Eritrea

Kenya

Approximately 200,000 Eritreans have been displaced by the war, including 40,000 children under five years old. The Eritrean government estimates that there are 69,000 displaced people in camps in Debub and 118,000 in Gash Barka. In addition to the IDPs, Ethiopia has also expelled some 60,000 Eritreans since the war started. This policy has continued over the reporting period. The population from Ethiopia is probably at higher risk than those who are internally displaced as they have been separated from their communities and normal support mechanisms (IRIN -18/11/99; SCF-UK 19/08/99).

No new information on the nutritional situation of the IDPs and refugees is available. The most recent (anecdotal) reports suggest that there is no nutritional emergency in the camps at present (SCF-UK -19/08/99; 08/09/99). Donor response to appeals by the Eritrea Relief and Refugee Commission, however, are reported to be poor (IRIN -15/10/99).

Recommendations and priorities:

· Information on the nutritional situation of war-affected populations on the Ethiopia/Eritrea border is required.

· Funds should be made available for humanitarian operations for the war-affected populations in the north.

Kenya

There were approximately 196,000 refugees in UNHCR camps in Kenya at the end of July. The majority of the refugees are Somalis and Sudanese, but there are also approximately 5,000 Ethiopians. The camps are in two areas: Kakuma near the Sudanese border (camp population 80,600) and Dadaab, near the Somali border (camp populations 115,600). A population re-registration exercise in the Dadaab camps is due to take place in the next few months.

Dadaab camps

The three refugee camps around Dadaab town in Garissa District; Ifo, Dagahaley and Hagadera, were established in 1991 and 1992 following an influx of refugees fleeing fighting in the middle/lower Juba and Gedo regions of Somalia. These regions of Somalia are still considered areas of crises and UNHCR does not, currently, consider repatriation a feasible option for the majority of these refugees.

97% of the refugees in the Dadaab camps are Somalis. Approximately 75% of the refugees have rural pastoral or agricultural backgrounds, the remaining 25% come from large urban centres. 50% of the population is female and 17% are under five years old or over sixty years old (SCF-UK-25/09/99a).

Food and non-food distributions

Food-basket monitoring in 1999 found adequate levels of energy in the ration (2100 Kcal/person/day) and that the planned amounts of oil and cereals have been regularly distributed. A shortage of pulses occurred for three months, but this was compensated for with CSB (SCF-UK-25/09/99a).

Firewood, soap, and kitchen sets were also delivered during 1999. A firewood distribution project was started in 1998. This aims to provide 30% of a household’s monthly requirement of firewood, although interviews with refugees suggest that it may only provide 20-25% of their requirements and thus they still have to collect or buy additional wood (SCF-UK-25/09/99a).

Food economy assessment

A food economy assessment by SCF-UK in the Dadaab camps in September reported the following findings (SCF-UK - 25/09/99a):

· The major source of food within the camps is the ration supplied by WFP. The poorest households (35-45% of the population) have difficulty in meeting their food and non-food needs. They often sell part of their cereal ration in order to buy small amounts of vegetables and milk. This means that they finish their rations two to three days prior to the next distribution, and rely on gifts from relatives to bridge the gap up to the next distribution.

· The rest of the population rely on various mechanisms to earn cash. Refugees have tried all opportunities available to them, and most households have someone engaged in trade, or the provision of services to the better-off households, such as collecting and selling firewood, or building houses, or transporting goods.

· The wealthier households (those who have access to remittances from outside of Kenya, or are involved in countrywide trade) purchase some, if not all of their food needs. There has been an increase in the number of people in this group since the last food economy survey in these camps in 1996.

· A household’s wealth is mainly determined by its connections. The camp operates on a type of patronage system. The wealthier households assist their clansmen in earning income and increasing their wealth, particularly through giving them credit to operate a small business. Refugees who are related to Kenyan Somalis may obtain access to land. Those without connections to the local clan or established individuals face greater constraints in meeting their food and other needs. They are more reliant on the ration and other assistance provided by external agencies and are most vulnerable to food insecurity. Women who have been victims of violence, or who are alone, may be among the poorest as they may not receive patronage or support from others.

· The most important barrier to self-reliance is the arid environment in which the camps are situated. The refugees who have come from a rural background, who might normally be able to secure a portion of their food needs through agricultural activities, are seldom able to do so in the camp. There are virtually no kitchen gardens and seasonal agricultural activities are limited because the rains are unreliable and the soil is not welt suited to rain-fed agriculture. The quantity of water pumped prohibits the cultivation of tap-stand gardens for all but a very few. It may also be difficult for unconnected refugees to access land. Lack of seeds is a further constraint. Insecurity affects farming and the collection of wild foods.

· Some 25% of the refugees do not have an agricultural background and there is little opportunity for those with technical skills, for example those who were previously carpenters or mechanics, to use their skills in the camps.

· The possibility of selectively reducing the ration given to less needy refugees was not recommended, given the complex and delicate inter-relationships between “better-off” groups and the poorer households, and the likely consequences (increased tension in the camps) and the practical difficulties of such a scheme. The present size of the better-off group helps to sustain the dynamics of the camp economy, and as such, they contribute by increasing opportunities to access food, markets and cash. Implementing a food-for-work scheme may have a negative affect on the refugees’ ability to earn cash income themselves.

· The phasing-out of relief support to refugees with a view to longer-term self-reliance is not tenable in the present environment and should only be considered if the groups were able to re-establish themselves in areas where access to essential resources for a sustainable livelihood were not restricted.

MSF-B conducted a survey in the three camps in July 1999 (see annex). The graphs below show the results of these surveys compared to others since 1992 (the prevalence of wasting is defined using percentage of median in these graphs and does not include oedema so as to allow for comparisons with previous years). The prevalence of wasting (defined as <-2 z scores weight-for-height) and/or oedema ranges from 15.2% to 15.6% in these camps. There has been a slight, non-significant increase in the prevalence of wasting and/or oedema since the last survey in September 1998. There were no significant differences in the prevalence of malnutrition between the camps.

The prevalence of wasting (defined using medians) Hagadera camp, Dadaab

The prevalence of wasting (defined using medians) in Ifo camp, Dadaab

The prevalence of wasting (defined using medians) In Dagahaley camp, Dadaab

The number of admissions to therapeutic feeding centres had remained relatively constant in all three camps. The authors of the survey commented that the findings of a “mini-survey” conducted in the feeding programme indicated that most of the families of children in the feeding programme had a larger family than was shown in their ration card (MSF-B-28/08/99).

Kakuma camps

Kakuma is located in north-western Kenya, about 100 km south of the Sudanese border. The camp was established in 1992 for Sudanese refugees fleeing conflict in Bor County, Upper Nile. Since 1992, the camp has expanded to about four times its original size. In 1998 Kakuma II was opened, primarily to accommodate Somali refugees who were transferred from camps in Mombassa, which were closed. In May 1999, Kakuma III was opened for more Sudanese fleeing from the war. The camp populations change almost daily as more Sudanese refugees arrive (approximately 11,000 have sought refuge this year) (SCF-UK-25/09/99b).

Approximately 71% of the population is Sudanese, 22% are Somali and 4% are Ethiopian. Men make up more than 60% of the population over four years old. Many of the males registered in Kakuma are unmarried and they may travel (illegally) in and out of the camps fairly regularly, trying to find work or “to see how the situation is” in Sudan.

Thus the actual difference in the number of men and women in the camps at any one time may be less than the registration figures suggest. Fourteen percent of the population are under five or over sixty years old (SCF-UK - 25/09/99b).

Food and non-food distributions

Food-basket monitoring in 1999 found adequate levels of energy in the ration (2100 Kcal/person/day) and that the planned amount of cereals has been regularly distributed. A shortage of pulses occurred for three months. There was also a shortage of oil that was compensated for with an increase in the cereal ration (SCF-UK - 25/09/99b).

Less soap and firewood have been distributed to the refugee population in Kakuma than in Dadaab in 1999. As in Dadaab, the refugees reported that the quantity of firewood was insufficient to cover their needs (SCF-UK - 25/09/99b).

Food economy assessment

A food economy assessment by SCF-UK in the Kakuma camps in September reported the following major findings (SCF-UK-25/09/99b):

· For 95% of households in Kakuma, the WFP ration provides around 90% of their food needs. The “poor” (approximately 40% of the population) derive most of their cash income by selling 25% of their cereal ration, which is spent on small amounts of special foods, such as milk, and firewood or charcoal. The amount of rations that poor households sell depends on whether or not they receive a firewood ration (they sell more of their ration if they do not receive firewood).

· The income of the remaining 60% of the population can be as low as 500 shillings per month. Sources of income are limited to trade - buying and selling ration items, shops, small restaurants - and earning ‘incentives’ from the agencies working in the camps. Households spend the majority of their income on small amounts of food and firewood or charcoal.

· In the Sudanese community, wealth is broadly determined by access to incentive income. Those with incentives are under pressure to share their income with their relatives. In contrast, the Somalis and Ethiopians have more contacts in Nairobi, Mombassa and overseas with whom they maintain active links. In addition, the Somali community brought many items from Mombassa with them. Although less than half of the Somali households in Kakuma earn a regular income, they share their wealth amongst relatives in the camp and few are found in the poorest groups.

· There has been a decrease in the number of unaccompanied minors (persons less than eighteen years old, separated from both their parents, who are not being taken care of by someone who by law or custom is responsible) in Kakuma since 1996. This is partially due to a policy of placing the children in foster-care and also because many of the children have now grown-up and have begun to work. In addition, programmes have been designed and implemented to increase the unaccompanied minors’ level of cash income, for example - growing vegetables.

· Several policies have improved the refugees’ nutritional situation. These include the school feeding programmes that provide a porridge meal for all school attendants when the schools are open. Given that many of the poorer households have school-aged children this programme may be effective in helping the children in these households meet their minimum energy requirements despite part of their rations being sold. Income generating schemes, such as IRC’s micro-enterprise programme have also contributed positively to income generation in the camp, especially for women.

· As in Dadaab, one of the most important barriers to self-reliance is the arid environment in which the camps are situated. The potential for agricultural activities is extremely limited. The quantity of water pumped prohibits the cultivation of tap-.stand gardens for all but a very few. The relationship between the Turkana host population and the refugees is such that the refugees are forbidden to cultivate, collect wild food or wood, or to own livestock. Much of this hostility revolves around the poverty of the area and the resentment the host community feels towards the refugees who receive a regular food ration,

· The limited market in Kakuma restricts the economic impact of the education and training activities in the camps. The better-off refugees, particularly the Somalis, may have links outside Kakuma, but the majority of the population do not. In addition, Kakuma is geographically isolated from Kenya’s main towns and trade routes and the refugees are not permitted to travel freely in Kenya.

· Given that less than 10% of the population in Kakuma can afford to buy their own food, it would be very difficult to selectively reduce food assistance in these camps. In addition, those who are better-off assist their relatives and hence a reduction would affect much of the population.

· Similarly to Dadaab, options to phase out relief support to the refugees and to achieve self-reliance and sustainability are not tenable under the present circumstances. The possibility of repatriating the Sudanese population to selected areas of southern Sudan, and planning programmes for their repatriation could be considered.

IRC conducted a survey in Kakuma in May (see annex). The graph below shows the results of these surveys compared to others since 1995. The prevalence of wasting (defined by z-scores) was higher than that estimated in the Dadaab camps. No oedema was reported. The prevalence of malnutrition had increased by 2.7% since the last survey in October 1998 and has increased by 3.6% since April 1995. The causes for this increase are not well understood, however the survey attempted to assess some of the possible factors involved (IRC - 05/99).

The prevalence of wasting (defined as <-2 z scores) in Kakuma camps

The prevalence of illness was significantly higher among malnourished children than those who were normally nourished. The most common types of morbidity reported were diarrhoea, fever and cough. This survey was conducted at the end of the rainy season, which might explain why the prevalence of morbidity was so high (57.4% of the children interviewed were reported to be ill in the two weeks prior to interview) (IRC - 05/99).

No association between feeding practices and malnutrition were observed, although the prevalence of wasting was higher in the 6-29 month age group than the older group. Forty percent of caretakers interviewed reported giving their children their first solid or fluid food other than breast-milk before 6 months and 10% of the children were breast-fed for less than 6 months (IRC - 05/99).

Vaccination coverage was relatively low - only 53% of the children had had all their vaccinations recorded. Only 5% of the children had received vitamin A supplements in the 6 months prior to the survey. Possible explanations given for the low coverage include the under-estimation of coverage due to poor recording or loss of clinic cards, and the inadequate knowledge of health staff as to when to give supplements (IRC - 05/99).

The number of children entering the supplementary feeding programmes in Kakuma has increased ten-fold since January as a result of the bi-monthly MUAC screening of all under-fives which was started in January. This has facilitated regular monitoring and identification of malnourished children and has also increased referrals to the supplementary feeding programmes. The survey results, however, suggest that the coverage of this programme needs to be improved (IRC - 05/99).

Recommendations and priorities:

· Continue to provide the general ration of 2100 Kcal/person/day to all registered refugees; continue to provide CSB in the ration.

· Re-register the population to reduce abuses of the system.

· Continue to provide firewood on a regular basis.

· Promote breastfeeding rigorously; discourage bottle-feeding,

· Provide vitamin A supplements for all children under five.

· Train and retrain nutrition workers regularly in order to make sure they know about immunisation, supplementation etc. Establish mechanisms/procedures within health/nutrition structures.

· Strengthen the screening programmes for the under-fives.

· Conduct an in-depth assessment into the causes of malnutrition in under-fives, in particular assess the types and causes of morbidity.

· Continue to promote the income generation schemes.