United Nations System
Standing Committee on Nutrition

Nutrition Information in Crisis Situations - Tanzania
 

NICS 8, January 2006

Although the repatriation of refugees, and especially of Burundian refugees, has begun, Tanzania still hosts an estimated 355,000 refugees in Kigoma and Kagera regions. Nutrition surveys conducted in the12 refugee camps in September 2005 showed a nutrition situation under control and which seemed to have slightly improved compared to 2004 (figure 8), despite reduction in food rations due to shortages since November 2004 (UNHCR/joint, 09/05). It is thought that this might be due to increase coping mechanisms among families who stayed in Tanzania, while those who can not cope with a reduced ration opted for repatriation. Nutrition centres have also known a decrease in admissions in 2005.

On the other hand, anaemia was still a major problem in the camps (table 10). Stunting was also significant, varying between 19.9% and 39.5% depending on the camp.

Increased restrictive measures recently taken towards refuges (see Burundi) could affect the food security of the refugees in the near future.

Figure 8 Prevalence of acute malnutrition, refugee camps in Tanzania

Table 10 Anaemia among children and women, refugee camps in Tanzania, Aug-Sept 2005 (UNHCR, 09/05)

NICS 4, November 2004

Around 80,000 Burundians have been voluntary repatriated since the beginning of 2004 (RI, 04/11/04) but the flow seems to have decreased since October, probably due to the postponement of the elections in Burundi originally scheduled in October 2004 and now postponed until early 2005 (WFP, 12/11/04). However, Tanzania still hosts an estimated 420,000 refugees mostly from Burundi and DRC, in 13 camps. Funding shortages have obliged WFP to cut cereal and pulse rations by 25%; the situation will not improved until new donors' commitments (WFP, 25/10/04).

Nutrition situation not critical

Random-sampled nutrition surveys were conducted in each refugee camp in August-September 2004 (UNHCR/joint, 09/04). The results showed that the nutrition situation was under control and has remained stable when compared to last year but that the prevalence of malnutrition has slightly increased in some camps, compared to 2002 (figure 5). This may be explained by the cut in food rations experienced in 2003 and 2004 and by the restriction of movements of refugees which was reinforced in 2003 (see RNIS 43). The prevalence of stunting varied between 22% and 42%, depending on the camp.

Anaemia was assessed among children and pregnant women and was found to be a significant health problem (table 8). Anaemia was especially high in Lugufu II, which receives new arrivals from DRC.

Measles vaccination coverage was reported as exceeding 95%.

Figure 5 Prevalence of acute malnutrition, Tanzania refugee camps

Table 8 Anaemia among children and women, refugee camps in Tanzania, Aug-Sept 2004 (UNHCR, 09/04)

 * Hb < 11 g/dl for children 6-59 months and pregnant women

Overall

The prevalence of acute malnutrition is not critical in the refugee camps in Tanzania. However, anaemia is a significant public health problem in most of the camps. Focus on micro-nutrients should be a priority.

RNIS 43, November 2003

Tanzania hosts about 500,000 refugees, of whom 150,300 are Congolese refugees in the camps of Lugufu and Nyarugusu, and 350,000 refugees from Burundi hosted in Kasulu, Kibondo and Ngara districts. As at 4 September 2003, UNHCR estimated that about 55,500 Burundi refugees had returned home since the beginning of 2003; 20,000 benefited from facilitated repatriation by UNHCR, whilst 35,000 returned spontaneously (OCHA, 14/09/03). Spontaneous returns have especially increased since May 2003, and have probably been due to the reduction in aid assistance in the camps combined with a restriction of movements outside the camps imposed by the Tanzanian government; this has undermined the ability of the refugees to fulfill their basic needs (see RNIS 42).

The impact of hosting refugees

A study on the impact of hosting refugees, commissioned by humanitarian organisations, was carried out by the Centre for the Study of Forced Migration, University of Dar el Salaam, (OCHA, 15/10/03).

The main findings of the study were: that the high insecurity prevailing in the regions hosting refugees could not be mainly attributed to refugees, the ratio of criminals among refugee population being comparable to the ratio of criminals among local populations; that, although environment degradation has occurred in the years following the influx of refugees, recent environmental programmes have redressed former negative impacts; that, in the same way, the initial burden on infrastructure, health services and education has been reversed after the setting up of humanitarian operations; that although the lack of internal security may have contributed to the lack of productivity in agriculture, local purchase by WFP has supported producers and suppliers, business has increased due to increased disposable income and agricultural activity in the area has been expanded due to the presence of a cheap workforce of refugees. Tax collection from humanitarian agencies is also a non-negligible source of income.

However, aid to the Tanzanian authorities for local governance and administration has been far too low.

Nutrition situation

A nutrition survey was carried out by UNHCR in 13 refugee camps, in August 2003 (UNHCR/UNICEF, 08/03). The nutrition situation of under-five children was under-control, although the prevalence of malnutrition had increased slightly compared to July 2002 (see table). There has been report of an increase in admissions to TFCs and SFCs. Average crude and under-five mortality rates in 2003 were below the threshold: CMR was 0.10/10000/day and under-five mortality rate was 0.29/10000/day, as recorded by routine surveillance. Full vaccination coverage among infants under one year old was reported to be more than 90% in most of the camps.

Acute malnutrition, Tanzania refugee camps, 2002-2003

Food security

Refugees are meant to receive 1857 Kcal/pers/day, which is less than the full 2,100 recommended ration; this was based on the assumption that refugees were able to complement the food ration distributed, with other sources of food or income (WFP/UNHCR, 06/03). Because of food shortage, food rations were halved from January to March 2003. Food rations were then increased but some food items were, however, only distributed at 50 to 75% of the full ration. WFP/UNHCR mission found that the decrease in food ration led to an increase in social unrest at household level and in banditry in and outside the camps (WFP/UNHCR, 06/03). Full ration distributions at about 1,800 Kcal resumed in October 2003 (WFP, 26/09/03). Because of restrictions of movement outside the camps, refugees have had difficulties in obtaining fresh food (OCHA, 10/10/03) and they have no longer been able to carry out income-generating activities or the collection of fire-wood.

Refugees were selling part of their food rations for other food items (cassava, banana, vegetables) or for non- food items (WFP/UNHCR, 06/03).

Availability of non-food items

Non-food items, such as blankets, jerry cans or cooking sets, are distributed on arrival at the camp but they are not replaced when worn; sanitary material and soap should be distributed regularly, although there are recurrent breaks (WFP/UNHCR, 06/03). Firewood is not distributed and the collection of firewood is one of the main problems. Women can go as far as 30 km two to three times a week to collect firewood, which also expose them to security problems (WFP/ UNHCR, 06/03).

Public health

There were no reports of particular health or water and sanitation problems in the camps, although a funding shortfall and decrease in sources of income may have an impact. Breaks in distribution of sanitary material and soap are recurrent (see above).

Social and care environment

According to the survey, 75% to 85% of the 6-24 month olds were breast-fed, depending on the camp. The majority of the children were receiving three to four meals a day, but a significant proportion (varying from 7% to 70%, depending on the camp) was only receiving one to two meals a day. It seems that the overall social behaviour has deteriorated, for example, there was a high degree of domestic violence in June 2003.

Overall - The recent restrictions of movement outside the camps and the reduction in assistance and especially of food assistance seemed to have had a slight impact on the nutrition status of children underfive, which is, however, still under-control (category III). Moreover, thousands of refugees have left the camps, partly because of the hardship conditions. Had they remained, the nutrition status may have been worst.

Recommendations:

From the UNHCR nutrition survey:

• Ensure that the food basket as agreed by UNHCR/WFP is provided to the refugee population
• Implement sustainable income generating activities
• Intensify case-findings for malnourished cases through community health workers

From the WFP/UNHCR joint assessment:

• Increase the food ration of 1,857 Kcal/pers/ day to an appropriate level, where required, based on an expanded analysis of refugee needs and coping mechanisms
• Promote, advocate and negotiate for increased opportunities for refugees to increase income-generating activities inside and outside the camps
• Replace worn out NFIs
• Ensure that refugees have access to a reliablesource of fire-wood
• Support refugee host areas, by providing marketing and agricultural assistance to farmers in order to enable increased local procurement from the area

RNIS 42, August 2003

Unexpected number of returnees from Tanzania

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

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

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

RNIS 41, April 2003

Tanzania hosts more than some 520,000 refugees, mostly from the Great Lakes region. The last nutrition survey results showed an acceptable nutritional status of the refugee children (see RNIS 40). However, the food ration has recently been cut by 50% because of food shortages (AFP, 21/02/03), which may undermine the nutrition situation.

RNIS 40, Dec 2002

Tanzania hosts more than 500,000 refugees, mainly from Burundi and to a lesser extent , from DRC and Rwanda. The political and military conflicts in the Great Lakes region continue to cause refugees to enter the country. Some 17,000 Burundians entered Tanzania in October 2002 (AFP, 14/11/02), compared to 3,000 in September (RNIS 39). There has also been an increase in refugees entering Tanzania from eastern DRC.

UNHCR announced that repatriation of Rwandan refugees from Tanzania was concluded at the end of 2002. About 23,500 Rwandan refugees have been repatriated in 2002, of whom 19,000 have been repatriated in November and December 2002 (AFP, 02/01/03). However, Refugee International expressed its concern about this repatriation movement (RI, 13/01/03). It appears that the repatriation was less than fully voluntary. According to RI, the plan was set up too quickly. A review of the refugees unwilling to repatriate was not implemented before the repatriation deadline. Furthermore, at the beginning of the repatriation plan, the reception of the repatriated refugees in Rwanda was inadequate. Some Rwandan refugees, unwilling to repatriate, spread out in Tanzania or went to another country. It seems that 3,000 Rwandan refugees have fled from Tanzania to Uganda (Xinhua, 18/12/02).

Burundian returns have dropped dramatically over the past weeks because of an upsurge in violence in Burundi. The Tanzanian government has reiterated its opposition to refugee integration (Xinhua, 21/10/02).

Nutrition status of the refugees

A nutritional survey was undertaken by UNHCR, in collaboration with their partners, in July 2002 (UNHCR, 07/02). Eleven refugee camps in western Tanzania, which host almost all the refugees settled in the country, were surveyed. People are almost entirely reliant on relief aid because they cannot engage in agricultural activities and are not allowed to move beyond the 4 km perimeter of their camps. It seems that some refugees are able to cultivate home-gardens.

The nutrition situation of the refugees was under control (see table). It has remained stable over the past three years. Vitamin A supplementation coverage varied from 82% to 98%. Crude and under-five mortality rates, recorded through routine surveillance, have remained stable since the beginning of the year: CMR were around 0.3/1000/month and under-five mortality rates varied slightly between 0.8 and 1.2/1000/month. There were no reports of particular health or water and sanitation problems in the camps. WFP food distributions were adequate in the first semester of 2002 (see graph). However, WFP distributed only 72% of the cereal ration in December 2002 because of a cereal shortage. WFP has also warned that the cereal pipeline may be empty from February 2003, unless new contributions are made (WFP, 13/12/02). Disruption of food distributions in previous years had a disastrous effect on refugee health and mortality; a 50% ration cut obliged refugees to sell their mosquito nets in order to buy food, which led to an increase in mortality.

Acute malnutrition, refugee camps in western Tanza- nia, July 2002 (UNHCR, 07/02)

Overall The nutrition situation of the refugees in western Tanzania is under control (category IV). Adequate relief aid supply has to be continued.

Recommendations and priorities:

From the UNHCR survey:

• Maintain stable public health environment
• Ensure that the international community provides adequate food basket
• Strengthen infant feeding programmes

RNIS 39, October 2002

Tanzania hosts more than 500,000 refugees in Kigoma, Kibondo, Kasulu and Ngara districts. The refugees are mainly from Burundi but also from DRC and Rwanda. Tanzania is in the process of formulating a new refugee policy in order that all refugees are repatriated home in the shortest time possible (Xinhua, 26/07/02).

Repatriation of Rwandan and Burundian refugees is ongoing with 1,951 Rwandans repatriated since the beginning of 2002 (WFP, 09/08/02). About 24,000 Burundian refugees have also been repatriated by UNHCR while another 17,600 have spontaneously returned (OCHA, 08/09/02).

Meanwhile, the deterioration of security conditions in the eastern and southern eastern provinces of Burundi has caused an increase in new arrivals and prevented repatriation to those areas. In the month of September, 3,000 Burundian refugees arrived in Tanzania, a 10 fold increase from August. They were reported to be either previously displaced in Burundi or former refugees. The total number repatriated also decreased from 1,500 per week a few months ago to about 350 per week (UNHCR, 01/10/02). New arrivals of Congolese refugees have also been reported (WFP, 30/08/02).

Except for pulses and CSB which were sometimes distributed at respectively 80% and 60%, WFP reported providing 100% of the ration regularly to the refugee population (WFP, 09/08/02; WFP, 04/10/02).

The average crude mortality rate and under-five mortality rate for the camps of western Tanzania were 0.33/10000/day and 0.75/10000/day respectively in July 2002 (UNHCR, 07/02). The under-five mortality rate was noticeably higher in some of the camps, the highest being in Lugufu 2. This camp, receiving new arrivals, had a rate of 1.91/10000/day. There were 490 patients in therapeutic feeding centres at the end of the month and 2,735 in supplementary feeding centres (UNHCR, 07/02).

An outbreak of meningococcal disease is spreading in the Great Lakes area. A vaccination campaign was completed on the 23^rd of September for both the camp and resident populations of Kibundo district. A vaccination campaign was also scheduled for the end of September in Ngara and Kasulu (WHO, 02/10/02).

Overall The situation of refugees seems to continue to be under control (category IV), although new arrivals experienced higher risks of death.
 

Tanzanie La Tanzanie abrite environ 500 000 réfugiés, essentiellement burundais mais aussi rwandais et congolais. Les taux de mortalité juvéniles, dans les camps de l’ouest de la Tanzanie, étaient de 0,75/10000/jour au mois de juillet 2002, mais plus élevés dans le camp recevant les nouveaux arrivants (1,91/10000/jour).

RNIS 38, July 2002

The regional conflict in the Great Lakes continues to affect the lives of millions of people.  For the number of affected populations see the table below.

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

Tanzania is host to the largest refugee population in Africa. Although the country has never been directly involved in the conflict that has affected many countries in the Great Lakes region, it has provided an important safe haven for refugees from neighbouring countries. There are currently estimated to be 512,004 refugees in a selection of camps in the Kigoma and Ngara regions of Western Tanzania. The majority of refugees in the camps are from Burundi, many of them Hutu, fleeing the ongoing violence in the country. UNHCR have estimated that as many as 353,000 Burundian refugees are currently resident in camps, with the remainder being from DRC, Rwanda and Somalia.

The sheer number of refugees has placed a great deal of pressure on the Tanzanian government and there have been increasingly greater calls for them to be repatriated. The presence of the refugees has also been a cause of contention between the Tanzanian and Burundian governments and the Burundian government has accused Tanzania of harbouring and even supporting rebels, a fact that the Tanzanians have stringently denied. In May 2002, the Tanzanian and Burundian governments signed a tripartite agreement with UNHCR to assist a voluntary repatriation of Burundian refugees. The timing of the agreement has been questioned given that insecurity is still such a problem in Burundi, however UNHCR is only assisting returns to the northern provinces in Burundi, which are substantially more secure than those in the south and east. However, the vast majority of those registering are in Karago, Nduta and Mtendeli camps in the Kigoma Region and wish to return to the southern provinces where they are originally from. UNHCR have estimated that from 31 June to 14 July 2002, over 17,200 Burundian refugees were repatriated and a further 87,100 people have registered for repatriation (WFP 19/07/02).

Given the ongoing violence in the Burundi, it is surprising that there have been such a high number of people registering for assisted return. Many factors have contributed to this, including the increasing restrictions placed on the refugees within the camps. There have been recent moves by the Tanzanian government to ban refugees from moving out of the camps and there has been a noticeable build up of police around the camp areas. This is making life extremely difficult for camp inhabitants who are increasingly unable to conduct any form of livelihood activities such as seeking work on neighbouring farms. This is serving to increase the dependency that people have on humanitarian assistance and offers no opportunity to supplement diets with alternative food sources. A problem of particular concern is that of sourcing fuel for cooking. Refugees have traditionally gathered wood from around the camp, which has denuded much of the surrounding area. As a result, people are forced to walk from 20-40 Km to find dead wood but if found out of the camp they can face imprisonment and deportation. There are reports that some refugees are selling their rations to local Tanzanians in exchange for fire wood (UNOCHA 08/05/02). This has prompted some refugees to conclude that it is better to leave under a voluntary assisted programme than wait until an increasingly hostile host country forcibly repatriates them. However, it is interesting to note that the numbers of people actually turning up for the repatriation convoys is dwindling despite the large numbers of people registered. The pressure to repatriate is growing, both from the Tanzanian and Burundian governments, and there has been some talk of repatriation taking place within six months (UNOCHA 08/07/02).

There has been no recent nutrition survey in the camps but the most recent data has shown that the situation is stable and well below emergency thresholds. This is probably a result of the regular food distribution, which includes a 100 % ration for all beneficiaries, although it is important to note that Corn Soya Blend (CSB), a fortified blended food, is only being distributed at a 60 % ration. The provision of health services to the refugees is also good with routine vaccinations and access to routine primary health care and good water and sanitation. This has gone a long way towards ensuring the stability of the situation.

Overall

The reporting period has seen a great many people registering for assisted voluntary repatriation, however the ongoing violence in Burundi is making it extremely difficult for many to return to their areas of origin. There is evidence of greater restrictions on the refugees in the camps, particularly in terms of forbidding them to move outside camp perimeters. This is serving to increase dependency on external assistance. The health and nutrition situation in the camps appears to be stable (category III).

Recommendations

From the RNIS

• Continue the full general food ration and increase the amount of fortified food available to refugees.
• Ensure that conditions are safe for repatriation in Burundi before further repatriation continues.

RNIS 36/37, April 2002

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

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

Tanzania is currently host to 512,004 refugees located in a number or camps in the Kigoma and Ngara regions of Western Tanzania (UNHCR 04/02). The sheer number of refugees has meant that Tanzania is host to the largest refugee population in Africa and, although not actively involved in the conflict currently affecting the Great Lakes region, it has received many of the people fleeing violence in the DRC and Burundi. It is currently estimated that there are 353,104 Burundian refugees and 129,567 from DRC (UNHCR 04/02). The remainder are mostly from Rwanda, with small amounts from Somalia.

The increasing numbers of refugees has been cause for considerable concern with the Tanzanian government and calls for their repatriation have increased. In a recent address to parliament, the Tanzanian president, Benjamin Mkapa, announced that Tanzania could not keep bearing the burden of refugees and he appealed to the international community to help avert a snowballing crisis in the country (PANA 11/01/01). This mirrors a widely held belief that the refugees are an increasing financial burden to the Tanzanian government and contribute to a rise in insecurity. The Burundian government has accused Tanzania of harbouring rebels in the camps, from where they make raids back into Burundi. The problem for the UNHCR is that they are very reluctant to organise voluntary repatriation for the refugees whilst their countries of origin are still mired in conflict and large-scale displacement continues to take place. However, there have been some moves to facilitate returns for those that wish to do so. In February 2002, it is estimated that some 25,000 Burundian refugees registered for repatriation, however reservations over the timing of the repatriation have been expressed (UNHCR 14/03/02). Most of the returnees are planning to return to stable provinces in the south and in the east and will be received in transit centres and provided with food rations to last for 3 months.

UNHCR, in conjunction with UNICEF, WFP and NGO implementing partners, conducted a nutrition survey in all refugee camps in the Kigoma and Ngara regions of western Tanzania. The survey was conducted between November and December 2001. In order to estimate the prevalence of malnutrition across the entire refugee population, a two-stage cluster survey was conducted in each camp. The results of the survey indicated that the prevalence of acute malnutrition (W/Ht < -2 Z scores and/or oedema) was 3.2% including 1.1% of severe acute malnutrition (W/Ht < -3 Z scores and/or oedema) (UNHCR/UNICEF/WFP 17/12/01). This reveals that acute malnutrition is currently not a problem of public health importance in the camps. The results of the survey also indicate that the nutrition situation is stable and has not changed since a similar survey in July 2001. This is most probably a result of the regular food distribution and the relatively good access to water, sanitation and comprehensive medical facilities. The camps benefit from a very comprehensive medical surveillance system, which ensures that any changes in disease patterns are closely monitored and, if outbreaks occur, they can be swiftly dealt with. The reports indicate that the crude and under-five mortality rates are both well within prescribed limits and are a further indication that the humanitarian situation for the refugees is well under control.

The survey also examined infant feeding practices and found children may benefit from improved infant feeding practices. Consequently, considerable emphasis for future interventions will be placed on community nutrition activities. There will also be an increased emphasis on improving household food security through the planting of community fruit trees with the aim of enhancing micronutrient intake.

Overall

The numbers of people seeking refuge in Tanzania are still increasing and this is causing mounting tension with the Tanzanian authorities. The level of support to the refugees remains good and all indications are that the humanitarian situation within the camps is good. The nutritional situation of the refugees is considered stable (category III).

Recommendations

From the UNHCR/UNICEF/WFP nutrition survey in Western Tanzania

• Ensure a general ration balanced in terms of both quantity and quality.
• Focus on the control of communicable diseases.
• Investigate the underlying causes of existing malnutrition.

RNIS 35, October 2001

Tanzania has not been actively involved in the conflict in the DRC but has been heavily affected by it. The reporting period has seen a steady stream of new refugees crossing the borders from both Burundi and the DRC as a result of the continued conflict in the countries. There has been a recent escalation of fighting in South Kivu in DRC in and around the town of Fizi, which has resulted in the displacement of around 6,000 people across lake Tanganyika, where they have entered various refugee camps (RI 25/10/01). The latest statistics for the refugee caseload are from September 2001 and indicate that there are an estimated 543,145 refugees mainly in the Kigoma and Ngara regions in the north west of the country (OCHA 12/10/01).

The steady increase in the number of refugees in Tanzania has been a point of concern for the Tanzanian government, who claim that the refugees are an increasing burden on the country and are threatening to destabilise the areas where they reside. In particular there is concern that the camps are used to some degree by Burundian rebels, and this has resulted in poor diplomatic relations with the Burundian government over the last few months. Ideally the Tanzanian government would like to see the repatriation of refugees to their country of origin, however the peace processes in both Burundi and DRC have yet to bare fruit. As a result, mass voluntary repatriation is unlikely and refugee numbers are actually likely to increase. There have been some reported assisted repatriation of Rwandan refugees and in August WFP indicated that 3,200 Rwandans had returned home since the beginning of 2001 (WFP 02/11/01).

Food assistance to the refugees has continued after concerns over pipeline breaks, which resulted in the lowering of the general ration. WFP recently announced that they have increased the ration size to 90% of the full ration and distributed to 487,250 people in Kigoma, Kibondo, Kasulu and Ngara districts from the 8^th to the 21^st of October. Throughout the ration cuts WFP maintained a full ration to extremely vulnerable individuals (WFP 02/11/01). Despite the ration cuts, the humanitarian situation in the camps is not reported to be serious. WFP conducted a survey in July 2001, with preliminary results indicating that levels of acute malnutrition are well below emergency thresholds. However, it appears that problems with micronutrient deficiency remain an issue, which is highly suggestive of a poor quality diet. Large, long term refugee populations with a high dependence on general food distributions are particularly prone to micronutrient deficiencies and every effort should be taken to increase the quality of the general ration in order to protect against further problems of micronutrient deficiency. Recent reports on the health of the refugee populations have not pointed to an alarming situation (WFP 02/11/01).

Overall

The numbers of refugees continues to increase with the majority still from Burundi. In general the condition of the refugees has remained stable despite forced ration cuts during the earlier part of the year. A better donor response has resulted in an improvement in the overall food pipeline and the current ration sizes are 90% of the full ration. In general, the nutritional situation of the refugees is considered stable (category III).

Recommendations

• Continue support for the Inter-Agency appeal
• Conduct food security assessments in the camps to determine the current use of food ration and define alternative food sources
• Introduce fresh food to the general ration to increase diet quality and help in the prevention of micronutrient deficiencies.

RNIS 34, July 2001

The reporting period has seen a continued influx of mainly Burundian refugees, into the Kigoma region of Tanzania. The new arrivals cite heavy fighting between Burundian government forces and rebels as the main reason for crossing the border (UNHCR 06/01). The latest statistics for the refugee caseload from UNHCR are from June and indicate that there are 538,573 mainly in the Kigoma and Ngara regions (UNHCR 14/07/01). UNHCR also estimate that 4,545 new refugees arrived in the Kigoma region from April to June, the vast majority of them from Burundi (UNHCR 06/01).

The peace process in DRC has resulted in the Kinshasa regime withdrawing support to Burundian rebel groups previously active in eastern DRC. As a result many of these groups are returning to Burundi and increasingly clashing with government troops. It is expected that the number of Burundian refugees will continue to increase as the insecurity continues. This would appear to dash hopes of large scale voluntary repatriation to Burundi. However, there was an important meeting between the governments of Tanzania and Burundi and UNHCR in May, which resulted in the signing of an agreement to establish a commission for the repatriation of hundreds of thousands of Burundian refugees. The meeting acknowledged that returns were unlikely with the prevailing security situation but stressed that it was essential to have a clear framework for the planning and supervision of returns when conditions allowed (Xinhua 08/05/01).

Food assistance has continued to refugees with WFP reporting regular two weekly distributions to an average of 523,855 beneficiaries (WFP 15/06/01; 13/07/01). The size of the general ration has remained reduced but attempts have been made to improve it and there is no longer a break in the pipeline for fortified Corn Soya Blend (CSB) and the general ration is now calculated to be 85% of the full ration. WFP also reports that 5,723 vulnerable individuals continue to receive a full ration (WFP 13/07/01).

The RNIS has not received any new nutrition reports over the reporting period but WFP report that a nutritional screening took place in the Lugufu camps at the end of April. The screening uses a different methodology from the previous weight for height surveys and therefore a comparison is difficult. However, the recorded prevalence of acute malnutrition was not considered to indicate a critical situation. Furthermore, UNHCR health surveillance data from the Lugufu camps in June, reports an estimated crude mortality rate of 0.1/10,000/day and an under five mortality rate of 0.73/10,000/day (UNHCR 06/01). Both of these rates are well below emergency thresholds and indicate a stable health situation. In general the food supply situation in the country is good with the Famine Early Warning System (FEWS) reporting in their July report that overall food production in the country could be the best in five years and following the harvest season in July, the price of staple foods has decreased (FEWS 09/07/01).

Overall

Increases in the number of new refugees entering the country continues with the majority of the new caseload coming across the border with Burundi. The increased numbers continue to put pressure on scarce resources for the refugee population. However, there has been no break in food pipelines and although there have been no new nutrition surveys reports indicate that the health and nutrition situation is relatively stable for the camp populations (category IV). The general food security outlook for the country is good and will positively impact on the food outlook of the refugees.

Recommendations

• Support funding of the Inter-Agency appeal to Tanzania
• Conduct full livelihood and household economy surveys to assess the impact of ration cuts

RNIS 32/33, April 2001

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

United Republic of Tanzania

Tanzania has continued to receive influxes of new refugees as continued civil unrest in Burundi and the DRC has continued to force people across the border. Tanzania currently hosts the fourth largest number of refugees of any country in the world, and has one of the lowest GDPs. The regions of Kigoma and Kagera, which currently host the majority of the refugees in the country are also amongst the poorest areas (UNICEF 31/01/01; 02/01; WFP 01/01).

The numbers of refugees have continued to grow over the last year and the current estimates of refugees in camps being assisted by UNHCR are taken from the March 2001 monthly statistics and indicate that there are 527,916 refugees in camps. This marks an increase from numbers reported in RNIS 31. UNHCR report that as of mid October 2000, approximately 90,000 new refugees had registered with UNHCR in Tanzania. The vast majority came from Burundi but some came from Rwanda and from DRC (UNHCR 2001; 03/01). The new influx has meant that Karago camp in the Kigoma region of western Tanzania near the border with Burundi, has reached full capacity. The camp was opened in December 1999 and its capacity was stretched to 50,000 people. New refugees will be accommodated in Nduta camp in Kibondo district where 2000 new plots have been made available. (UN 2001; WFP 01/01).

WFP have also reported the creation of a new camp called Kitali Hills in the Ngara district. The camp was reported operational in November 2000 with the relocation of 1,800 Rwandese refugees from Mbuba transit centre, also in Ngara district (WFP 11-12/00).

Table taken from UNHCR summary statistics for refugees in Tanzania in March 2001

	Kigoma	Ngara	Mkuyu	Total
Burundians	260,097	120,229	0	380,326
Congolese	114,954	4	0	114,958
Rwandese	0	27,845	0	27,845
Mixed	1,694			1,694
Somalis	0	0	3,093	3,093
Total	376,745	148,078	3,093	527,916

The increasing number of refugees represents a problem for both the UNHCR and the government of Tanzania who would like to see repatriations take place. Large scale repatriation is very dependent on the security situation in the countries of origin. Plans have been made for the repatriation of Burundian refugees by UNHCR. It is hoped that 75,000 will voluntarily repatriate during 2001 (UNHCR 2001).

A major problem for all actors dealing with the refugees in Tanzania is the fact that humanitarian assistance has not kept pace with the increasing numbers. Funding shortfalls for WFP and UNHCR during 2000 resulted in a ration cut of 40 % in July 2000, which resulted in the energy value of the ration dropping to an average of 1170 Kcal/day. The ration cut was a result of a break down in the food pipeline and took place in all camps, from July to December 2000 when the rations were increased to 80 % of the full ration. To minimise the impact of the ration cuts, vulnerable households, such as those headed by the elderly or the chronically ill, continued to receive full rations (UNHCR 12/00).

A nutrition survey was conducted by UNHCR in July 2000 and found a prevalence of malnutrition of between 3.3% and 5.3% (<-2 z-scores), including 0.2 to 1.2% severe malnutrition (< -3 z-scores or oedema). A cluster survey was done in each of 11 camps. Some camps indicate a slight increase in the prevalence compared to September 1999, and others a slight decrease but these are unlikely to be significant. A second survey was carried out in December but problems with the survey design mean that it is impossible to determine the impact of the ration cuts (UNHCR 12/00).

The UNHCR monthly report on health and nutrition from January of 2001 notes that there was a marked increase in mortality in December and January with 65 % of deaths being amongst the under fives. Whilst the CMR remains below emergency thresholds the under five mortality gives cause for concern. The report also indicates that a rise in the number of admissions to selective feeding programmes has been observed (UNHCR 01/01)

The reported rises in under five mortality is worrying and coupled with the evidence from nutritional surveys, would suggest that the nutritional situation could be beginning to deteriorate and should be watched very closely although more information is needed.

Overall

Tanzania continues to receive new refugees, largely from Burundi but with some influxes from the DRC. Funding shortfalls have caused break - downs in the food pipeline, ration cuts and inadequate overall humanitarian assistance.

Recommendations

• Support WFP and UNHCR in providing assistance to refugees in Tanzania.
• Discourage repatriation to Burundi and DRC, as long as conditions in these countries are not conducive to safe return.

RNIS 31, July 2000

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

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

	Mar-1999	Jun-1999	Sep-1999	Dec-1999	Mar-2000	Jul-2000
Burundi	222,000	451,000	617,000	821,000	830,000	670,000
Rwanda	690,000	640,000	673,000	650,000	652,000	69,000*
RoC	213,000	213,000	343,000	823,000	438,000	233,000
DRC	788,000	952,000	1,104,000	1,185,000	1,418,000	1,759,500
Tanzania	328,000	373,000	373,000	400,000	465,000	440,000
Total	2,241,000	2,629,000	3,110,000	3,880,000	3,803,000	3,171,500

* this figure has decreased dramatically because of a new definition of an IDP in Rwanda (see text for more details)

United Republic of Tanzania

The political and military conflicts in the Great Lakes region of Africa continue to cause refugees to enter the United Republic of Tanzania. In particular, continued civil and political unrest in Burundi and DRC hinders voluntary repatriation to these countries and continues to cause new influxes of refugees. UNHCR provides assistance to over 440,000 refugees (out of a total of 800,000 estimated by the Government) from Burundi, DRC, Rwanda and Somalia (the Somalis are no longer assisted by WFP). A re-registration exercise was undertaken in June in the west-em camps. This information is currently being processed. Since the beginning of the year an estimated total of 53,600 refugees (of Congolese, Burundian and Rwandan origin) have sought refuge in the United Republic of Tanzania (UNHCR - 19/07/00,21/07/00; WFP - 20/07/00).

UNHCR and the Burundian government have prepared a contingency plan for refugee repatriation in the event that the ongoing Arusha peace process delivers an accord (IRIN- 02/06/00).

Joint Food Assessment Mission

A Joint Food Assessment Mission to the camps in the United Republic of Tanzania was undertaken by WFP and UNHCR in May, the following findings were noted (UNHCR/WFP - 07/00):

• The average CMR in 1999 was 0.15/10,000/day, with a peak in June and July. Under-five mortality rates averaged 0.43/10,000/day. Both of these rates are within acceptable limits. Malaria was the most important cause of mortality, followed by pneumonia and diarrhoea.
• The nutritional status of the population is generally satisfactory. The most recent surveys estimated the prevalence of acute malnutrition at 1.8% in the camps in Kigoma and Kagera regions, although the prevalence of stunting was much higher at 44.1% (see RNIS 27). In light of these results, the supplementary feeding programmes in the camps will be decentralised as a community-based activity and will be integrated into the health posts. Case detection of malnourished children will be systemised in the outreach activities.
• According to UNHCR's health information system, only 9% of babies born in the camp had low birth-weights (<2,500g) compared to 20-30% in previous years. This decrease was attributed to a combination of interventions in antenatal care, malaria prophylaxis, and supplementary feeding for pregnant women.
• Micronutrient deficiencies, particularly anaemia, were still reported (see RNIS 27). This was attributed to a combination of factors including the prevalence of malaria and infectious diseases, and reliance on a limited number of foods.
• Several food economy surveys conducted in the camps in 1999 and 1998 (these reports are not available to the RNIS) have indicated that most of the refugees are dependent on WFP's food rations, although a few have some level of self-reliance. As the refugees are not allowed to move beyond the 4km perimeter of their camps without special permission and as it is illegal for them to either engage in agricultural activities (although some do) or paid labour, it is not possible to contemplate large-scale reductions in the provision of food. The assessments found qualitative and quantitative confirmation of the inter-relationship between land allocated for home production and the level of self-sufficiency. A small reduction in the pulses ration may be considered if the refugees are allowed to maximise their potential for home production.
• Food requirements were met during 1999, with the exception of transient shortages of pulses, cereals and CSB. These shortages did not have an obvious effect the nutritional status of the beneficiaries.
• The scarcity of firewood remains an issue of concern. In some camps, for example Ngara and Mtabila, refugees are forced to travel great distances to obtain sufficient amounts of wood to meet their basic needs. On average, refugees spend two entire days a week obtaining adequate amounts of firewood. Women, who are usually responsible for the collection of firewood, are also put at risk. Local officials have complained that the environment is being damaged and that the refugees are competing with the residents for a scarce resource.
• The nutritional situation of the surrounding populations is worse than that of the refugees (see RNIS 28). There are an estimated 1 million local inhabitants in the refugee-affected areas who are mainly subsistence farmers with very low incomes. Subsistence food production and poor farming practices with poor roads and weak marketing systems is common in both regions. The refugees' presence has resulted in sharp price rises in the prices of local food, deteriorating security as well as environmental degradation.

UNHCR in collaboration with its implementing partners is currently undertaking a nutritional survey in Kagera and Kigoma regions. In addition, the agency has obtained funds from the United Nations Foundation to implement projects aimed at enhancing the nutritional status of women, adolescents and children in four African countries. The multi-agency project has recently been launched in the United Republic of Tanzania (UNHCR - 19/07/00).

Resources

Although funding for the refugee programme in the United Republic of Tanzania has previously been generous, WFP is facing a severe shortfall in food resources for the refugees in Kigoma and Kagera Region. Only about 50% of the desired ration is available. In order to stretch the available food resources until the end of the year, WFP will have to reduce the current food aid rations for the refugees by 40%, starting immediately. On a daily basis, this means a reduction from 600g to 360g (WFP - 20/07/00).

All efforts will be made to protect the most vulnerable refugees by maintaining a full ration for the elderly, patients in hospital, pregnant and lactating mothers and small children. The reduction in the food ration will clearly lead to increased food insecurity and may lead to nutritional problems for the poorest group of refugees. In addition, the pipeline break may increase personal insecurity and tensions between local populations and refugees in some areas (UNHCR/WFP - 07/00; WFP - 21/07/00).

In addition to the problems associated with cut in the rations described above, WFP's preparedness to deal with any more population movements in the region, including repatriation, will be severely compromised. This is due to the current reduction of food supplies and buffer stock (WFP - 20/07/00).

Overall, although the most recent surveys and assessments of the refugees in the United Republic of Tanzania do not show elevated rates of malnutrition, WFP has been forced to cut the population's rations. Thus the refugees are considered at high risk of malnutrition (category II).

Recommendations and priorities:

• Provide funding for WFP's refugee programmes.

From the UNHCR/WFP assessment mission (07/00):

• Continue to monitor the nutritional status of the population on an annual basis, after the rainy season.
• Conduct a registration exercise.
• Continue with iron supplementation and de-worming programmes in order to reduce the incidence of anaemia. Monitor the prevalence of anaemia in annual surveys and through antenatal screening.
• Assist refugees with seeds and tools in order to support existing horticultural activities.
• Establish a formal mechanism for high-level dialogue with the Government with a view to obtaining additional access to land for refugee agricultural activity.
• Work with GOT to formulate a policy regarding agricultural activity, land access and utilisation, also allowing Congolese fishermen to fish in Lake Tanganyika.
• Plant fast-growing trees for firewood in the areas surrounding the camps. Promote the use of fuel-efficient stoves.
• Assist the local communities in infrastructure rehabilitation, education, agriculture, environment management, health and potable water supply.

RNIS 30, March 2000

The humanitarian crisis in Burundi continues, particularly in Bujumbura Rurale where over 330,000 people remain in regroupment camps in appalling conditions. Large numbers of displaced people are beginning to return to their homes in the Republic of Congo after the peace agreements were signed in December 1999 and the humanitarian situation is improving. In the Democratic Republic of Congo, access to war-affected and other vulnerable populations was significantly reduced over the reporting period, and there are reports of a further 230,000 people being displaced. The humanitarian situation in some of the eastern provinces is reported to be particularly poor. A large number of refugees from Burundi and Democratic Republic have sought refuge in the United Republic of Tanzania since October 1999. The table below shows the estimated number of refugees, IDPs and returnees in need of assistance in the Great Lakes Region. A severe drought is currently affecting the horn of Africa including several countries in the Great Lakes Region.

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

	June 1998	Mar 1999	Jun 1999	Sep 1999	Dec 1999	Mar 2000
Burundi	670,000	222,000	451,000	617,000	821,000	830,000
Rwanda	550,000	690,000	640,000	673,000	650,000	652,000
RoC	50,000	213,000	213,000	343,000	823,000	438,000
DRC	621,000	788,000	952,000	1,104,000	1,185,000	1,418,000
Tanzania	329,000	328,000	373,000	373,000	400,000	465,000
Total	2,220,000	2,241,000	2,629,000	3,110,000	3,880,000	3,803,000

United Republic of Tanzania

Refugees from both Burundi and the DRC have continued to flood into the United Republic of Tanzania during the reporting period. In particular there has been a huge influx of Burundians, since October some 80,000 have sought refuge in the United Republic of Tanzania. The majority of the new arrivals are women, children and young men. The refugees are housed in camps in twelve locations in the Kagera, Kigoma and Tanga regions (UNHCR - 31/03/00; WFP -10/02/00).

At the end of March, UNHCR’s refugee caseload stood at 465,000 persons. The planning figures for WFP’s operation have increased to 525,000 (including 25,000 poor Tanzanians who live around the camps). Approximately 15,000 refugees receive therapeutic and supplementary feeding every month, including pregnant and lactating women. This operation is currently seriously under-funded (UNHCR - 28/02/00, 31/03/00; WFP-22/02/00).

The RNIS has not received any new information on the nutritional situation of the refugees. The most recent survey in Kigoma and Kagera estimated low prevalences of malnutrition in the camps (RNIS 27). Higher prevalences of malnutrition were recorded in the villages surrounding the camps (RNIS 28). Most of the refugees have no access to agricultural land are therefore totally dependent on the ration provided by WFP and its donors (UNHCR - 28/02/00).

Overall, the refugees in the United Republic of Tanzania are not considered to be at heightened risk of malnutrition (category IV), although if funding is not found for WFP’s programme there will be a break in the pipeline in July, which could lead to increases in the rates of malnutrition.
 

RNIS 29, December 1999

There has been an escalation of the crisis in Burundi during the reporting period and the nutritional situation of the newly displaced population is critical. Humanitarian agencies cannot access very large areas of the Republic of Congo (Brazzaville) where the nutritional situation is severe. Peace in the Democratic Republic of Congo has resulted in improved access to war affected populations, but high prevalences of malnutrition have been recorded in some areas. No changes in the nutritional situation of the refugees and IDPs in United Republic of Tanzania and Rwanda have been reported. The table below shows the numbers of refugees, IDPs an returnees who require assistance in the Great Lakes Region.

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

	Dec. 97	Mar. 98	June 98	Mar. 99	Jun. 99	Sep. 99	Dec. 99
Burundi	570,000	600,000	670,000	222,000	451,000	617,000	821,000
Rwanda	1,400,000	690,000	550,000	690,000	640,000	673,000	650,000
RoC	650,000	400,000	50,000	213,000	213,000	343,000	823,000
DRC	585,000	568,500	621,000	788,000	952,000	1,104,000	1,185,000
Tanzania	318,000	345,000	329,000	328,000	373,000	373,000	400,000
Total	3,542,200	2,603,500	2,220,000	2,241,000	2,629,000	3,110,000	3,880,000

United Republic of Tanzania

Tanzania currently hosts some 400,000 refugees in twelve designated locations in the Kagera, Kigoma and Tanga Regions. These refugees are mainly from Burundi (294,000) and the DRC (95,000), but there are also some from Rwanda (7,500) and Somalia (3,300) (WFP -10/12/99).

Given the situation in Burundi, it is expected that Tanzania will continue to host large numbers of Burundians. The number of Burundians seeking refuge in Tanzania increased over the reporting period, and aid agencies are preparing contingency plans for a possible influx of up to 300,000 more. In October, the repatriation programme to Burundi was suspended as a result of security conditions. Since August 1998, over 70,000 Congolese refugees have arrived in Tanzania (OCHA -11/99; WFP -15/11/99).

The refugees in Tanzania are almost entirely dependent on the food ration provided by WFP. The food pipeline was reported to be poor in June/July. Stocks were low in early August. In addition, access to agricultural land is severely restricted by the Government, and the refugees can only produce very limited amounts of food. WFP food assistance also benefits villagers from local communities participating in food-for-work programmes.

The RNIS has received no new information on the nutritional situation of the refugees in Tanzania. The most recent survey in Kigoma and Kagera estimated low prevalences of malnutrition.

Overall, the refugees in Tanzania are not considered to be at heightened risk of malnutrition (category IV).
 

RNIS 28, September 1999

United Republic of Tanzania

Refugee Programme

The annual verification exercise was carried out in August in the southern camps (Kigoma region). Figures released by UNHCR indicate significant reductions in the caseload and the overall caseload in the camps in Tanzania is now estimated at 372,500 refugees.

The greatest reduction in the caseload was noted in the camps which have been receiving new arrivals, notably Lugufu (32%) and Mtendeli (22%). The drop in the beneficiary figure is mainly due to the number of "re-cyclers" previously registered. These are refugees who return to the border without being "de-registered" and come back into Tanzania and register as "new" refugees. This is done in order to obtain multiple ration cards and also more non-food items. A new screening committee consisting of UNHCR and the local authorities has been set-up in order to cut down on this problem (UNHCR - 23/09/99; WFP - 15/09/99, 23/09/99).

Between January and late August 1999, approximately 100,500 refugees from DRC, Burundi and Rwanda sought asylum in Tanzania. The number of refugees seeking asylum decreased to approximately 2,300 during August. During the same period a total of 7,800 Burundian and Rwandan refugees were repatriated to their home countries (WFP - 15/09/99, 10/09/99, 05/09/99).

The general security situation in and around Kasulu, Kibondo and Kigoma was of some concern in August, with armed robberies and attacks increasing even in the day. The local population reported severe loss of their harvest due to nightly thefts by the refugees. According to CARE, the refugees are increasing their agricultural activities in and outside the Nyarugusu camp perimeter in Kasulu district. This has resulted in some conflicts between the residents and refugees (WFP - 15/09/99).

Food assistance

WFP provides food rations to all registered refugees in camps in Tanzania and additional food commodities are distributed to thousands of the most vulnerable refugees under therapeutic and supplementary feeding programmes. Tanzanians also have access to the medical facilities that are located in the camps, and thus may also be in the supplementary and therapeutic feeding centres. At of the end of August 13,500 people were assisted in the special feeding programmes including pregnant and lactating women (WFP - 15/09/99, 23/09/99).

WFP's food availability has gradually improved over the reporting period and full rations will be distributed to the refugees in the next distribution cycles. In previous months, the refugees were only receiving half rations of cereals, although other commodities were covered at 100%. This resulted in tension in some camps. To ease food pipeline shortages, efforts are being undertaken to purchase pulses locally (UNHCR - 16/09/99; WFP -30/07/99, 13/08/99, 02/09/99, 15/09/99, 23/09/99).

Nutritional situation

UNHCR reports that the camp population's nutritional status is stable. Surveys are scheduled for late in September (UNHCR - 16/09/99).

The preliminary results of an IFRC/TRCS/UNICEF/UNHCR nutritional survey amongst Tanzanian children under five living in 16 Tanzanian villages close to the camps in Kasulu, Kibondo, Ngara and Kigoma districts have just been made available (see Annex). The survey estimated the prevalence of acute wasting at 5.2% and severe wasting at 2.8%. These prevalences are considerably higher than those obtained in a survey in the refugee camps in the same area in May, which estimated the prevalence of acute wasting at 1.8% and severe wasting at 0.2% (see RNIS 27).

Drought response

WFP/Government/Donor assessments conducted in July and August have concluded that an emergency situation continues to exist in the regions of Dodoma, Mara, Shinyanga, Singida, Tabora, Tanga and southern Mwanza, all of which have now suffered three consecutive bad harvests. In Shinyanga and parts of southern Mwanza there has been both a very poor crop performance and a collapse of cotton production, which is the main crop. By the end of July, approximately 925,000 people had received food. The WFP EMOP will continue until December (WFP - 13/08/99).

Overall, the refugees in Tanzania are not considered to be at heightened risk (category IIc), given the levels of assistance they receive.
 

RNIS 27, July 1999

Security conditions in the Democratic Republic of the Congo (DRC) and Congo-Brazzaville are still very poor in some areas resulting in continued displacement of the population. The IDPs returning to Congo-Brazzaville are reported to be in very poor nutritional condition. Little is known about the condition of the IDPs in the rebel-held areas of DRC. Large numbers of refugees continue to seek asylum in the United Republic of Tanzania. In Burundi and Rwanda the nutritional situation continues to improve in the areas where there have been improvements in security. The table below shows the numbers of refugees, IDPs and returnees who require assistance in the Great Lakes region.

	Sep. 97	Dec. 97	Mar. 98	June 98	Mar. 99	Jun. 99
Burundi	260,000	570,000	600,000	670,000	222,000	451,000*
Rwanda	727,000	1,400,000	690,000	550,000	690,000	670,000
Tanzania	311,000	318,000	345,000	329,000	328,000	373,000
DRC	823,000	585,000	568,500	621,000	788,000	952,000
Congo-B	465,000	650,000	400,000	50,000	213,000	211,000
Total	2,586,000	3,542,200	2,603,500	2,220,000	2,241,000	2,657,000

*Burundian IDPs/returnees assisted by WFP has increased due to expanded seed protection programmes

In June, WFP appealed for additional donor contributions (US$ 13 million) for the WFP operation to provide assistance for IDPS and refugees in Burundi, Rwanda, Tanzania and Uganda. Delays in delivery of food commitments may bring operations to a halt in August. Thus to make existing stocks last longer, country offices in Burundi, Rwanda, Tanzania and Ugana have been requested to reduce rations by 20 -30% immediately, or to reduce distributions (WFP - 04/06/99).

Tanzania

Recent influx of refugees from DRC and Burundi

The surge in fighting in Eastern DRC has led to a dramatic influx of refugees into the country. More than 87,000 new arrivals have entered the country since the outbreak of hostilities in August 1998. The newly arrived refugees, who have consistently reported being caught in the middle of ongoing skirmishes in the DRC, are generally in good health and have a satisfactory nutritional status. Before this recent influx, there was one camp for Congolese refugees - Nyarugusu, refugees were then transferred to Lugufu (Kigoma). Recent reports have suggested that the present capacity of Lugufu camp is near to saturation and efforts are being made by UNHCR to secure alternative camps sites (UNHCR - 03/06/99, 11/06/99, 29/06/99).

New Burundian arrivals were also registered over the reporting period, with the influx peaking in late April-early May when some 5,000 Burundians entered the country due to hostilities in the Burundian province of Ruyigi. This influx was concurrent with the repatriation of smaller numbers of refugees - between January and April of this year 5,000 Burundians repatriated from Tanzania (UNHCR -29/06/99; WFP - 05/05/99, 27/05/99).

As part of an information campaign to encourage the voluntary repatriation of Rwandans in United Republic of Tanzania, a delegation of former Rwandan refugees recently visited the Ngara region. A small number of refugees decided to return voluntarily. A group of more than 60 refugees is due to return to their place of origin in order to report back to the camps on the situation in Rwanda. It is not known how many will eventually repatriate (IRIN - 28/04/99, WFP - 06/05/99).

Nutritional Status in Kagera and Kigoma camps

The nutritional status of the refugees in the Tanzanian camps is satisfactory. A recent survey conducted by UNHCR in the camps in the four districts in Kigoma and Kagera regions (i.e.: the camps in the west of the country) estimated the prevalence of acute wasting to be 1.8% and severe wasting to be 0.2% (see Annex). No cases of oedema were reported and no child was found with a MUAC<110 mm. The prevalence of chronic undernutrition - measured by stunting - was much higher at 44.1% with 18.8% severe stunting, and closer to that found in the resident population surrounding the camps. These results suggest that although the current nutritional situation is adequate the children's previous nutritional history may have been poor.

The survey report gives credit for the improved nutritional situation to WFP and its donors for providing a stable food pipeline to this refugee population and, indeed, in the current reporting period the food supply continued to be adequate, as did the supply of water (WFP - 05/05/99, 12/05/99). Credit is also given to UNICEF and the other agencies which have provided a series of preventative and curative health services including growth monitoring, malarial control and de-worming programmes as well as micronutrient supplements, post-natal care and selective feeding programmes.

The survey also examined the prevalence of anaemia in the refugee population. Among children under-five, 18.8% were found to have moderate/mild anaemia (10.0-10.9 g/dl) and 14.3% were suffering from severe anaemia (<9.0 g/dl). The mean haemoglobin level was 11.8 g/dl in this age group. No direct relationship between severe undernutrition and anaemia was found (possibly because only a very few cases of severe wasting were seen).

Haemoglobin levels were also assessed amongst the children's mothers and fathers. The mean haemoglobin level for the women was 13.2 g/dl; 13.8% of them were classified as mildly anaemic (11.0-11.9 g/dl) and 9.7% suffered from severe anaemia (<10.9 g/dl). The men's mean haemoglobin level was 14.9 g/dl and only 6.7% had haemoglobin levels < 12 g/dl. Thus the haemoglobin levels were better in men than in women or children.

A high (90.7%) proportion of the children had vaccination cards. The vaccination programme, however, is aiming for full coverage and hence problems such as the loss of cards (mainly in the older children), poor filing and misinformation on the cards, which are relatively common, need to be addressed. In addition, it was apparent that many of the children did not receive their vaccinations at the right age (e.g.: amongst those with cards it could be seen that 91.3% of children received a measles vaccination, however only 52.6% of these received their vaccination within one year of birth).

Acute respiratory infections in the two weeks prior to interview were reported among 43.1% of the children and 40% also reported fever in the same time period. The prevalence of diarrhoea was low in comparison - only 20%. These findings were supported by reports from the out-patients clinic. Analysis revealed an association between wasting and reported illness.

A health NGO in Matabila and Muyovozi camps in Kasulu reported that they are planning to commence an HIV test programme in the camps. This has arisen in light of reports received from Lukole camps where 25% of blood donors were found to be HIV positive (WFP - 05/05/99). HIV is a very serious problem in Tanzania, the latest UNICEF/Government estimates suggest that there will be between 800,000 and one million children orphaned by AIDs by the year 2000 (IRIN -17/06/99).

Drought response

Nine regions of Tanzania are being targeted for food distributions under the WFP operation for assistance to drought affected persons. In some regions food allocations for a one month distribution, instead of the planned three months, are to be distributed to the most severely affected persons (WFP 26/04/99). WFP's targeted assistance to the population in drought affected areas of Singida and Dodoma (EMOP 6112) has been extended to June (WFP - 21/05/99, 27/05/99). A joint UN/Government crop and food supply assessment mission was scheduled for the end of May 1999 (WFP - 21/05/99). Initial reports from the mission in the field indicate that some areas in Dodoma will face food shortages after the harvest in July due to the rains stopping at the critical ripening stage of the crop (WFP -11/06/99).

Overall, the nutritional situation among the refugees in the western camps appears stable as a result of effective humanitarian response programmes, and hence their nutritional situation is not critical (category IIc). However, the funding shortfalls could place them at greater risk in future.

Priorities and Recommendations:-

• Funds are urgently needed for the WFP operation to provide assistance for the refugees in the United Republic of Tanzania. Breaks in the pipeline mean that rations will either be cut or distributions undertaken less frequently.

Recommendations from the UNHCR survey include:-

• Maintain levels of wasting at current levels through regular general food distributions. The referral of undernourished children to the feeding centres should be continued and improved if possible.
• Reinforce efforts to prevent and treat anaemia (although the levels found were lower than expected).
• Improve de-worming and immunisation programmes.

RNIS 26, March 1999

Insecurity in the Eastern Democratic People's Republic of Congo (DRC) and Congo-Brazzaville has led to a fresh wave of population displacements and has negatively affected food security for many people. In both countries, there are reports of pockets where the nutrition situation is very poor. In Rwanda, the number of IDPs has increased dramatically, although since December approximately half have been gradually resettled into new villages, and reports describing their nutritional status suggest that the situation has improved. In Burundi, present indications are of a decreasing number of IDPs and an improving nutritional situation for much of the affected population - this is mainly due to increased stability in the country. The table below gives an estimate of the number of IDPs and refugees requiring humanitarian assistance in the region.

	Jun. 97	Sep. 97	Dec. 97	Mar. 98	June. 98	Mar. 99
Burundi	265,000	260,000	570,000	600,000	670,000	222,000
Rwanda	2,600,000	727,000	1,400,000	690,000	550,000	690,000
Tanzania	390,000	311,000	318,000	345,000	329,000	328,000
DRC	514,000	823,000	585,000	568,500	621,000	788,000
Congo-B		465,000	650,000	400,000	50,000	213,000
Total	3,769,000	2,586,000	3,542,200	2,603,500	2,220,000	2,241,000

Tanzania

During the period between August 1998 and March 1999 there was a large influx of refugees to Tanzania from both Burundi and the DRC. As of September 1998, 260,000 Burundis lived in refugee camps in Tanzania. Although UNHCR assisted approximately 8,700 Burundis to repatriate in 1998, at least 58,000 new arrivals were recorded over the same period (OCHA -12/98).

Instability in the DRC has also caused many thousands of people to flee. Since August 1998 approximately 34,000 Congolese refugees have been registered in Kigoma, bringing the total number of UNHCR-registered Congolese in western Tanzania to approximately 53,204. This number is rising constantly, although the peak influx appears to have been in mid-January (UNHCR, 12/02/99). In addition there are 15,000 Rwandans living in Tanzanian camps (OCHA - 12/98).

The number of refugees from the DRC is changing daily and is dependent on the activities of the rebels in South Kivu. However, recent reports suggest that the influx of refugees is decreasing because the rebels in DRC are blocking the main exit point from DRC to the lake villages of Tanzania (IRIN - 05/02/99, 19/02/99; WFP -18/02/99, UNHCR - 12/02/99). A threat of a possible cholera outbreak in the Lugufu camp has prompted IFRC to screen all refugees coming through Kigoma before transporting them to the camps (IRIN - 29/01/99).

The nutritional status of refugees in Ngara camps has improved according to a survey undertaken by UNHCR in September 1998, which showed a fall in the rates of wasting since the previous September, from 5.0% to 2.8%. (see Annex I(2i)). Severe wasting had decreased from 1.4% to 0.1% (see graph). Crude mortality in 1998 ranged between 0.9 and 0.2/10,000/day, peaking at the same time as malaria transmission rates from March to July. Under-five mortality followed the same pattern, ranging from 0.2 to 3.6/10,000/day. Reasons given for the improvement in nutritional status included:- (a) a stable food pipeline, (b) increased emphasis on health/nutrition education, (c) strengthening of the selective feeding programmes (therapeutic and supplementary), (d) a short period of blanket feeding of Corn Soya Blend for the under fives, and (e) an improved Malaria control programme (UNHCR - 30/01/99, 05/02/99).

Prevalences of Wasting in Ngara camps in 1998

An FAO/WFP food and crop supply assessment mission was conducted at the request of the Tanzanian Government in early January 1999. This followed reports from assessments undertaken in Dodoma and Singida in December 1998, indicating a critical situation. The mission found that with the exception of Kigoma and Kagera, the short 'vuli' rains in all other bi-modal areas was significantly delayed and well below normal, which seriously affected land preparation and planting. The mission confirmed a large and unexpected shortage of cereals, with an unmet maize import requirement of 480,000 tons between February and May 1999 (FAO/WFP -15/02/99).

The central zone of Tanzania, Dodoma and Singida, had received assistance under a previous WFP emergency operation (EMOP 5889 - Assistance to drought affected people). A rapid nutritional assessment, which was part of the larger joint WFP/FAO food and crop supply mission, reported that the current food crisis in these provinces began after the poor harvest during the 1996/97 crop season caused by drought which affected most regions in the country. The situation was aggravated during the 1997/98 crop season, by floods and pests (green bugs, and quelea quelea birds) which destroyed crops in the early stages of maturity. In many parts of the region some households faced food shortages as early as July/ August 1998. Of these two regions, Sindida is considered at heightened nutritional risk because of low grain availability, relatively higher prices when it is available, and poor terms of trade between livestock and grain.

Although famine conditions (as evinced by acute malnutrition, destitution, distress migration, mortality and morbidity, etc) are not yet apparent, in several regions all of the "trailing factors" are in evidence: successive crop failures, very reduced food supplies, inflated staple prices, and steeply declining livestock/cereals terms of trade. Had it not been for the previous distribution, which reached half a million people, the situation would be more serious. Although in affected regions where food aid had not been recently distributed, the most vulnerable households had no reserves at all.

A new WFP emergency operation (Tanzania 6112), to provide food assistance to 1.14 million drought affected persons in Tanzania was approved by WFP on 1 March, this will cover the period of the hungry season prior to the next harvest due in May/ June. The Government of Tanzania had already released all its remaining reserves (35,000 tons of maize, of which 10,000 is for free distribution).

Overall, the refugees in Tanzania are considered to have a low risk of malnutrition (category IIc), however, the new influx of Congolese refugees may alter this.

Recommendations and Priorities:

• In order to prevent widespread famine in Tanzania, food assistance is urgently required for the million people affected by poor rains.
• Refugees in Tanzania are almost entirely dependent on food rations provided by WFP and must continue to be supplied rations of 2,100 kcal/person/day.
• FAO and UNHCR aims to supply minimum essential agricultural inputs to 80,000 refugee households living in camps in order to reduce their dependence on external aid. Priority will be given to households headed by women (OCHA-12/98).

RNIS 25, October 1998

RNIS 25 was devoted to reviewing some of the changes in emergency response over the last five years. We will first highlight situations where wasting was brought rapidly under control. We will then look at some of the factors that have led to less than optimal results, followed by what has been accomplished to improve response over the last five years. We conclude with some ideas for future improvements in the RNIS Reports that could even further enhance communication, stimulate thought, and promote improvement.

RNIS 24, June 1998

Insecurity in Burundi, Rwanda and Eastern Democratic People's Republic of Congo (DRC) is leading to a fresh wave of population displacements and negatively affecting food security for many people. There are reports of very high levels of wasting in parts of Burundi and in Rwanda, poor crop production due to heavy rains and logistical problems affecting food aid deliveries are reportedly leading to reduced food security. The Burundi and Congolese refugees in Tanzania are generally in good nutritional condition although there are high levels of malaria in some camps.
 

Location	Jun. 97	Sep. 97	Dec. 97	Mar. 98	Jun. 98
Burundi	265,000	260,000	570,000	600,000	670,000
Rwanda	2,600,000	727,000	1,400,000	690,000	550,000
Tanzania	390,000	311,000	318,000	345,000	329,000
DRC	514,000	823,000	585,000	568,500	621,000
Congo/Brazzaville	-	465,000	650,000	400,000	50,000
Malawi	-	1,200	1,200	260	-
Total	3,769,000	2,587,200	3,542,200	2,553,770	2,220,000

Tanzania There are approximately 329,000 refugees in Tanzania comprised mainly of 275,000 Burundian refugees in the Kigoma and Ngara regions and 51,000 Congolese refugees, mainly in the Kigoma region. There are also about 3,000 Rwandan refugees in the Ngara region. Organised repatriation is continuing for the Burundi and Congolese refugees. To date, approximately 45,000 Congolese and 2,000 Burundi refugees have returned home. However, people continue to arrive from Burundi, and their number is reported to be greater than those being repatriated [UNHCR 10/06/98, WFP 03/04/98, 01/05/98, 15/05/98].

The last RNIS Report (no 23) described a situation where rations were reduced in Kigoma and Ngara camps because of difficulties in transporting commodities due to heavy rains. Road conditions improved with the dry season, and as of the end of April 1998, ration provision has improved accordingly. A rapid assessment in April using MUAC showed a stable nutritional situation in spite of the ration reductions [UNHCR 10/06/98, WFP 10/04/98,17/04/98].

Malnutrition in Refugee Camps in Tanzania, May 1998

taken from: Preliminary Results of Nutritional Surveys in Tanzania, UNHCR, May 1998

Preliminary results from nutrition surveys carried out in April and May confirmed a generally stable nutritional situation. Levels of wasting varied from 1.0%-5.6% (see Annex I (2 c-i)). However, under-five mortality rates were deemed to be high, particularly in the Ngara camps where the rate was 3.1/10,000/day. Most of the mortality is attributable to malaria, and malaria associated with anaemia. It should be noted that the peak malaria season is July-August. Several interventions aimed at rectifying the situation are underway including supervised chloroquine administration, close monitoring of complicated cases, indoor spraying and the possible distribution of impregnated mosquito nets [UNHCR 10/06/98, WFP 03/04/98, UNHCR 09/04/98, WHO 19/05/98].

Overall, those requiring emergency assistance in Burundi, along with the Burundi refugees and the displaced people in Eastern DRC are at heightened nutritional risk (category IIa in Table 1) due to problems in delivering aid largely as a result of insecurity and poor road conditions. Nothing is known about the nutritional status of the Rwandan refugees in DRC or the IDPs from Shaba (category III in Table 1). The remaining refugees in DRC are not at heightened nutritional risk (category IIc in Table 1). The affected population in Rwanda can be considered to be at moderate nutritional risk (category IIb in Table 1) with a tendency toward deterioration due to f