GREATER HORN OF AFRICA
WEST AFRICA
GREAT LAKES REGION
SOUTHERN AFRICA
Eritrea
Ethiopia
Kenya
Somalia
Sudan
Since April 2001, Eritrea and Ethiopia established a Temporary Security Zone (TSZ) manned by UN peacekeepers and observers. The TSZ effectively separates the two sides whilst final stage talks are taking place (IRIN 06/07/01). The final status of the TSZ remains unresolved and although the UN Mission in Ethiopia and Eritrea (UNMEE) remains optimistic concerning the situation, tensions do still exist (UN DPI 20/06/01) and full normalisation of relations between the countries has not yet taken place.
Response to the humanitarian appeal for 2001 has been slow. As of June 14th only 25,000 MT of food aid had been pledged out of a requested 223,000 MT. A quick response would facilitate the resettlement of IDPs in their home areas and help them restart their normal lives (FEWS 14/06/01).
War-affected displaced
The RNIS has not received any recent nutritional surveys of displaced in Eritrea. However, the cessation of hostilities and a better pattern of precipitation has led to some improvement in the overall situation. This has prompted an increase in the return of IDPs to their places of origin. Previously the RNIS reported that 208,163 IDPs were in 24 organised camps in the three zones of Debub, Gash-Barka and Northern Red Sea (RNIS 32 and 33). Current UN figures indicate that about 120-150,000 IDPs have returned to their places of origin. An estimated 50-60,000 remain in camps because of land mines or lack of local infrastructure in their home areas. (IRIN 06/07/01; IRIN-HOA 18/06/01).
The continued presence of mines and unexploded ordinance continues to be one of the chief obstacles for returnees and the future food security of the area. Two of the most affected areas, Gash-Barka and Debub, have traditionally been regarded as the breadbasket of Eritrea with the two contributing up to 75% of national cereal production (IRIN 06/07/01). Every effort is being made to demine affected areas by UNMEE.
An assessment by the UN and the government of Eritrea in Gash-Barka zone revealed considerable damage to infrastructure including houses, schools, churches, mosques, health stations, government offices and fuel stations (FEWS 07/05/01). Of particular and immediate concern is the rehabilitation and expansion of water sources and the government of Eritrea and UNHCR are working with NGOs to implement quick impact projects (UNHCR 06/06/01). Until infrastructure is rebuilt, returnees are likely to continue to need both food and non-food assistance (FEWS 07/05/01).
Drought affected populations
RNIS 32 and 33, reported that an estimated 738,450 people were directly affected by the drought in 2000 (RNIS 32 and 33). The short rain season (azmera) that normally starts in April and May has all but failed (FEWS 14/06/01). The azmera is particularly important for the emergence and establishment of long-cycle crops such as maize, millet and sorghum and its failure will have a serious impact on the overall production of crops for 2001 (FEWS 07/05/01; 14/06/01).
The most affected areas remain Anseba, North and South Red Sea and Maakel zones. Reports from the Anseba zone indicate that drought conditions are worsening in all sub-zones. The main summer rain season will begin at the end of July and current predictions indicate that there is only a 35% chance of normal rainfall, leaving continued cause for concern over the future food security of the area. (FEWS 14/06/01).
Returnees
The war with Ethiopia sent many Eritreans across the border into neighbouring countries such as Sudan and Yemen. The US committee for Refugees estimates that some 335,000 Eritreans were refugees at the end of 2000 (USCR 19/06/01). An agreement between Eritrea, UNHCR and Sudan was signed in March 2001 to facilitate the voluntary repatriation of refugees from Sudanese camps. Returnees will be constrained by the food security constraints generally seen in the country. Demining activities have already cleared areas in the Gash-Barka zone, which has been identified as an area of return for refugees and surveys within the Eritrean refugee population in Sudan have indicated that 71% wish to return. Provisional planning figures estimate that 62,000 refugees will return from Sudan to Eritrea during the course of 2001 (FEWS 07/05/01).
The repatriation began in May 2001 and by June 26th a total of 16,588 had returned from the Sudanese camps of Hawata, Mafaza and Gulsa. Efforts increased to move the refugees before the upcoming rainy season in late July, with 27,000 having signed up for return to date (UNHCR 26/06/01). The arrival of the refugees will directly impact on the national food outlook
Overall
The humanitarian situation in Eritrea has improved largely as a result of the continued peace with Ethiopia that has allowed the return of many of the displaced and refugees. Although there are no new nutritional survey reports, it is likely that food security has improved as a result of the cessation of hostilities and slightly improved rain-fall. The presence of landmines and other forms of unexploded ordinance is still limiting access to land in some areas, restricting farming and pastoralist activities in affected areas. The destruction of basic infrastructure, such as water resources and medical facilities, also hinders the return of displaced and refugees to their home areas (Category IV).
Recommendations and Priorities
· Increase the level of food aid by supporting the humanitarian appeal of 2001.· Continue the de-mining of the conflict zones.
· Continue the rebuilding of basic infrastructure in affected areas.
The number of people estimated to be in need of assistance as a result of drought has decreased from 6.2 million in January 2001 (RNIS 32 and 33) to 2.5 million estimated to be vulnerable in April 2001. Most highland farmers dependent on the Belg harvest are optimistic that it will be near normal (the harvest is expected in July). However, the rains in the pastoral areas of the east and southeast, most notably the Somali region, have been light and erratic, starting late and ending early. Areas of particular concern are parts of Gode zone, Southern Liben, Afder zones and eastern Warder zone (ENFS 15/06/01). RNIS has received no new nutritional survey reports of drought affected populations.
Refugees
In early 2001, there were an estimated 206,879 refugees in Ethiopia, mostly from Somalia, Sudan and Eritrea. 22,000 Somali refugees were repatriated from the camps of Teferiber and Darwonaji by the end of June 2001. The closure of a third camp, Daror, is expected by December 2001. This will bring the total number of Somali refugees in Ethiopia to 60,000 in the remaining camps (IRIN, 2/07/01). RNIS has received no new information on the nutritional status of Somali and Sudanese refugees.
UNHCR, ARRA and WFP conducted a nutrition survey of Eritrean refugees in the Walanhibi site in Tigray in March 2001. The total number of refugees in the site is 3781. The survey measured all children between six months and five years and showed a prevalence of acute malnutrition of 21.8% (W/H <-2 Z-scores and / or oedema), including 2.2% severe (W/H <-3 Z-scores and / or oedema). The prevalence of severe malnutrition has increased from 0.3% since the last survey in September 2000. The overall prevalence of malnutrition remains high at around 20%. This can be attributed to poor availability and irregular distribution of food, coupled with poor health care. Whilst the recommended food ration is composed of 500 g wheat, 50 g pulses, 30 g oil and 5 g salt/person/day, food aid often arrives late, distributions are irregular and refugees have few other food sources. It is likely that infectious disease is also a cause of the high prevalence of, in particular severe, malnutrition. Mortality was estimated from local reports of deaths, which gave a CMR of 0.33/10,000/day and an under 5 mortality rate of 1.3/10,000/day (UNHCR/ARRA/WFP 03/01).
The prevalence of malnutrition in the 6 - 29 month olds is twice as high as that in 30 - 59 month olds (33.3% and 14.5% respectively), which points to a problem of poor support for caring practices of young children. The general food ration does not include any appropriate special foods for young children. RNIS notes with concern, however, the distribution of 5.5 kgs of milk powder per household in January 2001. This is against official UN and NGO policy.
War displaced population in Tigray and Afar
The Algiers Peace Accord signed in December 2000 continues to hold and the creation of a Temporary Security Zone (TSZ), separating the disputed border area has served to keep the opposing Eritrean and Ethiopian forces apart until final border agreements have been reached (UNICEF 09/04/01). The TSZ is currently manned by UN peacekeepers and observers under the auspices of the UN Mission in Ethiopia and Eritrea (UNMEE). The UNMEE mandate has been extended until September 2001 (UNMEE 15/06/01).
The RNIS reported 395,000 displaced in Tigray and Afar regions (RNIS 32 and 33). The improvement in the security situation has allowed the majority of these displaced to return to their areas of origin. The RNIS has received no new nutritional information on these returnees. The greatest problems facing the returnees are the large amount of mines and unexploded ordinance and the destruction of basic infrastructure (UNDP-EUE 28/06/01). To date over 70% of health post construction is completed in Tigray and is expected to be fully completed in August 2001 (UNDP-EUE 28/06/01). General food distributions are ongoing in the Tigray and Afar areas but they are likely to be affected by the current global shortfall in food aid (UNDP-EUE 28/06/01).
Somali Region, Eastern Ethiopia
Drought displaced
The humanitarian community is currently providing aid to over one million drought affected people in Somali region who remain acutely food insecure. The Ethiopia Network on Food Security (ENFS) estimates that there are between 70,000 and 120,000 drought displaced in camps in Somali Region (ENFS 15/06/01).
RNIS 32 and 33reported on a series of surveys by MSF-B in Denan in Gode zone, where the prevalence of acute malnutrition was the same in April 2001 as it was in May 2000, above 40%. These were extremely alarming findings, but unfortunately RNIS has not received further details of the nutritional situation in Denan.
UNICEF and MCDO conducted a nutrition survey at the end of April 2001 in the IDP camps of Fafan in Jijiga zone in the Somali region. This comprises a total of 7 camps, with an estimated 1664 dwellings. The number of displaced was estimated at 8986. The origins of the displaced included Degahabur (52%), Fik (25%), Korahai (12%), and Gode (9%).
The survey showed prevalence of acute malnutrition 21.2% (W/H <-2 Z-scores and/or oedema), including 3.3% severe malnutrition (W/H <-3 Z-scores and/or oedema). Mortality data was collected but not considered reliable. This indicates an increase in the prevalence of malnutrition since January, when an MCDO survey indicated 15.5% malnutrition, with 4% severe. The methods of the survey in January are however not available to the RNIS. MCDO conducted a similar survey in early April 2001, which found 31% acute malnutrition (W/Ht <-2 Z-scores), with 17.3% severe acute malnutrition (W/Ht <-3 Z-scores). It is difficult to comment on the difference between the MCDO and the UNICEF/MCDO survey results, but it is unlikely that such a change could have occurred within a matter of weeks.
The increase in the prevalence of malnutrition can be explained in part by expected seasonal changes in malnutrition in Somali region. In late December 2000 and early 2001, agencies working in other parts of Somali region reported a decrease in the prevalence of malnutrition associated with the short rains. The long rains in Somali region started in March/April, and the period of the survey and therefore represent a food insecure time of the year. The report provides no other information on causes of malnutrition. However, it does contain a recommendation for regular general ration distributions and this leads RNIS to believe that there was no regular distribution at the time of the survey (UNICEF 30/04/01). Given this expected increase of food insecurity, and associated increase in malnutrition, feeding programmes should probably not have been closed in March 2001. Feeding programmes tend to be set up in conjunction with health programmes and following the closure of the feeding programmes, no health care was provided to the displaced. Many of those remaining in camps are the destitute. (UN-EUE 29/06/01).
During 2001, there has been a decrease in the number of humanitarian organisations working in Somali region and this has adversely affected the amount of humanitarian assistance provided. In late June WFP reported that there was a considerable shortfall for their Horn of Africa relief operations. As a result, the August and September food distributions in Ethiopia are currently threatened (WFP 29/06/01). MSF have also pointed out that current food aid rations are far from nutritionally balanced, often comprised of cereals alone and missing pulses and oil (ENFS 15/05/01).
Overall
The nutritional situation of displaced and refugees remain precarious. Whilst it is not uncommon to see high prevalence of acute malnutrition in Ethiopia at this time of the year, poor rains, and reduced levels of assistance mean that the situations is likely to deteriorate. The deterioration is particularly likely because people have not fully recovered from the drought in 2000. The situation for the war displaced has improved, but there are still problems of access to land and destruction of basic infrastructure (category III). Eritrean refugees are considered at moderate risk (category III). The drought displaced in Somali region also remain at moderate risk (category III). Levels of malnutrition in some areas are high mostly as a result of late food deliveries and inadequate health care. As a result, the need for timely and adequate external assistance to all these groups remains a priority.
Recommendations
· Support the UN appeal for both war and drought affected persons in EthiopiaFrom the UNICEF/MCDO nutrition survey in Fafan IDP camps (UNICEF 30/04/01)
· Ensure the distribution of a timely and nutritionally adequate general food rationFrom UNHCR, ARRA, WFP assessment:· Investigate the causes of malnutrition
· Establish a health care referral system for all sick patients
· Improve the regularity of food distribution to refugees· Include a fortified complimentary food in the general ration that can be used for children in the 6-29 month age group
· Improve health services
Since the last issue of RNIS, the estimated number of drought affected people in need of assistance decreased from 4.4 million to about 3 million (OCHA). The long rains started in March, which considerably improved the food security outlook. Rains have benefited in particular the agricultural areas in the central and western areas of the country. However the outlook in some of the pastoral areas in the north and north-east is less optimistic with the almost total failure of the rains in May.
Earlier predictions of a break in the food pipeline in June were narrowly averted when the government of Kenya contributed an estimated 26,000 MT of cereals. However, funding shortfalls forced WFP to cut rations for supplementary feeding programmes in early June (WFP 08/06/01). There is also concern over the supply of oil and pulses for the general ration (FEWS 14/06/01).
Refugees
There remain an estimated 203,500 refugees from Sudan, Somalia, Ethiopia, Eritrea, Uganda, Burundi, Rwanda and the Democratic Republic of the Congo, in camps around Dadaab in the remote north-east of the country and in Kakuma camps in the north west (UNHCR 2001; USRC 2001). These camps are located in some of the districts worst affected by the recent drought (Garrissa and Turkana Districts respectively).
RNIS has received no new nutritional surveys from the Dadaab camps. However, an MSF press release stated that there had been an alarming increase in the number of children in the feeding programmes, from 72 under fives in January 2001 to 196 by mid June. Over the past six months, the refugees in Dadaab, north-eastern Kenya, have experienced a 35% drop in the amount of food distributed. This has meant that on average refugees are receiving a ration of 1,399 Kcals, instead of the recommended 2,100 Kcals. MSF attributes the increase in malnutrition to the observed cuts in refugee rations (MSF 26/06/01). The increase in malnutrition gives cause for concern, given that in February 2001 the prevalence of malnutrition was 16.1%, including 4.5% severe mal-nutrition (RNIS 32 and 33). At the time however, the coverage of feeding programmes was only 30% of the camp population, so the increase in the number of children in the feeding programmes could partly be a result of improved coverage.
IRC/UNHCR and ICH conducted a survey in Kakuma refugee camp in April 2001. At the time of the survey, the number of refugees was estimated at 72,459. The majority of the refugees are Sudanese, but there are also Somali, Ethiopian, Eritrean, Ugandan, Burundian, Rwandan and Congolese refugees (IRC/HCR/ICH 12/04/01). Whilst the survey assessed anthropometric and micronutrient status, the results of the micronutrient survey are not yet ready available and so only the anthropometric results are reported.
The results indicate an estimated prevalence of acute malnutrition of 17.2% (W/H <-2 Z-scores and / or oedema) including 1.4% severe (W/H <-3 Z-scores and / or oedema). These results are similar to those reported in RNIS 32 and 33, from a UNHCR survey in June 2000. The survey in June 2000 did not randomly sample the whole camp population, so the results of the two surveys are not strictly comparable. It does appear, however, that the prevalence of malnutrition in Kakuma camp, has remained stable at 17-18% (<-2 Z scores) since early 1999 (note that according to% of the median the prevalence of malnutrition is 8.5% <80% WFH). Coverage of the feeding programme is 32%. It is difficult to interpret the prevalence of malnutrition without further information on the health environment to estimate the health risks associated with malnutrition. From the survey report, the energy content of the ration appears good (2,200 Kcal), but no information on the equity of the distribution system is provided. The ration is inadequate in riboflavin.
Overall
The nutrition situation for refugees in Dadaab appears to be deteriorating (category II). Food rations for refugees in Dadaab have been inadequate, and they are located in one of the worst drought affected districts. The nutritional situation for refugees in Kakuma camps is stable, at moderately high prevalence of malnutrition (category III).
Recommendations
· Support the 2001 UN Inter-Agency Appeal.Dadaab camps
· Increase the general ration distributed in the camps.Kakuma camp (IRC/HCR/ICH 12/04/01).· Investigate whether the increase in children in feeding programmes is a result of improved coverage or an increased prevalence of malnutrition.
· Ensure the continuation in adequate general food ration.· Investigate the equity of the general ration distribution system.
· Assess the health environment to be able to better interpret malnutrition rates.
Opposition to the Transitional National Government (TNG), established in August 2000, has resulted in conflict within the country, particularly in and around Mogadishu, which is currently divided amongst five small armies. The potential for conflict was illustrated on the 12th of May as fighting broke out when one of the opposition leaders from the Somali Reconciliation and Reconstitution Council (SRRC) tried to enter the port area controlled by factions loyal to the TNG (IRIN 12/05/01). The biggest fear is that the opposition to the TNG could lead to an escalation of conflict within the whole country. Heavy fighting between militia loyal to Aideed and Ato (of the SRRC) and those loyal to the TNG continued in Mogadishu until mid July (IRIN 18/07/01).
Insecurity and threats to humanitarian workers increased, and has meant that humanitarian access is now considered to be at its worst since the departure of UNOSOM in 1995 (UNICEF 05/01).
The Gu rains began as expected in April and were slightly less than average. Many farmers responded by planting their long cycle crops such as sorghum and maize only to find that crucially the rains failed in May and June (FSAU 10/07/01). The areas most affected by the failure of the Gu are rain fed cereal producing areas of Bay, Bakool, Gedo and Hiran. The lack of rain has resulted in the loss of much of the Sorghum crop and WFP have issued a warning of a potentially serious food insecurity situation. The Food Security Analysis Unit (FSAU) predicted that the total sorghum harvest could be sixty percent lower than average post war figures (FSAU 10/07/01). Rainfall was slightly better in some other areas of the country particularly in Middle and Lower Shabelle and Middle Juba. In June, WFP put out an appeal for 20,000 MT of relief food to allow the agency to preposition supplies for the next 12 months (WFP 01/06/01).
Those most affected by the rain failure are likely to be the IDPs, because they are often separated from their kin, as well as poorer agro pastoral households and the urban poor. The FSAU estimates that there are about 340,000 people in the four most affected regions who will be most obviously vulnerable (FSAU 10/07/01). In addition to continued political instability and poor rains, inflation caused by the illicit importation of Somali banknotes is threatening food security by reducing the purchasing power of vulnerable groups (IRIN, 21/05/01).
UNICEF Somalia has released the results of their End of Decade Multiple indicator cluster survey for 2000. Combined data for Somaliland, Puntland in the north as well as South and Central Somalia, give a prevalence of acute malnutrition of 17% (W/Ht <-2 Z-scores). This is extremely high for a national survey, and will include some areas with much higher levels. Disaggregated data give the highest prevalence for South and Central Somalia (about 20%), followed by Puntland (12-13%) and the lowest prevalence was found in Somaliland (<10%). Whilst the method and time of year is not given (in FSAU nutrition update for July 2001), the prevalence of malnutrition appears closely associated with political instability.
Gedo
Continued political instability and poor Gu rains, contribute to a poor food security situation in Gedo. The FSAU reports sharp increases in local cereal prices and drops in the prices of livestock. Substantial out-migration from northern areas has been reported. FSAU also reports that southern areas of the region are experiencing in-migration from Somali livestock traders returning from Kenya where livestock prices have dropped (FSAU 08/06/01; 10/07/01).
Luuq
ACF report an increase in the numbers of children in the Feeding Centre (SFC) in Luuq, from 100/month in March 2001, to 305 per month in April and 500 per month in May. Similar trends have been seen in their Therapeutic Feeding Centre (FSAU, June 2001). AMREF reported a sharp increase in the proportion of malnourished children attending the MCH clinic in May (FSAU, July 2001).
An increase in the prevalence of malnutrition would be expected just before the Gu harvest. AMREF however attributes the sharp rise in the proportion of malnourished children to the arrival of displaced from Elbon (Gedo) and Wajid (Bakool) into Luuq town. FSAU reported the arrival of 1200 new IDPs in June. ACF is planning to open another feeding centre in Elbon. The combined effects of inflation and poor rains have increased food prices, thus increasing food insecurity. The rise in the cost of fuel has hit communities dependent on irrigated farming along the Juba River. The effects of bad rains in 1999 are still felt and farmers were unable to plant as much as they would have liked, despite relatively good harvest rains in 2000 (FSAU 06/01).
Beled-Hawo (Bulla Hawa)
Figures from MCH clinics indicate that whilst the number of children attending the Bulla Hawa centre has dropped, the proportion of those presenting with acute malnutrition seems to have increased from earlier in the year (FSAU 06/01). High proportions of malnourished children continue to be reported, despite ongoing supplementary feeding programmes and targeted food distributions by CARE (FSAU, July 2001).
Bulla Hawa suffered from inter-clan fighting in March, which resulted in considerable displacement of population to neighbouring Kenya (FSAU 06/01). Initial estimates of 7-10,000 people displaced into Kenya, were revised downwards to 5-7000 in June. With the support of UNHCR, 300 families were registered to move to refugee camps inside Kenya. The majority returned spontaneously to Bulla Hawa in June (IRIN, 20/06/01). The new District Commissioner for Bulla Hawa, however reported that the returnees were facing food problems on their return.
El Wak
A rapid screening of children in El Wak Somalia was done following a survey in El Wak Kenya, which showed 28.1% malnutrition (W/Ht <-2 Z-scores) in May 2001. Because of lack of access for international staff, members of the local NGO Soma Action were trained in doing a MUAC assessment. 6.4% of children were found to be severely malnourished (<11 cm) and 38% of children were moderately malnourished. RNIS can-not comment on the reliability of the findings, because the methods do not appear to follow standard procedure. At the time of the assessment, the District had not yet received the Gu rains, and livestock was reported to have moved out of the District.
Bay and Bakool
Bay and Bakool Regions remain food insecure regions, particularly following the recent failure of the Gu rains. This has resulted in the failure of most rain fed crops and a deterioration in water and pasture sources. The projected Gu harvest in Bay region has been estimated at 15% of the post war average (FSAU 10/07/01). Many people from Bay have also begun to migrate to areas in the Shabelle and Juba valleys in search of employment.
The RNIS has not received new nutritional survey information for the region but MCH data indicates increasing rates of malnutrition from the monthly screening, which is expected in the period just prior to the harvest.
Juba valley
The FSAU reports that the region has experienced good Gu rains in 2001 and that the overall crop condition is good. This has improved pasture, water and livestock conditions and greatly improved the food security outlook (FSAU 08/06/01; 10/07/01).
In March/April of 2001 UNICEF conducted a nutrition survey in Jamame district, Lower Juba. The survey was carried out in response to fears that the district was suffering from failed harvests in 2000. The survey showed a prevalence of malnutrition of 14.3% (W/Ht <-2 z-scores and/or oedema) including 2% severe acute malnutrition (W/Ht <-3 z-scores and/or oedema). The survey also noted high rates of morbidity, particularly diarrhoea and respiratory tract infections, and the overall rates of observed malnutrition were considered high for an agriculturally productive area (FSAU 05/01), however the survey was conducted at the end of the dry Jilaal period. Given the good Gu rains, the next harvest prospects are good and it is hoped that the nutrition situation will improve.
Lower and Middle Shabelle
The RNIS has received no new nutrition information from Shabelle, however the FSAU reports that the Gu rainfall in the two areas has been good. This has improved water sources and pasture and livestock conditions and milk yields are reportedly good. The cereal crops are generally good and the price of food products has not risen. The food security of the poorer, more vulnerable households is described as good as employment and petty trade opportunities seem high and there are wild fruits and vegetables to collect (FSAU 08/06/01; 10/07/01).
Mogadishu
RNIS has received no new nutritional information from Mogadishu. The situation appears alarming however, due to continued fighting and the withdrawal of aid workers. The importation of Somali shillings continues to cause inflation of Somali currency and has had the effect of increasing food prices. Food prices are also likely to rise in reaction to the reduced Gu grain harvest, and it is likely that this will negatively impact the many displaced in Mogadishu.
Northern Regions
Somaliland
The most important political event in the northern regions has been the referendum for independence in Somaliland on the 31st of May 2001. The referendum sought to assert the independent status of Somaliland and to introduce sweeping political changes by removing the present clan-based system of governance (IRIN 10/07/01). The administration has since announced that 97% of people voted resoundingly for change. The historic event has met with very little world recognition but internally the TNG denounced the referendum as illegal and stated that the splitting up of Somalia into small fiefdoms was ‘unacceptable’ (UNICEF 05/01). This may have implications for future insecurity in the area.
UNHCR closed the second of 8 camps in Somali Region in Ethiopia, resulting in an estimated return of about 22,000 refugees to Somaliland in June 2001. The same month, UNICEF/MoH Somaliland and FSAU carried out a nutritional survey in returnee camps in and around Hargeisa town. Preliminary results indicated that the prevalence of malnutrition is significantly higher in returnees than in the resident population. Observations from some of the survey teams indicate the nutritional situation in some settlements to be very poor but the full results will be published later (FSAU 07/01).
Rains were late in many areas of the north, adding to existing vulnerabilities from the livestock ban (see RNIS 32 and 33 and FSAU flash report March 2001). The last RNIS reported that Burao town was particularly vulnerable to the livestock ban because it has one of the largest livestock markets. MCH statistics show an increasing trend in the proportion of malnourished children over the course of 2001. The FSAU points toward the high catchment area of the clinic and high rates of attendance and suggest that observed trends are quite significant (FSAU 06/01). Despite a slight relaxing of the ban from the UAE there does not appear to be much change regarding the economic impacts (FSAU 06/01).
Puntland
Reports from SRCS in Garowe, report that the proportion of malnourished children coming to Dangorayo MCH increased from January to June 2001 (FSAU, 07/01). The welfare of IDPs and the urban poor is thought to be negatively affected by the local currency devaluation and the livestock ban (FSAU, 06/01). The Gu rains have also been poor in terms of both distribution and volume meaning that there could be water and pasture problems in coming months. The partial lifting of the livestock ban in the UAE has marginally increased employment opportunities for some groups although this is extremely limited at present.
Overall
The combined effects of political instability, inflation, the livestock ban and failure of the Gu rains in many parts of the country, will affect the food security of many people particularly in southern Somalia and within this, particularly the displaced. The recent fighting in Mogadishu and the evacuation of aid workers places the displaced in Mogadishu at highest risk (category II). Displaced in Gedo are also considered at moderate risk; their food security situation is precarious and likely to deteriorate, but targeted food distributions and feeding programmes continue for these groups (category III). Returnees from Ethiopia to Somaliland, particularly those who live in settlements around Hargeisa town, also appear at risk (category III).
Recommendations
· Support nutritional surveillance done by UNICEF, FSAU etc.· Support WFP's request for the pre-placement of contingency food stocks.
· Support peace and reconciliation moves between the SRRC and the TNG.
· Continue to monitor the importation of illegal currency and its effect on inflation.
The humanitarian situation in Sudan has deteriorated markedly over the course of 2001 as a result of an escalation in insecurity in much of southern Sudan, particularly in western Bahr-el-Ghazal and drought in Dafur and the Red Sea Hills area. The effects of the drought and increased insecurity have exacerbated the current hungry season and resulted in a dramatic increase in the need for food assistance. Current estimates indicate that, as of June 2001, over 3 million people are affected by drought or conflict or both in north and south Sudan (FEWS 15/06/01) and where these needs are not met, falls in nutritional status can be expected. IDPs in areas of Western Bahr el Ghazal, Upper Nile, Eastern Equitoria, Darfur and Kordofan are particularly vulnerable.
A one-day peace summit in early June between John Garang, the SPLM leader, and Omar Hassan al-Bashir, the Sudanese president failed to reach a cease-fire agreement (UN-EUE 06/06/01). One of the main sticking points in the talks were the rich oil reserves found in the Western Upper Nile region. Oil has become an increasingly important source of revenue for the Government of Sudan (GoS) and much of the recent fighting has been over control of oil reserves. Conflict between the GoS and rebel movements in the south has continued and even escalated over the course of 2001.
More recently the SPLA has given a cautious welcome to the latest Libyan-Egyptian Sudan peace initiative aimed at ending Sudan's 18-year civil war. The Sudanese Government has also announced that it had accepted the peace initiative. The initiative calls on both sides - the government and the opposition - to set up a committee leading to a national reconciliation conference. (BBC 05/07/01).
Continued Insecurity
May and June have seen large-scale offensives by both the GoS, in the Nuba mountain area of the country, and from the SPLA in Western Bahr el Ghazal. The offensives have resulted in tens of thousands of people being displaced into neighbouring areas. Insecurity throughout the south has been further heightened by the continued use of aerial bombing by the GoS. Despite an announcement by the GoS that they would cease all air attacks by May 25th, the attacks have continued (IRIN 28/05/01) and bombs were reported to have narrowly missed a WFP plane conducting food drops in Bahr el Ghazal on June 8th (IRIN 08/06/01). The bombing tends to be fairly indiscriminate and coupled with the upsurge in fighting has led to a marked deterioration in the general security situation. This is significant because it is affecting humanitarian access to populations who rely on humanitarian assistance to meet at least some of their food needs. For example, in May 2001, the International Committee of the Red Cross suspended its humanitarian flights to Sudan for two weeks, after a Danish pilot was killed flying over southern Sudan (BBC 21/05/01).
Continued drought
The increased insecurity and displacement comes at a time when in large parts of Sudan people are still suffering and struggling to cope with the effects of two years of poor rains. The drought is particularly severe in Darfur and north Kordofan where water shortages are now critical and up to 600,000 people were estimated to be in urgent need of food aid (WFP 29/03/01).
Increasingly people are having to fall back on coping strategies which are potentially damaging to peoples health and livelihoods in the longer-term. For example, reducing food intake and the consumption of crucial seed stock. Lower harvests combined with depleted stocks have led to a sharp rise in cereal prices; with a threefold average increase in March and April 2001 compared to the same period in 2000 (FAO/GIEWS 14/05/01). This average figure masks more extreme price rises in worst affected regions. This has a significant impact on the purchasing power of vulnerable groups and increases dependence on wild foods and relief aid. Whilst food deficit is often experienced in many areas at this time of year, the drought has been extreme and its effects compounded by the ongoing conflict. In the south the conflict continues to restrict the use of many coping mechanisms, particularly those that require mobility, leaving many extremely food insecure and at great risk of acute malnutrition (FEWS 11/05/01; SCF-UK 01/06/01).
Humanitarian Response
The delivery of essential food assistance has been further constrained by an initial low donor response to the general appeal for Sudan. As a result food distributions were 50-60% of the planned ration at a time when people’s food needs were increasing (FEWS 15/03/01). In response to the increasing needs for food aid, WFP took the decision to divert 23,200 tonnes of food destined for Ethiopia to Sudan, which significantly boosted the pipeline in April (IRIN 10/04/01). The United State’s government has also recently pledged 40,000 MT of food aid to both the GoS and rebel-controlled areas of the country. This offers a significant boost to the food pipeline (FEWS 15/06/01). Other responses have included the distribution of seeds, agricultural and fishing equipment by FAO and INGOs.
South Sudan, non-GoS controlled areas (OLS Southern Sector)
The WFP/Technical Support Unit (TSU) estimates that there are 300-400,000 IDPs in southern Sudan as of May 2001. This includes people returning to South Sudan, particularly from the north (FEWS 16/05/01)
Bahr El Ghazal (BEG)
Rainfall has been erratic since April and delayed the main planting season. Critically this is likely to extend the hunger season for one to two months in the Aweil counties and parts of Gogrial and Twic counties. This is likely to have a very negative impact on food security in these areas but the single greatest determinant of food security remains the insecurity generated by the war (FEWS 16/06/01). May and June have seen a strong offensive in Western Bahr el Ghazal by the SPLA, around the government held towns of Wau, Aweil and the infamous railway track. IRIN reports that 30,000 people have been displaced and are fleeing north to Ed Daein in South Darfur and to the surrounding counties. Current reports of their condition remain sketchy but it is thought to be extremely poor (FEWS 16/06/01).
Aweil East
Poor rains and insecurity continue to affect the area, and have severely disrupted the planting season. WFP/TSU estimated that there were a total of 28,500 IDPs and returnees in the area in May while most were fleeing the fighting around the railway line or from within Aweil West (WFP/TSU 05/01). Tearfund has conducted two nutrition surveys in Malualkon, Aweil East. The first, in March 2001, reported 15.5% acute malnutrition (W/Ht < -2 Z-Scores and/or oedema) and 1.8% severe acute malnutrition (W/Ht < -3 Z-Scores and/or oedema) (see RNIS 32 and 33). A follow-up survey in June indicated that the nutrition situation had substantially deteriorated with a prevalence of acute malnutrition of 28.9% (W/Ht <-2 Z-scores) including 5.5% severe wasting (W/Ht <-3 Z-scores) (see graph below) (Tearfund 07/06/01).
Tear Fund surveys in Aweil East during 2001
The results are particularly alarming because the survey was conducted in the hunger gap and the population faces further food shortages ahead. It indicates that household food stores are already severely depleted if not empty and that reliance on relief and wild foods has risen dramatically (Tearfund 07/06/01). The possibility of increased insecurity remains high and this will further disrupt existing coping mechanisms, cause population displacements and further nutritional decline and increased risk of dying. To put the figures into perspective, during the height of the 1998 famine according to Tearfund surveys the rate of acute malnutrition reached 36.2%.
MSF-F also carried out a nutrition status and health survey in the same area in April. The RNIS does not have access to the report, but WFP report that the rate of acute malnutrition was 17.1% including 1.7% of severe (using Z-scores) (WFP 28/06/01). The lack of information on methodology from the MSF-F survey makes comparison with the Tearfund survey very difficult. Both agencies report falls in the number of children attending their selective feeding programmes as mothers take their children to the fields during the cultivation season. However, numbers are expected to rise again with the end of the cultivation period (WFP 28/06/01).
Aweil West
Recent insecurity has particularly affected both East and West Aweil Counties, and Concern Worldwide had to pull out of the area but will go in when conditions permit. As a result, no new survey information exists but given the insecurity and the conditions seen in Aweil East, it is likely that the nutritional situation of the populations has already been compromised. In May WFP/TSU estimated that there were 22,940 IDPs and returnees in the area (WFP/TSU 05/01).
Gogrial County
WFP/TSU reported 19,000 IDPs in the area mostly centred around Akon (WFP/TSU 05/01). Agencies on the ground have noted deteriorating nutritional conditions with increased admissions to selective feeding programmes. MSF-B conducted a 30x30 cluster survey in Ajiep, Kuajok Payam, in May and found an estimated prevalence of acute malnutrition of 15.5% (W/Ht <-2 Z-scores and/or oedema) including 2.2% severe malnutrition (W/Ht <-3 Z-scores and/or oedema). MSF-B reports that the results are double those of a similar survey done in July 2000 and are an indication of a rapidly deteriorating situation. Mortality rates were not estimated but the coverage rate of measles vaccination was very poor and the potential for an epidemic was considered high (MSF-B 14/05/01). MSF-B opened a Therapeutic Feeding Centre (TFC) in Ajiep in May and are expecting the number of admittances to increase from an initial 45 cases in the first 3 weeks. The relative high prevalence of malnutrition at the beginning of the hungry season is a result of insecurity and drought and the risk of further deterioration is high (FEWS 15/06/01).
Twic County
A TSU assessment in March 2001 estimated that there were a total of 7,400 IDPs and returnees in Twic County (WFP/TSU 05/01). The late rains threaten to extend the hunger gap for one to two months, which will exacerbate the current nutritional risk. The most recent nutritional survey information is from a Goal nutrition survey in February of three payams, Wunrok, Turalei and Aweng in Twic County. It estimated 26% acute malnutrition (W/Ht <-2 Z-scores and/or oedema) including 2.4% severe wasting (W/Ht <-3 Z-scores). The results are alarming and particularly so given that they were at the beginning of the hunger gap. The survey indicated that there was little food available on the ground and that general food security was poor. The survey included pastoralists and agro-pastoralists, and noted that less than half the people interviewed owned cattle, with one third having access to milk, which is a major food source. Little stored food was evident and people reported a high dependence on wild food sources (Goal 12/02/01). A recent WFP report indicates that the numbers in the Goal SFC are rising rapidly and calls for close monitoring of the situation (WFP 28/06/01).
Goal operate four feeding programmes in the area, and eight clinics. Two of their clinics were without food because of logistical difficulties. They noted with alarm that selective feeding programmes were not the answer to the current widespread food insecurity, which requires a regular and reliable general food distribution to all those who need it.
In the absence of a general ration, a selective feeding programme is likely to encourage the worst affected to abandon their homes and congregate around feeding centers in the hope of some assistance. The impact of this ‘magnet effect’ around feeding centers has in the past had a catastrophic effect on the health environment and the displaced people’s access to food, and resulted in massive mortality, as witnessed in Kuajok Payam in 1998. Apart from this problem, take-home supplementary feeding is of limited benefit as the distances are too long between the centers and peoples homes in the three payams for mothers to walk on a weekly basis for a few kilograms of Unimix.
Equatoria
The food security situation in the surplus producing counties of the Western Equatorial region remains relatively good. The rainfall and crop development has been described as good. The RNIS does not have any recent nutritional information but the general situation in the West is not deemed to be critical. Rains have generally been good in the Eastern parts of the region and this will mean that the majority of the IDPs in Kapoeta, estimated at around 15,000, will most likely be able to supplement their food aid with wild food sources. The rains are also likely to have a positive impact on livestock and milk production (FEWS 15/06/01; WFP/TSU 05/01). However, the situation remains precarious in some areas and FEWS reports that WFP suspended food distributions to Kapoeta in May as a result of increased insecurity and looting of food. It is feared that this may lead to further depletion of livestock holdings (FEWS 11/05/01).
Upper Nile / Jongolei
FEWS reports that the rains have been good in some parts of Leech, Latjor and Phou states. However the food security situation looks extremely grim as a result of continued conflict in the Western Upper Nile region around rich oil fields. The extent of the fighting has displaced tens of thousands of people and made many areas inaccessible, leading to a resultant food deficit, as people are simply unable to access potentially fertile land. WFP/TSU reports that there are an estimated 50,000 IDPs in Leech state with a further 68,000 in Latjor and 29,000 in Phou (WFP/TSU 05/01).
Phou State
ACF-US have recently conducted two nutrition surveys in Old Fangak and Maraeng districts of Phou State. The surveys found an estimated prevalence of 20.4% acute malnutrition in Old Fangkak and 21.3% in Maraeng (W/Ht <-2 Z-scores and/or oedema) including 3% and 2.3% severe malnutrition (W/Ht <-3 Z-scores and/or oedema) respectively, which are serious cause for concern as they occur prior to the main hungry season. (See Graph below)
ACF-US Nutritional Surveys in Phou State, Western Upper Nile, April 2001
The food security situation will almost certainly deteriorate with the coming of the hunger season and the survey noted that traditional trade opportunities were almost non-existent due to the insecurity. The survey also highlighted the extremely poor access to medical care and reported high rates of morbidity. The main cause of death was diarrhoea and malaria. The lack of health care means treatment is generally unavailable. Vaccination coverage was extremely poor, with a total of only 4% of children being vaccinated for measles from card and mother/carer report (ACF-US 04/01). This makes the population extremely vulnerable to epidemics that could further compromise nutritional status and increase mortality.
Bieh State, Jongolei
In the last RNIS high rates of acute malnutrition were reported from MSF-B nutrition surveys in Akobo, Bieh State. The high rates of malnutrition were due to large numbers of IDPs and the poor food security situation. The RNIS has no new nutrition survey information for Akobo but a recent FEWS visit to the area observed that the MSF-B supplementary feeding centre was admitting exceptionally large numbers of beneficiaries. The number of new admissions rose by 28% in May with a reported 3,200 beneficiaries at the end of June (WFP 28/06/01). MSF-B estimates that 40% of the beneficiaries are IDPs. The agency also reports that the incidence of diarrhoea and malaria was very high in those attending centres (FEWS 15/06/01).
South Sudan, GoS controlled areas (OLS Northern Sector)
The GoS controlled areas of Southern Sudan remain affected by the increased insecurity and the prevailing drought conditions. SPLA offensives led to the capture of certain GoS held towns in Western Bahr el Ghazal, in early June. The fighting displaced tens of thousands of people from the towns of Raga and Daym Zubayr who are making their way northwards to southern Darfur (IRIN 02/07/01).
Unity State
The situation in Unity state remains extremely precarious with continued fighting. The fighting is largely around the oil rich areas of the state and has resulted in the displacement of many thousands of people. The RNIS has not received any new nutritional information from the area. The last survey was conducted by ACF-F in July 2000 and indicated very high rates of acute malnutrition. Given the prevailing security and drought conditions, it is very likely that the nutritional risk in the area is extremely high.
Northern Sudan. Transitional Zone
Drought and war have had serious impacts on the populations of government held areas of Sudan and FEWS estimate that there are currently 1,820,000 affected people (FEWS 15/06/01).
South Kordofan
The RNIS has not received any new information from South Kordofan but current estimates indicate about 100,000 people are currently suffering from drought or war displacement. The GoS has escalated attacks in the Nuba mountains area and this has resulted in the closure of all the airstrips that had been previously used to bring food and medical relief to the area. Soldiers are also reported to have destroyed houses and food stores (IRIN-HOA 04/06/01). The area is also suffering from a very severe drought that has resulted in the loss of most crops and seen the rapid deterioration of water sources and livestock condition. Coupled with the insecurity, the food security outlook is extremely grim and the risk of nutritional deterioration extremely high.
Darfur
Darfur is suffering from a drought that some are claiming is the worst in 60 years, with over 400,000 people critically short of water (SCF-UK 15/05/01). SCF-UK conducted a series of nutritional surveys in five food economy zones in North Darfur (see graph below), one of which included the displaced living on the outskirts or El Fasher. The overall prevalence of acute malnutrition was 23.4% (W/Ht <-2 Z-scores and/or oedema) and included 2.1% of severe malnutrition (W/Ht <-3 Z-scores and/or oedema) (SCF-UK 15/05/01).
SCF-UK Nutrition surveys in N Darfur, March-April 2001
The very high levels of acute malnutrition six months before the peek of the hungry season are extremely grave. The displaced population were considered particularly vulnerable as they have fewer resources and coping strategies to fall back on. The high level of severe malnutrition among the displaced may also indicate a poorer public health environment. Displaced people were 1.7 times more likely to report sickness and 1.5 times more likely to report diarrhoea than others surveyed.
The surveys also highlighted low rates of measles vaccination (36.6%) which combined with the high rates of acute malnutrition greatly increases the risk of measles epidemics with devastating effects on risk of dying and nutritional status (SCF-UK 15/05/01).
The main cause of acute malnutrition was food insecurity; lack of availability and limited access to food sources and the general breakdown in the usual mechanisms to cope with food scarcity. Three out of the previous four harvests have been very poor or failed altogether, leaving people with almost no stored food. As a result the survey indicated that 87.7% of people are dependent on purchased food. In times of food crisis wild foods usually account for a large proportion of food consumed but the drought has resulted in the failure of koreb, one of the most commonly eaten wild food source. The price of staple cereals has risen beyond the reach of most people and the prices of livestock are declining making the terms of trade for people trading livestock to buy cereals extremely poor. In the pastoral food economy zone of North East Darfur (Malha) the rise in acute malnutrition has closely followed the rise in millet prices.
Employment usually offers another alternative way to generate cash for food purchase but the survey also records considerable slumps in labour wage rates. The author convincingly demonstrates that many of the traditional coping mechanisms have been exhausted not just for the poorer sections of society but that everybody has been affected. A frequency distribution graph of all the children showed that the nutritional status of the previously better-nourished children has slipped as much or more than those presenting with a poorer nutritional status. The population is extremely nutritionally vulnerable and in desperate need of food assistance and associated interventions to prevent loss of life (SCF-UK 15/05/01).
Khartoum
The Greater Khartoum area contains almost two million IDPs but only a few hundred thousand reside in designated camps. The RNIS has not received any recent nutritional information on the IDPs in the area but the OLS Southern sector have noted that there have been considerable returns to Southern Sudan from the North. This would appear surprising given the poor conditions in the south and it is considered indicative of a deteriorating situation for displaced in the north (FEWS 16/06/01).
Refugees
The war between Ethiopia and Eritrea sent many Eritreans across the border into Sudan. An agreement between Eritrea, UNHCR and Sudan was signed in March 2001 to facilitate the voluntary repatriation of refugees from Sudanese camps. The RNIS does not have any information on the nutrition situation of the refugees but it is assumed to be non critical. The Gash-Barka zone in Eritrea has been identified as an area of resettlement and surveys within the refugee population have indicated that 71% wish to return. Provisional planning figures estimate that 62,000 refugees will return from Sudan to Eritrea during the course of 2001 (FEWS 07/05/01).
Repatriation efforts began in May 2001 and it is reported that by June 26th a total of 16,588 had being repatriated by convoys from the camps of Hawata, Mafaza and Gulsa. Efforts have increased to move the refugees before the upcoming rainy season in Eritrea, which starts in late July. At the end of June, 27,000 had signed up for return (UNHCR 26/06/01).
Overall
The situation in Sudan has deteriorated significantly during the first half of 2001. The re-occurrence of drought in many areas of the country has left many people food insecure and reliant on a variety of marginal coping mechanisms. The escalation of insecurity, particularly in the southern areas, has led to massive displacement of population and further eroded people’s ability to cope with the deteriorating situation. The RNIS has reports of high rates of acute malnutrition from various areas and there is a great need for a substantial humanitarian relief effort to avert further deterioration of the nutrition situation and associated mortality (category I).
Recommendations
From the Greater Horn of Africa Food Security Update of June 15th (FEWS 15/06/01)
· Increase pledges to the humanitarian appealFrom the Tearfund survey in Malualkon, Aweil East County (Tearfund 07/06/01)· Improve the speed of response to avert the short term humanitarian crisis
· Continue supplementary feeding and improve coverage through the use of extension workers.From the MSF-B survey in Kuajok Payam (MSF-B 14/05/01)· Increase the current general food ration from a 50% ration to 75%, during this phase of the hunger gap.
· Improve targeting of the general ration at the most vulnerable, particularly those attending feeding centres.
· A full general food distribution should be given during the cultivation period when accessibility and availability to food is at its lowest.From the ACF-US surveys in Phou State (ACF-US05/01)· A blanket supplementary ration should be distributed to all children under 3
· Implement a measles vaccination campaign
· WFP to continue their food distribution.From the SCF-UK survey in Darfur (SCF-UK 15/05/01)· Start an SF programme to cover the hunger gap.
· Introduce nutrition and disease surveillance.
· Undertake emergency measles immunization campaign and start routine immunizations in PHC structures.
· An advocacy campaign to raise international awareness to the seriousness of the situation in North Darfur.· Introduce a blanket supplementary food distribution to all children under five, pregnant and lactating women.
· Establish intensive supplementary feeding programme for severely malnourished.
· Carry out immediate measles vaccination programmes.
Cote d’Ivoire
Guinea
Liberia
Sierra Leone
The situation in West Africa remains highly changeable. Insecurity has continued along the borders that Guinea shares with Sierra Leone and Liberia and the security situation has deteriorated considerably within Liberia. However, the reporting period has seen a stabilisation of the situation within Sierra Leone. This continues to result in an steady influx of both returning Sierra Leonean refugees and new refugees from both Guinea and Liberia. Furthermore, WFP has issued warnings that it is likely to suffer pipe line cuts in September for its West African programmes, unless further funding is forthcoming (IRIN-WA 28/06/01).
Instability in neighbouring Guinea and fighting in the Lofa region of Liberia has resulted in a new influx of refugees into the country. According to UNHCR there are 120,000, mostly Liberian refugees, remaining from an influx in 1999 (IRIN-WA 29/05/01). A recent OCHA update reported that a steady flow of 50 Liberian refugees a day has been entering Côte d’Ivoire since early May when fighting broke out in Lofa county, northern Liberia. From May 3rd to July 19th a total of 4,076 new Liberian refugees have been registered (IRIN-WA 20/07/01).
The refugees are being accommodated in the Zone d’Accueil des Refugies (ZAR), which is an area designated by the Ivorian government to shelter refugees. The ZAR is made up of two prefectures, Danane, located only 30 Km from Liberia, and Guiglo, 150 Km to the south of Danane and the refugees are not permitted to move out-side of this area. Guiglo contains the only refugee camp in Côte d’Ivoire, called Nicla, which currently has a population of 8,000 people (OCHA 28/06/01). The rest of the refugee population lives in parts of Guiglo and Danane and ten small towns in between. Reports of the new refugee influx have indicated that most appear to be girls and women between five and sixty years of age (OCHA 28/06/01). The high proportion of women and children make the new refugees particularly vulnerable as a result of poor work opportunities, and the population is likely to be dependent on humanitarian assistance for the immediate future.
WFP has begun distributions to 500 newly arrived refugees who have already arrived in Nicla camp in Guiglo. The 500 are the initial caseload out of 1,068 who have registered to go to the camp. It is reported that they will receive a full ration of corn, vegetables, vegetable oil and salt (IRIN-WA 24/07/01). The RNIS has no nutrition information on either the long term or new refugees in the country
Overall
Many of the long term refugees in Côte d’Ivoire receive assistance and are able to seek employment and are therefore not considered at high risk (category IV). However, the new refugees are likely to be at slightly elevated risk as a result of their recent displacement and the high percentage of women and children in the population and their situation will need careful monitoring (category III).
Recommendations
· Ensure timely and sufficient food and non food distributions to the new arrivals.· Help to ensure the integration of new arrivals into the established refugee and non refugee communities.
The reporting period has seen a continuation of violence in the Mano River Union area, on the border with Sierra Leone and Liberia. The area has long been a home to refugees from the ongoing conflicts in Sierra Leone and Liberia, with particular concentrations around the N’zerekore area and around Gueckedou in Guinea Forestiere, concentrated in a strip of land jutting out into Sierra Leone called the Parrot’s Beak. There are also concentrations in the Forecariah area in the west of the country bordering the RUF controlled Kambia district of northern Sierra Leone. UNHCR estimates that there are about 420,000 refugees in the country and it is reported that about 150,000 people have been displaced from the sensitive border areas (UN 2001).
The Guinean response has played a big part in the development of the humanitarian situation in the country. The Guinean army has mobilised along the border areas and has been actively encouraging refugees to move, claiming that many are rebel sympathisers. This mirrors a general hostility in Guinea towards the refugees who have been blamed by the government for the border insecurity. This hostility has translated to open harassment within Guinea, including arbitrary arrests and detentions and the withdrawal of support from host communities (HRW 07/01). In the face of continued insecurity this has left many refugees with few choices. They can either remain where they are in insecure areas where they are likely to suffer further attacks or they can repatriate to their country of origin or they can relocate to the new and supposedly safer, inland camps set up by UNHCR.
Some refugees have chosen to stay in the border areas in the hope that they can escape further attacks. Many of these have been living in the areas for many years and have strong cultural ties with local communities and the land, often sharing the same ethnicity and language as the locals. The borders are also considered to offer opportunities for escape into other areas should it become necessary (HRW 07/01). The improved security in Sierra Leone has increased the possibilities of repatriation for some although many come from areas that are still insecure within Sierra Leone and insecurity in Liberia makes the prospect of return unlikely. The remaining choice for many is relocation within Guinea to the camps set up away from the insecure border areas. However, many fear the often open hostility shown to them within Guinea and are loath to move to new and unfamiliar areas which are invariably away from towns and in regions with unsympathetic host communities (HRW 07/01).
The RNIS has not received any nutritional surveys from either displaced or refugee populations but reports indicate that there has been a slight deterioration of the nutrition situation. Reasons cited for the deterioration are the breakdowns in the traditional mechanisms of food security such as farming and employment. The insecurity has also led to extreme difficulties in moving around the country and this has restricted the flow of merchandise and led to important rises in the price of food and other essential items. The reporting period has also seen the start of the rainy season which lasts from June to October. This is the annual hunger season before the harvest in October. The rainy season is usually associated with increases in morbidity from malaria, respiratory infections and diarrhoea, and this can negatively impact on nutritional status (ACH 24/07/01).
The South East Forest Region
In June IRIN reported that UNHCR had finished the relocation of 57,000 refugees from the Parrot’s Beak area to six new camps in Albadariah and Dabola prefectures, 200 Km north of the border areas. UNHCR have also announced that they will cease the provision of aid to refugees remaining in the insecure border zones. This is likely to be a problem to an estimated 20,000 refugees who have opted to remain close to the border areas. These refugees can be considered to be extremely vulnerable, as a result of the decreased availability of and access to food (HRW 07/01; IRIN 01/06/01).
WHO report figures from June 24th for four of the six camps in the Albadariah and Dabola areas which have received refugees; Kountaya with 25,956 refugees, Boreah with 13,163, Sem-bakounya with 7,366 and Telikoro with 11,322 (WHO 24/06/01). In general the situation in the new camps is not critical but epidemiological surveillance indicates that morbidity and mortality rates are high with a CMR of 0.84/10,000/day and an under five mortality rate of 2.69/10,000/ day calculated from routine surveillance over the week of the 18th to the 24th of June (WHO 24/06/01). The CMR remains below emergency thresholds but is nonetheless elevated and the under five rate is worryingly high. ACH reports increases in the number of children attending Supplementary feeding centres but stresses that the numbers still remain relatively low. The relatively high mortality and observed increases in children in supplementary feeding centers suggests that the situation is more precarious than it was. However, the rates are not unexpected given the increased morbidity and the hunger season, and they remain below critical levels.
WFP also reports that government forces arrested refugees in Telikoro camps at the end of June and this sparked off rioting that prompted the evacuation of aid workers from the camp and the suspension of distribution activities. This illustrates the potential for further insecurity in the camps and there are concerns that this may affect humanitarian access to the refugees in the future (WFP 06/07/01).
Repatriation
Hostility to refugees within Guinea and the increased insecurity has led to a steady repatriation of Sierra Leonean refugees. The better security situation currently experienced in Sierra Leone is facilitating the repatriations but many areas of the country remain insecure and many refugees are going into already crowded displacement camps in government held areas. It is extremely difficult to estimate the number of people repatriating because many travel overland across the border and are not registered upon arrival. However, Human Rights Watch report that since the repatriation programme began last September, over 35,000 Sierra Leonean refugees have repatriated by boat from Conakry to Free-town or with UNHCR assistance (HRW 07/01). As the cease-fire continues the repatriation is expected to increase. The RNIS has no information on the nutritional status of the returnees.
Overall
The humanitarian situation remains precarious for refugees and IDPs in Guinea. The continued hostility within the country towards the refugees remains a major concern and is affecting the refugees sense of security within the country. The most important development has been the relocation of most of the refugees from the south eastern region to camps in the interior. The general condition of the refugees in the camps appears to have deteriorated slightly and there is cause for concern although their condition is not considered to be critical (category III). There is further concern for refugees who have opted to remain in the insecure border areas as they no longer receive any form of humanitarian assistance and they must be considered to be at elevated risk of malnutrition (category II).
Recommendations
· Ensure that refugees remaining near the border areas have access to material assistance if they require it· Conduct sensitisation activities amongst host populations to prevent further harassment of the refugees
· Continue nutritional surveillance within the camps
The humanitarian situation in Liberia has deteriorated further during the reporting period as a result of continued fighting between government troops and rebels in Lofa county in the north of country. Fighting continues amidst claims and counter claims that Liberia and Guinea are trying to destabilise each others countries through the support of rebel factions. The fighting has resulted in a huge displacement of population from the Lofa region.
The UN estimates that at the end of May there were 40,000 people in IDP camps, the numbers having risen from 15,000 in April (IRIN 14/06/01; UN 2001). The main thrust of displacement has been south to Bong, Cape Mount and Gbarpolu counties, where they are spread between about five of six different camps. Conditions in the camps are extremely poor as many of the displaced were forced from their villages some time ago and have been living in the forest. For many the journey from Lofa has been extremely arduous and there are wide spread reports of harassment by Liberian military along the way. ACF recently reported that many have been unable to access their land and harvest crops as a result of the fighting, leaving them critically short of food stocks (ACF 25/07/01). Furthermore, access to these populations has been severely impeded by the insecurity and by government imposed bans on the movement of humanitarian agencies. This has restricted the supply of humanitarian assistance to the affected populations and there are now reports of great needs for food and medical aid. MSF report that families have used up their food stocks and are suffering high rates of respiratory infection, malaria and some cases of bloody diarrhoea (MSF 03/07/01).
WFP has been conducting food distributions to IDPs in the camps but has also suffered from the restricted access. On June 30th WFP completed a round of distribution to IDPs in Gbalatuah and Bellefanai towns in Bong county. The distribution was only possible after the government lifted a travel ban, and was the first distribution in a month and a half (WFP 06/07/01). The restricted access is particularly concerning given the poor acute needs of many of the IDPs. On July 4th distributions also started to IDPs in the TV tower and CARI camps in Bong county, and to Jenemana and Bopolu in Cape Mount and Gbarpolu counties. The distributions will bring some relief to the displaced but concern remains for those still in Lofa county, many of whom are currently in hiding. The total population of Lofa is estimated to be about 60,000 people and if and when the remainder of these people reach Bong County their nutrition and health situation is expected to be very poor. It has also been noted that many villages in Bong county have started to prepare to evacuate in the eventuality that fighting spreads from Lofa. This highlights the prospect of considerable further displacements (UN 2001). The RNIS has received no nutritional surveys on the displaced population and it is believed that this is largely a result of the lack of access and insecurity in the areas concerned.
The plight of the displaced is heightened by the extreme poverty of the country as a whole. It is estimated that two thirds of the Liberian population are living below the international poverty line of less than one dollar a day. The unemployment level is estimated to be 85% and access to basic amenities such as water, health and education services varies between 11 and 26% (UN 2001). This means that many of the displaced will be chronically impoverished with little or no means of accessing food other than from humanitarian assistance. It is also important to note that it is currently the rainy season which will last until September or October. This is traditionally the hunger season when food availability is at its low-est and morbidities such as malaria and diarrhoea increase. It is expected that the needs of the displaced population will remain extremely high and that they will be at elevated risk of malnutrition.
Refugees
The last RNIS reported an estimated 80,000 Sierra Leonean refugees in the country but continued insecurity has led to an increased number leaving for Guinea and returning to Sierra Leone. It is very difficult to estimate how many have returned, but UNHCR reports that in April 2001 there were 69,762 refugees in Liberia. This means that at least 10,000 have returned to Sierra Leone and the figures have probably increased since then (UNHCR 18/07/01). The RNIS has no recent information on the nutritional situation of refugees within Liberia.
Overall
The insecurity in the north of the country has led to considerable displacement of population within Guinea. Although no nutritional information is available, reports indicate that the IDPs are in extremely poor condition having travelled for some time without much in the way of food or medical care to reach camps. Those that have reached camps are suffering from exhaustion, lack of food and high rates of morbidity. The poor condition of the displaced coupled with the rains and the hunger season make this population very vulnerable (category II). Furthermore, an unknown number are still inaccessible to humanitarian workers and their condition is currently unknown (category V) but can be considered to be poor.
Recommendations
· Advocate for improved access to displaced populations.· Support efforts to provide emergency food and non food relief to IDPs.
· Conduct nutrition surveys to assess the nutritional status of the displaced populations.
The reporting period has seen significant developments in both the political and humanitarian contexts in Sierra Leone. At the regional level, fighting in Liberia and the border areas of Guinea continues to send both refugees and returnees into the country in large numbers. The most significant internal development has been the review of the Abuja Cease-fire Agreement of November 2000 between the Government of Sierra Leone and the rebel Revolutionary United Front (RUF). The review took place on May 2nd 2001 and included the Government of Sierra Leone, the Economic Committee of West African States (ECOWAS), the UN and the RUF. The meeting resulted in a firm commitment by both the RUF and the government controlled Civil Defence Force (CDF) to recommence the Disarmament Demobilisation and Reintegration (DDR) programme (UNSC 25/06/01).
Since the meeting on May 2nd there has been a general adherence to the cease-fire and the DDR activities. The first stage of the disarmament began on May 18th in the north of the country in the Kambia and Port Loko areas. By May 31st a total of 3,502 ex combatants had disarmed (UNSC 25/06/01). The DDR programme has continued as scheduled through June and July with RUF and CDF members handing in weapons in the Lunsar and Bonthe areas and to a limited degree in Kono. Ex-combatants are being placed in reintegration camps where they will stay for six to twelve months before being reintegrated into new areas. Reintegration camps exist at Port Loko, Bo, Moyamba, Kenema and Daru and new camps are being built at Makeni, Lunsar, Kamakwie, Masingbi, Koidu, Pujehun and Bonthe (UNSC 25/06/01).
The cease-fire agreement has also allowed the redeployment of the Sierra Leonean Army (SLA), UNMASIL and civil police force members, into previously rebel held areas. On May 29th the SLA deployed into Mange and Kambia in the northern region, following the official withdrawal of the RUF. The deployment will allow the areas to be secured from further insecurity and create an environment where civil authority can be re-established (OCHA 29/05/01). This process is receiving a great deal of support from the international community. In particular the mandate of the UN mission to Sierra Leone (UNMASIL) has been extended with the number of troops increased to 17,500. Part of this mandate is the facilitation of the delivery of humanitarian assistance (UNSC 25/06/01).
The increased security in the country will hopefully ensure that people have improved access to land for food production and increased opportunities for economic activities. This should help to improve general food security. In areas where acute needs remain, the better security situation is leading to increased humanitarian access, ensuring the delivery of essential food and non food items to populations in need. Whilst the overall picture is encouraging, insecurity does still exist and WFP recently reported that fighting has been confirmed between the RUF and the CDF in Koindu, Kailahun district in the East of the country near the border with Guinea (UNSC 25/06/01; WFP 20/07/01). Human Rights Watch have also reported serious cease-fire violations in the eastern district of Kono and the northern district of Koinadugu (HRW 24/07/01). This suggests that the cease-fire is potentially quite fragile and is particularly concerning as it is likely to prevent returns to the area and will hinder humanitarian access.
Displaced Population and Returnees
The displaced population in Sierra Leone remains hard to estimate but the figure is thought to be around 400,000 people in vario us camps across the country (IRIN 28/06/01). The majority of the registered IDPs are in the Tonkilili and the Port Loko districts as well as in major urban centres such as Freetown, Kenema, Daru and Bo township. However, many are unregistered and reside with host families in all areas (NRC 2001). The total number of displaced is increasing as a result of the return of refugees from Liberia and Guinea and the ex-combatants from the DDR programmes.
These returns have increased pressures on the camp infrastructures. As a result there has been an effort to promote return, whe re possible, of people to either their original areas or to new areas where they can begin to rebuild their lives. In June IRIN reported that in phase I of the resettlement programme 40,498 people were resettled in safe areas (IRIN-WA 01/06/01). Considerable constraints to return exist as many areas have been very badly damaged by the conflict and suffer from a lack of working infrastructure. Concern has been expressed that without sufficient commitment to the rebuilding of many of these areas, many potential returnees are likely to remain in camps.
Northern Province
The improved security situation has particularly affected the northern province which has traditionally been extremely insecure. The reporting period has seen the withdrawal of RUF troops from the area and the deployment of SLA troops. This has led to estimates that up to 30,000 people currently displaced could return to the area (NRC 2001). However, a recent multi-sectoral assessment indicated that the region has sustained massive destruction of infrastructure. In some areas as many as 80% of villages have been destroyed. A recent MSF-H health assessment indicated that although the health situation is not alarming, there is a general lack of medicines and many medical centres have been destroyed (OCHA 16/06/01). In general the outlook for the displaced and returnees is relatively good as increased access to land and markets will improve both the access and availability of food. There will also be improved access to vulnerable populations by humanitarian organisations.
Western Province
Security in the western province continues to remain stable although there is concern over the large number of IDPs in and around the Freetown area. It is hoped that the general countrywide security will continue to improve and allow the displaced to move out of the camps to their areas of origin. The RNIS does not have any new nutrition information for the displaced populations in the west.
Southern and Eastern Provinces
Generally the security situation in the south and east is much improved and disarmament of RUF and CDF has taken place in Kono and Kailahun districts although some fighters are still supposed to be present. It is hoped that the general opening up of areas will facilitate the return of the displaced to their places of origin.
Daru, Kailahun district
The proximity of the area to the continued insecurity in the Parrot’s Beak area of Guinea and the border with Liberia has resulted in the steady arrival of both refugees and returnees. UNHCR report that the total number of returnees to Daru as of July 18th is 25,000 people (IRIN-WA 23/07/01). Reports have indicated that the humanitarian situation is deteriorating in the town because many of the new arrivals are in very poor condition as a result of being trapped for long periods between Guinea and RUF controlled areas with insufficient access to food and medical care. Many cite the termination of assistance and the closure of camps as one of the main reasons for returning (UNHCR 20/07/01).
A recent ACF food security assessment on IDPs, returnees and refugees reported that they have adopted various coping mechanisms including farming, palm fruit harvesting, casual labour and petty trade. Coping mechanisms have been helped by the improved security situation and increased links with other areas of the country. However, there is concern that resources in the area are not sufficient to cope with a continued influx of people (OCHA 11/06/01). It is important to note that the area is entering the hunger season until the next harvest in September. This will considerably increase the vulnerability of the affected population and if numbers continue to increase, a deterioration in the condition of the displaced can be expected. The RNIS does not have any new nutritional information from the southern and eastern provinces but the most recent reports (see RNIS 32 and 33) indicate that the prevalence of acute malnutrition is not high. The improved security access to vulnerable populations is likely to mean that the nutrition situation remains uncritical.
Overall
The humanitarian outlook for Sierra Leone has improved dramatically as a result of the adherence of both government and rebels forces to the cease-fire agreement. This has resulted in a general opening up of previously inaccessible areas to humanitarian agencies and it is expected that this will reveal new humanitarian needs. The improved situation will also create an environment where displaced, returnee, refugee and non displaced populations will be better able to address their own needs through increased access to land and improved employment and trade opportunities. Whilst this should increase food security in the short term, the future food security situation is contingent with the continuation of the cease-fire. The majority of the displaced, returnees and refugees will be Category III but pockets of more acute needs also exist particularly in some of the Eastern areas such as Kailahun.
Recommendations
· Continue to support the peace efforts through funding of the Inter-agency appeal· Support efforts to rebuild essential infrastructure to facilitate the return process
· Continue to monitor the health situation particularly in camps
· Provide agricultural inputs to returnees to ensure sufficient resources for the next harvest period.
Burundi
Democratic Republic of Congo (DRC)
United Republic of Tanzania
Uganda
OCHA reports that out of a population of 6,654,766 there are 379,779 people recorded as displaced and there are a possible further 200,000 IDPs beyond the reach of humanitarian assistance. The continuing conflict, high levels of infectious disease such as malaria, and drought conditions, have all contributed to food insecurity and nutritional status decline. The displaced have been particularly vulnerable, having reduced coping mechanisms, but much of the population has been affected.
The Arusha peace accords of August 2000 were an important step towards ending the long-standing internal conflict within Burundi and were designed to bring opposing groups to the negotiating table. However, the failure to include two rebel groups, the Forces pour la Defense de la Democratie (FDD) and the Forces Nationales de Liberation (IRIN 31/05/01) has resulted in their failure to recognise the process.
As a result of the ongoing peace process in neighbouring DRC, the Congolese president, Joseph Kabila, has begun to decommission foreign rebel groups allied to his Kinshasa regime. The pressure to leave DRC has forced the return of up to 4,000 well-equipped FDD rebels to Burundi, resulting in an increase in security incidents with the Burundian military (AFP 14/05/01). The increased insecurity has particularly affected some of the previously central areas of the country. The escalation in conflict levels was seen most forcibly in February this year when rebels launched an offensive on the capital Bujumbura. This resulted in huge temporary displacement of population into Bujumbura rural, as people fled the crossfire.
The most recent development in the peace process has been the announcement that the Burundian President, Pierre Buyoya, will lead the first eighteen months of the country’s transitional government. Although a step forward for the peace process, the rebel FDD and FNL factions have indicated that they will continue their fight (IRIN-CEA 13/07/01) and it is certain that insecurity will continue to play an important part in the development of the humanitarian context.
The Effects of the insecurity
The uncertain political climate and continued insecurity has detrimentally affected humanitarian access to many of the communities who are most in need of assistance. The problem of access was highlighted by an attack on a WFP food convoy in April in which aid workers were injured. May saw the kidnapping of six aid workers by rebels from the FDD in Southern Makamba province and an attack on the MSF-F residence in Ngozi. In June a member of the agency Children’s Aid Direct was killed in an ambush in Bubanza and in response all agencies in the area suspended their programmes (OCHA 29/06/01). This succession of security incidents has highlighted the danger of working in many areas and has led to both NGOs and the UN imposing restrictions on the movements of their staff. This has important implications for the continued access to certain areas and vulnerable populations. It is estimated that humanitarian access is only intermittently possible in 70% of the country (USAID 03/07/01).
The increased insecurity also threatens to spill over into neighbouring countries. Tanzania has increasingly claimed that the Burundian refugee camps within Tanzania are training and recruiting grounds for rebels that threaten to further destabilise the area. Tanzania has become increasingly impatient with its high Burundian refugee caseload and the president has stated that he is considering sending them home (IRIN 31/05/01). The sudden arrival of 500,000 Burundian refugees from Tanzania would have severe negative implications for the humanitarian situation in the country. The humanitarian response has also been constrained by the under funding of both the 2000 and 2001 Consolidated Inter-Agency Appeal. Up until the end of May 2001 OCHA report that only 15.1% of requirements had been covered (OCHA 31/06/01).
Food Security outlook
Burundi has suffered from several below average harvests that have contributed to the food insecurity of much of the population, particularly the 380,000 IDPs and drought affected persons currently in the country. Encouragingly, FAO/GIEWS report that the output of the 2001 A season harvest appears to be satisfactory as result of improved precipitation, an increase in the overall area of land planted and calmer security in some areas. However, the northern and eastern provinces of Karuzi, Kayanza, Muramvya, Muyinga, Mwaro and Ngozi were particularly badly hit by the drought conditions and resultant crop failure. In preparation for the 2001 B harvest FAO have distributed seeds to populations affected by the drought and WFP has been distributing an associated food protection ration. This ration is to ensure that the distributed seeds went to the next harvest and were not consumed (OCHA 31/05/01). In further response to the assessed food needs WFP, with CARE, has been conducting food distributions to affected populations.
As well as poor food security, the observed nutritional status decline reported by RNIS 32 and 33 has been associated with poor access to medical care and high rates of infectious disease, particularly malaria. The WHO has reported a drop in the high rates of malaria infection seen earlier in the year, probably a result of the onset of the dry season. However, high rates of infection are still observed in the provinces of Gitega and Karusi (OCHA 29/06/01). Despite the precarious situation in much of the country, OCHA reported a decline in the admissions to selective feeding centres from 98,141 in March to 68,002 in June, however the exact reasons for this drop are unexplained (OCHA 29/06/01).
Bujumbura Rural
The UN continues to report insecurity in the province with regular confrontations between the Burundian army and the FDD. The FDD are also reported to be using the province as a base to move closer to the capital. It is very difficult to track numbers of displaced because much of the displacement is temporary, with people returning to their homes when fighting stops. However, the last RNIS reported a total of 30,889 IDPs in an area with a total population of 456,891 (IRIN-CEA 02/07/01). IRIN reports that at the end of May there were 6,498 people in sixteen supplementary feeding centres in the province, however the RNIS does not have any recent nutrition survey information. The better 2001 A harvest and the good prospects for the B harvest will help to improve food availability. In June WFP reported the suspension of targeted distributions in the province as a result of insecurity. The ability of the population to implement coping mechanisms and maintain their food security will remain highly dependent on the security situation. (WFP 29/06/01).
Karusi and Ngozi
WFP has been continuing food distributions to the drought affected population and reported distributing to 251,770 people in the first half of June (WFP 29/06/01). The RNIS has not received any new nutrition surveys for Karusi during the reporting period. The improved precipitation has led to a better 2001 A harvest and reasonable projections for the upcoming 2001 B harvest and the future food prospects appear to be reasonable. However, it is important to note that there are still high rates of malaria reported in the provinces and this will continue to adversely affect nutritional status (OCHA 31/05/01; 29/06/01).
Bubanza
The province of Bubanza continues to suffer acute insecurity. This resulted in large amounts of displacement within the province with many people living in IDP and regroupment camps. During the course of 2000 many of the regroupment camps were dismantled and people have returned to the traditionally farmed high ground areas. In March 2001 Children’s Aid Direct conducted a nutrition survey on some of the returnee population as a way of assessing their current condition. The survey showed an estimated prevalence of 8.6% acute malnutrition (W/Ht <-2 Z-scores and/or oedema) including 2.2% severe malnutrition (W/Ht <-3 Z-scores and/or oedema). Although not alarmingly high, the rate of severe malnutrition shows a substantial increase from the last survey in February 2000, which showed 0.78% severe malnutrition (W/Ht <-3 Z-scores and/or oedema). The overall rate of acute malnutrition remains the same. The authors point out that the 2000 survey was conducted in the regroupment camps and that some of the increase may be a result of differences in the assessed population and their environment. However, the amount of severe malnutrition is of concern and the survey attributes the increase to drought induced food insecurity and a high disease burden, in particular malaria. The survey also shows an elevated under five mortality rate of 5/10,000/day, which is above emergency thresholds and suggests that the nutritional status decline is contributing to mortality (CAD 23/03/01).
Overall
The situation in Burundi still remains extremely precarious in terms of security and this is likely to continue affecting the food security of the displaced (category III). However there are indications that the drought conditions of the last few years are improving, and the first harvest of this year was reported to be satisfactory and the prospects for the next harvest are encouraging. The coming of the dry season has seen a reduction in the amount of malaria in the country and this will significantly affect the health environment of much of the population. In general there does appear to be an improvement in the overall nutrition situation in the country although security remains a significant problem for displaced and non displaced alike and is likely to be the limiting factor in future nutritional risk.
Recommendations
· Negotiate humanitarian access to affected populations in currently inaccessible areaFrom the CAD Bubanza survey (CAD 23/03/01)
· Conduct food security assessments to determine the needs of the affected population· Actively trace cases of malnutrition in the community with outreach workers
· Implement food security programmes to improve access and availability of food.
The reporting period has seen the continuation of the peace process in DRC and with it the promise of better security and increased access to populations made vulnerable by the years of conflict within the country.
Insecurity continues in certain areas, mostly as a result of pressure on various rebel groups to leave, and is threatening to spill over into the neighbouring countries of; Rwanda, Burundi and Tanzania. One of the major obstacles to the peace process is that certain rebels groups have never been involved in peace negotiations and have vowed to carry on fighting. A meeting took place on July 4th between Joseph Kabila, the DRC president, and his Ugandan counterpart Yoweri Museveni to discuss issues of importance to the two countries. This is a positive development given the strained diplomatic relations over the last few years as a result of the hostile presence of Ugandan troops within DRC (IRIN-CEA 04/07/91). There is also an important upcoming summit of the Organisation of African Unity (OAU) in Lusaka, Zambia, which will bring key players from many African countries together to further discuss the ongoing peace process (AFP 05/07/01).
Disengagement and withdrawal of foreign troops from the DRC has continued. In June IRIN reported the redeployment of a 7000 Ugandan and 600 Namibian troops. Foreign troops from Angola, Zimbabwe, Namibia, Uganda and Uganda do still remain, but still have time to disengage on schedule as agreed in the Lusaka agreement (IRIN-CEA 11/06/01; 15/06/01).
Another integral element of the continuing peace process has been the deployment of UN peace-keepers (MONUC) and the reporting period has seen a strengthening of MONUC troops in a number of places. The troops are mandated to over-see the withdrawal of foreign militarised forces in the country and have brought the hope of relative stability to previously chronically insecure areas. In recognition of MONUC’s role in the implementation of the peace process, a meeting of the UN Security Council in June has further extended MONUC’s mandate until June 2002. The renewed mandate will include a civilian police force component and will see them coordinating the disarmament, demobilisation, rehabilitation and reintegration (DDRR) operations in the country (IRIN-CEA 18/06/01).
Numbers and distributions of IDPs
The conflict within DRC has led to huge population displacement. The deployment of MONUC peace-keepers has improved access to many areas. The number of displaced appears to have risen since December 2000 but it is likely that much of this is not due to fresh displacement but to increased accessibility to IDPs who were previously inaccessible.
Table showing distribution of IDPs by province (June 2000, December 2000, April 2001) (OCHA 04/01).
|
Area |
June 2000 |
December 2000 |
April 2001 |
|
Equateur |
250,000 |
300,000 |
170,524 |
|
Orientale |
215,000 |
160,000 |
220,000 |
|
North Kivu |
287,000 |
640,000 |
620,000 |
|
South Kivu |
220,000 |
350,000 |
373,158 |
|
Katanga |
250,000 |
305,000 |
354,000 |
|
Mariema |
110,000 |
137,000 |
132,000 |
|
Easter Kasai |
30,000 |
30,000 |
114,000 |
|
Western Kasai |
140,000 |
80,000 |
29,000 |
|
Total |
1,502,000 |
2,002,500 |
2,012,682 |
The humanitarian situation in DRC remains critical. The years of insecurity have resulted in the collapse of infrastructure and the economy, and systematically eroded people’s ability to cope with the situation. As a result mortality and morbidity have increased and nutritional status declined. The humanitarian response continues to be hampered by insecurity and by the physical inaccessibility of many areas. To address problems of access WFP has recently established a Special Operation (SO) passenger service for humanitarian staff (WFP 29/06/01).
Kinshasa
Kinshasa has experienced rampant inflation rates estimated at 890% in the year 2000 (SCF-UK 18/04/01). Food prices have increased due to the restriction of supplies from the traditional food producing eastern areas of the country as a result of insecurity. The salaries of civil servants are not adjusted on a regular basis. In addition, many communes in Kinshasa have experienced a sharp increase in epidemic diseases, which reflects poor access to water and primary health care services.
SC-UK conducted a survey in April 2001, in Masina and Kimbanseke; two of the poorer communes in East Kinshasa. These are peripheral communes that are rural in character. The survey found a prevalence of acute malnutrition of 11% (W/Ht <-2 Z-scores and/or oedema), including 2% of severe malnutrition (W/Ht <-3 Z-scores and/or oedema). There was an estimated 1.2% of oedema-tous malnutrition in the sample. The survey also assessed the mortality rate of children under five, which was 0.77/10,000/day. The main cause of mortality was fever, or suspected malaria. The mortality rate was estimated over a one year period, which is unusual for an assessment of mortality in emergencies. The report estimated that only 8.8% of the malnourished children in the survey were attending a feeding centre for treatment indicating that the feeding centre coverage was extremely poor. A graph of deaths by month for the year 2000, shows mortality to be highest during the rainy season in December and February and is unlikely to be related to food insecurity. The survey was conducted at the end of the rainy season, when the prices of staple foods are at their highest and the prevalence of acute malnutrition is expected to be high. However, the prevalence of severe acute malnutrition is higher than would be expected (SCF-UK 18/04/01).
Previous surveys by CEPLANUT and ACF-F indicated a seasonal trend to malnutrition rates in the city. A survey showed similar prevalence of malnutrition, in the same communes in February 2001, an overall prevalence of 12.4% malnutrition, including 2.4% severe. Their survey in September 1999, when availability of food is usually good, showed a prevalence of 6.7% acute malnutrition (SCF-UK 18/04/01).
The SC-UK April 2001 survey indicates large differences between the four communes surveys. Whilst the prevalence of malnutrition in Kimban-seke Air de Sante was relatively low at 5% acute malnutrition, it was high especially in Lobiko at 18.3% acute malnutrition and in Tshimungu 11.3% acute malnutrition. Lobiko has poor road access, poor soil for cultivation, and poor infrastructure in terms of provision of water, latrines, health care and schools. Tshimungu is very densely populated, so limiting the availability of plots for household food production. Latrines tend to flood in the rainy season (SCF-UK 18/04/01).
Orientale
OCHA figures from April 2001 indicate that there are 220,000 displaced and 80,085 refugees from Sudan and Uganda (OCHA 04/01). Figures for the number of IDPs have risen from the 160,000 reported in the last RNIS report. It is likely that much of this increase is a result of previously displaced people becoming accessible as a result of improved security.
Ituri district
The situation in the district remains extremely serious and WFP reports that some 140,000 IDPs face serious food shortages following the systematic destruction of crops by rebel groups. Humanitarian access to the area has been constrained as a result of continued insecurity. A stark example of the insecurity and the risk to humanitarian aid came with the deaths of six Red Cross workers in April. As a direct result all agencies pulled out of the Bunia area. OCHA reported in early July that little by little the humanitarian community are choosing to resume their programmes (OCHA 04/07/01).
Kisangani
The peace accord between Rwandan and Ugandan forces in the area has seen the entry of MONUC troops to the town and the establishment of better security conditions. Initially rebel groups obstructed the entry of peacekeepers, but the troops were eventually permitted to enter and have managed to restore some order. Administrative control of the town of Kisangani has now been handed over to the RCD rebel group. However, MONUC is insisting on the withdrawal of militarised factions from the town (IRIN-CEA 18/06/01). No new nutritional information has been received
North and South Kivu
The Kivus remain extremely insecure and areas of intense humanitarian need. Their position on the border with Burundi and Rwanda make them important bases for rebel groups from the two countries. One of the chief concerns is that the rebel groups have never entered into any peace negotiations or signed any cease-fire. The number of displaced are currently estimated to be in the region of 993,500 people, a significant proportion of the total population of the area (OCHA 04/01). The insecurity continues to restrict humanitarian access to the most needy areas and a recent OCHA report estimated that only 10% of north and south Kivu were accessible to humanitarian actors (OCHA 15/06/01).
The area of Beni in north Kivu is of particular concern at present with NGOs warning of a “catastrophic situation”. The area has been the place of much conflict over it’s rich natural resources and access is currently extremely poor (IRIN-CEA 15/06/01). WFP is also reporting massive displacement in Walungu territory with 378,158 IDPs identified. The insecurity has reduced access to the affected populations with airlifts currently supplying only 21,000 IDPs out of 100,000 in the area of Shabunda (WFP 15/06/01). RNIS considers that the IDPs remain at high nutritional risk.
Maniema Province
Maniema lies in the east of DRC on the western borders of north and south Kivu. OCHA figures from April 2001 report the presence of 132,000 IDPs in the province, which indicates a drop in numbers since December 2000. This is likely to be a result of an improvement in the general security situation in the province that has allowed people to return to their lands (OCHA 04/01).
Merlin conducted a survey in May 2001 in Kalima town, which included both displaced and resident populations. The number of displaced decreased from 30,000 in August 2000 to 14,000 in May 2001. The survey found a prevalence of 4.6% acute malnutrition (W/Ht <-2 Z-scores and/or oedema) including 0.9% severe (W/Ht <-3 Z-scores and/or oedema). CMR was calculated retrospectively over the previous three months as 1.2/10,000/day and the under five mortality was 3.6/10,000/day.
The prevalence of malnutrition has decreased from 14.1% acute malnutrition (W/Ht <-2 Z-scores and/or oedema), with 8.1% severe acute malnutrition (W/Ht <-3 Z-scores and/or oedema) in January 2001. Much of the severe malnutrition in January 2001 was oedematous, and it is likely that the high under five mortality over the last three months was partly due to the deaths of severely malnourished children.
According to Merlin, the reasons for the improvement are the improved security conditions in the area, which have resulted in the return of many IDPs to the surrounding villages. The survey was carried out after a reasonable harvest at a time of relative plenty. As a result, general food availability has improved and market prices have fallen. The fall in market prices seems particularly important because 60% of households relied on purchased food. The high mortality rates suggest that the health situation remains extremely precarious and despite improvements the situation will need careful monitoring (Merlin 05/01).
Katanga
As a result of an improvement in the security situation in Katanga, thousands of people are emerging from hiding in desperate need of humanitarian assistance. The numbers of IDPs have risen to 354,000 from the 305,000 reported in the last RNIS (OCHA 04/01). WFP have reported that there are 330,000 IDPs in the government held areas of which 128,000 are currently receiving WFP rations. In general the security situation appears to be stable although incidents do occur, including the harassment of food transporters on the Bukamu-Kinkondja river axis (IRIN-CEA 18/06/01).
The RNIS has not seen any recent nutrition survey reports from the area but OCHA report on an MSF survey in Manono and Kanteba which indicated raised rates of acute malnutrition but relatively low rates of severe. RNIS considers the IDP population in Katanga at high nutritional risk.
Equateur
The security in Equateur has been very poor for some time and OCHA estimates that there are 170,524 displaced in the province. An inter-agency assessment mission in May highlighted high levels of vulnerability and recommended the provision of food aid, agricultural implements and the rehabilitation of the local infrastructure (WFP 29/06/01). The past months have seen the withdrawal of armed forces from some areas of Equateur. This has increased access to previously inaccessible areas such as the front line between Bmandaka and Ikela, which contains an estimated 60,000 IDPs. The local population is also in great need of assistance as the heavy military presence experienced in the area has had a very negative impact on the food security (WFP 15/06/01). The RNIS does not have any nutritional survey information but populations in Equateur can be considered at heightened risk of poor nutritional status.
Refugees
The total refugee population as of April 2001, according to OCHA figures, is estimated to be 329,812 people (OCHA 04/01). There have not been any recent nutritional assessments done on refugees in DRC but surveys done in Bas Congo in October 2000 indicated low levels of acute malnutrition. Issues of insecurity and humanitarian access are likely to affect the refugees in the same way as the displaced.
Angolan Refugees
Continued insecurity in Angola has meant the continued influx of refugees into Bas-Congo, Kinshasa, Bandudu and Katanga Provinces. The number of Angolans, as of April 2001, was estimated to be 178,280. In June, WFP assisted 32,555 Angolan refugees, providing them with an incomplete food basket due to shortfalls of pulses and salt. The delivery of pulses has been affected by striking rail workers and further strikes are likely to obstruct the July distributions (WFP13/07/01). WFP has also reported the arrival of 4,000 Angolan refugees gathered along the border of Bas-Congo province and Angola. The Congolese authorities have agreed to give them asylum so long as they move further away from the border. UNHCR will provide them with food assistance for six months.
Burundian Refugees
There are an estimated 20,000 Burundian refugees, mostly in South Kivu with some in Kasai Orientale. Many remain inaccessible to assistance and there is no available nutritional information (OCHA 04/01).
Central African Republic (CAR) Refugees
There are currently supposed to be about 30-45,000 refugees from CAR who have fled the attempted coup against president Ange-Felix Patasse, on May 28th. The refugees are currently in north western Equateur province in the Zongo and Libenge areas (IRIN-CEA 16/07/01). The RNIS has no information on their current situation and it is uncertain whether they will stay or return after a short time.
Congolese Refugees
Repatriation to RoC continues but 3,005 Congolese refugees remain in Kimaza camp in Bas-Congo for the time being. The camp is supposed to close at the end of 2001.
Rwandan Refugees
There are an estimated 42,472 Rwandan refugees, indicating a decline in numbers reported by the last RNIS. This is a result of voluntary repatriation over the last months. Many are Hutus and unlikely to return whilst there is still a Tutsi government in Kigali.
Ugandan Refugees
There are an estimated 13,000 Ugandan refugees in Orientale province and many remain inaccessible due to insecurity so very little is know of their condition.
Overall
The reporting period has seen significant movement in the implementation of the Lusaka peace accords, including the continued withdrawal of foreign troops and the disassociation of the Kin-shasa regime with rebel elements in the East. UN peacekeepers (MONUC) have continued to be deployed and their mandate strengthened. This has brought improvements to the security situation in many areas, significantly improving the humanitarian access to populations in need. However, insecurity still remains in many areas, particularly the eastern provinces of the country. The combined effects of the long term conflict, poor economy and the lack of working infrastructure, continues to create huge vulnerabilities amongst displaced and non displaced alike (category II and III). The war displaced in Kinshasa are currently category III. IDPs in the east of the country remain at extremely high risk (category I) although there have been improvements in some areas such as Kalima town in Maniema (category II). As areas continue to become accessible it is likely that more and greater needs will become apparent. The situation of refugees remains varied but they are also at elevated risk from insecurity and lack of access (category II).
Recommendations
Support funding of the Inter-Agency Appeal.
· Continue to support deployment of MONUC.From the Merlin Survey in Kalima, Maniema province (Merlin 05/01)· Put in place a system for rapid provision of assistance as access is gained to previously displaced populations.
· Nutritional surveillance and monitoring should be continued in all clinics in Kalima town.From the SCF-UK survey in Kinshasa (SCF-UK 18/04/01)· Agricultural inputs should be supplied to families with access to land.
· There is a need for EPI and a mass measles campaign.
· Improve feeding centre coverage by improving nutrition screening and referral.· Improve water supply and primary health care services.
The reporting period has seen a continued influx of mainly Burundian refugees, into the Kigoma region of Tanzania. The new arrivals cite heavy fighting between Burundian government forces and rebels as the main reason for crossing the border (UNHCR 06/01). The latest statistics for the refugee caseload from UNHCR are from June and indicate that there are 538,573 mainly in the Kigoma and Ngara regions (UNHCR 14/07/01). UNHCR also estimate that 4,545 new refugees arrived in the Kigoma region from April to June, the vast majority of them from Burundi (UNHCR 06/01).
The peace process in DRC has resulted in the Kinshasa regime withdrawing support to Burundian rebel groups previously active in eastern DRC. As a result many of these groups are returning to Burundi and increasingly clashing with government troops. It is expected that the number of Burundian refugees will continue to increase as the insecurity continues. This would appear to dash hopes of large scale voluntary repatriation to Burundi. However, there was an important meeting between the governments of Tanzania and Burundi and UNHCR in May, which resulted in the signing of an agreement to establish a commission for the repatriation of hundreds of thousands of Burundian refugees. The meeting acknowledged that returns were unlikely with the prevailing security situation but stressed that it was essential to have a clear framework for the planning and supervision of returns when conditions allowed (Xinhua 08/05/01).
Food assistance has continued to refugees with WFP reporting regular two weekly distributions to an average of 523,855 beneficiaries (WFP 15/06/01; 13/07/01). The size of the general ration has remained reduced but attempts have been made to improve it and there is no longer a break in the pipeline for fortified Corn Soya Blend (CSB) and the general ration is now calculated to be 85% of the full ration. WFP also reports that 5,723 vulnerable individuals continue to receive a full ration (WFP 13/07/01).
The RNIS has not received any new nutrition reports over the reporting period but WFP report that a nutritional screening took place in the Lugufu camps at the end of April. The screening uses a different methodology from the previous weight for height surveys and therefore a comparison is difficult. However, the recorded prevalence of acute malnutrition was not considered to indicate a critical situation. Furthermore, UNHCR health surveillance data from the Lugufu camps in June, reports an estimated crude mortality rate of 0.1/10,000/day and an under five mortality rate of 0.73/10,000/day (UNHCR 06/01). Both of these rates are well below emergency thresholds and indicate a stable health situation. In general the food supply situation in the country is good with the Famine Early Warning System (FEWS) reporting in their July report that overall food production in the country could be the best in five years and following the harvest season in July, the price of staple foods has decreased (FEWS 09/07/01).
Overall
Increases in the number of new refugees entering the country continues with the majority of the new caseload coming across the border with Burundi. The increased numbers continue to put pressure on scarce resources for the refugee population. However, there has been no break in food pipelines and although there have been no new nutrition surveys reports indicate that the health and nutrition situation is relatively stable for the camp populations (category IV). The general food security outlook for the country is good and will positively impact on the food outlook of the refugees.
Recommendations
· Support funding of the Inter-Agency appeal to Tanzania· Conduct full livelihood and household economy surveys to assess the impact of ration cuts
The reporting period has seen the continuation of insecurity in many areas of the country, but the continued withdrawal of Ugandan troops from DRC has improved the general security situation in areas of the west and southern provinces. However, there is still fighting across the border in DRC and therefore the security situation is still potentially volatile. The general security situation in the north of the country remains extremely poor. The Lord’s Resistance Army (LRA) is still active in the north west, and this continues to result in ambushes and raids. OCHA also reports an increase in confrontations between the LRA and government troops (OCHA 06/01). The north eastern regions of the country have also suffered insecurity as a result of attacks and raids from Karimojong warriors.
OCHA estimates that at the end of May there were 999,175 people affected by conflict or drought in Uganda. This includes 227,437 refugees from Sudan, DRC, Burundi and Rwanda and 568,657 IDPs. The figure also includes 196,475 drought affected people (OCHA 06/01). The number of IDPs has decreased slightly from March, mostly as a result of improved security in the south western areas of the country. At the end of June, WFP report that they were assisting a total of 700,372 beneficiaries under their current PRRO. This included 520,241 IDPs and 148,415 Sudanese refugees in Arua, Adjumani, Gulu, Bundibugyo, Kitgum, Masindi and Moyo Districts. WFP indicate that they expect to experience food pipeline problems in July as a result of a lack of pulses (WFP 29/06/01).
The precarious security status of many areas in Uganda continues to create problems of access to populations in need of humanitarian support. OCHA reports that in May a humanitarian convoy made up of both INGO and UN vehicles was ambushed whilst returning from delivering aid to IDPs in Atanga camp in the Kitgum area. The ambush resulted in death and injury.. This and similar attacks have led to the suspension of programmes. (OCHA 30/06/01). The raids and ambushes also caused considerable displacement of population, particularly in Katakwi district where there are reports that many people have been unable to cultivate crops this season as a result. IDPs in camps in Kitgum and Gulu limit their farming activities for fear of attack. Both OCHA and FEWS report good overall levels of precipitation over the country which has led to good harvests and supplies of staple foods (FEWS 15/06/01; OCHA06/01). Water and pasture in the pastoral areas of the north east have also benefited from good levels of rainfall. The most vulnerable are likely to remain the displaced, particularly in the insecure northern areas of the country.
IDPs in Northern Uganda
Drought conditions improved over the course of this year, but LRA and Karimojong raiding continues. The result has been large scale displacement of population and severe deterioration of the food security of the affected areas (FEWS 15/06/01)
Kitgum
There are currently estimated to be 82,645 IDPs in Kitgum and 26,702 Sudanese refugees (OCHA 06/01). Attacks and raids by the LRA have been noted throughout the reporting period. The ICRC conducted a survey in IDP camps in the Kitgum / Pader area during March 2001 to gather baseline data on the socio -economic situation of the IDPs. The survey defined three main wealth groups within the IDP population; a rich group which earns incomes from salaries and petty trade, a middle wealth group which obtains money from the sale of own produce and a poor group which engages in casual labour and the sale of natural resources. Access to land is essential for the production of food for all of the groups. When compared to the resident local populations, a greater proportion of the IDPs use the land for the production of subsistence crops. The resident population grow cash crops as well as subsistence crops and this is most probably an indication of their better access to markets. This very probably gives the resident population alternative access to cash and is an indication of their relatively better food security. The survey also showed that the IDPs were far more likely to share their production with relatives than the local population, which puts a greater stress on the available food reserves of the IDPs. Finally within the IDP wealth classes, the poorer groups were far more reliant on food aid (IHDP 03-04/01)
Gulu
Gulu continues to suffer insecurity but no acute food problems have been noted. This is largely a result of good rainfall and harvest prospects which have seen most IDPs able to access food to supplement the WFP rations they receive.
ACF-US conducted 2 surveys, one in the western and one in the eastern IDP camps of Gulu, between February and March 2001. The division of the camps was made on the request of WFP because IDPs in the western camps have poorer access to land for cultivation (ACF-US 07/03/01).
In the eastern camps the survey found a prevalence of 6.7% acute malnutrition (W/Ht <-2 Z-scores), including 1% severe acute malnutrition (W/Ht <-3 Z-scores and/or oedema). The survey also estimated an under five mortality rate of 1.78/10,000/day, over the preceding three months. Measles vaccination coverage was estimated from card and mother/ carer reports as 73.1% (ACF-US 07/03/01)
In the western camps the survey found a prevalence of 7.7% acute malnutrition (W/Ht <-2 Z-scores and/or oedema), including 1.8% severe acute malnutrition (W/Ht <-3 Z-scores and/or oedema). The under five mortality was estimated to be 2.27/10,000/day and the measles vaccination coverage was 76.6% (ACF-US 07/03/01). The main cause of mortality was fever (malaria), which is similar to previous survey findings and is the main cause of child mortality nationally.
The prevalence of acute malnutrition was low in both the eastern and western camps with no significant difference between the two areas. The relatively low prevalence of acute malnutrition was attributed to a period of relative security at the time of the survey which allowed people to access land. The surveys were also done just after the harvest, when the prevalence of malnutrition is expected to be low. The prevalence of malnutrition is highest in the youngest age groups and the report attributed this to a lack of support for infant feeding practices and high rates of morbidity. The RNIS notes that the general ration provides no foods appropriate for young children.
In June OCHA reported an increase in confrontations between the LRA and government troops (OCHA 06/01).WFP has reported that food stocks for some IDPs are becoming low as a result of lack of access to farms.
IDPs in Western Uganda
The situation in western Uganda remained calm during the reporting period. The number of displaced in Bundibugyo has decreased from 97,457 to 81,172 in May. This can probably be explained by better security. It is noted that people have reverted to normal trading activities and are prepared to walk long distances to sell and buy goods. There is also better access to gardens and coupled with the good harvest prospects, it is expected that IDPs will be able to supplement the relief food rations that they receive. One of the main needs is for seeds and other agricultural inputs. (OCHA 06/01).
Karamoja
The food security of the area in general has improved in the districts of Kotido and Moroto. This is mostly as a result of good rains, which have improved crucial access to water and pasture. This has seen an improvement in livestock conditions which should ensure good access to milk and other animal protein. The rain has also resulted in good harvest prospects in the area and there is no immediate concern for the food security situation (FEWS 15/06/01).
Refugees
Uganda is presently host to 227,437 IDPs from Sudan, Rwanda, Burundi and Congo. This represents a slight increase from the 225,042 reported in the last RNIS mostly as a result of LRA activity in Sudan which has caused the influx of Sudanese refugees into the districts of Moyo, Adjumani and Arua. The RNIS has no recent reports on the nutrition status of refugees in Uganda but OCHA reported on a survey conducted by Africa Humanitarian Action in refugee settlements in Adjumani. The RNIS has not seen the survey report but OCHA reports that the results did not indicate a high rate of acute malnutrition (OCHA 30/05/01). WFP also report on a survey by DED in Rhino camps that indicated that levels of malnutrition have dropped since November 2000 (WFP 25/06/01).
Overall
The reporting period has seen good rainfall and a good harvest. Insecurity continues in the northern districts of Kitgum and Gulu and offers a significant impediment to food security, putting the displaced at moderate risk of malnutrition (category III). The security in the south west has improved, and has allowed people to access land for farming. IDPs are not considered to be at elevated nutritional risk (category IV). The nutritional status of refugees is currently unknown (category V).
Recommendations
· Monitor IDPs ability to access to land and find alternative sources of food.· Maintain good nutritional status of IDPs by providing an adequate general ration.
· Conduct a nutritional survey on the refugee populations.
Angola
Zambia
The reporting period has seen the continuation of violence between the UNITA rebels and the government of Angola. The government still retains control over provincial and municipal centres with rebels occupying areas around the provincial centres and much of the rural hinterland. Much of the fighting is fuelled by often illicit revenue from oil and diamonds and as a result is particularly centred on districts such as Bie, Huambo, Huila, Malanje, Moxico and Luanda Sol, districts that are rich in these natural resources.
It is worth noting that whilst the government claims it controls 90% of Angolan territory, the areas and populations that are actually accessible to humanitarian agencies remain extremely limited (MSF 02/07/01). At the end of May, OCHA estimated that almost a quarter of the population, an estimated 3.1 million people, have been displaced as a result of the fighting since the renewal of hostilities in 1998. Of this number, 1.2 million IDPs have been confirmed by humanitarian organisations with an estimated 237,000 having been displaced since the beginning of 2001 (OCHA 20/06/01). Considerable numbers of people remain in inaccessible areas in conditions that are largely unknown. Recent estimates by OCHA have reported that as many as 500,000 people remain inaccessible but in need of urgent assistance (USAID 09/07/01).
In areas accessible to humanitarian agencies, IDPs have tended to collect in urban areas that are generally under government control, such as Malange, Kuito and Humabo. This is largely because many of the rural areas are heavily insecure and farming practices are frequently interrupted by security incidents. During the last several months, new influxes of displaced populations have reported for a number of urban locations including Kuito, Malange and Lobito. The urban areas offer some hope of security as well as access to the possibility of humanitarian assistance. However, the obvious lack of access to land in these urban locations limits their opportunities for food production resulting in affected populations becoming heavily reliant on food assistance. The heavy insecurity and the almost total dereliction of the road infrastructure have meant that access to many areas, for the humanitarian community, continues to be almost totally dependent on air transport from Luanda. The reporting period saw a considerable set back to the supply of humanitarian relief, with two separate attacks on WFP aircraft during the first two weeks of June (WFP 22/06/01). The attacks resulted in all passenger and cargo flights being stopped nationwide for a week. This represented a very significant set back for the humanitarian effort, since 60% of all deliveries of humanitarian aid are transported by air. WFP have also expressed concern at the poor state of airstrips in some areas of the country, particularly Kuito in Bie province, where humanitarian needs are currently described as extremely high (WFP 22/06/01).
An FAO/WFP Crop and Food Supply Assessment Mission conducted in June has estimated that cereal production for the 2000/2001 agricultural year is fifteen percent higher in comparison to last year. The report indicates that the increase is largely a result of good progress in the allocation of land to IDPs in secure areas, increased access to populations as well as timely distributions of relatively larger quantities of seeds and tools. In addition, weather conditions were generally favourable last year, particularly in the main cereal growing areas in the central and southern provinces such as Huambo and Huila. Prices of maize are currently stable or declining in some markets with the arrival of the new crop. By contrast, yields of maize, beans and groundnuts that were planted in the northern provinces were severely affected by the prolonged dry spell in December/ January. As a result of disruption in trade activities, there are therefore large differences in cereal prices in the markets in the central and northern provinces. The report estimated that 218,000 IDPs were active in farming during the 2000/01 season (FAO/WFP 19/06/01) - this figure representing only a small proportion (approximately 8%) of the total displaced population. Therefore, as a result of continuing influx of displaced due to ongoing insecurity in rural areas, lack of access to land in urban areas and an inability to plant on allocated land areas, a large majority of the displaced population will continue to rely on food assistance. The report also observed that food security in much of the population is closely linked to good access to land and to other resources such as grazing and forest products as well as the ability to access markets for trade (FAO/WFP 19/06/01).
Acute malnutrition rates in rural Angolan populations characteristically show a seasonal pattern with highest levels of malnutrition occurring during the lean season from January to April. Levels of malnutrition are expected to show a decrease from June onwards when the main harvests are expected and are normally at their lowest in September. Obviously, displacement and consequent lack of access to harvests as well as exposure to poor health environments in over-crowded displaced camps, will significantly distort these seasonal patterns of malnutrition.
Malange
The RNIS has not received any new nutritional surveys during the reporting period but the last surveys received indicated relatively satisfactory rates of acute malnutrition although the crude and under five mortality rates were above emergency thresholds (See RNIS 32 and 33). In general the security situation in areas accessible to humanitarian workers has been fairly stable. However, many of the outlying areas remain insecure and have hampered attempts to resettle about 50,000 IDPs to the Lau, Quissol and Cambondua areas. The resettlement has also been constrained by a lack of fuel that has negatively affected de-mining activities (UNICEF 30/06/01). In addition, water and sanitation systems are not in place, agricultural lands have not been demarcated and there are no health and educational facilities - factors that are likely to delay resettlement schemes (IRIN-SA, 20/07/01). In general the nutrition situation is thought to be stable but WFP reports that the situation is worrying in Cangandala municipality where Concern World-wide has noted that admissions to their SFC from the 17th to the 23rd of June have risen by 87% compared to the previous month (WFP 06/07/01). The increase in admissions is most likely as a result of new IDPs, the majority of which are arriving from Kwanza Sul Province (IRIN SA 20/07/01).
Bie Province
The situation has continued to deteriorate in the province with insecurity continuing to cause significant displacement into the towns of Kuito and Camacupa (80km from Kuito). OCHA estimates that a further 15-20,000 IDPs from Kuemba municipality may arrive in Camacupa and Kuito over the following months (IRIN-SA 20/07/01).
Camacupa
In July IRIN reported that about 200,000 people are living in camps around Camacupa and the humanitarian agencies are bracing themselves for the arrival of up to 20,000 more in the following months (IRIN-SA 27/07/01). In March MSF-B conducted nutritional screening, using MUAC, on children in the camps in Camacupa and showed a prevalence of 28% acute malnutrition with 11% severe malnutrition. A retrospective mortality survey from the same period indicated a crude mortality of 3/10,000/day and an under five mortality of 5.4/10,000/day (MSF 31/05/01) The RNIS does not have access to the methodology used for the mortality figures but it is assumed to be from routine surveillance. The results of other screenings amongst the displaced populations indicated very alarming rates of both acute and severe malnutrition. The high prevalence of reported malnutrition is likely to be a result of the fact that displaced populations travelled long distances with little food. The high mortality rates may be linked to underlying respiratory infections associated with extreme cold at night (OCHA 13/06/01).
On the 13th of July WFP delivered food to 14,211 people in camps in Camacupa covering only half of the food requirements for the increasing number of people arriving into the town. These newly displaced are reported to have poor nutritional status (WFP, 20/07/01). Consequently, in addition to the newly established Therapeutic Feeding Centre, humanitarian agencies have established a plan to substantially scale up assistance to the population, including; conduct nutritional surveys to verify the nutritional situation, preposition emergency food stocks and distribute Vitamin B to address the potential pellagra outbreak (IRIN-SA 20/07/01).
Kuito
The upsurge in insecurity over the course of 2001 has seen the arrival of 52,161 new IDPs in Kuito, with 8000 arriving in the month of May alone. Current estimates of total numbers of IDPs in Kuito are for 160,000 people in fifteen camps. Reports indicate a deteriorating situation with new arrivals carrying very little in the way of basic survival items and are in need of immediate assistance (OCHA 13/07/01). Mortality rates at the Therapeutic Feeding Centres (TFC) that have been set up in the town have already reached alarming levels. The TFC at the Kuito hospital recorded a mortality rate of 24% during the first two weeks of June although this fell to 14% in the following week (OCHA 13/07/01).
MSF-B conducted a nutrition survey in the camps in Kuito in July. The RNIS does not have access to the full survey report but the survey estimates 13% acute malnutrition (W/Ht <-2 Z-Scores and/ or oedema) including 2.3% severe acute malnutrition (W/Ht < -3 Z-Scores and/or oedema) (MSF 13/07/01). This indicates the poor nutritional status of the IDPs. It is also concerning to note that agencies have been reporting high numbers of cases of pellagra (niacin deficiency), with a total of 783 cases reported since April (UNICEF 30/06/01). An outbreak of pellagra in the population suggests strongly that that the access and availability of food has been very poor for at least the last six months. It is extremely worrying that the number of pellagra cases continues to increase in Kuito, since the first reported cases were reported in August 1999 (see RNIS 29).
The future food security for Camacupa and Kuito remains critical because the number of IDPs continues to rise in the face of a potentially decreased humanitarian capacity. Kuito is heavily dependent on the transport of supplies by air and given that the runaway is in extremely poor condition - which has significantly reduced both the number and size of the planes able to land - the potential for meeting the humanitarian needs, including food deliveries, remains precarious (OCHA 13/06/01).
Benguela Province
The security situation in Benguela Province continues to be precarious with reports of continued population displacement. ACH conducted nutritional surveys amongst displaced and non-displaced populations in Ganda town, in May 2001. The surveys indicated a prevalence of 9.5% and 10.1% acute malnutrition (W/Ht < -2 Z-Scores and/or oedema) in the displaced camps and the non-displaced population respectively. Further-more, the figures for acute malnutrition included 1.1% of severe acute malnutrition (W/Ht < -3 Z-Scores and/or oedema) in both surveys. The report also indicates a crude mortality rate of 1.28/10,000/day and 1.41/10,000/day with an under five mortality rate of 3.11/10,000/day and 2,1/10,000/day respectively. The respective measles vaccination coverage was 46.6% for the displaced and 57.2% for the non-displaced, and was calculated from both health card and mother/carer report (ACH 05/01).
The prevalence of malnutrition is not highly elevated but does suggest that the nutrition situation remains precarious. Furthermore, the results confirm that the nutritional situation has deteriorated since the last survey in November 2000 where the prevalence of acute malnutrition (W/ Ht) was reported to be 5.8% acute and 0.6% severe malnutrition (ACH 05/01). The RNIS does not have access to the November report but the methodology is assumed to be the same. The reported mortality rates (see above) are higher than emergency thresholds, particularly the crude mortality (CMR), suggesting that an usually large proportion of the reported mortality is from people over five years of age.
Potential reasons for the deterioration in the nutritional situation include; the relative isolation of Ganda town and trading opportunities limited as a result of poor road infrastructure. Insecurity of the surrounding areas is a serious problem that has prevented people from accessing land or other resources (ACH 05/01). In relation to the problem of land access, the Government has been requested by humanitarian agencies to increase security guarantees, access and protection to IDPs and to achieve a more timely distribution of arable land to the displaced population (WFP, 20/07/01) Losses of some maize harvests had been reported as a result of flooding in some parts of the Province (FAO, 19/06/01).
Cuando Kubango Province
Cuito Cuanavale
The reporting period has seen a continuation of insecurity and the displacement of people, particularly from the Mavinga areas. Reports indicate that there are approximately 6,000 IDPs in the reception camps of Cambambi and Mulumbei. ACH undertook a nutrition survey of children from 6 to 59 months amongst IDPs and resident Barrios in Cuito Cuanavale Municipality in June 2001. The prevalence of acute malnutrition was estimated to be 6.0% (W/Ht -2 Z-scores and/or oedema) including 1.9% severe (W/Ht -3 Z-scores and/or oedema). The prevalence of acute malnutrition has remained very similar to the last survey in May 2000 (see RNIS 31) indicating that the nutritional situation is stable. The survey also reported a CMR of 1.6/10,000/day and an under five mortality of 4.1/10,000/day. These mortality rates are both higher than emergency cut offs, suggesting a public health problem in the area. The measles vaccination coverage for IDPs present in the area for less than a year was low at 41.6%. Based on the findings of the report, the general food ration, which provides 1.500 kcal/ person/day, is below the recommended minimum requirement. Therefore, an inadequate food ration, high mortality rates and ongoing population displacement justifies continued nutritional interventions (ACH 13/06/01) as well as ongoing nutritional surveillance of the population.
Uige Province
The security situation in Uige has remained precarious with a major UNITA assault on the city on June 26th. The assault was thwarted by the Angolan army but it resulted in the evacuation of humanitarian personnel from the city. The current situation is more secure and staff have started to return to the city. OCHA estimate that there are currently 42,000 people relying on food distributions to survive (OCHA 01/07/01). MSF-Spain conducted a survey in the city in March and found an estimated prevalence of acute malnutrition of 5.2% (W/Ht -2 Z-scores and/or oedema) including 0.8% severe malnutrition (W/Ht -3 Z-scores and/or oedema). The RNIS has not seen the final report but the figures are comparable with a survey conducted in October 2000 (see RNIS 32 and 33) and indicate that the situation is stable (MSF-Sp 17/07/01; WFP 22/06/01).
Refugees
Ongoing civil war in Angola continues to force people to seek more secure areas across the border in neighbouring countries. Current estimates indicate that there are 430,781 Angolan refugees with 199,086 in Zambia, 179,550 in DRC, 18,515 in RoC and 28,889 in Namibia (USAID 09/07/01). The RNIS does not have any new nutrition information on Angolan refugees.
Overall
The overall humanitarian situation in Angola remains precarious with continued insecurity leading to ongoing population displacement. The continued insecurity has heightened the vulnerability of affected populations, particularly the displaced, and has limited humanitarian access. Based on the limited number of nutrition surveys that have recently been conducted, the nutrition outlook appears mixed; many areas do not show increases in prevalence of malnutrition (as expected during this time of the year) while a few isolated ‘pockets’ of populations are at increased risk showing concomitant increases in prevalence of acute malnutrition. One important factor is related to the volatile nature of the situation. Populations are unpredictably forced to move from rural areas and humanitarian agencies face difficulties in accessing these populations in a timely manner. With further insecurity incidents, it is expected that more isolated pockets of population will require assistance. A second determining factor appears to be the challenge for humanitarian agencies to maintain a regular and sufficient supply of humanitarian assistance to these populations. In areas where access is not reported to be a problem, such as Huambo and Lobito, the IDPs can be considered to be Category III, whilst in Camacupa and Kuito, where the continued supply of assistance is posing considerable problems, the IDPs are considered to be Category I. Further-more, the internally displaced populations, who have no access to land for agriculture and are entirely reliant on the ration, are considered to be in Category II given the fragility of the food pipeline. However, it is also evident that a large number of people are in areas inaccessible to humanitarian relief and their condition is currently unknown (Category V).
Recommendations
From a Needs Assessment mission in Bie Province in June (OCHA 13/07/01)
· Increase the delivery of food through the hiring of additional aircraft and repairing existing runawaysFrom the ACH Ganda Survey in Buengela Province (ACH 05/01)· Preposition emergency food stocks in strategic locations
· Ensure a full food basket and distribute vitamin B to curb the pellagra outbreak
· Ensure the timely delivery of seeds and tools and access to agricultural land for the forthcoming planting season.
· Continue the food distribution and reinforce selective feeding activitiesFrom the ACH Nutritional Survey in Cuito Cuanavale in Cuando Kubango Province· Intensify the outreach activity
· Conduct a nutritional causal analysis
· Strengthen the food ration to 2100 Kcal/ person/day· Ensure the allocation of land to IDPs in time for the next farming cycle
· Initiate health education programmes and training in the health structures
As a result of a good general security situation, Zambia has continued to attract considerable numbers of refugees. The majority are mostly from neighbouring Angola and DRC and latest estimates put the total number residing within the country at 258,661, distributed amongst about five camps (UNHCR 18/07/01). The high numbers have put considerable strain on the governments response capacity and this has led to some problems in supplying sufficient humanitarian assistance: This has been particularly problematic as Zambia has suffered from some internal food security problems as a result of flood damage in the spring (IRIN-SA 20/07/01).
The supply problems were emphasised a few months ago when the refugees at Kala camp in northern Zambia’s Luapula Province rioted in response to the lack of availability of food aid. However, the United States has recently pledged 400,000 US dollars to the Zambian refugee population (Xinhua 19/07/01).
Fighting in Angola resulted in an influx of about 1000 refugees per month until April 2001, however this has decreased a little since April. There has also been a continuous trickle of refugees from DRC into northern Zambia, particularly as a result of fighting in DRC’s Katanga province. There are currently estimated to be 50,000 Congolese refugees in the country but the continuing peace process has raised the hope that repatriation may be possible in the not too distant future (UNHCR 18/07/01).
The RNIS has not received any new nutritional information on refugees in Zambia but the last surveys (see RNIS 32 and 33) did not indicate alarming levels of acute malnutrition. The situation is not considered critical.
Overall
The numbers of refugees is increasing as a result of continuing violence in neighbouring countries. However, the situation for refugees is not considered to be critical (category IV) although there is some concern over possible pipeline cuts.
Recommendations
· Advocate for the provision of funds to UNHCR programmes to ensure the continued provision of food aid
