04.06.95 - 07.06.95

Asmara, June 1995

INDEX

Introduction 1

Aims of the mission 1

1) Meeting with the Manager of the Alighider project 2

2) Visit to the structure of the guesthouse 2

3) Visit to the structures of the common office 2

4) Visit to the structures of the school 3

5) Visit to the villages 3

5.1 Visit to villages 9-11 3

5.2 Visit to village 10 3

5.3 Visit to village 8 4

6) Visit to the structures of the project 5

7) Visit to the clinic of Alighider 5

8) Execution of the farm’s rehabilitation works 6

9) Medical-sanitary situation in the project’s area 6

9.1 General data 6

9.2 Alighider’s clinic 7

9.3 Villages 8

Pictures

Annex 1 Comparative table of the expense items for the 1994-1995 emergency program Gash-Setit ex fighters

Introduction

Participants to the mission:

Dr. Piero Puliti, local responsible of the projects’ activities

Dr. Ghebremedhin Ghebreigzabiher, expert of the DGCS-MAE sanitary sector

Mr. Gian Pietro Testolin, logistic expert of the Asmara’s GSO

Mr. Goitom Ghebrai, surveyor (local personnel) of the Asmara’s GSO

the following program has been carried out:

04-06-95

• Meeting with the Manager of the Alighider Project (Mr. Ghebremeschel)
• Visit to the structures of the Guesthouse
• Visit to the structures of the common offices
• Visit to the structures of the school of Alighider
• Visit to the areas designated for the Housing Project

05.06.95

• Visit to the villages 9, 10 and 11 and meeting with the village’s responsible
• Visit to the structures of the agricultural development project of Alighider
• Visit to the clinic of Alighider
• Visit to the area once occupied by village 8

06.06.95

• Meeting with the manager of the "Alighider" Project
• Visit the provincial hospital of Tessenei
• Visit to the regional hospital of Barentu

Aims of the mission

• Supervision of the initial proceedings
• Verification of the living condition of the newcomers in the villages
• Gathering of the data necessary to the planning
• Study of the soil type in the areas designated to the building of the dwellings
• Gathering of the data concerning the sanitary situation at a local, provincial and regional level

1)Meeting with the Manager of the Alighider Project, Mr. Ghebremeschel

In the preliminary meeting with the Manager of the project "Alighider", the modes and times of the mission have been decided and consequently a program of the field visits has been established.

After a relation on the general situation concerning the ex-fighters arrived in the zone, particular attention has been delved on some urgent problems.

The necessity of making available within short times containers for potable water (with chemical reagents for potable water) has been evidenced as an increase of the diarrheal sicknesses has been registered in the groups of the newcomers (ten containers are expected at Asmara for the 11 June 1995).

With the arrival of the rainy season it will be necessary to provide to the supply of anti-malarial medicines taking due care that they be of the injectable type; as a matter of fact many are those cases where it is not possible to administer medicines orally (vomit).

The Manager has expressed his own satisfaction for the swiftness of the purchase of foods and first-necessity equipment which have allowed a minimum of subsistence to the newcomers. At the same time it has been asked to continue the sustaining action in favour of the ex fighters.

We have been informed that a work-group of the Department of Hydric Resources has started the study for the project of hydric supply in the areas chosen for the construction of the dwellings and that a second group is expected within the next days.

2) Visit to the structures of the Guesthouse

The guesthouse building (see picture in the annex) is in good conditions. Two rooms and a bathroom will be destined to the GSO’s emergency office personnel. Restoration works and fencing will be carried out. The drawings, calculations and cost estimates will be carried out by the surveyors of the GSO of Asmara who will carry out a technical mission as from 12.06.1995.

Visit to the structures of the common office

The building is nearing completion (see picture in the annex). We therefore expect to make the adjoining office functional within 10.07.95 (the co-operation will avail itself of a room of about 20 m^2). Within this date the furniture, appliances and air conditioners will be delivered to us. We have requested the enlargement of the shadowing roof on the front side of the building , due to the particular climatic conditions. Furthermore the hygienic services for the personnel will be built in an area detached from the main building. The drawings, calculations and cost estimates will be carried out by the surveyors of the GSO of Asmara who will carry out a technical mission as from 12.06.1995.

Visit to the structures of the school

Two buildings, made up of 6 rooms, constitute the school structure of Alighider (see picture in the annex). In our opinion the structure is not suitable for the area’s increasing exigencies (see further on the data on the population on the various villages, particularly the increasing number of children). However, only the re-structuring and fencing of the existing buildings, building of bathrooms and the purchasing of desks, forms and small boards for the classrooms, will be carried out, deferring eventual adjunctive interventions which will depend on the availability of funds and on the general planning by part of the Eritrean counterpart. . The drawings, calculations and cost estimates will be carried out by the surveyors of the GSO of Asmara who will carry out a technical mission as from 12.06.1995.

Even if in their emergency situation, the dwelling structures (tents or straw-houses) are kept with dignity and orderly and the fields have an optimal organisation. There is however a situation of extreme emergency as for what is concerning the hygienic-sanitary situation. There are some tanks for the hydric supply which is assured trough tankers but they are not protected and they are not sufficient for the needs.

As primary interventions, tanks for the potable water will be supplied (with chemical reagents for potable water) and more tents will be supplied for the dwelling of the newcomers.

With the arrival of the ambulance and the fencing of the clinic of Alighider an adequate sanitary assistance will be granted until the settlement of the ex-fighters in the new areas destined to the construction of the dwellings. Also, four tents of medium size which will be used for first-emergency will be supplied.

The soil’s examination of the area destined for the construction of the dwellings has revealed that, contrary to what previously communicated to us, there are no problems of any nature whatsoever for the foundations. As a matter of fact it is a soil with abundant presence of sand and silt and of a nature completely different from the subsoil. Foundations 80-100 cm deep , in accordance to the foreseen construction typologies, should give optimum safety warranties. A study to define the planimetries of the villages, the typology of the dwellings and the annexed structures is under way. The study will allow to define the specification for the bid of the project "Housing".

5.2 Visit to village 10 and meeting with the village’s responsible

Even if in their emergency situation, the dwelling structures (tents or straw-houses) are orderly kept and the fields are organised with dignity. In this case too the persistence of a grave hygienic-sanitary emergency situation is registered. (Some tanks are present (cement reservoirs) for the hydric supply granted through tanker, by the are not supplied with adequate protection (the water inside them tends to be infected within short times) and as well they are not sufficient to the needs.

As primary interventions tanks for potable water (with chemical reagents for potable water) and tents for the dwelling of the newcomers will be supplied. With the arrival of the ambulance, the installation of tents of medium size to be destined for first emergency in the village and the refitting of the clinic of Alighider will grant an adequate sanitary assistance to the ex-fighters.

The soil’s examination of the area destined for the construction of the dwellings has revealed that, contrary to what previously communicated to us, there are no problems of any nature whatsoever for the foundations. As a matter of fact it is a soil with abundant presence of sand and silt and of a nature completely different from the subsoils quoted in the housing report of the ERRA. Foundations 80-100 cm deep , in accordance to the foreseen construction typologies, should give optimum safety warranties.

5.3 Visit to the area once occupied by village 8.

The inhabitants of village 8 transferred themselves to village 10 with all the field’s materials, including the dwellings (tucul). There are probabilities that the village will temporarily be used during the crop season as a provisional work field, but it will not be within the emergency program.

The following tables show the data on the actual number of ex-fighters and of their families who will benefit from the project.

Table 1. Group of ex-fighters arrived in 1994.

Table 2. Group of ex-fighters arrived in 1995.

Table 3. Total of ex-fighters and their families settled in the area of the project "Alighider"

6) Visit to the structures of the Project for the agricultural development of Alighider

The infrastructures of the project for the agricultural development of Alighider have been visited and particularly: the mechanical workshop, the buildings for the sheltering of the farm tractors, agricultural equipment and vehicles, the project’s offices (where the new seat of the common office is under construction). The cultivated areas and the large catchment area of hydric reserve for irrigation (built by the italians in the ‘50es) with a capacity of about 10 million m³ have been visited. Rehabilitation works of the catchment area which should grant its utilisation for the next rain season are taking place.

In 1994 2,500 hectares of land have been cultivated, in 1995 6,000 hectares (4,000 cotton and 2,000 sorghum).

To each ex-fighter (man or woman) two hectares are given to cultivate for his own.

For the newcomers the mechanical activities necessary for the cultivation under irrigation are freely granted, for those already settled and who benefit of an own income the use of the machinery is through payment.

The ex-fighters are divided in groups for the work activities and the experts previously formed teach to the newcomers the agricultural techniques necessary to the cultivation.

7) Visit to the clinic of Alighider

The structures of the edifice used as project’s clinic are in good conditions (see picture in the annex).

The building is composed of:

1 ambulatory, 1 medical study, two retreat halls (with 4 hygienic facilities annexed), 1 pharmacy, 1 kitchen, 3 rooms for the personnel and two small rooms actually not utilised.

The personnel is composed of:

1 nurse, 3 sanitary assistants, 1 in charge of cleaning services and 1 guardian.

In accordance with the statistical data supplied by the clinic’s personnel the structure has assisted, during the stretch of the past year, 5,817 out-patients and 278 retreats have been effectuated. The most frequent pathologies are, in the order:

malaria, cutaneous and under-cutaneous infections, diarrheal diseases, diseases of the respiratory apparatus and sexually transmitted diseases.

The Ministry of Sanity periodically supplies the clinic with basic pharmaceuticals sufficient for six months (not all the requested pharmaceuticals are supplied in a sufficient quantity).

The two hospitals of reference are those of Tessenei, which is 9 km away from Alighider, and that of Barentu (114 km).

A plastic container for potable water and a certain quantity of chemicals to obtain drinkable water will be directed to the sanitary structure.

The clinic is already provided with the water distribution network which actually is unusable. Therefore a cement underground reservoir (35-40 m³) will be built, supplied with autoclave or of a system with a container set on the roof which will be supplied by an electrical pump; the system connected to the network will secure current water to the structure.

The living quarters for the medical and paramedical personnel will be built on the model of the buildings for the ex-fighters’ dwellings, in such a way that the 3 rooms actually occupied by the personnel can be used for the sanitary service.

The fencing, partially destroyed, will be reconstructed. In the compound’s inner part a roofing will be built, of traditional typology, for the temporary acceptance of the patients’ kindred and a dwelling for the guardian. . The drawings, calculations and cost estimates will be carried out by the surveyors of the GSO of Asmara who will carry out a technical mission as from 12.06.1995. The clinic will be supplied with an ambulance, for which a purchase tender is already under way, and which will secure a link with the various villages and with the hospital of Tessenei.

8) Execution of the farm’s rehabilitation works.

It has been suggested that the works of restoration and rehabilitation be carried out by a team made up of about 20 ex-fighters who have completed a training period at the Ministry of Constructions, co-ordinated by two surveyors chosen by the GSO. The team co-ordinated by the office of co-operation on site will avail itself, for the execution of the works, of the assistance of the structures and of the personnel of the GSO. The setting up of a on-site committee will be proposed for the administrative management and for the management of the bids, whenever possible on site and for the remaining part in Asmara (the regulations dictated by the DGCS will rigorously be respected and all the documentation will be checked off by the Embassy in Asmara). The same team might subsequently be employed at the side of the building enterprises which will carry out the "Housing Project". The on-site office of co-operation will be responsible for the training for the management and administration (accounting, participation to tenders, purchase of materials etc.) and for the formation "on the job" of two representatives of the group of the ex-fighters.

9) Medical-sanitary situation in the project’s area

9.1 General data

From the medical-sanitary survey carried out by the UNICEF and by the Eritrean Authorities, in 1993, is has appeared that concerning the infant mortality, out of 10 babies born alive one dies within the first year of life and two before reaching the age of five.

Due to a very wanting maternal infant’s assistance the maternal mortality is very high, 710 for each 100,000 born alive.

The infants’ immunisation percentage is low, with a vaccination for polio and measles of 20%, for tetanus and diphtheria of 22%. Only 11% of the babies has a total coverage for vaccination.

Malaria is endemic in great part of Eritrea, particularly in the northern and western lowlands (Smear, Sale, Bark and Gash Setit). More that 85% of the malaria cases are registered between the months of August and December with peaks in the September-November months.

Undernourishment is one of the main causes responsible of mortality jointly with the infective diseases.

Due to decades of years of war, of minefields, draughts and famine the rural zones are those mostly hit by grave sanitary situations. In the rural zones the population that can avail itself of drinkable water doe not exceed 7% and most of it depends on surface wells, pools, springs or rivers. The prevalence of diharreal diseases is mostly due the above mentioned factors and it is the cause of an annual mortality of infants estimated at 14 per 1,000. The use of privies is very limited and available to only 4% of the families.

The Gash-Setit area is one of the poorest zones of Eritrea and sanitary services are very scarce. For a population of about 350,000 individuals there are only two hospitals and 8 clinics and they are, however, in extremely critical situations.

There are no telecommunication nor transportation means except for two ambulances given as gift by the CRIC (in the hospitals of Tessenei and Barentu).

9.2 Clinic of Alighider

The structure used as clinic for the project is in good conditions and it is formed by: emergency service, 1 Opd, two retreat halls (one for males and one for females), with 4 hygienic services, 1 pharmacy, 1 kitchen, 4 rooms used as living quarters for the personnel and 2 small rooms actually not utilised.

The personnel is composed of: 1 nurse, 4 sanitary assistants, 1 in charge of cleaning services and 1 guardian.

According to the statistical data supplied by the clinic’s personnel the structure has assisted, during the last year, 5,817 out-patients and 278 retreats have been effectuated. The most frequent pathologies, in the order, are:

malaria, cutaneous and under-cutaneous infections, diarrheal diseases, diseases of the respiratory apparatus and sexually transmitted diseases.

The Ministry of Sanity periodically supplies the clinic of basic pharmaceuticals, every six months (not all the requested pharmaceuticals are supplied in a sufficient quantity).

The two hospitals of reference are: that at Tessenei (9 km from Alighider) and that of Barentu (14 km).

The Ministry of Sanity plans to raise the clinic of Alighider to Health Centre or to build a new one.

The local Authorities have stressed the necessity to reinforce the basic sanitary service in the area. It has been suggested the formation of 10 sanitary assistants, the rehabilitation of the clinic and its reinforcement through the supply of adequate equipment, the installation of tents and equipment for the formation of centres for emergency care in the villages.

It will be necessary to supply to the assistants under formation a kit of equipment for emergency care.

The building of dwellings for the sanitary personnel will allow the utilisation of the three rooms, actually used as living quarters, so as to increase the bed-places of the clinic.

The clinic will be supplied of: 20 beds, 50 chairs, 3 tables, 2 cupboards, 2 shelves, one electrical sterilizer.

In order to improve the actually wanting hygienic services, it will be necessary to build 4 public baths, one close to the clinic and the other three in the villages.

The morbidity incidence is due, in decreasing order, to:

malaria, diarrheal diseases, cutaneous and under-cutaneous infections, diseases of the respiratory apparatus and snake bites.

There are no communication means, either telephonic or by radio, and it would be opportune to intervene in such direction with the supply of a radio communication system so as to allow a minimum of communication with the central structures (for emergencies, request of urgent interventions etc.).

9.3 Villages

Actually, in the villages, the sanitary assistance is given by 2 sanitary assistants who utilise their straw-house to assist the inhabitants. The cases which cannot be treated are sent to the clinic in Alighider and when necessary to Tessenei, utilising, when available, the project’s cars.

Other 21 sanitary assistants are present in the villages, who can be raised to a superior formation for the assistance of the village’s inhabitants.

The project supplies to the newcomers (1995) food supplies for 4 months, so distributed:

- flour 25 kg,

- sorghum 25 kg,

- powered milk 6 kg,

- oil 1.5 kg,

- sugar 3 kg,

- lentils 9 kg.

The group which arrived in 1994 is self-sufficient and it purchases its necessities with the income derived from the precedent year’s work.

Water is supplied daily from Tessenei or through tankers from nearby wells, which supply some tanks, usually built in cement, placed in the villages and which are easily subject to pollution lacking any protection whatsoever.

The vaccination campaign started a short time ago, up to now a very limited percentage of individuals has been vaccinated among mothers and children.

The most frequent diseases are diarrhea, diseases of the respiratory apparatus, cutaneous and under-cutaneous diseases and old-dated malaria.

With the incoming of the rainy season, in a highly endemic zone, malaria becomes a factor of elevated morbidity and mortality. Hence a specific request for vial and syrup anti-malarial pharmaceuticals has been made.

Dr. P Puliti Dr. G. Ghebreigzabiher T.I. G. P. Testolin.

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