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Nutrition in Crisis SituationsVol 3, August2004 Summary of the nutrition survey results Notes on the survey methodologies Indicators and risk categories HighlightsKenya—Drought emergency declared in 26 districts—The president of Kenya declared the current drought a "national disaster" and appealed for relief food assistance. Early cessation of rains in May has led to the wilting of crops and insufficient replenishment of pastures. Twenty-six of the 71 districts of Kenya are affected and 1.8 million people are considered in need of food aid. The most vulnerable households are found in Eastern province, Coastal province and in pastoral areas. Somalia—Poor performance of the Gu season and increase in food insecurity—The 2004 Gu cereal production is expected to be one of the three worst crops since 1995. Overall, the performance of the 2004 Gu season will be only 75% of the post-war average and 80% of the 2003 production. The highest deficits are recorded in Bakol, Lower Juba and Middle Juba. This will lead to food insecurity in south Somalia, in addition to the dire situation experienced in north and central Somalia for more than a year. Sudan—Dire situation in Darfur and situation of concern in Southern Sudan—Most of the assessment reports highlight the poor living conditions in the IDP camps and gatherings in Darfur, with a lack of adequate shelters, insufficient access to clean water, health care and sanitation. Although health care coverage has improved from 45-50% in May to 69% in July, it remains a serious concern. An outbreak of hepatitis E affected 2431 people and killed 41 between 22 May and 20 August 2004. Around 1.2 million people are estimated in need of food aid. There were 20 TFCs caring for 4,820 children and 24 SFPs where about 18,000 had been admitted as of end July 2004. A greater capacity for the care of malnourished children is needed. Blanket supplementary feeding programmes will also be implemented. Protection is a major issue; civilians, including IDPs, being targeted by violence. In Southern Sudan, the performance of the crop production is expected to vary depending on the area owing to drought in June-July, mitigated by good rains in August in some areas. In addition, insecurity, chronic food insecurity and the return of IDPs contribute to the precariousness of the situation. Chad—Appalling nutrition situation among the refugees in three northern camps and among the resident population— A nutrition survey was conducted in three camps, which were considered the most vulnerable (Irisimi, Touloum and Kounoungo) and an assessment was carried out in the Chadian villages surrounding the camps. The results showed dramatically high prevalence of acute malnutrition among both populations. Mobilisation of resources towards the refugee and the Chadian population is crucial for avoiding the crisis deteriorating. Ivory Coast—Contrasted nutrition situation — Eight nutrition surveys were conducted throughout the country between November 2003 and February 2004. In all the regions, acute malnutrition seemed higher in rural areas than in urban areas. The highest prevalence of acute malnutrition was recorded in the north of the country, especially in rural areas, where the rates of malnutrition were of concern. The prevalence of acute malnutrition was average in the south and in the rural areas of the centre, and was under-control in the urban areas of the centre and the west. Severe acute malnutrition was especially high in rural areas of the north, north-east and west of the country. Colombia—Food insecurity and micro-nutrient deficiencies— Colombia has been experiencing 40 years of civil unrest, which has led to the displacement of several thousands of people inside the country and in nearby countries. As of June 2004, 61% of the resident families and 88% of the displaced families in Puerto Asis municipality, Putumayo department earned less than the national minimum wage. Anaemia was found to be a problem of high significance in children. 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. Risk Factors affecting Nutrition in Selected SituationsSituations 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.
J Adequate Greater Horn of Africa
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| Regions | % change in cereal production: 2004 vs 2003 |
% change in cereal production: 2004 vs post war average |
| Bakol | +40% | -84% |
| Bay | -8% | -38% |
| Gedo | 0% | -38% |
| Hiran | +398% | -8% |
| Lower Juba | -87% | -89% |
| Lower Shabelle | -26% | -5% |
| Middle Juba | -63% | -83% |
| Middle Shabelle | +9% | +4% |
| Total | -20% | -25% |
A randomly sampled nutrition survey was conducted in May 2004 (FSAU, 05/04) following alarming reports about the food security and nutrition situation in the area (see RNIS 43, NICS 1 and NICS 2).
The poor households rely mostly on their own rain-fed production and on income through agricultural labour. The poor crop harvests over the past three years have increased the vulnerability of the population, whose coping mechanisms are insufficient to maintain adequate levels of food security.
The results of the survey showed a critical situation (table 2), with a high prevalence of malnutrition, and mortality rates well above emergency thresholds. The main presumed causes of under-five mortality were diarrhoea and kwashiorkor. Measles vaccination coverage was low, although vitamin A supplementation coverage was better.
The public health and food security situation was also poor (box 1).
Table 2 Acute malnutrition, Vitamin A supplementation and measles vaccination coverage, and mortality rates, Somalia, 2004 (FSAU, 05/04; FSAU/N, 07/04)
|
Date |
% Acute Malnutrition (95% CI) |
% Severe Acute Malnutrition (95% CI) |
Measles immunisation coverage (%)* |
Vitamin A supplementation within 6 months prior to the survey |
Crude Mortality (/10,000/day) | Under 5 Mortality (/10,000/day) |
|
Jilib riverine areas, Middle Juba |
||||||
| May 04 | 19.5 (17.0-22.2) |
3.7 (2.6-5.2) |
23.2 | 70.6 | 2.2 | 5.4 |
|
Sool plateau |
||||||
| June 04 | 13.7 (11.5-16.1) |
3.1 (2.1-4.5) |
73.0 | 57.8 | 0.9 | 2.9 |
According to a nutrition survey carried out in June 2004 in Sool plateau, the situation continues to be of concern (table 2) (FSAU/N 07/04). The nutrition situation seems stable compared to 2003, but under-five mortality rate seems on the rise. On the other hand, measles vaccination and vitamin A coverage have significantly improved. Around 11% of the mothers had a MUAC < 21 cm.
These results are a dilemma in terms of the assistance which has been provided in the area. The development of food and nutrition programmes may have mitigated the situation but their scale seems to have been insufficient to significantly improve the situation. At any rate, the humanitarian assistance has been identified for long time as insufficient to meet the needs (FSAU/FS, 03/04).
Box 1 Food security, public health and child feeding practices, Jilib riverine area, Middle Juba, Somalia (FSAU, 05/04)
| Food intake Dietary diversity Consumption of one-two food groups/day: 43% of the households Three food groups/day: 17% Four or more food groups: 40% Cereals were consumed by 91% of the families; sugar in tea by 61% of the families Food security Public health Disease in the previous 2 weeks Water Sanitation Child feeding practices |
From the FSAU survey in Jilib riverine areas:
Despite a cease-fire agreement signed in April 2004 between the government of Sudan and the two opposition forces (the Sudan Liberation Movement/Army (SLA) and the Justice and Equality Movement (JEM)), clashes and violence are still reported on the ground (DPA, 30/08/04). Protection is a major issue in Darfur; civilians, including IDPs, being targeted by violence (IRIN, 30/08/04).
On the 30th of July 2004, the UN Security Council passed a resolution demanding that the government of Sudan disarm the Janjaweed militia, accused of committing atrocities against civilians in Darfur (DPA, 30/08/04). According to HRW, Janjaweed camps were still active as of mid-August 2004 (HRW, 27/08/04). The UN also stated that the Sudanese government has failed to fully implement commitments (DPA, 01/09/04).
A hundred ceasefire monitors have been deployed by the African Union, together with about 300 troops to protect them. This strength is, however, far from sufficient to monitor the situation on the ground properly (DPA, 30/08/04).
Most of the assessment reports highlight the poor living conditions in the IDP camps and gatherings, with a lack of adequate shelters, insufficient access to clean water, health care and sanitation (OCHA, 25/08/04; SAB, 15/08/04; WV, 24/07/04). As of late July, it was estimated that only 47% of the affected population had adequate access to clean water and only 20% had access to latrines (OCHA, 25/08/04).
Although health care coverage has improved from 45-50% in May to 69% in July, it remains a serious concern. Moreover, it seems that IDPs may have difficulties in accessing health care because they have to pay fees (WV, 24/07/04).
An outbreak of hepatitis E affected 2431 people and killed 41 between 22 May and 20 August 2004 (WHO, 30/08/04). The most affected area is West Darfur.
Around 1.2 million people are estimated in need of food aid. WFP reached 82% of its target of 800,000 people in June and 95% of its target of 1 million beneficiaries in July 2004 (OCHA, 25/08/04). Logistical constraints and lack of capacity hamper the delivery of food aid. WFP has begun food airdrops to inaccessible locations. However, WFP only reached 35% of its target of 1.2 million beneficiaries in August (WFP, 27/08/04).
There were 20 TFCs caring for 4,820 children and 24 SFPs where about 18,000 had been admitted as of end July 2004 (OCHA, 25/08/04). A greater capacity for the care of malnourished children is needed. Blanket supplementary feeding programmes will also be implemented.
The availability of cooking fuel is also a major problem, because women fetching wood are being exposed to sexual violence (OCHA, 25/08/04; WV, 24/07/04).
According to a survey conducted by ACF-F in an IDP camp, near El Fasher, North Darfur where about 30,000 IDPs have settled since May 2004, the nutrition situation was extremely critical (table 3) (ACF-F, 06/04). Mortality rates were also very high (table 3). The main presumed cause of death amongst the under-five year olds was measles. Measles vaccination coverage according to cards and mothers' statements was only 52.8%. People received some non-food items when they arrived at the camp and they were entitled to food distributions.
A survey was done in Malha pastoral area, North Darfur in May 2004 (SC-UK, 05/04). The results were extremely worrying, especially regarding the nutrition situation. However, the under-five mortality rate was average (table 3). In this survey, only 1% of the children were from displaced families. This shows that resident populations are also at high risk. Indeed, the malnutrition rate has increased rapidly since the beginning of 2003, coinciding with the escalation of violence: the prevalence of malnutrition was 15.5% in April 2003 and had remained stable over the previous year, but rose to 25.0% in October 2003 and 33.4% in the current survey. The trading conditions for this pastoral population were unfavourable at the time of the survey and the area was cut off from external intervention between October 2003 and April 2004. At the time of the survey, neither general food distributions nor feeding centres were in place and the survey recommended that such programmes be implemented. The health system and access to water also needed to be supported and improved.
Two surveys carried out amongst internally displaced persons in Zalingei and Murnei, West Darfur (Epicentre/MSF, 06/04) also showed a serious situation (table 3). In Zalingei, as of May 2004, a lot of the families interviewed reported having received no food distributions, blankets or jerry cans: 56%, 68.3% and 80% respectively. In Murnei, the situation was slightly better with almost all the families having received food distributions, but 43% of the families did not own any blankets and 25% did not have jerry cans. Moreover, it was estimated that most of the shelters would not offer proper protection against the rain.
Table 3 Results of nutrition surveys, Darfur, Sudan, June 2004 (ACF-F, 06/04; Epicentre/MSF, 06/04)
|
Date |
% Acute Malnutrition (95% CI) |
% Severe Acute Malnutrition (95% CI) |
Measles immunisation coverage (%)* |
Crude Mortality (/10,000/day) |
Under 5 Mortality (/10,000/day) |
|
Abu Shok displaced camp, El Fasher, North Darfur |
|||||
| June 04 | 39.0 (34.5-43.6) |
9.6 (7.2-12.8) |
52.8 | 2.15 | 6.76 |
|
Malha, North Darfur |
|||||
| May 04 | 33.4 (28.9-37.8) |
5.4 (3.4-7.5) |
30.9 | - | 1.0 |
|
Murnei diplaced population, West Drafur |
|||||
| May04 | 20.6# (17.4-24.2) |
4.1# (3.1-5.6) |
85.6 | 3.4 | 1.6 |
| Zalingei displaced population, West Darfur | |||||
| May 04 | 23.4# (19.4-28.0) |
4.5# (2.8-7.0) |
90.3 | 2.2 | 1.8 |
# Including children with MUAC < 110 mm
* According to cards and mothers' statements
The performance of the crop production is expected to vary depending on the area owing to drought in June-July, mitigated by good rains in August in some areas (FEWS, 26/08/04). In addition, insecurity, chronic food insecurity and the return of IDPs contribute to the precariousness of the situation (FEWS, 26/08/04). There is a fear that the Darfur crisis is overshadowing the situation in south Sudan and that a humanitarian crisis could occur, should a high number of IDPs suddenly return to South Sudan (AFP, 30/08/04).
According to two randomly-sampled nutrition surveys carried out in Bhar el Ghazal and Upper Nile during the hunger-gap season, the nutrition situation was serious and the mortality rates were high (table 4) (AAH-US, 07/04; Concern, 07/04).
Table 4 Results of nutrition surveys, South Sudan, July 2004 (AAH-US, 07/04; Concern, 07/04)
|
Date |
% Acute Malnutrition (95% CI) |
% Severe Acute Malnutrition (95% CI) |
Measles immunisation coverage (%)* |
Crude Mortality (/10,000/day) |
Under 5 Mortality (/10,000/day) |
|
Aweil West and North Counties, Bahr el Gazal |
|||||
| July 04 | 23.8 (21.1-26.8) |
2.9 (1.9-4.2) |
46.2 | 0.38 | 3.2 |
|
Duk Payuel Payam, Duk county, Central Upper Nile |
|||||
| July 04 | 22.7 (18.9-27.0) |
4.1 (2.5-6.5) |
53.2 | 1.36 | - |
* According to cards and mothers' statements
The humanitarian situation is still of great concern in Darfur (category I). In Southern Sudan, the situation is still critical (category II).
After several months of stalemate, it seems that the "Forces Nouvelles", which controls the north of the country, and the President of Ivory Coast have renewed their commitment to the peace process. An agreement which aims at consolidating the implementation of the Linas-Marcoussis peace process was signed in Accra on the 30 July 2004 (Accra SC, 31/07/04). Three ministers (one of whom is the leader of the "Forces Nouvelles"), who were sacked by President Laurent Gbagbo in May, have been re-appointed to their charges and a cabinet meeting was held for the first time in months (AFP, 09/08/04). Meanwhile, there is still violence in parts of the country and especially in the west and north (OCHA, 12/07/04; OCHA, 27/07/04).
Eight nutrition surveys were conducted throughout the country between November 2003 and February 2004 (MOH/UNICEF, 06/04). The results of the nutrition survey carried out in the west of the country were reported in NICS 1 but are also included in the present issue to allow comparison with the other regions surveyed. A further survey is planned in Abidjan.
At national level, the prevalence of acute malnutrition among 0 to 59 month-old children was 5.6% (4.3-7.3) and 9.0 % (7.9-10.2) in urban and rural areas, respectively. They are similar to the rates of malnutrition recorded in 1998/99 in urban (excluding Abidjan) and rural areas (DHS, 1998/99): 7% and 8.5% respectively.
Stunting was higher in rural areas (27.7% (26.0-29.5)) than in urban areas (15.2 (15.4-20.8)). When compared to the results of the 1998/99 survey, stunting was within the same range in rural areas, but was lower in the present survey than in 1998/99 when stunting in urban areas (excluding Abidjan) was 27.9%.
The proportion of women having a BMI < 18.5 was 6.4% in urban areas and 8.1% in rural areas and was similar to the 1998/99 survey results (6.5% and 9.5% in urban and rural areas, respectively). On the other hand, a significant proportion of women were overweight (BMI > 25): 25.5% and 13.9% in urban and rural areas, respectively.
At regional level, the results showed contrasting nutrition situations, depending on the area (figures 2 & 3). In all the regions, acute malnutrition seemed higher in rural areas than in urban areas. The highest prevalence of acute malnutrition was recorded in the north of the country, especially in rural areas, where the rates of malnutrition were of concern. The prevalence of acute malnutrition was average in the south and in the rural areas of the centre, and was under-control in the urban areas of the centre and the west . Severe acute malnutrition was especially high in rural areas of the north, north-east and west of the country.
Figure 2 Prevalence of acute malnutrition in urban areas, Ivory Coast, Nov 2003-Feb 2004 (MOH/UNICEF, 06/04)
Figure 3 Prevalence of acute malnutrition in Rural areas, Ivory Coast, Nov 2003-Feb 2004 (MOH/UNICEF, 06/04)
Chronic energy deficiency measured in women varied between 3.6 and 10.2% and also seemed higher in rural areas (table 5). The proportion of women having a visible goitre was especially high in the northern rural area (table 6).
According to the mothers' statements, a higher proportion of children have been vaccinated against measles or have received vitamin A supplementation, since the beginning of the crisis, in the centre and southern regions than in the north and west (table 6). This is in line with the fact that, whilst the MOH is still active in the centre and south of the country, there has been disruption in health care in the north and west.
In none of the regions surveyed, were the source of water and the sanitary conditions affected by the crisis. Potential changes in the quality and available quantity of water were not investigated.
Table 5 Chronic Energy Deficiency among non-pregnant women, Ivory Coast, Nov 2003-Feb 2004 (MOH/UNICEF, 06/04)
| URBAN | RURAL | ||
| Chronic Energy Deficiency BMI < 18.5 (%) |
Severe Chronic Energy Deficiency BMI < 16 (%) |
Chronic Energy Deficiency BMI < 18.5 (%) |
Severe Chronic Energy Deficiency BMI < 16 (%) |
| West | |||
| 8 | 1.5 | 9.5 | 1.6 |
| North | |||
| 6.7 | 1.3 | 9.5 | 1.1 |
| North-west | |||
| 9.6 | 0.3 | 10.2 | 1.3 |
| Centre | |||
| 5.6 | 0.6 | 10.0 | 1.4 |
| North-east | |||
| 7.5 | 0.5 | 8.6 | 0.7 |
| Centre-west | |||
| 3.6 | 0.9 | 5.4 | 0.3 |
| South-east | |||
| 6.7 | 0.5 | 8.1 | 0.9 |
| South | |||
| 7.3 | 1.2 | 7.5 | 0.4 |
Table 6 Measles vaccination, vitamin A supplementation and presence of goiter, Ivory Coast, Nov 2003-Feb 2004 (MOH/UNICEF, 06/04)
| URBAN | RURAL | ||||
| Children having received measles vaccination since the beginning of the crisis (%) |
Children having received vitamin A supplementation since the beginning of the crisis (%) |
Mothers having a visible goitre |
Children having received measles vaccination since the beginning of the crisis (%) |
Children having received vitamin A supplementation since the beginning of the crisis (%) |
Mothers having a visible goitre |
| West | |||||
| 9.0 | 7.5 | 5.4 | 2.9 | 2.3 | 4.5 |
| North | |||||
| 26.4 | 21.4 | 4.1 | 10.4 | 5.0 | 12.3 |
| North-west | |||||
| 33.4 | 12.9 | 4.6 | 15.4 | 8.1 | 3.3 |
| Centre | |||||
| 59.4 | 73.1 | 3.3 | 40.2 | 27.4 | 2.2 |
| North-east | |||||
| 31.4 | 8.9 | 3.3 | 18.4 | 6.9 | 2.8 |
| Centre-west | |||||
| 43.6 | 47.7 | 5.9 | 46.3 | 49.8 | 3.7 |
| Southeast | |||||
| 40.9 | 38.8 | 3.6 | 35.4 | 39.8 | 4.7 |
| South | |||||
| 45.6 | 35.2 | 2.5 | 37.9 | 43.5 | 4.7 |
The percentage of displaced families interviewed during the surveys was the highest in the urban centres of the west, centre-west and north regions (table 7).
The west of the country seemed to have been especially affected by the crisis (see NICS 1): fewer people had a permanent work since the beginning of the crisis; fewer families could rely on food production as their main source of food; the number of meals significantly decreased as well as the budget allocated to food purchase, which was about 45% lower at the time of the survey than before the crisis. Only around 6-8% of the families received food distribution (table 8).
On the other hand, the main source of income and the main source of food seemed little affected in the south, south-east, centre-west and north-east of the country.
In the north and north-west, there has been a significant reduction in the proportion of families having a permanent job, and the expenses allocated to food decreased by about 25% compared to before the crisis.
In the centre, permanent work as the main source of income dramatically decreased in urban areas (from 73% before the crisis to 48.5% at the time of the survey). On the other hand, more than 60% of the urban population received food distributions (table 8) and the budget allocated to the food expense only decreased by 10%.
Table 7 Percentage of displaced families, Ivory Coast, Nov 2003-Feb 2004 (MOH/UNICEF, 06/04)
| Percentage of displaced families | |
| Urban | Rural |
| North | |
| 8.4 | 4.6 |
| North-west | |
| 3.0 | 1.7 |
| North-east | |
| 5.3 | 3.9 |
| South-east | |
| 5.9 | 2.4 |
| South | |
| 6.0 | 1.0 |
| Centre | |
| 1.8 | 6.6 |
| Centre-west | |
| 15.1 | 4.8 |
| West | |
| 21.6 | 4.1 |
Table 8 Percentage of families having received food distribution, Ivory Coast, Nov 2003-Feb 2004 (MOH/UNICEF, 06/04)
| Percentage of families having received food distribution | |
| Urban | Rural |
| North | |
| 2.1 | 2.0 |
| North-west | |
| 3.0 | 1.7 |
| North-east | |
| 7.1 | 2.3 |
| South-east | |
| 3.5 | 3.1 |
| South | |
| 4.3 | 2.8 |
| Centre | |
| 68 | 14.3 |
| Centre-west | |
| 8.1 | 4.3 |
| West | |
| 8.5 | 6.4 |
Exclusive breast-feeding was low: 4.6% in urban areas and 3.1% in rural areas. Adequate complementary feeding for the 6-9 month olds was 78.6% in the urban areas vs. 67% in the rural areas. 78% and 84% of the 12-15 month olds were still breastfed in urban and rural settlings, respectively.
The nutrition and food security situation seems average to precarious (category II/III) in Ivory Coast with the northern and western parts of the country seeming more vulnerable.
The security situation has improved in most of the country owing to the deployment of the UNMIL forces, but some pockets of insecurity remain, especially along the border areas (AAH, 16/08/04).
The Disarmament and Demobilisation process has continued smoothly over the last months. Some 60,000 ex-combatants have been disarmed since December 2003 (OCHA, 30/07/04).
Little of the US$ 540 million which was pledged at a donor conference in February 2004 has been released so far (OCHA, 01/07/04). As of August 2004, WFP was facing acute food shortages: no pulses were available and therefore the distributed food ration was cut from the full 2,100 Kcal/pers/day to 1,531 Kcal/pers/day. Beneficiaries from WFP programmes include 317,000 IDPs, 72,300 school children, 19,900 vulnerable people and some 60,000 ex-combatants (OCHA, 06/08/04). It is also feared that there will be a major break in cereal stocks from September 2004, unless new contributions are made (OCHA, 13/08/04). On the other hand, Liberia got US$ 24.3 million from the global fund for programmes on AIDS, tuberculosis and malaria (UNDP, 17/06/04).
There has been concern about trading of food rations between refugees in Guinea and Liberia (IRIN, 22/07/04). On the other hand, some people thought that this trading may help Liberians in districts near the border, who are especially vulnerable, to access food. It also seems that some refugees criss-cross the border with Liberia. The situation is tense in Guinea camps, with riots against attempts to update refugee figures.
According to a vulnerability analysis carried out in Totota, Salala and Kakata towns and in three IDP camps (Maimu 1, Salala and Conneh) in Bong and Margibi counties, it seems that the nutrition situation was under control with a prevalence of acute malnutrition at 3.3% (2.0-6.7) (WFP/VAM, 05/04). However, people were vulnerable to food insecurity. About 20% were thought to be very vulnerable in both towns and camps: they had no assets and no access to land; they had, at best, one source of income; they spent more than 70% of their income on food and had only one inadequately balanced meal a day. About 60% and 68% of the households were potentially vulnerable in towns and camps, respectively. They had few assets and a small garden; they had below 3-4 sources of income; they spent between 65-70% of their income on food and they had 1-2 meals a day with a minimal diet.
The programme of voluntary repatriation of Sierra Leonese refugees was completed at the end of July 2004, after about 178,000 refugees were repatriated and 92,000 returned on their own to Sierra Leone (UNHCR, 21/07/04). It is estimated that about 15,000 refugees have chosen to integrate locally.
The security council adopted a resolution to authorise the deployment of the United Nations Operation in Burundi (ONUB) for an initial period of six months (UNSC, 21/05/04). ONUB will consist of a maximum of 6,650 troops and be authorised to use all necessary means to ensure respect for cease-fire agreements; to carry out the disarmament, demobilisation and reintegration process; to monitor the illegal flow of arms across national borders; to contribute to the creation of the necessary security conditions for the provision of humanitarian assistance; to facilitate the voluntary return of refugees and IDPs; and to contribute to the successful completion of the electoral process.
The FDD (Forces for the Defence of Democracy) became a political party at the beginning of August 2004 (OCHA, 15/08/04). The situation is still tense in Bujumbura Rural province, the stronghold of the FNL (National Liberation Forces) (OCHA, 27/06/04).
As of 15 August 2004, around 67,400 refugees had been repatriated from Tanzania so far this year and an estimated 4,200 had returned on their own (OCHA, 15/08/04).
Following the upsurge in violence in Bukavu at the beginning of June 2004, thousand Congolese sought refuge in Burundi. As of 20 August 2004, it was estimated that 20,000 refugees were settled in three transit camps near the DRC border (UNHCR, 20/08/04).
On 13 August, the Gatumba transit centre was attacked and 160 Tutsi refugees were killed and more than 100 wounded (OCHA, 15/08/04). The FNL has claimed responsibility for the massacre. It is thought that an armed group from DRC also participated in the killing (Reuters, 19/08/04). The border with DRC was officially closed and more UN peace keepers have been deployed on the border and near the refugee transit centres (UNHCR, 17/08/04). The tension between Burundi, Rwanda and the DRC has escalated following the slaughter (AFP, 17/08/04).
Two camps will be settled further inland in Muramvya and Rutana provinces and refugees will be transferred from the border (UNHCR, 20/08/04).
An assessment was conducted between March and May 2004 (UNICEF/WHO, 05/04). The mission major findings were:
The peace process has suffered a significant setback over the last months. At the beginning of June, renegade former RCD (Rally for Democracy) soldiers mutinied against the army in Bukavu (USAID, 20/08/04). This was the beginning of a two-month wave of violence in Bukavu and in Kahele region, south Kivu, which has led to the displacement of an estimated 35,000 people within DRC and of 20,000 people who fled to Burundi (OCHA, 31/07/04). The humanitarian activities were suspended for about two months.
In Mahagi territory, Ituri district, at least 35,000 people have been displaced owing to violence during July 2004 (OCHA, 31/07/04).
In addition, on the political front, the RCD has suspended his participation in the transitional government and in the parliament (AFP, 23/08/04).
The International Crisis Group has called for a greater commitment by the international community to the resolution of the DRC's crisis (ICG, 24/08/04).
WHO has announced a resurgence in major epidemics, such as measles, cholera, meningitis and plague (AFP, 12/08/04).
Because of sporadic rains during the main cropping season (May-June), Uganda may experience a 30% decrease in maize production this year (FEWS, 26/07/04). IDPs will especially suffer from these poor rains as well as the Karamoja region because of its uni-modal cropping season. It is thought that the rest of the Ugandan population will be little affected. However, it seems that there were heavy rains at the beginning of August, which may mitigate the situation.
The security situation continues to be volatile with sporadic attacks of the Lord's Resistance Army (LRA) on IDP camps. About 1.6 million people are still displaced and mostly depend on food aid. However, WFP will face a 34,000 MT food shortage from August if no further funds are received (WFP, 06/08/04). The government of Uganda, in partnership with the FAO, has begun supporting agricultural production in the north: distributing agricultural implements (Xinhua, 29/07/04). However, the limited access to land due to insecurity is a major constraint to agricultural production.
Since the visit of the UN's Emergency Relief Coordinator in Uganda, there has been more commitment from the UN agencies and the donors to the crisis, such as the opening of more UN agencies' offices in the north and more funds allocated (NRC, 06/07/04). However, according to NRC, no tangible improvement in security or humanitarian situation has yet occurred.
A random-sampled nutrition survey was conducted in Gulu IDP camps in June 2004 (AAH-US, 06/04). The results showed an acceptable nutrition situation which has been stable over the last years (figure 4). Crude mortality rate (1.2/10,000/day) was however above alert threshold.
Figure 4 Prevalence of acute malnutrition, IDP camps, Gulu district, Northern Uganda
In Gulu district, there are two TFCs, caring for some 30-50 children a month and 16 SFCs where 2,300 children were registered in May 2004.
According to cards and mothers' statements, 97% of the children were vaccinated against measles. Although the food security situation is fragile, IDPs receive general food distributions and are engaged on small-scale agricultural activities; they have also access to income generating activities (box 2) (WFP, 04/04).
During the nutrition survey, the under-six month olds who were in the families selected for the 6-59 month olds' survey were also measured. The results are not representative but give some indications. Seventy infants were surveyed; two infants, who were twins, measured less than 49 cm and weighed 2.2 and 2.8 kg, respectively: they were considered malnourished. None of the other infants surveyed were acutely malnourished. All infants were breast-feeding and 87% did not receive other food; eight of the nine infants receiving complementary food were aged four months or above.
Box 2 Sources of food and sources of income, Gulu IDP camps, Uganda (WFP, 04/04)
| Sources of food* Food distribution: 96% Purchase: 82% (expenditure on food = 38% of total household expenditure) Own crop: 53% Labour exchange: 31% Gathering: 15% Sources of income* Limited access to land* |
*100 families interviewed in ten camps and focus group discussion
According to a random-sampled nutrition survey conducted in Kalongo town (including resident and displaced population) in July 2004, the nutrition situation was average (GOAL, 07/04) and seems to have improved compared to the same period last year (figure 5). However, mortality rates were well above alert thresholds: CMR=1.7 deaths/10,000/day and <5MR=3.3 deaths/10,000/day. The main presumed causes of under-five mortality were fever/malaria and candidiasis.
The proportion of households which cultivated during the 2004 crop season was higher than
at the same time in 2003: 65.4% vs. 29%. The percentage of households using an unprotected source of water has remained stable since August 2003 and represented about one third of the families.
Figure 5 Acute malnutrition, Kalongo town, Pader district, Northern Uganda
Sudanese refugees still face dire conditions in Chad. As of August 2004, there were an estimated 180,000 refugees in Chad (WFP, 30/07/04) and a new wave of about 500 people poured into the country at the beginning of August (UNHCR, 17/08/04).
Two additional camps (Oure Cassoni and Djabal) have been opened in the last two months, bringing the number of camps to nine (see map). Around 142,000 refugees were settled in camps as of late July 2004 (UNHCR, 30/07/04). The opening of two more camps was planned firstly, to help to relieve the pressure on some of the camps which are overcrowded, such as Breidjing camp, where 36,000 are settled in a camp with a capacity of 25,000, and, secondly, to move refugees from spontaneous settlements at the border to camps (UNHCR, 06/08/04).
Refugee camps, Chad, August 2004
The very typology of the region renders the living conditions of the refugees and the delivery of aid extremely difficult. The scarcity of water resources hampers the establishment of refugee camps and limits refugees' access to water (UNHCR, 30/07/04). The poor road conditions, especially during the rainy season (which will end by mid-September), and the vastness of the area where refugees are settled, cause difficulties in delivering aid. However, it seems that humanitarian aid has scaled up, with France providing military airlifts to fly relief supplies (IRIN, 02/08/04) and more agencies being involved in aid delivery. UNHCR has increased its budget for the Chad crisis from US$ 20 million to US$ 55.8 million (UNHCR, 11/06/04). As of 10 August 2004, funding amounted to US$ 45,800 (UNHCR, 10/08/04).
Meanwhile, security conditions have deteriorated. There have been several cross-border incursions from Sudan into Chad over the last months (HRW, 22/06/04). France has deployed 200 of its troops based in Chad to secure the border (IRIN, 02/08/04). Tensions between refugees and aid agencies in Breidjing and Farchana camps, have led to two deaths owing to clashes with local security forces, and to a temporary withdrawal of aid agencies from the camps (AFP, 25/07/04). There have also been reports of harassment of refugees and the host population and of attacks on NGO vehicles by unidentified armed groups (WFP, 09/07/04).
An outbreak of hepatitis E has been reported in Goz Amer camp (WHO, 19/08/04). Between June 26 and August 13, 672 cases and 21 deaths were reported. The outbreak is thought to be related to an insufficient supply of clean water and to poor sanitary conditions.
A joint survey (CDC UNHCR/WFP/UNICEF/MOH) conducted in three camps in the north of Biltine prefecture revealed that watery and bloody diarrhoea were the major diseases and causes of death among the 6-59 month-olds (CDC, 06/04). Whilst almost all the refugees derived their water from a water bladder with tap, only 32.6% of the refugees had access to latrines. The quantity of safe drinking water available per refugee and per day was not investigated. At the time of the survey, only 13.6% of the refugees reported having soap at home. However, it seems that access to water and sanitation has recently improved in the camps (IRIN, 13/08/04).
The same study carried out in refugee settlements near the border, showed that about 30% of the refugees relied on rivers, open water and dams and that about half of them needed more than five hours to get water. None had access to latrines and almost none of them had shelter. Only 15% had soap in the house.
Joint random-sampled nutrition surveys (CDC/UNHCR/WFP/UNICEF/MOH) were conducted in three camps, which were considered the most vulnerable (Irisimi, Touloum and Kounoungo) and among spontaneous refugee settlements at the border (Bahai and Cariari). Most of these refugees have since been relocated to camps.
The results showed dramatically high prevalence of acute malnutrition (table 9). On the other hand, mortality rates were average in the refugee settlements but were higher in the refugee camps (table 9). The fact that crude mortality was higher than under-five mortality may be explained by the high number of war-related deaths among the more than five year-olds.
At the time of the survey, there was one therapeutic feeding centre at the Iriba hospital caring for 150-170 children referred from Irimi and Touloum camps and from the frontier settlements and one TFC at the Guereda hospital serving Kounoungo camp, but there were no TFCs at camp sites. Supplementary feeding programmes were established in Iridimi and Touloum camps.
Following the survey, a joint UNHCR/WFP assessment endorsed the establishment of blanket feeding programmes for under-fives, and pregnant and lactating women (IRIN, 13/08/04).
In the refugee camps, according to cards and mothers' statements, 83.1% of the children had been vaccinated against measles within the six months prior to the survey and 61.1% had received vitamin A.
Most of the refugees (99.4%) reported having received food rations over the six months prior to the survey. The percentage of families who received a food distribution increased from March (65.9%) to May (98.3%). However, it seems that the ration received decreased in June 2004. Most of the families (91.7%) were able to cook food at home. About 17% of the families reported selling part of the ration. Only two families said they were relying on their own production for food.
Table 9 Prevalence of acute malnutrition and mortality rates among Sudanese refugees in Chad, June 2004 (CDC/joint, 06/04)
| % Acute Malnutrition (95% CI) |
% Severe Acute Malnutrition (95% CI) |
Crude mortality rate (/10,000/day) |
Under-five mortality rate (/10,000/day) |
| Irisimi, Touloum and Kounoungo refugee camps | |||
| 35.6 (30.9-40.3) | 5.5 (3.1-7.9) | 1.56 (1.44-1.67) | 1.46 (1.3-1.62) |
| Bahai and Cariari refugee border settlements | |||
| 39.2 (34.3-44.2) | 6.4 (4.0-8.8) | 0.62 (0.53-0.7) | 0.44 (0.31-0.57) |
It seems that the nutrition situation was more stable in the southern camps with a low number of admissions to TFCs and SFCs.
The joint (CDC/UNHCR/WFP/UNICEF/MOH) survey also investigated the nutrition situation in the Chadian villages surrounding the camps (CDC, 06/04). Because of non-availability of population figures, a convenience sampling was used. 35% of the children surveyed were acutely malnourished, including 3.7% severely malnourished. Only 32.5% of the children had been vaccinated against measles within the six months prior to the survey and 26.6% had received vitamin A. Diarrhoea and bloody diarrhoea were the main diseases. The majority of the families were sourcing their water from open wells and 82.6% of the families had soap in the house.
Most households reported sharing water and food with refugees. This has led to an increase in the distance for fetching water (the median number of hours for fetching water was 2 last year, compared to 3 this year) and to a reduction in availability of food and water. About 25% of the Chadian families reported giving charity to the refugees, whilst 62% reported employing refugees against food.
Both the refugees and the Chadian population in the area of refugee settlements are facing a dire situation. Refugees in the north of the area seem especially at risk (category I), whilst the situation seems more stable in the southern camps. Mobilisation of resources towards the refugee and the Chadian population is crucial for avoiding the crisis deteriorating.
From the CDC/UNHCR/WFP/UNICEF/MOH survey:
For refugees:
In villages:
Two years after the signing of the peace agreement, macro-economic indicators and transparency, especially regarding oil revenues, have improved, but the overall economic and infrastructure situation is still weak and funding to allow a smooth stabilisation of the country is lacking. The rate of inflation declined by 50% in 2003 and the GDP grew by about 3.5 % (IMF, 21/07/04). The number of people in need of food aid at the beginning of 2004 decreased by 33% compared to last year, but one million people were still estimated food insecure between November 2003 and April 2004, with returnees being the most vulnerable and making up 60% of the people in need of food aid (OCHA, 30/06/04). However, WFP has been experiencing food shortages for several months and therefore has reduced the rations distributed (see NICS 2). Only 24% of the WFP's return and resettlement programme was funded as of late July 2004, whilst UNHCR repatriation programmes from Namibia, Zambia and DRC resumed in May/June 2004 (UNHCR, 06/07/04). Unless new contributions are received, no distribution will be conducted during the hunger gap season, beginning in September (WFP, 30/07/04).
The 2003/2004 agricultural season has been doing well generally, with 90% of families cultivating more land compared to the previous year. However, adverse climatic conditions have jeopardised food security in the central highlands and in the south east (OCHA, 30/06/04).
Landmines are still an issue and limit the population's movement and access to lands (OCHA, 30/06/04).
The public health situation is of concern, with pipeline breaks in essential medicines in Moxico, Bie, Kuando Kubango, Huila, Benguela and Luanda Norte (OCHA, 30/06/04). The capacity of health staff is also still limited. Moreover, the lack of funding obliged NGOs to hand medical structures over to the MOH, despite a concern of lack of capacity. The same pattern is observed for nutrition centres (see below) (OCHA, 30/06/04).
The maps show the coverage of the TFCs and SFCs (UNICEF-A, 05/04). As of March 2004, there were 20 TFCs managed by 78 MOH
staffs trained in the management of severe malnutrition according to national protocols, and four TFCs managed by NGOs. In 2003/2004, twelve TFCs were handed over by NGOs to the MOH and one TFC was closed. During the same period, ten SFCs managed by NGOs closed, 18 were handed over to the MOH and 14 SFCs were opened by the MOH (UNICEF-A, 05/04). As of March 2004, there were 33 and 10 SFCs managed by the MOH and NGOs, respectively.
The number of children registered in the SFCs has been stable since July 2003, remaining around 10,000. On the other hand, the number of admissions to TFCs seems to have been lower in late 2003/beginning 2004 than in late 2002/beginning 2003. In particular, the number of admission has only slightly increased during the hunger-gap season, compared to previous years (figure 6). This may be explained either by a better food security situation or by the fact that the quality of care in the TFCs has decreased since mid-2003, discouraging people to bring their children to the centres. Indeed the rates of mortality and absconding have increased from less or around 10 % before mid-2003 to more than 10% with peaks at about 15% thereafter (UNICEF-A, 05/04). This may be partly explained by the decrease of the staff-patients ratio which is of 1:20-25 in TFCs managed by the MOH and which was probably higher when the TFCs were managed by NGOs.
Figure 6 Number of admission to therapeutic feeding centres, Angola (UNICEF-A, 05/04)
Child-growth monitoring is part of the National Nutrition Programme and aimed to be further developed (OCHA, 30/06/04). As of March 2004, 330 health facilities were running growth monitoring and 43% were providing regular and reliable reports (see map) (UNICEF-A, 05/04). According to these reports, 7% and 3.3% of the children who were measured were moderately and severely malnourished, respectively, in February 2004 (UNICEF-A, 05/04).
TFC coverage by municipality, Angola, May 2004 (UNICEF-A, 05/04)
SFC coverage by municipality, Angola, May 2004 (UNICEF-A, 05/04)
Growth monitoring coverage by municipality, Angola, May 2004 (UNICEF-A, 05/04)
A random-sampled nutrition survey was undertaken in Balombo municipality in May 2004 (CRS, 05/04). 63% of the families interviewed were resident, whilst 37% were returnees (arrived after April 2002).
The results showed an acceptable nutrition situation, which has gradually improved since 2001 and was stable compared to 2003 (figure 7). Mortality rates were average (under-five mortality rate = 1.86/10,000/day, crude mortality rate = 0.72/10,000/day), but have decreased since March 2002, when under-five mortality rate and crude mortality rate were respectively 3.2/10,000/day and 1.4/10,000/day (see RNIS 36/37). The main presumed cause of under-five mortality was malaria (74%). Measles vaccination coverage for the 12-23 month olds was 17% according to cards and has not improved compared to 2003. Vitamin A distribution coverage was also low at 16%.
Figure 7, Prevalence of Acute Malnutrition Bolombo Municipality, Benguela Province, Angola, May 2004 (CRS, 05/04)
The nutrition situation remains stable with more and more nutrition centres handed over to the Ministry of Health, who plans to develop growth-monitoring and vitamin A distribution as part of the National Nutrition Programme.
The security situation is still very tense with terrorist attacks and factional fighting (BAAG, 31/07/04). NGOs continue to be targeted and MSF withdrew from Afghanistan after 5 of its staff were killed (MSF, 29/07/04). Thirty-four aid agencies denounced the blurring between military operations and aid work in the country, which, they said, adds to the tension and danger face by the workers (AFP, 01/09/04).
The presidential election, in which 18 candidates will compete, is scheduled for the 9th of October 2004 (UN News, 07/09/04).
About 450,000 refugees, 242,000 from Iran and 210,000 from Pakistan, have been voluntarily repatriated to Afghanistan so far this year (UNHCR, 20/07/04). The high number of returns from Iran may be linked to increased pressure from the government of Iran on the refugees, such as demanding high fees for education or health care (RI, 09/07/04). In Pakistan, UNHCR stopped the aid provided to 194,000 refugees settled in "new camps" established after the American intervention in Afghanistan along the border in unsafe areas (UNHCR, 20/07/04). 82,000 refugees were voluntarily repatriated to Afghanistan whilst others were moved to another camp (UNHCR, 07/09/04).
An estimated 20,000 refugees were obliged to flee Pakistani army operations in South Waziristan (AFP, 23/07/04). They were given a 72 hours notice to leave. They have fled to Paktika province, a stronghold of the Taliban, where UN and humanitarian agencies have little access (IWPR, 20/08/04).
As of late July 2004, the IDPs' caseload was estimated at 145,000 in the south, 20,000 in the west, 9,000 in the north and 5,000 in both east and south-east provinces (BAAG, 31/07/04). Spin Boldak IDP camp was expected to close at the end of August. As of July, 20% of the IDPs wished to be transferred to Zhare Dasht camp; only 2% wanted to return home and the remaining wished to stay in Spin Boldak and were therefore no longer considered as IDPs (UNHCR, 05/07/04).
An appeal was launched by the Afghan government and the UN for combating the consequences of the drought (GTISA, 01/09/04). According to a recent study, 37% of the population are thought to be food insecure, a doubling in the past 12 months.
Poorly distributed precipitation and the early and rapid depletion of the snow pack owing to higher than normal temperature are responsible for ground water levels dropping, scarcity of access to water and to an expected crop failure (FEWS, 12/07/04). The south of the country is the most affected (see map).
Districts affected by water shortage, Afghanistan, July 2004 (FEWS, 12/07/04)
Chaghi district in Baloshistan province is a drought-prone area. The district suffered an especially acute drought between 1999 and 2002, which led to a loss of livestock and to poor crop production. Food distributions were carried out during the period. Rains were better in 2003. About 60% of the population is from the agro-pastoral group; 20% are tenant farmers; the others are landowners (5-10%), or are involved in government work or in urban business.
A random-sampled nutrition survey was carried out in the district in March 2004 (Oxfam-GB, 03/04). The results showed a poor nutrition situation: the prevalence of acute malnutrition was 8.3% (6.1-10.4), including 1.3% (0.8-2.0) severe acute malnutrition. Crude and under-five mortality rates were below alert thresholds and stood at 0.4/10,000/day and 0.8/10,000/day, respectively. Measles vaccination and vitamin A distribution coverage were average: 70.4% and 84.6%, respectively.
The nutrition situation seemed to have improved compared to August 2002, when the rate of acute malnutrition was 15.9% (12.4-17.0), reflecting an improvement in the availability of food and of peoples' access to it, although the population is still vulnerable.
The annual nutrition survey was conducted in June 2004 in the seven camps where about 104,000 were settled (AMDA, 06/04). The results showed a stable situation in terms of acute malnutrition and prevalence of angular stomatitis, compared to 2003 (figures 8 & 9). The prevalence of stunting was 25.3%, including 7.7% severe stunting, and has remained stable over the past five years.
Measles vaccination and vitamin A distribution coverage were satisfying: 97.2% and 97.6%, respectively.
The proportion of families who had kitchen gardens decreased by 12% compared to last year: 60% vs. 72%. On the other hand, the number of families reporting having regular income seems to have increased from 54% in
2003 to 69% in 2004. The main sources of income were daily work, incentives from aid agencies and petty trade. 93% of the families reported purchasing food in addition to the general ration, mainly vegetables (100%) and dairy products (49%).
According to ante-natal care records, 9.3% of the children surveyed weighed less than 2,500 g at birth, which is similar to 2003 (11.4%). Among the children with a low birth weight, 25% were acutely malnourished at the time of the survey, compared to 6.3% who were acutely malnourished amongst the children who had a birth weight above 2,500 g.
The political crisis is still raging in Nepal (see NICS 2). A blockade recently paralysed the capital, Kathmandu (AFP, 25/08/04). A natural disaster also occurred, with floods devastating the eastern and central regions (IFRC, 20/08/04). 800,000 people have been affected and 185 killed.
The pressure of the Maoists on NGOs and donors has increased over the recent months, leading to the suspension of programmes previously benefiting about 55,000 people (IDP Project, 06/04).
A joint OCHA/IDP unit mission to Nepal reported that Nepal "is not yet experiencing a humanitarian crisis. Basic needs in terms of food, health, shelter and water continue to be met, at least according to the standard of a very poor developing country" (OCHA/IDP Unit, 06/04). The report highlights that most of the aid agencies involved in Nepal have a development perspective and are reluctant to engage in humanitarian activities, for fear of undermining population's coping mechanisms.
There are no specific programmes targeting IDPs partly because most of them are hosted in local communities. The mission recommends not establishing such programmes for fear of destabilising the situation, but recommends that a broader approach based on the protection of civilians be adopted.
The report also stated that women and children are especially at risk, with, among other things, an increasing risk of being involved in trafficking and prostitution.
The mission emphasised the fact that little information exists on socio-economic conditions, population movements, and human rights abuses, and that the existing information is of low quality.
Figure 8 Prevalence of acute malnutrition, Bhutanese refugee camps, Nepal
Figure 9 Prevalence of angular stomatitis, Bhutanese refugee camps, Nepal
From the joint OCHA/IDP Unit mission:
Colombia has been experiencing 40 years of civil unrest, in which several armed guerrilla movements, such as the Colombian Revolutionary Armed Forces (FARC) and the National Liberation Army (ELN) are engaged. This has led to the displacement of several thousands of people inside the country and in nearby countries. In 2003, it was estimated that 904 of the 1,100 municipalities were affected (IDPProject, 2003). IDPs suffer from inadequate food intake due to a limited access to food and they are in worse living conditions than the urban poor (WFP, 16/06/03).
Putumayo department is one of the areas which was the most affected by violence and population displacement in 2003. Puerto Asis municipality has received a high number of displaced families, who settled mostly with relatives.
The majority of the population in Puerto Asis municipality face difficult living conditions with limited access to employment, poor housing conditions and intra-familial and social violence. About 40% of the displaced families are female-headed. The population reported that their main needs are food, shelter, work, children's care, potable water and access to health care.
A random-sampled nutrition survey was conducted in the urban area of Puerto Asis municipality in June 2004 (ACH, 06/04). The rate of acute malnutrition was low, but under-weight and stunting were higher (table 10). These results were within the same range as the DHS national survey carried out in 2000, which found 0.8% wasting, 13.5% stunting and 6.7% under-weight (DHS, 2000).
Table 10 Nutritional status, Puerto Asis municipality, Putumayo department, Colombia, June 2004 (ACH-S, 06/04)
| Date | % Acute Malnutrition (95% CI) |
% Severe Acute Malnutrition (95% CI) |
% Under-weight* | % Severe Under-weight# |
% Stunting | % Severe Stunting |
| June 04 | 1.4 | 0.1 | 6.2 | 0.5 | 9.4 | 1.6 |
* Weight-age < -2 Z-scores
# Weight-age < -3 Z-scores
Anaemia was found to be a problem of high significance in children: about 50% of the children surveyed had anaemia (table 11). The youngest children were especially at risk. Among the 6-59 month olds who were anaemic, 3.6% had severe anaemia (Hb < 7 g/L). Vaccination against measles was 91.3%, and crude and under-five mortality rates were under-control: 0.3/10,000/day and 0.1/10,000/day, respectively. 45% of deaths among the over fives were due to violence.
6.2% of the families surveyed were displaced. About 61% of the resident families and 88% of the displaced families earned less than the national minimum wage. 37% of the displaced families had benefited from a nutritional programme or from humanitarian aid the year prior to the survey, whilst only 16% of the resident families had.
| AAH-USA | Action Against Hunger USA |
| ACF-F | Action Contre la Faim France |
| ACH-S | Action Contra El Hambre Spain |
| AFP | Agence France Presse |
| BAAG | British Agencies Aghanistan Group |
| BMI | Body Mass Index |
| CDC | Center for Disease Control |
| CMR | Crude Mortality Rate |
| < 5 MR | Under-five Mortality Rate |
| CRS | Catholic Relief Service |
| DHS | Demographic and Health Surveys |
| DPA | Deutsche Presse Agentur |
| DPPC | Disaster Prevention and Preparedness Commission |
| FEWS | Famine Early Warning System |
| FSAU | Food Security Analysis Unit for Somalia |
| GTISA | Government of the Transitional Islamic State of Afghanistan |
| HRW | Human Rights Watch |
| ICG | International Crisis Group |
| IDP | Internally Displaced Person |
| IFRC | International Federation of Red Cross and Red Crescent Societies |
| IMF | International Monetary Fund |
| IRIN | International Regional Information Network |
| IWPR | Institute for War and Reporting |
| MOH | Ministry of Health |
| MSF | Médecins Sans Frontières |
| MUAC | Mid-upper arm circumference |
| NGO | Non-governmental Organisation |
| OCHA | Office for the Co-ordination of Humanitarian Assistance |
| PRRO | Protracted Relief and Recovery Operation |
| RI | Refugees International |
| SC-UK | Save the Children-United Kingdom |
| UNDP | United Nations Development Programme |
| UNHCR | United Nations High Commission on Refugees |
| UNICEF | United Nations International Children’s Emergency Fund |
| UNSC | United Nations Security Council |
| UNSG | United Nations Secretary General |
| USAID | US Agency for International Development |
| WFP | World Food Programme |
| WHO | World Health Organization |
| WV | World Vision |
FEWS 17/06/04 Eritrea, food security update
FEWS 20/07/04 Eritrea, food security update
IRIN 21/06/04 Eritrea: Critical water shortages reported in several regions
UNICEF 15/07/04 UNICEF humanitarian action donor update 15 Jul 2004
AddisTribune 06/08/04 Ethiopia: UN aid team goes to Somali region
DPPC http://www.dppc.gov.et/pages/earlywarningsystems.htm
DPPC 05/04 Nutrition survey report of Chewaka resettlement area, Bedela woreda,
Illubabur zone; http://www.dppc.gov.et/pages/earlywarningsystems.htm
EWS 07/04 Alert, impact of the Belg/Gu season on the food security situation of the Belg producing and pastoral areas
FEWS 22/07/04 Seed shortfalls remain in many drought-stricken areas
IRIN 08/06/04 Major relief effort in progress for resettled people
IRIN 13/07/04 Food trucks attacked as drought, insecurity hit Somali region
UNHCR 01/07/04 World’s largest refugee camp closed in Ethiopia
AFP 14/07/04 Kenya’s Kibaki declares food crisis a national disaster
FEWS 06/07/04 Food aid interventions improve food security in parts of Turkana and
Marsabit districts, but targeting uneven
KFSSG 14/07/04 Rapid long rains assessment 2004, consolidated inter-agency report
OCHA 10/08/04 Kenya flash appeal 2004
UNICEF 03/08/04 UNICEF gears up emergency response in drought affected areas in Kenya
WFP 06/08/04 WFP Emergency report No 32
AFP 05/08/04 Six killed in inter-clan fighting in Somali capital
FSAU/FS 04/05 Monthly food security report
FSAU 05/04 Jilib riverine nutrition survey, Middle Juba region, Somalia
FSAU/N 07/04 Nutrition update
FSAU 08/04 Monthly food security and nutrition report
IRIN 01/07/04 Somalia: WFP appeals for US$ 14 m to fund humanitarian operations
IRIN 14/07/04 Somalia: more funds needed for humanitarian operations-agencies
IRIN 17/08/04 Somalia: More than 20 killed in fighting in Bay region
IRIN 19/08/04 Names submitted for proposed MPs but divisions linger
UNSG 23/08/04 Secretary-General welcomes inauguration of transitional federal parliament for Somalia
ACF-F 06/04 Nutritional anthropometric survey, children under 5 year old, Abu Shok camp, El Fasher, North Darfur state, Sudan
AFP 30/08/04 World faces humanitarian failure in southern Sudan, UN warns
DPA 30/08/04 Violence continues in Darfur as UN deadline expires
DPA 01/09/04 Sudan fails commitments in Darfur, UN says, sanctions loom
Epicentre/MSF 06/04 Health assessment in emergencies, Munei and Zalingei, West Darfur,
FEWS 26/08/04 Food security update
HRW 27/08/04 Janjaweed camps still active
IRIN 30/08/04 Major protection crisis in Darfur—UN mission Sudan
OCHA 25/08/04 Remaining humanitarian requirements for Sudan until 31 December 2004
SAB 15/08/04 Sudan Assistance Bulletin No 32
SC-UK 05/04 Malha, nutrition survey report
WFP 27/08/04 WFP Emergency report No 35
WHO 30/08/04 Hepatitis in Sudan—update
WV 24/07/04 Rapid assessment report
ACCRA SC 31/07/04 Accord d’Accra III sur la Côte d’Ivoire
AFP 09/08/04 Peace process pushes forward at first Ivory Coast cabinet meeting in months
DHS 1998/99 Enquête démographique et de santé, Côte d’Ivoire
MOH/UNICEF 06/04 Enquête nutrition, santé et mortalité en Côte d’Ivoire
OCHA 12/07/04 Crisis in Côte d’Ivoire, situation report No 29
OCHA 27/07/04 Crisis in Côte d’Ivoire, situation report No 30
AAH 16/08/04 Liberia, un an après
IRIN 22/07/04 Guinea-Liberia: refugees criss-cross a fluid and volatile border
OCHA 01/07/04 Liberia, humanitarian update No 106
OCHA 30/07/04 Liberia, humanitarian update No 110
OCHA 06/08/04 Liberia, humanitarian update No 111
OCHA 13/08/04 Liberia, humanitarian update No 112
UNDP 07/06/04 Liberia gets $24.3 million from Global Fund to fight HIV/AIDS, tuberculosis and malaria
WFP 05/04 Vulnerability analysis and mapping, Liberia: Bong and Margibi counties
UNHCR 21/07/04 UNHCR’s Sierra Leone repatriation draws to end
AFP 17/08/04 New crisis in Great Lakes as Rwanda, Burundi threaten DR Congo
OCHA 27/06/04 OCHA-Burundi situation report 21-27 Jun 2004
OCHA 15/08/04 OCHA-Burundi situation report 09-15 Aug 2004
Reuters 19/08/04 Tutsis massacre part of Congo conflict– Zuma
UNHCR 17/08/04 UN peacekeepers tighten security along Burundi-Congo border
UNHCR 20/08/04 Burundi: Agreement reached with government on second site for transit camp
UNSC 21/05/04 Security Council, unanimously adopting resolution 1545 (2004), authorises UN operation in Burundi for initial six-month period
UNICEF/WHO 25/05/04 Interagency WHO and UNICEF health and nutrition needs assessment
AFP 12/08/04 Resurgence of epidemics hitting much of DR Congo: WHO
AFP 23/08/04 Former DR Congo rebels suspend role in government
ICG 24/08/04 Prevent the return to full-scale war in the Congo
OCHA 31/07/04 Humanitarian situation in DRC monthly update, Jul 2004
USAID 20/08/04 DR Congo: Complex Emergency Situation Report#4
OCHA 21/05/04 Humanitarian situation in DRC 15-21 May 2004
AAH-US 06/04 Nutrition survey in IDP camps, Gulu district, Northern Uganda
FEWS 26/07/04 Monthly food security update
GOAL 07/04 Preliminary nutrition survey report for Kalongo town, Agago county, Pader district, Uganda
NRC 06/07/04 Uganda: Increased international attention has yet to produce concrete results for the displaced
WFP 04/04 Emergency food security assessment, Gulu district
WFP 06/08/04 WFP Emergency Report No. 32
Xinhua 29/07/04 War-torn northern Uganda resumes massive food production
AFP 25/07/04 Two Darfur refugees killed in Chad amid tensions with aid groups: UN
CDC/joint 06/04 Emergency nutrition and mortality surveys conducted among Sudanese refugees and Chadian villagers, North-eastern Chad
IRIN 02/08/04 France provides airlift to eastern Chad, deploys troops to secure border
IRIN 13/08/04 Chad-Sudan: special feeding targets malnourished refugees but water problems persist
HRW 22/06/04 Sudan: Darfur atrocities spill into Chad
UNHCR 11/06/04 UNHCR revises budget for Chad operations to $55.8 million
UNHCR 30/07/04 UNHCR completes refugee transfer from major border towns in Chad
UNHCR 06/08/04 Chad: government/UNHCR sign agreement for new refugee camp in Adre region
UNHCR 10/08/04 UNHCR Sudan funding overview as of 10 August 2004
UNHCR 17/08/04 New arrivals reported from Sudan; the burden on Chad
WFP 09/07/04 WFP Emergency Report No. 28
WFP 30/07/04 WFP Emergency Report No. 31
WHO 19/08/04 Disease outbreak reported: hepatitis E in Chad
IMF 21/07/04 Statement by IMF mission staff on Angola
CRS/MOH 05/04 Inquerito de nutricao, cobertura vicinal e mortalidade, Balombo, Angola
OCHA 30/06/04 Humanitarian situation in Angola Quarterly Analysis April-June 2004
UNHCR 06/07/04 Angola: second phase of repatriation from DRC begins
UNICEF-A 05/04 Nutrition group meeting
WFP 30/07/04 WFP Emergency Report No. 31
AFP 23/07/04 Humanitarian crisis looms as Afghan refugees flee Pakistan’s Al-Qaeda hunt
AFP 01/09/04 Aid workers accuse military in Afghanistan of putting them in danger
BAAG 31/07/04 BAAG Afghanistan monthly review, July 2004
GTISA 01/09/04 Afghan Government and UN launch Emergency Appeal to combat drought: USD 71.3 million needed
IWPR 20/08/04 Little aid for refugees forced out of Pakistan
MSF 29/07/04 MSF pulls out of Afghanistan
RI 09/07/04 Afghan refugees: maintain assistance as returns continue into 2005
UNHCR 05/07/04 UNHCR starts relocating Afghan IDPs under plan to close border camps
UNHCR 20/07/04 Afghan returns from Iran surpass those from Pakistan, says UNHCR
UNHCR 07/09/04 Pakistan: Enhanced voluntary repatriation programme for “new camp” Afghans completed
UN News 07/09/04 Afghanistan’s first free presidential election campaign kicks off
Oxfam-GB 03/04 Anthropometric nutrition and food security survey, district Chaghi, Baloshistan
AFP 25/08/04 Kathmandu returns to normality as rebels lift blockade
AMDA 06/04 Report of annual nutrition survey 2004
IDP Project 06/04 Many aid agencies suspend their work in rural areas under Maoist pressure
IFRC 20/08/04 Nepal: Floods emergency appeal No 17/2004 Operations update No 3
OCHA 06/04 Report of the OCHA/IDP unit mission to Nepal
ACH-S 06/04 Encuesta nutricional, municipio de Puerto Asis, departamento de Putumayo, Colombia
DHS 2000 Encuesta Nacional de Demografia y Salud
IDPProject 2003 Colombia: “Democratic security” policy fails to improve protection of IDPs
WFP 16/06/04 Vulnerabilidada a la Inseguridad Alimentaria de la Poblacion Desplazada por la Violencia en Colombia
Table Continued...
Table continued...
Chewaka resettlement area, Bedela woreda, Illubabur zone, Oromya region
The survey was conducted by DPPC in May 2004. A two-stage cluster sampling methodology of 30 clusters was used to measure 932 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.
Jilib riverine area, Middle Juba
The survey was conducted by FSAU in May 2004. A two-stage cluster sampling methodology of 30 clusters was used to measure 913 children between 6-59 months. The survey also estimated measles vaccination and vitamin A coverage, morbidity, retrospective mortality rates over the 3 months prior to the survey and various food security and public health indicators.
Sool plateau, Northern Somalia
The survey was conducted by FSAU in June 2004. A two-stage cluster sampling methodology of 30 clusters was used to measure 901 children between 6-59 months. The survey also estimated measles vaccination and vitamin A coverage, morbidity, retrospective mortality rates over the 3 months prior to the survey, women’s MUAC and various food security and public health indicators.
Abu Shok camp, El Fasher, North Darfur
The survey was conducted by ACF-F in June 2004. A two-stage cluster sampling methodology of 30 clusters was used to measure 955 children between 6-59 months. The survey also estimated measles vaccination and retrospective mortality rate over the month prior to the survey.
Malha, North Darfur
The survey was conducted by SC-UK in May 2004. A two-stage cluster sampling methodology of 30 clusters was used to measure 941 children between 6-59 months. The survey also estimated measles vaccination and retrospective mortality rate over the three months prior to the survey.
Murnei and Zalingei, West Darfur
Two surveys were conducted by Epicentre/MSF in Murnei and Zalingei in April/May 2004. A two-stage cluster sampling methodology of 30 clusters was used to measure 470 and 917 children between 6-59 months, respectively. The surveys also estimated measles vaccination and retrospective mortality rates over the previous 6 months.
Aweil West and North counties, Bahr el Gazal
The survey was conducted by Concern in July 2004. A two-stage cluster sampling methodology of 30 clusters was used to measure 907 children between 6-59 months. The survey also estimated measles vaccination coverage and retrospective mortality rate over the previous four months.
Duk Payuel Payam, Payam-Duk county, Central upper Nile
The survey was conducted by AAH-US in July 2004. A two-stage cluster sampling methodology of 30 clusters was used to measure 903 children between 6-59 months. The sample only included villages situated within a 3 hours’ walk from Poktap town centre. The survey also estimated measles vaccination coverage and crude mortality rate over the 3 months prior to the survey.
West, North, North-west, Centre, North-east, Centre-west, South-east and South
Eight surveys were conducted between November 2003 and February 2004. The samples were stratified multi-stage random samples. The samples were drawn from 2 to 3 departments, randomly selected and considered representative of each zone.
| Areas | Regions Included in the Survey |
| West | Montagnes and Moyen Cavally |
| North | Worodougou and Bafing |
| North-west | Denguele et Savanes |
| Centre | Vallee du Bandama, du Nzi-Comoe and lakes |
| North-east | Zanzan |
| Centre-west | Haut Sassandra and Marahoue |
| South-east | Agneby, Moyen Comoe and South Comoe |
| South | Lagune, South Bandana and Bas Sassandra |
The surveys also estimated various food security and public health indicators.
Kalongo town, Pader district
The survey was conducted by GOAL in July 2004. A two-stage cluster sampling methodology of 30 clusters was used. The survey also estimated mortality rates, morbidity and various food security indicators.
IDP camps Gulu district
The survey was conducted by AAH-US in June 2004. Only the official camps which were accessible according to the security situation were included in the sampling frame. A two-stage cluster sampling methodology was used to measure 1072 children between 6-59 months. The survey also estimated measles vaccination coverage, crude mortality rate over the previous three months and infant nutritional status.
Irisimi, Touloum and Kounoungo refugee camps
The survey was conducted by CDC in June 2004. A two-stage cluster sampling methodology of 25 clusters was used to measure 151 children between 6-59 months in Iridimi. In Touloum and Koundoungo, systematic samplings were conducted. 219 and 54 children were measured respectively. The survey also estimated measles vaccination and vitamin A distribution within six months prior to the survey, mortality rates over the previous six months and several food security and public health indicators.
Bahai and Cariari refugee frontier settlements
The survey was conducted by CDC in June 2004. 375 children between 6-59 months were measured through systematic random sampling . The survey also estimated measles vaccination and vitamin A distribution within six months prior to the survey, mortality rates over the previous six months and several food security and public health indicators.
Balombo municipality, Benguela province
The survey was conducted by CRS in May 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 four months.
Chaghi district, Balochistan province
The survey was conducted by OXFAM-GB in March 2004. A two-stage cluster sampling methodology of 30 clusters was used to measure 933 children between 6-59 months. The survey also estimated measles vaccination coverage, vitamin A distribution coverage, mortality rates over the previous month, morbidity and several food security indicators.
Bhutanese refugee camps
The surveys were conducted by AMDA in June 2004.A systematic sampling was used to measure 387 children. The survey also estimated measles vaccination and vitamin A coverage, the prevalence of clinical signs of angular stomatitis and various food security indicators.
Puerto Asis municipality, Putumayo department
The survey was conducted by ACH-S in June 2004. A two-stage cluster sampling methodology of 30 clusters was used to measure 911 children between 6-59 months. The survey also estimated measles vaccination coverage, mortality rates over the previous three months and several food security indicators. Measurement of haemoglobin was performed directly in the household using a portable photometer ‘Hemocue B-hemoglobin’ Photometer.
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,
Email: scn@who.int
Web: http://www.unsystem.org/scn
___________________________________________
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
International Development.
ISSN 1564-376X
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