2. Great Lakes Region

Burundi
Rwanda
Congo-Brazzaville
Democratic Republic of Congo (DRC)
United Republic of Tanzania

Security conditions in the Democratic Republic of the Congo (DRC) and Congo-Brazzaville are still very poor in some areas resulting in continued displacement of the population. The IDPs returning to Congo-Brazzaville are reported to be in very poor nutritional condition. Little is known about the condition of the IDPs in the rebel-held areas of DRC. Large numbers of refugees continue to seek asylum in the United Republic of Tanzania. In Burundi and Rwanda the nutritional situation continues to improve in the areas where there have been improvements in security. The table below shows the numbers of refugees, IDPs and returnees who require assistance in the Great Lakes region.

	Jun. 97	Sep. 97	Dec. 97	Mar. 98	June 98	Mar. 99	Jun. 99
Burundi	265,000	260,000	570,000	600,000	670,000	222,000	451,000*
Rwanda	2,600,000	727,000	1,400,000	690,000	550,000	690,000	670,000
Tanzania	390,000	311,000	318,000	345,000	329,000	328,000	373,000
DRC	514,000	823,000	585,000	568,500	621,000	788,000	952,000
Congo-B		465,000	650,000	400,000	50,000	213,000	211,000
Total	3,769,000	2,586,000	3,542,200	2,603,500	2,220,000	2,241,000	2,657,000

*Burundian IDPs/returnees assisted by WFP has increased due to expanded seed protection programmes

Burundi

The initial optimism which greeted the suspension of the economic sanctions on Burundi earlier this year is beginning to fade. The price of an average family's food basket has fallen slightly since the lifting of the embargo but still remains nearly twice as high as it was before the sanctions were imposed. At the same time, the local currency has continued to devalue compared to both official and unofficial US dollar rates partially because of a severe shortage of foreign currency in the country (OCHA -05/05/99).

Security incidents and attacks on civilian populations continue particularly in Bubanza, Bujumbura, Bururi and Makamba provinces. Burundian Government sources claim that the attacks in the South have been launched from Tanzania by Interahamwe militia and rebels of the Force de Defense pour la Democratie (IRIN -06/04/99, 09/04/99, 28/05/99). Of particular concern was the attack in Ruyigi's Kinyinya commune where the destruction of some 600 households was confirmed. This area was previously considered relatively secure and had seen considerable progress in the reconciliation process (OCHA - 05/05/99).

Despite the fighting, further peace talks took place in Arusha in May (IRIN- 1/05/99, 27/05/99). The government has unveiled a "plan for society" which details its vision of a proposed ten-year transition period. The plan envisages a democracy based on "consensus" and an enlarged national assembly which will include groups taking part in the Arusha peace process which are not currently represented in parliament (IRIN -04/06/99). It remains to be seen how the government's opponents react to this proposal.

THE GREAT LAKES REGION

update by ReliefWeb: 7.6.96

The boundaries and names shown on this map do not imply official endorsement or acceptance 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.

There are currently estimated to be over half a million displaced people in Burundi. The situation remains fluid: new people are forced to flee even while others return. For example, violence in Makamba caused the displacement of 12,000 people in areas along the Tanzanian border and the local authorities have asked for WFP's assistance (WFP -21/05/99).

WFP provides food assistance to approximately 451,000 people per month, which includes the following categories, emergency distributions - 119,000; nutritional support - 47,500; vulnerable groups - 25,000; seeds protection rations - 126,000; returnee packages - 3,500; and food for work - 130,000. The original planning figure was 282,000, but this figure has been increased as a result of a large seeds protection ration distribution programme jointly implemented by WFP and FAO. Emergency distributions target not only IDPs but also resettled IDPs and residents who are considered food insecure (WFP - 24/06/99).

As reported in RNIS 26, the nutritional situation of many of the war-affected populations in Burundi does appear to be slowly improving. The surveys described below all show a decrease in the prevalence of malnutrition in these populations. Additional data from UNICEF covering the period from September 1998 to February 1999 indicates the prevalence of malnutrition in 10 Provinces ranged from 5.6% to 14.7%. This represents an improvement compared with data collected between January and August 1998 (which ranged between 10.0% to 23.8% in seven Provinces). Reports from these surveys are not currently available to the RNIS, and thus the representativeness of the sample is unknown (UNICEF - 21/06/99).

Kayanza Province

A survey undertaken by ACF in Kayanza Province in January recorded a decrease in the prevalence of wasting in children under five since the last survey in this area in 1997 (see Annex). Acute wasting and/or oedema had decreased from 14.0% to 9.8% and severe wasting and/or oedema was estimated at 1.7% compared to 2.3%. (Oedema was recorded in 0.9% of the children surveyed). However, the two survey populations were different: - the earlier survey was only in the camps and the second survey included residents, thus the decrease in the rates of wasting and/or oedema found might be expected even without an improvement in the nutritional status of IDP's.

Adult nutritional status was also measured as a large proportion of beneficiaries in the feeding centres in this area were adults. The table below shows the distribution of the population by Chronic Energy Deficiency (CED) level. It can be seen that only 52% of the adult (aged 15y+) population were categorised as "normally" nourished according to the classification employed; 8.4% of the total adult population were defined as severely malnourished.

BMI (kg/m2)	CED level	Male (%)	Female (%)
<= 15.9	Severe	9.2	7.7
16-16.9	Moderate	10.6	13.4
17-18.4	Marginal	27.8	26.9
=> 18.5	Normal	52.5	52.0

* please note that the RNIS will soon be issuing a special report on the classification of adult nutritional status

For less severe adult malnutrition, ACF uses a BMI of 16.0-16.9 kg/m² and/or a MUAC<21 cm as adult admission criteria into their supplementary feeding programme in the study area. Using this definition, 18.6% of adult women and 12.9% of adult men were classified as malnourished.

In general, coverage of the nutritional programmes was low - only 12.3% of wasted children and 4.9% of malnourished adults were enrolled in a programme. Measles vaccination was confirmed by card for 66.4% of the children. The retrospective CMR for the study population showed an improvement compared to 1997 and was estimated to be 0.56/10,000/day. Under five mortality was 0.93/10,000/day compared to 4.5/10,000/day in August 1997.

By questioning respondents about their activities, sources of food and revenue, agricultural systems, household social structure (sex of head of household etc), origins and access to health care, the survey also examined possible indicators of vulnerability in this community. Although no causal relationships could be established, an association between head of household's gender and malnutrition in children was clearly seen - children in female-headed households were more likely to be wasted. In addition, a wasted child was less likely to live in a household possessing at least one animal. The elderly living alone were also vulnerable. The authors of the study were careful to stress that the study population is a relatively homogenous group in terms of activities and income and thus these indicators alone will not be sufficient to differentiate between vulnerable and non-vulnerable households.

Gitega Province

Oxfam/SCF-UK/Solidarites/MOH conducted a follow-up survey in March in Gitega province where Oxfam has established a supplementary feeding programme (see Annex). The results of all three surveys are shown in graphs below. It can be seen that the level of wasting and/or oedema has decreased in both the north and southern areas of the province over the past fifteen months. CMR in the northern part of the province also decreased from 0.57/10,000/day in November to 0.25/10,000/day in March. In the South, CMR decreased from 0.79/10,000/day to 0.44/10,000/day. Mortality for children under five years also decreased during the period in both regions - from 0.67/10,000/day to 0.38/10,000/day in the North and from 1.23/10,000/day to 0.96/10,000/day in the South. According to vaccination cards carried by the mother, 53.5% of children were vaccinated in the north and 60.1% in the south. This can be compared to 63% and 64% respectively in November.

Prevalence of wasting and/or oedema in Northern Gitega

Prevalence of wasting and/or oedema in South Gitega

Other indicators of an improving nutritional situation included a drop in new admissions to the feeding programmes, and increased land cultivation by the population. Health services are now functioning in the province. Given these improvements Oxfam is now working towards a hand-over of the management and logistics of the feeding programme to the provincial Ministry of Health. It is envisaged that this will take six months. Oxfam will train health centre staff and mothers in best nutrition and hygiene practices (OCHA -05/05/99, Oxfam - 27/04/99, 19/05/99).

Muramvya and Mwaro provinces

Results from a nutritional survey undertaken by Solidarites in February in Muramvya and Mwaro provinces among children under five years old recorded 11% acute wasting with 1.5% severe wasting. CMR was reported to be 0.53/10,000/day (OCHA - 18/05/99).

Bubanza Province

Children's Aid Direct in collaboration with the DPAE (Department of Agriculture) conducted a food security survey in Bubanza Province in March as a complement to the anthropometric survey undertaken in February (which found a prevalence of 9.75% acute malnutrition, of which 2.7% was nutritional oedema). The population is estimated at 270,000 with almost 60% being internally displaced. The displaced have been moved from large camps to smaller sites with the aim of moving people closer to their origin and hence improve accessibility to land.

No significant difference was found between residents and the internally displaced in terms of their cultivation and food production. The IDPs may have smaller fields to cultivate, but the residents have insufficient seeds and other agricultural inputs to plant the whole area. Unlike the IDPs they do not benefit from seeds and tools distributions.

Insecurity has contributed to a 40% decrease in agricultural production, as a result of restricted access, and increased prices of fertilisers and pesticides. Small livestock have been affected particularly badly, and have decreased by 90%, while large livestock have decreased by 37%, as compared with the situation before the crisis. However in recent months, improved security has increased access to markets, health centres and fields, but despite this, instability in some parts of Bubanza prevents the population returning to their original collines. The on-going food insecurity is reflected in the many re-admissions reported by the supplementary and therapeutic feeding programmes, as discharged children become malnourished once again.

Army worm infestation

More generally, FAO has identified some 20,000 hectares of land which have been infested by army worm in the north-eastern areas of Burundi. The infestation threatens to reduce cereal crops including wheat, rice, maize, millet, sorghum and sugar cane crops. Pasture lands are also affected and cause a negative impact on livestock. WFP and government officials are reviewing the situation in order to discuss possible food aid requirements resulting from the infestation (WFP - 14/05/99).

Refugees in Burundi

A new UNHCR verification exercise carried out in Citiboke revealed that only 363 Congolese remained on site, approximately 100 less than during the last survey carried out in February (OCHA - 16/04/99). There are also some 2,000 urban Rwandan refugees in the country.

Overall, the improvements in the nutritional situation in Burundi reported in RNIS 26 have been sustained, and the IDPs are currently considered to be at moderate nutritional risk (category IIb).

Priorities and Recommendations:

· Although the nutrition surveys describe an improving situation the food security of the IDPs in Burundi is still fragile. Food assistance may still be required in some areas where previously it was not necessary and in other cases assistance may be slowly phased out. Ongoing food economy assessments carried out by WFP and others should establish which areas are most in need of assistance.

· Funds are urgently needed for the WFP operation to provide assistance for the refugees in the region generally, including those in Burundi. Breaks in the pipeline mean that rations will either be cut or distributions undertaken less frequently.

· Given the fragile state of the population's nutritional status the supplementary and therapeutic feeding programmes should be continued.

· Ensure that the population is aware of these facilities, and hence that the coverage of the programmes will improve, this is particularly true for adult males.

· Undertake further studies on the nutritional situation of the population

· Include vulnerable residents in the collines in seed distribution programmes.

· Encourage breeding of small livestock where security allows through associations of credit schemes.

Rwanda

The last RNIS reported large numbers of IDPs in the northwest of the country who had left their homes as a result of Interahamwe militia violence in the area. The government has currently largely re-established stability in the area and many of the IDP camps in Ruhengeri and Gisenyi prefectures have been dismantled. Most of the formerly displaced people are now living in new settlements known as "imudugudu" following massive resettlement programmes organised by the government which started in December last year (IRIN -09/04/99, 20/05/99, SCF-UK - 19/05/99). These imidugudu are situated close to the roads and families are grouped according to their original cellules and secteurs. The intention is that families should be closer to their fields than when they were in the large camps which were close to the administrative centres (SCF - 02/99).

In terms of humanitarian assistance, the cereals pipeline situation for Rwanda is cause for concern, as there are no cereal stocks for Rwanda in the region. This is due to shipping delays with an expected shipment due in April now not expected until August (WFP - 25/04/99). Local purchases in Uganda have been unsuccessful due to insufficient stocks on the market as a result of the Tanzanian drought.

Ruhengeri Prefecture

The nutritional situation of the IDPs in Ruhengeri has improved in the past three months. In January very high rates of severe wasting and/or oedema were recorded (6.4%) but this rate is reported to have declined since then.

Food Economy assessment in Ruhenegri Prefecture

Following the nutrition survey in January 1999, Save the Children Fund UK undertook an assessment of the food economy of the displaced population in Ruhengeri Prefecture (SCF - 02/99). The population of Ruhengeri prefecture is estimated to be 869,000, of which possibly 573,000 were displaced. The assessment concluded that families were able to meet their energy (kilocalories) requirements between July 1998, and January 1999, however their diet was extremely monotonous and of poor nutritional quality (with 80% of energy from sweet potatoes, and very limited sources of protein). Sources of food in the larger camps and the imidugudu included harvest from own or others fields; agricultural labour; food aid; and market purchase or begging. A deficit of two thirds of food requirements was predicted for the period January to June 1999, when food and income sources should stabilise with the harvest.

From the descriptions of parents of severely malnourished children a number of possible causal factors were identified, including; repeated illnesses, (often measles, diarrhoea and/or vomiting); living in hiding in the bush or forest for prolonged periods; and lack of appropriate care due to the death of one or even two parents (SCF -02/99).

Not all Ruhengeri Prefecture was equally affected by the insecurity in 1998. SCF divided up the prefecture into three regions; region A was relatively secure throughout and less displacement occurred, whereas in regions B and C massive displacement occurred, and currently this is where the imidugudu are. Region C appeared to have the highest prevalence of severe malnutrition, which was attributed to a worse security situation which occurred earlier - hence the displacement of the population from Region C was longer and there was greater disruption to harvests. The soil is also less fertile in this region. Many health centres destroyed during the insecurity were yet to be rehabilitated, hence access to health care was limited. Also this region is more inaccessible, which limits trading networks and hinders the delivery of humanitarian assistance (SCF - 02/99).

Situation begins to stabilise

Since this assessment the number of admissions to feeding programmes has in fact decreased. This is attributed to improved targeting by WFP, increased frequency of food deliveries, increased NGO presence and activity in the nutritional sector (supplementary and therapeutic feeding programmes were put in place), and an early harvest in some communes. Agricultural activities in Ruhengeri prefecture have resumed in most communes as a result of improved security: most of the IDPs now have access to their farmlands (IRIN - 20/05/99; WFP -19/04/99, 06/05/99; SCF-UK - 18/05/99).

Despite the progress described above, the nutritional situation of these people is still precarious. Food will continue to be scarce until the harvest in late July and WFP will need to provide essential food assistance until at least then. There is a need to remove restrictions on residents wishing to provide agricultural and general labour outside their own communes. Such restrictions - which are in place because of security concerns - have a direct impact on well being as a substantial proportion of income currently comes from paid labour. These restrictions should therefore be removed wherever security allows, as a means to raising the standard of living. There is also a need for further investigation of, and support for, alternative income generating activities for imudugudu residents who have no, or very limited, access to land for cultivation (SCF-UK -18/05/99).

Gisenyi Prefecture

The RNIS has not received a report which focuses specifically on the nutritional situation of the IDPs in Gisenyi prefecture although a survey has been planned for later in the year (WFP - 06/05/99). A WFP assessment of Mubuga cellule, in Kanombe Sector, Gisenyi, observed destroyed and abandoned houses. In Mugbuga cellule where 3,092 IDPs are living in makeshift camps, no agricultural activities were observed.

Returnees from DRC

In the past few months some 15,000 Rwandans are reported to have returned to the northwest of the country from North Kivu in DRC. These people, who left Rwanda in 1994, have told UNHCR that they returned home because local officials in eastern DRC warned them to do so. The relative calm in north-western Rwanda also encouraged them to return. UNHCR staff have helped the returnees back to their communes of origin and have distributed blankets, plastic sheeting and other materials to the group. WFP provides a three month resettlement ration to the returning refugees. Local authorities have indicated that several thousand more returnees could follow (UNHCR - 04/05/99, WFP -19/04/99,21/05/99).

Army Worm Infestation

More generally, agriculture in Rwanda is suffering from an infestation of army worms, especially in the prefectures of Mutara, Kibungo, Beera and Kigali Rural. Army worms have so far infested about 6,000 hectares of agricultural land according to estimates by the Ministry of Agriculture. Humanitarian sources warned that the invasion could seriously impact the season's agricultural production as well as the country's limited livestock resources if no action was taken. The ministry of Agriculture and FAO initiated some rapid interventions and, combined with the favourable effects of the rains, the impact of the infestation has been reduced. However, there are still concerns about a potential second invasion of the worms at the end of their next reproductive cycle (IRIN - 27/04/99, 04/05/99, 13/05/99).

Refugees in Rwanda

There is no new information on the nutritional status of the approximately 30,000 Congolese refugees from North Kivu in Rwanda.

Overall, The nutritional situation of 625,000 (UNHCR - 10/06/99) IDPS in the north-west remains precarious, as they have not yet re-established their livelihoods and there are major problems assuring a continuous food aid pipeline. The IDPs are therefore considered at moderate risk (category IIb). The nutritional situation of returnees from DRC is apparently adequate (category IIc). The nutritional situation of the Congolese is unknown (category III).

Priorities and recommendations:

· Additional donor contributions for Rwanda are urgently required to prevent the nutritional status and health of IDPs and others deteriorating.

· Distribute seeds, fertilisers, pesticides and tools. Particular emphasis should be placed on a seed distribution (especially beans and soya) in time for the next planting season in August/September. This would contribute to increasing households' income in a sustainable manner.

· Support for the feeding programmes is still required

· Support is needed to repair access roads and bridges to Communes receiving the WFP ration. Some of the most food-insecure communities are those for whom physical access during the rainy season is most difficult.

· Distribute non-food items such as plastic sheeting, blankets, children's clothing and soap. These are particularly required to help in the treatment and prevention of scabies, a condition which affects the majority of children in the imudugudu. A substantial number of residents live in houses roofed only with banana leaves which give little protection against the current rains and have an inevitable effect on health.

Congo-Brazzaville

The health and nutritional situation of the people returning to Brazzaville is reported to be "catastrophic". Over 30,000 people have returned to Brazzaville from places where they have been hiding since December 1998. Much of the capital (particularly the southern suburbs of Makelekele and Bas Congo) was emptied during fierce fighting between the government and rival militia forces in December and January. Many of the IDPs have been hiding in the forests for months, subsisting only on roots and other wild foods; thousands are believed to still be there.

Some of the displaced people are now being transported back to their homes by the Congolese army and UNHCR. It is estimated that the influx of IDPs could reach 100,000 by the end of June (IRIN - 06/05/99, IRIN-19/05/99, 23/06/99; WFP- 10/06/99, 16/05/99, 31/05/99).

Fighting still continues sporadically. Ninja militia aligned with former prime minister Bernard Kolelas have attacked army forces in the Brazzaville area several times resulting in civilian deaths and short term population displacement. The militiamen are also active in the south of the country (IRIN - 11/05/99, 13/05/99, 07/06/99). Moreover the Ninja militiamen have warned that they will obstruct any humanitarian aid to the south of the country by military means unless certain conditions are met. Any assistance to areas under the control of the rebels must first be negotiated with their leaders and humanitarian agencies may not be escorted by government troops (IRIN - 26/05/99).

Brazzaville

MSF-F reports that in Makelekele between 6^th and 29^th May, 822 individuals (approximately 75% of whom were children under five) were admitted to the therapeutic feeding centre. Over 75% of these individuals were oedematous. In addition, in a single two week period in May approximately 2,900 individuals were admitted to a supplementary feeding programme. Security conditions do not permit a full-scale survey or screening of the population, but there can be no doubt that a large number of the newly returned children and adults in the city are in very poor nutritional condition. MSF-F states that a general food distribution is urgently required. In addition to this, the NGO reports that the risk of a cholera epidemic in the city is very high (MSF-F -03/06/99).

WFP has responded to the crisis by borrowing money from its emergency fund to meet the most immediate food needs of 100,000 of the worst affected people. This is an addition to the 50,000 people it is already assisting in the country (25,000 in Brazzaville and 25,000 in Pointe Noire).

Poole area

The security situation in the Poole area is very poor and it is difficult even for local NGOs and Churches to gain access. The latest reports suggest that the army is making way against the Ninja rebels (IRIN - 13/04/99, 30/06/99). An unknown number of displaced people are in the area around Pool, however increasing numbers of refugees from this area are reported to be crossing into the Bas-Congo province of DRC (IRIN - 30/06/99).

In contrast, security is reported to be improving in some parts of the country and some of the 120,000 IDPs who fled from the southern towns of Dolisie and Nkayi are returning to their homes (WFP - 20/04/99). A UN-Government team which visited the towns in early April described very poor health and sanitation services in the almost deserted town of Dolisie; cases of Kwashiorkor were reported amongst some of the children present (IRIN-13/04/99).

Refugees in Congo-Brazzavile

As reported in RNIS 26, Kintele camp has become militarised and hence UNHCR has withdrawn (and ceased most activities). 2,600 Rwandans remain in the north (Lukolela) of the country and continue to be assisted (UNHCR - 28/06/99). No information on the nutritional status of these refugees, or the 8,000 Angolan refugees in the country, is available to the RNIS.

Overall, the situation is extremely serious, and although no surveys have been undertaken, reports from feeding centres indicate that the IDPs and returnees within Brazzaville have a high prevalence of malnutrition (category 1). Information is not available for the rest of the country, but it is also considered to be at high risk (category IIa). The nutritional status of the refugees is unknown (category III).

Priorities and Recommendations:

· A response is urgently needed to WFP's recently-approved emergency operation to feed a total of 200,000 war-affected people over the next three months (WFP - 10/06/99).

· Distribute a general food ration as soon as possible, particularly to those recently returned from Pool, DRC.

· Begin cholera preparedness campaigns and stock pile anti-cholera drugs.

Democratic Republic of Congo (DRC)

The crisis in the DRC continues and now involves at least a dozen African countries, either directly as combatants in the fighting or indirectly as mediators in various peace initiatives. The rebel forces, comprising Congolese soldiers, Congolese Tutsi Banyamulenge, Rwandan, Ugandan and some Burundian government troops, accuse President Kabila of behaving like a dictator and increasing regional instability by his support for the guerilla groups opposed to the governments of his former allies, including the Rwandan 'genocidaires'. Kabila is resisting the rebel movement with support from Angolan, Zimbabwean and Namibian troops and accuses Rwanda and Uganda of aggression and "foreign adventurism" in regard to Congolese territory and natural resources (ICG - 21/05/99).

The rebels currently control approximately a third of the country (in the north and east), including Goma and Uvira (IRIN - 09/06/99). The violence continues in many parts of the country. Uvira and Goma were both bombed by forces allied to the government in May resulting in civilian deaths (IRIN-12/05/99).

Progress in the search for a negotiated peace is elusive. Proposals for a national debate have been put forward and the government has declared its willingness to hold "direct talks" with the rebels, but the start of the talks has been postponed several times (IRIN - 17/05/99, 09/06/99). In late May Rwanda declared a unilateral ceasefire in DRC (IRIN - 31/05/99), but the government continued to bomb rebel held areas and hence the ceasefire no longer holds (IRIN - 03/06/99). The rebel factions have also held talks to discuss a peace settlement, but cracks in their alliance have begun to appear and they have ousted their leader Wamba dia Wamba (IRIN -18/05/99).

IDPs in DRC

There is only limited information available concerning the nutritional situation of the people of DRC. Thus it is difficult to estimate the scale of the humanitarian crisis and needs. Given the current security situation, no surveys have been undertaken recently in rebel held areas, because of limited access and as a result of the near-complete destruction and/or loss of infrastructure. It is estimated that there may be up to 660,000 IDPs in the country, the majority of whom are in South Kivu (220,000) and Katanga (150,000) (IRIN - 22/06/99).

Kinshasa

In Kinshasa the recent devaluation of the currency has affected market prices and basic food costs have increased substantially. A study conducted by FAO and UNDP noted that food insecurity has been increasing in the city since August 1998. This is linked to both a reduction in food availability due to; insecurity, lack of currency for importing goods, and shortage of fuel, and also restricted access to food due to high inflation and unemployment. The study, which was undertaken between mid-March and early April, found that the purchasing power of the city's population had diminished by 30-35% since the beginning of the war (IRIN -06/05/99, WFP - 27/04/99). Anecdotal reports have described increases in the prevalence of wasting among children (IRIN - 16/04/99). Fuel has also become expensive - disrupting the transport system and hence the city's economy. WFP airlifts from Pointe-Noire to Brazzaville continue as rail traffic between the two cities is not possible due to insecurity. Part of this food is then ferried across the river to for distribution in Kinshasa (WFP - 28/04/99).

Lubumbashi, South East DRC

ACF conducted a study in Lubumbashi district, Katanga province in May (see Annex). The most recent census (1997) estimated the population of the district to be approximately one million people. Lubumbashi town developed around the mining activities in the province - there are large quantities of zinc, silver, lead and cobalt deposits in the area. The socio-economic and political situation of the town's population, who are mainly salaried workers, is precarious. The recent insecurity has caused massive population displacements and increased unemployment. Many of the labourers have not received their salaries for several months. In addition, the devaluation of the congolese franc to the dollar has increased the population's difficulty in purchasing sufficient food.

The survey estimated 2.1% acute wasting and 0.1% severe wasting in children under-five. Oedema was recorded in 0.7% of the children. A much higher proportion of the children were defined as stunted (low height-for-age): 50.8%; 16.2% were defined as severely stunted.

Maternal nutritional status was also studied. 18.8% of the women had a BMI<18.5 kg/m² of which 7.5% of these had a BMI < 17. kg/m². 6.1% of the women had a MUAC < 220mm. If the women's MUAC and BMI were considered together (BMI<18.5 kg/m² and MUAC<220 mm) it was found that 8.5% were classified as undernourished. This figure was reduced to 2.0% when only those with a very low BMI and low MUAC were considered (BMI<16.0 kg/m² and MUAC<220 mm). A further 12.4% were considered to have marginal nutritional status (BMI>18.5 kg/m² and MUAC<220 mm).

Enquiries about vaccination status revealed that only 19% of the children had been vaccinated against measles as confirmed by a card, however, based on mothers' reporting vaccination coverage increased to 80%. Approximately half of those children vaccinated were less than nine months of age, which is generally considered to be too young.

Given the population's precarious socio-economic and political situation, the prevalence of wasting amongst the children is not as high as might be expected. There are virtually no facilities for caring for undernourished children in this area. Maternal nutritional status appears to be poorer than that of children and therefore may be a more serious problem. A simple analysis found no association between maternal and child nutritional status. In addition, there was no significant difference between the nutritional status of households who possessed a garden plot (46%) as compared with those who did not.

Lukaya district, Bas-Congo

ACF also conducted a study in Lukaya district, Bas-Congo province in March (see Annex). During August-September 1998 this area was directly affected by the war when the aggressors fought along the main roads from Kisantu-Kinshasa and Kisantu-Angola. There were numerous civilian deaths, houses were looted and demolished and agricultural fields were destroyed. The health centres were emptied of medicines and equipment. Many farmers lost their seeds and tools and were forced to delay planting their crop. The survey, which was conducted six months after these events, was undertaken at the request of UNICEF who reported an increase in the number of admissions to the supplementary feeding centres in the villages. The survey estimated acute wasting at 4.9% and 0.5% severe wasting in children under-five. Oedema was recorded in 0.2% of the children. A much higher proportion of the children were defined as stunted (low height-for-age): 43.5%; 19.6% were severely stunted.

Maternal nutritional status was also studied. 20.4% of the women had a BMI<18.5 kg/m² of which 5.2% of these had a BMI < 17.0 kg/m². 8.0% of the women had a MUAC < 220mm. If the women's MUAC and BMI were considered together (BMI<18.5 kg/m² and MUAC<220 mm) it was found that 8.4% were classified as undernourished. This figure was reduced to 1.6% when only those with a very low BMI and low MUAC were considered (BMI<16.0 kg/m² and MUAC<220 mm). A further 13.1% were considered to have marginal nutritional status (BMI> 18.5 kg/m² and MUAC<220 mm).

Enquiries about vaccination status revealed that only 34.5% of the children had been vaccinated for measles as confirmed by a card, however this figure reached 43.9% when based on mothers' verbal reports. About half of the children with cards had been vaccinated before the age of nine months. An estimated 7% of the children were reported to have had diarrhoea in the two weeks before interview and 42.8% had suffered from a fever. The treatment of those who suffered from diarrhoea was not always ideal - only 45.2% were given oral rehydration salts and food was withheld from some (30.6%).

The crisis six months prior to this survey does not appear to have had lasting effects on nutritional status of children. The area is sufficiently well equipped with nutritional centres to deal with the estimated number of undernourished children in the population. Maternal nutritional status was, once again, less satisfactory. A weak significant association was found between the maternal and child nutritional status.

Rebel held areas

Approximately 20,400 IDPs and malnourished children are receiving supplementary and therapeutic feeding in Goma through a WFP-funded project. An FAO-sponsored food security programme is providing seeds to some 10,000 displaced families in the region (IRIN- 06/05/99). No further information on the nutritional situation of the population in these areas is available.

Measles and polio vaccination campaigns have been carried out in North and South Kivu by IRC/UNICEF/WHO/MSF/SCF-UK in collaboration with local health authorities. The campaign followed earlier reports of deaths from measles in these areas in February. Stocks of meningitis vaccines are currently being built up in response to a continuing epidemic in the province (IRIN - 06/05/99, 11/05/99).

An outbreak of a viral haemorraghic fever has been confirmed by WHO in the north-eastern region of the country. The latest figures suggest that there have been 90 confirmed cases and 60 deaths. The majority of these patients were men working in gold mines around Duba in Province Orientale. The epidemic was not caused by the Ebola virus, but may have been due to the related Marburg virus. The most recent reports suggest that the epidemic is diminishing (IRIN - 12/05/99).

Refugees in DRC

Angolan Refugees

There are estimated to be 145,000 Angolan refugees in the DRC (UNHCR - 10/06/99). The assistance programme to 50,000 Angolans in southern parts of the country continues to be hampered by several constraints. There have been serious and chronic delays in food arrivals due to the scarcity of wagons for the transport of food and poor road conditions. Airflights are also scarce and very expensive. As a result of inadequate food deliveries, UNHCR has been required to purchase much of the food for these refugees locally. The nutritional situation of the refugees, which was reported to be extremely poor in February, has improved following a decision to extend food assistance and health care to all children under-five (WFP - 30/04/99).

Refugees from Congo Brazzaville

Over 30,000 Congolese fled to Bas-Congo in the DRC at the height of the conflict. UNHCR has assisted approximately 13,000 Congolese refugees to return from the DRC to Brazzaville and more are scheduled to return. Approximately 10,000 other refugees are thought to have returned without assistance (IRIN - 14/05/99, 30/06/99).

Fresh waves of violence have, however, precipitated more fleeing from the Pool area. Constant movement in and out of the area renders it difficult to provide an exact caseload of the refugees (the most recent estimate is that there are 32,000 refugees from Congo-Brazzaville). The new arrivals are reported to be in poor health and nutritional condition as many had been hiding in the forest around Pool for up to four months without regular access to food. The most recent report from UNHCR states that mortality rates are very high. Health facilities are available in Luozi camp which has a capacity of 15,000 people. UNHCR plans to buy food for these refugees locally, as WFP has not been able to provide the required ration (IRIN - 11/05/99,14/05/99, 30/06/99; UNHCR - 28/06/99, 30/06/99, WFP - 31/05/99).

Burundian, Rwandan and Sudanese refugees in DRC

There are estimated to be some 20,000 Burundian refugees in S. Kivu and some 60,000 Sudanese people in the country. Approximately 25,000 of the Sudanese may have regrouped in Am where UNHCR is in the process of opening an office in order to assist them. No information is available on their nutritional situation of the others as they were scattered by the recent conflict and have been hiding in the hills and forest. UNHCR has reopened its office for the Goma region which had been closed since October 1997. A large number of Rwandans remain unaccounted for in this area (UNHCR - 28/06/99).

Overall, the IDPs in the government held areas are at moderate risk (category IIb). Those in the rebel-held areas may be at higher-risk (estimated number: 370,000), but no information is available to the RNIS (category III). The Angolan refugees in Bas-Congo are considered to be at high risk (category IIa). High mortality rates are reported for the refugees from Congo-Brazzaville (category I). No information is available on the nutritional status of the other refugees (category III).

Priorities and recommendations:

· Access to the rebel-held areas is still the priority for the humanitarian community in DRC.

· Set up therapeutic and supplementary programmes for the treatment of the undernourished children.

· Create a surveillance programme which will refer children to these centres

· Continue the treatment of the undernourished children in the existing programmes

· Continue growth monitoring programme of the children in health centres but add height monitoring to this (currently just weight-for-age)

· Educate and sensibilise the population about the proper treatment of diarrhoea

· Develop food security activities in order to respond to the longer-term problem of stunting among the children.

· Improve and strengthen the measles vaccination campaign.

United Republic of Tanzania

Recent influx of refugees from DRC and Burundi

The surge in fighting in Eastern DRC has led to a dramatic influx of refugees into the country. More than 87,000 new arrivals have entered the country since the outbreak of hostilities in August 1998. The newly arrived refugees, who have consistently reported being caught in the middle of ongoing skirmishes in the DRC, are generally in good health and have a satisfactory nutritional status. Before this recent influx, there was one camp for Congolese refugees - Nyarugusu, refugees were then transferred to Lugufu (Kigoma). Recent reports have suggested that the present capacity of Lugufu camp is near to saturation and efforts are being made by UNHCR to secure alternative camps sites (UNHCR - 03/06/99, 11/06/99, 29/06/99).

New Burundian arrivals were also registered over the reporting period, with the influx peaking in late April-early May when some 5,000 Burundians entered the country due to hostilities in the Burundian province of Ruyigi. This influx was concurrent with the repatriation of smaller numbers of refugees - between January and April of this year 5,000 Burundians repatriated from Tanzania (UNHCR -29/06/99; WFP - 05/05/99, 27/05/99).

As part of an information campaign to encourage the voluntary repatriation of Rwandans in United Republic of Tanzania, a delegation of former Rwandan refugees recently visited the Ngara region. A small number of refugees decided to return voluntarily. A group of more than 60 refugees is due to return to their place of origin in order to report back to the camps on the situation in Rwanda. It is not known how many will eventually repatriate (IRIN - 28/04/99, WFP - 06/05/99).

Nutritional Status in Kagera and Kigoma camps

The nutritional status of the refugees in the Tanzanian camps is satisfactory. A recent survey conducted by UNHCR in the camps in the four districts in Kigoma and Kagera regions (i.e.: the camps in the west of the country) estimated the prevalence of acute wasting to be 1.8% and severe wasting to be 0.2% (see Annex). No cases of oedema were reported and no child was found with a MUAC<110 mm. The prevalence of chronic undernutrition - measured by stunting - was much higher at 44.1% with 18.8% severe stunting, and closer to that found in the resident population surrounding the camps. These results suggest that although the current nutritional situation is adequate the children's previous nutritional history may have been poor.

The survey report gives credit for the improved nutritional situation to WFP and its donors for providing a stable food pipeline to this refugee population and, indeed, in the current reporting period the food supply continued to be adequate, as did the supply of water (WFP - 05/05/99, 12/05/99). Credit is also given to UNICEF and the other agencies which have provided a series of preventative and curative health services including growth monitoring, malarial control and de-worming programmes as well as micronutrient supplements, post-natal care and selective feeding programmes.

The survey also examined the prevalence of anaemia in the refugee population. Among children under-five, 18.8% were found to have moderate/mild anaemia (10.0-10.9 g/dl) and 14.3% were suffering from severe anaemia (<9.0 g/dl). The mean haemoglobin level was 11.8 g/dl in this age group. No direct relationship between severe undernutrition and anaemia was found (possibly because only a very few cases of severe wasting were seen).

Haemoglobin levels were also assessed amongst the children's mothers and fathers. The mean haemoglobin level for the women was 13.2 g/dl; 13.8% of them were classified as mildly anaemic (11.0-11.9 g/dl) and 9.7% suffered from severe anaemia (<10.9 g/dl). The men's mean haemoglobin level was 14.9 g/dl and only 6.7% had haemoglobin levels < 12 g/dl. Thus the haemoglobin levels were better in men than in women or children.

A high (90.7%) proportion of the children had vaccination cards. The vaccination programme, however, is aiming for full coverage and hence problems such as the loss of cards (mainly in the older children), poor filing and misinformation on the cards, which are relatively common, need to be addressed. In addition, it was apparent that many of the children did not receive their vaccinations at the right age (e.g.: amongst those with cards it could be seen that 91.3% of children received a measles vaccination, however only 52.6% of these received their vaccination within one year of birth).

Acute respiratory infections in the two weeks prior to interview were reported among 43.1% of the children and 40% also reported fever in the same time period. The prevalence of diarrhoea was low in comparison - only 20%. These findings were supported by reports from the out-patients clinic. Analysis revealed an association between wasting and reported illness.

A health NGO in Matabila and Muyovozi camps in Kasulu reported that they are planning to commence an HIV test programme in the camps. This has arisen in light of reports received from Lukole camps where 25% of blood donors were found to be HIV positive (WFP - 05/05/99). HIV is a very serious problem in Tanzania, the latest UNICEF/Government estimates suggest that there will be between 800,000 and one million children orphaned by AIDs by the year 2000 (IRIN -17/06/99).

Drought response

Nine regions of Tanzania are being targeted for food distributions under the WFP operation for assistance to drought affected persons. In some regions food allocations for a one month distribution, instead of the planned three months, are to be distributed to the most severely affected persons (WFP 26/04/99). WFP's targeted assistance to the population in drought affected areas of Singida and Dodoma (EMOP 6112) has been extended to June (WFP - 21/05/99, 27/05/99). A joint UN/Government crop and food supply assessment mission was scheduled for the end of May 1999 (WFP - 21/05/99). Initial reports from the mission in the field indicate that some areas in Dodoma will face food shortages after the harvest in July due to the rains stopping at the critical ripening stage of the crop (WFP -11/06/99).

Overall, the nutritional situation among the refugees in the western camps appears stable as a result of effective humanitarian response programmes, and hence their nutritional situation is not critical (category IIc). However, the funding shortfalls could place them at greater risk in future.

Priorities and Recommendations:-

· Funds are urgently needed for the WFP operation to provide assistance for the refugees in the United Republic of Tanzania. Breaks in the pipeline mean that rations will either be cut or distributions undertaken less frequently.

· Maintain levels of wasting at current levels through regular general food distributions. The referral of undernourished children to the feeding centres should be continued and improved if possible.

· Reinforce efforts to prevent and treat anaemia (although the levels found were lower than expected).

· Improve de-worming and immunisation programmes.