United Nations System
Nutrition in Crisis Situations
Vol 2, May2004
Ethiopia—Dire situation of IDPs in Somali region
Kenya—Nutrition crisis in north-eastern zone of Tukana district
Chad—Sudanese refugees at risk
Sudan—Worsening situation in Darfur
Liberia—Average nutrition situation
Nepal—Intensification of the crisis
The nutrition status of the refugees is average, with micro-nutrient deficiencies reported, although some measures have been taken to overcome this problem.
Risk Factors affecting Nutrition in Selected Situations
Situations in the table below are classed into five categories relating to prevalence and or risk of malnutrition (I—very high risk/prevalence, II—high risk/prevalence, III—moderate risk/prevalence, IV—not at elevated risk/prevalence, V-unknown risk/prevalence; for further explanation see section "Indicators and classification" at the end of the report).
The prevalence/risk is indirectly affected by both the underlying causes of malnutrition, relating to food security, public health environment and social environment, and the constraints limiting humanitarian response.
These categories are summations of the causes of malnutrition and the humanitarian response, but should not be used in isolation to prescribe the necessary response.
The Bahri rains (November-February) were poor and improved only in February, which was too late to benefit crops but did replenish pastures (FEWS, 25/03/04). On the other hand, despite coming later than usual, the Azmera rains facilitated agricultural activities in April (FEWS, 21/04/04).
As of April 2004, pledges for the WFP's drought emergency programme amounted to approximately 54% of the 2004 requirements (WFP, 30/04/04). When programmes through NGOs and bilaterals were also taken into account, only 38% of the food needs were covered, and food rations have therefore been reduced (OCHA, 23/04/04). Non-food needs were even less resourced, with only 37% coverage for seed needs and an overall 5% coverage for the non-food sector (OCHA, 23/04/04).
Precarious nutrition situation
The MOH in collaboration with UN agencies and NGOs has set up the National Nutrition Surveillance System (N-NSS) to develop unified methodologies, training manuals and harmonization of approaches and data systems.
As part of this system, random-sampled nutrition surveys were conducted in rural areas of Anseba, Debub, Gash Barka and Northern Red Sea in December 2003 (MOH/Joint, 12/03). , depending on the region (table 1). Moreover, a significant proportion of women had a BMI < 18.5 (table 1). The results showed that the situation was of concern, with acute malnutrition rates varying between 12.8% and 16.9%
When compared with previous surveys, the situation does seem to have improved slightly. This was mostly attributed to the seasonal harvest and general and supplementary food distributions.
Table 1 Prevalence of acute malnutrition, Eritrea, December 2003 (MOH/joint, 12/2003)
Most of the families interviewed during the assessment (96%) said that the food security situation at the time of the survey was not bad.
According to the survey, about 99% of the families had received regular food distributions within the four months prior to the survey. Depending on the area, the households had received an average amount of 10.4-12.3 kg cereals, 0.5-0.7 kg pulses, 0.4-0.6 kg oil per person per month (about 1400 Kcal/pers/day).
The coverage of vitamin A supplementation was high as well as the measles vaccination coverage (table 2). This was partly attributed to the “polio and measles catch-up immunisation” campaigns, carried out beside the regular programme. On the other hand, a low percentage of the mothers were seeking care when their children were ill (table 2).
Table 2 Measles vaccination coverage, Vitamin A distribution coverage and health care, Eritrea, December 2003 (MOH/joint, 12/03)
* According to cards only
Access to water and to safe drinking water was very poor (table 3).
Table 3 Access to water, Eritrea, December 2003 (MOH/joint, 12/03)
Internally Displaced Persons
It is estimated that there are about 59,000 IDPs settled in camps or in host communities. Most are displaced because of the lingering effects of the border war with Ethiopia (OCHA, 23/04/04). IDPs in Koronko camp in Gash Barka region face dire conditions: IDPs were reported as lacking basic facilities such as access to water and potable water, sanitation, sufficient food rations and non-food items (OCHA, 02/04/04).
The lingering effects of the war with Ethiopia and the last years’ drought have had a significant impact on households’ food security and nutritional status in a country where the general situation was already poor. Emergency and long-term development programmes as well as reforms at the macro-economic level are crucial.
From the MOH/joint surveys
Despite an improvement in the food security situation owing to better harvests and rains in 2003 than in 2002, the situation remains precarious. About 7 million people are still in need of food aid in 2004. However, as of April 2004, food aid needs were only 43% funded (ENFS, 04/04). Nutrition programmes have been scaled down and NGOs have handed some facilities over to the Ministry of Health (USAID, 08/04/04).
Worrying situation in some resettlement sites
The Government of Ethiopia started a resettlement programme in 2003, with the aim of addressing food insecurity. In 2003 and 2004, approximately 350,000 people were resettled in Amhara, Oromya, SNNPR and Tigray regions (USAID, 08/04/04). A joint evaluation in some resettlement areas showed that the sites, especially in Oromya region, lacked adequate food, access to water, shelter, health care and agriculture inputs (USAID, 08/04/04). In addition to the cereal ration, a supplementary food distribution of blended food has been started for vulnerable groups (WFP, 21/05/04). A very high number of malnourished children was recorded in October 2003 in resettlement sites in Tigray (see RNIS 43).
Improved but still average nutrition situation in South Wollo zone, Amhara region
Three random-sampled nutrition surveys were conducted during the harvest in November-December in South Wollo (table 4) (Concern, 11/03; DSA, 12/03). The surveys showed average rates of acute malnutrition.
Whilst it was the first survey which was conducted in Tedhudere district, comparison with previous survey results was possible in Dessie Zuria and Kalu districts. In both districts, trends in prevalence of malnutrition showed that the situation in November 2003 was comparable to that in 2000, 2001 and the beginning of 2002. On the other hand, the situation has improved when compared to the second semester of 2002 (which corresponded to the period of drought) when the rates of malnutrition were the highest recorded since 2000.
In the three districts, 50% to 60% of the families received food through the Employment Generation Scheme (EGS) in 2003.
In Dessie Zuria and Kalu districts about 15% of the children also received food through supplementary feeding programmes. In these districts, the current harvest was better than in 2002. The main sources of income were sale of livestock, cash crops and petty trading. EGS was interrupted in September-October 2003 and was intended to restart in April/May 2004 (when the poorest may have exhausted their harvest), targeting a lower proportion of the population than in 2003.
Young children feeding practices seemed poor, with about half of the mothers not being given colostrom within the first three days of their children’s lives. Food was introduced into the children’s diet between 4-6 months of age by only 60% of the mothers.
Table 4 Acute malnutrition and measles vaccination coverage, South Wollo, Amhara region, Ethiopia, Nov-Dec 2003 (Concern, 11/03; DSA, 12/03)
* According to cards and mothers' statements
High food insecurity in Somali region
Poor rains at the end of last year have significantly affected food security in some parts of Somali region. However, rainfall improved in March and April 2004, mitigating the poor situation (ENFS, 04/04).
Precarious nutrition situation in Ayshia, Shinile, Dembel & Erer districts, Shinile zone
Two random-sampled nutrition surveys were conducted in September 2003, within the agro-pastoral and pastoral population (SC-UK, 09/03). The surveys showed an improvement in the nutrition situation compared to 2002 (figure 1), but the situation remains precarious (table 5). The surveys were conducted during the rainy season but before the harvest. The condition of livestock was reported as being good by almost all the households interviewed. Relief food had been received by most of the population within the month prior to the survey and represented the major source of staple food. The population was using coping mechanisms to get incomes.
Access to health care and safe drinking water was poor as well as the measles vaccination coverage.
Table 5 Acute malnutrition, measles vaccination coverage and mortality rates, Somali region, Ethiopia
* According to cards and mothers' statements
Figure 1 Prevalence of acute malnutrition, Pastoral and agro-pastoral population, Shinile zone, Ethiopia (SC-UK, 09/03)
Poor nutrition situation in Gode District
The nutrition situation was poor in Gode district in February 2004 (table 5) and within the same range as in November 2000, according to a random-sampled nutrition survey conducted by SC-US (SC-US, 02/04); the mortality rates were also very high (table 5). The food security situation appeared poor, partly due to the insufficient rains over the end of 2003 (see NICS 1); the general food distribution did not significantly improve the food security level of the population.
Dire situation of internally displaced persons in Somali region
There are several displaced persons camps in Somali region. Fafen and Hartishiek displaced persons camps, situated in Jijiga zone, host between 10,700 to 14,700 people (depending on the estimation) who have been displaced for some years because of drought. Recent dispute on land ownership in Bordode/Mieso areas has led to the displacement of about 14,900 people in Shinille zone (OCHA, 03/2004).
An assessment conducted in March 2004 showed dire conditions in the camps (OCHA, 03/04). Food delivery has been prevented in Fafen since the beginning of the year, because of rivalries between the local population and the IDPs. At the time of the assessment, no general food distribution was implemented in Bordode/Mieso but food had been distributed to vulnerable groups.
Access to safe drinking water was not guaranteed in the camps and cooking and shelter materials were greatly needed.
Nutrition surveys carried out in Fafen and Hartisheikh IDP camps in December 2003 showed appalling rates of malnutrition: 31.8% (27.7-35.9) and 28.5% (24.6-32.7) acute malnutrition, respectively (FSAU-N, 03/04). The malnutrition rates were within the same range as in March 2002 in both camps (see RNIS 38).
Nutrition situation under control in parts of Oromya region
According to two random-sampled nutrition surveys carried out in December 2003 and January 2004 (CRS, 01/04; SC-UK, 12/03), the nutrition situation in Meta, Kersa and Golo Oda districts is under control (table 6). These surveys were carried out just after the main harvest and so reflect an optimal situation.
Golo Oda district
Malnutrition rates have dramatically decreased in Golo Oda compared to the rates in 2001 and 2002 (figure 2). However, in 2001 and 2002, the surveys were performed at a less favourable period in regard to the food security situation (not at the harvest time).
Figure 2 Prevalence of malnutrition, Golo Oda, Oromya, Ethiopia
The indicators of the food security situation showed an improvement at the time of the survey, compared to 2001 and 2002; the health situation has also improved, although it was still average (box 1). Mortality rates have decreased over the past years and were average (table 6).
Table 6 Results of nutrition and mortality surveys, Oromya region, Ethiopia
* According to cards and mothers' statements
Box 1 Improved food security and health care in Gola Oda district, East Hararghe zone, Oromya, Ethiopia, December 2003 (SC-UK, 12/03)
Meta and Kersa districts
Similarly, the food security in these districts was reported as being satisfactory, with a good harvest and animals in a good condition. However under-five mortality rate was high (table 6), particularly due to malaria and relapsing fever epidemics.
Average to precarious nutrition situation in SNNPR
The nutrition situation was average to precarious according to several surveys conducted in SNNPR (table 7); mortality rates were under-control.
At the end of 2003, the nutrition situation had not improved in Meskan and Mareko districts, Gurahe zone compared to March 2003 (SC-US, 11/03). The food security situation was still precarious owing to an only average rainy season.
In Lanfuro and Darecha district, the malnutrition rates have remained stable since March 2003 (SC-US, 12/03). Most of the households thought they will rely primarily on their crop production within the next three months.
In Offa woreda, Wolaita zone, although the nutrition and food security situation has significantly improved compared to September 2003, it remained precarious in December 2003, despite the harvest (Concern, 12/03). The crop was reported as being worse than in previous years and most of the households were relying on coping mechanisms.
In Shebedino woreda, Sidama zone, the nutrition situation was average in February 2004 and the food security situation was reported as having improved compared to the previous six to 12 months (GOAL/SC-US/ACF, 02/04).
Table 7 Acute malnutrition and measles vaccination coverage, SNNPR, Ethiopia
The nutrition and food security situation has improved in most parts of Ethiopia compared to 2002 and 2003. This may be attributed to better weather conditions and to the humanitarian aid which have probably mitigated the situation. Whilst in some areas (such as some districts in Oromya zone), the nutrition situation seems under-control (category III), it is still average to precarious in most parts of Ethiopia (category II). The Somali region is especially at risk (category I), due to poor rainfall and the presence of IDPs.Urgent action is needed in the IDP camps in Somali region where dire living conditions have been reported as well as appalling rates of malnutrition (category I).
Serious food security and nutrition situation in Turkana and Marsabit districts
Turkana and Marsabit districts are classified as “arid and semi-arid lands” and are amongst the driest and least productive in Kenya.
This area is chronically food insecure with a significant reduction in herds over the years. The last years of drought in 1999-2002 further weakened the livelihoods of this mostly pastoral population. The October-December short rains were poor in Marsabit district and poorly distributed in Turkana district, which prevented the pastures in the worst affected areas from being replenished. Moreover, increased insecurity in Turkana district, such as cattle raiding, has further exacerbated the poor situation. The condition of livestock was reported as deteriorating, the price of livestock was very low and the terms of trade were unfavourable to pastoralists (FEWS, 19/03/04). However, good rains in April may have mitigated the situation (FEWS, 06/05/04).
Several nutrition surveys recently carried out in these districts showed high rates of acute malnutrition, ranging from 18% to 34% (FEWS, 05/04/04).
About 230,000 persons (40% of the population) will benefit from food aid from April to July 2004, at a 50% ration (FEWS, 05/04/04).
Nutrition crisis in north-eastern zone of Tukana district
An appalling nutrition situation was found in the northeastern zone of Turkana district during a random-sampled nutrition survey conducted in February 2004 (OXFAM, 02/04). The prevalence of acute malnutrition was 34.4% (31.3-37.4), including 5.4% (4.0-7.0) severe acute malnutrition, and has dramatically increased within the last two years. The rate of malnutrition was around ten percent in 2001 and 2002 and was about 28% in March 2003. Different factors, such as the poor rains in 2002-2003, the halt in the food distribution programme at the end of 2002 and the overall destitution of households over the years, may explain the deterioration of the nutrition situation. Mortality rates were also high: CMR=2.1 /10,000/day and <5MR=2.6 /10000/day.
A significant proportion of pregnant and lactating women (42%) had a MUAC < 23 cm.
Vitamin A distribution coverage was low and measles vaccination coverage was average (table 8).
Table 8 Measles vaccination and vitamin A distribution coverage, Northern Turkana district, Kenya, February 2004 (OXFAM, 02/04)
The number of meals has significantly decreased compared to "normal times" (table 9). It is worth noting that 20% of the families reported having no meal the day prior to the survey, indicating a very worrying situation.
Table 9 Number of meals taken, North-eastern Turkana district, Kenya, February 2004 (OXFAM, 02/04)
The main livelihoods of households were pastoralism (64%), fishing (11%) and handicrafts (10%).
The traditional sources of income (from livestock or fishing) were limited by the bad condition of livestock and its low price, and by the high cost of inputs for the use of boats. People tended to shift to coping strategies such as an increase in petty trading.
As of May 2004, emergency general food distributions and food for work programmes were on-going and the implementation of treatment of severe malnutrition was planned.
Precarious nutrition situation in the north-western zone of Turkana district
A survey done at the same time as in the eastern part of Turkana district (see above), showed a precarious situation but which had not deteriorated since 2003 (OXFAM, 02/04). The prevalence of acute malnutrition was 16.8% (14.5-19.4) including 1.8% (1.1-2.9) severe acute malnutrition in February 2004, 18.9% in March 2003 and 11.4% in February 2002. The same factors as for the eastern part of the district may explain the deterioration of the nutrition situation compared to 2002. Mortality rates were also lower than in the eastern part of the district; CMR and <5 MR were respectively 1.5 /10,000/day and 1.2 /10,000/day. Measles vaccination and vitamin A coverage were low (table 8).
Most of the population was pastoralist or urban/semi-urban. The number of meals has decreased when compared to "normal times" but to a lesser extent than in the eastern zone.
The proportion of income from livestock has decreased in both groups whilst the proportion of income from petty trade has increased. The sale of wild food has also widely decreased, which may be due to scarcity or an increase in consumption.
The Kakuma refugee camp, hosting about 80,000 people and the humanitarian Operation Life Line Sudan headquarters are situated in this area. It is thought that the activities and trade opportunities they offer, may partly explain why the nutrition situation has deteriorated less than in the eastern part.
Worsening nutrition situation in Kakuma refugee camp, Turkana district
Kakuma refugee camp was set up in 1992 and hosts mostly Sudanese refugees (about 60%), Somali refugees (about 35%) and a small number of people from the Great Lakes. In December 2003, the camp was hosting about 87,000 people. Although the movement of the refugees and the employment opportunities outside the camps are restricted, some refugees manage to get incomes. The better-off also receive remittances from abroad. The poorest refugees are those who can not secure regular and significant incomes (35-45% of the refugees). Most of the refugees are highly dependant on international aid. The relation with the local population is tense and riots occur regularly.
The refugees are meant to receive a full food distribution (2,168 Kcal/pers/day), but the ration actually distributed is often lower due to frequent pipeline breaks. The distribution of CSB, which should supplement the ration in micro-nutrients is often reduced or omitted.
The nutrition situation is regularly followed with an annual nutrition survey. The situation has remained above acceptable levels for years (figure 3). The last nutrition survey carried out in December 2003 showed a significant deterioration of the situation compared to 2002 (figure 3) (IRC, 12/03).
Figure 3 Acute malnutrition, Kakuma camp, Turkana district, Kenya
During this survey, the haemoglobin status of 270 children aged 6-59 months was measured. Results showed appalling rates of anaemia (table 10), which have worsened when compared to the results of April 2001 when already 61.3% of the children were considered anaemic (Hb<11 g/dL). At the time the survey was written, the measurement of haemoglobin was repeated in order to verify these high rates of haemoglobin deficiency.
The measles vaccination and vitamin A distribution coverage, according to cards and mothers’ statement was 74.3% and 40.4%, respectively.
A small percentage of the families (about 2%) seemed not to be registered for the general food distribution.
Around 55% of the mothers interviewed during the survey reported having received counselling on breast-feeding. Some 62% of the mothers said they know that mothers can transmit HIV to their children.
The nutrition situation of the refugees seems to be comparable with that of the host population in the same regional zone (see above).
The insufficiency of aid provided may partly explain the rise in malnutrition. Although interactions between refugees and the host population are restricted, interactions exist and the actual food insecurity faced by the host population may also have some implications for the refugees.
Table 10 Anaemia among 6-59 month olds, Kakuma refugee camp, December 2003
Turkana district is chronically food insecure and households' livelihoods have been eroded over the years. In some areas such as the northeast, coping mechanisms are limited and the food security and nutrition situation has worsened within the past two years (category I); the prevalence of acute malnutrition has increased threefold between 2001-2002 and 2003-2004. In the northwest part of the district, the situation has also worsened but to a lesser extent (category II). The nutrition situation in Kakuma refugee camp is above acceptable levels (category II).
From the OXFAM survey in the Turkana district:
Eastern and western zones:
From the IRC survey in Kakuma:
The final round of peace-talks was due to begin at the end of May 2004 (IRIN, 25/05/04). The security situation is still tense, especially in Mogadishu, Gedo region and Sool plateau.
Deyr cereal production performance
The Deyr cereal production was considered normal but was 28% lower than in 2001 and 41% lower than in 2002. The production was especially affected by poor rains in Bakol, Hiran, Lower Juba and Middle Shabelle (table 11). The 2003 Gu production, which is the main harvest, had also been poorer than in 2002 (see RNIS 43).
Table 11 Deyr cereal production performance (FSAU-FS, 02/04)
Mitigation of the nutrition situation of IDPs in Mogadishu
A rapid nutrition assessment was conducted in six IDP camps (Coca-Cola, Dhkajo, Stadium, Fardowsa, Shabelle and Arsjisagoor) in Mogadishu in April 2004 (FSAU-N, 05/04). The results of the MUAC screening showed a precarious situation: of 515 12-59 month-olds screened, 3 had oedema (0.5%), 5 had a MUAC < 11 cm (0.9%) and 70 had a MUAC < 12.5 cm (14.5%).
Although the different assessments which have been carried out over the past years in the IDP camps are not directly comparable, because they were not done in the same camps, they do indicate that the percentage of malnourished children was lower in April 2004 than in August 2002 when 39% of the children had a MUAC < 12.5 cm (see RNIS 39), and is within the same range as in 2000, when 16.5% of the children had a MUAC < 12.5 cm.
The improvement of the situation was partly attributed to the implementation of a regular food distribution by WFP and Islamic organisations (FSAU/N, 05/04).
Acceptable nutrition situation in Belet Weyne town, Hiran region
The nutrition situation seemed acceptable in Belet Weyne town according to a nutrition assessment carried out in April 2004 (FSAU-N, 05/04). Among 919 12-59 month-olds screened, 45 (5%) were considered moderately malnourished (MUAC < 12.5 cm and/or oedema), including 6 (0.8%) considered severely malnourished (MUAC < 11 cm and/or oedema). This shows an impressive improvement compared to September 2002, when a similar kind of screening had found that 25% of the children were considered acutely malnourished (see RNIS 39).
The acceptable nutrition situation was attributed to the fact that the food security situation was good for the better-off and middle wealth groups who had several sources of income such as business, livestock and livestock products, skilled employment and remittances from abroad. It is thought that the poorest cope through social support, loans and change in diet pattern, despite increased food prices and limited income opportunities.
Worsening situation in Jilib and Buale riverine areas, Middle Juba
Several reports have highlighted the dire situation which the riverine population of the Juba valley faces, especially during the summer months when the situation is near a famine stage (see RNIS 43 and NICS 1).
Food security seems to have decreased this year (FSAU-FS, 05/04): the 2003/2004 crops were only 55% of post-war average; the drought has reduced availability of fish and wild food; and work opportunities were scarce. Moreover, food prices were very high in the area as of March, and insecurity prevailed.
MSF-H reported an increase in admission to the therapeutic feeding centre in March; 70% of the children admitted to the TFC had oedema. Several agencies have planned to reinforce the current relief and development programmes. In addition to the therapeutic feeding programme, support to health care and capacity-building initiatives, plans were made for the implementation of supplementary feeding programmes, food distribution and longer-term food security interventions (FSAU-N, 04/04).
Persistent dire situation in Gedo region
Food security in northern Gedo has gradually deteriorated partly due to insecurity. Recent renewed fighting in the area has led to new population displacement. A MUAC screening undertaken in April 2004 (FSAU-N, 04/04) showed that Belet Hawa district was the most affected district, with 27.1% of the children (12-59 months) screened considered acutely malnourished (MUAC < 12.5 cm and/or oedema) whilst the percentage of children considered acutely malnourished was 15.2%, 15.1% and 10.9% in Luuq, Dolow and Elwak districts, respectively.
Continuing food insecurity in Northern and Central Somalia
The Gu rains started in April but were inadequate. Death of livestock and rising destitution continue. As of March 2004, it was estimated that of an estimated 927,000 people in Lower Nugal, Togdheer, Central region and Sool region, 123,000 were affected by a livelihood crisis (most of them in Togdheer) and 95,000 were experiencing a humanitarian emergency (65,000 in Sool region and 30,000 in Lower Nugal) (FSAU-FS, 03/04). As of February 2004, there was a gap between the needs and the response.
The third round of nutrition screening in the sentinel sites in Sool plateau, which was done in April 2004 showed a worrying situation, but which seemed to have slightly improved compared to January 2004 (table 12). On the other hand, the nutritional status of women seemed to have worsened (table 12).
A random-sampled nutrition survey carried out in Garowe, south Gardo and Burtinle districts, Nugal region in March 2004 showed a situation of concern: the prevalence of acute malnutrition was 15.9% (12.7-19.6) including 3% severe acute malnutrition (1.7-5.1) (FSAU-N, 05/04). This rate seems to be higher than malnutrition rates generally recorded in Puntland (less or around 10%).
Table 12 Nutrition situation in Sool plateau, screening in sentinel sites (FSAU-N, 05/04)
The Northern and Central region of Somalia are especially at risk (category II). Riverine areas of Buale and Jilib districts need immediate intervention (category I) to alleviate the food insecurity and prevent a further deterioration of the nutritional status
A new accord was signed between the government of Karthoum and the Sudan People's Liberation Movement/Army (SPLM/A) regarding power-sharing and the resolution of conflict in Abyei, Southern Kardofan/Nuba mountains and Blue Nile states (IRIN, 28/05/04). Three protocols on the status of the South (six year period of autonomy, followed by a referendum), on security arrangements during the interim period and on wealth-sharing, had been signed at the beginning of the peace talks. It is expected that a comprehensive peace-agreement will be signed within the coming months.
The conflict in Darfur was not part of the peace protocols and separate peace talks have been conducted in Chad between the government of Karthoum, the Sudan Liberation Movement/Army (SLA) and the Justice and Equality Movement (JEM). A cease-fire agreement was signed on the 8 April for a renewable period of 45 days (AFP, 08/04/04). However, continuous violence has been reported on the ground.
Dire humanitarian situation in Darfur
Violence and human rights violations have been raging in Darfur for months. According to a mission led by the Office of High Commissioner for Human Rights, there have been frequent reports of killings with men and boys especially targeted, and of sexual violence; a climate of impunity has prevailed (UNCHR, 07/05/04). Attacks of the Janjawee, Arab militias who launch raids on villages, have led to killings, violence and destruction of villages, water and food reserves (ICG, 16/05/04).
There is also a need for better protection of IDPs, who face a greater risk of attacks after the delivery of humanitarian assistance (UNCHR, 07/05/04).
It is estimated that more than one million people are displaced throughout Darfur (570,000 in West Darfur, 290,000 in North Darfur and 140,000 in South Darfur) (UNICEF, 19/05/04). Some settled with host families whilst other gathered in camps (see map).
There are reports of the willingness of the government of Karthoum to forcibly return IDPs to their home areas (USAID, 21/05/04).
Access to the population is extremely difficult because of the logistic and security conditions but also owing to the restrictions imposed by the government of Karthoum, such as the requirement of special travel permits for humanitarian workers (USAID, 21/05/04). However, the government of Karthoum announced at the end of May 2004 that they will ease access to humanitarian workers (IRIN, 21/05/04); as of 20 May 2004, there were 116 humanitarian workers waiting for an entry visa or travel permits (UNRC, 20/05/04).
WFP reported restrictions on the partnership for food distribution: the government of Karthoum has ordered that only national NGOs are authorised to distribute food, not international NGOs (UNRC, 25/05/04).
ICRC reported that access to the population has improved but could be better (AFP, 25/05/04).
The availability of non-food items is inadequate to cover all the needs (USAID, 21/05/04). Availability of clean water and sanitation equipment is also reported as being scarce (OXFAM, 25/05/04).
The rainy season, which starts by mid-year and coincides with the hunger gap, will further worsen the situation because of the decreased availability of food, increased risk of diseases such as malaria and diarrhoea and more difficult access to the population (OXFAM, 25/05/04) (see map).
Two surveys were conducted in Kutum town, North Darfur and Wade Saleh and Mukjar provinces, West Darfur, in March and April 2004, respectively (SC-UK, 03/04; MSF-H, 04/04). In both surveys, IDPs represented the majority of the households surveyed: 89% and 75%, respectively. The nutrition situation and the under-five mortality rates were of concern in Kutum town and were serious in Wade Saleh and Mukjar provinces (table 13).
Table 13 Prevalence of acute malnutrition, measles immunisation coverage and mortality rates, Darfur region, Sudan (SC-UK, 03/04; MSF-H, 04/04)
* According to cards and mothers' statements
Kutum town was not accessible between November 2003 and January 2004. Some of the IDPs were living with relatives or in abandoned houses; the majority have gathered in an area in the town where they lack basic facilities. The main source of food was relief food for the majority of the households (87%), whilst the others relied on market (10%) or on their own production (2%).
In Wade Saleh and Mukjar provinces, morbidity was especially high: 85% of the children had been ill in the two weeks prior to the survey; major illnesses were diarrhoea (47%) and cough (28%). The food security situation has significantly deteriorated compared to before the crisis and people relied on coping mechanisms which were, however, limited (box 2).
Box 2 Food security indicators in Wade Saleh and Mukiar provinces, West Darfur (MSF-H, 04/04)
Internally Displaced People in Kassala state
Kassala state hosts both refugees, mainly from Eritrea, and displaced people; it is estimated that around 54,600 IDPs are settled in official camps. A nutrition survey was carried out in these camps by Goal in February 2004 (Goal, 02/04). The sources of income of the IDPs were mainly agricultural daily labour, wood cutting and charcoal production. Some were able to cultivate on residents' land or on small plots adjacent to the camps. The survey revealed an uncertain nutrition situation: 12.1% of the children were acutely malnourished, including 0.8% severely malnourished. Only one child had oedema. The nutrition situation was nevertheless slightly better than in 2002 and 2003 (figure 4).
The measles vaccination coverage proved by cards was 55.5% and was 75.5% when mothers' statements were also taken into account. A measles vaccination and vitamin A distribution campaign had been conducted in January 2004 in Kassala state; according to the survey, 96% of the children had received vitamin A.
Food distribution was reported as being irregular and has been halted since December 2003 for those IDPs who arrived the earliest and halved for the newly arrived IDPs.
Child feeding practices were sub-optimal.
Figure 4 Prevalence of malnutrition, IDP camps in Kassala state, Sudan
Improved situation in some areas of southern Sudan, whilst others remain at risk
Despite the signing of a new accord between the government of Karthoum and the SPLM/A, there are increasing reports of local conflicts over access to grazing land, resources and cattle, which have led to population displacements, especially in the lakes area of Bahr el Ghazal (IRIN, 19/05/04).
It seems that new restrictions have been imposed by the Sudan Relief and Rehabilitation Commission (SRRC), the SPLM/A's humanitarian wing, on humanitarian work, such as new taxes and work permits for expatriates. The SRRC would like to promote the employment of Sudanese workers; this may cause difficulties, considering the low level of education in southern Sudan (IRIN, 28/05/04).
An Ebola outbreak began in Yambio county, Western Equatoria; 19 cases have been identified as of 24 May 2004 (AFP, 24/05/04).
Wau town and IDP camps
Wau town has been a Government of Sudan enclave for the past 20 years. The town remains extremely isolated. In case of insecurity or a food gap, people from nearby villages seek refuge in the IDP camps, located in the outskirts of the town. Surveys were conducted in Wau town and in the surrounding IDP camps in February 2004 (ACF-F/joint, 02/04). The results revealed worrying rates of malnutrition, especially in some camps (figure 5).
However, the situation seemed to have slightly improved compared to 2003, when a new wave of displaced people had arrived in the area because of high food insecurity in rural areas (figure 5). Under-five mortality rates were below alert thresholds.
The decision of WFP to halt free food distribution to IDPs since December 2003 and to replace it by food for rehabilitation or food for training causes concern given the current un-acceptable nutrition situation in some of the camps. This newly established type of food distribution should ensure that the IDPs can meet their nutritional requirements.
Figure 5 Prevalence of acute malnutrition, Wau town and IDP camps, Sudan
Old Fangak, Upper Nile
The nutrition situation seemed to have greatly improved in Old Fangak district (table 14, figure 6) (AAH-US, 03/04). The same pattern was observed in Atar area (table 14) (AAH-US, 11/03). The food security was good in these areas in 2003, owing to good rainfall, few security incidents and on-going food distributions and humanitarian programmes.
Table 14 Prevalence of acute malnutrition, measles immunisation coverage and mortality rates, South Sudan (AAH-US, 09/03-02/04)
* According to cards and mothers' statements
Figure 6 Prevalence of acute malnutrition, Old Fangak, Sudan
Gumriak, Mareang and Nyadin, Upper Nile
On the other hand, the nutrition situation was poor in Gumriak, Mareang and Nyadin districts (table 14) (AAH-US, 10/03). This was attributed to floods and locusts which damaged the crops. Mortality rates were incredibly high (table 14); major causes of death were diarrhoea, bloody diarrhoea, measles and lower respiratory infection.
Kapoeta, Eastern Equatoria
In Kapoeta district, Eastern Equatoria, the nutrition situation was also of concern due to food insecurity owing to bad rains (table 14) (AAH-US, 01/04). Mortality rates were also high; the main causes of death were diarrhoea and fever.
The situation in Darfur remains at high risk (category I) and may worsen with the unset of the rainy season. On the other hand, due to an improvement in food security and security conditions, the situation has greatly improved in part of south Sudan but remains precarious (category II) whilst the situation remains serious in other parts which experienced bad weather conditions (category I). IDPs and the local population will require humanitarian and development action as long as the situation is not consolidated on the ground.
From the MSF-H survey in Western Darfur:
From the SC-UK survey in Kutum town, Northern Darfur
Guinea still hosts about 110,000 refugees in seven camps (see NICS 1) and an additional 70,000 refugees outside camps. UNHCR's repatriation programme for Sierra Leonean refugees resumed in January 2004 and is due to end in June 2004 (AFP, 04/05/04). About 6,000 refugees are still settled in camps. UNHCR has planned to stop material aid to Sierra Leonan refugees by June 2004 (AFP, 04/05/04). However, some refugees are reluctant to return because they want to harvest in Guinea before returning or because they think that living conditions in Sierra Leone are not satisfactory (OCHA, 20/02/04).
An evaluation carried out by the URD group in Guinea at the end of 2003 raised positive and negative points regarding the situation in the refugee camps and the impact of the establishment of the camps on the host population (URD, 12/2003) (box 3).
Box 3 Positive and negative points in and around the refugee camps, Guinea, December 2003 (URD, 12/03)
Peace accords have suffered a set-back within the recent months. A march organised by the rebels and opposition parties and which was officially banned took place in Abidjan on the 25th of March 2004 and degenerated into violence (IRIN, 25/03/04). The rebels and opposition parties suspended their participation in the government shortly thereafter.
A report on the events around the 25 March's march, led by the Office of the United Nations High Commissioner for Human Rights, said that at least 120 people were killed, 20 disappeared and 274 were injured. There was also evidence that some community groups were specially targeted, i.e. individuals from the north of the country or from neighbouring countries (UNSC, 13/05/04).
In protest against this report, demonstrations and sit-in have been organised by the Jeunesse Patriote, loyal to president Gbagbo (OCHA, 17/05/04); it also seems that a UN convoy was stoned (WFP, 21/05/04).
On 27 February the UN Security Council agreed to create a 6,240-strong peacekeeping force for Ivory Coast (UNSC, 27/02/04); the peacekeeping force had about 2,000 troops as of May 2004.
Violent ethnic clashes still continue in the west of the country where at least 3,000 people were displaced in May 2004 (WFP, 21/05/04). There are still several hundred thousands of displaced people and an estimated 75,000 refugees.
Decline in agricultural production
According to the FAO/WFP crop and food supply assessment mission, conducted in November/December 2003, food crop, cash crop and animal production was reduced in 2003 compared to previous years (table 15) (FAO/WFP, 03/04).
Table 15 Food crop, cash crop and animal production prospects for 2003/2004, compared to previous years (2002/2003 for food crops, 2001/2002 for cash crops), Ivory Coast (FAO/WFP, 03/04)
The decline in production may be attributed to the displacement of population, the lack of labour which resulted from it, the lack of agricultural services in parts of the country and the disruption to access to markets because of insecurity and levies at roadblocks. These factors are present to a greater or lesser degree, depending on the area (box 4).
Box 4 Factors affecting agricultural production in Ivory Coast (FAO/WFP, 03/04)
Nutrition situation under control in Bin Houye and Zouan Hounien sous-préfectures, Danane department, west Ivory Coast
Zouan Hounien is an area controlled by the force loyal to President Gbagbo, as is Bin Houye, apart from the north which is under the responsibility of the peace-keeping force. A lot of people fled the area at the end of 2002 but began to return in May/June 2003. The main source of income before the crisis was cash crops, and especially coffee. Cash crop cultivation has been badly affected by the crisis but people have been able to cultivate cassava, maize, swamp rice and vegetables. A few irregular food distributions have taken place. The health system is supported by NGOs; two supplementary feeding centres are in place and severely malnourished children are referred to a therapeutic feeding centre in Man.
A random-sampled nutrition survey was conducted in December 2003 in a 10 km radius from the two supplementary feeding centres (ACF-F, 12/03). The results showed that the situation was under control: the prevalence of acute malnutrition was 4.3% (2.7-6.6), including 0.5% (0.1-1.8) severe acute malnutrition. The measles vaccination coverage was low, with only 23.3% of the children being vaccinated against measles, according to cards and mothers' statements.
The political situation is highly volatile. Despite a decrease in food and cash crop production, the food security and nutrition situation remains average (category III) but is fragile. Any degradation of the political situation will put the population at risk.
The security situation has improved in Liberia and humanitarian organisations have had access to a wider part of the country (WFP, 20/05/04). However, security is still perilous, with outbreaks of violence and abuses of civilians, even in the areas controlled by UNMIL (GW, 24/05/04). As of May 2004, UNMIL was at full strength with 15,000 troops deployed throughout the country (UNICEF, 24/05/04).
The Disarmament, Demobilisation, Rehabilitation and Reintegration (DDRR) process resumed on 15 April 2004, in Gbarnga, Buchanan, Tubnamburg and outside Monrovia (UNICEF, 24/05/04). So far, 26,000 fighters from LURD, MODEL and former-government forces have been disarmed and have received the US$300 resettlement grant (IRIN, 12/05/04); it is however suggested that non-combatants may have also taken part in the process. Cash-payment to demobilised children and adolescents has also raised concerns, as it is thought that the grant will probably not be used for productive investments (RI, 21/04/04).
A national measles vaccination and vitamin A distribution campaign is under-way (UNICEF, 24/05/04).
Refugees and returnees
An estimated 10,000 Liberian refugees were still in camps as of May 2004. UNHCR intended to stop aid to Sierra Leonean refugees at the end of June and encouraged them to repatriate (UNHCR, 17/05/04).
About 17,000 Liberian refugees have spontaneously returned from neighbouring countries. About 7,000 are settled in two returnee camps in Montserrado county. After registration, they will receive a re-integration package (UNHCR, 18/05/04).
Internally Displaced Persons
A census, carried out in April 2004 in the 20 official displaced persons camps concluded that there were about 261,900 IDPs in these camps, of whom the majority were in Montserrado county (table 16) (OCHA/UNHCR, 05/04). The report acknowledged that it was
difficult to know the exact number of people as there was a lot of movement between the surrounding communities and the camps. The majority of IDPs plan to return to Bong, Lofa and Bomi counties.
Table 16 Number of IDPs in official IDP camps in Montserrado, Bong and Margibi counties, April 2004, Liberia (OCHA/UNHCR, 05/04)
|Camp||Acute Malnutrition (%)
|Severe Acute Malnutrition (%)
|Saygbeh||3.4 (1.7-6.5)||0.3 (0-2.2)|
|Blamase||3.8 (2.2-6.2)||1.2 (0.4-2.9)|
|Plumkor||6.3 (4.1-9.3)||1.5 (0.6-3.4)|
|Ricks||6.4 (4.4-9.2)||0.4 (4.4-9.2)|
|Jahtondo||6.6 (4.4-9.7)||0.7 (0.2-2.3)|
|Perry||6.7 (4.1-10.7)||0.4 (0.1-2.4)|
|Wilson||7.8 (5.1-11.6)||0.6 (0.1-2.9)|
A random-sampled nutrition survey conducted in Greater Monrovia in November 2003 showed average prevalence of malnutrition (category II) and mortality rates (table 18) (WFP/joint, 11/03). A similar malnutrition rate was shown in a survey carried out in six districts of Monrovia and two IDP camps on the outskirts of Monrovia (VAM, 11/03). The assessment also showed that the food security situation was of concern: on average, households were spending 70% of their income in food, this reached 95% for the IDPs. 40% of the households had no assets, whilst 26% had domestic assets and only 3% had productive assets. The majority of the families (60%) had poor dwelling conditions. Households were relying mainly on petty trading and wage labour and coping mechanisms seemed limited. Morbidity was very high: 75% of the children had been ill within the two weeks prior to the survey.
Table 18 Results of nutrition and mortality surveys, Greater Monrovia, Bomi and Grand Cape Mont counties, Liberia (WFP, 11/03; WV, 03/04)
|% Severe Acute
|Under 5 Mortality
|Greater Monrovia||WFP||Nov-03||6.9 (5.4-8.4)||0.9 (0.2-1.7)||93||0.63||1.13|
Grand Cape Mont
|WV||Mar-04||4.1 (2.3-5.9)||0.9 (0.1-1.8)||86.5||2.03||4.93|
* According to cards and mothers' statements
The nutrition situation in Bomi and Grand Cape Mount counties appeared acceptable (category III), according to a random-sampled nutrition survey conducted in March 2004 (table 18) (WV, 03/04). Measles vaccination and vitamin A distribution coverage (77.1%) were satisfactory.
On the other hand, mortality rates within the six months prior to the survey were very high.
The main causes of death among those over five year old were war related injury (21%), diarrhoea (20%) and fever (18%), whilst they were diarrhoea (30%), fever (25%) and malnutrition (26%) among the under fives.
About 74% of the families interviewed were resident, 23% were returnees and 3% were displaced.
Food security and public health seemed precarious (box 5).
Box 5 Food security and public health in Bomi and Grand Cape Mount counties, Liberia (WV, 03/04)
Main sources of food
Own production (15.2%)
Main sources of income
Agriculture (49%), palm nut oil, casual work, petty trading
6% of the households received food in January and March
UNAMSIL mandate has been extended until September 2004 and a residual force will probably remain till June 2005 (OCHA, 12/05/04). The security situation is calm but inflation is still on the rise (OCHA, 12/05/04). Some 7,400 refugees have been repatriated from Guinea (6,276) and from Liberia (1,175) by UNHCR since the resumption of the repatriation programme in January 2004 (OCHA, 12/05/04).
However, there are some weaknesses in the reconstruction process. According to the URD group, there is still a strong presence of humanitarian organisations during this rehabilitation phase, as was the case during the crisis, and some creative programmes are being implemented (URD, 12/03). On the other hand, UNHCR’s assistance to the returnees seems limited, there is a lack of housing programmes and the funding of the rehabilitation of the health system is insufficient.
The security situation is still calm throughout the country, except in Bujumbura rural, which is the stronghold of the FNL (National Liberation Forces), the only rebel movement which has not signed a peace agreement with the government (AFP, 06/05/04; USAID, 14/05/04). Clashes in Bujumbura rural caused the displacement of at least 50,000 persons in April and May (IRIN, 17/05/04). Despite the FDD (Forces for the Defence of Democracy) having signed a peace agreement with the President of Burundi at the end of last year, they have withdrawn from the transitional government, protesting against the slow process in the nomination of governorships, administrators and ambassadors (USAID, 14/05/04).
The number of displaced persons settled in camps has halved compared to 2002.
A survey counted about 140,000 IDPs in displaced camps in 2004, compared to 281,000 in 2002 (OCHA, 14/05/04). According to Refugee International (RI), IDPs are vulnerable but receive little attention (RI, 28/04/04).
Some 4,500 Congolese refugees were moved from a transit camp near the border to a safer camp in Muyinga province, where 4,000 Congolese refugees were already settled (IRIN, 17/05/04). The Government of Burundi estimates that there are about 40,500 Congolese refugees in Burundi.
More than 40,700 refugees returned from Tanzania so far this year (see map); about 176,000 refugees have returned since 2002 (UNHCR, 18/05/04). However, the return of the refugees raise a number of issues, regarding their conditions of departure from Tanzania as well as their conditions of return. The mounting pressure on Burundian refugees to leave Tanzania camps was denounced by Refugee International (RI, 14/04/04). For about one year, the restriction of movement has been reinforced (see RNIS 42); refugees are not allowed to move further than a four kms radius from the camps. Those who are caught outside this limit are arrested and deported to Burundi.
When they arrive at their destination, returnees face a number of challenges (IRIN, 14/04/04; IRIN, 15/04/04). First of all, housing is a high priority, as most of the refugees’ houses have been destroyed; some housing programmes are on-going. Secondly, they have to get their fields back; in some cases, their lands have been used or sold. It seems that there is an increasing number of disputes over land and an increase in the price of land. The agricultural situation of families who returned one year ago remains critical as compared to families who have not moved. The principal limitations the returnees face are insufficient banana and cassava shoots, exhausted land, loss of revenue from cash crops, little access to agricultural inputs such as fertilisers and tools (IRIN, 14/04/04). On their return, families are highly dependent on their relatives or neighbours, especially for housing and food.
Returnees benefit from a three-month food package, which seems to last less than that because it is shared with the host community or sold to get cash. When their food stock is exhausted, they mainly depend on the host community. Returnees also receive non-food items on their arrival and agricultural inputs if they are registered by the local administration.
Health care and education are other challenges that face returnees but also Burundians who did not move. The health and education system was already stretched before the returnees add a further pressure on the infrastructure. The cost-recovery system has been implemented in most part of the country (see below); it seems however, that returnees can obtain "certificates of poverty" to receive free treatment (IRIN, 14/04/04).
Moreover, Refugees International warns that large-scale repatriation could threaten peace (RI, 12/04/04). According to RI, Burundi is not politically stable enough, the infrastructure is too weak and the UNHCR's capacity to protect refugees is insufficient, for promoting large-scale repatriation.
RI also states that refugee return seems highly-linked with political considerations both in Burundi and Tanzania: the CNDD/FDD in Burundi is calling for the speedy return of the refugees to increase their chance of winning the next elections at the end of 2004. In Tanzania, the ruling party has promised that all the refugees will have returned home before the next election due at the end of 2005 (RI, 12/04/04).
Returnees from Tanzania
The number of admissions to feeding centres since the beginning of the year has been lower than in 2003 (figure 7) (UNICEF-B, 02/04-04/04). The highest number of admissions was in Bujumbura rural, which accounted for about 25% of the whole admissions. Bujumbura Mairie, Bururi, Cankuzo and Muramviya had the lowest number of admissions.
Figure 7 Admissions to therapeutic feeding centres (TFCs) and Supplementary Feeding Centres (SFCs), Burundi (UNCEF-B, 04/04)
MSF-B conducted a random-sampled nation-wide mortality survey and different assessments aiming at describing access to health care (Bujumbura Mairie was excluded) (MSF, 04/2004). For the purpose of the health surveys, the total population of Burundi was divided in three categories depending on the type of health care they can access. The results of these surveys were appalling; mortality rates stood well above the alert thresholds in each of the area surveyed. CMR were 1.2/10,000/day (0.8-1.6), 1.6/10,000/day (1.2-2.0) and 1.9/10,000/day (1.4-2.3) depending on the area surveyed and the < 5 MR was 3.3/10,000/day (2.0-4.6), 4.9/10,000/day (3.4-6.3) and 3.1/10,000/day (2.3-4.0).
The main cause of death was malaria.
A cost-recovery system was put in place in Burundi at the beginning of 2002; about 80% of the population of the country fell under it, whilst the others have access to health centres applying a flat fee or a cost-sharing system (50% of the price of medicine). The survey revealed that the frequentation of the health centres applying the cost-recovery system has decreased since this system was applied. Moreover, 17% of the population has no access to health care, mainly owing to financial reasons and about 80% of the people who have consulted have been obliged to take on debts for the payment of the consultation and medicines. Patients also tend to wait too long before attending a consultation.
From Refugee International:
From the MSF survey on access to health care:
Despite a general improvement in the security situation since the signing of a peace agreement in mid-2003, part of DRC is still not accessible because of poor infrastructure or insecurity, which prevails especially in the east (see map). Violence has been reported during April and May in North Kivu, South Kivu and Katanga; it is estimated that 30,000-35,000 people were displaced in April in these areas (OCHA, 30/04/04). In late May, fighting between rival factions of the army erupted in Bukavu; more than 2,000 people fled to Rwanda (IRIN, 31/05/04). A demobilisation and re-integration project of an estimated 150,000 ex-combatants has been approved by the World Bank (WB, 25/05/04).
Between 80,000 and 100,000 people, mainly Congolese, considered to be illegal diamond miners, have been expelled from Angola to DRC in dire conditions (see Angola).
The area was inaccessible for years owing to the war. Since mid-2003, the security situation has improved as well as the access to the area. The main activities are agriculture and fishing; they have been reduced during the war because of insecurity and lack of seeds and inputs. During the last few months, there seems to have been a lot of spontaneous returns of Congolese refugees to Fizzi; the number of returnees was estimated at 44,000 (OCHA, 21/05/04).
The nutrition situation in Nundu health zone is of concern (AAH-US, 11/03) (table 19). Despite the improvement in the security situation, people do not benefit from good food security or access to basic services.
Table 19 Results of nutrition and mortality surveys, DRC
|% Severe Acute
|Moba & Kansimba
In Lemera, security has been poor for years and is not yet completely stabilised. The main source of food is own production, essentially cassava. Although arable land is available, it is too expensive for the majority of the population. Prices of livestock have dramatically increased, following intense looting. The buying power of the population has decreased. However, the nutrition situation was average (table 19) in November 2003 (AAH-US, 11/03).
In Shabunda, the nutrition situation was also average in November 2003 (table 19) and has greatly improved compared to February 2002, when the prevalence of acute malnutrition was 20.4% (AAH-US, 11/03). The improvement has mostly been attributed to the amelioration of the security situation which allows cultivation and commercial exchanges.
The nutrition situation was under control in Moba and Kansimba in October 2003 (table 19) and has improved compared to November 2001 when the malnutrition rate was 6.2% (AAH-US, 10/03). This could possibly be due to the improvement in the security situation. However, mortality rates were high (table 19).
The main source of income before the war was coffee production but this was particularly affected during the war. The nutrition situation was of concern (table 19) as well as the food security situation (AAH-US, 02/04). Moreover, mortality rates were above alert thresholds (table 19).
The improvement of the security situation since mid-2003 seems to have played a part in the amelioration of the food security and nutrition status in some areas (category III), whilst others remain at risk (category II).
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.
The number of Sudanese refugees, fleeing violence in Darfur may be as high as 200,000, according to Refugee International, whilst the latest estimate of UNHCR is 125,000 (RI, 19/05/04).
Camps overcrowded and lacking basic facilities
Since the beginning of the year, about 77,000 refugees have been settled in seven refugee camps (table 20) (UNHCR, 24/05/04). However, the camps are already overcrowded, some refugees having gone by themselves to the camps in search of aid (IRIN, 25/05/04; UNHCR, 24/05/04).
Table 20 Number of refugees in refugee camps, Chad, May 2004 (UNHCR, 24/05/04)
|Camp||Number of refugees|
Availability of water is a major problem in this dry-land area and the recommended quantity of 15 litres/pers/day was not met in some camps (IRIN, 25/05/04; MSF, 11/05/04). Sanitation facilities were also reported lacking and disease was on the rise (MSF, 11/05/04). Food distributions were in place but seemed irregular and unbalanced, often with only cereals being distributed (FEWS, 25/03/04). The camps are located on dry-land and isolated areas and refugees probably rely almost only on external aid. It seemed that the nutrition situation of the refugees in the camps was worse than that of the refugees in host communities (MSF, 11/05/04).
Refugees near the border at risk
Several thousands of refugees are still settled within host communities near the border. They are at increased risk of being targeted by the Sudanese militia who have made several incursions into Chad (IRIN, 14/05/04). A high number of livestock deaths has been reported, but it is not clear if it was due to disease or lack of fodder (IRIN, 25/05/04). Some refugees have also been reported as lacking food, especially in the area of Korfou (RI, 05/05/04). An outbreak of meningitis occurred in Iriba district (WHO, 08/04/05); a vaccination campaign has been carried out.
Host population exhausted
The Chadian host population has provided help to refugees, especially in terms of food (IRIN, 20/05/04). This has weakened their livelihoods and they may be at risk of food insecurity amid increasing food prices and the beginning of the hunger-gap. Moreover, they are also subjected to cattle-raiding by the militia.
Difficult delivery of aid and insufficient funding
The delivery of aid is rendered difficult by the remoteness of the area, the size of the area to be covered (refugees are stretched over 600 km along the Sudanese border), poor logistic conditions and low availability of goods and skilled staff in Chad (IRIN, 25/04/04).
The upcoming rainy season, which will start in June will even worsen the situation; efforts are being made to pre-position food and non-food items.
WFP and UNHCR have only received 65% and 62% of their requirements, which, moreover, may have under-estimated the number of people in need (IRIN, 25/05/04).
The humanitarian situation of the refugees in Eastern Chad and of the host population seems to be rapidly deteriorating (category I). Programmes should be scaled-up and integrate the host population. Donor agencies should increase their commitment to the crisis. The onset of the rainy season will further impair the delivery of assistance.
Owing to heavy rains, Huambo province and part of Huila province, especially Caconda municipality face reduction in maize production. Maize production is expected to be 35% below normal in Huambo, and 75% below normal in Caconda municipality. Although there are surpluses in other areas, bad transport conditions will hamper marketing surplus production (OCHA, 30/04/05; FEWS, 12/04/05).
About 1.3 million Angolans are in need of food aid, including returnees. However, WFP faces a high funding shortfall: only US$ 35 million of the US$ 253 million required had been received (WFP, 06/05/04). Rations had already been halved in April and May and are scheduled to be further reduced by June, unless WFP receives cash pledges. WFP is also experiencing a shortfall in feeding Angolan refugees in nearby countries and will face serious challenges to provide a food package to refugees who will return with the UNHCR repatriation programme due to resume in May-June (UNHCR, 21/05/04).
There were several reports of human rights violations when Congolese and people from other nationalities, considered to be illegal diamond miners, were expelled from Angola (MSF, 29/04/04; AI, 14/05/04). An estimated 80,000-100,000 people have been expelled to DRC over the last months in dire conditions. People have been held with no basic services available, have been forced to walk for more than 60 km with no water and food. There have been reports of rape and other human rights violations. People arrived mostly in Bandudu and Kasai Orientale province in DRC stripped of possessions and clothes. Most of those expelled were born in Angola and have no place to which they can return. Humanitarian agencies provide aid as far as possible (OCHA, 07/05/04). The government of Angola has recently announced a 45-day suspension of expulsions (IRIN, 20/05/04).
According to several surveys received by NICS, the nutrition situation has not significantly improved since 2003 (ACH, 01/04-02/04; CRS, 04/04; MSF-S, 03/04). The same pattern is shown by the number of admissions to TFCs country wide (figure 8). Moreover, it seems that the number of admissions to TFC slightly increased in December 2003 compared to December 2002 in Benguela and Huila provinces (UNICEF-A, 02/04).
The only real improvement is seen in accessible areas of Caconda municipality (ACH, 01/04). This can be partly explained by the return of the IDPs to their area of origin: the population halved between June 2003 and January 2004 and in January 2004 the majority of the population was resident (91%), whilst in June 2003, more than half of the population was displaced people. On the other hand, screening conducted in areas where a lot of people returned, showed a more worrying situation, especially in areas not accessible to humanitarian agencies owing to poor road conditions and the presence of landmines: screening carried out during a food distribution found 166 acutely malnourished children of 927 children screened (17.9%) (ACH, 02/04). In Ganda and Cubal municipalities, 20% of the population was returnees.
Figure 8 Admissions to therapeutic feeding centres, Angola (UNCEF-A, 04/04)
Whilst mortality rates were under alert thresholds in Matala and Cubal municipality, they were high in IDP camps in Matala and in Caconda and Ganda municipalities (table 21). Measles vaccination and vitamin A distribution coverage was insufficient (table 21).
Table 21 Results of nutrition and mortality surveys, Angola
There has not been a noticeable improvement in the nutrition situation in Angola since 2003 (category II/III). This may be attributed to the fragile food security situation, especially for the returnees who represent a significant proportion of the population. Unfortunately, donors' and the government of Angola’s commitment to Angola's reconstruction is weak and far from sufficient to ensure a significant improvement of the situation.
From FEWS in Huambo province:
The last NICS report (see NICS 1) reported on a random sampled- nutrition survey which was carried out in the Angolan refugee camp of Nangweshi in July 2003 (UNHCR/ICH, 07/2003). The anthropometric nutritional status of the children was satisfactory. The survey also assessed micro-nutrient deficiencies among children, adolescents and adults.
Vitamin A deficiency was assessed among 204 adolescents and proved to be a severe public health problem (table 22). There was no difference between sexes but there was a high correlation with age; vitamin A status was more satisfactory among older adolescents than among younger. Vitamin A status was not assessed among children as a programme of distribution of vitamin A capsule was on-going and its coverage was reported as being high.
Anaemia was found to be a problem of high significance in children, of medium significance in pregnant women and of low significance in adolescents and non-pregnant women (table 23). There was no difference between sexes and no correlation with age, either among children or adolescents.
The measurements of iron deficiency and malaria infection tended to show that iron deficiency was a significant factor of anaemia, whilst malaria did not contribute significantly to anaemia.
No visible goitre was detected among 213 adolescents. Moreover, the mean urinary iodine concentration was 785 mg/L, indicating that consumption appears to be excessive. It is recommended that salt is tested for levels of iodine to ensure that the fortification level is appropriate.
Some cases of pellagra (vitamin B3 deficiency) were detected in the camp, although not within the sample frame of the survey. The presence of one clinical case of pellagra is regarded as indicative of a mild public health problem. A further screening among 1248 children enrolled in primary and secondary schools did not identify any cases of pellagra.
A pilot project of micro-nutrient fortification of the cereal meal distributed through the general ration has been implemented since September 2003.
A joint UNHCR/WHO evaluation of health and nutrition was carried out in the Angolan refugee camps of Mayukwayukwa and Nangweshi, West Zambia and the Congolese refugee camps of Kala and Mwange, North Zambia in December 2003 (UNHCR/WHO, 12/03).
The main findings regarding health are summarized below:
Data on mortality were unreliable; but mortality was not thought to be high.
Health centres appeared to be providing quality, conscientious and appropriate care although there were areas in each camp that needed attention and improvement.
It seems that there was a good referral system.
Several issues were raised regarding nutrition:
Food basket monitoring needs to be implemented or improved.
Whist in Mayukwayukwa and Nangweshi camps, selective feeding programmes follow international standards and protocols, management of acute malnutrition is done on an ad hoc basis in Kala and Mwange camps.
There were no specific case definitions and guidelines in use for the detection of micro-nutrient deficiencies.
Table 22 Vitamin A status of adolescents (10-19 years), Nangweshi refugee camp, Zambia, July 2003 (UNHCR/ICH, 07/03)
|Population group||N||Mild anaemia*
(%) (95% CI)
(%) (95% CI)
(%) (95% CI)
(%) (95% CI)
|6-59 months||155||15.5 (10.4-22.4)||31.0 (23.9-39.0)||1.3 (0.2-5.1)||47.7 (39.7-55.9)|
|10-19 years||213||9.4 (6.0-14.3)||7.5 (4.5-12.1)||1.9 (0.6-5.1)||19.3 (14.3-25.3)|
|Non-pregnant women||116||6.9 (3.2-13.6)||7.8 (3.8-14.6)||3.4 (1.1-9.1)||18.1 (11.8-26.6)|
|Pregnant women||28||14.3 (4.6-33.6)||10.7 (2.8-29.4)||0.0||25.0 (11.4-45.2)|
Table 23 Prevalence of anaemia, Nangweshi refugee camp, Zambia, July 2003 (UNHCR/ICH, 07/03)
Vitamin A Deficiency
< 0.7 mmol/L
|Medium Risk %
< 0.7 & ³ 0.35 mmol/L
|High Risk %
< 0.35 mmol/L
|204||47.1 (40.1 - 54.1)||41.7 (34.9 - 48.8)||5.4 (2.9 - 9.7)|
The security situation has remained volatile.
The Berlin donors' conference, held at the end of March 2004, was promising in terms of funding the next seven-year budget presented by the Afghan government. Donors' pledges were secured for the first year ($US 4.5 billion) and were encouraging for the initial three years (BAAG, 31/03/04).
The preliminary results of the National Risk and Vulnerability Assessment, a multi-stakeholder initiative, conducted in summer 2003 (at a time of a bumper harvest), found that more than half of the rural population was under poverty line (FEWS, 03/04). Poverty seems to be concentrated in the central and northwest regions. In rural areas, about 40% of the households interviewed felt that the situation had improved compared to the previous year, whilst 25% felt it had deteriorated. The impression of improvement was higher among the better-off than among the poorest. The households were equally distributed between those saying they could meet their food needs often, sometimes or rarely. Unsurprisingly, the poor had more difficulty in meeting their food needs than the better-off. The proportion of families within Afghanistan who cannot meet their food needs (defined as 2047 Kcal/pers/day) is heterogeneous (see map).
After eight years of drought, Badin district experienced heavy rains and floods during summer 2003. Hundred of deaths were reported, as well as a massive loss of crops and livestock, and destruction of housing. About 75% of the villages were estimated to have been affected. Most of the households have increased their debts to rebuild their houses, re-stock and buy agricultural inputs and food. Some families who have not been able to rebuild their houses have been living in public buildings. Families have reduced their food intake from two to three meals before the crisis to one meal at the time of the survey; the quality of the meals has also deteriorated.
A random sampled nutrition survey was carried out in the six most affected union councils of Badin district in February 2004 (ACF/F, 02/04). The survey showed a worrying nutrition situation: 17.3 % (14.0-21.3) of the 6-59 month olds were acutely malnourished, including 1.4% (0.6-3.2) who were severely malnourished. This survey confirmed findings of previous assessments. The food security situation is not likely to improve in the coming months as some fields are still flooded and the population has estimated that less than 40% of the fields will produce a crop in March 2004 (ACF-F, 11/03/04).
From the ACF-F survey:
Ethnic Nepali refugees from southern Bhutan began to arrive in Nepal towards 1991 following the Bhutanese authorities' enforcement of restrictive immigration and citizenship laws.
As of June 2003, around 103,000 refugees were settled in seven camps in Jhapa and Morang districts, eastern Nepal. Despite several rounds of negotiation over the last years, no solution to the refugee crisis has yet been found (HRW, 28/10/03).
Average anthropometric nutrition status
Regular yearly nutrition surveys have been conducted since 1992. Apart from the survey done in 1992 which showed a high level of acute malnutrition, the surveys carried out later revealed an average nutrition situation: the prevalence of acute malnutrition, expressed in percentage of the median until 1998, was about 5% (UNHCR/WHO, 03/04). Acute malnutrition rates expressed in Z-scores are available for 1999, 2000, 2002 and 2003 and also show an average nutrition situation (figure 9).
Prevalence of stunting has remained around 30.0% over the last four years (UNHCR/WHO, 03/04).
Figure 9 Prevalence of acute malnutrition in refugee camps, Nepal
High levels of micro-nutrient deficiencies such as scurvy, beri-beri and pellagra were reported in 1993-1994 (FE, 10/98; RNIS 5 to 7). After various actions had been taken to prevent micro-nutrient deficiencies, such as replacement of polished rice by parboiled rice and inclusion of fortified blended food in the general ration, distribution of green vegetables and nutrition education, cases of micro-nutrient deficiencies have decreased. However, a rise in the number of cases of angular stomatitis (deficit of vitamin B2) occurred in early 1999. This may have been linked with the withdrawal of the blended from the general ration and the irregular supply of green vegetables. The situation improved in late 1999 (see RNIS 26 to 31).
Clinical assessment of angular stomatitis is included in the nutrition surveys. The prevalence among the 6-59 month olds seems to have regularly declined since 1999 (figure 10). On the other hand, a significant number of new cases were still reported in the health facilities, in May and June 2003. Cases of mild beri-beri, vitamin A deficiencies and scurvy were also reported, whilst no case of pellagra was detected. However, health facilities do not seem to have written case definitions of micro-nutrient deficiencies (UNHCR/WHO, 03/04).
Bi-annual distributions of vitamin A capsules for children 6-59 months are implemented and, according to the nutrition surveys, the coverage seems to be adequate: 93.2%, 95.3% and 98.4% coverage in 2001, 2002 and 2003, respectively (AMDA, 08/01; 06/02; 06/03).
Figure 10 Prevalence of clinical signs of angular stomatitis assessed during nutrition surveys, refugee camps, Nepal (AMDA)
Regular food distributions of parboiled rice (410 g7pers/day), lentils (60 g/pers/day), chick peas (20 g/pers/day), salt (7.5 g/pers/day) and vegetable oil (25 g/pers/day) provide 2000-2100 Kcal/pers/day (UNHCR/WHO, 03/04). Fresh vegetables are also provided.
Other sources of food
In 2003, about 86% of the households declared having purchased food, mainly vegetables and dairy products (AMDA, 06/03).
A significant number of households have kitchen gardens: 53%, 71% and 61% in 2001, 2002 and 2003 respectively (AMDA, 08/01; 06/02; 06/03).
Sources of income
About half of the families surveyed reported having regular sources of income in 2003 (AMDA, 08/01; 06/02; 06/03). The main sources of income were petty trading, daily work and incentives from aid agencies.
Child care practices
The 2003 survey found that 98% of the 0-1 year olds were breastfeeding (AMDA, 06/03). However, mothers tend to introduce complementary feeding such as blended food or cow milk in the first 1-2 months of life (UNHCR/WHO, 03/04).
Selective feeding programmes are being implemented in all camps for malnourished children, pregnant and lactating (0-6 months after delivery) mothers, children aged 6-11 months, TB and elderly sick (UNHCR/WHO, 03/04). The bulk of the ration provided is a locally-produced fortified blended food. Some problems regarding the follow-up and the weight gain of the malnourished children were reported as well as an inadequate expertise in counselling the mothers about child feeding. No therapeutic feeding centres are in place (UNHCR/WHO, 03/04). Growth monitoring (weight-height and weight-age) is implemented for children aged 0-24 months. Whilst 0-12 month children regularly attend monthly growth monitoring because their mother receive supplementary food, only 30% of the one to two year olds are followed-up. No counselling is provided to mothers of children who fail to gain weight adequately.
* Reviewed by Oleg O.Bilukha from CDC and consultant for the WHO/UNHCR evaluation in refugee camps
The "People's war", a civil insurgency led by the Maoists, an opposition force to the Monarchy, erupted in 1996. The conflict escalated in late 2001 with the involvement of the army and the declaration of a state of emergency. A ceasefire agreement was signed in January 2003 but broke down in August the same year and the conflict has since escalated. As of the beginning of 2004, it was estimated that 73 of the 75 districts of Nepal were affected by the conflict (RI, 23/03/04).
Human rights abuses and violations by both parties have been on the rise and the war has created thousands of victims (RI, 23/03/04; AFP, 11/04/04).
Whilst until 2001, civilians targeted by the Maoists were mostly from the upper class, including teachers, it seems that in recent years, actions of both Maoists and government forces have been affecting any category of the population (NRC, 10/10/2003). Education has broken down and business, the local economy and public services have been disrupted.
The civil unrest has also led to displacements, mainly from the rural areas to district headquarters and city centres, and to migration to India. These are the same patterns that poor economic migrants traditionally follow. Estate and rent prices have gone up considerably in towns (Nepal news, 18/09/03). The number of IDPs is not known precisely and may be between 100,000 and 150,000 (NRC, 03/03). Whilst the better-off seem to have had the means to restart a new life in towns, poor IDPs are more at risk. Assistance to IDPs seems low, with no government policy and few assistance programmes (RI, 23/03/04). Estimation of the number of IDPs and the provision of assistance to IDPs are made difficult by the political situation.
As of 2003, it was not clear how far the current crisis had affected the food security of the population. According to an ICRC survey conducted in the west-central region in January 2003, there was no acute food crisis at the time but the persistence of the conflict could precipitate a crisis (ICRC, 13/01/03). Another study stated that as of 2003, although a significant proportion of the population was food-insecure, it was not clear whether there has been a decline in food security over the past five years and if this decline may be attributed to the conflict (EC, 2003). The study also recognised that the restrictions on the movement of people and goods may have the effect of increasing food insecurity, especially in the areas where self-reliance is impossible.
A rapid nutrition and food security assessment in four districts of the Mid-West region, carried out in January-February 2003 found a high level of food insecurity, but this had not changed significantly from the previous five years (WV, 01-02/03). Traditional coping mechanisms were becoming stretched.
Rapid nutrition assessments showed level of acute malnutrition slightly above 10% in three districts, whilst it was 5% in Lamjung district (WV, 01-02/03). According to a Demographic and Health Survey, the prevalence of malnutrition was 8.1% in the mid-western region in 2001 (MOH/ORC, 2001).
The on-going conflict has led to major human rights abuses and to the displacement of thousands of people into major cities and India. Whilst the better-off may be able to cope with the displacement, the poorest may be in a more difficult situation. In rural areas, although the direct impact of the conflict on food security is unclear, the recent upsurge in violence may have further weakened the already flimsy food security of the population, and coping mechanisms may become exhausted.
The nutrition status of the refugees is average, with micro-nutrient deficiencies reported, although some measures have been taken to overcome this problem.
From the UNHCR/WHO assessment in refugee camps:
FEWS 25/03/04 Eritrea, food security update
FEWS 21/04/04 Eritrea, food security update
MOH/joint 12/2003 Nutrition survey report, Anseba, Debub, Gash Barka and Northern Red Sea
OCHA 02/04/04 Eritrea: humanitarian update 2 Apr 2004
OCHA 23/04/04 Donor information update Eritrea Mar-Apr 2004
WFP 30/04/04 WFP emergency report nb 18
Concern 11/03 Nutrition survey report, Dessie Zuria woreda, south Wollo, Amhara region, Ethiopia
Concern 11/03 Nutrition survey report, Kalu woreda, south Wollo, Amhara region, Ethiopia
Concern 12/03 Nutrition survey, Offa woreda, Wolaita zone, SNNPR, Ethiopia
CRS 01/04 Nutrition survey report, Meta and Kersa district, East Hararghe, Oromia region, Ethiopia
DSA 12/03 Tehudere nutrition survey report
ENFS 04/04 Monthly report
FSAU-N 03/04 Nutrition update
GOAL/ 02/04 Finding of a nutrition survey: Shebedino woreda, SC-US/ACF Sidama, SNNPR
OCHA 03/04 Situation of IDPs in Bordode/Mieso, Fafen and Hartisheik areas of the Somali region
SC-UK 09/03 Nutrition assessment in agro-pastoral areas of Erer, Shinile and Dambal districts, Shinile zone, Somali region
SC-UK 09/03 Nutrition assessment in pastoral areas of Ayshia, Shinile, Dembel districts, Shinile zone, Somali region
SC-UK 12/03 Nutrition assessment in Golo Oda woreda of East Haraghe zoneand Arere districts, Oromyia region
SC-US 11/03 Nutritional survey report, Meskan woreda, Gurahe zone, SNNPR
SC-US 11/03 Nutritional survey report, Mareko woreda, Gurahe zone, SNNPR
SC-US 12/03 Nutritional survey report, Dalocha woreda, Siliti zone, SNNPR
SC-US 12/03 Nutritional survey report, Lanfuro woreda, Silti zone, SNNPR
SC-US 02/04 Gode woreda, Gode zone, Somali region, nutrition survey report
USAID 08/04/04 Ethiopia: complex health/food insecurity emergency situation report #2
WFP 21/05/04 Emergency report n° 21
FEWS 19/03/04 Fews Kenya food security warning - 19 Mars 2004
FEWS 05/04/04 Monthly food security update
FEWS 06/05/04 Kenya food security report
IRC 12/03 Nutritional survey, children 6-59 months, Kakuma refugee camp, Kenya
OXFAM 02/04 Nutritional anthropometric survey and food security assessment, Turkana district Somalia
IRIN 25/05/04 IGAD warns Somali leaders as talks enter final phase
FSAU-FS 02/04 Food security report
FSAU-FS 03/04 Food security report
FSAU-FS 05/04 Food security report
FSAU-N 04/04 Nutrition update
FSAU-N 05/04 Nutrition update
AAH-US 09/03 Nutritional anthropometric survey, children under five year old, Gumriak payam, Ruweng county, Upper Nile
AAH-US 10/03 Nutritional anthropometric survey, children under five year old, Nyadin payam, Zeraf county, Central Upper Nile
AAH-US 10/03 Nutritional anthropometric survey, children under five year old, Nyadin boma, Mareang payam, Zeraf county, Central Upper Nile
AAH-US 11/03 Nutritional anthropometric survey, children under five year old, Mareang payam, Zeraf county, Central Upper Nile
AAH-US 11/03 Nutritional anthropometric survey, children under five year old, Atar, Alam Piji and Duk payams, Khorfulous county, Upper Nile
AAH-US 01/04 Nutritional anthropometric survey, children under five year old, Kapoeta payam, Kapoeta county, Eastern Equatoria
AAH-US 03/04 Nutritional anthropometric survey, children under five year old, Old Fangak payam, Zeraf county, Central Upper Nile
ACF 02/04 Nutritional anthropometric surveys, summary report, Wau town and camps
AFP 08/04/04 Sudan government, Darfur rebels sign ceasefire deal
AFP 25/05/04 Red Cross chief says access to Darfur improved but could still be better
AFP 24/05/04 WHO confirms ebola outbreak in south Sudan, four dead
GOAL 02/04 Kassala state, nutrition survey report, IDP camps and the Gargaf area
ICG 16/05/04 Sudan's Darfur: an international responsibility to protect
IRIN 19/05/04 Conflict in the south escalates ahead of peace deal
IRIN 21/05/04 Sudan: government to ease travel restrictions for Darfur
IRIN 28/05/04 Details of peace protocols signed this week
IRIN 28/05/04 New restrictions imposed on NGOs working in the south
MSF-H 04/04 Preliminary findings, food and nutrition survey, Wade Saleh and Mukjat provinces, West Darfur, North Sudan
OXFAM 25/05/04 Oxfam update on the situation in Darfur, Sudan
SC-UK 02/04 Kutum, nutrition survey report
UNCHR 07/05/04 Report of the UN high commissioner for human rights: situation of human rights in the Darfur region of the Sudan
UNICEF 19/05/04 UNICEF humanitarian action: Sudan - children affected by Darfur crisis
UNRC 20/05/04 Darfur crisis, Sudan: UN humanitarian situation report
UNRC 25/05/04 Darfur crisis, Sudan: UN humanitarian situation report
USAID 21/05/04 Darfur: humanitarian emergency fact sheet # 6 (FY 2004)
AFP 04/05/04 UN to cut aid to Sierra Leone refugees in Guinea at end of June
OCHA 20/02/04 OCHA Guinea humanitarian situation report n°1
URD 12/2003 Le projet qualité dans la région du golfe de Guinée
ACF-F 12/03 Evaluation nutritionnelle, sous préfecture de Bin Houye et Zouan Hounien, département de Danane
FAO/WFP 03/04 FAO/WFP crop and food supply assessment mission to Côte d'Ivoire
IRIN 25/03/04 Côte d'Ivoire: opposition parties suspend role in government
OCHA 17/05/04 Crisis in Côte d'Ivoire Situation report n° 27
UNSC 27/02/04 Security Council establishes peacekeeping operation in Côte d'Ivoire, unanimously adopts resolution 1528 (2004)
UNSC 13/05/04 Côte d'Ivoire: Letter dated 12 May 2004 from UN SG addressed to the SC President
WFP 21/05/04 Emergency report n° 21
GW 24/05/04 Liberia: back to the future
IRIN 12/05/04 Liberia: UNMIL says 26,000 disarmed so far
IRIN 21/04/04 Demobilisation in Liberia: cash payments to child ex-combatants misguided
OCHA 10/01/04 Liberia humanitarian update
OCHA 05/04 IDP return survey of official camps, Liberia, /UNHCR preliminary report
RI 21/04/05 Demobilisation in Liberia: Cash payments to child ex-combatants misguided
SC/ACF 11/03 Nutritional anthropometric survey, Montserrado camps, Liberia
UNHCR 17/05/04 Top story: UNHCR encourages Sierra Leoneans to go home as deadline approaches
UNHCR 18/05/04 Liberia: returnee population registration and verification begin
UNICEF 24/05/04 UNICEF humanitarian action donor update
VAM 11/03 Vulnerability assessment of Monrovia and its environments
WFP 11/03 Nutrition and retrospective mortality survey preliminary report, Monrovia and its environs
WFP 20/05/04 Food aid steadies first steps to peace in Liberia
WV 03/04 Health and nutrition survey, Bomi and Grand Cape Mount counties, Liberia
OCHA 12/05/04 Sierra Leone: humanitarian situation report Apr 2004
URD 12/2003 Le projet qualité dans la région du golfe de Guinée
AFP 06/05/04 After a decade of war, most of Burundi rediscovers peace
IRIN 14/04/04 Burundi: FAO, government report on refugee returnees
IRIN 15/04/04 East Africa: special report on repatriation of Burundian refugees
IRIN 17/05/04 Burundi: thousands more displaced in latest fighting
IRIN 17/05/04 Burundi-DRC: le HCR reloge des réfugiés congolais dans un camp plus sûr.
MSF 04/04 Burundi: vulnerable population deprived of healthcare
OCHA 14/05/04 Burundi: number of internally displaced in camps halved
RI 12/04/04 Burundi: Large-scale repatriation would threaten peace
RI 14/04/04 Refugees International raises protection concerns for Burundian refugees with the US Department of State
RI 28/04/04 Refugee voices: Burundian internally displaced women vulnerable to sexual exploitation
UNHCR 18/05/04 Burundi: repatriation from Tanzania - number remaining under 300,000
UNICEF 02/04 Analyse de la situation nutritionnelle Burundi
UNICEF 04/04 Analyse de la situation nutritionnelle Burundi
USAID 14/05/04 Burundi: complex emergency situation report #2 (FY 2004)
AAH-US 10/03 Enquête nutritionnelle anthropométrique, zone de santé de Moba et Kansimba, province du Katanga, DRC
AAH-US 11/03 Enquête nutritionnelle anthropométrique, zone de santé de Lemera, province du Sud-Kivu, DRC
AAH-US 11/03 Enquête nutritionnelle anthropométrique, zone de santé de Shabunda, province du Sud-Kivu, DRC
AAH-US 11/03 Enquête nutritionnelle anthropométrique, zone de santé de Nundu, province du Sud-Kivu, DRC
AAH-US 02/04 Enquête nutritionnelle anthropométrique, zone de santé de Basankusu, province d'Equateur, DRC
IRIN 31/05/04 DRC-Rwanda: Bukavu crisis task force set up
OCHA 30/04/04 Humanitarian situation in DRC monthly update Apr
CHA 21/05/04 Humanitarian situation in DRC 15-21 May 2004
WB 25/05/04 DR Congo: Emergency demobilization and reintegration project
ADEO 03/04 Nutrition, measles vaccination coverage and latrine coverage survey in Palorinya refugee settlements of Moyo district
Epicentre 01/04 Rapid assessment of the situation of internally displaced populations, Lira district, Uganda
FEWS 16/04/04 A monthly newsletter on food security and vulnerability in Uganda
GOAL 02/04 Findings of nutritional survey, Kalongo twon, Pader district, Norther Uganda
IRIN 28/04/04 Government allocate emergency funds for IDPs
OCHA 29/02/04 Humanitarian update Uganda Feb 2004 Volume VI, Issue II
OCHA 31/03/04 Humanitarian update Uganda Mar 2004 Volume VI, Issue III
OCHA 30/04/04 Humanitarian update Uganda Apr 2004 Volume VI, Issue IV
UNHCR 07/05/04 Aid on the way for displaced Sudanese refugees in Uganda
USAID 05/05/04 Uganda complex emergency situation #3 (FY 2004)
WFP/MOH/UNICEF 10/03 Nutrition and health assessment in the internally displaced persons camps in Gulu district
WFP/MOH/UNICEF 10/03 Nutrition and health assessment in the internally displaced persons camps in Pader district
WFP/MOH/UNICEF 10/03 Nutrition and health assessment in the internally displaced persons camps in Kitgum district
WFP 13/05/04 Huge numbers facing food shortages amid violence in northern Uganda
IRIN 14/05/04 Chad: militias are "out of control" cattle raiders
IRIN 20/05/04 Chad-Sudan: refugee influx puts strain on local population
IRIN 25/05/04 Chad-Sudan: refugee camps overcrowded as influx from Darfur escalates
FEWS 25/03/04 Rapport mensuel de la sécurité alimentaire au Tchad: situation précaire des réfugiés
MSF 11/05/04 Catastrophic conditions for Sudanese refugees in Chad
RI 05/05/04 Korfou, Chad update: WFP to organize urgent food shipments to the border area
RI 19/05/04 Chad: with rains looming, relief community must mobilize to assist Sudanese refugees
UNHCR 24/05/04 Urgence Darfour/Tchad
ACH 01/04 Relatorio inquerito nutricional, municipio de Caconda, Angola
ACH 02/04 Relatorio inquerito nutricional, municipio de Ganda, Angola
ACH 02/04 Food security situation, Caconda municipality
Amnesty 14/05/04 DR Congo/Angola: forced repatriation leaves thousands destitute and facing human rights abuse
CRS 04/04 Inquerito nutricional e cobertura vicinal, municipio de Cubal, Provincia de Benguela, Angola
FEWS 12/04/04 Fews Angola food security update 12 Apr 2004: warning - urgent action required
IRIN 20/05/04 Angola-DRC: Luanda announces 45-day suspension of expulsions
MSF-S 03/04 Nutritonal survey, IDP camps in Katjanguite and Fazemda Tomba-Matala, Huila province, Angola
MSF-S 03/04 Nutritonal survey, Matala, Huila province, Angola
MSF 29/04/05 MSF concerns about ongoing deportation of diamond miners confirmed by joint assessment
OCHA 30/04/04 Humanitarian situation in Angola monthly analysis Apr 2004
OCHA 07/05/04 DR Congo: conditions for expellees stabilizing
UNHCR 21/05/04 Angola: repatriation from Namibia resumes
WFP 06/05/04 Angolans return home to peace - and hunger
UNHCR/ICH07/03 Baseline micronutrient and nutrition survey report, Nangweshi refugee camp, Zambia
UNHCR/WHO 03/04 Refugee health in Zambia, joint UNHCR-WHO evaluation of health and health programmes in refugee camps in Zambia
BAAG 31/03/04 BAAG Afghanistan monthly review, March 2004
FEWS 03/04 FEWS Afghanistan monthly food security bulletin Feb 2004- wheat growing season underway
ACF-F 02/2004 Nutritional anthropometric survey, Badin district, province of Sindh, Pakistan
ACF-F 03/2004 Pakistan: situation nutritionelle inquiétante pour des populations de la province de Sindh
AFP 11/04/04 Close to 2,500 dead since end of Nepal truce: rights group
AMDA 08/01 Report of annual nutrition survey 2001
AMDA 06/02 Report of annual nutrition survey 2002
AMDA 06/03 Report of annual nutrition survey 2003
EC 2003 Conflict and food security in Nepal, a preliminary analysis
Field 10/98 Persistent micro-nutrient problems among Exchange refugees in Nepal
HRW 28/10/03 Nepal/Bhutan: bilateral talks fail to solve refugee crisis
ICRC 13/01/03 Népal: mission d'évaluation dans une zone de conflit
MOH/ORC 2001 Demographic and health survey in Nepal
Nepalnews 18/09/03 Pressure on cities
NRC 03/03 Training workshop on protecting IDPs and the UN guiding principles on internal displacement
NRC 10/10/03 Nepal: a hidden IDP crisis
RI 23/03/04 Forgotten people: the internally displaced people of Nepal
UNHCR/WHO 03/04 Refugee health in Nepal
WV 01-02/03 Rapid nutrition and food security assessment report, Mid-Western development region, Nepal
Four surveys were conducted in Anseba, Debub, Gash Barka and Northern Red Sea in December 2003. The samples were stratified multi-stage random samples. 1098, 1314, 1367 and 840 children were measured in Anseba, Debub, Garsh Bharka and Northern Red Sea, respectively. BMI was measured among women aged 18 to 60 years. The survey also estimated measles vaccination and vitamin A distribution coverage, and various food security indicators.
Dessie Zuria District, South Wollo zone
The survey was conducted by Concern in November 2003. A two-stage cluster sampling methodology of 30 clusters was used to measure 936 children between 6-59 months. The survey also estimated measles vaccination coverage and various food security indicators.
Kalu district, South Wollo zone
The survey was conducted by Concern in November 2003. A two-stage cluster sampling methodology of 30 clusters was used to measure1052 children between 6-59 months. The survey also estimated measles vaccination coverage and various food security indicators.
Tehuldere district, South Wollo zone
The survey was conducted by Development Studies Associate in December 2003. A two-stage cluster sampling methodology of 30 clusters was used to measure 923 children between 6-59 months. The survey also estimated measles vaccination coverage.
Golo Oda district, East Haraghe zone
The survey was conducted by SC-UK in December 2003. A two-stage cluster sampling methodology of 30 clusters was used to measure 915 children between 6-59 months. The survey also estimated retrospective mortality over the previous three months, measles vaccination coverage, morbidity and various food security indicators.
Meta and Kersa districts, East Haraghe zone
The survey was conducted by CRS in January 2004. A two-stage cluster sampling methodology of 30 clusters was used to measure 901 children between 6-59 months. The survey also estimated retrospective mortality over the previous three months, measles vaccination coverage, morbidity, and various food security indicators.
Gode district, Gode zone
The survey was conducted by SC-US in February 2004. A two-stage cluster sampling methodology of 50 clusters was used to measure 925 children between 6-59 months. The survey also estimated retrospective mortality over the previous three months, measles vaccination coverage, morbidity, and various food security indicators.
Patoral and agro-pastoral areas of Ayshia, Shinile, Dembel & Erer districts, Shinile zone
The surveys were conducted by SC-UK in October 2003. A two-stage cluster sampling methodology of 30 clusters was used. 893 and 898 children were measured in the pastoral and agro-pastoral areas, respectively. The survey also estimated retrospective mortality over the previous three months, measles vaccination coverage, morbidity, and various food security indicators.
Offa district, Wolaita zone
The survey was conducted by Concern in December 2003. A two-stage cluster sampling methodology of 30 clusters was used to measure 910 children between 6-59 months. The survey also estimated measles vaccination coverage, morbidity, retrospective mortality over the previous three months and various food security indicators.
Dalocha district, Silti zone
The survey was conducted by SC-US in December 2003. A two-stage cluster sampling methodology of 30 clusters was used to measure 904 children between 6-59 months. The survey also estimated retrospective mortality over the previous three months, measles vaccination coverage, morbidity, and various food security indicators.
Lanfuro district, Silti zone
The survey was conducted by SC-US in December 2003. A two-stage cluster sampling methodology of 30 clusters was used to measure 907 children between 6-59 months. The survey also estimated retrospective mortality over the previous three months, measles vaccination coverage, morbidity, and various food security indicators.
Meskan district, Gurahe zone
The survey was conducted by SC-US in November 2003. A two-stage cluster sampling methodology of 30 clusters was used to measure 942 children between 6-59 months. The survey also estimated retrospective mortality over the previous three months, measles vaccination coverage, morbidity, and various food security indicators.
Mareko district, Gurahe zone
The survey was conducted by SC-US in November 2003. A two-stage cluster sampling methodology of 30 clusters was used to measure 903 children between 6-59 months. The survey also estimated retrospective mortality over the previous three months, measles vaccination coverage, morbidity, and various food security indicators.
Shebedino district, Sidama zone
The survey was conducted by GOAL/SC-US/ACF in February 2004. A two-stage cluster sampling methodology of 30 clusters was used to measure 858 children between 6-59 months. The survey also estimated retrospective mortality over the previous three months, measles vaccination coverage, morbidity, and various food security indicators.
North Western zone and North Eastern zone, Turkana district
Two surveys, using a two-stage cluster sampling methodology of 30 clusters, were conducted by OXFAM, in North Western zone (Kakuma, Lokichoggio & Oropoi districts) and North Eastern zone (Kaaleng, Kibish, Lapur & Lokitaung districts) of Turkana district, in February 2004. 950 and 944 children were measured in each zone, respectively. The surveys also estimated measles vaccination coverage, vitamin A distribution coverage, mortality rates over the previous three months and various food security indicators. MUAC was measured among pregnant and lactating women aged 16-45 years.
Kakuma refugee camp
The survey was conducted by IRC in December 2003. A two-stage cluster sampling methodology of 30 clusters was used to measure 890 children between 6-59 months. The survey also estimated measles vaccination coverage, vitamin A distribution coverage and aneamia. Measurement of haemoglobin was performed directly in the household using a portable photometer ‘Hemocue AB-hemoglobin’ Photometer among 386 6-59 month-old children.
Kutum town, Kutum province, North Darfur
The survey was conducted by SC-UK in March 2004. A two-stage cluster sampling methodology of 30 clusters was used to measure 916 children between 6-59 months. The survey also estimated measles vaccination, morbidity and retrospective mortality rate.
Wade Saleh and Mukjar provinces, West Darfur
The survey was conducted by MSF-H in April 2004. A two-stage cluster sampling methodology of 30 clusters was used to measure 915 children between 6-59 months. The survey also estimated measles vaccination, morbidity and retrospective mortality rates over the previous 3 months.
Wau town and IDP camps
The survey was conducted by ACF in February 2004. A two-stage cluster sampling methodology of 30 clusters was used to measure 978 children between 6-59 months in Wau town. Exhaustive surveys were carried out in the camps where 474, 270, 373, and 34 children 6-59 months were measured in Eastern Bank camp, Bar Yar camp, Marial Agieh camp and Salvation camp, respectively. The survey also estimated measles vaccination coverage and retrospective under-five mortality rate.
IDP camps, Kassala state
The survey was conducted by GOAL in February 2004. A two-stage cluster sampling methodology of 30 clusters was used to measure 894 children between 6-59 months. The survey also estimated measles vaccination and vitamin A coverage, morbidity, and various food security indicators.
Old Fangak district, Central Upper Nile
The survey was conducted by AAH-US in March 2004. A two-stage cluster sampling methodology of 30 clusters was used to measure 750 children between 6-59 months. The sample only included villages situated within a 3 hours walk from AAH-US base. The survey also estimated measles vaccination coverage and retrospective mortality rate over the previous three months. MUAC was measured among the mothers.
Kapoeta district, Kapoeta county, Eastern Equatoria
The survey was conducted by AAH-US in January 2004. A two-stage cluster sampling methodology of 30 clusters was used to measure 761 children between 6-59 months. The sample only included villages situated within a 4 hours walk from Kapoeta town. The survey also estimated measles vaccination coverage and. MUAC was measured among the mothers.
Atar, alam, Piji and Duk districts, Upper Nile
The survey was conducted by AAH-US in November 2003. A two-stage cluster sampling methodology of 30 clusters was used to measure 917 children between 6-59 months. The sample only included villages situated within a 4 hours walk from Atak airstrip. The survey also estimated measles vaccination coverage and retrospective mortality rate over the previous three months. MUAC was measured among the mothers.
Mareang district, Central Upper Nile
The survey was conducted by AAH-US in November 2003. A two-stage cluster sampling methodology of 30 clusters was used to measure 900 children between 6-59 months. The sample only included villages situated within a 4 hours walk from the airstrips. The survey also estimated measles vaccination coverage and retrospective mortality rate over the previous three months. MUAC was measured among the mothers.
Nyadin district, Central Upper Nile
The survey was conducted by AAH-US in October 2003. A two-stage cluster sampling methodology of 30 clusters was used to measure 810 children between 6-59 months. The sample only included villages situated within a 4 hours walk from the airstrips. The survey also estimated measles vaccination coverage and retrospective mortality rate over the previous three months. MUAC was measured among the mothers.
Gumriak district, Ruweng county, Upper Nile
The survey was conducted by AAH-US in September 2003. An exhaustive survey was used to measure 453 children between 6-59 months. The survey also estimated measles vaccination coverage and retrospective mortality rate over the previous three months. MUAC was measured among the mothers.
Bin Houye and Zouan Hounien sous-préfecture, Danane department
The survey was conducted by ACF in December 2003. A two-stage cluster sampling methodology of 30 clusters was used to measure 1005 children between 6-59 months. The sample only included villages situated within a ten kms radius form the supplementary feeding centres. The survey also estimated measles vaccination coverage.
The survey was conducted by WFP/joint in November 2003. A two-stage cluster sampling methodology of 30 clusters was used to measure 867 children between 6-59 months. The survey also estimated measles vaccination coverage and mortality rates over the previous six months.
IDP camps, Monserrado county
Seven surveys were conducted by SC/ACF in November 2003. Systematic sampling methodologies were used to measure 425 children in Blamase camp, 407 childre in Jahtondo camp, 267 children in Perry camp, 398 children in Plumkor camp, 290 children in Saygbeh camp, 455 children in Ricks camp and 309 children in Wilson camp.
Bomi and Grand Cape Mont County
The survey was conducted by WV in March 2004. A two-stage cluster sampling methodology of 30 clusters was used to measure 632 children between 6-59 months. The survey also estimated measles vaccination coverage, vitamin A distribution coverage and mortality rates over the previous six months using the previous birth history methodology.
Nundu health zone, Fizzi area, South Kivu
The survey was conducted by AAH-US in November 2003. A two-stage cluster sampling methodology of 30 clusters was used to measure 900 children between 6-59 months. The survey also estimated measles vaccination coverage.
Shabunda, South Kivu
The survey was conducted by AAH-US in November 2003 and included Shabunda-Lungungu, Shabunda-Matili and Matili-Mugembe axes. A two-stage cluster sampling methodology of 30 clusters was used to measure 900 children between 6-59 months. The survey also estimated measles vaccination coverage.
Lemera, South Kivu
The survey was conducted by AAH-US in November 2003. A two-stage cluster sampling methodology of 30 clusters was used to measure 932 children between 6-59 months. The survey also estimated measles vaccination coverage.
Moba & Kansimba health zones, Katanga
The survey was conducted by AAH-US in October 2003. A two-stage cluster sampling methodology of 30 clusters was used to measure 900 children between 6-59 months. The survey also estimated measles vaccination coverage and mortality rates over the previous three months.
Basankusu health zone, Equateur
The survey was conducted by AAH-US in February 2004. A two-stage cluster sampling methodology of 30 clusters was used to measure 927 children between 6-59 months. The survey also estimated measles vaccination coverage and mortality rates over the previous three months.
Kalongo twon, Pader district
The survey was conducted by GOAL in February 2004. A two-stage cluster sampling methodology of 30 clusters was used to measure 890 children between 6-59 months. The survey also estimated measles vaccination coverage, mortality rates over the previous six months and various food security indicators.
Lira municipality, Lira district
The survey was conducted by Epicentre in January 2004.A systematic sampling was used to measure 533 children in 9 IDP settlements. The survey also estimated measles vaccination coverage, mortality rates over the previous nine months and various food security indicators.
Palorinya refugee settlements, Moyo district
The survey was conducted by ADEO in March 2004. A two-stage cluster sampling methodology of 30 clusters was used to measure 929 children between 6-59 months. The survey also estimated measles vaccination coverage.
Katjanguite & Fazenda Tomba IDP camps, Matala, Huila province
The survey was conducted by MSF-S in March 2004. A two-stage cluster sampling methodology of 30 clusters was used to measure 921 children between 6-59 months. The survey also estimated measles vaccination coverage and mortality rates.
Matala, Huila province
The survey was conducted by MSF-S in March 2004. A two-stage cluster sampling methodology of 30 clusters was used to measure 921 children between 6-59 months. The survey also estimated measles vaccination coverage and mortality rates.
Cubal municipality, Benguela province
The survey was conducted by CRS in April 2004. A two-stage cluster sampling methodology of 30 clusters was used to measure 900 children between 6-59 months. The survey also estimated vaccination and vitamin A distribution coverage and mortality rates over the previous three months.
Ganda municipality, Benguela province
The survey was conducted by ACH in February 2004. A two-stage cluster sampling methodology of 30 clusters was used to measure 957 children between 6-59 months. The survey also estimated measles vaccination and vitamin A distribution coverage and mortality rates over the previous three months.
Caconda municipality, Huila province
The survey was conducted by ACH in January 2004. A two-stage cluster sampling methodology of 30 clusters was used to measure 958 children between 6-59 months. The survey also estimated measles vaccination and vitamin A distribution coverage and mortality rates over the previous three months.
Nangweshi refugee camp, Western province
The survey was conducted by UNHCR/ICH in July 2003. Households were selected using a systematic random sampling method.
Measurement of haemoglobin was performed directly in the household using a portable photometer ‘Hemocue B-hemoglobin’ Photometer, utilising the azidemethemoglobin principle. Peripheral blood collection was collected from a finger prick made using a safety lancet (Hemocue). The first drop was allowed to form and wiped away using tissue paper. The second drop was then transferred into a Hemocue cuvette for the measurement of haemoglobin. The cuvette was filled from one drop using a continuous action and any blood was wiped away from the faces of the cuvette before immediate insertion into the photometer.
Cut-off Points for Defining Anaemia
|Age / sex group||Categories of Anaemia|
|(Haemoglobin levels (g/dl)|
|Children 6 - 59 months||<11.0||10.9 - 10.0||9.9 - 7.0||< 7.0|
|Children 6 - 11 years||<11.5||11.4 - 11.0||10.9 - 8.0||< 8.0|
|Children 12 - 14 years||<12.0||11.9 - 11.0||10.9 - 8.0||< 8.0|
|Adult males >15 years||<13.0||12.9 - 11.0||10.9 - 8.0||< 8.0|
|Adult females >15 years||<12.0||11.9 - 11.0||10.9 - 8.0||< 8.0|
|Pregnant Women||<11.0||10.9 - 10.0||9.9 - 7.0||< 7.0|
Vitamin A status was assessed by the measurement of serum retinol in finger-stick blood samples. Analysis was performed using High Performance Liquid Chromatography (HPLC). It is well known that vitamin A status can be affected by the presence of infection. This can lead to levels appearing to be lower than otherwise and can result in people with marginal status being falsely classified as deficient. To allow correction for this effect serum samples were analyzed for the presence of elevated levels of C-reactive protein (CRP) using a test involving antibody binding (ELISA). This protein is increased in the blood during trauma and infection and has been used previously to correct measured levels of vitamin A levels for the presence of infection. 10 mg/L was used as a cut-off point for the diagnosis of inflammation and retinol results was discarded from subjects with levels of 10 mg/L or higher.
Survey teams collected urine from consenting adolescents in 100 ml collection cups. The urine was then transferred from the collection cups into a 10 ml Monovette urine collection tube or and labelled with the appropriate identification number of the adolescent. Urine tubes were stored in plastic bags at 0 - 8 Celsius until the end of the day when they were transferred into 5 ml Nalgene cryovials and frozen at -20°C.
Urinary iodine was measured according to routinely used techniques. An AutoAnalyzer II method was used with automatic handling of the samples, digestion with strong acid, and quantified with the Sandell-Kolthoff colorimetric reaction.
Badin district, Sindh province
The survey was conducted by ACF in February 2004. A two-stage cluster sampling methodology of 30 clusters was used to measure 900 children between 6-59 months. The survey also estimated measles vaccination coverage and mortality rates over the previous seven months.
Bhutanese refugee camps
The surveys were conducted by AMDA in June 2002 and June 2003.A systematic sampling was used to measure 429 children in 2002 and 439 children in 2003. The surveys also estimated measles vaccination and vitamin A coverage, the prevalence of clinical signs of angular stomatitis and various food security indicators.
|AAH-USA||Action Against Hunger USA|
|ACF-F||Action Contre la Faim France|
|ACH-S||Action Contra El Hambre Spain|
|ADEO||African Development and Emergency Organisation|
|AFP||Agence France Presse|
|BAAG||British Agencies Aghanistan Group|
|BMI||Body Mass Index|
|CMR||Crude Mortality Rate|
|< 5 MR||Under-five Mortality Rate|
|CRS||Catholic Relief Service|
|DSA||Development Studies Associate|
|ENFS||Ethiopia Network on Food Security|
|FAO||Food & Agricultural Organization of the United Nations|
|FEWS||Famine Early Warning System|
|FSAU||Food Security Assessment Unit for Somalia|
|HRW||Human Rights Watch|
|ICG||International Crisis Group|
|ICH||Institute of Child Health|
|ICRC||International Committee of the Red Cross|
|IDP||Internally Displaced Person|
|IRC||International Rescue Committee|
|IRIN||International Regional Information Network|
|MOH||Ministry of Health|
|MSF||Médecins Sans Frontières|
|MSF-B||Médecins sans frontières - Belgique|
|MSF-H||Médecins sans frontières - Holland|
|MSF-S||Médecins sans frontières - Spain|
|MUAC||Mid-upper arm circumference|
|NRC||Norwegian Refugee Council|
|OCHA||Office for the Co-ordination of Humanitarian Assistance|
|SC-UK||Save the Children-UnitedKingdom|
|SC-US||Save the Children-United States|
|UNCHR||United Nations Commission on Human Rights|
|UNCT||United Nations Country Team|
|UNHCR||United Nations High Commission on Refugees|
|UNICEF||United Nations International Children’s Emergency Fund|
|UNRC||United Nations Resident Coordinator|
|UNSC||United Nations Security Council|
|UNSG||United Nations Secretary General|
|USAID||US Agency for International Development|
|WFP||World Food Programme|
|WHO||World Health Organization|
The methodology and analysis of nutrition and mortality surveys are checked for compliance with internationally agreed standards (SMART, 2002; MSF, 2002; ACF, 2002).
Most of the surveys included in the Reports on Nutrition Information in Crisis Situations are random sampled surveys, which are representative of the population of the targeted area. The Reports may also include results of rapid nutrition assessments, which are not representative of the target population but rather give a rough idea of the nutrition situation. In that case, the limitations of this type of assessments are mentioned.
Most of the nutrition survey results included in the Reports target children between 6-59 months but may also include information on other age groups, if available.
Detailed information on the methodology of the surveys which have been reported on in each issue, is to be found at the end of the publication.
Unless specified, the Reports on Nutrition Information in Crisis Situations use the following internationally agreed criteria:
No international consensus on a definitive method or cut-off to assess adult under-nutrition has been reached (SCN, 2000). Different indicators, such as Body Mass Index (BMI, weight/height2), MUAC and oedema, as well as different cut-offs are used. When reporting on adult malnutrition, the Reports always mention indicators and cut-offs used by the agency providing the survey.
In emergency situations, crude mortality rates and under-five mortality rates are usually expressed as number of deaths/10,000 people/day.
Prevalence of malnutrition and mortality rates are late indicators of a crisis. Low levels of malnutrition or mortality will not indicate if there is an impending crisis. Contextual analysis of health, hygiene, water availability, food security, and access to the populations, is key to interpret prevalence of malnutrition and mortality rates.
Thresholds have been proposed to guide interpretation of anthropometric and mortality results.
A prevalence of acute malnutrition between 5-8% indicates a worrying nutritional situation, and a prevalence greater than 10% corresponds to a serious nutrition situation (SCN, 1995). The Crude Mortality Rate and under-five mortality rate trigger levels for alert are set at 1/10,000/day and 2/10,000/day respectively. CMR and under-five mortality levels of 2/10,000/day and 4/10,000/day respectively indicate a severe situation (SCN, 1995).
Those thresholds have to be used with caution and in relation to contextual analysis. Trend analysis is also recommended to follow a situation: if nutrition and/or mortality indicators are deteriorating over time, even if not above threshold, this indicates a worsening situation.
In the Reports, situations are classed into five categories relating to risk
and/or prevalence of malnutrition.
The prevalence/risk is indirectly affected by both the underlying causes of malnutrition, relating to food, health and care, and the constraints limiting humanitarian response. These categories are summations of the causes of malnutrition and the humanitarian response:
The Reports on Nutrition Information in Crisis Situations have a strong public
nutrition focus, which assumes that nutritional status is a result of a variety
of inter-related physiological, socio-economic and public health factors (see
figure). As far as possible, nutrition situations are interpreted in line with
potential underlying determinants of malnutrition.
Action contre la Faim (2002) Assessment and treatment of malnutrition in
emergency situation. Paris : Action contre la Faim.
Médecins sans Frontières (2002) Nutritional guidelines.
SCN (2000) Adults, assessment of nutritional status in emergency affected population. Geneva: SCN.
University of Nairobi (1995) Report of a workshop on the improvement of the nutrition of refugees and displaced people in Africa. Geneva : SCN.
SMART (2002) www.smartindicators.org
Young (1998) Food security assessment in emergencies, theory and practice of a livelihoods approach.
The UN Standing Committee on Nutrition, which is the focal point for harmonizing nutrition policies in the UN system, issues these Reports on Nutrition Information in Crisis Situations with the intention of raising awareness and facilitating action. The Reports are designed to provide information over time on key outcome indicators from emergency- affected populations, play an advocacy role in bringing the plight of emergency affected populations to the attention of donors and humanitarian agencies, and to identify recurrent problems in international response capacity.
The Reports on Nutrition Information in Crisis Situations are aimed to cover populations affected by a crisis, such as refugees, internally displaced populations and resident populations.
This system was started on the recommendation of the SCN's working group on Nutrition of Refugees and Displaced People, by the SCN in February 1993. Based on suggestions made by the working group and the results of a survey of the readers, the Reports on Nutrition Information in Crisis Situations are published every three months.
Information is obtained from a wide range of collaborating agencies, both UN and NGOs. The Reports on Nutrition Information in Crisis Situations are put together primarily from agency technical reports on nutrition, mortality rates, health and food security.
The Reports provide a brief summary on the background of a given situation, including who is involved, and what the general situation is. This is followed by details of the humanitarian situation, with a focus on public nutrition and mortality rates. The key point of the Reports is to interpret anthropometric data and to judge the various risks and threats to nutrition in both the long and short term.
This report is issued on the general responsibility of the Secretariat of the UN System/Standing Committee on Nutrition; the material it contains should not be regarded as necessarily endorsed by, or reflecting the official positions of the UNS/SCN and its UN member agencies. The designations employed and the presentation of material in this publication do not imply the expression of any opinion whatsoever on the part of the UNS/SCN or its UN member agencies, concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries.
This report was compiled by Dr Claudine Prudhon of the UNS/SCN Secretariat
Sarah Philpot assisted in the editing.
Design concept: Marie Arnaud Snakkers
The chairman of the UNS/SCN is Catherine Bertini
The SCN Secretariat and the NICS Coordinator extend most sincere thanks to all those individuals and agencies who have provided information and time for this issue, and hope to continue to develop the excellent collaboration which has been forged over the years.
If you have information to contribute to forthcoming reports, or would like
to request back issues of the report, please contact:
Claudine Prudhon, NICS Coordinator,
UNS/Standing Committee on Nutrition
20, avenue Appia, 1211 Geneva 27, SWITZERLAND
Tel: +(41-22) 791.04.56, Fax: +(41-22) 798.88.91,
Funding support is gratefully acknowledged from CIDA and UNHCR.
This report was made possible through the support provided to the Food and
Nutrition Assistance (FANTA) Project by the Office of Program, Policy and
Management at the Bureau for Democracy, Conflict and Humanitarian Assistance and
the Office of Health, Infectious Diseases and Nutrition at the Bureau for Global
Health at the U.S. Agency for International Development, under the terms of
Cooperative Agreement No. HRN-A-00-98-00046-00 awarded to the Academy for
Educational Development (AED). The opinions expressed herein are those of the
authors and do not necessarily reflect the views of the US Agency for