United Nations System
Standing Committee on Nutrition

Nutrition Information in Crisis Situations - Democratic Republic of the Congo
 

NICS 16, March 2008

Two earthquakes, measuring 6.1 and 5.0 on the Richter scale, were recorded along the DRC/Rwandan border on February 3, 2008 (OCHA, 04/02/08). Initial estimates confirmed 44 dead and over 1,000 injured. A UN assessment in the South Kivu capital of Bukavu in the weeks following the earthquake identified structural damage to homes and other buildings, including 56 medical facilities and several schools, as the major consequence of the earthquake (UNDAC, 22/02/08).

Katanga province remained in the midst of a cholera epidemic, recording 5,483 cases and 120 deaths in the first 7 weeks of the 2008 alone (OCHA, 02/08). Efforts are being made by the MoH and UN partners, as well as numerous NGOs to curb the epidemic, including provision of clean drinking water and well disinfection, improvement of sanitation facilities and community education (UNICEF, 04/03/08).

A series of random sampled surveys by AAH-US in South Kivu indicated the nutrition situation to be quite good (AAH-US, 11/07-01/08). Acute malnutrition rates ranged from 0.9-4.6%, while severe malnutrition was negligible and very few cases of edema were reported (figure 8).

Additional surveys conducted in other provinces found nutrition situations ranging from good to serious (AAH-US, 11/07-01/08; COOPI, 11/07) (figure 8). Under 5 mortality rates were above the emergency threshold in the Bandundu and Kasai Oriental province surveys.

IRC conducted randomly-sampled retrospective mortality surveys in 31 health zones, covering a recall period of 16 months (January 2006 - April 2007) (IRC/Joint, 01/08). Two surveys were done; one was carried out in 15 health zones in the west of the country and the other one was undertaken in 16 health zones, in the east of the country. The results showed high mortality rates, especially in the east of the country (table 8). The difference between the crude mortality rates in the east and west was statistically significant. Mortality rates have remained stable compared to 2004 in both areas (figure 9). Fever/malaria, diarrhea, respiratory infections, tuberculosis and neonatal conditions were responsible for over 55% of deaths.

Figure 8 Prevalence of acute malnutrition and mortality rates, DRC, November 2007-January 2008 (AAH-US, 11/07-01/08; COOPI, 11/07)

Figure 9 Mortality rates, DRC

Table 8 Results of mortality surveys, DRC, 2006-2007 (IRC, 01/08)

NICS 15, December 2007

The violence that began in North Kivu between the Forces Armées de la République Démocratique du Congo (FARDC) and Laurent Nkunda's forces in September 2007 has continued unabated. By mid-November OCHA had been able to confirm that at least 405,345 people were displaced in the region surrounding Goma (OCHA, 11/07). Humanitarian aid has been suspended in many areas due to the insecurity. In early December, the WFP was forced to halt all movements outside of Goma, postponing food distributions to as many as 335,000 IDPs (WFP, 12/07). ICRC reports to having treated numerous casualties of military clashes, including some civilians, and signal that rape, looting, and recruitment of child soldiers are on the rise (ICRC, 11/07).

Cholera outbreak confirmed in South of country

WHO reported 286 cases of cholera and 18 deaths (Case Fatality Rate 6.0%) in the southern city of Lubumbashi and its surrounding area during the month of October (WHO, 11/07). The primary explanation given for the elevated level of mortality was the lack of proper treatment centers within reasonable distance for those affected.

High levels of severe acute malnutrition persist

Nutrition surveys in Kinshasa, Orientale, Katanga, and Equateur provinces showed average to poor nutrition situation (figure 7), although it is important to note that severe malnutrition ranged from 1.5% to as high as 4.3%. The Kinshasa survey also measured the nutritional status of women and found BMI and iron supplementation levels to be acceptable (IPS/Joint, 04/07) (table 6).

Figure 7 Results of nutrition surveys, DRC, 2007 (ISP/Pronanut, 04/07; COOPI, 10/07; GOAL, 05/07; AAH-US, 08/07)

Table 6 Women’s Nutritional Status, Kinshasa Province (ISP/JOINT 04/07)

NICS 14, September 2007

An upsurge in violence in North Kivu in September 2007 has displaced thousands of new people (UNHCR, 29/09/07). Although some humanitarian assistance has been organised, it seems that acute malnutrition is highly prevalent (OCHA, 28/09/07; WFP, 13/09/07).

An outbreak of Ebola haemorrhagic fever has been reported in the Province of Kasai Occidental (WHO, 27/09/07).

Nutrition surveys conducted in Orientale, Katanga and Bandudu provinces showed under control to average nutrition situations, except in Gungu health zone where 2.3% of the children surveyed had oedema (figure 6). On the other hand, a nutrition survey conducted in Rwanguba health zone in North Kivu showed a very high prevalence of kwashiorkor, with 4.9% of oedematous children (WV/Joint, 03/07). The overall prevalence of acute malnutrition was 12.5%.

Figure 6 Results of nutrition surveys, DRC, 2007 (AAH-US, 05/07-07/07; WV/Joint, 03/07)

NICS 13, May 2007

The security situation remains volatile, especially in the east of the country.

Several surveys conducted in Kasai Oriental, in areas where fighting raged between 1998 and 2003, showed poor to critical nutrition situations (WFP, 10/06) (figure 6). Especially worrying was the high proportion of oedematous children. The surveys were conducted during the hunger-gap season and food security appeared poor. Families seemed to lack proper tools and seeds to undertake adequate agricultural and fishing activities. Exclusive breast-feeding rates were very low and introduction of complementary foods before six months was widespread.

Figure VI Prevalence of acute malnutrition, Kasai Oriental province, DRC, October 2006 (WFP, 10/06)

In Ituri district, Orientale province, the nutrition situation was still poor (figure 7) but showed a marked improvement compared to 2004 (COOPI, 11/06; COOPI, 12/06; COOPI, 01/07). The security situation had also improved, although it was reported to still be volatile.

In Tshopo district, Orientale province, levels of acute malnutrition, and especially of kwashiorkor, seemed critical in Yaleko health zone (figure 7) (LWF/joint, 10/06). On the other hand, the situation was under control in Opala health zone, and average in Bafwasende.

Figure VII Prevalence of acute malnutrition, Orientale province, DRC, October 2006-January 2007 (COOPI, 11/06; COOPI, 12/06; COOPI, 01/07; LWF/joint, 10/06)

The situation was also poor in Lusangi and Sarabila health zones, Maniema province. The prevalence of acute malnutrition was 11.3% (9.2-13.4) including 3.2% severe acute malnutrition (Concern, 02/07). Mortality rates were also worrying. The survey was conducted shortly after the harvest, at a time when the nutrition situation should be at its best. Access to quality health care was reported to be poor because of inadequate staffing and supplies in medicines, and high costs. Child-feeding practices were less than satisfactory. According to a survey conducted in Bulungu health zone, Kwilu district, Bandudu province, in January 2007, the prevalence of acute malnutrition was 9.5%, including 4.5% severe acute malnutrition, with 3.1% of oedematous children (PRONANUT/Joint, 01/07). This is within the same range as recorded in the nearby Vanga and Mosango health zones in October 2006 (see NICS 12).

Overall

Despite an improvement in the security conditions, the nutrition situation seemed to remain precarious (category II) in most of the areas of Maniema, Bandudu, Kasaï Orientale and Orientale provinces where surveys were conducted in late 2006/early 2007.

NICS 12, February 2007

Nutrition surveys conducted in South Kivu and North Kivu at the end of last year showed acceptable situations (figure 6) and an overall improvement in the situation when comparisons with previous surveys were possible (AAH-US/UNICEF, 10/06-12/06, SC/PRONANUT, 11/06). Mortality rates were average.

On the other hand, the nutrition situations were poor in Vanga and Mosango health zones, Bandudu province and under-five mortality rates were near alert threshold (figure 6) (AAH-US/UNICEF, 10/06). No information on possible explanations of the poor nutrition status was available in the draft survey reports

Figure VI Results of nutrition and mortality surveys, DRC (AAH-US, 10/06, AAH-US, 11/06; AAH-US, 12/06; SC, 11/06)

NICS 11, November 2006

Joseph Kabila is the first democratically elected President in DRC for over 40 years (DFID, 06/12/06). He won the second round of the elections, which were regarded as largely credible and transparent according to international and national observer missions, by 58% of the vote against 42% for his challenger Jean-Pierre Memba.

Security conditions have improved in parts of DRC such as Ituri and Katanga (OCHA, 24/11/06) although new fighting erupted in North Kivu (IRIN, 06/12/06). The number of displaced people was estimated at 1,075,300 as of October 2006, a significant decrease compared to 2005 and 2004 when it was 1,624,000 and 2,127,000, respectively (UNHCR, 08/11/06). The number of displaced people especially decreased in Kasai Occidental, Maniema and Katanga provinces. About 80,000 refugees are estimated to have returned in DRC this year; 410,000 remained out of their country (UNHCR, 28/12/06).

The overall living conditions in DRC remain difficult for most of the population with limited agricultural and economic opportunities and a poor public health system (ACF, 17/11/06).

Several nutrition surveys conducted in Bas Congo, Katanga, Orientale and Equateur provinces between June and September 2006 showed average to precarious situations (figure 14) (AAH-US/UNICEF, 06/06-09/06). The worst situation was seen in Mitwaba displaced camps and Mitwaba health zone, Katanga, which have experienced several years of insecurity. Prevalence of severe malnutrition was especially worrying: 4.9% (3.2-7.4) and 6.5% (4.7-8.9) in Mitwaba health zone and displaced camps respectively. This was probably due to a high number of oedematous children.

In Kilwa, Katanga, where a nutrition survey conducted in displaced camps in March 2006 showed an alarming situation (see NICS 9), the nutrition situation of non-displaced population was average, in July 2006. The security conditions had improved a lot in the area compared to March. However, the survey recorded a significant percentage of oedematous children, and mortality rates were above alert thresholds.

In Malemba Nkulu and Lwanba health zones, Katanga, the prevalence of acute malnutrition has slightly increased in 2006 compared to the same period in 2005 (see NICS 8), although confidence intervals of the 2 surveys overlap. Mortality rates ranged from under control in six areas, to above alert thresholds in the other six areas.

Figure XIV Prevalence of acute malnutrition, DRC (AAH-US/UNICEF, 06/06-09/06)

Overall

Despite an improvement in security, livelihoods and nutritional status remain precarious (category II) in DRC.

NICS 10, August 2006

At the end of July elections were held for the first time in more than 40 years in DRC. Following the release of the preliminary results of the first round of the presidential elections showing that Joseph Kabila and Jean-Pierre Memba were the two candidates to go on to the second round, fighting between the two candidates’ guards erupted at the end of August in Kinshasa, leading to at least 23 deaths (AFP, 03/09/06).

The fate of about 100,000 displaced people in the territory of Irumu, in Ituri, has raised concerns, especially in Gety where 40,000 displaced people are gathered (OCHA, 04/08/06). Although some food distributions have been conducted, they were insufficient to ensure the food security of the displaced. Moreover, a cholera outbreak has been reported. The provision of humanitarian aid is also made difficult by the insecurity in the region (IRIN, 01/09/06).

A nutrition survey conducted during the hunger-gap season in Ikela health zone, Equateur province, showed a poor nutrition situation with a prevalence of acute malnutrition of 13.6% (10.7-17.2) including 2.7% (0.5-4.8) severe acute malnutrition (AAH-US, 06/06). Mortality rates were above alert thresholds: CMR = 1.34 deaths/10,000/day and under-five MR=3.41 deaths/10,000/day.

NICS 9, May 2006

Appalling situation among IDPs in Katanga

Following an upsurge in violence in the north and the centre of Katanga province in November-December 2005, it is estimated that about 165,000 people have been displaced (IRIN, 04/05/06). Thousands of them, almost destitute, are gathered in displaced camps around towns, with makeshift shelters, poor access to basic needs, and lack of protection (MSF, 01/06). Relief has been slow and needs are still not covered, despite a recent upscale in aid. With the rainy season hampering access by road, WFP has recently air dropped food to the province (WFP, 09/05/06). However, their operation has a critical fund shortfall of 36%. Registration of displaced people is on-going, which will facilitate estimation of needs and provision of aid (IRIN, 04/05/06). According to a random-sampled nutrition survey conducted in March 2006 in the IDP camps near Dubie, the nutrition situation was bad, and mortality rates were appalling (table 5) (MSF-H, 03/06). Causes of mortality were not recorded. Most of the displaced arrived in November and December 2005 and while they had been able to find some work during the planting season, they have had very few means of earning income afterwards. They reported they had sold most of their belongings for food and were relying mostly on cassava. Food distributions have been erratic and covered less than half of the minimum requirements.

Table 5 Results of a nutrition and mortality survey among displaced people in Dubie, Katanga, March-06 (MSF-H, 03/06)

Overall

Funds and an upscale in relief programmes are urgently needed to contain the appalling situation (category I) of the displaced in Katanga.

NICS 8, January 2006

Fighting has continued in East DRC, especially in South and North Kivu, Maniema and Katanga provinces and has led to population movements inside the country and to neighbouring countries, particularly Uganda (OCHA, 30/11/05; UNHCR, 27/01/06).

Nutrition surveys conducted in Malemba and Lwamba health zones, Katanga province, in August 2005, showed a nutrition situation which was not critical, but a crude mortality rate on the edge of the alert threshold (table 9) (AAH-US, 08/05). The prevalence of acute malnutrition was within the same range as in 2004. At the time of the survey, the area had been calm for several months.

Table 9 Results of nutrition surveys in Malemba N'Kulu and Lwamba health zones, Katanga, DRC (AAH-US, 08/05)

NICS 7, August 2005

Improvement of the situation in Shabunda health zone, South Kivu

A random-sampled nutrition survey conducted in May 2005 showed improvement, compared to previous years, of all the indicators measured, such as the prevalence of acute malnutrition among the 6-59 month- old children, the nutrition status of the under-six month olds and the chronic energy deficiency among adults (figure 9) (AAH-US; 05/05). The crude mortality rate has also declined but was still at the alert level (1/10,000/day). The number of admissions to the therapeutic feeding centre in the first semester of 2005 was lower than in 2004 and 2003.

Figure 9 Nutrition status in Shabunda health zone, South Kivu

Average to precarious nutrition situation in South Ubangui district, Equateur province

According to nutrition surveys conducted in five health zones of South Ubangui district, the nutrition situation was average to precarious, depending on the health zone (table 6) (Pronanut/AHA/UNHCR, 06/05). Mortality rates were below alert threshold in most of the health zones but measles vaccination coverage was very varied (table 6). The poorest situation was in Zongo health zone, with more than 10% acute malnutrition, including 2.3% oedema and an under-five mortality of 2.1/10,000/day.

Table 6 Results of surveys in South Ubangui, Equateur province, DRC, June 2005 (Pronanut/AHA/UNHCR, 06/05)

NICS 6, May 2005

The security situation is still highly volatile in Eastern DRC, despite the disarmament of more than 11,000 ex-combatants following the arrest of former militia leaders who were preventing fighters from disarming (USAID, 30/04/05). A cholera epidemic has been reported in Ituri but was on the decrease as of beginning of May (OCHA, 06/05/05).

According to a random-sampled nutrition survey, conducted in Lubutu and Obokote health zones, Maniema province, the nutrition situation was precarious and the crude mortality rate was above emergency threshold (table 11) (AAH-US, 12/04). On the other hand, among a survey of 96 infants less than 6 months old, only three were acutely malnourished. The nutrition status of the adults (male and female) was considered average: BMI < 18.5 = 17.9%.

Table 11 Results of surveys in Maniema and South Kivu provinces, DRC (AAH-US, 11/05; AAH-US, 12/05)

The situation was worse in Shabunda health zone, South Kivu, where 4.1% of the adults (table 11) (AAH-US, 11/04). In addition, out of 112 0-6 month-old infants measured, five measured less than 49 cm and nine were considered acutely malnourished. The crude mortality rate was above alert threshold (table 11). The situation has worsened compared to November 2003 (figure 8).

Figure 8 Acute malnutrition in Shabunda health zone, South Kivu, DRC

NICS 5, February 2005

Despite the beginning of the disarmament process, violence is still widespread in the east of the country with fighting reported in Ituri district (UNNews, 31/01/05; IRIN, 13/01/05) and in North Kivu, with the displacement of at least 100,000 people, of whom some have sought refuge in Uganda (IRIN, 30/12/04) (see Uganda). Although a 10-km buffer zone has been created by the UNMIL, assistance has been difficult to deliver (IRIN, 30/12/04).

A cholera outbreak has been reported in South Kivu with 2,152 cases during January (IRIN, 27/01/05).

Following the alert launched by Refugee International about IDPs sheltered near Kinshasa (see NICS 4), a programme of repatriation has begun (RI, 31/01/05).

Mortality rates in western and eastern DRC

IRC conducted randomly-sampled retrospective mortality surveys in 25 health zones between April and July 2004, covering a recall period of 16 months (IRC, 07/04). Two surveys were done; one was carried out in ten health zones in the west of the country (formerly government held areas) and the other one was undertaken in fifteen health zones, in the east of the country (formerly non-government held areas). The major part of the east has experienced a higher level of violence. Forty-six health zones were removed from the sampling in the east owing to insecurity which prevented access.

The results showed high mortality rates, especially in the east of the country (table 14), where they were above alert threshold. The difference between the crude mortality rates in the east and west was statistically significant. Deaths due to violent injury were concentrated in 9 of the 15 eastern health zones, where at least one violent death had been reported, which increased the CMR by 75%, compared to eastern health zones where no violent death had been reported. In the same way, in the east, areas experiencing ongoing conflict had a CMR almost twice the CMR in more secure areas: 2.7/1,000/day vs. 1.4/1,000/day.

The number and proportion of violent deaths had, however, decreased over the 16 months of the recall period.

Morbidity-related causes of death were mainly due to fever, diarrhoea, malnutrition and respiratory infections.

In the east, the highest death rates were recorded in Katana and Shabunda (South Kivu), Moba and Kalemie (Katanga), and Kalima (Maniema), and in the west, in Mutena, Kalonda East and Kalonda West (Kasai Occidental), and Kipushi (Katanga).

When compared with the mortality survey conducted in 2002, although crude mortality has decreased by 23% in the east and 20% in the west, the difference was not significant (figure 4).

Figure 4 Mortality rates in DRC

CMR recorded in 2002 had significantly decreased compared to 2001 in the east (see RNIS 42).

Table 14 Mortality rates in DRC, April 2004 (IRC, 07/04)

 * Calculated from the rate expressed as /1,000/month

NICS 4, November 2004

The Rassemblement Congolais pour la Démocratie (RCD) resumed its participation in the government in September 2004 (OCHA, 23/10/04). The United Nations Mission in the Democratic Republic of Congo (MONUC) has been extended until March 2005, with a reinforcement of 5,900 civilian and military personnel (UNSC, 01/10/04). Instability is still prevailing in the east of the country, with reported violence against civilians, including sexual abuses (AI, 26/10/04). Moreover, some refugees, of Tutsi ethnicity, have been prevented from going back home for some time by local populations (OCHA, 31/10/04). The humanitarian situation is also dire. A joint mission reported that humanitarian needs are not covered on the Uvira-Fizzi-Bukavu axis (OCHA, 15/11/04).

UNHCR signed agreements with the Republic of Congo and the Central African Republic for the repatriation of an estimated 72,000 refugees (OCHA, 23/10/04). Refugee International has drawn attention to the IDPs in Kinshasa and Kalemie, who have been left without protection or assistance (RI, 22/10/04).

NICS 3, August 2004

The peace process has suffered a significant setback over the last months. At the beginning of June, renegade former RCD (Rally for Democracy) soldiers mutinied against the army in Bukavu (USAID, 20/08/04). This was the beginning of a two-month wave of violence in Bukavu and in Kahele region, south Kivu, which has led to the displacement of an estimated 35,000 people within DRC and of 20,000 people who fled to Burundi (OCHA, 31/07/04). The humanitarian activities were suspended for about two months.

In Mahagi territory, Ituri district, at least 35,000 people have been displaced owing to violence during July 2004 (OCHA, 31/07/04).

In addition, on the political front, the RCD has suspended his participation in the transitional government and in the parliament (AFP, 23/08/04).

The International Crisis Group has called for a greater commitment by the international community to the resolution of the DRC's crisis (ICG, 24/08/04).

WHO has announced a resurgence in major epidemics, such as measles, cholera, meningitis and plague (AFP, 12/08/04).

NICS 2, May 2004

Despite a general improvement in the security situation since the signing of a peace agreement in mid-2003, part of DRC is still not accessible because of poor infrastructure or insecurity, which prevails especially in the east (see map). Violence has been reported during April and May in North Kivu, South Kivu and Katanga; it is estimated that 30,000-35,000 people were displaced in April in these areas (OCHA, 30/04/04). In late May, fighting between rival factions of the army erupted in Bukavu; more than 2,000 people fled to Rwanda (IRIN, 31/05/04). A demobilisation and re-integration project of an estimated 150,000 ex-combatants has been approved by the World Bank (WB, 25/05/04).

Between 80,000 and 100,000 people, mainly Congolese, considered to be illegal diamond miners, have been expelled from Angola to DRC in dire conditions (see Angola).

Worrying situation in Bundu health zone, Fizi area, South Kivu

The area was inaccessible for years owing to the war. Since mid-2003, the security situation has improved as well as the access to the area. The main activities are agriculture and fishing; they have been reduced during the war because of insecurity and lack of seeds and inputs. During the last few months, there seems to have been a lot of spontaneous returns of Congolese refugees to Fizzi; the number of returnees was estimated at 44,000 (OCHA, 21/05/04).

The nutrition situation in Nundu health zone is of concern (AAH-US, 11/03) (table 19). Despite the improvement in the security situation, people do not benefit from good food security or access to basic services.

Table 19 Results of nutrition and mortality surveys, DRC

Average nutrition situation in Shabunda and Lemera, South Kivu

In Lemera, security has been poor for years and is not yet completely stabilised. The main source of food is own production, essentially cassava. Although arable land is available, it is too expensive for the majority of the population. Prices of livestock have dramatically increased, following intense looting. The buying power of the population has decreased. However, the nutrition situation was average (table 19) in November 2003 (AAH-US, 11/03).

In Shabunda, the nutrition situation was also average in November 2003 (table 19) and has greatly improved compared to February 2002, when the prevalence of acute malnutrition was 20.4% (AAH-US, 11/03). The improvement has mostly been attributed to the amelioration of the security situation which allows cultivation and commercial exchanges.

Acceptable nutritional status in Moba and Kansimba, Katanga

The nutrition situation was under control in Moba and Kansimba in October 2003 (table 19) and has improved compared to November 2001 when the malnutrition rate was 6.2% (AAH-US, 10/03). This could possibly be due to the improvement in the security situation. However, mortality rates were high (table 19).

Nutrition situation of concern in Bankusu, Equateur

The main source of income before the war was coffee production but this was particularly affected during the war. The nutrition situation was of concern (table 19) as well as the food security situation (AAH-US, 02/04). Moreover, mortality rates were above alert thresholds (table 19).

Overall

The improvement of the security situation since mid-2003 seems to have played a part in the amelioration of the food security and nutrition status in some areas (category III), whilst others remain at risk (category II).

NICS 1, February 2004

The power-sharing transitional Government, which consists of members of the former Government, of former rebel movements and of the political opposition, has been functioning since July 2003 (UNSC, 17/11/03). The capacity and role of the MONUC (the UN peace-keeping force) have been reinforced (see RNIS 43) and the MONUC has begun to deploy outside Bunia town (UNSC, 17/11/03). It seems, that, as a consequence of these positive developments, violence has scaled down (RI, 15/12/03). However, harassment of civilians, including sexual violence and looting of assets and crops, is still widespread, especially in eastern DRC (OCHA, 24/11/03; OCHA, 11/12/03; RI, 15/12/03). Demobilisation and reintegration of fighters will be one of the major challenges of the coming months.

Two random sampled nutrition surveys were conducted in Mweso and Birambizo health zones, North Kivu, in August and September 2003 (MSF-H, 09/03). The nutrition situation was average in Birambizo health zone (category III) but more worrying in Mweso health zone (category II); the proportion of oedematous children was of concern in both areas (see table 11). 17% and 33% of the families surveyed in Birambizo and Mweso health zones, respectively, were displaced. The population is mostly agricultural and the majority of the population was relying on its own production for food (see table 12). The population in Mwezo seemed to be more vulnerable: a higher proportion of the population was eating only one meal a day, was relying on purchase for food and was involved in daily work. This may be because there were more displaced people in Mweso health zone than in Birambizo health zone.

Table 11 Results of nutrition surveys, Birambizo and Mweso health zones, North Kivu, DRC, August-September 2003 (MSF-H, 09/03)

Table 12 Food security indicators, Birambizo and Mweso health zones, North Kivu, DRC, 08-09/03 (MSF-H, 09/03)

Recommendations

From the MSF-H survey in Birambizo and Mweso health zones

• Continue to address nutritional needs through targeted interventions
• Assess nutrition situation in newly-accessible areas
• Continue nutrition surveillance
• Advocate for exemption of health fees for vulnerable populations

RNIS 43, November 2003

Whilst the peace-process continues, with the recent authorization for former rebel groups to function as political parties (IRIN, 06/10/03), violence is still widespread in Eastern DRC. The mandate and means of the UN peace keeping force (MONUC) have been expanded (ISS, 19/09/03). In Ituri region, Orientale Province, which has known an incredible level of violence over the past months, the peace-keeping forces will eventually number 5,000. The troops took over Bunia town from the French-led Interim Emergency Multinational Force, in September, and they have begun to deploy outside Bunia town (Reuters, 08/10/03; Reuters 23/10/03). High insecurity has prevented humanitarian access to needy populations around Bunia town for months.

Oicha and Mutwanga, Beni, North Kivu

About 50,000 people arrived in Beni area, mostly from Orientale Province, around April 2003. The are settled in host communities, in camps or in public buildings. Two random sampled nutrition surveys were carried out in Oicha and Mutwanga health zones in June 2003 (WV, 06/03). Both surveys included a significant number of displaced families (see table).

The prevalence of malnutrition was of concern (see table) but had improved since the last surveys carried out in December 2002. It seemed that children of displaced families had a higher risk of malnutrition than children of resident families. The main source of food was agriculture (76% in Oicha, 93% in Mutwanga), followed by food aid (15.7% in Oicha, 1.4% in Mutwanga) and purchase (7.3% in Oicha, 4.0% in Mutwanga). Food aid was mostly received by IDPs.

Prevalence of acute malnutrition, Beni area, North Kivu, DRC, June 2003 (WV, 06/03)

Kabala, Kalemie, Katanga Province

The area has been prone to insecurity for years; the situation seems to have recently stabilised. A random-sampled nutrition survey was carried out in Kabalo health zone in April 2003 (MSF-S, 04/03). Because of insecurity, 40% of the health zone was not included in the survey. The survey was carried out during the harvest period; people had access to agriculture, fishing and hunting. The prevalence of acute malnutrition was average: 7.7 % (5.7-9.8) acute malnutrition, including 1.8% (0.5-3.1) severe malnutrition. Crude and under-five mortality rates were, however, worrying (1.9/10,000/day and 5.4/10,000/day, respectively). The major causes of under-five mortality were fever (malaria) and measles. Measles vaccination coverage was low; only 37.9% of the children had been vaccinated, according to cards and mothers' statements.

Overall

The nutrition situation seems to be mixed in DRC and malnutrition seems to be highly related to insecurity and population displacement.

Recommendations:

From the WV survey in Beni

• Continue nutrition programmes
• In depth analysis of the food security in the area

From the MSF-S survey in Kalieme:

• Continue nutrition programmes
• Increase detection of malnutrition cases
• Improve health care
• Carry out a measles vaccination campaign

RNIS 42, August 2003

The peace process is on -going. The government of DRC and opposition forces signed an agreement on the country's military structure, on 29 June 2003 (USAID, 30/07/03). However, violence has renewed in Eastern DRC, and especially in Bunia town and surroundings, Ituri, Orientale province. Some improvements have been seen on the economic side. The resumption of the transport of goods on the Congo river will probably help to produce a drop in commodity prices. Moreover, it seems that there was a positive economic growth in 2002 and that inflation has dropped from 135% to 16% in one year (BBC, 05/08/03).

Ituri, Orientale province

The withdrawal of the Ugandan troops from the area (in accordance with a previous accord between the governments of DRC and Uganda) in early May, has led to an escalation of violence between opposition forces, also affiliated to ethnic groups. It is estimated that several thousand people have been killed (MSF, 25/07/03). The number of people who have been displaced is difficult to know precisely, but there have been reports that at least 100,000 fled Bunia area (UNICEF, 19/05/03). The real number is probably more than that, as it has been reported that Bunia town (accounting for 200,000-350,000 inhabitants) was 80% empty in early June 2003 (AFP, 04/06/03). People have fled mostly to Uganda and south to the area around Beni in North Kivu (UNICEF, 19/05/03).

The UN Security Council has authorised the deployment of an Interim Emergency Multinational Force (IEMF) of some 1,500 troops to Bunia town, and the reinforcement of the MONUC presence, in order to secure the zone and protect civilians (RI, 02/06/03). The IEMF began to deploy in early June. The relative calm, which has consequently prevailed in Bunia town, has led some of the displaced people to come back (AFP, 04/06/03; OCHA, 02/07/03). It seems that the returnees were not able to re-establish their houses, which were largely destroyed, but have settled in existing camps (MSF, 04/07/03). Food aid was inadequate (MSF, 04/07/03).

The IEMF intervention has been seen as insufficient. The ICG has called for a bigger UN intervention force, operating in a wider geographical area (ICG, 13/06/03). MSF has also denounced insufficient protection and humanitarian aid for the populations in Bunia area (MSF, 25/07/03) and has especially expressed its concern about the fate of the population outside Bunia town, where the IEMF has no mandate to intervene. MSF has also deplored the insufficient aid deployed for the displaced people in Beni area.

Lubumbashi, Katanga province

AAH-USA has called attention to the situation in Lubumbashi, the capital of Katanga province. During the month of April 2003, 292 cases of severe malnutrition were admitted to TFC, compared to 88 cases admitted in December 2002 (AAH-USA, 28/05/03). The degradation of the situation may be attributed to several causes. The town has known an economic decline, with massive firing of employees, especially from the major copper mining company, which was employing several thousands of people and was also giving them benefits. Lubumbashi has also faced difficulties in supplying food. The main staples, cassava and corn, were coming either from an area in DRC, which is now under rebel control, or from Southern Africa (see RNIS 39). The drought in Southern Africa has probably had a major impact on food importation to Katanga.

Mortality rates in Western and Eastern DRC

IRC conducted a randomly -sampled retrospective mortality survey at the end of 2002 (IRC, 04/03). Two surveys were done; one was carried out in ten health zones, randomly chosen, in the west of the country and the other one was undertaken in ten health zones, randomly chosen, in the east of the country. The west of country was government controlled, whilst the major part of the east was rebel-controlled and has experienced a higher level of violence.

The results showed high mortality rates, especially in the east of the country (see table), where they were above alert threshold. The difference between the mortality rates in the east and west was, however, not statistically significant.

Crude mortality rate decreased in the east compared to the period of August 1998 to April 2001, when the CMR was 5.4 deaths/1,000/month. This reduction was attributed to an improvement in security conditions (peace accord between government of DRC , Uganda and Rwanda; MONUC deployment) and an increase in humanitarian assistance.

Moreover, the deaths attributed to violence seemed to have decreased sharply and was one-tenth the rate in previous years.

It is worth noting that in both surveys (2001 and 2002), areas inaccessible because of poor security conditions were not surveyed. Rates of mortality and deaths due to violence are probably far higher in these areas.

Under-five deaths from diarrhoea, measles and malnutrition were slightly higher in the east than in the west.

Crude and under-five mortality rates, DRC, 2002

RNIS 41, April 2003

Despite the peace agreement signed between the government of DRC and two main rebel groups (the Congolese Rally for Democracy (RCD) and the Congolese Liberation Movement (MLC) in December 2002, and discussions held in late February 2003 to discuss details of the peace deal, fighting is still raging in eastern DRC. Atrocities against civilian populations have been reported (MONUC, 15/01/03; UNSC, 24/02/03). People are trying to escape the conflict by hiding in the forest or seeking refuge in nearby countries. The number of IDPs has increased from 2,275,000 to 2,706,993 over the last six months (OCHA, 31/01/03) (see map). The most affected provinces were North Kivu and Orientale provinces, where 500,000 have been displaced in the last six months. In addition, somewhere between 5,000 to 11,000 people (OCHA, 31/01/03) have recently sought refuge in Uganda, and about 10,000 have fled to Burundi (UNHCR, 23/01/03). At the beginning of the year, fighting was still on going near Bunia but WFP has been able to airlift food to Bunia town (WFP, 31/01/03).

A study done by the Henry Dunant Centre for Humanitarian Dialogue (HDCHD, 02/03) criticised the minimal political, military, and humanitarian response to the DRC crisis.

The study particularly noted that development activities have been more commonly implemented than life-saving actions, the latter being constrained by security, the complexity of the conflict, and above all the political considerations of the peace building agenda. The study also deplored the lack of detailed information on the affected populations, which has further impaired the adequate provision of humanitarian assistance.

North Kivu

Bwito, Rutshuru

The security situation has improved in the area since 2001 and has led to the return of the displaced population in 2002. A food security survey done by SCF-UK in November 2002 showed that the population has been able to carry out "normal" cultivation and petty trade (SCF-UK, 11/02). In 2002, crop production was 70% of pre-war level. However, livestock holdings, which were an important determinant of wealth before the war, have been almost entirely destroyed during the war. At the time of the survey, restocking was starting gradually. The wealth of the population was dependent on access to land, the livestock owned, and volume of beer produced for sale. It was estimated that 45-55% of the households were poor, whilst 30-40% were middle and 10-20% were better-off. The sources of food of the poor households were mainly purchase and labour exchange; 70-80% of their expenditure was going towards purchasing food. September, October and December (before the harvest) are traditionally the most difficult months for the poor households because food availability and job opportunities are reduced. At the time of the survey, the main constraints to food security were: poor access to land; poor access to markets in central and western DRC which has led to low prices of staple food produced in the area and high prices for imported goods; loss of livestock during the conflict and over-dependency on the agricultural sector.

Masisi

SCF-UK undertook a Household Economy Analysis survey in Masisi in November 2002, as an update of a 1999 survey (SCF-UK, 11/02).

The security situation has greatly improved in Masisi since 1999, which has led to the return of the displaced. Those whose areas of origin were not accessible have gathered into camps in eastern Masisi, but the majority of the displaced, who had already settled in the area in 1999, have returned to their area of origin while the remainder have integrated within the host community. Agriculture and petty trade were the main economic activities in the zone. Brewing, sale of wood and charcoal has intensified since 1999. Small livestock activities have also progressed significantly and cattle restocking was also starting. Humanitarian interventions were more common than in 1999; they were mainly directed towards infrastructure rehabilitation, provision of materials and medicines, and livestock activities.

The proportion of the different wealth groups has changed due to the improvement of the food security situation (see table). The observed decrease in the better-off group may be explained by their migration to more secure urban centres. The poor group was obtaining more food from their own production than in 1999, but food still represented a very significant part of their expenditure and they had very little flexibility in purchasing other items or services. Poor access to Kinshasa and Western Congo markets has led to great difficulties in the export of the food produced (food exportation was very high before the war) and therefore to low prices of the staple foods in the area.

The region was therefore considered as cash poor but not food deficient. It was estimated that if security situation remains stable, the food security may continue to improve.

Wealth groups, Masisi, North Kivu, DRC, 11/02 (SCF-UK, 11/02)

South Kivu

Fizi health zone

Since 2000, insecurity has prevented implementation of programmes by international NGOs in the zone. A nutrition survey was carried out in October 2002 (AAH-USA, 10/02); the sample only included areas where security allowed access (Baraka-Kandali, Baraka-Fizi axis). At the time of the survey, some health structures were functioning but were lacking medicines and materials, and water systems were not functional. Among the families surveyed, 27% were displaced. The prevalence of malnutrition caused concern; the severe malnutrition rate particularly was elevated by a high percentage of oedematous children (2.4%) (see table). According to MUAC measurements, 1.2% of the children's mothers were severely malnourished (MUAC < 190 mm) and 7.9% were moderately malnourished (MUAC >= 190 mm and < 210 mm). Measles vaccination coverage was very low (see table). The most recent cultivation seasons were poor, rainfall was inadequate, people were prevented by insecurity from cultivating fields distant from their villages, there were seed shortages. In addition, people were often obliged to move due to insecurity and lost assets during displacements. The overall situation in the zone seemed very precarious. Moreover, the survey only targeted villages where security conditions were adequate to allow the implementation of the survey; the situation of inaccessible populations may be even worse.

Results of nutrition surveys, DRC (AAH-USA, 10/02; 01/03)

¹ According to card or mother's statement

Maniema province

Kindu town

Maniema province has experienced a high level of civil unrest since 1998, which has led to large population movements. A nutrition survey carried out in Kazongo health zone at the end of last year showed that the malnutrition rate had doubled since February 2002 (see RNIS 40). Kindu town and surroundings have been the theatre of fighting between the RCD, which controls the town, and the Maïmaï. The town has become more and more isolated. Most of the railroads, waterways, and airlines have been closed and there were very few exchanges between Kindu town and surroundings.

A nutrition survey was carried out in Kindu town (excepting one area for security reasons) in January 2003 (AAH-USA, 01/03). Acute malnutrition, and especially the percentage of children who had oedema was very high (see table). Households where children have been measured have also been asked about mortality over the previous six months; the result showed that 12% of the under-five children and 5% of the whole population died during this period. The major causes of under-five mortality, according to mothers' statement were malnutrition (42%) and fever (38%). Even though this survey was not completely representative of the entire population because only the families which had an under-five years old child were selected, it showed that mortality in the past six months was very high and that the situation in Kindu town was very poor.

Some 23% of the households interviewed were displaced. The two major waves of arrivals in the town were in December 2000-January 2001 and August-September 2002. The food security of the population seemed very weak. All economic activities in Kindu have collapsed. Moreover, access to fields outside the town was very restricted due to volatile security conditions. The situation was however starting to improve at the time of the survey; transport by river and movements between Kindu and surroundings were increasing, and market prices were decreasing. WFP airlifted some food to the town in February 2003 (WFP, 07/03/03). It was hoped that people would be able to use the seeds they had been distributed and if the town continues to be less isolated, the food security situation may improve. However, it is very important that the food security situation be closely followed, especially for the poorest, given the prevailing high prevalence of malnutrition and the elevated number of deaths.

Kasai Oriental province

Kabinda, Kalonda and Lubao health zones

These areas are hosting large numbers of displaced persons. Three nutrition surveys have been carried out, in Kabinda, Kalonda and Lubao health zones respectively, in September 2002 (PSF, 09/02). The results showed discrepancies between the health zones (see table). Whilst the nutrition situation seems acceptable in Lubao, it is of concern in Kalonda, especially the high percentage of oedema. In Kabinda, a very high percentage of oedema was found (22.1%); if this high prevalence is confirmed, it shows an alarming situation. The NGO which performed the nutrition survey (PSF, Pharmaciens sans Frontières) does not have the capacity to implement a larger nutrition programme and is calling for additional agencies to help tackle the problem.

Malnutrition prevalence, Kabinda, Kalonda and Lubao health zones, Kasai Orientale, DRC, September 2002 (PSF, 09/02)

* Needs to be confirmed

Katanga

A measles epidemic has been declared in the areas of Kamina Lengue and Mukubu. MSF is in charge of a measles vaccination campaign (MSF, 06/03/03).

Malemba N'Kulu health zone

Malemba N'Kulu has had a high level of insecurity since 2001 and populations were displaced or isolated in villages. The security situation has improved since September 2002; and the populace has returned to their villages, but in their absence livestock, food stocks, and tools have been looted. Consequently, people have not been able to cultivate their fields, and insecurity has rending food exchange with other areas difficult. Most of the infrastructure has also been destroyed or looted. MSF was running a TFC and AAH-USA had implemented several supplementary feeding centres and was supporting some health centres. Access to health services overall was however very poor, as was access to safe drinking water.

A nutrition assessment was carried out in Lwamba, Lubinda and Musao health areas in November 2002 (AAH-USA, 11/02). About 95% of the families surveyed were residents who had been displaced during the fighting and 5% were displaced persons. The majority of the residents had spent one to three months in the bush and came back to the villages between September and November. MUAC measurements and presence of oedema were assessed among 956 6-59 months old children, randomly selected according to a cluster sampling methodology (30 clusters). The nutrition situation seemed average (see table). The number of admissions to the TFC has decreased over the last months.

Dilala and Manika health zones, Kolwezi district

Kolwezi district has not suffered very much from war and population displacement. However, the war in the rest of the country has had a major economic impact on the district. Before the war the economic activities were mostly mining in the urban area, and agriculture in the rural areas. This supplied the town. The mining industry not only gave jobs to the population but also caused the roads and other services to be maintained, which effectively provided a safety net to the vulnerable population. The mining industry has collapsed with the war, which has led to unemployment and loss of purchasing power in the town. The urban population is no longer able to purchase food from the rural population and now subsist by cultivating small plots and selling mineral scraps. The rural population conversely is now only producing food for their own consumption. A nutrition assessment was carried out by AAH-USA in January 2003 (AAH-USA, 01/03). MUAC measurements and presence of oedema were assessed among 900 6-59 months old children, randomly selected according to a cluster sampling methodology (30 clusters). The MUAC results showed an average situation, though the percentage of oedema was very high (see table).

Results of MUAC surveys, Katanga, DRC (AAH-USA, 11/02;01/03)

Bandudu province

Inongo

In contrast to the eastern provinces, Inongo area has not been hit by war. A nutrition assessment was carried out by AAH-USA in November 2002 (AAH-USA, 11/02). 1289 6-59 months old children were screened in Inongo town and in three villages; no children had oedema, 0.7% of the children had a MUAC < 110 mm, 2.5 % of the children had a MUAC < 120 mm and 5.3 % had a MUAC < 125 mm. The nutrition situation seemed acceptable. The main problem in the area was the very poor transportation infrastructure, which impaired the circulation of goods and people and limited access to health structures. Safe water availability was also very poor.

Overall

The situation in war-affected areas in DRC remains extremely poor (category II), despite some apparent advances in peace negotiations. For several reasons, inadequate numbers of life-saving programmes are being implemented.

Recommendations and priorities

From the SCF-UK survey in Bwito, Rutshuru, and Masisi, north Kivu:

Short-term:

• Distribute tools
• Increase availability and access to small livestock
• Rehabilitate roads to improve access to market and health centres
• Implement cash-for-work programmes and support alternative livelihoods activities in addition to agriculture
• Implement training/awareness-raising in conjunction with agricultural and livestock programmes

Long-term:

• Assess mechanisms for improving poor farmer's access to fair market prices for their produce
• Study areas for building local capacity to produce items currently imported regionally or internationally

From the AAH-USA survey in Fizzi health zone, South Kivu:

• Implement a nutrition programme
• Support health centres

From the AAH-USA survey in Kindu town, Maniema:

• Provide management of acute and severe malnutrition
• Harmonise the nutrition interventions between the different organisations involved

From the PSF surveys in Kabinda, Kalonda, and Lubao, Kasai Oriental:

• Implement a nutrition programme
• Carry out regular nutrition surveys
• Develop food security programmes

From the AAH-USA survey in Malemba N'Kulu, Katanga:

• Strengthen and follow-up the food security situation
• Continue the nutrition programme
• Support health care
• Support road rehabilitation

From the RNIS:

• Urgently undertake verification of oedema cases in Kabinda health zone and if a high prevalence is confirmed, immediately implement appropriate actions
• Support life-saving programmes

République Démocratique du Congo

Malgré la signature d’accords de paix en décembre 2002, la situation reste très volatile dans l'est du pays, en particulier dans les provinces du Kivu Nord et de l'Orientale. Le nombre de déplacés a augmenté de 2 275 000 à 2 707 000 dans les six derniers mois. Différentes évaluations nutritionnelles ont montré des situations préoccupantes (voir tableaux) (catégorie II) dans certaines zones des provinces du Sud Kivu, Maniema, Katanga et Kasai Oriental.

RNIS 40, Dec 2002

Peace talks between the government and the two main rebel groups, the Congolese Liberation Movement (MLC) and the Congolese Rally for Democracy (RCD) resumed in South Africa at the end of October 2002. On the 17 December, all parties reached an agreement to end the four-year war. They agreed to set up a government of national unity. President Kabila will keep his function until elections are held in two years' time. Four vice-presidents, who will represent the government, the two rebel groups and the unarmed opposition, will be designated. Ministries will be distributed among the different parties (AFP, 17/12/02). However, renewed violence has spread in eastern DRC.

The Security Council has expanded to 8,700 the number of military personnel of the United Nation Organisation Mission in the DRC (MONUC) (UNSC, 04/12/02).

Following the withdrawal of Rwandan and Ugandan troups (which were backing rebel groups) as part of the peace agreement signed with those countries, Zimbabwe, Angola and Namibia, which were supporting the Kinshasa government, announced a final pull-out of forces at the end of October 2002 (OCHA, 25/10/02).

Upsurge in displacement

The withdrawal of Rwandan and Ugandan forces has led to an upsurge of fighting in north-eastern Congo.

In Inturi region, at least 500,000 people were displaced due to renewed fighting between Lendu and Hema communities (OCHA, 06/11/02). Over 5,000 people have crossed the border with Uganda (Xinhua, 23/10/02). The issue of ethnic cleansing has also raised concern (HRW, 31/10/02).

About 35,000 people were reported to have fled from Makeke town into Beni town on 31 December 2002 (MSF, 04/01/03). They are only a small part of hundreds of thousands who might be displaced in the region (MSF, 04/01/03, OCHA, 08/01/03). Extreme violence against the population has been reported (MSF, 04/01/03). However, a cease-fire agreement was reached on 31 December 2002 between the three factions which fight in the area. They also agreed to guarantee freedom of movement to the civil population and humanitarian organisations. MONUC will deploy military observers to the area (UNNS, 31/12/02).

The crisis affecting the northern town of Bunia continues. A cholera outbreak has been on -going since August and a humanitarian flight has been denied access (OCHA, 18/10/02).

In South-Kivu, the Mayi-Mayi forces took the town of Uvira, formerly controlled by the RCD, in mid-October. The town was recaptured by the RCD one week later. This led to the displacement of an estimated 60,000 people, of whom about 17,000 crossed the border with Burundi and 500 sought refuge in Tanzania (OCHA, 23/10/02). It seems that some 20,000 returned to Uvira after they were not permitted to enter Burundi (OCHA, 22/10/02). Despite the truce, a new upsurge in violence in the area at the end of December led to a new displacement of the population, of which 9,000 entered Burundi (UNHCR, 07/01/03).

Thousands of people have fled from Orientale Province to Eringeti area, northern Kivu (Tear Fund, 11/12/02).

In Katanga Province, 75,000 people were displaced by fighting between government troops and the Mayi-Mayi (22/11/02).

Maniema province

Before the war, Maniema Province was considered as the breadbasket of Congo. The region has been cut off from the rest of the country since the Kindu-Lubumbashi railroad was closed four years ago. Furthermore, in the months of August-September only, Kosongo area, southern Maniema, suffered from 15 attacks. Several villages have been burned or looted. Some 131,000 people, including 77,000 IDPs, are considered to be in need of humanitarian aid. A survey done by Concern in four sub-health zones of Kazongo health zone, showed a prevalence of acute malnutrition of 11.7%, including a high 3.8% rate of severe malnutrition. The rate of acute malnutrition was reported to have doubled since the last survey conducted in February 2002 (OCHA, 22/11/02).

Refugees

Forcible repatriation of Tutsi Congolese refugees from Rwanda (RNIS 39) appears to have ceased (OCHA, 25/10/02). The previously repatriated, who are settled in Kitchanga transit camp, are in great need of food and non-food aid (WFP, 07/11/02).

Overall - Although few nutrition data are available, the affected population in north-eastern DRC, and especially the IDPs, are considered to be at high risk of malnutrition (category I). If the cease-fire agreement proves to be effective, access to the population may improve and desperate humanitarian situations may be discovered.

République Démocratique du Congo

L'insécurité s'est fortement aggravée ces derniers mois dans le nord-est du pays. Une violence extrême envers les populations a été dénoncée. Des dizaines de milliers de congolais se sont déplacés dans la région, d'autres ont fui vers le Burundi ou la Tanzanie. Les déplacés sont très difficiles à atteindre par les agences humanitaires et sont probablement dans une situation très difficile (catégorie I).

RNIS 39, October 2002

Peace accords were signed at the end of July between DRC and Rwanda, aimed at withdrawing Rwandan forces and disarming the ex-FAR and In-terahamwe factions (Reuters, 30/07/02). Peace agreements were also signed between DRC and Uganda in early September (BBC, 09/09/02). Ugandan and Rwandan forces are currently withdrawing from RDC and 2,000 Rwandan Hutu ex combatants have been disarmed (OCHA, 26/09/02). Nevertheless, the security situation remains very tense in various parts of Congo with on-going displacement of populations and lack of access by humanitarian organisations to a significant number of people.

Internally Displaced Persons

The number of IDPs is extremely difficult to estimate because of widespread and frequent displacements due to fighting as well as access difficulties. However, OCHA estimates that as of July 2002, there were about 2 m people displaced throughout RDC. In 1996 the number of IDPs was estimated to be only 400,000, clearly the situation has worsened over the past several years. IDPs are mostly located in North Kivu, South Kivu and Orientale provinces. Most of the IDPs are living near relatives or in the bush.

Repatriation of Refugees from Rwanda

About 8,000 Congolese refugees previously settled in Gihembe camp in Byumba prefecture and at Kiziba in Kibuye prefecture have been repatriated by the Rwandan government to the Masisi region of Congo. UNHCR has expressed its concern about forced repatriation (UNHCR, 05/09/02). As of 17 September, it seems that the repatriation has slowed (UNHCR, 17/09/02). Despite some refugees saying they were willing to be repatriated, others claim they were forcibly returned. There were also reports of intimidation by local security forces stating it was time for the refugees to return home. The refugees who left hurriedly were only able to carry out few of their belongings (UNHCR, 17/09/02). The returnees are settled in Kitchanga, 80 km north of Goma, in an old tea factory. A UNHCR mission indicated that the sanitary situation was very poor with only three latrines for 8,000 people and a lack of potable water (UNHCR, 17/09/02). On the other hand, the Rassemblement Congolais pour la Démocratie (RCD) stated they had provided food and tools to the returnees (OCHA, 12/09/02). There are reports that direct access to the returnees is being prevented (OCHA, 19/09/02).

Nutrition and health situation

No recent survey reports have been made available to RNIS. WFP reported a troubling nutrition situation in the city of Kindu in Maniema. People were being prevented from going out of the town which was surrounded by the Mayi-Mayi forces (WFP, 30/08/02). The nutritional situation was also reportedly poor in Zongo in Equateur province (WFP, 26/07/02). WFP recommended that a nutritional survey be undertaken in Kindu, as well as support provided to feeding programmes (OCHA, 31/08/02). A TFC opened by AAH-USA in Shabunda in South Kivu, received more than 100 patients in the first month.

Recent fighting in Bunia, North Kivu, has led to a new humanitarian crisis. Food and non-food aid is being supplied now the situation in the town is more secure although it is still tense. A cholera outbreak, due to poor water supplies after the piped water was cut off has been reported continuing since August (MEDAIR, 06/09/02).

In Katanga, a cholera outbreak is still on going with 368 new cases in the week of 19-25 August 2002 (OCHA, 31/08/02). In addition the province of Katanga will probably be affected by the drought in Southern Africa because the province has been importing about 80 % of the staple food and 90% of the seeds from Southern Africa countries. It seems that there is already food shortage. Distribution of cassava seeds and cuttings is therefore needed in addition to on going food security programs (OCHA, 31/08/02; AFP, 20/09/02).

Overall The situation of millions of IDPs is thought to be still very poor (category I). In addition, forcibly repatriated refugees from Rwanda seem to lack basic services and are considered at risk (category II).

Recommendations and priorities

• Ensure full access to the people repatriated from Rwanda and more globally to the RDC population
• Provide basic services and food to IDP and repatriated
• Prevent the degradation of the situation in Katanga area

RNIS 38, July 2002

The humanitarian situation in DRC continues to be extremely precarious despite the ongoing peace process and the signing of a peace agreement between the Kinshasa regime and the Movement for the Liberation of Congo (MLC) in April 2002. The country is suffering from years of instability that has drawn in a number of neighbouring countries and resulted in a hugely complex protracted emergency. The emergency has resulted in the displacement of millions of people and irrevocably disrupted and destroyed the livelihoods of millions more.

For some time, the country has been split largely into three separate areas. The first area is in the west and is controlled by the Kinshasa government with the support of Angola, Zimbabwe and Namibia. The second is in the north in the provinces of Equateur and parts of Orientale and is controlled by the Movement for the Liberation of Congo. The third region is in the east of the country in the provinces of the Kivus, Maniema and parts of Orientale and Katanga. It is controlled by the Congolese Rally for Democracy (RCD-Goma) and supported by Rwanda. Numerous opposing forces in each area, which has meant that open conflict is almost continuous, further complicate the situation.

The latest developments have been an agreement between the Kinshasa government and the MLC to end hostilities and establish a transitional government that would share control over approximately 70 % of the country. There have been some disagreements over the implementation of the agreement and, in particular, the control of the armed forces (UNOCHA 09/07/02) but in general the agreement appears to be holding. Much more concerning for the humanitarian situation is the failure of the third groups, the RCD-Goma, to sign the agreement and their stated opposition to it. As a result, conflict has continued unabated in the eastern part of the country, which remains the worst affected region.

War displaced populations

The war in DRC has resulted in the displacement of millions of people and last official estimates indicated that there are in excess of 2.2 million displaced throughout the country. However it remains extremely difficult to ascertain numbers with any precision because of the vastness of the country and the lack of access to so many of the worst affected areas. Many of the displaced are in hiding from further violence and are located deep within forest areas where it is difficult to verify numbers. The reporting period has seen the continuation of mass displacement, particularly in the eastern regions of the country, and the numbers continue to increase. It is also estimated that there are approximately 365,025 refugees from Angola, Sudan, Rwanda, Central African Republic, Burundi and Uganda scattered throughout the country (USAID 02/05/02).

Humanitarian situation

The humanitarian situation across the country continues to be extremely poor despite the ongoing peace process. The reporting period has seen the continuation of fighting, particularly in the east of the country. Ultimately the humanitarian context is largely shaped by the years of conflict that have left the country in ruins, destroying infrastructure and the economy. Almost 2.3 million people have been displaced from their land and livelihoods and less than half of this number have access to assistance due to the inability of aid agencies to access the most needy populations.

The fighting in both urban and rural areas continues to displace populations, destroy infrastructure and restrict access to basic amenities such as health and education. There has also been a very profound and negative impact on the food security of the country. This is a result of both food availability and of poor access to food sources. Food availability has been affected by the restriction of access to agricultural land, which has had the effect of substantially reducing typical harvest yields. For those who are able to farm, the insecurity has effectively destroyed traditional markets, providing a further disincentive to produce surplus. For example the east was the traditional supplier of food to Kinshasa in the west and this market is no longer available. As a result, the price of food items has risen, particularly in urban markets. The collapse of the economy and of most livelihood systems has left much of the population impoverished and the rate of unemployment is extremely high. This has severely affected people’s purchasing power and left many struggling to meet even the most basic of needs and many have little or no access to health care or education. Various studies and surveys have indicated the severity of the situation and shown that common humanitarian indicators such as malnutrition and mortality rates are unacceptably high (USAID 02/05/02)

Key features of the current humanitarian situation have been the continuation of violence in the east with reports indicating that fighting has been particularly fierce in South Kivu province where there are estimated to be 435,000 IDPs. The ongoing violence and insecurity has restricted humanitarian access to many of the worst affected areas and as a result distributions of essential food rations have been disrupted as well as the provision of medical care. The peace negotiations have been ongoing and the MLC leader is expected to take up the position of prime minister in Kinshasa, but has not done so to date. On a regional level, there has been a significant agreement between Kinshasa and Rwanda to ensure the withdrawal of Rwandan troops from DRC. The agreement is seen as a significant development in the conflict in the east and it is hoped that it will bring greater stability to the area (BBC 22/07/02).

The low level of funding received through the 2002 UN Consolidated Annual Appeal is a cause for concern, particularly given the high needs in the country. Of the 194 million US dollars requested only 42 million or 21 % has been pledged to date (UNSC 05/06/02).

Western Region

The western region has remained under the control of the Kinshasa government but has been very badly affected by the ongoing hostilities in the country. The city of Kinshasa once relied on the fertile agricultural regions in the east for food and agricultural products but the conflict has cut off the traditional trade routes and meant that the city has to rely increasingly on the provinces of Bandundu and Bas-Congo. Food that is available is of a very high price and is often beyond the means of a population impoverished by high rates of unemployment and a collapsed economy. A recent report by FAO in Kinshasa has shown that there are significant levels of food insecurity, with much of the poor in densely populated areas of the city, eating woefully inadequate amounts. The report found that the average daily calorie intake was estimated to be 1,381 Kcals, which represents a shortfall of 40 % from internationally accepted norms. This is extremely alarming as such low levels of food intake, coupled with an extremely poor public health environment and lack of access to health services, makes the likelihood of nutritional decline and its associated morbidity and mortality increasingly likely. The report suggests that the primary reason for the poor intake is the lack of purchasing power of many households. The report also estimates that the average daily expenditure on food is 29 cents a day. The results are corroborated by the huge rates of unemployment in the city. The situation has been further exacerbated by the difficulty of transporting food due to the poor transportation infrastructure and lack of serviceable vehicles (UNOCHA 19/07/02). The RNIS does not have any recent nutritional information from Kinshasa or other areas in the West but the situation is assumed to be extremely poor.

Northern Region

Equateur

Equateur has an estimated 85,000 IDPs scattered throughout the province and has been badly affected by the presence of the front line that divided the province between the rebel MLC and the Kinshasa government. Recent nutrition and mortality surveys show a clear correlation between the severity of the situation and proximity to the front line and it is hoped that the power sharing agreement between the government and the MLC will bring an end to much of the violence in the province and allow people to begin to rebuild their lives. However, in the short term the situation looks set to be extremely poor due to the high level of grinding poverty and chronic food insecurity. The RNIS does not have any recent nutrition information for this region.

Orientale

The situation in the northeastern province of Orientale is characterised by severe insecurity, with as many as 250,000 people displaced, although the true figure is likely to be far larger. In mid May 2002 there was an uprising in the town of Kisangani that brought about a fresh outbreak of violence that resulted in the death of over 200 people, many through summary execution. The violence mirrors a similar event in the city in 2000 where up to 1,200 people were killed (Amnesty International 12/06/02). Reports indicate that an uneasy calm has returned to the city but the situation remains extremely volatile and indicative of how easily extreme violence can break out. It is the underlying tensions, even without direct conflict, that are preventing many people from returning to their land or restarting livelihood activities. There have also been reports of continued violence in the Ituri district around the town of Bunia, where the presence of various rebel groups and members of the Ugandan military have complicated ethnic tensions. The fighting has resulted in continued displacement. The RNIS does not have any recent nutritional information for these areas but the situation is assumed to be extremely precarious.

Southern and Eastern DRC

The situation in southern and eastern DRC remains extremely precarious largely as a result of continued insecurity in many areas. The region contains the majority of the country’s IDPs and the reporting period has seen large scale displacement of population and the inability of the humanitarian community to reach those most in need. Nutrition surveys from the region have repeatedly shown very high rates of acute malnutrition and mortality reports have shown that rates of mortality have been huge, indicating a desperately poor and highly protracted humanitarian disaster.

Kasai Orientale Province

Kasai Orientale has had the front line running through it for some years and has been affected by the ongoing insecurity. However, the front line has been fairly static for the last few years and many areas remain fairly secure. MDM conducted a nutrition survey in June 2002 in Tshofa zone, which is situated 140 Km from the front line area. However the zone has been more or less an enclave for some time, cut off by the front line and the lack of roads to the east. The area suffers from chronic food insecurity and there were reports of a large measles epidemic earlier in the year. The survey indicated that there was an estimated prevalence of acute malnutrition of 12.2 % (W/Ht < -2 Z scores and/or oedema), which included 2.7 % of severe malnutrition (W/Ht < -3 Z scores and/or oedema). Mortality rates were also measured and crude mortality was estimated at 1.1/10,000/day and under-five mortality at 3.3/10,000/day. The prevalence of malnutrition is elevated above emergency thresholds and gives cause for alarm. The poor situation is further corroborated by the mortality rates, which are all above emergency thresholds, particularly for the under-five population. The reasons given for the poor situation are the poor food security of the area and the very high rate of morbidity. The survey showed that 75 % of all children interviewed had experienced an episode of sickness during the two weeks prior to the survey and the measles outbreak is also probably responsible for high child mortality. It is also important to note that the survey occurred before the annual hunger season, which means that people will be going into the hunger season in poor condition. It can be assumed that the nutritional status of the population will drop further as the hunger season progresses (MDM 06/02; Valid International/SC-UK 15/05/02).

North and South Kivu

The situation in the Kivus remains one of the most serious in DRC with an estimated 1,195,111 IDPs. Fighting has been reported to be raging between Rwandan army troops and dissident Banyamulenge forces in the Minembwe/Itmombwe plateau and reports indicate that upwards of 40,000 people have been newly displaced (UNOCHA 02/07/02). ACF-USA conducted a nutrition survey in Shabunda zone in February 2002 that revealed rates of acute malnutrition of above 20 %, including high levels of severe malnutrition. Much of the severe malnutrition was made up of oedematous nutrition or Kwashiokor, which is an extremely serious form of malnutrition. The survey also revealed very high mortality rates that were greatly above emergency thresholds. The data indicates an extremely serious situation and is probably replicated in other areas of the Kivusand the eastern region. The main reason for the very poor situation is the ongoing insecurity, which has served to isolate the area from external assistance as well as ensuring that the population is unable to access food sources and health care (ACF-USA02/02).

SC-UK and Valid International conducted a nutrition survey in the Kyondo Health Zone of North Kivu in May 2002. North Kivu is suffering from a chronic nutritional emergency as a result of pro-longed displacement, isolation, lack of market outlets, severed food lines, price increases and greatly reduced purchasing power (SC-UK/Valid International 05/02). Kyondo Health Zone has only become accessible to the humanitarian community since January 2002 and there were reports of high rates of acute malnutrition. The survey revealed an estimated prevalence of acute malnutrition of 3.3 % (W/Ht < -2 Z scores and/or oedema) including 2.5 % of severe malnutrition (W/Ht < -3 Z scores and/or oedema). It is important to note that the rate of nutritional oedema, although low, was very high relative to the wasting. This is a feature of the area. The survey also indicated an estimated crude mortality rate of 0.3/10,000/day and an under-five mortality rate of 0.7/10,000/day. Both the rate of malnutrition and mortality were significantly below emergency thresholds and came as a surprise to the survey team. The low rates are explained by the great improvement in the security situation in the area, which has enabled many people to return to farming activities. It was also noted that the markets in the area appeared to be lively with items from all over the zone as well as further afield from places such as Goma and Butembo. It was also noted that the zone was well served by medical services, largely as a result of a highly capable local health officer. This has led to a very progressive and well supplied health infrastructure and it was particularly noted that the rates of child vaccination were close to 100 % (SC-UK/Valid International 05/02). The zone is a great example that security provides the back-drop for reconstruction of livelihoods and that well targeted and implemented health systems are possible. The results of the survey clearly indicate that Kyondo is currently not undergoing anacute emergency and that there is hope in other areas that the catastrophic health indicators can be reversed.

Overall

The situation in DRC remains extremely poor, despite some apparent advances in peace negotiations. The years of conflict and insecurity continue to take their toll on the civilian population, who are increasingly struggling to cope with the desperately poor economic outlook and chronic food insecurity. There appears to be some hope of a cessation of violence in some areas of the country but the eastern parts remain desperately insecure and suffer some of the worst humanitarian outlooks. The enormous numbers of IDPs are extremely vulnerable (category I) and require continued assistance to meet the very basic of subsistence needs.

Recommendations

From the RNIS

• Negotiate access to affected populations through support of MONUC.

From the ACF-USA survey in Shabunda, South Kivu, February 2002

• Establish a regular system of general food distribution.
• Open selective feeding centres.
• Implement an anti measles vaccination campaign.
• Conduct training for health personnel.

From the MDM-B survey in Tshofa Health Zone, June 2002

• Establish selective feeding centres for children under the age of five.
• Conduct education on public health and sanitation.
• Conduct training for existing health staff in the health system.

RNIS 36/37, April 2002

The humanitarian situation in DRC continues to deteriorate despite ongoing peace negotiations between the various groups party to the conflict. DRC has suffered from years of instability, with the present conflict beginning in 1996 when a rebel army, supported by Uganda and Rwanda, attacked the regime of the then president, Mobutu. This resulted in the fall of the Mobutu regime, which was replaced by that of Laurent Kabila. In 1998 there was a major rebellion, stemming in the Eastern region. As a result, a number of neighbouring countries were drawn into the conflict, which has served to displace millions of people and completely disrupt and destroy the livelihoods of millions more.

In 1999, a peace agreement was signed in Lusaka between the major antagonists in the conflict, including major rebel groups. The agreement provided for the deployment of a UN peacekeeping mission (MONUC) to oversee a cease-fire, however hostilities continued and in January 2001 the then president, Laurent Kabila, was assassinated. His son Joseph Kabila took his place as president. 2001 saw major advances in the peace process with the further deployment of MONUC troops and the initiation of the Interim Congolese Dialogues (ICD). The situation remains extremely confused with the country split into three major areas. The first area is in the west of the country and is controlled by the Kinshasa government with the support of Angola, Zimbabwe and Namibia. The second region is in the north of the country in the provinces of Equateur and parts of Orientale and is controlled by the Movement for the Liberation of Congo (MLC) with the support of Uganda. The third region is in the east of the country in the provinces of the Kivus, Maniema, parts of Orientale and Katanga. It is controlled by the Congolese Rally for Democracy (RCD-Goma) and is supported by Rwanda. However, each area also has numerous opposing forces and open conflict is continuous, particularly in the eastern regions of the country (NRC 26/03/02).

The complexity of the situation and the multitude of different interests has made the continuation of the peace process extremely difficult. However, the ICD met for the first time in February, in Sun City, South Africa. The dialogue was plagued with difficulties over representation and ongoing conflict. The Kinshasa government walked out of the talks on 14 March 2002 because of fighting in the government held town of Moliro in the east of the country resulting in its capture by RCD troops. After further negotiations, the talks continued and resulted in an agreement between the MLC and the Kinshasa government to form a transitional government that would share control over what amounts to approximately 70 % of the country (UN OCHA 19/04/02). It has been stressed that the agreement was reached outside of the framework of the ICD, and whilst it has been greeted with tentative support from members of the international community, the RCD-Goma, who did not sign the agreement, have vowed to continue fighting. It is feared that without all parties being a signatory to an agreement, the conflict in DRC will continue (UN OCHA 25/04/02).

Numbers and distributions of IDPs

The current caseload of IDPs is estimated to be 2,275,111. This represents an increase of 230,111 people since the last RNIS (OCHA 01/02). Given the inaccessibility of many areas, particularly in the east, the real figure is likely to be far greater. Most of the displaced are in the east and south east of the country in the provinces of the Kivus and Katanga. The majority of the observed new displacement has occurred in south Kivu as a result of ongoing conflict in the province.

Humanitarian situation

The dramatic political developments and military disengagement that have taken place since January 2001 have not resulted in significant improvements to the humanitarian situation of millions of affected people. Despite ongoing peace negotiations, the number of IDPs has continued to rise and is now estimated to be approaching 2.3 million people. Less than half of these have direct access to relief assistance, as a result of insecurity and poor infrastructure. This means that more than one million people are displaced without assistance. The disengagement has seen the opening up of some areas, most notably the Western government held areas. However, access still remains very limited in the east of the country despite the work of MONUC, who remain severely hampered in their ability to enforce cease-fires and end the conflict. The continuing violence has also resulted in many humanitarian relief organisations being unable to access areas of acute need.

Table showing the distribution of IDPs by province (UN OCHA 01/02)

Area	April 2001	September 2001	January 2002
Equateur	170,524	85,000	85,000
Orientale	220,000	230,000	250,000
North Kivu	620,000	760,000	760,000
South Kivu	373,158	225,000	435,111
Katanga	354,000	415,000	415,000
Maniema	132,000	160,000	160,000
Eastern Kasai	114,000	130,000	65,000
Western Kasai	29,000	-	65,000
Kinshasa	N/A	40,000	40,000
TOTAL	2,012,682	2,045,000	2,275,111

The food security situation in the country is very poor as the conflict has led to a huge decrease in the production of food and constrains the distribution and marketing of what little is produced for commercial use. This has affected food prices, particularly in urban areas. The collapse of the economy has also meant that employment opportunities are practically non-existent, very seriously affecting the purchasing power of people in most regions. The lack of availability and access to food has created a situation of both chronic and acute food insecurity where one third of the population, or 16 million people, are estimated to have critical food needs. The IDP and conflict affected populations in the east of the country are the most seriously affected as many have no opportunity to practice subsistence livelihood activities. Reports indicate that the level of destitution is incredibly high with many people without food, clean water, medicines or clothes (Oxfam 25/04/02). The lack of medical care is of great concern and UNICEF has reported that less than a quarter of the population have access to heath care, largely as a result of conflict. Many health zones also do not receive any external support (UNICEF 11/02/02).

The combination of conflict, acute food insecurity and lack of medical care has continued to have a severe impact on morbidity and mortality. Diseases such as malaria, diarrhoea, respiratory infections and malnutrition are rife and there has been a report of a large outbreak of cholera in Katanga province that has claimed the lives of thousands of people. At the beginning of 2001, IRC conducted a series of surveys that indicated catastrophic mortality rates and concluded that in excess of 2 million people had died of war related mortality in eastern DRC since 1998 (see RNIS 32 and 33). A similar study conducted by MSF-B published in December 2001 showed similarly high mortality rates in areas close to the front line, particularly in the provinces of Equateur and Katanga (MSF 12/01). The studies showed that children had been particularly badly affected, with mortality rates in some areas being three times the emergency threshold. UNICEF has estimated that of the 205 million babies born in an average year, 20% will not reach their first birthday. This makes the infant mortality rate in DRC 50% higher than the African average (UNICEF 11/02/02).

In recognition of the increasing humanitarian needs, the Consolidated Appeal (CAP) has been increased for 2002 to a total of 194 million US dollars from the 139 million requested in 2001 (UNSC 15/02/02). The appeal has attempted to address the range of needs, particularly by attempting to address the chronic under development of the country, but as of 25 April 2002, only 11 % of requirements had been received and almost all funds have been for traditional emergency assistance (Oxfam 25/04/02).

Western Region

Kinshasa

Kinshasa has been very badly hit by the conflict in the country. Much of the food that was available in markets originally came from eastern areas such as the Kivus, Maniema and Katanga that traditionally produced high amounts of food for export. The war has severely affected agricultural production in these areas and severed transportation routes. As a result, the city now relies on the provinces of Bandundu and Bas-Congo as its sole source of food (FAO 15/11/01). What food is available is of high price and the very high rates of unemployment in the city mean that much of the food is unaffordable, as people do not have the exchange entitlements to purchase it. People are relying on multiple coping strategies from all family members such as petty trade, menial work, begging, and illicit activities. Some of the petty trade involves women travelling many kilometres to cut wood for sale (FAO 15/11/01). This has left a very poor humanitarian situation with an estimated 40,000 IDPs and 3,300 refugees. WFP is currently targeting 92,000 individuals deemed to be acutely in need of food assistance. The RNIS does not have any recent nutritional information from Kinshasa, but past surveys have indicated high rates of acute malnutrition and the population is assumed to be extremely vulnerable to further nutritional decline, particularly if conflict in the country continues.

Other areas in the western region have benefited from less insecurity than that experienced in the east of the country. This is largely because it is under government control. However, the provinces of Bas Congo and Bandundu share a border with Angola which has a heavy refugee burden from the conflict there. The areas are also under great pressure to provide sufficient food for the Kinshasa region and other cities in the west of the country. The overall effects of the war are shared with the rest of the country and include the poor economy, high unemployment and poor access to medical care. The RNIS does not have any recent nutritional surveys but recent mortality surveys indicate that the situation is poor, although below emergency thresholds. However, given the prevailing humanitarian situation it is assumed that these populations remain highly vulnerable.

Northern Region

Equateur Province

Equateur is one of the provinces that has been most severely affected by the war and contains an estimated 85,000 IDPs. The province has been particularly affected by the presence of the front line, which has split it into two separate zone, one run by the rebel MLC and the other controlled by the government. A recent mortality survey conducted by MSF-B has indicated that the front line represents a particular risk, with the observed rates of mortality considerably higher in the areas closer to the front line. MSF-B also conducted a survey in the Basankusu health zone, very close to the front line and found an estimated prevalence of crude mortality of 2.7/10,000/day and an under-five mortality rate of 6.6/10,000/day (MSF 12/01). These rates indicate a very serious health situation as they are considerably above emergency thresholds. The rate of under-five mortality is particularly concerning as it is over three times higher than emergency thresholds and represents the death of a quarter of the under-five population over the past 12 months. The reasons for the high rates are the grinding poverty in the area and complete lack of opportunities to conduct normal subsistence activities. There were high reported rates of looting and very little access to health care. The physical and food insecurity has made the IDPs and the non-displaced population extremely vulnerable and created a very serious humanitarian outlook. It is hoped that the agreement between the MLC and the government may see an end to the front line but, unless conditions improve substantially for this population, the excess mortality is likely to continue.

Orientale province

The situation in Orientale continues to be extremely precarious with continuing violence reported in many areas. The province is currently estimated to contain 250,000 IDPs, which is an increase of some 20,000 over the reporting period. In addition to insecurity related to various armed groups, the area has suffered from recurring ethnic violence between the Lendu and Hema peoples of the Ituri district. This fighting has possibly been exacerbated through the influence of other armed parties. Violence once again broke out in the middle of February 2002 and humanitarian agencies have announced that 15,000 people have been displaced in the surrounding region (IRIN 19/02/02). The RNIS has not received any recent nutritional information from IDPs in this area but, given the prevailing insecurity, the IDPs and non-displaced populations are considered to be extremely vulnerable to nutritional decline.

Southern and Eastern DRC

The current humanitarian crisis in DRC is most severe in the southern and eastern regions of the country. The provinces of north and south Kivu, Maniema and Katanga were once fertile agricultural zones that produced agricultural surpluses which were sent to the western regions of the country, particularly to the capital, Kinshasa. The area is now the scene of some of the fiercest fighting and is considered chronically insecure. The majority of the country s almost 2.3 million IDPs are found in this region and the reporting period has seen the number grow considerably. As a direct result of the fighting, millions of people have found themselves displaced from their homes, their land and their livelihoods. The incidence of disease is appallingly high and recent months have seen the outbreak of cholera in the Katanga district. Nutrition surveys have routinely shown rates of acute malnutrition of over 20% and, combined with the acute food insecurity and almost total lack of medical facilities, have resulted in mortality rates that are far in excess of internationally recognised emergency thresholds.

North and South Kivu

The situation in the Kivus remains extremely precarious and ongoing fighting has resulted in displaced population estimated at 1,195,111. This represents an increase in excess of 200,000 people over the reporting period. The majority of this increase is in South Kivu and is a result of fighting between various armed rebel factions over control of strategic towns, particularly along the banks of lake Tanganyika. Areas of particular violence have been Fizi and Bukavu in south Kivu. This has served to seriously constrain humanitarian access to the affected populations and WFP announced in March that the Walungu, Fizi, Barak and Hauts Plateaux regions were inaccessible (WFP 08/03/01).

The area took a further blow to the humanitarian situation with the eruption of Mount Nyiragongo on 17 January 2002. The volcano is situated 10 Km from the town of Goma in North Kivu and it is estimated that it forced the displacement of 500,000 people, who fled to neighbouring Burundi. Many have since returned to the area but it is estimated that 20-30% of the town was destroyed and up to 80,000 people were made homeless. The humanitarian response to the situation was very large and it is likely that this helped to avoid a large deterioration in the situation. However, it has added to the burden of shocks on the population of the area and underlines the many hazards that face people in the region (UNSC 15/02/02). Reports indicate that the nutrition situation of the displaced is not seriously affected.

World Vision reported on a Middle Upper Arm Circumference (MUAC) nutrition survey they carried out in Rwanguba health zone in March 2002. The survey measured the MUACs of 1400 children below the age of five and found that the prevalence of acute malnutrition was well above emergency thresholds. The rate of severe acute malnutrition was significantly elevated, indicating a substantially increased risk of mortality. The reason for the high prevalence is attributed to the insecurity and looting that is widespread in the area, as well as the absence of functioning health clinics and the impoverishment of the population (WVI 15/03/02).

World Vision also conducted a weight for height survey on the under-five population, in the Oicha zone of North Kivu in December 2001. The survey indicated that the prevalence of acute malnutrition was 11.1% (W/Ht < -2 Z scores and/or oedema) including 4.4% of severe malnutrition (W/Ht <-3 Z Scores and/or oedema), of which 3.9 % was oedematous malnutrition (Kwashiokor). The prevalence of malnutrition in Oicha is raised above emergency thresholds and indicates that acute malnutrition is a problem of public health concern in the area (WVI 15/12/01). The survey attributes the observed malnutrition to poor availability and access to food, medical care and clean water. The overall picture of the nutrition situation in the Kivus is extremely alarming and there is little chance of an improvement whilst insecurity is still so prevalent

Maniema Province

The situation in Maniema is precarious, with repeated reports of insecurity between rebel groups and government and allied forces. The number of IDPs in the province appears to have stayed fairly stable at 160,000 people but further displacements could occur at any time. One positive move in the area has been the deployment of MONUC troops to the town of Kindu. A total of 400 Uruguayan soldiers were initially flown in to oversee phase III of the disengagement and disarmament process. It is hoped that the town will eventually support up to 2,500 troops. It is expected that the troops are likely to face some resistance to the disarmament, with one of the initial UN aircraft fired on in February 2002. However, their presence is a positive step forward and it is hoped that it may bring some security to the area (UN OCHA 13/02/02). The RNIS has not received any new nutrition surveys from the area but the population is assumed to be extremely vulnerable.

Katanga province

Katanga is divided by a front line between government and government backed forces and the RCD-Goma rebels. The presence of the front line has made the province extremely insecure and the number of IDPs indicates this accordingly. It is estimated that there are currently in excess of 415,000 IDPs in the province. The humanitarian situation is extremely bleak with the population being highly food insecure and with little or no access to health care facilities. The opportunity for economic activity is also negligible. In December 2001 MSF-B conducted a retrospective mortality survey in Kilwa health zone, situated close to the front line. The survey indicated that the crude mortality rate was 1.1/10,000/day and the under-five mortality was 3.1/10,000/day. This indicates a very concerning situation with both rates being above emergency thresholds. It is particularly alarming to note that the rate of under-five mortality means that 12% of the under-five population had died over the previous 12 months (MSF 12/01). The main causes of the high mortality are the exceptional poverty of the population, their food insecurity and the minimal access to health care. Over the reporting period, the vulnerability of the population has been emphasised with the discovery of a very large cholera outbreak. The worst affected areas are the central and southern zones, including the towns of Lubumbashi, Likasi and Kolwezi. By the middle of March 2002, there were 5,150 registered cases since November 2001 with 3,882 since the beginning of 2002 (AFP 16/03/02). The case fatality rate for cholera is very high if not treated. The RNIS does not have any recent nutrition information for the area but both the IDPs and the general population are assumed to be extremely vulnerable to further nutritional decline.

Refugees

There are currently estimated to be 368,000 refugees in DRC, predominantly from the Central African Republic (CAR) and Angola. Angolan refugees are primarily in the south of the country near the border areas with Angola. Many are long-term refugees and have developed some form of coping mechanisms. This has been particularly possible for those in the western regions where the level of insecurity is not as high. The refugees from CAR came into the country in 2001 as a result of an attempted coup. The majority of the refugees are in Mole camp in Equateur Province and UNHCR has announced that it has begun some voluntary repatriations. The RNIS does not have any recent nutritional data for these groups but they are considered vulnerable.

Overall

Despite some advances in the peace process, which have led to some disengagement in parts of the country, the overall humanitarian outlook for the people of DRC is extremely poor. In particular, the IDP population in the east of the country is particularly poor (category I). Recently arrived refugee populations also remain acutely vulnerable (category II). Evidence strongly indicates that insecurity is the chief cause of vulnerability and groups along existing front lines and in areas of acute insecurity are at increased risk of nutritional decline. The outlook is not encouraging given the failure of the ICD talks, and the failure of the RCD-Goma rebels to sign an agreement would indicate that more conflict is to be expected. There is some hope that the agreement that was signed between the Kinshasa government and the MCL will bring relative peace to areas in the north and west of the country.

Recommendations

From the RNIS

• Provide support to the UN consolidated appeal and in particular to activities that focus on developing newly secured areas.

From the WVI survey in Oicha

• Continue therapeutic feeding.
• Establish community outreach programmes to actively find malnourished individuals.
• Ensure the provision of a safe and adequate water supply.
• Conduct nutritional education.

RNIS 35, October 2001

In 2001 there have been significant strides forward in the peace proces