6. Liberia/Sierra Leone Region

Liberia

The nutritional situation for much of this region is stable or improving. In Sierra Leone access continues to improve to many of the war-affected areas and thus there have been assessment missions, followed by emergency food distributions. High prevalences of malnutrition have been reported in some areas. In Liberia, Guinea-Conakry and Cote d'Ivoire the nutritional situation of the refugees, IDPs and returnees remains stable. The table below shows the numbers of affected people requiring assistance in these countries

	Sep. 97	Dec. 97	Mar. 98	Jun. 98	Mar. 99	Jun. 99	Sep. 99
Liberia	700,000	700,000	726,000	209,000	495,000	505,000	505,000
Sierra-Leone*	453,000	200,000	200,000	300,000	400,000	708,000	758,000
Cote d'Ivoire	210,000	210,000	210,000	140,000	101,500	103,000	108,500
Guinea-C.	405,000	405,000	405,000	614,000	470,000	400,000	488,000
Total	1,768,000	1,515,000	1,541,000	1,263,000	1,466,500	1,716,000	1,859,500

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

Note that the nos. given for Liberia are those who WFP is giving food assistance to (including IDPs and returnees). This figure may have been underestimated previously.

Liberia

The Liberian civil war, which began in 1989, led to massive population displacements both within Liberia and into neighbouring countries. Since the elections in July 1997, when Charles Taylor was elected President, security conditions have improved considerably, which has prompted increasing numbers of refugees and IDPs to return to their homes. Human rights organisations, however, continue to report terrible abuses throughout the country. Social services remain poor. Monrovia still has no electricity or piped water supply system and local sources report that both unemployment and illiteracy rates are very high (IRIN-WA - 09/09/99).

Since the start of the repatriation of Liberian refugees in May 1997, some 120,000 people have been assisted home by UNHCR. A further 160,000 are believed to have returned unassisted. WFP and UNHCR support reconstruction efforts for schools, roads and bridges in Liberia to help repatriated refugees settle back home (WFP -23/07/99).

Survey in Monrovia

In late March 1999, ACF-F conducted two nutritional surveys in Monrovia (see Annex). The surveys estimated the prevalence of acute wasting and/or oedema at 13.5% among the town residents, and 14.0% among the population living in shelters. Severe wasting and/or oedema were estimated at 2.3% and 2.6% respectively. These prevalences are relatively high, particularly as the survey was undertaken at the beginning of the lean season. The graph following shows the prevalences of malnutrition in the shelters since February 1997. There has been virtually no change in the levels of malnutrition in these shelters for over two years. WFP has not provided a general food distribution in Monrovia since 1998 in order to encourage the displaced to return to their communes of origin. Some of the population of Monrovia may, however, obtain assistance through food-for-work programmes (WFP -14/09/99).

Prevalence of malnutrition in shelters in Monrovia

The survey also estimated retrospective mortality in both populations: CMR was estimated at 1.2/10,000/day in the communities and at 2.8/10,000/day in the shelters; under-five mortality was estimated at 1.5/10,000/day and 5.2/10,000/day respectively. Measles vaccination coverage was low at 30.2% in the communities and 44.5% in the shelters. Coverage of the selective feeding centres was also low in the communities - only 14.6%, although this was much higher (81%) in the shelters.

Survey in Upper Bong County

ACF-F conducted a study among residents and returnees in Upper Bong Country in mid-June. They estimated the prevalence of wasting and/or oedema at 8.1% including 1% severe wasting and/or oedema (see Annex). This result can be compared to those obtained over the past three years in the graph opposite. There has been a slight improvement in the nutritional situation in the past year, and the prevalence of malnutrition has remained below 10% in the past two years. The measles vaccination coverage rate in the area was low at 41.8%.

Prevalence of Malnutrition in Upper Bong County

Fighting in Northern Liberia

Renewed hostilities broke out in mid-August between government security and dissident forces in the volatile upper Lofa region, where a similar attack in April seriously disrupted relief activities. Over 50,000 civilians, mainly women and children, are reported to have been displaced by the fighting. Although the rebels have now been dislodged from most of the areas they initially occupied, sporadic fighting is reported. Most of the UN agencies and NGOs temporarily evacuated their staff from the area and suspended their operations when humanitarian workers were taken hostage and stores were looted. WFP have distributed a one-off emergency ration to more than 25,000 of the displaced in upper Lofa country. It is hoped that the displaced people will soon be able to return home (IRIN-WA - 07/09/99; UNHCR - 06/09/99: WFP -28/08/99).

Sierra Leonean refugees

There are an estimated 100,000 refugees from Sierra Leone in Liberia. Some 16,000 of the refugees were housed in camps near Kolahun where the fighting broke out in August. An estimated 5,000 refugees arrived in Tarvey in Lower Lofa having fled Kolahun. UNHCR has recommended that these refugees be relocated to an existing refugee camp in Sinje, Cape Mount. The agency reported that the refugees cited numerous incidents of harassment in Kolahun by Liberian security forces, and also said they worried that no aid agencies would return to Lofa after the recent violence (IRIN-WA - 24/08/99, 03/09/99; UNHCR - 20/09/99).

There is no new information on the nutritional status of the Sierra Leonean refugees. The most recent surveys (undertaken in April) indicated that their nutritional situation was not critical. WFP had pre-positioned assorted food commodities for the refugees in Kolahun, Harper and Zwedru in order to cover the needs of approximately 30,000 refugees and vulnerable persons during the peak of the rainy season (July-September) when the roads leading to these areas become impassable. However, some of these stocks were looted in Kolahun during a security incident in August (UNHCR -20/09/99; WFP 23/07/99).

Overall, the IDPs and returnees remain at moderate risk (category IIb) and will continue to be so until their livelihoods become more secure. The situation is most difficult for the IDPs in the volatile Lofa region, although little precise information about their nutrition situation is currently available. In Monrovia the prevalence of malnutrition in March was worryingly high as the lean season approached, although no new information is available, they are considered to be at moderate risk (category IIb). The situation of the Sierra Leonean refugees is not critical (category IIc).

Priorities and Recommendations:

From the ACF-F survey in Monrovia:

· Assess and monitor the food security situation of the population in Monrovia; continue to monitor their nutritional status.

· Ensure the continuity of treatment for moderate and severe cases of malnutrition.

· Inform the population about quick referrals to health facilities through community health workers.

· Continue to screen malnourished children and refer them to therapeutic feeding centres

· Continue to monitor the nutritional situation in Bong County.

· Promote the measles vaccination campaign through feeding centres and refer to the UNICEF EPI programme.