2. Great Lakes Region

Burundi
Rwanda

The situation in Brazzaville continues to be extremely serious; very high prevalences of malnutrition have been recorded amongst the returnees from Pool. Peace in the Democratic Republic of the Congo has resulted in improved humanitarian access to war affected. In Burundi and Rwanda the nutritional situation continues to improve in the areas where there have been improvements in security. A registration exercise in Tanzania has found in a decrease in the number of beneficiaries in the refugee camps in the south of the country. The table below shows the numbers of refugees, IDPs and returnees who require assistance in the Great Lakes Region.

	Sep. 97	Dec. 97	Mar. 98	June 98	Mar. 99	Jun. 99	Sep. 99
Burundi	260,000	570,000	600,000	670,000	222,000	451,000	617,000*
Rwanda	727,000	1,400,000	690,000	550,000	690,000	640,000	673,000
Tanzania	311,000	318,000	345,000	329,000	328,000	373,000	373,000
DRC	823,000	585,000	568,500	621,000	788,000	952,000	1,104,000
Congo-B	465,000	650,000	400,000	50,000	213,000	213,000	343,000
Total	2,586,000	3,542,200	2,603,500	2,220,000	2,241,000	2,629,000	3,110,000

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

Burundi

An estimated 617,000 people in Burundi require assistance. The vast majority of these people are IDPs and returnees; the highest concentrations are in Bubanza and Bujumbura (Mairie and Rural) districts. In addition, a total of 288,036 Burundian refugees remain outside the country of which 265,400 are in Tanzania (IRIN - 30/08/99: OCHA - 31/07/99).

Hopes that the Arusha Peace Process would result in an agreement by September or October have been quashed following disappointing progress in the talks in early July. The next round of talks is scheduled for September. Insecurity has increased during the reporting period in the Western and Southern Provinces, particularly around the capital. The rest of the country has seen only sporadic fighting, although Amnesty International has reported that human rights continue to be abused throughout the country. Reinstallation, rehabilitation and development programmes continue (AI - 17/08/99; OCHA - 31/07/99, 19/08/99).

The security situation around Bujumbura Rural has been particularly poor. There has been an increase in military activity and episodes of regroupment have caused an increase in the number of displaced people as the army has attempted to isolate the rebels. The governor of the province described the fighting between the security forces and armed gangs as "almost continuous". The heavy fighting has periodically prevented WFP from delivering food during the reporting period. Most deliveries resumed as soon as the security situation stabilised (IRIN - 08/07/99, 13/07/99, 19/07/99, 24/08/99, 06/09/99, 10/09/99; WFP - 12/07/99, 30/07/99, 17/08/99; 05/09/99).

Food Security

According to market price surveys by FAO, the price of the average food basket in Burundi is 126% higher than before the imposition of the regional embargo against the country in July 1996, even though the sanctions were suspended earlier this year (OCHA - 31/07/99).

THE GREAT LAKES REGION

updated by ReliefWeb: 7.6.96

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FAO, in collaboration with partner NGOs has begun to compile beneficiary lists for the upcoming distribution of agricultural materials for the 2000-A season. Approximately one million people will be assisted through the distribution of bean and vegetable seeds. Priority will be given to those who have access to land, returnees and displaced persons, drought-affected farmers and Batwa people who were recently allocated land. WFP will complement this effort by providing 15-day food rations to the beneficiaries (OCHA - 31/08/99; WFP - 15/09/99).

Nutritional situation of IDPs and returnees

No nutritional surveys have been conducted on Burundi's displaced populations during the reporting period. The most recent RNIS reports and a UNICEF report published in early August have all described how the nutritional status of the population has improved over the past 18 months. Since late 1998, UNICEF and the Burundian Ministry of Health have co-ordinated a series of ad hoc nutritional surveys of randomly selected samples of children under 5 years. A national survey was not considered to be appropriate, as aggregated data would have hidden important differences between provinces. The co-ordination resulted in successfully standardising the survey methodology (FAO and WFP were also involved in this process) applied by a number of NGOs. To improve nutritional monitoring most affected provinces have been assessed more than once since January 1998. In addition, a small food security component was added to the anthropometrical evaluation to improve understanding of the causes of malnutrition.

Reasons given for the improvement in the nutritional situation include:

· a gradual return to agricultural activities due to improved security,
· better access to land and consequently better harvests,
· improved access to health centres,
· improved case management of malnutrition through nutritional centres and
· support given to households through food distributions (UNICEF - 08/99).

	No. of IDPs	Prevalence of wasting &/or oedema	Source & date of nutritional data (where available)
Bubanza	170,760	11.6	CAD survey, 02/99
Citiboke	n/a	6.0	Concern survey, 10/98
Gitega	14,900	6.9-7.4	Oxfam/SCF/MOH survey, 03/99
Karuzi	13,600	6.7	MSF-B survey, 11/98
Kayanza	21,200	9.8	ACF survey, 01/99
Muramvya	26,800	11.0	Solidarities survey, 02/99
Muyinga	25,800	~10	Clinic data, UNICEF
Ngozi	25,300	10-15	Clinic data, UNICEF
Rutana	2,300	10-15	Clinic data, UNICEF
Bururi	86,200	~10	Clinic data, UNICEF
Kirundo	7,700	10-15	Clinic data, UNICEF
Bujumbura	150,000	n/a
Makamba	70,800	n/a
Ruyigi	1,700	n/a

In addition to the results seen above MSF-B has reported that the number of admissions to the therapeutic feeding centres in Bujumbura Mairie decreased between January and June 1999 from 180/month to 60/month. Admissions also decreased in Ruyigi and Karusi over the same time period, although the decreases in these provinces were not as dramatic (MSF-B - 07/99).

Despite the results seen in the table above, the nutritional situation in Burundi is still thought to be precarious in some areas: differences exist both within and between provinces over short periods of time. Some areas, e.g.: Makamba and Bujumbura Rurale, are still too insecure to conduct full assessments and hence no reliable information on the nutritional status of the population is available. These areas may have pockets of high prevalences of malnutrition. UNICEF's report stresses that although the number of beneficiaries enrolling in feeding centres has decreased between the end of 1998 and early 1999, the total case load of the programmes is still relatively high: 40,000 beneficiaries are currently enrolled in the supplementary feeding centres and 3,500 in the therapeutic feeding centres (UNICEF - 08/99).

Health services

In addition to poor food security in some provinces, the population's poor health status is a further risk factor for malnutrition. In some areas households are prevented from accessing health services and cannot obtain essential drugs due to geographical and/or financial barriers. In addition, the poor quality of the care provided at the health centres, due to a decreased number of skilled personnel, has resulted in a deterioration of the population's health status (UNICEF - 08/99).

Refugees in Burundi

Approximately 500 Congolese refugees remain in Citiboke and there are also some 2,000 urban Rwandan refugees in the country.

Overall, the nutritional situation of the IDPs and returnees in Burundi is improving. The IDPs and returnees in the provinces where access can be obtained and where survey or clinic data (concerning prevalences of malnutrition or admission rates) are available are considered to be at moderate nutritional risk (category IIb). The nutritional situation of those in Makamba is unknown (category III).

Priorities and Recommendations:

· Gradually shift from short-term emergency assistance to longer-term initiatives, with elements of sustainability, in the areas where improvements have been seen in the nutritional situation.

· Continue to monitor the nutritional situation closely.

Rwanda

The coalition government and political parties making up the parliament in Rwanda have agreed to extend the transition period that was due to end in July for another four years. They aim to resolve political and judicial problems before embarking on the process of constitutional change and the organisation of broader democratic elections. There remain 673,000 "affected" people in Rwanda requiring humanitarian assistance. This figure includes more than half a million IDPs the majority of whom are in Ruhengeri and Gisenyi. It also includes some 124,000 detainees, 33,700 refugees and 6,600 unaccompanied children (IRIN - 31/08/99; OCHA -19/08/99).

North western areas

The security situation in north-western Rwanda remains stable. There are, however, unconfirmed reports that between one and two thousand Interhamwe have infiltrated the country and are lying low and thus security checks remain in place between Ruhengeri and Gisenyi (OCHA - 19/08/99; WFP - 20/08/99).

The Rwandan National Population Office, UNFPA and UNDP reports that living conditions in the north-west of the country continue to be difficult even after the population has moved out of the displacement camps into the 'imudugu'. Sub-standard housing is widespread. 29.1% of the population are still living in tents and 33% continue to rely on plastic sheeting for the walls of their homes. Plastic sheeting is the principal material for roofing for 51.2% of the population. Men currently head only 66.1% of households. These figures have changed little since December, except the number of female-headed households has nearly doubled in Gisenyi. Thus more women are now carrying the increased burden of raising their children and trying to sustain a productive livelihood (OCHA - 03/08/99).

Food security

According to the report described above agricultural activities have increased significantly since people left the displacement camps, although only 50% of the population surveyed were able to access their land regularly. In Gisenyi, 74% of available land had been cultivated but only 56% had been cultivated in Ruhengeri. A recent FAO report noted that food prices had started to increase following reduced yields from the 1999b season. Another concern is that only 60% of people under 20 have access to agricultural land. Without education or opportunities for income generation, an underclass may soon develop in this age group (OCHA - 03/08/99).

Of additional concern in Gisenyi is that approximately 79% of households lack any sort of food stocks and, on average, 82% of their expenditures are on food. As a result, much of the population is still relying on food aid and cannot compensate for it should distributions be reduced. WFP provides food to 247,500 beneficiaries in Gisenyi. There are an estimated 143,000 IDPs in this area (OCHA - 03/08/99, 13/08/99; WFP - 04/08/99).

Nutritional survey in Gisenyi

Preliminary results from a survey in Gisenyi prefecture conducted in June by MOH/UNICEF/WFP/WHO estimate a prevalence of 11% acute wasting and/or oedema which includes 7.3% severe malnutrition amongst children aged 3-59 months (see Annex). Oedema was reported in 6.2% of the children. The nutritional situation was most severe in the south-eastern communes of Gisenyi where insecurity has been prolonged and humanitarian assistance has been difficult to provide. The full report of this survey is not yet available to the RNIS and thus no further conclusions can be drawn at this time (OCHA - 03/08/99; WFP - 04/08/99).

Ruhengeri

Following the early conclusion of the rainy season, the potential for crop failure was heightened in many areas if the north western prefecture of Ruhengeri. Anecdotal reports have indicated that seeds reserved for the October planting season are being consumed by farmers and their families instead of being planted. These reports are currently being evaluated. Currently, WFP provides food through general distributions to an estimated 270,000 beneficiaries in eight communes in Ruhengeri. There are approximately 365,000 IDPs in this area (WFP - 02/09/99).

Returnees from DRC

As of the end of August, approximately 25,000 Rwandans had returned from N. Kivu to Gisenyi and Ruhengeri. A combination of the improving situation in the north-west of Rwanda and the deteriorating conditions and sensitising campaigns in the DRC are the main reasons for the returns. The returnees are registered at a transit centre where WFP provides them with a 3 month food package and non-food items prior to departure for their home communes. UNHCR expects more returnees in the next few months. There have also been other returnees from Burundi, Uganda and Tanzania (OCHA - 13/08/99; UNHCR - 27/09/99; WFP - 04/08/99).

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, there has been little reported change in the situation of the IDPs in the north west of Rwanda over the reported period. It is clear that the IDPs have not yet fully established their livelihoods, although they receive food assistance from WFP and thus they remain at moderate risk (category IIb). The nutritional situation of the returnees appears to be adequate (category IIc). The nutritional situation of the Congolese is unknown (category III).

Priorities and Recommendations:

· Monitor the food security situation in Ruhengeri carefully.

· Support agricultural production and animal husbandry activities in north-west areas in order to improve access to food.