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 3 A)
The overall situation in Angola continues to improve. Although an estimated 1.4 million internally displaced people, returnees and/or war affected people still require emergency assistance it is reported that many of the displaced are now returning home for the planting season beginning in September. It was planned to distribute seeds and tools to over 700,000 farmers in preparation for planting [WFP 11/08/95-22/09/95].
A. Angola
Trend in numbers of displaced/war affected. Shaded areas indicate those at heightened nutritional risk.The much improved security situation is reducing dependence on expensive air transport of relief items, although banditry and landmines are still constraining expansion of relief programmes to some areas. At the end of August 1995 less than 30% of transport was by air because many roads which were closed, such as the one between Huambo and Menongue, now considered open. The demobilisation of soldiers is continuing [WFP 11/08/95- 02/10/95].
However, deterioration in land fertility due to over-use of safe farming areas in recent years, poor road infrastructure, land mines and occasional security incidents are still major constraints to agricultural production. As a result, the international community recognises the need to give urgent priority to rebuilding the devastated agricultural infrastructure and support services. NGO-managed food-for-work projects involving some 20,000 people are being implemented to re-build schools, health posts, latrines and irrigation canals and to re-open farmland and access roads [WFP 11/08/95-22/09/95, FAO Jul 95].
There is very little recent nutritional information available. One survey conducted in Caconda in Huila Province in August found 14.7% levels of wasting with 2.7% severe wasting (see Annex I (la)). Unfortunately, proposals for emergency feeding arising from this survey cannot be implemented due to the poor security situation in the area [WFP 25/08/95].
There are anecdotal reports of very high levels of wasting among the displaced populations surrounding cities, especially along the coast (i.e. Lobota, Benguera) [ICRC 10/10/95].
Overall, most of the 1.4 million Angolans currently receiving emergency assistance can be considered to be at moderate nutritional risk due to their dependence on food aid, although food security will most likely improve following the next harvest. However, significant levels of wasting may still exist in certain inaccessible parts of the country, particularly where insecurity is a factor, but accurate numbers of people affected are not available.
How can external agencies help? Continued support for the recovery of agricultural production is needed. As new areas become accessible, nutritional surveys would be very useful to facilitate situation analysis, assessment of needs, and targeting services to improve nutrition.
Violence in Togo in January 1993 led to the displacement of over 300,000 people into neighbouring Benin and Ghana. There are currently 157,000 refugees remaining in the two countries of asylum. Now that the political situation in Togo has stabilised, plans for an organised repatriation are being made.
Benin Approximately 5,000 Togolese refugees have already spontaneously repatriated to Togo leaving 45,000 refugees in the country. Organised repatriation is planned for the remainder in the near future [UNHCR 26/09/95, WFP 12/10/95]. There are no reports of any change in the adequate nutritional status of this refugee population.
Ghana It is hoped that a successful start to the spontaneous repatriation of Togolese refugees from Benin will encourage the approximately 98,000 refugees in Ghana to return home [UNHCR 28/09/95]. Their nutritional situation is not thought to be critical.
The adequate nutritional situation of the 14,000 assisted Liberian refugees has not seemingly changed since the last RNIS report. These refugees continue to adopt a "wait and see" attitude towards possible repatriation now that the situation in Liberia appears to be stabilising [UNHCR 28/09/95].
Overall, the approximately 157,000 refugees in this area are probably not at heightened nutritional risk (category IIc in Table 1).
(see Map 3)
There are approximately 74,000 assisted Touareg refugees in Burkina Faso and Mauritania. These refugees have fled ethnic violence in Mali.
Burkina Faso There are no reports of any change in the generally adequate nutritional situation of the 33,000 Touareg refugees from Mali and Niger in Burkina Faso. Many of this population arrived after a second wave of displacement in June/July 1994 [WFP 12/10/95].
Mauritania There are approximately 41,000 assisted Touareg refugees from Mali in Mauritania. These refugees began arriving in southeast Mauritania at the end of 1991. There have been no further nutritional surveys on this population since the last RNIS report which described levels of 17.1 % wasting with a crude mortality rate of 6 times normal. These high rates were largely attributed to a poor general ration supply and high rates of diarrhoea. However, since then there has been an improved general ration distribution of millet, oil and pulses in August providing 1900 kcals/person/day to camp populations [MSF-F 11/09/95].
Overall, the refugees in Burkina Faso are not currently considered to be at heightened nutritional risk (category lie in Table 1) while those in Mauritania could be considered to be at high risk (category IIa in Table 1).
(See Map 4 and Figure 3B)
With the exception of some camps around Uvira, in Zaire the nutritional status of most refugees, returnees and internally displaced people in the region is reported to generally remain adequate, in spite of persistent 20-30% short-falls in general ration allocations in the Zairian and Tanzanian refugee camps. The recent forced repatriation of Burundi and Rwandan refugees from Zaire has increased tensions. Re-registration in the Tanzanian camps has adversely affected relations between refugees, government and aid agencies. Voluntary repatriation is being encouraged although many refugees are reluctant to return home. Insecurity in parts of Burundi has rendered certain populations inaccessible while rebel incursions along the Zairian/Rwandan border are routinely reported. However, increasing numbers of people are returning to their land in Burundi while in Rwanda the process of rebuilding the damaged infrastructure is said to be progressing well.
B. Burundi/Rwanda Region
Trend in numbers of refugees/displaced and proportion severely malnourished or at high nutritional risk (black area).
Current estimates of affected populations by country of present residence are given in the box below:
|
|
Aug 94 |
Oct 94 |
Dec 94 |
Feb 95 |
Apr 95 |
Jul 95 |
Oct 95 |
|
Burundi |
1,230,000 |
770,000 |
1,200,000 |
740,000 |
492,500 |
515,000 |
315,000 |
|
Rwanda |
2,040,000 |
2,500,000 |
2,500,000 |
335,000 |
1,750,000 |
800,000 |
725,000 |
|
Tanzania |
353,000 |
556,000 |
556,000 |
630,000 |
686,000 |
644,000 |
629,000 |
|
Zaire |
1,500,000 |
1,240,000 |
1,240,000 |
1,290,000 |
1,130,900 |
1,202,200 |
1,158,000 |
|
Uganda |
10,000 |
10,000 |
10,000 |
5,000 |
5,000 |
6,700 |
6,400 |
|
TOTAL |
5,133,000 |
5,076,000 |
5,076,000 |
3,000,000 |
4,064,400 |
3,167,900 |
2,831,400 |
As a result of the sporadic need for supplementary food arising from periodic escalations in violence, a system for rapid provision of aid (normally a seven day ration) has been instituted in Burundi. This system has already benefited over 120,000 individuals. Insecurity is however, still preventing aid agency access in some areas, e.g. Cibitoke, with problems compounded by lack of implementing partners in the region and reluctance by private transporters to move food into unsafe areas.
There are approximately 215,000 Rwandan refugees remaining in Burundi. In line with other Rwandan refugees in the region, recent repatriations have been very small-scale with less than 200 people having returned to Rwanda in recent months [WFP 22/09/95].
There are no new nutritional surveys available from Burundi, but given the volatile security situation, it is likely that pockets of acute malnutrition exist among some inaccessible populations. Cases of cholera have been reported in several provinces particularly in areas where water has been in short supply. Due to problems of access it is reportedly proving difficult to control these outbreaks [WHO 11/09/95,15/09/95].
Rwanda The population of Rwanda is presently estimated at 5,885,000, of which 5,450,000 are rural and dependent on agricultural production. There are no longer any camps for displaced people; these were closed in May 1995. It is thought that vulnerable families who are mostly recent returnees or internally displaced account for 15% of this population (725,000). Almost 30% of households in Rwanda are female-headed. Food distributions to recent returnees and formerly internally displaced people are continuing but problems with distribution lists often delay allocations. These targeted distributions are taking place to large populations in Butare, Kigali, Giterama, Gisenyi and Gikongoro [WFP 15/09/95].
During the course of 1995 a total of 186,000 refugees have returned to Rwanda. A system of way stations and agricultural support schemes is in operation for most returnee households. The low level of repatriation has proven very disappointing to the international aid community and is believed to reflect lack of confidence amongst Rwandans in the authorities' ability to guarantee their safety upon return [WFP 18/08/95, 11/09/95, 22/09/95].
The Zairian/Rwandan border is still officially closed, although the movement of aid workers and convoys with returnees is still allowed. Poor road conditions have hampered food distributions in some parts of Rwanda but food for work projects are said to be rapidly restoring damaged infrastructure [WFP 25/08/95, 01/09/95].
The recent harvest in Rwanda, although an improvement over previous years, is still 40% below a good year's average so that large amounts of food aid are projected to be necessary in the coming year [FAO 18/07/95].
There have only been a small number of recent nutritional surveys. A national nutritional survey in May 1995 found 9.7% wasting (see Annex I (4a)) while another survey during May in three communes of one prefecture (unspecified) found only 2.9% wasting (see Annex I (4b)). A more recent survey in Butare prefecture found sufficiently high levels of wasting to justify the establishment of five nutritional centres on a short term basis [UNICEF 06/09/95, WFP 11/09/95].
The targeted food distributions and increasing numbers of food for work schemes suggest that most households in Rwanda are not currently at heightened nutritional risk. An exception may be in the Northeast where there are many returnees without land and where large numbers of cattle and a lack of water have raised fears of potentially serious problems [WFP 01/09/95].
Tanzania A re-registration exercise in the camps has been completed and has led to a reduction in the number of beneficiaries to 629,000. Prior to the registration in the Karagwe camps, an estimated 6,000 refugees moved from the Ngara camps into the Karagwe camps in the hope of obtaining extra ration cards. Repatriation to Rwanda is still continuing at a very slow pace with many refugees considering that it is unsafe to return. A number of security problems have been reported around the camps and appear connected with un-registered refugees and bandit attacks on agency vehicles.
A recent survey from Musuhura Hill Camp in July (estimated population 84,000) in Ngara district found 6.4% levels of wasting with 3.1 % severe wasting (see Annex 1 4(c)). Disaggregated results for two refugee communes of origin (Birenga and Nyarugenge) within the camp found higher levels of wasting (11.4% and 13.6% respectively). These results are not different from those obtained in April 1995. Possible explanations put forward for these persistent levels of wasting were inadequacy of the general food distribution (general food distributions have only provided an average per capita ration of 1600 kcals in recent months), poor sanitation until recently, fewer food items on the market due to the dry season and consequent higher prices. The higher levels of wasting found amongst refugees from Birenga commune are thought to probably reflect the fact that this population was recently transferred from Benaco camp where it was one of the poorest communes. The coverage of the therapeutic feeding programme in the camp is estimated as 24% of the severely malnourished while measles immunisation coverage is very high at 93% [MSF-H 22/07/95].
Goma, Zaire A combination of forced repatriation of some 6,000 refugees, voluntary repatriation and re-registration has led to a decrease in the refugee population to 708,000. Efforts to promote voluntary repatriation have largely been unsuccessful. Tension between the Zairian military contingent and the refugees mounted throughout August and a number of security incidents, mainly connected with forced repatriation, led to the evacuation of large numbers of relief staff who have subsequently returned. Tensions in Mugunga and Lac Vert camp led to temporary suspension of food distributions.
Food rations distributed throughout August and September have varied between 1500-1700 kcals/person/day.
The Zairian government announced its intention to start taxing commercial activity in refugee camps in August and by mid-September had announced a halt to all commercial activities by the refugees - a move which is expected to increase refugees dependence on food aid. The strategy of making the camps less attractive to refugees, including maintaining a curfew, is becoming clearer [WFP 11/08/95-02/10/95].
In Katale camp in July the crude mortality rate was 0.11/10,000/day and the under-five mortality rate was 0.26/10,000/day [MSF-H 14/09/95]. Both of these are below normally expected levels. Apart from these results, there have been no new surveys since the last RNIS report which showed a generally satisfactory nutritional situation in spite of low general ration deliveries in preceding months. However, the advent of the hungry season and potential effects of new legislation on refugee economic activity may well adversely affect refugee nutritional status in the coming months [WFP 22/09/95].
Bukavu, Zaire After the forced repatriation of some refugees from Bukavu, the situation in the town and camps remains tense. Tensions are also present between refugees and the local population. The number of refugees is currently estimated at 310,000 although the movement of refugees from one camp to another is making it difficult to be accurate about numbers. The voluntary repatriation programme is having only limited success as rumours of unfair imprisonment and clandestine massacres within Rwanda are spread by the Interhamwe in the camps. As in the Goma camps, only partial general rations (approximately 1500 kcals/person/day) have been delivered to camp populations in recent weeks. Furthermore, prevention of WFP trucks crossing the Burundi/Zaire border has led to low cereal stocks in Bukavu [WFP 18/08/95, 15/09/95].
Results from surveys conducted in the Bukavu camps in mid-July showed low levels of wasting ranging between 1.5%-4.8% with severe wasting varying from 0-1.6%. However, oedema, measured separately, was found in 2-4% of children (see Annex I 4(d-g)) [UNHCR 02/08/95].
Uvira, Zaire The recent attempted forced repatriation of large numbers of refugees caused most of the refugee population in Uvira to flee the camps temporarily and move to the hills. Camp food stores were looted during this exodus. Most of these refugees have now returned to the camps where a planning figure of 140,000 refugees (approximately 75,000 Burundis and 63,000 Rwandans) is still being used for food deliveries (the actual population in the camps is probably lower). Very few refugees are returning to Burundi while periodic influxes into Uvira continue as a result of security incidents in Burundi.
Food distributions are providing between 1700-1800 kcals/person/day and the nutritional situation appears to vary quite widely between camps. The Burundian military has ordered a halt to all deliveries of food aid by road from Burundi across the border to Uvira so that deliveries are now mainly by barge. There is concern that stocks of beans and oil may soon be exhausted [UNHCR 30/07/95].
Data at the end of July showed an increase in numbers admitted to feeding centres with many more cases of severe wasting. Under-five mortality rates had increased to over 2.5/10,000/day (2x normal) and in some camps was as high as 5/10,000/day (5x normal) [UNHCR 30/07/95].
Preliminary results from surveys conducted in the second half of August in three camps show worrying levels of wasting. In Runingo camp, the prevalence of wasting was measured at 21.6% with 12.3% severe wasting. In Kajembo camp wasting was 11.8% with 6.6% severe wasting and in Luberizi camp wasting was measured at 10.7% with 3.8% severe wasting and measles immunisation coverage was 61.1% (see Annex 14(h-k)) [UNHCR 30/08/95]. These levels of wasting are higher than those found in any previous survey since July 1994 (in April 1995 overall levels of wasting were only 3.8%) and may reflect a combination of factors including lack of access to general rations due to the departure from the camps following the forced repatriation attempts, the existence of cholera and dysentery, and the current hungry season [UNHCR 30/07/95].
Preliminary results from Kagunga camp indicated 6.1% levels of wasting and 2% severe wasting (see Annex I 4(h)). Measles immunisation coverage in this camp was 47.8% [UNHCR 30/08/95].
Coverage by therapeutic feeding programmes of the severely malnourished is extremely variable in the above camps, estimated as ranging from 24% to 80% in Kajebo and Runingo respectively [UNHCR 30/08/95].
Survey results in August from five other camps were better with wasting prevelances varying from 1.4-9.1 % and severe wasting ranging from 0-2.2% (see Annex 14 (1-p)). Measles immunisation coverage in the camps was low and ranged from 37%-62.5% [UNHCR 30/08/95].
Cholera has been reported in many camps throughout June, July and August with case fatality rates ranging from 1-22% (A case fatality rate for cholera of 1-2% is considered to be usual). Under five mortality rates for all camps in July were over 2.5/10,000/day (about twice the usual level) and appeared to be rising [UNHCR 29/07/95].
Uganda There are currently 6,400 Rwandan refugees in Uganda. This is a slight decrease from the time of the last RNIS report and is due to spontaneous repatriation of some of the refugees [UNHCR 18/09/95].
Overall, the internally displaced population in Burundi can be considered to be at high nutritional risk due to cholera (category IIa in Table 1) while no details on the nutritional status of the Rwandan refugees in Burundi are currently available (category III in Table 1). The vulnerable population in Rwanda and the refugee population in Tanzania are probably not currently at heightened nutritional risk (category lie in Table 1). The refugees in Goma and Bukavu, Zaire can be considered to be at moderate nutritional risk (category IIb in Table 1) and the refugees in Uvira at high risk (category I in Table 1) due to low measles immunisation coverage and, in some cases, elevated levels of wasting.
How could external agencies help?
· The main problem in Burundi is insecurity and resulting lack of access to vulnerable populations. However, when a reduction in insecurity allows, newly accessible areas should be rapidly surveyed for nutritional and health status and associated risk factors such as water availability.· In Rwanda continued support for infrastructure repair work is needed while there should be close monitoring of nutrition in the north east of the country.
· Continued efforts are needed to improve the amounts of general ration supplied to refugee camps in Tanzania and Zaire. Furthermore, sanitation conditions in Tanzanian camps need to be improved along with coverage of selective feeding programmes in the camp, particularly for vulnerable communes, through promoting active case finding of malnourished children. In Zairian refugee camps there is an increased need for careful monitoring of nutritional status as the effects of the government ban on economic activity are felt. In the Uvira camps where surveys show serious malnutrition there is a need to urgently improve: the surveillance and treatment of cholera; coverage of selective feeding programmes and measles immunisation; and access to general food distribution.
Most recent estimates are that there arc 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 refugees 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 are no reports of change to the somewhat variable nutritional situation for these refugees since the last RNIS report. At that time, the nutrition situation for the Sudanese refugees was generally satisfactory, with the exception of one camp. Levels of wasting for the Somali refugees were elevated, but appeared to be decreasing.
How could external agencies help? There are currently no confirmed pledges for this refugee programme, and interruptions in distributions after October are expected unless commitments from donors are received.
(see Map 8)
The total number of assisted refugees in Kenya has remained stable at 197,500 despite the continuing repatriation of Somali and Ethiopian refugees. This is largely due to the registration of children recently born in the Dadaab camps. Current estimates are that there are 158,000 Somali refugees, 33,000 Sudanese refugees and 6,000 Ethiopian refugees in Kenya.
There have been tensions over the governments plan to close Marafa camp (a coastal camp). The option given to refugees of repatriation or transfer to one of the Dadaab camps was not initially well received. Meanwhile voluntary repatriation has continued from the Dadaab camps with refugees returning to middle and lower Juba.
A recent round of surveys in August in the Dadaab area, where approximately 113,000 Somali, Sudanese and Ethiopian refugees are located, found that nutritional status appears to be deteriorating. These surveys were conducted as a follow up to surveys conducted in March 1995 (see RNIS #10) and were set against a background of a planned ration reduction in July 1995 from 2,100 kcals/person/day to 1,800 kcals. There was a recent update of ration cards as well which had led to a cancellation of many cards amongst the refugee population [MSF-B Aug 95, UNHCR 31/07/95].
In Hagadera camp (estimated population 41,000) wasting was measured at 12.1 % with 2.4 % severe wasting (see Annex 1 (8a)). This is an increase over a survey conducted almost a year ago when wasting was recorded at 5.3%. The survey team has suggested that the increase may be attributable to high rates of diarrhoea in the preceding two months and also to cancellation of ration cards. Measles immunisation coverage was 87.7% while coverage of the supplementary and therapeutic feeding programmes was only 37% and 22% respectively [MSF-B Aug 95].
In Ifo camp (population estimates vary from 44,000 to 37,000), wasting was measured at 12.1% with 4% severe wasting (see Annex 1 (8 (b)). A comparison with a recent survey shows a slight improvement in the overall nutritional status of the population (from 15.1 % in March 1995) but the level of severe wasting has increased and more children are presenting with oedema. It is possible that the reduced ration and removal of excess ration cards have contributed to the increase in malnutrition. A supplementary feeding programme was started in July 1995 but coverage remains low at 20%. Measles immunisation coverage was 74.2% [MSF-B Aug 95].
The level of wasting measured in Dagahaley (estimated population 34,000) was 9.8% with 1.5% severe wasting (see annex 1 (8 (c)). The overall level of wasting has increased from 6.5% in a March 1995 survey, but the level of severe wasting has decreased to 1.3%. This reduction in wasting may be due to therapeutic feeding centres and a supplementary feeding programme started in July. Based on estimates of numbers of malnourished children in the camp, coverage of feeding programmes is still low at 40%. Measles immunisation coverage was reportedly 89.9% [MSF-B Aug 95].
The overall nutrition situation in the coastal camps (estimated population 48,000) is described as adequate with food distributions proceeding smoothly. A policy has now come into effect whereby if cereal arrives in the form of grain, refugees are given 100 extra grams per person per day in order to compensate for milling losses. The water supply is also generally described as adequate, except in Jomuva camp where only 6.7 litres/person/day of water were available [IFRC 27/07/95].
Blended foods are being distributed to all refugees at 50 grams/person/day in an effort to prevent micronutrient deficiencies, in particular scurvy. This began in July 1995 and will continue for three to four months. The nutritional status of the population will be closely monitored and recommendations will be made on appropriate action to be taken regarding the general distribution (i.e duration of distribution, quantity of blended food distributed) of blended foods [WFP 12/10/95].
Overall, the situation in the Dadaab camps appears to be under control, although gradually increasing levels of wasting are cause for concern and require careful monitoring (category IIb in Table 1). The remaining 84,500 refugees are probably not at heightened risk (category IIc in Table 1) although the seasonal scurvy risk which appears to affect all refugees residing in Kenya, should be noted and guarded against.
How could external agencies help? There appears to be a need to increase the general ration level in the Dadaab camps where levels of wasting have gradually been increasing since rations were cut to 1800 kcals/person/day. There is also a need to improve the coverage of selective feeding programmes, through active case finding, and measles immunisation coverage in a number of camps. Water provision in Jomuva camp needs to be improved urgently.
(see Map 9 and Figure 3C)
C. Liberia
Trend in numbers of refugees/displaced and proportion severely malnourished and at high risk (black area).The signing of the peace accord in Liberia by all warring factions and the subsequent instalment of a Council of State is giving grounds for optimism that the present cease fire will hold and provide an opportunity for this war-ravaged country to rebuild itself. However, Liberian refugees in neighbouring Cote d'Ivoire and Guinea seem to be waiting to see how the disarmament process in Liberia progresses before repatriating. In contrast, the situation in Sierra Leone appears to be spiralling out of control as populations made inaccessible by fighting endure increasing hardship without outside relief assistance. This total population number is broken down by country as follows:
|
Location |
Aug 94 |
Oct 94 |
Dec 94 |
Feb 95 |
Apr 95 |
Jul 95 |
Oct 95 |
|
Liberia |
1,750,000 |
1,692,000 |
1,615,000 |
1,800,000 |
1,900,000 |
1,900,000 |
1,900,000 |
|
Sierra Leone |
300,000 |
300,000 |
506,000 |
506,000 |
500,000 |
730,000 |
730,000 |
|
Cote d'Ivoire |
250,000 |
325,000 |
330,000 |
330,000 |
330,000 |
227,000 |
305,000 |
|
Guinea |
539,000 |
534,000 |
534,000 |
568,000 |
603,000 |
578,000 |
536,000 |
|
TOTAL |
2,839,000 |
2,851,000 |
2,985,000 |
3,204,000 |
3,333,000 |
3 435 000 |
3,471,000 |
With the opening up of new areas has come the discovery of extremely high rates of wasting amongst certain population groups. For example, a survey conducted in July in Lower Bong and Upper Margibi counties found a critical nutritional situation with 56.2% malnutrition (37.1 % with oedema and 19.1 % wasted) (see Annex I 9(a)). As is typical of Liberia, most of the severe malnutrition manifested itself as kwashiorkor; however 37% kwashiorkor does indeed represent a very serious emergency, as it was described by Save the Children Fund. Furthermore, the survey showed that children in the 5-10 year age group were as malnourished as those under five. There are also anecdotal reports of a critical food situation in the Upper Porpka district of Cape Mount/Bomi counties [SCF 31/07/95, WFP 11/09/95].
Sierra Leone The security situation in Sierra Leone remains tense with frequent reports of both government and rebel military action. There are currently an estimated 730,000 internally displaced people in Sierra Leone. While security in the Western and Northern parts of the country remains relatively stable, sporadic rebel attacks on both convoys and small civilian settlements continues in the east and south of Sierra Leone. Consequently, populations confined to towns or behind RUF lines are in an increasingly precarious situation as relief agencies risk attack in their efforts to bring assistance. Furthermore, private contractors are reluctant to transport relief to certain areas such as Kenema. This lack of access to civilian populations is reportedly leading to extremely high levels of wasting and there are unconfirmed reports of hunger-related deaths.
A recent survey conducted in Kenema in early August measured wasting both in the town and in the displaced camp. In the town (estimated population 100,000) wasting was recorded at 22.6% with 7.7% severe wasting (see Annex I 9(b)). The crude mortality rate was 2.4/10,000/day (8x normal) and the under five mortality rate was 5.6/10,000/day (almost 5x normal). Measles immunisation coverage was 69% [MSF-H 08/08/95].
In the camps for displaced people around Kenema (estimated population 26,000) wasting was measured at 37% with 11.5% severe wasting (Annex I 9(c)). The crude mortality rate was 5.2/10,000/day (17x normal) and the under-five mortality rate was measured at 19/10,000/day (16x normal). Measles immunisation coverage was 72% [MSF-H 08/08/95].
These high levels of wasting can largely be attributed to lack of food as the most recent relief food distribution was in May 1995. Furthermore, food distributions in May and previous months were only half rations. Food is reportedly available in markets but prices are very high so that many people are surviving on wild fruit, leaves and bush yam [IFRC 15/09/95].
Since the survey mortality has been reported to have increased due to a cholera outbreak. The condition is particularly prevalent in the IDP camp. Due to lack of drugs, medical material and limited in-patient facilities, the case fatality from cholera is believed to be high [IFRC 15/09/95].
A survey in August 1995 in Bo (population 250,000) found an overall prevalence of wasting of 22%. There was no significant difference in prevalence of wasting between residents and the displaced population. This population has been without a general ration for several months [MSF-B 10/10/95]
As only limited food has been delivered to Daru, Segbwema, Magburuka or Makeni (collective internally displaced population of over 250,000) due to insecurity, it can be assumed that the nutritional status of these populations is similar to that of internally displaced people in Kenema [IFRC 15/09/95].
Cote d'Ivoire There are currently approximately 305,000 Liberian refugees in Cote d'Ivoire and while political improvements in Liberia have not led to any large scale repatriation, it is reported that some spontaneous return is occurring.
There is a two tier ration for this refugee population whereby the "old" refugee population who have been in Cote d'Ivoire sufficiently long to attain marked self-sufficiency receive a ration of 960 kcals/person/day while newer arrivals, who are not believed to be greatly self-sufficient, receive a ration of 1,300 kcals/person/day [MSF-F 11/09/95]. An attack by Liberian rebels in June on villages in the West of the country has seriously disrupted the formerly excellent relations between refugees and local population. As a result one refugee camp had to be moved for reasons of security [IFRC 4/07/95].
A nutritional survey was recently carried out in Tabou Prefecture, where approximately 160,000 people (105,000 Liberian refugees and 55,000 local residents) live. Among the refugee population, wasting was measured at 8% with 2% severe wasting, and oedema, which was measured separately, was 2.2%. Anaemia was reported in 4% of the children and Bitot's spots (an early sign of vitamin A deficiency) was found in 0.2% of children. For comparison, wasting among the local population was recorded at 8.8% with 2.4% severe wasting. Oedema was measured separately at 10.2%. Anaemia was seen in 12.5% of children, and Bitot's spot's were seen in 1% of children [CARITAS Jul 95]. The nutritional status was thus similar for the refugee and local populations.
Guinea Estimates of the number of Liberian and Sierra Leonean refugees in Guinea vary from approximately 536,000-578000 people. The continued civil war in Sierra Leone does not appear to have led to any recent large scale refugee movements into Guinea.
There are approximately 20,000 Sierra Leonean refugees in Forecariah Prefecture in Guinea who currently receive approximately 1300 kcals/person/day. A recent survey among this population measured 8.2% wasting with 0.7% severe wasting. Measles immunisation coverage was only 49% but as this was based on evidence of vaccination card holders it is probably an under-estimate [OXFAM 26/09/95].
Overall, the population in Liberia that has been accessible for some time is probably not at heightened nutritional risk (category He in Table 1) while the inaccessible or periodically accessible populations (e.g. Lower Margibi) are at high nutritional risk (category IIa in Table 1). The population in Bo and Kenema, Sierra Leone are known to be at high nutritional risk (category I in Table 1) and the remaining population is likely to be at high nutritional risk (category IIa in Table 1). In Cote d'Ivoire, the refugees in Tabou Prefecture are at high risk due to micronutrient deficiencies, while the remaining affected population is not known to be at heightened nutritional risk (category IIc in Table 1). Most of the refugee population in Guinea is not currently considered to be at heightened nutritional risk (category He in Table 1) with the exception of those in Forecariah Prefecture who are probably at moderate nutritional risk (category IIb in Table 1).
How could external agencies help? Further nutritional surveys in newly accessible areas in Liberia and subsequent support for large scale curative selective feeding programmes for all age groups where appropriate is urgently needed. This may involve re-opening abandoned and run-down health centres. In Sierra Leone, efforts must continue to improve food supplies to insecure areas in the south and east of the country while nutrition surveys should be conducted when and as security allows. There is also an urgent need to establish cholera surveillance in many of these areas as well as drug supplies and in patient facilities for treatment of the condition. In Tabou prefecture in Cote d'Ivoire there is a need for general ration support to counter the increase in levels of wasting while prophylaxis and treatment for vitamin A deficiency needs to be implemented through health centres. There is also a need for increased measles vaccination coverage in Forecariah prefecture in Guinea.
(see Map 3)
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 3D)
The number of returnees, demobilised soldiers and drought affected people requiring food aid in August in Mozambique was recently estimated at 600,000. This is an increase of 240,000 people since July due to household food stocks being used up. It is anticipated that this number will continue to increase up until the end of the marketing year. Official repatriation is complete, and the focus is now on reintegration programmes in Mozambique [UNHCR 11/10/95].
D. Mozambique
Trend in numbers of returnees and demobilised soldiers.Harvests in the northern and central provinces of Mozambique have been far better than in the southern provinces where maize prices have already begun to increase. However, the overall food security situation in the country continues to be stable in most areas. There are exceptions in certain districts of Tete, Manica and Gaza provinces in the central and southern regions of Mozambique. These districts have low food reserves as a result of poor agricultural production (up to 70% of households have no reserves in some districts). As this is the post-harvest period, such levels are cause for concern. These findings are corroborated by information and indicators on growth faltering, number of meals eaten, and dependence on famine foods which point to a worsening problem. It is feared that due to the bad harvest in some of these areas many people will not be able to save seed for the next planting season [MSF-CIS Aug 95].
Nutritional surveys generally show very low levels of wasting. A July survey in the province of Nampula found 4.0% wasting with 0.3% severe wasting and another survey found 4.3% wasting and 1.6% severe wasting. In August a subsequent survey in the province found only 1.9% wasting with 0.5% severe wasting (see Annex I 11(a-c)) [MSF-CIS 08/95]. A large number of measles cases were reported in Nampula indicating that immunisation coverage is not adequate. A large number of kwashiorkor cases has been seen among admissions to feeding centres in the province which may well be related to the incidence of measles [MSF CIS Jun 95, WV Jun 95, MSF-CIS Aug 95].
A survey in July in the drought affected district of Magoe in Tete province found 5% wasting with 2.1% severe wasting (see Annex 111 (d)). A critical lack of drinking water in the province was noted in this survey. Two nutritional surveys in July in Chibabave province and in Zambezia province found 3.3% levels of wasting (see Annex 11 l(e-f)) [MSF CIS 08/95. MSF-CIS Jun 95].
Food aid distributions have generally been adequate but there continue to be problems in reaching certain remote areas or where insecurity exists. Additional funds are being sought to strengthen food distributions to affected population, including returnees.
Overall, these surveys appear to confirm that while food security varies within Mozambique, the nutritional status of populations surveyed is normal for the region.
How could external agencies help? Measles immunisation needs to be stepped up in certain provinces such as Nampula. There is a need to improve mechanisms for distribution of food aid to remote areas receiving refugee returnees. This might involve further decentralisation of food distribution systems. Drought affected areas such as Tete province also need resources and agency support to improve water availability.
(see Map 12)
There are approximately 600,000 people who have been displaced by ethnic violence in the Shaba region in 1992. This population fled the area 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.
There are no reports of change to the nutritional situation of the population. In the last RNIS report, the displaced population in Mwene Ditu was considered to be at high nutritional risk due to elevated levels of wasting, and the displaced populations in Likasi, Mbuji Mayi or Kabinda (combined population of 158,000) were thought to be at moderate risk.
(see Map 13 and Figure 3E)
The capture of the town of Baidoa on September 17th by general Aideed's militia is only one example of the uncertain security situation in Somalia. Tensions are mounting in neighbouring Bakool and Gedo regions because of fears of possible further incursions by Aideed's forces. The previous RNIS report indicated that security incidents were having a significant impact on livelihood and almost certainly adversely affecting nutritional status. Due to weather patterns and access to farm inputs, the Gu harvest (August-September) varied from village to village in Lower and Middle Juba. It would appear that many people are now at significant nutritional risk, particularly those living in large towns [ICRC 10/10/95, WFP 25/08/95].
E. Somalia
Trend in numbers of internally displaced.The last RNIS report included preliminary information on a survey conducted in Mogadishu in June. The details of this survey are now available and are as follows. Wasting rates were equivalently high amongst both residents (1.5 million) and the displaced (129,000) and were 25.1% with 6.4% severe wasting and 26.3% with 5.4% severe wasting respectively. One significant difference between the two population groups was that the displaced were more likely to be jobless than residents and so more dependant on food aid distributions. Compared with a survey conducted in November 1994 when levels of wasting were recorded at 10.1%, these results show a serious deterioration in the nutritional status of this population [AICF 20/06/95].
The survey showed that one in three children had suffered from diarrhoea recently and that poor water supplies in the city were partly responsible. Measles immunisation rates were 54.3% [AICF 20/06/95].
Many factors have been identified to explain the rise in levels of wasting. These include the fact that this survey took place just before the harvest at a traditionally food scarce time. The withdrawal of UNOSOM and international agencies is also said to have played a role in that paid employment for thousands of individuals ceased. Another factor is the reduction in port activity following UNOSOM withdrawal and diminished agricultural trading in and around Mogadishu as clans control different sectors of the city and security is uncertain. The nutritional survey also shows that levels of wasting are highest in those city districts which are most politically and geographically isolated from Mogadishu centre. The high levels of diarrhoeal disease must also be playing a role, especially, as a prevalent Somali practice is to withhold food from those with diarrhoea [AICF 20/06/95].
The findings of this survey have led NGOs to open up more selective feeding programmes for vulnerable groups in Mogadishu, and appropriate foods have been airlifted in [WFP 05/08/95].
A nutritional survey in Kismayo town in July showed similar problems to those existing in Mogadishu although levels of wasting were not as high. Problems unique to Kismayo were also shown to exist. In the town (estimated population 97,000) wasting levels were recorded at 17.8% with 2.7% severe wasting and measles immunisation coverage was estimated to be 97.8%. In the camps for the displaced around Kismayo (estimated population 9,000) levels of wasting were found to be 11.6% with 1.8% severe wasting. Measles immunisation coverage was 64%. The lower levels of wasting in the camps were attributed to the better coverage of selective feeding programmes [UNICEF 19/07/95]. These levels of wasting show no significant change to results recorded since January 1994.
Numerous factors are believed to be playing a role in these high rates of wasting in Kismayo. These include the fact that, 15% of the town population have arrived from refugee camps in Kenya within the last six months, the departure of UNOSOM in December has left a lot of people without income, and after WFP left in April the community is completely dependant on market food which is increasingly expensive due to the poor harvest in the Juba valley, In Kismayo, the rainy season was long and illnesses seen as a result (i.e. diarrhoea and pneumonia) are also thought to be adversely affecting the nutritional status of this population [ICRC 10/10/95, UNICEF 19/07/95].
Overall, the displaced populations in Mogadishu and Kismayo can be considered to be at high risk with elevated levels of wasting (category I in Table 1). The remaining displaced population can be considered to be at moderate risk (category IIb in Table 1) due to the generally deteriorating security situation.
How can external agencies help? Nutritional surveys are needed in other large urban centres (e.g. Baidoa, Belet Weyn, etc.). These could usefully include additional information on food security, health and other factors affecting nutrition so that interventions will be based on fuller information. The improvement of water supplies and measles immunisation coverage should be given priority in Mogadishu and Kismayo. Selective feeding programmes may need to be set up and/or expanded in Mogadishu and Kismayo and active case finding may be needed to increase coverage of these programmes. It is likely that targeted food aid in some villages in Lower and Middle Juba is needed.
(see Map 14 and Figure 3F)
The situation in southern Sudan appears to be gradually deteriorating following a year when excellent harvests and improved relief access had created relatively stable food security for most of the population. This is due to a combination of constraints on OLS, poor rains in June and July leading to reduced planting, and increased levels of insecurity. There are also emerging concerns about the nutritional and health well-being of the displaced population in settlements around Khartoum.
F: Sudan
The estimated 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 and Eritrean 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 settled in various cities and towns. 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 people in Sudan in need of non-food assistance is estimated to be 4.25 million (not included in Tables 1 and 2) [DHA 24/05/95].
Since May, Operation Lifeline Sudan (OLS) has faced increasing restrictions with flights banned to certain destinations, and restrictions on aid agency activity. This has been especially critical during the rainy season. There have also been increased levels of insecurity in certain areas despite the informal extension of the cease-fire which was scheduled to end in July 1995. Security in Bahr-el-Ghazl has been particularly problematic with NGOs complaining of harassment by local authorities and militias. Conflict related displacement has been reported in the towns of Yei and Thiek Thou [WFP 22/09/95, USAID 31/07/95].
A new system of targeting food relief in the South has been implemented for over a year and involves a more comprehensive assessment of need including coping strategies. This approach involves the setting up of relief committees, the majority of members being women, who are responsible for setting eligibility criteria and for organising food distributions. This improved system of targeting is said to have allowed a significant increase in efficiency of food deliveries.
Poor rainfall in June and July has adversely affected maize and sorghum plantings and there is growing concern about a drought affected belt extending from upper Nile down through Eastern Equatoria into Kenya. The sorghum harvest is already underway along the Nile corridor leading to Juba and has led to a 25% reduction in grain prices in Equatoria in one week [WFP 2/10/95].
Although there are no recent nutritional survey data there have been a number of anecdotal reports of deteriorating nutritional status due to restricted relief deliveries. Areas and population groups affected include Juba, Mangalatore and a Dinka population leaving the Mundri area camps in Western Equatoria. There has been a reported outbreak of measles in settlements for displaced people in South Kordofan with over three hundred cases and 80 resulting deaths [USAID 31/07/95].
There have been extensive demolition campaigns in the displaced camps in the Khartoum area. As a result the populations in remaining camps are growing and in turn placing a strain on the limited health and nutrition services provided by NGOs. Furthermore, the remaining camps are up to 40 kms from Khartoum which restricts access to food, water, education, markets and other services. A recent survey in Jebel Aulia camp found that malnutrition has increased over the past four years despite an ongoing food aid programme [USAID 31/07/95].
Overall, the population in Southern Sudan and the displaced population around Khartoum can be considered to be at moderate nutritional risk (category IIb in Table 1). The refugees from Ethiopia and Eritrea and the remaining displaced populations are not currently considered to be at heightened nutritional risk (category IIc in Table 1).
How can external agencies help? There appears to be increasing restrictions on relief activities at the same time as a deterioration in the nutritional situation for most of the displaced/war affected population in this country. External agencies may want to consider means to increase access to vulnerable populations.
(see Map 15)
The total number of assisted Sudanese and Zairian refugees in Uganda has increased very slightly over the last two months. A registration is planned for October 1995. Current estimates of the total number of assisted refugees are summarised in the box.
|
Origin |
Aug 94 |
Oct 94 |
Dec 94 |
Feb 95 |
Apr 95 |
Jul 95 |
Oct 95 |
|
Sudanese Refugees |
230,000 |
268,000 |
274,000 |
300,000 |
310,000 |
322,000 |
324,000 |
|
Zairian Refugees |
16,000 |
16,000 |
16,000 |
313,000 |
13,000 |
13,400 |
13,700 |
|
TOTAL* |
246,000 |
284,000 |
290,000 |
313,000 |
323,000 |
335,400 |
337,400 |
*Rwandan refugees in Uganda are included in section #4.The total number of Sudanese refugees has increased marginally to 324,000, but there has been movement of refugees between camps. Results from three surveys carried out in camps in the northeast have recently become available and are as follows.
· Survey data from Ikafe camp, Arua district (estimated population 46,300 Sudanese refugees), in April 1995 revealed that wasting levels were 6.9% with 2% severe wasting (see Annex 115(a)). Crude mortality rates were 0.54/10,000/day (slightly above normal) and under-five rates were 1.7/10,000/day (also slightly elevated). Measles immunisation coverage was 78% and only 6-10 litres/person/day of water were available. There were also insufficient latrines in the camp. The main causes of morbidity and death were diarrhoea and measles [Epicentre 24/07/95]. It is reported that the water supply situation has improved since this survey [UNHCR 18/09/95].The food supply situation for Sudanese refugees in Uganda may have had some role in elevating levels of wasting. Food basket monitoring during August indicated that an estimated 80% of refugees still received a reduced ration and that this was largely due to inequities at the point of distribution. At the start of September, the average caloric content of the ration supplied to Red Cross managed camps was 1744 kcals/person/day [IFRC-a 15/09/95]. However, there is optimism amongst agencies that the food supply situation is generally improving.· Survey data from July in Koboko camp (estimated population 67,000 Sudanese refugees) indicated 8.2% levels of wasting with 1.9% severe wasting (see Annex I 15(b)). The crude mortality rate was 0.31/10,000/day (a normal level) and the under-five mortality rate was 1.4/10,000/day (slightly higher than usual). Measles immunisation coverage was estimated at 92.7% but water availability was reported as variable. There have been unconfirmed reports of some cholera cases [Epicentre 24/07/95].
· Recent survey data from July 1994 in Rhino camp (estimated population 22,000 Sudanese refugees) showed 13.9% wasting with 3.8% severe wasting (see Annex I 15(c)). The crude mortality rate was 0.41/10,000/day and the under five mortality rate was 1.3/10,000/day. Measles immunisation coverage was estimated to be 81.5% and approximately 14 litres/person/day of water were available. The main causes of morbidity were reported to be malaria and diarrhoea and there were also some unconfirmed reports of cholera [Epicentre 24/07/95]. It has recently been reported that the water supply situation in the camp has deteriorated due to repeated breakdown of the water pumps [UNHCR 18/09/95].
The number of Zairian refugees in Uganda has increased slightly to 13,700 people. Their nutritional status is reportedly adequate [UNHCR 18/09/95].
Overall, the refugees from the northeastern camps of Ikafe and Rhino can be considered to be at moderate risk due to a combination of inadequate or erratic water supplies, poor sanitation facilities and inequitable food distributions resulting in elevated levels of wasting (category IIb in Table 1). The remaining Sudanese refugee population along with the Zairian refugees are not currently considered to be at heightened nutritional risk (category He in Table 1).
How could external agencies help? Generally, there appears to be a need to review the current general ration distribution system for these camps. In Ikafe camp measles immunisation coverage, latrine construction and water availability need to be increased. In Koboko and Rhino camp cholera surveillance may be needed. Measles immunisation coverage needs to be improved. Water supplies also need to be improved.
(see Map 12)
The nutrition situation of approximately 14,000 Ugandan refugees in Zaire is reportedly stable. Many of these refugees are eager to repatriate, but agreement has yet to be reached on how this will take place [UNHCR 18/09/95].
These have been no reports of any change in the situation of the approximately 50,000 Sudanese and 41,000 assisted Angolan refugees in Zaire.
There are approximately 10,000 Angolan refugees assisted in Zambia. There are an additional 86,000 refugees who are not assisted and about whose nutritional status little is known. 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 to the reportedly adequate nutritional situation for the small number of Zairian refugees in Zambia.
