United Nations System
Nutrition in Crisis Situations
Vol 5, February 2005
Kenya—Serious nutrition situation in Turkana district—Contrary to expectations before the onset of the short rainy season, rains were poor in the marginal agricultural districts in Eastern, Coast and Central provinces, which has led to maize crop failure. In some districts of these provinces, the nutrition situation was not critical as of October 2004 but the poor last rainy season may worsen the situation.
Food security seemed to have improved in some pastoral areas, while it has remained difficult in others. According to nutrition surveys in Kakuma refugee camp and among resident populations around Kakuma town, Turkana district, the nutrition situation was serious and mortality rates were high.
Somalia—Precarious situation—Parts of south and north-eastern Somalia continue to experience high food insecurity and precarious to dire nutrition situations. The tsunami has affected at least 50,000 people in the north-eastern coastal area.
Sudan—Volatile situation—The security situation is still highly volatile in Darfur with reported attacks on villages, population displacement and harassment of aid workers. However, it seems that the nutrition situation has improved in some areas.
Liberia—Reconstruction phase—The situation has stabilized in Liberia but there are great challenges in terms of reconstruction, such as housing, roads and infrastructure. Re-integration of the IDPs and refugees will also be a major task.
Democratic Republic of the Congo—High rates of mortality—Despite the beginning of the disarmament process, violence is still widespread in the east of the country with fighting reported in Ituri district and in North Kivu, with the displacement of at least 100,000 people, of whom some have sought refuge in Uganda.
Retrospective mortality surveys showed high mortality rates, especially in the east of the country where they were above alert threshold. The major part of the east has experienced a higher level of violence than the west.
Chad—Situation still of concern—The situation is still bleak in Chad with outbreaks of hepatitis E and meningitis, a low water supply and the fact that insufficient food rations are provided. Sustaining and enhancing the efforts to support both refugees and resident populations is crucial.
Tsunami affected countries—High mobilisation—Following a quake in the Indian Ocean, 250 kilometres northwest of the Indonesian island of Sumatra on 26 December 2004, enormous waves (tsunamis) hit the Aceh area of Sumatra, Indonesia and travelled to several Asian countries such as Sri Lanka, Thailand, India, Burma, Malaysia, the Maldives, and finally to the East African coast in Kenya, Somalia and Tanzania .
Although precise figures are difficult to obtain, the death toll is enormous (between 150,000 and 250,000) as is the number of people affected, which stands at more than one million. Indonesia has been the hardest hit, followed by Sri Lanka, India and Thailand.
Mobilization of assistance and financial contributions to the victims from citizens, private companies and governments have been unprecedented. On the ground, it seems that massive efforts have been deployed by populations, governments and humanitarian agencies, in some cases logistically supported by armies of several countries.
Immediate needs were in terms of provision of health care, food, water, sanitation and shelter, while longer-term needs are to rebuild people's livelihoods.
No significant outbreaks of diseases have occurred so far.
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.
Low cereal production in 2004 and high number of people in need of assistance in 2005
In 2004, cereal production was nearly 47% below the average 1992-2003 production, and was 20% below last year’s production (table 1; FAO/WFP, 18/01/05).
The limited cereal production was due, among other factors, to erratic rainfall, lack of a labour force (most men are enrolled in National Service), lack of farm power (most oxen were sold during the drought in 2002) and a seed deficit. Due to poor rains, livestock has also been seriously affected.
It is estimated that the traditional "hungry season" will begin as soon as February, as opposed to May in "normal" years (OCHA, 31/12/05). Moreover, cereal prices continued to rise sharply in 2004.
The FAO/WFP crop and food supply assessment has estimated that 2.3 m vulnerable people will require 342,000 MTs of food aid in 2005, which is an increase compared to 2004 when 219,000 MTs of food aid were required for 1.4 m vulnerable people (FAO/WFP, 18/01/05). The vulnerable population includes severely drought-affected farmers who will be in need of food aid from January to October 2005, moderately drought-affected farmers, who will benefit from food aid from March to October 2005, agro-pastoralists/pastoralists who will require assistance between January and October 2005, war-affected people and the urban vulnerable (table 2).
Current food stocks for food distribution are expected to last until the end of March 2005 (OCHA, 31/12/05).
Table 1 Cereal production, Eritrea, 2004 (FAO/WFP, 08/01/05)
Table 2 Estimated vulnerable population, Eritrea, 2004 (FAO/WFP, 08/01/05)
Precarious nutrition situation in Southern Red Sea
A random-sampled nutrition survey was conducted in Southern Red Sea in October 2004 (N-NSS, 10/04). The prevalence of acute malnutrition was 13.9% including 1.9% severe malnutrition. It seemed that acute malnutrition was slightly higher in the urban area than in the coastal and inland areas. The nutrition situation compared favourably with March 2004 when the prevalence of acute malnutrition was 20.6% (16.0-25.8) (see NICS 3). This may be partly explained by seasonal patterns, with an improvement of the situation in October due to better rains. The March survey was done after a very dry Bahri rainy season (N-NSS, 10/04).
Although not directly comparable with the last round of surveys done in May-July 2004 in other regions, because surveys were not done in the same season, the nutrition situation in Southern Red Sea seemed comparable with the nutrition situation in Northern Red Sea, worse than in Debub and slightly better than in Anseba and Gash Barka (see NICS 4).
A significant proportion of women had a BMI< 18.5 (table 3). On the other hand, more than 10% of women were considered overweight (table 3). Most of them were located in the urban area.
As recorded in the surveys done in other regions, most families (87%) had received food aid within the four months prior to the survey. However food aid distribution was irregular, with 67.5% of families having received one food distribution only and 20.7% having received two food distributions, instead of the intended monthly food distributions. Moreover, the average amount of cereals received per distribution was 11 Kg, less than the intended 15 Kg. On average and taking into account cereals, pulses and oil, the households received 600 Kcal in the four months prior to the survey.
The supplementary food distribution was more regular than the general food distribution with, of the 82.2% of the children who received supplementary food within the four months prior to the survey, 64.6% having received four supplementary food distributions. However, supplementary food distributions seemed less regular in the inland area with only 20% of the children having received four distributions, compared to 76% and 96% in coastal and urban areas, respectively. This seemed to be a result of problems of food transportation in the inland areas.
Only 35.7% of the households had access to both enough (> 15 l/pers/day) and safe drinking water.
Table 3 Anthropometric nutritional status of non-pregnant women (18 to 60 year olds), Southern Red Sea, Eritrea, October 2004 (N-NSS, 10/04)
Average nutrition situation in Maekel
According to a nutrition survey conducted in Maekel in October 2004, the nutrition situation was average with a prevalence of acute malnutrition of 8.6% (FAO/WFP, 18/01/05). The situation has remained stable since 2003 (UNICEF/MOH, 12/04).
More people are estimated vulnerable in 2005 than in 2004 due to poor rains and crop performance in 2004. Depending on the region, the nutrition situation was average to precarious (category III/II) in 2004 and a substantial level of assistance is still needed to mitigate the crisis Eritrea has been facing for some years.
Medium and long-term policy directions, from the FAO/WFP crop assessment:
From the N-NSS survey:
While production prospects are good for 2005 in the west of the country, which is the grain basket of Ethiopia, the eastern agricultural and the eastern and north-eastern pastoral areas will experience food deficits as a result of poor rainfall (FEWS, 13/01/05). It is estimated that, in addition to the more than five million chronically food insecure who are included in the productive safety net programme, 2.2 million people will require emergency food assistance in 2005 (see maps).
Population requiring assistance under the productive safety net programme (FEWS, 13/01/05)
Population requiring assistance under the Emergency programme (FEWS, 13/01/05)
387,000 MTs of food aid will be required. It is to be noted that this number includes around 900,000 people from Somali and Afar regions, who will benefit from emergency food assistance in the first semester of 2004 and will thereafter be included in the productive safety net programme.
The government announced that certificates guaranteeing land rights will be delivered to ten million within the next three years in an attempt to boost agricultural productivity by creating greater security for farmers (IRIN, 11/01/04). However, analysts said that farmers will still be reluctant to invest in their land, because of lack of actual ownership; the land remaining the property of the state.
Pastoral areas especially affected
Despite some rains at the end of 2004, which somewhat mitigated the situation, pastoral areas continue to be highly affected, and especially, zones 2, 4 and parts of zone 1 and 3 of Afar region and parts of Degehabour, Fik, Warder, Afder and Gode zones of Somali region (FEWS, 13/01/05) (see map).
Areas of heightened concern in pastoral areas (FEWS. 13/01/05)
Several random-sampled nutrition surveys and nutrition rapid assessments showed a precarious nutrition situation in parts of Somali region.
Two random-sampled surveys were conducted in pastoral and agro-pastoral food-economy zones of Cherati, Doloo-Ado, Dollo-Bay and West-Emey districts, Afder and Liban zones, Somali region, in October 2004 (SC-UK, 10/04). The results revealed a precarious nutrition situation and an under-five mortality of concern (table 4).
A measles vaccination and vitamin A distribution campaign was conducted in September 2004, which explains the relatively high proportion of children having received measles vaccination and vitamin A (table 4). However, food security was precarious as well as public health and child-feeding practices (box 1).
Table 4 Results of surveys in pastoral and agro-pastoral areas of Cherati, Dollo-Ado, Dollo-Bay and West-Emey districts, Afder and Liban zones, Somali region, Ethiopia, October 2004 (SC-UK, 10/04)
* According to cards and mothers' statements
Box 1 Food security, public health and child feeding practices, pastoral and agro-pastoral food economy zones, Cherati, Dollo-Ado, Dollo-Bay and West-Emey districts, Afder and Liban zones, Somali region, Ethiopia, October 2004 (SC-UK, 10/04)
While the SC's household economy assessment carried out in December 2003 recommended that 30% of the population received a monthly food distribution, only one distribution was carried out in six months.
Two rapid nutrition assessments conducted in two of the worst affected sub-districts of Geladi district and Boh district, Warder zone, Somali region, in November 2004 revealed that about one out of five children measured (weight-height index) were acutely malnourished (ACF, 11/04).
SCF-USA's rapid assessments, measuring all children in two of the worst affected sub-districts of Gode, Adadle, and Ferfer districts of Gode zone and of Hargelle district of Afder zone, Somali region, in November 2004, showed that between 15% and 28% of the children measured (weight-height index and presence of oedema) were acutely malnourished (SC-USA, 11/04). The highest proportion of malnourished children was found in Gode district.
In August 2004, two random-sampled nutrition surveys were conducted in pastoral and agro-pastoral food economy groups in Shinile, Dambal and Erre districts of Shinile zone, Somali region (SC-UK, 08/04). The surveys showed an average nutrition situation with a prevalence of acute malnutrition of 8.1% (6.2-10.0) including 0.3% (0.0-0.7) severe malnutrition and of 9.8% (7.5-12.0) including 0.5% severe acute malnutrition (0.1-1.0) in agro-pastoral and pastoral food economy groups, respectively. The mortality rates were under-control to average: CMR=0.29 deaths/10,000/day and 0.09 deaths/10,000/day and under-five MR=1.19 deaths/10,000/day and 0.37/deaths/10,000/day in agro-pastoral and pastoral areas, respectively.
Measles vaccination was low, around 50%. According to periodical nutrition surveys undertaken by SC-UK in the same area, the nutrition situation has remained stable since September 2003. Shinile zone is not considered as one of the most affected area in Somali region (see above).
Acceptable to average nutrition situation in parts of East Hararghe and West Hararghe zones, Oromia region
According to seven random-sampled nutrition surveys conducted by Care in three districts of East-Hararghe and four districts of West Hararghe in October/November 2004, the nutrition situation was acceptable to average while mortality rates were under control (table 5) (Care, 11/04). These surveys were done during harvest time and seemed to show improvement in the nutrition situation compared to June 2004 (Care, 11/04).
Table 5 Prevalence of acute malnutrition and Mortality rates, East Hararghe and West Hararghe zones, Oromia region, Ethiopia, Oct-Nov 2004, (Care, 11/04)
From the SC-UK survey in Fader and Liban zones, Somali region:
Contrary to expectations before the onset of the short rainy season, rains were poor in the marginal agricultural districts in Eastern, Coast and Central provinces, which has led to maize crop failure (FEWS, 06/01/05). The expected short rainy season harvest of maize has been revised to 270,000 MTs instead of the 450,000 MTs which was originally expected (FEWS, 20/01/05). The long and short rain harvests are estimated at 2 million MTs instead of the 2.61 million MTs average of the10 previous years (FEWS, 20/01/05). Poor short rains have also badly affected the agro-pastoral district of Kajiado (FEWS, 20/01/05). Pastoral districts of Marsabit and western Mandera have experienced water shortages and fatal clashes over water have been reported in Mandera district and the Mai Mahiu region (FEWS, 20/01/05; AFP, 24/01/05). In other pastoral areas, food security seemed to have improved (FEWS, 20/01/05).
Food distribution to the 26 drought-affected districts improved in December 2004: 2.2 million people received food aid compared to 1.3 million in November. The ration also improved in quantity and quality (FEWS, 06/01/05).
Nutrition situation not critical in Kitui district, Eastern Region and Taita Taveta district, Coastal region
Random-sampled surveys conducted in two southern districts (mostly agro-pastoral), which have been declared affected by the drought, showed acceptable prevalence of acute malnutrition (table 6) (AMREF, 10/04; IMC, 10/04). However, the poor last rainy season may worsen the situation. Mortality was under control in Kitui district.
Table 6 Results of surveys in Kitui district, Eastern province and in Taita Taveta district, Eastern province, Kenya, October 2004 (AMREF, 10/04; IMC, 10/04)
* According to cards or mothers' statements
Precarious nutrition situation in Kakuma refugee camp and Kakuma town, Turkana district
Kakuma refugee camp was set up in 1992 and hosts mostly Sudanese refugees (about 75%), Somali refugees (about 14%) and a small number of people from the Great Lakes. In October 2004, the camp was hosting about 90,000 people.
Turkana district is classified as an “arid and semi-arid land” and is mostly pastoral.
This area is chronically food insecure with a significant reduction in herds over the past few years. The most recent droughts were experienced in 1999-2002 and in late 2003-2004 (see NICS 2).
Two random-sampled nutrition surveys were conducted in Kakuma refugee camp and among resident populations around Kakuma town in October 2004 (IRC, 10/04).
According to the surveys, the nutrition situation was serious and mortality rates were high (table 7). The nutrition status of resident and refugee children were comparable, while mortality rates seemed higher among the resident population than among the refugees.
Comparison with previous surveys showed that the nutrition situation in Kakuma camp was within the same range as in late 2003 (figure 1).
Figure 1 Prevalence of acute malnutrition, Kakuma refugee camp
A survey conducted in February 2004 in Kakuma, Lokichoggio and Oropoi divisions in Turkana district revealed a prevalence of malnutrition of 16.8% (14.5-19.4) (see NICS 2). Although this survey and the survey carried out in October 2004 are not directly comparable, because they were not conducted among the same population, the results of both surveys are within the same range.
Haemoglobin measurements among refugee and resident children showed that anaemia was a major public health problem in both resident and refugee populations (table 8).
Almost all refugee households were getting relief food (98.4%) while 30.7% of the resident households had access to food distributions. More than half of the refugees (58.9%) were selling part of the food distribution to buy items such as milk, meat, vegetables, cloths, soap or firewood.
Only about 35% of the refugee and resident mothers were exclusively breast-feeding their children until the age of 6 months.
Table 7 Results of surveys in Kakuma refugee camp and Kakuma town, Turkana district, Kenya, October 2004 (IRC, 10/04)
* According to cards
Table 8 Prevalence of anaemia, Kakuma refugee camp and Kakuma town, Turkana district, Kenya, October 2004 (IRC, 10/04)
*Mild anaemia: Hb = 7-11 g/dl; moderate anaemia: Hb = 5-7 g/dl; severe anaemia: Hb < 5 g/dl
Average nutrition situation in Dadaab refugee camps, Garissa district
A random-sampled nutrition survey was conducted in June 2004 in Dadaab refugee camp (GTZ, 06/04). At the time of the survey, the three camps located in Dadaab area (Hagadera, Dagahaley and Ifo) were hosting 134,784 people, mainly from Somalia. Unfortunately, the prevalence of acute malnutrition was only expressed as a percentage of the median. The prevalence of acute malnutrition was 6.9% (5.3-8.6), including 0.2% (0.1-0.6) severe acute malnutrition. Comparison with the prevalence of malnutrition, also expressed as a percentage of the median, from previous surveys showed an improvement compared to 2003 when acute malnutrition was 15.1% (12.2-17.9), including 2.2% (1.3-3.1) severe acute malnutrition.
Anaemia (Hb < 11 g/dl) was high among the 6-59 month-olds: Hagadera: 54.3%, Ifo: 61.2% and Dagahaley: 60.9%. It was, however, lower than in Kakuma (see above).
The food distribution seemed to have been near the intended 2,100 Kcal/pers/day over the six months prior to the survey, with an average distribution of 2072 Kcal/pers/day. About half of the households were selling part of their food ration and especially cereal, mainly in order to buy other food such as sugar, milk, meat, tea leaves, rice and vegetables, or soap and paraffin.
More than half of the households (56.1%) reported having some kind of income and/or property. Forty-two percent of the households owned livestock, while 27% had incomes: about 20% had some kind of waged labour or income-generating activities, 4% had their own business and another 4% were receiving remittances.
It seemed that fewer families who reported having incomes were selling part of their food ration (29%) than families who reported not having incomes (60%).
This might be explained by the fact that for families who do not have an income, selling part of the food ration is the only way to obtain other food or non-food items.
While the Tsunami hit the Kenyan coast at the end of December 2004, it seemed that the early evacuation of the beaches and coastal areas prevented major casualties. A few wounded people and one death were reported (Afrol News, 03/01/05). Mombasa city and nearby villages seemed to have been badly hit.
Food security is still poor in pastoral and agro-pastoral areas hit by drought. The nutrition situation of both refugee and resident population in Kakuma division, Turkana district is precarious (category II), while it seemed to have somewhat improved in Dadaab refugee camps.
The African Union is to deploy the first contingent of peacekeepers at the end of January 2005 in order to help the move of the transitional government and president from Nairobi to Somalia (IRIN, 06/01/05).
Deyr rains have been above normal in most part of the country and have helped regenerate rangeland resources (FEWS, 15/12/04). On the other hand, heavy rains have led to the death of large numbers of livestock and to destruction of properties in the north. In the south, flooding has forced farmers in the riverine area to abandon their farms and has destroyed part of the crops (FEWS, 15/12/04).
The amount of funds requested through the Consolidated Appeal Process for 2005 has increased by over 35% compared to 2004 and the amount requested for food aid has almost doubled (FEWS, 15/12/04). The 2004 CAP was only 50% funded.
About 50,000 people affected by tsunami in north-eastern Somalia
On 26 December 2004, deadly tidal waves hit Somalia as a consequence of the earthquakes in South Asia. The most affected area is north-eastern Somalia on a stretch of around 650 km between Hafun in Bari region and Garacad in Mudug region (IRIN, 25/01/05). In the south, it seems that some villages in Lower Juba have also been affected (IRIN, 25/01/05). Depending on the estimate, the death toll is between 150 and 300. About 50,000 people have seen their properties destroyed and have been displaced.
The inland region has been experiencing a drought over the past years and was already vulnerable. It seems that some of the people who have been displaced from the coast by the tsunami, had been previously affected by the drought and had moved to the coast in search of incomes (IRIN, 25/01/05). Furthermore, in the Hafun peninsula, which is the most affected area, the dunes, which were protecting the villages from the high tides, have been washed out by the tsunami. This means that people can not re-establish their settlement in its original location (IRIN, 14/01/05). An estimated 2,600 fishing boats were destroyed (IRIN, 14/01/05).
Insecurity and bad roads condition have hampered access to some of the communities. However, WFP had distributed food to 21,000 people as of mid-January 2005 (WFP, 14/01/05). A report released by the Somali government and aid agencies, recommends emergency support in food and non-food items for about six months together with support to economic production through re-stocking and procurement of fishing material (IRIN, 20/01/05).
North-eastern region still vulnerable
Two random-sampled nutrition surveys conducted in Bari region in October 2004 showed a precarious nutrition situation, while mortality rates were under control to average (table 9) (FSAU/N, 11/04).
A fourth round of nutrition surveillance was conducted in sentinel sites in Sool plateau and Lower Nugal valley in November 2004 (FSAU/N, 01/05). The area has experienced adverse weather conditions and high food insecurity for three years. The nutrition situation seemed to have slightly improved in Sool plateau (table 10), while it was highly precarious in Lower Nugal Valley where 33.9% of the children surveyed were acutely malnourished, including 6.6% severely malnourished. While mortality in Sool plateau seemed under control, mortality was very high in Lower Nugal Valley. The level of destitution has increased and people were relying on extreme coping mechanisms. Although insecurity has hampered the delivery of humanitarian assistance in the whole area, access to Sool plateau has been easier than to Lower Nugal Valley.
Table 9 Results of surveys in Bari region, Somalia, October 2004 (FSAU/N, 11/04)
* According to cards and mothers' statements
Table 10 Nutrition situation in Sool plateau, screening in sentinel sites (FSAU-N, 01/05)
Dire situation in Luuq district, Gedo region
A random-sampled nutrition survey conducted in Luuq district in October 2004 showed an appalling prevalence of malnutrition: acute malnutrition was 25.4% (22.7-28.4), including 5% (3.7-6.7) severe acute malnutrition (FSAU/N, 11/04). Mortality rates were also very high: crude mortality rate=1.5/10,000/day, under-five mortality rate=3.7/10,000/day. Measles vaccination coverage was only 61%. The chronic food insecurity in the area has been compounded by insufficient rains since 2000 and a high level of insecurity which both hampers people’s livelihoods and the delivery of assistance.
Serious situation in Baidoa district, Bay region
The district has been hard hit by insecurity since 2002, which has resulted in the disruption of livelihoods and the delivery of humanitarian assistance, despite four recent favourable cropping seasons. A random-sampled nutrition survey carried out in October 2004 showed a prevalence of acute malnutrition of 16.3%, including 2.9% severe malnutrition (FSAU/N, 11/04). This is within the same range as the prevalence of 17% recorded in the district in 2000. Measles vaccination coverage and vitamin A distribution coverage were only 44.6% and 41%, respectively.
Parts of south and north-eastern Somalia continue to experience high food insecurity and precarious to dire nutrition situations (category I/II). The tsunami has affected at least 50,000 people in the north-eastern coastal area.
Situation still volatile in Darfur
The security situation is still highly volatile in Darfur with reported attacks on villages, population displacement and harassment of aid workers (Reuters, 19/01/05; UNNews, 07/01/05).
SC-UK withdrew from Darfur after four of their staff members were killed (UN-RC, 30/12/04). 2.39 million people are estimated to have been affected by the conflict, including 1.66 million displaced persons and about 200,000 refugees in Chad (USAID, 30/12/04).
In December 2004, WFP was able to reach only 60% of planned targets, mainly because of security constraints (WFP, 29/12/04).
Situation still serious but better than 6 months ago in Abu Shok camp, South Darfur
A random-sampled nutrition survey was conducted by ACF-F in Abu Shok IDP camp, near El Fasher town, in North Dafur in November 2004 (ACF-F, 11/04). Although the situation was still serious, it has improved compared to June 2004 (figure 2). Mortality rates and especially under-five mortality also seemed to have improved but remain of concern (figure 2). Measles vaccination coverage was within the same range as in June 2004 and was below 50%.
Since the survey was carried out thousands of new arrivals have been registered in Abu Shok camp (WFP, 29/12/05).
Figure 2 Prevalence of acute malnutrition and mortality rates, Abu Shok camp, South Darfur
Table 11 Results of surveys in Darfur region, Sudan, (ACF-F, 09/04; Epicentre, 11/04; SC-US, 01/05)
* According to cards and mothers' statements
Average situation in Serif Uma, North Darfur
In the town of Serif Umra, North Darfur, where 59% of the surveyed population was displaced, the situation was average in November 2004, according to a random-sampled nutrition and mortality survey (table 11)(Epicentre, 11/04). People received food distributions in March (one month ration) in August (two month ration) and in October (one month ration). About 25% of the families interviewed did not possess a card for receiving food distributions. These were families which had arrived after the registration held in March 2004. Moreover, it seemed that for about 40% of the households having a card, fewer people were registered on the card than there were actually in the families. A significant proportion of the population had no access to jerry cans, blankets, soap or latrines. Oxfam were carrying a non-food item distribution at the time of the survey. They, however, had been prevented from distributing blankets.
Serious situation in Nyala town, South Darfur
In Nyala town, South Darfur, which also counts a high proportion of IDPs, the nutrition situation was serious as of September 2004, according to a random-sampled nutrition survey (table 11) (ACF-F, 09/05) and was within the same range as a nutrition survey conducted in the nearby Kalma IDP camp at the same period (see NICS 4).
At the time of the survey, no food distribution had been carried out in the town.
Average nutrition situation in Fur Baranga, Habila, West Darfur
A random-sampled nutrition survey conducted in Fur Baranga administrative unit, showed an average nutrition situation (table 11; SC-US, 01/05). Mortality rates were below alert thresholds (table 11). About 25% of the households interviewed were displaced. About 80% of the families have received a general food distribution. Migration for labour was widespread with 50% of the households having one person who has migrated for labour.
The government of Sudan and the SPLM/A (Sudan People's Liberation Movement/Army) signed a final peace accord at the beginning of January 2005, closing three years of negotiations (AFP, 09/01/05). However, some analysts have observed that prospects for lasting peace remain fragile (IRIN, 18/01/05). Nevertheless, following the peace agreement, some countries and the European Commission have shown their interest in reinforcing their commitment to Sudan (DFID, 24/01/05; EC, 25/01/05). The UN envoy has demanded the deployment of 10,000 peacekeepers to observe the ceasefire (DPA, 18/01/05).
It seems that a significant number of refugees and IDPs have begun to return spontaneously to southern Sudan, for example, an estimated 15,000 people from Uganda (PANA, 11/01/05).
The 2004 harvest was poor in most parts of southern Sudan and especially in the northern parts of Northern Bahr El Gazal (FEWS, 24/01/05). The poor rains have also undermined people's ability to gather wild foods and to fish (FEWS, 24/01/05). Depending on the area, the harvest is expected to last only until January-February 2005 in the worse case, and until May in the best case. In Western Equatoria, the second crop season will last until July-August 2005. In this fragile situation, the IDPs' ability to resettle properly will depend on the overall situation in their area of return.
The nutrition situation in Bentiu town, Unity state, an enclave controlled by the government of Khartoum, and in Mareang district, Zeraf county, Central Upper Nile, was critical, according to two random-sampled nutrition surveys (table 12), and has remained within the same range over the last few years (ACF-F, 07/04; AAH-US, 10/04).
The situation in Nuba mountains seemed average to precarious (table 12) (AAH-USA, 11/04; SC-USA, 12/04).
Table 12 Results of surveys in Southern Sudan (ACF-F, 07/04; AAH-USA, 10/04; AAH, USA, 11/04; SC-USA, 12/04)
* According to cards and mothers' statements
The situation in Darfur is still dire (category I) and insecurity still prevalent. In Southern Sudan, a high number of IDP's and refugees' returns are expected while food security in parts of the region will be poor this year.
Following the events which took place at the beginning of November 2004 (see NICS 4), the peace process between the government and the Forces Nouvelles, which controls the north of the country is still deadlocked. There have been reports of increasing unrest and harassment of civilians and humanitarian agencies (OCHA, 17/01/05). New IDPs have been registered in several locations, such as the IDP centre in Guiglo (OCHA, 17/01/05). Several cholera cases have been reported at the hospital of Bouake (OCHA, 17/01/05). It seems that the situation along the road of Guiglo-Duekoue was serious in terms of health and malnutrition (OCHA, 17/01/05).
The situation has remained calm, although some sporadic riots have been reported, such as in Harper and Gbarnga (IRIN, 27/01/04; WFP, 28/01/05).
Since the beginning of the IDP repatriation exercise, 26,380 displaced people have been repatriated, as well as 4,879 former Liberian refugees (WFP, 28/01/04). They have received a repatriation package. In addition, an estimated 100,000 refugees have made their own way to Liberia (UNHCR, 12/01/05). Inaccessible roads in parts of Grand Cape Mount and Gbarpolu counties render return to these areas difficult (OCHA, 20/12/04).
The food distribution to IDPs has been halved since June 2004 as a result of resource constraints (OCHA, 20/12/04).
Ivorian refugees at risk
About 6,000 Ivorian refugees have remained in Butuo area, Nimba county (see NICS 4). The majority have been sheltered by Liberian households. As of end December 2004, it seemed that food aid had not yet been distributed (RI, 20/12/04), although an assessment carried out in mid-November recommended air-lifting food in the first place and then repairing damaged bridges in order to transport food by road (Inter-Agencies, 11/04). The mission also recommended increasing capacity of health care, improving access to safe drinking water and sanitation and providing non-food items. Transfer of refugees from the insecure border further inland was also advocated (Inter-Agencies, 11/04).
Reconstruction and livelihood support crucially needed
An assessment in Vahun district, Lofa county observed that more than half of the inhabitants were newly returned (ICRC, 11/04). Therefore, agriculture activity was reduced as many people came back too late for the planting season. About 70% of the houses and shelters were damaged and 10% were abandoned. There were no medical services in the entire district, the government clinic having been destroyed. People in search of health care were travelling to Sierra Leone. Accessibility was very poor with poor roads and damaged bridges.
An assessment conducted in the three eastern counties of River Gee, Grand Kru and Maryland showed that the majority of the houses were occupied (ICRC, 08/04). Most people had started to cultivate and were expecting a small but good harvest. However, there was a big need for tools. In a more recent assessment of the same area, the lack of support in terms of assistance to these counties was deplored (HAC, 11/04).
Nutrition situation not critical in Bomi county
A random-sampled nutrition survey together with a food-security assessment were carried out in Bomi county in December 2004 (WFP/joint, 12/04). The nutrition situation was not critical and mortality rates were average (table 13). The prevalence of acute malnutrition was within the same range as shown by a nutrition survey done in Bomi and Grand Cape Mont counties in March 2004 (see NICS 2). The mortality rates were lower than in March 2004. The survey was done at the time of the year when fishing and palm oil production were largely available. The food security situation did not appear stable; the population under-going transition with minimal agricultural activity (box 2). Tubnamburg city was more vulnerable than the other districts (figure 3). According to the communities, health service provision was ranked as the first problem followed by inadequate educational facilities and training opportunities, inadequate food, and low agricultural production due to low accessibility to farm tools and seeds. Only 35-40% of the population seemed to have returned and 40% of the households have split families: it seems that some members of the households have remained in IDP camps, while others returned home.
Table 13 Results of a nutrition and mortality survey in Bomi county, Liberia, December 2004 (WFP/joint, 12/04)
* According to cards and mothers' statements
Box 2 Food security assessment in Bomi county, Liberia, Dec 2004 (WFP/joint, 12/04)
Figure 3 Vulnerability to food insecurity in Bomi county (WFP/joint, 12/04)
The situation has stabilized in Liberia but there are great challenges in terms of reconstruction, such as housing, roads and infrastructure. Re-integration of the IDPs and refugees will also be a major task.
From the survey in Bomi county:
The peace process has seen delays, with the referendum on the draft post-transition constitution being postponed for the third time (USAID, 31/12/04). On the other hand, demobilisation of former fighters began at the beginning of December, as expected (IRIN, 02/12/04).
More than half of the estimated 280,000 IDPs returned to their home in 2004, especially in the eastern and southern provinces, while people were more reluctant to return to the northern and central provinces (RI, 01/12/04). However, it seems that the majority of the 30,000 IDPs in Bujumbura Rural province have recently returned (IRIN, 21/12/04). This province is still the most insecure area in Burundi, being the stronghold of the only armed force which has refused to take part in the peace agreement. The security situation seems to have improved recently in the province.
A cholera outbreak has occurred in Bujumbura town and Rural. As of 24 January, 153 cases were registered (OCHA, 23/01/05).
About 2,285 refugees from Tanzania have returned to Burundi since the beginning of the year, as of 23 January 2005 (OCHA, 23/01/05).
The food security situation was bleak in the northern part of the country at the end of last year, the traditional hunger-gap season, and especially in Kirundo and Muyinga provinces, owing to a combination of drought and manioc mosaic virus (IRIN, 19/01/05). WFP has intensified its food distribution to the area (WFP, 17/12/04). A greater than usual deterioration in the nutrition situation has also been reported in Ngozi province (AAH, 26/01/05).
The Central African Republic has faced a structural crisis for years, with an institutional instability marked by mutinies, coup attempts, and destruction and looting of infrastructure and people's property (CAP, 2005). An armed rebellion took place between October 2002 and March 2003, when François Bozize ousted President Felix Patasse (IRIN, 15/03/04). Although the situation has calmed down, security has remained fragile and the rehabilitation and development of infrastructure is hampered by a lack of means. Banditry is widespread, especially in the north-west of the country (IRIN, 06/01/05). Presidential and parliamentary elections are scheduled for the beginning of 2005 (IRIN, 06/01/05). Thousands of people are still refugees, of whom 30,000 are in Chad (see NICS 4).
A random-sampled nutrition survey was conducted in Kuango sub-prefecture, Ouaka prefecture, in the centre of the country. The survey showed an average nutrition situation with 6.8% (4.7-8.8) of the children being acutely malnourished, including 1.2% (0.5-1.9) severely malnourished (MSF-S, 12/04). Mortality rates were also average: CMR=0.7/10,000/day and under-five MR= 1.7/10,000/day. Measles vaccination coverage was only 19.5%. A measles outbreak had just occurred in the area.
Despite the beginning of the disarmament process, violence is still widespread in the east of the country with fighting reported in Ituri district (UNNews, 31/01/05; IRIN, 13/01/05) and in North Kivu, with the displacement of at least 100,000 people, of whom some have sought refuge in Uganda (IRIN, 30/12/04) (see Uganda). Although a 10-km buffer zone has been created by the UNMIL, assistance has been difficult to deliver (IRIN, 30/12/04).
A cholera outbreak has been reported in South Kivu with 2,152 cases during January (IRIN, 27/01/05).
Following the alert launched by Refugee International about IDPs sheltered near Kinshasa (see NICS 4), a programme of repatriation has begun (RI, 31/01/05).
Mortality rates in western and eastern DRC
IRC conducted randomly-sampled retrospective mortality surveys in 25 health zones between April and July 2004, covering a recall period of 16 months (IRC, 07/04). Two surveys were done; one was carried out in ten health zones in the west of the country (formerly government held areas) and the other one was undertaken in fifteen health zones, in the east of the country (formerly non-government held areas). The major part of the east has experienced a higher level of violence. Forty-six health zones were removed from the sampling in the east owing to insecurity which prevented access.
The results showed high mortality rates, especially in the east of the country (table 14), where they were above alert threshold. The difference between the crude mortality rates in the east and west was statistically significant. Deaths due to violent injury were concentrated in 9 of the 15 eastern health zones, where at least one violent death had been reported, which increased the CMR by 75%, compared to eastern health zones where no violent death had been reported. In the same way, in the east, areas experiencing ongoing conflict had a CMR almost twice the CMR in more secure areas: 2.7/1,000/day vs. 1.4/1,000/day.
The number and proportion of violent deaths had, however, decreased over the 16 months of the recall period.
Morbidity-related causes of death were mainly due to fever, diarrhoea, malnutrition and respiratory infections.
In the east, the highest death rates were recorded in Katana and Shabunda (South Kivu), Moba and Kalemie (Katanga), and Kalima (Maniema), and in the west, in Mutena, Kalonda East and Kalonda West (Kasai Occidental), and Kipushi (Katanga).
When compared with the mortality survey conducted in 2002, although crude mortality has decreased by 23% in the east and 20% in the west, the difference was not significant (figure 4).
Figure 4 Mortality rates in DRC
CMR recorded in 2002 had significantly decreased compared to 2001 in the east (see RNIS 42).
Table 14 Mortality rates in DRC, April 2004 (IRC, 07/04)
* Calculated from the rate expressed as /1,000/month
It seems that the situation has somewhat improved in northern Uganda. The government of Uganda and the LRA (Lords' Resistance Army) conducted peace talks at the end of 2004 and a ceasefire was declared (USAID, 05/01/05). Security has improved, thus increasing access to camps for humanitarian assistance. The number of displaced people has decreased from 1.6 million in March 2004 to 1.3 million as of early January (USAID, 05/01/05). The situation is, however, still very precarious in camps. A cholera outbreak was declared in Pabbo camp, Gulu district (USAID, 05/01/05) and fires have resulted in several deaths and destroyed about 6,000 homes in Gulu and Lira districts (WFP, 28/01/05). Food and non-food items have been distributed to the victims (ICRC, 26/01/05; WFP, 28/01/05).
In January 2005, about 10,000 people crossed the border from DRC to Kanungu and Nkondo districts (IFRC, 25/01/05). Following insecurity in this area, only 3,000 have remained, the others have either returned to DRC or moved further inland to refugee camps. The refugees in Kanungu and Nkondo districts are in great need of assistance (26/01/05).
An alert has been launched about a possible food shortage in Karamoja region after crop failure (IRIN, 14/01/05). According to nutritional surveys, the nutrition situation was already poor as of August 2004, when the prevalence of acute malnutrition was 18.7% (USAID, 05/01/05).
There are an estimated 203,000 Sudanese refugees settled in eleven camps in eastern Chad. Although humanitarian assistance has increased over the past months, the situation remains highly precarious for both the refugees and the host population.
Some security incidents have been reported near the border with Sudan and around the refugee camps (AFP, 15/01/05; WFP, 14/01/05). Hepatitis E is still rampant in some of the camps and a meningitis outbreak has spread in Treguine, Bredjing and Farchana refugee camps since early January (WHO, 28/01/05). A vaccination campaign has been implemented (MSF, 28/01/05). Water scarcity is a major threat to sustaining refugee settlement (UNHCR, 21/12/04).
Preliminary results of nutrition surveys showed precarious to critical nutrition situations among refugee and resident populations
Surveys conducted in Bahai camp and among resident populations, showed a critical situation with a prevalence of acute malnutrition of 20.5% (16.9-24.5), including 1.7% severe acute malnutrition (0.4-5.3) and of 21.4% (15.6-28.5), including 1.7 (0.4-5.3) severe acute malnutrition among refugees and residents, respectively (AAH, 01/05). On the other hand, the nutritional situation was better, although precarious among refugee and resident populations in and around Treguine camp: acute malnutrition was 11.3% (8.6-14.6), including 1.1% (0.4-2.6) severe malnutrition, and 14.2% (11.2-17.8), including 1.2% (0.4-2.7) among refugee and resident populations, respectively.
Food distribution below the recommended ration
As most of the refugees depend almost entirely on food distribution to cover their food needs, the food basket per person and per day has been determined as followed: cereal: 425 g, pulses: 50 g, CSB: 50 g, oil: 25 g, salt: 5g and sugar: 15g, representing 2,063 Kcal/pers/day. According to food basket monitoring in ten camps, the average ration distributed represented 1903 Kcal/pers/day in November 2004, but only 1558 Kcal/pers/day in December 2004. This was mainly due to a pipeline break, especially in terms of pulse and CSB (WV, 12/04). CSB is the main source of vitamin and minerals: breaks in CSB distribution can lead to vitamin and mineral deficiencies.
Due to continued delays in food delivery to the region, reduced rations (1,600 to 1,800 Kcal) were also distributed in January 2005 (WFP, 14/01/05).
The blanket supplementary food distribution has also experienced pipeline breaks and only a half ration was distributed in seven camps, while no distribution was conducted in the other camps in December (WV, 12/04). The blanket supplementary food distribution is meant to continue at least until the results of nutrition surveys, which are currently carried out in the camps, are available.
A joint assessment mission, conducted in November 2004 (JAM, 11/04), recommended that: the supply of 2,100 Kcal/pers/day continues; cereals which suit refugee food habits, such as sorghum, millet and corn flour, be distributed; milling be taken into account either by distributing meals, implementing milling facilities at camp level or distributing an additional cereal grain ration of 50 g in order to offset milling coasts; information about the importance of CSB be provided to the population; the present system of group food distribution be shifted to family distributions; food basket monitoring be continued and post-distribution monitoring be implemented.
Other recommendations of the mission, regarding the refugees, were: to undertake a refugee identification exercise; to organize a training programme on screening for micronutrient deficiencies (it seems that three cases of scurvy had been identified); to define a joint operational strategy for opening and closing TFCs.
Assistance needed to the host population
The joint assessment mission (JAM, 11/04) recommended that host population receives an immediate and visible response; that projects be implemented using the available budget of UNHCR for "quick-impact projects" and using WFP food intended for 25,000 beneficiaries; that school feeding programmes be revitalized; that partners constitute a working group to develop a comprehensive strategy to cover emergency needs as well as longer-term projects; that in addition to feeding centres and health centres, the resident population has access to blanket supplementary feeding. The JAM also recommended that the resident population, who first hosted the refugees at the border area, also be taken into account.
The situation is still bleak in Chad with outbreaks of hepatitis E and meningitis, a low water supply and the fact that insufficient food rations are provided. Sustaining and enhancing the efforts to support both refugees and resident populations is crucial.
The security situation has remained volatile. Following the presidential election won by Hamid Karsai, a new cabinet has been appointed (BAAG, 31/12/04). As of early January 2005, about 32,210 former soldiers had disarmed (UNAMA, 06/01/05).
UNHCR expressed concerns over arrests of refugees in Iran. Iran has launched a crackdown against illegal migrants and it seems that people who were granted refugee status have also been harassed (IRIN, 12/01/05).
Nutrition situation still precarious in Northern Shamali/Southern
A random-sampled nutrition survey was conducted in four districts of Kapissa province, three districts of Parwan and two districts of Panjshir in August 2004 (ACF-F, 07/04). The survey indicated a precarious situation: 14.3% (11.3-17.9) of the children were acutely malnourished, including 2.3% (1.2-4.3) severely malnourished. This seems to be a slight decrease when compared to August 2003, although the confidence intervals overlapped (figure 5). The prevalence of malnutrition is traditionally higher during summer than winter. Mortality rates were below alert thresholds: CMR = 0.39/10,000/day, under-five MR = 0.62/10,000/day. The presence of goitre was assessed among 6 month to 15 year-old children (2226) and among women from 15 to 45 years. Seventeen percent of the 6 month to 15 year olds had goitre; girls were significantly more affected than boys: 19.7% vs. 14.3%. Forty percent of the women had goitre, which is a very high level. The use of iodized salt seemed, however, to have increased in 2004.
Shamali plain is very fertile but the area was the stronghold of the resistance against the Taliban and has suffered from destruction and blockades. It seems that little assistance is delivered to the area, which would benefit greatly from food security interventions.
Figure 5 Prevalence of acute malnutrition, Northern Shamali, Southern Panjshir
Following a quake in the Indian Ocean, 250 kilometres northwest of the Indonesian island of Sumatra on 26 December 2004, measuring 9.0 on the Richter scale, enormous waves (tsunamis) hit the Aceh area of Sumatra, Indonesia and travelled to several Asian countries such as Sri Lanka, Thailand, India, Burma, Malaysia, the Maldives, and finally to the East African coast in Kenya, Somalia and Tanzania (AFP, 13/01/05).
Although precise figures are difficult to obtain, the death toll is enormous (between 150,000 and 250,000) as is the number of people affected, which stands at more than one million (see map). Indonesia has been the hardest hit, followed by Sri Lanka, India and Thailand.
Mobilization of assistance and financial contributions to the victims from citizens, private companies and governments have been unprecedented (AFP, 13/01/05; BBCNews, 30/12/04; BBCNews, 27/01/05; MSF, 04/01/05). The G7 has agreed to suspend debt interest repayments by tsunami-hit nations (BBCNews, 07/01/05).
On the ground, it seems that massive efforts have been deployed by populations, governments and humanitarian agencies, in some cases logistically supported by armies of several countries.
Immediate needs were in terms of provision of health care, food, water, sanitation and shelter, while longer-term needs are to rebuild people's livelihoods. Psychological support for the survivors will also be a major issue (BBCNews, 02/02/05).
South Asia earthquake and tsunami: Affected populations (Reliefweb, 01/02/05)
Aceh province on the island of Sumatra has been the hardest hit by the Tsunami. This province has experienced a civil rebellion for years, with the rebels claiming the independence of the province. Before the tsunami, aid workers and journalists had been prevented from accessing the area for at least 18 months (BBCNews, 24/01/05). The government and the GAM (Free Aceh Movement) have declared a ceasefire to help aid get through to survivors. They have also met for the first time in almost two years in order to discuss smoothing the path of aid to victims (BBCNews, 31/12/04).
Indonesia Districts affected by Tsunami and earthquake (Reliefweb, 02/01/05)
The government estimated that 417,124 IDPs were living in spontaneous settlements while 260,000 were thought to be residing with extended families (OCHA, 28/01/05). It seemed that many of the camps were well-organized but there were also some ad hoc makeshift settlements (WFP, 31/01/05). Relocation centres were being established by the government of Indonesia for an estimated 100-150,000 IDPs for a period of up to two years (Joint mission, 01/05).
Food distributions have been on-going in Aceh. They were mostly composed of rice and noodles in the first instance (WHO, 01/05). As of end January, the pipe-line was secured for a more diversified ration, including canned fish and oil (OCHA, 28/01/05).
Concern was raised by the MOH about the large quantities of milk powder coming to Aceh (OCHA, 02/02/05).
Overall food prices in Aceh have risen by 20%, except for fish, which people don't want to consume for fear of post-tsunami contamination, and for rice owing to supplies from non-affected areas (OCHA, 28/01/05).
A rapid assessment, using a convenience sample, was conducted among 614 6-59 month- old children in 19 sites (camps in the open, camps in communal buildings and households with displaced persons in Bandah Aceh and Aceh Besar by MOH/UNICEF/CDC in mid-January. It was not possible to conduct a random-sampled survey because of the lack of reliable population figures. 12.7% of the children surveyed were acutely malnourished, including 1.5% severely malnourished, which is worrying (UNICEF; 21/01/05). No oedema was seen. BMI measurements of 334 women aged 18 to 45 showed that 15.3% had a BMI < 18.5, while 25.9% were overweight (BMI >= 25). Dietary intake seemed poor for 37% of the children (not having consumed rice, biscuits, noodles, canned fish and oil (the intended WFP food ration) the previous day at least), adequate for 38% of the children (having consumed at least the above-mentioned items) and good for 25% of the children (having consumed at least the above-mentioned items plus meat or eggs). Morbidity (cough, fever and diarrhoea) was high.
Nutrition surveys and the establishment of a nutritional surveillance among the displaced population and the affected non-displaced population have been planned (OCHA, 02/02/05).
No significant outbreaks of diseases have occurred so far (WHO, 01/05), although some cases of measles, dengue fever and bloody diarrhoea have been reported (WHO, 01/02/05). A measles vaccination campaign has been conducted in IDP camps and was due to continue among the non-displaced population (OCHA, 02/02/05).
Sanitary conditions seemed to be one of the major problems, still being poor in most of the camps (WHO, 01/05). Soap and hygiene products were also greatly needed. The quantity of the water supply did not seem to be a problem, although the quality of water was not optimum (WHO, 01/05). Non-food items have begun to be distributed to IDPs and host families (OCHA, 28/01/05).
A livelihood sector coordination group has been established to work on common guidelines for cash-for-work, cash grants and micro-finance (OCHA, 28/01/05).
Affected districts, Sri Lanka
Sri Lanka has been ravaged by a civil war for years, with parts of the country controlled by the government and parts by the Tamil Tiger rebel forces, with little possibility of communication between the two sides.
As of early February, there was no agreement between the government and the rebel Tamil Tigers on a joint mechanism to coordinate relief (Xinhua, 02/02/05). It seems that the response to the catastrophe has been slow in Sri Lanka. A government official said that, as of beginning of February, only 30% of the affected population had received aid so far (Xinhua, 02/02/05). Coordination and information flow seemed to be one of the major constraints (DFID, 03/02/05).
The water supply did not seem to be a problem in displaced camps but had not been properly assessed in affected communities (OCHA, 02/02/05). No outbreaks of disease have been reported (WHO, 02/02/05).
WFP reported an anticipated caseload of 845,000 people for February 2005, an increase of 9% in comparison with January (OCHA, 02/02/05). A WFP assessment anticipated that people who earn an income in the service sector, retail trade or tourism sector will be able to sustain themselves from the end of January (WFP, 31/01/05). Others will need public work, micro-credit and food-for-work. There was a fear that food distribution in rice-producing areas might negatively effect local markets (WHO, 02/02/05).
A rapid livelihood assessment conducted in coastal areas of Ampara and Batticaloa districts in January found that repair and reconstruction of housing was thought to be the first priority by the affected population (SC-UK, 18/01/05). Fishermen need the repair or replacement of fishing boats and equipment. Unskilled casual labourers, who form a substantial part of the population, are in need of cash-for-work, in the first instance, while restoring income for the long term will require the support of those who previously employed them, such as masons, carpenters and shopkeepers. Women-headed households will also need support to restart their economic activities and newly widowed-households will need skills-training.
Markets seemed to be well functioning and prices were unchanged from the pre-tsunami levels. The rice harvest was due soon. SC-UK recommended that, then, cash-based interventions would be more appropriate than food aid.
Six provinces of Thailand were affected. As of mid-January, the health situation was under control, mainly due to the rapid response implemented by the Ministry of Health (MMWR, 28/01/05).
The worst hit areas (Phuket, Pahn Nga and Krabi provinces) were areas of rapid and expanding development of mass tourism (UNDP, 01/05). The local population has moved towards livelihoods made profitable because of this tourism, such as fishing, small souvenir shops, working in hotels and restaurants and so on. These areas also attracted workers from all over Thailand, and migrant workers, mainly from Burma. This reliance on tourism rendered the population in the area highly vulnerable to the effects of the tsunami, as most of the fishing equipment and tourism infrastructure were destroyed. It is likely that, even if the infrastructure is reconstructed, the flow of tourism will decrease, at least for some time. Migrants will probably return to their area of origin or go elsewhere.
According to the UN, the situation in the Maldives has been overlooked by donors (DFID, 03/02/05). According to a WFP rapid vulnerability assessment, in the islands where displacement occurred, all households regardless of their socio-economic status require assistance (OCHA, 02/02/05). It is planned that 29,000 people will benefit from food aid, until cash-employment schemes begin (DFID, 03/02/05). No outbreaks of disease have been reported (WHO, 01/02/05).
The security situation has remained tense and volatile, especially in the area of Gonaives, which was one of the hardest hit by the hurricane in September last year (USAID, 31/12/04). The humanitarian situation seems to have improved with distributions of food aid, provision of health care and provision of safe drinking water (OCHA, 24/11/04). Needs, in terms of rehabilitation of irrigation schemes and distribution of seeds and tools, were still high (OCHA, 24/11/04).
The FAO/WFP crop and food assessment mission, conducted in October 2004, estimated the cereal production to be 9% higher than in 2003 and 6.5% above the last five-year average (FAO/WFP, 12/01/05). However, owing to insecurity and poor road conditions, transport from producing areas to main urban markets is difficult. This resulted in low maize prices in producing areas, while prices have risen in urban markets, and especially Port-au-Prince. It is estimated that 103,000 MTs of food aid are needed from July 2004 until June 2005, of which 78,000 have already been received and distributed.
A random-sampled nutrition survey, conducted in the commune of Belladère, Centre department, showed a nutrition situation that was not critical: 4.8% (3.1-7.4) of the children were acutely malnourished, including 0.8% (0.2-2.2) severely malnourished (ACF-F, 08/04). This prevalence was within the same range as malnutrition rates recorded in other areas at the same period (see NICS 4). Crude and under-five mortality rates were under control: 0.09/10,000/day and 0.75/10,000/day, respectively. On the other hand, measles vaccination coverage was low: 27.3%.
Greater Horn of Africa