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 Kenyan