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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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 >

By Yemisi Songo-Williams and Christina Ihle

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

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

September 12, 2012 – 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 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 the child fully recovered, the family remains fearful for Marie’s life. Her body is not as strong as Zechariah’s and she does not seem to have the strength to resist the waterborne disease.

Forty-two people already are infected in the small village of Koli Soko, which is the home of about 2,000. 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 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. Marie’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."

Marie’s neighbors are John and Yebefula, and their two children Sida, 5, and Moses, 10 months old. 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, oral rehydration solution and purification tablets to affected families – and those at risk – in Koli Soko. The team explains to every 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 is mobilizing all efforts to help with emergency aid and to seek long term solutions for villages in need.

Siaya is a town twenty miles from Lake Victoria, in Western Kenya. I am in town to visit community groups that my CARE Kenya colleagues (Alex, Lucy, and Margaret) have been working with in the last six months. The first group we visit named themselves Twelve Sisters, but they are quick to tell me they have fifteen members, as they have been growing. Six months ago, these women started working together as a community savings and loans group. The women meet twice a month, and at every meeting they contribute money to the group. They are required to contribute 20 Kenyan shillings (about 30 cents) to the group's social fund, and then they can choose the amount of money they want to contribute to the group's pooled funds. The pooled funds are lumped into shares, which cost 100 Kenyan shillings (about $1.50).

At any meeting, group members can take out loans from the group's pooled funds. In April, Dada started an embroidery business. Frances improved her poultry farm. Alice paid the secondary school fees for her children. The women repay their loans a month after they take them out, along with 10% interest.

The social fund, however, is a different matter altogether. The social fund grows every month, and if one of the women has a problem, the group votes on whether or not to use their social fund to help her. Two months ago, Frances' house caught on fire, and she lost many of her possessions. Twelve Sisters voted to nearly deplete their social fund, giving Frances a way to start over. Unlike the loan system, the social fund does not need to be repaid.

Beatrice, the group's president, tells me, "this box is a painkiller…before when we had problems we had nowhere to turn, but now we have a resource." While we only spent a day together, it was clear to see that Beatrice was a force to be reckoned with. In addition to leading Twelve Sisters, Beatrice is a community educator on clean water. Trained by CARE, Beatrice goes into rural villages armed with PUR water packets. Donated by Proctor and Gamble, these packets purify 10 liters of water. The packets cost 15 Kenyan shillings (20 cents), but thanks to Proctor and Gamble, Beatrice and other health workers can distribute samples for free when they conduct community trainings.

Beatrice shows me how she demonstrates the packets. She empties the packet into a bucket of brown water that she collected from the nearby river. As she sings a song about the process, Beatrice stirs the bucket for five minutes. Then we wait. Twenty minutes later, the water is miraculously clear. Beatrice ties a white cloth around a second bucket and uses it as a filter for the sediment that floats on top of the translucent bucket. "Now it is safe," she says. I must admit, I'm impressed.

Alex and Margaret, who run CARE's water and sanitation programs in Siaya, tell me that the funding from Proctor and Gamble will last two more years, and their clients are always asking for more PUR packets. The mortality rate from water-borne diseases has dropped significantly in Siaya since CARE started the Safe Water System Project, and families are eager to use the PUR packets because the water looks and tastes better, and they see immediate improvements in their health.

Beatrice asked me what I was going to do when I got back to the United States. I explained that my job is to tell stories to members of Congress, so they will support programs like Twelve Sisters and the Clean Water Project. I hope to make good on my promise.

There are two bills in Congress right now that could help women like Beatrice and groups like the Twelve Sisters. The Microenterprise Empowerment and Job Creation Act (H.R. 2524), and the Senator Paul Simon Water for the World Act (H.R. 3658). Please call the Capitol Switchboard at 202-224-3121, ask for the office of your member of Congress, orclick here to send him/her an e-mail in support of these life-saving pieces of legislation.

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In the highlands of Ethiopia, a group of 19 people sit in a circle in their communal field. In the middle of the circle are four coloured plates and a tin box with two locks.

This is the Water, Sanitation and Hygiene Committee of Sahvina Kebel*. They formed through CARE's Water, Sanitation and Hygiene project in late 2010.

Despite their name, this group does much more than improve access to clean water and sanitation in their community. With these simple tools, this committee and the woman leading them are also bringing new opportunities to their remote village.

It all began last year when the group built a new water pump with CARE's assistance. Less than one year later, this pump has given women more free hours in their day and reduced the amount of illness in the community, particularly the children.  

Tuesday 27 September WASH project in South Gondar, Farta and Estie Woredas. Beletech, 34 year old mother of four from Farta Woreda, Sahivna Kebel. She has four children and is the chairman of the WASHCO. Sitting on a tree stump with her child. Image: Josh Estey/CARE

Beletech, a 34-year-old mother of four, is the chairperson of the group. She explains 'Before the construction of the water pump, I would walk for one hour to collect water from the river. I lost time collecting water – walking and queuing because water is scarce. My children drank this unsafe water and had diseases. Now, the water is safe and my children can go to school and be healthy.'

The water pump was developed through a close partnership between CARE and the community – CARE provided skilled labour and the majority of the materials for the pump, and the community provided their own labour and sourced some local resources like sand and rocks.

The committee developed by-laws to protect the pump – if anyone breaks a law, they have to pay a fee. This money is then managed by the group to cover maintenance and other related costs.

That is just one of the funds the committee manages today. The committee also operates as a community savings group, with each member contributing 5 birr (30 cents) every month. As the total sum grows, members are able to take a loan out for income-earning activities, which is then repaid with interest.

The money is kept safely in a tin box under the security of two separate locks. Beletech holds one key, and the committee's treasurer holds the other.

'I am saving money, and starting to change my life,' says Beletech. The group has taken a loan already, to purchase salt and then on-sell it at the local market, making a profit of 55 birr ($3.20).

When the group meets, the money is divided amongst the coloured plates – with each one indicating a different "account" within the savings group. The green plate displays the groups' savings, yellow is the interest paid back from loans, red is the punishment fees that are paid if someone breaks a by-law; and blue is the social fund that all members contribute to and is available for anyone in the community to borrow from if they find themselves in urgent need of money.  

Beletech's role as leader of the group is another first for this community. Before, women were not usually allowed to speak in public or be involved in decision making. Now, she is leading this group of women and men towards creating a better future for their entire community.

'I am happy to be the chairperson of the group. I manage the meetings and have the power to speak in front of others and make decisions. I received training from CARE about speaking publicly, before I only ever spoke in church. Now, I speak in meetings and community discussions.'

The gender division of labour and opportunities is breaking down in Beletech's home as well as her community. She explains, 'In my home, my husband would only spend his time on farming and I would work in the house. Now, my husband shares the household chores like cooking and making coffee and there is improvement in my home.'

Now, with the opportunity to learn leadership skills and the ability to save money, the opportunities for women in Sahvina Kebel are flowing as freely as the clean water from the village's water pump.

*A kebel is an Ethiopian village

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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.

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 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.”

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."

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

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)

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.

• Read more about CARE's work in Haiti
• CARE scales up activities to respond to resurgence of cholera
• Donate now to help CARE respond to emergencies and fight poverty worldwide
  

By Robert Laprade
CARE Emergency Team in Japan
April 6, 2011

Robert Laprade, CARE Emergency Team Leader in northern Japan. Photo: CARE

These are my last days in Japan. I am back in Tokyo now and will leave the country on Friday. It has been almost four weeks since the tsunami hit the coast of northern Japan; in many areas it was more than 30 meters high. There are still so many humanitarian needs. Even though infrastructure is getting repaired by the government, with roads being cleared, ports functioning again, and the lights coming back on, it is apparent even to those unfamiliar with emergency work that it will take five to ten years to rebuild the area--at least. Survivors living in evacuation centers or with host families face huge challenges. They will not be going back home anytime soon as many of their houses are now nothing more than a foundation. Others’ homes are partially damaged with windows and doors torn off, filled with a meter of a mixture of mud and miscellaneous, smashed rubbish. The initial shock of the disaster has receded – now it is dawning on many people just how bad their situation really is. They realize that they will not be able to live in their homes soon, if ever, again. It’s a huge challenge for the government. In the first weeks, the focus has rightly been on searching for survivors and remains of victims, putting a roof over the affected people as quickly as possible, and getting basic infrastructure back up and running. Now the government needs to determine how to house people for a longer period before permanent housing can be built. In the fishing towns of Yamada and Otsuchi and many others, most buildings are destroyed—only the wood, metal siding, beams, and contents remain, strewn across the hideous landscape kilometers from where they once stood as offices, houses, and schools. Much of the coastline where the tsunami hit is mountainous. The only flat area is the land lining the coves and inlets wiped almost clean in the disaster. There is not much space to build temporary houses for all evacuees.

When I visited the evacuation centers I saw that many survivors had nothing to do. Many just sat there traumatized. Others conversed with friends and relatives. Being in close quarters—sleeping, eating, and talking to the same group of people in very cramped space—can be a stressful experience after some time. Many people are still clearly grieving as it is only now becoming clear that they will probably never see their missing loved ones again. In some of the centers, we have been looking at helping with recreational and cultural activities that can help reduce some of the stress and monotony, especially for elderly people who may have extra challenges of mobility. These need to be things that are culturally and socially familiar to them, and that they identify as giving comfort or providing a bit of fun.

The evacuation centers in Yamada where CARE provides hot meals two times a day are located in a school compound. But the school year starts in the next few weeks. That’s another challenge. We have already been told that we need to remove our kitchen and storehouse as they were located in the classrooms. Evacuation center residents are sleeping in the gym and will not be forced to leave. My Japanese CARE colleagues now have to identify new places to store food and supplies and a place to cook. But that’s the nature of humanitarian operations. It is our duty to act in the best interest of those affected. In this case, we want the kids to go back to school, the people who don’t have a home to have a place to live, and to ensure that we can still serve nutritious food for the residents. We need to be flexible in a dynamic environment, finding ways to bring help to survivors and meet the many different needs they have.

The past weeks in Japan have shown me how fragile life is. Whether we live in developed or developing countries, whether in cities or villages, we can never be too secure. I also think we should respond to the humanitarian needs of survivors, no matter in which region of the world they live, even if they happen to come from a “rich” country. The tsunami in Japan also really underlines the importance of disaster risk reduction and early warning systems. Had those systems not been in place, clearly casualties would have been much higher. It was also great to see how people helped each other out in their time of greatest need. The Japanese people have all pulled together, everyone doing their own part to in some way show their support for the victims and survivors. There were numerous donations and offers to host homeless survivors. Inhabitants of Tokyo try to save energy whenever they can. The hotel where I am staying in Tokyo turns out the lights in the lobby when breakfast is over. All the glitter and glamour that you visualize when you think of Japan is toned down. Excessive celebrations during this important time of traditional cherry blossom festivals are even frowned upon. The CARE team in Tokyo is still working long hours, until 10 p.m. every day. Everyone seems content making sacrifices, knowing that in some small way they are paying their respects to the inhabitants of the ravaged Northeast coast and making a difference in the lives of survivors.

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 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 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.

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.

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 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, 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!

Blog by Rick Perera, Media Officer, CARE International in Pakistan:

ISLAMABAD – It’s become depressingly familiar: a tragic attack on civilians. Tuesday’s hotel bombing in Peshawar is just the latest in a string of events marring this beautiful country.