Southern Sudan
Northern Sudan
In 1998, after a prolonged civil war and consecutive population displacements, southern Sudan faced a catastrophic humanitarian situation, with population displacement, acute food insecurity, localised health crises, extremely high levels of wasting and concurrent loss of life. The last RNIS described an improving nutritional situation for much of the population and this is still true for some areas. In other areas, however, the nutritional situation appears to be deteriorating and there are reports of increasing numbers of wasted children. Thus it must be stated that the nutritional situation at this time remains very fragile in many areas: an increase in insecurity and/or reduction in food assistance could result in a very poor nutritional situation developing again, particularly as the current season (May to September) is the traditional "hungry season".
On April 5th the Government of Sudan announced a comprehensive cease fire starting on April 15th, covering all parts of southern Sudan. The Sudan People's Liberation Movement (SPLM) announced a three month extension of the existing cease fire that is effective in Bahr el Ghazal region (BEG) in order to facilitate humanitarian assistance. Despite these announcements insecurity continues in some areas. Bombings, attributed to government forces, were reported in BEG in the villages of Akak and Nyamlell. These bombings have a particularly bad impact on the humanitarian situation in the "hungry season" as they not only cause civilian casualties and damage to property but may also prevent people from showing up to planned food distributions (IRIN -17/05/99).
Militia raids in northern BEG, which usually coincide with movements of the Government of Sudan (GoS) train between Aweil and Wau cause recurring displacements of population and affect their food security. Fighting between SPLM and GoS in Gumriak area (Western Upper Nile) and between SPLM and pro-government troops in Thiekthou area (BEG) resulted in burned villages and displacement of around 40,000 and 30,000 people respectively. Continuously denied flight access to several areas in Eastern Equatoria and Jonglei regions, reportedly on security grounds, resulted in lower relief inputs to these areas than expected, causing additional future requirements. Influx of returnees into Aweil East and West Counties has increased the needs for these areas where malnutrition is on an increase.
Recent positive donor response to the Sudan Emergency considerably improved the pipeline However, WFP is still under-resourced in Corn-Soy-Blend (CSB) and some 6,000 MT are required to cover the 1999 needs.
Non-GOS controlled areas
WFP operations are reaching 1.5 million beneficiaries in the southern sector. Note that, as stated above, the nutritional situation in Southern Sudan is variable. The surveys summarised below are only valid for the area where they were conducted and the results should not be generalised to other regions.
Bahr el Ghazal
Prevalence of wasting and/or oedema at various sites in Bahr El Ghazal between Feb-Jun 1999
A large number of surveys have been undertaken in BEG during the reporting period (see Annex). The prevalences of wasting and/or oedema in Rumbek, Baroud, Yirol, Tonj, Gogrial, Ajak, Aweil West, Ajep and Tieraliet can be seen in the graph below. All of these surveys have estimated the prevalence of wasting and/or oedema to be under 20%. The prevalence of severe wasting and/or oedema was less than 1.5% in all the surveys (no information is available on the prevalence for severe wasting and/or oedema for Aweil West). This represents an improvement in the nutritional status of the populations since the last surveys undertaken in all areas except Aweil West. However, it should be noted that some of the prevalences seen are still relatively high (e.g.: Yirol, Ajak and Tonj). The results of the previous surveys can be seen in RNIS 26.
Prevalence of wasting and/or or oedema in Ajep, Bahr El Ghazal
The graph opposite shows the decrease in wasting and/or oedema in just one site, Ajep, since July 1998 last year. Ajep is a relatively extreme example - very high rates of wasting were seen in this area last year - but it is clear from the graph that there has been a very substantial and continuous decrease in the prevalence of wasting and/or oedema since July 1998. Explanations given for the improvements in the results of the surveys shown include:- (i) many of these surveys were undertaken after the main harvest in December whereas those last year were conducted in the middle of the hungry season, (ii) improvements in the quality, quantity and regularity of ration distribution, and, (ii) some households had gone to cattle camps in the latest survey. ('Elite' families move to cattle camps at the beginning of the year. Traditional support mechanisms require that these families take their relatives unhealthy children to the cattle camp for feeding with milk. This could explain the fairly low level of both moderate and severe wasting found in the villages).
CMR and under-five mortality rates had also decreased in all sites where they were estimated except Aweil West which remained the same as that in January. The table below summarises the mortality rates recorded. In some areas such as Ajep, Tieraliet and Ajak the decreases in mortality rates were very steep. The mortality rates are high in Ajak, although they were recorded at 12.4/10,0007day (CMR) and 25.3/10,0007day (under-five) between December and February.
|
Site |
CMR |
Under-five Mortality |
|
Baroud (Feb) |
1.8 |
2.4 |
|
Ajak (Feb-May) |
5.7 |
11.1 |
|
Aweil West (May) |
1.1 |
2.2 |
|
Ajep (Jan-Jun) |
1.0 |
2.2 |
|
Tieraliet (Feb-Jun) |
2.1 |
1.4 |
Preliminary results suggest that the prevalence of relatively severe adult malnutrition (using MUAC cut-offs of <20cm for men and < 19 for women) was low for both men and women, and has remained stable. These results are similar to those found in January which were 0.0% and 1.4% respectively. Relative to the children's nutritional status, a deterioration in adult nutritional status would not have been expected at this stage
One of the reasons given for the high rates of wasting and/or oedema seen was the water source - the main source of water for the population was the river (70%). Only 9.2% of the population had access to a protected bore-hole source. At least 20.2% of the population used water from stagnant pools or unprotected wells. A child was more likely to become malnourished using water from stagnant pools or unprotected wells in comparison to bore-hole or a river source (Relative Risk = 1.44, p<0.05).
From observation, it was noted that almost all the households were cultivating. The seed being used had been received from either Concern or ICRC. Negligible amounts of seed had been kept from last year's stores due to the loss of harvests last year as a result of flooding. Many households were eating mainly wild foods (normal) with small amounts of cereal (generally maize from the general ration). The wild foods were reported to be in less abundance in comparison to previous years, possibly due to over-exploitation and uncharacteristic weather patterns. Fish had contributed significantly to household food over previous months partly due to the availability of fishing equipment this year. In comparison to last year, households appeared to be experiencing relatively better access to food (e.g. trading has revived and fishing activities have occurred) and improved availability of food assistance (50% general ration in three established food distribution sites).
The authors of all these surveys (including those which showed an improvement) stressed that the nutritional situation is fragile and is dependent on the potential to cultivate and harvest (i.e.: the amount of seeds and land available for planting). Any factor which restricts cultivation, such as increased insecurity, related population movements or drought, will have direct and serious consequences for the nutritional situation of the population. It was noted that groups without access to land and seeds will be at particular risk in the next few months.
Even under favourable conditions, no group in Southern Sudan is expected to be completely food secure during the hungry season and thus assessments of the situation should continue. Several food economy assessments described in WFP's Sudan Emergency Bulletins indicate a deficit from May-July 1999 for the very poor, poor and medium households in many areas of BEG. For example, a food economy assessment in Twic County has predicted that the poor and very poor socio-economic groups will face a food deficit of 15-25% from May-August. This is mainly due to insecurity which resulted in population displacement since February. Furthermore, the county has seen influxes of returnees from northern Sudan who have placed an additional strain on the local food security situation. The local population have tried to expand their consumption of fish and certain wild foods to meet their need but a deficit remains for certain groups (WFP - 22/04/99, 21/06/99).
Unity/Upper Nile/Jongelei/Equatoria
Insecurity in Western Upper Nile State in May seriously affected WFP operations in the area and has limited access to vulnerable populations in need of food aid. Food distributions have been scaled down and food economy assessments planned for June have been put on hold pending an improvement in the security situation (WFP - 04/06/99).
An MSF-B survey conducted in Akobo district, Pibor County Jongelei Region recorded a prevalence of acute wasting of 33.4% and severe wasting of 4.8% at the beginning of April (see Annex). This represents a deterioration in the nutritional situation of the study population as a survey in October 1998 recorded the prevalence of acute wasting at 24.8%. The number of children admitted to the feeding centres (both therapeutic and supplementary) increased by 50% between January and April of this year. CMR for the four months prior to the survey was estimated at 2.0/10,000/day and under-five morality was estimated at 2.5/10,000/day. The measles vaccination rate was low at 27.4%.
In response to these findings WFP undertook a food economy assessment in the area in mid-April in order to investigate the causes of the high level of wasting recorded as generally Akobo district is a surplus producing area (WFP - 05/99). The assessment found that the survey population did have sufficient food over the January-April period and would continue to do so for May and June. It was suggested that the high prevalences of malnutrition were associated with diarrhoea and cholera, which were due to the children drinking contaminated water. The majority of the population took water from a river which had a very low level of water and a high sediment content between January-April. In addition, due to a security incident, many of the children were evacuated from their homes to another area with contaminated water and returned a few weeks later with diarrhoea.
Normal seasonal population movements may also have added to the problem - as many people within the district migrate to this area at this time of year to access food and medical services. A concentration of people in the area may have resulted in the steep increase in the number of admissions to the centres and an increase in the number of people drinking from the contaminated river. The assessment concluded that the rates of malnutrition were not related to food security but more to disease prevalence in the area due to contaminated water in the rivers. Thus the rates of malnutrition should decrease as the water level starts to rise, the water quality improves and the people migrate away from the area to prepare for cultivation.
In March MEDAIR conducted a random assessment of children in Gumriak (Upper Nile). 23% of the children surveyed were acutely wasted. Gumriak has been closed to OLS operations on and off since mid-February (WFP - 09/06/99).
A number of recent food economy assessments in Unity/Upper Nile/Jongelei revealed that in certain areas, e.g. Leech and Bieh States, the local populations are facing food deficits across all socio-economic groups (WFP -11/05/99). In other areas such as Latjor State fishing and kinship sharing will be able to cover the populations food need until the next harvest in August (WFP - 22/04/99).
Southern Sudan, GOS controlled areas
In the government held towns of Aweil and Wau, WFP continues to distribute food to IDPs, children in school feeding programmes, orphans and war affected beneficiaries (WFP, 30/05/99). There are reports of population movements from Wau to the rebel held location of Acumcum (Wau County) (WFP, 30/05/99). A very recent report indicates increased insecurity in Wau, particularly in the southern part of the town. The local authorities have approved a new site for WFP distributions (WFP - 21/06/99).
There have been reports of fighting around oil installations in Unity State. The SPLM/A has warned foreign oil companies against investing in the country, but the government remains determined to export oil (IRIN -04/05/99, 06/05/99, 11/05/99). The twelfth Juba barge convoy delivered food to a total of 373,688 beneficiaries in 35 locations in Upper Nile, Unity, Jonglei and Equatoria regions (WFP, 24/04/99). Relief workers for WFP and UNICEF were attacked on a river barge in Unity State returning from delivering food supplies to Southern Sudan. In light of the attack, WFP temporarily suspended barge convoys, a cost-effective method of transporting food to more than 300,000 people in the South. A comprehensive security assessment is underway before the deliveries by barge resume (IRIN - 20/05/99, WFP - 22/05/99).
Displaced around Khartoum
There continue to be nearly two million displaced southern Sudanese people in camps around Khartoum. The ongoing civil war in the south and, to a lesser extent, recurrent droughts and floods are the main causes of their displacement. Targeted food assistance continues to the most vulnerable IDPs in squatter camps whose previous homes have been destroyed by GoS's rebuilding programme, although these food distributions are occasionally interrupted by insecurity. Supplementary feeding programmes co-ordinated by ADRA reach approximately 3,000 children under five (WFP -15/05/99).
Transitional Zone, South Darfur, West Sudan
An estimated 5,000 new IDPs have recently arrived at Khor camp in South Darfur. Approximately 35 families per day are reported to be arriving via Safawa and Meiram from parts of Northern BEG and Gogrial. An estimated 80% of the new arrivals are women and children. The most recent arrivals are reported to include several hundred wasting children. A recent nutrition survey carried out by SCF-UK in South Darfur in April 1999 revealed that the prevalence of acute wasting and/or oedema in South Darfur has increased to 18.2% from 13.7% in March 1998 (see Annex). As a result of the insecurity in the northern Bhar el Ghazal, new arrivals are continuously coming through "Safawa". The new IDPS arriving in Ed Daein are severely malnourished and require selective feeding. WFP has being providing full rations to these newly displaced persons who may not be able to cultivate during this planting season and may depend on relief food aid for a long period.
The IDPs indicated that they left their villages because of food shortages. They claimed that the food airdrops were insufficient for all the needy in northern BEG and some villages are too far away from the drop zones and people had no, or very limited, access to the zones. The IDPs also alleged that much of the food is being taken by SPLA forces in the area. An unspecified number of IDPs, mostly people who are too weak or too poor to make the journey to Dafur, are stranded in Safaha (IRIN - 18/05/99; SCF-UK - 04/99; WFP - 15/05/99, 09/06/99).
South Kordofan:
Abu Gebeha and Sidra camp: A recent nutritional survey conducted by SCF-US in South Kordofan indicated that the prevalence of acute wasting and/or oedema among the IDPs in Abu Gebeha is 12.7% and that of Sidra 16% (See Annex). SCF-US also recorded an influx of approximately 2,500 IDPs to these camps in May and June 1999. The nutritional status of the new arrivals is reported to be poor (SCF-US - 10/06//99).
In Kadugli, a recent nutrition assessment conducted by SCF-US and UNICEF in May, revealed a prevalence of acute wasting and/or oedema of 22.3% among the 600 IDPs in the resettlement areas in Kadugli town. WFP will provide relief food to these beneficiaries during the next four months (June-September 1999) (UNICEF -02/05/99).
Nuba mountains
The first UN assessment mission to the rebel held areas of the Nuba mountains (population 100,000-350,000) since the early 1980s, found evidence of malnutrition (including "signs of iron deficiency and goiter") and food insecurity, but "no signs of widespread famine". The mission reported that displaced persons have moved into the general population and are the most at risk of food insecurity, particularly those who have lost their cattle. Significant humanitarian needs were identified, including targeted food aid (following a food assessment mission) as well as seeds and tools. The water supply was described as "extremely difficult" in the dry season and the building of shallow wells was noted as a priority. Negotiations are underway in order to allow follow-up access for the delivery of humanitarian assistance (IRIN - 30/06/99, UN - 25/06/99).
Red Sea State
In Halaib Province, the failure of the winter rains in 1998 has resulted in poor pasture growth which has negatively affected grain production and livestock condition. Consequently household milk production and intake among, the mainly pastoral population, has been reduced. In addition, the poor condition of the livestock coupled with the low grain production in 1998 has led to a deterioration in the terms of trade between livestock and cereals. Households have had to trade live animals in exchange for grains to meet their requirements and thus those that have fewer numbers of livestock have had to reduce their milk and grain consumption. Food aid interventions will be provided by WFP from May to August (MOH - 12/98; WFP/SRC - 04/99; 05/99).
Kassala
A caseload of 30,000 displaced persons is assisted by WFP each month in Kassala area. The situation in the eastern border has remained highly insecure since March 1998, and these IDPs have not been able to cultivate, nor return to their homes of origin near the Eritrea border, nor re-establish their usual coping mechanisms. As a result they depend on emergency food aid for survival. The food insecurity situation in the area has further been exacerbated by the continued influx of newly displaced persons who are arriving in the area a poor physical and nutritional status. Selective feeding programmes are required for these new IDPs for a limited period (WFP -30/06/99).
Unity State
As a result of fighting among local militia for the control of the producing area, the security situation in Unity has deteriorated during the past months. Kidnappings, killings and displacements have been reported. Recent WFP monitoring visits to Pariang have found that a total of about 3,400 newly displaced people have gathered in the town due to the continued inter-factional skirmishes in and around Pariang and surrounding areas. Although the environmental conditions are favourable, the Ministry of Agriculture in Bentiu has predicted that the area under cultivation this year is far less than the previous years because of the uncertainty and volatility of security situation. Ministry officials have also reported a deterioration in the health situation in Bentiu and Mayoum as a result of the onset of rains, a shortage of drugs for prevalent diseases like diarrhea and malaria and lack of medical facilities (WFP - 06/99).
As a result of these developments, the rates of malnutrition have increased in Unity State. A recent CARE report indicated that an increased number of children had been admitted to the supplementary and therapeutic feeding centers in Bentiu during the past three months. Those admitted were reported to have come from Rubkona, Mayoum, Pariang and the newly displaced populations that have come into Bentiu from the surrounding areas (CARE-07/06/99).
White Nile, Displaced in Kosti
A survey in IDP camps in Kosti revealed a prevalence of wasting of 29.4% amongst children under five and 4.2% were severely wasted. Oedema was recorded in 7.6% of the children. The survey noted that the prevalence of wasting followed an outbreak of diarrhoea in March, poor medical facilities and poor sanitation were cited as contributing factors to the diarrhoeal outbreak, and hence the high prevalence of wasting (WFP -11/05/99).
Food distributions are targeted at 8,500 vulnerable persons in Gos es Salaam and Laya IDP camps by WFP. In addition, WFP supports the Sudan Council of Churches and IARA to run supplementary and therapeutic feeding programmes for 1,200 children and their carers in these camps (WFP, 30/05/99). A total of 500 IDP women, who attend training courses in child-care, treatment of diarrhoea, breast-feeding, immunization, sanitation, water use and hygiene, also receive family food rations on the days they attend (WFP, 24/04/99).
Meningitis outbreak
Throughout Northern Sudan, nearly 1,800 people have died from meningitis and a further 30,000 have been infected since the beginning of the epidemic last December. The disease, which was first reported in the northern Darfur state, has spread across the country. The epidemic is expected to last until June-July depending on the geographical location of the states. Vaccination campaigns are underway and 12.8 million doses of vaccine have been given throughout the country by various agencies. Further funds have been requested in order to implement a grassroots prevention training programme (IRIN - 4/29/99, 07/05/99, 20/05/99; IFRC -02/05/99. 17/06/99).
Ethiopian and Eritrean Refugees
Sudan has provided asylum since 1967 to a large number of refugees from Chad, Uganda, Zaire, Eritrea and Ethiopia. During the late 1980's most of these refugees returned to their respective countries, especially those from Chad, Uganda and Zaire. Over the years, many Eritrean and Ethiopians returned to their countries, but new influxes occurred in 1990/91 because of continued civil unrest in Ethiopia and Eritrea.
During the second quarter of 1999, food aid assistance was provided to approximately 133,000 refugees (91 % Eritrean and 9 % Ethiopian) who are living in 22 camps divided into three categories: reception centre, wage-based and land-based settlements. In addition, some 7,300 vulnerable refugees, mostly women and children were assisted under supplementary feeding programme. Nutrition surveys in the camps are annually undertaken in October. The most recent survey (October 98) estimated that the prevalence of acute wasting and/or oedema in the camps ranged from 5 % to 16 %. Malnutrition rates were consistently higher in the reception camps and in some of the wage-based settlements than in the land-based settlements. From March 1999 to May, WFP has implemented a blanket-feeding programme in six refugee camps for targeted beneficiaries. An assessment of the nutritional situation will be conducted in June-July 1999 in order to determine the level of impact of this feeding programme (WFP - 30/06/99).
Overall, the nutritional situation in Sudan appears variable, many areas have seen improvements in nutritional status, but there are exceptions where high rates of malnutrition continue to be found and are attributable to a combination of food insecurity, and public health risk factors (which in turn are usually attributable to the local security situation). However, at this time of year with the approaching rainy season a deterioration in the general nutritional situation is expected. It is felt the situation will not deteriorate as dramatically as last year, partly because of the pre-positioning of food by WFP (the pipeline is secure until August). Locally however, the situation could rapidly deteriorate in the event of conflict and increased insecurity. Thus the current risk category appears to be moderate (category IIb), but in the coming months the risk may increase. In parts of Unity State and Blue Nile the security situation is already unstable and NGOs are denied access, therefore the population i these areas are at higher risk (category IIa). The refugees are not considered to be at heightened nutritional risk (category IIc).
Recommendations and priorities:
· Given the fragile food security situation described it is important to monitor the nutritional situation of the population through regular surveys and assessments, particular in the event of conflict which could rapidly change the situation.LWF in Yirol and Rumbek recommends:· Follow-up to the humanitarian needs in the Nuba mountains, which partly hinges on securing access.
· General recommendations proposed by all survey reports include; strengthening immunisation programmes and health referral systems.
· Continue food assistance to alleviate the possibility of deterioration of nutritional status especially during the hunger period when the last crop has been consumed before the new harvest i.e.: To ensure there is adequate food until July-August, in particular to maintain levels of wasting below 15% during the hunger period.In Ajak, MSF-I recommends:· Increase the number of distribution sites in order to increase the geographical coverage, ensuring that food aid reaches as many people as possible.
· In terms of food rations (i) that the amount of oil in the food ration should be adjusted upwards to meet the WFP ration, (ii) a dry supplementary take-home ration for all children less than five years old should be considered depending on the availability of food.
· Increase the dialogue on targeting and vulnerability, involving community leaders, relief organisations, women's representatives and civil authority, in order to increase the likelihood of the most vulnerable groups benefiting from food relief.
· Improve the coverage of the supplementary and therapeutic feeding programmes.In Aweil West CONCERN recommends:
· Assess the causes of mortality. Check the mortality rates are accurate.
· the commencement of a decentralised supplementary feeding programme to meet acute needs over the next five to six months related to the hungry season.
