In Ethiopia, children are increasingly facing food insecurity. Humanity & Inclusion uses stimulation therapy to prevent development delays for children experiencing malnourishment.
The Horn of Africa is experiencing one of the worst droughts the area has ever seen. In Ethiopia alone, more than 8 million people have been affected and over 17 million people are in need of agricultural support. 4 million livestock have been lost, and 30 million more are at risk of starvation, further reducing food sources. Additionally, the average price of food items has increased by 40% since 2019.
“When children face malnutrition, it is highly likely that they will suffer developmental delay,” explains Gadisa Obsi, a physical therapist with Humanity & Inclusion in Ethiopia. “They may have difficulty performing daily activities compared to other children of the same age. Malnutrition can also lead to disability in the long term.”
Preventing long-term consequences
Humanity & Inclusion is present in the largest refugee camp in Gambella, Ethiopia, supporting displaced children with developmental delays resulting from malnutrition.
Complementary to nutrition support provided by Humanity & Inclusion partners, stimulation therapy uses play-based rehabilitation exercises to strengthen child development and prevent the disabilities that might occur as a result of malnutrition.
Obsi and his team identify children in need in the community, provide therapy sessions and do as much follow-up as possible. They also inform caregivers about early-childhood development and the importance of early exposure to stimulated play and human interactions in physical and cognitive development.
Making a difference
Nyatut Tholbok is is an 18-month-old child originally from South Sudan. She’s living as a refugee in Gambella with her mother, Nyabem Kher. When she first met Humanity & Inclusion’s team, Nyatut showed signs of severe malnutrition, and her motor skills had suffered tremendously. She struggled to stand on her own, or even to crawl like other children her age. With Humanity & Inclusion’s ongoing therapy sessions and nutrition assistance from partner Action Against Hunger, Nyatut has made noticeable improvements in her follow-up sessions. She has already begun to stand and continues to improve her mobility.
“The impact on the life of the child, their family and the community is immense,” Obsi explains. “We are so proud to have been successful in preventing developmental delay for many children while they were recovering from malnutrition.”
These activities are funded by the U.S. Department of State Bureau of Population, Refugees and Migration.
As a devastating drought continues in southern Madagascar, food insecurity is on the rise. Humanity & Inclusion is providing food assistance to households with the most acute needs.
Year after year of insufficient rainfall in southern Madagascar has caused one of the worst droughts in the country’s history. And communities are facing a food crisis.
“Life is not like it used to be,” says Nahy, 66, who lives in a village classified as severely impacted by the drought. “Things are getting harder. Before, there were abundant rains and we could cultivate crops. Today, there is no more rain and we’re suffering from it.”
Nahy has six children and 10 grandchildren.
“I take care of the entire family of 16 people alone because my husband and other family members have all passed away,” Nahy explains. “The youngest children live with me in my tiny house, and we all eat and sleep together on the floor.”
Critical food assistance
“We need to cook 10 kapoaka of rice (about 7 pounds) per day to feed everyone,” Nahy continues. “We don't have enough food, and we run out of what we can afford after just one week. We have to walk over a half-mile away to get water. My wish is that we can have enough food to last us each month so that we can have a better life.”
During a door-to-door evaluation, Nahy met with Victor, a partner community agent for Humanity & Inclusion living in her region. He learned about Nahy’s situation and connected her with Humanity & Inclusion to receive monthly food provisions for her family.
“During the distributions I receive 66 pounds of rice, 2.5 liters of vegetable oil, and 10 pounds of beans each month,” Nahy says.
People living with disabilities, low incomes or facing situations of extreme vulnerability face even more difficulty providing for themselves and their families during times of crisis. As crops fail to grow, food becomes scarce and prices increase. Nahy lives with a disability that affects the use of her hands and prevents her from working.
“Due to my disability, I cannot cook meals by myself and I need help for small tasks like getting dressed in the morning,” she explains. “My children and grandchildren are the ones who cook for us, because it causes me too much pain. I am not able to work, and my children cannot find jobs here, so we cannot afford the little food available.”
Humanity & Inclusion provides monthly food assistance to people with disabilities and their households living in the Atsimo Andrefana region of Madagascar to alleviate the negative impacts of the drought, reaching approximately 7,000 individuals. Teams also offer stimulation therapy to children, a rehabilitation service that helps prevent developmental delays and disabilities associated with a lack of nutrition. 320 children have already received stimulation therapy, and 350 others have been identified for the coming months.
Humanity & Inclusion is committed to reducing the adverse effects of climate change on populations worldwide. We help communities prepare for and adapt to climate shocks and stresses, and we respond to crises magnified by environmental factors. Applying a disability, gender and age (DGA) inclusion lens across all our actions, we advocate for practitioners and policy-makers to embed DGA in their climate work as well. Humanity & Inclusion is also determined to reduce its own ecological footprint by adapting and implementing environmentally conscious approaches to humanitarian action.
Nearly one in 10 people in Burkina Faso have been displaced by conflict. Most worryingly, the rate of severe food insecurity has nearly doubled compared to last year, with over 600,000 people in emergency hunger levels during this lean season, warns 28 international aid organizations operating in the country. An urgent increase in funding for humanitarian assistance is required to respond to the current situation.
“We now see more and more people forced to flee not from their hometowns, but increasingly from places where they had previously sought refuge,” explains Philippe Allard, Director of Humanity & Inclusion in Burkina Faso. “Each new displacement increases their vulnerability, and chips away at their resources and mental health.”
The multiplication of violent attacks has driven more people to flee between January and July 2022 than during the entire year of 2021. Meanwhile, large displacement shocks are becoming more frequent. Four years after its start, the displacement crisis in Burkina Faso remains one of the three fastest growing in the world.
“Too often, displacement and hunger come as a one-two punch,” says Hassane Hamadou, Country Director of the Norwegian Refugee Council. “People forced to move have left behind their fields and livestock. Many displaced families report being down to one meal a day in order to allow children to eat twice. Recent waves of displacement only heighten the urgency to act.”
“For children, who make up for the majority of the displaced, leaving their home behind is traumatic enough but having to flee again and again while trying to survive robs families of any chance to rebuild their lives,” adds Benoit Delsarte, Country Director of Save the Children.
Ousmane, 15, is one of many children facing such daunting uncertainty: “I have been displaced twice. It all started the day armed men came to my village and told us to follow their instructions or leave. My parents and I first sought refuge in a nearby village. Unfortunately, shortly after that, they came there and burned down schools, markets and stores. We were forced to flee, again.”
The town of Seytenga, near the border with Niger, hosted over 12,000 displaced people when it came under attack on June 11, killing dozens. In the following hours and days, over 30,000 people fled Seytenga and arrived in Dori, a city that had already tripled in size since the start of the crisis.
Despite immense challenges to provide shelter, water, healthcare and education among other essential services, communities have rallied to support each other. But more humanitarian support is critically needed.
“Host communities across the country have shown remarkable solidarity by taking in tens of thousands of displaced people, opening their homes and sharing their food for months, if not years on end,” says Antoine Sanon, Response Director of World Vision in Burkina Faso. “The efforts of the international community to provide lifesaving assistance should match theirs.”
“These communities are experiencing an exceptionally difficult lean season due to the food crisis resulting, in part, from last year's catastrophic agricultural season,” adds Omer Kabore, Oxfam Country Director. "The effects of climate change, mass displacement and the rising global cost of grain products have combined into a perfect storm engulfing over 3.4 million Burkinabè.”
Signatory organizations call for an urgent surge of financial resources. Eight months into the year, the humanitarian response is only reaching 36% of the funding required despite soaring needs.
Action Against Hunger
Alliance for International Medical Action (ALIMA)
Center for International Studies and Cooperation (CECI)
Comité International pour l’Aide d’Urgence et le Développement (CIAUD)
Cooperazione Internazionale (COOPI)
Danish Refugee Council
Humanity & Inclusion
IEDA Relief (International Emergency and Development Aid)
International Rescue Committee
LVIA (Association Internationale Volontaires Laiques)
Lutheran World Relief
Médecins du Monde-France
Médicos del Mundo
Norwegian Refugee Council
Première Urgence Internationale
Save the Children
Secours Islamique France
Terre des Hommes
Severe malnutrition has delayed Sosiany’s growth and development. Humanity & Inclusion’s specialists are using stimulation therapy and active play to help her prevent long-term consequences.
“When Sosiany was 3 months old, I noticed that she wasn’t developing normally,” explains her mother, Naliny. “She wasn’t able to hold her head up. Then, at 6 months, she could not sit up on her own.”
Concerned, Naliny brought Sosiany to see a doctor who determined that she was severely undernourished, and it was interfering with her growth and development. At 17 months old, Sosiany’s mental and motor development are more similar to those of a 6-month-old baby. These developmental delays can worsen over time and lead to irreversible disabilities if left untreated.
The doctor prescribed the child a nutritional supplement and referred her to the rehabilitation center at the regional hospital in Tuléar to see if Sosiany could benefit from Humanity & Inclusion’s stimulation therapy.
Early childhood stimulation therapy for undernourished babies and young children is a form of strategic active play that stimulates motor skills and cognitive development by engaging the child with toys and providing individual attention. Humanity & Inclusion’s rehabilitation specialists have trained physical therapists in Tuléar, Madagascar, to use the technique alongside emergency nutrition initiatives to give children the best chance of survival, improve quality of life and prevent the long-term consequences of undernourishment.
Rehabilitation disguised as play
Recently, Sosiany attended her second session with Denis, a physical therapist at the rehabilitation center who was trained in stimulation therapy by Humanity & Inclusion in October 2021.
“In the beginning, we let the child play with whatever they are drawn to,” Denis says. “The first goal is to get them comfortable. Then, you choose activities depending on the specific objective of each child. For example, Sosiany is not able to sit on her own, so we play in positions that train her leg muscles and get her used to sitting for longer periods of time.”
Each activity plays a specific role in Sosiany’s development. Holding a toy above her head will help her practice reaching. Drawing will start to improve her grasp. Simple actions like kicking a ball or pushing a toy car help develop her movement, interactions and reflexes.
Throughout each session, Denis also explains to Naliny how to continue the exercises with her daughter at home.
“Sosiany doesn’t have any toys of her own, but her mother says she likes to drum on a basin they have for washing clothes,” Denis explains. “To encourage her to crawl, she can simply move the basin further away. Then, Sosiany will have to crawl over to it before she can play on it. We can adapt any activity to stimulate the child, you just need to know what she likes to do.”
After about five sessions of stimulation therapy, children generally start to show improvements, but the length of therapy is adapted to the needs of each child based on their progress.
Inspired by the care her daughter is receiving, Naliny says she hopes Sosiany will grow up to be a doctor so that one day she can heal others.
Odile faces challenges in affording enough food for her son, Nasolo. Humanity & Inclusion provides stimulation therapy to help children like Nasolo overcome the consequences of undernourishment.
“My 16-month-old son, Nasolo, is underweight for his age,” Odile explains. “He struggles to hold things in his hands and he cannot walk yet. A community agent came to our home and found that Nasolo was malnourished.”
In Madagascar, Humanity & Inclusion trains community agents to recognize signs of malnutrition and other vulnerabilities in developing children. They then visit communities in the areas surrounding Tuléar, where malnutrition is common due to high poverty rates and dwindling food supply in an ongoing drought. The community agents identify children who may be in need of stimulation therapy and support from Humanity & Inclusion. If left untreated, malnutrition can cause developmental delays in young children which may lead to long-term disabilities or neurological disorders.
After meeting with the community agent, Odile was encouraged to enroll Nasolo in early childhood stimulation therapy at the Tuléar hospital rehabilitation center, where Humanity & Inclusion uses strategic play-based rehabilitation to encourage physical and cognitive development in undernourished children.
Families face food insecurity
Nasolo’s mother, Odile, is only 18 and is raising her son as a single parent. She has not been able to find work, which makes it difficult for her to provide sufficient food for her only child. At the moment, she is dependent on her mother to care for both her and Nasolo.
Odile lives more than 30 miles from the rehabilitation center and has to travel for an hour and a half to bring Nasolo to his stimulation therapy sessions. To support her and other families with children in stimulation therapy, Humanity & Inclusion covers food, transportation and hotel costs, in case families need to stay overnight, as well as the cost of the rehabilitation services.
Nasolo recently attended his third stimulation therapy session with the physical therapists and continues some exercises when he is at home with his mother. He is already starting to see some results.
“He can’t walk yet, but he is now able to hold things in his hand,” Odile says. “He loves toys and he likes to come here where he can play. I am very happy now that he has started to show progress.”
Malnutrition prevented Pal from developing like other children his age. With Humanity & Inclusion’s nutrition support and stimulation therapy, Pal can now sit, stand and walk on his own.
11-month-old Pal and his mother, Nyayual, 34, live in the Nguenyyiel refugee camp, in Gambella, Ethiopia. Originally from Nasir, South Sudan, Nyayual was forced to flee her home in 2017 due to war and unstable conditions. After leaving her husband behind in the conflict, Nyayual is raising her five children as a single mother in the camp and working as a cleaner.
Living in the refugee camp, Nyayual is faced with a lack of resources, insufficient finances and increasing drought, all of which make it difficult to access food and nutrition for her children.
Malnutrition has a particularly strong impact on babies and young children, like Pal, who are still developing their minds and bodies. Malnutrition and undernutrition are major factors in child mortality, illness and disability. Children may show delays in motor and cognitive development, associated with behavioral and communication problems. These can consolidate over time and lead to irreversible disabilities if left untreated. Most neurological disorders related to malnutrition are preventable.
“I was worried a lot about my baby,” Nyayual says. “His growth rate was slow and he was unable to sit up without support like other children his age.”
Overcoming developmental challenges
Nyayual brought her son to Humanity & Inclusion to begin stimulation therapy sessions and to receive emergency nutrition supplies. Early childhood stimulation therapy for children experiencing malnourishment stimulates motor skills and cognitive development through personalized care and playing with toys. Humanity & Inclusion’s rehabilitation specialists developed the therapy to use alongside emergency nutrition initiatives, rehydration and essential medical care to give children the best chance of survival, resilience and an improved quality of life.
After attending sessions with his mother, Pal began to show improvements. He can now sit without any support, stand by himself and he has recently started walking independently. Nyayual also learned skills to continue Pal’s progress at home.
“Being able to play with his peers and siblings at home also helps Pal to improve his social interactions and learn some gestures, which improves his language skills,” explains Gadisa Obsi, a physical therapist for Humanity & Inclusion in Ethiopia.
It’s been five months since Pal’s family began receiving nutritional support from Humanity & Inclusion, and Nyayual says she is very pleased with her son’s performance, which now fits with his age group. Pal’s favorite activities are dancing and “playing drums” by beating on household objects. His favorite food is mashed potatoes with milk.
“My ultimate goal is to see him go to school,” Nyayual says. “I hope one day he can become an educated person who will bring real change for our family.”
These actions are funded by the United States Department of State’s Bureau of Population, Refugees, and Migration, and implemented by Action Against Hunger, Humanity & Inclusion and other partner organizations.
In the Democratic Republic of the Congo, Humanity & Inclusion is working alongside local farmers to help communities cope with the threat of a food crisis.
More than 35% of the population in the Kasaï-Central province in the Democratic Republic of Congo is severely food insecure, leading to increasing levels of malnutrition. Action Against Hunger, Humanity & Inclusion and other partners are implementing agricultural recovery and food aid activities, funded by USAID, in the Dibaya area that will reach more than 32,500 people.
In March 2022, Humanity & Inclusion distributed vegetable growing kits to 4,700 households. These kits contained a spade, hoes, a rake, a watering can and seeds for vegetables including cabbage, okra, eggplant and tomato.
Supported by state technical services, Humanity & Inclusion teams have trained 63 “relay” farmers in vegetable-growing practices. The training is designed to strengthen the farmers’ skills while teaching them eco-friendly farming techniques, such as growing crops without the use of chemical pesticides and producing natural fertilizer. These farmers then relay their newly acquired knowledge to their communities, transferring their skills to more people.
Agnès Nkaya, pictured above, lives in Kabenguelé and completed the training.
“This is the first time we have had this kind of training in the village,” she explains. “It’s very useful because we have problems making our farmland fertile enough, and protecting our crops from pests and diseases. As part of the training, the Humanity & Inclusion teams taught us how to prepare a vegetable garden, how to recognize soil suitable for vegetable production, how to make the beds and how to plant the seeds.”
One goal of this training is to make agricultural activities sustainable by encouraging the use of fertilizer made from locally available products, such as plant debris, ash and manure.
“For me, the most interesting module was the one on natural fertilizers, especially the 7-day compost,” Nkaya continues. “This is the kind of knowledge we are looking for to improve our practices and production. We have all the raw materials we need in our villages, but, until now, we didn't know how to use them. Thanks to this training, I won’t have problems with my production anymore because I’ll make my own natural fertilizers."
Nkaya looks forward to sharing these new techniques with her neighbors.
“I’m well-equipped now and ready to pass on what I’ve learned to other people in my village,” Nkaya adds. “This will also be an opportunity for me to improve my own grasp of these techniques. As well as sharing knowledge with us, Humanity & Inclusion has provided us with equipment—waterproofs, rubber boots, rope and logbooks—to help us when we train other people. I will make good use of it!"
GREEN Initiative: Humanity & Inclusion is committed to reducing the adverse effects of climate change on populations worldwide. We help communities prepare for and adapt to climate shocks and stresses, and we respond to crises magnified by environmental factors. Applying a disability, gender and age (DGA) inclusion lens across all our actions, we advocate for practitioners and policy-makers to embed DGA in their climate work as well. Humanity & Inclusion is also determined to reduce its own ecological footprint by adapting and implementing environmentally conscious approaches to humanitarian action.
As a farmer, Fadimata Walet, relies on regular rainfall to provide for her 10-person household in Mali. Fadimata shares the challenges she’s facing as a result of environmental changes.
I work as a farmer, which serves as the main source of income for my family. We practice rain-fed agriculture, so we sow our seeds in the wintertime.
The rains used to be abundant, and so were the harvests. I was able to repay the credit I took out to prepare for the agricultural season and I had enough left over to cover six to eight months of my family's millet (a grain rich in fiber) needs. Over the years, we have noticed a decrease in the frequency and quantity of rain. The harvests became worse and even our finest seeds produced almost nothing.
There is a pond that used to fill up during the winter period, and the water is used by the women for market gardening. Before, it could last three to four months without drying up. But these last years, it barely stays one month after the winter. So, we have no choice but to reduce the area that we cultivate.
‘Trying to adapt’
Faced with this situation, I have had to take on more work. I started cultivating more diverse plant species, hoping to have a quantity of harvest that could cover me for two or three months. I started to grow vegetables that I sell with the help of my daughter. I also sell firewood and charcoal that I bring from the bush to provide for my family. I offer my services as a cook for ceremonies, and I had to resort to large debts and a loan to revitalize my small business.
I didn't need all this before, because the rains were abundant and sustained us. I know many families who go to the Mbera refugee camp in Mauritania after the harvest, where they receive food donations from NGOs because their crops are not enough. We hope that things will improve for us, but for the moment we are doing our best with what we have.
Times are hard and we are trying to adapt, but it is very hard to hold on for many of us. I know today that my situation is better than many other families who do not have support.
For two years now, I have been receiving financial support from Humanity & Inclusion, which is enough to cover my family’s food needs. I have a smile on my face because I am relieved from having to borrow, beg or go into debt to feed by family. I have also been able to buy some garden supplies to cultivate my millet field and harvest the vegetables my daughter sells at the market. Without this project, many households would be starving. Today, I am able to meet the needs of my family and am gradually returning to a normal life.
Supporting families impacted by climate change
In Mali, Humanity & Inclusion works to support households and communities like Fadimata’s by reinforcing their resilience to the risks of food and nutrition insecurity in response to climate change.
The organization provides financial support to families for daily necessities, strengthens malnutrition prevention community groups and implements infant and child dietary advice through community specialists. The project also supports local initiatives and community projects and reinvigorates spaces for dialogue between local leaders and affected citizens to promote the shared management of natural resources.
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Over 1 million people are facing severe food insecurity in southern Madagascar following the country’s worst drought in 40 years. Humanity & Inclusion is supporting at-risk families and malnourished children.
Within a population of 2.8 million people, over half of Madagascar’s population is in need of humanitarian assistance. Women, children and people with disabilities are particularly at risk, as they are among the most affected in times of crisis. Families must strictly ration their meals and many report eating insects, cactus leaves or even leather to overcome extreme hunger. As the “lean season” approaches, and a recent locust outbreak has depleted many of the few remaining crops, the number of people at risk is expected to double if aid is not provided urgently.
Active in Madagascar since 1986, Humanity & Inclusion’s team is responding to the crisis, and has already reached more than 1,000 households. Staff is facilitating access to food, specifically targeting individuals with disabilities or those facing other circumstances that limit mobility or ability to work. In times of crisis, people with disabilities are among those most affected.
Since August, 1,086 households have received assistance including cash transfers, vouchers and food baskets of staple items such as rice, peas, oil and salt. These efforts will continue through September and October, with a second wave of distributions to an estimated 640 additional households from December to February.
“Food aid is necessary, and people with disabilities are among those most vulnerable to the crisis,” says Harison Rainifara, Humanity & Inclusion’s area manager for the project. “The districts where we’re working are already classified as food security emergency zones. With the arrival of the lean season, we are just trying to prepare people to make it through.”
Preventing consequences of malnutrition
The increasingly high levels of malnutrition and undernutrition in children under the age of 5 put them at heightened risk of delaying their growth and development. In Madagascar, severe acute malnutrition (SAM) affects one in four children. That number is expected to rise as the crisis worsens. SAM can lead to difficulties in developing motor skills such crawling, sitting and grasping, or to Hypotonia, a disorder that affects nerve control by the brain. If not properly managed, these developmental delays consolidate over time and become lifelong disabilities.
Humanity & Inclusion teams in the region have identified over 800 children in need of nutrition support and physical therapy to facilitate normal growth and development to prevent disability. As part of the response, local actors will be trained in early childhood stimulation therapy to enable children with SAM to maintain normal weight gain, growth patterns and cognitive development.