Burundi
Democratic Republic of Congo (DRC)
Tanzania
Uganda
The regional conflict in the Great Lakes continues to affect the lives of millions of people. The peace process in the DRC is ongoing but has largely stalled without the cooperation of key rebel groups and as a result conflict is expected to continue. The likelihood of fresh conflict and there is little chance that the humanitarian situation in conflict affected areas will improve. For the number of affected populations see the table below.
Table showing the affected populations in the
|
Country |
IDPs |
Refugees |
Total |
|
Burundi |
432,818 |
28,800 |
461,618 |
|
DRC |
2,045,000 |
361,720 |
2,406,720 |
|
Tanzania |
N/A |
543,145 |
543,145 |
|
Uganda |
535,107 |
175,819 |
710,926 |
|
Total |
3,012,925 |
1,143,418 |
4,156,343 |
Burundi is suffering the affects of a ten-year civil war. The war has largely been a conflict between Hutu rebels and the mainly Tutsi army. The Tutsi s are a minority within the country, representing 14 % of the population, whilst the remainder is made up of the Hutus. Violence broke out in 1993 after the assassination of the then Hutu president and fighting has raged throughout the country resulting in the deaths of over 250,000 civilians. The violence has also resulted in huge population displacement, with many choosing to leave the country altogether and go to refugee camps in Western Tanzania where there are currently in excess of half a million Burundians. In January 2002 UN OCHA estimated that there were 375,509 IDPs in various parts of country, but this figure is likely to have increased as a result of an upsurge in conflict related displacement over the early months of 2002 (UN OCHA 01/02).
The creation of a Transitional Government (TG) in November 2001 marks a potentially significant step along the road to an end to the hostilities of the past years. The TG shares power between Tutsi and Hutu parties who signed the Arusha peace accords in August 2000. The TG will be in place for an initial three-year period, after which there will be democratic elections to decide on a government. However, although the TG represents a step forward, its ability to bring about peace is severely constrained because some Hutu rebel groups were not signatories of the Arusha accords and have continued the conflict with the army. Less than a week after the TG came to power there were a series of high profile kidnappings of school children by the rebel groups in apparent protest at their exclusion from the government. Negotiations have taken place and there was a meeting in Pretoria on 18 February 2002 that aimed to bring together the transitional government and the rebel groups concerned to discuss a possible cease-fire agreement. The rebel groups are the Force de Defence de la Democratie (FDD) and the Force Nationales de Liberations (FNL). However, of the two groups, only the FDD attended the meeting and this is likely to mean that fighting will continue without the inclusion of both groups in the peace process (UN OCHA 28/02/02).
Humanitarian situation
The humanitarian situation continues to be severely affected by insecurity. Over the past few months there has been an upsurge in attacks and ambushes in various parts of the country, but mostly in Bujumbura Rural province around the capital, Bujumbura. The insecurity continues to displace large numbers of people from their land and their means of subsistence. It has resulted in the looting of food stores, the loss of livelihood assets and has created a situation of both acute and chronic food insecurity.
Many of the IDPs live in very poor conditions with very little access to medical or educational facilities. Insecurity has also constrained the ability of the humanitarian community to access groups in need of assistance. WFP reports that during November, less than 30 % of the targeted beneficiaries received WFP assistance as a result of the security situation (WFP 28/12/01). The most recent upsurge in insecurity resulted in the cancellation of missions in the provinces of Bujumbura Rural and Ruyigi in February 2002, which severely affected planned assistance to 26,900 people (WFP 15/03/02). The rise in ambushes along many major roads has meant that movement between areas is very difficult and humanitarian workers rely on air transportation to cover very small distances.
Despite continued insecurity there has been a general improvement in the overall nutrition and food security outlook in the country. UNICEF has documented a dramatic decrease in numbers attending selective feeding programmes when compared to similar periods last year and nutritional surveys also indicate that nutrition rates are dropping. However, the situation is still very poor in insecure areas such as Bujumbura Rural, Rutana, Gitega, Cibitoke, Muramvya and Ruyigi (UNICEF 04/02/02). Overall, the harvest outlooks are good, which will undoubtedly increase the availability of food. However, security remains a critical factor in determining the accessibility of food sources. Other reasons for the improvement in the overall picture have been the greatly improved targeting of emergency food distributions to those groups most acutely in need of assistance. There has also been an increased investment in food security programmes and, in particular, there have been large-scale distributions of agricultural seeds. There was some concern that food insecurity in many areas would lead people to eat seeds intended for planting, however the distributions have been protected by the provision of a food or seed protection ration. The situation has also been helped by reduced rates of malaria, although the usual seasonal increase was seen at the end 2001 and early 2002.
Another issue of great significance to the humanitarian situation has been the possible return of Burundian refugees from Tanzania. There are estimated to be half a million registered Burundians in Tanzania, but there are increasing signs that the government of Tanzania would like to see a large scale repatriation. The establishment of the TG has also signalled the possibility of peace and stability and UNHCR has reported that tens of thousands of refugees have registered for a voluntary repatriation package. This would significantly increase the burden on existing humanitarian services and place pressure on the scarce land and resources available within Burundi. UNHCR have reported that some returns have taken place but it remains to be seen how many will actually opt to return when violence is still ongoing within the country.
Bujumbura Rural
The security situation in Bujumbura Rural continues to be extremely volatile with heavy fighting between the Burundian army and the FNL rebel group. At the beginning of January 2002, UN OCHA estimated that there were 28,677 IDPs in the province, however this number has risen substantially as a result of ongoing conflict. It is reported that at the beginning of 2002, 14,000 people were displaced from Isale commune and at the end of January 2002 were asked to return to their homes but were unable to due to ongoing fighting (UNICEF 04/02/02). Further fighting has taken place in March 2002 resulting in the displacement of an additional 10,000 people. The RNIS does not have any recent nutritional information from the province but the situation is assumed to be extremely precarious, as other areas of conflict in Burundi have shown high rates of acute malnutrition.
Karuzi
The province of Karuzi is situated towards the north of the country and has in past years suffered very high rates of acute malnutrition as a result of drought, insecurity and epidemics. The general outlook for 2002 has improved when compared to the past three years, with a good harvest and lowered rates of malaria. At the beginning of January 2002, UN OCHA estimated that there were 2,042 IDPs in the province. The area has benefited from the presence of a high number of humanitarian organisations and their assistance has taken the form of food distributions, selective feeding programmes and agricultural support. In particular, the area has benefited from the distribution of essential agricultural seeds along side seed protection rations. The results have been a marked reduction in the number of children being admitted to both the supplementary and therapeutic feeding centres in the region.
MSF-B conducted an anthropometric nutrition survey in September 2001 and found a prevalence of acute malnutrition of 4.2% (W/Ht < -2 Z scores and/or oedema) including 0.4% of severe acute malnutrition (W/Ht < -3 Z scores and/or oedema) (MSF-B 09/01). The survey also estimated mortality rates and found that the CMR was 0.4/10,000/day and the under-five mortality rate was 1.2/10,000/day. The rate of measles vaccination coverage was also measured and found to be 92.4%. The data indicates that the nutrition situation is not of public health concern and, furthermore, has improved considerably from a similar survey conducted in March 2001 which indicated a prevalence of acute malnutrition above emergency thresholds (see RNIS #32 and 33). The crude mortality rate is within acceptable limits, however the under-five mortality rate is cause for concern. The high measles vaccination coverage is also encouraging and an indication that preventative medical interventions are currently working.
The improvement in the situation is extremely encouraging, particularly because Karuzi has experienced extremely high rates of malnutrition in the past. The survey attributes this improvement to a number of causes including the distribution of a good general food ration, the strong agricultural support offered to the population, the reduction in the incidence of malaria and the effective treatment of remaining cases. The survey also points to the successful system of active case finding for the selective feeding centres. In conclusion, the outcome of the survey is that the nutritional situation is much improved but it is worth noting that the population remains vulnerable to future shocks, which could quickly lead to a deterioration in the situation.
Kayanza
The province of Kayanza is situated in the north of Burundi and shares a border with Rwanda. The province has been particularly affected by the conflict of recent years and the nutrition situation has remained extremely precarious. This is mostly a result of poor agricultural seasons, insecurity and epidemic outbreaks, most notably of malaria in 2000-2001. The population of the province was estimated to be 470,253 in August 2001 and in January 2002 UN OCHA estimated that there were 7,573 IDPs in the province (UN OCHA 01/02). The later half of 2001 saw a general improvement in the nutritional outlook in the province and this has been particularly noticeable in the reduction of children in selective feeding programmes.
ACF conducted a nutrition survey on the under-five population in November 2001 and found an estimated prevalence of malnutrition of 3.9% (W/Ht < -2 Z Scores and/or oedema). This did not include any severe malnutrition. The survey also estimated mortality rates and found a CMR of 0.3/10,000/day and an under-five mortality of 0.08/10,000/day (ACF 11/01). The data indicates that the nutrition situation is not concerning and indeed is well below emergency thresholds. It is encouraging to note that no severe acute malnutrition was observed. It is also noted that there has been a significant improvement from a previous ACF survey in September 2000. The survey attributes the observed improvement to a variety of causes including the good harvests seen in both the 2001 B and C seasons. This would have significantly improved the availability of food sources to the population. There has also been an upsurge in commercial activities in the region as a result of relatively good security. This has also allowed many people to return to their farms and continue essential farming activities. The health situation has also remained good with no reported disease outbreaks and the incidence of malaria has fallen dramatically. Whilst the situation appears greatly improved over the past few years, it is important to note that the area remains vulnerable to deteriorations in the nutrition situation as a result of conflict, drought and epidemics.
Rutana
Rutana province is located in the south east of Burundi on the border with Tanzania. The population of the province is estimated to be 287,834, with an estimated 77,901 IDPs (UN OCHA 01/02). The principle economic activity in the region is agriculture and this has been severely disrupted by continuing insecurity that has routinely displaced the population from their homes and farms. As a result, many people are too afraid to continue with agricultural activities, resulting in severe reductions in both the availability and accessibility of food items.
The International Medical Corps (IMC) conducted a nutrition survey in the province during October 2001. The survey was conducted over the entire province but it was noted that insecurity meant that only 119 hilltop settlements out of a possible 149 were accessible (IMC 20/10/01). Even with the survey confined to the secure areas of the province, it was still necessary to assess the possibility of access on a daily basis. The survey indicated that the prevalence of acute malnutrition amongst children under five years of age was 19.2% (W/Ht < -2 Z scores and/or oedema). This included 6.3% of severe acute malnutrition (W/Ht < -3 Z scores and/or oedema) (IMC 20/10/01). Crude mortality was not estimated but the under-five mortality rate was 1.6/10,000/day. The data indicate that the nutritional situation in Rutana is extremely poor with the prevalence of acute malnutrition being significantly elevated above emergency thresholds. The high rates are all the more surprising given that the survey was conducted in October, which is traditionally a month of relative plenty and when the numbers of children in selective feeding programmes usually falls. The causes of the observed malnutrition are undoubtedly linked to the insecurity of the area, which continues to disrupt traditional livelihood patterns and prevents access to essential subsistence needs. In contrast to the high rates of malnutrition, the rate of measles vaccination coverage was estimated to be 74%, suggesting that some preventative medical services were still ongoing and effective. The population should be considered to be highly vulnerable and the situation should be carefully monitored to prevent further deterioration of the situation.
Overall
The humanitarian situation in Burundi remains extremely precarious. However, in general, the nutrition and food security outlook is significantly improved from previous years. It is important to note that the situation appears to change drastically from area to area. The areas with the worst humanitarian outlooks and the highest observed prevalences of malnutrition are those currently suffering from the most insecurity. IDPs in these areas should be considered at high risk (category II), whilst populations in more secure areas are benefiting from an improved harvest and lower incidences of disease (category III).
Recommendations
From the MSF-B survey in Karuzi Province
· Continue general food distributions to vulnerable families.From the IMC survey in Rutana Province
· Continue the distribution of seeds and protection rations to improve the food security situation.
· Continue support for existing selective feeding programmes.From the ACF survey in Rutana Province
· Support food security through income generating programmes.
· Conduct nutritional education to all health centres.
· Reinforce the integration of selective feeding within the existing public health structures in the province.· Reinforce nutrition and public health education activities in existing public health structures.
The humanitarian situation in DRC continues to deteriorate despite ongoing peace negotiations between the various groups party to the conflict. DRC has suffered from years of instability, with the present conflict beginning in 1996 when a rebel army, supported by Uganda and Rwanda, attacked the regime of the then president, Mobutu. This resulted in the fall of the Mobutu regime, which was replaced by that of Laurent Kabila. In 1998 there was a major rebellion, stemming in the Eastern region. As a result, a number of neighbouring countries were drawn into the conflict, which has served to displace millions of people and completely disrupt and destroy the livelihoods of millions more.
In 1999, a peace agreement was signed in Lusaka between the major antagonists in the conflict, including major rebel groups. The agreement provided for the deployment of a UN peacekeeping mission (MONUC) to oversee a cease-fire, however hostilities continued and in January 2001 the then president, Laurent Kabila, was assassinated. His son Joseph Kabila took his place as president. 2001 saw major advances in the peace process with the further deployment of MONUC troops and the initiation of the Interim Congolese Dialogues (ICD). The situation remains extremely confused with the country split into three major areas. The first area is in the west of the country and is controlled by the Kinshasa government with the support of Angola, Zimbabwe and Namibia. The second region is in the north of the country in the provinces of Equateur and parts of Orientale and is controlled by the Movement for the Liberation of Congo (MLC) with the support of Uganda. The third region is in the east of the country in the provinces of the Kivus, Maniema, parts of Orientale and Katanga. It is controlled by the Congolese Rally for Democracy (RCD-Goma) and is supported by Rwanda. However, each area also has numerous opposing forces and open conflict is continuous, particularly in the eastern regions of the country (NRC 26/03/02).
The complexity of the situation and the multitude of different interests has made the continuation of the peace process extremely difficult. However, the ICD met for the first time in February, in Sun City, South Africa. The dialogue was plagued with difficulties over representation and ongoing conflict. The Kinshasa government walked out of the talks on 14 March 2002 because of fighting in the government held town of Moliro in the east of the country resulting in its capture by RCD troops. After further negotiations, the talks continued and resulted in an agreement between the MLC and the Kinshasa government to form a transitional government that would share control over what amounts to approximately 70 % of the country (UN OCHA 19/04/02). It has been stressed that the agreement was reached outside of the framework of the ICD, and whilst it has been greeted with tentative support from members of the international community, the RCD-Goma, who did not sign the agreement, have vowed to continue fighting. It is feared that without all parties being a signatory to an agreement, the conflict in DRC will continue (UN OCHA 25/04/02).
Numbers and distributions of IDPs
The current caseload of IDPs is estimated to be 2,275,111. This represents an increase of 230,111 people since the last RNIS (OCHA 01/02). Given the inaccessibility of many areas, particularly in the east, the real figure is likely to be far greater. Most of the displaced are in the east and south east of the country in the provinces of the Kivus and Katanga. The majority of the observed new displacement has occurred in south Kivu as a result of ongoing conflict in the province.
Humanitarian situation
The dramatic political developments and military disengagement that have taken place since January 2001 have not resulted in significant improvements to the humanitarian situation of millions of affected people. Despite ongoing peace negotiations, the number of IDPs has continued to rise and is now estimated to be approaching 2.3 million people. Less than half of these have direct access to relief assistance, as a result of insecurity and poor infrastructure. This means that more than one million people are displaced without assistance. The disengagement has seen the opening up of some areas, most notably the Western government held areas. However, access still remains very limited in the east of the country despite the work of MONUC, who remain severely hampered in their ability to enforce cease-fires and end the conflict. The continuing violence has also resulted in many humanitarian relief organisations being unable to access areas of acute need.
Table showing the distribution of IDPs by province (UN OCHA 01/02)
|
Area |
April 2001 |
September 2001 |
January 2002 |
|
Equateur |
170,524 |
85,000 |
85,000 |
|
Orientale |
220,000 |
230,000 |
250,000 |
|
North Kivu |
620,000 |
760,000 |
760,000 |
|
South Kivu |
373,158 |
225,000 |
435,111 |
|
Katanga |
354,000 |
415,000 |
415,000 |
|
Maniema |
132,000 |
160,000 |
160,000 |
|
Eastern Kasai |
114,000 |
130,000 |
65,000 |
|
Western Kasai |
29,000 |
- |
65,000 |
|
Kinshasa |
N/A |
40,000 |
40,000 |
|
TOTAL |
2,012,682 |
2,045,000 |
2,275,111 |
The combination of conflict, acute food insecurity and lack of medical care has continued to have a severe impact on morbidity and mortality. Diseases such as malaria, diarrhoea, respiratory infections and malnutrition are rife and there has been a report of a large outbreak of cholera in Katanga province that has claimed the lives of thousands of people. At the beginning of 2001, IRC conducted a series of surveys that indicated catastrophic mortality rates and concluded that in excess of 2 million people had died of war related mortality in eastern DRC since 1998 (see RNIS 32 and 33). A similar study conducted by MSF-B published in December 2001 showed similarly high mortality rates in areas close to the front line, particularly in the provinces of Equateur and Katanga (MSF 12/01). The studies showed that children had been particularly badly affected, with mortality rates in some areas being three times the emergency threshold. UNICEF has estimated that of the 205 million babies born in an average year, 20% will not reach their first birthday. This makes the infant mortality rate in DRC 50% higher than the African average (UNICEF 11/02/02).
In recognition of the increasing humanitarian needs, the Consolidated Appeal (CAP) has been increased for 2002 to a total of 194 million US dollars from the 139 million requested in 2001 (UNSC 15/02/02). The appeal has attempted to address the range of needs, particularly by attempting to address the chronic under development of the country, but as of 25 April 2002, only 11 % of requirements had been received and almost all funds have been for traditional emergency assistance (Oxfam 25/04/02).
Western Region
Kinshasa
Kinshasa has been very badly hit by the conflict in the country. Much of the food that was available in markets originally came from eastern areas such as the Kivus, Maniema and Katanga that traditionally produced high amounts of food for export. The war has severely affected agricultural production in these areas and severed transportation routes. As a result, the city now relies on the provinces of Bandundu and Bas-Congo as its sole source of food (FAO 15/11/01). What food is available is of high price and the very high rates of unemployment in the city mean that much of the food is unaffordable, as people do not have the exchange entitlements to purchase it. People are relying on multiple coping strategies from all family members such as petty trade, menial work, begging, and illicit activities. Some of the petty trade involves women travelling many kilometres to cut wood for sale (FAO 15/11/01). This has left a very poor humanitarian situation with an estimated 40,000 IDPs and 3,300 refugees. WFP is currently targeting 92,000 individuals deemed to be acutely in need of food assistance. The RNIS does not have any recent nutritional information from Kinshasa, but past surveys have indicated high rates of acute malnutrition and the population is assumed to be extremely vulnerable to further nutritional decline, particularly if conflict in the country continues.
Other areas in the western region have benefited from less insecurity than that experienced in the east of the country. This is largely because it is under government control. However, the provinces of Bas Congo and Bandundu share a border with Angola which has a heavy refugee burden from the conflict there. The areas are also under great pressure to provide sufficient food for the Kinshasa region and other cities in the west of the country. The overall effects of the war are shared with the rest of the country and include the poor economy, high unemployment and poor access to medical care. The RNIS does not have any recent nutritional surveys but recent mortality surveys indicate that the situation is poor, although below emergency thresholds. However, given the prevailing humanitarian situation it is assumed that these populations remain highly vulnerable.
Northern Region
Equateur Province
Equateur is one of the provinces that has been most severely affected by the war and contains an estimated 85,000 IDPs. The province has been particularly affected by the presence of the front line, which has split it into two separate zone, one run by the rebel MLC and the other controlled by the government. A recent mortality survey conducted by MSF-B has indicated that the front line represents a particular risk, with the observed rates of mortality considerably higher in the areas closer to the front line. MSF-B also conducted a survey in the Basankusu health zone, very close to the front line and found an estimated prevalence of crude mortality of 2.7/10,000/day and an under-five mortality rate of 6.6/10,000/day (MSF 12/01). These rates indicate a very serious health situation as they are considerably above emergency thresholds. The rate of under-five mortality is particularly concerning as it is over three times higher than emergency thresholds and represents the death of a quarter of the under-five population over the past 12 months. The reasons for the high rates are the grinding poverty in the area and complete lack of opportunities to conduct normal subsistence activities. There were high reported rates of looting and very little access to health care. The physical and food insecurity has made the IDPs and the non-displaced population extremely vulnerable and created a very serious humanitarian outlook. It is hoped that the agreement between the MLC and the government may see an end to the front line but, unless conditions improve substantially for this population, the excess mortality is likely to continue.
Orientale province
The situation in Orientale continues to be extremely precarious with continuing violence reported in many areas. The province is currently estimated to contain 250,000 IDPs, which is an increase of some 20,000 over the reporting period. In addition to insecurity related to various armed groups, the area has suffered from recurring ethnic violence between the Lendu and Hema peoples of the Ituri district. This fighting has possibly been exacerbated through the influence of other armed parties. Violence once again broke out in the middle of February 2002 and humanitarian agencies have announced that 15,000 people have been displaced in the surrounding region (IRIN 19/02/02). The RNIS has not received any recent nutritional information from IDPs in this area but, given the prevailing insecurity, the IDPs and non-displaced populations are considered to be extremely vulnerable to nutritional decline.
Southern and Eastern DRC
The current humanitarian crisis in DRC is most severe in the southern and eastern regions of the country. The provinces of north and south Kivu, Maniema and Katanga were once fertile agricultural zones that produced agricultural surpluses which were sent to the western regions of the country, particularly to the capital, Kinshasa. The area is now the scene of some of the fiercest fighting and is considered chronically insecure. The majority of the country s almost 2.3 million IDPs are found in this region and the reporting period has seen the number grow considerably. As a direct result of the fighting, millions of people have found themselves displaced from their homes, their land and their livelihoods. The incidence of disease is appallingly high and recent months have seen the outbreak of cholera in the Katanga district. Nutrition surveys have routinely shown rates of acute malnutrition of over 20% and, combined with the acute food insecurity and almost total lack of medical facilities, have resulted in mortality rates that are far in excess of internationally recognised emergency thresholds.
North and South Kivu
The situation in the Kivus remains extremely precarious and ongoing fighting has resulted in displaced population estimated at 1,195,111. This represents an increase in excess of 200,000 people over the reporting period. The majority of this increase is in South Kivu and is a result of fighting between various armed rebel factions over control of strategic towns, particularly along the banks of lake Tanganyika. Areas of particular violence have been Fizi and Bukavu in south Kivu. This has served to seriously constrain humanitarian access to the affected populations and WFP announced in March that the Walungu, Fizi, Barak and Hauts Plateaux regions were inaccessible (WFP 08/03/01).
The area took a further blow to the humanitarian situation with the eruption of Mount Nyiragongo on 17 January 2002. The volcano is situated 10 Km from the town of Goma in North Kivu and it is estimated that it forced the displacement of 500,000 people, who fled to neighbouring Burundi. Many have since returned to the area but it is estimated that 20-30% of the town was destroyed and up to 80,000 people were made homeless. The humanitarian response to the situation was very large and it is likely that this helped to avoid a large deterioration in the situation. However, it has added to the burden of shocks on the population of the area and underlines the many hazards that face people in the region (UNSC 15/02/02). Reports indicate that the nutrition situation of the displaced is not seriously affected.
World Vision reported on a Middle Upper Arm Circumference (MUAC) nutrition survey they carried out in Rwanguba health zone in March 2002. The survey measured the MUACs of 1400 children below the age of five and found that the prevalence of acute malnutrition was well above emergency thresholds. The rate of severe acute malnutrition was significantly elevated, indicating a substantially increased risk of mortality. The reason for the high prevalence is attributed to the insecurity and looting that is widespread in the area, as well as the absence of functioning health clinics and the impoverishment of the population (WVI 15/03/02).
World Vision also conducted a weight for height survey on the under-five population, in the Oicha zone of North Kivu in December 2001. The survey indicated that the prevalence of acute malnutrition was 11.1% (W/Ht < -2 Z scores and/or oedema) including 4.4% of severe malnutrition (W/Ht <-3 Z Scores and/or oedema), of which 3.9 % was oedematous malnutrition (Kwashiokor). The prevalence of malnutrition in Oicha is raised above emergency thresholds and indicates that acute malnutrition is a problem of public health concern in the area (WVI 15/12/01). The survey attributes the observed malnutrition to poor availability and access to food, medical care and clean water. The overall picture of the nutrition situation in the Kivus is extremely alarming and there is little chance of an improvement whilst insecurity is still so prevalent
Maniema Province
The situation in Maniema is precarious, with repeated reports of insecurity between rebel groups and government and allied forces. The number of IDPs in the province appears to have stayed fairly stable at 160,000 people but further displacements could occur at any time. One positive move in the area has been the deployment of MONUC troops to the town of Kindu. A total of 400 Uruguayan soldiers were initially flown in to oversee phase III of the disengagement and disarmament process. It is hoped that the town will eventually support up to 2,500 troops. It is expected that the troops are likely to face some resistance to the disarmament, with one of the initial UN aircraft fired on in February 2002. However, their presence is a positive step forward and it is hoped that it may bring some security to the area (UN OCHA 13/02/02). The RNIS has not received any new nutrition surveys from the area but the population is assumed to be extremely vulnerable.
Katanga province
Katanga is divided by a front line between government and government backed forces and the RCD-Goma rebels. The presence of the front line has made the province extremely insecure and the number of IDPs indicates this accordingly. It is estimated that there are currently in excess of 415,000 IDPs in the province. The humanitarian situation is extremely bleak with the population being highly food insecure and with little or no access to health care facilities. The opportunity for economic activity is also negligible. In December 2001 MSF-B conducted a retrospective mortality survey in Kilwa health zone, situated close to the front line. The survey indicated that the crude mortality rate was 1.1/10,000/day and the under-five mortality was 3.1/10,000/day. This indicates a very concerning situation with both rates being above emergency thresholds. It is particularly alarming to note that the rate of under-five mortality means that 12% of the under-five population had died over the previous 12 months (MSF 12/01). The main causes of the high mortality are the exceptional poverty of the population, their food insecurity and the minimal access to health care. Over the reporting period, the vulnerability of the population has been emphasised with the discovery of a very large cholera outbreak. The worst affected areas are the central and southern zones, including the towns of Lubumbashi, Likasi and Kolwezi. By the middle of March 2002, there were 5,150 registered cases since November 2001 with 3,882 since the beginning of 2002 (AFP 16/03/02). The case fatality rate for cholera is very high if not treated. The RNIS does not have any recent nutrition information for the area but both the IDPs and the general population are assumed to be extremely vulnerable to further nutritional decline.
Refugees
There are currently estimated to be 368,000 refugees in DRC, predominantly from the Central African Republic (CAR) and Angola. Angolan refugees are primarily in the south of the country near the border areas with Angola. Many are long-term refugees and have developed some form of coping mechanisms. This has been particularly possible for those in the western regions where the level of insecurity is not as high. The refugees from CAR came into the country in 2001 as a result of an attempted coup. The majority of the refugees are in Mole camp in Equateur Province and UNHCR has announced that it has begun some voluntary repatriations. The RNIS does not have any recent nutritional data for these groups but they are considered vulnerable.
Overall
Despite some advances in the peace process, which have led to some disengagement in parts of the country, the overall humanitarian outlook for the people of DRC is extremely poor. In particular, the IDP population in the east of the country is particularly poor (category I). Recently arrived refugee populations also remain acutely vulnerable (category II). Evidence strongly indicates that insecurity is the chief cause of vulnerability and groups along existing front lines and in areas of acute insecurity are at increased risk of nutritional decline. The outlook is not encouraging given the failure of the ICD talks, and the failure of the RCD-Goma rebels to sign an agreement would indicate that more conflict is to be expected. There is some hope that the agreement that was signed between the Kinshasa government and the MCL will bring relative peace to areas in the north and west of the country.
Recommendations
From the RNIS
· Provide support to the UN consolidated appeal and in particular to activities that focus on developing newly secured areas.From the WVI survey in Oicha
· Continue therapeutic feeding.
· Establish community outreach programmes to actively find malnourished individuals.
· Ensure the provision of a safe and adequate water supply.
· Conduct nutritional education.
Tanzania is currently host to 512,004 refugees located in a number or camps in the Kigoma and Ngara regions of Western Tanzania (UNHCR 04/02). The sheer number of refugees has meant that Tanzania is host to the largest refugee population in Africa and, although not actively involved in the conflict currently affecting the Great Lakes region, it has received many of the people fleeing violence in the DRC and Burundi. It is currently estimated that there are 353,104 Burundian refugees and 129,567 from DRC (UNHCR 04/02). The remainder are mostly from Rwanda, with small amounts from Somalia.
The increasing numbers of refugees has been cause for considerable concern with the Tanzanian government and calls for their repatriation have increased. In a recent address to parliament, the Tanzanian president, Benjamin Mkapa, announced that Tanzania could not keep bearing the burden of refugees and he appealed to the international community to help avert a snowballing crisis in the country (PANA 11/01/01). This mirrors a widely held belief that the refugees are an increasing financial burden to the Tanzanian government and contribute to a rise in insecurity. The Burundian government has accused Tanzania of harbouring rebels in the camps, from where they make raids back into Burundi. The problem for the UNHCR is that they are very reluctant to organise voluntary repatriation for the refugees whilst their countries of origin are still mired in conflict and large-scale displacement continues to take place. However, there have been some moves to facilitate returns for those that wish to do so. In February 2002, it is estimated that some 25,000 Burundian refugees registered for repatriation, however reservations over the timing of the repatriation have been expressed (UNHCR 14/03/02). Most of the returnees are planning to return to stable provinces in the south and in the east and will be received in transit centres and provided with food rations to last for 3 months.
UNHCR, in conjunction with UNICEF, WFP and NGO implementing partners, conducted a nutrition survey in all refugee camps in the Kigoma and Ngara regions of western Tanzania. The survey was conducted between November and December 2001. In order to estimate the prevalence of malnutrition across the entire refugee population, a two-stage cluster survey was conducted in each camp. The results of the survey indicated that the prevalence of acute malnutrition (W/Ht < -2 Z scores and/or oedema) was 3.2% including 1.1% of severe acute malnutrition (W/Ht < -3 Z scores and/or oedema) (UNHCR/UNICEF/WFP 17/12/01). This reveals that acute malnutrition is currently not a problem of public health importance in the camps. The results of the survey also indicate that the nutrition situation is stable and has not changed since a similar survey in July 2001. This is most probably a result of the regular food distribution and the relatively good access to water, sanitation and comprehensive medical facilities. The camps benefit from a very comprehensive medical surveillance system, which ensures that any changes in disease patterns are closely monitored and, if outbreaks occur, they can be swiftly dealt with. The reports indicate that the crude and under-five mortality rates are both well within prescribed limits and are a further indication that the humanitarian situation for the refugees is well under control.
The survey also examined infant feeding practices and found children may benefit from improved infant feeding practices. Consequently, considerable emphasis for future interventions will be placed on community nutrition activities. There will also be an increased emphasis on improving household food security through the planting of community fruit trees with the aim of enhancing micronutrient intake.
Overall
The numbers of people seeking refuge in Tanzania are still increasing and this is causing mounting tension with the Tanzanian authorities. The level of support to the refugees remains good and all indications are that the humanitarian situation within the camps is good. The nutritional situation of the refugees is considered stable (category III).
Recommendations
From the UNHCR/UNICEF/WFP nutrition survey in Western Tanzania
· Ensure a general ration balanced in terms of both quantity and quality.
· Focus on the control of communicable diseases.
· Investigate the underlying causes of existing malnutrition.
The humanitarian situation in Uganda has suffered as a result of a series of separate civil conflicts in various parts of the country. Particularly affected have been the northern and western areas where large numbers of people have been displaced and are living in various IDP camps. Conflict has also erupted in the east as a result of violent cattle raiding that has occurred traditionally for some time but escalated in 2000, displacing up to a third of the population in Katakwi province. The displacement has left the IDPs without access to their homes or land and has fundamentally disrupted household economies. The result has been high vulnerability to acute food insecurity and a heavy reliance on external assistance to meet their subsistence needs.
The reporting period has seen the continuation of the improvement in the humanitarian situation, largely as a result of better security in many areas. The improved security is due to a number of reasons including the withdrawal of some of Uganda s troops from areas in the Eastern DRC. The troops have been able to contribute to internal security by being deployed to areas of conflict in the country, including the northern areas of Kitgum and Gulu, along the border areas with Sudan. This pull back has positive repercussions for the Ugandan government s relationship with that of neighbouring DRC. However, the eastern region of DRC remains extremely volatile, especially after the failure of the main eastern based rebel group to become signatories to a recent peace initiative. The continued presence of armed groups therefore poses a potential risk to internal security in Uganda, particularly in the West, and the possibility of large influxes of refugees cannot be ruled out.
On the political front, there has also been a thawing in relations between the government of Uganda and the Sudanese Khartoum based government. Relations had been extremely poor as a result of Sudanese support to the Lord s Resistance Army (LRA), which has been responsible for the insecurity in north Uganda. The improved relations have resulted in cessation of Sudanese support to the LRA and have led to their collaboration with the Ugandan military in an anti LRA campaign. This potentially has great repercussions for the displaced in the north and west of the country and there has been considerable talk of IDPs returning from camps to their places of origin as the security situation has improved. Whilst this is still the case in the west, the situation is less clear in the north where there has been a resurgence in insecurity in March and April 2002. In eastern areas the government has pursued an aggressive policy of disarmament for the Karamojong warriors, by first offering an amnesty for people to hand in weapons, and then carrying out an enforced disarmament programme. It is hoped that this will end the armed raids that have resulted in the displacement of so many in Katakwi province.
UN OCHA estimates that as of the end of March 2002 there were an approximately 747,599 vulnerable people, including 183,902 refugees. There were also 552,587 IDPs, predominantly in the north, west and east of the country. The numbers have declined slightly, possibly as a result of returns in the west, but the largest collection of IDPs remains in the northern district of Gulu where there are an estimated 315,882 displaced (UN OCHA 31/03/02).
IDPs in Northern Uganda
The north of Uganda has been very badly affected by violent attacks from the Lord s resistance Army (LRA) over the course of the 1990s. It is currently home to the largest concentration of IDPs in Uganda, many of who are living in so called protected villages which were established by the Ugandan government as a means of offering protection from attacks. As it has transpired, the protected villages have offered little in the way of actual protection and the insecurity in the area has continued to prevent the population, almost all of who are farmers and livestock herders, from accessing their land. The resultant food insecurity and poor camp conditions have resulted in a concerning humanitarian situation.
The area has enjoyed a period of relative stability over the course of 2001 and for the first couple of months of 2002, allowing for considerable hope that this would provide a suitable environment for IDPs in the area to start the process of return. However, cases of violent attack and abduction have increased over the months of March and April 2002 and UN OCHA indicated that there could be no possibility of returns from the camps in the near future (UN OCHA 31/03/02). The Ugandan military have joined forces with the government of Sudan s forces within Southern Sudan in a large scale anti LRA campaign. However, there is some concern over the efficacy of a military approach to the problem and it is likely that the LRA have been driven deeper into Southern Sudan. The concentration of Ugandan troops in Sudan has also taken troops away from other areas in the north, leaving them vulnerable to further attacks.
Kitugum
The province of Kitgum currently contains 82,645 IDPs and 23,601 Sudanese refugees. The number of IDPs has not increased over the reporting period, largely as a result of the relative security that the area has enjoyed. The number of refugees has increased by over a thousand as a result of the ongoing insecurity in Southern Sudan. For much of the reporting period, the expectation in Kitgum was of the possibility of the IDPs being able to leave the camps and start their lives again in their areas of origin. However, this is currently less likely as a result of an upsurge in insecurity. The IDPs continue to receive both food and non-food support from the humanitarian community and the overall situation is not deemed to be critical. FEWS has reported that the general food outlook in the area is good and this should positively affect the food security of the IDP populations. The RNIS has not received any recent nutrition surveys on these groups.
Gulu
Gulu is currently home to 315,882 IDPs (UN OCHA 31/03/02) who have been displaced over the years by the violent attacks of the LRA. The area has enjoyed a period of relative calm over the last 12 months, which had led many IDPs, and the humanitarian community, to start considering the possibility of returns. The period of security is largely a result of the termination of support to the LRA by the Sudanese government and the posting of more troops to the border area to guard against incursions from south Sudan, where the LRA have their bases. Unfortunately, the period of security was not to last and on 22 February 2002, the LRA conducted an armed attack on the Agoro IDP camp, which resulted in the death and abduction of IDPs and the looting of assets (UN OCHA 31/03/02). This has been an extreme blow to the security situation and the prospects of IDP returns. In response, the Ugandan army, in conjunction with the Sudanese army, has mounted an anti LRA campaign within Southern Sudan. The effects of the campaign are not yet known but it has taken troops away from the Gulu area and the number of security incidents has grown throughout the month of March 2002. These have included various ambushes, abductions and attacks on IDP camps. It is extremely distressing to note that this has prevented returns taking place and, whilst the food security of the area remains relatively good, the possibility of a deterioration of the situation as a result of further attacks cannot be ruled out. Consequently, the population should be regarded as vulnerable.
IDP in Eastern Uganda, Katakwi
Katakwi district in northeast Uganda has suffered from intense raiding by Karimojong warriors over the past five years. In 2000 the raiding was particularly fierce and has resulted in the displacement of up to a third of the population into a number of IDP camps. UN OCHA currently estimates that there are 88,500 IDPs, predominantly in the counties of Usuk and Kapelebyong. The Karimojong are a pastoralist people living in the districts of Moroto and Kotido, who have a strong tradition of cattle raiding, however the availability of small arms has led to the raids becoming increasingly violent and destructive. The government has been accused of failing to protect the population of Katakwi by allowing the Karimojong to accumulate illegal small arms. The government has initiated a disarmament programme for the warriors that began in December 2001. The first phase of the disarmament was voluntary but due to the relatively poor response, a forced disarmament was initiated in February 2002. The disarmament of the Karimojong is seen as an important step towards normalising the humanitarian situation in Katakwi but security in the area still appears to be a long way off as it was reported that an Irish priest and three co workers were killed on 21 March 2002 (UN OCHA 31/03/02).
The current food security situation has been described as good everywhere in the country apart from Katakwi district. This is a result of continued insecurity and the inability of many IDPs to cultivate over the past two years. Prior to the displacements, the food security of the area was dependant on traditional agriculture and livestock herding, however, the raiding has resulted not only in the loss of human life, but up to 50% of the population have also lost access to their land and up to 90% have lost their livestock. The raiding has also resulted in the extensive loss of household assets through looting (Oxfam 28/11/01).
Oxfam conducted a food and nutrition survey on the displaced populations of Katakwi in November 2001. The survey revealed an estimated prevalence of acute malnutrition of 5.2% (W/Ht < -2 Z scores and/or oedema), which included 2.7% of severe malnutrition (W/Ht < -3 Z scores and/or oedema). The prevalence of acute malnutrition does not indicate that acute malnutrition is a problem of public health importance. However, the survey also estimated mortality rates and the CMR was 3.55/10,000/day, with the under-five mortality rate at 2.7/10,000/day (Oxfam 28/11/01). Both these rates are above emergency thresholds and are indicative of a very serious problem. The CMR is particularly high being over three times the cut off for an emergency situation. Some of this mortality is likely to be directly related to deaths resulting from the violent raiding, however, the survey indicated that the overall health situation of the camps was extremely poor and that health was the major concern in the camps. The prevalence of major morbidities such as malaria, diarrhoea, respiratory infections and worm infestations were all above 40% and the camps were under served in terms of appropriate medical services (Oxfam 28/11/01). The camps were also very densely populated with little spacing between houses. This has severely affected basic hygiene, as did the observed lack of availability of both water and sanitation.
In conclusion, the survey indicated that although the prevalence of acute malnutrition was low, the observed rates of mortality were extremely high, mostly as a result of the extremely poor health conditions. The insecurity in the region continues to disrupt household economies and food security remains extremely precarious. There is the continued threat of insecurity over the next months, particularly with Karimojong legitimately entering Katakwi in search of pasture and water for their cattle. The food security outlook for the IDPs remains bleak and they should be considered as extremely vulnerable.
IDPs in Western Uganda
The reporting period has seen the continuation of an improved security situation in the western regions and most notably in the districts of Bundibugyo, Kabarele, Kyenjojo and Kamwenge. This is largely a result of the demise of the rebel Allied Democratic Front (ADF), who have been responsible for much of the violence in the area. As a result, there is talk of large-scale returns of IDPs from the protected villages where many are staying. The government has enthusiastically embraced the idea of IDP returns and announced in November 2001 its intention to dismantle the camps (UN OCHA 12/01), which it would like to see begin from March 2002 onwards (UN OCHA 09/04/02). The idea has been taken up by agencies and IDPs alike and there are currently ongoing large-scale preparations. WFP reports that there are approximately 80,000 IDPs in the Bundibugyo district alone who are expecting to return to their villages this year (WFP 08/03/02). Notably, the Districts themselves are conducting much of the organisation of the returns. The main problems facing IDPs in camps have been the poor access to cultivable land and inadequate access to food and income. The main constraint to this has been security and now, with the improvements in the security situation, many more are likely to want to return. The problem is going to be how many will actually be able to return given the inadequate resources and destitution of many IDPs. Meanwhile, it has been announced that 13,000 IDPs in the Kasese district have already returned and are busy planting crops and hoping to benefit from the coming rains. The RNIS does not have any recent nutrition information on these populations but the situation is not deemed to be critical.
Kikagati returnees in southern Uganda
The Ugandan government has finalised plans to resettle 2,673 Ugandan returnees from Tanzania who have been camped in Kikagati, southern Uganda. They have been living under very difficult conditions in a water-logged camp with very poor sanitation. An earlier assessment by Oxfam reported that the returnees were in critical need of water, sanitation and housing. One of the problems for the returnees has been that they are not classified as either refugees or IDPs and so have fallen through the network, despite their needs for assistance. The original plan for the returnees was to resettle them in Kabale District but this was met with animosity from local populations. The resettlement, which occurred on 8 April 2002, took place in Kamwenge District and gave each family two acres of land and a three month food ration and agricultural tools (UN OCHA 18/04/02). The RNIS does not have nutrition information on this group but they are considered vulnerable.
Refugees
There are currently estimated to be 183,902 refugees in Uganda from Burundi, DRC, Rwanda and the majority being from southern Sudan. The figures have increased over the reporting period as a result of a steady influx of Rwandan refugees from camps in Tanzania, but also as a result of the escalation of violence in Southern Sudan. The RNIS has not received any recent nutritional information on refugees but their condition is not deemed to be critical as a result of the improved physical security situation in many areas and the generally good food security seen in the country. There have, however, been reports of increasing insecurity in the northwestern Nile areas of Moyo, Arua and Adjumani, which have suffered a number of rebel attacks, including on the Mongula refugee settlement. Insecurity is a considerable concern as it is likely to obstruct attempts to improve the self-reliance of refugees in the area and require that relief assistance be continued.
Overall
The overall situation is relatively good as a result of a long period of security and calm, however, the situation varies widely over the country and is heavily contingent on the prevailing security situation. This is particularly the case for IDPs in the west of the country who, it is hoped, will return from the camps to their own lands over the duration of 2002. Their situation is not critical (category III). IDPs in the north have benefited from an extended period of security but recent months have seen an upsurge in armed violence. The overall condition of the northern IDPs is not critical (category III) but they remain vulnerable. The exception to the general improvement in the situation is the eastern district of Katakwi, where the condition of IDPs continues to be extremely concerning and they should be viewed as being at heightened risk (category II). The situation of refugees is currently not thought to be critical (category III).
Recommendations
From the Oxfam survey in Katakwi district
· Strengthen public health services in camps.
· Improve and strengthen water and sanitation facilities in camps.
· Provide kitchen utensils, clothing and mattresses to families.
· Provide mosquito nets to protect IDPs from malaria.
· Implement cash and food for work programmes.
· Provide agricultural implements and seeds for families to engage in agriculture.
