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Nutrition Information in Crisis Situations - Uganda
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| Sources of food* Food distribution: 96% Purchase: 82% (expenditure on food = 38% of total household expenditure) Own crop: 53% Labour exchange: 31% Gathering: 15% Sources of income* Limited access to land* |
*100 families interviewed in ten camps and focus group discussion
According to a random-sampled nutrition survey conducted in Kalongo town (including resident and displaced population) in July 2004, the nutrition situation was average (GOAL, 07/04) and seems to have improved compared to the same period last year (figure 5). However, mortality rates were well above alert thresholds: CMR=1.7 deaths/10,000/day and <5MR=3.3 deaths/10,000/day. The main presumed causes of under-five mortality were fever/malaria and candidiasis.
The proportion of households which cultivated during the 2004 crop season was higher than
at the same time in 2003: 65.4% vs. 29%. The percentage of households using an unprotected source of water has remained stable since August 2003 and represented about one third of the families.
Figure 5 Acute malnutrition, Kalongo town, Pader district, Northern Uganda
The security situation has worsened since the beginning of 2004, leading to an increase in the number of displaced people. This may be due to a renewed military protocol between Uganda and Sudan, which allows Ugandan troops to pursue the Lord's Resistance Army (LRA) across the Sudanese border. It also seems that various armed Sudanese factions have attacked the LRA, forcing them to withdraw to Uganda (OCHA, 31/03/04).
It is estimated that between 1.2 and 1.6 million people are displaced in northern Uganda (FEWS, 16/04/04; WFP, 13/05/04); in Gulu, Pader and Kitgum districts, more than 90% of the population is displaced (see map). A major attack of the LRA in Barlonyo IDP camp in Lira district killed more than 200 people in February 2004 (OCHA, 29/02/04). In March, April and May, a number of sporadic attacks on IDP and refugee camps were reported in Gulu, Kitgum, Pader and Lira districts (USAID, 05/05/04). In Adjumani, 31,000 refugees fled after an attack. They have settled with relatives in other refugee settlements in Adjumani and Moyo districts (UNHCR, 07/05/04).
Conditions in most of the IDP camps are reported as being far from adequate. In most of the camps in Lira and Gulu districts, people can not get access to the 15l/pers/day of water recommended. Latrines are also reported as being scarce, in some camps there is only one latrine for 100 people or more (USAID, 05/05/04). In addition, IDPs have little access to health care (USAID, 05/05/04). HIV/AIDS prevalence is believed to be 13.2% in Gulu district (OCHA, 30/04/04).
Food security has been reported as deteriorating in Gulu, Kitgum and Pader districts, and it was recommended that the food ration distributed by WFP be increased to 75-80% of a full ration (OCHA, 31/03/04). Due to insecurity, people only have access to land within a three km radius around the camps (FEWS, 16/04/04). WFP urgently requires new donations, otherwise their stocks will be exhausted by July (WFP, 13/05/04).
The government of Uganda will allocate 630,000 US$ to IDPs, mainly to provide them with food (IRIN, 28/04/04).
A better security situation in Eastern Uganda has led to the return of some IDPs; most of the IDPs settled in Kumi district have returned to Kaberamaido, Katakwi and Soroti districts (FEWS, 16/04/03).
In Soroti district, eastern Uganda, the situation seems to have improved slightly, the number of children admitted to the TFC dropped from 430 at the peak of the crisis to 20 as of February 2004 (OCHA, 29/02/04).
Systematic random-sampled nutrition surveys were conducted in the 32 IDP camps of Gulu district in September/October 2003 (WFP/MOH/UNICEF, 10/03). The prevalence of malnutrition varied between 7.2% and 19.9%, depending on the camp. The malnutrition rate was below 10% in only three camps which were considered scattered and where people had appreciable access to intra-camp resources. The malnutrition rate was between 10% and 15% in 19 camps which were mixed congested and where people had access to resources. In ten camps, the prevalence of malnutrition was above 15%; these camps were overcrowded and people had low access to intra-camp resources. Access to water was reported lower than the 15 l/pers/day recommended. The malnutrition rates seem higher than was reported in May 2003, when a cluster-sampled nutrition survey in 21 of the 32 camps showed a prevalence of acute malnutrition of 6.7%.
Malnutrition rates varied between 5.3% and 21% in seven IDP camps (of a total of 12 camps) where systematic random-sampled surveys were conducted in September/October 2003 (WFP/MOH/UNICEF, 10/03).
The nutrition situation was under control in Kalongo town, according to a random-sampled nutrition survey (GOAL, 02/04). About 70% of the families interviewed were displaced. The prevalence of acute malnutrition was 4.7% (3.5-6.4), including 0.7% (0.3-1.5) severe acute malnutrition. The situation has greatly improved compared to August 2003 when the acute malnutrition rate was 11.6% (8.6-14.2) (see RNIS 43). No hypothesis regarding the improvement of the situation could be drawn from the survey report. However, the current survey was conducted after the harvest done in December 2003, and 44% of the families surveyed reported having harvested, which may have improved their food security. 73.5% of the families were registered to receive food distribution and 89% actually received a food ration between August 2003 and February 2004; this seems to be an increase compared to August 2003 when only 70% of the families registered had received a food distribution. The main source of income was daily labour and petty trading and the main source of food was purchase. This is the same pattern as in August 2003 (see RNIS 43). 30% of the households used an unprotected source of water: this has not improved compared to August 2003.
Mortality rates were above alert thresholds: CMR= 1.5/10,000/day, < 5 MR= 2.1/10,000/day.
According to seven systematic random-sampled nutrition surveys carried out in IDP camps in Kitgum district (of a total of 12 camps), malnutrition rates varied from 13.9 to 18.8%, depending on the camp (WFP/MOH/UNICEF, 10/03).
A random-sampled nutrition survey carried out in nine IDP settlements (of a total of 23 settlements) in Lira town showed that the nutrition situation was under-control: 4.9% (3.2-7.1) of the children surveyed were acutely malnourished, including 1.5% (0.6-2.9) severely malnourished (Epicentre, 01/04). On the other hand, mortality rates were high: CMR=1.9/10,000/day, < 5 MR=2.2/10,000/day. Violence accounted for 50% of the deaths among people more than five years old.
An assessment, using a convenience sample, was also conducted in two camps outside Lira town (Epicentre, 01/04). The prevalence of acute malnutrition was 8.8%, including 3.1% severe acute malnutrition.
Most of the IDPs arrived in Lira town and IDP camps between September and November 2003. Measles vaccination coverage seemed good (more than 95% in both assessments), but some deaths from measles were reported.
About 40% of the IDPs in Lira town had received at least one food distribution, since the implementation of distributions in October 2003. In one of the IDP camps, no food distribution had been carried out, whist in the other, 60% of the IDPs received at least one food distribution.
MSF-H has implemented a TFC in Lira hospital and two supplementary centres in Lira municipality. As of January 2004, about 40 children have been admitted each week to the TFC and 10,000 children were being cared for in supplementary feeding centres.
About 31,500 Sudanese refugees were settled in Palorinya as of February 2004. A random-sampled survey conducted in March 2004 showed an acceptable nutrition situation: The prevalence of acute malnutrition was 5.0% (3.2-7.5), including 0.2% (0.0-1.4) severe acute malnutrition (ADEO, 03/04). The nutrition situation has remained under control since 1998.
The situation of IDPs in northern Uganda is still dire (category II). They lack access to basic services and lands and are subjected to periodical violence; the provision of aid is greatly impaired by the insecurity. It seems that the situation in towns is better than in some camps in rural areas. This may be due to better security conditions and better access to basic services and coping mechanisms.
Attacks on the civilian population by the Lord's Resistance Army (LRA) have spread from northern Uganda to Teso region over the past months. It is estimated that, in addition to the 800,000 displaced in the north, about 300,000 people are displaced in the east (see map): 150,000 in Katakwi district, 80,300 in Soroti, 33,800 in Kaberamaido and 21,100 in Kumi (WFP, 25/09/03). The health status of the displaced people in the east has been reported as deteriorating(IRIN, 25/09/03). Concerns about the fate of the IDPs are growing. Despite an increase in funds dedicated to this crisis, additional funds are needed, and the UN agencies have been called to increase their action towards the IDPs (RI, 15/10/03). New cash contributions are urgently needed for WFP to continue carrying out highly-needed food distributions (WFP, 14/11/03).
On the other hand, food security has normalised in Karamoja, following a normal crop harvest. Prices of cereals were decreasing and prices of livestock were on the rise (FEWS, 10/10/03).
Kalongo town, Pader district
A random-sample nutrition survey was conducted in Kalongo town in August 2003 (GOAL, 08/03). About 70% of the households surveyed were displaced. The nutrition situation and the mortality rates were worrying (see table).
Results of a nutrition survey, Kalongo town, Pader district, Uganda, August 2003 (GOAL, 08/03)
| % Acute Malnutrition (95% CI) |
% Severe Acute Malnutrition (95% CI) |
Crude Mortality (/10,000/day) |
Under 5 Mortality (/10,000/day) |
Measles immunisation coverage (%)1 |
| 11.6 (8.6-14.2) | 2.9 (1.6-4.2) | 1.0 | 2.1 | 19 |
1 According to cards
The IDPs seemed to be at higher risk of malnutrition. The food security situation was poor and the public health system was inadequate (see box).
Food security and public health, Kalongo town, Pader district, 08/03 (GOAL, 08/03)
| Food security Food distribution Two food distributions had taken place in April and August 2003 74% of the families interviewed were registered for the general ration and 70% received it in August The ration distributed was less than a full ration Sources of food Purchase: 85.5%, own production: 13.9% vs own production: 96.4% in a normal year Price of staple food had doubled when compared with 2002 Cropping and livestock Only 29% of the families had planted this year, vs 95% of the households who would have planted in a normal year; the main reason for not planting was insecurity Only 39% of the families had access to land 17.8% of the families had livestock vs 86% in a normal year Sources of income The main source of income was daily labour (59%), followed by collection and sale of water (16%) and sale of own crop (12.5%) vs sale of own crop: 89.4% in a normal year Public health |
Overall
Increased commitments in terms of funding, humanitarian action and crisis resolution are needed to mitigate the dire situation in northern/eastern Uganda.
Recommendations:
From the GOAL survey in Pader district:
Insecurity in North Uganda, drought and raiding in Karamoja and Katakwi, and a new influx of refugees from DRC have worsened the situation in Uganda.
The security situation is still very tense in northern Uganda with continuous attacks by the Lord's Resistance Army (LRA). IDP camps, holding about 800,000 people, have been increasingly targeted (IRIN, 07/07/03) and looted for food (Fews, 09/07/03). More and more people, especially children, have taken refuge at night in the urban centres in fear of abductions to enrol them in the armed forces; several schools have been closed in Kitgum district for the same reason (OCHA, 30/06/03). The LRA has also expanded its area of attacks in Adjumani, Katakwi, Soroti and Kaberamaido districts, which has led to the displacement of thousands of people (OCHA, 30/06/03). Access to the population is still severely limited for humanitarian organisations.
The northern and eastern parts of the country are affected by food insecurity (see map, FEWSNET, 11/04/03).
WFP has launched an appeal for US$ 54 m to provide food aid to 820,000 IDPs, 655,000 drought victims and 147,000 refugees. WFP will run out of food in September if the appeal is not covered (WFP, 29/07/03).
Gulu district
A nutrition survey was carried out in 21 of the 31 IDP camps in Gulu district in May 2003 (AAH-USA, 05/03). The results revealed a nutrition situation under control, and which has remained stable over the past four years (see figure).
Prevalence of acute malnutrition, IDP camps, Gulu district, Uganda
Mortality rates were, however, dramatically high (under-five mortality rate = 5.7 deaths/10,000/day; crude mortality rate = 2.3 deaths/10,000/day), and were the highest recorded in the camps for five years (see figure).
Under-five mortality rates, IDP camps, Gulu district, Uganda
The main causes of under-five year old mortality were fever and diarrhoea. Measles vaccination coverage was 92.1% according to cards and mothers' statement.
The survey was done in 21 camps, which remained accessible despite volatile security conditions, but did not target 10 camps where insecurity prevented access. The situation in these camps is probably worse than in the camps surveyed.
A nutrition assessment, carried out in two camps in Gulu district in January 2003, found higher rates of acute malnutrition than the present survey (see RNIS 41). High percentages of oedema (4 to 8%) were recorded in January, which needed to be confirmed. Other reasons, which may explain the discrepancy between the two surveys, may be that the camps surveyed were not the same and that the amount of food distributed in the IDP camps has increased since March 2003.
Whilst the nutrition situation seemed under control, which may be partly explained by the access to food distribution, mortality rates were extremely high, as a result of a major public health problem (see boxes). The situation may worsen further if attacks and looting increase.
Immediate determinants of nutritional status and mortality, Gulu IDP camps, 2003
| Food intake1 78% of the families interviewed said they have reduced the number of meals consumed More than 50% were eating only one meal/day Diseases2 |
1 AAH-USA, 05/03
2 WFP/MoH, 01/03
Underlying determinants of nutritional status and mortality, Gulu IDP camps, 2003
| Household food security Food distribution1 Intended full distribution rations since March 2003 (2,100 Kcal) But, Shortage of oil, 1,800 Kcal provided Irregular monthly distribution Reports of looting of food after the distributions 88% of the families were recipient of WFP food distribution 22% of the families were not registered (WFP was to update registration lists) Sources of food1 Beside the general food distribution, 80% of the families reported to cultivate Difficulty accessing lands because of insecurity Quantities harvested probably low Public health Social and care1,2 |
1 AAH-USA, 05/03
2 WFP/MoH, 01/03
Karamoja
Karamoja (Kotido, Moroto and Nakapiripirit districts) is suffering from high food insecurity because of the very poor 2002 harvest (see RNIS 41). There have been reports of high rates of malnutrition.
People are depending on highly priced market grains and wild foods until the next harvest, which is expected by September 2003. The crop season has progressed well so far. The most affected households (estimated at 30 to 55 % of the total population) are those relying on agriculture and labour to meet their food needs. The agro-pastoral population seems to be in a better position, with favourable terms of trade and improvement of livestock conditions (because of renewed pasture due to rains), which increases access to livestock products, such as milk (Fews, 09/07/03).
WFP food distribution was targeting 95,400 households in June 2003.
Katakwi
Katakwi district has been threatened by insecurity due to Karamonjong raids for years (see RNIS 41), leading to the displacement of about 85,000 people.
Katakwi district, as well as the nearby Soroti district, have also recently experienced incursions of the LRA.
An interagency mission held in March 2003 (OCHA, 03/03), before incursions of the LRA, reported uncertain conditions in the camps.
Food security
Households were largely relying on the market for their food needs. The main sources of incomes for the poor (who represent the majority of the IDPs) were casual work and petty trade (beer brewing, charcoal and wood). Access to fields was made difficult by insecurity; moreover, the 2002 crop was poor because of the weather conditions. A food distribution has been implemented by the government but people have only received 2 kg of maize meal and 1 kg of beans per household per month, which is very low. In addition, it seemed that it has not been the more needy families who received the biggest quantities.
About 40 to 50 % of the displaced populations in camps were able to meet only 70% of their daily consumption needs. Meanwhile, populations' livelihoods were limited, impairing their long-term food security (Fews, 09/07/03).
Public health
Supply of potable water was not adequate. There were no latrines in some camps, whilst availability of latrines was very poor in others (1 for 100 or 200 persons), some of the camps were, however, better covered and programmes of latrine construction were under-way. Hygiene conditions in the camps were generally bad, the camps were overcrowded and presence of animals in the camps worsened the situation, although hygiene promotion has been implemented.
Health activities in the camps were poor, with shortage of medical staff and drugs; district health facilities were far from the camps.
The situation is probably worsening, as the recent LRA incursions and the insecurity that has resulted have prevented families from harvesting, which will further impair their food security. The district is also less and less accessible due to insecurity.
Refugees
Former refugees in Acholi-Pii camp, temporarily settled in Kiryandongo refugee camp, after Acholi-Pii camp was attacked by the LRA, expressed their discontent with being relocated in the northern Arua and Yumbe districts (WFP, 25/07/03).
Refugees from Ituri, DRC, have continued to arrive in districts bordering DRC, especially in Nebbi and Bundibugyo districts; they are estimated to be about 20,000. Refugees were hosted by families or were sleeping outdoors. They were managing to gather food by fishing, planting or doing daily labour. For several reasons (see RNIS 41), only 97 families agreed to be relocated to camps further inland (OCHA, 30/06/03). The situation of the refugees in the districts near the DRC border has raised more and more concern because some of them were lacking shelter and sanitary conditions were unsatisfactory (UNHCR, 19/05/03).
Overall Whilst the prevalence of malnutrition is not at an alarming level in the most accessible camps in Gulu district, mortality rates are dramatically high as a result of a major public health problem. The situation of IDPs in Katakwi district is also alarming as the populations are facing both insecurity from Karamojongs and LRA. There is room for improvement in all basic need services and food availability.
Attempts to organise peace-talks between the government of Uganda and the LRA (Lord's Resistance Army) fighting movement have not succeed to date.
Despite a decline in the intensity of fighting, the situation remains highly precarious with difficulties accessing the estimated 800,000 IDPs in Gulu (395,000), Kitgum (99,000), Pader (271,000) and Lira (47,000) districts (OCHA, 31/01/03). People have not been able to prepare land adequately and plant, and will therefore have a poor harvests in August 2003; they will still be highly dependent on food aid for several more months.
WFP faced food aid shortages at the end of 2002/beginning of 2003: the cereal ration (which provides the bulk of the food ration) was reduced by 30% in the last quarter of 2002, and was totally suspended in January 2003 (OCHA, 31/01/03). However, donors responded positively to the emergency appeal launched by WFP in January 2003 for IDPs and refugees in northern Uganda. WFP has received 90% of the funds required to provide food to the affected population from January to June 2003. Cereal distributions resumed in IDP camps in February 2003 and pipeline is guaranteed until April 2003. However, food shortages are already expected by April 2003 (OCHA, 28/02/03).
Gulu district
A nutrition assessment was undertaken by WFP/MOH in two of the main IDP camps in Gulu district in January 2003 (WFP/MOH, 01/03). A systematic sampling methodology was used; 155 children were measured in Pabbo IDP camp and 114 children were measured in Anaka camp.
A high percentage of children were acutely malnourished, especially in Anaka camp. The percentage of children who had oedema was particularly high (see table) although the method for assessing oedema was not reported in the survey report. On the other hand, preliminary results of a screening carried out on 2047 children in 11 IDP camps in northern Uganda reported a far lower percentage of oedema (less than 1%) (AAH-USA, 02/03). The high prevalence of oedema found in Pabbo and Anaka IDP camps needs to be confirmed. Whatever, these assessments indicate that the nutrition situation of children in IDP camps in Gulu district is worrying.
The number of admissions to TFC has gradually increased over the last months; about 200 children were admitted to TFC in December 2002 compared to about 100 in January 2002 although TFCs are situated in hospitals which are far from some of the IDP camps. According to the survey, households were more dependent on their own sources of food than on the general distribution during the two months prior to the survey because of the disruption to the food distributions. About 50% of the IDPs had access to their own production, which was mainly cassava. Prevalence of diarrhoea and fever was particularly high (> 40%) in 6-59 month olds. Access to safe drinking water, adequate sanitation, and health services were also reported to be low.
Prevalence of acute malnutrition in two IDP camps in Gulu district, Uganda, January 2003 (WFP/MOH, 01/03)
|
Acute |
Severe acute |
Oedema |
|
| Anaka IDP camp |
31.6 |
14.9 |
7.9 |
| Pabbo IDP camp |
18.1 |
7.8 |
3.9 |
Pader district
A joint emergency food needs assessment was carried out in 20 isolated IDP camps in Pader district in February 2003 (GoU, UN agencies, NGOs and Pader district authorities, 02/03). About 240,000 people were reported to be displaced (which accounted for 74% of the district's population) in 13 camps. The district was relatively spared by insecurity until mid 2002, when attacks from LRA spread out. As a consequence, the government of Uganda asked the population to gather in protected camps in September 2002. The camps were not prepared to receive such an influx of people and there was a lack of food, safe water points and health care.
The traditional and local council structures have been lost as people from the particular areas of origin dispersed to a variety of different camps. In addition, Pader district had only been created two years ago, and the capacity of the local administration is limited. The humanitarian capacity was also very restricted because of the presence of few NGOs, their limited capacity, and the insecurity.
The quality of health services was inadequate; a large number of qualified health staff have moved out of the district because of insecurity, and replenishment of drug stock has also been made difficult by the same insecurity. Safe water availability was low, and latrine coverage was only 7%. Both a therapeutic feeding centre and a supplementary feeding centre have been established at Kalongo hospital with the support of UNICEF and WFP. The district authorities also plan to open seven additional supplementary feeding centres and one therapeutic feeding centre.
The mission concluded that depending on which camp the displaced are settled in and the period they have been displaced, people experience different levels of vulnerability. Five categories have been defined: the host population; the old caseload IDPs, who have been displaced for 3-5 years; the new caseload IDPs, who were displaced from June 2002 onwards and integrated within the host community within the trading centres; the new caseload IDPs, who were displaced from June 2002 onwards and have settled into the camps; and the IDPs in transit who were in the process of establishing in the camps.
The host population and the old caseload IDPs were considered to be able to meet their food requirements by themselves, but they were more vulnerable than in the past in accessing basic services due to the new caseload IDPs. The other groups were considered to be food insecure and in need of food distribution, but a difference was drawn between IDPs living in the new camps and IDPs living in the old camps. The former were able to meet about 50% of their daily food requirements (defined as 2,100 Kcal/pers/day), whilst the latter are able to meet 60% of their daily food requirements (see table). The assessment however was carried out during the post-harvest period so the proportion of food people are able to access by their own means may decrease over the coming months.
Food sources in different camps, Pader District, Uganda, February 2003 (Joint assessment mission, 02/03)
|
Old camps |
New camps |
|
|
Own production |
25 % |
25% |
|
Market purchase |
15% |
20% |
|
Kinship |
5% |
0 |
|
Livestock |
2% |
0 |
|
Casual labour |
0 |
10% |
|
Petty trade |
0 |
10% |
| Net food gap |
53% |
40% |
Karamoja (Kotido, Moroto and Nakapiripirit districts) was reported to suffer from high food insecurity because of the very poor 2002 harvest, which has led to low household food stocks and decreased market supplies. Some people have started moving to urban centres in search of work, which is however scarce. Agro-pastoralists have also moved in search of food, which will limit livestock product access in the area. Price of sorghum has risen significantly compared to years of good production. Households were selling livestock to earn income to purchase food, and terms of trade were worsening. The situation will probably worsen as the hunger period intensifies until June. There have been contradictory reports of hunger related deaths in the area. WFP has started to increase food distribution in the three affected districts (OCHA, 19/02/03).
As a consequence of the current crisis in Karamoja, some armed pastoralists have been raiding other communities, especially in Katakwi district. This district has suffered from intense raiding by Karamojong warriors over the past five years leading to population displacements. The raiding was particularly fierce in 2000 and resulted in the displacement of about 85,000 people into protected settlements, of whom 75,000 remained displaced in 2002. Raiding significantly decreased in 2002, bringing the hope of returnee among IDPs but unfortunately the food insecurity which Karamoja is currently facing is reviving the raiding. About 10,000 people have fled the recent raids. They are in need of food, water supply, shelter materials, and non-food items (OCHA, 31/01/03).
An increasing number of arrivals in Moyo district from Sudan has been reported. Over 1,400 persons arrived in Morubi settlement in Moyo district in January 2003, compared to 110 in December 2002 (WFP, 28/02/03).
The upsurge in violence in eastern DRC has also caused several thousand people to cross the border with Uganda into Nebbi district. The security conditions in the district are volatile, as the conflict in DRC tends to spread into the neighbouring Ugandan district (OCHA, 12/02/03). UNHCR considers that only refugees who agree to be transferred to a designated refugee camp in Arua district should be assisted. UNHCR conducted an assessment in Nebbi and Arua district in November 2002. They estimated 5,000 people have sought refuge in these districts, of whom only 190 agreed to be relocated in a camp (OCHA, 31/01/03). On the other hand, an assessment done by IFRC in February 2003 estimated that at least 11,000 Congolese were settled in Nebbi district and commented that the real number may even be as high as 15,000 (IFRC, 20/02/03). Refugees were hosted with relatives or in public buildings. The reasons cited for unwillingness to move to the UNHCR designated camp were: the camp was too far from the border with DRC and refugees want to be near their area of origin to monitor the situation and reach their home to collect food and other items; some refugees have planted some crops in lands they obtained from the host community; some thought they could lose access to their livelihoods and lifestyle if moved to the camp. Overall, the majority preferred to receive services where they live. It seems that the Ugandan government has agreed with the provision of services to the refugees in this area. The public system is overwhelmed by the refugee influx. Major needs are provision of additional services such as water and sanitation installations, distribution of non-food items, and strengthening of the health facilities. These needs should be covered by IFRC and MSF Switzerland. No information has been received by RNIS concerning the food security and nutrition situation of the refugees.
The food security and nutrition situation is worrying in Gulu, Kitgum, Pader and Lira districts in northern Uganda, and in Karamoja and Katakwi districts in Eastern Uganda (category II).
From the WFP/MOH survey in two IDP camps in Gulu district:
From the joint mission in IDP camps in Pader district:
Ouganda
L'intensité des combats a diminué ces derniers mois dans le nord du pays, mais les 800 000 personnes déplacées sont toujours difficiles à atteindre en raison de l'insécurité.
Une évaluation nutritionnelle dans deux des plus grands camps de déplacés du district de Gulu a montré une situation nutritionnelle préoccupante (catégorie II) (voir tableau). Le nombre d'enfants présentant des oedèmes était particulièrement élevé, mais doit être confirmé, une autre évaluation dans des camps de déplacés n'ayant trouvé que peu d'enfants oedémateux.
Une évaluation réalisée dans le district de Pader, qui a connu une intensification du déplacement des populations au cours des derniers mois, a montré que si les anciens déplacés et les résidents étaient autosuffisants d'un point de vue alimentaire, les nouveaux déplacés ont besoin d'une aide alimentaire (voir tableau).
Le Karamoja connaît une forte insécurité alimentaire à la suite de mauvaises pluies. Le PAM a augmenté les distributions de nourriture dans cette région. En plus des conséquences sur la population résidente, cette situation engendre un regain d'attaques de la part des Karamonjongs dans le district de Katakwi. 10 000 personnes se seraient déplacées à la suite de ces attaques dans le district, venant s'ajouter aux 75 000 personnes déjà déplacées à la suite des attaques perpétrées ces dernières années.
Environ 10 000 à 15 000 personnes fuyant les combats en RDC ont trouvé refuge dans le district de Nebbi. La plupart d'entre eux refusent d'être transférés dans des camps situés à l'intérieur du pays.
Karthoum has agreed to indefinitely extend the right of Uganda to implement anti-LRA (Lord's Resistance Army) operations within Sudan (AFP, 21/11/02).
The LRA has pursued attacks against civilian populations and humanitarian convoys in the districts of Gulu, Kitgum and Pader, where there are an estimated 750,000 IDPs in 41 camps (WFP, 10/02). The Ugandan government policy of re-grouping people into protected camps also raised concern. It seems that security is not guaranteed in the camps and that basic services are not adequately provided for (HRW, 29/10/02). This policy also prevents people from cultivating and makes them totally dependent on food aid (RI, 22/10/02). FEWS reported that only 25% crop cultivation has been completed in northern Uganda (FEWS, 14/10/02). January's harvest, which usually covers food for the first semester of the year will probably be almost non-existent (WFP, 10/12/02). In Gulu district, agricultural activities were restricted to two kilometers outside of the camps; limited production of cassava, potatoes, beans and rice has been reported. IDPs relied on brewing of local drinks, casual labour and assistance from relatives as sources of income (WFP, 10/02).
The prevailing insecurity renders access to IDPs almost impossible outside the main towns; WFP delivers food aid under heavy military escorts. Food delivery was hampered by insecurity and pipeline breaks. WFP was obliged to reduce the food ration by 30% in October 2002 and anticipated a 40% cut in January 2003 (WFP, 20/12/02).
The conflict has also recently extended into neighbouring Lira and Adjumani districts. Some 42,000 people have been reported to have fled their homes into Lira town in September. The influx of IDPs has more than doubled the town's population. A few of them were able to access their fields to harvest (FEWS, 14/10/02).
Poor rainfalls have affected crop performance and have resulted in a poor harvest, estimated at 60 to 65 % of normal. However, most of the households had cultivated cassava, helping them to meet their food needs, and food stocks have been reported to be adequate in most households until next harvest. There are pockets of food insecurity, which include Usuk and Kaplebyong counties, in Katakwi district, where about 85,000 people are displaced in protected camps for fear of Karamonjong raiding (FEWS, 14/10/02). Market crop prices have increased since August but remain affordable for the majority of the population (FEWS,14/10/02).
Some 7,000 refugees from Ituri area, RDC, sought refuge in western Uganda. They moved with some goods and herds. They are currently settled among the host community (OCHA, 18/12/02).
In addition, some 3,000 Rwandan refugees, formerly settled in Tanzania arrived in Uganda in fear of being repatriated from Tanzania (Xinhua, 18/12/02).
Overall - The situation of IDPs in northern Uganda is still very precarious (category II).
Ouganda
Le sort des quelques 750 000 déplacés répartis dans 41 camps dans les districts de Gulu, Kitgum et Pader, au nord de l'Ouganda, est toujours préoccupant (catégorie II). L'accès à ces populations est très difficile. WFP distribue néanmoins une aide alimentaire sous protection armée, mais fait face à des ruptures de stock.
Uganda has experienced an upsurge in violence in the past months, especially in the northern part of the country, following the implementation of an anti Lord’s Resistance Army (LRA) campaign within Sudan. The LRA has increased their attacks on refugee and IDP camps, and resident populations, as well as humanitarian convoys. Insecurity hampered efforts to deliver assistance to the affected populations. The LRA issued a statement demanding all NGOs and UN organisations cease operations and leave Northern Uganda by August 14th (IRC, 08/08/02). Relief agencies nevertheless continued operations despite scaling back on staff and assets (AFP, 16/08/02).
Meanwhile in the western part of the country, nearly all the IDPs returned home as security stabilisated.
Northern Uganda
Refugee settlements
The LRA attacked the refugee camp of Acholi-Pii at the beginning of August, and more than 60 refugees were killed. Abductions, and looting of the camp warehouse were also reported. The 24,000 refugees settled in Acholi-Pii fled following the attack. Most of them were unable to save any belongings. They were temporarily accommodated in a transit camp in Kiryondongo. 8,000 of them have since been further transferred to the existing Kyangwali site, already hosting 6,800 Congolese refugees. Negotiations are underway to relocate those remaining (UNHCR, 30/08/02). Food, medical assistance and non food items have been provided (UNHCR, 09/08/02).
Maaji refugee settlement was also attacked at the beginning of September, leading to the displacement of 6,000 more refugees, who sought temporary shelter in buildings around the settlement (UNHCR, 13/09/02).
Impevi refugee settlements
The District Director of Health Services for Arua local government conducted a survey in the Impevi refugee settlements in June 2002 (DDHS 06/02). The survey showed a prevalence of acute malnutrition of 9.0 %; 0.9 % of the children were severely malnourished, including 0.4 % of oedematous children. The situation appears not to be critical. Other survey results previously available to RNIS were from AcF in May and October 1998 (RNIS 26). These surveys estimated the prevalence of acute malnutrition at respectively 5.8 % (3.9 - 8.5) and 5.4 % (3.6 - 7.9), including respectively 0.4 % (0 - 1.8) and 1 % (0.4 - 2.5) severe acute malnutrition. The prevalence of acute malnutrition has slightly increased since 1998.
The survey also reported that mortality surveillance through the community and the health facilities showed low mortality rates. Refugees have been allocated agricultural plots but the fertility of the soil is poor. WFP is providing a full food distribution for the new arrivals and a one-half ration for the earlier arrivals. The drought has affected the agricultural activities, and this may partially explain the slight increase in acute malnutrition. Severely malnourished children are treated at Kuluva hospital.
Rhinocamp
Rhinocamp hosts about 24,000 refugees, mainly from Sudan. The nutritional survey undertaken by the District Director of Health Services Arua district for Arua local government in May 2002 estimated the prevalence of acute malnutrition at 5.6 % (3.7 - 9.3) including 0.1% (0 - 2.4) of severe acute malnutrition (DDHS, 05/02). No oedema was recorded. The nutritional situation in Rhino-camp has been stable since 1998 (see graph below). A variety of nutritional interventions are undertaken in the camps, such as growth monitoring. Treatment of the severely malnourished children is in Kuluva hospital.
IDPs in Northern Uganda
Attacks have intensified during recent months in the districts of Gulu, Kitgum and Pader. The situation is more precarious now than it has been over the last 5-6 years. More than 20 out of the 38 displaced camps have been attacked. Houses have been burned, and women and children abducted (WFP, 09/08/02). WFP estimated that 522,000 IDPs were in need of food aid in July 2002.
Because of the insecurity, tens of thousands of people are estimated to be seeking refuge in the main towns of Kitgum and Gulu, particularly at night. Estimates of the numbers displaced are difficult to make however due to the insecurity and because people seek refuge only at night. Lacor hospital in Gulu hosts large numbers of displaced. Water and sanitation facilities have been implemented.
The Ugandan army has ordered 100,000 people in the districts of Gulu, Pader and Kitgum to leave their homes and move closer to camps protected by the army (BBCNews, 03/10/02).
WFP resumed food distribution to IDPs in the camps in mid July, with enhanced military escorts. They are also providing weekly food distributions for the in-transit IDPs in towns. (WFP, 23/08/02). Because they were able to cultivate, people were on 30% rations before the attacks, but will now require the full distribution (FEWS, 25/07/02). Distributions are also carried out for the resident population affected by drought and attacks in eastern Kitgum and Pader (WFP, 09/08/02) although the WFP distribution was disrupted in Kitgum district following an attack on a food convoy (WFP, 20/09/02).
Insecurity prevented IDPs accessing fields. They will probably lose the current harvest and be unable to plant for the smaller second harvest. They will be highly dependent on the food distribution until the next harvest in August 2003 (WFP, 23/08/02).
Prevalence of Acute Malnutrition among 6 - 59 Month Olds in Rhino Camp, Uganda
Eastern Uganda
Many of the displaced in the Katakwi district (about 85,000 people) continue to live in protected settlements, after displacements caused by intense raiding by Karimonjong warriors over the past five years. Despite the disarmament operation in Karamoja, for the first time in over a year a camp was attacked in Okoboi and 140 head of cattle were stolen (OCHA, 15/08/02).
The population is reported to be moderately food secure, confirmed by the results of the last nutrition survey available to RNIS. This showed levels of acute malnutrition far below the emergency threshold (RNIS 37/38). Very dry conditions since May 2002 have curtailed millet and sorghum cultivation and it is estimated that the harvest will be 60% of normal. Nonetheless, the situation was not as bad due to the availability of cassava and sweet potatoes (FEWS, 25/07/02). The situation will have to be carefully monitored as the combination of drought and raids may affect IDP food security.
IDPs in Western Uganda
The large-scale operation against the Allied Democratic Forces (ADF) rebels launched in 2000 has greatly improved the security situation in Western Uganda. Combined with the improved relationship between Uganda and Sudan, and reduced support for rebels in Congo, the Ugandan government believes that Western Uganda is safely secured (OCHA, 29/05/02).
Almost all the IDPs in Western Uganda had returned home as of August 2002. Even in May 2002, it was estimated that 90% of the displaced in Kasese and Kabarole had returned home, with only 500 remaining in camps (OCHA, 29/05/02). The remainder of the IDPs, settled in the district of Bundibugyo, returned home during the first week of August and were provided with a three month resettlement food package. Following this they will receive assistance through food for assets and school feeding (WFP, 27/09/02). There is concern about the resettled IDPs as the infrastructure in their original locations seems far from adequate and the presence of landmines. Humanitarian agencies are concerned that the government takes into account the development of these areas (OCHA, 29/05/02).
Overall The attacks on the camps in Northern Uganda have led to new population displacements which will probably impair population food security for the next 12 months (category II). The refugee situation in Arua district in Northern Uganda seems under control, if not destabilised by insecurity (category III). The situation of the refugees who fled from the Acholli-Pii and Maaji refugee camps has to be carefully monitored. IDPs in Western Uganda have been resettled but their nutrition situation is unknown (category V).
Recommendations and priorities
From the DDHS surveys in Impevi and Rhino camps
· Continue surveillance and screening to identify malnourished cases
· Continue food distribution
· Strengthen agricultural activities to reduce food insecurity, by providing improved seeds and agricultural education
From the RNIS
· Monitor the situation of IDPs in Northern Uganda and provide adequate support
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Ouganda Un regain de violence a de nouveau ravagé le nord de l’Ouganda. Le LRA a attaqué de nombreux camps de réfugiés et de déplacés ainsi que des villes et des villages. 30 000 réfugiés soudanais ont fui et doivent être réinstallés dans d’autres camps. De même, de nombreux Ougandais viennent trouver refuge dans les villes, principalement la nuit. Les déplacés qui auparavant pouvaient cultiver et ne recevaient qu’une ration alimentaire couvrant 30% de leurs besoins journaliers, sont désormais totalement dépendants de l’aide alimentaire. L’aide humanitaire est elle-même rendue difficile par l’insécurité. Les populations touchées par l’insécurité sont considérées comme à risque (catégorie II). Des enquêtes nutritionnelles réalisées dans 2 camps de réfugiés soudanais dans le district d’Arua, montrent une situation nutritionnelle moyenne à satisfaisante (voir graphique). Les deux enquêtes recommandent que la production agricole des réfugiés puisse être améliorée. A l’est du pays, dans le district de Katakwi, 85 000 personnes déplacées vivent toujours dans des camps protégés, de peur d’attaques de la part des Karamojongs. Ces populations subissent d’autre part les conséquences de la sécheresse. L’ouest de l’Ouganda connaît par contre une
stabilisation des conditions de sécurité. La plupart des
déplacés sont désormais retournés chez eux et ont
reçu une ration alimentaire d’accompagnement au retour mais les
infrastructures restent insuffisantes. |
Uganda has suffered a series of separate civil conflicts in various parts of the country. These conflicts have resulted in large displacement of population, many of whom have been grouped together in "protected" villages. The displacement has left the IDPs without access to their homes or land and has systematically disrupted livelihoods and household economies. This has come on top of a situation where almost 44 % of the country’s 21 million people live in absolute poverty, classified as below 50 cents a day (UNICEF 29/05/02). The result has been a population with high vulnerability to acute food insecurity and a heavy reliance on external assistance to meet their basic subsistence needs. The worst affected areas have traditionally been the northern region where the Lord’s Resistance Army (LRA) has waged a persistent war on the civilian population and in the west, where the Allied Democratic Front (ADF) have been active.
The reporting period has seen an upsurge in LRA activity in the north of the country. The month of June 2002 has seen numerous attacks on IDPs, refugees and local populations that have resulted in the burning of displaced camps and further fresh waves of displacement as people choose to flee the violence. The upsurge in insecurity comes after an extended period of security that resulted in a marked improvement in the overall humanitarian situation and left many IDPs and agencies alike talking of the possibility of wide scale returns. As a result, the new wave of violence has come as a considerable blow to the area and looks set to significantly deteriorate the humanitarian situation. The Ugandan government has taken advantage of the reestablishment of full diplomatic ties with Sudan, which were severed in 1995, to mount a campaign called "Operation Iron Fist" in South Sudan, against LRA strongholds. Traditionally the Sudanese government has offered significant support to the LRA in answer to support given to Sudanese rebels, the SPLA. The agreement, signed on 27 April 2002, has seen a considerable thawing in relations between the two governments and has allowed for the implementation of the anti-LRA operation within Sudan (UNOCHA 03/05/02). It was initially hoped that the campaign would remove the threat of the LRA for good and allow the IDPs in the north to return home and restart their lives. However, the upsurge in insecurity from the LRA is being taken as evidence that the campaign is not having the desired effect and that the LRA are trying to send a clear message to the Ugandan government that political negotiations should take place.
Latest estimates on the number of people considered to be vulnerable and in need of humanitarian assistance indicate that there are 859,166. This number includes 187,683 refugees and 660,373 IDPs situated in the north, west and east of the country.
IDPs in Northern Uganda
After a period of relative stability in the northern area of the country, the reporting period has seen an upsurge in violent attacks by the LRA rebels. The attacks have been directed towards destabilising the area and sowing fear in the populations and have resulted in ambushes along roads as well as attacks on towns, villages and on refugee and displaced settlements. Many of these attacks have resulted in the abduction of people, the looting of food and other belongings and the burning of huts. On 5 July 2002 rebels attacked Alero IDP settlement and burnt the houses and instructed people to leave the camps. As a result, there was a large exodus of people who fled without food and basic domestic necessities. Many IDPs are trying to make their ways to towns that are perceived as being safer than the so-called "protected" villages (UNOCHA 06/02). The attacks and the renewed displacement is placing considerable strain on existing relief and development work in the area and many NGOs are reported to have halted their work due to the poor security situation. WFP has been having severe difficulties in continuing much needed food distributions to people in camps as a direct result of the current poor security situation in the north. The security problems have resulted in the suspension of food aid to tens of thousands of people, although it has been reported that distributions were able to start again as a result of the redeployment of the Ugandan army in the area. It is particularly worrying to note that most of the 500,000 people in the north who receive food aid had developed a high degree of independence and were supplying 70 % of their own food prior to the attacks. However, they no longer have access to their gardens and suddenly find themselves dependent on food aid to meet their food requirements. This will involve a considerable mobilisation of new resources to meet the increased needs (UNOCHA 16/07/02). As a result, the IDPs in areas such as Kitgum and Gulu, which number around 506,440, should be considered to be extremely vulnerable and require continued assistance, particularly as the traditional hunger season is approaching when availability and access to food usually decreases.
IDPs in Eastern Uganda
The Katakwi district in northeast Uganda has suffered from intense raiding by Karimojong warriors over the past five years. Raiding is a traditional feature of this area of Uganda but the proliferation of small arms has meant that the raids have grown bigger and more deadly and have not stopped at the stealing of cattle but often involve wide scale looting, the burning of property, and the destruction of crops. The effect of the raiding has been displacement as people have fled the devastation left in their villages. However, the humanitarian situation has been exacerbated by the destruction of food supplies and the inability of the displaced to access their land. This has led to wide spread dependency on external assistance and the development of large displacement camps, which often suffer from poor public health environments.
The raiding was particularly fierce in 2000 and resulted in the displacement of in excess of 85,000 people, which corresponded to approximately 30 % of the district’s population (FEWS 17/06/02). The reporting period has seen significant improvements in the situation for many of the IDPs and there are reports of fewer attacks and the beginning of returns. It is currently estimated that there are about 75,000 people in camps with up to 10 % having returned home already. District authorities also report that households are able to access their land and grow crops, which is having a beneficial effect on household food stocks and the general food security of the area. The Ugandan government committed itself to disarming the Karamojong, who have been behind the attacks, and have found the process to be more difficult than originally thought. The Karamojong are fiercely independent and have not welcomed the disarmament attempts. There have been reports of clashes between the Ugandan army and the Jie, who are one of the Karamojong ethnic groups in Moroto and Kotido. The disarmament has yielded about 9,800 firearms, which represents approximately a quarter of the 40,000 expected. However, it is believed that the focus on disarmament may have prevented further raiding into the Kitakwi region (UNOCHA 21/05/02).
The RNIS does not have any recent nutritional information from the group but the last report indicated that the prevalence of acute malnutrition was not elevated above emergency thresholds. However, it was noted that the general health conditions in the camps were extremely poor and contributing to an unacceptably high mortality rate. The camps are now reported to be much cleaner, with good disposal of waste and improved water and sanitation. There has also been a marked improvement in the delivery of health care largely as a result of work done by various agencies.
IDPs in Western Uganda
The western regions have continued to enjoy good security as the threat of the ADF appears to have been significantly lessened. The areas with most IDPs, namely Kasesse, Kabarole, Bundibugyo, Kyenjonjo and Kamwenge lie beneath the Rwenzori mountains, which provide a natural barrier between DRC and Uganda. However, the Rwenzoris have also provided a hiding place for ADF rebels who were waging a war ostensibly against the government but which were targeted at the local population. The attacks drove tens of thousands into "protected" villages and prevented people accessing their valuable agricultural land. As a result, the local economy collapsed and people were left with a very high degree of dependence on humanitarian assistance. The Ugandan army led a large-scale operation against the rebels in 2000 and since that time the security situation has improved markedly. As a result, many people have started to return to their homes or have made serious provision to do so. The latest estimation exercise indicated that there were about 87,000 IDPs in camps in Bundibugyo. However, it is reported that the number of people returning home has increased, markedly leaving about 47,000 IDPs actually living in camps (UNOCHA 06/02). The IDPs who remain in camps do so largely because of uncertainty over the security situation or because they are waiting for the right moment when the raw materials to rebuild houses will be available. There is also a group who have established lucrative livelihood activities in the camps and who are unlikely to leave, meaning that the camps will become rural trading centres (UNOCHA 06/02).
The improved security has also meant that IDPs are much more self-reliant and are meeting 80 % of their food needs themselves. The areas of the west are extremely fertile and it is possible to get three crops a year, including lucrative cash crops such as vanilla, coffee and cocoa. As a result, WFP stopped general food distributions in Bundibugyo on 5 July 2002. Instead, a three-month ration will be distributed to IDPs who return to their homes. The RNIS does not have any recent nutritional information from this group but it is not thought to be critical.
Refugees
There are currently estimated to be 187,683refugees in Uganda from Burundi, DRC and Rwanda, although the majority come from Sudan. The number of refugees has continued to increase largely as a result of fresh influxes from Sudan as a result of the ongoing war in the south. The increase in insecurity in the northern regions is having a profound affect on the refugee community and there have been repeated reports of attacks on refugee camps. On 8 July 2002, LRA rebels attacked Maaji refugee settlement in Adjumani district, resulting in the killing of a soldier and refugees and the burning of houses. UNHCR have reported that many of the 11,000 Sudanese refugees who were in the camp have fled and headed towards the town of Adjumani, carrying their belongings with them (UNHCR 10/07/02). The insecurity has prevented some humanitarian agencies from accessing vulnerable populations and it is expected that the humanitarian situation is likely to deteriorate if the insecurity persists. The RNIS does not have any recent nutritional information from this group but they are considered to be highly vulnerable
Overall
The re-emergence of insecurity in the north has dealt a considerable blow to the prospects of mass returns of IDPs. It has also resulted in decreased access to affected populations by the humanitarian community and has also prevented livelihood activities. As a result, the IDPs in the north are at considerable risk in a declining humanitarian situation (category II). The situation in the east and the west is greatly improved (category III) as a result of a generally good security situation, which has allowed many to begin to return home and restart livelihood activities, particularly in the western regions.
Recommendations
From the RNIS
· Provide support in the form of seeds and tools and food for IDPs seeking to return to their homes.
· Ensure an adequate general ration to IDPs who are no longer able to access their normal food sources.
The humanitarian situation in Uganda has suffered as a result of a series of separate civil conflicts in various parts of the country. Particularly affected have been the northern and western areas where large numbers of people have been displaced and are living in various IDP camps. Conflict has also erupted in the east as a result of violent cattle raiding that has occurred traditionally for some time but escalated in 2000, displacing up to a third of the population in Katakwi province. The displacement has left the IDPs without access to their homes or land and has fundamentally disrupted household economies. The result has been high vulnerability to acute food insecurity and a heavy reliance on external assistance to meet their subsistence needs.
The reporting period has seen the continuation of the improvement in the humanitarian situation, largely as a result of better security in many areas. The improved security is due to a number of reasons including the withdrawal of some of Uganda s troops from areas in the Eastern DRC. The troops have been able to contribute to internal security by being deployed to areas of conflict in the country, including the northern areas of Kitgum and Gulu, along the border areas with Sudan. This pull back has positive repercussions for the Ugandan government s relationship with that of neighbouring DRC. However, the eastern region of DRC remains extremely volatile, especially after the failure of the main eastern based rebel group to become signatories to a recent peace initiative. The continued presence of armed groups therefore poses a potential risk to internal security in Uganda, particularly in the West, and the possibility of large influxes of refugees cannot be ruled out.
On the political front, there has also been a thawing in relations between the government of Uganda and the Sudanese Khartoum based government. Relations had been extremely poor as a result of Sudanese support to the Lord s Resistance Army (LRA), which has been responsible for the insecurity in north Uganda. The improved relations have resulted in cessation of Sudanese support to the LRA and have led to their collaboration with the Ugandan military in an anti LRA campaign. This potentially has great repercussions for the displaced in the north and west of the country and there has been considerable talk of IDPs returning from camps to their places of origin as the security situation has improved. Whilst this is still the case in the west, the situation is less clear in the north where there has been a resurgence in insecurity in March and April 2002. In eastern areas the government has pursued an aggressive policy of disarmament for the Karamojong warriors, by first offering an amnesty for people to hand in weapons, and then carrying out an enforced disarmament programme. It is hoped that this will end the armed raids that have resulted in the displacement of so many in Katakwi province.
UN OCHA estimates that as of the end of March 2002 there were an approximately 747,599 vulnerable people, including 183,902 refugees. There were also 552,587 IDPs, predominantly in the north, west and east of the country. The numbers have declined slightly, possibly as a result of returns in the west, but the largest collection of IDPs remains in the northern district of Gulu where there are an estimated 315,882 displaced (UN OCHA 31/03/02).
IDPs in Northern Uganda
The north of Uganda has been very badly affected by violent attacks from the Lord s resistance Army (LRA) over the course of the 1990s. It is currently home to the largest concentration of IDPs in Uganda, many of who are living in so called protected villages which were established by the Ugandan government as a means of offering protection from attacks. As it has transpired, the protected villages have offered little in the way of actual protection and the insecurity in the area has continued to prevent the population, almost all of who are farmers and livestock herders, from accessing their land. The resultant food insecurity and poor camp conditions have resulted in a concerning humanitarian situation.
The area has enjoyed a period of relative stability over the course of 2001 and for the first couple of months of 2002, allowing for considerable hope that this would provide a suitable environment for IDPs in the area to start the process of return. However, cases of violent attack and abduction have increased over the months of March and April 2002 and UN OCHA indicated that there could be no possibility of returns from the camps in the near future (UN OCHA 31/03/02). The Ugandan military have joined forces with the government of Sudan s forces within Southern Sudan in a large scale anti LRA campaign. However, there is some concern over the efficacy of a military approach to the problem and it is likely that the LRA have been driven deeper into Southern Sudan. The concentration of Ugandan troops in Sudan has also taken troops away from other areas in the north, leaving them vulnerable to further attacks.
Kitugum
The province of Kitgum currently contains 82,645 IDPs and 23,601 Sudanese refugees. The number of IDPs has not increased over the reporting period, largely as a result of the relative security that the area has enjoyed. The number of refugees has increased by over a thousand as a result of the ongoing insecurity in Southern Sudan. For much of the reporting period, the expectation in Kitgum was of the possibility of the IDPs being able to leave the camps and start their lives again in their areas of origin. However, this is currently less likely as a result of an upsurge in insecurity. The IDPs continue to receive both food and non-food support from the humanitarian community and the overall situation is not deemed to be critical. FEWS has reported that the general food outlook in the area is good and this should positively affect the food security of the IDP populations. The RNIS has not received any recent nutrition surveys on these groups.
Gulu
Gulu is currently home to 315,882 IDPs (UN OCHA 31/03/02) who have been displaced over the years by the violent attacks of the LRA. The area has enjoyed a period of relative calm over the last 12 months, which had led many IDPs, and the humanitarian community, to start considering the possibility of returns. The period of security is largely a result of the termination of support to the LRA by the Sudanese government and the posting of more troops to the border area to guard against incursions from south Sudan, where the LRA have their bases. Unfortunately, the period of security was not to last and on 22 February 2002, the LRA conducted an armed attack on the Agoro IDP camp, which resulted in the death and abduction of IDPs and the looting of assets (UN OCHA 31/03/02). This has been an extreme blow to the security situation and the prospects of IDP returns. In response, the Ugandan army, in conjunction with the Sudanese army, has mounted an anti LRA campaign within Southern Sudan. The effects of the campaign are not yet known but it has taken troops away from the Gulu area and the number of security incidents has grown throughout the month of March 2002. These have included various ambushes, abductions and attacks on IDP camps. It is extremely distressing to note that this has prevented returns taking place and, whilst the food security of the area remains relatively good, the possibility of a deterioration of the situation as a result of further attacks cannot be ruled out. Consequently, the population should be regarded as vulnerable.
IDP in Eastern Uganda, Katakwi
Katakwi district in northeast Uganda has suffered from intense raiding by Karimojong warriors over the past five years. In 2000 the raiding was particularly fierce and has resulted in the displacement of up to a third of the population into a number of IDP camps. UN OCHA currently estimates that there are 88,500 IDPs, predominantly in the counties of Usuk and Kapelebyong. The Karimojong are a pastoralist people living in the districts of Moroto and Kotido, who have a strong tradition of cattle raiding, however the availability of small arms has led to the raids becoming increasingly violent and destructive. The government has been accused of failing to protect the population of Katakwi by allowing the Karimojong to accumulate illegal small arms. The government has initiated a disarmament programme for the warriors that began in December 2001. The first phase of the disarmament was voluntary but due to the relatively poor response, a forced disarmament was initiated in February 2002. The disarmament of the Karimojong is seen as an important step towards normalising the humanitarian situation in Katakwi but security in the area still appears to be a long way off as it was reported that an Irish priest and three co workers were killed on 21 March 2002 (UN OCHA 31/03/02).
The current food security situation has been described as good everywhere in the country apart from Katakwi district. This is a result of continued insecurity and the inability of many IDPs to cultivate over the past two years. Prior to the displacements, the food security of the area was dependant on traditional agriculture and livestock herding, however, the raiding has resulted not only in the loss of human life, but up to 50% of the population have also lost access to their land and up to 90% have lost their livestock. The raiding has also resulted in the extensive loss of household assets through looting (Oxfam 28/11/01).
Oxfam conducted a food and nutrition survey on the displaced populations of Katakwi in November 2001. The survey revealed an estimated prevalence of acute malnutrition of 5.2% (W/Ht < -2 Z scores and/or oedema), which included 2.7% of severe malnutrition (W/Ht < -3 Z scores and/or oedema). The prevalence of acute malnutrition does not indicate that acute malnutrition is a problem of public health importance. However, the survey also estimated mortality rates and the CMR was 3.55/10,000/day, with the under-five mortality rate at 2.7/10,000/day (Oxfam 28/11/01). Both these rates are above emergency thresholds and are indicative of a very serious problem. The CMR is particularly high being over three times the cut off for an emergency situation. Some of this mortality is likely to be directly related to deaths resulting from the violent raiding, however, the survey indicated that the overall health situation of the camps was extremely poor and that health was the major concern in the camps. The prevalence of major morbidities such as malaria, diarrhoea, respiratory infections and worm infestations were all above 40% and the camps were under served in terms of appropriate medical services (Oxfam 28/11/01). The camps were also very densely populated with little spacing between houses. This has severely affected basic hygiene, as did the observed lack of availability of both water and sanitation.
In conclusion, the survey indicated that although the prevalence of acute malnutrition was low, the observed rates of mortality were extremely high, mostly as a result of the extremely poor health conditions. The insecurity in the region continues to disrupt household economies and food security remains extremely precarious. There is the continued threat of insecurity over the next months, particularly with Karimojong legitimately entering Katakwi in search of pasture and water for their cattle. The food security outlook for the IDPs remains bleak and they should be considered as extremely vulnerable.
IDPs in Western Uganda
The reporting period has seen the continuation of an improved security situation in the western regions and most notably in the districts of Bundibugyo, Kabarele, Kyenjojo and Kamwenge. This is largely a result of the demise of the rebel Allied Democratic Front (ADF), who have been responsible for much of the violence in the area. As a result, there is talk of large-scale returns of IDPs from the protected villages where many are staying. The government has enthusiastically embraced the idea of IDP returns and announced in November 2001 its intention to dismantle the camps (UN OCHA 12/01), which it would like to see begin from March 2002 onwards (UN OCHA 09/04/02). The idea has been taken up by agencies and IDPs alike and there are currently ongoing large-scale preparations. WFP reports that there are approximately 80,000 IDPs in the Bundibugyo district alone who are expecting to return to their villages this year (WFP 08/03/02). Notably, the Districts themselves are conducting much of the organisation of the returns. The main problems facing IDPs in camps have been the poor access to cultivable land and inadequate access to food and income. The main constraint to this has been security and now, with the improvements in the security situation, many more are likely to want to return. The problem is going to be how many will actually be able to return given the inadequate resources and destitution of many IDPs. Meanwhile, it has been announced that 13,000 IDPs in the Kasese district have already returned and are busy planting crops and hoping to benefit from the coming rains. The RNIS does not have any recent nutrition information on these populations but the situation is not deemed to be critical.
Kikagati returnees in southern Uganda
The Ugandan government has finalised plans to resettle 2,673 Ugandan returnees from Tanzania who have been camped in Kikagati, southern Uganda. They have been living under very difficult conditions in a water-logged camp with very poor sanitation. An earlier assessment by Oxfam reported that the returnees were in critical need of water, sanitation and housing. One of the problems for the returnees has been that they are not classified as either refugees or IDPs and so have fallen through the network, despite their needs for assistance. The original plan for the returnees was to resettle them in Kabale District but this was met with animosity from local populations. The resettlement, which occurred on 8 April 2002, took place in Kamwenge District and gave each family two acres of land and a three month food ration and agricultural tools (UN OCHA 18/04/02). The RNIS does not have nutrition information on this group but they are considered vulnerable.
Refugees
There are currently estimated to be 183,902 refugees in Uganda from Burundi, DRC, Rwanda and the majority being from southern Sudan. The figures have increased over the reporting period as a result of a steady influx of Rwandan refugees from camps in Tanzania, but also as a result of the escalation of violence in Southern Sudan. The RNIS has not received any recent nutritional information on refugees but their condition is not deemed to be critical as a result of the improved physical security situation in many areas and the generally good food security seen in the country. There have, however, been reports of increasing insecurity in the northwestern Nile areas of Moyo, Arua and Adjumani, which have suffered a number of rebel attacks, including on the Mongula refugee settlement. Insecurity is a considerable concern as it is likely to obstruct attempts to improve the self-reliance of refugees in the area and require that relief assistance be continued.
Overall
The overall situation is relatively good as a result of a long period of security and calm, however, the situation varies widely over the country and is heavily contingent on the prevailing security situation. This is particularly the case for IDPs in the west of the country who, it is hoped, will return from the camps to their own lands over the duration of 2002. Their situation is not critical (category III). IDPs in the north have benefited from an extended period of security but recent months have seen an upsurge in armed violence. The overall condition of the northern IDPs is not critical (category III) but they remain vulnerable. The exception to the general improvement in the situation is the eastern district of Katakwi, where the condition of IDPs continues to be extremely concerning and they should be viewed as being at heightened risk (category II). The situation of refugees is currently not thought to be critical (category III).
Recommendations
From the Oxfam survey in Katakwi district
· Strengthen public health services in camps.
· Improve and strengthen water and sanitation facilities in camps.
· Provide kitchen utensils, clothing and mattresses to families.
· Provide mosquito nets to protect IDPs from malaria.
· Implement cash and food for work programmes.
· Provide agricultural implements and seeds for families to engage in agriculture.
The reporting period has seen a general improvement in the humanitarian situation in Uganda. This has been largely a result of a lull in insecurity from rebel activities in both the northern regions of Kitgum and Gulu, and in the south western region around Bundibugyo. This has allowed many IDPs to access land and has contributed to a general improvement in food security. Although people remain optimistic that the lull in insecurity heralds a more permanent end to rebel activity, it is important to note that there was a similar lull in 1999 for nine months which resulted in the pull out of humanitarian agencies. However, further attacks came and thousands more people were displaced (OCHA 10/01).
On a regional level, Uganda has continued to pull out troops from the DRC, however tensions with Rwanda have been heightened as a result of power struggles between opposing rebel groups in DRC, supported by the two governments. This has led to fears of the possibility of armed clashes occurring between the two countries (AFP 29/10/01). This has implications for general security within the country, particularly in the west, and also for a possible influx of refugees. The reporting period has also seen greatly improved relations between Uganda and Sudan. As a result, President Bashir of Sudan has announced that Sudan has stopped supporting the Lord’s Resistance Army (LRA) rebels, whose activities have been responsible for the population displacements in the north west of Uganda (IRIN 21/08/01). There is great hope that this will substantially reduce further threats of insecurity in the north.
In general, the reporting period has seen a greatly improved security situation in the country but isolated incidents have continued to occur. On September 1st a member of the NGO Catholic Relief Services (CRS) was killed, along with five community members, when their car was ambushed in the north (OCHA 10/01). There have been other reports of ambushes but there have been no rebel attacks during the reporting period. This is being attributed to the greater presence of Ugandan troops in the north and the cessation of support for the LRA from Sudan. The effect on the humanitarian community has been an increase in access to vulnerable populations, and for the displaced and refugees the improved security has allowed a return to more normal patterns of livelihood. However, there have been further attacks by the Karamoja in the eastern district of Katakwi with the latest attack reported on September 13th. This has resulted in the continuation of displacement and the inability of the IDPs to return to their homes. Since this attack the security situation has remained relatively calm (OCHA 10/01).
OCHA estimate that in September 2001 there were 743,049 people affected by conflict and insecurity. These included 178,201 refugees from Burundi, DRC, Rwanda and Sudan and 563,738 IDPs situated in the northern province, the eastern province and in the south west. The largest collection of IDPs is found in the northern district of Gulu with 292,160 people (OCHA 10/01). The overall figures for affected people have substantially decreased over the course of 2001. This is thought to be a result of the improved security allowing returns of some IDPs and a considerable decline in the refugee population as a result of a recent re-registration exercise, which saw numbers fall by over 20% (OCHA 08/01).
IDPs in Northern Uganda
The situation for IDPs in northern Uganda is currently greatly improved over the early part of the year. This is a result of good rains and the absence of rebel attacks since June, which have both impacted very positively on the food security situation of the area and have done much to improve the overall humanitarian situation. It is also important to note that the hunger season is over and the next months traditionally see improved availability of food sources (IRC 07/01)
Kitgum
There are currently estimated to be 82,645 IDPs and 22,591 refugees in camps in Kitgum (OCHA 10701). The numbers remain unchanged from the July RNIS, however the reporting period has seen a substantial improvement in the security situation in the district. This is largely a result of ongoing peace negotiations with LRA rebels and the heavy deployment of Ugandan army troops in the area. The improved security has allowed the majority of IDPs to access their land and, helped by normal rainfall, to produce some of their own crops with which to supplement the WFP ration they have been receiving. OCHA reports that 60% of IDPs are able to spend time in their gardens, away from the camps (OCHA 10/01), however it is not known how much of this produce is eaten and how much is sold. OCHA also reports that casual labour is an important source of income for IDPs, with the money being spent on food and medical care. In general, the price of food in Kitgum and Pader has declined, making it more available to IDP families. The RNIS does not have any recent nutritional information from Kitgum but the improved food security and humanitarian situation in the district is expected to have stabilised and improved the situation.
Gulu
The current estimates for the number of IDPs in Gulu are 292,160 people, the largest collection of IDPs in Uganda. However, the July/August OCHA report records a reduction in numbers as a result of a re-registration in the twenty IDP camps. The original figure was for 340,420 people. The reasons for the drop in numbers are the return of some IDPs to their homes, largely as a result of the poor living conditions experienced in many camps, and the removal of ghost IDPs from the register (OCHA 08/01). The new figures were presented and accepted by district officials and camp leaders. The majority of the IDPs are from the Acholi people who stayed in the so called “protected” villages guarded by the Ugandan army. However, in August the Acholi Religious Leaders Peace Initiative (ARLPI) produced a report condemning the conditions under which the IDPs were staying (IRIN-CEA 20/08/01).
The reporting period has seen no further LRA activity and WFP recently report that the security situation remains calm but is considered fluid. There is a report of a WFP vehicle being fired upon in Gulu (WFP 26/10/01). FEWS report that the food security outlook is good with the area having received good rainfall. This, coupled with the increased access to land, has ensured increased availability of food sources in addition to those distributed by WFP. The RNIS does not have any new nutritional information but the last nutrition surveys from earlier in the year indicated prevalence of acute malnutrition below alert thresholds and, in the absence of factors liable to adversely affect the nutrition status, it is assumed that the situation remains relatively good.
IDPs in Eastern Uganda, Katakwi
In contrast with the rest of Uganda the reporting period has seen the situation for IDPs in Katakwi continue to deteriorate. The people of Katakwi have suffered from attacks by Karimojong warriors from the northern districts of Kotido and Moroto. The attacks have typically resulted in loss of life and property, particularly livestock. As a result, it is estimated that 8,623 people, or 38% of the district, have been displaced into forty-six camps (OCHA 01/08/01). The most severely affected areas are the sub counties of Usuk and Kapelebyong (FEWS 15/10/01). Many of the IDPs are too afraid to go to their fields and, as a result, access to food is very poor. It is also reported that the Karimojong deliberately uprooted and slashed crops further exacerbating the food security situation.
The last attack came in early September when a group of Karimojong warriors attacked the IDP settlement of Ngariam camp killing sixteen people and resulting in the looting of numerous cattle (OCHA 10/01). In response to this and other attacks there have been revenge attacks on the Karamoja and there is a fear that the situation could deteriorate into further fighting. However, considerable efforts are being made to create peace between the two areas and the Ugandan president has recently announced that the disarmament of the Karamoja will take place starting on November 30th (OCHA 31/10/01). Since mid September the area has not seen any major insecurity but the situation remains tense.
The RNIS does not have any nutritional information on the Katakwi IDPs but their condition is believed to be poor. Reports indicate that the health, water and sanitation facilities in the camps are very poor and that access and availability to food sources is severely constrained by the ongoing insecurity and the destruction of crops.
IDPs in Western Uganda
The reporting period has seen a generally good security situation in the west with the absence of ADF attacks. The only report of a suspected attack was on the 25th of August when Kikyo IDP camp in Bundibugyo was attacked. The lack of insecurity has had a very positive effect on the humanitarian situation in the area where IDPs have tended to be restricted to “protected” camps and have been mostly unable to access their land or other income generating activities. This has left many people heavily reliant on humanitarian assistance. Over the past few months, there are reports that more and more people are moving back to their homes to access their gardens and sleeping in the camps at night. There is even a trend amongst some to move away from the camps all together (OCHA 08/01). There is a degree of uncertainty over who will guarantee the safety of the returning IDPs and the authorities have refused to officially offer protection. However, many IDPs are starting to ask for return packages from various NGOs (OCHA 08/01) and this may mark, depending on the security situation, the start of a wider move away from the camps
In general, the food security situation of the area is good as a result of the harvest producing good crops of beans, potatoes and rice. This has significantly added to the availability of food in markets and prices are recorded as being good (OCHA 08/01). Food distributions are continuing but have become difficult in some areas as a result of seasonal flooding from the rainy season. Distributions have also been stopped in Bundibugyo town and Nahuka since April as a result of poor registration figures. They will be started again when new figures are available. The RNIS has not received any recent nutrition surveys but believes the situation to be non-critical.
Refugees
There are currently estimated to be 178,201 refugees from Burundi, DRC, Rwanda and Sudan. The majority of these are situated in the northern areas of the country particularly in Kitgum, Adjumani, Moyo and Arua districts. The present figure represents a substantial decrease from the figure reported in July (see RNIS # 34) and is a result of a countrywide re-registration. The exercise indicated a reduction of over 22%, which has been attributed to repatriation and resettlement. Numbers of Sudanese refugees are often difficult to estimate because there is a continual movement across the border as a result of the fluid security situation in southern Sudan (OCHA 10/01).
In general the food security of the refugee hosting areas appears to be good, particularly in the West Nile area. The refugees benefit from a self-reliance policy that allows them to access education, business activities, trade and establish farms (IRC 07/01). It is thought that this year’s good harvest will have positively affected the refugee population. The increase in security will also have significantly helped the livelihood activities of the various refugee communities and is likely to have contributed to an improvement in the overall situation.
IRC conducted a nutritional survey in Achol Pii refugee camp, situated north of Kitgum town in north Uganda. The survey was conducted in late June 2001, during the hunger season, when morbidity rates are expected to be elevated and work in the fields i
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