United Nations System
Standing Committee on Nutrition

Nutrition Information in Crisis Situations - Sudan
 

NICS 17, June 2008

Darfur

The security situation has remained highly precarious over the past months and the future is grim (OCHA, 15/05/08). Because of security problems, WFP has been obliged to cut rations by half since May (OCHA, 28/06/08). Additionally about 58,000 people could not be reached in April and May (UNICEF, 06/08). This is especially worrying as the hunger-gap season is just starting. Moreover, cereal prices are double what they were at the same time last year for a number of reasons including a poor 2007 harvest and global food and oil prices.

Since the peacekeeping force was transferred from the African Union to the UN leadership six months ago, barely any new battalions or air transport have reinforced the operation, which accounted for about 9,000 troops in June 2008 instead of the expected 26,000 (AFP, 25/06/08).

A joint statement by several UN agencies has recently been issued, following a high level UN team visit (UN Joint, 22/06/08). Among several declarations, they press the government of Sudan to ensure that food convoys with escorts are organised a minimum every 48 hours on main routes into Darfur. In addition, in order to return the food ration to normal levels, the authorities must permit food relief trucks to travel into Darfur every day, regardless of whether escorts are in place or not. The statement also urged all armed groups operating in Darfur who bear responsibility for attacks on humanitarians to cease hijacking of vehicles and assets and to demonstrate full respect for International Humanitarian Law and principles. Moreover, the UN agencies state that the Government of Sudan must urgently enact its agreement to release the results of technically cleared humanitarian surveys - including nutritional and crop surveys - and minimise delays in publishing future survey findings.

Admissions to therapeutic and supplementary feeding programmes have been on the rise since the beginning of the year which is in line with seasonality (figures 5 & 6) (UNICEF, 06/08). The number of admissions is higher this year than in 2007 for the same period. This is mainly attributed to higher prevalence of malnutrition among the new displaced people and in over-crowded camps, and to the addition of new centres and active case finding. Performance of supplementary and therapeutic feeding programmes was below Sphere standards.

A number of nutrition surveys which were conducted in the second half of 2007 and early 2008 have recently been cleared for release (UNICEF, 05/08; UNICEF, 06/08). Most of these surveys were done after the harvest period. They showed precarious to serious situations (figure 7), for most of them comparable to that of the previous year.

Figure 5 Admissions to supplementary feeding centres , Darfur (UNICEF, 06/08)

Figure 6 Admissions to therapeutic feeding centres, Darfur (UNICEF, 06/08)

Figure 7 Prevalence of acute malnutrition, Darfur (UNICEF, 06/08)

Southern Sudan

Most of the area is expected to be generally food secure, except Aweil West, North, East and South, and Gogrial and Twic in the west, because of localised conflict which disrupted supply routes, high numbers of returnees and unavailability of the seasonal subsidised sorghum provided by the government (FEWS, 06/08). Nyirol, Waat Diror, Wuror and Akobo in the east will also be highly food insecure until the next harvest in October 2008, because of last year's flood losses, persistent inter-clan conflict, and market isolation.

Several nutrition surveys conducted in Warrap, Jonglei and Northern Bahr el Ghazal states showed situations still precarious but which were comparable or slightly better than in 2006 and 2007 (table 2). Mortality rates were under control.

A conflict erupted in Abyei town between Sudanese government troops and the Sudan People's Liberation Movement/Army (SPLM/A) in mid-May 2008 (IRIN, 16/05/08). The oil-rich Abyei region has been in a political and administrative vacuum since the implementation of the 2005 Comprehensive Peace Agreement, because of disagreement over its status. Following the conflict, most residents of Abyei town fled southwards to the areas of Abtok, Awal Wunpeth, Malual Alio and Agok and into Twic county (OCHA, 27/06/08). It was estimated that 50,000 people were displaced and a further 40,000 were affected by the crisis. The last head count confirmed 26,000 displaced people at the end of May. The security situation has remained generally calm in the areas of displacement and access to the population in need was good. As of the end of June, WFP has assisted about 72,000 people with the provision of a full food basket. Only 5-10 litres per person and per day of safe potable water were available. Construction of shelters and latrines was under way. A significant number of malnourished children have been identified and feeding programmes were in place.

According to a nutrition survey conducted in December 2007 in Abyei town and Agoc area, the nutrition situation was already critical at that time with 21.0% (18.1-23.9) acute malnutrition, including 1.6% (0.6-2.5) severe acute malnutrition (GOAL, 12/07).

Table 2 Results of nutrition and mortality surveys, Southern Sudan (AAH-US, 02-06/08; Concern, 04/08)

North Sudan

A nutrition survey conducted in IDP camps around Kasala and in several areas of Kasala state showed a serious nutrition situation, which seemed slightly poorer than in the past two years (GOAL, 11/07). The prevalence of acute malnutrition was 18.5% (15.1-21.9), including 1.4% (0.5-2.2) severe acute malnutrition.

NICS 16, March 2008
 

South Sudan

Food security is expected to remain stable between January and April 2008 for the majority of households across all livelihood zones, with pockets of moderate to high flood-related food insecurity and pockets of moderate food insecurity due to chronic-structural food deficits (FEWS, 02/08).

Surveys were carried out among IDPs and residents in Renk County to assess the impact of July flooding on nutrition and food security (AAH-US, 10/07). The prevalence of acute malnutrition was above emergency levels in the IDP camps at 17.7% (C.I. 13.9-21.5), with a high percentage of severe malnutrition (figure 5). Rates were slightly lower among residents, but still show a serious situation. 68% of IDPs reported receiving food aid. Both groups said that they were heavily reliant on purchased food and that their access to food was good.

Another survey done in Tonj North County by AAH-US in December 2007 revealed an average situation (figure 5), with a lower prevalence of acute malnutrition than in surveys carried out in previous years (AAH-US, 12/07). The survey was done just after the harvest and the food security situation was reported to be adequate.

Darfur

Insecurity has increased in Darfur at the beginning of the year, especially in West Darfur (UN/SC, 11/03/08).

As a result of a pipeline break, CSB was in short supply and, in order to have adequate supplies for SFP programs, was removed from the general ration and replaced by pulses (UNICEF, 11/07).

Multiple surveys were conducted throughout the region, but only two were authorized for release by local authorities (UNICEF, 11/07). The surveys, both conducted in West Darfur, revealed rates of malnutrition at or above emergency levels (table 2). The prevalence of severe malnutrition was especially high in both studies although mortality rates were under control.

Figure 5 Results of nutrition and mortality surveys, South Sudan, October-December 2007 (AAH-US, 10/07; AAH-US, 12/07)

Table 2 Results of nutrition and mortality surveys, West Darfur (Tearfund/Joint, 06/07; World Relief, 09/07)

NICS 15, December 2007

Inter-ethnic clashes between Murle and Dinka groups in Jonglei State killed 34 people and wounded almost 100 people in November and early December 2007. Following a confrontation in an MSF-compound in Bor on November 29, 2007 that left 4 civilians dead and another wounded, humanitarian staff were evacuated to Juba. As a result of the fighting, UNHCR temporarily suspended repatriation efforts in the area (USAID, 12/07).

The full effect of the August 2007 floods is not yet clear. Some areas are expected to have a near-normal harvest, with food production adequate to fulfill household needs at least until February 2008 (FEWS, 11/07). On the other hand, certain regions, such as the Nile-Sobat and Eastern Flood Plains zones, were harder hit. The most vulnerable were expected to start experiencing food shortages in October, although it is anticipated that they will at least partially recover once flood waters recede leaving behind a good water supply, pastures, and improved fishing. However, the food security outlook was less optimistic for Bieh county. In addition to extensive flooding, it is also troubled by poor infrastructure, low market access, and continual loss of assets, mainly cattle theft by rival clans.

An outbreak of Rift Valley fever was reported in the states of White Nile, Sennar, and Gazeera in mid-October. According to WHO, 436 human cases, including 161 deaths, had been confirmed as of November 21, 2007. As the disease also affects animals, the outbreak could have potential consequences for those whose livelihoods depend on livestock and every effort was being made to contain the epidemic (WHO, 11/07).

AAH-US conducted a survey in Nyirol county, Jonglei State, in September 2007, which showed the nutrition situation to be critical (table 3). The local situation during the survey was perturbed by both insecurity and flooding. The survey team reported that most of the farms they observed had suffered some kind of flood damage. As 86.7% of those surveyed reported private production as their main source of food, the loss of crops is sure to have an impact (AAH-US, 09/07). Surface runoff and rain water were cited as the main source of water for the majority of the population and no latrines were observed in any of the households surveyed .

Table 3, Prevalence of Acute Malnutrition , South Sudan (AAH-US, 09/07; ACF-F, 10/07)

A nutrition survey was also done in Bentiu and Rob Kona towns in October 2007, this one by ACF-F (table 3). The prevalence of malnutrition was 20.5% (C.I. 17.0-24.6), a figure not statistically different from prior ACF surveys conducted during similar periods (ACF-F, 10/07). The majority of the population reported buying their food from the market, although some vulnerable households were still receiving targeted food aid through WFP food-for-rehabilitation programs. The average duration of exclusive breastfeeding was given as 3.6 months.

Darfur

Attacks targeting humanitarian staff, as well as unchecked banditry, are hampering aid activities in all three states of Darfur. Major cities excepting, most agencies are forced to travel by helicopter, limiting what areas are accessible (USAID, 20/12/07).

Coordination of humanitarian programs in IDP camps continued to be a challenge in 2007 (USAID, 20/12/07). Kalma camp in South Darfur has been without a coordinating agency for over one year, and there has never been an agency in Gereida, Darfur's largest camp which hosts over 120,000 people. The Spanish Red Cross will give up direction of Abu Shok and Zam Zam camps in North Darfur in the coming months after the Sudanese Red Crescent failed to renew their contract.

Initial results of a joint U.N. and GNU Emergency Food Security and Nutrition Assessment showed that the situation in Darfur rests quite serious (USAID, 20/12/07). A full 70% of people affected by the conflict were estimated to be food insecure and fewer people were able to plant and harvest crops in 2007 as compared to 2006. In addition, acute malnutrition rates have climbed over 3% since the last assessment in 2006 from 12.9% to 16.1% and at the same time, nutrition program coverage dipped negligibly from 14.2% to 13%. Results from nutrition surveys conducted by Tear Fund and Relief International revealed that the situation is even more critical in some areas (UNICEF, 08/07) (figure 4).

Figure 4 Results of Nutrition Surveys, Darfur, 2007 (UNICEF, 08/07)

Overall

High levels of acute malnutrition persist in Darfur and parts of South Sudan. Flooding in the South and ongoing conflict in Darfur pose important threats to food security.

NICS 14, September 2007

Small-scale fighting over livestock and land has continued to cause localised displacement in rural areas (OCHA, 31/08/07). Severe floods have especially affected Unity and Upper Nile State but also Western Bahr el Ghazal, Lakes, Central and Western Equatoria and more recently Southern Kordofan (OCHA, 31/08/07; UNNews, 24/09/07). Around 500,000 people have been affected. Food and non-food assistance has been established. It is expected that the hunger-gap period might be extended in the flood-affected areas. However, when floods recede in December-February, food security should improve due to increase availability of fish, water plants and good pasture.

A nutrition survey conducted in Kurmuk county, Blue Nile state, showed an average nutrition situation: 9.4% (5.9-12.9) of the children surveyed were acutely malnourished, which was comparable to that in early 2005 (GOAL, 04/07). Child- feeding practices were poor with only 4.9% of the children exclusively breastfed and 15.7% being introduced to complementary food between 6-9 months. Less than 50% of the households had access to potable drinking water.

Nutrition surveys conducted in South Sudan showed critical situations (table 4). In Sobat corridor, Upper Nile state and Twic county, Warap state, information on child-feeding practices revealed low proportions of exclusive breast feeding and timely introduction of complementary feeding (GOAL, 03/07; GOAL, 07/07). In Sobat corridor, almost none of the households had access to a protected source of water, while 58.4% of the households in Twic county used potable water. Diet diversity was poor in both survey areas with less than 10% of the households having consumed food from three different food groups the day prior to the survey.

In Athooc districts, although still critical, the situation had improved compared to the same season in 2005. The area has experienced food insecurity due to different factors such as floods in 2006, livestock diseases, persistent cattle raids and inadequate fishing and farming equipment (AAH-US, 06/07). Public health was also poor. None of the households surveyed had received food assistance in the three months prior to the survey. However, food distributions were being implemented for returnees at the time of the survey. There was no selective feeding programme in the area.

In Khorfulus and Atar areas, the nutrition situation was appalling during the hunger-gap season (table 4). The last harvest had been poor due to insecurity and pests (AAH-US, 06/07). The population also had poor access to health services, and water and sanitation were reported to be largely inadequate. There had been a large number of returnees in the area.

Table 4 Results of nutrition surveys, South Sudan (GOAL, 04/07-08/07; AAH-US, 06/07)

Darfur

The humanitarian situation has deteriorated, especially because of renewed displacement (OCHA, 31/08/07). It is estimated that about 240,000 people have been newly-displaced or re-displaced during 2007 (see map).

Major displacements, January-September 2007 (OCHA, 09/07)

In addition 30,000 Chadians are estimated to have sought refuge in Darfur this year. They are mainly scattered along the border with only approximately 6,000 registered in refugee camps (UNHCR, 09/07). Moreover, heavy rains have further worsened the situation. Insecurity is also still raging with an increase in attacks against relief workers in 2007 (UNNews, 27/09/07). In July, food was delivered to approximately 3.1 M beneficiaries, an increase from previous months explained by the inclusion of vulnerable rural residents during the hunger-gap season in the beneficiaries of food distribution.

The UN Security Council has authorised the deployment of an hybrid United Nations-African Union peace keeping force of 26,000 troops, which was accepted by the government of Sudan (UNNews, 31/07/07; UNHCR, 09/07).

Nutrition surveys continue to show precarious to critical nutrition situations (figure 4), which have remained stable compared to last year where data are available. In Kebkabiya town, the situation has even deteriorated compared to the same season in 2005 and 2006 (figure 5).

Figure 4 results of nutrition surveys, Darfur, 2007 (ACF-F, 05/07-08/07; UNICEF, 05/07-07/07)

Figure 5 Trends in prevalence of acute malnutrition and mortality rates, Kebkabiya town, North Darfur

A food security assessment conducted in Otash camp revealed that the main sources of food for the displaced people were the general food distribution and purchasing from markets (ACF-F, 02/07). People were entitled to a 75% food ration. Most of the food ration was consumed (90%), while the rest was sold to buy vegetables or to cover non-food needs. Most of the IDPs did not have a regular source of income. The most common sources of income were urban casual labour, selling of firewood, trading and NGO assistance. Access to potable water and sanitation was reported to be below international standards.

Overall

The situation in Darfur and South Sudan was still precarious due to several factors including insecurity, movement of people such as displacement in Darfur and returns in South Sudan and floods.

NICS 13, May 2007

Darfur

The security situation in Darfur has remained volatile (UNNEws, 18/05/07). Nutrition surveys conducted in South and West Darfur showed stable or improved situations compared to previous years.

In Nyala town and surrounding IDP camps, South Darfur, the prevalence of acute malnutrition has remained within the same range since 2005, with marked seasonal variations (figure 3) (ACF-F, 04/07). On the other hand, mortality rates seem to have increased but as confidence intervals were not provided in the survey reports, it is difficult to know if this increase is significant.

Figure III Prevalence of acute malnutrition and mortality rates, Nyala town & surrounding IDP camps, South Darfur, Sudan

In IDP camps, in Ed Daein, South Darfur, the situation was critical (table 4) as of February 2007 and comparable to that found in the same period in 2005 (UNICEF, 03/07). At the beginning of 2007, 25,000 new IDPs arrived in the camps. Only 70% of the displaced families were registered for food distribution. Access to soap and toilets, although reported as having improved compared to the end of 2005, was still insufficient with 64.6% and 40.9% of the families having access to them, respectively.

Table 4 Prevalence of acute malnutrition, Darfur, Sudan (UNICEF, 03/07)

In Gereida camp, South Darfur, the situation has improved compared to previous years and was average (figure 4) (UNICEF, 03/07). Mortality rates seemed also to have significantly improved.

Figure IV Prevalence of acute malnutrition and mortality rates, Gereida IDP camp, South Darfur, Sudan

In Beida locality, West Darfur, the situation was still precarious although it showed a slight but non-significant improvement compared to 2006 (table 4) (UNICEF, 03/07).

South Sudan

Food security is deteriorating as can be expected at the onset of the hunger-gap and is expected to worsen as the season progresses, especially for the poorest families, returnees and people affected by insecurity (FEWS, 04/07). The delayed rains in the Hills and Mountains livelihood zones (Bahr El Jabal and parts of Eastern Equatoria) are also a matter of concern. People in Northern Bahr el Gazal are expected to face difficult conditions because of poor harvest last year due to flooding, cattle rustling this year and a significant number of returnees (FEWS, 04/07).

About 34,500 people have been assisted to repatriate to the South (OCHA, 18/05/07). In addition, 143, 600 refugees have returned, including 61,400 assisted by UN organisations and partners.

Humanitarian needs remain unmet for several reasons such as a gap of funds during the transition between emergency and development, and the lack of capacity within the government of Sudan (IRIN, 22/05/07).

Surveys conducted in South Sudan continue to show critical nutrition situations. In Old Fangak, the prevalence of acute malnutrition was still high, although the situation had improved within the last four years (figure 5) (AAH-US, 12/06). In Melut, Malakal, and Gogrial county, the situation was poor (table 5) and comparable to that found in the same areas, although not exactly the same locations, within the previous years (AAH-US, 02/07; AAH-US, 03/07).

Table 5 Prevalence of acute malnutrition , South Sudan (AAH-US, 02/07; AAH-US, 03/07)

NICS 12, February 2007

A record cereal harvest of 6.64 m MT is forecast this year in Sudan (FAO/WFP, 01/02/07). This represents an increase of about 22% compared to last year and is 36% above the average of the previous five years. However, 4.6 m people will need emergency food assistance during 2007, mainly due to civil unrest, but also because of structural factors such as poor infrastructure, weak marketing systems, and economic isolation.

Darfur

Continuing violence in Darfur has led to a new wave of displacement of about 80,000 people since the beginning of the year (OCHA, 28/02/06). These displacements were due to the Government of Sudan, militia and rebel attacks as well as to inter-tribal fighting. The majority of displacements was recorded in South Darfur (54,450 people) while about 10,000 people were displaced in both North and West Darfur. IDP camps were approaching capacity, especially around El Fasher town. Because of the insecurity, 23% of the affected population could not be reached in January/February.

A food security assessment conducted in Gereida town and IDP camps, South Darfur, at the end of last year showed a precarious situation (ACF-F, 12/06). Almost no IDPs were able to cultivate in 2006, mainly because of insecurity. Moreover, it was estimated that only 11% had a source of income. Only about half of the general food distribution was consumed, with the rest used for essential milling costs, education costs and buying of food and necessary non-food items. Nutrition surveys conducted in the camps in January 2005 and June 2006 showed a worrying situation (see NICS 10). Residents in Gereida town have also been significantly affected by the conflict. Loss of livestock has been widespread and access to land has been significantly reduced. Food availability through normal sources has, therefore, decreased significantly and depletion of assets has increased. The assessment recommended that interventions to improve food security of the residents be urgently undertaken as no humanitarian aid was directed towards them.

The nutrition situation was precarious in Otash camp, Nyala town, South Darfur, in December 2006 (ACF-F, 12/06) (table 3). Moreover, mortality rates were above alert thresholds. A nutrition survey conducted in Abu Shok and As Salaam camps, North Darfur in November 2006 showed a critical nutrition situation (table 3) that has remained stable for the past 2 years (ACF-F, 11/06). A survey conducted in Umshalaya among residents, displaced people and refugees from Chad in October 2006 revealed 13.1% acute malnutrition and an under-five mortality rate of 2.09 deaths/10,000/day, which might have been due in part to a recent hepatitis E outbreak (UNICEF, 11/06).

Table 3 Results of nutrition and mortality surveys, Darfur Sudan, 2006 (ACF-F, 11/06; ACF-F, 12/06)

South Sudan

As of February 2007, the food security situation was stable, after a normal harvest and good environmental conditions for livestock (FEWS, 16/02/07). However, 350,000 to 450,000 people were estimated as being food insecure, including returnees and residents affected by localised conflict or poor food production. The situation is expected to worsen during the traditional hunger-gap period between May and August with a moderate deterioration in the food security. About 1.7 m people will be food insecure, including 500,000 returnees. However, if there are high levels of population return, combined with persistent localised conflict, the situation could worsen.

Returns of displaced people and refugees continue. It is estimated that about one million people have returned since the signing of the peace agreement (IOM, 27/02/07). Facilitated repatriations of IDPs are on-going (IOM, 27/02/07; IOM, 16/03/07). In addition, assisted repatriation of refugees from Central African Republic, DRC, Uganda, Kenya and Ethiopia has reached more than 30,000 refugees (UNHCR, 30/01/07). About 340,000 Sudanese refugees remain in exile. Returnees face considerable challenges and many host communities are struggling to absorb them, due to, among other things, poor infrastructure and insufficient basic services (UNHCR, 06/03/07). UNHCR has launched an appeal of US$ 56.1 m to rehabilitate boreholes, health clinics and schools.

A meningitis outbreak has spread over South Sudan with about 1,800 cases identified in January-February. A vaccination campaign targeting 800,000 people is on-going (Reuters, 24/02/07).

Nutrition surveys conducted in Unity state showed an average nutrition situation in Wudier district (figure 4) that might be explained by the acceptable food security situation at this time of the year (AAH-US, 09/06). On the other hand, the situation was precarious in Mankien and Tam districts at the same period (figure 4) (AAH-US, 11/06). In Bentiu, Rob Kona and Nhialdiu, a high prevalence of acute malnutrition was recorded at the beginning of the year (ACF-F, 02/07). The situation has not improved for the last five years.

Figure IV Results of nutrition and mortality surveys, Unity state, Sudan (AAH-US, 09/06; AAH-US, 11/06; ACF-F, 02/07)

Overall

Good food security prospects are anticipated for 2007 in Sudan. However, more than four million people are still at high risk due to conflict, especially in Darfur.

NICS 11, November 2006

Darfur

Security has remained highly volatile, hampering delivery of humanitarian aid, especially in North Darfur (UNNews, 05/12/06). Agricultural production was expected to remain similar to last year in South and West Darfur but to be reduced in North Darfur (UNICEF, 09/06).

As a follow-up of surveys conducted in September 2004 and September 2005 (see NICS 4 and NICS 8), a survey was conducted in Darfur in September 2006 (joint, 09/06). The target population was the displaced people and residents affected by the conflict, representing 3.74 M people, compared to 3.2 M in 2005. However, some areas could not be reached due to insecurity. The survey was designed to adequately measure the indicators in each Darfur state and in Darfur region overall.

Preliminary results showed prevalence of acute malnutrition within the same range as in 2005, except in West Darfur which showed a slight increase in malnutrition (figure 7). Slightly more than half of the surveyed population were displaced people, with the highest percentage in West Darfur (67.5%) and the lowest in North Darfur with 35.5%. Overall, IDPs seemed to have a slightly better nutrition status than residents. Vitamin A and measles vaccination coverage were below recommended. Iron/folate supplementation during pregnancy as well as Vitamin A post-partum supplementation was very low, 30.8% and 19.1%, respectively. About 7% of the pregnant or lactating women had a MUAC < 21.5 cm. Access to safe drinking water slightly increased from 63.0% in 2005 to 73.3% in 2006. The highest increase was seen in South Darfur. On the contrary, there was no change in access to latrines which was about 58% overall. Displaced people seemed to have better access to safe sources of drinking water (86%) than residents (57%) and to latrines: 68% vs. 51%.

About half of the population cultivated land in 2006, this is the same as in 2005. This was made up of about 80% of the residents, 48% and 15% of the IDPs in community and in camps being able to cultivate. According to the households interviewed, lack of security was the main constraint to cultivation. The number of households owning livestock is stable compared to 2005. Insecurity was also cited as the main constraint to animal raising because of theft and looting, and difficult access to pastures and grazing routes. The main sources of income for the population were waged labour (37%), sale of crops (20%), sale of firewood (15%), petty trade (10%) and sale of food aid (10%).

Overall, about 70% of the population was still food insecure, with 46% severely food insecure. This is comparable to 2005. However, food insecurity has increased in West and South Darfur, with respectively 57% and 50% of the population being severely food insecure in 2006 compared to 48% and 41% in 2005. On the contrary, food security has improved in North Darfur with 42% of the households considered food secure in 2006 compared to 32% in 2005, and 34% of families being highly food insecure compared to 44% in 2005. There are also great differences between residents and IDPs, with 42%, 27% and 14% of the residents, IDPs in community, and IDPs in camps being considered food secure, and 35%, 46% and 62% of the same groups considered severely food insecure. IDPs in camps are the most vulnerable and their food insecurity has increased compared to last year. This might be partly explained by the decrease in food distributions. On the other hand, food security of residents seemed to have somewhat improved compared to last year. The worsening of food insecurity in South and West Darfur reflects the increase in food insecurity of IDPs in camps, who represent about half of the surveyed population in these states.

Food aid delivery has gradually increased throughout the year, reaching 53% of the population in January and about 67% in July during the hunger season. However, insecurity, especially in North Darfur has prevented adequate food distribution which has remained around 50% throughout the year. About 30% of the recipients sold food aid, mainly to pay milling costs and buy other foods. The priorities identified by the households interviewed were firstly security/peace, followed by drinking water, health services and food aid. Food aid was the second priority for IDPs but the last for residents.

Nutrition surveys conducted in Kabkabyia town, North Darfur and in Kalma IDP camp and Nyala town and IDP camps, South Darfur in October 2006 showed high prevalence of acute malnutrition (ACF-F, 10/06).

In Nyala town, prevalence of acute malnutrition showed no improvement compared to the same period last year (figure 8). Seasonal patterns highly affect the nutrition status as shown in the figure. At the time of the survey, there was a cholera outbreak which might have contributed to the increase in death rates. The pre-harvest situation in south Nyala rural areas revealed that the area planted remains low and insufficient to cover the population's needs. Shortage of seeds was the main hindering factor, despite seeds and tools distributions (ACF-F, 09/06). The report stated that seeds and food distributions, and increase in rural casual work during the period have contributed to maintaining an average situation.

In Kalma camp, prevalence of acute malnutrition was still very high and had slightly increased compared to 2005 at the same time (figure 9). Seasonal variations in prevalence of acute malnutrition were also present. A cholera outbreak might have contributed to the increase in mortality rate. Food distributions have been reported as having been reduced to 75% of full ration for oil, sugar and pulses. The slight increase in prevalence of acute malnutrition might be partly explained by the increase in food insecurity among IDPs in camps, as reported in the joint survey (see above).

In Kabkabyia town, prevalence of acute malnutrition seems to have increased regularly since 2004 (figure 10). The report of the survey mentioned the increase in insecurity, the recent halving of the food rations and the delayed rainy season as some factors that might explain this increase. On the other hand, mortality rates have remained stable.

The fact that surveys conducted in localised populations showed higher prevalence of acute malnutrition than the Darfur -wide nutrition survey, although they were conducted within the same period, might be partly explained by the fact that localised surveys focused on the most vulnerable populations.

Figure VII Trends in prevalence of acute malnutrition, Darfur, Sudan

Figure VIII Trends in prevalence of acute malnutrition, Nyala town, South Darfur, Sudan

Figure IX Trends in prevalence of acute malnutrition, Kalma camp, South Darfur, Sudan

Figure X Trends in prevalence of acute malnutrition, Kabkabyia town, North Darfur, Sudan

South Sudan

The agricultural season in South Sudan was good this year and adequate access to food during the coming dry season was forecasted (Fews, 11/06). However growing civil insecurity in some areas might temper post-harvest gains (see map) (Fews, 04/12/06).

So far this year, about 350,000 people have been reported as having returned. Due to the population census scheduled for November 2007, it is expected that large numbers of people will return during next year, putting further stresses on the food security.

Major areas of concern, South Sudan (FEWS, 04/12/06)

Nutrition surveys conducted in Bentiu and Rob Kona, Unity state, in August 2006 showed a stable situation compared to previous years (figure 11) (ACF-F, 08/06). In Nyaldu and surrounding villages, the nutrition situation was also precarious with 13.6% (9.4-19.1) acute malnutrition, including 1.6% (0.4-4.6) severe malnutrition. However, the situation was less serious than shown by a rapid assessment in November 2005 (see NICS 8).

Figure XI Trends in prevalence of acute malnutrition, Bentiu and Rob Kona towns, Sudan

Red Sea state

Four nutrition surveys were conducted simultaneously in rural areas of Port-Sudan in June/July 2006 (MoH/UNICEF/OXFAM, 06-07/06). Results revealed critical nutrition situations during the hunger-gap season (figure 12). The situation is far worst in rural areas than in Port Sudan town according to a survey conducted in August 2005 when the prevalence of acute malnutrition was 11.5% (8.8-14.9). Historical data show that high prevalence of acute malnutrition similar to those reported in these surveys has been recorded in the area for years. Vitamin A deficiency was also present. Red Sea is a food deficit state with low food production capacity of agro-pastoral households and livestock herd composition having drastically changed over the last century because of increased competition for grazing areas and water resources and reduced capacity to cope with drought. Moreover there are limited income opportunities which constraints purchasing power. Access to markets in rural areas is extremely limited due to sparsely populated and remote communities. Although the National Strategic Reserve Authority stabilises sorghum prices by supplying markets with specific quantities of sorghum at reduced prices, this tends to focus on larger markets which are not accessible for most of this population. In addition, the state has experienced recurrent drought as well as frequent flooding over the past ten years with limited opportunities for recovery that have rendered the population chronically food insecure. Food distributions have been conducted in Port Sudan and Tokar localities but have been delayed in Halaib and Sinkat.

Access to primary health care services, including nutrition centres, is very limited in rural areas, with most of the health facilities being located in urban centres.

Figure XII Prevalence of acute malnutrition, Red Sea state, Sudan, July 2006 (MoH/joint, 07/06)

Refugee camps

Nutrition surveys were conducted in eight camps, accommodating mainly Eritrean refugees, in September 2006 (UNHCR/joint, 09/06). The situation was precarious to critical depending on the camp (figure 13). Seasonal trends showed that prevalence of acute malnutrition is higher at this time of year than at the beginning of year.

Figure XIII Prevalence of acute malnutrition, refugee camps, Sudan, September 2006 (UNHCR/joint, 09/06)

Recommendations

Some of the recommendations of the MoH/UNICEF/OXFAM survey in rural areas of Red Sea state:

• Provide food assistance to the vulnerable populations in each locality
• Pilot development of community-based treatment of severe malnutrition in each locality
• Strengthen and expand food security and nutrition surveillance systems
• Reinforce vaccination programmes at community level
• Increase access to primary health care
• Develop and diversify livelihoods

NICS 10, August 2006

Darfur

Insecurity has increased in recent months, partly due to the dispute between Darfurian armed groups over the signature of a peace-agreement by the largest rebel group in May 2006 (AI, 17/08/06). North Darfur and the Chadian borders have been the most affected. Attacks on humanitarian workers have also been on the rise (UNNews, 18/08/05).

Food distribution has decreased since May 2006. Only 50% of the full ration was distributed in May, and about 85% in June due to shortage of funding (WFP, 16/08/06). Moreover, insecurity prevented food distributions to 290,000 people in June and 470,000 in July.

Nutrition surveys conducted between May and August, during the hungry season, showed high levels of acute malnutrition (figure 3). When data were available, comparisons showed stable situations compared to last year (UNICEF, 06/06).

Admissions to feeding centres were on the rise, as expected at this time of year. Due to NGOs phasing out, the number of feeding centres was only one third of last year.

Figure III Results of surveys, Darfur, Sudan (ACF-F, 08/06; MSF-B, 0506; UNICEF, 06/06; UNICEF, 08/06)

Southern Sudan

The rains have been generally good in Southern Sudan this year (FEWS, 07/06). It is also thought that people will cope better with the hungry season this year than in previous years because of improved access to markets, availability of Government of Southern Sudan's subsidised, low-cost sorghum, timely food-aid distributions and increased availability of seasonal agricultural employment.

Three surveys conducted in Jongley state in June/July showed worrying nutrition situations (table 2).The situation was especially critical in Atar/Khorfulus county, where the population was experiencing food insecurity due to the poor harvest in 2005 as well as an outbreak of cholera (AAH-US, 05/06).

Surveys were also conducted in Bentiu and Rob Kona towns in February 2006 (ACF-F, 02/06). They showed high levels of acute malnutrition, which were in the same range as in previous years (table 2) (figure 4). Mortality rates were under control. General food distribution for residents stopped in August 2005 and has only continued for returnees. However, it seems that only 16 of the 39 returnee families interviewed during the survey received a general ration in January/February. The security in the area has only significantly improved since the beginning of the year, and food security is still poor. Food security programmes need to be developed.

Nutrition surveys conducted in Juba town and surroundings showed poor nutrition situations (table 2), which have remained within the same range over the past few years (ACF-F, 05/06). This is despite the change in the status of the Juba area, from a former enclave controlled by the government of Sudan to the capital of Southern Sudan, since the signature of the Peace Agreement in January 2005.

Table 2 Results of surveys in Southern Sudan (AAH-US, 05/06; AAH-US, 07/06; AAH-US, 07/06; ACF-F, 02/06; ACF-F, 05/06)

Figure IV Prevalence of acute malnutrition, Bentiu and Rob Kona towns, Sudan

South Kordofan

A nutrition survey was conducted in South Kordofan and 3 administrative units of Abyei (Abyei, El Mugad and El Meram) in January/February, during the post-harvest season (WFP/joint, 02/06). The majority of the families included in the survey were resident, while 6% were IDPs and 8% were returnees. The results showed a precarious nutrition situation with a prevalence of acute malnutrition of 13.4% (10.9-15.9), including 3.1% severe malnutrition (1.5-4.7). On the other hand, only 3.3% of the women surveyed (pregnant and non-pregnant) had a MUAC < 21 cm.

Exclusive breastfeeding was only 29.9% and mean age of introduction of complementary food was 3.8 months. Mortality rates were under control: CMR=0.37 death/10,000/day (0.20-0.54) and UFMR=0.49 death/10,000/day (0.15-0.83). About 60% of the households had access to safe drinking water and 30% had access to latrines. Returnees were the most at risk of food insecurity, followed by displaced people, while residents were better-off. 

NICS 9, May 2006

Darfur

Insecurity is still widespread in Darfur although a peace agreement was signed by the largest rebel group and the Government of Sudan, but not by the other rebel groups, in early May (USDS, 18/05/06). In addition, the food ration will be cut by half during the forthcoming hunger gap season due to WFP's severe funding shortfall (BBCNews, 28/04/06). Even if funding commitments were to be found, food aid would probably not be delivered on time due to transportation constraints. The decrease in food rations will probably compromise the stabilisation of the situation that has been seen over the last months. Although data are not directly comparable because some feeding centres have been closed due to low beneficiary numbers, or programmatic or funding constraints, admissions to feeding centres were far lower in April 2006 than in the same month last year (figure 4 & 5) (UNICEF, 04/06). This might be the result of improved humanitarian aid as well as a better harvest in 2005 than in 2004. Cereal harvest in 2005/2006 was estimated at about 190% of the 2004 harvest in the region (FAO/WFP, 15/02/06). Surveys conducted during the post-harvest season showed varied situations (figure 6). Where comparison with the same period in 2005 was possible, surveys showed a stable situation in terms of nutrition and mortality (figure 7 & 8).

Figure 4 TFC admissions in Darfur, Sudan (UNICEF, 04/06)

Figure 5 SFC admissions in Darfur, Sudan (UNICEF, 04/06)

Figure 6 Prevalence of malnutrition and mortality rates, Darfur, Sudan (ACF-F, 01/06; ACF-F, 02/06; ACF-F, 03/06; Concern, 02/06; Goal, 10/05; GOAL, 11/05; MSF-S, 11/05; MSF-S, 12/05)

Figure 7 Trends in prevalence of acute malnutrition, Darfur, Sudan

Figure 8 Trends in crude mortality rate, Darfur, Sudan

Food insecurity in Northern Bhar el Ghazal and pastoral areas of Kapoeta district

The 2005/2006 harvest was forecast at 55% higher than last year, and about 17% higher than the last five years average (FAO/WFP, 15/02/06). This good performance has been attributed to favourable rainfall, a low incidence of pests and diseases, and improved security. However 6.7 m people were estimated to be need of food aid, especially IDPs, returnees, and highly vulnerable residents. In Northern Bhar el Ghazal, the high number of returnees in Aweil East and West may further undermine the already precarious situation (Fews, 09/05/06). In the pastoral areas of Kapoeta county, Equatoria, inadequate recovery of pasture and water availability has raised concern. According to nutrition surveys conducted at the end of 2005 and beginning of 2006, the nutrition situation in the areas surveyed in Unity, Upper Nile and Bhar el Ghazal remained highly precarious (table 3), but stable compared to 2005 in areas where comparison was possible. It was slightly better in Kassala state, Eastern region, but still serious (table 3). On the other hand, mortality rates were under control (table 3).

Table 3 Results of nutrition and mortality surveys, Sudan (ACF-F, 11/05; AAH-US, 02/06; AAH-US, 03/06;GOAL, 11/05; GOAL, 12/05;GOAL, 01/06; Tearfund, 03/06)

Overall

Despite a generally good harvest in 2005/06, more than 6 million people remain in a highly precarious situation (category II), especially IDPs and returnees.

NICS 8, January 2006

Darfur

The security situation in Darfur remains highly unstable. Peace talks are on-going but with no significant achievement as yet (IRIN, 20/01/06). More than two million people were still considered affected by the crisis as of December 2005 (see map).

Affected population by locality, Darfur (HIC, 28/12/05)

There were two large scale nutrition and mortality surveys conducted in Darfur within the last few months. The first one was a random-sampled nutrition survey conducted in Greater Darfur in August-September 2005, during the lean season, as a follow-up of the survey conducted in September 2004 (WFP/joint, 12/05). As in September 2004, the target population was the IDPs and the residents considered affected by the crisis, or approximately 3.2 m in the 2005 survey (representing about 66% of the total population), double the number of the 2004 survey. The survey was designed to adequately measure the prevalence of acute malnutrition in each Darfur state and in Greater Darfur. The results showed a precarious nutrition situation at Greater Darfur level with North and South Darfur showing higher rates than West Darfur, where the nutrition situation was average (table 4). Although not directly comparable because the populations studied were not the same, the 2005 survey showed a better situation than the 2004 one when prevalence of acute malnutrition was 21.8% (18.2-25.3). Mortality rates were below alert thresholds (table 4) and seemed also to be lower than in the 2004 survey. However, 16.2% of the deaths were still related to violence.

Table 4 Results of surveys in Darfur, Sudan (ACF-F, 10/05; ACF-F, 11/05; Concern, 07/05; GOAL, 10/05;WFP/joint, 12/05; WHO/MOH, 09/05)

According to the analysis of food consumption and the share of household expenditure on food, food security seemed to have improved somewhat compared to 2004, especially among the IDPs (box 1). The proportion of households with acceptable food consumption has improved overall from 31% in 2004 to 58% in 2005, with an increase from 14% to 51%, 31% to 55% and 47% to 65% among the IDPs in camps, IDPs in host communities and resident population, respectively. Large scale food aid is considered to be an important factor of this improvement. About 58% of the households received WFP food distribution. Part of the food distribution was traded, mostly in IDP camps, in order to get other food commodities, to have cereals milled and to pay for fuel, education and medication. Public health and access to safe drinking water and sanitation were average as were child-feeding practices (table 4) (box 1).

Box 1 Food security, public health environment and children feeding practices, Darfur, August-September 2005 (WFP/joint, 12/05; WHO, 09/05)

About 73% of the households consumed iodised saltat least 15 ppm of iodine, as tested during the survey. 91.5% of the salt received during the food distribution was iodised.

The second survey was a follow-up of the mortality survey conducted in August 2004 by WHO/EPIET (WHO, 09/05). According to this survey, mortality rates were below emergency thresholds in all affected populations (IDPs in camps, IDPs in host population and affected resident populations), except for under-five mortality rate in IDP camps in South Darfur (table 4). Due to security constraints, no data could be recorded for the other population groups in South Darfur. When compared to the 2004 survey, there are indications that mortality rates have substantially decreased in IDP camps. Mortality related to injury was widespread, especially in North Darfur where it accounted for 9%, 34% and 55% among IDPs in camps, IDPs in host population and residents respectively.

Smaller scale surveys were also conducted throughout Darfur (table 4). In Abu Shok camp and the adjacent As Sallaam camp, prevalence of acute malnutrition has steadily decreased since June 2004 (figure 2) but remained precarious as of November 2005 (ACF-F, 11/05). The same pattern was observed for mortality rates, which were below alert threshold in November 2005 (figure 2). The appalling rate of under-five mortality in June 2004 was explained by a measles outbreak. While measles vaccination coverage has improved since then, it remained lower than recommended with only 73% coverage. Most of the families were receiving food distributions, but only 7.4% of the families arriving after August 2005 were registered for food distribution. A registration of these families was under way at the time of the survey.

In Kebkabiya town, which hosts a number of IDPs, the nutrition situation has not changed since August 2004 and remained serious as of October 2005 (table 4), although the majority of the households are registered for food distribution (ACF-F, 10/05). On the other hand, mortality rates have significantly decreased and were below alert threshold .

Figure 2 Trends in prevalence of acute malnutrition and mortality rates, Abu Shok camp, North Darfur

In Jebel Mara, West Darfur, the prevalence of acute malnutrition was still significant as of October 2005 (table 4), during the harvest period, although it had declined compared to March 2005 (GOAL, 10/05). There is no IDP camp in the area, but IDPs are thought to make up one third to one half of the population. Food distributions have been erratic since the beginning of the crisis. Moreover, mortality rates were above alert thresholds (table 4).

In Seleia and Kulbus, West Darfur, the prevalence of acute malnutrition had almost doubled in July 2005 compared to January the same year (table 4) (Concern, July 2005). It is difficult to know if the increase is only due to "normal" seasonal variation, as the first survey was done during the harvest period while the most recent was conducted during the hunger gap season, or if other factors have contributed to the deterioration of the situation. Food distributions seemed to have been irregular recently.

The same pattern was observed in Nyala town and IDP camps, South Darfur, where a random-sampled nutrition survey showed a worsening of the situation in September 2005 compared to February 2005 (post-harvest season) (figure 3) (ACF-F, 09/05). Furthermore, compared to September 2004, the overall nutrition situation has not improved. Mortality rates have remained under control. Although the surveys were not designed to derive the prevalence of acute malnutrition among resident and displaced population separately, there are indications that the situation was better among IDPs in September 2005 than one year before but had remained stable for the residents.

In Kalma camp, South Darfur, the prevalence of acute malnutrition also showed the same increase between February and August 2005 (figure 4), but the situation seemed to have somewhat improved in August 2005 compared to August 2004, although it has remained precarious (ACF-F, 08/05). Most of the displaced population was receiving general food distribution.

The prevalence of acute malnutrition was slightly better in Sanya Afendu and surrounding villages, South Darfur, according to a random-sampled survey conducted just after the harvest in November 2005 (table 4) (ACF-F, 11/05). Mortality rates were under control.

Figure 3 Trends in prevalence of acute malnutrition , Nyala, South Darfur

Figure 4 Trends in prevalence of acute malnutrition , Kalma camp, South Darfur

Port Sudan, Red Sea state

A random-sampled nutrition survey conducted in Port Sudan town in August 2005 showed a poor situation: 11.5% (8.8-14.9) acute malnutrition, including 1.1% (0.4-2.7) severe acute malnutrition) which was comparable to the situation in December 2003 and in August 1997 (see RNIS 22) (ACF-F, 08/05).

IDP camps, Kassala state

According to two surveys conducted in IDP camps in Kassala state, the situation was also precarious with a prevalence of acute malnutrition of 9.9% and 13.5% in Adraman and Dablawet IDP camp, respectively (GOAL, 05/05). Prevalence of acute malnutrition has, however, significantly improved compared to December 2004 when it was about 20%. This improvement is attributed to the implementation of a general food distribution to the IDPs and of a blanket-feeding programme for the under-fives.

IDP camps and settlements, Khartoum state

A rapid assessment conducted at the beginning of 2005 showed that the majority of the population had good access to health facilities but that health facilities were under utilized (MOH/WHO/UNIVEF, 05/05). The main reason for this seemed the cost of consultations and treatment. Some health facilities experienced drug shortages and vaccination coverage was below that recommended. The nutrition situation was not clear and seemed to vary depending on the camp and settlement.

Southern Sudan

According to a UNICEF review of malnutrition trends, malnutrition was serious in some areas in 2005, but not significantly worse than in the three previous years (UNICEF, 10/05). The pattern of admissions to feeding centres seems to follow seasonal variation in access to food, with the highest numbers of admissions between April and October (UNICEF, 12/05). A plan among agencies and Government of South Sudan counterparts for 2006 seeks to reach the capacity of treating 10,000 patients through therapeutic feeding programmes and 50,000 children as well as pregnant and lactating women in supplementary feeding programmes. The plan also includes the establishment of a national public nutrition capacity and integration of nutrition into health care service to ensure minimum standards of nutrition services in 100 PHCUs, 20 PHCCs and four hospitals (UNICEF, 10/05).

Food security for the forthcoming dry season (January-April 2006) is expected to be overall better than last year as a result of an improvement in crops, fish and wild food availability and better access to water and pasture (FEWS, 12/05). Even Northern Bhar el Ghazal has shown a temporary improvement in food security although chronic food insecurity still persists (FEWS, 03/01/06).

UNHCR signed a tripartite agreement for the repatriation of refugees from Kenya. There are an estimated 550,000 Sudanese refugees, mainly in Uganda, Ethiopia, DRC and Kenya. It is expected that about 70,000 refugees will be repatriated in the first semester of 2006 (UNHCR, 13/01/06).

A survey conducted in Juba, Bahr el Jebel, showed an average nutrition situation (figure 5) which has remained stable for the past few years (ACF-F, 09/05).

Figure 5 Prevalence of acute malnutrition , South Sudan

The situation was also average, in Mvolo district, Western Equatoria (figure 5) (AAH-US, 09/05). This district is mostly agricultural and has known favorable weather conditions until last year.

On the other hands, surveys in Upper Nile showed a precarious to critical nutrition situation (figure 5) and especially in the towns of Kodok and Malakal where prevalence of acute malnutrition was above 20%. In Malakal town, it has remained within the same range since August 2002.

In Old Fangak, although still precarious, the situation has improved compared to 2001, 2002 and 2003 when the prevalence of acute malnutrition was about 30%.

Mortality rates were under control in all areas surveyed, except in Kodok town.

Overall

Although it seems to have improved compared to 2004, partly due to external assistance, the nutrition situation is still precarious and volatile in Darfur (category II). In South Sudan, the situation seems also to have improved in some areas, while it has remained critical in others (category II).

NICS 7, August 2005

South Sudan

The death of John Garang, the leader of the SPLM/A (Sudan's People's Liberation Movement/Army) in a helicopter crash was followed by a few days of rioting between northerners and southerners in major towns such as Khartoum and Juba (AFP, 03/08/05). Salva Kiir took over from John Garang as head of the SPLM/A, vice president of Sudan and president of the autonomous Southern Sudan. Riek Machar was appointed as vice president of Southern Sudan (IRIN, 23/08/05). The accession of these two leaders who have less antagonistic rapport with the SSDF (the government-aligned South Sudan Defence Force) than the former leader might help to solve the outstanding issue of how to deal with other armed groups in southern Sudan (IRIN, 23/08/05).

The food security situation is bleak in northern Bahr el Gazal. Food deficits started in March-April, especially for the poorest households, as a result of last year's poor harvest and reduced flood levels which has led to significant reductions of dry season food sources such as wild food and fish (FEWS, 29/07/05). Sorghum has also become scarce in the markets. The high number of returnees has further exacerbated the food insecurity ( FEWS, 07/05). Furthermore, food aid requirements were not met, with less than 60% of the food aid required between January and May actually provided (FEWS, 13/07/05). Although the pipeline improved later, it is still insufficient to meet the needs.

The process of the current planting season is positive so far, but the harvest will not take place before October (FEWS, 04/08/05). In the meantime, households will need a significant amount of aid.

Several random-sampled nutrition surveys showed critical prevalence of acute malnutrition in Bahr el Gazal and Upper Nile (figure 4) (AAH-US, 04/05; AAH-US, 06/05; MSF-CH, 03/05). In the three locations where the surveys were conducted, last year's harvest was poor. On the other hand, a nutrition survey conducted in Eastern Equatoria showed an average nutrition situation (figure 4) (AAH-US, 06/05).

In the GOS-controlled town of Wau and the surrounding IDP camps, the nutrition situation has remained stable over the last years but is still precarious, especially among displaced people, while measles vaccination coverage and mortality rates were average (table 4) (ACF-F, 04/05).

According to random-sampled surveys conducted in the GOS-controlled towns of Bentiu and Rob Kona in February 2005, the situation has also remained stable within the last years and was precarious (ACF-F, 02/05). The prevalence of acute malnutrition was 16.2% (13.0-19.9), including 1.0% (0.4-2.6) severe acute malnutrition and 16.1% (12.9-19.9), including 2.1% (1.0-4.0) severe acute malnutrition in Bentiu and Rob Kona, respectively. Fighting and cattle looting in nearby areas in March 2005 resulted in a wave of displacements to Bentiu, Rob Kona and Nhialdiu. The number of admission to TFCs and SFCs in Rob Kona and Bentiu increased three fold. A rapid nutrition assessment (non-random sampled) in these three towns revealed that about 34% of the 6-59 month-old children surveyed in Rob Kona and Bentiu were acutely malnourished, including about 7% of children severely malnourished, and that 42% of the children surveyed in Nhialdu were acutely malnourished, including close to 10% severely malnourished (ACF-F, 05/04). Some food distributions have been implemented.

Figure 4 Results of nutrition surveys in Southern Sudan (AAH-US, 04/05; AAH-US, 06/05; MSF-CH, 03/05)

Table 4 Results of surveys in Wau town and camps, Western Bhar el Gazal (ACF-F, 04/05)

Darfur

As of early July, there was an estimated 3.2 million people affected by the crisis, including 1.88 million displaced people (UNRHC, 01/07/05). The increase in the number of resident people who are affected is due to exhausted coping mechanisms, lean season conditions, improved humanitarian access and increased operational capacity. According to UN security rules, 96% of the affected population was accessible in June 2005 in North and West Darfur, while only 77% of the population was accessible in South Darfur (UNRHC, 01/07/05). A deficit in humanitarian presence was noted in North Darfur. Moreover, MSF stated that while the situation has improved in the biggest displaced camps and settlements, the aid has not reach geographically remote areas or rebel-held territories to the same extent (MSF, 27/07/05).

As of June, the coverage of the affected population was far below the needs in all of the sectors of humanitarian aid (figure 5).

The security is still highly volatile with continued attacks on civilians, and banditry (UNNews, 16/08/05). Sexual violence is also widespread (MSF, 27/07/05). Insecurity has also been experienced in camps during registration processes (UNSC, 11/08/05). Insecurity hampered access to the affected population (MSF, 27/07/05).

Several random-sampled surveys conducted in the first semester of 2005 showed that the situation was still precarious (ACF-F, 02/05; ACF-F, 05/05; ACF-F, 06/05; Concern, 02/05; GOAL, 05/05; NCA/joint, 07/05; SC-US, 06/05; SMH, 03/05; SMH, 06/05; Tearfund, 03/05). The prevalence of acute malnutrition was more than 15% in most of the areas surveyed (figure 6). The situation seemed under control in Mornei camp in February 2005, where a regular general food distribution was implemented (Concern, 02/05). However, it seems that due to security problems, the general food distribution has recently been suspended for two months (MSF, 27/07/05). Mortality rates were below emergency threshold in all the locations surveyed (figure 6).

When compared with data from surveys conducted in 2004, it seems that crude mortality rates have decreased (figure 7).

A survey conducted by WHO in all three states of Darfur reported the same pattern, with an overall crude mortality rate of 0.8/10,000/day between November 2004 and May 2005 (WHO, 07/05). One third of the total deaths were due to injury.

The evolution of the nutrition situation is more varied, with improvement in some situations while others have remained stable or have even worsened (figure 8).

The number of admissions to supplementary and therapeutic feeding centres have increased in 2005 compared to 2004 (UNICEF, 15/07/05). This might, however be due to a higher availability of facilities. In the IDP camps in Ed Daein, South Darfur, only 32.9% of the IDPs had access to latrines, 20% had soap and 65% were registered for general food distribution (Tearfund, 03/05). It seems, however that a new registration of IDPs for general distribution was conducted after the survey.

In El Fasher, the food security situation was precarious as well as in Kutum.

In Sirba, 70% of the population was receiving a general food distribution as of June 2005 (SC-US, 06/05). However, the residents of Seraf Gidad (a part of Sirba) were not receiving any food distribution and were more food insecure than the rest of the population.

In the three locations, insecurity was a significant concern for the population: it prevented them from cultivating, fetching wood for cooking or looking for medical care at night.

Figure 5 Estimated sectoral needs and gaps in Darfur in terms of beneficiary numbers (UNRHC, 01/07/05)

Figure 6 Results of nutrition and mortality surveys, Darfur, first semester 2005 (ACF-F, 02/05; ACF-F, 05/05; ACF-F, 06/05; Concern, 02/05; GOAL, 05/05; NCA/joint, 07/05; SC-US, 06/05; SMH, 03/05; SMH, 06/05; Tearfund, 03/05)

Figure 7 Evolution of the mortality rates, Darfur, Sudan

Figure 8 Evolution of the prevalence of malnutrition , Darfur, Sudan

Overall

Despite some improvements in Darfur, the situation remains highly precarious and violence is still widespread. In Southern Sudan, food insecurity will affect a significant proportion of the population during the lean season and especially in Northern Bhar el Gazal. The pipeline for food distribution is insufficient to meet all needs.

NICS 6, May 2005

South Sudan

Following the peace agreement signed in January 2005 between the government of Khartoum and the SPLM/A (Sudan People's Liberation Movement/Army) (see NICS 5), donors have pledged US$ 4.5 billion for reconstruction in South Sudan for the period of 2005-2007, exceeding by US$ 2 billion the estimated minimum requirements (UNNews, 12/04/05). During a reconciliation conference held in Kenya in April 2005, factions operating in Southern Sudan agreed to support the peace deal (AFP, 21/04/05). However, this meeting was not attended by the Khartoum-backed militia which controls oil-rich areas in Upper Nile. On the ground, it seems that the population are still subjected to arbitrary taxations by the different factions (IRIN, 12/04/05).

Displaced and refugee populations continue to return to the South, although their number is impossible to estimate because of problems of registration and tracking (FEWS, 31/03/05). It seems that the influx is more significant in Northern Bhar-el- Ghazal. Urgent funding is needed to help the re-integration of the returnees, while host populations are already only surviving on meagre resources and will not be able to provide help for the returnees, especially in Bhar-el-Gahzal where the food security situation is fragile (FEWS, 04/05).

In Khartoum, arbitrary demolition of IDP settlements continues, compromising IDP livelihood (IRIN, 22/03/05).

UNICEF, together with WHO, will develop the Expanded Programme of Immunisation and implement a mass measles vaccination coverage, targeting children from six months to 15 years (UNICEF, 02/05). Vaccination coverage is generally very low in South Sudan.

Several random-sampled nutrition surveys conducted in South Sudan showed average to precarious nutrition situations.

The nutrition situation was critical in Twic and Abeyi counties, Bhar el Ghazal (table 5), mainly due to poor food security (AAH-US/GOAL, 04/05). Cereal stocks were depleted and the last food distribution took place in July 2004. Moreover, the security situation was still volatile. On the other hand, the nutrition situation was average in Bunagok district, Awerial county, Bhar el Ghazal (table 5) (AAH-US, 01/05). The food security situation in the area was considered satisfactory as the last harvest was good. The area seems to have benefited from a calm situation since 2000.

In Luakini county, Upper Nile, the nutrition situation was precarious mainly because of poor rains in 2004 (table 5) (AAH-US, 03/05).

Table 5 Results of surveys in Southern Sudan (AAH-US, 01/05; AAH-US, 03/05; AAH, US/GOAL, 04/05; GOAL, 02/05)

Crude mortality was under control in the three above mentioned locations (table 5).

The prevalence of acute malnutrition has significantly decreased in Kapoeta South county, when compared to January 2004 (figure 3) (AAH-US, 01/05). This might be explained by a good rainy season, leading to a better harvest than in the previous year and to the negotiation of a truce with neighbours, which has allowed access to the nearby valley for grazing pasture and to the route to Uganda for trading. However, measles vaccination coverage was very low and crude mortality rate was at the alert level.

Figure 3 acute malnutrition and mortality, Kapoeta county, Southern Sudan

In Kurmuk district, Southern Blue Nile, the nutrition situation was average (table 5) (GOAL, 02/05). Food security, health and access to water were also average (box 1). However, the mortality rates were above alert thresholds. The main cause of mortality was bloody diarrhoea.

Box 1 Food security, public health and child feeding practices, Kurmuk County, Southern Blue Nile, February 2005 (GOAL, 02/05)

It is worth noticing that these surveys were done after the rainy season, a favourable period in regard to food security.

Darfur

The security situation saw no improvement in Darfur (BBC, 11/04/05; UNNews, 18/04/05). Attacks on civilians seem to have decreased only marginally, while attacks against humanitarian personnel and convoys are on the rise. A new round of African-Union sponsored peace talks are due to begin in Nigeria in May 2005 (AFP, 26/04/05).

WFP food deliveries increased by 34% in February 2005 compared to January (UNNews, 15/03/05). New routes have been opened for food transportation from Abeche in Chad and from Libya (WFP, 09/05/05). However, as of April 2005, WFP was facing a funding shortfall of 40% of the total requirement (WFP, 06/05/05).

As of February 2005, it was estimated that 58% and 80% of the affected population were covered in regard with provision of drinking water and non-food items, respectively, while sanitary interventions covered 70% of the needs (UNSC, 12/04/05). Primary health coverage was still far from sufficient.

Access to several remote areas has recently been gained (UNSC, 12/04/05).

A recent report describes the effects of the conflict and humanitarian crisis on the livelihoods of the communities in Darfur (FIFC, 02/05). The main livelihoods in Darfur are crop cultivation and livestock rearing and trading, supplemented by migration and remittances, collection of natural resources (firewood, fodder and wild foods) and trade. The figure below attempts to summarise the main findings regarding the disruption to livelihood in Darfur (figure 4).

Figure 4 Disruption to livelihood, Darfur, Sudan (FIFC, 02/05)

Recent random-sampled nutrition surveys showed average to precarious nutrition situations (table 6).

Table 6 Results of surveys in Darfur region, Sudan

In the IDP camp of Kalma, South Darfur, the nutrition situation and the mortality rates have improved when compared to September 2004 (figure 5) (MSF-H, 02/05).

Figure 5 Malnutrition and mortality, Kalma IDP camp, South Darfur, Sudan

However, a rise in the number of admissions to the feeding centres has been reported from March 2005. Measles vaccination was low and despite the fact that the great majority of the population had access to a protected source of water, diarrhoea was widespread. There was a fear that some of the bladders might be contaminated. Latrine coverage has improved from 44.3% in September 2004 to 74.3% in February 2005. However, only 20% of the households surveyed reported having soap at home. Eighty-four percent of the families interviewed stated they had a ration card. Among them, 12% reported not having received a food distribution in the month prior to the survey.

In Gereida camp, South Darfur, the nutrition situation was precarious and the under-five mortality was above emergency threshold (however, mortality was recorded over the month prior to the survey and confidence intervals are probably very large) (table 6) (ACF-F, 01/05). Diarrhoea was the main cause of death. Ninety six percent of the families were benefiting from the general food distributions.

The nutrition situation was also precarious in Jebel Mara area, West Darfur and under- five mortality was of concern (table 6) (GOAL, 03/05). The area, which was the bread basket of Darfur, has been affected by food insecurity due to the conflict and poor rainfall. Only one food distribution had taken place in the five months prior to the survey (03/05).

Overall

Despite some improvements, the situation is still grim in both Southern Sudan and Darfur. Both regions suffer funding gaps (see map).

Funding gaps, Sudan (Humanitarian Information centre, Darfur, 02/05)

NICS 5, February 2005

Situation still volatile in Darfur

The security situation is still highly volatile in Darfur with reported attacks on villages, population displacement and harassment of aid workers (Reuters, 19/01/05; UNNews, 07/01/05).

SC-UK withdrew from Darfur after four of their staff members were killed (UN-RC, 30/12/04). 2.39 million people are estimated to have been affected by the conflict, including 1.66 million displaced persons and about 200,000 refugees in Chad (USAID, 30/12/04).

In December 2004, WFP was able to reach only 60% of planned targets, mainly because of security constraints (WFP, 29/12/04).

Situation still serious but better than 6 months ago in Abu Shok camp, South Darfur

A random-sampled nutrition survey was conducted by ACF-F in Abu Shok IDP camp, near El Fasher town, in North Dafur in November 2004 (ACF-F, 11/04). Although the situation was still serious, it has improved compared to June 2004 (figure 2). Mortality rates and especially under-five mortality also seemed to have improved but remain of concern (figure 2). Measles vaccination coverage was within the same range as in June 2004 and was below 50%.

Since the survey was carried out thousands of new arrivals have been registered in Abu Shok camp (WFP, 29/12/05).

Figure 2 Prevalence of acute malnutrition and mortality rates, Abu Shok camp, South Darfur

Table 11 Results of surveys in Darfur region, Sudan, (ACF-F, 09/04; Epicentre, 11/04; SC-US, 01/05)

* According to cards and mothers' statements

Average situation in Serif Uma, North Darfur

In the town of Serif Umra, North Darfur, where 59% of the surveyed population was displaced, the situation was average in November 2004, according to a random-sampled nutrition and mortality survey (table 11)(Epicentre, 11/04). People received food distributions in March (one month ration) in August (two month ration) and in October (one month ration). About 25% of the families interviewed did not possess a card for receiving food distributions. These were families which had arrived after the registration held in March 2004. Moreover, it seemed that for about 40% of the households having a card, fewer people were registered on the card than there were actually in the families. A significant proportion of the population had no access to jerry cans, blankets, soap or latrines. Oxfam were carrying a non-food item distribution at the time of the survey. They, however, had been prevented from distributing blankets.

Serious situation in Nyala town, South Darfur

In Nyala town, South Darfur, which also counts a high proportion of IDPs, the nutrition situation was serious as of September 2004, according to a random-sampled nutrition survey (table 11) (ACF-F, 09/05) and was within the same range as a nutrition survey conducted in the nearby Kalma IDP camp at the same period (see NICS 4).

At the time of the survey, no food distribution had been carried out in the town.

Average nutrition situation in Fur Baranga, Habila, West Darfur

A random-sampled nutrition survey conducted in Fur Baranga administrative unit, showed an average nutrition situation (table 11; SC-US, 01/05). Mortality rates were below alert thresholds (table 11). About 25% of the households interviewed were displaced. About 80% of the families have received a general food distribution. Migration for labour was widespread with 50% of the households having one person who has migrated for labour.

Southern Sudan

The government of Sudan and the SPLM/A (Sudan People's Liberation Movement/Army) signed a final peace accord at the beginning of January 2005, closing three years of negotiations (AFP, 09/01/05). However, some analysts have observed that prospects for lasting peace remain fragile (IRIN, 18/01/05). Nevertheless, following the peace agreement, some countries and the European Commission have shown their interest in reinforcing their commitment to Sudan (DFID, 24/01/05; EC, 25/01/05). The UN envoy has demanded the deployment of 10,000 peacekeepers to observe the ceasefire (DPA, 18/01/05).

It seems that a significant number of refugees and IDPs have begun to return spontaneously to southern Sudan, for example, an estimated 15,000 people from Uganda (PANA, 11/01/05).

The 2004 harvest was poor in most parts of southern Sudan and especially in the northern parts of Northern Bahr El Gazal (FEWS, 24/01/05). The poor rains have also undermined people's ability to gather wild foods and to fish (FEWS, 24/01/05). Depending on the area, the harvest is expected to last only until January-February 2005 in the worse case, and until May in the best case. In Western Equatoria, the second crop season will last until July-August 2005. In this fragile situation, the IDPs' ability to resettle properly will depend on the overall situation in their area of return.

The nutrition situation in Bentiu town, Unity state, an enclave controlled by the government of Khartoum, and in Mareang district, Zeraf county, Central Upper Nile, was critical, according to two random-sampled nutrition surveys (table 12), and has remained within the same range over the last few years (ACF-F, 07/04; AAH-US, 10/04).

The situation in Nuba mountains seemed average to precarious (table 12) (AAH-USA, 11/04; SC-USA, 12/04).

Table 12 Results of surveys in Southern Sudan (ACF-F, 07/04; AAH-USA, 10/04; AAH, USA, 11/04; SC-USA, 12/04)

* According to cards and mothers' statements

Overall

The situation in Darfur is still dire (category I) and insecurity still prevalent. In Southern Sudan, a high number of IDP's and refugees' returns are expected while food security in parts of the region will be poor this year.

NICS 4, November 2004

South Sudan

The rainy season has been poor in most areas of South Sudan. The harvests are below average and typical of a drought year (FEWS, 26/10/04). In Bhar el Ghazal, insecurity has also prevented people from cultivating (IRIN, 01/11/04). The capacity of the populations to put coping mechanisms in place will be determined within the next months. However, the absence of flooding has already jeopardized fishing and the gathering of wild food, such as water lily, which represent a significant source of food for many people (IRIN, 01/11/04).

In Karthoum, a number of IDP settlements, such as Soba, El Salam, Mayo and Wad El Bashir, have been destroyed (IRC, 20/10/04; IRIN, 13/10/04). The government promised to relocate 40,000 households. However, this is less than the number of households in need of a plot and most of the displaced households can not afford the cost for the plot and a new house. Most people have therefore built makeshift shelters. This policy may prompt the IDPs to return to South Sudan.

According to various nutrition surveys, the nutrition situation continues to be serious to critical, while mortality rates were average (table 4). In the first three quarters of 2004, rates of wasting were stable when compared to 2003 and to the average previous five years (UNICEF, 27/10/04). It seems that while the level of acute malnutrition was lower in the first two quarters of 2004 than in the average five previous years, it rose again in the third quarter (UNICEF, 27/10/04).

Table 4 Malnutrition, measles vaccination and mortality, South Sudan (AAH-US, 08/04; ACF-F, 08/04; MSF-CH, 05/04; Tearfund, 07/04)

Darfur crisis

Despite a renewed commitment by the Government of Sudan and the two armed opposition forces (the Sudan Liberation Movement/Army (SLA) and the Justice and Equality Movement (JEM)) to halt air bombardments and to facilitate the provision of humanitarian aid (DPA, 10/11/04), the situation on the ground is still dire. NGOs and WFP have reported deterioration in security conditions which hampers the delivery of assistance (IRC, 15/11/04; WFP, 12/11/04). Moreover, civilians continue to be targeted. They lack protection in rural areas and, in IDP camps, they are subjected to harassment and allegedly forced displacement (HRW, 15/11/04; RI, 10/11/04; IRIN, 25/10/04). There have been a number of calls for the international community to reinforce action on Sudan (IRC, 15/11/04; HRW, 15/11/04). The forces of the African Union, which are currently on the ground, will be reinforced to reach about 3,300 troops (DPA, 11/11/04).

About 2.2 m people are estimated affected by the crisis, including 1.6 m internally displaced persons (see map). While humanitarian assistance has increased over the past months, gaps in response to humanitarian needs are still widespread (see map).

High levels of malnutrition and mortality

Several surveys have been conducted recently in accessible areas of Darfur. They showed average to critical levels of mortality depending on the area (table 5) and a generally high prevalence of malnutrition (table 5). Most of the reports highlight the great number of deaths due to violence, especially among adult men. Depending on the area, deaths due to violence among adults varied from 12% to 70%. It seems that, among displaced people, most of the deaths due to violence occurred before displacement.

Table 5 Malnutrition and mortality, Darfur, Sudan (CDC/WFP, 08-09/04; WHO/EPIET, 08/04; Epicentre/MSF, 08/04; Epicentre/MSF, 09/04; Depoortere & al, 10/04)

Micro-nutrient deficiencies

The CDC/WFP survey also investigated micro-nutrient deficiencies (CDC/WFP, 09/04). Anaemia was found to be a significant public health problem in both children and women (table 6). The presence of Bitot's spots in children was investigated to assess severe vitamin A deficiency; none was found. However, 15.5% (9.1-21.8) of the women reported night blindness during their last pregnancy: a symptom of vitamin A deficiency. Vitamin A supplementation coverage among children 9- 59 months was average: 74.2% (66.8-81.5).

23.6% (16.7-31.5) of the women had detectable goitre, indicating substantial iodine deficiency. Iodine deficiency was already widespread before the current emergency.

Table 6 Anaemia among children and women, Darfur, Sudan, Aug-Sept 2004 (CDC/WFP, 08-09/04)

* Hb < 11 g/dl for children 6-59 months and pregnant women,
Hb < 12 g/dl for non-pregnant women

Precarious food security situation

WFP conducted a food security assessment among crisis-affected populations during summer 2004 (WFP, 10/04). IDPs were found to be more food insecure than residents: nearly half of the residents were found to be able to access adequate food intake while only 7% of IDPs could. However, residents were also at risk, especially those hosting IDPs or those being in areas where a high number of IDPs have settled.

The overall food security situation is bleak. Households have lost productive assets such as livestock (90% loss for IDPs and 40% loss for residents) or grain stocks (75-85% and 20% of the IDPs and resident households lost their grain stock, respectively).

The area planted in 2004 is only 40% of the area cultivated in 2003, with almost no cultivation for IDPs in camps and an 80-90% decrease in area planted for IDPs residing outside camps. About 60% of farmers bought seeds in 2004 compared to 25% in 2003. There have been few seed distributions.

ICRC also reported a poor food security situation due to insecurity and drought (ICRC, 20/10/04). The harvest expected in November/December may ease the situation but it is estimated that, at best, the harvest will only last until January/February 2005 in West Darfur and March/April in West and South Darfur. Even should the population be able to plant next year, the food gap will last until the end of the year. According to ICRC and SC-UK, relief interventions should be implemented in drought-affected areas in order to prevent people from moving to IDP camps in search of assistance (ICRC, 20/10/04, SC-UK, 25/09/04).

Food prices are reported to be 60% above "normal" level because of the poor 2003-2004 harvest and because of disruption in transportation of food from surplus areas.

Sources of income have decreased and income has dropped by 80% and 70% for the IDPs and residents, respectively, compared to pre-crisis levels. The main sources of income for IDPs are wage labour and the sale of firewood and grass. Competition for wage labour has increased.

Food distribution

The scale of food distribution has increased over the past months (figure 4). However, in September, more than half of the households received only cereals instead of a balanced food basket also including, oil, pulses, CSB and salt (WFP, 10/04). This reduces the energy of the ration to 1,500 Kcal/person/day instead of the intended 2,100 Kcal/kg/day, and also reduces access to micro-nutrients. Moreover, the cereal milling process leads to losses as well as the cost of the milling itself.

About 77% of IDP households had a ration card as well as 47% of the resident households (WFP, 10/04). Other surveys found that 87%, 75.7% and 98.1% of families in Habilah, Kass and Kalma IDP camp had a food distribution card (Epi/MSF, 08/04; Epi/MSF, 09/04).

In October 2004, WFP assisted 1.16 m people, or 73% of its 1.6 m target (WFP, 12/11/04).

According to WFP evaluation, the number of people in need of food aid will be 1.7 m until the end of 2004 and could increase to 2 m in 2005 (WFP, 10/04).

Figure 4 Proportion of households with ration cards receiving a food distribution by month and by region (WFP, 10/04)

Non-food items

Access to non-food items was average to low, depending on the area (table 7). Availability of soap was especially low.

Table 7 Access to non-food items, Water and sanitation Darfur, Sudan (Epicentre/MSF, 08/04; Epicentre/MSF, 09/04; WHO/EPIET, 08/04)

Public Health

Access to safe drinking water and sanitation was inadequate (table 7). It seems however, that it was better among the displaced people than among residents.

Measles vaccination coverage was below the 90% coverage required to prevent an outbreak in most of the areas surveyed, except in Habilah town.

Overall

The future is still bleak in Darfur where continued insecurity, lack of protection, drought and insufficient humanitarian aid jeopardize a real improvement of the situation. In South Sudan, a poor rainy season and continued insecurity will probably affect further the food security of the populations.

Recommendations

From the CDC/WFP survey in Darfur:

• Adjust the current general ration to compensate for milling losses and to address the lack of micro-nutrients
• Continue to provide food assistance to IDPs and residents living in mixed IDP/resident locations
• Provide assistance to the neediest residents in other areas in the form of productive and preferably self-targeting food aid schemes, such as food for work and school feeding
• Open market supply of sorghum to alleviate food gaps due to drought may be an appropriate response
• Continue or implement blanket and targeted supplementary feeding as well as therapeutic feeding
• Improve access to health care, water and sanitation

NICS 3, August 2004

Worsening situation in Darfur

Despite a cease-fire agreement signed in April 2004 between the government of Sudan and the two opposition forces (the Sudan Liberation Movement/Army (SLA) and the Justice and Equality Movement (JEM)), clashes and violence are still reported on the ground (DPA, 30/08/04). Protection is a major issue in Darfur; civilians, including IDPs, being targeted by violence (IRIN, 30/08/04).

On the 30th of July 2004, the UN Security Council passed a resolution demanding that the government of Sudan disarm the Janjaweed militia, accused of committing atrocities against civilians in Darfur (DPA, 30/08/04). According to HRW, Janjaweed camps were still active as of mid-August 2004 (HRW, 27/08/04). The UN also stated that the Sudanese government has failed to fully implement commitments (DPA, 01/09/04).

A hundred ceasefire monitors have been deployed by the African Union, together with about 300 troops to protect them. This strength is, however, far from sufficient to monitor the situation on the ground properly (DPA, 30/08/04).

Poor shelter and public health conditions

Most of the assessment reports highlight the poor living conditions in the IDP camps and gatherings, with a lack of adequate shelters, insufficient access to clean water, health care and sanitation (OCHA, 25/08/04; SAB, 15/08/04; WV, 24/07/04). As of late July, it was estimated that only 47% of the affected population had adequate access to clean water and only 20% had access to latrines (OCHA, 25/08/04).

Although health care coverage has improved from 45-50% in May to 69% in July, it remains a serious concern. Moreover, it seems that IDPs may have difficulties in accessing health care because they have to pay fees (WV, 24/07/04).

An outbreak of hepatitis E affected 2431 people and killed 41 between 22 May and 20 August 2004 (WHO, 30/08/04). The most affected area is West Darfur.

Serious food security and nutrition situation

Around 1.2 million people are estimated in need of food aid. WFP reached 82% of its target of 800,000 people in June and 95% of its target of 1 million beneficiaries in July 2004 (OCHA, 25/08/04). Logistical constraints and lack of capacity hamper the delivery of food aid. WFP has begun food airdrops to inaccessible locations. However, WFP only reached 35% of its target of 1.2 million beneficiaries in August (WFP, 27/08/04).

There were 20 TFCs caring for 4,820 children and 24 SFPs where about 18,000 had been admitted as of end July 2004 (OCHA, 25/08/04). A greater capacity for the care of malnourished children is needed. Blanket supplementary feeding programmes will also be implemented.

The availability of cooking fuel is also a major problem, because women fetching wood are being exposed to sexual violence (OCHA, 25/08/04; WV, 24/07/04).

According to a survey conducted by ACF-F in an IDP camp, near El Fasher, North Darfur where about 30,000 IDPs have settled since May 2004, the nutrition situation was extremely critical (table 3) (ACF-F, 06/04). Mortality rates were also very high (table 3). The main presumed cause of death amongst the under-five year olds was measles. Measles vaccination coverage according to cards and mothers' statements was only 52.8%. People received some non-food items when they arrived at the camp and they were entitled to food distributions.

A survey was done in Malha pastoral area, North Darfur in May 2004 (SC-UK, 05/04). The results were extremely worrying, especially regarding the nutrition situation. However, the under-five mortality rate was average (table 3). In this survey, only 1% of the children were from displaced families. This shows that resident populations are also at high risk. Indeed, the malnutrition rate has increased rapidly since the beginning of 2003, coinciding with the escalation of violence: the prevalence of malnutrition was 15.5% in April 2003 and had remained stable over the previous year, but rose to 25.0% in October 2003 and 33.4% in the current survey. The trading conditions for this pastoral population were unfavourable at the time of the survey and the area was cut off from external intervention between October 2003 and April 2004. At the time of the survey, neither general food distributions nor feeding centres were in place and the survey recommended that such programmes be implemented. The health system and access to water also needed to be supported and improved.

Two surveys carried out amongst internally displaced persons in Zalingei and Murnei, West Darfur (Epicentre/MSF, 06/04) also showed a serious situation (table 3). In Zalingei, as of May 2004, a lot of the families interviewed reported having received no food distributions, blankets or jerry cans: 56%, 68.3% and 80% respectively. In Murnei, the situation was slightly better with almost all the families having received food distributions, but 43% of the families did not own any blankets and 25% did not have jerry cans. Moreover, it was estimated that most of the shelters would not offer proper protection against the rain.

Table 3 Results of nutrition surveys, Darfur, Sudan, June 2004 (ACF-F, 06/04; Epicentre/MSF, 06/04)