1. Angola
2. Benin/Ghana/Togo Region
3. Burkina Faso
4. Burundi/Rwanda Situation
5. Central African Republic
6. Djibouti
7. Western Ethiopia/Eastern Ethiopia/Ogaden
8. Kenya
9. Liberia/Sierra Leone Region
10. Mauritanian Refugees in Senegal
11. Mozambique Region
12. Shaba/Kasai Regions
13. Somalia
14. Sudan
15. Uganda
16. Zaire (Refugees)
17. Zambia
(see Map 1 and Figure 3A)
A. Angola - Trend In numbers of displaced/war affected. Shaded areas indicate those at heightened nutritional risk.
With the signing of the peace accord on May the 6th and the partitioning of government and UNITA troops, the country has remained generally calm. Improvements in security have therefore made it increasingly possible to determine relief needs in formerly inaccessible areas and to dispatch assistance where appropriate. It has been reported that many of the displaced are beginning to return home. Large numbers of displaced people returned from Kuito and Kunje to their former homes in Bie province at the end of June and the displaced camp in Kunje, which held over 8,000 people, is now almost empty. In contrast the continuing lack of security outside of Luena in Moxico Province makes the return of the displaced to their nearby homes impossible. It is expected that repatriation of some of the approximately 300,000 Angolan refugees, mainly residing in neighbouring Zaire and Zambia, may soon take place. Food is being pre-positioned in the northern border ares of Zaire and Uige provinces for such an eventuality. The majority of these refugees are expected to return spontaneously [DHA 23/03/95, UNHCR 14/06/95].
However, a recent crop assessment mission in April/May forecast only a marginal increase in the harvest over last years poor output, leaving approximately 1.4 million people dependant on food aid over the next year. It is estimated that up to 2.2 million people require some form of food or non-food aid support during 1995/96. This number comprises the displaced (approximately 1.3 million) and war affected, returnees, and demobilised soldiers. The main constraints on agricultural production have been sporadic fighting, massive displacement of farmers and the existence of millions of landmines. There has also been a shortage of complementary agricultural inputs such as fertilizer [DHA 23/03/95, FAO 29/05/95, WFP 16/06/95, WFP 30/06/95].
The relative peace in the country has led to an increase in the amount of humanitarian aid that is being delivered by road rather than airlifted, thereby reducing transport costs. However, it is still envisaged that in the coming months air transport will continue to play an important role. In mid-June the first WFP road convoy carrying relief supplies to Malange departed from Luanda and at the end of the month a road convoy had successfully supplied Huambo and Kuito with relief items. WFP has also conducted a road assessment from Kuito to Menongue in order to determine the possibility of future convoys of relief supplies to this isolated city [DHA 23/03/95, FAO 29/05/95, UNHCR 14/06/95, WFP 16/06/95, WFP 30/06/95].
In general, the nutritional situation in accessible areas appears to be improving although these populations are still believed to be heavily reliant on food aid. For example, a survey completed in N’Dalatando (estimated population 75,000) found wasting rates between 2.3-5.5% with 0-1.1% severe wasting (see Annex I (1a)). This is an improvement over an earlier survey in November 1994 which found 26.5%-33.1% wasting with 9.1-13.5% severe wasting. Much of this dramatic reduction in levels of wasting has been attributed to the regular provision of a general ration and establishment of selective feeding programmes [Concern 94/95]. However, the dependence of the population on external support is a matter of concern and they are likely to be vulnerable to disruptions in food aid supply until agricultural production has improved and increased economic self-sufficiency achieved.
A survey conducted in Soyo, Zaire Province (estimated population 30,000) found 5.4% wasting and 0.8% severe wasting (see Annex 1 (1b)). These relatively normal levels of wasting are not mirrored by crude mortality rates of 1.5/10,000/day (5x normal) and an under five mortality rate of 4.3/10,000/day [MSF-H Jun 95]. A recent nutritional survey in Jamba indicated normal levels of wasting and, as a result, the general ration was reduced to half rations in early June [WFP 30/06/95]. A survey in Dondo in Cuanza None province in July found overall wasting rates of only 5.5% with 1% severe wasting (see Annex I (1c)) [WFP 16/07/95].
In contrast to these results, a survey carried out in Cafunfo, Lunda None (estimated population 10,000) in April/May found a catastrophic nutrition situation. The government controlled town has effectively been under siege conditions for the past year with surrounding areas controlled by UNITA forces. Market availability of food has therefore been extremely limited. Wasting was measured at 29.2% with severe wasting at 20.9% indicating an extreme emergency (see Annex I (1d)). Many cases of malnutrition were also noted among older children and adults. The crude mortality rate was 8.3/10,000/day (about 20x normal) and the under five mortality rate was 10.3/10,000/day [AICF 04/05/95]. A general ration programme was started in mid-May 1995 [WFP 19/05/95].
Overall, most of the affected population in Angola can be considered to be at moderate nutritional risk due to their dependence on food aid (category IIb in Table 1). However, conditions should improve quickly as populations become more accessible to delivery of humanitarian relief by road. Known exceptions are Cafunfo where the population are at high risk (category 1 in Table 1) and it is likely that other pockets of “famine” exist in formerly besieged areas which have yet to be properly assessed.
How could external agencies help? As the situation in Angola gradually improves, caution needs to be exercised in planning reductions in general ration provision. Nutritional surveillances should be established to ensure that withdrawal of emergency food aid does not lead to any marked decline in nutritional status. Efforts to de-mine large tracts of land and provide agricultural inputs to returnees should be given maximum priority and agencies should gear up for the possible return of large numbers of Angolan refugees.
The eruption of political violence in Togo in January 1993 triggered a refugee crisis which displaced up to 300,000 people more or less equally into neighbouring Benin and Ghana. The political situation in Togo has now stabilised to the extent that UNHCR are currently establishing plans for the voluntary repatriation of the remaining 161,000 refugees from Benin and Ghana [UNHCR 26/06/95].
Benin The latest indications are that the majority of the 49,000 Togolese refugees in Benin favour voluntary repatriation [UNHCR 26/06/95]. There are no reports of change to the generally adequate nutritional status of this population.
Ghana There are approximately 112,000 refugees in Ghana. This number is comprised of 98,000 Togolese refugees and a further 14,000 Liberian refugees. Although repatriation plans are underway for the Togolese refugees, there appears to be a more ‘wait and see’ attitude towards repatriation amongst this refugee population with many reluctant to return immediately. There have been reported problems with procurement of important drugs not on the “essential” drug list for refugees in Northern Volta camps while the Ministry of Health drug supply to the camp clinics in southern Volta are said to be inadequate [UNHCR-a 14/06/95, UNHCR 26/06/95].
There has been a slight increase in the number of Liberian refugees in Ghana due to recent displacement from fighting in Sierra Leone [UNHCR-a 14/06/95].
It is reported that most of the approximately 180,000 people in Northern Ghana, displaced by ethic violence which erupted in February 1994, have returned home. However, there have recently been some reports of renewed ethnic fighting although no indication of resulting displacement [UNHCR 26/06/95].
Overall, the 161,000 people affected regionally are probably not currently at heightened nutritional risk (category IIc in Table 1).
(see Map 10)
There are currently approximately 20,000 Touareg refugees from Mali and Niger in Burkina Faso comprising those who arrived between 1991-3 and others who arrived in June/July 1994. It is now hoped that the signing of a peace accord in Niamey in April will pave the way for repatriation of this population although extensive efforts to rehabilitate infrastructure will be needed before full-scale repatriation can occur [UNHCR 16/05/95].
There have been some reported difficulties with the provision of food aid for this refugee population who do not traditionally consume maize or sorghum. As a result, it appears that refugees have been exchanging their maize/sorghum rations for more traditional foods such as milk and millet. However, in spite of the provision of foods which are not normally consumed by this population the nutritional status of children appears not to have been adversely affected [UNHCR 16/05/95].
There are also approximately 41,000 assisted Touareg refugees from Mali in Mauritania. These refugees began arriving in southeast Mauritania at the end of 1991, fleeing ethnic conflict in Mali. During 1994 a planning figure of 80,000 refugees was used. An assessment mission in December 1994 resulted in a reduction of the cereal component of the ration by 25%. A subsequent census carried out in April 1995 identified 41,000 refugees in the camps. This population continued to receive a reduced general ration [UNHCR 29/06/95].
A recent nutritional survey conducted at the three refugee sites showed 17.1% wasting with 3.2% severe wasting. The crude mortality rate was 1.8/10,000/day (6x normal) and the under five mortality rate was 4.8/10,000/day. Principal causes of death were attributed to diarrhoea and malnutrition. Measles vaccination coverage was 88.4%. These high levels of wasting and mortality may be partially explained by a high incidence of diarrhoea and the overall reduction in the general ration provision for this population. It is reportedly possible that the high level of diarrhoea may in turn be related to the provision of DSM powder in the general ration which becomes contaminated when reconstituted at household level. Based on these survey results the ration, in particular the cereal component, will be increased in the near future. There will also be an additional one-off distribution of millet, oil and beans or lentils in August [MSF-F Jun 95, UNHCR 29/06/95, WFP 24-25/07/95].
It is hoped that repatriation of these refugees will take place in 1995 due to the present stabilisation of the political situation in Mali and as infrastructure at returnee sites in Mali are restored [UNHCR 29/06/95].
Overall, the more recently arrived population in Burkina Faso can be described as at moderate nutritional risk (category IIb in Table 1) while the refugees who have been in Burkina Faso longer are probably not at heightened nutritional risk (category IIc in Table 1). However, the refugees in Mauritania, can be considered to be at high nutritional risk due to elevated levels of wasting and mortality (category I in Table 1).
How could external agencies help? There is a need to monitor the appropriateness of the general ration commodities given to Malian refugees in Burkina Faso and to determine whether the exchange of certain commodities by the refugees for other commodities of preference reduces the overall nutritional adequacy of the general ration. Nutritional status and mortality rates of the Malian refugees in Mauritanian camps needs to be carefully monitored in the coming weeks to determine whether the overall reduction in the general ration continues to have an adverse effect on nutritional status. There also needs to be a review of the advisability of providing dried skimmed milk in the general ration and its possible role in increasing rates of diarrhoea.
(See Map 4 and Figure 3B)
B. Burundi/Rwanda Region - Trend in numbers of refugees/displaced and proportion severely malnourished or at high nutritional risk (black area).
There are approximately 3.2 million refugees and internally displaced people affected by this regional emergency. In Burundi, very poor security with frequent outbreaks of violence has hindered movement of relief supplies and created several new waves of displacement. Refugee camp populations have also been affected by the level of insecurity and have expressed fears of forced repatriation. Inside Rwanda, the rehabilitation programme is in full swing and targeted mainly to those communes which have received the largest number of returnees. Although there have been some security incidents in the country, a good July harvest is expected. Security around the refugee camps in Tanzania is said to be fragile but the food supply to refugees is now reported to be adequate. However, lack of water in the camps still continues to be a problem and is reflected in disease patterns. Despite inadequate food supplies to the Goma and Bukavu refugee camps in Zaire levels of wasting remain extremely low.
Current estimates of affected populations by country are given in the box below:
|
|
Jun 94 |
Aug 94 |
Oct 94 |
Dec 94 |
Feb 95 |
Apr 95 |
Jul 95 |
|
Burundi |
1.000.000 |
1.230.000 |
770.000 |
1.200.000 |
740.000 |
492.500 |
515.000 |
|
Rwanda |
2.060.000 |
2.040.000 |
2.500000 |
2.500.000 |
335.000 |
1.750.000 |
800.000 |
|
Tanzania |
410.000 |
353.000 |
556.000 |
556.000 |
630.000 |
686.000 |
644.000 |
|
Zaire |
113.000 |
1.500.000 |
1.240.000 |
1.240.000 |
1.290.000 |
1.130.900 |
1.202.200 |
|
Uganda |
10.000 |
10.000 |
10.000 |
10.000 |
5.000 |
5.000 |
6.700 |
|
TOTAL |
3.593.000 |
5.133.000 |
5.076.000 |
5.076.000 |
3.000.000 |
4.064.400 |
3.167.900 |
Security incidents have been continually reported over the past three months particularly in Bujumbura and in provinces such as Cibitoke leading to the temporary displacement of large numbers of people. There have been numerous reports of NGO vehicles and convoys being attacked and staff threatened. Security around refugee camps has become more precarious and Burundi officials are strongly advising that refugees return home. This insecurity is affecting access roads in and out of Bujumbura and to the northern provinces constraining food deliveries In mid-June 8-10,000 refugees from Mugano camp moved into the border area with Tanzania expressing fear of forced repatriation to Rwanda by the Burundian authorities [WFP 12/05/95, WFP 14/07/95, WFP 12/07/95].
In spite of these high levels of insecurity a joint government/WFP/Donor mission which completed its report in mid-June recommended that general food assistance to the internally displaced be phased out by March 1996 and that food should then be targeted to vulnerable groups and those without access to land, to replace the general food distribution. However, this missions findings were partly informed by the FAO/WFP crop and food supply assessment mission to Burundi in April which predicted a good second season crop before the pronounced deterioration in security of recent weeks. The Burundi government is presently studying these recommendations [FAO 24/03/95].
Rwanda The total number of internally displaced/returnees needing assistance is estimated to be 800,000 [WFP 21/07/95]. After the closure of the camps for the internally displaced in April/May 1995, a number crossed into Burundi, but many returned to their communes of origin [DHA 15/05/95]. Since the beginning of the year, food has been supplied to support a variety of first stage recovery activities in addition to continued support to recent returnees from refugee and internally displaced camps. Food for work programmes have been successfully undertaken in various sectors including infrastructure building, water and sanitation and education. Income generating activities have also been widely established.
These rehabilitation programmes are presently directed toward priority communes, estimated to have received 85% of the former IDP camp residents. Food is also supplied to hospitals, nutritional centres and unaccompanied children centres while rations to returnees continue to be provided through the way stations and transit centre system. Recent returnees currently receive a one month food distribution after which they are incorporated into targeted rehabilitation programmes.
UN and NGO vehicles are being regularly robbed and hijacked with threats to staff. In June and July there have been numerous reports of security incidents in Kigali, Gisenyi (partly due to incursions from Zaire), Butare and the Western prefectures of the country [WFP 23/06/95]. The UN security Council has extended UNAMIRs mandate for an additional six months although troops will gradually be reduced in number. Under the new mandate, UNAMIR will support and assist provision of humanitarian aid, contribute to security for UN staff, and assist in the training of the local police force [WFP 07/07/95, WFP 21/07/95].
The prospects for the harvest in July are reportedly encouraging, with approximately 60% of tillable land planted and adequate rainfall. Crop yields are expected to be near the pre-war average although a reduction in area planted will mean lower overall production [DHA 15/05/95, WFP 30/06/96].
Tanzania The total number of Burundi and Rwandan refugees has continued to rise slowly, despite the closure of the border by the government since March. It is currently estimated that there are just over 644,000 refugees in Tanzania [WFP 30/06/95]. Camp leaders from Ngara approached UNHCR at the end of June to discuss repatriation. This is the first time that such an initiative has come from the refugee community. The security situation in many of the camps is described as fragile [WFP 19/05/95, WFP 30/06/95]. Most recent reports indicate that the new distribution lists drawn up by camp leaders are creating tension in the camps, especially around distribution sites [WFP 21/07/95].
By mid-June satisfactory distribution of food was observed in all refugee camps with a full ration of maize, beans and CSB and the resource situation was said to be improving daily with new contributions. A joint WFP/Tanzanian Railways Corporation team completed its assessment in June and concluded that funds were urgently needed for the improvement of transport of food aid [WFP 24-25/07/95].
Recent nutritional information from Kitali Hill camp, in Kagera region (estimated population 58,000) found that 7.8% of children under five years of age were wasted and that 0.9% were severely wasted (see Annex 1 (4a)). Demographic analysis of the camp population showed that there were a greater number of children between 42-53 months than in the 6-17 month category possibly reflecting a higher mortality rate for those under 30 months in previous weeks or a low birthrate due to the war in Rwanda. The crude mortality rate was 0.9/10,000/day (3x normal) and the under-five mortality rate was 2.4/10,000/day. The camp had been receiving poor rations since the beginning of March and the theoretical general ration during April was only 1480 kcals per capita. The measles immunisation coverage rate was 94% [AICF 15/04/95].
A nutritional survey conducted in Musuhura Hill Camp in Ngara region (estimated population 58,000) found 11.2% wasting with 3.2% severe wasting (see Annex 1 (4b)). This does not compare favourably with an earlier survey result in November 1994 which only found 3.3% levels of wasting [MSF-H Jun 95].
Health conditions are generally said to be satisfactory in all camps with the most common health problems being lower respiratory tract infections, malaria and scabies. Adequate potable water is, however, a serious problem for all the refugee camps in Western Tanzania with average availability still only 6-7 litres/person/day. This is reflected in the high incidence of scabies. Efforts to improve the water supply are continuing [WFP 24-25/07/95].
Goma, Zaire There are approximately 722,000 refugees in Goma. It was reported at the end of April that the insecurity within Rwanda due to forced camp closures had temporarily stopped repatriation which had reached a peak of 1000/day by February. Repatriation began again in July 1995 [WFP 24-25/07/95]. In spite of a generally improved security situation in the Goma region, largely due to the presence of UNHCR Zairean security forced deployed since February, armed robberies of NGOs have been reported as well as unconfirmed information regarding an attack on Rwandan refugees from eastern Zaire.
Deliveries of food by truck have been inadequate over the last few months due to closure of the Rwandan/Zaire border, poor road conditions and escalating railway costs in Uganda. At the beginning of May, the general ration was only 1,140 kcals per capita and this was reduced further by mid-June to 1000 kcals per capita. Beans and/or CSB have periodically been missing from the ration [WFP 29/04/94, WFP 05/05/95, WFP 12/06/95]. There has also been concern over the lack of availability of maize meal. The high proportion of maize grain in the ration has been problematic for supplementary feeding programmes and young children in general. There has been a long-term shortage of milling facilities in the area with WFP lacking funds for milling costs [UNHCR 13/06/95].
Despite these problems with ration provision, recent nutritional surveys show an adequate nutritional situation. In Kahindo camp wasting rates were measured at 1.7% with 0.4% severe wasting (see Annex I (4c)). Nutritional survey results from Lac Vert camp showed 2.6% wasting and 0.6% severe wasting (see Annex I (4d)) and in Kibumba camp, wasting was measured at 3.5% with 1.9% severe wasting (see Annex I (4e)). Given the low levels of per capita rations distributed in recent weeks, it is likely that these extremely low levels of wasting reflect extensive coping strategies amongst these camp populations. A survey of camp markets in May and June showed a wide variety of food commodities available [MSF-B May/June 95, UNHCR 17/06/95, UNHCR 19/06/95].
Food distribution systems are still being improved in the camps with new family level systems being tested in Kibumba and Katale camps [WFP 30/06/95].
Bukavu, Zaire Most recent estimate are that there are 308,200 Burundi and Rwandan refugees in Bukavu [WFP 12/06/95]. The security situation is described as tense with numerous incidents reported between the Zairean authorities and Hutu politicians in the refugee camps largely as a consequence of the ban on certain political activities within the camps. A number of refugee killings have also been reported [WFP 03/05/95, WFP 16/06/95, WFP 23/06/95].
In early May, the Bukavu camps experienced a similar degree of food supply problems as the Goma camps largely as a result of closure of the border at Cyangugu. The per capita ration was only 960 kcals in early May rising to 1230 kcals by mid-May. However, these rations frequently lacked CSB and pulses and were therefore grossly deficient in key micro-nutrients. Increased use of food supplies via Burundi and some small scale local purchases determined that the food supplies had improved considerably by the end of June and were providing a per capita ration of 1500 kcals [WFP 12/05/95, WFP 19/05/95, WFP 23/06/95]. In the first two weeks of July shortages of pulses for the general ration were being reported [WFP 21/07/95].
There are no current nutritional data from the Bukavu camps although at the end of May levels of wasting were less than 5% with the consequent closure of many therapeutic feeding centres. Levels of wasting have generally been at this low level throughout the Bukavu emergency and, given the sporadic general ration supply to the Bukavu camps - especially in recent months, probably reflects the development of various coping strategies amongst this refugee population.
Uvira/Kamanyola, Zaire There have been some new arrivals in the region over the last few months largely due to the closure of the camps for internally displaced in Rwanda which led to over 23,000 new arrivals and violence in the Bujumbura area. Current estimates are that there are 172,000 Burundi and Rwandan refugees [UNHCR-b 14/06/95]. There have also been security incidents reported in this area, especially in Kamanyola camp [WFP 26/05/95].
The distribution system has been changed and food is now given directly to the oldest female in each household. This is reportedly improving equity and the amount of ration received by each family [WFP 03/05/95].
Uganda There are an estimated 6,700 Rwandan refugees in Uganda. Approximately 1,000 of these people had been refugees in Uganda before the April 1994 crisis erupted. The remaining 5,500 refugees arrived after April 1994 with many transiting through Tanzania or Zaire [UNHCR 03/07/94].
Overall, the population in Uganda is not currently considered to be at heightened nutritional risk (category IIc in Table 1). The population in Burundi is at moderate risk due to the high levels of insecurity with consequent threat to relief deliveries (category IIb in Table 1) and the refugee population in Tanzania may also be at moderate risk due to poor water supplies in the camps. Populations in the Goma, Bukavu and Uvira camps can be considered to be at low risk despite to the poor delivery of general (category IIc in Table 1). The population in Rwanda may be considered to be at moderate risk until they have fully re-established their normal agricultural and economic activities and until the infrastructure in the country has been properly rehabilitated (category IIb in Table 1).
How can external agencies help? The potential impact of the planned withdrawal of the general ration for the internally displaced in Burundi needs to be carefully monitored through nutritional and health surveillance. Furthermore, there needs to be a highly flexible approach to the targeted general ration withdrawal as security conditions within Burundi fluctuate so markedly. Cash resources are urgently needed for the Tanzanian refugee programme to support recommended improvements to the Tanzanian Railway to ensure regular deliveries of food aid to the refugee camps. Furthermore, continued efforts must be made by agencies to improve the water supply situation in the camps which have been problematic since the emergency began in April 1994. Donors must make even greater efforts to increase the provision of maize meal in the general ration for Rwandan refugees in the Goma camps due to the shortage of milling facilities. Where appropriate, donors could also provide milling costs for whole grain maize. Donors must continue to explore all options to ensure pulse and blended food provision in the general radon for the region as a whole. In some cases, this may require providing extra cash resources for local and regional purchase.
Most recent estimates are that there are 13,300 Chadian refugees and 25,500 Sudanese refugees in the CAR. It is reported that a group of approximately 900 refugees from Mboki camp want to repatriate to the Sudan [DHA 24/05/95]. There are no reports of any change in the stable nutritional situation of these refugee populations.
Repatriation of Ethiopian refugees is completed, and, as of July 1995, the total number repatriated had reached 17,000, leaving approximately 23,000, mainly Somali refugee in country [UNHCR 03/05/95, WFP 24-25/07/95].
(see Map 7)
The total number of refugees/displaced/returnees in Ethiopia is currently estimated to be 380,000. This number is comprised of just over 55,000 Sudanese refugees in the West, 272,000 Somali refugees in the east, 18,000 Djibouti refugees in the north-east. 24,000 Somali and Kenyan refugees in the south and 11,000 displaced Eritreans in camps around Addis Ababa.
There continues to be a gradual increase in the number of Sudanese refugees in western Ethiopia, the most recent of whom arrived from Nasir town in the upper Nile province of southern Sudan to Fugnido camp [UNHCR 03/05/95, UNHCR May 95]. Recent survey conducted by the ARRA in two of these camps showed levels of wasting of 6% with little or no severe wasting (see Annex 1 (7a-b)). However, the situation in Fugnido camp is somewhat worrying as levels of wasting were 17.6% (see Annex 1 (7c)). This shows no change from a survey conducted a year ago, and may be explained by the continuing influx of Sudanese refugees who often arrive in a malnourished state [SCF 18/07/95].
The number of registered Somali refugees has also increased with the most recent new arrivals fleeing fighting that erupted in Northwest Somalia in March 1994 [UNHCR 03/05/95, UNHCR May 95]. Surveys conducted by the ARRA in the five Jijiga zone camps in March 1995 showed levels of wasting between 12% and 17.3% with severe wasting ranging between 0.4-2.2% (see Annex 1 (7d-h)). Although these surveys compare favourably with survey results from May/June 1994 when wasting rates were above 21% in two of these camps, levels are still somewhat high. This probably reflects the long-term problem of over-registration of this refugee population which has led to a reduction in general ration provision which may penalise certain vulnerable groups.
Surveys in four other Eastern camps for Somali refugees conducted in July 1995 found a range of 7.5-13.3% wasting with severe wasting of 0.5-2.2% (see Annex I (7i-l)). Daror camp (estimated population 42,000) had the highest level of severe wasting and it is reported that this may be due to the continuing arrival of severely malnourished refugees to this camp. Approximately 12,000 have arrived since April 1995 [SCF 18/07/95].
The returnees in the Ogaden region who included those in and around Gode, are now considered to be adequately re-integrated and no longer in need of assistance.
Repatriation of Ethiopian refugees from Djibouti is completed, and is continuing from Kenya and Sudan. Most recent estimates are that there have been 17,000 returnees from Djibouti since the beginning of the programme. During May 1995, 2,100 refugees from Sudan and 800 from Kenya repatriated to Ethiopia [UNHCR 03/05/95, UNHCR May 95].
Overall, the populations in Fugnido, Kebre Beyah and Derwonaji can be considered to be at risk due to high levels of wasting (category I in Table 1) and the populations of Hartisheikh, Terferiber, Daror and Aisha can be considered to be at moderate nutritional risk with somewhat elevated levels of wasting (category IIb in Table 1). The remaining Somali and Sudanese populations are not thought to be at heightened nutritional risk (category IIc in Table 1), and there are no reports of change for the nutritional situation for the displaced around Addis Ababa (category IIb in Table 1). No information is available on the Djibouti refugees in the North (category III in Table 1).
How can external agencies help? The nutritional survey results indicate that there needs to be further analysis of why high levels of wasting persist in Fugnido camp in the West and two camps for Somali refuges in the Jijiga area. Follow up nutritional surveys which attempt to identify causes of nutritional vulnerability should be conducted in the near future.
(see Map 8 and Figure 3C)
C. Kenya - Trend in numbers of refugees.
Most recent estimates are that there are approximately 197,000 refugees in Kenya. There are 158,000 Somali refugees, 31.000 Sudanese refugees and 6,000 Ethiopians (along with 2,000 refugees of other national origin). This is a decrease from 230,000 at the end of April, largely due to the continued repatriation of Somalia and Ethiopian refugees. The coastal camp of Utange is now closed [UNHCR May 95].
The re-establishment of CSB (which contains vitamin C) in the general ration for refugees is said to be reducing fears of a seasonal scurvy outbreak in the coming months. The situation will be carefully monitored to determine whether this prevents seasonal scurvy [WFP 24-25/07/95].
How can external agencies help? Agencies should continue to monitor trends in the incidence of scurvy as the traditional “scurvy season” approaches. These scurvy data should then be correlated with the provision of micro-nutrient fortified CSB in the general ration to determine whether the latter prevents seasonal increases of this condition.
(see Map 9 and Figure 3D)
D. Liberia - Trend in numbers of refugees/displaced and proportion severely malnourished and at high risk (black area).
The overall situation in the region appears to be deteriorating. There are continued reports of skirmishes in Liberia, and despite the expansion of ECOMOG control into Cape Mount and Bomi counties, much of the country remains inaccessible to relief activities. Intensive rebel activity in Sierra Leone is continuing and estimates of the number of displaced people in the country vary from 730,000 to over a million people. Food distributions in Sierra Leone have been severely disrupted by the insecurity. The total number of people in need of humanitarian aid in the region has increased since the last RNIS report by over 100,000 to 3.4 million largely due to further displacements in Sierra Leone. This total population number is broken down by country as follows:
|
Location |
Jun 94 |
Aug 94 |
Oct 94 |
Dec 94 |
Feb 95 |
Apr 95 |
Jul 95 |
|
Liberia |
1.750.000 |
1.750.000 |
1.692.000 |
1.615.000 |
1.800.000 |
1.900.000 |
1.900.000 |
|
Sierra Leone |
300.000 |
300.000 |
300.000 |
506.000 |
506.000 |
500.000 |
730.000 |
|
Cote d’Ivoire |
234.000 |
250.000 |
325.000 |
330.000 |
330.000 |
330.000 |
227.000 |
|
Guinea |
628.000 |
539.000 |
534.000 |
534.000 |
568.000 |
603.000 |
578.000 |
|
TOTAL |
2.912.000 |
2.839.000 |
2.851.000 |
2.988.000 |
3.198.000 |
3.333.000 |
3.435.000 |
However, ECOMOG took control of the two main highways leading to Bomi and Cape Mount counties in mid-April, thereby greatly improving access to the populations in the western part of the country. In general the security situation has improved greatly in the major towns along these highways. Unfortunately, ECOMOG manpower is not sufficient to control areas off the highways where clashes between the two ULIMO factions have been reported as well as looting and atrocities committed against the civilian population. At the beginning of May ECOMOG extended its control over parts of Montserrado County, however, ECOMOG strength is gradually being weakened as the Tanzania military contingent start to leave. Throughout May there have been reports of skirmishes in many areas of Liberia including parts of Maryland county, Bong Mine and Gbarnga. Although it is difficult to gain precise information about the total number of newly displaced, approximately 200 people a day appear to be leaving Cess, Sinoa and areas north of Buchanan with another 500 per week from Bong Mine. The opening of the Bomi highway has allowed a large number of displaced people to travel to the camps around the Po River or to Monrovia [IFRC 02/06/95].
The total number of people requiring humanitarian assistance in Liberia remains at 1.9 million, but with the expanded control of ECOMOG forces, approximately 1.14 million of these people are now accessible to humanitarian aid in Monrovia (830,000), centres for the displaced in Rural Montserrado (90,000) and Lower Margibi and Lower Grand Bassa (215,000). It is reported that food is available in and around Monrovia both from the general ration distribution and on the markets [DHA 19/06/95, SCF 16/06/95, WFP 05/05/95].
A recent nutritional survey in Cape Mount in April showed 17% wasting with 5.3% severe wasting (see Annex 1 (9a)) [WFP 09/06/95]. Two other surveys in Margibi county showed a less severe situation. In Harbel Unification Town, wasting was measured at 7.4% with 1.1% severe wasting (see Annex 1 (9b)). The crude mortality rate was 0.69/10,000/day (2x normal) and measles immunisation coverage was 53.7%. In Goba Town, the prevalence of wasting was measured at 11.7% with 3.1% severe wasting (see Annex 1 (9c)). The crude mortality rate was 1.3/10,000/day (4x normal) and the measles immunisation coverage was 23.1% [MSF-H Jun 95].
There have also been a number of anecdotal reports from rapid assessment missions during April and May. One such report talks of deplorable human conditions around Harper in Maryland County, while another talks of no general signs of malnutrition in the towns visited in Grand Cape Mount County. Although various findings show that amongst the Liberian population there are pockets of malnutrition, the provision of medicines has been identified by some as an even higher priority than that of food [WFP 05/05/95, WFP 23/06/95].
Sierra Leone Rebel attacks have continued throughout the countryside in April and May with the anti-civilian characteristics that have come to be identified with this armed conflict, leading to further large scale civilian displacement. During June and early July there were reports that tension had eased in the Western Area and Freetown with unconfirmed news that the rebels had been routed from the rural western province, although there was also news of renewed rebel insurgence in Kono, Kenema and Kallahun. Attacks on highways have continued. Rough estimates are that there may be as many as 730,000 people internally displaced within Sierra Leone and a further 45,000 who have crossed the border into Guinea. As many as 40,000 people may have recently been displaced from Bo district while communities between Waterloo (only 25 miles from Freetown) and Lunsar have also reportedly had to move due to fighting [DHA 16/06/95, UNHCR 26/06/95].
Food convoys have regularly been looted and, based on the experience of last year, it has been suggested that rebel groups are stockpiling food for the rainy season. As a consequence food relief programmes are severely constrained. IFRC have reported that food is unavailable for distribution in Daru, Segbwema and Kenema as food stocks could not be positioned due to banditry and attacks on convoys. Food deliveries in June were therefore expected to be very poor. [WFP 23/06/95, DHA-a 15/05/95, IFRC 02/06/95]. It was also expected that distribution of foods in July for regions like Bo and Kenema would be delayed due to insufficient food available at WFP extended delivery points [WFP 21/07/95]. As security continues to deteriorate nationally, prices of basic food commodities are increasing daily.
A nutritional survey which was carried out in March 1995 in Freetown, showed 13.4% wasting with 7.2% severe wasting (see Annex 1 (9d)). No difference between the displaced and resident populations was found. Food was being distributed by different agencies in Freetown with allocated rations varying from 860 to 2240 Kcals per capita. The WFP assisted beneficiary caseload in the capital is still limited to less than 50,000 persons because of the difficulties of proper identification and registration. Measles immunisation coverage was found to be 53% [AICF 14/03/95].
Cote d’Ivoire There appears to be some confusion over the number of refugees in Cote d’Ivoire, and a recent attempt at a census was unsuccessful due to resistance by refugees. One estimate is that the number of refugees in need of humanitarian aid is approximately 270,000 [IFRC 02/06/95].
A poor nutritional situation for Liberian refugees in the Tabou prefecture of Cote d’Ivoire was described in the last RNIS report (14.8% wasting with 4.8% severe wasting). This situation has now reportedly improved considerably largely due to the interventions of various agencies [IFRC 02/06/95].
Guinea The total number of Liberian and Sierra Leonean refugees in Guinea is estimated to be 578,000. This represents a decrease from the last RNIS report (603,000) due to revised estimates of new arrivals from Sierra Leone [UNHCR 26/06/95]. We have no new information on the new arrivals in Forecariah prefecture who according to the previous RNIS were only receiving a per capita general ration of 1400 kcals and were therefore believed to be at some nutritional risk.
Overall, the population in Monrovia, Rural Montserrado, and Lower Margibi and Lower Grand Bassa who have access to humanitarian aid as well as refugees in Guinea and Cote d’Ivoire are not considered to be at heightened nutritional risk (category IIc in Table 1). Those in the newly accessible areas of Liberia are at moderate risk with many showing elevated levels of wasting and mortality and other populations showing low levels of measles immunisation coverage (category IIb in Table 1). The inaccessible populations of Liberia and Sierra Leone can be considered to be at high risk (category IIa in Table 1).
How can external agencies help? Urgent attention should be given to increasing measles vaccination coverage in the newly accessible areas of Cape Mount and Margibi county. Similarly, drug supplies need to be improved to these areas. Agencies should give priority to registering the “needy” displaced in Freetown in order to increase coverage of the general ration programme. Measles vaccination coverage also needs to be improved amongst this large urban population.
(see Map 10)
There are no reports of change in the situation for the approximately 52,000 Mauritanian refugees in Senegal currently receiving humanitarian aid. There are plans to phase out this assistance by the end of 1995, by which time it is hoped that the refugees will either have reached self-sufficiency or been repatriated.
(see Map 11 and Figure 3E)
Trend In numbers of refugees/returnees.
As of mid-June, the organised repatriation of Mozambican refugees in Malawi was completed, almost a year ahead of schedule [UNHCR 13/07/95]. Many of the returnees have now been in Mozambique long enough to have had a harvest and therefore are no longer considered to require food aid. Numbers of returnees and demobilised soldiers have accordingly decreased to 160,000. It is estimated that from May 1995, approximately 120,000 people who had no harvest, mostly in the provinces of Gaza and Maputo, would require emergency food aid and that this number was expected to increase to 400,000 in October, mostly from Tete and Gaza provinces, as food stores from limited harvests were used up. By the end of the marketing year the expected number of beneficiaries would be 700,000. In March a further 23,000 refugees from Malawi repatriated. This population, along with any other refugees who returned post November 1994, are eligible for continued returnee assistance until the next harvest in April 1996 [FAO 31/05/95, UNHCR 13/07/95, WFP 24-25/07/95].
An FAO/WFP crop assessment mission in April concluded that the recent harvest was, as predicted, a good one, with a 10-13% increase in area of land planted compared to the previous year and 140% greater yields than during the 1993/4 season. However, wide variation in output was anticipated with the four provinces in the north being roughly self-sufficient while other provinces would have far lower levels of production [FAO 31/05/95].
In spite of the recent harvest, nutritional data still indicate that there are vulnerable populations. A survey in Namacurra District in Zambezia province found 12.3% wasting (see Annex 1 (11a)) [Ministerio da Saude 07/04/95]. The recent harvest was variable throughout the district and the general food distributions were said to only be reaching a small proportion of the population so that further deterioration was feared [WV Apr 95].
Other surveys showed less worrying results. In Guija District (estimated population 99,000) in Gaza Province levels of wasting were recorded at 5.5% with 1.6% severe wasting (see Annex 1 (11b)) [MSF-CIS 10/04/95]. In Magude District (estimated population 73,000) in Maputo province, wasting was measured at 3.2% with 1.8% severe wasting (see Annex 1 (11c)) [MSF-CIS-a Apr 95]. In Guro District levels of 7.4% wasting were recorded (see Annex 1 (11d)). In all these surveys it was noted that household food reserves were low or non-existent and that wild foods were a significant part of the diet. The survey teams therefore recommended that it was advisable to closely monitor these populations as general food rations were being phased out from May onwards.
Overall, the assisted population is not currently at heightened nutritional risk (category IIc in Table 1), although it is likely that pockets of malnutrition exist in the more remote areas.
How could external agencies help? The situation appears to be improving as a result of the relatively good harvest, and as greater numbers of returnees have resumed agricultural activities. However, there are areas where crop production has been poor, or where new returnees have arrived too late to produce a crop. There are also population groups who are not easily accessible for delivery of food aid. The existence of these vulnerable groups is periodically reflected in nutritional survey results or high levels of growth faltering at Mother Child Health centres. Agencies should therefore give priority to the continued monitoring of these groups.
(see Map 12)
There are approximately 600,000 people who have been displaced by ethnic violence which erupted in Shaba region in 1992. This population fled the region and moved into the Kasai region farther north where many of their ancestors lived. Large numbers stayed in towns, e.g. Mwene Ditu and Likasi, along the route north to the Kasai region.
A recent survey in the town of Mwene Dim showed 25.8% wasting with 5.9% severe wasting (see Annex I (12a)). This represents a marked decline in nutritional status amongst this population since a survey conducted in March when wasting was measured at 13.9% with 2.7% severe wasting. It is not clear whether these high levels of wasting, which are similar to those found in Mwene Ditu shortly after the initial displacement from Shaba region in early 1993, reflect food price rises and hungry season shortages, or whether general ration supplies to this population have been reduced or stopped in recent months. As a consequence of these survey results, NGOs have requested the continuation of supplementary feeding programmes which were due to be phased out in August [MSF-B 27/06/95].
We have no new information on the displaced populations in Likasi, Mbuji Mayi or Kabinda (combined population of 158,000). These populations may however be at moderate risk (category IIb in Table 1) due to hungry season food shortages and in the event that the planned cessation of general ration programmes for populations, such as those in Likasi (March 1995), took place. The population of Mwene Ditu town can be considered to be at high risk (category I in table 1) with very high levels of wasting. The displaced/returnee population in the Kasai region are probably not currently at nutritional risk (category IIc in Table 1).
How can external agencies help? The high rates of wasting found in Mwene Ditu indicate an urgent need for a review of basic ration availability amongst this population. There is also a need for more current nutritional status information amongst displaced populations in urban centres such as Likasi and Kabinda.
(see Map 13)
There are presently 600,000 assisted people in Somalia many of whom are working on NGO and UN supported water, sanitation, health and agricultural programmes. Most recent reports suggest that the situation in Somalia is gradually deteriorating. Although there were optimistic reports as recently as May that the two main faction leaders were managing to co-operate and hence limit inter-ethnic rivalry amongst their respective supporters, there are now increasingly worrying signs throughout the country. Since the withdrawal of UNOSOM in March security incidents have slowly escalated in frequency and significance with the most recent of note being the destruction by fire of Bakaara market in Mogadishu. It is expected that this will seriously disrupt economic activity for many individuals in the capital city. Fighting has also been reported in Kismayo, where the influx of refugee returnees from northern Kenya has created additional burdens for the host population. The suspension of all non-emergency UN activities in Kismayo continues and security incidents have also been reported recently in Baidoa.
Although, harvest predictions were initially good for Somalia, recent floods and untimely rains may reduce production is some areas. A recent ICRC assessment mission to Bantu villages in the Jilib area of Lower Juba found widespread crop failure due to lack of rains as well as flooding. Also, the increasing levels of insecurity are said to be affecting the confidence of farmers, many of whom have been unsure of where to plant crops while others are showing reluctance to enter whole-heartedly into agricultural activity out of fear of a return to full-scale civil war [WV May 95].
There is a sense that food security may be declining most rapidly in urban areas as economic confidence dwindles due to the decrease in security and that rural areas are as yet not significantly affected. By mid-July prices of locally grown maize and sorghum were reported to have increased by 55% in Mogadishu. Recent nutritional surveys by one NGO in Mogadishu and Baidoa found extremely high levels of wasting (approximately 25% and 18% with 6% and 4% severe wasting respectively) (see Annex I (13a-b)). These results compare very unfavourably with a nutrition survey conducted in Mogadishu in November 1994 when levels of wasting were 11.1% and 12.5% among the resident and displaced population respectively. Most observers concur that nutritional conditions, particularly in larger towns, are beginning to deteriorate markedly and a number of NGOs now plan to open up several more feeding centres in Mogadishu. Other nutrition surveys in urban areas have recently been completed and although details of these surveys are not yet available indications are that wasting levels are high [AICF 25/07/95, DHA 15/07/95].
Overall, the 600,000 internally displaced people, which is the current planning figure for Somalia, are considered to be at moderate nutritional risk (category IIb in Table 1). However, the number of people in need of humanitarian aid may be far higher than that as indicated by the survey above, especially in urban areas.
How can external agencies help? Given the apparent deterioration in food security in many parts of the country, there is a need for close nutritional monitoring, particularly in urban areas, in order to determine the need for selective feeding programmes and possible emergency general ration provision.
(see Map 14 and Figure 3F)
F. Sudan - Trend in numbers of refugees/displaced and proportion severely malnourished and at high risk (black area). N.B. the change Dec 94 to Feb 95 is due to revised data.
The total number of refugees, displaced and war affected people in need of food assistance in the Sudan remains at 1.4 million. This number is comprised of 200,000 Ethiopian refugees, 720,000 displaced and war affected people in Southern Sudan, 94,927 displaced in the transitional zone (just north of Southern Sudan) and 240,000 displaced in four settlements in Khartoum and an additional contingency for 125,000 war-affected people in other areas. The actual number of Eritrean and Ethiopian refugees in Sudan is over 500,000 with the majority in 27 rural settlements and eight reception centres in eastern Sudan. Gradual repatriation is still taking place in spite of the break in diplomatic relations between the governments of Eritrea and Sudan. The total number of Sudanese in need of non-food assistance is estimated to be 4.25 million people [DHA 24/05/95].
Although there are reports of numerous violations, particularly in northern Bahr-el-Ghazl, the cease-fire declared in May 1994 in Southern Sudan appears to be holding while in other areas government and SPLA forces appear to have reached a “stale-mate”. This relative stability has created opportunities for improved access to the civilian population and increased deliveries of humanitarian assistance by river, rail and air. The number of locations accessible by air increased from 45 to 66 in January 1995. Although there are no new nutritional data on populations in the South, better relief programme access in combination with the excellent harvest last year appear to have safeguarded the nutritional situation of a large proportion of this population. However, as certain areas are not easily monitored by aid agencies and as the hungry season approaches it may be that some populations are beginning to experience nutritional stress [WFP 24-25/07/95].
By mid-June less than 15% of the inter-agency appeal for the Sudan, which was launched in January 1995, had been met. The lack of funds may lead to a scaling back of operations in the second half of 1995 although to date WFP has been able to adhere strictly to the policy of no delivery without assessment by international monitors and no distribution unless witnessed by international monitors [WFP 24-25/07/95].
Overall, the population accessible to humanitarian aid is probably not at heightened nutritional risk (category IIc in Table 1). However, there are large areas in Southern Sudan that are not accessible to humanitarian aid and nothing is known about the nutritional status of these people. Since it is now the hungry season, it is possible that these inaccessible populations are experiencing some food shortages.
How can external agencies help? Cash resources for WFP are urgently needed to ensure continued assessments and monitoring of food distributions in southern Sudan. In spite of the good 1994/95 harvest nutrition surveys in traditionally food insecure areas of the south should be conducted to identify whether pockets of nutritional stress are occurring during the present hungry season.
(see Map 15)
The total number of assisted Sudanese and Zairean refugees in Uganda has increased to 335,400. This is due to the continued slow but steady influx of Sudanese refugees from southern Sudan. Population estimates over time are summarised below.
|
Origin |
Jun 94 |
Aug 94 |
Oct 94 |
Dec 94 |
Feb 95 |
Apr 95 |
Jul 95 |
|
Sudanese Refugees |
206,000 |
230,000 |
268,000 |
274,000 |
300,000 |
310,000 |
322,000 |
|
Zairian Refugees |
15,000 |
16,000 |
16,000 |
16,000 |
313,000 |
13,000 |
13,400 |
|
TOTAL* |
221,000 |
246,000 |
284,000 |
290,000 |
313,000 |
323,000 |
335,400 |
The security situation in northern Uganda is described as fragile following the break in Ugandan-Sudanese diplomatic relations. Many refugees are being relocated to camps farther from the border, where it is hoped increased land availability and subsequent better prospects for farming will eventually lead to greater refugee self-sufficiency [IFRC 30/05/95, UNHCR 03/07/95].
Of the approximately 13,800 Zairean refugees in Uganda. 2,000 have requested support for repatriation. It is hoped that this first wave of repatriation will encourage other refugees to follow [UNHCR 03/07/95].
Overall, the Sudanese refugee population may be considered to be at moderate risk due to erratic general ration provision and in the case of the Koboko camps, poor water supplies (category IIb in Table 1). The Zairean and Rwandan refuges are not currently considered to be at heightened nutritional risk (category IIc in Table 1).
How can external agencies help? There continues to be a need to relocate refugees in order to de-congest reception and transit centres. The persistent water problems in the Koboko camps need to be addressed. Furthermore, nutrition surveys should also be implemented to determine whether the combination of poor general ration provision and water supply and over-crowding are having a significant impact on nutritional status.
(see Map 12)
There are approximately 200,000 Angolan refugees in Zaire. 41,000 of whom are currently assisted. It is hoped that with the current positive political situation in Angola that many of these refugees will repatriate spontaneously [UNHCR 14/06/95]. There are no reports of change for the almost 64,000 Sudanese and Ugandan refugees in Zaire.
There are approximately 96,000 Angolan refugees in Zambia. 10,000 of whom are currently assisted. It is hoped that with the current positive political situation in Angola that many of these refugees will repatriate spontaneously [UNHCR 146/06/95]. There are no reports of change to the reportedly adequate nutritional situation for the small number of Zairean refugees in Zambia.
