Hargeisa, Somalia — Chatting, laughing, crying, and coughing, several hundred children herded by anxious mothers crowd together in the shade of a tree just above a dried-out riverbed.
Only barely do its leaves provide relief from the merciless midday sun that beats down on this parched semidesert landscape. Hardly noticeable in thsi black throng of faces, some eager, others dismayed, two female relief workers ladle out carefully rationed cups of protein-enriched milk from large yellow containers.
As each child files past, egged on by its mother or older sister, a volunteer Somali student from Mogadishu checks a numbered band tied around the child's wrist and registers it in a grimy school notebook.
Just over three months ago, refugee children at Camp Agabar, a one-and-a-half hour drive by Landrover truck from this dusty provincial town, were dying at the rate of 20 a day from malnutrition and disease.
"We had almost no food to give them," said Australian nurse Cecilia Liddle of the Roman Catholic Institute for International Relations. "They were as thin as sticks and all we had was a bit of rice."
Some analysts contend that the refugee problem here in Somalia is as great as anywhere in the world -- perhaps even greater than elsewhere -- in terms of numbers of refugees in dire need. They include Indochina in their reckoning.
The total figure in Somalia may run as high as 1.5 million hungry and homeless people.
Recently, however, conditions have begun to improve. Food supplies, which are brought by raod from the Somali port of Berbera on the Indian Ocean, have become more regular, although they are still woefully inadequate. So have badly needed medical deliveries.
In particular, relief workers were able to start supplementary and therapeutic feelings four times a day in early May for young children, to give them the vital nourishment they would lack if forced to survive solely on camp rations.
As a result, the death rate for this camp of 94,000 ethnic Somali refugees, 90 percent of whom are women and childrend from the war- and drought-stricken Ogaden region of Ethiopia, has been reduced from about 20 to roughly 4 a day.
"This does not mean we have licked the problem," noted Dr. Ahmad Magan, one of the three doctors running a makeshift health center consisting of six communal tents and a dried-mud central building. "We are just one step ahead of disaster. Above all, we must prevent acute malnutrition."
Faced by a number of diseases, doctors in three camps recently visited by this reporter complain that they still have severe shortages of drugs.
"Up till now it has really been a question of survival of the fittest," said one European doctor. "Malnourished human beings are simply more vulnerable to disease. In the long run, prevention is the best medicine." More food, and above all more hygienic conditions, are threfore necessary.
This is what supplementary feedings now are trying to improve. Already the children, although still emaciated, have become more resistant. But a great concern remains that present food supplies, too limited to permit emergency stocking, might suddenly break down.
"Any serious delay in food distribution could bring us back to square one," warned a coordiantor for the United Nations High Commissioner for Refugees (UNHCR). Apart from a lack of food, one of the most hazardous problems faced by relief officials is how to provide enough clean drinking water.
Traditionally, nomads, like the majority of Somalia's refugees, travel in small groups. During the dry season they dig holes in riverbeds to obtain water. Almost all of Somalia's 26 refugee camps have been established along rivers. But their sheer numbers, roughly 725,000 today, are simply too vast to be provided with an ample supply of water in this manner.
Only a few weeks ago, OXFAM, the British volunteer relief agency, tried to bring fresh water to Agabar from a nearby spring by laying down pipes in order to save camp women the time and energy of having to make the one-mile trip several times a day.Work was almost complete when a freak rainstorm turned the riverbed into a surging torrent and carried away the pipes.Relief workers now have begun relaying the pipes.
Similarly, at Las Durive, a recently founded camp eight miles away, OXFAM has begun digging new wells.
Refugee officials regard bad water as the prime source of poor health conditions.Since no latrines are available, refugees tend to use the open savanna scrublands around their camps instead. This is considered acceptable under normal nomadic conditions.
But when thousands of human beings within a concentrated camp area are involved, human waste can provoke serious problems.During the dry season, solarization tends to neutralize a certain degree of such waste products, but they still attract plagues of flies.
Furthermore, during the monsoon period, rain waters can contaminate water supplies and lead to outbreaks of disease. In an attempt to reduce such dangers , World Vision, an American-based volunteer organization, has launched several programs at Las Durive.
"We are trying to teach the refugees to be more hygienic," said Indian dr. Sri Chander, "but this takes time." For example, World Vision has been trying to encourage women to boil water for drinking.But this is easier said than done. Firewood is scarce and the arid bushlands around the camps already have been denuded for miles around. Wood foraging expeditions often last all day. This reporter came across refugee women collecting wood up to 10 miles from the nearest camp.
Relief officials also have ordered insecticides to reduce the fly problem. Most of the older camps, such as Agabar, were established in a haphazard, disorganized manner. Tukuls, or huts built out of wood, reed, cardboard, and tarpaulin coverings, were simply placed wherever convenient.
This has caused innumerable difficulties for relief coordinators. Not only has it created problems in the distribution of food, but it also has seriously hampered the ability of health officials to carry out systematic medical checks.
Newer camps, like Las Durive, which now has more than 25,000 refugees, bear some semblance of planning. The tukuls, all constructed according to camp design by the refugees themselves, have been laid out in neat rows along the stony ground and have been divided up into sections of 400 families each.
Each section has its own health center and camp committee. Food supplies are distributed directly to these committees in order to prevent riotous food scrambles.
Only recently has a degree of long-term organization been brought to Somalia's inundation of refugees. Although many observers have praised the Somali government's willingness to cooperate with the international agencies, strong criticism has been leveled against the UNHCR for not having anticipated such a massive influx of refugees and for reacting too late.
It was only in December, 1979 that a UN inter-agency committee, acting on orders from Secretary-General Kurt Waldheim, actually carried out an in-depth investigation of the Somali problem, despite repeated previous warnings from members in the field.
Furthermore, some relief coordinators have suggested that transit camps along the Ethiopian border be used not only as staging points but also as processing centers and medical checkup points for the refugees.