United Nations System
Standing Committee on Nutrition

Nutrition Information in Crisis Situations - Liberia
 

NICS 10, August 2006

A country-wide nutrition and food security survey was conducted in rural and semi-rural population groups in Liberia (representing about 65% of the total population) between February and June 2006 (GoL/joint, 09/06). The survey design was such that representative data at county and national levels were obtained. At national level, only 14% of the households surveyed had never been displaced. Among the others, 7% were still displaced people or refugees, 57% had returned to their home before 2005 and 20% had returned afterwards.

The prevalence of wasting (oedema not reported) was average at national level, and varied from acceptable in Gbarpolu to precarious in Grand Bassa, Gran Gedeh and River Cess (figure 5). Country-wide prevalence of stunting was 39.2%. Compared to the MICS survey conducted in 1999/2000, rates of wasting and stunting are within the same range. Grand Cape Mount, Lofa and Margibi counties reported CMR and U5 MR above 1/10,000/day.

Figure 5 Prevalence of wasting, Liberia (GoL/joint, 09/06)

Based on food consumption and food access, 11% of the households were considered food insecure and 40% highly vulnerable to food insecurity. They were mostly concentrated in Lofa, Gran Kru, River Gee, Bomi, Gbarpolu, Nimba and Sinoe counties, but pockets of food insecurity may also exist in other counties. Only 9% were considered food secure, and 41% to have moderate risk of food insecurity.

Limitations to achieving food security were considered to be low agricultural production capacity due to lack of seeds and tools and knowledge on adequate processing techniques, and limited income-generation opportunities which hampered access to food. The most food insecure families were those who relied mostly on palm oil production, hunting and contract work, especially if they did not engage in crop production, while cash and food crop farmers were less likely to be affected by food insecurity. Employees and petty traders were also part of the better-off and charcoal producers, rubber tapers, palm oil and food crop producers, households depending on fishing and skilled labourers formed the medium group. People who recently returned were more vulnerable to food insecurity.

Child feeding practices and the public health environment were also far from acceptable. Overall, only 32% of the families had access to a protected source of water, with less than 20% in Gran Bassa, Gran Kru, Sinoe, River Gee and Gbarpolu, and only a quarter had access to latrines. About 90% of households had to walk on average nearly 3 hours to reach a health facility. Most of them (65%) were managed by humanitarian agencies, while the government only manages 14%. Vitamin A distribution coverage was 71%. Only 20% of the children were exclusively breast fed at the age of 4-6 months. The mean of breast feeding stoppage was 15 months.

Recommendations

From the Government of Liberia/joint food security and nutrition survey:

• Augment food availability through measurable increase in sustainable production and productivity of major food crops, fisheries, short-cycle livestock, improved crop diversity, improved storage and conservation, and improved marketing and acquisition of food and inputs for agricultural production.
• Increase people’s economic access to food through income-diversification in the agriculture and non-agricultural sector.
• Improve biological utilization by improving access to basic health care services, and access to clean water and sanitation combined with awareness campaigns on infant and young child feeding practices, food preparation, dietary diversity, micronutrients and HIV/AIDS.
• In the short-term, improve people’s access to food through food-for-work activities, supporting mother-and-child health through supplementary feeding programmes; and supporting education through food-for-education activities.
• Enhance the institutional capacity to manage national and local development interventions and resources devoted to the improvement of food security and nutrition – including the development of an institutional policy framework and food security monitoring system.

NICS 9

The return of 314,000 displaced people was completed by UNHCR at the end of April. Of the 22 camps and 13 spontaneous settlements, 22 have been closed (UNHCR, 21/04/06). More than 60,000 refugees have also returned. The majority of the returns took place in Lofa, Bomi, Bong, Capemount and Gbarplou counties. Reconstruction continues but needs, in terms of shelter, the availability of water and sanitation, health facilities, schools and food security, are still not covered (ACF-F, 12/05; ICRC, 04/06).

NICS 8, January 2006

The new president of Liberia, Ellen Johnson-Sirleaf, winner of the 8 November election, was sworn in on 16 January 2006 (Reuters, 16/01/06). She will face many challenges to the reconstruction of a country devastated by a 14-year civil war.

Returns of IDPs and refugees are on-going with 272,160 IDPs having received their return assistance package and meant to have returned to their places of origin, and about 43,100 refugees repatriated, mainly from Guinea and Ivory Coast (UNHCR, 17/11/05; UNHCR, 03/01/06; UNMIL,27/12/05). However, returnees still face difficult conditions. In Voinjama, Kolahun and Foya districts in Lofa county, one of the hardest hit by the war, the main problems faced by the returned households were cash, food, shelter, water and sanitation (ACF-F, 07/05). Moreover basic health services are still poor throughout Liberia (WHO-HAC, 22/01/06). Outbreaks of cholera and acute watery diarrhoea were reported in Tubnamburg and Zwedru (UNMIL, 01/12/05).

NICS 7, August 2005

Repatriation of refugees and displaced people is under way with about 209,100 displaced people and 38,380 refugees repatriated as of end August 2005 (UNMIL, 31/08/05; UNHCR, 30/08/05). The poor road conditions, especially at the onset of the rainy season, makes repatriation and delivery of assistance difficult (ACF-F, 06/05; UNMIL, 08/05). There seems to be funding shortfalls to repatriate 64,000 displaced people gathered in spontaneous settlements (IRIN, 31/08/05). Some malfunction of the process has been reported. For example, there is a lack of a coherent strategy for displaced people unwilling to return home, which leaves these people without proper shelter and assistance (RI, 18/07/05). In some districts, such as Kolahun district, Lofa county, there is no transit centre to host the returnees before they reach their own houses (ACF-F, 06/05). Returnees also face many problems when at home, such as the lack of materials to repair their houses (ACF-F, 06/05). The situation is not optimal for the more than 100,000 IDPs who have not been repatriated yet and are still in camps. The basic infrastructure in the camps are poor and the monthly food ration distribution is insufficient. Most NGOs have scaled down their activities in the camps (ACF-F, 06/05).

NICS 6, May 2005

The security situation has remained stable in Liberia. All the counties are now declared safe for return of IDPs and refugees. Lofa was the last county to be declared safe in February 2005 (IOM, 19/04/05). However, the problem of ex-fighters is not totally solved. About 100,000 former fighters were registered for disarmament, more than twice as what was expected. This has resulted in a lack of funds and only one of eight former fighters has been enrolled in a social rehabilitation programme (IRIN, 19/04/05). This is a cause of concern as it might trigger the fragile peace.

Repatriation of displaced and refugee populations

As of mid-April 2005 and since the start of the repatriation and resettlement process, about 12,000 refugees and 102,000 IDPs have been resettled (WFP, 15/04/05). They have received a four-month food distribution as part of the resettlement package. About 100,000 refugees should have returned by themselves. In the mean time, lack of funding has led to a reduction of the food ration distributed in Guinea and Sierra Leone refugee camps over the last months (AFP, 24/04/05; OCHA, 28/02/05). Assessments conducted in IDP camps in Montserrado, Margibi and Bong counties showed that the food security situation is relatively favourable but can be improved (ACF-F, 02/05). In addition, access to safe drinking water and sanitation is limited in some of the camps. ACF-F recommends that particular attention is paid to the future living conditions of the IDPs and that assistance does not scale down until all the IDPs are repatriated.

There are concerns that the return process of IDPs and refugees is neither safe nor sustainable (IDP project, 15/04/05) with areas of return lacking sufficient security guaranties, shelter and infrastructure. It is also argued that political considerations in the run-up to the October 2005 elections are given precedence at the expense of humanitarian principles (IDP project, 15/04/05). In addition, there is fear that long-term engagement to tackle the roots of the instability will continue to be insufficient.

Acceptable nutrition situation but unstable food security in Lofa county

Lofa county is thought to have suffered the worst impact of the civil war and at least three quarters of its population has sought refuge in IDP camps or nearby countries. As of February 2005, less than half of the inhabitants had returned. Some families have split, some members having returned to Lofa while the others have remained to the refugee or IDP camps. Before the war, Lofa was one of the leading agricultural and cash crop producers. Despite the disruption of agricultural activities during the war, land remains the most important source of food and income. Hunting, fishing and oil-pressed palm nuts are also major sources of food and income. People have mainly access to markets in Sierra Leone and Guinea. All the schools and health facilities were destroyed during the conflict as well as a significant number of shelters. They are gradually being rehabilitated.

A random-sampled nutrition survey and a food security survey were conducted in February 2005, excluding Vahun district because of inaccessibility and uncertain security situation (WFP, 02/05). About 75% of families interviewed were returnees while 20% had never moved and 5% were still displaced.

The nutrition situation was acceptable (table 8) but mortality rates were above alert thresholds.

Table 8 Results of nutrition and mortality surveys in Lofa and Grand Gedeh counties, Liberia, February-March 2005 (WFP, 02/05; WFP, 03/05)

Depending on the district, households' expenditure for food accounted for 52% to 61% of the total expenditure and between 15% and 70% of households had fairly good to good food consumption. The best food consumption pattern was observed in Voinjama and Zorzor districts and the worst in Foya district. Child feeding practices were average (table 9).

Table 9 Child feeding practices, Lofa and Grand Gedeh counties, Liberia (WFP, 02/05; WFP, 03/05)

Half of the population does not have the mean to adequately absorb the negative impacts of shocks. According to the community, the most pressing needs were the construction of shelters, the construction of health facilities and provision of health services, the rehabilitation of educational facilities and the development of skills training, the improvement of the quality of drinking water and agricultural rehabilitation.

It is worth noticing that the survey was done when less than half of the population had returned. The situation should be followed closely in the coming months as a significant number of people are expected to re-settle.

Nutrition situation under control in Grand Gedeh county

Before the war, the economy of Grand Gedeh county depended essentially on timber production and to a lesser extent on gold mining, cash crops and agricultural production. All these activities suffered significant setbacks during the war. In March 2005, the main source of income was hunting, collection of wild palm nuts and gold mining. Less than half of the population had moved during the war and it is thought that among them about half has already returned. Damage to infrastructure and shelter was lower than in Lofa county.

A random-sampled nutrition survey and a food security survey were conducted in March 2005 (WFP, 02/05). About 48% of families interviewed were returnees who came back in 2000 while 44% had never moved and 8% were still displaced.

The nutrition situation was under control but mortality rates were of concern (table 8). 21%, 39% and 63% of the households interviewed had a good to fairly good food consumption in Konobo, Gbarzon and Tchien districts, respectively. Child feeding practices were not optimum (table 9).

According to the population, priorities were to improve access to health services, safe drinking water and sanitation and to rehabilitate education infrastructure, agricultural means of production, and shelters.

Recommendations

From WFP surveys in Grand Gedeh and Lofa counties:

• Support agriculture through seeds and tools
• Enhance access to income-generating opportunities
• Improve access to education
• Construct/open health facilities, especially in remote parts of the counties
• Ensure adequate supply of drugs and other medical supplies
• Improve access to basic treatment
• Conduct a causal analysis of the high under-five mortality rate
• Improve access to safe drinking water
• Help with the reconstruction of shelters

NICS 5, February 2005

The situation has remained calm, although some sporadic riots have been reported, such as in Harper and Gbarnga (IRIN, 27/01/04; WFP, 28/01/05).

Since the beginning of the IDP repatriation exercise, 26,380 displaced people have been repatriated, as well as 4,879 former Liberian refugees (WFP, 28/01/04). They have received a repatriation package. In addition, an estimated 100,000 refugees have made their own way to Liberia (UNHCR, 12/01/05). Inaccessible roads in parts of Grand Cape Mount and Gbarpolu counties render return to these areas difficult (OCHA, 20/12/04).

The food distribution to IDPs has been halved since June 2004 as a result of resource constraints (OCHA, 20/12/04).

Ivorian refugees at risk

About 6,000 Ivorian refugees have remained in Butuo area, Nimba county (see NICS 4). The majority have been sheltered by Liberian households. As of end December 2004, it seemed that food aid had not yet been distributed (RI, 20/12/04), although an assessment carried out in mid-November recommended air-lifting food in the first place and then repairing damaged bridges in order to transport food by road (Inter-Agencies, 11/04). The mission also recommended increasing capacity of health care, improving access to safe drinking water and sanitation and providing non-food items. Transfer of refugees from the insecure border further inland was also advocated (Inter-Agencies, 11/04).

Reconstruction and livelihood support crucially needed

An assessment in Vahun district, Lofa county observed that more than half of the inhabitants were newly returned (ICRC, 11/04). Therefore, agriculture activity was reduced as many people came back too late for the planting season. About 70% of the houses and shelters were damaged and 10% were abandoned. There were no medical services in the entire district, the government clinic having been destroyed. People in search of health care were travelling to Sierra Leone. Accessibility was very poor with poor roads and damaged bridges.

An assessment conducted in the three eastern counties of River Gee, Grand Kru and Maryland showed that the majority of the houses were occupied (ICRC, 08/04). Most people had started to cultivate and were expecting a small but good harvest. However, there was a big need for tools. In a more recent assessment of the same area, the lack of support in terms of assistance to these counties was deplored (HAC, 11/04).

Nutrition situation not critical in Bomi county

A random-sampled nutrition survey together with a food-security assessment were carried out in Bomi county in December 2004 (WFP/joint, 12/04). The nutrition situation was not critical and mortality rates were average (table 13). The prevalence of acute malnutrition was within the same range as shown by a nutrition survey done in Bomi and Grand Cape Mont counties in March 2004 (see NICS 2). The mortality rates were lower than in March 2004. The survey was done at the time of the year when fishing and palm oil production were largely available. The food security situation did not appear stable; the population under-going transition with minimal agricultural activity (box 2). Tubnamburg city was more vulnerable than the other districts (figure 3). According to the communities, health service provision was ranked as the first problem followed by inadequate educational facilities and training opportunities, inadequate food, and low agricultural production due to low accessibility to farm tools and seeds. Only 35-40% of the population seemed to have returned and 40% of the households have split families: it seems that some members of the households have remained in IDP camps, while others returned home.

Table 13 Results of a nutrition and mortality survey in Bomi county, Liberia, December 2004 (WFP/joint, 12/04)

* According to cards and mothers' statements

Box 2 Food security assessment in Bomi county, Liberia, Dec 2004 (WFP/joint, 12/04)

Figure 3 Vulnerability to food insecurity in Bomi county (WFP/joint, 12/04)

Overall

The situation has stabilized in Liberia but there are great challenges in terms of reconstruction, such as housing, roads and infrastructure. Re-integration of the IDPs and refugees will also be a major task.

Recommendations

From the survey in Bomi county:

• Support rehabilitation of agricultural land and basic infrastructures
• Improve access to basic treatment
• Integrate the supplementary programme with basic health care activities
• Provide communities with seeds and tools in time for the next planting season
• Improve access to clean water and sanitary facilities
• Strengthen health, hygiene and nutrition education
• Continue providing safety net supplementary food

NICS 4, November 2004

The situation has remained calm, except in Monrovia where a riot over a land dispute left hundreds injured and led to the destruction or looting of Mosques, Churches, public building and private houses at the end of October 2004 (OCHA, 07/11/04).

Liberia's three warring factions (MODEL, LURD and the ex-government of Liberia) publicly announced the disbanding of their factions on the 3rd November (OCHA, 07/11/04). The disarmament and demilitarisation process officially ended at the end of October, but will be pursued at the border with Ivory Coast and Sierra Leone (OCHA, 17/11/04). Depending on the source, between 50,000 to 100,000 ex-combatants would have been disarmed (USAID, 31/10/04).

Refugee and IDP returns

About 70,000 Liberian refugees are estimated to have returned spontaneously in the past months, owing to an improvement of the security situation and the deployment of UNMIL forces (UNHCR, 08/11/04). In the meantime, UNHCR has launched a voluntary repatriation programme of Liberian refugees from Guinea, Sierra Leone, Ghana and Nigeria (UNHCR, 08/11/04). Repatriation of IDPs has also begun. Both IDPs and refugees will receive a resettlement package including food and non-food items (UNHCR, 29/10/04; UNHCR, 08/11/04). Most of the returns occurred in Lofa, Bomi and Montserrado counties.

Life has been restarting in counties which have been deserted for years. According to various assessments conducted in the south-east and north-west of the country, the food security situation is still precarious and people lack access to basic necessities such as clothes, construction equipment, tools and seeds (ACF-F, 08-09/04; ACF-F, 09/04; ICRC, 06/04).

Arrival of refugees from Ivory Coast

A wave of more than 13,000 refugees arrived in Liberia in the first two weeks of November, particularly in Botua, Nimba county and in Bimplay (UNHCR, 16/11/04; UNHCR, 17/11/04). They have settled in public buildings or with residents. Food, water and sanitation are crucially needed. However, the remoteness of the area, with many roads impassable by car, renders the delivery of assistance difficult. Emergency relief items have been airlifted by UNMIL helicopters.

NICS 3, August 2004

The security situation has improved in most of the country owing to the deployment of the UNMIL forces, but some pockets of insecurity remain, especially along the border areas (AAH, 16/08/04).

The Disarmament and Demobilisation process has continued smoothly over the last months. Some 60,000 ex-combatants have been disarmed since December 2003 (OCHA, 30/07/04).

Little of the US$ 540 million which was pledged at a donor conference in February 2004 has been released so far (OCHA, 01/07/04). As of August 2004, WFP was facing acute food shortages: no pulses were available and therefore the distributed food ration was cut from the full 2,100 Kcal/pers/day to 1,531 Kcal/pers/day. Beneficiaries from WFP programmes include 317,000 IDPs, 72,300 school children, 19,900 vulnerable people and some 60,000 ex-combatants (OCHA, 06/08/04). It is also feared that there will be a major break in cereal stocks from September 2004, unless new contributions are made (OCHA, 13/08/04). On the other hand, Liberia got US$ 24.3 million from the global fund for programmes on AIDS, tuberculosis and malaria (UNDP, 17/06/04).

There has been concern about trading of food rations between refugees in Guinea and Liberia (IRIN, 22/07/04). On the other hand, some people thought that this trading may help Liberians in districts near the border, who are especially vulnerable, to access food. It also seems that some refugees criss-cross the border with Liberia. The situation is tense in Guinea camps, with riots against attempts to update refugee figures.

According to a vulnerability analysis carried out in Totota, Salala and Kakata towns and in three IDP camps (Maimu 1, Salala and Conneh) in Bong and Margibi counties, it seems that the nutrition situation was under control with a prevalence of acute malnutrition at 3.3% (2.0-6.7) (WFP/VAM, 05/04). However, people were vulnerable to food insecurity. About 20% were thought to be very vulnerable in both towns and camps: they had no assets and no access to land; they had, at best, one source of income; they spent more than 70% of their income on food and had only one inadequately balanced meal a day. About 60% and 68% of the households were potentially vulnerable in towns and camps, respectively. They had few assets and a small garden; they had below 3-4 sources of income; they spent between 65-70% of their income on food and they had 1-2 meals a day with a minimal diet.

NICS 2, May 2004

The security situation has improved in Liberia and humanitarian organisations have had access to a wider part of the country (WFP, 20/05/04). However, security is still perilous, with outbreaks of violence and abuses of civilians, even in the areas controlled by UNMIL (GW, 24/05/04). As of May 2004, UNMIL was at full strength with 15,000 troops deployed throughout the country (UNICEF, 24/05/04).

The Disarmament, Demobilisation, Rehabilitation and Reintegration (DDRR) process resumed on 15 April 2004, in Gbarnga, Buchanan, Tubnamburg and outside Monrovia (UNICEF, 24/05/04). So far, 26,000 fighters from LURD, MODEL and former-government forces have been disarmed and have received the US$300 resettlement grant (IRIN, 12/05/04); it is however suggested that non-combatants may have also taken part in the process. Cash-payment to demobilised children and adolescents has also raised concerns, as it is thought that the grant will probably not be used for productive investments (RI, 21/04/04).

A national measles vaccination and vitamin A distribution campaign is under-way (UNICEF, 24/05/04).

Refugees and returnees

An estimated 10,000 Liberian refugees were still in camps as of May 2004. UNHCR intended to stop aid to Sierra Leonean refugees at the end of June and encouraged them to repatriate (UNHCR, 17/05/04).

About 17,000 Liberian refugees have spontaneously returned from neighbouring countries. About 7,000 are settled in two returnee camps in Montserrado county. After registration, they will receive a re-integration package (UNHCR, 18/05/04).

Internally Displaced Persons

A census, carried out in April 2004 in the 20 official displaced persons camps concluded that there were about 261,900 IDPs in these camps, of whom the majority were in Montserrado county (table 16) (OCHA/UNHCR, 05/04). The report acknowledged that it was

difficult to know the exact number of people as there was a lot of movement between the surrounding communities and the camps. The majority of IDPs plan to return to Bong, Lofa and Bomi counties.

Table 16 Number of IDPs in official IDP camps in Montserrado, Bong and Margibi counties, April 2004, Liberia (OCHA/UNHCR, 05/04)

IDP camps in Montserrado county

The nutrition situation was good to average among the IDPs settled in six camps in Montserrado county, according to random-sampled nutrition surveys carried out in November 2003 (table 17) (SC/ACF, 11/03).

Table 17 Prevalence of acute malnutrition in seven IDP camps in Montserrado county, Liberia, November 2003 (SC/ACF, 11/03)

Greater Monrovia

A random-sampled nutrition survey conducted in Greater Monrovia in November 2003 showed average prevalence of malnutrition (category II) and mortality rates (table 18) (WFP/joint, 11/03). A similar malnutrition rate was shown in a survey carried out in six districts of Monrovia and two IDP camps on the outskirts of Monrovia (VAM, 11/03). The assessment also showed that the food security situation was of concern: on average, households were spending 70% of their income in food, this reached 95% for the IDPs. 40% of the households had no assets, whilst 26% had domestic assets and only 3% had productive assets. The majority of the families (60%) had poor dwelling conditions. Households were relying mainly on petty trading and wage labour and coping mechanisms seemed limited. Morbidity was very high: 75% of the children had been ill within the two weeks prior to the survey.

Table 18 Results of nutrition and mortality surveys, Greater Monrovia, Bomi and Grand Cape Mont counties, Liberia (WFP, 11/03; WV, 03/04)

* According to cards and mothers' statements

Bomi and Grand Cape Mount counties

The nutrition situation in Bomi and Grand Cape Mount counties appeared acceptable (category III), according to a random-sampled nutrition survey conducted in March 2004 (table 18) (WV, 03/04). Measles vaccination and vitamin A distribution coverage (77.1%) were satisfactory.

On the other hand, mortality rates within the six months prior to the survey were very high.

The main causes of death among those over five year old were war related injury (21%), diarrhoea (20%) and fever (18%), whilst they were diarrhoea (30%), fever (25%) and malnutrition (26%) among the under fives.

About 74% of the families interviewed were resident, 23% were returnees and 3% were displaced.

Food security and public health seemed precarious (box 5).

Box 5 Food security and public health in Bomi and Grand Cape Mount counties, Liberia (WV, 03/04)

NICS 1, February 2004

The peace process, signed in August 2003, is on-going but is not running very smoothly. The armed factions have succeeded in their demand for more ministerial positions, to the detriment of unarmed political parties and civil society groups (IRIN, 07/01/04). The disarmament, demobilisation and re-integration process has been postponed, after several thousand soldiers rioted at the occasion of the opening of the disarmament campaign in mid-December 2003 (AFP, 15/12/03).

Sporadic fighting has occurred, especially in Nimba, Gran Bassa and Bong counties, particularly before the UNMIL (United Nations Mission in Liberia) deployed (AFP, 18/11/03) in Tubmanburg, Garnga, Buchanan, Zwedru and Tapeta (IRIN, 04/02/04). Moreover, harassment of civilians by fighters is widespread in areas not controlled by the UNMIL (HRW, 21/01/04; IRIN, 30/01/04). As of late January 2004, the UNMIL only had about half of the 15,000 peacekeepers authorised by the United Nations.

Donors pledged around US$ 500 million for the reconstruction of the country at a conference held in New York at the beginning of February (RI, 06/02/04). However, Refugee International notes that the Consolidated Appeal (CAP) 2004, to respond to the immediate humanitarian needs, has received very little support so far (RI, 06/02/04). The disarmament, demobilisation and reintegration project is also under-funded.

Location of known IDP concentration (HAC, 03/12/04)

Humanitarian situation

Reports of refugee returns from Guinea and Sierra Leone are increasing; UNHCR estimated that over 10,000 refugees returned, as of end January (UNHCR, 13/01/04; IRIN, 29/01/04).
Most of the IDPs who had sought refuge in public buildings in Monrovia during Summer 2003 have spontaneously returned or have been resettled in camps outside Monrovia, in Montserrado county, which account for about 164,300 IDPs (OCHA, 05/02/04). An additional 200,000 IDPs are registered in formal IDP camps throughout the country (see map) (OCHA, 05/02/04).
An assessment done by Refugee International in Montserrado IDP camps reported that, although the situation has improved compared to November 2003, the camps were overcrowded and assistance was provided ad hoc, with huge disparities between camps (RI, 29/01/04).
Preliminary results of a nutrition survey carried out in seven IDP camps in Montserrado county suggest that the nutrition situation is under control to average (OCHA, 10/01/04).
Distribution of rice seeds and of tools before the next planting season in April 2004 will be crucial for the future food security of the Liberians (FAO, 22/12/03; ICRC, 22/01/04).

Overall

The situation continues to be critical in Liberia, deployment of UNIMIL and disarmament of soldiers will be crucial for short-term improvement of the situation.

RNIS 43, November 2003

Heavy fighting between the government army and armed opposition factions, the Liberian United for Reconciliation and Democracy (LURD) and the MODEL (Movement for Democracy in Liberia), in the first semester of 2003, ended with the departure of the former president, Charles Taylor, on 11 August 2003. He has been replaced by the former vice-president, Moses Blah, and peacekeepers of the Economic Community of West African States (ECOWAS) deployed in Monrovia in early August (see RNIS 42). The armed opposition factions control a large part of the country; LURD controls the north and the centre of the country, whilst MODEL controls the south and east.

A peace agreement between the Government of Liberia, the LURD, the MODEL and the political parties was signed in Accra on 17 August 2003 (GOL/LURD/MODEL/PP, 18/08/03). The peace accord includes a total and permanent cessation of hostilities and cease-fire monitoring by a Joint Monitoring Committee; the deployment of an International Stabilisation Force; the disbanding of irregular forces, reforming and restructuring of the Liberian armed forces; security guarantees for safe and unhindered access by all humanitarian agencies throughout the country; organisation of elections not later than October 2005 and establishment of a transitional government and of a National Transitional Legislative Assembly (NTLA). The transitional government was established on 14 October 2003; it is composed of five ministers each from LURD, MODEL and the GOL and six ministers from unarmed political parties (USAID, 15/10/03). The members of NTLA have also been nominated.

The UN Security Council unanimously adopted a resolution to establish the United Nations Mission in Liberia (UNMIL), a 15,000-strong stabilisation force (UNSC, 19/09/03); the ECOWAS was transferred to the authority of the UNMIL on first October 2003. The UNMIL is expected to reach 15,000 troops by the end of the year. Monrovia has been declared a weapons-free zone (USAID, 15/10/03).

Humanitarian situation

Despite the implementation of the peace process, the security situation has been volatile, with fighting between the armed parties and harassment of civilian populations, especially in Lofa, Bong and Nimba counties. Totota, Kakata, Salala, Gbarnga and Sanoyea have been especially affected (OCHA, 23/09/03; UNHCR, 24/09/03;WV, 08/09/03). This has led to the displacement of more than 50,000 people inside Liberia, of whom some were already displaced people living in camps, and more than 10,000 persons fled into Guinea (see Guinea). Camps have been looted and civilians harassed. It seems that deployment of ECOMIL forces in Kakata, Salala and Totota has calmed the situation (OCHA, 11/09/03). Camp conditions in Salala and Totota were reported to be inadequate, with overcrowding and insufficient sanitation facilities (OCHA, 21/10/03).

The more than 250,000 displaced people, who were settled in camps near Monrovia, and had sought refuge in public buildings in the town in June 2003, have begun to be transferred back to camps outside Monrovia (USAID, 08/10/03). An outbreak of violence in Monrovia at the beginning of October, also touched some of the camps in Monserrado counties, which were looted, and the civilian population harassed (USAID, 08/10/03).

Assessment missions which were carried out in Zwedru (Gran Gedeh county) Voinjama, (Lofa county) and Tubnamburg (Bomi county), revealed dire situations. At the end of September 2003, Zwedru was inhabited by about half of the pre-war population. People barely managed to have one meal per day, harvesting cassava and looking for wild food. Food prices were reported to be extremely high and the purchasing power of the population very low (OCHA, 30/09/03). The town of Voinjama has been completely destroyed; people were mostly relying on wild food (OCHA, 20/10/03).

An outbreak of cholera has occurred in Monrovia since June 2003. A total of 17,561 cases have been reported. The case fatality rate was below 1%. Cholera treatment centres, rehydration corners and chlorination of wells have been implemented. The caseload seems to have begun to decline in Monrovia, but an increase in cholera cases has also occurred in Buchanan (WHO, 30/09/03). A measles vaccination and vitamin A distribution campaign has been carried out in Monrovia, Buchanan, Tubnamburg and Totota (OCHA, 21/10/03). As of mid-October, food had been distributed to about 250,000 IDPs in Monserrado, Totota, Kakata, Salala, Harbel, Buchanan and Bensonville (WFP, 10/10/03).

A rapid nutrition screening (not using a random sampling methodology), carried out in Tubnamburg, Bomi county, in September 2003, showed a high level of malnutrition (WV/ MOH/ UNICEF, 09/03). Among 503 children measured, 22 had oedema (4.1%), 11 (6.5%) had weight for height Z-score below -3, and a total of 83 (16.5%) were acutely malnourished.

Overall

Despite the implementation of a peace agreement, the security situation has remained volatile. Access to the population has, however, increased and some assessments have shown that many civilians are facing hard living conditions (category I).

Recommendations:

From the assessment in Tubnamburg:

• Implement general food distribution to the vulnerable families, depending on the continued improvement of the security situation
• Set up a therapeutic feeding centre and provide supplementary feeding

RNIS 42, August 2003

As of mid-July 2003, about four-fifths of the country were controlled by opposition armed factions: the Liberian United for Reconciliation and Democracy (LURD) and the MODEL (Movement for Democracy in Liberia), whilst the rest was still controlled by the government army. Fighting reached Monrovia, the capital of the country, in early June, and the LURD has taken control of parts of the capital. The one million population of the capital and an estimated 250,000 displaced people, who had sought refuge in Monrovia, have been trapped for weeks. Following a UN resolution, peacekeepers of the Economic Community of West African States (ECOWAS) began to deploy in Monrovia in early August (AFP, 02/08/03). Charles Taylor, the former Liberian president, who has been indicted by the Sierra Leone war crimes court, resigned and quit the country to Nigeria on 11 August 2003 (Alernet, 11/08/03). He handed over power to the vice-president, Mr Blah (Alertnet, 11/08/03). The political future of Liberia is, however, very uncertain, because rebels have claimed power (Le Monde, 13/08/03).

Since the deployment of the ECOWAS peace-keepers, calm has returned to Monrovia, but there were still reports of insecurity and targeting of civilians, including rape and looting (DEC, 12/08/03).

Renewed fighting has been reported near the port of Buchanan, between the MODEL and government forces (AFP, 12/08/03).

Humanitarian access has slightly improved in Monrovia since the deployment of peace-keeping forces, but about 70% of the country is still inaccessible to humanitarian aid (Le Monde, 12/08/03).

Population movement

There have been major waves of displacements during the last months. First of all, it is estimated that about 250,000 people, who were settled in displacement camps near Monrovia, have sought refuge in the town, when fighting intensified in the area (OCHA, 06/06/03). About 40,000 people have also fled from eastern Liberia to Ivory Coast (UNHCR, 31/07/03). The movement into Guinea seemed less, with about 120 Liberians per week seeking refuge in Guinea (UNHCR, 31/07/03).

Monrovia

The town has been besieged for two months by the LURD. Moreover, an estimated 250,000 people, who were settled in displacement camps near Monrovia have sought refuge in the capital, where they were living in makeshift facilities in stadium or public buildings. Resident and displaced populations have further moved around, by fighting. Populations in Monrovia have had little access to basic necessities, such as food, water and medical care. Shops and banks were closed. Insecurity renders humanitarian aid delivery uncertain (DEC, 12/08/03). Moreover, fighting intensified in the last two weeks of July and the port, which was the main point for humanitarian aid shipment, has been inaccessible due to insecurity. The LURD has engaged to hand the control of the port to the ECOWAS peacekeepers as per 14 of August 2003 (le Monde, 13/08/03). This may help to deliver adequate humanitarian assistance.

Prices of all commodities have risen sharply (ACF-F, 05/08/03). Rice prices have risen by 700% between May and the end of July and rice was less and less available in the market. Some food distribution for the IDP population took place in June and early July, but was then after halted by the deteriorating security conditions. Moreover, the distributions did not reach all the IDPs because of uncertain security conditions. It has been estimated that in June and July, 140,000 people received food, but they only received a two week ration (ACF-F, 05/08/03). IDPs have had few coping mechanisms available, the main one was petty trade. Some wild food was also collected in swamps, but availability of wild food in town is limited. Resident populations were able to rely on their belongings and savings, even if they were also affected, especially by the decrease of employment opportunities. Residents who possessed a garden were more able to cope (ACF-F, 05/08/03). Screenings carried out in accessible districts and IDP camps showed a poor nutrition situation. Among 6536 under-five-year olds screened between 10 June and 31 July 2003, 1965 (30%) were acutely malnourished, including 308 (4.7%) who were severely malnourished (ACF-F, 05/08/03). Two TFCs, which were opened in June and July were quartering 300 children, and 1,500 children were admitted to SFCs, as of mid-August.

A cholera outbreak has also been reported (MSF, 31/07/03).

Overall

After two months of blockade, the situation is dramatic in Monrovia (category I), and especially for the IDPs. All basic needs have to be met as soon as possible. It is hoped that the deployment of the ECOWAS peacekeepers and the departure of Charles Taylor will ease the delivery of humanitarian aid. In addition, the fate of thousands of people in inaccessible areas of Liberia is unknown.

RNIS 41, April 2003

Fighting in Liberia has intensified again over the past few months and has spread more widely in northern, eastern and western Liberia. The Liberian United for Reconciliation and Democracy (LURD) troops advanced to within 12 km of Monrovia in February 2003 but were pushed back by the Liberian army (Reuters, 18/02/03). The counties particulary affected are Lofa, Bong, Gran Gedeh, Cape Mount, Bomi, Monserado and Nimba. Fighting has taken place in areas hosting many IDPs, returnees, and refugees, and has led to further displacements of these populations . Degradation of the security situation has caused many people to be cut off from all assistance.

Donors' response to the Liberian crisis has been very low so far. WFP experienced food pipeline breaks, and reduced cereal and pulse rations by 25% and the oil ration by 20% in February and March 2003 (OCHA, 31/03/03). Notably, the UN inter-agency Consolidated Appeal for 2003 has only been 2% funded to date (OCHA, 25/03/03).

Population movements

As a result of the civil war which erupted in September 2002 in Ivory Coast, a large number of people from there have sought refuge in Liberia. Latest available figures estimate that 45,000 Liberians have returned and 40,000 Ivorians have entered Liberia (UNHCR, 07/03/02). Liberians have gone back to their homes or have settled in the already existing IDP camps. Many of the Ivorians have remained settled in host communities near the border. There have been few assessments in the area because of the poor security situation.

In addition, it is estimated that 12,000 nationals of third countries, especially nationals of Burkina Faso have entered the country. They have been trapped in Liberia on their way to their own country. UNHCR has no mandate to care for these people, although they are providing food and shelters. The International Organisation for Migration (IOM), which has the mandate to assist these people, has issued an appeal for US$ 1.5 m for them (OCHA, 13/03/03).

Population movements in response to fighting are difficult to follow precisely and to quantify because people spread out and seek refuge in different areas. Many people are also probably trapped within the conflict areas.

The attacks in Zwedru and Toe town in Gran Gedeh county, which occurred at the end of March 2003, led to the displacement of an estimated 45,000 people (Ivorian refugees, Liberian returnees from Ivory Coast and third country nationals) who were settled in the area (UNHCR, 04/04/03). Some of them have fled to the southern counties; about 5,000 have arrived in a camp situated in Harper, Maryland county, and some have settled in Sinoe county (UNHCR, 04/04/03).

Fighting in Gbanga and Ganta, Bong county, in early April 2003, also led to the displacement of an estimated 45,000 people (OCHA, 09/04/03). About 16,000 have crossed the border into Guinea, where they are settled in a transit camp and further relocated to Laine Camp (OCHA, 11/04/03). This camp however was originally designed for only 6,000 people and is already hosting 12,000 persons (OCHA, 02/04/03).

In addition, returns of Ivorians, Liberians and third country nationals to western Ivory Coast have been reported although not quantified (UNHCR, 10/04/03) and a new wave of Liberian refugees has also been reported to have entered Sierra Leone.

Three IDP camps situated in Monserado county, near Monrovia, were also attacked at the end of March/beginning of April and more than 40,000 IDPs were obliged to move yet again (OCHA, 11/04/03).

Living conditions in insecure areas

According to a study carried out by ACH-S between July and September 2002 based on interviews of Liberian refugees in Guinea, the living conditions of populations living in insecure areas are very worrying (ACH-S, 10/02). Before reaching Guinea, people were living in the bush, often for several months or years, due to constant attacks on their villages. They were either constantly moving or settling in semi-permanent settings. Before July 2002, people were able to cultivate in the bush or in the nearby farms and to carry out some petty trade activities. However, gathering was the main source of food and bush foods became scarce. With the increased insecurity, agricultural and petty trade activities became less and less easy to undertake, and harassment of the civilian population increased. Before entering Guinea, some people reported eating only three or four meals a week. Nutrition screening of Liberian children entering Guinea showed that they were in a poor condition.

Forced conscription, forced labour, increasing harassment, and payments to be allowed to escape were common. Whilst some people have been able to enter Guinea, it is anticipated that movement restrictions on the civilian population have increased over the past months and that thousands of people in very poor condition may be trapped.

Overall

All the populations, i.e. residents, displaced, returnees, refugees and third-country nationals, settled in the areas affected by fighting are considered at high risk (category II). The humanitarian community and donors should ensure that funding is made available and that adequate humanitarian assistance is provided, as far as security conditions allow.

Liberia

Les combats se sont intensifiés au Libéria entre l'armée gouvernementale et l'opposition armée. Les zones abritant les populations ayant fui les combats en Côte d'Ivoire ont été particulièrement touchées, entraînant de nouveaux déplacements. D'autre part, des camps de déplacés ont aussi été attaqués. De nombreuses personnes se sont déplacées vers le sud du pays qui reste plus calme. D'autres ont fui vers la Sierra Leone ou la Guinée.

En raison de l'insécurité, de nombreuses personnes sont coupées de toute aide humanitaire. Une étude réalisée en Guinée, auprès de réfugiés en provenance du Liberia, a montré que les conditions de vie des populations piégées par les combats sont très précaires.

RNIS 40, Dec 2002

Fighting between the Liberians United for Reconciliation and Democracy (LURD) troops and the government forces continues in northern Liberia (OCHA, 30/11/02). The number of Liberians, who have crossed the border into Sierra Leone, has decreased over the last months; no entry was recorded at the end of December.

Following an upsurge in violence in western Ivory Coast, many Liberian refugees and Ivorians sought refuge in Liberia. Between mid-November 2002 and mid-January 2003, UNHCR recorded 62,000 new arrivals in Liberia from Ivory Coast, of whom 38,000 were Liberians, 21,000 Ivorians and 3,000 were from other West African countries. Liberian returnees were transported back to their areas of origin as far as possible; people originating from areas where the security situation did not allow resettlement were directed to Totota IDP camp in Bong county. The majority of Ivorians were settled in villages near the border; the others were gathered in transit centres. UNHCR was discussing with the Liberian authorities the possibility of establishing new camps for Ivorians (UNHCR, 14/01/03).

Internally Displaced Persons

IRC conducted an assessment in five camps in Montserrado county and six camps in Bong county in July 2002 (IRC, 07/02). MUAC was used to assess the nutrition situation; oedema were not recorded, which might have led to an underestimation of the nutritional problems. The nutrition situation seemed average, but requires attention, especially in Montserrado county (see table). Mortality rates were very high in both locations, and especially in Montserrado county, where they were twice as high as the emergency threshold.

Survey results, IDP camps, Liberia, July 2002 (GOAL, 07/02)

Poor sanitation services, as the rainy season started, may have played a major role in the high mortality rates; cholera cases were diagnosed at the same time the survey was done. Curative primary health services were considered adequate, but gaps at the community health level have been identified. Major food aid distribution problems identified were delays in the monthly food distribution, fraud, and difficulties in accessing food aid: newly arrived IDPs had to wait until the forthcoming distribution and IDPs in temporary shelters had no access to food. These issues seemed to have been raised by WFP. Shelter building was also identified as an issue of concern: IDPs faced difficulties to access land and building materials.

Overall - The situation of IDPs, returnees and newly-created refugees in Liberia is of concern (category II). The large new influx of vulnerable people, adding further to the already high number of IDPs and refugees, will be a difficult challenge for humanitarian agencies to respond to.

Recommendations and priorities

From the IRC survey in IDP camps:

• Increase the number of latrines and improve their maintenance
• Increase safe drinking water availability and regularly monitor water quality at all sources
• Conduct anthropometric and food basket surveys
• Implement a measles vaccination campaign
• Strengthen the standardization of health information
• Strengthen the night health referral system

Libéria

L'insécurité prévaut toujours dans le nord du Libéria. De plus, à la suite de la guerre civile en Côte d'Ivoire, environ 62 000 personnes ont trouvé refuge au Libéria, dont 38 000 Libériens réfugiés en Côte d'Ivoire, 21 000 Ivoiriens et 3 000 personnes originaires d'autres pays d'Afrique de l'Ouest. Les Libériens sont, si possible, rapatriés dans leurs régions d'origine ou s'installent dans des camps de déplacés déjà existants. Les réfugiés ivoiriens se sont pour la plupart installés dans des villages frontaliers avec la Côte d'Ivoire. D'autres vivent pour le moment dans des camps de transit. Une évaluation nutritionnelle conduite en juillet 2002 dans les camps de déplacés, avant le nouvel afflux de population, avait montré une situation nutritionnelle moyenne (voir tableau), mais un taux de mortalité élevé. La situation des populations déplacées et réfugiées depuis plusieurs mois, ainsi que des populations nouvellement arrivées, est considérée comme à risque (catégorie).

RNIS 39, October 2002

The onset of fighting between the Liberians United for Reconciliation and Democracy (LURD) and the army, since the beginning of the year, has seen an increasing number of people fleeing insecurity, especially in May and June 2002. Since then, the influx has decreased. The Northern area has been the most affected by conflict. In mid September the Liberian president Charles Taylor lifted the state of emergency he had imposed in February because of reduced danger from rebels (BBCNews, 14/09/02). He also stated that he is categorically against foreign peacekeeping forces in Liberia (OCHA, 17/09/02).

Internally displaced people

It is estimated that there are about 196,000 IDPs. More than 50% are located in six camps in Montserrado county, in Monrovia suburb, the others being located in Bong county (Cari 1 and 2, Totota), Margibi county (Kakata), Nimba county (Ganta) and Gran Bassa county (Buchanan) (WHO, 31/08/02).

In addition to people in camps, some have sought refuge in towns, particularly in Monrovia where they are living with relatives or in abandoned buildings. Nevertheless, they are increasingly going to live in the camps where they receive some help (OCHA, 13/09/02).

A MOH/WHO joint assessment mission in IDP camps in Montserrado county carried out at the end of August 2002 reported insufficient chlorination of water and poor health care with lack of 24 hour health services, poor nutrition, no epidemiological surveillance and uncoordinated routine immunization services (WHO, 31/08/02). ACF reported a large increase in admissions to TFCs and SFCs in Montserrado county, particularly in the months of May and June.

An outbreak of cholera has been reported, with 661 cases in Montserado county (WHO, 13/09/02).

Due to delay in food arrivals, less than the full food ration has been delivered for some time to IDPs and refugees. The delivery of a full ration resumed in September. WFP is distributing food to 126,500 displaced persons and refugees (OCHA, 05/09/02).

Northern area

A mission was conducted in early September in Tubnamburg; nearly all the population had fled from here following attacks. Tubnamburg was recently retaken by the government. About 6,000 people came back to the town after living in the bush. They are able to get food from abandoned farms. However, the situation still needs to be closely monitored (WFP, 13/09/02).

Bong county

A survey of the new arrivals from Lofa county was conducted in July in Cari 1 and 2 transit shelter by ACF (ACF, 07/02). Those questioned reported they had survived on wild food in the bush near their villages for up to four months. As the insecurity and the harassment increased, they decided to flee. They arrived without any food items or belongings because of insecurity on the road. It seems that the new IDPs have not been registered to receive WFP ration yet.

During the hunger gap, from May to August, host populations as well as previously displaced persons and new IDPs are using the same coping mechanisms: consuming wild food and cassava. The burden of new IDPs is increasing further and putting additional pressure on food supply. In addition, food availability in the markets was very poor and prices were extremely high.

There were very few sources of income. The only day jobs available were weeding on resident farms. An IDP could only get a contract for two days a week and the salary was very low; only one third of normal rates.

A nutritional assessment using MUAC measurement showed that of 579 children measured (both new and old IDPs), 2.2% presented a MUAC of less than 11 cm, 7.8 % presented a MUAC between 11 cm and 12 cm, and a further 7.6 % presented a MUAC between 12 cm and 12.5 cm. This indicates an average situation.

Water supply was reported to be adequate, however, sanitation was insufficient. The situation of the IDPs will probably not improve rapidly as farming activities have been disrupted by insecurity in Bong county with the crop calendar delayed for one month, planting surface reduced and farms abandoned for a while.

Refugees

No new information has been obtained regarding the refugee situation. However, the refugee population, which was further displaced as a result of insecurity, is considered to experience the same poor living conditions as the displaced.

Overall The situation of displaced, refugee and resident population in affected areas is of concern (category II).

Recommendations and priorities

• Improve the conditions of the camps receiving new arrivals
• Monitor the situation of the resident population in affected areas

RNIS 38, July 2002

The humanitarian situation in Liberia continues to be extremely serious. The country is still suffering the effects of a crippling ten-year civil war, which ended in 1997. The war left the country in ruins and it remains one of the most impoverished countries in the world. There is very little access to any form of basic health care and it is estimated that 85 % of Liberians are unemployed due to the collapse of the economy and, as a result, 76 % of the entire population live below the poverty line and live on one dollar a day. A further 52 % of that group are categorised as living in absolute poverty, surviving on less than 50 cents a day. The poor economic outlook has also resulted in a general increase in the price of essential goods and increased the vulnerability of large sections of the population. The economic outlook has been further affected by the imposition of UN sanctions because of the government’s support of rebel groups in neighbouring countries.

The deplorable state of the country’s infrastructure and the lack of economic opportunities have created enormous vulnerabilities for much of the population. These have been exacerbated over the course of 2002 as a result of conflict between government forces and those of the rebel opposition group Liberians United for Reconciliation and Democracy (LURD). The fighting has been centred around the northern areas of the country, particularly in Lofa and Grand Cape mount counties, and has moved even closer to the capital Monrovia, prompting the announcement of a state of national emergency in February 2002. The fighting has continued to escalate over the reporting period and has resulted in mass displacements, with people fleeing both within the country and across the borders, in large numbers to Guinea and Sierra Leone.

The current situation

The humanitarian situation has continued to deteriorate dramatically as a result of an escalation of fighting during the month of May 2002. The fighting, which had been concentrated in Lofa county, spread to Bong and Bomi counties causing massive population movement to Ganta, Bomi, Grand Bassa and Margibi counties (UNICEF29/05/02). Fighting in and around the city of Gbarnga in Bong County resulted in the displacement of up to 70,000 people, including 30,000 IDPs from pre-existing camps, and up to 40,000 of the local population (UNOCHA 16/05/02). Humanitarian agencies estimate that there are now over 110,000 registered IDPs in the country with more continuing to be displaced. (UNOCHA 31/05/02).

An area of great concern has been the Sinje IDP and refugee camps in the north west of the country, close to the Sierra Leonean border. Sinje has been host to approximately 24,000 people, including 11,000 Sierra Leonean refugees, and the area has been the scene of frequent insecurity for some months. As a result of the insecurity, the camps have been cut off from humanitarian access for over a month and concern has been building over the fate of the camp inhabitants. The camp itself was attacked on 20 June 2002 and, although some of the affected population have arrived in camps in Monrovia, the fate of many is not known. The area has been suffering heavy rain and the condition of those who have fled to the bush is almost certainly deteriorating (UNHCR 12/07/02). There have also been increasing reports of large numbers of Liberians leaving the country to Sierra Leone and Guinea and this trend is continuing. It is estimated that over 30,000 have fled the country this year alone.

The fighting has had a huge and negative impact on the economy of the country and has driven up the prices of essential basic commodities, further deteriorating people’s ability to access food sources. Humanitarian sources have also expressed concern that the current insecurity could impact negatively on the mid term food security of the country because the current planting season is being severely disrupted (UNOCHA 06/06/02). The fighting has left many increasingly unable to cope with the deteriorating situation and there is a great need for external assistance to ensure that the basic needs of the population are met. Given the increasing needs within the country, it is alarming to note that the UN Consolidated Interagency Appeal is only 22 % funded and requires further donor commitment.

Bong County

ACF conducted a food security assessment in May 2002 in the town of Tota in Salala district. The town has remained free of security incidents but has been hosting a large IDP population from surrounding areas and, in particular, from the attacks on Gbarnga. The assessment indicated that farming activities are ongoing but are seriously curtailed by the ongoing insecurity. The availability of food in the markets is good but it is not available to IDPs and to the majority of the local population. Since most of western Liberia has been effected by insecurity, which has traditionally supplied the capital with much of its food requirements, the central regions are under increased pressure to supply food. As a result, available food sources are bought by traders from Monrovia and shipped straight to the capital.

The major constraint faced by IDPs is the lack of cash with which they can purchase food. One of the main sources of cash is through casual work but this is becoming increasingly scarce due to the large number of people available. Wild food sources are increasingly limited and the increasing number of IDPs means that residents are increasingly unable to support them. Many of the IDPs interviewed indicated that they had already resorted to erosive coping strategies such as the selling of personal items and key assets and more than half indicated that begging had been their main source of food the previous day (ACF 05/02). The main concerns from the assessment were that both food availability and accessibility were extremely poor and that there were indications of more desperate coping strategies employed by IDPs. The assessment also indicated that there was increasing evidence of poor nutritional status although no data exists. The IDPs must be considered to be extremely vulnerable and further deteriorations in their situation can be expected unless the overall security situation improves dramatically in the near future.

Overall

Liberia is suffering from a dramatic deterioration in the humanitarian situation as a result of ongoing fighting between the government and rebel troops. The fighting comes on top of years of past conflict that have left the country in ruins and the population at large hugely impoverished. Assessments of the current food security situation indicate that it is extremely poor and that people are turning to increasingly unsustainable strategies to meet their basic subsistence needs. IDPs and refugees in the country should be assumed to be extremely vulnerable (category II).

Recommendations

From the RNIS

• Support the Interagency appeal.
• Negotiate access to areas.

From the ACF food security assessment in Bong county, May 2002

• Establish facilities for the treatment of malnutrition.
• Consider important security implications of assistance, as it appears to be drawing people in large numbers to specific locations.
• Implement regular and adequate food distributions.

RNIS 36/37, April 2002

The humanitarian situation in Liberia remains extremely volatile. The country suffered the effects of devastating civil war between 1989 and 1997, which resulted in the collapse of the economy and the wide scale destruction of infrastructure. As a result, there is rampant inflation and basic goods and services are either lacking or not accessible to the vast majority of the population. It is estimated that 85% of Liberians are unemployed due to the economic collapse and the absence of a viable employment sector. 76% of the entire population live below the world poverty level of one dollar a day, and 52% of that group live in a state of absolute poverty, surviving on less than 50 cents a day. Access to basic health services, clean water and sanitation are similarly poor (UN 2002). Liberia is currently ranked 174^th out of 175 countries in the human development index. The political and economic situation has been further aggravated by the imposition of UN sanctions put in place because of the government s support of rebel groups in neighbouring countries and the continued exploitation of illegal diamond and mineral resources. The full affects of the sanctions on the population are unknown but it is suspected that they are having a detrimental impact on an already desperate situation.

These factors have greatly increased vulnerabilities and served to constrain livelihood options for much of the population. However, the situation has been further exacerbated by the continued insecurity between Liberian government forces and the opposition rebel group, Liberians United for Reconciliation and Democracy (LURD), who remain violently opposed to the government of Charles Taylor. During the reporting period there has been an escalation of violence between the groups, which has moved gradually closer to the capital city, Monrovia. This has moved the conflict out of the north western Lofa County, where it has traditionally been based, and has caused great alarm. In response, a state of national emergency was declared in February (WFP 15/02/02). There is great fear that the continuing violence could spread to neighbouring countries because rebel groups are often involved in all countries of the Mano River Union (MRU). The escalation of regional violence would spell disaster to a region already crippled by wars, particularly at a time when prospects for peace are potentially high. Despite mutual suspicions, the leaders of the MRU met together in February 2002 to discuss ways of easing regional tensions and this has born some fruit with the deployment of joint border security and confidence building units (UN OCHA 08/04/02). Internally there have also been moves towards peace and reconciliation between the government and opposition groups. However, the talks, which were held in Abuja, did not include the LURD rebels and so the likelihood of them establishing any form of usable consensus required for a peace process is extremely unlikely (IRIN 15/03/02).

The current situation

The reporting period has seen the escalation of conflict and continued, large-scale displacement of populations. The situation remains extremely fluid and it is very difficult to keep track of the changing numbers of affected people. However, there was an attack on the Sawmill camp in Lofa County, which is normally home to 20,000 people. The attack resulted in the flight of the camp s residents and those of the nearby town of Tubmanburg, which is the largest in Western Liberia. A number of the displaced fled to the town of Klay, some 47 Km north of the capital Monrovia. Unfortunately, the displaced were initially prevented for several days from fleeing, despite the sound of closing conflict. When the conflict eventually arrived at the town, the population was forced to leave in total panic, resulting in the separation of families. There are currently 9,000 IDPs in Klay but the whereabouts of the remaining displaced population is not known. The emergency nature of the flight also meant that people were unable to take anything with them in the way of food or supplies. For many of the IDPs displaced from Sawmill, their displacement is for the third or fourth time from camps in Bopolu, Jenemana and Gbarma. This repeated displacement has significantly increased the vulnerability of affected populations (ACF 31/01/02).

Access to the affected populations is extremely difficult as a result of the insecurity and the government s refusal to allow aid workers to work beyond the Klay Junction. Insecurity moved closer to Klay in February 2002 and the 10,000 IDPs there were forced to flee once again. The LURD attacks have continued and the town of Bong, which has traditionally been a safe haven for IDPs, was attacked later in February causing the displacement of an estimated 20,000 people. Bong is also only 80 Km from the capital city. The movement of the conflict towards the capital city is of grave concern and many Liberians are now trying to flee the area in search of safer zones. The city has also seen an increase in the number of IDPs seeking refuge in established camps around the city area. The numbers are fluctuating but it is estimated that there are about 5-6,000 IDPs in addition to the 8,700 refugees who were already there (UNHCR 18/02/02).

The effects of the conflict have been far reaching. It is estimated that there are over 50,000 IDPs in the country and 70,000 refugees. Many of the refugees are originally from Sierra Leone and large numbers have chosen to return directly as a consequence of the conflict. The farming season in the affected western areas normally starts in January and has been hugely disrupted this year, meaning that there will be food deficits at the next harvest. Consequently, there are huge humanitarian needs in the country as populations are simply not able to cope with the shock of displacement due to their basic level of impoverishment. Many of the most vulnerable groups, including IDPs and refugees, routinely have to spend up to 90 % of any earnings on food, leaving them with almost nothing to meet other essential needs such as health care. Humanitarian assistance has been constrained by a lack of access to affected populations due to poor security and government travel restrictions. Another huge constraint is the poor level of funding response to the UN Consolidated Appeal. OCHA reports that as of 6 April 2002, the health sector had been pledged 0.87 % of its total funding requirements.

Overall

The situation in Liberia is extremely poor for both the displaced and refugees. The country is in economic collapse and the upsurge in violence is further eroding people s capacity to cope with the already poor humanitarian situation. As a result, both IDPs and refugees should be considered to be highly vulnerable (category II).

Recommendations

• Support the Inter-agency appeal.
• Advocate for increased access to affected populations.
•  Support the regional peace initiatives.

RNIS 35, October 2001

The humanitarian situation in Liberia continues to deteriorate as a result of fighting between government troops and dissident groups in the north of the country, particularly Lofa County. The country was crippled during the civil war between 1989 and 1996, which destroyed the economy, infrastructure and social fabric of the country. Today, Liberia is classified as one of the least developed countries in the world and its Human Development Index (HDI) places it 174^th out of 175 countries (UNSC 05/10/01). Mortality rates and life expectancy are believed to have remained little changed in the last twenty years, largely as a result of the collapsed economy and lack of even basic medical care. It is estimated that 80% of the population live in poverty, on less than one US dollar a day, and half of these live in absolute poverty, classified as those surviving on less than half a US dollar a day (UNSC 05/10/01).

The governments of Sierra Leone and Guinea have been accusing the Liberian authorities of supporting anti government forces within their countries, particularly the RUF forces in Sierra Leone. This has led to very tense relations between the Mano River Union (MRU) countries and also led to the imposition of sanctions on the Liberian regime by the UN in May 2001. The sanctions were targeted at the Liberian authorities and particularly at the sale and supply of arms to the regime and the trade in diamonds. A recent report by the Secretary-General of the UN highlighted the fact that the continuation of sanctions was likely to have adverse and unintended affects on the general population and the report suggested the establishment of a committee to monitor these affects (UNSC 05/10/01). These potential affects are particularly concerning because they are likely to further reduce people’s ability to cope with the already poor humanitarian situation.

Despite traditionally poor relations between Liberia and the neighbouring MRU countries of Guinea and Sierra Leone, the past few months appear to have seen a thawing in diplomatic relations with meetings between security ministers from the three countries. The meetings are an important step towards a regional security process and will hopefully lead to a full MRU summit at the beginning of 2002 (IRIN 28/09/01). In a further show of improved relations with the other MRU countries, Liberia also announced the dropping of restrictions on diplomats within Liberia and the future opening of the border with Sierra Leone and Guinea, which were shut in March (AFP 01/10/01).

The past few months have seen the continuation of fighting in Lofa County and more recently in Gbarpalu, closer to the capital Monrovia. There are estimated to have been 40,000 people displaced, mostly from Lofa County in the north of the country. The majority of the displaced have fled southwards to Bong, Cape Mount and Gbarpolu counties where they are in a variety of different camps. MSF reports that the displaced are arriving in the camps in an extremely weak condition because they have been forced to walk extremely long distances without access to food and through extremely insecure zones. Indeed, it appears that families have been forcibly separated, with men forced to remain behind in Lofa, presumably as a way of preventing opposition groups from moving into other areas. There is also a great problem of access to the areas most severely affected. MSF also report that they have been able to make very few assessments in Lofa but those that have been made have shown wide scale destruction of property and crops. MSF have also been forced to evacuate their expatriate staff from Jenna Mana camp in Cape Mount County (MSF 17/10/01). The lack of access and the high dependence of IDPs on food aid is particularly concerning. It is important to note that there has been a lack of donor interest in the country and the programs remain under funded, resulting in concerns that there could be possible pipeline breaks. The RNIS has not received any new nutrition information from Liberia but the situation is assumed to be extremely poor.

Overall

The situation for both displaced and nondisplaced populations continues to deteriorate in Liberia. The displaced remain particularly vulnerable and their dependence on humanitarian relief is extremely high (category II).

Recommendations

• Support the Inter-Agency appeal for Liberia
• Improve access to displaced populations in order to ensure that relief reaches those in need of assistance
• Conduct nutrition and food security assessments of the displaced to determine and prioritise needs

RNIS 34, July 2001

The humanitarian situation in Liberia has deteriorated further during the reporting period as a result of continued fighting between government troops and rebels in Lofa county in the north of country. Fighting continues amidst claims and counter claims that Liberia and Guinea are trying to destabilise each others countries through the support of rebel factions. The fighting has resulted in a huge displacement of population from the Lofa region.

The UN estimates that at the end of May there were 40,000 people in IDP camps, the numbers having risen from 15,000 in April (IRIN 14/06/01; UN 2001). The main thrust of displacement has been south to Bong, Cape Mount and Gbarpolu counties, where they are spread between about five of six different camps. Conditions in the camps are extremely poor as many of the displaced were forced from their villages some time ago and have been living in the forest. For many the journey from Lofa has been extremely arduous and there are wide spread reports of harassment by Liberian military along the way. ACF recently reported that many have been unable to access their land and harvest crops as a result of the fighting, leaving them critically short of food stocks (ACF 25/07/01). Furthermore, access to these populations has been severely impeded by the insecurity and by government imposed bans on the movement of humanitarian agencies. This has restricted the supply of humanitarian assistance to the affected populations and there are now reports of great needs for food and medical aid. MSF report that families have used up their food stocks and are suffering high rates of respiratory infection, malaria and some cases of bloody diarrhoea (MSF 03/07/01).

WFP has been conducting food distributions to IDPs in the camps but has also suffered from the restricted access. On June 30^th WFP completed a round of distribution to IDPs in Gbalatuah and Bellefanai towns in Bong county. The distribution was only possible after the government lifted a travel ban, and was the first distribution in a month and a half (WFP 06/07/01). The restricted access is particularly concerning given the poor acute needs of many of the IDPs. On July 4^th distributions also started to IDPs in the TV tower and CARI camps in Bong county, and to Jenemana and Bopolu in Cape Mount and Gbarpolu counties. The distributions will bring some relief to the displaced but concern remains for those still in Lofa county, many of whom are currently in hiding. The total population of Lofa is estimated to be about 60,000 people and if and when the remainder of these people reach Bong County their nutrition and health situation is expected to be very poor. It has also been noted that many villages in Bong county have started to prepare to evacuate in the eventuality that fighting spreads from Lofa. This highlights the prospect of considerable further displacements (UN 2001). The RNIS has received no nutritional surveys on the displaced population and it is believed that this is largely a result of the lack of access and insecurity in the areas concerned.

The plight of the displaced is heightened by the extreme poverty of the country as a whole. It is estimated that two thirds of the Liberian population are living below the international poverty line of less than one dollar a day. The unemployment level is estimated to be 85% and access to basic amenities such as water, health and education services varies between 11 and 26% (UN 2001). This means that many of the displaced will be chronically impoverished with little or no means of accessing food other than from humanitarian assistance. It is also important to note that it is currently the rainy season which will last until September or October. This is traditionally the hunger season when food availability is at its low-est and morbidities such as malaria and diarrhoea increase. It is expected that the needs of the displaced population will remain extremely high and that they will be at elevated risk of malnutrition.

Refugees

The last RNIS reported an estimated 80,000 Sierra Leonean refugees in the country but continued insecurity has led to an increased number leaving for Guinea and returning to Sierra Leone. It is very difficult to estimate how many have returned, but UNHCR reports that in April 2001 there were 69,762 refugees in Liberia. This means that at least 10,000 have returned to Sierra Leone and the figures have probably increased since then (UNHCR 18/07/01). The RNIS has no recent information on the nutritional situation of refugees within Liberia.

Overall

The insecurity in the north of the country has led to considerable displacement of population within Guinea. Although no nutritional information is available, reports indicate that the IDPs are in extremely poor condition having travelled for some time without much in the way of food or medical care to reach camps. Those that have reached camps are suffering from exhaustion, lack of food and high rates of morbidity. The poor condition of the displaced coupled with the rains and the hunger season make this population very vulnerable (category II). Furthermore, an unknown number are still inaccessible to humanitarian workers and their condition is currently unknown (category V) but can be considered to be poor.

Recommendations

• Advocate for improved access to displaced populations.
• Support efforts to provide emergency food and non food relief to IDPs.
• Conduct nutrition surveys to assess the nutritional status of the displaced populations.

RNIS 32/33, April 2001

The spread of the sub regional violence to Guinea, from both Liberia and Sierra Leone, has forced the repatriation of Liberian refugees and it is feared that the further mass return of refugees would generate huge problems in a country already stretched to capacity. There are currently estimated to be a combined total of some 460,000 Sierra Leonean refugees (80,000) and Liberian returnees (360,000) in the country with many being in the volatile Lofa county. The intensification of fighting in the area has rendered it largely inaccessible to relief agencies. This makes the precise determination of numbers returning from the recently war torn south eastern zone of Guinea, extremely difficult (UNHCR 2001).

The UN is planning to implement sanctions against Liberia in response to the regime's continued funding of rebel insurgency movements in Sierra Leone and the illegal profits taken from illict diamond and timber extraction. Sanctions will be imposed on May 7^th unless the Liberian government meets certain prerequisites and can prove that it has ceased illegal activities. The prerequisites include the expulsion of foreign rebel movements in the country and a cessation of funding and military support to rebel groups and the illicit trade in rough diamonds and illegal timber. With the absence of definitive proof that these criteria have been met, it would seem likely that the sanctions will be implemented. The effects of the sanctions on the populous and particularly the refugees and newly returned is difficult to predict (PANA 22/04/01).

Situation of returnees

Current estimates indicate up to 30,000 returnees over the past year. The majority of the country is safe but the area of Lofa county on the border with Sierra Leone remains extremely insecure and the scene of frequent fighting. The deteriorating situation in Guinea has also prompted the return of many but numbers remain extremely difficult to estimate. To date the RNIS has not received any new nutritional or food security data on the conditions of returnees in the country (UN 2001).

Refugees in Liberia

There are an estimated 80,000 Sierra Leonean refugees in Liberia and according to the government 5,000 have returned to Sierra Leone over the last year. About 35,000 remain in camps in Montserrado and Grand Cape Mount counties and another 45,000 are scattered throughout Lofa county with little or no access to humanitarian assistance. The political instability in Sierra Leone makes the prospect of return unlikely in the foreseeable future. The RNIS has received no new information on the nutritional and food security status of the refugees (UNHCR 2001).

Overall

There is no new information on the nutritional status of either refugees or newly returned. It is assumed that the situation remains uncritical for those currently in non insecure areas of the country. However those in the highly insecure areas of Lofa county, particularly those forced to flee insecurity in Guinea, should be assumed to have an elevated risk of malnutrition (category III).

Recommendations

• Advocate for increased humanitarian access to the insecure regions of Lofa county.
• Continue to monitor the situation of refugees and the newly returned particularly those in Lofa county.

RNIS 31, July 2000

The humanitarian situation in Sierra Leone has severely deteriorated following the resumption of hostilities between the rebels and pro-government forces. Large numbers of people have been newly displaced and access to the rebel-held areas is non-existent. No significant changes in the humanitarian situation in Liberia, Cote d'Ivoire or Guinea-Conakry have been reported. The table below shows the numbers of affected people requiring assistance in these countries

Estimated numbers of refugees, IDPs and returnees In the Liberia/Sierra Leone Region

	June-1998	Mar-1999	June-1999	Sep-1999	Dec-1999	Mar-2000	Jul-2000
Liberia	209,000	495,000	505,000	505,000	510,000	96,000	87,000
Sierra-L.	300,000	400,000	708,000	758,000	758,000	757,000	1,156,000
Cote d'Iv.	140,000	101,500	103,000	108,500	101,500	101,500	88,000
Guinea-C.	614,000	470,000	400,000	488,000	488,000	489,000	450,000
Total	1,263,000	1,466,500	1,716,000	1,859,500	1,857,500	1,443,500	1,781,000

Note that the numbers, given for Liberia are refugees only (returnees no longer Included In this table). Numbers, for Sierra Leone are based on estimates of IDPs and refugees.

Liberia's seven-year civil war ended in July 1997. Since this time the international relief community in Liberia has focused its efforts on the resettlement and reintegration of returning refugees and IDPs. Some 150,000 Liberian refugees have been assisted by UNHCR to return home and at least 200,000 people have spontaneously repatriated. since the start of the repatriation programme in May 1997. Following the regional review of the progress made on the repatriation operation in February 2000, it has been decided to continue the assisted returns from Cote d'Ivoire and Guinea until the end of 2000 (UNHCR - 12/12/99, 27/03/00, 20/07/00; WFP - 17/12/99).

Despite the relatively calm security situation, Liberia's economy is very poor. The country's infrastructure and provision of basic services including health care are well below pre-war levels. Unemployment remains high, and the literacy rate is only about 20%. It has been suggested that donor reluctance to provide assistance to Liberia is associated with Charles Taylor's links with the rebels in Sierra Leone (IRIN-WA - 17/07/00,18/07/00).

Situation of returnees

An estimated 75% of IDPs have returned to their places of origin and it is probable that the remaining 25% may settle permanently where they are. The Government of Liberia and WFP no longer consider these people to be displaced. WFP, however, continues to provide assistance to some 420,000 people (many of them returnees) in Liberia under a variety of programmes including food-for-work projects, vulnerable-group feeding and also school feeding (WFP - 17/12/99).

A nutritional survey by ACF in Grand Bassa County (estimated population 60-80,000) estimated the prevalence of acute malnutrition at 6.7%, including 1.0% severe acute malnutrition (see annex). The level of malnutrition in this community, which is home to many returnees, seems to have stabilised (see graph). CMR was estimated at 0.49/10,000/day and under-five mortality at 0.79/10,000/ day. Measles vaccination coverage, verified by a card, was estimated at 36.5% (ACF-F - 03/00).

The prevalence of malnutrition (defined using z scores and/or oedema) in Grand Bassa County

Refugees In Liberia

There are an estimated 87,000 Sierra Leonean refugees in Liberia. Over 33,000 refugees assisted by UNHCR are now concentrated in camps in Montserrado and Sinje in Grand Cape Mount County. UNHCR estimates that there are a further 54,000 non-assisted refugees living in Grand Cape Mount, Bomi, Bong, Margibi and Lofa Counties (UNHCR - 20/07/00).

Dissidents have attacked locations in Upper Lofa in August 1999 and again in June/July 2000. In August 1999 most of the refugees in Kolahun were forced to flee the area. Government troops are currently fighting the dissidents, who are believed to have come from Guinea, in Voinjama (the county capital). MSF has suspended its operations in the area (IRIN-WA - 11/07/00, 12/07/00). Due to the fighting, UNHCR has also had to temporarily suspend the organised repatriation of Liberian refugees from Guinea (UNHCR-20/07/00).

UNHCR is consulting with the Liberian government on the latter's unilateral decision to relocate Sierra Leonean refugees from the Sinje camp to a new camp. At the same time they are developing contingency plans with various partners should the refugees choose to return to Sierra Leone rather than be relocated (OCHA - 11/07/00; UNHCR - 20/07/00). The most recent nutritional survey in Sinje camp found relatively low levels of acute malnutrition among the refugees, although their food-security situation was poor (see RNIS 30). If the refugees are relocated again it is likely that their food security will deteriorate further, at least in the short term.

Overall, there is no new nutritional information on the refugees in Liberia. It is assumed that the nutritional situation of the refugees in Vahun remains non-critical (category IV). However, those in Sinje are considered at heightened risk because of the insecurity and the possibility of relocation (category III).

Recommendations and priorities:

• Monitor the situation of refugees in Sinje given the heightened insecurity.
• Support UNHCR in consultations with the Liberian government to stop the forcible relocation of refugees.

RNIS 30, March 2000

The nutritional situation for much of this region is stable or improving. Following the Peace Accord, much larger areas of Sierra Leone have become accessible to humanitarian agencies, although there is little information available about the nutritional situation. No significant changes in the humanitarian situation in Liberia, Cote d’Ivoire or Guinea-Conakry have been reported. The table below shows the numbers of affected people requiring assistance in these countries.

Estimated numbers of refugees, IDPs and returnees in the Liberia/Sierra Leone Region

	Mar-1998	June-1998	Mar-1999	June-1999	Sep-1999	Dec-1999	Mar-2000
Liberia	726,000	209,000	495,000	505,000	505,000	510,000	96,000
Sierra-L.	200,000	300,000	400,000	708,000	758,000	758,000	757,000
Cote d’Iv.	210,000	140,000	101,500	103,000	108,500	101,500	101,500
Guinea-C.	405,000	614,000	470,000	400,000	488,000	488,000	489,000
Total	1,541,000	1,263,000	1,466,500	1,716,000	1,859,500	1,857,500	1,443,500

Note that the numbers, given for Liberia are refugees only (returnees no longer included in this table). Numbers, for Sierra Leone are based on estimates of IDPs and refugees.

Liberia’s seven-year civil war ended in July 1997. Since this time the international relief community in Liberia has focused its efforts on the resettlement and reintegration of returning refugees and IDPs. Over 130,000 Liberian refugees have been assisted by UNHCR to return home and at least an estimated 200,000 people have spontaneously repatriated since the start of the repatriation programme in May 1997. Following the regional review of the progress made on the repatriation operation in February 2000, it has been decided to continue the assisted returns mainly from Cote d’Ivoire and Guinea until the end of 2000 (UNHCR - 12/12/99, UNHCR - 27/03/00; WFP -17/12/00).

An estimated 75% of IDPs have returned to their places of origin and it is probable that the remaining 25% may settle permanently where they are. The Government of Liberia and WFP no longer consider these people as IDPs and the RNIS will no longer include them in its reports. WFP, however, continues to provide assistance to some 420,000 people (many of them returnees) in Liberia under a variety of programmes including food-for-work projects, vulnerable-group feeding and also school feeding (WFP -17/12/00).

Refugees in Liberia

There are an estimated 96,000 Sierra Leonean refugees in Liberia. Some 38,000 refugees assisted by UNHCR are now concentrated in camps in Montserrado and Sinje camp in Grand Cape Mount County. It is believed that some 58,000 non UNHCR-assisted refugees reside in Grand Cape Mount, Bomi, Bong, Margibi and Lofa Counties. Should the security situation in Sierra Leone considerably improve, UNHCR will start to facilitate the return of Sierra Leonean refugees during the course of 2000 (UNHCR-27/03/00).

Sinje camps

Due to insecurity in Upper Lofa in August 1999 most of the 17,000 refugees in Kolahun were forced to flee to Tarvey in Lowa Lofa as a result of considerable harassment from soldiers. More recently, UNHCR relocated these refugees (some 11,500) to a new camp in Sinje in Cape Mount County where they joined an existing caseload of refugees who had arrived in 1998.

ACF-F undertook anthropometric surveys of both the old and relocated refugees in the Sinje camps in December 1999 (see annex). WFP provides a ration of 1100 Kcal/person/day to the more established refugees in camp I, and a ration of 1700 Kcal/person/day to the relocated refugees in camp II. The rationale behind these rations is that the more long-term refugees have obtained access to land and have had time to establish means to obtain income, hence they require less support. In contrast the relocated refugees have no access to land yet and very limited means to acquire food and other basic needs. ACF-F found a slightly higher prevalence of acute malnutrition (not significantly so) in the more established refugee camp than in the newer camp, although mortality rates were higher among the relocated refugees (ACF-F - 12/99a). In the ACF feeding programmes the progress of children originally from Sinje was poor; some even showed a deterioration.

Results of nutritional surveys in Sinje camps

	Camp I (old refugees)	Camp II (relocated refugees)
Acute malnutrition	9.0%	6.5%
Severe acute malnutrition	0.6%	0.9%
CMR (deaths/10,000/day)	0.48	0.98
Under-five mortality rate (deaths/10,000/day)	1.05	1.61
Feeding Centre Coverage	57%	33%
Measles Vaccination Coverage (with card)	56.8%	57.1%

ACF-F undertook a food security assessment of the relocated refugees (camp II) in order to assess how they had survived since leaving Kolahun and also whether or not their ration could be reduced to be in line with that of the more established refugees. The main findings of the food security assessment are summarised below (ACF-F -12/99b):

• The refugees’ food security has deteriorated since they left Kolahun. In Kolahun many of the refugees had established coping mechanisms, including personal food production through backyard gardens, rice farms and income-generating activities (petty trade, labour contracts). During the journey to Tarvey, however, the population encountered many difficulties and households were forced to spend their savings and sell their assets. At Tarvey food availability and accessibility were limited, as were income-generating activities - particularly for the households who had remained in Kolahun the longest (usually the most vulnerable such as older, single women or women with children). In addition, during this period many of the households were split up between Kolahun and Tarvey and as a result 34% of the households in Sinje are female-headed.
• There are opportunities for resource-generating activities in Sinje and its surroundings. However, labour contracts, which represented the main source of income in Kolahun, are more limited. Mining, waged work and petty trade are the major potential sources of income.
• Some 3,000 refugees (14%) are benefiting from rice, cassava and vegetable programmes. A palm oil plantation some 20 km from the camp may also provide employment/food for some of the refugees.
• At the time of the survey, the main source of food among the refugees in Sinje was the food distributions provided by WFP. To provide for the food needs not met by the ration, the majority of refugees (59%) have had to sell part of their assets, which has eroded their already fragile economic base. An estimated 14% of the population are living in extremely precarious conditions - they have no source of income and are forced to rely on begging/credit/or asset sales and they may not be able to meet their daily needs. The majority of households are involved in low income-generating activities: 64% of households are involved in petty trade (sale of small items, firewood, bush products, hand-made products, palm wine, food ration), 4% are in business, 6% have a member who has salaried work and 12% of the households rely on labour contracts.
• Bulgur wheat is the staple food in the ration and is consumed every day as a substitute for their preferred Sierra Leonean staple food - rice. Part of the vegetable oil in the ration is bartered or sold to have red palm oil, which is preferred. Access to protein rich sources of food is determined by the purchasing power of the family (the peas in the ration are not eaten regularly, but instead are cooked in bulk every few days).
• The main sources of expenditure include food, soap, household items, health, clothes, tools and credit repayments. The poorer refugees spend a higher proportion of their money on food (80-90%) than those involved in business or waged work (40-60%).
• An immediate decrease in the ration provided to the relocated refugees, to the level of that received by the more established group, was not recommended until increased opportunities for agricultural activities and self-sufficiency were obtained. Any decrease in the ration could severely affect the nutritional situation of these people, who have no source of food other than the general distribution. This is particularly true for households without an adult capable of working, or those who are headed by women.
• The relocated refugees are not ethnically similar to the local population in Sinje and difficulties integrating with the local population are anticipated.

Refugees in Vahun

There is no new information on the nutritional situation of the refugees in Vahun.

Overall, even though the refugees relocated to Sinje have been subject to considerable harassment and extremely difficult conditions, most are still managing to meet their food requirements. However, a deterioriation in their nutritional situation was reported. Their situation continues to be precarious and therefore they are considered to be at moderate risk (category III). It is assumed that the nutritional situation of the refugees in Vahun remains non-critical (category IV).

Recommendations and Priorities:

From the ACF survey and assessment in Sinje Camps:

• Maintain the current level of ration for all refugees for the next three months.
• Re-evaluate the number of vulnerable households (those relying entirely on food distributions) and increase food assistance to this group.
• Continue nutritional surveillance; including food security assessments, anthropometric surveys and assessments of the coping mechanisms.

RNIS 29, December 1999

The seven-year Liberian civil war ended in July 1997 and, since the elections, security conditions have improved considerably. The country continues, however, to suffer from very high unemployment levels; insufficient supplies of potable water and electricity; shortages of food, shelter and health care; and continued insecurity.

The international relief community in Liberia has focused its efforts on the resettlement and reintegration of returning refugees and IDPs. Since the start of the repatriation in May 1997, some 123,000 Liberian refugees have been assisted by UNHCR to return home. In addition it is estimated that some 200,000 Liberian refugees have spontaneously repatriated. Over half of the Liberian refugees living in surrounding countries have now repatriated and an estimated 75% of IDPs have returned to their places of origin, it is probable that the remaining 25% may stay where they are. UNHCR’s organised repatriation convoys are planned to be completed by the end of 1999. Those who are still willing to repatriate (especially from Cote d’Ivoire and Guinea) beyond this deadline will be assisted through provision of a modest repatriation package until the end of June 2000 (IRIN-WA - 28/10/99; UNHCR 01/11/99, 12/12/99; USAID - 30/09/99; WFP -17/12/99).

Nutritional situation of the returnees

The RNIS has received no new surveys or food security assessments for the returnees in Liberia over the reporting period. The most recent RNIS reports have described a nutritional situation that is slowly stabilising and improving, at least in rural areas. Agricultural production has resumed, and improved access to land and markets has led to a corresponding increase in food production, a decrease in the prevalence of malnutrition and less reliance on food aid. However, the displacement of farmers during the war resulted in the loss of their seeds and farm tools, which are still required in some areas. In addition, during the rainy season, when the roads are in poor condition, food may be harder to obtain. In some urban areas, for example, Monrovia, relatively high prevalences of malnutrition are still being recorded among IDPs (see RNIS 28).

Agricultural Outlook

A recent FAO/GIEWS report states that the overall food situation in Liberia has improved significantly in 1999 as both rice and cassava production have increased. Food supply in urban markets is relatively stable and, in general, prices are reported to be lower than in 1998. The exception to this general improvement is in Lofa County where fighting broke out in August and an estimated 25,000 people were displaced. It is unlikely that these IDPs will be able to harvest their crops (FAO -10/11/99).

Refugees

There are a total of some 90,000 Sierra Leonean refugees in Liberia. Over 10,000 of these refugees were housed in camps in Kolahun that was the site of fighting in August. These refugees have now evacuated the camps, many walking on feet to Tarvey (100 km from Kolahun) where a transit camp has been set-up. UNHCR assisted those who were unable to reach Tarvey alone. Some 12,000 of the refugees have now been transferred to a camp in Sinje under a relocation exercise that was completed in late November (IRIN-WA-28/10/99; UNHCR-26/10/99, 12/12/99).

No new information on the nutritional situation of the refugees has been received by the RNIS. The most recent surveys, in April, indicated that their nutritional situation was not critical.

Recommendations and Priorities

• Continue to supply agricultural inputs to farmers.

Overall, the situation of the returnees remains at moderate risk and will continue to be so until their livelihoods become more secure (category III). The situation of the Sierra Leonean refugees is not critical (category IV).

RNIS 28, September 1999

The Liberian civil war, which began in 1989, led to massive population displacements both within Liberia and into neighbouring countries. Since the elections in July 1997, when Charles Taylor was elected President, security conditions have improved considerably, which has prompted increasing numbers of refugees and IDPs to return to their homes. Human rights organisations, however, continue to report terrible abuses throughout the country. Social services remain poor. Monrovia still has no electricity or piped water supply system and local sources report that both unemployment and illiteracy rates are very high (IRIN-WA - 09/09/99).

Since the start of the repatriation of Liberian refugees in May 1997, some 120,000 people have been assisted home by UNHCR. A further 160,000 are believed to have returned unassisted. WFP and UNHCR support reconstruction efforts for schools, roads and bridges in Liberia to help repatriated refugees settle back home (WFP -23/07/99).

Survey in Monrovia

In late March 1999, ACF-F conducted two nutritional surveys in Monrovia (see Annex). The surveys estimated the prevalence of acute wasting and/or oedema at 13.5% among the town residents, and 14.0% among the population living in shelters. Severe wasting and/or oedema were estimated at 2.3% and 2.6% respectively. These prevalences are relatively high, particularly as the survey was undertaken at the beginning of the lean season. The graph following shows the prevalences of malnutrition in the shelters since February 1997. There has been virtually no change in the levels of malnutrition in these shelters for over two years. WFP has not provided a general food distribution in Monrovia since 1998 in order to encourage the displaced to return to their communes of origin. Some of the population of Monrovia may, however, obtain assistance through food-for-work programmes (WFP -14/09/99).

Prevalence of malnutrition in shelters in Monrovia

The survey also estimated retrospective mortality in both populations: CMR was estimated at 1.2/10,000/day in the communities and at 2.8/10,000/day in the shelters; under-five mortality was estimated at 1.5/10,000/day and 5.2/10,000/day respectively. Measles vaccination coverage was low at 30.2% in the communities and 44.5% in the shelters. Coverage of the selective feeding centres was also low in the communities - only 14.6%, although this was much higher (81%) in the shelters.

Survey in Upper Bong County

ACF-F conducted a study among residents and returnees in Upper Bong Country in mid-June. They estimated the prevalence of wasting and/or oedema at 8.1% including 1% severe wasting and/or oedema (see Annex). This result can be compared to those obtained over the past three years in the graph opposite. There has been a slight improvement in the nutritional situation in the past year, and the prevalence of malnutrition has remained below 10% in the past two years. The measles vaccination coverage rate in the area was low at 41.8%.

Prevalence of Malnutrition in Upper Bong County

Fighting in Northern Liberia

Renewed hostilities broke out in mid-August between government security and dissident forces in the volatile upper Lofa region, where a similar attack in April seriously disrupted relief activities. Over 50,000 civilians, mainly women and children, are reported to have been displaced by the fighting. Although the rebels have now been dislodged from most of the areas they initially occupied, sporadic fighting is reported. Most of the UN agencies and NGOs temporarily evacuated their staff from the area and suspended their operations when humanitarian workers were taken hostage and stores were looted. WFP have distributed a one-off emergency ration to more than 25,000 of the displaced in upper Lofa country. It is hoped that the displaced people will soon be able to return home (IRIN-WA - 07/09/99; UNHCR - 06/09/99: WFP -28/08/99).

Sierra Leonean refugees

There are an estimated 100,000 refugees from Sierra Leone in Liberia. Some 16,000 of the refugees were housed in camps near Kolahun where the fighting broke out in August. An estimated 5,000 refugees arrived in Tarvey in Lower Lofa having fled Kolahun. UNHCR has recommended that these refugees be relocated to an existing refugee camp in Sinje, Cape Mount. The agency reported that the refugees cited numerous incidents of harassment in Kolahun by Liberian security forces, and also said they worried that no aid agencies would return to Lofa after the recent violence (IRIN-WA - 24/08/99, 03/09/99; UNHCR - 20/09/99).

There is no new information on the nutritional status of the Sierra Leonean refugees. The most recent surveys (undertaken in April) indicated that their nutritional situation was not critical. WFP had pre-positioned assorted food commodities for the refugees in Kolahun, Harper and Zwedru in order to cover the needs of approximately 30,000 refugees and vulnerable persons during the peak of the rainy season (July-September) when the roads leading to these areas become impassable. However, some of these stocks were looted in Kolahun during a security incident in August (UNHCR -20/09/99; WFP 23/07/99).

Overall, the IDPs and returnees remain at moderate risk (category IIb) and will continue to be so until their livelihoods become more secure. The situation is most difficult for the IDPs in the volatile Lofa region, although little precise information about their nutrition situation is currently available. In Monrovia the prevalence of malnutrition in March was worryingly high as the lean season approached, although no new information is available, they are considered to be at moderate risk (category IIb). The situation of the Sierra Leonean refugees is not critical (category IIc).

Priorities and Recommendations:

From the ACF-F survey in Monrovia:

• Assess and monitor the food security situation of the population in Monrovia; continue to monitor their nutritional status.
• Ensure the continuity of treatment for moderate and severe cases of malnutrition.
• Inform the population about quick referrals to health facilities through community health workers.

From the ACF-F survey in Upper Bong County, Liberia

• Continue to screen malnourished children and refer them to therapeutic feeding centres
• Continue to monitor the nutritional situation in Bong County.
• Promote the measles vaccination campaign through feeding centres and refer to the UNICEF EPI programme.

RNIS 27, July 1999

The Liberian civil war which began in 1989 led to massive population displacements both within Liberia and into neighbouring countries. Since the elections in July 1997, when Charles Taylor was elected President, security conditions have improved considerably, which has prompted increasing numbers of refugees and IDPs to return to their homes. The return and assistance operation has proceeded with impressive results, despite the often adverse conditions (IFRC - 28/04/99: OCHA -12/98).

IDPs and returnees

Since the start of the repatriation of Liberian refugees in late 1977, over 110,000 Liberians (of an original estimate of 480,000 refugees) have been assisted home by UNHCR. Some 160,000 are believed to have returned unassisted. UNHCR plans to wind down its Liberian repatriation operation by June 2000. Convoys will operate until the end of December 1999 and it is hoped that by this point all Liberians in countries of asylum will have been given the chance to be assisted home. The agency will continue reintegration projects in Liberia itself for another six months (UNHCR - 03/06/99).

The Government inter-agency resettlement commission, in co-operation with the Red Cross and other humanitarian agencies, have also been successful in their attempts to assist IDPs to resettle. An estimated 48,000 (out of an initial total of 187,000) IDPs remain in Monrovia located in eleven of the remaining fifteen shelters. These people require assistance to relocate, but due to resource constraints the Red Cross programme has been suspended and the balance of IDPs have not be able to return before the rains (IFRC - 28/04/99).

Food security

The last RNIS reported on the findings of an FAO assessment of the food and crop situation in Liberia, which indicated a significantly improved overall "food situation" for the country, although paddy production remains about 70% of pre-civil strife levels (FAO - 26/01/99).

Inter-agency food security assessments have been undertaken in Margibi County in early October, 1998 (SCF - 01/01/99) and Grand Cape Mount County in November, 1998 (SCF - 01/02/99). These are intended to serve as baseline food and livelihood security information for future food security monitoring.

Margibi County -food security assessment

Margibi County was divided into three production zones, within each of which 3 to 5 socio-economic groups were identified.

• Zone 1: Upper Margibi's Gibi and Worhn Districts where the main source of livelihood is subsistence rice farming, with cassava inter-cropping, and sugar cane production. Own food production is insufficient to cover a households food requirements, which must be met through income earned from contract labour, and the collection of wild foods. Market activity is limited by the poor road conditions in the rainy season and restricted access.
• Zone 2: Central Margibi encompasses and is dominated by the Firestone rubber plantation, which employs more than 8,500 employees officially in the area, and many more on an unofficial casual basis. As a result there is a wide variation in incomes. Women and children often work for Firestone employees in collecting latex and 'under-brushing' the plantation. The report predicts a "dangerously high shortfall in food needs in 1999" as only between 0 and 10% of food requirements are met by own food production. Strategies to make up this shortfall include; consumption of Firestone-issued subsidised rice, reduced rice consumption between February and November, casual labour, and gathering wild foods. Because of the presence of Firestone, the local population consider this area to be better-off than the other zones because of the availability of subsidised rice and also the greater access to cash through labour.
• Zone 3: Lower Margibi's coastal area, where fishing and charcoal production are common. Five socio-economic groups were identified in this zone, all of which rely mainly on fishing activities and charcoal production for food and income. There is little suitable agricultural land, which restricts subsistence rice production and cassava farming. Late and limited access to seeds reduced the amount of rice grown, and production was only expected to last 3 months. Charcoal production is now a permanent adaptive strategy, rather than a coping strategy.

In all three zones in Margibi County, the recent return from asylum and limited access to seeds and tools, combined to reduce the size of the 1998 harvest. The coping strategies carry social, health and educational costs particularly for children. For example, rice consumption tends to decrease during the 'hungry season'.

Interagency Food Security Assessment in Grand Cape Mount County

Grand Cape Mount is an area supporting a high number of returnees and has varying degrees of war damage. The assessment divided Grand Cape Mount into five production areas:

• Tewor/Garwula is a palm and cassava producing area. Rice production is not substantial, and the processing of palm oil has all but ceased since the closure of the processing plantation during the war. There is now more emphasis on mining of diamonds through the Greater Diamond Company, and tapping rubber, with the revitalisation of the Guthrie rubber plantation. These companies draw workers into the area from other counties, including Bong and Lofa.
• Robertsport is a fishing area, but suffers from limited opportunities to market its fish as a result of very poor roads. Women are directly involved in the drying and petty trading of fish. Agriculture is limited by the area's topography.
• Porkpa is an agricultural area which borders Sierra Leone and traditionally was an area of high rice production. Farming continued throughout the war so a supply of seed rice and cassava exists. Although rice is a major component of the diet amongst growers, it only comprises 35% of the staple food needs of poorer groups, who must depend on a range of coping strategies to make up the shortfall. These include the collection of wild food, trapping bush animals, and migration to the diamond mines for work especially during the hungry season. The conflict in Sierra Leone is more likely to impact on this border area than other districts in Cape Mount.
• South Gola Konneh is a rice and cassava producing area, to which many returnees came prior to or in 1997. A further large group returned in 1998. Most are agriculturally productive, and have established cassava and vegetable gardens. In addition, they rely on savings and assistance from relatives, wild foods and trapping animals for consumption and sale. Many of the cocoa and coffee farms are yet to restart production.
• Central and North Gola Konneh District is a gold and diamond mining area with less emphasis on agriculture. The majority of staple food is brought in from other areas. Gold mining tends to provide a steadier source of income, whereas diamond mining is more speculative. Recent returnees and poorer groups earn income by casual labour on local farms particularly in northen Gola Kennah. Because of the high demand for foodstuffs and other essentials, prices are high which creates difficulties for poorer groups.

Buchanan, Grand Bassa county

The prevalence of wasting oedema in Grand Basa County

An ACF survey conducted in the community of Buchanan city (population approximately 72,000) in Grand Bassa county in March 1999 reported a prevalence of 6.8% acute wasting and 1.0% severe wasting (see Annex). No oedema was reported. The results of earlier surveys can be seen in the graph opposite. At the time of this most recent survey no new demographic data for the community was available, thus the survey sample was drawn from a population screening conducted by ACF in 1997. The level of wasting has remained relatively stable since July 1997. The report suggests that most of the displaced have relocated to their county of origin and that those remaining are now well-integrated into the community and the prevalence rates of wasting are returning to the pre-crisis levels of February 1996.

The report notes, however, that a significant number of malnourished children were still found. It is suggested that some, probably socially isolated, households have not become involved in the general process of improvement seen elsewhere. The coverage of the nutrition programme was low at 28.2%, which suggests that these socially isolated families either do not know of the existence and/or location of the Day Care Centre and dry ration distribution programmes, or alternatively are unable to, or prefer not to, attend.

Retrospective mortality rates were found to be relatively high at 1.13/10,000/day and under-five mortality was recorded at 2.07/10,0000/day. Deaths were attributed to a variety of illnesses including malaria and diarrhoea. The measles vaccination rate (according to possession of a card) was low at 41.1%, although this figure is considerably increased (to 86%) if based on the mother's confirmation.

Sierra Leonean Refugees

There are some 105,000 refugees from Sierra Leone in Liberia. About 50,000 of these receive WFP food rations in camps of Kolahun, Vahun, in the eastern town of Sinje and in settlements around Monrovia (UNHCR - 03/06/99; WFP - 23/05/99).

MSF undertook an athropometric survey amongst the refugees in Kolahun camps I and II Upper Lofa County in April (see Annex, UNHCR - 22/06/99). The survey found 3.4% acute wasting in camp I (population approximately 13,900); no cases of severe wasting or oedema were seen. In Camp II (population approximately 5,700) there was estimated to be 5.9% acute wasting and/or oedema and 0.9% severe wasting and/or oedema. CMR was estimated at 0.28/10,000/day in camp I and 0.2/10,000/day in camp II. These results indicate an improvement in the nutritional situation since the last survey undertaken in these camps in June 1998. The level of measles immunisation has also improved from 37.9% last year to 72.4% in April.

The main reason for the improvement was the timely general food distribution which met 80% of the basic minimum needs, for three months prior to the survey. Additional means of obtaining income were also possible for most households. The public health and sanitary conditions of the camp were reported to be satisfactory: water availability varied from 14.7-23.4 litres/person/day and between 16-23 people shared a latrine.

A security incident in Voinjama in late April led to heightened anxiety and tightened security. Residents are reported to have fled in large numbers from some towns in the area, although most have since returned. WFP food distributions were suspended in Kolahun and Vahun camps for over a month, but deliveries have since restarted (WFP -11/06/99).

A preliminary report of an exercise to verify refugee numbers in Kolohun camps indicated a 30% reduction, which was attributed to the relocation of some refugees to other parts of the country due to economic and other reasons, and also it was suspected that a number of refugees recycled during the initial registration period. Harassment of refugees, especially in Vahun, in the market place, on farms and on the road, apparently continues (WFP, 04/99).

Overall, the IDPs and returnees are still considered to be at moderate risk (category IIb), and will remain so until their livelihoods become more secure. Improvements in the nutritional situation of the Sierra-Leonean refugees, means their situation is not critical (category IIc).

Priorities and recommendations:

Given the current rate of return of both IDPs and refugees to their places of origin the needs for assistance are significant:

• Re-habilitate water and sanitation facilities.
• Re-start crop production with seeds and agricultural tools.
• Re-build health and education systems.
• Ensure the IDPs receive cooking utensils, clothing, blankets and other relief supplies.
• Rehabilitate and improve roads and bridges in areas where trade links are weak, and hence improve access to markets.

Recommendations from the Interagency Food Security Assessment in Margibi County include:

• Ensure greater efforts are made to target the poorer households, as previously the poor and better-off have been targeted equally.
• Conduct food security monitoring throughout 1999, with a view to intervene with food assistance if necessary.
• Invite the Firestone Rubber Plantation to discuss the assessment results and participate and co-operate in local initiatives to address food insecurity.
• Explore options for rehabilitating cash cropping by subsistence farmers in Upper Margibi.
• Explore ways to increase cassava production and fishing in Lower Margibi as alternatives to charcoal production.

Recommendations from the Interagency Food Security Assessment in Grand Cape Mount County include:

• Ensure Cape Grand Mount is prioritised for food security monitoring, in particular the area that borders Sierra Leone.
• Establish micro-credit projects for women's groups

Recommendations from the ACF study in Buchanan city include:

• Assess the underlying causes of malnutrition in the families with malnourished children and continue to monitor the nutritional situation.
• Provide training and support to the Ministry of Health, in order to incorporate the treatment or referral of malnutrition into their routine work.
• Inform and sensitise the population about malnutrition and its prevention and treatment at home and through the Day Care Centre and dry ration programme.

Recommendations from the MSF study in the Kolahun camps

• Review the need for reducing selective feeding programmes given the satisfactory nutritional status of the population in these camps.
• Continue screening of new arrivals, the distribution of a general ration, and the identification and referral of malnourished children. The surveillance of the population's nutritional status (through surveys) should also continue.
• Review the situation of the most vulnerable families (e.g.: those who cannot obtain income) as rations only cover 80% of food requirements.
• A sustainable water supply is required and should be considered by UNHCR.

RNIS 26, March 1999

Deterioration in the security situation of Sierra Leone has led to widespread displacement throughout the country. However as the access of humanitarian organisations to the affected areas is severely restricted, it is difficult to estimate the numbers of people involved and the extent of their deprivation. The situations in Guinea-Conakry, Cote d'Ivoire and Liberia are more stable, although recent events in Sierra Leone may alter this. The table below gives an estimate of the number of IDPs and refugees requiring humanitarian assistance in the region.

	Jun. 97	Sep. 97	Dec. 97	Mar. 98	Jun. 98	Mar. 99
Liberia	710,000	700,000	700,000	726,000	209,000	345,000
Sierra Leone	453,000	453,000	200,000	200,000*	300,000*	495,000*
Cote d'Ivoire	305,000	210,000	210,000	210,000	140,000	101,500
Guinea	545,000	405,000	405,000	405,000	614,000	470,000
Total	2,013,000	1,768,000	1,515,000	,541,000	1,263,000	1,411,500

* numbers requiring humanitarian assistance may be far higher than the current estimate.

Note that is possible that the number of people requiring assistance was underestimated for Liberia in June 98

5. Liberia

The Liberian civil war led to massive population displacements both within Liberia and into neighbouring countries. Since the elections in July 1997, when Charles Taylor was democratically elected President, security conditions have improved considerably, which has prompted increasing numbers of refugees and displaced people to return home (OCHA - 12/98).

As part of the national reconciliation process, UNHCR began a large-scale repatriation programme in late 1997. It is estimated that there were 480,000 Liberian refugees at the beginning of 1998, the majority of whom were living in Guinea or the Cote d'Ivoire. Over 100,000 Liberians had repatriated with UNHCR's assistance and a further 160,000 are estimated to have repatriated spontaneously. Of the approximately 221,000 Liberians who are still refugees a further 190,000 are expected to repatriate by the end of this year (100,000 with UNHCR's assistance). The remainder are expected to stay in their countries of asylum (UNHCR, 02/3/9; OCHA 12/98).

In December 1998, it was estimated that there were some 750,000 displaced people in Liberia, more than a third of whom were residing in shelters in Montesedarro, Bong, Margibi and Grand Bassa Counties (OCHA - 12/98). An inter-agency programme was set up in 1998 by the Liberian government - in collaboration with UN agencies, USAID and the EU - to help an estimated 187,000 IDPs return home from Monrovia. The IFRC has reported that the programme helped 95,207 IDPs resettle in their communities of origin in 1998. The IDPs are given relocation kits and assisted with transportation. Now in its third phase, the programme requires additional funding to help another 40,000 people from Monrovia return home (IRIN-WA 15/01/99).

A survey conducted amongst IDPs in the 'regular and irregular' displaced shelters in and around Monrovia in May 1998 recorded 16.3% wasting and 3.1% severe wasting (see Annex I(5a)). No Oedema was noted. The prevalence of wasting was marginally higher than results recorded in 1997 for both the February survey (14.5%) and the August survey (12.9%). The prevalence of severe wasting remained approximately the same as in August 1997. Coverage of the supplementary and therapeutic feeding programmes was extremely low. The measles immunisation coverage was also low at 39.7%. This survey is now 9 months old, and given that many of the IDPs are now leaving Monrovia, these results may not apply to the current situation.

The Liberian Food Security Forum continued to assess food security issues for returnees in various parts of the country in 1998 (see RNIS 23 and 24). An SCF-UK report on the returnees in Cape Mount County in June-July found that very few households could produce enough food to meet their needs; and many of the households interviewed used a high proportion of their expenditure to buy food (see Annex I(5b)). This was particularly true for recent returnees even in traditionally high production areas such as South Porka district. The "old" returnees had harvested rice before the study, but this alone did not account for the differences observed. In some cases the new returnees had missed the distribution of agricultural inputs such as tools and seeds. Old returnees had also managed to secure the most productive traps for bushmeat in some areas (SCF-UK - 08/98).

Sierra Leonean Refugees

There are some 95,000 Sierra Leonean refugees in Liberia (UNHCR - 02/03/99). Assessments of the health and nutritional status among refugees in Vahun and Kolahun camps were undertaken in June 1998 (see Annex I(5c-d)). Vahun camp, close to the border with Sierra Leone, is the first point of arrival for refugees. The June - October rainy season makes the access road to Vahun impassable for weeks at a time. In contrast, Kolahun camp is 70 km from the border and more accessible from Voinjama, the regional centre.

The prevalence of wasting in Vahun camp, was 21%, with 5% of the children surveyed severely wasted. Oedema was reported at 1%. Since February 1998, children at Vahun camp needing supplementary or therapeutic feeding were being transported to Kolahun on a daily basis when possible. These children were excluded from the results above and, if included, would reportedly give a prevalence of wasting of 28.9%. Crude mortality was 1.8/10,000/day, and under-five mortality was 6.1/10,000/day. Measles immunisation coverage was low at 28.3%.

In Kolahun camp the situation was slightly better: the prevalence of wasting in the survey was 7%, with severe wasting at 1.3% (although this does not include those children admitted to the feeding centres, which according to the report would push the overall prevalence to 28.6%). Oedema was reported at 0.8%. Crude mortality was 0.9/10,000/day and under-five mortality was 4.8/10,000/day. Measles immunisation coverage was at 37.9%.

The higher rates of malnutrition in Vahun were attributed to: the relatively poorer condition of recent arrivals from Sierra Leone, less regular food distributions in Vahun, and the presence of a therapeutic feeding centre in Kolahun. Note once again that it has been nine months since the survey and that the situation is likely to have changed.

An FAO assessment of the food and crop situation in Liberia indicated a significantly improved overall food situation for the country. The mission estimated that paddy production had increased 25% from 1997 and is about 70% of pre-civil strife levels. Cassava production is at 96% of pre-civil strife levels. The main factors which contributed to the increases in production include an expansion in the planted area as a result of the return of large numbers of families to their homes, increased yields due to greater access to NGO-supplied inputs (especially seeds and tools) and improved crop husbandry practices as more extension services become available. The mission estimates that Liberia will need to import 155,000 tonnes of cereals this year - of which 50,000 tonnes of which will be required as food aid (FAO - 26/01/99).

Overall, the most recent surveys of the IDPs in Liberia suggest that they are at moderate nutritional risk (category IIb). The Sierra-Leonean refugees are also thought to be in this category.

Recommendations and Priorities:

• To repatriate as many refugees as possible prior to the annual rainy season, which is from May to October.
• Basic services within Liberia e.g.: schools and health services, are poorer than those in the neighbouring countries of asylum so there is a need to improve facilities within Liberia to encourage refugees to return.
• Funds are required to support the programme helping IDPs return home from Monrovia.
• Agricultural inputs are required to help the returnees build up their food production capabilities.
• There is a need for further assessments of the nutritional situation of the returnees and resettled IDPs in order to facilitate targeting of assistance.

The Vahun and Kolahun survey recommendations include:-

• The transfer of refugees to Kolahun from Vahun
• The opening of supplementary and therapeutic feeding centres in Vahun
• Increasing the food ration to a minimum of 2,100kcal per person per day.

RNIS 25, October 1998

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

RNIS 24, June 1998

This regional refugee/IDP situation is the result of two separate conflicts in very different stages of resolution. In Liberia, the security situation appears mainly under control, and refugees and IDPs are returning home. In Sierra Leone, despite much of the western part of the country being calm, there continue to be reports of clashes in the eastern part of the country, leading to a huge influx of refugees into Guinea. These refugees consistently recount appalling stories of atrocities committed against the civilian population by the retreating rebels. Many of these refugees are arriving malnourished and in poor health after spending weeks in the bush before reaching the camps.

Location	Dec. 96	Mar. 97	Jun. 97	Sep. 97	Dec. 97	Mar. 98	Jun. 98
Liberia	1,800,000	1,100,000	710,000	700,000	700,000	726,000	209,000
Sierra Leone	609,000	548,000	453,000	453,000	200,000*	200,000*	300,000*
Cote d'Ivoire	305,000	305,000	305,000	210,000	210,000	210,000	140,000
Guinea	536,000	536,000	545,000	405,000	405,000	405,000	614,000
Total	3,250,000	2,489,000	2,013,000	1,768,000	1,515,000	1,541,000	1,263,000

* Numbers requiring humanitarian assistance may be far higher than the current estimate.

Liberia A civil war in Liberia began in 1989 with the overthrow of President Doe, leading to massive population displacements both within Liberia and into neighbouring countries, and leaving many areas of the country inaccessible. A series of peace accords and the establishment of a West African peace keeping force helped to stabilise the situation in Liberia. In July 1997, Charles Taylor was democratically elected President through what were determined to be free and fair elections. Since the elections, the security situation has improved and most of the country is accessible. Donors have agreed to resume a regular aid programme for Liberia after an almost ten year break due to the civil war. Initially, a two-year reconstruction programme is envisaged.

Some refugees as well as internally displaced people are returning home. Around 100,000 Liberian refugees have returned since the elections (30,000 assisted by UNHCR and 70,000 spontaneously) while a further 100,000 have registered with UNHCR to return. Food distributions are no longer carried out in the displaced shelters, rather rations are provided upon arrival in their communes. This is intended to encourage people to travel home. As of early May approximately 67,000 had benefited from food aid in this way. In addition, approximately 155,000 people receive aid in the form of food-for-work programmes, vulnerable group feeding and school feeding programmes [OCHA 15/05/98, WFP 08/05/98].

It is hoped that a series of food security assessments will provide an understanding of how communities, and groups within communities are coping and what types of survival strategies are indicative of abnormal or severe stress. This understanding would help in the identification of location-specific security indicators which could be monitored for early warning purposes. It would also allow for better targeting of resources. This type of monitoring and targeting will become more critical as emergency food aid is slowly phased out. In order to co-ordinate assessments in Liberia, a 'Food Security Forum' is being set up with WFP as the focal point. This forum will aim to develop common methodologies and share information among agencies (see Special Focus in RNIS 23 on 'Food Security in Liberia'). There is, in addition, a 'Joint Food Security Monitoring System'¹ to coordinate information, particularly from food security assessments, during and beyond this transition phase. This system works with the Food Security Forum in terms of partnership in the field for assessments and analysis of data collected [WFP 09/06/98].

¹ This is a system whereby three NGOs monitor the food security situation in 90% of the country. This is coordinated by WFP with institutional links to decision-making committees in Liberia such as the Seeds and Tools Committee and the Food Aid Committee.

An example of the types of food security assessments currently underway was one conducted in the Salayea and Zorzor districts in Lofa county. The assessment established that 80-90% of the family heads had returned spontaneously, with many children remaining in Guinea presumably to finish the school year. They were believed likely to return at the end of the term which coincides with the middle of the rainy season when the food situation may be precarious. The assessment also found that the majority were facing an equally uncertain rainy season. Very few people had produced enough crops to meet their needs [WFP/LWS/KDRO/CRS 30/03/98].

It was therefore determined that purchase and exchange of food was and will be the most important source of food. Selling palm oil might be an adequate source of income for male-headed households; however, this is likely to be inadequate for female-headed households. Women will most likely depend on labour-intensive, less profitable work like palm kernel collection and processing, which will have adverse short and medium-term effects such as:

· female-headed households will spend considerably more time than male-headed households acquiring sufficient food and seeds for the family;

· children, particularly girls, are likely to be taken out of school to help;

· time and energy spent to meet immediate needs means less is available to invest in agriculture, limiting their possibilities for next year.

The assessment concluded that female-headed households were particularly vulnerable to food insecurity and targeting of food aid needs to take this into account [WFP/LWS/KDRO/CRS 30/03/98].

Malnutrition in Upper Bong County, Liberia, over time

taken from: Nutritional Survey Upper Bong, Liberia, Action contre la Faim, April 1998

A nutritional survey carried out in Upper Bong County showed 9.1% wasting with 0.8% severe wasting. Oedema was measured at 0.4% (see Annex I (7a)). This is a slight improvement over a survey carried out at the same time last year. This is thought to be largely due to improved security allowing for better accessibility to food. Measles immunisation, as confirmed by a vaccination card was low at 55.6%, but is improving [ACF 16/04/98].

In Buchanan, Grand Bassa County, a recent survey confirmed a stable nutritional situation with 6.7% wasting and 1.2% severe wasting. Oedema was measured at 0.3% (see Annex I (7b)). Measles immunisation coverage is improving, but is still low at 46%, as confirmed by a vaccination card [ACF 19/02/98].

The return of refugees and internally displaced populations is somewhat slower than the international community had hoped. This is felt to be due in large measure to the poor state of the roads and bridges. In light of this, rehabilitation of roads and bridges along major routes is being undertaken. In addition, poor access to services such as education and health is also likely to be a factor in lower than expected rates of return. The services available in Liberia tend to be of a lower standard and higher cost when compared to those available in Guinea or Cote d'Ivoire [IRIN 03-09/04/98, WFP 03/04/98, WFP 08/06/98].

An upsurge in fighting in Sierra Leone (see below) has led to the influx of approximately 54,000 refugees to the Vahun region of Liberia. The last RNIS report described the food security situation in the region before this new influx. The main findings of that assessment were that:

• access to safe drinking water was a problem;
• people had good access to food through their own production or via contract labour for cash or through gifts;
• lack of money was a serious problem;
• roads were in poor condition but there was trade with Sierra Leone.

In March, a nutrition survey showed 9.9% wasting and/or oedema with 3.5% severe wasting and/or oedema among the refugees (see Annex I (7c)). Major areas of concern were water supplies and sanitation facilities. Wells and latrines are being constructed, and a mass measles immunisation campaign was carried out for the new arrivals [IRIN-WA 20-26/03/98, OCHA 15/05/98].

The onset of the rainy season is likely to render the population in Vahun inaccessible as road conditions deteriorate. Efforts are being made to encourage the refugees to move to a more easily accessible site near Kolahun. Meanwhile, assistance will continue in Vahun for as long as access remains feasible. Unfortunately, there is only a small airstrip in Vahun so airlifting food is not an option [OCHA 15/05/98].

Overall, refugees in Liberia from Sierra Leone are at moderate nutritional risk with a tendency toward deterioration as the rainy season makes access more difficult. The IDPs in Sierra Leone are at heightened nutritional risk (category IIa in Table 1) due to insecurity. Initial survey results point to a less severe situation than was feared, but many areas remain unassessed. In Guinea, the Sierra Leonean refugees are at heightened risk (category IIa in Table 1). New refugees are arriving in bad condition, and the influx is stretching facilities for others. Liberian refugees in Guinea and Cote d'Ivoire are probably not at heightened nutritional risk (category IIc in Table 1).

On-going interventions In Liberia, funding for repatriation is needed; only about 10% of funding requested has been received to date. Rehabilitation of roads, health centres and schools already underway must continue. On-going measles immunisation campaigns also need continued support. As emergency food aid is phased out, great care needs to be taken to ensure that the process is gradual and that any evidence of nutritional decline as support is removed, is identified quickly. This requires careful monitoring. More specifically, in Vahun, efforts must continue to strengthen measles immunisation and to provide water and sanitation.

There is concern over a potential break in the food aid pipeline for Sierra Leone in June/July. Indeed some NGOs are running out of food and WFP is focusing on vulnerable group feeding and food-for-agriculture projects. Donors need to respond generously and as a matter of priority to appeals for this emergency. Measles immunisation and water chlorination continue as far as security allows. Food should be prepositioned for potential deliveries where possible and consideration must be given to ways of improving food deliveries in areas of conflict. This might entail strengthening security forces, and/or providing external transport fleets as the private sector is reluctant to risk their vehicles. Measles immunisation coverage needs to be improved in Waterloo and Clay Factory camps for the displaced. High levels of wasting in Rose Road and OIC camps need to be investigated and feeding programmes implemented as necessary.

RNIS 23, March 1998

There are at least 1.5 million people requiring humanitarian assistance in the region. In Sierra Leone, the humanitarian situation deteriorated significantly with the escalation of fighting in the early months of 1998. At present, the situation appears to be stabilising and the democratically elected president has returned to Freetown. However, skirmishes continue to be reported outside the capital and at the time of writing the magnitude of the crisis and the number of people requiring assistance remain uncertain.

Population estimates for refugee and IDP populations over time are summarised in the table below:

Location	Sep. 96	Dec. 96	Mar. 97	Jun. 97	Sep. 97	Dec. 97	Mar. 98
Liberia	1,800,000	1,800,000	1,100,000	710,000	700,000	700,000	726,000
Sierra Leone	609,000	609,000	548,000	453,000	453,000	200,000*	200,000*
Cote d'Ivoire	305,000	305,000	305,000	305,000	210,000	210,000	210,000
Guinea	536,000	536,000	536,000	545,000	405,000	405,000	405,000
Total	3,250,000	3,250,000	2,489,000	2,013,000	1,768,000	1,515,000	1,541,000

* Numbers requiring humanitarian assistance may be far higher than the current estimate.

In Liberia, the focus of activities is shifting from emergency aid to development assistance. However, it is recognised that a retention of emergency capacity in country is important as the peace process is somewhat fragile. General food distributions in displaced shelters have been discontinued, and it is assumed that many of the 700,000 IDPs will now return home. Some repatriation is taking place, but since much of it is spontaneous, exact numbers are difficult to determine. Estimates are that more than 70,000 people have returned from Cote d'Ivoire and Guinea over the last few months. There are reports that 60,000 people are ready to return from Guinea [IRIN-WA 13/03/98, 14-16/03/98].

Approximately 26,000 Sierra Leonean refugees arrived in Liberia, fleeing insecurity in the country. It appears that the improved security situation in Sierra Leone is not yet encouraging these refugees to return [IRIN-WA 18/03/98].

Further details on the situation in Liberia can be found in the middle section of this report: 'Food Security in Liberia'.

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

Ongoing interventions Funding support for the programmes to repatriate Liberian refugees is needed. The food security assessments in Liberia should continue in order to inform appropriate preparations for the anticipated large-scale repatriation of refugees. In Vahun, which has recently received a large influx of Sierra Leonean refugees, water supplies need to be urgently improved.

RNIS 22, December 1997

After almost twenty years of civil war, the peace process in Liberia seems firmly in place. Almost all areas in the country are now accessible. Internally displaced people are beginning to return home and repatriation is scheduled to begin before the end of 1997. In Sierra Leone, there is guarded optimism since the signing of a peace accord to end the fighting which has been ongoing since a coup d'etat in May 1997. Somewhat increased access to populations in conjunction with the recent harvest is likely to be having a positive effect on the nutritional situation of the population.

Population estimates for refugee and IDP populations over time are summarised in the box below:

Location	Jun. 96	Sep. 96	Dec. 96	Mar. 97	Jun. 97	Sep. 97	Dec. 97
Liberia	1,800,000	1,800,000	1,800,000	1,100,000	710,000	700,000	700,000
Sierra Leone	756,000	609,000	609,000	548,000	453,000	453,000	200,000*
Cote d'Ivoire	305,000	305,000	305,000	305,000	305,000	210,000	210,000
Guinea	536,000	536,000	536,000	536,000	545,000	405,000	405,000
Total	3,397,000	3,250,000	3,250,000	2,489,000	2,013,000	1,768,000	1,515,000

* Numbers requiring humanitarian assistance may be far higher than the current estimate.

Liberia A civil war in Liberia, which began in 1989 with the overthrow of the President, came to an end with the signing of a peace accord and the subsequent election of Charles Taylor as president. It is estimated that at least 700,000 people require humanitarian assistance in Liberia, and there are approximately 480,000 refugees in neighbouring countries. Much of Liberia was inaccessible to humanitarian aid during the war due to insecurity. It is now reported that most of country is accessible, and preparations are underway for the repatriation of refugees in countries of refuge such as Guinea and Cote d'Ivoire.

The stable security situation has allowed for improved food security in many areas. Populations are able to obtain more food for themselves, and humanitarian aid can be delivered. This is resulting in an improvement in the nutritional status in many areas. For example, a survey carried out in Upper Bong county in September showed 6.7% wasting with 0.4% severe wasting. Oedema was measured at 1.9% (see Annex I (9a)). Survey results overtime are shown in the graph below. Measles coverage, confirmed by a vaccination card, was 45.5%. Coverage not confirmed by a card (i.e. mother's recollection) was 20.1%. While these coverages are still low, they do show an improving trend. However, food security is still poor in some areas. For example, a recent report indicated that farmers in Nimba country were borrowing food and that there were few food commodities on the market [WFP 03/10/97, ACF 12/09/97].

Malnutrition in Upper Bong County, Liberia overtime

Organised repatriation is scheduled to begin before the end of 1997 for the approximately 480,000 Liberian refugees in neighbouring countries. It is estimated that to date about 120,000 refugees have spontaneously returned - mainly from Cote d'Ivoire and Guinea. The repatriation process is scheduled to be completed by the end of 1998. Internally displaced people are also reportedly returning home. For example, a recent verification exercise in the shelters for displaced people in Monrovia showed a decrease of 16,000 people. A number of quick impact projects to rehabilitate roads, schools and clinics have been carried out as part of re-integration activities for returnees [UNHCR Oct. 97, WFP 03/10/97].

The twenty year war has left the country's infrastructure in total ruins, and schools, roads and health centres will need to be rebuilt. Areas of the country which are still inaccessible remain so due to a lack of roads. Some of the necessary reconstruction work is underway and is being implemented as food-for-work projects [DHA 30/09/97, 29/10/97].

Overall, the affected population in Sierra Leone can be considered to be at heightened risk due to continuing insecurity and reduced humanitarian relief receipt (category IIa in Table 1). The rest of the population affected regionally is probably not at heightened nutritional risk (category IIc in Table 1).

Ongoing interventions: As repatriation to Liberia begins, the need to rehabilitate the country's infrastructure intensifies, i.e. schools, roads, water and sanitation and health services. Nutritional surveillance systems need to be established in country as agencies begin to consider withdrawing. More specifically, in Upper Bong County measles immunisation coverage needs to be improved and the efficacy of the present vaccination system should probably be re-assessed. Efforts to collect information on food security in the area should also be intensified.

RNIS 21, September 1997

The security situation in Sierra Leone after a coup d'etat in May 1997 remains fluid. Displacement in Sierra Leone is widespread, and agricultural activities have been disrupted. Food is becoming scarcer and there are reports of increasing malnutrition. In contrast, the security situation in Liberia is stable and almost all areas of the country are now accessible. There are also greater opportunities for people to diversify their food sources and levels of malnutrition are falling. Repatriation of refugees back to Liberia is planned to begin in the near future.

Population estimates for refugees and IDPs over time are summarised in the box below:

Location	Apr 96	Jun 96	Sep 96	Dec 96	Mar 97	Jun 97	Sep 97
Liberia	1,800,000	1,800,000	1,800,000	1,800,000	1,100,000	710,000	700,000
Sierra Leone	756,000	756,000	609,000	609,000	548,000	453,000	453,000
Cote d'Ivoire	305,000	305,000	305,000	305,000	305,000	305,000	210,000
Guinea	536,000	536,000	536,000	536,000	536,000	545,000	401,000
Total	3,397,000	3,397,000	3,250,000	3,250,000	2,489,000	2,013,000	1,764,000

Liberia Civil war had been ongoing in Liberia since the ousting of President Doe in 1989. A series of peace accords and the creation and implementation of a West African peacekeeping force helped to re-establish peace in Liberia and on 19 July 1997 Charles Taylor was elected president in what was decreed to be free and fair elections. The United nations Observer Mission in Liberia (UNOMIL) will conclude its mission at the end of September, and a UN office will be set up to assist with national reconstruction and development [IRIN-WA 18/07/97, USAID 14/08/97, WFP 25/07/97].

Relief organisations verify caseloads in all displaced shelters prior to monthly food distributions. Recent verifications have shown that many IDPs have spontaneously returned home because demobilisation has resulted in increased security in their home areas. The current situation is encouraging some refugees, particularly in Guinea, to return home. It is currently estimated that 700,000 people in Liberia require assistance. In addition, there are at least 3,500 refugees from Sierra Leone who have fled the recent upsurge in fighting and arrived in Liberia [JRS 15/09/97, UNDPI 16/09/97, WFP 25/07/97].

The improved security situation in the country is allowing for better access to populations and also providing greater opportunities for people to diversify their food sources. These factors are apparently leading to an improved nutritional status among many population groups.

For example, a survey was carried out in April 1997 in Tubmanburg to follow-up on a survey in October 1996. The October survey showed 38% wasting and/or oedema. Since that time, general ration distributions, selective feeding programmes and public kitchens have been in operation and have undoubtedly contributed to an improvement in nutritional status. The survey in April 1997 showed wasting levels of 4.0% with 0.8% severe wasting (see Annex I (9d)). Oedema was measured at 0.1%. Measles immunisation coverage, confirmed by a vaccination card was 41.1%. Immunisation coverage confirmed by card or mother's recollection without a card was 90%. Recommendations for future interventions based on this dramatically improved nutritional status were to conduct a food security assessment to determine access to food, and improve the measles immunisation coverage [ACF 11/04/97].

In Buchanan, Grand Bassa County (estimated population 97,200), a recent survey showed an improved nutritional status among the displaced and resident populations. The survey, carried out in July 1997, showed 6.6% wasting with 0.3% severe wasting. Oedema was measured at 0.3% (see Annex I (9e)). This compares very favourably with a survey carried out in August 1996 when wasting and/or oedema was measured at 47.6%. This improved situation is attributed to a number of factors including improved security in the area allowing for better access to the population and giving the population greater opportunity to diversify their food sources. General ration and selective feeding programmes have been operational for many months. However, measles immunisation coverage was low at 41.1% [ACF 25/07/97].

Monrovia was the scene of intensive fighting in April 1996, leading to large scale displacement and rendering thousands dependent on international aid. Levels of wasting were high, but showed a decreasing trend over time (see graph on left). The most recent survey showed 10.3% wasting with 1.2% severe wasting in the community. Oedema was measured at 0.1% (see Annex I (9f)). The increase in wasting in the communities since the last survey may be due to the start of the wet season when access to food is reduced. Measles immunisation coverage, as confirmed by a card, was 37.6%. In the displaced shelters, wasting was measured at 11.9% with 1.8% severe wasting Oedema was 1.0% (see Annex I (9g)). This only shows a slight improvement since the previous survey. The allocation of a general ration in the shelters may however have prevented the seasonal decline in nutritional status witnessed in the community. The number of children eligible to attend selective feeding programmes can be determined using the prevalence of wasting. When this number is compared with the number actually attending, it appears that the feeding programme is not covering all vulnerable children. Measles immunisation coverage was 32.7%. One of the recommendations of the survey teams was to conduct a food economy assessment to design more appropriate interventions for the population aimed at aiding their return home [ACF 25/08/97].

The overall situation in the country is improving as access to populations is increasing. A problem, which has been identified in previous RNIS reports, is continuing low levels of measles immunisation coverage.

Overall,  the affected population in Liberia are probably not a heightened risk (category lie in Table 1) although low levels of measles immunisation are cause for some concern.

Ongoing interventions: The security situation has improved in Liberia to the point where organised repatriation plans are underway. Appeals for funds for the repatriation of Liberian refugees, along with projects aimed to re-build the infrastructure in Liberia, will need generous and rapid responses from the donor community. Although food security in Liberia is steadily improving, the existence of vulnerable groups indicates a need to better understand the nature of food insecurity throughout the country. Inadequate measles immunisation coverage remains a problem country-wide.

More specifically, in Buchanan another measles immunisation campaign is required and the nutrition and food security situation needs to be closely monitored. In Monrovia, it is necessary to continue treating cases of malnutrition at feeding centres and to improve the outreach of this programme as coverage is low. It is also important to conduct a food security assessment to investigate the reasons for the differences in nutritional status between the community population and the shelter populations. Measles immunisation programmes must also continue.

RNIS 20, June 1997

Despite a number of security incidents, the overall situation in Liberia is improving with signs of continuing stability. Although delayed, the electoral process is moving ahead in Liberia. A recent coup d'etat in Sierra Leone has meant humanitarian activities have been put on hold, however prior to the coup, people were returning home, either from within the country or from neighbouring countries. There are approximately 2 million people affected regionally.

Trend in numbers of refugees/displaced and proportion severely malnourished and at high risk (shaded area).

Current estimates of the numbers of people affected in the region are summarised below:

Location	Feb 96	Apr 96	Jun 96	Sep 96	Dec 96	Mar 97	Jun 97
Liberia	1,800,000	1,800,000	1,800,000	1,800,000	1,800,000	1,100,000	710,000
Sierra Leone	730,000	756,000	756,000	609,000	609,000	548,000	453,000
Cote d'Ivoire	305,000	305,000	305,000	305,000	305,000	305,000	305,000
Guinea	605,000	536,000	536,000	536,000	536,000	536,000	545,000
TOTAL	3,440,000	3,397,000	3,397,000	3,250,000	3,250,000	2,489,000	2,013,000

Liberia The security situation in Liberia is improving and the disarmament process is now completed. These two factors are giving rise to optimism and small numbers of refugees and IDPs are returning home. Elections, which were scheduled for the 30th of May, have been postponed until July 1997. It is not currently felt that this alone will encourage large numbers of people to return. An estimated 710,000 people in Liberia presently require emergency food assistance. Most areas of the country are now accessible. In fact Grand Kru County remains the last inaccessible area in Liberia. WFP are continuing to support the peace process by providing food for work and support to demobilised child soldiers [DHA 01/05/97, RPG Mar 97, WFP 10/02/97].

Assessments are taking place throughout the country and find widely different circumstances. For example, the findings of an assessment in Sinoe, Grand Gedeh and Maryland Counties were that the population appeared fairly well-nourished although there were signs of widespread poverty. All the pre-war hand pump wells were either non-functional or had been looted by fighters so that the population was dependent on shallow open wells and streams, increasing the risk of diarrhoeal diseases. Farming, fishing, hunting and petty trading were the main economic activities in the region and there were reports of refugees returning from Cote d'Ivoire. However, many were homeless, their villages and towns having been completely destroyed during the war. These returnees urgently needed a resettlement package. In contrast, an assessment in Nimba county found signs of a fairly rapid economic recovery in the northern and central areas. There was considerable small-scale economic activity. In rural areas there was less economic activity due to the lack of transport infrastructure [DHA 01/05/97].

Nutritional surveys throughout the country generally show an improvement compared to previous surveys, largely due to improved security, general ration distributions, selective feeding programmes, and harvests. However, as the rainy season approaches some decline in nutritional status can be expected. Many areas of the country are also now being visited to assess the health infrastructure in order to determine rehabilitation needs.

A survey was conducted in Monrovia in February 1997 as a follow up to a survey conducted in July 1996. The February survey showed 6.1 % wasting with 0.9% severe wasting among the community (estimated population 954,000). Oedema was measured at 0.1%. Measles immunisation coverage confirmed by possession of a vaccination card was 35.1%. Among the displaced (estimated population 254,000), wasting was measured at 13.2% with 0.9% severe wasting. Oedema was measured at 1.3%. Measles immunisation, confirmed by possession of a vaccination card was 38.6% (see Annex I (9a,b)) [ACF Feb. 97].

These survey results show a dramatic improvement over those seen in the July survey when wasting and/or oedema was measured at 15.3% in the community, and 24.7% in the displaced shelters. This is likely to be due to a number of factors including a general improvement in the security situation in Monrovia and an increased availability of food in the November-April period due to the harvest. Other factors contributing to the improvement may have been the intensive feeding programme in the capital and the general ration distributions carried out in the shelters. However, malnutrition rates are still high among the displaced population, and information on the food security situation of these people may help indicate the best way to ensure continued nutritional improvement [ACF Feb. 97].

A recent survey in Gabrnga, Bong County (estimated population included in the survey: 166,570), showed 9.1% wasting with 1.0% severe wasting. Oedema was measured at 1.2% (see Annex I (9c)). These results compare favourably with a survey conducted in August 1996 when wasting and/or oedema was measured at 26.8%. This improvement is felt to be due to an improved security situation, improved availability of food from a harvest and the food distributions in the area. As the rainy season begins and in the three months leading up to the harvest an increase in prevalence of wasting can be expected. Measles immunisation coverage, as confirmed by possession of a vaccination card, was 37.6% while coverage of supplementary and therapeutic feeding centres was only 22% and 21% respectively [ACF 05/03/97].

An earlier survey in Buchanan, Grand Bassa County (estimated population in the town 50,000) showed 14.2% wasting with 0.4% severe wasting. Oedema was measured at 0.1%. Measles immunisation coverage confirmed by possession of a vaccination card, was 45.3%. Among the population in the shelters (estimated at 13,000), wasting was measured at 6.1% with 0.3% severe wasting. Oedema was measured at 0.1%. Measles immunisation coverage, confirmed by possession of a vaccination card, was 52.4%. These results show an improvement from a survey conducted in July 1996, when wasting and/or oedema among the entire population was measured at 47.6% (see Annex (9d,e)). Possible factors contributing to this improvement include the on-going feeding programme, a harvest, and the resumption of fishing activities. It should be noted that food distributions in the shelters were designed on the assumption that there were nine in a family while among the community, the family size was assumed to be four, resulting in higher food receipts among the populations in shelters [ACF 13/12/96].

The common needs in the country side are for safe water, basic health care including immunisation, and seeds and tools. In addition, in many areas the repair of roads and bridges is a priority since these are currently inadequate and hamper the movement of people and goods [DHA 02/04/97, 16/04/97, 23/04/97, 01/05/97].

Overall, those affected regionally are not currently thought to be at heightened nutritional risk regionally (category IIc in Table 1) with the exception of the displaced in Monrovia and of those in Sierra Leone. These internally displaced people are likely to be at least at moderate nutritional risk due to the recent evacuation of some agencies.

How could external agencies help? In Liberia, road and bridge repair will be important to allow for the transport of people and goods. Once road conditions allow for unhindered movement, other priorities will be reestablishing the health care system, provision of clean water, seeds and tools.

As we are entering the traditional "lean season" in Liberia people have little or no food reserves and a deterioration in nutritional status is likely. In Monrovia, continuing efforts should be made to improve measles immunisation coverage. The high rates of wasting in the displacement shelters also need to be investigated. If necessary, rations to this population may need to be increased. Feeding centre coverage should also be improved by strengthening the outreach system. In Gabrnga, Bong County coverage of the dry ration distribution targeting the most vulnerable should be improved and it would be helpful to find out more about the present food security situation and reasons for low attendance at feeding centres. In Buchanan, measles immunisation coverage needs to be improved.

Support for these initiatives once the current crisis is resolved will be essential to ensure a lasting peace and to help the population move towards self-sufficiency.

RNIS 19, March 1997

Continuing peace in Liberia is allowing the return of many internally displaced people and some refugees to their villages. It is also allowing access by humanitarian agencies to previously inaccessible areas and the implementation of emergency interventions where need dictates. The peace process also appears to be progressing in Sierra Leone with a relatively stable security situation allowing improved access to needy populations leading to marked improvements in their nutritional situation. If peace holds, it is expected that large numbers of IDPs and refugees will return home during 1997 and aid programmes are already beginning to shift their focus from emergency relief to resettlement and rehabilitation programmes.

Liberia/Sierra Leone

Trend in numbers of refugees/displaced and proportion severely malnourished and at high risk (shaded area).

Current estimates of the numbers of people affected in the region are summarised below:

Location	Dec 95	Feb 96	Apr 96	Jun 96	Sep 96	Dec 96	Mar 97
Liberia	1,900,000	1,800,000	1,800,000	1,800,000	1,800,000	1,800,000	1,100,000
Sierra Leone	730,000	730,000	756,000	756,000	609,000	609,000	548,000
Cote d'Ivoire	305,000	305,000	305,000	305,000	305,000	305,000	305,000
Guinea	605,000	605,000	536,000	536,000	536,000	536,000	536,000
TOTAL	3,540,000	3,440,000	3,397,000	3,397,000	3,250,000	3,250,000	2,489,000

Liberia There are positive indications that the existing peace in Liberia may continue to hold. Demobilisation is progressing, despite continued insecurity in some parts of the country which were reportedly hindering the process. Over 80% of fighters are believed to have disarmed and demobilised. Elections are scheduled for May 1997 and it was agreed that Liberian refugees should register and vote in Liberia. Demobilisation has prompted the spontaneous return of internally displaced persons from the Monrovia shelters to their villages in parts of Bomi, Cape Mount, Bong and Margibi counties. An inter-agency assessment mission to Lofa County confirmed reports of increasing numbers of returnees from Guinea to towns in Foya and Zorzor districts that had been destroyed by war and abandoned for several years [FAO 03/01/97, UN 20/02/97, WFP 24/01/97, 07/02/97, 28/02/97].

Food aid will be needed for approximately 1.1 million people in Liberia in 1997. Much of this food aid will be utilised to assist returning refugees, and IDPs. Despite hostilities during 1996, the rice crop was substantially greater than in 1995, due largely to improved security in the two main producing areas of Liberia. This enabled various NGOs to distribute seed and tools to farmers. Rice production overall was estimated to be 30% of pre-war production levels [FAO 03/01/97].

As the security situation improves, areas that were previously cut-off have become accessible to humanitarian organisations. For example, Zwedru had been cut of for at least eight months but recently became accessible to outside agencies. Following a rapid assessment, it became apparent that the resident population had little food, there was no market activity, water supplies were unsafe and there were no health clinics. The population is forced to forage in the bush for wild foods. There is a clear need for assistance to this population, although the overwhelming presence of LPC (Liberia Peace Council, a rebel group) fighters who are in control of the town make the delivery of such assistance problematic [DHA 15/01/97, WV 16/01/97].

There are no new nutritional survey results available but there are reports of a high incidence of malnutrition in Maryland country and cases of cholera were also reported [DHA 05/02/97].

Overall, those in Liberia, along with internally displaced in Segbwema and Freetown in Sierra Leone can be considered to be at moderate nutritional risk (category IIb in Table 1), as are the children newly emerged from the forest. The remaining affected population in the region is not currently thought to be at heightened nutritional risk (category IIc in Table 1).

How could external agencies help? There is an on-going need in Liberia to reactivate health centres and rebuild bridges to enhance the movement of relief and rehabilitation material throughout the country. The need for expanding the immunisation programmes is beginning to be addressed as security permits. Specific needs have been identified in Rivercess country. These include improving the drug supply, dispatch of a tuberculosis health team, improving immunisation coverage and improvements in the water supply and sanitation facilities.

RNIS 18, December 1996

A fragile peace process in Liberia is holding although there have been some cease-fire violations. It is hoped that as the peace process advances with disarmament and demobilisation continuing, confidence will grow to a point where repatriation of refugees is possible. As hitherto insecure areas become accessible to humanitarian agencies, extremely high levels of wasting and mortality are being discovered. However, these situations appear to respond well to rapid emergency interventions. In Sierra Leone, there is a growing sense that despite some insecurity in the countryside and a continued need for targeted emergency relief, there is now scope to commence more developmentally oriented projects.

Trend in numbers of refugees/displaced and proportion severely malnourished and at high risk (shaded area).

Current estimates of the numbers of people affected in the region are summarised below:

Location	Oct 95	Dec 95	Feb 96	Apr 96	Jun 96	Sep 96	Dec 96
Liberia	1,900,000	1,900,000	1,800,000	1,800,000	1,800,000	1,800,000	1,800,000
Sierra Leone	730,000	730,000	730,000	756,000	756,000	609,000	609,000
Cote d’Ivoire	305,000	305,000	305,000	305,000	305,000	305,000	305,000
Guinea	536,000	605,000	605,000	536,000	536,000	536,000	536,000
TOTAL	3,471,000	3,540,000	3,440,000	3,397,000	3,397,000	3,250,000	3,250,000

Liberia The peace process in Liberia is considered very fragile, and sporadic cease-fire violations continue to be reported throughout the country. For example, recent fighting in the Cape Mount region has led to the displacement of 3,000 people. Food distributions for this newly displaced population have been planned as security permits. There have also been security incidents involving humanitarian agencies in Monrovia and surrounding areas which have led to postponements in food distribution activities [WFP 08/11/96].

Implementation of the peace process in on-going. The disarmament programme began on schedule in November and is progressing slowly. Repatriation has not yet begun although it is hoped that as the peace process advances, refugees will be encouraged to return home [DHA 10/10/96, WFP 11/10/96, 06/12/96, UNHCR 19/11/96, USAID 30/09/96].

There are at least 1.8 million people affected by the war and its aftermath. Many areas of the country have been inaccessible for long periods of time and catastrophic nutrition and health situations are being discovered as these areas become accessible. For example, a recent joint assessment mission visited Bo-Waterside in Grand Cape Mount, where the population is estimated at 2,000, half of whom are thought to be Sierra Leonean refugees. A nutrition screening in the area showed 28% wasting with 11% severe wasting. Oedema was measured at 13% (see Annex I (9a)). Many people reported having access to arable land, but that much of the harvest had been taken by factional fighters. Refugees appeared to have less access to land than the local population. Some limited market activity was noted, but households seemed to depend heavily on foraged foods and would spend many days in the bush searching for wild foods. Households identified security and freedom of movement, food (but not without security from ECOMOG), medicines/health care, seeds and tools, as priorities for intervention. Individuals spoke of high levels of abuse by factional fighters, confiscation of food supplies and extortionate transport charges for moving products to market. Villagers in the area were adamant that no relief supplies should be delivered without the provision of security by ECOMOG forces. An outbreak of cholera in the area seemed to be subsiding although there were frequent reports of lack of drugs and medical supplies in health centres. Cholera cases have also been reported in Montserrado and Bomi County [DHA 10/10/96, 01/11/96].

Tubmanburg (estimated population 22,000) in Bomi County became accessible in September 1996, after being cut off from humanitarian aid for many months. In response to obvious need, food distributions were started immediately while severely malnourished people were transported to Monrovia and targeted feeding programmes implemented by the end of the month.

A rapid health assessment was carried out in October which measured wasting and/or oedema at 38% with 32% severe wasting and/or oedema (see Annex I (9b)). Mortality rates were equally horrifying. In August 1996 the crude mortality rate was 18.5/10,000/day (40x normal) with an under-five mortality rate of 51.2/10,000/day (around 50x normal). In the first ten days of October, the CMR was 5.4/10,000/day (approximately 10x normal) and the under-five mortality rate was 11.8 (roughly 10x normal) [EPICENTRE Oct 96].

Although much reduced, the mortality rates in mid-October were still ten times normal and triggered a number of recommendations from the assessment team. These included the continued implementation of a general food distribution and supplementary feeding programmes, the implementation of a medical care programme, mortality surveillance and a follow up anthropometric survey in the coming weeks. The assessment team recognised that an important factor in the relative improvement in health and nutrition of this population, in addition to the provision of food aid, may have been the reduced harassment by factional fighters who still control the “bush”. These fighters have benefited from the re-opening of roads, the assistance programmes, looting of food distributions, presence of their families in nutritional programmes and improved trading links with Monrovia [EPICENTRE Oct 96].

Data from ‘Demographic and Nutrition Assessment Tubmanburg, Bomi County, Libera’ Medecins sans Frontieres, EPICENTRE. October 1996.

Overall, the populations of Tubmanburg, Bo Waterside and the internally displaced population around Bo, Sierra Leone are at high risk (category I in Table 1) due to sharply elevated levels of wasting and mortality. The population outside of Monrovia in Liberia can be considered to be at moderate risk, while the remainder of the population affected regionally is probably not currently at heightened nutritional risk (category IIc in Table 1).

Haw can external agencies help? In Liberia, as new areas become accessible extremely high rates of wasting and mortality are being found. The international community has shown in Tubmanburg that if access is possible, these situations can be quickly brought under control. Efforts to rapidly assist newly accessible populations must continue to be supported. These interventions will most likely be comprised of general food distributions, targeted feeding, immunisation programmes and health service provision along with the provision of seeds and tools.

However, it is vital that allocation of food is only under-taken where ECOMOG forces can guarantee some level of protection for beneficiaries or lives may be put at risk. The efficiency of interventions therefore rely on political decisions regarding the creation of protection zones where access is allowed. ECOMOG may need further encouragement and support to act as an interposition force in some areas.

RNIS 17, September 1996

Famine situations are being uncovered in many areas of Liberia which are now accessible due the most recent cease-fire. The peace, however, is described as fragile. The cease-fire in Sierra Leone is also holding and the overall situation is said to be improving as humanitarian agencies gain increasing access to affected populations. It is planned to phase out general ration distribution in Guinea and Cote d’Ivoire by the end of 1996, although targeted feeding for vulnerable refugee groups will continue.

Current estimates of the numbers of people affected in the region are summarised below:

Trend in numbers of refugees/displaced and proportion severely malnourished and at high risk (shaded area).

Location	Jul 95	Oct 95	Dec 95	Feb 96	Apr 96	Jun 96	Sep 96
Liberia	1,900,000	1,900,000	1,900,000	1,800,000	1,800,000	1,800,000	1,800,000
Sierra Leone	730,000	730,000	730,000	730,000	756,000	756,000	609,000
Cote d’Ivoire	227,000	305,000	305,000	305,000	305,000	305,000	305,000
Guinea	578,000	536,000	605,000	605,000	536,000	536,000	536,000
TOTAL	3,435,000	3,471,000	3,540,000	3,440,000	3,397,000	3,397,000	3,250,000

Liberia A cease-fire was successfully brokered in Liberia following the eruption of hostilities in Monrovia in April 1996. However, reports indicate the continuation of small-scale hostilities in some counties so that the security situation is generally described as stable, though fragile. A series of meetings in Abuja have led to a number of statements and resolutions concerning the dismantling of checkpoints, the commencement of physical disarmament of fighters, the resumption of ECOMOG deployment through the country and unhindered movement of humanitarian personnel and supplies. Elections have been set for May 1977 [DHA 07/08/96, 21/08/96, UNHCR 10/09/96].

The cease-fire has allowed access to many areas which had been cut-off from humanitarian assistance for several months, and in some cases, years. For example, the road from Monrovia to Vahun is now considered secure and clear for humanitarian agency travel. There has also been an assessment in Suehn and Fefeh towns (Bomi County) in early August. Most of this population have been displaced by earlier fighting in Tubmanburg and other areas of Bomi and Grand Cape Mount Counties and had been surviving on foraged foods which reportedly lacked protein. Another assessment in Buchanan and the Liberian Agricultural Company Compound found an internally displaced population of over 30,000 who reported abuses by different factional groups which had prevented attempts at agricultural production [DHA 07/08/96, 14/08/96, 21/08/96],

The problems in newly accessible areas appear to be similar in that there are alarmingly high levels of wasting and low levels of measles immunization. For example, a survey carried out in Gbanga, Bong county (estimated population 134,600) measured wasting at 23.7%, with 6.6% severe wasting. Oedema was measured at 3.1% (see Annex 19(a)). This represents a dramatic decline in the nutritional status of the population since the previous survey in February 1996 which showed a prevalence of 6.1% wasting and/or oedema. Survey respondents indicated that they had no food stocks and relied on a daily search for food involving both foraging in the bush and market purchases. The majority of families were only eating one meal a day comprised mainly of cassava or yam roots. Measles immunization coverage was only 25% [ACF 15/08/96].

Although Buchanan area was not directly affected by the violence in Monrovia in April and May 1996 (see below for details), some feeding programmes were suspended for a seven week period. A survey conducted after the resumption of activities showed a catastrophic situation with wasting measured at 47%. Severe wasting was measured at 4.9% and oedema at 0.6% (see Annex I 9(b)). This survey shows a dramatic deterioration in the situation when compared to a survey conducted in February 1996. At that time, wasting was measured at 4.7%. Some possible explanations could be a lack of availability of food either due to the ‘lean season’ or low ration distributions of 160-200 kcals/person/day, and poor public health conditions. Measles immunisation coverage was 26.3%, and an increasing number of cases of measles was being reported in June and July, indicating a possible epidemic [ACF 03/08/96].

An assessment in Tubmanburg, which had been cut-off from humanitarian aid since early 1996 showed a catastrophic situation. Signs of malnutrition are reportedly seen in vulnerable populations gathered in two separate centres. Food distribution is now underway, although roads conditions, particularly the unstable condition of one bridge, are slowing down progress [IFRC 07/09/96. WFP 13/09/96].

Another assessment was carried out in Bong Mines where recommendations made by the team included an urgent need for medical supplies, a general ration and school feeding programme, provision of chlorine tablets and supply of agricultural inputs [DHA 14/08/96].

The security situation in Monrovia is now stable following the fighting that displaced thousands of people in April and May. However, many houses have been destroyed and humanitarian aid resources, particularly nonfood items, have been looted, leaving many is a desperate situation [UNHCR 10/09/96].

A recent nutritional survey in the capital revealed an alarming situation. Amongst the displaced population (estimated at 285,000) wasting was 21.2% with 3.6% severe wasting (see Annex 19(c)). Oedema was measured at 3.6% and measles immunization coverage amongst this group was 54%. Amongst the resident population (estimated at 954,000 before the fighting in April 1996) wasting was measured at 13.3% with 2.2% severe wasting (see Annex 19(d)). Oedema was measured at 1.9% and measles immunization coverage was 69%. Although not strictly comparable, these results compare extremely unfavourably with a nutritional survey conducted in December 1995 when levels of wasting of only 9.6% with 1.7% severe wasting were recorded. The survey team recommended strengthening targeted feeding by opening up new feeding centres, increasing immunization coverage, gathering data on household food security and a follow-up survey in November 1996 [ACF/MOH/UNICEF/UMCOR/WHO Jul 96].

An outbreak of cholera was reported in Monrovia and its environs with an estimated 3,300 cases in June and July. Medical and surveillance measures have been taken and the situation is now under control. However, as the rains normally commence in September and October, it is recognized that great care will be needed to ensure that the situation does not escalate out of control [DHA 07/08/96, 14/08/96, 21/08/96].

A nutritional survey was carried out in Macenta Prefecture in July 1996, where many Liberian refugees are residing, in response to a noted increase in the number of children admitted to feeding centres. The survey showed 4.8% wasting and/or oedema with 0.3% severe wasting and/or oedema (see Annex 19(g)). This is comparable to a survey in November 1995 which found a 6.2% prevalence of wasting with 1.2% severe wasting. The under-five mortality rate was measured at 2.23/10,000/day (2x normal), while only 16.5% of children were immunized against measles. It is believed that the elevated mortality may be related to a measles epidemic in May 1996 which underscores the need to improve immunisation coverage [ACF 09/07/96].

The survey also found that 41% of households did not receive any food aid during June and that only 48% of malnourished children were enrolled on the supplementary feeding programme. The poor coverage of these programmes and the relatively low levels of wasting found in the survey suggest that refugees have developed considerable self-reliance in recent years [ACF 09/07/96].

Overall, in Liberia the displaced population in Monrovia, Gbaranga and Buchanan are at high risk with sharply elevated levels of wasting (category I in Table 1). It is likely that many other newly accessible populations in Liberia are at similar nutritional risk (category IIa in Table 1), although supporting data is not currently available.

How could external agencies help? As anticipated in the June RNIS report, with new areas in Liberia becoming accessible, famine situations are being discovered in areas such as Buchanan, Tubmanburg, and Bong Mines. It is therefore probable that there will be a need to provide general rations and selective feeding as well as essential drugs and vaccines, chlorine tablets for well chlorination, and agricultural inputs in many areas in the coming months.

Location-specific needs in the region include:

· a one-off general ration for Gbanga before the harvest season, an increase in the number of therapeutic feeding centres, as well as a mass immunization campaign;

· In Buchanan there is urgent need for an increased general ration, expanded selection feeding programmes with improved outreach, a mass immunization campaign and better support for health services. A follow-up nutrition survey in October/November 1996 is also advised;

· improved immunization coverage in Gondama, probably through awareness programmes for refugees since clinics are operating in the area;

· In Macenta, Guinea there is a need for better community outreach in order to increase the enrollment of malnourished children in feeding centres. Measles immunization coverage also urgently needs to be increased.

RNIS 16, June 1996

Liberia/Sierra Leone - Trend in numbers of refugees/displaced and proportion severely malnourished and at high risk (shaded area).

Recent violence in the Monrovia has led to large scale displacement within and from the capital to and serious disruption to relief and rehabilitation work throughout Liberia. In recent weeks most agency activity has been focused upon Monrovia. The current insecurity has meant that plans for voluntary repatriation of Liberian refugees have been put on hold. Recent attempts at political mediation have failed and the overall security situation is currently extremely fluid. In contrast, the security situation in Sierra Leone has improved in recent weeks. This has led to improved humanitarian agency access to populations resulting in signs of improving nutritional and health status amongst conflict affected populations.

Current estimates of the numbers of people affected in the region are summarised below:

Location	Apr 95	Jul 95	Oct 95	Dec 95	Feb 96	Apr 96	Jun 96
Liberia	1,900,000	1,900,000	1,900,000	1,900,000	1,800,000	1,800,000	1,800,000
Sierra Leone	500,000	730,000	730,000	730,000	730,000	756,000	756,000
Côte d'Ivoire	330,000	227,000	305,000	305,000	305,000	305,000	305,000
Guinea	603,000	578,000	536,000	605,000	605,000	536,000	536,000
TOTAL	3,333,000	3,435,000	3,471,000	3,540,000	3,440,000	3,397,000	3,397,000

Liberia Although there had been considerable progress towards enduring peace since the signing of the Abuja peace accords in August 1995, eruption of fighting between the NPLF and ULIMO-Krahn on April 6th in Monrovia has placed the whole peace process in jeopardy. Within a few days, many areas of the city had been looted and thousands of inhabitants had been displaced. Most humanitarian operations ceased and comprehensive assessment of needs has still not been possible. Factional fighting spread up-country to Bong Mines and Greenville. Most expatriate agency staff were evacuated from Monrovia and the majority of UN and NGO offices were completely devastated making rapid resumption of relief activities throughout the country problematic [WFP 19/04/96].

By the end of May the security situation had improved, and ECOMOG troops had been redeployed in Monrovia. Simultaneously, cross-border deliveries of food from Cote d'Ivoire into Nimba and Bong counties began, and shipments of humanitarian aid by land and sea have commenced out of Monrovia. However, 12 NGOs have adopted a common position on scaling down relief activities in the country due to widespread looting of property and abuse of humanitarian principles. As a result, the NGOs decided that the resumption of full activities is not possible and instead will only undertake targeted and life saving interventions [WFP 14/06/96]. There are approximately 1.8 million people in Liberia in need of humanitarian assistance [WFP 19/04/96, WFP 31/05/96, USAID 11, 12, 16, 24/05/96].

Fighting had displaced at least 80,000 people within the capital with an estimated 20,000 in Greystone compound in the US embassy. The health status of this over-crowded population has been extremely worrying with reports of diarrhoea, and measles. Concerted efforts have now been taken to improve water availability and sanitation in this compound. The situation for the displaced in Barclays Training Centre (BTC) in Monrovia has also been critical particularly with regard to water, health and sanitation. Both Greystone and BTC have periodically been cut off from outside agency assistance during April and May as lulls in fighting have given way to major skirmishes in nearby areas. New checkpoints manned by NPLF and ULIMO-K fighters have also made the city centre and Greystone camp periodically inaccessible to WFP food relief convoys. Large numbers of displaced have sought refuge in Bushroad Island [WFP 10/05/96] while others are reported to have fled to Kakata, Toteta, Ganta and Gbarnge [USAID 16/05/96, 21/05/96, WFP 10/05/96, 17/05/96].

In Monrovia, water and food provision are now the main concern. Some mini-markets are appearing although food prices are up to four times normal. It is hoped that food distributions for an indicative target of 692,000 will continue on a temporary and contingent basis until order is re-established [WFP 26/04/96]. Cholera outbreaks continue to be reported in the capital while the incidence of measles is another concern [USAID 24/04/96, 7, 8/05/96].

ECOMOG troops have withdrawn from bases in Bo Waterside and Tiene in Cape Mount county where 29,000 and 70,000 internally displaced people were sheltered. Lack of ECOMOG presence in the county will make it extremely difficult to bring relief assistance as civilians are being directly targeted by the warring factions. Cross-border food convoys have now resumed from Cote d'Ivoire to Nimba and Bong country and the government is now urging a shift in focus of relief from Monrovia to rural areas [DHA 14/05/96].

The improved security situation is allowing for some assessment of the nutritional situation of those who have been isolated for many weeks or months. A serious deterioration of the nutritional situation is reported in Tubmanberg, where over 50,000 people last received food aid in January 1996. There are reports of up to ten people a day dying of starvation and disease [WFP 07/06/96]. There have also been reports that some of the population in Lofa country is in urgent need of food aid [DHA 09/06/96]

An unconfirmed number of Sierra Leonean refugees in the Cape Mount area have spontaneously repatriated. There are reports of an estimated 5,000 Liberians having fled by boat to neighbouring countries with an unknown number fleeing to Sierra Leone over land [DHA 14/05/96, UNHCR 24/05/96].

Overall, those in Liberia living outside of Monrovia are likely to be at high nutritional risk (category IIa in Table 1) since many areas have now been cut off from humanitarian aid for several weeks and lack of protection for agencies is preventing improved delivery of relief items. Although, some cross-border deliveries from Cote d'Ivoire are occurring, the decision of many NGOs to stream-line activities to a minimum as a result of looting and lack of respect for humanitarian principles may also have serious repercussions for the food security of populations affected by the conflict outside of Monrovia. The affected population in Monrovia can be considered to be at moderate risk (Category IIb in Table 1), as the situation is apparently coming under control. Those requiring emergency food aid in Sierra Leone can be considered to be at moderate risk (category IIb in Table 1) due to continued sporadic insecurity. The refugees in Cote d'Ivoire and Guinea are probably not at heightened nutritional risk (category IIc in Table 1).

How could external agencies help? As attention of the humanitarian agencies has shifted to Monrovia in recent weeks, there is little information on the needs of populations outside of the capital. It is, however, clear that actions similar to those identified in the April RNIS (strengthening nutritional surveillance capacity for newly accessible areas and an extension of measles immunisation coverage in selected areas) have been precluded. When agencies are able to re-establish their operational bases within Liberia, large scale humanitarian needs may become apparent. At that point, agencies may need substantial additional resources for widespread needs assessments and the provision of humanitarian relief items. As NGO rehabilitation activities are being scaled down due to insecurity, nutrition and health risks may increase; every means of protecting and supporting NGO activities should therefore be considered.

With continuing insecurity in Monrovia, adequate supplies of clean water, food and medical care, especially cholera and measles prevention, are urgently required, notably for the 80,000 or so people in Greystone compound and the Barclay Training Centre.

Based on a recently launched UN consolidated appeal, the last RNIS report highlighted certain necessary activities in Sierra Leone, including the possible expansion of selective feeding programmes, and investment in rebuilding and extending health, sanitation and water infrastructure in the country. To date, the response to the appeal has been minimal; for example only 5% of the food needs projected by WFP have been pledged. If this situation persists, delays in programme implementation will be encountered.

Other specific needs in Sierra Leone include an immunisation campaign in the Bonthe Island area, and an assessment of the nutritional status of those populations who have recently returned home.

RNIS 15, April 1996

Trend in numbers of refugees/displaced and proportion severely malnourished and at high risk (shaded area).

Recent fighting in Monrovia is leading to large-scale displacement. It is too early to assess the nutritional impact of this most recent fighting. Elsewhere in Liberia, the security situation is making it difficult to establish a clear time frame for repatriation plans. Furthermore, several areas of the country remain periodically inaccessible to relief activity so that affected populations may be at nutritional risk. The recent election of a new president in Sierra Leone and subsequent talks with rebel leaders are giving rise to guarded hopes that the desperate situation in the country may begin to improve. However, given the shattered infrastructure, massive displacement to over-crowded urban centres and length of time that some populations have been cut-off from assistance, there will be a need for large-scale humanitarian support for many months to come even if political progress is rapid. Recent nutritional surveys in Sierra Leone (e.g. in Bo) continue to show extremely high levels of wasting amongst some urban populations.

Current estimates of the numbers of people affected in the region are summarised below:

Location	Feb 95	Apr 95	Jul 95	Oct 95	Dec 95	Feb 96	Apr 96
Liberia	1,800,000	1,900,000	1,900,000	1,900,000	1,900,000	1,800,000	1,800,000
Sierra Leone	506,000	500,000	730,000	730,000	730,000	730,000	756,000
Cote d’Ivoire	330,000	330,000	227,000	305,000	305,000	305,000	305,000
Guinea	568,000	603,000	578,000	536,000	605,000	605,000	536,000
TOTAL	3,204,000	3,333,000	3,435,000	3,471,000	3,540,000	3,440,000	3,397,000

Liberia Recently, an outbreak of factional fighting in Monrovia is causing tens of thousand to flee their homes, going for days without food or water. Agency personnel are currently being evacuated from the capital city. It is too early to assess the impact of this fighting will have on the population of Monrovia [UNHCR 12/04/96]. Although there had been considerable progress towards stability since the signing of the Abuja peace accord in August 1995, periodic outbreaks of insecurity throughout the country continue to pose a threat to the overall peace process. Advances have been made in deployment of ECOMOG peace-keepers and UNOMIL observers, the disarmament/demobilisation of soldiers and extension of central government administration throughout Liberia. However, in recent weeks insecurity and cease-fire violations have been reported in Lofa, Grand Gedah, Grand Kru, Maryland, Bomi and Cape Mount counties. In some cases this has led to the continued suspension of humanitarian activities. In other areas, such as Rivercess and Sinoe counties, improvement in security has allowed displaced populations to return to their homes and to receive assistance from humanitarian agencies [DHA 04/03/96, UNHCR Jan 96, WFP 01/03/96].

There are an estimated 1.8 million refugees, displaced and war-affected people in Liberia. The recent crop assessment mission to Liberia found that massive population displacement had reduced production of rice to about one quarter of pre-war levels. Cassava production has also been adversely affected. The volatile security situation determines that those populations who are sporadically cut off from humanitarian aid are at some nutritional risk. For example, there have been anecdotal reports of increasing humanitarian needs in Bong Mines, and Grand Cape Mount. Acute shortages of food have also been reported in three camps for internally displaced people in Tieni, Bo Waterside and Sinje [FAO Jan/Feb 96, WFP 01/03/96].

In contrast, populations that have been easily accessible in recent months show a far more stable nutritional situation. For example, a recent survey carried out in Buchanan (estimated population 50,000 displaced living in camps and displaced sites and 50,000 resident people) showed 4.1 % wasting with 0.6% severe wasting. Oedema was measured at 0.5% (see Annex I (9a)). However, the crude mortality rate was 3.0/10,000/day (10 × normal) and the under-five mortality rate was 5.0/10,000/day (4 × normal). Main causes of mortality were diarrhoea and fever. Measles immunisation coverage was low at 52.7%. Over 80% of the population have been in receipt of a general ration [ACF Feb 96].

Another survey has recently been completed in Bong County (estimated population 141,000). Levels of wasting were measured at 6.1% with 1.4% severe wasting (see Annex I (9b)). There was no significant difference in levels of wasting between resident and displaced populations. In contrast to these low levels of wasting, mortality rates were extremely high. Crude mortality rates were 5.5/10,000/day (22 × normal) and under-five rates were 8.5/10,000/day (8.5 × normal). Measles immunisation coverage was very low at 6.2%. The food situation of this population was considered to be precarious as food stocks were low and the next harvest is not expected until July. Morbidity rates were also considered to be very high with fever and diarrhoea the most common complaint [ACF 22/02/96].

Plans for the voluntary repatriation of the approximately 750,000 Liberian refugees residing in neighbouring countries have been drawn up, but due to the fluid security situation in Liberia the proposed timing of the programme may well have to remain flexible. It is estimated that 623,000 refugees will wish to return and that approximately 70,000 of this population will return spontaneously without agency assistance [UNHCR Feb 96].

Overall, the populations of Buchanan and Bong counties in Liberia are at high risk due to elevated mortality rates (category I in Table 1); the population in the camps around Bo are also at high risk due to elevated levels of wasting. The remaining displaced population in Sierra Leone is likely to be at heightened nutritional risk (category IIa in Table 1) due to insecurity. The population in Liberia that is inaccessible, or only periodically accessible can be considered to be at moderate nutritional risk (category IIb in Table 1) while the accessible population in Liberia and the refugees in Cote d'Ivoire and Guinea are probably not at heightened nutritional risk (category IIc in Table 1).

How could external agencies help? Effects of recent fighting in Monrovia could not be assessed as of 12 April. In Liberia needs include:

• strengthening nutritional survey capability so that levels of malnutrition can be quickly determined in newly accessible areas, for a rapid targeting of food aid where needed and feasible;
• survey reports (e.g. Buchanan County) continue to show very high mortality rates, due mainly to diarrhoea and fever in children, as well as malnutrition (oedema, kwashiorkor), which require urgent action, notably an extension of measles immunization coverage (e.g. 6% only covered according to survey results from Bong County).

Recent reports indicate that the food pipeline for the region which was reported as inadequate in RNIS #14 has improved substantially in recent weeks. However, cash needs for monitoring and logistics support remain an urgent priority. It appears that the needs for increased measles immunisation throughout both Sierra Leone and Liberia have still largely to be met.

RNIS 14, February 1996

Apart from one large-scale incident, the security situation has generally been calm in Liberia, allowing increased relief access to formerly inaccessible populations. Enduring peace is allowing some spontaneous refugee repatriation. Surveys in newly accessible areas often show extremely high levels of wasting and virtually non-existent health infrastructure. Recent crop assessments in Liberia have shown very poor aggregate levels of production. Until the recent cease-fire at the end of January in Sierra Leone, poor security had continued to disrupt provision of relief supplies and led to marked food price inflation. Nutritional surveys in areas that are poorly accessible due to insecurity repeatedly show high levels of wasting. A recent cereal crop assessment in Sierra Leone shows harvests to be well below averages of previous years.

Liberia

Trend in numbers of refugees/displaced and proportion severely malnourished and at high risk (shaded area).

Current estimates of the numbers of people affected in the region are summarised below:

Location	Dec 94	Feb 95	Apr 95	Jul 95	Oct 95	Dec 95	Feb 96
Liberia	1,615,000	1,800,000	1,900,000	1,900,000	1,900,000	1,900,000	1,800,000
Sierra Leone	506,000	506,000	500,000	730,000	730,000	730,000	730,000
Cote d'Ivoire	330,000	330,000	330,000	227,000	305,000	305,000	305,000
Guinea	534,000	568,000	603,000	578,000	536,000	605,000	605,000
TOTAL	2,985,000	3,204,000	3,333,000	3,435,000	3,471,000	3,540,000	3,440,000

Liberia Until recently, the current cease fire had been relatively well respected by the opposing political factions in Liberia. This had led to plans being made for the repatriation of over 700,000 Liberian refugees from surrounding countries of asylum. However, at the end of December, intensive fighting between ULIMO and ECOMOG forces in Tubmanburg, Bomi County resulted interrupted relief activities in the region. An estimated 17,500 people have now left the area and are residing in three shelters at the Bo river where they are receiving assistance. Eventually, food aid was delivered to over 50,000 civilians trapped in Tubmanburg. Other less serious security incidents, some involving international NGOs, have been reported in Lofa country and in Sinoe county in recent weeks [UNHCR 26/01/96, WFP 19/01/96].

It is currently estimated that there are 1.8 million people in Liberia who are in need of humanitarian assistance. Approximately 1.1 million of these people are living either in Monrovia, or in the surrounding counties and are therefore accessible. The remaining 700,000 are inaccessible or only periodically accessible. This also includes about 120,000 Sierra Leonean refugees, although the number may well be higher as an unknown number of refugees have crossed into Liberia due to the insecurity in their home country. There is reportedly some spontaneous repatriation taking place. Although numbers are difficult to verify, an estimated 3,000-12,000 refugees have repatriated so far [UNHCR 26/01/96, WFP 05/01/96].

A recent convoy to Lofa reported that most towns and villages in the area have been destroyed, including schools and hospitals. This picture of a shattered infrastructure is repeatedly documented by agencies visiting formerly inaccessible areas. The majority of the population in areas outside ECOMOG control have limited or no access to health services. This is particularly worrying given reports of yellow fever and cholera in many areas. A yellow fever outbreak was confirmed in November 1995, with at least 359 cases reported in Buchanan and many other suspected cases reported throughout the country. Since then a massive immunisation campaign has been underway in Monrovia and accessible areas outside the capital. There is no specific treatment for yellow fever and case fatality rates can be as high as 50% [WHO 03/01/96, 04/01/96].

In spite of the cease-fire violations, ECOMOG deployment has allowed roads to be opened to areas of Grand Gedeh, Sinoe and Maryland county during December. This has allowed for nutritional assessment of some populations that have been cut-off from humanitarian assistance for very long periods. One such rapid assessment in the Putu area (estimated population 10,000) of the northern district of Konobo in Grand Gedeh county found 37.1% wasting with 5.7% severe wasting (see Annex 1 9(a)). None of the children included in the survey had a health card and there were concerns for an extremely low rate of measles immunisation coverage. These results are even more worrying considering that the sample was a settled population and that future refugee returnees from Cote d'Ivoire may well settle in the area. Such high levels of wasting clearly dictate an urgent need for emergency general and selective feeding programmes in the area [WFP 05/01/96, WV Dec 95].

Displacement of people to avoid fighting means not only a short-term need for humanitarian aid, but also leads to a longer term disruption to agricultural production. An FAO crop assessment mission estimated that even on the most optimistic assumptions, rice production in 1995 was only 23% of the pre-civil war level and cassava production had fallen by as much as 50%. The mission also reported that extensive and continuous population displacement had left large tracts of land deserted and that insecurity in settled areas outside the ECOMOG controlled zone had made it difficult for farmers to store seed for planting. A major influx of returnees will, therefore, have significant implications for food aid needs. Furthermore, few households, even in high potential areas, will be self-sufficient in rice production [FAO Jan 96, SCF 12/02/95].

At the end of 1995, delays in receiving donor pledges and a break in arrivals in the food pipeline have caused serious problems in relief food distributions. WFP food stocks were limited to bulgur wheat and CSB at the end of December and donors had only pledged one quarter of requirements for 1996 by the end of 1995 [WFP 26/01/95].

Overall, the affected populations in the Putu area, Grand Gedeh (Liberia) are in category I in Table 1 due to high levels of wasting. The population in Liberia that is periodically accessible are considered to be at moderate nutritional risk (category IIb in Table 1). The accessible population in and around Monrovia are not currently thought to be at heightened nutritional risk (category IIc in Table 1).

How could external agencies help? In Liberia, needs include:

• increase food aid pledges;
• provide increased funding to support the rebuilding of health infrastructure in newly accessible areas;
• continue epidemiological surveillance and immunisation capacity for yellow fever and measles;
• assess the nutritional situation of those recently displaced to Bo river;
• distribute an emergency general ration, and set up selective feeding and measles immunisation programmes in Konobo district.

RNIS 13, December 1995

Liberia - Trend in numbers of refugees/displaced and proportion severely malnourished and at high risk (shaded area).

The present peace accord appears to be holding in Liberia, despite some skirmishes in the countryside. However, these security incidents mean that many areas remain inaccessible to relief activities. A few recent nutritional surveys indicate low levels of wasting in accessible areas. Intense fighting is continuing in Sierra Leone with only occasional periods of calm. Much of the country is inaccessible and it is reported that levels of malnutrition are particularly high in affected regions (southern and eastern).

Current estimates of the numbers of people affected in the region are summarised below:

Location	Oct 94	Dec 94	Feb 95	Apr 95	Jul 95	Oct 95	Dec 95
Liberia	1,692,000	1,615,000	1,800,000	1,900,000	1,900,000	1,900,000	1,900,000
Sierra Leone	300,000	506,000	506,000	500,000	730,000	730,000	730,000
Cote d’Ivoire	325,000	330,000	330,000	330,000	227,000	305,000	305,000
Guinea	534,000	534,000	568,000	603,000	578,000	536,000	605,000
TOTAL	2,851,000	2,985,000	3,204,000	3,333,000	3,435,000	3,471,000	3,540,000

Liberia Despite several reports of skirmishes in Liberia, the faction leaders still appear committed to the peace accords. Unfortunately, delays in pledging for ECOMOG and its deployment in new areas has resulted in the postponement of the disarmament process until December 1995 [WFP 13/10/95, WFP 10/11/95].

Many parts of the country are not yet fully accessible by road due to security concerns. Insecurity has affected some relief programmes. For example, a food convoy in Gbaranga was postponed due to fighting in early October while much needed selective feeding programmes have been adversely affected by lack of access to the Bong area. Nevertheless, assessment missions are continuously being planned and implemented in formerly inaccessible areas. Current estimates are that there are 800,000 affected people in Liberia who are accessible, and a further million inaccessible people in need of humanitarian aid. There are also approximately 100,000 Sierra Leonean refugees in Liberia [WFP 13/10/95, WFP 10/11/95].

The expanded relief requirements that arise from improved access to populations will pose numerous logistical challenges for relief agencies while increased donor efforts will be required for timely delivery of food commodities and cash pledges to cover resettlement and reintegration activities. Currently, delays in pledges/arrivals have meant that WFP Liberia is nearly out of stocks of vegetable oil and pulses and only cereal (bulgur wheat) is available for distribution. However, it is hoped that with the arrival of the harvest season, some areas may no longer require general ration support [WFP 13/10/95, WFP 10/11/95].

Continued fighting in neighbouring Sierra Leone has led to further refugee influxes into Cape Mount and Bomi during October.

Recent nutritional surveys have shown a much improved situation in many parts of the country. Indeed, concern that high rates of wasting may be found in newly accessible areas such as Greenville and surrounding villages has not, in some cases, been borne out by the evidence [WFP 27/10/95].

A survey carried out in Buchanan (estimated population 50,000) showed 8.9% wasting with 1.0% severe wasting. Oedema was seen in 0.3% of the children measured (see Annex 1 (9a)). This prevalence of wasting was comparable to that measured in an earlier survey in January 1995. There was no significant difference found in wasting rates between the resident and displaced population and the majority of families were found to have general ration distribution cards. Crude mortality rates varied from 0.8-3.7/10,000/day (2-10x normal) and the under five mortality rate was 1.4/10,000/day (a normal level). Main causes of death cited were diarrhoea and fever [MSF-F/AICF Jul 95].

Recently an outbreak of yellow fever has been reported in the area, and a massive vaccination campaign is underway. It should be noted that only an estimated 20% of Liberia’s pre-war health facilities are currently operating making such primary health care activities extremely difficult [WHO 15/11/95, 27/11/95].

A survey was recently carried out in Lower Bong and Upper Margibi to evaluate the impact of a general ration distribution and targeted feeding programme implemented after a survey in July 1995 showed a critical nutrition situation with 19.1% wasting and 37.1% oedema (see RNIS #12). The more recent survey showed 6.4% wasting and/or oedema and 0.7% severe wasting and/or oedema (see Annex 1 (9b)). This is a remarkable improvement and is largely attributed to the general ration of 1800 kcals/person/day which has been reaching an estimated 96.5% of the population since July. However, coverage of the targeted feeding programme has been far less effective with only an estimated 20% of malnourished children attending the supplementary feeding facilities. Measles vaccination coverage was also low at 43.6% with communities off the main road particularly badly served [MSF-H 21/10/95].

Overall, the inaccessible population in Liberia can be considered to be at high risk (category IIa in Table 1) and the accessible populations in Liberia are probably not at heightened nutritional risk (category IIc in Table 1).The inaccessible population in Liberia can be considered to be at moderate nutritional risk (category IIb in Table 1).

How could external agencies help? In Liberia, ECOMOG may need increased support. Increased pledges from donors for supplies of oil and pulses would help to ensure adequacy of the general ration pipeline. Projects to help rehabilitate the devastated primary health care infrastructure in the country may be of priority. Improved coverage of selective feeding programmes and measles immunisation in the Lower Bong and Upper Margibi is required.

RNIS 12, October 1995

C. Liberia

Trend in numbers of refugees/displaced and proportion severely malnourished and at high risk (black area).

The signing of the peace accord in Liberia by all warring factions and the subsequent instalment of a Council of State is giving grounds for optimism that the present cease fire will hold and provide an opportunity for this war-ravaged country to rebuild itself. However, Liberian refugees in neighbouring Cote d'Ivoire and Guinea seem to be waiting to see how the disarmament process in Liberia progresses before repatriating. In contrast, the situation in Sierra Leone appears to be spiralling out of control as populations made inaccessible by fighting endure increasing hardship without outside relief assistance. This total population number is broken down by country as follows:

Location	Aug 94	Oct 94	Dec 94	Feb 95	Apr 95	Jul 95	Oct 95
Liberia	1,750,000	1,692,000	1,615,000	1,800,000	1,900,000	1,900,000	1,900,000
Sierra Leone	300,000	300,000	506,000	506,000	500,000	730,000	730,000
Cote d'Ivoire	250,000	325,000	330,000	330,000	330,000	227,000	305,000
Guinea	539,000	534,000	534,000	568,000	603,000	578,000	536,000
TOTAL	2,839,000	2,851,000	2,985,000	3,204,000	3,333,000	3 435 000	3,471,000

Liberia There remains an estimated 1.9 million people in Liberia in need of humanitarian assistance. Although the cease-fire, which came into effect at the end of August, is generally holding, certain areas, notably Southeast Liberia and Rivercess, still remain inaccessible to relief assistance due to insecurity. However, general ration distributions are now regularly taking place in the ECOMOG secured areas of urban Monrovia, Rural Montserrado, Lower Margibi and Lower Grand Bass (including Buchanan) to over 1.1 million beneficiaries. The composition of the food basket has recently been altered so that rice is replaced by bulgur wheat. The change has reportedly been accepted well by beneficiaries [WFP 18/08/95, 15/09/95].

With the opening up of new areas has come the discovery of extremely high rates of wasting amongst certain population groups. For example, a survey conducted in July in Lower Bong and Upper Margibi counties found a critical nutritional situation with 56.2% malnutrition (37.1 % with oedema and 19.1 % wasted) (see Annex I 9(a)). As is typical of Liberia, most of the severe malnutrition manifested itself as kwashiorkor; however 37% kwashiorkor does indeed represent a very serious emergency, as it was described by Save the Children Fund. Furthermore, the survey showed that children in the 5-10 year age group were as malnourished as those under five. There are also anecdotal reports of a critical food situation in the Upper Porpka district of Cape Mount/Bomi counties [SCF 31/07/95, WFP 11/09/95].

Overall, the population in Liberia that has been accessible for some time is probably not at heightened nutritional risk (category He in Table 1) while the inaccessible or periodically accessible populations (e.g. Lower Margibi) are at high nutritional risk (category IIa in Table 1).

How could external agencies help? Further nutritional surveys in newly accessible areas in Liberia and subsequent support for large scale curative selective feeding programmes for all age groups where appropriate is urgently needed. This may involve re-opening abandoned and run-down health centres.

RNIS 11, July 1995

D. Liberia - Trend in numbers of refugees/displaced and proportion severely malnourished and at high risk (black area).

The overall situation in the region appears to be deteriorating. There are continued reports of skirmishes in Liberia, and despite the expansion of ECOMOG control into Cape Mount and Bomi counties, much of the country remains inaccessible to relief activities. Intensive rebel activity in Sierra Leone is continuing and estimates of the number of displaced people in the country vary from 730,000 to over a million people. Food distributions in Sierra Leone have been severely disrupted by the insecurity. The total number of people in need of humanitarian aid in the region has increased since the last RNIS report by over 100,000 to 3.4 million largely due to further displacements in Sierra Leone. This total population number is broken down by country as follows:

Location	Jun 94	Aug 94	Oct 94	Dec 94	Feb 95	Apr 95	Jul 95
Liberia	1.750.000	1.750.000	1.692.000	1.615.000	1.800.000	1.900.000	1.900.000
Sierra Leone	300.000	300.000	300.000	506.000	506.000	500.000	730.000
Cote d’Ivoire	234.000	250.000	325.000	330.000	330.000	330.000	227.000
Guinea	628.000	539.000	534.000	534.000	568.000	603.000	578.000
TOTAL	2.912.000	2.839.000	2.851.000	2.988.000	3.198.000	3.333.000	3.435.000

Liberia The prospects for peace in Liberia do not appear to be improving. A summit on the 17th of May called by the ECOWAS (Economic Organisation of West African Stales) was not attended by Charles Taylor (head of one ULIMO faction) so that little progress towards peace could be made. Although a subsequent meeting between Taylor and the president of Niger resulted in a commitment by the former to disarm, there has as yet been no indication of Taylor’s ULIMO faction acting upon this commitment [DHA 19/06/95, UNHCR 26/06/95].

However, ECOMOG took control of the two main highways leading to Bomi and Cape Mount counties in mid-April, thereby greatly improving access to the populations in the western part of the country. In general the security situation has improved greatly in the major towns along these highways. Unfortunately, ECOMOG manpower is not sufficient to control areas off the highways where clashes between the two ULIMO factions have been reported as well as looting and atrocities committed against the civilian population. At the beginning of May ECOMOG extended its control over parts of Montserrado County, however, ECOMOG strength is gradually being weakened as the Tanzania military contingent start to leave. Throughout May there have been reports of skirmishes in many areas of Liberia including parts of Maryland county, Bong Mine and Gbarnga. Although it is difficult to gain precise information about the total number of newly displaced, approximately 200 people a day appear to be leaving Cess, Sinoa and areas north of Buchanan with another 500 per week from Bong Mine. The opening of the Bomi highway has allowed a large number of displaced people to travel to the camps around the Po River or to Monrovia [IFRC 02/06/95].

The total number of people requiring humanitarian assistance in Liberia remains at 1.9 million, but with the expanded control of ECOMOG forces, approximately 1.14 million of these people are now accessible to humanitarian aid in Monrovia (830,000), centres for the displaced in Rural Montserrado (90,000) and Lower Margibi and Lower Grand Bassa (215,000). It is reported that food is available in and around Monrovia both from the general ration distribution and on the markets [DHA 19/06/95, SCF 16/06/95, WFP 05/05/95].

A recent nutritional survey in Cape Mount in April showed 17% wasting with 5.3% severe wasting (see Annex 1 (9a)) [WFP 09/06/95]. Two other surveys in Margibi county showed a less severe situation. In Harbel Unification Town, wasting was measured at 7.4% with 1.1% severe wasting (see Annex 1 (9b)). The crude mortality rate was 0.69/10,000/day (2x normal) and measles immunisation coverage was 53.7%. In Goba Town, the prevalence of wasting was measured at 11.7% with 3.1% severe wasting (see Annex 1 (9c)). The crude mortality rate was 1.3/10,000/day (4x normal) and the measles immunisation coverage was 23.1% [MSF-H Jun 95].

There have also been a number of anecdotal reports from rapid assessment missions during April and May. One such report talks of deplorable human conditions around Harper in Maryland County, while another talks of no general signs of malnutrition in the towns visited in Grand Cape Mount County. Although various findings show that amongst the Liberian population there are pockets of malnutrition, the provision of medicines has been identified by some as an even higher priority than that of food [WFP 05/05/95, WFP 23/06/95].

Overall, the population in Monrovia, Rural Montserrado, and Lower Margibi and Lower Grand Bassa who have access to humanitarian aid as well as refugees in Guinea and Cote d’Ivoire are not considered to be at heightened nutritional risk (category IIc in Table 1). Those in the newly accessible areas of Liberia are at moderate risk with many showing elevated levels of wasting and mortality and other populations showing low levels of measles immunisation coverage (category IIb in Table 1). The inaccessible populations of Liberia and Sierra Leone can be considered to be at high risk (category IIa in Table 1).

How can external agencies help? Urgent attention should be given to increasing measles vaccination coverage in the newly accessible areas of Cape Mount and Margibi county. Similarly, drug supplies need to be improved to these areas. Agencies should give priority to registering the “needy” displaced in Freetown in order to increase coverage of the general ration programme. Measles vaccination coverage also needs to be improved amongst this large urban population.

RNIS 10, April 1995

D. Liberia - Trend in numbers of refugees/displaced and proportion severely malnourished and at high risk (black area).

The overall situation in the region appears to be deteriorating. In Liberia, the ceasefire that appeared to be operational in early 1995 is no longer holding with reports of skirmishes throughout the country. Increased insecurity in Sierra Leone is adding to the internally displaced population who already number several hundred thousand and has also caused the repatriation of up to 1,000 Liberian refugees. Others have fled the country to Guinea where reports indicate the need 10 improve humanitarian support for new arrivals. Similarly, the deteriorating condition of Liberian new arrivals in Cote d’Ivoire indicates the need to strengthen present relief efforts.

Current estimates of the refugee and displaced populations in the region are as follows:

Location	Apr 94	Jun 94	Aug 94	Oct 94	Dec 94	Feb 95	Apr 95
Liberia	1,750,000	1,750,000	1,750,000	1,692,000	1,615,000	1,800,000	1,900,000
Sierra Leone	297,000	300,000	300,000	300,000	506,000	506,000	500,000
Cote d’Ivoire	250,000	234,000	250,000	325,000	330,000	330,000	330,000
Guinea	415,000	628,000	539,000	534,000	534,000	568,000	603,000
TOTAL	2,712,000	2,912,000	2,839,000	2,851,000	2,988.000	3,198,000	3,333,000

Liberia It is estimated that there are approximately 1.9 million people in Liberia in need of humanitarian assistance. This includes approximately 1.8 million Liberians who are internally displaced and 120,000 Sierra Leonean refugees. Many of these people are still inaccessible due to widespread insecurity. All areas in the southeast and Rivercess county are inaccessible as fighting continues between the NPFL and LPC forcing people into Buchanan and Tabou in Cote d’Ivoire. ULIMO clashes have also been reported in Lower Lofa and Cape Mount while the situation in the Bong Mines area is reported to have worsened with sieges, abductions and food shortages [UNHCR 24/02/95, UNHCR 14/03/95, WFP 24/02/95, WFP 10/03/95].

As has been the case for many months food is still only delivered in ECOMOG secured areas such as Monrovia, Montserrado and Buchanan although WFP plan to visit Bong, Nimba and Upper Margibi in April in order to assess the food needs of the area and the possibility of a cross-border food delivery convoy. Due to fighting on the border of Bong and Nimba counties, nearly 50,000 people including Sierra Leonean refugees entered the displaced camps in Buchanan. In spite of earlier reports of serious problems with shelter and sanitation, their health situation is reported to be generally satisfactory [UNHCR 24/02/95, UNHCR 14/03/95, WFP 24/02/95, WFP 10/03/95].

A recent nutritional survey in Montserrado county showed 7.3% wasting with 1.2% severe wasting (see Annex 1 (9a)). The crude mortality rate was 0.89/10,000/day (approximately 2x normal) [MSF-H 27/04/95].

Continued insecurity in Sierra Leone has caused further displacement of Sierra Leoneans and Liberian refugees to Liberia. However, due to insecurity at their likely points of arrival, verification of numbers displaced is currently not possible [UNHCR 14/03/95].

Overall, the inaccessible population in Liberia and the displaced population in Sierra Leone are also considered to be at high risk (category IIa in Table 1). The population in Liberia sporadically accessible and the new arrivals from Liberia to Guinea are probably at moderate nutritional risk (category IIb in Table 1).

How could external agencies help? Due to the level of insecurity the most realistic achievement in Liberia and Sierra Leone would be that nutritional assessments and necessary interventions are implemented when and as security permits. Donors should also be alert to the possible need to provide more resources for water programmes in Sierra Leone as the increasing numbers of displaced exert pressures on existing supplies. In Cote d’Ivoire there is an urgent need to speed up the registration procedure for refugee new arrivals and also to review their existing general ration level which may be inadequate. Similarly, there is a need to review and possibly increase ration levels for new refugee arrivals in Forecariah prefecture in Guinea.

RNIS 9, February 1995

A Liberian peace agreement which contained a provision for an immediate cease-fire as well as a timetable for creation of buffer zones, safe-havens, demobilization of soldiers and eventual democratic elections was signed in Accra, Ghana, on the 21st of December 1994. There is optimism that this new agreement will hold as the principal signatories represent all Liberian warring factions. Apart from a few small-scale skirmishes, the cease-fire appears to be holding. Unfortunately, the situation in neighbouring Sierra Leone has continued to deteriorate during the new year period with greatly intensified rebel activities leading to massive internal displacement and a further refugee outflow into Guinea. The total number affected by the crisis regionally has, therefore, increased to just over three million people. The food pipeline for vegetable oil and beans for the region is said to be very weak with need for early provision of cash funds for staffing and logistic support costs to ensure necessary food aid logistics, co-ordination and monitoring [WFP 20/01/95].

Trend in numbers of refugees/displaced and proportion severely malnourished and at high risk (black area).

Current estimates of the populations affected by the conflict are summarized in the box below.

Location	Feb 94	April 94	June 94	Aug 94	Oct 94	Dec 94	Feb 95
Liberia	1,750,000	1,750,000	1,750,000	1,750,000	1,692,000	1,615,000	1,800,000
Sierra Leone	300,000	297,000	300,000	300,000	300,000	506,000	506,000
Cote d’Ivoire	250,000	250,000	234,000	250,000	325,000	330,000	330,000
Guinea	600,000	415,000	628,000	539,000	534,000	534,000	568,000
TOTAL	2,900,000	2,712,000	2,912,000	2,839,000	2,851,000	2,988,000	3,198,000

Liberia Although there has already been some delay in the implementation of the peace accord with resulting demonstrations and clashes in Monrovia, the cease fire in Liberia is generally holding [UNHCR 30/01/95, WFP 08/01/95]. Recent estimates are that there are 1.8 million people in Liberia requiring humanitarian assistance. One million three hundred thousand of these are in Monrovia and surrounding areas controlled by ECOMOG. This population has regularly been receiving humanitarian aid while the approximately 500,000 war affected people outside ECOMOG-controlled areas have only been receiving sporadic relief when ECOMOG convoys have been able to provide protection [UNSC 06/01/95].

As a result of the cease-fire and improved security, agencies have been able to re-start cross-border food convoys from Cote d’Ivoire to Upper Nimba county and WFP have been planning cross-line food convoys to Bomi and Cape Mount For example, in December, rice, vegetable oil and CSB were distributed in Nimba county, and in February there was a food delivery to Cape Mount [WFP 08/01/95, WFP 16/02/95]. There are also plans for cross-border food deliveries from Guinea to Upper Lofa county for a population, including many Sierra Leonean refugees who, due to insecurity, have been cut off from assistance for over one year. [UNHCR 30/01/95].

The most recent nutrition surveys available from Liberia (October 94) show low levels of wasting amongst the displaced in Montserrado county (an ECOMOG controlled area), In Somokai town and Paynseville displaced centres, levels of wasting were found to be 7.7% and 5.8% respectively (see Annex 1 (1a,b)). One would expect to find considerably higher levels of wasting amongst those populations who have effectively been cut-off from all relief in recent months [MSF-H 03/10/94].

Overall, the approximately 1.3 million people in Monrovia, Buchanan and surrounding areas of Liberia are not currently considered to be at heightened nutritional risk (category IIc in Table 1). The approximately 500,000 people who have until now only been sporadically accessible in the counties outside of the Monrovia area can be considered to be at high nutritional risk (category IIa in Table 1).

How could external agencies help? With continuation of the cease fire large areas of Liberia will become increasingly accessible. There will be a need for nutritional and health surveys in formerly inaccessible areas in order to establish need for general and selective feeding programmes as well as health programmes; measles immunisation programmes would probably be a priority. Organisations may therefore need to gear up for expanded relief programmes in Liberia.

There is an urgent need for donors to pledge greater quantities of beans and oil for the whole regional programme as well as more cash to support staffing, logistical, co-ordination and monitoring components of the programme.

RNIS 8, December 1994

The security situation in Liberia and Sierra Leone has continued to deteriorate over the last two months and is now affecting an estimated 3 million people in the region. The increase in total population affected since the last RNIS report (2.8S million) is due to revised estimates of the number of internally displaced in Sierra Leone [UNHCR 24/11/94, WFP 11/11/94].

Trend in numbers of refugees/displaced and proportion severely malnourished and at high risk (black area).

Current estimates of the populations affected by the conflict are summarized in the box below.

Location	Dec 93	Feb 94	April 94	June 94	Aug 94	Oct 94	Dec 94
Liberia	1,750,000	1,750,000	1,750,000	1,750,000	1,750,000	1,692,000	1,615,000
Sierra Leone	150,000	300,000	297,000	300,000	300,000	300,000	506,000
Cote d'lvoire	250,000	250,000	250,000	234,000	250,000	325,000	333,000
Guinea	600,000	600,000	415,000	628,000	539,000	534,000	534,000
TOTAL	2,750,000	2,900,000	2,712,000	2,912,000	2,839,000	2,851,000	2,988,000

Liberia Recent attempts to advance the peace process have achieved little effect on the ground. The Liberian National Conference and a separate meeting held between a number of armed factions, who feared marginalization at the conference, generated several important resolutions concerning disarmament, demobilization and governance. However, it appears that recommendations made at the two meetings are not being followed through and widespread fighting persists with consequent displacement of more refugees to Cote d'Ivoire, and to a lesser extent, Guinea [UNHCR 11/11/94].

Fighting has intensified in the South East and throughout October and November there have been reports of fighting in Grand Cape Mount County, Bomi/Lower Lofa County (within ULIMO) and in Southern River Cess County (between the NPFL and LPC). Most of the country has been inaccessible during this period with relief operations largely suspended except in ECOMOG controlled areas, e.g. Monrovia. Relief supplies have continued to be distributed to 830,000 beneficiaries in urban Monrovia (30,000 are in displaced centres), 180,000 beneficiaries in rural Montserrado (80,000 refugees and displaced in centres) and 200,000 beneficiaries in Lower Margibi and Lower Grand Bassa (almost all are displaced in centres or towns). During this reporting period depletion of WFP rice stocks led to partial substitution of the rice ration with CSB and bulgar wheat [WFP 28/10/94, WFP 11/11/94].

A nutrition survey in Buchanan in Grand Bassa County in July recorded 15.3% wasting among new arrivals (see Annex 1 (1a)) which was a marked reduction compared to the 29.5% levels found in May. The improvement was attributed to better organized centres for new arrivals [AICF Jul 941. A nutrition survey in a camp for the displaced in Paynesville (population 32,000) in Montserrado county during October/November found 5.8% levels of wasting and general ration receipts of less than 1,500 kcals. Another survey in a displaced centre (population 1,400) in Samokai town in Montserrado country in November found wasting levels of 7.7% (see Annex 1 (1b,c)). The survey team concluded that disease may have been a significant cause of wasting as incidence of diarrhoea was 29% [MSF-H 14/11/94, MSF-H 15/11/94].

ECOMOG has managed to establish "safe havens" in Bomi and Cape Mount Counties where refugees and the internally displaced can receive some assistance. Other food deliveries in insecure areas are sporadically carried out on a "hit and run" basis where the security of an ECOMOG escort allows. For example, only some ten tons of food and other relief supplies were delivered into upper Nimba hospitals in the second week on December. Although UNOMIL (UN peace keeping force) mandate has now been extended until January 1995, the scaling down of both ECOMOG and UNOMIL forces is gradually eroding this capacity [WFP 16/12/94].

The skeleton NGO presence in the field has meant that there are virtually no recent data on the nutritional status of the population in the conflict areas. However, it can be assumed that with near cessation of relief supplies to many areas, the nutritional situation, which was precarious before the withdrawal of international NGOs in August/September, has deteriorated further.

Overall, there are approximately 1.2 million people in Monrovia and the surrounding counties with access to food aid and they are not currently considered to be at heightened nutritional risk (category IIc in Table 1). The inaccessible population in Liberia (estimated to be 405,000) can be considered to be at high risk (category IIa in Table 1).

How could external agencies help? In Liberia, general opinion is that current levels of insecurity prevent assistance to the estimated 400,000 or more people inaccessible in Liberia and Sierra Leone. International efforts that enhance security in Liberia would create more situations where relief deliveries can be carried out and allow a greater NGO presence.

Overall, resources made available by donors for those programmes that can be implemented seem to be adequate at present, at the food and non-food resources in the pipeline are reported satisfactory. In the few places, mainly near Monrovia, where access is feasible, logistics (fuel, transport, storage) are not reported as major problems. Equally, accessible camps and settlements (about 1.2 million people) have generally adequate food supplies. In the accessible areas, lack of information is not a major constraint, except perhaps in Guinea.

From information made available in the last two months, specified needs identified are as follows. In Montserrado county, efforts could be increased to improve sanitation and water availability in the camps for the displaced. In Gerahun camp in Sierra Leone there is an urgent need to increase measles immunization coverage.

RNIS 7, October 1994

The security situation in both Liberia and Sierra Leone has deteriorated over the past two months leading to further movements of refugees and internally displaced people. However, the total number of people affected by the continuing conflicts in the region is thought to remain stable at approximately 2.8 million. In Liberia the increased level of conflict has led to the virtual suspension of international NGO activities in those areas not controlled by ECOMOG. Cross-line and cross-border food convoys have also been suspended while waiting for security guarantees. The elections that were scheduled for the 7th of September 1994 were not held and a new agreement was signed on the 12th of September providing for elections on the 10th of October 1995 [UNHCR 15/09/94, WFP 5/08/94].

A. Liberia

Trend in numbers of refugees/displaced and proportion severely malnourished and at high risk (black area).

Current estimates of the populations affected by the conflict are summarized in the box below.

Location	Dec 93	Feb 94	April 94	June 94	Aug 94	Oct 94
Liberia	1,750,000	1,750,000	1,750,000	1,750,000	1,750,000	1,692,000
Sierra Leone	150,000	300,000	297,000	300,000	300,000	300,000
Cote d'Ivoire	250,000	250,000	250,000	234,000	250,000	325,000
Guinea	600,000	600,000	415,000	628,000	539,000	534,000
TOTAL	2,750,000	2,900,000	2,712,000	2,912,000	2,839,000	2,851,000

Liberia Although food distributions have continued regularly in the ECOMOG controlled areas of Greater Monrovia and Buchanan (approximately 1.1 million beneficiaries), humanitarian assistance within other parts of Liberia is now being provided on an ad hoc “hit and run” basis as security allows. Thus, urgently needed distributions to Bong county have been limited while most of Grand Gedeh, Rivercess, Central Bassa, Nimba and Sinoe counties have been inaccessible. Where possible deliveries of food and other basic needs are dropped along the main roads where the refugees and internally displaced people are concentrated [UNHCR 12/08/94, WFP 30/09/94].

Fighting is being reported between the LPC (Liberia Peace Council) and the NPLF in Bassa, Grand Cru and Grand Gedeh counties as well as within factions of the NPLF. There are approximately 30,000 people near Ggarnga in “a desperate security situation” and 500,000 are displaced by expanded fighting and the loss of NPFL command in Bong and Nimba counties [WFP 5/08/94, WFP 30/09/94].

Before the security situation led to the evacuation of NGOs from Nimba county (now under ULIMO command), a nutritional survey carried out between 29th of June and 5th of July found 7.3% wasting with 2.6% severe wasting (see Annex 1 (1a)). Measles immunization coverage had improved since March and was recorded at 84% and the crude mortality rate was 1.1/10,000/day (almost 4 times normal). Numbers of children enrolled on the supplementary feeding programme had increased marginally since March 1994. These results are not particularly alarming, although the deteriorating security situation and subsequent lack of humanitarian aid could easily threaten the situation [MSF-B 5/07/94].

Reports from Margibi, Grand Bassa and Bong counties in July show an overall average of 10.6% wasting with 2% severe wasting (see Annex 1 (1b)). However, these same reports indicated extremely high levels of wasting in certain towns such as Garney with 42% wasting and 18% severe wasting, and Jaingbetta with 26% wasting. The last food distributions to these towns was in October 1993 where poor water and sanitation and the lack of accessible health services is thought to have contributed to these crisis levels of wasting [MSF-H July 1994].

Fighting is also reported to be intensified in the areas of Bomi and Lofa counties. A recent influx of 4,500 Liberians from Lofa county into Guinea has been reported [WFP 5/08/94, UNHCR 15/09/94].

The 1.1 million people in Liberia receiving regular food aid are not currently thought to be at nutritional risk. The newly displaced/inaccessible population in Liberia (approximately 594,000) and the population in Sierra Leone (approximately 300,000) are at high risk (category IIa in Table 1).

How could external agencies help? The evacuation of NGO's and subsequent looting of materials means that when it is possible for NGOs to return, they will need to start virtually from scratch. Donors should, therefore look favourably on requests for funds. It would also be useful to enhance/support ECOMOG operations for “hit and run” deliveries. In Waterloo camp, the ration should be reviewed and another survey would be useful to monitor any potential decline in the nutritional status of the camp population.

RNIS 6, August 1994

The overall number of people affected by the war in the Liberia region has remained relatively stable at 2.8 million; however continued inter and intra-factional fighting in Liberia has led to further internal displacement affecting tens of thousands of people [UNHCR 18/07/94]. For example, the number of internally displaced people in Tubmanburg grew from a "handful" to 23,000 within a matter of days as factional fighting within ULIMO flared up in the Bomi county area [UNHCR 29/06/94].

A. Liberia

Trend in numbers of refugees/displaced and proportion severely malnourished and at high risk (black area).

The disarmament process is at a standstill, and it appears likely that elections scheduled for September will be postponed. This will inevitably delay any substantial repatriation programme although an average of 1,000 people have been returning every month from Guinea, Cote D'Ivoire, and Sierra Leone to areas in Nimba and Bong Counties as well as Monrovia and its environs [UNHCR 18/07/94].

The Liberia National Transitional Government, which was installed in March, has yet to extend its authority outside of areas under ECOMOG control [UNHCR 29/06/94].

Current estimates of populations affected are as follows:

Location	Dec 93	Feb 94	April 94	June 94	Aug 94
Liberia	1,750,000	1.750,000	1,750,000	1,750,000	1,750,000
Sierra Leone	150,000	300,000	297,000	300,000	300,000
Cote d'Ivoire	250,000	250,000	250,000	234,000	250,000
Guinea	600,000	600,000	415,000	628,000	539,000
TOTAL	2,750,000	2,900,000	2,712,000	2,912,000	2,839,000

Food distributions are continuing for approximately 1.1 million people in Liberia as security allows. However, there are still inaccessible areas in the South East, Lofa, Cape Mount and Bomi counties [UN Sec Coun. 24/06/94]. It is reported that half the affected population in Sierra Leone is inaccessible to assistance due to insecurity [WFP 5/08/94].

NPFL Area Intensified fighting between the NPFL and AFL (Armed Forces of Liberia) and the NPFL and LPC (Liberia Peace Council) has affected relief activities in areas such as rural Grand Bassa and Grand Gedeh counties [UNHCR 29/06/94]. Nevertheless cross line convoys from Monrovia into NPFL areas have continued [WFP 17/06/94].

Agencies continue to expand selective feeding programmes in Nimba county in response to evidence of nutritional decline as the hungry season advances. The limited general ration distributions reported in the previous RNIS are of particular concern in the Southern pan of the county where there are new influxes of displaced from Grand Gedeh and River Cess counties [MSF-B Apr 94].

ULIMO Area Fighting between factions of ULIMO has been reported in areas north of Tubmanburg and in Lower Lofa. There has also been military activity between a ULIMO faction and the LDF (Lofa Defence Force) in Upper Lofa near the border with Guinea. After many unsuccessful attempts to reach the 23,000 civilians trapped by the ongoing fighting in Tubmanburg (Bomi county) an ECOMOG escorted relief convoy was finally able to get through in mid-June and deliver both food and non-food aid relief items. Fighting continues to prevent any relief distributions in Upper Lofa county [UNHCR 29/06/94].

Given the security situation in Liberia and Sierra Leone, no large scale repatriation programme is immediately foreseeable. There have however been some small scale spontaneous repatriations [UNHCR-a 18/07/94],

The populations of Liberia and Sierra Leone that are inaccessible due to insecurity can be considered to be at high risk (category IIa in Table 1). The remainder of the affected population can be considered to be at moderate risk (category IIb in Table 1) due to sporadic insecurity (Liberia and Sierra Leone) and registration problems (Guinea). Those in Cole d'Ivoire are not currently thought 10 be at particular risk (category IIc in Table 1).

How could external agencies help? NGO's and UN agencies should be encouraged and supported in efforts to maintain a capacity to rapidly respond to the needs of newly displaced populations, perhaps requiring a decentralization of staff where security allows.

RNIS 5, June 1994

While the estimated number of people in the region affected by the civil wars in Liberia and Sierra Leone remains virtually unchanged at 2.9 million the installation in March of a transitional government in Liberia may now have broken the political stalemate [WFP 9/05/94]. In accordance with the peace agreement signed in July 1993, general elections are scheduled to take place in early September. It is thought that these elections may encourage many refugees to return to vote [UNHCR 13/05/94], although if current levels of violence continue this may be open to doubt.

A. Liberia - Trend in numbers of refugees/displaced and proportion severely malnourished and at high risk (black area).

However, the disarmament process is proceeding slowly with approximately 3,000 soldiers out of an estimated 50-60,000 surrendering their weapons. Coupled with various political impasses leading to factionalism within ULIMO, this timetable for elections now appears optimistic. A positive aspect of this is that it may provide greater time to raise funds for a repatriation programme [UNHCR 13/05/94, WFP 3/06/94].

Current estimates of populations affected are as follows:

Location	Dec 1993	Feb 1994	April 1994	June 1994
Liberia	1,750,000	1,750,000	1,750,000	1,750,000
Sierra Leone	150,000	300,000	297,000	300,000
Cote d'lvoire	250,000	250,000	250,000	234,000
Guinea	600,000	600,000	415,000	628,000
TOTAL	2,750,000	2,900,000	2,712,000	2,912,000

Over the past two months food distributions have covered 1.5 million displaced persons in Greater Monrovia and Bomi and Nimba counties. However, an estimated 300,000 people have been cut off from any assistance in South Eastern and Central Liberia and Upper Lofa due to insecurity. Most recently food distributions in the Western counties of Lower Lofa, Bomi and Cape Mount have been postponed because of continued fighting within ULIMO. Rural areas of Grand Bassa and Rivercess have not been accessible due to fighting between NPFL and LPC [WFP 9/05/94].

NPFL Area There are 455,000 people being provided with food aid in this area. Recent skirmishes between the NPFL and LPC (Liberia Peace Council in the central counties of Grand Bassa, Rivercess and Grand Gedeh have made these areas inaccessible [WFP 9/05/94].

A nutritional survey carried out in early April in Nimba county found wasting levels of 12.7% with 6.7% severe wasting (see Annex I la). In some areas wasting rates were above 20%. Measles immunisation campaigns started in February have increased vaccination coverage to over 72%. Throughout this crisis there has been an observed association between measles outbreak and malnutrition/oedema. Crude mortality rates were measured at 1/10,000/day (3 x normal) with an under-five mortality rate of 2/10,000/day, the latter especially is considered to be high. With the advent of the hungry season between May and September it is expected that the nutritional status of this population will deteriorate further unless there is improved food distributions in the region. There have been no organised general food distributions in Nimba county since September 1993. In February 1994 Lutheran World Foundation (LWF) began distributing rations of rice in the larger towns only, and is gradually expanding its distribution capacity [MSF-B 4/4/94, WFP 9/06/94].

Mean length of stay in supplementary feeding centres has been increasing and may reflect inappropriate rations for malnourished children as there was a temporary lack of corn-soya blend (CSB) available for feeding. Data from therapeutic feeding centres in Bong and Nimba county in March indicated 22% and 55% of admissions respectively as having oedema [MSF-B Mar 94].

ULIMO Area Internal fighting between different factions in ULIMO has led to the displacement of approximately 10,000 to the outskirts of Monrovia (ECOMOG controlled) and has prevented aid from reaching Bomi and Cape Mount counties [WFP 9/05/94]. Upper Lofa county remains inaccessible due to continued fighting within ULIMO. It is assumed that the approximately 175,000 displaced Liberians and Sierra Leonean refugees are in a critical state as they have been cut off from aid since December 1993 [UNHCR 13/05/94].

Overall, the population in Liberia with little or no food distribution are thought to be at high risk (category IIa in Table 1). Since fighting continues in Liberia, the rest of that population is considered to be at moderate risk (category IIb in Table 1).

How could external agencies help? Current external resource availability appears adequate for the accessible populations, however about half the affected population is inaccessible to external assistance. There are signs of a future break in food pipeline supplies for Guinea. Only rice and oil are being distributed in some camps; beans or another culturally acceptable source of protein are required. There are reportedly registration problems in some camps in Guinea - over-registration is reported, as well as under-registration. However, if the elections in Liberia do take place along with the anticipated repatriation then considerable funding will be needed for a repatriation programme and for the restoration of infrastructure to allow adequate resource provision in the early stages of resettlement.

There is a need to ensure a continuous supplies of CSB for selective feeding programmes.

RNIS 4, April 1994

Liberia

Trend in numbers of refugees/displaced and proportion severely malnourished and at high risk (black area).

A large proportion of the population of Liberia continues to be affected by the civil war while the unstable situation in Sierra Leone is also affecting large numbers. Estimates for the region are that 2,600,000 refugees and internally displaced people will require emergency assistance throughout 1994.

Estimates of populations affected are as follows:

		December 1993	February 1994	April 1994
Liberia		1,750,000	1,750,000	1,750,000
Sierra Leone		150,000	300,000	297,000
Cote d'Ivoire		250,000	250,000	250,000
Guinea		600,000	600,000	415,000
	TOTAL	2,750,000	2,900,000	2,712,000

In February, the security situation continued to deteriorate and expanded ECOMOG forces were deployed enabling cross-line convoys to deliver some relief food to Bong County (Gbanga). Fighting has been heaviest in Bong, Bassa, Lofa, River Cess and Sinoe counties [WFP 11/02/94]. An estimated 120,000 people in South East Liberia and 145,000 in Upper Lofa Country are currently cut off from food distributions (WFP 28/02/94]. However, recent agreement reached between the various warring factions has led to the tentative beginning of disarmament and the hope that previously inaccessible areas such as Upper Lofa County will become accessible to relief agencies. The planting season is now beginning - the fields are being prepared and seeds should be planted by June. It is reported that there is a shortage of seeds and an inadequate harvest would extend the region's dependence on external food sources [SCF 18/04/94]. Here are some details by area.

NPLF Area In Bong, Nimba and Grand Bassa Counties the low measles vaccination coverage of 44% prompted plans to expand the vaccination programme, starting in mid-February with Nimba County [MSF-B 21/01/94].

A survey conducted in January in Upper Margibi, Lower Bong and Grand Bassa Counties (population approximately 350,000) found 4.5% wasting with 1.5% severe wasting. However, crude mortality rates were 1.4-1.7/10,000/day (5 to 6 x normal) and under-five mortality rates were 3.7-5.6/10,000/day (see Annex I la). Food aid distributions are said to be insufficient (less than 1400 kcals/capita) with distributions primarily along main roads leaving large inaccessible and remoter areas unserved. As local harvest resources have largely been depleted, the impact of the coming rainy season in May is almost certain to cause a deterioration in nutrition and health status as food transportation becomes more difficult [MSF-H 29/03/94].

ULIMO Area Fighting is continuing throughout Upper Lofa, and currently there are no international organizations present in the area. There is, therefore, little information on the status of the resident population. The anticipated return of relief agencies and resumption of their activities once disarmament is properly under way will undoubtedly be hampered by the large-scale destruction of infrastructure which has reportedly taken place with this most recent round of fighting. Given the likely displacement of many Liberians from this region into Sierra Leone accurate assessments of numbers in this area are not available [UNHCR-A 24/03/94].

Overall, there is a gleam of hope in the situation in the Liberia region with the recent disarmament agreement, already leading to the return of a reported 19,000 refugees to Liberia from Cote D'Ivoire and Guinea [UNHCR-A 24/03/49]. However, 350,000 people with known high mortality rates are at risk (category I in Table 2) especially with the rains due in May. Those in inaccessible areas, such as Upper Lofa, (estimated population of 145,000), South East Liberia (estimated population 120,000) and the 82,000 refugees and internally displaced in Sierra Leone are also believed to be at high risk, although precise details of their condition are not known (category Ha in Table 2). The remainder of the affected population in Liberia are considered to be at moderate risk (category IIb in Table 2) with a tendency to improvement if the current disarmament process continues.

How could external agencies help? Part of the affected population is inaccessible for security reasons, and thus external assistance is not currently a major issue. However, the infrastructure within such areas has presumably been damaged, and donors could consider future funding needs for reconstruction as a prerequisite for effective rehabilitation when security allows access; transport, food, medical supplies, and personnel will also be likely to be needed. This currently applies to a population of around 265,000 in Liberia, and another 82,000 in Sierra Leone.

For the population accessible in terms of security, nutrition is improving with the harvest and with external assistance, which is understood to be presently adequately funded. However, remoter areas, even if accessible from a security viewpoint, are reportedly under served with relief food and supplies. The low coverage of measles immunization remains a major risk; stepped up immunization has begun, but additional funding may be needed for wide coverage.

RNIS 3, February 1994

The refugee and displaced population affected by civil war in the region is approximately 2,900,000 although the fluid security situation - particularly in Liberia and Sierra Leone - causes some refugees to spontaneously repatriate to newly liberated areas while other groups are displaced as the front line changes, e.g. 3000 people recently moved from River Cess and Grand Bassa into Buchannan while 11,000 Liberian refugees returned from Cote d'Ivoire, 800 Sierra Leonean refugees returned from Guinea and most recently 1200 Liberians fled to Guinea from Upper Lofa.

Current estimates of refugees/displaced people in the region are:

Liberia	1,750,000
Sierra Leone	300,000
Cote d'Ivoire	250,000
Guinea	600.000
Total	2.900.000

There are still major shortfalls in food and cash pledges for the regional operation so that food stock levels are already low. There are worries that food shortages may occur as a result in one or more of the affected counties in February/March. In general, the security situation is reported as continuing to deteriorate. [WFP 11/2/94]

Available surveys and information are summarized below.

Liberia General Although food and health service provision continued to improve throughout November and December administrative delays have hindered food aid distributions coming from Monrovia. These problems have been seriously compounded by events in early January 1994 when cross-line operations were suspended following ULIMO decisions to block all aid convoys along the Kakata-Gbaranga road which connects Monrovia to the northeast (e.g. Nimba County). Cross-border operations from Cote' d'Ivoire have been intensified in view of this with many NGOs involved.

NPFL Area (see Map 1B) A survey conducted by MSF- Belgium in December in Nimba County found 9.6% wasting and 4.3% severe wasting (see Annex I(la) for details) and a crude mortality rate of 1.5/10000/day, which is five times normal. Measles vaccination coverage of this population was 55%, indicating high risk of epidemic in case of an outbreak of measles. [MSFB-A 7/1/94]

In Grand Bassa county, MSF- Belgium conducted a nutritional survey at the end of November to assess the effectiveness of its feeding program after two months in operation. The level of wasting was 9.2% while severe wasting was 2.6% (see Annex I(1b) for details). These relatively low prevalences were considered to be due to MSF- Belgium's distributing half rations for two months at the time of the survey, and to the rice harvest in October. 44% of those under five in the survey were vaccinated against measles, again indicating a high risk of epidemic. The crude mortality rate was 2.1/10000/day, which is 7 times the normal rate. [MSFB-B 7/1/94]

Rapid assessments in January in Upper Margibi, Bong, Lofa and Grand Bassa counties showed between 15 and 55% wasting. Crude mortality rates were over 2/10000/day while under-five rates were over 5/10000/day. Five to eight time normal morbidity was mainly due to measles and diarrhoeal diseases (see Annex I(lc) for details). [MSFH 25/1/94] The situation in Upper Margibi is still out of control, but more assistance is becoming available.

ULIMO Area (see Map 1B) Renewed fighting in Vahun in Upper Lofa County has precipitated the departure of all international personnel. As Vahun is the base for all activities in Upper Lofa, this will adversely affect support to the estimated 175,000 refugees/displaced in the area and may provoke fresh refugee influxes into Sierra Leone. [UNHCR 13/1/94 and UNHCR-A 25/1/94]

The limited harvest in many of the war affected areas (noted in last RNIS report) will probably determine that prevalences of wasting will rise as limited food stores run out later in the year.

The population breakdown for those being provided with food aid are 455,000 in NPLF areas including 130,000 in Upper Margibi, Lower Bong and West Bong/East Lofa and 45,000 in Lac, Grand Bassa and Riverine counties in need of urgent attention. There are approximately 390,000 people in ULIMO areas and 175,000 of those in Upper Lofa are now made vulnerable due to the events described above. There are a further 905,000 (approximately 150,000 displaced) urban Monrovia, rural Montserando, Lower Margibi and Grand Bassa whose situation is stable. [SCF 1/11/93] Recent surveys show an improvement over information in December's RNIS.

An assessment was conducted in Waterloo refugee camp (5590 Liberian refugees) in Sierra Leone in early November. Results were that the refugees received, on average, 1270 kcal/person/day which includes 21 grams of protein/person/day. A rapid assessment was conducted using mid-upper arm circumference (MUAC) (see Annex I(1d) for details). The results of the survey showed 5.8% wasting (MUAC<12 cm) and 1.7% severe wasting (MUAC<11 cm). Results from other districts housing displaced populations were similar wasting levels were between 4-13.1% and severe wasting was 0.2-5%. The rates in this reported range are similar to prevalences observed in the non-displaced population in Sierra Leone. [AICF 4/11/93]

Liberia region It is estimated that 65,000 people in the Liberia region have high prevalences of malnutrition (category I in Table 2). This estimate includes half the population of Upper Margibi, Nimba, Bong, and Grand Bassa Counties based on survey data cited above. The other half of this population is considered to be at high risk (category IIa in Table 2). The population of Upper Lofa (175,000) can also be considered to be at high risk due to the departure of international personnel (category Ha in Table 2). An additional 45,000 people from Lac, Grand Bassa, and Riverine counties are also considered to be at high risk (category IIa in Table 2). As food has been reaching the other areas of the region, they are not currently considered to be in a critical condition (category IIc in Table 2).

RNIS 2, December 1993

Despite the signing of the cease-fire agreement in August 1993 the civil war in Liberia has continued unabated in certain areas. The usual population of Liberia is about 2.5 - 3 million. It is estimated that virtually the entire population is affected by the war and much of the population are now displaced or refugees. For example, WFP's current planning figure for emergency feeding is 2,675,000. Food is now reaching the majority of the displaced and war affected population in Liberia. However, there are substantial population groups who, due to insecurity, remain virtually inaccessible; such surveys as have been feasible show appalling levels of malnutrition and mortality among these.

Current estimates (November 1993) of the numbers of refugees and displaced people in the region are²:

Liberia	1,750,000
Sierra Leone	150,000
Cote d'Ivoire	250,000
Guinea	600,000
Total	2,750,000

² These numbers are compiled from many sources. They are intended to give a general idea of the distribution of refugees and displaced in the region. For this reason, they may not tie in exactly with other figures in the text.

Some 400,000 refugees are expected to return to Liberia, into NPLF areas (see Map 1B), although a new exodus of refugees from Lofa County to Guinea is also reported. There have also been reports of people fleeing North and East Lofa County into NPLF territory due to continued insecurity. Fighting has more recently been reported in parts of River Cess County between the NPLF and LPC (new rebel group) with the result that thousands of civilians are fleeing to Lac Plantation and Buchanan in Grand Bassa County.

Food distributions have been proceeding during October and November through a combination of air-drops (e.g. Vahun, in Upper Lofa County), cross-border and cross-line convoys (NPFL areas) and intra-area distributions. Levels of per capita food receipts are however not known, but have certainly varied depending upon a variety of security and logistical constraints. In some areas planned distributions have reportedly been slow or non-existent. In early November the detaining of WFP convoys by the security forces in Gbarnga led to the virtual suspension of distributions in former NPLF areas. The overall effect is undoubtedly that considerable numbers of people have not had access to adequate food supplies, and thus extensive malnutrition among these is to be expected. Direct information by area is given in the next paragraphs.

The total population in the NPLF area of Liberia (see Map 1B) is estimated at 820,000 of which 200,000 are in areas with reportedly catastrophic rates of wasting (Upper Margibi, Lower Bong and Lac Plantation and other parts of Grand Bassa County). The most recent survey in Upper Margibi County (October 1993) found crude mortality rates of 4.6/10,000/day (17 x normal) and a prevalence of 34% of children were severely wasted. More than 25% of children showed oedema. These results show no major improvement since similar findings in July. Food availability in October was reportedly low with only 30% of households expecting any rice harvest. Emergency food aid distributions in Upper Margibi County have been minimal; in September 67% of households received small amounts of rice, while in October coverage was only 17% and quantities were similarly inadequate.

The total population in ULIMO areas (see Map 1B) is estimated at 390,000 of which 100,000 are Sierra Leonean refugees. Of this population, 160,000 people are in Upper Lofa County where excessive rates of wasting were prevalent before a recent WFP/HCR intervention began. Most recent survey results from Upper Lofa County show considerable improvement with levels of wasting falling between August and October 1993, from 30% to 16% in Vahun Town, and 16% to 9% in Yandehun; however, there are still pockets where very high levels of wasting are evident, e.g. Lukasu (20%) and Yengema (25%). These crises appear to occur where subsistence production is minimal and/or where there are high concentrations of recent returnees or newly displaced.

The WFP current planning figure for emergency feeding in Sierra Leone is 300,000 of whom only 6000 are refugees. The remaining 294,000 are internally displaced due to civil conflict in Sierra Leone. Many of the displaced are in villages rather than in camps. A recently completed assessment (November 1993) found nutritional status was generally adequate. However, there may be small population pockets where lack of access due to insecurity prevents food aid delivery which is adversely affecting nutritional status. There are currently no hard data to verify this.

We have had no recent reports on the Liberian and Sierra Leonean refugees in Guinea and Cote d'Ivoire and assume that these populations remain in stable condition.

World Food Programme requests to donors for non-food aid requirements (administration, logistics etc, of $4.2 million for 1994) have largely remained unmet.

Based on the above information, the populations in the region are categorized in Table 2 as follows. 100,000 are currently severely malnourished in Liberia (Table 2, column I). This refers to Upper Margibi County and parts of Upper Lofa County. A further 260,000 are considered to be at high risk (Table 2, column IIa) as they are in areas where fighting continues and access is restricted. The remaining 2,205,000 people (Table 2, column III) represent: those receiving food aid in Liberia in relatively secure areas and with some access to harvests; internally displaced in Sierra Leone; and refugees in Guinea and Cote d'Ivoire.

The situation could slowly improve for the majority of the population in Liberia in the coming months if means of delivering food aid are improved; harvesting took place from October, but production was extremely poor with reduced areas planted due to the conflict. However, the unpredictability of the fighting may well determine that new population groups are put at risk and that population groups currently in crisis remain so.

RNIS 1, October 1993

The overall population of refugees/displaced people in this region is nearly two million (estimated as 1,986,000). The majority of this population are in a stable condition, not currently reported to be at unusual risk of malnutrition. However, the fighting that flared up again in the Liberian civil war in November 1992 prevented UNHCR from assisting a population of more than 100,000 Sierra Leonean refugees stranded in the isolated North of the country (Upper Lofa County). Surveys at that time found prevalence of wasting to be extremely high (34%) in some groups.

Very recently it was reported that a further 80,000 people in Upper Margibi County (see Map 1) are in "a catastrophic situation since several months" (see below).

Recent reports (20 August 1993) indicate a continuing nutritional and health crisis now affecting 175,000 Sierra Leonean refugees and displaced Liberians fleeing the conflict, in Upper Lofa County (see Map 1). Recent nutritional survey results in Vahun town (population of 20,000) gave levels of 30% wasting including 6% severe wasting in young children. Rough mortality estimates in the town of Yandehun (population of 10,000) are 3/10,000/day (10 x normal). Staple foods are unavailable and markets are non-existent. A lull in the fighting has allowed relief supplies to trickle into the area but transport vehicles and washed out roads and bridges prevent full emergency deliveries. There have been limited deliveries of rice in Vahun amounting to less than 20% of a full ration but there have been no distributions in villages along the road north of Vahun. Selective feeding established for vulnerable groups is at best a holding operation to minimize increased mortality but it is expected that the situation will deteriorate as the general food basket remains inadequate due largely to the logistical difficulties.

The situation is further aggravated by contaminated drinking water, and inadequate sanitary facilities. Cases of measles have been reported in all villages in this area.

WFP is currently planning an air-drop operation to assist this population cut-off by the rainy season.

Reports are also coming in of an emerging crisis in Upper Margibi County affecting 80,000 people, mostly displaced from Cape Mount, Bomi County and Kakata in February and March. Most of this displaced population (between 60-80% of the present population in Upper Margibi County) stay with relatives with whom they share available food resources. Extremely limited quantities of rice have been brought in "cross-line" by the UN but estimates are that this has barely provided food for five days. Rough nutritional surveys in July and August found prevalences of kwashiorkor (severe oedematous malnutrition) of 39% and 45% respectively. (Given the very high mortality risk of kwashiorkor, these rates if true are quite extraordinary, and do indeed indicate a catastrophic situation.) Severe wasting is estimated as 6%. Extremely high mortality rates of children between 0-15 years were recorded at 14.4/10,000/day (50 x normal -- at this rate half the population of that age would die within a year). This area, which is also close to the front line, has been cut-off from outside food and relief supplies for several months due to the embargo imposed by ECOMOG.

Information for September from Upper Margibi County indicates a crude mortality rate of 10.2/10,000/day (equivalent to 37% of the population dying within a year). The mortality rate for children under five was measured at 42.5/10,000/day. This rate indicates all children under five would die within eight months.

A nutritional survey done in a population affected by the war but not displaced, the South East region of Liberia (estimated population of 112,000), showed 10.4% wasting and 4.2% severe wasting. The prevalence of kwashiorkor was measured at 3.4%.

Reports are also coming in (10/9/93) of high levels of wasting in Nimba County (See Map 1).