United Nations System
Standing Committee on Nutrition

Nutrition Information in Crisis Situations - Democratic Republic of the Congo
 

NICS 16, March 2008

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

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

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

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

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

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

Figure 9 Mortality rates, DRC

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

NICS 15, December 2007

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

Cholera outbreak confirmed in South of country

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

High levels of severe acute malnutrition persist

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

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

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

NICS 14, September 2007

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

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

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

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

NICS 13, May 2007

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

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

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

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

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

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

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

Overall

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

NICS 12, February 2007

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

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

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

NICS 11, November 2006

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

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

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

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

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

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

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

Overall

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

NICS 10, August 2006

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

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

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

NICS 9, May 2006

Appalling situation among IDPs in Katanga

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

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

Overall

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

NICS 8, January 2006

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

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

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

NICS 7, August 2005

Improvement of the situation in Shabunda health zone, South Kivu

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

Figure 9 Nutrition status in Shabunda health zone, South Kivu

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

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

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

NICS 6, May 2005

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

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

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

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

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

NICS 5, February 2005

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

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

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

Mortality rates in western and eastern DRC

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

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

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

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

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

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

Figure 4 Mortality rates in DRC

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

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

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

NICS 4, November 2004

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

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

NICS 3, August 2004

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

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

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

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

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

NICS 2, May 2004

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

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

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

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

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

Table 19 Results of nutrition and mortality surveys, DRC

Average nutrition situation in Shabunda and Lemera, South Kivu

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

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

Acceptable nutritional status in Moba and Kansimba, Katanga

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

Nutrition situation of concern in Bankusu, Equateur

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

Overall

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

NICS 1, February 2004

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

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

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

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

Recommendations

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

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

RNIS 43, November 2003

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

Oicha and Mutwanga, Beni, North Kivu

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

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

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

Kabala, Kalemie, Katanga Province

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

Overall

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

Recommendations:

From the WV survey in Beni

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

From the MSF-S survey in Kalieme:

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

RNIS 42, August 2003

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

Ituri, Orientale province

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

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

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

Lubumbashi, Katanga province

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

Mortality rates in Western and Eastern DRC

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

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

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

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

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

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

Crude and under-five mortality rates, DRC, 2002

RNIS 41, April 2003

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

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

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

North Kivu

Bwito, Rutshuru

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

Masisi

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

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

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

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

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

South Kivu

Fizi health zone

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

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

¹ According to card or mother's statement

Maniema province

Kindu town

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

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

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

Kasai Oriental province

Kabinda, Kalonda and Lubao health zones

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

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

* Needs to be confirmed

Katanga

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

Malemba N'Kulu health zone

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

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

Dilala and Manika health zones, Kolwezi district

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

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

Bandudu province

Inongo

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

Overall

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

Recommendations and priorities

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

Short-term:

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

Long-term:

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

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

• Implement a nutrition programme
• Support health centres

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

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

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

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

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

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

From the RNIS:

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

République Démocratique du Congo

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

RNIS 40, Dec 2002

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

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

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

Upsurge in displacement

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

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

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

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

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

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

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

Maniema province

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

Refugees

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

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

République Démocratique du Congo

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

RNIS 39, October 2002

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

Internally Displaced Persons

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

Repatriation of Refugees from Rwanda

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

Nutrition and health situation

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

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

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

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

Recommendations and priorities

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

RNIS 38, July 2002

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

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

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

War displaced populations

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

Humanitarian situation

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

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

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

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

Western Region

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

Northern Region

Equateur

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

Orientale

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

Southern and Eastern DRC

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

Kasai Orientale Province

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

North and South Kivu

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

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

Overall

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

Recommendations

From the RNIS

• Negotiate access to affected populations through support of MONUC.

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

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

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

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

RNIS 36/37, April 2002

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

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

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

Numbers and distributions of IDPs

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

Humanitarian situation

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

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

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

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

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

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

Western Region

Kinshasa

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

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

Northern Region

Equateur Province

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

Orientale province

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

Southern and Eastern DRC

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

North and South Kivu

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

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

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

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

Maniema Province

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

Katanga province

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

Refugees

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

Overall

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

Recommendations

From the RNIS

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

From the WVI survey in Oicha

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

RNIS 35, October 2001

In 2001 there have been significant strides forward in the peace process with increasing attempts to involve some of the key rebel groups whose absence from the talks has proved to be one of the key obstacles to their progression. To this end, talks were scheduled for October 15^th in Addis Ababa, to include delegations from government, rebels, opposition parties and civil society to start a national reconciliation dialogue (UNICEF 23/10/01). The talks represent a potentially ground breaking commitment to move forward in the peace process; however, they broke down after a week, with the walk out of the DRC government delegates. Whilst the initial failure of the talks is indicative of the many obstacles to peace in DRC, all parties have indicated their commitment to join further talks, probably at the beginning of 2002.

In general, the cease-fire along the front line is still largely respected and forces have continued to disengage. In particular, Ugandan forces have largely withdrawn from Equateur province but will maintain a battalion in the East and Namibia has withdrawn its troops (UNSC 16/10/01). However, warring factions, ethnic groups, and increasingly isolated non-state actors continue to clash in the east of the country and the general security situation is very poor. MONUC recently reported that armed groups and soldiers from Rwanda, Burundi and the Congolese Rally for Democracy (RCD) are taking part in intensified clashes around Fizi in south Kivu (UNDPI 27/09/01). There are also indications that remaining Ugandan and Rwandan troops are likely to clash over disputing front line positions in Kanyaboyanga inNorth Kivu province (PANA 26/10/01). These and other smaller clashes continue to have a very profound affect on the ability of humanitarian agencies to access many areas containing populations with acute needs.

The reporting period has seen the continued deployment of MONUC troops and observers in numerous areas of the country and as of October 15^th, 2001, there were a total of 2,408 military personnel in the country. To date, MONUC has deployed in many critical areas within the country, particularly to cities such as Kisangani, Mbandaka, Kalemie and Kananga. From the areas of deployment they have been able to oversee the disengagement of troops and monitor the cease-fire, however there are still many areas where they have no access. MONUC deployment has three phases, the first two being the disengagement of troops from the front line and the preparation of plans for the withdrawal of foreign troops. In a recent report, the Secretary-General of the UN has indicated that it is time to move to phase III which is the organisation of the disarmament, demobilisation, repatriation, resettlement and reintegration (DDRRR) of warring parties (UNDPI 27/09/01). The Secretary-General stressed that MONUC has neither the means nor mandate to carry out many of the practical tasks of the DDRRR but the intention to move to phase III is an indication of how far the peace process has come. It is important to note that should fighting continue the future of phase III is likely to be jeopardised.

Numbers and distributions of IDPs

The current caseload of IDPs is estimated to be 2,045,000 IDPs. This represents an increase of 35,881 since April 2001 (OCHA 12/10/01). However, much of this increase is likely to be a result of IDPs from newly accessible areas and not as a result of new displacement. Many of the displaced remain in the eastern areas of the country where fighting is still ongoing and where access is still often extremely difficult. There are also currently an estimated 361,720 refugees (OCHA 12/10/01).

Table showing distribution of IDPs by province

Area	Dec 2000	Apr 2001	Sept 2001
Equateur	300,000	170,524	85,000
Orientale	160,000	220,000	230,000
North Kivu	640,000	620,000	760,000
South Kivu	350,000	373,158	225,000
Katanga	305,000	354,000	415,000
Maniema	137,000	132,000	160,000
E. Kasai	30,000	114,000	130,000
W. Kasai	80,000	29,000
Kinshasa	N/a	N/a	40,000
TOTAL	2,002,500	2,012,682	2,045,000

Humanitarian situation

Despite the peace process and the resultant cease-fire and disengagement of armed groups, the humanitarian situation remains critical. There has been increased international awareness of the crisis and the overall humanitarian response has been good. However the humanitarian needs are huge. A study by WHO and UNICEF shows that the vast majority of the population can be classified as living in absolute poverty, surviving on the equivalent of 0.20 US dollars a day and consuming less than two thirds of the daily food energy needed to maintain good health. Approximately 70% of the population have little or no access to health care and up to sixteen million people, or one third of the entire population, have critical food needs as a result of prolonged displacement, isolation, lack of market outlets, severed food supply lines, price increases and declining purchasing power. Within this grim humanitarian context, acute food insecurity and malnutrition are widespread, along with rates of morbidity and mortality that are routinely well above emergency thresholds (UN 2002; UNSC 16/10/01).

Given the scale of the needs within the country it is concerning to note that there is still an enormous problem of access to many areas. Part of the reason for this lies in the physical isolation of many areas, which creates enormous logistical problems to the supply of aid. It is estimated that out of 58,000 Km of road network only 3,000 Km remain in working order and over 80% of the rail network has been destroyed (Moreels 07/01). The other major constraint to access has been the insecurity seen in many areas, which has made it impossible for humanitarian agencies to work in any safety. The scale of the needs makes the inability to access vulnerable populations extremely serious.

Kinshasa

Kinshasa has not experienced the insecurity seen in the east of the country but has been gravely affected by the collapse in the economy and the break down in the supply of food from the east, which traditionally supplied the markets. As a result, the population remain extremely vulnerable, and WFP announced that it was considering distributing food to 81,000 vulnerable people (WFP 27/07/01) in the province. It is currently estimated that there are 40,000 IDPs in the province (OCHA 12/10/01) with numerous other vulnerable groups including 28,262 malnourished children (WFP 28/09/01). The RNIS has not received any new nutrition survey information from Kinshasa but the situation is understood to be extremely poor.

Eastern DRC

The crisis in DRC is at its most acute in the east. The area is the scene for some of the fiercest fighting and is home to countless armed militias allied to different countries and regimes, but whose allegiances often shift. The fighting has tended to be concentrated around the two Kivus and Maniema province, particularly around the larger towns Uvira, Bukavu, Goma, Kisangani, Kindu, Punida, Kampene, and Kalima. However, the entire area is considered insecure. The fighting has taken an enormous toll on the civilian population and it is most starkly seen in a mortality survey conducted by IRC which calculated that over 2 million people have died as a direct result of the fighting in eastern DRC since the start of the war in 1998 (see RNIS # 32/33). The situation in eastern DRC remains extremely critical.

Orientale

There are currently estimated to be 230,000 IDPs in Orientale, an increase of 10,000 from figures released in April (OCHA 12/10/01). The province is headed by the important city of Kisangani, which has been the focus and source of much fighting. The province is under rebel control and is largely split between factions that are loyal to either Uganda or Rwanda. It has also been the source of bitter ethnic conflict between Lembu and Hema, which has left thousands dead and displaced. The RNIS has no recent nutritional information from the province but the situation is thought to be serious.

Kisangani

MONUC have continued to be deployed in the town, which remains firmly under the control of the RCD rebel group. The RCD have rejected calls to demilitarise the town and maintains forces there allegedly to counter the threat of attack by the Mai-Mai and Interahamwe. There have been no reports of recent conflict in or around the town, but the RNIS does not have any recent nutritional information on the situation of IDPs in the area.

North and South Kivu

The situation in the Kivus remains extremely precarious. There are currently estimated to be 985,000 thousand displaced in the region, but numbers are hard to verify and are likely to change frequently as a result of continued conflict between the many different rebel groups in the area. The insecurity and lack of infrastructure in the region continues to obstruct humanitarian access and reports indicate that there have been numerous incidents of humanitarian workers being ambushed. On Oct 15^th a WVI car was ambushed and the occupants robbed on the road from Beni to Bunia in north Kivu (OCHA 22/10/01). WFP operations have also been severely hampered by insecurity in the plains of Ruzizi and Uvira and all field missions have been suspended. There have also been extensive movements of troops in Bunyakiri, Hombo and Nyabibwe that have resulted in new population displacement towards Walungu, Kabare, Shabunda and Ninja (OCHA 06/11/01). There has also been a considerable escalation of violence around the town of Fizi and reports indicate that up to 6,000 people have fled across lake Tanganyika to Tanzania in order to escape the violence (RI 25/10/01).

The insecurity in the Kivus is extremely unpredictable and changeable. As a result, large sections of the population are displaced and suffer from poor access and availability of food. There is also a considerable problem of lack of access to health facilities, which has led to outbreaks of disease. There is currently a meningitis outbreak in Katana in south Kivu but OCHA estimates that only seven out of fourteen health zones are currently accessible and so vaccination is not possible for much of the population (OCHA 22/10/01). On Oct 16^th MSF announced that it was launching a healthcare program in Shabunda, which is the first time that international aid has reached the place over the last 18 months (MSF 16/10/01). The RNIS does not have any recent nutritional information from the area but the population is considered to be extremely vulnerable to nutritional decline.

Maniema Province

Maniema province continues to suffer from extreme insecurity. There are currently estimated to be 160,000 IDPs in the area. The last survey from the area of Kalima town indicated that levels of acute malnutrition had improved and this attributed to improvements in the overall security situation of the province. The RNIS has not received any new reports on the nutrition situation but notes that WFP reports that they suspended their activities in the area of Kindu as a result of violent clashes (WFP 05/10/01). This again highlights the unpredictability of security in the area and it is unlikely that any large-scale return of displaced will take place until there are concrete indications of a working cease-fire and demobilisation of armed groups. There are also plans for MONUC to develop an operational and logistics base at Kindu as part of plans for Phase III of the MONUC mandate, which includes the disarmament, demobilisation, repatriation, resettlement and reintegration (DDRRR) of warring parties. This would make Kindu the main hub of activities within the east of the DRC. In order for the plan to go ahead there will have to be considerable improvements in the security situation and it would be necessary to rehabilitate the rail and river link between Kisangani and Kindu. At the moment, all supply is done by air but this will limit the size of any possible operations due to cost (UNSC 16/10/01).

Katanga

The north of Katanga is an extremely fertile area that used to produce a surplus of food and supply other areas. However, the presence of the front line running across the province, has shut down much of the agricultural activities and cut off access to markets for both producers and consumers. There are indications that the security situation is stable in some areas and there are reports that civilians are now travelling across the front line. However, many areas remain cut off from assistance and on Sept 28^th WFP started an appeal to airlift food to 25,000 people in North Katanga who remain cut off by war (WFP 28/09/01). There is particular concern over the people of Mulongo and Kiambi who have been unreachable by air or road due to the insecurity.

Whilst the situation in north Katanga remains critical, World Vision also highlight desperate needs in south Katanga in the town of Kalomeno, where 3,000 IDPs remain acutely food insecure and in need of food and agricultural inputs. World Vision stress that the population appears to be heavily dependent on food distributions to meet their food needs (WVI 27/09/01). The RNIS also notes with concern that there is currently an outbreak of cholera in Ankoro in north central Katanga and on October 14^th there were 221 recorded cases. Access to the area is very difficult and is constraining efforts to bring the outbreak under control (OCHA 22/10/01). The RNIS has not received any new nutritional information from the area.

Equateur

It is currently estimated that 85,000 people remain displaced by conflict and the presence of armed militias in the area (OCHA 12/10/01). There have been reports of looting of food crops and the presence of land mines and both have served to drastically reduce both the availability and accessibility of food. There have also been problems of ethnic violence particularly between the Landus and the Hemas, which has lead to a deterioration in the security situation (WFP 12/10/01). WFP have reported that the situation in the Mbandaka area is serious. The RNIS does not have any recent nutritional information for the area.

Refugees

There are currently estimated to be 361,720 refugees from surrounding countries in DRC (OCHA 12/10/01). The largest recent influxes of refugees have come from the Central African Republic (CAR) and from Angola, where recent fighting has continued to send streams of people into the country. The RNIS has not seen any recent survey on the various refugee populations but those in registered camps have access to humanitarian assistance. However, the reliance of refugees on humanitarian assistance is generally high and they remain affected by issues of humanitarian access in the same way as both IDP and nondisplaced populations.

Angolan Refugees

There is a large Angolan refugee population, which has been resident in the country for some years, but recent months have seen increased fighting in the northern Angolan province of Makela D’Nzombo. The fighting has resulted in a rush of new refugees who have crossed the border into Bas Congo province and beyond. It is now estimated that the recent caseload in and around Kimvula is around 20,000 people (WFP 05/10/01). The RNIS does not have any information on the nutritional status of this group but they are assumed to be extremely vulnerable.

Central African Republic (CAR) Refugees

An attempted coup in May 2001 sent thousands of refugees from CAR across the border into Equateur province. The refugees have collected in the town of Zongo where there is currently estimated to be caseload of 25,000 people. In September WFP established a sub-office in Zongo from which it commenced food distributions and is preparing to deliver additional food by barge from Kinshasa (WFP 02/11/01). The RNIS does not have any nutritional information on the refugees.

Overall

The reporting period has seen the continuation of the peace process. This has served to improve the humanitarian situation in some areas. However the situation remains extremely volatile and IDPs, refugees and non-displaced populations remain extremely vulnerable. The situation of war displaced remains both critical and extremely varied (category II and III) and in some areas of the east, the conditions are desperate (category I). The situation for refugees remains precarious as a result of their dependence on assistance. It is helpful to distinguish between some of the long-term refugee caseload (category III) and some of the recent caseload, most notably the Angolan refugees who remain extremely vulnerable (category II). The current peace process has yet to bring significant improvements but it does offer the opportunity for a vast improvement in the overall humanitarian situation within the country.

Recommendations

• Support the Inter-Agency Appeal
• Support the continued deployment of MONUC
• Support self reliance activities in areas where security permits

RNIS 34, July 2001

The reporting period has seen the continuation of the peace process in DRC and with it the promise of better security and increased access to populations made vulnerable by the years of conflict within the country.

Insecurity continues in certain areas, mostly as a result of pressure on various rebel groups to leave, and is threatening to spill over into the neighbouring countries of; Rwanda, Burundi and Tanzania. One of the major obstacles to the peace process is that certain rebels groups have never been involved in peace negotiations and have vowed to carry on fighting. A meeting took place on July 4^th between Joseph Kabila, the DRC president, and his Ugandan counterpart Yoweri Museveni to discuss issues of importance to the two countries. This is a positive development given the strained diplomatic relations over the last few years as a result of the hostile presence of Ugandan troops within DRC (IRIN-CEA 04/07/91). There is also an important upcoming summit of the Organisation of African Unity (OAU) in Lusaka, Zambia, which will bring key players from many African countries together to further discuss the ongoing peace process (AFP 05/07/01).

Disengagement and withdrawal of foreign troops from the DRC has continued. In June IRIN reported the redeployment of a 7000 Ugandan and 600 Namibian troops. Foreign troops from Angola, Zimbabwe, Namibia, Uganda and Uganda do still remain, but still have time to disengage on schedule as agreed in the Lusaka agreement (IRIN-CEA 11/06/01; 15/06/01).

Another integral element of the continuing peace process has been the deployment of UN peace-keepers (MONUC) and the reporting period has seen a strengthening of MONUC troops in a number of places. The troops are mandated to over-see the withdrawal of foreign militarised forces in the country and have brought the hope of relative stability to previously chronically insecure areas. In recognition of MONUC’s role in the implementation of the peace process, a meeting of the UN Security Council in June has further extended MONUC’s mandate until June 2002. The renewed mandate will include a civilian police force component and will see them coordinating the disarmament, demobilisation, rehabilitation and reintegration (DDRR) operations in the country (IRIN-CEA 18/06/01).

Numbers and distributions of IDPs

The conflict within DRC has led to huge population displacement. The deployment of MONUC peace-keepers has improved access to many areas. The number of displaced appears to have risen since December 2000 but it is likely that much of this is not due to fresh displacement but to increased accessibility to IDPs who were previously inaccessible.

Table showing distribution of IDPs by province (June 2000, December 2000, April 2001) (OCHA 04/01).

Area	June 2000	December 2000	April 2001
Equateur	250,000	300,000	170,524
Orientale	215,000	160,000	220,000
North Kivu	287,000	640,000	620,000
South Kivu	220,000	350,000	373,158
Katanga	250,000	305,000	354,000
Mariema	110,000	137,000	132,000
Easter Kasai	30,000	30,000	114,000
Western Kasai	140,000	80,000	29,000
Total	1,502,000	2,002,500	2,012,682

Humanitarian Situation

The humanitarian situation in DRC remains critical. The years of insecurity have resulted in the collapse of infrastructure and the economy, and systematically eroded people’s ability to cope with the situation. As a result mortality and morbidity have increased and nutritional status declined. The humanitarian response continues to be hampered by insecurity and by the physical inaccessibility of many areas. To address problems of access WFP has recently established a Special Operation (SO) passenger service for humanitarian staff (WFP 29/06/01).

Kinshasa

Kinshasa has experienced rampant inflation rates estimated at 890% in the year 2000 (SCF-UK 18/04/01). Food prices have increased due to the restriction of supplies from the traditional food producing eastern areas of the country as a result of insecurity. The salaries of civil servants are not adjusted on a regular basis. In addition, many communes in Kinshasa have experienced a sharp increase in epidemic diseases, which reflects poor access to water and primary health care services.

SC-UK conducted a survey in April 2001, in Masina and Kimbanseke; two of the poorer communes in East Kinshasa. These are peripheral communes that are rural in character. The survey found a prevalence of acute malnutrition of 11% (W/Ht <-2 Z-scores and/or oedema), including 2% of severe malnutrition (W/Ht <-3 Z-scores and/or oedema). There was an estimated 1.2% of oedema-tous malnutrition in the sample. The survey also assessed the mortality rate of children under five, which was 0.77/10,000/day. The main cause of mortality was fever, or suspected malaria. The mortality rate was estimated over a one year period, which is unusual for an assessment of mortality in emergencies. The report estimated that only 8.8% of the malnourished children in the survey were attending a feeding centre for treatment indicating that the feeding centre coverage was extremely poor. A graph of deaths by month for the year 2000, shows mortality to be highest during the rainy season in December and February and is unlikely to be related to food insecurity. The survey was conducted at the end of the rainy season, when the prices of staple foods are at their highest and the prevalence of acute malnutrition is expected to be high. However, the prevalence of severe acute malnutrition is higher than would be expected (SCF-UK 18/04/01).

Previous surveys by CEPLANUT and ACF-F indicated a seasonal trend to malnutrition rates in the city. A survey showed similar prevalence of malnutrition, in the same communes in February 2001, an overall prevalence of 12.4% malnutrition, including 2.4% severe. Their survey in September 1999, when availability of food is usually good, showed a prevalence of 6.7% acute malnutrition (SCF-UK 18/04/01).

The SC-UK April 2001 survey indicates large differences between the four communes surveys. Whilst the prevalence of malnutrition in Kimban-seke Air de Sante was relatively low at 5% acute malnutrition, it was high especially in Lobiko at 18.3% acute malnutrition and in Tshimungu 11.3% acute malnutrition. Lobiko has poor road access, poor soil for cultivation, and poor infrastructure in terms of provision of water, latrines, health care and schools. Tshimungu is very densely populated, so limiting the availability of plots for household food production. Latrines tend to flood in the rainy season (SCF-UK 18/04/01).

Orientale

OCHA figures from April 2001 indicate that there are 220,000 displaced and 80,085 refugees from Sudan and Uganda (OCHA 04/01). Figures for the number of IDPs have risen from the 160,000 reported in the last RNIS report. It is likely that much of this increase is a result of previously displaced people becoming accessible as a result of improved security.

Ituri district

The situation in the district remains extremely serious and WFP reports that some 140,000 IDPs face serious food shortages following the systematic destruction of crops by rebel groups. Humanitarian access to the area has been constrained as a result of continued insecurity. A stark example of the insecurity and the risk to humanitarian aid came with the deaths of six Red Cross workers in April. As a direct result all agencies pulled out of the Bunia area. OCHA reported in early July that little by little the humanitarian community are choosing to resume their programmes (OCHA 04/07/01).

Kisangani

The peace accord between Rwandan and Ugandan forces in the area has seen the entry of MONUC troops to the town and the establishment of better security conditions. Initially rebel groups obstructed the entry of peacekeepers, but the troops were eventually permitted to enter and have managed to restore some order. Administrative control of the town of Kisangani has now been handed over to the RCD rebel group. However, MONUC is insisting on the withdrawal of militarised factions from the town (IRIN-CEA 18/06/01). No new nutritional information has been received

North and South Kivu

The Kivus remain extremely insecure and areas of intense humanitarian need. Their position on the border with Burundi and Rwanda make them important bases for rebel groups from the two countries. One of the chief concerns is that the rebel groups have never entered into any peace negotiations or signed any cease-fire. The number of displaced are currently estimated to be in the region of 993,500 people, a significant proportion of the total population of the area (OCHA 04/01). The insecurity continues to restrict humanitarian access to the most needy areas and a recent OCHA report estimated that only 10% of north and south Kivu were accessible to humanitarian actors (OCHA 15/06/01).

The area of Beni in north Kivu is of particular concern at present with NGOs warning of a “catastrophic situation”. The area has been the place of much conflict over it’s rich natural resources and access is currently extremely poor (IRIN-CEA 15/06/01). WFP is also reporting massive displacement in Walungu territory with 378,158 IDPs identified. The insecurity has reduced access to the affected populations with airlifts currently supplying only 21,000 IDPs out of 100,000 in the area of Shabunda (WFP 15/06/01). RNIS considers that the IDPs remain at high nutritional risk.

Maniema Province

Maniema lies in the east of DRC on the western borders of north and south Kivu. OCHA figures from April 2001 report the presence of 132,000 IDPs in the province, which indicates a drop in numbers since December 2000. This is likely to be a result of an improvement in the general security situation in the province that has allowed people to return to their lands (OCHA 04/01).

Merlin conducted a survey in May 2001 in Kalima town, which included both displaced and resident populations. The number of displaced decreased from 30,000 in August 2000 to 14,000 in May 2001. The survey found a prevalence of 4.6% acute malnutrition (W/Ht <-2 Z-scores and/or oedema) including 0.9% severe (W/Ht <-3 Z-scores and/or oedema). CMR was calculated retrospectively over the previous three months as 1.2/10,000/day and the under five mortality was 3.6/10,000/day.

The prevalence of malnutrition has decreased from 14.1% acute malnutrition (W/Ht <-2 Z-scores and/or oedema), with 8.1% severe acute malnutrition (W/Ht <-3 Z-scores and/or oedema) in January 2001. Much of the severe malnutrition in January 2001 was oedematous, and it is likely that the high under five mortality over the last three months was partly due to the deaths of severely malnourished children.

According to Merlin, the reasons for the improvement are the improved security conditions in the area, which have resulted in the return of many IDPs to the surrounding villages. The survey was carried out after a reasonable harvest at a time of relative plenty. As a result, general food availability has improved and market prices have fallen. The fall in market prices seems particularly important because 60% of households relied on purchased food. The high mortality rates suggest that the health situation remains extremely precarious and despite improvements the situation will need careful monitoring (Merlin 05/01).

Katanga

As a result of an improvement in the security situation in Katanga, thousands of people are emerging from hiding in desperate need of humanitarian assistance. The numbers of IDPs have risen to 354,000 from the 305,000 reported in the last RNIS (OCHA 04/01). WFP have reported that there are 330,000 IDPs in the government held areas of which 128,000 are currently receiving WFP rations. In general the security situation appears to be stable although incidents do occur, including the harassment of food transporters on the Bukamu-Kinkondja river axis (IRIN-CEA 18/06/01).

The RNIS has not seen any recent nutrition survey reports from the area but OCHA report on an MSF survey in Manono and Kanteba which indicated raised rates of acute malnutrition but relatively low rates of severe. RNIS considers the IDP population in Katanga at high nutritional risk.

Equateur

The security in Equateur has been very poor for some time and OCHA estimates that there are 170,524 displaced in the province. An inter-agency assessment mission in May highlighted high levels of vulnerability and recommended the provision of food aid, agricultural implements and the rehabilitation of the local infrastructure (WFP 29/06/01). The past months have seen the withdrawal of armed forces from some areas of Equateur. This has increased access to previously inaccessible areas such as the front line between Bmandaka and Ikela, which contains an estimated 60,000 IDPs. The local population is also in great need of assistance as the heavy military presence experienced in the area has had a very negative impact on the food security (WFP 15/06/01). The RNIS does not have any nutritional survey information but populations in Equateur can be considered at heightened risk of poor nutritional status.

Refugees

The total refugee population as of April 2001, according to OCHA figures, is estimated to be 329,812 people (OCHA 04/01). There have not been any recent nutritional assessments done on refugees in DRC but surveys done in Bas Congo in October 2000 indicated low levels of acute malnutrition. Issues of insecurity and humanitarian access are likely to affect the refugees in the same way as the displaced.

Angolan Refugees

Continued insecurity in Angola has meant the continued influx of refugees into Bas-Congo, Kinshasa, Bandudu and Katanga Provinces. The number of Angolans, as of April 2001, was estimated to be 178,280. In June, WFP assisted 32,555 Angolan refugees, providing them with an incomplete food basket due to shortfalls of pulses and salt. The delivery of pulses has been affected by striking rail workers and further strikes are likely to obstruct the July distributions (WFP13/07/01). WFP has also reported the arrival of 4,000 Angolan refugees gathered along the border of Bas-Congo province and Angola. The Congolese authorities have agreed to give them asylum so long as they move further away from the border. UNHCR will provide them with food assistance for six months.

Burundian Refugees

There are an estimated 20,000 Burundian refugees, mostly in South Kivu with some in Kasai Orientale. Many remain inaccessible to assistance and there is no available nutritional information (OCHA 04/01).

Central African Republic (CAR) Refugees

There are currently supposed to be about 30-45,000 refugees from CAR who have fled the attempted coup against president Ange-Felix Patasse, on May 28^th. The refugees are currently in north western Equateur province in the Zongo and Libenge areas (IRIN-CEA 16/07/01). The RNIS has no information on their current situation and it is uncertain whether they will stay or return after a short time.

Congolese Refugees

Repatriation to RoC continues but 3,005 Congolese refugees remain in Kimaza camp in Bas-Congo for the time being. The camp is supposed to close at the end of 2001.

Rwandan Refugees

There are an estimated 42,472 Rwandan refugees, indicating a decline in numbers reported by the last RNIS. This is a result of voluntary repatriation over the last months. Many are Hutus and unlikely to return whilst there is still a Tutsi government in Kigali.

Ugandan Refugees

There are an estimated 13,000 Ugandan refugees in Orientale province and many remain inaccessible due to insecurity so very little is know of their condition.

Overall

The reporting period has seen significant movement in the implementation of the Lusaka peace accords, including the continued withdrawal of foreign troops and the disassociation of the Kin-shasa regime with rebel elements in the East. UN peacekeepers (MONUC) have continued to be deployed and their mandate strengthened. This has brought improvements to the security situation in many areas, significantly improving the humanitarian access to populations in need. However, insecurity still remains in many areas, particularly the eastern provinces of the country. The combined effects of the long term conflict, poor economy and the lack of working infrastructure, continues to create huge vulnerabilities amongst displaced and non displaced alike (category II and III). The war displaced in Kinshasa are currently category III. IDPs in the east of the country remain at extremely high risk (category I) although there have been improvements in some areas such as Kalima town in Maniema (category II). As areas continue to become accessible it is likely that more and greater needs will become apparent. The situation of refugees remains varied but they are also at elevated risk from insecurity and lack of access (category II).

Recommendations

Support funding of the Inter-Agency Appeal.

• Continue to support deployment of MONUC.
• Put in place a system for rapid provision of assistance as access is gained to previously displaced populations.

From the Merlin Survey in Kalima, Maniema province (Merlin 05/01)

• Nutritional surveillance and monitoring should be continued in all clinics in Kalima town.
• Agricultural inputs should be supplied to families with access to land.
• There is a need for EPI and a mass measles campaign.

From the SCF-UK survey in Kinshasa (SCF-UK 18/04/01)

• Improve feeding centre coverage by improving nutrition screening and referral.
• Improve water supply and primary health care services.

RNIS 32/33, April 2001

The past year has seen more violence in DRC. The conflict is a labyrinth of political alliances between no less than six nations and as many as ten local militia movements. On one side there are Angolan, Namibian and Zimbabwean soldiers allied with government troops controlled from Kinshasa. On the other side is a tenuous alliance between Rwandan and Ugandan troops that supports various fighters opposed to the Kinshasa regime (STRATFOR 17/04/01).

The most significant event of the past year has been the assassination of President Laurent Kabila on the 16^th of January 2001. Kabila was replaced by his son Joseph Kabila and in the months since he has taken office he has made moves to implement the stalled Lusaka Peace Agreement, first signed in August 1999. This opens up the possibility of a resolution to the conflicts currently being fought in DRC which would have important effects on the humanitarian context. Joseph Kabila has invited Ketumile Masire, the former president of Botswana, to mediate among Congolese factions (IRIN CEA 19/01/01).

The past months have also seen the beginnings of a disengagement of the armed forces of Angola, Namibia and Zimbabwe from DRC on March 29^th. This marks the first part in a four stage timetable for foreign forces to withdraw from the DRC by August 19^th. The March 29^th date coincided with the deployment of a UN mission (MONUC) to act as observers for the continued implementation of the peace accords. (STRATFOR 17/04/01; NRC 2001).

The progress in implementing the peace agreement marks the first real step towards ending the country’s three year war. The implications of the peace agreement, the deployment of MONUC troops and the disengagement of foreign armed forces on the humanitarian situation are huge. One of the major problems facing humanitarian interventions in DRC has been access to people in insecure areas and it has been very difficult to estimate the numbers of people affected as so many have hidden themselves in the jungle. As MONUC troops deploy in new areas, it is expected that more and more people will come out of hiding to seek assistance. On the 8^th of May WFP issued a warning that a very significant humanitarian crisis is unfolding, citing northern Katanga province where MONUC troops have already deployed, as an area where people are already beginning to emerge from years of isolation and poor living conditions in the forest. Similar trends are being seen in north and south Kivu as agencies continue to gain access to previously cutoff areas and are finding populations in very poor conditions (WFP 11/05/01).

Numbers and distribution of IDPs

Conflict related displacement has continued to increase from 750,000 at the beginning of 2000, to 1.4 million in June 2000 rising to 2,002,500 by the end of 2000. This is despite the return of an estimated 810,000 former IDPs to their place of origin (UN OCHA 17/04/00).

Table showing distribution of IDPs by province (July 99, June 200, December 2000)

Area	July 99	June 2000	Dec 2000
Equateur	100,000	250,000	300,000
Orientale	70,000	215,000	160,000
North Kivu	160,000	287,000	640,000
South Kivu	195,000	220,000	350,000
Katanga	150,000	250,000	305,000
Maniema	20,000	110,000	137,000
Easter Kasai	60,000	30,000	30,000
Western Kasai		140,000	80,000
Total	775,000	1,502,000	2,002,500

(UN OCHA 31/12/00)

Humanitarian situation

The UN estimates that about 16 million people, or 33 % of the population, face chronic and acute food insecurity as fighting and insecurity continue in many areas of the DRC, particularly in the east of the country in provinces such as north and south Kivu, Equatoria and Orientale. The insecurity has seen large population displacement to forest areas which provide comparative safety but have seen people living in very bad conditions without medicines, safe water or systematic food supplies. The scale of the displacement and the lack of access has largely masked the extent of the crisis and it is highly likely that as access increases the humanitarian situation will appear to worsen as many isolated populations emerge to access assistance (UN 2001).

RNIS 31 reported on a series of mortality surveys conducted by the IRC that showed alarmingly high levels of both crude and under five mortality. The survey was released in May 2000. The IRC have conducted another series of surveys in eastern DRC, along with one in the rebel held area of Kasai Orientale Province As in the previous surveys the recall period was 16 months and the RNIS has converted mortality rates from deaths/1000/month to deaths/10,000/day for easy comparison with other mortality data reported (IRC 05/01).

The table of results shows extremely high mortality figures for populations in the eastern DRC, all of which are above emergency cut-offs for crisis situations. The surveys confirm the general findings of the first report that death rates remain alarmingly high and that the highest rates of mortality are seen in the under five population. The high rates of under five mortality are seen very forcibly in the far fewer young children seen relative to older children and other age groups. In Katana where the IRC has been surveying over the past three years there has been a systematic drop in the percentage of under five children in the population (IRC 05/01).

Results of the mortality studies in eastern DRC

Location	Province	Sample Size	CMR	Under 5 mortality
Kalamie	Katanga	2204	3.6/10,000/day	7.9/10,000/day
Kalima	Maniema	1958	2.5/10,000/day	5.7/10,000/day
Katana	South Kivu	1802	1.6/10,000/day	4.3/10,000/day
Kabare	South Kivu	1778	1.5/10,000/day	1.8/10,000/day
Lubunga	Orientale	2317	0.9/10,000/day	2.3/10,000/day

Cause of death varied but it is clear that violence remains a major cause in all survey sites and there appears to be a correlation between areas with more violence and areas with higher death rates from non violent causes such as infectious diseases and malnutrition. In other words, areas with increased violence also suffered from increased general mortality from all causes. For example violence was the major reported cause of death in Kalamie in Katanga province where the highest CMR and under five mortality were recorded. Equally only 59% of people were accessible to the survey in Kalima, the second highest observed rates, due to insecurity between Mayi-Mayi and RCD soldiers (IRC 05/01).

The survey also emphasises the high rates of under five mortality and stresses that not only do the rates indicate a severe public health crisis but these rates appear to have been experienced for years. A continuous under five mortality of over 3/10,000/day means that 60% of children die before their fifth birthday. In the Kalamie survey it was estimated that 38% of children in their second year of life died during the recall period. The survey points out that if these conditions have existed for the last two years, 75% of children born two years ago have died (IRC 05/01).

From the total number of households surveyed from eastern DRC, the results represent the mortality experience of 1.27 million people. Despite reservations expressed by the authors, the reported mortality rates were extrapolated to the 19.9 million people in eastern DRC to estimate the number of excess deaths in the whole of the area since the outbreak of the recent fighting. The survey estimates that 2.5 million deaths in excess of the million people who might have been expected to die, have occurred. The survey acknowledges the difficulties of extrapolation and attempts to look at the effect of worst and best case scenarios have on the final outcomes and concludes that in all scenarios the amounts are over 2 million (IRC 05/01).

Nutrition situation

The effects of the war, particularly in eastern DRC in areas such as north and south Kivu, Maniema, Kantanga and Orientale, have resulted in a steady deterioration of the nutritional situation. Further areas of poor nutritional status are very likely to become apparent as access to hitherto inaccessible areas improves.

Kinshasa

There is no new information on the nutritional situation of the population in Kinshasa but a news report from PANA on May 14^th indicates a high burden of disease with 138,350 cases of malaria reported in the first quarter of the year with outbreaks of typhoid and bacillary dysentry also reported. Measles is also on the increase despite vaccinations (PANA 14/05/01).

Orientale

The latest estimates from the end of 2000 indicate that there are 160,000 IDPs in Orientale Province along with 71,000 Sudanese and 12,980 Ugandan refugees. Fighting has continued in the province with clashes between Ugandan and Rwandan troops in June 2000, which caused substantial displacement from Kisangani. IRIN reports wide scale displacement, price rises and a general decline in purchasing power Orientale, particularly in urban centres such as Kabinda and Mbuji-Mayi (IRIN CEA 16/02/01; NRC 2001).

Ituri district

Ituri district has been the scene of repeated, violent clashes that have led to large scale displacement and the systematic targeting of civilian populations, including the destruction of food crops. The clashes are largely a result of ethnic fighting between the Lendu and Hema tribes in the area and 2001 has seen the continuation of conflict in the area. This has led to acute food insecurity with an estimated 140,000 people affected around Bunia and the surrounding area. The area has been opening up in recent months as a result of a general country wide commitement to the peace process and increasing humanitarian access. However, on April 27^th six Red Cross workers were killed whilst on a routine mission and as a result 20 aid agencies working in eastern DRC suspended humanitarian activities from the 30^th April to the 2^nd of May. The attack illustrates the dangers and unpredictability of the situation in the area (AFP 27/04/01; WFP 30/03/01; 11/05/01).

Kisangani

RNIS 31 reported intense fighting in June 2000 between Ugandan and Rwandan forces in the town of Kisangani, causing widespread destruction and displacement. Kabila’s commitment to the peace process has seen the withdrawal of foreign troops from the town and the entry of MONUC peace keepers on the 20^th of April 2001. The deployment of the Moroccan troops was initially blocked by rebel forces hostile to the peace keepers but was eventually agreed upon after some delay (UNDPI 18/04/01).

In August 2000, MSF-H conducted a nutrition survey in Kisangani town. The prevalence of acute malnutrition of 8.5 % including 3.5 % of severe malnutrition. The relatively low prevalence of malnutrition is not explained in the report. The prevalence is similar to that found in November 1999, when MSF found 9.2% and 5.2% respectively. Whilst the prevalence of severe malnutrition has decreased, it remains high. At the same time, under five mortality has also decreased. In August 2000, the under five mortality was 1.04/10,000/day, and in November 1999, this was 2.95/10,000/day. The CMR was found to be 0.57/10,000/day and mortality was highest in the zones where fighting had been most intensive. MSF has been running supplementary and therapeutic feeding centres in the town, but unfortunately the coverage was not assessed by the survey (MSF-H 08/00).

MSF-H also conducted a nutritional survey in Aire de Sante Madula in August 2000. This is a rural area close to Kisangani, some 30 km to the southeast of the town. The area was badly affected by the fighting in June. People fled the town and many were forced to seek shelter in the jungle. The survey showed a prevalence of acute malnutrition of 6.9 %, including 3.9 % severe. The prevalence of malnutrition in August 2000, was significantly lower than in August 1999, when the prevalence was 13.2%, including 3.9% severe malnutrition. This reduction is not explained in the report. The CMR increased (from 0.84/10,000/day to 1.14/10,000/day), and under five mortality remained similar (1.55 and 1.61/10,000/day) over this period (MSF-H 08/00). The RNIS does not have any new nutritional information on this population.

North and South Kivu

Fighting has continued and even intensified in the Kivus over the past year and the numbers of IDPs have increased dramatically. UN estimates of displacement at the end of last year indicated that almost a million people were displaced within the two provinces as a direct result of continued conflict and insecurity. Many parts remain inaccessible as a result of the desperate security situation although recent deployments of MONUC troops in Goma on May 14^th have increased hopes that insecurity and access will lessen (UN 14/05/01).

North Kivu

In September 2000 there were reports that large numbers of IDPs were fleeing the Masisi area and were seeking refuge in Kanyabayonga, Kirumba and Kaynas. In November IRIN reported intimidation of the populations around Goma by Interahamwe militias in the area. The intimidation resulted in many people fleeing into the deep forest in an attempt to find safer afeas (IRIN 16/11/00). A WFP report from March this year indicates an improvement in the security situation in eastern DRC and particularly in the Kivus, which has resulted in a mass return home of displaced, and there are an estimated 137,000 people in need of seeds and tools to help with restarting agricultural activities (NRC 2001; WFP 31/03/01).

In June 2000 SCF-UK did a nutrition survey in the two health zones of Butembo and Katwa in north Kivu. The survey indicates an estimated prevalence of acute malnutrition of 14.5% with 12.6% of severe malnutrition, including 11.9% oedema. The survey does not record mortality rates but the rates of malnutrition are extremely high, particularly for oedematous malnutrition. The explanations given for the high rates of malnutrition include the fact that mothers are forced to travel great distances in order to be able to cultivate crops and this leaves them little time to devote to children and often means they fail to seek medical help when it is needed. The extremely high rate of oedematous malnutrition is not unknown in the great lakes region and is described as being a result of two extremely poor harvest seasons due to drought that has greatly reduced the amount of available food and has impacted heavily of basic livelihood activities. The effects of the continuing conflict resulting in poor access to cultivatable land is highlighted as one of the main causes of the malnutrition (SCF-UK 06/00).

MUAC screenings in November/December show that the nutritional situation around Goma has remained poor. The survey results for the area, taken as a whole are alarming and are another indication of the severity of the crisis in eastern DRC.

South Kivu

South Kivu continues to be highly insecure with escalations in the fighting between various militia groups such as the Interahamwe, Mai-Mai, FDD and the RDC. The fighting continues to force tens of thousands of people from their homes into the forest to live in appalling conditions. Insecurity in the area has increased for humanitarian agencies and AAH-USA report an increase of security incidents in the area over the first part of 2000. Vast areas continue to remain inaccessible to agencies, making a thorough assessment of the situation extremely difficult. However, it is hoped that the deployment of peace keepers in the area and reduced rebel activity as of March 2001 will increase access to some of the affected populations. AAH-USA report estimates that only 40 % of the village populations in accessible areas remain undisplaced. The displaced populations rely on host communities and on what little they were able to bring with them at the time of their displacement which is often very little (AAH-USA 08/00).

Some of the fiercest fighting has taken place in Shabunda and Mwenga where the number of displaced living in the forest is estimated to be in excess of 100,000. The situation in this area is described as desperate with no shelter, medical facilities and little to eat. There are reports of very high morbidities including endemic cholera. The ongoing fighting in the Shabunda area continues to displace people who have been fleeing towards the town of Kalima in the neighbouring Maniema province (AAH-USA 08/00; NRC 2001).

Maniema Province

Merlin conducted a nutrition survey in Kalima town on children 6-59 months in January 2001 and found an estimated prevalence of acute malnutrition of 14.1 % including 8.1 % severe malnutrition. The CMR was calculated retrospectively over the past three months and was estimated at 3/10,000/day with a under five mortality of 7.9/10,000/day. The anthropometric results suggest a very high level of severe malnutrition, much of which was oedematous. The mortality rates are alarmingly high and the authors caution that there may have been over reporting, but state that even if the rates are halved they still represent dangerously high levels. The high rates of mortality and malnutrition are very probably the result of the large influx of IDPs to the area and the resultant acute food insecurity of both the displaced and the resident population (Merlin 01/01). RNIS 31 reported am estimated 110,000 IDPs in the forest in Maniema. In addition, the town was experiencing a measles epidemic at the time of the survey, and there has been no emergency food distributions for either the displaced or the resident population (Merlin 01/01).

Katanga

On the 8^th of May 2001 WFP issued a statement that a humanitarian crisis was emerging in north Katanga province as a result of an influx of previously isolated displaced people arriving in towns seeking urgent assistance. The displaced have been encouraged to emerge from hiding as the security situation improves in the region where there condition is described as extremely grave. A recent assessment mission to Kiambi town in north Katanga is reported to have revealed very high rates of malnutrition and mortality (WFP 11/05/01). The RNIS does not have access to the report. WFP is making preparations to deliver 650 tons of food into the area. The lack of air capacity is proving critical and for the time being food is being pre-positioned in Kalemie. WFP also reports that it faces a major funding problem with only 30% of its operation currently funded (WFP 11/05/01).

The last UN estimate of numbers of displaced in Katanga indicates 305,000 people. The is an increase from the last RNIS report and is a result of both continued insecurity in the northern most regions of Katanga that continues to displace population and improving security situations in other areas that have brought ‘new’ IDPs out of the forest (WFP 11/05/01). Some the worst clashes in the province have been around the town of Pweto, which is reported to have tripled in size as a result of IDP influxes from more insecure areas. MSF-Belgium reports a desperate lack of medical care in the town. The insecurity has involved looting of harvest and seeds and there is great concern over the impact that this will have on food security in the area (WFP 23/02/01). There are also 51,576 Angolan and 9,600 Burundian refugees in Katanga province.

Refugees

The total refugee population of DRC is currently estimated to be 332,000 people.

WFP and UNHCR carried out an assessment of the food economy of refugees in Katanga, Bas-Congo and Bandundu in November 2000. In Katanga, there are a total of 51,587 refugees, but only those who arrived after 1998 receive assistance. This amounts to 27,672, who live in 3 sites. Refugees who arrived before 1998, are considered to be self sufficient in agriculture. In Bas Congo, the total number was 21,504, in 3 sites. The food security of refugees in Bas Congo was restricted because they do not have access to farmland, and their movement is limited by the local authorities. UNHCR has now obtained permission for refugees to farm, and has distributed seeds and tools. In Bandundu, the refugee population doubled during 2000. About 10,000 lived in three sites, and another 15,000 live with Congolese host families. Only the 10,000 living in camps receive assistance (WFP/HCR 11/00).

The general ration distribution to all refugees has been well below recommended levels throughout the year 2000. The energy content of the ration in Katanga was best from March to June 2000, with about 1600 kcals/person/day. From July to October 2000 the ration was around 1100 kcals/person/day. For most distributions, the ration consists of cereals only. In March oil was distributed, and in September and October pulses. Refugees supplement their ration with income from farm labour, sale of non-food items, kitchen gardens, and petty trade. WVI did a nutritional survey in Kisenge in April 2000 which showed 7.8% malnutrition, including 3.1% severe (WFP/HCR 11/00).

In Bas Congo, refugees usually received a ration of cereals, pulses, oil, salt and CSB. From August 2000, the refugees received half rations because of problems with the food pipeline. Between July and August, the energy content of the ration decreased from 2035 kcals/person/day to about 1000 kcals. The assessment found that in addition to the income earning activities in Katanga, many of the refugees in Bas Congo were found to be in debt.

UNHCR and local partners conducted three nutritional surveys in October 2000; the prevalence of malnutrition was low and ranged between 5.8% in Nkondo and 3.3% in Kimaza (WFP/HCR 11/00).

Food assistance to Bandundu has been very irregular, due to severe logistical and security problems. The food aid provided has been inadequate throughout 2000. There were no food distributions in May and June 2000. From July to October the energy content of the ration was between 350 and 870 kcals/person/day. In November 2000, 18,000 Angolans were reported to be at the border but decided to stay in the forest in Angola, rather than live in the poor conditions in the refugee camps in Bandundu. For the refugees, strategies for obtaining food and income are more desperate, and include illegal acts such as theft. Refugees in Bandundu were also reported to have no clothes, blankets or cooking utensils (WFP/HCR 11/00).

Angolan Refugees

The influx of Angolan refugees continued throughout 2000 with new arrivals being accommodated in camps in Bandundu, Bas-Congo and Katanga provinces. UNHCR estimates that at the end of 2000 there were 173,000 Angolan refugees with 106,000 currently being assisted to integrate locally. However, fresh fighting in Angola’s Lunda Norte province has forced fresh waves of refugees into the Bas-Congo region of DRC (UNHCR 09/03/01).

In March 2001 UNHCR reported on a joint UNHCR/WFP assessment mission to the border areas of the southern Bas-Congo region of DRC. The assessment found nearly 2000 Angolan refugees around the town of Kimvula. Logistical constraints prevented the assessment from confirming reports of other Angolan refugee populations in the town of Popokabaka and on the other side of Angolan border in Kasongo-Lunda in Bandundu province (UNHCR 09/03/01).

Burundian Refugees

An estimated 19,000 Burundian refugees remain scattered in the forests of south Kivu, many inaccessible to international agencies. There are an expected 5000 Burundian refugees expected to arrive in DRC during 2001 (UNHCR 2001).

Congolese Refugees (RoC)

The repatriation of Congolese refugees continues and it is expected that the Kimaza camp will close by the end of 2001 (UNHCR 2001).

Sudanese Refugees

There are an estimated 70,000 Sudanese refugees in the DRC. The majority are long term located in fertile agricultural areas of Orientale Province (UNHCR 2001).

Rwandan Refugees

There are an estimated 50,000 Rwandans in DRC and up to 20,000 are expected to voluntarily repatriate in 2001. Many of the remainder are Rwandan Hutus who are unlikely to return peacefully whilst the Tutsi government remains (UNHCR 2001).

Ugandan Refugees

There are an estimated 13,000 Ugandan refugees in Irumi, Beni and Boga but they are all currently inaccessible due to insecurity.

Overall

It remains extremely difficult to draw any definite conclusions about the nutritional status of both the displaced and general populations in DRC. Reports indicate that the nutritional situation of IDPs in many areas is extremely poor but the problem remains that access to the most insecure areas, probably containing the most severe needs, remains very difficult. However, RNIS anticipates that as MONUC peace keepers mobilise in particular areas, access will improve, and the full extent humanitarian crisis will become apparent.

Areas of insecurity are widespread but are largely concentrated in the east of the country in the Provinces of Orientale, the Kivus, Maniema and Katanga. The populations in these areas can be considered to be at very high risk of malnutrition (category I) and the opportunities for the situation to deteriorate further are very great. The situation of refugees in the country varies, some of whom are at high risk (category II or III).

Recommendations

• Support MONUC in improving humanitarian access.
• Support demobilisation process
• Support humanitarian agencies to address acute needs as humanitarian access improves.

RNIS 31, July 2000

Despite the Lusaka ceasefire agreements, the parties involved in the conflict in the DRC (Governments, rebels and their backers) multiplied their offensives during the reporting period and continued to demonstrate a lack of willingness to allow a peaceful resolution to their differences. The opposition in the DRC is supported by Burundi, Rwanda and Uganda. The Government is supported by Angola, Namibia, Zimbabwe and, reportedly, Sudan. The Government also has links with armed groups collectively known as mayi-mayi as well as an alliance with interahamwe militia. Accusations of ceasefire violations by all sides have continued since the beginning of the year. Human rights violations have been reported in both government and non-government controlled areas. Credible reports of military and communications equipment being airdropped to armed non-state actors who are not party to the Lusaka agreement have been received. (Al - 31/05/00; OCHA - 08/06/00, 12/07/00).

The estimated number of IDPs has increased to 1,502,000. This is partially due to a large increase in the Kivus, where numbers have increased dramatically after more displaced people were identified by an assessment Mission. In reality, the total number of IDPs has probably not increased.

Humanitarian situation

A recent IRC report has provided mortality information in 5 different locations in eastern DRC. The recall period was 16 months. RNIS has converted mortality rates from deaths/1000/month, to deaths/10,000/day for easy comparison with the other mortality data reported here. Several methodological limitations are described for the Kalongi displaced survey. The results can be seen in the table below (IRC - 05/00):

Results of the mortality studies in eastern DRC

Location	Sample size	CMR	Under 5 mortality
Kisangani	2305	0.87/10,000/day	1.6/10,000/day
Kabari	1273	0.9/10,000/day	1.9/10,000/day
Katana	1219	0.9/10,000/day	2.3/10,000/day
Kalongi displaced	1330	2.1/10,000/day	4.7/10,000/day
Moba	1212	3.8/10,000/day	8.2/10,000/day

High mortality and a decrease in fertility rates are also indicated by 30-40% fewer children under 2 years of age than would be expected (IRC - 05/00).

Violence was a major cause of death in all locations, and particularly in those with the highest mortality rates. Causes of death ranged from malaria in Kisangani, female genital mutilation in Kabari, malaria and diarrhoea in children in Katana and violence to people more than five years old. The violence in 1999 was between Mayi-Mayi and Rwandese or RCD forces, whereas in 2000, it is attributed to violence of Interahamwe against citizens of the area. Violence was also a major cause of death in the Kalongi displaced (people from previously inaccessible parts of South Kivu). The increase in violence was also associated with deaths from other causes. The main causes of mortality in children in Moba were cholera, dysentery, TB, and violence. Maternal mortality was estimated at 11% of full term pregnancies (IRC - 05/00).

Despite the reservations expressed by the authors, these mortality rates were extrapolated to estimate the number of excess deaths in the whole of Eastern Congo since the outbreak of the recent fighting. As the total estimated population in Eastern Congo is 19.9 million, the number of excess death was estimated at is 1.7 million. Clearly, there may be some problems in extrapolating survey data from five areas to cover half a country and it is not known how accurate this summary figure is (IRC - 05/00).

Most IDPs have lost their homes and possessions. Health centres and hospitals in conflict areas lack basic medical equipment and qualified personnel. Due to low vaccination coverage rates, epidemics of measles and cholera are rising (UNICEF - 07/07/00).

Nutritional situation

The RNIS has not received any new nutritional surveys for DRC during the reporting period. An OCHA study in west-em DRC revealed that soaring consumer prices and large food deficits are the norm in urban areas (OCHA - 12707/00). Prolonged lack of access to food and basic health care usually leads to increased levels of malnutrition. However, most nutritional surveys recently conducted do not show alarmingly high prevalences of malnutrition (see RNIS 29,30). It is probable that the most food-insecure populations are inaccessible.

Kinshasa

There is no new information on the nutritional situation of the population of Kinshasa, The most recent surveys, conducted in October 1999, did not find especially elevated rates of acute malnutrition (see RNIS 29). A food security assessment indicated that the population living on the outskirts of the city were most at risk of food insecurity because of poor infrastructure and limited employment opportunities (RNIS 30).

Orientale

There are an estimated 215,000 displaced people in Orientale Province (OCHA - 12/07/00).

Ituri district

Ituri district has been the scene of violent clashes between the Lendu and the Hema. Joint assessment missions during the period have identified new pockets of displacement and need. However, the humanitarian situation of the IDPs in Ituri is reported to be improving as a result of multi-sector health, nutrition, sanitation, and food security responses by the international community. There are an estimated 115,000 IDPs in Bunia and the surrounding area (OCHA - 08/06/00,12/07/00).

Kisangani

The humanitarian situation in Kisangani reached a new low during the reporting period. Ugandan and Rwandan forces fought each other even as the UN was supervising a withdrawal of troops in an attempt to demilitarise the town. The resident population (estimated at 600,000) was caught in the middle and at least 750 civilian deaths were reported. Around 70% of the housing and infrastructure was destroyed. Huge numbers of landmines were laid. Massive displacement followed. Recent reports indicate that there remain an estimated 30-60,000 displaced people in the Kisangani area, of which 5,000 are within the town. The majority of the urban IDPs are expected to re- turn to their homes as soon as the security situation has stabilised (IRIN - 26/06/00; MSF - 24/06/00, 05/07/00; OCHA - 12/07/00).

Health and nutrition have been acute problems for a long period, both within and outside the town. MSF, which has 12 feeding centres in Kisangani, has reported an increase in admissions to its centres over the past few weeks. Market prices have risen and there is a shortage of some goods. Health care centres are too expensive for much of the population. In addition, the water supply is insufficient (MSF - 05/07/00).

WFP delivered and distributed food to the town population by air in mid-June. An estimated 12,500 people in collective sites were assisted. A further 35,000-40,000 people in the greater urban areas also require food aid. The delivery of humanitarian assistance to the IDPs outside the town is more problematic, given the security situation. WFP has stressed that aid flights are only a temporary solution and that humanitarian corridors must be opened, particularly on the Congo River (MSF - 24/06/00; WFP - 16/06/00).

North and South Kivu

The war in the Kivus has intensified. Fighting and raiding have been reported in Bukavu, Uvira and Bwito (IRIN - 09/06/00, 30/06/00, 07/07/00). There are now an estimated 282,000 IDPs in North Kivu and 220,000 in South Kivu. The number of IDPs in South Kivu has risen as a result of an ongoing assessment exercise. The humanitarian needs of many of the displaced remain unmet, mainly because of insecurity and insufficient resources. In early July several international NGOs suspended their operations in South Kivu due to attacks on their staff (AAH - 11/07/00; OCHA - 08/06/00,12/0700).

An SC(UK) survey in October 1999 of children aged 6-59 months in Nyambita and Nyakariba in the Masisi health zone of North Kivu estimated the prevalence of acute malnutrition at 9.7%, including 5.9% severe acute malnutrition (SC(UK) - 10/99). This survey was undertaken in conjunction with a food economy assessment of the area that reported very poor food security for much of the population in the area (see RNIS 30).

Katanga

There are an estimated 250,000 displaced people in Katanga Province who are dispersed throughout the province, scattered in camps (for example in Lumumbashi) or resettlement sites, or hosted in local communities. The IDPs are both on sides of the frontline of the rebels and the Government's armed forces. An Assessment Mission to Ankoro in Katanga province in May, the first since the outbreak of hostilities in 1998, estimated that there are 44,000 IDPs and 190,000 residents in the town. The town is situated on the Congo river, but the populations on either side are unable to fish due to insecurity. Although no formal assessment was conducted, visible signs of malnutrition were evident. Sanitation and health facilities were poor. WFP delivered food to the area soon after the mission, and other international organisations are planning to start programmes in the area (OCHA - 23/05/00, 12/07/00).

Maniema

An FAO mission to Maniema in May estimated that 110,000 IDPs remain in the forest in Maniema. Fish breeding programmes are being supported in order to improve food security. Water projects are also underway (OCHA - 12/07/00).

Eastern Kasai

The high level of military activity in this province restricts access to the communities in need. The bulk of the displaced (conservatively estimated at 140,000) are reported to be hiding in the forest. The IDPs are in desperate need for protection (appalling human rights abuses have been reported) and also require relief supplies (mainly medicines). No information on their nutritional situation is available (OCHA - 12/07/00).

Western Kasai

Data on displacement in this province are very scarce, most of the estimated 140,000 IDPs are living along the railways. The frontline intersects the most densely populated zones. An OCHA study reported that the food security situation was very poor due to the large scale displacement of farmers growing staple foods. No assistance is provided in a systematic manner to this area (OCHA - 12/07/00).

Equateur

Equateur remains the most active part of the frontline. There are an estimated 250,000 IDPs in the province. Reports of civilians fleeing areas of intensive combat have been received. A WFP barge left Kinshasa to Mbandaka in early July, the first of such operations since the start of the war. Food commodities and other emergency supplies will be dispatched to areas affected by displacement, including those across the frontline (OCHA - 12/07/00). At least 35,000 refugees have arrived in RoC from Equateur Province during the reporting period.

Refugees

Angolan refugees

The influx of Angolan refugees into DRC continues. An excess of 1,600 refugees are reported to have arrived in Kimpese camp in March and April. Insecurity along the borders is restricting access and hence UNHCR and NGOs are unable to assess the situation and the numbers. As of late May, there were an estimated 155,000 Angolan refugees in DRC in Bas Congo, Bandundu and Katanga. No new information on their nutritional situation is available (OCHA - 08/06/00; UNHCR - 21/07/00).

Burundian refugees

There are an estimated 19,000 Burundian refugees in South Kivu and 500 in Mbuji-Mayi. Most of these are unassisted due to the insecurity in the region. Their nutritional situation is unknown (OCHA - 08/06/00; UNHCR - 21/07/00).

Congolese refugees (from RoC)

Luozi camp (Bas Congo), which hosted refugees and extended services to the resident population, was closed on April 5. UNHCR has assisted the majority of the refugees to return to Brazzaville. The remaining caseload, mainly political refugees, were transferred to Kimbanza camp. There are an estimated 9,000 Congolese refugees in DRC. No new information on their nutritional situation is available (OCHA - 08/06/00).

Sudanese refugees

There is no new nutritional information available for the estimated 72,000 Sudanese refugees in Orientate province. Approximately 35,000 of these refugees are unassisted (OCHA - 08/06/00).

Rwandan refugees

The repatriation of Rwandan refugees from North and South Kivu is ongoing. UNHCR reported that approximately 32,000 Rwandans were assisted to repatriate from the Kivus in 1999. An estimated 60,000 Rwandans remain in DRC and are unassisted. There are a further 1,250 Rwandan refugees in Mbuji-Mayi who are assisted by UNHCR. There is no new information on the nutritional situation of the Rwandan refugees (OCHA - 08/06/00).

Ugandan refugees

There are an estimated 3,200 Ugandan refugees in Orientate Province. There is no new information on their nutritional situation (OCHA - 08/06/00).

Overall, it is extremely difficult to draw any definite conclusions about the nutritional situation of the displaced in DRC because humanitarian agencies are unable to gain access to many of the affected areas and hence there is very little information available. However, it seems probable that the areas in which there has been recent righting and displacement will be the most nutritionally vulnerable (Orientale, Kivus, Equateur, East and West Kasia). The IRC survey in eastern Congo also indicates that areas of violence, particularly those that are inaccessible, are likely to suffer high mortality rates. These people are therefore considered to have a high to very high risk of malnutrition (category I and II). The displaced in other areas are considered at high to moderate risk (category II and III). The nutritional situation of the people in Kinshasa is currently stable (category IV). The nutritional situation of the Angolan refugees is assumed to be unchanged, that is non-critical (category IV). The Congolese are at moderate risk (category III). The nutritional situation of the other refugees in DRC is unknown (category V).

Recommendations and priorities:

• Advocate for peace in DRC.Establish humanitarian corridors to reach the populations most affect by the war.
• Continue with programmes to assist the IDPs and other vulnerable populations in accessible areas.

RNIS 30, March 2000

The reporting period has seen an unprecedented amount of diplomatic activity over the crisis in the DRC, culminating with the UN Security Council’s Special session that approved the expansion of the UN mission into the DRC. Fighting has continued in much of the country, however. Renewed fighting occurred in Equateur and Kasai provinces and a high level of inter-ethnic tension was sustained in Orientale. Access to war-affected and other vulnerable populations was significantly reduced on both sides of the frontline in January 2000, reducing the humanitarian community’s capacity to assist those in need. The reduced access was due to heightened insecurity in eastern parts of the country, and to the “bureaucratic” process for the granting of clearances in many Government-controlled areas (OCHA -15/02/99). Lack of access is the main constraint to humanitarian assistance in Eastern DRC. Out of a total estimated IDP population of 1.12 million, approximately 115,000 receive assistance in the Kivus and Orientale, 30,000 in Katanga, and 15,000 in Kinshasa.

Economy

The DRC wartime economy continued to decline in the reporting period. The Congolese Franc has continued to devalue and inflationary trends continue (333% in 1999). There have been official attempts to control market operations - including a ban on foreign currency holdings and fixing of the exchange rate at unrealistic prices. Shortages of basic goods are expected to worsen as importers and domestic traders who supply Kinshasa are being increasingly affected by these policies. Humanitarian agencies have also been affected and some are no longer capable of disbursing their limited project budgets to obtain goods and services at the fixed exchange rate (IRIN - 14/03/00; OCHA-03/00).

IDPs

There has been a 15% increase in the number of IDPs and Congolese refugees in third countries. IDPs alone increased by 230,000. There are currently an estimated 1.25 million IDPs within the country, whose distribution can be seen in the map/table below. New internal movements of the population have been recorded in all 11 provinces and the capital (OCHA-15/02/99).

Nutritional situation

The RNIS has received two new nutritional surveys for DRC in the reporting period in Kinshasa and Lemera in South Kivu. The latest report from OCHA suggests that some 10 million Congolese on both sides of the frontline face food shortages of varying degrees. The food security outlook is grim given that the majority of the food producing regions (the Kivus, Northern Katanga, parts of Maniema, western and eastern Orientale and Equateur) are seriously affected by the war. In addition, an estimated 800,000 farmers have been displaced and lost their production capacity; and road, fluvial and railway infrastructure is crippled by insecurity and dilapidation (OCHA -03/00).

Kinshasa

The most recent nutritional surveys in Kinshasa, undertaken by AAH-USA in October, indicated that the nutritional situation was not out of control and that the prevalence of acute malnutrition ranged from 3.5-7.7%. However, given the city’s huge population (6 million inhabitants), a very large number of children require supplementary feeding. The prevalence of malnutrition was highest in the outskirts of the city (see RNIS 29).

Following the nutritional survey, ACF carried out a food security assessment. The aim of the survey was to assess household food security and the impact of the economic crisis and conflict, with resulting increased unemployment; loss of purchasing power; and decline of access routes to the centre of Kinshasa. The survey assessed food security in 4 zones: Kimbanseke, Selembao, Kingabwa and Kinshasa (2 peripheral and 2 central zones) (ACF-USA -03/00a).

The results of the assessment indicated that food security is most precarious for the population living on the outskirts of the city. Conflict has led to increasing migration out of the city. The outskirts of the city are most severely affected because they are mainly dependent on agriculture, but opportunities to sell produce are limited because of degradation of access routes. There are few other income earning strategies. In addition, irrigation systems used for market gardening have been destroyed due to looting in the 1991 and 1993 wars. People also have difficulties accessing seeds and tools. Water, electricity and health services are either not functioning or non-existent. Furthermore, where such services do exist, many people have been unable to pay their bills and their services have been cut off. As a result, people either have to beg for water from their neighbours or are forced to get their water from contaminated sources. Fishing has been affected by a night curfew and theft. These factors have had a negative impact on food security and nutrition (ACF-USA - 03/00).

Acute food insecurity due to the current economic crisis was indicated by the following:

• Changes in consumption patterns: the majority of households are only eating one meal per day, whereas the better off would normally eat two or three. The poorest families have reduced the quantity of the one daily meal, or every family member has to fend for him or herself. Some only eat on alternate days. In the periphery, people collect wild foods such as insects, grubs and mushrooms.
• Changes in income earning strategies; a variety of alternative strategies have been developed. Some are based on speculation, i.e., the buying up of certain commodities, hoarding and selling them when the price has increased. Others include a system of loans without interest between groups of households, asking for gifts from relatives with regular salaries. Many have resorted to begging, and survey respondents mentioned an increase in prostitution (including by children, and sometimes only for food). Women in particular are looking for any way to make money, which reportedly has a negative impact on childcare.
• Reduction in expenditure on health and education.
• Changes in networks of sharing; in the periphery, there has been an increase in the proportion of nuclear families. Households refuse to host migrants, as they can no longer afford to feed them, and since there are few income earning possibilities in the periphery, there is little chance of the migrants contributing income to the household. In contrast, in the centre, the number of people living and eating together in one compound has increased. It is possible for households in the centre to host migrants because of the greater income earning possibilities there.

ACF identified the most socially vulnerable as being:

• The children of prostitutes, who are taken care of by their extended families, but not treated equally to other children in the family. Many of the children in the ACF feeding programmes are children of prostitutes.
• Widows and orphans. These are not automatically taken care of by their extended family.

Recent anecdotal reports suggest that the food security in Kinshasa has improved since December 1999, because of the harvest. The food supplies to the city have changed from Equateur and Kisangani to BasCongo and Northern Kasai. However, the recent fighting in Kasai threatens the new food supply. It is expected that the hungry season will be earlier than usual because of the reduction in the harvest due to fighting (Fennell - 30/03/00).

Orientale Province

The conflict between the Lendu and Hema tribes is a major source of instability in eastern DRC. The conflict has rapidly expanded from its epicentre (Djigu), and by mid-January 2000 affected several densely populated areas including Bunia. The alleged partiality of the Ugandan army (which has occupied the Ituri district of the DRC since November 1998) may be fuelling the confrontation that has resulted in a heavy death toll and the displacement of some 220,000 civilians (OCHA -15/02/00).

The IDPs are concentrated in isolated bush areas, major trading centres and in Bunia town (where a small amount of food is being distributed by MEDAIR). The displaced populations are reported to be in need of protection, shelter, food, medical assistance and safe water, but widespread insecurities are preventing an adequate humanitarian response. Some international NGOs have been forced to leave after being accused of impartiality (IRIN -03/03/00). The most recent nutritional survey in Bunia estimated the prevalence of acute malnutrition at 11.6%, including 9.1% severe acute malnutrition (see RNIS 29). Recent anecdotal reports suggest that adults are also becoming malnourished and that there have been increasing numbers of deaths from diarrhoeal diseases (IRIN -17/02/00).

In Djigu, the displaced have congregated around the trading centre. Many of the IDP’s houses and possessions have been destroyed - including seeds and tools. Seasonal planting has been affected which will have long-term implications for food security (IRIN - 03/03/00).

Recent reports have also described rising tensions in Kisangani, the site of a fierce battle between Ugandan and Rwandan troops in August 1999 (IRIN - 29/03/00).

North and South Kivu

IDP numbers are increasing in South and North Kivu. Hate speech and communal violence have increased alarmingly in the provinces, directed mainly at Congolese Tutsis (the Banyamulenge) by the Mayi Mayi militias. The longstanding ethnic tensions in the area have been exacerbated by the continuing Rwandan occupation and reported atrocities committed by their troops against the civilian population. War-affected communities are reported to be fleeing further from their homes in search of security and in anticipation of all-out war (IRIN - 31/03/00; OCHA -03/00). This displacement could have a severe impact on the food security of the affected population as the agricultural season is about to start.

SCF-UK undertook a food economy assessment of six areas of South and North Kivu Provinces between September and December 1999. There has been a decline in both the quantity and quality of foodstuffs consumed by farmers in traditionally wealthy agricultural regions of the Kivus. A summary of the findings is presented below (SCF-UK - 22/01/00). The main causes of food insecurity are the looting of livestock, disruption of trading activities and agriculture due to insecurity, loss of income (e.g. from sale of agricultural produce or wage labour), an increase in the cost of basic commodities, and displacement. Some people are reportedly held hostage in the forest.

South Kivu

• In all four zones (the Plaine de la Ruzizi, the Moyens Plateaux, the Savane and the Foret) all household types (poor, middle and rich) have suffered a reduction in their purchasing power since 1997. Households are able to obtain adequate calories and other basic items. However their reduced purchasing power has implications for the quality of diet, healthcare and education that they can afford.
• This loss of purchasing power is most serious for the poor in the Savane (which is the poorest zone). The poorest households are only able to obtain sufficient calories by forgoing expenditure on education and healthcare and reducing expenditure on soap, salt and other basic items. They are a priority for assistance.
• The ability of households to cope with a period of displacement (either when they are displaced themselves or when they must act as hosts) varies from zone to zone. Households in the Savane have the least capacity to cope with displacement, whereas those in the Foret have large fields of mature cassava that can be harvested. However, even those in the Foret may have longer-term problems if they are just harvesting (and not weeding or replanting because of security risks). Previous surveys in the region have shown that a purely cassava-based diet may lead to oedematous malnutrition.

North Kivu

• The Masisi Plateaux has suffered large-scale conflict since 1993, as well as extreme insecurity in the past two years. Large numbers of the population are displaced. Sources of food and income have decreased dramatically. Income sources for the poor include crop sales, agricultural labour and other labour types. Expenditure among the poor is minimal; none purchased kerosene and 60% of total expenditure was on food.
• Most of the displaced who were previously rich have moved to urban centres where they are in business. The poor have generally moved to rural villages where they survive by being manual labourers or by producing their own crops
• The poor households in the Zone Volcanique, Rutshuru were affected by a reduction in crop production and an increase in the prices of items they need to purchase.

The food economy assessment did not discuss mineral extraction in the Kivus, which could be an important source of income.

ACF-USA undertook a nutritional survey of children aged 6-59 months and mothers in Lemera health zone, South Kivu in January 2000 (see annex). Lemera is part of the Moyens Plateaux food economy zone, its altitude (which determines the vegetation and cultivation type) varies from 1,200-2,000m. Prior to the wars in 1996 and 1998, cassava, beans, rice, bananas, sweet potatoes, maize and coffee were all grown. Much of the produce was sold. The war caused displacement and a breakdown of irrigation and infrastructure systems. Much of the population have moved off their land and have lost their tools and other farming inputs. The insecurity continues together with regular displacements and systematic looting. As reported above, this has resulted in very decreased expenditure on any non-food items, such as healthcare and education. ACF-USA provided seeds and tools to 10,000 households in September 1999 and plans to do so again later this year (ACF-USA-01/00).

Insecurity resulted in the survey being delayed several times and eventually prevented the team from visiting all the villages in the zone, thus the results presented reflect the nutritional situation of the majority of the population (which was estimated at 115,000), but are not based on an entirely random selection of children. The prevalences of malnutrition in both mothers and children can be seen in the graph (maternal malnutrition is defined as BMI<18.5kg/m² and/or oedema, and severe malnutrition as BMI<16.0kg/m² and/or oedema). A high proportion of severe malnutrition was oedematous malnutrition. The high prevalence of severe malnutrition in children in relation to moderate malnutrition (4.8 and 6.1% respectively) was attributed to the lack of primary health care. The feeding programme coverage was estimated at 33.3% for children aged 6-59 months. Retrospective mortality, estimated over the three months prior to the survey, was estimated at 2.46/10,000/day for children under five. This indicates an emergency. The major cause of mortality was reported by mothers as being fever (68%), followed by diarrhoea (20%). The very limited access to health care is an important risk factor (ACF-USA - 01/00).

Equateur, West and East Kasai Provinces

Sporadic cease-fire violations transformed into intense fighting in Equateur province around Ikela and Opela during the reporting period. An estimated 250,000 people are displaced. Similarly, military activity in West and East Kasai has also intensified, and an estimated 140,000 people are thought to be displaced in these provinces (OCHA - 03/00). No nutritional information is available.

The prevalence of acute malnutrition (defined using z scores and BMI and/or oedema) in children aged 6-59 months and mothers in Lemera, South Kivu

Refugees in DRC

Despite the continuing unrest in the DRC, thousands of refugees still seek protection in the country. There have not been any significant refugee influxes recently.

Sudanese refugees

There are an estimated 72,000 Sudanese refugees in Orientale Province. There is no new information on their nutritional situation.

Angolan refugees

There are an estimated 156,000 Angolan refugees in Bas-Congo, Bandundu, and Katanga Provinces. Some 56,000 Angolans fled into DRC in late 1998 and early 1999. These people joined the 100,000 refugees who were already in the country. The most recent assessment of these refugees described their nutritional situation as non-critical (see RNIS 29).

Congolese refugees (from RoC)

There are an estimated 11,600 refugees from RoC in Bas-Congo. The most recent nutritional survey in this area recorded extremely high prevalences of malnutrition, particularly kwashiorkor (see RNIS 30). Repatriation of the Congolese refugees to RoC is ongoing and it is anticipated that this process will be speeded up by the increased stability in RoC (UNHCR-31/03/00).

Burundian refugees

There are an estimated 19,500 Burundian refugees in South Kivu (UNHCR - 31/03/00). UNHCR’s efforts to assist these people have been shattered by the fighting. There is no new information on their nutritional situation, but given the upheaval in South Kivu it is assumed that they are living in difficult conditions.

Rwandan refugees

There are approximately 35,000 Rwandan refugees in various locations throughout DRC. UNHCR and the Congolese government have started an operation to integrate some 5,000 of these refugees into Congolese society. There is no new information on their nutritional situation.

Ugandan refugees

There are an estimated 3,200 Ugandan refugees in Orientale Province (OCHA - 15/02/99). There is no new information on their nutritional situation.

Overall, it is extremely difficult to draw any definite conclusions about the nutritional situation of the displaced in DRC because humanitarian agencies are unable to gain access to much of the affected areas. However, it seems probable that the areas in which there has been recent fighting and displacement will be the most nutritionally vulnerable (Orientale, Kivus, Equateur, East and West Kasia). These people are therefore considered to be at high to very high risk of malnutrition (category I and II). The displaced in other areas are considered at high to moderate risk (category II and III). The nutritional situation of the people in Kinshasa is temporarily improved, but is likely to deteriorate when food prices rise at the start of the hunger season (category IV). Given the economic vulnerability of people in Kinshasa, they remain at nutritional risk. The nutritional situation of the refugees is assumed to be unchanged: the Angolan refugees are considered non critical and the Congolese in Bas Congo are at very high risk. The nutritional situation of the other refugees is unknown.

Recommendations and Priorities:

• People will only become food secure with an end to the conflict. In the meantime, negotiating access to war affected populations is the main priority.

From the SCF-UK food economy assessment in the Kivus:

• Improve access to land, particularly for the poor. Provision of credit to the poor should be considered so that they can rent land.
• Support farmers through the provision of tools and seeds. Implement projects to drain land and to counter erosion etc.
• Promote small-scale animal raising projects
• Rehabilitate roads in order to improve market access.
• Provide free healthcare to the displaced and returnees to help them recover from their journeys.
• Monitor food security information (crop production/yields, market prices etc).

From the ACF-USA survey in Kinshasa:

• Improve public health; including access to health care and water.
• Improve access to markets for the peripheral zones by repairing roads.
• Agricultural support: including promotion of the keeping of small stock, improving access to fishing tools, and rebuilding of irrigation systems.
• Improve nutritional support. Ensure that the severely malnourished are admitted to feeding programmes, train CHWs in nutrition monitoring and educate mothers in hygiene and sanitation.

RNIS 29, December 1999

A tenuous cease-fire is being observed across the Democratic Republic of the Congo (DRC) following the signature of the Lusaka cease-fire accord. The accord charts a multi-track course that should lead to the withdrawal of all foreign forces and the restoration of Congolese state authority over the entire country. There still remain, however, formidable challenges including the demobilisation of numerous militia groups and defining a common ground for political consensus. Peace efforts must also address the humanitarian problems resulting from the war including the return and re-integration of over one million IDPs and refugees (IRIN -10/12/99; OCHA-11/99).

The UN Security council has established a peacekeeping force for the DRC that will be deployed throughout the country for an initial period of 3 months to monitor and support the implementation of the Lusaka cease-fire accord, and facilitate the delivery of humanitarian assistance in DRC (IRIN-08/12/99).

Numbers affected

Almost 14 million persons have been directly affected by the war in DRC and are in need of humanitarian assistance, although to varying degrees. An estimated 916,000 people have been displaced by fighting within the country (see map). The IDPs and their hosts remain exposed to violence and extortion perpetrated by various military and militia. A further 130,000 Congolese have found refuge in Tanzania and Zambia. Over 270,000 refugees from neighbouring countries remain in the DRC (OCHA -11/99).

Approximately 2,200,000 Congolese IDPs, returnees and socially unprotected urban groups and refugees in the DRC face severe food insecurity. This represents more than 4% of the country’s population (OCHA -11/99).

Economy

In urban areas the dire economic situation, a legacy of years of misrule, has been exacerbated by the war. The economy is characterised by major losses in state income, trade standstill between the west and east of the country, enormous military expenses and restrictive monetary measures. These factors are making urban livelihoods extremely fragile (OCHA-11/99, 15/11/99).

IDPs in DRC (from OCHA, 15/11/99)

Security, access and funding

The security situation within DRC remains critical, with the exception of Kinshasa. The Kivus, Katanga, Equateur and Orientale provinces are particularly insecure and as a result it is difficult to provide humanitarian assistance in these provinces. Little information on the nutritional situation in these areas is available, but it is assumed that conditions are very poor, given that trade with the rest of the country is severely restricted, fighting has damaged agricultural activities and medical supplies are low or non-existent (IRIN 07/12/99, 26/11/99, 25/11/99, 10/11/99, 12/10/99).

WFP’s EMOP for the DRC aims to assist 350,000 IDPs and vulnerable people; clearly more people require assistance than this, but gaining access to them is difficult, although improving. WFP’s appeal had only received 29% of its requirements in mid-December and hence cannot currently even fully support those to whom it has access (IRIN -07/12/99; 08/12/99; OCHA -11/99; WFP -10/12/99).

Kinshasa

The capital city of DRC, which is made up of 24 communes, covers a surface area of 150 km² and, according to a census in 1998, is home to approximately 5,500,000 people. ACF-USA undertook four nutritional surveys in the city in October (see annex). The surveys were conducted in four separate communes, two of which are on the outskirts of the city and have more agricultural activity (Kimbanseke and Selembao communes) and two of which are in more urban, central zones (Kinshasa and Kingabwa communes). The results of the surveys, for both children aged 6-59 months and their mothers, can be seen in the graphs below.

The prevalence of acute (wasting and/or oedema) and severe acute (severe wasting and/or oedema) malnutrition among children aged 6-59 months in four communes in Kinshasa, October 1999

The prevalence of stunting and severe stunting among children aged 6-59 months in four communes in Kinshasa, October 1999

The prevalence of moderate and severe malnutrition (defined using the BMI and MUAC) in mothers in four communes in Kinshasa, October 1999

The prevalence of malnutrition is higher, in both children and their mothers, in the peripheral communes that are more “rural”. ACF-USA is preparing to undertake a food security assessment that may provide some explanation for the differences (ACF-USA -11/99).

The nutritional situation was not considered “out of control”, but a huge number of children require supplementary and therapeutic feeding. In Kimbanseke commune alone, where there are an estimated 105,300 children under-five, approximately 3,000 children require therapeutic feeding (ACF-USA-11/99).

Mortality rates for children under-five, coverage of feeding programmes and measles vaccination rates can be seen in the table below. The coverage of the feeding programmes was very low in all four communes. Vaccination rates were also poor if confirmation was given by card alone, although this figure increased considerably when the mothers were asked about their children’s immunisation history (ACF-USA-11/99).

Results of nutritional assessments in Kinshasa

Commune	Under-five mortality rates	Coverage of feeding programmes	Vaccination
	deaths/10,000/day	(%)	With card	With/without card
Kimbaseke	n.a.	5.1	28.7	71.9
Selembao	2.3	5.6	33.0	88.8
Kinshasa	1.0	6.3	29.1	92.3
Kingabwa	1.0	7.1	28.9	92.8

In November, floods displaced 15,000 citizens of Kinshasa. The Congo River reached a historical high, although the peak of the rainy season is not expected until mid-December. As two thirds of Kinshasa is built on plains and is vulnerable to flooding, there is concern that many more citizens will have to be evacuated. The risk of cholera, already endemic in this area, is extremely high (OCHA - 02/12/99, 06/12/99).

Kisangani Town

MSF-H conducted a survey in Kisangani Town in November as a follow up of a survey conducted in January (see RNIS 26). The prevalence of wasting decreased from 13.4% in January to 9.2% in November (see graph). Fifty-three percent of the malnourished children had oedema. Female-headed households were twice as likely to have a severely malnourished child. The prevalence of stunting was estimated at 42.7%, including 19.7% severe stunting (see annex).

The prevalence of total and severe malnutrition in Kisangani Town in January and November 1999

The survey reported that under-five mortality rates and CMRs had increased since January (see graph). In addition, the number of admissions of children over five to feeding centres had increased between the two surveys (MSF-H-11/99).

The CMR and under-five mortality rates in Kisangani Town in January and November 1999

MSF-H have suggested that while the prevalence of wasting has decreased, the nutritional situation overall may in fact have worsened. The reduction in the prevalence of wasting was largely due to a decrease in the prevalence of severe malnutrition. A reduction in severe malnutrition could be a result of mortality, or therapeutic feeding, rather than an improvement in the nutritional situation of all children. However, the coverage of the feeding programme was not determined in the survey and hence it is not possible to assess whether the reduction in severe malnutrition was due to therapeutic feeding or increased mortality.

The increase in mortality may in part be because people can no longer afford to pay for health care. Health care is available, but it is too expensive. Similarly, the high prevalence of kwashiorkor may be related to the fact that much of the population cannot afford to buy a selection of foodstuffs from the market and must rely only on what they grow - thus the quality of their diet is inadequate. Increased numbers of people are reported to be leaving the city to obtain food more cheaply (MSF-H-11/99).

Bas-Congo

MERLIN conducted a nutrition survey and food security assessment among residents, refugees and returnees in the Bas-Congo health zones of Luozi and Mangembo in September and October (see annex). The survey estimated the prevalence of acute malnutrition at 26.0%. The prevalence of oedema was extremely high at 20.3%. The prevalence of stunting was estimated at 64.2%, including 38.7% severe stunting. The measles vaccination rate was 72% according to carers’ reports and the polio immunisation rate was 81.6%. These figures, however, could not be confirmed, as the number of children possessing vaccination cards was extremely low (MERLIN-11/99).

This survey was conducted at the end of the dry season, when food insecurity is worst. Given that there were no baseline data available, it was difficult to verify to what extent the prevalence of malnutrition was due to an exacerbation of a recognised, traditional seasonal problem. The very high prevalences of severe acute malnutrition, in particular oedema, however, do indicate a serious health risk (MERLIN-11/99).

The majority of the severe acute malnutrition was kwashiorkor. The population’s primary staple during the survey period was cassava, and the consumption of meat and poultry was low. High intakes of cassava, with little complements, may be linked to a high incidence of kwashiorkor (MERLIN-11/99).

Chronic food insecurity in these areas has been exacerbated by the war in neighbouring RoC. While food production was not worse than previous years, the influx of refugees and economic migrants returning from RoC placed increased demands on the local economy. Traditionally, Bas-Congo had strong economic links with the RoC. The local population exported their agricultural surplus to RoC in exchange for sugar, salt, meat, fish and manufactured goods. The closure of the border has stopped this trade and restricted access to a wider variety of food produce. Although 65% of the returned economic migrants were reported to have access to land, only half of these had access to seeds. Looting of livestock and crops by the military further marginalised household food supply. There were no differences in the prevalence of wasting, stunting or oedema between the resident, returnee or refugee groups (MERLIN-11/99).

Katanga

An inter-agency mission in Northern Katanga in October witnessed large-scale devastation of areas affected by combats. The situation of the returnees and those still living in the bush (over 120,000 persons) was described as pre-catastrophic (OCHA - 15/11/99). An MSF-B assessment mission to monitor the situation of IDPs in Duni and Pweto in the north east of Katanga Province reported that the nutritional situation was critical (WFP - 01/10/99).

Medical and food assistance has been provided to IDPs in Pweto, and Lubumbashi. The rest of Katanga’s approximately 195,000 IDPs remain unassisted (OCHA -15/11/99).

A UNHCR nutritional survey of the refugees in Katanga is described below in the refugee section.

Kivus

A recent registration of IDPs estimated that there were 155,000 IDPs in the accessible areas of North Kivu province. The total IDP figure for North Kivu is expected to rise considerably when the figures for the currently inaccessible areas are included. Preliminary estimates put the number of IDPs in South Kivu at 180,000 (OCHA - 15/11/99). In November, only 31% of the target population is assisted. WFP expects to extend assistance to additional beneficiaries when further resources for its EMOP are mobilised (WFP -12/11/99).

Insufficient stocks of cereals have created a bottleneck for the implementation of assistance programmes for IDPs in Goma. There is also a scarcity of sugar and CSB, which is required for the special feeding programmes. The movement of goods in this area has been restricted by insecurity. Population displacement due to military activities continues in both North and South Kivu (WFP-01/10/99, 12/11/99).

Orientale Province

A local conflict in the east of the country - Ituri district - between the pastoralists Hema and agriculturalist Lendu ethnic groups which began in June has expanded in the reporting period. Large numbers of people have been displaced (up to 50,000) and many villages have been burnt (IRIN -15/11/99; OCHA-15/11/99).

An MSF-H nutritional survey in late October in Bunia Health Zone, Ituri district, estimated the prevalence of wasting and/or oedema at 11.6% (see annex). The prevalence of oedema was high at 8.6%. The prevalence of malnutrition was higher among the displaced children than residents, although poor food security had affected the whole population. Market prices had increased since the conflict began. The population were employing coping mechanisms such as a reduction in the amount of food consumed, planting small gardens and seeking employment in the fields of other cultivators (MSF-H-12/99).

The authors of the survey concluded that, given the political and economic situation in the district, the outlook for food security in this area is poor. They anticipate an increase in prices of foods and eventually a shortage of staples because of the insecurity (MSF - H -12/99).

Refugees in DRC

Despite the continuous fighting in the DRC during 1999, tens of thousands of refugees fled civil strife in their country to the relative security of the DRC. Specifically, the escalation of the conflict in the Republic of Congo (RoC) and Angola resulted in a substantial influx of refugees to Bas-Congo, Bandundu, and Katanga Provinces. There are currently an estimated 260,000 refugees in the DRC.

Sudanese refugees

There are an estimated 60,000 Sudanese refugees in Orientale Province. There is no new information on the nutritional situation of these refugees.

Angolan refugees

There are an estimated 156,000 Angolan refugees in Bas-Congo, Bandundu, and Katanga Provinces. Some 56,000 Angolans fled into DRC in late 1998 and early 1999. These people joined the 100,000 refugees (67,000 of whom are assisted by UNHCR) who were already in the country (OCHA-11/99; UNHCR-16/12/99).

Kisenge camps, Katanga

There are an estimated 42,000 Angolan refugees in 3 camps in Kisenge. 22,000 of these had arrived in the 1970’s and had become self-sufficient by 1998. UNHCR was in the middle of a repatriation programme when civil war in Angola resulted in a further 20,000 Angolans arriving at the camp. The repatriation programme was halted; prospects for repatriation are very poor at the moment (UNHCR/WFP -11/99).

UNHCR undertook a nutritional survey in the 3 camps in August, which showed that the nutritional situation had dramatically improved. The survey in August estimated the prevalence of wasting at 3.5%, including 0.3% severe wasting. The prevalence of oedema was estimated at 0.14% (one child was oedematous) (UNHCR -17/09/99).

This survey took place after a three-month intensive nutritional programme in the camps, following the results of an MSF-B survey in the area in February that reported high prevalences of malnutrition (see RNIS 26),

The feeding programme coverage was estimated at 57.7%, which is relatively low, possibly because of the large distances to the clinics from some of the refugee camps. Vaccination coverage was high -89.7% of the children had been vaccinated for measles (although only 11.2% were confirmed by card) (UNHCR -17/09/99).

The improvement in nutritional status was partially due to the coping strategies adopted by the refugees, which included: working in manioc fields for Congolese or more established refugees, eating manioc tubers before complete maturity, sweet potatoes, wild honey, wild fruits, wild ignames; eating or selling vegetables, rodents or insects. WFP also provided a general ration. (although this was low in calories, averaging 820/Kcal/person/day in the five months before the survey) (UNHCR -17/09/99).

Despite of the low prevalence of malnutrition recorded, the author of the survey warned that the hungry season was approaching and that it would last until February/March 2000. A complete ration is required for the refugees during this time of year (UNHCR/WFP -17/09/99).

A higher prevalence of wasting was recorded in the newly arrived refugees compared to those who had been there longer. The interagency mission to Katanga noted that the new caseload of Angolan refugees “is far from being self-sufficient”, mainly because of insufficient land available for planting as well as a shortage of tools. Most of the old caseload has enough land to be considered self-sufficient (UNHCR/WFP-11/99).

Kilueka camp, Bas-Congo

There are an estimated 18,400 Angolan refugees in Kilueka and Nkondo camps in Bas-Congo. The health and nutritional situation of these refugees is considered acceptable, if very fragile. The UNHCR/WFP JFAM in October 1999 found no signs of nutritional problems in Nkondo camp. No reliable nutritional surveys have been conducted in these camps (UNHCR/WFP-11/99).

The interagency mission observed that there had been no planting of staple foods around Kilueka camp, primarily because of the limited land availability. A limited amount of vegetables had been planted. Other sources of income, such as petty trading and brewing, are possible for these refugees. Land availability in these areas is the major obstacle for self-sufficiency for the refugees (UNHCR/WFP -11/99).

Congolese refugees (from RoC)

There are an estimated 6,000 Congolese refugees from RoC in Bas-Congo. The resumption of civil war in RoC forced 46,000 refugees into DRC, but a tripartite agreement between the governments of RoC, DRC and UNHCR facilitated the return of 40,000 of the refugees to Brazzaville via Kinshasa.

The MERLIN nutritional survey of the refugees in Luozi, Bas-Congo (described above) found a very high prevalence of malnutrition, particularly kwashiorkor. Many of the refugees in Luozi arrive in a very poor condition, having hidden in the forests for months. Most of the refugees have urban backgrounds; in any case there is no land available for the refugees to cultivate. The refugees from Brazzaville consider Luozi to be a transit centre and will move back to RoC as soon as possible. This may not be so for those from the Pool Region who will require a full ration (UNHCR -11/99).

Burundian refugees

There are an estimated 20,000 Burundian refugees in South Kivu. Efforts by UNHCR to assist these people were shattered by the rebellion. As the rebel forces swept through South Kivu, the refugees fled to the forest. They are reported to be living in extremely difficult conditions, but there has been no new information on their nutritional situation (OCHA-11/99).

Rwandan refugees

There are approximately 25,000 Rwandan refugees in various locations throughout DRC, The situation of these refugees is precarious, as the rebels perceive that they support President Kabila. Twenty-five thousand Rwandans were recently repatriated from North and South Kivu by local NGOs and UNHCR (OCHA - 11/99; UNHCR -16/12/99). The nutritional situation of the Rwandan refugees is unknown.

Ugandan refugees

There are approximately 2,300 Ugandan refugees in Orientale province. There has been no information on their nutritional situation.

Recommendations and priorities:

• Support WFP’s emergency operation for the DRC, which is currently seriously under-funded.
• Continue to assess humanitarian needs in newly accessible areas.

From the surveys in Kinshasa:

• Precise recommendations must await the food security assessment, but it is clear that feeding programmes are needed in Kinshasa, particularly in the more rural zones.

From the survey in Kisangani:

• Continue and strengthen MSF-H nutritional interventions.
• Begin active screening of malnourished cases.
• Investigate the increasing mortality rates and the causes for the reduction in severe malnutrition.
• Conduct a food security assessment.

For the refugees:

• Monitor the nutritional situation of all the refugee groups closely. Monitoring should include regular nutritional surveys, food-basket monitoring and food economy assessments. Ensure the reliability of nutritional surveys using standard techniques.

From the survey in Bas-Congo

• Distribute a general ration of 2,100 kcal/person/day.
• Start targeted supplementary feeding programmes for the acutely malnourished under-fives.
• Distribute seeds and tools for the returnees.
• Improve therapeutic feeding of malnourished within existing health structures. Train health personnel on nutritional surveillance and treatment of malnutrition.
• Instigate long-term agricultural programmes aimed at improving yields and diversification of crops.

From the survey in the Kisenge camps

• Provide a ration of 1,900 kcal/person/day to all refugees in these camps until March 2000.
• Close the therapeutic feeding centres.

Overall, the IDPs are considered at high risk, particularly those in the Kivus, Katanga, Equateur, and Orientale Provinces (category II). However, there has been no assessment in these areas because of insecurity. War affected populations elsewhere are considered to remain at moderate risk, e.g. Kisangani and Kinshasa (category III). The situation of the Angolan refugees appears non-critical (category IV). The Congolese (RoC) in Bas-Congo are at very high risk (category I). The nutritional situation of the other refugees is unknown, e.g. the Sudanese, Ugandans, Rwandans and Burundians (category V).

RNIS 28, September 1999

An agreement between the governments of the six countries involved in the conflict in the DRC was signed in Lusaka on July 10^th. More recently, the agreement was signed by the Ugandan backed rebel group Mouvement de Libération Congolais (MLC) and the other major rebel group, the Rassemblement Congolais pour la Démocratie (RCD). The agreement calls for the cessation of military activities within 24 hours of all parties signing. A Joint Military Commission should then implement and monitor the cease-fire, the withdrawal of foreign forces from the DRC, the deployment of an international peacekeeping force, the disarming of militia groups and the initiation of an inter-Congolese dialogue on the political future of the DRC. At the time of going to print, the rebel factions were still unable to agree on the representation of the Joint Military Commission (IRIN - 02/09/99, 08/09/99).

Despite the ceasefire agreement, large numbers of civilians continue to be exposed to indiscriminate violence, looting and destruction of productive assets in almost all parts of the country, thus forcing their displacement. Thus, the reporting period was marked by high mobility of the affected population within the country and cross border movements. The table below shows the geographical location of the estimated 836,000 IDPs in DRC. These figures are considerably higher than those estimated previously. This increase reflects both the continuation of a high level of military activity in the eastern provinces and in western and northern Equateur. The increase in the number of IDPs reported is also due to the improved accessibility to displaced populations that has resulted in greater accuracy and depth of the information presented (OCHA - 19/08/99, 24/08/99, 15/09/99).

Katanga	E. Kasai	Equateur	Maniema	N. Kivu	Orientale	S. Kivu
185,000	60,000	126,000	20,000	160,000	80,000	195,000

Access and funding

The accessibility of vulnerable populations both in RCD and government controlled areas has significantly improved since the signing of the Lusaka peace agreement, although long bureaucratic formalities are still required to gain access to many areas. Remaining pockets of inaccessibility are primarily defined by; military activity in the northern (Equateur) and southern (Katanga and eastern Kasai) fronts; protracted insurrection (the Kivus and Orientale) and re-emerged "tribal" clashes in Orientale (OCHA - 24/08/99).

The WFP EMOP for war-affected populations in DRC remains seriously under-funded. At the time of going to print, only $5.8 million had been pledged out of a total of $30 million required (WFP - 15/09/99). Thus despite the improvement in accessibility, many of the war-affected populations will still be unassisted.

Economy

Any positive impact of the Lusaka cease fire agreement on the economy of the DRC was short-lived and negligible. Economic indicators are still in decline: devaluation of the national currency and inflation continue. The country's major sources of income - copper and cobalt production, as well as diamond mining - are in recession. The state's revenue from diamond sales is further threatened by the rebel advance in Kasai. The country's economic performance has had a serious impact on purchasing power and food security, particularly in urban areas (OCHA - 15/07/99, 19/08/99, 24/08/99).

Kinshasa

Access to food continued to become more difficult for the population in Kinshasa in the reporting period. The main factors affecting household food security are hyperinflation and an inadequate flow of foodstuffs into the market. The US embassy in Kinshasa estimated a 41% increase in food prices in the food market between June and July (OCHA - 15/07/99).

Research by the Diocesan Bureau for Medical Research (BDOM) indicates that 80% more cases of malnutrition were being treated in church sponsored centres in June 1999 compared to June 1998 (this may be partially due to the increased number of feeding centres open this year). A survey undertaken by the AAH-USA in Kimbanseke Commune of Kinshasa in late July estimated the prevalence of wasting and/or oedema at 8.7%, which includes 2.9% severe wasting and/or oedema. Oedema was found in 2% of the children measured. Chronic malnutrition or stunting (height-for-age) was estimated at 33.3%, which includes 13.5% severe malnutrition. Children's mothers were also examined using the BMI (kg/m²). The results can be seen in the table below. 11.5% of the women were classified as malnourished, which included 4.3% severely malnourished. A further 15.5% of the women could be considered to be at risk of malnutrition.

16.0<BMI	16.0<=BMI<17.0	17.0<=BMI<18.5	18.5<=BMI<25	25<=BMI<30	BMI>=30
4.3%	7.2%	15.5%	64.7%	6.5%	1.8%

The survey also estimated measles vaccination rates which were low according to the possession of a vaccination card (28.1%), but were much higher when confirmed by the children's parents/guardians (71.9%). The feeding programme coverage was very low at 5.1%.

Province Orientale

MSF-H have been running a nutrition programme in Kisangani since a survey conducted in January estimated the prevalence of acute wasting and/or oedema at 13.2% which included 9.5% severe undernutrition (compared to the results of a WHO survey which found 3.7% acute wasting and/or oedema and 3.0 severe wasting and/or oedema in November 1997). In a demographic review of the admissions to the Feeding Centre it was noted that an increasingly large number of children were coming to the Kisangani centres from areas far outside the town. Many children had travelled 40-50 km for treatment and some up to 160 km. Thus the NGO decided to undertake a survey in the Aire de Sante de Madula (about 30 km south east of Kisangani) on the routes to Ituri and Lubutu in early August (MSF-H 08/99; MSF-H - 09/09/99).

The MSF-H survey estimated the prevalence of acute wasting and/or oedema at 13.2% and severe wasting and/or oedema at 9.5% (see Annex). About one third of the malnourished children had bilateral oedema, including 80.3% of the severely malnourished children. These prevalences are very similar to those recorded in Kisangani in January. The report suggested that the malnutrition could be attributed to the area's economic decline and the generalised insecurity. The peak prevalence of malnutrition occurred approximately 35 km from Kisangani. The authors suggested that those in more rural areas were less malnourished because they were able to produce their food at home. Those closer to the town had easier access to the town's facilities, but those in between had neither advantage. The measles vaccination coverage rate in the survey was dangerously low at 12.8%, particularly given the nutritional status of the children.

MSF-H conducted a comparison of local market prices in Kiangani town between September 1999 and August 1998 (pre-conflict). The prices of all goods compared were significantly higher following the war, for example casava leaves had increased from US $0.02 to $1.00 over this period (MSF-H - 15/09/99).

Conflict between the Hema and Lendu ethnic groups in Ituri district, Province Orientale has led to a sharp increase in cholera cases and a measles epidemic according to reports recently received. The conflict, which began in mid-June, has made approximately 40,000 people homeless and resulted in a heavy death toll (up to 3,500 people). The displaced are reported to be living in conditions of poor hygiene. In addition, health centres in the region have been looted, torched or abandoned, leaving both the local population and the displaced without medical aid. In response to the measles epidemic MSF-H has launched a large-scale vaccination campaign targeting 30-35,000 children. It has also distributed anti-cholera drugs and water purification sets. (IRIN - 03/09/99; MSF-H - 18/08/99; OCHA - 15/09/99).

Katanga

The first UN mission to northern Katanga which has been able to obtain full and unconditional access to areas affected by population displacement since the beginning of the war identified more than 54,000 displaced persons in the area. Over 28,000 IDPs were registered in Lubumbashi, of whom only 3,300 were being assisted. An estimated 125,000 residents of the Manono area were also believed to be dispersed in "hardly accessible" areas of Kiluba. The assessment mission noted that the coping mechanisms of the host communities in Katanga were "seriously weakened" and that they had difficulty supporting the displaced. Anecdotal reports of high rates of morbidity and mortality among displaced children have been received, although these reports are unconfirmed at the time of going to print (IRIN - 18/08/99; OCHA - 15/09/99).

Further anecdotal reports of a poor food security situation and a growing number of malnourished children in Kalemie have been received. According to a recent report, most of the supply routes into the town have been cut because of the war, and only small amounts of food have been arriving from Moba, which has resulted in food being priced at about four times pre-war levels. The food security in Moba, traditionally the area's bread basket, was also reported to be poor as the war had disrupted agricultural activities in the area. About half of Moba's 400,000 residents had left the town, many were still hiding in nearby forests (IRIN - 02/09/99).

South Kivu

As a result of intensive population movement, insecurity, and military activity compounded with drought, the food security situation is reported to have deteriorated in South Kivu over the past two months. FAO has estimated that some 125,000 households will not be able to cultivate during the coming agricultural season unless interventions are carried out immediately. The UN humanitarian office in South Kivu estimates that food shortages will directly affect 800,000 people in this area, including 195,000 who are displaced. No further information concerning this situation is currently available to the RNIS (OCHA - 15/09/99).

Polio vaccination campaign

The campaign to vaccinate children against polio is reported to have successfully reached 6.7 million of the country's 10 million children under five. Fighting stopped in 90% of the country to allow the campaign to proceed. Despite fighting in Kisangani on the final day of the campaign, 70% of children in the city were still vaccinated (OCHA - 15/09/99; WHO - 20/08/99).

Although the overall operation has been described as a success, considerable numbers of children in the rural areas were not covered. This was partially due to less awareness of the campaign in rural areas. A combination of security and logistical problems resulted in disappointing coverage of only 23% in Equateur province (IRIN - 26/08/99).

Refugees in DRC

Angolan refugees

There are an estimated 157,000 Angolan refugees in DRC. The difficult situation in Angola continued to generate refugee influxes into Bas Congo province. Poor road conditions and the number of military roadblocks are forcing WFP to use rail transport in order to provide food for feeding programmes in Katanga province for over 43,000 Angolan refugees in the area. A scarcity of wagons is causing frequent delays in food dispatches and disrupting planned distributions. As a result of the inadequate food deliveries, UNHCR continues to supply complementary food items to this group of refugees (OCHA - 19/08/99, 15/09/99; UNHCR - 27/09/99).

The current nutritional situation of these refugees is unknown. Reports earlier in the year suggested that the nutritional status was very poor, but improvements in the situation due to a general food distribution for children under five has been reported more recently (WFP - 30/04/99).

Refugees from Congo-Brazzaville

In mid-September there were an estimated 20,000 refugees from the RoC in DRC. The rate of arrival of Congolese refugees to Bas Congo has diminished over the reporting period and many are returning to Congo-Brazzaville. However, anecdotal reports suggest the health and nutritional condition of the newly arrived refugees (mainly from the Pool region) is very poor, much worse than those who had arrived earlier. There are no survey data available to the RNIS, however, to confirm these reports. UNHCR and WFP continue to try to provide assistance, but there are difficulties in getting supplies to the area (IRIN - 30/07/99; OCHA - 15/07/99).

Burundian, Rwandan and Sudanese refugees in DRC

There are an estimated 20,000 Burundian and 10,000 Rwandan refugees in the Kivus. There are also a further 61,000 Sudanese in Province Orientale. The nutritional situation of these refugees is unknown.

Overall, improvements in the nutritional situation are expected provided the cease-fire agreement holds and humanitarian agencies are allowed free access throughout the country. Thus it is probable that the inhabitants of Kinshasa, Kisangani and other areas that are accessible are at moderate risk of malnutrition (category IIb). Anecdotal reports suggest that the IDPs in South Kivu and Katanga are at greater risk, although this information requires confirmation (category IIa). There is little or no information about the nutritional situation of the large number of other IDPs in other areas of the country. Thus the nutritional situation of all these people must therefore be classified as unknown (category III). Given the situation in Congo-Brazzaville, it is probable that the refugees from this country are at high risk of malnutrition (category IIa). The nutritional situation of the other refugees is unknown (category III).

Priorities and Recommendations:

• Provide international support for the implementation of the Lusaka agreement in order to promote regional stability.
• Provide funds to support WFP's programme.
• Conduct surveys and needs assessments in newly accessible areas in order to determine needs on a provincial basis.
• Gain access to the previously inaccessible rebel-held areas.

From the MSF-H survey outside Kisangani:

• Transport all severely malnourished identified in the survey to Kisangani TFCs for treatment.
• Investigate potential sites for nutritional centres outside Kisangani using demographic data from the Kisangani nutritional centres.
• Alert UNICEF and other EPI health officials to the low measles coverage in the area.
• Strengthen nutrition education in the communities.
• Identify an agricultural or fishing partner to strengthen food security.

RNIS 27, July 1999

The crisis in the DRC continues and now involves at least a dozen African countries, either directly as combatants in the fighting or indirectly as mediators in various peace initiatives. The rebel forces, comprising Congolese soldiers, Congolese Tutsi Banyamulenge, Rwandan, Ugandan and some Burundian government troops, accuse President Kabila of behaving like a dictator and increasing regional instability by his support for the guerilla groups opposed to the governments of his former allies, including the Rwandan 'genocidaires'. Kabila is resisting the rebel movement with support from Angolan, Zimbabwean and Namibian troops and accuses Rwanda and Uganda of aggression and "foreign adventurism" in regard to Congolese territory and natural resources (ICG - 21/05/99).

The rebels currently control approximately a third of the country (in the north and east), including Goma and Uvira (IRIN - 09/06/99). The violence continues in many parts of the country. Uvira and Goma were both bombed by forces allied to the government in May resulting in civilian deaths (IRIN-12/05/99).

Progress in the search for a negotiated peace is elusive. Proposals for a national debate have been put forward and the government has declared its willingness to hold "direct talks" with the rebels, but the start of the talks has been postponed several times (IRIN - 17/05/99, 09/06/99). In late May Rwanda declared a unilateral ceasefire in DRC (IRIN - 31/05/99), but the government continued to bomb rebel held areas and hence the ceasefire no longer holds (IRIN - 03/06/99). The rebel factions have also held talks to discuss a peace settlement, but cracks in their alliance have begun to appear and they have ousted their leader Wamba dia Wamba (IRIN -18/05/99).

IDPs in DRC

There is only limited information available concerning the nutritional situation of the people of DRC. Thus it is difficult to estimate the scale of the humanitarian crisis and needs. Given the current security situation, no surveys have been undertaken recently in rebel held areas, because of limited access and as a result of the near-complete destruction and/or loss of infrastructure. It is estimated that there may be up to 660,000 IDPs in the country, the majority of whom are in South Kivu (220,000) and Katanga (150,000) (IRIN - 22/06/99).

Kinshasa

In Kinshasa the recent devaluation of the currency has affected market prices and basic food costs have increased substantially. A study conducted by FAO and UNDP noted that food insecurity has been increasing in the city since August 1998. This is linked to both a reduction in food availability due to; insecurity, lack of currency for importing goods, and shortage of fuel, and also restricted access to food due to high inflation and unemployment. The study, which was undertaken between mid-March and early April, found that the purchasing power of the city's population had diminished by 30-35% since the beginning of the war (IRIN -06/05/99, WFP - 27/04/99). Anecdotal reports have described increases in the prevalence of wasting among children (IRIN - 16/04/99). Fuel has also become expensive - disrupting the transport system and hence the city's economy. WFP airlifts from Pointe-Noire to Brazzaville continue as rail traffic between the two cities is not possible due to insecurity. Part of this food is then ferried across the river to for distribution in Kinshasa (WFP - 28/04/99).

Lubumbashi, South East DRC

ACF conducted a study in Lubumbashi district, Katanga province in May (see Annex). The most recent census (1997) estimated the population of the district to be approximately one million people. Lubumbashi town developed around the mining activities in the province - there are large quantities of zinc, silver, lead and cobalt deposits in the area. The socio-economic and political situation of the town's population, who are mainly salaried workers, is precarious. The recent insecurity has caused massive population displacements and increased unemployment. Many of the labourers have not received their salaries for several months. In addition, the devaluation of the congolese franc to the dollar has increased the population's difficulty in purchasing sufficient food.

The survey estimated 2.1% acute wasting and 0.1% severe wasting in children under-five. Oedema was recorded in 0.7% of the children. A much higher proportion of the children were defined as stunted (low height-for-age): 50.8%; 16.2% were defined as severely stunted.

Maternal nutritional status was also studied. 18.8% of the women had a BMI<18.5 kg/m² of which 7.5% of these had a BMI < 17. kg/m². 6.1% of the women had a MUAC < 220mm. If the women's MUAC and BMI were considered together (BMI<18.5 kg/m² and MUAC<220 mm) it was found that 8.5% were classified as undernourished. This figure was reduced to 2.0% when only those with a very low BMI and low MUAC were considered (BMI<16.0 kg/m² and MUAC<220 mm). A further 12.4% were considered to have marginal nutritional status (BMI>18.5 kg/m² and MUAC<220 mm).

Enquiries about vaccination status revealed that only 19% of the children had been vaccinated against measles as confirmed by a card, however, based on mothers' reporting vaccination coverage increased to 80%. Approximately half of those children vaccinated were less than nine months of age, which is generally considered to be too young.

Given the population's precarious socio-economic and political situation, the prevalence of wasting amongst the children is not as high as might be expected. There are virtually no facilities for caring for undernourished children in this area. Maternal nutritional status appears to be poorer than that of children and therefore may be a more serious problem. A simple analysis found no association between maternal and child nutritional status. In addition, there was no significant difference between the nutritional status of households who possessed a garden plot (46%) as compared with those who did not.

Lukaya district, Bas-Congo

ACF also conducted a study in Lukaya district, Bas-Congo province in March (see Annex). During August-September 1998 this area was directly affected by the war when the aggressors fought along the main roads from Kisantu-Kinshasa and Kisantu-Angola. There were numerous civilian deaths, houses were looted and demolished and agricultural fields were destroyed. The health centres were emptied of medicines and equipment. Many farmers lost their seeds and tools and were forced to delay planting their crop. The survey, which was conducted six months after these events, was undertaken at the request of UNICEF who reported an increase in the number of admissions to the supplementary feeding centres in the villages. The survey estimated acute wasting at 4.9% and 0.5% severe wasting in children under-five. Oedema was recorded in 0.2% of the children. A much higher proportion of the children were defined as stunted (low height-for-age): 43.5%; 19.6% were severely stunted.

Maternal nutritional status was also studied. 20.4% of the women had a BMI<18.5 kg/m² of which 5.2% of these had a BMI < 17.0 kg/m². 8.0% of the women had a MUAC < 220mm. If the women's MUAC and BMI were considered together (BMI<18.5 kg/m² and MUAC<220 mm) it was found that 8.4% were classified as undernourished. This figure was reduced to 1.6% when only those with a very low BMI and low MUAC were considered (BMI<16.0 kg/m² and MUAC<220 mm). A further 13.1% were considered to have marginal nutritional status (BMI> 18.5 kg/m² and MUAC<220 mm).

Enquiries about vaccination status revealed that only 34.5% of the children had been vaccinated for measles as confirmed by a card, however this figure reached 43.9% when based on mothers' verbal reports. About half of the children with cards had been vaccinated before the age of nine months. An estimated 7% of the children were reported to have had diarrhoea in the two weeks before interview and 42.8% had suffered from a fever. The treatment of those who suffered from diarrhoea was not always ideal - only 45.2% were given oral rehydration salts and food was withheld from some (30.6%).

The crisis six months prior to this survey does not appear to have had lasting effects on nutritional status of children. The area is sufficiently well equipped with nutritional centres to deal with the estimated number of undernourished children in the population. Maternal nutritional status was, once again, less satisfactory. A weak significant association was found between the maternal and child nutritional status.

Rebel held areas

Approximately 20,400 IDPs and malnourished children are receiving supplementary and therapeutic feeding in Goma through a WFP-funded project. An FAO-sponsored food security programme is providing seeds to some 10,000 displaced families in the region (IRIN- 06/05/99). No further information on the nutritional situation of the population in these areas is available.

Measles and polio vaccination campaigns have been carried out in North and South Kivu by IRC/UNICEF/WHO/MSF/SCF-UK in collaboration with local health authorities. The campaign followed earlier reports of deaths from measles in these areas in February. Stocks of meningitis vaccines are currently being built up in response to a continuing epidemic in the province (IRIN - 06/05/99, 11/05/99).

An outbreak of a viral haemorraghic fever has been confirmed by WHO in the north-eastern region of the country. The latest figures suggest that there have been 90 confirmed cases and 60 deaths. The majority of these patients were men working in gold mines around Duba in Province Orientale. The epidemic was not caused by the Ebola virus, but may have been due to the related Marburg virus. The most recent reports suggest that the epidemic is diminishing (IRIN - 12/05/99).

Refugees in DRC

Angolan Refugees

There are estimated to be 145,000 Angolan refugees in the DRC (UNHCR - 10/06/99). The assistance programme to 50,000 Angolans in southern parts of the country continues to be hampered by several constraints. There have been serious and chronic delays in food arrivals due to the scarcity of wagons for the transport of food and poor road conditions. Airflights are also scarce and very expensive. As a result of inadequate food deliveries, UNHCR has been required to purchase much of the food for these refugees locally. The nutritional situation of the refugees, which was reported to be extremely poor in February, has improved following a decision to extend food assistance and health care to all children under-five (WFP - 30/04/99).

Refugees from Congo Brazzaville

Over 30,000 Congolese fled to Bas-Congo in the DRC at the height of the conflict. UNHCR has assisted approximately 13,000 Congolese refugees to return from the DRC to Brazzaville and more are scheduled to return. Approximately 10,000 other refugees are thought to have returned without assistance (IRIN - 14/05/99, 30/06/99).

Fresh waves of violence have, however, precipitated more fleeing from the Pool area. Constant movement in and out of the area renders it difficult to provide an exact caseload of the refugees (the most recent estimate is that there are 32,000 refugees from Congo-Brazzaville). The new arrivals are reported to be in poor health and nutritional condition as many had been hiding in the forest around Pool for up to four months without regular access to food. The most recent report from UNHCR states that mortality rates are very high. Health facilities are available in Luozi camp which has a capacity of 15,000 people. UNHCR plans to buy food for these refugees locally, as WFP has not been able to provide the required ration (IRIN - 11/05/99,14/05/99, 30/06/99; UNHCR - 28/06/99, 30/06/99, WFP - 31/05/99).

Burundian, Rwandan and Sudanese refugees in DRC

There are estimated to be some 20,000 Burundian refugees in S. Kivu and some 60,000 Sudanese people in the country. Approximately 25,000 of the Sudanese may have regrouped in Am where UNHCR is in the process of opening an office in order to assist them. No information is available on their nutritional situation of the others as they were scattered by the recent conflict and have been hiding in the hills and forest. UNHCR has reopened its office for the Goma region which had been closed since October 1997. A large number of Rwandans remain unaccounted for in this area (UNHCR - 28/06/99).

Overall, the IDPs in the government held areas are at moderate risk (category IIb). Those in the rebel-held areas may be at higher-risk (estimated number: 370,000), but no information is available to the RNIS (category III). The Angolan refugees in Bas-Congo are considered to be at high risk (category IIa). High mortality rates are reported for the refugees from Congo-Brazzaville (category I). No information is available on the nutritional status of the other refugees (category III).

Priorities and recommendations:

• Access to the rebel-held areas is still the priority for the humanitarian community in DRC.

Recommendations from the ACF survey in Lubumbashi include:

• Set up therapeutic and supplementary programmes for the treatment of the undernourished children.
• Create a surveillance programme which will refer children to these centres

Recommendations from the ACF survey in Bas-Congo include:

• Continue the treatment of the undernourished children in the existing programmes
• Continue growth monitoring programme of the children in health centres but add height monitoring to this (currently just weight-for-age)
• Educate and sensibilise the population about the proper treatment of diarrhoea

Both surveys recommend:

• Develop food security activities in order to respond to the longer-term problem of stunting among the children.
• Improve and strengthen the measles vaccination campaign.

RNIS 26, March 1999

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).

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

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].

RNIS 23, March 1998

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].

RNIS 22, December 1997

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].

RNIS 21, September 1997

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].

RNIS 20, June 1997

Refugees in Democratic Republic of Congo (excluding Rwandans and Burundis included in section #4). There are an estimated 160,000 Angolan refugees in Democratic Republic of Congo, most of whom do not require assistance. It was hoped that most of the assisted population will spontaneously return to Angola after the signing of a peace treaty in 1994, but to date, there has been no significant return. There are approximately 111,000 Sudanese and 18,500 Ugandan refugees receiving some assistance in Democratic Republic of Congo [UNHCR May 97].

Displaced from Shaba, Democratic Republic of Congo There are approximately 600,000 people who have been displaced by ethnic violence which erupted in the Shaba region at the end of 1992. This population fled north into the Kasai region where many had ancestral links. During the migration large numbers stopped temporarily in villages along the route north, while others settled permanently at these sites. Currently, there is little further displacement from the Shaba region and based on the most recent set of nutritional survey information, it is believed that many of these people are self-sufficient and no longer require humanitarian aid. The exception to this is in Mwene Ditu where critically high levels of wasting of about 43% in the displaced population, estimated at 40,000 people, and 17% wasting in the resident population (estimated at 220,000) were reported [MSF-B 09/04/96 - RNIS #15].

However, as fighting in Eastern Democratic Republic of Congo moved further into the interior of Democratic Republic of Congo, this already vulnerable displaced population is likely to have experienced increasing hardship:

Overall, the displaced and resident affected populations in Mwene Ditu are in category 1 in Table 1 due to elevated levels of wasting. The remaining displaced population from Shaba are no longer considered to require assistance ad so are not included in Table 1. The refugees are not currently considered to be at heightened nutritional risk (category IIc in table 1).

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.

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

RNIS 19, March 1997

Refugees in Zaire (excluding Rwandans and Burundis included in section #4). There are an estimated 50,000 Angolan refugees in Zaire; It is also estimated that a further 119,000 Angolans are unassisted (and not included in tables 1 and 2). It is hoped that most of the assisted population will spontaneously return to Angola now that there has been such a marked improvement in the political and security situation. Organised repatriation for the 50,000 assisted refugees is scheduled to begin by mid 1997. There are approximately 94,000 Sudanese refugees receiving some assistance in Zaire.

Displaced from Shaba, Zaire There are approximately 600,000 people who have been displaced by ethnic violence which erupted in the Shaba region at the end of 1992. This population fled north into the Kasai region where many had ancestral links. During the migration large numbers stopped temporarily in villages along the route north, while others settled permanently at these sites. Currently, there is little further displacement from the Shaba region and based on the most recent set of nutritional survey information, it is believed that many of these people are self-sufficient and no longer require humanitarian aid. The exception to this is in Mwene Ditu where critically high levels of wasting of about 43% in the displaced population, estimated at 40,000 people, and 17% wasting in the resident population (estimated at 220,000) were reported [MSF-B 09/04/96 - RNIS #15].

However, as fighting in Eastern Zaire moves further into the interior of Zaire, this already vulnerable displaced population could experience increasing hardship.

Overall, the displaced and resident affected populations in Mwene Ditu are in category 1 in Table 1 due to elevated levels of wasting. The remaining displaced population from Shaba are no longer considered to require assistance ad so are not included in Table 1. The refugees are not currently considered to be at heightened nutritional risk (category IIc in table 1).

Burundi/Rwanda Region

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.

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].

RNIS 18, December 1996

Refugees in Zaire (excluding Rwandans and Burundis included in section #4) There are an estimated 50,000 Angolan refugees in Zaire; an estimated further 119,000 are unassisted (and not included in Tables 1 and 2). It is hoped that most of the unassisted population will spontaneously return to Angola now that the situation has improved there. Organised repatriation for the 50,000 assisted refugees is scheduled to begin by mid 1996. There are approximately 94,000 Sudanese refugees receiving some assistance in Zaire. The slight increase is due to a small number of new arrivals fleeing the continued insecurity in southern Sudan. There are over 12,000 Ugandan refugees and a further 6,000 new arrivals whose refugee status unclear [UNHCR 17/01/96, 1995-1997].

Displaced from Shaba, Zaire There are approximately 600,000 people who have been displaced by ethnic violence which erupted in the Shaba region at the end of 1992. This population fled north into the Kasai region where many had ancestral links. During the migration large numbers stopped temporarily in villages along the route north, while others settled permanently at these sites. Currently, there is little further displacement from the Shaba region and based on the most recent set of nutritional survey information, it is believed that many of these people are self-sufficient and no longer require humanitarian aid. The exception to this was in Mwene Ditu where critically high levels of wasting of about 43% in the displaced population, estimated at 40,000 people, and 17% wasting in the local affected population (estimated at 220,000) are reported [MSF-B 09/04/96 - from RNIS #15].

Overall, the displaced and resident affected populations in Mwene Ditu are in category I in Table 1 due to elevated levels of wasting. The remaining displaced population from Shaba is no longer considered to require assistance and so is not included in Table 1. The refugees are not currently considered to be at heightened nutritional risk (category IIc in Table 1).

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.

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].

RNIS 17, September 1996

Refugees in Zaire (excluding Rwandans and Burundis included in section #4) There are an estimated 50,000 Angolan refugees in Zaire; an estimated further 119,000 are unassisted (and not included in Tables 1 and 2). It is hoped that most of the unassisted population will spontaneously return to Angola now that the situation has improved there. Organised repatriation for the 50,000 assisted refugees is scheduled to begin by mid 1996 [UNHCR 17/01/96,1995-1997].

There are approximately 94,000 Sudanese refugees receiving some assistance in Zaire. The slight increase is due to a small number of new arrivals fleeing the continued insecurity in southern Sudan [UNHCR 17/01/96].

There are over 12,000 Ugandan refugees and a further 6,000 new arrivals whose refugee status unclear [UNHCR 17/01/96].

Displaced from Shaba, Zaire There are approximately 600,000 people who have been displaced by ethnic violence which erupted in the Shaba region at the end of 1992. This population fled north into the Kasai region where many had ancestral links. During the migration large numbers stopped temporarily in villages along the route north, while others settled permanently at these sites.

Currently, there is little further displacement from the Shaba region and based on the most recent set of nutritional survey information, it is believed that many of these people are self-sufficient and no longer require humanitarian aid. The exception to this was in Mwene Ditu where critically high levels of wasting of about 43% in the displaced population, estimated at 40,000 people, and 17% wasting in the local affected population (estimated at 220,000) are reported [MSF-B 09/04/96 - from RNIS #15].

Overall, the displaced and resident affected populations in Mwene Ditu are in category I in Table 1 due to elevated levels of wasting. The remaining displaced population from Shaba is no longer considered to require assistance and so is not included in Table 1. The refugees are not currently considered to be at heightened nutritional risk (category IIc in Table 1).

Burundi/Rwanda (Great Lakes) Situation

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

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].

RNIS 16, June 1996

Refugees in Zaire (excluding Rwandans and Burundis included in section #4) There are an estimated 50,000 Angolan refugees in Zaire; an estimated further 119,000 are unassisted (and not included in Tables 1 and 2). It is hoped that most of the unassisted population will spontaneously return to Angola now that the situation has improved there. Organised repatriation for the 50,000 assisted refugees is scheduled to begin by mid 1996 [UNHCR 17/01/96, 1995-1997].

There are approximately 94,000 Sudanese refugees receiving some assistance in Zaire. The slight increase is due to a small number of new arrivals fleeing the continued insecurity in southern Sudan [UNHCR 17/01/96].

There are over 12,000 Ugandan refugees and a further 6,000 new arrivals whose refugee status unclear [UNHCR 17/01/96].

Displaced from Shaba, Zaire There are approximately 600,000 people who have been displaced by ethnic violence which erupted in the Shaba region at the end of 1992. This population fled north into the Kasai region where many had ancestral links. During the migration large numbers stopped temporarily in villages along the route north, while others settled permanently at these sites.

Currently, there is little further displacement from the Shaba region and based on the most recent set of nutritional survey information, it is believed that many of these people are self-sufficient and no longer require humanitarian aid. The exception to this was in Mwene Ditu where critically high levels of wasting of about 43% in the displaced population, estimated at 40,000 people, and 17% wasting in the local affected population (estimated at 220,000) are reported [MSF-B 09/04/96 - from RNIS #15].

Overall, the displaced and resident affected populations in Mwene Ditu are in category I in Table 1 due to elevated levels of wasting. The remaining displaced population from Shaba is no longer considered to require assistance and so is not included in Table 1. The refugees are not currently considered to be at heightened nutritional risk (category IIc in Table 1).

How could external agencies help? In Mwene Ditu, financial support to continue the functioning of feeding centres is a main priority.

Burundi/Rwanda Situation

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

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].

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].

RNIS 15, April 1996

Refugees in Zaire (excluding Rwandans and Burundis included in section #4) There are an estimated 169,000 Angolan refugees in Zaire of whom 50,000 are assisted in some way. It is hoped that most of the unassisted population will spontaneously return to Angola now that the situation has improved there. Organised repatriation for the 50,000 assisted refugees is scheduled to begin by mid 1996 [UNHCR 17/01/96, Jun 95-Dec 97].

There are approximately 94,000 Sudanese refugees receiving some assistance in Zaire. The slight increase is due to a small number of new arrivals fleeing the continued insecurity in southern Sudan [UNHCR 17/01/96].

There are over 12,000 Ugandan refugees and a further 6,000 new arrivals whose refugee status unclear [UNHCR 17/01/96].

Displaced from Shaba, Zaire There are approximately 600,000 people who have been displaced by ethnic violence which erupted in the Shaba region at the end of 1992. This population fled north into the Kasai region where many had ancestral links. During the migration large numbers stopped temporarily in villages along the route north, while others settled permanently at these sites.

Currently, there is little further displacement from the Shaba region and the most recent set of nutritional survey information shows that the level of self-sufficiency obtained by this migrant population varies enormously. Most recent survey data were included in RNIS #14. These surveys showed low levels of wasting among most of these people.

The exception to this was in Mwene Ditu where in October 1995 wasting was measured at critically high levels of about 43% in the displaced population, estimated at 40,000 people, and 17% in the local affected population (estimated at 220,000). It has recently been reported that the nutrition situation in and around Mwene Ditu has not improved. Over 6,000 children are included in supplementary and therapeutical feeding centres and financial support for these centres is apparently running out [MSF-B 09/04/96].

Masisi Region, Zaire Since November 1995, there has been a marked escalation in a conflict in Masisi zone of North Kivu (estimated population 500,000-600,000). The conflict is between the Banyarwanda people (Rwandese origin), most of whom are Hutu, and Zairians of mostly Hunde ethnic origin. Although lack of access precludes an accurate assessment of numbers, many people are undoubtedly being killed and tens of thousands displaced from their homes. Estimates of the total number of displaced people vary widely and range from 100,000 to 250,000. The reason for this dramatic explosion of conflict at the end of last year appears to have been related to the threatened expulsion of Rwandan refugees in December 1995 [DHA 26/02/96, WFP 16/02/96].

The area has been inaccessible to humanitarian organisations since January due to the high level of insecurity. Poor roads and the risk of being associated with one faction also make it very difficult for humanitarian agencies to work in the area. Many of the displaced people are surviving by living among extended families or friends and using marginal land to cultivate their own crops. A nutritional survey carried out in Kinchanga, where some 12,000 displaced people are gathered, showed an extreme crisis with wasting and/or oedema rates measured at 31 % with 13% severe wasting and/or oedema (see Annex I (15a)) [MSF-H 13/02/96].

Most recent reports are that fighting is continuing in the Masisi region and that some of the conflict incidents are occurring closer to Mugunga refugee camp in Goma [WFP 15/03/96].

Overall, the displaced and resident affected populations in Mwene Ditu is in category I in Table 1 due to elevated levels of wasting, as is the population in the Masisi region. The remaining displaced population from Shaba and the refugees are not currently considered to be at heightened nutritional risk (category IIc in Table 1).

How could external agencies help? In Mwene Ditu, financial support to continue the functioning of feeding centres is one priority.

More information is needed from the Masisi area where ethnic violence is leading to large scale displacement. Very probably interventions including emergency food and health assistance are urgently needed for several thousand people.

Burundi/Rwanda Situation

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

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].

RNIS 14, February 1996

Refugees in Zaire (excluding Rwandans and Burundis included in section #4) There are estimated to be well over 200,000 Angolan refugees in Zaire although only 50,000 are currently being assisted by UNHCR. The assisted population are expected to require assistance in order to repatriate to Angola while the remainder will probably return spontaneously. The organised repatriation is due to begin in mid-1996 when pre-departure health and nutrition screening, immunisation programmes and the updating of health cards are planned [UNHCR Jun 95-Dec 97].

Displaced from Shaba, Zaire There are approximately 600,000 people who have been displaced by ethnic violence which erupted in the Shaba region at the end of 1992. This population fled north into the Kasai region where many had ancestral links. During the migration large numbers stopped temporarily in villages along the route north, while others settled permanently at these sites. Currently, there is little further displacement from the Shaba region and the most recent set of nutritional survey information shows that the level of self-sufficiency obtained by this migrant population varies enormously.

Many of those fleeing the Shaba region settled in the sub-region of Kabinda in the Kasai region of Zaire. During 1995, this population received some general ration support and were also given agricultural tools and seeds. A nutritional survey in November 1995 in Lupata found wasting rates of 9.9% with a severe wasting prevalence of 1.3% (see Annex 1 (15(a)). There appeared to be little difference between the nutritional status of the resident and displaced population. A survey in Gandajika recorded wasting at 8.6% with 0.6% severe wasting (see Annex 1 15(b)). Levels of oedema of 4.0% were more worrying. Furthermore, this survey found significantly higher prevalence of wasting among those displaced from Shaba than amongst the resident community [MSF-B 17/11/95].

A nutritional survey conducted in Likasi in December 1995 found levels of wasting of 5.5% with 0.3% severe wasting and no reported oedema (see Annex 1 15(c)). These levels show no significant difference to the 7% prevalence recorded in a survey in January 1995. The results are encouraging and suggest that a large part of the displaced population are now self-sufficient as a general ration was gradually phased out during 1995. As a result of these consistently low levels of wasting the selective feeding programmes implemented by MSF Belgium will now be phased out in early 1996 [MSF-B 07/12/95].

In contrast, a survey conducted in Mwene Dim, another transit point along the route north from Shaba, showed a far more serious situation. Among the resident population (estimated at 220,000) wasting and/or oedema rates were measured at 17.8% with 4.8% severe wasting and/or oedema. Wasting and/or oedema rates among the displaced population (estimated at 40,000) was 42.9% with 9.3% severe wasting and/or oedema (see Annex 1 15(d-e)). These extremely high levels of wasting probably reflect a variety of factors. For example, the survey was conducted in the “hungry” season just prior to the harvest and therefore also coincided with a period when food prices were very high. Also, the increased population in the town has placed enormous strain on available agricultural land and food resources. Furthermore, many household income receipts are barely sufficient to cover food needs so that there is little income to spend on health care so that untreated childhood illnesses often lead to malnutrition [MSF-B-a 26/10/95].

Overall, the displaced and resident affected populations in Mwene Ditu is in category I in Table 1 due to elevated levels of wasting. The remaining displaced population and the refugees are not currently considered to be at heightened nutritional risk (category IIc in Table 1).

How could external agencies help? There is an urgent need to increase agricultural support for the large population in Mwene Ditu, especially the displaced, and to improve coverage of selective feeing programmes by decentralising facilities and implementing active case finding at immunisation sites. There is also a clear requirement for funding for increased health staff, equipment, drugs and medicine at existing and new health centres. In Gandajika there is a need for targeted agricultural support for those who have been displaced from Shaba.

Burundi/Rwanda Situation

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.

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

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].

RNIS 13, December 1995

Refugees in Zaire (excluding Rwandans and Burundis included in Section #4) The nutrition situation of approximately 14,000 Ugandan refugees in Zaire is reportedly stable. Many of these refugees are eager to repatriate, but agreement has yet to be reached on how this will take place [UNHCR 18/09/95].

These have been no reports of any change in the situation of the approximately 50,000 Sudanese and 41,000 assisted Angolan refugees in Zaire.

Displaced from Shaba, Zaire There are approximately 600,000 people who have been displaced by ethnic violence in the Shaba region of Zaire in 1992. This population fled the area and moved into the Kasai region farther north where many of their ancestors lived. Large numbers stayed in towns, e.g. Mwene Ditu and Likasi, along the route north to the Kasai region.

There are no reports of change to the nutritional situation of the population. In the last RNIS report, the displaced population in Mwene Ditu was considered to be at high nutritional risk due to elevated levels of wasting, and the displaced populations in Likasi, Mbuji Mayi or Kabinda (combined population of 158,000) were thought to be at moderate risk.

Burundi/Rwanda Situation

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

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].

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].

RNIS 12, October 1995

There are approximately 600,000 people who have been displaced by ethnic violence in the Shaba region in 1992. This population fled the area and moved into the Kasai region farther north where many of their ancestors lived. Large numbers stayed in towns, e.g. Mwene Ditu and Likasi, along the route north to the Kasai region.

There are no reports of change to the nutritional situation of the population. In the last RNIS report, the displaced population in Mwene Ditu was considered to be at high nutritional risk due to elevated levels of wasting, and the displaced populations in Likasi, Mbuji Mayi or Kabinda (combined population of 158,000) were thought to be at moderate risk.

The nutrition situation of approximately 14,000 Ugandan refugees in Zaire is reportedly stable. Many of these refugees are eager to repatriate, but agreement has yet to be reached on how this will take place [UNHCR 18/09/95].

These have been no reports of any change in the situation of the approximately 50,000 Sudanese and 41,000 assisted Angolan refugees in Zaire.

Burundi/Rwanda Region

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.

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

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].

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].

RNIS 11, July 1995

There are approximately 600,000 people who have been displaced by ethnic violence which erupted in Shaba region in 1992. This population fled the region and moved into the Kasai region farther north where many of their ancestors lived. Large numbers stayed in towns, e.g. Mwene Ditu and Likasi, along the route north to the Kasai region.

A recent survey in the town of Mwene Dim showed 25.8% wasting with 5.9% severe wasting (see Annex I (12a)). This represents a marked decline in nutritional status amongst this population since a survey conducted in March when wasting was measured at 13.9% with 2.7% severe wasting. It is not clear whether these high levels of wasting, which are similar to those found in Mwene Ditu shortly after the initial displacement from Shaba region in early 1993, reflect food price rises and hungry season shortages, or whether general ration supplies to this population have been reduced or stopped in recent months. As a consequence of these survey results, NGOs have requested the continuation of supplementary feeding programmes which were due to be phased out in August [MSF-B 27/06/95].

We have no new information on the displaced populations in Likasi, Mbuji Mayi or Kabinda (combined population of 158,000). These populations may however be at moderate risk (category IIb in Table 1) due to hungry season food shortages and in the event that the planned cessation of general ration programmes for populations, such as those in Likasi (March 1995), took place. The population of Mwene Ditu town can be considered to be at high risk (category I in table 1) with very high levels of wasting. The displaced/returnee population in the Kasai region are probably not currently at nutritional risk (category IIc in Table 1).

How can external agencies help? The high rates of wasting found in Mwene Ditu indicate an urgent need for a review of basic ration availability amongst this population. There is also a need for more current nutritional status information amongst displaced populations in urban centres such as Likasi and Kabinda.

There are approximately 200,000 Angolan refugees in Zaire. 41,000 of whom are currently assisted. It is hoped that with the current positive political situation in Angola that many of these refugees will repatriate spontaneously [UNHCR 14/06/95]. There are no reports of change for the almost 64,000 Sudanese and Ugandan refugees in Zaire.

Burundi/Rwanda Region

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

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].

RNIS 10, April 1995

There are approximately 600,000 people who have been displaced by ethnic violence which erupted in Shaba region in 1992. These people fled the region and moved into the Kasai regions further north, for example Likasi and Mwene Ditu.

A nutritional survey was carried out in Likasi (estimated population of displaced people 7,000) in February 1995. Prevalence of wasting was found to be 7.7% with 1.1% severe wasting (see Annex 1 (12a)). These levels show a continuation of a trend toward improvement noted in past surveys - in December 1992 wasting was 27.1%, in June 1993 15.1% and in July 1994, 9.9%. The general ration distribution has until now provided for 1000 kcals/person/day in recognition of the partial self-reliance of this population. However, the implementing agency planned to stop this ration at the end of March. Observers have indicated that it is therefore vital to resettle this population as quickly as possible in Kasai or ensure full assimilation into Likasi in order to avoid an increase in levels of wasting. This need is given added urgency as the hungry season approaches and maize prices increase [MSF-B Feb 95].

A recent nutritional survey in the rural areas surrounding Mwene Ditu showed 6.2% wasting and 1.6% severe wasting (see Annex 1 (12b)). In the town of Mwene Ditu, wasting was measured at 13.9% with 2.7% severe wasting. In neither case was a difference noted between the displaced and resident populations. Most of those who are living outside the town of Mwene Ditu are able to engage in some agricultural activities, while in the town itself conditions are described as crowded [MSF-B Mar 95, MSF-B 05/04/95].

We have no further information on the population of Mbuji Mayi or Kabida (combined population 151,000) who according information from August October 1994 were experiencing levels of wasting as high as 30%.

Overall, the population of Mwene Ditu and Likasi may be considered to be at moderate nutritional risk (category IIb in Table 1) while the approximately 200,000 people in West Kasai are probably not at heightened nutritional risk (category IIc in Table 1).

How could external agencies help? There is a notable shortage of data on the nutritional and health status of the population displaced from Shaba. This may reflect the limited number of international NGOs working with this population. Indigenous NGOs might therefore be given greater encouragement and resources to conduct nutritional and health assessments of the populations with whom they are currently working.

There is no new information on the approximately 104,700 assisted refugees in Zaire. This total number does not include refugees from Burundi and Rwanda in Eastern Zaire discussed in section #4.

Burundi/Rwanda Region

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

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].

RNIS 9, February 1995

We have no new information on the almost 600,000 people who have been displaced by ethnic violence which erupted in Shaba region in 1992. The previous RNIS report indicated a generally improved, but nonetheless precarious, nutritional situation for the large majority of this displaced population.

The number of assisted refugees in Zaire is now approximately 104,700 people, excluding the Burundi and Rwandan refugees who are discussed in section #15 below. This total is comprised of 41,000 Angolan refugees, 62,000 Sudanese refugees, and 1,700 Ugandan refugees [UNHCR-a 09/12/94].

It is thought that the signing of the Angolan peace accord could lead to large-scale repatriation of the Angolan refugee population. However, there continues to be a steady stream of arrivals from Sudan to Zaire, although repatriation to Uganda is continuing [UNHCR-a 09/12/94].

There is no current information available on the nutritional status of these refugee populations, although it is thought to be adequate (category IIc in Table 1).

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.
 

	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.

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].

RNIS 8, December 1994

We have little new information on the estimated 400,000 people who have been displaced by ethnic violence which erupted in Shaba region in 1992. The previous RNIS indicated a generally improved, but nonetheless precarious, nutritional situation for the large majority of this displaced population.

The flow of people from Shaba into Mwene Ditu continues, with approximately 15,000 arrivals in September. Many of these displaced continue on into the Kasai regions and some remain in camps around Mwene Ditu [MSF-B Sep 94].

We have no updated information on the camp populations of Mbuji Mayi or Kabinda (combined population 151,000) and it is assumed that the high levels of wasting recorded in previous RNIS reports have not changed (category I in Table 1). The populations of Mwene Ditu and Likasi can be considered to be at moderate risk (category IIb in Table 1) and the approximately 200,000 people in West Kasai are not currently thought to be at risk (category IIc in Table 1).

The number of assisted refugees in Zaire is now approximately 102,700 people, excluding the Rwandan and Burundi refugees in Eastern Zaire, discussed in section #15. This total is comprised of 41,000 Angolan refugees, 60,000 Sudanese refugees and 1,700 Ugandan refugees. These planning figures are a reduction from previous ones and follow a recent assessment mission to Haut-Zaire, where the camps for the Sudanese and Ugandan refugees are located. There have recently been about 2,000 Ugandan refugees who repatriated. No details of the nutritional situation of these populations are currently available, but it is thought that their nutritional state is adequate (category IIc in Table 1) [UNHCR 17/10/94].

Burundi/Rwanda Situation

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.

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

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].

RNIS 7, October 1994

Ethnic violence that erupted in Shaba in 1992 has forced an estimate 400,000 people to flee the province and head north through various transit towns, (i.e. Likasi and Mwene Ditu) and eventually to the Kasai region.

A nutritional survey carried out in Likasi on the estimated 41,000 displaced people in July found 9% wasting with 3% severe wasting (see Annex 1 (11a)). Although not entirely comparable due the high rate of flux of the population, this appears to be an improvement over the levels of 15% wasting with 7.4% severe wasting measured in June 1993. This transit population receives a half ration amounting to 1000 kcals/person/day. Measles immunization coverage was recorded at 75.6% in the survey [MSF-Bb Jul 94].

The nutritional situation for the local residents of Likasi (estimated population of 160,000) in July was somewhat worse than that of the displaced population. Wasting was measured at 12.1% with 6.9% severe wasting. These relatively high levels of wasting probably reflect the economic crisis currently affecting much of Zaire which has been accompanied by rapid inflation and the resulting diminished capacity of many families to purchase basic food commodities. Measles immunization coverage for the local population was recorded at 63.4% (see Annex 1 (11b)) [MSF-Bc Jul 94].

There have been unconfirmed reports of pellagra in Likasi [MSF-B 15/09/94].

The number of arrivals to Mwene Ditu varies monthly with an estimated 15,000 arriving in June, and 6,000 arriving in July. Some of these arrivals continue north to Kasai region while some remain in Mwene Ditu town or in Simmons camp. A census carried out at the end of July found the actual camp population to be just under 5,000 people. The displaced population in the town itself is probably about 60,000.

The crude mortality rate in June, July and August in the camp was 0.2/10,000/day, which is a normal level, and the under five mortality rate was 0.4 - 0.26/10,000/day. Despite a vaccination campaign, cases of measles are still reported in the camp as the constant turn-over of the camp population makes it difficult to ensure complete coverage of the programme [MSF-Ba Jul 94, MSF-B Aug 94].

A nutritional survey carried out in the camp in mid-July found 16.3% wasting and 4.2% severe wasting (see Annex 1 (11c)). This level of wasting compares favourably with results obtained in March 1994 (31.4%) although there is a slight increase in the prevalence of severe wasting (3.8% in March) [MSF-Ba Jul 94].

We have no updated information on the camp populations of Mbuji Mayi or Kabinda (combined population 24,000) or the displaced living amongst local residents (127,000). The previous RNIS indicated high levels of wasting amongst the camp populations with increasing hardship for those subsisting amongst the local community. We are assuming that these population groups remain at high risk (category I in Table 1). The populations of Likasi and Mwene Ditu (displaced and local residents) can be considered to be at moderate risk with elevated levels of wasting (category IIb in Table 1). The approximately 200,000 people who have resettled in West Kasai are not currently thought to be at heightened nutritional risk.

How could external agencies help? Immunization coverage for the displaced populations needs to be improved, and anecdotal reports of pellagra need to be investigated. Family rations for children in feeding programmes may be useful. Programmes to enhance food security may provide a longer term solution.

There is no new information on the nutritional status of the approximately 163,000 assisted refugees in Zaire (N.B. Rwandan and Burundi refugees are not included in this group. See section # 15).

Burundi/Rwanda Region

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.

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

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].

RNIS 6, August 1994

Since ethnic violence erupted in August 1992 in Shaba province in Zaire, an estimated 400,000 people have fled into East and West Kasai. Humanitarian efforts focused on assisting the displaced as they moved along the train lines through Shaba and into the Kasais. These two provinces are now experiencing a long-term and more intractable emergency as there are few communities in which the displaced population can be easily assimilated.

Despite attempts to encourage the displaced to move beyond the transit points and into rural areas, growing numbers are opting to remain in the urban transit centres, straining both the absorptive capacity of the local economy and church/NGO emergency resources. Mwene-Ditu is one such transit point where there have been consistently high levels of wasting and mortality reported in several recent RNIS reports. Despite the growing problem in the town and camp in Mwene Dim there has been no implementation of a general ration programme. Without a co-ordinated resettlement strategy by the international community this situation is unlikely to improve.

In Mbuji Mayi, a town of almost 1 million, the displaced population is estimated to be 112,000 with 17,000 in camps. A recent nutrition survey in the camps showed 30% wasting with 12.5% severe wasting (see Annex I (1 la)). Food delivery in the camps is reportedly inadequate and distributions of what little food there is may be inequitable. There were only approximately 2-4 litres per person of water available for the camp populations. For the majority of the displaced living in the town, life is becoming increasingly difficult. With no access to the free food distributions, they attempt to survive on incomes earned in the informal sector [USAID May 94].

Another destination for the displaced leaving Mwene Ditu is Kabinda. At the end of May 39,000 displaced had passed through the town's transit camp with some 6-7,000 having elected to settle in the town itself. A survey in January found 28% wasting among children between 29-59 months from displaced families and lower but growing levels of wasting among children of the host population (see Annex I (11b)) [USAID May 94].

The emergency response to the estimated 200.000 displaced people in Kananga, West Kasai, has been quite different to that of towns in East Kasai. Local church structures and international NGOs have succeeded in establishing food distributions, health care and a resettlement programme that quickly moved people out of the capital onto land they could cultivate [USAID May 94].

At all the transit points described above the principal problem has been lack of a balanced general ration. In mid-March 1994 WFP finally began a six month maize distribution programme but the tonnages programmed were only sufficient to meet the food needs of 70,000 people which is a small percentage of the needy population [USAID May 94].

The displaced populations of Mwene Ditu (estimated at 65,000), Mbuji Mayi (estimated population 17,000) and Kabinda (estimated at 7,000) are at high risk with high levels of wasting (category I in Table 1). The approximately 200,000 people displaced to East Kasai are probably not at any heightened nutritional risk (category IIc in Table 1). The remaining 111,000 displaced people are probably at risk (category Ha in Table 1) due to a shortage of food, but there are no current survey data to support this observation.

How could external agencies help? An expanded general ration programme for the large numbers of displaced who have yet to achieve any degree of self-sufficiency must be urgently implemented. Furthermore future emergency assistance programmes should make greater efforts to integrate into, and build upon, existing local church/NGO networks. There also needs to be improved co-ordination of resettlement plans amongst agencies to ensure that the displaced are not encouraged to remain at transit centres, but rather to move on to their final destination.

Current estimates are that there are approximately 163,000 assisted refugees in Zaire (N.B. Rwandan and Burundi refugees are not included in this group). This estimate includes 41,000 Angolan refugees in Shaba, Bas Zaire and Kinshasa (south), 17,000 Ugandan refugees and 105,000 Sudanese refugees in Haul Zaire (north) [UNHCR May 94].

The first general ration distribution in four months finally took place in May for the Angolan refugees in Shaba [UNHCR May 94].

It has been reported that due to SPLA incursions and also a lack of food, many refugees in Haut Zaire are moving towards the interior away from the Sudanese border. Road conditions are said to be poor in the area making regular aid deliveries difficult. Thus, in April 1994, the camps received their first food delivery of the year. However, despite these infrequent food deliveries, no major nutritional and/or health problems have been reported [UNHCR May 94].

The refugees in Zaire are not currently considered to be at heightened nutritional risk, although insecurity in Haut Zaire may be cause for concern.

How could external agencies help? A baseline nutritional survey would be very helpful as it would increase confidence that the nutritional status of these refugees has not been adversely affected by recent difficulties in food distributions and some insecurity in Haut Zaire.

Burundi/Rwanda Region

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.

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].

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.

RNIS 5, June 1994

Since ethnic violence erupted in August 1992 in Shaba province in Zaire, an estimated 400,000 people have fled into East and West Kasai. Humanitarian efforts focused on assisting the displaced as they moved along the train lines through Shaba and into the Kasais. These two provinces are now experiencing a long-term and more intractable emergency as there are few communities in which the displaced population can be easily assimilated.

Despite attempts to encourage the displaced to move beyond the transit points and into rural areas, growing numbers are opting to remain in the urban transit centres, straining both the absorptive capacity of the local economy and church/NGO emergency resources. Mwene-Ditu is one such transit point where there have been consistently high levels of wasting and mortality reported in several recent RNIS reports. Despite the growing problem in the town and camp in Mwene Dim there has been no implementation of a general ration programme. Without a co-ordinated resettlement strategy by the international community this situation is unlikely to improve.

In Mbuji Mayi, a town of almost 1 million, the displaced population is estimated to be 112,000 with 17,000 in camps. A recent nutrition survey in the camps showed 30% wasting with 12.5% severe wasting (see Annex I (1 la)). Food delivery in the camps is reportedly inadequate and distributions of what little food there is may be inequitable. There were only approximately 2-4 litres per person of water available for the camp populations. For the majority of the displaced living in the town, life is becoming increasingly difficult. With no access to the free food distributions, they attempt to survive on incomes earned in the informal sector [USAID May 94].

Another destination for the displaced leaving Mwene Ditu is Kabinda. At the end of May 39,000 displaced had passed through the town's transit camp with some 6-7,000 having elected to settle in the town itself. A survey in January found 28% wasting among children between 29-59 months from displaced families and lower but growing levels of wasting among children of the host population (see Annex I (11b)) [USAID May 94].

The emergency response to the estimated 200.000 displaced people in Kananga, West Kasai, has been quite different to that of towns in East Kasai. Local church structures and international NGOs have succeeded in establishing food distributions, health care and a resettlement programme that quickly moved people out of the capital onto land they could cultivate [USAID May 94].

At all the transit points described above the principal problem has been lack of a balanced general ration. In mid-March 1994 WFP finally began a six month maize distribution programme but the tonnages programmed were only sufficient to meet the food needs of 70,000 people which is a small percentage of the needy population [USAID May 94].

The displaced populations of Mwene Ditu (estimated at 65,000), Mbuji Mayi (estimated population 17,000) and Kabinda (estimated at 7,000) are at high risk with high levels of wasting (category I in Table 1). The approximately 200,000 people displaced to East Kasai are probably not at any heightened nutritional risk (category IIc in Table 1). The remaining 111,000 displaced people are probably at risk (category Ha in Table 1) due to a shortage of food, but there are no current survey data to support this observation.

How could external agencies help? An expanded general ration programme for the large numbers of displaced who have yet to achieve any degree of self-sufficiency must be urgently implemented. Furthermore future emergency assistance programmes should make greater efforts to integrate into, and build upon, existing local church/NGO networks. There also needs to be improved co-ordination of resettlement plans amongst agencies to ensure that the displaced are not encouraged to remain at transit centres, but rather to move on to their final destination.

Current estimates are that there are approximately 163,000 assisted refugees in Zaire (N.B. Rwandan and Burundi refugees are not included in this group). This estimate includes 41,000 Angolan refugees in Shaba, Bas Zaire and Kinshasa (south), 17,000 Ugandan refugees and 105,000 Sudanese refugees in Haul Zaire (north) [UNHCR May 94].

The first general ration distribution in four months finally took place in May for the Angolan refugees in Shaba [UNHCR May 94].

It has been reported that due to SPLA incursions and also a lack of food, many refugees in Haut Zaire are moving towards the interior away from the Sudanese border. Road conditions are said to be poor in the area making regular aid deliveries difficult. Thus, in April 1994, the camps received their first food delivery of the year. However, despite these infrequent food deliveries, no major nutritional and/or health problems have been reported [UNHCR May 94].

The refugees in Zaire are not currently considered to be at heightened nutritional risk, although insecurity in Haut Zaire may be cause for concern.

How could external agencies help? A baseline nutritional survey would be very helpful as it would increase confidence that the nutritional status of these refugees has not been adversely affected by recent difficulties in food distributions and some insecurity in Haut Zaire.

Burundi/Rwanda Region

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.

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].

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.

RNIS 4, April 1994

The needs of the displaced population in Shaba in the transit towns of Kamina (population 4,000) and Kolwezi (population 21,000) and Likasi (population 20,000) are now reported to be adequately met. Relief agencies are planning to phase out their programmes in Kolwezi and Kamina although the 20,000 people living in temporary shelters in Likasi will continue to require international agency support.

The situation is very worrying in Kasai region, to where several hundred thousand people displaced from Shaba due to the eruption of ethnic violence (which is now subsiding) are returning. Although nutritional survey results are not currently available, wasting and child mortality rates are reportedly high amongst this returnee population [WFP 25/03/94].

Part of the displaced population from Shaba arriving in Mwene-Ditu stay in that area, while others move on further to the north. In February there were approximately 13,000 arrivals and 2,000 departures. A nutritional survey carried out in January 1994 in Mwene Ditu (estimated resident population of 140.000 and displaced population 65,000) showed levels of wasting of 13% and severe wasting of 4.9%. This was further broken down into residents of Mwene Ditu (wasting 10% and severe wasting 4.1%) and displaced (wasting 19.5% and severe wasting 6.6%) (see Annex I 1 la). The crude mortality rate from a camp for the displaced reported in February was 3/10,000/day (10 x normal). There are approximately 8 litres/caput of water available [MSF-B-C Jan.94, MSF-B-A Feb.94].

The inaccessibility of the area and high transport costs have constrained food supplies to Kaisi. Limited food supplies carried by aircraft and train have only been delivered to the area since the beginning of March. Airlifts would be the most appropriate mode of transport but the response to requests for donor funds to cover such an expensive operation has been very limited [WFP 25/03/94].

In sum, the displaced population of Mwene-Ditu in Kaisi is in a critical situation (category I in Table 2) while the non-displaced population is at moderate risk (category IIb in Table 2). The populations in the Shaba towns of Kamina, Kolwezi and Likasi are not known to be at particular risk (category IIc in Table 2).

How could external agencies help? Costs associated with moving food into Kasai, a remote area, are a major constraint, for which donor assistance is needed. Resettlement of the displaced population returning to Kasai (many having been away for decades) requires help, through local and external NGOs. Information is scarce, and a survey of the returnee population in Kasai would be very useful.

Of the approximately 260,000 Angolans in Bas Zaire (south) only 25,000 are receiving assistance, and that will end by mid-May. These refugees have been in Zaire for many years (they left Angola before the current civil war) and are integrated into the community and self-sufficient.

The number of Sudanese and Ugandan refugees in Haut Zaire (north) receiving rations has been reduced from approximately 140,000 to 60,000. This reduction in numbers is due to the integration of the refugees into the local community [WFP 15/04/94].

Burundi Situation

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

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

Ethnic violence continues in the Shaba region of Zaire, causing thousands of people of Kasaian origin to flee northward. In December 1993 it was estimated that 140,000 had returned to East and West Kasai while up to 150,000 were displaced and in transit camps/locations. There is currently no formal general ration distribution for the population in transit. Although there has been some food distributed by NGOs, it has been in insufficient quantities. WFP is planning food distribution operations, but donor response has been inadequate to cover high costs of delivery in this land-locked area. [WFP 3/2/94]

Approximately 13,000 displaced arrived in the town of Mwene Ditu from Shaba in October. This represented a decreased trend compared to September. Half of this population is integrated into the transit camps and the other half is transported to more permanent camps (Mbuji Mayi and Kabinda- see below). In Mwene Ditu new arrivals are seen by MSF-Belgium health staff and where appropriate children between 6 months and 12 years are vaccinated.

The most common illness seen amongst the population in Mwene Ditu is malaria and accompanying anaemia. There has been a recent outbreak of measles but this is now under control. Crude mortality rates in October were 4.1/10,000/day and the under-five rate was 9.6/10,000/day. These rates are very high (12 x normal). Malaria and measles remain the leading causes of death for children, although the vaccination campaign should substantially reduce measles mortality. The level of wasting measured in September was 25.3% while severe wasting was 7.1% (see Annex I (11a) for details). These levels indicate a very serious situation. [MSFB-D 7/1/94]

Reports from Kabinda (eastern Kasai) reveal a catastrophic situation for the approximately 20,000 displaced people. Among the displaced population, wasting prevalence is estimated as 38%, with 10% severe wasting. For the population overall (including non-displaced), these figures are 15.1% and 5.7% (see Annex I (11b) for survey details). These statistics indicate a severe crisis. Approximately 60% of the children are vaccinated against measles. There has, to date, been only one distribution of food in Kabinda (by small local agencies) although WFP is seeking the necessary resources to start regularly distributions. [MSFF 4/12/93, WFP 4/2/94] The previous RNIS report indicated that political considerations and high transport costs, as well as shortage of funds for WFP, had delayed allocations of a general ration. It would appear that this situation continues for the displaced from Shaba. The current hungry season (November-February) can only lead to further nutritional and health deterioration amongst this poorly served population.

Recent information regarding the status of the displaced in Kolwezi and Likasi transit centres (whose population numbered 90,000 at the end of last year) states that ICRC is providing food and non-food assistance to them before their departure by train into Kasai. [WFP 4/2/94] We have no recent information on their nutritional status.

This situation appears out of control for those populations in transit camps not yet receiving general rations (e.g. Mwene Ditu and Kabinda population (33,000), in column I in Table 2). The remaining 257,000 displaced population from Shaba is considered to be at moderate risk (category IIb in Table 2).

There is no reported change in this situation since the December RNIS newsletter (see Table 2) which reported a generally satisfactory situation for the 426.600 refugees (this excludes the approximately 60.000 Burundi refugees in Zaire who are included below - situation #15). The text from the December report is reproduced for ease of reference.

"Apart from the Burundi refugee crisis (see no. 15 below) and ethnic conflict in Shaba discussed earlier (see no. 11) there are a number of other current refugee/displaced person emergency problems in Zaire.

"There are 27,600 Angolan refugees in Shaba region distributed over three sites. This population is on partial rations as they are partly self-sufficient. Their nutritional status is believed to be good. There are also 200,000 Angolan refugees in Lower Zaire and 60,000 in Kinshasa. These latter refugees live amongst the local population. We have no data on their nutritional or health status.

"There are between 100-125,000 Sudanese refugees and 15,000 Ugandan refugees in Upper Zaire. There have been enormous difficulties in providing food to these refugees due to poor road infrastructure. One of the three camps is said to be virtually unreachable. Zairian authorities have also occasionally held up food deliveries. Nevertheless, assessment missions have reported an adequate food situation, partly due to economic assimilation with the local population, and even recommended ration reductions in one camp.

"Approval by WFP has recently been given to operate an emergency feeding programme for 60,000 displaced people in Kivu (7 November 1993). The displaced are residing mainly in churches and schools and the situation has arisen from tribal conflict. We have no data on health or nutritional conditions amongst this population.

"Overall, these refugee populations are not reported to be in critical situations, although there is concern regarding the populations in Upper Zaire due to difficulty in transporting food to them."

Burundi situation

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.

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]

RNIS 2, December 1993

The ethnic violence in Shaba region (reported in the last RNIS bulletin) continues with further large-scale displacement of the mining work-force to transit camps in Kolwezi, Kamina, Likasi and Mwene-Ditu. There is also a portion of the displaced in Mwene-Ditu that returns to West and Eastern Kasai. Population movement is, therefore, in both directions.

Our most recent information (September-October 1993) is that the displaced population around Kolwezi and Kamina has decreased slightly to 21,000 and 4,000 respectively and that crude mortality rates appear to have improved greatly to between 0.23-1.1/10,000/day (normal to 4.1 x normal). The previous report cited CMRs of between 2-5/10,000/day (7.4-18 x normal). The displaced population around Likasi has also fallen slightly to 65,000 (formerly 75,000) and CMRs are also low 0.3/10,000/day (normal levels). However, nutritional data from the dispensaries in Likasi (October 1993), although not representative of the overall displaced population, show extremely high levels of wasting (38%) with 5% severe wasting amongst children presented. There is also data which indicates the existence of pellagra while observed adult oedema may be due to beri-beri. Given this information, the low CMR in Likasi may be an under-estimate and probably in part reflect a reluctance to declare deaths for fear of losing entitlement to available food rations. The same circumstances may apply to the low CMRs found in Kolwezi and Kamina. We have no current information on per capita food receipts amongst these displaced groups.

The previous RNIS report identified a nutritional and health crisis in Mwene-Ditu (September 1993) affecting more than 60,000 displaced people situated in three camps and around the main town. We have no new data on this population.

Over 140,000 displaced from Shaba are now estimated to have arrived in East and West Kasai. OXFAM began food distributions to this population in October on the basis that this would be reimbursed by WFP in the near future. Constraints on WFP, which delayed the start of this operation (the displaced began to arrive in June), have been due to a variety of factors which include delayed needs assessment missions, donor reluctance to pledge food due to political considerations and high transport costs, and shortage of funds within WFP. We have no current information on the nutritional and health situation of this population. Food distribution and clinics are now running smoothly in these transit towns and there are no indications that the situation will change.

Apart from the Burundi refugee crisis (see no. 15 below) and ethnic conflict in Shaba discussed earlier (see no. 11) there are a number of other current refugee/displaced person emergency problems in Zaire.

There are 27,600 Angolan refugees in Shaba region distributed over three sites. This population is on partial rations as they are partly self-sufficient. Their nutritional status is believed to be good. There are also 200,000 Angolan refugees in Lower Zaire and 60,000 in Kinshasa. These latter refugees live amongst the local population. We have no data on their nutritional or health status.

There are between 100-125,000 Sudanese refugees and 15,000 Ugandan refugees in Upper Zaire. There have been enormous difficulties in providing food to these refugees due to poor road infrastructure. One of the three camps is said to be virtually unreachable. Zairian authorities have also occasionally held up food deliveries. Nevertheless, assessment missions have reported an adequate food situation, partly due to economic assimilation with the local population, and even recommended ration reductions in one camp.

Approval by WFP has recently been given to operate an emergency feeding programme for 60,000 displaced people in Kivu (7 November 1993). The displaced are residing mainly in churches and schools and the situation has arisen from tribal conflict. We have no data on health or nutritional conditions amongst this population.

Overall, these refugee populations are not reported to be in critical situations, although there is concern regarding the populations in Upper Zaire due to difficulty in transporting food to them.

Burundi Refugees and Displaced People as of November 1993

Burundi	150,000	Internally displaced
Rwanda	375,000	Refugees
Tanzania	325,000	Refugees
Zaire	58,600	Refugees
Total	908,600	Refugees, internally displaced

Following an attempted coup d'etat on 20th October, and subsequent heavy fighting, around one million people were uprooted, most fleeing the country. It is estimated that 75% of the refugees are women and children. These refugees have crossed borders into Rwanda, Tanzania, and Zaire.

A similar crisis is being reported in Zaire where the initial case-load of 39,000 refugees in Uvira Region has now increased to 58,600 in 17 different sites/camps. Initial food needs were met by local purchase. The most current reports indicate a rapidly deteriorating situation with overcrowding, lack of shelter, insufficient food and epidemics of cholera and dysentery in certain camps. More and more wasting among children is evident (no precise survey data are available yet) and mortality rates are said to be increasing.

The entire Burundi refugee population in Rwanda (375,000) is considered to be in a critical situation (Table 2, column I). This is shown, for example, by the mortality data. We have placed the remaining Burundi refugees in Zaire and Tanzania and Burundi internally displaced in column IIa, as we know that they are at serious risk due to a variety of factors. In the short-term we expect the situation to deteriorate further in advance of the international aid community being able to provide adequate food, water, shelter, and health care.

RNIS 1, October 1993

Since August 1992 ethnic violence in this region has led to the displacement of large numbers of people towards the towns of Likasi, Kolwezi and Kamina (see Map 11). The displaced population around Likasi is estimated at 75,000, the majority of whom live in makeshift shelters. Three nutritional surveys amongst this population (December 1992, March 1993, and June 1993) have shown wasting levels ranging from 8-15% with a recent level of 13%. Currently levels of severe wasting are 6% which may reflect a recent influx of new arrivals in a poor state. Around Kolwezi and Kamina the displaced populations of 23,000 and 6,000 respectively are showing mortality rates of between 8 to 20 times normal.

The violence has also led to the displacement of large numbers from Shaba region to the region of Mwene-Ditu. By June 1993 it was estimated that there were 13,000 displaced in three camps and 50,000 (September 1993) in the main town. New arrivals are reported as being in a desperate medical and nutritional condition. A nutrition survey in the camps in June 1993 found prevalence of wasting to be 22% with 7% severely wasted. Many adolescents and adults are also found to be moderately and severely wasted. Reports for September show mortality rates of 6.7/10,000/day (week of 12 September) and 5.1/10,000/day (week of 19 September). This increased mortality (up from a reported level of 3.5/10,000/day in August) is in large part explained by an outbreak of severe malaria, the displaced coming from mountainous areas in Shaba with low malaria endemicity, moving into an endemic region in full rainy season. Rations for one week are currently given out to new arrivals but there were no stocks for a general distribution in June. Many of the new arrivals since May have come from Kolwezi where general rations of 1,200 kcals/caput/day have only been available since June.