Suffering in Silence 2019

Madagascar is a country mostly known for its unique wildlife and rich biodiversity. But it also ranks among the poorest countries in the world, with three-quarters of its population living on less than US$1.90 per day. It is one of the countries most affected by the human-made climate crisis due to its dependence on agriculture and natural resources on the one hand, and its high exposure to natural disasters, such as recurring cyclones, chronic droughts and pests, on the other.

At the end of 2019, more than 2.6 million people were affected by the impacts of drought, and more than 916,000 people were in immediate need of food assistance.

Madagascar has the world’s fourth highest rate of chronic malnutrition, with one in every two children under five suffering from stunting. This severely impairs their cognitive and physical development, increasing the risk of contracting or developing other diseases. At the beginning of 2019, an unusually large measles outbreak with more than 127,000 confirmed cases coincided with the seasonal occurrence of the plague. These diseases affected children the most.

Approximately 80% of the Malagasy population is engaged in agricultural activities, and thus highly susceptible to climate shocks affecting the crop cycle. Over recent years, the Grand Sud region in particular has suffered from consecutive years of severe rain shortfalls during the agricultural season, which were further aggravated by the El Niño weather phenomenon in 2016/17. The fall armyworm infestation since 2017 and below-average precipitation in 2018 reduced harvest yields of the main staple foods: rice, maize and cassava. Increased food prices forced families to sell their assets, reduce the number of meals per day and travel increasingly longer distances to search for alternative incomes.

This particularly affects women, as rising levels of food insecurity place additional burdens on them. Struggling to feed their families, they are vulnerable to abuse and exploitation. Crop damages and income losses often increase family tensions and the likelihood of child marriage and domestic violence.

CARE provided life-saving humanitarian assistance to more than 40,000 people in Madagascar and helped improve food and nutrition security for 105,000 people. CARE supported the drought-affected population by increasing productivity and profitability of crops and worked with farmers on using modern farming techniques. CARE also repaired broken water systems and established new ones, while supporting village savings groups to help people set up alternative sources of income. The main goal was to support communities to become more resilient to climate change and recurring natural disasters.

Since gaining independence in 1960, the Central African Republic (CAR) has enjoyed only short periods of political calm. The latest internal conflict broke out in 2013 and intensified in 2017. Fights have led to widespread displacement and an escalation of humanitarian needs. Despite the signing of a peace accord in early 2019, the security situation remains tense. About 2.6 million people, more than half of the population, are in desperate need of humanitarian assistance.

Violent clashes and attacks on civilians have forced one in four citizens of the Central African Republic to flee their homes. More than 600,000 people are displaced inside their own country and almost 594,000 people have sought refuge in neighbouring countries such as Cameroon, the Democratic Republic of Congo and Chad, all of which struggle with high poverty rates themselves.

Years of conflict have also taken their toll on health, water supply and sanitation, as well as crippling agricultural production patterns. Consequently, 1.8 million people – 41% of the population – are severely food insecure. Particularly in areas with high numbers of displaced people, access to agricultural fields is limited due to movement restrictions. This prevents households from planting and maintaining their crops, hunting and gathering. In addition, security concerns along trade routes have disrupted market activities and contributed to shortages of food and rising prices.

As in most armed conflicts, women and children are particularly vulnerable to sexual and gender-based violence and often resort to desperate measures including “transactional sex” to be able to afford basics like food. Some are even pushed into this practice by distressed parents.

With 244 attacks in 2019, the Central African Republic is one of the most dangerous places in the world for aid workers. Regular attacks on staff, looting of facilities and road blockages are a daily struggle for humanitarian agencies. Poor road conditions make it extremely hard to reach those in need. Heavy seasonal rainfall and flooding have further complicated the delivery of humanitarian aid.

CARE continues to support Central African refugees and host communities in the neighboring countries of Cameroon and Chad, ensuring access to water and sanitation, distributing plastic sheeting and sanitary items and working to prevent sexual and gender-based violence.

In Zambia, the effects of climate change are undeniable. An estimated 2.3 million people in the country are in urgent need of food assistance as a result of recurring and prolonged droughts. Food insecurity due to extreme weather events, pests or epidemics is nothing new for the landlocked nations in Southern Africa, however, temperatures in the region are rising at about twice the global rate, according to the Intergovernmental Panel on Climate Change. Zambia, along with its neighbouring nations, is increasingly being impacted by more extreme weather shocks. As such, malnutrition rates remain persistently high in Zambia – approximately 40% of children under five are stunted.

In 2019, seasonal rainfalls in southern and western Zambia were recorded at their lowest levels since 1981. The lack of rainfall has devastated people’s livelihoods after prolonged dry spells in 2015/16 and again in 2017/18, from which many families had not yet recovered. For the second consecutive year, cereal crop harvests decreased sharply, with some districts recording an almost complete failure of the maize crop. This has put families who rely on these crops to sustain their livelihoods in a dire situation. As a result of crop failures, household stocks are rapidly depleting and families have been forced to sell their livestock and other assets to secure food to survive. This demand for food has in turn driven up the price for maize, the main staple crop in Zambia, which was 70% higher in August 2019 compared to the previous year and is continuing to rise. Furthermore, as families search for safe drinking water, boreholes are increasingly becoming overused, making access to water a major concern.

In Zambian society, women play a crucial role in food collection and preparation as well as the care and feeding of children. The drought has placed additional hardships and risks on women as they cope with the changing climate. For example, some women now report waking up as early as 3 a.m. in order to be the first to collect the scarce water available and then spend all day searching for food. Many have resorted to collecting whatever wild fruits they can find to feed their families.

CARE started its operations in Zambia in 1992 to respond to the severe drought of the early 1990s. Currently, CARE supports the rehabilitation and drilling of boreholes in the most drought-affected areas to provide safe drinking water. CARE so far has reached about 36,000 crisis-affected people with humanitarian assistance and 54,000 people with aid to improve their food and nutrition security and resilience to climate change.

With prolonged political insecurity, high levels of poverty and significant human rights concerns, the humanitarian situation in Burundi remains fragile. Natural disasters, population movements, malaria epidemics and the risk of Ebola crossing into the country compound an already precarious situation. Despite increasing returns of Burundian refugees from Tanzania, close to 326,000 people still remain refugees in neighboring countries, including Rwanda, Uganda and the Democratic Republic of Congo. With a quarter (24%) of returnees without land following repatriation, more than 106,000 people are displaced inside Burundi; many returnees have been displaced again due to severe weather conditions, including floods and droughts, and the socio-political situation.

While levels of food insecurity and malnutrition have improved in 2019 due to relatively good agricultural seasons, the majority still live under the poverty line and lack basic services, such as healthcare, water and sanitation. Reports indicate that some 1.7 million people – over 15% of the country’s population – chronically struggle to feed their families and are experiencing a steady decline in off-farm income. The country is suffering from a slowdown of economic activity and a disruption of markets and trade. In addition, a recent joint national nutrition and food security survey found that 5% of all children are malnourished, with 1% experiencing severely acute conditions.

According to the Human Development Index, Burundi is among the poorest countries in the world, ranking 185th out of 189, and the country most affected by chronic malnutrition. Limited access to water and sanitation also aggravates the risk of communicable diseases. While over 90% of the population depend on agriculture for their livelihoods, Burundi has some of the lowest land productivity rates in East Africa due to land conflicts, extreme population density and environmental degradation. Burundi’s low preparedness for emergencies and crises is troubling. Communities lack capacity to cope with severe shocks such as droughts, epidemics and floods, which often claim lives and undermine livelihoods.

Women and girls suffer the most. Not only do they bear additional financial and domestic responsibilities to look after their families, but many also endure daily violence and insecurity. Some resort to paid sex to support themselves and their children.

In 2019, CARE provided emergency packages that are specially tailored to the needs of women and girls. CARE helps vulnerable women with small savings groups to start up small businesses. At the same time, CARE works with communities to provide information about balanced nutrition and how to prepare food safely in order to prevent malnutrition.

Even though Eritrea’s population suffers from a drought-induced food and water crisis and recurring armed violence and displacement, it is hardly ever covered by international media. As the country remains widely cut off from the outside world, aid organizations and media face major challenges. The last reliable data on the humanitarian situation states that half of all children under five are stunted as a consequence of malnourishment.

A severe drought in 2019 following an above- average dry year in 2018 now worsens the situation as further crop failures lead to food insecurity and malnourishment in wide parts of the population. Nomadic communities are especially vulnerable to natural disasters such as drought and flooding during rainy seasons. The national food production is largely unable to meet the people’s needs: estimates suggest that a good agricultural season can only produce 60-70% of the country’s requirements, a bad year just 20-30%.

Even though the existing conflicts with Ethiopia and Somalia were officially put to an end last year, landmines and other explosive war remnants still endanger people. The prolonged military service obligation and forced labour coupled with ongoing conflict and poor economic conditions continue to leave young Eritreans no other choice than to migrate.

Hundreds of thousands leave the country every year, making Eritrea one of the countries with the strongest exodus of people. On their route towards what they hope to be a better life, many experience torture, rape and kidnapping.

In Eritrea, women and girls are exposed to severe gender-based risks: child marriage is still common in many conservative communities, leading to girls becoming mothers at a very young age. This deprives them of the chance to go to school and live a self-determined, independent life. Additionally, female genital mutilation remains a widespread practice even though it is formally illegal. The mutilation results in a very high maternal mortality rate and lifelong suffering for women.

Since private humanitarian organizations are banned from operating inside the country and access for journalists is almost impossible, many Eritreans suffer in silence.

Due to the political isolation of North Korea and the ban on journalists in the country, the dire humanitarian situation of large parts of the population remains hidden from the eyes of the world. The UN estimates that around 10.9 million people are in need of humanitarian assistance to meet their food, health, water, sanitation and hygiene needs. An estimated 43% of the population is undernourished as agricultural food production fails to meet their requirements due to the lack of modern equipment, compounded by heatwaves, droughts and floods. Several such natural disasters in 2018 led to increasing food shortages in 2019.

The Global Hunger Index classifies North Korea’s situation as ‘serious’ since the percentage of the people suffering from malnutrition has grown continuously in recent years and is now up to almost half of the population. A very poor dietary diversity contributes to this alarming figure. Almost 40% of the people in North Korea, especially in rural areas, do not have access to clean drinking water and many lack safe sanitation facilities. As a result, the risk of illness is high and diarrhea is still one of the top causes of child deaths.

Lactating and pregnant women are particularly affected by the food crisis and water shortages. They lack necessary nutrients and cannot meet the needs of their children, who then often end up chronically malnourished as well. This cycle of malnourishment has disastrous effects as consequently children are often stunted – a severe health impediment that is even more likely to hit girls than boys. Additionally, existing health facilities lack life-saving medicines and equipment. With many mothers giving birth at home with no medical support, the maternal mortality ratio remains high.

The geopolitical position of North Korea has major impacts on humanitarian work in the country. Organizations struggle to deliver aid supplies since there is little funding and no banking channel for humanitarian transfers. Access for international media is hardly ever granted – resulting in a lack of up-to-date data, coverage and public awareness.

Kenya is a popular tourist destination and is well known for breathtaking landscapes and wildlife. But climate change is heavily and continuously showing its impact on the East African country. Kenya has been facing droughts in recent years, with the most severe hitting the country in 2016/17. Scientists found that the probability of such a drought has doubled because of human-made climate change raising sea-surface temperatures. In 2019, rainfall was at least 20% below average, leading to a prolonged drought and adding to consecutive failed harvesting seasons that destroyed livelihoods and diminished the ability of communities to cope. In western Kenya, the long rainy season has been the driest on record.

This directly affects the nutrition situation in the country, which remains alarming. More than 1.1 million people live without regular access to food and more than 500,000 children under five are in need of treatment for malnutrition. Continuing dry conditions across Kenya have led to the deterioration of livestock and crop productivity, higher food prices and a decrease of water. Agricultural production has halved according to estimates. When there is not too little rainfall, there is far too much: heavy rains displaced tens of thousands of people during the fall months and destroyed farmland and livestock. This worsened an already dire food situation in the country.

Adding to this, conflicts over waning resources in the shadows of the climate crisis are already a reality. Tensions between communities are rising as the competition for scarce resources such as land and water intensifies.

The climate extremes exacerbate existing inequalities, vulnerabilities and negative gender norms. Girls face particular risks, including child marriage. While women and girls are suffering disproportionately, they also bring unique experiences and skills as active agents of change and first responders. CARE is trying to harvest their power in community resilience when it comes to disaster risk reduction, climate change and resilience-building strategies.

Significant needs for food, livelihood support, water, sanitation, health and protection exist in drought-affected areas in Kenya. In 2019, CARE reached more than 660,000 disaster-affected people with life- saving supplies and more than 1.1 million people to support their food and nutrition security as well as resilience and adaptation to climate change.

Burkina Faso has been marked by years of protracted political instability resulting from security challenges, a power vacuum, weak governance and the presence of armed groups. Additionally, the country is extremely poor and suffers from high levels of economic inequality and agricultural deficits largely due to insecurity. Burkina Faso remains vulnerable to climatic shocks related to changes in rainfall patterns and faces an acute food and nutrition crisis. This is a direct result of a major drought, which affected the Sahel region in 2017/18.

Unfortunately, the situation has been deteriorating since late 2018 when violence escalated in Central Sahel. Armed attacks and insecurity are an everyday reality in parts of northern and eastern Burkina Faso. Around 5.2 million people – more than a quarter of the population – are affected by this crisis. An average of 30,000 people per month were driven from their homes in 2019.

The conflict has caused mass displacement and disrupted the livelihoods of more than 486,000 people, a six-fold increase since the beginning of the year. This affects both displaced and host communities as access to food and livelihoods is becoming more difficult and resources are stretched. Areas affected by violence show high levels of food insecurity and malnutrition. To make things even worse, almost 2,000 schools were unable to reopen due to insecurity. A total of 71 health facilities were closed and 75 provide only limited services. This affects more than 880,000 people.

Overall, around 1.5 million people in Burkina Faso needed humanitarian aid – protection, food and livelihoods assistance – in 2019, and this number is expected to rise to 2.2 million in 2020.

The risk of experiencing gender-based violence, sexual assault and rape is elevated, especially for displaced women and girls due to a lack of security in settlements. These incidents often go unreported. Furthermore, child marriage is widespread in Burkina Faso, with one in two women (51%) married off before the age of 18.

CARE supports communities in Burkina Faso with water, hygiene, sanitation, food and tools to adapt to climate change. In the long term, CARE also focuses on conflict prevention, peace-building and women’s inclusive participation. We reached more than 400,000 people in 2019.

Ethiopia faced multiple challenges in 2019: there was a drought in the eastern and south-eastern parts of the country, localized flooding, as well as the significant humanitarian and recovery needs of internally displaced people, refugees, returnees and host communities.

Across the country, 84% of all families live in rural areas and depend on subsistence farming. The country faces recurrent droughts and severe land degradation in many areas, which exacerbates the extreme poverty. Humanitarian needs like health, water and food assistance mostly arise from natural hazards, particularly drought and flooding. Several consecutive years of drought in southern and south-eastern Ethiopia have worsened the food security situation and disrupted the livelihoods of hundreds of thousands of farmers. About 7.9 million people suffer from a serious level of malnutrition, particularly pregnant and lactating women, infants and the elderly. Localized flooding worsens the hunger situation. People’s livelihoods are at risk due to crop losses, livestock diseases and displacement. In 2019, about 200,000 people are estimated to have lost their homes.

Ethiopia is one of the world’s most drought- prone countries; unpredictable rains and in some years the complete failure of seasonal rains are linked to climate change. While the country contributes only 0.27% to global emissions, it suffers extremely from the impact of the human-made climate crisis.

Overcrowded shelters in displacement and return areas in combination with lack of access to basic services have increased the risk of gender-based violence for women and girls. Many resort to desperate measures such as survival sex to be able to cover their most essential needs. Women and girls affected by the drought also face an increased risk of sexual violence when fetching water or collecting firewood.

CARE has been working in Ethiopia since 1984. In 2019, we reached 684,000 crisis-affected people with life-saving humanitarian assistance and projects to increase food security and resilience, nutrition and access to water. CARE is also working to increase awareness of climate impacts and to improve people’s capacity to respond and adapt their livelihoods so they can better deal with the immediate and long- term implications of climate change.

The crisis in the Lake Chad Basin has many faces: 10 years of conflict and violence, poverty, hunger, displacement and the sinking water levels of the lake have led to nearly 10 million people in need of humanitarian assistance.

In Chad, about 657,000 displaced are in need of help. In addition, thousands of refugees from the Central African Republic and from Sudan have sought refuge in Chad. Their prospects of returning remain restricted since the safety situation in their home countries continues to be fragile. The burden of displacement does not only pose exceptional challenges to the refugees but also puts strain on host communities.

In neighboring northeast Nigeria, chronic under-development and poverty persist. Insecurity has led to waves of mass displacement and continues to impact humanitarian operations. At least 20 aid workers have been killed in northeast Nigeria since the beginning of the humanitarian response in 2016. Recent surges of armed violence caused 40,000 people to flee to Cameroon. Many of them were forced to return, which violates the principle of voluntary return. Displacement rates reached a new peak with 2.5 million people displaced.

Another threat for the suffering population is the worsening food crisis. In Cameroon, Chad and Nigeria, there are almost 3.4 million people with irregular access to food at crisis and emergency levels. In Chad, the number of malnourished people increased by 29% in 2019 compared to the year before, and by an alarming 59% for children during the lean season. In Nigeria, 3 million people are food insecure, an 11% increase since October 2018.

One reason for the critical situation in the region is the shrinking of Lake Chad as a consequence of climate change and exploitation. The lake once served the people as a source of life for fishing or as watering fields. Today, the lake has only one- tenth of its surface area left.

Due to limited access to clean water, lack of hygiene and low immunization coverage, diseases and epidemics such as measles, cholera, hepatitis E and malaria spread rapidly. Combined with a dysfunctional health system, the consequence is a mortality rate of 133 per 1000 people; one of the highest worldwide.

Pregnancy and childbirth are life-threatening in the Lake Chad Basin, with maternal deaths accounting for 45% of all deaths of women aged 15 to 49 years. Marriage of under-aged girls is widespread and sexual violence as well as exposure to trafficking and other forms of gender-based violence is rampant because of the armed conflict.