|
|
|
Nutrition Information in Crisis Situations
|
| Acute malnutrition (%) | Severe acute malnutrition (%) | |
| December 2002 | 15.0 | -* |
| March 2003 | 11.6 | -* |
| June 2003 | 13.3 | 1.2 |
* Not available from the survey reports
IDPs are intended to receive a food distribution (RNIS does not know about the intended amount of food distributed). However, in March 2003, 75% of the people reported eating only one meal per day.
Water and sanitation seemed to be under-control and health care has been supported by MSF since April 2003 (MSF, 09/04/03). Dry supplementary feeding was in place as well as a TFC. The displaced recently received non-food item distributions (ICRC, 15/07/03).
Pool region
Total access to the Pool region has been granted by the government to the humanitarian community in June 2003, for the first time since March 2002. The preliminary results of a joint assessment mission reported that the situation in the region is very poor, with very high level of destruction of villages, including infrastructure, lack of work in fields for more than one year, short supply of food and medicines and uncertain security conditions (WFP, 20/06/03). According to the MSF survey in the camps in March 2003, about 60% of the IDPs witnessed the destruction of their houses (MSF-H, 03/03). Aid to the returnees in the Pool has been planned, including reconstruction/ rehabilitation of private houses and infrastructure, food for work and distribution of non-food items (WFP, 20/06/03; OCHA, 10/07/03). Some people have already returned but the scale of future returns is difficult to anticipate as some people may prefer delay to their returns until security conditions and basic needs are guaranteed. RNIS has not received any information on the nutrition situation of the population who has stayed in the Pool during the conflict.
Overall
The nutrition situation of IDPs in Brazzaville is precarious (category II), as is probably the nutrition situation of the populations who have been trapped in the Pool region. Donor commitment to this crisis should increase, both to provide relief assistance to the IDPs in Brazzaville and to help the resettlement of the returnees in the Pool region by providing direct assistance to the returnees and infrastructure reconstruct i on/ rehabilitation.
The Republic of Congo has suffered heavily from a series of resurgent civil conflicts in the last six years that have forced hundreds of thousands of people from their homes. RNIS 31 reported that the nutritional situation has stabilized and the outlook for the future is guardedly optimistic as the fighting of the 90s appears to be at and end with the signing of a cease fire agreement on the 29th of December 1999 (UN 2001; UNHCR 2000).
Considerable headway has been made on the road to a lasting peace settlement with broad based discussions. The first phase talks were boycotted by internal and external opposition figures who protested the agenda and the lack of security assurances afforded to them. The talks were lead by the Gabonese president and mediator Omar Bongo. Talks were designed to begin to address the subject of a draft constitution for the country which would mandate a president of the Republic to be elected for a seven year mandate, renewable only once. The draft constitution will be reviewed by referendum at the end of the year. Opposition leaders have criticised the large amount of power given to the president by the proposed constitution and have suggested the creation of two vice presidential positions (PANA 26/03/01).
Humanitarian situation
The humanitarian focus for the first part of the year 2000 was on the provision of emergency assistance to newly accessible areas but this quickly changed to the facilitation of resettlement and to the building of schools, health clinics and other basic services. One of the most positive signs has been the beginnings of demobilisation of the estimated 25,000 ex-combatants with an amnesty on small arms. To date over 16,000 small arms have been handed over, however, it is assumed that a great many probably remain in circulation (UN 2001).
Refugees
The continuation of the war in the Democratic Republic of Congo has resulted in an influx of 100,000 refugees coming over the border to RoC. Latest figures put the number of refugees at over 100,000 and they are currently spread out along a 700 km stretch of the Congo and Ubangui rivers from Bentou in the north to Njoundou and Liranga in the south. They have arrived over the past six months. This is a militarised area and access continues to be problematic. No new information is available on the nutritional status of these refugees. Should the situation in DRC deteriorate further then significant extra numbers of new refugees can be expected. The needs of the Angolan refugee population has greatly reduced over the past year as many have been integrated into local villages (UN 2001; UNHCR 2000).
Table showing numbers of assisted and non assisted refugees in RoC (UNHCR 31/03/01)
|
Caseload |
Assisted |
Non-assisted |
Total |
|
Congolese |
30,000 |
57,200 |
87,200 |
|
Angolans |
3,575 |
14,940 |
18,515 |
|
Rwandans/Burundians |
3,485 |
3,370 |
6,855 |
|
Total |
37,060 |
75,510 |
112,570 |
Overall
The general humanitarian situation, has stabilised over the past year. The majority of the displaced have returned home. The country remains extremely debilitated by previous conflict and much of the future work will involve the rebuilding of infrastructure. A process of establishing a constitution is currently underway, although not all potential actors are involved, which may mean more conflict in the future. The most acute needs in the country are along the border with DRC where refugees remain strung out in insecure zones and access remains problematic. Given the lack of access and insecurity, refugees should be considered to be category II.
Recommendations
The situation in the Republic of the Congo (RoC) has improved dramatically during the first half of the year. The ceasefire agreement has held and much of the civilian population has returned to their homes. Some 630,000 of 810,000 IDPs (of a total population of 2.9 million) are reported to have returned to their places of origin. Humanitarian access has expanded rapidly. Thousands of militia members have been disarmed and disbanded. However, the country requires significant assistance in order to build on these achievements, and avoid a return to war. To date, only 10% of the funds requested by the UN consolidated appeal for the RoC have been received (OCHA - 06/07/00).
Humanitarian situation
Almost complete access to the country is now possible and assessment missions have reached most of the affected areas. Overall, the most serious humanitarian needs are decreasing, although expanded access has increased the potential to actually meet the needs. Needs are also diversifying, shifting in emphasis towards social reintegration and basic community-level reintegration. Health care needs are most pronounced, having accumulated during several years of non-access in some areas. There is also a requirement for clean water and other basic services (OCHA - 06/00).
The conflict seriously affected food security in the southern regions of the country, which previously accounted for 57% of total crop production, supplying two-thirds of the urban consumption. According to recent missions to war-affected areas, the revival of agriculture and livestock production has not yet started, except for limited vegetable production in some areas (OCHA - 06/00).
Map of the Republic of the Congo
WFP provided food to some 200,000 persons in Brazzaville, Pointe Noire and accessible areas of Pool, Bouenza, Niari and Lekoumou regions in the first half of this year. The agency anticipates providing food to an average of 120,000 beneficiaries until the end of the year (OCHA - 06/00).
Brazzaville
The nutritional situation in Brazzaville has stabilised. The most recent nutritional surveys by ACF-F of children and adults in north and south Brazzaville found a low prevalence of malnutrition (see RNIS 30). The prevalence of malnutrition was higher in both adults and children in south Brazzaville than north Brazzaville (ACF-F - 03/00).
All age groups in southern Brazzaville were equally affected by malnutrition. In the northern parts of the city, malnutrition affected the 6-29 month group more. This indicates that the population in the south was more severely affected by the recent conflict; almost the entire population was displaced from this area. Malnutrition is more common among the displaced and returnees than the people who stayed in the city (ACF-F - 03/00).
ACF also undertook a mortality survey at the same time. The results indicated that 13.5% of children less than 5 years died in the Pool region during the period of displacement. The primary cause of death was malnutrition. Approximately 6% of the total population of Pool died during the same period. However, CMR estimated over the 30 days prior to the survey was lower (0.79/10,000/day) as was mortality under-five, which was estimated at 1.7/10,000/day. These results imply that the problems of food security and nutrition arose mainly when the population was displaced in the Pool Region (ACF-F - 03/00).
Measles vaccination rates were low (21.8% according to vaccination cards, and an additional 32% according to mothers). Vaccination should be a priority (ACF-F - 03/00).
At the time of the survey, Brazzaville's economy was reported to be improving, however food security remained fragile. Market prices continue to fluctuate because of irregular supply (due to strikes, poor or unopened railways, high oil prices) and a lack of seeds for market gardens (ACF-F - 03/00).
Southern Regions
A recent humanitarian mission to Pool, Kinkala, Boko, Mindouli and Kibuende reported that the nutritional situation in these areas is generally under control. However, the need for shelter and health services are acute, especially in Kibuende. Between 4,000 and 5,000 people have returned to Kibuende where almost all housing has been destroyed. No health or sanitation facilities exist (OCHA - 06/00, 06/07/00).
Approximately 41,000 households have been registered as potential beneficiaries for WFP food in the Pool, Niari, Bouenza and Lekoumou regions following recent assessments (WFP - 16/06/00). FAO plans to assist some 100,000 farming households affected by the crisis in these areas through the distribution of essential inputs including seeds and tools. The agency will also assist with the resumption of small-scale livestock production and the rehabilitation of fish farms. ICRC has begun to assist a food security and income-generation programme for IDPs returning to Pool and Lekomou. (IRIN - 14/07/00; OCHA - 06/00).
Refugees
Between 11-12,000 refugees have arrived in the first two weeks of July in Liranga and Njoundou, about 500 km north of Brazzaville, escaping renewed fighting in Equateur province in DRC. The fighting in Equateur has also forced UNHCR to suspend all relief interventions on the Congo River and use much more difficult land routes. UNHCR is investigating the possibility of moving the refugees away from the volatile river area. A shigella outbreak has been reported among the new refugees (IRIN - 14/07/00; UNHCR - 21/07/00).
In addition to the refugees in Liranga and Njoundou, a further 20,000 refugees from Equateur have settled further along the Ubangui river in RoC. UNHCR estimates that there are between 5,000 and 10,000 refugees in wholly inaccessible areas along the river border area, bringing the overall total of refugees from DRC in RoC to over 40,000 (IRIN - 14/07/00; UNHCR - 21/07/00).
There is no new nutritional information on the 8,000 Angolan or 5,000 Rwandan refugees in RoC. UNHCR has appealed for funding to assist in the integration of up to 5,300 Rwandan and Burundian and 5,000 Angolan refugees in RoC. The agency also plans to assist some of the Angolan refugees to repatriate (OCHA - 06/00).
Overall, the nutritional situation in RoC has stabilised. The IDPs and returnees are still considered to be at moderate risk because many have lost their livelihoods (category III). They may be considered more food-secure after the next harvest. The newly arrived refugees from the DRC are considered at higher risk (category II) because of the insecurity in the areas in which they have settled, and UNHCR's difficulties in providing assistance. The nutritional situation of the Angolan and Rwandan refugees is unknown (category V).
Recommendations and priorities:
From the survey in Brazzaville (ACF-F - 03/00):
The second peace accord between the Government and opposition parties in the Republic of Congo (RoC) was signed on 29 December 1999 in Brazzaville. This has consolidated the first accord of 16 November and has resulted in a decline in military activities in the country. No reports of fighting have been received during the reporting period. Militia members are beginning to disarm voluntarily. Humanitarian access is expanding rapidly and approximately half the interior is currently reachable. The UN and NGOs are starting to provide rehabilitation assistance in communities of return, many of which had been completely gutted and left with few or no social services and economic activities (IRIN - 24/02/00, 10/03/00).
Displacement
The humanitarian situation is currently characterised by the continuous movement of displaced people from the forests to their homes and villages, particularly in areas where security is guaranteed. An estimated 400,000 people had returned by mid-February and a further 200,000 are expected to have returned home by April or May 2000. Thus approximately 600,000 (three-quarters of those who were still displaced in December 1999) may have returned home by the middle of this year (IRIN - 24/02/00, 10/03/00). At the same time, some displacement from the Pool to Brazzaville continues because of a lack of access to resources and health care in the Pool (ACF - 30/03/00).
Brazzaville
The nutritional situation in Brazzaville has improved dramatically since September 1999 (see RNIS 28). ACF-F conducted nutritional surveys among both adults and children aged 6-59 months in March in both the southern and northern zones of the city (see annex). The prevalence of acute malnutrition varied from 5.4-6.6% in children and 7.4-4.3% in adults (adult malnutrition was defined using a BMI<17.0kg/m2 for those aged 18-49 and BMI<16.0kg/m2 for those aged fifty or more, and/or oedema), indicating that, currently, there is not a nutritional crisis in the city (see graphs). The nutritional situation of the population is, however relatively precarious given that there are still many displaced families from outside Brazzaville (mainly the Pool) living with host families (ACF-F - 30/03/00). Previous assessments in Brazzaville found that IDPs were at higher risk of malnutrition than the residents (see RNIS 29).
The prevalence of acute malnutrition in children aged 6-59 months (defined using z-scores and/or oedema) in Brazzaville
The prevalence adult undernutrition (defined using the BMI an/or oedema) in Brazzaville
The Pool region
IDPs are returning to their homes in the Pool region as the security situation stabilises. Access to the Pool and the resumption of private and public transport has reduced the number of displaced at risk. The ICRC has closed their reception centre in Brazzaville for people displaced from the Pool. Humanitarian agencies have begun to undertake nutritional assessments in the region. Previous information about the nutritional situation in Pool was mainly obtained from reports from IDPs in safer areas. ACF opened therapeutic feeding centres in Boko and Mindouli (ACF-F -30/03/00).
In February, ACF-F undertook a MUAC assessment in Mayama (central Pool) on children between 75 and 130 cm tall (see annex). Eighteen percent of the sample was severely malnourished (MUAC<110mm) and 24.1% were had low MUAC (MUAC<125mm). The severely malnourished were taken to Brazzaville for treatment. In March in north Pool, ACF recorded MUAC measurements on 1903 children in various locations (the sampling methodology is currently unknown to the RNIS): 2% had very low MUAC and 9.9% had low MUAC (see annex). Thus the nutritional emergency in Pool appears to have passed, although ACF-F has stressed that there is an urgent need for medical assistance in the region (ACF-F - 30/03/00).
Niaria and Bouenza regions
ACF-F have reported that the nutritional situation in both Dolisie and (Niari region) and Nkayi (Bouenza region) is better than in Pool. This is partially attributed to easier access to food through farming and markets (ACF-F -30/03/00).
Refugees in RoC
Refugees from DRC have been crossing into RoC during the reporting period. They are fleeing fighting between rebel and government troops in Equateur Province, DRC. An estimated 25,000 refugees have settled in villages on the RoC side of the river Oubangui stretching some 500 km from Betou to the north and Njoundou to the south. Many of the refugees are fisherman and obtain their food from the river. UNHCR is facing fuel shortages and general insecurity in the area and hence the relief operation is extremely difficult. The agency has managed to provide plastic sheeting, fishing nets and soap to 13,500 refugees in 17 villages (IRIN -13/03/00; UNHCR -10/03/00).
There is no new information on the nutritional situation of the 8,000 Angolan or 5,000 Rwandan refugees in RoC.
Overall, the returnees to Brazzaville and war affected in the Pool and other areas, are considered at moderate risk of malnutrition, because although humanitarian agencies have access to them, many have lost their livelihoods (category III). Their nutritional risk has declined because of increased stability and humanitarian access. The nutritional situation of the other IDPs and returnees and refugees is unknown (category V).
Recommendations and priorities:
From the ACF-F surveys:
The Republic of Congo (RoC) collapsed into an intense civil war in December 1998 after only a short period of relative stability since the large-scale fighting in 1997. Hostilities began in the Pool region in September 1998, spread to Brazzaville in December, and went on to cover most of the southern part of the country. A sustainable solution to the conflict has not yet been found, although there have been reports of an accord signed between the Government’s armed forces and representatives for the Ninja and Cocoye rebels in Point Noire in November. Sporadic skirmishes between government forces and opposition-backed militia continued over the reporting period, although on a reduced scale. Abuses of human rights continue, particularly against IDPs. Currently, opposition forces control only a few areas and all major towns are under government control. The Government has adopted a policy of normalisation and has requested all IDPs to return to their homes (IRIN-19/11/99, 26/11/99; OCHA -11/99).
Numbers affected
An estimated 810,000 people have been displaced by the conflict in RoC, mainly from Brazzaville, Dolisie and Nkayi. As of the end of October, an estimated 200,000 IDPs had returned to urban areas, but a further 170,000 remain displaced in urban centres and 440,000 people remained displaced in rural areas (see map). A further 30,000 people are refugees in DRC and Gabon, the majority of which are in Gabon (OCHA-11/99).
Republic of the Congo 810,000 displaced and returned persons
Sources: UN, Government, donor, NGO and church representatives.
Access
Access for the delivery of humanitarian assistance up until the second half of this year was mainly restricted to Brazzaville and Pointe Noire. Only small areas of the interior of the country could be reached by humanitarian agencies on an irregular basis. WFP has been unable to distribute all of the food aid it planned and many of the IDPs in the forests or rural areas have not received humanitarian assistance (IRIN-26/11/99; OCHA-11/99).
The fighting in RoC has disrupted agriculture and marketing activities, and reduced food imports throughout the country. The two most important agricultural areas of the country, Pool region and the Niari valley, have been seriously affected by the war (ACF-F -11/99; FAO/GIEWS -10/11/99).
Brazzaville
The population of Brazzaville was estimated at 950,000 before the recent crisis. The population’s main economic activities were trade, petty trade and agriculture (mainly vegetable gardening). Approximately 70,000 people were employed by the state. However, their salaries were paid infrequently; most of them were also involved in other income-generating activities (ACF-F-11/99).
Following the fighting in December 1998, the population living in the southern parts of Brazzaville were displaced. Of these, approximately 60,000 moved into camps or with host families in the north of the city, 200,000 people fled to the Pool region and approximately 30,000 found refuge in the DRC.
The displaced population is currently returning to Brazzaville, and the most recent figures (end of October) indicate that 150,000 people have returned. A further 60,000 people from rural areas have also gathered in Brazzaville (OCHA -11/99). An ICRC assessment estimated that about 20-30% of people living in the southern quarters of Brazzaville were displaced (ICRC -10/99). There has been a decrease in the numbers of returnees in November (IRIN - 19/11/99) which could mean that the majority have now returned, and a proportion of the people still absent have died (ICRC -10/99).
Nutritional situation in Brazzaville
Extremely high prevalences of malnutrition have been recorded among the returnees to Brazzaville. Until the end of September, the prevalence of severe malnutrition (mostly kwashiorkor) in newly arrived children under-five in Brazzaville remained constant at about 20% (see RNIS 28). It is worth noting that oedematous malnutrition was unknown in the RoC prior to the current conflict. After the 1997 war, MSF reported a prevalence of severe malnutrition of 1.6%. The causes of malnutrition in the arrivals clearly originate in the Pool Region. By July 1999, the population in the Pool were effectively cut off from all food sources except cassava (ICRC-10/99).
In September, agencies in Brazzaville noticed the development of oedema in individuals who were apparently healthy on arrival. Oedema developed 1-3 weeks after arrival. As this problem also occurred in the displaced who received a regular general ration from ICRC, it is likely that the causes were related to the development of a metabolic abnormality whilst in the Pool Region, either as a result of a deficient diet or infection (Golden - 9/99). An increase in salt consumption after arrival in Brazzaville was associated with the increase in oedema. IRC/UNICEF and ACF are investigating this problem further.
Food Security in Brazzaville
ACF-F assessed food security in Brazzaville to establish what coping mechanisms people were using and which groups are the most vulnerable (ACF-F - 9/99). ICRC later assessed food security of both displaced persons from the Pool Region and returnees to Brazzaville (ICRC ~ 10/99). The main findings of the assessments are summarised below:
Humanitarian situation outside Brazzaville
In the week of 17-24th September, ICRC carried out a mortality survey on every third family arriving at the transit centre in Brazzaville. The main aim of the survey was to confirm the severity of the situation as indicated by the high malnutrition rates in new arrivals. Also, interviews with new arrivals indicated that a large proportion of family members had died (ICRC-10/99).
In total, 399 families that originated from the Pool Region and 1151 families who came from Brazzaville were interviewed. Using the pre-war population of the families as a baseline, it was estimated that 4.4% of Pool residents had died between December 1998 and September 1999, and 5.6% of Brazzaville residents (ICRC -10/99).
Mortality rates in Brazzaville residents increased gradually between December and May and reached crisis proportions by June 1999 (2.6/10,000/day). By August mortality was 4/10,000/day. For Pool residents, mortality showed a sudden increase from June, and by August was 5.5/10,000/day. The major cause of death for both groups was malnutrition (usually identified as swollen feet). All age groups were affected. In both groups, about 25% of deaths were in the 15-45 year age group (ICRC -10/99). There is no new information on the nutritional situation of the IDPs or residents outside of Brazzaville. Much of the area is still inaccessible to humanitarian agencies except Kinkala, a town 65 km south west of Brazzaville (IRIN - 29/10/99; Oxfam-08/12/99).
Refugees in RoC
No new information on the nutritional situation of 8,000 Angolan or 5,000 Rwandan refugees in RoC is currently available.
Recommendations and priorities:
From the food security assessments in Brazzaville:
Overall, the situation remains critical for those people in inaccessible areas, given that their mortality had already reached very high levels in August (category II). The prevalence of acute malnutrition in new arrivals is assumed to remain high. However, after their arrival in Brazzaville their food security situation rapidly improves due to resumption of economic activity, food distributions and feeding programmes. Therefore, the nutritional situation of the population in Brazzaville is considered less critical (category III). The nutritional situation of the IDPs in other areas and the refugees is unknown (category V).
The humanitarian situation in the Republic of Congo (RoC) has been characterised as a forgotten war, no peace initiative has been sponsored at either the domestic or the international level since the war resumed in December 1998. Large numbers of people have fled their homes and are dispersed in forests, remaining inaccessible to the humanitarian community. An estimated 332,000 people have been displaced by the conflict (OCHA - 19/08/99).
The presence of numerous militia allied to different political factions has complicated negotiations for access. Reconciliation talks and offers of amnesty by the government to those who have taken up arms have not been taken seriously. Reports of continued harassment of IDPs and refugees returning home to Brazzaville persist.
The government, meanwhile, has adopted a policy of normalisation encouraging the return of Brazzaville residents from the Pool region and the DRC since May. Between May and mid-August, nearly 175,000 people have moved to the capital - this figure includes IDPs who had sought refuge in the Pool region at the outset of fighting, residents of Pool seeking refuge in the capital and refugees who had been in the DRC. At the time of going press, approximately 1,000 people per day were arriving in Brazzaville (Jaspars - 23/09/99; OCHA -19/08/99).
Brazzaville
When people return to Brazzaville they are registered. Those with no address, relatives, or friends in the city go to a displaced site. All returnees receive a week's ration. Those in the displaced site receive food as long as they are in Brazzaville (i.e.: have not returned to Pool). The ration is currently determined by WFP's food availability.
MSF-F has been screening children under-five as they are registered. Very high levels of malnutrition have been continuously found since early August, as can be seen in the table below. Note that these results are from a screening and may be biased (e.g., it is possible that some children were not measured or that others were.
|
Date of screening |
Oedema |
<70% median weigh-for-height |
70-89% median weight-for-height |
|
2/8-8/8 |
17.3 |
2.1 |
12.4 |
|
9/8-15/8 |
19.7 |
6.0 |
14.4 |
|
16/8-22/8 |
22.0 |
4.1 |
14.3 |
|
23/8-29/8 |
20.2 |
5.5 |
19.8 |
|
5/9 |
21.7 |
4.3 |
16.5 |
Older children and adults in Brazzaville are also suffering
from malnutrition. 63.8% of all admissions to the therapeutic feeding centre in
August were people over 5 years old: this is indicative of the wider nutritional
problem (MSF-F - 08/99).
In August, CARITAS started a food distribution for vulnerable families in Bacongo and Makelekele with WFP food. Approximately 37,000 vulnerable families were identified, who received food for five days. The number of vulnerable people registered has since been increased to 50,000 to include all those discharged from feeding programmes, but there have been no distributions since August due to pipeline difficulties. WFP reports that local food purchasing is being considered, pending the arrival of food through the regular pipeline (WFP -17/09/99).
Pool
Information on the situation in Pool and Nibolek, home to 800,000 Congolese, is limited as neither the humanitarian or religious communities are able to obtain access to these areas; or cannot go without a military escort. Anecdotal reports describe a situation where the local population is trapped between the Ninja militia and the army. Many people are unable to leave Pool and have very little information about the situation in Brazzaville. Travel along the main road is dangerous. Those people who have arrived in Brazzaville have spoken of leaving weaker family members behind and of many deaths.
The Pool region was one of the main suppliers of Brazzaville's markets, selling cassava, vegetables, pulses, wood, palm wine, cattle etc. Traders would return with salt and smoked fish form the north of the country. At the start of the crisis the population of Pool could generally access their farms in the forest and obtain food, however, since July the price of cassava has dropped to very low levels.
In addition to the very poor food security situation all state care services including health care have broken down in the Pool area.
Refugees in RoC
It is hoped that the 2,600 Rwandan refugees of concern to UNHCR in the RoC will be locally settled as soon as possible. An agreement, although not yet formalised, has been reached with the Government and it is hoped that the programmes can be implemented soon (UNHCR - 27/09/99). No information is available on the nutritional situation of the 8,000 Angolan refugees in the country.
Overall, the situation in RoC is very serious. In Brazzaville, the available information indicates that the situation is critical, and the returnees are classified as category (I). Information is not available for the rest of the country, but the displaced populations in Pool are also considered to be at high risk, given the security situation described and the condition in which people are leaving the area (IIa). The nutritional status of the refugees is unknown (category III).
Priorities and Recommendations
The health and nutritional situation of the people returning to Brazzaville is reported to be "catastrophic". Over 30,000 people have returned to Brazzaville from places where they have been hiding since December 1998. Much of the capital (particularly the southern suburbs of Makelekele and Bas Congo) was emptied during fierce fighting between the government and rival militia forces in December and January. Many of the IDPs have been hiding in the forests for months, subsisting only on roots and other wild foods; thousands are believed to still be there.
Some of the displaced people are now being transported back to their homes by the Congolese army and UNHCR. It is estimated that the influx of IDPs could reach 100,000 by the end of June (IRIN - 06/05/99, IRIN-19/05/99, 23/06/99; WFP- 10/06/99, 16/05/99, 31/05/99).
Fighting still continues sporadically. Ninja militia aligned with former prime minister Bernard Kolelas have attacked army forces in the Brazzaville area several times resulting in civilian deaths and short term population displacement. The militiamen are also active in the south of the country (IRIN - 11/05/99, 13/05/99, 07/06/99). Moreover the Ninja militiamen have warned that they will obstruct any humanitarian aid to the south of the country by military means unless certain conditions are met. Any assistance to areas under the control of the rebels must first be negotiated with their leaders and humanitarian agencies may not be escorted by government troops (IRIN - 26/05/99).
Brazzaville
MSF-F reports that in Makelekele between 6th and 29th May, 822 individuals (approximately 75% of whom were children under five) were admitted to the therapeutic feeding centre. Over 75% of these individuals were oedematous. In addition, in a single two week period in May approximately 2,900 individuals were admitted to a supplementary feeding programme. Security conditions do not permit a full-scale survey or screening of the population, but there can be no doubt that a large number of the newly returned children and adults in the city are in very poor nutritional condition. MSF-F states that a general food distribution is urgently required. In addition to this, the NGO reports that the risk of a cholera epidemic in the city is very high (MSF-F -03/06/99).
WFP has responded to the crisis by borrowing money from its emergency fund to meet the most immediate food needs of 100,000 of the worst affected people. This is an addition to the 50,000 people it is already assisting in the country (25,000 in Brazzaville and 25,000 in Pointe Noire).
Poole area
The security situation in the Poole area is very poor and it is difficult even for local NGOs and Churches to gain access. The latest reports suggest that the army is making way against the Ninja rebels (IRIN - 13/04/99, 30/06/99). An unknown number of displaced people are in the area around Pool, however increasing numbers of refugees from this area are reported to be crossing into the Bas-Congo province of DRC (IRIN - 30/06/99).
In contrast, security is reported to be improving in some parts of the country and some of the 120,000 IDPs who fled from the southern towns of Dolisie and Nkayi are returning to their homes (WFP - 20/04/99). A UN-Government team which visited the towns in early April described very poor health and sanitation services in the almost deserted town of Dolisie; cases of Kwashiorkor were reported amongst some of the children present (IRIN-13/04/99).
Refugees in Congo-Brazzavile
As reported in RNIS 26, Kintele camp has become militarised and hence UNHCR has withdrawn (and ceased most activities). 2,600 Rwandans remain in the north (Lukolela) of the country and continue to be assisted (UNHCR - 28/06/99). No information on the nutritional status of these refugees, or the 8,000 Angolan refugees in the country, is available to the RNIS.
Overall, the situation is extremely serious, and although no surveys have been undertaken, reports from feeding centres indicate that the IDPs and returnees within Brazzaville have a high prevalence of malnutrition (category 1). Information is not available for the rest of the country, but it is also considered to be at high risk (category IIa). The nutritional status of the refugees is unknown (category III).
Priorities and Recommendations:
In Brazzaville, given the very serious situation:
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
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.
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].
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:
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].
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].
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].
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