Preventing History From Repeating Itself

In the humanitarian world, there are the disasters you see coming, and the ones you don’t.

We didn’t foresee the massive 2010 earthquake in Haiti … the devastating floods in Pakistan… the earthquake and tsunami in Japan…or the conflicts sweeping the Arab world.

But the current drought and famine in East Africa? We saw that coming. The only question was how bad would it be?

The answer: very bad and getting worse.

This crisis has now affected a staggering 12.4 million people – it has killed tens of thousands, and put 400,000 children at risk of starvation. Think about those numbers. Roll them around in your head.

We saw this emergency unfolding 9 months ago when the rains began to fail, the harvests were poor, and food and fuel prices shot up. Families already facing scarce food resources suddenly had to make do with much less. Throw in more than 20 years of violent conflict in Somalia and you have approximately a million refugees crossing the borders into Kenya, Ethiopia, Djibouti, seeking some sort of escape.

Make no mistake, this is the worst humanitarian crisis in the world today.

But that’s the macro.

Here’s the micro: a nine-month pregnant Somali woman, her two-year-old son, her husband, and his brother, journey many treacherous miles by foot across arid, forbidding desert to the Ethiopia border. There they wait to be processed. They wait outside for days in 100-degree heat and high winds that whip sand across their faces. Eventually they are bused to a refugee camp about 20 miles north, inside Ethiopia, where they are given a tent and a bit of food.

They come to International Medical Corps’ nutrition center in the camp, by which time the mother is so weak from severe malnutrition that she can barely keep her eyes open or speak. She cannot hold her own son in her rail-thin arms, and childbirth may very likely kill her. Her husband has been too ill to come to the center. Her brother-in-law holds her child for her, but he too is so weak that when he stands his legs and arms shake from the strain and he is forced to sit down again. The child cradled in his arms is so severely malnourished that he is non-responsive, not uttering a sound.

People should not be suffering like this. I keep saying the same phrase over and over in my head: “This is not right.”

Sadly, a crisis such as this has struck the region before: the famine in Ethiopia in 1984, famine and civil war in Somalia in 1991. These are horrific cycles that plague East Africa. While the government and communities have made great strides in mitigating the impact of these cycles, this past year has seen a perfect storm of factors that are especially pernicious and tough to combat.

I was in Ethiopia during the “global food crisis” in 2008, and witnessed a tremendous amount of starvation, pain and suffering. And yet, that crisis technically was not as severe as what’s happening today. It did not constitute what the humanitarian community defines as “famine” – the malnutrition and mortality rates were not at the levels they are now. When 1 in 1,000 people dies of malnutrition, that is considered a humanitarian emergency; right now, in the refugee camps where International Medical Corps and other NGOs are working, the mortality rates have hovered around 14 percent. Rates of severe malnutrition have been as high as 45 percent.

In the face of these grim statistics, what are our solutions?

I ask my colleague, Daniel, who runs our nutrition programs in the camps. A native of eastern Ethiopia, he has seen famine unfold here before. As he meets with new arrivals at the nutrition center, he is compassionate, but no-nonsense. One teenaged mother has brought in her 3-year-old severely malnourished son. His chest and ribcage protrude sharply over his distended belly, his limbs are twigs, he lets out a persistent, desperate hunger-wail. Daniel explains to the child’s mother that if he is not admitted to a stabilization center he will not survive - that milk is not enough, he needs therapeutic feedings.

As Daniel reflects on the great suffering he has witnessed recently and in years past, he also vividly remembers the victories. He recalls when he first began doing nutrition work in the early ‘90s, and himself was learning how to care for people and pass on skills. One woman in particular he remembers brought in two malnourished children for treatment – along with a third who she said was disabled, his arms and legs completely rigid and unmovable. All three children underwent therapeutic feedings. Suddenly one day, the disabled child straightened his arms and legs, and stood up. Daniel realized this child was not disabled; he was severely malnourished and needed proper nutrients to reverse the paralysis in his limbs. Witnessing and learning from this recovery proved a seminal moment for him – and to this day provides him with the hope that education can and will save lives.

Fighting back tears, Daniel says simply: “That was a day when I felt really good about my work. I will never forget it. Never.”

First Disaster - Then Luck, Perseverance, and New Beginnings

Alex and I are sitting at the kitchen table, having some eggs before we and the rest of the team head out to one of our health clinics in Jacmel, a coastal town in southern Haiti.

Up to that point I knew very little about Alex. On the way down from Port-au-Prince, he was driving; I was in the back seat mostly talking with our logistics coordinator, Dave.

But sitting at the table on this morning, I offered a typical icebreaker, “How long have you been working with us?” It’s a simple enough question. Still, I have found - whether in Haiti or Lebanon or Congo – that out of that question, a surprising, fascinating yarn always unfurls.

Alex’s yarn was no different.

He told me he started working for International Medical Corps on January 16^thof 2010, just days after the earthquake that killed 316,000 people and left millions of others homeless.

When the quake hit, Alex and his wife, Gerda, were inside their home in Port-au-Prince. As their surroundings began to shake violently, they raced outside, only to watch their concrete home collapse seconds later.

Alex also lost his retail soda business in the disaster. With no home and no livelihood, he and Gerda sought temporary shelter in the Delmas district of Port-au-Prince.

Hearing that help was needed at the general hospital downtown, Alex went there to lend a hand, perhaps get some sort of work. “I speak Creole, French and Spanish so I thought I might be able to be a translator.”

He arrived to a chaotic scene; several hundred injured lay on the pavement outside, the hospital’s buildings too damaged for use. “The doctors and nurses were amazing. God bless them.”

Here, I interrupt Alex.  “So you were at the hospital right after the earthquake? So was I.”

He stares at me, a sudden recognition crossing his face.

“I remember you! You gave me a job. You grabbed me and said, ‘I need a translator, can you help me?’”

The scene rushed back to me. I remembered him too. I remembered the stocky guy with a big smile and an eagerness to help. He did help immeasurably. In addition to translating, he moved patients, loaded and unloaded boxes, helped keep watch over pharmaceuticals and supplies in our command post.

I remembered near the middle of his first day at the hospital, taking the roll of tape with “International Medical Corps” printed on it and wrapping it around his t-shirt – the quickest way, in the sea of patients, family members, medical personnel, military, and media, to identify who was working with us.

So many people, so many Haitians, had come to the hospital to help. Alex was one of them, and he stood out. Each morning he returned first thing, asking what he could do.

As our emergency response continued to ramp up to meet the need, we began instituting systems for employing local staff and putting them on the payroll. Our head of logistics saw how valuable Alex was and hired him. He’s been with us ever since.

Today, Alex and Gerda still live in that temporary shelter, hoping soon to get a permanent home. Four months ago, they had a daughter, Chrislex.

Alex admits theirs are difficult living conditions, but he remains grateful that out of the ashes of the earthquake he is building a future with a job and family that make him happy.

And then he flashes that smile.