United Nations System
Standing Committee on Nutrition

Nutrition in Crisis Situations

Vol 4, November 2004

Greater Horn of Africa

• Eritrea
• Ethiopia
• Kenya
• Somalia
• Sudan

West Africa

• Ivory Coast
• Liberia
• Sierra Leone

Central Africa

• Burundi
• Democratic Republic of Congo
• Uganda
• United Republic of Tanzania
• Chad

Southern Africa

• Angola

Asia

• Afghanistan

The Caribbean

• Haiti

Middle East

• Occupied Palestinian Territories

Abbreviations and Acronyms

References

Summary of the nutrition survey results

Notes on the survey methodologies

Indicators and risk categories

Highlights

Eritrea—Critical nutrition situation—The lingering effects of the war with Ethiopia and the 2002 drought have had a significant impact on households’ food security and nutritional status in a country where the general situation was already poor. The future of the food security situation is bleak, partly because of the recent failure of rains.

The National Nutrition Surveillance System, a collaborative inter-agency group set up by the Ministry of Health conducted a second round of nutrition surveys in Northern Red Sea, Gash Barka, Debub and Anseba in mid-2004. The results showed that the situation was critical in all the areas surveyed except Debub where the situation was average.

Emergency and long-term development programmes need to be strengthened.

Sudan—Situation still grim in Darfur and of concern in Southern Sudan—Despite a renewed commitment by the Government of Sudan and the two armed opposition forces to halt air bombardments and to facilitate the provision of humanitarian aid, the situation on the ground is still dire.

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

Several surveys have been conducted recently in accessible areas of Darfur. They showed average to critical levels of mortality depending on the area and a generally high prevalence of malnutrition.

Moreover, access to safe drinking water and sanitation is inadequate.

In South Sudan, a poor rainy season and continued insecurity will probably affect further the food security of the populations.

Chad—Precarious situation among the refugees and the resident population— Most of the refugees are now located in the eleven camps settled in eastern Chad. Tension and several security incidents have been reported in and around the camps.

Availability of water is a main issue and the water table has been decreasing very rapidly in some of the camps.

As of October 2004, the nutrition situation seemed to have slightly improved in the camps , when compared with summer months.

Resident Chadian populations in the areas of refugee settlement seem to experience more and more difficulties. Government of Chad/UN mission recommended that 20,000 MT of emergency food assistance be distributed to 157,000 resident people .

Donor's and agencies' commitment should be sustained to allow the situation to improve further .

Haiti—Nutrition situation not critical— Haiti has known both political and natural crises in 2004. In early 2004, an armed uprising and international political pressure led to the resignation of the president Jean-Bertrand Aristide. This was followed by the deployment of a UN peace-keeping force, the MINUHSTAH and by the appointment of an interim government until the elections scheduled in 2005. However, the situation is volatile. Violence and insecurity are on the rise , which hampers the proper delivery of aid, in the hurricane affected areas of Artibonite and North West departments, where about 300,000 people are vulnerable. Nutrition surveys conducted in the hurricane-affected areas before the hurricane or in on-affected areas showed an acceptable nutrition situation.

Occupied Palestinian Territories—Food insecurity and micro-nutrient deficiencies—The second Intifada, which began in September 2000, is still on-going. It had seemed there was a slight improvement in the situation in 2003, with a relaxation of closures and a modest economic recovery due to an increase in the amount of employment within the territories.

The situation suffered a further setback in 2004, especially in the Gaza Strip where an estimated 20,000 people lost their jobs. Restrictions of movement have intensified as well as incursions by the Israeli army which has led to an unprecedented destruction of houses and infrastructure . Coping mechanisms developed by the Palestinians to deal with the economic crisis have tended to become overstretched. However, it seems that basic needs services are still provided thanks to donors' commitment, although support from donors declined slightly in 2003 compared to 2002. A nutrition survey, which was conducted in mid-2003 and recently released, showed an acceptable situation. A survey on micro-nutrient deficiencies was carried out in June 2004 among children 6-59 months old. The survey revealed a high prevalence of vitamin A, vitamin E and iron deficiencies.

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.

J Adequate
K Mixed
L Inadequate

Greater Horn of Africa

Eritrea

The future of the food security situation in Eritrea is bleak. The kremti rains (June-September) were poor in most of the country, and the harvest is forecast at 109,000 MT, which is only 58% of average production and 20% of the total annual food requirement (FEWS, 18/10/04). Pasture and grazing conditions are also very poor. The situation is compounded by the poor performance of the previous azmera rains (March-May) in some areas and by the overall drought experienced by the country over the previous years. Water shortage is acute throughout the country and the government has designed a mitigating action plan to improve access to safe potable drinking water for around 1.8 million people (FEWS, 18/10/04).

The current food pipeline for food distribution was sufficient to distribute a full ration to the intended 1.9 million beneficiaries towards the end of 2004 (FEWS, 18/10/04).

Critical nutrition situation

The National Nutrition Surveillance System (N-NSS), a collaborative inter-agency group set up by the Ministry of Health conducted a second round of nutrition surveys in Northern Red Sea in May 2004, in Gash Barka in mid-June, in Debub at the end of June and in Anseba in mid-July (N-NSS, 07/04).

The results showed that the situation was critical in all the areas surveyed except Debub where the situation was average (table 1). Moreover, a significant proportion of women had a BMI < 18.5 (table 1).

When compared with previous surveys carried out in December 2003, the situation seems to have worsened in Anseba and Gash Barka, whilst it has remained stable in Northern Red Sea (figures 1 & 2). The nutritional status of both children and women has improved significantly in Debub (figures 1 & 2).

The December surveys were conducted during the post-harvest period, whilst the second round of surveys was done during the hunger-gap season. The increase in the prevalence of malnutrition recorded in Anseba and Gash Barka may be explained by an increase in food insecurity during the lean season, which was not compensated by coping mechanisms and humanitarian aid. On the other hand, it seems that the population in Debub has begun to recover from the 2002 drought.

Table 1 Prevalence of acute malnutrition and chronic energy deficiency, Eritrea, May-July 2004 (N-NSS, 07/2004)

Figure 1 Wasting in Eritrea, December 2003-June 2004

Figure 2 Chronic Energy Deficiency in Eritrea, December 2003-June 2004

Food distribution

According to the survey, the vast majority of families received food distributions within the four months prior to the survey (table 2). The average amount of cereal received varied from 6.3 kg to 8.4 kg per person per month, depending on the area (table 2). This was less than in December 2003 when the families reported having received 10.4-12.3 kg of cereals.

Supplementary feeding

There was no common mechanism of supplementary food distribution. Supplementary feeding was targeted at malnourished children in some places, whilst there was no targeting in other areas.

A significant percentage of children were receiving supplementary food (table 2) but the average amount received was generally less than the intended 6-10 kg/pers/month (table 2). Moreover, the distribution of supplementary food was irregular.

Table 2 General and supplementary food distribution, Eritrea, June 2004 (N-NSS, 07/04)

Public health

Only about half of the mothers were seeking care when their children were ill. This is unchanged compared to December 2003.

Access to water and to safe drinking water was also still very poor and has not improved compared to December 2003. Only 8.7%, 7.8%, 24.6% and 33.5% of the households had access to both enough (> 15 l/pers/day) and safe water, in Anseba, Debub, Gash Barka and Northern Red Sea, respectively.

Overall

The lingering effects of the war with Ethiopia and the 2002 drought have had a significant impact on households’ food security and nutritional status in a country where the general situation was already poor. The future of the food security situation is bleak, partly because of the recent failure of rains. Emergency and long-term development programmes need to be strengthened.

Recommendations

From the N-NSS survey:

• Ensure regular distribution of food aid and supplementary food
• Implement treatment of severe malnutrition in the areas where acute malnutrition is high and facilities do not exist
• Facilitate accessibility of health care and increase effective treatment and prevention of childhood infection

Ethiopia

The prospect of food security in Ethiopia in 2005 is poor owing to below average rainfall and structural factors. The Belg/Gu season (March-May) was bad in most part of eastern Ethiopia and the Meher/Karma (June-September) rainy season was below average in the eastern crop-dependent areas, and late and erratic in pastoral areas (FEWS, 26/10/04). The Somali region is especially affected and the evolution of the situation will depend on the performance of the Deyr/Hagaya rains (October-December) (FEWS, 29/10/04).

There is a 22% shortfall in pledges towards current cereal needs through October to December 2004. The needs may further increase if the situation deteriorates in pastoral areas (FEWS, 29/10/04). Only 44% of the non-food sector needs have been met so far (FEWS, 29/10/04).

A Productive Safety Net Programme has been designed to respond to the needs of 5.1 million people chronically food insecure and to differentiate them from people requiring emergency assistance. The programme will be cash-oriented rather than food-oriented (DFID, 04/10/04).

Kenya

The short rainy season started earlier than usual and was expected to be good in agricultural areas. This will improve the situation in the drought-affected agricultural areas from the harvest expected in February 2005. On the other hand, drought was expected to continue in parts of Turkana, Marsabit, Isiolo and Laikipia districts (FEWS, 07/10/04). An assessment conducted early October in pastoral areas showed that the situation was still serious (FEWS, 28/10/04).

The August-January Kenya emergency operation was only 60% resourced as of October 2004 and it was anticipated that while cereal needs will be met, shortfalls of pulses and blended food will remain (FEWS, 07/10/04, WFP, 29/10/04).

WFP has experienced food shortfalls and delivery problems for Dadaab refugee camps; the food rations distributed have been lower than intended (WFP, 29/10/2004).

Investigation of the outbreak of aflatoxin intoxication in eastern and central regions, which peaked between April and July 2004 (see NICS 3), revealed aflatoxin concentrations above tolerated threshold (> 20 ppb) in about half of the food samples collected from households and markets, with some samples showing concentrations as high as 8,000 ppb (MMWR, 04/09/04). The government of Kenya provided replacement food in the most affected districts and people have been advised to avoid eating food suspected to be mouldy.

Precarious situation in the pastoral area of Garissa district and critical nutrition situation in Wajid district

Garissa district is one of the 26 districts declared affected by drought in 2004. The district has also been included in the 12 districts selected by the Health and Nutrition sector group for interventions. A random-sampled nutrition survey was conducted in September 2004 in the pastoral area of the district (UNICEF/MOH, 09/04). The prevalence of acute malnutrition revealed a precarious situation with 16.5% (14.3-18.8) of the children surveyed being acutely malnourished, including 3.5% (2.6-4.8) severely malnourished. 11.8% of the mothers were classified energy deficient (MUAC < 22 cm). About 64% of the children had received measles immunisation and only 43% of the children had received vitamin A during the year prior to the survey. Mortality rates were average: CMR = 0.46 pers/10,000/day and under-five mortality rate = 1.1 pers/10,000/day. The food security situation was estimated poor.

According to two nutrition surveys conducted in Wajid West and Wajid South in October 2004, the situation was critical: the prevalence of acute malnutrition was 31.5%, including 3.5% severe acute malnutrition, and 22.4%, including 2.3% severe malnutrition, in Wajir West and Wajir South, respectively (FEWS, 11/11/04).

Situation of concern in Mandera district

Mandera district has been highly affected by the current drought. This district is also chronically food insecure, at least since the major drought in 1991-92 when pastoralists, the predominant group in this area, lost most of their livestock. A rapid assessment conducted in Mandera Central, Takaba, Kotulo, Lafey and Wargadud divisions in August 2004 (AAH-UK, 08/04), showed a situation of concern: 28.6% of the children ( 12-59 months) measured were at risk of malnutrition (MUAC ≥ 12 cm and < 13.5 cm), while 1.9% and 0.7% were moderately (MUAC < 12 cm and ≥ 11 cm) and severely (< 11 cm) malnourished, respectively. Scarcity of water has reached a critical level in some divisions.

Somalia

The Transitional Federal Parliament was completed at the end of August (AFP, 29/08/04) and the members elected Mr Abdullahi Yussuf as transitional president (IRIN, 12/10/04). He himself appointed Mr Ali Mohamed Ghedi as prime minister (BBCNews, 03/11/04). A demilitarisation process will be planned, including the possible deployment of African Union peace-keeping forces (AFP, 11/10/04; AU, 01/11/04).

In the meantime, clashes and tension have worsened between Puntland and Somaliland in the disputed region of Sool (IRIN, 01/11/04).

As of October 2004, areas of major concern regarding the food security situation were the northeast, although good Deyr rainfall coverage may mitigate the situation, the central region, northern Gedo and Juba valley, where civil insecurity continues to play a major role in the poor food security situation (see map).

Situation still dire in Jilib riverine area, Middle Juba

The situation remains critical in the Jilib riverine area where admissions to TFCs and SFCs doubled between January and August 2004 (FSAU/N, 09/04). The coverage area of supplementary feeding has been extended and some food security programmes have been put in place, such as the distribution of seeds, of irrigation pumps and fishing nets, as well as food for work (FSAU/N, 10/04).

High vulnerability of IDPs in Mogadishu and Bossaso

An exhaustive nutrition survey was carried out in IDP settlements in Bossaso town (FSAU/N, 09/04). The prevalence of acute malnutrition was critical and has not improved when compared to the two previous years (table 3, figure 3). Mortality rates were also of concern (table 3). The main source of income was casual work

for 95% of the families interviewed and the main coping mechanisms were borrowing and begging. Water and sanitation conditions were still dire. Only 46% of the 9-59 month old children were vaccinated against measles and 11% of the children were reported as having had measles in the month prior to the survey. About 75% of the children had received vitamin A within the six months prior to the survey.

In Mogadishu, a random-sampled nutrition survey was conducted in July 2004 (FSAU/N, 10/04). The survey found a serious prevalence of acute malnutrition, while mortality rates seemed acceptable (table 3). The main source of income was casual work for 53% of the households. However, lack of appropriate skills and insecurity prevented IDPs from accessing sufficient incomes. The main coping strategies were borrowing and begging. Water and sanitation conditions in the camps were poor. The malnutrition rate was in the same range as in 2000, where a random sample survey found 12.9% (10.0-16.5) acute malnutrition, including 2% severe acute malnutrition (1.0-3.9).

Table 3 Acute malnutrition, measles vaccination and mortality rates, Bossaso IDP camps and Mogadishu IDP camps, July 2004 (FSAU/N, 09/04; FSAU/N, 10/04)

* According to cards and mothers' statements

Figure 3 Prevalence of acute malnutrition, Bossaso IDP settlements, Somalia

Critical situation in Dhusamareeb and Adaado districts, Gagadud region

The area has experienced the effect of drought and civil insecurity in the past years. The region is traditionally mostly pastoralist but according to household interviews during a survey carried out in September 2004, only 40% of the families declared themselves as being pastoralists, while 42% were involved in petty trade or self-employment and 18% relied on relatives or begging (FSAU/N, 10/04). The food security situation seems to have deteriorated over the last years. All families had had to use coping mechanisms in the month prior to the survey, such as switching to low quality food, limiting portion size, borrowing from relatives or purchasing on credit.

The prevalence of acute malnutrition was critical: 20.5% (18.0-23.3) of the children surveyed were acutely malnourished, including 2.5% (1.6-3.7) severely malnourished. Pregnant women also showed a high vulnerability with 7.9% of them having a MUAC less than 20.7 cm, defined as severe risk of malnutrition and 22.9% had a moderate risk of malnutrition (MUAC between 20.7 and 22.9 cm). Crude and under-five mortality rates were of concern: 1.66/10,000/day and 2.39/10,000/day, respectively.

Measles vaccination and vitamin A supplementation coverage were poor: 35% and 33% respectively. Access to water was very limited with a majority of households using only 1.59-2.5 litres of water per person per day.

Overall

The situation is critical in Galgadud region (category II) which has experienced drought and civil insecurity and increasing destitution over the last years. IDPs in Mogadishu and Bossaso are highly vulnerable (category II) and people in Jilib area continue to experience dire living conditions.

Recommendations

From the survey in IDP camps in Mogadishu:

• Improve health situation
• Improve access to food
• Implement medium and long-term projects to address poor living conditions and food insecurity

From the survey in Galgadud region:

• Implement targeted supplementary feeding programmes/family ration through MCH
• Improve health care
• Support food intervention

Sudan

South Sudan

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

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

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

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

Darfur crisis

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

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

High levels of malnutrition and mortality

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

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

Micro-nutrient deficiencies

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

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

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

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

Precarious food security situation

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

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

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

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

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

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

Food distribution

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

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

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

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

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

Non-food items

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

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

Public Health

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

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

Overall

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

Recommendations

From the CDC/WFP survey in Darfur:

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

West Africa

Ivory Coast

The civil war erupted again in Ivory Coast. At the beginning of November, the government air force bombed two rebel-held towns: Bouake and Korhogo. Some French peace-keepers were killed or wounded and French peace-keepers destroyed the government air force and took the control of Abidjan airport. This was followed by rampage, mostly in Abidjan, and especially targeting French and other foreigners (UN HCHR, 15/11/04), and then by the intervention of the French peace-keepers, leading to killing and injury, according to the Ivorian Government (BBCNews, 14/11/04). Thousands of expatriates were repatriated and more than 15,000 Ivorians fled to Liberia and Guinea (AAH, 09/11/04; UNHCR, 17/11/04). It seemed that the situation has calmed down as of mid-November (UN News, 16/11/04).

The Security Council has imposed a 13 month arms embargo and has threatened further restrictions on travel and finance if the Ivorian parties fail to implement their commitments to the peace process by 15 December 2004 (UN SC, 15/11/04). The African Union will play a major role in further peace talks (DPA, 17/11/04).

Liberia

The situation has remained calm, except in Monrovia where a riot over a land dispute left hundreds injured and led to the destruction or looting of Mosques, Churches, public building and private houses at the end of October 2004 (OCHA, 07/11/04).

Liberia's three warring factions (MODEL, LURD and the ex-government of Liberia) publicly announced the disbanding of their factions on the 3rd November (OCHA, 07/11/04). The disarmament and demilitarisation process officially ended at the end of October, but will be pursued at the border with Ivory Coast and Sierra Leone (OCHA, 17/11/04). Depending on the source, between 50,000 to 100,000 ex-combatants would have been disarmed (USAID, 31/10/04).

Refugee and IDP returns

About 70,000 Liberian refugees are estimated to have returned spontaneously in the past months, owing to an improvement of the security situation and the deployment of UNMIL forces (UNHCR, 08/11/04). In the meantime, UNHCR has launched a voluntary repatriation programme of Liberian refugees from Guinea, Sierra Leone, Ghana and Nigeria (UNHCR, 08/11/04). Repatriation of IDPs has also begun. Both IDPs and refugees will receive a resettlement package including food and non-food items (UNHCR, 29/10/04; UNHCR, 08/11/04). Most of the returns occurred in Lofa, Bomi and Montserrado counties.

Life has been restarting in counties which have been deserted for years. According to various assessments conducted in the south-east and north-west of the country, the food security situation is still precarious and people lack access to basic necessities such as clothes, construction equipment, tools and seeds (ACF-F, 08-09/04; ACF-F, 09/04; ICRC, 06/04).

Arrival of refugees from Ivory Coast

A wave of more than 13,000 refugees arrived in Liberia in the first two weeks of November, particularly in Botua, Nimba county and in Bimplay (UNHCR, 16/11/04; UNHCR, 17/11/04). They have settled in public buildings or with residents. Food, water and sanitation are crucially needed. However, the remoteness of the area, with many roads impassable by car, renders the delivery of assistance difficult. Emergency relief items have been airlifted by UNMIL helicopters.

Central Africa

Burundi

The elections due to take place in October 2004 have been postponed until early 2005. The new timetable includes local and communal elections in February, legislative elections in March and presidential elections in April (IRIN, 18/10/04). A referendum on a draft constitution, which lays out power sharing for the Hutu and Tutsi at a ratio of 60-to-40, should take place at the end of December 2004 (AFP, 17/11/04; IRIN, 03/11/04). Meanwhile, the transitional government has been extended for six months and the draft constitution has been acting as an interim constitution since the beginning of November. The uncertainty about the election timetable led to hundreds of Burundians fleeing to Burundi and Tanzania at the end of October, in fear of violence (IRIN, 03/11/04). Some of them returned shortly thereafter.

The United Nations Operation in Burundi (ONUB) is currently deployed (ONUB, 02/11/04). Demobilisation of 45,000 soldiers and 35,000 former rebels should begin at the end of November 2004 (AFP, 10/11/04).

More than 80,000 refugees have been repatriated from Tanzania so far this year. It seems, however, that due to the political uncertainties, repatriation has slowed down since October 2004 (OCHA, 07/11/04).

The re-integration of the returnees is ongoing and several programmes have been put in place. Donor's commitments to this process is crucial for the future in Burundi (RI, 04/11/04).

The nutrition situation seems to have been stable over the last months (UNICEF-B, 09/04).

Democratic Republic of the Congo

The Rassemblement Congolais pour la Démocratie (RCD) resumed its participation in the government in September 2004 (OCHA, 23/10/04). The United Nations Mission in the Democratic Republic of Congo (MONUC) has been extended until March 2005, with a reinforcement of 5,900 civilian and military personnel (UNSC, 01/10/04). Instability is still prevailing in the east of the country, with reported violence against civilians, including sexual abuses (AI, 26/10/04). Moreover, some refugees, of Tutsi ethnicity, have been prevented from going back home for some time by local populations (OCHA, 31/10/04). The humanitarian situation is also dire. A joint mission reported that humanitarian needs are not covered on the Uvira-Fizzi-Bukavu axis (OCHA, 15/11/04).

UNHCR signed agreements with the Republic of Congo and the Central African Republic for the repatriation of an estimated 72,000 refugees (OCHA, 23/10/04). Refugee International has drawn attention to the IDPs in Kinshasa and Kalemie, who have been left without protection or assistance (RI, 22/10/04).

Uganda

The humanitarian situation continues to be grim for the estimated 1.4 million IDPs in Northern Uganda, despite a slight improvement in the security situation in September and October 2004 (OCHA, 31/10/04).

Several nutrition surveys showed a precarious nutrition situation. In Kitgum district, acute malnutrition rates ranged between 7.4% and 18.3% depending on the camp, while the prevalence of acute malnutrition was between 4.4% and 12.2% in IDP camps in Kitgum district (WFP, 07/04).

A survey conducted in 6 IDP camps in Lira district and one IDP camp in Pader district showed a prevalence of acute malnutrition of 8.3% (6.5-10.0), expressed in percentage of the median, including 4.4% (3.1-5.7) severe acute malnutrition. Half of severe malnutrition was due to oedema (MSF-H, 11/04). Moreover, mortality rates were extremely high: < 5 MR = 5.4 deaths/10,000/day and CMR = 2.79 deaths/10,000/day. Access to water was insufficient: on average, only 7.5 l/pers/day were available, which is far less than the minimum standard. 21% of the families collected water from unprotected sources.

A cholera epidemic broke out in the largest camp of Gulu district where about 64,000 people are settled. In October 2004, 56 patients were identified, of whom three died (WHO, 10/11/04).

Protection is also a major issue. According to the above mentioned MSF survey, 56% of the families interviewed didn't feel safe in the camps. Mental health problems, especially among women, caused by the exposure to traumatic events are also a major concern (MSF-H, 09/04).

UNHCR reported arrivals of about 4,200 refugees from Sudan in September-October 2004, owing to an increase in raids by the Ugandan Lord's Resistance Army and a growing food shortage (UNHCR, 19/11/04).

United Republic of Tanzania

Around 80,000 Burundians have been voluntary repatriated since the beginning of 2004 (RI, 04/11/04) but the flow seems to have decreased since October, probably due to the postponement of the elections in Burundi originally scheduled in October 2004 and now postponed until early 2005 (WFP, 12/11/04). However, Tanzania still hosts an estimated 420,000 refugees mostly from Burundi and DRC, in 13 camps. Funding shortages have obliged WFP to cut cereal and pulse rations by 25%; the situation will not improved until new donors' commitments (WFP, 25/10/04).

Nutrition situation not critical

Random-sampled nutrition surveys were conducted in each refugee camp in August-September 2004 (UNHCR/joint, 09/04). The results showed that the nutrition situation was under control and has remained stable when compared to last year but that the prevalence of malnutrition has slightly increased in some camps, compared to 2002 (figure 5). This may be explained by the cut in food rations experienced in 2003 and 2004 and by the restriction of movements of refugees which was reinforced in 2003 (see RNIS 43). The prevalence of stunting varied between 22% and 42%, depending on the camp.

Anaemia was assessed among children and pregnant women and was found to be a significant health problem (table 8). Anaemia was especially high in Lugufu II, which receives new arrivals from DRC.

Measles vaccination coverage was reported as exceeding 95%.

Figure 5 Prevalence of acute malnutrition, Tanzania refugee camps

Table 8 Anaemia among children and women, refugee camps in Tanzania, Aug-Sept 2004 (UNHCR, 09/04)

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

Overall

The prevalence of acute malnutrition is not critical in the refugee camps in Tanzania. However, anaemia is a significant public health problem in most of the camps. Focus on micro-nutrients should be a priority.

Chad

The situation is still precarious for the estimated 200,000 Sudanese refugees in Chad, as well as for the resident population.

Sudanese refugees

Most of the refugees are now located in the eleven camps settled in eastern Chad (WFP, 05/11/04). Tension and several security incidents have been reported in and around the camps (IRIN, 03/11/04; UNHCR, 01/10/04).

Availability of water is a main issue and the water table has been decreasing very rapidly in some of the camps (UNHCR, 26/10/04). In most of the camps, the quantity of water available per person/day seems to be less than the 15 litres recommended; the number of latrines also seems insufficient.

Cases of hepatitis E have decreased in Goz Amer camp but not in the neighbouring villages (WHO, 27/09/04). The virus has now spread into Bredjing camp, where 41 suspect cases were reported as of 31 October 2004 (IRIN, 03/11/04).

The nutrition situation seems to have slightly improved in the camps. World Vision reported an improvement in October when compared to September. According to MUAC screenings conducted in seven camps during the distribution of blanket supplementary feeding rations, 17.6% of the children had a MUAC < 12.5 cm in September, compared to 12.4% in October (WV, 22/10/04).

A nutrition survey conducted in September in Iridimi and Touloum refugee camps, showed a malnutrition rate of 19.6% (15.9-23.2), including 2.4% (1.3-3.5) severe malnutrition (MSF-B, 10/04). This compares favourably with the nutrition survey conducted by CDC in June 2004 in Iridimi, Touloum and Kounoungo refugee camps when the prevalence of acute malnutrition was 35.6% (see NICS3). Mortality rates were still high: CMR= 1.3 (0.8-1.8), under 5 MR= 2.2 (1.2-3.1). Measles vaccination coverage was good: 96%. At the time of survey, the number of children admitted to TFCs and SFCs were 100 and 2,000 respectively. The number of admissions to feeding centres peaked in July and decreased thereafter. According to the survey, the coverage of the nutrition programme was around 62%. It seems that cases of micro-nutrient deficiencies had been diagnosed in health centres.

Food distributions are on-going in the camps, but due to delays in delivery, shortfalls are expected during the months of November and December (WFP, 19/11/04). According to food basket monitoring, the average food ration distributed in five camps represented 1961 Kcal/pers/day in September and 1967 Kcal/pers/day in October, instead of the intended 2063 Kcal/pers/day. In October, according to the food basket monitoring, the rations distributed varied from 1702 Kcal/pers/day to 2070 Kcal/pers/day, depending on the camp (WV, 20/10/04). According to MSF-B's survey in Iridimi and Touloum camps, 99.6% of the families interviewed had a distribution card and 99.4% received a food distribution in September (MSF-B, 10/04). However, 53.5% of households reported that the number of persons registered on the food distribution card was lower than the actual number of persons in the family. On the other hand, the number of people registered on the card was higher than the actual number of people for 9.5% of the families.

The intended food ration was set at 2061 Kcal in September 2004, but was deficient in some micro-nutrients, especially, vitamin A, vitamin C, riboflavin, iron and folic acid. Moreover, according to the families, 15.4% did not receive sorghum, 28.8% did not receive maize meal, 37% did not receive beans and 10% did not receive CSB during the September distribution.

Blanket supplementary feeding programmes have been implemented in all the refugee camps, and also include monthly screening and referrals of malnourished children to feeding centres (WV, 20/10/04).

Resident population

Resident Chadian populations in the areas of refugee settlement seem to experience more and more difficulties. Not only did they share food supplies with the refugees on their arrival, but refugees and residents populations continue to compete for the scarce resources of the area, such as pasture, water, firewood, wild food and labour opportunities (FEWS, 29/10/04). Moreover, the insecurity in Darfur halted the opportunities for cross-border trade, which was a significant component of the economy. Food prices are rising owing to the disruption of trade with Sudan and the increased demand. The food security situation is also adversely affected by the poor rains in June-September, which have affected both agriculture and pasture (FEWS, 29/10/04). A Government of Chad/UN mission recommended that 20,000 MT of emergency food assistance be distributed to 157,000 resident people (FEWS, 29/10/04). WFP also recommended food for work programmes, school feeding and blanket supplementary feeding (WFP, 05/11/04).

Refugees from Central African Republic

At the end of 2002/beginning of 2003, refugees fled from Central African Republic to southern Chad. Approximately 30,000 refugees are currently settled in two camps. While the situation, including the nutrition situation, was precarious on the arrival of the refugees (MSF, 18/03/04; MSF, 28/05/04), it seems that it has now stabilized. According to a joint WFP/UNHCR assessment conducted in August 2004, the number of malnourished children was low (WFP/UNHCR, 08/04). Refugees had access to labour and trade opportunities and to agricultural activities, which helped them to maintain their food security, despite irregular food distributions due to funding shortages. Public health, water and sanitation were reported as being acceptable. The environment in southern Chad is much easier than in eastern Chad: water is available, there are opportunities for agricultural activities and the area is more developed.

Overall

Despite some improvements, the situation is still precarious in the refugee camps in Eastern Chad, especially regarding the sanitary conditions and the delivery of food aid. Moreover, the Chadian population in the surrounding area face dire conditions. Donor's and agencies' commitment should be sustained to allow the situation to improve further.

Southern Africa

Angola

Since the peace accord in April 2002, about 274,000 refugees have returned home, of whom about 150,000 have been repatriated by UNHCR (IRIN, 15/11/04). However, programmes to support the resettlement are under funded. WFP food distribution programme was only 40% resourced as of October 2004 while FAO had a shortage of toolkits (IRIN, 16/11/04; WFP, 19/11/04). Bad road conditions and the presence of land mines continue to hamper access to part of the country.

The 2003/2004 cereal production was 9% higher than last year and 27% higher than the average five previous years, due particularly to an increased area being under cultivation (FAO/WFP, 06/08/04). Around 1.6 m people have been estimated in need of food aid between May 2004 and April 2005. The number of people categorized food insecure (mostly returnees arrived after the 2003 planting season) has decreased by 67%, compared to the previous year, while the number of people estimated moderately vulnerable and requiring food aid only during the hunger gap has increased by 29% (table 9).

According to various nutrition surveys, the nutrition situation is still average and mortality rates were under control (table 10). In Caconda and Ganda municipalities, the number of admissions to TFCs and SFCs were lower in 2004 than in 2003.

In Caconda municipality, the increase in the malnutrition rate when compared with January 2004 may be explained by the failure of the harvest due to heavy rains. Depending on the area, measles vaccination coverage and vitamin A coverage were average to low (table 10). The prevalence of anaemia was a significant public health problem in Caconda and Chipindo municipalities. According to measurements of iodine concentration in salt, only 48% of families consumed iodized salt in Caconda municipality, while 80.7% of households consumed iodized salt in Chipindo municipality. However, 9% and 22.2% of the iodized salt contained less than 15 ppm iodine, in Caconda and Chipindo, respectively, which is less than the recommended amount.

Table 9 People requiring food assistance between April 2004 and May 2005, Angola (FAO/WFP, 08/04)

Table 10 Results of nutrition surveys among children 6-59 months old, Angola, August-September 2004 (ACH-S, 08-09/04)

* According to cards and mothers' statements
** Hb < 11 g/dl

Asia

Afghanistan

The presidential elections ran more smoothly than expected and Hamid Karzai, the former interim president was elected with 55.4% of votes (BAAG, 31/10/04; ICG, 23/11/04). There was a high turnout and it seems that voting was highly driven by regional and ethnic identity. The parliamentary elections are scheduled in April 2005.

The 2004 harvest was poor, due particularly to insufficient rainfall. The cereal harvest is estimated at 3.06 million MT, which is 43% down on the bumper harvest of 2003 and 18% down on the average harvest of 1998 (FAO/WFP, 08/09/04). In addition to reduced precipitation, a slight decrease in the area planted, inappropriate cereal seeds distributed in some parts of the country, crop diseases and diluted mineral fertilisers have also contributed to the poor crop. In some areas, crop failure affected between 50 and 75% of areas planted.

It is estimated that more than six million people will be food insecure and will require support. Among them, four million will have access to assistance through government programmes, while 2.3 million people will be targeted by WFP's emergency programme (FAO/WFP, 08/09/04).

The most affected provinces are Nimroz, Kandahar, Paktika, Zabul, Kunar, Logar and Faryab, with more than 50% of their population who will not be able to meet their basic food needs during winter and spring (MRRD, 09/04).

About 17,000 households were displaced during summer due to a lack of drinking water or irrigation water, or to food shortages (FEWS, 30/09/04).

Refugee repatriation continues. About 373,000 and 366,000 people were repatriated from Pakistan and Afghanistan so far this year: the total number of returns since 2002 amounting to about three million (UNHCR, 07/11/04).

Average situation in Kabul city

A random-sampled nutrition survey was conducted in Kabul in July 2004 (ACF-F, 08/04). Among the families surveyed, 65% were residents, 30% were returnees and 5% were displaced. The prevalence of acute malnutrition was 8.9% (6.6-12.0), including 0.6% (0.1-2.0) severe acute malnutrition. The mortality rates were under control: CMR= 0.3/10,000/day and under five MR= 0.63/10,000/day. Measles vaccination coverage was average: 85.2%. The prevalence of acute malnutrition is higher during summer months than during winter. Compared with the previous two years, at the same season, the nutrition situation seems to have been stable (figure 6).

Figure 6 Prevalence of acute malnutrition, Kabul, Afghanistan

A random-sampled nutrition survey was also carried out in May 2004, among the under six-month-olds as they represent a significant proportion of admissions to TFCs (ACF-F, 05/04). Among the 507 infants measured, 18 had a height of less than 49 cm and therefore their weight-height index could not be calculated. Seven of these children had a weight lower than 2.5 kg.

Among the remaining 489 infants, only two cases of moderate malnutrition and no cases of severe malnutrition were recorded. The mean weight-height was -0.15 Z-scores.

98.4% of the infants were breastfed, of whom only 44.1% were exclusively breastfed. The others received liquids such as tea, water, juice and powdered milk (20.2%) and/or solid food (34.2%). About 25% of the mothers reported using feeding bottles, most of the time for giving powdered milk.

Although not directly comparable, the results of this survey compare favourably with the results of a survey conducted in February 1999, in conjunction with an anthropometric survey of 6-59 month-old children, where among about 132 infants measured, 6.1% (1.8-15.7) were found to be malnourished.

A vulnerability mapping analysis conducted in Kabul in January 2004 showed that access to infrastructure and services was key to vulnerability and was not equally available throughout the city (ACF-F, 01/04). Neighbourhoods left out of the municipality master plan were especially at risk. It also appeared that the status of the families (residents, displaced or returnees) was a less important factor of vulnerability than the stability of income resources, the network, the composition of the household and the housing situation, with the highest vulnerability among those who had to rent a house. The study recommends that comprehensive long-term plans on urban planning, health care, transportation and sanitation network be put in place as soon as possible, and that in the short to medium-term, rehabilitation of destroyed housing, income generation schemes, and public infrastructure be enhanced in highly vulnerable areas.

The Caribbean

Haiti

Haiti has known both political and natural crises in 2004. In early 2004, an armed uprising and international political pressure led to the resignation of the president Jean-Bertrand Aristide. This was followed by the deployment of a UN peace-keeping force, the MINUHSTAH and by the appointment of an interim government until the elections scheduled in 2005. However, the situation is volatile. Only two-thirds of the peace-keeping forces have yet been deployed and no disarmament of illegal armed groups has been initiated. The transitional government has failed to establish its authority in most of the provinces, which are controlled by former military, and supporters of the former president control most of the poor neighbourhoods of Port-au Prince (ICG, 18/11/04). Violence and insecurity are on the rise (OCHA, 17/11/04), which hampers the proper delivery of aid, especially in the hurricane affected areas of Artibonite and North West departments.

The total number of people affected by the mid-September hurricane is estimated at 298,926 and Gonaive has been particularly affected (see map) (OCHA, 10/04). Food distribution was ongoing in Gonaive from the onset of the floods until mid-October. It was then replaced by targeted food distributions (WFP, 19/11/04). It is estimated that 80% of the irrigation system has been destroyed in the area (OCHA, 17/11/04). The floods have also had a significant impact on the fishing sector with a loss of assets such as hoop nets, fishing nets and boats. Moreover, people were reluctant to eat fish and the price of fish was very low. The salt marshes have also been badly affected with most of them being over-flooded (ACF-F, 10/04).

Tropical storm Jeanne, Haiti (OCHA, 09/04)

Random-sampled nutrition surveys conducted before the hurricane, in Anse Rouge (Artibonite department) and Saint Louis du Nord (North West department), showed an acceptable nutrition situation (ACF-F, 04/04; ACF-F, 05/04). The prevalence of acute malnutrition was 5.4% (3.6-8.0), including 0.2% (0.0-1.4) severe acute malnutrition and 3.8% (2.3-6.1), including 0.5% (0.1-1.9) severe acute malnutrition in Anse Rouge and Saint Louis du Nord, respectively. The impact of the hurricane on the nutrition situation has not yet been documented.

Other random-sampled nutrition surveys conducted in vulnerable areas of departments which were not affected by the hurricane (South and North-East departments ) or less affected (North department) also showed acceptable nutrition situations and mortality rates (table 11).

Table 11 Results of nutrition surveys among children 6-59 months old, Haiti, June-July 2004 (ACF-F, 06-07/04)

* According to cards and mothers' statements

Middle East

Occupied Palestinian Territories

The second Intifada, which began in September 2000, is still on-going. The recent death of the president of the Palestinian Authority, Yasser Arafat has meant that there will be elections in January 2005 (AFP, 14/11/04). Restrictions on the movement of Palestinians have particularly affected food security as many have lost their former employment in Israel. Moreover, the blockade paralyses the economy of the territories and hampers access to health care (see RNIS 43).

It had seemed there was a slight improvement in the situation in 2003, with a relaxation of closures and a modest economic recovery due to an increase in the amount of employment within the territories (WB, 11/04). The Palestinian Authority budget recovered somewhat in 2003 with an increase in the transfers of clearance revenue from Israel and collection efforts by the Palestinian authorities (WB, 03/04). On the other hand, budget support from donors declined to US$ 230 million in 2003 from US$ 467 million and US$ 530 million in 2002 and 2001, respectively (WB, 03/04).

The construction of the Separation Barrier, which aims to separate the West Bank from Israel intensified in 2003. However, the construction of the barrier has had a limited impact on the economy compared to the impact of closures, although agricultural lands, infrastructure and water resources have been destroyed and access to land has been further restricted (WB, 11/04). Moreover, thousands of Palestinians have had less access to basic services.

The situation suffered a further setback in 2004, especially in the Gaza Strip where an estimated 20,000 people lost their jobs (WB, 11/04). Restrictions of movement have intensified as well as incursions by the Israeli army which have led to an unprecedented destruction of houses and infrastructure (UNRWA, 11/04). Only an average of 1,900 workers crossed daily from the Gaza Strip to Israel this year, compared to about 10,000 in 2003 (OCHA, 10/04). Humanitarian access to the Gaza Strip has also seen the worst restrictions since the beginning of the Intifada (UNRWA, 11/04).

Coping mechanisms developed by the Palestinians to deal with the economic crisis have tended to become overstretched. While in 2001, 70% of the poorest families drew down their savings, only 13% were able to do so in 2003 (WB, 11/04). Support from relatives is also a significant way of coping, but it seems that the value of assistance from relatives has sharply decreased since the beginning of the Intifada, especially in the Gaza Strip (IUED, 10/03).

However, it seems that basic needs services are still provided thanks to donors' commitment, although support from donors declined slightly in 2003 compared to 2002 (WB, 11/04). The proportion of the population who received assistance was consistent between 2001 and 2003 and was 48% in July 2003 (IUED, 10/03). Coverage of the needy population seemed to have increased in 2003 compared to 2002, maybe due to better targeting (IUED, 10/03). However, 24% of the hardship cases reported that they did not receive assistance. The proportion was especially high outside the camps: 38% in the West Bank and 19% in the Gaza Strip.

Food was the main type of assistance received (69% of families), followed by financial aid (17%) (IUED, 10/03).

WFP has estimated that in 2004, 752,000 people are food insecure among the non refugee population, among whom WFP aims at targeting 457,000 for whom food aid is considered an appropriate intervention (WFP, 06/04): the "chronic poor", "new poor farmers" (farmers whose land is confiscated or who have lost access to markets) and "new poor unskilled waged workers" (waged workers who have lost jobs due to closure).

In addition, UNRWA, the agency caring for the refugees in the Occupied Palestinian Territories (estimated at about 1.5 m) has made an appeal to distribute a 60% food ration to 226,000 families, besides other programmes such as employment creation, health care and house reconstruction (UNRWA, 11/04).

Nutrition situation

A nutrition survey, which was conducted in mid-2003 and recently released, showed an acceptable situation: the prevalence of acute malnutrition was 3.9% in the Gaza Strip and 3.1% in the West bank, while stunting rates were 12.7% and 9.2% in the Gaza Strip and the West Bank, respectively (AQU/JHU/Care, 08/03). Stunting was significantly higher in the Gaza Strip than in the West Bank and significantly higher in refugee children than in non-refugees. However, there was no difference in wasting or stunting between camps, rural areas or urban areas, which is not contradictory to the fact that refugee children are more affected by stunting, because more than half of the refugees live outside the camps. The nutrition situation has been stable over the previous two years (see RNIS 43).

A survey on micro-nutrient deficiencies was carried out in June 2004 among children 6-59 months old (MARAM, 06/04). The survey revealed a high prevalence of vitamin A, vitamin E and iron deficiencies (table 12). Low plasma level of vitamin A may be caused or compounded by infection. When adjusted for infectious status, a significant proportion of the children remained vitamin A deficient (table 12). Prevalence of all micro-nutrient deficiencies was significantly higher in the Gaza Strip than in the West Bank.

The results of this survey are in line with the food consumption survey done by AQU/JHU/Care, which found that a significant proportion of children had an intake of vitamin A, vitamin E, folic acid and iron lower than the Recommended Dietary Allowance, and for vitamin A and iron in particular in the Gaza Strip (AQU/JHU/Care, 08/03).

The MARAM survey also assessed use of iodized salt in the households. According to the survey, 80% of the families were using iodized salt, although about half of the women didn't know they were using it or thought they were not.

Table 12 Vitamin A, vitamin E deficiencies and anaemia among 12-59 month olds, The Gaza strip and West Bank, June 2004 (MARAM, 06/04)

Overall

The economic situation is still dire in the Palestinian territories. The resilience of the population, as well as the external assistance, has helped to keep the nutrition situation acceptable, although there are significant levels of micro-nutrient deficiencies. Only a political solution may see the situation improving.

Abbreviations and acronyms
 

References

Greater Horn of Africa

Eritrea

FEWS 18/10/04 Eritrea, food security update

N-NSS 07/04 Nutrition survey report, Northern Red Sea, Gash Barka, Debub, Anseba

Ethiopia

DFID 04/10/04 Humanitarian situation in Ethiopia, Sep 2004

FEWS 26/10/04 Monthly food security update

FEWS 29/10/04 Food security emergency, October 2004

Kenya

AAH-UK 08/04 Rapid assessment, nutrition and water, Mandara Central, Takaba, Kotulo, Lafey and Wargadud divisions, Mandera district, Kenya

CDC 03/09/04 Outbreak of aflatoxin poisoning-Eastern and Central provinces, Kenya, January- July 2004, MMWR

FEWS 07/10/04 Food security report

FEWS 28/10/04 FEWS Kenya food security warning 28 October 2004—Pipeline shortfall elevates risk

FEWS 11/11/04 Monthly food security update

UNICEF/MOH 09/04 Integrated programme survey, Garissa district, summary report

WFP 29/10/04 WFP Emergency report No 44

Somalia

AFP 29/08/04 Another batch of Somali lawmakers sworn in Nairobi

AFP 11/10/04 Somali president extends olive branch to warlords

AU 01/11/04 New initiative to support strategic planning for demilitarisation in Somalia

BBC News 03/11/04 Somali hopes rest with new Prime Minister

IRIN 01/11/04 Somalia: over 100 killed in clashes between Somaliland and Puntland

FSAU 10/04 Food security and nutrition monthly briefing

FSAU/N 09/04 Monthly nutrition update

FSAU/N 10/04 Monthly nutrition update

FSAU 11/04 Food security and nutrition, November monthly brief

Sudan

AAH-US 08/04 Nutritional anthropometric survey, children under 5 years old, Mayiandit district, Mayiandit county, Western Upper Nile

ACF-F 08/04 Nutritional anthropometric survey, preliminary results report, 7 villages in Lafon Rural Council

CDC/WFP 09/04 Emergency nutrition assessment of crisis affected populations, Darfur region

Depoorter E. & al. 10/04 Violence and mortality in West Darfur, Sudan, (2003-04): epidemiological evidence from four surveys, The Lancet. http://image.thelancet.com/extras/04art9087web.pdf 

DPA 10/11/04 Sudanese military raid camp in Darfur, despite agreements

DPA 11/11/04 African Union names Special Representative to Sudan

Epi/MSF 08/04 A survey of internally displaced persons and resident population in Habilah, West Darfur, Sudan

Epi/MSF 08/04 Health assessment in emergencies, Kebkabyia, North Darfur, Sudan

Epi/MSF 09/04 Rapid health assessments of populations in Kass, Kalma and Muhajiria, South Darfur, Sudan

FEWS 26/10/04 FEWS Southern Sudan Food Security Update, harvest brings relief

HRW 15/11/04 “If we return, we will be killed” - Consolidation of ethnic cleansing in Darfur

ICRC 20/10/04 ICRC food needs assessment in Darfur

IRC 20/10/04 Khartoum: Bulldozers raze settlements of Sudan’s displaced

IRC 15/11/04 NGOs call on the UN to take strong action on Sudan

IRIN 13/10/04 Sudan: Demolitions render thousands of IDPs homeless

IRIN 25/10/04 70,000 Darfur reportedly taken back to their homes

IRIN 01/11/04 Sudan: Absence of flooding threatens food security in the south

MSF-CH 05/04 Nutrition and measles vaccination coverage survey, Tonj county, South Sudan

RI 10/11/04 Lack of coordination is hampering effective relocation policy in Darfur

SC-UK 25/09/04 Darfur Food Information System Bulletin

Tearfund 07/04 Anthropometric nutritional survey for children under five years

UNICEF 27/10/04 South Sudan Operation: Nutrition Situation October 2005

WFP 10/04 Emergency food security and nutrition assessment in Darfur, Sudan

WFP 12/11/04 WFP Emergency Report No 46

WHO/EPIET 09/04 Retrospective mortality survey among internally displaced population, Greater Darfur, Sudan

West Africa

Ivory Coast

AAH 09/11/04 Guinée: Action contre la Faim s’apprête à accueillir les réfugiés de Côte d’Ivoire

BBCNews 14/11/04 Expats flood out of Ivory Coast

DPA 17/11/04 All nations must enforce UN arms embargo on Ivory Cast: Mbeki

UNHCR 17/11/04 Ivorian refugee arrivals in Liberia reach 13,000

UNCRH 15/11/04 United Nations human rights experts express strong concern about new outbreak of violence in Côte d’Ivoire

UNNews 16/11/04 UN reports improvement in Côte d’Ivoire conflict with hate messages ending

UNSC 15/11/04 Security Council imposes immediate, 13-month arms embargo on Côte d’Ivoire, unanimously adopts resolution 1572 (2004)

Liberia

ACF-F 09/04 Food security surveillance assessment update, Bong County

ACF-F 08-09/04 Food security assessment reports, Lofa County

ICRC 06/04 Ecosec evaluation mission River Gee, Maryland, Grand Kru

OCHA 07/11/04 Liberia humanitarian situation update No. 124

UNHCR 29/10/04 Liberians repatriate from Guinea, IDPs set to return

UNHCR 08/11/04 Internally displaced Liberians start journey home; first airlift from Nigeria

UNHCR 16/11/04 Liberia: arrivals from Côte d’Ivoire in last 10 days top 10,000

UNHCR 17/11/04 Ivorian refugee arrivals in Liberia reach 13,000

USAID 31/10/04 USAID field report Liberia Oct 2004

Central Africa

Burundi

AFP 10/11/04 Massive demobilisation operation in Burundi to start November 29

AFP 17/11/04 Burundi’s constitutional referendum postponed until 22 December

IRIN 18/10/04 Burundi: Transitional government to be extended six months

IRIN 03/11/04 Burundi: New interim constitution ushers optimism

OCHA 07/11/04 OCHA-Burundi situation report 1-7 Nov 2004

ONUB 02/11/04 Burundi: Opening of two new ONUB regional offices

RI 04/11/04 Refugee voice: Burundians returning from Tanzania

UNICEF-B 09/04 Analyse de la situation nutritionnelle

Democratic Republic of Congo

Amnesty 26/10/04 Democratic Republic of Congo: Mass rape leaves a public health crisis

OCHA 23/10/04 RDC: Rapport mensuel Septembre 2004

OCHA 31/10/04 RDC: Rapport mensuel Octobre 2004

OCHA 15/11/04 RDC Uvira/Fizzi: Un renfort financier et en partenaires humanitaires est indispensable

RI 22/10/04 DRC: UN humanitarian agencies are failing displaced in camps

UNSC 01/10/04 UN SC extends DRC mission until 31 March 2005, authorizes additional 5,900 troops, police– Unanimously adopts resolution 1565 (2004)

Uganda

MSF-H 09/04 Pader: a community in crisis, a preliminary analysis of MSF-Holland’s baseline mental health assessment in Pader, Uganda

MSF-H 11/04 Internally Displaced Camps in Lira and Pader Northern Uganda, a baseline survey, preliminary report

OCHA 31/10/04 Humanitarian update Uganda, Oct 2004, volume VI, issue X

UNHCR 19/11/04 Uganda: Arrivals from southern Sudan on the increase

WFP 07/04 Summary of nutrition and health assessment in the internally displaced persons camps in Pader district

WFP 07/04 Summary of nutrition and health assessment in the internally displaced persons camps in Kitgum district

WHO 10/11/04 Update on cholera outbreak in Pabbo IDP camp

United Republic of Tanzania

RI 04/11/04 Refugee voice: Burundians returning from Tanzania

UNHCR/ 09/04 A joint nutrition survey conducted by UNHCR, UNICEF and WFP in joint collaboration with the health implementing partners in the refugee camps in Western Tanzania

WFP 25/10/04 WFP cuts food rations for refugees in Tanzania

WFP 12/11/04 WFP emergency report No. 46

Chad

IRIN 03/11/04 Chad: Fresh unrest at refugee camp slows efforts to block deadly virus

FEWS 29/10/04 Chad: Food security emergency 29 Oct 2004—Resource competition increases tension

MSF 18/03/03 Chad-CAR: Still no food or shelter as the influx continues

MSF 28/05/03 First signs of malnutrition among refugees

MSF-B 10/04 Enquête nutritionnelle, de mortalité rétrospective et de sécurité alimentaire, camps de réfugiés soudanais de Touloum et Iridimi, region d’Iriba, Est-Tchad

UNHCR 01/10/04 Security boost for Chad’s camps amid violence against refugees

UNHCR 26/10/04 Camps in north-eastern Chad running dry, warns UNHCR

WFP 05/11/04 WFP Emergency Report No. 45

WFP 19/11/04 WFP Emergency Report No. 47

WFP/ 08/04 Rapport de mission d’évaluation conjointe PAM/HCR/Gouv du Tchad, ONGs, des UNHCR besoins des populations réfugiées Centrafricaines au sud du Tchad

WHO 27/09/04 Hepatitis E in Chad—update 4

WV 22/10/04 Blanket supplementary feeding program, nutrition update report

Southern Africa

Angola

ACH-S 08/04 Inquerito Nutricional e de mortalidade, Municipio de Caconda, Provincia de Huila

ACH-S 09/04 Inquerito Nutricional e de mortalidade, Municipio de Chipindo, Provincia de Huila

ACH-S 09/04 Inquerito Nutricional e de mortalidade, Municipio de Ganda, Provincia de Benguela

FAO/WFP 08/04 FAO/WFP crop and food supply assessment mission to Angola

IRIN 15/11 Angola: Homecoming joy for returnees, but what next?

IRIN 16/11 Lack of aid hampers reintegration of returnees

WFP 19/11/04 WFP Emergency Report No. 47

Asia

Afghanistan

ACF-F 01/04 Kabul vulnerability mapping

ACF-F 05/04 Nutrition anthropometric survey, infant below 6 months, Kabul city, Afghanistan

ACF-F 08/04 Nutrition anthropometric survey, children under 5 years old, Kabul city

BAAG 31/10/04 BAAG Afghanistan monthly review, October 2004

FAO/WFP 08/09/04 FAO/WFP crop and food supply assessment mission to Afghanistan

FEWS 30/09/04 Fews Afghanistan monthly food security bulletin Sep 2004—severe water shortage

ICG 23/11/04 From presidential to parliamentary elections

MRRD 09/04 Analysis of drought impact in Afghanistan

UNHCR 07/11/04 UNHCR assisted voluntary repatriation to Afghanistan

The Caribbean

Haiti

ACF-F 04/04 Enquête nutritionnelle anthropométrique, Saint Louis du Nord, Haiti

ACF-F 05/04 Enquête nutritionnelle anthropométrique, Anse Rouge, Haiti

ACF-F 06/04 Enquête nutritionnelle anthropométrique, Cap Haitien, Haiti

ACF-F 06/04 Enquête nutritionnelle anthropométrique, Terrier Rouge, Haiti

ACF-F 07/04 Enquête nutritionnelle anthropométrique, Tiburon, Haiti

ACF-F 10/04 Agro-ecological and economical zones, Anse Rouge et Terre Neuve, Haiti

ICG 18/11/04 A new chance for Haiti?

OCHA 10/04 Haiti, 2004, flash appeal

OCHA 17/11/04 Haiti: socio-political crisis OCHA situation report No. 16

WFP 19/11/04 WFP Emergency Report No. 47

Middle East

Occupied Palestinian Territories

AFP 14/11/04 Palestinian presidential elections to be on January 9: official

AQU/JHU/CARE  08/03 Nutritional assessment of the West Bank and Gaza Strip

IUED 10/03 Palestinian public perceptions on their living conditions

MARAM 06/04 Prevalence of vitamin A deficiency among children aged 12-59 months in the West Bank and Gaza strip

OCHA 10/04 Gaza on the edge

UNRWA 11/04 UNRWA Emergency Appeal 2005

WB 03/04 West Bank and Gaza update

WB 11/04 Four years—Intifada closures and Palestinian Economic Crisis

WFP 06/04 Emergency food security needs assessment , 2004 update assessment

Summary of the Survey Results

Table Continued...

Table continued...

Notes on the survey methodologies

The Greater Horn region

Eritrea

Four surveys were conducted in Anseba, Debub, Gash Barka and Northern Red Sea between May and July 2004. The samples were stratified multi-stage random samples. 1122, 1313, 1391 and 863 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 morbidity and various food security indicators.

Kenya

Pastoral area, Garissa district

The survey was conducted by UNICEF/MOH in September 2004. A two-stage cluster sampling methodology of 30 clusters was used to measure 1118 children between 6-59 months. The survey also estimated measles vaccination and vitamin A coverage, retrospective mortality rates and various food security indicators.

Somalia

IDP settlements, Bossaso

The survey was conducted by UNICEF/FSAU/MOH in July 2004. An exhaustive survey was conducted. 1,411children were surveyed. 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.

IDP camps, Mogadishu

The survey was conducted by UNICEF/WFP/joint in July 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 and vitamin A coverage, morbidity, retrospective mortality rates over the 3 months prior to the survey and various food security and public health indicators.

Dusamareeb and Adaado districts, Galgadud

The survey was conducted by FSAU/UNICEF/MOH in September 2004. A two-stage cluster sampling methodology of 30 clusters was used to measure 928 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, pregnant women’s MUAC and various food security and public health indicators.

Sudan

IDPs, North and West Darfur

The survey was conducted by WHO/EPIET in August 2004. A two-stage cluster sampling methodology was used. For each state, 50 clusters were randomly selected. 30 households were interviewed in each cluster. The survey estimated retrospective mortality rate over the three months prior to the survey and various public health indicators.

Greater Darfur

The survey was conducted by CDC/WFP in August-September 2004. A two-stage cluster sampling methodology of 46 clusters was used to measure 888 children between 6-59 months and to interview 880 households. The survey also estimated measles vaccination and retrospective mortality rate over the six months prior to the survey.

Measurement of haemoglobin was performed directly in the household using a portable photometer ‘Hemocue B-haemoglobin’ Photometer. Iodine and vitamin A deficiencies were also assessed as well as the anthropometric nutritional status of pregnant women.

Kass, Kalma and Muhajiria, South Darfur

Three surveys were conducted by Epicentre/MSF in September 2004. A two-stage cluster sampling methodology of 30 clusters was used to measure 898, 888 and 896 children between 6-59 months, respectively. The surveys also estimated measles vaccination, retrospective mortality rates over the previous 6 to 7 months and various public health and food security indicators.

Kebkabyia, North Darfur

The survey was conducted by Epicentre/MSF in August 2004. A two-stage cluster sampling methodology of 30 clusters was used to measure 921 children between 6-59 months and to interview 909 families. The survey also estimated measles vaccination coverage, retrospective mortality rate over one month prior to the survey and various food security and public health indicators.

Habilah, West Darfur

The survey was conducted by Epicentre/MSF in August 2004. A two-stage cluster sampling methodology of 32 clusters was used to measure 938 children between 6-59 months and to interview 960 families. The survey also estimated measles vaccination coverage, mortality rate over the two months prior to the survey and various food security and public health indicators.

Lafon Rural Council, Eastern Equatoria

The survey was conducted by ACF-F in August 2004. A two-stage cluster sampling methodology of 30 clusters was used to measure 950 children between 6-59 months, respectively. The survey also estimated measles vaccination and retrospective mortality rate over the previous 3 months.

Aweil South county, Bahr el Gazhal

The survey was conducted by Tearfund in Ayai, Wathmok, Gakrol, Panthou and Tieralet districts, in July 2004. A two-stage cluster sampling methodology of 30 clusters was used to measure 931 children between 6-59 months. The survey also estimated measles vaccination, retrospective mortality rate and various public health indicators.

Mayinadit district, Mayiandit county, Western Upper Nile

The survey was conducted by AAH-USA in August 2004. An exhaustive survey was conducted, 470 children were measured. The survey only included villages situated within a 3 hour walk radius from the airstrip. The survey also estimated measles vaccination and retrospective mortality rate.

Tonj county, Bahr el Ghazal

The survey was conducted by MSF-CH in Akop, Ananatak, Paweng and Makuac districts in August 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 and retrospective mortality rate over the five months prior to the survey.

Central Africa

United Republic of Tanzania

Refugee camps

Thirteen surveys were conducted by UNHCR/UNICEF/joint in August-September 2004. Two-stage cluster sampling methodologies of 30 clusters were used. The surveys also estimated measles vaccination. Measurement of haemoglobin was performed directly in the household using a portable photometer ‘Hemocue B-haemoglobin’ Photometer.

Chad

Touloum and Iridimi refugee camps

The survey was conducted by MSF-B in October 2004. A two-stage cluster sampling methodology of 30 clusters was used to measure 828 children. The surveys also estimated measles vaccination, retrospective mortality over the previous 2 months and various indicators regarding the food distribution.

Southern Africa

Angola

Chipindo municipality, Huila province

The survey was conducted by ACH-S in September 2004. A two-stage cluster sampling methodology of 30 clusters was used to measure 950 children between 6-59 months. The survey also estimated vaccination and vitamin A distribution coverage and mortality rates. Measurement of haemoglobin was performed directly in the household using a portable photometer ‘Hemocue B-haemoglobin’ Photometer. Iodine concentration in salt was measured using field test kit for iodised salt (MBIKITS International).

Caconda municipality, Huila province

The survey was conducted by ACH-S in August 2004. A two-stage cluster sampling methodology of 30 clusters was used to measure 950 children between 6-59 months. The survey also estimated vaccination and vitamin A distribution coverage and mortality rates. Measurement of haemoglobin was performed directly in the household using a portable photometer ‘Hemocue B-haemoglobin’ Photometer. Iodine concentration in salt was measured using field test kit for iodised salt (MBIKITS International).

Ganda municipality, Huila province

The survey was conducted by ACH-S in September 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.

Asia

Afghanistan

Kabul city

The survey was conducted by ACF-F in July 2004. A two-stage cluster sampling methodology of 30 clusters was used to measure 951 children between 6-59 months. The survey also estimated measles vaccination coverage and mortality rates over the previous three months.

The Caribbean

Haiti

Anse Rouge, Artibonite department

The survey was conducted by ACF-F in May 2004. A two-stage cluster sampling methodology of 30 clusters was used to measure 924 children between 6-59 months. The survey also estimated measles vaccination coverage and mortality rates over the previous three months.

Saint Louis du Nord, North-West department

The survey was conducted by ACF-F in April 2004. 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.

Terrier Rouge, North-East department

The survey was conducted by ACF-F in June 2004. A two-stage cluster sampling methodology of 30 clusters was used to measure 931 children between 6-59 months. The survey also estimated measles vaccination coverage and mortality rates over the previous three months.

Tiburon South, South department

The survey was conducted by ACF-F in July 2004. A two-stage cluster sampling methodology of 30 clusters was used to measure 926 children between 6-59 months. The survey also estimated measles vaccination coverage and mortality rates over the previous three months.

Shada II and Bas Aviation neighbourhoods, North department

The surveys were conducted by ACF-F in June 2004. A systematic random sampling methodology was used to measure 280 children and 351 children between 6-59 months in Shada II and Bas Aviation, respectively. The surveys also estimated measles vaccination coverage and mortality rates over the previous three months.

Middle East

Occupied Palestinian Territories

The survey was conducted by AQU/JHU/CARE in August 2003. The sample was a stratified multi-stage random sample. 3,089 children between 6-59 months were surveyed. The survey also estimated food consumption and various food security indicators.

Micronutrient deficiencies

The survey was conducted by MARAM in June 2004. The sample was a stratified multi-stage random sample. 1,107 children between 12-59 months were surveyed. Retinol and vitamin E plasma concentration were measured by High Pressure Liquid Chromatography (HPLC) method.

Indicators, interpretation and classification

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.

Nutrition indicators in 6-59 month olds

Unless specified, the Reports on Nutrition Information in Crisis Situations use the following internationally agreed criteria:

• Wasting, defined as weigh-for-height index (w-h) < -2 Z-scores.
• Severe wasting, defined as weigh-for-height index < -3 Z-scores.
• Oedematous malnutrition or kwashiorkor, diagnosed as bilateral pitting oedema, usually on the upper surface of the feet. Oedematous malnutrition is always considered as severe malnutrition.
• Acute malnutrition, defined as the prevalence of wasting (w-h < -2 Z-scores) and/or oedema
• Severe acute malnutrition, defined as the prevalence of severe wasting (w-h < -3 Z-scores) and/or oedema.
• Stunting is usually not reported, but when it is, these definitions are used: stunting is defined as < - 2 Zscores height-for-age, severe stunting is defined < - 3 Zscores height-for-age.
• Mid-Upper-Arm Circumference (MUAC) is sometimes used to quickly assess nutrition situations. As there is no international agreement on MUAC cut-offs, the results are reported according to the cut-offs used in the survey.
• Micro-nutrient deficiencies are reported when data are available.

Nutrition indicators in adults

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.

Mortality rates

In emergency situations, crude mortality rates and under-five mortality rates are usually expressed as number of deaths/10,000 people/day.

Interpretation of indicators

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.

Classification of situations

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:

• Populations in category I – the population is currently in a critical situation; they either have a very high risk of malnutrition or surveys have reported a very high prevalence of malnutrition and/or elevated mortality rates.
• Populations in category II are currently at high risk of becoming malnourished or have a high prevalence of malnutrition.
• Populations in category III are at moderate risk of malnutrition or have a moderately high prevalence of malnutrition; there maybe pockets of high malnutrition in a given area.
• Populations in category IV are not at an elevated nutritional risk.
• The risk of malnutrition among populations in category V is not known. 
  

Nutrition Causal Analysis

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.
 

References

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.

NICS Quarterly Reports

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