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Nutrition Information in Crisis Situations - Guinea
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Refugee population |
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| Positive points | Negative points |
Food security |
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| Regular food distributions | Distributed food does not fit feeding habits |
| Exploitation of swamps | Because of a lack of cash, people need to sell part of their food ration |
| Implementation of income generating activities | Insufficient training to go with the income-generating activities has sometimes led to some people getting into debt |
| Identification of vulnerable people on the arrival of refugees at the camps | |
Public health |
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| Good access to health care | Bad living conditions in transit camps |
| Good access to potable water and good sanitation | |
Social environment |
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| Average security environment | The fear of refugees of repatriating not taken into account enough |
| Education and alphabetisation programmes | |
Delivery of assistance |
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| Good collaboration between refugee committees and aid organisations | |
Host population |
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| Positive points | Negative points |
Food security |
|
| Food distribution in 2002 | Rising of food prices, especially rice |
| Implementation of income-generating activities | |
Public health |
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| Access to health care in the camps | |
| Improvement of access to water and sanitation | |
Social and ecological environment |
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| Good relationships with some aid organisations | Several problems regarding the implementation of the camps: not enough dialogue with the local population, compensation for the parcels not always given |
| Camp infrastructures will be used by the local population after refugee departure | |
| Improvement of road conditions | |
| Re-afforestation | Massive de-forestation |
After a massive wave of Liberian refugees in September 2003 (see RNIS 43), the influx of refugees has calmed down and only 100-200 arrivals per week were recorded in November/December 2003 (OCHA, 19/12/03). In addition, it seems that a significant number of Liberian refugees returned spontaneously to Liberia, although it is unknown if their returns are permanent (OCHA, 19/12/03).
It was estimated that, in addition to about 100,000 refugees settled in camps (see table 6), around 70,000 refugees were living outside camps, as of mid-December 2003 (OCHA, 19/12/03). The majority of the refugees are Liberian (89,000), followed by Sierra Leonean (15,400) and Ivorian (6,800).
About 25,000 Sierra Leonean refugees were repatriated from Guinea (see RNIS 42)
in the first semester of 2003. Repatriations were suspended during the rainy
season and resumed in December 2003.
Table 6 Refugees settled in camps in Guinea,
December 2003 (OCHA, 19/12/03)
| Location | Camp | Number of refugees |
| Kissidougou | Boreah | 7,795 |
| Kountaya | 16,350 | |
| Telikoro | 9,402 | |
| N'Zerekore | Kouankan | 32,205 |
| Kola | 6,527 | |
| Nonah | 6,820 | |
| Laine | 32,090 | |
| Total | 111,189 | |
An evaluation of food security in Guinea showed that the situation in Forest Guinea, where the majority of the refugees are settled, although not critical, needs to be monitored carefully because of potential risks connected to the security situation in border areas and influx of populations (ACH-S, 07/03).
Forest Guinea has also experienced an influx of returnees from Ivory Coast, since the events in Ivory Coast in September 2002. A rapid evaluation has estimated that, of around 100,000 returnees, about 50,000 are settled in five prefectures (Lola, Beyla, Kankan, Mandiana and N'Zerekore) along the Ivory Coast-Guinea border (OCHA, 09/01/04). Returned families represented about 10% of the total population in the border area (OCHA, 09/01/04), and according to an ACH-S evaluation, six of the 17 villages surveyed in Forest Guinea hosted returned families (ACH-S, 07/03). Nearly all the returned families resided with host families and were highly dependent on them for subsistence (OCHA, 09/01/04). Moreover, the economic situation has been affected in the area by the closure of the border with Ivory Coast (OCHA, 09/01/04).
The priority needs, according to the people interviewed in the OCHA assessment, were health care, food and nutrition support, education and potable water (OCHA, 09/01/04). OCHA called for a comprehensive evaluation of the needs in the area and for action to sustain returnees' and host communities' livelihoods.
A new wave of about 11,000 refugees entered Guinea from Liberia in September 2003, following fighting or insecurity in Lofa, Bong and Nimba counties (see map) (OCHA, 19/10/03; UNHCR, 30/09/03). The movement decreased in October (OCHA, 20/10/03). Refugee International reported that the conditions of the camps in the Nzerekore region have highly improved in the past years. The assessment reported that in Laine, Kouankan and Kola camps, the water-supply system was adequate, food distributions were regular and consistent and health care was provided. Refugees can also engage in farming, trading or local employment (RI, 03/09/03).
It is estimated that as of July 2003, about 27,000 people had entered the country since the beginning of 2003, of whom 39% were Guineans returning from Ivory Coast, 43% were Liberians, 10% were Ivorians and 8% were third country nationals (OCHA, 31/07/03). Guinea was hosting an estimated 91,000 refugees as of 3 July 2003 (OCHA, 31/07/03).
During the same period, 25,000 Sierra Leonese refugees were repatriated to Sierra Leone (OCHA, 31/07/03).
Laine refugee camp, which has a capacity to host 6,000 people, is still hosting 28,000 people, whilst relocation from the Kouankan refugee camp to the Kissidougou area has begun; 6,100 out of 33,000 have been relocated so far (OCHA, 31/07/03).
Various studies tend to show that host-communities in Guinea are facing growing difficulty meeting their food needs and access to basic services (OCHA, 30/07/03).
It is estimated that between the upsurge in violence in Ivory-Coast and March 1st 2003, 18,000 Ivorian and Liberian people have entered the country, as well as 12,000 foreign nationals in transit, adding to the near 100,000 refugees already settled in Guinea (OCHA, 27/03/03). The repatriation of Sierra Leonan refugees resumed, and about 4,000 were repatriated in the first two months of 2003.
For security reasons, refugees will be relocated from the Kouankan camp, situated near the border to the Albaderia camp, situated further inland (OCHA, 27/03/03).
A new wave of Liberian refugee (about 16,000) has been reported to have entered Guinea because of renewed fighting in Liberia (OCHA, 11/04/03).
A food security survey was undertaken in Kountaya and Telikoro refugee camps, Kissidougou, in September and October 2002 (UNHCR, 12/02); the camps host Sierra Leonan refugees as well as new -comers from Liberia. The major sources of income were daily labour; exploitation of natural products; skilled trade; agriculture; business and NGO employment. According to the refugees, the most important needs not met by humanitarian assistance were additional oil and complementary foods (condiments, green vegetables, fish or meat); milling of the bulgur distributed as food ration; fuel for cooking; kerosene to light the shelters; clothing and shoes; shelter maintenance. Cost of food and preparation was 65% of the expenses. Seven wealth groups have been identified (see table). Households which were more self-reliant were those with a member employed by an NGO, paid as a committee member or engaged in business with no credit. Households which were least self-reliant were newly arrived Liberians; women-headed households; households headed by a middle-aged, elderly or handicapped man; and households where worker to dependent ratio was less than 1:2. The survey recommends that improvement of household self-reliance should include promotion of food production; income generation from agriculture; practice of skilled trades, business and NGO employment.
Wealth groups, Kountaya and Telikoro refugee camps, Kissidougou, Guinea, September-October 2002 (UNHCR, 12/02)
| Wealth groups level | Estimated proportion | Major sources of income |
| I | 1%-3% | Higher paid NGO workers Wholesale business people |
| II | 8-12% | Lower paid NGO workers Camp committee members Retailers with little or no credit |
| III | 30-35% | Large-scale gardeners Retailers on credit Select tradesmen |
| IV | 18-20% | Most skilled trades people Group fishermen Basket/mat makers Stronger, better-connected male daily workers |
| V | 5-10% | Petty traders Charcoal makers Bulgur grinders |
| VI | 10-13% | Camp security staff Weaker, poorly-connected male daily workers Lone fishermen Wood cutters Women daily workers |
| VII | 15-18% | Unskilled handicapped, elderly,
youth New Liberian arrivals |
| Guinée
Environ 18 000 Ivoiriens et Libériens sont arrivés en Guinée à la suite des combats en Côte d'Ivoire, de même que 16 000 Libériens fuyant l'insécurité au Libéria. Une évaluation de la sécurité alimentaire des réfugiés sierra-léonais et libériens dans deux camps, a montré que différents groupes socio-économiques coexistent au sein des camps (voir tableau). Les foyers les plus vulnérables sont les nouveaux arrivants et les foyers ne pouvant générer que peu de revenus par le travail. |
Guinea hosts about 100,000 refugees, mainly from Liberia and Sierra Leone. Repatriation of Sierra Leonan refugees has been suspended at least to the end of the year because of financial constraints (UNHCR, 12/11/02). Due to the civil war devastating Ivory Coast, some 40,000 Guineans are estimated to have crossed back into Guinea over the last two months; 2,000 Ivorians and 3,450 of other nationalities also have sought refuge in Guinea (OCHA, 04/01/03). The presence of unidentified armed elements in Kouankan camp has raised concern about the security of the refugees (OCHA, 01/10/02). Refugees settled in Kuankan camp will be relocated to the Kissidougou area (UNICEF, 12/12/02). It seems that all camps throughout Guinea are overcrowded, with far more refugees than their capacities should allow. Following a report which indicated evidence of "extensive" sexual exploitation of refugee children in Liberia, Guinea and Sierra Leone, which involved workers of NGOs and UN agencies, at the beginning of 2002 (UNHCR, 26/02/02), the Office of Internal Oversight Services of the United Nations conducted an investigation into this matter. The investigation did not confirm the allegation of widespread sexual exploitation, but it confirmed that sexual exploitation is a significant issue and urged humanitarian agencies to pursue corrective action (UN, 22/10/02).
According to different estimates, Gueckedou prefecture was hosting 150,000 to 260,000 refugees, before an outbreak of violence which occurred from September 2000 to March 2001 (see RNIS 32/33) and led to the displacement of both refugees and host populations. Most of the refugees were relocated into camps further inside the country. However, it was estimated that about 20,000 refugees preferred to return to the area where they settled in villages. The majority of the Guineans also returned except in Guekedou town and in villages near the Liberian border. Although there is no precise figure, it is estimated that the number of refugees who remain in the area has decreased. No specific relief is provided to the refugees.
ACH-S undertook a nutrition survey in Guekedou prefecture in September 2002. About 73% of the population derived their major sources of food from their own crops, whist 24 % relied on purchase. The results showed that 7.9% of the children were acutely malnourished, including 0.7% severely malnourished. These results are very similar to the ones of a survey done in March 2002 (8.2% acute malnutrition, 0.3% severe acute malnutrition) (see RNIS 36/37). However, the 2002 malnutrition rates were higher than the malnutrition rates in the same region in July 2000 when the prevalence of acute malnutrition was respectively 4.2% for the host population and 2.6% for the refugee population (see RNIS 31). Although the prevalence of malnutrition found in July 2002 was average, the nutrition situation of this population has deteriorated significantly between 2000 and 2002.
From the ACH-S survey in Guekedou prefecture:
GuinéeLa Guinée abrite environ 100 000 réfugiés. A la suite de la guerre civile en Côte d'Ivoire, environ 40 000 Guinéens seraient retournés dans leur pays. Deux milles Ivoiriens et 3 500 personnes originaires d'autres pays d'Afrique de l'Ouest auraient aussi fui la côte d'Ivoire vers la Guinée. Selon diverses estimations, entre 150 000 et 260 000 réfugiés étaient établis dans la préfecture de Guéckédou avant qu'une période d'insécurité à la fin de l'année 2000 ne les force à fuir, ainsi que la population locale. Une partie de ces réfugiés (environ 20 000) serait ensuite retournée dans cette région, ainsi que la majorité de la population locale. Une enquête réalisée dans cette préfecture a montré une prévalence de malnutrition sévère aiguë de 8,2%, incluant 0,3% de malnutrition sévère. Ce taux est beaucoup plus élevé qu'en Juillet 2000, où la prévalence de la malnutrition était de 4,2% dans la population locale et 2,6% chez les réfugiés. |
Refugees
Guinea hosts a large number of Sierra Leonan and Liberian refugees, comprising 47,000 Liberian refugees and 43,000 Sierra Leonans in seven camps and one transit centre and more than 60,000 Liberian living in towns along the Liberian border (UNHCR, 07/08/02). The past months have seen some refugee movement. Sierra Leonans have been repatriated while new arrivals from Liberia have been registered as a result of the onset of fighting in Liberia (see table).
Refugee influx (OCHA, 26/07/02)
|
|
Liberian refugees arrival |
Sierra Leonan refugees repatriation |
|
January |
914 |
1,878 |
|
February |
490 |
1,728 |
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March |
2,290 |
2,975 |
|
April |
2,456 |
5,255 |
|
May |
6,814 |
2,195 |
|
June |
400 |
3,899 |
|
July |
5,447 |
0 |
|
Total |
22,811 |
17,930 |
Camps are overcrowded, particularly Kouankan and Kola camps,
near Nzerekore, where most of the new refugees have been transferred from the
border (UNHCR, 07/08/02). A new site near Laine in Nzerekore has been opened and
will host about 6,000 refugees (WFP, 13/09/02). The new influx of arrivals has
some impact on the host communities and refugees (OCHA, 26/07/02). There has
been a decline in the sanitary conditions of the camps, a deterioration in the
basic standard of living among the host population, and increased hostility
between refugees and host communities. Sexual exploitation in the camps seems to
continue, although sensitization programmes have been implemented. So far, UNHCR
has received only 10% of the US$ 3 million required to address the problem
(USCR, 07/02).
Internally Displaced Persons
Insecurity in 2000, particularly in the Parrot’s Beak area, as well as the 2001 floods in Upper Guinea have led to the displacement of thousands of Guineans, who had been integrated with resident populations to a large extent. The number of IDPs has been highly controversial. A census conducted at the beginning of the year identified a total of 82,000 IDPs (OCHA, 26/07/02). No recent nutrition information has been made available to RNIS for this group.
Macenta prefecture
A nutrition survey was carried out in the rural and urban areas of Macenta prefecture by ACH in March 2002 (ACH, 03/02); 2.1% of the surveyed families were refugees and 1.5% were displaced. The survey revealed that 8.0% of the surveyed children suffered from acute malnutrition including 0.9% presenting severe acute malnutrition; only one child presented oedema. Measles vaccination coverage was reported to be 37.8%, according to the card and 74.5% if the mother’s history was added. The crude and under-five mortality rates were both 1.4/10000/day. The nutrition situation of this population is average and may be improved.
Overall The situation of the refugees seems to have deteriorated, partly due to the influx of new arrivals. The issue of sexual exploitation has to be addressed urgently.
Recommendations and priorities
|
Guinée La Guinée accueille environ 47 000 réfugiés libériens et 43 000 réfugiés sierra léonais dans 7 camps et 60 000 Libériens vivant en ville le long de la frontière. Le rapatriement des réfugiés sierra léonais est en cours, alors que de nouveaux réfugiés libériens arrivent. Bien qu’un nouveau camp ait été récemment aménagé, les camps existants sont surchargés conduisant à une détérioration des conditions sanitaires et des conditions de vie générales des réfugiés. L’exploitation sexuelle continue, le HCR n’a reçu que 10% des fonds requis pour endiguer ce problème. L’accueil des nouveaux réfugiés ainsi que les programmes de lutte contre l’exploitation sexuelle doivent être soutenus. Une enquête nutritionnelle dans la préfecture de
Macenta a révélé une prévalence de malnutrition
aiguë d’environ 8% incluant 0,9% de malnutrition sévère.
L’échantillon de cette enquête comprenait environ 3% de
réfugiés et de déplacés. |
Guinea has traditionally been relatively stable in a region marked by successive civil conflicts. As a result, it has been the destination for many refugees seeking a haven from conflict. The security of the country was disrupted in 2000 as a result of incursions from armed groups from Sierra Leone, mostly in the Gueckedou area and around Macenta and N’Zerekore. The attacks occurred in areas where there were large amounts of refugees and resulted in widespread loss of life, destruction of property and mass displacements of both the existing refugee communities and local populations. The international response was to move the refugees inland and away from the border areas. The majority moved to the new camps but some have stayed near the borders and currently receive no assistance. There have been no further reports of conflict or tension within Guinea itself but the reporting period has seen the arrival of large amounts of new refugees from Liberia.
The funding for the Consolidated Interagency Appeal (CAP) has been extremely poor and is currently only 30 % funded. This continues to have very adverse affects on the ability of the humanitarian community to respond to the needs of the refugees in Guinea and is of particular concern because the number of Liberians arriving in Guinea has increased dramatically and is placing further pressures on the limited resources.
Refugees
The majority of refugees are currently hosted in the Albadaria and Dabola regions in Upper Guinea but there are also refugee camps in Macenta and N’Zerekore in the Forest region, close to the Liberian border. Ongoing violence in Liberia has forced over 13,000 new refugees to flee into Guinea in the last month, more than tripling the number of new arrivals since the beginning of the year (UNICEF 03/07/02). Approximately 7,000 Liberians entered the country on 13 June 2002 alone (UNICEF 17/06/02) and it is estimated that 80 % are women and children. It is also reported that significant numbers of Liberian refugees could still arrive in the country and humanitarian agencies are making contingency plans. The majority of the new refugees are staying in the N’Zerekore region. In order to cope with the new influx, the government of Guinea has approved the creation of a new refugee camp at a location called Laine, 60 Km north east of N’Zerekore. However the latest reports indicate that local authorities have suspended the setting up of the camp. The RNIS does not have any nutritional information on the new refugees but they are assumed to be in poor condition with some having travelled for many days to reach the border.
The continued peace in Sierra Leone has continued to prompt the return of refugees from Guinea. The process has been facilitated by the opening of the Pamelap-Kambia axis in March, which has allowed many to travel overland across the Guinea-Sierra Leonean border, which until recently had not been possible. In May 2002, UNHCR estimated that 30,000 Sierra Leoneans had returned home since the start of 2002 (USAID 12/06/02). As a result, the camp population of Sierra Leoneans has fallen and it is currently estimated that about 43,000 Sierra Leoneans remain within Guinea.
Overall
The situation in Guinea remains calm but there is concern over the number of refugees currently arriving from Liberia, which threaten to overwhelm the resources and capacity of the humanitarian community. They should be considered extremely vulnerable (category II). The remaining refugee community is stable and is not considered to be at elevated risk (category III). Refugee returns to Sierra Leone are ongoing and this is resulting in a dramatic decrease in the number of registered camp refugees.
Recommendations
From the RNIS
The civil conflicts in Sierra Leone and Liberia resulted in many people entering Guinea in search of the safety the country offered. The majority of these refugees were located in camps and within communities along the borders with Liberia and Sierra Leone, including the Parott s Beak area of Gueckedou. The security of the area was disrupted in September 2000 when Sierra Leonean rebels launched a series of attacks into Guinea. The attacks were around the areas of Gueckedou, Macenta and N Zerekore and resulted in wide scale loss of life, destruction of property and crops. This lead to a period when humanitarian access was cut off from approximately 250,000 refugees in the Parott s Beak area after which many of the refugees and host populations moved inland away from the borders.
The security situation has improved dramatically over the course of 2001 and 2002 and there have been no reports of further violence. However, the violence has resulted in the relocation of refugees into camps in the interior of the country, and any that have chosen to remain along the border areas are no longer eligible for relief assistance (IFRC 20/11/01). With the advent of a viable peace process in Sierra Leone, many Sierra Leonean refugees have chosen to return, especially to vote in the upcoming elections in May. The situation for remaining refugees is uncertain and heavily contingent on the continuation of good security in the country, as well as the continuation of adequate funding to the UN appeals. Despite the internal stability, there is concern over fighting in Liberia and Guinea has already received a number of Liberian refugees over the reporting period. Steps towards a regional peace have been taken and the presidents of all three Mano River Countries met in February and have vowed to end tensions between their countries and cooperate on issues of border security (UN OCHA 28/02/02). This could have very significant implications, as the future of the refugees is heavily contingent on the development of regional security.
The funding of the UN Consolidated Appeal for West Africa has been extremely poor for a number of years. It was recently announced that the current funding level was only 4.27 % of the total appeal figure. It is also important to note that the majority of the funding so far has gone towards refugee programmes and IDPs remain underfunded (UN OCHA 10/04/02). UN OCHA reports that Guinea is likely to experience shortfalls of oil and Corn Soya Blend (CSB) in April, May and June. It is also reported that current stocks of cereals will only be sufficient for half rations in June, although WFP hopes to provide full rations for further distributions (UN OCHA 11/04/02). This is very concerning given the current level of needs.
Internally displaced
Until the insecurity of late 2000, Guinea had not suffered internal displacement. However, incursions into the country by Sierra Leonean rebels caused huge internal displacement of population who fled inland from border areas. It is currently estimated that there are 359,000 IDPs in Guinea, although many of them have been able to return to their places of origin and begin the process of rebuilding their lives. This is being facilitated by the improvement in the security situation along the border areas with Sierra Leone.
ACF-SP conducted a nutritional survey in the Gueckedou area, known as the Parrot s Beak, in April 2002. The Parrot s Beak area was particularly affected by the fighting and insecurity in late 2000, which displaced both refugee and host populations. The majority of refugees were moved to camps further inside the country, but ACF estimates that as many as 20,000 remained. ACF stress that the camps that existed prior to the insecurity are still empty and that the refugees are currently living in villages with host communities. The report also notes that 75-80 % of the people displaced by the fighting have returned and are trying to make a living in the area. The survey covered both newly returned IDPs and refugees and indicated that there was a prevalence of acute malnutrition (W/Ht <-2 Z scores and/or oedema) of 8.2 % including 0.3 % of severe malnutrition (W/Ht < -3 Z scores and/or oedema). The survey did not measure mortality rates but did show that the coverage of measles vaccination was 75 % (ACF 04/02). This does not indicate a critical situation as the prevalence of malnutrition remains below emergency thresholds. However, the situation in the Parrot s Beak area is precarious as a result of a long period of drought in 2001 that adversely affected the harvest of staple food crops and resulted in extremely low food stores. The population is not receiving any food assistance and so must rely on trading and foraging to make up the existing food deficit. The continued food security of the population will be heavily contingent on the security situation.
Refugees
The fighting in the southeast forest area brought about a fundamental change to the location of IDPs in Guinea. This was prompted by issues of protection and security, where refugees were living by potentially unstable border areas, and the need of the humanitarian community for appropriate levels of access. The relocation movement began with the evacuation of the Parrot s Beak area by UNHCR. Refugees were moved to a variety of locations but primarily to the Albadaria and Dabola prefectures of Upper Guinea. The original plan had been to open four camps in Albadaria and three in Dabola to accommodate an expected 250,000 refugees. The actual number proved to be far less than this at around 65,000, mostly Sierra Leonean refugees (IFRC 20/11/01). There are now three camps in the Albadaria region; Boreah with 13,066 refugees, Kountaya with 25,652 and Telikoro with 11,898. The Dabola area has one active camp called Sembakounya with 7,289 refugees. The areas of Macenta and N Zerekore in the Forest region also have two camps of mostly Liberian refugees, Kouankan with 13,500 refugees and Kola with 5,900 (USAID 14/01/02).
The numbers of refugees are changing quickly as a result of influxes of Liberian refugees fleeing the violence in the north of their country, and due to the number of returning Sierra Leonean refugees. It is currently estimated that 4,700 Liberians, mostly women and children, have entered the country since January 2000 and the numbers are expected to keep growing as fighting continues. UNHCR expects a total of 10,000 to enter the country during 2002 (UN OCHA 11/04/02). Some of these are reported to be in extremely poor condition and their immediate needs are likely to be high. The return of Sierra Leoneans is still ongoing and has been facilitated by the opening of border areas, allowing refugees to return overland. It is estimated that 11,000 have returned since 27 September 2001 and UNHCR reports that a further 15,000 are registered to return from the Kissidougou area (UNHCR 19/03/02). UNHCR has estimated that by June 2002 the number of refugees in camps will be 68,400, with a further 92,000 living with host communities. By December 2002, these figures are likely to be 54,700 and 73,500, respectively (UN OCHA 11/04/02). The RNIS does not have any recent nutritional information on the refugees but the situation is not thought to be serious as a result of ongoing assistance and the improved security.
Overall
The situation in Guinea has improved over that seen at the beginning of 2001 as a result of a stable security situation. However, the continuation of fighting in Liberia is of concern and could potentially serve to destabilise the entire region. There are encouraging signs that solutions to the regional tensions are currently being pursued. The condition of both refugees in camps and IDPs is not currently thought to be serious (category III), however the situation will be heavily dependent on the development of the security situation.
Recommendations
From the ACF-SP survey in Gueckedou Prefecture
The Mano River Union area has been the scene of repeated violence over the years, however the relative stability within Guinea has meant that it has received a great number of refugees from the neighbouring countries of Liberia and Sierra Leone. Many of these refugees were traditionally located in the south eastern Forest region of the country. The traditional stability of the area was broken at the end of 2000 by armed incursions into Guinea that resulted in the displacement of tens of thousands of both the local population and refugees. This resulted in a crisis at the beginning of 2001 with many people being cut off from humanitarian relief by ongoing insecurity. However, over the course of the summer the security situation has greatly improved in all regions of the country, mostly as a result of greatly increased stability and the continued disarmament of rebel groups in neighbouring Sierra Leone. Crucially, the areas along the border with Sierra Leone, notably the Parrot’s Beak and Gueckedou, remain secure. The return of stable security has greatly improved the humanitarian access to affected populations and allowed for a considerable improvement in the humanitarian situation within Guinea.
Recent months have seen a considerable worsening of relations between the government of Guinea, led by president Lansana Conte, and opposition groups within the country. The reason lies in a proposed referendum designed to seek approval for changes to the constitution. These changes include controversial plans to change the length of the presidential term from five to seven years and to allow the president to run for a third term of office. The proposals have not been well received by the opposition and there is a planned boycott of the referendum (IRIN 26/10/01).
Internally displaced
Fighting on the borders of Guinea, particularly in the south east Forest Area, resulted in the displacement of around 190,000 people to areas further into the country (OFDA 03/10/01). The displaced were extremely vulnerable but the stability of the current situation has allowed many to return to their homes and begin to reconstruct their lives. The increased security in the south east has led to the partial reestablishment of the major market town of Gueckedou, increasing the demand for crops and encouraging many farmers to return to their land with the hope of selling their crops. However, the conflict has severely disrupted the agricultural cycle in the affected areas and large amounts of crops were destroyed in the fighting. As a result, the 2001 harvest is expected to be poor. This follows on from good harvest years in 1999 and 2000. The harvest nationally has also been affected by flooding in the north, which is estimated to have destroyed 2,000 hectares of farmland and affected 220,000 people (IRIN 22/10/01). The reduced harvest is likely to increase demand for humanitarian food assistance. In response to the reduced harvest prospects in the south east, agencies have been implementing agricultural recovery and seed distribution programs. However, it is widely considered that their introduction was only possible too late in the season and that their affect will not be felt until next year (OFDA 03/10/01). The RNIS does not have any recent survey information on the IDP population but the situation is not considered to be critical.
Refugees
Fighting in the south eastern Forest area of Guinea has seriously affected the resident refugee communities. For some time, there was considerable concern for refugees trapped in the Parrot’s Beak area. The lack of humanitarian access to the population was of great concern and, when security permitted, 57,000 were relocated to new camps further within Guinea during May 2001. The main areas of new settlement are in the Albadaria and Dabola Prefectures in Upper Guinea, where the majority of the refugees are of Sierra Leonean origin. The Albadaria area has three camps; Boreah with 13,000 refugees, Kountaya with 26,000 and Telikoro with 11,500 (OFDA 03/10/01). The Dabola area has Sembakounya camp with a total of 7,500 refugees. There is also a group of predominantly Liberian refugees in the Macenta and N’Zerekore areas of the Forest area. The two active camps are Kouankan with 13,500 refugees and Kola with 4,100 (WFP 12/10/01). Some refugees are currently being moved from Kounkan to Kola to relieve over crowding. There are also a substantial number of refugees who have not registered with UNHCR and who have moved into host families or established their own settlements, however there is very little information concerning their condition.
The security situation for the refugees has remained good allowing for continued humanitarian access. The only area reported to be suffering from some insecurity is the town of Kissidougou, with access to the area remains difficult. Reports indicate that the refugees are still heavily reliant on humanitarian assistance and improved security has allowed regular food distributions and health activities to take place. UNICEF reports that the under-five mortality rates have remained at non-alert levels in the camps and that rates of infectious diseases are low. The RNIS has not received any new nutritional information on refugees but WFP report that the nutrition situation in camps has remained stable, hovering around the 5% level, for this year. This is probably due to the greatly improved security situation, which has increased both the availability and accessibility of food. The only point of concern lies with the poor situation in neighbouring Liberia, which is still forcing Liberians over the border into Guinea.
Repatriations
Repatriation of Sierra Leonean refugees continues to take place with an estimated 50,000 having been repatriated by sea to Freetown and a further 20,000 having crossed the border, making their own way back to their area of origin, or the various returnee camps within Sierra Leone. It is likely that the number of returnees will increase if the situation in Sierra Leone continues to improve and new areas open up.
Overall
The stabilisation of the humanitarian situation is largely a result of the improved security within the country and, to some degree, in neighbouring Sierra Leone. The continuation of fighting in Liberia, close to the Guinean border, is concerning and is likely to result in an increase in the number of Liberian refugees. The refugees currently in established camps are not considered to be in a critical condition (category III). The condition of IDPs is also thought to have improved (category III).
Recommendations
The reporting period has seen a continuation of violence in the Mano River Union area, on the border with Sierra Leone and Liberia. The area has long been a home to refugees from the ongoing conflicts in Sierra Leone and Liberia, with particular concentrations around the N’zerekore area and around Gueckedou in Guinea Forestiere, concentrated in a strip of land jutting out into Sierra Leone called the Parrot’s Beak. There are also concentrations in the Forecariah area in the west of the country bordering the RUF controlled Kambia district of northern Sierra Leone. UNHCR estimates that there are about 420,000 refugees in the country and it is reported that about 150,000 people have been displaced from the sensitive border areas (UN 2001).
The Guinean response has played a big part in the development of the humanitarian situation in the country. The Guinean army has mobilised along the border areas and has been actively encouraging refugees to move, claiming that many are rebel sympathisers. This mirrors a general hostility in Guinea towards the refugees who have been blamed by the government for the border insecurity. This hostility has translated to open harassment within Guinea, including arbitrary arrests and detentions and the withdrawal of support from host communities (HRW 07/01). In the face of continued insecurity this has left many refugees with few choices. They can either remain where they are in insecure areas where they are likely to suffer further attacks or they can repatriate to their country of origin or they can relocate to the new and supposedly safer, inland camps set up by UNHCR.
Some refugees have chosen to stay in the border areas in the hope that they can escape further attacks. Many of these have been living in the areas for many years and have strong cultural ties with local communities and the land, often sharing the same ethnicity and language as the locals. The borders are also considered to offer opportunities for escape into other areas should it become necessary (HRW 07/01). The improved security in Sierra Leone has increased the possibilities of repatriation for some although many come from areas that are still insecure within Sierra Leone and insecurity in Liberia makes the prospect of return unlikely. The remaining choice for many is relocation within Guinea to the camps set up away from the insecure border areas. However, many fear the often open hostility shown to them within Guinea and are loath to move to new and unfamiliar areas which are invariably away from towns and in regions with unsympathetic host communities (HRW 07/01).
The RNIS has not received any nutritional surveys from either displaced or refugee populations but reports indicate that there has been a slight deterioration of the nutrition situation. Reasons cited for the deterioration are the breakdowns in the traditional mechanisms of food security such as farming and employment. The insecurity has also led to extreme difficulties in moving around the country and this has restricted the flow of merchandise and led to important rises in the price of food and other essential items. The reporting period has also seen the start of the rainy season which lasts from June to October. This is the annual hunger season before the harvest in October. The rainy season is usually associated with increases in morbidity from malaria, respiratory infections and diarrhoea, and this can negatively impact on nutritional status (ACH 24/07/01).
The South East Forest Region
In June IRIN reported that UNHCR had finished the relocation of 57,000 refugees from the Parrot’s Beak area to six new camps in Albadariah and Dabola prefectures, 200 Km north of the border areas. UNHCR have also announced that they will cease the provision of aid to refugees remaining in the insecure border zones. This is likely to be a problem to an estimated 20,000 refugees who have opted to remain close to the border areas. These refugees can be considered to be extremely vulnerable, as a result of the decreased availability of and access to food (HRW 07/01; IRIN 01/06/01).
WHO report figures from June 24th for four of the six camps in the Albadariah and Dabola areas which have received refugees; Kountaya with 25,956 refugees, Boreah with 13,163, Sem-bakounya with 7,366 and Telikoro with 11,322 (WHO 24/06/01). In general the situation in the new camps is not critical but epidemiological surveillance indicates that morbidity and mortality rates are high with a CMR of 0.84/10,000/day and an under five mortality rate of 2.69/10,000/ day calculated from routine surveillance over the week of the 18th to the 24th of June (WHO 24/06/01). The CMR remains below emergency thresholds but is nonetheless elevated and the under five rate is worryingly high. ACH reports increases in the number of children attending Supplementary feeding centres but stresses that the numbers still remain relatively low. The relatively high mortality and observed increases in children in supplementary feeding centers suggests that the situation is more precarious than it was. However, the rates are not unexpected given the increased morbidity and the hunger season, and they remain below critical levels.
WFP also reports that government forces arrested refugees in Telikoro camps at the end of June and this sparked off rioting that prompted the evacuation of aid workers from the camp and the suspension of distribution activities. This illustrates the potential for further insecurity in the camps and there are concerns that this may affect humanitarian access to the refugees in the future (WFP 06/07/01).
Repatriation
Hostility to refugees within Guinea and the increased insecurity has led to a steady repatriation of Sierra Leonean refugees. The better security situation currently experienced in Sierra Leone is facilitating the repatriations but many areas of the country remain insecure and many refugees are going into already crowded displacement camps in government held areas. It is extremely difficult to estimate the number of people repatriating because many travel overland across the border and are not registered upon arrival. However, Human Rights Watch report that since the repatriation programme began last September, over 35,000 Sierra Leonean refugees have repatriated by boat from Conakry to Free-town or with UNHCR assistance (HRW 07/01). As the cease-fire continues the repatriation is expected to increase. The RNIS has no information on the nutritional status of the returnees.
Overall
The humanitarian situation remains precarious for refugees and IDPs in Guinea. The continued hostility within the country towards the refugees remains a major concern and is affecting the refugees sense of security within the country. The most important development has been the relocation of most of the refugees from the south eastern region to camps in the interior. The general condition of the refugees in the camps appears to have deteriorated slightly and there is cause for concern although their condition is not considered to be critical (category III). There is further concern for refugees who have opted to remain in the insecure border areas as they no longer receive any form of humanitarian assistance and they must be considered to be at elevated risk of malnutrition (category II).
Recommendations
The past year has seen a major shift in the humanitarian situation in Guinea. Until recently Guinea had avoided direct involvement with the conflicts across its borders, but since September 2000 there have been increasing incursions from hostile, armed groups, into the south eastern region of the country. The south-east borders both Sierra Leone and Liberia, and fighting has focused on the thin strip of Guinean territory around Gueckedou that juts out into Sierra Leone, and is known as "the Parrot's beak" (UN 2001).
Prior to this violence, Guinea hosted about 420,000 refugees, of whom about 300,000 were from Sierra Leone, and 120,000 from Liberia (UN 2001). Many of the refugees were in the south east which was destabilized by fighting, forcing mass movements of both refugees and the resident population (ACF 02/01; NRC 2001).
One of the major ramifications of the incursions and the resultant internal instability, has been a major shift in attitude to refugees within Guinea by both the government and the general population. For years Guinea has been a willing host to the refugees within its border but increasingly, internal public opinion, fuelled by inflammatory remarks by the president, is turning against them. Refugees are being blamed for bringing fighting into the country. In many cases the backlash against the refugees has turned violent and has contributed to the increasing number choosing to return to their 'war torn' countries of origin (ACF 02/01; NRC 2001).
The RNIS has not received any recent nutrition surveys on either the displaced or refugee populations in Guinea. However reports from ACF based on the monitoring of health centres and some rapid assessments, indicate that the nutritional status of populations in the affected areas of the Parott's Beak is not alarming (ACF 02/01).
The south east Forest Region
Fighting began in the region in September 2000 and has resulted in large scale population displacement. ACF report that a UN registration in June 2000 estimated the total caseload of refugees from Sierra Leone and Liberia in Gueckedou prefecture to be 263,000 people. This was considered an overestimate by NGOs who estimated the total refugee population to be 150,000. The intensity of the fighting has severely restricted humanitarian access to the affected areas. UNHCR report that attacks on the Parrot's Beak area have continued and on March 9th the town of Nongoa was attacked sending thousands running for safety. Insecurity of the Parrot's beak areas has led to attempts to move the affected population out of the zones of conflict, to camps where their security is more assured (UNHCR 06/04/01)
As of April 20th UNHCR reported that 30,000 had been moved to the Albadaria area north of Kissidougou and the relocation continues with refugees being moved out Parrot's Beak. The numbers of people involved have severely constrained attempts to move them and relocation effort remain a race against time as the rainy season approaches after which roads become impassable (ACF 02/01; NRC 2001; UN 2001; UNHCR 06/04/00).
Many refugees have chosen to move themselves and have either headed northwards to the transit camp of Kankan to await transportation to the newly prepared camps in the Albadaria area north of Kissidougou, or they have moved towards Conakry with the aim of being repatriated to Sierra Leone. Some have even risked walking across the border with Sierra Leone into deeply insecure areas held by the rebels they initially fled from. Numbers remain extremely difficult to track as the situation continues to unfold day to day but a considerable number of people still remain in the Parott's Beak (NRC 2001; UNHCR 20/04/01). ACF conducted a rapid evaluation of the food security situation in Gueckedou in February 2001 as there has been concern that the cessation of food distributions and the ongoing conflict have adversely affected food security. ACF have highlighted that Gueckedou prefecture has received two waves of refugees in 1991/2 and in 1998. The 'new' refugees make up about 25% of the refugee population. Refugees have quickly developed coping mechanisms that often allow them to survive without dependence op food aid although ACF stresses that the 'new' refugees have more difficulty in becoming involved in agricultural activities. However, the ACF assessment concluded that the majority of refugees in Parott's Beak had been able to meet their food needs mostly as a result of an abundance of rice from the latest harvest and cheap market prices for food items. There is very limited access to external markets and the poor purchasing power of many refugees means that the long term effects of the insecurity could reduce access to food (ACF 02/01).
Forecariah Area
Latest reports from the Forecariah area put the number of refugees at 15,885 people although this number is likely to change very quickly. There have been reports of outright hostility to refugees in the area making their presence there increasingly difficult, however the Red Cross report that government authorities have finally agreed that refugees can be moved to one camp in the Kindia Prefecture which removes them from a potentially hostile border area (IFRC 19/03/01; WFP 06/04/01).
Repatriation
Issues of repatriation have taken on a new urgency as the fighting in the south east has destabilised the country as a whole and markedly changed the previous good feeling towards the refugee populations in Guinea. It is difficult to keep up with the unofficial repatriations, as many people have chosen to move themselves back across the borders into Liberia and Sierra Leone, but the transit camps in Conakry has seen large influxes of Sierra Leonean refugees wanting to be repatriated by boat to Sierra Leone. Latest figures indicate that there are some 5,598 people in the camps awaiting repatriation with more arriving every day (WFP 06/04/01).
Overall
The humanitarian situation for refugees and for the large number of newly displaced people, has deteriorated markedly since September of 2000. Of particular concern is the current hostility being shown to refugees within Guinea which affects the support they receive from neighbouring host communities. Refugees should be considered at moderate to high risk of malnutrition (Category II).
Recommendations
Guinea-Conakry hosts approximately 450,000 refugees, principally from Liberia (120,000) and Sierra Leone (325,000). The remaining refugees are from a variety of countries, including Guinea-Bissau. The majority of refugees are housed in Gueckedou, Forecariah and N'zerekore. New refugees from Sierra Leone continue to arrive at a steady pace in Forecariah. Since the beginning of May, over 5,000 new refugees have been registered in the newly established camp of Kalako (UNHCR - 20/07/00).
Guectodou
There are several categories of refugees in the Gueckedou region: (i) 'old' Liberian refugees, who arrived before April 1999, (ii) 'old' Sierra-Leonean refugees who arrived before 1998, (iii) 'new' Liberians who arrived in April 1999 and, (iv) 'new' Sierra Leonean refugees who have arrived since 1999. Different schemes for food and health assistance are provided to these different groups. The 'new' groups of refugees receive both food and health assistance. The 'old' group of Liberians do not receive food assistance and only the most vulnerable cases receive medical assistance. The old group of Sierra Leoneans receive medical assistance, but only vulnerable cases receive food (UNHCR - 04/00).
ACF undertook nutritional surveys of refugee and resident children aged 6-59 months in Gueckadou (see annex). The (preliminary) results can be seen in the table below, Compared to the last survey, which took place in June 1999, the nutritional status of the refugees has remained stable. However, the prevalence of acute malnutrition has doubled among the Guinean children (severe rates have not changed). The rates of malnutrition are within acceptable levels for both groups. Food distributions to the refugees are reported to have been regular. (ACF - 07/00; UNHCR - 10/07/00).
Results of surveys of refugees and residents in Gueckadou
|
|
Acute malnutrition |
Severe acute malnutrition |
|
Refugees |
2.6% |
0.2% |
|
Guineans |
4.2% |
0.4% |
An analysis of UNHCR's health data found that respiratory
infections were the most frequently reported illnesses. Diarrhoeal disease was
also common. A measles epidemic highlighted the need to improve vaccination
coverage. Mortality rates remained within acceptable limits between January 1999
and February 2000 (CMR ranged from 0.22-0.6/10,000/day and under-five mortality
from 0.79-1.84/10,000/day) (UNHCR - 04/00). The ACF survey estimated that 80% of
the children had been vaccinated for measles.
Forecariah
The nutritional situation of the refugees in Forecariah is reported to be satisfactory. ACF-F will undertake a nutrition survey will take place among the Sierra Leonean refugees in Forecariah later this year (UNHCR - 10/07/00).
Repatriation
In June, UNHCR organised the repatriation of some 470 refugees from Guinea-Bissau. The voluntary repatriation of Liberians, mainly from N'zerekore, resumed in May, following the opening of the border between the two countries. Since then, about 5,160 refugees returned, of which 1,673 went through organised repatriation. Following the most recent fighting in Lofa County (Liberia), however, the repatriation convoys were temporarily suspended. In addition, this repatriation exercise will be put on hold during the rainy season (July-September) as transport will become impossible. The Liberian refugees who settled in the camps in Macenta are mainly from Lofa County in Liberia and will not be repatriated at the moment because of the security problems in Lofa (UNHCR - 20/07/00).
Overall, the nutritional situation of the refugees in Guinea is satisfactory (category IV).
Recommendations and priorities:
From UNHCR's mission to Gueckedou (UNHCR - 04/00):
From the nutritional survey in Gueckadou (ACF-F - 07/00):
Guinea-Conakry hosts approximately 489,000 refugees, principally from Liberia (120,000) and Sierra Leone (366,000). The remaining refugees are from a variety of countries, mainly Guinea-Bissau. The majority of the refugees are housed in Gueckadou, Forecariah and N’zerekore (UNHCR-12/12/99).
UNHCR has recently drawn attention to the plight of the refugees and residents of Guinea who are currently receiving a “cool response” from donors. Guinea’s population of 7 million is reported to be becoming increasingly unhappy with the refugee situation as what little aid that does come to the country is targeted directly at the refugees instead of being split with the local population (UNHCR - 20/03/00).
The RNIS has received no new information on the nutritional situation of the refugees in Guinea. The most recent reports suggested that the refugees in Gueckadou (some 305,000 people), have a poor food security outlook, although the prevalence of malnutrition is relatively low (see RNIS 29).
Overall, the refugees in Guinea-Conakry remain at moderate risk of malnutrition because of the poor food security outlook (category III).
Guinea-Conakry hosts approximately 488,000 refugees. Of these some 120,000 are Liberian and some 366,000 are from Sierra Leone. The remaining refugees are from a variety of countries, mainly Guinea-Bissau. The majority of the refugees are housed in Gueckadou (360,000), but there are also some 60,000 in Forecariah and a further 60,000 in N’zerekore (UNHCR-12/12/99).
Gueckadou
In terms of nutrition, the refugee population in Gueckadou can be split into two groups: (i) “new” refugees, who are provided with a full general ration of 2100/Kcal/person/day (6% of the total refugee population), and (ii) vulnerable groups who receive 1750/Kcal/person/day (60% of the total population). The first group consists of those who arrived after 1998, but have not yet been resettled, and the second group is those who arrived before 1998 but are considered vulnerable.
An interagency mission in October reported that only 10% of the refugee population in Gueckadou benefits from programmes to increase their self-sufficiency; 8% were enrolled in agricultural programmes and 2% in income-generating activities. Gueckadou is a very densely populated area (there are more than 70 people/km2 in the southern part of the prefecture) and it is difficult to establish agricultural programmes (UNHCR/WFP - 09/99).
The mission concluded that although the first group of refugees - those who received a full ration - were receiving 100% of their needs, the second group of refugees were not receiving sufficient food assistance(UNHCR/WFP - 09/99). Although the survey in RNIS 28 which was undertaken in late June reported a low prevalence of wasting in this population (2.4%).
The most recent estimates of the mortality rates for the Gueckadou refugees (from July) are 0.2/10,000/day for the total population and 0.18/10,000/day for children under-five years. These rates are within acceptable limits, although in some camps they are reported to be elevated (UNHCR/WFP-09/99).
Recommendations and priorities:
From the interagency assessment in Gueckadou:
Overall, despite the relatively low prevalence of malnutrition among the refugees in Gueckadou, the recent interagency mission reported that the food security situation of this group is poor. Thus the refugees are considered to be at moderate nutritional risk (category III).
Latest UNHCR figures estimate that there are 490,000 refugees in Guinea-Conakry. Of these some 108,000 are Liberian and 380,000 are from Sierra Leone. The remaining refugees are from a variety of countries (UNHCR - 20/09/99).
Nutritional survey in Gueckadou
ACH-S conducted a nutritional survey amongst the population in Gueckadou Prefecture in late June (see Annex). The survey estimated the prevalence of wasting and/or oedema in three different population groups: refugees who had arrived before 1998, those who arrived in the latest wave in early 1998, and residents. The prevalences of acute wasting, severe wasting, oedema and measles vaccination in the three groups can be seen below.
|
|
Severe wasting |
Acute wasting |
Oedema |
Measles Vaccination |
|
|
<-3 z scores |
>=-3 z scores <-2 |
by card |
history |
||
|
Newly arrived refugees |
0.3 |
2.0 |
0.0 |
36.8 |
34.8 |
|
Long term refugees |
0.4 |
2.4 |
0.3 |
33.1 |
37.5 |
|
Residents |
0.4 |
1.7 |
0.0 |
39.1 |
40.0 |
The prevalence of malnutrition is low in all three groups. The
significant improvement in the nutritional situation of the newly arrived
refugees can be seen in the graph opposite. When this latest wave of Sierra
Leonean refugees arrived in February/March 1998 their nutritional status was
very poor, but due to well organised interventions and the regular distribution
of 2,100 kcal/person/day the situation has ameliorated. The nutritional status
of the long-term refugees has also improved - in May 1998 the prevalence of
wasting and/or oedema was estimated at 9.9% and severe wasting and/or oedema at
2.6%.
The prevalence of wasting and/or oedema amongst newly settled refugees in Gueckadou
The refugees were asked when they had last received food assistance. More than 55% of the long-term refugees had not received food in 1999. Almost 30% of the newly arrived refugees had not received food assistance either, although the majority of these did not have a registration card. During analysis, an association was seen between poor nutritional status and lack of food assistance, although this association was not significant - possibly because the sample size was relatively low.
The most recent UNHCR epidemiological report concerning the refugees assisted by UNHCR estimates the population's CMR at 0.21/10,000/day. Under-five mortality was estimated at 0.61/10,000/day. The main causes of death amongst the total population are malaria and pneumonia; peri/neo-natal deaths are also important causes of mortality in the under-fives (UNHCR - 07/99).
Overall, the refugees in Guinea-Conakry are considered to be at low risk of malnutrition (category IIc).
Priorities and Recommendations:
From the ACH-S survey:
The situation in Guinea-Conakry is relatively stable, although violent tensions elsewhere in the region may have an impact on the country. Increasing border tensions with both Liberia and Sierra Leone have been reported (EIU-18/06/99).
Rebels from the RUF in Sierra Leone have extended their terrifying campaign over the border into Guinea, raiding the villages and nearby refugee camps. These attacks have resulted in a number of civilian (both refugee and Guinean) deaths and injuries. Guinean soldiers are reported to have killed up to 400 Sierra Leonean rebels in a recent cross-border attack in retaliation for the attacks on villages near the border. In addition, the Guinean authorities have also closed their border with Sierra Leone intermittently, preventing new refugees from arriving (IRIN-WA - 10/06/99; USCR - 03/06/99).
Latest UNHCR figures estimate that there are 450-500,000 refugees in Guinea-Conakry. Of these there are approximately some 100,000 from Liberia and some 300,000 are from Sierra Leone; the others are from a variety of countries (UNHCR- 25/06/99).
Sierra-Leonean Refugees
As a result of the cross-border raids, UNHCR has started to transfer some 50,000 refugees from vulnerable camps near Gueckadou to sites further away from the border at Katkama and Guelo. Unfortunately, the transfers are reported to have been hampered by poor road conditions and the short supply of trucks. Only 10,000 refugees had been transferred by mid-May. Given that the unpaved roads leading to these areas become virtually impassable during the rainy season, which has just begun, it is improbable that many more transfers will be undertaken in the immediate future. Refugee camps and villages in the Forecariah area were repeatedly raided in April and May, prompting UNHCR to approach authorities in this area to discuss shifting camps as well (HRW - 31/05/99; UNHCR -14/04/99, 03/06/99: USCR - 09/06/99).
In the last RNIS report it was reported that the nutrition situation of the Sierra Leonean refugees was improving. No new information is available at this time.
Liberian Refugees
Significant new influxes of Liberian refugees ceased in 1997 because of improving security in Liberia. An estimated 130,000 Liberians returned home in Guinea during 1998 and tens of thousands more have repatriated since the beginning of this year (USCR - 09/06/99). There is no new information on the nutritional situation of the Liberian refugees in Guinea. The latest RNIS reports suggested that the situation was stable.
Overall, no new information on the nutritional situation of the Sierra Leonean refugees in Guniea-Conakry has been received, it is assumed that their nutritional status remains the same as did it in March, i.e.: not critical (category IIc). No information is available on the nutritional status of refugees from other countries.
Priorities and recommendations
The situation in Guinea has been fairly stable and is expected to remain so, in spite of some disturbances in the wake of the presidential election in December 1998 (WFP - 09/02/99). The country has a heavy caseload of almost 470,000 refugees from Liberia and Sierra Leone, mostly in the Gueckedou region. Of these, some 350,000 are Sierra Leoneans and 120,000 are Liberians (UNHCR - 23/02/99).
The last RNIS electronic update (July 1998) reported on a nutritional survey conducted on refugees in camps in Kissidougou and Faranah Prefectures in late April 1998. The results showed extremely high levels of malnutrition and crude mortality rates more than four times the usual rate. Similarly, a survey undertaken by ACF in refugee camps in Gueckedou Prefecture in May 1998 recorded prevalences of 18.6% wasting and 5.0% severe wasting (see Annex I(7a)). In response to these findings, new therapeutic feeding centres were established, twenty-six dry ration sites were either restarted or created, and nutritional surveillance activities were increased in all health centres in refugee camps Gueckedou prefecture.
In September 1998, a comparable survey was conducted in the same camps in Gueckedou by the DPS/ACF/MSF (see Annex I(7b)). The prevalence of wasting had declined considerably to 7.9% and severe wasting to 1.3%. Oedema was measured at 0.8%. This improvement must in part be due to the success of the interventions put in place following the last survey. It was predicted that the prevalence of wasting would decrease even further, although recent events in Sierra Leone may preclude this. It was noted that some refugee sites had received only one of the three expected food distributions this was due to the limited access to the sites as a result of the poor condition of the roads during the rainy season. Measles vaccination coverage was high at 80% following an MSF campaign a few months previously.
A health report from UNHCR in November 1998 reported crude mortality rates for the total refugee population in the camps in Guinea to be approximately 0.16 /10,000/day. Mortality rates for the under fives were 0.36/10,000/day (UNHCR - 11/98). More recent information is not available. UNHCR carried out a detailed census of Sierra Leonean refugees in Gueckedou in mid-February.
Overall, the refugees in Guinea are no longer considered to be at heightened risk of malnutrition (category IIc).
Recommendations and Priorities:-
Recommendations from the Gueckedou survey included:-
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.
While some Liberian refugees are returning home, the upsurge in violence has led to a large number of new arrivals from Sierra Leone to Guinea. As of the end of May, there were estimated to be 244,000 new arrivals, mostly in Gueckedou. Up to 300 people a day were crossing the border and there are reports of 50,000 people still in Sierra Leone but moving towards Guinea [IRIN-WA 15-21/05/98]. Based on these population movements, there are approximately 614,000 refugees in Guinea, 200,000 of whom are from Liberia and 414,000 of whom are from Sierra Leone.
Most of the new arrivals are women and children, and are suffering from malaria, respiratory illness, diarrhoea and malnutrition. They are arriving in Guinea having spent weeks in the bush without adequate food or shelter.
“The children and their mothers sleep in the open
air, because there is no proper shelter.
Food and medicine for them is another serious
problem,”
(Paramount Chief Abu Kongombba in IPS press
release)
Furthermore, the new influx is straining the capacities of the existing camps and there are shortages of water, shelter and sanitary facilities. Food aid is being pre-positioned in anticipation of transport difficulties due to the coming rainy season [IPS 12/06/98, OCHA 06/05/98, WFP 15/05/98].
In Guinea, the Sierra Leonean refugees are at heightened risk (category IIa in Table 1). New refugees are arriving in bad condition, and the influx is stretching facilities for others. Liberian refugees in Guinea and Cote d'Ivoire are probably not at heightened nutritional risk (category IIc in Table 1).
In Guinea, the large new influx of refugees from Sierra Leone requires increased food aid commitments and prepositioning of food stocks. The poor state of arriving refugees also demands rapid provision of shelter, medicine, sanitary facilities and water. New arrivals need to be registered as quickly as possible in order to benefit from available services and consideration should be given to the establishment of a new camp to avoid over-stretching existing camp facilities. UNHCR launched an appeal in May 1998 for funds needed to deal with this emergency.
There remain approximately 405,000 refugees in Guinea. The fighting in Sierra Leone has not led to an increase in refugees, since most of these people fled to Liberia. There are reports of approximately 65,000 refugees waiting to return to Liberia [IRIN-WA 18/03/98].
There are estimated to be 170,000 Sierra Leonean refugees and 235,000 Liberian refugees in Guinea. Some spontaneous repatriation has already taken place, and a further 45,000 people are expected to repatriate in 1997. The remainder will repatriate in 1998 [UNHCR Cot 97].
There are estimated to be 170,000 refugees from Sierra Leone in Guinea, 21,000 of whom have arrived since the coup d'etat in May 1997. In addition, there are 231,000 Liberian refugees in Guinea. This decrease in the number of Liberian refugees is due to some spontaneous repatriation, both before and after recent elections in Liberia, and a revision due to a census. Organised repatriation for these Liberian refugees is scheduled to begin soon [UNHCR 25/09/97, WFP 27/06/97].
There are estimated to be 545,000 Sierra Leonian and Liberian refugees in Guinea. Some spontaneous repatriation is reported, although since the coup d'etat in Sierra Leone, repatriation has apparently stopped, and 8,000 new arrivals have been registered [RI 30/05/97, UNHCR 16/05/97].
There remain approximately 650,000 Liberia and Sierra Leonean refugees in Guinea, 536,000 of whom are assisted with emergency food aid. There are no reports of change to the generally adequate health and nutritional status of this population.
There are approximately 650,000 Liberian and Sierra Leonean refugees in Guinea, 536,000 of whom are assisted with emergency food aid. Overall, the health and nutrition situation of these refugees is considered to be adequate, and it is hoped that as the peace process in Liberia and Sierra Leone continues to progress, the refugees will begin to repatriate [UNHCR 19/11/96].
A survey carried out in August 1996 showed a much improved situation for the Liberian refugees in the eastern zone of Guinea Forrestiere. Wasting varied from 1.1-3.2% with virtually no severe wasting or oedema seen (see Annex I (9f)). These results compare favourably with those from 1995 when levels of wasting were 14.7%-16.4%. It was felt that the improved quality and regularity of general rations have been key factors in effecting this improvement [MSF-B Aug 96].
However, measles immunisation coverage varied from 50-72% which is below the minimum coverage recommended of 80% [MSF-B Aug 96].
There has been no significant increase in the Liberian and Sierra Leonean refugee populations in Guinea, although it is likely that there are a few new arrivals. Populations estimates remain at 536,000 assisted refugees [UNHCR 10/09/96].
A nutritional survey was carried out in Macenta Prefecture in July 1996, where many Liberian refugees are residing, in response to a noted increase in the number of children admitted to feeding centres. The survey showed 4.8% wasting and/or oedema with 0.3% severe wasting and/or oedema (see Annex 19(g)). This is comparable to a survey in November 1995 which found a 6.2% prevalence of wasting with 1.2% severe wasting. The under-five mortality rate was measured at 2.23/10,000/day (2x normal), while only 16.5% of children were immunized against measles. It is believed that the elevated mortality may be related to a measles epidemic in May 1996 which underscores the need to improve immunisation coverage [ACF 09/07/96].
The survey also found that 41% of households did not receive any food aid during June and that only 48% of malnourished children were enrolled on the supplementary feeding programme. The poor coverage of these programmes and the relatively low levels of wasting found in the survey suggest that refugees have developed considerable self-reliance in recent years [ACF 09/07/96].
There are approximately 605,000 Liberian and Sierra Leonean refugees in Guinea of whom 536,000 receive food aid. There are no reports of change to their adequate and stable nutritional situation. The recent fighting in Liberia has not reportedly led to any large-scale influx of refugees [UNHCR 24/05/96].
There are approximately 605,000 Liberian and Sierra Leonean refugees in Guinea of whom 536,000 receive food aid. [UNHCR 22/03/96]. In the past the nutritional security of much of this population has been described as adequate but precarious and highly vulnerable to any breaks in the food aid pipeline [RNIS #14].
There are approximately 605,000 refugees from Liberia and Sierra Leone in Guinea, 536,000 of whom receive food aid. Actual numbers may be slightly lower due to some recent spontaneous repatriation to Liberia [UNHCR 26/01/96].
There are approximately 605,000 refugees from Liberia and Sierra Leone in Guinea of whom 536,000 receive food aid. Following a joint WFP/UNHCR assessment mission, a reduction in rations is planned for the refugees who arrived before the end of 1993, as it is believed that they have attained some degree of self-sufficiency [UNHCR 17/11/95, WFP 05/12/95].
The population in Guinea is probably not at heightened nutritional risk (category IIc in Table 1).
Estimates of the number of Liberian and Sierra Leonean refugees in Guinea vary from approximately 536,000-578000 people. The continued civil war in Sierra Leone does not appear to have led to any recent large scale refugee movements into Guinea.
There are approximately 20,000 Sierra Leonean refugees in Forecariah Prefecture in Guinea who currently receive approximately 1300 kcals/person/day. A recent survey among this population measured 8.2% wasting with 0.7% severe wasting. Measles immunisation coverage was only 49% but as this was based on evidence of vaccination card holders it is probably an under-estimate [OXFAM 26/09/95].
Most of the refugee population in Guinea is not currently considered to be at heightened nutritional risk (category He in Table 1) with the exception of those in Forecariah Prefecture who are probably at moderate nutritional risk (category IIb in Table 1).
The total number of Liberian and Sierra Leonean refugees in Guinea is estimated to be 578,000. This represents a decrease from the last RNIS report (603,000) due to revised estimates of new arrivals from Sierra Leone [UNHCR 26/06/95]. We have no new information on the new arrivals in Forecariah prefecture who according to the previous RNIS were only receiving a per capita general ration of 1400 kcals and were therefore believed to be at some nutritional risk.
Refugees in Guinea are not considered to be at heightened nutritional risk (category IIc in Table 1).
There are approximately 603,000 Liberian and Sierra Leonean refugees in Guinea. This number includes the 45,000 recently arrived Sierra Leonean refugees in Forecariah prefecture who are living amongst the local population and a further 25,000 Liberian refugees who have arrived in Guinea Forrestiere over the past two months [UNHCR 01/03/95].
It has been reported that all the new arrivals have been receiving the same ration of 1,400 kcals/person/day consisting of cereals and oil. While other food is reportedly available to those refugees in Guinea Forrestiere to supplement this ration, concern has been expressed that this is not the case for those in Forecariah prefecture where the new arrivals are felt to be completely dependant on food aid. There are also concerns that the water supply in the prefecture is not adequate, especially in certain sub-prefectures such as Bentry. Lack of water is adding to sanitary problems caused by over-crowding and a few cholera related deaths have already been reported. A number of NGOs are working intensively to support these various sectoral needs [UNHCR-a 17/03/95].
The newly arrived refugees in Guinea from Sierra Leone are at high risk (category I in Table 1). The new arrivals from Liberia to Guinea are probably at moderate nutritional risk (category IIb in Table 1). The rest of the refugee population in Guinea is not currently considered to be at heightened nutritional risk (category IIc in Tale 1).
The upsurge in fighting in Sierra Leone has led to an influx of refugees into the Forecariah prefecture of Guinea. At the end of January 1995, the number of new arrivals was estimated to be 35,000 [UNHCR 30/01/95, WFP 03/02/95]. This recent influx increases the total number of registered Liberian and Sierra Leonean refugees in Guinea to approximately 568,000. There are reportedly 120,000 refugees in Guinea who have achieved self-sufficiency and food aid for this group will be phased out [WFP 16/02/95]. There are reported to be many thousands more refugees in Guinea who are not registered [CAMA Oct 94].
It is estimated that about a quarter of the refugees are found in urban centres with the rest either integrated into villages or in rural refugee camps. The government of Guinea maintains a liberal “open-door” policy in providing asylum to Liberian and Sierra Leonean refugees and permits spontaneous settlement in local communities with few restrictions on refugee farming and employment [CAMA Oct 94].
However, some difficulties are reported to exist in the refugee programme in Guinea. One problem is that there have been frequent delays in processing the registrations and responding with food assistance for new arrivals. Furthermore, the partial rations provided have been criticised as inadequate for new arrivals. Another problem is that there are large numbers of unregistered refugees (perhaps as many as 25% of the refugee population) who are not provided with any food assistance. Some nutritional surveys are reportedly finding high levels of malnutrition among unregistered new arrivals. A further problem that has been identified is that it has proven difficult to target additional support to vulnerable groups, such as female headed households and the elderly. Overall, these problems with the food assistance programme have been compounded by food stock ruptures which have led to reduced rations being distributed [CAMA Oct 94].
Preliminary results of a nutritional survey in mid January 1995 found rates of malnutrition amongst refugees between 4-12% (see Annex 1 (1d)), with up to 30% malnutrition reported amongst new arrivals [UNHCR Jan 95].
In Guinea, refugees can be considered to be at moderate risk with new arrivals, vulnerable groups and unregistered refugees at high risk, but estimates of the numbers of people affected are not available.
With the recent influx of 50,000 Liberian refugees the current refugee population in Guinea is estimated to be between 534,000-600,000 [UNHCR 09/11/94, RNIS #7, WFP 16/12/94]. There is no new information on the nutritional status of this population.
The population in Guinea could be considered to be at moderate risk (category IIb in Table 1).
A census carried out in Nzerekore and Yomou prefectures lead to the elimination of approximately 37,000 beneficiaries from the food distribution rolls. This re-registration exercise in now continuing in the prefectures of Gueckedou and Macenta [WFP 5/08/94]. Prior to this new census, there were an estimated 539,000 Liberian and Sierra Leonean refugees in Guinea. However, the fighting in Liberia has reportedly lead to a new influx of 32,000 refugees into Guinea in the beginning of September. Therefore, the current refugee population is estimated to be 534.000 [WFP 30/09/94, UNHCR 20/09/94].
The 1.1 million people in Liberia receiving regular food aid are not currently thought to be at nutritional risk, nor are the approximately 325,000 refugees in Cote d'Ivoire or the longer standing refugee population in Guinea (category IIc in Table 1). Those newly arrived in Guinea are at moderate risk (category IIb in Table 1) and the newly displaced/inaccessible population in Liberia (approximately 594,000) and the population in Sierra Leone (approximately 300,000) are at high risk (category IIa in Table 1).
Estimates of the number of Liberian and Sierra Leonean refugees in Guinea are 539,000. This is a downward estimate base on verification exercises conducted by UNHCR since June 1994 [WFP 5/08/94].
An attempt to substitute bulgur wheat for rice in the general ration at the beginning of the year due to large quantities of rice appearing on the local market not surprisingly met with resistance from the refugee population whose traditional subsistence crop is rice. As a result the Guinean government rejected the shipment so that it was finally agreed to provide maize meal in its place [UNHCR-a 18/07/94 WFP 5/08/94].
The remainder of the affected population can be considered to be at moderate risk (category IIb in Table 1) due to registration problems (Guinea).
There are an estimated 628,000 Liberian refugees in the Guinea Forrestiere region of Guinea of which 50,000 are relatively new arrivals [UNHCR 6/05/94, WFP 23/05/94]. It is reported that many of the new arrivals are not being registered, and are therefore not receiving any rations. General ration provision is said to be insufficient. It is reported that the quantity is low and the ration is lacking a protein source and certain micronutrients [CAMA 13/06/94]. In the East the prevalence of wasting among children was reported as 11.9%, with 2.2% kwashiorkor in Thuo and 2.8% in Banie. In the West these wasting rates among the refugees have recently been recorded at 18.9% (see Annex I 1b) and there are anecdotal reports of levels of wasting as high as 25% among new arrivals [CAMA 13/06/94]. These high rates are believed to be due not only to new influxes of refugees from Liberia, but also to a decrease in the basic ration since 1993. Up to 120,000 refugees are estimated to be benefitting from agricultural projects and it is hoped that the majority of these individuals will no longer require food aid support by the end of the 1994 [UNHCR 6/05/94]. A new influx of 1,758 people from Lofa due to renewed fighting was reported at the end of May
The 50,000 new arrivals in Guinea are considered to be at high nutritional risk (category I in Table 1) with high levels of wasting.
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