CURRENT SITUATION (Sub-Saharan Africa)

1. Liberia Region
2. Western Ethiopia/Eastern Ethiopia/Ogaden
3. East, Central and West Sudan
4. Kenya
5. 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/Rwanda Situation
16. Mauritania/Senegal
17. Djibouti
18. Zambia

1. Liberia Region

(see Map 1 and Figure 3A)

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

However, the disarmament process is proceeding slowly with approximately 3,000 soldiers out of an estimated 50-60,000 surrendering their weapons. Coupled with various political impasses leading to factionalism within ULIMO, this timetable for elections now appears optimistic. A positive aspect of this is that it may provide greater time to raise funds for a repatriation programme [UNHCR 13/05/94, WFP 3/06/94].

Current estimates of populations affected are as follows:

Location	Dec 1993	Feb 1994	April 1994	June 1994
Liberia	1,750,000	1,750,000	1,750,000	1,750,000
Sierra Leone	150,000	300,000	297,000	300,000
Cote d'lvoire	250,000	250,000	250,000	234,000
Guinea	600,000	600,000	415,000	628,000
TOTAL	2,750,000	2,900,000	2,712,000	2,912,000

Over the past two months food distributions have covered 1.5 million displaced persons in Greater Monrovia and Bomi and Nimba counties. However, an estimated 300,000 people have been cut off from any assistance in South Eastern and Central Liberia and Upper Lofa due to insecurity. Most recently food distributions in the Western counties of Lower Lofa, Bomi and Cape Mount have been postponed because of continued fighting within ULIMO. Rural areas of Grand Bassa and Rivercess have not been accessible due to fighting between NPFL and LPC [WFP 9/05/94].

NPFL Area There are 455,000 people being provided with food aid in this area. Recent skirmishes between the NPFL and LPC (Liberia Peace Council in the central counties of Grand Bassa, Rivercess and Grand Gedeh have made these areas inaccessible [WFP 9/05/94].

A nutritional survey carried out in early April in Nimba county found wasting levels of 12.7% with 6.7% severe wasting (see Annex I la). In some areas wasting rates were above 20%. Measles immunisation campaigns started in February have increased vaccination coverage to over 72%. Throughout this crisis there has been an observed association between measles outbreak and malnutrition/oedema. Crude mortality rates were measured at 1/10,000/day (3 x normal) with an under-five mortality rate of 2/10,000/day, the latter especially is considered to be high. With the advent of the hungry season between May and September it is expected that the nutritional status of this population will deteriorate further unless there is improved food distributions in the region. There have been no organised general food distributions in Nimba county since September 1993. In February 1994 Lutheran World Foundation (LWF) began distributing rations of rice in the larger towns only, and is gradually expanding its distribution capacity [MSF-B 4/4/94, WFP 9/06/94].

Mean length of stay in supplementary feeding centres has been increasing and may reflect inappropriate rations for malnourished children as there was a temporary lack of corn-soya blend (CSB) available for feeding. Data from therapeutic feeding centres in Bong and Nimba county in March indicated 22% and 55% of admissions respectively as having oedema [MSF-B Mar 94].

ULIMO Area Internal fighting between different factions in ULIMO has led to the displacement of approximately 10,000 to the outskirts of Monrovia (ECOMOG controlled) and has prevented aid from reaching Bomi and Cape Mount counties [WFP 9/05/94]. Upper Lofa county remains inaccessible due to continued fighting within ULIMO. It is assumed that the approximately 175,000 displaced Liberians and Sierra Leonean refugees are in a critical state as they have been cut off from aid since December 1993 [UNHCR 13/05/94].

Sierra Leone There are an estimated 300,000 refugee and displaced people in Sierra Leone. Sporadic fighting continues with government forces now on the offensive after earlier rebel gains in the South East in April. Some assistance has now reached the 82,000 people previously cut off in Kenema and Segbwema but insecurity prevents regular food aid deliveries [UNHCR 25/05/94, WFP 9/05/94].

Cote d'Ivoire After a screening exercise conducted on distribution cards, the number of beneficiaries has decreased to 234,000 from 258,000 [WFP 9/05/94]. Many of the refugees work on local farms, on coffee plantations, or are involved in other income generating projects thereby attaining varying degrees of self-sufficiency. Almost 100,000 are now enrolled in an agricultural co-operative scheme which it is hoped will lead to them attaining complete self-sufficiency by the end of 1994 [UNHCR 6/05/94]. Cross border deliveries into Liberia are continuing [WFP 9/05/94].

Guinea There are an estimated 628,000 Liberian refugees in the Guinea Forrestiere region of Guinea of which 50,000 are relatively new arrivals [UNHCR 6/05/94, WFP 23/05/94]. It is reported that many of the new arrivals are not being registered, and are therefore not receiving any rations. General ration provision is said to be insufficient. It is reported that the quantity is low and the ration is lacking a protein source and certain micronutrients [CAMA 13/06/94]. In the East the prevalence of wasting among children was reported as 11.9%, with 2.2% kwashiorkor in Thuo and 2.8% in Banie. In the West these wasting rates among the refugees have recently been recorded at 18.9% (see Annex I 1b) and there are anecdotal reports of levels of wasting as high as 25% among new arrivals [CAMA 13/06/94]. These high rates are believed to be due not only to new influxes of refugees from Liberia, but also to a decrease in the basic ration since 1993. Up to 120,000 refugees are estimated to be benefitting from agricultural projects and it is hoped that the majority of these individuals will no longer require food aid support by the end of the 1994 [UNHCR 6/05/94]. A new influx of 1,758 people from Lofa due to renewed fighting was reported at the end of May

Overall, the 50,000 new arrivals in Guinea are considered to be at high nutritional risk (category I in Table 1) with high levels of wasting; the populations in Sierra Leone and Liberia with little or no food distribution are thought to be at high risk (category IIa in Table 1). Since fighting continues in Liberia, the rest of that population is considered to be at moderate risk (category IIb in Table 1) and the refugees in Cote d'Ivoire are not currently thought to be at particular nutritional risk (category IIc in Table 1).

How could external agencies help? Current external resource availability appears adequate for the accessible populations, however about half the affected population is inaccessible to external assistance. There are signs of a future break in food pipeline supplies for Guinea. Only rice and oil are being distributed in some camps; beans or another culturally acceptable source of protein are required. There are reportedly registration problems in some camps in Guinea - over-registration is reported, as well as under-registration. However, if the elections in Liberia do take place along with the anticipated repatriation then considerable funding will be needed for a repatriation programme and for the restoration of infrastructure to allow adequate resource provision in the early stages of resettlement.

There is a need to ensure a continuous supplies of CSB for selective feeding programmes.

2. Western Ethiopia/Eastern Ethiopia/Ogaden

(see Map 2)

Ethiopia is reported to be experiencing a serious drought affecting about 7 million people. Large numbers of people are said to be abandoning villages and there are reports of deteriorating nutritional status in Northern Wollo, Southern Tigray, Gondor, Wolayita and South Omo [FAO Mar/April 1994, SCF 14/04/94, WFP 30/05/94]. Although people have been advised to remain in villages and await aid supplies there has already been some movement towards centres such as Sekota and Korem where food aid stocks are presently insufficient to meet demand [WFP 8/04/94).

How could external agencies help? The situation remains unchanged for the approximately 35,000 in the Ogaden and seems likely to continue this way unless deliberate action is taken. Food adequate in quantity, variety and quality is not getting to the population in camps in the Ogaden for a variety of reasons, including internal. Donors may want to consider that priority be given rectify this continuing nutritional crisis. Furthermore, the severe drought is likely to cause deterioration, and it is clear that food aid will be required on a massive scale.

3. East, Central and West Sudan

(see Map 3)

In the areas of East, Central and West Sudan there are approximately 1,700,000 displaced Sudanese. A large proportion are displaced Southerners who have fled the civil war in the South. However, environmental marginalisation of certain Northern areas and continuing drought in the West has led to the destitution of many families who have been forced to settle in camps or the outskirts of large towns and become dependent on external assistance.

The current drought has caused sharp cereal price rises throughout Sudan indicating an acute food shortage [SCF Apr 1994, WFP 2/05/94]. Prospects for the harvests are poor and in areas where harvesting has already occurred, reduced production has been reported [FAO Mar/Apr 94].

Khartoum The displaced population in camps around Khartoum may be as high as one million people. In March levels of wasting in the four official displaced camps in Khartoum were measured at 20.8% (see Annex I 3a) [UNICEF 23/03/94]. Over the past six years levels of wasting have often reached crisis levels in these camps when seasonal grain prices have increased dramatically. Recent reports indicate the need for more therapeutic feeding facilities in these camps and greater regularity in supply of supplementary foods for malnourished children. Medical facilities are also reportedly poor with frequent shortages of key drugs such as chloroquine and antibiotics [UNICEF 12/05/94, UNICEF 23/03/94].

Darfur Due to prolonged drought, it is widely anticipated in Darfur that in the absence of substantial external food supply there will be large scale migration out of the area and substantial famine deaths [SCF Apr 94]. A recent assessment mission identified 67,300 people in Southern Darfur as in need of aid due to rising cereal prices and continuing drought. The food shortage in this region has been exacerbated by the arrival of Chadians who purchase what little food there is in the local markets due to the hyper-inflation in their own country [WFP 2/05/94].

Kordofan Although food was distributed to approximately 500,000 drought affected people in North Kordofan in March, there were insufficient stocks for the April distribution. The GOS has indicated that up to 100,000 people may face starvation in Hamrat El Wiz and Gebrat El Sheik [WFP 2/05/94].

Prevalence of wasting among children in Dilling and Kadugli have been recorded at 19% (see Annex I 3b) and there have also been reports of wild food consumption in other areas [WFP 2/05/94].

Overall, the 100,000 reported to be facing starvation in Kordofan are at high risk (category IIa in Table 1) and the rest of the displaced population is considered to be at moderate risk (category IIb in Table 1).

How could external agencies help? Since the Government of Sudan declared a drought emergency only a small amount of food aid has been pledged or received. There is now a considerable overall physical shortage of food in the country. Although there are well-known political obstacles, withholding food aid (and non-food resources) will inevitably prolong and worsen exiting food shortages, especially in the more remote areas. There is also a need for greater provision of foods for supplementary feeding programmes and of essential drugs for large numbers of displaced populations in camps of which there are probably 1 million near Khartoum.

4. Kenya

(see Map 4 and Figure 3B)

B. Kenya - Trend in numbers of refugees/displaced.

Food stocks are reportedly adequate and all major roads are passable allowing prompt delivery to camps [UNHCR-a 25/05/94, WFP 2/05/94].

Information available from March for Hagadera camp (estimated population 31,300 Somali refugees) shows a crude mortality rate of 0.36/10,000/day and an under-five mortality rate of 0.73/10,000/day (see Annex I 4a) [MSF-B-a Mar 94]. The crude morality rates are around normal levels.

A population count was scheduled for Kakuma camp but the mainly Sudanese refugees population refused and looted all materials related to the exercise. A riot ensued, where many houses were burned so that assistance had to be suspended. The census has now been postponed and assistance resumed [UNHCR-a 25/05/94].

The situation for the refugee population remains generally under control with no populations currently at particular nutritional risk (category IIc in Table 1).

How could external agencies help? The overall needs of this refugee population are reported to be adequately met.

5. Somalia

(see Map 5)

Food deliveries in Luuq were hampered by lack of military escorts for convoys and poor road conditions to Buaale and Bardera have restricted food aid deliveries. In spite of these difficulties over 1,000 small food-for-work rehabilitation projects have continued to be supplied with food through nine regional centres while the remaining 20% of food aid has been used as direct assistance for 274,000 people [WFP 16/05/94].

A nutritional survey carried out in Genale in February 1994 showed 2.8% wasting with 1.1.% severe wasting (see Annex I 5a) [AICF 1/02/94]. A survey carried out in Bur Akabe district in January 1994 measured wasting at 4.5% and severe wasting at 2.49 (see Annex I 5b). This is a considerable improvement over a survey carried out in the same district in April 1993 when wasting was measured at 11.8%. The crude mortality rate was 0.72/10,000/day. However, it was estimated that only 7.1% of children between 12-23 months old were vaccinated against measles [AICF 1/01/94].

The spread of cholera in Kismayo has slowed down with the total number of cases treated so far at 2,724. However, new cases have been confirmed in Juba valley [WV Apr 94].

How could external agencies help? Continued donor support is essential for rehabilitation programmes while international agencies must build up local staffing capacity for nutritional and health service provision. This may prove vital in the event of future breakdown in security and the evacuation of international agency staff. Given the low levels of immunization measured in Bur Akabe, an immunization campaign is probably warranted.

6. Mozambique

(see Map 6 and Figure 3C)

C. Mozambique - Trend in numbers of refugees/displaced.

Repatriation is continuing. As of April 1994 out of this 1.85 million total, 775,000 refugees had returned to Mozambique. The arrival of a further 51,000 is expected over the next few months although there are an estimated 800,000 Mozambican refugees still residing in neighbouring countries [MSF-CIS Feb 94, WFP 16/05/94].

Those people in areas with access to land who had previously received timely and adequate agricultural inputs were believed to have sufficient food until the coming harvest, but inadequate rains have led recently to poor harvest prospects. In addition, those who had failed to plant, e.g. new returnees, will continue to be dependent on food distributions. Some problems with food distributions had been noted due to poor roads, transportation problems, lack of fuel and insufficient quantities of food available. As a result certain areas have not received distributions for several months, e.g. Mogincual in Nampula district [FAO/WFP May 94, MSF-CIS Mar 94, WFP 9/06/94].

Thus, the nutritional situation in Mozambique was reported to be generally stable, but with pockets of malnutrition thought to exist, especially among recent returnees [MSF-CIS Feb 94]. Increasing rates of malnutrition have been reported in districts of Tete and Nampula provinces with significant numbers of new returnees.

The health situation in districts affected by cyclone Nadia in Nampula and Cabo Delgado provinces, e.g. the district of Nacaia Porto, has been precarious as health infrastructure and water supply systems were damaged [DHA 19/04/94].

Anti-personnel mines remain a severe problem throughout the country with accidents continuing so that some NGOs have been forced to reconsider their activities in isolated provinces. These mines also render many fields useless that would ordinarily be used for farming [MSF-CIS Feb 94].

Overall the population is not currently considered to be at particular nutritional risk (category IIc in Table 1).

How could external agencies help? A key priority is to establish a better system of monitoring recent returnees. This may require greater decentralization of international agency staff, on a temporary basis to areas where large groups have returned. Agencies supporting recent returnees may need more resources for such activity. Logistics remained a problem for remoter areas in part because of land mines, partly because of a lack of infrastructure. A transition to more local food purchasing is planned, showing a shift from food aid to non-food resources. More use of local trading channels for food distribution is desirable.

7. Rwanda

(see Map 7)

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).

Since April, the civil war in Angola has continued unabated. There have been reports throughout April and May of concerted fighting around Malanje town, Kuito, Huambo town and province, Kwanza-South Benguela and Kwanza North. Major provincial capital cities are still effectively under siege, although with some interruptions, international agencies continue to fly in massive amounts of food aid. Up to 900 tons a week are being flown into Huambo by WFP with an estimated population of 400,000 people largely dependent on food aid.

In spite of these efforts, limited infrastructure and logistical capacity as well as periodic interruptions to supply caused by insecurity, have meant mat thousands of Angolans are still at considerable risk. There is little recent nutritional or mortality survey data, but a number of anecdotal/qualitative reports are cause for concern. Following a visit in April by the UN under-secretary for humanitarian affairs, a statement was made that the situation in Kuito was "one of the worst in the world", while a UN joint assessment mission to Tchindgenje and Balombo in Huambo province at the end of April found a "very grave situation".

In April, an airlift began into Cubal in Benguela province where an estimated 100,000 displaced people were reported to be in need of food aid [WFP 9/05/94].

Although the nutritional situation in Malange (estimated population 200,000) is reported to be improving, crude mortality rates in April were measured at 1.3/10,000/day (4 x normal). The under-live mortality rate was 0.4/10,000/day. A nutrition survey conducted in May measured wasting at 6.6% with severe wasting at 1.3% (see Annex I 8a). This is a considerable improvement over levels of wasting measured in October 1993 (37%) and February (11.1%) in large part due to WFP's success in airlifting food. However, anecdotal reports are now arriving of pellagra in Melange [MSF-H 7/05/94, MSF-H 23/05/94].

How could external agencies help? The international community is providing effective support and this needs to continue. Large scale relief and rehabilitation measures may be required when the most affected populations (e.g Kuito and Huambo) become accessible, when security improves; donor contingency planning may be needed. Insecurity necessitating airlifting remains a constraint, requiring special funding. There is also an urgent need for data on nutritional and health status from these large urban centres. Currently, the majority of data are anecdotal reports. Measures to support such data collection should be supported where possible.

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).

Many areas served by air operations from Lokichokio (in Kenya), which were severely curtailed during April due to lack of funds, have received less than 50% of projected food needs. Flights from Entebbe to Juba also ceased in April due to lack of funding. Overall, shortage of funds and food meant that only 65% of WFP planned food deliveries for April took place for a target population of 530,000 [WFP 16/05/94]. Some airlifting from Entebbe to Juba restarted in June. WFP requests donors to allocate relief food to meet the food gap for Southern Sudan (ex Khartoum) which is estimated at 24,000 MT [WFP 13/06/94].

Nutritional survey reports from several areas in the South show crisis levels of wasting with some of these areas having been directly affected by interruptions to the air-drop operation. This is described by area below. Population estimates by area are unavailable.

Equatoria The food situation in Juba remains critical with only enough food to allow 70% of those eligible for wet feeding to enrol on the programme. Furthermore, the displaced camps around Juba have only been supplied with rations of small amounts of vegetable oil and pulses with no staple foods [WFP 2/05/94].

In spite of the rains and insecurity, road convoys did manage to reach 150,000 people in 17 villages in Eastern Equatoria. Another convoy reached 35,000 people to the Eastern side of the Lopit mountains where WFP reported a serious food deficit. There were also reports of 51,000 people newly displaced from Opari, Aswa, and Pageri who were moving towards Mugale (East of Nimule) [WFP 16/05/94].

The nutrition situation is thought to be extremely bad. For example, a nutritional survey in April carried out at Labone camp (estimated population 50,000) near the Ugandan border found high levels of wasting at 37.0% including 13.8% severe wasting. Rates of oedema were measured at 4.5% (sec Annex I 9a) [AICF 19/04/94].

Bahr el Ghazal The food and nutritional situation in many areas has been reported as critical. The current crisis in the county has undoubtedly been worsened by the effects of the 1993 drought. The status of the displaced living in Marial Ajith and Eastern Bank camp is alarming as the last general food distribution in February reached only one quarter of the displaced who in turn only received 25% of cereal needs for a short period. Current reports are that wild foods are the only food now available. Local relief authorities have been reporting high mortality in the camps due to starvation and sickness, worsened by poor sanitation [WFP 2/05/94].

A nutritional survey carried out in Alek county (in the north of the province with an estimated population of 345,000) found very high levels of wasting of 45.4% with severe wasting measured at 10.3% (see Annex I 9b) (this shows a dramatic deterioration compared to October 1993 results of only 12% wasting).

Measles immunisation coverage was less than 50% which is insufficient to prevent an epidemic the effect of which would be catastrophic. How far these results apply to a wider area is not Known, but it is possible that any bias would be to underestimate malnutrition as this area is receiving some assistance [MSF-F 16/04/94].

Serious fighting was reported between GOS and SPLA in Wau and Gogrial in Western Bahr El Ghazal in the first week of May [UNICEF 13/05/94].

Upper Nile The military-political situation remains complex with mass population movements along the river making needs assessment and food aid delivery difficult. Unconfirmed reports are that tens of thousand of people have been pushed towards the Ethiopian border. In April approximately 17,000 people in Nassir received a half ration via an air drop [WFP 16/05/94].

Jonglei With reduced air lift capacity during April only limited food could be distributed to Waat town (estimated population 16,000) despite the acute need shown by a nutrition survey in March. This survey showed 24.8% wasting, with 4.9% severe wasting (see Annex I 9c). Crude mortality rates were 4.4/10,000/day (11 x normal) and under-five mortality rates were 11.2/10,000/day. We are again seeing alarmingly high mortality rates. Recent reports indicate people are eating seeds and that even wild foods are in short supply [MSF-H Mar 94, WPF 16/05/94].

In sum, the populations of Bahr El Ghazal, Labone camp in Equatoria and Juba are known to be in a critical state (category I in Table 1). The 100,000 people on the border at Nimule are thought to be in a critical nutritional condition (category IIa in Table 1) and the rest of the displaced population can be considered to be at moderate risk (category IIb in Table 1).

How could external agencies help? Food aid supplies for Southern Sudan via Khartoum for May-December are estimated to be inadequate by about half, requiring 24,000 MT; current pipeline supplies will last until August. It is hoped to transport supplies by a combination of road, rail, water, and air. A main priority for Southern Sudan is to continue funding for the air transport operation on which urgent relief measures are dependant The interruptions in the programmes due to lack of funding are directly worsening nutritional status and mortality. Once adequate food deliveries can be resumed, there is a need for greater decentralization in international agency operations, and where working through local implementing partners, to assist these in improved needs assessment and monitoring. Immunization, water/sanitation and health services are critically inadequate, both for those in camps and otherwise displaced (the majority).

10. Uganda

(see Map 10)

Population estimates over time are as follows:

Origin	Feb 1994	April 1994	June 1994
Sudanese Refugees	188,000	190,000	206,000
Zairian Refugees	5,000	5,000	15,000
Rwandan Refugees	11,350	3,500 (before 6 April)	10,000*
TOTAL	204,350	198,500	231,000

*Rwandan refugees are discussed under #15.

There are an estimated 206,000 Sudanese refugees in Uganda. 86,000 are in Arua district and 120,000 in East Moyo district. Those in Arua district are settled in six camps in the Koboko area where they started arriving in August 1993. Since January 1994, conflict in Southern Sudan has given rise to a steady influx of around 1,000 per week [UNHCR 29/04/94, UNHCR 23/05/94].

Although the management and administration of the camps is reported to be satisfactory, water shortages have reached critical levels so that at best supplies only serve adequately 70% of the population. In February, the ration distributed was reduced by 30%, but has now been raised again. Nevertheless, delays in food deliveries have resulted in refugees in Koboko going without food for periods exceeding 30 days [UNHCR 29/04/94].

There has also been a steady influx since January 1994 of 1,000 refugees per week into the camps in East Moyo. Some 93,000 refugees are spread over three transit camps while the remaining 27,000 are living in settlements having reached various levels of self-sufficiency. A food ration cut was introduced recently for this latter population. A November 1993 assessment mission suggested that a portion of the 93,000 in transit, although not having access to land, had reached a certain level of self-sufficiency [UNHCR 29/04/94].

Although there have been reports of renewed Ugandan rebel activity in the North making road travel difficult, and water provision and erratic food deliveries cause some hardship, the overall situation for the Sudanese refugee population seems to be under control. However, there are approximately 100,000 displaced people on the Sudanese border at Nimule. If this population were suddenly to cross the border, the strain on existing relief capacity in Uganda might prove excessive [UNHCR 29/04/94, UNHCR 23/05/94].

How could external agencies help? There is still a need to strengthen existing NGO/agency capacity to look after new arrivals - requiring expertise as well as resources to combat poor water supplies and to improve coordination. It is also important that sufficiently sensitive surveillance systems are established to quickly detect any adverse reaction in those situations where rations are reduced for populations attaining a degree of self-sufficiency.

11. Shaba/Kasai Regions, Zaire

(see Map 11)

Recent reports from Mwene Ditu, a transit area with a total displaced population of approximately 65,000, continue to be very worrying. In March, crude mortality rates in Simmons camps just outside of Mwene-Ditu (estimated population 3,500 people) were recorded at 3/10,000/day which is ten limes the normal level. The under-five mortality rate was 1/10,000/day which is a considerable improvement over the February rate of 5/10,000/day. In May, unconfirmed cholera cases were reported [MSF-B-b Mar 94].

A nutritional survey conducted in March showed levels of wasting at 31.7% with 3.8% severe wasting (see Annex I 11a). 79.6% of children had been vaccinated against measles. Water availability is only 6 litre/person/day. A 40% mortality rate among those hospitalized is reported. After beginning a general distribution in February, the ration had reached at 2500 kcals/caput in March which should bring some improvement [MSF-B-c Mar 94],

NGOs working in Mwene Ditu have been arguing for regular general ration provision but also fear a disincentive effect to return home if this is implemented.

Kananga is a transit town, like Mwene Ditu, that has been receiving those displaced from Shaba. The total estimated population of Kananga is 663,000, and the breakdown between residents and the displaced population is not known. A survey done in January 1994 showed 6.1% wasting with 0.7% severe wasting (see Annex I 11b). However, 2.8% of those measured had oedema. According to a MUAC measurement, the level of wasting in the displaced population is twice as high as the level in the resident population. A baseline survey done in July 1993 showed wasting at 3.3% and severe wasting at 0.9%; oedema was measured at 8.1%. The pattern of malnutrition has changed a bit, but overall rates are static [OXFAM 29/10/93, OXFAM 7/06/94].

The displaced population of Mwene Ditu is considered to remain at high risk (category 1 in Table 1), although the ration is now reported to be adequate. The remainder of the displaced population in the region (including Kananga) can be considered to be at moderate risk (category IIb in Table 1).

How could external agencies help? Information on the displaced returning to Kasai is still scarce and needs improving. Facilities for the displaced (at camps and in the towns) are clearly inadequate. Food supplies are improving, but water/sanitation, health services etc. are inadequate and greatly underfunded; supplementary feeding for children needs expansion, especially close to camps.

12. Ghana, Togo, Benin Region

(see Map 12)

As many as 150,000 additional people have been displaced in Northern Ghana due to the ethnic violence which broke out in early February 1994 between the Kokombas on one side and Nanumbas, Dagombas, Gonjas and Mamprusis on the other side. The number of casualties is thought to run into thousands and many villages have been razed to the ground. The displaced population has moved to towns, (e.g. Bimbila), camps, (e.g. Nyohini) and military barracks. Although the displaced population is thought to be in a stable nutritional and health condition, the low measles immunisation coverage of 51% is cause for concern [UNHCR 25/02/94].

13. Central African Republic

(see Map 13)

14. Zaire (Refugees)

(see Map 11)

The situation has not reportedly changed for the approximately 163,000 assisted refugees in Zaire who are not considered to be at particular nutritional risk (category IIc in Table 1) [UNHCR 26/05/94].

15. Burundi/Rwanda Situation

(See Map 15 and Figure 3F)

F. Burundi/Rwanda Region - Trend in numbers of refugees/displaced and proportion severely malnourished and at high risk (black area).

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

	Dec 1993	Feb 1994	April 1994	June 1994
Burundi	150,000	282,000	536,000	1,000,000
Rwanda	375,000	272,300	250,000	2,060,000
Tanzania	325,000	300,000	60,000	410,000
Zaire	58,600	60,000	60,000	113,000
Uganda				10,000
TOTAL	908,600	914,300	906,000	3,593,000

Rwanda Approximately two million people are currently displaced within Rwanda with hundreds of thousands camped outside Kigali where vigorous fighting continues. While most of the 275,000 Burundi refugees that were in Rwanda have returned home, an estimated 60,000 remain in Southern Rwanda [UNHCR-a 26/05/94]. The poor security situation in Rwanda has so far only allowed limited relief activities so that humanitarian activities in Kigali have been limited to small scale feeding of the displaced located mainly in the stadium and in hotels while in the South where the refugee and displaced population is estimated to be 243,000, some limited distributions have occurred.

A division of labour has been agreed between WFP and ICRC which will leave WFP with responsibility for the North-Eastern part of Rwanda and the Southern part up to and including Butare. There are also many NGOs waiting to move into Rwanda as soon as security permits [SCF 24/05/94]. It is hoped that the security council resolution to strengthen UNAMIR forces by expanding their numbers to 5,500, will allow creation of safe haven areas and the distribution of relief supplies.

Already, food stocks for the displaced population must have run out and it is probable that vulnerability is growing as stocks of medical goods, clean water and food are depleted, made inaccessible or destroyed. Malnutrition is reported among children in displaced camps in Kigali [WFP 13/06/94]. It should be expected that a large proportion of the population will require distributions of a complete food basket. Even before the escalation of the civil war, earlier drought and conflict had led to estimates of food deficits of 285,000 MT [FAO 29/04/94].

Tanzania Between April 28-29th 250,000 Rwandans arrived near the town of Ngara in Western Tanzania. Tanzania is now hosting the largest number of refugees in the region - current estimates are of 410,000 people with an influx continuing at 500-4000/day. Before this recent influx Tanzania was already hosting 60,000 Burundi and Rwandan refugees. The majority of refugees are women, children and young men under 18 years from the Hutu tribe. There are now seven camps in Ngara and Karagwe districts the largest of which is Benako. Often refugees cross the border and still have a difficult journey of several days to the nearest camps [UNHCR 18/05/94, UNHCR-a 26/05/94].

The camps are overcrowded, with insufficient water supply although since these refugees arrived in good health, these problems have not yet been reported to cause high mortality and malnutrition rates. The pipeline of food commodities for both Rwandese and Burundi refugees in Tanzania is satisfactory for between 2-4 months depending on commodity, and is based on diversions, local purchases using immediate response account funds, and loans. However, the movement of food commodities has been made difficult by the recent heavy rainfall in Karagwe and Bukoba districts which has washed many bridges away and made roads impassable. Feeding centres and clinics are now being established in the camps [UNHCR-a 26/05/94].

Information available from Benaco camp (estimated population 281,000) at the end of May showed wasting prevalences in children of 14.4% (see Annex I 15a). This was measured during a measles immunization campaign resulting in an almost complete coverage. The general distribution is reported to be usually satisfactory, despite assessments showing that the food basket for 21 May varied from 1300-2200 kcal/person/day [MSF-F 28/05/94].

Burundi There may be as many as one million people dependent on emergency food aid in Burundi. These people are internally displaced from the October coup and subsequent fighting, refugees returned from Rwanda, and Rwandan refugees (an estimated 70,000). While there is sporadic fighting in rural areas around Bujumbura, the general situation in Burundi is calm [UNHCR-a 26/5/94]. There is, however, some concern that the fighting in Rwanda may spread to Burundi.

Due to logistical constraints, particularly insufficient off-loading capacity at the lake port of Bujumbura, rations for the assisted population were not exceeding 1,000 kcals/person/day. However, port capacity is now reported to be improved and WFP reports that rations are providing 1900 kcals/person/day [WFP 9/06/94]. The nutritional situation for those beneficiaries outside of the camps is said to be satisfactory, but there is particular concern for those Rwandese refugees and Burundi returnees in camps (approximately 200,000) who are almost entirely dependent on external food aid [WFP 23/05/94, WFP 9/06/94].

Zaire There are now an estimated 102,000 Burundi refugees in Zaire, 49,000 of whom fled following the October 1993 coup attempt with the remainder being new arrivals from the current Rwanda crisis. A further 11,000 Rwandan refugees in Kivu and Goma have also fled recent events in Rwanda. The overall situation for these refugees is described as stable but in need of improvement [UNHCR-a 26/05/94].

Uganda There are approximately 10,000 recent Rwandan arrivals in Uganda, but it is reported that many more are gathered at the border and may cross over at any time [UNHCR-a 26/05/94].

Overall The refugee and internally displaced population of Rwanda (approximately 2.06 million people) are considered to be at high risk due to their lack of access to relief resources while the 410,000 refugees in Tanzania are also at high risk due to overcrowding, and insufficient water (category IIa in Table 1). The 1 million refugees and returnees in Burundi camps are at high risk due to poor general ration delivery (category I in Table 1). The 113,000 refugees in Zaire are placed at high risk (category IIa in Table 1) while the 10,000 refugees in Uganda are defined as at moderate risk (category IIb in Table 1).

How could external agencies help? Food aid pledges and cash resources for non-food aid items are urgently needed for the enormous programme and have yet to be met following the UN emergency appeal in early May. The immediate response account of WFP urgently needs to be replenished to allow local purchases of food. Funding for storage capacity is also desperately needed. Logistics are a constraint due to the distances involved, affecting supplies not only of food but of equipment for water/sanitation, more of which is needed. Camps are generally crowded, unsanitary and with poor variety of diet.

Until the violence inside Rwanda lessens it will be difficult to extend external assistance. Comments below refer to the populations outside of Rwanda. In Tanzania, the large number of refugees and resulting overcrowding in existing camps require urgent measures to relocate some populations and to establish optimal sanitation and hygiene conditions in all camps. In Burundi, where security is generally much improved, there is a need to establish nutritional surveillance of returnees and the internally displaced as general ration provision is far below requirements.

16. Mauritania/Senegal

(see Map 16)

17. Djibouti

(see Map 17)

18. Zambia

(see Map 18)

The current assisted population is estimated remain at:

Origin	February/June 1994
Zairian Refugees	18,000
Angolan Refugees	17,000
Somali Refugees	1,000
TOTAL	36,000

The majority of this refugee population is not generally at risk. Recent reports indicate that the poor 1993/94 harvest has meant that 75% of a refugee population (in Maheba settlement, overall population of 25,000) are in urgent need of assistance [CARE Jan 94].

How could external agencies help? Better monitoring of agricultural production of "self-sufficient" refugees are required so that more timely warning of the effects of production failure can be given to donors.