In a dried-out riverbed a woman and her young son kneel beside a hand-dug hole in the ground, using plastic canisters to scoop water burbling up through the sand. Several naked children with swollen bellies wait their turn. The improvised well seems to be little more than a puddle, yet an entire community of 600 people depend on it. A hand pumped well is just several hundred meters away, under the shade of palm trees, but the bolts on it are bust. The villagers tried to repair it with palm fronds, but that did not work.
Nakujan Ariong, a mother of six, says she knows that the dirty water is not safe to drink, but her family has no alternative. “This is the only water available, and that's why we use it," she tells The Lancet. As she is speaking, a man brings over two camels to drink from the watering hole, which the children have just vacated.
It is still early in the year, but already nearly 1.3 million Kenyans are going hungry. In Turkana, in the northwest, the percentage of children younger than 5 years at risk of malnutrition is more than 21 percent. One woman was arrested for feeding her children the family dog.
In Wajir, in the northeast of the country, people are again having to rely on water being trucked to their communities, while water sources dry up and “drought birds” have made an appearance, despoiling local water supplies with faeces. Hungry residents are crossing into Somalia seeking pasture and water.
Hunger is an ever-present specter in much of Kenya, where close to half the population is below the poverty line, and about three-quarters work in subsistence agriculture. Even in 2012, which was considered a good year, an estimated 2 million people did not have enough to eat. An assessment of the 2011 famine in Somalia found that 260,000 people died during the crisis, more than twice what was previously estimated. This underscores the fragile status of many people living in the Horn of Africa, and shows how a lack of preventive action can easily boil over into catastrophe.
Yet despite repeated promises by international donors that they want to address the underlying conditions that lead to yearly malnutrition in so much of sub-Saharan Africa, the basic lack of infrastructure — water, sanitation, and roads — at the root of these chronic emergencies remains unaddressed. Meanwhile, climate change, war, and growing populations put increased pressure on dwindling resources. Droughts, which used to come every decade in the region, now occur every few years (video).
“What you are seeing is that people are being knocked off their feet by one shock and not quite able to get back on their feet before the next one hits,” says Nicholas Cox of the Office of U.S. Foreign Disaster Assistance. “So that level of vulnerability remains the same or left unaddressed and so by the time the next shock comes around you have many people that are still in a very vulnerable state…then you can have millions of people tipping over into a crisis.”
Although U.S. and European aid agencies are fond of talking about resilience as the new aid paradigm, it begs the question: To what norm are people supposed to bounce back? Even in a good year, the arid, northern lands where the pastoralists live have poverty rates between 60 percent and 80 percent, and there is paltry access to health care, education, energy, water or financial services.
Overall, water and sanitation are arguably two of the most crucial factors in health and nutrition, and yet they are among the least addressed, often falling into the cracks between the humanitarian and development portfolios. “A lot of the analysis has shown in these areas that the drivers of those humanitarian needs are really development issues,” says Cox. “Chronic crises don't really fit into our pre-existing categories and really demand a much more multiyear, but humanitarian-style response, which really doesn't exist within most agencies.”
The issue is only becoming more urgent. By 2025, two-thirds of the world's population could be living in “severe water stress conditions," according to the UN's Food and Agriculture Organization. Seven hundred eighty-three million people do not have clean water and 2.5 billion lack hygienic sanitation.