United Nations System
Standing Committee on Nutrition

Nutrition Information in Crisis Situations - Kenya
 

NICS 16, March 2008

Presidential elections were held in Kenya on December 27, 2007 and accusations made by the opposition party of voting irregularities plunged the country into chaos. Schools and businesses closed across the country. As of the end of March 2008, there were about 202,600 displaced persons in camps and centres, and 196,000 displaced people within host communities, the majority of those from Rift Valley province (USAID, 26/03/08). Another 12,000 fled across the border to neighboring Uganda. The death toll rose to 1,020, with many more injured. Perceptions of ongoing insecurity have persisted, despite a decreased threat of violence since the signing of a power-sharing agreement on 28 February 2008.

Humanitarian actors, both national and international, were quick to jump into action, setting up shelters, providing food and medicines, as well as addressing water and sanitation needs. However, assessments by Kenya's Food Security Steering Group indicated that host families, most of whom are subsistence farmers, were under increasing pressure to sustain their own household food security in addition to that of displaced persons (FEWS, 12/02/08). More over, about seven districts that are affected severely by the conflict in Rift Valley province, account for close to 50 percent of all cereal produced in the country annually. As a result, current and future production has been severely disrupted by the insecurity (FEWS, 02/08).

NICS 15, December 2007

As of November 2007, the short rainy season had begun throughout the country and the supply of maize was predicted to be enough to meet domestic demand in the coming months (FEWS, 11/07).

Pastoralist regions in the northwest received early rainfall in October, providing much needed relief after poor rainfall earlier in the year. However, ongoing conflict in the area has closed both schools and markets, leaving the population vulnerable to food insecurity and malnutrition (FEWS, 11/07).

Rains were late or sporadic in some parts of the country, notably the southeast and coastal marginal agricultural regions. Already stricken by prolonged drought, the food security situation is at risk of deteriorating further if adequate rainfall is not received (FEWS, 11/07).

Nutrition surveys carried out by GTZ in August 2007 in the three Dadaab refugee camps in northern Kenya showed that the situation, while still serious, has markedly improved since similar surveys were carried out at the same time last year (figure 2). Mortality rates were all within acceptable range (GTZ, 08/07).

Vaccination rates were high in all of the camps. At the same time, levels of anemia among both mothers and children were much higher than WHO recommended cut-offs, ranging between 52.0-62.4% (mothers) and 77.4-84.1% (children). Approximately 2/3 of survey participants reported consuming at least two meals per day.

Figure 2 Results of nutrition surveys, Dadaab Refugee Camps, Kenya, August 2007 (GTZ/UNHCR, 08/07)

NICS 14, September 2007

Overall, national cereal availability has been favourable (Fews, 08/07). However, some of the districts previously affected by drought, i.e. Isiolo, Wajir, Garissa and Tana river, have remained highly food-insecure. Evolution of the food security situation will be determined by the forthcoming short rains between October and December.

According to nutrition data, the nutrition situation seems to have improved in Mandera, Marsabit, Wajir and Turkana districts in 2007 compared to 2006, although the prevalence of acute malnutrition has remained high (Fews, 08/07).

Three random-sampled nutrition surveys conducted in April-May 2007 in Wajir and Turkana districts showed critical nutrition situations in Wajir district and central and south-east parts of Turkana district (figure 2) (Merlin, 04/07; WV, 05/07). The situation was better, although still of concern in south-west of Turkana district. In both districts, food distribution and selective feeding centres were implemented. Both surveys recommended that current programmes be continued and strengthened when necessary and that long-term strategies to address food insecurity be implemented.

Figure 2 Results of nutrition surveys, Kenya, April-May 2007 (MERLIN, 04/07; WV, 05/07)

NICS 13, May 2007

Food security has generally improved in the previously drought-affected areas and food distribution beneficiaries will be reduced from 2.4 m in 2006 to 1.3 m in 2007 (FEWS, 05/07). Nutritional surveillance showed a decline in malnutrition in Garissa, Marsabit and Turkana districts. Compared to the same period in 2006, acute malnutrition has almost halved in the first quarter of the year. As of May 2007, the prognosis in key cropping areas was looking promising. However, Wajir, Isiolo, Garissa, Tana River and Ijara districts were still considered highly food insecure. The pastoralists will need time to recover from the drought and the Kenya Food Security Steering Group has identified critical long-term interventions to sustain improvements in pastoral food security (FEWS, 04/07).

The number of suspected cases of Rift Valley Fever has decreased and the ban on the slaughter of livestock has been lifted (OCHA, 04/04/07).

Grim situation in Mont Elgon - The escalation of clashes between rival communities around land allocation issues in Mount Elgon district, west Kenya, has led to the displacement of about 62,000 people representing nearly half of the total population in the district (KRCS, 04/07). In addition, a significant number of homes and some crops were burnt (OCHA, 04/04/07). The IDPs live mainly in market centres, churches, mosques and public buildings, or with relatives.

Food security is reported to be very poor as crops were burnt or left behind and insecurity has prevented the IDPs to return for harvesting. People have lost their main income source, the district being one of the country's granaries and people’s livelihoods depending mainly on the sale of crops. There is also a lack of grazing land for the families that keep livestock.

Prices of food and fuels have sharply increased. The water and sanitation situation is reported to have deteriorated. Some health facilities are not accessible due to insecurity; others are closed because of the displacement of health staff. The operational and accessible health facilities are overwhelmed. Protection is also an issue with increasing reports of rape and violence against young girls.

Concerted efforts to restore peace and resolve conflict are on-going (OCHA, 07/05/07). Some humanitarian aid has been delivered and more is planned. Food, non-food items and medical supplies have been distributed to the IDPs and support to health care implemented. Needs that are not covered include protection, psycho-social care for victims of violence, sanitation, education, and seeds and tools for families who have returned. Moreover, 11,000 people who have taken refuge in the most inaccessible areas have not received assistance yet. Impaired access due to poor roads and volatile security condition is a major constraint on the delivery of humanitarian relief.

About 5,000 people have sought refuge in nearby Uganda where they have not received any external assistance. The conditions in the area are reported to be deplorable and will further deteriorate with the onset of the hunger-gap season.

Critical nutrition situation in Mandera district - Three surveys conducted in Mandera districts showed critical nutrition situations (AAH-US, 03/07) (figure 2). The prevalence of acute malnutrition was comparable with that of surveys done in the same area in March 2006. Mandera district is chronically food insecure and part of the district was also affected by severe flooding at the end of 2006. The food security prospect was favourable in April/May 2007.

Figure II Prevalence of acute malnutrition, MAndera district, Kenya, March 2007 (AAH-US, 03/07)

Recommendations

From the Kenya Food Security Steering Group to sustain improvements in pastoralist areas:

• Establish hunger safety nets
• Establish a certification system for Rift Valley Fever and other diseases requiring quarantine
• Rehabilitate and develop infrastructure in the market-dependent pastoral livelihood zones
• Address chronically high malnutrition and poor access to health services
• Assist destitute pastoralists
• Strengthen existing early warning and food security analysis systems
• Enhance emergency preparedness
• Improve land, water and crop management
• Enact the National Policy for the Sustainable Development of Arid and Semi Arid Lands of Kenya

NICS 12, February 2007

Rift Valley Fever outbreak

Most parts of eastern Kenya remain extremely food-insecure after the floods that affected the area at the end of 2006 (see map) (FEWS, 02/07). Moreover, as a consequence of the floods, these districts have also been hit by an outbreak of Rift Valley Fever, a disease that affects livestock and is transmitted to humans (see map). As of February 2007, 150 people had died from the disease. Market, movement and slaughter restrictions were imposed and a livestock vaccination campaign launched. As of end February, the situation seemed to have improved in Garissa, Ijara, Mandera and Wajir districts, where the ban was lifted (OCHA, 28/02/07). A range of interventions, including health and nutrition have been implemented in the highly food-insecure areas (FEWS, 22/01/07).

Improved nutrition situation in Isiolo district

The nutrition situation had significantly improved in Isiolo district in November 2006 compared to May the same year (figure 1) (see NICS 10). This follows the same pattern as that observed in Mandera district (see NICS 11) and might be explained partly by seasonal variation, November being a more favourable season than May. Moreover, about 60% of the population received a full general food ration and blanket feeding was provided to pregnant and lactating women as well as children under-five. Selective feeding programmes were also in

place. However, the situation was still highly precarious, 80% of the people interviewed being highly reliant on food distribution, and access to meat and milk remaining limited.

Nutrition situation still precarious in Kakuma refugee camp

According to a nutrition survey conducted in Kakuma refugee camp in November 2006, the nutrition situation remains precarious, although it was significantly better than in December 2003 (figure 2) (IRC, 11/06). The general food distribution was regular in 2006, but about three quarters of the population sold part of their food ration, mainly to buy charcoal, soap, sugar, vegetables, milk and meat. Infant feeding practices were poor with only 25% of exclusive breastfeeding. Mothers introduced mostly plain or sugared water. Bottle feeding was used by 30% of the mothers. Frequency of feeding, and dietary diversity score were low for complementary feeding.

Anaemia among children was very high (81.7% of the 6-59 month-olds had haemoglobin < 11 g/dl) and was similar to the level found in 2004.

Areas affected by floods and Rift Valley fever (FEWS, 02/07)

Figure I Prevalence of acute malnutrition and mortality rates, Isiolo district, Kenya

Figure II Prevalence of acute malnutrition, Kakuma refugee camp, Kenya

Recommendations from the survey in Sericho and Merti divisions, Isiolo district:

• Continue food distribution and blanket supplementary feeding
• Continue selective feeding programmes and nutrition surveillance
• Reinforce MCH antenatal care
• Increase access to health facilities through mobile clinics

NICS 11, November 2006

Major floods have recently hit parts of Kenya, Somalia and Ethiopia (see map).

Affected populations in Kenya, Somalia and Ethiopia

Estimated numbers of the affected populations are changing rapidly because assessments are still on-going, and new flooding is still occurring. The table below gives some of the latest estimates available (table 1). Rains are expected to continue at least through December so the situation might deteriorate further (WFP, 20/11/06). The major impacts of the floods are the destruction of assets, shelter and infrastructure including roads, contamination of water, destruction of farmlands and deaths of animals. This leads to a disrupted food supply, increase food insecurity, and risk to disease for both humans and animals. In most of the affected areas, road accessibility remains one of the biggest constraints for humanitarian intervention.

Table 1 Estimates of affected population, Kenya, Ethiopia and Somalia floods, November 2006

Kenya

The most affected provinces in Kenya are North-Eastern and Coastal provinces although some floods have also affected Nyanza and Western provinces as well as Nairobi (OCHA, 28/11/06; OCHA 29/11/06) (table 2). In addition to the districts given in table 2, Moyale district in North-Eastern province and Mombasa district in Coastal province have been reported to have been affected (WHO, 19/11/06). In Garissa, Ijara and Tana River districts, critical issues noted were limited access to food, limited supplies in health facilities and major need for water treatment (OCHA, 29/11/06). There is little substantial evidence of major outbreaks so far. However, it seems that cases of diarrhoea have risen significantly in Dadaab area (WHO, 26/11/06). Thirteen cholera cases have also been confirmed in Mombasa (WHO, 26/11/06), two cases in Moyale (OCHA, 22/11/06) and 12 cases in Kwale (WHO, 19/11/06). Water sources are contaminated, drainage systems have collapsed and water pipes have been washed away (WHO, 26/11/06).

US$ 11.8 M have been allocated to UN agencies through the Central Emergency Relief Fund (CERF), for support in food, nutrition, logistics, protection, health, water, and refugee and livestock sectors in Kenya (OCHA, 22/11/06).

WFP has launched a massive three-month air operation to help affected populations in Kenya and Somalia (WFP, 24/11/06). However, it is unlikely that all food aid can be moved by air, so opening of roads remains an important priority (OCHA, 22/11/06). Food had been pre-positioned in affected districts before the onset of the rainy season and the main constraint for distribution was linked to logistics (OCHA, 29/11/06). Health interventions and distributions of non-food items have also taken place. It is difficult to know the extent of the gaps from existing information.

Animal health intervention will be critical in safeguarding livestock from Rift Valley Fever in Kenya (OCHA, 22/11/06). The livestock export ban that followed the 1997 floods was only lifted this year.

The Kenyan government has been urged by aid groups to declare the recent floods that have affected the country a "national disaster" (AFP, 27/11/06).

Table 2 Estimates of affected populations, Kenya, Nov 2006 (OCHA, 29/11/06)

Dadaab camps

More than 100,000 of the 160,000 refugees in Dadaab camps have been displaced by the floods (UNHCR, 21/11/06). About 90% and 70% of the refugees have been affected in Ifo and Dagahaley camps, respectively (UNHCR, 13/11/06). Most have lost their personal belongings. Latrines have flooded, contaminating standing water and posing a serious health risk.

Transfer of the most affected refugees in Ifo camp has begun; partly to Hagadera camp which was not affected by floods and partly to higher and dryer ground near Ifo camp, where some refugees have already settled, although no infrastructure is in place, notably water supplies and sanitation facilities. The new site is expected to cater for 20,000 people. UNHCR is currently working on the design and management of the new camp (UNHCR, 24/11/06).

Dadaab camps are very isolated due to impassable roads. Some supplies are airlifted but Dadaab airstrip cannot take large cargo planes. In addition to supplying the affected population, diesel is needed to run the generators that power the pumps supplying water in the three camps (UNHCR, 24/11/06).

Food stocks in Dadaab will last until mid-December (WFP, 24/11/06). Food distributions were conducted as usual in mid-November in Dagahaley and Hagadera camps while in Ifo about 8,000 people received a 7-day ration and 17,700 people received high energy biscuits. However, shortage of cooking fuel remains a main concern (OCHA, 22/11/06). Non-food items and health supplies have been delivered (UNHCR, 21/11/06).

Malnutrition and diarrhoea have been reported to be rising rapidly (UNHCR, 28/11/06).

Short rains have brought some relief to the drought-affected areas. However, floods have had devastating effects in parts of Kenya (see above). Where there was no flooding, grazing pastures and the condition of livestock have improved. Nevertheless, pastoralists remain food-insecure due to the long-standing effects of droughts on their livelihoods, and because of structural factors (Fews, 9/10/06; Fews, 8/11/06). Maize crops are expected to be good.

Improvement of the nutrition situation in Mandera district

A nutrition survey, conducted in Wargadud, Lafey, El Wak, Kotulo and Shimbir Fatuma divisions, Mandera district, in October 2006 showed that the situation had improved significantly compared to March this year (MSF-B, 10/06). Prevalence of acute malnutrition was 15.3% (12.6-18.1) including 1.0% (0.4-1.7) severe malnutrition in October vs. 29.8% (25.9-33.6) including 2.3% (1.3-3.3) severe malnutrition in March. Mortality rates have also decreased significantly from 1.5 (0.9-2.1) to 0.3 (0.1-0.5) for CMR and from 4.1 (2.1-6.1) to 0.8 (0.2-1.2) for under-5 MR. Although no explanation was given in the report, improvement might be partly attributed to seasonal effects: March corresponded to the peak of the drought after poor Oct-Dec 2005 short rains, while fair long rains improved the food security thereafter (FEWS, 09/10/06). Relief aid might also have helped: Food distributions targeting 75% of the population were conducted as well as blanket supplementary feeding for children under 5 years between June and September.

High prevalence of malnutrition in Turkana district

Six nutrition surveys were conducted simultaneously in Turkana district in May 2006 (CCF/OXFAM/WV/UNICEF, 05/06). Results showed critical nutrition situations (table 9). Turkana district has suffered recurrent droughts within the past years, the latest being in 2005-2006. When available, comparisons showed that the situation was comparable to 2005 but has improved compared to 2004 in Kaaleng, Kibish, Lapur and Lokitaung divisions, while it has worsened in Kakuma, Lokicchogio and Oropori divisions (figure 4). People who fish for a livelihood seemed to have the better nutritional status while natural resource dependants and casual/formal employees were the worse off. Pregnant and lactating women also had a poor nutrition status according to MUAC measurements (table 9). Access to latrines was poor in all the surveys, while access to safe drinking water ranged from 31.8% in Central, Kerio and Kalokol divisions to 68.5% in Kaaleng, Kibish, Lapur and Laukitaung divisions.

Child-feeding practices were poor with exclusive breastfeeding varying between 25% and 45%, and introduction of complementary feeding at six months ranging from 3.3% to 21.0%, depending on the survey.

Food distributions were received by 29.7% to 87.6% of the families interviewed depending on the survey. Rations accounted for about 30% of energy needs. Most of the ration was consumed with about 10% to 15% being shared. Relief food represented about 20% of the source of food, while gifts from relatives represented about 15% and buying in markets, which was the major source, 49%. At the time of the surveys, families were obliged to use coping mechanisms, with between 30% and 51% of the households using severe or very severe coping mechanisms. This showed that food insecurity was highly prevalent.

The survey reports deplored that no concerted efforts to improve food security and health exist at district level.

Table 9 Results of nutrition surveys in Turkana district, Kenya, May 2006 (CCF, OXFAM, WV, 05/06)

Nutrition situation remains critical in Dadaab camps

A nutrition survey was conducted in Dadaab camps in June 2006 (GTZ, 08/06). At that time, the camps hosted about 130,000 refugees mostly from Somalia. About 30,000 new Somali refugees have recently arrived at the camps, fleeing insecurity in Somalia. The survey showed a critical nutrition situation that has not improved within the last few years (figure 5). Anaemia levels among children and women were also very worrying with 78% and 72.7% of the children and pregnant women showing anaemia, respectively. Although anaemia is probably due to low levels of micro-nutrients in the diet, the high consumption of tea and high prevalence of malaria can be compounding factors.

Food distributions (cereals, oil, pulses, CSB and sugar) were regular within the year preceding the survey. However, due to a very limited capacity of the refugees to gain incomes, part of the food was used to buy other foods such as tea, sugar, milk and vegetables and non-food items especially soap, which were not distributed regularly in the camps. Food rations last on average 9 days instead of the 15 days they are intended to. To compensate for this, most of the refugees (81.2%) relied on borrowing from neighbours and relatives and buying food (37.8%) with incomes earned from manual labour or firewood collection.

Exclusive breastfeeding was 29.1% and timely introduction of complementary feeding was only 25%. Dietary diversity for children seemed very poor, reflecting the monotonous diet of the refugees, and the number of meals they ate per day was lower than recommended.

Vitamin A supplementation and measles vaccination coverage were good and mortality rates were below alert thresholds.

Figure IV Trends in prevalence of acute malnutrition, Turkana district, Kenya

Figure V Trends in prevalence of acute malnutrition, Dadaab refugee camps, Kenya

Overall

Rains have improved the situation in drought-affected areas but floods have had a very negative impact in parts of Coastal and North-Eastern provinces. Food security of pastoralists who were not affected by the floods is expected to improve somewhat, even though they will not be able to recover in the short term.

NICS 10, August 2006

Highland cropping areas have reported a favourable harvest and prices have fallen in these areas. However, the rainy season has brought only modest improvements in marginal agricultural areas, where the harvest was poor (FEWS, 09/08/06). The situation is also still precarious in most of the pastoral areas.

Critical situations in Mandera and Isiolo districts

Nutrition surveys conducted in Mandera district, which is mostly pastoralist, in March 2006 showed critical nutrition situations (AAH-US, 03/06; MSF-B, 03/06) (figure 2). Mortality rates were under control except in the south-eastern part of the district where they were above emergency thresholds (figure 2). The main causes of deaths were diarrhoea and fever. The situation was also critical in Merti and Sericho divisions of Isiolo district, according to a survey conducted in May 2006 (SC-UK, 05/06) (figure 2). The prevalence of acute malnutrition recorded in this survey was significantly higher than in March 2005 in a survey including Oldornyiro division in addition to the two divisions surveyed in 2006. Moreover, a significant number of women were found malnourished according to MUAC measurements (table 1). These mostly pastoralist divisions were the areas of the district the hardest hit by the drought, and inhabitants regard this year’s drought as the worst since 1996. People interviewed during the survey reported that adults were only eating one or two meals a day, compared to three in 2003, which they considered as a particularly "good" year. Children were fed only two to three times a day compared to six to eight times in 2003. This was the result of a lack of food but also of an increased demand on mothers to fetch water and fodder for sick animals. Close to 90% of the families interviewed were reliant on general food distributions, and families reported a shortage of milk and meat, compared to 2003.

Figure II Results of surveys, Kenya (AAH-US, 03/06; MSF-B, 03/06; SC-UK, 05/06 )

Table 1 Women nutritional status, Isiolo district (SC-UK, 05/06)

Recommendations

From the SC-UK survey in Isiolo district:

Short term (food and nutrition):

• Improve general food distribution by adding pulses and oil to the food basket
• Update register of food distribution beneficiaries taking into account recent livestock losses
• Implement blanket supplementary food distribution for all under-five children, pregnant and lactating women in the next three months
• Initiate treatment of severe malnutrition
• Continue supplementary feeding at least until December 2006 and include pregnant and lactating women in the programme.

Long term:

• Several actions are proposed to sustain livelihoods, such as an increase in food sources and improved management and selling of livestock.

NICS 9, May 2006

Nutrition situation still poor in Kakuma and Dadaab refugee camps

Kakuma refugee camp is located in Tukana district and hosts about 90,000 refugees, mostly from Sudan (80%) and Somalia (17%). A new wave of Somali refugees has begun to pour in to the camp as a result of drought in parts of Somalia (CARE, 27/04/06). According to a nutrition survey conducted in November 2005, the nutrition situation was still highly precarious in the camp and has not improved compared to previous years (figure 2) (IRC, 01/06). In 2005, the general food distribution was about 90% of the targeted 2,100 Kcal/pers/day full ration. Refugees seem highly reliant on the general ration and the poorest people sell part of it to buy other foods, such as sugar, vegetables and meat or non-food items which are not distributed regularly. Breast-feeding practices seem average with 89.3% of the 0-23 month olds being breastfed, and 95.5% of the 6-23 month olds receiving complementary feeding. On the other hand, only 20% of those less than six months old were exclusively breastfed, and dietary diversity of complementary food was poor.

Dadaab refugee camps in Garissa district host about 140,000 refugees, mainly from Somalia. The nutrition situation was highly precarious as of June 2005 and has remained stable compared to 2003 (BMZ/UNHCR/GTZ, 06/05). The food distribution for the first semester of 2005 had been near the targeted 2,100 Kcal/pers/day, except in May when it was lower. As in Kakuma, people sold part of their rations for other foods such as sugar, milk or meat. Anaemia was widespread in the camps among children and pregnant women and was indicative of a public health problem (table 2).

Table 2 Prevalence of anaemia, Dadaab refugee camp, Kenya, June 2005 (BMZ/UNHCR/GTZ, 06/05)

Food insecurity still extremely severe in pastoral areas

About 3 m people are in need of emergency food aid , especially in Marsabit, Isiolo, Mandera and Turkana districts (see map), but the food pipeline is only 50% resourced (FEWS, 10/04/06). The beginning of the rains has brought some relief but the overall performance of this rainy season will determine the future food security of the affected areas.

Food security status, Kenya , March 2006 (Fews, 10/04/06)

Random-sampled nutrition surveys conducted in Moyale, Samburu and Marsabit districts, three of the ten districts considered as the most affected by the drought, showed dire situations, especially in Marsabit (figure 2) (UNICEF, 03/06). Most of the households have reduced their food intake and were reliant on food aid. Almost all households reported receiving food in the three months prior to the survey. The survey report recommended, among other things, the continuation and scale-up of the food distribution, and the implementation of supplementary and therapeutic feeding programmes.

Figure 2 Prevalence of acute malnutrition, Kenya, March 2006 (UNICEF, 03/06)

NICS 8, January 2006

Failure of the short rainy season has compounded the already poor situation in eastern and northern Kenya (FEWS, 19/12/05). Malnutrition rates have been reported as being very high in Wajir, Mandera and Marsabit districts. The need for emergency food aid is expected to expand from the current caseload of 1.14 million. More precise information will be available at the beginning of February when in-depth assessments will be completed. However, mobilisation to ensure that the food pipeline is replenished is urgently required.

NICS 7, August 2005

Ethnic tensions exacerbated by poor livelihoods

In mid-July 2005, about 70 people were killed in a clash between two ethnic groups in Marsabit district (IRIN, 01/08/05). In Mandera district, where the food security situation is very poor, ethnic clashes were reported at the beginning of the year. The poor situation is exacerbated by the presence of an estimated 17,000 refugees fleeing Somalia and sharing the meagre resources of the host community (IRIN, 01/08/05).

Prevalence of acute malnutrition still high in Turkana district

According to a nutrition survey conducted in North-Eastern and North-Western Turkana in March 2005 (OXFAM, 03/05), the situation was still highly precarious, despite the provision of relief assistance (table 2). The situation has, however, improved in the North-Eastern zone, which was the more affected in February 2004 (figure 2). Measles vaccination coverage was average, despite a measles vaccination campaign which took place in May 2004. Vitamin A distribution coverage seemed not bad, Vitamin A having been distributed during measles and polio vaccination campaigns. The under-five mortality rate was above alert threshold (table 2). Most of the households in the North-Eastern and North-Western zones were pastoralists (55% and 47%, respectively). The main additional livelihood groups were fisher folk (12%), employed (11%) and firewood/charcoal sellers (9%) in the North-East and firewood/charcoal sellers (21%), employed (16%) and traders (12%) in the North-West. When compared to the last "normal" year, which was 1997 according to the population, pastoralists have lost a significant number of livestock. Overall, the food security situation and access to water were poor (box 1). According to the assessment, households in the North-East were more food insecure than households in the North-West.

Seventy percent and 50% of the households in the North-East and North-West, respectively, were entitled to receive a full food basket of cereals, pulses, vegetable oil and salt (2,100 Kcal/pers/day). In addition, blanket supplementary feeding has been implemented for children under 12 years old, pregnant and lactating women, and the elderly population, equating to 62% of the target population of the general food distribution. According to the households interviewed, the coverage of the general food distribution and of the blanket food distribution was higher than planned (box 1), probably due to inter household sharing. However, the food distribution was erratic: the quantity of food distributed was far below what was planned (box 1). This was principally due to a WFP pipeline shortage. Treatment of severely malnourished and moderately malnourished children was available in some divisions.

Table 2 Results of surveys in Turkana districts, Rift Valley province, Kenya (OXFAM, 03/05)

* According to cards or mothers' statements

Figure 2 Prevalence of acute malnutrition, Turkana district, Kenya

Box 1 Food security and water sources, North-Eastern and North-Western Turkana, Kenya (OXFAM, 03/05)

Recommendations:

From the OXFAM survey in Turkana district:

• Continue to provide a full general food ration to a minimum of 75% of households if the long rainy season fails
• Continue to provide blanket supplementary feeding to under-five year olds, pregnant and lactating women
• Continue support to severely malnourished children and improve the referral system in the North-West
• Continue to support existing health facilities
• Implement cash-for-work and food-for-work programmes
• Continue to support the provision of safe water
• Support livestock development
• Incorporate peace-building and conflict-reduction activities at community level

NICS 6, May 2005

Following a poor short-rainy season in parts of Kenya, the delay in the onset of the long-rains season is a cause of concern (FEWS, 14/04/05). A significant number of districts are considered as being in the alert phase regarding food security. The drought-affected pastoral and marginal agricultural areas are the most at risk. Moreover, inter-clan clashes have been reported in Turkana, West Pokor, Garissa, Marsabit and Mandera districts (IRIN, 16/03/05, FEWS, 14/04/05). Food distributions have been disrupted in March due to logistical problems (FEWS, 14/04/05).

Beside weather hazards, the problem of chronic poverty seems to be also related to minorities' issues in some districts. A report highlights that some minorities are the frequent victims of development policies (MRG, 13/04/05). For example, the total development budget for the district of Turkana, which is one of the poorest districts in Kenya and is regularly hard hit by drought, was less than one sixth of the budget for the relatively prosperous Nyeri district, in 2004-2005. The report warns that excluding minorities from development can result in conflict.

Appalling rates of malnutrition in North Eastern Kenya

Wajir and Mandera districts are part of the arid lands. They are mainly populated by Somali ethnic pastoralists. The areas suffer political, social and economic marginalisation and have poor infrastructure and very limited employment opportunities. They were also hard hit by the drought which began in 2003. Random-sampled nutrition surveys were conducted in the worst affected areas of the districts: Wajir South and Wajir West in October 2004 (OXFAM, 10/04), and Mandera Central and Khalalio divisions in Mandera district in March 2005 (AAH-US, 03/05). The surveys revealed very high rates of acute malnutrition while crude mortality rates were under control (table 2). The under-five mortality rate was above alert threshold in Wajir West. When compared with the results of nutrition surveys carried out in September 2001, the nutrition situation in Wajir South seems to have remained stable while it has significantly worsened in the Western zone. A food distribution is implemented in the district, targeting 22% of the households. This is clearly not enough to guarantee an adequate nutritional status.

Table 2 Results of surveys in Mandera and Wajir districts, North-Eastern province, Kenya (OXFAM, 10/04; AAH-US, 03/05)

In Mandera district, the comparison with previous surveys conducted in Mandera Central division showed that the nutrition situation is within the same range as in March 2002, but has significantly deteriorated when compared to March 2001. Despite the implementation of a targeted food distribution and of supplementary and therapeutic feeding programmes, the nutrition situation is still highly precarious.

Recommendations

From the Oxfam nutrition survey in Wajir:

• Distribute a full general ration to at least 60% of the population
• Implement blanket supplementary feeding for children under-five years old
• Implement supplementary feeding centres for moderately malnourished children
• Improve the accessibility and availability of affordable medical care and access to water and sanitation
• Implement programmes to support livelihood recovery

NICS 5, February 2005

Contrary to expectations before the onset of the short rainy season, rains were poor in the marginal agricultural districts in Eastern, Coast and Central provinces, which has led to maize crop failure (FEWS, 06/01/05). The expected short rainy season harvest of maize has been revised to 270,000 MTs instead of the 450,000 MTs which was originally expected (FEWS, 20/01/05). The long and short rain harvests are estimated at 2 million MTs instead of the 2.61 million MTs average of the10 previous years (FEWS, 20/01/05). Poor short rains have also badly affected the agro-pastoral district of Kajiado (FEWS, 20/01/05). Pastoral districts of Marsabit and western Mandera have experienced water shortages and fatal clashes over water have been reported in Mandera district and the Mai Mahiu region (FEWS, 20/01/05; AFP, 24/01/05). In other pastoral areas, food security seemed to have improved (FEWS, 20/01/05).

Food distribution to the 26 drought-affected districts improved in December 2004: 2.2 million people received food aid compared to 1.3 million in November. The ration also improved in quantity and quality (FEWS, 06/01/05).

Nutrition situation not critical in Kitui district, Eastern Region and Taita Taveta district, Coastal region

Random-sampled surveys conducted in two southern districts (mostly agro-pastoral), which have been declared affected by the drought, showed acceptable prevalence of acute malnutrition (table 6) (AMREF, 10/04; IMC, 10/04). However, the poor last rainy season may worsen the situation. Mortality was under control in Kitui district.

Table 6 Results of surveys in Kitui district, Eastern province and in Taita Taveta district, Eastern province, Kenya, October 2004 (AMREF, 10/04; IMC, 10/04)

* According to cards or mothers' statements
** Not including oedematous children

Precarious nutrition situation in Kakuma refugee camp and Kakuma town, Turkana district

Kakuma refugee camp was set up in 1992 and hosts mostly Sudanese refugees (about 75%), Somali refugees (about 14%) and a small number of people from the Great Lakes. In October 2004, the camp was hosting about 90,000 people.

Turkana district is classified as an “arid and semi-arid land” and is mostly pastoral.

This area is chronically food insecure with a significant reduction in herds over the past few years. The most recent droughts were experienced in 1999-2002 and in late 2003-2004 (see NICS 2).

Two random-sampled nutrition surveys were conducted in Kakuma refugee camp and among resident populations around Kakuma town in October 2004 (IRC, 10/04).

According to the surveys, the nutrition situation was serious and mortality rates were high (table 7). The nutrition status of resident and refugee children were comparable, while mortality rates seemed higher among the resident population than among the refugees.

Comparison with previous surveys showed that the nutrition situation in Kakuma camp was within the same range as in late 2003 (figure 1).

Figure 1 Prevalence of acute malnutrition, Kakuma refugee camp

A survey conducted in February 2004 in Kakuma, Lokichoggio and Oropoi divisions in Turkana district revealed a prevalence of malnutrition of 16.8% (14.5-19.4) (see NICS 2). Although this survey and the survey carried out in October 2004 are not directly comparable, because they were not conducted among the same population, the results of both surveys are within the same range.

Haemoglobin measurements among refugee and resident children showed that anaemia was a major public health problem in both resident and refugee populations (table 8).

Almost all refugee households were getting relief food (98.4%) while 30.7% of the resident households had access to food distributions. More than half of the refugees (58.9%) were selling part of the food distribution to buy items such as milk, meat, vegetables, cloths, soap or firewood.

Only about 35% of the refugee and resident mothers were exclusively breast-feeding their children until the age of 6 months.

Table 7 Results of surveys in Kakuma refugee camp and Kakuma town, Turkana district, Kenya, October 2004 (IRC, 10/04)

 * According to cards

Table 8 Prevalence of anaemia, Kakuma refugee camp and Kakuma town, Turkana district, Kenya, October 2004 (IRC, 10/04)

*Mild anaemia: Hb = 7-11 g/dl; moderate anaemia: Hb = 5-7 g/dl; severe anaemia: Hb < 5 g/dl

Average nutrition situation in Dadaab refugee camps, Garissa district

A random-sampled nutrition survey was conducted in June 2004 in Dadaab refugee camp (GTZ, 06/04). At the time of the survey, the three camps located in Dadaab area (Hagadera, Dagahaley and Ifo) were hosting 134,784 people, mainly from Somalia. Unfortunately, the prevalence of acute malnutrition was only expressed as a percentage of the median. The prevalence of acute malnutrition was 6.9% (5.3-8.6), including 0.2% (0.1-0.6) severe acute malnutrition. Comparison with the prevalence of malnutrition, also expressed as a percentage of the median, from previous surveys showed an improvement compared to 2003 when acute malnutrition was 15.1% (12.2-17.9), including 2.2% (1.3-3.1) severe acute malnutrition.

Anaemia (Hb < 11 g/dl) was high among the 6-59 month-olds: Hagadera: 54.3%, Ifo: 61.2% and Dagahaley: 60.9%. It was, however, lower than in Kakuma (see above).

The food distribution seemed to have been near the intended 2,100 Kcal/pers/day over the six months prior to the survey, with an average distribution of 2072 Kcal/pers/day. About half of the households were selling part of their food ration and especially cereal, mainly in order to buy other food such as sugar, milk, meat, tea leaves, rice and vegetables, or soap and paraffin.

More than half of the households (56.1%) reported having some kind of income and/or property. Forty-two percent of the households owned livestock, while 27% had incomes: about 20% had some kind of waged labour or income-generating activities, 4% had their own business and another 4% were receiving remittances.

It seemed that fewer families who reported having incomes were selling part of their food ration (29%) than families who reported not having incomes (60%).

This might be explained by the fact that for families who do not have an income, selling part of the food ration is the only way to obtain other food or non-food items.

Tsunami

While the Tsunami hit the Kenyan coast at the end of December 2004, it seemed that the early evacuation of the beaches and coastal areas prevented major casualties. A few wounded people and one death were reported (Afrol News, 03/01/05). Mombasa city and nearby villages seemed to have been badly hit.

Overall

Food security is still poor in pastoral and agro-pastoral areas hit by drought. The nutrition situation of both refugee and resident population in Kakuma division, Turkana district is precarious (category II), while it seemed to have somewhat improved in Dadaab refugee camps.

NICS 4, November 2004

The short rainy season started earlier than usual and was expected to be good in agricultural areas. This will improve the situation in the drought-affected agricultural areas from the harvest expected in February 2005. On the other hand, drought was expected to continue in parts of Turkana, Marsabit, Isiolo and Laikipia districts (FEWS, 07/10/04). An assessment conducted early October in pastoral areas showed that the situation was still serious (FEWS, 28/10/04).

The August-January Kenya emergency operation was only 60% resourced as of October 2004 and it was anticipated that while cereal needs will be met, shortfalls of pulses and blended food will remain (FEWS, 07/10/04, WFP, 29/10/04).

WFP has experienced food shortfalls and delivery problems for Dadaab refugee camps; the food rations distributed have been lower than intended (WFP, 29/10/2004).

Investigation of the outbreak of aflatoxin intoxication in eastern and central regions, which peaked between April and July 2004 (see NICS 3), revealed aflatoxin concentrations above tolerated threshold (> 20 ppb) in about half of the food samples collected from households and markets, with some samples showing concentrations as high as 8,000 ppb (MMWR, 04/09/04). The government of Kenya provided replacement food in the most affected districts and people have been advised to avoid eating food suspected to be mouldy.

Precarious situation in the pastoral area of Garissa district and critical nutrition situation in Wajid district

Garissa district is one of the 26 districts declared affected by drought in 2004. The district has also been included in the 12 districts selected by the Health and Nutrition sector group for interventions. A random-sampled nutrition survey was conducted in September 2004 in the pastoral area of the district (UNICEF/MOH, 09/04). The prevalence of acute malnutrition revealed a precarious situation with 16.5% (14.3-18.8) of the children surveyed being acutely malnourished, including 3.5% (2.6-4.8) severely malnourished. 11.8% of the mothers were classified energy deficient (MUAC < 22 cm). About 64% of the children had received measles immunisation and only 43% of the children had received vitamin A during the year prior to the survey. Mortality rates were average: CMR = 0.46 pers/10,000/day and under-five mortality rate = 1.1 pers/10,000/day. The food security situation was estimated poor.

According to two nutrition surveys conducted in Wajid West and Wajid South in October 2004, the situation was critical: the prevalence of acute malnutrition was 31.5%, including 3.5% severe acute malnutrition, and 22.4%, including 2.3% severe malnutrition, in Wajir West and Wajir South, respectively (FEWS, 11/11/04).

Situation of concern in Mandera district

Mandera district has been highly affected by the current drought. This district is also chronically food insecure, at least since the major drought in 1991-92 when pastoralists, the predominant group in this area, lost most of their livestock. A rapid assessment conducted in Mandera Central, Takaba, Kotulo, Lafey and Wargadud divisions in August 2004 (AAH-UK, 08/04), showed a situation of concern: 28.6% of the children ( 12-59 months) measured were at risk of malnutrition (MUAC ≥ 12 cm and < 13.5 cm), while 1.9% and 0.7% were moderately (MUAC < 12 cm and ≥ 11 cm) and severely (< 11 cm) malnourished, respectively. Scarcity of water has reached a critical level in some divisions.

NICS 3, August 2004

Drought emergency declared in 26 districts

The president of Kenya declared the current drought a "national disaster" and appealed for relief food assistance (AFP, 14/07/04). Early cessation of rains in May has led to the wilting of crops and insufficient replenishment of pastures. Twenty-six of the 71 districts of Kenya are affected (UNICEF, 03/08/04) and 1.8 million people are considered in need of food aid, as well as 500,000 school children in addition to the one million school children already benefiting from school feeding programmes (KFSSG, 14/07/04).

The most vulnerable households are found in Eastern province, Coastal province and in pastoral areas (KFSSG, 14/07/04). Grain prices have risen and terms of trade have worsened for pastoralists. People have begun to engage in coping mechanisms.

Should the next rainy season be poor, an additional one million people would be in need of food aid (KFSSG, 14/07/04).

A drought relief EMOP prepared by WFP was approved at the beginning of August 2004 (WFP, 06/08/04). In addition, a flash consolidated inter-agency appeal was launched. The appeal covers the period of August 2004 to February 2005 and includes food aid, health and nutrition, water and sanitation, education, agriculture and livestock, and coordination and support services (OCHA, 10/08/04).

In five districts of the eastern region, aflatoxin (a toxin created by mould on grains) contamination of maize grains has led to more than 100 deaths (KFSSG, 14/07/04). Testing of grains for aflatoxin and destruction of contaminated stocks are under-way.

Emergency assistance in Turkana districts

Following assessments showing high food insecurity and appalling rates of malnutrition, food distribution and nutrition programmes have been implemented in Turkana and Marsabit districts and seemed to have mitigated the poor situation (FEWS, 06/07/04).

Recommendations

According to the KFSSG assessment:

• Immediate food aid assistance for 1.8 million drought affected people and 500,000 school children
• Increase of the number of beneficiaries if the next rainy season fails
• Closely monitor the performance of the next short rainy season

In addition, the following needs were identified and more information and analysis is required:

• Supplementary feeding for children and pregnant/lactating mothers.
• Seeds to plant during short rains.
• Water trucking in some parts of the country.
• Water purification tablets.
• Rehabilitation and construction of boreholes and dams.
• Control of crop destruction by wildlife.

NICS 2, May 2004

Serious food security and nutrition situation in Turkana and Marsabit districts

Turkana and Marsabit districts are classified as “arid and semi-arid lands” and are amongst the driest and least productive in Kenya.

This area is chronically food insecure with a significant reduction in herds over the years. The last years of drought in 1999-2002 further weakened the livelihoods of this mostly pastoral population. The October-December short rains were poor in Marsabit district and poorly distributed in Turkana district, which prevented the pastures in the worst affected areas from being replenished. Moreover, increased insecurity in Turkana district, such as cattle raiding, has further exacerbated the poor situation. The condition of livestock was reported as deteriorating, the price of livestock was very low and the terms of trade were unfavourable to pastoralists (FEWS, 19/03/04). However, good rains in April may have mitigated the situation (FEWS, 06/05/04).

Several nutrition surveys recently carried out in these districts showed high rates of acute malnutrition, ranging from 18% to 34% (FEWS, 05/04/04).

About 230,000 persons (40% of the population) will benefit from food aid from April to July 2004, at a 50% ration (FEWS, 05/04/04).

Nutrition crisis in north-eastern zone of Tukana district

An appalling nutrition situation was found in the northeastern zone of Turkana district during a random-sampled nutrition survey conducted in February 2004 (OXFAM, 02/04). The prevalence of acute malnutrition was 34.4% (31.3-37.4), including 5.4% (4.0-7.0) severe acute malnutrition, and has dramatically increased within the last two years. The rate of malnutrition was around ten percent in 2001 and 2002 and was about 28% in March 2003. Different factors, such as the poor rains in 2002-2003, the halt in the food distribution programme at the end of 2002 and the overall destitution of households over the years, may explain the deterioration of the nutrition situation. Mortality rates were also high: CMR=2.1 /10,000/day and <5MR=2.6 /10000/day.

A significant proportion of pregnant and lactating women (42%) had a MUAC < 23 cm.

Vitamin A distribution coverage was low and measles vaccination coverage was average (table 8).

Table 8 Measles vaccination and vitamin A distribution coverage, Northern Turkana district, Kenya, February 2004 (OXFAM, 02/04)

The number of meals has significantly decreased compared to "normal times" (table 9). It is worth noting that 20% of the families reported having no meal the day prior to the survey, indicating a very worrying situation.

Table 9 Number of meals taken, North-eastern Turkana district, Kenya, February 2004 (OXFAM, 02/04)

The main livelihoods of households were pastoralism (64%), fishing (11%) and handicrafts (10%).

The traditional sources of income (from livestock or fishing) were limited by the bad condition of livestock and its low price, and by the high cost of inputs for the use of boats. People tended to shift to coping strategies such as an increase in petty trading.

As of May 2004, emergency general food distributions and food for work programmes were on-going and the implementation of treatment of severe malnutrition was planned.

Precarious nutrition situation in the north-western zone of Turkana district

A survey done at the same time as in the eastern part of Turkana district (see above), showed a precarious situation but which had not deteriorated since 2003 (OXFAM, 02/04). The prevalence of acute malnutrition was 16.8% (14.5-19.4) including 1.8% (1.1-2.9) severe acute malnutrition in February 2004, 18.9% in March 2003 and 11.4% in February 2002. The same factors as for the eastern part of the district may explain the deterioration of the nutrition situation compared to 2002. Mortality rates were also lower than in the eastern part of the district; CMR and <5 MR were respectively 1.5 /10,000/day and 1.2 /10,000/day. Measles vaccination and vitamin A coverage were low (table 8).

Most of the population was pastoralist or urban/semi-urban. The number of meals has decreased when compared to "normal times" but to a lesser extent than in the eastern zone.

The proportion of income from livestock has decreased in both groups whilst the proportion of income from petty trade has increased. The sale of wild food has also widely decreased, which may be due to scarcity or an increase in consumption.

The Kakuma refugee camp, hosting about 80,000 people and the humanitarian Operation Life Line Sudan headquarters are situated in this area. It is thought that the activities and trade opportunities they offer, may partly explain why the nutrition situation has deteriorated less than in the eastern part.

Worsening nutrition situation in Kakuma refugee camp, Turkana district

Kakuma refugee camp was set up in 1992 and hosts mostly Sudanese refugees (about 60%), Somali refugees (about 35%) and a small number of people from the Great Lakes. In December 2003, the camp was hosting about 87,000 people. Although the movement of the refugees and the employment opportunities outside the camps are restricted, some refugees manage to get incomes. The better-off also receive remittances from abroad. The poorest refugees are those who can not secure regular and significant incomes (35-45% of the refugees). Most of the refugees are highly dependant on international aid. The relation with the local population is tense and riots occur regularly.

The refugees are meant to receive a full food distribution (2,168 Kcal/pers/day), but the ration actually distributed is often lower due to frequent pipeline breaks. The distribution of CSB, which should supplement the ration in micro-nutrients is often reduced or omitted.

The nutrition situation is regularly followed with an annual nutrition survey. The situation has remained above acceptable levels for years (figure 3). The last nutrition survey carried out in December 2003 showed a significant deterioration of the situation compared to 2002 (figure 3) (IRC, 12/03).

Figure 3 Acute malnutrition, Kakuma camp, Turkana district, Kenya

During this survey, the haemoglobin status of 270 children aged 6-59 months was measured. Results showed appalling rates of anaemia (table 10), which have worsened when compared to the results of April 2001 when already 61.3% of the children were considered anaemic (Hb<11 g/dL). At the time the survey was written, the measurement of haemoglobin was repeated in order to verify these high rates of haemoglobin deficiency.

The measles vaccination and vitamin A distribution coverage, according to cards and mothers’ statement was 74.3% and 40.4%, respectively.

A small percentage of the families (about 2%) seemed not to be registered for the general food distribution.

Around 55% of the mothers interviewed during the survey reported having received counselling on breast-feeding. Some 62% of the mothers said they know that mothers can transmit HIV to their children.

The nutrition situation of the refugees seems to be comparable with that of the host population in the same regional zone (see above).

The insufficiency of aid provided may partly explain the rise in malnutrition. Although interactions between refugees and the host population are restricted, interactions exist and the actual food insecurity faced by the host population may also have some implications for the refugees.

Table 10 Anaemia among 6-59 month olds, Kakuma refugee camp, December 2003

Overall

Turkana district is chronically food insecure and households' livelihoods have been eroded over the years. In some areas such as the northeast, coping mechanisms are limited and the food security and nutrition situation has worsened within the past two years (category I); the prevalence of acute malnutrition has increased threefold between 2001-2002 and 2003-2004. In the northwest part of the district, the situation has also worsened but to a lesser extent (category II). The nutrition situation in Kakuma refugee camp is above acceptable levels (category II).

Recommendations

From the OXFAM survey in the Turkana district:

Eastern zone:

• Distribute immediately a full food ration to a minimum of 70% of the affected population for up to three months
• Include a blanket supplementary food distribution to the general ration for at least all the under-five children and consider implementing it for all the under-12 year olds
• Include a blanket food distribution for all women of reproductive age, as 70% are considered to be either pregnant or lactating
• Support the existing health facilities in the treatment of severe malnutrition

Eastern and western zones:

• Support vitamin A distribution and measles vaccination
• Follow the food security and nutrition situation closely
• Implement school feeding programmes in all schools
• Implement long-term programmes aimed at supporting livelihood recovery
• Enhance existing conflict resolution and peace building

From the IRC survey in Kakuma:

• Identify underlying determinants of malnutrition
• Strengthen community support systems
• Step up vitamin A supplementation programme

RNIS 43, November 2003

Refugee camps in Dadaab

The three refugee camps, Ifo, Daghaley and Hagadera, located around Dadaab town in Garissa district, were established in 1991 and 1992. The camps host about 130,000 refugees, mainly from Somalia.

A random sampled nutrition survey was carried out in the three camps in June 2003 (MSF-B, 06/03). The prevalence of acute malnutrition was 23.9% (20.0-27.7) including 3.7% (2.5- 4.9) severe acute malnutrition. The prevalence of malnutrition has remained high since 1997 and has increased significantly since last year (see graph). A retrospective mortality survey was also carried out. The results showed a high under-five mortality rate (2.1/10,000/day), whilst crude mortality rate remained undercontrol (0.5/10,000/day). These results were not in accordance with the results of the mortality routine surveillance, which showed lower mortality rates.

Prevalence of acute malnutrition, Dadaab refugee camps, Kenya

Household food security seems to be precarious, with the majority of the refugees having few income opportunities (see box). The main constraints to income opportunities are arid environment, government policy which restricts freedom of movement and lack of employment opportunities. Moreover, at the beginning of 2003, food distributions were lower than the intended full food ration, as recorded by food basket monitoring (GTZ, 08/03) (see graph).

Household food security and public health environment, Dadaab camps

Food distribution, Dadaab refugee camps, Kenya, 2003 (GTZ, 08/03)

Overall - Malnutrition rates are unacceptably high in Dadaab camps (category II). Refugees, and especially the poorest are highly dependent on external aid. Donors should ensure that adequate food rations and basic items are regularly provided to the refugees.

RNIS 42, August 2003

The two huge refugee camp areas have been affected over these past months. In Dadaab area, 3,000 of the 130,000 refugees hosted in three camps were homeless after floods devastated their homes (AFP, 07/05/03). In Kakuma refugee camps, a riot between Sudanese refugees and Turkana people, native to the area, has resulted in 12 deaths; 30,000 Sudanese refugees had temporarily fled their shelters (OCHA, 22/07/03). The violence emerged after a cattle-rustling incident. Rivalries between the Turkana people and refugees, comes partly because of the destitution of both communities, which are struggling to survive in the hard environment of this dry-hot area (OCHA, 22/07/03). Food aid rations have been restored to their intended level (full ration), from a previously 75% ration in March 2003 (WFP, 08/08/03).

RNIS 41, April 2003

Kenya hosts more than 200,000 refugees mostly from Sudan and Somalia. The majority of the refugees are settled in huge camps in dry-hot areas. They are prevented from moving freely outside of the camps and are not allowed to own cattle, cultivate land or work. Most of the refugees are therefore almost totally reliant on external aid. The humanitarian assistance to the refugees has been under-funded for years; food and non-food item (such as wood) distributions have not been sufficient to cover all the refugee needs. The prevalence of acute malnutrition has been above the acceptable range over the past years (see RNIS 40). The new government of Kenya is willing to review the encampment policy and to take different measures to increase refugee self-sufficiency (Reuters, 17/02/03). The government was examining the possibility of re-locating the camps to areas where people will be able to cultivate land, and to authorize people to work. The improvement of the refugee status will be a great advance for their well -being.

RNIS 40, Dec 2002

Refugees

Kenya hosts some 200,000 refugees, mostly from Sudan and Somalia. Kakuma camp is located in Turkana district, north-western Kenya, near the Sudan border and three camps are located in Garissa district, east Kenya, near the Somalia border.

Kakuma camp

The camp was established in 1992 for Sudanese refugees fleeing conflict in the Upper Nile. In 1998, Kakuma II was opened, primarily to accommodate Somali refugees who were transferred from camps in Mombassa, which were closed. In 1999, Kakuma III was opened for more Sudanese fleeing from the war.

In September 2002, the population of Kakuma camp was estimated at around 66,000, of which 80.5% were Sudanese, 15% Somali, 3% Ethiopian and the rest from the Great Lakes region.

Refugees experience harsh living conditions and face many constraints: they are settled in a dry-hot area, they are prevented from moving freely out of the camp, and the resident population is hostile to them as they see them as competitor for scarce resources. These factors have made the majority of the refugees almost totally reli- ant on relief aid, although some are able to access income-generating activities.

A nutritional survey was carried out by IRC in Kakuma refugee camp in September 2002 (IRC/ UNHCR/LWF, 09/02). About 2% of the households interviewed were Burundian, 4% were Ethiopian, 15 % were Somali and the majority (79%) was from Sudan. The survey revealed that 14.3 % of the children surveyed were acutely malnourished, including 1.3 % severely malnourished; 0.4 % of the children had oedema. However, when expressed as percentage of the median, the acute malnutri- tion rate fell to 6.3%, including 0.1% severe malnu- trition, which is not considered to be critical. The discrepancy may be partly explained by the fact that a significant number of children were border- line cases (with a weight-height index slightly lower than -2 Z-scores) and therefore were classified as malnourished when Z-score was used but not when percentage of the median was used.

Levels of acute malnutrition have remained stable, between 14% and 19%, since 1997 (see graph).

Acute malnutrition, Kakuma refugee camp

Food aid appeared to be the main source of food. According to the survey results, about 50% of the refugees consumed only food from the general distribution (the day prior to the survey), about 25% of the refugees ate food from the general distribution together with food from other sources, 20% consumed food borrowed or given by relatives and 5% consumed only food purchased from the market.

These results seem to be in line with a food security assessment done in September 1999. According to this assessment, the poor group (35-45% of the refugees) has very little access to incomes. The less poor group (15-20%) is able to get some incentives from small business. The middle incentive group (30-40%) and the better-off (15%) are comprised of traders and higher incentive earners, as well as those who receive remittances. They often support a wide range of people.

Food distribution is scheduled on a bi-monthly basis and is intended to be a full ration of 2,100 Kcal/pers/day. However, the amounts of food distributed have been irregular and were equivalent on average to 1,960 Kcal/pers/day in 2000, 1,730 Kcal/pers/day in 2001 and 1,670 Kcal/pers/day in 2002 (see graph). During the first half of 2002, the average Corn Soya Blend (CSB) distribution, which is intended to supplement the ration in micro-nutrients, was 17 g/pers/day instead of the planned 40 g/pers/day. For the poorest who can not access incomes, the food ration is not only the main source of food but also a significant way to get cash to buy basic items such as firewood or soap, when they are not provided in sufficient quantity by relief agencies. Measles vaccination coverage was good with 50.8% coverage confirmed by card and 91.9% when also taking mothers' statements into account. About 80% of the children surveyed received vitamin A. Most of the families got water from taps, but hygiene practices seemed inadequate, as well as the children's feeding practices.

The average prevalence of malnutrition observed in the camp may be related to multi-sectoral causes, such as inadequate food and non-food item distribution to the poorest, and poor hygiene and feeding practices. The funding shortfall that UNHCR is currently facing may further undermine refugee living conditions. UNHCR will be obliged to reduce to a third the amount of firewood which was distributed to refugees, who will need to sell part of their food ration to buy wood, or to risk being beaten or raped when collecting wood in surrounding private land (UNHCR, 14/11/02).

Dadaab camps

The three refugee camps around Dadaab town in Garissa district; Ifo, Dagahaley and Hagadera, were established in 1991 and 1992 following an influx of refugees fleeing fighting in the middle/ lower Juba and Gedo regions of Somalia. In June 2002, the population was estimated at around 130,000 refugees; about 37,000 in Dagahaley, 48,000 in Hagadera and 45,000 in Ifo. MSF-B undertook a nutrition survey in Dadaab camps in June 2002 (MSF-B, 06/02). The prevalence of acute malnutrition among 6-59 month-old children was 15.0 %, including 2.1% severe malnutrition; 1.2 % of the children had oedema. Malnutrition rates have remained high since 1997 (see graph). The amount of food distributed has not been more regular in Dadaab camps than in Kakuma camp. The average of food distributed was 1900 Kcal/kg/day in 2000 and fell to 1800 Kcal/pers/ day in 2001 and 2002 (see graph).

Acute malnutrition, Dadaab camps

Food distribution, Kakuma refugee camp (WFP Kenya, 11/02)

Food distribution, Dadaab refugee camps (WFP Kenya, 11/02)

Overall - The current nutrition situation of the refugees in Kenya can not be considered acceptable (category II/III). Refugees, especially the poorest, are highly dependent on external aid. The funding shortfall UNHCR is currently facing, as well as the food shortfall WFP is expecting from February , may worsen the situation.

Recommendations and priorities

From the IRC survey in Kakuma camp

• Continue feeding programmes and improve coverage
• Ensure supplementation of vitamins and mineral through clinics and/or home visits
• Lobby to increase the food ration distribution in order to meet the basic nutritional requirements and to allow refugees to exchange part of the food from the general ration to micro- nutrient rich food
• Ensure the provision of non-food items in sufficient quantities
• Implement a comprehensive monitoring system of the nutritional status of the population

From the MSF-B survey in Dadaab camps

• Ensure a full food ration distribution
• Monitor the nutrition status of the population

RNIS 39, October 2002

Refugees

More than 200,000 refugees, mostly from Somalia and Sudan are still located in two huge camps: Dadaab and Kakuma. For a number of reasons, including restricted movement from the camps and environmental hostility, the refugees rely totally on food aid distribution. High rates of malnutrition and micronutrient deficiencies have been reported for years as documented by RNIS. This is mostly attributed to inadequate food rations both in quantity and quality, because of a shortage in the food pipeline. This has led IRC recently to raise the issue of Kakuma camp before the US senate (IRC, 06/02). Distribution of non-food items was also reported to be inadequate leading refugees to sell food to buy wood for cooking, for example. IRC was also concerned about the decrease in donor contribution to the management of the camp. The IRC testimony has perhaps had an impact: WFP have reported that due to additional donations, they will be able to provide almost full rations to refugees until January 2003. However, more food is needed for the period January-June 2003. A joint assessment mission is planed by UNHCR, WFP, Government of Kenya and potential donors at the end of September 2002 (WFP, 30/08/02).

There have been reports of increased tension and antipathy towards the refugee community. In the districts where Kakuma and Dadaab camps are located and as elections are approaching, some politicians are using the case against the refugees as part of their electoral campaign (JRS, 31/07/02). Also, some forced repatriation of Somali refugees from Mandera has been reported. (OCHA, 18-07-02).

Drought affected population

Having begun in March 2000, the Kenya drought relief EMOP is now being phased out, following an assessment mission which reported a significant improvement in the food security of the affected population. However, some pastoral and agro-pastoral areas in Eastern province are still in need of some form of relief intervention (WFP, 09/08/02). A final general food distribution took place mid-September. The food for work programme will be on-going until the food pipeline is depleted (WFP, 30/08/02).

Flood affected population

About 50 people were killed and 150,000 displaced by floods occurring in May (Xinhua, 13/05/02). The most affected provinces were Nyanza, Coast, Western and North Eastern provinces. This was followed by an outbreak of malaria in the Nyanza and Rift Valley province claiming over 500 lives in June and July (IFRC, 28/08/02). Food and non-food items have been provided by the Kenyan Red Cross Society.

Overall The nutrition situation of refugees in Kenya is still of concern (category II).

Recommendations and priorities

From the RNIS

• Continuous support in both food and non-food items is required for refugees
• Refugee situation needs to be closely monitored

RNIS 38, July 2002

The current humanitarian situation in Kenya has seen improvements over the past couple of years, although the frequency of drought and the presence of inter ethnic fighting has left many areas of the country acutely food insecure and vulnerable to further crises. The food security prospects appear relatively good in most arable areas of the countryand the areas of greatest concern remain the northern pastoralist regions, particularly Mandera and Turkana, where rates of malnutrition are reported to be particularly high.

The humanitarian response is suffering from budgetary constraints, which continue to threaten the food pipeline, and reductions in food rations have been reported. WFP have announced that there is a food deficit of 5,000 MT until the end of 2002 (WFP 24/05/02) and there is an urgent need for new pledges to ensure that the needs of refugees in the Kakuma and Dadaab camps are met.

Refugees

Kenya has a large refugee population of around 220,000 people, mostly from Somalia and Sudan. The government policy has been to house the refugees in two large camps in the northeast and northwest of the country. Kakuma camp, in the northwest, is home to approximately 83,000 people and Dadaab, in the northeast, to over 130,000. The camps are located in intensely arid zones, where they are generally not allowed to settle outside the camp or conduct business activities. This has created an almost total dependence on humanitarian assistance. The inability to develop their own coping mechanisms and their dependency on food aid is particularly concerning given the current problems with providing funding. This has prompted the International Rescue Committee (IRC), who oversee the activities in Kakuma camp, to highlight the issue to the US senate. The last survey to be conducted (see RNIS 36 and 37) indicated a prevalence of acute malnutrition well above emergency thresholds, and more commonly associated with acute nutritional emergencies and not with a population in a stable camp environment (IRC 04/06/02). The situation has not improved and has been attributed to the cut backs in the general ration which have been necessitated by funding problems for WFP. WFP have announced that they have been forced to reduce the food ration from the recommended 2100 Kcal to 1600 Kcal and that, unless further funding was forthcoming, further reductions were inevitable.

Fighting in the Gedo town of Bulo Hawa, borderingthe Kenyan Mandera district, has resulted in the influx of close to 10,000 Somalis. Approximately 5,000 returned to Somalia but the remainder are located a mere 500 m from the border and have remained largely inaccessible to humanitarian workers. The situation in Gedo, with regards to both security and the humanitarian situation, is extremely serious and many of the remaining refugees are reported to be in extremely poor shape. Up to 80 % of the refugees are reported to be women and children and there are very little available food and medical supplies. There has been considerable concern over the future of the refugees because the Kenyan government has been very reluctant to either repatriate them or move them to one of the designated refugee camps. Many refugees have been hesitant to relocate within Kenya because they anticipate returning as soon as the situation in Gedo improves. The RNIS does not have any nutrition information on this group but they are considered to be extremely vulnerable.

Overall

The overall situation in Kenya is showing signs of improvement although the chronic food and livelihood insecurity of some areas, particularly the northern pastoral regions, means that areas of acute need do still exist. The refugee population is considered to be at considerable risk (category II) of further nutritional decline if the food pipeline situation does not improve. There is also concern over the fate of recent Somali refugees in the Mandera district who should be considered at elevated risk of malnutrition.

Recommendations

From the RNIS

• Ensure that funding is made available to the PRRO to ensure that refugees dependent on food assistance receive an adequate general ration.
• Ensure that distributed food is adequately fortified with micronutrients.

RNIS 36/37, April 2002

Kenya has been suffering from the regional Horn of Africa drought and as a result many, areas of the country have experienced episodes of acute food insecurity. The situation has improved over the course of 2001 and early 2002 with the advent of better rainfall and improved crop yield. This improvement in the general food security outlook has been particularly important for the pastoralist populations of the arid and semi arid marginal areas in the north of the country. However, the drought has extended over five seasons, substantially eroding the pastoral livelihoods of populations in the northern regions. This has left many chronically food insecure and ill able to cope with future shocks. As a result, needs in some areas are likely to remain high.

WFP has been conducting an extensive food aid programme across the country but has suffered from considerable budgetary restraints, making the food pipeline extremely precarious. General food distributions will be confined to an estimated one million persons in nine pastoral districts, requiring approximately 85,708 MT of food to last from April to September 2002. There is currently a shortfall in the food pipeline of 77,396 MT, consisting mostly of maize (FEWS 08/03/02).

Refugees

The number of refugees in Kenya is steadily increasing as a result of continued influxes from people fleeing the war in Southern Sudan. UN OCHA estimated that there were approximately 215,000 refugees at the start of 2002 with some 132,000, mostly Somali refugees, in Dadaab camp in the northeast and over 83,000 in Kakuma in the northwest (UN OCHA 22/03/02). However, it is reported that numbers are increasing steadily, particularly in Kakuma camp where it is estimated that numbers will increase to 90,000 during 2002 (ACT 08/01/02). The majority of new arrivals are women and children.

The camps are situated in the arid and semi arid northern zones of the country, with the situation for refugees made worse by the lack of a local settlement policy. As a result, there is 100 % dependence on the international community for food aid. The refugees are not permitted to herd livestock and their freedom of movement is restricted, further curtailing the possibility of developing coping mechanisms to facilitate alternative access to food sources. This has forced a high level of reliance on food aid, which is concerning due to funding shortfalls for the WFP food pipeline. WFP have reported that their programme faces a shortfall of 8,200 MT of food until the end of 2002 and urgent pledges are required to ensure that refugees continue to receive an adequate diet (WFP 26/04/02). The funding shortfalls have resulted in cuts to the general ration to around 1400 Kcal, which can detrimentally affect refugee nutritional status due to the high dependence the general ration. (WFP 20/02/02). WFP are hoping to be able to raise the ration but this will depend on future pledges.

The RNIS has not received any recent nutritional surveys from the refugee population but it is assumed that they remains extremely vulnerable to nutritional decline due to their dependency on food aid and lack of options for alternative livelihood activities. In particular it is alarming to note that nutritional surveys in 2001 indicated elevated levels of acute malnutrition and a high prevalence of micronutrient deficiency. This would strongly indicate that the diet quality of the refugees is poor and the continuation of sub optimal rations is likely to result in further deteriorations in nutritional status (see RNIS # 35).

Overall

There has been an improvement in the humanitarian situation as a whole in Kenya, however refugees remain highly vulnerable as a result of their dependence on food assistance and the lack of alternative livelihood options. As a result, the insecurity of the food pipeline due to funding shortfalls is alarming and the refugees should be seen as being at high risk of further nutritional decline (category II).

Recommendations

From the RNIS

• Lobby for increased funding to the refugee PRRO.
• Assure continued food distributions of sufficient quality and quantity through the use of fortified foods.

RNIS 35, October 2001

Kenya has been suffering from the regional drought in the Horn of Africa and has seen acute food insecurity emerge in many areas of the country. The current outlook is for an improved situation in the traditional arable districts and highland areas of Western Kenya but the outlook in the north and east of the country remains poor. Pastoralists continue to be most at risk with areas of Turkana, Wajir, Garissa and the Tana River district being the worst affected (FEWS 07/09/01). There are wide spread reports of poor pasture and water availability, animal deaths and unseasonal migration. The situation is extremely concerning and a deterioration in nutritional status amongst affected populations is likely.

WFP is currently running an enormous food aid program all across Kenya and has suffered from poor funding, resulting in ration cuts in an attempt to avert breaks in the food pipeline. WFP recently announced that their drought relief programme is currently less than 50 percent funded and requires in excess of 34 million US dollars to meet shortfalls (WFP 02/11/01). As a result, a possible break in the pipeline is expected from November onwards. The current food basket is primarily cereals with shortfalls in pulses, critical for their protein content, beginning in October.

Refugees

In July 2001, UNHCR reported that there were an estimated 213,610 refugees in Kenya living in camps around Dadaab and Kakuma in the north east and north west of the country. The refugee populations remain highly dependent on food aid as a result of their inability to engage in economic activities and because the camps are situated in some of the areas most affected by the drought, precluding any agricultural activities. In Dadaab the food ration was substantially reduced, although it is reported that it was increased to 1,700 Kcal from the 1,399 Kcal that were distributed from mid April (OCHA 31/07/01). The RNIS has not received any new nutritional information from Dadaab but the continuation of drought conditions and problems of funding the food pipeline make the refugees extremely vulnerable.

In the last update the RNIS reported on a nutritional survey conducted by IRC/UNHCR and ICH in Kakuma refugee camp (see RNIS # 34). The survey had two components; the first being the assessment of acute nutritional status by anthropometry and the second the assessment of micronutrient status using biochemical indicators. As reported in the last RNIS, nutritional status is poor, with levels being above emergency thresholds. However, a series of surveys over the past few years indicate that the level of acute malnutrition in the population appears to have remained fairly constant at around 17%. The measurement of micronutrient status marks an important departure from the norm, where the focus has traditionally been on the supply of sufficient dietary energy (macronutrients) and has tended to see dietary quality as a secondary concern. The issue of dietary quality is of particular concern in longterm refugee communities. Refugees tend to be heavily dependent on food aid, particularly when in closed camp environments such as Kakuma. This results in very restricted access to food sources other than the general ration and this tends to result in poor diet quality.

The Institute of Child Health (ICH) performed a biochemical analysis on blood samples taken from amongst the refugee population. The biochemical survey indicated very high rates of anaemia in the under-five population with 61.3% of children having a haemoglobin level of below 11.0 g/dl of blood. Anaemia, although an indicator of iron deficiency, can be caused by numerous factors including infection, malaria and other parasitic infections. In order to control for this ICH performed a number of other tests, concluding that the high rate of observed anaemia was a result of iron deficiency (IRC/HCR/ICH 12/04/01). Vitamin A status was also assessed and it was estimated that 47% of children assessed had a serum retinol level below 0.7 µmol/L and were therefore classified as suffering from vitamin A deficiency. It is alarming to note that both the prevalence of iron deficiency anaemia and vitamin A deficiency are both well above emergency thresholds and are indicative of a problem of severe public health importance (WHO 96.10; 2000). The results highlight the need to focus on dietary quality particularly for long-term recipients of food aid. It is also concerning to note that the current deterioration of the humanitarian situation in Kenya with regards to the inadequacy of the existing food pipeline, and the deterioration in food security in the areas where the refugees are situated, means that the refugee populations will remain highly vulnerable to further deteriorations in both macro and micronutrient status.

Overall

There has been an improvement in the food security of some areas but further deterioration in the food security of pastoralists in the north east and west of the country have taken place. Refugees remain highly dependent on humanitarian assistance, with shortages and possible breaks in the pipeline, coupled with the deteriorating food security situation in areas where they are staying, contributing to their extreme vulnerability (category II).

Recommendations

• Support the global appeals for Kenya

From the IRC/HCR/ICH survey in Kakuma

• Continue to administer high levels of vaccination coverage
• Improve the micronutrient content of the general ration preferably with the distribution of fresh food
• Ensure adequate fortification of the main components of the general food ration
• Implement food basket monitoring to ensure effective and equitable distributions

RNIS 34, July 2001

Since the last issue of RNIS, the estimated number of drought affected people in need of assistance decreased from 4.4 million to about 3 million (OCHA). The long rains started in March, which considerably improved the food security outlook. Rains have benefited in particular the agricultural areas in the central and western areas of the country. However the outlook in some of the pastoral areas in the north and north-east is less optimistic with the almost total failure of the rains in May.

Earlier predictions of a break in the food pipeline in June were narrowly averted when the government of Kenya contributed an estimated 26,000 MT of cereals. However, funding shortfalls forced WFP to cut rations for supplementary feeding programmes in early June (WFP 08/06/01). There is also concern over the supply of oil and pulses for the general ration (FEWS 14/06/01).

Refugees

There remain an estimated 203,500 refugees from Sudan, Somalia, Ethiopia, Eritrea, Uganda, Burundi, Rwanda and the Democratic Republic of the Congo, in camps around Dadaab in the remote north-east of the country and in Kakuma camps in the north west (UNHCR 2001; USRC 2001). These camps are located in some of the districts worst affected by the recent drought (Garrissa and Turkana Districts respectively).

RNIS has received no new nutritional surveys from the Dadaab camps. However, an MSF press release stated that there had been an alarming increase in the number of children in the feeding programmes, from 72 under fives in January 2001 to 196 by mid June. Over the past six months, the refugees in Dadaab, north-eastern Kenya, have experienced a 35% drop in the amount of food distributed. This has meant that on average refugees are receiving a ration of 1,399 Kcals, instead of the recommended 2,100 Kcals. MSF attributes the increase in malnutrition to the observed cuts in refugee rations (MSF 26/06/01). The increase in malnutrition gives cause for concern, given that in February 2001 the prevalence of malnutrition was 16.1%, including 4.5% severe mal-nutrition (RNIS 32 and 33). At the time however, the coverage of feeding programmes was only 30% of the camp population, so the increase in the number of children in the feeding programmes could partly be a result of improved coverage.

IRC/UNHCR and ICH conducted a survey in Kakuma refugee camp in April 2001. At the time of the survey, the number of refugees was estimated at 72,459. The majority of the refugees are Sudanese, but there are also Somali, Ethiopian, Eritrean, Ugandan, Burundian, Rwandan and Congolese refugees (IRC/HCR/ICH 12/04/01). Whilst the survey assessed anthropometric and micronutrient status, the results of the micronutrient survey are not yet ready available and so only the anthropometric results are reported.

The results indicate an estimated prevalence of acute malnutrition of 17.2% (W/H <-2 Z-scores and / or oedema) including 1.4% severe (W/H <-3 Z-scores and / or oedema). These results are similar to those reported in RNIS 32 and 33, from a UNHCR survey in June 2000. The survey in June 2000 did not randomly sample the whole camp population, so the results of the two surveys are not strictly comparable. It does appear, however, that the prevalence of malnutrition in Kakuma camp, has remained stable at 17-18% (<-2 Z scores) since early 1999 (note that according to% of the median the prevalence of malnutrition is 8.5% <80% WFH). Coverage of the feeding programme is 32%. It is difficult to interpret the prevalence of malnutrition without further information on the health environment to estimate the health risks associated with malnutrition. From the survey report, the energy content of the ration appears good (2,200 Kcal), but no information on the equity of the distribution system is provided. The ration is inadequate in riboflavin.

Overall

The nutrition situation for refugees in Dadaab appears to be deteriorating (category II). Food rations for refugees in Dadaab have been inadequate, and they are located in one of the worst drought affected districts. The nutritional situation for refugees in Kakuma camps is stable, at moderately high prevalence of malnutrition (category III).

Recommendations

• Support the 2001 UN Inter-Agency Appeal.

Dadaab camps

• Increase the general ration distributed in the camps.
• Investigate whether the increase in children in feeding programmes is a result of improved coverage or an increased prevalence of malnutrition.

Kakuma camp (IRC/HCR/ICH 12/04/01).

• Ensure the continuation in adequate general food ration.
• Investigate the equity of the general ration distribution system.
• Assess the health environment to be able to better interpret malnutrition rates.

RNIS 32/33, April 2001

Note: the RNIS is mandated to provide nutritional information on internally displaced and refugee populations. The RNIS cannot report comprehensively on the drought affected populations of Kenya, although the situation is very severe in some areas. More information can be obtained from www.reliefweb.int

OCHA reported that in February, over 4.4 million people in 22 Districts were suffering from the effects of drought in Kenya. Rains have been inadequate or failed for the last two years. The northern regions of the country remain most severely affected. The drought has resulted in massive loss of livestock and the emergence of acute food insecurity. Emergency food distribution started in some Districts in December 1999 (e.g. Turkana) and in others in July 2000 (e.g. Wajir and Garissa). The Kenya Humanitarian update in March 2001 reports that the scarcity of pasture and water in some northern areas has resulted in an increase in inter clan and inter tribal fighting particularly in the Mandera and Tana river districts. There have also been reports of banditry and on March 14^th a UNICEF staff member was injured by bandits in the northern region. This has resulted in major security constraints for humanitarian personnel and many of the northern and eastern areas of the country remain under emergency phase III status, requiring military escorts for travel (IRIN OCHA 31/03/01; WFP 04/05/01).

In March 2001, OCHA reported that poor funding of the Donor Alert 2001 was becoming an issue of major concern with only 13% of the alert funded (OCHA 31/03/01). This has and will continue to impact on the food pipeline and WFP have reported serious pipeline shortages from May 2001, with no available oil or blended food. Due to a delay in the arrival of a 30,000 ton shipment, there will probably be a shortfall in June (WFP 04/05/01). Only 2,408,040 people were being targeted for the May general distribution, as in March. No food distribution took place in April as a result of the late finish of the March distribution (WFP 04/05/01).

FEWS reports that the general food security outlook has improved since the onset of the critical 2001 long rains season during the last weeks of March. There have been reports of fairly heavy rain in the northern pastoral districts, with the exception of Mandera and Wajir, and this has greatly heightened the prospects for significant improvements in grazing and water (FEWS 12/04/01).

However, it is important to emphasize that the prolonged nature of the drought has seriously impacted on people's livelihoods and food aid and other forms of assistance will be required to assist in recovery. The greatest cause for concern at the moment is the lack of donor interest that threatens to force severe ration cuts and generally impact on the quality of assistance to affected populations (IRIN OCHA 31/03/01).

Refugees

Following some repatriation, refugee numbers decreased from 215,000 to 203,500 over the course of 2000. The majority of refugees are from Somalia (135,600), Sudan (54,600), Ethiopia (4,000) and Uganda (5,800). During the course of 2000 some 13,000 refugees arrived in Kenya as a result of conflicts in neighbouring countries, particularly Sudan where an increase in insecurity in Sudan's East Equatoria district drove some 10,000 Sudanese refugees to Lokichokio in north western Kenya earlier in the year (UNHCR 2001).

MSF-B conducted a nutrition survey in the camps in Dadaab (Garissa District) in February 2001. The prevalence of acute malnutrition in February was of 16.1 % (< -2 Z-scores) and 4.5 % severe malnutrition including 3.4 % with oedema. The February survey showed no significant change since August 2000 (MSF-B 02/01).

The general ration supply was particularly low from June to October 2000, averaging of 1900 Kcals. MSF-B conducted some food basket monitoring and have shown a slight improvement in the ration since January with an estimated average of 1914 Kcals. However distribution of the ration amongst the refugees in the Dadaab area is inequitable (MSF-B 02/01).

In North East Kenya, drought induced food insecurity also became severe around July 2000, which will have impacted on the refugees, particularly as opportunities for finding other sources of food will have been more limited.

Although there does not appear to be much change in the Dadaab survey results from August to February, the remaining high prevalence of severe malnutrition is alarming and in particular the oedema. MSF-B suspects the oedema to be related to micro-nutrient deficiencies, and is hoping to collaborate with the Institute of Child Health in London to look further into the matter. Another cause for concern in the area is the low coverage of the feeding programmes with a reported coverage of 30.5 % in February, down from 37.8 % in August (MSF-B 02/01).

SCF-UK reported a similar phenomenon in neighbouring Wajir District from May to August 2000. In Eldas in North Wajir, 18 people began to show symptoms of multiple micronutrient deficiency from May to August 2000. All those presenting with symptoms had been surviving on a diet of relief maize alone and had not had milk since January/February. Symptoms decreased after the distribution of fortified UNIMIX (SCF-UK 09/00).

A nutrition survey was conducted in Kakuma refugee camp by UNHCR in June 2000. (UNHCR 06/00) The results indicate an estimated prevalence of malnutrition of 18.1 % (<-2 Z-scores) including 2.7 % severe. This prevalence is similar to that in May 1999. The survey in June 2000 excluded new arrivals (6 months prior to the survey) to the camp.

Given that new arrivals came from South Sudan in 2000, the survey done in June 2000 may therefore not reflect the true nutritional situation of the refugees in Kakuma. Sample size was not estimated appropriately for this survey.

Fifty two percent of children were reported to have suffered from illness, mainly diarrhoea, in the two weeks prior to the survey. The potential for finding other sources of food is extremely limited for refugees in Kakuma refugee camp, as movement outside the camp is restricted by the Government of Kenya. The survey was done at a time when Turkana District was experiencing severe drought induced food insecurity, which would have limited food and income sources for all in the District (UNHCR 06/00).

The increase in insecurity in areas containing refugee camps has eroded prospects for the refugees by limiting access to markets and to opportunities of paid employment. This has resulted in a very high degree of dependence on food aid, particularly during a period of acute food insecurity for the Kenyan population (UNHCR 06/00).

Overall

Overall the last year has seen the continuation of very serious drought conditions in much of the country. The latest food security reports indicate that long awaited rains have arrived in some Districts, and this will do much to alleviate the acute food needs of drought affected populations. However, the effects will take some time to show and it is expected that the need for emergency food aid will continue for some time to come. The prevalence of malnutrition has remained high in the refugee populations, due to rations inadequate in quantity and quality. Refugees have also been affected by the drought (Category III). The future development of the situation depends largely on continued donor support.

Recommendations

• Continue to find support for the Kenya consolidated appeal.
• Conduct a survey in Kakuma camp which includes new arrivals.
• Follow up on and investigate the causes of oedematous malnutrition in the Somali population.

From the MSF survey in the Dabaab refugee camps

• The ration should be increased to a 2100 kcal/person/day as the refugees do not have access to other sources of food.
• Improve the quality of the ration, add blended foods, to control micronutrient deficiencies.
• The nutrition programmes should be continued.
• Children should be screened for malnutrition; coverage of the feeding programmes should be improved.
• A nutrition survey should be repeated in the next six months and the coverage of the nutrition programmes assessed.

RNIS 31, July 2000

Note: the RNIS is mandated to provide nutritional information on internally displaced and refugee populations. The RNIS cannot report comprehensively on the drought-affected populations of Kenya, although the situation is very severe in some areas. More information can be obtained from www.reliefweb.int

Refugees

Kenya hosts some 215,000 Sudanese, Somali and Eritrean refugees in UNHCR camps in Dadaab and Kakuma. There is no new information on the nutritional situation of the refugees, which was reported to be uncritical in the most recent surveys and assessments (RNIS 29). However, it is likely that the refugees will be affected by the drought. The prices of local goods, including milk, will increase as their availability decreases. The refugee population are mainly pastoralists and regularly trade their relief food for milk. In addition, water will be more limited than normal, possibly causing hygiene and sanitation problems. These factors will probably result in an increase in the rate of malnutrition in the refugee populations.

Drought

Prolonged drought is increasing food insecurity throughout Kenya. Nearly 3.3 million people are in urgent need of food assistance. Apart from some areas in Western and Nyanza provinces, there has been very little or no rainfall in the rest of the country, leading to widespread crop failure and large livestock losses in pastoral areas in the north, northeast and northwest. Pastoral communities are of particular concern, as they are faced with the fourth consecutive failure of the rainy season. Prospects for the 2000 main cereal crop, which is normally harvested in October, are very unfavourable (WFP - 21/07/00).

As recorded in earlier droughts, destitute pastoralists are settling in the outskirts of district centres, however large numbers of displaced people have not yet been reported.

Turkana is one of the most affected districts. In March just before the long rains were expected, an Oxfam survey estimated the prevalence of acute malnutrition at 21.6%, including 4.6% severe acute malnutrition. CMR was estimated at 2.1/10,000/day and under-five mortality at 5.6/10,000/day. Since then, the long rains which normally account for 80% of total food production have failed. The prevalences of malnutrition can therefore be expected to increase until the end of the year. This situation calls for urgent action (Oxfam - 04/00).

An extension to WFP's EMOP for the drought-affected Kenyans was approved at the end June. About 30% of the operational requirements have been resourced so far. The food pipeline situation is thus not good for any commodities, particularly non-grains (WFP - 21/07/00).

Overall, the refugees are considered at heightened nutritional risk because of the drought (category III). The drought affected Kenyan population are at high risk of malnutrition and mortality.

Recommendations and priorities:

• Support the appeal for the drought in Kenya.
• Continue to monitor the nutritional situation of the refugees.

RNIS 30, March 2000

Refugees

There are currently some 215,000 Sudanese, Somalia and Ethiopian refugees in UNHCR camps in Dadaab and Kakuma. An estimated 20,000 new Somalia and Sudanese have sought refuge in the country since October 1999. WFP/UNHCR have reported a serious funding shortfall for the refugee operations in Kenya (IRIN - 01/03/00).

The RNIS has not received any new information on the nutritional situation of these refugees during the reporting period. The results of extensive food economy analyses and nutritional surveys were reported in RNIS 29. The food economy assessment found that the vast majority of the refugee population are almost entirely dependent on the ration provided by WFP and its donors. A break in the pipeline could have disastrous effects on the refugees’ nutritional situation.

Drought

An estimated 780,000 Kenyans are at risk of drought in the next few months according to information gathered through local and national early warning systems and drought response co-ordination mechanisms. Although this is usually a difficult time of year, the situation is particularly severe (according to satellite rainfall and vegetation coverage mapping, as well as locally collected indicators such as population movements, terms of trade etc). The outlook for rains for March - May is also poor in Turkana district, in the northwest of the country, which remains the most affected area with some 250,000 people at risk. Other affected districts include Marsabit, Moyale and Mandera. The main constraints impeding relief assistance include limited access to affected areas and inadequate targeting-mechanisms (Oxfam -15/03/00; USAID -07/03/00).

In Turkana, the drought-monitoring bulletin reports an overall worsening trend: 75% of the district is likely to be in a state of emergency by the end of March. There has been no rain for many months, leading to increasing water stress, diminishing pasture, increased incidence of livestock diseases and livestock concentration around permanent water sources, as a significant number of shallow wells have dried up. The majority of the population are nomadic pastoralists, but an increasing proportion are reported to be adopting more sedentary lifestyles, resorting to petty trading as a consequence of the loss of their livestock and subsequent impoverishment (Oxfam -15/03/00).

Overall, the nutritional situation of the refugees in Dadaab is not considered critical (category IV). Those in Kakuma are considered to be at higher risk because of a recent nutritional survey that estimated a relatively high prevalence of wasting in the camps (category III). However, the nutritional situation of these refugees could deteriorate rapidly if WFP’s funding shortfall for Kenya is not made up shortly.

Recommendations and priorities:

• Provide funding for WFP’s programme for Kenya urgently.

RNIS 29, December 1999

There were approximately 196,000 refugees in UNHCR camps in Kenya at the end of July. The majority of the refugees are Somalis and Sudanese, but there are also approximately 5,000 Ethiopians. The camps are in two areas: Kakuma near the Sudanese border (camp population 80,600) and Dadaab, near the Somali border (camp populations 115,600). A population re-registration exercise in the Dadaab camps is due to take place in the next few months.

Dadaab camps

The three refugee camps around Dadaab town in Garissa District; Ifo, Dagahaley and Hagadera, were established in 1991 and 1992 following an influx of refugees fleeing fighting in the middle/lower Juba and Gedo regions of Somalia. These regions of Somalia are still considered areas of crises and UNHCR does not, currently, consider repatriation a feasible option for the majority of these refugees.

97% of the refugees in the Dadaab camps are Somalis. Approximately 75% of the refugees have rural pastoral or agricultural backgrounds, the remaining 25% come from large urban centres. 50% of the population is female and 17% are under five years old or over sixty years old (SCF-UK-25/09/99a).

Food and non-food distributions

Food-basket monitoring in 1999 found adequate levels of energy in the ration (2100 Kcal/person/day) and that the planned amounts of oil and cereals have been regularly distributed. A shortage of pulses occurred for three months, but this was compensated for with CSB (SCF-UK-25/09/99a).

Firewood, soap, and kitchen sets were also delivered during 1999. A firewood distribution project was started in 1998. This aims to provide 30% of a household’s monthly requirement of firewood, although interviews with refugees suggest that it may only provide 20-25% of their requirements and thus they still have to collect or buy additional wood (SCF-UK-25/09/99a).

Food economy assessment

A food economy assessment by SCF-UK in the Dadaab camps in September reported the following findings (SCF-UK - 25/09/99a):

• The major source of food within the camps is the ration supplied by WFP. The poorest households (35-45% of the population) have difficulty in meeting their food and non-food needs. They often sell part of their cereal ration in order to buy small amounts of vegetables and milk. This means that they finish their rations two to three days prior to the next distribution, and rely on gifts from relatives to bridge the gap up to the next distribution.
• The rest of the population rely on various mechanisms to earn cash. Refugees have tried all opportunities available to them, and most households have someone engaged in trade, or the provision of services to the better-off households, such as collecting and selling firewood, or building houses, or transporting goods.
• The wealthier households (those who have access to remittances from outside of Kenya, or are involved in countrywide trade) purchase some, if not all of their food needs. There has been an increase in the number of people in this group since the last food economy survey in these camps in 1996.
• A household’s wealth is mainly determined by its connections. The camp operates on a type of patronage system. The wealthier households assist their clansmen in earning income and increasing their wealth, particularly through giving them credit to operate a small business. Refugees who are related to Kenyan Somalis may obtain access to land. Those without connections to the local clan or established individuals face greater constraints in meeting their food and other needs. They are more reliant on the ration and other assistance provided by external agencies and are most vulnerable to food insecurity. Women who have been victims of violence, or who are alone, may be among the poorest as they may not receive patronage or support from others.
• The most important barrier to self-reliance is the arid environment in which the camps are situated. The refugees who have come from a rural background, who might normally be able to secure a portion of their food needs through agricultural activities, are seldom able to do so in the camp. There are virtually no kitchen gardens and seasonal agricultural activities are limited because the rains are unreliable and the soil is not welt suited to rain-fed agriculture. The quantity of water pumped prohibits the cultivation of tap-stand gardens for all but a very few. It may also be difficult for unconnected refugees to access land. Lack of seeds is a further constraint. Insecurity affects farming and the collection of wild foods.
• Some 25% of the refugees do not have an agricultural background and there is little opportunity for those with technical skills, for example those who were previously carpenters or mechanics, to use their skills in the camps.
• The possibility of selectively reducing the ration given to less needy refugees was not recommended, given the complex and delicate inter-relationships between “better-off” groups and the poorer households, and the likely consequences (increased tension in the camps) and the practical difficulties of such a scheme. The present size of the better-off group helps to sustain the dynamics of the camp economy, and as such, they contribute by increasing opportunities to access food, markets and cash. Implementing a food-for-work scheme may have a negative affect on the refugees’ ability to earn cash income themselves.
• The phasing-out of relief support to refugees with a view to longer-term self-reliance is not tenable in the present environment and should only be considered if the groups were able to re-establish themselves in areas where access to essential resources for a sustainable livelihood were not restricted.

Nutritional survey

MSF-B conducted a survey in the three camps in July 1999 (see annex). The graphs below show the results of these surveys compared to others since 1992 (the prevalence of wasting is defined using percentage of median in these graphs and does not include oedema so as to allow for comparisons with previous years). The prevalence of wasting (defined as <-2 z scores weight-for-height) and/or oedema ranges from 15.2% to 15.6% in these camps. There has been a slight, non-significant increase in the prevalence of wasting and/or oedema since the last survey in September 1998. There were no significant differences in the prevalence of malnutrition between the camps.

The prevalence of wasting (defined using medians) Hagadera camp, Dadaab

The prevalence of wasting (defined using medians) in Ifo camp, Dadaab

The prevalence of wasting (defined using medians) In Dagahaley camp, Dadaab

The number of admissions to therapeutic feeding centres had remained relatively constant in all three camps. The authors of the survey commented that the findings of a “mini-survey” conducted in the feeding programme indicated that most of the families of children in the feeding programme had a larger family than was shown in their ration card (MSF-B-28/08/99).

Kakuma camps

Kakuma is located in north-western Kenya, about 100 km south of the Sudanese border. The camp was established in 1992 for Sudanese refugees fleeing conflict in Bor County, Upper Nile. Since 1992, the camp has expanded to about four times its original size. In 1998 Kakuma II was opened, primarily to accommodate Somali refugees who were transferred from camps in Mombassa, which were closed. In May 1999, Kakuma III was opened for more Sudanese fleeing from the war. The camp populations change almost daily as more Sudanese refugees arrive (approximately 11,000 have sought refuge this year) (SCF-UK-25/09/99b).

Approximately 71% of the population is Sudanese, 22% are Somali and 4% are Ethiopian. Men make up more than 60% of the population over four years old. Many of the males registered in Kakuma are unmarried and they may travel (illegally) in and out of the camps fairly regularly, trying to find work or “to see how the situation is” in Sudan.

Thus the actual difference in the number of men and women in the camps at any one time may be less than the registration figures suggest. Fourteen percent of the population are under five or over sixty years old (SCF-UK - 25/09/99b).

Food and non-food distributions

Food-basket monitoring in 1999 found adequate levels of energy in the ration (2100 Kcal/person/day) and that the planned amount of cereals has been regularly distributed. A shortage of pulses occurred for three months. There was also a shortage of oil that was compensated for with an increase in the cereal ration (SCF-UK - 25/09/99b).

Less soap and firewood have been distributed to the refugee population in Kakuma than in Dadaab in 1999. As in Dadaab, the refugees reported that the quantity of firewood was insufficient to cover their needs (SCF-UK - 25/09/99b).

Food economy assessment

A food economy assessment by SCF-UK in the Kakuma camps in September reported the following major findings (SCF-UK-25/09/99b):

• For 95% of households in Kakuma, the WFP ration provides around 90% of their food needs. The “poor” (approximately 40% of the population) derive most of their cash income by selling 25% of their cereal ration, which is spent on small amounts of special foods, such as milk, and firewood or charcoal. The amount of rations that poor households sell depends on whether or not they receive a firewood ration (they sell more of their ration if they do not receive firewood).
• The income of the remaining 60% of the population can be as low as 500 shillings per month. Sources of income are limited to trade - buying and selling ration items, shops, small restaurants - and earning ‘incentives’ from the agencies working in the camps. Households spend the majority of their income on small amounts of food and firewood or charcoal.
• In the Sudanese community, wealth is broadly determined by access to incentive income. Those with incentives are under pressure to share their income with their relatives. In contrast, the Somalis and Ethiopians have more contacts in Nairobi, Mombassa and overseas with whom they maintain active links. In addition, the Somali community brought many items from Mombassa with them. Although less than half of the Somali households in Kakuma earn a regular income, they share their wealth amongst relatives in the camp and few are found in the poorest groups.
• There has been a decrease in the number of unaccompanied minors (persons less than eighteen years old, separated from both their parents, who are not being taken care of by someone who by law or custom is responsible) in Kakuma since 1996. This is partially due to a policy of placing the children in foster-care and also because many of the children have now grown-up and have begun to work. In addition, programmes have been designed and implemented to increase the unaccompanied minors’ level of cash income, for example - growing vegetables.
• Several policies have improved the refugees’ nutritional situation. These include the school feeding programmes that provide a porridge meal for all school attendants when the schools are open. Given that many of the poorer households have school-aged children this programme may be effective in helping the children in these households meet their minimum energy requirements despite part of their rations being sold. Income generating schemes, such as IRC’s micro-enterprise programme have also contributed positively to income generation in the camp, especially for women.
• As in Dadaab, one of the most important barriers to self-reliance is the arid environment in which the camps are situated. The potential for agricultural activities is extremely limited. The quantity of water pumped prohibits the cultivation of tap-.stand gardens for all but a very few. The relationship between the Turkana host population and the refugees is such that the refugees are forbidden to cultivate, collect wild food or wood, or to own livestock. Much of this hostility revolves around the poverty of the area and the resentment the host community feels towards the refugees who receive a regular food ration,
• The limited market in Kakuma restricts the economic impact of the education and training activities in the camps. The better-off refugees, particularly the Somalis, may have links outside Kakuma, but the majority of the population do not. In addition, Kakuma is geographically isolated from Kenya’s main towns and trade routes and the refugees are not permitted to travel freely in Kenya.
• Given that less than 10% of the population in Kakuma can afford to buy their own food, it would be very difficult to selectively reduce food assistance in these camps. In addition, those who are better-off assist their relatives and hence a reduction would affect much of the population.
• Similarly to Dadaab, options to phase out relief support to the refugees and to achieve self-reliance and sustainability are not tenable under the present circumstances. The possibility of repatriating the Sudanese population to selected areas of southern Sudan, and planning programmes for their repatriation could be considered.

Nutritional survey

IRC conducted a survey in Kakuma in May (see annex). The graph below shows the results of these surveys compared to others since 1995. The prevalence of wasting (defined by z-scores) was higher than that estimated in the Dadaab camps. No oedema was reported. The prevalence of malnutrition had increased by 2.7% since the last survey in October 1998 and has increased by 3.6% since April 1995. The causes for this increase are not well understood, however the survey attempted to assess some of the possible factors involved (IRC - 05/99).

The prevalence of wasting (defined as <-2 z scores) in Kakuma camps

The prevalence of illness was significantly higher among malnourished children than those who were normally nourished. The most common types of morbidity reported were diarrhoea, fever and cough. This survey was conducted at the end of the rainy season, which might explain why the prevalence of morbidity was so high (57.4% of the children interviewed were reported to be ill in the two weeks prior to interview) (IRC - 05/99).

No association between feeding practices and malnutrition were observed, although the prevalence of wasting was higher in the 6-29 month age group than the older group. Forty percent of caretakers interviewed reported giving their children their first solid or fluid food other than breast-milk before 6 months and 10% of the children were breast-fed for less than 6 months (IRC - 05/99).

Vaccination coverage was relatively low - only 53% of the children had had all their vaccinations recorded. Only 5% of the children had received vitamin A supplements in the 6 months prior to the survey. Possible explanations given for the low coverage include the under-estimation of coverage due to poor recording or loss of clinic cards, and the inadequate knowledge of health staff as to when to give supplements (IRC - 05/99).

The number of children entering the supplementary feeding programmes in Kakuma has increased ten-fold since January as a result of the bi-monthly MUAC screening of all under-fives which was started in January. This has facilitated regular monitoring and identification of malnourished children and has also increased referrals to the supplementary feeding programmes. The survey results, however, suggest that the coverage of this programme needs to be improved (IRC - 05/99).

Recommendations and priorities:

• Continue to provide the general ration of 2100 Kcal/person/day to all registered refugees; continue to provide CSB in the ration.
• Re-register the population to reduce abuses of the system.
• Continue to provide firewood on a regular basis.

Specifically for Kakuma:

• Promote breastfeeding rigorously; discourage bottle-feeding,
• Provide vitamin A supplements for all children under five.
• Train and retrain nutrition workers regularly in order to make sure they know about immunisation, supplementation etc. Establish mechanisms/procedures within health/nutrition structures.
• Strengthen the screening programmes for the under-fives.
• Conduct an in-depth assessment into the causes of malnutrition in under-fives, in particular assess the types and causes of morbidity.
• Continue to promote the income generation schemes.

Overall, the nutritional situation of the refugees in Dadaab is not critical at the moment (category IV), although the proportion of children just above the cut-off point for wasting (and therefore the numbers at risk of becoming malnourished) is unusually large The refugees in Kakuma have a higher prevalence of malnutrition and hence are considered to be at moderate risk (category III). Both groups of refugees, however, are almost entirely dependent on the ration provided by WFP and its donors; a break in the pipeline could have disastrous effects on their nutritional status.
 

RNIS 28, September 1999

There were approximately 193,800 refugees in UNHCR camps in Kenya at the end of June. The majority of these are Somalis and Sudanese, but there are also approximately 5,000 Ethiopians. The camps are in two areas: Kakuma near the Sudanese border (camp population 79,400) and Dadaab, near the Somalian border (camp population 114,410). There has been an increase in the number of Sudanese refugees, fleeing fighting in the south of their country, over the reporting period. In Kakuma a total of 3,600 new refugees were registered in June alone. There was also small increase in the number of Somalis. More recently the Kenyan Government has announced the closure of the border between Kenya and Somalia. UNHCR has reported that there was no "direct impact" of the closure on refugees because there has not been an influx of refugees since early June (IRIN - 24/08/99; UNHCR - 22/07/99).

The refugee camps are in semi-arid areas which are traditionally populated by pastoral nomads. The refugees face many barriers to self-reliance; there is little opportunity for food production, income generation or trade. Thus the refugees remain heavily reliant on the general ration provided by WFP and its donors (WFP -24/03/98).

Food Basket Monitoring in Dadaab Camps, Kenya

No reports of any change in the nutritional situation in the camps have been received. The most recent surveys (September 1998) reported a satisfactory situation. Food basket monitoring from Dadaab has shown that WFP continues to provide an adequate general ration to the population (see graph). The mean CMR in the refugee camps in June was 0.13/10,000/day and the under-five mortality rate was 0.60/10,000/day. The main causes of death were malaria and respiratory tract infections in all age groups (UNHCR - 22/07/99).

Overall, the nutritional situation of the refugees in Kenya remains non-critical (category IIc).

Priorities and Recommendations:

• Conduct a survey to assess the nutritional situation of the refugees in Kenya.

RNIS 27, July 1999

At the end of May there were approximately 182,000 UNHCR registered refugees in camps in Kenya (WFP -05/07/99). The majority of these are Somalis and Sudanese, but there are also approximately 5,000 Ethiopians. The camps are in two areas: Kakuma near the Sudanese border (camp population 71,927) and Dadaab, near the Somalian border (camp population 110,342). These are semi-arid areas which are traditionally populated by pastoral nomads. The refugees face many barriers to self-reliance; there is little opportunity for food production, income generation or trade. The Kenyan Government's policies also discourages the refugees from integrating with the local populations. Thus the refugees remain heavily reliant on the general ration provided by WFP and its donors (WFP - 24/03/98).

President Daniel arap Moi has claimed that the Somali refugees in Kenya are contributing to crime and insecurity in north-eastern Kenya. UNHCR is looking at ways to support the Kenyan government's efforts in maintaining security in the area and will also look at the possibilities for voluntary repatriation for the refugees to safe parts of Somalia (IRIN -05/05/99).

On average 1,200 Sudanese refugees have entered Kenya from South Sudan per month over the reporting period. They are seeking asylum mainly because of war and drought in the areas where they live. The refugees, who are reported to be weak, will probably be resettled in Kakuma camp (IRIN -10/06/99; UNHCR - 05/07/99).

The most recent health report (March 1999) stated that the CMR for the first three months of the year was satisfactory, ranging from 0.44-0.54/10,000/day in all the camps (UNHCR - 19/05/99). The under-five mortality rate ranged from 0.27-2.0/10,000/day. The main causes of death were malaria and respiratory tract infections in all age groups. The incidence of malaria was 58.6/1,000/month in March, which is normal for the onset of the rainy season. A few cases of meningitis were also reported and this situation is being closely monitored, especially in Kakuma, given the outbreak of meningitis which has been reported in South Sudan.

No reports of any change in the nutritional situation in the camps have been received and WFP reports that the nutritional status and health of the population remains "very good". The most recent surveys in the Dadaab camps (September 1998) estimated the prevalence of acute wasting at around 10%, with 2% severe wasting. In Kakuma the most recent survey estimated a prevalence of wasting of 15.6% and 1.7% severe wasting (October 1998). Food basket monitoring from Dadaab has shown that WFP continues to provide an adequate general ration to the population, currently the average is 2,100 kcal/day/person. A vitamin-A distribution organised in March reached 82.1% of the population aged between 6 - 59 months (UNHCR - 19/05/99; WFP - 05/07/99).

Poor rains in May

More generally, a recent FEWS report said that most parts of Kenya remained unusually dry in May, with the exception of the western and coastal areas. The continued absence of rainfall was of "pronounced concern" in pastoral districts, drought-prone marginal areas and some key-grain producing districts in Rift Valley province. The welfare of farm households in marginal agricultural areas was reported to have been significantly undermined and livestock migration in pastoral districts has been earlier than usual (IRIN - 18/06/99). The results of an anthropometric survey by MSF-Spain in the Mandera area of Northeastern province in May have confirmed these findings (IRIN - 23/06/99). An estimated 39.2% of the population surveyed was suffering from acute wasting and/or oedema compared to 21% in January (see Annex). This rate is close to that reported during the severe drought of 1996/97. Many vulnerable people with no income source are reported to have moved to Mandera town from the surrounding districts.

Overall, the nutritional situation of the refugees in Kenya remains satisfactory (category IIc). An unknown number of people may be at risk because of the poor rains.
 

RNIS 26, March 1999

There are approximately 178,000 refugees in Kenya in two areas: Kakuma near the Sudanese border (71,156 mostly Sudanese refugees); and Dadaab, near the Somali border (107,000 mostly Somali refugees). These are semi-arid areas traditionally populated by pastoral nomads such as the Turkana and the Somali-Kenyans. The refugees in these camps face many barriers to increased self-reliance because they live in remote, arid and insecure areas, where there is little opportunity for trade, income generation or food production. Travel by refugees in restricted. Studies by SCF-UK (see RNIS 22) have concluded that all sections of the refugee population remain very heavily dependent upon the general ration provided by WFP for their main source of dietary energy (WFP - 24/03/98).

The latest surveys in September 1998, from the three camps in Dadaab, show a small decrease in acute malnutrition in children under five, compared to previous years (see Annex I(4a)). In the three camps, Ifo, Hagadera and Dagahaley, the rates of wasting were 11.6%, 11% and 10.5% respectively, with 1.6%, 2.1% and 1.9% severe wasting in each of the three camps. The graph below shows a comparison of the September 1998 survey (in terms of percentage of the median) and earlier surveys. The number of new admissions to the selective feeding programmes decreased from May 1998. The under-five mortality rates from the Dadaab camps were relatively stable before the surveys and ranged from 0.34-0.62/10,000/day.

Prevalence of Acute Malnutrition in Dadaab camps (in percentage of the median)

Food basket monitoring in these camps by MSF-B found that the energy content of the ration was between 2,000-2,100 kcals per person per day from June to August 1998, which must have contributed to the reduction in malnutrition. From March to June, however, the energy content was only 1,200-1,600 kcals. The survey reported that all cases of severe malnutrition were followed up in nutritional programmes. A further reason for the decrease in the amount of wasting may be the newly introduced distribution of free firewood for cooking - in the past there may have been insufficient fuel for cooking (UNHCR -08/03/99).

A survey in Kakuma camp (population 71,156) in October 1998 found a malnutrition prevalence of 15.6% and severe malnutrition at 1.7% (see Annex I(4b)). Coverage of the dry feeding programme was 25% and that of the wet feeding programme was nearly 100%. Under-five mortality rates ranged from 0.1-0.58/10,000/day in the months before the survey and crude mortality rates from 0.08-0.15/10,000/day. These results reflect little change in the nutritional status of the camp population.

In addition to the surveys described above, further studies were conducted in November 1998 to assess the prevalence of anaemia and the BMI-for-age in adolescents aged 10-19 years of age in refugee camps in both Kakuma and Dadaab (see Annex I(4c-d)). These surveys were undertaken in order to follow-up and assess the results of a survey in Kakuma in April 1997, which identified anaemia as a serious public health problem among school age children and adolescents in the camp (see RNIS 22). There were particular concerns about the high proportion of unaccompanied adolescent boys in Kakuma, who currently number roughly 5,000 out of approximately 16,846 in total, many of whom have been in the camp from three to six years. The unaccompanied adolescents are thought to be at nutritionally greater risk because they lack the normal support mechanisms from relatives. The mean duration of stay of these boys was 3.2 years, and 29% of them reported they had been in Kakuma six years or longer.

The studies conducted in 1998 used a different and more accurate technique to measure haemoglobin levels than that in 1997, and found slightly lower levels of anaemia. The findings of the preliminary analysis were:

• The prevalences of anaemia found in both camps, were similar to those in other stable populations in Africa and hence not thought to be an overwhelming public health problem. According to WHO age and sex specific cut-off values the overall prevalence of anaemia was 47.2% (Kakuma) and 42.9% (Dadaab). However, if a haemoglobin concentration cut-off point of 11 gm/dl Hb is employed only 25% (Kakuma) and 21.7% (Dadaab) of the population is classified as anaemic.
• These prevalence rates may represent a 'seasonal low' as they were measured during the dry season, and would be expected to increase during the rainy season as a result of increased incidence of malaria and hookworm, both important causes of iron deficiency anaemia.
• Given the presumed low incidence of malaria and hookworm, much of the current anaemia is thought to be diet related rather than disease related.
• The prevalence of anaemia in the community of unaccompanied adolescents was 61% compared with 46% among those adolescents living with relatives (although this appears a considerable difference, this result was not found to be statistically significant).
• The Sudanese adolescents had a significantly higher prevalence of anaemia than the Somalis. In addition, preliminary analyses suggest that adolescents who have lived longer in Kakuma were more likely to be anaemic (further analysis is required to confirm this association). Anaemia does not disproportionately affect any age or sex group in the sample, which is surprising given that adolescent girls aged 15-19 require twice the amount of iron in their diet as compared with boys (32 mg compared with 15 mg assuming low bioavailability - WHO, 1995).
• The prevalence of low BMI-for-age was 57% in Kakuma and 60.6% in Dadaab. The authors question the validity of using this nutritional index as an indicator of protein energy malnutrition in adolescents. Nevertheless the results show that unaccompanied adolescents have a significantly lower BMI-for-age, as compared with those living with relatives.
• Night blindness was reported by 24% of the sample, and Bitots spots were noted in 4%. Similar prevalences of these signs and symptoms among young children indicate endemic vitamin A deficiency.
• The general rations provided between 19.9 and 27.5 mg iron (of low bioavailability), which represents 97.5% to 135% of the WHO recommended amounts for emergency-affected populations.

Certain northern-eastern parts of Kenya are currently experiencing drought conditions. The failure of the short rains (October to January) has led to extensive crop-failures in the short-rains production area. The drought has also increased stress on water and grazing resources in the pastoral rangelands. Reports suggest that food distributions are not yet justified, but that the most immediate priority is to renovate and maintain key boreholes (FEWS- 26/02/99; PANA - 12/01/99).

Overall, the refugees in Kenya are not considered to be at heightened nutritional risk (category IIc).

Recommendations from the anaemia studies include:

• Further studies on the prevalence of anaemia, low vitamin A status and their causes in other (high-risk) groups, taking into account seasonal differences.
• To re-assess standard methodologies of measuring adolescent nutritional status, both for protein-energy deficiency and anaemia.
• It would also be worthwhile to analyse the reason why the group of unaccompanied adolescents in Kakuma are apparently less able to adopt the wide range of coping strategies used by the other refugees, which then may be addressed.

Recommendations and Priorities:

• There is a continued need for general food distribution for refugees.
• MSF plans to continue selective feeding programmes in Dadaab camps and to monitor nutritional status

RNIS 25, October 1998

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

RNIS 24, June 1998

There are approximately 120,000 Somali refugees in the Dadaab area camps, and 59,000 refugees in Kakuma. Most of the refugees in Kakuma are of Sudanese origin [UNHCR 31/03/98]. In the most recent RNIS report (No 23), flooding in the Dadaab area camps leading to destruction of infrastructure and livestock was described. Flooding had made many access roads to the camps impassable, and relief food had to be airdropped to the refugees. It was therefore only possible to supply half-rations for this population. Indeed, rations receipts have consistently been less than planned since March 1997. In February 1998, the floods had receded to the point where a nutritional survey was carried out to determine the effects of the floods on the nutritional status of the population.

Malnutrition in the Dadaab Area Camps for Somali Refugees in Kenya, over time

taken from: Nutritional Survey report for Ifo, Dagahaley and Hagadera Camps, MSF-B, Feb. 98

In Ifo camp, wasting was measured at 16.1% with 1.0% severe wasting. Oedema was measured at 1.6%. In Dagahaley camp, wasting was measured at 10.9% with 0.9% severe wasting. Oedema was measured at 1.6%. In Hagadera camp, wasting was 14.7% with 1.5% severe wasting. Oedema was measured at 0.6% (see Annex I (6a-c)). For all camps coverage of selective feeding programmes is low, particularly for therapeutic feeding. For the three camps only about 22% of severely malnourished and 70% of moderately malnourished children are covered by the selective feeding programmes. In March, the crude mortality rate for the camps was 0.17/10,000/day and the under-five rate was 0.5/10,000/day. Both of these are within usual limits. Average water availability for the month of March was estimated at 13.4 litres/person/day [MSF-B Feb. 1998, UNHCR 31/03/98].

In general the nutritional status of the children under five has not changed significantly in the Dadaab area camps since August 1997 (see graph). The exceptions to this were in Ifo and Dagahaley camps, which were most seriously affected by the floods. White levels of wasting remain high, the fact that there was no decline in nutritional status is thought to be due in large part to massive efforts by WFP to airlift food aid to the affected population during the floods. By the end of April, food supplies were back to normal and full rations were distributed after six weeks of half rations. Road repairs have now been effected allowing better access to the camps [IRIN 17-23 Apr. 98, MSF-B Feb. 1998].

In Ifo and Hagadera, rates of malnutrition are highest amongst those households that have no ration cards. This is of concern as following the floods in Somalia, a new influx of refugees arrived in poor nutritional condition. These new arrivals are dependent of food sharing until they are registered or return to Somalia [MSF-B Feb. 98].

Kakuma camp (population estimated at 59,000) houses mainly Sudanese refugees with a high proportion of unaccompanied minors. Mortality rates in the camp in March were 0.13/10,000/day and the under-five mortality rate was 0.45/10,000/day. This represents a significant decline and is largely due to a reduction in malaria-related mortality. Both of these mortality rates are within usual limits. Funding is being sought for a number of projects to maintain and expand water supply, income generating projects and for recreational and sports projects [CWS 08/05/98, UNHCR 31/03/98].

Overall, the refugees in the Dadaab camps can be considered to be at moderate nutritional risk (category IIb in Table 1), although the situation appears to be stable. Those in Kakuma are not currently thought to be at heightened risk of malnutrition and mortality (category IIc in Table 1).

On-going interventions Coverage of the selective feeding programmes needs to be improved in the Dadaab camps. This should be achievable through the existing community health outreach programmes. A nutritional survey should be repeated in six months time partly to help assess selective feeding programme coverage. Finally, water availability is still somewhat low and needs to be improved.
 

RNIS 23, March 1998

There are approximately 179,300 refugees in Kenya, mainly comprised of 133,800 Somali refugees in the Dadaab area camps and 36,700 Ethiopian and Sudanese refugees in Kakuma [UNHCR 12/03/98].

Flooding in the north-eastern area of Kenya has left the 125,000 Somali refugees in the Dadaab camps stranded. The floods destroyed refugee food stores and led to the death of many livestock. Reports indicate outbreaks of cholera, Rift Valley Fever, acute respiratory tract infections and malaria. Water supplies are said to be polluted and latrines are collapsed or overflowing, posing a serious health hazard. Prior to this flooding, the nutritional situation in the camps, although still giving cause for concern, was gradually improving. Levels of wasting had decreased in the first six months of 1997 from 26-33% to 10-17.6%. A few cases of scurvy were being identified in the health clinics as recently as February 1998, and the crude mortality rate was 0.20/10,000/day (see Annex I 5a) [UNHCR Dec 97, Feb 98, WFP 23/01/98, 20/02/98, WHO 28/01/97].

Since the floods, food has been airlifted to the camps as road transport has not been possible. Inadequate funding of this programme has meant that refugee rations will need to be cut by 50%. This is likely to create nutritional problems as the population currently has no other source of food. With the imminent onset of seasonal rains, the next few weeks will be critical to build up food stocks for distribution scheduled for April and May. However, import duties, which had been waived, are now reinstated, and relief food is being held up in ports as a result [IRIN 21-23/03/98, WFP 13/03/98].

There are no reports of change to the situation for the refugees in Kakuma camp. Levels of wasting below (80% wt/ht) were described in the last RNIS report (no. 22). School children were identified as most vulnerable malnutrition so that school feeding programmes were begun. In December 1997, the crude mortality rate in the camps was 0.16/10,000/day and under-five mortality rates were 0.63/10,000/day [UNHCR Dec 97].

Overall, the refugee population in Dadaab is at heightened risk of malnutrition (category Ha in Table 1) with a tendency towards deterioration due to reduced rations. The remaining refugee population in Kenya is not currently thought to be at heightened nutritional risk (category IIc in Table 1).

On-going interventions

Although the floodwaters have begun to recede, the immediate need is to maintain the airbridge to provide food to stranded populations. Only light-weight vehicles can reach the camps so far. The need to rebuild damaged infrastructure, particularly in order to re-establish road access, will be critical. Ensuring adequate and safe water supplies will also be a priority in the short-term.

In the longer term, the potential problem of recurring scurvy in the Dadaab camps needs to be addressed. The health centres often report scurvy in the August-December period. Questions have been raised about the accuracy of the diagnosis, so as a first step the diagnosis needs to be verified. If scurvy is confirmed, preventive measures must be in place before August 1998.
 

RNIS 22, December 1997

There are approximately 175,000 refugees in two main areas in Kenya. This total number is comprised of 132,000 Somali, 37,000 Sudanese and 6,000 Ethiopian refugees [UNHCR 31/10/97].

There were approximately 132,000 Somali refugees in three camps in the Dadaab region of Kenya. Most of these refugees arrived in 1991-2, fleeing fighting which accompanied the over-throw of the military rulers. Recent flooding has led to the spontaneous evacuation of most people in these camps. Information below describes the situation prior to the flooding.

Surveys carried out in January 1997 showed very high levels of wasting of 26-33%. In response, a blanket feeding programme was begun in March. A follow-up survey in August 1997 showed an improved situation with wasting 10.4-17.6% and severe wasting 0.8-1.7% (see Annex I (8a-c)). Measles immunisation coverage, confirmed by a vaccination card, was 95% in two of the camps. In Hagadera camp, coverage was 90%. It has been suggested that the increase in levels of wasting seen between November 1996 and January 1997 were due to a serious outbreak of diarrhoea combined with a seasonal peak in malaria. Furthermore, the situation had begun to improve before the introduction of the blanket feeding. The under-five mortality rate had decreased to 0.4/10,000/day [MSF-B Aug. 97, MSF-B 12/10/97].

Under-five Mortality Rates in the Dadaab Area Camps for Somali Refugees

*Blanket supplementary feeding programme began:

General ration provision has been erratic in 1997. One or more commodities have often been missing, and while attempts are made to compensate for the energy value of a missing item by increasing the quantity of another, this doesn't compensate for the nutrient content of the missing item [MSF-B 12/10/97]. Energy needs for this population are now estimated at 1880 kcals per person even though the 1996 assessment recommended 2100 kcals per capita per day. Furthermore, blended foods are only given out during the dry season even though no such restrictions were made by the 1996 assessment team. The immediate consequence of missing commodities from the general ration is that refugees are quickly drawn into an economy of swapping and ration trading. However, the terms of trade often do not favour refugees and calorie intake may be further reduced.

In addition, scurvy has been identified as a seasonal problem in these camps. Cases of scurvy are often noted during the August-December period, which coincides with a reduction in the availability of camel milk and what little fresh vegetables are sometimes available. The micronutrient content of the ration has been deficient in vitamin C, and other micronutrients. Efforts to distribute micronutrient-rich foods, such as fresh vegetables, have been mostly unsuccessful due to the remote location of the camps and a drought in the area leading to reduced production. Blended foods were not distributed in the general ration until September. It is not known, however, how much vitamin C remains in CSB after cooking. Vitamin supplements have been provided to children in feeding programmes over the last year. More recently, questions have been raised over the validity of the diagnosis of scurvy in the camps [SCF 23/09/97, UNHCR 20/11/97].

A household food economy assessment was carried out in September to update information obtained in September 1996. The report stresses that the situation for these refugees has changed little and they remain highly dependent on food aid. In some cases, these people are "thought to be slightly worse off than they were a year ago. This is attributed to many factors including the arrivals of refugees transferred from other camps, irregularities in food commodities distributed, and drought in the area. A number of fundamental barriers to increased self-reliance were also mentioned in the assessment, For example, the camps are in a semi-arid environment and travel outside the camp is officially restricted [SCF 23/09/97].

Heavy rains at the end of November led to flooding and it is reported that most of the refugees have fled the camps in search of higher ground. It is reported that shelters have collapsed, food stocks have been destroyed, and latrines have been flooded. Food and non-food items are being airlifted into flood-affected areas [WFP 21/11/97, 05/12/97].

There are approximately 48,000 refugees in Kakuma camps, mainly of Sudanese origin. A survey in April 1997 showed high prevalences of wasting and anaemia among children under five years old and school age children. Unaccompanied boys were noted as being particularly severely affected by anaemia.

Questions were raised about the validity of these findings, and, after a further screening and validation exercise, it was concluded jointly by UNHCR and the International Rescue Committee (IRC) that the prevalence of wasting was likely to be at or below 5% less than 80% of the median weight for height for children under five years old. A school feeding programme has been initiated for 17,000 children, and it was further recommended that adequate health care services be provided along with vitamin A, iron, folic acid and vitamin C on a regular basis [UNHCR 17/11/97].

A recent household food economy assessment concluded that the major source of food for the Kakuma population remains food aid. There are a number of constraints preventing refugees from becoming more self-sufficient, including the limited potential for farming, a ban on owning livestock and difficulties in travelling outside of the camp. There are also problems with erratic general ration commodity supplies. Although efforts are always made to compensate for the calories of a missing general ration commodity, the nutrient value is often not replaced. Food commodity supplies have been more irregular than last year (no beans for two and a half months from January and no oil for two and a half months between June and August). The ration is deficient in certain micronutrients although some efforts have been made to provide complementary foods like cabbage and dried fish. However, these commodities have been provided in such small quantities that the micronutrient shortfall in the general ration has remained considerable. The assessment concluded that the situation for the majority of the camp had deteriorated slightly since last year. However, the ability of certain individuals to "recycle" and therefore obtain extra ration cards may have gone some way to offset factors that undermined food security [SCF 19/09/97].

Both the Dadaab and Kakuma camps have problems in providing the full general ration allocation at each distribution. Breaks in the pipeline for different commodities are not uncommon. Many of the difficulties are due to the remoteness of the refugee sites and transportation, particularly during the rainy season.

Overall, the nutritional data available on the refugees in the Dadaab camps points to an improving situation. However, recent flooding has disrupted camp facilities, and these refugees are at heightened risk of mortality due to flooding (category IIa in Table 1). The situation for those in the Kakuma camps is less dire than previously available information indicated. This population can be considered to be at moderate risk due to the irregular supply of the ration (category IIb in Table 1).

Ongoing interventions: The Dadaab camps will need rebuilding once flood levels recede. These camps also require redoubled efforts to provide the general ration food basket in future distributions. UN and donors must commit themselves to meeting these needs. The blanket supplementary feeding programme should continue as long as general rations remain inadequate. At the same time it may prove useful and instructive to investigate whether it is cost effective to implement a blanket feeding rather than improve general ration provision. Furthermore, questions have been raised on the veracity of scurvy diagnoses in the camps. These need to be validated.

An assessment is needed in Kakuma camp to determine whether the water table can tolerate increased water extraction leading to pumping in order to enhance tapstand gardens. There is also a need to address elevated levels of anaemia in school-age children.
 

RNIS 21, September 1997

There has been a slight increase in the total number of refugees in Kenya over the last three months due to the arrival of approximately 3,000 Sudanese refugees. The total number of refugees is comprised of 131,000 Somali refugees, 41,000 Sudanese refugees, and 4,500 Ethiopian refugees [UNHCR 31/08/97].

In response to a survey carried out in January 1997 which showed levels of wasting varying from 26-33% among the Somali refugees in the Dadaab camps (see RNIS #19), blanket feeding programmes have been started and are planned to continue up until November 1997. A follow-up survey will be conducted in the near future to determine whether the blanket feeding programme is having the desired impact [UNHCR 09/09/97].

Scurvy is often seen among the Somali refugee population in Kenya during the September-December period. Curative measures are now taken rather than preventive ones. This is in part because of the difficulties experienced in the past of providing vitamin C rich supplementary foods such as vegetables due to logistical difficulties and poor local availability of these foods. Vitamin C tablets are available at the health centres, however it is acknowledged that reliance on health centre treatment will not be effective in reaching the total population at risk [UNHCR 09/09/97].

A survey carried out in Kakuma camp for Sudanese refugees in April 1997 also showed high levels of wasting and anaemia, particularly among school aged children (see RNIS #20). Interventions undertaken in response to the survey results included the distribution of dried fish to vulnerable groups, including school-aged children, in April and May, and a distribution of CSB and therapeutic milk to school children in May. Efforts in the past to provide meat, fish and vegetables have failed due to problems of supply and logistical difficulties. A school feeding programme is planned to begin once the construction of kitchens and shelters are completed [UNHCR 04/07/97].

It should be noted that there are serious difficulties in supplying the Kakuma and Dadaab camps with food aid. These camps are very isolated and road conditions, particularly during the rainy season, are not good. In addition, the availability of some foods locally, for example fresh vegetables or meat and fish, is poor [UNHCR-a 16/09/97].

Overall, the refugees in Kakuma and the Dadaab camps are at high risk due to elevated levels of wasting (category I in Table 1) and the remaining refugees in Kenya are not currently thought to be at heightened risk (category lie in Table 1).
 

RNIS 20, June 1997

There are approximately 173,500 refugees in Kenya in need of assistance. This total number is comprised of 131,000 Somali refugees, 38,000 Sudanese refugees and 4,500 Ethiopian refugees.

The last RNIS report contained results of a nutritional survey carried out in the Dadaab camps (estimated population 115,000) for Somali refugees which showed a very serious situation with levels of wasting ranging from 26.0% to 33.3%. In response to this situation, a fortified blended food was distributed to improve the quality and caloric content of the general ration. However, stocks ran out in mid-April so distributions have now been discontinued [UNHCR 15/05/97].

Reports of an unusually high prevalence of anaemia among boys aged between 8-20 years in Kakuma camp (estimated population 32,000), contained in the last RNIS report, prompted a nutritional survey which was carried out in April 1997. This nutritional survey included school age children between the ages of 6-11 years who were assessed using weight-for-height and 12-20 year olds who were assessed using body mass index (BMI). Among the 6-11 year old age group, wasting was measured at 40% with 7% severe wasting (see Annex I (8a)). Anaemia prevalence was 69%. In the 12-20 year old age group wasting was measured at 19.8% with 0.8% severe wasting. Refer to Annex I for details pertaining to cut-offs used in this survey. Anaemia prevalence was 75-86%. There were no significant difference between the sexes, nor between those living in foster care and unaccompanied minors. Based on this survey, the problem of wasting and anaemia extended to all school age children. Since the survey a school feeding programme has been started in the camp and a fortified blended food (UNIMIX) will be re-introduced to the general ration in order to improve the situation [IRC Apr. 97, UNHCR 15/05/97].

A survey among children between 6-59 months old was also carried out. Levels of wasting were 14.0% with 0.6% severe wasting (see Annex I (8c)). However, oedema was measured at 5.0% and signs of anaemia and vitamin B complex deficiencies were noted. Levels of wasting in September 1996 were only 10.4% with 2.3% severe wasting. Crude mortality rates over the last six months have been 0.3/10,000/day. Measles immunisation coverage was 93% [IRC Apr. 97, UNHCR 14/04/97].

Overall, the refugees in the Dadaab area are likely to remain at high nutritional risk. Those in Kakuma camp are also at high nutritional risk (category I in Table 1). The remaining refugees are not currently considered to be at heightened risk (category DC in Table 1).

How can external agencies help? Fortified blended foods need to be re-introduced into the general ration in the Dadaab area camps as soon as possible to improve the quality and caloric content of the ration. There also needs to be an analysis of why levels of malnutrition are so high amongst all school age children and adolescents in Kakuma refugee camp and an assessment of whether the current school feeding programme is beginning to address the appalling nutritional situation found in the recent survey. Nutritional surveys should also be conducted on adults above the age of 20 years of age to determine whether the problem is only confined to school children and adolescents. It may be that there needs to be a considerable improvement made to the level of general ration provision.
 

RNIS 19, March 1997

There are approximately 166,000 refugees in Kenya requiring humanitarian assistance. This population is comprised mainly of 4,000 Ethiopian, 130,000 Somali and 32,000 Sudanese refugees.

The health and nutrition situation of the Somali refugees in the Dadaab area camps (total estimated population 114,000) has markedly deteriorated over the past six months, leading to what is being described as a nutritional emergency. Problems with the food supply and the distribution systems in the camps have been identified as primary factors contributing to the increased levels of wasting being seen. Since June 1996, there have been problems with the supply of beans and the average number of kcals/person/day supplied in the general ration has been less than 1700. The general ration has not contained blended foods or sugar, despite recommendations made following an assessment mission in October 1996 to include these foods in the general ration. An increase in the incidence of diarrhoeal disease and malaria may also be influencing nutritional status. Furthermore, some cholera cases have been confirmed in the last few months [MSF-B 31/01/97, WFP 11/02/97].

A recent survey in Ifo camp showed 33.3% wasting with 6.7% severe wasting (see Annex I 8(a)). The general ration provided approximately 1,850 kcals/person/day in November 1996 and 1700 kcals/person/day in December 1996. The under-five mortality rate was 5/10,000/day in January 1997 (5x normal). Coverage of the therapeutic feeding programme was only 63% [MSF -B 31/01/97].

In Dagahaley camp wasting was measured at 31.4% with 6.7% severe wasting (see Annex I 8(b)). The general ration in November 1996 provided just over 1900 kcals/person/day and in December 1700 kcals/person/day. The under-five mortality rate was 3.6/10,000/day (over 3x normal). Coverage of the therapeutic feeding programme was only 56% [MSF-B 31/01/97].

Wasting in Hagadera was measured at 26.0% with 5.3% severe wasting (see Annex I 8(c)). Rations provided approximately 1900 kcals/person/day in October and November 1996 and 1650 kcals/person/day in December. The under-five mortality rate was 3.5/10,000/day in December (over 3x normal). Coverage of the therapeutic feeding programme was 70% [MSF-B 31/01/97].

Scurvy is a seasonal problem in this area and has been regularly reported during the September-January period in 1993, 1994, 1995 and again in 1996 [RNIS 2. 8, 17, 18). However, the number of new scurvy cases in the three camps began to decline in December 1996. This was probably due in part to the distribution of vitamin C tablets to the refugee population. It had been recognised that CSB does not greatly affect the seasonal incidence of scurvy in these camps so that planned distributions were only for the dry season period (May to October) with attempts to provide or increase the availability of fresh fruits and vegetables for the remaining six months of the year. The nutritional surveys cited above also reported the presence of vitamin A deficiency and a very large number of anaemia cases [MSF-B 31/01/97].

A number of steps have so far been taken to redress this serious nutritional situation. Attempts have been made to procure maize and beans locally for the general ration to ensure more reliable deliveries. However, the current drought in the region has somewhat thwarted this initiative. Another initiative has been the establishment of blanket selective feeding with com soy blend for all children under five and pregnant and lactating women [WFP 21/02/97, UNHCR-a 27/02/97].

There remain approximately 16,000 Somali refugees in three camps on the coast of Kenya. These camps were supposed to be closed by the end of 1996, with refugees either repatriating or being moved to the camps in the north-east of Kenya. However, this deadline was not met. Currently a food basket of pulses, cereals, vegetable oil and salt is being distributed to this refugee population and targeted supplementary feeding programmes are distributing a fortified blended food, sugar and oil. An outstanding problem in these camps is the existence of a large, unregistered population who do not benefit from the general ration. It is believed that many of the malnourished who are admitted to the supplementary feeding programme, come from this unregistered population [IFRC 11/02/97].

A recent assessment in Kakuma camp (estimated population 32,000 Sudanese refugees) revealed a very high rate of severe anaemia amongst boys aged between 8-20 years. This unusually high incidence was attributed to a number of factors. Many of this "teenage" population were effectively unaccompanied minors with little linkage to the household economies in the camp. Furthermore, the average per capita kilo calorie requirements for this age group (2200 kcals) were not being met by the 1900 kcals general ration. Also, the general ration was deficient in absorbable iron and vitamin C (which is essential for the absorption of iron) [WFP 07/02/97].

Other factors were that a recent re-registration had reduced the number of excess ration cards in the camp (many of which were previously held by this group) and a high proportion of the unaccompanied minors were known to be selling off a part of their general ration in order to purchase essential non-food items. High levels of intestinal worm infestation amongst this age group may also have been contributing to this unusual pattern of severe anaemia. A school feeding programme utilising CSB has been recommended in response to this serious nutritional problem. As Kakuma camp has a high rate of school enrolment this strategy should be effective in ensuring an increased intake of absorbable iron amongst this target group [WFP 07/02/97].

Overall, the Somali refugees in the Dadaab camps are at high risk (category I in Table 1) while the refugees in the coastal camps are not currently considered to be at heightened risk (category IIc in Table 1). The marginalised population identified as having very high rates of severe anaemia in Kakuma camp are at high risk while the remaining Sudanese and Ethiopian refugees are not at heightened risk (category IIc in Table 1).

How could external agencies help? Some of the proposed actions to remedy the situation in the Dadaab area camps which are currently under consideration include:

• supplying vitamin A enriched oil and fortified blended foods in the general ration to reduce micronutrient deficiency diseases;
• increase the general ration to 2100 kcals/person/day;
• determine any social causes of malnutrition;
• investigate reasons for poor coverage of therapeutic feeding programmes and increase coverage of the therapeutic feeding programmes through appropriate measures, e.g. better outreach activities.

These interventions, where implemented, would need financial support. The newly established blanket supplementary feeding programmes will also need to be evaluated in the near future in order to determine whether rates of wasting are declining as a result of this measure.

In the coastal camps there is an urgent need to register "unregistered" individuals so that they can obtain the food and non-food resources to which they are entitled.

In Kakuma camp the effects of the newly introduced school feeding programme on rates of severe anaemia amongst males aged 8-20 years of age should be closely monitored. In the event that this strategy fails to have a marked impact on the problem, then other strategies, e.g. improving the general ration food basket, should be considered.
 

RNIS 18, December 1996

There are approximately 167,000 refugees in Kenya comprised of 4,500 Ethiopian refugees, 130,500 Somali refugees and 32,000 Sudanese refugees. There has been a decrease in the number of Somali refugees due to repatriation, and an influx of Sudanese refugees. In August 1996, the Kenyan government announced that all Somali refugee camps would be closed by the end of 1996. It is however, unlikely that this deadline will now be met as it would involve the repatriation and/or resettlement of over 130,000 refugees over the next few weeks [IFRC 17/10/96, UNHCR 30/11/96].

The most recent RNIS report contained details of a nutritional survey in the Dadaab camps where there are approximately 113,000 Somali refugees. At that time it was reported that cases of scurvy were noted by the survey team. More recent information indicates an epidemic of scurvy with at least 700 cases being reported per month (5.8/10,000/month). Vitamin C tablets have been distributed amongst this population [MSF-B 06/11/96].

Overall, the refugees in the Dadaab camps are at high risk (category I in Table 1) due to micronutrient deficiency diseases. The remaining refugees are not currently considered to be at heightened nutritional risk (category IIc in Table 1).
 

RNIS 17, September 1996

There remain approximately 165,000 refugees in Kenya. This total number is comprised of 6,000 Ethiopian refugees, 130,000 Somali refugees, and 29,000 Sudanese refugees. The total number has decreased due to the continued repatriation of Sudanese refugees. However, there has been an increase in the number of Somali refugees due to heightened insecurity in Somalia (see section #12 for details) [UNHCR 31/08/96].

Recent surveys in the three camps for Somali refugees in the Dadaab area show a deteriorating situation. In Ifo camp (estimated population 34,000), wasting and/or oedema was measured at 18.6% with 4.0% severe wasting and/or oedema. A previous survey in August 1995 showed 12.1% wasting and/or oedema. In Hagadera camp (estimated population 40,000) wasting and/or oedema was measured at 18.2% with 3.6% severe wasting and/or oedema. These results also compare unfavourably with those from the August 1995 survey when wasting and/or oedema was measured at 12.1%. In Dagahaley camp (estimated population 38,000), wasting and/or oedema was measured at 15.1% with 2.0% severe wasting and/or oedema; in August 1995 wasting and/or oedema was 9.8% (see Annex 18(a-c)). In addition to these elevated levels of wasting, cases of scurvy were also noted. Outbreaks of this micronutrient deficiency often occur among these refugees in the August-October period [MSF-B 25/09/96].

After a planned reduction in the food basket, the ration has recently been providing approximately 1800 kcals/person/day. Furthermore, sugar and Unimix (a fortified blended food) have not been provided in the ration over the last year. It is likely that the reduced general ration in conjunction with the limited trading opportunities around the camps are major contributing factors to the increased levels of wasting [MSF-B 25/09/96].

Overall, the Somali refugees in the Dadaab camps in Kenya are at high risk (category I in Table 1) due to elevated levels of wasting, and the presence of scurvy. The remaining Somali refugees, along with the Ethiopian and Sudanese refugees are not currently considered to be at heightened nutritional risk (category IIc in Table 1).

How could external agencies help? The most direct way to address the elevated levels of wasting currently seen in the Dadaab camps would be to increase to size of the general ration and to expand selective feeding programme capacity and coverage. Scurvy appears to be seasonal among this refugee population; indeed outbreaks have been reported in the past (see RNIS #8). The present scurvy outbreak suggests a need for the immediate distribution of a vitamin C fortified blended food. Furthermore, as this appears to be a seasonal occurrence, plans to provide vitamin C in some form to this population during the August-October period need to be made in advance. A review of potential mechanisms for providing this remote Somali population with an adequate vitamin C supply would be appropriate. Such mechanisms might include: fortification of water supplies, fortification of a general ration commodity such as cereals, and the distribution of vitamin C tablets.
 

RNIS 16, June 1996

There are approximately 176,000 refugees remaining in Kenya, comprised of 125,000 Somali refugees, 45,000 Sudanese refugees and 6,000 Ethiopian refugees. The slight increase in the total number is due to a small influx of Sudanese refugees [UNHCR 31/05/96].

There are no recent nutritional survey data on the Somali refugees in Kenya. However, fortified blended foods are still absent from the general ration and as there have frequently been reports of scurvy amongst this population, especially in the August-October period, there may be some cause for concern that case of scurvy re-appear [UNHCR 11/06/96]

There has recently been a security incident at Kakuma camp (for Sudanese refugees) where two food distribution centres were destroyed. These were erected in order to facilitate a move away from general ration distributions through group elders to distributions to heads of families [WFP 19/04/96].

Micronutrient fortified blended foods have not been included in the general ration. Since there have often been reports of scurvy among this population, especially in August-October, the lack of fortified blended foods is causing concern [UNHCR 11/06/96].

Overall, the refugees in Kenya are not currently thought to be at heightened nutritional risk (category IIc in Table 1).

How could external agencies help? Efforts should be made to reintroduce micronutrient fortified blended foods into the ration to avoid possible cases of scurvy in the August-October period, when outbreaks have occurred in the past. The need for such an initiative was also noted in the April RNIS report.
 

RNIS 15, April 1996

There are approximately 173,000 refugees remaining in Kenya. 126,000 of these are Somali, 41,000 are Sudanese and 6,000 are Ethiopian.

The nutritional situation in the Dadaab camps (Hagdera, estimated population 37,000, Ifo, estimated population 34,000 and Dagahaley, estimated population 32,000) appears to be adequate. The most recent nutritional surveys were carried out in August 1995 (details in RNIS #12) and showed levels of wasting and/or oedema ranging from 6.2-8.9%. Mortality rates recorded in October 1995 were at normal levels [MSF-B 18/03/96].

Since the August survey, the average general ration distribution has provided 2,000 kcals/person/day, although inequity in the distribution system is regularly observed through food basket monitoring. Furthermore, there has been no provision of com soy blend in the general ration since October 1995. This is particularly worrying given the scarcity of fresh fruit and vegetables in the region and the known vulnerability of this refugee population to outbreaks of micro-nutrient deficiency disease, in particular scurvy [MSF-B 18/03/96].

Overall, the refugees in Kenya are not currently thought to be at heightened nutritional risk, although it will be crucial to monitor the nutritional situation to detect signs of scurvy if CSB is not reintroduced in the general ration. This will be especially important towards the end of the summer and the autumn, when outbreaks of scurvy have occurred in the past.

How can external agencies help? Given the lack of availability of fresh fruit and vegetables to camp populations and the historical susceptibility to scurvy in these camps, there is a clear need to provide sources of vitamin C, and re-introduction of micronutrient fortified (including vitamin C) corn soy blend into the general ration, possibly on a seasonal basis.
 

RNIS 14, February 1996

The total estimated number of refugees in Kenya continues to decrease due largely to the repatriation of Somali refugees. It is currently estimated that there are 173,000 refugees in Kenya. This number is comprised of 126,000 Somalis, 41,000 Sudanese and 6,000 Ethiopians [UNHCR 31/12/95].

There are no recent nutritional data available on these refugees. However, as highlighted in the previous RNIS report, there needs to be continued monitoring for any potential negative impact on nutritional status due to the reduction in the ration from 2100 Kcals/person/day to 1800 Kcals/person/day and the discontinuation of CSB. These refugees are not currently thought to be at heightened nutritional risk (category IIc in Table 1).
 

RNIS 13, December 1995

The total number of assisted refugees in Kenya has decreased over the past two months to just over 186,000 people. This number is comprised mainly of 140,000 Somali refugees, 40,000 Sudanese refugees and 6,000 Ethiopian refugees. There are an additional 51,000 unassisted refugees in Kenya (not included in Table 1) [UNHCR 16/11/95].

The number of Somali refugees in Kenya continues to decline with a further 8,000 repatriating during October bringing the total population repatriated during 1995 to over 40,000. The reduction in Somali refugee numbers will allow the closure of Marafa camp (coastal camp) in the near future [UNHCR 16/11/95].

The recent reduction in the ration for this population from 2100 kcals/person/day to 1800 kcals/person/day in conjunction with the discontinuation of CSB in the general ration requires careful monitoring for any potential negative impact on nutritional status [UNHCR 16/11/95].

Overall, the refugee population in Kenya is probably not at heightened nutritional risk (category IIc in Table 1).
 

RNIS 12, October 1995

The total number of assisted refugees in Kenya has remained stable at 197,500 despite the continuing repatriation of Somali and Ethiopian refugees. This is largely due to the registration of children recently born in the Dadaab camps. Current estimates are that there are 158,000 Somali refugees, 33,000 Sudanese refugees and 6,000 Ethiopian refugees in Kenya.

There have been tensions over the governments plan to close Marafa camp (a coastal camp). The option given to refugees of repatriation or transfer to one of the Dadaab camps was not initially well received. Meanwhile voluntary repatriation has continued from the Dadaab camps with refugees returning to middle and lower Juba.

A recent round of surveys in August in the Dadaab area, where approximately 113,000 Somali, Sudanese and Ethiopian refugees are located, found that nutritional status appears to be deteriorating. These surveys were conducted as a follow up to surveys conducted in March 1995 (see RNIS #10) and were set against a background of a planned ration reduction in July 1995 from 2,100 kcals/person/day to 1,800 kcals. There was a recent update of ration cards as well which had led to a cancellation of many cards amongst the refugee population [MSF-B Aug 95, UNHCR 31/07/95].

In Hagadera camp (estimated population 41,000) wasting was measured at 12.1 % with 2.4 % severe wasting (see Annex 1 (8a)). This is an increase over a survey conducted almost a year ago when wasting was recorded at 5.3%. The survey team has suggested that the increase may be attributable to high rates of diarrhoea in the preceding two months and also to cancellation of ration cards. Measles immunisation coverage was 87.7% while coverage of the supplementary and therapeutic feeding programmes was only 37% and 22% respectively [MSF-B Aug 95].

In Ifo camp (population estimates vary from 44,000 to 37,000), wasting was measured at 12.1% with 4% severe wasting (see Annex 1 (8 (b)). A comparison with a recent survey shows a slight improvement in the overall nutritional status of the population (from 15.1 % in March 1995) but the level of severe wasting has increased and more children are presenting with oedema. It is possible that the reduced ration and removal of excess ration cards have contributed to the increase in malnutrition. A supplementary feeding programme was started in July 1995 but coverage remains low at 20%. Measles immunisation coverage was 74.2% [MSF-B Aug 95].

The level of wasting measured in Dagahaley (estimated population 34,000) was 9.8% with 1.5% severe wasting (see annex 1 (8 (c)). The overall level of wasting has increased from 6.5% in a March 1995 survey, but the level of severe wasting has decreased to 1.3%. This reduction in wasting may be due to therapeutic feeding centres and a supplementary feeding programme started in July. Based on estimates of numbers of malnourished children in the camp, coverage of feeding programmes is still low at 40%. Measles immunisation coverage was reportedly 89.9% [MSF-B Aug 95].

The overall nutrition situation in the coastal camps (estimated population 48,000) is described as adequate with food distributions proceeding smoothly. A policy has now come into effect whereby if cereal arrives in the form of grain, refugees are given 100 extra grams per person per day in order to compensate for milling losses. The water supply is also generally described as adequate, except in Jomuva camp where only 6.7 litres/person/day of water were available [IFRC 27/07/95].

Blended foods are being distributed to all refugees at 50 grams/person/day in an effort to prevent micronutrient deficiencies, in particular scurvy. This began in July 1995 and will continue for three to four months. The nutritional status of the population will be closely monitored and recommendations will be made on appropriate action to be taken regarding the general distribution (i.e duration of distribution, quantity of blended food distributed) of blended foods [WFP 12/10/95].

Overall, the situation in the Dadaab camps appears to be under control, although gradually increasing levels of wasting are cause for concern and require careful monitoring (category IIb in Table 1). The remaining 84,500 refugees are probably not at heightened risk (category IIc in Table 1) although the seasonal scurvy risk which appears to affect all refugees residing in Kenya, should be noted and guarded against.

How could external agencies help? There appears to be a need to increase the general ration level in the Dadaab camps where levels of wasting have gradually been increasing since rations were cut to 1800 kcals/person/day. There is also a need to improve the coverage of selective feeding programmes, through active case finding, and measles immunisation coverage in a number of camps. Water provision in Jomuva camp needs to be improved urgently.
 

RNIS 11, July 1995

Trend in numbers of refugees

Most recent estimates are that there are approximately 197,000 refugees in Kenya. There are 158,000 Somali refugees, 31.000 Sudanese refugees and 6,000 Ethiopians (along with 2,000 refugees of other national origin). This is a decrease from 230,000 at the end of April, largely due to the continued repatriation of Somalia and Ethiopian refugees. The coastal camp of Utange is now closed [UNHCR May 95].

The re-establishment of CSB (which contains vitamin C) in the general ration for refugees is said to be reducing fears of a seasonal scurvy outbreak in the coming months. The situation will be carefully monitored to determine whether this prevents seasonal scurvy [WFP 24-25/07/95].

How can external agencies help? Agencies should continue to monitor trends in the incidence of scurvy as the traditional “scurvy season” approaches. These scurvy data should then be correlated with the provision of micro-nutrient fortified CSB in the general ration to determine whether the latter prevents seasonal increases of this condition.
 

RNIS 10, April 1995

Trend in numbers of refugees.

There are currently 230,000 assisted refugees in Kenya. This number represents a decrease since the February RNIS and is due to the continued repatriation of Somali refugees and the start of the repatriation programme for Ethiopian refugees. At the same time the anticipated renewed dry season government offensive in southern Sudan caused a further influx of 3,500 refugees to Kakuma since mid-February [UNHCR 21/03/95].

Crude mortality rates for Sudanese refugees in Kakuma camp have been estimated at 0.17/10,000/day with an under five mortality rate of 0.67/10,000/day. Both these rates are within usual limits [UNHCR 21/03/95].

Reports indicate that there has been a general improvement in food management at camp level for Somali refugees in Hagadera, Ifo and Dagahaley camps with the supply of most food commodities remaining stable. However, stocks of blended foods continue to be exceptionally low with no blended foods allocated in February.

Furthermore, recent information shows that although the officially allocated ration for 1994 for the Dadaab camps (total population approximately 142,000) has been 2,400 kcals/person/day, ration allocations to non-officially registered refugees determines that ration receipts may only be in the region of 1800 kcals/person/day [MSF-F Mar 95].

A survey which was conducted in March 1995 found 15.4% wasting with 1.9% severe wasting (see Annex 1 (8a)) in Ifo camp (estimated population 31,000) which shows a deterioration compared to results obtained in an August 1994 survey. In Dagahale (estimated population 38,000) the prevalence of wasting appears to have remained the same at approximately 6.5% (see Annex 1 (8b)) although levels of severe wasting have increased to 3%. A number of agencies have expressed the fear that as the general ration contains insufficient vitamin C and the as proportion of blended foods has been reduced for 1995, it is likely that the outbreak of scurvy which occurred towards the end of 1994 will recur in 1995 at around the same lime unless sufficient quantities (50 gms) of blended foods to ensure adequate intake of vitamin C are provided in the general ration [MSF-F Mar 95].

Overall, the population in Ifo camp in Dadaab can be considered to be at moderate risk with elevated levels of wasting (category IIb in Table 1). The remaining refugee population in Kenya is not currently considered to be at heightened nutritional risk (category IIc in Table 1).

How could external agencies help? The nutritional situation in Ifo camp needs to be closely monitored and supplementary feeding programmes re-established if levels of wasting increase further. It may also be necessary to increase the general ration amount in those camps where large numbers of un-registered refugees receive food unofficially and where levels of wasting appear to be increasing. The need for this may be most easily detected by careful food basket monitoring. There is also a need to safe-guard against the seasonal recurrence of scurvy in all the camps by, for example, increasing the amount of blended food in the general ration, or, it has been suggested, by the provision of vitamin C tablets.
 

RNIS 9, February 1995

At the end of January 1995, it was estimated that there were approximately 232,000 refugees in Kenya. This population comprises 196,000 Somali refugees 26,000 Sudanese refugees and 10.000 Ethiopian refugees. The decrease in numbers from the previous RNIS (255,000) is due almost entirely to a re-registration exercise conducted in Kakuma camp although during this period there have also been new arrivals (mainly from Sudan) and repatriations (mainly to Somalia) [UNHCR 31/12/94, UNHCR-b 31/01/95, WFP 16/02/95]. An air lift of some 4,500 Ethiopian refugees back to their home region in Addis Ababa. Gode and Dire Dawa, has been scheduled for early 1995 [UNHCR Nov 94].

Trend In numbers of refugees.

The most recent reports on the nutritional status of the refugee population in Hagadera indicated 5.3% wasting with 0.8% severe wasting (see Annex 1(4a)). These are very low levels of wasting. Apart from temporary closure of the road to the Dadaab camps (Ho, Dagahaly and Hagadera) in November due to the rains, there is no reason to assume that this situation will have changed greatly. As there are no new reports of scurvy in the camps, this population is not currently considered to be at heightened nutritional risk (category IIc in Table 1) [UNHCR 31/01/95, WFP 17/12/94].
 

RNIS 8, December 1994

Most recent estimates are that there are 255,000 registered refugees in Kenya. This includes approximately 200,000 Somali refugees, 44,0000 Sudanese refugees and 11,000 Ethiopian refugees.

The decreased total number of refugees in Kenya (276,000 in the previous RNIS) mainly reflects more rigorous identification of beneficiaries. However, there have been a small number of repatriations; for example in October a total of 647 refugees returned home. Most repatriation is to Middle and Lower Juba in Somalia. The much awaited massive return to Somalia is only likely if there is a marked reduction in clan warfare and factional rivalry in Somalia.

Trend in numbers of refugees

There continues to be a steady influx of refugees from Southern Sudan into Kenya at the rate of up to 1,000 per month [UNHCR 31/10/94, UNHCR 27/11/94].

There are no recent nutritional survey data on the Sudanese refugees in Kakuma camp although health centre data indicates levels of wasting to be below 10%. Most cases of wasting are in the new arrival population. There were reports in October of lack of cooking oil and CSB for the general ration. Water availability at 17 litres per person per day is generally satisfactory. A census is scheduled to take place in Kakuma during December 1994 [UNHCR 02/11/94, WFP 16/12/94].

Nutritional survey data for the Somali refugee population indicates a mixed situation. Crude mortality rates during August and September were measured at 0.5/10,000/day (slightly above normal) while the under five rate was 1.5/10,000/day. Nutrition surveys in Dagahaley camp (estimated population 30,000) found 6.7% wasting with 0.8% severe wasting and in Ifo (estimated population 39,000) found 8.9% wasting with 1.4% severe wasting (see Annex 1 (4a,b)). However, a major outbreak of scurvy is looming in the Dadaab area camps (total population 110,000) with 420 cases reported during August and September. The reason for the outbreak is being investigated, but may reflect shortages of vegetables and fruits in the markets since the drought began in June, and over-cooking of CSM thereby destroying its vitamin content. This may be compounded by seasonal factors affecting food availability. In an effort to avert a major epidemic, vitamin C tablets are being distributed twice weekly to the entire Somali refugee population over a period of 6-12 weeks [UNHCR 19/10/94].

In general, food distributions have been adequate to all camps. Some problems have, however, been reported from the coastal camps, where allocations are now a whole month behind schedule due limited camp level storage and government pressure to close camps. Water supply to the refugees continues at an average of 12-15 litres per person per day [UNHCR 19/10/94].

Despite efforts to improve security there continues to be serious violent incidents both within and around several of the Somali camps [UNHCR 01/11/94].

Overall, the population in the Dadaab area camps are considered to be at high risk due to the presence of scurvy (category I in Table 1), and the remaining refugee population is not currently considered to be at particular risk (category IIc in Table 1).

How could external agencies help? The most urgent nutritional issue at present concerns scurvy. First, it is necessary to decide on preventive and curative action, including preparation for the likely resurgence of scurvy this time next year. Probably better provision of blended foods, as well as supplementation with vitamin C (possibly in the water supply), and exploring other sources such as camels' milk, need to be looked into. Distribution of vitamin C tablets themselves is difficult because of the frequency required, hence lack of adequate compliance, which requires careful monitoring.

Aside from this, the present situation is relatively good. However, contingency plans may be necessary for the significant risk of major new inflows of new refugees from Somalia, if the situation deteriorates when the UN forces withdraw in the near future.
 

RNIS 7, October 1994

The total number of Somali and Ethiopian refugees in Kenya is now estimated at 276,000, including 302 new arrivals in August.

Following the transfer of 18,750 Somali refugees to Dadaab and repatriation of 24,000 to Somalia, UNHCR reported the closure of Liboi refugee camp on 29th of June. Repatriation and camp transfer plans are currently underway following government of Kenya requests to close Utange camp which hosts 48,000 refugees [WFP 5/09/94].

B. Kenya

Trend in numbers of refugees.

The refugee population in Kenya is not currently considered to be at heightened nutritional risk (category IIc in Table 1).
 

RNIS 6, August 1994

Current estimates are that there are 277,000 refugees in Kenya. The slight increase from 268,000 reported in the last RNIS is largely due to the continuing influx of Sudanese refugees into Kakuma camp in the North at the rate of 150 per week. Steady repatriation of both Somali and Ethiopian refugees is however progressing with UNHCR and Liboi camp has recently been closed [UNHCR-a 14/07/94].

As a result of stable nutritional conditions amongst the refugee population, it has been possible to close supplementary feeding programmes throughout the camps. Therapeutic feeding for the severely malnourished is now carried out in local hospitals [UNHCR 30/06/94].

The refugee population in Kenya is not currently considered to be at heightened nutritional risk (category IIc in Table 1).

Trend in numbers of refugees/displaced.

How could external agencies help? The withdrawal of supplementary feeding facilities has led to the concern that slight increases in levels of wasting may occur as a result. It is recommended that surveillance be properly established in order to detect any early changes in overall nutritional status of the refugee population.
 

RNIS 5, June 1994

While the overall number of refugees in Kenya has decreased to 268,000 due to repatriation, there has been a reported influx of both Somali refugees in Garissa district (about 300 arrivals per week) and Sudanese refugees (about 200-300 arrivals per week). Both influxes are due to increased fighting in the respective countries of origin. The majority of refugees in Kenya are Somali (219,967), Sudanese (38,271) and Ethiopians (8,805) [UNHCR-a 25/05/94, WFP 2/05/94].

B. Kenya - Trend in numbers of refugees/displaced.

Food stocks are reportedly adequate and all major roads are passable allowing prompt delivery to camps [UNHCR-a 25/05/94, WFP 2/05/94].

Information available from March for Hagadera camp (estimated population 31,300 Somali refugees) shows a crude mortality rate of 0.36/10,000/day and an under-five mortality rate of 0.73/10,000/day (see Annex I 4a) [MSF-B-a Mar 94]. The crude morality rates are around normal levels.

A population count was scheduled for Kakuma camp but the mainly Sudanese refugees population refused and looted all materials related to the exercise. A riot ensued, where many houses were burned so that assistance had to be suspended. The census has now been postponed and assistance resumed [UNHCR-a 25/05/94].

The situation for the refugee population remains generally under control with no populations currently at particular nutritional risk (category IIc in Table 1).

How could external agencies help? The overall needs of this refugee population are reported to be adequately met.
 

RNIS 4, April 1994

Trend in numbers of refugees/displaced.

The overall number of Somali and Ethiopian refugees in Kenya has decreased from 352,000 in January 1994 to 272,000 in March 1994 and two more camps are now closed (El Wak and Mandera) with the Somali inhabitants either being repatriated or moved to another camp. However, the influx of Sudanese refugees from Southern Sudan continues. The situation is complicated by the worsening drought in Kenya which is creating a demand for assistance from the local population [UNHCR 22/03/94, WFP 11/03/94]. The Government of Kenya is working to contain the effects of drought.

Information available in January 1994 from Hagadera camp (population 30,000) shows a crude mortality rate of 0.4/10,000/day and an under-five mortality rate of 1.3/10,000/day (see Annex I 4a). The under-five mortality rate has improved since January (1.9/10,000/day) [MSF-B-B Jan.94]. However, in February, the under-five mortality rate increased to 1.9/10,000/day, mainly due to diarrhoea [MSF-B-C Feb.94).

A nutritional survey conducted in Marafa camp in January found 7.1% prevalence of wasting with no severe wasting (see Annex I 4b). These rates are a considerable improvement on June 1993, when a survey found 16% wasting and 3.4% severe wasting [IFRC 28/03/94].

There continues to be a steady influx of approximately 300-400 Sudanese refugees per week into Kakuma camp in the northwest. Camp infrastructure and resources appear to be adequate to cope with this rate of influx, and the nutritional condition of this refugee population is believed to be satisfactory [UNHCR 22/03/94].

The overall refugee population in Kenya continues to decline as repatriation proceeds. The refugee situation can be described as under control with no population groups at unusual risk (population categorized as IIc in Table 2).

How could external agencies help? A priority for the refugees/displaced population, either in Northern Kenya or repatriating to Somalia and Ethiopia, would be rehabilitation of their means of livelihood when they return. Probably, the most effective way is going to be support for local NGOs, notably in Somalia. At the same time, serious drought is affecting the area, and the usual needs for mitigating the effects of drought are becoming increasingly important.
 

RNIS 3, February 1994

While there is a small number of refugees now arriving in Northern Kenya, many camps in the Mandera district are scheduled to close and the Somalis living there will either be repatriated of moved to camps farther from the border, where insecurity will be less of a problem. The current refugee population in Northern Kenya is 352,000 and food stocks for the refugee program are reportedly adequate for all commodities for 4-6 months. [WFP 13/1/94]

The most recent information available from Mandera camp (population 30,000) shows a crude mortality rate of 0.59/10,000/day and an under-five mortality rate of 0.95/10,000/day. The level of wasting was 6.1 % and severe wasting was 0.5% (see Annex I (4a) for details). These numbers are low and nearly normal for the region. [MSFB-G 7/1/94] UNHCR plans to close Mandera camp as soon as possible. [UNHCR 1/2/94]

In Hagadera camp the situation is much the same as in Mandera. Crude mortality rates were 0.46/10,000/day while the under-five rate was 1.87/10,000/day (both around twice normal). Wasting levels in August were 6% and severe wasting was 0.4% (see Annex I (4b) for details). These numbers are relatively low for the region. The area around the camp is not secure - bandits are active in the area. Security is a problem - rape and thievery have been reported. [MSFB-G 7/1/94]

The nutritional indicators from El Wak camp on the Somali border are similar to those of the surrounding area. The crude mortality rate of 0.21/10,000/day is normal as are the levels of wasting (2.1% with no severe wasting measured) (see Annex I (4c) for details). MSF- Belgium in November, had decided to gradually withdraw from the camp. [MSFB-G 7/1/94] El Wak was scheduled to close officially on 15 December, but is now planned to close at the end of February or the beginning of March. [WFP 13/1/94, UNHCR 1/2/94]

There has been an influx of refugees from the Sudan into Kakuma camp of about 120-200 refugees per week, and the Kakuma camp population is 37,000. [UNHCR 1/1/94] The government of Ethiopia has agreed to receive 18,000 returnees from Banissa camp. [WFP 17/12/93] By January 7000 refugees had been repatriated and the camp is now closed. [WFP 13/1/94, WFP 11/2/94, UNHCR 1/2/94]

The number of refugees in Kenya is decreasing due to an emphasis on repatriation of Somali and Ethiopian refugees. This situation appears to be now under control and the refugees are not currently at unusual risk (population catagorized as IIc in Table 2).
 

RNIS 2, December 1993

Repatriation of Somali and Ethiopian refugees continues spontaneously at a rate of 1,000-1,200 per week leaving a current refugee population of approximately 359,000 (361,980 on 29 October (WFP)). Although anthropometric data indicate low levels of wasting and planned food distributions are proceeding normally, there are still anecdotal reports of scurvy from some of the camps.

There has been an influx of Sudanese refugees from Southern Sudan into Kakuma camp in NW Kenya. The current rate of influx is 200 per week. On the other hand, some Somali refugees are returning home citing insecurity in the camps as the reason for leaving.

The 359,000 refugees in Northern Kenya appear to be in relatively stable condition. However, due to banditry and a current severe drought, a substantial (unknown) portion of this population may now be starting to be exposed to particular risk (see Table 2). Ample in-country food stocks and donor pledges would suggest that the relatively stable situation will endure in the coming months unless the current drought and likely resulting emergency programme divert resources away from the refugee programme.
 

RNIS 1, October 1993

The nutritional and health situation in the camps for Somali refugees has improved enormously in recent months (e.g. since February 1993). There has been both spontaneous and organized repatriation and the current refugee population number is less than 360,000 compared to 620,000 in February 1993. Their condition is reported to be stable.