CURRENT SITUATION

1. Liberia Region
2. Western Ethiopia/Eastern Ethiopia/Ogaden
3. East, Central and West Sudan
4. Kenya
5. Southern Somalia
6. Mozambique
7. Rwanda
8. Angola
9. Southern Sudan
10. Uganda
11. Shaba/Kasai Regions, Zaire
12. Ghana, Togo, Benin Region
13. Central African Republic
14. Zaire (Refugees)
15. Burundi Situation (Burundi, Rwanda, Tanzania, Zaire)
16. Mauritania/Senegal
17. Djibouti
18. Zambia
Southern Iraq

1. Liberia Region

(see Maps 1A, 1B and Figure 3A)

A. Liberia

Trend in numbers of refugees/displaced and proportion severely malnourished and at high risk (black area).

Estimates of populations affected are as follows:

		December 1993	February 1994	April 1994
Liberia		1,750,000	1,750,000	1,750,000
Sierra Leone		150,000	300,000	297,000
Cote d'Ivoire		250,000	250,000	250,000
Guinea		600,000	600,000	415,000
	TOTAL	2,750,000	2,900,000	2,712,000

In February, the security situation continued to deteriorate and expanded ECOMOG forces were deployed enabling cross-line convoys to deliver some relief food to Bong County (Gbanga). Fighting has been heaviest in Bong, Bassa, Lofa, River Cess and Sinoe counties [WFP 11/02/94]. An estimated 120,000 people in South East Liberia and 145,000 in Upper Lofa Country are currently cut off from food distributions (WFP 28/02/94]. However, recent agreement reached between the various warring factions has led to the tentative beginning of disarmament and the hope that previously inaccessible areas such as Upper Lofa County will become accessible to relief agencies. The planting season is now beginning - the fields are being prepared and seeds should be planted by June. It is reported that there is a shortage of seeds and an inadequate harvest would extend the region's dependence on external food sources [SCF 18/04/94]. Here are some details by area.

NPLF Area In Bong, Nimba and Grand Bassa Counties the low measles vaccination coverage of 44% prompted plans to expand the vaccination programme, starting in mid-February with Nimba County [MSF-B 21/01/94].

A survey conducted in January in Upper Margibi, Lower Bong and Grand Bassa Counties (population approximately 350,000) found 4.5% wasting with 1.5% severe wasting. However, crude mortality rates were 1.4-1.7/10,000/day (5 to 6 x normal) and under-five mortality rates were 3.7-5.6/10,000/day (see Annex I la). Food aid distributions are said to be insufficient (less than 1400 kcals/capita) with distributions primarily along main roads leaving large inaccessible and remoter areas unserved. As local harvest resources have largely been depleted, the impact of the coming rainy season in May is almost certain to cause a deterioration in nutrition and health status as food transportation becomes more difficult [MSF-H 29/03/94].

ULIMO Area Fighting is continuing throughout Upper Lofa, and currently there are no international organizations present in the area. There is, therefore, little information on the status of the resident population. The anticipated return of relief agencies and resumption of their activities once disarmament is properly under way will undoubtedly be hampered by the large-scale destruction of infrastructure which has reportedly taken place with this most recent round of fighting. Given the likely displacement of many Liberians from this region into Sierra Leone accurate assessments of numbers in this area are not available [UNHCR-A 24/03/94].

Sierra Leone The most recent estimates of numbers of refugees and internally displaced people in Sierra Leone is 297,000. However, given the lack of information on numbers of people fleeing Upper Lofa, this may now be an under-estimate of the actual population. Reports at the beginning of February indicated that intensification of rebel activities had cut off the main access route to Segbwema, a major food distribution site for 70,000 displaced persons in Eastern province. A further 12,000 Sierra Leoneans in Kenema were cut off from NGO assistance due to insecurity at the end of February. The general situation was described as unstable and generating concern about impact on relief operations throughout February and March [WFP 28/03/94].

Overall, there is a gleam of hope in the situation in the Liberia region with the recent disarmament agreement, already leading to the return of a reported 19,000 refugees to Liberia from Cote D'Ivoire and Guinea [UNHCR-A 24/03/49]. However, 350,000 people with known high mortality rates are at risk (category I in Table 2) especially with the rains due in May. Those in inaccessible areas, such as Upper Lofa, (estimated population of 145,000), South East Liberia (estimated population 120,000) and the 82,000 refugees and internally displaced in Sierra Leone are also believed to be at high risk, although precise details of their condition are not known (category Ha in Table 2). The remainder of the affected population in Liberia are considered to be at moderate risk (category IIb in Table 2) with a tendency to improvement if the current disarmament process continues.

How could external agencies help? Part of the affected population is inaccessible for security reasons, and thus external assistance is not currently a major issue. However, the infrastructure within such areas has presumably been damaged, and donors could consider future funding needs for reconstruction as a prerequisite for effective rehabilitation when security allows access; transport, food, medical supplies, and personnel will also be likely to be needed. This currently applies to a population of around 265,000 in Liberia, and another 82,000 in Sierra Leone.

For the population accessible in terms of security, nutrition is improving with the harvest and with external assistance, which is understood to be presently adequately funded. However, remoter areas, even if accessible from a security viewpoint, are reportedly under served with relief food and supplies. The low coverage of measles immunization remains a major risk; stepped up immunization has begun, but additional funding may be needed for wide coverage.

2. Western Ethiopia/Eastern Ethiopia/Ogaden

(see Map 2)

Western Ethiopia Most recent reports are that this group of 44,000 Sudanese refugees who are being helped to permanently settle in Western Ethiopia have an adequate nutritional status [UNHCR-B 24/03/94).

Eastern Ethiopia There are approximately 100,000 Somali refugees in this area. Repatriation plans are in place but implementation is pending [UNHCR-B 24/03/94], although there are reports of substantial population movements already (SCF 13/4/94].

Ogaden (Gode 1&2, Bohelagare camps) A census carried out in the three camps in January 1994 indicates a returnee and displaced person population of 35,000. Crude mortality rates in February in Gode 1 and 2 were 0.9/10,000/day (3 x normal) and under-five mortality rates were 0.9/10,000/day (see Annex I 2a). These rates show a slight improvement over those reported from November when mortality rates were 1.1/10,000/day and under-five mortality rates were 1.4/10,000/day. As many people are now moving in and out of Bohelagare camp the mortality figures are no longer thought to be very meaningful, however.

Micronutrient deficiency diseases such as scurvy and vitamin A deficiency are reported every month at the camp clinics. In January the incidence of scurvy diagnosed at the clinics was reported as 12.8/1,000/month which is three times that seen in November and the incidence of signs of vitamin A deficiency was 0.6/1,000/month (see Annex I 2b). The extent of vitamin A deficiency is unclear. Food distributions to the camps have been erratic and between November and January per capita calorie receipts have worked out at 95 kcals/person/day. Indeed throughout 1993 rations have amounted to less than 1,000 kcals/person/day. It is therefore not surprising that a nutritional survey carried out in December showed wasting levels of 30.5% with severe wasting at 6.8% (see Annex I 2c). Measles vaccination coverage was 88.9% [MSF-B-A Jan.94, MSFB Feb.94).

The 35,000 returnees/displaced in the Ogaden remain in a critical situation. While the mortality rates indicate an improving situation, prevalence of wasting and the continued presence of micronutrient deficiencies indicate the extremely poor nutritional condition of this group (category I in Table 2). Without the provision of an adequate general ration and a rehabilitation programme to encourage self-sufficiency this situation is unlikely to improve. The 144,000 Sudanese and Somali refugees are in a stable condition and are probably not currently at risk (category IIc in Table 2).

How could external agencies help? One issue here concerns the future of the relatively small population (35,000) in the Ogaden, who are in a chronically deprived situation. They need much better food rations (quantity and quality) for survival - as well as the means for rehabilitation of livelihood. It is unclear why this situation has persisted for so long. Certain NGOs are working in the area, and may require increased support (e.g. MSFB, SCF).

Vitamin A supplementation for vulnerable groups may be indicated. Scurvy is also occurring, less easily tackled through supplementation, requiring fresh fruit and vegetables. Provision of fortified blended foods may also need to be considered.

3. East, Central and West Sudan

(see Map 3)

Kordofan Results from a state nutrition survey in January 1994 in Kordofan found levels of wasting in the provinces varying between 7.1% and 14.6% with severe wasting as high as 4.5% in Sodari. In the camps for displaced Southerners and the drought affected, levels of wasting varied between 1.1% and 26% with severe wasting at 5.6% in Abyei (see Annex I 3a and b). Although a few provinces and camps had lower levels of wasting compared with the July 1993 survey, the majority showed an increase in prevalence of wasting. This may partly be explained by a constant influx of new arrivals who are malnourished [UNICEF 22/03/94]. Another factor may be the continuous rise in cereal prices (22% per month) due to the poor harvest and lack of fuel for transport.

There are also reports of approximately 4,200 people migrating south of Kadugli due to insecurity and/or drought There is concern that this additional group of people will exhaust the already low food stocks in the area [WFP 11/02/94].

At the end of February there were reports from North Kordofan of NGOs being forced to turn away drought affected applicants from Food For Work projects. The demand for employment is overwhelming compared to last year's minimal response. In South Kordofan food stocks in local markets were almost completely run-down [WFP 28/02/94].

Darfur The impact of the drought in Darfur has been severe causing a huge escalation in cereal prices with scarcity in many local markets reported in February. Remittances from migrant workers in Libya have now stopped, worsening the situation [SCF 13/04/94].

While we know some portion of the 1,700,000 people in this area is in a critical state, population breakdowns are not currently available. We have, therefore, categorized the entire population as IIb in Table 2.

How could external agencies help? Some donors are reluctant to provide general rations for camps, for political reasons, hence food supplies are erratic at least to those camps showing high levels of malnutrition. Unless donor policies change in the current context, provision of external food will remain a problem influencing nutrition.

4. Kenya

(see Map 4 and Figure 3B)

B. Kenya

Trend in numbers of refugees/displaced.

Information available in January 1994 from Hagadera camp (population 30,000) shows a crude mortality rate of 0.4/10,000/day and an under-five mortality rate of 1.3/10,000/day (see Annex I 4a). The under-five mortality rate has improved since January (1.9/10,000/day) [MSF-B-B Jan.94]. However, in February, the under-five mortality rate increased to 1.9/10,000/day, mainly due to diarrhoea [MSF-B-C Feb.94).

A nutritional survey conducted in Marafa camp in January found 7.1% prevalence of wasting with no severe wasting (see Annex I 4b). These rates are a considerable improvement on June 1993, when a survey found 16% wasting and 3.4% severe wasting [IFRC 28/03/94].

There continues to be a steady influx of approximately 300-400 Sudanese refugees per week into Kakuma camp in the northwest. Camp infrastructure and resources appear to be adequate to cope with this rate of influx, and the nutritional condition of this refugee population is believed to be satisfactory [UNHCR 22/03/94].

The overall refugee population in Kenya continues to decline as repatriation proceeds. The refugee situation can be described as under control with no population groups at unusual risk (population categorized as IIc in Table 2).

How could external agencies help? A priority for the refugees/displaced population, either in Northern Kenya or repatriating to Somalia and Ethiopia, would be rehabilitation of their means of livelihood when they return. Probably, the most effective way is going to be support for local NGOs, notably in Somalia. At the same time, serious drought is affecting the area, and the usual needs for mitigating the effects of drought are becoming increasingly important.

5. Southern Somalia

(see Map 5)

Applications from local NGOs to WFP for food to support rehabilitation activities are increasing and at the end of March implementation was proceeding without major problems in Bardera, Baidoa, and Bakool [WFP 11/02/94]. For example, the operation of a health program in Baidoa is continuing, with changes being implemented to require a minimum external supervision [WV 31/03/94].

A nutritional survey carried out in Mogadishu in April showed 8.1% wasting and 1.3% severe wasting in North Mogadishu (where relatively few displaced people are living) and in South Mogadishu (where most displaced people are living) the level of wasting was 8.9% with 2.1% severe wasting (see Annex I 5a) [AICF 15/04/94].

The population requiring emergency assistance (274,000) is not thought to be currently at any heightened nutritional risk (category IIc in Table 2).

How could external agencies help? Rehabilitation of livelihood, especially supporting locally active NGOs, is one priority. These efforts will have to be large scale and sustained. The particular ecology of Somalia means that rehabilitation of livelihood that depends upon livestock (including camels), drought-resistant agriculture, and access to water (bore holes, etc.) will make particular demands upon technology, equipment, and funds.

6. Mozambique

(see Map 6 and Figure 3C)

C. Mozambique

Trend in numbers of refugees/displaced.

Food distribution has been posing a problem in some areas as there is inadequate transport capacity to move food while road conditions have deteriorated due to the rains. This is the situation in Mecula District, Niassa Province where, according to reports in January, returnees from Tanzania had been without assistance for months. An assessment in the region in December showed levels of wasting at 13.6% (see Annex I 6a) [MSF-CIS Dec.93].

Land mines also remain a problem as the rains have exposed some deeply buried mines which have caused accidents. Mines have also inhibited farming in some area. However, in January, the number of mining incidents declined considerably.

In several districts "growth faltering rates" increased to around 15% while the number of malnourished children admitted to feeding centres increased in several areas. As January is the peak of the hungry season this may be a seasonal trend of increasing malnutrition as food reserves are dwindling. It may also reflect the greater vulnerability of returnees many of whom arrived too late to participate in last years agricultural season while others did not possess enough seeds and tools to do so. Others may have received food assistance upon arrival but as they moved further towards their zones of origin, ended up beyond the reach of food aid distributions [MSF-CIS Jan.94].

In January there were no more cases of cholera reported in Namapa district and the outbreak in Memba was diminishing. The number of deaths reportedly due to diarrhoea also seemed to be decreasing [MSF-CIS Jan.94].

Meteorological data indicated favourable rains throughout January and the prospects of a good national harvest in February [MSF-CIS Jan.94).

Overall, the situation appears to be under control although there are pockets of heightened vulnerability. This population is therefore not considered to be currently at particular risk (category IIc in Table 2).

How could external agencies help? Most of the areas into which the population has returned are now accessible in terms of security, although there are pockets, particularly in the north, that are logistically difficult to reach. Rehabilitation of the means of livelihood of the returning population is needed. The repair and development of infrastructure, roads, bridges, etc. is required. In the short run, access to remote areas in the north may require airlifting with a transient high cost De-mining operations will be of high priority, not only to prevent injury, but to rehabilitate livelihood.

7. Rwanda

(see Map 7)

Food distributions of rations containing 1,900 kcals/person/day were continuing in March for the 320,000 displaced in the camps North of Kigali; these were probably adequate on average. Distributions were also continuing for the 25-30,000 returnees in the Rwandan Patriotic Front (RFP) zone in the North. The nutritional status amongst these groups was, at that time, said to be good and continuing to improve, and food distributions had been satisfactory [ICRC 28/03/94, WFP 11/03/94, WFP 28/03/94).

Surveys in January in nine of the camps (population 150,000) found only 1.2% prevalence of wasting with 0.4% severe wasting. Crude mortality rates were 0.3/10,000/day and under-five mortality rates were 0.8/10,000/day. These mortality rates are approximately what one would expect in a non-displaced population in Rwanda. However, water availability was only 6 litres per person per day which is well below recommended levels (20 litres/person/day) (see Annex I 7a) [MSF-H 29/03/94].

The effects of a drought inside the DMZ, which caused the extension until June 1994 of the general distribution of a half ration for 240,000 returnees to the DMZ, seemed to have been contained as reports before the recent destabilization were that nutritional status had been continually improving in this area. However, there were no hard data on this.

There were also reports of the spontaneous repatriation of approximately 12,500 Rwandan refugees from Uganda to the RPF controlled area in the North. The remaining Rwandan refugee population in Uganda is 3,500. UN forces in Rwanda were providing an escort for these returnees, and food was be distributed for at least one month. However, these returnees were settling in an area with many land mines which will constrain their ability to farm and make them more nutritionally vulnerable [UNHCR 24/03/94, UNHCR 29/03/94).

Recent events in Rwanda have lead to a very unstable and fluid situation. The destabilization of the country has forced humanitarian agencies out of Rwanda. The Rwandan Red Cross, MSF and the International Committee of Red Cross remain operational. For these reasons the entire displaced population (572,200) is categorized as "at moderate risk" (category IIb in Table 2), and the estimated 1,500,000 war affected are considered to be at high risk (category IIa in Table 2).

How could external agencies help? Before the deaths of the Presidents of Rwanda and Burundi in an air plane crash on 6 April, the priorities for external assistance included a need for more information about conditions in the demilitarized zone (DMZ). This area has been affected by drought, and only half-rations have been distributed. A nutrition survey was needed. An appeal will be issued on or about 25 April for emergency assistance needed in Rwanda. At the present time the situation is too uncertain to go beyond this.

8. Angola

(see Map 8 and Figure 3D)

D. Angola

Trend in numbers of refugees/displaced and proportion severely malnourished and at high risk (black area).

The civil war in Angola is continuing, although access for humanitarian aid is improving. After a temporary suspension in early February, relief flights to Huambo and Cuito have now resumed. However, shelling of Melanje recommenced at the beginning of March, while Menonge came under heavy attack one week later causing the evacuation of international relief staff. Apart from these incidents, relief operations have continued normally to most other destinations over the past two months with priority being given to Huambo, Cuito and Melanje. Meanwhile peace talks were held in Lusaka but eventually broke down at the end of March. Although the cities tend to be government controlled, UNITA controls much of the countryside and supplying the cities is difficult.

In spite of this agencies will continue to airlift food to major cities which have borne the brunt of the civil war. Many of these cities have large displaced populations who are known to have suffered high rates of conflict, malnutrition and disease related mortality. Apart from sporadic interruptions due to insecurity, food deliveries by relief agencies have gradually improved. While there are only data from Melanje which demonstrate an improved nutritional status, it is probable that other cities show similar improvement. Two recent surveys which may be typical of other areas are described below.

Melanje had suffered severe food shortages since mid 1993 due to the continued fighting between the NPLA and UNITA forces. A significant proportion of the cities' food demands was from large displaced populations entering the city as refugees from surrounding municipalities. In February a nutrition survey in Melanje (population estimated at 240,000) indicated a wasting level of 11.2% and severe wasting of 2.2%. (see Annex I 8a). This compares favourably with data in October 1993 which recorded wasting levels of 34% with 19% severe wasting. Crude mortality rates in February of 1.0/10,000/day and an under-five mortality rate of 1.7/10,000/day are still very high; these include war related deaths. These rates are similar to those reported in January (1.3/10,000/day). In February the average ration receipt was 1,720 kcals/person/day, marginally adequate on average. Melanje will continue to be heavily dependent on food supplies in the coming months so that it can be expected that any interruptions to food supplies from outside will very quickly precipitate another nutritional crisis [MSF-H 29/03/94].

In order to determine the need for emergency selective feeding a nutritional survey was conducted in Ombadja district, in the province of Cunene in December 1993. The low levels of wasting found, 4.8% with 1.1% severe wasting, led to the decision not to open feeding centres in the area (see Annex I 8b) [AICF 10/12/93].

How could external agencies help? Requirements depend on the security situation, and especially the effect on logistics. Delivering food fast enough by air, the main available route, to the cities, is proving very difficult, as well as expensive. Food in the pipeline seems currently not the main constraint, although supplies of medicine may be. Lack of information remains an important constraint, and as feasible surveys of nutrition conditions, immunization coverage, etc. would be most desirable, especially in the cities that have been cut off. If and when the security situation improves, repair to infrastructure will be important to facilitate relief efforts.

9. Southern Sudan

(see Map 9 and Figure 3E)

E. Southern Sudan

Trend in numbers of refugees displaced and proportion severely malnourished and at high risk (black area).

This situation is compounded by the short-fall in cereal for the on-going relief operation which has led to less than 50% of food requirements for Southern Sudan being met in January 1994. A further problem has been the lack of funds to cover costs of transport so that numerous planned airlifts of food have had to be postponed. As a result relief food stocks have recently been very low or exhausted in a number of places including Wau, Meiram, Dilling, Kadugli, Juba and Abyei. Donors have been asked to provide funds for both transport and local purchase of sorghum and also to expedite food deliveries to ensure pre-positioning prior to the on-set of the rainy season.

A number of recent surveys indicate the seriousness of the situation.

Upper Nile An anthropometric survey in Chotbura found 24.3% wasting with 6.4% severe wasting (see Annex I 9a). There was also evidence that families had exhausted traditional coping mechanisms and that food and livestock resources were very limited [WV Dec.93, WV Jan.94].

A survey conducted in Obel-2 displaced camp in February found 30.2% wasting with 6.7% severe wasting (see Annex I 9b). Over two thirds of those found to be wasted were girls [UNICEF 22/03/94].

Eastern Equatoria Reports from Juba indicate that there has been almost no food for the displaced population and that many have had to resort to eating wild roots and leaves [WFP 11/03/94). CART (a government/NGO consortium with responsibility for food distribution) reported that 65 children died in the first two weeks of February. With newly available donor funds the resumption of airlifts in mid-March should halt the nutritional decline [WFP 28/02/94].

Bahr el Ghazal There are reports of an estimated 11,000 people in urgent need of food deliveries with numbers increasing due to drought and insecurity in the area. It is reported that three to six children are dying daily in Mariel Ajeith displaced camp in Wau and Unicef found that over 25% of children surveyed in the camp were "suffering from malnutrition" [WFP 11/03/94).

Jonglei Information available from Waat where there are approximately 17,000 displaced people shows 17.4% wasting and 2.6% severe wasting. Crude mortality rates were 3.1/10,000/day (ten times normal) and under-five mortality rate was 9.7/10,000 day (see Annex I 9c) [MSF-H 29/03/9].

The already precarious situation in Southern Sudan is being seriously threatened by the renewed government offensive which is creating new waves of displacement. Funding, logistical, food availability and security problems which have existed throughout this conflict, are being compounded by the demands of feeding an even larger displaced population. The 17,000 displaced in Waat are known to have high prevalences of malnutrition and elevated mortality rates and are therefore categorized in column I in Table 2. The remaining displaced population (483,000) is thought to be at high risk (category IIa in Table 2), while the war affected population of 1,500,000 is thought to be at moderate risk (category IIb in Table 2).

How could external agencies help? Recent fighting has increased the numbers of people displaced, stopped transport by barge of food supplies, and thus increased (for both reasons) the dependency on airlifting which urgently requires more funding. Security and poor land communications are a problem everywhere. The rapid increase in numbers makes the situation similar to the start-up of a new emergency. Food in the pipeline is inadequate, pledges need to be speeded up, and funds made available for local and regional purchases of food, and for transport especially by air. Health services, immunization coverage, etc. are all likely to be urgent problems.

10. Uganda

(see Map 10)

		February 1994	April 1994
Sudanese Refugees		188,000	190,000
Zairian Refugees		5,000	5,000
Rwandan Refugees		11,350	3,500 (before 6 April)
	TOTAL	204,350	198.500

Most of the Sudanese refugee population in the North West of Uganda (120,000 of the estimated 190,000) either live in settlements and are partly self-sufficient, or reside in transit camps. Their situation is generally believed to be stable.

However, there are approximately 2,000 Sudanese refugees at the Pachara Reception Centre in Moyo district. Pachara is one of an increasing number of reception centres to accommodate the newly arrived Sudanese. Reception centres (sometimes called transit centres) are meant to be a first stop when the refugees arrive, and from there they are moved to proper camps or settlements once land is available. This centre was originally set up as a temporary measure to isolate the incoming population due to a measles epidemic amongst the new arrivals. As it was intended to be a temporary centre, facilities are inadequate for permanent residence. Water availability is only 4 litres/person/day and of reportedly poor quality. Up until December 1993 food distributions were regular but have now become erratic. Between 22 November 1993 and 11 February 1994 crude mortality rates were 2.4/10,000/day which is 8 times the normal level while wasting was 31.3% with 7.4% severe wasting (see Annex I 10a), indicating a very serious situation. Pachara has also been the source of a meningitis outbreak which by mid-March had spread to a number of nearby settlements and transit centres [MSF-CH 01/03/94].

Approximately 20,000 Sudanese refugees have recently arrived in the area of Koboko (bordering Zaire), bringing the total number of refugees in this area to 70,000. Crude mortality rates in January 1994 were 0.6-1.1/10,000/day (2-4 x normal) and under-five mortality rates were 1.8-2.8/10,000/day (see Annex I 10b). It was reported that 80% of children between 9 months and 14 years old were immunized against measles [UNHCR 11/02/94]. More recent information (March 1994) shows levels of wasting of 11.6% and 2.1 % severe wasting. The crude mortality rate was 0.7/10,000/day (2 x normal) and the under-five mortality rate was 1.5/10,000/day (see Annex I 10c) possibly showing some improvement over January. Major types of morbidity and causes of mortality were diarrhoea, dysentery, and malaria. In view of the continuing risk several NGOs are warning against plans to cut the current food ration of 2000 kcals/person/day to less than 1500 kcals/person/day [MSF-H 29/03/94].

In sum, new arrivals from Southern Sudan (approximately 2,000) in the Pachara reception centre are at high risk (category I in Table 2) while the rest of the newly arrived Sudanese in Koboko (20,000) are considered to be at high risk. The remainder of the refugee population (176,500) are not at particular risk. However, there are concerns as new transit centres open to accommodate the continued influx of new arrivals from Southern Sudan that the absence of suitable relief agencies on the ground will lead to conditions similar to those currently seen in Pachara reception centre. The increase in the Sudanese refugees in Uganda is mainly due to the arrival of 300-400 refugees/day (up from approximately 100/day in February) fleeing the intensified fighting in Southern Sudan.

How could external agencies help? The increasing influx of refugees from Southern Sudan will overstretch the capabilities of local relief agencies. There is need to strengthen existing NGO/agency capacity to look after new arrivals - requiring expertise as well as resources, to combat overcrowding, poor water supplies, bad camp facilities, and to improve coordination. The food in the pipeline is reported to be adequate.

11. Shaba/Kasai Regions, Zaire

(see Map 11)

The situation is very worrying in Kasai region, to where several hundred thousand people displaced from Shaba due to the eruption of ethnic violence (which is now subsiding) are returning. Although nutritional survey results are not currently available, wasting and child mortality rates are reportedly high amongst this returnee population [WFP 25/03/94].

Part of the displaced population from Shaba arriving in Mwene-Ditu stay in that area, while others move on further to the north. In February there were approximately 13,000 arrivals and 2,000 departures. A nutritional survey carried out in January 1994 in Mwene Ditu (estimated resident population of 140.000 and displaced population 65,000) showed levels of wasting of 13% and severe wasting of 4.9%. This was further broken down into residents of Mwene Ditu (wasting 10% and severe wasting 4.1%) and displaced (wasting 19.5% and severe wasting 6.6%) (see Annex I 1 la). The crude mortality rate from a camp for the displaced reported in February was 3/10,000/day (10 x normal). There are approximately 8 litres/caput of water available [MSF-B-C Jan.94, MSF-B-A Feb.94].

The inaccessibility of the area and high transport costs have constrained food supplies to Kaisi. Limited food supplies carried by aircraft and train have only been delivered to the area since the beginning of March. Airlifts would be the most appropriate mode of transport but the response to requests for donor funds to cover such an expensive operation has been very limited [WFP 25/03/94].

In sum, the displaced population of Mwene-Ditu in Kaisi is in a critical situation (category I in Table 2) while the non-displaced population is at moderate risk (category IIb in Table 2). The populations in the Shaba towns of Kamina, Kolwezi and Likasi are not known to be at particular risk (category IIc in Table 2).

How could external agencies help? Costs associated with moving food into Kasai, a remote area, are a major constraint, for which donor assistance is needed. Resettlement of the displaced population returning to Kasai (many having been away for decades) requires help, through local and external NGOs. Information is scarce, and a survey of the returnee population in Kasai would be very useful.

12. Ghana, Togo, Benin Region

(see Map 12)

However, due to ethnic fighting in Ghana, approximately 6,000 people have recently been reported to be seeking refuge in Togo, while approximately 150,000 people are displaced within Ghana. No further details are available, and their nutritional situation is unknown [WFP 13/04/94]. An assessment mission is planned for mid-April to determine the needs of this newly displaced population [UNICEF 15/03/94].

13. Central African Republic

(see Map 13)

14. Zaire (Refugees)

(see Map 11)

The number of Sudanese and Ugandan refugees in Haut Zaire (north) receiving rations has been reduced from approximately 140,000 to 60,000. This reduction in numbers is due to the integration of the refugees into the local community [WFP 15/04/94]. (Please note: Burundi refugees in Zaire are discussed separately - see # 15 below.)

15. Burundi Situation (Burundi, Rwanda, Tanzania, Zaire)

(See Map 15 and Figure 3F)

F. Burundi

Trend in numbers of refugees/displaced and proportion severely malnourished and at high risk (black area).

The establishment of a new presidency in Burundi along with the beginning of the planting season in March led to the spontaneous repatriation of many Burundi refugees from Zaire and Tanzania along with a smaller number from Rwanda. Some Burundi refugees in Rwanda were said to be crossing the Rwandan border into Burundi by day to plant and tend fields and returning to Rwanda at night. Prospects for the harvest are said to be satisfactory, but due to insecurity, normal sowing levels have not been reached. However, violence in the capital city of Bujumbura early in March led to further displacement and a reduction in the rate of repatriation [FAO/WFP Apr.94].

Estimates of the displaced/refugee/returnee populations over time are:

		December 1993	February 1994	April 1994
Burundi		150,000	282.000	536,000
Rwanda		375,000	272,300	250.000
Tanzania		325,000	300,000	60,000
Zaire		58,600	60,000	60,000
	TOTAL	908,600	914,300	906.000

Burundi It is estimated that 25,000 refugees have spontaneously returned to Burundi since the beginning of January. The security situation in Burundi is precarious with continued sporadic fighting, especially in Bujumbura. It is estimated that approximately 15,000 people have fled the city to surrounding hills and across the border into Zaire after the most recent ethnic clashes in early March [UNHCR 29/03/94, WFP 11/02/94, WFP 28/03/94]. At the end of March it was estimated that there were over 500,000 internally displaced/returnees registered as in need of assistance but only enough resources to meet 30% of a full ration. The situation is expected to improve in April as food arrivals increase. There is little information on the nutritional status of those displaced within Burundi or returning from neighbouring countries although there were anecdotal reports from WFP field monitors of extensive moderate and severe malnutrition amongst returnees from the Tanzanian camps and consequent need for additional supplies (including supplementary foods).

A nutritional survey was carried out in the province of Ruyigi (near the Tanzanian border) in February 1994. The estimated population of the province in 250,000, and the level of wasting was 10.7% with 2.2% severe wasting (see Annex I 15a), indicating a moderate level of malnutrition [MSF-B-B 01/02/94].

Rwanda While there were reported (prior to 6 April) to be sufficient stocks of most food commodities there continued to be a shortage of beans so that the ration was reduced for the 250,000 Burundi refugees remaining in Rwanda. Corn-soya blend was distributed to compensate for this shortfall although only a partial ration could be allocated because of limited availability. Already in March ethnic clashes briefly interfered with relief efforts [WFP 28/02/94].

With increased quantities of food being distributed, improved health care in the camps and the movement of many refugees to Maza, a new camp in Rwanda, conditions for Burundi refugees in Rwanda overall were improving in March. The level of wasting in the camps, 40% (with 10% severe wasting) in January 1994, had been reduced to 20-25% (although this is still extremely high). Mortality rates were also improving; crude mortality rates were 0.71/10,000/day and the under-five mortality rate was 1.6/10,000/day (see Annex I 15b). This is still 2.6 times normal but an improvement on crude mortality rates of 3.7-5.6/10,000/day recorded in January. Exact immunisation coverage is not known although 68% of children in the camps have a vaccination card. After many months of crisis health and nutrition status was beginning to improve substantially after mid-February, although crude mortality rates were still 1.9/10,000/day (6 x normal) [UNHCR 29/03/94, WFP 18/02/94, WFP 28/03/94].

Information from March on Kagina camp (population 15,200) showed 25.4% wasting with 10.8% severe wasting, and a crude mortality rate of 0.7/10,000/day (2.5 x normal). The under-five mortality rate was 1.1/10,000/day (see Annex I 15c). In Rugogwe (population 10,500) the level of wasting was 16.7% with 6.1% severe wasting. Crude mortality rates were 1.1/10,000/day (4 x normal) and the under-five mortality rate was 2.3/10,000/day (see Annex I 15d). In Ngoma camp (population 9,000) levels of wasting were 7.6% with 2.0% severe wasting. The crude mortality rate was 0.6/10,000/day (2 x normal) and the under-five mortality rate was 0.7/10,000/day (see Annex I 15e). While the food basket was not providing full nutritional requirements, it was improving [MSF-H 29/03/94).

A survey conducted in mid-March 1994 in Kanage (estimated population 17,000) found wasting levels of 12.4% and severe wasting at 4.4% (see annex I 15f). Food distributions were often said to be late and provided a variable calorie content of 1,130-2,110 kcals/person/day. It is believed that the refugees have access to other food sources. Measles vaccination coverage is almost 86%. These data indicated an improving situation in the camp [MSF-B 18/03/94].

Kankuba is a new camp which opened in January 1994 and has an estimated population of 3,100. Wasting levels recorded in Mid-March were 4.9% with 0.9% severe wasting (see annex I 15g). Measles vaccination coverage here is also almost 86%. The results of this survey also confirmed an improving nutritional status for the refugees in the camp [MSF-B 25/03/94].

Information from camps called Saga I & II also showed an improving nutritional state with wasting levels of 3.7 - 5.4% and severe wasting 0.3 -1.5% (see Annex I 15h) [AICF 11/04/94].

Despite the re-registration that took place in December 1993, registration problems persist due to lost/stolen cards, unregistered cards (indicating cards were sold before or during the census) and some computer errors in deleting names. There also continues to be a small influx of Burundi refugees due to the resurgence of fighting amounting to approximately 10,000 new arrivals. A census is planned for Mid-April when new ration cards will be issued. [UNHCR 21/03/94, WFP 28/03/94]

Tanzania It was estimated in March that 80% of the Burundi refugees had spontaneously repatriated leaving approximately 60,000 in the camps. It is presumed that those that stayed behind are those least able to travel, e.g. the sick, malnourished and old, and that as a result, health and nutrition status in the camps remains a major concern. Food supplies have gradually improved. In February, rations ranged from 1,400-1,800 kcals/person/day - rather low - depending on the district, while by March supply had further improved [UNHCR 28/02/94, UNHCR 14/03/94].

Crude mortality rates for the first week of March varied between camps from 0.5-2.2/10,000/day (2-7 x normal) while under-five mortality rates varied from 0.7-7.4/10,000/day (see Annex I 15i). This is a considerable improvement compared to January when crude mortality rates varied between 2-7/10,000/day. The highest under-five mortality rate has been found in Kasula district and is thought to be due to malaria. A malaria control plan has now been prepared to combat this problem [UNHCR 14/03/94].

Zaire The clashes in Bujumbura in March resulted in the displacement of a further 15,000 Burundis into Zaire [UNHCR 28/03/94]. Logistical problems meant that supplies to the existing 49,000 refugees already in camps and living among the local population have been irregular so that this further refugee influx places an added strain on the food supply capacity [WFP 18/03/94].

In sum, the situation within Burundi is still politically tense with the displaced population in a precarious situation (category IIa in Table 2). While the situation for refugees in Rwanda showed much improvement compared to the extreme crisis reported up until January, mortality and wasting levels still indicate a serious situation (category IIa in Table 2). Mortality rates in Tanzania were very high, and the population is considered to be at high risk (category I in Table 2). Although little is known about the nutritional condition of the refugees in Zaire, logistical constraints would indicate that they are at heightened risk (category IIb in Table 2).

With the deaths of the Presidents and the subsequent destabilization of Rwanda, it is probable that many Burundi refugees in Rwanda will leave the country. This could further jeopardize their precarious situation. It is also possible that the currently calm situation in Burundi could degenerate, leading to the displacement of large numbers of people. The situation is very fluid, with a worsening tendency.

How could external agencies help? The information here does not take account of any changes that may have occurred since the death of the Burundi President on 6 April. There is little information on the nutrition of most of the displaced population, but it was reported that they were only receiving 30% of food requirements. A nutrition assessment is indicated before requirements for assistance can be specified.

While food supplies in the pipeline may turn out adequate, there is a current shortfall and funds are required for local or regional purchase, until the external food arrives. At the same time, account should be taken of the possible increase in numbers. For refugees from Burundi in Rwanda, a census was planned by UNHCR and the Rwandan Red Cross for all camps in mid-April to try to improve the serious registration problems; this may require assistance both in terms of expertise and funds. For the Burundi refugees in Tanzania, monitoring of those remaining is of high priority. Similarly, for the refugees in Zaire also, information, preferably through survey, is required.

16. Mauritania/Senegal

(see Map 16)

17. Djibouti

(see Map 17)

In January 1994 crude mortality rates were near normal varying between 0.1-0.3/10,000/day. Although the beri-beri out-break (caused by lack of vitamin B1) reported earlier (RNIS #2) is now said to be under control as a result of vitamin (thiamine) treatment and addition of com soy blend to the ration, some cases are still being reported. For example, 142 cases were reported in January 1994. Aour-Aoussa and Assamo camps (estimated population 10,000) had the most cases of beri-beri reported. However, it should be noted that mild cases can be very difficult to diagnose correctly so there may be some over-reporting [UNHCR 18/02/94, WFP 25/03/94].

There have been some anecdotal reports of a newly displaced population in the North who may require assistance, although no details are currently available [ICRC 28/03/94].

While most of the refugee population are probably not currently at risk (category IIc in Table 2), the estimated 10,000 in Aour-Aoussa and Assamo camps are still at high risk due to the existence of beri-beri (category Ia in Table 2).

How could external agencies help? The main priority here, is to ensure that the food pipeline is not disrupted, paying particular attention to availability of micronutrients, either as thiamine supplements, and/or as com soya blend.

18. Zambia

(see Map 18)

		February 1994
Zairian Refugees		18,000
Angola Refugees		17,000
Somali Refugees		1,000
	TOTAL	36,000

As the government of Zambia provides land for resettling refugees [WFP-A 25/03/94], they are not currently considered to be at nutritional risk (category IIc in Table 2).

Southern Iraq

A recent UN report on the situation of human rights in Iraq, submitted by the Special Rapporteur of the Commission on Human Rights [UN-ECOSOC 25/02/94] states that "Since his last report to the General Assembly, the Special Rapporteur has received a continuous flow of information concerning the deteriorating food and health situation in the country from a number of both nongovernmental and intergovernmental organizations."..."particularly the most vulnerable, are bearing heavy and painful consequences as mortality and morbidity rates rise...". The Special Rapporteur goes on to note that in the Southern pan of the country Government prohibitions and restrictions effectively deny the marsh dwellers access to food and health care, and "the general food and health situation has been further aggravated by the Government's draining of the marshes, which constitute the foundation of the local economy, support the traditional way of life and used to provide the main sources of protein (from fish and water buffalo) for the local population." Thus, aside from the military activity, the population is suffering both from little or no access to food and medicine distribution, and a declining source of livelihood - "water has become stagnant and polluted and has caused the death of large numbers of fish and water buffalo, i.e. the main sources of nutrition and income for the local population". The flow of refugees crossing the border into Iran has recently been "on average, 30 to 40 refugees each week" reported to be less than during 1993. Even the original population of the marshes is not known, but is variously reported as around quarter of a million people. The numbers internally displaced are again unknown, but are certainly in the tens or possibly hundreds of thousands. UNHCR reports that the number of Marsh Arabs assisted by the Government, UNHCR, and WFP in Iran is around 7,000. More than 600,000 refugees from all parts of Iraq are known to be in Iran, of which 110,000 are receiving assistance from UNHCR.

The Amar Appear (an international NGO) reports [Amar 19/04/94) that it is working with local NGOs to assist with food and medical care at Himmet (the border crossing) and in refugee camps, including some 20,000 squatters: of one group (some 10,000) displaced inside the marshes, the children are described as starving, many with dysentery, with negligible shelter with no firm ground under foot. Medical reports from displaced and refugee populations emphasize the high incidence of respiratory diseases, with the cold weather.

Other reports speak of renewed fighting during March causing increased internal displacement and destruction of villages. Refugees arriving on the border are described as suffering from severe malnutrition, and from exposure to unprecedented swarms of mosquitoes, perhaps due to ecological change [ICA 18/04/94].