United Nations System
Standing Committee on Nutrition

Somalia—Hundreds of thousands of displaced face dire conditions— Fighting between the Transitional Federal Government (TFG), backed by the Ethiopian troops, and anti-TFG factions increased in Mogadishu in March and April, and was reported to be the worst wave of violence in the city for 16 years. An estimated 395,000 people, representing about one third of the town’s population, have fled the city and concentrated mostly in Shabelle, Galgadud, Hiran, Mudug and Bay regions. In addition, another 30-40% of the population of Mogadishu is estimated to be displaced within the city. As of the end of April, the situation had calmed down in Mogadishu with the TFG reporting to control most of the city, and displacements out of the city had slowed dramatically.

The humanitarian situation of the displaced was reported dire with a lack of shelter, clean water, safe sanitation, health care, medicine and food (FSAU, 30/04/07). Host populations were also affected by the massive influx of the displaced. As of the beginning of May, humanitarian aid had reached about 250,000 people, with 181,400 having received non-food items and 100,000 food aid .

Central African Republic—Humanitarian aid reaches the IDPs— An upsurge in violence in the north of the country in 2006 has led to the displacement of thousands of people, especially in the north-west. As of February 2007, the number of displaced was estimated at around 212,000 people. The humanitarian presence has increased in the area over the past few months, but access has remained uncertain.

The conflict has had several consequences on the livelihoods of the population, such as the loss of food stocks and productive assets; reduction in crop production; drastic reduction of cotton production; reduced commercial flow and access to market; and an increase in prices of basic products.

Despite this degradation in food security and livelihood, the situation was not considered catastrophic as of March 2007 in Ouham Pende, Ouham and Nana-Grimbizi provinces.

However, it has been estimated that 190,000 displaced people and 32,000 non-displaced people were in a state of acute food insecurity in the north and were in need of food distribution, especially during the forthcoming hunger gap.

Nepal—Increasing concerns — According to a WFP assessment conducted in November/December 2006, 197,905 people were experiencing an acute food and livelihood crisis and another 215,463 were facing a deteriorating food security situation, due to drought and other adverse weather conditions. All the households were worse off compared to the same season last year with 63% of them experiencing a food shortage. The poorer the families were, the higher the decrease in income and access to food was.

In the camps, where about 100,000 Bhutanese refugees are sheltered, a nutrition survey conducted in January 2007 showed an acceptable level of acute malnutrition. However, stunting was significant as well as anaemia.

Occupied Palestinian Territories—Food security still precarious—A food security analysis concluded that 34% of the population of West Bank and the Gaza Strip was considered food secure in 2006, while 20% was marginally food secure, 12% was vulnerable to becoming food insecure and 34% was food insecure. Although not directly comparable with the FAO/WFP food security assessment in 2003, which used a different methodology, the findings were similar.

The results of the Palestinian Family Health Survey conducted at the end of 2006/beginning of 2007 showed that the level of wasting has remained under control. Compared with the same type of surveys conducted in 2000 and 2004, it seemed that stunting showed a slight increase especially in the Gaza Strip. However, it is difficult to know the significance of this increase.

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

Ethiopia

In spite of the good 2006/2007 Meher harvest and a general improvement in the food security situation, constraints are still affecting poor households: pastoralists have not yet recovered from the previous drought; cereal prices have remained at record highs; and official border closures with Somalia have disrupted market activities and supplies in south-eastern Somalia (FEWS, 10/05/07). The prospect of the Belg season is uncertain due to a dry spell that affected cropping areas of Oromia, Tigray, Amhara and SNNPR regions in February/early March 2007.

Cases of acute watery diarrhoea were still reported in 62 of the 192 districts affected, mostly from Bale, Borena and East Hararge zone, Oromia; Gedeo zone, SNNPR; zone 1 and 3 of Afar and in Harare and Somali regions. However, the case fatality rate has remained relatively low at 1.2% (OCHA, 14/05/07).

It has been reported that about 50,000 refugees recently flew from Somalia to Ethiopia (FEWS, 04/07), although only some 1,500 were registered in Kebrikebeyah and Hartisheik camps (WHO, 16/05/07).

The government and humanitarian partners have agreed to implement the IASC cluster approach to respond to emergencies (DPPA, 15/03/07). The cluster approach aims to improve coordination and accountability of international and national humanitarian actors in several sectors such as nutrition, health, and water and sanitation.

General improvement of the nutrition situation in the post-harvest season, but pockets remain at risk - A nutrition survey conducted in Dolo Bay and Dolo Ado districts, Afder and Liben zones, in February 2007, showed a critical nutrition situation (ENCU, 31/03/07), which was comparable to January 2006 and worse than in September 2006, despite an improvement in the food security situation at macro level. The prevalence of acute malnutrition was 22.5% (19.1-25.8), including 2.7 % (1.4-4.1) severe malnutrition in February 2007 compared to 14.5% (11.8-17.2), including 0.7 % (0.1-1.3) severe malnutrition in September 2006. Measles vaccination and vitamin A distribution coverage were far below expected levels, but mortality rates were below alert thresholds. It does not seem that the population of these districts benefited from the Productive Safety Net (PSN) or food aid in 2007.

In SNNPR, the situation differed depending on the district, with Boreda Abaya and Miab Abaya districts, Gamo Gufa zone, Duna in Hadiaya zone, and Humbo and Sodo Zurie districts, Wolayita zone, revealing a prevalence of acute malnutrition under control or typical of a post harvest period (figure 1). In Sidama zone, the prevalence of acute malnutrition was average in Hulla and Boricha districts. It has significantly decreased in Hulla, compared to the prevalence recorded during the hunger-gap period in April 2006. In Hulla and Boricha, 7% and 16% of the population was entitled to the PSN, respectively, and none to food aid distribution between January and June 2007.

Figure 1 Prevalence of acute malnutrition, SNNPR, Ethiopia, December 2006-February 2007 (ENCU, 31/03/07)

Surveys in Amahara, Harare and Oromia also showed the nutrition situation was under control to average with the exception of Dessie Zuria, South Wollo zone, Amhara where the prevalence of acute malnutrition was of concern (table 1). The survey was conducted after a poor Meher harvest in the area, and the food security situation was also of concern. About 30% of the population was benefiting from the PSN and no food distribution was planned in the area between January and June 2007.

Table 1 Prevalence of acute malnutrition, Ethiopia, January-February 2007 (ENCU, 31/03/07)

Kenya

Food security has generally improved in the previously drought-affected areas and food distribution beneficiaries will be reduced from 2.4 m in 2006 to 1.3 m in 2007 (FEWS, 05/07). Nutritional surveillance showed a decline in malnutrition in Garissa, Marsabit and Turkana districts. Compared to the same period in 2006, acute malnutrition has almost halved in the first quarter of the year. As of May 2007, the prognosis in key cropping areas was looking promising. However, Wajir, Isiolo, Garissa, Tana River and Ijara districts were still considered highly food insecure. The pastoralists will need time to recover from the drought and the Kenya Food Security Steering Group has identified critical long-term interventions to sustain improvements in pastoral food security (FEWS, 04/07).

The number of suspected cases of Rift Valley Fever has decreased and the ban on the slaughter of livestock has been lifted (OCHA, 04/04/07).

Grim situation in Mont Elgon - The escalation of clashes between rival communities around land allocation issues in Mount Elgon district, west Kenya, has led to the displacement of about 62,000 people representing nearly half of the total population in the district (KRCS, 04/07). In addition, a significant number of homes and some crops were burnt (OCHA, 04/04/07). The IDPs live mainly in market centres, churches, mosques and public buildings, or with relatives.

Food security is reported to be very poor as crops were burnt or left behind and insecurity has prevented the IDPs to return for harvesting. People have lost their main income source, the district being one of the country's granaries and people’s livelihoods depending mainly on the sale of crops. There is also a lack of grazing land for the families that keep livestock.

Prices of food and fuels have sharply increased. The water and sanitation situation is reported to have deteriorated. Some health facilities are not accessible due to insecurity; others are closed because of the displacement of health staff. The operational and accessible health facilities are overwhelmed. Protection is also an issue with increasing reports of rape and violence against young girls.

Concerted efforts to restore peace and resolve conflict are on-going (OCHA, 07/05/07). Some humanitarian aid has been delivered and more is planned. Food, non-food items and medical supplies have been distributed to the IDPs and support to health care implemented. Needs that are not covered include protection, psycho-social care for victims of violence, sanitation, education, and seeds and tools for families who have returned. Moreover, 11,000 people who have taken refuge in the most inaccessible areas have not received assistance yet. Impaired access due to poor roads and volatile security condition is a major constraint on the delivery of humanitarian relief.

About 5,000 people have sought refuge in nearby Uganda where they have not received any external assistance. The conditions in the area are reported to be deplorable and will further deteriorate with the onset of the hunger-gap season.

Critical nutrition situation in Mandera district - Three surveys conducted in Mandera districts showed critical nutrition situations (AAH-US, 03/07) (figure 2). The prevalence of acute malnutrition was comparable with that of surveys done in the same area in March 2006. Mandera district is chronically food insecure and part of the district was also affected by severe flooding at the end of 2006. The food security prospect was favourable in April/May 2007.

Figure II Prevalence of acute malnutrition, MAndera district, Kenya, March 2007 (AAH-US, 03/07)

Recommendations

From the Kenya Food Security Steering Group to sustain improvements in pastoralist areas:

Establish hunger safety nets
Establish a certification system for Rift Valley Fever and other diseases requiring quarantine
Rehabilitate and develop infrastructure in the market-dependent pastoral livelihood zones
Address chronically high malnutrition and poor access to health services
Assist destitute pastoralists
Strengthen existing early warning and food security analysis systems
Enhance emergency preparedness
Improve land, water and crop management
Enact the National Policy for the Sustainable Development of Arid and Semi Arid Lands of Kenya

Somalia

Fighting between the Transitional Federal Government (TFG), backed by the Ethiopian troops, and anti-TFG factions increased in Mogadishu in March and April, and was reported to be the worst wave of violence in the city for 16 years. An estimated 395,000 people, representing about one third of the town’s population, have fled the city and concentrated mostly in Shabelle, Galgadud, Hiran, Mudug and Bay regions (table 2) (FSAU, 10/05/07). In addition, another 30-40% of the population of Mogadishu is estimated to be displaced within the city (FSAU, 30/04/07).

Table 2 Number of people displaced from Mogadishu by region (FSAU, 10/05/07)

As of the end of April, the situation had calmed down in Mogadishu with the TFG reporting to control most of the city, and displacements out of the city had slowed dramatically (OCHA, 30/04/07). There were even reports of a small number of families coming back, mostly to the areas of the city which had not been involved in the fighting (UNHCR, 11/05/07). However, fear of violence was preventing large scale return. Were people to come back, shelter would be a major issue. Houses, and abandoned public buildings where some of the estimated 250,000 people who were internally displaced within the city by previous conflicts were sheltering, were destroyed by the battles. Moreover, the TNG announced that people would have to leave the public buildings in the coming weeks. UNHCR has engaged in negotiations in order that these people can be relocated in other parts of the city where they can access basic services and infrastructure.

Hundreds of thousands of displaced face dire conditions - The humanitarian situation of the displaced was reported dire with a lack of shelter, clean water, safe sanitation, health care, medicine and food (FSAU, 30/04/07). Host populations were also affected by the massive influx of the displaced. Prices of imported food and non-food items have sharply risen since mid-March.

As of the beginning of May, humanitarian aid had reached about 250,000 people, with 181,400 having received non-food items and 100,000 food aid (OCHA, 04/05/07). WFP also started food distribution in Mogadishu at the end of April (WFP, 08/05/07).

Insecurity, banditry, incidents of piracy, logistic difficulties and limited humanitarian presence in some areas have hampered delivery of humanitarian aid (OCHA, 30/04/07).

The lull in the fighting as well as discussions between the UN Emergency Relief Coordinator, the TFG and civil society to improve support for unhindered humanitarian access to populations in need, seems to have allowed for some improvement in access lately.

Although the food appeal was well resourced with 97% coverage, other sectors were under funded, with the overall appeal being only 37% covered. CERF funds were given to UNICEF and UNHCR (OCHA, 18/05/07).

An exhaustive nutrition assessment in Baidoa town, conducted in five camps hosting families displaced by the recent fighting as well as families displaced for more than ten months, showed a critical nutrition situation (FSAU/N, 04/07). Among the 1,106 children aged 1-5 years screened, 18.6% had a MUAC < 12.5 cm, including 4.3% with a MUAC < 11 cm. There seemed to be no difference between the new and old displaced.

High numbers of acute diarrhoea cases are still being reported in South and Central regions, with 30,101 cases, including 966 deaths, between the first of January and the eleventh of May (OCHA, 18/05/07). While the outbreak has been effectively contained in areas where the situation allows access, the response is inadequate in the other areas due to insecurity and/or lack of health partners to implement the response.

Nutrition situation still critical in the South - Several surveys conducted in South Somalia showed serious to critical nutrition situations (table 3) , which were comparable to those found in previous years when comparisons were possible (FSAU/N, 03/07). The riverine areas of Hiran experienced floods at the end of last year and most of the population was considered to be suffering from an acute food and livelihood crisis or humanitarian emergency. On the other hand, food security in the agro-pastoral and pastoral livelihood groups of Hiran, and Qansadhere and Dinsor district of Bay, was considered to have improved following the Deyr rains. This improvement does not seem to have translated into a similar improvement in the nutrition situation.

Nutrition surveys conducted in the three livelihood zones of Guedo also showed critical nutrition situations (table 3) (FSAU/N, 04/07), which, however, seemed to have slightly improved, although not significantly, compared to 2006. Levels of acute malnutrition have remained consistently high in the region since the 1992 crisis. Although the food security situation improved in 2007 compared to 2006, 200,000 people were still considered suffering from an acute food and livelihood crisis, or a humanitarian emergency at the time of the surveys.

Table 3 Prevalence of acute malnutrition and mortality rates , Somalia, February-April 2007 (FSAU/N, 03/04/07; FSAU/N, 04/04/07)

Overall

The situation of the close to 400,000 people displaced by the fighting in Mogadishu appears dire. Although some humanitarian aid is provided, gaps in response remain, due to insufficient funding, hindered access and lack of humanitarian actors. In areas surveyed in Bay, Bakool and Hiran regions, the nutrition situation is still critical (category II) in spite of a reported improvement in food security in most of these areas.

Sudan

Darfur

The security situation in Darfur has remained volatile (UNNEws, 18/05/07). Nutrition surveys conducted in South and West Darfur showed stable or improved situations compared to previous years.

In Nyala town and surrounding IDP camps, South Darfur, the prevalence of acute malnutrition has remained within the same range since 2005, with marked seasonal variations (figure 3) (ACF-F, 04/07). On the other hand, mortality rates seem to have increased but as confidence intervals were not provided in the survey reports, it is difficult to know if this increase is significant.

Figure III Prevalence of acute malnutrition and mortality rates, Nyala town & surrounding IDP camps, South Darfur, Sudan

In IDP camps, in Ed Daein, South Darfur, the situation was critical (table 4) as of February 2007 and comparable to that found in the same period in 2005 (UNICEF, 03/07). At the beginning of 2007, 25,000 new IDPs arrived in the camps. Only 70% of the displaced families were registered for food distribution. Access to soap and toilets, although reported as having improved compared to the end of 2005, was still insufficient with 64.6% and 40.9% of the families having access to them, respectively.

Table 4 Prevalence of acute malnutrition, Darfur, Sudan (UNICEF, 03/07)

In Gereida camp, South Darfur, the situation has improved compared to previous years and was average (figure 4) (UNICEF, 03/07). Mortality rates seemed also to have significantly improved.

Figure IV Prevalence of acute malnutrition and mortality rates, Gereida IDP camp, South Darfur, Sudan

In Beida locality, West Darfur, the situation was still precarious although it showed a slight but non-significant improvement compared to 2006 (table 4) (UNICEF, 03/07).

South Sudan

Food security is deteriorating as can be expected at the onset of the hunger-gap and is expected to worsen as the season progresses, especially for the poorest families, returnees and people affected by insecurity (FEWS, 04/07). The delayed rains in the Hills and Mountains livelihood zones (Bahr El Jabal and parts of Eastern Equatoria) are also a matter of concern. People in Northern Bahr el Gazal are expected to face difficult conditions because of poor harvest last year due to flooding, cattle rustling this year and a significant number of returnees (FEWS, 04/07).

About 34,500 people have been assisted to repatriate to the South (OCHA, 18/05/07). In addition, 143, 600 refugees have returned, including 61,400 assisted by UN organisations and partners.

Humanitarian needs remain unmet for several reasons such as a gap of funds during the transition between emergency and development, and the lack of capacity within the government of Sudan (IRIN, 22/05/07).

Surveys conducted in South Sudan continue to show critical nutrition situations. In Old Fangak, the prevalence of acute malnutrition was still high, although the situation had improved within the last four years (figure 5) (AAH-US, 12/06). In Melut, Malakal, and Gogrial county, the situation was poor (table 5) and comparable to that found in the same areas, although not exactly the same locations, within the previous years (AAH-US, 02/07; AAH-US, 03/07).

Table 5 Prevalence of acute malnutrition , South Sudan (AAH-US, 02/07; AAH-US, 03/07)

Central Africa

Central African Republic

An upsurge in violence in the north of the country in 2006 has led to the displacement of thousands of people, especially in the north-west (see NICS 11). As of February 2007, the number of displaced was estimated at around 212,000 people (see map). The humanitarian presence has increased in the area over the past few months, but access has remained uncertain.

Displaced populations, CAR, February 2007 (Reliefweb, 13/03/07)

beit at low levels, and food availability in markets was low (WFP, 03/07). Trade with the rest of the country and with neighbouring countries was almost inexistent and imported goods such as sugar, oil and salt were absent in rural markets.

Food frequency and diet diversity had significantly decreased, according to a WFP assessment (WFP, 03/07). Most of the people interviewed only ate once a day (compared to twice a day before the crisis) and meat, fish and oil had disappeared from the diet. Cereal consumption had also decreased. Most families had consumed roots, tree bark and wild fruit the day before the interview. People were also reported to have few cooking instruments and little access to water.

Despite this degradation in food security and livelihood, the situation was not considered catastrophic as of March 2007 in Ouham Pende, Ouham and Nana-Grimbizi provinces (SC, 03/07). Moreover, according to a nutrition assessment conducted in the provinces of Ouham and Ouham-Pende, which was not representative of the population but was conducted in areas where security allowed, the nutrition situation was not alarming (ACF-F, 02/07). Among the 104 6-59 month-old displaced children screened, none had a MUAC < 110 mm and only one had a MUAC < 120 mm. Among the 381 resident children screened, 4 (1.0%) had a MUAC < 110 mm and 16 (4.2%) had a MUAC < 120 mm. No oedematous children were found.

However, the WFP assessment estimated that 190,000 displaced people and 32,000 non-displaced people were in a state of acute food insecurity in the north (WFP, 03/07) and were in need of food distribution, especially during the forthcoming hunger gap. The WFP will distribute a full food ration for 6 months to this food-insecure population. The FAO was also to distribute seeds and tools for the forthcoming planting season (SC, 03/07) and provision of health care was under way (SC, 03/07).

In addition to the displaced population within the Central African Republic, 50,000 people have fled to Chad and 25,000 have sought refuge along the border in Cameroon. The latter are mostly nomadic cattle breeders who, according to assessment missions, live in destitute conditions (UNHCR, 27/03/07). The food security and nutrition situation seemed poor. Most of the refugees have lost or sold their livestock (IFRC, 28/05/07). They lack agricultural implements and seeds for planting, although local communities have allowed them some lands. They mainly rely on the sale of firewood. The refugees in Cameroon have received little international help so far, and the most pressing priorities are food, health care, and water and sanitation projects.

As a follow-up to a nutrition survey conducted in Bangui in January 2006 (see NICS 11), another survey was conducted in January 2007 (ACF-F, 01/07). The nutrition situation was not critical, with a prevalence of acute malnutrition of 5.8% (4.2-7.4), including 0.5% (0.0-1.1) severe malnutrition, and was within the same range as in January 2006. Mortality rates were under control: CMR= 0.49 (0.27-0.72), U5 MR=0.36 (0.0-0.92).

Overall

The situation of the displaced people and people affected by the conflict in the North of the country is poor (category III). The on-going humanitarian response to the crisis might prevent further deterioration during the forthcoming hunger gap.

Chad

The number of IDPs has continued to increase in Eastern Chad over the past months and was estimated at around 140,000 as of April 2007 (CAP, 09/05/07). The IDPs are sheltered mainly in Dar Sila and Dar Assongha departments, in nine major sites and a number of smaller sites (see map).

The security situation in the area is still volatile, although the state of emergency, imposed six months ago in the country, was lifted in May (IRIN, 25/05/07).

Displaced families have received humanitarian aid such as non-food items, food, safe drinking water and health care. However, gaps in provision of aid remain and access to many areas will become increasingly difficult during the rainy season between June and September.

There are few data available on the nutrition status of the displaced population. In Ade IDP site, however, the nutrition situation has been reported as worrying (UNICEF, 15/05/07). It seems that there are few nutrition programmes for the IDPs, apart for those located near to Goz Amir and Djabal refugee camps, who can access the nutrition centres there. It is unclear if the lack of nutrition activities is explained by a nutrition situation that does not warrant implementation of such activities, or by a gap in the humanitarian response.

Estimated displaced population in Eastern Chad, April 2007 (OCHA, 29/04/07)

Democratic Republic of the Congo

The security situation remains volatile, especially in the east of the country.

Several surveys conducted in Kasai Oriental, in areas where fighting raged between 1998 and 2003, showed poor to critical nutrition situations (WFP, 10/06) (figure 6). Especially worrying was the high proportion of oedematous children. The surveys were conducted during the hunger-gap season and food security appeared poor. Families seemed to lack proper tools and seeds to undertake adequate agricultural and fishing activities. Exclusive breast-feeding rates were very low and introduction of complementary foods before six months was widespread.

Figure VI Prevalence of acute malnutrition, Kasai Oriental province, DRC, October 2006 (WFP, 10/06)

In Ituri district, Orientale province, the nutrition situation was still poor (figure 7) but showed a marked improvement compared to 2004 (COOPI, 11/06; COOPI, 12/06; COOPI, 01/07). The security situation had also improved, although it was reported to still be volatile.

In Tshopo district, Orientale province, levels of acute malnutrition, and especially of kwashiorkor, seemed critical in Yaleko health zone (figure 7) (LWF/joint, 10/06). On the other hand, the situation was under control in Opala health zone, and average in Bafwasende.

Figure VII Prevalence of acute malnutrition, Orientale province, DRC, October 2006-January 2007 (COOPI, 11/06; COOPI, 12/06; COOPI, 01/07; LWF/joint, 10/06)

The situation was also poor in Lusangi and Sarabila health zones, Maniema province. The prevalence of acute malnutrition was 11.3% (9.2-13.4) including 3.2% severe acute malnutrition (Concern, 02/07). Mortality rates were also worrying. The survey was conducted shortly after the harvest, at a time when the nutrition situation should be at its best. Access to quality health care was reported to be poor because of inadequate staffing and supplies in medicines, and high costs. Child-feeding practices were less than satisfactory. According to a survey conducted in Bulungu health zone, Kwilu district, Bandudu province, in January 2007, the prevalence of acute malnutrition was 9.5%, including 4.5% severe acute malnutrition, with 3.1% of oedematous children (PRONANUT/Joint, 01/07). This is within the same range as recorded in the nearby Vanga and Mosango health zones in October 2006 (see NICS 12).

Overall

Despite an improvement in the security conditions, the nutrition situation seemed to remain precarious (category II) in most of the areas of Maniema, Bandudu, Kasaï Orientale and Orientale provinces where surveys were conducted in late 2006/early 2007.

Southern Africa

Zambia

A random-sampled nutrition survey was conducted in Kalma refugee camp in March 2007 (AAH, 03/07). The camp shelters 19,040 people, mostly from DRC origin. Although the refugees relied mainly on the food distribution (full food ration), they were also engaged in small-scale agricultural and income-generating activities. Water availability and sanitation were reported as being good.

The nutrition situation was acceptable and has been stable for the past few years. The prevalence of acute malnutrition was 3.2% including 0.3% severe malnutrition. However, the level of stunting was high, with 55% of the children stunted.

Asia

Nepal

As another step in the peace agreement, an interim coalition government was formed at the beginning of April 2007 (OCHA, 05/04/07). However, some groups protested that they were not included. Clashes and disruption of official activities were still reported throughout the country.

Although no reliable figures exist, about 200,000 people were estimated to have been displaced by the conflict (see NICS 7) (IDMC, 16/10/06). Few returns seemed to have taken place so far.

Poor food security and nutrition situations in vulnerable areas of Nepal - A mission of experts on the human right to food has described hunger and food insecurity across the country as "pervasive" (IRIN, 23/04/07). The mission stated that the government has no comprehensive strategy to address hunger, and that there is a lack of coordination between the capital and the regions and between ministries. Main obstacles to food access were found to be endemic discrimination; insufficient and insecure access to land, and evictions; and discriminatory access to resources such as forests and fishing areas.

According to a WFP assessment conducted in November/December 2006, 197,905 people were experiencing an acute food and livelihood crisis and another 215,463 were facing a deteriorating food security situation, due to drought and other adverse weather conditions (WFP, 01/07). However, these numbers had decreased compared to the previous assessment when 900,000 people were facing a deteriorating or acute food security situation.

According to the families interviewed during the assessment, the main problems they were facing were adverse weather conditions (20.5%); human illness (18.9%); lack or loss of employment (17.1%), and unavailability of food (16.3%). All the households were worse off compared to the same season last year with 63% of them experiencing a food shortage. The poorest were the most affected with 93.8% of the extremely poor and 67.7% of the poor experiencing a food shortage compared to 17.9% of the better-off. A significant proportion of the populations reported a reduction in income, especially in the Terai (close to 70%). A decrease in access to food was even more pronounced with more than 60% of families affected in the Terai and the Far-West. The poorer the families were, the higher the decrease in income and access to food was. The most common coping mechanisms were shifting to less expensive/preferred foods; reducing meals, borrowing and migration. Sale of assets or lands was not widely practised. Casual labour represented the main livelihood for the poor, followed by crop farming and remittance. Assistance programmes only represented a very low proportion of the livelihood of all the wealth groups.

However, the winter harvest was reported to have been good, especially in the Terai (OCHA, 12/04/07). In the Hills and Mountain districts of Mid and Far Western Regions, a substantial localised decrease in production was reported.

A nutrition survey conducted in the eight most vulnerable Village Development Committees of Bahjang district in the Far-West region in December 2006, showed a poor nutrition situation (ACF-F, 01/07). The prevalence of acute malnutrition was 11.0% (7.6-14.4), including 1.2 % (0.0-2.4) severe malnutrition. Night blindness was reported in 0.5% of the children and 15.4% of the women. Mortality rates were under control. The survey was conducted before the traditional hunger-gap period between February and June, and the situation might worsen further.

The nutrition situation was comparable to that of the nearby Humla and Mudug districts where a survey was conducted at the beginning of 2006. Feeding patterns were inadequate, with 46% of the women having consumed neither vegetables nor fruit the day prior to the interview, and 23.7% having eaten neither animal foods nor pulses. Only 21.2% of the women had had antenatal care during their current/last pregnancy. Access to health services appeared low with more than half of the women reporting there was no functioning health post in the community. The main obstacles to going to a health post were distance and cost. On the other hand, most women have had contact with the Female Community Health Volunteers, especially during vaccination campaigns.

Refugees

About 104,000 refugees are sheltered in seven camps in Jhapna and Morang districts, south-eastern Nepal. They are ethnic Nepalese who left Bhutan in the early nineties when the kingdom launched cultural reforms, and have lived in the refugee camps ever since. Although talks have been held repeatedly, no agreement about repatriation of the refugees has been reached yet.

As of the end of May 2007, violence erupted at the Nepal-India border as a group of about 7,000 refugees tried to cross the border to reach Bhutan via India (IRIN, 30/05/07). Two refugees were killed and hundreds injured. Tension between the refugees who want to go to a third country and those who insist on being given the right to return to Bhutan had increased since the US offer to resettle 60,000 of the refugees (AFP, 29/05/07).

A random-sampled nutrition survey conducted in January 2007 showed an acceptable level of acute malnutrition (CDC/joint, 03/07) (table 6). However, stunting was significant as well as anaemia. Night blindness was also reported in 2% of the children and 10% of their mothers. Angular stomatitis, a sign of riboflavin deficiency was present in 1% (0.4-2.3) of the children, while about 10% showed scarred angular stomatitis, a sign of past riboflavin deficiency.

Table 6 Results of a nutritional survey, Bhutanese refugee camps, Nepal, January 2007 (CDC/joint, 01/07)

Compared to previous years, the prevalence of acute malnutrition and angular stomatitis has decreased (figure 8 & 9). However, the present survey was conducted in January, a time when food security is better than in June-July when the previous surveys had been conducted. It is therefore difficult to interpret the apparent improvement in the situation.

Figure VIII Trends in prevalence of acute malnutrition, refugee camps, Nepal

Figure IX Trends in prevalence of angular stomatitis, refugee camps, Nepal

Comparison with the results of the 2006 Demographic and Health Survey in the south-eastern areas of Nepal (DHS, 2006), showed that stunting, wasting, and anaemia in women seemed lower among refugees than Nepalese (stunting = 36.9%; wasting = 11.2%; anaemia among women = 36.9%), but that anaemia in 6-59 month-olds was at about the same level.

Although breastfeeding was almost universal at ages 1 and 2, exclusive breastfeeding below six months was low with about 76% of the children having received water, tea or other liquids before three months of age. Mothers' practices of complementary feeding were poor because of inadequate knowledge and possibly high cost of nutrient-rich foods.

Refugees receive a full food ration as well as some non-food items, such as cooking fuel (WFP/UNHCR, 06/06). Refugees have not been accorded the right to work or to access agricultural land. Many, though, work outside the camps but only on a limited scale with earnings far less than what is needed for sustainability (WFP/UNHCR, 06/06).

According to the survey, about 92% of the mothers reported that at least one of the household members earned cash income. Only 33% and 19% of the mothers owned a kitchen garden and chicken or goats, respectively. Almost all women bought food in the market, especially vegetables, potatoes, milk, meat and fruit.

Access to good quality water, with an average of 20-25 l/pers/day, and sanitation were reported to be adequate in the camps (WFP/UNHCR, 06/06). Health status also seemed satisfactory and the mortality rate was under control.

Middle East

Occupied Palestinian Territories

Since the start of the second Intafada in 2000, Palestinians have suffered a deterioration in their livelihoods, food security, and access to basic services (see RNIS 43 and NICS 4).

A food security analysis released early 2007 concluded that 34% of the population of West Bank and the Gaza Strip was considered food secure in 2006, while 20% was marginally food secure, 12% was vulnerable to becoming food insecure and 34% was food insecure (FAO/WFP, 21/02/07). Although not directly comparable with the FAO/WFP food security assessment in 2003, which used a different methodology, the findings were similar.

Refugees were most likely to be food insecure with 39.7% of the refugees categorised as food insecure, and 29.1% as food secure, compared to 30.2% and 38.5% for non-refugees. Moreover, refugees living in camps, who represent only 34% of the refugees, were more vulnerable with 44.7% of them food insecure and only 23.3% food secure. The urban population was more likely to be food secure than rural population: 39.4% vs. 30.4%. The Gaza Strip was more affected by food insecurity with 58% of the food insecure non-refugees located in the Gaza Strip and 24% in the West Bank.

New population groups such as families supported by the Palestinian Authority government employees have become food insecure since the beginning of 2006. This is explained by the fact that following the victory of Hamas at the parliamentary elections at the beginning of 2006, key donors suspended international aid to the Palestinian Authority government (PA), leading to a drop of 60% in its income (OXFAM, 04/07). This is reported to have had an adverse effect on the livelihoods of Palestinians , the PA being a major employer, employing about 161,000 people who support about 1 m dependents. The decrease in income has meant that salary payments have been irregular and services, such as health care, schools and provision of welfare payments have been curtailed. OXFAM reported a 30% increase in poverty in 2006. To mitigate this situation, a temporary international mechanism was established by the European Commission in the last semester of 2006 with the aim of channelling aid directly to Palestinians. This has included social allowances to health workers, provision of fuel to hospitals and water systems. A new unity government was formed in March 2007, following an agreement between Fatah and Hamas. However, direct aid to the Palestinian Authority had not resumed as of April 2007.

Economic access to food was still the most significant concern in terms of food security, with increases in food prices, especially in the Gaza Strip amidst the drastic reduction in livelihoods. Food aid was found as having recently become a more prominent source of food. Factors leading to food insecurity are described in figure 10.

The results of the Palestinian Family Health Survey conducted at the end of 2006/beginning of 2007 showed that the level of wasting has remained under control with 1.4% of the children wasted, including 1.7% in West Bank and 1.2% in the Gaza Strip (PCBS/joint, 04/07). About 13% of the children were stunted in the Gaza Strip and 7.9% in the West Bank, or an average 10.2% in the Palestinian Territories. Compared with the same type of surveys conducted in 2000 and 2004, it seemed that stunting showed a slight increase from 7.5% in 2000 to 9.9% in 2004 and 10.2% in 2006. This was especially marked in the Gaza Strip with an increase from 8.3% in 2000 to 13.2% in 2006. As the confidence intervals or a statistical comparison were not provided in the report, it is difficult to know the significa

Figure X Factors leading to food insecurity as depicted in qualitative feedback sessions (FAO/WFP, 21/02/07)

Abbreviations and acronyms

AAH	Aktion Afrika Hilfe
AAH-US	Action Against Hunger USA
ACF-F	Action Contre la Faim France
AFP	Agence France Presse
CAP	Consolidated Appeal Process
CDC	Center for Disease Control
CMR	Crude Mortality Rate
< 5 MR	Under-five Mortality Rate
DHS	Demographic and Health Surveys
DPPC	Disaster Prevention and Preparedness Commission
ENCU	Emergency Nutrition Coordination Unit
FAO	Food & Agricultural Organization of the United Nations
FEWS	Famine Early Warning System
FSAU	Food Security Analysis Unit for Somalia
IDMC	International Displacement Monitoring Centre
IFRC	International Federation of Red Cross and Red Crescent Societies
IRIN	International Regional Information Network
KRCS	Kenya Red Cross Society
LWF	Lutheran World Federation
MOH	Ministry of Health
OCHA	Office for the Co-ordination of Humanitarian Assistance
SC-UK	Save the Children-United Kingdom
UNHCR	United Nations High Commission on Refugees
UNICEF	United Nations International Children’s Emergency Fund
WFP	World Food Programme
WHO	World Health Organization

References