SUB-SAHARIAN AFRICA - GREATER HORN OF AFRICA

Eritrea
Ethiopia
Kenya
Somalia
Sudan

Eritrea

The situation in Eritrea continues to be of concern and it is estimated that up to 1.3 million people, including war and drought affected populations, deportees and returning refugees, remain vulnerable as a result of both drought and the affects of the recent war with Ethiopia. The drought and recent conflict have both had a remarkably heavy toll on livelihoods within the country and, although there has been a general improvement in the humanitarian situation, the number of people in need of assistance remains high.

The overall humanitarian situation has undergone some improvement and has been greatly helped by the long awaited decision on the exact location of the border separating Eritrea and Ethiopia on 13 April 2002 (UNOCHA 29/04/02). The two countries have both announced their acceptance of the decision and it is hoped that this marks a very positive development that will allow the continuation of vital work to demobilise and reintegrate soldiers, clear areas of unexploded ordinance (UXO) and mines, and rehabilitate the infrastructure destroyed during the war.

The border agreement has not been without its set backs and, on 27 April 2002, Ethiopia closed the border to the UN peace keeping mission over what Ethiopia claimed were violations of its rights when the UN force brought journalists in to view a contested village. The border was subsequently reopened and the improved security has seen the return of many people to their places of origin. However, the number of people considered to be vulnerable still remains high and some of the most badly affected areas of the country remain Gash Barka, Debub, North and South Red Sea States and Anseba, where it is estimated that 529,400 vulnerable people are still suffering from drought (WFP 10/05/02). There are also approximately 57,200 people internally displaced, who have not been able to return to their areas of origin, largely as a result of mines and UXOs and lack of infrastructure. There are also more than 13,000 people in camps who were expelled from Ethiopia.

Table of Vulnerable groups receiving food aid

(UN 2002)

Number of IDPs in camps	50,239
Number of IDPs in host communities	14,199
Number of IDPs outside camps	9,311
Total number of IDPs	73,749
Expellees/deportees	13,694
Total number of drought affected persons	524,098
Total number of refugees expected to return from Sudan in 2002	90,000
Number of refugees in Eritrea	1,922
Total number of food aid beneficiaries in 2002	800,000

It is concerning to note that there has been a very poor response to the UN’s Consolidated Inter-Agency Appeal (CAP) for 2002, which has left the food pipeline available for the war and drought affected beneficiaries at its lowest level since the current emergency began in 1999 (FEWS 31/05/01). It is estimated that only 17.2 % of the appeal has been met (UNOCHA 10/06/02) and in March 2002 food distributions were cut by 50 % to cover only those deemed most acutely in need of assistance (FEWS 31/05/02). This is particularly concerning because the summer period from June to September represents the annual hunger season before the next harvest in mid October.

War affected displaced

The war with Ethiopia has had a huge impact on the livelihoods of many and those that remain most affected are those still in displaced camps in various areas of the country. Whilst many have been able to return to their areas of origin, many areas along or close to the border region are still very heavily affected with a very high amount of mines and UXOs which continue to exclude people from potentially fertile farming areas. The result is a group of people, estimated at approximately 50,000, who are still living in camps in areas in Gash Barka and the Red Sea states, who have lost their livelihoods and have been unable to secure them again. As a result, they are dependent on external assistance for their subsistence needs. The RNIS has not received any nutrition reports over the reporting period but notes with concern that the last survey (see RNIS 36 and 37) appeared to indicate a decline in the nutritional status of under-five children in war displaced camps in the Gash Barka region. This is particularly concerning as the previous surveys had indicated a relatively stable and non-critical situation. The continuation of ration cuts and the present hunger season gives cause for concern for these groups.

Drought affected displaced

Up to 529,400 people are considered vulnerable as a result of the chronic effects of a region wide drought in 1999 and 2000. The most affected zones are those of Anseba and the North and South Red Sea zones. The situation has been exacerbated by a poor rainfall distribution in early March and late April 2002 and in June FEWS announced that the Azmera rain season, from Marchto May, had failed. As a result the long cycle crops, which are normally planted during this period, will probably fail. This represents the second year of failure for the Azmera (minor) rainy season and it is expected that this will adversely impact on livestock health because the rains are an important source of feed and water for livestock. This will certainly have a negative impact on food security for many in Eritrea and, although the RNIS has not received any recent nutrition surveys on drought affected populations, they are considered to be at risk of further nutritional decline.

Returnees

Eritrea has suffered from a series of wars and natural disasters and the refugee caseload in neighbouring countries such as Sudan is one of the oldest in Africa. Since the peace with Ethiopia and the prospects of a secure future for the country, a programme of voluntary assisted returns has been implemented by UNHCR. This programme has been targeted specifically at the 147,000 camp based refugees in about 23 camps in Sudan (UNHCR 11/06/02). At the beginning of July it was announced that 50,000 had returned and many more are expected to do so this year (ICC 02/07/02). The number of returnees is increasing and this is largely a result of a decision by UNHCR to no longer consider the long-term Eritrean refugees in Sudan as eligible for refugee status (UNHCR 08/05/02). This has important implications for the remaining refugees in camps in Sudan, who must now decide whether they will return or apply to stay in Sudan. The returnees are receiving a return package to help them re-establish themselves and many are returning to areas such as Golujk, south of Tesseney, which is a region considered to be particularly fertile and good for farming (UNOCHA 27/05/02). The RNIS has not received any nutritional information on this group but it is not thought to be critical.

Overall

The situation in Eritrea is precarious as a result of the continuing affect of an ongoing drought that is threatening food security at the country level. The country is also still suffering the effects of the war with Ethiopia and much workneeds to be done to reintegrate fighters and rehabilitate much of the land and infrastructure in war affected areas. This has left a great deal of people acutely vulnerable and suffering from chronic food insecurity. It is therefore concerning to note that the humanitarian programmes, specifically designed to facilitate the country to get back on its feet, are so under funded and it is clear that this will have an effect on the overall humanitarian situation.

Recommendations

From the RNIS

· Urgently provide funding to the UN CAP appeal to ensure an adequate food pipeline for vulnerable population groups.

· Closely monitor the nutrition and food situation amongst the IDP communities, particularly during the hunger season from June to September.

Ethiopia

The humanitarian situation in Ethiopia remains extremely mixed, with some areas of acute needs and others where the situation is relatively stable. The worst affected zones remain Amhara, Tigray, Afar, Oromiya and the Somali region and it is estimated that over 5 million people require assistance.

The reporting period has seen the development of the short Belg/Gu rain season and the start of the Meher season. In general, the rains have been average to below average and there is concern for badly affected pastoralist areas such as Afar where poor rains have come on top of successive years of drought conditions. Other badly affected areas are Oromiya and the north of Somali zone. The over riding critical factor for many areas is the chronic food insecurity that will not be alleviated by one or two years of good rains. The country has suffered from intermittent droughts and conflict for the last decade and beyond and this has resulted in the destruction of livelihoods for many people dependent on their livestock and/or crops. Various assessment missions have indicated that the current problems are less to do with the deficiencies of the current rains and more to do with the accumulated deficits of past years. As a result, people have been stripped of their ability to cope with renewed crises and their reliance on external humanitarian assistance has grown (UN-EUE 30/04/02).

Table of Population in Need of Relief in 2002

(FEWS 14/02/02)

Region	Number of Beneficiaries	Percentage	Population in Need as % of Rural Population
Tigray	917,200	17.7	26.8
Afar	225,400	4.3	20.3
Amhara	1,724,800	33.3	11.0
Oromiya	1,051,400	20.3	5.0
Somali	894,800	17.3	28.9
Benishangul- Gumuz	9,000	0.2	1.7
SNNP	303,300	5.9	2.5
Gambela	32,800	0.6	19.7
Harari	13,000	0.3	20.0
Dire Dawa	10,000	0.2	10.5
TOTAL	5,181,700	100	9.2

The overall crop production in the country has also been affected by the limited use of improved seeds and fertilizer this year. This is largely because many farmers were encouraged to take out loans for these agricultural inputs but the years of poor rain have left them unable to repay loans and unable to purchase further inputs. This has been exacerbated by the poor price of grains on the market, meaning that farmer’s returns are often insufficient to cover their costs (FEWS 16/05/02). Pastoralists have also been badly affected by the poor availability of pasture and water sources, which has led to poor livestock condition and affected their price on the market. As a direct result, there has been a significant drop in purchasing power in both pastoral and farming communities that will affect the accessibility of food stocks.

Given the continuing needs in the country, it is concerning to note that the 2002 UN Consolidated Interagency funding appeal remains under funded and has prompted the DPPC to reduce the planned monthly general food ration from 15 Kg to 12.5 Kg. At best this will prolong the recovery time of affected populations and, in the worst case scenario, it will lead to the further erosion of assets and a deterioration in nutritional status (FEWS 16/05/02). The recurrent cycle of drought and malnutrition has prompted calls for a shift away from purely emergency response to longer-term development commitments that seek to address the root causes of food and livelihood insecurity. This involves addressing the numerous structural deficiencies that exist, such as water availability, health and education.

Refugees

Ethiopia has two main refugee populations of 84,000 Sudanese in the west and 67,000 Somalis in the east. The situation of the refugees remains very mixed and, in general, there is a high dependency on food assistance. The Sudanese community is likely to remain relatively static given the ongoing conflict in Sudan but there have been substantial returns of Somalis from the camps of Hartisheik, Kebribeyah, Camaboker, Rabasso and Aisha. Ethiopian authorities are expecting up to 35,000 refugees to be repatriated during the first half of 2002 (AFP 25/05/02). The RNIS does not have any recent nutritional information from this group but they must be considered to be extremely vulnerable as a result of their dependence on food assistance and the ongoing food insecurity in the Somali region.

War displaced population in Tigray and Afar

The war between Ethiopia and Eritrea in 1998 resulted in the large-scale displacement of people from the Tigray and Afar region who suffered the destruction of their homes and livelihoods. Many have been able to return to their areas of origin with the signed peace accords as the threat of further conflict diminishes. The presence of large amounts of mines and unexploded ordinance (UXO) continues to pose a threat to returnees, but work is ongoing to clear areas and ensure the safety of pastoralists and farmers who require unhampered access to their land.

The situation has been complicated in recent months by the continuation of drought conditions, particularly in Afar. Afar is acknowledged to be one of the driest places on earth and there are reports of serious shortages in water and pasture despite receiving near adequate rain from March to April. This is having a serious impact on the food security of the population in the area and has resulted in the out migration of pastoralists. The situation is concerning for those displaced and affected by the war, particularly the estimated 40 % of households headed by women who have lost their husbands due to war and famine (UNOCHA 11/06/02). The RNIS has not received any recent nutritional information on this group.

Somali region, Eastern Ethiopia

The Somali Regional State, known as Region 5, is one of the largest areas in Ethiopia and remains one of the worst affected. The official population of the area is 3.4 million people and up to 85 % of them are pastoralists who rely entirely on their cattle for their livelihoods. The drought of 2000 was a catastrophe because it resulted in huge livestock deaths and left much of the population struggling to cope even with the improved situation.

The Gu rain season in the Somali region has generally been good for pasture and livestock this year but the humanitarian outlook remains extremely bleak due to the chronic erosion of livelihoods and the constant food insecurity suffered as a result. This has highlighted the enormous need for long-term development commitment to the area rather than just emergency response programmes.

UNICEF, in conjunction with the Mother and Child Development Organisation (MCDO) and other partners, conducted two surveys in the displaced camps of Fafan and Hartisheik in February and March 2002. The survey in Fafan IDP camp found an estimated prevalence of acute malnutrition of 28.4 % (W/Ht < - 2 Z scores and/or oedema), which included 3.4 % severe malnutrition (W/Ht < - 3 Z scores and/or oedema). The survey also estimated that the under-five mortality rate was 4/10,000/day (UNICEF/MCDO 10/02/02). The results are alarming because they are above emergency thresholds and indicative of a serious situation with unacceptably high rates of acute malnutrition and mortality. It is also concerning to note that the nutritional situation appears to have deteriorated since the last survey in October 2001. The main factor in the deterioration has been the lack of regular general food distributions, with a reported lack of any distribution from October to December. Some food had been made available for distribution but had still not been distributed in February 2002 due to disagreements with the local administration (UNICEF/MCDO 10/02/02).

The second survey was conducted in Hartisheik camp and it was noted that the under-five population represented less than the expected 17 % of the population, prompting speculations that the total camp population may have been over estimated. There were also a high number of aged people present in the camp, representing a significant vulnerable population. The survey was conducted on all the under-fives and indicated a rate of acute malnutrition of 26.6 % (W/Ht <-2 Z scores and/or oedema) including 2.2 % of severe malnutrition (W/Ht <-3 Z scores and/or oedema). The survey also showed that the CMR was 0.15/10,000/day and the under-five mortality was 1.6/10,000/day (UNICEF/MCDO 05/03/02). The results once again point to an alarming situation with the malnutrition rates well above emergency thresholds, although the mortality rates are within emergency limits. The high rates of acute malnutrition have been attributed directly to the poor provision of general food rations. The last distribution before the survey was in October 2001. This is a result of a dispute with the local administration responsible for the distribution, which insist that the food should also go to the local population. Without a proper resolution, all food remains undistributed. The presence of selective feeding programmes has prevented a high infant mortality but the poor water and sanitation conditions in the camp present a considerable risk to further deteriorations in the nutrition situation. (UNICEF/MCDO 05/03/02).

Overall

The continuation of acute needs in many parts of the country despite the occurrence of an average rain season has served to highlight the acute food and livelihood security of much of the population. The situation is precarious in various parts of the country, in particular the Afar and the Somali region (category II) and the displaced in the Somali region remain acutely vulnerable (category II). The situation is unlikely to improve without further long-term development commitment to affected areas.

Recommendations

The RNIS notes that these recommendations are not new and have been repeated in past surveys in the camps. If they are not implemented then the unacceptably high rate of malnutrition and disease WILL continue.

From the UNICEF/MCDO surveys in Fafan and Hartisheik IDP camps, Feb/March 2002

· Distribute a regular, monthly and nutritionally adequate general ration, targeting the IDPs as a priority.

· The DPPB should take responsibility for the distribution of food to IDPs.

· Implement a blanket distribution of CSB and oil to all under-five children in the camp for at least 3-6 months.

· Continue the weekly Supplementary Feeding Programme and maintain the Therapeutic Feeding Centre.

· Improve health care facilities in the camp, including vaccination.

· Ensure the provision of adequate safe drinking water and improve sanitation facilities.

Kenya

The current humanitarian situation in Kenya has seen improvements over the past couple of years, although the frequency of drought and the presence of inter ethnic fighting has left many areas of the country acutely food insecure and vulnerable to further crises. The food security prospects appear relatively good in most arable areas of the countryand the areas of greatest concern remain the northern pastoralist regions, particularly Mandera and Turkana, where rates of malnutrition are reported to be particularly high.

The humanitarian response is suffering from budgetary constraints, which continue to threaten the food pipeline, and reductions in food rations have been reported. WFP have announced that there is a food deficit of 5,000 MT until the end of 2002 (WFP 24/05/02) and there is an urgent need for new pledges to ensure that the needs of refugees in the Kakuma and Dadaab camps are met.

Refugees

Kenya has a large refugee population of around 220,000 people, mostly from Somalia and Sudan. The government policy has been to house the refugees in two large camps in the northeast and northwest of the country. Kakuma camp, in the northwest, is home to approximately 83,000 people and Dadaab, in the northeast, to over 130,000. The camps are located in intensely arid zones, where they are generally not allowed to settle outside the camp or conduct business activities. This has created an almost total dependence on humanitarian assistance. The inability to develop their own coping mechanisms and their dependency on food aid is particularly concerning given the current problems with providing funding. This has prompted the International Rescue Committee (IRC), who oversee the activities in Kakuma camp, to highlight the issue to the US senate. The last survey to be conducted (see RNIS 36 and 37) indicated a prevalence of acute malnutrition well above emergency thresholds, and more commonly associated with acute nutritional emergencies and not with a population in a stable camp environment (IRC 04/06/02). The situation has not improved and has been attributed to the cut backs in the general ration which have been necessitated by funding problems for WFP. WFP have announced that they have been forced to reduce the food ration from the recommended 2100 Kcal to 1600 Kcal and that, unless further funding was forthcoming, further reductions were inevitable.

Fighting in the Gedo town of Bulo Hawa, borderingthe Kenyan Mandera district, has resulted in the influx of close to 10,000 Somalis. Approximately 5,000 returned to Somalia but the remainder are located a mere 500 m from the border and have remained largely inaccessible to humanitarian workers. The situation in Gedo, with regards to both security and the humanitarian situation, is extremely serious and many of the remaining refugees are reported to be in extremely poor shape. Up to 80 % of the refugees are reported to be women and children and there are very little available food and medical supplies. There has been considerable concern over the future of the refugees because the Kenyan government has been very reluctant to either repatriate them or move them to one of the designated refugee camps. Many refugees have been hesitant to relocate within Kenya because they anticipate returning as soon as the situation in Gedo improves. The RNIS does not have any nutrition information on this group but they are considered to be extremely vulnerable.

Overall

The overall situation in Kenya is showing signs of improvement although the chronic food and livelihood insecurity of some areas, particularly the northern pastoral regions, means that areas of acute need do still exist. The refugee population is considered to be at considerable risk (category II) of further nutritional decline if the food pipeline situation does not improve. There is also concern over the fate of recent Somali refugees in the Mandera district who should be considered at elevated risk of malnutrition.

Recommendations

From the RNIS

· Ensure that funding is made available to the PRRO to ensure that refugees dependent on food assistance receive an adequate general ration.

· Ensure that distributed food is adequately fortified with micronutrients.

Somalia

Somalia continues to have one of the worst humanitarian outlooks in the world and has been a "complex emergency" for over eleven years. The protracted emergency has its roots in a combination of recurrent periods of devastating drought that have hugely affected the livelihoods of much of the population, and intense insecurity brought about by regular inter-clan fighting and the lack of a centralised government. These factors have led to the destruction of the economy, infrastructure and livelihoods and have routinely prevented the provision of social services throughout the country. The result has been a greatly impoverished nation suffering from chronic food insecurity and levels of acute malnutrition that are amongst the highest in the world.

Current humanitarian situation

Somalia has received a good Gu rainfall that has seen an improved crop outlook and the replenishment of vital water and pasture sources. However, despite the relatively good rainfall and the positive implications it could have for food security, the greatest impediment, currently, to the improvement of the humanitarian situation remains the chronic cycle of insecurity in the country. Conflict in various parts of the country, particularly in areas of the northern and southern regions, has resulted in displacement and constrained the ability of the population to implement coping strategies. The conflict is a result of inter-clan rivalries and opposition between the Transitional National Government (TNG) in Mogadishu and rival opposition groups. Insecurity has resulted in the suspension of aid agency activities and the evacuation of personnel, often from areas where the humanitarian needs are greatest. Staff from UN agencies, the EU and international NGOs were all evacuated from the northern Punt-land region in May 2002 due to fighting between the past and present presidents of the region (UNOCHA 22/05/02). In April 2002, a senior member of the Gedo Health Consortium was killed by crossfire in Bulo Hawa and access to the area was further constrained by the mining of roads to the area (UNICEF 29/05/02). There have also been repeated reports of kidnappings of humanitarian aid agency staff. On 28 April 2002 a UNDP staff member was kidnapped in Mogadishu, prompting the suspension of all UN activities. The situation in northern Gedo, particularly around the town of Bulo Hawa, is particularly serious, as the renewed conflict, starting in late March 2002, has compounded the existing critical humanitarian situation due to consecutive years of drought. This has resulted in a population that is heavily dependent on humanitarian assistance to meet the majority of its subsistence needs.

Conflict and drought have contributed to the appalling economic conditions seen in Somalia. Other factors that have served to increase the severity of the current situation are the ongoing livestock ban on Somali livestock imposed by the Gulf States who represent the largest importers of livestock. Livestock have traditionally been a major source of revenue for the country and pastoralists have traditionally relied on this important form of cash as one of their chief livelihood activities. As a result, the ban continues to have important adverse affects on pastoral communities. Another blow to the economy has been the shutting down of the primary remittance firm in the country, Al Barakat, due to its alleged links with the Al Qaeda terror network. Remittances have traditionally played an essential role in the economy and have helped to support beleaguered coping strategies in many areas. The combined shocks to the economy have resulted in the continued devaluation of the Somali shilling. This has combined with rises in the cost of imported commodities to further reduce the purchasing power of impoverished groups and thus hamper access to essential food sources (FSAU 05/02).

The effects of the current situation have left many people, already chronically food insecure from years of drought and conflict, extremely vulnerable and increasingly dependent on external assistance. It is currently estimated that there are 500,000 people in need of emergency relief assistance, with the situation for 200,000 people in the Gedo region deemed extremely critical (FSAU 01/07/02).

Southern Regions

Gedo

The situation, particularly in the north, continues to be considered critical. Key features of the crisis have been the failure of water and pasture sources and the upsurge in conflict that has constrained the already overburdened coping mechanisms and prevented humanitarian access to those in need. The drought in the area is entering its third year and has resulted in people turning to more and more extreme coping strategies including the movement of livestock to distant areas where they have become inaccessible to those left behind. The situation has deteriorated as a result of low wages in urban areas and the general erosion of social support systems, which have traditionally been important sources of help for impoverished people (FSAU 07/02).

Conflict has been common in the area for some time but became wide scale in March 2002, and is centred on the northern town of Bulo Hawa. Large numbers of people have been displaced into the Madera district of northern Kenya and into Ethiopia, as well as within Somalia. The already critical humanitarian situation was made worse by the lack of access to the area by the humanitarian community due to fighting and the presence of land mines on roads to key areas. For three months, all humanitarian operations, as well as the ability to import foodstuffs from other areas of the country, have been interrupted. Some food distributions took place in late June 2002 in Elwak, Bulo Hawa and a few parts of Dolow, but it is important to note that there has been no distribution in the critical area of Luuq for the third consecutive month (FSAU 07/02). The RNIS does not have any recent nutritional information from Gedo but the situation is known to be critical. Much of the population relied on food assistance prior to the upsurge in conflict and the absence of any form of assistance for more than three months substantially increases the likelihood that the nutrition situation has deteriorated considerably.

Bay and Bakool

The prospects for the upcoming harvest are mixed with some areas of Bay receiving adequate rains whilst areas of Bakool have been affected by poor rainfall. Bakool represents the area of greatest concern with reports of poor livestock condition as a result of poor water and pasture. As a result, livestock movement has been reported. The FSAU report that a nutrition survey was conducted in May 2002 in Berdaale district in the Bay region. The district was identified as vulnerable as a result of particularly poor Gu and Deyr rain seasons in2001, which led to crop failures. The survey indicated that prevalences of acute malnutrition were well above emergency thresholds and indicated a deterioration of the nutrition situation compared with results from a similar survey in 2000. The reasons for the high rates are thought to be poor food security and high incidences of communicable disease.

Mogadishu

The RNIS has not received any recent nutritional information on the displaced in Mogadishu but the situation is deemed to be of concern as a result of the general poor economy and impoverishment within the country. This has led to a poor food security outlook in many areas, but in particular urban environments where lack of employment opportunities have had a severe impact on all population groups, particularly vulnerable groups such as the displaced.

Northern Regions

Somaliland

President Mohamed Ibrahim Egal of Somaliland died at the beginning of May 2002, however the transition of power to his successor has been peaceful. The self claimed state has suffered from the drought of recent years and has been particularly affected by the livestock ban from the Gulf States. However, the relative peace and stability of the region has allowed robust coping to take place and indications are that the situation is not critical, certainly in comparison to other areas of the country. In May 2002, the Ministry of Health and Labour (MoHL), with FSAU and UNICEF, conducted a nutrition survey in the Sahil region of Somaliland. This area includes some of the most populated zones of the region, including the port and capital of Berbera. The survey, as reported by the FSAU, indicates that the prevalence of acute malnutrition was moderately high and just above the emergency threshold of 10 %. The survey also noted that the presence of childhood disease was relatively low and that the main cause of observed malnutrition was poor food security due to the drought and the economic effects of the livestock ban. It was also noted that some child-care practices, most notably breast-feeding, were less than optimal (FSAU 05/02).

MoHL, FSAU and UNICEF conducted a second survey in May 2002 in Haud of Hargeisa. The crop prospects for the area are considered bad as a result of poor rains and the livestock ban has severely affected livestock activity, which is the main livelihood activity in the area. There have also been increases in the price of cereals due to the closure of the refugee camps in Ethiopia that traditionally have provided a source of cheap cereals. The survey indicated that the prevalence of acute malnutrition is not raised above emergency thresholds. This is a result of generally good coping opportunities in the area and the resultant adequate food security. This has undoubtedly been helped by the lack of conflict in the area (FSAU 07/02).

Puntland

The situation in Puntland is poor as a result of on-going fighting in the area. Fighting resumed on 6 May 2002 between the former president and his successor and this has resulted in displacement and the evacuation of aid staff after the 9 May 2002 announcement that they were not welcome in Puntland (UN OCHA 22/05/02). Staff were subsequently welcomed back into the area but the security situation remains poor. The RNIS does not have any recent nutrition information on the region but the situation is assumed to be poor.

Overall

The humanitarian situation in Somalia continues to be extremely precarious, with the region of Gedo being of particular concern due to ongoing insecurity and the inability of aid agencies to access populations in critical need (category I).

Recommendations

From the RNIS

· Address issues of water and food availability as matters of priority.
· Facilitate humanitarian access to affected populations where possible.

Sudan

Sudan has a long history of natural disaster and civil conflict, which have resulted in the displacement of over 4 million people. Much of the displacement has taken place in the south of the country and is a direct consequence of conflict between the government and southern rebel groups such as the Sudanese People’s Liberation Army (SPLA). This conflict, punctuated by periods of intense drought, has systematically driven people from their lands, destroyed their livelihoods and constrained coping strategies, resulting in a population that has come to rely heavily on the provision of humanitarian assistance.

The current humanitarian situation is extremely poor, as the reporting period has coincided with the main dry season fighting period, which has seen an enormous increase in the level of military activity. The fighting has involved the extensive use of aerial bombing and the targeting of civilian populations and, as a result, there has been a great deal of renewed population displacement. This is particularly concerning because it has occurred at a time when people would normally be preparing land for cultivation and it is inevitable that this will have further adverse affects on the food security of many people. The areas that appear worst affected are the western and central Upper Nile regions and areas of the Bahr al Ghazal where there has been an observed deterioration in the humanitarian situation and increasing levels of acute malnutrition. This trend is expected to worsen further during the annual hunger season, which started in June.

The physical size and inaccessibility of much of the affected areas means that it is extremely difficult to calculate how many people are currently affected by the crisis. However, WFP estimated in their annual needs assessment that there are in excess of 1.5 million in need of emergency food assistance in southern Sudan alone (WFP/SCF 10/01). This number is likely to have increased as a result of the scale of upsurge in conflict and the reports of displacement. Given the scale of the current needs, it is alarming to note that at the end of May 2002 the UN appeal for Sudan had only received 18 % of its requested funding, leaving a shortfall of 223 million US dollars (UNOCHA 31/05/02). The shortfall comes at a time when the needs appear to be growing enormously and there is very real concern over the continuation of life saving support to populations in need.

Humanitarian access

Humanitarian access has always been a problem in Sudan, however the reporting period has seen access deteriorate, particularly to key affected regions in the western Upper Nile, or Unity State and to areas in Bahr al Ghazal. Due to the physical size of much of the south, the humanitarian community has relied on air transportation to supply much needed supplies to populations. The government of Sudan (GoS) has traditionally issued permission for aircraft to access individual sites. The reporting period has seen an increase in the number of sites that have been banned from humanitarian access and at the beginning of April 2002 there were 40 locations in southern Sudan that were not accessible to flights or general humanitarian access due to "security reasons". This effectively prevented 1.7 million people from receiving humanitarian assistance. On 16 May 2002, the GoS announced that there was a ban on all flights to the entire western Upper Nile area (UN OCHA 24/05/02), which is one of the areas most affected by the conflict and also most sensitive to the government due to the lucrative oil fields in the area. The implications of the denial of access are extremely alarming because they affect so many people by preventing them from receiving life saving humanitarian assistance. It is particularly concerning to note that the scale of the current flight denials, at a time when there is increased military action by both sides in the conflict and has led to widespread civilian displacement, mirrors the same pattern of events which led to the humanitarian catastrophe in the Bahr al Ghazal in 1998.

South Sudan, non-GoS controlled areas

(OLS Southern Sector)

The humanitarian situation in south Sudan has worsened overall compared to last year as a result of the continued conflict in the already desperately food insecure areas such as western and central Upper Nile and areas of Bahr al Ghazal. In areas where there is no fighting the food security situation is relatively good as a result of reasonable rain and harvests. However, most areas have been affected by the current round of fighting and have either received IDPs or have suffered from disruptions in trade and livelihoods.

Aweil counties

The Aweil counties have tended to suffer insecurity due to their proximity to the train track that supplies the government held enclave of Wau town with the north. Recent surveys have indicated that the situation is extremely precarious with high levels of acute malnutrition. The RNIS has received reports of a recent nutrition survey by Teafund, following up on a survey conducted in November 2001 (see RNIS 36 and 36). The survey indicates that there has been no real change in the nutritional status of the population in the last 6 months, with acute malnutrition estimated at over 20 % (Personal communication). The consistently high prevalence of acute malnutrition is very concerning and certainly indicative of a very poor situation. The report attributes the causes of malnutrition predominantly to public health problems and a lack of community awareness of malnutrition. The outlook for the future is extremely mixed as the area is now in the seasonal hunger period and there is some time before the next harvest. As a result vulnerability is expected to remain high.

Equatoria

The RNIS has not received any recent nutritional information from Equatoria but the situation is assumed to be very poor as a result of ongoing fighting between the Ugandan army and the Lord’s Resistance Army (LRA), which has based itself in Equatoria. The reporting period has seen the continuation of the campaign by the Government of Uganda to hunt down the LRA and prevent its incursions into northern Uganda. The fighting has resulted in large-scale displacement of population and the disruption of normal trade and livelihood activities. Areas particularly affected have been the Torit and Lainya areas in Yei. The food security situation for the displaced from Raga living in Tambura (Western Equatoria) has improved as they have been able to access the local economy through the sale of labour during the cash-cropping season (FEWS 12/06/02).

Jongolei

The situation in Bieh state is still considered to be extremely poor and surveys conducted in Akobo and Nyandit in February 2002 indicated a very poor situation. MSF conducted a survey at the end of May 2002 in the Dirror district, close to Akobo. The population is largely nomadic and people rely on their cattle as their chief livelihood activity. The area has been particularly badly affected by a mass exodus of population in 2001 to follow a "prophet", who was subsequently killed in January 2002. Crucially, the exodus occurred during the main cropping period and people have faced this season without anything, including their cattle, which were raided whilst they were away. As a result, the population has been surviving mostly on wild foods such as laloup and is extremely food insecure. The survey showed an estimated prevalence of acute malnutrition of 39.9 % (W/Ht < -2 Z scores and/or oedema), which included 9.8 % of severe malnutrition (W/Ht < -3 Z scores and/or oedema) (MSF 05/02). The survey also indicated that the CMR was 1.1/10,000/day and the under-five mortality was 2.2/10,000/day. Both the nutrition and mortality results indicate that the situation is extremely serious. The prevalence of malnutrition is four times that which defines an emergency and it is doubly alarming to note that one third of the children who were not yet severely malnourished were imminently at risk of becoming so. The survey also indicates that the mortality figures are likely to be greatly underestimated, as people did not like to talk about the dead. The results demand immediate action to prevent further loss of life.

Upper Nile

The Upper Nile region remains acutely insecure from fighting over the oil reserves in the area, and has been extremely difficult to access for humanitarian agencies. The RNIS does not have any recent nutritional surveys from the area but reports indicate that rates of malnutrition remain extremely high and well above what are considered to be emergency thresholds. This indicates a population in extreme distress and, with the current hunger season and ongoing conflict, it is likely that there will be further deteriorations in the nutritional status of the populations in the area, which will inevitably impact on rates of both morbidity and mortality.

South Sudan, GoS controlled areas

(OLS Northern Sector)

Many of the GoS controlled areas have been at the epicentre of the upsurge in conflict and the populations remain very heavily affected with very poor food security and vulnerable to further nutritional insults.

Wau

Wau town is located 800 Km southwest of Khartoum and has been a GoS enclave for the past 18 years. The town remains extremely isolated and dependent on supplies by air and from a government supply train once a year. The town is still viewed in the area as a refuge in case of serious insecurity and the camps continue to accommodate new IDPs. ACF conducted a series of surveys in three of the IDP camps (Eastern Bank, Marial Agieth and Bar Yar). The IDPs are all mainly pastoralist in origin but have mostly lost their cattle and now concentrate on agriculture. However, the WFP annual needs assessment calculated that they would suffer an overall food deficit of over 80 % for 2002. The survey took place in February and March of 2002, before the beginning of the hunger season. The results of the three surveys can be seen in the table below and indicate that the levels of acute malnutrition are above emergency thresholds and offer cause for concern (ACF 03/02).

Table showing the results of the ACF survey in Wau IDP camps Feb/March 2002

Acute Malnutrition
	W/Ht < -2 Z scores and/or oedema	W/Ht < -3 Z scores and/or oedema	Under-Five Mortality Rate/10,000/day
East Bank	18.4	1.6	1.06
Marial Agieth	14.3	2	0.7
Bar Yar	15.7	2	Not measured

It is also important to note that the prevalence of malnutrition marks a significant decline from surveys done in 2000. The camps are served with basic amenities but there is evidently a high burden of chronic disease, poor sanitation and grinding poverty without the opportunity to develop sustainable strategies of coping or to restart livelihood activities. It is particularly important to note that the population was traditionally accustomed to having access to milk and milk products from their livestock, which are no longer available to them. The surveys indicate that the IDPs are at considerable risk and highly dependent on the support offered to them by humanitarian agencies.

Juba town

Juba town is a government enclave in Bahr al Jebel State. The last mass wave of internal displacement to Juba was in 1998 and the town and its surroundings have been quiet for the past couple of years. The food security of the town is largely dependent on external supply by barge or by plane and WFP is providing targeted food distribution to the vulnerable groups of the IDP population. ACF conducted surveys in the town and surrounds in December 2001 (ACF 12/01). The surveys indicate that the situation was not critical, with all indicators below emergency thresholds (see table below)

Table showing results from ACF survey in Juba town and surrounds December 2001

Acute Malnutrition
	W/Ht < -2 Z scores and/or oedema	W/Ht < -3 Z scores and/or oedema	Under-Five Mortality Rate/10,000/day
Juba town	8.9	1	1.05
Juba surrounds	8.2	0.8	0.44

The greatest problem facing the IDPs and other residents of the town is that of the poor economy and lack of employment opportunities. The conflict continues to disrupt trade routes and many of the IDPs remain extremely dependent on external assistance.

Unity State

Unity state is currently one of the most insecure states in Sudan and has also suffered extensively from GoS flight bans. It is bordered by West Kordofan, Bahr al Ghazal and Upper Nile States. The state has been massively affected by the fighting between GoS forces and the SPLA who are fighting for control over the lucrative oil reserves in the area. The insecurity has increasingly made the populations of the area unable to sell their labour to the oil fields, which until recently had provided a very important source of income. Many people have suffered displacement and have moved to towns such as Rob Kona and Bentiu, where they are largely dependent on external assistance. ACF conducted surveys in the towns in April 2002 and the results (see table below) indicate that the nutrition situation is extremely alarming, with the prevalence of acute malnutrition double the emergency threshold. It is particularly concerning to note that the survey was conducted before the beginning of the hunger season and it is reasonable to expect that the nutritional situation will deteriorate further with the coming of the rains, as will various communicable diseases (ACF 04/02).

Table of results from ACF surveys in Bentiu and Rob Kona, April 2002

Acute Malnutrition
	W/Ht < -2 Z scores and/or oedema	W/Ht < -3 Z scores and/or oedema	Under-Five Mortality Rate/10,000/day
Bentiu	21	2.1	1.3
Rob Kona	24.3	3	0.97

Overall

The overall humanitarian situation in Sudan is extremely poor as a result of an upsurge in violence, which has continued to result in population displacement and has constrained the ability of the humanitarian community to address the increased needs of vulnerable populations. It is alarming to note that access is proving most difficult in areas where the needs appear to be the greatest and people should be considered to be at greatly elevated risk (category I).

Recommendations

From the RNIS

· Facilitate access to critically vulnerable populations.
· Urgently provide food distributions to populations in need.

· Continue regular nutritional surveillance.
· Maintain feeding centres in order to have a crisis response capacity.
· Conduct education on infant feeding and child-care.

· Conduct a food security and nutritional causal analysis in the camps.
· Improve the referral system in the camps.
· Provide timely, adequate general food rations.
· Develop agricultural programmes to decrease dependency on food aid.

· Continue selective feeding programmes.

· Ensure timely arrival of monthly general food distributions.

· Implement water and sanitation activities.

· Reinforce the analysis of the food security situation, including post distribution monitoring and population movement, to ensure adequate response capacity.

· Implement immediate Therapeutic and Selective Feeding programmes.
· Implement blanket feeding programme for all under-fives.
· Advocate for increased food ration.