Sub-Saharan Africa

1. Angola
2. Burundi/Rwanda (Great Lakes) Region
3. Djibouti
4. Ethiopia
5. Kenya
6. Liberia/Sierra Leone Region
7. Somalia
8. Sudan

1. Angola

A twenty year long conflict in Angola ended with the signing of the Lusaka peace accords in November 1994. Since that time, there has been a slow consolidation of the peace process, including demobilisation of soldiers and gradual return of refugees and internally displaced people to their places of origin. The war has left the country's infrastructure in ruins. Decimation of health systems and an enormous number of mines remain major areas of concern. The security situation in the country has recently been tense, with reports of banditry and armed clashes in some areas interrupting humanitarian activities and causing further displacements. There has also been tension associated with the incomplete disarmament of UNITA soldiers. However, a recent announcement that demobilisation will be completed before the end of March has somewhat eased these tensions [IRIN 07-09/03/98, OCHA-a Jan-Dec 98, WFP 09/01/98].

It is currently estimated that 900,000 people will continue to need emergency assistance in 1998, although that number is likely to slowly decrease over the year as people return home. This population is comprised of 820,000 long-term displaced and 80,000 recently displaced people. There are a further 300,000 unregistered internally displaced people (IDPs) who are not currently receiving assistance (not included in Table 1). There are a number of especially vulnerable groups, such as traumatised children, street children and orphans under age soldiers, war disabled, elderly and female headed households that require special assistance efforts. In addition, there are likely to be some refugee returnees, mainly from the Democratic Republic of Congo and Zambia, who will require support upon their return [OCHA-a Jan-Dec 98].

Malnutrition over time in Menongue, Angola

from: Enquete Nutritionnelle, Menongue, 8-10 octobre 1997 Accion contre la Hambre

A recently launched United Nations Consolidated Inter-Agency Appeal for Angola sets out some priorities for 1998. These include meeting arising and existing basic emergency needs, prioritising vulnerable groups, and maintaining support to a coordinated and phased approach to re-settlement and re-integration of displaced, returnees, demobilised soldiers and their families. As the peace process consolidates, the main focus during the year will shift from emergency to developmental programmes. The Office for the co-ordination of Humanitarian Affairs will divest itself of humanitarian coordination responsibilities in 1998 and as a result, an increasingly active role in coordinating and managing humanitarian programmes by the Government will be required. It is, however, recognised that the retention of capacity to respond to emergencies is essential. To this end, an Emergency Response Unit (ERU) will be established to allow for a coordinated emergency preparedness and response capacity among UN agencies. Specifically, the ERU will help to maintain the ability to respond to emergencies through coordinated situation assessments, identification of priority groups, implementation of joint operations and resource sharing [OCHA-a Jan-Dec 1998].

Overall, the population requiring assistance in Angola is not currently considered to be at heightened nutritional risk (category IIc in Table 1).

On-going interventions

There are a number of specific needs outlined in the Consolidated Appeal which, when met, are likely to have a positive effect on the nutrition and food security situation of the affected population.

Some of these include:

· demining of secondary and tertiary roads to allow access to more remote areas;

· re-establishment and rehabilitation of local health systems, including the control of communicable disease like measles, and TB;

· support for improved infant feeding practices, including the promotion of exclusive breastfeeding;

· promotion of food security through the supply of seeds and tools to returning refugees, IDPs and affected farmers;

· improvement of water supplies and sanitation facilities - only 32% of Angolans have access to clean water, and only 40% access to sanitation facilities.

2. Burundi/Rwanda (Great Lakes) Region

Widespread violence in the Great Lakes region over the last four years, including the genocide in Rwanda in 1994, the overthrow of the Zairian government in 1997 and continued insecurity in Burundi, has led to massive population displacements, rendering millions of people vulnerable to malnutrition, disease and death. Despite improvements in the situation in 1997, notably in Rwanda, approximately 2.6 million people require food aid in the region (see table below). The food deficit in many areas has increased, social services have been disrupted, and the economies of the region severely disrupted. In addition, the unusually heavy rains in the region have made food aid transportation difficult [OCHA Jan-Dec 98].

Location	Sep. 96	Dec. 96	Mar. 97	Jun. 97	Sep. 97	Dec. 97	Mar. 98
Burundi	300,000	296,000	300,000	265,000	260,000	570,000	600,000
Rwanda	598,000	1,179,000	2,600,000	2,600,000	727,000	1,400,000	690,000
Tanzania	653,000	759,000	344,000-	390,000	311,000	318,000	345,000
DRC	1,444,000	668,000	599,000	514,000	823,000	585,000	568,500
Congo/Brazzaville	-	-	-	-	465,000	650,000	400,000
Malawi	-	-	-	-	1,200	1,200	260
Total	3,002,000	2,913,500	3,843,000	3,769,000	2,587,200	3,542,200	2,553,770

Burundi

Despite formidable obstacles, there have been many achievements in the delivery of humanitarian aid during the course of 1997. These include:

· emergency food aid provision as security allowed (general rations, supplementary and therapeutic feeding programmes);

· seeds and tools distributions;

· control of typhus and cholera outbreaks;

· strengthening of humanitarian agency coordination.

Insecurity continues in many provinces in Burundi, with attacks regularly reported throughout the country, hindering deliveries of food aid and the establishment of feeding centres, and rendering some populations inaccessible. For example, an attack outside Bujumbura in December left hundreds of people dead and at least 10,000 temporarily displaced. Another attack forced several hundred returnees to flee their transit centre at Gatumba. Some populations are inaccessible due to the high density of landmines in surrounding areas. These mines pose a serious constraint on the ability of these people to resume normal activities once the fighting stops. Furthermore, flooding in parts of Kenya and Tanzania resulted in the closure of stretches of road and rail lines hampering relief food deliveries to Burundi at the beginning of the year. As a result food rations were reduced to some of the neediest populations [OCHA 22/02/98, WFP 02/01/98, IRIN 23/01/98].

THE GREAT LAKES REGION

updated by ReliefWeb 7.6.96

The boundaries and name as show in this map do not imply official endorsement or acceptances by the United Nations or ReliefWeb. These maps may be freely distributed. If more current information is available, please update the maps and return them to ReliefWeb for posting.

A survey was carried out in accessible areas of Bubanza province in February 1998 as a follow-up to a survey conducted in August 1997. The August survey showed 13.2% wasting, and 6.2% oedema. Supplementary feeding programmes were set up and the follow-up survey was conducted to assess the impact of these programmes. Much of the province (total population 270,000 of which 123,000 are in regroupment camps) is inaccessible due to insecurity. The insecurity is reducing the amount of cultivable land so that food production is diminished and market prices have increased substantially. As a result, people are eating less. The situation has been made even worse by excessively heavy rains [CAD 21/02/98].

The current survey showed 16.0% wasting with 3.2% severe wasting. Oedema was measured at 1.3% (see Annex I 2a). The under-five mortality rate was 4.3/10,000/day (about 3 times normal), and malnutrition was recorded as the leading cause of death. Average caloric intake was just under 1000 kcals/person/day. However, there has been a reduction in the prevalence of severe malnutrition and oedema. There is a pressing need for feeding programmes to be established in the area. The August survey reported on suspected cases of micronutrient deficiency diseases, specifically beri-beri, pellagra and scurvy. So far, there has been no verification of these deficiencies. These results are from accessible areas of the province there is concern that the nutritional situation in inaccessible areas is even more serious [CAD 21/02/98].

A joint OXFAM(UK)/SCF(UK) survey in Gitega was carried out in January 1998. The security situation in the province is precarious, and has prevented farming activities. In the northern part of the province, wasting was measured at 19.7% with 2.4% severe wasting. Oedema was measured at 4.1% (see Annex I 2b). The crude mortality rate (CMR) was determined to be 0.3/10,000/day. In the southern part of the province, wasting was measured at 8.5% with 0.9% severe wasting. Oedema was measured at 4.8% (see Annex I 2c). The CMR was 0.79/10,000/day. Based on these results and estimations of the population, coverage of feeding programmes is insufficient, and efforts should be pursued to increase coverage of these programmes [OXFAM(UK)/SCF 22/01/98].

Measles immunisation coverage, as confirmed by a card, was low at 34% in the north and 24% in the south. If confirmation from mothers is included, coverage is 70% and 87% in the north and south respectively. It was further reported that limited access to land to farm, along with the destruction of planted crops by heavy rains meant that people were not able to meet their basic food needs [OXFAM(UK)/SCF 22/01/98].

An assessment of the food economy was carried out on the rural population in Gitega Province and was timed to coincide with the nutritional survey to provide context with which to interpret the anthropometric results, and to identify possible interventions to improve the situation. The group considered to be most vulnerable was that which did not have enough land and livestock to produce what they need to survive. This group had to rely on market purchases to complete their food needs. The purchasing power of this group has been eroded since the crisis by a reduced income. This is due to the fact that wages for manual labour have not risen in line with price inflation, migration labour opportunities have decreased, and the prices of the crops they sell have not risen with inflation. Interventions identified as likely to improve the food security in the area, but specifically within the poorest group, included support to seed distribution centres, which used to have a good supply of appropriate seeds at the commune level, to increase the income of this group [WFP/SCF(UK) 17/02/98].

Crop production for the first of three cropping seasons in Burundi (the 'A' season) was somewhat below that of 1997. It was noted that there were increased areas planted, but a lack of fertiliser, along with adverse weather conditions, prevented an increase in production [FAO 20/03/98].

Estimated Food Production in 'A' Season In Burundi

taken from: FAO/WFP Crop and Food Supply Assessment Mission to Burundi, 20 March 1998.

Congo/Brazzaville Civil strife in Congo/Brazzaville, which occurred between May and November 1997, led to large-scale displacement both within the country and into neighbouring Democratic Republic of Congo (DRC) and Cameroon. Since the end of hostilities, most of the refugees have returned; however there remain between 250,000-350,000 IDPs in the country [FAO 03/03/98].

In the short term, the fighting had:

· a limited impact on food production;

· a negative impact on purchasing power in urban areas due to loss of jobs;

· led to an increase in food prices, which, while starting to decline, remain higher than before the war [FAO 03/03/98].

There are an estimated 13,500 Rwandan refugees in Congo/Brazzaville. Most of these refugees want to stay due to the insecure situation in Rwanda [WFP 30/01/98].

Democratic Republic of Congo (DRC)

Household food security and nutritional status of the population are major areas of concern in the DRC. Nutrition surveys carried out in Kinshasa have revealed malnutrition rates of 5.9-10.7% and the nutritional situation in the interior of the country is believed to be generally worse. Key factors contributing to a declining nutritional status include long-term degradation of the infrastructure, and more recently population displacement due to insecurity and flooding and interruptions in the food production process. Population displacements both during and after the civil war caused significant declines in nutritional status amongst many - particularly for those in the Masisi and Fizi zones of Kivu province. Moreover, food crops now being harvested are expected to be reduced by the serious floods around Kisangani. A total of 99,000 IDPs in need of humanitarian assistance have been identified in the DRC [OCHA 01/02/98, OCHA Jan-Dec 98].

The security situation, while not as volatile as at the end of 1997, remains tense. Access to areas outside of Goma town was denied to humanitarian agencies, leaving an estimated 65,000 people in the region without assistance from November until early March. Access to the high plateau region in Uvira has also been difficult due to rain. An estimated 35,000 were without assistance. Prices were reported to have already doubled in Uvira [WFP 02/01/98, 13/03/98].

Flooding in Kisangani left 13,000 people in temporary need of food and non-food assistance. There were reports of cholera with over 1,500 cases and 270 deaths. There has been some concern over the situation in Kapata camp in Kisangani. This is a closed military re-education camp for Mai-Mai warriors holding approximately 4000 people. Some 300 children were reportedly severely malnourished and no medicines were available. Many of the Congolese returning from Tanzania are settling in the Uvira area. In addition, refugees continue to arrive from Burundi Tensions are reportedly increasing in the area [WFP 23/01/98, 06/02/98, 20/02/98, 27/02/98].

Other refugees and IDPs in DRC

There are a number of other refugee and IDP populations in the DRC.

· Rwandan refugees There are estimated to be 37,000 Rwandan refugees scattered in Eastern and Central DRC. In addition, there are approximately 3,000 unaccompanied Rwandan children in DRC [OCHA 01/02/98]. There are no nutritional details available for these refugees.

· Burundi refugees There are estimated to be 4,000 refugees from Burundi in DRC [OCHA 01/02/98]. There are no details available on the nutritional status of this population.

· Internally displaced from Shaba There have been no new nutritional data on the approximately 260,000 resident and displaced people in Mwene Ditu since October 1995, when levels of wasting as high as 42% were seen (see RNIS #14). It is not clear whether this is because the population has been successfully assimilated, or they are not accessible, or there are no agencies working in the area.

· Angolan refugees There are approximately 150,000 Angolan refugees in the DRC, 50,000 of whom require assistance. Prior to an upsurge in fighting in Angola, some spontaneous repatriation was occurring (see RNIS #21).

· Sudanese refugees There are approximately 111,000 Sudanese refugee in DRC who are fleeing the continuing insecurity in Sudan (RNIS #21).

· Ugandan refugees There are approximately 4,000 Ugandan refugees in Eastern DRC [OCHA 01/02/98].

General ration distributions have been phased out and 640,000 people are targeted for food aid in the first six months of 1998. This aid will be in the form of supplementary and institutional feeding, food-for-work programmes, vulnerable group feeding and aid to refugees [FAO 16/02/98].

Insecurity is increasing in Rwanda, particularly in the north-west prefectures. There have been several attacks and massacres over the past two months. This insecurity is leading to fresh population displacements within Rwanda, as well as hampering relief and development efforts. For example, there are reports of population displacements in Gisenyi where the situation has been described as somewhere between warfare and low level conflict [FAO 16/02/98, WFP 02/01/98, 20/02/98].

There are reports of a deteriorating nutritional situation in many prefectures, particularly affecting recent returnees. Cases of marasmus and kwashiokor are 'not uncommon'. The cause of this apparent increase in malnutrition is believed to be increasing food prices in conjunction with high levels of disease such as malaria, diarrhoea and respiratory infections. Poor infant feeding practices are also likely to contribute to elevated levels of malnutrition [FAO 16/02/98, OCHA Jan-Dec 98].

There are approximately 50,000 refugees in Rwanda, most of whom are from DRC. An attack on Mudende camp for Congolese refugees resulted in the movement of these people to Kageyo camp in Byumba. There have been recent reports of starvation in this camp. This is being attributed to the need of refugees to exchange their ration for other more costly goods. Another attack on Kibiza camp (13,500 Congolese refugees) in Kibuye province has led to efforts to move this population to a safer camp in the east [IRIN 09/01/98, WFP 23/01/98].

Tanzania There remain approximately 345,000 refugees in Tanzania, 69,000 of whom originate from the DRC and 276,000 from Burundi. Refugees are continuing to arrive from Burundi. For example, 675 refugees arrived between 5-11 January 1998 and 423 from the 9-15 February 1998. Repatriation of Congolese refugees is ongoing; to date approximately 13,000 refugees have been repatriated. The heavy rains in the region have led to deteriorating road conditions in Kigoma and Ngara, disrupting food deliveries to these areas. Because of this, cereal and pulse rations are being reduced and monitoring for any adverse effects is underway [WFP 09/01/98, 16/01/98, 20/02/98, 13/03/98].

Mortality Rates In the Kigoma Region of Tanzania over Time

taken from: Health Situation Report (Kigoma Region) February 1998, UNHCR.

Overall, the population in Burundi can be considered to be at heightened nutritional risk (category Ha in Table 1). Certain populations, for example in Bubanza and Gitega provinces are at high risk, although population breakdowns are not available. The affected population in Congo/Brazzaville can be considered to be at moderate nutritional risk (category IIb in Table 1) with a tendency towards improvement. The refugee population in DRC is not currently considered to be at heightened risk, with the exception of the refugees from Rwanda, whose condition is unknown (category III in Table 1). The IDPs in DRC are at moderate nutritional risk (category IIb in Table 1) due to inaccessibility. The refugees in Rwanda are at heightened risk due to insecurity (category IIa in Table 1), while the remaining affected population, along with the refugee population in Tanzania are at moderate risk (category IIb in Table 1).

On-going interventions

Many of the needs highlighted in a recently released Consolidated Appeal are intended to foster a more development-oriented approach to humanitarian aid in the region, despite on-going conflict in some areas.

In Burundi efforts must continue to promote food security through a variety of initiatives, such as income generating projects. There is also a widespread need to improve access to potable water and sanitation facilities. More specifically, therapeutic feeding facilities need to be urgently established in Bubanza province as well as an investigation into suspected cases of micronutrient malnutrition. Furthermore, supplementary feeding programmes should be introduced into other health centres and double rations allocated until food security improves. Decisions should also be taken rapidly concerning the need to establish general rations and selective feeding programmes in Murago in Buriri province and in Gitega.

The interior of the DRC is largely inaccessible due to the conditions of the roads. Some areas are highly vulnerable since movement of food from one region to another through regular market mechanisms is problematic. The opening up of key-feeder roads from areas of agricultural production to urban areas and establishment of viable transport links between regions must be considered a priority in order to decrease the incidence of localised food crisis. The food and nutritional situation in the Uvira region should be investigated in order to determine what needs there may be. It appears that there is an urgent need for some response to the situation in Kapata camp where at the very least medicines are needed.

In Rwanda, further investigations into reports of malnutrition should be made in order to quantify the extent of any nutritional problem. Particular attention should be paid to nutrition education as it relates to the introduction of complementary foods and infant feeding practices. Measures to prevent or reduce food price inflation should also be considered. Other needs include:

· continuing to strengthen primary health care to reduce morbidity and mortality rates particularly of children under five and women and health promotion to establish a strong home and community based response to preventable diseases;

· nutrition and epidemiological surveillance;

· provision of agricultural inputs to sustain agricultural recovery.

In Tanzania, assistance to ease transport constraints once the rains have subsided will be crucial. This would include road, bridge and rail line repairs so that food can rapidly be moved throughout the country. More specific needs will include assessing the nutrition situation for any effects of the reduced ration, with particular attention necessary in the Kigoma region camps. Malaria control measures, including vector control, impregnated bednets and antimalarials particularly for infants and pregnant women, must be expanded to control anaemia.

3. Djibouti

There are approximately 25,000 Somali and Ethiopian refugees in Djibouti requiring food aid. No details on the nutrition situation of these refugees are currently available.

4. Ethiopia

There are approximately 394,000 refugees in Ethiopia comprised of 278,000 Somali refugees, 53,000 Sudanese refugees, 8,700 Kenyan refugees, 18,000 Djibouti refugees, 11,000 internally displaced people around Addis Ababa and a further 25,000 people in the Dollo region, including 10,000 people in Gode.

A recent WFP/UNHCR/ARRA Joint Food Aid Assessment Mission (JFAM) found that while the health situation in the camps for Somali refugees had improved somewhat since 1996, the nutritional situation remained unsatisfactory. Wasting rates in the nine camps were between 8.5% and 19.2%. The number of Sudanese refugees continues to increase due to ongoing fighting in Sudan. The nutritional status of this population had deteriorated during 1997, and malnutrition rates varied from 10.8%-27.2% (see RNIS 22 for details). The present nutritional status is believed to be due to shortcomings in health and sanitation services, poor access to clean water, sale of part of the food ration to purchase other essential items, and incomplete food rations resulting from poor distribution systems. The current distribution system works through selected group leaders of 20 families or more. Plans are under way to provide food directly to each head of household and to involve women more as distributors and group leaders. Given the poor nutritional status in the camps, blanket supplementary feeding programmes for children under five will be continued and kept under review through periodic nutritional surveys. Commodities provided in this programme include a fortified blended food [WFP/UNHCR/ARRA 05/12/97].

While the need to move from free food distributions to move development-orientated programmes was acknowledged by the mission, it was recognised that the potential for such activities was limited in the Somali camps due to a number of factors. Some of these are a lack of land and water for agricultural activities. The Sudanese refugee camps are situated in areas that offer better opportunities for self-reliance [WFP/UNHCR/ARRA 05/12/97].

Overall, while the nutritional situation in the Eastern camps shows a slightly improving trend, levels of wasting remain elevated and this population can be considered to be at heightened risk (category I in Table 1). The exception to this would be the populations in Rabasso and Daror camps which can be considered to be at moderate risk (category IIb in Table 1).

The Sudanese refugees in the Western camps can be considered to be at heightened risk (category I in Table 1) due to high levels of wasting. Those in the Gode region affected by flooding are also at high risk. No information is currently available on the internally displaced, those in Dollo, or the Kenyan refugees (category III in Table 1).

On-going interventions

The recent JFAM made a number of recommendations:

· continuation of food distributions and blanket feeding programmes;

· revision of the current distribution system to provide food directly to each household;

· promoting and facilitating the participation of women in food management and distribution;

· establishment of a performance monitoring system which would include tracking of quality and types of foods distributed, frequency of distributions, percentage of women receiving rations directly, and nutrition and mortality trends;

· improvement in the supply of health services;

· improvement in the supply of clean water.

5. Kenya

There are approximately 179,300 refugees in Kenya, mainly comprised of 133,800 Somali refugees in the Dadaab area camps and 36,700 Ethiopian and Sudanese refugees in Kakuma [UNHCR 12/03/98].

Flooding in the north-eastern area of Kenya has left the 125,000 Somali refugees in the Dadaab camps stranded. The floods destroyed refugee food stores and led to the death of many livestock. Reports indicate outbreaks of cholera, Rift Valley Fever, acute respiratory tract infections and malaria. Water supplies are said to be polluted and latrines are collapsed or overflowing, posing a serious health hazard. Prior to this flooding, the nutritional situation in the camps, although still giving cause for concern, was gradually improving. Levels of wasting had decreased in the first six months of 1997 from 26-33% to 10-17.6%. A few cases of scurvy were being identified in the health clinics as recently as February 1998, and the crude mortality rate was 0.20/10,000/day (see Annex I 5a) [UNHCR Dec 97, Feb 98, WFP 23/01/98, 20/02/98, WHO 28/01/97].

Since the floods, food has been airlifted to the camps as road transport has not been possible. Inadequate funding of this programme has meant that refugee rations will need to be cut by 50%. This is likely to create nutritional problems as the population currently has no other source of food. With the imminent onset of seasonal rains, the next few weeks will be critical to build up food stocks for distribution scheduled for April and May. However, import duties, which had been waived, are now reinstated, and relief food is being held up in ports as a result [IRIN 21-23/03/98, WFP 13/03/98].

There are no reports of change to the situation for the refugees in Kakuma camp. Levels of wasting below (80% wt/ht) were described in the last RNIS report (no. 22). School children were identified as most vulnerable malnutrition so that school feeding programmes were begun. In December 1997, the crude mortality rate in the camps was 0.16/10,000/day and under-five mortality rates were 0.63/10,000/day [UNHCR Dec 97].

Overall, the refugee population in Dadaab is at heightened risk of malnutrition (category Ha in Table 1) with a tendency towards deterioration due to reduced rations. The remaining refugee population in Kenya is not currently thought to be at heightened nutritional risk (category IIc in Table 1).

On-going interventions

Although the floodwaters have begun to recede, the immediate need is to maintain the airbridge to provide food to stranded populations. Only light-weight vehicles can reach the camps so far. The need to rebuild damaged infrastructure, particularly in order to re-establish road access, will be critical. Ensuring adequate and safe water supplies will also be a priority in the short-term.

In the longer term, the potential problem of recurring scurvy in the Dadaab camps needs to be addressed. The health centres often report scurvy in the August-December period. Questions have been raised about the accuracy of the diagnosis, so as a first step the diagnosis needs to be verified. If scurvy is confirmed, preventive measures must be in place before August 1998.

6. Liberia/Sierra Leone Region

There are at least 1.5 million people requiring humanitarian assistance in the region. In Sierra Leone, the humanitarian situation deteriorated significantly with the escalation of fighting in the early months of 1998. At present, the situation appears to be stabilising and the democratically elected president has returned to Freetown. However, skirmishes continue to be reported outside the capital and at the time of writing the magnitude of the crisis and the number of people requiring assistance remain uncertain.

Population estimates for refugee and IDP populations over time are summarised in the table below:

Location	Sep. 96	Dec. 96	Mar. 97	Jun. 97	Sep. 97	Dec. 97	Mar. 98
Liberia	1,800,000	1,800,000	1,100,000	710,000	700,000	700,000	726,000
Sierra Leone	609,000	609,000	548,000	453,000	453,000	200,000*	200,000*
Cote d'Ivoire	305,000	305,000	305,000	305,000	210,000	210,000	210,000
Guinea	536,000	536,000	536,000	545,000	405,000	405,000	405,000
Total	3,250,000	3,250,000	2,489,000	2,013,000	1,768,000	1,515,000	1,541,000

* Numbers requiring humanitarian assistance may be far higher than the current estimate.

Approximately 26,000 Sierra Leonean refugees arrived in Liberia, fleeing insecurity in the country. It appears that the improved security situation in Sierra Leone is not yet encouraging these refugees to return [IRIN-WA 18/03/98].

Further details on the situation in Liberia can be found in the middle section of this report: 'Food Security in Liberia'.

Sierra Leone has experienced repeated waves of insecurity since an offensive was launched in 1991 to overthrow the government. Kabbah was elected as president in March 1996, and a peace accord was signed in November 1996. However, disagreements between the antagonists continued on many key issues, such as demobilisation, and in May 1997, the president was ousted and a military government took control. The international community including the Economic Comity of West African States (ECOWAS), Organisation of African Unity (OAU) and the United Nations (UN) demanded the restoration of the elected president, and ECOWAS Cease-fire Monitoring Group (ECOMOG) forces were deployed to this end [USAID 28/01/96].

An embargo was also imposed on the country. Humanitarian goods were supposed to be exempt, but in practice, this type of selective embargo proved difficult to implement. As a result of this and widespread insecurity, the food supplies in country became increasingly strained. Rice prices shot up although these have now begun to decline [IRIN-WA 02-08/01/98].

A survey in Freetown in December 1997 showed 8.7% wasting with 1.6% severe wasting (see Annex I 6a). No cases of oedema were seen. It was reported that living conditions continued to decline in the city since the coup d'etat in May 1997 and availability of food was increasingly problematic. The survey indicated that there had been no general ration distributions and only limited targeted feeding programmes since the coup [ACF 04/12/97].

Since this survey, there was a sustained military campaign in Freetown and in early February ECOMOG forces took control of the city. The president returned in mid-March 1998. During the period January 1998 - February 1998, fierce fighting was reported more or less throughout the country. Food shortages were noted in many areas of the country; for example in Bo the situation had been described as alarming. Food, medicine and shelter are said to be needed urgently in cities which have suffered massive destruction at the hands of the retreating fighters of the Armed Forces Revolutionary Council [ACT 19/03/98, CARE 05/03/98, IRIN-WA 12/02/98, 13-19/02/98, WFP 13/02/98].

The escalation in fighting led to further population displacements, both within Sierra Leone and into neighbouring Liberia and Guinea. Approximately 26,000 people arrived in Vahun in Liberia. These refugees are said to be in good health, although the supply of clean water is inadequate and a cause for concern [UNHCR 03/03/98]. There are no current estimates for numbers of people requiring humanitarian assistance in Sierra Leone, and estimates of 200,000 people before the upsurge in hostilities are most surely an underestimate.

Guinea There remain approximately 405,000 refugees in Guinea. The fighting in Sierra Leone has not led to an increase in refugees, since most of these people fled to Liberia. There are reports of approximately 65,000 refugees waiting to return to Liberia [IRIN-WA 18/03/98].

Cote d'Ivoire The number of Liberian refugees in Cote d'Ivoire has declined due to small scale repatriation. In addition, there have been an unknown number of spontaneous returnees.

Overall, the affected population in Sierra Leone can be considered to be at heightened risk of malnutrition (category IIa in Table 1) due to inaccessibility resulting for insecurity. The remainder of the affected population is not currently considered to be at heightened risk (category IIc in Table 1).

Ongoing interventions Funding support for the programmes to repatriate Liberian refugees is needed. The food security assessments in Liberia should continue in order to inform appropriate preparations for the anticipated large-scale repatriation of refugees. In Vahun, which has recently received a large influx of Sierra Leonean refugees, water supplies need to be urgently improved.

A recent Flash Appeal for Sierra Leone outlines some priority interventions over the next three months. These include:

· restoration of the primary health care system;
· rehabilitation of water and sanitation facilities;
· support of agricultural activities;
· resumption of food distributions to those in need.

7. Somalia

Insecurity in Somalia, which erupted with the civil war in 1988, and intensified with the overthrow of the military rulers in 1991, persists in many areas today. This insecurity combined with low crop yields has led to heightened food insecurity in parts of the country. The numbers of people requiring emergency assistance in Somalia are estimated at 1.2 million. These include beneficiaries of food-for-work projects, returnees and IDPs.

An outbreak of cholera was reported in December 1997 in Mogadishu. In mid-January, one hospital was reporting over 100 admissions each day. Since then the situation has improved due in large part to the rapid establishment of rehydration centres and drug provision [ICRC 15/01/98, 29/01/98].

Recent flooding in southern Somalia along the Juba and Shabelle rivers has led to some population displacements. There were reports of movements towards the Kenyan border, but as the floodwaters begin to recede, it appears that people are returning home [FSAU 17/02/98]. Food was airdropped to large numbers of displaced.

A rapid nutritional assessment carried out by the Food Security Assessment Unit (FSAU/WFP) and American Refugee Committee (ARC) in Hagar, Afmadow and Bilis Qoqani, described an improving situation. Floodwaters were receding and numbers of IDPs were decreasing. However, livestock were said to be in a bad condition.

In all three areas, the food supply is improving due to the arrival of food aid. Market availability of food is low and prices, although declining, are still high. The report concluded that the three locations were experiencing different conditions.

· In Hagar, the nutritional situation was returning to normal, but still fragile.

· In Afmadow, the situation was described as critical with 'many severe malnutrition cases'.

· In Bilis Qoqani, the situation was described as poor due to 'chronic malnutrition existent before the floods but made worse by them' [FSAU 11/02/98].

Deyr Season Production in Somalia over time

taken from: Flash Crop Production Survey in Southern Somalia Deyr Season 1997/98, Food Security Assessment Unit 18 Feb, 1998.

Above average rainfall for the rainy season (March-June) is being predicted, leading to fears of further flooding. It is being anticipated that up to a further 200,000 people could be affected. Recovery operations in early 1998 include support for food-for-work projects to rebuild roads, bridges, dikes and embankments. Food will also be sold into commercial markets to ensure supplies and attempt to maintain a stable price system [FSAU 18/02/98, WFP 13/02/98].

Overall, populations requiring assistance in Somalia can be considered to be moderate nutritional risk (category IIb in Table 1) due to a combination of factors including insecurity, food price inflation and recent flooding. Loss of livestock and crops have increased the vulnerability to malnutrition for many people, and it is likely that the nutritional status of many will deteriorate without humanitarian interventions.

On-going interventions

Support for infrastructural repairs will continue to be needed and price stabilisation measures should also continue. Contingency plans should be drawn up in the event of further flooding. In flooded areas like Burdhubo food drops have to be maintained and veterinary inputs may be required to protect remaining livestock from disease.

8. Sudan

The civil war in the south of the country has been on-going for 14 years. Despite continuing efforts to find a peaceful solution to the conflict, fighting intensified in 1997. Increased military activity, combined with the onset of drought conditions has led to a further decline in already sub-standard living conditions in many areas. As a result, the number of people requiring assistance in 1998 is projected to increase by as much as 25% over the course of the year. There are currently estimated to be 2.7 million people in Sudan who require humanitarian assistance. These are displaced and war-affected populations throughout both northern and southern Sudan who will require support at different times during the year [DHA Jan-Dec 98].

In 1997, efforts were made to improve the quality of humanitarian operations in Sudan and to broaden access to populations in need. These efforts resulted in improved delivery and distribution of relief supplies including increased use of overland routes, improved monitoring and improved cost-efficiency. The needs of the internally displaced people were also given greater priority [DHA Jan-Dec 98].

However, in spite of these improvements, many of the objectives set for the 1997 were not achieved due to insecurity, restricted access to areas by the government, and critical shortfalls in funding. Emergency food was distributed in limited quantities, with detrimental effects on the health and nutritional status of the intended beneficiaries. Malnutrition levels have been estimated to increase from a general level of 18% in 1995 to 28% in 1997. Livestock herds have reportedly been depleted for many of the poorest, further increasing their vulnerability [DHA Jan-Dec 98, FAO 22/12/97].

A recent crop assessment mission in Sudan estimated cereal production would be lower than the 1997 record harvest, but higher than the five year benchmark of 1988/9-92/3. However, these are national production figures and mask regional shortfalls. For example, cereal production is down by 45% in the southern areas due to drought, and transportation problems within the country seriously constrain redistribution of food from surplus to deficit areas. In some areas, like east and west Equatoria, unseasonal and heavy rains have led farmers to predict harvest losses ranging from 50-100%. Recent returnees from northern Uganda are without assets or resources to offset the disappointing crop and they will continue to depend on relief assistance. Prices of sorghum have risen sharply in recent months, and the exchange value of livestock has plummeted dramatically [USAID 29/12/97, FAO 22/12/97].

There are also serious food deficits in the western regions of North Darfur and North Kordofan where this year's cereal production is the third consecutive reduced crop [USAID 29/12/97, FAO 22/12/97].

Khartoum There are an estimated 2.2 million IDPs in Khartoum, many of whom do not receive emergency assistance. It is estimated that 176,000 people residing in four displaced camps will need assistance in 1998. Camp residents do not have access to land for cultivation, rely principally on labour wages and achieve food security through food purchases from local markets. It is estimated that 80% of the Khartoum displaced population in the camps are able to meet only 50% of their annual food needs through their own resources. A major focus for interventions in 1998 will be to improve the quality and impact of services provided [DHA Jan-Dec 98].

The Red Sea State A major food security crisis was identified in the Red Sea State over a year ago. Attempts to start an emergency programme were fraught with logistical, political, security and funding related difficulties. However, eventually general food distributions were carried out although delays meant that the programmes did over-run in some areas. Sorghum was distributed to men and lentils, oil and blended foods were distributed to women. The programme has now closed down [OXFAM Jan 98].

Southern Sudan It is currently estimated that 2.2 million people in southern Sudan require relief assistance. Fighting has intensified in the south in 1998 in Bahr-el-Ghazal around Wau, Aweil and Gorgorial, leading to fresh population displacements of an estimated 150,000 people. There has been growing concern amongst humanitarian agencies working in the area that the resources to meet the survival needs of this population are not available.