Historical accounts of famines in Ethiopia go as far back as the 9th century, however, evidence on its impact on health only started to emerge from the 15th century onwards. Unfortunately, famine has been endemic in Ethiopia in the last few decades. The 1973 famine is reported to have claimed over 300,000 lives. In 1985 approximately 10 million people were reported to be starving, with approximately 300,000 already dead and about 1,000 dying daily. In the following years, droughts leading to food shortage have had local and national adverse health effects, in particular in 1999/2000. This paper describes the initial findings of a literature review of evidence on the health impact of droughts leading to famine in Ethiopia and highlights gaps in knowledge. The key finding, thus far, is the marked paucity of health impact data. This review also highlights the fact that adverse health impacts of famines are probably complex and long lasting. Interpretation of any health impact data is difficult as there are few baseline data to compare. Health effects also impact livelihoods. Livelihood disruption following famine does not just affect one generation but also subsequent generations. Surveillance systems are needed so that records of the health impacts of a drought that leads to famine can inform action. With climate change bringing increased likelihood of drought and famine in some parts of the world, the findings of this review could be beneficial not just for Ethiopia but also elsewhere.
drought; famine; Ethiopia; surveillance; health impacts
Ethiopia is a developing country (Figure 1) which has had more than its fair share of droughts leading to famines in recent memory. It was for this reason and a pressing need to learn from previous natural disasters especially in view of global climate change, that Ethiopia was selected for this review.
More than 85% of the population of Ethiopia depend on agriculture as their primary source of income.1 Ethiopian agriculture is reported as being dominated by a subsistence rain-fed farming system (Figure 2), which could leave the livelihoods of those who depend on it vulnerable to climatic conditions. Adverse climatic conditions such as droughts have caused major fluctuations in agricultural and economic growth, rendering the country one of the poorest in the world. The largest group of poor people in Ethiopia is small-scale farmers. The impact of adverse climatic conditions has been exacerbated by the improving, yet still, underdeveloped farming technology, transport and communication networks and environmental degradation (Ethiopia has one of the highest rates of soil nutrient depletion in sub-Saharan Africa).1 The country is reported to be currently only irrigating 5.8% of its irrigable potential with plans to improve this capacity by 2010.1 In 2007/08, only 59.9% of the population had access to safe water and coverage with latrines was just 37%.2
Pankhurst reported that historical accounts of famines in Ethiopia began in the first half of the 9th century.3,4 Between the 9th century and the 1984/85 famine, there were over 20 reported famines. However, Pankhurst stated: '...prior to 1888, the character and paucity of evidence makes a detailed assessment of Ethiopian famines and epidemics impossible.'3,4 (Table 1). Of the famine of 1888-1892, Pankhurst gathered evidence from around 100 different sources including diplomatic reports, personal accounts, traditional Ethiopian chronicles and interviews of eye witnesses.5 He stated: '...food prices rose by about thirty and forty fold, with the consequences of the starving scratching the ground for roots, ground old cowhides into powder for soup, ate animal dung and carrion and that cannibalism was not unknown.'
During this famine, it is estimated that a third of the population perished. Pankhurst describes the long-term impact of this event as serious, citing 'displacement of populations through migrations, the collapse of traditional institutions and subsistence in agriculture and long-term disruption of the traditional balance in relations between sectors of society' as some of the consequences. …