Anatomy of a Famine

When the worst drought in 50 years struck in 2010 and threatened its people with famine, Somalia, the world's most failed state, was in no position to handle the crisis on its own. The country hasn't had a functioning central government since 1991, and much of its territory is under capricious warlord rule, including by the Islamist militant group, the Al-Qaeda affiliate Al-Shabaab.

Effectively a ward of the international humanitarian community, the desperately underdeveloped country has received periodic emergency food aid in the past, but Al-Shabaab has made Somalia the most dangerous country in the world for aid workers-two-thirds of those killed in 2008 worldwide died in Somalia. The World Food Programme pulled out.

Chronic hunger conditions deteriorated. As a telltale torrent of desperately hungry people moved to refugee camps in neighboring countries, there were more than the usual complicating circumstances. "There was a kind of perfect storm of very bad conditions-climactic, political and security and many other things-at just the very point when we should have been focused on this, other things were happening, the Arab Spring and other big news events," explains Courtland Robinson, PhD '04, associate professor in International Health and deputy director of the Center for Refugee and Disaster Response.

The result was that the global relief community failed to act promptly, leading to a largely avoidable tragedy. Robinson and a London-based colleague have studied the consequences of that failure, and the results are a stunning indictment: an estimated 258,000 lives were lost, a figure that at least equals the toll from the last famine Somalia suffered more than 20 years ago. "An estimated 4.6 percent of the total population and 10 percent of children under 5 died in southern and central Somalia," noted the May 2013 report.

"The numbers that we found were beyond what anybody had predicted," says Robinson. Previous estimates were orders of magnitude smaller, in the tens of thousands. But this study found that the famine, at its most savage peak, was claiming 20,000 "excess deaths" each month-above and beyond an already high baseline mortality rate.

"That the needless hemorrhage of human lives took place again in the Horn of Africa in 2011, in spite of all our knowledge and all our experience, is an outrage," said Jan Egeland, UN emergency relief coordinator 2003-2006, echoing the sentiments of many.

Robinson, who has researched other famines, including in North Korea (where official denial of famine is still intact), primarily worked out the demographic denominators for the study-that is, the total population of Somalis (non-displaced, internally displaced and refugees in other countries) exposed to famine mortality risk. This complemented the work of the study's main author, Franchesco Checchi, at the time in the London School of Hygiene and Tropical Medicine (now at the Save the Children, UK), who processed data from hundreds of surveys to calculate baseline and excess mortality rates for the different populations of displaced and non-displaced Somali populations. The study, released in May (which made headlines in Europe but barely a blip in the U.S.), has helped fuel anger and frustration among humanitarian professionals trying to understand how they failed-once again.

There was a kind of perfect storm of very bad conditions—at just the very point when we should have been focused on this.

After decades working in this region, the international relief community is in a position to do far better. A key part of its extensive infrastructure are two early warning systems, set up almost 30 years ago, by USAID and the UN's Food and Agriculture Organisation (FAO). The monitoring systems offer detailed on-the-ground assessments (down to current market prices of red sorghum) to help spot probable conditions three to six months ahead.

The increasingly sophisticated monitoring networks (Famine Early Warning Network and FAO's Food Security and Nutrition Analysis Unit for Somalia) worked as intended. Beginning in August 2010, their technical experts started issuing warnings that grave conditions were worsening. Some relief efforts got under way but were hampered by local conflicts and uncertainty about the severity of food insecurity, according to Robinson. After a famine was officially declared in July 2011, the international community's ensuing operations were impressively effective and helped to save many. By the time, the famine was declared over in April 2012 a quarter-million Somalis had perished.

Exactly why that happened continues to haunt those who take seriously the wealthy world's obligation to help their fellow humans to avoid the age-old curse of starvation, and the myriad diseases that opportunistically ride on top of such blows. Some criticize the process of determining a famine that is occurring as too technical-not sufficiently open to strong, earlier anecdotal evidence-and flawed by relying on some lagging indicators, such as mortality, that take months to show up in the data. "I think we need a different metric because mortality doesn't always happen early, and it's hard to measure quickly enough," says Robinson.

Others insist the process-which relies on the Integrated Food Security Phase Classification (IPC) scale-is still the best now available means of achieving an internationally accepted determination of famine, which should then galvanize unreserved global action.

Chris Hillbruner, one of the key technical experts involved in determining when famine level has been reached, insists a declaration could not have been made earlier in this instance. But he quickly adds: "A response to an emergency like this should not require a declaration famine. If you wait until a famine declaration to respond, you will always be late-food insecurity deteriorates over time and you have got to respond earlier on."

Just why this happened is not clear and was probably due to a complex convergence of factors. The global economy was still in recession. The Arab Spring and the Japanese earthquake/tsunami were grabbing headlines. "Somalia fatigue" and concern about running afoul of U.S. anti-terrorism statutes likely played a role as well.

But there is also a nagging sense that, as Robinson says, "we took our eye off the ball." That has practitioners on the front line calling for reforms that will further depoliticize the process and secure more upfront donor aid commitments that can be tapped without waiting for key capitals to deliberate each time there is a crisis.

Luca Alinovi, a leading Somalia expert, has suggested (along with FAO colleagues) that major donors and UN agencies should agree to "Ulysses Pacts" that would irrevocably bind major donors to future assistance to help vulnerable populations. Key aid personnel, he adds, should be accountable for achieving measurable results with a "specific measure of recourse" for failures, including being dismissed from their posts.

It seems unclear-perhaps unlikely-that the big power players are going to sign up for this. "I am not that optimistic that we will never again have a famine as severe as this, with the kind of mortality that we believe occurred, that we'll fix this for the next time-there are just too many factors that will conspire against this, again possibly, sadly, even in Somalia," says Robinson.

Still, he hopes the study might help promote a better understanding of what happened in Somalia and forge a new international resolve of "never again!"