United Nations System
Standing Committee on Nutrition

Nutrition Information in Crisis Situations - Eritrea
 

NICS 6, May 2005

Owing to the poor crop in 2004, 2.3 m vulnerable people require food aid in 2005 (see NICS 5).

Nutrition situation remains precarious in Anseba and Northern Red Sea

Nutrition surveys conducted in Anseba and Northern Red Sea in January 2005 showed a precarious nutrition situation with a prevalence of acute malnutrition of 12.6% in Anseba and 14.2% in Northern Red Sea (DPPC, 01/05). This is comparable to the rate of acute malnutrition found in the same season in 2004 and is lower than the prevalence of acute malnutrition found during the lean season in summer 2004 in Anseba, while the prevalence of malnutrition remains stable in Northern Red Sea (figure 1).

On the other hand, chronic energy deficiency among women has slightly decreased when compared to December 2003 in Anseba, but has not changed in Northern Red Sea (figure 2).

As in previous surveys, most families (98% in Anseba and 94% in Northern Red Sea) had received food aid in the four months prior to the survey. On average, they had received 8 kg of cereals per person per month in Anseba, but only 6.3 kg in Northern Red Sea, which is slightly less than in June 2004 when families received an average of 7.9 kg of cereals. The coverage of the supplementary feeding programme was about 69% in Anseba, which was slightly lower than in June 2004.

In Anseba, ninety-three percent of children less than one year old were breastfeeding as well as 68% of the 12 to 23 month-olds.

Only 6% and 12.1% of the families interviewed had access to sufficient safe drinking water in Anseba and Northern Red Sea, respectively. This has remained stable when compared to the previous surveys.

In Anseba, it seems that Selea area was the most at risk according to the different factors measured in the survey while Gheleb area was the "better-off".

Recommendations

From the N-NSS survey in Anseba for Selea area:

• Improve coverage and frequency of supplementary feeding, where possible community based, also for energy-deficient women
• Provide health education to improve child feeding practices and reduce infection and diseases
• Improve the quality of the drinking water
• Consider livelihood interventions targeting the improvement of household food security

Figure 1 Prevalence of wasting, Anseba and Northern Red Sea, Eritrea

Figure 2 Prevalence of Chronic energy deficiency, Anseba and Northern Red Sea, Eritrea

NICS 5, February 2005

Low cereal production in 2004 and high number of people in need of assistance in 2005

In 2004, cereal production was nearly 47% below the average 1992-2003 production, and was 20% below last year’s production (table 1; FAO/WFP, 18/01/05).

The limited cereal production was due, among other factors, to erratic rainfall, lack of a labour force (most men are enrolled in National Service), lack of farm power (most oxen were sold during the drought in 2002) and a seed deficit. Due to poor rains, livestock has also been seriously affected.

It is estimated that the traditional "hungry season" will begin as soon as February, as opposed to May in "normal" years (OCHA, 31/12/05). Moreover, cereal prices continued to rise sharply in 2004.

The FAO/WFP crop and food supply assessment has estimated that 2.3 m vulnerable people will require 342,000 MTs of food aid in 2005, which is an increase compared to 2004 when 219,000 MTs of food aid were required for 1.4 m vulnerable people (FAO/WFP, 18/01/05). The vulnerable population includes severely drought-affected farmers who will be in need of food aid from January to October 2005, moderately drought-affected farmers, who will benefit from food aid from March to October 2005, agro-pastoralists/pastoralists who will require assistance between January and October 2005, war-affected people and the urban vulnerable (table 2).

Current food stocks for food distribution are expected to last until the end of March 2005 (OCHA, 31/12/05).

Table 1 Cereal production, Eritrea, 2004 (FAO/WFP, 08/01/05)

Table 2 Estimated vulnerable population, Eritrea, 2004 (FAO/WFP, 08/01/05)

Precarious nutrition situation in Southern Red Sea

A random-sampled nutrition survey was conducted in Southern Red Sea in October 2004 (N-NSS, 10/04). The prevalence of acute malnutrition was 13.9% including 1.9% severe malnutrition. It seemed that acute malnutrition was slightly higher in the urban area than in the coastal and inland areas. The nutrition situation compared favourably with March 2004 when the prevalence of acute malnutrition was 20.6% (16.0-25.8) (see NICS 3). This may be partly explained by seasonal patterns, with an improvement of the situation in October due to better rains. The March survey was done after a very dry Bahri rainy season (N-NSS, 10/04).

Although not directly comparable with the last round of surveys done in May-July 2004 in other regions, because surveys were not done in the same season, the nutrition situation in Southern Red Sea seemed comparable with the nutrition situation in Northern Red Sea, worse than in Debub and slightly better than in Anseba and Gash Barka (see NICS 4).

A significant proportion of women had a BMI< 18.5 (table 3). On the other hand, more than 10% of women were considered overweight (table 3). Most of them were located in the urban area.

As recorded in the surveys done in other regions, most families (87%) had received food aid within the four months prior to the survey. However food aid distribution was irregular, with 67.5% of families having received one food distribution only and 20.7% having received two food distributions, instead of the intended monthly food distributions. Moreover, the average amount of cereals received per distribution was 11 Kg, less than the intended 15 Kg. On average and taking into account cereals, pulses and oil, the households received 600 Kcal in the four months prior to the survey.

The supplementary food distribution was more regular than the general food distribution with, of the 82.2% of the children who received supplementary food within the four months prior to the survey, 64.6% having received four supplementary food distributions. However, supplementary food distributions seemed less regular in the inland area with only 20% of the children having received four distributions, compared to 76% and 96% in coastal and urban areas, respectively. This seemed to be a result of problems of food transportation in the inland areas.

Only 35.7% of the households had access to both enough (> 15 l/pers/day) and safe drinking water.

Table 3 Anthropometric nutritional status of non-pregnant women (18 to 60 year olds), Southern Red Sea, Eritrea, October 2004 (N-NSS, 10/04)

Average nutrition situation in Maekel

According to a nutrition survey conducted in Maekel in October 2004, the nutrition situation was average with a prevalence of acute malnutrition of 8.6% (FAO/WFP, 18/01/05). The situation has remained stable since 2003 (UNICEF/MOH, 12/04).

Overall

More people are estimated vulnerable in 2005 than in 2004 due to poor rains and crop performance in 2004. Depending on the region, the nutrition situation was average to precarious (category III/II) in 2004 and a substantial level of assistance is still needed to mitigate the crisis Eritrea has been facing for some years.

Recommendations

Medium and long-term policy directions, from the FAO/WFP crop assessment:

• Adopt better farming practices, including using improved seed and more suitable crop varieties, improved water-harvesting techniques
• Develop appropriate policies and programmes for land access and tenure
• Improve management of livestock, such as enclosures of hillsides to enable natural range to recover from overgrazing, better provision of feed
• Improve the macro-economic management

From the N-NSS survey:

• Improve regularity of food aid distribution to increase food security
• Improve the coverage and regularity for supplementary feeding in inland areas
• Improve water supply

NICS 4, November 2004

The future of the food security situation in Eritrea is bleak. The kremti rains (June-September) were poor in most of the country, and the harvest is forecast at 109,000 MT, which is only 58% of average production and 20% of the total annual food requirement (FEWS, 18/10/04). Pasture and grazing conditions are also very poor. The situation is compounded by the poor performance of the previous azmera rains (March-May) in some areas and by the overall drought experienced by the country over the previous years. Water shortage is acute throughout the country and the government has designed a mitigating action plan to improve access to safe potable drinking water for around 1.8 million people (FEWS, 18/10/04).

The current food pipeline for food distribution was sufficient to distribute a full ration to the intended 1.9 million beneficiaries towards the end of 2004 (FEWS, 18/10/04).

Critical nutrition situation

The National Nutrition Surveillance System (N-NSS), a collaborative inter-agency group set up by the Ministry of Health conducted a second round of nutrition surveys in Northern Red Sea in May 2004, in Gash Barka in mid-June, in Debub at the end of June and in Anseba in mid-July (N-NSS, 07/04).

The results showed that the situation was critical in all the areas surveyed except Debub where the situation was average (table 1). Moreover, a significant proportion of women had a BMI < 18.5 (table 1).

When compared with previous surveys carried out in December 2003, the situation seems to have worsened in Anseba and Gash Barka, whilst it has remained stable in Northern Red Sea (figures 1 & 2). The nutritional status of both children and women has improved significantly in Debub (figures 1 & 2).

The December surveys were conducted during the post-harvest period, whilst the second round of surveys was done during the hunger-gap season. The increase in the prevalence of malnutrition recorded in Anseba and Gash Barka may be explained by an increase in food insecurity during the lean season, which was not compensated by coping mechanisms and humanitarian aid. On the other hand, it seems that the population in Debub has begun to recover from the 2002 drought.

Table 1 Prevalence of acute malnutrition and chronic energy deficiency, Eritrea, May-July 2004 (N-NSS, 07/2004)

Figure 1 Wasting in Eritrea, December 2003-June 2004

Figure 2 Chronic Energy Deficiency in Eritrea, December 2003-June 2004

Food distribution

According to the survey, the vast majority of families received food distributions within the four months prior to the survey (table 2). The average amount of cereal received varied from 6.3 kg to 8.4 kg per person per month, depending on the area (table 2). This was less than in December 2003 when the families reported having received 10.4-12.3 kg of cereals.

Supplementary feeding

There was no common mechanism of supplementary food distribution. Supplementary feeding was targeted at malnourished children in some places, whilst there was no targeting in other areas.

A significant percentage of children were receiving supplementary food (table 2) but the average amount received was generally less than the intended 6-10 kg/pers/month (table 2). Moreover, the distribution of supplementary food was irregular.

Table 2 General and supplementary food distribution, Eritrea, June 2004 (N-NSS, 07/04)

Public health

Only about half of the mothers were seeking care when their children were ill. This is unchanged compared to December 2003.

Access to water and to safe drinking water was also still very poor and has not improved compared to December 2003. Only 8.7%, 7.8%, 24.6% and 33.5% of the households had access to both enough (> 15 l/pers/day) and safe water, in Anseba, Debub, Gash Barka and Northern Red Sea, respectively.

Overall

The lingering effects of the war with Ethiopia and the 2002 drought have had a significant impact on households’ food security and nutritional status in a country where the general situation was already poor. The future of the food security situation is bleak, partly because of the recent failure of rains. Emergency and long-term development programmes need to be strengthened.

Recommendations

From the N-NSS survey:

• Ensure regular distribution of food aid and supplementary food
• Implement treatment of severe malnutrition in the areas where acute malnutrition is high and facilities do not exist
• Facilitate accessibility of health care and increase effective treatment and prevention of childhood infection

NICS 3, August 2004

The Azmera rains (March-May) were considered near normal to below normal depending on the area (FEWS, 17/06/04). Whilst the rains improved pasture in Southern Red Sea, they were insufficient to allow the proper development of long-cycle crops in Maekel and Debub. Moreover, it is thought that limited planting was caused by a lack of seeds: only 38% of the requirement of seeds was pledged as of June 2004 and far less had actually been distributed (FEWS, 17/06/04). The Kremti rains (July-September) started at the end of June and were near normal but became scarce at the beginning of July. The Kremti rainy season will be crucial for the crop production (FEWS, 20/07/04).

Critical drinking-water shortages have been experienced in several areas. As of June 2004, about 30,000 people were benefiting from water trucking, but more people were in urgent need of improved access to water (IRIN, 21/06/04).

As of June 2004, food stocks for food distribution were low and were expected to last only until the end of September, unless additional food is delivered (FEWS, 20/07/04).

According to two nutrition surveys carried out in March 2004, it seems that the prevalence of acute malnutrition was very high in Southern Red Sea region (20.6% (16.0-25.8)) and was similar to the situation in Northern Red Sea region (see NICS 2), whilst the prevalence of malnutrition was lower in Maekel (9.3% (6.2-13.3)) (FEWS, 17/06/04). The nutritional status of the women also seemed precarious. A vitamin A deficiency survey revealed that a high proportion of children had low retinol levels (UNICEF, 15/07/04).

NICS 2, May 2004

The Bahri rains (November-February) were poor and improved only in February, which was too late to benefit crops but did replenish pastures (FEWS, 25/03/04). On the other hand, despite coming later than usual, the Azmera rains facilitated agricultural activities in April (FEWS, 21/04/04).

As of April 2004, pledges for the WFP's drought emergency programme amounted to approximately 54% of the 2004 requirements (WFP, 30/04/04). When programmes through NGOs and bilaterals were also taken into account, only 38% of the food needs were covered, and food rations have therefore been reduced (OCHA, 23/04/04). Non-food needs were even less resourced, with only 37% coverage for seed needs and an overall 5% coverage for the non-food sector (OCHA, 23/04/04).

Precarious nutrition situation

The MOH in collaboration with UN agencies and NGOs has set up the National Nutrition Surveillance System (N-NSS) to develop unified methodologies, training manuals and harmonization of approaches and data systems.

As part of this system, random-sampled nutrition surveys were conducted in rural areas of Anseba, Debub, Gash Barka and Northern Red Sea in December 2003 (MOH/Joint, 12/03). , depending on the region (table 1). Moreover, a significant proportion of women had a BMI < 18.5 (table 1). The results showed that the situation was of concern, with acute malnutrition rates varying between 12.8% and 16.9%

When compared with previous surveys, the situation does seem to have improved slightly. This was mostly attributed to the seasonal harvest and general and supplementary food distributions.

Table 1 Prevalence of acute malnutrition, Eritrea, December 2003 (MOH/joint, 12/2003)

Food security

Most of the families interviewed during the assessment (96%) said that the food security situation at the time of the survey was not bad.

Food distribution
The intended food distribution was 15-17 kg cereals, 1.2 kg pulses and 0.9 kg oil per person per month (2100/Kcal/pers/day) to 60-70% of the population.

According to the survey, about 99% of the families had received regular food distributions within the four months prior to the survey. Depending on the area, the households had received an average amount of 10.4-12.3 kg cereals, 0.5-0.7 kg pulses, 0.4-0.6 kg oil per person per month (about 1400 Kcal/pers/day).

Supplementary feeding
A significant percentage of children were receiving supplementary food: 28%, 40%, 49% and 36% in Gash Barka, Debub, Northern Red Sea and Anseba, respectively. There was no common mechanism of supplementary food distribution. Supplementary feeding was targeted at malnourished children in some places, whilst there was no targeting in other areas.

Public health

The coverage of vitamin A supplementation was high as well as the measles vaccination coverage (table 2). This was partly attributed to the “polio and measles catch-up immunisation” campaigns, carried out beside the regular programme. On the other hand, a low percentage of the mothers were seeking care when their children were ill (table 2).

Table 2 Measles vaccination coverage, Vitamin A distribution coverage and health care, Eritrea, December 2003 (MOH/joint, 12/03)

* According to cards only

Access to water and to safe drinking water was very poor (table 3).

Table 3 Access to water, Eritrea, December 2003 (MOH/joint, 12/03)

Internally Displaced Persons

It is estimated that there are about 59,000 IDPs settled in camps or in host communities. Most are displaced because of the lingering effects of the border war with Ethiopia (OCHA, 23/04/04). IDPs in Koronko camp in Gash Barka region face dire conditions: IDPs were reported as lacking basic facilities such as access to water and potable water, sanitation, sufficient food rations and non-food items (OCHA, 02/04/04).

Overall

The lingering effects of the war with Ethiopia and the last years’ drought have had a significant impact on households’ food security and nutritional status in a country where the general situation was already poor. Emergency and long-term development programmes as well as reforms at the macro-economic level are crucial.

Recommendations

From the MOH/joint surveys

• Monitor the nutrition situation closely
• Develop a system to gather and analyse a larger set of food security and nutrition data
• Link relief responses to long-term actions
• Develop nutrition training and growth monitoring

NICS 1, February 2004

The food security situation will still be very uncertain in 2004. Cereal production was poor in 2003; it was only 56.6% of the average 1992-2002 production, but was 25% higher than in 2002 (see table 1; FAO/WFP, 27/11/03).
 
 
Table 1 Cereal production, Eritrea, 2003 (FAO/WFP, 27/11/03)

The limited cereal production was due, among other factors, to erratic rainfalls, lack of labour force (most men are enrolled in National Service) and lack of farm power (most oxen were sold during the drought in 2002).

On the other hand, livestock seemed to be in a better condition than in 2002.

Cereal prices rose sharply in 2002 and 2003, and the terms of trade for livestock owners have been unfavourable since early 2002.

The nutrition situation seemed not to have improved in 2003 compared to 2002 (see RNIS 43).

The FAO/WFP crop and food supply assessment has estimated that 1.4 m vulnerable people will require 219,000 MTs of food aid in 2004 (FAO/WFP, 27/11/03). The vulnerable population includes severely drought-affected households who will be in need of food aid throughout the year, moderately drought-affected households, who will benefit from food aid until June 2004 and war-affected people (see table 2).
 
Table 2 Estimated vulnerable population, Eritrea, 2004 (FAO/WFP, 27/11/03)

It is also anticipated that seed distribution will be necessary. Food distribution, however, is already facing challenges; because of constraints on resources, WFP's food rations were reduced to a 60% level for drought-affected people and to a 85% level for the war-affected population in January 2004 (Reuters, 21/01/04).

Recommendations

Medium and long-term policy directions, from the FAO/WFP crop assessment

• Adopt better farming practices, including using improved seed and more suitable crop varieties, improved water-harvesting techniques
• Develop appropriate policies and programmes for land access and tenure
• Improve management of livestock, such as better provision of water, feed, forage and veterinary services
• Create rural finance and marketing facilities
• Improve the macro-economic management

RNIS 43, November 2003

Whilst donors' responses to the humanitarian appeal was low at the beginning of the year, their commitment to the crisis in Eritrea has since increased and so far has reached 62% of the revised 2003 Consolidated Appeal (CAP). About 75% and 40% of the funds requested have been secured in the food sector and in the non-food sector, respectively (ICC, 16/10/03). Additional funds are, however, urgently needed.

About 60,000 people are still displaced in the country; they are mainly settled in camps in Gash Barka and Debub regions (ICC, 16/10/03).

The Azmera rains (March-May) were poor, affecting the performance of long-cycle crops, but the Kremti season (June-September) went reasonably well and agricultural production is expected to be average in 2003 and to represent a significant improvement over production in 2002 (FEWS, 16/09/03; FEWS, 21/10/03). Livestock condition has also improved with the onset of the rains. However, staple food prices are much higher than last year (FEWS, 16/09/03; FEWS, 21/10/03).

The water situation has deteriorated in the country and, according to a survey carried out by the water resource department and UNICEF, and covering 46% of the rural population, the average daily water consumption was 13 litres/person/day, which is very low (ICC, 16/10/03).

Nutrition situation

The nutrition situation does not seem to have improved in 2003 compared to 2002, as suggested by the comparison of the prevalence of malnutrition in 2002 and 2003 in the different regions of Eritrea (UNICEF-E, 09/03). In 2003, malnutrition rates stood above 15% in Northern Red Sea, and Southern Red Sea (UNICEF-E, 09/03), and were especially high in Gash Barka, varying between 20.2% and 27.1% depending on the area (FEWS, 21/10/03). The malnutrition rates were below 10% in Maekel (UNICEF-E, 09/03) and varied from 10.7% to 13.3% in Debub (FEWS, 10/03).

The fact that many families are headed by women, mostly because men have enrolled in the National Service, seems to play a significant role in both food security of the household and the ability of the women to care for the children. Mortality rates seem, however, to remain under-control, which may be partly attributed to disease control and high immunisation coverage (UNICEF, personal communication).

Anseba

In three sub-zones of Anseba (Asmat, Hagaz and Habero), a random-sampled nutrition survey carried out in March 2003, revealed that the nutrition situation was still of concern (see table) and had not improved since 2002 (Concern, 03/03). The nutrition status of women was also worrying (see table). Under-five and crude mortality rates were, however, under-control (0.38/10,000/day, 0.15/10,000/day, respectively). Food distributions targeted about 60% of the population and were estimated to provide 50% to 80% of a full ration (2,100 Kcal). According to informal group discussions, food aid was thought to be insufficient and was shared between all the members of the community.

Debub

A random-sampled nutrition survey was conducted in the rural parts of five of the 12 administrative sub-zones of Debub (CRS, 06/03). The nutrition situation was of concern (see table). Measles vaccination coverage was 83.8% and 93% of the children had received a vitamin A supplement in the six months preceding the survey.

Prevalence of malnutrition, Eritrea, 2003 (Concern, 03/03; CRS, 06/03)

People in the area are mostly reliant on agriculture and experienced a very bad harvest in 2002. About half of the households surveyed reported having received food aid the month prior to the survey. On average, the amount of cereal received was 243 g/pers/day, which is only about half the full cereal ration. The main coping strategies of the population were food aid, borrowing from relatives and casual labour.

Access to clean water was scarce, with only about 10% of the households having access to clean water. The average amount of water available was low: 16 litres/pers/day. Health facilities were reported to be located far from villages and to suffer from a lack of medicines. Child feeding practices were average (see box).

Breast-feeding and complementary feeding practices, Debub, Eritrea (CRS, 06/03)

Overall

The nutrition situation does not seem to have improved in 2003 (category II). The expected average next harvest will probably temper the food insecurity for some months, but food aid will probably still be required in 2004.

RNIS 42, August 2003

The Eritrean Relief and Refugees Commission has estimated that about 1.4 m people are drought-affected and in need of food-aid in 2003. WFP intended to support 900,000 people. However, due to a lack of resources (WFP has only 62% of the food required), WFP can only assist 600,000 people (WFP, 14/08/03). Moreover, an emergency operation to help 500,000 people (including malnourished children, displaced populations, returnees and school children) had to be delayed for three months because of a lack of resources (OCHA, 13/08/03; WFP, 14/08/03). As of mid-July, there was also a gap of seeds of more than 50% of the requirements (FEWS,20/08/03).

Despite a reported good beginning of the Kremti rains, food insecurity is expected to worsen until the next harvest, due by October 2003, because people will have exhausted their food stocks (FEWS, 20/08/03).

There have been reports of high rates of acute malnutrition, reaching 14% to 20% (USAID, 24/07/03). Funds are needed to support drought-affected Eritreans.

RNIS 41, April 2003

More than one million people are estimated to be in need of food aid, because of the drought. The RNIS has not received any new information on the nutrition situation. The last results of nutrition surveys showed, however, a precarious situation (see RNIS 40) which will probably worsen until the next agricultural season in October 2003. The normal coping mechanisms are already almost totally exhausted (OCHA, 21/03/03). Donor's response to the humanitarian appeal has been very low so far; only 25% of the food requirements have been received and of the non-food requirements only 3% have been funded (OCHA, 10/03/03). Food aid rations were only 60% of the assessed needs in February 2003 (FEWS, 10/03/03) and WFP was expecting a pipeline break in April 2003 if they do not receive further contributions (WFP, 13/03/03). WFP was also considering distributing food to only half of the drought-affected population because of the scarce resources. In this case, the food pipeline would last until the end of July (WFP, 21/03/03). Funding is urgently needed to avoid a humanitarian catastrophe.

RNIS 40, Dec 2002

The Eritrean Relief and Refugee Commission expressed its concern about the future of thousands of Eritrean refugees in Sudan. Despite an on-going repatriation scheme and the fact that the refugees have been settled in Kassala region for years, the government of Karthoum would still prefer to relocate them further inland (ICC, 29/10/02). UNHCR stated they were unaware of this situation (OCHA, 01/11/02).

Drought

The FAO/WFP crop and food supply assessment has estimated that 1.04 m vulnerable people will require 140,000 MTs of food aid in 2003 (FAO/ WFP, 03/10/02).

The spring rainy season ( Azmera rains, March- June) almost totally failed in key agricultural areas and the main rains ( Kremti rains, June- September) were delayed by more than one month. It is anticipated that crop production will be only about 40% of the average for the previous ten years, the lowest level since independence. All regions are affected but Gash Barka and Debub, the bread basket regions, will suffer the biggest lost in absolute terms (see table).

Cereal production in 2002 compared to average (1993-2001), Eritrea (FAO/WFP, 03/10/02)

High livestock mortality rates (10-20%) were reported in most areas, as a result of depletion of available pasture and crop residues since April. However, in most areas, the remaining livestock has recovered since August, when the Kremti rains began, except in Southern and Northern Red Sea regions where poor summer rains occurred. The absence of young men, who have enrolled in National Service, is also limiting the most common coping mechanism, i.e. casual labour. It is estimated that emergency food aid will be required at least until the next harvest in November/December 2003. A shortage of seeds for the next planting season will also probably occur as a result of the poor harvest in 2002.

Northern and Southern Red Sea Regions

Two nutritional surveys were undertaken by MOH/DIA in August 2002 in urban and rural areas of Northern and Southern Red Sea Regions (MOH/DIA, 08/02). A high prevalence of acute malnutrition was found (see table); no oedema was recorded.

Acute malnutrition, Northern and Southern Red Sea regions, Eritrea, MOH/DIA, August 2002

Rates of malnutrition seem to have declined in urban areas since the last survey, which was done in September-December 2001, whilst they remain at the same level in rural areas (see graph).

Acute malnutrition, Northern and Southern Red Sea state, Eritrea

The Southern Red Sea region has particularly suffered from economic shocks since the war between Eritrea and Ethiopia in 1998. The port of Assab, which was the focus of major economic activity of the region, is currently almost unused. Pastoralists can no longer freely move to Ethiopia in search of pasture because of the closure of the border. Food aid has been distributed in both regions in 2002, for six months out of 12 in Northern Red Sea Region and for eight months out of 12 in Southern Red Sea Region. Given the current drought conditions, the nutritional status of the population may further worsen, unless additional action is undertaken to strengthen the food security of the population.

Anseba region

A nutrition survey was conducted by Concern in three sub-zones (Hagaz, Asmat and Habero) of Anseba region in November 2002 (Concern, 11/02). Agriculture and pastoralism are the main economic activities of the region, which has experienced drought for the last four years. The prevalence of malnutrition was 14.7%, which included 1.5% severe malnutrition; 0.4% of the children surveyed had oedema. The prevalence of malnutrition seemed to be similar to that recorded in Hagaz and Asmat sub-zones, in December 2001. Results of previous surveys, carried out in 2001 and 2002, showed that malnutrition rates are higher in summer months. In the current survey, the Asmat sub-zone seemed to be the most vulnerable. 95.7% of the children were vaccinated against measles, including 84.7% confirmed by cards. Various indicators have also been assessed during the survey (see table) by interviewing 770 families. The prevalence of malnutrition in the area is of concern. It may further increase in the coming months, because of seasonal variations, and because of the current drought.

Various socio-economic indicators, Anseba zone, Ethiopia, November 2002 (Concern, 11/02)

Overall - According to available data, the nutrition situation in some areas is very precarious (category I/II). It may worsen further because of the current drought.

Recommendations and priorities

From the MOH/DIA survey in Northern and Southern Red Sea:

• Continue food aid distribution
• Ensure a balanced full food ration
• Distribute supplementary food to children under five
• Support the initiative of the Ministry of Health to establish treatment of severe malnutrition in referral hospitals
• Carry out a nutrition survey in six months

From the Concern survey in Anseba region:

• Continue supplementary feeding
• Improve households' access to water and sanitation facilities
• Implement health promotion sessions
• Diversify food ration, with oil and pulses distributed together with cereals

RNIS 39, October 2002

Refugee repatriation

It is estimated that there are about 355,000 Eritrean refugees in Sudan (see table), most of whom come from the Gash Barka region. There have been 51,683 repatriations since May 2001, mainly to the Gash Barka region (UNHCR, 10/09/02). No information on the conditions of returned refugees has been made available to RNIS. Automatic refugee status granted to Eritreans will expire at the end of 2002. UNHCR has assessed that there are no longer grounds for Eritreans to remain as refugees since the war and drought have both ended. Repatriation will continue and screening for Eritreans who wish to claim refugee status, because of a fear of persecution, will begin (AFP, 12/09/02).

Eritrean refugees in Sudan (UNHCR, 10/09/02)

	Number
Camp-based receiving assistance	147,000
Registered urban-based receiving assistance	13,000
Estimated urban-based receiving limited assistance	195,000
Total	355,000

Internally displaced persons

There are an estimated 60,000 displaced persons living in camps as a result of deportation from Ethiopia or because unexploded mines prevent them from returning home (ECHO, 18/07/02). No recent information on the nutrition of this population is available to RNIS.

Drought

The government recently launched an appeal for humanitarian assistance. It is anticipated that the cereal harvest will be reduced by 84%. Crops planted in the spring cultivation season (March-May) have dried up as a result of poor rainfall. The June-September rains were delayed by about six weeks, causing a significant drop (37%) in planting surface. The estimated requirement for food aid is more than 400,000 MTs of cereals, beans and oil (ICC, 28/08/02).

Erithrée Environ 355 000 Erythréens sont actuellement réfugiés au Soudan. Leur statut automatique de réfugiés expirera à la fin de l’année 2002, le HCR estimant que la situation en Erythrée ne nécessite plus l’expatriation. 51 683 Erythréens ont déjà été rapatriés depuis mai 2001, la plupart sont retournés dans la région de Gar Barka. De plus, l’Erythrée compte 60 000 déplacés internes. RNIS n’a pas reçu de récentes informations nutritionnelles concernant ces populations. L’Erythrée est d’autre part touchée par la sécheresse et la quantité d’aide alimentaire nécessaire est estimée à 400 000 tonnes.

RNIS 38, July 2002

The situation in Eritrea continues to be of concern and it is estimated that up to 1.3 million people, including war and drought affected populations, deportees and returning refugees, remain vulnerable as a result of both drought and the affects of the recent war with Ethiopia. The drought and recent conflict have both had a remarkably heavy toll on livelihoods within the country and, although there has been a general improvement in the humanitarian situation, the number of people in need of assistance remains high.

The overall humanitarian situation has undergone some improvement and has been greatly helped by the long awaited decision on the exact location of the border separating Eritrea and Ethiopia on 13 April 2002 (UNOCHA 29/04/02). The two countries have both announced their acceptance of the decision and it is hoped that this marks a very positive development that will allow the continuation of vital work to demobilise and reintegrate soldiers, clear areas of unexploded ordinance (UXO) and mines, and rehabilitate the infrastructure destroyed during the war.

The border agreement has not been without its set backs and, on 27 April 2002, Ethiopia closed the border to the UN peace keeping mission over what Ethiopia claimed were violations of its rights when the UN force brought journalists in to view a contested village. The border was subsequently reopened and the improved security has seen the return of many people to their places of origin. However, the number of people considered to be vulnerable still remains high and some of the most badly affected areas of the country remain Gash Barka, Debub, North and South Red Sea States and Anseba, where it is estimated that 529,400 vulnerable people are still suffering from drought (WFP 10/05/02). There are also approximately 57,200 people internally displaced, who have not been able to return to their areas of origin, largely as a result of mines and UXOs and lack of infrastructure. There are also more than 13,000 people in camps who were expelled from Ethiopia.

Table of Vulnerable groups receiving food aid

(UN 2002)

Number of IDPs in camps	50,239
Number of IDPs in host communities	14,199
Number of IDPs outside camps	9,311
Total number of IDPs	73,749
Expellees/deportees	13,694
Total number of drought affected persons	524,098
Total number of refugees expected to return from Sudan in 2002	90,000
Number of refugees in Eritrea	1,922
Total number of food aid beneficiaries in 2002	800,000

It is concerning to note that there has been a very poor response to the UN’s Consolidated Inter-Agency Appeal (CAP) for 2002, which has left the food pipeline available for the war and drought affected beneficiaries at its lowest level since the current emergency began in 1999 (FEWS 31/05/01). It is estimated that only 17.2 % of the appeal has been met (UNOCHA 10/06/02) and in March 2002 food distributions were cut by 50 % to cover only those deemed most acutely in need of assistance (FEWS 31/05/02). This is particularly concerning because the summer period from June to September represents the annual hunger season before the next harvest in mid October.

War affected displaced

The war with Ethiopia has had a huge impact on the livelihoods of many and those that remain most affected are those still in displaced camps in various areas of the country. Whilst many have been able to return to their areas of origin, many areas along or close to the border region are still very heavily affected with a very high amount of mines and UXOs which continue to exclude people from potentially fertile farming areas. The result is a group of people, estimated at approximately 50,000, who are still living in camps in areas in Gash Barka and the Red Sea states, who have lost their livelihoods and have been unable to secure them again. As a result, they are dependent on external assistance for their subsistence needs. The RNIS has not received any nutrition reports over the reporting period but notes with concern that the last survey (see RNIS 36 and 37) appeared to indicate a decline in the nutritional status of under-five children in war displaced camps in the Gash Barka region. This is particularly concerning as the previous surveys had indicated a relatively stable and non-critical situation. The continuation of ration cuts and the present hunger season gives cause for concern for these groups.

Drought affected displaced

Up to 529,400 people are considered vulnerable as a result of the chronic effects of a region wide drought in 1999 and 2000. The most affected zones are those of Anseba and the North and South Red Sea zones. The situation has been exacerbated by a poor rainfall distribution in early March and late April 2002 and in June FEWS announced that the Azmera rain season, from Marchto May, had failed. As a result the long cycle crops, which are normally planted during this period, will probably fail. This represents the second year of failure for the Azmera (minor) rainy season and it is expected that this will adversely impact on livestock health because the rains are an important source of feed and water for livestock. This will certainly have a negative impact on food security for many in Eritrea and, although the RNIS has not received any recent nutrition surveys on drought affected populations, they are considered to be at risk of further nutritional decline.

Returnees

Eritrea has suffered from a series of wars and natural disasters and the refugee caseload in neighbouring countries such as Sudan is one of the oldest in Africa. Since the peace with Ethiopia and the prospects of a secure future for the country, a programme of voluntary assisted returns has been implemented by UNHCR. This programme has been targeted specifically at the 147,000 camp based refugees in about 23 camps in Sudan (UNHCR 11/06/02). At the beginning of July it was announced that 50,000 had returned and many more are expected to do so this year (ICC 02/07/02). The number of returnees is increasing and this is largely a result of a decision by UNHCR to no longer consider the long-term Eritrean refugees in Sudan as eligible for refugee status (UNHCR 08/05/02). This has important implications for the remaining refugees in camps in Sudan, who must now decide whether they will return or apply to stay in Sudan. The returnees are receiving a return package to help them re-establish themselves and many are returning to areas such as Golujk, south of Tesseney, which is a region considered to be particularly fertile and good for farming (UNOCHA 27/05/02). The RNIS has not received any nutritional information on this group but it is not thought to be critical.

Overall

The situation in Eritrea is precarious as a result of the continuing affect of an ongoing drought that is threatening food security at the country level. The country is also still suffering the effects of the war with Ethiopia and much workneeds to be done to reintegrate fighters and rehabilitate much of the land and infrastructure in war affected areas. This has left a great deal of people acutely vulnerable and suffering from chronic food insecurity. It is therefore concerning to note that the humanitarian programmes, specifically designed to facilitate the country to get back on its feet, are so under funded and it is clear that this will have an effect on the overall humanitarian situation.

Recommendations

From the RNIS:

• Urgently provide funding to the UN CAP appeal to ensure an adequate food pipeline for vulnerable population groups.
• Closely monitor the nutrition and food situation amongst the IDP communities, particularly during the hunger season from June to September.

RNIS 36/37, April 2002

Eritrea continues to suffer from the affects of the war with Ethiopia and the regional drought of 2000. Both constituted considerable external shocks to the population, resulting in huge disruption of livelihoods and culminating in mass internal displacement of population. The Annual Needs Assessment for Eritrea concluded that 1.3 million persons remained vulnerable and would require continued food and other forms of assistance during 2002 (FEWS 04/12/01). This figure includes war-affected displaced, drought-affected populations, deportees and returning refugees (see table below).

The number of people in need of assistance remains high but the general humanitarian outlook is improving. Many people have returned to their areas of origin, with the chief constraint to further returns remaining the wide scale destruction around border areas and the presence of large amounts of mines and unexploded ordinance (UXO). The drought affected population make up the largest vulnerable group, with the areas of Anseba, North Red Sea and Southern Red Sea being the worst affected. It is important to note that less than 1 % of Eritrea s humanitarian needs of 120 million US dollars has currently been met (FEWS 25/03/02). The country has no emergency food resources to fall back on and there is a very real possibility that Eritrea will not be able to meet the food needs of its vulnerable populations. As a result, the government has had to redefine vulnerable groups and heavily target those considered most vulnerable.

Table of Vulnerable groups receiving food aid
(UN 2002)

Number of IDPs in camps	50,239
Number of IDPs in host communities	14,199
Number of IDPs outside camps	9,311
Total number of IDPs	73,749
Expellees/deportees	13,694
Total number of drought affected persons	524,098
Total number of refugees expected to return from Sudan in 2002	90,000
Number of refugees in Eritrea	1,922
Total number of food aid beneficiaries in 2002	800,000

The security situation with Ethiopia is still tense but the establishment of the Temporary Security Zone in April 2001 and the presence of over 4,000 peacekeepers and observers from the United Nations Mission to Ethiopia and Eritrea (UNMEE), has helped to prevent further hostilities. An important recent development has been the definitive ruling on the delimitation of borders, which occurred on 13/04/02. Both parties have agreed to abide by the decision and it is hoped that this will contribute to a lasting peace. The insecurity has been a major constraint on the improvement of the humanitarian situation. The UN Security Council has extended UNMEE s mandate until September 15^th and UNMEE will facilitate in the demarcation of the border area, including the removal of mines and UXO. This will help to facilitate the return of IDPs to their areas of origin (UN OCHA 19/04/02).

Another important development, which could affect the humanitarian situation, is the evident concern of donors over the perceived reluctance of the government to embrace democratisation. Donor countries have expressed concern over the blocking of opposition parties and the expulsion of the Italian ambassador to Eritrea in September 2001. Italy has traditionally been one of the biggest donors to the country. In January 2002, Denmark announced that it would radically reduce assistance in 2002 and end its bilateral cooperation in 2005 as a result of government assaults on democratic principles and human rights (UNDP EUE 05/03/02).

War-affected displaced

The stabilisation of the security situation has seen many people who were internally displaced during the war with Ethiopia return to their places of origin. However, the presence of land mines and UXO, and the sensitivity of some areas close to the TSZ, has meant that some IDPs still remain. There are an estimated 73,749 IDPs, with 50,239 remaining in camps in the Gash Barka and Debub zones. The remainder are living either with host communities or in scattered groups. These groups have very little access to land or livelihood opportunities and remain highly dependent on food aid, at least for the duration of 2002 (FEWS 04/12/01). Nutrition surveys in July/August 2001 indicated that the nutrition status of IDPs was relatively good and appeared better than non-displaced populations in similar areas as a result of the emergency assistance IDPs received. However a series of surveys conducted over the last quarter of 2001 indicate a decline in the nutritional status of both displaced and non-displaced populations.

SCF-UK conducted three surveys in August, October and December 2001. The surveys revealed that the proportion of children under five was above 30 % and therefore higher than expected. A national demographic survey in 1995 indicated that the proportion of under-fives was 20.6 % (SCF-UK 12/01). The reason for this appears to be the large number of adults, particularly men, who are missing from families either because they are fighting at the front or because they have moved in search of employment. As a result, the number of female-headed households was high and is a risk factor for food insecurity and for nutritional status decline. The results of the surveys can be seen in the graph below. The first survey in August 2001 indicated a prevalence of acute malnutrition below emergency thresholds. However the two subsequent surveys show preva-lences that are raised above emergency thresholds and are indicative of a decline in the overall nutritional status of the population in the surveyed areas.

SCF Nutrition Surveys in Gash Barka Region, Eritrea

In the first two surveys the IDP population showed a better nutritional status than the non-displaced population due to the better provision of resources to IDPs. However, this was no longer the case in the third survey as a result of a decline in emergency assistance and essential services. The reasons for the decline in nutritional status appear to be related, primarily, to a decline in food availability. This is largely because the general ration was cut to 60 % where the resultant ration was 1553 Kcal as opposed to the 2100 Kcal recommended for populations dependent on food aid. WFP food monitors noted that relief food makes up 95 % of all food found in the community (WFP 04/01/02). The ration cut was carried out on the assumption that the November harvest would be good, which proved not to be the case. Crude and under-five mortality was also measured and in all three surveys was well below emergency thresholds (see table below). The surveys also indicated a decline in access to water and health services.

Table showing mortality rates in Gash Barka region
(SCF-UK 12/01)

	August 2001	October 2001	December 2001
Crude Mortality	0.3/10,000/day	0.43/10,000/day	0.39/10,000/day
Under-five mortality	0.5/10,000/day	0.57/10,000/day	0.12/10,000/day

The surveys indicate a deterioration in the Gash Barka zone but WFP also reports declining nutritional status in Northern and Southern Red Sea and Anseba zones. In general, it is felt that the increase in the general ration should mean that the nutritional decline will not continue. However, it is clear that the war-affected population will require continued assistance for some time.

Drought affected populations

The drought affected population make up the largest group of vulnerable people. They currently number 524,098 persons and are located in Anseba, North and South Red Sea zones. The vulnerability of these groups is a result of acute food insecurity, stemming from successive crop failures and the decimation of livestock herds. Even if there were to be series of good harvests, it is likely that it would take some time for this group to fully recover. The situation has been exacerbated by the failure of the Bahri rain season, which normally starts in October and carries on until March. This year s season has been delayed by three months. The North Red Sea zone has been particularly badly hit and, as a result of the total absence of rain during the first three months of the season, farmers have abandoned crop planting and are concerned about the fate of their livestock (FEWS 08/01/02). Recent rainfall estimates indicate that the situation could improve but drought-affected populations will remain highly vulnerable and dependent on external assistance.

Returnees

As a result of the recent conflict with Ethiopia and previous episodes of drought, there has been a large body of Eritrean refugees in countries such as Sudan. A series of agreements between the Eritrean and Sudanese governments were established during 2001 and the task of repatriating refugees, some of whom have been in Sudan for years, was started. The original plan was to repatriate 62,000 refugees by the end of 2001. However, the actual figure was 32,648 (FEWS 08/01/02). The reasons for this were firstly that the harvest season in eastern Sudan, where the refugees have been residing, coincided with the repatriation and refugees were reluctant to move before harvesting their crops. Secondly many of the refugees are Muslim and the repatriation fell during the Holy Month of Ramadan when refugees were also reluctant to move. It is estimated that 121,000 Eritreans still remain in refugee camps in Sudan s Kassala and Gedaref states. The problem for many is that they have very little to return to and will require substantial assistance. They will be helped in part with a return package of food and non-food items.

Overall

The humanitarian situation in Eritrea has generally improved as a result of improved security with neighbouring Ethiopia and an improved food outlook. However, it is important to note that very large proportions of the population remain extremely vulnerable to food insecurity as a result of the systematic erosion of livelihoods through both drought and conflict. As a result, dependence on external assistance is high and will continue for at least the duration of 2002 and very probably into 2003. Given the situation, it is alarming to note that the response by the international donor community to the humanitarian needs has been very small and, as a result, there are likely to be severe pipeline shortages. The improvement of the humanitarian situation is contingent on continued good security with Ethiopia and good rainfall. This will help facilitate returns and the reestablishment of livelihoods. Given the dependence of the vulnerable population on external assistance and the poor funding response, vulnerable groups should be regarded as being at moderate risk (category III).

Recommendations

From the SCF-UK nutrition surveys

• Supplementary food rations should be provided to all women and children who are malnourished.
• The general food ration should be maintained at 100 % for at least the next 6 months.
• The capacity to measure and monitor the food and nutrition situation should be improved.

RNIS 35, October 2001

The last three months have seen the continued improvement of the humanitarian situation in Eritrea. As a result of both the past war with Ethiopia and the regional drought of last year, the WFP have been targeting 1,048,404 war affected persons that include IDPs, expellees, vulnerable host communities, returning refugees from Sudan and demobilised soldiers. (FEWS 06/09/01). The number of people requiring humanitarian assistance is expected to increase by as much as 100,000 by the end of the year because of the number of refugees currently being repatriated from Sudan. The repatriation is a good indication of the improving situation but it will mean that the need for food assistance will continue until returnees are able to return to their places of origin or are resettled.

The security situation has greatly improved and Eritrea and Ethiopia remain separated by a Temporary Security Zone (TSZ) manned by over 4,000 peacekeepers and observers from the United Nations Mission in Ethiopia and Eritrea (UNMEE) (ICC 16/08/01). UNMEE plays a crucial role in monitoring the peace agreement between Eritrea and Ethiopia and recently helped to dispel tension from Ethiopian claims that Eritrea was once again preparing for war. On September 14^th the UN Security Council voted to extend its mandate until March 15^th, 2002 (UNDP-EUE 22/10/01).

A recent crack down on alleged dissidents by the government resulted in the arrest of eleven Eritrean journalists as well as former senior government officials and soldiers (UNDP-EUE 22/10/01). The arrests have been widely condemned and in a related action the Eritrean government expelled the Italian ambassador on September 29^th. The expulsion of the ambassador, who is also a key representative of the European Union, is believed to be a result of a letter of condemnation of the arrests that he had written. It is now feared that his expulsion will adversely affect future EU funding to the country (IRIN 19/10/01).

War-affected displaced

The improvement in security within the country and the alleviation of drought conditions have allowed more of the war-affected displaced to return to their places of origin. It is estimated that over 170,000 IDPs have returned to their home areas since the end of June 2001 (FEWS 06/09/01). Current figures for remaining camp based IDPs indicate that there are 43,995 IDPs in nine camps in the Debub and Gash Barka zones (ICC 30/09/01). The remaining IDPs are currently not able to return to their places of origin. This is a consequence of either insecurity from mines and unexploded ordinance, or the absence of basic infrastructure such as health, water or education facilities. Infrastructure was heavily destroyed during the war. The government, the UN and NGOs are all helping to facilitate the safe return of IDPs by securing areas and helping to reconstruct infrastructure and basic services.

The RNIS has not seen any new nutrition surveys on the war-affected displaced but FEWS reports on a survey carried out in August by SCF-UK, in conjunction with the MOH and ECHO, amongst under- five children in the Gash Barka Zone. The survey indicated that rates of acute malnutrition were not alarming and were below emergency thresholds, as were both the crude and underfive mortality rates (FEWS 06/10/01). The low rates of acute malnutrition and mortality were attributed to the fact that the survey population came from camps that were well supplied with general food rations, supplementary feeding programs, health care, water and sanitation. However, these results cannot be extrapolated to all IDPs in camps in Eritrea and it should be stressed that the IDPs remain highly dependent on external aid.

Drought affected populations

Successive years of drought in the Horn of Africa, culminated last year in widespread acute food insecurity as failed harvests left people with very little resources to fall back on to meet their nutritional needs. The RNIS reported in July that the short azmera rain season, normally starting in April, had all but failed. FEWS reports that the main kremti rain season starting in August, proved to be one of the wettest on record. The extreme weather has delayed the planting of some crops and severe storm damage has been reported in some areas of Debub, Northern Red Sea State and Makel. The adverse affects of the unexpectedly high precipitation are concerning but despite this the Ministry of Agriculture has issued a preliminary crop estimate that is considerably higher than last years’ figures. The expected production is 223,978 MT, while last year’s yield was only 85,000 MT (FEWS 06/09/01). FEWS also points out that the high precipitation levels will fill reservoirs and replenish chronically low water tables. This will have beneficial effects on the quantity and quality of grazing for the country’s many livestock owners.

Returnees

UNHCR reports that there were 376,400 Eritrean refugees in Sudan at the end of 2000 (UNHCR 02/10/01). Repatriation of the refugees began in March 2001 after an agreement between the Sudanese and Eritrean governments. 160,000 refugees have been identified for repatriation by the end of 2002 and the exercise began in May 2001 but had to be halted at the end of July because of the onset of the rainy season, making transportation of the refugees impossible. A further agreement between the two governments and UNHCR was signed on September 22nd and as of 20^th October 2001, a total of 21,417 refugees have been repatriated. UNHCR hopes to assist the repatriation of a further 40,000 refugees by the end of 2001, with an additional 90,000 expected to follow in 2002. Many of the refugees have been in exile for some time, arriving with very little to help them restart their lives, and will need considerable assistance before they are resettled and are able to be self sufficient. To facilitate their reintegration each family will be given up to two hectares of arable land, a cash grant, a food ration and household and agricultural supplies (UNHCR 22/10/01). The RNIS does not have any nutritional information on the returnees.

Overall

The improved security and crop prospects have all contributed to a general improvement in the humanitarian situation in Eritrea. High levels of precipitation have caused some crop damage but will do much to alleviate the chronic water problems in the country. The fate of the displaced and the newly returned is highly dependent on their ability to return to their places of origin or other areas and re establish their livelihoods free of any dependence on external assistance. This will be highly dependent on the continuation of a good security situation and the de contamination of war affected areas from mines and other forms of unexploded ordinance. In view of the current security state and the improved food security outlook in the country the IDPs are not considered to be at high risk (category IV).

RNIS 34, July 2001

Since April 2001, Eritrea and Ethiopia established a Temporary Security Zone (TSZ) manned by UN peacekeepers and observers. The TSZ effectively separates the two sides whilst final stage talks are taking place (IRIN 06/07/01). The final status of the TSZ remains unresolved and although the UN Mission in Ethiopia and Eritrea (UNMEE) remains optimistic concerning the situation, tensions do still exist (UN DPI 20/06/01) and full normalisation of relations between the countries has not yet taken place.

Response to the humanitarian appeal for 2001 has been slow. As of June 14^th only 25,000 MT of food aid had been pledged out of a requested 223,000 MT. A quick response would facilitate the resettlement of IDPs in their home areas and help them restart their normal lives (FEWS 14/06/01).

War-affected displaced

The RNIS has not received any recent nutritional surveys of displaced in Eritrea. However, the cessation of hostilities and a better pattern of precipitation has led to some improvement in the overall situation. This has prompted an increase in the return of IDPs to their places of origin. Previously the RNIS reported that 208,163 IDPs were in 24 organised camps in the three zones of Debub, Gash-Barka and Northern Red Sea (RNIS 32 and 33). Current UN figures indicate that about 120-150,000 IDPs have returned to their places of origin. An estimated 50-60,000 remain in camps because of land mines or lack of local infrastructure in their home areas. (IRIN 06/07/01; IRIN-HOA 18/06/01).

The continued presence of mines and unexploded ordinance continues to be one of the chief obstacles for returnees and the future food security of the area. Two of the most affected areas, Gash-Barka and Debub, have traditionally been regarded as the breadbasket of Eritrea with the two contributing up to 75% of national cereal production (IRIN 06/07/01). Every effort is being made to demine affected areas by UNMEE.

An assessment by the UN and the government of Eritrea in Gash-Barka zone revealed considerable damage to infrastructure including houses, schools, churches, mosques, health stations, government offices and fuel stations (FEWS 07/05/01). Of particular and immediate concern is the rehabilitation and expansion of water sources and the government of Eritrea and UNHCR are working with NGOs to implement quick impact projects (UNHCR 06/06/01). Until infrastructure is rebuilt, returnees are likely to continue to need both food and non-food assistance (FEWS 07/05/01).

Drought affected populations

RNIS 32 and 33, reported that an estimated 738,450 people were directly affected by the drought in 2000 (RNIS 32 and 33). The short rain season (azmera) that normally starts in April and May has all but failed (FEWS 14/06/01). The azmera is particularly important for the emergence and establishment of long-cycle crops such as maize, millet and sorghum and its failure will have a serious impact on the overall production of crops for 2001 (FEWS 07/05/01; 14/06/01).

The most affected areas remain Anseba, North and South Red Sea and Maakel zones. Reports from the Anseba zone indicate that drought conditions are worsening in all sub-zones. The main summer rain season will begin at the end of July and current predictions indicate that there is only a 35% chance of normal rainfall, leaving continued cause for concern over the future food security of the area. (FEWS 14/06/01).

Returnees

The war with Ethiopia sent many Eritreans across the border into neighbouring countries such as Sudan and Yemen. The US committee for Refugees estimates that some 335,000 Eritreans were refugees at the end of 2000 (USCR 19/06/01). An agreement between Eritrea, UNHCR and Sudan was signed in March 2001 to facilitate the voluntary repatriation of refugees from Sudanese camps. Returnees will be constrained by the food security constraints generally seen in the country. Demining activities have already cleared areas in the Gash-Barka zone, which has been identified as an area of return for refugees and surveys within the Eritrean refugee population in Sudan have indicated that 71% wish to return. Provisional planning figures estimate that 62,000 refugees will return from Sudan to Eritrea during the course of 2001 (FEWS 07/05/01).

The repatriation began in May 2001 and by June 26^th a total of 16,588 had returned from the Sudanese camps of Hawata, Mafaza and Gulsa. Efforts increased to move the refugees before the upcoming rainy season in late July, with 27,000 having signed up for return to date (UNHCR 26/06/01). The arrival of the refugees will directly impact on the national food outlook

Overall

The humanitarian situation in Eritrea has improved largely as a result of the continued peace with Ethiopia that has allowed the return of many of the displaced and refugees. Although there are no new nutritional survey reports, it is likely that food security has improved as a result of the cessation of hostilities and slightly improved rain-fall. The presence of landmines and other forms of unexploded ordinance is still limiting access to land in some areas, restricting farming and pastoralist activities in affected areas. The destruction of basic infrastructure, such as water resources and medical facilities, also hinders the return of displaced and refugees to their home areas (Category IV).

Recommendations and Priorities

• Increase the level of food aid by supporting the humanitarian appeal of 2001.
• Continue the de-mining of the conflict zones.
• Continue the rebuilding of basic infrastructure in affected areas.

RNIS 32/33, April 2001

The cessation of hostilities between Eritrea and Ethiopia on June 18^th brought a halt to the fighting. The cease-fire was formalised in December 2000 with the Algiers Peace Accord. As a part of the peace agreement the two countries agreed to the creation of a buffer or Temporary Security Zone (TSZ) between the two borders to be controlled by a peace keeping force. The government of Eritrea completed the redeployment of its forces on April 16^th 2001 and the TSZ was declared officially established on April 18^th. This paves the way for the clearance of mines from many of the border area zones (FEWS 07/05/01).

The end to the war with Ethiopia has allowed many of the displaced to return to their places of origin. However, the process of recovery is likely to be slow as many are constrained by the extremely precarious food security situation caused by the war and recurrent drought. Many areas of the south of the country remain heavily mined and are extremely dangerous until de-mining can take place.

The major target groups for assistance are as follows:-

1. Drought affected populations. 738,000, mostly in Anseba, North and South Red Sea Zones.

2. Rural war affected. 708,241 people including; IDPs outside camps, host communities, Eritrean deportees/Expellees, Returned IDPs and refugees.

3. IDPs in camps. 208,163 people in 24 organised camps in Debub, Gash-Barka and North Red Sea/Anseba.

Table showing numbers and categories of beneficiaries (UN-2001)

Target Population		Population Number
Drought Affected		738,450
	Anseba	269,835
	North Red Sea	255,842
	Southern Red Sea	134,133
	Maakel	78,640
IDPs in Camps		208,163
Rural War Affected		708,241
Total		1,654,854

War displaced

After the cessation of hostilities in June 2000, an estimated 400,000 IDPs returned to their homes which they found to be either destroyed or looted. In June 2000, SCF-UK reported that there were an estimated 208,163 people remaining in displaced camps in various parts of the country with over 100,000 in the zones of Debub and Gash-Barka. (SCF-UK 07/00).

In July 2000 SCF-UK conducted a nutritional survey of Af'abet displaced camp, which is situated about 70 km north of Keren in the North Red Sea Zone. The camp was set up after the closure of a camp in Dabat and is made up of people from Barentu and the surrounding area. The population at the time of the survey was 24,616 people. The survey revealed an estimated rate of acute malnutrition of 7.7 % including 0.7 % of severe malnutrition. In combination with a CMR of 0.2/10,000/day and an under five mortality of 0.3/10,000/day, the indication is that the situation is under control with all indicators below emergency thresholds (SCF-UK 07/00).

SCF-UK conducted a further survey of three camps to the east of Barentu in October. The three camps of Korokon, Kotobia and Tole-Gamje have existed for at least two years before the recent conflict. The IDPs come from the Gash-Barka zone. During the most recent conflict, fierce fighting in the area forced all IDPs to flee the camp and seek safer sites in the bush. The survey revealed an estimated prevalence of acute malnutrition of 6.6 % including 0.6 % of severe. Again, the mortality figures in combination with the anthropometric results do not indicate an alarming situation. SCF attributes the low prevalence of malnutrition to the timely provision of humanitarian assistance (SCF-UK 10/00).

Outside of the camps there are an estimated 708,241 people, either displaced or severely affected by the war. The majority do not receive the assistance received by those in the camps. The RNIS has not received any surveys specifically on this group but the MoH annual report indicates that the rates of malnutrition are higher amongst this group with rates from 11-14 % (EmoH-2000).

MSF-France made an assessment in Senefa sub Zoba in March 2001. The assessment team visited Rokoyoto displaced camp. Their village of origin is extremely close to the TSZ and people have said that they will not return until there is a civilian administration in the area. The camp receives food from the ICRC but the general conditions in the camp are poor, particularly water supply which is taken from the nearby river and is of questionable quality (MSF-F 03/01).

Drought affected populations

The twin effects of the war and the drought are difficult to disentangle but the population predominantly hit by the drought is estimated as 738,450 people. The worst affected areas are the zones of Anseba and the North and South Red Sea Zones. In the Anseba zone the most affected areas have been surveyed and global malnutrition estimated at 16.1 % as reported in the MoH annual nutrition report for 2000. However, the RNIS does not have access to the individual reports. The same MoH annual report from the Northern Red Sea Zone estimated the total malnutrition rate as 12 % and in the Southern Red Sea Zone as 13.9 (MoH 2000; UN 2001).

Overall

Despite large scale displacements and drought in Eritrea, the nutritional status of those displaced who were assessed in 2000 remained at satisfactory levels (category IV). Food security and nutrition in general appears to be improving, as a result of the peace accord with Ethiopia and "normal" rainfall in many areas.

Recommendations:

• Continue general food distribution in camps so that good nutritional status is maintained.
• Support the UN appeal for both war and drought affected populations in Eritrea
• Concentrate on the rehabilitation of the destroyed infrastructure including roads, health and water systems.
• Assess the nutritional status of non-camp populations.
• Ensure that areas are quickly made safe through de-mining and the removal of other unexploded ordnance.

RNIS 31, July 2000

The border war between Eritrea and Ethiopia, which started in May 1998, escalated dramatically on May 12 on the Merb-Sebit front, and displaced huge numbers of people on both sides. A ceasefire agreement, negotiated by the Organisation of African Unity, was signed on June 18. The agreement has brought an end to the fighting for the time being, but several key issues remain unresolved and the final demarcation of the border still needs to be agreed.

The humanitarian situation in Eritrea deteriorated very seriously during the months of May and June. The Eritrean Relief and Refugee Commission (ERREC) estimates that more than one million people are currently internally displaced (out of a total population of approximately 3 million). UNHCR has registered 95,000 new Eritreans refugees in eastern Sudan (IRIN - 03/07/00; UNHCR - 12/07/00). Despite the ceasefire, food security will remain a problem at least until next year. Like the rest of the Horn of Africa, the population is facing a severe drought, and competing claims for assistance with other drought-affected populations in the region. In addition, the southern parts of the country will have to be de-mined before many of the displaced can return home and resume their normal lives.

War-affected displaced

Some 265,000 people were internally displaced in Eritrea before the latest fighting began. The IDPs were located in Gash-Barka Region, close to Badme in the southwest lowlands, the Debub Region, south of Asmara in the highlands and also in the Assab area of the Southern Red Sea Region. However, the fighting forced most of the population of Gash Barka to flee. More than 70% of the refugees in Sudan are from this zone and over half a million of the IDPs originate from there. Thus many of the displaced have been forced to flee twice (UNHCR - 12/07/00).

Precise estimates of IDP numbers are difficult to obtain, as population movements are fluid. UNHCR operates on the basis of a 550,000 figure for IDPs in and from Gash-Barka, while the overall IDP population is one million. Some of the displaced have started to return to their home areas since the ceasefire, but many more are spread throughout the country in 30 or more camps. Others are staying with relatives, or are simply living in the open, along riverbanks. Only one third of Eritrean IDPs are believed to have adequate shelter. Thus shelter materials are urgently required. Many IDPs are prevented from returning home because roads and bridges have been destroyed. The seasonal rains have also begun, making many roads impassable. Flash flooding may be dangerous in dry riverbeds where people are seeking refugee. In addition, some home areas have been mined are therefore not safe for return (IRIN - 03/07/00; RI - 27/06/00; UNHCR - 05/07/00).

Many of the IDPs lack the most basic items and have only restricted access to food and clean drinking water. Increased quantities of water are needed, but an inadequate supply of tankers for transport has limited supplies. No reports of increased incidences of malnutrition or morbidity have been received by the RNIS to date. However, the onset of the rainy season is likely to contribute to the spread of diarrhoeal disease and the malarial incidence will probably rise. Hospitals and health clinics have also been destroyed in the fighting (IRIN - 03/07/00; RI - 27/06/00; USAID - 21/06/00, 10/07/00; UNHCR - 07/07/00).

The food situation is reported to be very precarious, with food stocks in the country sufficient to cover the needs of IDPs and other affected populations for only another month (UNHCR - 05/07/00).

The long-term food security outlook is very poor. Even those IDPs who have been able to return home to a non-mined area will have difficulty planting their crops in time. In addition to displacement, the region is facing severe drought-induced food insecurity. Up to 100,000 animals have been killed. WFP is planning to provide food assistance to 750,000 displaced and war-affected people in Eritrea until April 2001. NGOs and other agencies will provide food to the rest of the affected population (RI - 27/06/00; WFP - 07/07/00, 21/07/00).

Drought

In addition to the problems caused by the war, Eritrea's population is also suffering from the drought that is affecting the rest of the Horn of Africa. An estimated 335,000 people are affected. WFP is providing assistance to people in the Anseba region (WFP - 30/06/00). The RNIS has not received any nutritional information on the drought-affected population.

Refugees in Sudan

WFP and the ERREC have jointly prepared distribution plans to meet the food requirements of approximately 80,000 Eritreans expected to return to Eritrea from the Sudan. According to UNHCR, the refugees will bring nonfood items donated to them during their stay in Sudanese camps. WFP aims to have the stock in position prior to the rainy season (WFP - 30/06/00).

Overall, the humanitarian situation in Eritrea is critical. Although no reports of elevated levels of malnutrition or morbidity have been received so far it seems likely that the next few months will be very difficult for the displaced populations in Eritrea, unless the relief operation is expanded and maintained. They are therefore classified at high to moderate risk (categories II and III).

Recommendations and priorities:

• Support the UN Appeal for the war-affected populations in Eritrea.
• Obtain accurate estimates of the number of IDPs requiring assistance.
• Provide shelter and other basic needs to the IDPs as soon as possible.
• Reconstruct roads and other infrastructure.
• De-mine affected areas.

RNIS 30, March 2000

Almost 20% of Eritrea’s population is in need of humanitarian assistance according to the latest reports from UNCT. Some 372,000 war-affected people, who are living along the border with Ethiopia, and 212,000 drought-affected people, mainly in Northern Red Sea and Anseba Regions require food aid. This is an immense drain of resources on a country of a population of only 2-3 million people (UNCT-28/01/00).

War-affected areas

Twenty months have passed since the outbreak of the border conflict between Eritrea and Ethiopia in May 1998. After several months of calm, new fighting broke out in February this year and tension along the border remains high, preventing displaced people from returning to their places of origin. Despite efforts by the Organisation of African Unity and the international community the peace process seems to have stalled (UNCT - 28/01/00; UNDP-10/03/00).

One hundred and thirty thousand of the displaced have settled in a string of 31 makeshift camps in Debub and Gash Barka Zones and a further 135,000 are housed with host families. Others are living with host families in Guluj. Many have been displaced 2 or 3 times, as fears of a fresh attack have led to the movement of several of the camps within shelling range. The vast majority of those who are living in camps come from rural agricultural areas. Many have lost their livestock and their land, and consequently their livelihoods. All the displaced children have missed an entire year of education. Health services are severely overstretched as a result of the additional needs of the IDPs, combined with the loss of many health professionals who left their posts to join the army. Sanitation conditions are appalling and the risk of outbreaks of childhood diseases is high. The host population has also suffered. Displaced people are forced to compete with stable, resident populations for land, grazing areas for their animals, water and basic social services that were already in short supply (SCF-UK-17/03/00, 23/03/00).

Despite this bleak picture, the nutritional status of children under five has generally remained within acceptable limits. The Ministry of Health, SCF-UK and UNICEF jointly established a nutritional surveillance programme in approximately 32 sites (in camps and in the host community) in October 1999 (see annex). The surveillance programme is linked to a supplementary ration programme in the camps, so the majority of the children are measured every month. However, there is quite a lot of movement in and out of the camps (in order to prepare fields or harvest etc) and there fore the population numbers are not stable. The nutritional situation in different sites is variable; however, prevalences of wasting above 10% were reported in up to one-fifth of monitored sites in October. Since October, the overall prevalence of wasting has decreased (see graph). This is largely due to the government’s decision to distribute a locally produced supplementary food (DMK - a blended food made from wheat, chickpeas, groundnuts or milk powder and salt, and fortified with iron and vitamin A) to all children under five in addition to a general ration of wheat or sorghum, lentils or chickpeas and oil. Nevertheless, the current nutritional situation is fragile. Food stocks are running out and donors appear to be ambivalent about sending more; an interruption to the pipeline could result in very severe consequences for the nutritional situation of these people (SCF-UK -17/03/00,23/03/00).

The prevalence of wasting (defined using medians) among IDPs In Debub Zone (“D”) and Gash Barka Zone (GB), Eritrea

Overall, the nutritional situation of the war-affected population in Eritrea has to some extent stabilised although is still precarious given their dependence on humanitarian assistance. Pockets of malnutrition are likely to continue to appear unless preventative action is taken and therefore this population is considered at moderate risk of malnutrition (category III)

Recommendations and priorities:

• Prevent a break in the pipeline by supporting WFP’s programme for the Eritrean IDPs.
• Continue nutritional surveillance of the war-affected population, and investigate the causes of high prevalence of malnutrition in the camps where it exists.

RNIS 29, December 1999

Approximately 200,000 Eritreans have been displaced by the war, including 40,000 children under five years old. The Eritrean government estimates that there are 69,000 displaced people in camps in Debub and 118,000 in Gash Barka. In addition to the IDPs, Ethiopia has also expelled some 60,000 Eritreans since the war started. This policy has continued over the reporting period. The population from Ethiopia is probably at higher risk than those who are internally displaced as they have been separated from their communities and normal support mechanisms (IRIN -18/11/99; SCF-UK 19/08/99).

No new information on the nutritional situation of the IDPs and refugees is available. The most recent (anecdotal) reports suggest that there is no nutritional emergency in the camps at present (SCF-UK -19/08/99; 08/09/99). Donor response to appeals by the Eritrea Relief and Refugee Commission, however, are reported to be poor (IRIN -15/10/99).

Recommendations and priorities:

• Information on the nutritional situation of war-affected populations on the Ethiopia/Eritrea border is required.
• Funds should be made available for humanitarian operations for the war-affected populations in the north.

Overall, the nutritional situation of the war refugees and IDPs is currently unknown, although they are probably at risk, because of limited humanitarian resources (category V).

RNIS 28, September 1999

Approximately 200,000 Eritreans have been displaced by the war, including 40,000 children under five. The Eritrean government estimates that there are 69,000 displaced people in camps in Debub and 118,000 in Gash Barka. In addition to the IDPs, Ethiopia has also expelled some 60,000 Eritreans since the war started. The population from Ethiopia is probably at higher risk than those who are internally displaced as they have been separated from their communities and normal support mechanisms (IRIN - 27/07/99; SCF-UK 19/08/99).

The government is distributing food in the camps, but its stocks are running low and it has begun to ask NGOs to consider providing food relief. Some families are able to supplement their rations by trading, working and cultivating their own food. Anecdotal reports suggest that there is no nutritional emergency in the camps at present, although the government reports that the number of cases of malnutrition and associated diseases is on the increase, particularly among children and breast-feeding mothers. There are also anecdotal reports about vitamin A deficiency. SCF-UK and the government are currently setting-up a nutritional surveillance system in order to identify the malnourished (SCF-UK - 19/08/99; 08/09/99).

SCF reports that conditions in the camps are poor; shelter is inadequate for most families, clothes are in short supply, sanitation facilities are lacking and there is a shortage of potable water and paediatric medicines. Malaria is currently one of the most important diseases in the camps, and with the rainy season approaching, the prevalence of malaria is expected to increase (SCF-UK - 19/08/99).

Despite a satisfactory harvest in 1998, the food situation for the farmers in areas close to the border war is described as "very tight". WFP has launched an appeal to provide food assistance to 268,000 beneficiaries in rural areas of Debub, Gash-Barka and South Sea Province affected by the border conflict. To date this emergency operation has only received 5.3% of its food cost and 2.7% of its total cost (WFP - 20/08/99).

Overall, although the nutritional situation of the war refugees and IDPs is yet to be confirmed by surveys, they are considered to be at moderate risk, because of limited humanitarian resources and poor conditions described in the camps (category IIb).

Recommendations and priorities:

• More information is required about the nutritional situation of war-affected populations on the Ethiopia/Eritrea border.
• Funds should be made available for WFP's emergency operation for the war-affected populations in the north.

RNIS 27, July 1999

WFP has also launched an emergency operation in Eritrea for the most vulnerable among the war-affected. Assistance will be given to 268,000 people consisting of 246,000 IDPs and 21,500 Eritreans from Ethiopia (either forced deportees or voluntary arrivals). Unfortunately to date the response to this appeal has been very poor. Sanitation and water supply to the IDPs is inadequate, and the public health risks are high. Food is also reported to be in "short supply" as are medicines and medical equipment (IRIN - 15/06/99; Oxfam - 27/04/99, RI-23/06/99).

Overall, the IDPs and returnees in Eritrea are thought to be at high risk as (category IIa), principally because of the public health problems and lack of funding in reposes to the appeal.

Priorities and recommendations:

• Funding is required for the Eritrean war-affected population appeal.