Abdiya Burre's severely malnourished 13-month-old baby stared blankly in the air, his eyes wide open. An intravenous needle protruded from his emaciated left hand.

"I was not producing enough [breast] milk. Our animals are too hungry to be milked. I had nothing else to give the baby, so he became thin," said Abdiya, a 36-year-old mother of six. She had placed her hopes for her son’s survival in the hands of the medical personnel at Mandera district hospital's therapeutic feeding centre. 

"I am now more worried about the health of my five other children at home," she told IRIN. "They may not be getting enough food to eat."

In another section of the centre, which is run by the nongovernmental organisation Action Against Hunger (AAH), a six-month-old baby struggled to survive a bout of tuberculosis. 

An emaciated 12-year-old girl from Suftu, on the Ethiopia side of the nearby Kenya-Ethiopia border, was receiving treatment for kala azar, also known as visceral leishmaniasis - an often-fatal disease transmitted to human beings through the bite of an infected female sand fly.

The three patients were among 50 babies and children admitted to the facility on 1 March. They all had one trait in common - each had been severely weakened by lack of adequate food.

"AAH's 14 supplementary feeding centres in Mandera have seen cases of malnutrition soar from a monthly average of 500 between August and October last year to 1,500 in November, December and January as the effects of the drought worsened," said Kelly Delaney, senior nutritionist with the organisation. 

"As a result of food insecurity because of the animals dying, you have [the number of] children with moderate and severe malnutrition on the rise," she added.

Records compiled by aid workers show that cases of malnutrition in Kenya's drought-stricken northeastern Mandera district have tripled during the past four months as the availability of milk dwindled with increasing livestock deaths caused by lack of pasture and water. 

Delaney said there were several cases of deaths in the feeding centres every month, but most of the fatalities could not specifically be attributed to malnutrition alone. The children had other illnesses when they arrived, including malaria and waterborne diseases like diarrhoea and vomiting. 
Adults affected, too

Although children are the most vulnerable to malnutrition, the condition and its associated problems have become widespread among adults too - especially the elderly people.

Abdia Maalim Adan said she was 52, but because she was emaciated and seriously ill looked much older. She was unable to swallow boiled maize, the only form of food aid the Kenyan government has supplied to affected populations so far. 

"The only thing we are giving her is tea," said Abdia's husband, Nur Isak. "We do not have any money to take her to hospital."

The family had lost 240 camels, cattle and goats since December. With only 10 animals left, they decided to move from Garbaluka village to Libehiya in central Mandera because there was still some water available. It was also closer to a food aid distribution point.

The nursing officer at the Libehiya health dispensary, Omar Salat, said they had recorded many cases of anaemia, malaria, diarrhoea, respiratory tract infections and tuberculosis. "People have low immunity because they do not have enough to eat. They are easily falling sick. The elderly and children are weak and emaciated." 

Epicentre of drought

Mandera lies at the epicentre of a region that has been devastated by drought. Aid workers and local residents say adequate rains have not fallen in this area over the last five or six years. 

According to the USAID-funded Famine Early Warning System (FEWS Net), the food security situation in Kenya's most severely drought-affected pastoral districts, like Mandera, deteriorated alarmingly, following poor March-June 2005 long rains and the failure of the October-December 2005 short rains. 

"The enormous detrimental impact of two poor seasons on livelihoods and household food security suggests that households' capacity to cope with poor seasons has declined, pointing to a growing chronic food security crisis," FEWS Net said in an update on 9 February. "Scarcity of water and pasture is approaching a catastrophic situation and could worsen between now and the start of the long-rains season."

Compounding the region’s worries is the outlook for the 2006 long rains. "Preliminary indications show that the 2006 long rains season are likely to be unfavourable...If this pessimistic forecast holds, then the crisis will deepen to unprecedented levels," FEWS Net said.

Residents said they receive about three to five litres of water per day each, but aid workers said this is below accepted standard requirements. 

Aid workers said the lack of adequate water has made matters worse. "In may cases mothers can not make the Unimix [a high-nutrition supplement] because they don't have water to cook it with," Delaney said.

James Morris, executive director of the United Nations World Food Programme (WFP), described the situation on 5 March as "serious - very, very serious."

He warned that millions of vulnerable people in Kenya could face a catastrophe if sufficient food donations were not delivered to them over the coming months. 

Pastoralists most affected
The most severely affected, according to aid workers and local officials in Mandera, are pastoralists who have suffered a heavy loss of livestock, including camels. Tens of thousands of people have been rendered virtually destitute. Ordinarily, the camel is the most drought-resistant animal and can survive without water for up to a month. 

"When camels start dying as a result of lack of water, then you know the situation is bad," said a local resident. 

Abdul Maalim Hassan, programme coordinator for Islamic Relief, an NGO active in the district, said that by the end of February, livestock keepers in Mandera had lost between 40 percent and 50 percent of their herds. Out of an estimated population of 290,000, about 60 percent of the people had suffered livestock losses.

"I have seen people who had as many as 500 heads of cattle and now have only 10; people who had 1,000 who have less that 20. And these 20 will be dying in the next one month because we expect the rains after one-and-half months," said Shaaban Ali Issack, assistant minister for local government and Member of Parliament for Mandera East constituency.

So desperate is people's desire to save some breeding stock that families have started sharing whatever little food aid they received with their animals. 

"We share the same food with the cows," said Barrey Shuaib, a 38-year-old mother of 10, as she boiled maize in a large aluminium container at Damasa village, 130 km south of Mandera town. Once ready, the bland meal was shared between Shuaib's children and five surviving calves.

"We will soon be completely destitute. Unless well-wishers come and help us, we will never be able to own livestock again," Nur Issak, the 66-year old resident of Libehiya said.

The lack of adequate food has been compounded by severe water shortages that have forced thousands of people to move to areas closer to roads where government and humanitarian agency water tankers can easily reach them. 

The Daua River, which runs along the Kenya-Ethiopia border, has dried up, making it harder for the pastoralists to water their animals. Last week, several people were digging into the riverbed to try and reach water for their livestock.

"Ensuring that water is available for everyone in the arid Northeastern province now and in the longer term will cushion people against that loss of their livestock whenever drought struck," Issack added.

Access problems

Mandera district and the entire remote northeastern province is a region of few passable roads. None of the roads in the district are paved. 

The terrain is so difficult that water tankers frequently break down, causing untold suffering to residents and their livestock, who have to go without water for days. Along Mandera's dusty roads, desperate women and children flag down motorists to beg for water. 

The Kenyan government and the Kenya Red Cross Society are delivering some water using tanks, but it is inadequate. At times it is too late for livestock. Two weeks ago, a tanker delivered water to people and livestock at Jabi Bar village in central Mandera after a 10-day interval, and 375 goats belonging to 24 families died in one day, apparently because they drank too much water.

"People have congregated around boreholes. This is a region of long-term livelihood vulnerability," said Said Abdullahi Gessey, who heads a Mandera-based NGO known as Emergency Pastoralist Assistance Group (EPAG). "There are huge infrastructure problems that require long-term planning." 

For the 5,700 residents of Damasa, the situation remains precarious. Every one of them is in need of food aid. Around the small dusty centre, which lies on the Kenya-Somalia border, the parched fields are littered with carcasses of cattle, goats, sheep and even camels. 

Recently hundreds of families with their surviving livestock have come to the town because it has a functioning borehole and monthly food aid distribution. The borehole, however, is under enormous pressure, operating for an average of 18 hours a day instead of the normal dry-season time of 10 hours.

"We would have more people here if others had not migrated towards Kismayo," said the assistant chief in charge of Damasa, Mohammed Barre Rahoy.

Not everyone who deserves food aid in Damasa had received it. "People are suffering from hunger and thirst," he said. "We [also] fear that an outbreak of measles across the border might spread here, and we have no health facilities."

Eighty-year-old Abdiya Aden, a resident of Damasa, claimed that she could not remember a drought as severe as the current one. "I only have five goats left. I used to have 200. Only God knows what will happen to us if the rains do not come soon," she said.

More vulnerable people
Sahal Mohammed, an official with EPAG, said the number of vulnerable people in the region was rising everyday, along with the incidence of livestock deaths and the drying up of water wells.

"Only 60 percent are targeted for distribution, as per a decision taken by the Kenya Food Security Group, which conducted a survey here in January," he said. "The estimates at the time of planning were based on the 1999 census, yet the numbers have changed. Many more people have become vulnerable."

Local residents in Mandera said even the accuracy of that census could have been affected by a local conflict between the Garre and Murule communities, which displaced some people at the time of the count.

"Last week, I received a ration of 5 kg of maize and 5 kg of rice. I redistributed 5 kg of the food to relatives and neighbours who had got nothing. The food that remained lasted three days," said Barrey Ali, a 45-year-old mother who has taken to hawking tea in the local market to feed her family.

In almost all food distribution centres visited by IRIN during the first week of March, only maize was being given to the hungry. Many people complained that the maize would not meet the nutritional requirements of children under the age of five. 

Peter Smerdon, WFP spokesmen in Nairobi, said the agency would, if it were possible, be happy to provide whatever food its beneficiaries were used to eating, but the agency was only able to distribute what it received from its donors.

Kenya's agriculture minister Kipruto arap Kirwa said the high cost of transporting grain from the country's breadbasket Rift Valley province to 25 drought-stricken districts in Kenya was hindering the relief effort. While there were enough maize stocks in the country to last until the middle of the year, the problem was how to get it to drought-affected areas.

"Food is available in the country. The problem is transporting it from the highly productive areas to the low productive areas, and this is where the government needs support," the minister said on Monday.

Smerdon said it was the responsibility of the Kenyan government to buy maize from producers in the western Kenya region, which has a surplus of the commodity, for distribution to areas facing food shortages. 

"It is up to the government to buy it [maize] up, but the problem is people are not selling to the government," he told IRIN, adding that the farmers preferred to sell to traders who transported the maize to markets in neighbouring countries because the prices offered by the government were low and payment was delayed. 

WFP is currently not buying maize from Kenya because prices had soared as a result of the drought in other parts of eastern Africa, Smerdon added.

Gov't contribution

The Kenyan government has recently donated 60,000 tonnes of maize and rice, which, according to WFP, will cover cereal requirements for March and April for some 3.5 million Kenyans in drought-affected areas. However, WFP only has half the quantity of beans needed for March and no vegetable oil. 

Earlier in February, the government, UN agencies and NGOs had appealed for US $245 million to help an estimated 3.5 million people, including 500,000 children who are in need of urgent humanitarian assistance in 25 districts.

In February, WFP which still requires $189 million for Kenya, distributed food aid to 183,336 people in Mandera - 63 percent of the total population. The beneficiaries were given a 75 percent food ration each.

"It is a difficult population to target," said Smerdon. "We have to agree with our partners, the government and the Kenya Food Security Meeting if we are going to increase rations in certain areas or whether we going to feed more people. There are increasing needs and we need to consult with everyone about this problem," he added.