdi Mahommed with his five year old daughter Milkiya. She has been here for one week, has recovered her strength and appetite. Both father and daughter will leave the center the next day. They will continue receiving weekly rations of therapeutic food, to ensure Milkiya’s condition stays stable. But Abdi has sold his ox to buy food for his family of eight. “I don’t know how to plant for the next season, I have no ox and no seeds,” he says. He is glad his daughter has regained her appetite and started playing again. “All that matters is saving my daughter’s life.”

Searching for labor

Kado’s husband has moved to the nearest town in search of work. But he is not alone. Fathers stream into the towns offering their labor – and salaries have dropped by 50 percent. “My husband now earns 10 Birr a day, in normal years he can earn 20 Birr”, says Kado. Ten Birr are USD 0.60; and that is how much a kilo of maize costs. A price, that has risen significantly over the past months. “My husband comes back every four days, giving me money to buy food. My four children and I are dependent on him, we have no other income.” She now stays with Sabona in the health center, until the little boy can eat again and reaches a stable condition.

Kado’s other children are at home, alone. Neighbors look after them, but they have no meals to share either. And the health center has run out of resources to hand out food to mothers like Kado coming to stay with their children. “CARE is now starting to provide food for the mothers in the health centers. Because if they don’t get anything to eat, they might be forced to leave or refrain from coming here with their malnourished children,” says Jundi Ahmed, CARE Ethiopia’s Emergency Nutrition Advisor.

A malnourished generation

Today, almost every tenth pregnant woman or lactating mother in East Haraghe is malnourished due to the insufficient rainy seasons. However, malnutrition is a chronic condition for many Ethiopians. Even during years with normal rainfall, the small plots owned by households in East Haraghe do not yield enough to cater for balanced and sufficient meals. Malnourishment during pregnancy determines the entire life of a child. Sons and daughters, who do not receive sufficient nutrition in the first five years of their life will not fully develop their mental and physical capabilities. “It is a chronic hunger cycle that can last for generations. Malnourished mothers give birth to malnourished children and have no means to feed them with most needed vitamins, iodine and iron. Children are smaller in height than well-fed children their age, they are stunted. And it is very likely that they will also have malnourished children,” says Jundi Ahmed.

CARE started food distributions to reach 66,000 people in the zones of East and West Haraghe and Afar. Kado’s family and others in her district receive monthly rations of sorghum, vegetable oil, supplementary food such as corn-soy-blend and beans whereas pregnant mothers and lactating women get special supplementary food. But CARE also has long term development programs in the area, supporting families to overcome poverty and hunger. Through Village Savings and Loan Associations, for example, women can contract small loans to open shops and small businesses. With an additional income families can save assets that protect them in times of drought.

Drought comes in different shapes in Ethiopia. But whether in the dry areas of Borena in southern Ethiopia or the lush green mountains of East Haraghe – the pain and consequences of drought and hunger are the same throughout.

Muna* is the envy of her friends in Dagahaley camp. She is also a newly arrived refugee, in fact just nine days in the camp, but unlike her friends who have to live in the outskirts, she has what seems like the comfort of a room within the camp. As soon as she arrived, she managed to trace some of her clan members, who let her use the room in their homestead. Muna is 40 years old, and arrived in Dadaab with her seven children.

Her story, however, is nothing to envy.

She left her husband behind because bus fare for all of them was too expensive. They had to pay Ksh 15, 000 each for the journey on a bus, so he let them go ahead, remaining behind to raise more money for his own trip. “I will join you soon,” he said as he waved them goodbye.

Muna’s journey from Somalia took her 18 long days, having to feed her children wild fruits and look out for wild animals and hyenas. Her children are all safe, and they did not come across any wild animals on the way. However, what her friends would not envy about her is that she was raped on her way to Dadaab. It was midway through their journey, bandits (shiftas) stopped their bus and ordered all the women to step out. “We were eight women on total, so they separated the older women from the younger ones, and told them to get back into the bus. The five of us stayed behind, with our children, and the bus driver was ordered to drive off and leave us behind. That is when they raped us,” she said.

They were in the middle of nowhere, with their children, and strange armed men. The children were pushed away behind some bushes and instructed to be quiet by one of the men, as the others went back to the women and raped them. Some of the other women were gang raped.

Although it was in broad daylight, no other vehicle passed by, and even though they all screamed for help and their children were crying in fear, nobody came to help them. “Afterwards they told us to take our children and keep walking,” Muna and the other women ended up walking 17 kilometres before coming to Dif, where they told some village elders what had happened to them, and they raised some money so the women could go on their journey.

Muna and the other ladies finally came to Dadaab, and she is happy to stay away from her fellow newly arrived refugees, in some private space with her children, among her larger clam. She has gone through reception, and her registration date is set for November 11th. “I am glad we arrived here, and all my children are ok. We finally got some food and water and I have a tent. There are so many people here, even those who came with us, but it is still like we are alone, because my husband is not here.”

The most dangerous period for refugees is when they are on the move. Women and girls are especially vulnerable to rape, abduction, illness and even death on the journey. Many women set out on the journey alone with their children, leaving husbands behind and they may walk for weeks in search of safety.

According to UNHCR reports, the numbers of sexual and gender-based violence cases have quadrupled in the last six months in Dadaab: 358 incidents reported from January until June 2011, in comparison with 75 during the same period in 2010.

CARE has set-up a screening tent at reception centers in Ifo and Dagahaley camps in Dadaab to help identify survivors of sexual abuse or other violence on their journey. In the first six months of this year, since the refugee influx began, 136 cases have been documented, compared to 66 in the same period in 2010. Upon identification, counseling and referred emergency medical attention is administered.

“The deep psychological affects that drought, conflict and subsequent movement can have on woman refugees is immense. We have witnessed high levels of anxiety, panic and trauma due to loss of family members along the way and women are sharing stories of rape, violence and hunger,” said Wilson Kisiero, CARE’s Gender and Community Development manager in Dadaab. “CARE is providing immediate psychological support to the newly arrived women and girl refugees and we are doing all we can to ensure follow-up visits.”

Muna was referred to the MSF clinic by the CARE staff that interviewed her, but she has not gone to the clinic yet, she is afraid she may be pregnant from the ordeal, or she may have a disease. She said she would wait a few more days and then go, but not just yet.

*Not her real named

In Hagadera camp, Fatumo Osman Abdi, 50 has just settled into her tent. She is weary from the journey of 20 days from Somalia. She came with her three grandchildren (aged 13, 5 and 4), her son and pregnant daughter-in-law. Back in Somalia they were farmers, in a place called Kurdun where they grew food for her family. The lack of food became a bigger and bigger problem with time, until they decided to leave.

“Every night as we traveled here, we slept out in the open land, under the stars. We were very afraid, we did not know what was out there, or if there were people coming. We had heard many stories of man-eating lions so we could not even sleep,” she said.

The journey was a difficult one, but Fatumo is thankful that they did not meet any robbers. On their way to Dadaab, they were given food by Muslims on the way, just well wishers who decided to lend a helping hand.

“We arrived here so hungry, so tired. My grandchildren were so tired, I was afraid they would die on the way. Even my daughter-in-law. We slept out in the open for many days, we were under the stars again, but we were safe. After so many days I finally have my tent,” she said.

Seventy year old Habibi* came to Kenya as one of 72 people who traveled together from Somalia. That was almost her entire village, she says, and was made up of her family and friends. Her son had heard of Dadaab and told them about it years ago, he had said that they could run to it because of the fighting. Habibi’s husband had declined, opting to stay in Somalia longer.

Back home they were farmers and pastoralists, growing sorghum, and keeping cows, goats and sheep. They left Somalia because of drought, came here with her friends and neighbours, children and grandchildren. She describes the journey to Dadaab as the ‘worst thing she has ever experienced’.

“We were attacked by strange men, they looted all our belongings, women were raped and men were beaten, but we thank God nobody died,”. Habibi was also raped, and manages to talk about it openly, her anger and confusion still evident. “Our husbands and sons were all there to see it happen to us, it was very bad!”

She is still in the influx area of Dagahaley camp, with only 16 other friends and relatives. The others settled in another camp, Hagadera. One of her relatives gave up his tent for her so she could have shelter with her four grandchildren. All they had to eat on the way was maize, and more maize as they traveled the long journey to Dadaab.

“I do not want to go back to Somalia, all our problems are still there! I am here with nothing, but I would rather stay here. Life here is hard, the food they give us is little because now we have to wait for registration, but I would rather stay here than go back,” she said.

*Not her real name.

KOLKATA- STATUS OF ELDERLY POPULATION

Though modern medicine and improved health facilities have contributed to better life expectancy and a huge increase in India’s elderly population in the past 50 years, geriatric medicine and social security measures have failed to keep pace. Consequently, increased longevity, breaking up of the joint family and lack of geriatric care have left the elderly helpless in most cities and towns, this despite the declaration of the National Policy for Older Persons by the Government of India in 1999. Currently, 81 million population is made up of the elderly out of which 30% are absolutely single. Yet, financial and other constraints prevent geriatric wards from being set up in rural and urban centre by the government.

In Kolkata more or less scenario is also similar like other part of India.

On economical/financial point of view these Senior Citizens are categorized in to 3 parts:-

                     ♦From Low Socioeconomic Group/Underpriviledged Group

                     ♦From Middle Class

                     ♦From Higher Class

As per their economic condition these elderly people are suffering from mainly 4 types of Insecurity:-

                     ♦ECONOMICAL INSECURITY

                     ♦HEALTH INSECURITY

                     ♦EMOTIONAL INSECURITY

                     ♦LEGAL INSECURITY

♦ECONOMICAL INSECURITY:-

                     Due to low income or no pension system or more no of family members in
elderly population belonging to Low Socioeconomic Group/Underpriviledged Group
are suffering from economical insecurity.
On the other hand elderly population belonging to Middle Class are also suffering
from economical insecurity due to very low pension or no pension or no source
of income,so they are basically dependent to their children &
due to increase no of nuclear family in majority cases they are neglected.

♦HEALTH INSECURITY:-

                   Health is one of the prime   concern  for elderly population.
Though there is separate discipline- GERIATRIC is specially meant for elderly
people but due to lack of awareness this is not popular till now in
Kolkata. Elderly population belonging to Low Socioeconomic
Group/Underpriviledged Group are much more
sufferer due to their financial constrain & unavailability of any opportunity
in Government Health sector.
Due to huge premium value of Mediclaim/Health insurance, majority of elderly
population belonging to Middle Class are unable to take the facility.
Huge medical cost due to increase cost of medicines & hospital bill
are also key responsible factor for insecurity. Though money is not
prime factor for elderly population belonging
to Higher class but their main insecurity is due to lack
of man power specially during emergency medica
l crisis period. Lack of any Doctor/Medical personnel to attend the elderly
people at home during emergency
is also another factor of insecurity in Kolkata.

♦EMOTIONAL INSECURITY:-

                     Emotional insecurity is mainly seen in elderly population
belonging to Higher Middle Class & Higher class because of nuclear family pattern
& breakdown of family bonding. Major portion of this population remain isolated
from their children. Due to lack of emotional attachment many of them are
suffering from serious mental disorder & depression.

♦LEGAL INSECURITY:-

                   Legal insecurity is another main concern for our elderly people.
Due to lack of knowledge/awareness, many senior citizens are not aware of how LAW empowers them.

          The free legal cell of Calcutta High Court offers help to the elderly.
They can take up abuse-related issues directly with the unit and their cases
will be fought for free.

                               FEW IMPORTANT LAW IN FAVOR OF ELDERLY:-

● Section 125 Code of Criminal Procedure 1973 (Order for maintenance of wives, children and parents)

● An elderly woman facing abuse or turned out of the house by her children can also lodge a complaint under the Protection of Women from Domestic Violence Act, 2005. If there is any evidence of abuse the children can be jailed.

●A male victim can seek justice under Section 323 of the Indian Penal Code.

●The Maintenance and Welfare of Parents and Senior Citizens Act, 2007, has had few takers so far, says Calcutta High Court advocate Jaymalya Bagchi. But this Act compels a child or heir to provide maintenance, including food, clothing, residence and medical attendance, up to Rs 10,000 to parents, including adoptive parents or step-parents.

          SOME SIGNIFICANT INFORMATION REGARDING ELDERLY CARE IN KOLKATA:-

♠ FIRST GERIATRIC CONSULTANT:-

                              DR.KOUSHIK MAJUMDER,MRCP,FRCP-Presently attached with NNC

♠ FIRST GERIATRIC SEPARATE OPD UNIT:-

                               MEDICAL COLLEGE HOSPITAL ON 04.08.2001

 OTHER STATE HOSPITAL WHERE SEPARATE GERIATRIC UNIT IS AVAILABLE:-

IPGME&R (SSKM)

CALCUTTA NATIONAL MEDICAL COLLEGE

♠ FIRST GERIATRIC SEPARATE UNIT IN PRIVATE HOSPITAL:-

                              AMRI(DHAKURIA)

♠ FIRST 24 HOURS HELP LINE & EMERGENCY HEALTHCARE SUPPORT TO HOME:-

                              BANCHBO healing touch(www.banchbo.org.in),HELP DESK-(91)9903388556/9231914390

♠ FIRST HELP DESK OF KOLKATA POLICE FOR ELDERLY:-

                             PRONAM- (033)24190740

♠ FIRST TRAINING INSTITUTE ON GERONTOLOGY:-

                             Calcutta Metropolitan Institute of Gerontology

           KEY PERSON RELATED WITH GERIATRIC CARE IN KOLKATA:-

                     ♦DR.KOUSHIK MAJUMDER,MRCP,FRCP-Geriatric Consultant, Founder of CARES

                     ♦DR.POOVIAH- Geriatric Consultant,AMRI

                     ♦DR.SUBRATA MAITRA-Geriatric Consultant.
                   *DR.TAPAS DAS- Incharge,Geriatric Unit,IPGME&R(SSKM)

                     ♦DR.SUDIPTA KR.SEN-Eminent Medicine Consultant.

                     ♦DR.A.K.ROY CHOWDHURY- Eminent Physician,Chief Medical Adviser,
BANCHBO healing touch.

                     ♦DR.DHIRES KR.CHOWDHURY- Chief Functionary, BANCHBO healing touch.

                     ♦DR.INDRANI CHAKRABORTY- Director, Calcutta Metropolitan Institute of Gerontology.

                     ♦AMIT ROY-President, Safhi.

                     ♦DR.DIPANKAR DEBNATH-Geriatric Consultant. Institute of Geriatric Care & Research.

             HELP A CALL AWAY (ORGANISATION FOR ELDERLY CARE IN KOLKATA):-

                        ♥ Pronam: (033)24190740

                        ♥ Dignity Foundation: (033)30690999

                        ♥ Helpage India: 1800-345-1253

                        ♥ BANCHBO healing touch: (033)65160058,(91)9903388556
(For medical emergencies only)

                        ♥ Saanjhbaati: (91)9748856000

                        ♥ CARES: (91)9830779291

                        ♥ SOCIETY OF GERIATRIC ANIMATOR: (033)65197474

• Alzheimer and Related diseases Society of India (A.R. D.S.I.)
• Indian Association of Retired Persons
• Bethune Institute of Geriatrics Research and Rehabilitation Centre

                         ♥ Institute of Geriatric Care & Research: (91)9830372605

       ♣ SIGNIFICANT DAY CELEBRATION FOR ELDERLY:-

                       1ST OCTOBER, INTERNATIONAL SENIOR CITIZEN DAY,
ORGANISED BY VISWA PRABIN DIBAS UDJAPPAN COMMITTEE
 If any one like to modify/correct/add any information please inform without any hesitation
 

In Borena in southern Ethiopia the last two rainy seasons have brought no water. The drought took one third of all livestock, leaving families without income.

Little Salad is sleeping soundly. Gamu Kamad, his mother, is very relieved. Just a few days ago, the 11-months old could do nothing but vomit. He could not crawl, he did not play; he was just too weak. In the past weeks, Gamud feed him only water – she had no money to buy milk. Most of her cattle died. In the Borena zone, in southern Ethiopia, the last two rainy seasons did not bring any water and a worrying drought has gripped the region. In the Moyale district, the land is brown and dusty. Bushes and trees have lost their last leaves, their trunks and branches reach naked into the air. A little green is left on thorny shrubberies and acacia trees, both either too dangerous or too high for cattle to reach.

Gamud and Salad have found help in a health center in the town of Moyale, run by the local government. Salad was weighed and screened. His diagnose: severe acute malnutrition. He was brought to the stabilization center, where he now receives therapeutic supplementary food, provided by CARE Ethiopia, until his condition improves and he reaches a normal weight for a boy of his age. His mother stays with him and receives food as well. “I was very worried about Salad,” she explains. “We came here four days ago, but now Salad’s condition is already much better.” She looks at the tiny bundle lying next to her, still sleeping calmly. “Before I brought him here, he could not open his eyes any more. He threw up the water I gave him. But now he gets stronger every day.”

The health centers in the Moyale district have experienced a rise in malnutrition cases for children under five years. Almost 500 severely malnourished children were admitted from January to June. In 2010, this was the rate for the entire year. In the Borena culture, children are given the most food. They eat first, followed by the father and then the mother. Parents give their children the little food they have, but now they have no groceries left and no money to buy some.

Livestock is life
The prices for cattle are the lowest in the past decade in Moyale. At the same time, prices for food have risen sharply. In a pastoralist society such as in Borena, people depend on their livestock. They are their income and source of nutrition – their life. When livestock die, people lose their assets. In the Borena zone, one third of all livestock have starved. “Even goats and camels find no pasture any longer. This very unique, as they are usually drought resistant animals”, says Mandefro Mekete, CARE Ethiopia’s Emergency Operations Coordinator. But it has never happened before that both the Hagaya autumn rains and the Genna spring rains have failed in Borena. Scientists credit this drought to La Nina, a weather phenomenon that changes weather patterns and causes drier conditions in East Africa.

Gamud has lost 36 of her 51 cattle to the drought. The residual cattle are too emaciated to give milk or to sell on the market. Her husband is trying to save the lives of the remaining ones by taking them to areas where pasture is still available. Some people migrate as far as 400 kilometers in search of water and pasture, putting pressure on the remaining grazing grounds. CARE, in close collaboration with the local government, opened 21 slaughter destocking sites to recover some value from emaciated and unproductive animals that would otherwise die and to prevent conflict that might arise from competition around scarce pasture grounds.

The smell of slaughtered meat hangs in the air. The bones of cattle are thrown into a square, deep pit. Bloods seeps away into the brown ground, leaving dark red streams on the earth. Hasalo Duba has come with two cows to the slaughter destocking site in Dima village. “Before the drought I had ten cattle. Six died already and I brought two here today. I have only two left now; only one of them gives milk,” the 25-years old mother of six children says. She will receive 800 Birr (47 USD) per cattle which allows her to buy staple foods on the market. She will also get some hay and supplementary animal feed to save the life of her remaining two cattle. “Eight vulnerable families will receive the meat of the slaughtered cattle,” Mandefro Mekete explains. “The slaughtering takes place with technical assistance from official meat inspectors, who ensure that the meat is safe for consumption.” However, there is not much meat left on the bones of the barren cattle waiting in front of the slaughtering pit.

No rains expected to come soon
Malicha Galgalo has already received her money. The 40-year old wears a long black dress with red applications; she sits on top of a heap of white bags full of hay, surrounded by children. “I have to find a donkey to carry the bag home. I have lost 25 cows, only five survived,” she says. Malicha believes that Moyale is in a very critical situation. “Before the drought, I could sell the milk and I had a steady income. But now I don’t earn any money and I have ten children to feed.” She depends on food distributions from the government. With the 800 Birr she received for her cow Malicha bought one kilo of grain. “I will save the remaining money. I don’t expect the situation to improve, there will be no rain coming soon.”

The next rainy season is supposed to arrive in September or October. Until then, many pastoralists predict most if not all of their remaining cattle will starve. Some elderly already fear that the Hagaya rains, as the autumn rainy season is called, will fail as well. Kofobicha is 55 years old and has lived through several times of hardship. But the drought has never been as bad. “We don’t expect the next rainy season to come. Even if the Hagaya rains come, no cattle will be left by September,” he forebodes. “But we don’t care about our livestock any more. All that counts now is to save human live. We have accepted that we need to fast, but who saves our children?”

Salad from Moyale town was lucky, he has been saved. Life has returned to him, thanks to CARE’s and the government’s interventions. But many more children and their parents will need assistance in the coming months. They need urgent humanitarian support, but they need also a long-term strategy to become more resilient to the impacts of drought. So Salad’s mother is able to buy him food when the next drought hits.

Dama Godona lives in a place of great contrast: even though the grass in Dire, Borena in southern Ethiopia looks green it is the harbinger of a severe drought. Consecutive failed rains did not provide enough water to yield sufficient pasture growth, which is important to sustain the cattle of the region’s pastoralists. Dama lost seven out of her 17 cattle and used all of her savings to purchase animal feed and water for her livestock. She plans to sell six of her remaining cattle in order to buy more cereals, animal feed, and water.

Over the past weeks Dire woreda (the Ethiopian equivalent of a district) has received some rain. But it is missing the heavy rain needed of bringing new plant or crop growth to the area. The people of Borena are pastoralists and dependent on their cattle, goats, sheep and camels. Due to the drought, many cattle have died leaving people without assets - and prone to food insecurity.

One can tell by the way she carries herself, that she exudes confidence but that she has also experienced hardship in her life. Her husband died in a car accident and since then she has to take care for her four children alone. During the discussion, Dama took the lead in the group, speaking out on behalf of her community and clearly outlining what they need most now in order to adapt to the drought conditions. When asked what the three most important needs are for people within her community Dama stated that she needs food for her family, animal feed and increased access to water, but also support for Village Savings and Loans Associations (VSLAs).

Through CARE’s Regional Reliance Enhancement Against Drought (RREAD) project she was able to contract two loans of 2,000 Birr (about 118 USD) each through a VSLA over the last four years. Upon receiving the loans, she bought emaciated cattle at a low price, fattened them and sold them with profit. With this profit she was able to open a small road side shop. Since opening the shop, she has paid off the loan with interest and is now the head of the very association which helped her increase her income, protect her assets and care for her family. Dama’s position as a pastoralist and a merchant makes her quite unique in this region.

Dama shows that prevention is key to help individuals in times of drought. She demonstrates how increasing an individual’s ability to diversify their livelihoods can spur entrepreneurship, create employment, generate income and ultimately empower an individual. Additionally, it also shows that when Village Savings and Loan Associations are used correctly they can help people provide for their families and can also reduce vulnerabilities associated with drought. Hopefully, Dama’s example will not be so unique in the near future.

Dama Godana knows all too well how difficult the life of a pastoralist woman is. In addition to the usual daily household chores of cooking, cleaning and taking care of the children, she has to walk long distances to fetch water and pasture for the small and weak animals during the dry season.

“Sometimes we have to move to inaccessible areas to look for pasture facing the risk of snakes, injuries and exposure to the harsh rays of the sun,” explains 40-year-old Godana.

When Godana heard what women in other non pastoralists communities around Ethiopia were doing to help themselves, she visited them and with the knowledge she gained she founded the Darara Women’s Savings and Credit Group in 2007. “Most pastoralist women depend on handouts from their husbands. They are not empowered,” says Godana. “I formed this credit group, so that we can work together make some income and improve our lives.”

Dama Godana	Darara Women	Darara Hay pens	Darara Pressing Hay

The group started with a membership of 15 women each paying 60 Birr (about US$ 6) as a registration fee and a monthly contribution of 10 birr (US$ 1) per month. “With this money we invested in two young bulls and during the dry season we bought concentrated animal feed and sold it to the community members,” explains Godana. The group made a profit of 2000 birr (US$ 200).

During the dry season, the group sold scarce cereals like maize, beans and sugar to the community members and to date their membership has increased to 23 with a total budget of 8459 Birr (US$ 845) plus 4 bulls. Haymaking

CARE International in Ethiopia, under the Resilience Enhancement against Drought (RREAD) project, realized the difficulty these women faced in seeking pasture for their animals and trained them on haymaking. “Training the women’s group in haymaking was not only meant to lessen their burden but also to make pasture available for the small and weak animals during the dry and drought season, thus increasing their chances of survival,” says Temesgen Tesfaye, CARE project officer in Ethiopia. For the Darara women’s group haymaking has become second nature. Immediately after the rains stop they cut hay and collect it as it begins to yellow. This sequence retains the hay’s nutritional value. The hay is then laid out to dry on especially made beds to prevent its decay. Afterwards, it is piled in stacks and stored for use in the dry season.

“We are thankful to CARE for this initiative because during the drought seasons we don’t have to suffer anymore,” says Ashure Jaldessa, a member of the Darara women’s group.

The RREAD project also provides the group with a one-off payment of 25,000 Birr (US$ 2500) to strengthen their trading business and livestock marketing. “This money will increase our household income and improve our resiliency to drought,” beamed a happy Godana. RREAD also trained the women to handle different roles and responsibilities within the group. These include basic auditing, financial management and record keeping skills.

For Godana, the journey has been long. Married as a child at a tender age of 8 years, Godana lost her husband three years later. With no education but full of determination and ambition, she started selling local brew until she got enough capital to sell roofing materials, a business she still runs to date.

“I have no education and that’s something I regret but life experiences have taught me a lot and one lesson I learnt is that one must always strive to make life better and this is what I tell my fellow women,” says Godana. “This does not mean that education is not important. It definitely is and we must ensure that our girls to go to school and stay there.”

Godana’s efforts to improve the lives of women in her community caught the attention of Ethiopia’s Prime Minister Meles Zenawi who in 2001 awarded her with a medal that reads, “Although illiterate, this woman’s struggle to uplift the women in her community has made her a symbol of development and we are proud of her.”

I arrived in Borena Zone, Oromia Region, in the southern part of Ethiopia two days ago. I am here with my CARE colleagues to conduct a deeper assessment on the impact of the current drought on women, men, boys and girls. We have talked to different groups, and even though we just had four basic questions, there was so much to listen to and to learn from. Basically, I could have asked 10,000 questions! Today we visited Moyale woreda (a woreda is the equivalent of a district), that is bordering Kenya. It has not rained there in the past six months, only the last ten days saw some rain. However, these rains were very sparse and did not bring enough water. So some areas look greener now, while others are still very dry.

But a green pasture does not mean there is no drought. The people of Borena are pastoralists and dependent on their cattle, goats, sheep and camels. But so many cattle have died already. Even though pastoralists move them to one place in order to avoid diseases, I could see carcasses lying around, there are just too many of them. Some people told me that this is not the first drought, of course, Ethiopians are used to the cycles of aridity and rain. However, what is really unique now is that it is not only cattle dying, but also sheep and goats. This is really concerning because goats usually resist quite well to drought since they can eat almost anything if needed (shrubs, bushes, branches, etc.).

A whole day to fetch water

There is not enough pasture, there is not enough water. This has a huge impact on women. Women are usually responsible for fetching water and they have to walk much longer distances now than before. One group of women told me that before the drought, it took them 30 minutes to the water point for one way. Now they have to walk three hours – one way. The second group mentioned that they not only need two hours now instead of 15 minutes to fetch water but they also need to queue at the water point for four to six hours. Because there is very little food, they don’t take anything to eat with them. They come back home hungry and exhausted. And they have to go through this ordeal every day.

In addition of spending almost the entire day to get water, women also need to collect pasture for their cattle. They therefore have very little time for their daily household chores. They can’t properly take care of their children and provide them with food. In some cases, I saw elderly people watching small children. But very often parents see no choice but taking their children out of school. School drop outs are already being visible here in Ethiopia, and it is mostly girls who need to stop their education because they have to assist their mothers with household chores and take care of their siblings. One young man of 17 years told me about the drop outs in his school. His 4th grade consisted of 82 students before the drought. Now, just 25 students are attending school – and most of them are boys.

One meal per day

I saw many cattle that are really, really weak. People told me many of them were too weak to stand up without help and how they constantly needed to support them to do it. A minimum of three strong people are needed to do this. I have not had the opportunity to see that myself but one of my colleagues sent the picture he took during one of its field visits. Impressive.

Since there is no pasture, men need to climb trees to cut leaves and use them as fodder for their livestock. People also reduce their food intake. While most families usually had three meals every day, they now can only eat once per day. Children eat first, then the father and the mother is the last one to receive what is left. So it is no surprise that most women told me: “We need food.” Even though there is food to buy at the market, the prices have steeply increased for the last months. In April 2011, the food index increased by 35.5 percent in Oromia Region compared to April 2010. People just cannot afford to buy products any longer.

An important element of a pastoralist diet is milk. Since their cattle are dying and starved, there is a shortage of milk, so people have replaced nutritious milk with tea. Without any nutrients and proteins, people are at high risk of becoming weak and malnourished. In some areas, I heard of conflict that arose due to the scanty resources. When pasture and water is limited and when people see their animals dying, tensions can get high.

These are all very concerning accounts. However, most people expect that the biggest impacts have not even begun. The worse is yet to come. The rains of the past days belong to a short rainy season and after it another dry cycle that will last until September starts. People have huge fears about their future and their ability to cope with the drought. The Ethiopian government is already responding to the drought with different interventions of which food distributions. I saw one of those today, but it is clearly not enough to reach every one who is in need right now.

By Audrée Montpetit, CARE Senior Humanitarian Program Quality Advisor

We traveled ten hours by car from Addis Ababa to reach the CARE Ethiopia Borena Field office based in Yabello. This small town is located some 200 kilometers from the Kenyan border. CARE is scaling up its emergency relief operations rapidly to address the worsening drought situation for this primarily pastoralist population. The Borena pastoralists are known for their hardiness and endurance, as well as for their cultural tradition of ensuring that the children are fed and asleep before the men eat, and finally the women. When malnourishment of children amongst this population becomes a source of concern, it is clear that there is a crisis on hand.

In a presentation at the CARE office, the CARE field staff and government officials jointly painted a very grim picture of the current situation and repeatedly referred to a disaster in the making with the loss of over 200,000 livestock dead in Borana (out of 750,000) as a result of lack of pasture and water. Without cattle, there will be neither income to buy food or milk to feed the children. As the cattle weaken and become emaciated, they no longer produce milk and often reach a stage that by the time they are slaughtered, there is hardly any meat left on the bone to consume.

In one of CARE’s innovative programs in close collaboration with government authorities and community leaders, we aim to recover some value from emaciated and unproductive animals that would otherwise die from the effects of drought. Slaughter destocking decreases the grazing pressure at times of high pasture scarcity. We saw carcass after carcass being thrown into a pit after the animal was killed, and those animals that still yielded some meat were butchered and shared amongst families identified by government authorities as vulnerable. CARE Ethiopia’s program of de-stocking provides an opportunity to pastoralists to sell their cows at a fair price and to receive in addition to nearly USD 50 for each cow, grain to feed two remaining cattle. This project is an excellent effort to help families not only gain some savings from their cattle before they die from weakness, but also to try to save those that they still have.

But their remaining cattle are very few. Of original herd sizes of 15, 30 or 40 in nearly every case, women and men would tell us that they had only two or three cows left. They have lost the majority of their cattle in the past few months with mounds of partially decomposed skeletons scattered throughout the landscape attesting to this fact.

The respected elderly clansmen of Borena have predicted that the next rains will fail as well. Scientists credit the current drought to the La Nina phenomenon which changes weather patterns and causes drier conditions in Eastern Africa. The rains are not even due for another two months yet they are expecting the worse as their situation now is very grim. A dignified elder told us that there was no hope for them: ”We shall pass, but we must help the children.” He told us that they are not able to care for their cattle and that this is not their first priority anymore. The major issue is now the health of their children who are already starting to suffer. His words highlighted the scenes and conversations of the day visiting a local health center where too-thin babies were being treated for malnutrition, to the destocking site, and water provision activities, and later to the amazing clan gathering of around 15,000 Borena who meet every eight years to elect new leaders.

At this gathering, we were told that there were very few cattle and camels. One of the elders gestured to the encampment area and said: ”Look, it is empty. In the past years there were too many cattle and we had no space. This year we have hardly any cattle.” They told us that their fate is not in their own hands, and that they have to pray to God for rain. However, their cultural wisdom of ages past leads them to believe that the rains in September will fail again.

There is a window of opportunity for the Borena: If assistance is able to reach them at this time. They have lost their assets, their source of family insurance has gone, and they now face three months, at the very least, of continued drought. They are sure that without help, they and their families are at extreme risk of losing their lives. The CARE Ethiopia team has worked diligently over the past years to develop an excellent strategy and complementary set of interventions to help mitigate this situation in Borena. But, the complex set of factors created by a catastrophic region wide drought caused by the La Nina phenomenon, the loss of a cattle market in the Middle East, chronic poverty and the dramatic increase in food prices has resulted in a situation where the Borena are on the edge of disaster.

CARE is acting now to scale up and expand our efforts in our current programming areas of CARE Ethiopia -- to save lives that will be at extreme risk in the coming months. But we need more help. We need to prevent people from leaving their homelands in search of refuge, to prevent a further long term catastrophe including complete loss of livelihoods as well as loss of lives.

Story of Shangara Hassan, a Somali woman who traveled to Dadaab refugee camp with her four children.

“I think I am twenty years old. I have four children – two of them are very sick and two of them are OK. The oldest is six years and the youngest is six months.

"I have come to Dadaab from a village in southern Somalia. I came with my children, alone, to save our lives. There was a very bad drought there – it hasn’t rained for four years, and everything was very dry. Nearly all of our animals had died because there was no food for them to eat. We used to keep small animals – goats and sheep. What few we have left my husband has stayed to look after. Once they are dead he will come here too. We used to have nearly sixty but now there are less than ten.

"On our plot in our village we used to grow sorghum and that is what we used to eat. But because there has been no rain, the sorghum hasn’t grown. The ground has become very dry and the seeds don’t even come up anymore.

"Nobody has seen a drought like this for many years. Everyone in our community in Salag is leaving. All of my neighbors left at about the same time as me and they are living around me here in Dadaab. The only people who are remaining are the ones who still have a few animals alive to look after but I think they will all come here soon.

"There was hardly any water left to drink either. We used to get our water from a nearby stream but this had dried up. There was no water point in our village. So when the stream dried up we started to walk to a river that was a long way from our village to collect water to drink, wash and cook. It would take me about two hours to walk there and three to walk back when my container was full. It was very hard work because it was so hot. I can’t remember when it has been that hot in Somalia before.

"My husband decided that we had to leave when we hadn’t eaten for over a week. He said if we didn’t leave we would die.

"We arrived here about two weeks ago now. We walked from our village to the border and then we got a bus along with other people from our village. When we arrived in Dadaab we went to a reception point and were given some maize, sleeping mats and some other things. We had nothing with us. I couldn’t carry anything when we left because I had the four children.

"But now all of that food is gone. We are meant to go and be registered now so that we can get food regularly. But I have been there twice now and each time I have been told that I have to come back another day because there are too many people waiting to be registered.

"My second born child, Habiba, is very sick and my third born is starting to get sick. Because I haven’t registered I don’t think I can go and find them medical help. I don’t know where to go to find them a doctor as this camp is very big.

"Also if I go with one child, I don’t have anyone to leave the other children with. I am also breastfeeding my youngest and if I carry her, I can’t manage to carry Habiba too. Her condition is getting worse every day and I don’t know what to do. I am worried that all of my children may get sick soon because we are only eating once a day as we only have very little maize left.

"But even though it is hard here, it is better than what we left behind.“

Story of Osman Sheikh Hussein, who fled drought and conflict in Somalia to arrive at the Dadaab Refugee Camp in northeastern Kenya.

“My family and I have come from Somalia – from Baidera in the Upper Juba Valley. I took the decision to leave with my family because of drought and violence. The situation had become very bad. There had been no rain and everybody was starving.

"We walked by foot all of the way. It took us 32 days and every night we stayed under the sky. When we reached the border with Kenya some of the women and children were very tired and sick. So I managed to get some money and paid for them to come here in the back of a truck. It was a difficult journey.

"We have been here 29 nights now but still haven’t been able to register to get food aid. When we first arrived, we went to a place with other new arrivals and we got some food and other basic things. Because we had to leave out town quickly we left nearly everything behind. Along with way we lost some things too – the children were so tired that we had to carry them.

"I have been wanting to leave Somalia for a long time – the situation never gets better. There was nothing left in Somalia – it wasn’t like it used to be. There were no schools or health facilities – and I want my children to have an education.

"The security situation was getting worse and the drought has meant that there is now a lot of violence because people are hungry. I don’t know when the conflict is going to end and in our community it hadn’t rained for nearly five years.

"Everybody’s animals have died. We used to have a big herd of goats and sheep and also some camels. All of them have died because of lack of food. It is so dry there now and I don’t think the rains are going to come again.

"Here we only have this shelter that we have made from plastic sheeting and wood. But at least we can get food and water. There is a health center too and for the first time in many years I feel safe and don’t go to sleep worrying my children may die."

We’ve just returned from a visit to Dadaab Refugee camp in northern Kenya, where I was accompanied by the CARE Canada President and CEO Kevin McCort, CARE Australia Head of Fundraising Andrew Buchannan and CARE USA Head of Foundations Liz McLaughlin.

In my more than 20 years of field experience with CARE, I have not seen such widespread levels of the effects of lack of food on so many people.

Every single man, woman and child that we saw and met with of the more than 1,500 people arriving daily do not have a spare ounce of flesh on their bodies. The adults are literally down to the bone; the children are incredibly listless, showing obvious signs of malnutrition and distress.

Single mothers carry one or two children on their backs with others holding tightly onto their ragged wrap. We met groups of over 40 people who had traveled together, leaving behind the elderly whom they knew would not be able to make the walk of 20 or more days to reach Dadaab. They do not know if they will ever see each other again.

Every single person with whom we talked -- from those who had just arrived after a grueling journey to those who have been waiting in small hastily and sparsely constructed shelters, to those working as volunteers with CARE to provide food and some basic essentials -- asked us to help them to tell the world of their plight.

“Please share our message from Dadaab that we need help, that we cannot wait, that we have come this far and we still do not have the food and shelter that we need.”

There are more than 15,000 refugees who have arrived who are still not on the U.N. registration system and are not entitled to receive basic health services or a monthly ration of food. We met many of these people on the outskirts of one camp where CARE is now providing additional water and sanitation services. When I asked to see their vouchers that were provided to them upon arrival to confirm when a date had been set by which they would be officially registered, I was surrounded by many people who dug into their carefully wrapped worn bags and pockets to show me vouchers with dates for as far away as mid September.

One young woman asked, “I am hungry now and I have no shelter, how will I be able to wait this long for food for myself and my children? We thought we would be able to get help here but there is no help.”

Yet, these vouchers are like gold, and each one is carefully wrapped up and tucked back away for safe keeping. Without a voucher, a family does not get into the system, and therefore it is as if they had not walked and risked their lives to reach Dadaab. They do not exist in the system.

Our CARE staff is working many long hours each and every day to help speed up food distribution, to get water and sanitation services out to those who are escaping from the drought plaguing the region, and to increase educational services for the influx of many more young children.

The commitment and dedication of our staff is incredibly impressive, and they are doing this in the face of many challenges and difficult working and living conditions. There is no complaint voiced ever, yet their faces are lined and, at the end of the day, they're almost too tired to talk. We must get them additional help and support and we need to get it to them now.

I am extremely heartened by the great willingness and generosity of the CARE members to offer expertise and personnel as well as hopefully, in the short term future, significant additional funding. Many of the people who we met thanked us -- for the support they are receiving now and for what they truly hope will come.

Engda Asha, Emergency Project Manager for CARE Ethiopia in West Hararghe, gives an update on the devastating effects of the drought on one of the worst-hit parts of Eastern Ethiopia.

The situation in West Hararghe is critical. As verified through nutritional survey conducted by some aid agencies, there is an increased percentage of children under five showing signs of acute malnutrition in most districts of the zone. The number of households needing general food assistance is increasing at an alarming rate every day. As a result, the number of beneficiaries to be addressed by CARE alone has skyrocketed from 28,000 at the beginning of the crisis to 135,240 just as of 12 July 2011. People are mostly in need of food assistance.

Owing to the seriousness of the condition, the regional Disaster prevention and preparedness commission (DPPC) officials are on stand by, closely monitoring the situation on weekly basis. A command post is in place at kebele level (lowest administration unit) and they report to the Federal level. CARE is one of the members of the command post and is involved in situational assessments every week.

Currently, it has started to rain in this part of Ethiopia and hence some water is available both for people and livestock. Following the improvement in the availability of pasture and water, I can say that livestock condition is improving. But the human condition remains critical, because there is not enough food.

We meet Asli at the registration centre in IFO sitting under a leafless tree with her four children, one of whom kept crying. When we ask her what the problem is, Asli says that the child is two years old and mentally challenged, and he has had a fever for the past few days. When asked whether she had taken him to hospital, she told us that the registration process was more important at the moment.

“When we get registered, we will be settled enough and we can then seek medical care,” she said.

With nearly 1,500 people arriving in the Dadaab refugee camps in North-eastern Kenya every day, registration is taking nearly three weeks to register new families, and arrange for them to settle into the camps. It used to take just days.

To help people cope with the delay, CARE, in partnership with the World Food Programme, has increased our emergency food distribution to new arrivals. CARE staff provide new arrivals with three weeks of food, instead of a two-week supply. Once families are registered in the camps, they are entitled to receive regular food rations, and critical support such as access to safe drinking water and medical care.

The life Asli led with her family in Somalia took a turn after all the cattle and goats they owned died because of drought and her crops failed due to lack of rain.

“The situation got worse every day. We spent all the little resources we had, until we had nothing more to spend,” said Asli, whose children are aged between four years and three months old.

“The sight of seeing our children crying, and me having no breast milk for my baby, made my husband Abdi Osman Abdi decide to take the little money of our savings and come to Dadaab Refugee Camp which we had been hearing about while we were back at home. Even some of our neighbours had fled to Kenya because they said in Dadaab there are different agencies that give food, medical care and education for free and that’s all we need.”

Their journey from Somalia was long; it took the family five days to reach the Ifo refugee camp in Dadaab. They went to the reception centre after their arrival and they were given wrist bands to prepare for registration and access to safety and support from the many aid groups working in Dadaab.

But in the confusion of arrival, Asli and her family didn’t know to go to the food tent to receive their food rations. According to CARE staff, so many people are arriving, exhausted, traumatized and hungry, they sometimes misunderstand how to access help and get the supplies they are entitled to when they first arrive. That’s how CARE staff found Asli and her family when we were giving information to new arrivals about how to get assistance, and how to report and seek counseling if they had been attacked or sexually assaulted as they fled Somalia. Asli and her family were sheltering at their makeshift structure outside the camp, along with all the other new arrivals – but it had been 13 days since Asli’s family arrived, without food.

“My children are sick and hungry,” she said. “We have been here from six o’clock in the morning. It is now one o’clock, and the sun is hot. We do not have any money with us. We have been seeing women selling tea and mandazi (local donut-like pastry), but we cannot afford it. We will wait to get registered then we can go look for food from any good Samaritan.”

As soon as CARE staff found Asli and her family, we quickly arranged a representative from UNHCR to ensure they received their three-week ration of food, and soon they will be registered and settle into their camp in Dadaab.

But Asli’s relief at arriving in Dadaab – a hot, barren camp in the middle of nowhere – shows how difficult her life was at home in drought-stricken Somalia. It shows how important it is to find long-term solutions to food shortages and drought, to help people stay at home, instead of seeking shelter in overcrowded refugee camps.

Photo: © CARE 2011

I woke up early in the morning and accompanied American and German journalists to a reception center before it had opened for the day. We found people sitting outside in neat rows. Women with their small children made up three lines of about 20 adults each, then two lines were made up of families, fathers and mothers together with their children, and lastly, another three lines of single men, young and old alike. This is the prioritization for access to the reception center – women and children first.

What struck me today were the children and the mothers. I have had the privilege of traveling to many places in this big world of ours. I have found that in places where I spend time with people with whom I don’t share a common language, smiling and nodding hello is a great way to initiate communication. Often, the children I have met along the way find ways to laugh, to play, to joke with me…or the youngest of the children stare and sometimes cry if I get too close.

Here, at the reception center, the children were not laughing, not playing…. The mothers did not really give me a smile back, barely any nodded back at me – rather they just stared at me. The children were sitting, very quietly and others curled on their mothers laps. Not exactly what you think of when you think of a two year-old in line somewhere. Many of these people have just arrived from their long journeys here. And at 7:30 am, they were really only focused on the last few hours before they were to receive their first ration of WFP food.

Later in the afternoon, we arrived at the area where refugees who have been here for about three months had set up their homes. We arrived around 4:30 in the afternoon. Areas with water taps were bustling with activity. Women and men were talking along the side of the dirt road, as women with wood on their heads and a man on bicycle passed by. Goats grazed on mostly barren bushes. And there were children – wow, were there children…they were hard to miss: running, smiling, laughing, playing, and wrestling. I was struck by the contrast of this morning’s scene. Water. Food. Shelter. Latrines. Education - all the services these refugees were now accessing; it gave me hope.

The worst drought in 60 years is spreading across East Africa, creating the most severe food crisis in the world and threatening the lives of 10 million people. Life-saving support is urgently needed. Make a donation |Learn more

La pire sécheresse des 60 dernières années se répand à travers l'Afrique orientale, provoquant la crise alimentaire la plus grave au monde qui menace la vie de 10 millions de personnes. Des secours sont urgemment requis. Faire un don | En savoir plus

Emergency Media Officer Alexandra Lopoukhine describes the situation in Dadaab refugee camp, northern Kenya, where nearly 1,500 people are arriving each day.

When a family arrives:
Outside of the reception centres, crowds of people are waiting. UNHCR has set up a structure that is open on all sides, but has a roof to help shade the burning noon day sun. It is still not big enough for all the people. The people are quiet; they are exhausted and in what seem like shock. They are called into the reception centre in small groups to keep the flow inside moving.

Once they are called up to enter the reception centre (a fenced in compound with various tents, benches, tanks and taps of water CARE provides) , they go to one of the three reception centres being run by UNHCR staff. They first go through an electronic finger printing screening which registers them and their family. They get coloured bracelets based on which camp they are being received in (Blue bracelet in Ifo, Yellow in Dagahaley and Red in Hagadera). They then move to receive non-food items – being distributed by CARE staff (plastic mats to sleep or sit on, blankets, jerry cans). At that point they move to food tent, and receive two weeks’ worth of food. CARE staff gives the food out. There is a medical tent for malnutrition screening and the CARE tent for counselling. The final step is they are given a registration date and time to get to the one UNHCR Registration centre which they then get their WFP ration card, and tents and allocation of land.

Living in the camp:
Because the camps are full, people are setting-up their places to live where they can find land. This has lead to sprawling overflow, haphazardly set up. Deforestation (de-shrubbing) has taken place. This is a real source of tension with the host community- this is the land that typically Kenyan-Somali use as nomadic feeding and living grounds. So, when the wind blows, the wind blows red dusty dirt all around. At time the dust is so thick, you cannot see one foot in front – cars stop, people cover their faces; lack of visibility can last up to a minute. The houses are round stick buildings with any type of covering around. The wind can blow these houses down. The children are generally covered in the dust. Feet are perpetually dirty it seems. The sandy-ground is hot, and many refugees have no shoes. Flip flops from China seem to be the most popular type of footwear.

One woman’s story:
Hawa Aden Hassan, 30 years old with 3 children, her husband stayed in Somalia, she has been here 5 months. She and a friend went out to collect branches to make their houses and they were attacked. They were able to get away and suffered only minor injuries. They are now afraid to go out and collect what is needed; she said they are sleeping in the open air. They generally don’t feel afraid, but they really want schools for the kids.

“The violence (in Somalia) is not good. This place is good as long as there is no fighting and there are schools to go to.” 14-year-old boy

Newly arrived refugees from Somalia wait to be registered at Dagehaley camp, one of three camps that make up the Dadaab refugee camp in Dadaab, Noertheastern Kenya on the 9th July, 2011.

July 10, 2011

This morning, CARE staff were discussing, at length, ideas and plans on how to increase water supply in the areas where the newly arrived refuges have settled. A CARE International Water Expert has been with the team here in Dadaab for a few days now, assessing current needs and formulating a plan forward: more 10,000 gallon tanks; more drilling; more boreholes.

This afternoon, I headed out to the outskirts of Dagahaley and talked with some people who have been here for less than three months. A crowd quickly formed. One woman told me about the lack of water. Above us all, stood a very tall man (I am quite short, but he really was tall) and he explained to me that way too many people have to share one latrine. He told me they need more water – what they have now really isn’t enough. The crowd all agreed.

It was then that I explained that a water expert has come to help CARE determine what we can do about the water supply situation. I told him we know it is not enough. I told him the world is paying attention; money is coming-in to help get them more food, more water and more support. I apologized that things are this way right now, but that with all the new people coming recently, it has genuinely been hard to keep up. I asked them for patience.

What happened then will stay with me for a very long time. As my translator finished explaining that we were working hard to figure this out, he smiled. He smiled and stared me in the eyes and said thank you. The crowd nodded their heads and smiled as well. I say this now, this “thank you”, was the most sincere exchange I have ever been part of.

Newly arrived refugees from Somalia collect water at a water point that is having water delivered to it by a CARE water truck at Dagehaley camp, one of three camps that make up the Dadaab refugee camp in Dadaab, Noertheastern Kenya.

By Alexandra Lopoukhine, Emergency Media Officer
July 7, 2011

On the far outskirts of the Ifo camp (one of three that make up the Dadaab Refugee Camps), round houses – sticks intertwined and covered with tattered cloth and pieces of torn plastic, are home to the newly arrived refugees. Today, I walked around and met a few people who had just arrived – last week in fact.

There was excitement to have me around, the children were pretty interested in me and there was a lot of laughter and smiles. It is a wonderful thing about being human: the smile transcends languages.

But through an interpreter, I was able to understand the language of pain. The stories I heard today did bring me to tears, I will admit. So too did seeing malnourished children. Mothers patiently waiting at the Médecins Sans Frontières clinic which was well placed in the middle of the newly arrived area of homes – their children receiving the immediate care they needed. CARE delivers water to this clinic; it was great to see a partnership of this sort, with the same goal of supporting the refugees, in action.

Some families have walked two weeks. Two weeks. Sleeping where they could, pushing-on to get to this camp. The children are much smaller than they should be. One story I heard was devastating: a mother walking, arrives at the clinic, takes her baby off her back and finds it has died without her knowing. I can't even imagine the pain this causes her. One man spoke to us in perfect English – he told us he has been a refugee since 1991, and now, here among the newly arrived, is his grandfather.

I feel privilege to have this time here, to talk and to hear the stories of people. I was asked today to tell the world, to share the stories and the reality of the situation. Thank you for reading.

Women and children collect water from a temporary  water tap near the Ifo camp. (Photo: 2011 Alexandra Lopoukhine/CARE)

By Alexandra Lopoukhine, Emergency Media Officer
July 6, 2011

The heat is strong and the wind is blowing. The shade provides relief. People are lined-up, orderly and patient. There is an overwhelming sense of calm. This is not exactly what I would have expected in the Dagahaley Registration Center, as today, 1,055 people wait for food and to be brought into the United Nations High Commissioner on Refugees (UNHCR) system.

Then, we spoke to a few of the women and they explained their long and challenging journey that brought them here, to Dadaab, the world's largest refugee camp. They told us of their days of walking, of the challenges they faced in the last few days, and last few hours before they reach here. The hunger they faced at home. The insecurity. One women explained she had heard on the radio in Somalia that here, in Dadaab, they were giving away free food. This was the information she needed to get her kids in order and start the move. People were calm, I realized, because they had arrived.

They arrived to be greeted by staff from UNHCR, World Food Programme, CARE, and so many other organizations here, ready and able to support them. Relief was offered in the tangible supplies water, food and order.Orderly lines, orderly registration points, orderly information given to people reeling from their recently history of chaos. This is today's relief.

Newly-arrived refugees from Somalia wait to be registered at Dagehaley camp, one of three camps that make up the Dadaab Refugee Camps in northeastern Kenya. Photo: 2011 Kate Holt/CARE

by Laura Bellinger

Bobbing in and out of his chair, a spritely six-year-old boy answers "Mignon" when asked his name. Mignon means "cute" in French. The name suits him, but unfortunately his life has become anything but cute.

Mignon and his father, Tiehi Didier, are staying a camp in Duékoué, Côte d'Ivoire sheltering 10,000 of the more than 500,000 Ivorians forced from their homes after several months of bitter, post-election fighting. And the heartbreaking story of how son and father arrived here speaks to why CARE has created a "listening center" to provide professional psychosocial support for survivors of Côte d'Ivoire's brutal violence.

Two months ago, Mignon and his mother traveled to Dabou, a coastal town where his mother regularly bought cassava to sell near their home in Abidjan. Like most Ivorians, Mignon's mother did not own a car, so, as is quite common there, they shared a ride home with a stranger. As the car neared Abidjan, they were stopped at a roadblock. Unbeknownst to Mignon's mother, the driver of their car had a gun. When the people manning the roadblock found the driver's gun, they ordered everyone out of the car.

"They cut off the driver's head," Mignon says quietly, "Then they told my mother to close her eyes. She closed her eyes and they shot her with the gun and cut her arms with a machete." Mignon gestures to his own arms to show where the men cut his mother, then gets up from his chair and runs behind his father.

"Mignon ran home to find help," Tiehi says. "And his aunt called me."

Tiehi hopes the listening center's social workers will be able to help Mignon. A school administrator, Tiehi says he understands the importance of counseling gravely traumatized children. Tiehi was traumatized during the post-election violence, too. Separated from Mignon's mother, Tiehi was living in Bloléquin during the attacks. Not only was his house burned down, but he was imprisoned as well.

"I was chained by the ankles for four days. They thought I was with a rebel group and I finally convinced them to let me go," he says. Tiehi and Mignon, along with Tiehi's wife and their four other children found shelter at the camp for internally displace people in Duékoué.

"I don't know what to do with Mignon," Tiehi says quietly. "He can't sleep. He has no distractions. He keeps asking to go back to school, but now I have no money for school. We have no home."

Working with the local partner ASAPSU, the CARE listening center offers private one-on-one sessions where these victims of violence can work through feelings of grief, fear, sadness, and revenge. The listening center also provides referrals to professional psychologists for the worst cases of severe trauma. It's a crucial first step, not only for personal healing, but for preventing further violence and working towards reconciliation.

CARE has extensive experience implementing programs that strengthen the bonds between different groups in Cote d'Ivoire: Muslims and Christians; planters and cattle farmers; Boso fishermen and local fisherman. CARE continues to believe that the forces bringing them together are stronger than those pulling them apart.

Only by listening and learning can these groups build a future in which Mignon and the thousands of other children like him can sleep soundly once again.

Tiehi Didier brings his son Mignon to CARE's listening center regularly to try to him help him deal with the loss of his mother. Photo: 2011 Laura Bellinger/CARE

Martine Johopaoudy has regular sessions with CARE listening center social worker Vlei Leontine. "I need to be heard every day," says Martine. Photo: 2011 Hortense Agnimel/CARE

• Read more: CARE Advances Cote d'Ivoire Reconciliation through ''Listening Centers''
• Donate now: Make a difference for children, families and communities around the world

June 6, 2011
Stories and photos by Mildrède Béliard, CARE Haiti

On the road to Carrefour, nothing has changed. At the entrance to the town, you see the market where fruit and vegetable waste is rotting and where traders stand with their feet in water.>

You may not notice it but the town has been facing a resurgence of the cholera epidemic, which reappeared here just under two weeks ago. This morning, a 12 year old boy died. He was one of two people carried on the backs of other residents of the site to a Cholera Treatment Center (CTC). He did not make it. He was living near the camp Bel Air 3. He had been ill since the previous afternoon, but his mother refused to admit that he had cholera until camp residents, trained and sensitized by CARE, realized he was suffering from the disease.

In the car taking us to Lycée Louis Joseph Janvier, which houses more than 1,200 people, the cell phone of Naomie Marcelin, one of CARE's health promotion activities supervisors, does not stop ringing. She is told that three cases have been identified in a site that had not previously been affected by cholera.

"Last week we distributed aquatabs in sites where we work already. We have also offered HTH solutions (concentrated chlorine) to disinfect the tents where there is a risk of cholera," says Naomi. "During the week we plan to deliver oral rehydration salts (ORS) to households."

Naomie is dismayed about the death of the young boy . To avoid a similar situation, she plans to propose the installation of oral rehydration posts (ORP) on sites in remote areas. "The boy died of dehydration. If people had been able to rehydrate him before taking him to the CTC, he would have survived," she explains.

At Lycée Louis Joseph Janvier, CARE teams are ready! They have posters and leaflets to explain key practices to prevent the spread of the cholera epidemic to representatives of a number of other local camps.

Around 20 people are present. Some are members of mothers' or youth clubs created by CARE WASH and Health teams to serve as peer educators.

Brice Sodlon is a voodoo priest who performs at Lycée Louis Joseph Janvier: "It is essential to learn, especially if you are a leader in your community. My family lives in this camp. My friends live in this camp. It is a duty for me to learn how to protect them from this disease," said Brice. "CARE can't stop. CARE does not have the right to stop. If CARE had run this training at the start of the crisis at Grand'Anse, I am sure all these voodoo priests would not have been killed by the people who were accusing them of causing the disease," he says.

Like other participants at the training, Brice knows the essential actions to take to protect himself against cholera: wash hands regularly, treat drinking or cooking water, cook food well, wash fruit and vegetables thoroughly with chlorinated water, treat human waste. Simple actions that save lives.

The cholera outbreak, which had decreased a few months ago, returned in force two weeks ago, affecting areas in which it had not previously been seen. CARE has started training and awareness sessions in camps, and also plans to distribute hygiene kits, water purification tablets, oral rehydration salts and concentrated chlorine solutions.

On Saturday, May 4, CARE donated sanitation equipment – wheelbarrows, shovels, rakes, trash cans – to Carrefour City Hall, which had organized activities to mark International Environment Day. These materials will be used to clean camps and public areas to avoid the worst.

Béatrice Jean-Louis and Magdala Saint-Ange, CARE staff members, holding a training session on cholera prevention at Lycée Louis Joseph Janvier, an IDP camp housing approximately 1,200 people. The cholera outbreak hits Carrefour where more than a thousand people are hospitalized.

Brice Sodlon, a voodoo priest in Carrefour, participating in the training session

A CARE mother's club member showing to the group how to use purification tablets to clean water at the training session.

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CARE distributes hot meals twice a day in three evacuation centers in Yamada, northern Japan. Photo CARE Japan

By Futaba Kaiharazuka, (Assistant Program Director, Emergency Response, CARE Japan)

In one of the evacuation centers where CARE Japan is providing hot meals, there is a man with perfectly groomed hair who wears a certain jacket. The man is in his late 60s or early 70s and always joins in the aid work at the center, volunteering to help with the heavy lifting. He is one of those people who is always courteous and never stops smiling.

One member of the CARE team had the chance to chat with him a few days ago during the food distribution. His house, like many of the disaster victims, and all his household possessions were washed away. When the tsunami struck he was wearing the same jacket he now wears all the time. He explained that he wears the jacket not because he cannot change his clothes; the evacuation center has received many relief items including clothing and underwear, rather, he wears it because out of all his personal possessions, his jacket is the only item that survived the tsunami. “Everything I had was washed away, but I am a fighter”, he said with his usual smile whilst chatting to the kitchen staff. There is a mountain of relief goods such as clothes and new items that have been delivered, but despite this, he feels wearing his own jacket gives him the strength and courage to go on.

In the midst of such great post-disaster disorder, CARE sees countless examples of people helping each other through the chaos, despite the severity of their own circumstances. The old man’s story shows the strength and courage of these people who are determined to pick themselves up again.

Otsuki town hall(total 18staffs including the mayer have been died by the Tsunami. Photo: CARE/Yoshio Kondo

By Yuko Ota, (Assistant Program Officer, Emergency Response, CARE Japan)

The CARE Japan team visited a family of 11 members including a grandfather, his daughter and her husband (in their 50s), a grandchild, two great-granddaughters (eight and two years old) as well as five relatives who had lost their house. The lived in Kirikiri district in the city of Otsuchi in Iwate Prefecture, one of the regions that was most destroyed by a massive tsunami on March 11. The sun was setting as the CARE team arrived so there was a chill in the air – but this area hasn't yet had the water or gas supply restored so the family could not use the heater in the living room. The temperature indoors was almost the same as outside.

We talked to the mother and she told us that electricity has still not been restored. ''A few days ago our neighbors let us share some of their power supply. For the first time in one month we saw the extent of the damage on TV'', she said. ''Until then we had no information at all, and since seeing the vast scale of destruction in Tohoku on TV, I cry everyday.'' She described witnessing the sheer might of the tsunami approaching: ''I thought tsunamis were noisy splashing waves. But the tsunami last month crept in silently and in an instant swept away houses and everything else in its path.''

When the earthquake struck, her grandmother was on her way to collect the great-grandchild from Kirikiri elementary school. ''She was swept away by the tsunami, was missing, and then nine days later her body was found'', described the mother through her tears. They finally found a crematorium and were told that usually bodies would be cremated within three days of being found, but there were so many bodies in that area that a regional mass funeral is scheduled to be held at a temple on 29th April.

The mother continued explaining how the first three nights after the tsunami the family of six slept in their car in case they had to suddenly escape. ''We are still so worried that there might be another earthquake in the night, so we slept fully clothed in case we have to flee.''

The only granddaughter is heavily pregnant. ''As she is in her final month of pregnancy, she should be growing bigger, but she hasn't really grown. I wish she could have bath in clean water, but there is still no water supply'', the mother described, looking very worried. The Japanese military set up simple bathing facilities in the Kirikiri elementary school nearby, but it is very exhausting for the granddaughter to go there.

The mother runs a barber shop next door, but as there is no water, gas or reliable electricity supply, she doesn't know when she will be able to reopen. ''We have no daily income. I am very unsure of our future. But we are the lucky ones. Many neighbors have lost family members, their houses and their possessions. The town mayor also died so we will have to join hands and work together and restore the town.''

It has now been one month since the disaster struck. The disaster victims, despite experiencing great hardship, are determined to encourage and help each other to grow stronger and step by step restore their lives. In order to support the strength of the local people, CARE assessed the situation in the disaster zone so we can provide the people with the aid they really need. We provide food to evacuees in three centers – in a situation like this, with cold temperatures and many older people in poor health condition, it is important to get nutritious food in order to stay healthy.

By Robert Laprade
April 1, 2011

Otsuchi--duplex houses occupied by two families or individuals. This is an area where people did not have much to begin with, where younger ones have moved to the cities to find better paid work and where only the old ones are left. Photo: CARE/Robert Laprade

Today we distributed hot meals to evacuees in Yamada. Since the tsunami hit northern Japan, many survivors have not received balanced, hot meals on a regular basis. They are mostly surviving on just rice and some occasional fruit. In a situation like this, with cold temperatures and many older people in poor health condition, it is important to get nutritious food in order to stay healthy. Trained cooks and cafeteria staff helped us to prepare the food to ensure cleanliness. We are providing two meals a day in three locations of one big school compound here in Yamada. The evacuees were really happy and thankful. In this rather positive mood we set off to do some further assessment in Otsuchi, a fishing town south of Yamada. When we arrived there, my good mood was suddenly replaced by pure shock. Described by some newspapers as one of the worst hit towns, Otsuchi was in dreadful condition. Here again we could see the destructive force of a tsunami: debris everywhere for kilometers as far as the eye could see—houses, cars, parts of large concrete bridges, large electrical turbines, even a few fire engines strewn across the muddy landscape as if a giant child had emptied his set of Legos and children's toys into a muddy, dirty sandbox. In the areas where the waves had reached their maximum incursion inland, some houses were but left with one to two meters of grey, ugly mud that now covers everything. Within that mud, everything imaginable is mixed. Driving through the area of Otsuchi where some of these houses survived, we saw elderly people digging in the mud, trying to find even just a few belongings that can remind them of the world they once knew.

We talked to one woman, who was picking around the smelly mud. She was around 70 years old. The tsunami took her husband away. When we approached her, she had just dug a few dishes out and squatted around a plastic bowl where she cleaned them in water. It was cold outside but she wanted to rescue her few little things; it was all that she had left. She told us that even though a few volunteers came to help, she was really doing the cleaning all by herself. Her house was still standing, but everything inside was destroyed. It was really heart-wrenching. The tears from my CARE Japanese colleagues ran down their cheeks for five minutes; I think it was a blessing that I required a translation and could not understand everything she said. We were so far away from the glittery, high-tech world of Tokyo that we see from the movies and TV about Japan. People here did not possess much to begin with, most lived in small duplex houses, provided by the government and which looked like trailers. This was a fishing area. Those young, agile, and educated enough have long gone to the cities to find better paid work. Only the old ones were left.

We met another woman together with her husband. Both were also digging through the mud, looking for a few valuables. She told me she was the youngest around here – and she was already 60 years of age. She pointed to some of the houses, saying that almost all of the inhabitants are 80 years and older. Most of them are just physically not able to clean the mud from their houses. They need help. They were questioning why the municipality did not help them. When we drove about a kilometer over a hilly outcropping and gazed out over a small bay we realized why nobody would help for a very, very long time. The entire commercial and downtown residential area of Otsuchi was gone. Washed away. The mayor died—so did anybody else who remained behind or couldn't run fast enough when the warning sirens went off. From the hill, it looked like a bomb hit this town. Probably only one in twenty buildings were even recognizable as buildings—just foundations or a post or two of metal, maybe a half wall here and there. When entering this burned out ghost town of mangled metal, concrete, and mud, I noticed an overhead highway sign that remained standing. It indicated that Sendai is 230 kilometers away--230 kilometers to the center of tsunami impact. How in the world could it look worse than here?

After this awful excursion into hell, we went back to Yamada. I am glad that we could provide the people here nutritious food. And we'll do more of it elsewhere. Afterall, it's people like the women we met who are the residents of the evacuation centers. There is so much work to do.

Story and photo by Marie-Eve Bertrand, CARE Haiti
November 11, 2010

Yveline walks up to me with a nice smile, but I can tell she is reserved. As we walk into her parent's house, I notice that all of her family's belongings are stored on the table, on the higher cupboards or shelters.

"When Tomas approached, CARE staff brought a speakerphone to the community and told us to get prepared. We stored our things and, therefore, did not lose too much," Yveline says. "The rain and water filled the streets and our house." She shows me the mark on the wall, indicating the water level: three feet high.

Yveline is one of the 333 children that CARE sends to school here in Gonaïves. She has been in the project for six years and is really thankful for the help her family gets from CARE. She is smart and caring.

"My dream is to be a doctor because I want to help my community and other people who are disadvantaged. I know it is a lot of work, but thanks to CARE's generous donors, I have been able to concentrate on my studies," Yveline tells me. "My family supports me, and I know that one day I will do good work."

I asked her about cholera and the situation in Gonaïves. She tells me about what they have learned so far through CARE's prevention training."Cholera is an illness that is treatable and preventable. People need to wash their hands, disinfect their house if someone is sick and give them rehydration salts. And we need to make sure that we should not abandon those who are sick. They need help!"

She adds, "Cholera should not kill so many people. The problem is that we have little sanitation infrastructure, and now with Tomas' flooding it is even worse. We have very poor land management. We cut too many trees with no plans, and did not pay attention to our natural resources. Now, it is our infrastructure that is missing. We do not have enough gutters, and we do not care enough for our environment." "

When looking at her, you see that she does care for her neighbors. She is volunteering with CARE – attending meetings and training. She wants to make a difference in her world.

We walked outside of her parent's house, and jumped on stones to avoid stepping in the mud that covers their yard. The streets are filled with waste and mud. But, Yveline is off, helping spread information on how to prevent cholera.

Once she's gone, I can't help wonder how many out young Yvelines did not have the chance to go to school, live their dreams and build a better life for themselves and their communities.

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Story and photo by Marie-Eve Bertrand, CARE Haiti
November 11, 2010

The sun is shining, dogs are barking and the wind is blowing. This could be a normal day in Gonaïves. But it's not. Streets are empty, kids are not in school and mothers are concerned.

As I was with a community volunteers team, we were training women on how to purify the water they sell with bleach that CARE is providing them. A woman showed up. Wearing a mask, she was scared to approach me, scared to touch anyone.

Our team then visited an area called Descoteaux. This part of Gonaïves was flooded by Hurricane Tomas a few days ago. Now mud and garbage are covering streets. We stopped at Rosette Noël's house situated in a zone where CARE's volunteers and staff have distributed aid. A little girl is looking at us. Suddenly, another one joins her, then a grandma, a dad, two teenagers and a mom. Rosette is the mother of many kids she tells me. Her family includes her sister, her brother, and many siblings. I tried to get an exact figure. I don't think she knew.

Rosette tells me that when Tomas struck, they did not have enough time to gather their belongings. I could tell this was true by looking at the clothes and miscelleous household items drying on the brick wall between the houses.

"There was mud everywhere," she says. "We sought refuge with our neighbors. In this neighbourhood, we take care of one another. But what concerns me now is that my niece was sick yesterday. And now it is my sister. They are resting in bed, and we give them rehydration salts and clean them. We do what we hear on the radio messages." CARE's public information campaign via radio instructing Haitians on how best avoid and prevent cholera has reached at least 200,000 people to date. I am glad Rosette has hear them.

When I asked her why she was not taking them to the hospital, she turns her head. She is concerned about the fact that the hospitals are already over capacity and that the staff does have the ability to take care of her loved ones.

"We know that some people were left on the streets because they were sick. I don't want that to happen to my family. We can take care of them. I am afraid that they will get more sick in the hospital," Rosette explains. "Family is everything."

Her youngest looks at me. She is gorgeous and smiling. Her eyes are full of life and joy. I just wish I could do something to help them. But they know what to do.

"CARE helped us a lot. They came here to tell us how to protect ourselves before Tomas, and then after [explaines how to help]avoid being sick. We received soap bars and aquatabs," Rosette says.

As I leave the house, they wave goodbye to me. The grandma tells me to take good care and to stay healthy. These people are generous, and I am so proud I got to meet them.

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by Dr. Franck Geneus, CARE health manager in Haiti
November 10, 2010

The situation here in Artibonite is all but reassuring. You can feel the angriness rising slowly but surely. In Raboto, it was reported that the dead were being abandoned in the streets. Hospitals are already at capacity with patients infected with diarrhea. Others who are infected are being discharged or discouraged not to go to the hospital in the first place. The police have assigned a car that transports infected people both dead and alive. This car is not being disinfected.

Protests in the streets were reported by the press. The fear of illness is everywhere. The sick are not adequately being taken care of and are seen as pests. Babies have been abandoned. Those that have children in schools are thinking of keeping them at home.

The number of new cholera cases have increased to 15 per day up from 3-5 cases before the hurricane struck. In the Hospital of Marmelade, over 200 cases have been reported since the beginning of the epidemic on October 20. Dead bodies are not being properly disposed of. Support staff are reluctant to come into contact with them because they don't have appropriate protective outfits.

CARE is supporting communities where we have our presence by providing early detection and management of cases; medically assisting rehydration; and conducting proper evacuation of cases. CARE's main focus is in helping facilities use proper hygiene and sanitation. CARE was approached by the Ministry of Education, for example, to clean a school which was flooded near a cemetery where bodies were wrongly disposed of. The cases are increasing and it wouldn't be a surprise if we see a boom in the epidemic in the coming days.

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by Marie-Eve Bertrand, CARE Haiti Emergency Team

09:00, Nov. 6, 2010

Saturday was a busy day for CARE's team. I spent the day with CARE teams on their field visit to Léogâne. When we arrived in the downtown area, I was shocked by the level and the strength of water in the streets. The Rouyonne River had overflowed. Once again. And it has washed away a substantial part of downtown.

People are walking in the knee-deep water filled with garbage, human waste, bugs, and what else...

Women and men were cleaning their houses or shelters, removing the mud and trying to make it look clean. Truth is, I am concerned that a broomstick is not enough to sanitize a place that was filled with filthy water.

Yet, amazingly, not everyone we met was in despair. Indy, a young women living with her mom, was cleaning their little brick house. Her mom was telling me it was enough, it had to stop. She was cleaning her clothes as Indy was removing the muddy water from the one room they use as a kitchen, living room, dining room and bed room. Indy was smiling to me, and I asked her if she was upset. She said, "No ... What would it change?"

(Indy cleaning her house in Léogâne after Hurricane Tomas flooded the town. Photo: Marie-Eve Bertrand/CARE)

I stopped to visit the family living in CARE's first temporary shelter. I remember meeting her this summer, as she was just about to move in. It would have been great to meet her in a better situation. She lost everything but her family in January. This time, their belongings were pilled up, the mattress was wet, the walls were dirty, and her ti-moun (child) was hungry.

She looked at the sky and said: "This is an act of God, what else can I say? But it's enough. I want fresh food for my kids, I don't want them to be sick. There are very few latrines here. People do their things in bags and throw them in the canal. It was always like that. Now the canal is overflowing."

(Read more about CARE's work helping survivors have a sturdy roof over their heads and a strong foundation to rebuild their lives. Photo: Marie-Eve Bertrand/CARE)

Yes, it is. And I saw those bags floating around. Filled with human waste. While kids were playing around ...

Cholera, of course, is on the mind of everyone, including the CARE staff. Sunday, our CARE team distributed help to 9500 beneficiaries in Léôgane. We gave them aquatabs, Hygiene kits or BP5 (high energy biscuits) based on their needs. The response is done in partnerships with the other NGO's on the ground.

In Bino Lester, a grandma walked up to me. Her crops had flooded. She was frustrated. Enough, she said. This has to stop. Even the strong people of Haiti have their limits.

Tomorrow, I head to Gonaïves, where a CARE team will continue distributions and raise awareness of health risks such as cholera. The flooding was quite serious there. I might see another smile like Indy's. But given the triple-dose of disaster in Haiti these days, it would not surprise me if I did not.

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by Marie-Eve Bertrand, CARE Haiti Emergency Team

06:00, Nov. 5, 2010

I woke up to dark grey clouds. There is no sun in Port-au-Prince today. It was pretty quiet first thing this morning as the storm was 'stopped' by the mountains, but then suddenly, it was as if someone opened the tap. It is loud now... very loud! The rain sounds as if you're standing next to a waterfall. For a moment I thought we would be okay. Now I am really concerned about our staff and friends living in camps or shelters. You don't want to be outside at this time...

Yesterday the staff and people in our neighbourhood were getting ready for the storm - packing up food, water supplies. I was at the market yesterday and you could tell that people were nervous. Everyone was filling up their baskets, talking loud, moving fast ...

Usually the market it's pretty relaxed, but yesterday everything changed. People were in the streets, the traffic was heavier much sooner as everyone tried to get home to their families, and the businesses closed much earlier.

People were asking: "Why this? Why us? Why again?"

The rain is getting harder. The wind hasn't picked up yet, but if this gets worse, I can only imagine how bad it will be for the people in the camps.

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by Chloé Dessemond
July 28, 2010

The village of N'Guelbély, 170 kilometers north of Diffa, is surrounded by sand dunes. Scattered houses made of straw look naked because the straw has been eaten by the few cows that survive. The food crisis, caused by a poor rainy season in 2009, is escalating herein Niger.

Usually, pastoralists of N'Guelbély move around their village, but this year, they had to go further to find pasture land to feed their livestock. In October, they started moving north until they reached an area known here as "angle of death." The land, located between the territories of two ethnic groups, has no supply market or local authorities and the land was not fruitful. Pastoralists tried to go back south in February. But many animals, too weak to move, died on the way or were left behind.

Omarou Moumouni lost one third of his livestock in the north or on the way back. Coming back to N'Guelbély was not a relief. Without pasture land, another third of his original livestock died in the village. He's situation is no unique – 80 percent of the total livestock is estimated to have died here.

A couple of weeks ago, Omarou received animal feed distributed by CARE in the area. The 150 kilograms will enable him to hold out until the rain falls.

CARE, the only operating non-governmental organization in this remote land, is carrying out food distributions, and has plans to reach the vulnerable pastoralists in the north soon.

South of the region, in Goujou, rain has started to fall. Except for the sand dunes, the landscape in Goujou is green. There, makeshift camps – or rather small piles of items under tarpaulins – prove that hundreds of pastoralists brought their livestock to the site. The pasture land is covered with goats and cows but this picture is misleading. There is not enough grass to support the high concentration of pastoralists. Moreover, this grass is mixed with sand, which can bring on death for already-weak animals.

Idi Abdou had 42 animals before the crisis. Now, he has only 17 left. He comes from Bonsoro, about a hundred kilometers north of Goujou. He traveled to Nigeria with his son to find pasture land before coming to Goujou. Because of the bad condition of the cattle, the price of the animals has fallen. Therefore, in order to buy food, Idi had to sell all of his goats and more cows than usual.

A few days ago, CARE launched an operation to help. CARE is purchasing weak animals at a higher price than they would be bought on the market, thereby, helping pastoralists maintain their purchasing power. CARE bought an animal from Idi Abdou who received eight times the money he would have had on the market.

"If CARE wasn't there, there wouldn't be many people helping us," asserts the chief of N'Guelbely village. "We experienced big crisis before, like in 1973, and we had less assistance then. But this year, the situation is worst than ever."

This crisis raises many questions concerning the future of pastoralists. In N'Guelbély, discussions on the topic are lively.

"Pastoral life is different nowadays," says one villager. "We need to find other solutions, diversify our activities." Other people suggest alternatives to pastoral life.

Hadamou Moumouni lost 79 animals this year. He has only one left. "For me, pastoral life is over. My children will have to make their own way. They can do anything, except livestock farming. They will probably go to the urban centers and start a small business."

Boucar Souley has only 10 animals left out of 70. His breeding animals died, which put a threat on the replacement of the herd – and on the life of his family for whom milk is a staple food. Boucar travels with seven of the 20 members of his family, and thinks about moving again in his constant search for pasture land. After that, he admitsm "I really don't know what to do."

For these pastoralists and so many others in the Shahel region of West Africa, and in Niger in particular, the crisis has just begun ...

by Jonathan Mitchell, CARE International's emergency response director
August 28, 2010

This blog entry is part of an e-mail that Jonathan sent to co-workers at CARE:

Dear Colleagues,

I have just returned from Pakistan, where I saw the flood situation and CARE's response first-hand, and worked with the country office and CARE USA's Asia regional director, Nick Osborne, to support scaling-up CARE's response.

As you will know, the devastation caused by the floods in Pakistan is unprecedented with an estimated 17 million people affected - stretching from the Himalayas in the North to the Arabian Sea in the South of the country. An estimated 1.2 million people have lost their homes and 3.4 million are displaced.

Together with CARE's country director Waleed Rauf, regional director Nick Osborne, other colleagues from CARE Pakistan and one of our local partners, we visited affected areas in Swat and Nowshera districts in Northwest Pakistan – one of the first areas hit by the floods four weeks ago.

In the Swat valley, the swollen river had cut huge swathes out of the river banks, destroying many homes, businesses, roads, bridges and other infrastructure, as well as agricultural land. Displaced people are mainly staying in school buildings or with host families. One of the main problems for aid delivery in areas like this is lack of access due to roads being cut. To get up the Swat valley, we had to leave vehicles behind at several points where there were no roads and hike by foot across steep hillsides to the next intact section of road.

In Swat, CARE has supported our local partner to quickly set up mobile health units providing badly-needed primary health services to the communities. Each unit moves around to different sites and includes both a female and a male doctor. The urgent priority now is to find alternative ways to overcome the access difficulties so that CARE and our partners can deliver other relief supplies such as tents, household kits, and materials for water and sanitation.

The situation in Nowshera district, which we also visited, is quite different. It is located south of Swat where the land opens into the plains. Here, the river flooded entire villages, washing away houses and livestock, and inundating agricultural land. Many displaced people are living in makeshift camps on higher ground close to their flooded or destroyed houses. CARE and our partners have set-up mobile health units here as well. In addition, CARE Pakistan quickly provided, through our partners, all of the tents and household kits that CARE Pakistan had stockpiled to people in Nowshera and another neighboring district. But this only met the immediate shelter needs of a small proportion of those needing help in these districts; CARE is working hard to procure the much larger quantities of supplies still needed. Three hundred additional tents were received from vendors last week, but with so much demand, all humanitarian agencies are experiencing serious delays getting enough supplies from vendors in Pakistan. Where appropriate, we are, therefore, looking at sourcing relief supplies from outside the country.

There are many other critical needs in the displaced people's camps as well. A camp that we visited had no water supply, toilets or other sanitation facilities. The situation for women, who have no access to private sanitation facilities, is particularly bad. CARE and our partners are focusing with urgency on the need to address the awful sanitation and water situation. Construction of toilets is starting, a shipment of water purification supplies has arrived, and two water purification plants are being set-up in Nowshera and the neighboring district.

The sanitation issues also illustrate why focusing on gender must be an important aspect of our response, and one that we need to address with sensitivity in the conservative social environment of many of the communities we are working in. The country office is hiring a full-time gender advisor to support our work in this area.

In addition to these districts in the northwest of Pakistan, CARE is also responding in South Punjab and Sindh Provinces further south.

During the visit, we worked with the country office to revise its emergency response strategy. The revised strategy plans for a scaled-up emergency response to reach 300,000 people in the three operational areas over an 18 month period. The response will be in two phases: the first relief phase will last up to nine months and will include interventions in health, shelter, non-food items and water/sanitation; the second recovery phase will overlap with the relief phase and will continue until around December 2011 and will include interventions in livelihood recovery, transitional shelter, etc.

I would like to sincerely appreciate the hard work of colleagues in CARE and our partners in Pakistan, under the strong leadership of country director, Waleed Rauf, who are doing so much to respond to this humanitarian crisis. The great support of many CARE International members is also most valued, and we look forward to continuing to work together with all involved to ensure that CARE's response to this crisis provides significant assistance to the people of Pakistan affected by these devastating floods.

Best regards,
Jon

Read more about the floods and CARE's relief efforts in Pakistan >

2010 Waleed Rauf/CARE

by Deborah Underdown, CARE media specialist in Pakistan
August 24, 2010

The word flood has taken on a new meaning for me. Last month, a flood was a burst water pipe in my flat in London, a few ruined carpets and the inconvenience of sleeping in my lounge. Today, a flood means your entire home being submerged with water. A flood is all your possessions being washed away. A flood is something that forces you to live in a tent wondering where fresh water and food will come from.

Nowshera is about an hour and a half drive from Pakistan's capital, Islamabad. When I arrived I was shocked to see the floods waters hadn't receded. On my left were the submerged houses and on the right, overlooking what used to be their homes, were families living in tents.

I met Khayal Marjan. She smiled at me from inside her tent, provide by CARE, and spoke to me about the floods.

"Our sewing machine was damaged in the flood – it was our only source of income," she said. "I also had 40 chickens and some goats and cows; they all drowned. We only had time to save ourselves."

Approximately 400 families are living in tents provided by CARE – a shelter from the monsoon rains that continue to fall. The needs of the families in these camps are numerous, ranging from shelter to medical care and food to clean water. CARE continues to help. There is a mobile health clinic treating skin diseases and the growing number of diarrhea cases.

The scale of this disaster is overwhelming and unimaginable. Nowshera is just one area of Pakistan affected by these floods. There are many other cities, towns and villages in the same situation - all needing more support.

Flood waters are still present on Nowshera, where some people told us that their homes are still submerged in 4 feet of water.

Children in Nowshera wade through flood water to salvage what they can from their homes.

A camp set up by CARE and local partner IDEA in the village of Nowshera.

Photos: 2010 Deborah Underdown/CARE

Read more about the floods and CARE's relief efforts in Pakistan >

By Faiz Paracha
August 24, 2010

It was my first day working with CARE, and I visited one of the worst affected areas of Khyber-Pakhtoon-Khaw, Nowshera and Charsada. Both districts have been devastated severely by the flood. Traveling along the Motorway M-1, you cannot realize the wreckage that the torrential flood water has caused.

When we left the M-1 through the Nowshera interchange, I was shocked to see the destruction caused by the flood. The river Kabul flows side-by-side to the road to Nowshera, and there are a lot of villages constructed sporadically alongside the banks of the river. This has affected people living in those villages tremendously.

We stopped at a village called Zareenabad.

The local people told us that the flood water came in a two-meter-high wave. All of it was so sudden that they had no time to gather their valuables – but could only run for their lives. Many of them got swept away by the water and others are still missing, heir families believing them to be dead.

The water has taken away their belongings and their houses. Many houses collapsed when the flood wave came and the rest broke down due to standing water. Their entire household lost in water. People remained under the open sky with nothing – until CARE reached them. CARE was the first organization to provide them with shelter.

CARE has established a camp with our local partner IDEA for the affected people of this village. This camp is accommodating some 400 families. The camp has been provided with tents, non-food items, kitchen utensils and hygiene kits. Drinking water tanks are provided twice a day.

People here need more help. The damage that we see now is only the beginning. The basic source of livelihood in this region was agriculture, daily wage labor or cattle farming. All have been engulfed by water. New homes will be needed to be built for them. Funds will be needed to help rebuild their livelihoods so that they can make it on their own. People, especially children, will require psychosocial support.

It is vital that the pledges by international donors materialize. Concrete and fulfilling promises regarding aid are needed so that the people of Pakistan are saved from their worst humanitarian crisis.

CARE and partner organization IDEA has provided tents to around 400 families in Nowshera.

Read more about the floods and CARE's relief efforts in Pakistan >

CARE Media Specialist in Pakistan Thomas Schwarz interviews CARE Pakistan's Country Director Waleed Rauf

August 17, 2010

Q. After more than two weeks, how would you describe the situation in Pakistan as of today?

A. It still raining and we are in the midst of the second phase of the monsoon – and there are always three phases. The overall situation is worsening, and the United Nations meanwhile spoke about up to 3.5 million children in danger of waterborne disease.

Q. That sounds as if the aid agencies are not able to help?

A. CARE and other aid agencies are working up to their limits. Even now during the fasting Ramadan period, they are working around the clock. Together, with our partners in the northwest of the country as well as in the south, we are contributing to the people.

Q. What is it exactly, what CARE is doing? What kind of support are you providing?

A. There are different regions of Pakistan we work in. CARE is supporting mobile health units through our partners in Khyber Pakshtoon Kwa (KPK) and Sindh Provinces. We are providing access to basic medicines and first aid care. We emptied all of our warehouses immediately after the floods started. They were the stocks CARE maintains for emergencies such as this one. These included stocks of basic items such as tents, clothing, kitchen sets and hygiene kits, which as of today, have all been distributed in the worst-affected areas of Nowshera and Charsadda. More will be distributed in Punjab and Sindh as soon as possible.

Q. Many people have fears that the aid do not reach the victims but instead go to hidden channels. What is your opinion on that?

A. Well, the challenges here are enormous but aid is getting through to those who need it. I can assure each and every donor who is ready to support CARE. Our long experience in the field and the passion of our partners on the ground guarantee this, and we have rigorous systems in place to ensure that aid goes directly to the people in need. Undoubtedly, there is much more to do and international organizations, including CARE, are committed to doing so. Even through the fasting month of Ramadan, our colleagues continue to work around the clock to ensure aid reaches those in need.

Q. So, what is needed most? What is the priority number one?

A. There are three priorities – all at the same time because they are interdependent. As we see the rising numbers of hungry flood survivors, food is an urgent need. Hygiene is a priority, too. Stagnant water in 100-plus degree heat and humidity provides the perfect breeding ground for waterborne diseases so health is a major issue. Children and women especially are threatened here. The United Nations announced this week that as many as 3.5 million children are at risk of disease. The third priority is shelter. Many of the tents sent to Haiti after the earthquake came from Pakistan suppliers, and stocks here in Pakistan are not yet back up to the needed levels.

Q. What is your overall expectation about the next two to three weeks?

A. If we – and I am not only talking about CARE – receive sufficient funding and donations, Pakistan could respond much more quickly. We could do much more, broaden our response, reach more people more quickly. If not, I would not want to guess what could happen to the millions of survivors who haven't yet received any assistance and are struggling alone.

Read more about the floods and CARE's relief efforts in Pakistan >

by Thomas Schwarz, CARE media specialist in Pakistan
August 16, 2010

The Taliban helps flood victims and then publicly praises its own work. This is what I read in the news. In interviews, journalists ask if it is true, and I say yes. Of course they publicize their good works. Everybody who does good deeds for others publicizes it. But, is this the question we should be asking right now? Not for me.

This debate about the Taliban has nothing to with the reality we face here everyday across the country. The debate is a Western obsession, not one of the flood-affected people in need.

Frankly, I barely understand the connection between the topic and the biggest natural disaster of our time. We should be focusing our attention on how we can provide immediate relief efficiently and effectively to those in need.

I witnessed in Moltan just how CARE is supporting mobile health clinics so that primary health care is accessible to those who need it.

The temperature here is a humid 104 degrees, and flies are everywhere. A man shoos them away. Flood survivors queue patiently for their turn to registrater and receive medical assistance. The process is quick and efficient, and the people here are directly benefiting from this intervention because of generous donations to CARE.

Moltan lies to the south of Punjab Province, where new floods are predicted as monsoon rains continue.

CARE's warehouses here are all now empty and, as more donations come in, we are procuring more supplies to distribute to those in need. Since the floods began we have distributed tents, hygiene kits, mosquito nets and kitchen sets. It is not true that humanitarian assistance is not reaching those in need. It is – but simply not enough!

Along the main, four-lane road out of Moltan, we see tents, one after another like a string of pearls. Tents? That's an exaggeration. They are really just plastic sheets held up by wooden poles. The fronts and backs remain open, offering no privacy for those who seek shelter. But they at least provide some protection from the fierce sun.

A 70-year-old man sits alone, staring into space. Around him children sit likewise.

When we arrive, we are surrounded by people immediately. Everybody wants to say something. They all say the same thing, "We have no tents. Look!" They point to a village, less than 200 meters away. It is completely flooded – all we see are roofs. We know that these people will not be able to return to their village as long as the rains continue and the stagnant water refuses to recede.

We are relieved to hear that the villagers are receiving food. When we ask from whom, and they reply, "People from Moltan are coming every day to deliver food.” The people from Molten are strangers, but the villagers know they can rely on them.

Today, as the holy fasting month of Ramadan has now started, the strangers arrive in the evening after sunset. Tomorrow, Pakistan celebrates its independence from the British empire. People help people in Pakistan. This is the true Pakistan I know and appreciate.

By the way, Zahid, the sick little boy I met in Charsadda, is back home and playing again! My colleague, Mujahid, just sent me an e-mail to let me know.

Another question often asked by journalists comes to mind: “Does the help reach people?” Yes, it does.

Read more about the floods and CARE's relief efforts in Pakistan >

by Thomas Schwarz, CARE Media Specialist in Pakistan
August 10, 2010

When we started out early this morning from Islamabad, I didn't exactly know what would be awaiting me in the region of Mardan. I had seen many reports on TV, read the papers, listened to the radio and spoken with my CARE colleagues. The whole weekend, I spent meeting with United Nations representatives as well as other international humanitarian organizations.

We drove the motorway No. 1, direction northwest. This highway is cut into three pieces, almost through half of the whole country, from Lahore in the South to Karachi in the northwest. On both sides there are fields and women and men alike are working them. Everything seems to be okay at first – at least it looks like it's okay. No flooding, no water, not even rain.

Then, after about 50 kilometers, we saw the Indus River. Aggressive, powerful, and threatening. It has doubled in size. We cross it, over a long bridge, and all of a sudden it disappeared, as if it were trying to hide from us, in the fog. But there it is, the monster that has claimed lives and stolen everything from millions of flood victims. And, as always, it was taken from the poorest and most vulnerable.

The water has stolen everything

After the bridge and the fog, maybe 60 to 70 kilometers later, we see tents, again and again. They stood in fields, along the highway. People put them anywhere they found a space without water. There they live now, those who have lost their homes and almost lost their lives. After another 30 kilometers, we arrive in a town where 26,000 people live in normal times.

There, we meet Nambarj. She's 65 years old and a widow. "See here, this house. It disappeared," she says. "It is simply not there anymore."

When the flood came, the water jumped more than two meters above the wall of the courtyard. What is left? "Look there," she says. She shows the old kitchen, where she used to have all her kitchen utensils. "There, this is everything I have now. Two small machines. Everything else, the water has stolen from me."

CARE has provided her with a tent. We promise to bring the woman kitchen utensils within a few days. When one has lost everything, even small things can make a really big difference.

Terrible pictures, unbelievable poverty

In this area, CARE is cooperating with local partners. Imran Inan of the Community Research and Development Organisation, or CRDO, is a person who deserves my deepest respect. The way he accompanies me and translates impresses me. He has a word for each and every remark of the survivors. His patience and humble work is really something I admire. CRDO is just one of several partner organizations of CARE in Pakistan.

I have an idea about poverty. I have seen it in many different countries; it is a reality. What I have seen now, though, leaves me stunned. Not only the situation of the widow, but also the one of the old man, who tells us simply: "I don't even have shoes anymore." He lives with his children and grandchildren in a tent next to his son's house, which is still standing. Imran is listening carefully. "He will get them tomorrow," he says. "We just received shoes. He will get them tomorrow. Promised."

The people in the northwestern part of Pakistan are poor, even poorer than many in other parts of Pakistan.

Is there a boy like Zahid in rich countries, too?

But it is the small boy laying on the wet, muddy floor of his family's small, simple house that shocks me. Zahid is only four years old. His coughing and a high fever has exhausted him so much that he is sleeping, his chest is slowly going up and down. It is 3:30 in the afternoon. The mother cries, when she sees not only me, but also the others coming to her house. It is empty aside from Zahid laying on the floor.

The mother does not have enough money for the transportation to the hospital or for the medication he urgently needs. Someone gives her some money for the transport. "Do you know, Thomas," my CARE colleague, Mujahid, says, "there are many cases like this one in this region. We will find a solution."

I find it profoundly shaming, how we – the rich countries – are coping with one of the biggest natural disasters in decades. At the same time I try not to become unjust. Also in our countries are poor people, of course. There is poverty, yes. But I wonder, if there is a boy like Zahid in the United Kingdom, the Netherlands, France or Germany. I am not sure.

Read more about the floods and CARE's relief efforts in Pakistan >

by Thomas Schwarz, CARE media specialist in Pakistan
August 9, 2010

This week is a very special one in the flooded nation that is Pakistan. August 14 is the national Day of Independence. On August 14, 1947, the British colonial rulers granted independence to their former colony. At the same time as India, by the way. On top of the national Day of Independence, Pakistan's majority Muslim population will also begin the holy month of Ramadan this week, which includes praying and fasting.

Mmedia reports are full of pictures showing people who are fasting, yet have nothing to eat. Thousands of hectares of agricultural land are completely flooded. If nothing is done, this will mean widespread hunger. Even Prime Minister Yousaf Raza Gilani spoke on Sunday about a "second monsoon" that is likely to hit the south, the breadbasket of the country, soon. This country knows the meaning of hunger – and a large number of people are frightened of it.

Postive news

Too many of the 180 million inhabitants of Pakistan have virtually lost everything. The country is already one of the poorest in the world. And what is more, Pakistan mainly gets attention when there is talk of terrorism. Positive news from this region is rare, although we do encounter good news here every day.

We meet neighbors helping neighbors, and people whose houses are not destroyed helping those who lost their homes. We see college students walking through the city of Islamabad raising funds for the victims.

"We know that it will not be more than a small sum," says one of them, pointing at the cardboard box with the money he collected. "But we do this on our own initiative instead of waiting for help to come from outside."

Every day shows clearly that this help is urgently needed. But relief work is difficult.

CARE's partner organizations have delivered medication and medical supplies to pregnant women, who could not make it to the hospital for childbirth. The women were reached with the aid of donkeys and mules because so bridges and streets remain impassable.

Plates, forks, cutlery – nothing left

There are some distributions of kitchen supplies, bandages and other relief items. Nothing is left of the house that has been swept away by the floods. But at least the people have some relief now. And tents, the affected families also need tents. It does not stop raining.

CARE focuses its work on women and children. About a dozen CARE trucks are transporting doctors and other aid workers to the affected areas. They treat those that are most in need, and they try to get an overview of the needs in order to plan their work.

Today, Zahid from CARE Pakistan and I will drive up to Mardan in the northwestern part of the country. During the next couple of days, he will plan and coordinate CARE's relief operation for the area. I will get a firsthand look in order to report back to my colleagues and the world. I need to see things with my own eyes. Images on TV and the reports we hear reports cannot accurately reflect the immense suffering.

I know I am repeating myself, but I have to say it repeatedly: what is missing still, and foremost, is money. It is that simple. If humanitarian organizations like CARE do not get enough funding, there will be too little help. I cannot bear the thought that the fate of 12 million people is being ignored by the world simply because they are living in Pakistan.

Read more about the floods and CARE's relief efforts in Pakistan >

August 7, 2010

On a cable TV network I can watch the recorded World Cup match between Germany and Uruguay. Football. It's a draw right now. I switch to DAWN-TV, a Pakistani TV channel: Two anchormen talking about food support activities in their mother tongue, Urdu.

I have just arrived in Islamabad, much later than expected. The airplane was not able to land in the capital of Pakistan due to bad weather conditions on the ground. We had to fly to Karachi, wait there for a couple of hours, then head back to Islamabad. Karachi is the biggest city in Pakistan and close to the estuary of the Indus River. Now the river is twice as broad as usual. With a population of almost 13 million people, Karachi is one of the biggest cities worldwide. It ranks third place in the list of the world’s biggest cities. I have only seen the airport building, of course. No clue where to find the famous stock exchange, which is also based in this big city. Finally, after five hours we can fly to Islamabad, where the CARE country office has its headquarters.

The DAWN also has an English print version. The newspaper and its website deliver around-the-clock news about the situation in the flooded areas of the country. Reading the paper, I am reminded of last year in May when a huge number of people fled from violence in the Swat valley. At that time, just like today, the numbers of internally displaced people were rising by the hour. More than 12 million people are affected by this horrible flood. Can anyone really grasp this number?

A colleague tells me that the website of the National Disaster Management Authority would be a good source. She was right. The authority is directly linked to the prime minister's office. On the website the government informs about the actions undertaken to help the flood victims. As a first step, bridges are provisionally repaired. It's a nightmare for all aid workers: the infrastructure is so heavily damaged that there are still people out there who have not been reached yet.

Far too little has been done so far, but ...

Meanwhile, CARE has supported thousands of people with tents, clothes, mosquito nets and other important emergency items. Eleven trucks were sent out to the affected areas. They are also transporting tablets to clean dirty water. Today, a radio reporter asked me, “Is that enough or is it just a drop in the ocean?“ No, of course it is not enough. Far too little has been done for the victims so far. But even this little bit means survival for many of them.

However, there is an immense lack of funding; many, many millions of dollars are needed to increase the speed and scale of the response. The rich states are still hesitant. That is a common assumption here in Pakistan, not just a gut feeling. Whoever sees and hears how desperate people in this area are simply cannot understand how slowly money is coming in.

Read more about the floods and CARE's relief efforts in Pakistan >

By Mujahid Hussain, emergency program manager for CARE in Pakistan

August 6, 2010

Nowshera has been declared one of the calamity areas of Khyber Pakhtunkhwa. Entire villages and farms have been swept away. Homes have disappeared under flood waters and livestock have been left to rot in the mud.

CARE’s team has responded to the needs of the affected population through our local partners with basic non-food items to the locals, who were able to come to the accessible highland areas and roads. Through our partners and relief team's rapid assessment, surveys have been conducted to ascertain facts and figures about the damages and losses of the people in the area.

As the floods have caused extensive damage to crops, livestock and other food sources in the affected regions, food supply issues remain paramount. People are in desperate need of food and shelter and, as the days pass by, health issues are getting worse.

Here’s what we heard from some of the people:

• "Thousands of lives could be lost if food aid and shelter do not reach the affected communities within the coming days."
• “My six acres of land washed out in front of my eyes and I couldn’t do anything. All my crops have vanished. My whole family is homeless; now we are sleeping on the road.
• "The flood has left no difference between rich and poor; every one is suffering losses and striving for their lives”.
• “I had a four-story big house in Nowshera. My daughter was suppose to get married this month and all her dowry items were ready, including furniture, gold, clothing, appliances along with her wedding dress. Now we are left with nothing except the hope of getting the basics to survive”.
• “There is so much mud due to the devastation."
• "The situation is getting even worse as people are throwing all the food waste nearby. It is causing more pollution in the vicinity and will turn out to be a major reason of health and hygiene issues.”
• “Oh God, why we have to suffer again and again ..."
• “We have become migrants in our own homes.”
• "There is nothing but just water all around us.”
• “We don’t have even clean drinking water as all wells have been contaminated and waterborne diseases are spreading.”
• "I've lost my house and everything, including food.”
• “Food and water comes in every day from local donors but they don't know when or how much there will be -- and there's never enough.”

By Umaz Jalal, security manager for CARE in Pakistan.

August 5, 2010

On the eve of August 4, I was tasked to deliver a convoy carrying relief goods to flood-affected areas of Pakistan. We started our journey for the distribution point at a little past 7:00 p.m.

As usual, we communicated the departure to the security unit and the field staff. The convoy traveled through the Grand Trunk Road as the motorway was badly damaged in the recent floods. When we reached Nowshera (in the Khyber-Pakhtunkhwa Province of Pakistan), we were told by the police that the Grand Trunk Road was also blocked by the floods and we had to take a detour to get to our final destination -- the city of Mardan.

Our convoy was going slowly when I could saw the reflection of water on both sides of the road. I asked if we were still crossing the Kabal River. To my shock, the driver told me, "It’s not the river; it’s the flood water that we are passing."

I remembered that there were lots of small towns on both sides of Grand Trunk Road, which use to be full of life even at night time.

While crossing a small village, which was badly affected by the rain and floods close to 3:00 a.m., no life was present as far as eye could see. Then, I saw a woman who was undergoing labor pains and in need of urgent medical help, being carried by a girl and old man towards the nearest hospital.

I asked the driver to stop the vehicle so I could ask the old man if he needed any help. He told me that they have been walking for two hours trying to take his daughter to the hospital in Mardan as the all medical facilities in Nowshera were damaged by the floods. We told them that we were headed to Marden, which was 17 Kilometers away, and would drop them at the hospital.

The condition of the woman looked serious, but she safely reached hospital and was provided medical care.

After that, our convoy reached Mardan and all of the relief goods we were carrying were distributed.

Read more about the floods and CARE's relief efforts in Pakistan >

By Jamshed Naseer, security officer for CARE in Pakistan, who witnessed the devastation in Khyber Pakhtunkhwa province.

There are plans that we make, and there is God’s plan. The truth of this phrase has never hit me as hard as it did on July 28, 2010.

The day before started off like any other summer day. The sun was shining bright, and our enthusiastic team of five set off to visit Swat.

Swat was a hot spot for all tourists once upon a time, not long ago. I remember Swat, and the people of this beautiful valley, who offered a smile and warm welcome to anyone who came there. I knew how the smiles had been replaced by lines of worry due to the recent political situation these brave people had faced. People are still warm and welcoming, but the air of this place once known to be "heaven on earth" tells a tale of its own.

My team and I were following our trip schedule, meeting local authorities, going to a CARE project site , and discussing areas we needed to focus on for the trip. We all went to bed satisfied, our heads filled with plans for the next day. I remember falling asleep with the sound of the rain drop's pitter-patter echoing in my ears like a lullaby.

July 28, 2010. A date engraved in my memory for the years to come. It was 8:15 a.m. when Waleed, Mujahid and I were sitting in the lobby of the hotel, enjoying hot breakfast and admiring the rain, and how it made the valley look fresh and clean.

Despite the rain, we started our day's journey as planned, visiting a health project. Sitting comfortably in the front seat of our car with the air conditioner blasting, I could see people running around covering their heads with newspapers, shopping bags or their hands.

Some of the women were carrying their children and men were carrying household items -- I wondered, why are they out in the rain? The question came and left my mind fleetingly. Concentrate, my mind said, as I tried to focus on my duties for the day.

The rain was pouring, visibility was poor and our cars were crawling along the road, when we heard that the Gwaliari Bridge had collapsed. We went as near as we could to the bridge and assess the damage caused.

I stood there watching what the rain we were all praying for had done.

The sound of the water gushing, wood cracking, and amongst the havoc, people leaving everything that they had worked so hard for -- running, saving their very lives. The people on the road came back to my mind. I saw, how the fathers were trying to keep their young ones safe, hauling them on the shoulders, how mothers, not caring for their own security, were protecting their children. I saw a landslide wipe away homes and bury them in mud.

The water, not caring who and what it took with its force, pushed on.

The road was cracking and giving way to the force of the water. I moved my team to safety. Everyone was busy getting information, planning what to next.

With every second that passed by, I felt worse. Here we were, safe and warm, with a roof over our head, food in our stomachs, a soft bed to sleep on. The sound of the rain that was lullaby to my ears yesterday seemed to turn into cry for help. I felt responsible for the rain that we had all been praying for.

I tossed and turned in my bed at night and I asked myself over and over again, “Is this what we prayed for?”

Read more about the floods and CARE's relief efforts in Pakistan >

By Sabine Wilke

March 2010

Standing in the middle of the dusty parking lot surrounded by huge trucks, you find yourself right in hustle and bustle of the logistics center supporting CARE's emergency response. Planes are roaring over the site every couple of minutes – Port-au-Prince's airport is only a couple of blocks away from the warehouse. And there is another particularity to this location: "We're right in the middle of the red zone," says Geoffroy Larde from the CARE logistics team. The warehouse borders on Cité Soleil, the infamous slum that has been neglected for years and has experienced severe damage from the January 12 earthquake.

by Melanie Brooks, CARE International Media Officer in Haiti

Saturday, February 7, 2010

Night falls, and one by one, the candles flicker on in the camps – tiny pinpricks of light in a city clad in darkness. As the sun retreats, the muffled cries begin. And the women creep deeper into their flimsy shelters of bed sheets and plastic tarps, praying for the morning to come.

Story by Rick Perera, CARE Media Officer in Haiti

Saturday, February 6, 2010

In earthquake-ravaged Haiti, where broken bones and open wounds far outnumber doctors, people have grown accustomed to long waits for medical attention. But many who turn up at Saurel Saintie's mud-brick home have waited longer than most. These patients have traveled five hours or more along a rutted, dirt road -- aboard battered old buses, in backs of trucks or perched by threes and fours on motorbikes – to escape the ruined capital, Port-au-Prince. Many have gone weeks without having their injuries attended to.

by Loetitia Raymond

Thursday, January 21, 2010

At the fragile moment in time when a life enters the world, when a child leaves the warm, protective cocoon of her mother's womb, one gesture can change everything. It can transform what could have been a happy occasion into the saddest of all.

by Steve Hollingworth, CARE USA COO and EVP, Global Operations

Wednesday, January 21, 2010

I received an e-mail today that I deeply appreciated. It also made me proud to be a part of CARE!!

by Patrick Solomon, CARE USA SVP, Global Support Services

Thursday, January 21, 2010

Yesterday, the CARE staff went to the Place Saint Pierre in Pétion-ville extremely close to the CARE office to do pre-work for today's distribution of hygiene kits. The team did an assessment and registration process to identify pregnant and elderly women to make sure they were recipients of the distribution. Today, the team ensured that these women were given priority in the distribution process.

Tuesday, January 19, 2010

It's obvious that people here are still in grave shock. You can see in the grim faces as people try to pick up the pieces that they are in desperate need. Everywhere we go, we see hand-painted signs on bed sheets pleading for help, asking for medicine for children or letting people know bodies are there.

by Patrick Solomon, CARE USA SVP, Global Support Services

Tuesday, January 19, 2010

Patrick Solomon and Steve Hollingworth, CARE's COO and EVP for Global Operations, spent the day with in the hart-hit town of Léogâne, southwest of Port-au-Prince, where CARE distributed water bladders, jerrycans and hygiene kits to 135,000 people.

by Steve Hollingworth, CARE USA COO and EVP, Global Operations

Tuesday, January 19, 2010

11:00 a.m.

Patrick Solomon, CARE's SVP for Global Support Services, and I are traveling with a CARE convoy to distribute water bladders, jerrycans and hygiene kits to 135,000 people staying in an areas southwest of Port-au-Prince in a town called Léogâne. We have 21 staff moving out in four SUVs and a large truck. There is lots of apprehension in the car about keeping together through the extremely congested traffic. The trip should take around two hours.

by Rick Perera, CARE's emergency media officer in Haiti
January 18, 2009

Its name, Hôpital La Paix, means Peace — but this massively overflowing hospital is anything but peaceful. The largest medical facility still standing in devastated Port au Prince, La Paix is beyond overflowing with critically injured people.

by Rick Perera, emergency media officer in Haiti

Sunday, January 17, 2010

If charity begins at home, CARE is in the right place. Just outside our Haiti headquarters, many hundreds, perhaps thousands — no one has counted them — of newly homeless people are camped out in the main square of Pétionville, a near suburb of Port-au-Prince. They wait patiently in the hot sun, but their desperation grows by the hour. At night, groups of people can be heard clapping and chanting. Some have hung banners, painted on bedsheets, with messages like "We need help!" in English and Creole.

by Rick Perera, emergency media coordinator in Haiti

Saturday, January 16, 2010

I'm with a convoy of three CARE vehicles carrying water purification supplies form the airport to three different points of distribution. In order to avoid the risk of mobs trying to take materials, we're using ordinary SUVs — Toyota Land Cruisers — and piling the materials low enough so they can be covered and out of view from the windows.

by Rick Perera, emergency media coordinator in Haiti

I am near the airport at the U.N. security base. CARE's country director in Haiti, Sophie Perez, and our emergency response leader, David Gazashvili, are here meeting with the heads of all the relief agencies. We are coordinating how best to get help to those in urgent need.

by Rick Perera, emergency media coordinator in Haiti

We're crossing the border at Jimeni, between the Dominican Republic and Haiti. Things are moving fairly quickly, at least on the Dominican Republic side. We're seeing supplies crossing the border including search and explore teams with dogs, many large tanker trucks with water, backhoes and other construction equipment, mobile kitchens from the Dominican Republic, and many journalists.

by Hauke Hoops, regional emergency coordinator in Haiti

This is one of the biggest disasters I’ve ever seen, and it is a huge logistical challenge. Everything has to come in by plane or boat, but the port is destroyed. The airport is overstretched, overcrowded with flights.

as told by Sophie Perez, CARE's Country Director in Haiti

Wednesday, January 13, 2010

Sophie was in the CARE office in Port-au-Prince when the earthquake hit at about 5 p.m. local time January 12, 2010.
We reached her by phone at 6.30 a.m. local time the following morning.

by Adjie Fachrurrazi, CARE emergency coordinator in Indonesia
October 5, 2009

It has been raining non-stop for the past six hours. Heavy, heavy rain.

People are traumatized. They are asking for help. Everyone is suffering. People say to me, "Don't count the number of destroyed houses. Count the number of houses still standing. It will be faster." In most villages I have seen, only 15 percent of houses are still standing. Some houses are totally flattened. The roof is flat on the ground. People lost everything. Their houses are destroyed, everything in them is destroyed. And everyone is afraid so those with houses will not go inside. There have been aftershocks over the past few days but today was mostly quiet. Everyone is afraid of another earthquake.

So people are sleeping outside, living outside. We are all wet. They have no shelter. Some people are sleeping under broken pieces of roof. Shelter is the main issue. People also need mosquito nets. They are sleeping outside, and with all this rain, there will be mosquitoes and malaria. Children are already starting to get sick. They need blankets, mosquito nets and plastic sheeting for shelter.

***

People are drinking coconut juice, or river water. People in these village used to get their water from springs, but the pipes are broken. In Padang city, the municipal water is not running yet.  The water from the river is not clean, and people don't have stoves to boil water. They need clean drinking water or there is going to be a rise in waterborne illness. We have supplies to help 5,000 people to start, but we need funds to help more.

***

There are many injured people and people still buried under buildings. It is very hard to reach the affected areas. Landslides have blocked roads and there is debris everywhere. Our team went out by motorbike today. We have 20 people on the emergency team, including staff from our local partner. This damage looks worse than the Yogyakarta quake in 2006.

It has been five days now. It's not clear how many people are affected yet. We don't have all the information from the rural areas. There are many dead bodies. And the smell is coming.

Helene Gayle, president and CEO of CARE, reflects on her trip to Kenya.

During the past few days we've learned a lot, visited various sites, dividing into three groups going to communities and through urban areas.

When reflecting on visits to countries like Kenya, I'm always impressed and encouraged by the enthusiasm of the people I've met along the way. In the case of the recent Kenya Learning Tours trip, it gave me great hope to witness health workers, mothers, people with HIV and youth express their commitment to solve health problems and work to overcome extreme poverty. Their names, faces and powerful stories will always be with me to drive my work.

As co-chair of the CSIS Commission on Smart Global Health Policy with Admiral Bill Fallon, we hosted this trip to Kenya to learn and bring back messages to U.S. policy makers on global health solutions. Much can be drawn from Kenya to be applied more broadly as we look to enhance awareness and commitment to health issues around the world. We are seeing improvements but we aren't where we should be. Clearly, there's no quick nor easy fix to get there.

The good news is we know the kinds of things that make health systems work from procurement of medicines to training health workers to good policies that make efforts sustainable. And, as more evidence-based data is collected and analyzed, it will help drive priorities. Moving forward, as we look to solve health problems and increase access to health services, it's important to not solely think about the technical interventions. Donor integration and coordination is also extremely critical. Increased flexibility of investments will be a major driver of success. Ultimately, our goal is to allow governments and communities to use this platform to take on more of an ownership role and make it sustainable. The bottom line is that we need to get this strategy right and efforts should not be about political advantage but rather on the health and well-being of the people, like the one's I've met in Kenya and in so many other developing countries I've visited over the years.

A woman in Siaya District (Nyanza Province), Kenya. (2009 Allen Clinton/CARE)

Helene Gayle, president and CEO of CARE, blogs from her trip to Kenya.

August 10, 2008

Well, we arrived last night to Nairobi around 9 p.m. and settled in. Most of the Learning Tours group ended up on the same flight to Nairobi from Amsterdam, which was great as it gave us a bit of time to connect with each other and get focused on the Learning Tour trip.

This morning after a breakfast briefing we loaded up in a van and headed to a drop off point to get to Kibera Tabitha Clinic. Kibera is a densely populated "informal settlement" or slum area of Nairobi. Population estimates for Kibera are as high as 1 million people. It's probably the largest and most studied slum in Africa – nearly the size of Manhattan's Central Park. From our drop off point at the top of a hill, it looks like a corrugated sea of rusted tin roofs and open sewers.

Reaching the clinic involves walking through a maze of muddy walking paths as there are no streets. While there we were briefed by Dr. Rob Breiman of the Centers for Disease Control and Prevention (CDC), who is a former colleague from my days at CDC, and the clinic's director, Salim Mohammed. The clinic took two years to build and was completed this year. The bricks to build it were all carried by hand down the same narrow, windy path to the site and was built by the community.

The clinic partners with the CDC to identify trends in infectious diseases and develop programs to meet the highest priorities for improving health. They also integrate HIV training, reproductive health and antenatal care. About 150-200 people visit this clinic every day.

Staff also do home visits to households every other week, asking questions to identify possible health issues. For example, if someone has a cough or potential complications with a pregnancy, it initiates a specific set of questions to help determine the whether there is a problem that needs attention. I had the chance to go on a home visit to meet with a woman named Cynthia, a mother of five. It was interesting to see how the local health worker, Jaciuta, gathered surveillance information on Cynthia's family that was logged on a handheld PDA – technology put to good use. This allowed the home health worker to go back to the office and upload household health information on a daily basis. Sure beats old fashion paper record keeping!

From there, we walked through another part of Kibera to meet with a group of women. They told us about the daily struggles they face as well as some of the support they receive from a woman named Judy, a retired nurse who started her own organization that CARE supports as a local partner through our Local Links program. Judy helps the women start small businesses, like selling vegetables, to earn their own income.

The story of one woman, Mwinza Mwema, especially impressed me. She has seven children and two orphans in her care. Her vegetable stand was burned to the ground during the post-election violence in Kenya last year but she didn't give up hope. She takes on jobs washing clothes and dishes, making a little over a dollar a day. It never ceases to amaze me the resilience of women like Mwinza, who continues to have a positive attitude despite the hardship she faces. This is a woman who survived home childbirth, cutting the umbilical cords herself because she couldn't afford to go to a hospital. She was lucky to have survived and that her children still have a mother. She mentioned other women she knew who didn't survive home childbirth, a common practice in poor areas. Hopefully as more clinics like Tabitha go up, more people will start accessing health and family planning services.

During lunch we spoke with Peter Anyang Nyong, minister for medical services, who noted health challenges in Kenya, and how improving infrastructure and human resources are critical to the country's development.

(L to R: Admiral Fallon, Minister for Medical Services Peter Anyang Nyongo and me at lunch)

From there we drove to Pumwani Maternity Hospital for our final visit of the day. According to the director, Dr. Charles Wanyoni, it's the busiest maternal health hospital on the continent. This year, he said they've experienced seven maternal deaths for some 11,000 deliveries. He noted that "when it's this busy you can expect complicated cases." The hospital has two operating rooms, one antenatal clinic, family planning services, services to prevent mother-child transmission of HIV and comprehensive care. Because it's located right next to Kibera, many women and girls who deliver there have to work out with a hospital committee how they will pay for services – approximately $40 for a normal delivery and double that if a caesarean-section is needed.

(Here I am visiting the Pumwani Maternal Health Hospital's neonatal unit.)

Because the hospital was built in 1926, it was obvious they've have to expand, which is a constant struggle when facing high demand and low funding. It was good to see that the CDC is supporting the hospital with a laboratory, and it also receives PEPFAR (the U.S. President's Emergency Plan for AIDS Relief) funding. The hospital staff has aspirations for developing their infrastructure during the next five years to include things like a new water system and more skills training workshops for staff.

I really hope for the day when poor women can focus on getting the care they need without putting themselves in precarious financial positions that deepens their poverty. This is what I will continue to push for: more investment in maternal health and family planning. These issues really need to become a priority, not just in Kenya, but  on a global scale.

Tonight, I have to brush off the dust from today's trip to wear another hat: meeting with health leaders and key donors at the residence of U.S. Ambassador Ranneberger. More tomorrow!