United Nations System
Standing Committee on Nutrition

Nutrition Information in Crisis Situations - Central African Republic

NICS 15, December 2007

The security situation in CAR has become increasingly volatile, especially in the northwestern part of the country. An estimated 299,000 people have been displaced since the beginning of 2007, including 79,000 who have fled to neighboring countries (UNICEF, 28/09/07). The deployment of MINURCAT, the U.N. force for Chad and Central African Republic, scheduled for November 2007, whose mandate is to protect civilians, was delayed due to lack of technical and material inputs (AI, 29/11/07).

Two nutrition surveys were carried out by MSF-CH in August/September 2007 among Central African refugees living in Adamaoua and Eastern Province, Cameroon. The prevalence of acute malnutrition surpassed critical levels in each of the surveys (MSF-CH, 09/07) (table 6). Moreover, the U5MR in the Eastern Province survey was 5.1/10,000/day (C.I. 4.3-6.0), well beyond emergency levels; in Adamaoua, it was below the alert threshold.

Table 6 Prevalence of Acute Malnutrition and Mortality Among CAR Refugees living in Cameroon (MSF-CH 08-09/07) (MSF-B 04/07)

Conflict Zones and Rebel or Population Movement, Central African Republic (HDPT, 12/07)

NICS 13, May 2007

An upsurge in violence in the north of the country in 2006 has led to the displacement of thousands of people, especially in the north-west (see NICS 11). As of February 2007, the number of displaced was estimated at around 212,000 people (see map). The humanitarian presence has increased in the area over the past few months, but access has remained uncertain.

Displaced populations, CAR, February 2007 (Reliefweb, 13/03/07)

The conflict has had several consequences on the livelihoods of the population, such as the loss of food stocks and productive assets; reduction in crop production; drastic reduction of cotton production; reduced commercial flow and access to market; and an increase in prices of basic products (SC, 03/07). As of March 2007, basic food stuffs such as cassava and groundnuts were still available in the area, al

beit at low levels, and food availability in markets was low (WFP, 03/07). Trade with the rest of the country and with neighbouring countries was almost inexistent and imported goods such as sugar, oil and salt were absent in rural markets.

Food frequency and diet diversity had significantly decreased, according to a WFP assessment (WFP, 03/07). Most of the people interviewed only ate once a day (compared to twice a day before the crisis) and meat, fish and oil had disappeared from the diet. Cereal consumption had also decreased. Most families had consumed roots, tree bark and wild fruit the day before the interview. People were also reported to have few cooking instruments and little access to water.

Despite this degradation in food security and livelihood, the situation was not considered catastrophic as of March 2007 in Ouham Pende, Ouham and Nana-Grimbizi provinces (SC, 03/07). Moreover, according to a nutrition assessment conducted in the provinces of Ouham and Ouham-Pende, which was not representative of the population but was conducted in areas where security allowed, the nutrition situation was not alarming (ACF-F, 02/07). Among the 104 6-59 month-old displaced children screened, none had a MUAC < 110 mm and only one had a MUAC < 120 mm. Among the 381 resident children screened, 4 (1.0%) had a MUAC < 110 mm and 16 (4.2%) had a MUAC < 120 mm. No oedematous children were found.

However, the WFP assessment estimated that 190,000 displaced people and 32,000 non-displaced people were in a state of acute food insecurity in the north (WFP, 03/07) and were in need of food distribution, especially during the forthcoming hunger gap. The WFP will distribute a full food ration for 6 months to this food-insecure population. The FAO was also to distribute seeds and tools for the forthcoming planting season (SC, 03/07) and provision of health care was under way (SC, 03/07).

In addition to the displaced population within the Central African Republic, 50,000 people have fled to Chad and 25,000 have sought refuge along the border in Cameroon. The latter are mostly nomadic cattle breeders who, according to assessment missions, live in destitute conditions (UNHCR, 27/03/07). The food security and nutrition situation seemed poor. Most of the refugees have lost or sold their livestock (IFRC, 28/05/07). They lack agricultural implements and seeds for planting, although local communities have allowed them some lands. They mainly rely on the sale of firewood. The refugees in Cameroon have received little international help so far, and the most pressing priorities are food, health care, and water and sanitation projects.

As a follow-up to a nutrition survey conducted in Bangui in January 2006 (see NICS 11), another survey was conducted in January 2007 (ACF-F, 01/07). The nutrition situation was not critical, with a prevalence of acute malnutrition of 5.8% (4.2-7.4), including 0.5% (0.0-1.1) severe malnutrition, and was within the same range as in January 2006. Mortality rates were under control: CMR= 0.49 (0.27-0.72), U5 MR=0.36 (0.0-0.92).

Overall

The situation of the displaced people and people affected by the conflict in the North of the country is poor (category III). The on-going humanitarian response to the crisis might prevent further deterioration during the forthcoming hunger gap.

NICS12, February 2007

The country has been affected by civil insecurity for years. An upsurge in violence erupted over the last few months, especially in the north of the country. In the northeast, recent fighting has displaced thousands of people (OCHA, 16/11/06). In the northwest, civil populations have been trapped and targeted by the different parties (MMCAR, 11/06). It is estimated that the number of IDPs has tripled since the beginning of the year (MMCAR, 11/06). Several villages have recently been attacked and their inhabitants have deserted them (WFP, 05/12/06). An estimated 150,000 people are believed to be living in the bush with a very poor diet and difficult access to health care, some of them for more than one year. As the northwest is the breadbasket of CAR, the disruption of production in these regions has also had an impact on the rest of the country (WFP, 05/12/06)

There are few humanitarian agencies currently on the ground and their access to the population is increasingly difficult (MSF, 11/06). However, there is more and more interest in CAR with US OFDA having recently placed CAR on its list of emergencies and ECHO having sent an assessment mission (MMCAR, 11/06). Although the displaced people have received some food, health and non-food items assistance, there are urgent needs for further assistance. A CAP requiring US$ 49.5 m for 2007 has been launched recently (CAP, 2007). United Nations Humanitarian Air Services were set up in November 2006 to run daily flights to destination across the country (OCHA, 16/11/06).

According to the Multidisciplinary Mission to CAR, the crisis has multiple facets (MMCAR, 11/06). The state is weak and almost absent outside the capital, Bangui. The country is also acutely underdeveloped and social indicators, including life expectancy, have dropped for years. This together with insecurity has led to a humanitarian crisis with one million people, a quarter of the population, affected. However, the lack of reliable data makes a thorough assessment of the humanitarian situation difficult.

Despite this bleak picture, a nutrition survey conducted in Bangui in January 2006 showed an acceptable nutrition situation: acute malnutrition was 4.7% (2.9-7.2), including 0.7% (0.1-2.1) severe malnutrition (ACF-F, 01/06). Mortality rates were also under control: U5MR = 0.98 deaths/10,000/day and CMR = 0.52 deaths/10,000/day.

There are also 50,000 refugees from CAR in Chad and a further 20,000 who have fled recently to Cameroon (MMCAR, 11/06; Reuters, 07/12/06).

Recommendations

Some of the recommendations from the Multidisciplinary Mission in CAR:

Improve in-country coordination and inclusiveness
Increase UN agencies' in-country emergency programming skills/response capacity
Increase the UN's presence in the most affected areas
Increase the presence of NGOs
Ensure adequate linkages between emergency, recovery and development

NICS 11, November 2006

There are also 50,000 refugees from CAR in Chad and a further 20,000 who have fled recently to Cameroon (MMCAR, 11/06; Reuters, 07/12/06).

Recommendations

Some of the recommendations from the Multidisciplinary Mission in CAR:

Improve in-country coordination and inclusiveness
Increase UN agencies' in-country emergency programming skills/response capacity
Increase the UN's presence in the most affected areas
Increase the presence of NGOs
Ensure adequate linkages between emergency, recovery and development

NICS 5, February 2005

The Central African Republic has faced a structural crisis for years, with an institutional instability marked by mutinies, coup attempts, and destruction and looting of infrastructure and people's property (CAP, 2005). An armed rebellion took place between October 2002 and March 2003, when François Bozize ousted President Felix Patasse (IRIN, 15/03/04). Although the situation has calmed down, security has remained fragile and the rehabilitation and development of infrastructure is hampered by a lack of means. Banditry is widespread, especially in the north-west of the country (IRIN, 06/01/05). Presidential and parliamentary elections are scheduled for the beginning of 2005 (IRIN, 06/01/05). Thousands of people are still refugees, of whom 30,000 are in Chad (see NICS 4).

A random-sampled nutrition survey was conducted in Kuango sub-prefecture, Ouaka prefecture, in the centre of the country. The survey showed an average nutrition situation with 6.8% (4.7-8.8) of the children being acutely malnourished, including 1.2% (0.5-1.9) severely malnourished (MSF-S, 12/04). Mortality rates were also average: CMR=0.7/10,000/day and under-five MR= 1.7/10,000/day. Measles vaccination coverage was only 19.5%. A measles outbreak had just occurred in the area.

RNIS 22, December 1997

Periodic mutinies among the Central African Republic (CAR) military have occurred since April 1996. Peace accords were signed in January 1997, and a peace keeping force was established. Further clashes between army mutineers and peacekeepers in Bangui at the end of June led to the displacement of up to 100,000 people who left the capital city and moved to Samba and Bimon, south-west of the city. There was concern that this increased population would strain local services, and that food, shelter, clean drinking water and medicines would be in short supply. However, most of the displaced people have now returned home [DHA 11/07/97, UN 06/08/97, WFP 04/07/97].

Efforts are being focused on strengthening the peace process in CAR to avoid this sporadic violence. For example, a UNDP initiative will help demobilise and reintegrate soldiers into civilian life, design a disarmament strategy, and plan a national conference on reconciliation [UNDP 28/07/97].

The 20,000 Chadian refugees in CAR have repatriated and the approximately 25,000 Sudanese refugees have reportedly attained self-sufficiency and no longer require emergency assistance [WFP 10/12/97].

RNIS 21, September 1997

There are approximately 1,000 Rwandan and Congolese refugees in CAR requiring assistance; a further 12,000 Congolese in the country have not requested assistance [WFP 04/07/97]. There are approximately 27,400 Sudanese and 5,000 Chadian refugees in CAR whose nutritional status is reportedly adequate and stable. These refugees are not currently considered to be at heightened risk (category lie in Table 1).

RNIS 20, June 1997

There are approximately 32,400 assisted Sudanese and Chadian refugees in the Central African Republic. This total number is comprised of 5,000 Chadian refugees and 27,400 Sudanese refugees. See section on the Great Lakes Region for information pertaining to new arrivals from the Democratic Republic of Congo.

There are no reports of change to what has been described as an adequate and stable nutritional situation for these refugees (category IIc in Table 1).

RNIS 19, March 1997

There are approximately 32,400 assisted Sudanese and Chadian refugees in the Central African Republic, this total number is comprised of 5,000 Chadian refugees and 27,400 Sudanese refugees [UNHCR 27/02/97],

The number of Sudanese refugees has increased due to a small influx of refugees from the camps in Eastern Zaire. These refugees had been living in refugee camps in Zaire for many years and are now fleeing righting in Eastern Zaire. There are a small number (perhaps 50) who have newly crossed into the CAR. These people are not seeking refugee status, and are expected to return home shortly [UNHCR 27/02/97].

There are no reports of change to what has been described as an adequate and stable nutritional situation for these refugees (category IIc in Table 1).

RNIS 18, December 1996

There are no reports of change to the nutritional situation the of 27,000 assisted Sudanese refugees in the Central African Republic. There are also approximately 5,000 assisted Chadian refugees whose nutritional status is believed to be adequate [UNHCR 16/01/96].

RNIS 17, September 1996

RNIS 16, June 1996

There is a continuing influx of Sudanese refugees into the Central African Republic and it was recently estimated that there are just over 27,000 assisted Sudanese refugees in the country. There are also approximately 5,000 assisted Chadian refugees whose nutritional status is believed to be adequate [UNHCR 16/01/96].

RNIS 15, April 1996

RNIS 14, February 1996

Most recent estimates are that there are 13,300 Chadian refugees and 25,500 Sudanese refugees in the CAR. There are no reports of any change in the stable nutritional situation of these refugee populations.

RNIS 13, December 1995

RNIS 12, October 1995

Most recent estimates are that there arc 13,300 Chadian refugees and 25,500 Sudanese refugees in the CAR. It is reported that a group of approximately 900 refugees from Mboki camp want to repatriate to the Sudan [DHA 24/05/95]. There are no reports of any change in the stable nutritional situation of these refugee populations.

RNIS 11, July 1995

Most recent estimates are that there are 13,300 Chadian refugees and 25,500 Sudanese refugees in the CAR. It is reported that a group of approximately 900 refugees from Mboki camp want to repatriate to the Sudan [DHA 24/05/95]. There are no reports of any change in the stable nutritional situation of these refugee populations.

RNIS 10, April 1995

There are no reports of any change in the situation for the 13,300 Chadian refugees in the CAR. In the past few months their situation has been described as precarious due to erratic and sometimes incomplete distribution of general rations. There are a reported 7,000 refugees who wish to repatriate [WFP 27/04/95].

There is also no reported change in the situation of 25,500 Sudanese refugees where the main problems in the past few months have been inadequate water supply with resulting adverse impact upon hygiene and health. A joint UNHCR/WFP assessment mission in March 1995 found a certain degree of self reliance among these refugees [WFP 27/04/95].

RNIS 9, February 1995

The Chadian refugee population in the CAR had increased slightly to 13,300 by the end of November 1994. There are some indications that these refugees migrate to CAR for the harvest of cotton and other crops. Problems with the distribution of the general ration reported in the previous RNIS report have continued. The November distribution took place three weeks late and supplied a ration with no beans and only half the cereal entitlement [UNHCR-a Nov 94, WFP 16/02/95].

The number of assisted Sudanese refugees remains at 25,500 people. A measles outbreak was reported among this refugee population in late November and resulted in 29 deaths. Necessary medication was flown in and as of mid-December 1994, the epidemic was reportedly under control. There are also reported water supply problems for this population which are apparently having an adverse impact on hygiene and health. The problems are caused by a lack of material for well construction [UNHCR-a Nov 94, UNHCR 07/12/94].

Overall, the Chadian and Sudanese refugee populations may be said to be at moderate nutritional risk (category IIb in Table 1) due to erratic and incomplete general ration distributions in the former case and the measles outbreak in the latter case.

How could external agencies help? While problems with general ration distributions persist there is a need to establish nutritional monitoring to determine any resulting adverse impact. Also, following the recent measles outbreak, vaccination coverage must be re-assessed and further immunisations instigated, if appropriate.

RNIS 8, December 1994

The slow but steady increase in the number of Chadian refugees in the CAR noted in the last RNIS report has continued and by the end of September, the assisted refugee population was just over 13,000. There are also 1,200 unassisted Chadian refugees. During September there were reported problems with food distributions. Due to insufficient food stocks, only half rations of cereals were allocated and oil was only distributed to "vulnerable" cases. As this population has some arable land, many households had a small harvest during September. However, the limited ration during September has meant that much of this meager harvest has already been consumed [UNHCR-a 25/10/94].

Shortage of drugs in the health centres has meant that the number of refugees seeking medical help has halved [UNHCR-a 25/10/94].

The number of assisted Sudanese refugees has increased slightly to approximately 25,500. There have also been food distribution problems for this population, despite an air-lift, and they only received a maize and salt distribution in September [UNHCR-a 25/10/94].

The refugees in the Central African Republic are not currently thought to be at heightened nutritional risk (category IIc in Table 1).

RNIS 7, October 1994

There has been a slow but steady increase in the number of assisted Chadian refugees in the CAR. By the end of July the number had risen to 12,600 refugees. There is no recent information on the nutritional status of this population [UNHCRa 18/08/94].

The number of Sudanese refugees has remained virtually constant at 25,000 people. Rations are reportedly insufficient, but it is thought that the refugees are able to adequately supplement their rations themselves [UNHCRa 18/08/94].

How could external agencies help? For Sudanese refugees the is an urgent need for non-food items (i.e. kitchen utensils, blankets, clothes, jerry cans).

RNIS 6, August 1994

The nutritional condition of the approximately 12,000 Chadian refugees in CAR remains adequate [UNHCR June 94].

There are roughly 25,000 Sudanese refugees in CAR whose nutritional status is reported to be adequate despite some difficulties in transporting food rations [UNHCR April 94]. These are not new arrivals, but there are no details available on their current nutritional status.

RNIS 5, June 1994

There has been no information indicating change in the nutritional and health status of the 12,000 Chadian refugee population [WFP 9/06/94] since the last report in April 1994. The population is categorized as not at particular risk (category IIc in Table 1).

RNIS 4, April 1994

There has been no change in this Chadian refugee population (11,000) since the last RNIS report which, apart from some goitre, indicated a stable nutritional situation.

RNIS 3, February 1994

The civil conflict in Chad early in 1993 caused many people to seek refuge in neighbouring Central African Republic, and 11,000 refugees remain in Boubou camp which is near Bossangoa. In general, the population is in stable condition although the levels of wasting are still too elevated, especially given this is now a well-established camp.

A nutritional survey carried out in November showed 8.8% wasting with 2.6% severe wasting. The crude mortality rate was 1.2/10,000/day (3-4 times normal) and the under five mortality rate was 1.8/10,000/day. Causes of morbidity noted were anaemia (4.6% of morbidity) and goitre (2.3% of morbidity). [AICF 20/11/93]

This population receives a general ration of 880 kcal/day. There must be a certain level of self-sufficiency and/or market access since nutritional status (as indicated by wasting prevalences) has not severely deteriorated. Goitre is reported among the refugee population, indicating the need to provide iodized salt This population is currently at moderate risk (column IIb in Table 2) due to the presence of goitre. [AICF 20/11/93]

United Nations System Standing Committee on Nutrition