GREAT LAKES

Burundi
Democratic Republic of Congo
United Republic of Tanzania
Uganda

GREAT LAKES REGION

Burundi

The security situation remains volatile with insecurity in several provinces as well as attacks in Bujumbura. One hundred and eighty three people, many civilians, were killed in Gitega on the 9^th of September (AFP, 17/09/02). The involvement of the army is unclear (AFP, 19/09/02; OCHA, 20/09/02). Peace talks between the government and the main faction of Hutu rebels, the Forces for the Defence of Democracy” (FDD) began in Tanzania on the 12^th of August 2002 and are continuing, but there has been no tangible progress so far (AFP, 11/09/02). Attacks have also led to population displacements, sometimes for only short periods. Populations are in any case disrupted by these continued attacks, which often ruin property and prevent cultivation. WFP will distribute seed protection rations in the provinces particularly affected by insecurity, together with seeds and tools provided by FAO (WFP, 20/09/02).

The recurrence of attacks has also seen a new influx of about 3,000 Burundian refugees into Tanzania, in September. There have been reports of the army preventing refugees crossing the border (OCHA, 20/09/02).

Repatriation of refugees from Tanzania into Burundi is still continuing with an estimated 24,650 facilitated repatriations and 18,000 spontaneous returns, but this has decreased within the recent weeks, possibly due to the upsurge of violence (UNHCR, 20/09/02).

Nutrition and food security situation

The results of the nutritional surveys carried out since the beginning of the year in 5 provinces show low rates of malnutrition except in Makamba province. This province hosts the highest number of displaced (see map).

Acute malnutrition prevalence, Burundi, 2002 (UNICEF Burundi)

In the provinces where previous data is available, rates of malnutrition are far lower this year than in the previous years (see graphs). The process of transferring the nutritional activities to the MOH has begun in some of the provinces. It is hoped that the on going fighting will not lead to a repeat rise in malnutrition rates.

Malnutrition prevalence among 6-59 month olds children, Kirundi province, Burundi

Malnutrition prevalence among 6-59 month olds children, Karuzi province, Burundi

Malnutrition prevalence among 6-59 month olds children, Muyinga province, Burundi

A food security assessment was conducted in Ruyigi province in June 2002 by AcF. The acute malnutrition rate estimated through a survey in March 2002 was of 3.8%. The province received a lot of returnees, mainly spontaneous returnees (an estimated 5,500 from January to August) because the area is considered insecure by UNHCR. These refugees receive no help from UNHCR for either repatriation or when returned (UNHCR, 22/08/02). The survey reported that the vulnerable population presents the following criteria: no livestock, poor access to highlands and swamps and low fertility of lands and agricultural wages as an important source of income.

The crop production of the poorest lasts only for one to two months, and is compensated for by a higher consumption of tubers. Health access is very poor due to lack of means.

Disease outbreak

There have been outbreaks of cholera and meningitis in the past months. The cholera outbreak has spread into Bujumbura (591 cases), Bubanza (46 cases) and Cibitoke (157 cases) (WHO, 29/08/02). The number of cases decreased in September.

A meningitis epidemic has been declared in the provinces of Muyinga, Kirundo, Ngozi and Ruyigi, and some cases have been reported in Cankuzo province. A vaccination campaign will take place in the affected provinces (WHO, 12/09/02).

Overall The nutrition situation seems to be under control (category IV), apart from the displaced, who are still at risk (category II).

Recommendations and priorities

From The AcF survey in Ruyigi

· Support agricultural production of the vulnerable families through groupements.

· Monitor the situation of new IDPs

Democratic Republic of Congo

Peace accords were signed at the end of July between DRC and Rwanda, aimed at withdrawing Rwandan forces and disarming the ex-FAR and In-terahamwe factions (Reuters, 30/07/02). Peace agreements were also signed between DRC and Uganda in early September (BBC, 09/09/02). Ugandan and Rwandan forces are currently withdrawing from RDC and 2,000 Rwandan Hutu ex combatants have been disarmed (OCHA, 26/09/02). Nevertheless, the security situation remains very tense in various parts of Congo with on-going displacement of populations and lack of access by humanitarian organisations to a significant number of people.

Internally Displaced Persons

The number of IDPs is extremely difficult to estimate because of widespread and frequent displacements due to fighting as well as access difficulties. However, OCHA estimates that as of July 2002, there were about 2 m people displaced throughout RDC. In 1996 the number of IDPs was estimated to be only 400,000, clearly the situation has worsened over the past several years. IDPs are mostly located in North Kivu, South Kivu and Orientale provinces. Most of the IDPs are living near relatives or in the bush.

Repatriation of Refugees from Rwanda

About 8,000 Congolese refugees previously settled in Gihembe camp in Byumba prefecture and at Kiziba in Kibuye prefecture have been repatriated by the Rwandan government to the Masisi region of Congo. UNHCR has expressed its concern about forced repatriation (UNHCR, 05/09/02). As of 17 September, it seems that the repatriation has slowed (UNHCR, 17/09/02). Despite some refugees saying they were willing to be repatriated, others claim they were forcibly returned. There were also reports of intimidation by local security forces stating it was time for the refugees to return home. The refugees who left hurriedly were only able to carry out few of their belongings (UNHCR, 17/09/02). The returnees are settled in Kitchanga, 80 km north of Goma, in an old tea factory. A UNHCR mission indicated that the sanitary situation was very poor with only three latrines for 8,000 people and a lack of potable water (UNHCR, 17/09/02). On the other hand, the Rassemblement Congolais pour la Démocratie (RCD) stated they had provided food and tools to the returnees (OCHA, 12/09/02). There are reports that direct access to the returnees is being prevented (OCHA, 19/09/02).

Nutrition and health situation

No recent survey reports have been made available to RNIS. WFP reported a troubling nutrition situation in the city of Kindu in Maniema. People were being prevented from going out of the town which was surrounded by the Mayi-Mayi forces (WFP, 30/08/02). The nutritional situation was also reportedly poor in Zongo in Equateur province (WFP, 26/07/02). WFP recommended that a nutritional survey be undertaken in Kindu, as well as support provided to feeding programmes (OCHA, 31/08/02). A TFC opened by AAH-USA in Shabunda in South Kivu, received more than 100 patients in the first month.

Recent fighting in Bunia, North Kivu, has led to a new humanitarian crisis. Food and non-food aid is being supplied now the situation in the town is more secure although it is still tense. A cholera outbreak, due to poor water supplies after the piped water was cut off has been reported continuing since August (MEDAIR, 06/09/02).

In Katanga, a cholera outbreak is still on going with 368 new cases in the week of 19-25 August 2002 (OCHA, 31/08/02). In addition the province of Katanga will probably be affected by the drought in Southern Africa because the province has been importing about 80 % of the staple food and 90% of the seeds from Southern Africa countries. It seems that there is already food shortage. Distribution of cassava seeds and cuttings is therefore needed in addition to on going food security programs (OCHA, 31/08/02; AFP, 20/09/02).

Overall The situation of millions of IDPs is thought to be still very poor (category I). In addition, forcibly repatriated refugees from Rwanda seem to lack basic services and are considered at risk (category II).

Recommendations and priorities

· Ensure full access to the people repatriated from Rwanda and more globally to the RDC population

· Provide basic services and food to IDP and repatriated

· Prevent the degradation of the situation in Katanga area

United Republic of Tanzania

Tanzania hosts more than 500,000 refugees in Kigoma, Kibondo, Kasulu and Ngara districts. The refugees are mainly from Burundi but also from DRC and Rwanda. Tanzania is in the process of formulating a new refugee policy in order that all refugees are repatriated home in the shortest time possible (Xinhua, 26/07/02).

Repatriation of Rwandan and Burundian refugees is ongoing with 1,951 Rwandans repatriated since the beginning of 2002 (WFP, 09/08/02). About 24,000 Burundian refugees have also been repatriated by UNHCR while another 17,600 have spontaneously returned (OCHA, 08/09/02).

Meanwhile, the deterioration of security conditions in the eastern and southern eastern provinces of Burundi has caused an increase in new arrivals and prevented repatriation to those areas. In the month of September, 3,000 Burundian refugees arrived in Tanzania, a 10 fold increase from August. They were reported to be either previously displaced in Burundi or former refugees. The total number repatriated also decreased from 1,500 per week a few months ago to about 350 per week (UNHCR, 01/10/02). New arrivals of Congolese refugees have also been reported (WFP, 30/08/02).

Except for pulses and CSB which were sometimes distributed at respectively 80% and 60%, WFP reported providing 100% of the ration regularly to the refugee population (WFP, 09/08/02; WFP, 04/10/02).

The average crude mortality rate and under-five mortality rate for the camps of western Tanzania were 0.33/10000/day and 0.75/10000/day respectively in July 2002 (UNHCR, 07/02). The under-five mortality rate was noticeably higher in some of the camps, the highest being in Lugufu 2. This camp, receiving new arrivals, had a rate of 1.91/10000/day. There were 490 patients in therapeutic feeding centres at the end of the month and 2,735 in supplementary feeding centres (UNHCR, 07/02).

An outbreak of meningococcal disease is spreading in the Great Lakes area. A vaccination campaign was completed on the 23^rd of September for both the camp and resident populations of Kibundo district. A vaccination campaign was also scheduled for the end of September in Ngara and Kasulu (WHO, 02/10/02).

Overall The situation of refugees seems to continue to be under control (category IV), although new arrivals experienced higher risks of death.

Tanzanie La Tanzanie abrite environ 500 000 réfugiés, essentiellement burundais mais aussi rwandais et congolais. Les taux de mortalité juvéniles, dans les camps de l’ouest de la Tanzanie, étaient de 0,75/10000/jour au mois de juillet 2002, mais plus élevés dans le camp recevant les nouveaux arrivants (1,91/10000/jour).

Uganda

Uganda has experienced an upsurge in violence in the past months, especially in the northern part of the country, following the implementation of an anti Lord’s Resistance Army (LRA) campaign within Sudan. The LRA has increased their attacks on refugee and IDP camps, and resident populations, as well as humanitarian convoys. Insecurity hampered efforts to deliver assistance to the affected populations. The LRA issued a statement demanding all NGOs and UN organisations cease operations and leave Northern Uganda by August 14^th (IRC, 08/08/02). Relief agencies nevertheless continued operations despite scaling back on staff and assets (AFP, 16/08/02).

Meanwhile in the western part of the country, nearly all the IDPs returned home as security stabilisated.

Northern Uganda

Refugee settlements

The LRA attacked the refugee camp of Acholi-Pii at the beginning of August, and more than 60 refugees were killed. Abductions, and looting of the camp warehouse were also reported. The 24,000 refugees settled in Acholi-Pii fled following the attack. Most of them were unable to save any belongings. They were temporarily accommodated in a transit camp in Kiryondongo. 8,000 of them have since been further transferred to the existing Kyangwali site, already hosting 6,800 Congolese refugees. Negotiations are underway to relocate those remaining (UNHCR, 30/08/02). Food, medical assistance and non food items have been provided (UNHCR, 09/08/02).

Maaji refugee settlement was also attacked at the beginning of September, leading to the displacement of 6,000 more refugees, who sought temporary shelter in buildings around the settlement (UNHCR, 13/09/02).

Impevi refugee settlements

The District Director of Health Services for Arua local government conducted a survey in the Impevi refugee settlements in June 2002 (DDHS 06/02). The survey showed a prevalence of acute malnutrition of 9.0 %; 0.9 % of the children were severely malnourished, including 0.4 % of oedematous children. The situation appears not to be critical. Other survey results previously available to RNIS were from AcF in May and October 1998 (RNIS 26). These surveys estimated the prevalence of acute malnutrition at respectively 5.8 % (3.9 - 8.5) and 5.4 % (3.6 - 7.9), including respectively 0.4 % (0 - 1.8) and 1 % (0.4 - 2.5) severe acute malnutrition. The prevalence of acute malnutrition has slightly increased since 1998.

The survey also reported that mortality surveillance through the community and the health facilities showed low mortality rates. Refugees have been allocated agricultural plots but the fertility of the soil is poor. WFP is providing a full food distribution for the new arrivals and a one-half ration for the earlier arrivals. The drought has affected the agricultural activities, and this may partially explain the slight increase in acute malnutrition. Severely malnourished children are treated at Kuluva hospital.

Rhinocamp

Rhinocamp hosts about 24,000 refugees, mainly from Sudan. The nutritional survey undertaken by the District Director of Health Services Arua district for Arua local government in May 2002 estimated the prevalence of acute malnutrition at 5.6 % (3.7 - 9.3) including 0.1% (0 - 2.4) of severe acute malnutrition (DDHS, 05/02). No oedema was recorded. The nutritional situation in Rhino-camp has been stable since 1998 (see graph below). A variety of nutritional interventions are undertaken in the camps, such as growth monitoring. Treatment of the severely malnourished children is in Kuluva hospital.

IDPs in Northern Uganda

Attacks have intensified during recent months in the districts of Gulu, Kitgum and Pader. The situation is more precarious now than it has been over the last 5-6 years. More than 20 out of the 38 displaced camps have been attacked. Houses have been burned, and women and children abducted (WFP, 09/08/02). WFP estimated that 522,000 IDPs were in need of food aid in July 2002.

Because of the insecurity, tens of thousands of people are estimated to be seeking refuge in the main towns of Kitgum and Gulu, particularly at night. Estimates of the numbers displaced are difficult to make however due to the insecurity and because people seek refuge only at night. Lacor hospital in Gulu hosts large numbers of displaced. Water and sanitation facilities have been implemented.

The Ugandan army has ordered 100,000 people in the districts of Gulu, Pader and Kitgum to leave their homes and move closer to camps protected by the army (BBCNews, 03/10/02).

WFP resumed food distribution to IDPs in the camps in mid July, with enhanced military escorts. They are also providing weekly food distributions for the in-transit IDPs in towns. (WFP, 23/08/02). Because they were able to cultivate, people were on 30% rations before the attacks, but will now require the full distribution (FEWS, 25/07/02). Distributions are also carried out for the resident population affected by drought and attacks in eastern Kitgum and Pader (WFP, 09/08/02) although the WFP distribution was disrupted in Kitgum district following an attack on a food convoy (WFP, 20/09/02).

Insecurity prevented IDPs accessing fields. They will probably lose the current harvest and be unable to plant for the smaller second harvest. They will be highly dependent on the food distribution until the next harvest in August 2003 (WFP, 23/08/02).

Prevalence of Acute Malnutrition among 6 - 59 Month Olds in Rhino Camp, Uganda

Eastern Uganda

Many of the displaced in the Katakwi district (about 85,000 people) continue to live in protected settlements, after displacements caused by intense raiding by Karimonjong warriors over the past five years. Despite the disarmament operation in Karamoja, for the first time in over a year a camp was attacked in Okoboi and 140 head of cattle were stolen (OCHA, 15/08/02).

The population is reported to be moderately food secure, confirmed by the results of the last nutrition survey available to RNIS. This showed levels of acute malnutrition far below the emergency threshold (RNIS 37/38). Very dry conditions since May 2002 have curtailed millet and sorghum cultivation and it is estimated that the harvest will be 60% of normal. Nonetheless, the situation was not as bad due to the availability of cassava and sweet potatoes (FEWS, 25/07/02). The situation will have to be carefully monitored as the combination of drought and raids may affect IDP food security.

IDPs in Western Uganda

The large-scale operation against the Allied Democratic Forces (ADF) rebels launched in 2000 has greatly improved the security situation in Western Uganda. Combined with the improved relationship between Uganda and Sudan, and reduced support for rebels in Congo, the Ugandan government believes that Western Uganda is safely secured (OCHA, 29/05/02).

Almost all the IDPs in Western Uganda had returned home as of August 2002. Even in May 2002, it was estimated that 90% of the displaced in Kasese and Kabarole had returned home, with only 500 remaining in camps (OCHA, 29/05/02). The remainder of the IDPs, settled in the district of Bundibugyo, returned home during the first week of August and were provided with a three month resettlement food package. Following this they will receive assistance through food for assets and school feeding (WFP, 27/09/02). There is concern about the resettled IDPs as the infrastructure in their original locations seems far from adequate and the presence of landmines. Humanitarian agencies are concerned that the government takes into account the development of these areas (OCHA, 29/05/02).

Overall The attacks on the camps in Northern Uganda have led to new population displacements which will probably impair population food security for the next 12 months (category II). The refugee situation in Arua district in Northern Uganda seems under control, if not destabilised by insecurity (category III). The situation of the refugees who fled from the Acholli-Pii and Maaji refugee camps has to be carefully monitored. IDPs in Western Uganda have been resettled but their nutrition situation is unknown (category V).

Recommendations and priorities

From the DDHS surveys in Impevi and Rhino camps

· Continue surveillance and screening to identify malnourished cases
· Continue food distribution
· Strengthen agricultural activities to reduce food insecurity, by providing improved seeds and agricultural education

· Monitor the situation of IDPs in Northern Uganda and provide adequate support