1. Angola
2. Benin/Ghana/Togo Region
3. Burkina Faso and Mauritania - Touareg Refugees
4. Burundi/Rwanda Situation
5. Central African Republic
6. Djibouti
7. Ethiopia
8. Kenya
9. Liberia/Sierra Leone Region
10. Mauritania Refugees in Senegal
11. Mozambique Region
12. Somalia
13. Sudan
14. Uganda
15. Zaire
16. Zambia
(see Map 1 and Figure 3)
Angola - Trend in numbers of displaced/war affected. Shaded areas indicate those at heightened nutritional risk.
The overall security situation in Angola remains calm and the first practical steps towards registering UNITA fighters in Angola’s demobilisation and reintegration programme are underway [WHO 15/11/95]. Emergency assistance is still being provided to approximately 1.4 million internally displaced people, returnees and/or war-affected people and agreement has recently been reached with donors to provide for the food needs of an average of one million people each month from March 1996 until March 1997. It is anticipated that this food will assist the transition from widespread emergency food assistance to more targeted developmental reconstruction and rehabilitation activities [WFP 20/10/93, 3/11/95, 17/11/95].
The relative calm in Angola is allowing increased deliveries of food aid by road thereby reducing the overall cost of transport. Only 22% of transport was by air in the first week of November. As the country is entering the pre-harvest hungry season it is important that current food delivery schedules be maintained. There are some areas where relief deliveries remain problematic. In certain cases this is due to logistical difficulties such as poor runways in Caconda in Huila province, while in other areas, for example in Cabir in northern Huila province, insecurity is preventing access. Nevertheless, population access is generally improving with the needs of formerly inaccessible towns and cities being increasingly met [WFP 20/10/93, 3/11/95, 17/11/95].
The nutritional situation appears to be adequate in areas where relief supplies are being maintained. For example, a recent survey in Malange measured wasting and/or oedema at 1.8% with severe wasting and/or oedema at 0.2% (see Annex 1 (1a)). These low levels of wasting in Malange have now been maintained for the last year and appear to reflect high levels of access to safe farm land and sources of income which supplement the general ration. Less than three percent of children surveyed were consuming an inadequate diet. Nevertheless, the population is still believed to be dependant on the existing level of general ration provision. It is feared that any decrease in the food supply could lead to an increase in mine accidents as people might be forced to farm unsafe areas [CONCERN 17/10/95, WHO 15/11/95].
Another example of improved nutritional status is in Cafunfo, Luanda Norte Province. In April 1995, when the area first became accessible, levels of wasting were as high as 20% (see RNIS #11). Emergency general ration provision and therapeutic feeding were immediately implemented. A follow up survey in July 1995 showed only 2.8% wasting with 0.6% severe wasting (see Annex 1 (1b)). No cases of oedema were seen and measles immunisation coverage was recorded at 72.7%. This marked improvement is believed to reflect a combination of factors including, previous mortality of children under five years old, food relief, renewal of the diamond business and improved supplies of food by traders [AICF 11/07/95].
However, in areas that are newly accessible or where access is difficult, malnutrition is often still a serious problem. In Matala for instance, wasting and/or oedema were measured at 15.4% with 6.7% severe wasting and/or oedema among the displaced and resident population (see Annex 1 (1c)). Only the former are currently receiving food aid [WFP 10/11/95]. Preliminary results from a recent survey in Galungo Alto showed 20.4% wasting and/or oedema and 12% severe wasting and/or oedema (see Annex 1 (1d)). It was noted that road access has been difficult since the onset of the rains [WV Oct 95].
WFP are facing funding shortages for their light aircraft which are essential for transporting personnel to areas that remain inaccessible by road in both government and UNITA held areas. A rupture in the food pipeline is creating expectations of a shortage of oil in the food basket during November and December [WFP 3/11/95].
Overall, the majority of the 1.4 million people dependant on food aid in Angola could be considered to be at moderate nutritional risk (category IIb in Table 1). The pre-harvest “hungry” season may exacerbate vulnerability amongst particular groups, e.g. those inaccessible to relief supplies or not in receipt of any general ration support.
How could external agencies help? Priorities include increased funding for aircraft transportation in Angola and ensuring adequate pledges to address the current vegetable oil shortage in the general ration pipeline. Nutritional surveys in newly accessible areas are important, with contingency resources held over in order to be able to respond to identified needs. There may also be a need to provide general rations to resident populations where these are hosting large numbers of displaced as in Matala town.
There are currently approximately 124,000 refugees in Benin and Ghana. Most of this population arrived from Togo in January 1993 and now that the situation which led to the refugee crisis has apparently stabilised, repatriation has begun and will continue into 1996.
Benin There is reportedly no change in the adequate nutritional status of the 28,000 Togolese refugees remaining in Benin. Repatriation of these refugees has begun [UNHCR-a 17/11/95, WFP 05/12/95].
Ghana There are approximately 82,000 assisted Togolese refugees remaining in Ghana. The reduction from 98,000 reported in the previous RNIS is due to some spontaneous repatriation, and a recent verification exercise of existing ration cards. The nutritional situation of this population is reported to be adequate and repatriation is also planned during 1996 for these refugees [UNHCR 21/11/95, WFP 05/12/95].
There are 14,000 assisted Liberian refugees in Ghana whose nutritional status reportedly remains stable. There are currently no plans for repatriation of these refugees [UNHCR 21/11/95].
Overall, the approximately 124,000 refugees in this region are not currently considered to be at heightened nutritional risk (category IIc in Table 1).
(see Map 3)
There are approximately 68,000 assisted Touareg refugees in Burkina Faso and Mauritania. Numbers have declined recently with the spontaneous repatriation of approximately 5,000 refugees from Mauritania.
Burkina Faso There is no change reported in the generally adequate nutritional situation of approximately 33,000 Touareg refugees from Mali and Niger.
Mauritania There are approximately 35,000 Touareg refugees from Mali in Mauritania. The recent spontaneous repatriation of 5,000 refugees will allow for the closure of one of the three camps. Organised repatriation is now being planned, and it is hoped that a pilot repatriation of about 150 people will take place before the end of 1995. Large scale repatriation will hopefully be completed in 1996 [UNHCR 21/11/95].
There has been no update on the nutritional condition of this population since a survey conducted over five months ago found levels of wasting in excess of 17% and crude mortality rates of 6 times normal. This situation was largely attributed to poor general ration supplies and high rates of diarrhoea. However, as an improved general ration of 1900 kcals/person/day has been delivered for at least the three previous months, it can probably be inferred that the nutritional condition of this population has improved [UNHCR 21/11/95].
Overall, the Touareg refugees in Burkina Faso and Mauritania are probably not at heightened nutritional risk (category IIc in Table 1).
(See Map 4 and Figure 3)
Burundi/Rwanda Region - Trend in numbers of refugees/displaced and proportion severely malnourished or at high nutritional risk (shaded area).
The nutritional situation for approximately three million people affected in the region remains generally adequate with low levels of wasting reported in most surveys carried out in recent months. However, the security situation in Burundi is reportedly deteriorating and causing displacement of people, may of whom are inaccessible to relief. The high level of insecurity is said to be affecting planting for the next rice crop. There are also health problems in a number of refugee camps in Uvira some of which are still showing elevated levels of wasting. Levels of oedema appear high in several camps. Repatriation from Tanzania and Zaire is continuing although there has been confusion over the Zairian government announcement that all refugees must be repatriated before the end of the year.
Current estimates of affected populations by country of present residence are given in the box below:
|
|
Oct 94 |
Dec 94 |
Feb 95 |
Apr 95 |
Jul 95 |
Oct 95 |
Dec 95 |
|
Burundi |
770,000 |
1,200,000 |
740,000 |
492,500 |
515,000 |
315,000 |
504,000 |
|
Rwanda |
2,500,000 |
2,500,000 |
335,000 |
1,750,000 |
800,000 |
725,000 |
800,000 |
|
Tanzania |
556,000 |
556,000 |
630,000 |
686,000 |
644,000 |
629,000 |
621,000 |
|
Zaire |
1,240,000 |
1,240,000 |
1,290,000 |
1,130,900 |
1,202,200 |
1,158,000 |
1,146,000 |
|
Uganda |
10,000 |
10,000 |
5,000 |
5,000 |
6,700 |
6,400 |
6,400 |
|
TOTAL |
5,076,000 |
5,076,000 |
3,000,000 |
4,064,400 |
3,167,900 |
2,831,400 |
3,077,400 |
The level of violence has affected relief activities and only recently, following the death of an aid worker near Cibitoke, a decision has been taken to temporarily suspend all humanitarian activities in Cibitoke and Bubanza. Nevertheless, security permitting, agencies continue to provide relief items to recently displaced populations on receipt of requests for assistance from local authorities. For example, at the end of October one off distributions of food were made to 6,300 displaced families in rural Bujumbura and a further 3,000 beneficiaries in Karuzi in Central Provinces. It is difficult to determine the number of internally displaced in Burundi due to the continuous process of displacement and the lack of access to problem areas. However, current food stocks appear to be adequate to feed up to 504,000 beneficiaries of whom 214,000 are Rwandan refugees [WFP 13/10/95 - 17/11/95].
A small number of Rwandan refugees continue to return home with the total repatriating during 1995 having reached 20,639. At the same time new refugee waves are being created in areas like Cibitoke where populations are fleeing to Uvira in Zaire. In the last week of October an estimated 2,520 people left for Uvira [WFP 13/10/95 -17/11/95].
Recent information from three camps for Rwandan refugees shows a generally adequate nutritional situation. In Magara camp wasting and/or oedema was measured at 2.6% with 0.4% severe wasting and/or oedema. Wasting and/or oedema was also low in Ruvumu camp at 3.6% and in Kibezi, wasting and/or oedema was measured at 3.5% (see Annex 1 (4a-c)) [AICF Oct 95].
The recently reported cholera outbreak(see RNIS #12) is affecting rural Bujumbura, Bururi and Bubanza. [WHO 7/12//95]. The condition may also be occurring in some inaccessible areas.
Rwanda Security incidents involving clashes between the Former Rwandan Government Forces (FRGF) and RPA continue to be reported inside Rwanda. There have also been numerous land-mine explosions - particularly in western areas bordering Zaire. There are constant reports of sabotage related incursions by FRGF rebels from the Zairian camps into Rwanda. Judicial processes for those participating in the genocide are expected to start in the near future [WFP 27/10/95 - 17/11/95].
Repatriation from Zairian, Tanzanian and Burundi refugee camps is continuing with over 11,000 returnees reported during October. Over 200,000 refugees have now repatriated between January and September 1995. WFP and UNHCR have recently agreed to distribute an initial two-month food ration to all returnees in way stations and transit centres, instead of the previous one month ration, in order to provide additional time for the planning of follow-up distributions once the returnees have reached their final destination. Food aid is also distributed though food for work and income generating activities (68% of food distributed), targeted feeding (8% of food distributed) and institutional feeding (14% of food distributed) [WFP 27/10/95 - 17/11/95].
Despite the partial recovery in food security inside Rwanda due to the August 1995 harvest, as many as 800,000 people may still be vulnerable to food shortages as the prospects for the January harvest remain poor. These vulnerable families are mainly female headed households, returnees without land and remaining refugees and internally displaced groups [FAO Oct 95].
A recent nutritional survey conducted in Kigali showed an adequate nutritional situation. Wasting was measured at 5% and severe wasting was 0.6% in children. Oedema was measured at 0.3% (see Annex 1 (4d)). Measles immunisation coverage was 98% and the under-five mortality rate was 0.17/10,000/day (below normal). Adult wasting was measured at 10.7% with severe wasting at 0.5% (see Annex 1 (4e)). The crude mortality rate was very low at 0.09/10,000/day [AICF Sep 95].
Tanzania Current estimates are that there are 621,000 Burundi and Rwandan refugees in Tanzania. Small scale repatriation has been taking place and approximately 28,000 refugees from Rukira commune in Benaco camp have expressed their willingness to return to Rwanda as a group. However, due to the deteriorating security situation in Burundi, contingency plans are also being made for a possible influx of refugees from Burundi into Tanzania [WFP 17/11/95, 08/12/95].
The nutrition situation in the N’Gara camps seem to show a pattern of low levels of wasting and elevated levels of oedema. For example, a recent nutrition survey carried out in Musuhura Hill camp (estimated population 77,000) showed 3.5% wasting with 0.2% severe wasting. Oedema was measured in 1.7% of children under five (see Annex 1 (4f)). These results show no statistically significant change in prevalence of wasting since a survey carried out in July 1995. Such low levels of wasting have been maintained despite the inadequate general ration receipts recorded in August and September of 1,570 and 1,440 kcal/person/day respectively. General ration deliveries reportedly improved during October. The survey also found that coverage of the therapeutic feeding programmes has improved from 22.4% in July to 49% in November and that measles vaccination coverage was 87% [MSF-H 04/11/95].
A survey in Benaco camp showed 4.3% wasting with 0.2% severe wasting. Oedema was measured at 1.6% (see Annex 1 (4g)). Measles immunisation coverage was 82.6%. The crude mortality rate was 0.56/10,000/day and the under-five mortality rate was 1.61/10,000/day. Both of these rates are slightly above normal [AICF 23/09/95].
In Kitali camp, a recent survey showed wasting at 5.2% with 0.4% severe wasting. Oedema was measured at 2.1% (see Annex 1 (4h)). The ration has varied between 1400-1900 kcals/person/day. Feeding centre coverage was only estimated to be 26.9%. It was noted that there are approximately 1,000 new arrivals how have not been registered and therefore have no access to food distributions or medical services [AICF 01/10/95].
Recent reports from the camps in the Karagwe district show a generally satisfactory nutritional situation although mortality rates are slightly elevated in some camps. A nutritional survey in Omukariro (estimated population 8,600) showed 1.02% wasting with no severe wasting (see Annex 1 (4i)). The crude mortality rate was 0.15/10,000/day, and the under-five mortality rate was 0.37/10,000/day. These are both below normal levels. The distributed ration provided 1700 kcals/person/day [MSF-CH 14/10/95, MSF-CH Oct 95].
In Kagenyi camp (estimated population 16,000) the crude mortality rate was 0.81/10,000/day (about twice a normal level) and the under-five mortality rate was 1.92/10,000/day. The ration provided 1500 kcals/person/day. In Ruberwa camp (estimated population 26,000) the crude mortality rate was 0.55/10,000/day and the under-five mortality rate was 2.12/10,000/day (about twice normal). The ration provided 1600 kcals/person/day [MSF-CH Oct 94].
Goma, Zaire Continued small scale repatriation and a registration/verification exercise have reduced the estimated number of refugees in the Goma camps from 707,758 at the start of September to 695,750 by mid-November. The speed of repatriation has to some extent been influenced by conflicting messages from the Zairian government regarding the deadline of the 31st of December for all refugees to return to Rwanda. It now appears that this deadline will not be altered. A recent assessment in Kahindo camp found that about 80% of the adult male returnees are elderly while the remaining are young uneducated men returning to rural areas. Many of the women repatriating are heads of households or are leaving their husbands behind [WFP 3/11/95-05/12/95].
Recent surveys indicate a generally stable nutritional situation in the camps. This could be the effect of the balance of two opposing factors. On the one hand, improved food deliveries to the area due to the opening of a new access road probably has had a positive effect on the nutritional situation, but on the other hand the ban on refugee economic activity introduced by the Zairian authorities in early October would most likely have had an adverse effect. Levels of wasting varied from 2.1-4.3% in children under five (see Annex 1 (4j-m)). The exception to this is Kibumba camp, where wasting was measured at 8.3% including 4.8% severe wasting. Oedema was measured at 1.4% (see Annex 1 (4n)). This is not statistically different from the previous survey, but does show a trend toward deterioration of the nutritional situation [UNHCR 30/11/95]. There has however been a reported assessment of special feeding programs in the Goma camps with a view to discontinuing the operations and where appropriate integrating the beneficiaries into general food distributions [WFP 3/11/95-27/11/95].
Bukavu The security situation for the approximately 310,000 refugees in Bukavu remains tense due a variety of factors including confiscation of fake ration cards, news of numerous landmine explosion around the Goma camps, and the continuous fear of forced repatriation. Small scale repatriation is occurring, although, as in Goma, rates have been affected by the confused messages concerning the December 31st deadline.
Improved food deliveries to the area has allowed the accumulation of buffer stocks in warehouses and ensured adequate ration provision [WFP 27/10/95]. The nutritional situation is assumed to be stable.
Uvira The situation for the approximately 140,000 refugees in Uvira is described as tense, with reports of robbery and assault on international relief agency property and staff [WFP 20/10/95].
A recent set of surveys reveals a pattern of low levels of wasting, but high levels of oedema. For example, a survey in Runingo measured wasting and/or oedema at 7.1%, and oedema was measured at 3.7% (see Annex 1 (4o)). A similar situation was found in Kajembo camp where wasting and/or oedema was measured at 7.5% and oedema was 3.6% (see Annex 1 (4p)). These results nonetheless show an improvement since surveys in August in the two camps found prevalence of wasting of 21 % and 12% respectively [UNHCR 30/11/95].
Lack of access to general rations, the existence of cholera and dysentery, and the hungry season have all been identified as factors contributing to these somewhat elevated levels of wasting. More recent anecdotal reports indicate that poor health care, sanitation and water supplies are still causing health problems in some camps which in turn is adversely affecting nutritional status [UNHCR 15/10/95].
Uganda There are approximately 6,400 Rwandan refugees residing in two separate sites in Uganda. The nutritional status of these refugees is reportedly adequate. It is hoped that about 1,000 of these refugees will repatriate in the near future [UNHCR 16/11/95].
Overall, the internally displaced population in Burundi is probably at heightened nutritional risk (category IIa in Table 1) due to limited access to this population by relief agencies, while the refugee population in Burundi is probably not at heightened risk (category IIc in Table 1). The vulnerable population in Rwanda and the refugees in Uganda are probably not currently at heightened nutritional risk (category IIc in Table 1). The refugees in Tanzania can be considered to be at moderate nutritional risk (category IIb in Table 1) due to high levels of oedema and elevated mortality rates. The Rwandan refugees in Goma are probably not currently at heightened nutritional risk (category IIc in Table 2) with the exception of those in Kibumba camp, who are at moderate risk with elevated levels of wasting and oedema (category IIb in Table 1). The refugees in Bukavu, Zaire are also probably at moderate nutritional risk (category IIb in Table 1) due to the enforced curtailment of their economic activities, while some of those in Uvira can be considered to be at high risk due to high levels of oedema (category I in Table 1).
How could external agencies help? There is a general need for increased nutritional monitoring of internally displaced and returnee populations in the region. This is particularly important in parts of Burundi where the displaced may be cut off from relief assistance for long periods due to insecurity, and also in Rwanda where large numbers of returnees may be vulnerable to food insecurity. There is an urgent need to conduct an extensive review of the health situation in the Uvira camps in order to determine how and whether health systems should be strengthened and the impact of health status on nutritional well-being of the population. This is especially important given the continued influx of refugees from Burundi. Agencies need to investigate the factors leading to the existing unusual prevelances of oedema indicating kwashiorkor in certain refugee camps in Goma, N’Gara, and Uvira, with a view to improving preventive measures, presumably including a better diet. There is a need to improve coverage of the selective feeding programmes in Musuhura Hill and Kitali camps in Tanzania. This may be achieved by improving the outreach of the primary health care programme.
Most recent estimates are that there are 13,300 Chadian refugees and 25,500 Sudanese refugees in the CAR. There are no reports of any change in the stable nutritional situation of these refugee populations.
(see Map 6)
There are approximately 25,000 Somali refugees in Djibouti whose nutritional status is reportedly adequate. There are currently no plans for repatriation of these refugees [UNHCR 20/11/95].
(see Map 7)
There are approximately 388,000 assisted and a further 35,000 unassisted refugees in Ethiopia (not included in Table 1).
Current estimates are that there are 275,000 assisted Somali refugees in camps in Eastern Ethiopia and a further 35,000 Somali refugees in the Dolo area and in urban centres who are not assisted. The camp population in the East rose sharply (by 90,000 or more) between the end of 1994 and August 1995 due to the renewed outbreak of fighting in north west Somalia. A slow but steady influx has continued during the past two months. This fighting has hindered the prospects for voluntary repatriation and has made it necessary to upgrade care and maintenance activities in the camps [UNHCR-a Sep 95]. There have been no recent reports of nutritional surveys on this population.
There are approximately 60,000 Sudanese refugees in Western Ethiopia. This population has not grown as rapidly as might have been expected given the level of fighting in southern Sudan. Unlike many other refugee situations, where the majority tend to be women and children, the Sudanese refugee settlements in Ethiopia range from this usual gender distribution in Bonga to the largely male settlement of Dimma. The overall objective of this programme is said to be the promotion of partial self-sufficiency in local settlements through increased crop/animal production, education and income generating activities and decreased dependence on external services and supplies [UNHCR-a Sep 95].
Current estimates are that there are 18,000 Djibouti refugees in Ethiopia, mostly in the Afar Region 2 of the country. This population are mainly Afar pastoralists and due to the inaccessibility of the area and scattered nature of the population it has been difficult to conduct any kind of demographic survey. Given that these refugees are unlikely to repatriate in the near future, the overall objective for this caseload is said to be to streamline care and maintenance activities in the critical sectors such as food, health and education, while avoiding the creation of camps [UNHCR-a Sep 95].
There is no new information on the approximately 11,000 displaced in camps around Addis Ababa or on the approximately 24,000 Somali and Kenyan refugees in the south of the country.
A recent funding appeal by the UNHCR for repatriation and reintegration of Ethiopian and Somali refugees and returnees has been made. This appeal states that responses to similar earlier appeals have been extremely poor so that many activities have been curtailed if not stopped altogether. The appeal goes on to warn that if adequate support for the repatriation and reintegration programme fails to materialise then the need for care and maintenance programmes in the refugee camps in Djibouti, Ethiopia, Kenya and Sudan may continue indefinitely [UNHCR-a Sep 95].
Overall, since no information to indicate that the situation has changed is available, it is assumed that the populations in Fugnido, Kebre Beyah, and Darwonaji remain at high risk (category I in Table 1) and the populations of Hartisheikh, Teferiber, Daror and Aisha can be considered to remain at moderate risk (category IIb in Table 1). The remaining refugee populations are probably not at heightened nutritional risk (category IIc in Table 1).
(see Map 8)
The total number of assisted refugees in Kenya has decreased over the past two months to just over 186,000 people. This number is comprised mainly of 140,000 Somali refugees, 40,000 Sudanese refugees and 6,000 Ethiopian refugees. There are an additional 51,000 unassisted refugees in Kenya (not included in Table 1) [UNHCR 16/11/95].
The number of Somali refugees in Kenya continues to decline with a further 8,000 repatriating during October bringing the total population repatriated during 1995 to over 40,000. The reduction in Somali refugee numbers will allow the closure of Marafa camp (coastal camp) in the near future [UNHCR 16/11/95].
The recent reduction in the ration for this population from 2100 kcals/person/day to 1800 kcals/person/day in conjunction with the discontinuation of CSB in the general ration requires careful monitoring for any potential negative impact on nutritional status [UNHCR 16/11/95].
Overall, the refugee population in Kenya is probably not at heightened nutritional risk (category IIc in Table 1).
(see Map 9 and Figure 3)
Liberia - Trend in numbers of refugees/displaced and proportion severely malnourished and at high risk (shaded area).
The present peace accord appears to be holding in Liberia, despite some skirmishes in the countryside. However, these security incidents mean that many areas remain inaccessible to relief activities. A few recent nutritional surveys indicate low levels of wasting in accessible areas. Intense fighting is continuing in Sierra Leone with only occasional periods of calm. Much of the country is inaccessible and it is reported that levels of malnutrition are particularly high in affected regions (southern and eastern).
Current estimates of the numbers of people affected in the region are summarised below:
|
Location |
Oct 94 |
Dec 94 |
Feb 95 |
Apr 95 |
Jul 95 |
Oct 95 |
Dec 95 |
|
Liberia |
1,692,000 |
1,615,000 |
1,800,000 |
1,900,000 |
1,900,000 |
1,900,000 |
1,900,000 |
|
Sierra Leone |
300,000 |
506,000 |
506,000 |
500,000 |
730,000 |
730,000 |
730,000 |
|
Cote d’Ivoire |
325,000 |
330,000 |
330,000 |
330,000 |
227,000 |
305,000 |
305,000 |
|
Guinea |
534,000 |
534,000 |
568,000 |
603,000 |
578,000 |
536,000 |
605,000 |
|
TOTAL |
2,851,000 |
2,985,000 |
3,204,000 |
3,333,000 |
3,435,000 |
3,471,000 |
3,540,000 |
Many parts of the country are not yet fully accessible by road due to security concerns. Insecurity has affected some relief programmes. For example, a food convoy in Gbaranga was postponed due to fighting in early October while much needed selective feeding programmes have been adversely affected by lack of access to the Bong area. Nevertheless, assessment missions are continuously being planned and implemented in formerly inaccessible areas. Current estimates are that there are 800,000 affected people in Liberia who are accessible, and a further million inaccessible people in need of humanitarian aid. There are also approximately 100,000 Sierra Leonean refugees in Liberia [WFP 13/10/95, WFP 10/11/95].
The expanded relief requirements that arise from improved access to populations will pose numerous logistical challenges for relief agencies while increased donor efforts will be required for timely delivery of food commodities and cash pledges to cover resettlement and reintegration activities. Currently, delays in pledges/arrivals have meant that WFP Liberia is nearly out of stocks of vegetable oil and pulses and only cereal (bulgur wheat) is available for distribution. However, it is hoped that with the arrival of the harvest season, some areas may no longer require general ration support [WFP 13/10/95, WFP 10/11/95].
Continued fighting in neighbouring Sierra Leone has led to further refugee influxes into Cape Mount and Bomi during October.
Recent nutritional surveys have shown a much improved situation in many parts of the country. Indeed, concern that high rates of wasting may be found in newly accessible areas such as Greenville and surrounding villages has not, in some cases, been borne out by the evidence [WFP 27/10/95].
A survey carried out in Buchanan (estimated population 50,000) showed 8.9% wasting with 1.0% severe wasting. Oedema was seen in 0.3% of the children measured (see Annex 1 (9a)). This prevalence of wasting was comparable to that measured in an earlier survey in January 1995. There was no significant difference found in wasting rates between the resident and displaced population and the majority of families were found to have general ration distribution cards. Crude mortality rates varied from 0.8-3.7/10,000/day (2-10x normal) and the under five mortality rate was 1.4/10,000/day (a normal level). Main causes of death cited were diarrhoea and fever [MSF-F/AICF Jul 95].
Recently an outbreak of yellow fever has been reported in the area, and a massive vaccination campaign is underway. It should be noted that only an estimated 20% of Liberia’s pre-war health facilities are currently operating making such primary health care activities extremely difficult [WHO 15/11/95, 27/11/95].
A survey was recently carried out in Lower Bong and Upper Margibi to evaluate the impact of a general ration distribution and targeted feeding programme implemented after a survey in July 1995 showed a critical nutrition situation with 19.1% wasting and 37.1% oedema (see RNIS #12). The more recent survey showed 6.4% wasting and/or oedema and 0.7% severe wasting and/or oedema (see Annex 1 (9b)). This is a remarkable improvement and is largely attributed to the general ration of 1800 kcals/person/day which has been reaching an estimated 96.5% of the population since July. However, coverage of the targeted feeding programme has been far less effective with only an estimated 20% of malnourished children attending the supplementary feeding facilities. Measles vaccination coverage was also low at 43.6% with communities off the main road particularly badly served [MSF-H 21/10/95].
Sierra Leone Recent reports on the security situation in Sierra Leone indicate that while the northern and eastern regions remain relatively calm, there has been an upsurge in rebel activities in the southern region. As a result, villages in the Bo and Moyamba districts have suffered devastation. These attacks have reportedly precipitated influxes into Bo at an average of 100 displaced persons a day since mid-October. WFP operations in the entire country are reportedly being adversely affected by problems of poor control over registration and insecurity at WFP stores. It is currently estimated that 730,000 people are affected in the country.
Over the past few months the nutritional situation has been alarming amongst the displaced populations in Kenema, Segbwema, Dam and Bonthe Island with rates of wasting and/or oedema as high as 27%. Even higher levels of wasting are feared in the districts of Kailahun and Pujehun which are under RUF control and therefore still inaccessible to relief assistance.
However, preliminary results from a more recent survey in Kenema showed a much improved situation over that seen in an August 1995 survey. At that time, wasting levels were measured at 23-37%. In this follow-up survey, wasting and/or oedema in Kenema town were measured at 1.8% with 0.5% severe wasting and/or oedema. In RTI camp for the displaced, wasting and/or oedema were measured at 5.6% with 0.9% severe wasting and/or oedema (see Annex 1 (9c-d)) [MSF-H 27/11/95]. These much improved levels of wasting are almost certainly attributable to recent general ration distributions to this population.
A survey in Bo (estimated population of residents and displaced 250,000) showed 19.8% wasting with 2.4% severe wasting. Oedema prevalence was measured at 1.3% (see Annex 1 (9e)). Measles immunisation coverage was estimated at 36.6% but as this was based solely upon presentation of a vaccination card, this may be an under-estimate [AICF Jul 95]. Since this survey general food distributions have been implemented in Bo as well as in Segbwema, Daru, Maken. It is therefore likely that the nutritional situation will begin to improve in these areas [WFP 27/10/95, WFP 10/11/95].
Cote d’Ivoire2 There are approximately 305,000 Liberian refugees in Cote d’Ivoire. At present only small scale spontaneous repatriation is occurring. The two tier general ration system for old case load refugees and newer arrivals is continuing and is believed to be serving the needs of this population adequately [UNHCR 17/11/95].
2 Due to a miscommunication, the previous RNIS report described a July 1994 survey in Cote d’Ivoire as a survey which took place in July 1995.Guinea There are approximately 605,000 refugees from Liberia and Sierra Leone in Guinea of whom 536,000 receive food aid. Following a joint WFP/UNHCR assessment mission, a reduction in rations is planned for the refugees who arrived before the end of 1993, as it is believed that they have attained some degree of self-sufficiency [UNHCR 17/11/95, WFP 05/12/95].
Overall, the population in Bo, Sierra Leone can be considered to be at high risk with high prevalence of wasting (category I in Table 1). The remaining population in Sierra Leone and the inaccessible population in Liberia can be considered to be at high risk (category IIa in Table 1) and the accessible populations in Liberia and the populations in Guinea and Cote d’Ivoire are probably not at heightened nutritional risk (category IIc in Table 1).The inaccessible population in Liberia can be considered to be at moderate nutritional risk (category IIb in Table 1).
How could external agencies help? In Liberia, ECOMOG may need increased support. Increased pledges from donors for supplies of oil and pulses would help to ensure adequacy of the general ration pipeline. Projects to help rehabilitate the devastated primary health care infrastructure in the country may be of priority. Improved coverage of selective feeding programmes and measles immunisation in the Lower Bong and Upper Margibi is required. In Sierra Leone it is important that, security permitting, nutritional assessments are carried out in areas which are periodically cut off from relief activities, e.g. Bo, Kenema, etc. As in Liberia, support for primary health care infrastructure and activity is essential. For example, in Bo there is an urgent need to increase rates of measles immunisation coverage.
(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 3)
Mozambique - Trend in numbers of returnees and demobilised soldiers.
The number of returnees, demobilised soldiers and drought affected people requiring food aid in Mozambique has risen to 790,000 [MSF-CIS Nov 95]. This is a planned increase in beneficiary numbers following an initial food security assessment earlier in the year which anticipated the limited food stocks from the harvest being used by this time of the year.
Food reserves at household level are variable. Districts in northern provinces continued to report harvests into September. By contrast, households in the provinces of Maputo, Gaza and Inhambane reported almost no harvests during these months and reserves and markets reflected a rapidly deteriorating food security situation. In numerous districts in these provinces the only foods consumed were reported to be famine foods and in August the province of Gaza proclaimed a state of emergency [MSF-CIS Oct 95].
The nutritional situation in the northern provinces of the country remains more or less stable. Surveys undertaken in districts of Sofala and Nampula province found very low prevalence of wasting (approximately 3%) [MSF-CIS Oct 95].
The nutritional and health situation has however been preoccupying in two provinces. An epidemic of meningitis in Nampula province continued to spread and to claim lives during August, although by the end of September the epidemic was reportedly under control. Measles immunisation coverage in the province was only 11% [MSF-CIS Nov 95].
In Mutarara in Tete province, an outbreak of pellagra amongst returnees has been reported continuously since August. The population of Mutarara district increased form 50,000 to at least 200,000 due to the returning refugees population from Malawi. The number of reported cases at clinics had been steadily increasing with 169 cases reported in the first few weeks of November. It is felt however, that cases may be under-reported as many people do not have easy access to health centres. In response to the outbreak, WFP will provide groundnuts to the returnees in Mutarara. There are no plans currently for a population wide distribution although, should pellagra be confirmed amongst the resident population, additional intervention measures may be required [MSF-CIS 04/12/95].
A recent nutritional survey in Mutarara showed wasting and/or oedema in 5.2% of children included in the survey. Severe wasting and/or oedema were measured at 0.1% (see Annex 1 (11a)) [MSF-CIS 04/12/95].
Overall, the returnee population in Mutarara is at high risk due to pellagra (category I in Table 1). The remaining vulnerable population in Mozambique is probably not at heightened nutritional risk, although pockets of malnutrition may exist.
How could external agencies help? Nutritional monitoring should be supported in areas where there are large numbers of returnees, especially where harvests are known to be poor. Problems appear to be related to distribution and targeting of beneficiaries. There is also a need for careful follow up and assessment of the impact of ground-nut provision on the rates of pellagra being reported in Mutarara district. Furthermore, there should be some form of proactive monitoring of pellagra in similarly vulnerable areas, e.g. where there are large numbers of recent returnees, perhaps through careful checking of health centre records and interviews with health staff. Improvement of measles immunisation coverage should be pursued.
(see Map 12 and Figure 3)
Somalia - Trend in numbers of internally displaced and proportion severely malnourished or at high nutritional risk (shaded area).
The security situation in Somalia remains tense, especially in and around many of the cities. For example, there have been continuing attacks on Aideed’s forces occupying Baidoa which in turn has severely disrupted land preparation and planting for the “deyr season” in the contested area between Baidoa and Burhakaba. Initial prospects for the coming Deyr harvest are however favourable in eight of the major production areas, particularly in the Shabelle regions. Anticipated crop production in the Bay and Juba valley region is less promising and may well compound the situation brought about by poor crop yields in these areas during the previous Gu harvest. In the Bay regions Gu harvest yields were reduced by an estimated 77% compared to pre-war production.
The closure of Mogadishu port for eight months since UNISOM departed has led to massive price inflation of most food commodities in the town and outlying regions. As outlined in the last RNIS report, this has been one of several aggravating factors in leading to a high prevalence of wasting in the city. In mid-November WFP were finally able to deliver food to Mogadishu by vessel through the port of El Ma’an which is about 35 kms north of the city. There is continued support for feeding programmes in Mogadishu targeting over 20,000 beneficiaries per month in hospitals, mother/child health clinics and orphanages. Food security cannot have been helped by the fact that in early November 1995, heavy rains and flooding caused extensive damage in parts of Mogadishu. The camps for the displaced were among the worst affected areas [DHA 07/11/95, WFP 17/11/95, WFP 03/11/95].
The situation for the displaced and resident population in and around Kismayo town also remains precarious. A recent assessment found that many households are not self-sufficient. Prices are reportedly rising and with limited employment opportunities, especially since the departure of UNISOM, effective demand is very limited. With the expected poor Deyr harvest in the Juba valley, it is likely that prices will continue to rise. Wasting is said to be widespread among the displaced population, and may be a high as 50% of children, although there is as yet very little severe wasting. An earlier survey conducted in July found 17.8% prevalence of wasting with 2.7% severe wasting in the town with lower levels of wasting (11.6%) among the displaced in camps (estimated population 9,000). A food distribution for this population is planned until the next harvest is due in January [ICRC 21/11/95].
Overall, food security has continued to deteriorate in many areas of Somalia over the last two months. A significant proportion of displaced and resident households in Mogadishu and Kismayo are probably at heightened nutritional risk, although planned food distributions should help improve food security. Other populations at risk may exist in contested areas, e.g. around Baidoa, and where harvests are expected to be poor, e.g. the Bay and Juba valley regions.
How could external agencies help? With the expected poor harvest in some areas, and the increasing prices of commodities in the markets in large urban centres, an assessment is needed to identify nutritionally vulnerable groups so that food aid can be appropriately targeted. This may include portions of the resident as well as displaced populations.
(see Map 13 and Figure 3)
Sudan
The situation for many people in southern Sudan is precarious following a year when excellent harvests and improved relief access had created relatively stable food security for most of the population. The deteriorating circumstances have been due to a combination of constraints on OLS, poor rains in June and July leading to reduced planting, and increased levels of insecurity.
The estimated total number of refugees, displaced and war affected people in need of food assistance in the Sudan has not changed from the 1.4 million cited in the last RNIS report. 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. A census exercise in the camps for the remaining Ethiopian and Eritrean refugees is likely to be completed by the end of November so that adjustments to the 200,000 caseload “working figure” may subsequently be made. The total number of people in Sudan in need of non-food assistance is estimated to be 4.25 million [DHA 24/05/95, WFP 20/10/95].
Insecurity in Southern Sudan has continued to disrupt Operation Lifeline Sudan (OLS) activities. For example, insecurity determined that in the case of Juba, food has had to be delivered by air rather than river while relief programmes to all areas of Jonglei and northern Bahr El Ghazal were delayed during October [WFP 20/10/95, 10/11/95].
The outcome of the 1995 crop season in southern Sudan has been worse than expected due to a combination of pest attack and unfavourable weather conditions. The entire crop is estimated to cover less than half of the consumption requirements for the southern states. Price differentials between surplus and deficit areas are already wide (as much as five times) and will render a large proportion of food deficit households vulnerable as the purchasing power of the majority of the population has been sharply reduced during this long-term civil conflict. In recent years the switch from livestock agriculture to subsistence agricultural production has meant that large sections of the population become dependent on food aid when even small reductions in production due to drought or pest attack occur [FAO 10/11/95],
This type of vulnerability is amply demonstrated by a nutritional survey in Labone camp for the displaced coming from Ame and Atepi (estimated population 38,000). The survey, which was conducted in August, and followed the first general ration distribution (1,775 kcals/person/day) in three months, found 22.6% prevalence of wasting with 3.3% severe wasting. Oedema was measured at 0.2% (see Annex 1 (13a)). General rations had been suspended in the previous three months due to insecurity. Coverage of the selective feeding programme in the camp was only 25.4% [AICF 30/08/95].
A survey carried out in September 1995 in Tonj (estimated population 150,000) in Bahr el Ghazal found 9.7% wasting and 2.4% severe wasting. No cases of oedema were seen (see Annex 1 (13b)). These levels of wasting are slightly higher than those seen in April 1995 (8.2% wasting and 1.8% severe wasting), and may be partly explained by the timing of the survey which took place just before the harvest. Security constraints on sampling methodology determined that these results cannot be extrapolated to the whole of Tonj county. Measles immunisation coverage had increased from 10.2% in April to 28.3% in August [WV Sep 95].
There has been no further information since the last RNIS report on the displaced population around Khartoum. At the time this population were described as under increasing nutritional and health stress due to overcrowding in remaining camps and the relative isolation of these camps from centres of economic and market opportunity.
Overall, the displaced population in Labone camp are at high risk due to elevated levels of wasting (category I in Table 1) and the remaining affected population in southern Sudan can be considered to be at heightened nutritional risk due to disruptions in OLS operations (category IIa in Table 1). The displaced in and around Khartoum can be considered to be at moderate risk (category IIb in Table 1) while the refugee population are probably not currently at heightened nutritional risk (category IIc in Table 1).
How could external agencies help? Continued support for Operation Lifeline Sudan is essential. The continued problem of identifying vulnerable populations also needs to be addressed in southern Sudan. Where possible, nutritional assessments should be carried out as a priority on populations in areas where harvest failure has been substantial and significant food price inflation is evident. There is a need to improve coverage of selective feeding programmes in Labone camp for the displaced and to continue the measles immunisation campaign in Tonj county.
(see Map 14)
A census in October 1995 in Uganda has led to a reduction in the number of assisted Sudanese and Zairian refugees. Current estimates are summarised in the box below:
|
Origin |
Oct 94 |
Dec 94 |
Feb 95 |
Apr 95 |
Jul 95 |
Oct 95 |
Dec 95 |
|
Sudanese Refugees |
268,000 |
274,000 |
300,000 |
310,000 |
322,000 |
324,000 |
217,000 |
|
Zairian Refugees |
16,000 |
16,000 |
313,000 |
13,000 |
13,400 |
13,700 |
11,800 |
|
TOTAL* |
284,000 |
290,000 |
313,000 |
323,000 |
335,400 |
337,400 |
228,800 |
*Rwandan refugees in Uganda are included in section #4.Following the recent census, the number of Sudanese refugees in Uganda is estimated to be 217,000. New settlements are currently being established farther away from the Sudanese border in order to decongest existing camps -particularly Koboko camp with an estimated population of 71,000 people [UNHCR Sep 95, UNHCR 16/11/95].
There are no new nutritional data currently available, but the food supply situation has reportedly improved with most refugees now receiving an adequate ration. However, the food pipeline in not assured after December 1995 [UNHCR Sep 95, UNHCR 16/11/95].
The current focus of the refugee programme is to improve agricultural access and subsequent productivity, water supplies and school services. New boreholes have been drilled in many of the camps, and more are planned for 1996. It is hoped that refugees will attain self-sufficiency as soon as possible. Indeed in some settlements, including Kiryandongo, food rations and dependency on external assistance have already been reduced [UNHCR Sep 95, UNHCR 16/11/95].
It is currently estimated that there are 11,800 Zairian refugees in Uganda, although this number appears to fluctuate with movements between Uganda and Zaire. It is hoped that repatriation of these refugees will be realisable in 1996 [UNHCR 16/11/95].
Overall, the nutrition and health situation for the Sudanese refugees in Uganda appears to be improving due to better food deliveries and water supplies (category IIc in Table 1). The nutritional situation for the Zairian refugees appears to remain stable (category IIc in Table 1).
(see Map 15)
Refugees in Zaire (excluding Rwandans and Burundis included in Section #4) 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.
Displaced from Shaba, Zaire There are approximately 600,000 people who have been displaced by ethnic violence in the Shaba region of Zaire 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.
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.
