United Nations System
Standing Committee on Nutrition

Nutrition Information in Crisis Situations - Ivory Coast
 

NICS 8, January 2006

Violence erupted again in government's controlled areas of Ivory Coast following a recommendation made by an international group of negotiators to dissolve the interim parliament at the end of its term in office (Reuters, 23/01/06). Road blocks were erected and the "Jeunes Patriotes", supportive of Laurent Gbagbo, attacked UN bases, vehicles and residences for several days. The rioting ended when Gbagbo asked protesters to stop and announced that its party would return to peace process. UN and NGO bases were also attacked in the West of the country (OCHA, 20/01/06).

On the other hand, as of October 2005, the situation seemed to have somewhat normalised in West Ivory Coast (ACF-F, 11/05). The intensification of the presence of the peace-keeping forces has led to the return of a certain number of displaced people to their area of origin, although some pockets of insecurity persist. Agricultural activities have increased, allowing an improvement of the food security situation. Admissions to Zouan Houni TFC were about 100 children per month between May and October 2005, the seasonal peak of admissions (ACF-F, 11/05).

NICS 6, May 2005

After the renewal of violence in Ivory Coast in November 2004, the president of South Africa, mandated by the African Union, has led new rounds of peace-talks (IRIN, 11/01/05). Some progress has been made towards the organisation of elections in October 2005, the latest being the Ivory Coast president authorising Alassane Ouattara to stand in October's elections (IRIN, 27/04/05). Alassane Ouattara, the leader of the opposition Rally of the Republicans party could not stand in the 2000 elections as a result of the new constitution adopted before this election, which stipulates that candidates to the election should have two Ivorian parents.

The situation is still volatile on the ground with tensions and clashes, especially in the west of the country (IRIN, 27/04/05; OCHA, 21/04/05). In the north, access to health care, education and safe drinking water continues to cause concern (OCHA, 21/04/05).

A nutrition survey was conducted in Abidjan in late 2004 (UNICEF, 2004). The nutrition situation was average with a prevalence of acute malnutrition of 6.3% (5.1-7.5) including 1.1% (0.6-1.6) severe acute malnutrition. Chronic Energy Deficiency (BMI < 18.5) was found in 5.3% of the women measured, while 34.1% were overweight or obese (BMI ≥ 25). Only 10.8% of the children were exclusively breastfed while 84.2% of the children 6-9 months were receiving an adequate food supplement. Twenty percent of the children aged 20-23 months were still breast-feeding.

A nation-wide iodine deficiency disorders survey was carried out in mid 2004 (UNICEF, 11/04). Eighty-four percent of the 4,680 households surveyed had access to iodised salt. The average iodine content of 415 samples analysed was 145.4 ppm, 34.2% of which contained more than 100 ppm, the current standard at production in the country. The average iodine content of 1,190 urine samples of children 6 to 12 years old was 202.7 µg/l. Twenty seven percent had an iodine content of less than 100 µg/l, characterising an iodine deficiency, while 32% had an iodine content of more than 300 µg/l, or an excess of iodine. The overall prevalence of goitre among the 6-12 year-olds was 4.8% indicating a situation under control. Nevertheless, some regions were experiencing a mild iodine disorder.

Recommendations

From the IDD survey:

• Ensure the adjustment of the rate of salt iodisation at production to be in line with international standards: 20-40 ppm.
• Strengthen the promotion of iodised salt consumption
• Strengthen the enforcement of regulatory measures through a tighter control

NICS 5, February 2005

Following the events which took place at the beginning of November 2004 (see NICS 4), the peace process between the government and the Forces Nouvelles, which controls the north of the country is still deadlocked. There have been reports of increasing unrest and harassment of civilians and humanitarian agencies (OCHA, 17/01/05). New IDPs have been registered in several locations, such as the IDP centre in Guiglo (OCHA, 17/01/05). Several cholera cases have been reported at the hospital of Bouake (OCHA, 17/01/05). It seems that the situation along the road of Guiglo-Duekoue was serious in terms of health and malnutrition (OCHA, 17/01/05).

NICS 4, November 2004

The civil war erupted again in Ivory Coast. At the beginning of November, the government air force bombed two rebel-held towns: Bouake and Korhogo. Some French peace-keepers were killed or wounded and French peace-keepers destroyed the government air force and took the control of Abidjan airport. This was followed by rampage, mostly in Abidjan, and especially targeting French and other foreigners (UN HCHR, 15/11/04), and then by the intervention of the French peace-keepers, leading to killing and injury, according to the Ivorian Government (BBCNews, 14/11/04). Thousands of expatriates were repatriated and more than 15,000 Ivorians fled to Liberia and Guinea (AAH, 09/11/04; UNHCR, 17/11/04). It seemed that the situation has calmed down as of mid-November (UN News, 16/11/04).

The Security Council has imposed a 13 month arms embargo and has threatened further restrictions on travel and finance if the Ivorian parties fail to implement their commitments to the peace process by 15 December 2004 (UN SC, 15/11/04). The African Union will play a major role in further peace talks (DPA, 17/11/04).

NICS 3, August 2004

After several months of stalemate, it seems that the "Forces Nouvelles", which controls the north of the country, and the President of Ivory Coast have renewed their commitment to the peace process. An agreement which aims at consolidating the implementation of the Linas-Marcoussis peace process was signed in Accra on the 30 July 2004 (Accra SC, 31/07/04). Three ministers (one of whom is the leader of the "Forces Nouvelles"), who were sacked by President Laurent Gbagbo in May, have been re-appointed to their charges and a cabinet meeting was held for the first time in months (AFP, 09/08/04). Meanwhile, there is still violence in parts of the country and especially in the west and north (OCHA, 12/07/04; OCHA, 27/07/04).

Contrasted nutrition situation

Eight nutrition surveys were conducted throughout the country between November 2003 and February 2004 (MOH/UNICEF, 06/04). The results of the nutrition survey carried out in the west of the country were reported in NICS 1 but are also included in the present issue to allow comparison with the other regions surveyed. A further survey is planned in Abidjan.

National level

At national level, the prevalence of acute malnutrition among 0 to 59 month-old children was 5.6% (4.3-7.3) and 9.0 % (7.9-10.2) in urban and rural areas, respectively. They are similar to the rates of malnutrition recorded in 1998/99 in urban (excluding Abidjan) and rural areas (DHS, 1998/99): 7% and 8.5% respectively.

Stunting was higher in rural areas (27.7% (26.0-29.5)) than in urban areas (15.2 (15.4-20.8)). When compared to the results of the 1998/99 survey, stunting was within the same range in rural areas, but was lower in the present survey than in 1998/99 when stunting in urban areas (excluding Abidjan) was 27.9%.

The proportion of women having a BMI < 18.5 was 6.4% in urban areas and 8.1% in rural areas and was similar to the 1998/99 survey results (6.5% and 9.5% in urban and rural areas, respectively). On the other hand, a significant proportion of women were overweight (BMI > 25): 25.5% and 13.9% in urban and rural areas, respectively.

Regional level

At regional level, the results showed contrasting nutrition situations, depending on the area (figures 2 & 3). In all the regions, acute malnutrition seemed higher in rural areas than in urban areas. The highest prevalence of acute malnutrition was recorded in the north of the country, especially in rural areas, where the rates of malnutrition were of concern. The prevalence of acute malnutrition was average in the south and in the rural areas of the centre, and was under-control in the urban areas of the centre and the west . Severe acute malnutrition was especially high in rural areas of the north, north-east and west of the country.

Figure 2 Prevalence of acute malnutrition in urban areas, Ivory Coast, Nov 2003-Feb 2004 (MOH/UNICEF, 06/04)

Figure 3 Prevalence of acute malnutrition in Rural areas, Ivory Coast, Nov 2003-Feb 2004 (MOH/UNICEF, 06/04)

Chronic energy deficiency measured in women varied between 3.6 and 10.2% and also seemed higher in rural areas (table 5). The proportion of women having a visible goitre was especially high in the northern rural area (table 6).

According to the mothers' statements, a higher proportion of children have been vaccinated against measles or have received vitamin A supplementation, since the beginning of the crisis, in the centre and southern regions than in the north and west (table 6). This is in line with the fact that, whilst the MOH is still active in the centre and south of the country, there has been disruption in health care in the north and west.

Water and sanitation

In none of the regions surveyed, were the source of water and the sanitary conditions affected by the crisis. Potential changes in the quality and available quantity of water were not investigated.

Table 5 Chronic Energy Deficiency among non-pregnant women, Ivory Coast, Nov 2003-Feb 2004 (MOH/UNICEF, 06/04)

Table 6 Measles vaccination, vitamin A supplementation and presence of goiter, Ivory Coast, Nov 2003-Feb 2004 (MOH/UNICEF, 06/04)

Food security

The percentage of displaced families interviewed during the surveys was the highest in the urban centres of the west, centre-west and north regions (table 7).

The west of the country seemed to have been especially affected by the crisis (see NICS 1): fewer people had a permanent work since the beginning of the crisis; fewer families could rely on food production as their main source of food; the number of meals significantly decreased as well as the budget allocated to food purchase, which was about 45% lower at the time of the survey than before the crisis. Only around 6-8% of the families received food distribution (table 8).

On the other hand, the main source of income and the main source of food seemed little affected in the south, south-east, centre-west and north-east of the country.

In the north and north-west, there has been a significant reduction in the proportion of families having a permanent job, and the expenses allocated to food decreased by about 25% compared to before the crisis.

In the centre, permanent work as the main source of income dramatically decreased in urban areas (from 73% before the crisis to 48.5% at the time of the survey). On the other hand, more than 60% of the urban population received food distributions (table 8) and the budget allocated to the food expense only decreased by 10%.

Table 7 Percentage of displaced families, Ivory Coast, Nov 2003-Feb 2004 (MOH/UNICEF, 06/04)

Table 8 Percentage of families having received food distribution, Ivory Coast, Nov 2003-Feb 2004 (MOH/UNICEF, 06/04)

Children's feeding practices

Exclusive breast-feeding was low: 4.6% in urban areas and 3.1% in rural areas. Adequate complementary feeding for the 6-9 month olds was 78.6% in the urban areas vs. 67% in the rural areas. 78% and 84% of the 12-15 month olds were still breastfed in urban and rural settlings, respectively.

Overall

The nutrition and food security situation seems average to precarious (category II/III) in Ivory Coast with the northern and western parts of the country seeming more vulnerable.

NICS 2, May 2004

Peace accords have suffered a set-back within the recent months. A march organised by the rebels and opposition parties and which was officially banned took place in Abidjan on the 25th of March 2004 and degenerated into violence (IRIN, 25/03/04). The rebels and opposition parties suspended their participation in the government shortly thereafter.

A report on the events around the 25 March's march, led by the Office of the United Nations High Commissioner for Human Rights, said that at least 120 people were killed, 20 disappeared and 274 were injured. There was also evidence that some community groups were specially targeted, i.e. individuals from the north of the country or from neighbouring countries (UNSC, 13/05/04).

In protest against this report, demonstrations and sit-in have been organised by the Jeunesse Patriote, loyal to president Gbagbo (OCHA, 17/05/04); it also seems that a UN convoy was stoned (WFP, 21/05/04).

On 27 February the UN Security Council agreed to create a 6,240-strong peacekeeping force for Ivory Coast (UNSC, 27/02/04); the peacekeeping force had about 2,000 troops as of May 2004.

Violent ethnic clashes still continue in the west of the country where at least 3,000 people were displaced in May 2004 (WFP, 21/05/04). There are still several hundred thousands of displaced people and an estimated 75,000 refugees.

Decline in agricultural production

According to the FAO/WFP crop and food supply assessment mission, conducted in November/December 2003, food crop, cash crop and animal production was reduced in 2003 compared to previous years (table 15) (FAO/WFP, 03/04).

Table 15 Food crop, cash crop and animal production prospects for 2003/2004, compared to previous years (2002/2003 for food crops, 2001/2002 for cash crops), Ivory Coast (FAO/WFP, 03/04)

The decline in production may be attributed to the displacement of population, the lack of labour which resulted from it, the lack of agricultural services in parts of the country and the disruption to access to markets because of insecurity and levies at roadblocks. These factors are present to a greater or lesser degree, depending on the area (box 4).

Box 4 Factors affecting agricultural production in Ivory Coast (FAO/WFP, 03/04)

Nutrition situation under control in Bin Houye and Zouan Hounien sous-préfectures, Danane department, west Ivory Coast

Zouan Hounien is an area controlled by the force loyal to President Gbagbo, as is Bin Houye, apart from the north which is under the responsibility of the peace-keeping force. A lot of people fled the area at the end of 2002 but began to return in May/June 2003. The main source of income before the crisis was cash crops, and especially coffee. Cash crop cultivation has been badly affected by the crisis but people have been able to cultivate cassava, maize, swamp rice and vegetables. A few irregular food distributions have taken place. The health system is supported by NGOs; two supplementary feeding centres are in place and severely malnourished children are referred to a therapeutic feeding centre in Man.

A random-sampled nutrition survey was conducted in December 2003 in a 10 km radius from the two supplementary feeding centres (ACF-F, 12/03). The results showed that the situation was under control: the prevalence of acute malnutrition was 4.3% (2.7-6.6), including 0.5% (0.1-1.8) severe acute malnutrition. The measles vaccination coverage was low, with only 23.3% of the children being vaccinated against measles, according to cards and mothers' statements.

Overall

The political situation is highly volatile. Despite a decrease in food and cash crop production, the food security and nutrition situation remains average (category III) but is fragile. Any degradation of the political situation will put the population at risk.

NICS 1, February 2004

Members of the "New Forces", the rebel movement which controls half of the country, attended their first cabinet meeting at the beginning of January, after having suspended their participation since the end of September 2003 (IRIN, 06/01/04).

The decision to deploy an additional six thousand UN peace-keeping troops to supervise the disarmament process and to secure the country until the next election, due to be held in 2005, has been postponed, bending to pressure from the US (IRIN, 05/02/04).

The security situation is still volatile. In the northern and north-western parts of the country, there have been reports of clashes between factions and of intimidation of civilians (OCHA, 30/01/04).

In the southwest, inter-communal violence is reported being on the rise, leading to new displacements of people of Burkinabe origin (OCHA, 22/01/04). It was estimated that 21,000 IDPs were settled in Guiglo and that 7,400 Liberian refugees and IDPs resided in the nearby transit centres in Nicla. These transit centres were reported as lacking shelter and adequate sanitation to cope with the recent influx; programmes were underway to improve the situation. MSF and ACF were reported as being in the process of closing their nutrition programmes in Guiglo, owing to the improvement of the situation (OCHA, 02/01/04).

In the regions controlled by the "New Forces", the health system is almost totally dependent on humanitarian intervention and seems to run at only 30% of its normal capacity (OCHA, 30/01/04).

Nutrition situation under control in the west

A random sampled nutrition survey was conducted in Man, Danane and Toulepleu departments in November 2003 (MOH/UNICEF/WHO, 11/03). Among the households surveyed, 13.2% were displaced; a higher proportion of displaced families resided in urban centres (21.6%) than in rural areas (4.1%).

The results of the survey did not show a critical nutrition situation, either among children or women (see table 7).

Table 7 Food security indicators, Tolepleu, Man and Danane departments, western Ivory Coast, November 2003 (MOH/UNICEF/WHO, 11/03)

The survey also suggested that mortality rates were under control; the majority of the deaths which occurred over the year previous to the survey were due to war casualties.

However, sources of income, sources of food and diet patterns have been altered by the current crisis.

Sources of income more precarious

Sources of income were more precarious than before the war; only 68.6% of the households had a permanent job at the time of the survey (53.2% and 84.3% in urban and rural areas, respectively), compared to 84.9% before the crisis (76.5% and 93.9% in urban and rural areas, respectively). At the time of the survey, people were more reliant on temporary work.

Decrease in food consumption and food diversity

Sources of food have changed, the proportion of food purchased being higher than before the war (see table 8). However, the amount of money allocated to purchase of food has been more than halved compared to the pre-crisis situation.
 
Table 8 Food security indicators, Tolepleu, Man and Danane departments, western Ivory Coast, November 2003 (MOH/UNICEF/WHO, 11/03)

The number of meals has decreased (see table 8) and the diet is less diversified than before, with the frequency of consumption of dairy products, vegetable oil (except palm oil), and cereal meals having been particularly reduced (see figure 2). About 7.5% of the population received food aid.

Figure 2 Change in food consumption after the crisis, Tolepleu, Man and Danane departments, western Ivory Coast, November 2003
(MOH/UNICEF/WHO, 11/03)

Stable situation in terms of water and sanitation

On the other hand, the main source of water and the sanitation situation, although not ideal, were comparable to before the crisis.
 
Children's feeding practices

According to the survey, breastfeeding was initiated within one hour after birth by 43% of the mothers; consumption of colostrum was reported by 94% of the mothers. 80.5% of the 12-16 month olds were still breastfed (68.5% and 91.5% in urban and rural areas, respectively), as well as 41% of the 20-23 months (34.0% and 49% in urban and rural areas, respectively). Only 4% of the minus 6-month-olds were exclusively breastfed; bottle-feeding was used by 6.6% of the mothers. Only 56.4% of the 6-10 month olds (67.7% and 46.7% in urban and rural areas, respectively) had received solid or semi-solid food the day prior to the survey.

Average food security situation in Tabou department

Tabou department is divided into Grabo and Tabou sous-préfectures.

A food security assessment carried out in Grabo sous-préfecture by Oxfam in October 2003, showed that the population in Grabo could manage in the short-term (Oxfam, 10/03).

Cash cropping is predominant in the area. The production of palm oil nuts, rubber and coconuts is mostly under the control of big private companies, whilst cocoa and coffee are grown and sold by village communities. Before the war, a high number of third country nationals were cultivating in the area, which was also hosting Liberian refugees. Because of the conflict, a lot of third country nationals and Liberian refugees fled, leading to a lack of man-power, which was, at the time of the survey, one of the major constraints to agricultural production. On the other hand, labour was widely available for the remaining population.

Although the rice harvest has been impaired by the conflict, people have been able to purchase rice or to switch to other staples such as maize or cassava. The nutrition situation did not seem critical; a rapid assessment conducted by ACF-F showed that among 624 children measured, 51 had a MUAC < 135 mm (8.2%), including 8 children who had a MUAC < 120 mm (1.6%) and 2 children who had a MUAC < 110 mm (0.3%); data on oedema were not provided.

Access to health care seemed very poor because of distance, lack of staff and shortage of medicines.

In the long-term, the current situation may have an impact on the food security in the area, because of lower incomes from cash crops and outside the area because of a decreased production of cash crops and rice.

Tabou sous-préfecture is adjacent to the Liberian border and is estimated to host about 45,000 Liberian refugees, mainly settled in villages. According to a food security assessment conducted by Oxfam in November 2003 (OXFAM, 11/03), food accessibility and availability has not deteriorated since June 2003 and did not seem to be of concern. The Ivorian population had strong livelihoods; they were deriving incomes from cash crop production and subsistence farming, the later also being a source of food. The Liberian community was involved in a wide range of income generating activities such as work in plantations, fishing and petty trade; to a lesser extent, they were also engaged in subsistence farming. Work opportunities in plantations were wide at the time of the survey but any reduction of employment opportunities would have a great impact on the livelihoods of Liberians. The most vulnerable cases seemed to be supported by other members of the communities.

The assessment recommended supporting existing coping mechanisms.

Priorities identified by the Ivorian community were health, education, water, roads and transport, whilst the priorities identified by the Liberian community were education, health care, sanitation, closer markets for selling goods, travel permits for ease of movement, clothes and food.
Access to health care seemed to be very limited, due to distance, a lack of qualified staff and shortage of medicines.

Overall

Although the situation is still volatile in western Ivory Coast and people's living conditions have changed since the beginning of the crisis, it seems that the communities are able to cope and that the nutrition situation is not critical (category III). Strengthening of coping mechanisms is, however, necessary.

Recommendation

From the food security survey in Grabo:

• Implement a food security surveillance system
• Ensure access of appropriate and timely agricultural inputs to vulnerable members of the community through distribution of seeds and tools

From the food security survey in Tabou

• Implement a food security surveillance system
• Support and strengthen existing coping mechanisms through the provision of inputs such as fishing nets, agricultural inputs, improved market access through rehabilitation of roads

From the nutrition survey in the West

• Support the strengthening of nutrition activities

RNIS 43, November 2003

The implementation of the peace agreement between the "Forces Nouvelles" and President Laurent Gbagbo, signed in January 2003, is chaotic. The former rebels have suspended their participation in the Government of National Reconciliation and in the disarmament programme, since the end of September 2003 (BBC News, 24/09/03). The humanitarian situation remains precarious. In Yamoussoukrou district, an assessment showed that the host population has less and less capacity to cope with the high number of displaced (OCHA, 06/10/03). In the west, the security situation remains tense, which hampers efforts of humanitarian organisations. Expulsion of Ivorians not native to the area and of immigrants workers has been reported in the south-west area (OCHA, 04/09/03). The administration has not re-deployed in the north and the west, greatly limiting access to health care (WFP, 17/10/03).

RNIS 42, August 2003

The Implementation of the Marcoussis peace agreement, which was signed in January 2003, is on -going. The warring parties (the Ivory Coast Patriotic Movement (MPCI), the Movement for Justice and Peace (MJP) and the Far West Ivory Coast People's Movement (MPIGO), which control about half of the country (see RNIS 41), officially declared the war over and pledged their loyalty to President Laurent Gbagbo, at the beginning of July 2003 (AFP, 04/07/03).

The "Forces Nouvelles" (comprising the three armed opposition groups) and the army, loyal to Laurent Gbagbo, signed a new agreement at the beginning of May 2003. They, jointly with the peace- keeping forces, have subsequently deployed in western Ivory Coast to create a weapons-free zone of confidence, and disarm or expel armed Liberian elements from the area (UN SC, 08/08/03).

The Government of National Reconciliation is functioning and has presented a draft programme for the implementation of the Marcoussis agreement (UN SC, 08/08/03).

On the other hand, uncontrolled armed militia are still perpetrating human rights abuses and are undermining peace in the country (UN SC, 08/08/03; HRW, 05/08/03).

The mandate of the peace-keeping troops has been extended for six more months (UN SC, 04/08/03).

Due to a lack of resources, WFP had to reduce rations and caseloads by 30% in August. The shortfall is expected to continue until October 2003 (WFP, 22/08/03).

Western region

Following the creation of a "weapons-free zone of confidence" in western Ivory Coast, the population which had been displaced by heavy fighting in the area has begun to return home, especially in June 2003. The situation has, however, remained tense, with the presence of gunmen; isolated communities are especially at risk (OCHA, 16/07/03). Humanitarian work with the needy Ivory Coast returnees and the newly refugees from Liberia (estimated at 30,000) is therefore limited (OCHA, 16/07/03; USCR, 07/08/03).

The humanitarian situation in western Ivory Coast is reported to be dire. Many people have been hiding in the bush for months, and find their homes destroyed or looted when returning.

Nutrition

The nutrition situation seems highly precarious. In June 2003, about 500 severely malnourished children were taken in charge by the two TFCs in the West; and screening at mobile clinics showed that between 11% and 34% of the children screened were eligible for admission to either therapeutic or supplementary feeding centres (MSF, 10/07/03). The worst situation seemed to be in Zouan Hounien area. Moreover, there was a high proportion of children with oedema (70% of the admission in TFCs), which is characteristic of people having hidden in the bush and reflects a very serious situation.

Food security

An assessment in Zouan Hounien and Bin Houyé areas among resident, displaced and returned populations, has shown a precarious situation (ACF, 20/07/03). People who had fled fighting, have been hiding in the bush for between five and seven weeks. Before the war, the two main sources of income of the population were the sale of cash crops and the sale of agricultural produce. At the time of the survey, 75% of the population reported that their cash crop stocks had been looted and about 80% reported that their agricultural stocks had been looted; the two main sources of income for the population were petty trade and sale of agricultural produce. About 80% of the families surveyed only consumed one meal per day, compared with three meals per day before the war. The main problems cited by the population in order of importance were food, health care, water, basic assets, housing and education. The main sources of food were by purchase and gathering of wild food.

However, people have begun to restart cultivation, especially rice cultivation. About 95% of the families interviewed have had access to land and 60% have already begun planting. Access to seeds did not appear to be a problem, but there was a shortage of tools. People were also complaining they could not employ workers to cultivate because of a lack of resources.

Food and non-food items were available in the area, but people were lacking money to buy them. WFP was intending to begin food distributions.

Health

The health care system has totally collapsed, because it is no longer supported by government structures; the majority of health workers, who did not originate from the zone, have fled; health structures have been destroyed and/or looted, and the provision of medicines has been halted. Although humanitarian agencies are supporting health structures, they cannot replace the entire system (MSF, 10/07/03). Moreover, the population has difficulty accessing health care because of volatile security conditions and transport costs. MSF also stated that the institutional response, especially from the UN has been weak (MSF, 10/07/03).

Overall

Implementation of the Marcoussis peace agreements is on-going but security is still tense in some areas, and especially in the west of the country. In this area, the situation of the population, of whom a significant proportion has recently returned from displacement in the bush, is extremely precarious (category I/II), and humanitarian access is hampered by the volatile security situation.

Recommendations and priorities

Zouan Hounien and Bin Houyé areas, from the AcF survey:

• Continue food distribution to the whole population until December 2003, when people will harvest coffee and food for their own consumption
• Distribute non-food items
• Put in place screening of malnutrition cases in rural areas and food security surveillance

RNIS 41, April 2003

Following a coup attempt on the 19 September 2002, about half of the country is controlled by rebel forces; the Ivory Coast Patriotic Movement (MPCI) in the north; the Movement for Justice and Peace (MJP) and the Far West Ivory Coast People's Movement (MPIGO) in the west (see map).

Ivory Coast situation map (Alernet, 27/01/03)

A peace agreement was signed between the government of Ivory Coast, the armed opposition groups and the political opposition parties in Marcoussis, France, on the 24 January 2003 (GoCI, 24/03/03). The peace agreement concerned the constitution of a new government, which should include ministers from all parties, whilst the president keeps his function. However, the constitution of a new government has been highly controversial and participation by the rebels with the government only began on the third of April.

The first troops of the Economic Community of West Africa States (ECOWAS) have been deployed in the country, in reinforcement of the 3,000 French troops (PANA, 19/03/03). Despite the peace agreement, the security situation is still volatile, especially in Abidjan and in the west of the country, near the Liberian border.

Population movement

Although, it is difficult to know precisely the number of IDPs, it is estimated that 600,000 to 800,000 people may be internally displaced. Most of them are settled with relatives (OCHA, 07/03/03). It is also estimated that about 300,000 migrants have returned to their countries of origin (see table).

Returns of migrants from Ivory Coast since September 2002 (OCHA, 18/03/03)

¹ Source RGPH, 1998
² Source IOM

Some 12,000 might be trapped in Liberia (see Liberia).

Before the crisis, Ivory Coast also hosted about 70,000 Liberian refugees, mostly settled in the west of the country. It is estimated that, as of March 2003, 35,000 were still in the country, whilst more than 40,000 had returned home (UNHCR, 21/03/03). The fate of some 5,000 Liberian refugees, who will not be safe in Liberia if they return, is of particular concern; UNHCR has not yet found them a country of asylum.

More than 42,000 Ivorians have also fled mainly to Liberia and to a lesser extent to Guinea.

Humanitarian situation

The health sector is especially affected. WHO has estimated that in the rebel controlled areas, 85% of the medical staff has left and that 70% of the health infrastructure has been closed (WHO, 12/02/03). A measles outbreak has been reported in western Ivory Coast (OCHA, 07/03/03). Several humanitarian agencies are supporting the health sector.

Different vulnerabilities among the population have been identified. In the area where a high number of IDPs have sought refuge with relatives, food security may worsen rapidly as the resources are shared between the residents and IDPs. In the towns, loss of employment and an increase in food prices may affect food security of the urban population.

The worst affected rural populations might be those relying on sugar and cotton production in the north of the country. They are estimated at 30,000 families (WFP, 07/03/03).

ACF-F carried out several food security and nutrition assessments (ACF-F, 01-02/03).

MPCI controlled area

Odienne town and rural area

Following the events mentioned above, people have fled from the town. It is estimated that only 55% of the pre-crisis population has remained in town. The main problem was the poor functioning of health structures because of lack of health staff and medicines. Access to food has decreased since the beginning of the crisis, but food insecurity did not seem to be widespread; the most affected groups were the ones who were already vulnerable before the crisis, i.e. daily agricultural workers and social cases; they are in need of help.

In the rural area, the food security situation seemed good; people relied on their own food production and cash crops. The main problem was access to health care.

The MUAC assessment did not show a precarious nutrition situation (see table). About 3% of the children, however, had oedema, which is of concern.

Bouake- rural areas

The area had received a lot of displaced people from the town; it is estimated that the population has increased by 30% to 40%. The population in the villages located near the river (in Sakassou district) had access to fishing and was not considered vulnerable; people were able to cope with the displaced influx. No cases of malnutrition have been found in these villages (see table). On the other hand, the population in villages (in Diabo district)which have no access to the river was more vulnerable because of the disruption of the commercialisation of agricultural products. The resident populations also shared their food stocks with the displaced, and this may reduce the availability of seeds for the next planting season. Although the nutrition situation is not alarming as yet (see table), strengthening in food security is needed.

Dabakala, rural areas

These areas have received a limited number of displaced people, but a bad harvest and the disruption of trade have lowered sources of incomes and food consumption. The nutrition situation still seemed, however, to be under-control (see table) but programmes to strengthen food security are needed.

Korhogo

At the time of the assessment, the town counted about 70% of the initial population. There were no problems of food availability in the town and prices of locally produced goods had decreased because of the limitation of the purchasing power of the population.

The rural population, which relied on their own food production, did not seem to be at risk. On the other hand, villages where the main activity was handicrafts seemed particularly at risk because they have lost their outlets.

Although the MUAC measurements did not show particular problems, the high number of children with oedema was of concern (see table), especially in the handicraft villages. These villages require special attention.

MPIGO controlled area

Man town and rural areas

At the time of the assessment, the population of Man was 30% to 50% of the initial population, because some people had fled the town. On the other hand, 30% of the resident population were hosting displaced families. The main problem identified in the town was the lack of cash and an increase in unemployment. The nutrition assessment did not show a critical situation (see table).

The rural areas host people from the town. Food stocks have therefore decreased more quickly than usual. In addition, the coffee harvest was only partial and the harvest has been difficult to sell. The nutrition situation in the rural area was worse than in the town (see table).

Results of MUAC assessments, Ivory Coast, January-February 2003 (ACF-F, 01-02/03)

Areas controlled by loyalist troops

Daloa town and surroundings

The area included a large number of displaced people, mostly settled in host families. The food has been shared between host and displaced families and food stocks were decreasing more quickly than usual. In addition, insecurity in this area near the frontline hampered people's access to fields. The next agricultural season will probably be lower than usual. The most vulnerable population seemed to be the displaced families who were not hosted by relatives and have no access to fields, and the host families who hosted a large number of IDPs.

The nutrition situation in this area was worse, especially in the rural areas, than in the other areas surveyed. The percentage of oedematous children was of particular concern (see table).

Overall

The food security situation varies between different areas. Whilst nutrition assessment has not showed dramatic situations (category III), most of the population has experienced a decrease in their food security situation. Food security needs to be strengthened in order to avoid deterioration of the nutrition situation.

Côte d'Ivoire

Des accords de paix ont été signés fin janvier 2003, entre le gouvernement ivoirien et les factions et partis politiques opposants, aboutissant à la création d'un gouvernement réunissant les différentes représentations.

Les mouvements de population ont été très importants depuis le début des hostilités. Environ 600 000 à 800 000 personnes seraient déplacées à l'intérieur du pays, 300 000 migrants économiques seraient retournés dans leur pays d'origine et environ 40 000 réfugiés libériens en Côte d'Ivoire auraient trouvé refuge au Libéria et en Guinée, ainsi que 42 000 Ivoiriens.

Le secteur de la santé est particulièrement touché dans les zones contrôlées par les opposants, en raison de la fuite des personnels de santé et de la difficulté d'approvisionnement en médicaments. La plupart des évaluations montrent, d'autre part, une dégradation de la sécurité alimentaire des populations, plus ou moins importante selon les zones. Les évaluations nutritionnelles ne montrent pas de résultats alarmants (voir tableau) (catégorie III), mais la sécurité alimentaire des populations doit être soutenue afin d'éviter une poursuite de la dégradation de la situation.

RNIS 40, Dec 2002

Following a coup attempt on 19 September 2002, a cease-fire agreement was signed at the end of October between the government, which controls the south of the country, and the Ivory Coast Patriotic Movement (MPCI), which controls the north. At the end of November 2002, two new rebel groups, the Movement for Justice and Peace (MJP) and the Far West Ivory Coast People's Movement (MPIGO), began fighting in the west (AFP, 15/01/03). The presence of Liberian soldiers in their ranks has been reported (Reuters, 02/12/02). As of mid-January, the three rebel groups were controlling about half of Ivory Coast territory. French troops have been deployed along the front line. Although several clashes between the French troops and the rebels have since been reported on the western front line, a truce was signed by the MPCI and MPIGO in mid January 2003, and the three rebel movements, the government of Ivory Coast and the political opposition have also entered peace talks, brokered by France (Reuters, 15/01/03). At the time this report was written, peace talks were on-going. Human rights abuses and violence against civilians by all parties have been denounced (Reuters, 19/12/02; ICRC, 19/12/02).

Population movements

The conflict has led to major displacements. About 1.1 m Ivorians have probably been displaced. The first wave of violence in the north led to the displacement of an estimated 600,000 people, whilst the fighting in the west caused the displacement of about a further 500,000 people (OCHA, 10/01/03). Most of the IDPs are settled with relatives which renders accurate estimations difficult.

Shantytowns, which host many migrants and refugees, have continued to be razed by government troops. Thirteen shantytowns have reportedly been razed in Abidjan, displacing 40,000 people (UNHCR, 19/11/02). Many of the displaced families were reported now to be living in a precarious condition although some of them have taken refuge with friends or relatives. UNHCR was caring for 1,000 displaced refugees in Abidjan (UNHCR, 19/11/02). Sierra Leonan refugees have asked to return home but UNHCR was unsure of being able to facilitate returns, due to funding shortfalls.

Fear of persecution has also caused thousands of migrants to flee to their homelands. About 35,000 Burkinabe out of the 2.5 m settled in the country (OCHA, 04/01/03), plus thousands of Nigerians (Reuters, 12/11/02), Malians (PANA, 15/11/02), Guineans, and people from other nationalities, have already fled.

In addition, the Liberian refugees who had been mostly settled in western Ivory Coast have returned en mass to their country (see table). Most of them returned under their own means; UNHCR has begun to help with repatriations since mid-January 2003. Massive influxes of Ivorians into Liberia, and to a lesser extent into Guinea, have also been reported (see table). UNHCR has expressed fears for the fate of several thousands Liberian refugees who are still settled in western Ivory Coast, particularly those who are afraid to return to Liberia because of their ethnicity. About 5,000 are estimated to be settled in Nicla camp, near Guiglo. UNHCR has however, not yet succeeded in moving them to a safer location (UNHCR, 17/01/03).

Population movement, Ivory Coast, as of mid-January 2003

Humanitarian situation

Although access to the populations in central and northern rebel-held area has been unimpeded, access to western areas has seemed more difficult (OCHA, 04/01/03). The most pressing humanitarian needs are in the health sector, which lacks medicines, equipment and health staff, especially in rebel-controlled areas (OCHA, 04/01/03). Food insecurity will worsen in the coming months as reserves will be exhausted, and the next harvest, expected in March 2003, may be disrupted. Many people have lost their sources of income because of the insecurity. As IDPs are mostly settled with relatives, assistance should be provided to both refugees and host populations. WFP food distributions in January and February 2003 were intended to reach 61,200 beneficiaries in Buake, 34,600 in Yamousoukro and 5,300 in Nicla camp (WFP, 10/01/03). The ongoing conflict has had a major impact on the economy of the whole sub-region. Ivory Coast accounted for 40% of the gross domestic product of West Africa; millions of migrants from neighbouring countries were dependent on job opportunities in Ivory Coast. The loss from cash crops in the northern region is estimated so far at about 300 millions Euros/Dollars. In addition, neighbouring countries can no longer use the port of Abidjan; they are obliged to use more distant ports which had led to an increase in the cost of transportation. Prices in the whole region seem to have increased dramatically since September 2002 (AFP, 15/01/03).

Côte d'Ivoire

Alors que le mouvement de rébellion qui avait vu le jour mi-septembre et contrôlait une grande partie du pays avait signé un accord de paix avec le gouvernement à la fin du mois d'octobre, deux nouveaux mouvements de rébellion se sont engagés dans des combats dans l'ouest du pays, à la fin du mois de novembre. Ceci a entraîné un déplacement massif des milliers de réfugiés libériens qui étaient installés dans cette zone. Environ 38 000 seraient retournés au Libéria en quelques semaines. De même, de nombreux ivoiriens ont fui vers les pays voisins, dont environ 20 000 vers le Liberia et 2 000 vers la Guinée. Des milliers de migrants installés en Côte d'Ivoire sont retournés dans leur pays d'origine, par peur de persécutions. Le nombre d'Ivoiriens s'étant déplacés à l'intérieur du pays est estimé à environ 1 million, la plupart ont trouvé refuge chez des proches. L'accès aux populations semble être adéquat dans le nord du pays alors qu'il est plus difficile dans l'ouest. Les besoins humanitaires les plus pressants sont dans le domaine médical, mais la sécurité alimentaire des populations risque de se dégrader rapidement. Une conférence de paix se tient actuellement en France.

RNIS 39, October 2002

Ivory Coast is experiencing troubles following a mutiny by soldiers on the 19^th September 2002. At the beginning of October, soldiers controlled two major towns in the North of the country, including Buake, the second largest town of the country and some smaller towns (BBCNews, 02/10/02). Army reprisals, as they were looking for rebels, targeted an area in the suburbs of Abidjan hosting many migrants; houses were burned. About 6,000 Ivorians, immigrants and refugees are reported to be homeless (UNHCR, 02/10/02). They were looking for shelter and were in need of food and adequate sanitation (IFRC, 24/09/02). The Ivorian representatives called for cessation of attacks on migrant; they also blamed foreign countries for helping the rebels (BBCNews, 22/09/02).

In a country exposed to economic crisis, there has been increasing resentment against migrants and migrants’ descendants. There is a fear that this may degenerate into a civil conflict involving ethnic/political and religious groups.

Refugees

Since the beginning of the fighting in Liberia and Sierra Leone, Ivory Coast has hosted thousands of refugees. Unlike many other countries, where the refugees are settled in camps, in Ivory Coast they are settled in the host community in a 500-km-long and 50 km-wide stretch of land bordering Liberia. The area is designated as Zone d’Accueil des Réfugiés (ZAR). Only one camp had been settled in 1995 (Nicla camp). Refugees are registered in the Danane transit centre at their arrival. At the end of 2001, it was estimated that the area counted about 120,000, mostly Liberian, refugees. Refugees from Sierra Leone are estimated at around 2,000 (UNHCR, 24/05/02). Although the government of the Ivory Coast wants the integration of refugees, refugees themselves have reported harassment when travelling and restricted access to land and work (RI, 24/07/02). From the beginning of 2002 until July 2002, UNHCR had registered 15,560 new Liberian refugees in Ivory Coast, of which 3,800 were settled in Nicla camp. WFP is providing food assistance for the refugees in Nicla camp and Danane transit centre (WFP, 19/07/02).

The mortality rate has been reported to be 0.03/10000/day in Nicla camp. In Danane transit centre, a rate of malnutrition of 7.8% with no case of severe malnutrition has been reported. (The source and methodology of this assessment was not reported.) (WFP, 21/06/02).

Two hundred refugees from Sierra Leone and Liberia have sought assistance from UNHCR after their homes were burnt in Abidjan (see above) (UNHCR, 24/09/02). The impact of the current crisis on the refugee situation in ZAR is unknown at the time this issue was completed.

Recommendation and priorities

· Monitor the situation of the migrants and refugees and provide additional relief if needed

RNIS 34, July 2001

Instability in neighbouring Guinea and fighting in the Lofa region of Liberia has resulted in a new influx of refugees into the country. According to UNHCR there are 120,000, mostly Liberian refugees, remaining from an influx in 1999 (IRIN-WA 29/05/01). A recent OCHA update reported that a steady flow of 50 Liberian refugees a day has been entering Côte d’Ivoire since early May when fighting broke out in Lofa county, northern Liberia. From May 3^rd to July 19^th a total of 4,076 new Liberian refugees have been registered (IRIN-WA 20/07/01).

The refugees are being accommodated in the Zone d’Accueil des Refugies (ZAR), which is an area designated by the Ivorian government to shelter refugees. The ZAR is made up of two prefectures, Danane, located only 30 Km from Liberia, and Guiglo, 150 Km to the south of Danane and the refugees are not permitted to move out-side of this area. Guiglo contains the only refugee camp in Côte d’Ivoire, called Nicla, which currently has a population of 8,000 people (OCHA 28/06/01). The rest of the refugee population lives in parts of Guiglo and Danane and ten small towns in between. Reports of the new refugee influx have indicated that most appear to be girls and women between five and sixty years of age (OCHA 28/06/01). The high proportion of women and children make the new refugees particularly vulnerable as a result of poor work opportunities, and the population is likely to be dependent on humanitarian assistance for the immediate future.

WFP has begun distributions to 500 newly arrived refugees who have already arrived in Nicla camp in Guiglo. The 500 are the initial caseload out of 1,068 who have registered to go to the camp. It is reported that they will receive a full ration of corn, vegetables, vegetable oil and salt (IRIN-WA 24/07/01). The RNIS has no nutrition information on either the long term or new refugees in the country

Overall

Many of the long term refugees in Côte d’Ivoire receive assistance and are able to seek employment and are therefore not considered at high risk (category IV). However, the new refugees are likely to be at slightly elevated risk as a result of their recent displacement and the high percentage of women and children in the population and their situation will need careful monitoring (category III).

Recommendations

• Ensure timely and sufficient food and non food distributions to the new arrivals.
• Help to ensure the integration of new arrivals into the established refugee and non refugee communities.

RNIS 32/33, April 2001

Côte d'Ivoire has traditionally been a beacon of stability in the West African Region, characterised by a relatively good socio-economic situation and an infrastructure that has benefited from extensive development aid. According to UNHCR there are 110,000 Liberian refugees in the country, of which some 50,000 remain unregistered. There ore also about 2,000 Sierra Leonean refugees on the Western borders. There is concern that a deterioration in either the internal security of Côte d'Ivoire or in the sub region as a whole, may force an unplanned return of over a 100,000 refugees to their country of origin (UNHCR 2001; UN 2001).

Table of beneficiaries in West Africa taken from the UN Consolidated Inter-Agency Appeal for West Africa 2001

Country	IDPs	Refugees	Returnees	Host/other	Total
Guinea	150,000	420,000	NA	3000,000	870,000
Sierra Leone	500,000	6,000 Liberians	100,000	1,000,000	1,606,000
Liberia	20,000	70,000 Sierra Leone	30,000	600,000	720,000
Cote d'Ivoire	NA	60,000 Liberia	NA	NA	63,700
		2000 Sierra Leone
		1,700 Urban
Total	670,000	559,700	130,000	1,900,000	3,259,700

After years of stability Côte d'Ivoire experienced a coup d'état in 1999 when the civilian government was overthrown by the military. A second coup attempt in January 2000 failed and has subsequently been attributed by the government to the neighbouring countries of Burkina Faso, Mali and Guinea. Further tension occurred in October 2000 on the announcement of presidential election results where the supreme court invalidated the candidature of Mr Ouattara on the basis that he was not a true Ivorian citizen. As a result social tensions were aroused resulting in wide scale violence. (UN 2001)

The RNIS has no current information on the nutritional status of refugees in the country.

Overall

The situation is not critical but there is concern that the situation could deteriorate with the increase in regional insecurity and the internal troubles that hove been affecting the country since the coup d'état of 1999. The nutritional situation of the refugees is not critical but will depend on the continued stability of the country.

Recommendations

• Improve surveillance systems for both nutrition and health at the local level.
• Ensure that contingency planning has been done for the health and nutrition sectors.

RNIS 31, July 2000

Cote d'Ivoire currently hosts some 86,000 Liberians and some 1,500 Sierra Leoneans. WFP/UNHCR undertook a joint assessment mission of the Liberian refugees in Cote d'Ivoire in February. The mission was sent to assess the nutritional situation and also the impact of the changes in the medical arrangements in the camps in Tabou, Danané and Guiglo since January 2000 (UNHCR is no longer responsible for providing health care to all the refugees) (UNHCR /WFP- 03/00; UNHCR - 20/07/00).

RNIS 30, March 2000

Cote d’Ivoire currently hosts more than 100,000 Liberians and some 1,500 Sierra Leoneans. UNHCR has assisted 11,000 Liberians refugees to repatriate since August 1999 (IRIN-WA - 03/03/00). No new information is available on the nutritional situation of these refugees, which was reported to be satisfactory in the most recent reports (RNIS 27) (category IV).

RNIS 29, December 1999

Cote d’Ivoire currently hosts more than 100,000 Liberian refugees and some 1,500 Sierra Leoneans. This number has been decreasing as some of the Liberians repatriate. No new information is available on the nutritional situation of these refugees, which was reported to be satisfactory in RNIS 27 (category IV).

RNIS 28, September 1999

Cote d'Ivoire currently hosts more than 100,000 Liberian refugees and several thousand Sierra Leoneans (UNHCR - 02/02/99). This number has been decreasing as some of the Liberians repatriate. No new information is available on the nutritional situation of these refugees which was reported to be satisfactory in the last RNIS (category IIc).

RNIS 27, July 1999

Cote d'Ivoire currently hosts more than 100,000 Liberian refugees and several thousand Sierra Leoneans (UNHCR - 02/02/99). No new information is available on the nutritional situation of these refugees which was reported to be satisfactory in the last RNIS (category IIc).

RNIS 26, March 1999

Cote d'Ivoire currently hosts more than 100,000 Liberian refugees (UNHCR - 02/02/99). This number has been decreasing as the refugees are helped home by UNHCR or repatriate spontaneously.

The most recent report on the health/nutrition of the refugees in Tabou (the reception zone for Liberian refugees entering the Cote d'Ivoire) describes a stable situation (MSF-Tabou - 11/98). Reductions in the number of admissions to both the supplementary and therapeutic feeding centres between July 1997 and September/October 1998 were recorded. MSF has now closed its nutritional and medical programmes in the area and has helped to facilitate the transfer of the programmes to the Ministry of Health and local groups. ACF has also decreased its activities in the area.

Overall, the refugees in Cote d'Ivoire are not considered to be at heightened risk of malnutrition (category IIc).

RNIS 25, October 1998

RNIS 25 was devoted to reviewing some of the changes in emergency response over the last five years. We will first highlight situations where wasting was brought rapidly under control. We will then look at some of the factors that have led to less than optimal results, followed by what has been accomplished to improve response over the last five years. We conclude with some ideas for future improvements in the RNIS Reports that could even further enhance communication, stimulate thought, and promote improvement.

RNIS 24, June 1998

There were approximately 210,000 Liberian refugees in Cote d'Ivoire. It is estimated that some 70,000 have returned to Liberia, leaving about 140,000 Liberian refugees in country [WFP 15/05/98]. There are no reports of change in the adequate nutritional status of these refugees.

RNIS 23, March 1998

The number of Liberian refugees in Cote d'Ivoire has declined due to small scale repatriation. In addition, there have been an unknown number of spontaneous returnees.

Overall, the affected population in Sierra Leone can be considered to be at heightened risk of malnutrition (category IIa in Table 1) due to inaccessibility resulting for insecurity. The remainder of the affected population is not currently considered to be at heightened risk (category IIc in Table 1).

RNIS 22, December 1997

There are approximately 210,000 Liberian refugees in Cote d'Ivoire. There are no reports of change to their generally adequate and stable nutrition situation of this refugee population. Repatriation for these refugees is scheduled to begin in 1998 [UNHCR Oct. 97].

RNIS 21, September 1997

There are no reports of change to the adequate nutritional status of the approximately 210,000 assisted Liberian refugees in Cote d'Ivoire. Due to the stable situation in Liberia, repatriation of these refugees is hoped to begin soon [UNHCR May 97].

RNIS 20, June 1997

There are approximately 305,000 Liberian refugees in Cote d'Ivoire. There are reports of some people returning to Liberia, but exact numbers are not available. It is believed that many refugees are returning to Liberia to verify the situation before deciding to go back for good [UNHCR 16/05/97].

RNIS 19, March 1997

There remain approximately 305,000 Liberian refugees in Cote d'lvoire. There are no reports of change to the generally adequate health and nutritional status of this population.

RNIS 18, December 1996

There are approximately 305,000 Liberian refugees in Cote d’Ivoire whose health and nutritional status are reportedly adequate and stable [UNHCR 19/11/96].

RNIS 17, September 1996

There has been no significant increase in the Liberian refugee population in Cote d’Ivoire, although it is likely that there will have been a few new arrivals due to the sporadic insecurity in Liberia. Population estimates remain at 305,000 Liberian refugees [UNHCR 10/09/96].

RNIS 16, June 1996

There are approximately 305,000 Liberian refugees in Cote d'Ivoire, whose nutritional status is reportedly adequate and stable. The recent fighting in Liberia has not reportedly led to any large-scale influx of refugees [UNHCR 24/05/96].

RNIS 15, April 1996

There remain approximately 305,000 Liberian refugees in Cote d’Ivoire. Although some limited spontaneous repatriation may be occurring, it is believed that most refugees are crossing into Liberia during the day and then returning to Cote d’Ivoire at night with a view to retaining refugee status until there is greater confidence in the prospects of long-term peace and security in Liberia [UNHCR 22/03/96].

RNIS 14, February 1996

It is currently estimated that there are 305,000 Liberian refugees in Cote d'Ivoire, although the actual number may be somewhat lower due to spontaneous repatriation [UNHCR 26/01/96].

RNIS 13, December 1995

There are approximately 305,000 Liberian refugees in Cote d’Ivoire. At present only small scale spontaneous repatriation is occurring. The two tier general ration system for old case load refugees and newer arrivals is continuing and is believed to be serving the needs of this population adequately [UNHCR 17/11/95].

² Due to a miscommunication, the previous RNIS report described a July 1994 survey in Cote d’Ivoire as a survey which took place in July 1995.

RNIS 12, October 1995

There are currently approximately 305,000 Liberian refugees in Cote d'Ivoire and while political improvements in Liberia have not led to any large scale repatriation, it is reported that some spontaneous return is occurring.

There is a two tier ration for this refugee population whereby the "old" refugee population who have been in Cote d'Ivoire sufficiently long to attain marked self-sufficiency receive a ration of 960 kcals/person/day while newer arrivals, who are not believed to be greatly self-sufficient, receive a ration of 1,300 kcals/person/day [MSF-F 11/09/95]. An attack by Liberian rebels in June on villages in the West of the country has seriously disrupted the formerly excellent relations between refugees and local population. As a result one refugee camp had to be moved for reasons of security [IFRC 4/07/95].

A nutritional survey was recently carried out in Tabou Prefecture, where approximately 160,000 people (105,000 Liberian refugees and 55,000 local residents) live. Among the refugee population, wasting was measured at 8% with 2% severe wasting, and oedema, which was measured separately, was 2.2%. Anaemia was reported in 4% of the children and Bitot's spots (an early sign of vitamin A deficiency) was found in 0.2% of children. For comparison, wasting among the local population was recorded at 8.8% with 2.4% severe wasting. Oedema was measured separately at 10.2%. Anaemia was seen in 12.5% of children, and Bitot's spot's were seen in 1% of children [CARITAS Jul 95]. The nutritional status was thus similar for the refugee and local populations.

RNIS 11, July 1995

There appears to be some confusion over the number of refugees in Cote d’Ivoire, and a recent attempt at a census was unsuccessful due to resistance by refugees. One estimate is that the number of refugees in need of humanitarian aid is approximately 270,000 [IFRC 02/06/95].

A poor nutritional situation for Liberian refugees in the Tabou prefecture of Cote d’Ivoire was described in the last RNIS report (14.8% wasting with 4.8% severe wasting). This situation has now reportedly improved considerably largely due to the interventions of various agencies [IFRC 02/06/95].

RNIS 10, April 1995

Most current estimates are that there are 330,000 Liberian refugees in Cote d’Ivoire. Relatively new arrivals (those who arrived in the last three months of 1994) are estimated to number between 85-120,000.

A January 1995 survey conducted in Tabou prefecture in January 1995 examined both the refugee (96,000 people) and local (24,000 people) population. Among the refugee population, many of whom fled fighting in Liberia during September 1994, prevalence of wasting was measured at 14.8% with 4.5% severe wasting (see Annex 1 (9b)). This shows a marked deterioration in nutritional status since the previous survey in September 1994 (3.3% wasting). The crude mortality rate was 2/10,000/day (7x normal) and the under five mortality rate was 5.6/10,000/day. Much of this situation can be attributed to the fact that less than 50% of new arrivals claim 10 have received a general ration. Furthermore, the general ration has only been providing 950 kcals/person/day which is inadequate for those new arrivals who have yet to develop means to supplement their ration [MSF-F Jan 95].

Among the local population, prevalence of wasting was measured at 5.4% with 0.4% severe wasting (see Annex 1 (9c)). The crude mortality rate was 1.5/10,000/day (4x normal) and the under-five mortality rate was 1.9/10,000/day. In total 80.6% of the children were immunised against measles [MSF-F Jan 95].

RNIS 9, February 1995

Conflict in Liberia up until the end of December 1994 led to a continued influx of refugees into Cote d’Ivoire. Although the number of Liberian refugees is estimated to be 330,000, this is recognised to be a provisional figure in anticipation of an imminent census of new arrivals, who it is estimated number between 85,000 to 120,000 people. There are also approximately 97,000 Liberian refugees who were estimated to be self-sufficient in March 1994, and will stop receiving food aid in 1995 [WFP 16/02/95].

Liberian refugees in Cote d’Ivoire have continually been encouraged and supported by government and relief agencies in their efforts to attain self-sufficiency. In line with this policy, their food rations have been reduced over the years and currently stand at 200 gms of cereal and 25 gms of vegetable oil per person per day (equivalent to about 1,000 kcals/person/day). However, there has been some recent concern expressed about the adequacy of partial rations for new arrivals. Furthermore, a recent devaluation has effectively doubled the price of consumer items for partly self-sufficient refugees. Preliminary results of a nutritional survey conducted in January 1995 amongst refugees in the Tabou area of Cote d’Ivoire also give cause for concern as levels of 14.8% malnutrition were recorded with 4.5% severe malnutrition (see Annex 1 (1c)) [UNHCR Jan 95].

RNIS 8, December 1994

The recent upsurge in fighting in southeast Liberia has caused a new influx of approximately 100,000 refugees into Cote d'Ivoire since mid-September. This brings the estimated total number of Liberian refugee in Cote d'Ivoire to 330,000. This is a provisional figure, and a proper census of new arrivals is scheduled for early 1995 [UNHCR 07/11/94, WFP 16/12/94].

Currently, new arrivals in Cote d'Ivoire receive a standard daily ration., and the nutrition situation appears to be adequate. A nutrition survey carried out in Cote d'Ivoire in September measured wasting at 3.3% and severe wasting at 1.3% (see Annex 1 (1e)) [AICF 28/09/94].

RNIS 7, October 1994

The fighting in Liberia has lead to a new influx of approximately 75,000 refugees into Cote d'Ivoire [WFP 30/09/94]. This increases the Liberian refugees population to 325,000 [WFP 20/10/94]. Most recent reports indicate that there are no major nutritional or health concerns amongst this refugee population.

RNIS 6, August 1994

It is currently estimated that there are over 250,000 Liberian refugees in Cote d'Ivoire the majority of whom have achieved varying degrees of self-sufficiency. The joint WFP/UNHCR census and stricter registration criteria and some spontaneous return to Bong and Nimba counties, has led to a reduction in numbers of registered beneficiaries [WFP 4/07/94]. These refugees are acknowledged to have been generously welcomed and supported by government and the host population and most recent reports indicate that there are no major nutritional or health concerns amongst this refugee population [UNHCR-a 18/07/94].

RNIS 5, June 1994

After a screening exercise conducted on distribution cards, the number of beneficiaries has decreased to 234,000 from 258,000 [WFP 9/05/94]. Many of the refugees work on local farms, on coffee plantations, or are involved in other income generating projects thereby attaining varying degrees of self-sufficiency. Almost 100,000 are now enrolled in an agricultural co-operative scheme which it is hoped will lead to them attaining complete self-sufficiency by the end of 1994 [UNHCR 6/05/94]. Cross border deliveries into Liberia are continuing [WFP 9/05/94].