United Nations System
Standing Committee on Nutrition

Nutrition Information in Crisis Situations - Sierra Leone

NICS 6, May 2005

Sierra Leone is recovering from a ten- year civil war which ended in 1999. A random-sampled nutrition survey was conducted in the Capital of the country, Freetown, in September 2004 (ACF, 09/04). The nutrition situation was under control (table 10).

Table 10 Results of a nutrition survey in Freetown, Sierra Leone, September 2004 (ACF-F, 09/04)

NICS 3, August 2004

The programme of voluntary repatriation of Sierra Leonese refugees was completed at the end of July 2004, after about 178,000 refugees were repatriated and 92,000 returned on their own to Sierra Leone (UNHCR, 21/07/04). It is estimated that about 15,000 refugees have chosen to integrate locally.

NICS 2, May 2004

UNAMSIL mandate has been extended until September 2004 and a residual force will probably remain till June 2005 (OCHA, 12/05/04). The security situation is calm but inflation is still on the rise (OCHA, 12/05/04). Some 7,400 refugees have been repatriated from Guinea (6,276) and from Liberia (1,175) by UNHCR since the resumption of the repatriation programme in January 2004 (OCHA, 12/05/04).

However, there are some weaknesses in the reconstruction process. According to the URD group, there is still a strong presence of humanitarian organisations during this rehabilitation phase, as was the case during the crisis, and some creative programmes are being implemented (URD, 12/03). On the other hand, UNHCR’s assistance to the returnees seems limited, there is a lack of housing programmes and the funding of the rehabilitation of the health system is insufficient.

NICS 1, February 2004

The situation continues to improve. Economic performance has been doing well in 2003, with a 6.5% growth in real gross domestic product, resulting from growth in diamond production, a modest increase in manufacturing output, expansion in construction activities and recovery in agriculture (UNSC, 23/12/03). In 2003, rice out-put was 78% of its pre-war level, owing to an increase in areas planted and to major distributions of seeds. Other crops, such as cassava, sweet potatoes and groundnuts have also recovered. However, inflation rose in 2003, with, among others, the food index rising by 5% and medicine and medical care by 24%.

There have been no significant influxes of refugees into Sierra Leone over the past six months. As of first January 2004, Sierra Leone hosted an estimated 70,000 Liberian refugees, of whom, 55,000 were settled in camps, 7,000 in urban centres and 7,500 at the border area (OCHA, 06/11/03).

An estimated 14,000 Sierra Leonean refugees are still settled in Liberia and about 15,000 Sierra Leonean refugees are hosted by Guinea (UNHCR, 31/10/03; OCHA, 19/12/03). About 4,000 refugees were repatriated from Liberia in 2003 (UNHCR, 31/10/03), and about 25,000 refugees were repatriated from Guinea (see RNIS 42) in the first semester of 2003. Repatriations from Guinea were suspended during the rainy season and resumed in December 2003.

Contrasted nutrition situation in refugee camps

Random sampled nutrition surveys were carried out in eight Liberian refugee camps in Bo, Pujehun, Kenema and Mayamba districts in October 2003 (UNHCR/joint, 10/03). At the time of the assessment, 55,000 refugees were estimated to be living in the camps. Refugees were supposed to receive a full food ration (2,100 Kcal), although some problems in the distribution were reported, especially in Bandajuma camp. Refugees were considered to be almost dependent on food distribution, although some were engaged in income-generating activities or in agriculture. Health care was provided in all the camps, as well as access to safe drinking water and to sanitation facilities. However, a below standard amount of water was reported in Largo and Taiama camps during the dry season. There were supplementary feeding centres in Jimmi Bagbo, Bandajuma, Gondama, Jembe, Gerihun and Largo camps. Severely malnourished children were referred to therapeutic feeding centres.

The nutrition situation was contrasted depending on the camps; it was average in Gondama, Gerihun, Jembe, Jimmi Bagbo and Tobanda (category III), whilst it was of concern in Bandajuma and Taiama (category II), and serious in Largo (category I) (see table 9). The mortality rates were under-control (see table 9), except in Jimmi Bagbo, where a Lassa fever outbreak occurred.

No hypothesis regarding the difference in the nutrition situation between the camps could be drawn from the survey report. According to the people interviewed during the survey, more than 95% of the families in all the camps were receiving the general distribution. However, the actual amount of food received was not documented. In Largo camp, where the nutrition situation was the worst, the proportion of the refugees who arrived in 2003 was 34% and significantly higher than in the other camps (see table 9); this may play a role in the high prevalence of malnutrition recorded. Moreover, Largo is a newly established camp, refugees may have less access to food or income outside the camps, compared to refugees in long-term established camps.

When compared to the prevalence of malnutrition recorded in August 2002 in six camps (see RNIS 40; see figure 3), the nutrition situation was better in October 2003 in all the camps, except in Bandajuma, where it has not changed and in Taiama where it has worsened.

Table 9 Results of nutrition surveys, refugee camps, Sierra Leone, October 2003 (UNHCR/joint, 10/03)

Camp	% of the families interviewed who arrived in 2003	% Acute Malnutrition (95% CI)	% Severe Acute Malnutrition (95% CI)	Crude Mortality (/10,000/day)	Under 5 Mortality (/10,000/day)	Measles immunisation coverage (%)*
Gondama, Bo district	15	4.8 (2.8-6.8)	0.1 (0.0-0.4)	0.1 (0.0-0.3)	0.3 (0.0-0.6)	97.8
Gerihun, Bo district	1.8	5.9 (3.6-8.2)	1 (0.7-1.3)	0.3 (0.1-0.4)	0.7 (0.2-1.2)	88.3
Jembe, Bo district	9.0	7.6 (5.1-10.1)	1.6 (0.4-2.8)	0.3 (0.1-0.5)	0.5 (0.1-0.9)	95.5
Jimmi Bagbo, Bo district	1.6	7.6 (5.0-10.2)	1.8 (0.5-3.1)	0.9 (0.6-1.1)	1.2 (0.6-1.8)	97.8
Bandajuma, Punjehun district	10.9	14.3 (10.7-17.9)	2.1 (0.7-3.5)	0.2 (0.1-0.3)	0.4 (0.1-0.7)	98.8
Largo, Kenema district	33.9	29.2 (25.0-33.2)	3.7 (2.0-5.4)	0.3 (0.1-0.4)	0.5 (0.1-0.9)	88.3
Tobanda, Kenema district	1.8	5.8 (3.7-7.9)	1 (0.8-1.2)	0.2 (0.1-0.3)	0.5 (0.1-0.8)	94.4
Taiama, Moyamba district	1.8	12.9 (9.9-15.9)	1.7 (0.6-2.8)	0.2 (0.1-0.3)	0	98.7

* According to cards and mothers' statements

Figure 3 Prevalence of acute malnutrition, refugee camps, Sierra Leone

Recommendations

From the survey in the refugee camps:

Continue to provide a full food ration
Maintain monitoring of the general food distribution
Continue to run existing SFCs and implement SFCs in Taiama and Tobanda
Strengthen active case finding and growth monitoring in clinics
Give refugees better access to land cultivation

From NICS in the refugee camps

Investigate the causes of the high rates of malnutrition recorded in some of the camps

RNIS 43, November 2003

Refugee movement has been low over the past months. Most of the refugees are settled in eight camps and some live in host communities. Seeds will be distributed to refugees, both in camps and in host communities, in order that they can improve their access to food (OCHA, 31/08/03).

RNIS 41, April 2003

Despite on-going conflict in neighbouring countries, the situation in Sierra Leone continues to improve with an economic growth of six percents and low inflation (WB, 26/02/03). However, the country has still to recover from a 10 year war. The World Bank has approved US$ 40 m in grants for reconstructing the health sector, rehabilitating basic education and boosting social action programmes (WB, 26/02/03).

A survey conducted by the Ministry of Health and Food Security and the FAO concluded that 70% of the estimated seed requirements were distributed before the 2002 agricultural season. The main constraints affecting agricultural production were long distances to collect inputs; lack of knowledge of agricultural practice and lack of seeds (OCHA, 28/02/03).

The security situation is still tense at the border with Liberia with reported incursions of the Liberians United for Reconciliation and Democracy (LURD).

Bombali district

A nutrition survey was carried out in Bombali Sebora chiefdom, Bombali district, in November 2002 (ACF-F, 11/02). This area was one of the hardest hit during the war; nearly all the population had returned at the time of the survey. The survey showed a prevalence of acute malnutrition of 8.0%, which included 0.5% severe malnutrition. No oedema was recorded. The malnutrition rate is average and a little bit higher than the prevalence of malnutrition which was found during a survey conducted in the whole district except Bombali Sebora chiefdom in February 2002, where the prevalence of malnutrition was 4.9%. The number of admissions to the supplementary feeding centre which covers the chiefdom remained stable over 2002. The measles vaccination coverage was 39% proved by card and 73% according to cards and mothers' statements. Several humanitarian assistance programmes are being implemented in the district, including health, nutrition and agricultural programmes.

Refugees

A new wave of Liberian refugees has been reported to have entered Sierra Leone because of renewed fighting and the relaxation of border controls by the armed forces in Liberia. As of 23 February 2003, about 9,000 Liberian and a few Sierra Leonese have entered the country since the beginning of the year (WFP, 28/02/03), adding to about 35,000 who had already taken refuge in Sierra Leone. UNHCR has opened a new refugee camp in Kenema district (OCHA, 03/04/03). Some of the refugees prefer to stay in villages near the border, in areas humanitarian agencies have difficulties to access. Resources will be shared between the resident population and the refugees, which may lead to food insecurity for both populations. RNIS has not received any recent nutrition information on the new refugee population; the nutrition situation of the previously refugee population seems stable. The repatriation plan of Sierra Leonese refugees from Guinea has resumed since the beginning of the year; 4,500 Sierra Leonese have been repatriated in January and February 2003 (OCHA, 12/03/03).

Overall

Whilst the situation of the population of Sierra Leone is improving, refugees from Liberia are still seeking refuge in the country. Their nutrition situation is considered at risk (category II).

Recommendations

From the ACF survey in Bombali:

Continue supplementary and therapeutic feeding programmes
Promote identification of malnourished children at PHU level
Strengthen routine immunisation activities in the PHUs

Sierra Leone

La situation continue de s'améliorer en Sierra Leone, avec une croissance économique de 6%, bien que le pays soit encore loin d'avoir effacé les dégâts de dix ans de guerre civile.

Une enquête nutritionnelle dans le district de Bombali a montré une situation nutritionnelle moyenne. Une nouvelle vague de réfugiés est arrivée en provenance du Libéria. Les réfugiés se sont installés dans des villages près de la frontière avec le Libéria où ils sont difficiles à atteindre en raison des mauvaises conditions des routes et de la sécurité volatile. Le partage des ressources entre la population résidente et réfugiée risque de conduire ces populations à une insécurité alimentaire.

RNIS 40, Dec 2002

The government of Sierra Leone has released a national strategy plan for 2002-2003. The plan has four main components: restoration of state authority, rebuilding communities, peace building and human rights, and restoration of the economy. The rebuilding of the community component includes IDP and returnee resettlement. Resettlement of some 10,000 remaining IDPs should be achieved by the end of 2002, while it is expected that 50,000 returnees will be repatriated and resettled in 2003.

Regarding the health system, the government's objective is that all community health centres and community health posts are rehabilitated and functional, that every district has a functional hospital, that the number of medical doctors outside of the western area is increased, and that the full immunization coverage is at least 60%. In 2002, 221 Peripheral Health Units were made functional, bringing the total number of PHU to 86% of the pre-war number. Two districts did not have a functional hospital. Full immunization coverage was low (34%) and maternal mortality rate had not decreased. A shortfall of qualified health staff outside of Freetown was one of the major problems of the health system. Access to PHU was worst in Kailahun, Kono, Bombali, Koinadugu and Kambia districts.

Access to safe drinking water and sanitation will also be increased, especially in Kailahun, Kono, Bombali and Tonkolili, which have particularly low levels of access.

Shelter destruction levels are highest in Kono, Kailahun, Pujehun, Kenema and Tonkolili districts. Of the 340,000 houses which have been destroyed during the war, the government's objective is to have at least 20,000 houses reconstructed. Agriculture will also be revitalised with the objective of reducing by half the need for food aid in 2004 (GSL, 28/10/02).

Refugees

A UNHCR funding shortfall has highly compromised the ability to cope with the needs of the growing numbers of Liberian refugees. Only essential food, water and health services could be provided. It seems that due to inadequate living conditions in camps, a growing number of Liberians returned home (OCHA, 31/10/02). No major influx has been reported over the last months.

Nutrition surveys were undertaken by ACF-F in the refugee camps in Bo, Pujehun and Moyamba districts in August 2002 (ACF-F, 08/02). The results showed that the nutrition situation was of concern in most of the camps, and especially in Jimmi camp, whilst it was better in Taiama camp (see table). Under-five and crude mortality rates were, however, under control (see table).

Results of nutrition and mortality surveys in refugee camps in Bo, Pudjehun and Moyamba districts (ACF-F, 08/02)

Camps	Acute malnutrition	Severe acute malnutrition	Under-five MR (/10000/day)	CMR (/10000/day)
Jimmi	22.2	2.4	1.16	0.52
Bandaju-ma	14.5	3.5	1.4	0.48
Gondama	10.1	2.9	1.02	0.27
Gerihun	12.7	1.9	0.77	0.17
Jembeh	9.8	0.7	0.83	0.41
Taiama	6.6	0.4	0.31	0.12

A therapeutic feeding centre was operating in Bo hospital. Following the survey, supplementary feeding has been implemented in all the camps but Taiama (WFP, 06/12/02).

Repatriation of Sierra Leonan refugees from Guinea has been suspended at least to the end of the year, due to financial constraints (UNHCR, 12/11/02).

Internally Displaced Persons

As of October 2002, a total of 12,800 registered IDPs remained to be resettled; 3,800 were in the western area and sought return to Kailahun and M91; 9,000 were in Tonkolili district and will return to Makeni, Magburaka and Koidu. A further 4,000 have not yet been registered for return (OCHA, 31/10/02).

Overall - The nutrition situation of the Liberian refugees in south Sierra Leone was precarious in August 2002 (category II/III). However, it is hoped that stabilization in the number of refugees has allowed an improvement in their living conditions since that time.

Recommendations and priorities

From the ACF-F survey in refugee camps:

Strengthen/implement nutrition surveillance system in the camps
Implement supplementary feeding
Improve the capacity of Bo hospital to treat severely malnourished cases
Implement a follow-up survey early 2003

Sierra Leone

Le flux de réfugiés en provenance du Liberia s�est fortement ralenti ces derniers mois. Des enquêtes réalisées dans les camps de réfugiés des districts de Bo, Pujehun et Moyamba en Août 2002, ont montré des taux de malnutrition assez élevés (catégorie II/III) dans pratiquement tous les camps (voir tableau). Par contre, les taux de mortalité restaient inférieurs au seuil de gravité. Depuis, un programme de nutrition supplémentaire a été initié dans les camps, et l�on peut penser que la stabilisation du nombre de réfugiés a permis d�améliorer leur situation.

RNIS 39, October 2002

The overall situation within the country remains stable, whereas the border area with Liberia is still insecure. Six chiefdoms of Kailahun district have been declared safe for repatriation in August, whilst two (Malama and Kissi Teng) remain unsafe (OCHA, 31/08/02). President Kabbah asked UN forces to stay longer than late September. He is concerned about the destabilisation of the whole country, which could result from the on-going fighting in Liberia. He is also concerned that security will deteriorate when a war-crimes tribunal begins next year (OCHA, 10-09-02). The UN mission mandate has been extended for six months (UNSC, 24/09/02). The Sierra Leone government seeks to boost the economy in the country. The President pronounced a ban on illegal diamond mining in order to assure total control of diamond sales (AFP, 29/08/02). Diamond exploitation was one of the major causes of the civil war in the country.

Refugees, returnees and IDPs

Repatriation of Sierra Leonan refugees continues. Repatriation from Guinea resumed mid-August following a 40 day interruption due to a shortage of trucks (UNHCR, 16/08/02). Sierra Leonan refugees were also repatriated by boat from Liberia. It is estimated that 30,888 Sierra Leonans have been repatriated by UNHCR from Liberia this year and more than 18,000 from Guinea. More than that have spontaneously returned. UNHCR temporarily suspended repatriation procedures at the beginning of September as not many people seemed to want to return (UNHCR, 10/09/02). 270 from the 2,000 who sought refuge in Nigeria have expressed a willingness to be repatriated. The unaccompanied and separated minors, many of whom were born in Liberia, constitute a special issue (IRIN 20-26/07/02).

Liberian refugees continue to enter Sierra Leone but the flow is less than in previous months. As of August, 33,576 Liberian refugees were registered (see table).

Numbers of registered Liberian refugees in Sierra Leone, (OCHA, 31/08/02)

Location

Registered population

Bandajuma

4,814

Taiama

6,383

Jimmi/Bagbo

6,048

Gondama

3,267

Jembe

6,401

Gerihun

6,663

Total

33,576

Some refugees have been relocated from the Liberian border into camps in Bo and Kenema (OCHA, 31/08/02).

The government wants to reclaim government land and asked 10,000 IDPs in the Clay Factory camp near Freetown to move within three months. IDPs want more discussion for proper planing and more time to prepare the move (PANA, 18/08/02).

Resettlement and re-integration of the returnees

The last returnees from a transit area in Bari have been resettled to their home in eastern Kono and Kailahun district (IRIN, 10-16/08/02). Relocation of returnees from the Freetown camps continues (OCHA, 31/08/02). There is deep concern about the living conditions of resettled returnees, particularly in the most war-affected districts of Kono and Kailahun, where in some areas more than 70% of homes have been destroyed. According to USCR, some homes are occupied by squatters. Women on their own face particular obstacles to re-integration; they have difficulties reclaiming property, which traditionally belongs to men. They also experience violence. During the war 72% had experienced human rights abuses and more than 50% were victims of sexual violence. There is a call for new programmes especially for women, to help them both psychologically and materially (USCR, 19/07/02).

Tonkolili district

A nutritional survey was carried out by ACF in February 2002 in Tonkolili district in the Northern part of Sierra Leone (ACF, 02/02). People began to come back to Tonkolili district from March 2001. Three main food economy zones coexist in the district: the gold-based zone in the northeast, the agricultural and livestock subsistence in the north and trading in the south. The survey revealed a dramatic improvement in the nutritional situation since October 1997 (see table), the last previous survey in this district, which was thereafter inaccessible for security reasons. Although Tonkolili was one of the most affected districts during the war, the nutritional situation now seems under control. The measles vaccination coverage, however, is low with only 27.5 % coverage confirmed by card and 66.9 % when also taking into account mother’s statement. Health structures re-opened gradually and are supported by NGOs but the district is still not totally covered for health and water facilities. However, a high number of returnees is still expected and the situation has to be carefully monitored.

Malnutrition rate, Tonkolili district, Sierra Leone (ACF, 02/02)

October 1997

February 2002

Acute malnutrition (95 % CI)

18.9 % (15.4 23)

5.6 % (3.7 8.3)

Severe acute malnutrition (95 % CI)

3.1 % (1.7 5.3)

0.6 % (0.1-2.0)

Kenema district

Internally displaced old people

A survey was undertaken by Help Age International in Kenema district, Nongowa chiefdom, on vulnerable internally displaced elderly (Helpage, 02/02). The survey targeted the most vulnerable (see annex), and is not representative of the entire population of the elderly. Those surveyed were aged 70 to 85 years. Among them, 80 % presented a BMI < 18.5, defined as malnourished, which included 46 % with a BMI < 16, defined as severe Chronic Energy Deficiency; 78 % presented a MUAC < 22 cm. Main food sources were relief food (41%), wood selling (27%) and gardening (8%). This pattern was completely different from that of 1990, defined as a normal year, when the major food sources were farming (57 %) and cash crop sales (24 %). The use of the available food also changed, 54 % of the food being eaten at the time of the survey versus 38 % before the war. Slightly more food is sold than before and only 3% of food is stored compared to 18% before war. The major income sources are wood selling (48%), relief items (25%), begging (9%) and gardening (8%). Before the war, the major sources of income were farming and cash crops (69%) followed by trading (10 %) and livestock (8%). This survey, even if only targeted on the most vulnerable of the elderly shows a poor nutritional status and reflects the change in the food security situation after ten years of war.

Resettlers

A joint assessment mission was carried out by UNOCHA, NaCSA and Africare in Dama, Koya and Gaura chiefdoms in August 2002. There were 6,000 IDPs who had resettled at that time, increasing the local population by 90% (OCHA, 31/08/02). According to former IDPs, they are struggling more for water or school fees for their children than previously. However, some reported enhanced well being, compared to when they lived in the camp.

Kailahun district

Kailahun district is hosting both refugees from Liberia as well as Sierra Leonean returnees from Guinea and Liberia. A food security survey was carried out by ACF in May 2002 in Kissi Tenge, Kissi Tongi, Kissi Kama and Luawa chiefdoms (ACF, 05/02). At the time of the survey, these areas had not been declared safe. Housing, water and sanitation facilities and health facilities had been destroyed.

Liberian refugees

Refugees are settled either in camps (Buedu, 1,268 people; Kailahun, 250 people) or in communities in temporary shelters. Most of refugees prefer to stay in the Northern area, because they are closer to home; they are waiting for relatives; they share the culture and language of the host population and they can cultivate fields. The newly-arrived refugees reports to have come with very few belongings, and with no food or seeds. Initially, they were provided with food and shelter by the host community on their arrival. However, this has not been the case for some time because the food stock of the host community has been exhausted. Both refugees and host communities rely on wild food. About 70 % of the refugees in camps are considered poor, whilst 20 % are considered as middle-income and 10% as better off. Wealth was mostly related to the number of people in the family (the largest families are poorer), the land cultivated (poor families have less land) and time of arrival; the newly-arrived being more vulnerable. Refugee income-generating schemes are numerous: palm fruit and kola nut harvesting and processing, collection of pepper bushes, farming, labouring for residents, casual labour, wood selling, stick collection for reconstruction and water collection. They are in competition with returnees for jobs.

Sierra Leonean returnees

Sierra Leonean returnees came back both from Guinea and Liberia, some because of the recent insecurity in Liberia. Returnees from Guinea have been able to come back with some food, unlike those from Liberia. The middle-income and better-off returnees from Liberia have been supported in terms of food and housing material by their families who had remained in Sierra Leone. They were also able to come back with some belongings. The poorest, including female headed households, came without anything. Most of the interviewed households spontaneously returned and did not receive any food assistance. The food sources varied (see table).

Food sources of Sierra Leonan returnees in Kailahun district (ACF, 05/02)

Poor

Middle

Better-off

From Liberia

From Guinea

From Liberia

From Guinea

From Liberia

From Guinea

Own crop (%)

0

20

0

20

0

30

Wild food (%)

25

25

20

10

10

5

Exchange/
labour (%)

20

30

0

0

0

0

Purchase (%)

15

15

40

40

40

50

Kinship (%)

10

10

20

20

30

5

Food aid (%)

10

10

10

10

10

10

Loan (%)

20

10

10

Sources of income were much the same as for Liberian refugees but also included petty trading. The better-off households coming from Guinea also received remittances from relatives in Guinea or other countries. This represented about 30% of their income.

Having seeds for plantation was one of the major issues for the returnees. The major source of seeds for the poorest households was labour exchange, followed by loans, family support and humanitarian aid. Middle-income households also mostly relied on labour exchange and loans, while the better-off were supported by loans and family support.

Depending on the date of their arrival, returnees face different problems. Returnees who arrived before January 2002 were able to cultivate different sorts of crops such as rice, cassava, groundnuts and vegetables. They have to share with newly-arrived members, which reduces food security in the long term and makes difficult to save seeds.

Those who came in April missed the registration for seed distribution. They had to borrow seeds and will have to reimburse these from their harvest.

People who came in April-August will mostly depend on relief food and casual work.

Kono district

Kono district has been one of the districts most affected by the war. Since the war ended, farming, cash crop plantation, trading and diamond mining have resumed. About 90% of the structures were destroyed during the war, including health facilities. Water and sanitation facilities are almost non-existent. Of the resettled community, 60% came from Guinea, 30% from Bo/Kenema and 10% from bush camps within Kono district. ACF carried out a food security survey in the district in May 2002 (ACF, 05/02)

The returnees have the same sources of income as before the war but they are carrying them out on a smaller scale because of a lack of means: farmers don’t have enough crops, diamond miners lost their equipment, cash crop farmers lost their marketing network. The majority of those who returned at the beginning of the year have been able to plant several crops and have also been involved in several kinds of income-generating activities.

The others did not plant upland rice (normally in May-June) because of a lack of seeds or late returns. They plan to plant swamp rice in September, obtaining seeds from relief or using their incomes. The large cacao and coffee plantations have suffered from the war and it will need some time to have yields similar to those before the war. The palm oil harvest from April to June is one of the major sources of income for returnees. Seeds were obtained mostly from purchase or labour exchange, followed by loans and humanitarian aid. The sources of income for the poor are mostly the sale of vegetables and bush crops. For others it is contract labour, wood selling and palm oil processing. Middle-income households derive their income mostly from palm oil processing and small trading, whilst the better-off rely on palm oil processing for 70%. Returnees mostly depend on purchasing their food (see table).

Source of food, returnees, Kono district (ACF, 05/02)

Poor

Middle

Better-off

Purchase (%)

35

50

65

Loan (%)

25

20

15

Gift (%)

20

15

5

Humanitarian aid (%)

10

10

10

Bush harvest (%)

10

5

5

Overall Returnees are facing difficult conditions in districts particularly affected by war. They lack basic services and infrastructure such as shelter, health care, water and sanitation. They are, however, considered at moderate risk of malnutrition (category III). The situation of the new Liberian refugees is unknown (category V).

Recommendations and priorities

From the inter-agency assessment in Kenema district

Support existing and resettling households with seeds and tools.
Continue efforts to re-unify families
Enhance the provision of basic services such as health, education and agriculture
Raise protection issues to combat and alleviate the abuse many have suffered.

From the ACF food security survey in Kailahun district

Food aid and rice seed distribution are not recommended along the border with Liberia because it could increase the risk of looting
Short season seeds (cassava, vegetables) should be distributed in non-border areas
Ensure registration of unassisted spontaneous returnees
Follow-up of the food security situation.

From the ACF food security survey in Kono district

Provide food and non-food assistance to spontaneous resettling households
Distribute food for agriculture
Distribution seeds and tools according to the planting seasons
Ensure registration of unassisted spontaneous return
Rehabilitate or construct water, sanitation and health facilities
Undertake a nutrition survey

From the RNIS

Ensure basic services access to the population
Strengthen livelihood of the returnees
Provide particular attention to female headed households

Sierra Leone

Le mandat des forces de maintien de la paix a été prolongé de 6 mois. Le rapatriement des réfugiés sierra léonais continue, environ 31 000 d’entre eux ayant été rapatriés du Libéria, et 18 000 de Guinée par le HCR, un nombre encore plus important étant revenu spontanément. 30 000 Libériens sont actuellement réfugiés en Sierra Leone, dont un nouvel afflux depuis le début de l’année 2002.

Une enquête nutritionnelle a été menée en février 2002 dans le district de Tonkolili par AcF. Les taux de malnutrition y étaient assez faibles: 5,6% de malnutrition aiguë, incluant 0,6 % de malnutrition sévère, montrant une nette amélioration depuis la dernière enquête réalisée en octobre 1997.

Néanmoins, de nombreuses personnes sont en train de se réinstaller dans le district et la situation doit être suivie de près.

Helpage a réalisé une enquête chez les plus vulnérables des personnes âgées déplacées. Cette enquête même si elle n’est pas représentative de toute la population âgée déplacée a révélé que 80% des personnes de l’échantillon présentaient un BMI inférieur à 18,5: il s’agit donc d’une situation très précaire pour cette population vulnérable qui vit essentiellement de vente de bois, d’aide alimentaire et de mendicité.

Les districts de Kailahun et de Kono ont été parmi les plus touchés par la guerre qui a causé la destruction d’un grand nombre de bâtiment et de maisons. De nombreux Sierra Léonais qui avaient fui s’y sont réinstallés. Il est urgent de mettre en place dans ces districts des infrastructures garantissant l’accès des populations aux services de base, avec une attention particulière pour les femmes seules, connaissant le plus de freins à leur réintégration. De nombreux Libériens trouvent aussi refuge dans le district de Kailahun, frontalier avec le Liberia. Bien que la situation nutritionnelle de ces réfugiés ne soit pas précisément connue, ils sont considérés comme à risque.

RNIS 38, July 2002

Sierra Leone has and is still suffering the effects of more than a decade of civil war that has left much of the country in ruins, destroyed the economy, resulted in the mass displacement of population, both within the country and as refugees in the region, and left many people in positions of extreme poverty and with limited ability to cope. The internal conflict has created a disastrous humanitarian situation, with Sierra Leone situated at the very bottom of the Human Development Index chart and its people amongst the poorest on earth.

The current outlook is greatly improved as a result of an ongoing peace process that has resulted in the official end of the war and the mass disarmament and demobilisation of the various warring parties. It is estimated that in total, in excess of 72,500 combatants, including 6,845 children, were demobilised (UNICEF 29/05/02). The peace process, and the stability that it has brought to the country, has been greatly facilitated by the presence of the largest UN peace-keeping force in world, the UN Mission in Sierra Leone (UNMASIL), which consists of 17,500 troops. The UN troops have played a vital role in overseeing the disarmament process in all areas of the country, ensuring the safe return of IDPs and Sierra Leonean refugees to their areas of origin.

An indication of just how far the peace process has come was given on 14 May 2002, when presidential elections were held with an estimated national voter turn out of 80 %. The elections were won by president Ahmad Tejan Kabbah with 70.6 % of the vote and were remarkable for their apparent transparency and peacefulness (UNOCHA 31/05/02). This bodes well for the ongoing internal stability of the country and paves the way for the essential tasks of reconstruction and rehabilitation that are now essential for the development and the general well being of the country and its population.

Humanitarian Situation

The humanitarian situation has continued to improve over the reporting period as a result of a generally good internal security situation. This has been greatly assisted by the presence of UN-MASIL troops and the injection of 2 billion US dollars. However, the UN has announced that the peacekeepers will be downsized significantly from December 2002, although there are currently no details as to how many troops will be withdrawn (UNOCHA 28/06/02). Some observers have warned that although the situation is currently extremely encouraging in terms of internal stability, the potential for deterioration in the overall situation exists. This is a result of underlying ethnic tensions in the country and the need to address the enormous human rights violations that took place during the civil war. The high number of demobilised militias is also cause for concern because, although they have received assistance, it is often woefully late and inadequate. Many are reported to be disillusioned with the lack of employment opportunities and there is real concern that there could be a return to violence if the re-integration process is not speeded up to provide suitable livelihood opportunities (ICG 15/07/02).

The ongoing internal stability has meant that all areas of the country have now opened up to both humanitarian agencies and the government. This has allowed essential humanitarian assistance to reach areas that have been inaccessible for years. The findings of many assessment missions indicate that fighting has destroyed much of the infrastructure and that the rebuilding and rehabilitation of basic infrastructure is essential. However, the overall food security situation in the country looks promising as a result of both the good security and an agricultural recovery. There are estimated to be 32,000 IDPs throughout the Bo and Kenema districts as well as approximately 23,000 IDPs in Freetown camps (UNOCHA 31/05/02). The number of IDPs in camps has continued to fall as many have returned to their areas of origin. Resettlement was briefly stopped over the period of the election but resumed on 4 June 2002 in the formerly inaccessible areas of Kono and Tonkolili (UNICEF 10/06/02). The greatest challenge to the current humanitarian situation is the continued need to provide support to the large number of returning IDPs and refugees, all of whom require assistance to support them whilst they establish sustainable livelihood activities in previously war ravaged areas.

There is cause for considerable concern with the upsurge in conflict within neighbouring Liberia. The reporting period has seen the continuation of fighting between the Liberian army and rebels. The escalation in the fighting has been particularly focused in the north and west of the country and has forced tens of thousands of people to flee the instability and seek refuge in neighbouring countries. Sierra Leone has received some of the highest numbers of Liberians and the greatly increased return of Sierra Leonean refugees from camps near the Liberian capital. It is estimated that 17,000 Liberian refugees and close to 8,000 returnees have crossed the border into Kailahun and Pujehun districts, during June 2002 alone (UNOCHA 01/07/02). The problem for the ongoing humanitarian situation is that the vastly increased numbers of refugees and returnees is placing a huge strain on the humanitarian system and is threatening to side track the ongoing efforts to reintegrate tens of thousands of IDPs and returnees from other countries. There is considerable concern that the arrival of so many refugees and the close proximity of the conflict in neighbouring Liberia could potentially destabilise what is still a very fragile situation within Sierra Leone. The border areas are already considered to be very unstable and local media have reported that Liberian army and rebels have raided across the border in search of food (UNOCHA 02/07/02).

Northern Province

The good security in the country has seen a continued improvement in the general humanitarian situation in the northern province. All districts have been assessed and are now safe for returnees. Thousands have returned to Koindugu and Bombali, particularly from the camps in the Port Loko area, as well as from camps in the west. Work is ongoing to reconstruct basic infrastructure to ensure that returnees have access to basic amenities such as health care facilities and schools. The RNIS does not have any recent nutritional information from the province but the situation is not deemed to be critical at this time.

Western Province

The western province, particularly around the capital of Freetown, has traditionally been the site of many displacement camps. The current good humanitarian outlook has had a very positive effect on the situation on IDPs and returnees, many of who have returned to their places of origin. The beginning of June 2002 saw the start of a programme to resettle in excess of 12,000 IDPs from western camps to the eastern districts of Kono and Tonkolili. A further 3,640 IDPs were resettled in the Mile 91 area and there are more than 20,000 waiting to be resettled in the Kono, Tonkolili and Bombali districts (UNOCHA 31/05/02). The RNIS does not have any recent nutritional information from the area but the population is not deemed to be at high risk and reports indicate that there is an overall improvement in the economic outlook, particularly in the capital Freetown. This is likely to have a beneficial impact on employment opportunities and on food prices and should improve the general food security outlook for many.

Southern and Eastern Provinces

The security situation in the southern and eastern provinces has remained good and the general humanitarian outlook is extremely positive. However, there is considerable concern over the up-surge in violence in Liberia and the large number of refugees that are being driven across the border as a result. The conflict and the refugees represent a considerable threat to the humanitarian situation as their numbers place increasing strain on existing resources. There is also concern that armed elements could enter the country with the refugees and could provoke direct conflict between Sierra Leone and Liberia.

It is estimated that 17,000 Liberians have entered the country in June 2002 alone (UNOCHA 01/07/02) and are being sent to six camps in Gerihun, Jimmi Bagbo, Bandajuma Sowa, Jembe, Taiama and Gondama. The influx of refugees increased enormously with the attacks on the Sinje refugee camp in Liberia, close to the Sierra Leonean border, on 20 June 2002. The attack drove thousands into Sierra Leone and threatens to push many more to seek refuge. The majority of the new arrivals are in extremely poor condition, with agencies reporting that malnutrition amongst children is visible, although the RNIS has not received any direct nutrition reports on this population group. Many are being housed, temporarily, in the Zimmi way station and there is increasing pressure to open new camps to accommodate the increasing number of refugees. UNO-CHA has reported that they have developed a contingency plan for 50,000 refugees in February 2002 and that the current situation in Liberia has prompted the development of contingency plans for up to 125,000 Liberian refugees (UNOCHA 01/07/02). Present activities centre on the development of Gondama and the creation of two new sites at Mano Junction and Tobunda for an additional 39,000 people (UNOCHA 01/07/02).

Kailahun

Kailahun has traditionally been one of the most insecure areas of Sierra Leone but has remained conflict free over the reporting period. The area contains a large local population that has been struggling to absorb around 45,000 former Sierra Leonean refugees who have returned over the preceding months. The largest threat to the stability of the district and the humanitarian situation is the influx of Liberian refugees. The refugee influx is straining the already stretched resources of the area and the need for continued assistance is crucial. The RNIS does not have any recent nutrition reports from this area

Kenema

Traditionally, Kenema has been one of the districts most affected by the conflict in Sierra Leone. However, a marked improvement in the security situation has allowed the rehabilitation of vital infrastructure, the development of agricultural activities and the development of coping strategies. Nutrition surveys in the area over the past couple of years have indicated significant improvements in the situation of IDPs with prevalence of acute malnutrition falling below emergency thresholds (see RNIS 36 and 37). The entire district is estimated to contain approximately 418,000 people, with the regional town of Kenema containing about 25,000 IDPs in three camps (Goal 05/02). Goal conducted a nutrition survey in Kenema district in May 2002 that revealed an estimated prevalence of acute malnutrition of 5.7 % (W/Ht < -2 Z scores and/or oedema) including 0.8 % of severe malnutrition (W/Ht < -3 Z scores and/or oedema). Mortality rates were also estimated and Crude Mortality was 1.15/10,000/day and under-five mortality was 1.96/10,000/day. The estimated malnutrition indicates that the nutritional situation is not critical with prevalences below emergency thresholds and very much in line with recent past surveys. The mortality rates give more cause for concern with the CMR being above the emergency cut off and under-five mortality fractionally below. However, the survey explains that the recall period is 12 months and that it is possible that poor recall, including people who died more than 12 months ago, has artificially elevated the mortality (Goal 05/02). In general, the survey indicates a situation that is well within control and that has remained stable for some time.

Overall

The overall humanitarian outlook in Sierra Leone has continued to improve over the reporting period with more and more people able to return to their places of origin as a result of the cessation of violence within the country. The majority of local populations, displaced and newly returned, appear to have benefited from the security and are deemed to be at reduced risk (category III). The one point of concern is for the large number of Liberian refugees who have been driven to seek refuge in Sierra Leone. Reports indicate that they are arriving in very poor condition and in great need of assistance and should be considered to be at greatly elevated risk (category II).

Recommendations

From the Goal nutrition survey in Kenema distrct, May 2002

Continue the monitoring of the nutrition situation via regular nutrition surveys.
Follow up of the high mortality rates should be conducted.
Routine vaccination coverage should be improved.

RNIS 36/37, April 2002

Sierra Leone has suffered the effects of a decade long civil war that has devastated much of the country, destroying infrastructure, bringing about economic collapse and destroying livelihoods. One of the foremost features of the conflict has been the mass displacement of hundreds of thousands of people as both IDPs and refugees into neighbouring countries. This has created an extremely serious humanitarian situation, where the people of Sierra Leone are amongst the poorest on earth, with the country ranking at the very bottom of the Human development Index chart. The humanitarian situation has been primarily affected by the conflict, which has resulted in the systematic destruction of people s ability to cope with the situation. Consequently, many have been simply unable to meet their basic subsistence needs. This has been further exacerbated by the lack of access to many areas of the country by humanitarian agencies, due to the conflict and insecurity. As a result, the needs of many have gone unmet.

Despite the chronically poor humanitarian backdrop, the past year has seen improvements in the overall situation in the country. This has been brought about by a peace process that took shape in May 2001 through a meeting between the government and the Revolutionary United Front (RUF). The meeting established a cease-fire agreement and set the agenda for a Disarmament, Demobilisation and Reintegration programme (DDR). The peace process, and in particular the DDR, has benefited from the firm support and commitment of the government, the RUF and the international community. The process has been greatly helped by the presence of peacekeeping troops under the auspices of the UN Mission in Sierra Leone (UNMASIL). The UNMASIL peacekeeping force is now the largest of its kind in the world and consists of 17,500 troops (UN OCHA 30/11/01).

The DDR process was not without its setbacks. The process was delayed by the RUF over their dissatisfaction with the outcome of a National Consultative Conference in November (ICG 19/12/01). The disarmament process was officially declared completed on 17 January 2002, when it was estimated that 47,076 combatants had disarmed between 18 January 2001 and 17 January 2002 (UNSC 14/03/02). This also marked the official declaration of the end of the civil war and the lifting of a curfew that had been in place for the last four years (WFP 01/02/02). Positive developments have also been seen, with the announcement of parliamentary and presidential elections to take place on 14 May 2002. Overall, the situation in Sierra Leone is extremely positive but there is call for some caution as the situation is far from stable. There is concern that the elections may be premature with the peace process still ongoing and it is feared that they may result in renewed conflict in some areas (ICG 19/12/01). It is also important to note that there is an upsurge in conflict in Liberia, with reports that some RUF fighters are currently involved in the fighting there, which could present a potentially destabilising influence (ICG 19/12/01).

Humanitarian situation

The continued development of the peace process has had an extremely significant and positive impact on the humanitarian situation. Humanitarian access is now possible throughout the country and it has been announced that all but 11 of the 150 chiefdoms are safe for resettlement. The greatly improved overall security has allowed humanitarian agencies to access many areas that have been without assistance for some time. The resultant emerging humanitarian picture is one of very differing degrees of needs, which vary from area to area. The needs appear to be particularly high in newly accessible areas where the level of destruction of housing and basic infrastructure has been very great. As agencies move into these areas they are finding that the populations are in extremely poor condition, with high rates of malnutrition, morbidities and mortality. IDPs, refugees and returnees represent particularly vulnerable groups, many of whom are highly food insecure and dependent on humanitarian assistance.

As of January 2002 it was estimated that there were 204,000 registered IDPs being assisted by the international community and, as a direct consequence of the improved security, many of these have been returning to their areas of origin spontaneously or as part of organised resettlement programmes. The organised returns have taken place in three phases to date. The first and second phases took place from May 2001 to February 2002 and resulted in the resettlement of approximately 65,000 people (UN OCHA 18/04/02). The majority of the resettlements took place in the Western Area, Southern Province and the north western districts of Port Loko and Kambia. The third phase of the resettlement process began in March 2002 and it is hoped that this will see the permanent resettlement of 155,000 IDPs in the North and in the Eastern districts of Kono, Kailahun and Kenema. There have also been large numbers of Sierra Leonean refugees in the surrounding countries that have either returned or registered to do so. To facilitate the return of refugees from Guinea, the UNHCR has negotiated a land bridge across the Guinean/Sierra Leonean border and increasing numbers are choosing to return. The conflict in Liberia is also leading to increased returns from Liberia.

The returnees are increasing the pressure on the capacity of the humanitarian community to assist those in need within the country. Many are returning to areas that have very little in the way of viable infrastructure. This includes housing, education, water and basic medical facilities. It is also concerning to note that much of the land, although now free, has been uncultivated for long periods and is likely to require a great deal of work before it is productive. This makes the returnees extremely vulnerable and will increase their reliance on external assistance. The returnees are given a two month food package to help the resettlement process, but this thought unlikely to be sufficient. The task of getting people to return is proving relatively easy but the problem will be to get them to stay. It has been reported that a great many of the newly resettled are moving from area to area in an attempt to find a place where they feel they can establish themselves. The situation is further complicated by the arrival of increasing numbers of Liberians fleeing the insecurity in the north and western areas of Liberia. WFP reports that 10,700 Liberian refugees have arrived in Jendema on the southeast border of Siera Leone. The refugees are being assisted but place an added pressure on already stretched resources (WFP 15/03/02).

Northern Province

The RNIS does not have any recent nutritional information from the northern province. However, the situation is assumed to have greatly improved as a result of the prevailing security situation. All districts in the northern district have been assessed and announced to be safe for returnees, leading to considerable returns to the area, particularly as part of the phase II of the resettlement programme. In particular, the camps at Port Loko have closed as the camp residents have moved back to areas in the Port Loko and Kambia districts. There have also been returns from the camps in the west of the country to the same area. Assessments of needs in the area reveal that there has been very great destruction of property and infrastructure and it is imperative that new housing, schools and medical facilities should be provided soon to meet the needs of the increasing numbers of people in the area. The humanitarian response has been large. In terms of immediate needs, WFP continues to supply a food ration to vulnerable groups and other emergency programmes have focused on issues such as access to clean water and the provision of housing and medical facilities. Other programmes have begun to address long-term needs by rebuilding schools and developing income generation schemes. It is hoped that this will provide the impetus for further returns and provide essential services to the populations present in the area.

Western Province

The RNIS has not received any recent nutritional information from the Western province but the situation is assumed to be stable. There have been some movements of both returned refugees and IDPs from the camps around the capital Freetown to their areas of origin and it is hoped that this will relieve some of the overcrowding. There have been reports of increased rates of crime in and around Freetown, indicative of the high rates of unemployment and poverty in the area. However, it is hoped that the upsurge in the economy, that the peace process has brought, will provide employment opportunities for many of the residents of the area. A great many IDPs remain in the area but it is hoped that the increased security of many areas will ensure that they resettle in their places of origin over the duration of 2002.

Southern and Eastern Provinces

The security situation in the south and east has remained good over the reporting period and this has encouraged the dismantling of camps and return of IDPs and refugees to the area. The conflict currently taking place in Liberia does offer some cause for alarm as some areas border conflict zones in Liberia and have received a number of Liberians seeking refugee status. UNMASIL and the Sierra Leonean Army have increased their patrolling of the border areas to insure that there are no incursions by armed groups. However, as a result of the potential insecurity, some chiefdoms in Kailahun district have not been declared safe for returns. The area has also been known as the main diamond producing area within Sierra Leone and control over the diamonds was largely responsible for much of the conflict. Despite some minor clashes, the peace and DDR programmes went ahead and do not appear to have sparked further insecurity.

Kailahun District

Kailihun district is the only district where some chiefdoms are still deemed too insecure to return. This is as a result of continuing insecurity in Liberia just over the border. As a result, there are fears that armed groups could cross the border and destabilise the area. This has affected 11 chiefdoms which all border Guinea and Liberia. Kailahun has traditionally been one of the worst affected areas in the country due to its proximity to the border and to key diamond mining areas within Sierra Leone. A recent assessment of needs in the district revealed that there were high levels of destruction in all chiefdoms, especially along the border areas. This has meant that the short-term priorities for the area are shelter, WATSAN, road repair, seeds, tools and food aid. It is hoped that a concentration on key areas of need will help facilitate further returns to the area (UN OCHA 28/02/02).

Kenema district

Kenema district has seen a great deal of violence over the duration of Sierra Leone s civil war. However, security has improved over the past few years and allowed the population to develop some coherent coping strategies. Consequently, recent nutrition surveys in the area have not shown high prevalences of acute malnutrition. Merlin conducted a series of nutrition surveys in the district during September 2001. The first survey concentrated on Kenema town where it was noted that almost 40% of the population were displaced. The survey revealed a prevalence of acute malnutrition (W/Ht < -2 Z scores and/or oedema) of 6.3% including 2.6% of severe malnutrition (W/Ht < -3 Z scores and/or oedema) (Merlin 09/01). There was also 1.5% of oedematous malnutrition. The survey also estimated the under-five mortality rate and found it to be 1.72/10,000/day. The nutritional data does not indicate a critical situation, with the prevalence being below alarm thresholds. However, it is concerning to note that there appeared to be a relatively high percentage of Kwashiokor (oedematous malnutrition), which is associated with high rates of mortality. The rate of under-five mortality rate does appear to be elevated although, again, below emergency thresholds.

The second survey took place in the three IDP camps around Kenema. The camps surveyed are Lebanese, Nandeyama and Gofer and it was determined that they contained predominantly IDPs who were long term residents of the camps for periods of over one year. The prevalence of acute malnutrition (W/Ht < -2 Z scores and/or oedema) was estimated to be 4.2% and included 1.7% of severe malnutrition (W/Ht < -3 Z scores and/or oedema) (Merlin 09/01). This indicates that the nutrition situation is stable and well below emergency thresholds. In general, the camp residents were well covered for food, medical and water. Surveys were also conducted in the near by town and camps of Blama, where the nutrition situation was found to be similar to that in Kenema. It has since been noted that the Blama camps have been closed and many of the residents relocated. It was noted that the situation in the area has been calm since 1999 and that the majority of IDPs had been in residence for over 12 months. As a result, it is likely that the population has managed to establish livelihood patterns that enable them to meet the majority of their basic subsistence needs. However, it is important to stress that the continued stability of the nutrition situation is dependent on continued good security and the improvement of markets and employment opportunities.

Kono district

Kono district is in the north east of Sierra Leone in one of the major diamond mining areas. As a result it has experienced extreme insecurity for a number of years and has been inaccessible to humanitarian agencies until the middle of 2001. The area has suffered massive destruction, and many settlements have been destroyed as well as most of the essential infrastructure such as health systems. It is reported that the area has had virtually no health care for the past 10 years. The continuation of the peace process has seen an opening up of the area and there have been large-scale returns of previously displaced populations. In September 2001, World Vision conducted a nutrition survey in three of the most southern chiefdoms of the district in order to assess the nutritional situation of the newly accessible area. The survey found an estimated prevalence of acute malnutrition (W/Ht <-2 Z scores and/or oedema) of 17.1% and included 4.7% of severe malnutrition (W/Ht < -3 Z scores and/or oedema) (WVI 09/01). The survey also indicated that the Crude Mortality Rate (CMR) was 1.4/10,000/day and the under-five mortality rate was 6.1/10,000/day. These data indicate that the nutrition situation is extremely poor in the area, with both nutrition and mortality indicators all above emergency thresholds. It is also possible that the high infant mortality rate may have resulted in an underestimation of the true malnutrition rate.

The fact that the area has only recently been accessible means that there is no baseline data to compare the survey results to. The reason for the observed high prevalence of malnutrition is the acute vulnerability of the population as a result of the violence in the area and the resultant food insecurity and lack of access to basic subsistence needs. In this respect, the results are highly alarming but not surprising. However, it is hoped that increased access to the area will facilitate the provision of emergency relief and the rehabilitation and reconstruction of infrastructure. The improved security and access to subsistence needs will hopefully result in a substantial improvement of the nutritional status of the population. However, the survey also notes that large numbers of people are returning to the area and as a result there will be increased pressure on the already poor resources, with immediate emergency needs likely to remain high for some time.

Overall

The reporting period has seen the continuation of improvements to the humanitarian situation in Sierra Leone. This has been a result of the ongoing peace process, which has allowed for the opening up of much of the country that had previously been closed to humanitarian assistance. The opening up of new areas has revealed very differing emergency needs, with newer areas generally having a poorer humanitarian situation. Peace has brought about the return of both IDPs and refugees to their areas of origin, with this process set to continue for the duration of 2002. The returnees will require continued assistance before they are able to re establish livelihood activities. They are not considered to be at high risk (category III), however some of the newly arrived refugees are thought to be considerably more vulnerable (category II).

Recommendations

From the Merlin survey in Kenema district

Conduct nutrition and health education to address problems of child weaning practices.
Facilitate the reconstruction of basic infrastructure.

From the World Vision survey in Kono district

Improve the coverage of medical facilities in the district.
Rehabilitate wells and other water sources.
Improve vaccination coverage.

RNIS 35, October 2001

The reporting period has seen the continued improvement of the situation in Sierra Leone. Regionally there have been encouraging signs of a thawing of relations between the Mano River Union countries and closer cooperation. An indication of the greater cooperation between the countries is the announcement that Guinea, Liberia and Sierra Leone would deploy joint patrols along the border areas in an attempt to stop the proliferation of small arms (WFP 12/10/01). There has been no cross border fighting reported between the Revolutionary United Front (RUF) and Guinean forces since fighting earlier in the year. This is largely a result of the ongoing disarmament of the RUF within Sierra Leone. The Abuja peace agreement of November 2000 has continued to be implemented and the ceasefire has held.

The peace process has not been without its problems and on October 4^th the UN Security Council expressed concern over the slow pace of disarmament by the RUF in the Bombali zone of northern Sierra Leone (IRIN 04/10/01). The Process has also been strained by an announcement by the Sierra Leonean government that elections would be delayed until May 14^th 2002 and that the government would extend its current state of emergency, for the second time, by a further six months (OCHA 30/09/01). The announcement prompted the RUF to boycott tripartite peace talks in protest, however the talks have since been rejoined. Despite some tensions, the programme of disarmament has continued all across the country with OCHA reporting on October 15^th that 20,284 combatants from various fighting factions had disarmed since May 18^th 2001 (OCHA 15/10/01). This has been greatly facilitated by the presence of UN peacekeepers in the form of UNMASIL. As new areas have opened up, UNMASIL have deployed across the country and, in recognition of their roles in the disarmament process and in the facilitation of the delivery of humanitarian assistance, the UN Security Council has extended their mandate for a further six months from the end of September 2001 until March 31^st 2002 (OCHA 30/09/01).

The most important affect of the disarmament has been the opening up of areas of the country, which have been largely inaccessible to humanitarian actors, some for a number of years. For example, in August UNMASIL deployed peacekeeping troops to the northern district of Koinadugu, which had been occupied by the RUF since 1996 (IRIN 09/08/01). This has enormous implications for the development of the humanitarian situation within Sierra Leone because it allows access to vulnerable populations and is promoting the increasing return of displaced to their places of origin. The current security within the country is also allowing people to access their land and conduct farming activities and this combined with improved economic opportunities is likely to have a positive affect on the food security of the population in general and the IDPs and newly returned in particular. It is also important to note that the opening up of new areas is also revealing areas of acute need where infrastructure, particularly the health system, has been destroyed for some years as a result of fighting. Despite the increased access and higher demands for assistance, the consolidated appeal for Sierra Leone remains badly under funded at just over 40% by midyear. WFP have announced that they are expecting food pipeline breaks in December, with an expected shortfall in cereal of 3427 MT (WFP 12/10/01). This has created concern because it will constrain the ability of humanitarian agencies to respond to both the short and long term needs of the population (UNSC 07/09/01).

Displaced Populations and Returnees

The displaced population remains hard to estimated but OCHA reported at the beginning of August that 127,000 IDPs remained in camps, with a further 120,000 living with host communities (OFDA 03/10/01). The majority of the registered IDPs are in or near urban areas such as Freetown, Kenema, Bo and Daru and also in the Tonkilili and Port Loko districts. The number of people returning from Guinea has also increased and it is currently thought that an estimated 75,000 returnees have arrived back in Sierra Leone since the beginning of 2001. The majority of those officially repatriated by UNHCR and IOM have arrived in transit camps around Freetown. Concern has been expressed over overcrowding in the camps as a result of the numbers of returnees. UNHCR and the Sierra Leonean government have taken the step of asking 8,000 returnees in Jui, Waterloo and Lumpa camps in the Freetown area to relocate to resettlement sites in eastern and southern Sierra Leone. The move is an attempt to alleviate the overcrowding in the transit camps (IRIN 13/08/01). However, MSF have warned that the influx of returnees could potentially trigger a new emergency in the country as many return to areas of the country which are deemed secure. They point out that nine years of civil war has almost totally destroyed the health facilities in many areas, leaving low rates of vaccination and regular outbreaks of infectious diseases such as malaria, yellow fever, lassa fever, cholera and measles (IRIN 28/09/01). The fear is that the lack of infrastructure in many areas will contribute to high morbidity and mortality rates and ongoing food insecurity. This will slow down the rates of return and serve to maintain a high dependency on external humanitarian assistance.

Northern Province

The RNIS does not have any new nutritional information from the northern province but the situation is assumed to be stable as a result of the greatly improved security and access to the area by humanitarian agencies. The districts of Kambia, Bombali and Koinadugu have all seen disarmament take place and as a result IDPs have continued to return to their areas of origin. A local NGO Community Action Project have registered 15,000 IDPs moving from Port Loko to their home towns in Samu and Magbema chiefdoms in Kambia district. In some cases the areas of return have been inaccessible for a number of years and concern does exist that little infrastructure remains to support the increasing numbers of returning people. A recent UNICEF assessment in the Tonkilili district, on the existing water and sanitation facilities available to the population, indicated a very high incidence of diarrhoea. Many of the communities lack protected water sources and as a result many existing sources are supposed to be suffering from contamination (OCHA 30/09/01). These findings are concerning because of the need for good and adequate sources of clean water to support the increasing numbers of returnees to newly opened areas.

In an effort to start the reconstruction of essential infrastructure UNDP has started the construction of 400 houses and various public facilities in the Kambia district. There is also considerable work going into the rebuilding of medical facilities, including the re training of medical staff. WFP and its partners are also supporting returnees to resume farming activities with the distribution of seeds and tools and the implementation of a program called Food for Agriculture. It is hoped that the improved access to land will positively affect the food security prospects for the area.

Western Province

The RNIS has not received any new nutrition surveys on displaced populations in the western province. The large number of IDPs still remaining in camps in and around the capital Freetown remain dependent on food assistance and the over crowding in some of the camps has caused concern that the public health of the displaced could suffer. However, the overall security in the country will hopefully allow many of the displaced in the west to return to their areas of origin and become less dependent on humanitarian assistance.

Southern and Eastern Provinces

The security situation in the south and east has remained good despite some delays in the disarmament process. Notably the diamond mining zone of Kono is no longer under rebel control and it is hoped that this will go some way towards diffusing one of the chief sources of conflict in recent years.

Kenema district

Goal conducted a survey in Kenema district in August 2001. The target group of the survey was not specifically IDPs but the results give an important indication of conditions in an area that is likely to receive continued influxes of returnees seeking to re-establish themselves. Some areas of the district were not accessible to the survey teams as a result of insecurity or of rain blocking road access. The survey was conducted on children under the age of five and estimated a prevalence of acute malnutrition of 6.2% (W/Ht <-2 Z scores and/or oedema) including 1.6% severe malnutrition (W/Ht <-2 Z scores and/or oedema). The survey also measured mortality and estimated an under-five mortality rate of 1.8/10,000/day. Both the acute malnutrition and mortality rates are below alert thresholds and the situation is not deemed to be critical (Goal 08/01). WFP report that both Merlin and Goal have seen a drastic drop in the number of admissions to their selective feeding programs and it is thought that this indicates an improvement in the overall situation in Kenema (WFP 02/11/01).

Kailahun

The situation in Kailahun is considered to be precarious as a result of its proximity to the conflict- ridden Lofa County in neighbouring Liberia. This has resulted in a stream of Liberian refugees entering the country, often in extremely poor condition. It is currently unclear how many have crossed into the country but the number is believed to be in the thousands with UNHCR reporting that over 2,500 are being temporarily accommodated in the township of Bandajuma before being moved to a new camp in Pujehun district. WFP have expressed concern over the fragility of the food security situation in the Kailahun district and in August reported that there was little or no rice in the major trading centres of Kailahun and Pendembu (IRIN 22/08/01). In a recent move, UNAMSIL have deployed in the district and it is hoped that this will enhance the security in the area and allow greater access by humanitarian agencies (IRIN 26/10/01). The RNIS has not received nutrition reports from the area but the nutrition situation is understood to be extremely poor.

Overall

The reporting period has seen an improvement in the humanitarian situation in Sierra Leone with the continued implementation of the Abuja peace accords and the disarmament of various rebel groups. This has led to the crucial opening up of many areas of the country to both returnees and to humanitarian agencies. As a result of the improved security and access, the food security outlook in the country is good although many still rely on humanitarian assistance. In general the situation of IDPs remains fair (category III) and if the security situation permits continued returns, the situation is likely to improve further. However, concerns about the poor infrastructure within the country and the affect this may have on returning populations still exist. Fighting in Liberia and the resultant flow of refugees into the east of the country has left some areas of acute vulnerability (category II).

Recommendations

Increase support of the inter agency appeal
Support efforts to rebuild the infrastructure of newly secured areas

From the Goal nutrition survey (Goal 08/01)

Phase out existing feeding centres when the number of beneficiaries drops sufficiently
Conduct a program of health promotion and in particular on malarial prevention
Implement water and sanitation activities.

RNIS 34, July 2001

Displaced Populations and Returnees

Northern Province

Western Province

Southern and Eastern Provinces

Kenema district

Kailahun

Overall

Recommendations

Increase support of the inter agency appeal
Support efforts to rebuild the infrastructure of newly secured areas

From the Goal nutrition survey (Goal 08/01)

Phase out existing feeding centres when the number of beneficiaries drops sufficiently
Conduct a program of health promotion and in particular on malarial prevention
Implement water and sanitation activities.

RNIS 32/33, April 2001

The past year has seen big changes in both the political and humanitarian contexts in Sierra Leone and the region at large. In May 2000 there was a breakdown of the Lomé Peace Agreement after the attack and detention of hundreds of UN peacekeepers by the Revolutionary United Front (RUF). This sparked a dramatic deterioration in the security situation in the country that displaced thousands of people and resulted in the evacuation of many international aid agencies and the temporary suspension of humanitarian activities. The spread of conflict to the south eastern forest area of Guinea, has resulted in the return of tens of thousands of Sierra Leonean refugees who had been staying in camps there (UN 2001).

Since the end of last year the security situation in Sierra Leone has been relatively calm with signs that rebels were seeking to re-enter the peace process and in November a new cease fire agreement was signed between the government of Sierra Leone and the RUF rebels. This has been accompanied by a more welcoming attitude by the rebels to humanitarian assistance with the RUF agreeing to allow humanitarian agencies to operate unhindered in RUF held areas of the country. However, some areas, particularly in the north and east of the country, remain humanitarian 'no go' zones. The insecurity in the north has continued to resulted in the unequal distribution of aid (UN2001).

Displaced populations

The insecurity in many areas and the fast changing situation make the estimation of numbers of internally displaced extremely difficult, but at the end of 2000 there were approximately 400,000 registered IDPs in the country with over 50 % of them newly displaced since May 2000. The critical developments on the Sierra Leone-Guinea border have prompted an armed response from Guinean security forces who have shelled Sierra Leonean territory in an attempt to prevent incursions from rebel groups. This has resulted in large-scale population displacement from the affected areas that have dramatically added to the IDP caseload. Original projections by WFP were for a caseload of 520,000 in 2001 and this has already risen to 544,050 which has major resourcing implications. There are 170,000 people in eighteen official camps in safe and accessible areas. The UN also estimates that there could be as many as a million more internally displaced, who have been absorbed by host communities. This means a current total of about 1.5 million people. Women and children make up to 70 % of the displaced caseload (NRC 2001; UN 2001; WFP 16/03/01).

The vast majority of the registered IDPs have sought refuge in the Tonkilili District (including Mile 91) and the Port Loko District (including the Lungi area). Other areas of concentration remain urban areas such as Freetown, Kenema and Bo that offer some protection from rebel attack. A registration of IDPs in Lungi has indicated 28,000 people who had fled areas in Kambia as a result of the conflict on the border with Guinea (NRC 2001; WFP 09/03/01).

In an attempt to relieve the pressure on camps, a National Resettlement Day was launched on March 20^th. IDPs and returnees volunteering for resettlement will receive a two months food ration, but inertia to the idea is very great due to a perceived lack of infrastructure in the areas concerned. WFP reported that 30,921 people in the Western Area and 12,458 people in Port Loko have currently registered for resettlement but it is unclear how many will actually follow it up (WFP 30/03/01).

Returnees

The outbreak of violence in the south eastern Forest Region of Guinea is a new development in an already tense regional situation, which has created an acute humanitarian emergency for thousands of Sierra Leonean refugees. However, the development of fighting within Guinea has resulted in considerable hostility towards the refugees, by both the Guinean authorities and the general population. This has resulted in the return of an estimated 50,000 to 60,000 refugees to Sierra Leone since fighting broke out in September. It is suggested that between 2,000 and 2,500 refugees are returning to Sierra Leone each week (NRC 2001; UN 2001 UNICEF 31/03/01; USAID 20/04/01).

Total numbers of returnees are difficult to follow because some are choosing sea routes from Conakry aided by the UNHCR and the International Organisation for Migration (IOM) whilst others have made their own way across the borders of both Liberia and Guinea and have not been officially registered. The IOM report that they have transported 22,000 returnees from Guinea since January this year. The situation for many remains critical as they find themselves unable to return to their areas of origin. Many come from areas such as Kambia, Kono and Kailahun which remain highly insecure. As a result returnees find themselves in vastly overcrowded camps or staying with host communities who are themselves experiencing great difficulties, and who can ill afford the added burden of a sharp population increase. (IOM 24/04/01; NRC 2001).

Northern Province

The Northern province is the site of much of the present insecurity with ongoing conflict between rebel groups and the Guinean security forces. This has greatly restricted access to areas within the province and it is assumed that the situation for many in outlying areas remains critical. Insecurity in Kambia district continues to displace large amounts of the population. Due to insecurity the RNIS has not received any nutritional information from the majority of areas (NRC 2001).

Port Loko

ACF conducted two nutrition surveys in the Port Loko area in December 2000. The first was in the town itself and the second in the camp (see table of results below).

The prevalence of malnutrition in the town and camp are similar and not unduly elevated, however mortality rates are alarming. The main causes of mortality are ARI, malaria and measles, while malnutrition also contributes to these high death rates (ACF 12/00).

The results corroborate the general impression of poor sanitation, overcrowding and lack of access to health facilities in the country. There have been considerable further displacements since December and it is likely that there has been a deterioration in the nutritional status of the populations. The authors of the survey stress that the results cannot be extrapolated to the area at large and indicate that much of the area to the north and east remains inaccessible due to insecurity (ACF 12/00).

Table of results for ACF surveys in Port Loko town and camp (December 2000)

Port Loko town

Port Loko camp

Acute malnutrition(<-2 z scores)

3.8 %

3.7 %

Severe malnutrition (<-3 z scores and/or oedema

0.3 %

0.9 %

Crude Mortality Rate

1/10,000/day

1.3/10,000/day

Under five Mortality Rate

3.1/10,000/day

4.1/10,000/day

Measles vaccination coverage*

76%

48%

* Determined from vaccination card and mother/carer report

Western Province

The security in the Western Province remains fairly stable with deployment of UNMASIL troops. The Freetown and Lungi peninsula continues to receive large influxes of both IDPs and returnees. There are currently about 30,000 IDPs in Lungi as a result of fighting in Kambia and the influx of returnees from Guinea continues.

In February 2001 ACF conducted post distribution monitoring in the displaced camps in Freetown to look at the reliance on food aid and to assess the livelihood strategies of the displaced populations. The survey indicated that the middle and better off families which represent 50 % of the total camp population, do not rely on food aid but use it as an additional source of income. The remaining poor households do have a stronger reliance on food assistance and are often forced to borrow from the richer groups. The loaned food is paid back in kind or with money and this forces poorer households into a vicious cycle of borrowing and repaying debts that prevents them from being able to use food aid for their sole consumption (ACF 02/01).

There is no new nutritional information for this area but given the stable security and the access to humanitarian aid, it is assumed that the situation remains fairly stable.

Southern and Eastern Provinces

The southern Province has remained relatively free of fighting since the latest outbreak of violence and the same goes for the Eastern province although areas bordering Liberia can be assumed less secure. An estimated 12,500 people have arrived by foot in Daru in the south east, after fleeing Guinea and Sierra Leone and the rebels have reported the presence of 4,500 Liberian refugees in Kailihun (IRIN-WA 25/04/01).

Bo District

ACF conducted a nutritional survey in Bo district in November 2000. 2.1 % of the sample were internally displaced and 0.2 % were returnees. The survey found and estimated a prevalence of malnutrition of 3.8 % (<-2 z score) including 0.9 % severe malnutrition (<-3 z scores and/or oedema).

The Crude mortality rate was estimated as 1.1/10,000/day and the under five mortality as 5.9/10,000/day. The vaccination coverage for measles was estimated as 83.4 %, but only 39.7 % were confirmed with a card. Whilst the malnutrition rates appear acceptable, the mortality rates are extremely high. Malnutrition is again given as one of the main causes of mortality, along with, ARI, malaria, and diarrhoea.

Kenema

Merlin has conducted a series of nutrition surveys over the past year in the towns of Kenema and Blama and their surrounding camps. The RNIS has only seen summary reports, which indicate a low prevalence of malnutrition in both July 2000 and January 2001. In July, the prevalence was 3.7% in Kenema town and 2.2 in the camp. In January 2001, this remained stable at 3.8 and 1.2 respectively (Merlin 08/00).

The mortality rate in January 2001, was estimated at between 1 and 2/10,000/day. The surveys indicated a good improvement in the rates of vaccination coverage in the area (Merlin 08/00).

Overall

The humanitarian situation in Sierra Leone is extremely poor. The upsurge in insecurity continues to displace the general population and strongly effects general food security. Whilst available information on nutritional status of displaced does not indicate an alarming situation, mortality rates do indicate a health crisis (category II). All surveys presented have been from relatively secure areas and there must be grave concern for the populations currently inaccessible to humanitarian aid. No information exists for those currently inaccessible but they are considered at high nutritional risk (category V).

Recommendations

Negotiate critical humanitarian access to populations in currently insecure areas.
Carry out more in depth investigations on the causes of high under five mortality.
Closely monitor the health situation of the population with particular emphasis of populations in camps.
Increase vaccination coverage in all areas.
Livelihood activities should be strengthened to enable poor households to break the cycle of borrowing and repayment of food aid.

RNIS 31, July 2000

The situation in Sierra Leone is constantly changing. Tracking displaced populations and their needs is therefore very difficult. More up-to-date information can be obtained from www.reliefweb.int

Sierra Leone has been embroiled in a civil crisis since 19991. The war has claimed at least 20,000 lives and caused massive displacement both within Sierra Leone and as refugee movement into neighbouring countries. Appalling civil rights abuses have been recorded. In July 1999, the warring parties signed the Lombe Peace accord. In November, a Disarmament, Demobilisation and Reintegration (DDR) programme was set-up and UN troops entered the country. However, in the first week of May 2000, the peace process was dealt a serious setback when Revolutionary United Front (RUF) fighters killed at least four UN peacekeepers and took others hostage in a series of attacks in the north and east of the country. There was a lull in the fighting in June, after the rebel leader Fodah Sankoh was captured, but recent reports suggest that the fighting between pro-Government forces and RUF rebels has escalated again (IRIN-WA - 09/06/00, 07/07/00).

The renewed fighting has resulted in a deterioration of the humanitarian situation. Two months after the resumption of hostilities, poor security in many parts of the country continues to trigger mass population movements. At the same time, the prevailing security situation severely hampers efforts to address the needs of those who are being forced to leave their homes. Agencies are still unable to ascertain the situation of civilians in most of the north as there is no formal contact with RUF officials to facilitate access initiatives (OCHA - 11/07/00).

Displaced population

Up to 150,000 new IDPs have been registered in accessible areas in southern and western Siera Leone since May. Some of these have settled in official sites (many of which are already overcrowded), others are occupying abandoned buildings or are living in squatter camps. A further 160,000 IDPs living in various parts of the country were registered before the recent fighting. An estimated 500,000 displaced people are thought to be living in communities in government-controlled areas with host communities. Many of the hosts in these areas (estimated at 500,000 people) are also considered to be in need of assistance as their resources are being shared with so many displaced people. In addition to these populations a further one million people may be affected by the war in rebel-controlled areas (either as IDPs or as hosts) and are inaccessible to humanitarian agencies. Thus an estimated total of more than two million people are in need of assistance in Sierra Leone. The total population of the country is less than 5 million (OCHA-11/07/00).

Nutrition and health situation

The RNIS has not received any nutritional surveys of the affected population during the reporting period. The country's food security situation was poor even before the resumption of hostilities (see RNIS 30). Reports indicate that the nutritional situation in Freetown and the surrounding areas are stable, but more problems are reported outside the capital. The nutritional situation of the population in rebel-controlled areas is unknown.

In spite of the insecurity, WFP in collaboration with NGOs are continuing to distribute food-aid commodities. The agencies reached approximately 100,000 beneficiaries, including some of the new IDPS, in the two weeks prior to publication of this report. A two-year expansion of a special operation providing logistics support for humanitarian operations, including the repair of roads and rehabilitation of bridges has recently been approved (IRIN-WA - 17/07/00; OCHA - 11/07/00).

The population's current health situation is poor. Large influxes of IDPs into urban centres are leading to outbreaks of diseases such as the recent outbreak of Lassa fever in Freetown. Malaria also remains a significant problem. An estimated one million people are without health care in the northern and eastern areas of the country (IRIN-WA - 09/06/00, 07/07/00; OCHA - 11/07/00).

Northern Province

The fighting between the rebels and pro-government forces has been most intense in this region, and hence the population living in the area is the most affected.

Mile 91

The situation in Mile 91 remains precarious and highly volatile. It is not clear how many IDPs remain in the area, as reports indicate that a significant number have moved out in search of food and safety. Prior to the most recent outbreak of fighting an estimated 45,000 displaced people were thought to require assistance. UNAMSIL troops reported that humanitarian conditions of the IDPs are dire, but security prevents interventions at the moment. Before the situation deteriorated, some of the IDPs in Mile 91 and surrounding villages had benefited from non-food and food distributions. As there is no official camp for the displaced in the area, shelter is reported to be the population's most pressing need (IRIN-WA - 23/06/00; 14/07/00; OCHA - 11/07/00).

The lack of basic health services is also a major concern, as many of the IDPs developed health problems due to exposure to harsh conditions during their flight. ACF continues to maintain one therapeutic and one supplementary feeding centre for the under-five population in the Mile 91 area (OCHA - 11/07/00).

Lungi/Pot Loko area

There are a total of 60,000 new IDPs in this area. WFP was able to distribute rations to these groups at the end of July. The population of the islands of Tasso and Kakum, and the 8,000 IDPs living there, are reported to be in facing severe food shortages. This is due to limited arable land and a curfew limiting fishing activities (OCHA - 11/07/00, 25/06/00).

Western Province

A 'horseshoe' of UNAMSIL deployment protects the Freetown and Lungi peninsular areas and hence this zone has been the least affected by the fighting. However, security remains poor in some locations of Western Province, including Waterloo. Some 48,000 IDPs were registered in Western Province before the latest hostilities (IRIN-WA - 30/06/00; OCHA - 26/06/00, 11/07/00).

Overcrowding is a serious problem in the Freetown IDP camps. Health facilities are limited. An inter-agency verification of needs, origin and numbers of IDPs is currently underway. ACF has reported that the nutritional status of vulnerable groups in the Freetown area has been relatively stable. The number of severely malnourished children decreased between April and June. Many of the admissions to the Therapeutic Feeding Centre were new IDPs (OCHA - 26/06/00).

In response to the overcrowding in Freetown, the camps in Waterloo are being expanded. The problem of land allocation remains (OCHA - 26/06/00).

Southern and Eastern Provinces

The Southern province is currently free of fighting, and has been the least affected area during this recent outbreak of hostilities. However, humanitarian access is hindered by the general security situation (IRIN-WA - 14/07/00).

Kenema and Bo

Approximately 72,000 IDPs were registered in Kenema and Bo before the current outbreak of hostilities. WFP has been able to distribute food in these areas intermittently. MERLIN has intensified outreach services for prevention and treatment of Lassa fever, which is prevalent in the area. They are also conducting a nutritional survey of IDPs in camps. ACF has reported a marked increase in admissions to their Therapeutic Feeding Centres in the past few weeks (IRIN-WA - 14/07/00; OCHA - 26/06/00, 11/07/00).

Liberian refugees

UNHCR is conducting a screening of over 6,000 Liberian refugees to determine those who are eligible for international protection, following the termination of the organized voluntary repatriation programme (OCHA - 11/07/00). The RNIS has not received any new nutritional information on these refugees.

Outflow of refugees

Some 420,000 Sierra Leoneans are refugees. Most of them are in Guinea and Liberia. The recent military clashes and other security incidents in the Kambia area have led to a further outflow of populations into Kalako camp in Forecariah, in Guinea. According to UNHCR, over 5,000 new Sierra Leonean refugees have been registered in the camp since May, arriving mainly from Kambia and Port Loko Districts (IRIN-WA - 22/06/00; OCHA - 11/07/00; UNHCR - 20/07/00).

Returnees

Some spontaneous returnees have been reported at a time when the security situation in the places of origin is not favourable. Already, 1,400 refugees who returned from Liberia since the end of 1999 have settled in IDP camps in Blama and Kenema and with host communities, as they are mostly from areas presently under rebel control. The situation may create more pressure in the already over-stretched camps. While UNHCR is prepared to provide limited relief assistance for the returnees in IDP camps, they do not encourage a situation where returnees become IDPs (OCHA - 11/07/00; UNHCR - 20/07/00).

Overall, the humanitarian situation in Sierra Leone is very poor. Huge numbers of people are affected by the war and are in need of assistance. The IDPs in Freetown and its immediate surroundings are at moderate risk (category III). Those in other Government-held areas are probably at greater risk (category I and II), as assistance can only be provided to them sporadically. The nutritional situation of the displaced (and resident) populations in the rebel-controlled areas is unknown (category V).

Recommendations and priorities:

UN to negotiate access to affected populations with the RUF.
Monitor the health status of the populations in displaced camps carefully. Improve sanitation and reduce overcrowding in these areas.
Continue to deliver food and other items where possible.

RNIS 30, March 2000

The civil war in Sierra Leone began in 1991. A Peace Agreement Accord was signed on 7 July 1999 in Lome. While some progress has been made towards the implementation of the accord, there are indications that the process is troubled. Security has improved in the south and west (particularly where the UN troops have been deployed), but the overall situation remains tense and volatile. Reports of atrocities against civilians continue to be received. The process of disarmament, demobilisation and rehabilitation of the rebels is slow. Achieving unhindered humanitarian access, one of the first major agreements signed by the parties to the conflict, has proved difficult. Despite the formation of the Government of National Unity, former RUF/AFRC (Revolutionary United Front/Armed Forces Revolutionary Council) fighters continue to lay claim to large areas of the country, obstructing free movement (OCHA - 07/03/00; RI - 01/03/00).

Humanitarian access

At this time humanitarian agencies still do not have unhindered

United Nations System Standing Committee on Nutrition

Nutrition Information in Crisis Situations - Sierra Leone

NICS 6, May 2005

NICS 3, August 2004

NICS 2, May 2004

NICS 1, February 2004

Contrasted nutrition situation in refugee camps

Recommendations

RNIS 43, November 2003

RNIS 41, April 2003

Bombali district

Refugees

Overall

Recommendations

RNIS 40, Dec 2002

Refugees

Internally Displaced Persons

Recommendations and priorities

Sierra Leone

RNIS 39, October 2002

RNIS 38, July 2002

RNIS 36/37, April 2002

RNIS 35, October 2001

RNIS 34, July 2001

RNIS 32/33, April 2001

RNIS 31, July 2000

RNIS 30, March 2000

United Nations System
Standing Committee on Nutrition