United Nations System
Standing Committee on Nutrition

Nutrition Information in Crisis Situations - Burundi
 

NICS 15, December 2007

Reports of banditry and harassment by FNL elements caused some NGOs to halt activities in rural Bujumbura, including an important nutrition survey scheduled for December 2007(OCHA, 02/12/07).

Outbreaks of cholera were reported in Rumonge/Bururi province, as well as in the southern city of Mvugo in the Nyanza Lac commune. The first cases were reported on November 2nd and by early December, at least 132 confirmed cases were identified. No deaths were reported (OCHA, 02/12/07).

Repatriation efforts continue and figures show that 38,681 refugees have returned to the country since the beginning of 2007, the overwhelming majority coming from Tanzania (OCHA, 02/12/07). Approximately 120,000 refugees are still in Tanzania awaiting return. The Tanzanian government has indicated that they will close all camps in 2008, pushing UNICEF and UNHCR to increase their capacity to integrate returnees. A new joint program by the two organizations aims to help construct houses for as many as 20,000 households as well as build 15 new schools and 15 new pre-schools (OCHA, 12/12/07).

A UNICEF/GoB national nutrition survey was carried out in August 2007. Preliminary results indicate that the nutrition situation is generally under control and has improved since the last countrywide survey in 2005 (UNICEF, 10/07) (figure 6). Comparisons, however, should be made with caution as the two surveys were carried out at different periods of the year. Acute malnutrition rates ranged from 2.4% in Mwaro to 11.5% in Rutana.

Figure 6 Results of Country Wide Nutrition Survey, Burundi (UNICEF/GoB, 08/07)

MSF-B conducted a nutrition survey in the district of Karuzi in April 2007 (MSF-B, 04/07). The results of the survey, while under emergency levels, nonetheless reveal a serious nutrition situation (table 5). Mortality rates were under control. At the time of the survey, MSF-B was in the process of handing over its nutrition activities to the MoH hospital.

Table 5 Results of Nutrition Survey, Burundi (MSF-B 04/07)

NICS 12, February 2007

Floods at the end of last year have affected at least 7 of the 17 provinces of Burundi (IRIN, 09/02/07). The majority of the November and January crops have been affected. This phenomenon has compounded an already fragile food security situation caused by the previous prolonged dry season, the "cassava mosaic virus" and structural weaknesses (FAO-CAUR, 02/07). As of the beginning of 2007, food prices were on the rise and people were relying on coping mechanisms such as the consumption of "hunger foods", reduction in the quantity and number of meals, selling of animals and assets, and migration. An estimated 2 m people, representing 25% of Burundi's population, have been affected (WFP, 06/02/07). WFP has requested US$ 12 m to cover food aid requirements until July. Due to pipeline breaks, reduced rations were delivered at the beginning of the year. The Government of Burundi has put in place a solidarity fund to help flood-affected families (IRIN, 09/02/07).

The last rebel group in Burundi signed a peace agreement in September 2006 (AFP, 19/02/07).

In 2006, about 43,000 refugees returned to Burundi (OCHA, 10/12/06).

Nutrition surveys showed acceptable situations in Ngozi and Ruygi provinces while the situation was average in Kayanza province (ACF-F, 11/06; ACF-F, 01/07) (figure 5). Mortality rates were below alert thresholds. However, floods might have a negative impact on the nutrition situation.

Figure V Results of nutrition and mortality surveys, Burundi (ACF-F, 11/06; ACF-F, 11/06; ACF-F, 02/07)

NICS 8, January 2006

The food security situation has been deteriorating in Burundi over the last few months, mostly due to poor weather conditions. North-Eastern provinces have been especially affected (SAP-SSA, 12/05). Last harvests were below "normal" and food prices have remained high. The food deficit was estimated at 334,000 in 2005 compared to 254,000 in 2004 (IRIN, 17/11/05). Admissions to feeding centres were higher in 2005 than in 2004. Food distributions have been scaled up, with planned distribution for the period of November 2005-March 2006 of double the quantity of the January-November 2005 distribution. Distributions of crops resistant to weather hazards have also been made. Nevertheless, migrations of Burundian to Tanzania have been reported (IRIN, 20/01/06).

Returns of refugees have decreased in late 2005. This might be due to the on-going insecurity because of the FNL activities and to the bad agricultural year. About 68,000 refugees went back to Burundi in 2005, mostly from Tanzania, of whom 66,400 were repatriated by the UNHCR (IRIN, 27/01/06). Pressure from Tanzania intensified at the end of 2005 and restrictive measures such as stopping all refugees from working for relief organisations in the camps, in compliance with Tanzanian law, have been implemented in Kibondo district (IRIN, 30/12/05).

Average nutrition situation at national level

A national nutrition survey was conducted in February-March 2005 (MOH/joint, 09/05). According to the survey, the prevalence of wasting was 6.5% (5.9-7.0), and 0.2% of the children had oedema.

About 45% of the children less than six months old were exclusively breastfed, and 87.5% of the children 6-8 months old were receiving complementary food.

According to vaccination cards, only 29.7% of the 12-23 month olds were vaccinated against measles and 7.3% of the 6-59 month olds had received vitamin A during the previous six months.

A significant proportion of women had an energy deficiency (table 7), while more than 20% of the women in urban areas were overweight. The elderly were especially at risk of chronic energy deficiency.

The survey also revealed micro-nutrient deficiencies: 29.3% of the children were considered vitamin A deficient as they had a blood retinol concentration below 0.7 µmol/l. Moreover, 60.5% of the 7-12 year olds had a urinary iodine excretion of less than 100 µg/l, indicating an iodine deficiency, although among the samples of salt which were analysed for presence of iodine (87% of the families had salt in the house at the time of the survey), 98% was iodised. However, iodisation might have been below the level recommended.

Table 7 Anthropometric nutritional status of 15-49 year olds women and of elderly (> 60 year olds), Burundi, Feb-Mar, 2005 (MOH/joint, 03/05)

Precarious prevalence of acute malnutrition in Bujumbura rural

A nutrition survey was conducted in Muhuta, Mutambu and Mukike communes of Bujumbura rural in November 2005, which corresponds to the hunger-gap period (Concern, 11/05). Bujumbura rural, being the stronghold of the lone remaining guerrilla army (FNL) has known insecurity for years. The survey showed a precarious nutrition situation, although mortality rates were below alert threshold (table 8).

Table 8 Results of a nutrition survey in Bujumbura rural, Burundi (Concern, 11/05)

Overall

Despite political and security improvement, the situation remains precarious in Burundi (category III), mostly due to poor last harvests and continuing insecurity, especially in Bujumbura rural.

NICS 7, August 2005

Elections, which ended the period of the transitional government, ran smoothly and the political wing of the Force for the Defence of Democracy (FDD), a former rebel group, won the majority of seats at the local elections (AFP, 23/06/05), national assembly (AFP, 06/07/05) and senate (AFP, 29/07/05). Pierre Nkurunzira of the FDD was elected president and named a new cabinet composed of a 60-40 ratio of Hutus to Tutsis, in accordance with the new constitution (IRIN, 31/08/05). Nevertheless, the lone remaining Hutu guerrilla army (Front for National Liberation) has continued their attacks in Bujumbura and in western provinces of Bubanza and Cibitoke (AFP, 01/09/05; WFP, 02/09/05).

Repatriation of refugees from Tanzania is under way and the number of returns has rocketed following the elections: 6,000 and 15,000 people returned in July and August 2005, respectively (WFP, 02/09/05). An agreement was signed for the repatriation of about 7,000 Burundian refugees in Rwanda (UNHCR, 19/08/05). As of mid-August, 2,100 refugees had been repatriated.

On the other hand, there have been concerns about forced returns of some 8,000 Rwandan refugees in Burundi (IRIN, 15/07/05).

The food security situation is precarious in the northern province of Kayanza and Ngozi (ACF-F, 08/05). These provinces count the highest number of chronically food insecure households (30% against a national average of 16%). The coffee crop was poor this year and estimated to have decreased by 78% compared to 2004. Moreover, the "cassava mosaic virus" destroyed most of the cassava plants in Ngozi province and bean crops were poor in June 2005. The price of beans rose by 30-40% between June 2004 and June 2005. The number of admissions to TFCs in both provinces was far higher in the first semester of 2005 than in the same period in 2004. ACF recommends that food distributions targeted at the most vulnerable households be implemented, that supplementary feeding centres be fully functional, and that nutrition surveys be implemented in October 2005.

NICS 6, May 2005

New developments in the peace process have recently been achieved. Firstly, the last active rebel group and the government of Burundi signed a peace deal announcing an immediate end to hostilities and the beginning of negotiations for a formal cease fire at the beginning of May 2005 (AFP, 16/05/05). Secondly, the long expected referendum on the new constitution was eventually held on the 28 February 2005 and 90.1% of the voters agreed to the new constitution (IRIN, 07/03/05). As of February 2005, 18,000 ex-fighters had been disarmed, as opposed to 3,000 who had refused to disarm (AFP, 16/02/05).

As of 5 May 2005, UNHCR reported 10,539 facilitated and 808 spontaneous returns since the beginning of the year (OCHA, 12/05/05).

The food security situation has deteriorated as a result of below normal rainfall in 2004 and the spread of the manioc mosaic virus. It has been estimated that 2 m Burundians will be in need of emergency food aid in 2005 (WFP, 16/03/05). Food prices have been on the rise, limiting access to food for the poorest. Northern areas are especially at risk. The 2005A agricultural season is estimated 6% lower than the 2004A season (Minagri, 2005). According to a Vulnerability Assessment Mapping, conducted in summer 2004, 16% of Burundian households are chronically food insecure, 67% are exposed to food insecurity, 11% have stable food security and 5% have adequate food security (VAM, 12/04).

Admissions to feeding centres have risen by the end of 2004, which is a normal seasonal pattern. The increase in the number of admissions was higher than in 2004 (figure 7).

Figure 7 Admissions to therapeutic (CNT) and supplementary (CNS) feeding centres, Burundi (MINAGRI, 2005)

Nutrition situation under control in Northern Kirundo

Parts of Bugabira, Kirundo and Busoni communes have been classified as especially affected by food insecurity. A random-sampled nutrition survey was conducted in these three communes in January 2005 (MSF-H, 01/05). The nutrition situation was considered under control: acute malnutrition was 3.8% (2.6-10.3) including 0.5 (0-1.2) severe acute malnutrition. It is worth noting that the upper confidence interval is high. The mortality rates were at the limit of alert threshold: CMR = 1/10,000/day and under-five MR = 1.8/10,000/day. Measles vaccination coverage was 89%. The prevalence of malnutrition was within the same range as of August 2004. About 6% of the families included in the survey were returnees from Rwanda. It seemed that mortality was especially high among these. This might be partly explained by the fact that contrary to the returnees from Tanzania, returnees from Rwanda do not benefit from free health care.

Overall

Despite positive improvements arising from the peace process, the situation in Burundi is still fragile (category III), especially regarding the food security prospects and the re-integration of the returnees. The situation needs continued careful attention.

NICS 5, February 2005

The peace process has seen delays, with the referendum on the draft post-transition constitution being postponed for the third time (USAID, 31/12/04). On the other hand, demobilisation of former fighters began at the beginning of December, as expected (IRIN, 02/12/04).

More than half of the estimated 280,000 IDPs returned to their home in 2004, especially in the eastern and southern provinces, while people were more reluctant to return to the northern and central provinces (RI, 01/12/04). However, it seems that the majority of the 30,000 IDPs in Bujumbura Rural province have recently returned (IRIN, 21/12/04). This province is still the most insecure area in Burundi, being the stronghold of the only armed force which has refused to take part in the peace agreement. The security situation seems to have improved recently in the province.

A cholera outbreak has occurred in Bujumbura town and Rural. As of 24 January, 153 cases were registered (OCHA, 23/01/05).

About 2,285 refugees from Tanzania have returned to Burundi since the beginning of the year, as of 23 January 2005 (OCHA, 23/01/05).

The food security situation was bleak in the northern part of the country at the end of last year, the traditional hunger-gap season, and especially in Kirundo and Muyinga provinces, owing to a combination of drought and manioc mosaic virus (IRIN, 19/01/05). WFP has intensified its food distribution to the area (WFP, 17/12/04). A greater than usual deterioration in the nutrition situation has also been reported in Ngozi province (AAH, 26/01/05).

NICS 4, November 2004

The elections due to take place in October 2004 have been postponed until early 2005. The new timetable includes local and communal elections in February, legislative elections in March and presidential elections in April (IRIN, 18/10/04). A referendum on a draft constitution, which lays out power sharing for the Hutu and Tutsi at a ratio of 60-to-40, should take place at the end of December 2004 (AFP, 17/11/04; IRIN, 03/11/04). Meanwhile, the transitional government has been extended for six months and the draft constitution has been acting as an interim constitution since the beginning of November. The uncertainty about the election timetable led to hundreds of Burundians fleeing to Burundi and Tanzania at the end of October, in fear of violence (IRIN, 03/11/04). Some of them returned shortly thereafter.

The United Nations Operation in Burundi (ONUB) is currently deployed (ONUB, 02/11/04). Demobilisation of 45,000 soldiers and 35,000 former rebels should begin at the end of November 2004 (AFP, 10/11/04).

More than 80,000 refugees have been repatriated from Tanzania so far this year. It seems, however, that due to the political uncertainties, repatriation has slowed down since October 2004 (OCHA, 07/11/04).

The re-integration of the returnees is ongoing and several programmes have been put in place. Donor's commitments to this process is crucial for the future in Burundi (RI, 04/11/04).

The nutrition situation seems to have been stable over the last months (UNICEF-B, 09/04).

NICS 3, August 2004

The security council adopted a resolution to authorise the deployment of the United Nations Operation in Burundi (ONUB) for an initial period of six months (UNSC, 21/05/04). ONUB will consist of a maximum of 6,650 troops and be authorised to use all necessary means to ensure respect for cease-fire agreements; to carry out the disarmament, demobilisation and reintegration process; to monitor the illegal flow of arms across national borders; to contribute to the creation of the necessary security conditions for the provision of humanitarian assistance; to facilitate the voluntary return of refugees and IDPs; and to contribute to the successful completion of the electoral process.

The FDD (Forces for the Defence of Democracy) became a political party at the beginning of August 2004 (OCHA, 15/08/04). The situation is still tense in Bujumbura Rural province, the stronghold of the FNL (National Liberation Forces) (OCHA, 27/06/04).

As of 15 August 2004, around 67,400 refugees had been repatriated from Tanzania so far this year and an estimated 4,200 had returned on their own (OCHA, 15/08/04).

Massacre of DRC refugees

Following the upsurge in violence in Bukavu at the beginning of June 2004, thousand Congolese sought refuge in Burundi. As of 20 August 2004, it was estimated that 20,000 refugees were settled in three transit camps near the DRC border (UNHCR, 20/08/04).

On 13 August, the Gatumba transit centre was attacked and 160 Tutsi refugees were killed and more than 100 wounded (OCHA, 15/08/04). The FNL has claimed responsibility for the massacre. It is thought that an armed group from DRC also participated in the killing (Reuters, 19/08/04). The border with DRC was officially closed and more UN peace keepers have been deployed on the border and near the refugee transit centres (UNHCR, 17/08/04). The tension between Burundi, Rwanda and the DRC has escalated following the slaughter (AFP, 17/08/04).

Two camps will be settled further inland in Muramvya and Rutana provinces and refugees will be transferred from the border (UNHCR, 20/08/04).

WHO/UNICEF interagency health and nutrition need assessment

An assessment was conducted between March and May 2004 (UNICEF/WHO, 05/04). The mission major findings were:

• Data on anthropometric nutritional status were of good quality, but were principally available for the under five year-olds with some data for pregnant women. No data were available for adolescents and elderly.
• Data on micro-nutrient deficiencies were out of date or not available.
• No clear policy on infant and young children feeding practices has been adopted so far by the government; this would be especially important in the context of HIV/AIDS.
• The inter-sector coordination of nutrition activities is weak; the adoption by the government of the National Action Plan for Nutrition may improve it.
• The integration of the nutrition activities carried out by NGOs during the crisis into the national health system is a priority, and has been designed.
• A community based approach of nutrition activities will also be developed.
• The provision of adequate staffing, of equipment, and of treatment affordable to the poorest is a challenge for the forthcoming years.

NICS 2, May 2004

The security situation is still calm throughout the country, except in Bujumbura rural, which is the stronghold of the FNL (National Liberation Forces), the only rebel movement which has not signed a peace agreement with the government (AFP, 06/05/04; USAID, 14/05/04). Clashes in Bujumbura rural caused the displacement of at least 50,000 persons in April and May (IRIN, 17/05/04). Despite the FDD (Forces for the Defence of Democracy) having signed a peace agreement with the President of Burundi at the end of last year, they have withdrawn from the transitional government, protesting against the slow process in the nomination of governorships, administrators and ambassadors (USAID, 14/05/04).

Internally Displaced Persons

The number of displaced persons settled in camps has halved compared to 2002.

A survey counted about 140,000 IDPs in displaced camps in 2004, compared to 281,000 in 2002 (OCHA, 14/05/04). According to Refugee International (RI), IDPs are vulnerable but receive little attention (RI, 28/04/04).

Congolese refugees

Some 4,500 Congolese refugees were moved from a transit camp near the border to a safer camp in Muyinga province, where 4,000 Congolese refugees were already settled (IRIN, 17/05/04). The Government of Burundi estimates that there are about 40,500 Congolese refugees in Burundi.

Returnees face challenges

More than 40,700 refugees returned from Tanzania so far this year (see map); about 176,000 refugees have returned since 2002 (UNHCR, 18/05/04). However, the return of the refugees raise a number of issues, regarding their conditions of departure from Tanzania as well as their conditions of return. The mounting pressure on Burundian refugees to leave Tanzania camps was denounced by Refugee International (RI, 14/04/04). For about one year, the restriction of movement has been reinforced (see RNIS 42); refugees are not allowed to move further than a four kms radius from the camps. Those who are caught outside this limit are arrested and deported to Burundi.

When they arrive at their destination, returnees face a number of challenges (IRIN, 14/04/04; IRIN, 15/04/04). First of all, housing is a high priority, as most of the refugees’ houses have been destroyed; some housing programmes are on-going. Secondly, they have to get their fields back; in some cases, their lands have been used or sold. It seems that there is an increasing number of disputes over land and an increase in the price of land. The agricultural situation of families who returned one year ago remains critical as compared to families who have not moved. The principal limitations the returnees face are insufficient banana and cassava shoots, exhausted land, loss of revenue from cash crops, little access to agricultural inputs such as fertilisers and tools (IRIN, 14/04/04). On their return, families are highly dependent on their relatives or neighbours, especially for housing and food.

Returnees benefit from a three-month food package, which seems to last less than that because it is shared with the host community or sold to get cash. When their food stock is exhausted, they mainly depend on the host community. Returnees also receive non-food items on their arrival and agricultural inputs if they are registered by the local administration.

Health care and education are other challenges that face returnees but also Burundians who did not move. The health and education system was already stretched before the returnees add a further pressure on the infrastructure. The cost-recovery system has been implemented in most part of the country (see below); it seems however, that returnees can obtain "certificates of poverty" to receive free treatment (IRIN, 14/04/04).

Moreover, Refugees International warns that large-scale repatriation could threaten peace (RI, 12/04/04). According to RI, Burundi is not politically stable enough, the infrastructure is too weak and the UNHCR's capacity to protect refugees is insufficient, for promoting large-scale repatriation.

RI also states that refugee return seems highly-linked with political considerations both in Burundi and Tanzania: the CNDD/FDD in Burundi is calling for the speedy return of the refugees to increase their chance of winning the next elections at the end of 2004. In Tanzania, the ruling party has promised that all the refugees will have returned home before the next election due at the end of 2005 (RI, 12/04/04).

Returnees from Tanzania

Average nutrition situation

The number of admissions to feeding centres since the beginning of the year has been lower than in 2003 (figure 7) (UNICEF-B, 02/04-04/04). The highest number of admissions was in Bujumbura rural, which accounted for about 25% of the whole admissions. Bujumbura Mairie, Bururi, Cankuzo and Muramviya had the lowest number of admissions.

Figure 7 Admissions to therapeutic feeding centres (TFCs) and Supplementary Feeding Centres (SFCs), Burundi (UNCEF-B, 04/04)

High mortality rates and low access to health care

MSF-B conducted a random-sampled nation-wide mortality survey and different assessments aiming at describing access to health care (Bujumbura Mairie was excluded) (MSF, 04/2004). For the purpose of the health surveys, the total population of Burundi was divided in three categories depending on the type of health care they can access. The results of these surveys were appalling; mortality rates stood well above the alert thresholds in each of the area surveyed. CMR were 1.2/10,000/day (0.8-1.6), 1.6/10,000/day (1.2-2.0) and 1.9/10,000/day (1.4-2.3) depending on the area surveyed and the < 5 MR was 3.3/10,000/day (2.0-4.6), 4.9/10,000/day (3.4-6.3) and 3.1/10,000/day (2.3-4.0).

The main cause of death was malaria.

A cost-recovery system was put in place in Burundi at the beginning of 2002; about 80% of the population of the country fell under it, whilst the others have access to health centres applying a flat fee or a cost-sharing system (50% of the price of medicine). The survey revealed that the frequentation of the health centres applying the cost-recovery system has decreased since this system was applied. Moreover, 17% of the population has no access to health care, mainly owing to financial reasons and about 80% of the people who have consulted have been obliged to take on debts for the payment of the consultation and medicines. Patients also tend to wait too long before attending a consultation.

Recommendations

From Refugee International:

• Slow down the repatriation process until the government of Burundi has shown more progress towards addressing key social issues
• UNHCR deploy protection officers at registration and transit centres
• Donor countries make available fund pledged at the January 2004 Brussels' conference for the rebuilding of basic infrastructure

From the MSF survey on access to health care:

• Urgently implement a health care system accessible to all
• Give particular attention to the most vulnerable

NICS 1, February 2004

The peace process is raising hope in Burundi. Members of the Forces for the Defence of Democracy (FDD), a former rebel group which has signed a peace agreement with the President of Burundi, entered a new Government in late November (AFP, 23/11/03). Demobilisation of the FDD’s fighters is also on -going. Moreover, promising peace-talks between the National Liberation Forces (FNL), the only rebel group which has not joined the peace process yet, and the President of Burundi, were on-going in January 2004 (AFP, 20/01/04).
The security situation has improved, except in Bubanza province and in Bujumbura Rural province, where about 10,000 people were reported as having moved in January 2004 (IRIN, 14/01/04).

The number of Burundian refugees in Tanzania who returned to Burundi increased sharply in December 2003, with 6,000 returns (IRIN, 14/01/04). In 2003, according to UNHCR, 37,000 refugees were repatriated from Tanzania and 45,000 returned spontaneously (UNHCR, 20/01/04). It is estimated that around 300,000 Burundian refugees are still living in camps in Tanzania, in addition to about 470,000 refugees settled outside the camps (UNHCR, 20/01/04).

Nutrition situation

A random sampled nutrition survey was carried out in Ruyigi province in November 2003, during the hunger gap (ACF-F, 11/03). The nutrition situation was average (category III) and the mortality rates were under control (see table 10). The prevalence of malnutrition was higher than in March 2002 (see RNIS 39), but this may be due to the hunger gap season.

Table 10 Results of nutrition surveys, Burundi, 2003 (ACF-F, 11/03; IMC, 07/03)

* According to cards and mothers' statements

Two random sampled nutrition surveys were conducted in Kirundo and Myinga provinces in July 2003 (IMC, 07/03). The nutrition situation was under control in Kirundo (category III) but of concern in Muyinga (category II), especially given that the surveys were done after the harvest (see table 10). The nutrition situation seemed worse than in June 2002, particularly in Muyinga province. This may be partly explained by the failure of the crop season at the beginning of 2003.

In the first semester of 2003, the number of admissions to feeding centres in the whole country was significantly higher than in 2002; admissions to SFCs were especially high (see figure 4; UNICEF-Burundi, 01/04). This may be due to the failure of the early 2003 crop season (A crop season). In the second semester of 2003, the number of admissions to feeding centres dropped to 2002 levels.

Figure 4 Admissions to therapeutic feeding centres (TFCs) and Supplementary Feeding Centres (SFCs), Burundi (UNCEF-B, 01/04)

Overall

Although the nutrition situation remains under control to average (category II/III), it seems that 2003 was a worse year than 2002. The next harvest is expected to be good, but insecurity in some provinces and the high number of returnees from Tanzania are factors that may affect vulnerability in 2004.

RNIS 43, November 2003

There was an upsurge in violence in August and September 2003, which, among other things, has led to the displacement of about 53,000 people in Bujumbura rural Province and 21,000 people in Bubanza Province (OCHA, 29/08/03; WFP, 26/09/03). After the signature of a peace agreement between the Burundian President and the country's largest Hutu rebel group, the Forces for the Defence of Democracy (FDD), in early October, the situation has calmed down but has remained volatile (AFP, 07/10/03; UNICEF, 06/11/03). An enlarged government with members of the FDD, should be formed by the end of November 2003 (AFP, 07/11/03). However, the other Hutu rebel group, the National Liberation Force (FNL) was not part of the cease-fire negotiations (AFP, 08/10/03).

The deployment of about 3,000 peacekeepers from Ethiopia, Mozambique, and South Africa, to help in the demobilisation, disarmament, demobilisation and reintegration of rebel troops and to monitor the transition to democracy, has been completed (OCHA, 02/11/03).

As of end October 2003, UNHCR reported 26,690 facilitated returns of Burundian refugees and 42,103 spontaneous returns in 2003 (OCHA, 02/11/03).

Nutrition situation

Admissions to TFCs and SFCs diminished slightly in July and August 2003, compared to June 2003, which is in line with the seasonal patterns. However, in some Provinces, the diminution in admissions might be due to a decrease in accessibility caused by insecurity (UNICEF-B, 09/03). Rains have been inadequately distributed and the 2004 A agricultural season might be difficult (SAP-SSA, 09/03).

A random sampled nutrition survey was done in Karuzi Province in July 2003 (MSF-B, 07/03). The nutrition situation was not critical: the prevalence of acute malnutrition was 4.8% (3.3-6.2), including 0.8% (0.3-1.6) severe malnutrition, and was in the same range as malnutrition rates in September 2001 and March 2002 (see RNIS 36/37 and RNIS 38). Crude and under-five mortality rates were average (respectively, 0.5/10,000/day and 1.8/10,000/day) and were similar to the mortality rates recorded in March 2002.

RNIS 42, August 2003

At the end of April 2003 the former president, Pierre Buyoya, from the UPRONA, which leads the Tutsi political grouping, transferred power to the former vice-president Ndayizeye, from the FRODEBU, which is the biggest Hutu political party, (OCHA, 30/04/03). This is in accordance with the Arusha peace agreement. Talks about the revival of a cease-fire agreement, which was signed in December 2002, but has not been implemented, took place in August 2003 (AFP, 21/08/03).

Nevertheless, insecurity has spread over the last months, leading to new population displacements. Among others, an attack in Bujumbura and surroundings at the beginning of July 2003 has led to the displacement of somewhere between 15,000 and 40,000 people (AFP, 14/07/03). They have been provided with humanitarian assistance (OCHA, 20/07/03). A majority has returned back home (OCHA, 15/07/03). Theft of goods, livestock and households also seems to have increased (OCHA, 03/08/03), as well as the abduction of humanitarian workers and looting of humanitarian agencies (OCHA, 10/08/03; OCHA, 20/07/03).

Unexpected number of returnees from Tanzania

The number of returnees from Tanzania has increased sharply since May 2003. As of mid-April, about 14,000 people had returned, since the beginning of 2003 (see RNIS 41). About 28,000 returned between May and July 2003. This sharp increase in refugee returns has raised concern. Massive returns of the refugees in a country which is not stable might be due to indirect pressure for departure. Refugee International stated that there is major pressure on the refugee population from the governments of Tanzania and Burundi, some international agencies and local populations (RI, 18/06/03).

Refugees said that major reasons for leaving the Tanzanian camps were the diminution of aid assistance and a new restriction of movement outside the camps, imposed by the Tanzanian government (UNHCR, 03/06/03). Because of food shortages, food rations were halved from January to March and were 70% of the full ration in April (UNHCR, 03/06/03). Distribution of non-food items have been halted because of a lack of funding (RI, 18/06/03). Moreover, the government of Tanzania has imposed new restrictions on refugee movements, including a household curfew between 8 pm and 6 am, no movement outside some camps, no permits to any refugee to travel outside the camps (RI, 18/06/03). Refugees were previously able to move freely within a 4-km radius of the camps; they were carrying out some activities which enabled them to add to the humanitarian aid (UNHCR, 03/06/03).

Refugee International calls for the UNHCR to fulfil its protection mandate, for the government of Tanzania to ease restriction on refugees' freedom of movement, and for the donors to fully fund appeals for Tanzania camps (RI, 18/06/03). The situation of the returnees, when back in Burundi, should be closely monitored and they should receive assistance if needed.

Nutrition and food security situation

The assessment of the 2003 B agricultural season has shown a 1% decrease in production compared to the 2002 B agricultural season. It is anticipated that crops will not last until the next harvest (UNICEF-B, 07/03). Areas are variously affected by food insecurity.

The number of admissions to TFCs (25 TFCs) and SFCs (212 SFCs) declined from January 2003 to June 2003, which is in line with the seasonal pattern (see figures); the nutrition situation has not improved in Bururi, Gitega and Ngozi provinces (UNICEF-B, 07/03). Admissions to both SFCs and TFCs were higher in 2003 than in the same period in 2002 (see figures).

RNIS 41, April 2003

In line with the stipulations of the Arusha peace agreement, Burundi's two major political parties, the UPRONA, which leads the Tutsi political family, and the FRODEBU, which is the biggest Hutu political party, signed an agreement at the end of March 2003. The current President, Pierre Buyoya from the UPRONA, will step down at the end of April and will be replaced by the current Vice President, Ndayiezeye, from the FRODEBU (GoSA, 30/03/03). However, despite the ceasefire agreements signed at the end of 2002 between the government and all rebel factions (except the FNL) fighting has intensified over the last months.

Refugees, returnees

As of 12 April 2003, since the beginning of the year UNHCR has reported 7,782 facilitated and 6,000 spontaneous returns (OCHA, 20/04/03). In addition, about 300 Congolese refugees entered the country in April 2003.

Food security and nutrition situation

The poor last harvests, compounded by insecurity, have led to an increase in the number of affected people. A UN inter-agency food and crop yields assessment mission indicated that the number of people in need of food aid in the first semester of 2003 has doubled compared to the same period last year (WFP, 11/03/03). A 19% fall in bean production has been reported; the next harvest might also be disrupted because of poor and delayed rains (OCHA, 30/03/03). Insecurity has hampered food distribution; at least 54,000 people did not receive any food distribution in February 2003 because of insecurity (WFP, 11/03/03). FAO launched a seeds and tools distribution to 266,500 vulnerable households at the end of February 2003 (OCHA, 02/03/03). The number of admissions to TFC has been reported to have increased in Ruyigi, Ngozi, Kayanza and Karuzi provinces (WFP, 11/03/03; MSF, 07/02/03).

Kayanza province

A nutrition assessment was carried out in Kayanza province (excluding Kayanza town and camps) in November 2002 (ACF-F, 11/02). The results showed that the prevalence of acute malnutrition was 7.1%, including 2.1% severe acute malnutrition. Although this prevalence is average, it is higher than in November 2001, when the rate of acute malnutrition was 3.9%. Crude and under-five mortality rates were respectively 0.32/10,000/day and 0.85/10,000/day. 114 infants aged 0 to 6 months have also been measured; 2.6% had a weight-height index < - 2 Z-scores, none had a weight-height index < -3 Z-scores. The measles vaccination coverage was estimated at 79% according to cards and 97.2% according to cards and mothers' statements.

Overall - The food security and nutrition situation in Burundi has deteriorated in the last few months (category II/III).

RNIS 40, Dec 2002

A cease-fire agreement was signed on the third of December between the Burundi government and the FDD (Forces for Defence of Democracy), one of the two main rebel groups (Reuters, 03/12/02). However, the other main remaining force, the FNL (Forces of National Liberation) did not participate in the peace talks. Despite the truce, clashes continue to be reported.

Refugees, returnees, displaced persons

As of 31 December 2002, UNHCR estimated that a total of 52,853 Burundians have returned to Burundi from Tanzania, which includes 31,421 facilitated returns and 21,432 spontaneous returns (OCHA, 12/01/03). Because of an upsurge in violence, returns have dropped dramatically over the past weeks. In addition, the number of Burundians who fled to Tanzania has greatly increased. Some 17,000 Burundians entered Tanzania in October 2002 (AFP, 14/11/02), compared to 3,000 in September (RNIS 39).

Following renewed fighting in Uvira area in the Democratic Republic of Congo since mid-October, thousands of Congolese have sought refuge in Burundi. About 12,000 were registered at the end of October and a new wave of about 9,000 ar- rived at the end of 2002 and the beginning of 2003. Refugees first settled near the volatile border area, in Gatumba and Bujumbura rural provinces. UNHCR began to move them to newly- developed camps; as of mid-January, 3,000 were settled in Cishemeye camp, in Cibitoke province and 2,400 were settled in Gasorwe camp in Muyinga province (UNHCR, 07/01/03). It seems that far more Congolese were prevented from crossing Burundi's border.

Disease outbreak

No new cases of cholera were diagnosed during the second week of October (OCHA, 31/10/02). About 1,100 cases of meningitis and 257 deaths were reported in October 2002. Northern and central provinces were particularly affected. A vaccination campaign has been launched in north- eastern Burundi (MSF, 25/10/02). A malaria epidemic has been declared in Gitega and Ngozi provinces (MSF, 05/12/02).

Food security and nutrition situation

A two-month delay in rains for the 2003 A crop season (September/October-January) and the poor 2002 C harvest (September) is putting pres- sure on the food security of the population, at least until February 2003. Fighting and inflation are further compounding the situation (SAP-SSA, 11/02). It is estimated that the number of people in need of food aid could rise from 580,000 to 1.2 m (WFP, 02/12/02). History of admissions to feeding centres shows that admissions were significantly lower in 2002 than in previous years, especially than in 2000 and 2001 (see graph). However, the number of admissions has been reported to have increased since October 2002.

Admissions to Therapeutic Feeding Centres, Burundi (UNICEF Burundi)

Admissions to Supplementary Feeding Centres, Burundi (UNICEF Burundi)

Overall - The current food security situation in Burundi seems to be very precarious. Close monitoring and food aid should be provided in order to prevent any significant deterioration of the nutrition status.

RNIS 39, October 2002

The security situation remains volatile with insecurity in several provinces as well as attacks in Bujumbura. One hundred and eighty three people, many civilians, were killed in Gitega on the 9^th of September (AFP, 17/09/02). The involvement of the army is unclear (AFP, 19/09/02; OCHA, 20/09/02). Peace talks between the government and the main faction of Hutu rebels, the Forces for the Defence of Democracy” (FDD) began in Tanzania on the 12^th of August 2002 and are continuing, but there has been no tangible progress so far (AFP, 11/09/02). Attacks have also led to population displacements, sometimes for only short periods. Populations are in any case disrupted by these continued attacks, which often ruin property and prevent cultivation. WFP will distribute seed protection rations in the provinces particularly affected by insecurity, together with seeds and tools provided by FAO (WFP, 20/09/02).

The recurrence of attacks has also seen a new influx of about 3,000 Burundian refugees into Tanzania, in September. There have been reports of the army preventing refugees crossing the border (OCHA, 20/09/02).

Repatriation of refugees from Tanzania into Burundi is still continuing with an estimated 24,650 facilitated repatriations and 18,000 spontaneous returns, but this has decreased within the recent weeks, possibly due to the upsurge of violence (UNHCR, 20/09/02).

Nutrition and food security situation

The results of the nutritional surveys carried out since the beginning of the year in 5 provinces show low rates of malnutrition except in Makamba province. This province hosts the highest number of displaced (see map).

Acute malnutrition prevalence, Burundi, 2002 (UNICEF Burundi)

In the provinces where previous data is available, rates of malnutrition are far lower this year than in the previous years (see graphs). The process of transferring the nutritional activities to the MOH has begun in some of the provinces. It is hoped that the on going fighting will not lead to a repeat rise in malnutrition rates.

Malnutrition prevalence among 6-59 month olds children, Kirundi province, Burundi

Malnutrition prevalence among 6-59 month olds children, Karuzi province, Burundi

Malnutrition prevalence among 6-59 month olds children, Muyinga province, Burundi

A food security assessment was conducted in Ruyigi province in June 2002 by AcF. The acute malnutrition rate estimated through a survey in March 2002 was of 3.8%. The province received a lot of returnees, mainly spontaneous returnees (an estimated 5,500 from January to August) because the area is considered insecure by UNHCR. These refugees receive no help from UNHCR for either repatriation or when returned (UNHCR, 22/08/02). The survey reported that the vulnerable population presents the following criteria: no livestock, poor access to highlands and swamps and low fertility of lands and agricultural wages as an important source of income.

The crop production of the poorest lasts only for one to two months, and is compensated for by a higher consumption of tubers. Health access is very poor due to lack of means.

Disease outbreak

There have been outbreaks of cholera and meningitis in the past months. The cholera outbreak has spread into Bujumbura (591 cases), Bubanza (46 cases) and Cibitoke (157 cases) (WHO, 29/08/02). The number of cases decreased in September.

A meningitis epidemic has been declared in the provinces of Muyinga, Kirundo, Ngozi and Ruyigi, and some cases have been reported in Cankuzo province. A vaccination campaign will take place in the affected provinces (WHO, 12/09/02).

Overall The nutrition situation seems to be under control (category IV), apart from the displaced, who are still at risk (category II).

Recommendations and priorities

From The AcF survey in Ruyigi:

• Support agricultural production of the vulnerable families through groupements.

From the RNIS

• Monitor the situation of new IDPs

RNIS 38, July 2002

Table showing the affected populations in the Great Lakes region

Country	IDPs	Refugees	Total Affected Populations
Burundi	432,818	28,800	461,618
DRC	2,045,000	361,720	2,406,720
Tanzania	N/A	543,145	543,145
Uganda	535,107	175,819	710,926
Total	3,012,925	1,143,418	4,156,343

Burundi has been suffering the effects of an ethnic war that has resulted in the deaths of over 250,000 people. The war has largely been a conflict between Hutu rebels and the mainly Tutsi dominated army. Approximately 85 % of Burundi’s population is Hutu and violence broke out in 1993 when the Tutsi dominated army assassinated the president, a Hutu, who was freely elected in country-wide elections. The resulting violence has resulted in massive internal displacement and has driven hundreds of thousands more Burundians to seek refuge outside of the country. In July 2002 it was estimated that 387,469 people were internally displaced in 226 official displaced camps (UNICEF 17/07/02). It is estimated that a further 845,000 have fled the country, mostly to Tanzania, where approximately 357,000 are currently in camps (RI 15/05/02).

In August 2000, various political parties from Burundi came together in Aursha, Tanzania, and signed a widely feted peace accords. The accords provided the framework for the establishment of a 3-year transitional government, led for the first 18 months by a Tutsi and for the second 18 months by a Hutu. The accords also laid the foundations for ethnically balanced armed forces. The first tenure of the transitional government began in November 2001 and was accompanied by great expectations for peace in the country. However, the much anticipated cease fire of hostilities has not occurred because the two main rebel groups; the Force pour la Defense de la Democracie (FDD) and the Force Nationales de Liberations (FNL), were not signatories of the Arusha accords. Peace negotiations have taken place, but the failure to bring about a cease-fire has resulted in continued violence, continued displacement and a continuation of the stark humanitarian situation.

The humanitarian situation

Despite the creation of a transitional government in November 2001, fighting has been ongoing and the humanitarian situation continues to be bleak in many areas of the country as a result. The continued insecurity repeatedly drives people from their lands and livelihoods and continuously erodes their ability to cope with the deteriorating situation. WFP has estimated that 634,643 people, or 9 % of the total population, from all 17 provinces will require emergency assistance between June and December 2002 (WFP 21/06/02). The conflict is characterised by repeated displacement and the looting of food and belongings and the general terrorising of the civilian population. Fighting has escalated from March 2002 in Burundi’s western Bujumbura Rural Province and there are reports of insecurity and open conflictin many areas of the country, particularly in the east and southeast. Continuing military operations have displaced 84,000 people in Bujumbura Rural since January 2002 and fighting in the area is continuing. A further 40,000 were displaced from Kibuye, southeast of Bujumbura and 32,000 in Ruyigi, eastern Burundi (UNOCHA 30/05/02; USAID 20/06/02). The fighting and general poor security in many areas is continuing to hamper humanitarian access to areas most affected by the violence. This includes IDPs in the 226 registered IDP settlements, as well as many more displaced, non-displaced and refugees, who are all affected by the ongoing situation. The UN have indicated that up to 1 million people within the country depend on humanitarian aid in Burundi and without considerable advances in the peace process, including the vital cease fire, the needs and dependency on humanitarian assistance will remain high.

The overall food security situation has improved when compared to the disastrous harvests and high burden of disease experienced a couple of years ago. However, many households remain extremely vulnerable and are increasingly unable to access their farming land through actual insecurity or fear of being attacked. Areas of particular concern are Cankuzo, Ruyigi, Rutana, Makamba and Bujumbura Rural province, as well as all areas bordering the Kibira forest (USAID 20/06/02). The needs of the many vulnerable groups are being addressed by WFP, who are providing regular food distributions with most families receiving a ration of maize, pulses and cooking oil. The current nutritional situation in the country is thought to be precarious, however needs are extremely varied with rates of malnutrition being high in some areas and reduced in others. The incidence of malnutrition has dropped since the high rates seen in 2000 and it has been noted that there continues to be a drop in the number of people attending both supplementary and therapeutic feeding centres in the country. The security situation undoubtedly plays a very significant role in the current level of humanitarian needs in differing areas.

The reporting period has seen the return of thousands of Burundian refugees from neighbouring Tanzania. There are over half a million registered Burundian refugees in Tanzania, the vast majority of them in camps close to the Burundian border. The presence of so many refugees has been a source of discomfort for the Tanzanian government for some time and has led to considerable friction with the authorities in Burundi. An agreement between UNHCR and the governments of Tanzania and Burundi established a framework for assisted repatriations and the reporting period has seen large numbers of Burundians, many of whom have been resident in Tanzania for some time, register for repatriation. It is estimated that 80,000 refugees have registered for repatriation and that over 16,000 have actually joined UNHCR convoys and gone home (UNOCHA 08/07/02). The majority of returnees are going to Muyinga in the north where there is an existing IDP population of 15,954 people in 17 sites (UNICEF 17/07/02). The assisted repatriations have been to the relatively secure northern regions, but many of the refugees are hoping to return to areas such as Rutana and Ruyigi in the south where the security situation is still very poor. There have been some reports of returns to Ruyigi, but UNHCR have stated that these returns were spontaneous. The greatest problem for the future of the returns remains insecurity. However, questions have also been raised over what the majority will return to, as the destroyed infrastructure, including health, schooling and housing as well as a lack of agricultural land, will make life very difficult for returnees. As the security situation appears to worsen there are indications that refugees who had previously signed up for repatriation are dropping out of the process and there is an overriding air of "wait and see" for many of the refugees. Without significant improvements to the security situation it seems unlikely that repatriation will continue as it was initially anticipated.

Bujumbura Rural

The security situation in Bujumbura Rural continues to be extremely volatile with continued fighting between government troops and rebels. Bujumbura Rural has been the scene of fierce fighting for many years as rebels have launched repeated attacks on or near the capital Bujumbura. Recent fighting has included a June 22 clash between the government and Hutu rebels that resulted in significant displacement and, as a result, UNOCHA have reported that over 20,000 people are in need of food and other assistance (UNOCHA 04/07/02). There has also been mass displacement from Ruziba, south of the capital, with an estimated 15,000 people affected (AFP 30/06/02). The fighting has resulted in 18,363 officially registered IDPs in 13 sites but many more exist in the province (UNICEF 17/06/02). The fighting appears set to continue and will restrict access to affected populations as well as preventing access to land and livelihood activities. There have also been reports of a cholera out-break in the Bujumbura Mairie region with up to 100 cases identified. This illustrates the vulnerability of people to communicable disease and is indicative of the generally poor water and sanitation conditions of many settlements in the area. The RNIS does not have any recent nutritional information from the area but the population is assumed to be extremely vulnerable.

Karuzi

The province of Karuzi has been badly affected in the past by insecurity, disease and high rates of acute malnutrition. The security situation continues to be volatile and the situation in the province is generally poor as a result of its relative geographic isolation, the destruction of existing infrastructure and the presence of an estimated 9,131 IDPs in 11 sites (UNICEF 17/07/02). There are likely to be many more IDPs in the area living outside of the camps with host communities. Recent nutrition surveys in the province have shown an improvement in the general nutritional situation. In March 2002 MSF-B conducted a survey to assess the prevalence of acute malnutrition. The survey indicated that there was an estimated prevalence of acute malnutrition of 4.2 % (W/Ht < -2 Z scores and/or oedema), which included 0.4 % of severe malnutrition (W/Ht < -3 Z scores and/or oedema). The survey also estimated mortality and indicated that the CMR was 0.7/10,000/day and the under-five mortality 1.8/10,000/day (MSF-B 03/02). The results indicate that the situation is not critical, with the prevalence of malnutrition falling well within emergency thresholds. It is also important to note that the situation appears to have remained stable since the last survey in September 2001. The mortality rates are also below normal thresholds, however they do appear elevated from expected baseline levels and indicate a problem of poor public health. The survey attributes the stability of the malnutrition rate to the relatively good economic situation in the province, which has aided accessibility to food sources and the good availability of food. The situation has also been helped by favourable climatic conditions for agriculture and the good and timely delivery of humanitarian aid. It is also noted that the incidence of malaria has dropped significantly since the out-break of a couple of years ago (MSF-B 03/02).

Overall

The humanitarian situation remains extremely precarious and, despite the ongoing peace negotiations, the reporting period has seen an upsurge in violence and armed clashes between the government and rebel groups. The clashes continue to result in displacement and have seriously affected humanitarian access to affected populations with areas in the south and east of the country being worst affected. IDPs should be considered to be extremely vulnerable (category II) and the situation has the potential for further deterioration unless a cease-fire can be negotiated.

Recommendations

From the MSF-B survey in Karuzi, March 2002

• Continue follow up for selective feeding programmes.
• Continue general food distributions to affected populations.
• Continue the seed distributions and seed protection rations.
• Closely follow the malaria situation in the region.

RNIS 36/37, April 2002

The regional conflict in the Great Lakes continues to affect the lives of millions of people. The peace process in the DRC is ongoing but has largely stalled without the cooperation of key rebel groups and as a result conflict is expected to continue. The likelihood of fresh conflict and there is little chance that the humanitarian situation in conflict affected areas will improve. For the number of affected populations see the table below.

Table showing the affected populations in the Great Lakes region

Country	IDPs	Refugees	Total Affected Populations
Burundi	432,818	28,800	461,618
DRC	2,045,000	361,720	2,406,720
Tanzania	N/A	543,145	543,145
Uganda	535,107	175,819	710,926
Total	3,012,925	1,143,418	4,156,343

Burundi is suffering the affects of a ten-year civil war. The war has largely been a conflict between Hutu rebels and the mainly Tutsi army. The Tutsi s are a minority within the country, representing 14 % of the population, whilst the remainder is made up of the Hutus. Violence broke out in 1993 after the assassination of the then Hutu president and fighting has raged throughout the country resulting in the deaths of over 250,000 civilians. The violence has also resulted in huge population displacement, with many choosing to leave the country altogether and go to refugee camps in Western Tanzania where there are currently in excess of half a million Burundians. In January 2002 UN OCHA estimated that there were 375,509 IDPs in various parts of country, but this figure is likely to have increased as a result of an upsurge in conflict related displacement over the early months of 2002 (UN OCHA 01/02).

The creation of a Transitional Government (TG) in November 2001 marks a potentially significant step along the road to an end to the hostilities of the past years. The TG shares power between Tutsi and Hutu parties who signed the Arusha peace accords in August 2000. The TG will be in place for an initial three-year period, after which there will be democratic elections to decide on a government. However, although the TG represents a step forward, its ability to bring about peace is severely constrained because some Hutu rebel groups were not signatories of the Arusha accords and have continued the conflict with the army. Less than a week after the TG came to power there were a series of high profile kidnappings of school children by the rebel groups in apparent protest at their exclusion from the government. Negotiations have taken place and there was a meeting in Pretoria on 18 February 2002 that aimed to bring together the transitional government and the rebel groups concerned to discuss a possible cease-fire agreement. The rebel groups are the Force de Defence de la Democratie (FDD) and the Force Nationales de Liberations (FNL). However, of the two groups, only the FDD attended the meeting and this is likely to mean that fighting will continue without the inclusion of both groups in the peace process (UN OCHA 28/02/02).

Humanitarian situation

The humanitarian situation continues to be severely affected by insecurity. Over the past few months there has been an upsurge in attacks and ambushes in various parts of the country, but mostly in Bujumbura Rural province around the capital, Bujumbura. The insecurity continues to displace large numbers of people from their land and their means of subsistence. It has resulted in the looting of food stores, the loss of livelihood assets and has created a situation of both acute and chronic food insecurity.

Many of the IDPs live in very poor conditions with very little access to medical or educational facilities. Insecurity has also constrained the ability of the humanitarian community to access groups in need of assistance. WFP reports that during November, less than 30 % of the targeted beneficiaries received WFP assistance as a result of the security situation (WFP 28/12/01). The most recent upsurge in insecurity resulted in the cancellation of missions in the provinces of Bujumbura Rural and Ruyigi in February 2002, which severely affected planned assistance to 26,900 people (WFP 15/03/02). The rise in ambushes along many major roads has meant that movement between areas is very difficult and humanitarian workers rely on air transportation to cover very small distances.

Despite continued insecurity there has been a general improvement in the overall nutrition and food security outlook in the country. UNICEF has documented a dramatic decrease in numbers attending selective feeding programmes when compared to similar periods last year and nutritional surveys also indicate that nutrition rates are dropping. However, the situation is still very poor in insecure areas such as Bujumbura Rural, Rutana, Gitega, Cibitoke, Muramvya and Ruyigi (UNICEF 04/02/02). Overall, the harvest outlooks are good, which will undoubtedly increase the availability of food. However, security remains a critical factor in determining the accessibility of food sources. Other reasons for the improvement in the overall picture have been the greatly improved targeting of emergency food distributions to those groups most acutely in need of assistance. There has also been an increased investment in food security programmes and, in particular, there have been large-scale distributions of agricultural seeds. There was some concern that food insecurity in many areas would lead people to eat seeds intended for planting, however the distributions have been protected by the provision of a food or seed protection ration. The situation has also been helped by reduced rates of malaria, although the usual seasonal increase was seen at the end 2001 and early 2002.

Another issue of great significance to the humanitarian situation has been the possible return of Burundian refugees from Tanzania. There are estimated to be half a million registered Burundians in Tanzania, but there are increasing signs that the government of Tanzania would like to see a large scale repatriation. The establishment of the TG has also signalled the possibility of peace and stability and UNHCR has reported that tens of thousands of refugees have registered for a voluntary repatriation package. This would significantly increase the burden on existing humanitarian services and place pressure on the scarce land and resources available within Burundi. UNHCR have reported that some returns have taken place but it remains to be seen how many will actually opt to return when violence is still ongoing within the country.

Bujumbura Rural

The security situation in Bujumbura Rural continues to be extremely volatile with heavy fighting between the Burundian army and the FNL rebel group. At the beginning of January 2002, UN OCHA estimated that there were 28,677 IDPs in the province, however this number has risen substantially as a result of ongoing conflict. It is reported that at the beginning of 2002, 14,000 people were displaced from Isale commune and at the end of January 2002 were asked to return to their homes but were unable to due to ongoing fighting (UNICEF 04/02/02). Further fighting has taken place in March 2002 resulting in the displacement of an additional 10,000 people. The RNIS does not have any recent nutritional information from the province but the situation is assumed to be extremely precarious, as other areas of conflict in Burundi have shown high rates of acute malnutrition.

Karuzi

The province of Karuzi is situated towards the north of the country and has in past years suffered very high rates of acute malnutrition as a result of drought, insecurity and epidemics. The general outlook for 2002 has improved when compared to the past three years, with a good harvest and lowered rates of malaria. At the beginning of January 2002, UN OCHA estimated that there were 2,042 IDPs in the province. The area has benefited from the presence of a high number of humanitarian organisations and their assistance has taken the form of food distributions, selective feeding programmes and agricultural support. In particular, the area has benefited from the distribution of essential agricultural seeds along side seed protection rations. The results have been a marked reduction in the number of children being admitted to both the supplementary and therapeutic feeding centres in the region.

MSF-B conducted an anthropometric nutrition survey in September 2001 and found a prevalence of acute malnutrition of 4.2% (W/Ht < -2 Z scores and/or oedema) including 0.4% of severe acute malnutrition (W/Ht < -3 Z scores and/or oedema) (MSF-B 09/01). The survey also estimated mortality rates and found that the CMR was 0.4/10,000/day and the under-five mortality rate was 1.2/10,000/day. The rate of measles vaccination coverage was also measured and found to be 92.4%. The data indicates that the nutrition situation is not of public health concern and, furthermore, has improved considerably from a similar survey conducted in March 2001 which indicated a prevalence of acute malnutrition above emergency thresholds (see RNIS #32 and 33). The crude mortality rate is within acceptable limits, however the under-five mortality rate is cause for concern. The high measles vaccination coverage is also encouraging and an indication that preventative medical interventions are currently working.

The improvement in the situation is extremely encouraging, particularly because Karuzi has experienced extremely high rates of malnutrition in the past. The survey attributes this improvement to a number of causes including the distribution of a good general food ration, the strong agricultural support offered to the population, the reduction in the incidence of malaria and the effective treatment of remaining cases. The survey also points to the successful system of active case finding for the selective feeding centres. In conclusion, the outcome of the survey is that the nutritional situation is much improved but it is worth noting that the population remains vulnerable to future shocks, which could quickly lead to a deterioration in the situation.

Kayanza

The province of Kayanza is situated in the north of Burundi and shares a border with Rwanda. The province has been particularly affected by the conflict of recent years and the nutrition situation has remained extremely precarious. This is mostly a result of poor agricultural seasons, insecurity and epidemic outbreaks, most notably of malaria in 2000-2001. The population of the province was estimated to be 470,253 in August 2001 and in January 2002 UN OCHA estimated that there were 7,573 IDPs in the province (UN OCHA 01/02). The later half of 2001 saw a general improvement in the nutritional outlook in the province and this has been particularly noticeable in the reduction of children in selective feeding programmes.

ACF conducted a nutrition survey on the under-five population in November 2001 and found an estimated prevalence of malnutrition of 3.9% (W/Ht < -2 Z Scores and/or oedema). This did not include any severe malnutrition. The survey also estimated mortality rates and found a CMR of 0.3/10,000/day and an under-five mortality of 0.08/10,000/day (ACF 11/01). The data indicates that the nutrition situation is not concerning and indeed is well below emergency thresholds. It is encouraging to note that no severe acute malnutrition was observed. It is also noted that there has been a significant improvement from a previous ACF survey in September 2000. The survey attributes the observed improvement to a variety of causes including the good harvests seen in both the 2001 B and C seasons. This would have significantly improved the availability of food sources to the population. There has also been an upsurge in commercial activities in the region as a result of relatively good security. This has also allowed many people to return to their farms and continue essential farming activities. The health situation has also remained good with no reported disease outbreaks and the incidence of malaria has fallen dramatically. Whilst the situation appears greatly improved over the past few years, it is important to note that the area remains vulnerable to deteriorations in the nutrition situation as a result of conflict, drought and epidemics.

Rutana

Rutana province is located in the south east of Burundi on the border with Tanzania. The population of the province is estimated to be 287,834, with an estimated 77,901 IDPs (UN OCHA 01/02). The principle economic activity in the region is agriculture and this has been severely disrupted by continuing insecurity that has routinely displaced the population from their homes and farms. As a result, many people are too afraid to continue with agricultural activities, resulting in severe reductions in both the availability and accessibility of food items.

The International Medical Corps (IMC) conducted a nutrition survey in the province during October 2001. The survey was conducted over the entire province but it was noted that insecurity meant that only 119 hilltop settlements out of a possible 149 were accessible (IMC 20/10/01). Even with the survey confined to the secure areas of the province, it was still necessary to assess the possibility of access on a daily basis. The survey indicated that the prevalence of acute malnutrition amongst children under five years of age was 19.2% (W/Ht < -2 Z scores and/or oedema). This included 6.3% of severe acute malnutrition (W/Ht < -3 Z scores and/or oedema) (IMC 20/10/01). Crude mortality was not estimated but the under-five mortality rate was 1.6/10,000/day. The data indicate that the nutritional situation in Rutana is extremely poor with the prevalence of acute malnutrition being significantly elevated above emergency thresholds. The high rates are all the more surprising given that the survey was conducted in October, which is traditionally a month of relative plenty and when the numbers of children in selective feeding programmes usually falls. The causes of the observed malnutrition are undoubtedly linked to the insecurity of the area, which continues to disrupt traditional livelihood patterns and prevents access to essential subsistence needs. In contrast to the high rates of malnutrition, the rate of measles vaccination coverage was estimated to be 74%, suggesting that some preventative medical services were still ongoing and effective. The population should be considered to be highly vulnerable and the situation should be carefully monitored to prevent further deterioration of the situation.

Overall

The humanitarian situation in Burundi remains extremely precarious. However, in general, the nutrition and food security outlook is significantly improved from previous years. It is important to note that the situation appears to change drastically from area to area. The areas with the worst humanitarian outlooks and the highest observed prevalences of malnutrition are those currently suffering from the most insecurity. IDPs in these areas should be considered at high risk (category II), whilst populations in more secure areas are benefiting from an improved harvest and lower incidences of disease (category III).

Recommendations

From the MSF-B survey in Karuzi Province

• Continue general food distributions to vulnerable families.
• Continue the distribution of seeds and protection rations to improve the food security situation.

From the IMC survey in Rutana Province

• Continue support for existing selective feeding programmes.
• Support food security through income generating programmes.
• Conduct nutritional education to all health centres.

From the ACF survey in Rutana Province

• Reinforce the integration of selective feeding within the existing public health structures in the province.
• Reinforce nutrition and public health education activities in existing public health structures.

RNIS 35, October 2001

Burundi has been suffering the affects of a crippling internal conflict since 1993, resulting in massive displacement of population and erosion of basic essential infrastructure. The result has been wide scale acute food insecurity and a rise in levels of acute malnutrition, exacerbated in recent years by severe drought conditions and high levels of infectious diseases such as malaria. Latest OCHA figures indicate that out of a population of 6.65 million people, 432,818 are registered as internally displaced. This is an increase of over 50,000 people since May and, with insecurity continuing in western provinces, the numbers of displaced can be expected to increase. The majority of IDPs are resident in the south of the country with an estimated 106,540 in Makamba, 104,986 in Bururi and 78,840 in Rutana province. Burundi also has a refugee population estimated to be 28,800, mostly from the DRC (OCHA 12/10/01).

The reporting period has seen significant developments in the ongoing Arusha peace process started in August 2000. On 23 July 2001, a deadlock in negotiations was broken as Nelson Mandela, chosen to mediate the discussions, managed to garner agreement on a decision that Pierre Buyoya and Domitien Ndayizeye should be president and vice president of Burundi for the first phase of a transition government (ICG 14/08/01). The creation of the transition government is an opportunity to bring together opposing groups and establish a government that can bring peace to the war torn country. The biggest stumbling block to this remains the failure of the negotiators to bring two rebel factions, the Force de Defence de la Democratie (FDD) and the Force Nationales de Liberations (FNL) to the negotiating table. Within the transition government itself there was disagreement over the creation of an interim protection force for the institutions of the transitional government and for the protection of returning political exiles. The transition government was installed, as planned, on November 1^st and its significance lies in its potential to see a lasting peace develop within the country. A successful peace process could lay the way for the repatriation of over 400,000 Burundian refugees in Tanzania and open up many areas of the country to humanitarian assistance. However, concern remains that there is potential for the continuation of violence. It is noted with concern that there have been two attempted coups in April and July 2001, clearly indicating dissatisfaction with the current political discussions. Further attempts could further undermine the ongoing peace process (ICG 14/08/01).

Humanitarian outlook

In general the humanitarian outlook in Burundi is still very precarious. Despite indications that the 2001A harvest had been reasonable and that prospects for the B harvest were also good, the food security situation in many areas remains poor. Particularly affected areas are Bujumbura Rural, Gitaga, Karuzi, Kayanza, Kirundo, Muramvya, Muyinga, Ngozi and Rutana (OCHA 17/09/01). One of the major reasons for the food insecurity is the continued conflict between government forces and rebel groups. It is currently estimated that seven out of a total of seventeen provinces are currently on UN security phase IV (I is the most secure and V the least). Fighting is regularly reported in Bujumbura Rural province as well in Cibitoke and Bubanza. The fighting at best limits access to farms and at worst forces displacement away from land and property. It is also widely recognised that armed groups freely loot food crops. This serves to constrain both the access and availability of food sources (WFP 27/07/01). Looting may be one of the reasons for large numbers of people tending to sell their produce rather than storing them. The sale of food produce is also used to generate much needed cash and is an indication of a possibly nonsustainable coping mechanism (WFP12/07/01). In response to food insecurity the FAO has maintained its seeds and tools distribution program and aims to distribute to 207,900 families (1,039,500 individuals) in preparation for the 2002 A harvest. WFP will also conduct Seed Protection Rations (SPR) to ensure that the distributed seeds are not eaten.(WFP 12/07/01)

The presence of high rates of infectious disease has also had an adverse affect on the humanitarian situation. The year 2000 saw very high rates of malaria infection, which resulted in high mortality rates and contributed to a declining nutritional status observed in affected populations. 2001 has not seen the crisis levels of malaria or malnutrition seen in 2000 but UNICEF warn that the number of malaria cases could climb as a result of the development of similar environmental conditions as those seen during the outbreak in 2000 (UNICEF 22/10/01). Official statistics place HIV/AIDS as the first cause of adult mortality in Burundi with 40,000 HIV/AIDS related deaths in 2000 alone. UNAIDS estimates that there are over 230,000 HIV/AIDS orphans in the country (OCHA 17/09/01). Agencies also point to the lack of access to appropriate medical facilities by much of the population as being of particular concern. It is also worrying to note that many communities have very little access to sources of potable water and adequate sanitation facilities. This is very likely to be linked to the high rates of diarrhoeal morbidity seen in many areas.

Very high rates of acute malnutrition have been seen over the past year but recent reports indicate that rates appear to be declining. The RNIS has not received any new nutritional surveys from Burundi but in August IRIN reported that a survey in seven provinces had indicated 10% of acute malnutrition (IRIN-CEA 02/08/01). The RNIS has not seen the survey report but 10% of acute malnutrition, whilst not suggesting a critical situation, is still suggestive of a precarious situation particularly given the ongoing insecurity and the affects of the drought. The improvement in the general nutritional situation is also suggested by figures for the number of beneficiaries in Supplementary Feeding Centres (SFC), which appear to have fallen significantly from 94,554 in April 2001 to 42,227 in August. The decrease is being attributed to the humanitarian response by the UN and NGOs, including the timely general food distributions to affected populations, the implementation of selective feeding programs, increased access to medical care and the distribution of seeds, tools and protection rations (UNICEF 22/10/01).

Bujumbura Rural

The situation in the province continues to be very poor with continued clashes between the FNL and government forces. There are also reports that crime is rising in the capital, particularly robberies of NGO offices. This is largely fuelled by the poor economy. WFP report that the food insecurity of the rural areas continues to be affected by the looting of crops by armed groups (WFP 27/07/01). At the beginning of October the Burundian Government requested assistance for an estimated 18,762 households comprised of both new and old IDPs (UNICEF 22/10/01). Whilst much of the rural population remains vulnerable a recent assessment in the Buterere Zone of Bujumbura Mairie indicated that the Batwa community, displaced from Bujumbura Rural, were facing a precarious food security situation as a result of a lack of access to farming land, water, sanitation and shelter (OCHA 17/09/01). The RNIS has not received any recent nutrition reports from the province but the situation is assumed to be precarious despite ongoing food distributions to the affected populations.

Karusi and Ngozi

Both provinces have suffered from the affects of drought, insecurity and infectious disease epidemics and as a result they both saw high rates of acute malnutrition in 2000 and the beginning of 2001. The food insecurity continues to be a problem as a result of insecurity but the drought and infectious disease episodes have largely improved. Food distributions to affected populations are continuing but access due to the insecurity is often a problem. The RNIS has not received any new nutritional information from affected populations but it is assumed that high levels of food insecurity remain, leaving the populations extremely vulnerable to nutritional decline.

Bubanza

The province continues to suffer acute insecurity as a result of its proximity to the border and incursions by Interehamwe and ex-FAR forces from DRC. The RNIS has not received any new nutritional surveys but the last survey in March (see RNIS # 34) indicated a possibly deteriorating situation, although levels of acute malnutrition fell below emergency thresholds. The observed rates of under-five mortality were, however, raised and gave cause for alarm. It is assumed that the reasonable crop prospects for the country will benefit the province but the food security of the population will be constrained by insecurity.

Refugees and returnees

Burundi is currently estimated to host 28,800 refugees, from various east and central African countries. The long history of conflict in Burundi has also driven up to 500,000 people across borders to become refugees, mostly in Tanzania. The sheer number of refugees in Tanzania has created a considerable burden on the country and has resulted in cooling in diplomatic relations between the two countries. There is little chance of an organised return of Burundian refugees until a ceasefire and lasting peace settlement have been reached. However, in the first eight months of 2001 it is estimated that almost 20,000 spontaneous repatriations took place with the majority settling in the eastern provinces of Ruyigi and Rutana. The RNIS has no nutritional information on either the refugee population in Burundi or returnee Burundian refugees from Tanzania.

Overall

The situation in Burundi remains extremely precarious for displaced and non-displaced alike. There are signs that the food security situation of some areas is improving and agencies are not recording the extremely high rates of acute malnutrition or malaria that were seen last year. However, the continuation of insecurity, despite ongoing peace efforts, means that populations remain extremely vulnerable (category III). It is hoped that the current peace efforts, seen in the installation of the transition government, will help to reduce the conflict related insecurity in the country and allow the process of rebuilding to begin.

Recommendations

• Support the UN Interagency Appeal
• Implement food security analysis to understand how IDPs are coping with the current situation
• Support agricultural activities with the continued distribution of seeds and tools and seed protection rations

RNIS 34, July 2001

OCHA reports that out of a population of 6,654,766 there are 379,779 people recorded as displaced and there are a possible further 200,000 IDPs beyond the reach of humanitarian assistance. The continuing conflict, high levels of infectious disease such as malaria, and drought conditions, have all contributed to food insecurity and nutritional status decline. The displaced have been particularly vulnerable, having reduced coping mechanisms, but much of the population has been affected.

The Arusha peace accords of August 2000 were an important step towards ending the long-standing internal conflict within Burundi and were designed to bring opposing groups to the negotiating table. However, the failure to include two rebel groups, the Forces pour la Defense de la Democratie (FDD) and the Forces Nationales de Liberation (IRIN 31/05/01) has resulted in their failure to recognise the process.

As a result of the ongoing peace process in neighbouring DRC, the Congolese president, Joseph Kabila, has begun to decommission foreign rebel groups allied to his Kinshasa regime. The pressure to leave DRC has forced the return of up to 4,000 well-equipped FDD rebels to Burundi, resulting in an increase in security incidents with the Burundian military (AFP 14/05/01). The increased insecurity has particularly affected some of the previously central areas of the country. The escalation in conflict levels was seen most forcibly in February this year when rebels launched an offensive on the capital Bujumbura. This resulted in huge temporary displacement of population into Bujumbura rural, as people fled the crossfire.

The most recent development in the peace process has been the announcement that the Burundian President, Pierre Buyoya, will lead the first eighteen months of the country’s transitional government. Although a step forward for the peace process, the rebel FDD and FNL factions have indicated that they will continue their fight (IRIN-CEA 13/07/01) and it is certain that insecurity will continue to play an important part in the development of the humanitarian context.

The Effects of the insecurity

The uncertain political climate and continued insecurity has detrimentally affected humanitarian access to many of the communities who are most in need of assistance. The problem of access was highlighted by an attack on a WFP food convoy in April in which aid workers were injured. May saw the kidnapping of six aid workers by rebels from the FDD in Southern Makamba province and an attack on the MSF-F residence in Ngozi. In June a member of the agency Children’s Aid Direct was killed in an ambush in Bubanza and in response all agencies in the area suspended their programmes (OCHA 29/06/01). This succession of security incidents has highlighted the danger of working in many areas and has led to both NGOs and the UN imposing restrictions on the movements of their staff. This has important implications for the continued access to certain areas and vulnerable populations. It is estimated that humanitarian access is only intermittently possible in 70% of the country (USAID 03/07/01).

The increased insecurity also threatens to spill over into neighbouring countries. Tanzania has increasingly claimed that the Burundian refugee camps within Tanzania are training and recruiting grounds for rebels that threaten to further destabilise the area. Tanzania has become increasingly impatient with its high Burundian refugee caseload and the president has stated that he is considering sending them home (IRIN 31/05/01). The sudden arrival of 500,000 Burundian refugees from Tanzania would have severe negative implications for the humanitarian situation in the country. The humanitarian response has also been constrained by the under funding of both the 2000 and 2001 Consolidated Inter-Agency Appeal. Up until the end of May 2001 OCHA report that only 15.1% of requirements had been covered (OCHA 31/06/01).

Food Security outlook

Burundi has suffered from several below average harvests that have contributed to the food insecurity of much of the population, particularly the 380,000 IDPs and drought affected persons currently in the country. Encouragingly, FAO/GIEWS report that the output of the 2001 A season harvest appears to be satisfactory as result of improved precipitation, an increase in the overall area of land planted and calmer security in some areas. However, the northern and eastern provinces of Karuzi, Kayanza, Muramvya, Muyinga, Mwaro and Ngozi were particularly badly hit by the drought conditions and resultant crop failure. In preparation for the 2001 B harvest FAO have distributed seeds to populations affected by the drought and WFP has been distributing an associated food protection ration. This ration is to ensure that the distributed seeds went to the next harvest and were not consumed (OCHA 31/05/01). In further response to the assessed food needs WFP, with CARE, has been conducting food distributions to affected populations.

As well as poor food security, the observed nutritional status decline reported by RNIS 32 and 33 has been associated with poor access to medical care and high rates of infectious disease, particularly malaria. The WHO has reported a drop in the high rates of malaria infection seen earlier in the year, probably a result of the onset of the dry season. However, high rates of infection are still observed in the provinces of Gitega and Karusi (OCHA 29/06/01). Despite the precarious situation in much of the country, OCHA reported a decline in the admissions to selective feeding centres from 98,141 in March to 68,002 in June, however the exact reasons for this drop are unexplained (OCHA 29/06/01).

Bujumbura Rural

The UN continues to report insecurity in the province with regular confrontations between the Burundian army and the FDD. The FDD are also reported to be using the province as a base to move closer to the capital. It is very difficult to track numbers of displaced because much of the displacement is temporary, with people returning to their homes when fighting stops. However, the last RNIS reported a total of 30,889 IDPs in an area with a total population of 456,891 (IRIN-CEA 02/07/01). IRIN reports that at the end of May there were 6,498 people in sixteen supplementary feeding centres in the province, however the RNIS does not have any recent nutrition survey information. The better 2001 A harvest and the good prospects for the B harvest will help to improve food availability. In June WFP reported the suspension of targeted distributions in the province as a result of insecurity. The ability of the population to implement coping mechanisms and maintain their food security will remain highly dependent on the security situation. (WFP 29/06/01).

Karusi and Ngozi

WFP has been continuing food distributions to the drought affected population and reported distributing to 251,770 people in the first half of June (WFP 29/06/01). The RNIS has not received any new nutrition surveys for Karusi during the reporting period. The improved precipitation has led to a better 2001 A harvest and reasonable projections for the upcoming 2001 B harvest and the future food prospects appear to be reasonable. However, it is important to note that there are still high rates of malaria reported in the provinces and this will continue to adversely affect nutritional status (OCHA 31/05/01; 29/06/01).

Bubanza

The province of Bubanza continues to suffer acute insecurity. This resulted in large amounts of displacement within the province with many people living in IDP and regroupment camps. During the course of 2000 many of the regroupment camps were dismantled and people have returned to the traditionally farmed high ground areas. In March 2001 Children’s Aid Direct conducted a nutrition survey on some of the returnee population as a way of assessing their current condition. The survey showed an estimated prevalence of 8.6% acute malnutrition (W/Ht <-2 Z-scores and/or oedema) including 2.2% severe malnutrition (W/Ht <-3 Z-scores and/or oedema). Although not alarmingly high, the rate of severe malnutrition shows a substantial increase from the last survey in February 2000, which showed 0.78% severe malnutrition (W/Ht <-3 Z-scores and/or oedema). The overall rate of acute malnutrition remains the same. The authors point out that the 2000 survey was conducted in the regroupment camps and that some of the increase may be a result of differences in the assessed population and their environment. However, the amount of severe malnutrition is of concern and the survey attributes the increase to drought induced food insecurity and a high disease burden, in particular malaria. The survey also shows an elevated under five mortality rate of 5/10,000/day, which is above emergency thresholds and suggests that the nutritional status decline is contributing to mortality (CAD 23/03/01).

Overall

The situation in Burundi still remains extremely precarious in terms of security and this is likely to continue affecting the food security of the displaced (category III). However there are indications that the drought conditions of the last few years are improving, and the first harvest of this year was reported to be satisfactory and the prospects for the next harvest are encouraging. The coming of the dry season has seen a reduction in the amount of malaria in the country and this will significantly affect the health environment of much of the population. In general there does appear to be an improvement in the overall nutrition situation in the country although security remains a significant problem for displaced and non displaced alike and is likely to be the limiting factor in future nutritional risk.

Recommendations

• Negotiate humanitarian access to affected populations in currently inaccessible area

From the CAD Bubanza survey (CAD 23/03/01)

• Conduct food security assessments to determine the needs of the affected population
• Actively trace cases of malnutrition in the community with outreach workers
• Implement food security programmes to improve access and availability of food.

RNIS 32/33, April 2001

GREAT LAKES REGION (updated by ReliefWeb 7.6.96)

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The crisis in the Great Lakes continues to unfold. Burundi has seen heavy fighting around Bujumbura and a further deterioration in the humanitarian situation in the north of the country resulting in dramatic rises in malnutrition rates and a severe malaria epidemic. The crisis in the Democratic Republic of the Congo (DRC) remains critical despite advances in the peace talks. Many areas of the country remain inaccessible and reports indicate extreme needs as the number of displaced continues to rise. Recently UN observers were deployed in eastern DRC to oversee the withdrawal of foreign armed forces from the country. Uganda is still involved in the larger regional conflict and the presence of external rebel groups continues to displace populations and create conditions of food insecurity. The regional fighting in DRC and Burundi has increased the influx of refugees to the United Republic of Tanzania and prevented hoped for voluntary returns. Lastly the drought affecting the Horn of Africa has also had its impact on the food security of the region.

Burundi

The Arusha peace talks, which started in June 1998, resulted in the signing of a peace agreement between 19 parties of on the 28^th August 2000. However, several armed rebel groups were opposed to the peace negotiations and did not sign the agreement. These groups increased their attacks during the peace negotiations. They continue to fight government forces creating widespread insecurity in many areas of the country. The most recent round of heavy fighting started on the 25^th of February 2001 in around Bujumbura. The fighting resulted in the displacement of around 50,000 people from the suburbs of Kinama, Cibitoke and Kamenge to areas in the Bujumbura rural around the capital. Many of these displaced have subsequently been able to return but have found all of their property looted. Insecurity in the country continues with the most affected areas being Makamba, Bujumbura Rural, Rutana, Ruygi and Bururi province (NRC 00;WFP 16/03/01; UNHCR 02/05/01).

The last year has seen a number of important developments in population displacement in Burundi and current estimates of numbers indicate that there are 379,000 IDPs in the country. This represents a considerable drop in numbers from July 2000 when there was an estimated 670,000 IDPs. The reason for the drop in numbers has been the government dismantling of the regroupment camps in Bujumbura Rural in July 2000. Other areas with large numbers of IDPs are Makamba, Bururi and Rutana Provinces (NRC 00; UN 01; UNHCR 02/05/01).

Estimated Numbers of refugees, IDPs and returnees in the Great Lakes Region

	Jun-99	Sept-99	Dec-99	Mar-2000	July-2000	May-2001
Burundi	451,000	617,000	821,000	830,000	670,000	379,000
Rwanda	640,000	673,000	650,000	652,000	69,000	38,000
RoC	213,000	343,000	823,000	438,000	233,000	112,500
DRC	952,000	1,104,000	1,185,000	1,418,000	1,759,500	2,334,500
Tanzania	373,000	373,000	400,000	465,000	440,000	528,000
Total	2,629,000	3,110,000	3,880,000	3,803,000	3,171,500	3,392,000

Food Security Situation

The continued insecurity in areas such as Bujumbura rural, Gitega and Ruyigi provinces has had an adverse impact on the food security of the affected populations. Insecurity prevents farmers from accessing their land and helps to explain worrying new cropping trends. Farmers are switching from the traditional legume and cereal crops to less labour demanding, but less nutrition-ally valuable root crops. The food security situation has been further hampered by severe drought that has particularly affected the northern region of the country for the past three years (UN 2001; FAO 04/01).

Both season A and season B harvests were poor during 2000, however FAO reports that the recently harvested season A harvest in 2001 is satisfactory. A locally organised FAO/WFP/UNICEF Assessment Mission estimated food production from the season A 2001 harvest to be systematically higher than season A 2000. The area planted increased significantly during the season A 2001 season reflecting relatively better security in the west (particularly in the provinces of Bubanza and Cibitoke) and the closure of regroupment camps in Bujumbura Rural Province, allowing farmers to return to their fields. The other factor which contributed to higher plantings this season was the timely seed distribution by the Government and international agencies, mainly in Kirundo and Muyinga provinces, the areas worst affected by drought during the 2000 A season (FAO/GIEWS 04/01).

Despite a late start of the rainy season, precipitation was abundant and well distributed from October to November benefiting crop development. However, excessive rains in parts resulted in floods and crop losses and, in general, reduced yields, particularly for beans. Yields of bananas and plantains are expected to increase only from March/April as trees were seriously affected by previous prolonged dry weather. The small 2000 C season harvest in the marshlands, from mid-June to September, was poor reflecting the dry weather in previous months. Food output was estimated to be 4% below the level of the 1999 C season (FAO/GIEWS 04/01).

Food insecurity has been further undermined by a very serious malaria epidemic which saw more than 3 million cases reported in the latter half of 2000. The epidemic was particularly bad in the northern provinces and Karusi (UN 2001; WFP 20/02/01).

Bujumbura Rural

IDP numbers in the Bujumbura Rural area have dropped from 200,008 in June 2000+0 30,889 in November as a result of the dismantling of regroupment camps. The "dispersed" populations have scattered into the surrounding areas, where insecurity hampers their attempts to cope and makes humanitarian access extremely difficult. The IDPs remain as vulnerable as before and represent a priority for future humanitarian action. The RNIS has no new nutritional information on the IDP population in this area (NRC 2001).

Karusi

Provinces in northern Burundi are suffering from three consecutive years of drought and crop disease. Karusi, although badly affected by the drought, has received a lot of people from surrounding provinces such as Ngozi, who have suffered worse drought effects and are less served by humanitarian assistance. Much of the influx to Karusi is a result of the perception that conditions are slightly better in the Province (NRC 2001).

In August 2000 MSF-B raised concerns over increases in attendance at their feeding centres and a WFP rapid assessment recommended the provision of rations to families with children enrolled in feeding programmes. In October and November there was a severe outbreak of malaria where more than 75 % of admissions to health centres tested positive to malaria (MSF-B 11/00).

MSF-B conducted a nutritional survey in November 2000, and March 2001. In November 2000, the prevalence of acute malnutrition was estimated as 23.7 % (<-2 Z scores), severe malnutrition 14.4 % (<-3 Z scores), while 13.3 % had oedema. The CMR in the 76 days prior to the survey was recorded as 0.9/10,000/day and the under five mortality as 3.1/10,000/day. The cover- age of nutritional programmes was 17.7 % and 48 % of children had a card showing they had been vaccinated against measles (with a further 36 % claimed they had been vaccinated but unable to provide a card) (MSF-B 11/00).

The survey report does not explain the causes of malnutrition, apart from the malaria epidemic. However, the poor season B harvest, and the influx of displaced almost certainly contributed to this situation. In addition, in November 2000, there was no general food distribution in Karusi. The high prevalence of oedematous malnutrition, although not unknown in this population, is particularly alarming.

The survey in March 2001 showed a prevalence of acute malnutrition of 13.4 %, with 2.5 % of severe malnutrition. Oedema was reported in 1.2 % of the population. CMR in the five months prior to the survey was estimated at 1.2/10,000/day and the under five mortality rate at 3.2/10.000/day. The coverage of the feeding programmes had improved slightly to 27%. A total of 38% of children could provide a card showing positive measles vaccination status. A further 44.3 % claimed they had received measles vaccination (MSF-B 03/01).

This appears to indicate an improvement in the nutritional situation. However, RNIS is concerned that the drop in the prevalence of malnutrition is mainly due to a decrease in the severely malnourished. Given the low coverage of the feeding programmes, and the high under five mortality, the apparent improvement in the nutritional situation could be due to high death rates amongst the severely malnourished (MSF-B 03/01).

The MSF-B nutritional survey report also describes a survey conducted in Ngozi Province in February 2001 which showed an estimated prevalence of acute malnutrition of 17.8 %, 4.1 % were severely malnourished. This province has been one of the worst affected by drought, epidemics and insecurity over the course of 2000 (MSF 11/00). The situation in Karusi and the northern provinces remains very worrying with high rates of malnutrition and increasing numbers of admissions to selective feeding programmes. MSF reported on the 11^th of January that they had 16,700 people in supplementary feeding programmes which was ten times higher than the number in January 1999. In March this figure had risen to 22,000 people. The majority of these beneficiaries are children and adolescents but there are also significant problems amongst the adult population. The situation needs to be very carefully monitored.

Acute and severe malnutrition in Karusi and Ngozi provinces

Bubanza Province

Bubanza has been particularly badly affected by unrest in Burundi and until the disbanding of the regroupment camps in June 2000, had one of the largest populations of IDPs in Burundi. However, the past year has seen large reductions with numbers falling from 117,440 in June 2000 to 14,588 in November 2000. The RNIS has not received any new information on nutrition but the last survey done showed falling rates of malnutrition.

Kirundo Province

Kirundo is in the far north east of Burundi, bordering Rwanda to the north, Muyinga to the east and Ngozi to the south west. The population is estimated to be 500,000 people with 5000 being displaced. The province has suffered from four successive years of drought and there are signs that people have begun to change their eating habits. ACF conducted a nutrition survey in September 2000 and showed an estimated prevalence of acute malnutrition of 6.8 %, while 1.2 % were severely malnourished. The CMR was estimated as 0.4/10,000/day and the under five mortality as 4.35/10,000/day calculated retrospectively over the past month. The measles vaccination coverage estimated from vaccination cards was 38 % with a further 47 % claiming a positive vaccination status. The survey does not show alarming rates of malnutrition but the poor food security situation and access to health facilities mean that the situation should be monitored very carefully (ACF 09/00).

Overall

The nutritional situation in Burundi has deteriorated over the last year. This is a result of continued insecurity, successive poor harvests and a high burden of disease. A severe malaria epidemic developed over the latter half of 2000. Areas in the north of the country have been particularly badly affected. Overall, the prevalence of malnutrition in affected communities appears to have improved, but importantly, the under five mortality is alarmingly high. With the current situation IDPs should be regarded as highly vulnerable (category II). Particular note should be taken of the fact that very little information is available from the southern areas of the country due to the prevailing insecurity. However, it is likely that needs in this area remain very high and the overall situation needs very close monitoring.

Recommendations

• Closely monitor the development of nutritional status of affected populations.
• Try to assure humanitarian access to affected populations in currently inaccessible areas of the country.

From the MSF surveys in Karusi Province in November 2000 and March 2001.

• General food distribution should be established as quickly as possible to ensure that the nutritional situation does not deteriorate
• Seed and seed protection ration distributions should further cover the upcoming harvest periods.
• The coverage of feeding programmes needs to be improved.
• The causes of oedema should be determined.
• Measures should be taken for the prevention/preparedness of future malaria epidemics.
• There is a need for a widescale measles vaccination campaign.

From the ACF survey in Kirundo Province in September 2000

• Conduct a study of health and sanitation problems in the region and how the coverage might best be improved.
• Evaluate the impact of the food distribution and food security programmes.
• Improve access to drinking water for the general population of Kirundo.

RNIS 31, July 2000

The dismantling of the regroupment camps in Burundi is underway, but a very high proportion of the population are still displaced. The humanitarian crisis in the Democratic Republic of Congo remains severe. Access to war-affected and other vulnerable populations remains limited. The humanitarian situation in some of the eastern provinces is particularly poor. Large numbers of displaced people have returned to their homes in the Republic of Congo after the peace agreements were signed in December 1999. Funds are urgently required to support the reconciliation process. A large number of refugees from Burundi and Democratic Republic have sought refuge in the United Republic of Tanzania since October 1999. The table below shows the estimated number of refugees, IDPs and returnees in need of assistance in the Great Lakes Region. A severe drought is currently affecting the horn of Africa including several countries in the Great Lakes Region.

Estimated numbers of refugees, IDPs and returnees in the Great Lakes Region

	June-1998	Mar-1999	Jun-1999	Sep-1999	Dec-1999	Mar-2000	Jul-2000
Burundi	670,000	222,000	451,000	617,000	821,000	830,000	670,000
Rwanda	550,000	690,000	640,000	673,000	650,000	652,000	69,000*
RoC	50,000	213,000	213,000	343,000	823,000	438,000	233,000