1. Angola (see Map 1)
2. Benin/Ghana/Togo Region
3. Burkina Faso and Mauritania - Malian Refugees
4. Burundi/Rwanda (Great Lakes) Situation (See Map 4 and 14)
5. Central African Republic
6. Djibouti
7. Ethiopia (see Map 7)
8. Kenya (see Map 8)
9. Liberia/Sierra Leone Region (see Map 9 a, b)
10. Mozambique Region (see Map 10)
11. Somalia (see Map 11)
12. Sudan (see Map 12)
13. Uganda (see Map 13)
14. Zaire (see Map 14)
15. Zambia
Angola
Trend in numbers of displaced/war affected.
Shaded areas indicate those at heightened nutritional risk.
As peace slowly returns to Angola, more and more refugees and
displaced persons are expected to return to their homes during 1997.
Approximately 980,000 displaced and war affected people, and demobilised
soldiers currently require humanitarian assistance. The decrease in numbers
since the previous RNIS report is due to the increasing self-sufficiency of
large numbers of returnees and war affected population groups. The de-mining
process is gathering pace thereby allowing return of displaced populations to
former homes in areas such as Quincunzo and Caje. Security incidents, although
few and far between, are still being reported. Only recently, SCF closed its
Quibaxe office in Bengo province after repeated armed attacks on their
warehouse, and fighting has been reported in Cauingolo and Cubal [WFP 10/02/97,
WFP 24/01/97, 14/02/97, 28/02/97].
There are no new nutritional data on this population. Throughout 1996, a pattern emerged whereby rapidly improving nutritional status was observed following interventions in areas which had previously been cut-off from humanitarian assistance due to insecurity. The continually improving access to the countryside and freedom of movement of people and goods would indicate that the improving nutritional situation seen in 1996 will continue [DHA 31/01/97].
However, in some areas such as Cuanze Norte, Bengo and Luanda, local authorities and NGOs are concerned that irregular rainfall will result in poor maize production in the first quarter of the 1996-7 agricultural season. Furthermore, food security of some populations will also be adversely affected by the late delivery of seeds and tools at the end of last year before the planting season [DHA 31/01/97].
The focus of humanitarian agency activities during 1997 will be on rehabilitation and resettlement. Efforts will also be increased to better target food assistance. One initiative to strengthen this process has been the creation of a "vulnerability Analysis and Mapping Unit" which will work with government, NGOs and donors to collect and analyse data to identify areas of food insecurity and beneficiaries in need of assistance [WFP 24/01/97].
The main diseases reported by agencies continue to be malaria, tuberculosis and trypanosomiasis [DHA 31/01/97].
Overall, this population is not considered to be at heightened nutritional risk (category IIc in Table 1).
How could external agencies help? The improved security situation in Angola has allowed for greater access to the countryside and many needs noted in earlier RNIS reports are now being addressed. For example, programmes to immunise women and children against tetanus, polio, measles and meningitis have begun. However, more support is needed to fight trypanosorniasis, including improved vector control.
There remain approximately 13,500 assisted Togolese refugees in Benin and Ghana. Thee refugees originally fled political unrest in Togo in 1993. Repatriation began once the political situation allowed, and in 1996, 50,000 people returned to Togo from Ghana and almost 9,000 people from Benin. It is anticipated that, providing the political situation remains stable, all but a very few people will have repatriated by the end of 1997 [UNHCR 27/02/97].
This population is not considered to be at heightened nutritional risk (category IIc in Table 1). Furthermore, current funding is anticipated to be adequate for the 1997 repatriation programme [UNHCR 27/02/97].
Burkina Faso There are approximately 25,000 Malian refugees remaining in Burkina Faso [WFP 10/02/97]. There are no reports of change to what has been described as an adequate and stable nutritional status of this population.
Mauritania There remain approximately 25,000 Malian refugees in M'Berra camp in Mauritania, comprised largely of women and children, the men having already repatriated. This population is considered to be almost totally dependent on food aid, and the ration is set at 1900 kcals/person/day. Only a limited number of people have access to income either through casual employment or through income generating activities supported by agencies. The recent transfer of refugees from Bassiknou to M'Berra has doubled the refugee population in M'Berra and pressure on basic assets such as water, sanitation, gardening land, class rooms, tools and expertise for income generating activities has consequently increased. However it is expected that this pressure will gradually be reduced as repatriation proceeds. Repatriation, which is scheduled to be completed by the end of 1997, is on-going, with approximately 1,000 people returning each month [WFP 02/02/97].
This information is as of 7 March 1997.
As rebel forces make significant advances in Eastern Zaire, displaced Rwandan refugees and Zairians have been constantly on the move from one make-shift camp to another. Insecurity has prevented full access by humanitarian agencies to these camps and high levels of mortality have been recorded amongst this population. Approximately 1.3 million Rwandan refuges have returned home and although this population is facing problems of re-integration in an increasingly insecure environment, there are no reports of significant nutritional problems.
Burundi/Rwanda Region
Trend in numbers of refugees/displaced and
proportion severely malnourished and at high risk (shaded area).
High levels of insecurity in Burundi continue to lead to
population displacements and the army have rounded up some populations into
"re-groupment" camps for security reasons. There are reports of high levels of
malnutrition in some of these camps as well as camps for refugees. This is
attributed to over-crowding and unhygienic conditions as well as lack of
provision of foods due to insecurity. Over 400,000 Rwandan refugees repatriated
from Tanzania at the end of 1996 but continued insecurity in Burundi and Zaire
has led to an influx of up to 1,000-2,000 new refugees each day. The nutritional
status of these newly arriving refugees is believed to be deteriorating due to
poor water and sanitation provision and incomplete food deliveries as a result
of logistical difficulties.
Estimates of populations affected regionally are summarised in the box below:
|
Location |
Dec 95 |
Feb 96 |
Apr 96 |
Jun 96 |
Sep 96 |
Dec 96 |
Mar 97 |
|
Burundi |
504,000 |
275,400 |
290,000 |
289,000 |
300,000 |
296,000 |
300,000 |
|
Rwanda |
800,000 |
737,000 |
737,000 |
749,000 |
598,000 |
1,179,000 |
2,600,000 |
|
Tanzania |
621,000 |
653,000 |
624,000 |
642,000 |
653,000 |
759,000 |
344,000 |
|
Zaire |
1,146,000 |
1,211,000 |
1,166,000 |
1,419,000 |
1,444,000 |
668,000 |
599,000 |
|
TOTAL |
3,077,400 |
2,883,200 |
2,823,900 |
3,106,000 |
3,002,000 |
2,913,500 |
3,843,000 |
Since the conflict erupted in November 1996, makeshift camps have been established in Eastern Zaire. During January and February, refugees were regularly displaced from these makeshift camps as rebels made advances so that new camps were established in "safer" areas. In early March, the rebels took over Tingi-Tingi, which had been the most long-standing camp in the area and thousands of refugees were reported to be on the move once again towards Kisingani. International humanitarian agency staff were evacuated from Eastern Zaire at the end of February. Recognising that this population is in a constant state of flux, the best estimates of numbers affected by the conflict are as follows: 218,000 refugees whose movements have been traced in Eastern Zaire, a further 249,000 refugees are accounted for. There are also an estimated 132,000 IDPs or residents affected by the conflict in the area [WFP 07/02/97, 14/02/97, 28/02/97, IRIN 18-20/01/97].
Since early January about 2,000 refugees a day have been returning to Rwanda from South Kivu region of Eastern Zaire. Of the 143,000 Burundian refugees originally in the Uvira area, some 64,000 have arrived in Tanzania. The rate of organised and spontaneous repatriation from the Goma and Bukavu areas to Rwanda fluctuates with the security situation in these areas. As military activity escalates, refugees often flee en mass and hide in nearby forests. Way stations have been established on route for those making the arduous journey home [WFP 07/02/97, 14/02/97, 28/02/97, IRIN 18-20/01/97].
Increased military operations, commandeering of planes and trucks, evacuation of agency staff, and extremely poor road conditions have seriously hindered efforts to reach these needy populations in Eastern Zaire with food and other aid. Dozens of civilians have been killed by government air-raids over Kisingani. Security permitting, relief items are flown to Kisangani, and then transported either by road or locally chartered aircraft to where groups of refugees are gathered [WFP 03/01/97, USAID 17/02/97].
There are hardly any health and nutritional data available from this area of Eastern Zaire. There are however some data from Tingi-Tingi, whose population, until early March, was the most stable in the area. Between the end of December and third week of January daily rations only provided an average of 600 kcals/person per day in Tingi-Tingi camp. Despite the considerable efforts of agencies the crude mortality rates (CMRs) in this camps are reported to be extremely high with an estimated 40 deaths per day, mostly of children and infants. In January the CMR was estimated at 2.0/10,000/day (reaching 4/10,000/day in the second week) and the under-five mortality rate was 6.4/10,000/day (reaching 10/10,000/day in the second week of January) (see Annex I 4(a,b)). The first occasion where a near full ration was delivered was at the end of February. However, as mortality rates have continued to remain high, there has been some speculation that rations may have been appropriated by the Rwandan militia and ex-soldiers in the camps. The number of severely malnourished admitted to therapeutic feeding facilities in the camp increased dramatically towards the end of January. Furthermore, about 150 cases of diarrhoea are being diagnosed every day in Tingi-Tingi some of which are reported as being cholera cases. By mid- February 350 cases of cholera had been reported [IRIN 18-20/01/97, 26/02/97, WFP 10/01/97, 24/01/97, 31/01/97, 07/02/97, USAID 14/02/97, EPICENTRE 15/01/97, 06/02/97].
The estimated 20,000 refugees and IDPs who were in Punia, a transit point, were said to be in a very poor nutritional state and have been surviving on high energy biscuits.
However, in areas where military activities have stopped, the nutritional situation appears to have improved. An example of this is seen in areas north of Goma which was the scene of fighting and subsequent population displacements in February 1996. At that time, levels of wasting in the area were over 30%. A more recent survey showed 10.7% wasting with 3.6% severe wasting in Sake. It was noted that female-headed households suffered more malnutrition (17.3%) than male-headed households (9.6%) [MSF-H 05/03/97].
In conclusion, the present level of insecurity has meant that little data are available on the health and nutritional status of populations currently affected by conflict in Eastern Zaire. However, repeated displacements, limited access by humanitarian agencies and reports of high mortality indicate a very serious situation which is likely to be deteriorating for most of this refugee and internally displaced population. WFP has been attempting a distribution of food to 35,000 internally displaced people in Kisangani although rebel forces are now setting their sites on this critical government strong-hold [IRIN 04/03/97].
Rwanda The security situation in Rwanda, particularly in Western prefectures, is apparently deteriorating and security incidents, including attacks directed at expatriate agency staff and civilians, are continually being reported in country. For example, three Medecins du Monde staff members were shot and killed in Ruhengeri and four employees of the UN Human Rights Field Operation in Rwanda (HRFOR) were shot dead on the 4th of February 1997. These killings are the latest in a series of attacks directed against foreigners. As a result of this escalating violence, most NGO and UN staff were evacuated to Kigali and to Naiobi in February [IRIN 18-20/01/97, WFP 24/01/97, 07/02/97, 21/02/97, UNICEF 06/02/97].
Despite the deteriorating security situation, refugees continue to return. Estimates of the numbers of refugees returning to Rwanda in 1996 are 719,000 from Zaire, 88,000 from Burundi, 483,000 from Tanzania and 9,000 from Uganda. There are also approximately 6,000 Burundi refugees in Rwanda. Most of these people fled fighting in Cibitoke province in June 1996, and the Government of Rwanda has announced that these refugees must return home. In addition there are 14,000 Zairian refugees who fled the Masisi region in 1996 [IRIN 11-13/01/97, USAID 14/02/97].
It is currently estimated that 2.6 million people in Rwanda will require food aid for the first six months of 1997 This number includes recent returnees, previous returnees who will have to leave farm areas that they are currently occupying, and other vulnerable groups (e.g. widows, elderly, orphans). Despite an improved harvest compared to recent years, crop production still remains below pre-civil strife averages due largely to the lower cropped areas, low yields of pulses, and crop losses in prefectures affected by dry weather. There are two main concerns regarding food security in the coming months. First, food shortages are seen as inevitable due to the reduction in bean production coupled with a sharp increase in demand for food from returning refugees. This may lead to a deteriorating nutritional situation in areas such as Gikongoro and Butare prefectures, where crop production has been particularly poor and there are large numbers of recent returnees [FAO 23/12/96].
Secondly, although some food deliveries are still taking place, full scale distribution cannot restart until security can be guaranteed. Where distributions are possible, these have also been delayed by lack of precise information on numbers of target beneficiaries. There are therefore concerns that irregular food distributions may have a negative impact on the nutritional status of the most vulnerable groups. Furthermore, there are fears that tensions in the country, which are already high, will likely be further increased if there is not enough food available for needy populations. Responsibility for food distributions are presently being handed over from NGOs to local authorities and guidelines have been proposed to ensure effective and transparent implementation of these new systems of food allocation [IRIN 18-20/01/97, WFP 24/01/97, 07/02/97, 21/02/97, UNICEF 06/02/97].
Aid agencies warn that Rwanda will remain heavily dependent on food aid for the next few years unless donor countries concertedly attempt to rehabilitate the agricultural sector of the country. Seeds and tools are in the process of being distributed to new returnees as they are heavily dependent on food aid and have not had access to a harvest. If completed in time, these distributions will enable the majority of the returnees to plant their first crops in several years [FAO 23/12/96, IRIN 07/02/97, WFP 03/01/97].
Burundi There are at least 300,000 people in Burundi requiring emergency aid. This number is comprised of returnees, internally displaced people and 'regrouped' people - those gathered in camp-like situations for security reasons. There are an estimated 200,000 'regrouped' civilians in these special camps, set up so the army could afford protection to the civilian population in the troubled provinces of Cibitoke, Bubanza, Muramvya and Karuzi [DHA 12/02/97, WFP 07/02/97].
The volatile security situation in most parts of the country in January only allowed for sporadic relief initiatives. Land mine explosions, ambushes and killings were regularly reported, and the Burundi army admitted to killing 126 refugees who tried to escape from detention centres. However, there were signs briefly in February that the security situation was improving. Humanitarian agency activities which had been temporarily suspended, were restarted in some areas of the country [WFP 24/01/97, 31/01/97, 07/02/97, 28/02/97].
Restrictions on fuel imports due to sanctions against Burundi were threatening to further restrict humanitarian efforts. However, just recently, authorisation has been granted by the Regional Sanctions Coordinating Committee for fixed quotas of fuel to be imported for the use of UN agencies and NGOs. The quantities of fuel now approved are those initially requested, but exemption has been made for importing kerosene which is badly needed for storage and transportation of vaccines and medical supplies [WFP 24/01/97, 31/01/97, 07/02/97 28/02/97].
There are reports of the existence of pockets of severe malnutrition among people living in hills in the country side. There are also reports of severe malnutrition in some of the displaced camps, with particularly concern being expressed over conditions in Maramvya camp, near Bujumbura [IRIN 24/01/97].
A recent survey conducted in Maramvya centre (estimated population 1,300 people) showed 17.9% wasting with 7.1% severe wasting among children 6-59 months old. Oedema among this group was measured at 14.3%. 13.6% of children 5-10 years old were either wasted or oedematous. Among those over ten years old, wasting (defined as BMI<16) or oedema was 23.6% (see annex I 4(c,d)). The general ration was providing approximately 1200 kcals/person/day. Sharply elevated levels of malnutrition are seen among all age groups, and admission criteria for feeding centres have been set up to include all age groups [ACF 31/01/97].
An assessment carried out in Rukana camp for repatriated refugees from Zaire and EDPs concluded that there are likely to be elevated rates of wasting among the approximately 5,000 people in the camp. It was recommended that a general ration programme be instituted for this population, and that an anthropometric survey be carried out to more precisely define the problem [ACF 10/01/97].
Information on the re-grouped populations (estimated at 200,000 people) is that the health and nutrition situation of this population is deteriorating, due in large part to the unhygienic conditions in the camps. The number of typhus cases has soared and there has been a rise in the number of cases of diarrhoea, malaria and respiratory tract infections as well as malnutrition. In most regroupment centres residents do not have access to land and are therefore totally dependant of food aid [IRIN 12/02/97].
Reports of a cholera outbreak in southern Burundi indicated at least 150 people have been infected and ten have died [IRIN 09/01/97].
Tanzania The return of the majority of Rwandan refugees at the end of December 1996 due to a repatriation deadline imposed by the Government of Tanzania left approximately 248,000 Burundi refugees in country. Since that time, insecurity in Burundi and Zaire has led to an almost constant influx of refugees with 1-2,000 new arrivals per day. Current estimates are that there are over 344,000 Burundi and Zairian refugees in Tanzania. The Tanzanian government has insisted that all Burundian refugees living outside the camps return to them. Many refugee had moved to local villages and towns [WFP 17/01/97, 31/01/97, 14/02/97].
Relief workers in Kigoma region face a daily battle with roads frequently rendered impassable after heavy rains. Flooding on some of these roads continues to hinder operations such as the continued delivery of food, water and medical assistance, as well as the movement of refugees themselves from the holding centres to the camps.
A nutritional survey was carried out in Nyarungusu camp in Kasula district, Kigoma region for Zairian refugees (estimated population at the time 28,000) at the end of December 1996. Wasting was measured at 5.0% with 0.2% severe wasting. Oedema was measured at 0.3% (see Annex I 4(e)). The ration was providing 1900 kcals/person/day at the end of December although during November rations were often below 1300 kcals/person/day, and it was estimated that 90% of children were immunised against measles. Food basket monitoring found rather large differences between ration receipts amongst families, reflecting an inequitable distribution system. Furthermore, commodities distributed were frequently exchanged for foods that are more commonly accepted by Zairians, such as manioc and leaves [MSF-S 31/12/96].
Crude mortality rates were 1.9/10,000/day and the under-five mortality rate was 4.4/10,000/day. Both of these rates are four times normal and quite close to what is considered an emergency out of control (see box on page 4). The main reason for the high mortality rates was considered to be high levels of disease. Water availability and sanitation were found to be inadequate with only 12 litres per person per day available and too few latrines. Principal causes of death were diarrhoea, fever, anaemia, and malnutrition [MSF-S 31/12/96].
Since the survey, new refugees have continued to arrive in the district, and the overall nutritional status of the refugee population is said to have declined. Access to the camps (total population of three camps circa 111,000) is difficult, particularly in the current rainy season. Food and non-food deliveries arc therefore not regular and the ration has only been providing 1200 kcals/person/day in recent weeks [UNHCR 22/02/97].
There is no new information on the Burundi refugees in the Ngara region of Tanzania.
Overall, those who were in Tingi-Tingi I and II with high mortality rates are in category I in Table 1. The remaining population in Eastern Zaire requiring humanitarian assistance can be considered to be at high risk (category IIa in Table 1) due to insecurity and resulting inaccessibility. Those in Burundi in regroupment camps are also likely to be at high risk due to a lack of clean water and sanitation, evidenced by increasing morbidity. The returnees in Maramvya centre are in category I in Table 1 due to sharply elevated levels of wasting and oedema. The returnee population in Rwanda along with the remaining population in Burundi requiring humanitarian assistance are likely to be at moderate risk (category IIb in Table 1).
The refugees in Nyarungusu camp, Kasula district in Kigoma in Tanzania are at high risk (category I in Table 1), and the remaining refugees in Kigoma are probably at heightened risk (category IIa in Table 1). The refugees in Ngara district are probably not currently at heightened nutritional risk (category IIc in Table 1).
How can external agencies help? The high level of insecurity and lack of agency presence in Eastern Zaire is preventing full access to refugee and internally displaced populations so that there is only partial information on their nutritional and health condition. It is however clear that many thousands are in a desperate situation. At present, agencies can work toward a high state of preparedness for assessment and response as and when security allows. Consideration should be given to the creation of corridors for humanitarian assistance, with guarantees of safety for refugees, IDPs and agency personnel.
In Rwanda, there is a need for establishing nutritional and mortality surveillance at commune level. This is particularly important given the large numbers of returnees in certain prefectures and the adverse effects of insecurity on delivery of assistance and support to these returning populations. Efforts to strengthen health care provision to these populations must also be supported.
In Burundi, camps for the displaced and regrouped populations need to be carefully monitored as there are reports of deteriorating nutritional and health status amongst these populations. Water and sanitation provision for these camps must be improved and where over-crowding is contributing to high levels of disease, alternative camps must be established. Efforts should be made to ensure that the embargo on kerosene is lifted.
In Kigoma region of Tanzania high levels of mortality in the refugee camps are being attributed to inadequate supplies of water and poor sanitation. There is therefore an urgent need to improve the provision of water and latrines. In Nyaraguso camp the unequal receipts of general rations suggest the need for on-going food basket monitoring and review of the current general ration distribution system. If necessary, this system may need to be modified to ensure greater equity.
There are approximately 32,400 assisted Sudanese and Chadian refugees in the Central African Republic, this total number is comprised of 5,000 Chadian refugees and 27,400 Sudanese refugees [UNHCR 27/02/97],
The number of Sudanese refugees has increased due to a small influx of refugees from the camps in Eastern Zaire. These refugees had been living in refugee camps in Zaire for many years and are now fleeing righting in Eastern Zaire. There are a small number (perhaps 50) who have newly crossed into the CAR. These people are not seeking refugee status, and are expected to return home shortly [UNHCR 27/02/97].
There are no reports of change to what has been described as an adequate and stable nutritional situation for these refugees (category IIc in Table 1).
There are 2,500 Somali and Ethiopian refugees in Djibouti requiring assistance. There are no current details on the nutritional status of this refugee population.
There are an estimated 532,500 assisted refugees in Ethiopia. This total number is comprised of 77,800 Sudanese refugees, 287,000 Somali refugees, 8,700 Kenyan refugees, 18,000 Djibouti refugees, 11,000 internally displaced people around Addis Ababa and an additional 130,000 people in the Dolo region.
A recent intensification of fighting in Sudan, near the Ethiopian border has led to an influx of at least 5,800 people into western Ethiopia. These new arrivals were reportedly in a desperate state. Wasting was measured at 31% with 13% severe wasting (see Annex I 7(a)). The crude mortality rate was estimated at 5.0/10,000/day and the under-five rate was estimated at 10/10,000/day. Both of these rates are ten times normal. These refugees were depending on wild foods for their survival [UNHCR Dec 96, 24/02/97].
In response to this situation, supplementary feeding programmes were set up and targeted to all children under five years old, the severally ill, the elderly, and pregnant and lactating women. In addition, plans are underway for a measles immunisation campaign which will include the distribution of vitamin A. More recent reports indicate that the condition of these new arrivals has improved [UNHCR Dec 96, 24/02/97].
There remain approximately 287,000 assisted Somali refugees in Ethiopia. Repatriation of these refugees has begun with 200 people returning in February 1997. Blanket selective feeding programmes for all under fives which were introduced following a survey in May 1996 that showed a poor nutritional situation, are continuing in all the camps for Somali refugees in the East. These programmes are said to be running well. The drought, which is currently affecting the entire region, has resulted in a water shortage in these camp [UNHCR 18/02/97, 24/02/97],
A household food economy assessment conducted by SCF towards the end of 1996 in Kebri Beyah refugee camp has provided information on the food security of this refugee population and may also describe some aspect of the food security situation in other nearby camps. The assessment found that as food distributions have been irregular, providing less than 100% of caloric needs over the year, and each family has had to develop income generating strategies in order to survive. As most families lacked any capital for starting up a business, most of these activities are small scale and opportunistic, e.g. selling firewood, making charcoal and working for local people [SCF Oct. 96],
The main sources of food for this population are the general ration and food purchased on the market which together account for 88-96% of total caloric intake. Another source of food is a blanket feeding programme which provides approximately 6% of an average household's food needs for each child registered in the programme. This programme also appears to have resulted in a reduction in malnutrition rates which were observed to be very high in May 1996 [SCF Oct. 96].
A recent assessment in the Dollo region of Ethiopia, fielded in response to reports of influxes of Somali refugees into the area, concluded that there is a population of approximately 40,000 in need of humanitarian aid. There are a further 90,000 nomads who are fleeing drought in Northern Kenya. Aid will provided to this mixed group [UNHCR 24/02/97]
Overall, the newly arrived Sudanese refugees can be considered to be at moderate risk. The remaining Sudanese refuges, and those from Kenya and Djibouti are probably not at heightened risk (category IIc in table 1). The Somalia refugees in the Eastern camps can be considered to be at heightened risk (category IIa in table 1) due to a water shortage caused by the drought in the region. Little is known about the nutritional status of the newly identified population in the Dollo region.
How could external agencies help? Per capita water availability in the Eastern camps for Somali refugees needs to be assessed given the current drought. If appropriate, water provision may need to be increased. There are an absence of specialist medical staff in the Somali refugee programme which is compromising health service provision. Every effort must be made to strengthen the staffing component of this programme.
In Kebri Beyah, the effects of any developments which may negatively affect income sources for refugees, e.g. poor harvest or cross border trade restrictions, should be closely monitored through regular market price data collection and appropriate action taken to support income generation activities where necessary. Credit programmes for women combined with appropriate skills training or education could serve to create alternatives to the increasingly difficult and low-income activities employed by this refugee population.
There are approximately 166,000 refugees in Kenya requiring humanitarian assistance. This population is comprised mainly of 4,000 Ethiopian, 130,000 Somali and 32,000 Sudanese refugees.
The health and nutrition situation of the Somali refugees in the Dadaab area camps (total estimated population 114,000) has markedly deteriorated over the past six months, leading to what is being described as a nutritional emergency. Problems with the food supply and the distribution systems in the camps have been identified as primary factors contributing to the increased levels of wasting being seen. Since June 1996, there have been problems with the supply of beans and the average number of kcals/person/day supplied in the general ration has been less than 1700. The general ration has not contained blended foods or sugar, despite recommendations made following an assessment mission in October 1996 to include these foods in the general ration. An increase in the incidence of diarrhoeal disease and malaria may also be influencing nutritional status. Furthermore, some cholera cases have been confirmed in the last few months [MSF-B 31/01/97, WFP 11/02/97].
A recent survey in Ifo camp showed 33.3% wasting with 6.7% severe wasting (see Annex I 8(a)). The general ration provided approximately 1,850 kcals/person/day in November 1996 and 1700 kcals/person/day in December 1996. The under-five mortality rate was 5/10,000/day in January 1997 (5x normal). Coverage of the therapeutic feeding programme was only 63% [MSF -B 31/01/97].
In Dagahaley camp wasting was measured at 31.4% with 6.7% severe wasting (see Annex I 8(b)). The general ration in November 1996 provided just over 1900 kcals/person/day and in December 1700 kcals/person/day. The under-five mortality rate was 3.6/10,000/day (over 3x normal). Coverage of the therapeutic feeding programme was only 56% [MSF-B 31/01/97].
Wasting in Hagadera was measured at 26.0% with 5.3% severe wasting (see Annex I 8(c)). Rations provided approximately 1900 kcals/person/day in October and November 1996 and 1650 kcals/person/day in December. The under-five mortality rate was 3.5/10,000/day in December (over 3x normal). Coverage of the therapeutic feeding programme was 70% [MSF-B 31/01/97].
Scurvy is a seasonal problem in this area and has been regularly reported during the September-January period in 1993, 1994, 1995 and again in 1996 [RNIS 2. 8, 17, 18). However, the number of new scurvy cases in the three camps began to decline in December 1996. This was probably due in part to the distribution of vitamin C tablets to the refugee population. It had been recognised that CSB does not greatly affect the seasonal incidence of scurvy in these camps so that planned distributions were only for the dry season period (May to October) with attempts to provide or increase the availability of fresh fruits and vegetables for the remaining six months of the year. The nutritional surveys cited above also reported the presence of vitamin A deficiency and a very large number of anaemia cases [MSF-B 31/01/97].
A number of steps have so far been taken to redress this serious nutritional situation. Attempts have been made to procure maize and beans locally for the general ration to ensure more reliable deliveries. However, the current drought in the region has somewhat thwarted this initiative. Another initiative has been the establishment of blanket selective feeding with com soy blend for all children under five and pregnant and lactating women [WFP 21/02/97, UNHCR-a 27/02/97].
There remain approximately 16,000 Somali refugees in three camps on the coast of Kenya. These camps were supposed to be closed by the end of 1996, with refugees either repatriating or being moved to the camps in the north-east of Kenya. However, this deadline was not met. Currently a food basket of pulses, cereals, vegetable oil and salt is being distributed to this refugee population and targeted supplementary feeding programmes are distributing a fortified blended food, sugar and oil. An outstanding problem in these camps is the existence of a large, unregistered population who do not benefit from the general ration. It is believed that many of the malnourished who are admitted to the supplementary feeding programme, come from this unregistered population [IFRC 11/02/97].
A recent assessment in Kakuma camp (estimated population 32,000 Sudanese refugees) revealed a very high rate of severe anaemia amongst boys aged between 8-20 years. This unusually high incidence was attributed to a number of factors. Many of this "teenage" population were effectively unaccompanied minors with little linkage to the household economies in the camp. Furthermore, the average per capita kilo calorie requirements for this age group (2200 kcals) were not being met by the 1900 kcals general ration. Also, the general ration was deficient in absorbable iron and vitamin C (which is essential for the absorption of iron) [WFP 07/02/97].
Other factors were that a recent re-registration had reduced the number of excess ration cards in the camp (many of which were previously held by this group) and a high proportion of the unaccompanied minors were known to be selling off a part of their general ration in order to purchase essential non-food items. High levels of intestinal worm infestation amongst this age group may also have been contributing to this unusual pattern of severe anaemia. A school feeding programme utilising CSB has been recommended in response to this serious nutritional problem. As Kakuma camp has a high rate of school enrolment this strategy should be effective in ensuring an increased intake of absorbable iron amongst this target group [WFP 07/02/97].
Overall, the Somali refugees in the Dadaab camps are at high risk (category I in Table 1) while the refugees in the coastal camps are not currently considered to be at heightened risk (category IIc in Table 1). The marginalised population identified as having very high rates of severe anaemia in Kakuma camp are at high risk while the remaining Sudanese and Ethiopian refugees are not at heightened risk (category IIc in Table 1).
How could external agencies help? Some of the proposed actions to remedy the situation in the Dadaab area camps which are currently under consideration include:
· supplying
vitamin A enriched oil and fortified blended foods in the general ration to
reduce micronutrient deficiency diseases;
· increase the general ration to
2100 kcals/person/day;
· determine any social causes of malnutrition;
·
investigate reasons for poor coverage of therapeutic feeding programmes and
increase coverage of the therapeutic feeding programmes through appropriate
measures, e.g. better outreach activities.
These interventions, where implemented, would need financial
support. The newly established blanket supplementary feeding programmes will
also need to be evaluated in the near future in order to determine whether rates
of wasting are declining as a result of this measure.
In the coastal camps there is an urgent need to register "unregistered" individuals so that they can obtain the food and non-food resources to which they are entitled.
In Kakuma camp the effects of the newly introduced school feeding programme on rates of severe anaemia amongst males aged 8-20 years of age should be closely monitored. In the event that this strategy fails to have a marked impact on the problem, then other strategies, e.g. improving the general ration food basket, should be considered.
Continuing peace in Liberia is allowing the return of many internally displaced people and some refugees to their villages. It is also allowing access by humanitarian agencies to previously inaccessible areas and the implementation of emergency interventions where need dictates. The peace process also appears to be progressing in Sierra Leone with a relatively stable security situation allowing improved access to needy populations leading to marked improvements in their nutritional situation. If peace holds, it is expected that large numbers of IDPs and refugees will return home during 1997 and aid programmes are already beginning to shift their focus from emergency relief to resettlement and rehabilitation programmes.
Liberia/Sierra Leone
Trend in numbers of refugees/displaced and
proportion severely malnourished and at high risk (shaded area).
Current estimates of the numbers of people affected in the
region are summarised below:
|
Location |
Dec 95 |
Feb 96 |
Apr 96 |
Jun 96 |
Sep 96 |
Dec 96 |
Mar 97 |
|
Liberia |
1,900,000 |
1,800,000 |
1,800,000 |
1,800,000 |
1,800,000 |
1,800,000 |
1,100,000 |
|
Sierra Leone |
730,000 |
730,000 |
756,000 |
756,000 |
609,000 |
609,000 |
548,000 |
|
Cote d'Ivoire |
305,000 |
305,000 |
305,000 |
305,000 |
305,000 |
305,000 |
305,000 |
|
Guinea |
605,000 |
605,000 |
536,000 |
536,000 |
536,000 |
536,000 |
536,000 |
|
TOTAL |
3,540,000 |
3,440,000 |
3,397,000 |
3,397,000 |
3,250,000 |
3,250,000 |
2,489,000 |
Food aid will be needed for approximately 1.1 million people in Liberia in 1997. Much of this food aid will be utilised to assist returning refugees, and IDPs. Despite hostilities during 1996, the rice crop was substantially greater than in 1995, due largely to improved security in the two main producing areas of Liberia. This enabled various NGOs to distribute seed and tools to farmers. Rice production overall was estimated to be 30% of pre-war production levels [FAO 03/01/97].
As the security situation improves, areas that were previously cut-off have become accessible to humanitarian organisations. For example, Zwedru had been cut of for at least eight months but recently became accessible to outside agencies. Following a rapid assessment, it became apparent that the resident population had little food, there was no market activity, water supplies were unsafe and there were no health clinics. The population is forced to forage in the bush for wild foods. There is a clear need for assistance to this population, although the overwhelming presence of LPC (Liberia Peace Council, a rebel group) fighters who are in control of the town make the delivery of such assistance problematic [DHA 15/01/97, WV 16/01/97].
There are no new nutritional survey results available but there are reports of a high incidence of malnutrition in Maryland country and cases of cholera were also reported [DHA 05/02/97].
Sierra Leone Despite some security incidents, e.g. clashes between Kamajors and government soldiers in Moyamba and Bonthe districts, the peace process in Sierra Leone appears to be moving forward. There has been a generally stable security situation in recent weeks and many observers are optimistic that this situation will endure. These events have set the stage for the demobilisation process to begin in February 1997 and significant numbers of internally displaced people are returning home. Aid programmes in Sierra Leone are beginning to shift their focus from emergency relief to resettlement and rehabilitation. The general ration programme was stopped at the end of 1996. There remain approximately 548,000 people in need of emergency assistance in Sierra Leone [WFP 10/02/97].
If the reigning peace in the country holds, it is feasible that most, if not all, of the internally displaced population (IDPs) could return home in 1997. Furthermore, initial plans are being made for the repatriation of the approximately 375,000 Sierra Leonean refugees in neighbouring countries. Food aid will be a critical component in supporting the processes of resettlement, reconstruction and rehabilitation. A one to three month ration will be provided to returning IDPs, while targeted feeding programmes, including therapeutic feeding, school feeding and food-for work will be established. Food for work activities will be implemented to aid in the reconstruction of village infrastructure and support agricultural production [FAO 15/01/97, UNHCR 17/01/97, WFP 24/01/97].
The relative peace in the country has allowed for improved access to needy populations. This has generally had a positive impact on the nutritional status of many populations. For example, a recent survey in Segbwema town in Kailahun district (estimated population 117,000) showed 5.6% wasting and/or oedema with 1.4% severe wasting and/or oedema. This compares favourably with a previous survey carried out in July 1996 when wasting and/or oedema were measured at 11.1% (see Annex I 9(a,b)). It should however be noted that the recent survey was conducted following what was described as a good harvest and that many of the displaced maintained some access to land for farming. The survey did indicate a low measles immunisation coverage of only 41% [CONCERN 06/12/96].
The majority of people fleeing the fighting in Sierra Leone moved to Bo and Freetown. It is estimated that 400,000 people went to the capital, approximately 300,000 of whom were living in camps. The remaining 100,000 people were living among the resident population. A nutritional survey conducted in January 1996 showed 7.6% wasting and/or oedema amongst the displaced living in Freetown, so that food aid was discontinued. A follow up survey was conducted in December 1996 to assess the nutritional status of this population since the discontinuation of food aid. Wasting was measured at 5.5% with 0.8% severe wasting. No cases of oedema were seen (see Annex 1 9(c)). Only 14% of malnourished children were enrolled in the selective feeding programmes while measles immunisation coverage was estimated at 53% [ACF Dec 96].
Government soldiers have recently rescued some 700 unaccompanied children living in the forest in Kailahun district. The children aged 9-15 apparently fled rebel attacks four years ago and are reported to be severely malnourished [WFP 28/02/97].
A major concern as displaced people return home will be the support necessary to resume farming activities. Returnees will require seeds, tools and other farm inputs to resume production. These families will also need food aid support until the next viable harvest in the second half of 1997. Such support is already being provided, as far as security has allowed, and will need to be continued and expanded to meet the needs of a growing returnee population [FAO 15/01/97].
Guinea There remain approximately 650,000 Liberia and Sierra Leonean refugees in Guinea, 536,000 of whom are assisted with emergency food aid. There are no reports of change to the generally adequate health and nutritional status of this population.
Cote d'Ivoire There remain approximately 305,000 Liberian refugees in Cote d'lvoire. There are no reports of change to the generally adequate health and nutritional status of this population.
Overall, those in Liberia, along with internally displaced in Segbwema and Freetown in Sierra Leone can be considered to be at moderate nutritional risk (category IIb in Table 1), as are the children newly emerged from the forest. The remaining affected population in the region is not currently thought to be at heightened nutritional risk (category IIc in Table 1).
How could external agencies help? There is an on-going need in Liberia to reactivate health centres and rebuild bridges to enhance the movement of relief and rehabilitation material throughout the country. The need for expanding the immunisation programmes is beginning to be addressed as security permits. Specific needs have been identified in Rivercess country. These include improving the drug supply, dispatch of a tuberculosis health team, improving immunisation coverage and improvements in the water supply and sanitation facilities.
Throughout Sierra Leone a priority must be to support returnees in re-establishing themselves in the agricultural sector. Furthermore, immunisation coverage must be improved nationally. This should now be feasible given the current positive security environment. More specifically, immunisation coverage must be improved in Segbwema while in Freetown facilities for therapeutic feeding should be expanded and coverage improved, if possible, through home visiting and referrals from mother child health centres and health units. The vaccination programme must also be continued with efforts made to increasingly sensitise mothers to the importance of immunisation.
Emergency food assistance is currently being provided to 162,600 returnees and internally displaced people in Mozambique, mostly concentrated in Tete, Gaza and Maputo provinces. This assistance will be continued until the harvest in April 1997 when it is assumed that these returnees will have achieved self-sufficiency. However, as this is the "hungry period" just before the harvest when foods stocks for many have run out, food aid to this group is currently a priority. A food security assessment conducted in mid-1996 indicated that over 10% of families in Mozambique do not have sufficient production or income to guarantee access to food and that at least half of these families will experience prolonged shortage of food each year. [WFP 10/02/97, MSF-CIS Dec 96].
Mozambique
Trend in numbers of returnees and
demobilised soldiers.
The nutritional and health situation in some districts in Tete
province has been described as worrying. Some cases of pellagra, which are
probably seasonal in nature, were noted in September. However, by October, the
number of cases had begun to decrease. Nutrition education programmes to prevent
these apparently seasonal outbreaks from occurring, are ongoing. In addition
some cases of measles were reported [MSF-CIS Dec 96].
Severe flooding has been reported in some provinces in central and north western Mozambique. Among those provinces affected are Tete, an area with many returnees still dependent on food aid. An estimated 400,000 people have been affected and emergency operations are underway. Road communications are very difficult and preliminary reports indicate that food stocks seem to be running out. Weather forecasts suggest that heavy rains are set to continue until April [DHA 21/02/97].
Overall, this population is not currently considered to be at heightened nutritional risk (category IIc in Table 1).
How could external agencies help? Sporadic cases of measles which are reported in Mozambique indicate a need for improved immunisation coverage. However, as access for immunisation programmes is difficult in many of the districts where outbreaks are reported, an initial step requires that road infrastructure be improved.
Extensive field based discussions between UN agencies, NGOs, donors and Somalis has recently generated an innovative "Strategic Framework for Humanitarian Assistance" for Somalia. This framework takes into account the varied needs and operating environments in areas of the country; those in crisis, in transition and in recovery. The common country strategy focuses on:
· emergency assistance;
· reintegration of internally displaced people;
· refugees and returnees from abroad;
· rehabilitation and;
· governance.
Somalia
Trend in numbers of returnees and
internally displaced with proportion severely malnourished or at high
nutritional risk in shaded area.
Food assistance will be used to support these activities.
There are an estimated 200,000-400,000 internally displaced people in Somalia.
Most of these people are living in temporary camps and are considered to be very
vulnerable [DHA 16/12/96].
The security situation in Somalia remains volatile. The most intense fighting seen since 1992 rocked South Mogadishu towards the end of December 1996 with over 300 deaths and 1400 casualties reported. Many families fled the city and surrounding areas as a result of this fighting. Mogadishu was relatively quiet in January. Other security incidents have recently been reported in border towns of Gedo region and in the Mogambo area of Juba Valley [DHA-a 15/01/97].
An evaluation of the 1996/7 Deyr crop at the end of last year estimated that cereal production was roughly 45% less than the previous year's Deyr harvest and that within the rainfed areas, Bay and Lower Shabelle regions were the most adversely affected.
There are now reports of drought in Southern Somalia and WFP is pre-positioning food in order to be prepared to respond quickly to possible emergency food aid needs. However, the food security situation for most of this population appears adequate until May. There are reasonable food reserves and food availability on the local markets is good. Furthermore, there are many traditional coping strategies that can be employed, including remittances from abroad, sale and slaughter of livestock, foraging for wild fruits and casual labour. [WFP 24/01/97, 21/02/97]. There are no reports to date of any substantial drought induced displacements in the area although there have been small-scale movements in Sanaag, Bay, Hiran and Bakool regions.
There are few nutritional data currently on the Somali population. One recent survey carried out in Hiran region showed 22.4% wasting and/or oedema with 3.8% severe wasting and/or oedema (see Annex I 11 (a)). This compares unfavourably with a survey carried out in the same region in August 1996 when wasting and/or oedema was measured at 13.4%. Children of farmers with access to river irrigation showed less malnutrition than those dependent on rain fed agriculture. Children of pastoralists seemed to be least malnourished possibly reflecting continual access to milk. Crop assessments in the region indicate a worrying situation with poor and scattered rainfall, which would indicate a need to closely monitor families dependant of rain fed agriculture [DHA-a 15/01/97, FSAU 23/12/96].
A few cases of cholera have recently been reported in Mogadishu city but there have been no confirmed cases in any other part of the country. A cholera task force involving UN agencies, NGOs, local authorities and communities has been extremely proactive in putting into place effective public information, sanitation and case management programmes [DHA-a 15/01/97]
Overall, the population in southern Somalia can be considered to be at moderate nutritional risk (category IIb in Table 1) as many are being forced to employ traditional coping strategies in order to mitigate the effects of crop failure.
How could external agencies help? Over the coming months it is imperative that there is close monitoring of the evolving food security situation. Particular attention must be paid to people's access to food (purchasing power). It may be that areas most severely affected by drought and crop failure should be targeted and that interventions to be considered should include using food aid cereals for sale at market prices and establishing food for work projects.
Total cereal production in Sudan for the 1996/7 cropping season is predicted to increase substantially compared to last year and to be greater than the excellent crop of 1994/5. However, the situation in certain areas, namely Darfur, Kordofan, the Red Sea State and the south as a whole is believed to be precarious as these are food deficit regions.
Sudan
Emergency food aid will be needed for an estimated 2.8 million displaced and war-affected people. This total number is comprised of 2.2 million people in Southern Sudan (an increase of 300,000), 374,000 in the transitional zone, 78,000 in Khartoum and the White Nile states, and approximately 138,000 Eritrean and Ethiopian refugees [FAO 19/12/96, WFP 21/02/96].
Displaced around Khartoum Access to the displaced populations living in camps around Khartoum improved slightly in 1996, allowing therapeutic and supplementary feeding programmes to be established. There are anecdotal reports of an improving vitamin A status amongst this population, but no recent assessment results available to confirm this [DHA 1997].
Southern Sudan Emergency relief has been delivered to about 2,000 new returnees from Zaire fleeing the escalating fighting in Eastern Zaire. These returnees, who had originally fled fighting in southern Sudan in 1990-1, have settled in three camps in the Madiri area of Western Equatoria. An assessment team found that the returnees "looked reasonably well-nourished, but were weak and hungry from their journey". They had returned with very little food, mainly cassava and sweet potato, most of which had run out. In neighbouring Mundri county a further 8,000 people have been displaced by fighting between the SPLA and Sudanese government during 1996. This population are reported to be in a serious condition [OLS 04/02/97].
As has been seen in Southern Sudan in past years, findings of recent assessments and surveys indicate a variable nutritional situation amongst resident and displaced populations.
An assessment carried out in January 1997 found a satisfactory health and nutritional situation in Wau town and the nearby camps for the internally displaced. Levels of wasting were measured at 10% (see Annex I 12(a)), although caution was advised as the "hungry season" begins in March and this period is usually when high levels of diarrhoeal disease and eye infections occur due to deteriorating sanitary conditions. Furthermore, the groundnut harvest, a staple food in the area, was adversely affected by a long dry spell. Interventions currently underway to maintain availability of foods on the market might mitigate the worst effects of this situation but agencies are anticipating a decline in nutritional status in Wau town, Eastern Bank and Marial and Ajith camps in the coming months [OLS 23/01/97],
A recent assessment in Sidra camp in South Kordofan found that the nutritional status of children under five was deteriorating due to lack of food at household level and poor health. Over a third of children at the supplementary feeding centre were found to be re-admissions [OLS 23/01/97].
An outbreak of measles has been reported in Tonj Country with between 200-400 cases identified [OLS 28/01/97].
Red Sea State The last RNIS report described a deteriorating situation for the populations in Sinkat and Tokar provinces. Levels of wasting were 48% and 30% respectively and micronutrient deficiency diseases were also noted.
Extremely high levels of malnutrition and loss of traditional coping strategies coupled with the effects of severe drought, demanded immediate intervention. The risk of mortality amongst these populations was already extremely high and likely to increase in the event of large numbers becoming displaced and gathering in over crowded camps. However, appeals for funds to begin a general ration programme designed not only to improve the nutrition situation but also to prevent widespread population displacements, have gone largely unheeded. Supplementary feeding programmes have been set up but it is felt that these will not address the root causes of the declining nutritional status of this population.
Refugees from Ethiopia and Eritrea There are approximately 138,000 assisted Ethiopian and Eritrean refugees in Eastern Sudan. Thee refugees are housed in four large reception centres, and a further twenty settlements. Repatriation efforts are on-going with the most recent repatriation taking place in the first half of 1996 when over 27,000 Ethiopian refugees returned to Ethiopia [UNHCR 05/12/96, 28/01/97].
Crude mortality rates in December 1996 were measured at 0.22/10,000/day and the under-five rate was 0.43/10,000/day. Nutrition surveys are carried out among this population on an annual basis; the most recent round being conducted in December 1996. Preliminary results of the surveys show levels of wasting in two of the bigger reception centres as being the highest - 15.7% and 14.4%. These levels of wasting had not changed since the 1995 surveys. The remaining settlements showed levels of wasting varying from 3.2% to 12.5% (see Annex I 12(b-i)). Results from five of the settlements are not yet available [UNHCR 05/12/96, 28/01/97].
Overall, the internally displaced populations around Khartoum can be considered to be at moderate risk. The affected populations in Southern Sudan can be considered to be at moderate nutritional risk, although there are likely to be pockets of high risk. The displaced in the Red Sea Hills are at high risk. Refugees from Ethiopia and Eritrea can be considered to be at moderate risk (category IIb in Table 1) with some camps reporting elevated levels of wasting.
How could external agencies help? A recently launched Consolidated Inter-Agency Appeal for Sudan highlights some areas to be strengthened during 1997. Financial support is being sought for these proposed activities. Some of these include:
· continued
food assistance to vulnerable groups, particularly those in southern Sudan
during the "hunger gap" of April-July;
·
improvement of sanitation and supply of safe drinking water in the displaced
camps around Khartoum;
· the continued supply of
essential drugs for the displaced camps around Khartoum;
·
improved co-ordination between UN, NGO and Sudanese authorities in implementing
programmes for the displaced around Khartoum and;
· expanded immunisation coverage
programmes for this population.
Red Sea Hills Urgent intervention measures, most of
which were outlined in the previous RNIS report, are needed to deal with the
existing emergency to prevent further displacement. Supplementary feeding
programmes have already been initiated, but other high priority interventions
which need to be implemented include:
For the displaced:
· a general
ration of 440 gms cereal, 50 gms pulses, 20 gms of oil and 50 gms of fortified
blended foods;
· vitamin A capsule
distributions;
· immunisation campaigns against measles as coverage is currently so low;
· shelter and blanket provision for Sinkat province.
Assistance to rural areas should
include:
· adequate general rations for
all those in rural areas and rural towns;
·
support for the destitute during the current agricultural season, e.g. transport
to areas of cultivable land and provision of agricultural inputs;
· strengthening health care
provision in rural areas.
There are approximately 468,000 refugees and internally displaced people in Uganda requiring humanitarian food aid assistance. This number is broken down by country of origin in the box below. There are approximately 50,000 unassisted refugees in Uganda, not included in the tables in this report.
|
Origin |
Dec 95 |
Feb 96 |
Apr 96 |
Jun 96 |
Sep 96 |
Dec 96 |
Mar 97 |
|
Sudanese Refugees |
217,000 |
210,000 |
214,000 |
214,000 |
214,000 |
214,000 |
225,000 |
|
Internally Displaced Ugandans |
-- |
-- |
-- |
-- |
20,000 |
200,000 |
200,000 |
|
Rwandan Refugees (formerly included in Section
#4) |
6,400 |
6,800 |
6,900 |
7,000 |
7,000 |
11,500 |
14,500 |
|
Zairian Refugees |
11,800 |
12,300 |
12,300 |
12,300 |
15,800 |
15,800 |
28,800 |
|
TOTAL |
235,200 |
229,100 |
233,200 |
233,300 |
256,800 |
441,300 |
468,300 |
Humanitarian agencies have been providing assistance to Sudanese refugees in northern Uganda since the first influx in 1988. There are currently 225,000 Sudanese refugees in Northern Uganda. Despite land allocations by the Ugandan government in some areas, insecurity in the settlements prevent refugees from working the land and reaching self-sufficiency. Approximately, 90,000 refugees still remain in camps without access to land for cultivation. The food pipeline for this refugee population remains precarious and contributions are still urgently needed for grain, oil, sugar, pulses, blended foods, and salt [UNHCR 07/03/97, WFP 31/01/97].
A survey carried out in Mongola settlement in northern Uganda (estimated population 10,000) for Sudanese refugees indicated a deteriorating nutritional trend. Wasting was measured at 11.9% with 1.5% severe wasting. Oedema was measured at 2.0% (see Annex I 13(a)). This survey begins to show a deteriorating trend when compared to a survey carried out in April 1996 where levels of wasting and/or oedema were measured at 8.7%. This apparent deterioration may be explained by the fact that the insecurity in the area led to half rations of cereals being allocated since July 1996. Furthermore, refugees in Mongola are entitled to receive a habitation plot as well as fanning land. This allocation of land is supposed to provide the opportunity to reach self-sufficiency through agricultural production. However, at the time of the survey barely 20% of the refugees had received their farming land. The survey also established that only 40% of malnourished children were enrolled on selective feeding programmes. Measles immunisation coverage was 82% [ACF 08/12/96].
Refugees in Oligi/Ogujebe transit camps have also only received half rations for the past six months as have refugees in Palorinya settlements. There have been no recent nutritional surveys of these populations, but as with Mongola settlement, a deterioration in nutritional status is likely to have occurred [ACF 08/12/96],
There are approximately 14,500 Rwandan refugees in Uganda (formerly included in section#4). This number includes 4,000 people who arrived from Tanzania when the camps were closed [UNHCR 07/03/97].
There are almost 28,800 Zairian refugees in Uganda. Many of these people (12,800 people) have been in settlements in the West for many years. There are 20,000 new arrivals, fleeing insecurity in Eastern Zaire [UNHCR 07/03/97]. No nutritional details are available for these new arrivals.
Overall, the refugees and IDPs in northern Uganda are at heightened risk (category IIa in Table 1) due to insecurity. The Rwandan refugees and the Zairians who are not newly arrived are not currently considered to be at heightened nutritional risk (category IIc in Table 1). There is no nutritional information currently available on the newly arrived Zairian refugees (category III in Table 1)
How could external agencies help? The increasing numbers of internally displaced in northern Uganda in need of humanitarian assistance is placing a strain on humanitarian agency resources and capacity to respond. Pressing needs for this displaced population include shelter materials (plastic sheeting), essential drugs and an improved water supply (drilling of boreholes).
Food aid pledges are urgently needed for the Sudanese refugee population in northern Uganda. In Mongola settlement needs include improved coverage of selective feeding programmes, resumption of full general rations and improved access to land. There is also a need to supply F100 milk for those in therapeutic feeding and to introduce home visiting to identify malnourished children as well as monitoring of new arrival children in order to refer some to feeding centres, if necessary. Agencies should continue to monitor food security of this population in order to check on their degree of self-sufficiency and to make recommendations for eventual phasing out of general ration.
Nutritional surveys are required in the refugee transit camps and Palorinya as only half rations have been supplied for last six months of 1996 and it is quite possible that nutritional status has deteriorated as a result.
Refugees in Zaire (excluding Rwandans and Burundis included in section #4). There are an estimated 50,000 Angolan refugees in Zaire; It is also estimated that a further 119,000 Angolans are unassisted (and not included in tables 1 and 2). It is hoped that most of the assisted population will spontaneously return to Angola now that there has been such a marked improvement in the political and security situation. Organised repatriation for the 50,000 assisted refugees is scheduled to begin by mid 1997. There are approximately 94,000 Sudanese refugees receiving some assistance in Zaire.
Displaced from Shaba, Zaire There are approximately 600,000 people who have been displaced by ethnic violence which erupted in the Shaba region at the end of 1992. This population fled north into the Kasai region where many had ancestral links. During the migration large numbers stopped temporarily in villages along the route north, while others settled permanently at these sites. Currently, there is little further displacement from the Shaba region and based on the most recent set of nutritional survey information, it is believed that many of these people are self-sufficient and no longer require humanitarian aid. The exception to this is in Mwene Ditu where critically high levels of wasting of about 43% in the displaced population, estimated at 40,000 people, and 17% wasting in the resident population (estimated at 220,000) were reported [MSF-B 09/04/96 - RNIS #15].
However, as fighting in Eastern Zaire moves further into the interior of Zaire, this already vulnerable displaced population could experience increasing hardship.
Overall, the displaced and resident affected populations in Mwene Ditu are in category 1 in Table 1 due to elevated levels of wasting. The remaining displaced population from Shaba are no longer considered to require assistance ad so are not included in Table 1. The refugees are not currently considered to be at heightened nutritional risk (category IIc in table 1).
There are approximately 5,000 new arrivals from Zaire who are fleeing the fighting in the East of the country. However, most of these people are not asking for refugee status and are expected to return shortly to Zaire [UNHCR 27/02/97, USAID 07/02/97].
In addition, there are 6,500 assisted Angolan and Zairian refugees in Zambia [WFP 10/02/97].
