United Nations System
Standing Committee on Nutrition

Nutrition Information in Crisis Situations - Burundi
 

NICS 15, December 2007

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

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

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

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

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

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

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

NICS 12, February 2007

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

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

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

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

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

NICS 8, January 2006

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

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

Average nutrition situation at national level

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

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

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

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

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

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

Precarious prevalence of acute malnutrition in Bujumbura rural

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

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

Overall

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

NICS 7, August 2005

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

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

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

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

NICS 6, May 2005

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

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

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

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

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

Nutrition situation under control in Northern Kirundo

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

Overall

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

NICS 5, February 2005

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

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

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

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

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

NICS 4, November 2004

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

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

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

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

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

NICS 3, August 2004

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

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

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

Massacre of DRC refugees

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

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

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

WHO/UNICEF interagency health and nutrition need assessment

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

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

NICS 2, May 2004

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

Internally Displaced Persons

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

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

Congolese refugees

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

Returnees face challenges

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

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

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

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

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

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

Returnees from Tanzania

Average nutrition situation

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

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

High mortality rates and low access to health care

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

The main cause of death was malaria.

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

Recommendations

From Refugee International:

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

From the MSF survey on access to health care:

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

NICS 1, February 2004

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

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

Nutrition situation

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

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

* According to cards and mothers' statements

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

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

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

Overall

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

RNIS 43, November 2003

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

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

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

Nutrition situation

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

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

RNIS 42, August 2003

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

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

Unexpected number of returnees from Tanzania

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

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

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

Nutrition and food security situation

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

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

RNIS 41, April 2003

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

Refugees, returnees

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

Food security and nutrition situation

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

Kayanza province

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

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

RNIS 40, Dec 2002

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

Refugees, returnees, displaced persons

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

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

Disease outbreak

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

Food security and nutrition situation

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

Admissions to Therapeutic Feeding Centres, Burundi (UNICEF Burundi)

Admissions to Supplementary Feeding Centres, Burundi (UNICEF Burundi)

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

RNIS 39, October 2002

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

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

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

Nutrition and food security situation

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

Acute malnutrition prevalence, Burundi, 2002 (UNICEF Burundi)

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

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

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

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

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

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

Disease outbreak

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

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

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

Recommendations and priorities

From The AcF survey in Ruyigi:

• Support agricultural production of the vulnerable families through groupements.

From the RNIS

• Monitor the situation of new IDPs

RNIS 38, July 2002

Table showing the affected populations in the Great Lakes region

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

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

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

The humanitarian situation

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

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

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

Bujumbura Rural

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

Karuzi

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

Overall

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

Recommendations

From the MSF-B survey in Karuzi, March 2002

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

RNIS 36/37, April 2002

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

Table showing the affected populations in the Great Lakes region

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

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

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

Humanitarian situation

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

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

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

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

Bujumbura Rural

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

Karuzi

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

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

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

Kayanza

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

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

Rutana

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

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

Overall

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

Recommendations

From the MSF-B survey in Karuzi Province

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

From the IMC survey in Rutana Province

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

From the ACF survey in Rutana Province

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

RNIS 35, October 2001

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

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

Humanitarian outlook

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

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

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

Bujumbura Rural

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

Karusi and Ngozi

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

Bubanza

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

Refugees and returnees

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

Overall

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

Recommendations

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

RNIS 34, July 2001

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

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

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

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

The Effects of the insecurity

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

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

Food Security outlook

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

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

Bujumbura Rural

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

Karusi and Ngozi

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

Bubanza

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

Overall

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

Recommendations

• Negotiate humanitarian access to affected populations in currently inaccessible area

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

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

RNIS 32/33, April 2001

GREAT LAKES REGION (updated by ReliefWeb 7.6.96)

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

Burundi

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

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

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

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

Food Security Situation

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

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

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

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

Bujumbura Rural

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

Karusi

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

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

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

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

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

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

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

Acute and severe malnutrition in Karusi and Ngozi provinces

Bubanza Province

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

Kirundo Province

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

Overall

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

Recommendations

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

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

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

From the ACF survey in Kirundo Province in September 2000

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

RNIS 31, July 2000

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

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

	June-1998	Mar-1999	Jun-1999	Sep-1999	Dec-1999	Mar-2000	Jul-2000
Burundi	670,000	222,000	451,000	617,000	821,000	830,000	670,000
Rwanda	550,000	690,000	640,000	673,000	650,000	652,000	69,000*
RoC	50,000	213,000	213,000	343,000	823,000	438,000	233,000
DRC	621,000	788,000	952,000	1,104,000	1,185,000	1,418,000	1,759,500
Tanzania	329,000	328,000	373,000	373,000	400,000	465,000	440,000
Total	2,220,000	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)

Burundi

Since its independence in 1962, Burundi has suffered from large-scale communal and political violence. Conflict between the Hutu rebel groups and the armed forces persists and has forced huge numbers of civilians to leave their homes and farms. The Arusha peace process is ongoing, but no significant gains have been made during the reporting period; the insecurity continues, particularly in Bujumbura Rural, Ruyigi and Makamba Provinces (IRIN - 11/07/00; WFP - 15/06/00).

Displacement

Population displacement now affects an estimated 670,000 people, or about 10% of the population. Most of the long-term displaced are living in 320 sites across the country. Short-term displacements take place constantly without necessarily being recorded. In addition, numerous IDPs are hiding in the forests or living with relatives (NRC - 30/06/00).

The displaced population increased dramatically in September and October 1999, reaching a total of more than 800,000 people, as a result of a policy of forced relocation or "regroupment" of approximately 300,000 civilians into 50 newly created camps located mainly in Bujumbura Rural. The international community was concerned that the "regroupment" was carried out without adequate consideration of water, sanitation and access to food. President Buyoya recently assured the international community that these sites would be dismantled by July 31.

The dismantling process is underway, and recent figures from OCHA/WFP suggest that approximately 112,000 people have returned. However, the situation is fluid and people are moving back and forth in the wake of military operations. In some cases the IDPs have returned to the sites or created new ones due to insecurity in their home areas. Others have chosen not to leave their sites until the security situation has improved. The dismantling process has shown that the majority of the population are living in the sites voluntarily because the security situation is poor in their home areas (NRC - 30/06/00; WFP - 04/07/00, 13/07/00).

Drought

Government authorities have reported a low yield of crops for Season 2000B due to insufficient rains in many parts of the country. Beans and other pulses have been particularly adversely affected. WFP has distributed food to an estimated 1.4 million drought-affected Burundians since September 1999 (WFP - 15/06/00).

Bujumbura Rural

An estimated 58% of the population of Bujumbura Rural is displaced. No new information on the nutritional situation of these people has been received by the RNIS during the reporting period. The most recent reports suggested that the prevalence of malnutrition is variable. Insecurity restricts movements of the displaced to their farms and frequently prevents the humanitarian community from conducting assessments and providing assistance within the camps. Health care facilities are very poor and there are few skilled staff remaining in the affected areas (NRC - 30/06/00; WFP - 04/07/00).

Karusi

MSF-B undertook a nutritional survey in Karusi Province in March 2000 in response to an increasing number of admissions to their feeding programmes (see annex). The prevalence of acute malnutrition was estimated at 15%, including 3.9% severe acute malnutrition. Oedema was recorded in 2.9% of the sample population. Most of the malnourished children were living in Gitaramuka and Buhiga communes. CMR in the three months prior to the survey was estimated at 0.6/10,000/day and under-five mortality at 0.75/10,000/day. The coverage of the therapeutic feeding programme was low at 12.5%; 53% of the moderately malnourished children were in the supplementary feeding programme. Forty-nine percent of the children had a card to show they had been vaccinated for measles (a further 38% claimed to have been vaccinated, but did not have a card) (MSF-B-03/00).

The prevalence of malnutrition in Karusi has increased since the last survey in November 1998 (see graph), although the mortality rates have remained approximately the same. The increase can be partially explained by the fact that the most recent survey was conducted during the "lean" season, whereas the first was not. The malnutrition in the area is mainly due to a shortage of food, which in turn was caused by several factors including the drought affecting the whole Horn of Africa, the province's very poor economic situation (high inflation has reduced purchasing power), and the overcrowding in the province that prevents access to sufficient land for some households. Poor health also contributed to the high prevalence of malnutrition (MSF-B - 03/00). Late rains are expected to result in a lower than normal harvest.

Bubanza Province

Bubanza Province is one of the areas most affected by the continuing unrest in Burundi, and up until the recent crisis, had the greatest number of IDPs (approximately 45-50% of the total population of 250,000 are displaced). Bubanza is one of the most fertile provinces, and before the current crisis, was often referred to as one of Burundi's granaries. The civil war and subsequent economic problems and insecurity have led to land degradation and a scarcity of agricultural inputs. CAD undertook a nutritional survey in February, of children aged 6-59 months, the results of which are shown in the graph (see annex). Displaced, regrouped people and residents from all 5 communes of Bubanza were represented in the survey. The prevalence of malnutrition (particularly severe acute malnutrition) was lower than it has been at any point since CAD began their work in the area in August 1997. CMR had also decreased to 1.1/10,000/day although under-five mortality remained relatively high at 2.9/10,000/day. Fever and diarrhoea were reported to be the main causes of mortality (CAD - CAD also undertook a nutritional survey of adults in the province in response to the increasing number of adults being admitted to therapeutic feeding programmes (see table and annex). It is not possible to compare these results to previous surveys of adults in the Province as none have been conducted before. However, ACF reported relatively similar prevalences in a survey in Kayanza Province undertaken in November 1999 (see RNIS 30). The prevalence of malnutrition is particularly high for older adults, although this group is notoriously difficult to measure accurately. The authors of the survey commented that it was difficult to ensure that all healthy adults remained in the village on the day of the survey and hence it is possible that these results are biased towards less healthy individuals. A gradual increase in the number of TB patients in the feeding programmes has been observed for some time and recent statistics for Burundi reveal very high HIV infection rates (20% in urban areas and 8% in rural areas) suggesting that these illnesses may be contributing to the high levels of adult malnutrition recorded (CAD - 02/00).

The prevalence of malnutrition (defined using z scores and/or oedema) in children aged 6-59 months in Karusi Province

The prevalence of malnutrition (defined using z scores and/or oedema) in children aged 6-59 months in Bubanza Province

Results of adult survey in Bubanza

	18-49 years	>49 years*
Grade II chronic undernutrition (BMI<17 and/or oedema)	11.4%	23.6%
Grade III chronic undernutrition (BMI<16 and/or oedema)	3.3%	10.3%

* Note that oedema was not used as a symptom of malnutrition in the older age group as oedema in this age group is often due to other (medical) problems.

A food security survey by CAD indicated that 61% of the sample population have only one meal per day and only 10% have three meals per day. The frequency of meals was associated with the amount of land owned. Market prices had started to fall in February, but erratic rains suggested the B harvest in May /June would probably be adversely affected. Although FAO had distributed seeds and tools during the six months prior to the survey, fertilisers and pesticides remained scarce (CAD - 02/00).

The significant improvement in the children's nutritional status coincides with a general improvement in the security situation, facilitating access to health care, fields and markets. In general, living conditions have improved, for example new health care centres have been opened. At the time of the survey, many of the larger camps were in the process of being dismantled and new, smaller camps or villages closer to the population's original homes were being established. These positive changes were particularly apparent in the west of the Bubanza commune in the northwest of the province. Conversely, areas bordering Bujumbura Rurale have been affected by the recent difficulties there and the majority of new admissions to feeding centres are reported to be either from these areas or from Kibira Forest. The authors of the survey stressed that the nutritional situation in Bubanza, although improving, remains extremely fragile and is highly susceptible to poor harvests, climatic change, market prices, access to land for cultivation and healthcare. Access to health care and land for cultivation is very dependent on the security situation (CAD - 02/00).

Overall, the nutritional situation in Burundi is variable. As no new data on the nutritional situation of the IDPs in Bujumbura Rural have been received it is assumed that they remain at high to very high risk (category I or II). IDPs in other parts of the country, including Bubanza and Karusi are considered to be at moderate risk (category III).

Recommendations and priorities:

• Continue to urge the Government and the international community to ensure the provision of basic humanitarian assistance and protection to the displaced; in particular access to the camps must be obtained in Bujumbura Rural.

From the survey in Karusi Province (MSF-B-03/00):

• Reinforce and improve the supplementary and therapeutic feeding programmes in Karusi Province. Open new therapeutic feeding centres in the most affected areas (Gitaramuka and Nyabikere).
• Improve the referral of malnourished children to the nutritional programmes.
• Continue to monitor the nutritional situation.

From the survey in Bubanza Province (CAD - 02/00):

• Stabilise and sustain the improvement in the nutritional situation in Bubanza by continuing the therapeutic and supplementary nutrition programmes and surveillance.
• Expand and consolidate income-generation schemes and skill-building programmes for people in the camps so that they can take them back to their places of origin. Focus on anti-erosion techniques to improve soil quality.

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

	Mar-1998	June-1998	Mar-1999	Jun-1999	Sep-1999	Dec-1999	Mar-2000
Burundi	600,000	670,000	222,000	451,000	617,000	821,000	830,000
Rwanda	690,000	550,000	690,000	640,000	673,000	650,000	652,000
RoC	400,000	50,000	213,000	213,000	343,000	823,000	438,000
DRC	568,500	621,000	788,000	952,000	1,104,000	1,185,000	1,418,000
Tanzania	345,000	329,000	328,000	373,000	373,000	400,000	465,000
Total	2,603,500	2,220,000	2,241,000	2,629,000	3,110,000	3,880,000	3,803,000

Burundi

The security situation in Burundi remains of concern. Reports of fighting in Bujumbura Rurale, Rutana, Ruyigi and Gitega have been received since the beginning of the year. The Arusha peace process talks have resumed under the leadership of Nelson Mandela and dialogue between the Government of Burundi and the major armed rebel factions has begun (OCHA - 03/00).

Humanitarian agencies have reported a deterioration in the humanitarian situation not only in the province of Bujumbura Rurale, but also in the provinces affected by the drought (North and East of the country) and in those affected by the escalation of the conflict (South and North, moving along the eastern border) (OCHA - 03/00). It is estimated that some 830,000 people, or approximately 13% of the total population, are presently displaced in Burundi. Many of these people have been displaced since 1993 (WFP-21/03/00).

Drought

A joint FAO/WFP/Ministry of Agriculture assessment in December 1999 estimated that 2,250,000 people need assistance because of a drought in the country. FAO inputs will include bean and vegetable seeds as well as hoes. WFP will provide seed protection rations for 10-15 days using the same beneficiary lists as FAO (OCHA -03/00; WFP-22/02/00).

Bujumbura Rurale Regroupment Sites

Since September 1999, almost 70% of the population of Bujumbura Rurale has been regrouped into camps around the capital. An estimated 350,000 people were forcefully relocated into 53 sites. Living conditions in the camps are reported to be appalling - they are overcrowded and there is insufficient access to food, water, sanitation and health-care. An outbreak of cholera occurred in December and the risk of further epidemics remains high (Oxfam -15/03/99; WFP-23/02/99).

The nutritional situation in the regroupment camps is variable. According to WFP, nutritional assessments undertaken in eight sites in December 1999 estimated the prevalence of acute malnutrition between 3.6% and 18.0%. The prevalence of severe acute malnutrition varied from 0.5-4.6%. Further rapid nutritional assessments in January 2000 in Kabezi, Kavumu and Ruyaga sites estimated the prevalences of malnutrition at 29%, 17% and 14% respectively. These reports are currently unavailable to the RNIS (WFP - 22/02/00, 23/02/00, 21/03/00).

There has been a large increase in the number of admissions of all age groups to the therapeutic feeding centre in Bujumbura Marie between July and December 1999 (see graph). This is despite difficulties in accessing the therapeutic centres. The increase is partially attributed to limited access to farmland and low harvests; diversion of food aid by soldiers; and limited general food distributions due to insecurity and the evacuation of NGOs and the UN in many sites (MSF-B - 01/00, WFP - 21/03/00).

Number of people in Supplementary (SFP) and Therapeutic (TFP) feeding programmes in Bujumbura Marie

Much of the population in the regroupment camps live off small businesses or obtain employment as casual labourers within Bujumbura town. Others have access to their fields and are able to harvest cassava. Factors associated with the malnutrition in the camps include the lack of access to fields, loss of crops due to looting, uneven distribution of relief foods, low vaccination coverage and outbreaks of disease. The uneven distribution of relief foods was due to problems of access and the compilation of beneficiary lists. In addition, the food pipeline has been insufficient (OCHA - 03/00; WFP - 22/02/00, 21/03/00).

Drought in some areas of the province is exacerbating the problems of regroupment. The FAO/WFP/Ministry of Agriculture assessment in December 1999 indicated that the 2000A harvest (January) will be down 50% compared to 1999 for approximately 25% of the regrouped population in the Imbo agricultural zone (WFP - 23/02/99).

In response to fierce international criticism, the Government of Burundi has undertaken to dismantle 11 camps by May 2000. Phase I of the dismantling is underway and approximately 11,000 of the 60,000 people living in these camps have returned to their homes. Phase II is currently being planned. The scale and nature of food and non-food needs in the months to come will be partially determined by the timing of the IDPs’ return to their homes. If the displaced have been able to plant in time for the 2000B season (planting should be in February and March) and the security situation remains stable, then it is possible food assistance will only be required on a large scale until the next harvest (May and June). However, food-aid needs will also be determined by the amount of planting and tending to their crops that people who are still in the camps are able to undertake. A further unpredictable but important factor is the amount of looting that may or may not occur as the crops mature (Oxfam -15/03/99; WFP - 23/02/00, 21/03/00).

WFP used resources from the regional PRRO to provide food for 255,000 people in Bujumbura Rurale between September and December 1999. A new EMOP for Bujumbura Rurale was signed on March 1 2000. This EMOP aims to provide food for an average of 257,000 people per month over the next six months (WFP - 21/03/00).

THE GREAT LAKES REGION

updated by ReliefWeb: 7.6.96

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Kayanza Province

ACF-F conducted a food security assessment and nutritional survey in Kayanza Province in November 1999 (see annex). The majority of the survey population were returnees to Kayanza. The prevalence of acute malnutrition in children aged 6-59 months was estimated at 6.7%, which included 1.1% severe acute malnutrition (0.2% with oedema). These prevalences are significantly less than those estimated in January 1999 (see graph). The under-five mortality rate was estimated at 0.93/10,000/day and CMR at 0.56/10,000/day. The coverage of the therapeutic feeding centre programme was 26.3%. Measles vaccination was confirmed by card for 66.4% of children aged more than 9 months (ACF-F-11/99).

The prevalence of acute malnutrition (defined using z-scores and/or oedema) in Kayanza Province, Burundi In children aged 6-59 months

The survey also examined the nutritional status of adults (aged 18 years +) using the BMI and chronic energy deficiency (CED) cut-offs proposed by WHO (see table). Fourteen percent of adults were malnourished (BMI <17 kg/m²). A significantly larger proportion of older adults (defined as 50+ years) were malnourished than younger adults, as is usual in the developing world. The prevalence of CED in adults had decreased significantly since January 1999. CMR was estimated at 0.53/10,000/day. The coverage of the therapeutic feeding programme was 15.5% for adults aged 18-49 years old, but 0% for adults aged more than 50 years (i.e., none of the malnourished older group were enrolled in the feeding programme) (ACF-F -11/99).

Results of adult nutritional survey in Kayanza

CED grade (BMI, kg/m2)	18-49 years (n=658)	50+ years (n=275)	18+ years (n=933)
Severe CED (<16.0)	3.2%	7.6%	4.5%
Moderate CED (16.0-16.9)	7.4%	14.2%	9.4%
Marginal CED (17.0-18.4)	16.9%	25.5%	19.4%
Normal (>=18.5)	72.5%	52.7%	66.7%

The decrease in the prevalence of malnutrition in all age groups was partially attributed to an improvement in security conditions between January and November 1999. This has allowed the population to increase its agricultural activities over the year. The food security situation is, however, still fragile. A relatively large number of adults continue to be admitted to the therapeutic feeding programmes (ACF-F -11/99).

The food security assessment attempted to evaluate associations between various household characteristics and the risk of malnutrition in either children, adults or both. Characteristics examined included: the sex and age of the head of the household; the principle method of obtaining food; access to land; availability of cassava; possession of livestock; access to food aid; available income and household size. Twenty-five percent of households were female-headed. Farming is the main source of food and income for households. In some communes market-purchase of food is important because of insecurity and theft, which hinders cultivation. Ninety percent of households reported not having received food aid during 1999. Livestock ownership varied within and between collines, and most families had only one source of income. Most were involved in small-scale trade or services, or sold farm products (including coffee as a cash crop). The only statistically significant association found was that families with a malnourished child were more likely to have a malnourished adult than those without a malnourished child. The authors of the survey commented that a more vulnerable group within this population probably exists, but that further studies are required to ascertain their characteristics and hence design appropriate interventions (ACF-F -11/99).

Karusi Province

MSF-B has reported a large increase in the number of admissions of children aged 0-17 years old to the NGO’s therapeutic feeding centre in Buhiga between August and December 1999. The majority of cases came from outside Buhiga commune, from areas where there are no therapeutic feeding centres. A large proportion of the cases are from Ngozi province. Given that security conditions prevent a nutritional survey in the province it is not possible to assess whether the nutritional situation outside of Buhiga commune is worse than within Buhiga or whether the people are coming to the clinic because there are no clinics in the areas where they live (MSF-B - 01/00).

Rutana and Ruyigi Provinces

Population displacements have been reported in the Provinces of Rutana and Ruyigi due to a significant escalation of the conflict between the army and the rebels. There are unconfirmed reports that the Interhamwe and ex-FAR are participating in these attacks. The RNIS has not received any new information about the nutritional situation in these areas; the latest reports estimated the prevalence of acute malnutrition in Rutana to be 10-15% (see RNIS 28). The affected population in these areas receive little assistance as NGO and UN activities are limited due to the insecurity (OCHA-03/00).

Outflow of refugees

About 82,000 Burundians arrived in the United Republic of Tanzania between October 1999 and February 2000, bringing the total number of Burundians in the United Republic of Tanzania up to 340,000. Some 3,400 new arrivals were registered in only one day at the end of December (UNHCR - 31/03/00).

Overall, while the prevalence of malnutrition amongst the IDPs in Bujumbura is very variable, the RNIS considers a high proportion of these people to be at considerable risk (category I or II). Food insecurity is exacerbated by the appalling sanitary conditions. IDPs in other areas are considered to be at moderate risk (category II).

Recommendations and Priorities:

• Obtain access to IDPs in Bujumbura Rurale - this remains a priority.
• Improve the living conditions of the IDPs in Bujumbura.

From the ACF-F survey in Kayanza:

• Continue with therapeutic and supplementary feeding programmes.
• Improve nutrition education and coordination with other programmes.
• Analyse and support local capacities that could prevent malnutrition.
• Establish a system for monitoring the nutritional and food security situation.
• Continue with agricultural support projects.

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

Burundi

Burundi is on the verge of a humanitarian and human rights crisis following an escalation of the internal conflict in the past few months. Intensified fighting between government forces and rebels in several areas during the past three months, particularly in Bujumbura Rurale province, has caused loss of civilian lives, including the death of UN humanitarian workers. The deteriorating security situation has resulted in large-scale population displacement and forced a suspension of virtually all humanitarian assistance in late October and November. The Arusha Peace process stalled after its mediator, Julius Nyerere, died in mid-October. Nelson Mandela has been nominated as the new mediator (IRIN-01/12/99).

Displacement

Since early September the Government has forcibly relocated an estimated 300,000 people from Bujumbura Rurale into “regroupment” sites away from their homes. The regroupment was ostensibly to allow soldiers to better protect civilians from rebel attacks, but also prevents the civilian population from providing the rebels with food and support.

The newly displaced add to an estimated 500,000 people who were already in 300 regroupment sites. It is estimated that 821,000 people, or more than 13% of the total population, are at present in regroupment camps. The worst affected provinces are Bujumbura Rurale with 73 percent of its population displaced, followed by Bubanza (60%), Makamba (24%) and Bururi (20%). Also, in the province of Rutana, which was relatively calm until recently, the number of displaced people has increased from around 2,000 to over 16,000 since September (FAO - 05/11/99).

Excessive dry weather

Crop prospects for the first season of 1999/2000 (September-January) have been affected by unfavourable weather. Planting, which normally starts from mid-September to mid-October, was delayed by dry weather during October. In the most productive areas of Kirundo in the north, Mosso in the east and Imbo in the west, no significant planting has taken place because of insufficient precipitation (FAO-05/11/99).

A reduced harvest this season will follow the below-normal harvest of the last season, which ended in July. The current dry weather will also negatively affect planting in the first season of 2000 starting next February as harvesting of the late-planted crops this season will overlap with planting next season, and a shortage of seeds could limit the planted area (FAO - 05/11/99).

General nutritional situation

Prior to the current crisis the nutritional situation in Burundi had been improving (see RNIS 27 and 28). In general, the prevalence of wasting decreased from 1998 to early 1999, largely because of improved security and access to emergency-affected populations. This allowed a gradual return to agricultural activities and better access to health and feeding centres, as well as food distributions.

THE GREAT LAKES REGION - Update by ReliefWeb 7.6.96 - The boundaries and name es shown on this map do not imply official endorsement or acceptance by the Unites Nations or ReliefWeb. The maps may be freely distributed. If more current information is available, please update the maps and return them to ReliefWeb for posting.

The latest escalation of insecurity, however, resulted in the temporary suspension of WFP’s food distributions under the general feeding programmes, food-for-work activities, provision of transit and return packages for repatriating refugees. The nation-wide seed protection rations programmes have been temporarily suspended or significantly reduced. Over the next six months, the agency plans to provide food assistance to 350,000 displaced/vulnerable/drought-affected people and nutritional support to a further 38,000 (WFP-15/11/99, 13/12/99).

There is a considerable risk that nutritional status will deteriorate over the coming months. Nutritional centres have already witnessed a significant increase in the number of beneficiaries, due to both drought and insecurity (WFP -13/12/99).

Nutritional situation of the newly regrouped

The majority of the newly regrouped populations in Bujumbura Rurale have no, or very little, access to their fields at a time when the first cropping season has already started, and any food stocks they were able to bring with them to the sites have been exhausted. As a result of the prevailing insecurity and lack of access, the populations were largely without food assistance from mid October to late November (WFP - 15/11/99). Since late November, WFP has organised food distribution through its NGO partners to some 182,000 people in the accessible regroupment sites (WFP - 26/11/99,17/12/99).

Information on the nutritional situation of the newly displaced is very limited. Thirteen of the 58 regroupment sites are inaccessible for logistical regions. Anecdotal reports have described problems of malnutrition and disease in the most vulnerable groups (infants and older people). Conditions in the camps are reported to be appalling: they are overcrowded, with insufficient drinking water and shelter, as the rainy season is about to begin (Concern -20/11/99).

Kirundo Province

SCF-UK conducted a nutritional survey in September in Kirundo Province as a follow-up to a survey conducted by IMC in the same area in January (see annex). The prevalence of wasting and/or oedema was estimated at 7.3%, compared with 10.9% in January. One percent of children were severely wasted and/or had oedema. Moderate stunting was recorded in 27.7% of the children measured and severe stunting in a further 19.9%. The graph below shows the results of both the January and September surveys. The prevalence of oedema was lower in the more recent survey, although the prevalence of marasmic malnutrition (low weight-for-height, but no oedema) was similar. The difference in the prevalence of oedema may be due to differences in the diagnosis of oedema (SCF-UK -10/99).

The prevalence of acute malnutrition in Kirundo Province in January and September 1999

Diseases such as acute respiratory infections, fever and diarrhoea were significantly associated with wasting. Also, the loss or absence of a parent placed the child at nutritional risk (SCF-UK -10/99).

The survey concluded that acute malnutrition does not appear to be a major problem, requiring an emergency response. However, interventions are required to address the poor hygiene and sanitation, the poorly functioning government health sector, and to ensure access to services and health care by the displaced (SCF-UK -10/99).

Bubanza Province

Bubanza Province is one of the areas worst affected by the continuing unrest in Burundi and, up until the recent crisis, had the greatest number of IDPs (approximately 165,000 in a total population of 289,000). The results of a follow-up survey by CAD in Bubanza Province are shown in the graph below (see annex). The prevalence of both acute and severe wasting increased between February and August, as did that of oedema. Conversely, the number of beneficiaries in the feeding centres has decreased. This was attributed, in part, to greater access to fields for agricultural activities.

The prevalence of acute malnutrition in Bubanza Province

Poor security and limited seeds or land available for cultivation continues to affect the livelihoods of both displaced groups and residents. Theft and insecurity has left many families without small livestock. In 1999, food insecurity was exacerbated by poor harvests, drought, high market prices and a lack of agricultural inputs. Visual observations suggested that the levels of malnutrition were higher in the areas most affected by the drought, where there was less access to fields, and in those sites that were furthest from Musigati and Bubanza communes (CAD -10/99).

The survey found a large increase in the number of children fully vaccinated: 95% of the children measured had a BCG scar and 76% of the children had completed their vaccination programme (compared with 41% in August 1998). This increase has been achieved through an intensive three-month vaccination campaign throughout the province and the national polio immunisation days (CAD -10/99).

Recommendations and Priorities:

• Obtain access to the IDPs in Bujumbura Rurale and gather information on their nutritional status.
• Support the coordinating rote of UNICEF in nutritional surveillance.

From the survey in Kirundo Province:

• Expand and give extra technical input to the current provision of nutritional services (an emergency response Is not required); this may include establishing a programme of community nutrition workers.
• Implement an integrated community-based program to address the problems of water, sanitation, hygiene and intestinal worm control. This may include household latrine building, provision of safe-water to each colline, a mass treatment campaign against hookworm and roundworm, and provision of flip-flop sandals.
• Encourage the use of ORS therapy for diarrhoea. From the survey in Bubanza Province:
• Expand the income-generating and agricultural programmes (via women’s associations).
• Continue support and supervision of therapeutic feeding centres.
• Intensify nutritional education.

Overall, while the nutritional situation had been improving for some IDPs in the last 18 months, the recent escalation of the crisis is likely to result in a deterioration in their nutritional situation. This is particularly the case for the newly displaced population in Bujumbura Rurale who are considered to be at high risk (category II). The IDPs outside Bujumbura Rurale are at moderate risk (category III).

RNIS 28, September 1999

The situation in Brazzaville continues to be extremely serious; very high prevalences of malnutrition have been recorded amongst the returnees from Pool. Peace in the Democratic Republic of the Congo has resulted in improved humanitarian access to war affected. In Burundi and Rwanda the nutritional situation continues to improve in the areas where there have been improvements in security. A registration exercise in Tanzania has found in a decrease in the number of beneficiaries in the refugee camps in the south of the country. 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	Sep. 99
Burundi	260,000	570,000	600,000	670,000	222,000	451,000	617,000*
Rwanda	727,000	1,400,000	690,000	550,000	690,000	640,000	673,000
Tanzania	311,000	318,000	345,000	329,000	328,000	373,000	373,000
DRC	823,000	585,000	568,500	621,000	788,000	952,000	1,104,000
Congo-B	465,000	650,000	400,000	50,000	213,000	213,000	343,000
Total	2,586,000	3,542,200	2,603,500	2,220,000	2,241,000	2,629,000	3,110,000

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

WFP food availability under the Great Lakes regional operation has gradually improved over the reporting period and no major cereal shortfall for this operation are expected, provided scheduled shipments arrive on time (WFP - 15/09/99).

Burundi

An estimated 617,000 people in Burundi require assistance. The vast majority of these people are IDPs and returnees; the highest concentrations are in Bubanza and Bujumbura (Mairie and Rural) districts. In addition, a total of 288,036 Burundian refugees remain outside the country of which 265,400 are in Tanzania (IRIN - 30/08/99: OCHA - 31/07/99).

Hopes that the Arusha Peace Process would result in an agreement by September or October have been quashed following disappointing progress in the talks in early July. The next round of talks is scheduled for September. Insecurity has increased during the reporting period in the Western and Southern Provinces, particularly around the capital. The rest of the country has seen only sporadic fighting, although Amnesty International has reported that human rights continue to be abused throughout the country. Reinstallation, rehabilitation and development programmes continue (AI - 17/08/99; OCHA - 31/07/99, 19/08/99).

The security situation around Bujumbura Rural has been particularly poor. There has been an increase in military activity and episodes of regroupment have caused an increase in the number of displaced people as the army has attempted to isolate the rebels. The governor of the province described the fighting between the security forces and armed gangs as "almost continuous". The heavy fighting has periodically prevented WFP from delivering food during the reporting period. Most deliveries resumed as soon as the security situation stabilised (IRIN - 08/07/99, 13/07/99, 19/07/99, 24/08/99, 06/09/99, 10/09/99; WFP - 12/07/99, 30/07/99, 17/08/99; 05/09/99).

Food Security

According to market price surveys by FAO, the price of the average food basket in Burundi is 126% higher than before the imposition of the regional embargo against the country in July 1996, even though the sanctions were suspended earlier this year (OCHA - 31/07/99).

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A recent joint crop and food assessment by the government, FAO and WFP has forecast a 22% shortfall in pulse production and a 10% drop in cereals compared to last year as a result of poor rains and the army-worm invasion earlier in season 'B'. Most of the annual bean and cereal production is produced in this season. There have also been reduced food distributions due to WFP shortages. Thus an increase in the prevalence of malnutrition may be seen in some parts of the country by the end of the year (IRIN - 30/08/99).

FAO, in collaboration with partner NGOs has begun to compile beneficiary lists for the upcoming distribution of agricultural materials for the 2000-A season. Approximately one million people will be assisted through the distribution of bean and vegetable seeds. Priority will be given to those who have access to land, returnees and displaced persons, drought-affected farmers and Batwa people who were recently allocated land. WFP will complement this effort by providing 15-day food rations to the beneficiaries (OCHA - 31/08/99; WFP - 15/09/99).

Nutritional situation of IDPs and returnees

No nutritional surveys have been conducted on Burundi's displaced populations during the reporting period. The most recent RNIS reports and a UNICEF report published in early August have all described how the nutritional status of the population has improved over the past 18 months. Since late 1998, UNICEF and the Burundian Ministry of Health have co-ordinated a series of ad hoc nutritional surveys of randomly selected samples of children under 5 years. A national survey was not considered to be appropriate, as aggregated data would have hidden important differences between provinces. The co-ordination resulted in successfully standardising the survey methodology (FAO and WFP were also involved in this process) applied by a number of NGOs. To improve nutritional monitoring most affected provinces have been assessed more than once since January 1998. In addition, a small food security component was added to the anthropometrical evaluation to improve understanding of the causes of malnutrition.

Reasons given for the improvement in the nutritional situation include:

• a gradual return to agricultural activities due to improved security,
• better access to land and consequently better harvests,
• improved access to health centres,
• improved case management of malnutrition through nutritional centres and
• support given to households through food distributions (UNICEF - 08/99).

The table below shows the most recent estimates of the prevalence of malnutrition in children under five and the number of displaced people by province. The estimates of malnutrition are based on data gathered from nutritional centres and nutritional surveys and are for both IDPs and residents. Note that data from centres are likely to be biased (geographical distribution of centres, access to the centres and attitudes to attendance), in contrast to survey data based on a sample representative of the entire population. The prevalences of wasting may have been estimated either as standard deviations scores (z scores) or as percentages of the reference median and hence the results are not directly comparable.

	No. of IDPs	Prevalence of wasting &/or oedema	Source & date of nutritional data (where available)
Bubanza	170,760	11.6	CAD survey, 02/99
Citiboke	n/a	6.0	Concern survey, 10/98
Gitega	14,900	6.9-7.4	Oxfam/SCF/MOH survey, 03/99
Karuzi	13,600	6.7	MSF-B survey, 11/98
Kayanza	21,200	9.8	ACF survey, 01/99
Muramvya	26,800	11.0	Solidarities survey, 02/99
Muyinga	25,800	~10	Clinic data, UNICEF
Ngozi	25,300	10-15	Clinic data, UNICEF
Rutana	2,300	10-15	Clinic data, UNICEF
Bururi	86,200	~10	Clinic data, UNICEF
Kirundo	7,700	10-15	Clinic data, UNICEF
Bujumbura	150,000	n/a
Makamba	70,800	n/a
Ruyigi	1,700	n/a

In addition to the results seen above MSF-B has reported that the number of admissions to the therapeutic feeding centres in Bujumbura Mairie decreased between January and June 1999 from 180/month to 60/month. Admissions also decreased in Ruyigi and Karusi over the same time period, although the decreases in these provinces were not as dramatic (MSF-B - 07/99).

Despite the results seen in the table above, the nutritional situation in Burundi is still thought to be precarious in some areas: differences exist both within and between provinces over short periods of time. Some areas, e.g.: Makamba and Bujumbura Rurale, are still too insecure to conduct full assessments and hence no reliable information on the nutritional status of the population is available. These areas may have pockets of high prevalences of malnutrition. UNICEF's report stresses that although the number of beneficiaries enrolling in feeding centres has decreased between the end of 1998 and early 1999, the total case load of the programmes is still relatively high: 40,000 beneficiaries are currently enrolled in the supplementary feeding centres and 3,500 in the therapeutic feeding centres (UNICEF - 08/99).

Health services

In addition to poor food security in some provinces, the population's poor health status is a further risk factor for malnutrition. In some areas households are prevented from accessing health services and cannot obtain essential drugs due to geographical and/or financial barriers. In addition, the poor quality of the care provided at the health centres, due to a decreased number of skilled personnel, has resulted in a deterioration of the population's health status (UNICEF - 08/99).

Refugees in Burundi

Approximately 500 Congolese refugees remain in Citiboke and there are also some 2,000 urban Rwandan refugees in the country.

Overall, the nutritional situation of the IDPs and returnees in Burundi is improving. The IDPs and returnees in the provinces where access can be obtained and where survey or clinic data (concerning prevalences of malnutrition or admission rates) are available are considered to be at moderate nutritional risk (category IIb). The nutritional situation of those in Makamba is unknown (category III).

Priorities and Recommendations:

• Gradually shift from short-term emergency assistance to longer-term initiatives, with elements of sustainability, in the areas where improvements have been seen in the nutritional situation.
• Continue to monitor the nutritional situation closely.

RNIS 27, July 1999

The initial optimism which greeted the suspension of the economic sanctions on Burundi earlier this year is beginning to fade. The price of an average family's food basket has fallen slightly since the lifting of the embargo but still remains nearly twice as high as it was before the sanctions were imposed. At the same time, the local currency has continued to devalue compared to both official and unofficial US dollar rates partially because of a severe shortage of foreign currency in the country (OCHA -05/05/99).

Security incidents and attacks on civilian populations continue particularly in Bubanza, Bujumbura, Bururi and Makamba provinces. Burundian Government sources claim that the attacks in the South have been launched from Tanzania by Interahamwe militia and rebels of the Force de Defense pour la Democratie (IRIN -06/04/99, 09/04/99, 28/05/99). Of particular concern was the attack in Ruyigi's Kinyinya commune where the destruction of some 600 households was confirmed. This area was previously considered relatively secure and had seen considerable progress in the reconciliation process (OCHA - 05/05/99).

Despite the fighting, further peace talks took place in Arusha in May (IRIN- 1/05/99, 27/05/99). The government has unveiled a "plan for society" which details its vision of a proposed ten-year transition period. The plan envisages a democracy based on "consensus" and an enlarged national assembly which will include groups taking part in the Arusha peace process which are not currently represented in parliament (IRIN -04/06/99). It remains to be seen how the government's opponents react to this proposal.

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War-affected populations

There are currently estimated to be over half a million displaced people in Burundi. The situation remains fluid: new people are forced to flee even while others return. For example, violence in Makamba caused the displacement of 12,000 people in areas along the Tanzanian border and the local authorities have asked for WFP's assistance (WFP -21/05/99).

WFP provides food assistance to approximately 451,000 people per month, which includes the following categories, emergency distributions - 119,000; nutritional support - 47,500; vulnerable groups - 25,000; seeds protection rations - 126,000; returnee packages - 3,500; and food for work - 130,000. The original planning figure was 282,000, but this figure has been increased as a result of a large seeds protection ration distribution programme jointly implemented by WFP and FAO. Emergency distributions target not only IDPs but also resettled IDPs and residents who are considered food insecure (WFP - 24/06/99).

As reported in RNIS 26, the nutritional situation of many of the war-affected populations in Burundi does appear to be slowly improving. The surveys described below all show a decrease in the prevalence of malnutrition in these populations. Additional data from UNICEF covering the period from September 1998 to February 1999 indicates the prevalence of malnutrition in 10 Provinces ranged from 5.6% to 14.7%. This represents an improvement compared with data collected between January and August 1998 (which ranged between 10.0% to 23.8% in seven Provinces). Reports from these surveys are not currently available to the RNIS, and thus the representativeness of the sample is unknown (UNICEF - 21/06/99).

Kayanza Province

A survey undertaken by ACF in Kayanza Province in January recorded a decrease in the prevalence of wasting in children under five since the last survey in this area in 1997 (see Annex). Acute wasting and/or oedema had decreased from 14.0% to 9.8% and severe wasting and/or oedema was estimated at 1.7% compared to 2.3%. (Oedema was recorded in 0.9% of the children surveyed). However, the two survey populations were different: - the earlier survey was only in the camps and the second survey included residents, thus the decrease in the rates of wasting and/or oedema found might be expected even without an improvement in the nutritional status of IDP's.

Adult nutritional status was also measured as a large proportion of beneficiaries in the feeding centres in this area were adults. The table below shows the distribution of the population by Chronic Energy Deficiency (CED) level. It can be seen that only 52% of the adult (aged 15y+) population were categorised as "normally" nourished according to the classification employed; 8.4% of the total adult population were defined as severely malnourished.

BMI (kg/m2)	CED level	Male (%)	Female (%)
<= 15.9	Severe	9.2	7.7
16-16.9	Moderate	10.6	13.4
17-18.4	Marginal	27.8	26.9
=> 18.5	Normal	52.5	52.0

* please note that the RNIS will soon be issuing a special report on the classification of adult nutritional status

One of the problems with this classification scheme is that it does not take into account physiological changes during ageing. The data obtained in this study (and many others) describe a decreasing BMI as age increases. If adults younger than 50 years are examined separately then only 4.0% of the population is classified as severely malnourished (<16 kg/m² and/or oedema), 2.2% of women and 5.6% of men. In adults over 50 years, 6.8% of women and 7.7% of men were defined as severely malnourished (BMI<15.0 kg/m²). Oedema was reported in 0.2% of the under-50 age group and 3.4% of the over-50 age group. (The presence of oedema in the younger age group is used as an admission criterion to the TFC, but cannot be in the older group as oedema may be caused by various common pathological conditions as well as malnutrition in this group).

For less severe adult malnutrition, ACF uses a BMI of 16.0-16.9 kg/m² and/or a MUAC<21 cm as adult admission criteria into their supplementary feeding programme in the study area. Using this definition, 18.6% of adult women and 12.9% of adult men were classified as malnourished.

In general, coverage of the nutritional programmes was low - only 12.3% of wasted children and 4.9% of malnourished adults were enrolled in a programme. Measles vaccination was confirmed by card for 66.4% of the children. The retrospective CMR for the study population showed an improvement compared to 1997 and was estimated to be 0.56/10,000/day. Under five mortality was 0.93/10,000/day compared to 4.5/10,000/day in August 1997.

By questioning respondents about their activities, sources of food and revenue, agricultural systems, household social structure (sex of head of household etc), origins and access to health care, the survey also examined possible indicators of vulnerability in this community. Although no causal relationships could be established, an association between head of household's gender and malnutrition in children was clearly seen - children in female-headed households were more likely to be wasted. In addition, a wasted child was less likely to live in a household possessing at least one animal. The elderly living alone were also vulnerable. The authors of the study were careful to stress that the study population is a relatively homogenous group in terms of activities and income and thus these indicators alone will not be sufficient to differentiate between vulnerable and non-vulnerable households.

Gitega Province

Oxfam/SCF-UK/Solidarites/MOH conducted a follow-up survey in March in Gitega province where Oxfam has established a supplementary feeding programme (see Annex). The results of all three surveys are shown in graphs below. It can be seen that the level of wasting and/or oedema has decreased in both the north and southern areas of the province over the past fifteen months. CMR in the northern part of the province also decreased from 0.57/10,000/day in November to 0.25/10,000/day in March. In the South, CMR decreased from 0.79/10,000/day to 0.44/10,000/day. Mortality for children under five years also decreased during the period in both regions - from 0.67/10,000/day to 0.38/10,000/day in the North and from 1.23/10,000/day to 0.96/10,000/day in the South. According to vaccination cards carried by the mother, 53.5% of children were vaccinated in the north and 60.1% in the south. This can be compared to 63% and 64% respectively in November.

Prevalence of wasting and/or oedema in Northern Gitega

Prevalence of wasting and/or oedema in South Gitega

Other indicators of an improving nutritional situation included a drop in new admissions to the feeding programmes, and increased land cultivation by the population. Health services are now functioning in the province. Given these improvements Oxfam is now working towards a hand-over of the management and logistics of the feeding programme to the provincial Ministry of Health. It is envisaged that this will take six months. Oxfam will train health centre staff and mothers in best nutrition and hygiene practices (OCHA -05/05/99, Oxfam - 27/04/99, 19/05/99).

Muramvya and Mwaro provinces

Results from a nutritional survey undertaken by Solidarites in February in Muramvya and Mwaro provinces among children under five years old recorded 11% acute wasting with 1.5% severe wasting. CMR was reported to be 0.53/10,000/day (OCHA - 18/05/99).

Bubanza Province

Children's Aid Direct in collaboration with the DPAE (Department of Agriculture) conducted a food security survey in Bubanza Province in March as a complement to the anthropometric survey undertaken in February (which found a prevalence of 9.75% acute malnutrition, of which 2.7% was nutritional oedema). The population is estimated at 270,000 with almost 60% being internally displaced. The displaced have been moved from large camps to smaller sites with the aim of moving people closer to their origin and hence improve accessibility to land.

No significant difference was found between residents and the internally displaced in terms of their cultivation and food production. The IDPs may have smaller fields to cultivate, but the residents have insufficient seeds and other agricultural inputs to plant the whole area. Unlike the IDPs they do not benefit from seeds and tools distributions.

Insecurity has contributed to a 40% decrease in agricultural production, as a result of restricted access, and increased prices of fertilisers and pesticides. Small livestock have been affected particularly badly, and have decreased by 90%, while large livestock have decreased by 37%, as compared with the situation before the crisis. However in recent months, improved security has increased access to markets, health centres and fields, but despite this, instability in some parts of Bubanza prevents the population returning to their original collines. The on-going food insecurity is reflected in the many re-admissions reported by the supplementary and therapeutic feeding programmes, as discharged children become malnourished once again.

Army worm infestation

More generally, FAO has identified some 20,000 hectares of land which have been infested by army worm in the north-eastern areas of Burundi. The infestation threatens to reduce cereal crops including wheat, rice, maize, millet, sorghum and sugar cane crops. Pasture lands are also affected and cause a negative impact on livestock. WFP and government officials are reviewing the situation in order to discuss possible food aid requirements resulting from the infestation (WFP - 14/05/99).

Refugees in Burundi

A new UNHCR verification exercise carried out in Citiboke revealed that only 363 Congolese remained on site, approximately 100 less than during the last survey carried out in February (OCHA - 16/04/99). There are also some 2,000 urban Rwandan refugees in the country.

Overall, the improvements in the nutritional situation in Burundi reported in RNIS 26 have been sustained, and the IDPs are currently considered to be at moderate nutritional risk (category IIb).

Priorities and Recommendations:

• Although the nutrition surveys describe an improving situation the food security of the IDPs in Burundi is still fragile. Food assistance may still be required in some areas where previously it was not necessary and in other cases assistance may be slowly phased out. Ongoing food economy assessments carried out by WFP and others should establish which areas are most in need of assistance.
• Funds are urgently needed for the WFP operation to provide assistance for the refugees in the region generally, including those in Burundi. Breaks in the pipeline mean that rations will either be cut or distributions undertaken less frequently.

From the ACF survey:

• Given the fragile state of the population's nutritional status the supplementary and therapeutic feeding programmes should be continued.
• Ensure that the population is aware of these facilities, and hence that the coverage of the programmes will improve, this is particularly true for adult males.
• Undertake further studies on the nutritional situation of the population

From the CAD study in Bubanza:

• Include vulnerable residents in the collines in seed distribution programmes.
• Encourage breeding of small livestock where security allows through associations of credit schemes.

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

Burundi

There are currently estimated to be over half a million displaced people in Burundi. Although many are returning home, the situation remains fluid: new people are forced to flee even while others return. Not all of these people, however, require food aid - WFP estimates that a monthly average of 222,000 IDPs and vulnerable groups will require nutritional support in 1999 (OCHA - 12/98). A total of 321,792 refugees still remain outside Burundi, including 5,079 who fled to Tanzania between August 1998 and February 1999. Since August 1998, 6, 217 Burundian IDPs have returned from South Kivu (OCHA - 17/02/99). A verification exercise on the number of Congolese refugees at Rugombo camp found the numbers to be reduced to only 450 (WFP -25/02/99).

Economic sanctions imposed on Burundi by East and Central African states for two and a half years have been suspended. The move followed the 7th Regional Summit on Burundi, which was called to review the political situation in the country and progress in peace negotiations. Regional trade has now resumed as normal with Tanzania, Uganda, Kenya and Rwanda as the ban on imports and exports is lifted and borders are opened (IRIN - 25/1/99). According to a UN report, the sanctions had a disastrous effect for the poor, compounding the already serious consequences of the country's prolonged conflict. The sanctions wasted both time and money by complicating the delivery of badly needed humanitarian assistance with cumbersome procedures and long delays (OCHA, 12/98).

Although substantial political progress has been made in the past six months and further peace talks are scheduled to take place in Arusha in March and May, continued insecurity persists in many areas of the country. In particular, there has been an alarming number of reports on attacks of IDPs and civilians, primarily in the southern provinces (IRIN - 30/10/98, 12/11/98, 24/12/98, 31/12/98, 8/1/99, 5/2/99, 19/02/99).

Present indications show an improving nutritional situation for much of the affected populations in Burundi. Increased stability in some areas (such as Cibitoke in the north west) has resulted in many IDPs returning to their homes, enabling them to re-start farming and economic activities as well as improving their access to public health facilities.

A survey by CONCERN in Cibitoke province in October found a significant reduction in the level of acute malnutrition identified in the region, compared to results from a survey in April 1998 (see Annex I(2a)). Cibitoke province has been one of the worst affected by the civil war, although during the seven months between the two surveys there were many changes, including the dispersal of IDP camps with people moving back to their homes, and many families have been able to restart agricultural activities. Furthermore, access to some areas has improved, and in addition to CONCERN, other health agencies have begun activities in Cibitoke. These positive changes were reflected by the fall in the rate of acute malnutrition from 21.1% to 5.6%, with a decrease in severe acute malnutrition from 10.5% to 0.8%. Oedema was measured at 0.36% compared to 7.2% in April. The levels of admissions to therapeutic feeding centres had also fallen over the period, as did the retrospective mortality rates. Only in one commune, Buininyana, had the rate of malnutrition remained static (22%), although there was a reduction in the level of severe malnutrition (from 13.4% to 2.5%). This may be because the nutritional programme in Burkininyana started later than in other parts of the province due to insecurity in the area. Generally, vaccination coverage was low - 19.2% for measles, while 55.2% of children aged more than 12 months had a BCG scar.

A survey by OXFAM in Gitega province in November found that rates of malnutrition had decreased since the previous January (see Annex I(2b)). Results revealed that the rate of acute malnutrition had fallen from 23.8% to 12.9% in the northern part of the province and from 13.8% to 8.3% in the south. Severe malnutrition decreased from 6.5% to 2% in the north and from 5.7% to 1.4% in the south. Under-five mortality was estimated at 0.67/10,000/day in the north, while crude mortality was 0.57/10,000/day. In the south the under-five mortality rate was estimated at 1.23/10,000/day and 0.79/10,000/day for the total population. Vaccination coverage was 63% in the north and 64% in the south (OCHA - 17/02/99).

A survey in Karusi, in November 1998, reported 6.7% wasting and 1.7% severe wasting (see Annex I (2c)). Crude mortality was 0.57/10,000/day. Coverage of the therapeutic feeding programme for the severely malnourished children was low (16%). This was in part due to problems of access - there was only one therapeutic feeding centre in the province and it was difficult for some people to reach it. Measles vaccination coverage as confirmed by a card was 68.3%.

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A survey by CAD in August in Bubanza province (population 250,000 with 138,000 IDPs, also one of theprovinces and where security has improved slightly) showed encouraging results in areas which had been accessible for some time (see Annex I(2d)). A decrease in the prevalence of acute malnutrition between February and August 1998, from 17.2% to 11.6%, and from 4.5% to 3.9% severe malnutrition, was recorded. These results are even more impressive when compared to a malnutrition rate of 19.5%, with 9.2% severe in August 1997. It should be noted that although these rates are improving, they are still relatively high. Furthermore, in the newly accessible sites (Rugazi and Ngara) it was visually observed that the nutritional situation was worse than in other areas. It was noted that the number of beneficiaries in the Supplementary Feeding Programme had increased (the majority of which were adults). The expansion of the Supplementary Feeding Programme may in part reflect an increase in programme coverage, as well as problems with food availability. Amongst children over 12 months only 41% had a card showing them to be fully vaccinated; 85% had a BCG mark.

The results of the surveys described above indicate a greatly improved nutritional situation. The main reason for the decrease in the rates of malnutrition is the improved security situation, which has enabled camps of displaced people to be dispersed and people to return home from hiding in the forest. Prolonged upheaval and displacement has seriously disrupted the ability of rural people to cultivate their land and continue their usual agricultural and economic activities. Rural farmers should normally enjoy three harvests in a single year, which produce a range of crops, including cash crops. Other reasons cited for the improvement include food and seed distributions by WFP/FAO, the programmes for supplementary and therapeutic feeding by NGOs, and increased availability of medicines for treatment of malaria, which is a major cause of morbidity and mortality.

Overall, the nutritional situation of the IDPs in Burundi has improved. The IDPs are considered to be at moderate nutritional risk (category IIb).

Priorities and Recommendations:

• In Cibitoke CONCERN advises that it may be time to re-evaluate the need for supplementary feeding programmes in all parts of the province, although some areas (Bukininyana) require extended coverage of this programme. The consensus, now that most households are resettling, is that fertilisers, pesticides, seeds and tools are currently the priority needs for the population.
• The CAD study in Bubanza, which was conducted 7 months ago, advised that Therapeutic Feeding Programmes should be improved in the south of the province and that the regular general food distribution should continue to the most needy in the sites.
• Oxfam Gitega advised that although the malnutrition rate had declined, nutritional feeding and food security activities should continue especially since the months to follow were considered a "lean period" and malnutrition figures could rise again.
• MSF-B in Karusi advised that the referral system for malnourished children be improved and also that a food security analysis should be conducted in the area.

More generally:

• WFP/FAO have jointly launched a project to assist families who were severely hit by drought in the last agricultural season. FAO will distribute seeds to some 220,000 families, mainly in Kirundo, to ensure that people do not have to resort to eating their seeds in order to survive; WFP expects to provide rations to 160,000 of the most vulnerable families who will receive 15-30 days' rations.
• 124 new food for work programmes have been initiated by WFP since January 1999 (WFP -25/02/99).
• The capacity of the ministry of health to increase vaccination coverage should be increased.
• Further surveys on nutritional status and food security should be carried out, particularly in Bubanza.

Congo-Brazzaville

An estimated 200,000 residents of south Brazzaville and an undetermined number of people from Pool and other southern regions of the country have been displaced since December 1998 as a result of the latest conflict involving militia groups and government forces. The Congolese people, who had not yet recovered from the devastating civil war in 1997, are now facing a new and potentially more serious crisis.

Insecurity caused by fighting between armed groups allied to the Congo's key political figures has continued sporadically since the end of the 1997 war. The militia groups were created to serve as the private armies of the country's three main political leaders. Militia-men are drawn mainly from the home areas of the respective leaders, a trend which has resulted in sharp cleavages between regional groups based on ethnic or regional lines. An analyst has described the politics of Congo-Brazzaville as "triangular, representing three different parts of the country. Two sides become aligned against the third, and those alliances are constantly changing". Currently, the Cocoye and Ninja militia are united against government forces. Without a political solution regional analysts predict that it is difficult to foresee an end to the instability plaguing the country (OCHA - 17/02/99).

Heavy fighting has been reported in and around Brazzaville for several months (IRIN - 24/02/99, 19/02/99, 05/02/99, 29/01/99, 22/01/99, 31/12/98). Many neighbourhoods of southern Brazaville have been completely destroyed or looted during the unrest (IRIN - 31/12/98). As a result, an estimated 120,000 people fled the city towards the Pool region, possibly into the nearby forests (IRIN - 18/12/98). Their whereabouts remain unknown and is a source of growing concern as access to food and basic health services are very limited in the area. Anecdotal reports of the "catastrophic" condition of these displaced people have been received, however, humanitarian aid agencies have not had access to the region since fighting erupted there in October 1998 (IRIN -12/02/99; OCHA - 10/03/99).

There are reported to be over 31,000 people staying in 17 displaced peoples sites in northern Brazzaville according to figures provided by the IFRC. Most of the sites are located around church compounds; they are reported to be cramped and unsanitary (WFP - 29/01/99, IRIN - 15/01/99). Some of the most vulnerable IDPs receive food aid from WFP. However, the provision of relief is sometimes interrupted by insecurity and looting (WFP - 12/03/99). The Red Cross movement is also providing water supplies and health care services and is distributing UNICEF-donated essential drugs (IRIN - 11/02/99). It is estimated that another 30,000 IDPs are staying with friends or family in the north of the city.

Anecdotal reports suggest that the nutritional situation of the IDPs in Brazzaville are deteriorating to very poor levels (PANA- 17/03/99). Further accounts confirm this and report an increasing number of admissions of malnourished children to feeding centres in Brazzaville (IRIN - 29/01/99). Shortages of food and non-food items, primarily due to insecurity on the supply routes, have been reported (WFP - 12/02/99, 29/01/99, 18/12/98). The ongoing fighting has periodically cut the links between the city and Pointe-Noire, the main entry point for imports (WFP - 18/02/99). The situation in Point Noire is also critical - some 20,000 IDPs have made their way to the city (WFP - 19/02/99, IRIN - 12/02/99).

UNHCR is planning to phase out its assistance to Rwandans in Congo. Male Rwandans from Kintele, Njoundou and Luokolela camps have become involved in the fighting in the country. Plans are being drawn up to remove all women, children and others who have not taken up arms to a single site (IRIN - 15/02/99).

Overall, it is probable that the IDPs and refugees in areas to which access is restricted are at heightened risk of malnutrition and mortality (category IIa). Those in areas which are less difficult to access are considered to be at moderate nutritional risk (category IIb).

Recommendations and Priorities

• In terms of the delivery of humanitarian assistance, the major problem encountered in the Congo-Brazzaville is that of access to the affected areas. In particular, there is an urgent need for assessments and, as seems likely, deliveries of humanitarian assistance to the Pool region.

Democratic Republic of Congo

The Democratic Republic of the Congo (DRC) is undergoing dramatic political and military developments which create an extremely complex humanitarian situation. In early August 1998 the ethnic and military tensions that persisted in the eastern provinces of the country throughout 1997-1998 transformed into a rebellion. The crisis is a regional conflict with involvement of armies from at least seven countries, as well as a number of local and foreign insurgent groups (OCHA - 12/98).

In mid-September 1998 an immediate military threat to Kinshasa (population 5 million) was averted, yet, citizens in Kinshasa are experiencing serious food shortages (WFP - 22/01/99; IRIN - 10/02/99). Insecurity is preventing traders' access to food producing areas, thus limiting supplies. Prices in food commodities have also risen (WFP 22/01/99). Imports of fuel and other basic commodities have decreased since the government introduced new currency regulations. The closing or scaling down of some factories and businesses has led to an increase in unemployment. Reports on the food security situation in the outskirts of the city indicate that families may spend 90% of their daily expenses on food and consume meat only once every two weeks (IRIN - 10/02/99).

WFP has food stocks for Kinshasa in the port of Pointe Noire. Due to blockades of the road and railway links from the city, however, WFP has only been able to deliver limited quantities of food aid through expensive and unexpected air operations (WFP - 18/12/98, 12/02/99). Their target beneficiary figure for March is 52,000; which represents an increase of 18,000 people since the beginning of the year because of the deterioration of the situation (WFP - 04/03/99).

Increasing military activity in the east of the country (South and North Kivu, Province Orientale and Maniema) is intensifying the current crisis. Serious violations of Human Rights have been reported, including the deaths of many civilians (IRIN - 26/02/99). The latest OCHA reports estimate that there are 235,000 displaced people in these areas:- 110,00 in South Kivu and 125,000 in North Kivu. This number includes recent displacement since August 1998, as well as people who were displaced earlier (Refugees International, 15/01/99).

One of the major outcomes of the ongoing war is the complete destruction and/or loss of infrastructure built by the relief community in the east of the DRC beginning in October-November 1996. This means that it is extremely difficult to deliver assistance in certain parts of the country. Several agencies have reported deteriorating conditions in the nutritional situation in South Kivu during the past few months. In November SCF described the food security situation as precarious. The number of malnourished children increased, but a number of feeding centres had been closed because of the conflict (IRIN - 13/11/98). Food for the Hungry International also reported that the number of people requiring assistance in the Uvira region of South Kivu had increased, but their programme was also suspended from August 1998. They previously had an agricultural programme targeting some 6,000 vulnerable families (IRIN - 31/12/98). In February, the IRC found high mortality rates in the Katana zone near Bukavu: the crude mortality was 3.8/1,000/month (approximately five times the normal level for the region) and children under five were dying at the rate of 10.1/1,000/month (approximately three times the normal level). Deaths were mainly attributed to diarrhoea, malaria and measles (IRIN - 26/02/99).

Latest reports from Goma in eastern DRC indicate increased population displacements in the area (see Annex I(2e)). Families are arriving from Rutshuru, fleeing armed clashes (IRIN - 19/02/99). Recently, humanitarian sources have reported the preliminary results of a survey indicating that 3% of the children in Goma town are malnourished, with 1% severe malnutrition (IRIN - 24/02/99). This result indicates that acute malnutrition is not a problem in Goma town. The first direct delivery of WFP food to Goma since mid-98 arrived in mid-February (WFP - 19/02/99).

A recent survey in Kisangani showed an alarming nutritional situation; the prevalence of acute malnutrition was 13.4% (<-2 z-scores), and severe acute malnutrition was 9.1% (see annex I(2f)). Oedema accounted for most of the severe malnutrition (8.7%). Severe wasting without oedema only affected the youngest group (6 to 17 months). The authors suggested that the cause of the malnutrition was more likely to be an imbalance of nutrients in the diet, and disease, rather than overall lack of food. Crude mortality reported in the survey was 0.97/10,000/day, while the under-five mortality rate was 2.0/10,000/day.

Angolan refugees in DRC: Angolans continue to arrive in DRC, fleeing from armed clashes in northern parts of their country. The most recent estimates suggest a total of 140,000 Angolan refugees in the DRC, of which 75,00 are recent arrivals (UNHCR - 17/03/99).

UNHCR reports that malnutrition and mortality among 41,000 Angolans in Kisenge, Eastern Kasia province, is rising (UNHCR - 12/02/99). A survey by MSF- B in late February 1999 reported a prevalence of acute malnutrition rate of 25%, and 12.8% severe malnutrition. Oedema was reported to be 11.6, which is extremely high (see Annex I(2g)).

Burundians in DRC: It is estimated that some 37,000 Burundian refugees from camps in the DRC have spontaneously repatriated since the start of the recent conflict. A further 15,000 are hosted by the local population in villages in various areas of South Kivu, mainly in the Uvira region (UNHCR- 17/03/99). The most recent reports concerning these refugees suggested they were in poor health with high prevalences of malnutrition (IRIN - 30/10/98).

Sudanese refugees in DRC: Latest reports suggest that there are 60,000 Sudanese in the DRC (UNHCR -17/03/99). The nutritional situation of these people is unknown; WFP does not assist them (WFP - 12/03/99).

Rwandan refugees in DRC. There are estimated to be 35,000 refugees from Rwanda in DRC. This number has been determined, from NGO reports, but not verified by UNHCR. UNHCR currently has no access to and provides no assistance to these refugees. The estimate does not include some 173,000 persons previously assisted in refugee camps in North and South Kivu who are now unaccounted. The number unaccounted (based on population estimates in October 1996, minus known returnees) is subject to an unknown margin of error and does not take into consideration unknown spontaneous returns or numbers of refugees who may have died from natural or violent causes (UNHCR - 17/03/99). No nutritional data are available for these refugees.

Congolese- Brazzaville refugees in DRC: At the end of January, an Inter-Agency Mission visited Luozi in Bas-Congo province to assess the situation of Congolese refugees who arrived after war broke out in Brazzaville. The mission identified 16,500 Congolese refugees who need emergency humanitarian assistance. Presently, 8,500 live with family or friends while others are sheltered in public buildings (WFP - 09/02/99).

Congolese refugees in neighbouring countries:

Congolese in Tanzania: The crisis has halted the UNHCR repatriation programme of Congolese refugees from Tanzania. Some 60,000 persons were assisted in their return to South Kivu from Tanzanian camps pre-August 1998, but reports suggest that thousands of DRC refugees are streaming back into Tanzania barely a year after repatriation (IRIN - 31/01/99; UNHCR - 19/03/99).

Congolese in Central African Republic: Amid claims and counter-claims of military victories in Equator province, the number of Congolese in the Central African Republic has grown to 7,500. The refugees, who are mainly women and children fleeing from fighting in Zongo, began arriving in mid-January (IRIN - 08/01/99; UNHCR - 12/02/99).

Congolese in Zambia: Recent reports suggest that tens of thousands of Congolese are also fleeing to the Zambia (UNHCR - 19/03/99).

Overall, the IDPs in Kivu regions are considered to be at high risk (category IIa). IDPs in other parts of the country are considered to be less at risk as are some of the refugees from Angola and Congo-Brazzaville (category IIb). Very high prevalences of wasting and crude mortality rates have been recorded for the Angolan refugees in Kisenge (category I). No data is available for the refugees from Rwanda, Sudan and Burundi.

Recommendations and Priorities

Fighting in the east of the DRC is expected to result in severe food shortages in the coming months, aggravating the already poor situation. Moreover, humanitarian agencies have very limited access to certain regions because of insecurity and denial of access which will only be resolved by a political solution.

For the Angolan Refugees:

• Food aid and medicine are urgently required for the Angolan refugees in Kisenge and the population of Katana. The main problem is the lack of food. At the time of going to press the first delivery of WFP food aid had arrived by train from Lubumbashi after a five-day journey (IRIN - 19/03/99).
• Recommendations from the survey by MSF include increasing the capacity of therapeutic and supplementary feeding programmes, as well as medical care facilities. This has been agreed upon by UNHCR. Further recommendations include investigating the causes of the high prevalence of oedema recorded.
• UNHCR has approached authorities in the port of Matadi to plan for a site for another group of recently-arrived Angolan refugees. An estimated 12,000 Angolans fled M'banza Congo in Angola at the beginning of February and have not been able to find shelter with the local population (IRIN - 19/02/99).

Rwanda

There has been a dramatic increase in number of IDPs in Rwanda from about 35,000 in December 1997 to over 650,000 in February 1999 (IRIN - 19/02/99). The majority of the IDPs, who fled as a result of military operations, are in Ruhengeri and Gisenyi Prefectures. Since June 1997, insecurity has increased in the Northwest of the country as a result of ex-FAR soldiers and hard-liners of the previous government fighting against the military. As the security situation worsened, there was a massive movement of the population away from the collines (rural areas) and towards the administrative centres, as nearly the entire population moved to live in large camps near the communal office. In addition, many people fled, or were taken hostage, into the surrounding bush and forest (SCF-UK - 02/99).

In November 1998, the Government of Rwanda announced plans for a gradual resettlement of the displaced people into new villages (known as imidugudu) in close proximity to their traditional farmlands (WFP -27/11/98). This process of "villagisation" is under away and the latest figures from the Government indicate that about 300,000 displaced people have been resettled to new sites in the prefectures of Gisenyi (118,730) and Ruhengeri (176,363). From December 1998, the security situation was said to have improved (SCF - 02/99). UNHCR has not been involved in the transfers of these IDPs, but continues to distribute blankets, soap and other items (UNHCR - 12/02/99). A total of 660,000 internally displaced Rwandans in the north-western prefectures of Ruhengeri and Gisenyi are currently benefiting from WFP food assistance (WFP - 22/01/99).

Reports of very poor living conditions for the IDPs have been received since October. Many are living without proper shelter, access to clean water, adequate medical services and opportunities to farm their land. Children, women, the elderly and handicapped "figure prominently" amongst the IDPs (WFP - 30/10/98, 06/11/98; IRIN -18/12/98). Their nutritional situation is variable: some reports are favourable, whereas others indicate a serious level of malnutrition.

According to WFP reports, health authorities in Gisenyi, confirmed a decreasing number of cases of malnutrition. Results of a screening exercise carried out in early December 1998, show a reduction in the number of malnourished persons in special feeding programmes. Supplementary feeding is to be phased out in most centres in the coming months (WFP - 22/01/99).

Anecdotal reports suggest,however, that the nutritional status in Nyarutovu and Nyamugali camps in Ruhengeri Prefecture is deteriorating (WFP - 18/02/99). Since September the number of malnourished children enrolled in feeding programmes in the camp hospitals have doubled. WFP has agreed to double the supplementary ration and provide full rations to mothers of the severely malnourished children who stay at the centres. The present programme will also expand to include pregnant and lactating mothers. In addition, qualitative monitoring systems are being set up to assess what rations are received and what other sources of food exist.

A joint Ministry of Health/NGO survey in February covering nine communes of Ruhengeri prefecture found 10.7% wasting with 6.4% severe wasting of (see Annex I(2h)). Chronic malnutrition was recorded at 59.5% and severe chronic malnutrition at 29.2%. Oedema was measured at 4.7%. Measles vaccination was recorded for 92% of the population over 6 months following a campaign the previous month. The communes with the highest rates of acute malnutrition were Mataba (23.3%), Nyarutovu (18.7%), and Gatonde (16.7%). The higher rates in these communes were attributed to a combination of the negative impact of the insecurity on harvests, variable or poor soil fertility, limited access to health care, inadequate provision of shelter, and restricted road access (SCF-UK - 02/99).

A food economy analysis was conducted in conjunction with the anthropometric survey in Ruhengeri (SCF-UK, 2/99). It was reported that although most of the population had been able to be meet their energy requirements up until the survey, their diet was nutritionally unbalanced.. Around 80% of their calories were estimated to have come from sweet potatoes, with less than 5% from pulses (the latter is extremely low for a population whose preferred staple is beans). Their main sources of food were from harvesting their own land (or other's) when security permitted; agricultural labour, food aid, or begging. Due to logistical and security constraints WFP had been unable to deliver food regularly and the ration lacked oil. Furthermore, insecurity had prevented most families from cultivating or maintaining their own crops. Thus it was predicted that after months of harvesting without planting (due to insecurity), the sweet potato crop will soon be exhausted for most families. Tools and seeds for farming had also been stolen and hence, it would be difficult to re-plant.

In addition to the IDPs, there are currently some 30,000 Congolese refugees (from North Kivu) in Rwanda (OCHA - 12/98). No new information is available on the nutritional situation of these people.

A Ministry of Agriculture/FAO/WFP/ EU assessment of crop production in Rwanda during the 1999 season A (November to February) has reported an increased yield compared to 1998. Due to the unevenly distributed rains, however, the positive impact was mainly limited to deep-rooted plants like bananas. Bean production is almost 20% lower than the 1998 level. A food deficit for January-July 1999 is estimated to be approximately 99,000 metric tons, of which 52,000 will be covered by current food aid interventions (FEWS - 26/02/99).

Overall, the reports on the nutritional situation of the IDPs in Rwanda are variable. Thus they are considered to be at moderate nutritional risk (category IIb).

Recommendations and Priorities

• Seed and tools must be distributed to the IDPs in the north so that they can become more self-sufficient The Ruhengeri surveys' recommendations include:
• The general ration increasing from 900 kcal to 2,100 kcal per person per day including oil in the most nutritionally at risk communes and to a half ration - including oil - in the remaining communes.
• To prevent them being eaten, seeds and tools should be provided concurrently with food distributions.
• The monitoring of distributions should be improved to ensue equity of distribution.
• Expanding supplementary and therapeutic programmes, and re-opening previously closed centres.
• Public health priorities include: improving facilities and access to health centres, constructing of latrines, providing clean water and shelter.

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	Dec. 96	Mar. 97	Jun. 97	Sep. 97	Dec. 97	Mar. 98	Jun. 98
Burundi	296,000	300,000	265,000	260,000	570,000	600,000	670,000
Rwanda	1,179,000	2,600,000	2,600,000	727,000	1,400,000	690,000	550,000
Tanzania	759,000	344,000	390,000	311,000	318,000	345,000	329,000
DRC	668,000	599,000	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	2,913,500	3,843,000	3,769,000	2,587,200	3,542,200	2,553,770	2,220,000

Burundi There are approximately 670,000 displaced people in Burundi, but it is likely that not all of these people require emergency aid. This number includes many people in 'regroupment camps' throughout the country. Improvements in security conditions allowed some of the population in the regroupment and displacement camps to return to their farms during the second half of 1997. However, insecurity and resulting population displacements continue. For example, there were over 18,000 new arrivals to the commune of Isale fleeing fighting in early April [IRIN 27 Mar-2 Apr 98, 04/06/98].

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Efforts to resolve the ongoing crisis in Burundi are continuing. Peace talks will resume in Arusha on 15 June against the backdrop of a somewhat improved relationship between the government and parliament. This improved relationship resulted in the recent signing of a transitional constitution. The breakthrough over the constitution is a hopeful sign for a resolution to the conflict [IRIN-a 10/06/98].

Food assistance is currently provided through several programmes including emergency relief for those displaced by conflict and insecurity and return packages for displaced persons and refugees returning home. There are also supplementary and therapeutic feeding programmes for malnourished and vulnerable groups where possible, as well as infrastructure rehabilitation programmes through food-for-work [FAO May 98, WFP 08/05/98, 22/05/98].

Food security and nutritional status in many parts of the country are precarious due to a combination of factors including insecurity, poor harvests, an economic embargo and poor road and rail systems to transport food throughout the country. This is leading to price increases rendering adequate quantities of food beyond the reach of many people. Forecasts are that there will be a small decline in the 1998 A season harvest (first of three annual harvests) compared to 1997 and that this will be 20% lower than the pre-crisis average. Yields have been affected by lack of agricultural inputs and late but exceptionally heavy rains and flooding. Total food production for 1998 is predicted to be 9% below the 1988-93 average. WFP is planning a second airlift of essential food commodities into Bujumbura in order to have enough stocks to meet emergency food needs. On a more positive note, the April 1998 decision to ease economic sanctions has allowed renewed activity in some economic sectors, particularly trade [FAO My 98, WFP 08/05/98, 22/05/98].

Nutrition surveys continue to reveal alarming levels of malnutrition. For example, a recent survey of accessible communes in Cibitoke Province (estimated population 310,000) showed 14.0% wasting with 3.3% severe wasting. Oedema was measured at 7.2% (see Annex I (2a)). The crude mortality rate was measured at 3.3/10,000/day, and the under-five mortality rate was 5.0/10,000/day. These mortality rates indicate a very serious emergency. Measles immunisation coverage, as confirmed by a vaccination card was low at 9.9% [CONCERN 18/04/98].

Most of the population has access to food through their own production and approximately 80% of the households surveyed had access to land. However, normal agricultural practices have been interrupted due to a number of constraints including insecurity and reduced availability of seeds and tools. At the time of the survey, the population was mainly relying on cassava as the staple food. In addition, health service delivery was inadequate with a shortage of medicine and health staff [CONCERN 18/04/98].

The last RNIS Report (No 23) described a worrying nutritional situation in the accessible areas of Bubanza province with wasting levels of 16%. One of the main recommendations of the survey was to establish feeding programmes in the area. A therapeutic feeding centre with a capacity for 750 people has now been opened. Supplementary feeding centres are also being opened [IRIN 01-07/05/98].

Available information points to a serious nutritional situation. The number of patients at the nutritional recovery centres and health and nutrition centres throughout the country is rising and mortality rates are high. There are many malnourished adults amongst the cases of malnutrition seen, suggesting a serious situation in many areas. However, a national assessment of malnutrition has yet to be carried out, and many areas remain inaccessible.

Congo/Brazzaville Rail traffic between Brazzaville and Pointe Noire was suspended following clashes between government troops and supporters of the ousted president. This adversely affected the supply of food in Brazzaville until transport was re-established in mid-May. It is currently estimated that 50,000 people in the country need emergency assistance. During March, food was delivered to 46,000 vulnerable Congolese. A survey conducted in Brazzaville in February showed that the prevalence of malnutrition had increased from 5.5% in January to 9.3% (see Annex I (2b)) [OCHA-a 29/04/98, WFP 10/04/98,15/05/98].

There are an estimated 6,300 Rwandan refugees in three northern camps and close to 2,900 at Kintele camp near Brazzaville. As the three northern camps are geographically isolated and are plagued by mosquitoes and malaria, some Rwandan refugees have been moving from there to Kintele [OCHA-a 29/04/98].

An earthquake struck the region of Likouala. There are currently no details on the extent of the damage in the area [IRIN 30/04/98].

Eastern Democratic Republic of Congo There are substantial population movements in the Eastern Democratic Republic of Congo (DRC). These include returnees from Tanzania who are brought to the Uvira area, new arrivals from Burundi in Uvira and newly displaced people in the Goma region. Heavy rains have left many people homeless, led to the further deterioration of the road system and hampered food deliveries. In addition, there are reports of cholera in the Kivu areas of eastern DRC, which includes Uvira and Bukavu [IRIN 27 Mar-2 Apr 98, WHO 19/05/98].

There are an increasing number of reports of insecurity in eastern DRC, specifically in the Kivu region. Recent examples include an attack by rebel forces on Beni and rebel attacks on Butembo in north Kivu which resulted in the deaths of at least 30 people [IRIN 03-09/04/98, 22-28/05/98, IRIN 24/04/98].

Repatriation from Tanzania continues. Returnees are provided with a one-month ration in Uvira before moving on to their final destination. However, the pace of repatriation is somewhat slower than initially planned because of travel difficulties, mainly due to the poor condition of the roads. Since the resumption of the operation in mid-December, over 33,000 Congolese refugees have been repatriated [WFP 17/04/98].

There are new arrivals from Burundi to the Uvira area. These refugees are fleeing insecurity in Burundi and approximately 10,000 people have crossed the border since January 1998. These newly arrived refugees are said to be in poor health and malnourished. There are reports that some refugees are being forced back to Burundi [IRIN 03-09/04/98, WFP 10/04/98, 01/05/98].

Assistance was provided to those affected by flooding in Kisangani, as detailed in the last RNIS report (No 23), along with former children combatants housed in a camp nearby. This assistance was completed at the end of April [WFP 01/05/96].

Rebel incursions from Rwanda have forced approximately 20,000 people to flee their homes in Goma for safer areas farther from the border. These newly displaced people are without shelter or health care facilities. There are estimated to be 129,000 internally displaced people in Eastern DRC [IRIN 04/06/98, WFP 15/05/98].

Continuing transport constraints due mainly to poor road conditions, have meant that food stocks in eastern DRC are low. By the end of April 1998, distributions needed to be targeted to a restricted number of beneficiaries [WFP 03/04/98, 24/04/98].

Other refugees and IDPs in DRC There are a number of other refugee and IDP populations in the DRC:

• Rwandan refugees There are estimated to be 37,000 Rwandan refugees scattered in Eastern and Central DRC. In addition, there are approximately 3,000 unaccompanied Rwandan in DRC [RNIS 23]. There are no nutritional data available for these refugees.
• Internally displaced from Shaba There have been no new nutritional data on the approximately 260,000 resident and displaced people in Mwene Ditu since October 1995 when levels of wasting as high as 42% were seen (see RNIS #14). It is not clear whether this lack of data is because the population has been successfully assimilated or that the population are not accessible. It may also be that there are no agencies working in the area who can provide information on the population.
• Angolan refugees There are approximately 150,000 Angolan refugees in the DRC, 50,000 of whom require assistance. Prior to an upsurge in fighting in Angola, some spontaneous repatriation was occurring (see RNIS #21).
• Sudanese refugees There are approximately 111,000 Sudanese refugees in the DRC who are fleeing the continuing insecurity in Sudan (RNIS #21).
• Ugandan refugees There are approximately 4,000 Ugandan refugees in Eastern DRC. There has been some repatriation back to Uganda in recent weeks [WFP 22/05/98].

Rwanda The security situation in Rwanda remains volatile, particularly in Gisenyi and Ruhengeri prefectures, leading to population displacements. For example, there were reports of a massacre in Gisenyi prefecture at the end of March that left 40 people dead. There were also reports of five students killed and seven injured in Ruhengeri in March. Further reports were made in April of killings in Gitarama prefecture and of 4,000 people fleeing their homes due to insecurity. Most recently there have been reports of 100,000 displaced persons in Gisenyi and Ruhengeri due to insecurity. Immediate food assistance is being planned for this population, most of whom are accommodated around administrative and military centres [IRIN 20-26/03/98,10-16/04/98,24-30/04/98, WFP 08/05/98].

Food aid is currently planned for 550,000 people in Rwanda. This will be in the form of supplementary and institutional feeding, food-for-work programmes, vulnerable group feeding and aid to refugees. New projects have been started in some prefectures where people are finding it increasingly difficult to acquire food due to a combination of factors including erratic rainfall and flooding [FAO 16/02/98, IRIN 24-30/04/98, USAID 28/04/98].

Food insecurity is generally increasing in Rwanda due to a combination of poor crop production due in part to heavy rains, food delivery difficulties and insecurity. Many roads have been closed due to flooding and mud slides, including the southern corridor, a main supply route from the south. As a result, prices for staple foods are reportedly high and supplies are limited. Particularly hard hit are the prefectures of Butare and Gikongoro, where there were anecdotal reports of malnutrition among the adult population in April, and children were reported to be abandoning school due to hunger. There are also steep increases in the number of persons requiring supplementary and therapeutic feeding. Furthermore, there have recently been reports of a deteriorating nutritional situation amongst residents of resettlement camps in Kibungo. Food is now being distributed through newly established nutritional centres in the camps and plans are afoot to increase food aid deliveries in June in order that a partial ration of 1025 kcals/person/day can be provided. It is anticipated that the harvest in July will improve the food supply in areas like Butare, Byumba, Gikongoro, Gitarama, and Kigali [IRIN 17/04/98, WFP 10/04/98, 17/04/98, 06/05/98, USAID 28/04/98].

Food aid deliveries have been unbalanced, resulting in a ration of mostly cereals. There has been a shortage of pulses and oil for food-for-work projects. It is expected that this situation will improve in the coming months as a result of regional purchases of food and the re-opening of the southern corridor [WFP 22/05/98].

There are approximately 35,000 refugees in Rwanda. The number of Congolese refugees continues to increase, while some refugees from Burundi have been returning home [IRIN 01-07/05/98, WFP 01/05/98].

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 food insecurity. Indeed, anecdotal reports are of malnutrition in many areas. The refugees in Tanzania can also be considered to be at moderate risk due to high rates of anaemia and malaria, with a tendency towards improvement as measures are being taken. The remaining refugees in the region are not currently considered to be at heightened risk (category IIc in Table 1).

On-going interventions The UN Consolidated Appeal for the Great Lakes Region, key aspects of which were summarised in RNIS 23, has, as of the end of May, met with a disappointing response with only 9% of needs being pledged. In the region, it is clear that programmes must be predicated on full, uninterrupted access to beneficiary populations for maximum benefit. Regional improvement of road and rail systems is imperative.

In Burundi, it is important to systematically quantify malnutrition rates throughout the country for short-term interventions, and to assess underlying causes so that longer-term corrective measures can be taken. However, until security allows for full and regular access to populations, agencies will continue to be dependent on a short-term strategy of implementing selective feeding programmes where needs can be ascertained. Overland transport (road and rail) needs to be improved in order to deliver aid. Consideration might also be given to some form of market intervention which reduces the impact of inflation on the vulnerable.

In Congo, there is a need for a concerted campaign to address the malaria problem in the three northern camps for Rwandan refugees.

In DRC, poor road conditions due in large measure to the recent rains are hampering returnee movement and food aid deliveries. Roads must be improved as a priority. There is also a need for further nutritional information on newly arrived Burundi refugees in Uvira region and on the remaining scattered Rwandan refugees. Shelter and health care provision for the newly displaced in Goma region are also areas of concern.

In Rwanda, every effort should be made to secure stocks of pulses and oil for food-for-work projects which recently have only been able to provide cereals. Better information on the situation people in Rwanda are facing is needed to target appropriate interventions. This would include:

• nutrition and food security assessments in Butare and Gikongoro prefectures and in Kibungo resettlement camp, where there are increasing concerns due to anecdotal reports of malnutrition;
• information on recent returnees, who are thought to be most affected by the worsening food security situation;
• information on population movements as a result of insecurity to determine appropriate interventions.

In the long term, food security problems in Rwanda can only be properly solved through ending the violence that continues to plague the country.

In Tanzania, the need to improve roads in the regions of refugee concentration is on-going. Some projects are underway during the current dry season. In addition, funds for the procurement of impregnated bednets are needed.
 

RNIS 23, March 1998

Widespread violence in the Great Lakes region over the last four years, including the genocide in Rwanda in 1994, the overthrow of the Zairian government in 1997 and continued insecurity in Burundi, has led to massive population displacements, rendering millions of people vulnerable to malnutrition, disease and death. Despite improvements in the situation in 1997, notably in Rwanda, approximately 2.6 million people require food aid in the region (see table below). The food deficit in many areas has increased, social services have been disrupted, and the economies of the region severely disrupted. In addition, the unusually heavy rains in the region have made food aid transportation difficult [OCHA Jan-Dec 98].
 

Location	Sep. 96	Dec. 96	Mar. 97	Jun. 97	Sep. 97	Dec. 97	Mar. 98
Burundi	300,000	296,000	300,000	265,000	260,000	570,000	600,000
Rwanda	598,000	1,179,000	2,600,000	2,600,000	727,000	1,400,000	690,000
Tanzania	653,000	759,000	344,000-	390,000	311,000	318,000	345,000
DRC	1,444,000	668,000	599,000	514,000	823,000	585,000	568,500
Congo/Brazzaville	-	-	-	-	465,000	650,000	400,000
Malawi	-	-	-	-	1,200	1,200	260
Total	3,002,000	2,913,500	3,843,000	3,769,000	2,587,200	3,542,200	2,553,770

Burundi

Despite formidable obstacles, there have been many achievements in the delivery of humanitarian aid during the course of 1997. These include:

• emergency food aid provision as security allowed (general rations, supplementary and therapeutic feeding programmes);
• seeds and tools distributions;
• control of typhus and cholera outbreaks;
• strengthening of humanitarian agency coordination.

Many of these services benefited populations in 'regroupment' camps. However, insecurity, insufficient funds and an on-going embargo meant that many needs were unmet. Economic sanctions against the country have been somewhat relaxed, but there have been calls for an urgent review of the sanctions in recognition of the government's efforts to improve security and human rights. It is currently estimated that 600,000 people require emergency assistance in Burundi [FAO 20/03/98, IRIN 02/01/98, OCHA Jan-Dec 98].

Insecurity continues in many provinces in Burundi, with attacks regularly reported throughout the country, hindering deliveries of food aid and the establishment of feeding centres, and rendering some populations inaccessible. For example, an attack outside Bujumbura in December left hundreds of people dead and at least 10,000 temporarily displaced. Another attack forced several hundred returnees to flee their transit centre at Gatumba. Some populations are inaccessible due to the high density of landmines in surrounding areas. These mines pose a serious constraint on the ability of these people to resume normal activities once the fighting stops. Furthermore, flooding in parts of Kenya and Tanzania resulted in the closure of stretches of road and rail lines hampering relief food deliveries to Burundi at the beginning of the year. As a result food rations were reduced to some of the neediest populations [OCHA 22/02/98, WFP 02/01/98, IRIN 23/01/98].

THE GREAT LAKES REGION

updated by ReliefWeb 7.6.96

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Present indications are of a serious nutritional situation for much of the affected population in Burundi. For example, in Kayanza province, a therapeutic feeding centre set up for 50 people is now assisting 450 people. Another larger centre is being constructed to assist this increased number. Reports on the 37,000 displaced people in Murago, Buriri province are that 20 people are dying per day (equivalent to a CMR of 5.3/10,000/day) from malnutrition and disease [OCHA 03-09/02/98, WFP 23/01/98].

A survey was carried out in accessible areas of Bubanza province in February 1998 as a follow-up to a survey conducted in August 1997. The August survey showed 13.2% wasting, and 6.2% oedema. Supplementary feeding programmes were set up and the follow-up survey was conducted to assess the impact of these programmes. Much of the province (total population 270,000 of which 123,000 are in regroupment camps) is inaccessible due to insecurity. The insecurity is reducing the amount of cultivable land so that food production is diminished and market prices have increased substantially. As a result, people are eating less. The situation has been made even worse by excessively heavy rains [CAD 21/02/98].

The current survey showed 16.0% wasting with 3.2% severe wasting. Oedema was measured at 1.3% (see Annex I 2a). The under-five mortality rate was 4.3/10,000/day (about 3 times normal), and malnutrition was recorded as the leading cause of death. Average caloric intake was just under 1000 kcals/person/day. However, there has been a reduction in the prevalence of severe malnutrition and oedema. There is a pressing need for feeding programmes to be established in the area. The August survey reported on suspected cases of micronutrient deficiency diseases, specifically beri-beri, pellagra and scurvy. So far, there has been no verification of these deficiencies. These results are from accessible areas of the province there is concern that the nutritional situation in inaccessible areas is even more serious [CAD 21/02/98].

A joint OXFAM(UK)/SCF(UK) survey in Gitega was carried out in January 1998. The security situation in the province is precarious, and has prevented farming activities. In the northern part of the province, wasting was measured at 19.7% with 2.4% severe wasting. Oedema was measured at 4.1% (see Annex I 2b). The crude mortality rate (CMR) was determined to be 0.3/10,000/day. In the southern part of the province, wasting was measured at 8.5% with 0.9% severe wasting. Oedema was measured at 4.8% (see Annex I 2c). The CMR was 0.79/10,000/day. Based on these results and estimations of the population, coverage of feeding programmes is insufficient, and efforts should be pursued to increase coverage of these programmes [OXFAM(UK)/SCF 22/01/98].

Measles immunisation coverage, as confirmed by a card, was low at 34% in the north and 24% in the south. If confirmation from mothers is included, coverage is 70% and 87% in the north and south respectively. It was further reported that limited access to land to farm, along with the destruction of planted crops by heavy rains meant that people were not able to meet their basic food needs [OXFAM(UK)/SCF 22/01/98].

An assessment of the food economy was carried out on the rural population in Gitega Province and was timed to coincide with the nutritional survey to provide context with which to interpret the anthropometric results, and to identify possible interventions to improve the situation. The group considered to be most vulnerable was that which did not have enough land and livestock to produce what they need to survive. This group had to rely on market purchases to complete their food needs. The purchasing power of this group has been eroded since the crisis by a reduced income. This is due to the fact that wages for manual labour have not risen in line with price inflation, migration labour opportunities have decreased, and the prices of the crops they sell have not risen with inflation. Interventions identified as likely to improve the food security in the area, but specifically within the poorest group, included support to seed distribution centres, which used to have a good supply of appropriate seeds at the commune level, to increase the income of this group [WFP/SCF(UK) 17/02/98].

Crop production for the first of three cropping seasons in Burundi (the 'A' season) was somewhat below that of 1997. It was noted that there were increased areas planted, but a lack of fertiliser, along with adverse weather conditions, prevented an increase in production [FAO 20/03/98].

Estimated Food Production in 'A' Season In Burundi

taken from: FAO/WFP Crop and Food Supply Assessment Mission to Burundi, 20 March 1998.

Over the course of 1998, food aid will be distributed in the form of emergency assistance, support for re-integration, food for work and assistance to vulnerable groups and targeted feeding. Plans to distribute seeds and tools country wide were in place for the 1998B planting season (February and March). As of the end of February, distribution had begun in seven provinces [OCHA 22/02/98, WFP 23/01/98].

Congo/Brazzaville Civil strife in Congo/Brazzaville, which occurred between May and November 1997, led to large-scale displacement both within the country and into neighbouring Democratic Republic of Congo (DRC) and Cameroon. Since the end of hostilities, most of the refugees have returned; however there remain between 250,000-350,000 IDPs in the country [FAO 03/03/98].

In the short term, the fighting had:

• a limited impact on food production;
• a negative impact on purchasing power in urban areas due to loss of jobs;
• led to an increase in food prices, which, while starting to decline, remain higher than before the war [FAO 03/03/98].

In the six-month period from November 1997 - April 1998, it is estimated that 400,000 people will require emergency assistance in Congo/Brazzaville. The situation, while improving, has been aggravated by heavy rains in the region and it is estimated that 50,000 people will still require food aid at the end of this six month period [FAO 03/03/98].

There are an estimated 13,500 Rwandan refugees in Congo/Brazzaville. Most of these refugees want to stay due to the insecure situation in Rwanda [WFP 30/01/98].

Democratic Republic of Congo (DRC)

Household food security and nutritional status of the population are major areas of concern in the DRC. Nutrition surveys carried out in Kinshasa have revealed malnutrition rates of 5.9-10.7% and the nutritional situation in the interior of the country is believed to be generally worse. Key factors contributing to a declining nutritional status include long-term degradation of the infrastructure, and more recently population displacement due to insecurity and flooding and interruptions in the food production process. Population displacements both during and after the civil war caused significant declines in nutritional status amongst many - particularly for those in the Masisi and Fizi zones of Kivu province. Moreover, food crops now being harvested are expected to be reduced by the serious floods around Kisangani. A total of 99,000 IDPs in need of humanitarian assistance have been identified in the DRC [OCHA 01/02/98, OCHA Jan-Dec 98].

The security situation, while not as volatile as at the end of 1997, remains tense. Access to areas outside of Goma town was denied to humanitarian agencies, leaving an estimated 65,000 people in the region without assistance from November until early March. Access to the high plateau region in Uvira has also been difficult due to rain. An estimated 35,000 were without assistance. Prices were reported to have already doubled in Uvira [WFP 02/01/98, 13/03/98].

Flooding in Kisangani left 13,000 people in temporary need of food and non-food assistance. There were reports of cholera with over 1,500 cases and 270 deaths. There has been some concern over the situation in Kapata camp in Kisangani. This is a closed military re-education camp for Mai-Mai warriors holding approximately 4000 people. Some 300 children were reportedly severely malnourished and no medicines were available. Many of the Congolese returning from Tanzania are settling in the Uvira area. In addition, refugees continue to arrive from Burundi Tensions are reportedly increasing in the area [WFP 23/01/98, 06/02/98, 20/02/98, 27/02/98].

Other refugees and IDPs in DRC

There are a number of other refugee and IDP populations in the DRC.

• Rwandan refugees There are estimated to be 37,000 Rwandan refugees scattered in Eastern and Central DRC. In addition, there are approximately 3,000 unaccompanied Rwandan children in DRC [OCHA 01/02/98]. There are no nutritional details available for these refugees.
• Burundi refugees There are estimated to be 4,000 refugees from Burundi in DRC [OCHA 01/02/98]. There are no details available on the nutritional status of this population.
• Internally displaced from Shaba There have been no new nutritional data on the approximately 260,000 resident and displaced people in Mwene Ditu since October 1995, when levels of wasting as high as 42% were seen (see RNIS #14). It is not clear whether this is because the population has been successfully assimilated, or they are not accessible, or there are no agencies working in the area.
• Angolan refugees There are approximately 150,000 Angolan refugees in the DRC, 50,000 of whom require assistance. Prior to an upsurge in fighting in Angola, some spontaneous repatriation was occurring (see RNIS #21).
• Sudanese refugees There are approximately 111,000 Sudanese refugee in DRC who are fleeing the continuing insecurity in Sudan (RNIS #21).
• Ugandan refugees There are approximately 4,000 Ugandan refugees in Eastern DRC [OCHA 01/02/98].

Rwanda The return of over a million refugees to Rwanda at the end of 1996 and early in 1997 placed considerable strain on what was already a tight food supply situation. At that time, food aid was required for over 2.6 million people. Since then, areas under cultivation have increased and it is reported that Rwanda's food crop production is on the way to recovery. However, there are more people in Rwanda than before the crisis so now less food is available on a per capita basis. Furthermore, there have been unusually heavy rainfalls which have led to crop losses. These factors are leading to a tight food supply situation in country [FAO 16/02/98].

General ration distributions have been phased out and 640,000 people are targeted for food aid in the first six months of 1998. This aid will be in the form of supplementary and institutional feeding, food-for-work programmes, vulnerable group feeding and aid to refugees [FAO 16/02/98].

Insecurity is increasing in Rwanda, particularly in the north-west prefectures. There have been several attacks and massacres over the past two months. This insecurity is leading to fresh population displacements within Rwanda, as well as hampering relief and development efforts. For example, there are reports of population displacements in Gisenyi where the situation has been described as somewhere between warfare and low level conflict [FAO 16/02/98, WFP 02/01/98, 20/02/98].

There are reports of a deteriorating nutritional situation in many prefectures, particularly affecting recent returnees. Cases of marasmus and kwashiokor are 'not uncommon'. The cause of this apparent increase in malnutrition is believed to be increasing food prices in conjunction with high levels of disease such as malaria, diarrhoea and respiratory infections. Poor infant feeding practices are also likely to contribute to elevated levels of malnutrition [FAO 16/02/98, OCHA Jan-Dec 98].

There are approximately 50,000 refugees in Rwanda, most of whom are from DRC. An attack on Mudende camp for Congolese refugees resulted in the movement of these people to Kageyo camp in Byumba. There have been recent reports of starvation in this camp. This is being attributed to the need of refugees to exchange their ration for other more costly goods. Another attack on Kibiza camp (13,500 Congolese refugees) in Kibuye province has led to efforts to move this population to a safer camp in the east [IRIN 09/01/98, WFP 23/01/98].

Tanzania There remain approximately 345,000 refugees in Tanzania, 69,000 of whom originate from the DRC and 276,000 from Burundi. Refugees are continuing to arrive from Burundi. For example, 675 refugees arrived between 5-11 January 1998 and 423 from the 9-15 February 1998. Repatriation of Congolese refugees is ongoing; to date approximately 13,000 refugees have been repatriated. The heavy rains in the region have led to deteriorating road conditions in Kigoma and Ngara, disrupting food deliveries to these areas. Because of this, cereal and pulse rations are being reduced and monitoring for any adverse effects is underway [WFP 09/01/98, 16/01/98, 20/02/98, 13/03/98].

Mortality Rates In the Kigoma Region of Tanzania over Time

taken from: Health Situation Report (Kigoma Region) February 1998, UNHCR.

Mortality rates in the Kigoma region (population 221,000), while still within normal ranges, are snowing an increasing trend. High mortality rates were noted a recent health report on Kanembwa and Mtendeli camps with major causes of death being malaria, lower respiratory tract infection and anaemia. Malaria and anaemia taken together account for almost 50% of the total number of deaths reported. As of February 1998, it was noted that the number of children in the therapeutic feeding programmes in the two camps has doubled. With the reduced ration in the camps, monitoring of the situation will be vital [UNHCR 09/03/98].

Overall, the population in Burundi can be considered to be at heightened nutritional risk (category Ha in Table 1). Certain populations, for example in Bubanza and Gitega provinces are at high risk, although population breakdowns are not available. The affected population in Congo/Brazzaville can be considered to be at moderate nutritional risk (category IIb in Table 1) with a tendency towards improvement. The refugee population in DRC is not currently considered to be at heightened risk, with the exception of the refugees from Rwanda, whose condition is unknown (category III in Table 1). The IDPs in DRC are at moderate nutritional risk (category IIb in Table 1) due to inaccessibility. The refugees in Rwanda are at heightened risk due to insecurity (category IIa in Table 1), while the remaining affected population, along with the refugee population in Tanzania are at moderate risk (category IIb in Table 1).

On-going interventions

Many of the needs highlighted in a recently released Consolidated Appeal are intended to foster a more development-oriented approach to humanitarian aid in the region, despite on-going conflict in some areas.

In Burundi efforts must continue to promote food security through a variety of initiatives, such as income generating projects. There is also a widespread need to improve access to potable water and sanitation facilities. More specifically, therapeutic feeding facilities need to be urgently established in Bubanza province as well as an investigation into suspected cases of micronutrient malnutrition. Furthermore, supplementary feeding programmes should be introduced into other health centres and double rations allocated until food security improves. Decisions should also be taken rapidly concerning the need to establish general rations and selective feeding programmes in Murago in Buriri province and in Gitega.

The interior of the DRC is largely inaccessible due to the conditions of the roads. Some areas are highly vulnerable since movement of food from one region to another through regular market mechanisms is problematic. The opening up of key-feeder roads from areas of agricultural production to urban areas and establishment of viable transport links between regions must be considered a priority in order to decrease the incidence of localised food crisis. The food and nutritional situation in the Uvira region should be investigated in order to determine what needs there may be. It appears that there is an urgent need for some response to the situation in Kapata camp where at the very least medicines are needed.

In Rwanda, further investigations into reports of malnutrition should be made in order to quantify the extent of any nutritional problem. Particular attention should be paid to nutrition education as it relates to the introduction of complementary foods and infant feeding practices. Measures to prevent or reduce food price inflation should also be considered. Other needs include:

• continuing to strengthen primary health care to reduce morbidity and mortality rates particularly of children under five and women and health promotion to establish a strong home and community based response to preventable diseases;
• nutrition and epidemiological surveillance;
• provision of agricultural inputs to sustain agricultural recovery.

In Kageyo camp the provision of essential non-food commodities should be ensured to prevent sale of food commodities which is proving to be a damaging coping strategy in this camp.

In Tanzania, assistance to ease transport constraints once the rains have subsided will be crucial. This would include road, bridge and rail line repairs so that food can rapidly be moved throughout the country. More specific needs will include assessing the nutrition situation for any effects of the reduced ration, with particular attention necessary in the Kigoma region camps. Malaria control measures, including vector control, impregnated bednets and antimalarials particularly for infants and pregnant women, must be expanded to control anaemia.
 

RNIS 22, December 1997

There remain approximately 3.5 million people requiring humanitarian assistance in the Great Lakes Region. Security incidents appear to be intensifying in number and severity in the Eastern Democratic Republic of Congo (DRC), Burundi and Rwanda. The insecurity is having a negative impact on the food security situation of large numbers of people; at the same time, it is hampering efforts by the humanitarian aid community to assist, particularly in Eastern DRC and Burundi. Numbers of people affected and locations overtime are summarised in the box below:

Location	Jun. 96	Sep. 96	Dec. 96	Mar 97	Jun. 97	Sep. 97	Dec. 97
Burundi	289,000	300,000	296,000	300,000	265,000	260,000	570,000
Rwanda	749,000	598,000	1,179,000	2,600,000	2,600,000	727,000	1,400,000
Tanzania	642,000	653,000	759,000	344,000	390,000	311,000	318,000
DRC	1,419,000	1,444,000	668,000	599,000	514,000	823,000	585,000
Congo/Brazzaville	-	-	-	-	-	465,000	650,000
Malawi	-	-	-	-	-	1,200	1,200
Total	3,106,000	3,002,000	2,913,500	3,843,000	3,769,000	2,587,200	3,542,200

Burundi Insecurity has plagued the country since a coup d'etat in July 1996, and in many provinces, the security situation appears to be deteriorating. The provinces that are reportedly particularly affected are those near the border with Tanzania, and with that of the DRC.

Approximately 570,000 people are housed in 'regroupment camps' similar to camps for IDPs. These people have been grouped together ostensibly for their own protection in particularly insecure provinces. However, recent reports from some areas are of attacks on these camps. For example, an attack by insurgents on a camp in Southern Buriri left eight people dead. In another example, 4,000-5,000 people were evicted from Rwegura in Kayanza province, and the site was burned. In other more secure areas, return packages are being distributed and people are returning home [IRIN 21/10//97, 10/11/97, UNDPI 07/11/97, WFP 03/10/97, 10/10/97].

Two surveys were carried out in the regroupment camps in Kayanza province (estimated population in camps 70,000) in August 1997. In the camp in the south of the province, wasting was 12.8% with 0.9% severe wasting. Oedema was measured at 1.1%. Measles immunisation coverage was 23.5% as determined by possession of an immunisation card, and 85.1% including oral verification by the mother. The under-five mortality rate was 4.7/10,000/day, four times a usual level (see Annex I (4a)). In the camp in the north of the province, wasting was 13.4% with 1.9% severe wasting. Oedema was measured at 0.7%. Measles immunisation coverage was 35.4% as determined by possession of an immunisation card, and 79.3% including oral verification by the mother (see Annex I (4b)). The under-five mortality rate was 4.3/10,000/day, again four times a usual level. The ration provided to the camps has provided just under 1800 kcals/person/day [ACF Aug. 97].

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The main causes of the high mortality rates were identified as diarrhoea and malnutrition. Sources of water are reportedly far from residences making it difficult to access. In addition, health and nutritional centres are also far away for many people [ACF Aug. 97].

In Bubanza province (estimated population of 225,000 with 65,000 displaced), wasting was measured in six displaced and regroupment camps and found to be 13.2% with 9.2% severe wasting. Oedema was measured at 6.2% (see Annex I (4c)). In addition, suspected cases of pellagra, beri-beri and scurvy were noted by the survey team. Further investigation in order to verify the presence of this micronutrient malnutrition is underway. Supplementary feeding programmes are underway and include over 6,000 beneficiaries [CAD 21/08/97, 29/11/97].

Market prices in Bubanza have increased to five times the pre-crisis level. Based on the nutrition survey in August, one meal per day was usually consumed, consisting of cassava leaves, cassava or rice. Vegetables were generally difficult to find on the market, apart from tomatoes. Water supplies are reportedly inadequate in the province and sanitation is a major problem. The communes in the north and east are inaccessible due to insecurity and cultivable land is being reportedly being sabotaged The insecurity is forcing people to remain in camps instead of going back to the fields to cultivate and in some areas is also preventing NGOs from assisting with nutritional programmes targeted to vulnerable groups [CAD 21/08/97, 29/11/97].

Since these surveys, anecdotal reports are of an 'alarming nutritional status' in many provinces. A nation-wide assessment of nutritional programmes by one NGO indicated a serious nutritional problem in areas of conflict. In addition, there are reports that feeding centres are over-burdened, in many cases caring for three times the intended number of patients. There are currently 46,000 malnourished children receiving supplementary and therapeutic feeding in Burundi [DHA 31/10/97, IRIN 19/11/97, WFP 07/11/97].

The Government of Burundi had planned to close the regroupment camps as security allowed. Current plans are to move people to smaller camps, closer to their homes. Most of these new sites are located along main roads and construction of housing is reportedly underway. However, in areas like Kayanza province where there has been no improvement in security, reinstallation of regrouped persons remains suspended [IRIN 17-23/10/97].

The internal air operation which has served as a vital link to the interior of the country cut off by insecurity, has been under threat due to shortages of funds.

Congo/Brazzaville After four months of fighting between government forces and supporters of the democratically-elected president, supporters of the former military leader took control of the capital city, the second largest city, Pointe Noire and the airport, and a formal end to the war was declared on the 16th of October 1997. However, it is reported that the security situation is not completely calm. The fighting in the country led to wide-scale population displacements both internally and as refugees to neighbouring DRC. Now that the situation is relatively stable, some people are returning to their homes. It is estimated that 650,000 people in the Congo will need humanitarian assistance over the next three months [IRIN 10-16/10/97, 22/10/97, 21/11/97, WFP 17/10/97, 14/11/97].

Recommendations have been made to provide a one month ration to returnees and a three month ration of CSB, oil and high energy biscuits to other vulnerable groups in the city. In addition, food-for-work projects will be implemented to assist in the rebuilding of the city [WFP 31/10/97].

Much of the city's infrastructure, which had been damaged in earlier fighting in 1992 after elections, has been destroyed, and since the rainy season has begun, the risk of epidemics is growing. Work currently being undertaken is intended to prevent epidemics and includes the provision of medicines, shelter, improved sanitation and provision of drinking water. There have been critical shortages of medical equipment and medicines [IFRC 06/11/97, IRIN 22/10/97].

There are a 60,000 people displaced in Pointe Noire. Food rations were distributed to this population in mid-October. There are approximately 10,000 Rwandan and Burundi refugees in two sites in Congo/Brazzaville who fled DRC during Kabila's take-over of the country [WFP 17/10/97, 24/10/97].

Democratic Republic of Congo (DRC) The total number of refugees and IDPs in DRC is estimated to be 585,000. This number does not take account of the unknown number of Burundi and Rwandan refugees who remain unaccounted for since the dispersal of refugee camps in Eastern DRC (then Zaire) in 1996. This number could be as high as 200,000. There are at least 23,000 Rwandan and Burundi refugees remaining in Eastern DRC. A UN investigation team, sent to look into allegations of human rights violations in Eastern DRC began work on 8 December 1997, after weeks of delays [DHA 17/11/97, IRIN 25/11/97, 08/12/97].

The number of refugees from Congo/Brazzaville in DRC increased in October until there were estimated to be 40,000 in the country. Most of these people were living with families in Kinshasa and approximately 10,000 were housed in Kinkole camp outside of Kinshasa. A measles epidemic broke out in Kinkole camp in early October. Immunisation campaigns were immediately undertaken. Since the end of hostilities, voluntary repatriation has begun, and the number of refugees remaining in DRC is currently estimated to be 30,000 [IRIN 03/12/97, WFP 03/10/97, 10/10/97].

Current estimates are that there remain 23,000 Burundi and Rwandan refugees in Eastern DRC [WFP 17/10/97]. Many feel there are up to 200,000 who are still are unaccounted for. Insecurity caused by clashes between rebel groups and government forces have led to internal displacement in Eastern DRC of over 100,000 people [DHA 17/11/97, IRIN 10-16/10/97].

A survey carried out in the village of Kitchanga (estimated population of 19,538), 90 km northwest of Goma, may give an idea of the nutritional situation in other villages in the region. Inter-ethnic conflict which has plagued the area since 1993 has led to large displacements. The nutritional status of Kichanga village had deteriorated. In February 1996, a survey showed a global malnutrition rate of 8.2% (wt/ht <-2 SD or oedema). A survey carried out in April 1997 showed only 3.3% wasting. However, oedema was measured at 8.1% (see Annex I (4d)). The survey showed that residents were more at risk of malnutrition than the displaced. This may have reflected a number of factors including the high rates of crop theft and the fact that those left in the town may have been those with the least means to leave. The crude mortality rate was 0.94/10,000/day and the under-five mortality rate was 1.37/10,000/day. Measles immunisation coverage was 54% [MSF-H Oct. 1997].

Since the above-mentioned survey, the security situation has remained tense in Eastern DRC with periodic upsurges of violence interrupting humanitarian activities. For example, during the week of 6-13 of October, food was provided in Bukavu for over 4,000 people. However, no monitoring of the distributions was possible due to the security situation. UNHCR has closed its office in Goma, and is reducing activities in Bukavu [WFP 17/10/97].

Recent reports are that chronic malnutrition (stunting) is a more serious problem among children in Eastern DRC than acute malnutrition (wasting). Specifically, it was stated that wasting varied from 6-11% with 0.1-1.3% severe wasting while stunting was 58-67% [IRIN 21/10/97]. However, some acute problems do occur. For example, during September there was an estimated 20% increase in the number of people receiving supplementary and therapeutic feeding in Goma connected with the arrival of displaced persons from Masisi.

Other refugees and IDP population in DRC: There are a number of other refugee and IDP populations in the DRC.

• Internally Displaced from Shaba There are no new nutritional data on the approximately 260,000 residents and displaced in Mwene Ditu. Most recent reports are from October 1995, and showed levels of wasting as high as 42% (see RNIS #14). Insecurity in DRC is likely to exacerbate their already difficult situation.
• Angolan refugees There are approximately 150,000 Angolan refugees in the Democratic Republic of Congo, 50,000 of whom require assistance. Prior to an upsurge in fighting in Angola, some spontaneous repatriation was occurring (see RNIS #21).
• Sudanese refugees There are approximately 111,000 Sudanese refugees in DRC who are fleeing the continuing insecurity in Sudan (see RNIS #21).
• Ugandan refugees There are approximately 4,000 Ugandan refugees in Eastern DRC [DHA 17/11/97].

Rwanda The return of over a million refugees to Rwanda and escalating insecurity in many prefectures has put a considerable strain on the food supply in the country. In addition, the rains began a few weeks later than normal which is likely to have a negative impact on the January harvest. Food aid will be needed for 1.4 million people in the coming months in the form of food-for-work, feeding programmes and seed protection rations. At the same time, reconstruction and rehabilitation of the country's infrastructure are underway [IRC 10/10/97, WFP 03/10/97].

Insecurity is increasing in the country, particularly in the western prefectures. One example of this was the murder of a WFP driver when his vehicle was attacked at a check point. Since this attack, stricter measures, including military escorts, have been taken to ensure safety when delivering food. These added precautions, which have been shown to be necessary, have led to some delays in food deliveries. Intense fighting between the Rwandan army and Hutu rebels was reported in the north-western area of Gisenyi in early October and a large number of people are said to have fled. The border with the DRC has been closed by the DRC authorities in order to prevent movement of Rwandans into neighbouring Goma [IRIN 14-20/11/97, UNDPI 04/11/97, WFP 24/10/97].

Household food stocks in many prefectures are reportedly low. Food prices continue to rise, particularly for beans, a staple food, and the purchasing power of many rural families is low. As a result, more and more people are participating in food-for-work programmes [USAID 27/10/97, WFP 17/10/97].

The food security situation is not likely to improve before the January harvest. Furthermore, the prospects for the January harvest are uncertain due to a number of factors. Less than optimal rain patterns early in the growing season led to a delay in planting of nearly a month. In some areas insecurity has hampered cultivation, and some households reportedly lack sufficient agricultural inputs, such as seeds and tools [USAID 27/10/97].

There are approximately 15,000 refugees from the DRC in Mudende camp in Rwanda. Preliminary discussions with the refugees are underway on the possibility of repatriation, but no date has been set as yet [WFP 17/10/97].

Programmes aimed at helping with the reintegration of returnees and rehabilitation of infrastructure are on-going. Examples of projects currently underway include:

• the rehabilitation of rural water systems;
• the rehabilitation of schools and health centres;
• loan schemes to start small businesses;
• training programmes for women [IRC 10/10/97].

There are no nutritional details on the vulnerable population in Rwanda, however the worsening food security situation coupled with what appears to be increasing insecurity in many provinces is likely to have an adverse effect on the nutritional status of the population. There are anecdotal reports that malnutrition is increasing and emergency food assistance is being given in some areas following requests from local authorities [IRIN 03-09/10/97]. As a consequence of growing food insecurity, more and more people are participating in food for work programmes with new projects being created in a number of prefectures. The months leading up to the January harvest are likely to be particularly difficult without the increased participation of humanitarian agencies.

Tanzania There remain approximately 318,000 Congolese and Burundi refugees in Tanzania, The government of Tanzania is pursuing its programme to identify and resettle refugees and illegal immigrants in the towns along the Rwandan and Burundi border [DHA 17/11/97].

Since the end of September, approximately 8,500 Congolese and 8,900 Rwandans have been identified by the Government of Tanzania as living illegally in the villages of Kigoma. Most of these refugees have been transferred to camps, where some are already registered, while a few Congolese have preferred to spontaneously repatriate [WFP 01/11/97].

Some organised repatriation to DRC had been taking place. During the month of September almost 3,500 refugees returned. In addition, a further 500 refugees returned on their own. There are reportedly 45,000 refugees registered to repatriate. One constraint on the repatriation exercise is the limited capacity to receive refugees in DRC [IRIN 24/11/97, WFP 03/10/97, 10/10/97, 05/12/97].

Malnutrition in Refugee Camps in Tanzania Aug-Sep 1997

Surveys carried out in Kasulu District (estimated population for the four camps is 146,000) in September 1997 showed levels of wasting varying from 2.3-5.4% (see Annex I (e-h)). This is a significant improvement over results from a survey in April, when levels of wasting were as high as 23%. The under-five mortality rate was 1.2/10,000/day, and measles immunisation coverage varied from 57.8% -79.1%. Although the food pipeline has been stable in camps like Nyarugusu since March 1997 there have been some complaints that the food distributed is not sufficient for the two week period and that certain commodities like green peas and white maize meal cause abdominal problems. Selective feeding programme coverage in this camp is also poor at only 28% and 46% for supplementary and therapeutic feeding programmes respectively. Water availability in Nyarugusu is also poor at only 12.6 litres per person per day [AEF 23/04/97, 29/08/97, UNHCR 18/09/97].

Survey results from the four camps in the Kibondo district (estimated population 60,000) showed levels of wasting ranging from 1.3-5.6% (see Annex I (4i-l)). These results are comparable to those from a survey carried out in April, except for Nduta camp. Measles immunisation coverage varied from 68.1% -82.3%. These camps have received a stable general ration and residents have also had access to small plots of land where they have been able to grow vegetables and some other crops. However, in some of the camps supplementary feeding programmes coverage is very poor. For example, in Mtendelti camp only 9% of moderately malnourished children reported participation in the feeding programme [IRC 30/08/97, 01/09/97, 03/09/97, 05/09/97, UNHCR 18/09/97].

In April, wasting in Nduta camp (population estimated at 13,735) was measured at 11.7% (see RNIS #20). In response, a blanket feeding programme was implemented to provide 200 grams of blended food per day to children under five years old. In the September survey, wasting was measured at 1.3% with 0.4% severe wasting. No cases of oedema were seen. Measles vaccination coverage was 82.3%. The reduction in levels of wasting is largely attributed to the blanket feeding and to the fact that there are far fewer new arrivals to the camp showing a compromised nutritional condition [IRC 01/09/97, UNHCR 18/09/97, WFP 14/11/97].

A two month buffer stock of food was pre-positioned in all the refugee camps in October. This was done because in the past, the rains, which normally fall in November and April, often make access to the camps difficult, if not impossible. This pre-positioning will allow for uninterrupted food distributions should the camps become temporarily inaccessible due to rains [WFP 10/10/97].

Overall, in regroupment camps where surveys have been carried out, high levels of severe wasting and elevated mortality rates indicate these populations are at high risk (category I in Table 1). The remaining population in Burundi is likely to be in a similar situation (category IIa in Table 1), although there are no data currently available. The refugee and displaced populations in Congo/Brazzaville can be considered to be at moderate risk (category IIb in Table 1) since insecurity is hampering some relief efforts. The IDPs and refugees from Uganda in DRC can be considered to be at moderate risk (category IIb in Table 1), and the remaining refugees in DRC are not currently considered to be at heightened risk (category IIc in Table 1).

The affected population in Rwanda can be considered to be at moderate risk (category IIb in Table 1) and the refugees in Tanzania are not currently considered to be at heightened risk (category IIc in Table 1).

Ongoing Interventions: Given the uncertainty of the status of the regroupment camps in Burundi, it is difficult to plan strategies and interventions. Close monitoring of the nutritional situation in these camps should, however, be continued and short-term interventions undertaken where feasible. Funding for the WFP internal flight network in Burundi needs to be found if this important operation is not to be suspended. In Bubanza province, the current coverage of the general ration programme needs to be investigated and there is an urgent need for a targeted feeding programmes. Furthermore, there needs to be verification of suspected micronutrient malnutrition.

In the Congo/Brazzaville, a flash appeal for food, shelter, health care, sanitation, seeds and tools needs to be met in order not to waste the opportunity to rapidly normalise the humanitarian situation. With the advent of the rainy season, there is an increasing risk of epidemics, making water and sanitation provision top priorities.

The Government of DRC has recently estimated the cost of a proposed reconstruction plan at $1.29 billion, $728 million of which it hopes will be covered by donors. The Eastern DRC is still lacking medical supplies. Furthermore, immunisations not regularly being carried out, suggesting these programmes need further support. Furthermore, in Kitchanga and other villages in areas which have recently experienced insecurity, there may be a need to establish therapeutic and supplementary feeding facilities and to consider the implementation of measles vaccination campaigns.

Rwanda will require increasing support in the form of food aid until the January harvest. Much of this support, which may still be required after January, will need to be in the provision of expanded food-for-work programmes which can partly address the need to rebuild the country's devastated infrastructure. It is also important to provide agricultural inputs before the next planting season.

Although the nutritional situation in the camps in Tanzania is generally good, there are some specific problems. In Nduta camp, there is a need to improve the community outreach of health workers so that they can identify a greater number of cases of malnutrition for referral to feeding centres, thereby improving feeding programme coverage. There is a similar need in Mtendelti camp. In Nyarugusu camp there is an urgent need to improve the water supply and investigate complaints about the general ration. Selective feeding programme coverage also needs improvement through strengthening health worker outreach. There is a need to improve measles immunisation coverage in many of the Tanzanian camps.
 

RNIS 21, September 1997

Violence in this region over the last three years, including the genocide in Rwanda in 1994 and the overthrow of the Zairian government in early 1997, has led to widespread displacement. Numbers of people affected and locations over time are summarised in the box below:

Location	Apr 96	Jun 96	Sep 96	Dec 96	Mar 97	Jun 97	Sep 97
Burundi	290,000	289,000	300,000	298,000	300,000	285,000	280,000
Rwanda	737,000	749,000	598,000	1,179,000	2,800,000	2,800,000	727,000
Tanzania	624,000	842,000	853,000	759,000	344,000	390,000	311,000
DRC	1,166,000	1,419,000	1,444,000	888,000	599,000	514,000	823,000*
Congo/Brazzaville	-	-	-	-	-	-	485,000
Malawi	-	-	-	-	-	-	1,200
Total	2,823,900	3,108,000	3,002,000	2,913,500	3,843,000	3,789,000	2,587,200

* includes refugees and IDPs formerly included under section 14.

Insecurity is the overwhelming problem regionally leading to fresh population displacements and hampering humanitarian aid efforts. Fighting has been widespread in Burundi, eastern Democratic Republic of Congo (DRC), and in Brazzaville in the Republic of Congo. There have also been many security incidents in western Rwanda as well as tensions in some of the remaining refugee camps in Tanzania. Thousands of refugees in eastern DRC remain unaccounted for, and a United Nations investigation team has been set up to determine whether these refugees have been massacred. The team has yet to begin its investigation. Food security in being adversely affected as a result of these conflicts with the displaced particularly vulnerable.

Burundi A coup d'etat in June 1996 did not significantly reduce the widespread insecurity, and over a year later incidents continue to be reported throughout the country. Furthermore, both personnel and anti-tank landmines are causing injury and death. The continued insecurity is hampering relief efforts and leading to the further displacements of Burundis both within the country and to neighbouring Tanzania. At the same time, there are a small number of Burundi refugees returning home [IRIN 5-11/08/97. WFP 13/06/97, 25/07/97].

THE GREAT LAKES REGION

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The overriding problem in Burundi is widespread food insecurity. This is the result of the fighting throughout the country which is hampering efforts to assess needs and deliver humanitarian aid and also preventing farmers from working in the fields. Furthermore, sanctions are reducing the availability of farm inputs and leading to price increases. Although there is not an acute shortage of food, high prices mean that what is available on the markets is too expensive for most people to buy. It is currently estimated that food aid will be needed for an estimated 260,000 people in the second half of 1997. Food aid is currently being distributed to the displaced, as well as to smaller populations through food for work and selective feeding programmes [FAO 25/07/97].

Although, sanctions are theoretically being maintained, there are signs that the embargo is loosening. For example, the border with DRC is now officially open and Kenya has lifted sanctions on exporting aviation fuel to Burundi [IRIN 15-21/07/97].

In some of the more insecure provinces, civilians have been living in 'regroupment camps', which are similar to displaced camps. There are an estimated 300,000 Burundi people in regroupment camps. These camps were ostensibly created to allow the government to better protect these populations in certain areas. People have varying degrees of access to farmland and therefore varying degrees of self-sufficiency depending on the location of the camps. Many of the camp locations are remote and inaccessible. There have been many reports of poor living conditions in these camps with common problems being lack of adequate sanitation facilities, inadequate food supplies and a lack of medical care [FAO 25/07/97, WFP 04/07/97,15/08/97, 29/08/97].

There are no recent nutritional data available but anecdotal reports are of 'obvious signs of malnutrition' and 'hundreds of cases of marasmus and kwashiorkor being admitted to therapeutic feeding units' among children and adults when visiting the camps. In the province of Karuzi, an estimated 100,000 people are in regroupment camps with limited access to food; it was recently found that many of those in the camps were consuming less than 1200 kcals/person/day. It was also noted that many people were not eating fresh vegetables thereby increasing the risk of micronutrient malnutrition [UNHCR 10/06/97, WFP-a 15/08/97].

Recently, people have begun leaving the camps to return home. They receive a 90 day ration upon departure, along with seeds and some farming tools. However, since the security situation does not appear to be improving, it is unclear whether returnees will be able to resume subsistence activities [WFP 29/08/97, 05/09/97]. Furthermore, their return may not be sufficiently early to allow planting for the next agricultural season.

Food economy assessments carried out during the second half of June have shown that many resident people in Kayanza and Bubanza province were in dire need of food assistance due to insecurity and lack of access to land under cultivation. Many residents showed clear signs of malnutrition [WFP 11/07/97].

Nutritional surveys have been carried out in a limited number of areas and sites in recent months. Such surveys commonly find acute malnutrition rates in under five children in excess of 15%. However, the information is piecemeal and no concerted effort has yet been made to assess the prevalence of acute malnutrition at community level and to set up a surveillance system for the country. Yet despite the lack of comprehensive data on malnutrition rates, NGO reports from the provinces of Ruyiga, Muyinga, Rutana, Kayanza, Bujumbura Rural and Gitega indicate a continued decline in nutritional status amongst local populations [FAO 25/07/97, IRIN 15/08/97].

There are three harvests per year in Burundi - June, September, and January. The graph to the right summarises production over the last few years. Production has increased compared to 1996, but remains well below the pre-crisis levels, when the populations were self-sufficient [FAO 25/07/97]. Prospects for the next season are said to be uncertain and will depend on the evolution of the security situation, weather conditions and the supply of agricultural inputs.

From: 'FAO/WFP Crop and Food Supply Assessment Mission to Burundi', 11 July 1997.

Democratic Republic of Congo (formerly Zaire). Widespread insecurity is leading to population displacements within the DRC as well as to neighbouring countries. An upsurge in fighting in the Masisi and Fizi areas have led to population displacements into areas of Goma and Sake; some have been displaced across the border into Gisenyi in Rwanda. There have been concerns over human rights abuses which have led UNHCR to pull out of the area, although as of mid-September, the decision had not yet been implemented. The suspension of activities will affect the search and rescue operations for remaining Rwandan refugees. However, assistance to Congolese, Angolan and Ugandan refugees will continue [IRIN 5-11/09/97, 16/09/97, UNHCR 10/09/97]. The effect this suspension will have on other agencies and projects currently underway in the area is unclear. Other humanitarian organisations may follow suit, thereby further jeopardising refugee and IDPs programmes.

Estimates are that the number of unaccounted for Rwandan and Burundian refugees in the east are 200,000 and 35,000 respectively. Repatriation by air of Rwandan refugees in the DRC continued into early September, although it was becoming more and more difficult to locate the refugees. Since the massive return of more than 700,000 Rwandan refugees in November 1996, a further 250,000 refugees have returned home. Sixty one thousand of these returned home by air transport. In addition, recent fighting in eastern DRC has led to the return of some Burundi refugees, with up to 100 refugees returning per day in September [IRIN 5-11/09/97, UNHCR 10/09/97]. The DRC government forcibly repatriated some Rwandan and Burundi refugees.

In the eastern part of the country, new groups of refugees or displaced people continue to be found. Some of these are from the Masisi and Fizi areas, and it is estimated that there are up to 120,000 IDPs in the area. Nutritional assessments are not possible given the volatile security situation, however while a few of these groups appear to be in relatively good health most are found to be in a appalling nutritional state. Anecdotal reports tell of widespread malnutrition among children and adults, and mortality rates of 45/10,000/day (150 times normal) were reported [IRIN 15-21/07/97, Pres. Comm. Aug. 97, UNHCR 04/06/97].

A survey carried out in Uvira showed 13% wasting and/or oedema among children (see Annex I (4a)). In response to these survey results, it was planned to set up nutritional rehabilitation centres [IRIN 24-30/06/97]. Refugees fleeing insecurity in Cibitoke province in Burundi continued to arrive in Uvira throughout August.

Some rehabilitation activities have been undertaken in the eastern part of the country. For example, a project has been set up for the construction and maintenance of water sources in the Bukavu area in order to ensure access to potable water, reduce water-borne diseases, alleviate the burden on women collecting water and improve hygiene. A vaccination project is also underway in North Kivu (UNICEF 22/08/97).

Conflicts in neighbouring Congo and Uganda have led to refugee influxes to the DRC. At least 20,000 refugees fleeing fighting in Brazzaville in the Republic of Congo are currently residing in Kinshasa. Many of these people are living with friends or relatives although there is a growing number (more than 22,000 by mid-September) in Kinkole camp just outside of the city [WFP 19/09/97]. More than 27,000 Ugandan refugees have also recently fled fighting in Uganda's western frontier and crossed into the Beni area of the DRC. Many of this population are living with local families and initial assessments indicate that the population are in reasonable health [IRIN 1-7/07/97, UNHCR 23/07/97, WFP 25/07/97].

Other refugees and IDP populations in DRC There are a number of other refugee and internally displaced populations in the DRC.

• Internally Displaced from Shaba There are no new nutritional data on the approximately 260,000 residents and displaced in Mwene Ditu. Most recent reports are from October 1995, and showed levels of wasting as high as 42% (see RNIS # 14). Insecurity in DRC is likely to exacerbate their already difficult situation.
• Angolan refugees There are approximately 150,000 Angolan refugees in the Democratic Republic of Congo, 50,000 of whom require assistance. Prior to an upsurge in fighting in Angola, some spontaneous repatriation was occurring [DHA 30/06/97, UNHCR May 97, WFP 05/09/97].
• Sudanese Refugees There are approximately 111,000 Sudanese refugees in DRC who are fleeing the continuing insecurity in Sudan [UNHCR May 97].

Republic of Congo/Brazzaville Heavy fighting between government forces and supporters of the former president is continuing in the capital and spreading throughout the country. This fighting has led to the evacuation of relief agency staff and the temporary suspension of relief activities for the 11,000 refugees in the country. There are reportedly at least 450,000 people who have been displaced by the fighting, out of a pre-war population of 900,000, but that number is difficult to verify due to insecurity. Among the displaced, child malnutrition and diseases such as diarrhoea and measles have been reported. A limited number of relief organisations have been providing humanitarian assistance to Brazzaville's displaced population, but the war has placed considerable constraints on the procurement of supplies and access to the affected population [IRIN 5-11/08/97, 20-22/09/97, WFP 13/06/97].

In July there were approximately 9,000 Rwandan refugees in three locations: Luokolela, Ndjoundou, and Liranga. These refugees had fled the DRC (formerly Zaire) following the advances of what were then “rebel” forces. Aid for these refugees was delivered by river and air avoiding the capital city. Repatriation to Rwanda began in July. There were a further 2,000 Rwandan refugees at Bilolo. Many refugees have been without plastic sheeting, blankets and kitchen utensils. These were not provided as repatriation was expected to be completed by the end of September [WFP 25/07/97, 22/08/97].

Rwanda The population in Rwanda has grown dramatically due mostly to the massive return of approximately 1.2 million refugees at the end of 1996. This presented a considerable challenge for the Government of Rwanda and humanitarian agencies, which to a large extent has been successfully met. For example, over six million rations were delivered in Rwanda during the first six months of 1997. However, during the second half of 1997, free food distributions are to be phased out and replaced by more targeted programmes. Assistance will be predominantly through food-for-work programmes aimed at agricultural recovery, and the rebuilding of housing and other infrastructure [WFP 20/06/97, 11/06/97].

Figure taken from: FAO/WP Crop and Food Supply Assessment Mission to Rwanda, 11 July 1997

These positive achievements must however, be viewed against a backdrop of increasing insecurity, particularly in the western prefectures of Ruhengeri and Gisenyi. For example, three UN staff members were recently shot dead in Ruhengeri, leading WFP to suspend its operations in the prefecture. Heavy clashes between the army and rebels were reported in Gisenyi in August. At the end of August, an attack on a camp in Gisenyi resulted in the death of 148 refugees from the DRC. Furthermore, the food security situation in Ruhengeri has been described as precarious with malnutrition rates high especially in the less secure northwest and southern areas of the prefecture. The situation has been exacerbated by the mass return of refugees to these prefectures [IRIN 25/08/97, UNHCR 23/07/97, USAID 15/08/97, WFP 20/06/97].

Food security may also be increasingly threatened throughout the country in the coming months. Prices for staple foods in Rwanda have been rising steadily due to a combination of the increased demands of an expanded population, and reduced availability due to poor harvests in January, particularly for beans. Prices of pulses have tripled and of cassava and sweat potato have almost doubled in the last year. The harvest in September is predicted to produce somewhat higher yields than last year; however production will remain below pro-crisis levels. Agricultural production has been hampered by a number of factors including the late arrival of many returnees in relation to field preparation, land disputes between returnees and current farm occupants, a lack of agricultural inputs such as agricultural tools and seeds, and irregular rains. Therefore, although the current harvest is likely to result in somewhat lower prices for some foodstuffs, they are likely to remain higher than last year [FAO 11/07/97].

Much of the population, especially in this time of transition, will have to meet a large portion of their food needs through market purchases, and higher prices will have an obvious impact on how well they are able to do this. Food aid will, therefore, be needed for approximately 700,000 people during the second half of 1997 [FAO 11/07/97].

Fighting in the Masisi area of DRC is causing thousands to flee to Rwanda. Recent estimate were of 5,000 new arrivals into Gisenyi at the end of August, and 3,300 in early September. These refugees have settled in Mudende camp, which now houses 14,000 refugees. There are also 13,000 refugees in Kibiza camp in Kibuye. There is no information on the nutritional status of these populations. A small number of refugees continue to return from DRC. At the same time, repatriation of the approximately 1,500 Burundi refugees in Rwanda has begun [IRIN 12-18/09/97, IRIN 18/09/97, WFP 04/07/97, 05/09/97, 19/09/97].

Tanzania A registration exercise in the refugee camps in Tanzania has led to a revised estimate of the total number of refugees of 311,000 people. This total number is comprised of approximately 237,000 Burundis and 73,000 Congolese refugees. New arrivals from Burundi continue and at the same time, there are reports of spontaneous repatriation of up to 3,000 refugees per month to Burundi [WFP 12/09/97].

The security situation remains tense in Lukole refugee camp in Ngara region and in Lugufu refugee camp in northwestern Tanzania. The majority of the 35,000 in Lugufu camp are from the Fizi region of DRC and resisted the Alliance of Democratic Forces for the Liberation of Congo (ADFL) advances through the DRC. Tensions have therefore arisen between those willing to repatriate and those staunchly opposed to returning home [IRIN 12-18/08/97].

There have been recent reports of high levels of malnutrition in Nduta (Kibondo) and Lugufu camps. As a response, blanket supplementary feeding programmes are being implemented for a period of two months [WFP 27/06/97].

Agreement has been reached by the government of Tanzania, DRC and UNHCR on the repatriation of Congolese refugees in Tanzania, and voluntary repatriation began on 1 September 1997. Some spontaneous repatriation had occurred before the organised repatriation [WFP 29/08/97, 05/09/97].

The food security situation of refugees in Tanzania needs to be considered in the context of the far reaching drought affecting much of the country. There are reports of total crop failure in some of the key producing areas, and large-scale food deficits are expected. Household food stores in some villages are non-existent, and population displacements have already been reported in some areas [IRIN 12-18/08/97].

Malawi There are 1,200 refugees from Rwanda and DRC in Malawi [IRIN 25/08/97].

Gabon Approximately 1,000 Rwandan refugees arrived in Gabon and were subsequently flown to Kigali [IRIN 15-21/07/97, USAID 15/08/97].

Overall, those who are inaccessible, or periodically accessible, can be considered to be at heightened nutritional risk, and are in category IIa in Table 1. This includes those in Burundi, unaccounted for refugees and IDPs in DRC, and the inaccessible population in the Republic of Congo/Brazzaville. Those in Rwanda can be considered to be at moderate risk of malnutrition and associated mortality (category IIb in Table 1) due to price inflation and pressure on available resources. The affected population in Mwene Ditu is likely to remain at high risk (category I in Table 1). The remaining affected population is not currently considered to be at heightened risk (category lie in Table 1).

Ongoing interventions: Response to a 'Consolidated Appeal for the Great Lakes Region' launched in March 1997 has been generous in many cases. For example, by July 1997, WFP and UNHCR had secured over 75% of the total funding needed for their programmes. On the other hand, appeals from other agencies have met with limited success. Further pledges are therefore needed to broaden the scope of possible interventions, with a view to strengthening human rights, and more development and rehabilitation orientated projects.

• The level of violence is seriously undermining food security for many in Burundi. Some of this food insecurity could be relieved by the increased provision of agricultural inputs for locals and returnees. Many of those returning from IDP or regroupment camps have missed planting and will need support. Reports from the IDP and regroupment camps indicate that the nutritional situation of many, particularly in insecure areas, is very poor. Efforts should therefore continue to gain access to these camps and to monitor the situation carefully. In some situations emergency selective feeding and health and sanitation programmes may need to be established. A national nutrition surveillance system should be established to help monitor a rapidly changing situation.
• There is a need to assess the nutritional and health situation of new refugees in Beni and Kinshasha who, although reportedly in reasonable condition and living with families, may still require some form of support. Agencies will also need to be geared up to meeting the emergency needs of those newly displaced from Masisi and Fizi regions when and as security allows. Many of the newly displaced are reportedly in an extremely poor nutritional condition.
• In Rwanda planting is now over. Until the harvest in January, food aid for targeted groups and rebuilding of infrastructure will be the priorities. Provision of agricultural inputs in preparation for the 1998 season should also be a priority. Support should also be given to strengthening national capacity to collect and analyse agricultural statistics. Establishing an early warning system should be part of this initiative. There should be careful monitoring of the food security situation throughout the country given the reduced harvest, food price inflation and pressures on land and food resources with the recent large influx of returnees. Particular attention should be paid to the western prefectures where insecurity is widespread and is affecting agricultural activities. In addition, information on the refugee populations in western prefectures is needed.
• In Tanzania the severe drought and drawing down of the strategic grain reserve may require that agencies attempt to build up buffer stocks at camp level as government grain reserves may not be available should breaks in the donor food pipeline occur.

RNIS 20, June 1997

As rebel forces swathed across Democratic Republic of Congo, assuming control of the country in May, thousands of Rwandan refugees and former Zairians were displaced. There were numerous reports of high mortality and malnutrition rates among these populations as a result of arduous journeys and lack of access by humanitarian agencies. However, many refugees have now been repatriated, although returnees passing through transit camps in Rwanda are in a poor nutritional state. There is currently a high level of insecurity in Rwanda, partly fueled by the large number of returnees. Food price inflation is also causing concern. The food security situation among populations in Burundi living in regroupment camps is currently very poor and is exacerbated by the continuation of some level of sanctions and insecurity. Water and sanitation are also problems in many of these camps. In Tanzania, is spite of logistical difficulties with food and water provision for the Kigoma camps, refugees appear to be in a stable nutritional situation.

Trend in numbers of refugees/displaced and proportion severely malnourished and at high risk (shaded area).

Estimates of populations affected regionally are summarised in the box below:

Location	Feb 96	Apr 96	Jun 96	Sep 96	Dec 96	Mar 97	Jun 97
Burundi	275,400	290,000	289,000	300,000	296,000	300,000	265,000
Rwanda	737,000	737,000	749,000	598,000	1,179,000	2,600,000	2,600,000
Tanzania	653,000	624,000	642,000	653,000	759,000	344,000	390,000
Democratic Republic of Congo	1,211,000	1,166,000	1,419,000	1,444,000	668,000	599,000	514,000
TOTAL	2,883,200	2,823,900	3,106,000	3,002,000	2,913,500	3,843,000	3,769,000

Democratic Republic of Congo The Alliance of Democratic Forces for the Liberation of Congo (ADFL), led by Laurent-Desire Kabila swept across the country, arriving in Kinshasa on the 16th of May 1997. After a series of negotiations, Mobutu left Kinshasa leaving the way open for Kabila to assume control of the country. A number of governments, including those of Kenya, Angola, Sudan, Lybia, Rwanda and Burundi, have acknowledged the new government. Over the past weeks there have been numerous allegations levelled against the ADFL of human rights abuses including incidents involving massacres of Rwandan refugees [ERIN 17-18/05/97].

The advances westward of Kabila's forces meant that refugees were continually forced to move from one makeshift camp to another, with barely enough time between moves for the delivery of humanitarian aid. There were reports of lack of food and water in these make-shift camps and of cases of cholera. Many groups of refugees emerged from arduous journeys requesting repatriation. For example, a group of 20-30,000 people who were believed to originate from Katale and Kahindo camps, emerged near Sake [IRIN 01/04/97, WFP 04/04/97].

In March, ex-FAR and Interhamwe elements reportedly separated from the refugees, moving toward borders on neighbouring countries. Refugees started to gather along the rail lines clustered in several groups near Kisangani, where it was periodically possible to deliver emergency food aid to at least 90,000 refugees. By mid-April the number of refugees and IDPs being fed in the Kisangani area were 141,000. The ration delivered to these refugees and displaced people was 2050 kcals/person/day. However, reports at that time indicated that the refugees were still weak and sick with some cases of cholera being reported. The mortality rates varied from 11.4- 20/10,000/day (see Annex 1 (4a)). These rates are 20 to 40 times normal, and well above the 2/10,000/day which indicates a crisis. By mid-April, the planned evacuation of 80-100,000 refugees and internally displaced people had begun [IRIN 03/04/97, 23/04/97, 11/04/97, 18/04/97].

Repatriation and resettlement are continuing, both by air and land transport. The most vulnerable and weak are transported by air. Many refugees arrived in Biaro, south of Kisangani, to await repatriation. There were anecdotal reports that malnutrition rates were as high as 60% amongst this population. All refugees in Biaro have now been moved to Kisangani and repatriation efforts will now be farther south. Approximately 45,000 refugees have been airlifted back to Rwanda, using planes to carry food into the former Zaire, and then carry people out. Despite guarantees given by rebel authorities, access and safe passage for staff and vehicles carrying relief assistance for Rwandan refugees has often been problematic [IRIN 02/05/97, 5-11/05/97, 21/05/97, 03/06/97, USAID 11/04/97, 16/05/97].

There are also other concentrations of refugees. Thirty thousand refugees have been reported to be assembled at the Angolan border, and a further 65,000 are on their way to the Central African Republic. These are refugees from the former Tingi Tingi camps. There is a growing number of refugees in the CAR with refugees from Rwanda, Democratic Republic of Congo and Sudan arriving in Mboki camp [IRIN 15/05/97].

There are also 8,000 refugees who have crossed into the Congo, with a further 13,000 gathered on the border. There had been 50,000 Rwandan refugees in the Mbandaka area, which is near the Congolese border, a certain number of whom crossed into the Congo as the rebels took the area. Many of these refugees were reportedly in very poor condition and extremely hungry. Mortality rates reported are extraordinarily high. Repatriation by air of some of those near the border has begun. As many as 5,000 of those refugees currently in the Congo were impossible to reach due to the marshy condition of the land. This population lacked food, water and shelter and cases of cholera were being reported from the area. Access to these populations varies with what appears to be a deteriorating security situation in the Congo [IRIN 09/05/97, 5-11/05/97, 19-25/05/97, 03/06/97, 06/06/97, WFP 18/04/97].

Approximately 3,400 refugees have also arrived in Northern and Luapula provinces of Zambia. The vast majority are nationals from the former Zaire although this population does include some Rwandans and Burundians. These refugees are generally in good health and adequately nourished [IFRC 04/03/97].

The nutritional situation in the Eastern part of the country remains precarious. A nutritional survey at the beginning of the year in Sake located 20 km from Goma (population 21,800) found 10.7% wasting with 3.6% severe wasting of which 2.3% presented with oedema (see Annex I (4b)). Over half of the Sake population were displaced from the Masisi inter-ethnic conflict. The rate of wasting among the displaced was 13.5% with 20.4% wasting amongst female headed households. The cause of malnutrition was believed to be largely due to a lack of food. Measles immunisation coverage was low with less than 10% of children having documentary evidence of immunisation [MSF-H 01/02/97].

A nutritional survey conducted in Rwanguba health zone situated on the border with Uganda and Rwanda found an extremely alarming situation. Rates of wasting were 12.6% yet prevalence of severe wasting and/or oedema was extremely high at 9.4% (see Annex I (4c)). The malnutrition was largely attributed to ah unbalanced diet and in particular a shortage of beans. There was limited feeding centre capacity in the area and measles vaccination coverage was very low [MSF-H 16/03/97].

Recognising that these population figures change rapidly, it is estimated that 382,000 refugees remain in Democratic Republic of Congo. With all the recent large scale population movements, estimates of the number of IDPs are uncertain. The last RNIS report indicated that there were 132,000 IDPs, although some have now returned home [IRIN 02/05/97, 5-11/05/97, 21/05/97, USAID 11/04/97, 16/05/97].

Rwanda It is currently estimated that 2.6 million people in Rwanda will require food aid assistance for the first six months of 1997. This total number includes recent returnees, previous returnees who will have to leave farm areas they currently occupy and other vulnerable groups (i.e. widows, the elderly, orphans). Although the level of insecurity in Rwanda remains high, food distributions during March were not adversely affected. Tensions remain particularly high in the prefectures of Gisenyi and Ruhengeri with many of the repatriated refugees from Democratic Republic of Congo arriving at communes within these prefectures. Numbers of returnees from Democratic Republic of Congo, which were low in March, increased in April. Efforts are being made to pre-position food at transit centres so that new returnees can be provided with a one month's ration before returning to their home communes. All returnees are provided with high energy biscuits and wet feeding while at the transit centres. Any further distributions will be carried out at commune level and be overseen by local authorities. By April, rains were affecting the delivery of food in many parts of the country and hampering project activities. Most recent reports indicate that insecurity in Ruhengeri has led to suspension of all distribution activities [FAO 23/12/96, WFP 14/03/97, 04/04/97, 18/04/97],

Market prices of food throughout the country continue to rise due largely to the increased demand of the returnees. Other inflationary pressures come from the poor harvest in both Rwanda and southern Uganda and the ongoing trade embargo with Burundi [WFP 28/03/97]. Prices of staple foods have increased by 30% compared to the same time last year.

Seeds have been widely distributed in Rwanda. However, although all the planned distributions for beans were carried out there were shortfalls in the distributions of sorghum and sweet potatoes. As sweet potatoes are a staple food in the Rwandan diet, it is likely that this will have a negative impact on the already fragile food security situation in the country. There have also been recent reports of lack of maize meal and pulses in the country due to railway delays. This has led to a shortage of pulses in Runda transit centre, thereby slowing the return of returnees from the centre to their home communes [IRIN 23/04/97, WFP 28/03/97].

There have been some recent nutritional data on children screened at transit centres. In Nkamira, levels of wasting amongst under fives screened between the 31 st of March and 6th of April were extremely high with large numbers of severely malnourished children. A similar screening exercise in Musange transit centre in the first two weeks of April also found very high levels of wasting and unusually high levels of severe wasting and/or oedema. As screening was not systematic these results must be viewed with caution; however, the degree of measured severe wasting alone gives grave cause for concern about the nutritional situation of this returning population [MSF-B 25/05/97].

There have been recent discussions regarding the establishment of a food assessment unit in the country which will help to identify pockets of poverty and areas considered to be vulnerable. This should also allow for some follow-up with the severely malnourished people seen at the transit centres and lead to better targeted food aid interventions in the future [WFP 02/05/97].

Before the large-scale repatriation in November and December 1996, there were approximately 16,000 refugees from the Masisi region in Democratic Republic of Congo in Umumbo camp who were moved to Kibiza. Following some repatriation, approximately 12,000 remained at the new site. A screening (using MUAC) of this population in December 1996 showed 9.7% wasting with 1.0% severe wasting (see Annex I (4d)). Oedema was measured at 0.3%. There are a further 3,000 Burundi refugees in Rwanda housed in two camps [MSF-B 01/01/97, UNHCR 28/04/97].

Burundi It is currently estimated that there are 600,000 internally displaced people in Burundi. Some of this population are either living with family or friends, or are near enough to their farms to cultivate land and therefore do not require emergency assistance. An estimated 265,000 therefore require emergency assistance. The security situation remains volatile with recent incidents including a mine explosion in Bujumbura, an attack on a regroupment camp in Cibitoke, and an attack by rebels in Bururi in southern Burundi. These security incidents continue to cause population displacements [DHA 09/04/97, FAO 04/03/97, IRIN 03/06/97, WFP 28/03/97, 09/05/97].

Regional sanctions have been somewhat relaxed against Burundi, with food and food products, education and construction materials, medicines and agricultural inputs now exempted [WFP 18/04/97],

A recent FAO/WFP Crop and Food Supply Assessment Mission reported a precarious food security situation in the country following several years of civil unrest and below average agricultural production. The report also argued that the situation had been exacerbated by the economic embargo. Aggregate food production for the first 1997 season is estimated at 18% below the pre-crisis average for 1988-93. The outlook for the second and third season suggests a recovery in output although the overall food supply situation remains extremely tight. On average, food prices increased by more than 40-50% compared to the beginning of 1996, whilst that of beans alone has more than doubled in most areas since July 1996, reflecting a reduced harvest [FAO 04/03/97].

Large numbers of people are still living in regroupment camps, which are similar to camps for internally displaced people. For example, in Bubanza province, 86,190 people are grouped in 36 displaced and regroupment camps where most have access to their fields and military escorts are provided for harvesting. A good harvest is anticipated. In Cibitoke province, 60% of the population (100,000 people) presently reside in regroupment camps. Owing to the insecurity in the province, the population does not have access to land and there is little opportunity to supplement rations [FAO 04/03/97].

A rapid evaluation team recently visited 70 sites housing displaced persons in nine provinces. Findings on food resources and agricultural production were that in 45% of sites the population was considered to be highly vulnerable. This was defined as having one meal a day, living mostly on roots and with poor access to land, seeds and tools, reduced time spent farming due to insecurity, and a projected reduction in harvests. Thirty seven percent were considered moderately vulnerable since they are living on food left from last year's poor harvest and have limited access to land and farm inputs [FAO 04/03/97].

Piece-meal nutritional data indicate that some populations are in an extremely poor nutritional state. For example, there are reports of people who had been hiding in forests for long periods emerging in a desperate nutritional state. Anecdotal reports for north Bubanza province indicate that 20% of new hospital admissions are for cases of adult malnutrition [IRIN 5-11/05/97]

At the end of February, a nutrition survey carried out in Karuzi showed 16.9% wasting with 3.1% severe wasting. Oedema was measured at 1.8% (see Annex I (4e)). Since then a mission to camps for the displaced or regrouped in Karuzi and Gitega provinces found "appalling" food water and sanitation conditions [MSF-B Feb. 97, WFP 28/03/97].

There are reports of at least 20,000 cases of typhus in Burundi, the worst outbreak since World War II [IRIN 5-11/05/97].

Tanzania The total number of refugees from the Democratic Republic of Congo and Burundi in Tanzania is estimated to be 390,000, comprised of 105,000 refugees in Kagera and 285,000 in Kigoma regions. There are still population movements across the borders between Democratic Republic of Congo and Burundi in both directions, with new arrivals and spontaneous repatriations being reported. A larger scale repatriation of refugees to the Democratic Republic of Congo is envisaged within three months [IRIN 03/04/07, WFP 04/04/97, 09/05/97].

Poor road conditions and limited trucking capacity are hampering food deliveries in the Kigoma region. Furthermore, these problems in early March made pre-positioning of food before the worst of the rainy season quite difficult. As a result, rations have been below the recommended levels. A shortage of beans has been experienced in all the Kigoma camps. Supplies of water to the camps have also been affected by these logistical difficulties as has movement of newly arrived refugees to camps. Agencies are still operating with very limited capacity in terms of human resources and materials [UNHCR May 97, WFP 14/03/97, 09/05/97, 23/05/97].

Despite these difficulties, indicators available point to a generally adequate health and nutrition situation. For example, in Nyarugusu camp for refugees from the former Zaire (estimated population 44,000) wasting and/or oedema was measured at 5.3% with 0.6% severe wasting and/or oedema (see Annex I (40). The CMR was 0.5/10,000/day; however the under-five mortality rate was 1.78/10,000/day, almost twice the normal level. Water availability was low at 9-12 litres/person/day [UNHCR 25/03/97].

In Mtendeli camp for Burundi refugees (estimated population 66,000), the CMR was 0.7/10,000/day and the under-five mortality rate was 1.51/10,000/day. Water availability was again low at 7 litres/person/day (see Annex I (4g)). Under five mortality rates in Lugufu camp are also high and are over 2/10,000/day. Most of the deaths are attributed to malaria and anaemia [UNHCR May 97, 25/03/97]

Preliminary results from surveys conducted in five camps showed a similarly adequate nutritional status. Levels of wasting and/or oedema varied from 1.8-7.2% with severe wasting and/or oedema varying from 0.0-0.8% (see Annex I (4h-l)). Further details are not yet available [UNHCR 13/05/97]

Feeding programmes are proceeding well in all camps with the exception of Muyvosi camp. Stocks of therapeutic milk were reportedly due to run out by the end of May 1997 [UNHCR 25/03/97].

A task force is being established in Kigoma to make preparations for the organised repatriation of refugees from the former Zaire from Tanzania [WFP 23/05/97]

Overall, the affected population around Sake can be considered to be at moderate nutritional risk (category IIb in Table 1) while the remaining refugee and displaced populations in Democratic Republic of Congo can be considered to be at heightened risk (category IIa in Table 1). The vulnerable population in Rwanda can be considered to be at moderate risk due to some insecurity, although it is possible that those in Ruhengeri are at high risk. In Burundi, those described as highly vulnerable in a recent assessment are in category IIa, those described as moderately vulnerable are in category IIb in Table 1, and the remaining affected population is not currently though to be at heightened risk (category IIc in Table 1). The refugees in Tanzania are not currently thought to be at heightened nutritional risk.

How can external agencies help? In Democratic Republic of Congo, agencies will need to continue to seek out the displaced and provide full humanitarian support. Agencies should also support the repatriation process and provide food, water, shelter, and health services to those waiting for repatriation. In Sake, food distributions need to be established for the displaced population and reasons for poor food security of the displaced and in particularly female headed households need to be investigated. Low coverage of feeding programmes need to be improved. This may be achieved through improving active case finding or by switching from on-site to take home supplementary feeding. In Rwanguba health zone selective feeding programmes should be urgently implemented and the nutritional situation needs to be carefully monitored.

The monitoring of food security in Rwanda should become a priority. Food prices in particular should be monitored as inflation appears to be rampant. Given the large numbers of recent returnees to Ruhengeri and Gisenyi, and especially given the interruptions in food deliveries to Ruhengeri due to insecurity, food security and nutritional status should be carefully monitored in these two prefectures. High levels of wasting seen in the transit camps need to be addressed, most probably in their home communes where selective feeding programmes may need to be rapidly established.

In Burundi, high and moderately vulnerable regroupment camps need urgent attention. Many of these camps need improved food, water and sanitation provision. Nutritional and mortality surveillance should also be rapidly established in these camps. More specifically, more fortified blended food for the 'emergency selective feeding programmes currently operating should be provided.

In Tanzania, there is an urgent need to improve trucking capacity in the Kigoma region as well as to improve storage capacity. Efforts should also be made to provide maize meal as a priority in place of whole grain and preference also given to white maize to improve acceptability among the recipients. Consideration might also be given to providing rice once or twice a month to diversify the diet.
 

RNIS 19, March 1997

This information is as of 7 March 1997.

As rebel forces make significant advances in Eastern Zaire, displaced Rwandan refugees and Zairians have been constantly on the move from one make-shift camp to another. Insecurity has prevented full access by humanitarian agencies to these camps and high levels of mortality have been recorded amongst this population. Approximately 1.3 million Rwandan refuges have returned home and although this population is facing problems of re-integration in an increasingly insecure environment, there are no reports of significant nutritional problems.

Burundi/Rwanda Region

Trend in numbers of refugees/displaced and proportion severely malnourished and at high risk (shaded area).

High levels of insecurity in Burundi continue to lead to population displacements and the army have rounded up some populations into "re-groupment" camps for security reasons. There are reports of high levels of malnutrition in some of these camps as well as camps for refugees. This is attributed to over-crowding and unhygienic conditions as well as lack of provision of foods due to insecurity. Over 400,000 Rwandan refugees repatriated from Tanzania at the end of 1996 but continued insecurity in Burundi and Zaire has led to an influx of up to 1,000-2,000 new refugees each day. The nutritional status of these newly arriving refugees is believed to be deteriorating due to poor water and sanitation provision and incomplete food deliveries as a result of logistical difficulties.

Estimates of populations affected regionally are summarised in the box below:

Location	Dec 95	Feb 96	Apr 96	Jun 96	Sep 96	Dec 96	Mar 97
Burundi	504,000	275,400	290,000	289,000	300,000	296,000	300,000
Rwanda	800,000	737,000	737,000	749,000	598,000	1,179,000	2,600,000
Tanzania	621,000	653,000	624,000	642,000	653,000	759,000	344,000
Zaire	1,146,000	1,211,000	1,166,000	1,419,000	1,444,000	668,000	599,000
TOTAL	3,077,400	2,883,200	2,823,900	3,106,000	3,002,000	2,913,500	3,843,000

Eastern Zaire The number of displaced refugees and Zairians in the Lubutu and Kisangani areas of eastern Zaire are rising as a result of increased fighting between rebel forces and those loyal to the government. Attempts at political negotiation have so far met with little success in terms of reducing the conflict on the ground. Rebel forces have been making dramatic advances in the past few days. In early March, the strategically important town of Lubutu, which is 200 kms south east of Kisangani and the nearby camp of Tingi-Tingi fell to rebel forces. In addition to the refugees and internally displaced people affected in Zaire, others continue seeking asylum in neighbouring countries with 1,000-2,000 crossing into Kigoma, Tanzania per day, some are moving into southern Sudan border towns where there were an estimated 10,000 by the middle of February, and approximately 7,200 moving into Zambia [WFP 14/02/97, IRIN 16/01/97, USAID 17/01/97].

Since the conflict erupted in November 1996, makeshift camps have been established in Eastern Zaire. During January and February, refugees were regularly displaced from these makeshift camps as rebels made advances so that new camps were established in "safer" areas. In early March, the rebels took over Tingi-Tingi, which had been the most long-standing camp in the area and thousands of refugees were reported to be on the move once again towards Kisingani. International humanitarian agency staff were evacuated from Eastern Zaire at the end of February. Recognising that this population is in a constant state of flux, the best estimates of numbers affected by the conflict are as follows: 218,000 refugees whose movements have been traced in Eastern Zaire, a further 249,000 refugees are accounted for. There are also an estimated 132,000 IDPs or residents affected by the conflict in the area [WFP 07/02/97, 14/02/97, 28/02/97, IRIN 18-20/01/97].

Since early January about 2,000 refugees a day have been returning to Rwanda from South Kivu region of Eastern Zaire. Of the 143,000 Burundian refugees originally in the Uvira area, some 64,000 have arrived in Tanzania. The rate of organised and spontaneous repatriation from the Goma and Bukavu areas to Rwanda fluctuates with the security situation in these areas. As military activity escalates, refugees often flee en mass and hide in nearby forests. Way stations have been established on route for those making the arduous journey home [WFP 07/02/97, 14/02/97, 28/02/97, IRIN 18-20/01/97].

Increased military operations, commandeering of planes and trucks, evacuation of agency staff, and extremely poor road conditions have seriously hindered efforts to reach these needy populations in Eastern Zaire with food and other aid. Dozens of civilians have been killed by government air-raids over Kisingani. Security permitting, relief items are flown to Kisangani, and then transported either by road or locally chartered aircraft to where groups of refugees are gathered [WFP 03/01/97, USAID 17/02/97].

There are hardly any health and nutritional data available from this area of Eastern Zaire. There are however some data from Tingi-Tingi, whose population, until early March, was the most stable in the area. Between the end of December and third week of January daily rations only provided an average of 600 kcals/person per day in Tingi-Tingi camp. Despite the considerable efforts of agencies the crude mortality rates (CMRs) in this camps are reported to be extremely high with an estimated 40 deaths per day, mostly of children and infants. In January the CMR was estimated at 2.0/10,000/day (reaching 4/10,000/day in the second week) and the under-five mortality rate was 6.4/10,000/day (reaching 10/10,000/day in the second week of January) (see Annex I 4(a,b)). The first occasion where a near full ration was delivered was at the end of February. However, as mortality rates have continued to remain high, there has been some speculation that rations may have been appropriated by the Rwandan militia and ex-soldiers in the camps. The number of severely malnourished admitted to therapeutic feeding facilities in the camp increased dramatically towards the end of January. Furthermore, about 150 cases of diarrhoea are being diagnosed every day in Tingi-Tingi some of which are reported as being cholera cases. By mid- February 350 cases of cholera had been reported [IRIN 18-20/01/97, 26/02/97, WFP 10/01/97, 24/01/97, 31/01/97, 07/02/97, USAID 14/02/97, EPICENTRE 15/01/97, 06/02/97].

The estimated 20,000 refugees and IDPs who were in Punia, a transit point, were said to be in a very poor nutritional state and have been surviving on high energy biscuits.

However, in areas where military activities have stopped, the nutritional situation appears to have improved. An example of this is seen in areas north of Goma which was the scene of fighting and subsequent population displacements in February 1996. At that time, levels of wasting in the area were over 30%. A more recent survey showed 10.7% wasting with 3.6% severe wasting in Sake. It was noted that female-headed households suffered more malnutrition (17.3%) than male-headed households (9.6%) [MSF-H 05/03/97].

In conclusion, the present level of insecurity has meant that little data are available on the health and nutritional status of populations currently affected by conflict in Eastern Zaire. However, repeated displacements, limited access by humanitarian agencies and reports of high mortality indicate a very serious situation which is likely to be deteriorating for most of this refugee and internally displaced population. WFP has been attempting a distribution of food to 35,000 internally displaced people in Kisangani although rebel forces are now setting their sites on this critical government strong-hold [IRIN 04/03/97].

Rwanda The security situation in Rwanda, particularly in Western prefectures, is apparently deteriorating and security incidents, including attacks directed at expatriate agency staff and civilians, are continually being reported in country. For example, three Medecins du Monde staff members were shot and killed in Ruhengeri and four employees of the UN Human Rights Field Operation in Rwanda (HRFOR) were shot dead on the 4th of February 1997. These killings are the latest in a series of attacks directed against foreigners. As a result of this escalating violence, most NGO and UN staff were evacuated to Kigali and to Naiobi in February [IRIN 18-20/01/97, WFP 24/01/97, 07/02/97, 21/02/97, UNICEF 06/02/97].

Despite the deteriorating security situation, refugees continue to return. Estimates of the numbers of refugees returning to Rwanda in 1996 are 719,000 from Zaire, 88,000 from Burundi, 483,000 from Tanzania and 9,000 from Uganda. There are also approximately 6,000 Burundi refugees in Rwanda. Most of these people fled fighting in Cibitoke province in June 1996, and the Government of Rwanda has announced that these refugees must return home. In addition there are 14,000 Zairian refugees who fled the Masisi region in 1996 [IRIN 11-13/01/97, USAID 14/02/97].

It is currently estimated that 2.6 million people in Rwanda will require food aid for the first six months of 1997 This number includes recent returnees, previous returnees who will have to leave farm areas that they are currently occupying, and other vulnerable groups (e.g. widows, elderly, orphans). Despite an improved harvest compared to recent years, crop production still remains below pre-civil strife averages due largely to the lower cropped areas, low yields of pulses, and crop losses in prefectures affected by dry weather. There are two main concerns regarding food security in the coming months. First, food shortages are seen as inevitable due to the reduction in bean production coupled with a sharp increase in demand for food from returning refugees. This may lead to a deteriorating nutritional situation in areas such as Gikongoro and Butare prefectures, where crop production has been particularly poor and there are large numbers of recent returnees [FAO 23/12/96].

Secondly, although some food deliveries are still taking place, full scale distribution cannot restart until security can be guaranteed. Where distributions are possible, these have also been delayed by lack of precise information on numbers of target beneficiaries. There are therefore concerns that irregular food distributions may have a negative impact on the nutritional status of the most vulnerable groups. Furthermore, there are fears that tensions in the country, which are already high, will likely be further increased if there is not enough food available for needy populations. Responsibility for food distributions are presently being handed over from NGOs to local authorities and guidelines have been proposed to ensure effective and transparent implementation of these new systems of food allocation [IRIN 18-20/01/97, WFP 24/01/97, 07/02/97, 21/02/97, UNICEF 06/02/97].

Aid agencies warn that Rwanda will remain heavily dependent on food aid for the next few years unless donor countries concertedly attempt to rehabilitate the agricultural sector of the country. Seeds and tools are in the process of being distributed to new returnees as they are heavily dependent on food aid and have not had access to a harvest. If completed in time, these distributions will enable the majority of the returnees to plant their first crops in several years [FAO 23/12/96, IRIN 07/02/97, WFP 03/01/97].

Burundi There are at least 300,000 people in Burundi requiring emergency aid. This number is comprised of returnees, internally displaced people and 'regrouped' people - those gathered in camp-like situations for security reasons. There are an estimated 200,000 'regrouped' civilians in these special camps, set up so the army could afford protection to the civilian population in the troubled provinces of Cibitoke, Bubanza, Muramvya and Karuzi [DHA 12/02/97, WFP 07/02/97].

The volatile security situation in most parts of the country in January only allowed for sporadic relief initiatives. Land mine explosions, ambushes and killings were regularly reported, and the Burundi army admitted to killing 126 refugees who tried to escape from detention centres. However, there were signs briefly in February that the security situation was improving. Humanitarian agency activities which had been temporarily suspended, were restarted in some areas of the country [WFP 24/01/97, 31/01/97, 07/02/97, 28/02/97].

Restrictions on fuel imports due to sanctions against Burundi were threatening to further restrict humanitarian efforts. However, just recently, authorisation has been granted by the Regional Sanctions Coordinating Committee for fixed quotas of fuel to be imported for the use of UN agencies and NGOs. The quantities of fuel now approved are those initially requested, but exemption has been made for importing kerosene which is badly needed for storage and transportation of vaccines and medical supplies [WFP 24/01/97, 31/01/97, 07/02/97 28/02/97].

There are reports of the existence of pockets of severe malnutrition among people living in hills in the country side. There are also reports of severe malnutrition in some of the displaced camps, with particularly concern being expressed over conditions in Maramvya camp, near Bujumbura [IRIN 24/01/97].

A recent survey conducted in Maramvya centre (estimated population 1,300 people) showed 17.9% wasting with 7.1% severe wasting among children 6-59 months old. Oedema among this group was measured at 14.3%. 13.6% of children 5-10 years old were either wasted or oedematous. Among those over ten years old, wasting (defined as BMI<16) or oedema was 23.6% (see annex I 4(c,d)). The general ration was providing approximately 1200 kcals/person/day. Sharply elevated levels of malnutrition are seen among all age groups, and admission criteria for feeding centres have been set up to include all age groups [ACF 31/01/97].

An assessment carried out in Rukana camp for repatriated refugees from Zaire and EDPs concluded that there are likely to be elevated rates of wasting among the approximately 5,000 people in the camp. It was recommended that a general ration programme be instituted for this population, and that an anthropometric survey be carried out to more precisely define the problem [ACF 10/01/97].

Information on the re-grouped populations (estimated at 200,000 people) is that the health and nutrition situation of this population is deteriorating, due in large part to the unhygienic conditions in the camps. The number of typhus cases has soared and there has been a rise in the number of cases of diarrhoea, malaria and respiratory tract infections as well as malnutrition. In most regroupment centres residents do not have access to land and are therefore totally dependant of food aid [IRIN 12/02/97].

Reports of a cholera outbreak in southern Burundi indicated at least 150 people have been infected and ten have died [IRIN 09/01/97].

Tanzania The return of the majority of Rwandan refugees at the end of December 1996 due to a repatriation deadline imposed by the Government of Tanzania left approximately 248,000 Burundi refugees in country. Since that time, insecurity in Burundi and Zaire has led to an almost constant influx of refugees with 1-2,000 new arrivals per day. Current estimates are that there are over 344,000 Burundi and Zairian refugees in Tanzania. The Tanzanian government has insisted that all Burundian refugees living outside the camps return to them. Many refugee had moved to local villages and towns [WFP 17/01/97, 31/01/97, 14/02/97].

Relief workers in Kigoma region face a daily battle with roads frequently rendered impassable after heavy rains. Flooding on some of these roads continues to hinder operations such as the continued delivery of food, water and medical assistance, as well as the movement of refugees themselves from the holding centres to the camps.

A nutritional survey was carried out in Nyarungusu camp in Kasula district, Kigoma region for Zairian refugees (estimated population at the time 28,000) at the end of December 1996. Wasting was measured at 5.0% with 0.2% severe wasting. Oedema was measured at 0.3% (see Annex I 4(e)). The ration was providing 1900 kcals/person/day at the end of December although during November rations were often below 1300 kcals/person/day, and it was estimated that 90% of children were immunised against measles. Food basket monitoring found rather large differences between ration receipts amongst families, reflecting an inequitable distribution system. Furthermore, commodities distributed were frequently exchanged for foods that are more commonly accepted by Zairians, such as manioc and leaves [MSF-S 31/12/96].

Crude mortality rates were 1.9/10,000/day and the under-five mortality rate was 4.4/10,000/day. Both of these rates are four times normal and quite close to what is considered an emergency out of control (see box on page 4). The main reason for the high mortality rates was considered to be high levels of disease. Water availability and sanitation were found to be inadequate with only 12 litres per person per day available and too few latrines. Principal causes of death were diarrhoea, fever, anaemia, and malnutrition [MSF-S 31/12/96].

Since the survey, new refugees have continued to arrive in the district, and the overall nutritional status of the refugee population is said to have declined. Access to the camps (total population of three camps circa 111,000) is difficult, particularly in the current rainy season. Food and non-food deliveries arc therefore not regular and the ration has only been providing 1200 kcals/person/day in recent weeks [UNHCR 22/02/97].

There is no new information on the Burundi refugees in the Ngara region of Tanzania.

Overall, those who were in Tingi-Tingi I and II with high mortality rates are in category I in Table 1. The remaining population in Eastern Zaire requiring humanitarian assistance can be considered to be at high risk (category IIa in Table 1) due to insecurity and resulting inaccessibility. Those in Burundi in regroupment camps are also likely to be at high risk due to a lack of clean water and sanitation, evidenced by increasing morbidity. The returnees in Maramvya centre are in category I in Table 1 due to sharply elevated levels of wasting and oedema. The returnee population in Rwanda along with the remaining population in Burundi requiring humanitarian assistance are likely to be at moderate risk (category IIb in Table 1).

The refugees in Nyarungusu camp, Kasula district in Kigoma in Tanzania are at high risk (category I in Table 1), and the remaining refugees in Kigoma are probably at heightened risk (category IIa in Table 1). The refugees in Ngara district are probably not currently at heightened nutritional risk (category IIc in Table 1).

How can external agencies help? The high level of insecurity and lack of agency presence in Eastern Zaire is preventing full access to refugee and internally displaced populations so that there is only partial information on their nutritional and health condition. It is however clear that many thousands are in a desperate situation. At present, agencies can work toward a high state of preparedness for assessment and response as and when security allows. Consideration should be given to the creation of corridors for humanitarian assistance, with guarantees of safety for refugees, IDPs and agency personnel.

In Rwanda, there is a need for establishing nutritional and mortality surveillance at commune level. This is particularly important given the large numbers of returnees in certain prefectures and the adverse effects of insecurity on delivery of assistance and support to these returning populations. Efforts to strengthen health care provision to these populations must also be supported.

In Burundi, camps for the displaced and regrouped populations need to be carefully monitored as there are reports of deteriorating nutritional and health status amongst these populations. Water and sanitation provision for these camps must be improved and where over-crowding is contributing to high levels of disease, alternative camps must be established. Efforts should be made to ensure that the embargo on kerosene is lifted.

In Kigoma region of Tanzania high levels of mortality in the refugee camps are being attributed to inadequate supplies of water and poor sanitation. There is therefore an urgent need to improve the provision of water and latrines. In Nyaraguso camp the unequal receipts of general rations suggest the need for on-going food basket monitoring and review of the current general ration distribution system. If necessary, this system may need to be modified to ensure greater equity.
 

RNIS 18, December 1996

This information is as of 14 December 1996.

Fighting which erupted in Eastern Zaire in early November led to the dispersal of most of the 1.2 million refugees in the region and also caused the displacement of an unknown number of Zairians. The insecurity resulted in approximately 600,000 Rwandan refugees returning home, mainly without incident. The large-scale returnee influx into Rwanda is generally being well-managed by the international community. The number of refugees remaining in Zaire and the number of internally displaced Zairians is unknown but likely to be in the hundreds of thousands. Some refugees have fled to Uganda while some Burundi refugees have returned home. The continued insecurity in Burundi is also causing tens of thousands of people to flee their homes, mainly heading for Tanzania. The Tanzanian government has served notice that it intends to repatriate the large refugee population by the end of the year.

Trend in numbers of refugees/displaced and proportion severely malnourished or at high nutritional risk (shaded area).

Current estimates of affected populations by country of present residence are given in the box below:

Location	Oct 95	Dec 95	Feb 96	Apr 96	Jun 96	Sep 96	Dec 96
Burundi	315,000	504,000	275,400	290,000	289,000	300,000	296,000
Rwanda	725,000	800,000	737,000	737,000	749,000	598,000	1,179,000
Tanzania	629,000	621,000	653,000	624,000	642,000	653,000	759,000
Zaire	1,158,000	1,146,000	1,211,000	1,166,000	1,419,000	1,444,000	668,000
Uganda	6,400	6,400	6,800	6,900	7,000	7,000	11,500
TOTAL	2,831,400	3,077,400	2,883,200	2,823,900	3,106,000	3,002,000	2,913,500

Eastern Zaire The recent outbreak of intense fighting between Tutsi rebels and the Zairian army in Eastern Zaire which flared up at the end of October, has resulted in major population movements. The Tutsi Banyamulenge joined forces with other Zairian rebels to form the Alliance of Democratic Forces for the Liberation of Congo-Zaire (ADLF). The conflict has led to the displacement of most of the 1.2 million refugees as well as large scale internal displacement of local populations. The three main areas of refugee concentration in the region - Goma, Bukavu and Uvira are now under rebel control. The vast majority of Rwandan refugees in Goma have reportedly left the camps with many believed to be in the area around Kisangani, west of Goma. Refugees camps in Bukavu and Uvira are also virtually empty. The fighting is continuing with rebel forces reportedly making significant gains. Aid agencies have recently been confined to Goma and Sake although there has been periodic access to other areas [IRIN 29/11/96]

Approximately 600,000 Rwandan refugees have returned home, mainly without incident, but the total number of refugees remaining in Zaire and the number of internally displaced Zairians remains unknown. It is believed that there are up to 500,000 refugees gathered in at least five separate areas in Eastern Zaire and as many as 170,000 internally displaced. Some refugees have fled to Uganda while others have returned home to Burundi where the continued insecurity is also causing tens of thousands of people to flee their homes with many seeking refugee status in Tanzania [USAID 22/11/96, 12/05/96, IRIN 03-4/11/96 04/11/96, 08/11/96].

The high level of insecurity has forced most humanitarian agencies to evacuate the region and it is currently virtually impossible to deliver food and other relief supplies to the area. The risk of an emerging nutritional and health crisis increases daily as this situation persists [USAID 22/11/96, IRIN 03-4/11/96, 04/11/96, 08/11/96].

The plan to dispatch a multi-national military force, whose mandate would be limited to assisting food deliveries and the voluntary repatriation of refugees, has been “put on hold” partly so as not to interfere with the large-scale repatriation to Rwanda and also because of the enormous difficulties that are being encountered in locating hundreds of thousands of refugees and internally displaced people in the area. The security risk to such a force has also been a factor in the delay. Relief agencies have launched airlifts of high energy biscuits, medical supplies, plastic sheeting and blankets into areas where refugees have been located [USAID 22/11/96, IRIN 03-4/11/96 04/11/96, 08/11/96, 12/12/96].

Bukavu By mid-November the Bukavu refugee camps were reportedly empty although the whereabouts of the refugees was unclear. Very few of the returnees to Rwanda have been from the Bukavu camps and it is believed that most of this refugee population has moved westward [IRIN 22/11/96].

Agencies have been planning small-scale targeted distributions to vulnerable groups in hospitals, orphanages and to 8-9,000 refugees and internally displaced persons who are in or near Bukavu and in need of assistance. Out of this population, up to 4,000 are reportedly in a very bad condition [WFP 29/11/96].

Uvira Initial reports suggested that as fighting between rebel and government forces escalated all of the 220,000 refugees (143,000 Burundian and 73,000 Rwandan) fled the camps which were subsequently burnt. Up to 36,000 of the Burundi refugees in the Uvira area have reportedly returned to Burundi. Most of the Rwandan refugee appear to have moved north of Uvira with others fleeing south towards Fizi. A UN/NGO team was able to visit the town for the first time in early December and found the situation to be very calm with markets now re-opened and quite well supplied. There were no refugees visible on roads. Most of the refugees who were in the Uvira camps have not received food aid since the middle of October as access by relief agency staff has not been possible. High levels of malnutrition have been found among refugees who have returned to Burundi from Uvira [IRIN 08/12/96].

Rwanda Approximately 600,000 refugees returned to Rwanda by the end of November and were being assisted with food and non-food items during transit and on return to their communes of origin. Due to the scale and speed of return (200,000 returned between the 15-16th of November) it has not so far been possible to conduct nutritional surveys. However, the returnees are generally reported to be in good health, although more recent returnee children are said to be suffering from dehydration, exhaustion and hunger [IRIN 17/11/96, 22/11/96]. There are also approximately 576,000 people in Rwanda who will require emergency assistance probably until the harvest in January 1997.

Relief agencies established eight way stations between Gisenyi and Ruhengeri in Rwanda to address the needs of the returnee population. The size of the population precluded distribution of a general ration during transit so that returnees were allocated high energy biscuits. However, resupplying way stations has proven problematic at times due to refugee congestion on the roads. NGOs therefore began to restock warehouse after dark when the roads were clear for the night [IRIN 22/11/96].

General rations lasting between one to four weeks are being supplied to returnees on arrival at their communes of origin and the registration of the 600,00 Rwandan returnees is said to be continuing in the communes without major disruption. However, there have been some administrative problems with food distribution in Gisenyi and Ruhengeri [IRIN 03/12/96, WFP 21/11/96].

In spite of the fact that the nutritional state of the returnees has been generally better than expected, the need for supplementary feeding at commune level has increased due to the influx. However, in order to avert the need for establishing large numbers of feeding centres it has been decided to incorporate a 100 gms of UNIMIX/child/day into the general ration. There is also increasing concern over the food security situation in both Butare and Gikongoro prefecture where irregular rainfall during the past two months and increasing demand for food from refugee returnees from Burundi in July and August is increasing the pressures on food supplies [WFP 29/11/96].

A recent nutritional survey in Kibangira camp (approximately 3,000 Burundi refugees) in Rwanda showed 6.1% wasting with 2.8% severe wasting. No cases of oedema were seen (Annex 1 (4a)). The crude mortality rate was 0.4/10,000/day and the under-five mortality rate was 1.9/10,000/day. The ration distributed was 1950 kcals/person/day just prior to the survey while measles immunisation coverage was 97%. These indicators describe a generally adequate situation [MSF-B 11/10/96]

Burundi At least 46,000 Burundi refugees have recently returned to Bujumbura and Cibitoke provinces from Zaire with many reportedly in an appalling nutritional state. A recent screening among those arriving at Gatumba transit camp, regardless of age, showed 18.2% wasting with 4.2% severe wasting. Another screening showed 13% severe wasting for those under 15 years old, with 17.6% severe wasting for children under five years old (see Annex I (4b-c)). This situation is thought to be due to the combined effects of a reduced ration in the camps prior to departure and the lengthy period of transit from Zaire which may take up to one week. The transit camp is now reportedly empty as people return to their communes; food rations are being provided to returnees [IRIN 03-04/11/96, UNHCR 17/11/96, WFP 14/11/96].

A total of 3,000 returnees who transferred from the Gatumba transit camp are living on a site in Rugombo and are awaiting transfer to their home communes. Although this population has sufficient food, their limited access to water and sanitation is said to be alarming. A further 16,000 returnees are camped near Buganda and have not passed through Gatumba camp. They have therefore not received any assistance and are lacking both food and non-food items. Their lack of access to water and sanitation is also causing grave concern [WFP 29/11/96].

Widespread insecurity persists throughout Burundi with approximately 75,000 Burundians having fled to Tanzania in the first two weeks of November. Most of this population have come from the provinces of Bururi, Rutana, Gitega and Ruyigi. The slaughter of 298 Burundian returnees who were killed in Murumba church in Cibitoke province at the end of October received widespread media coverage. At the end of November the dramatic deterioration of security in Kayanza province led to a displacement of up to 100,000 people. Further large scale security induced displacements have also recently been reported in southern Bujumbura rural province and northern Bururi province [WFP 29/11/96].

There are estimated to be at least 250,000 internally displaced people in Burundi. Many of these people are inaccessible for varying periods of time due to insecurity and receive rations as and when security allows. A further problem for this population has been the inclusion of fuel and food aid on the list of items which sanctions preclude from entry into Burundi. As these restrictions have now been reduced it is hoped that humanitarian aid activities can increase in scale and scope [WFP 18/10/96, 01/11/96].

A survey among the internally displaced in Karuzi province, Burundi (affected population estimated at 50,000 in approximately ten camps) showed 13% wasting, with 2.7% severe wasting. Oedema was measured at 1.1 % (see Annex 1 (4d)). Measles immunisation coverage was 85.6%. These somewhat worrying results can, in part, be explained by the fact that this population has little or no access to farmland, and that humanitarian food deliveries have often not been possible due to insecurity. In order to redress this situation, it has been proposed to increase the capacity of feeding centres, and to organise weekly food distributions. This is, however, only feasible where security allows [DHA 15/10/96, MSF-B 30/08/96].

Tanzania More than 100,000 refugees fleeing insecurity in Burundi and a further 35,000 from Zaire arrived recently in Tanzania in the Kigoma region. Tanzania now hosts more than 759,000 refugees including 535,000 Rwandans, 189,000 Burundi refugees, and 35,000 Zairian refugees [MSF 24/11/96, USAID 12/12/96].

Recent nutrition assessments have revealed generally low levels of wasting and oedema among the under-five population of refugees in Tanzania. However, cases of adult malnutrition were seen in most of the camps, which were determined to be largely attributable to medical and socio-economic problems. In addition, signs of micronutrient deficiencies were noted, particularly in the Ngara camps. Ration supplied during 1996 were on average 1880 kcals/person/day. Food distribution systems were changed in late 1995 from family to communal level distribution, based on community participation. This system is said to be more successful than previous ones as there is greater transparency and equity and refugee families do not have to spend such long periods distribution queues. Furthermore, agencies spend less time implementing the distributions. Provision of firewood remains a problem in many camps, with the notable exception of Kigoma [WFP/UNHCR Oct 96].

In Kigoma (estimated population 43,000), recent surveys showed levels of wasting which varied from 3.0-12.5% with 0.0-1.1% severe wasting. Almost no cases of oedema were seen (see Annex I (4e-h)). Crude mortality rates varied from 0.17-0.33/10,000/day, and the under-five mortality rate was 0.3-1.14/10,000/day. Water supply is on average 15-30 litres/person/day. However, in Mtendeli camp where 40,000 Burundi refugees have arrived since the beginning of November, the most recent arrivals are reportedly in a poor nutritional state. Rates of malnutrition for children under five were recorded at almost 19%. The overall prevalence of wasting is 12.5%. A new camp has been opened to help accommodate the recent case load and despite what is described as overcrowded conditions, the health and food situations are reportedly under control. However, there are reports that only approximately 4 litres of water/person/day are available and that soap and blankets are in short supply [WFP/UNHCR Oct 96, WFP 29/11/96].

The most recent nutritional surveys for the Ngara camps (estimated population 490,000) are from September 1996. These surveys showed levels of wasting ranging from 1.9-3.6% with severe wasting from 0.1-0.3%. Oedema varied from 0.0-0.8% (see Annex I (4i-k)). Crude mortality rates were measured at 0.14-0.59/10,000/day and the under-five mortality rates were 0.39-1.96/10,000/day. Water availability ranged from 8-12 litres/person/day. This is below the recommended 20 litres/person/day. A survey amongst school children in the camps (6-15 year olds) found prevalence rates of angular stomatitis of 8.% to 15.5%. This suggests the need to review the availability of micronutrients in both the general ration, and through alternative (e.g. markets, gardens) [WFP/UNHCR Opt 96].

In Karagwe (estimated population 125,000), surveys showed wasting and/or oedema from 0.3-1.8% with severe wasting and/or oedema 0.0-0.4% (see Annex I (41-p)). No land is officially designated for farming, however many refugees have small home gardens. Water availability is problematic during the dry season when only 3-4 litres/person/day are available. During the rainy season, 8-17 litrers/person/day are available [WFP/UNHCR Oct 96].

UN sources have said that the repatriation of the approximately 535,000 Rwandan refugees from Tanzania could take place before the end of the year. Indeed, it is reported that Rwandan refugees appear to be preparing to leave the camps, but in some cases there are population movements further into Tanzania, not toward Rwanda. Agencies are preparing for a large scale return to Rwanda by prepositioning food at commune level and high energy biscuits “en route” [IRIN 11/12/96, 12/12/96, WFP 22/11/96, 29/11/96].

Uganda There are approximately 11,500 refugees from Rwanda and Zaire in Uganda [USAID 05/12/96]. There are no current reports on the nutritional status of this population.

Overall, the returnees in Burundi are at high risk (category I in Table 1) due to elevated levels of wasting seen as they came through transit centre. The refugees in Ngara, Tanzania are also at high risk due to micronutrient deficiency diseases. The refugees and internally displaced people in Eastern Zaire along with those in Burundi can be considered to be at high risk (category IIa in Table 1) due to inaccessibility. New returnees to Rwanda and new arrivals in Tanzania can be considered to be at moderate risk (category IIb in Table 1). The population in Rwanda dependant on food aid until the harvest and the remaining refugees in Tanzania are not currently thought to be at heightened nutritional risk (category IIc in Table 1).

How could external agencies help? Until access to Eastern Zaire improves, perhaps facilitated through the dispatch of a multi-national military force, little humanitarian work can proceed. However, it can be surmised that the majority of those refugees and internally displaced people remaining in the region are increasingly in need of humanitarian aid support in the form of food, shelter, clean water and sanitation facilities, and health service provision. It is therefore vital that the relief community prepare for an intervention involving large numbers of malnourished and sick people. It is also essential that governments and UN agencies arrive at a clear policy regarding the ultimate destination of this newly displaced refugee population in order to plan for the most appropriate type of humanitarian aid support. Aid workers in the region have identified the following major impediments to resumption of humanitarian operations in Eastern Zaire once security problems are resolved; shortage of aid vehicles and logistic equipment, destruction of relief structures, chronic fuel shortages and poor road access.

In Rwanda there is an ongoing need for nutritional and food security monitoring in communes which are receiving large numbers of refugee returnees, This need is particularly acute in the prefectures of Gikongoro and Butare where poor harvests are posing an additional strain on food security. It is also important that agencies carefully monitor the equity of general ration distribution systems put in place as the speed of influx into communes may well necessitate distribution through commune leaders with an inherent risk of high levels of leakage to privileged groups.

In Burundi, the high level of insecurity continues to thwart efforts to adequately support newly displaced populations. These populations invariably require expanded selective feeding programme facilities and general ration distributions and it is important that distribution systems are selected on the basis of posing least risk to beneficiaries while ensuring greatest likelihood of disbursement. The new influx of returnee refugees is an additional problem. Water and sanitization facilities need to be urgently improved at the transit camp at Rugumbo, while new returnees camped near Bugongo need to be urgently registered for food distributions and supplied with water and sanitation facilities.

In Kigoma region in Tanzania, the large influx of refugees leading to over-crowded camp conditions, insufficient water supplies and lack of soap and blankets in Mtendeli and newly established camps, is increasing the risk of outbreaks of cholera and measles. A high level of preparedness is needed in the event that such diseases occur. Furthermore, the high incidence of vitamin B2 deficiency leading to angular stomatitis indicates the need to review the quality of the ration and the efficiency of the distribution system.
 

RNIS 17, September 1996

Trend in numbers of refugees/displaced and proportion severely malnourished or at high nutritional risk (shaded area).

The recent coup in Burundi has not stemmed the rising tide of violence which is seriously affecting humanitarian relief programmes. Since the coup, all Rwandan refugees have returned home from Burundi, while the exodus of Burundi refugees to neighbouring Uvira, Zaire, and Tanzania continues. The Zairian Government has announced that all Rwandan refugees will be repatriated from Zaire by next year. Currently, the nutritional situation amongst this refugee population is adequate and stable. However, the continued reduction in rations in the Zairian refugee camps and the curtailment of refugee economic activity may eventually have an adverse impact on nutritional status. The overall nutritional status of refugees from the Masisi area of Zaire residing in a refugee camp in Rwanda is poor, due mostly to the continued flow of new arrivals who are malnourished.

Current estimates of affected populations by country of present residence are given in the box below:

	Jul 95	Oct 95	Dec 95	Feb 96	Apr 96	Jun 96	Sep 96
Burundi	515,000	315,000	504,000	275,400	290,000	289,000	300,000
Rwanda	800,000	725,000	800,000	737,000	737,000	749,000	598,000
Tanzania	644,000	629,000	621,000	653,000	624,000	642,000	653,000
Zaire	1,202,200	1,158,000	1,146,000	1,211,000	1,166,000	1,419,000	1,444,000
Uganda	6,700	6,400	6,400	6,800	6,900	7,000	7,000
TOTAL	3,167,900	2,831,400	3,077,400	2,883,200	2,823,900	3,106,000	3,002,000

Burundi A bloodless coup, which occurred in June when widespread insecurity throughout the country was claiming lives at an alarming rate and relief operations were under constant threat of disruption, has left Burundi in a state of political turmoil. Many countries condemned the coup and have imposed economic sanctions. Subsequently, sanctions were relaxed to allow for the importation of fuel to facilitate the distribution of humanitarian supplies and the continuation of some essential operations in country. Seeds and fertilizer have also been exempted [IRIN 07/07/96,28/07/96, 25/08/96, WFP 12/07/96, 13/09/96, 27/09/96].

Since the coup, there have been reports of continued insecurity throughout the country. Violence has been particularly acute in the north west region where the situation has been described as a “war zone”. Significant humanitarian needs are believed to exist through those areas affected by conflict. However, periodical closure of national highways and cessation of relief programmes in several provinces due to the high level of insecurity continues to hinder effective delivery of humanitarian aid [USAID 16/08/96].

The entire Rwandan refugee population was repatriated by the end of August, leaving up to an estimated 300,000 displaced people in Burundi [DHA 2/09/96]. However, a large portion of this population is only displaced for short periods and returns home to farm land within a few weeks [USAID 16/08/96]. There are no new nutritional data on the internally displaced populations in Burundi although the recent harvest may buffer the worst effects of the prevailing insecurity and diminished humanitarian aid upon nutritional status.

Rwanda The security situation in Rwanda remains generally calm. However, a number of attacks reportedly launched by infiltrators from Zairian refugee camps have occurred in the neighbouring western prefectures of Cyangugu, Kibuye, Gisenyi and Ruhengeri [UN Jul 96, USAID 09/07/96].

There are approximately 576,000 people in Rwanda currently dependent on food aid (approx. 9% of the population). Although estimated agricultural production in 1996 has increased by 15% compared to last year, levels are still 23% below those harvested in 1990 prior to the escalation in civil conflict. The two factors inhibiting a faster rate of agricultural recovery are lack of high quality seeds, and the shortage and/or high prices of pesticides and other inputs [FAO 12/07/96, UN Jul 96].

There are no recent nutritional data on the Rwandan population, although the improving agricultural situation in conjunction with ready availability of food aid would indicate an adequate and stable nutritional situation. There is, however, considerable concern over the health and nutritional status of prisoners in detention centres. The most common reported diseases amongst this group are malaria, dysentery and respiratory diseases often linked to HIV infection. Furthermore, overcrowding and lack of water for washing is leading to a high incidence of skin disease [UN Jul 96].

Food aid is mainly distributed through food-for-work and income generating programmes (over 60%), although targeted assistance to the vulnerable people, e.g. orphans, detainees, and the internally displaced, continues. Numerous activities are taking place in the health sector, including the establishment of oral rehydration therapy centres in all regions, a national polio vaccination campaign, and a national growth monitoring and promotion programme [FAO 12/07/96, UN Jul 96].

The closure of refugee camps in Burundi has led to the voluntary, and in some case, forced, repatriation of all Rwandan refugees from Burundi. Returnees have been given food rations as well as non-food items, and have been transported to their communes of origin [UN Jul 96].

A recent movement of Burundi refugees to Rwanda which began in 27 June, has resulted in 5,700 new arrivals [WFP-a 27/09/96].

After a recent meeting between the Prime Ministers of Rwanda and Zaire, it was announced that the two countries would seek a “rapid” and “massive” repatriation of Rwandan refugees from Zaire, to be completed before the beginning of Zaire’s electoral process in May 1997. A statement was made that the Government of Zaire would begin the progressive closure of the camps and that the Rwandan Government would take measures to welcome and install the returnees [IRIN 25/08/96].

Goma, Zaire There are approximately 727,000 Rwandan refugees remaining in the Goma camps. The general security situation is described as tense, with reports of mined roads and armed attacks on extended delivery points. Such incidents exacerbate mistrust between refugees and the local population [WFP 21/06/96, 05/07/96, 16/08/96].

The ration for refugees has been reduced from 1,400 kcals/person/day to under 800 kcals/person/day. This reduction arises from a ban by major donors on the delivery of their food aid to the camps pending credible refugee numbers, which in turn depends on a successful verification exercise. This exercise was originally boycotted by the refugees, but now refugees leaders are said to be willing to cooperate. However, the exercise has been postponed due to insecurity in the Uvira area [WFP 13/09/96, 20/09/96, WFP-a 27/09/96].

A recent set of nutritional surveys showed lo and stable prevalences of wasting, despite the reduced ration and the ban on economic activities. Levels of wasting varied from 1.6-3.5%, with severe wasting from 0.0-0.8%. Only one case of oedema was seen in all the camps (see Annex I 4(a-e)). Crude mortality rates in the camps are low and vary from 0.08-0.28/10,000/day; under-five mortality rates are also low at 0.39-1.1/10,000/day. However, there is some concern over cases of child mortality following the closure of a number of camp clinics which appear to have resulted in increasing numbers of refugees deferring to traditional medicines and practitioners [UNHCR 08/09/96, 14/09/96, WFP 12/07/96]. Furthermore, there is a risk that the declining level of rations may ultimately have some adverse impact upon nutritional status.

Bukavu, Zaire There are approximately 302,000 refugees in 22 camps in the Bukavu region. All economic activities have been stopped in the camps and several security incidents have occurred as a consequence [WFP-a 27/09/96].

A recent set of surveys in the camps showed levels of wasting varying from 0.9% to 7.0% with severe wasting measured at 0% in many cases (see Annex 14(f-k)). The highest levels of wasting were found in Inera camp with 7.0% wasting and 0.2% severe wasting [WFP 12/07/96, UNHCR 23/08/96].

There is concern that the embargo on refugee economic activity along with general rations levels which vary from 1400-1500 kcals/person/day, will eventually lead to an increased risk of malnutrition. Indeed, there have been reports of increased levels of anaemia amongst children as well as increasing numbers of low-birth weight children. Furthermore, the increase in frequency of certain infections is thought to be partly attributable to lower immunity as a result of poorer nutrition status [UNHCR 23/08/96].

Uvira, Zaire The influx of Burundi refugees fleeing insecurity is continuing with an average of 400 people arriving each day during July. It is currently estimated that there are 215,000 refugees in Uvira and preparations for the construction of an additional refugee camp in the area are on-going. However, insecurity is said to be increasing to the point where an unconfirmed number of refugees have fled the camps, leaving several refugee camps ‘partially empty’ [WFP 09/08/96, 30/08/96, 27/09/96].

The camps in Uvira are currently facing a shortage of cereals and pulses, due largely to technical problems at Uvira port [WFP-a 27/09/96].

Tanzania There has been an increase in the rate of influx of Burundi refugees following the coup in June and it is currently estimated that there are 653,000 Burundi and Rwandan refugees in Tanzania. It is reported that many of the new arrivals from Burundi are suffering from high levels of anaemia, and attendance at feeding centres is said to be increasing. Sites of new refugee camps to accommodate the increased population are currently being sought [WFP 09/08/96,06/09/96].

The Tanzanian Government has agreed to re-open its border with Burundi in order to allow the passage of humanitarian aid. There are no new nutritional data on the refugee population although there are concerns over a possible water shortage in the Karagwe camps (especially Chablisa I and II) with camp leaders being advised to control the use of water during the next two months [WFP 12/07/96, 16/08/96].

Masisi Region Following inter-ethnic conflict earlier in the year, the security situation in the region is now reportedly calm and some of the 200,000 people estimated to have been displaced by the fighting are returning home. Markets in some areas are operating once again. However, a number of security incidents, usually related to livestock thefts, continued to be reported. Much of the region is depopulated, with some fleeing to Rwanda or the periphery of the region, while others are in camps for the internally displaced (approx. 30,000 people).

Some groups are believed to be particularly vulnerable. For example, in Kichanga, it is very dangerous to forage for fire-wood for cooking purposes. As a result, levels of malnutrition amongst the displaced population are said to be increasing with a corresponding increase in the number of children attending the feeding centre [IRIN 23/08/96]. A nutritional survey in February had already found somewhat elevated levels of wasting of 8.2% with 0.8% severe wasting [MSF-B Aug 96].

There are now approximately 16,000 Zairian refugees in Rwanda who have fled this conflict. This population passed through Nkarima transit centre (now closed) and on to Umubano camp where the general ration level is set at 1,980 kcals/person/day. Nutritional surveys in April this year found high levels of wasting of 21.4% and 17% in the transit centre and Umubano camp respectively. The situation has improved somewhat as a more recent survey in Umubano camp found 10.2% wasting with 1.6% severe wasting. Rates of oedema were measured at 1.3% (see Annex I 4(1)). This is largely attributed to the fact that refugees continue to arrive in a poor nutritional state, having spent long periods displaced in Zaire and then a period in an over-crowded and poorly served transit centre. A supplement of 100 gms of beans/person/day to the general ration is now being provided partly as a response to these high levels of wasting [MSF-B 20/08/96, UN Jul 96, WFP 30/08/96].

Uganda Approximately 7,000 Rwanda refugees remain in Uganda. Their nutritional status is believed to be adequate and stable [UNHCR 16/09/96].

Overall, the internally displaced population in Burundi and the refugees from Masisi, Zaire in Rwanda can be considered to be at heightened nutritional risk (category IIa in Table 1). The internally displaced population in Masisi, Zaire, along with refugees in Zaire can be considered to be at moderate nutritional risk (category IIb in Table 1), while the refugees in Tanzania, the Burundi refugees in Rwanda and the affected population in Rwanda are not currently thought to be at heightened nutritional risk (category IIc in Table 1).

How can external agencies help? Many of the constraints to the regional emergency programme, which were identified in the June RNIS report, have still not been resolved. For example, there continues to be a shortage of food pledges as well as funds for regional purchase of foods. Furthermore, humanitarian goods are still not exempt from closure of the Burundi/Zaire border. These factors, along with an earlier lack of cooperation of the refugees for a registration exercise, have led to the reduction of rations in refugee camps in Zaire.

The recent exemption of fuel, seeds and fertilizer from sanctions on Burundi is a step forward in the effort to continue humanitarian assistance to populations in the country. However, it is likely that food and non-food stocks are running low, and other humanitarian goods will need to be exempt from sanctions in the near future.

In addition, a number of other more recently observed constraints and adverse factors need to be addressed in the region. In Uvira, the lack of barge capacity in conjunction with increasing numbers of damaged cranes are limiting supplies of food to the camps. In the Karagwe camps of Tanzania there is a shortage of water. This is especially acute in the Chablisa I and II camps. In Rwanda, there is a need for more supplies of seeds, pesticides and other agricultural inputs for recent returnees.
 

RNIS 16, June 1996

Burundi/Rwanda Situation - Trend in numbers of refugees/displaced and proportion severely malnourished or at high nutritional risk (shaded area).

The total number of people affected by the regional emergency has remained virtually constant at about three million. Repatriation of Rwandan refugees is continuing at a very slow rate from Zaire and Tanzania, and both host governments are demonstrating increasing frustration with the lack of progress (i.e. the recent curtailment of economic activities in Zaire). The situation in Burundi has deteriorated significantly over the last few weeks, with insecurity spreading to almost every province of the country. As food and nutrition assessments are sporadic and dependant on the prevailing security situation, it is difficult to determine the effect of the insecurity on nutritional status of the population in Burundi.

Serious disruptions in the food supply to the region are anticipated between September and December 1996. Currently there are limited supplies of corn soya blend (CSB) for the general ration and vegetable oil is lacking in several locations due to sporadic supplies and transport problems.

Current estimates of affected populations by country of present residence are given in the box below:

	Apr 95	Jul 95	Oct 95	Dec 95	Feb 96	Apr 96	Jun 96
Burundi	492,500	515,000	315,000	504,000	275,400	290,000	289,000
Rwanda	1,750,000	800,000	725,000	800,000	737,000	737,000	749,000
Tanzania	686,000	644,000	629,000	621,000	653,000	624,000	642,000
Zaire	1,130,900	1,202,200	1,158,000	1,146,000	1,211,000	1,166,000	1,419,000
Uganda	5,000	6,700	6,400	6,400	6,800	6,900	7,000
TOTAL	4,064,400	3,167,900	2,831,400	3,077,400	2,883,200	2,823,900	3,106,000

Burundi The security situation in Burundi, which was described as tense at the end of April, has deteriorated markedly since that time. Peace talks in continue to be held, but there is little or no progress toward ending the escalating violence in Burundi. The United Nations Secretary general has appealed to member nations to develop contingency plans for a standby force to intervene for humanitarian purposes, should the violence escalate further [DHA 17/05/96, KIN 26/04/96, 07/06/96, USAID 23/05/96].

Violent incidents including assassinations, attacks by armed rebels on military positions, and targeting of aid personnel, have been reported in almost all of the 15 provinces [IRIN 12/04/96, DHA 27/04/96]. One very serious incident involved the alleged massacre of 375 people, many of whom were women and children, in Bubanza Province; another involved the ambush and death of three ICRC workers in Cibitoke Province, while another reported massacre at the end of May where 50 people, mainly women and children, were killed in an IDP camp in Ruyige province. The violence has led to further large scale displacements and evacuation of many relief agency staff. The increasingly hazardous security conditions on the most important national routes and their frequent closures because of mines have seriously hampered movement of both staff and aid convoys [IRIN 3/05/96, 19/04/96, DHA 06/05/96, ICRC 04/06/96].

By mid-May an estimated 23,000 Burundi people had crossed into the Uvira camps in Zaire since the end of April fleeing the increasing violence in the country. A further 85 people per day were moving into Tanzania where numbers at transit centres were reportedly approaching capacity [WFP 17/05/96]. Numbers of internally displaced people are difficult to estimate as the situation remains so fluid. Also, many people flee their homes for only short periods of time. Best estimates are that there are 200,000 internally displaced people at any one time. There are approximately 89,000 Rwandan refugees in camps in northern Burundi [WFP 10/05/96].

The current crisis of security in the country is almost certainly affecting food availability because of transport constraints and the uncertainty of maintaining adequate relief staff in areas where violence is occurring. Over the last few months, lack of funding has been jeopardising continuation of WFP aircraft operations which have provided transport for the humanitarian community. This programme is vital as attacks on main roads are currently so frequent. Last minute donations will now enable the aircraft programme to continue for the next six months [IRIN 26/04/96, UNHCR 18/06/96].

Rwanda UNIMIR, whose mandate expired on the 8th of March, are to be replaced by a UN office which will be charged with helping to promote national reconciliation, strengthening the judicial system, facilitating the return of refugees and rehabilitating the country's infrastructure. Approximately 737,000 vulnerable people, including displaced and returnee populations, are expected to require assistance during the first half of 1996 [DHA 18/04/96, USAID 23/05/96].

The security situation in most of the country is calm, with the exception of the western prefectures where there continue to be serious incidents involving planned attacks by interhamwe militia and RPA forces and frequent land-mine detonations. Cross border incursions into western areas appear to have intensified and to be better organised. Furthermore, transport companies are increasingly reluctant to deliver food aid and monitoring and evaluation activities in the area have been curtailed as a result of the insecurity [ICRC 03/06/96, IRIN 26/04/96, WFP 26/04/96, 10/05/96].

According to a recent survey by WFP/FAO and the Ministry of Agriculture, the food security situation in Rwanda appears to be improving with only an estimated 10% of the population structurally vulnerable due in large measure to unequal land distribution [WFP 10/05/96]. The largest share of WFP food allocations are now made though food for work and income generating activities (69%) but there are still some targeted general ration deliveries to vulnerable groups [DHA 18/04/96].

Approximately 46,000 refugee returnees arrived between Jan-April 1996, with the majority from Burundi (20,000) and Zaire (18,941) [WFP 10/05/96]. The number of returnees fell dramatically during the month of March, with only 5,700 people arriving as opposed to 23,000 during February. Intimidation and propaganda in camps were reportedly major factors in discouraging return of refugees [DHA 18/04/96].

Approximately 12,000 refugees from the Masisi and Rutshuru area of Zaire are currently being assisted in camps but as many as 50,000 may have crossed the border into Rwanda [WFP 17/05/96, IRIN 26/04/96]. Anecdotal reports indicate “serious levels of malnutrition” amongst this recent wave of refugees [WFP 10/05/96]

Masisi Zone, Zaire In recent weeks, ethnic conflict in Masisi zone appears to have diminished in intensity partly due to depopulation and partly due to the presence of the Zairian military. Whole villages are reported to have emptied as civilians have fled towards Sake and Goma. However, the conflict between Rwandan Hutus and Zairian people now appears to have spread to Rutshuru zone in the East and is moving further south. ICRC estimate that 65,000 have been displaced from homes in Rutshuru since April and they are distributing non-food assistance to several thousand people [DHA 10/05/96, IRIN 19/04/96].

It is estimated that up to 200,000 people overall have now been displaced by the fighting and that there are at least 116,000 people being assisted in the area. It is probable that many thousands of unassisted people require aid but are inaccessible. Measles is reportedly at epidemic levels but given the current population flux, a vaccination campaign is not being considered at this time [DHA 10/05/96, WFP 03/05/96, 24/05/96].

There are many constraints affecting humanitarian operations in the region. The most significant are insecurity, continuous population movements, and the high degree of ethnic polarisation leading to accusations of ethnic bias against relief agencies seen to be assisting any particular population group. These problems are further compounded by poor quality roads in the area [DHA 10/05/96].

There are approximately 12,000 people who have crossed the border into Rwanda and are currently considered as refugees. A recent nutritional survey conducted in the camp showed 17% wasting and/or oedema with 7.4% severe wasting and/or oedema (see Annex I (4a)). Measles immunisation was begun as the refugees arrived, and the current coverage is estimated to be 90%. Selective feeding programmes are under way in the camp [MERLIN 02/06/96].

Goma, Zaire It is currently estimated that there are 723,000 Rwandan refugees in the refugee camps in the Goma area. The Zairian Prime Minister recently announced a new deadline of July 1996 for the repatriation of Rwandan refugees [WFP 12/04/96, 20/06/96].

A number of security incidents have been reported throughout the month of May including mine explosions near the airport and ambushing of vehicles. As a result some food distributions have been interrupted [WFP 07/06/96]. Conflict in the Rutshuru area is also threatening security around Katale camp and its extended delivery point. The enforcement of a ban on refugee economic activities has led to the arrest of several refugees who have breached the new regulations on work, and markets in all four camps are now closed [WFP 19/04/96].

Wood distribution in the camps continues to be insufficient and women are often seen to risk their lives in foraging for fuel supplies [WFP 12/04/96]. Firewood distribution in the camps is expected to fall dramatically in the coming weeks due to tribal fighting in the Rutshuru area [WFP 10/05/96].

Although there are no new nutritional data on this refugee population, the continued restriction on economic activities in conjunction with anecdotal reports of malnutrition related mortality in Mugunga camp [WFP 19/04/96] indicate that the nutritional situation of this refugee population may be deteriorating and needs to be closely monitored. Latest data on water availability in the Goma camps also indicates a worrying situation with less than 14 litres per person per day in all camps and less than 10 litres/person/day in Kibumba and Katale [UNHCR 07/04/96].

The availability of oil for general ration distributions is currently threatened by gaps in the food aid pipeline [WFP 19/04/96].

Bukavu, Zaire There are approximately 313,000 refugees in the camps in Bukavu. The general security situation around the camps is said to be tense [WFP 19/04/96].

Although the nutritional and health situation for the majority of refugees is described as satisfactory and the current ration is being maintained at 1600 kcals/person/day, the food and fuel supplies transport is difficult due to the continued border closure between Burundi and Zaire. Furthermore, due to programme restrictions imposed by the Zairian government, only limited essential services are being supplied to all camps. As a result, most camps are suffering from a lack of shelter [UNHCR 20/05/96, WFP 19/04/96, 26/04/96]. If this situation persists, the nutritional situation of this population may deteriorate.

Uvira, Zaire During May, Burundi refugees continued to arrive fleeing the escalation of violence back home. It is currently estimated that there are 183,000 refugees in the camps of whom 25,000 are recent new arrivals. Over 27,000 Burundian refugees arrived in Uvira camp in the first two weeks of May [WFP 10/05/96].

There are mixed reports on the health and nutrition status of the new arrivals. In some reports, new arrivals are said to be in reasonable health. Other reports indicate obvious signs of malnutrition among the new arrivals, especially among women and children [UNHCR 18/04/96, WFP 10/05/96, 17/05/96].

Surveys conducted in nine camps in March show levels of wasting of below 10% in all camps except Kagunga where 11 % wasting with 3.5% severe wasting was recorded (see Annex I (4b-j)). This compares with a level of 4.4% wasting recorded in October 1995 in the same camp. Apart from Kagunga, levels of wasting have risen slightly in only two camps since surveys under-taken at the end of 1995 and have diminished in the other six camps surveyed [UNHCR Mar 96]. Some further investigation into the reason for this atypical deterioration may be advisable.

The closure of the border with Burundi is having an adverse impact on supplies in Uvira. For example, transfer of salt and sugar from Bujumbura is currently more difficult because a more circuitous route must be used. There is also a shortage of diesel fuel that could affect the water supply as water pumps are diesel powered [DHA 15/05/96, WFP 26/04/96, 20/06/96].

Tanzania The number of refugees in Tanzania has been increasing steadily with the on-going influx of refugees from Burundi. Many of the new arrivals claim that the Burundian army are conducting operations against Hutus. Current estimates are that there are now 642,000 refugees in Tanzania but this number will need to be updated as the influx continues [WFP 17/05/96, 20/06/96].

A recent nutritional survey in Chabalisa camp II in Karagwe showed 2% wasting (see Annex I (4k)) [WFP 03/05/96]. The nutritional situation for refugees in the Ngara camps is also reportedly adequate and is largely attributed to maintenance of the 1900 kcal/person/day ration, in spite of periodic breaks in the food aid pipeline, and economic and agricultural activities of the refugees. The largest single source of income in the camps is said to come from those who work for international agencies [SCF 23/03/96, WFP 26/04/96].

However, a new government decree that refugees are no longer permitted to cultivate land or conduct business activities beyond a four kilometre radius of the camps will certainly reduce food security [WFP 26/04/96]. There is also continuing concern over the delivery of poor quality maize grain and the absence of mills in the Ngara region. Recommendations have been made to increase the quantity of beans in the general ration at the expense of maize grain and that, where possible, grain should be substituted with maize meal. Distribution of salt in the region has been very sporadic [UNHCR 10/04/96].

Uganda There is no reported change to the adequate nutritional situation of the approximately 7,000 Rwandan refugees in Uganda [UNHCR 23/05/96].

Overall, the nutritional status of the affected populations in Rwanda, Tanzania, and Goma and Bukavu, Zaire appears to be stable (category IIc in Table 1). However, the curtailment of refugee economic activity in Zaire and Tanzania will necessitate careful monitoring in order to determine whether this situation changes in the coming weeks. The refugees from the Masisi area in Rwanda are at high risk (category I in Table 1), and the affected populations in Burundi and in Masisi Zaire are likely to be at heightened nutritional risk (category IIa in Table 1) due to escalating insecurity.

How could external agencies help? Pronounced shortfalls in food supply for the region are currently anticipated from September 1996. Food aid pledges are therefore urgently needed. As potential new food pledges will only arrive toward the end of the year, immediate cash donations to procure food in the region are required. Furthermore, exemption of humanitarian goods from the closure of the Burundi/Zaire border is important for the continued expeditious transfer of humanitarian aid from Bujumbura to Zaire. Some specific needs by country are highlighted below.

In Rwanda there continues to be a need (RNIS 15#) for nutritional surveys in western areas where insecurity may be adversely affecting food availability especially in areas to which refugees have returned.

In Zaire, needs include:

• additional cooking fuel distribution in the Goma camps;
• additional pledges of edible oil for the general ration for the Goma refugee population;

In Tanzania, lack of milling facilities for maize has been reported as a problem in the Ngara camps for the last two years, probably contributing to nutritional risk. Maize meal may have to be substituted for grain. The proportion of beans in the ration may also be too low.

The need for additional funding for aircraft deliveries in Burundi was highlighted in the last RNIS report as a problem. Funding has now been secured for the next six months. Other priorities identified previously such as regular nutritional surveys of IDP camp populations and increased coverage of selective feeding programmes in areas of insecurity, have not been achievable due to the marked increase in insecurity in recent weeks.
 

RNIS 15, April 1996

Trend in numbers of refugees/displaced and proportion severely malnourished or at high nutritional risk (shaded area).

The focus of discussions at a recently held summit meeting between the presidents of Rwanda, Burundi, Tanzania, Uganda and Zaire was on encouraging the repatriation of two million Rwandan and Burundi refugees, and to bring to a halt the emerging crisis in Burundi [WFP 22/03/96]. Fighting is continuing in parts of Burundi and placing those populations in insecure areas at nutritional risk. The government strategy of surrounding refugee camps in Goma and Bukavu with a view to restricting refugee activity and encouraging repatriation is continuing. However, in comparison to the overall number of refugees, there has been relatively little repatriation in recent weeks.

Current estimates of affected populations by country of present residence are given in the box below:

	Feb 95	Apr 95	Jul 95	Oct 95	Dec 95	Feb 96	Apr 96
Burundi	740,000	492,500	515,000	315,000	504,000	275,400	290,000
Rwanda	335,000	1,750,000	800,000	725,000	800,000	737,000	737,000
Tanzania	630,000	686,000	644,000	629,000	621,000	653,000	624,000
Zaire	1,290,000	1,130,900	1,202,200	1,158,000	1,146,000	1,211,000	1,166,000
Uganda	5,000	5,000	6,700	6,400	6,400	6,800	6,900
TOTAL	3,000,000	4,064,400	3,167,900	2,831,400	3,077,400	2,883,200	2,823,900

Burundi While the security situation in many areas of the country has reportedly been calm in recent weeks, fighting and other violent incidents have taken place in the provinces of Muramvya, Gitega, Kayanza, Karuzi and Buriri. Most recent reports indicate an overall decline in security with the southern most provinces worst affected [DHA 20/3/96]. The insecurity has led to further displacements of varying duration which make it difficult to determine with any degree of accuracy the total number of internally displaced within Burundi. Best estimates are that there may be 200,000 internally displaced people at any given time. Government and humanitarian agency policy is to provide food aid on an ad hoc basis to newly displaced populations following an initial assessment [DHA-a 08/03/96, USAID 12/03/96, WFP 01/03/96, 22/03/96].

Security problems have also reportedly impacted refugees and internally displaced in recent weeks. For example, tensions between the refugees and militia have been reported in Rukuramigabo refugee camp following the announcement that the camp was to be closed in two weeks With the exception of sporadic shootings in the surrounding hills, the capital has remained calm with banditry being the main security risk factor. There have also been reports of militia attacks on IDP camps in Bubanza province [DHA 13/03/96, WFP 22/03/96].

Repatriation of Rwandan refugees is continuing and it is currently estimated that there are just over 90,000 refugees remaining in the northern part of the country. The rations currently distributed to this refugee population provide 1,950 kcals/person/day. The most recent nutritional data available on this population comes from a survey in November 1995 in Rukuramigabo camp in Kirundo which showed levels of wasting and/or oedema at 1.7% and severe wasting and/or oedema at 0.2% (see Annex I (4a)) [UNHCR 1/03/96]. There have been recent reports of increases in the numbers of children attending selective feeding programmes in Magara and Rukuramigabo camps and that many of the new admissions have exhibited signs of kwashiorkor [UNHCR 07/03/96].

Nutritional survey data for internally displaced and resident populations in areas of insecurity indicate a more worrying situation. The last RNIS report noted levels of wasting in four camps for internally displaced people ranging from 15-18.2%. A more recent survey in Ngozi province (population 510,000) in December 1995 found 9.3% wasting with 1.2% severe wasting amongst a sample of resident and displaced households; oedema was measured at 1.8% (see Annex I (4b)). These elevated levels of wasting may partially be explained by the timing of the surveys which was in the “hungry season” just prior to harvest. However, limited access to food due to the effect of insecurity on agricultural activity has undoubtedly played a significant role. The survey also determined that coverage of selective feeding programmes in the province is very low (less than 2% of malnourished children were enrolled at feeding centres). Furthermore, default rates at the feeding centres were very high. This was mainly thought to reflect the financial difficulty imposed by participating in these programmes and difficulties of regular attendance due to insecurity [ACF Dec 95].

Since this survey, some roads in the province have been washed away by rains leading to a reduction in amounts of food delivered. Furthermore, the ration was recently reduced to 1,600 kcals/capita/day due to lack of stocks [UNHCR 06/03/96, WFP 16/03/96]. It is therefore likely that the nutritional condition of this population has continued to decline.

Rwanda The pace of repatriation of refugees sped up slightly during February, with a reported 23,000 refugees returning from neighbouring countries. The majority of returnees came from Burundi and Zaire [UN 15/03/96, WFP 08/03/96]. However, during the first half of March less than 3,000 refugees returned with most returnees coming from Zaire [WFP 28/03/96]. Refugees from the Masisi area of Zaire, where ethnic conflict has recently intensified, are continuing to arrive.

The security situation in most of the country is reported as calm with the exception of the western border areas with Zaire where regular incursions and security incidents, such as a recent attack on an NGO vehicle in Cyangugu province, take place. The UN peacekeeping force (UNAMIL) will reportedly not have its mandate renewed and troops will be withdrawn by April 19. Trials of those with suspected involvement in the genocide will also begin at this time. A small political office representing the UN will remain open in Kigali [DHA 08/03/96, IRIN 22/03/96, WFP 01/03/96, 12/04/96].

It is expected that food aid will be needed for approximately 737,000 vulnerable people, including displaced and returnee populations, in the first half of 1996. It is anticipated that the food supply situation will remain tight in parts of the prefectures of Kibungo, Gikongoro, and Butare and in areas of Cyangugu, Kibuye and Gitarama. Elsewhere in the country, although the harvests have been satisfactory and markets are well supplied, the low purchasing power in the post-war economy still results in inadequate food access for large sections of the population. During February WFP distributed food to approximately 296,000 persons in all prefectures of Rwanda. The largest share of food was distributed through food for work and income-generating activities. Some 45,900 people believed to be vulnerable to food shortages were provided with general food rations through targeted assistance and seed protection programmes. [FAO 28/12/95, FAO Jan/Feb 96, UN 15/03/96]. The health sector is reportedly recovering with most of Rwanda's 250 health centres and 36 hospitals now operating. Morbidity and malnutrition rates among children are now believed to be lower than pre-war rates [USAID 18/03/96]. Although there are no new nutritional survey data, the recent harvest and relatively unimpeded food aid programme suggests that the nutritional status of the majority of people is likely to be satisfactory. However, it should be noted that short-falls of oil and sugar for food aid programmes are expected in April [WFP 08/03/96].

Goma, Zaire It is currently estimated that there are 695,000-714,000 Rwandan refugees in the Goma camps. At the end of February, the government of Zaire reaffirmed its position that it would continue to restrict economic activities of refugees and that all NGOs were to begin phasing down their programmes. The Zairian military had surrounded certain camps in Goma and Bukavu with a view to enforcing these restrictions and encouraging repatriation, and agencies working in the camps have been instructed to gradually replace Rwandan staff with Zairians. There is now anecdotal information that the military blockade of camps has eased [UNHCR-a 22/03/96, WFP 16/02/96, 08/03/96, 15/03/96, 12/04/96].

NGOs have also been informed of the closure of all selective feeding programmes for malnourished children in every camp except Kibumba, as a result of budgetary constraints. However, with the exception of Kibumba, where according to a survey in November 1995, levels of wasting and/or oedema are highest at 8.3%, the low levels of wasting are felt to warrant the closure of these programmes. Nutritional surveys are planned for May 1996 in order to verify that the closure of the centres has not had an adverse impact upon refugees [UNHCR 28/02/96, UNHCR-a 22/03/96, WFP 16/02/96, 08/03/96, 15/03/96].

As the refugee community fear and anticipate a general pulling out of relief agencies, the level of thefts and security incidents is reportedly increasing. Supplies of firewood have been severely reduced, in part due to the escalating conflict in the Masisi region of Zaire which has until now been a major source of wood. This has forced many refugees to illegally enter nearby nature preserves, in search of wood [WFP 15/03/96].

The ration has recently been increased from 1,520 kcals/person/day to 1,700 kcals/person/day to compensate for loss of agricultural wages. However, a break in the pipeline for com soy blend was predicted for mid-April leading to a decision to reduce quantities in the general ration in order to extend supplies for longer. Furthermore, the price of vegetable oil in all camps had increased by as much as 50% mid-March as it had been absent from the general ration for the preceding two weeks. It is anticipated that the oil ration will improve again in April [UNHCR-a 22/03/96, WFP 15/03/96, 22/03/96].

Bukavu, Zaire There are approximately 295,000-310,000 Rwandan refugees in Bukavu. Some camps have been surrounded by the Zairian military as in some camps in Goma, in order to restrict refugee economic activity and encourage repatriation. However, until now there has only been limited repatriation of refugees to Rwanda [UNHCR 28/02/96, WFP 01/03/96].

Rations have recently had to be reduced below 1,700 kcals/person/day and it is reported that stocks of vegetable oil, which were very low, have been replenished [WFP 01/03/96, 12/04/96].

Uvira, Zaire There are approximately 176,000 refugees in Uvira. Most of these refugees come from Burundi (roughly 110,000) while the remainder are from Rwanda. The number of new arrivals from Burundi has slowed in recent weeks, possibly due to the mining of the border area [WFP 23/02/96].

The health and nutritional status of this population appears adequate with low mortality rates recorded in the last RNIS report. More recent information is that there has been a steady decrease in the number of children at selective feeding programmes in the camps. Water supplies in the camps are mostly at or above the target minimum of 10 litres/person/day, although levels are still below the general accepted goal of 20 litres/person/day [UNHCR-a 22/03/96, 06/03/96].

Salt had been absent from the ration, but was re-introduced at the end of March [UNHCR 28/02/96].

Tanzania There are currently about 624,000 refugees from Rwanda and Burundi in Tanzania. Repatriation has been proceeding at a very slow pace over the past few weeks. General rations delivered in March provided 1900 kcals/person/day, although rations for a brief earlier period had been considerably lower. The current food stocks and expected deliveries are only adequate until the end of April [WFP 08/03/96, 22/03/96].

Recent reports from the camps for Rwandan refugees in Karagwe district show an adequate health and nutrition situation. In Kagenyi camp (estimated population 16,000) the crude mortality rate was recently measured at 0.81/10,000/day (about 2 × normal) and the under-five rate was 1.45/10,000/day (again about 2 × normal). In Rubwera camp (estimated population 26,000) the crude mortality rate was 0.28/10,000/day (normal) and the under-five rate was 0.69/10,000/day (just below normal) (see Annex I (4c,d)). The main current health problem in both camps is the high level of malaria and resulting anaemia [MSF-CH Feb 96].

There has been no new information on the nutrition situation in the refugee camps in Ngara district. It is therefore assumed that, as indicated in the previous RNIS report, the nutritional situation in these camps is adequate and stable. Refugees are not allowed to work outside of a four kilometer radius of the camps. However, some refugees flout this restriction and are cultivating land [LSHTM 05/04/96].

Uganda There are approximately 6,900 Rwandan refugees in Uganda whose nutritional status is reportedly adequate [UNHCR 25/03/96].

Overall, the internally displaced population in Burundi can be considered to be at heightened nutritional risk (category IIa in Table 1) due to insecurity. The refugees in Goma, Bukavu and Uvira, Zaire can be considered to be at moderate nutritional risk (category IIb) due to some security problems, and a lack of fuel for preparing food. The refugees in Tanzania and Uganda, along with the vulnerable population in Rwanda are not currently though to be at heightened nutritional risk (category IIc in Table 1).

How could external agencies help? In Burundi needs include:

• regular nutritional surveys of internally displaced camp populations, especially in areas of insecurity in order to determine if food aid needs are being adequately met;
• increased coverage of selective feeding programmes in areas of insecurity, such as Ngozi, and a review of the appropriateness of feeding programme design, e.g. on site feeding may be more appropriate in areas with high levels of insecurity;
• funds for an aircraft operation which is essential to the distribution of relief commodities within Burundi;
• urgent need to supply sugar and oil for distribution during April.

In Rwanda needs include nutritional monitoring in those areas where food supply is known to be poor.

In Zaire needs include more donor pledges of com soy blend and oil for the general ration.

In Tanzania needs include development of a strategy for use of land for cultivation, particularly in Ngara.

A lack of cooking fuel for the people in the camps around Goma and Bukavu, Zaire was noted in RNIS #14 report, and although efforts have been made to bring in more fuel, supplies are currently still inadequate. The need for improved logistical capacity in Burundi (RNIS #14) has been partially addressed with the re-opening of Bujumbura port.

RNIS 14, February 1996

Widespread insecurity in northern Burundi has led to some refugee displacement to Tanzania and movement into Uvira in Zaire. The insecurity has constrained relief deliveries in the area. There is also concern over cholera in the north, and limited population access to health facilities. Refugee repatriation from Zaire, Tanzania and Burundi to Rwanda is continuing at a steady but slow pace. Harvest estimates are better than last year but still well below pre-civil war levels so that emergency food aid will continue to be needed in Rwanda throughout 1996. The nutritional situation of refugees in Tanzania and Zaire is reportedly adequate.

Burundi/Rwanda Region

Trend in numbers of refugees/displaced and proportion severely malnourished or at high nutritional risk (shaded area).

Current estimates of affected populations by country of present residence are given in the box below:

	Dec 94	Feb 95	Apr 95	Jul 95	Oct 95	Dec 95	Feb 96
Burundi	1,200,000	740,000	492,500	515,000	315,000	504,000	275,400
Rwanda	2,500,000	335,000	1,750,000	800,000	725,000	800,000	737,000
Tanzania	556,000	630,000	686,000	644,000	629,000	621,000	653,000
Zaire	1,240,000	1,290,000	1,130,900	1,202,200	1,158,000	1,146,000	1,211,000
Uganda	10,000	5,000	5,000	6,700	6,400	6,400	6,800
TOTAL	5,076,000	3,000,000	4,064,400	3,167,900	2,831,400	3,077,400	2,883,200

Burundi The security situation in Burundi has been extremely poor in recent weeks, and this has adversely affected deliveries of humanitarian aid. Serious incidents in Ngozi at the end of December led to the temporary evacuation of virtually all international aid staff from the north of the country. A major security incident was reported between the Hutu militia and the Burundi army causing between 12,000-16,000 Rwandan Hutu refugees in the northern Burundi camp of Mugano to flee to Tanzania. Although the Tanzanian authorities reinforced the closure of the border with Burundi, an exception was made and this new influx of refugees was allowed to cross. More recently, there were reports at the end of January that a further 15,000 refugees from the nearby camp of Ntamba had left for the Tanzanian border [SCF 12/02/96, UNHCR 31/01/96, WFP 05/01/96, 12/01/96, 19/01/96].

UN and NGO activity has also been largely suspended in the north western province of Bubanza and Cibitoke where insecurity has reportedly led to several thousand people leaving the area and moving into Zaire or safe points along the border. Reports indicate that the civilian population, including some wounded, are fleeing to Uvira at a rate of 200-300 per day. WFP activities in the central province of Gitega were also suspended in mid-December following grenade attacks on staff. No movement of returnees has taken place from Uvira through Gatumba since the closure of the Burundian border with Zaire in early December [WFP 05/01/96, WFP 12/01/96, 19/01/96].

Estimates for Burundi in 1996 are that there will be 170,000 beneficiaries who are either internally displaced, recent returnees or in the first stages of recovery and rehabilitation, and a further 105,400 Rwandan refugees who will require food aid in the coming year. However, given the fluid security situation in Burundi, these beneficiary estimates may prove to be quite inaccurate [FAO 28/12/95, WFP 19/01/96].

Cases of cholera which were initially identified in August 1995 are continuing to be reported in northern provinces, particularly Cibitoke, Bubanza and Bujumbura Rural and Bururi provinces. As humanitarian organisations have evacuated these areas due to insecurity, affected populations have extremely limited access to health care. It is feared that literally hundreds of people with cholera in these provinces are not receiving medical assistance [WHO 28/12/95].

The most recent survey information available is from camps for the internally displaced at the end of November 1995 when wasting and/or oedema in Muhanga camp (estimated population 5,800) was 16.1% with 5% severe wasting and/or oedema. In Gasenyi camp (estimated population 4,900), wasting and/or oedema was measured at 15.0% with 3.9% severe wasting and/or oedema. A similar situation was seen in Gohombo camp (estimated population 400) and Buraniro camp (estimated population 820) where wasting and/or oedema were 18.2% and 17.2% with 3.0% and 4.1 severe wasting and/or oedema respectively (see Annex 1 4(a-d)). These wasting and oedema levels are high, usually associated with elevated mortality and should trigger remedial action [MSF-H 13/02/96].

Rwanda With the exception of Cyangugu province, the overall security situation in the country appears to be improving with a continual decline in reported security incidents over the past six months. UNAMIR has now received a final mandate extension until March 8th with its primary role being to facilitate the voluntary and safe repatriation of Rwandan refugees. Weekly repatriation rates from neighbouring countries have ranged from approximately 1,000 to over 4,000 over the past six weeks. The majority of returnees come from Zaire and Burundi [WFP 12/01/96, 19/01/96].

Results from the WFP/FAO annual crop assessment mission indicate that yields are better than last year but still well below pre-civil war levels. It is expected that food aid assistance will still be needed for approximately 737,000 vulnerable people, including displaced and returnees, in the first half of 1996. Given the unpredictability of rates of repatriation, these estimates may need to be significantly revised at some subsequent date. Areas in Kibungo, Butare and Byumba prefectures are all reporting poor harvests due to erratic rainfall. Food for work programmes are now being targeted at the most vulnerable in these areas. Although, there are currently no new nutritional data, the improved harvest in conjunction with the targeted food aid programme suggests that the majority of the Rwandan population currently enjoy a relatively stable food security situation [FAO 28/12/95, WFP 19/01/96].

Tanzania The estimated number of refugees in Tanzania has increased to 653,000 with the recent arrival of 22,000 Rwandan refugees coming from Burundi. The border with Burundi remains officially closed, but some Rwandan refugees coming from Burundi have been allowed to cross [SCF 12/02/96, WFP 26/01/96, 09/02/96].

There have been no further nutritional surveys since the last RNIS report. These previous surveys indicated low levels of wasting of between 1-5% in the Ngara camps. However, the food supply situation is reportedly tight, and buffer stocks of food are being used to feed the refugees [IFRC 14/02/96].

Goma, Zaire Repatriation is continuing at a slow pace and current estimates are that there are approximately 721,000 Rwandan refugees residing in the Goma camps. This increase since the last RNIS report is due to births in the camps. Although the food supply situation in Goma is said to be good, lack of fire-wood is becoming a limiting factor in food preparation. A firewood distribution programme in Kahindo and Katale camp has had to be cancelled due to lack of funding. Many women faced great risk as they were forced to forage further afield in search of wood outside the camps. Rapes were frequently reported. Most recent reports are that there has been a firewood distribution for this population. It has also been reported that the Zairean army has moved into some of the camps in the Goma region. This is hindering efforts to bring food into the camps [IFRC 14/02/96, WFP 26/01/96, 09/02/96].

Results from the most recent nutritional surveys for the camps were included in the last RNIS report. These surveys generally indicated very low levels of wasting of between 1-4%. However, a trend toward an increasing level of malnutrition was noted, and it has been suggested that the current ration of 1500 kcals/person/day be increased. Water availability in the camps averages 11.2 litres/person/day [UNHCR 01/01/96, 08/01/96, UNHCR-a 08/01/96].

Meetings are currently underway in all camps to involve women in the organisation of relief food distribution [WFP 12/01/96, 19/01/96].

Bukavu, Zaire Current estimates are that there are 310,000 Rwandan refugees in Bukavu. Lack of firewood has also placed considerable strain upon this refugee population some of whom reportedly started dismantling bridges out of desperation to acquire a fuel source. Most recent reports are that as in the Goma camps there has been a firewood distribution for this population. Current rations are approximately 1600 kcals/person/day [UNHCR 29/01/96, WFP 19/01/96, 26/01/96].

The border closure between Burundi and Zaire in early December has reportedly had an adverse effect upon the Bukavu food delivery schedule [WFP 05/01/96].

Uvira, Zaire The number of refugees in Uvira has increased to approximately 180,000 due to the influx from Burundi and movement of refugees living in nearby villages into camps. Refugees are arriving from Burundi at a rate of 200-300 per day with observers describing some of the new arrivals as malnourished [WFP 12/01/96].

A recent household survey in one camp found that at least two thirds of refugee income comes from sale of the general ration. Other revenues and resources come from day labour. Refugees have apparently begun to prepare for forced repatriation by economising on ration consumption and monetising whatever is left. There is no new information on refugee nutritional status since the previous RNIS report which indicated low levels of wasting [WFP 19/01/96].

Crude mortality rates in many of the camps are just above normal ranging from 0.27/10,000/day to 0.63/10,000/day and under-five mortality rates range 0.49/10,000/day to 1.98/10,000/day. The exception to this is Luvungi camp where the crude mortality rate was 0.84/10,000/day (almost three times normal) and the under-five mortality rate was 2.88/10,000/day (again, about three times normal) [MSF-H 13/02/96].

Uganda There are approximately 6,800 Rwandan refugees currently in Uganda whose nutritional status is reportedly adequate. There are no current plans for an organised repatriation of this population [UNHCR 10/01/96].

Overall, the refugee and displaced populations in Burundi can be considered to be high nutritional risk (category Ia in Table 1) clue to heightened insecurity in the country, and limited survey data indicating high levels of wasting and/or oedema. The remaining population affected regionally is not currently considered to be at heightened nutritional risk (category IIc in Table 1).

How could external agencies help? Logistical infrastructure needs improvement throughout the region, e.g. port rehabilitation in Bujumbura, road rehabilitation in Tanzania and road maintenance in Uvira and Bukavu as well as additional support for the Tanzanian railway corporation and a logistic base in Kampala. Additional support is needed urgently for health programmes in Burundi, particularly reinforcing epidemiological surveillance capacity for cholera and intensifying information programmes which promote chlorination of water.

Nutritional surveys in those areas of Burundi where insecurity is currently affecting relief deliveries. Rapid nutritional assessments would provide updated information on areas where security is currently affecting food aid deliveries. In Rwanda there is a need for nutritional monitoring in areas where large numbers of returnees are settling, while in Uvira nutritional surveys are required in camps which are receiving new arrivals from Burundi. Finally, a long-term strategy is required for providing cooking fuel for refugees in Goma and Bukavu.
 

RNIS 13, December 1995

Burundi/Rwanda Region - Trend in numbers of refugees/displaced and proportion severely malnourished or at high nutritional risk (shaded area).

The nutritional situation for approximately three million people affected in the region remains generally adequate with low levels of wasting reported in most surveys carried out in recent months. However, the security situation in Burundi is reportedly deteriorating and causing displacement of people, may of whom are inaccessible to relief. The high level of insecurity is said to be affecting planting for the next rice crop. There are also health problems in a number of refugee camps in Uvira some of which are still showing elevated levels of wasting. Levels of oedema appear high in several camps. Repatriation from Tanzania and Zaire is continuing although there has been confusion over the Zairian government announcement that all refugees must be repatriated before the end of the year.

Current estimates of affected populations by country of present residence are given in the box below:

	Oct 94	Dec 94	Feb 95	Apr 95	Jul 95	Oct 95	Dec 95
Burundi	770,000	1,200,000	740,000	492,500	515,000	315,000	504,000
Rwanda	2,500,000	2,500,000	335,000	1,750,000	800,000	725,000	800,000
Tanzania	556,000	556,000	630,000	686,000	644,000	629,000	621,000
Zaire	1,240,000	1,240,000	1,290,000	1,130,900	1,202,200	1,158,000	1,146,000
Uganda	10,000	10,000	5,000	5,000	6,700	6,400	6,400
TOTAL	5,076,000	5,076,000	3,000,000	4,064,400	3,167,900	2,831,400	3,077,400

Burundi High levels of insecurity persist in parts of Burundi with continuous clashes between the military and rebels reported. Most incidents have been reported in the northern and western provinces and have led to substantial displacement. The worst incident recently reported involved over 250 deaths in Tangara near Ngozi. The violence is also having a considerable impact on the existing internally displaced population many of whom are being forced to relocate and as a result have no access to food or shelter. There are anecdotal reports of high levels of malnutrition in the area. A further consequence of the insecurity has been the constraint on October planting of rice in areas like Bubanza which is one of the main rice growing areas of the country producing up to 30% of the national crop [WFP 13/10/95 -08/12/95].

The level of violence has affected relief activities and only recently, following the death of an aid worker near Cibitoke, a decision has been taken to temporarily suspend all humanitarian activities in Cibitoke and Bubanza. Nevertheless, security permitting, agencies continue to provide relief items to recently displaced populations on receipt of requests for assistance from local authorities. For example, at the end of October one off distributions of food were made to 6,300 displaced families in rural Bujumbura and a further 3,000 beneficiaries in Karuzi in Central Provinces. It is difficult to determine the number of internally displaced in Burundi due to the continuous process of displacement and the lack of access to problem areas. However, current food stocks appear to be adequate to feed up to 504,000 beneficiaries of whom 214,000 are Rwandan refugees [WFP 13/10/95 - 17/11/95].

A small number of Rwandan refugees continue to return home with the total repatriating during 1995 having reached 20,639. At the same time new refugee waves are being created in areas like Cibitoke where populations are fleeing to Uvira in Zaire. In the last week of October an estimated 2,520 people left for Uvira [WFP 13/10/95 -17/11/95].

Recent information from three camps for Rwandan refugees shows a generally adequate nutritional situation. In Magara camp wasting and/or oedema was measured at 2.6% with 0.4% severe wasting and/or oedema. Wasting and/or oedema was also low in Ruvumu camp at 3.6% and in Kibezi, wasting and/or oedema was measured at 3.5% (see Annex 1 (4a-c)) [AICF Oct 95].

The recently reported cholera outbreak(see RNIS #12) is affecting rural Bujumbura, Bururi and Bubanza. [WHO 7/12//95]. The condition may also be occurring in some inaccessible areas.

Rwanda Security incidents involving clashes between the Former Rwandan Government Forces (FRGF) and RPA continue to be reported inside Rwanda. There have also been numerous land-mine explosions - particularly in western areas bordering Zaire. There are constant reports of sabotage related incursions by FRGF rebels from the Zairian camps into Rwanda. Judicial processes for those participating in the genocide are expected to start in the near future [WFP 27/10/95 - 17/11/95].

Repatriation from Zairian, Tanzanian and Burundi refugee camps is continuing with over 11,000 returnees reported during October. Over 200,000 refugees have now repatriated between January and September 1995. WFP and UNHCR have recently agreed to distribute an initial two-month food ration to all returnees in way stations and transit centres, instead of the previous one month ration, in order to provide additional time for the planning of follow-up distributions once the returnees have reached their final destination. Food aid is also distributed though food for work and income generating activities (68% of food distributed), targeted feeding (8% of food distributed) and institutional feeding (14% of food distributed) [WFP 27/10/95 - 17/11/95].

Despite the partial recovery in food security inside Rwanda due to the August 1995 harvest, as many as 800,000 people may still be vulnerable to food shortages as the prospects for the January harvest remain poor. These vulnerable families are mainly female headed households, returnees without land and remaining refugees and internally displaced groups [FAO Oct 95].

A recent nutritional survey conducted in Kigali showed an adequate nutritional situation. Wasting was measured at 5% and severe wasting was 0.6% in children. Oedema was measured at 0.3% (see Annex 1 (4d)). Measles immunisation coverage was 98% and the under-five mortality rate was 0.17/10,000/day (below normal). Adult wasting was measured at 10.7% with severe wasting at 0.5% (see Annex 1 (4e)). The crude mortality rate was very low at 0.09/10,000/day [AICF Sep 95].

Tanzania Current estimates are that there are 621,000 Burundi and Rwandan refugees in Tanzania. Small scale repatriation has been taking place and approximately 28,000 refugees from Rukira commune in Benaco camp have expressed their willingness to return to Rwanda as a group. However, due to the deteriorating security situation in Burundi, contingency plans are also being made for a possible influx of refugees from Burundi into Tanzania [WFP 17/11/95, 08/12/95].

The nutrition situation in the N’Gara camps seem to show a pattern of low levels of wasting and elevated levels of oedema. For example, a recent nutrition survey carried out in Musuhura Hill camp (estimated population 77,000) showed 3.5% wasting with 0.2% severe wasting. Oedema was measured in 1.7% of children under five (see Annex 1 (4f)). These results show no statistically significant change in prevalence of wasting since a survey carried out in July 1995. Such low levels of wasting have been maintained despite the inadequate general ration receipts recorded in August and September of 1,570 and 1,440 kcal/person/day respectively. General ration deliveries reportedly improved during October. The survey also found that coverage of the therapeutic feeding programmes has improved from 22.4% in July to 49% in November and that measles vaccination coverage was 87% [MSF-H 04/11/95].

A survey in Benaco camp showed 4.3% wasting with 0.2% severe wasting. Oedema was measured at 1.6% (see Annex 1 (4g)). Measles immunisation coverage was 82.6%. The crude mortality rate was 0.56/10,000/day and the under-five mortality rate was 1.61/10,000/day. Both of these rates are slightly above normal [AICF 23/09/95].

In Kitali camp, a recent survey showed wasting at 5.2% with 0.4% severe wasting. Oedema was measured at 2.1% (see Annex 1 (4h)). The ration has varied between 1400-1900 kcals/person/day. Feeding centre coverage was only estimated to be 26.9%. It was noted that there are approximately 1,000 new arrivals how have not been registered and therefore have no access to food distributions or medical services [AICF 01/10/95].

Recent reports from the camps in the Karagwe district show a generally satisfactory nutritional situation although mortality rates are slightly elevated in some camps. A nutritional survey in Omukariro (estimated population 8,600) showed 1.02% wasting with no severe wasting (see Annex 1 (4i)). The crude mortality rate was 0.15/10,000/day, and the under-five mortality rate was 0.37/10,000/day. These are both below normal levels. The distributed ration provided 1700 kcals/person/day [MSF-CH 14/10/95, MSF-CH Oct 95].

In Kagenyi camp (estimated population 16,000) the crude mortality rate was 0.81/10,000/day (about twice a normal level) and the under-five mortality rate was 1.92/10,000/day. The ration provided 1500 kcals/person/day. In Ruberwa camp (estimated population 26,000) the crude mortality rate was 0.55/10,000/day and the under-five mortality rate was 2.12/10,000/day (about twice normal). The ration provided 1600 kcals/person/day [MSF-CH Oct 94].

Goma, Zaire Continued small scale repatriation and a registration/verification exercise have reduced the estimated number of refugees in the Goma camps from 707,758 at the start of September to 695,750 by mid-November. The speed of repatriation has to some extent been influenced by conflicting messages from the Zairian government regarding the deadline of the 31st of December for all refugees to return to Rwanda. It now appears that this deadline will not be altered. A recent assessment in Kahindo camp found that about 80% of the adult male returnees are elderly while the remaining are young uneducated men returning to rural areas. Many of the women repatriating are heads of households or are leaving their husbands behind [WFP 3/11/95-05/12/95].

Recent surveys indicate a generally stable nutritional situation in the camps. This could be the effect of the balance of two opposing factors. On the one hand, improved food deliveries to the area due to the opening of a new access road probably has had a positive effect on the nutritional situation, but on the other hand the ban on refugee economic activity introduced by the Zairian authorities in early October would most likely have had an adverse effect. Levels of wasting varied from 2.1-4.3% in children under five (see Annex 1 (4j-m)). The exception to this is Kibumba camp, where wasting was measured at 8.3% including 4.8% severe wasting. Oedema was measured at 1.4% (see Annex 1 (4n)). This is not statistically different from the previous survey, but does show a trend toward deterioration of the nutritional situation [UNHCR 30/11/95]. There has however been a reported assessment of special feeding programs in the Goma camps with a view to discontinuing the operations and where appropriate integrating the beneficiaries into general food distributions [WFP 3/11/95-27/11/95].

Bukavu The security situation for the approximately 310,000 refugees in Bukavu remains tense due a variety of factors including confiscation of fake ration cards, news of numerous landmine explosion around the Goma camps, and the continuous fear of forced repatriation. Small scale repatriation is occurring, although, as in Goma, rates have been affected by the confused messages concerning the December 31st deadline.

Improved food deliveries to the area has allowed the accumulation of buffer stocks in warehouses and ensured adequate ration provision [WFP 27/10/95]. The nutritional situation is assumed to be stable.

Uvira The situation for the approximately 140,000 refugees in Uvira is described as tense, with reports of robbery and assault on international relief agency property and staff [WFP 20/10/95].

A recent set of surveys reveals a pattern of low levels of wasting, but high levels of oedema. For example, a survey in Runingo measured wasting and/or oedema at 7.1%, and oedema was measured at 3.7% (see Annex 1 (4o)). A similar situation was found in Kajembo camp where wasting and/or oedema was measured at 7.5% and oedema was 3.6% (see Annex 1 (4p)). These results nonetheless show an improvement since surveys in August in the two camps found prevalence of wasting of 21 % and 12% respectively [UNHCR 30/11/95].

Lack of access to general rations, the existence of cholera and dysentery, and the hungry season have all been identified as factors contributing to these somewhat elevated levels of wasting. More recent anecdotal reports indicate that poor health care, sanitation and water supplies are still causing health problems in some camps which in turn is adversely affecting nutritional status [UNHCR 15/10/95].

Uganda There are approximately 6,400 Rwandan refugees residing in two separate sites in Uganda. The nutritional status of these refugees is reportedly adequate. It is hoped that about 1,000 of these refugees will repatriate in the near future [UNHCR 16/11/95].

Overall, the internally displaced population in Burundi is probably at heightened nutritional risk (category IIa in Table 1) due to limited access to this population by relief agencies, while the refugee population in Burundi is probably not at heightened risk (category IIc in Table 1). The vulnerable population in Rwanda and the refugees in Uganda are probably not currently at heightened nutritional risk (category IIc in Table 1). The refugees in Tanzania can be considered to be at moderate nutritional risk (category IIb in Table 1) due to high levels of oedema and elevated mortality rates. The Rwandan refugees in Goma are probably not currently at heightened nutritional risk (category IIc in Table 2) with the exception of those in Kibumba camp, who are at moderate risk with elevated levels of wasting and oedema (category IIb in Table 1). The refugees in Bukavu, Zaire are also probably at moderate nutritional risk (category IIb in Table 1) due to the enforced curtailment of their economic activities, while some of those in Uvira can be considered to be at high risk due to high levels of oedema (category I in Table 1).

How could external agencies help? There is a general need for increased nutritional monitoring of internally displaced and returnee populations in the region. This is particularly important in parts of Burundi where the displaced may be cut off from relief assistance for long periods due to insecurity, and also in Rwanda where large numbers of returnees may be vulnerable to food insecurity. There is an urgent need to conduct an extensive review of the health situation in the Uvira camps in order to determine how and whether health systems should be strengthened and the impact of health status on nutritional well-being of the population. This is especially important given the continued influx of refugees from Burundi. Agencies need to investigate the factors leading to the existing unusual prevelances of oedema indicating kwashiorkor in certain refugee camps in Goma, N’Gara, and Uvira, with a view to improving preventive measures, presumably including a better diet. There is a need to improve coverage of the selective feeding programmes in Musuhura Hill and Kitali camps in Tanzania. This may be achieved by improving the outreach of the primary health care programme.
 

RNIS 12, October 1995

With the exception of some camps around Uvira, in Zaire the nutritional status of most refugees, returnees and internally displaced people in the region is reported to generally remain adequate, in spite of persistent 20-30% short-falls in general ration allocations in the Zairian and Tanzanian refugee camps. The recent forced repatriation of Burundi and Rwandan refugees from Zaire has increased tensions. Re-registration in the Tanzanian camps has adversely affected relations between refugees, government and aid agencies. Voluntary repatriation is being encouraged although many refugees are reluctant to return home. Insecurity in parts of Burundi has rendered certain populations inaccessible while rebel incursions along the Zairian/Rwandan border are routinely reported. However, increasing numbers of people are returning to their land in Burundi while in Rwanda the process of rebuilding the damaged infrastructure is said to be progressing well.

B. Burundi/Rwanda Region

Trend in numbers of refugees/displaced and proportion severely malnourished or at high nutritional risk (black area).

Current estimates of affected populations by country of present residence are given in the box below:

	Aug 94	Oct 94	Dec 94	Feb 95	Apr 95	Jul 95	Oct 95
Burundi	1,230,000	770,000	1,200,000	740,000	492,500	515,000	315,000
Rwanda	2,040,000	2,500,000	2,500,000	335,000	1,750,000	800,000	725,000
Tanzania	353,000	556,000	556,000	630,000	686,000	644,000	629,000
Zaire	1,500,000	1,240,000	1,240,000	1,290,000	1,130,900	1,202,200	1,158,000
Uganda	10,000	10,000	10,000	5,000	5,000	6,700	6,400
TOTAL	5,133,000	5,076,000	5,076,000	3,000,000	4,064,400	3,167,900	2,831,400

Burundi Estimates of the number of internally displaced people in Burundi are very difficult to make due to continued insecurity and resulting displacement in many provinces, notably rural Bujumbura, Cibitoke and Bubanza. Most recently there have also been reports of fighting in Muyinga province. An estimated one third of the population of these provinces is currently on the move as confrontation between the army and militia continues. The continued insecurity is creating further refugee movements, with, for example, 2000 new refugees reported to have arrived in Uvira in mid- September. This is offset by the return of refugees from Uvira to secure areas of Burundi. Improved security in many other areas has allowed the return of numerous displaced people to their fields permitting in turn a progressive reduction in the scale of emergency food aid distributions. A planning figure for the provision of emergency aid to 100,000 people is currently being used and it is anticipated that by March 19% this figure will have been further reduced to only 19,000 [FAO 16/08/95, WFP 18/08/95-22/09/95].

As a result of the sporadic need for supplementary food arising from periodic escalations in violence, a system for rapid provision of aid (normally a seven day ration) has been instituted in Burundi. This system has already benefited over 120,000 individuals. Insecurity is however, still preventing aid agency access in some areas, e.g. Cibitoke, with problems compounded by lack of implementing partners in the region and reluctance by private transporters to move food into unsafe areas.

There are approximately 215,000 Rwandan refugees remaining in Burundi. In line with other Rwandan refugees in the region, recent repatriations have been very small-scale with less than 200 people having returned to Rwanda in recent months [WFP 22/09/95].

There are no new nutritional surveys available from Burundi, but given the volatile security situation, it is likely that pockets of acute malnutrition exist among some inaccessible populations. Cases of cholera have been reported in several provinces particularly in areas where water has been in short supply. Due to problems of access it is reportedly proving difficult to control these outbreaks [WHO 11/09/95,15/09/95].

Rwanda The population of Rwanda is presently estimated at 5,885,000, of which 5,450,000 are rural and dependent on agricultural production. There are no longer any camps for displaced people; these were closed in May 1995. It is thought that vulnerable families who are mostly recent returnees or internally displaced account for 15% of this population (725,000). Almost 30% of households in Rwanda are female-headed. Food distributions to recent returnees and formerly internally displaced people are continuing but problems with distribution lists often delay allocations. These targeted distributions are taking place to large populations in Butare, Kigali, Giterama, Gisenyi and Gikongoro [WFP 15/09/95].

During the course of 1995 a total of 186,000 refugees have returned to Rwanda. A system of way stations and agricultural support schemes is in operation for most returnee households. The low level of repatriation has proven very disappointing to the international aid community and is believed to reflect lack of confidence amongst Rwandans in the authorities' ability to guarantee their safety upon return [WFP 18/08/95, 11/09/95, 22/09/95].

The Zairian/Rwandan border is still officially closed, although the movement of aid workers and convoys with returnees is still allowed. Poor road conditions have hampered food distributions in some parts of Rwanda but food for work projects are said to be rapidly restoring damaged infrastructure [WFP 25/08/95, 01/09/95].

The recent harvest in Rwanda, although an improvement over previous years, is still 40% below a good year's average so that large amounts of food aid are projected to be necessary in the coming year [FAO 18/07/95].

There have only been a small number of recent nutritional surveys. A national nutritional survey in May 1995 found 9.7% wasting (see Annex I (4a)) while another survey during May in three communes of one prefecture (unspecified) found only 2.9% wasting (see Annex I (4b)). A more recent survey in Butare prefecture found sufficiently high levels of wasting to justify the establishment of five nutritional centres on a short term basis [UNICEF 06/09/95, WFP 11/09/95].

The targeted food distributions and increasing numbers of food for work schemes suggest that most households in Rwanda are not currently at heightened nutritional risk. An exception may be in the Northeast where there are many returnees without land and where large numbers of cattle and a lack of water have raised fears of potentially serious problems [WFP 01/09/95].

Tanzania A re-registration exercise in the camps has been completed and has led to a reduction in the number of beneficiaries to 629,000. Prior to the registration in the Karagwe camps, an estimated 6,000 refugees moved from the Ngara camps into the Karagwe camps in the hope of obtaining extra ration cards. Repatriation to Rwanda is still continuing at a very slow pace with many refugees considering that it is unsafe to return. A number of security problems have been reported around the camps and appear connected with un-registered refugees and bandit attacks on agency vehicles.

A recent survey from Musuhura Hill Camp in July (estimated population 84,000) in Ngara district found 6.4% levels of wasting with 3.1 % severe wasting (see Annex 1 4(c)). Disaggregated results for two refugee communes of origin (Birenga and Nyarugenge) within the camp found higher levels of wasting (11.4% and 13.6% respectively). These results are not different from those obtained in April 1995. Possible explanations put forward for these persistent levels of wasting were inadequacy of the general food distribution (general food distributions have only provided an average per capita ration of 1600 kcals in recent months), poor sanitation until recently, fewer food items on the market due to the dry season and consequent higher prices. The higher levels of wasting found amongst refugees from Birenga commune are thought to probably reflect the fact that this population was recently transferred from Benaco camp where it was one of the poorest communes. The coverage of the therapeutic feeding programme in the camp is estimated as 24% of the severely malnourished while measles immunisation coverage is very high at 93% [MSF-H 22/07/95].

Goma, Zaire A combination of forced repatriation of some 6,000 refugees, voluntary repatriation and re-registration has led to a decrease in the refugee population to 708,000. Efforts to promote voluntary repatriation have largely been unsuccessful. Tension between the Zairian military contingent and the refugees mounted throughout August and a number of security incidents, mainly connected with forced repatriation, led to the evacuation of large numbers of relief staff who have subsequently returned. Tensions in Mugunga and Lac Vert camp led to temporary suspension of food distributions.

Food rations distributed throughout August and September have varied between 1500-1700 kcals/person/day.

The Zairian government announced its intention to start taxing commercial activity in refugee camps in August and by mid-September had announced a halt to all commercial activities by the refugees - a move which is expected to increase refugees dependence on food aid. The strategy of making the camps less attractive to refugees, including maintaining a curfew, is becoming clearer [WFP 11/08/95-02/10/95].

In Katale camp in July the crude mortality rate was 0.11/10,000/day and the under-five mortality rate was 0.26/10,000/day [MSF-H 14/09/95]. Both of these are below normally expected levels. Apart from these results, there have been no new surveys since the last RNIS report which showed a generally satisfactory nutritional situation in spite of low general ration deliveries in preceding months. However, the advent of the hungry season and potential effects of new legislation on refugee economic activity may well adversely affect refugee nutritional status in the coming months [WFP 22/09/95].

Bukavu, Zaire After the forced repatriation of some refugees from Bukavu, the situation in the town and camps remains tense. Tensions are also present between refugees and the local population. The number of refugees is currently estimated at 310,000 although the movement of refugees from one camp to another is making it difficult to be accurate about numbers. The voluntary repatriation programme is having only limited success as rumours of unfair imprisonment and clandestine massacres within Rwanda are spread by the Interhamwe in the camps. As in the Goma camps, only partial general rations (approximately 1500 kcals/person/day) have been delivered to camp populations in recent weeks. Furthermore, prevention of WFP trucks crossing the Burundi/Zaire border has led to low cereal stocks in Bukavu [WFP 18/08/95, 15/09/95].

Results from surveys conducted in the Bukavu camps in mid-July showed low levels of wasting ranging between 1.5%-4.8% with severe wasting varying from 0-1.6%. However, oedema, measured separately, was found in 2-4% of children (see Annex I 4(d-g)) [UNHCR 02/08/95].

Uvira, Zaire The recent attempted forced repatriation of large numbers of refugees caused most of the refugee population in Uvira to flee the camps temporarily and move to the hills. Camp food stores were looted during this exodus. Most of these refugees have now returned to the camps where a planning figure of 140,000 refugees (approximately 75,000 Burundis and 63,000 Rwandans) is still being used for food deliveries (the actual population in the camps is probably lower). Very few refugees are returning to Burundi while periodic influxes into Uvira continue as a result of security incidents in Burundi.

Food distributions are providing between 1700-1800 kcals/person/day and the nutritional situation appears to vary quite widely between camps. The Burundian military has ordered a halt to all deliveries of food aid by road from Burundi across the border to Uvira so that deliveries are now mainly by barge. There is concern that stocks of beans and oil may soon be exhausted [UNHCR 30/07/95].

Data at the end of July showed an increase in numbers admitted to feeding centres with many more cases of severe wasting. Under-five mortality rates had increased to over 2.5/10,000/day (2x normal) and in some camps was as high as 5/10,000/day (5x normal) [UNHCR 30/07/95].

Preliminary results from surveys conducted in the second half of August in three camps show worrying levels of wasting. In Runingo camp, the prevalence of wasting was measured at 21.6% with 12.3% severe wasting. In Kajembo camp wasting was 11.8% with 6.6% severe wasting and in Luberizi camp wasting was measured at 10.7% with 3.8% severe wasting and measles immunisation coverage was 61.1% (see Annex 14(h-k)) [UNHCR 30/08/95]. These levels of wasting are higher than those found in any previous survey since July 1994 (in April 1995 overall levels of wasting were only 3.8%) and may reflect a combination of factors including lack of access to general rations due to the departure from the camps following the forced repatriation attempts, the existence of cholera and dysentery, and the current hungry season [UNHCR 30/07/95].

Preliminary results from Kagunga camp indicated 6.1% levels of wasting and 2% severe wasting (see Annex I 4(h)). Measles immunisation coverage in this camp was 47.8% [UNHCR 30/08/95].

Coverage by therapeutic feeding programmes of the severely malnourished is extremely variable in the above camps, estimated as ranging from 24% to 80% in Kajebo and Runingo respectively [UNHCR 30/08/95].

Survey results in August from five other camps were better with wasting prevelances varying from 1.4-9.1 % and severe wasting ranging from 0-2.2% (see Annex 14 (1-p)). Measles immunisation coverage in the camps was low and ranged from 37%-62.5% [UNHCR 30/08/95].

Cholera has been reported in many camps throughout June, July and August with case fatality rates ranging from 1-22% (A case fatality rate for cholera of 1-2% is considered to be usual). Under five mortality rates for all camps in July were over 2.5/10,000/day (about twice the usual level) and appeared to be rising [UNHCR 29/07/95].

Uganda There are currently 6,400 Rwandan refugees in Uganda. This is a slight decrease from the time of the last RNIS report and is due to spontaneous repatriation of some of the refugees [UNHCR 18/09/95].

Overall, the internally displaced population in Burundi can be considered to be at high nutritional risk due to cholera (category IIa in Table 1) while no details on the nutritional status of the Rwandan refugees in Burundi are currently available (category III in Table 1). The vulnerable population in Rwanda and the refugee population in Tanzania are probably not currently at heightened nutritional risk (category lie in Table 1). The refugees in Goma and Bukavu, Zaire can be considered to be at moderate nutritional risk (category IIb in Table 1) and the refugees in Uvira at high risk (category I in Table 1) due to low measles immunisation coverage and, in some cases, elevated levels of wasting.

How could external agencies help?

• The main problem in Burundi is insecurity and resulting lack of access to vulnerable populations. However, when a reduction in insecurity allows, newly accessible areas should be rapidly surveyed for nutritional and health status and associated risk factors such as water availability.
• In Rwanda continued support for infrastructure repair work is needed while there should be close monitoring of nutrition in the north east of the country.
• Continued efforts are needed to improve the amounts of general ration supplied to refugee camps in Tanzania and Zaire. Furthermore, sanitation conditions in Tanzanian camps need to be improved along with coverage of selective feeding programmes in the camp, particularly for vulnerable communes, through promoting active case finding of malnourished children. In Zairian refugee camps there is an increased need for careful monitoring of nutritional status as the effects of the government ban on economic activity are felt. In the Uvira camps where surveys show serious malnutrition there is a need to urgently improve: the surveillance and treatment of cholera; coverage of selective feeding programmes and measles immunisation; and access to general food distribution.

RNIS 11, July 1995

B. Burundi/Rwanda Region - Trend in numbers of refugees/displaced and proportion severely malnourished or at high nutritional risk (black area).

There are approximately 3.2 million refugees and internally displaced people affected by this regional emergency. In Burundi, very poor security with frequent outbreaks of violence has hindered movement of relief supplies and created several new waves of displacement. Refugee camp populations have also been affected by the level of insecurity and have expressed fears of forced repatriation. Inside Rwanda, the rehabilitation programme is in full swing and targeted mainly to those communes which have received the largest number of returnees. Although there have been some security incidents in the country, a good July harvest is expected. Security around the refugee camps in Tanzania is said to be fragile but the food supply to refugees is now reported to be adequate. However, lack of water in the camps still continues to be a problem and is reflected in disease patterns. Despite inadequate food supplies to the Goma and Bukavu refugee camps in Zaire levels of wasting remain extremely low.

Current estimates of affected populations by country are given in the box below:

	Jun 94	Aug 94	Oct 94	Dec 94	Feb 95	Apr 95	Jul 95
Burundi	1.000.000	1.230.000	770.000	1.200.000	740.000	492.500	515.000
Rwanda	2.060.000	2.040.000	2.500000	2.500.000	335.000	1.750.000	800.000
Tanzania	410.000	353.000	556.000	556.000	630.000	686.000	644.000
Zaire	113.000	1.500.000	1.240.000	1.240.000	1.290.000	1.130.900	1.202.200
Uganda	10.000	10.000	10.000	10.000	5.000	5.000	6.700
TOTAL	3.593.000	5.133.000	5.076.000	5.076.000	3.000.000	4.064.400	3.167.900

Burundi The closure of the camps for the internally displaced in Rwanda led to an influx of Rwandan refugees into Burundi and most recent estimates are that there are now 215,000 refugees in need of assistance [UNHCR 14/06/95]. There are also an estimated 300,000 internally displaced people in Burundi, although the fluid security situation means that the numbers are constantly changing as people leave home and then return [WFP 29/04/95, WFP 03/05/95].

Security incidents have been continually reported over the past three months particularly in Bujumbura and in provinces such as Cibitoke leading to the temporary displacement of large numbers of people. There have been numerous reports of NGO vehicles and convoys being attacked and staff threatened. Security around refugee camps has become more precarious and Burundi officials are strongly advising that refugees return home. This insecurity is affecting access roads in and out of Bujumbura and to the northern provinces constraining food deliveries In mid-June 8-10,000 refugees from Mugano camp moved into the border area with Tanzania expressing fear of forced repatriation to Rwanda by the Burundian authorities [WFP 12/05/95, WFP 14/07/95, WFP 12/07/95].

In spite of these high levels of insecurity a joint government/WFP/Donor mission which completed its report in mid-June recommended that general food assistance to the internally displaced be phased out by March 1996 and that food should then be targeted to vulnerable groups and those without access to land, to replace the general food distribution. However, this missions findings were partly informed by the FAO/WFP crop and food supply assessment mission to Burundi in April which predicted a good second season crop before the pronounced deterioration in security of recent weeks. The Burundi government is presently studying these recommendations [FAO 24/03/95].

Rwanda The total number of internally displaced/returnees needing assistance is estimated to be 800,000 [WFP 21/07/95]. After the closure of the camps for the internally displaced in April/May 1995, a number crossed into Burundi, but many returned to their communes of origin [DHA 15/05/95]. Since the beginning of the year, food has been supplied to support a variety of first stage recovery activities in addition to continued support to recent returnees from refugee and internally displaced camps. Food for work programmes have been successfully undertaken in various sectors including infrastructure building, water and sanitation and education. Income generating activities have also been widely established.

These rehabilitation programmes are presently directed toward priority communes, estimated to have received 85% of the former IDP camp residents. Food is also supplied to hospitals, nutritional centres and unaccompanied children centres while rations to returnees continue to be provided through the way stations and transit centre system. Recent returnees currently receive a one month food distribution after which they are incorporated into targeted rehabilitation programmes.

UN and NGO vehicles are being regularly robbed and hijacked with threats to staff. In June and July there have been numerous reports of security incidents in Kigali, Gisenyi (partly due to incursions from Zaire), Butare and the Western prefectures of the country [WFP 23/06/95]. The UN security Council has extended UNAMIRs mandate for an additional six months although troops will gradually be reduced in number. Under the new mandate, UNAMIR will support and assist provision of humanitarian aid, contribute to security for UN staff, and assist in the training of the local police force [WFP 07/07/95, WFP 21/07/95].

The prospects for the harvest in July are reportedly encouraging, with approximately 60% of tillable land planted and adequate rainfall. Crop yields are expected to be near the pre-war average although a reduction in area planted will mean lower overall production [DHA 15/05/95, WFP 30/06/96].

Tanzania The total number of Burundi and Rwandan refugees has continued to rise slowly, despite the closure of the border by the government since March. It is currently estimated that there are just over 644,000 refugees in Tanzania [WFP 30/06/95]. Camp leaders from Ngara approached UNHCR at the end of June to discuss repatriation. This is the first time that such an initiative has come from the refugee community. The security situation in many of the camps is described as fragile [WFP 19/05/95, WFP 30/06/95]. Most recent reports indicate that the new distribution lists drawn up by camp leaders are creating tension in the camps, especially around distribution sites [WFP 21/07/95].

By mid-June satisfactory distribution of food was observed in all refugee camps with a full ration of maize, beans and CSB and the resource situation was said to be improving daily with new contributions. A joint WFP/Tanzanian Railways Corporation team completed its assessment in June and concluded that funds were urgently needed for the improvement of transport of food aid [WFP 24-25/07/95].

Recent nutritional information from Kitali Hill camp, in Kagera region (estimated population 58,000) found that 7.8% of children under five years of age were wasted and that 0.9% were severely wasted (see Annex 1 (4a)). Demographic analysis of the camp population showed that there were a greater number of children between 42-53 months than in the 6-17 month category possibly reflecting a higher mortality rate for those under 30 months in previous weeks or a low birthrate due to the war in Rwanda. The crude mortality rate was 0.9/10,000/day (3x normal) and the under-five mortality rate was 2.4/10,000/day. The camp had been receiving poor rations since the beginning of March and the theoretical general ration during April was only 1480 kcals per capita. The measles immunisation coverage rate was 94% [AICF 15/04/95].

A nutritional survey conducted in Musuhura Hill Camp in Ngara region (estimated population 58,000) found 11.2% wasting with 3.2% severe wasting (see Annex 1 (4b)). This does not compare favourably with an earlier survey result in November 1994 which only found 3.3% levels of wasting [MSF-H Jun 95].

Health conditions are generally said to be satisfactory in all camps with the most common health problems being lower respiratory tract infections, malaria and scabies. Adequate potable water is, however, a serious problem for all the refugee camps in Western Tanzania with average availability still only 6-7 litres/person/day. This is reflected in the high incidence of scabies. Efforts to improve the water supply are continuing [WFP 24-25/07/95].

Goma, Zaire There are approximately 722,000 refugees in Goma. It was reported at the end of April that the insecurity within Rwanda due to forced camp closures had temporarily stopped repatriation which had reached a peak of 1000/day by February. Repatriation began again in July 1995 [WFP 24-25/07/95]. In spite of a generally improved security situation in the Goma region, largely due to the presence of UNHCR Zairean security forced deployed since February, armed robberies of NGOs have been reported as well as unconfirmed information regarding an attack on Rwandan refugees from eastern Zaire.

Deliveries of food by truck have been inadequate over the last few months due to closure of the Rwandan/Zaire border, poor road conditions and escalating railway costs in Uganda. At the beginning of May, the general ration was only 1,140 kcals per capita and this was reduced further by mid-June to 1000 kcals per capita. Beans and/or CSB have periodically been missing from the ration [WFP 29/04/94, WFP 05/05/95, WFP 12/06/95]. There has also been concern over the lack of availability of maize meal. The high proportion of maize grain in the ration has been problematic for supplementary feeding programmes and young children in general. There has been a long-term shortage of milling facilities in the area with WFP lacking funds for milling costs [UNHCR 13/06/95].

Despite these problems with ration provision, recent nutritional surveys show an adequate nutritional situation. In Kahindo camp wasting rates were measured at 1.7% with 0.4% severe wasting (see Annex I (4c)). Nutritional survey results from Lac Vert camp showed 2.6% wasting and 0.6% severe wasting (see Annex I (4d)) and in Kibumba camp, wasting was measured at 3.5% with 1.9% severe wasting (see Annex I (4e)). Given the low levels of per capita rations distributed in recent weeks, it is likely that these extremely low levels of wasting reflect extensive coping strategies amongst these camp populations. A survey of camp markets in May and June showed a wide variety of food commodities available [MSF-B May/June 95, UNHCR 17/06/95, UNHCR 19/06/95].

Food distribution systems are still being improved in the camps with new family level systems being tested in Kibumba and Katale camps [WFP 30/06/95].

Bukavu, Zaire Most recent estimate are that there are 308,200 Burundi and Rwandan refugees in Bukavu [WFP 12/06/95]. The security situation is described as tense with numerous incidents reported between the Zairean authorities and Hutu politicians in the refugee camps largely as a consequence of the ban on certain political activities within the camps. A number of refugee killings have also been reported [WFP 03/05/95, WFP 16/06/95, WFP 23/06/95].

In early May, the Bukavu camps experienced a similar degree of food supply problems as the Goma camps largely as a result of closure of the border at Cyangugu. The per capita ration was only 960 kcals in early May rising to 1230 kcals by mid-May. However, these rations frequently lacked CSB and pulses and were therefore grossly deficient in key micro-nutrients. Increased use of food supplies via Burundi and some small scale local purchases determined that the food supplies had improved considerably by the end of June and were providing a per capita ration of 1500 kcals [WFP 12/05/95, WFP 19/05/95, WFP 23/06/95]. In the first two weeks of July shortages of pulses for the general ration were being reported [WFP 21/07/95].

There are no current nutritional data from the Bukavu camps although at the end of May levels of wasting were less than 5% with the consequent closure of many therapeutic feeding centres. Levels of wasting have generally been at this low level throughout the Bukavu emergency and, given the sporadic general ration supply to the Bukavu camps - especially in recent months, probably reflects the development of various coping strategies amongst this refugee population.

Uvira/Kamanyola, Zaire There have been some new arrivals in the region over the last few months largely due to the closure of the camps for internally displaced in Rwanda which led to over 23,000 new arrivals and violence in the Bujumbura area. Current estimates are that there are 172,000 Burundi and Rwandan refugees [UNHCR-b 14/06/95]. There have also been security incidents reported in this area, especially in Kamanyola camp [WFP 26/05/95].

The distribution system has been changed and food is now given directly to the oldest female in each household. This is reportedly improving equity and the amount of ration received by each family [WFP 03/05/95].

Uganda There are an estimated 6,700 Rwandan refugees in Uganda. Approximately 1,000 of these people had been refugees in Uganda before the April 1994 crisis erupted. The remaining 5,500 refugees arrived after April 1994 with many transiting through Tanzania or Zaire [UNHCR 03/07/94].

Overall, the population in Uganda is not currently considered to be at heightened nutritional risk (category IIc in Table 1). The population in Burundi is at moderate risk due to the high levels of insecurity with consequent threat to relief deliveries (category IIb in Table 1) and the refugee population in Tanzania may also be at moderate risk due to poor water supplies in the camps. Populations in the Goma, Bukavu and Uvira camps can be considered to be at low risk despite to the poor delivery of general (category IIc in Table 1). The population in Rwanda may be considered to be at moderate risk until they have fully re-established their normal agricultural and economic activities and until the infrastructure in the country has been properly rehabilitated (category IIb in Table 1).

How can external agencies help? The potential impact of the planned withdrawal of the general ration for the internally displaced in Burundi needs to be carefully monitored through nutritional and health surveillance. Furthermore, there needs to be a highly flexible approach to the targeted general ration withdrawal as security conditions within Burundi fluctuate so markedly. Cash resources are urgently needed for the Tanzanian refugee programme to support recommended improvements to the Tanzanian Railway to ensure regular deliveries of food aid to the refugee camps. Furthermore, continued efforts must be made by agencies to improve the water supply situation in the camps which have been problematic since the emergency began in April 1994. Donors must make even greater efforts to increase the provision of maize meal in the general ration for Rwandan refugees in the Goma camps due to the shortage of milling facilities. Where appropriate, donors could also provide milling costs for whole grain maize. Donors must continue to explore all options to ensure pulse and blended food provision in the general radon for the region as a whole. In some cases, this may require providing extra cash resources for local and regional purchase.
 

RNIS 10, April 1995

B. Burundi/Rwanda Region - Trend in numbers of refugees/displaced and proportion severely malnourished or at high nutritional risk (black area).

Surveys conducted in the region at the end of 1994 and early 1995 showed low levels of wasting in camps for refugees and internally displaced people. However, recent interruptions in food delivery at the camp level may determine that this situation is not sustainable. There had been repealed warnings since early January that the Burundi/Rwanda region food aid pipeline for the coming months was inadequate. This has resulted in shortages of food aid which have meant that emergency general rations for refugees and internally displaced people in Burundi, Zaire and Tanzania have frequently had to be cut throughout March and April. WFP made a public appeal from Rome on the 9th of February alerting donors to the shortfall in both food aid pledges and operational costs while urging them to react in lime to avert catastrophe. In March 1995, OXFAM and Save the Children UK issued a joint statement warning that the lack of available food aid would have dire consequences [OXFAM/SCF 16/03/95].

The results of a current round of surveys will determine whether ration reductions have had a pronounced effect upon nutritional status and mortality. The partial rations allocated in response to these shortages have led to greater insecurity in the camps, thereby jeopardising the lives of many of their relief workers and beneficiaries. It is hoped that the installation of large numbers of Zairean military personnel to oversee future food distributions in the Goma and Bukavu camps will reduce existing tensions among these populations.

The latest information is that some deficits are expected for Tanzania and Zaire in May. In addition to the pipeline shortfalls, the situation in Zaire is compounded by logistical problems on the ground, especially border closures. The pipeline in Burundi is reportedly adequate - warehouses are said to be full. Logistical problems do exist which include bottlenecks at Bujumbura port and difficulties in moving food from Tanzania to Burundi [WFP 28/04/95].

As a result of regional food shortages, the EU plans to establish a food buffer stock in Uganda of about 20,000 tons which could be used to act as a stop-gap for future shortfalls in the pipeline. There have been frequent difficulties with purchases on the Ugandan market due to a poor bean harvest in that country. Furthermore, a poor cereal harvest in Southern African and low availability of pulses regionally have limited options for regional purchases of cereal and beans [FAO 28/03/95, WFP 07/04/95].

Apart from problems of food supply, it is the volatile security situation in Burundi which commands most attention. There have been reports of insecurity in numerous provinces with resulting displacement of refugees and Burundi nationals into neighbouring Tanzania and Zaire. At the same time, the numbers of internally displaced people within Rwanda continue to decline with numerous camps closing as people return home. However, the recent harvest indicates that many returnees will require humanitarian assistance for several months to come.

Current population estimates for the region are summarised below:

	Apr 94	Jun 94	Aug 94	Oct 94	Dec 94	Feb 95	Apr 95
Burundi	536,000	1,000,000	1,230.000	770,000	1,200,000	740,000	492,500
Rwanda	250,000	2,060,000	2,040,000	2,500,000	2,500,000	335,000	1,750,000
Tanzania	60,000	410,000	353,000	556,000	556,000	630,000	686,000
Zaire	60,000	113,000	1,500,000	1,240,000	1,240,000	1,290,000	1,130,900
Uganda	-	10,000	10,000	10,000	10,000	5,000	5,000
TOTAL	906,000	3,593.000	5,133,000	5,076,000	5,076,000	3,000,000	4,064,400

Burundi Most recent estimates are that there are approximately 192,500 Rwandan refugees and 300,000 internally displaced people in Burundi in need of emergency general rations. Continued insecurity has been reported throughout March and early April. For example, in Muyinga province over 8,000 Rwandan refugees and 14,000 Burundi nationals fled to Tanzania as a result of escalating insecurity. Insecurity has also affected relief efforts in Kirundo province and led to withdrawal of some relief agencies. Outbreaks of violence and grenade threats have been a daily occurrence at Bujumbura markets. Violence escalated further following the assassination of three ex-patriates on March 19th with security incidents reported in Cibitoke and Ngozi and student strikes in Bubanza [WFP 02/04/95, WFP 07/04/95].

There has been both an influx and exodus from Burundi in recent weeks. Up to 400 Rwandan refugees have been arriving daily from South West Rwanda. Many of this population are in transit to Zaire. There has also been a total of 13,000 Burundi refugees returning. Fears for their security propelled 40,000 Rwandan refugees to leave Magara camp in northern Burundi en route to Ngara in Tanzania. Many of these refugees settled in Kabanga (40 km from the Tanzanian border) where relief agencies set up a temporary transit camp. Water and sanitation were said to be problematic at this site [WFP 10/03/95, WFP 25/03/95, WFP 02/04/95]. Most of this population have now moved back to Magara camp [WFP 21/04/95].

Current plans are to phase out general food distribution for the internally displaced by the end of May. Indeed a gradual phasing out of distributions has been taking place since March with beneficiaries receiving return packages of food. However, some of this programme has been disrupted by shortages of resources. Furthermore, delivery of general rations for internally displaced people has been constrained throughout March and early April by lack of food which is currently affecting the whole regional programme. By the end of March the distributed ration was anticipated to be as low as 1240 kcals/person/day. Actual deliveries at the end of March were even lower in areas such as Kayanza where quarter rations were allocated. Rations for Rwandan refugees have also been drastically cut in recent weeks [WFP 10/03/95, WFP 02/04/95, WFP 07/04/95].

A number of nutritional surveys carried out before the current regional food crisis showed an adequate nutritional status amongst the Rwandan refugee population in camps in Ngozi province.

In Rumuvu camp (estimated population 170,000) in December found 1.0% wasting with no severe wasting (see Annex 1 (4a)). This was a marked improvement compared to August 1994 when a survey found 8% wasting. The crude mortality rate in December was 0.3/10,000/day and the under-five mortality rate was 0.5/10,000/day, both of which are within usual ranges [AICF Dec 94]. In Rumuvu 2 camp which opened in November 1994 to accommodate newly arrived Rwandan refugees, a survey in January 1995 found 2.8% levels of wasting with 0.6% severe wasting (see Annex 1 (4b)) [AICF 28/01/95].

The nutritional situation in February in Kibezi camp, Ngozi province (estimated population 23,000) was similarly satisfactory. Wasting was measured at 1.6% and severe wasting was 0% (see Annex 1 (4c)). The crude mortality rate was 0.5/10,000/day and the under five mortality rate was 1.5/10,000/day [AICF Feb 95]. In Magara camp (estimated population 40,000), wasting was measured at 2.4% with 0.6% severe wasting (see Annex 1 (4d)). The crude mortality rate was 0.3/10,000/day and the under five mortality rate was 0.7/10,000/day. Both these rates are within normal limits [AICF 03/02/95].

These surveys showed a vast improvement over the situation seen in August when levels of wasting were generally around 10% in these camps. Recent short-falls in the general ration are very likely to have an adverse nutritional effect upon these populations. For example, a basket monitoring exercise at the end on April showed that on average 1300 kcals/person/day were received [AICF 27/04/95].

Rwanda Out of an estimated national population of 5.6 million people, between 250-280,000 are still believed to be internally displaced. Most of these are in Gikongoro prefecture. ‘Operation Retour’ is continuing to assist those wishing to return home by providing food packages. Over 700,000 internally displaced people have now returned home of whom approximately 100,000 are still believed to be in need of humanitarian assistance. Refugees have continued to return with over 5,000 new returnees from Uganda in March and over 10,000 from Zaire in January/February. However, numbers of returnees from Zaire have dropped from 200 per week to 200 per month. In total, it is expected that food aid will be necessary to support rehabilitation activities and that the total number of food aid beneficiaries including returnees and internally displaced for the first semester of 1995 would be 1.75 million [WFP 24/02/95, WFP 03/03/95, WFP 10/03/95].

There had been several more security incidents reported throughout Rwanda involving either relief agency staff and beneficiaries or government troops and Interahamwe confrontation. The closing of Kibeho camp (estimated population before camp closure of 200,000 people) resulted in a reported 2,000 deaths [IHT 24/04/95]. There are approximately 30,000 people remaining in the camp. It is now reported that sanitation facilities are non-existent in the camps, and water is being brought in by trucks [UNICEF 21/04/95]. There had also been reports of increased tensions in certain areas such as Gesenyi and Kibuye which have had some impact on relief efforts [WFP 03/03/95, WFP 02/04/95]. As the facts regarding the circumstances of the Kibeho camp clearance by government forces and the resulting deaths are still emerging, it is unclear how overall security in Rwanda and neighbouring countries will be affected.

In spite of the insecurities, food aid deliveries have generally continued smoothly with almost the entire March food requirements delivered to sub-offices warehouse, except in Kibuye where only 70 percent was delivered due to bad road conditions and problems with local transporters. Further closure of camps for internally displaced people are anticipated in the coming weeks [WFP 07/04/95].

A recent FAO/WFP crop and food supply assessment mission indicated that the expected harvest this season compared to average pre-war harvest would be approximately 50% for cereals, beans and roots and tubers. The prefectures with the worst deficits include Gikongoro, Butare, Cyangugu and Kigali. The mission also indicated that the increased demand for food aid at the communal level rather than in camps was straining the logistic capacity of agencies who required increased transport facilities. It was also noted that co-operation between agencies and NGOs needed improving in order to ensure timely and comparable reports on food distribution [FAO 24/03/95, WFP 17/03/95].

Tanzania Current estimates are that there are 686,000 Rwandan and Burundi refugees in Tanzania. During February approximately 30,000 refugees from both Rwanda and Burundi arrived in Tanzania with the influx continuing throughout March until closure of the border on the 2nd of April. The majority of refugees new arrivals are from Burundi [WFP 03/03/95, WFP 10/03/95, WFP 17/03/95, WFP 25/03/95, WFP 07/04/95].

Security has generally been stable in the camps although there have been tensions both amongst refugees and between refugees and the local population. Furthermore, there has been considerable concern that the shortage induced reduction in general rations may place beneficiaries and aid agency staff at risk. However, meetings with refugee leaders to forewarn of ration reductions seems to have pre-empted any general ration related security incidents [WFP 17/03/95, WFP 07/04/95].

With the regional food shortages, general rations have been reduced during March and early April with half rations being allocated in Ngara and Karagwe camps on a number of occasions. The reduction was carried out in order to stretch current stocks until the food pipeline could be fully restored [WFP 03/03/95, WFP 17/03/95, WFP 25/03/95, WFP 07/04/95]. Most recent reports are that the food supply situation is improving with current pledges received ensuring that near full rations of most commodities can now be guaranteed until the end of May/June depending on the commodity. A food basket monitoring exercise at the end of April in Benaco camp, however, showed that on average 1200 kcals/person/day were received and that neither beans nor oil were included in the ration [AICF 27/04/95].

The cholera outbreak in Ngara camps highlighted in the previous RNIS report appears to be under control. Crude mortality rates in Ngara and Karagwe camps were less than 1/10,000/day (approximately 3x normal) in January. However, water provision remains extremely poor with only five litres/caput available in the Ngara camps and even less in certain Karagwe camps where lack of rain has meant that surface water sources are drying up [UNHCR 27/02/95].

Goma, Zaire There are an estimated 720,000 refugees in Goma. The main developments over the previous two months have been reduced general ration distributions due to supply shortages and resulting security incidents. Rations began to be reduced at the end of February and are still providing less than 1,100 kcals/person/day. Relief agency staff responsible for general ration distribution in Kibumba and Mugunaga camps have been threatened because of these shortages and in some cases held hostage. To date, 620 Zairean troops have been deployed in the Goma camps which it is hoped will improve security. Another difficulty for the Goma programme has been due to land-mines on roads used to transport relief items. This has necessitated WFP re-routing convoys to avoid passage through Rwanda [WFP 03/03/95, WFP 17/03/95, WFP 07/04/95].

Initial results from one recent nutrition surveys carried out in Kahindo camp, indicates rising levels of wasting which may reflect the reduction in general ration provision. Wasting levels of 6.4% with 3.2% severe wasting (see Annex 1 (4e)) compare unfavourably with a survey carried out in January where wasting levels were found to be only 3.8% with 0.9% severe wasting [MSF-B/WFP 02/04/94].

However, another survey in Mugunga camp in March only found 1.8% wasting with 1.3% severe wasting (see Annex 1 (4f)). This compares very favourably with a survey in February where levels of overall wasting and severe wasting were 9.5% and 4.5% respectively. During February crude mortality rates were 0.9/10,000/day and under five rates were 1.97/10,000/day. Both rates are within usual limits [UNHCR 17/03/95].

A survey carried out in Katale camp in April showed similarly low levels of wasting of 2.2% with 0.1% severe wasting. No oedema was seen (see Annex 1 (4g)). Since the observed food basket over the last two months has provided less than 1000 kcals/person/day, it is hypothosised that other sources of food are available [MSF-H 18/04/95]. A survey in Kituku camp showed 1.3% wasting and 0.3% severe wasting (see Annex 1 (4h)) [MSF-H-a 18/04/95].

Bukavu, Zaire The security situation in Bukavu has also been tense with threats to agency staff, partly as a result of a census which was carried out at the end of February. This led to a 17% reduction in the population figure which is now estimated to be 305,000 [WFP 03/03/95, WFP 17/03/95]. In the second week of April Birawa camp was attacked by armed men resulting in 35 deaths and 56 injuries. There are fears that camps near the Rwandan border may face similar attacks. A 300 strong Zairean military contingent have now arrived and will soon be posted in the camps to maintain security [WFP 07/04/95, WFP 13/04/95].

In mid-March a ration providing almost 2,000 kcals/person/day was distributed to the camps for two weeks. This was the first time since October 1994 that a full ration had been allocated. The ration was again reduced by the end of March due to the unavailability of cereals and transit problems at the Rwandan border [WFP 07/04/95]. By mid-April low food stocks had obliged WFP to reduce rations to 1,000 kcals/person/day, a level which existing food stocks could support for a further three weeks [WFP 21/04/95].

Nevertheless, in spite of general ration short-falls, the crude mortality rate in Bukavu at the end of February was only 0.2/10,000/day and the under-five mortality rate was 0.6/10,000/day; both of these rates are within usual range) [WHO 28/02/95]. Furthermore, the apparently good nutritional situation in the camps led to the supplementary feeding ration being reduced from 180 gms of CSB to 20 gms/day.

Uvira/Kamanyola, Zaire Most recent estimates are that there are 105,900 refugees in the Uvira/Kamanyola area. This total includes a new influx of 3,000 Rwandans. It also includes approximately 27,000 people who fled Burundi at the end of March/early April comprising 13,000 Zaireans who were working in Bujumbura, 7-8,000 Burundi refugees who are currently in Uvira town and 7-8,000 Burundi refugees who are now in camps. The number of camps has been reduced from 23 to 11 [WFP 03/03/95, WFP 02/04/95, WHO 31/03/95]. In early April agencies began distributing food to female heads of households in order to ensure greater equity of distribution. This initiative was met with some resistance but was eventually implemented [WFP 21/04/95].

Uganda There are approximately 5,000 Rwandan refugees in Uganda whose nutritional status is described as adequate [UNHCR 13/04/95].

Overall, the refugee population in Uganda is not currently considered to be at heightened nutritional risk (category IIc in Table 1). The population in Tanzania is considered to be at moderate risk (category IIb in Table 1) due to some problems in the pipeline. The remaining refugee populations in Burundi, Rwanda and Zaire are considered to be at high nutritional risk due (category IIa in Table 1) either to insecurity and/or pipeline problems.

How could external agencies help? Every effort should be made to re-secure the food aid pipeline for this regional emergency programme and, if necessary, supply sufficient financial resources to ensure that necessary local and regional purchases of food can be made as required. It is also important that food basket monitoring is carefully implemented in all camps affected by the planned ration reductions to determine the extent to which inequity in food distributions further reduces rations for certain vulnerable groups. Also, during this period of ration reductions care should be taken to protect the food supply pipeline for selective feeding programmes which may need to enrol greater numbers of beneficiaries. Furthermore, agencies may need to devote even greater efforts to active case-finding of malnourished individuals for inclusion in selective feeding programmes.

More specifically, there is a need for donors to support the logistic and transport requirements of NGOs currently working in Rwanda who are increasingly having to work at commune, rather than camp level. An additional requirement is for better co-ordination amongst agencies in Rwanda so that procedures for monitoring food distributions in Rwanda become more standardised.
 

RNIS 9, February 1995

The number of people estimated to require emergency assistance as a result of the regional crisis has decreased since last December to approximately three million people. This is due to a number of factors including relatively good harvests in Burundi and Rwanda and the return of many internally displaced to their homes, as well as re-registration exercises undertaken in the refugee camps in Tanzania and Zaire. Population estimates over time are summarised below.

Trend in numbers of refugees/displaced and proportion severely malnourished or at high nutritional risk (black area).

	Feb 94	April 94	June 94	Aug 94	Oct 94	Oct 94	Feb 95
Burundi	282,000	536,000	1,000,000	1,230,000	770,000	1,200,000	740,000
Rwanda	272,300	250,000	2,060,000	2,040,000	2,500,000	1,860,000	335,000
Tanzania	300,000	60,000	410,000	353,000	556,000	607,000	630,000
Zaire	60,000	60,000	113,000	1,500,000	1,240,000	1,506,000	1,290,000
Uganda	-	-	10,000	10,000	10,000	4,000	5,000
TOTAL	914,300	906,000	3,593,000	5,133,000	5,076,000	5,177,000	3,000,000

There has been a notable increase in the frequency and severity of security incidents in the region. Banditry, armed robbery and threatened hostage taking have been reported in Burundi and in the camps in Zaire, while the security situation in the Tanzanian camps has been described as tense. In contrast, conditions appear calmer in Rwanda where resettlement of the displaced population and subsequent closure of camps is proceeding.

Available nutritional survey data from the refugee camps in Tanzania and Zaire and the camps for the internally displaced in Rwanda show very low levels of wasting. However, since early January 1995, WFP has been warning of a serious food availability crisis which will hit the entire sub-region in March 1995 unless action is urgently taken by the donor community. In recent weeks, WFP have been forced to take emergency measures in order to continue to supply food, using loans, cash resources and scarce International Emergency Food Reserves. However, these actions will only meet the most immediate needs for the next eight weeks and will have a major effect on WFP’s capacity to respond to emergency needs elsewhere in the world this year. In view of this critical situation, donors are being urged to make provision of cash resources, for procurement of commodities on regional and international markets, an immediate priority. Cash contributions for non-food requirements, such as agency operating costs, are also urgently needed.

Burundi Current estimates are that there are 740,000 people in Burundi needing food assistance. This number includes 521,000 internally displaced Burundis and 219,000 Rwandan refugees. The January 1995 harvest (there are three main harvest seasons in Burundi) was predicted to be far better than the equivalent harvest last year but still some 10% lower than the 1993 harvest Nevertheless the overall food supply situation remains extremely restricted with wide provincial variations. The most precarious food security is to be found in the Northern provinces of Kayanza, Ngozi, Muyinga and Kirundo, and Karusi province in the centre of the country. These provinces, where most of the internally displaced population and all of the Rwandan refugees are located, are still affected by frequent ethnic clashes. The food situation in these provinces is extremely precarious because of limited food supplies, looting and theft of crops and the virtual non-existence of farm stocks [FAO 16/12/94, WFP 08/01/95].

Violent incidents including threatened hostage taking and looting of warehouses have repeatedly been reported throughout December and January in the Northern provinces of Kirundo, Ngozi, Muyinga and in Karusi province in Central Burundi. There have also been violent outbreaks in rural Bujumbura in early January. In several cases this has led to temporary suspension of food aid assistance and evacuation of international agency staff. Furthermore, private companies have reportedly been reluctant to move food for the humanitarian operations in the North due to frequent incidents of banditry and looting. By the end of January, security had deteriorated to the point where WFP had requested army escorts to deliver food in the northern province of Muyinga [WFP 08/01/95, WFP 27/01/95, WFP 03/02/95].

There is currently very little movement of Rwandan refugees in and out of the country, although 6,000 refugees were transferred from Cibitoke to Muyinga in January. In Bubanza and Cibitoke, return packages are being given to internally displaced people with plans to extend this programme into the province of Rutana. Currently, the general ration for the internally displaced does not include oil due to limited supply in country. Furthermore, low stocks of beans due to low quantities in the pipeline and border problems may hinder the return package operation planned in February for up to 122,000 beneficiaries.

Although no quantitative survey data are currently available, reports indicate an acceptable nutritional situation among the displaced in Cibitoke and Ruyigi, although the health status among the displaced in Ngozi is said to be poor with little NGO presence in me area [WFP 20/1/95, WFP 27/01/95, WFP 03/01/95].

Surveys among the Rwandan refugees also indicate low levels of malnutrition. As a result some NGOs have terminated refugee therapeutic feeding programmes [WFP 10/02/95]. Earlier reports on the internally displaced in Ngozi and Kayanza province in October and November 1994 indicate very low general ration receipts, high levels of default at selective feeding centres due to insecurity, and high levels of re-admission (almost 20%) due to the inadequate general ration [MSF-B Oct 94, MSF-B Nov 94].

Rwanda The overall security situation in the northern part of the country appears to be calm, but the situation in the south has been far less stable with a number of incidents involving ex-government forces crossing over the border. There have also been security incidents involving returnees at waystations dissatisfied with their allocated ration. There are reports that some internally displaced in Gikongoro are unwilling to return home due to the perceived threat of insecurity in their home area. Nevertheless, relocation of the internally displaced from camps in Rwanda (Operation Retour) is continuing and it is hoped that all the internally displaced people in camps will be relocated and camps closed by the end of February 1995. Over 37,000 displaced people had been returned to their communes of origin by mid-February 1995. The numbers of Rwandan refugees repatriating from Goma, Zaire is reportedly increasing, with as many as 1,000 returnees a day entering Rwanda since 10 February. However, repatriation of refugees from Tanzania continues at a slow pace [DHA 20/02/95, WFP 13/01/95, WFP 20/01/95, WFP 27/01/95, WFP 03/02/95].

Many of Rwanda’s internally displaced are in the prefecture of Gikongoro. In December 1994 a nutritional survey in the displaced camp of Ndago (estimated population 45,000) found 11.3 % wasting with 1.9% severe wasting (see Annex 1 (15a)). These levels of wasting are high for Rwanda and may partly reflect the fact that almost 10% of the camp population claimed not to be receiving a general ration in spite of efforts to improve the food distribution system. Measles immunisation coverage was 94% [AICF 06/12/94]. These figures compare less favourably with a nutritional survey of children under five years of age conducted in Kaduha commune, Gikongoro, in November 1994, which found only 4.7% levels of wasting with 0.5% severe wasting. Measles immunisation coverage was estimated to be between 85%-95% (see Annex 1 (15b)) [MSF-F 03/11/94].

Due to limited areas planted and a lack of agricultural inputs, a recent FAO crop assessment mission predicted that the aggregate production of food crops for the first 1995 agricultural season would only be about one half of the equivalent season in 1990 (the most recent normal year). The mission concluded that large quantities of relief food would therefore be required in 1995 for Rwandas estimated 5.6 million population.

Tanzania The total refugee population in Tanzania at the end of January was 632,500. Refugees continue to arrive at a rate of 2,000-3,500 per week. These new arrivals are mainly from Burundi although some are still coming from Rwanda [WFP 27/01/95].

A cholera outbreak was reported in Ngara in December and by mid-January the number of cases was still increasing. Although this is a controlled outbreak, deaths are occurring. These are said to be occurring mainly at night when expatriate staff cannot be present due to poor security [MSF-H 12/01/95]. Water availability in the camps has continually been poor and is still only six litres/person/day after eight months of this refugee programme. Benako lake is currently dry [WFP 20/01/95]. Crude mortality rates in the Ngara camps at the end of December were between 0.33-0.89/10,000/day (normal to 3x normal) and the under-five mortality rate was between 0.43-1.03/10,000/day. The mortality rates do not appear to be increasing due to the cholera outbreak [MSF-H 17/01/95].

Food basket monitoring was carried out in December in Musuhura camp (estimated population at the time 55,000). The average ration distributed was 1,755 kcals/person/day. The minimum ration was 1,430 kcals/person/day and the maximum was 2,100 kcals/person/day [MSF-H 19/01/95]. By the end of January, it was reported that food distribution was going well and there was a distribution of a full food basket [WFP 27/01/95].

At the end of January 1995, security incidents were reported involving threats made against international agency staff as warnings against any attempt to arrest and prosecute alleged war criminals. All camps in Ngara and Karagwe districts were placed on alert following these incidents.

There is continued concern about the environmental impact of the fuel wood consumption needs of the camps. An estimated 1,200 mt of fuel wood are being consumed daily and relations between refugees and local residents in Kagenyi I and II camps are reported to be worsening with threats to interrupt food supplies and chase refugees collecting firewood [WFP 27/01/95, WFP 03/02/95].

Goma, Zaire The first phase of a registration exercise has now ended having identified 726,000 refugees. Voluntary repatriation is continuing slowly with a total of 239,000 refugees being repatriated since August 1994. There were serious disruptions to refugee food supplies in the Goma camps in late December and early January due mainly to closure of the border with Rwanda as well as over-lengthy customs clearance procedures. Closure of the border, which prevented all cross-border food deliveries, was due to the holidays as well as introduction of a new currency in Rwanda. Camps stocks were therefore totally depleted and rations had to be cut. By the end of January, the border was again open although custom formalities were still causing delays in food deliveries [WFP 08/01/95, WFP 13/01/95, WFP 20/01/95. WFP 27/01/95].

Nutritional surveys in December generally show a vastly improved situation in the camps. In Kahindo camp wasting was measured at 3.8% with 0.9% severe wasting (see Annex 1 (15c)). The camp supplementary feeding programme was terminated as a result of these low levels of wasting [MSF-B 19/01/95]. A survey in Kibumba camp (estimated population 180,000) at the end of December showed 2.2% wasting with 0.9% severe wasting (see Annex 1 (15d)). These results demonstrate a downward trend in rates of wasting - in August 1994 wasting rates were measured at 20.2% and in October only 6.4%. In the most recent survey, measles immunisation coverage was 90%. These latter results are particularly re-assuring given the fact that general ration receipts in Kibumba were on average little more than 1,500 kcals/caput/day during the month of December [MSF-B 31/12/94]. However, security problems are reportedly frequent, and Zairean troops are now deployed in the camp [WFP 17/01/95].

A survey conducted in Katale camp (estimated population 150-200,000) in December recorded 7.8% wasting with 5.3% severe wasting (see Annex 1 (15e)) and only 65% measles immunisation coverage. Crude mortality rates were measured at between 0,32-0.43/10,000/day, depending on assumed population size. Although these figures represent a somewhat worse situation than those found in Kahindo and Kibumba camps, they do reflect improvement since the previous survey in October 1994 when rates of wasting were measured at 10.4% with 5.8% severe wasting [MSF-H 07/02/95].

In contrast to these camps, a survey in Kituku camp (estimated population 20,000) in December recorded 27.6% wasting with 20.6% severe wasting. Many malnourished adults were also reportedly being seen at feeding centres. The stark difference with the situation in the other camps prompted questions about the validity of the findings so that a repeat survey was under-taken in mid- January 1995. This subsequent survey only found 12.4% levels of wasting with 7.8% severe wasting (see Annex 1 (15f)). The improved results were believed to reflect better diagnosis of oedema by the survey team and a real improvement in the camp’s health and nutritional status due to the opening of a feeding centre and the onset of the dry season [MSF-H 07/02/95].

Bukavu, Zaire Current estimates are that there are 348,000 refugees in Bukavu. A census is being planned and it is expected that the new figure will be about 20% less than current estimates. A recent pre-census registration at the sites of Kashusha and Birava reduced the number of beneficiaries by 15% and 18% respectively [WFP 08/01/95, WFP 10/02/95]

By the end of December, the security situation in Bukavu had deteriorated to the point where relief activities were suspended each evening at 1800 hours. Incidents of looting and robbery were being reported virtually every week with a number of NGOs forced to evacuate staff for their own safety. A contingent of 1,500 Zairean soldiers is expected to be placed in the camps to restore security [WFP 13/01/95, WFP 20/01/95, WFP 27/01/95, WFP 03/02/95].

As in Goma, the border was closed following introduction of the new currency in Rwanda, stopping relief supplies in early January. When the border re-opened, transportation delays were experienced leading to the partial depletion of stocks in Bukavu. As a result, rations had to be cut to 950 kcals/person/day, which is less than half the theoretical ration. Loans for commodities in short supply were obtained in early February [Oxfam 07/02/95, WFP 27/01/95, WFP 03/02/95].

Surveys conducted at the end of December and the beginning of January showed levels of wasting ranging from 0.4% to 4.3% and severe wasting from 0 to 0.7% (see Annex 1 (15g)) [UNHCR 05/01/95]. These very low levels of wasting are believed to reflect the fact that many of the refugees have been receiving double rations as lack of a proper census has led to an over-supply of food to the camps. Also, many refugees reached this pan of Zaire with some resources of their own. However, nutritional status can be expected to deteriorate if the food supply situation doesn’t improve soon.

Uvira and Kamanyola, Zaire A recent assessment in early January resulted in a reduction in the estimated number of beneficiaries in the Uvira area from 370,000 to 216,000. Due the influx of 7,000 Rwandans from South West Rwanda at the end of the month, the total figure is now 224,000 refugees. Contention over the census has led to road blocks with some NGO personnel being temporarily taken hostage. A restructuring of the zones in the Uvira region is taking place to reduce the number of camps from 27 to 11 [WFP 08/01/95, WFP 27/01/95, WFP 03/02/95].

Uganda There are approximately 5,000 Rwandan refugees in Uganda, although there are recent reports of two way movement between Tanzania and Uganda making precise estimates of numbers uncertain [UNHCR 31/01/95, WFP 13/01/95].

Overall, the population affected in the region can be considered to be at moderate risk (category IIb in Table 1) with the exception of the population in Uganda who are not currently reported to be at heightened nutritional risk (category IIc in Table 1). It should be noted that this situation is currently faced with serious problems (i.e. increasing insecurity, gaps in the food pipeline) that could lead to a rapid change in the nutritional status of this population.

How could external agencies help? The most urgent priority is for donors to provide cash for local and regional purchases of foods for the region. Without this it can be expected that the substantial gains recently made in the nutritional condition of refugees and the internally displaced will be rapidly reversed. In Tanzania, water supplies to the camps have been very poor since the inception of the programme in June 1994. This needs to be urgently remedied especially as poor water supplies may have had some role in the recent cholera outbreak in Benaco. Requirements for fuel must also be addressed by relief agencies working with refugees in Tanzania as the impact of refugee fuel use is creating extreme demands on the host population. In Rwanda, where “Operation Retour” is proceeding rapidly, the need to ensure an adequate general ration for all those eligible in camps for the internally displaced must not be over-looked. Current reports indicate that up to 10% of camp populations may not receive a general ration.
 

RNIS 8, December 1994

Although levels of malnutrition and mortality are improving amongst those populations affected by the Rwanda/Burundi crisis, increasing insecurity, particularly in Burundi, Rwanda and Zaire, is seriously hampering relief efforts. Outbreaks of fighting in Burundi have led to large displacements within the country and to Zaire and Tanzania. In Rwanda, vulnerable groups are being targeted for free food rations. Agencies are focussing resources on supporting efforts of the population to produce a harvest in January and February 1995, and overt ethnic discrimination in the Rwandan refugee camps in Zaire has resulted in a highly inequitable general ration distribution system..

Trend in numbers of refugees/displaced and proportion severely malnourished or at high nutritional risk (black area).

Refugees from Rwanda and Burundi continue to arrive in Tanzania, where several camps have had food distribution problems due to shortages of food and logistical difficulties. Many of these camps are still reportedly overcrowded.

The overall number of refugees/internally displaced and returnees affected by the crisis in the region is 5.2 million, as summarized below:

	Dec 93	Feb 94	April 94	June 94	Aug 94	Oct 94	Dec 94
Burundi	150,000	282,000	536,000	1,000,000	1,230,000	770,000	1,200,000
Rwanda	375,000	272,300	250,000	2,060,000	2,040,000	2,500,000	1,860,000
Tanzania	325,000	300,000	60,000	410,000	353,000	556,000	607,000
Zaire	58,600	60,000	60,000	113,000	1,500,000	1,240,000	1,506,000
Uganda	-	-	-	10,000	10,000	10,000	4,000
TOTAL	908,600	914,300	906,000	3,593,000	5,133,000	5,076,000	5,177,000

Burundi A volatile security situation in Burundi has led to further displacements within and from the country. In October and November violent clashes were reported in the provinces of Ngozi, Bururi, Karuzi and Cibitoke. In Cibitoke an estimated 30,700 people have recently fled to Zaire. There are also reports of Burundi refugees in Zaire spontaneously repatriating. The level of insecurity is increasingly affecting humanitarian operations with food deliveries and agency staff movements affected [WFP 28/10/94].

There is also considerable internal movement of Rwandan refugees within Burundi as well as into and out of the country. Some of the movement is due to threats to security. For example, at the end of October over 50 Hutu refugees were killed in Gittwa transit camp [WFP 14/11/94].

From mid-September to the end of October an estimated 36,000 Rwandan refugees arrived in Cibitoke province. Due in part to the level of insecurity none of these refugees are installed in UNHCR camps. An estimated 200 Rwandan refugees arrive daily at each camp in Ngozi, allegedly for safety reasons. Refugees are also leaving Burundi with 2,500 departing from camps in Bujumbura to return to Rwanda and others leaving for Tanzania [WFP 27/11/94].

This high level of population movement makes it very difficult to be precise about numbers of refugees and internally displaced in Burundi. Best estimates are that there are currently 200,000 Rwandan refugees and 1 million internally displaced Burundis [WFP 11/11/94, WFP 21/11/94].

Limited off-loading capacity at Bujumbura port is still a constraint for the relief programme in Burundi although trucking resources have increased considerably with the arrival of vehicles from Eritrea and Zimbabwe. However, fuel shortages and muddy roads are complicating secondary deliveries [WFP 27/11/94].

Although violent incidents regularly occur, the gradual strengthening of government structures is now said to be helping relief agencies develop more coherent relief and rehabilitation strategies with plans to move away from general distributions towards specific rehabilitation schemes [WFP 28/10/94].

Rwanda The main types of relief activity currently taking place in Rwanda are feeding of internally displaced persons, returnees and unaccompanied children, food rations to civil servants and teachers, supplementary and vulnerable group feeding. Food distributions in conjunction with distribution of seeds was carried out during the planting season in September-October 1994 [WFP 28/10/94, WFP 11/11/94, WFP 16/12/94],

A food programme was initiated in October which is targeted to vulnerable groups which include the physically handicapped, the elderly, single parent families with more than three children under seven hosting unaccompanied children, and selected, destitute foster families. Food can also be obtained at reception centres for returnees, e.g. in Kigali and at waystations where returnees can get food while in transit [WFP 28/10/94, WFP 16/12/94, WFP 27/11/94].

Violence continues at a low level in Rwanda. Security incidents occurred in October around Kigali and UNAMIR reported fresh mines being laid in and around Kigali. An estimated 2-3 children are injured each day in Rwanda by mines. At the end of October violence erupted in the camps near Butare with a reported 8-10 people killed. Local officials are exerting pressure to have the displaced population moved. Outbreaks of violence also occurred at the end of November in the camps north of Gikongoro (estimated population 160,000) [WFP 10/28/94, WFP 11/11/94].

A recent nutritional survey conducted in Kibeho camp for the displaced in Gikongoro prefecture (estimated population 100,000) showed 17.5% wasting with 4.6% severe wasting (see Annex 1 (15a)). The crude mortality rate was 4.7/10,000/day (11 x normal) and the under-five mortality rate was 6.7/10,000/day. It is felt that dysentery is contributing to these high levels of wasting and elevated CMRs [AICF 27/09/94]. A survey carried out in Kirado, Gikongoro Prefecture (estimated population 3,500) showed 9.4% wasting with 1.5% severe wasting (see Annex 1 15(b)). Water availability is 7 litres/person/day [AICF 15/10/94]. In Cyanika camp, Gikongoro Prefecture, wasting was measured at 6.8% with 0.7% severe wasting (see Annex 1 (15c)). This represents an improvement over a survey conducted in August when wasting was 26.3% and severe wasting was 11.5% (measured using MUAC) [AICF 20/10/94].

In the prefecture of Ruhengeri (estimated population 760,000) a small scale survey found a relatively good situation, with wasting rates of 2.4% in early November and 0.8% severe wasting (see Annex 1 (15d)). Measles immunization coverage was 85% and estimates of the daily per capita ration receipts were 1500 kcals. Most of the population in this prefecture are now back on their farms [AICF 14/10/94].

In the transit camp of Gisenyi, a survey using MUAC measured 9.1% wasting with 2.6% severe wasting (see Annex 1 (15e)) [AICF 23/10/94].

The beans and maize that will be harvested in the coming months should have a positive effect on the food security situation for those in Rwanda.

Tanzania The total number of refugees in Tanzania is just over 607,000 and the security situation in camps is described as fragile due to both shortages in food and heightened political tension [WFP 21/10/94]. There have been 6,500 new arrivals from Burundi to the Ngara region [WFP 11/11/94] and a continuing influx of Rwandan refugees into Kyabilisa (Karagwe district) with over 2,500 people registered in the first week of November [UNHCR 07/11/94].

During the last two months there have been food distribution problems in most of the camps. Shortage of maize meal meant that half rations were distributed throughout much of October. Camps in Karagwe district received neither CSB nor oil for six weeks. Earlier data from September indicated that rations were at times low in Ngara (1775 kcals) and Karagwe (1575 kcals) districts. There were also reports in November that all therapeutic and supplementary feeding programmes in camps were experiencing shortages in food stocks especially sugar and CSB [UNHCR 07/11/94].

The food distribution problems have been due both to shortage of various commodities and to logistical problems. There is an urgent need to procure maize for the Tanzanian refugee camps from December/January onwards.

The steady influx of refugees into Tanzania is compounding problems of camp congestion, thereby affecting camp management, aggravating the security situation and leading to shortages of water and firewood. There are continuing reports of military training in the camps by ex-Rwandan military. Decongestion measures, including demarcation of plots and latrine construction, were undertaken in Benaco camp (population 253,000). There are also plans to re-locate 70,000 refugees from the camp [UNHCR 07/11/94]. Dysentery is still reported as a major cause of death among children under five years of age [WFP 9/12/94].

Crude mortality rates recorded for the first week of November in the five camps in Karagwe district ranged from 0.6/10,000/day (2 x normal) to 2.2/10,000/day (7 x normal) while the under five mortality rates ranged from 0.0/10,000/day to 3.4/10,000/day [UNHCR 07/11/94].

Goma, Zaire There are approximately 740,000 Rwandan refugees in the four camps in the Goma area of Zaire. There are also an estimated 30-50,000 refugees scattered in areas northeast of Katale who are not in camps [UNHCR 20/11/94].

Between mid-September and mid-November approximately 171,000 refugees spontaneously repatriated from the area while a further 9,000 arrived in the camps [UNHCR 20/11/94], At the end of October a tripartite agreement was signed between the governments of Rwanda and Zaire, and UNHCR, on the repatriation of Rwandan refugees from Zaire. Most recent estimates are that about 1,500 refugees cross the border back to Rwanda daily but that only 25% are from the recently displaced population. The remainder are mostly from the population which fled to Zaire in 1959 [WFP 9/12/94].

Continued security incidents have threatened both the refugees and international personnel so that some NGOs have ceased operating in the camps. Many suspected RPA infiltrators have been killed and agency staff have frequently been harassed particularly with regard to general food distributions.

General ration distributions have continued to be very problematic. Those responsible for general ration distributions in the camps have excluded many households on the basis of ethnic origin. Much food has also been diverted to militia within the camps. Agencies have discussed increasing the number of distribution points and their monitoring capacity to prevent these practices, but due to insecurity and lack of staff they have limited capacity to make an impact There has also been some recent discussion about introducing increased distribution of cooked food (" wet feeding") as a way around inequitable distribution of the general ration [UNHCR 20/11/94].

The general ration programme has also been adversely affected by food shortages. A shortage of beans in the region has meant that bean ration allocations have either been reduced or completely absent. Based upon imprecise population figures and a highly inequitable distribution system, estimates of per capita calories supplied by the general ration were 1,890 kcals in late October and between 1,480 and 1,660 kcals in the second week of November. During the third week of November per capita rations stood somewhere between 1,600-1,700 kcals [UNHCR 20/11/94].

Average crude mortality rates for the four camps at the end of November were 0.98/10,000/day (3 x normal) with an under five rate of 2.36/10,000/day. The highest CMR was 1.42/10,000/day in Mugunga camp. Although these rates are still elevated, they show a dramatic improvement over rates of over 40/10,000/day recorded as recently as August 1994 [UNHCR 20/11/94].

Nutritional surveys also show some improvement in these camps. In October levels of wasting in Mugungua camp were 16.4% with 8.2% severe wasting (see Annex 1 (15f), similar to a survey in My. In Katale camp rates of wasting in October were measured at 10.4% with 6.6% severe wasting (Annex 1(15g)) This may be somewhat low as selective feeding programme centres remained open during the survey thereby excluding a number of malnourished children. However, results still compare favourably with July when wasting rates were 23.6%. Wasting rates in Kahindo camp were found to be 17.5% in October (see Annex 1 (15h)), compared with 20.2% found in July. In Kibumba camp, an October survey found only 6.3% wasting (see Annex 1(15i)) which indicates a much unproved situation compared to July, when 20.2% wasting rates were found amongst children. In response to the high levels of wasting found in Kahindo camp, a food basket survey was implemented in November. The survey found that 72% of households received a ration of less than 2,000 kcals, compared with a survey at the end of October in Katale camp where only 23% of households received a radon of under 2,000 kcals [MSF Belgium 4/11/94, MSF Holland 31/10/94, UNHCR 01/11/94].

Bukavu, Zaire It is currently estimated that there are 390,000 refugees in Bukavu [WFP 2S/11/94]. The vast majority of this population reside in 26 settlements with the remainder in villages. Although there have been some violent incidents in the settlements, the security situation is generally calm. Population movements to and from the settlements are continuing and at the start of October it was estimated that 200 Rwandan refugees were arriving each day while at the end of the month 100 people were reported to be repatriating each day.

Heavy rains in October impeded food deliveries to settlements and it is anticipated that road conditions will deteriorate further during the month of December. However there have still been regular food deliveries to refugees with an average daily radon allocation of just under 1,800 kcals. Due to inequitable general radon distributions, a new distribution system was introduced in Kashusha settlement (population 42,560] whereby food was delivered directly to family heads rather than to heads of settlement sectors.

A nutrition survey at the end of October in Kalehe settlement (population 8,000) found only 4.3% wasting and 0.8% severe wasting (see Annex 1(15j)). Meningitis cases have been reported in a number of settlements [UNHCR 25/10/94].

Uvira and Kamanyola, Zaire The total number of registered beneficiaries in Uvira and Kamanyola is 376,152 although UNHCR and WFP have agreed to cut the numbers being assisted to 270,000 as figures are recognized to be inflated. This figure includes 15,000 new arrivals from Burundi. UNHCR is making some progress in transferring refugees from urban areas to camps located mainly in the northern comer of the region. UNHCR also wish to move the three Rwandan camps away from the borders of Burundi and Rwanda as these camps contain a large number of Rwandan militia and therefore pose a considerable security threat.

Food distributions between 8th and 19th of October could not take place due to a shortage of maize. Furthermore, it has been reported that the recent arrival of new refugees from Burundi has "compromised" the existing food distribution system. Lack of food is also said to have reduced the ability of local church groups to carry out selective feeding programmes of malnourished individuals [UNHCR 25/10/94].

Uganda The number of Rwandan refugees in Uganda has decreased to approximately 4,000. Some of the reduction is due to refugees returning home when, for security reasons, their camps were moved further from the Rwandan border. A number of refugees have also moved to Tanzania in an effort to re-unite their families [UNHCR 21/11/94].

Overall, the refugee and displaced populations in Burundi can be considered to be at risk (category IIa in Table 1) due to insecurity. The populations of Kibeho and Kirado camps in Gikongoro Prefecture are at high risk (category I in Table 1) with very high mortality rates. The population of Cyanka camp in Gikongoro Prefecture can be considered to be at moderate risk, as can the groups dependant on food for work plans (category IIb in Table 1). Those newly returned home in Ruhengeri Prefecture are not currently at heightened risk (category IIc in Table 1). The refugees in Tanzania can be considered to be at high risk (category IIa in Table 1) with many, although not all, camps reporting high mortality rates. The population in Goma is considered to remain at high risk (category I in Table 1), although the tendency is one of improvement. The refugees in Bukavu are considered to be at high risk (category IIa in Table 1) with the exception of the populations in Kalehe and Kashusha camps who are considered to be at moderate risk (category IIb in Table 1). The refugee population of Uvira and Kamanyola can be considered to be at high risk (category IIa in Table 1).

How could external agencies help? Insecurity in the region is a major cause for concern. It is widely considered that violence could erupt and spread in Burundi and that all possible diplomatic avenues have to be explored to avoid this possibility. It may be prudent to gear up for a major exodus from Burundi. In Rwanda, it is also widely feared that violence could erupt again. Disarming the militias in the camps may help avoid that situation.

Specifically, donors could provide more support for the costs of fuel in Burundi and support all efforts to secure more maize and beans for the December and January general ration in Tanzania, as well as foods for supplementary and therapeutic feeding programmes in the camps. This may require cash for local purchases. In spite of the difficulties, all implementing agencies need support for their efforts to improve the general ration distribution system in the Rwandan refugee camps in Zaire. International agencies could also consider unproved support for local church groups in Uvira and Kamanyola in Zaire, operating feeding programmes for those refugees not in camps.
 

RNIS 7, October 1994

The overall situation in the region remains unstable. Security incidents have been reported from all four countries giving rise to further displacements and interruptions to relief efforts. There are reports of retaliation against “would be” returnees from Goma and Bukavu in Zaire, and against inter-ethnically married couples in Tanzanian camps, while in Burundi growing violence in the North has led to further displacements and interrupted relief efforts. Dysentery is currently a major cause of mortality in all four countries affected by the Rwanda/Burundi crisis and is exacting a particularly heavy toll on human life in over-crowded camps. Rwandan refugees have continued to arrive in Tanzania and Zaire throughout August and September.

F. Burundi/Rwanda Region

Trend in numbers of refugees/displaced and proportion severely malnourished or at high nutritional risk (black area).

Estimates of the displaced/refugee/returnee populations over time are:

	Dec 93	Feb 94	April 94	June 94	Aug 94	Oct 94
Burundi	150,000	282,000	536,000	1,000,000	1,230,000	770,000
Rwanda	375,000	272,300	250,000	2,060,000	2,040,000	2,500,000
Tanzania	325,000	300,000	60,000	410,000	353,000	556,000
Zaire	58,600	60,000	60,000	113,000	1,500,000	1,240,000
Uganda	-	-	-	10,000	10,000	10,000
TOTAL	908,600	914,300	906,000	3,593,000	5,133,000	5,076,000

Rwanda Estimates place the population inside Rwanda at approximately 5 million of which roughly 4 million are located on farm holdings and 620,000 to 1 million are displaced. The majority of the displaced are in Gikongoro, Cyangugu, and Kibuye. Preliminary findings of the recent WFP/FAO Food and Crop Assessment mission estimate 2.5 million Rwandans in need of food aid assistance over the next five months and that much of the summers harvest has been lost either due to being left in the ground or from looting. There are also increasing reports of insecurity and banditry leading to a need for increased protection of relief agency staff [FAO 17/08/94, WFP 9/09/94].

It is estimated that 100,000 people have spontaneously returned to Rwanda with a constant flow reported to the North and Northeast WFP have recently started to distribute one week rations to an initial 48,000 returnees and displaced people in Butare prefecture over and above the 160,000 people being assisted in four refugee camps in northern Gikongoro. There is also a continuing assessment of 15 communes in Butare where a total of approximately 150,000 are reported to be in need of emergency food, seeds and tools [WFP 16/09/94].

The overall relief food supply situation in the country is said to be stable with beneficiary numbers in Rwanda now reaching 571,886 people. There are no recent nutritional survey reports from Rwanda [WFP 16/09/94].

Burundi The estimated population in Burundi requiring assistance is 557,000 internally displaced people and 220,000 Rwandan refugees. Growing insecurity, logistical problems and appalling sanitary conditions in refugee camps are currently hindering efforts to stabilize the nutritional and health condition of the internally displaced and refugee population [WFP 2/09/94].

In August there was growing unrest in the Northern provinces which affected food distributions. However, following an improvement in food arrivals, WFP were able to supply a fifty percent ration to all the displaced for the first time in a month. In Ngozi province there were reports of improvements in the crude mortality rate from 0.8 to 0.5/10,000/day (from 2.5 × normal to 1.5 × normal) [WFP 9/09/94].

Nutrition surveys in the Rwandan refugee camps in early August found 8% and 10% wasting in Ruvumu and Magara camp respectively. Wasting rates of 12.7% with 3.1% severe wasting in Kibesi camp at the end of August were slightly more worrying (see Annex 1 (15a, 15b, 15c)) [AICF 5/09/94, AICF 9/08/94].

More recently there has been further displacement of an estimated 20,000 people due to fighting in Muramvya, Kayanza and Ngozi. Relief operations are also said to be hampered by absence of government authorities in place and minimal presence of other agencies and NGOs as well as lack of security. The situation in Gitega is said to be especially worrying with lack of basic medicines and non-food items. Ongoing fighting in the North and Central regions of the country has disrupted numerous relief convoys. Poor port performance and lack of trucks for transport are a further constraint for the Burundi operation [WFP 2/08/94].

By September there were reports of rising rates of dysentery throughout Northern Burundi and a suspected epidemic of meningitis. There were also reports of 10% severe wasting in Mugano camp for Rwandan refugees. Mortality rates for refugees in the North were clearly rising at the end of September and were on average 1.3/10,000/day with the highest rate reported in Majuri camp at 2.6/10,000/day (8 × normal). Dysentery is thought to be the major cause of mortality. NGOs are currently insisting that a campaign to drain areas around latrines in all camps is necessary before the rainy season leads to widespread contamination of the water supply [WFP 23/09/94].

Goma, Zaire Estimates of the refugee numbers in Goma remain equivocal, although a planning figure of 740,000 is being used. Some NGOs estimate the actual number of refugees to be lower [UNHCR 26/08/94, WFP 30/09/94]. Security incidents mainly in the form of banditry have been a serious problem in the town and camps and were responsible for disrupting food distributions at Kibumba camp in September. Most recent estimates are that some 800 Rwandan refugees per day are repatriating from Goma and that while cereals are available, beans are urgently required and vegetable oil supply may become a problem [WFP 16/09/94].

The cholera epidemic that ravaged the refugee population is now said to be under control. Estimates of the peak mortality rates caused by the epidemic vary (depending on the population estimate used in the calculation) from 54.5/10,000/day to 34.1/10,000/day. These rates are 100-180 times normal mortality rates and are the highest ever recorded in the early stages of a refugee crisis [CDC Aug 94, UNHCR 15/08/94]. Mortality rates are now considerably lower, with most deaths occurring from dysentery and pneumonia. Construction of sanitation facilities including latrines have improved the health and living conditions in all the camps in the Goma area.

The public health problems of refugees in the area have been exacerbated by a number of other factors. These include: inadequate registration of refugees and inequitable internal food distribution systems, delays in acquiring adequate quantities of vegetable oil and blended cereals for distribution in the general ration, delays in establishing effective therapeutic feeding programmes for severely malnourished children, serious delays in providing an adequate supply of soap for domestic hygiene in the camps hampering efforts to prevent the transmission of dysentery, and development of antibiotic resistance by organisms responsible for cholera and dysentery outbreaks necessitating the use of more expensive drugs [CDC Aug 94].

A nutrition survey was carried out in early August in Katale camp (estimated population at the time of 80,000). Prevalence of wasting was measured at 22.1% and severe wasting was 6.6%. The crude mortality rate was 41.3/10,000/day and the under-five mortality rate was 40.4/10,000/day. Most of these deaths were associated with diarrhoeal diseases (see Annex 1 (15d)) [MSF-H 4/08/94].

A survey in Kibumba camp found similar rates with 20.2% wasting and 3.0% severe wasting (see Annex 1 (15e)) [WFP 26/08/94].

Bukavu, Zaire There are 230,314 registered refugees in organized camps sites and a further 40-45,000 remaining in the town. Their nutritional status is said to be adequate with pockets of malnutrition amongst new camp arrivals from the town. The time taken to settle the refugees in camps and the demands of the existing refugee population in the town have contributed to strong tensions between refugees and the local population. Approximately 500 refugees are still crossing the border into Bukavu daily [WFP 23/09/94].

Uvira and Kamanyola, Zaire There are over 44,000 refugees in Kamanyola of which less than 1,000 have been installed in camps. There are a further 150,000 Rwandan refugees in Uvira with up to 300 arriving per week. The problem of lack of camps in Uvira and Kamanyola where less than 14% of WFP beneficiaries live in camps, has led to disorderly general ration distributions, often resulting in fights, threats and protests. Thus, although food is available no distribution has taken place in Kamanyola since the 15th of August [WFP 23/09/94].

Tanzania Refugees from Rwanda continued to arrive in Tanzania with the estimated population rising from 476,000 in August to 556,000 at the beginning of October. Camp conditions were reported to be deteriorating with mortality rates, mainly due to diarrhoeal diseases, as high as 10/10,000/day (33 × normal) [WFP 26/08/94, WFP 7/10/94].

In August at Benako camp, wasting was found in 10% of children under five years old (as compared to 7.1% in June) and severe wasting was measured in 2.8% (1.8% in June) (see Annex 1 (15f)). The apparent deterioration in nutritional status was attributed to the high incidence of diarrhoeal disease, exacerbated by over-crowded conditions and poor water supply, rather than a lack of food. Meningitis has also been reported in Benako camp [MSF-H 4/09/94].

By September, the refugee population had reached 538,000 with new influxes into Ngara, although approximately 400-500 refugees were returning to Rwanda per day. Security conditions in the camps were unstable with unconfirmed reports of killings of inter-ethnically married couples. Mortality rates seemed to be improving with a crude mortality rate of about 3/10,000/day (10 × normal) and an under-five mortality rate of about 8.5/10,000/day [MSF-H 4/09/94]. However, agencies are still very wary that conditions could deteriorate further due to lack of water availability, increased numbers of refugees, limited health and sanitation facilities and the approaching rains.

Uganda There are no reports of change in the satisfactory nutritional status of the approximately 10,000 Rwandan refugees in Uganda.

Overall, the refugee populations in Burundi (approximately 220,000), Goma (approximately 740,000) and Tanzania (approximately 556,000) are considered to be at high risk with high levels of wasting and elevated mortality rates. The approximately 2 million displaced in Rwanda thought to require food aid who are not yet receiving it can be considered to be at risk (category IIa in Table 1), while the 500,000 receiving aid are probably at moderate risk (category IIb in Table 1). The refugee population in Bukavu can be considered to be at moderate risk (category IIb in Table 1). The displaced population in Burundi along with the refugee populations in Uvira and Kamanyola can be considered to be at high risk. The refugee population in Uganda is probably not at heightened nutritional risk.

How could external agencies help? Nutritional surveys on the population in Rwanda are needed. More NGOs are needed in Burundi to run the needed programmes. Sanitary conditions in many of the camps in Burundi are inadequate and household resources (i.e. soap, water) are needed to stop the spread of disease.

In Goma, beans and vegetable oil are desperately needed, as are funds for the expensive drugs needed to treat the dysentery. Better organization of the camps in Uvira and Kamanyola is needed. In Tanzania, the over-crowding of camps needs to be relieved and sanitary conditions improved.
 

RNIS 6, August 1994

As of the beginning of August, the total number estimated to be affected by the regional crisis was 5.1 million in five countries.

Prior to the Eastern Zaire crisis the overall population in the sub-region requiring emergency assistance in the coming months had been estimated at 3.1 million. While the majority of this population are refugees and internally displaced uprooted by violence and its threat in Rwanda, approximately 20% are refugees, returnees and internally displaced from the continuing civil conflict in Burundi.

F. Burundi/Rwanda Region

Trend in numbers of refugees/displaced and proportion severely malnourished and at high risk (black area).

Until the recent massive refugee exodus from Rwanda into Eastern Zaire, brought about by RPF military successes and warnings from media controlled by former government forces of likely RPF reprisals against Hutus, the nutritional and health needs of the majority of refugees in Tanzania, Rwanda, Burundi, Zaire and Uganda fleeing this regional crisis were largely being met. However, the almost unprecedented speed with which an estimated 1.7 million Rwandans crossed over into Goma and Bukavu in Eastern Zaire in Mid-July has overwhelmed international response capacity. Currently, lack of water and sanitation in vastly overcrowded camps has precipitated a massive outbreak of cholera and dysentery which is exacting an enormous toll on human life. It is thought that crude mortality rates are extraordinarily high although no data are yet available.

Estimates of the displaced/refugee/returnee populations over time are:

	Dec 93	Feb 94	April 94	June 94	Aug 94
Burundi	150,000	282,000	536,000	1,000,000	1,230,000
Rwanda	375,000	272,300	250,000	2,060,000	2,040,000
Tanzania	325,000	300,000	60,000	410,000	353,000
Zaire	58,600	60,000	60,000	113,000	1,500,000
Uganda	-	-	-	10,000	10,000
TOTAL	908,600	914,300	906,000	3,593,000	5,133,000

Up until these most recent events in Eastern Zaire, the main difficulties faced by relief agencies involved in this regional emergency programme over the past two months have included restricted access to many of the internally displaced in Rwanda due to insecurity, serious logistical problems involving lack of trucks, insufficient port capacity in Bujumbura, and deteriorating road conditions in Tanzania with the increased movements of relief commodities, and a lack of certain food commodities such as beans and CSB. However, international relief agencies appeared to be gradually bringing the situation under control.

At the beginning of June the WFP country director in Burundi was quoted as saying "with war still waging in Rwanda, we can expect a wave of refugees arriving in Burundi and/or Zaire at any moment". At this point in time it is not clear why such predictions were not translated into greater disaster preparedness for the present Eastern Zaire crisis [WFP 2/06/94].

Burundi The total estimated refugee/returnee/displaced population in Burundi is estimated at 1.23 million people.

At the end of July it was estimated that there were over 230,000 Rwandan refugees in Northern Burundi, with a considerably lesser number in camps and receiving aid [UNHCR 27/06/94, WFP 15/07/94]. Many have been unwilling to enter camps for fear of the Tutsi-dominated Burundi army so that it has been very difficult for aid agencies to reach them. A massive influx on 17 and 18 July increased numbers by at least 60,000 with an estimated 5,000 per day arriving subsequently. Large numbers of Rwandans are apparently waiting to cross the border [WFP 4/07/94]. Potential camps sites with water are scarce and there are already considerable tensions created by the difference in rations between Rwandan refugees and Burundi displaced populations as, faced with food shortages, WFP have given priority to refugees allocations.

A recent MSF report indicates an alarming situation in two camps for Rwandan refugees in Ngozi where CMRs were 4-6/10,000/day (13-20 × normal) with dysentery responsible for up to 50% of mortality (see Annex I (15a)). There has however been an improvement in general ration provision to these camps with per capita receipts of between 2,018 and 2,213 kcals per person per day in mid-June compared to a maximum of 1,200 kcals in May. Nevertheless there is still a reported shortage of CSB, oil, milk and sugar for selective feeding programmes in these camps [UNHCR 27/06/94, WFP 11/07/94).

The number of returnees and internally displaced in Burundi may be as high as 1 million and there has been concern that the election of a new president may further destabilise the country and lead to massive population movements within Burundi and into Tanzania. Throughout July there have been reports of insecurity and lighting, especially in Northern Burundi and along main access routes to the North [WFP 4/07/94].

The situation for returnees and internally displaced in the North is least satisfactory with many returnee sites receiving less than 1900 kcals per capita [UNHCR 27/06/94]. Furthermore, with temporarily low country food stocks and a low food supply line between Tanzania and Burundi, rations have been reduced at the end of July from 350 to 200 grams per capita of cereal and contained no beans. In the first week of August it will not be possible to implement any distribution to the internally displaced [WFP 25/07/94]

In spite of this, planning for a phase-down of free food distributions to the internally displaced and returnees has been progressing in the South. This is in pan due to an assessment in March/April which indicated that many more refugee returnees than expected had returned to their land to plant. A preliminary agro-economic survey by WFP indicated that agricultural production is down by 24% in the country and that this is mainly due to the insecurity. An expected 300,000 beneficiaries will be returning to their plots within one month and will be given a food and seed package for their resettlement [WFP 15/07/94].

Continuing constraints in Burundi include periodic insecurity, limited port capacity for off-loading relief items and the lack of trucking capacity for relief items and funds to pre-position and mobilise a transport fleet [WFP 28/06/94].

Rwanda The RPF has now gained control of almost the entire country, with many of those of Hutu origin recently fleeing the country into Zaire, or seeking refuge in the protected zone set up by the French military presence in the South West of the country. Kigali fell on July 4th. Very rough estimates are that out of an original population of 8 million people in Rwanda, 2 million are refugees, 0.5 million were killed, 1.5 million are missing and 4 million remain in country as many as 2 million of whom may be displaced. This leaves a very reduced proportion of the population in their villages at a time when they would normally be harvesting. It is reported that some of the displaced people are harvesting crops near to the displaced camps for their immediate needs, but that no stock-piling is occurring. This situation is therefore likely to result in much of the population being dependant on food aid until the next harvest begins in December assuming that it is feasible to plant fields in September [FAO 21/06/94, ICRC 1/07/94].

Before Kigali fell to the RPF there were reports of very poor nutritional and health conditions amongst the internally displaced in the camps south of Butare. Conditions in the South have been further complicated by widespread drought. Until recently there have been very few NGOs operational in Rwanda with WFP the principal food assistance channel for those in the South, Kigali and North East Rwanda and ICRC mainly responsible in the North, North West and parts of Central Rwanda. At the end of June the joint planning figure for emergency assistance in Rwanda was 1,570,000. Up until now the implementation of emergency assistance has been least problematic in the RPF held territories of Northern Rwanda while the large displacement of people from Kigali and the Northern provinces has placed an immense strain on the South [WFP 28/06/94].

There had been no general food distributions in Kigali up until mid-July for fear of creating a security hazard [WFP 15/07/94].

Latest reports on the situation in the South where the French military have created a "humanitarian zone" are that there are 260,000 people in Northern Gikongoro who fled Gitarama in June and have received limited agency assistance and a further 200,000 in the South of the prefecture who have yet to be reached by relief agencies. Cyangugu prefecture in Southern Rwanda has 15,000 displaced with 9,000 in camps. There are already signs of epidemics in the camps for these displaced and fears that food supplies are inadequate. WFP and implementing partners face numerous constraints with regard to this zone with few trucks willing to enter Rwanda and prices demanded excessively high. There is a lack of electricity and housing and warehousing and most agencies have weak food pipelines for the next two months [WFP 15/07/94].

It is estimated that there are fewer than 40,000 Burundi refugees remaining in Rwanda out of an original population of 275,000 following the failed October 1993 coup [UNHCR 27/06/94].

Tanzania Current estimates for the refugee population in Tanzania are 353,000. Up to 4,000 refugees have been arriving daily since early June. Most refugees crossed into Ngara district with a smaller population entering Karagwe district. It appears, however that the original population figures were an over-estimate as a re-registration exercise in Ngara district found a total refugee population of only 230,000 in Benaco and Lumasi camp which were previously thought to hold 300,000. The food pipeline for most commodities is reported to be adequate although future supplies of beans, which are being borrowed or purchased locally and corn-soya blend, for which there is a predicted break in the pipeline at the end of July, may be problematic. There has been some concern about the suitability of whole grain maize in the ration for a population habitually dependent on tuber crops for subsistence. However, the large amounts of maize seen in the market, which triggered this concern, may be more a reflection of excess ration cards than unacceptability [UNHCR 17/06/94, WFP 29/07/94].

In general the international community has managed to protect the nutritional and health status of this large Rwandan population. However, the programme has not been without its difficulties. Among these are the fact that both food deliveries and storage capacity in camps has remained poor with distribution cycles of 2-3 days throughout June placing heavy demands on staff. By Mid-July this has improved to 6 day cycles. Another problem has been that poor roads and air strips have been further damaged by the heavy traffic flow for relief items and have slowed down delivery schedules. Furthermore, lack of transport capacity in country has been exacerbated by the use of private trucks to move the existing Tanzanian harvest [UNHCR 17/06/94, WFP 4/07/94].

The programme has also exacted some toll on the host country. For example, Tanzania's strategic grain reserve, from which WFP has borrowed quantities of food to supply Rwandan refugees, will have been drawn down to 110,000 tonnes below the official target at a time when the reserve is needed to supply populations badly affected by the countries own serious drought. There is also an acknowledged adverse impact on the local host population in terms of use of local resources and environmental degradation which is beginning to cause some local resentment [UNHCR 28/06/94].

Ngara District In mid-June, before refugees from Benaco camp were separated into three camps to reduce camp numbers to manageable proportions, the average per capita general ration receipt varied between 1,250 and 3340 kcals partly reflecting logistical difficulties and over-registration. A nutritional survey carried out in Benaco in early June found wasting rates of only 7.1%. Crude mortality rates have also remained low, since the establishment of the camp, at 0.5/10,000/day (see Annex I (15b)). It has been argued that this relatively stable situation may reflect generous general ration receipts as a result of the initial over-registration in many households and that once correct numbers of ration cards are allocated following a re-registration, nutritional and health status may begin to deteriorate [UNHCR 11/06/94, UNHCR 17/06/94].

Concern has also been expressed that the maize based rations which are deficient in niacin and vitamin C, may eventually lead to outbreaks of pellagra and scurvy. Indeed most recent reports from the WFP country office and NGOs warn of deteriorating general nutritional conditions in some camps amongst children under five and pregnant and lactating women. High mortality rates have also recently been reported in sections of Benaco camp, e.g. among the Rusumo commune, with death usually being due to diarrhoea, dysentery and dehydration as a result of poor water supply and sanitation facilities. In Burigi camp, wasting has recently been reported at 8.8% (see Annex I (15b)) [UNHCR 17/06/94, WFP 15/07/94].

Kayanga District There are an estimated 75,000 refuges in five camps in Kayanga district. No nutritional problems have been signalled to date The main problem for this population is currently reported to be an inadequate water supply with only half recommended quantities being available [UNHCR 10/06/94].

Zaire The scale and speed of the refugee movement to Eastern Zaire has by all accounts entirely overwhelmed international response capacity. Reliable and precise data on numbers of refugees and their nutritional and health status are therefore not currently available, but estimates are that the total refugee population in Eastern Zaire is 1.5 million people.

Estimates of the numbers around Goma and surrounding camps such as Katale (200,000) and Kibumba (250,000) are that there are 1.1 million people. Although food is urgently needed, the priority has been to establish clean and safe water supplies and medical services that can adequately cope with the massive cholera, dysentery and shigella outbreaks that have already claimed thousands of lives in Goma and surrounding camps. In mid-July these conditions were said to be killing up to 2.000 people a day with a 50% case fatality rate from cholera. This rate is slowly being reduced with dysentery now the major disease problem. Latest reports are that the food situation in Goma is now becoming dramatic with widespread starvation inevitable unless food deliveries are stepped up. Until now there have been no deliveries of oil which is needed particularly for planned selective feeding programmes.

Further south around Bukavu there may be as many as 400,000 refugees with another 350,000 further south in Uvira. Conditions here are reportedly much better than in Goma and over half the refugees are living in small sites including churches, schools and other public places [WFP 29/07/94, WFP 5/08/94].

Although the international response has now moved into top gear with US and UK troop involvement, air-drops and massive donor resources being made available, it is expected that many more fatalities will occur before conditions stabilise. Less than 100,000 refugees are thought to have returned to the French Humanitarian Zone in Southern Rwanda, but whether large-scale repatriation is feasible (or advisable), is not clear. Within the camps there is reportedly considerable pressure on Hutus to remain as commune leaders warn of likely Tutsi reprisals on return and use threats on those who do not heed such warnings. It is also not clear whether the international community and new Rwandan government are managerially and logistically able to safely repatriate such a large and weakened population, especially as this might well risk a dispersed cholera epidemic within Rwanda itself. It is difficult to predict how events in Eastern Zaire will unfold.

Uganda There are approximately 10,000 Rwandan refugees in two camps in Southern Uganda although there are plans to consolidate these camps into one farther from the Rwandese border. It has been reported that all those refugees from the Tutsi tribe that were in Uganda have now returned leaving 10,000 exclusively Hutu refugees [UNHCR 4/07/94].

Overall, the refugee population around Goma can be considered to be at high risk, with inadequate food and water (category IIa in Table 1). The displaced population in Rwanda can also be considered to be at high risk due to limited food distributions (category IIa in Table 1). The refugee/returnee/displaced populations in Burundi and Tanzania are probably at moderate risk due to insecurity (Burundi) and possible breaks in the food pipeline (Burundi and Tanzania) (category IIb in Table 1). The refugees in South Kivu and Uvira, Zaire along with the refugees in Uganda are not reported to be currently at any heightened risk nutritionally (category IIc in Table 1).

How could external agencies help? There are still enormous short-falls in food and cash pledges for this large regional programme as well as shortfalls in cereals and oil for current general ration distributions mainly affecting programmes in Burundi. Southern Rwanda and Zaire. The effect on the nutritional status of the internally displaced in Burundi, Southern Rwanda and refugees in Zaire will be catastrophic unless adequate general rations are secured. Donors must respond immediately to provide necessary resources. In Rwanda it is vital that a security presence is maintained in order to encourage refugee return from situations where the international community cannot guarantee appropriate levels of care and to ensure at least some limited planting before September. Without a reasonable harvest Rwanda may require as much as 2,000 metric tons of food imports per day until the 1995 harvest. It is also important that UNAMIR is sufficiently strengthened to ensure a smooth transition following French troop withdrawal or the there is the real prospect of as many as 2 million more refugees moving into areas South of Goma. It is also essential that transit feeding stations and medical facilities are provided for Rwandan returnees, many of whom will be arriving in a sick and weakened state. Finally, there must be on-going surveillance of the large Rwandan refugee population in Tanzania so that any adverse effects of re-registration on nutritional status can be rapidly identified and acted upon.
 

RNIS 5, June 1994

The death of the Rwandan president on April 6th and ensuing civil war escalation has so far led to the displacement of an estimated 2.5 million people both within Rwanda and across borders into neighbouring Tanzania, Burundi, Zaire and Uganda. The ferocity and brutality of this war has led to the slaughter of probably over 200,000 people. Reports of the shores of Lake Victoria in Tanzania being awash with thousands of corpses, many of them mutilated women and children, has left the international community asking itself what steps it could have taken to prevent Rwanda's transformation into what many have likened to a human abattoir.

F. Burundi/Rwanda Region - Trend in numbers of refugees/displaced and proportion severely malnourished and at high risk (black area).

Estimates of the displaced/refugee/returnee populations over time are:

	Dec 1993	Feb 1994	April 1994	June 1994
Burundi	150,000	282,000	536,000	1,000,000
Rwanda	375,000	272,300	250,000	2,060,000
Tanzania	325,000	300,000	60,000	410,000
Zaire	58,600	60,000	60,000	113,000
Uganda				10,000
TOTAL	908,600	914,300	906,000	3,593,000

Rwanda Approximately two million people are currently displaced within Rwanda with hundreds of thousands camped outside Kigali where vigorous fighting continues. While most of the 275,000 Burundi refugees that were in Rwanda have returned home, an estimated 60,000 remain in Southern Rwanda [UNHCR-a 26/05/94]. The poor security situation in Rwanda has so far only allowed limited relief activities so that humanitarian activities in Kigali have been limited to small scale feeding of the displaced located mainly in the stadium and in hotels while in the South where the refugee and displaced population is estimated to be 243,000, some limited distributions have occurred.

A division of labour has been agreed between WFP and ICRC which will leave WFP with responsibility for the North-Eastern part of Rwanda and the Southern part up to and including Butare. There are also many NGOs waiting to move into Rwanda as soon as security permits [SCF 24/05/94]. It is hoped that the security council resolution to strengthen UNAMIR forces by expanding their numbers to 5,500, will allow creation of safe haven areas and the distribution of relief supplies.

Already, food stocks for the displaced population must have run out and it is probable that vulnerability is growing as stocks of medical goods, clean water and food are depleted, made inaccessible or destroyed. Malnutrition is reported among children in displaced camps in Kigali [WFP 13/06/94]. It should be expected that a large proportion of the population will require distributions of a complete food basket. Even before the escalation of the civil war, earlier drought and conflict had led to estimates of food deficits of 285,000 MT [FAO 29/04/94].

Tanzania Between April 28-29th 250,000 Rwandans arrived near the town of Ngara in Western Tanzania. Tanzania is now hosting the largest number of refugees in the region - current estimates are of 410,000 people with an influx continuing at 500-4000/day. Before this recent influx Tanzania was already hosting 60,000 Burundi and Rwandan refugees. The majority of refugees are women, children and young men under 18 years from the Hutu tribe. There are now seven camps in Ngara and Karagwe districts the largest of which is Benako. Often refugees cross the border and still have a difficult journey of several days to the nearest camps [UNHCR 18/05/94, UNHCR-a 26/05/94].

The camps are overcrowded, with insufficient water supply although since these refugees arrived in good health, these problems have not yet been reported to cause high mortality and malnutrition rates. The pipeline of food commodities for both Rwandese and Burundi refugees in Tanzania is satisfactory for between 2-4 months depending on commodity, and is based on diversions, local purchases using immediate response account funds, and loans. However, the movement of food commodities has been made difficult by the recent heavy rainfall in Karagwe and Bukoba districts which has washed many bridges away and made roads impassable. Feeding centres and clinics are now being established in the camps [UNHCR-a 26/05/94].

Information available from Benaco camp (estimated population 281,000) at the end of May showed wasting prevalences in children of 14.4% (see Annex I 15a). This was measured during a measles immunization campaign resulting in an almost complete coverage. The general distribution is reported to be usually satisfactory, despite assessments showing that the food basket for 21 May varied from 1300-2200 kcal/person/day [MSF-F 28/05/94].

Burundi There may be as many as one million people dependent on emergency food aid in Burundi. These people are internally displaced from the October coup and subsequent fighting, refugees returned from Rwanda, and Rwandan refugees (an estimated 70,000). While there is sporadic fighting in rural areas around Bujumbura, the general situation in Burundi is calm [UNHCR-a 26/5/94]. There is, however, some concern that the fighting in Rwanda may spread to Burundi.

Due to logistical constraints, particularly insufficient off-loading capacity at the lake port of Bujumbura, rations for the assisted population were not exceeding 1,000 kcals/person/day. However, port capacity is now reported to be improved and WFP reports that rations are providing 1900 kcals/person/day [WFP 9/06/94]. The nutritional situation for those beneficiaries outside of the camps is said to be satisfactory, but there is particular concern for those Rwandese refugees and Burundi returnees in camps (approximately 200,000) who are almost entirely dependent on external food aid [WFP 23/05/94, WFP 9/06/94].

Zaire There are now an estimated 102,000 Burundi refugees in Zaire, 49,000 of whom fled following the October 1993 coup attempt with the remainder being new arrivals from the current Rwanda crisis. A further 11,000 Rwandan refugees in Kivu and Goma have also fled recent events in Rwanda. The overall situation for these refugees is described as stable but in need of improvement [UNHCR-a 26/05/94].

Uganda There are approximately 10,000 recent Rwandan arrivals in Uganda, but it is reported that many more are gathered at the border and may cross over at any time [UNHCR-a 26/05/94].

Overall The refugee and internally displaced population of Rwanda (approximately 2.06 million people) are considered to be at high risk due to their lack of access to relief resources while the 410,000 refugees in Tanzania are also at high risk due to overcrowding, and insufficient water (category IIa in Table 1). The 1 million refugees and returnees in Burundi camps are at high risk due to poor general ration delivery (category I in Table 1). The 113,000 refugees in Zaire are placed at high risk (category IIa in Table 1) while the 10,000 refugees in Uganda are defined as at moderate risk (category IIb in Table 1).

How could external agencies help? Food aid pledges and cash resources for non-food aid items are urgently needed for the enormous programme and have yet to be met following the UN emergency appeal in early May. The immediate response account of WFP urgently needs to be replenished to allow local purchases of food. Funding for storage capacity is also desperately needed. Logistics are a constraint due to the distances involved, affecting supplies not only of food but of equipment for water/sanitation, more of which is needed. Camps are generally crowded, unsanitary and with poor variety of diet.

Until the violence inside Rwanda lessens it will be difficult to extend external assistance. Comments below refer to the populations outside of Rwanda. In Tanzania, the large number of refugees and resulting overcrowding in existing camps require urgent measures to relocate some populations and to establish optimal sanitation and hygiene conditions in all camps. In Burundi, where security is generally much improved, there is a need to establish nutritional surveillance of returnees and the internally displaced as general ration provision is far below requirements.
 

RNIS 4, April 1994

Trend in numbers of refugees/displaced and proportion severely malnourished and at high risk (black area).

The deaths of the Presidents of Rwanda and Burundi on 6 April 1994 have lead to widespread violence in Rwanda, while as of 18 April, Burundi remains calm. The Burundi refugees in Rwanda must be at very high risk. The available information, reported here, refers mostly to the situation before 6 April 1994.

The establishment of a new presidency in Burundi along with the beginning of the planting season in March led to the spontaneous repatriation of many Burundi refugees from Zaire and Tanzania along with a smaller number from Rwanda. Some Burundi refugees in Rwanda were said to be crossing the Rwandan border into Burundi by day to plant and tend fields and returning to Rwanda at night. Prospects for the harvest are said to be satisfactory, but due to insecurity, normal sowing levels have not been reached. However, violence in the capital city of Bujumbura early in March led to further displacement and a reduction in the rate of repatriation [FAO/WFP Apr.94].

Estimates of the displaced/refugee/returnee populations over time are:

		December 1993	February 1994	April 1994
Burundi		150,000	282.000	536,000
Rwanda		375,000	272,300	250.000
Tanzania		325,000	300,000	60,000
Zaire		58,600	60,000	60,000
	TOTAL	908,600	914,300	906.000

Burundi It is estimated that 25,000 refugees have spontaneously returned to Burundi since the beginning of January. The security situation in Burundi is precarious with continued sporadic fighting, especially in Bujumbura. It is estimated that approximately 15,000 people have fled the city to surrounding hills and across the border into Zaire after the most recent ethnic clashes in early March [UNHCR 29/03/94, WFP 11/02/94, WFP 28/03/94]. At the end of March it was estimated that there were over 500,000 internally displaced/returnees registered as in need of assistance but only enough resources to meet 30% of a full ration. The situation is expected to improve in April as food arrivals increase. There is little information on the nutritional status of those displaced within Burundi or returning from neighbouring countries although there were anecdotal reports from WFP field monitors of extensive moderate and severe malnutrition amongst returnees from the Tanzanian camps and consequent need for additional supplies (including supplementary foods).

A nutritional survey was carried out in the province of Ruyigi (near the Tanzanian border) in February 1994. The estimated population of the province in 250,000, and the level of wasting was 10.7% with 2.2% severe wasting (see Annex I 15a), indicating a moderate level of malnutrition [MSF-B-B 01/02/94].

Rwanda While there were reported (prior to 6 April) to be sufficient stocks of most food commodities there continued to be a shortage of beans so that the ration was reduced for the 250,000 Burundi refugees remaining in Rwanda. Corn-soya blend was distributed to compensate for this shortfall although only a partial ration could be allocated because of limited availability. Already in March ethnic clashes briefly interfered with relief efforts [WFP 28/02/94].

With increased quantities of food being distributed, improved health care in the camps and the movement of many refugees to Maza, a new camp in Rwanda, conditions for Burundi refugees in Rwanda overall were improving in March. The level of wasting in the camps, 40% (with 10% severe wasting) in January 1994, had been reduced to 20-25% (although this is still extremely high). Mortality rates were also improving; crude mortality rates were 0.71/10,000/day and the under-five mortality rate was 1.6/10,000/day (see Annex I 15b). This is still 2.6 times normal but an improvement on crude mortality rates of 3.7-5.6/10,000/day recorded in January. Exact immunisation coverage is not known although 68% of children in the camps have a vaccination card. After many months of crisis health and nutrition status was beginning to improve substantially after mid-February, although crude mortality rates were still 1.9/10,000/day (6 x normal) [UNHCR 29/03/94, WFP 18/02/94, WFP 28/03/94].

Information from March on Kagina camp (population 15,200) showed 25.4% wasting with 10.8% severe wasting, and a crude mortality rate of 0.7/10,000/day (2.5 x normal). The under-five mortality rate was 1.1/10,000/day (see Annex I 15c). In Rugogwe (population 10,500) the level of wasting was 16.7% with 6.1% severe wasting. Crude mortality rates were 1.1/10,000/day (4 x normal) and the under-five mortality rate was 2.3/10,000/day (see Annex I 15d). In Ngoma camp (population 9,000) levels of wasting were 7.6% with 2.0% severe wasting. The crude mortality rate was 0.6/10,000/day (2 x normal) and the under-five mortality rate was 0.7/10,000/day (see Annex I 15e). While the food basket was not providing full nutritional requirements, it was improving [MSF-H 29/03/94).

A survey conducted in mid-March 1994 in Kanage (estimated population 17,000) found wasting levels of 12.4% and severe wasting at 4.4% (see annex I 15f). Food distributions were often said to be late and provided a variable calorie content of 1,130-2,110 kcals/person/day. It is believed that the refugees have access to other food sources. Measles vaccination coverage is almost 86%. These data indicated an improving situation in the camp [MSF-B 18/03/94].

Kankuba is a new camp which opened in January 1994 and has an estimated population of 3,100. Wasting levels recorded in Mid-March were 4.9% with 0.9% severe wasting (see annex I 15g). Measles vaccination coverage here is also almost 86%. The results of this survey also confirmed an improving nutritional status for the refugees in the camp [MSF-B 25/03/94].

Information from camps called Saga I & II also showed an improving nutritional state with wasting levels of 3.7 - 5.4% and severe wasting 0.3 -1.5% (see Annex I 15h) [AICF 11/04/94].

Despite the re-registration that took place in December 1993, registration problems persist due to lost/stolen cards, unregistered cards (indicating cards were sold before or during the census) and some computer errors in deleting names. There also continues to be a small influx of Burundi refugees due to the resurgence of fighting amounting to approximately 10,000 new arrivals. A census is planned for Mid-April when new ration cards will be issued. [UNHCR 21/03/94, WFP 28/03/94]

Tanzania It was estimated in March that 80% of the Burundi refugees had spontaneously repatriated leaving approximately 60,000 in the camps. It is presumed that those that stayed behind are those least able to travel, e.g. the sick, malnourished and old, and that as a result, health and nutrition status in the camps remains a major concern. Food supplies have gradually improved. In February, rations ranged from 1,400-1,800 kcals/person/day - rather low - depending on the district, while by March supply had further improved [UNHCR 28/02/94, UNHCR 14/03/94].

Crude mortality rates for the first week of March varied between camps from 0.5-2.2/10,000/day (2-7 x normal) while under-five mortality rates varied from 0.7-7.4/10,000/day (see Annex I 15i). This is a considerable improvement compared to January when crude mortality rates varied between 2-7/10,000/day. The highest under-five mortality rate has been found in Kasula district and is thought to be due to malaria. A malaria control plan has now been prepared to combat this problem [UNHCR 14/03/94].

Zaire The clashes in Bujumbura in March resulted in the displacement of a further 15,000 Burundis into Zaire [UNHCR 28/03/94]. Logistical problems meant that supplies to the existing 49,000 refugees already in camps and living among the local population have been irregular so that this further refugee influx places an added strain on the food supply capacity [WFP 18/03/94].

In sum, the situation within Burundi is still politically tense with the displaced population in a precarious situation (category IIa in Table 2). While the situation for refugees in Rwanda showed much improvement compared to the extreme crisis reported up until January, mortality and wasting levels still indicate a serious situation (category IIa in Table 2). Mortality rates in Tanzania were very high, and the population is considered to be at high risk (category I in Table 2). Although little is known about the nutritional condition of the refugees in Zaire, logistical constraints would indicate that they are at heightened risk (category IIb in Table 2).

With the deaths of the Presidents and the subsequent destabilization of Rwanda, it is probable that many Burundi refugees in Rwanda will leave the country. This could further jeopardize their precarious situation. It is also possible that the currently calm situation in Burundi could degenerate, leading to the displacement of large numbers of people. The situation is very fluid, with a worsening tendency.

How could external agencies help? The information here does not take account of any changes that may have occurred since the death of the Burundi President on 6 April. There is little information on the nutrition of most of the displaced population, but it was reported that they were only receiving 30% of food requirements. A nutrition assessment is indicated before requirements for assistance can be specified.

While food supplies in the pipeline may turn out adequate, there is a current shortfall and funds are required for local or regional purchase, until the external food arrives. At the same time, account should be taken of the possible increase in numbers. For refugees from Burundi in Rwanda, a census was planned by UNHCR and the Rwandan Red Cross for all camps in mid-April to try to improve the serious registration problems; this may require assistance both in terms of expertise and funds. For the Burundi refugees in Tanzania, monitoring of those remaining is of high priority. Similarly, for the refugees in Zaire also, information, preferably through survey, is required.
 

RNIS 3, February 1994

The failed October coup in 1993 in Burundi and subsequent civil war forced the movement of up to one million people both within Burundi and to surrounding Rwanda, Tanzania and Zaire. The appalling conditions endured by this population continue and remain little changed since the previous RNIS newsletter two months ago. The current refugee and displaced population in the four affected countries is as follows:

Burundi	282,000
Rwanda	272,334
Tanzania	300,000*
Zaire	60.000*
Total	914.334

* an unconfirmed number of these refugees has spontaneously repatriated, but some of these will still be displaced.

The political situation in Burundi may stabilize with the appointment of a new president although there are still reports of fighting within the country.

Increased stability and the arrival of the planting season may encourage many refugees to return home. Repatriation is already evident from Tanzania in spite of the rains and there are estimates that up to 80% of refugees will return from Tanzania and 50% from Zaire in the next few months. Insecurity in the Northern region of Burundi is preventing significant repatriation of refugees from Rwanda. Overall up to 120,000 refugees may have already returned to Burundi. [WFP 21/1/94, WFP 28/1/94] but this number is still included in the figures given above.

Rwanda The situation for the Burundi refugees in Rwanda continues to deteriorate. Reports as recently as the end of January record continuing shortage of food at camp level and very bad sanitary conditions. Many camps are situated on the flanks of hills and risk being washed away in rains. Sewage has been building up and also seeps into the valleys polluting water sources.

After a recent census, the estimates of the refugee population in Rwanda were reduced from about 400,000 to 272,000 living in 25 camps. [WFP 21/1/94] UNHCR reports wasting levels of almost 40% (using MUAC) (see Annex I (15a) for details). [UNHCR 7/1/94] January surveys in Kagina and Rugogwe camps also show high levels of wasting (25.4% and 16.6% respectively) with 10.8 and 6.1% severe wasting (see Annex I (15b) for details). [MSFH 25/1/94] In Kigali prefecture Nzangwa, Rutonde, Burenge and Nyarungenge sites were found to have wasting levels of almost 30% with 6% severe wasting in January. These particularly worrying statistics are thought to be due to over-crowding, poor quality maize meal, and distribution problems. Crude mortality rates from three camps (Kagina, Rugogwe and Ngoma) recorded in January vary from 3.7/10,000/day to 5.6/10,000/day with under-five mortality rates of about 11.5/10,000/day. [MSFH 25/1/94, UNHCR 7/1/94] This translates into over 100 deaths per day of whom 20 are children under five years of age, and this is 10-15 times normal. Supplementary and therapeutic feeding programmes have been implemented in most camps but approximately 30% of camps are uncovered. [UNHCR 7/1/94]

In general incidence of dysentery in decreasing, but case fatality is still high at 7-8%. The incidence of measles is now reported to be under control, but again case fatality remains high (up to 50%). [UNHCR 7/1/94] Malaria is currently the most common health problem with many refugees coming from areas of low endemicity to camps situated near swamps.

The distribution system of food to the refugees remains problematic. In Burenge where there are 40,000 refugees, the food basket received for the last week of December was only 700 kcal/person. While such a low quantity may not be representative, it did reflect the overall inadequacy of ration provision during this period. [UNHCR 7/1/94] While delivery problems, e.g. lack of transport, played an important role in this situation, they were compounded by the flawed registration system and high rates of ration card theft. [WFP 21/1/94] Thus, the quantity of food distributed to the refugees in inadequate. More recent reports indicate that the food basket improved considerably in January due to a reorganisation of the distribution system. [WFP 28/1/94, MSFH 25/1/94]

It has recently been decided to transfer some refugees to newly developed camps in an effort to alleviate the congestion of some of the existing camps. The largest of these is Maza camp, designed to house up to 50,000 refugees. Transfer of refugees to Maza began at the end of January. [UNHCR 18/1/94] This transfer will also be an opportunity to re-register some of the refugees and will allow the space necessary for proper sanitation and dispensaries.

Given the very high rates of malnutrition and the greatly elevated mortality rates, this situation should be considered to be out of control. However, new camp sites and improving distribution systems at the camp level may help alleviate the situation.

Tanzania The Burundi refugee population in Tanzania is also in a state of crisis. There are reports of spontaneous repatriation of some 10,000 of the 300,000 refugees. This may be due in part to the continuing shortage in camps of food, cooking items, milling machines and fuelwood, and the absence of a proper registration and distribution system. Some of the difficulties emanate from low trucking capacity and the inaccessibility of many of the 45 sites. [WFP 23/12/93]

In December data showed crude mortality rates ranging from 1.4/10,000/day in Nyarulama camp to 12.2/10,000/day in Kabanga. This latter is extremely high. The main causes of death were dysentery. Data on prevalence of wasting varied between camps ranging from 5.% to 17% using MUAC and 13% in Nyarulama using weight for height measurements (see Annex I (15d) for details). [UNHCR 21/1/94]

By the end of January reports were describing a further deterioration in refugees' nutritional status. Crude mortality rates varied between 2-7/10,000/day in different camps giving an average of 3/10,00/day. The main causes of death were identified as malnutrition, malaria, and/or dysentery. It was estimated that 43% of deaths in Kibondo district at the end of January were due to malnutrition (see Annex I (15e) for details). [LSHTM 3/2/94, UNHCR 21/1/94] The situation is clearly still deteriorating rapidly.

Zaire The number of Burundi refugees in Zaire is now estimated to be 60,000 in 17 different sites. The last RNIS report recorded a rapidly deteriorating situation, with over-crowding, lack of shelter, insufficient food and epidemics of cholera and dysentery in certain camps. Since then, preliminary investigations have been conducted at three new sites in Eastern Zaire. As yet, no decision has been taken to move the refugees to new sites. [UNHCR 18/1/94]