Malnutrition among children younger than five is a silent emergency in Djibouti, where a survey conducted in 2006 showed malnutrition rates well above the emergency threshold, the United Nations Children's Fund (UNICEF) said.

"The situation is alarming," Aloys Kamuragiye, UNICEF representative for Djibouti, told IRIN on Wednesday. "It is a silent emergency which calls for a humanitarian response. People can become complacent about it probably because there is no war in Djibouti."

The 2006 Multi-Indicator Cluster Survey attributed the poor nutritional status of Djibouti infants and children mainly to frequent droughts, high unemployment and food prices that were beyond the means of most poor people in urban and rural areas.

One of the most striking findings was that the global acute malnutrition rate had risen to 20.4 percent compared with 17.9 percent in 2002, and severe acute malnutrition was 7.1 percent, against 5.9 percent in 2002. The UN World Health Organization (WHO) considers a global acute malnutrition rate of 15 percent critical.

Kamuragiye said a national nutrition project launched in February 2006 by the government and its development partners had helped reduce mortality rates among the severely malnourished from 11 percent to 6.7 percent within that year through therapeutic and supplementary feeding programmes.

"What we did was to help avoid death. But this kind of intervention does not reduce vulnerability. You have to also attack the underlying causes of malnutrition," Kamuragiye said, noting that a sound food security policy encompassing recurring drought and poverty was needed.

The government has set up a national committee that was formulating a national food security policy with the help of UN and donor agencies, he said.

"Severe drought, together with higher staple food prices, created significant food deficits in rural areas, and higher unemployment rates in urban areas reduced the purchasing power of urban poor households," noted the survey, by Djibouti's Ministry of Health and the Department of Statistics and Demographic Studies with support from UN and other agencies.

"The decline in dietary intake combined with poor water and sanitation conditions and poor healthcare contributed to the increase in rates of malnutrition," said the Famine Early Warning Systems Network (FEWS Net), which carried a summary of the survey's report.

"The high rates of stunting [32.2 percent] are evidence of chronic food insecurity," it added.

According to the survey, pastoral livelihoods had declined because of successive droughts, and would take several years and intensive asset-building programmes to recover.

Two-thirds of Djibouti's estimated 800,000 people live below the poverty line; 10 percent live in extreme poverty. The 60 percent unemployment rate is a major factor influencing food insecurity in urban poor households.

More than 85 percent live in urban areas where competition is fierce for limited opportunities in casual labour and petty trade, the principal sources of income for poor urban households, according to the survey.

It estimated the infant mortality rate in urban areas in 2006 at 67 per 1,000 for all children. For infants living in urban areas, the mortality rates is 68 per 1,000 compared with 54 per 1,000 in rural areas. The survey put the national under-five mortality rate at 94 per 1,000.

Malnutrition was highest among children aged 12-23 months, mainly because that was when a lot of children are weaned from maternal milk and exposed to contaminated water, food and environment.

Data for the survey was collected at the height of the 2006 drought and the peak of the hunger season, when household food security was at a critical level, especially in rural areas, and the quality of water was poor, increasing the spread of water-borne diseases.

In urban areas, the data was collected during the summer months when the purchasing power of poor households is normally low because casual labour and petty trade opportunities are limited.

Since the data was collected, adequate rainfall in rural areas where the malnutrition rates were the highest has improved livestock conditions and thus improved rural food security.