Famine always takes youngest first One in four under age of 5 said to have succumbed

December 08, 1992|By New York Times News Service

MOGADISHU, Somalia -- A year ago, 5-year-old Mohammed Abukar lay on his back in a decrepit hospital yard, his right leg newly amputated after a shell blast in the war that killed his family.

With only his grandmother to look after him and a famine looming, the prospects of survival were dim for the bright, brown-eyed boy with an engaging smile.

Last year, he lay outdoors in the heat, swatting flies with a piece of cardboard. Yesterday, on the anniversary of his operation, a smiling Mohammed loped around with his friends, helped by a steel crutch clamped to his arm.

But children Mohammed's age and younger are rare in Somalia today. Famines always take the youngest first, and in the past year, this famine has killed one in four Somali children under the age of 5, according to the French agency Doctors Without Borders.

And when a relief operation led by U.S. troops arrives, the Americans will find even bleaker conditions in rural areas, as well as doubts about how much good can be done after months of devastation.

"Somalia has lost part of a generation, that's for sure," said Sam Toussie, an epidemiologist with the International Medical Corps who has worked in Somalia for more than a year.

In the camps for the rural displaced in Baidoa, a bush town 150 miles west of Mogadishu, as many as 70 percent of children under 5 have died since May.

So few were spared that the Centers for Disease Control in Atlanta found it impossible to conduct a reliable assessment of the nutritional condition of the remaining children.

"Only 8.9 percent of the surveyed population was under 5 years old compared to 20 to 25 percent for most developing country populations," said a report the CDC issued after a visit to Baidoa in November.

In Baidoa, the weakest already have perished. So many children have died that the 50 to 60 lives that were lost each day in the past month have been adults who were killed by disease, not hunger.

Baidoa will be one of the centers for the U.N. operation led by American troops, but the studies and the absence of babies and children in the streets and camps and fields are leading some Somalis to say the Americans are coming too late.

In the ravaged rural areas, the aid operation will be critical in helping rural families grow healthy enough to return to their land in time for the next crop cycle, Mr. Toussie said.

If farmers were ready for planting next May, their livelihoods would improve, and self-sufficiency would bring on a problem of another kind.

During a famine, women's fertility drops to almost zero, Mr. Toussie said. But if conditions improve sufficiently, Somali women who in normal times tend to have as many as eight or nine children would start to give birth again, he said. After such a bleak period, the number of young children would suddenly expand, creating a new crisis.

"Then you get an imbalance in the population because of a very high number of small children after a famine," he said. "You have a large pool of young children under a year who will need more immunizations. In an underdeveloped country like this one, they become especially vulnerable to disease, measles, for example, because the poor medical services can't cope with the volume."

His prognosis for the surviving children was hopeful. "Lots of studies will be done on the psychological effects of war and famine on the surviving children," Mr. Toussie said. "In fact, they are amazingly resilient."

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