NAIROBI, KENYA – The year 2011 was not good for women such as Joan Ochieng. Just about everything was a struggle.
"We were not treated fairly," the Nairobi resident and single mother said of life in 2011, noting the many pressures, including spiraling food prices that caused her and her family of four children and one grandchild to often go to bed hungry.
When things like rice doubled in price in six months, a bowl of porridge was often the only salve in a day in which eating three meals was almost unheard of. Even eating two meals was often a rarity.
That was not good for a woman who must also take anti-viral medicines for treating HIV. Such treatment can be debilitating on an empty stomach, and it caused Ochieng to shake and experience nausea.
These factors left Ochieng, 41, who lives in the Kiamaiko section of Kenya's capital city, pessimistic as the new year began.
"It's out of our control," she said, "it's up to God." It also made her angry that the experiences of her and other poor Nairobi residents do not seem to be a priority for Kenyan politicians – nor for the larger world.
Humanitarian agencies struggled in 2011 with raising funds and sustaining public interest in the Horn of Africa food crisis, which affected about 13 million people in varying degrees.
Worst hit was Somalia, and international agencies such as the World Bank have warned that as many as 750,000 Somalis are still vulnerable and could die from hunger-related causes through the first few months of 2012.
The humanitarian response by international agencies, many with Church ties, saved lives, particularly at the refugee camps in Dadaab, Kenya, across the border from Somalia.
The East African nation has been on high alert in recent months because of its military response to threats from the radical Somali Islamic group al-Shabab.
In the midst of these crises, the quieter, less-visible experiences of those like Ochieng and others who live in Nairobi and in other urban centres in the Horn of Africa, like Addis Ababa, Ethiopia, have been ignored. That worries social service workers in the region.
More than half of those seen at the Catholic-supported Baraka health centre in Nairobi, many of them children, require some kind of food supplement now.
"People are simply malnourished," said Rose Omia, a Baraka social worker.
Unfortunately, the current food crisis – which was set off by the jump in fuel prices early in 2011, causing a ripple effect through the region's food chains – touches upon nearly everything else.
Many of Baraka's patients are already fighting HIV and tuberculosis, said Elizabeth Njoki Mwai, Baraka's project coordinator. Malnutrition only puts more strain on a body trying to fight HIV and tuberculosis.
"We often hear people say, 'I have not taken food in two or three days,'" Njoki Mwai said.
Such situations do not exist in a vacuum, of course; most of those living in Nairobi's slums, like Ochieng, do not have permanent employment; they have "casual jobs" where income is sporadic – so that when a food crisis hits, eating the basics becomes sporadic, too.
In such an environment, the pressures on women become particularly acute, Omia said. She and other health workers have seen a rise in teenage pregnancies recently as young women accept food in exchange for sex. Increased HIV rates are likely to result, as well, she said.
"When your stomach is full, you can say 'no,''' Omia said of unwanted sexual relations or pregnancies. "But if you're hungry, you'll do anything. You are reduced. Your dignity is really lowered."
Any humanitarian crisis "will affect women more than men," said Dr. Dehab Belay, an HIV/AIDS specialist with Catholic Relief Services' Ethiopia program, based in Addis Ababa.
When there are regional or national traumas like drought, men in rural areas leave to find work and leave behind women and children, Belay said. But when men do not return, women are forced to look for work that causes them to migrate to the nearest town.
Begging becomes one way to cope; another is to become a sex worker. Many experience a downward spiral that can often end in death on the streets.
"Women don't have ownership of land, so women are already economically disadvantaged," Belay said. But even at the level of household economy, women and girls are the last to eat.
"What is offered first goes to men, what is left goes to the child," Belay said of family life when men are still within the household. "Sometimes the mother doesn't get anything."
"It's not fair," she said. "It's not fair."
Of course, nothing is fair in a humanitarian crisis. Ochieng notes that when she is sick and cannot work, something terrible awaits her children and grandchild. "My family doesn't eat at all."