1. Liberia Region
2. Western Ethiopia/Eastern Ethiopia/Ogaden
3. East, Central and West Sudan
4. Kenya
5. Somalia
6. Mozambique Region
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
(see Map 1 and Figure 3A)
The security situation in both Liberia and Sierra Leone has deteriorated over the past two months leading to further movements of refugees and internally displaced people. However, the total number of people affected by the continuing conflicts in the region is thought to remain stable at approximately 2.8 million. In Liberia the increased level of conflict has led to the virtual suspension of international NGO activities in those areas not controlled by ECOMOG. Cross-line and cross-border food convoys have also been suspended while waiting for security guarantees. The elections that were scheduled for the 7th of September 1994 were not held and a new agreement was signed on the 12th of September providing for elections on the 10th of October 1995 [UNHCR 15/09/94, WFP 5/08/94].
A. Liberia
Trend in numbers of refugees/displaced and proportion severely malnourished and at high risk (black area).
Current estimates of the populations affected by the conflict are summarized in the box below.
|
Location |
Dec 93 |
Feb 94 |
April 94 |
June 94 |
Aug 94 |
Oct 94 |
|
Liberia |
1,750,000 |
1,750,000 |
1,750,000 |
1,750,000 |
1,750,000 |
1,692,000 |
|
Sierra Leone |
150,000 |
300,000 |
297,000 |
300,000 |
300,000 |
300,000 |
|
Cote d'Ivoire |
250,000 |
250,000 |
250,000 |
234,000 |
250,000 |
325,000 |
|
Guinea |
600,000 |
600,000 |
415,000 |
628,000 |
539,000 |
534,000 |
|
TOTAL |
2,750,000 |
2,900,000 |
2,712,000 |
2,912,000 |
2,839,000 |
2,851,000 |
Fighting is being reported between the LPC (Liberia Peace Council) and the NPLF in Bassa, Grand Cru and Grand Gedeh counties as well as within factions of the NPLF. There are approximately 30,000 people near Ggarnga in “a desperate security situation” and 500,000 are displaced by expanded fighting and the loss of NPFL command in Bong and Nimba counties [WFP 5/08/94, WFP 30/09/94].
Before the security situation led to the evacuation of NGOs from Nimba county (now under ULIMO command), a nutritional survey carried out between 29th of June and 5th of July found 7.3% wasting with 2.6% severe wasting (see Annex 1 (1a)). Measles immunization coverage had improved since March and was recorded at 84% and the crude mortality rate was 1.1/10,000/day (almost 4 times normal). Numbers of children enrolled on the supplementary feeding programme had increased marginally since March 1994. These results are not particularly alarming, although the deteriorating security situation and subsequent lack of humanitarian aid could easily threaten the situation [MSF-B 5/07/94].
Reports from Margibi, Grand Bassa and Bong counties in July show an overall average of 10.6% wasting with 2% severe wasting (see Annex 1 (1b)). However, these same reports indicated extremely high levels of wasting in certain towns such as Garney with 42% wasting and 18% severe wasting, and Jaingbetta with 26% wasting. The last food distributions to these towns was in October 1993 where poor water and sanitation and the lack of accessible health services is thought to have contributed to these crisis levels of wasting [MSF-H July 1994].
Fighting is also reported to be intensified in the areas of Bomi and Lofa counties. A recent influx of 4,500 Liberians from Lofa county into Guinea has been reported [WFP 5/08/94, UNHCR 15/09/94].
Sierra Leone The security situation is reportedly deteriorating in the countryside with increased fighting between government forces and rebels. Prior to this escalation, there were an estimated 300,000 refugees and displaced people in Sierra Leone. During August food distributions to Segbwema/Kenema in the Eastern province were delayed by insecurity on the Bo/Kenema highway and rebel attacks in Northern and Southern provinces have led to influxes of displaced populations into Freetown where food assistance for 23,000 displaced is now being provided [WFP 05/09/94, WFP 19/09/94].
There is food available in Freetown, but serious shortages exist in many rural areas as most of the country side did not have a harvest last year due to the poor security. Some areas on the Guinea/Sierra Leone border have not had a harvest since 1991 [CAMA 29/07/94]. A cholera epidemic has reportedly broken out in Freetown with about 10,000 cases currently reported [WFP 30/09/94].
A recent nutritional survey carried out in Waterloo Camp (estimated population 6,000 Liberian refugees) showed 13.5% of those under five years old were wasted (see Annex 1 (1c)). In addition 11.2% of those measured were on the borderline of being wasted (between 80-85% weight for height). This is an increase compared to results from a similar survey conducted in 1992 where the level of wasting was only 4.0%. It has been suggested that the increased levels of wasting may be associated with a reduced ration which was implemented in 1993. Rice was reduced from 300 to 200 gms per day and pulses were eliminated from the food basket [UNHCRa Jul 94]. A joint WFP/UNHCR food assessment mission is scheduled to visit Sierra Leone at the beginning of November to investigate the causes of the degradation in nutritional status [WFP 20/10/94].
Cote d'Ivoire The fighting in Liberia has lead to a new influx of approximately 75,000 refugees into Cote d'Ivoire [WFP 30/09/94]. This increases the Liberian refugees population to 325,000 [WFP 20/10/94]. Most recent reports indicate that there are no major nutritional or health concerns amongst this refugee population.
Guinea A census carried out in Nzerekore and Yomou prefectures lead to the elimination of approximately 37,000 beneficiaries from the food distribution rolls. This re-registration exercise in now continuing in the prefectures of Gueckedou and Macenta [WFP 5/08/94]. Prior to this new census, there were an estimated 539,000 Liberian and Sierra Leonean refugees in Guinea. However, the fighting in Liberia has reportedly lead to a new influx of 32,000 refugees into Guinea in the beginning of September. Therefore, the current refugee population is estimated to be 534.000 [WFP 30/09/94, UNHCR 20/09/94].
The 1.1 million people in Liberia receiving regular food aid are not currently thought to be at nutritional risk, nor are the approximately 325,000 refugees in Cote d'Ivoire or the longer standing refugee population in Guinea (category IIc in Table 1). Those newly arrived in Guinea are at moderate risk (category IIb in Table 1) and the newly displaced/inaccessible population in Liberia (approximately 594,000) and the population in Sierra Leone (approximately 300,000) are at high risk (category IIa in Table 1).
How could external agencies help? The evacuation of NGO's and subsequent looting of materials means that when it is possible for NGOs to return, they will need to start virtually from scratch. Donors should, therefore look favourably on requests for funds. It would also be useful to enhance/support ECOMOG operations for “hit and run” deliveries. In Waterloo camp, the ration should be reviewed and another survey would be useful to monitor any potential decline in the nutritional status of the camp population.
(see Map 2)
The number of assisted refugees/returnees/displaced in the region has increased slightly in the reporting period from 187,000 to 191,000. This is due to the fact that assistance to the returnees in Bohelagare town in the Ogaden has now been stopped as most of the population are original inhabitants and are reported to be in reasonable nutritional condition. At the same time, there has also been an influx of approximately 5,000 newly arrived Sudanese refugees into the camps in Western Ethiopia, and, at the same time, an influx of Somali refugees into Gode [UNHCR 2/09/94].
The recent influx of about 250 Sudanese refugees per week into Western Ethiopia has brought the total population to almost 50,000. Most current nutritional surveys between May and June show levels of wasting of 7.8-14.2% with 1.1 to 1.5% severe wasting (see Annex 1 (2a)) [UNHCRa 16/08/94, UNHCR 2/09/94]. Although these levels of wasting do not indicate a crisis, they are elevated compared to previous surveys. This may simply reflect a normal hungry season effect in conjunction with bias caused by the new arrivals, but in any event the situation needs to be carefully monitored to detect any further deterioration in the nutritional status of this population.
The situation for the approximately 100,000 Somali refugees in the East is more alarming. Most recent surveys in May and June show levels of wasting ranging from 9.0% in Hartisheik B to 21.4% in both Darwonji and Teferiber. Severe wasting ranges from 0.2% to 1.6% (see Annex 1 (2b)) [UNHCR 16/08/94]. This is a marked increase compared to previous surveys which only found 5-16% wasting in the camps. A three month supplementary feeding programme has begun due to these elevated levels of wasting [UNHCR 2/09/94]. There has been no progress reported on the plans to repatriate the Somali refugees [UNHCR 2/09/94].
Preliminary survey results of Ethiopian returnees from Eastern Sudan in Humera, Tigray Province have indicated a very serious situation with regard to vitamin A and iodine deficiency. Prevalence of xerophthalmia appears to range from 4.3-7.8% amongst different groups while prevalence of goitre ranges from 1.7% up to 50% amongst some groups [UNHCR 16/08/94].
An influx into Gode of approximately 5,000 Somalis brings the estimated population to 41,000 [UNHCR 2/09/94]. In July when the estimated population was 36,000, the crude mortality rate was 0.5/10,000/day (about twice normal) and the under-five mortality rate was 0.7/10,000/day which compares favourably with figures of 0.82/10,000/day and 1.4/10,000/day recorded in June. However, given that scurvy and vitamin A deficiency are still seen regularly at health centres and that the most recent nutrition survey in May found prevalence of wasting of 35.2% and also that there has been no general food distribution between January and July 1994, this population are clearly still in nutritional crisis [MSF-B Jul 1994].
The population of Gode continues to be in a critical state due to the presence of micronutrient deficiencies (category I in Table 1). The approximately 50,000 Sudanese refugees in the West can be considered to be at moderate risk with signs of deteriorating nutritional status (category IIb in Table 1) while 45,000 Somali refugees may be considered in crisis with levels of wasting above 20% (category I in Table 1).
How could external agencies help? The situation in the western part of the country should be monitored to due signs of a declining nutritional status of the population. In the East, a analysis of why some Somali camps are in crisis and not others may be useful. The start of supplementary feeding programmes may only address the symptoms of the problem if it is one of, for example, general ration. In Gode, a regular, diversified ration is needed to address the continuing high levels of wasting and persistent micronutrient deficiencies.
(see Map 3)
The estimated number of displaced Sudanese in East, West and Central Sudan is 1.7 million. This population is mainly comprised of displaced Southerners in camps such as those around Khartoum and other large urban centres. There are also large numbers of Sudanese displaced from their farming areas due to a succession of droughts and increasing environmental marginalization of certain area in the North.
Recent heavy rains has caused flooding and closed roads in parts of Darfur and Kordofan. There is also fear of the Nile flooding in Central, Khartoum and Northern states as the Blue Nile is rising to dangerous levels. However, the rains are likely to ensure a very good harvest [WFP 19/08/94].
The latest round of nutritional surveys of Ethiopian refugees in Eastern Sudan (approximate population 200,000) gives variable results with certain camps clearly experiencing nutritional stress. A survey in August found 19.4% wasting in Shagarab camp (see Annex 1 (3a)) mainly attributable to poor water quality and high rates of diarrhoea amongst children. In Wad Sherife preliminary results show 14.1% wasting (see Annex 1 (3b)) which is two percent higher than in the previous year. In Fau 5 the prevalence of wasting is 13.% (see Annex 1 (3c)) which is slightly higher than the previous year and shows a clear deterioration over three consecutive years. The indication is that the degree of self-sufficiency and adequacy of the current ration for Fau 5 needs to be re-assessed. The remaining six camps all have satisfactory nutritional status with levels of wasting ranging from 1.7% to 9.6% [UNHCR 7/09/94].
This population can be considered to be at moderate risk with somewhat elevated levels of wasting (category IIb in Table 1).
How could external agencies help? Improved monitoring in the camps and an analysis of why the nutritional status in certain camps is deteriorating would be useful. The problem of poor water quality in Shagarab needs to be addressed, as does the ration in camps with high levels of wasting.
(see Map 4 and Figure 3B)
The total number of Somali and Ethiopian refugees in Kenya is now estimated at 276,000, including 302 new arrivals in August.
Following the transfer of 18,750 Somali refugees to Dadaab and repatriation of 24,000 to Somalia, UNHCR reported the closure of Liboi refugee camp on 29th of June. Repatriation and camp transfer plans are currently underway following government of Kenya requests to close Utange camp which hosts 48,000 refugees [WFP 5/09/94].
B. Kenya
Trend in numbers of refugees.The refugee population in Kenya is not currently considered to be at heightened nutritional risk (category IIc in Table 1).
(see Map 5)
The estimated number of displaced people in Somalia requiring assistance has remained stable at about 400,000 although there have been increasing numbers of Somali, Ethiopian and Yemeni refugees arriving in Bossasso as well as Ethiopian refugee influxes into Huddur.
Security incidents seem to be increasing in both frequency and severity causing the temporary evacuation of international agency staff from Bardera, Bossasso, and Kismayo. Security incidents in Mogadishu port and in Baidoa have also disrupted agency rehabilitation and food relief activities. There are now claims of malnutrition among the displaced in Kismayo [WFP 12/08/94].
Bumper harvests have been reported in many parts of Somalia, although some areas have reported crop damage due to disease and bird infestation [WFP 12/08/94, WFP 26/08/94, WFP 9/09/94].
The assisted population in Somalia is not currently considered to be at heightened nutritional risk (category IIc in Table 1).
How could external agencies help? It could be useful to strengthen UNISOM forces in country to protect convoys and keep things running smoothly at the port of Mogadishu. Claims of malnutrition in Kismayo need to be investigated. Some nutritional surveys would be useful to detect any nutritional problems arising from interrupted food deliveries.
(see Map 6 and Figure 3C)
As repatriation of refugees and demobilization of soldiers in Mozambique moves ahead, the number of people in the region in need of humanitarian aid remains stable at approximately 1.8 million. Registration for the elections in Mozambique scheduled for the 27th-28th of October continued into August despite some minor disturbances [MSF-CIS May 94].
Since the signing of the peace agreement between the Mozambican government and RENAMO in October 1992, about 900,000 Mozambican refugees have returned home. The greatest movement has been from Malawi from where approximately 700,000 refugees have returned. Large-scale repatriation of refugees form Tanzania and Zambia planned to start in July have been delayed. Official repatriation from Swaziland was completed on June 3rd [MSF-CIS May 94].
C. Mozambique
Trend in numbers of refugees/returnees.Mozambique will remain in need of food assistance until next years harvests due to the failure of much of this years crops. The northern areas of Manica and Sofala provinces, the southern region of Tete province and areas of Maputo and Gaza provinces were the most adversely affected by rain shortfalls in the country this year [MSF-CIS May 94].
Nutritional status data in the country generally shows a stable situation. Levels of wasting measured in Manica Province were between 2-8% with 0.1% severe wasting in May. Other surveys carried out since January 1994 in Mozambique show consistently low levels of wasting. However, other data indicate that there are pockets of food stress. In Inhambane province, interviews conducted showed that 12% of households in Mussenge reported the consumption of only wild foods the day before and that approximately one third of households reported food stores of less than one month in May. Lack of access to parts of Niassa province have disrupted food distributions and is causing concern, while the Renamo zone of Mogincual district in Nampula province has been without organized food distributions between January and May 1994 despite demonstrable need and the occurrence of new cases of tropical neuropathy [MSF-CIS May 94].
Reports in June from Zambezia, Sofala and Tete province indicate that although the harvest in April and May has improved food security and overall numbers of admissions to nutritional centres are at their lowest since the beginning of the year, the harvest is unlikely to be sufficient for the entire year. Furthermore, people are still suffering from food shortages, as evident from numbers enrolled at feeding centre, but often not benefitting from food support. This applies particularly to returnees who are the most vulnerable as they are not yet established on land and are unable to rely on traditional support structures. At the same time, their mobility can make it difficult to identify them for registration into the food aid network [WVa June 94].
The refugee/displaced/returnee population in the Mozambique region is not currently considered to be at heightened nutritional risk (category IIc in Table 1).
How could external agencies help? Food aid deliveries need to be focused on returnees, and follow-up through to the next harvest will be necessary to detect any nutritional problems. Nutritional surveys in areas difficult to access could help to quantify potential problems.
(see Map 7) (now included in section #15 below)
(see Map 8 and Figure 3D)
The estimated number of people in Angola in need of food and non-food aid remains at 3.2 million. Agreement between the government of Angola and UNITA was finally reached in August at the Lusaka peace talks, although the agreement is not yet signed. This agreement in conjunction with a general reduction in hostilities has resulted in resumption of relief flights to most cities [DHA 20/07/94, WFP 5/08/94, WFP 10/7/94].
D. Angola
Trend in numbers of displaced/war affected.Consequently, the first regular relief deliveries since mid-May finally arrived in Huambo and Malange in August. In September limited relief flights also began to Kuito, which had been cut-off from outside assistance for over three months. Regular flights to Menongue were also re-started [WFP 12/08/94, WFP 26/08/94, WFP 9/09/94].
In spite of these encouraging signs, fighting has increased in certain areas such as in the northern province of Lunda Norte bordering Zaire where approximately 3,000 people are reported to be fleeing to the outskirts of Saurimo. Increasing hostilities have also been reported in NDalatando, Kuanza Norte province [WFP 9/09/94, WFP 19/09/94].
Now that many cities are accessible again, the effects of the break in assistance are being assessed. For example, preliminary results from a survey conducted in Malange (estimated population 250,000) in early September 1994 found levels of wasting of 15% and severe wasting of 5% (see Annex 1 (8a)). This represents a sharp increase in levels of wasting, which had decreased steadily before the most recent break in assistance from 34% in November 1993 to 6.6.% in early May 1994. It is feared that similar nutritional deterioration will be found in cities such as Huambo and Kuito when nutritional surveys are under-taken [MSF-H 3/09/94].
A nutrition survey carried out in mid-July in Dondo measured the prevalence of wasting at 7.7% with 2.5% severe wasting (see Annex 1 (8b)). These relatively low levels of wasting were attributed to the success of NGO operated feeding programmes [DHA 7/08/94].
Outbreaks of meningitis have been confirmed in Huila province and measles in Saurimo. As a result, agencies such as UNICEF have given urgent priority to the procurement of cold chain equipment, and have requested more funds for the purchase of vaccines and related equipment [DHA 7/08/94].
The main planting season in Angola is September and every effort was being made to register beneficiaries eligible to receive agricultural packs of seeds and tools and to pre-position these inputs. However, with the increased access to many major cities there may well be conflict between the need to deliver food and these agricultural items. Furthermore, there are reports that the timely distributions of seeds are were jeopardized by the refusal of UNITA to grant flight security clearances for Bie and Benguela [WFP 26/09/94].
Improved access to the cities resulting from the agreement at the Lusaka peace talks gives ground for guarded optimism. The nutritional situation in the country has probably deteriorated in those cities and areas which have been cut off from assistance until recently. The survey in Malange showed levels of wasting indicative of a critical situation (category I in Table 1). Reports indicate that populations in Huambo and Kuito are likely to be amongst those at risk (category IIa in Table 1) and the rest of the population is likely to be at moderate risk (category IIb in Table 1).
How could external agencies help? Continued funds for air transport will be needed, with the eventual transfer to ground transport. Nutritional surveys in newly accessible cities are necessary to assess any change in the situation. Pledges for all basic commodities are needed to avoid any gaps in the food pipeline. It may be useful to consider stockpiling some supplies in cities in anticipation of possible future inaccessibility.
(see Map 9 and Figure 3E)
The onset of the rainy season has reduced military activity in the region. Thus, improved security in conjunction with increased air capacity due greater donor support, has led to improved food delivery for the approximately 2 million war affected people in the region.
It is reported that 85% of food needs for the region were met for the month of August through a combination of air, road and barge deliveries. Furthermore, recent government clearance has cleared the way for deliveries along the Bor/Juba corridor for 467,000 beneficiaries. However, heavy rains have delayed air drops, for example to Gogrial, where hunger-related deaths were reported, while insecurity has delayed road convoys from northern Uganda and led to cancellation of scheduled air-drops in the Akon area [WFP 16/09/94, WFP 5/09/94].
E. Southern Sudan
Trend in numbers of refugees/displaced and proportion severely malnourished and at high risk (Mack area).Equatoria Cereal prices in Juba are reportedly dropping due to the harvest and continuing relief food deliveries. There has, however, been a sharp increase in the child mortality rate attributed largely to outbreaks of diarrhoeal disease, chest infections and malaria [WFP 16/09/94].
There were also reports in June of continued outbreak of measles in Yambio county [WV June 94].
Upper Nile The security situation in most of Upper Nile was reported as stable throughout the month of June and food distributions were markedly improved. Agencies working in the province hoped that with the August/September harvest rations could be cut by half [WV June 94].
Bahr El Ghazal An assessment the district of Tonj in June following destruction of the town by government forces, indicated that large quantities of food aid were needed for the district and that large numbers of people had been displaced to relief centres in search of food. Hunger in Thiet and Akop counties was observed to be acute. [WV June 94].
This population can be considered to be at moderate risk (category IIb in Table 1) with the improved status of the population attributable to increased access and the harvest.
How could external agencies help? The increased deliveries to the region were possible largely due to increased air capacity. Additional funds are needed for the leasing of aircraft and for operational support and monitoring. Funds may also be needed to set up supplementary and therapeutic feeding programmes, along with immunization programmes.
(see Map 10)
The total number of refugees in Uganda has significantly increased to approximately 284,000 due to the continuing influx of Southern Sudanese refugees. Population estimates over time are as follows:
|
Origin |
Feb 94 |
April 94 |
June 94 |
Aug 94 |
Oct 94 |
|
Sudanese Refugees |
188,000 |
190,000 |
206,000 |
230,000 |
268,000 |
|
Zairian Refugees |
5,000 |
5,000 |
15,000 |
16,000 |
16,000 |
|
TOTAL* |
193,000 |
195,000 |
221,000 |
246,000 |
284,000 |
*Rwandan refugees are discussed under # 15.A nutritional survey conducted in April 1994 in East Moyo District (population estimates at the time were 70,000 Sudanese refugees in transit camps and 35,000 in settlements) found levels of wasting of 8% in the transit centres (with 23% severe wasting) and 6% in the settlements (with 2.3% severe wasting) (see Annex 1 (10a)). Measles vaccination coverage was poor with only 57% vaccinated in the transit centres and 38% in the settlements. At this time, the ration provided just under 2000 kcals/person/day but distributions were reportedly irregular and the commodities were sometimes spoiled. Problems were noted with an inadequate water supply leading to a high incidence of diarrhoeal diseases [MSF-CH 22/04/92].
More recent survey data comes from Koboko camp in Arua district where there are approximately 85,000 Sudanese refugees with influxes continuing. A July survey found levels of wasting of 12.2% with 3% severe wasting (see Annex 1 (10b)). The crude mortality rate was 0.4/10,000/day (approximately normal) and the under five mortality rate was 0.93/10,000/day (also approximately normal). This indicates a marginal improvement compared to May when crude and under five mortality rates were recorded at 0.5 and 1.5/10,000/day respectively. Rations for this camp population are set at 2,100 kcals/person/day although distributions are reportedly irregular [MSF-H-2 13/09/94].
The populations in East Moyo and Koboko can be considered to be at moderate risk due respectively to a low vaccination coverage and slightly elevated levels of wasting (category IIb in Table 1). The rest of the population is probably not currently at heightened nutritional risk.
How could external agencies help? A measles immunization programme in East Moyo could be useful given the low immunization rates and an emphasis on oral rehydration at the household level could help with the high incidence of diarrhoeal diseases.
(see Map 11)
Ethnic violence that erupted in Shaba in 1992 has forced an estimate 400,000 people to flee the province and head north through various transit towns, (i.e. Likasi and Mwene Ditu) and eventually to the Kasai region.
A nutritional survey carried out in Likasi on the estimated 41,000 displaced people in July found 9% wasting with 3% severe wasting (see Annex 1 (11a)). Although not entirely comparable due the high rate of flux of the population, this appears to be an improvement over the levels of 15% wasting with 7.4% severe wasting measured in June 1993. This transit population receives a half ration amounting to 1000 kcals/person/day. Measles immunization coverage was recorded at 75.6% in the survey [MSF-Bb Jul 94].
The nutritional situation for the local residents of Likasi (estimated population of 160,000) in July was somewhat worse than that of the displaced population. Wasting was measured at 12.1% with 6.9% severe wasting. These relatively high levels of wasting probably reflect the economic crisis currently affecting much of Zaire which has been accompanied by rapid inflation and the resulting diminished capacity of many families to purchase basic food commodities. Measles immunization coverage for the local population was recorded at 63.4% (see Annex 1 (11b)) [MSF-Bc Jul 94].
There have been unconfirmed reports of pellagra in Likasi [MSF-B 15/09/94].
The number of arrivals to Mwene Ditu varies monthly with an estimated 15,000 arriving in June, and 6,000 arriving in July. Some of these arrivals continue north to Kasai region while some remain in Mwene Ditu town or in Simmons camp. A census carried out at the end of July found the actual camp population to be just under 5,000 people. The displaced population in the town itself is probably about 60,000.
The crude mortality rate in June, July and August in the camp was 0.2/10,000/day, which is a normal level, and the under five mortality rate was 0.4 - 0.26/10,000/day. Despite a vaccination campaign, cases of measles are still reported in the camp as the constant turn-over of the camp population makes it difficult to ensure complete coverage of the programme [MSF-Ba Jul 94, MSF-B Aug 94].
A nutritional survey carried out in the camp in mid-July found 16.3% wasting and 4.2% severe wasting (see Annex 1 (11c)). This level of wasting compares favourably with results obtained in March 1994 (31.4%) although there is a slight increase in the prevalence of severe wasting (3.8% in March) [MSF-Ba Jul 94].
We have no updated information on the camp populations of Mbuji Mayi or Kabinda (combined population 24,000) or the displaced living amongst local residents (127,000). The previous RNIS indicated high levels of wasting amongst the camp populations with increasing hardship for those subsisting amongst the local community. We are assuming that these population groups remain at high risk (category I in Table 1). The populations of Likasi and Mwene Ditu (displaced and local residents) can be considered to be at moderate risk with elevated levels of wasting (category IIb in Table 1). The approximately 200,000 people who have resettled in West Kasai are not currently thought to be at heightened nutritional risk.
How could external agencies help? Immunization coverage for the displaced populations needs to be improved, and anecdotal reports of pellagra need to be investigated. Family rations for children in feeding programmes may be useful. Programmes to enhance food security may provide a longer term solution.
(see Map 12)
The political situation in Togo is believed to be stabilizing with some refugees repatriating spontaneously as a result. The estimated number of Togolese refugees in Ghana is at 100,000 and it is hoped that large-scale repatriation can begin early in 1995. There are reports of water problems in Klikor camp in Volta region where there are approximately 14,000 Togolese refugees. There were also difficulties in resourcing and purchasing food so that there was no distribution for the Togolese refugee population in July [UNHCR Jul 94].
There are approximately 15,000 assisted Liberian refugees in Ghana. A small proportion of these are new arrivals from Cote d'Ivoire [UNHCR Jul 94].
The situation resulting from tribal conflict in the northern region of Ghana which led to the displacement of approximately 150,000 people is gradually returning to normal with an undetermined number of people returning to their devastated villages to farm [UNHCR Jul 94].
There are approximately 73,000 Togolese refugees in Benin whose nutritional status is believed to be adequate. However, in June this population (estimated at 42,359 at the time) did not receive maize in their general ration due to a shortage of stocks. The maize was eventually delivered in mid-July [UNHCR 17/8/94, UNHCR 20/09/94].
(see Map 13)
There has been a slow but steady increase in the number of assisted Chadian refugees in the CAR. By the end of July the number had risen to 12,600 refugees. There is no recent information on the nutritional status of this population [UNHCRa 18/08/94].
The number of Sudanese refugees has remained virtually constant at 25,000 people. Rations are reportedly insufficient, but it is thought that the refugees are able to adequately supplement their rations themselves [UNHCRa 18/08/94].
How could external agencies help? For Sudanese refugees the is an urgent need for non-food items (i.e. kitchen utensils, blankets, clothes, jerry cans).
(see Map 11)
There is no new information on the nutritional status of the approximately 163,000 assisted refugees in Zaire (N.B. Rwandan and Burundi refugees are not included in this group. See section # 15).
(See Map 15 and Figure 3F)
The overall situation in the region remains unstable. Security incidents have been reported from all four countries giving rise to further displacements and interruptions to relief efforts. There are reports of retaliation against “would be” returnees from Goma and Bukavu in Zaire, and against inter-ethnically married couples in Tanzanian camps, while in Burundi growing violence in the North has led to further displacements and interrupted relief efforts. Dysentery is currently a major cause of mortality in all four countries affected by the Rwanda/Burundi crisis and is exacting a particularly heavy toll on human life in over-crowded camps. Rwandan refugees have continued to arrive in Tanzania and Zaire throughout August and September.
F. Burundi/Rwanda Region
Trend in numbers of refugees/displaced and proportion severely malnourished or at high nutritional risk (black area).
Estimates of the displaced/refugee/returnee populations over time are:
|
|
Dec 93 |
Feb 94 |
April 94 |
June 94 |
Aug 94 |
Oct 94 |
|
Burundi |
150,000 |
282,000 |
536,000 |
1,000,000 |
1,230,000 |
770,000 |
|
Rwanda |
375,000 |
272,300 |
250,000 |
2,060,000 |
2,040,000 |
2,500,000 |
|
Tanzania |
325,000 |
300,000 |
60,000 |
410,000 |
353,000 |
556,000 |
|
Zaire |
58,600 |
60,000 |
60,000 |
113,000 |
1,500,000 |
1,240,000 |
|
Uganda |
- |
- |
- |
10,000 |
10,000 |
10,000 |
|
TOTAL |
908,600 |
914,300 |
906,000 |
3,593,000 |
5,133,000 |
5,076,000 |
It is estimated that 100,000 people have spontaneously returned to Rwanda with a constant flow reported to the North and Northeast WFP have recently started to distribute one week rations to an initial 48,000 returnees and displaced people in Butare prefecture over and above the 160,000 people being assisted in four refugee camps in northern Gikongoro. There is also a continuing assessment of 15 communes in Butare where a total of approximately 150,000 are reported to be in need of emergency food, seeds and tools [WFP 16/09/94].
The overall relief food supply situation in the country is said to be stable with beneficiary numbers in Rwanda now reaching 571,886 people. There are no recent nutritional survey reports from Rwanda [WFP 16/09/94].
Burundi The estimated population in Burundi requiring assistance is 557,000 internally displaced people and 220,000 Rwandan refugees. Growing insecurity, logistical problems and appalling sanitary conditions in refugee camps are currently hindering efforts to stabilize the nutritional and health condition of the internally displaced and refugee population [WFP 2/09/94].
In August there was growing unrest in the Northern provinces which affected food distributions. However, following an improvement in food arrivals, WFP were able to supply a fifty percent ration to all the displaced for the first time in a month. In Ngozi province there were reports of improvements in the crude mortality rate from 0.8 to 0.5/10,000/day (from 2.5 × normal to 1.5 × normal) [WFP 9/09/94].
Nutrition surveys in the Rwandan refugee camps in early August found 8% and 10% wasting in Ruvumu and Magara camp respectively. Wasting rates of 12.7% with 3.1% severe wasting in Kibesi camp at the end of August were slightly more worrying (see Annex 1 (15a, 15b, 15c)) [AICF 5/09/94, AICF 9/08/94].
More recently there has been further displacement of an estimated 20,000 people due to fighting in Muramvya, Kayanza and Ngozi. Relief operations are also said to be hampered by absence of government authorities in place and minimal presence of other agencies and NGOs as well as lack of security. The situation in Gitega is said to be especially worrying with lack of basic medicines and non-food items. Ongoing fighting in the North and Central regions of the country has disrupted numerous relief convoys. Poor port performance and lack of trucks for transport are a further constraint for the Burundi operation [WFP 2/08/94].
By September there were reports of rising rates of dysentery throughout Northern Burundi and a suspected epidemic of meningitis. There were also reports of 10% severe wasting in Mugano camp for Rwandan refugees. Mortality rates for refugees in the North were clearly rising at the end of September and were on average 1.3/10,000/day with the highest rate reported in Majuri camp at 2.6/10,000/day (8 × normal). Dysentery is thought to be the major cause of mortality. NGOs are currently insisting that a campaign to drain areas around latrines in all camps is necessary before the rainy season leads to widespread contamination of the water supply [WFP 23/09/94].
Goma, Zaire Estimates of the refugee numbers in Goma remain equivocal, although a planning figure of 740,000 is being used. Some NGOs estimate the actual number of refugees to be lower [UNHCR 26/08/94, WFP 30/09/94]. Security incidents mainly in the form of banditry have been a serious problem in the town and camps and were responsible for disrupting food distributions at Kibumba camp in September. Most recent estimates are that some 800 Rwandan refugees per day are repatriating from Goma and that while cereals are available, beans are urgently required and vegetable oil supply may become a problem [WFP 16/09/94].
The cholera epidemic that ravaged the refugee population is now said to be under control. Estimates of the peak mortality rates caused by the epidemic vary (depending on the population estimate used in the calculation) from 54.5/10,000/day to 34.1/10,000/day. These rates are 100-180 times normal mortality rates and are the highest ever recorded in the early stages of a refugee crisis [CDC Aug 94, UNHCR 15/08/94]. Mortality rates are now considerably lower, with most deaths occurring from dysentery and pneumonia. Construction of sanitation facilities including latrines have improved the health and living conditions in all the camps in the Goma area.
The public health problems of refugees in the area have been exacerbated by a number of other factors. These include: inadequate registration of refugees and inequitable internal food distribution systems, delays in acquiring adequate quantities of vegetable oil and blended cereals for distribution in the general ration, delays in establishing effective therapeutic feeding programmes for severely malnourished children, serious delays in providing an adequate supply of soap for domestic hygiene in the camps hampering efforts to prevent the transmission of dysentery, and development of antibiotic resistance by organisms responsible for cholera and dysentery outbreaks necessitating the use of more expensive drugs [CDC Aug 94].
A nutrition survey was carried out in early August in Katale camp (estimated population at the time of 80,000). Prevalence of wasting was measured at 22.1% and severe wasting was 6.6%. The crude mortality rate was 41.3/10,000/day and the under-five mortality rate was 40.4/10,000/day. Most of these deaths were associated with diarrhoeal diseases (see Annex 1 (15d)) [MSF-H 4/08/94].
A survey in Kibumba camp found similar rates with 20.2% wasting and 3.0% severe wasting (see Annex 1 (15e)) [WFP 26/08/94].
Bukavu, Zaire There are 230,314 registered refugees in organized camps sites and a further 40-45,000 remaining in the town. Their nutritional status is said to be adequate with pockets of malnutrition amongst new camp arrivals from the town. The time taken to settle the refugees in camps and the demands of the existing refugee population in the town have contributed to strong tensions between refugees and the local population. Approximately 500 refugees are still crossing the border into Bukavu daily [WFP 23/09/94].
Uvira and Kamanyola, Zaire There are over 44,000 refugees in Kamanyola of which less than 1,000 have been installed in camps. There are a further 150,000 Rwandan refugees in Uvira with up to 300 arriving per week. The problem of lack of camps in Uvira and Kamanyola where less than 14% of WFP beneficiaries live in camps, has led to disorderly general ration distributions, often resulting in fights, threats and protests. Thus, although food is available no distribution has taken place in Kamanyola since the 15th of August [WFP 23/09/94].
Tanzania Refugees from Rwanda continued to arrive in Tanzania with the estimated population rising from 476,000 in August to 556,000 at the beginning of October. Camp conditions were reported to be deteriorating with mortality rates, mainly due to diarrhoeal diseases, as high as 10/10,000/day (33 × normal) [WFP 26/08/94, WFP 7/10/94].
In August at Benako camp, wasting was found in 10% of children under five years old (as compared to 7.1% in June) and severe wasting was measured in 2.8% (1.8% in June) (see Annex 1 (15f)). The apparent deterioration in nutritional status was attributed to the high incidence of diarrhoeal disease, exacerbated by over-crowded conditions and poor water supply, rather than a lack of food. Meningitis has also been reported in Benako camp [MSF-H 4/09/94].
By September, the refugee population had reached 538,000 with new influxes into Ngara, although approximately 400-500 refugees were returning to Rwanda per day. Security conditions in the camps were unstable with unconfirmed reports of killings of inter-ethnically married couples. Mortality rates seemed to be improving with a crude mortality rate of about 3/10,000/day (10 × normal) and an under-five mortality rate of about 8.5/10,000/day [MSF-H 4/09/94]. However, agencies are still very wary that conditions could deteriorate further due to lack of water availability, increased numbers of refugees, limited health and sanitation facilities and the approaching rains.
Uganda There are no reports of change in the satisfactory nutritional status of the approximately 10,000 Rwandan refugees in Uganda.
Overall, the refugee populations in Burundi (approximately 220,000), Goma (approximately 740,000) and Tanzania (approximately 556,000) are considered to be at high risk with high levels of wasting and elevated mortality rates. The approximately 2 million displaced in Rwanda thought to require food aid who are not yet receiving it can be considered to be at risk (category IIa in Table 1), while the 500,000 receiving aid are probably at moderate risk (category IIb in Table 1). The refugee population in Bukavu can be considered to be at moderate risk (category IIb in Table 1). The displaced population in Burundi along with the refugee populations in Uvira and Kamanyola can be considered to be at high risk. The refugee population in Uganda is probably not at heightened nutritional risk.
How could external agencies help? Nutritional surveys on the population in Rwanda are needed. More NGOs are needed in Burundi to run the needed programmes. Sanitary conditions in many of the camps in Burundi are inadequate and household resources (i.e. soap, water) are needed to stop the spread of disease.
In Goma, beans and vegetable oil are desperately needed, as are funds for the expensive drugs needed to treat the dysentery. Better organization of the camps in Uvira and Kamanyola is needed. In Tanzania, the over-crowding of camps needs to be relieved and sanitary conditions improved.
(see Map 16)
There are no reports of change in the nutritional status of the approximately 52,000 Mauritanian refugees in Senegal.
(see Map 17)
There are no reports of change in the nutritional status of the approximately 32,000 refugees in Djibouti.
(see Map 18)
There are no reports of change in the status of the approximately 36,000 refugees in Zambia.
The current assisted population is estimated remain at:
|
Origin |
February/October 1994 |
|
Zairian Refugees |
18,000 |
|
Angolan Refugees |
17,000 |
|
Somali Refugees |
1,000 |
|
TOTAL |
36,000 |
