Dr Unni Karunakara | International president of Medecins sans frontieres

Somali famine a many-headed beast

• Unni Karunakara
• From: The Australian
• September 07, 2011 12:00AM

THE emergency unfolding in and around Somalia is being portrayed by aid organisations and the media in one-dimensional terms, such as "famine in the Horn of Africa" or "worst drought in 60 years".

Only blaming natural causes ignores the complex geopolitical realities exacerbating the situation and suggests that the solution lies in merely finding funds and shipping enough food to the Horn of Africa.

Unfortunately, glossing over the man-made causes of hunger and starvation in the region and the difficulties in addressing them will not help resolve the crisis.

Malnutrition is chronic in many parts of the Horn of Africa and there needs to be a long-term international effort to ensure that nutritious foods are reaching the people who need them. Today, however, the most urgent needs are concentrated in southern and central Somalia.

The failed harvests exacerbated what was already a catastrophe. Somalia is the theatre for a brutal war between the Transitional Government, strongly backed by Western nations and supported by African Union troops, and armed opposition groups, most notably al-Shabaab. In a failed political landscape, it is this war, combined with the internecine rivalries of the Somali clans, that has kept independent international assistance away from many communities.

Against the backdrop of conflict, where many agendas are at play, it is difficult for a medical humanitarian organisation like Medecins sans frontieres to expand health services and have an impact. MSF has been working in Somalia for two decades and has projects in nine locations on both sides of the front lines, in areas under the control of the Transitional Government and al-Shabaab. We are doing everything we can to scale up our activities to meet the growing needs. We already have more than 8000 acutely malnourished children in our feeding program.

In refugee camps in Kenya and Ethiopia, we have been able to provide medical and nutritional care for tens of thousands. But scaling up operations inside Somalia is difficult. MSF is constantly being forced to make tough choices in deploying or expanding our activities. Without the ability to carry out independent assessments and provide assistance in what we believe to be the hardest hit areas, we will not be able to prevent the worst consequences of this emergency.

Humanitarian aid has come to be seen by all sides in the conflict as either an opportunity or a threat. In areas considered to be the epicentre of this crisis, al-Shabaab, suspicious of Western agendas, has placed bans on foreign staff, on the supply of medicines and materials by air, and on vaccination activities.

The reality of providing aid in Somalia today is about as grim as it gets. Our staff runs a constant risk of being shot or abducted while they provide lifesaving medical assistance. In spite of our constant negotiations with all parties to the conflict, we may have to live with the reality that we may never reach the communities most in need of help or that we will have to compromise some of our independence when we do reach them.

It is amid this hostile climate that slogans like the "Famine in the Horn of Africa" are being used to raise impressive amounts of money for food and other supplies being sent to the region. But I am concerned with the last mile: getting assistance and supplies from the ports of Mogadishu to the people who need it urgently. Unless all parties remove the barriers that stand between organisations with the capacity to save lives and the people who rely on them for their survival, thousands more may die.

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