SUB-SAHARAN AFRICA

The Greater Horn Region
Eritrea
Ethiopia
Kenya
Somalia
Sudan

The Greater Horn Region

In the Greater Horn of Africa some 16 million people who suffer from both drought and conflict will continue to have great needs this year with over two thirds of the World Food Programme's total projected food needs being designated for the Horn in 2001. This is a result of both ongoing conflicts in some countries, and a chronic drought situation that has destroyed crops, season after season, and left many almost totally reliant on humanitarian assistance (WFP-12/01/01).

Eritrea

The cessation of hostilities between Eritrea and Ethiopia on June 18^th brought a halt to the fighting. The cease-fire was formalised in December 2000 with the Algiers Peace Accord. As a part of the peace agreement the two countries agreed to the creation of a buffer or Temporary Security Zone (TSZ) between the two borders to be controlled by a peace keeping force. The government of Eritrea completed the redeployment of its forces on April 16^th 2001 and the TSZ was declared officially established on April 18^th. This paves the way for the clearance of mines from many of the border area zones (FEWS 07/05/01).

The end to the war with Ethiopia has allowed many of the displaced to return to their places of origin. However, the process of recovery is likely to be slow as many are constrained by the extremely precarious food security situation caused by the war and recurrent drought. Many areas of the south of the country remain heavily mined and are extremely dangerous until de-mining can take place.

The major target groups for assistance are as follows:-

1. Drought affected populations. 738,000, mostly in Anseba, North and South Red Sea Zones.

2. Rural war affected. 708,241 people including; IDPs outside camps, host communities, Eritrean deportees/Expellees, Returned IDPs and refugees.

3. IDPs in camps. 208,163 people in 24 organised camps in Debub, Gash-Barka and North Red Sea/Anseba.

Table showing numbers and categories of beneficiaries (UN-2001)

Target Population		Population Number
Drought Affected		738,450
	Anseba	269,835
	North Red Sea	255,842
	Southern Red Sea	134,133
	Maakel	78,640
IDPs in Camps		208,163
Rural War Affected		708,241
Total		1,654,854

War displaced

After the cessation of hostilities in June 2000, an estimated 400,000 IDPs returned to their homes which they found to be either destroyed or looted. In June 2000, SCF-UK reported that there were an estimated 208,163 people remaining in displaced camps in various parts of the country with over 100,000 in the zones of Debub and Gash-Barka. (SCF-UK 07/00).

In July 2000 SCF-UK conducted a nutritional survey of Af'abet displaced camp, which is situated about 70 km north of Keren in the North Red Sea Zone. The camp was set up after the closure of a camp in Dabat and is made up of people from Barentu and the surrounding area. The population at the time of the survey was 24,616 people. The survey revealed an estimated rate of acute malnutrition of 7.7 % including 0.7 % of severe malnutrition. In combination with a CMR of 0.2/10,000/day and an under five mortality of 0.3/10,000/day, the indication is that the situation is under control with all indicators below emergency thresholds (SCF-UK 07/00).

SCF-UK conducted a further survey of three camps to the east of Barentu in October. The three camps of Korokon, Kotobia and Tole-Gamje have existed for at least two years before the recent conflict. The IDPs come from the Gash-Barka zone. During the most recent conflict, fierce fighting in the area forced all IDPs to flee the camp and seek safer sites in the bush. The survey revealed an estimated prevalence of acute malnutrition of 6.6 % including 0.6 % of severe. Again, the mortality figures in combination with the anthropometric results do not indicate an alarming situation. SCF attributes the low prevalence of malnutrition to the timely provision of humanitarian assistance (SCF-UK 10/00).

Outside of the camps there are an estimated 708,241 people, either displaced or severely affected by the war. The majority do not receive the assistance received by those in the camps. The RNIS has not received any surveys specifically on this group but the MoH annual report indicates that the rates of malnutrition are higher amongst this group with rates from 11-14 % (EmoH-2000).

MSF-France made an assessment in Senefa sub Zoba in March 2001. The assessment team visited Rokoyoto displaced camp. Their village of origin is extremely close to the TSZ and people have said that they will not return until there is a civilian administration in the area. The camp receives food from the ICRC but the general conditions in the camp are poor, particularly water supply which is taken from the nearby river and is of questionable quality (MSF-F 03/01).

Drought affected populations

The twin effects of the war and the drought are difficult to disentangle but the population predominantly hit by the drought is estimated as 738,450 people. The worst affected areas are the zones of Anseba and the North and South Red Sea Zones. In the Anseba zone the most affected areas have been surveyed and global malnutrition estimated at 16.1 % as reported in the MoH annual nutrition report for 2000. However, the RNIS does not have access to the individual reports. The same MoH annual report from the Northern Red Sea Zone estimated the total malnutrition rate as 12 % and in the Southern Red Sea Zone as 13.9 (MoH 2000; UN 2001).

Overall

Despite large scale displacements and drought in Eritrea, the nutritional status of those displaced who were assessed in 2000 remained at satisfactory levels (category IV). Food security and nutrition in general appears to be improving, as a result of the peace accord with Ethiopia and "normal" rainfall in many areas.

Recommendations

· Continue general food distribution in camps so that good nutritional status is maintained.

· Support the UN appeal for both war and drought affected populations in Eritrea

· Concentrate on the rehabilitation of the destroyed infrastructure including roads, health and water systems.

· Assess the nutritional status of non-camp populations.

· Ensure that areas are quickly made safe through de-mining and the removal of other unexploded ordnance.

Ethiopia

The UN estimated that there are still 6.2 million drought affected people in Ethiopia. A total of 395,366 IDPs including some 30,000 Ethiopians have returned home as a result of the cessation of violence on the Ethiopian-Eritrean border (FAO-09/01/01; UN-2001).

War displaced population of Tigray and Afar

RNIS 31 reported the displacement of an estimated 316,000 Ethiopians as a result of conflict with Eritrea and Tigray, and a further 34,000 in Afar. Hostilities between Ethiopia and Eritrea reached a peak in May 2000 with a major Ethiopian offensive into Eritrea. An agreement on the cessation of hostilities was signed in June 2000, which was followed by the Algiers Peace Accord in December 2000. The UN officially announced the creation of the Temporary Security Zone (TSZ) on April 18^th 2001, and this marks a major step forward in the development of the peace process between the two countries. The TSZ also enables the work of de-mining the border areas to begin. This will facilitate the return of war displaced to the affected regions (FAO-09/01/01; FEWS 07/05/01; UN-2001).

To date an estimated 31,465 people have returned from Eritrea with a possible 33,000 people still expected to return. The estimated number of displaced and returnees in Tigray and Afar are indicated in the table below.

Estimated numbers of IDPs and returnees in the Tigray and Afar regions

IDPs/Returnees- Number of Beneficiaries
Region	Beneficiaries
Tigray - rural	246,500
Tigray - urban	83,500
Sub Total	330,000
Afar - rural	28,477
Afar- urban	5,424
Sub Total	33,901
Returnees/Deportees	31,465
TOTAL	395,366

It is estimated that as many as 70% of the displaced have returned to their place of origin but many have been unable to fully start the process of recovery. Their home areas have suffered wide scale destruction of the local infrastructure and a large amount of unexploded ordnance restricts access to farm land. Further concerns are the interruption of preventative health services in the region, the damage to water systems and the general environmental deterioration, which have all been responsible for the declining health situation in the post conflict zones (FAO-09/01/01; UN-2001).

The UN expects the recovery by farmers to be slow because the effects of the drought compound the problems of displacement. However, there are encouraging indications that cattle prices remain high in the area, particularly close to the border, as the soldiers in the area provide a ready market. (UN-2001).

Drought

Note that the RNIS is mandated to provide information on the nutritional situation of refugees and displaced populations only. RNIS cannot report the complexities of the Ethiopian drought, but indications are that the nutritional situation has improved since last year. More detailed information is available from www.reliefweb.int and from the UNDP Emergencies Unit for Ethiopia.

In January, predictions were for a total of 6.2 million people in need of continued assistance (FAO/WFP-09/01/01). The details are indicated in the table overleaf.

There are three main target groups for assistance:

1. Pastoral populations in the NE, South and SE. The recovery for households who suffered high livestock mortality will take at least several years even if future rains are good. The continued livestock ban from Ethiopia to Saudi Arabia and other Gulf States is a further impediment to the recovery.

2. Highland farmers dependent on the Belg harvest, which is normally due around July. Belg farmers have suffered four consecutive harvest failures. The next harvest, assuming good rains is not until mid year.

3. Lowland and midland farmers dependent on the Meher harvest. The harvest has been poor to mixed in vulnerable areas and it is not enough to off set the depletion caused by the droughts of recent years (FAO/WFP-09/01/01).

Table of drought affected person in Ethiopia by category (UN-2001)

REGION	Failure of Belg harvest	Recurrent Drought in Pastoral Areas	Meher failure	Total	Population Needing close Monitoring
Tigray			938,500	938,500	335,200
Afar		127,700		127,700	138,100
Amhara	555,900		1,574,100	2,130,000	903,600
Oromiya	9,700	458,100	661,200	1,129,00	1,073,450
Somali		981,000		981,000
SNNP			869,800	869,800	613,300
Benshangul-					3,200
Gumuz
Gambella					7,800
Harari			17,600	17,600
Dire Dawa			48,700	48,700
Total	556,600	1,566,800	4,109,900	6,242,300	3,074,650

Nutrition situation

The RNIS has received numerous nutritional surveys from the second half of 2000, almost all from drought affected populations but some include IDPs and there are some of refugees in camps in the east and west of the country. Whilst nutritional survey reports on the drought affected population are too numerous for the RNIS to report on, indications are that the nutritional status of most populations now is better than at this time last year.

For example, in Boloso Sorie woreda in Wolayita, Oxfam/MSF-S surveys in November 2000 and in February 2001, show a much improved nutritional situation. In November, a Oxfam/MSF-S reported a prevalence of malnutrition of 7.4% (<-2 Z-scores), including 0.9% severe malnutrition (<-3 Z-scores) (Oxfam/MSF-S 11/01). This was a dramatic change from an overall prevalence of acute malnutrition of 45% in June 2000. The decrease in malnutrition was attributed partly to a late Belg harvest. However, over 70% of households interviewed stated that 90% or more of the crop was damaged. Causes of this damage included the following: late heavy rains, infertile soil due to over-rotation and pest damage (Oxfam/MSF-S 11/00).

The feeding programmes implemented by MSF and Oxfam also contributed to the improvement in nutritional status. However, it was also suspected that a considerable number of children who were severely malnourished in June, died between the time of the surveys and the implementation of therapeutic feeding programmes. The under five mortality rate in the month before the survey was 5.28/10,000/day and the CMR was 3.22/10,000/day. Malaria was the main cause of death, followed by diarrhoea. General food distribution was well below the estimated needs (Oxfam/MSF-S 11/00).

Concern and MSF-Ch showed similar decreases in malnutrition in neighbouring woredas in Wolayita. In October, Concern showed 7.2% acute malnutrition in Damot Wayde, and MSF-Ch showed 4.2% in Damot Gale (Oxfam/MSF-S 11/00).

The Oxfam/MSF-S survey in late February 2001, showed similar rates of malnutrition to those in November; 7.8 % malnutrition (W/H <-2 z-scores), including 0.9 % severe malnutrition (W/H <-3 z-scores +/- oedema). By February, mortality rates had also decreased to more acceptable levels. The Crude Mortality Rate was 0.7/10 000/day, and the under 5 Mortality Rate was 1.2/10 000/day. The February surveys coincided with the Sape harvest of sweet potato. People were depleting their Belg and Meher harvest stores, and the prevalence of malnutrition was expected to increase as people enter the annual hungry season. However, whilst the prevalence of malnutrition will increase until July, they were not expected to reach the same levels as 2000. This year, the prevalence of malnutrition at the start of the hungry season is lower than in 2000. One of the biggest problems farmers are faced with this year is indebtedness for the purchase of farm inputs such as seeds and fertilizer (Oxfam/MSF 03/01).

In Somali Region, Gode zone was the focus of international attention last year. SCF-US, Oxfam-6B, and MSF-B have conducted a number of surveys in this zone. SCF-UK has conducted surveys in neighbouring Fik zone. Most surveys showed an improvement in the nutritional situation towards the end of 2000, and many NGOs withdrew from the zone as a result. For example, SCF-UK surveys in Fik and Hamero in November 2000, showed a prevalence of 17.2 % acute malnutrition, including 1.6 % severe malnutrition. The prevalence in Segeg and Dehun woredas was however higher at 24.2% malnutrition, including 2.3 % severe malnutrition. The improvement in the nutritional situation was attributed to the return of livestock to the area, and improvement in livestock conditions, with the rains in mid to late 2000 (SCF-UK-07/00; SCF-UK-11/00).

MSF-B, however, continues to show extremely high malnutrition rates in Denan. in Gode zone. The results of nutritional surveys conducted by MSF-B are indicated below (MSF-B 08/00; MSF-B-10/00 MSF-B-02/01, MSF-B 04/01). Part of the explanation for the persistent high malnutrition rates in Denan could be that high proportion of displaced are living in the area. The population in April 2000 was 9000, which had increased to 12,151 in August and a reported 30,095 in December 2000. There is a displaced camp on the outskirts of the town, which has seen numbers increase from 7000 in April to 15,501 in August. MSF reports that newly displaced continue to arrive in Denan. The prevalence of malnutrition amongst the displaced was slightly higher at 56.6%, than that of town residents (at 45.2%) in April 2001 (MSF-B 04/01).

Comparison of MSF-B survey results in Denan, Ogaden for 2000

	May 2000	August 2000	October 2000	February 2001	April 2001
Acute malnut	52.4	43.7	40.8	37.2	51.1
Severe malnut	11.2	4.1	5.7	4.4	9.1
Bilateral oedema	1.4	0.1	1.1	1.0
CMR	8.9/10,000/day*	0.4/10,00/day	0.13/10,000/day	0.15/10,000/day	0.12/10,000/day
<5 yrs Mortality	27.5/10,000/day*	1.2/10,000/day	0.27/10,000/day	0.25/10,000/day	0.25/10,000/day

* Mortality rates for May were collected retrospectively over a period of 4 months.

At the same time, 94.2% of the population reported access to food distribution; 79.2 % of those received during the last distribution of 01/02/2001 and 20.8% received the last food 1 month before; early January 2001. The ration was however limited to 12,5 kg of wheat/person at the beginning of February 2001. The zone also received reasonable rains, and return of livestock to the zone was reported at the end of 2000. One possible reason for the continuing high malnutrition rates in Denan is that, with the closure of feeding programmes of other NGOs in the zone (and Region), Denan is attracting the malnourished and destitute because of the MSF feeding centre. RNIS also received nutritional surveys from MSF-H in Oromiya in July and November 2000, and in Konso Special Woreda in SNNPR in August 2000. Surveys in both areas showed an improvement in the nutritional situation (MSF-H-07/00, 08/00; 11/00). Similarly, a CARE survey in Dire, Yabello and Teltele woredas showed low rates of malnutrition (CARE 12/00).

Refugees

There are an estimated 206,879 refugees in Ethiopia, the majority from Sudan, Somalia and Eritrea. 6,000 Somali refugees were repatriated to the self proclaimed Somaliland Republic from the Dir Wanaje refugee camp in south east Ethiopia at the end of October 2000. 12,000 Ethiopian refugees in Sudan have registered for repatriation (EUE-23/11/00).

Table of estimated number of refugees in Ethiopia by country of origin (UN-2001)

Refugees	Numbers of Beneficiaries
Country of Origin	Beneficiaries
Sudan	77,245
Somalia	124,484
Eritrea	3,200
Djibouti	1,503
Urban - various	447
Total	206,879

Four Sudanese refugee camps in the West of the country host an estimated 77,245 refugees and eight Somali refugee camps in the West of the country host an estimated 124,484 people. In 2000, there was considerable concern over the effects of the drought on the nutritional status of the refugees and a UNHCR/BOE/ARRA/WFP survey in July 2000 of two of the Sudanese camps and five of the Somali camps showed non critical but worrying levels of malnutrition (UNHCR-07/00). At the time of this survey, 2 out of the 4 Sudanese camps and all Somali camps had supplementary feeding programmes for all under fives.

Table showing results of survey done in Sudanese and Somali refugee camps in July 2000

Camp	July 2000
	< 70 % W/H	< 80 % W/H
Western
Bonga	1.6	11.0
Sherkole	1.9	12.9
Eastern
Camaboker	1.1	15.0
Darror	0.0	6.5
Rambasso	0.8	8.8
Kebribeyah	0.9	8.4
Aisha	1.3	12.4

The nutritional status of the refugees was considerably better than that of the local population, in mid 2000. During this period, many Ethiopians had moved to the camp surroundings in search of relief.

UNHCR conducted further surveys in the eight Somali refugee camps, in January 2001. UNHCR meeting notes report that the highest rates of malnutrition were seen in Rambasso camp but were not alarming at 8.0 % (defined as < 80 % of the median weight for height and/or oedema). The other camps reportedly showed rates ranging from 3.9 % to 7.2 % and the results would indicate that the nutritional situation seems to have remained stable (Meeting-30/01/01; UNHCR-07/00)

Food Security Outlook

The FAO/WFP crop and food supply assessment to Ethiopia has noted a strong recovery of the main meher season crops as a result of generally sufficient rainfall in October of 2000. This has led to an increase in the availability of cereals and pulses, which are estimated to be seven percent up on last year. The timely arrival of the belg rains in late February has done much to alleviate concerns of further drought and climate forecasts are for a good rainfall through April. Many of the reports received by the RNIS indicate that the availability of pasture and livestock has improved in the latter half of 2000. (FAO-09/01/010; FEWS-12/03/01)

However, large proportions of the population are destitute from years of repeated droughts and are chronically food insecure. The vast majority of the chronically food insecure are partially dependent on external assistance (FEWS-20/02/01).

Overall

The nutritional status of refugees in Ethiopia has remained stable, with low levels of malnutrition in most camps. For most drought and war affected populations the overall picture is one of improvement since the crisis last year. Many however remain chronically food insecure. The situation of drought affected and displaced in Denan in Gode. zone is extremely alarming (category I).

Recommendations

From the FAO/WFP Crop and Food Supply Assessment mission to Ethiopia

· A general ration of 15 Kg/person/month should be distributed and fortified cereal flours should be provided.

· Supplementary food provision should be continued through NGOs in areas where the prevalence of malnutrition remains unusually high.

· In areas where the population is malnourished or risks becoming malnourished, the ration should be enhanced with the provision of pulses and oil and fortified blended foods.

· The local procurement of food should be increased.

· The general food distribution and blanket feeding programmes should continue until refugees can be repatriated.

· Training should continue to nutrition staff. The provision of adequate and safe water and sanitation supplies should be ensured.

· Investigate in more detail the causes of persistently high malnutrition levels.

· Re-establish an adequate general ration which includes oil and pulses.

· Maintain the supplementary program for moderately malnourished individuals and the therapeutic feeding for severely malnourished children.

· Reinforce the CHW network to improve the coverage of the nutritional program.

· Continue a nutritional and epidemiological surveillance system.

· Continue the water trucking for the population until the rain have sufficiently filled the water tables around Denan.

Kenya

Note: the RNIS is mandated to provide nutritional information on internally displaced and refugee populations. The RNIS cannot report comprehensively on the drought affected populations of Kenya, although the situation is very severe in some areas. More information can be obtained from www.reliefweb.int

OCHA reported that in February, over 4.4 million people in 22 Districts were suffering from the effects of drought in Kenya. Rains have been inadequate or failed for the last two years. The northern regions of the country remain most severely affected. The drought has resulted in massive loss of livestock and the emergence of acute food insecurity. Emergency food distribution started in some Districts in December 1999 (e.g. Turkana) and in others in July 2000 (e.g. Wajir and Garissa). The Kenya Humanitarian update in March 2001 reports that the scarcity of pasture and water in some northern areas has resulted in an increase in inter clan and inter tribal fighting particularly in the Mandera and Tana river districts. There have also been reports of banditry and on March 14^th a UNICEF staff member was injured by bandits in the northern region. This has resulted in major security constraints for humanitarian personnel and many of the northern and eastern areas of the country remain under emergency phase III status, requiring military escorts for travel (IRIN OCHA 31/03/01; WFP 04/05/01).

In March 2001, OCHA reported that poor funding of the Donor Alert 2001 was becoming an issue of major concern with only 13% of the alert funded (OCHA 31/03/01). This has and will continue to impact on the food pipeline and WFP have reported serious pipeline shortages from May 2001, with no available oil or blended food. Due to a delay in the arrival of a 30,000 ton shipment, there will probably be a shortfall in June (WFP 04/05/01). Only 2,408,040 people were being targeted for the May general distribution, as in March. No food distribution took place in April as a result of the late finish of the March distribution (WFP 04/05/01).

FEWS reports that the general food security outlook has improved since the onset of the critical 2001 long rains season during the last weeks of March. There have been reports of fairly heavy rain in the northern pastoral districts, with the exception of Mandera and Wajir, and this has greatly heightened the prospects for significant improvements in grazing and water (FEWS 12/04/01).

However, it is important to emphasize that the prolonged nature of the drought has seriously impacted on people's livelihoods and food aid and other forms of assistance will be required to assist in recovery. The greatest cause for concern at the moment is the lack of donor interest that threatens to force severe ration cuts and generally impact on the quality of assistance to affected populations (IRIN OCHA 31/03/01).

Refugees

Following some repatriation, refugee numbers decreased from 215,000 to 203,500 over the course of 2000. The majority of refugees are from Somalia (135,600), Sudan (54,600), Ethiopia (4,000) and Uganda (5,800). During the course of 2000 some 13,000 refugees arrived in Kenya as a result of conflicts in neighbouring countries, particularly Sudan where an increase in insecurity in Sudan's East Equatoria district drove some 10,000 Sudanese refugees to Lokichokio in north western Kenya earlier in the year (UNHCR 2001).

MSF-B conducted a nutrition survey in the camps in Dadaab (Garissa District) in February 2001. The prevalence of acute malnutrition in February was of 16.1 % (< -2 Z-scores) and 4.5 % severe malnutrition including 3.4 % with oedema. The February survey showed no significant change since August 2000 (MSF-B 02/01).

The general ration supply was particularly low from June to October 2000, averaging of 1900 Kcals. MSF-B conducted some food basket monitoring and have shown a slight improvement in the ration since January with an estimated average of 1914 Kcals. However distribution of the ration amongst the refugees in the Dadaab area is inequitable (MSF-B 02/01).

In North East Kenya, drought induced food insecurity also became severe around July 2000, which will have impacted on the refugees, particularly as opportunities for finding other sources of food will have been more limited.

Although there does not appear to be much change in the Dadaab survey results from August to February, the remaining high prevalence of severe malnutrition is alarming and in particular the oedema. MSF-B suspects the oedema to be related to micro-nutrient deficiencies, and is hoping to collaborate with the Institute of Child Health in London to look further into the matter. Another cause for concern in the area is the low coverage of the feeding programmes with a reported coverage of 30.5 % in February, down from 37.8 % in August (MSF-B 02/01).

SCF-UK reported a similar phenomenon in neighbouring Wajir District from May to August 2000. In Eldas in North Wajir, 18 people began to show symptoms of multiple micronutrient deficiency from May to August 2000. All those presenting with symptoms had been surviving on a diet of relief maize alone and had not had milk since January/February. Symptoms decreased after the distribution of fortified UNIMIX (SCF-UK 09/00).

A nutrition survey was conducted in Kakuma refugee camp by UNHCR in June 2000. (UNHCR 06/00) The results indicate an estimated prevalence of malnutrition of 18.1 % (<-2 Z-scores) including 2.7 % severe. This prevalence is similar to that in May 1999. The survey in June 2000 excluded new arrivals (6 months prior to the survey) to the camp.

Given that new arrivals came from South Sudan in 2000, the survey done in June 2000 may therefore not reflect the true nutritional situation of the refugees in Kakuma. Sample size was not estimated appropriately for this survey.

Fifty two percent of children were reported to have suffered from illness, mainly diarrhoea, in the two weeks prior to the survey. The potential for finding other sources of food is extremely limited for refugees in Kakuma refugee camp, as movement outside the camp is restricted by the Government of Kenya. The survey was done at a time when Turkana District was experiencing severe drought induced food insecurity, which would have limited food and income sources for all in the District (UNHCR 06/00).

The increase in insecurity in areas containing refugee camps has eroded prospects for the refugees by limiting access to markets and to opportunities of paid employment. This has resulted in a very high degree of dependence on food aid, particularly during a period of acute food insecurity for the Kenyan population (UNHCR 06/00).

Overall

Overall the last year has seen the continuation of very serious drought conditions in much of the country. The latest food security reports indicate that long awaited rains have arrived in some Districts, and this will do much to alleviate the acute food needs of drought affected populations. However, the effects will take some time to show and it is expected that the need for emergency food aid will continue for some time to come. The prevalence of malnutrition has remained high in the refugee populations, due to rations inadequate in quantity and quality. Refugees have also been affected by the drought (Category III). The future development of the situation depends largely on continued donor support.

Recommendations

· Continue to find support for the Kenya consolidated appeal.
· Conduct a survey in Kakuma camp which includes new arrivals.
· Follow up on and investigate the causes of oedematous malnutrition in the Somali population.

· The ration should be increased to a 2100 kcal/person/day as the refugees do not have access to other sources of food.

· Improve the quality of the ration, add blended foods, to control micronutrient deficiencies.

· The nutrition programmes should be continued.

· Children should be screened for malnutrition; coverage of the feeding programmes should be improved.

· A nutrition survey should be repeated in the next six months and the coverage of the nutrition programmes assessed.

Somalia

NB: the Food Security Unit for Somalia has recently started to produce regular 'Nutrition updates' on nutrition and related issues in Somalia. These reports contain more detailed data than the RNIS. To receive these reports please contact noreen.prederville@wfp.org

In august 2000, after months of negotiations between various Somali factions, a Transitional National Government (TNG) was selected for an interim 3-year period and installed in Mogadishu in October 2000. However, optimism associated with the new government has been short lived. The TNG does not have much influence outside of areas of Mogadishu and factions opposing the TNG have united as the Somali Reconciliation and Reconstitution Council (SRRC) and are based in Baidoa in south central Somalia. There was a meeting in Baidoa on the 19^th of April to discuss the first steps in the replacing the fledgling regime. The meeting clearly demonstrates the lack of support for the TNG and the potential for further outbreaks of conflict. The SRRC controls most of Bay and Bakool and parts of Mogadishu, including the airport whilst areas controlled by the TNG are decreasing. The political situation remains volatile and as a result, security could easily deteriorate (UN EUE 27/04/01).

Gu Crop 2000

RNIS 31 reported a generally good Gu harvest as a result of widely distributed rainfall during the first dekad of May. The FSAU describe the 2000 Gu season as close to normal in terms of quantity and it was very favourably compared to the harvest of 1997 which is considered to be one of the best postwar harvest years. This resulted in very good overall crop production during 2000 but the poor distribution of the 2000 Gu harvest in the areas of Hiran, Gedo. Middle and Lower Juba adversely impacted on maize and sorghum yields in those areas (FSAU 05/10/00).

Deyr Crop 2000

The FSAU report that normal Deyr rainfall was observed in early October and in the second dekad of November across southern Somalia, and the Deyr 2000 can be considered a good season in general, significantly above the post war average. The Deyr season seems to have been most significant in areas relying on irrigated crops, noticeably Bay and Lower Shabelle. Most rain fed areas had poor levels of production noticeably the Gedo region, Lower Juba and in Hiran (FSAU 03/01).

As a result of relatively good rains in the southern Somalia, general food security has stabilised. Pastoralists in the south have benefited from the rains, which have replenished pasture and water sources. There have also been low cereal prices since the relatively good Gu and Deyr harvest and relatively good livestock prices, due mainly to the availability of Kenyan markets to the south that have meant that southern pastoralists have not been hit as hard by the ban by the Gulf states on the importation of Somali livestock (FSAU-08/03/01).

Gu Crop 2001

The FSAU reports that as of 31^st of March 2001 most of Somalia was seasonably dry i.e. normal. There are some reports of the beginnings of fragmented rainfall in some areas, notably Gal-kayo, Mudug region. However if the dry season continues and rain does not fall then the Gu crop production will be severely compromised (FSAU 09/04/01).

Gedo

The food security situation in Gedo remains precarious as the prolonged Jilaal dry season has eroded pasture and decreased water sources. This has resulted in wide scale loss of livestock. FSAU reports that the prices of both local and imported commodities has increased and general purchasing power is reduced as a result of the depreciation of the Somali shilling (FSAU 03/01).

The latest FSAU report of May indicates that Gu rains began in the second week of April, with southern regions receiving average rainfall and the north poor rainfall. Seed prices also seem to have increased and the general collapse of the Somali shilling is impacting very heavily on all groups, particularly the poorer groups such as urban IDPs (FSAU 09/05/01).

Four surveys were done in the Gedo region in 2000 with the most recent conducted by UNICEF in September 2000 in Burdubo district (UNICEF 09/00) The prevalence of acute malnutrition was 17 % (<-2 Z-scores); 3 % were severely malnourished, 1 % had oedema. 31 % of children were reported to have suffered from diarrhoea and 20 % Acute Respiratory Infection in the two weeks prior to the survey. Rates of measles vaccination were very low with only 28 % of children having been vaccinated in the previous six months (FSAU 01/01).

Nutrition surveys in Gedo in 2000 (FSAU-01/01)

Date of survey	Area surveyed	Agency	Acute malnutrition Severe malnutrition *
04/00	Luuq town	ACF-F	14.9	1.9
04/00	Luuq displaced	ACF-F	20	4.2
05/00	Belet Hawa	UNICEF	21.5	3.5
09/00	Burdubo	UNICEF	17	3

* including Oedema

RNIS has received no new nutritional information on the area but RNIS 31 reports some high levels of acute malnutrition especially amongst displaced population in towns like Luuq and its surrounds.

Beled-Hawo (Build Hawa)

The RNIS has not received any new nutrition surveys from Beled-Hawo but can report that an inter-agency team carried out a review of the nutrition situation in Beled-Hawo, Dolo and Mandera districts in January 2001. The review suggests that a proportion of the population is still extremely vulnerable as a result of slow recovery from chronic stress, destitution and internal displacement. Moderate malnutrition seems to be common and although many children attend supplementary feeding programmes on both the Somali and Kenyan sides of the border, the food is being shared with other family members and is therefore not contributing to a general improvement in the nutritional situation of the child population. Food distributions have taken place but have consisted of sorghum alone and therefore have not contributed to diet quality (FSAU-01/01; FSAU-03/01).

Heavy fighting was reported in April between rival factions of the Marehan clan, which resulted in 10,000 Somalis fleeing over the border to Mandera in Kenya. IRIN reports that many were staying with friends or relatives or in temporary shelters whilst others were "commuting" from over the border depending on the security situation. The current condition of the refugees is unknown but IRIN reports that the Government of Kenya has ordered them to repatriate or go into designated refugee camps (IRIN CEA 10/05/01).

Bakool

Bakool and Bay regions have experienced a period of relative stability since the Rahanwein Resistance Army (RRA), opposed to the TN(S, captured most of this areas from Aideed's forces in late 1999. Following a period of acute food insecurity in early 2000, Bay and Bakool experienced good Gu rains and had the best harvest since the start of the civil war (FSAU 03/01).

A combination of relatively good Gu 2000 and Deyr 2000 rains have contributed towards a stable food security situation in the area. However, whilst the Deyr rains in 2000 improved both pasture and water availability, the high potential agriculture areas received poor rains and a poor harvest. After a late start the drains appear to be sufficient and pasture and water sources are improving. Livestock prices were reported to be high, but cereals were at affordable levels in local markets in March. Recent FSAU reports indicate that poor pastoralist households continue to sell assets and livestock products whilst pastoralists have begun to consume previously stored foods. The onset of Gu rains has improved the overall food security outlook of the area (FSAU01/01; FSAU08/03/01; FSAU 09/04/01; FSAU 09/05/01).

FSAU reported on surveys done by the International Medical Corps (IMC) in El Berde/Rabdure. and Hoddur districts during July and Agust 2000.

The RNIS has not received these reports and so caution must be exercised in interpreting the results. However, the first survey in Hoddur district shows a rate of acute malnutrition of 12.6 %, including 2.5 % severe. Very low rates of measles vaccination (7.3 %) were also reported indicating the low access to health services. It is worth noticing that one would expect a lower prevalence of malnutrition after the harvest period and that the level of severe malnutrition gives some cause for concern (FSAU 01/01).

The second survey was in Elberde and Rabdure districts and indicated a prevalence of malnutrition of 13.7 % including 3.8% of severe. The rate of measles vaccination was much higher with 59 % of children reported as having received measles vaccination (FSAU 01/01).

This appears to show a reduction in the prevalence of malnutrition since February in Wajid, when the overall prevalence was around 20%. This reduction would be expected following the harvest. However, it is difficult to make any definite conclusions without knowing survey methodology or any population movements since February.

In both districts the rates of both diarrhoea and respiratory infection were extremely high, strongly suggesting that these morbidities are an important causal factor in the observed malnutrition, particularly of severe malnutrition (FSAU-01/01).

Bay Region

The Bay region benefited from particularly good Gu and Deyr rains which have resulted in good crop yields and improved livestock conditions. Since 2001, cereal prices have increased significantly as have the prices of imported goods. Livestock prices have remained good as a result of the high demand and access to the Kenyan market of Garissa (FSAU-08/03/01).

The latest 2001 Gu rains have begun and although described by the FSAU as light are having a positive effect on agriculture and livestock. The FSAU reports that the prices of staples remain good and that overall food security is stable (FSAU 09/05/01)

Whilst the 2000 Gu rains in most of Bay region were normal, UNICEF reported the rains in Burhakaba to be late and inadequate. UNICEF carried out a survey in Burhakaba in June 2000 and showed an estimated prevalence of 22.4 % acute malnutrition, including 4% severe malnutrition (UNICEF 06/00). The survey also showed that only 16 % of children had received measles vaccinations.

The FSAU further reports that a UNICEF survey in July 2000 in Boidoa showed a rate of global malnutrition of 17 % including 3.3 % of severe, but once again the RNIS does not have access to the survey and cannot confirm the results (FSAU 01/01).

The prevalences of malnutrition in Baidoa and Burhakaba do not seem unusually high given that the surveys were done in the period just before the harvest. Seasonal changes in food security and malnutrition are expected in most rural populations, with the highest prevalence just before, and lowest prevalence just after the harvest. A prevalence of severe malnutrition of 3.3% is however alarming (FSAU 01/01).

FSAU nutrition update reports indicate that the IMC carried out two nutrition surveys in the Bay region in November and December 2000. The RNIS does not have access to the reports and cannot comment on the survey quality. The first was in Dinsor district and showed an estimated prevalence of acute malnutrition of 14.6 % with 3.2 % severe. The second survey in Berdale showed an estimated prevalence of 12.4 % malnutrition, including 1.7 % severe malnutrition. Whilst the prevalence of moderate malnutrition appears within normal ranges, the prevalence of severe malnutrition remains high (FSAU 03/01).

The FSAU has conducted a recent review of nutrition surveys in Bay and indicates that the quality and diversity of diet in the area remains a very serious problem as does the very low levels of infants exclusively breast fed for six months (FSAU 03/01).

Juba Valley Region

The Juba valley has suffered from insufficient Gu and Deyr rainfall in 2000 resulting in reduced harvest yields and wide spread water and pasture shortages. This has resulted in a general out migration of people and livestock to permanent water points with the accompanying problem of overgrazing. There has also been reports of insect damage to crops and the price of staple foods is reportedly high. However, the overall food security situation in the area is reported by the FSAU to be normal (FSAU 09/03/01).

The FSAU report that World Vision conducted a nutrition survey in Bualle in July 2000. The survey indicated an estimated prevalence of acute malnutrition of 14.7 % including 4.7 % of severe malnutrition which included oedema. This report is not available to RNIS (FSAU 01/01).

Recent evaluations of the Gu and Deyr harvests have concluded that cereal production is well below normal for lower Juba in general (FSAU 03/01). The FSAU reports that as of the 23/01/01 477 children have been screened by Muslim Aid UK and 36 % were discovered to be malnourished using weight for height as the indicator with the majority coming from Jamame town and its surrounding villages (FSAU-08/03/01).

Lower and Middle Shabelle

The dry Jilaal season in Lower and Middle Shabelle has adversely impacted on water and pasture availability and the FSAU reports high population movement among rainfed agro-pastoral and pastoral communities. In both areas the harvesting of sesame is ongoing as is the preparation of land for the upcoming maize crop. The FSAU reports that the overall health and nutrition status is considered normal. The RNIS has received no new nutritional information from the area (FSAU 03/01).

Mogadishu

Mogadishu is the capital of the fledgling Transitional National Government (TNG) but recent events such as the importation of Somali bank notes and high level meetings of groups opposed to the new government, have highlighted the precarious position it holds and the likelihood of further outbreaks of violence in the struggle for control over the country. After a period of relative calm, insecurity in the city has continued with various outbreaks of violence between rival clan factions over resources and most notably the kidnapping on March 27^th of UN and NGO staff from a compound within the city (Reuters 29/03/01).

The kidnappings resulted in the evacuation of all expatriate staff. The implications for the continued provision of aid are significant as agencies become increasingly wary of the poor security situation.

FEWS reports that fresh consignments of Somali bank notes have been imported into the capital in a repeat of previous large scale importations that threw the country into deep financial turmoil. As a direct result the Somali shilling has dropped to its lowest recorded level against the American dollar. The importation has very real implications for the food security of many people in the capital, which remains home to a very large displaced and vulnerable population. The poorest and most vulnerable groups will not be able to buy as much food with the little money they earn or get by begging. Even small retail businesses will be forced to close. The continued importation of fake money underlines the TNG inability to control the economy and other key areas of governance (FEWS 15/04/01).

Northern Regions

May 10^th saw the outbreak of insecurity between the two self claimed independent states of Somaliland and Puntland. Armed groups from the two areas were involved in a three hour gun battle in the village of Las Anod. The outbreak of conflict is worrying as the two states have been relatively conflict free of late but it is thought that a referendum due to be held at the end of May on the future status of Somaliland, sparked the conflict (Reuters (10/05/01).

On September 19^th 2000 a livestock ban was imposed by the Gulf States, because of an outbreak of Rift Valley Fever in the Gulf region that was assumed to have been brought in as a result of the Somali livestock trade. This has adversely affected an important traditional revenue of pastoralists. Trade with the Gulf states is the chief source of income for pastoralists in the north and central regions of Somalia and the impact of the ban has been severely felt. The onset of the Gu rains will hopefully bring some relief by improving pasture and water sources for the pastoralists but an early lifting of the ban is still needed. A recent visit by veterinarians from the United Arab Emirates has resulted in the partial lifting of the ban for chilled meat, which sets a positive precedent for a complete lifting of the livestock ban (FEWS 15/04/01; FSAU-03/01).

Of great concern is the population in urban centres such as Burao which is the site of the largest livestock market in Somalia. There is also a group of internally displaced in Burao who were already living in a state of almost total destitution. The IDPs are not integrated into the social network and are completely dependant on the livestock trade and associated activities for the generation of income. This includes IDPs in Haryan camp in Burao and Ajuraan camp in Yirowe. Other areas of concern are the Haud lowlands and the Ainabo district in Sool region and the Odweyne district in Toghdeer (FSAU-08/03/01).

Puntland

Gu rains have been relatively good in Puntland ensuring that the adverse affects of the livestock ban were not immediately felt. The most affected groups are the urban poor including the displaced, in towns such as Bossaso and Galcayo which are most heavily dependent on livestock trading. Of particular concern are the IDPs or Margaga camp in Mudug Region and the poor pastoralists of the Nugal valley lowlands and Addun. There have been reports of a reduction in the overall quantity of food being consumed by these groups (FSAU-08/03/01).

Overall

Over the course of 2000 and early 2001 there has been a gradual improvement in the food security situation in Somalia. This is a result of both improved rainfall leading to better crop yields and food prices and a general improvement in the general security situation. However, it is important to note that security incidents continue to occur and the opposition to the TNG is likely to bring about further fighting. Both the Gulf States livestock ban and the importation of large quantities of Somali bank notes have impacted very heavily on the food security of the general population. Populations of concern are refugees from Bulla Hawa, who were displaced due to fighting, but no information is currently available (category V) and IDPs in Mogadishu because of the withdrawal of aid agencies at a time of high inflation (category III). The situation for IDPs in the rest of the country has improved along with that of the resident population.

Recommendations

· Support UNICEF's nutritional surveys.

· Investigate the causes of remaining high levels of severe malnutrition and identify appropriate interventions.

· Continue to support long term livelihood strategies with the continued provision of food aid to affected populations at least until the next harvest

· Address malnutrition by improving vaccination rates, and promoting adequate health care and water supply.

· Livestock off take support. Buy livestock at a minimum price, selling later when conditions have improved or slaughter and provide meat to poorer households.

· Stabilise cereal prices to keep staples affordable.

· Implement income diversification projects.

· Subsidise water for poor pastoralists

· Subsidise and provide veterinary drugs and services

· Subsidise transport to facilitate the cheap cereals of the south reaching the north.

· Continue relief food interventions for the vulnerable households.

Sudan

Hostilities between the Sudanese People's Liberation Movement (SPLM) and the Government of Sudan (GoS) continue despite a ceasefire in June 2000. Subsequent military action, including aerial bombing, has resulted in large-scale displacement of people and has targeted civilian populations and undermined already tenuous survival strategies. Humanitarian work in the south is deteriorating with humanitarian workers also coming under increasing risk of attack, bombing and hostage taking (UN 2001).

The ongoing conflict combined with recurrent environmental disasters, especially drought, has given rise to the largest population of Internally Displaced People of any African country, with approximately 4 million IDPs in Sudan as a whole. In North Sudan, and the transitional zones, which are under 60S control, the IDPs tend to be settled in marginalized camps separated from the resident populations, whilst in the south the IDPs tend to be more integrated with the local population. One of the most significant political changes over the last year has been the further factionalisation and intensification of conflict in the oil rich area of Unity State, Western Upper Nile. People fleeing this conflict are being assisted in Bentiu and Northern Bahr al Ghazal. On a more positive note the Wunlit Nuer-Dinka peace agreement is holding and a similar process is underway on the East side of the Nile (UN 2001)

The chronic nature of the civil conflict and repeated natural disasters has led to a general decline in agricultural production, as well as localised humanitarian crises. Total cereal production in 2000/2001 is estimated at 3.4 million tons, which is about 20 % below the previous five years average. Although prospects for the 2001 harvest of commercially produced wheat in North Sudan are good, prolonged dry spells and late and erratic rainfall last year resulted in a poor harvest of coarse grains (sorghum, millet and maize) by subsistence farmers. Rainfall has been as much as six weeks late with the most affected populations in Darfur, Kordofan and Red Sea Hills in North Sudan, and northern Bahr al Ghazal, Bahr al Jebel, East Equatoria, Jongolei, Juba and Butana Province in Gezira State in southern Sudan. The erratic rainfall has drastically reduced available pastureland for livestock. This has resulted in conflict for access to both pasture and water sources amongst tribal groups. Drastic undernutrition amongst livestock is already being noted. Increased livestock sales are widespread, which has significantly depressed livestock prices. The increased sale of livestock, including core-breeding animals, in a bid to cope with the deteriorating situation will hamper attempts of future recovery and increase dependency on food aid, particularly for small scale subsistence farmers (UN 2001; FAO/WFP 22/12/00; FAO 04/01).

Current estimates suggest that there are 900,000 people affected by the current poor season with 600,000 in need of urgent food assistance. WFP estimates there are 3 million people in Sudan threatened by drought and the ongoing conflict situation (WFP 30/03/01).

South Sudan, non-GoS controlled areas (OLS Southern Sector) Bahr El Ghazal (BEG)

Drought and insecurity in northern Bahr el Ghazel has driven many families from their land and thus prevented cultivation. Rainfall has been reported to be within the normal range but extremely erratic in its distribution. This has led to destruction of crops and has negatively impacted on coping mechanisms, particularly in Raja, Wau, Twic, Aweil West and Aweil East. The population of Bahr El Ghazal also lacks sufficient safe water. Overall Bahr El Ghazal is expected to face a food deficit of 40 % over 2001 and some relief assistance for most areas will be required (FAO/WFP-22/12/00; UN-2001; WFP-30/03/01).

Aweil West County

Due to continued insecurity the area continues to be extremely food insecure. Concern has been conducting regular nutrition surveys in the area and the last survey, reported by WFP, was in February where an estimated prevalence of 13.8 % malnutrition (defined as <-2 z scores weight for height and/or oedema) including 0.9 % severe was reported.

Aweil East County

The pre-harvest hungry season has arrived earlier than usual. WFP estimate there are 9936 IDPs in the area, and report that their food security is worse than local residents.

A survey by Tearfund in March 2001 estimated the prevalence of acute malnutrition at 15.5 % including 1.8 % severe. This was not significantly different from the last survey results in July 2000. The survey also showed that the population had exhausted their harvest stock and were more or less totally reliant on WFP food and indigenous wild food sources. The survey also contained a percentage of internally displaced which seemed generally comparable to that of the non displaced populations. There is great concern that the current coping mechanisms, particularly the heavy reliance on indigenous wild foods is not sustainable and that further nutritional problems will ensue should the rains fail once again in the coming season (Tearfund 03/01; WFP 13/03/01).

Equatoria

In 2000 Eastern Equatoria and Bahr El Jebel experienced a second year of drought. This came on top of late seed and tool distributions and continued insecurity and has led to widespread food shortages. Poor pasture and disease outbreaks have also led to severe livestock losses. In Juba, Lafon and Kapoeta insecurity has led to limited access to areas outside of the towns which has served to undermine agricultural production and traditional coping mechanisms. The scarcity of food and water has led to large-scale distress migration. The migration often leaves mothers and children behind and with no access to the staple diet of blood and milk. The overall food deficit of the region is estimated to be 50 %. There is no new nutritional information for this area (UN-2001).

Upper Nile/Jongelei

In Upper Nile late rains, lack of seeds, pest infestations and continued insecurity have resulted in food shortages and displacements, with significant movement of people from Lure to Malakal. Fighting in the western Upper Nile region around the rich oil fields and in Bieh, Latjor and Leech states has lead to insecurity and inaccessibility, which has eroded food security. The food deficit in Upper Nile is expected to affect about 50 % of the population with particular needs indicated for Malakal and surrounding camps. In Jongelei the towns of Bor and Pibor will require particular attention and extensive food aid (UN-2001).

Bieh State, Upper Nile region

MSF-B have carried out surveys in October 2000 and February 2001 in Akobo district of Bieh State. The prevalence of acute malnutrition was similar in both surveys; 25.2 % in October, including 3.3 % severe malnutrition and 29.1 % in February 2001 (including 4.5 % severe malnutrition) (see graph below). Displaced people comprised 28.87% in the February sample. Measles vaccination coverage was low at 15.47% (with card). The full report of the February survey is not yet available.

Acute malnutrition in Akobo, Bieh State

Mortality rates are unavailable. WFP reports the area is food insecure (WFP 13/03/01).

Unity State

Fighting between pro-government militias. Inter tribal factions and the SPLA in the oil rich region of Unity State has resulted in the displacement of 60,000 IDPs. The influx has been mainly from Kikany, Leek, Jagei and Adok with most fleeing to the government held towns of Bentiu and Rubkona. In the days between 28^th and the 31^st of July 2000 some 19,000 displaced people, mainly women and children arrived in the two towns. The two towns are situated in an extremely marshy area, which has been made worse by 50,000 cattle brought by the displaced. The number of cattle and the lack of pasture raise great concerns for the future well being of the livestock and the people dependent on them. ACF conducted a nutritional survey on 1400 children under five, in July 2000 and found an estimated prevalence of acute malnutrition of 30 % with 7 % of severe malnutrition. The alarmingly high rates of malnutrition, the food insecurity of the area and the high risk of epidemic make the population extremely vulnerable (ACF 08/00; UN 2001).

Northern Sudan. Transitional Zone

White Nile

IDPs of varying ethnicity have been in White Nile State for the past 15 years. Displacement has forced some families to break up, leaving unaccompanied children, and creating further unemployment and chronic food insecurity. Approximately half the IDP's annual income is from farm labour, which has been badly hit by the ongoing drought in the region. Food deficits of 20% are expected in the coming year. The nutritional status of the IDPs is poor and is associated with poor sanitation and a high morbidity. Typically access to water is very poor with the majority of IDPs relying on the Nile for their water supply. During 2000 acute malnutrition rates remained above 16 % and improvements can only be expected with improved health and sanitation (UN 2001). The survey reports were not available to the RNIS at the time of going to press.

South and West Kordofan

There are an estimated 72,000 IDPs in these areas. Continued insecurity has severely restricted movement, with a knock on effect on reducing access to cultivable land. Late rains, continued dry spells and uneven distribution of rain have also hindered agriculture. The poor pasture and in creased cattle raiding has severely impacted the livestock ownership. Severe food shortages are expected from May to August 2001 with a food deficit of 40 % (FAO/WFP 22/12/00; UN 2001).

Darfur

Darfur is also chronically food insecure. The situation in North Darfur is already extremely perilous with very poor rainfall, and minimal crop production. The situation could lead to large movements if people into South Darfur. In South Darfur rainfall was late and erratic but on the whole relatively good. The average area planted was up by 40 % and general yields would seem to have improved from last year. As a result IDPs in South Darfur are expected to meet 70 % of their annual food needs with the estimated 30 percent food deficit being covered by general food distribution and food for work projects (FAO/WFP 22/12/00; UN 2001).

Red Sea State

Severe drought is also affecting Red Sea State, particularly Sinkat, Rural Port Sudan and the Halaeib province. Water shortages are critical and terms of trade between goats and sorghum have fallen (from one to six goats in exchange for a bag of sorghum). (Goats are the mainstay of the Beja's livelihood. As yet survey results are not available although WFP report that malnutrition admissions in local hospitals are up to 40%. (WFP 30/3/01).

Khartoum

In Greater Khartoum the UN estimates there are about 1.8 million IDPs. Yet only the 260,000 IDPs in designated camps (Mayo, El Salam, Jabal Awlia and Wad el Bashir) are recognized officially by the GoS. The remainder are scattered in various planned and unplanned areas. The main sources of income for IDPs are daily, casual and seasonal agricultural labour as well as petty trade. IDPs are expected to secure 85 % of their annual food needs while the remaining 15 % will be met through coping mechanisms and targeted food relief. The most stressful time is between July and September when demand for labour is at its lowest, and food prices are high. In 2001 the vulnerable IDP group is projected to be 25 % of the overall camp population. The RNIS does not have any new nutritional survey information for the area (UN 2001).

Refugees in Sudan

The border dispute between Ethiopia and Eritrea has resulted in an influx of refugees into Kassala district of Eastern Sudan. About 80,000 Eritrean refugees entered Sudan following a large offensive in May 2000. The cessation of hostilities has facilitated the return of the refugees and a 'great proportion' of them have already returned to their native Eritrea.

In Western Sudan a joint team of UNHCR/WFP/ARRA carried out nutrition surveys in November 2000 in four refugee camps (Bonga, Sherkole, Fugnido and Dimma). The prevalence of acute malnutrition in the four camps ranged from 4.2%-5.6%, including up to 0.5% severe malnutrition, which is satisfactory. This indicates an improvement over survey results six months earlier, which could be due to seasonal effects. In Fugnido camp there had been a significant improvement since the last survey in November 1999 (falling from 11.8% to 5.6%). Measles immunisation coverage ranged between 74.7-91.9% for the four camps. Coverage of supplementary feeding programmes was less satisfactory and ranged between 4% and 30% (UNHCR 12-1.4/11/00).

Overall

The general situation in Sudan remains extremely worrying as continued conflict and drought continue to erode general food security in many regions. The need for food assistance remain high. In particular the Darfur, Kordofan, Eastern Equatoria and Northern Bahr El Ghazal are particularly affected with large-scale distress migration and internal displacement (Category II). The situation in northern Bahr el Ghazel and Upper Nile is made more difficult by the continued insecurity and lack of humanitarian access to affected populations.

Recommendations

· Ensure follow-up surveys to the ones described above are conducted.

· Continue the blanket feeding programme in Bonga and Sherkole camps.

· Improve outreach capacity to increase coverage of programmes and intensify nutritional education.

· Repeat surveys in six months.

· Set up a supplementary feeding programme that includes nutrition education.

· Conduct a study of child care practices and infant weaning to improve understanding of poor nutritional situation.