by Ariza Francisco, MPA '23 for Annotations Blog

“We are on our fifth failed rainy season.”

This was a refrain that I heard over and over again when meeting with local stakeholders and activists during a winter-break policy trip to Nairobi, Kenya earlier this year. Leaders are not shy when speaking out about the fact that the Horn of Africa is experiencing its longest and most severe drought in decades, resulting in the death of millions of livestock, the destruction of crops, and the displacement of more than a million people. And it will only get worse, as this calamitous drought is forecasted to persist well past the current rainy season of March to May 2023.

While the devastating consequences of the drought are widespread, with at least 36.1 million people affected by October 2022, women and girls have been disproportionately affected. They face alarming rates of malnutrition, disease, and violence.

According to UNICEF, more than 20 million children confronted food insecurity in the Horn of Africa at the end of 2022, compared to the 10 million affected children in July of the same year. Moreover, approximately two million children in Ethiopia, Kenya, and Somalia are in need of immediate treatment for severe acute malnutrition.

Malnutrition is one immediate negative health outcome of drought. Food is difficult to access due to crop failures, livestock losses, and limited water. Reduced household income also means that it is more challenging for families to buy sufficient and nutritious food. Pregnant and nursing women, adolescents, and children under the age of five are especially susceptible to malnutrition due to their rapid growth and physical changes. Lastly, in some cultures, there may be a preference for feeding male children over female children during times of food scarcity.

Droughts increase the risk of contracting diseases. The lack of access to clean water may exacerbate waterborne diseases, such as cholera and diarrhea, because pathogens become concentrated in limited water supplies at the same time that people rely more heavily on rainwater and runoff. In Somalia, almost all districts impacted by the drought have reported outbreaks of acute watery diarrhea and cholera. Nearly two-thirds of those affected are children under five years old.

The climate crisis also poses serious threats to maternal and sexual health. Drought can lead to shortages of essential medicines, medical supplies, and trained healthcare personnel, which can make it more difficult for health clinics and hospitals to provide basic services. Drought and displacement strained already limited sexual and reproductive health services in countries like Somalia and Kenya, where maternal mortality rates are high. Moreover, when aid and resources are stretched thin, food is the priority compared to contraceptives, menstrual hygiene products, and under garments.

Lastly, the drought has led to an upsurge in gender-based violence (GBV). In this region, women and girls traditionally collect water or food for their household. Because of the drought, they are forced to travel further to collect water or food, putting them more at risk of sexual assault and harassment. Congested displacement or forced relocation to refugee camps also put women and girls at higher risk of violence. For instance, in Hagadera refugee camp in Kenya, cases of violence reported by women and girls nearly doubled from 198 in 2019 to 389 in 2021. During the period of the drought, UNICEF reported a more than 50% increase in female genital cutting and child marriages, as marriages often generate a dowry for the bride’s family. Additionally, GBV is a significant risk factor for HIV transmission, as it can increase the likelihood of forced or transactional sex and make it more difficult for women and girls to negotiate safer sex practices. In particular, women and girls experiencing food insecurity were found to be 28% more likely to engage in transactional sex.

We must prioritize the needs and rights of women and girls in our response, and also give them the power to lead in their communities.

Addressing health issues during the drought in the Horn of Africa calls for an urgent, multi-faceted approach. Here are some actions that can be taken:

Providing access to food. Providing food assistance in the form of food distribution, cash transfers, and support for agriculture and livestock can help to reduce the risk of malnutrition and improve health outcomes. For example, researchers found that providing women with direct food support led to a significant reduction (of 64%) in the risk of contracting HIV in Sub-Saharan Africa.

Improving access to clean water. Providing access to clean water through the drilling of boreholes, installation of water tanks, and introduction of water treatment facilities can prevent the spread of water-borne diseases. In turn, such actions will help women’s hygiene and improve safety and the quality of services in health facilities.

Supporting livelihoods and economic opportunities. Drought can lead to loss of livelihoods and income, making it difficult for people to access healthcare and basic necessities. The provision of vocational training, cash transfers, and loans for small businesses can address the negative financial aspects of the drought. 

Strengthening healthcare systems. Strengthening healthcare systems by training healthcare workers, offering free medical supplies, and supporting health facilities ensures that people can access the healthcare services they need. Capacity building for healthcare workers can include modules on emergency protocols, detection and treatment of malnutrition, WASH protocols, and tools for mental health care. African-led capacity building has been shown to work well in addressing healthcare challenges, especially as demonstrated by examples like the Sub-Saharan African Network for TB/HIV Research Excellence.

As we face the damaging effects of drought on the health of women and girls in the Horn of Africa, it's important to remember that this crisis is not inevitable. With the right investments and policies, the international community can build resilient health systems that can withstand the shocks of climate change and better serve vulnerable populations. We must prioritize the needs and rights of women and girls in our response, and also give them the power to lead in their communities. Right now, we need urgent humanitarian action to prevent the suffering of millions in the face of this ongoing crisis.

Meet the Author: Ariza Francisco

Ariza Francisco is an MPA '23 student at Princeton University's School of Public and International Affairs. She is passionate about health and gender policy, particularly in urban poor, remote rural, and emergency settings. Her previous roles include program manager for the former Vice President of the Philippines Leni Robredo; deputy director in a Metro Manila-based policy center; and graduate intern at UNICEF South Africa. Currently, she is working as a research assistant at Princeton University on health equity policy projects.