United Nations System
Standing Committee on Nutrition

SUB-SAHARAN AFRICA

Greater Horn Region

Eritrea

Refugees

The Eritrean Relief and Refugee Commission expressed its concern about the future of thousands of Eritrean refugees in Sudan. Despite an on-going repatriation scheme and the fact that the refugees have been settled in Kassala region for years, the government of Karthoum would still prefer to relocate them further inland (ICC, 29/10/02). UNHCR stated they were unaware of this situation (OCHA, 01/11/02).

Drought

The FAO/WFP crop and food supply assessment has estimated that 1.04 m vulnerable people will require 140,000 MTs of food aid in 2003 (FAO/ WFP, 03/10/02).

The spring rainy season ( Azmera rains, March- June) almost totally failed in key agricultural areas and the main rains ( Kremti rains, June- September) were delayed by more than one month. It is anticipated that crop production will be only about 40% of the average for the previous ten years, the lowest level since independence. All regions are affected but Gash Barka and Debub, the bread basket regions, will suffer the biggest lost in absolute terms (see table).

Cereal production in 2002 compared to average (1993-2001), Eritrea (FAO/WFP, 03/10/02)

High livestock mortality rates (10-20%) were reported in most areas, as a result of depletion of available pasture and crop residues since April. However, in most areas, the remaining livestock has recovered since August, when the Kremti rains began, except in Southern and Northern Red Sea regions where poor summer rains occurred. The absence of young men, who have enrolled in National Service, is also limiting the most common coping mechanism, i.e. casual labour. It is estimated that emergency food aid will be required at least until the next harvest in November/December 2003. A shortage of seeds for the next planting season will also probably occur as a result of the poor harvest in 2002.

Northern and Southern Red Sea Regions

Two nutritional surveys were undertaken by MOH/DIA in August 2002 in urban and rural areas of Northern and Southern Red Sea Regions (MOH/DIA, 08/02). A high prevalence of acute malnutrition was found (see table); no oedema was recorded.

Acute malnutrition, Northern and Southern Red Sea regions, Eritrea, MOH/DIA, August 2002

Rates of malnutrition seem to have declined in urban areas since the last survey, which was done in September-December 2001, whilst they remain at the same level in rural areas (see graph).

Acute malnutrition, Northern and Southern Red Sea state, Eritrea

The Southern Red Sea region has particularly suffered from economic shocks since the war between Eritrea and Ethiopia in 1998. The port of Assab, which was the focus of major economic activity of the region, is currently almost unused. Pastoralists can no longer freely move to Ethiopia in search of pasture because of the closure of the border. Food aid has been distributed in both regions in 2002, for six months out of 12 in Northern Red Sea Region and for eight months out of 12 in Southern Red Sea Region. Given the current drought conditions, the nutritional status of the population may further worsen, unless additional action is undertaken to strengthen the food security of the population.

Anseba region

A nutrition survey was conducted by Concern in three sub-zones (Hagaz, Asmat and Habero) of Anseba region in November 2002 (Concern, 11/02). Agriculture and pastoralism are the main economic activities of the region, which has experienced drought for the last four years. The prevalence of malnutrition was 14.7%, which included 1.5% severe malnutrition; 0.4% of the children surveyed had oedema. The prevalence of malnutrition seemed to be similar to that recorded in Hagaz and Asmat sub-zones, in December 2001. Results of previous surveys, carried out in 2001 and 2002, showed that malnutrition rates are higher in summer months. In the current survey, the Asmat sub-zone seemed to be the most vulnerable. 95.7% of the children were vaccinated against measles, including 84.7% confirmed by cards. Various indicators have also been assessed during the survey (see table) by interviewing 770 families. The prevalence of malnutrition in the area is of concern. It may further increase in the coming months, because of seasonal variations, and because of the current drought.

Various socio-economic indicators, Anseba zone, Ethiopia, November 2002 (Concern, 11/02)

Overall - According to available data, the nutrition situation in some areas is very precarious (category I/II). It may worsen further because of the current drought.

Recommendations and priorities

From the MOH/DIA survey in Northern and Southern Red Sea:

• Continue food aid distribution
• Ensure a balanced full food ration
• Distribute supplementary food to children under five
• Support the initiative of the Ministry of Health to establish treatment of severe malnutrition in referral hospitals
• Carry out a nutrition survey in six months

From the Concern survey in Anseba region:

• Continue supplementary feeding
• Improve households' access to water and sanitation facilities
• Implement health promotion sessions
• Diversify food ration, with oil and pulses distributed together with cereals

Ethiopia

It becomes more and more apparent that the current drought will have a major impact on some populations. The FAO/WFP crop and food supply assessment, carried out in November 2002, estimated that national cereal and pulse production would be about 25% down from 2001 and 21% down from the average of the previous five years. Some 11.3 m people will be in need of food aid, which will amount to 1.44 m MTs.

Whilst grain prices were very low in the first semester of 2002, they increased sharply thereafter and were 25% to 85% higher (depending on the cereal type) in October 2002 than at the same time the previous year (FAO/WFP, 30/12/02).

In previously identified crisis areas (Afar, eastern parts of Oromoya, several areas of Southern Nations and Nationalities People's Region, and part of Somali region), food aid delivery and harvest have increased food availability. However, other areas of concern have been further identified, such as parts of Arsi zone, Oromoya region (FEWS, 11/11/02).

Migrations have already been registered as a result of the drought. Some 20,000 people from East and West Hararghe and Arsi zones have settled in Bale National Park. Their living conditions seem far from adequate (UNDP, 01/11/02). Drought also stimulated ethnic clashes over scarce water resources, particularly in Afar region (OCHA, 08/11/02).

However, unseasonable rains fell in central Ethiopia in December 2002. It seems that the rains were not largely used for cultivation but that they certainly had a positive impact on pasture and water availability (WFP, 03/01/02).

Food aid availability and delivery were inadequate during the first half of 2002; distributions ranged from 12% to 54% of monthly requirements. However, distributions have improved over the past months: 67% of the requirements were covered in June, 97% in August and about 80% in September (FEWS, 11/11/02). Food aid pledges to WFP have been received from several donors and NGOs also received resources for food aid programmes (WFP, 22/11/02).

The current Ethiopian humanitarian crisis appears to be a consequence of structural weaknesses exacerbated by drought. According to some agencies, drought could be better coped with if farming methods were improved, food distribution freed from governmental control and stocks built up during good harvests (Alertnet, 15/11/02).

Land tenure is a highly controversial issue. The current policy is that government-owned lands are allocated to farmers. Plot sizes are too small to enable minimum food production. According to the Ethiopian Economic Association, efforts to increase productivity have largely failed. They advocate a mixture of state, private and communal land holdings, and for increase in plot sizes (OCHA, 07/11/02).

Moreover, the UN's Emergencies Unit for Ethiopia has called for the abolition of collective punishment imposed on farmers who can not repay seed or fertiliser debts. This practice is detrimental to production (OCHA, 30/10/02).

In addition, the two last years grain prices were highly depressed, which led to low producer incentives and therefore reduced the farmers' ability to purchase agricultural inputs (FAO/WFP, 30/12/02). Livestock deaths, poor performance of cash crops such as coffee and khat and low employment opportunities further compound the situation in some areas (FEWS, 13/12/02).

East Harerghe

SCF-UK carried out a nutrition survey in Golo Oda and Meyu Muluke woreda, East Harerghe zone, in October 2002 (SCF-UK, 10/02). The survey showed that 15.0 % of the children were acutely malnourished, including 1.1% with severe malnutrition. The households surveyed were from agro-pastoralist groups (49.3%), agriculturalist groups (43%) and pastoralist groups (7.7%). The region has suffered a four-year rain failure. It is expected that the actual drought will further aggravate the food security situation. At the time of the survey, 70% of the villages were expecting a complete harvest failure. Condition of livestock was reported to be good/medium by 58% of the households and poor/very poor by 42% of the households. Crude Mortality Rate and under-five mortality rate were respectively 0.62/10000/day and 1.81/10000/day. Measles vaccination coverage, according to mother's statements, was only 4.6%. Health care facilities were also reported to be very limited.

Measles vaccination and vitamin A supplementation campaign were implemented in West and East Harerghe in December 2002 (EUE, 27/12/02).

South Wollo

Two surveys were conducted by Concern in Kalu woreda and Dessie Zuria woreda, Sooth Wollo, Amhara region, in November and December 2002 (Concern, 11/02; Concern, 12/02). Belg and Meher rainy seasons have been erratic and led to poor harvests. The results of the surveys are of concern (see table); the percentage of oedematous children was significant in both surveys. The nutrition situation seems to have deteriorated since mid 2002 in both areas (see graph). The current surveys were conducted at the beginning of the Meher harvest but did not show any impact of the harvest on the children's nutritional status.

Malnutrition and mortality rates, South Wollo, Ethiopia, Nov-Dec 2002 (Concern, 11-12/02)

Acute malnutrition, South Wollo, Ethiopia

Both woreda have difficult topography, which hampers access to markets and services. In Kalu woreda, the majority of farmers are Meher dependent ( Meher harvest is due in November- December). Although 50,100 out of the 232,000 woreda population should have been receiving food aid from DPPC from March 2002 until October 2002, distribution was interrupted in May and June because of logistical problems. It was planned that only 3,180 beneficiaries were to receive food distribution in the last quarter of 2002. Only 40% of the population reported to have got food from their own production for the previous month, compared to 80% in November 2000. About 25% of the households interviewed reported eating only two meals per day, instead of the normal three, compared to only 7% in January 2002.

The population of Dessie Zuria is chronically food insecure because of long-term problems of degraded grazing and cultivation areas. Most of the farmers are either Belg dependent or Belg Meher mixed dependent. Some 100,000 people have been identified as beneficiaries for food distribution in 2003. At the time of the survey, half of the population relied on their own production for food sources, compared to 70% in August 2002. As a consequence of livestock feed shortage, farmers were selling livestock, which represents one of the farmers' most important assets, at a low price.

Afar region

Following a nutrition assessment, which showed a very precarious situation in seven villages considered as particularly vulnerable in Ayssaita and Afambo woreda in Afar, zone 1, in July 2002, ACF undertook a larger assessment in the area. Some 604 children (75 to 110 cm tall) were screened in five kebele in Ayssaita woreda, two Kebele in Assambo woreda and eight kebele in Dubti area in October 2002 (ACF, 10/02).

The results showed that few children presented a low MUAC (see table); presence of oedema was not assessed. However, the survey also revealed that household food security was precarious, especially because of livestock losses as a consequence of poor rains. In addition health care and water sources were inadequate. Implementation of food distribution and supplementary feeding programmes is planned.

Results of MUAC assessment, Afar region, zone 1, October 2002 (ACF, 10/02)

Refugees

Repatriation of Somali refugees continues from the camps in Somali region to Somaliland. Six of eight refugee camps have been closed and nearly 30,000 refugees have been repatriated since the beginning of 2002, halving the Somali refugee caseload in Ethiopia (UNHCR, 25/10/02; UNHCR, 05/11/02).

In Western Ethiopia, where 85,000 Sudanese refugees are settled in camps, ethnic clashes erupted between refugee communities in Fugnido camp. Forty-one refugees were killed and several houses were looted (OCHA, 12/12/02).

Overall - The nutrition situation in the areas currently affected by drought is of concern (category II). The food security will not improved in these areas at least until the next belg season which will start in March 2003.

Recommendations and priorities

From the SCF-UK survey in East Harerghe:

Short term:

• Increase relief assistance at least until March next year for pastoralists, at least to end of 2003 for the others
• Properly target the general ration and meet the minimum standards
• Implement a targeted supplementary food distribution
• Build the capacity of local health facilities to treat severe malnutrition
• Strengthen health facilities

Long term:

Implement irrigation projects to ensure grazing and access to water availability for livestock

• Promote irrigation projects that help to plant food and cash crops
• Consider implementing income diversification projects

From the Concern surveys in South Wollo:

• Improve the allocation of employment generating schemes food
• Implement targeted supplementary feeding
• Investigate setting up community therapeutic care
• Discuss with local authorities about support needs in the areas of emergency health, agricultural inputs and livestock interventions
• Further investigate and develop a long-term strategy to improve food-security
• Carried out a nutritional survey in three months' time

From the AcF survey in Afar, zone 1:

• Improve the general food distribution
• Improve primary health care and vaccination coverage
• Consolidate animal health and feeding programmes

From the RNIS:

• Consider providing seeds for the next Belg season (February-March 2003) in relevant areas

Kenya

Refugees

Kenya hosts some 200,000 refugees, mostly from Sudan and Somalia. Kakuma camp is located in Turkana district, north-western Kenya, near the Sudan border and three camps are located in Garissa district, east Kenya, near the Somalia border.

Kakuma camp

The camp was established in 1992 for Sudanese refugees fleeing conflict in the Upper Nile. In 1998, Kakuma II was opened, primarily to accommodate Somali refugees who were transferred from camps in Mombassa, which were closed. In 1999, Kakuma III was opened for more Sudanese fleeing from the war.

In September 2002, the population of Kakuma camp was estimated at around 66,000, of which 80.5% were Sudanese, 15% Somali, 3% Ethiopian and the rest from the Great Lakes region.

Refugees experience harsh living conditions and face many constraints: they are settled in a dry-hot area, they are prevented from moving freely out of the camp, and the resident population is hostile to them as they see them as competitor for scarce resources. These factors have made the majority of the refugees almost totally reliant on relief aid, although some are able to access income-generating activities.

A nutritional survey was carried out by IRC in Kakuma refugee camp in September 2002 (IRC/ UNHCR/LWF, 09/02). About 2% of the households interviewed were Burundian, 4% were Ethiopian, 15 % were Somali and the majority (79%) was from Sudan.

The survey revealed that 14.3 % of the children surveyed were acutely malnourished, including 1.3 % severely malnourished; 0.4 % of the children had oedema. However, when expressed as percentage of the median, the acute malnutrition rate fell to 6.3%, including 0.1% severe malnutrition, which is not considered to be critical. The discrepancy may be partly explained by the fact that a significant number of children were borderline cases (with a weight-height index slightly lower than -2 Z-scores) and therefore were classified as malnourished when Z-score was used but not when percentage of the median was used.

Levels of acute malnutrition have remained stable, between 14% and 19%, since 1997 (see graph).

Acute malnutrition, Kakuma refugee camp

Food aid appeared to be the main source of food. According to the survey results, about 50% of the refugees consumed only food from the general distribution (the day prior to the survey), about 25% of the refugees ate food from the general distribution together with food from other sources, 20% consumed food borrowed or given by relatives and 5 % consumed only food purchased from the market.

These results seem to be in line with a food security assessment done in September 1999. According to this assessment, the poor group (35-45% of the refugees) has very little access to incomes. The less poor group (15-20%) is able to get some incentives from small business. The middle incentive group (30-40%) and the better-off (15%) are comprised of traders and higher incentive earners, as well as those who receive remittances. They often support a wide range of people.

Food distribution is scheduled on a bi-monthly basis and is intended to be a full ration of 2,100 Kcal/pers/day. However, the amounts of food distributed have been irregular and were equivalent on average to 1,960 Kcal/pers/day in 2000, 1,730 Kcal/pers/day in 2001 and 1,670 Kcal/pers/day in 2002 (see graph). During the first half of 2002, the average Corn Soya Blend (CSB) distribution, which is intended to supplement the ration in micro-nutrients, was 17 g/pers/day instead of the planned 40 g/pers/day. For the poorest who can not access incomes, the food ration is not only the main source of food but also a significant way to get cash to buy basic items such as firewood or soap, when they are not provided in sufficient quantity by relief agencies. Measles vaccination coverage was good with 50.8% coverage confirmed by card and 91.9% when also taking mothers' statements into account. About 80% of the children surveyed received vitamin A. Most of the families got water from taps, but hygiene practices seemed inadequate, as well as the children's feeding practices.

Food distribution, Kakuma refugee camp (WFP Kenya, 11/02)

The average prevalence of malnutrition observed in the camp may be related to multi-sectoral causes, such as inadequate food and non-food item distribution to the poorest, and poor hygiene and feeding practices. The funding shortfall that UNHCR is currently facing may further undermine refugee living conditions. UNHCR will be obliged to reduce to a third the amount of firewood which was distributed to refugees, who will need to sell part of their food ration to buy wood, or to risk being beaten or raped when collecting wood in surrounding private land (UNHCR, 14/11/02).

Dadaab camps

The three refugee camps around Dadaab town in Garissa district; Ifo, Dagahaley and Hagadera, were established in 1991 and 1992 following an influx of refugees fleeing fighting in the middle/ lower Juba and Gedo regions of Somalia.

In June 2002, the population was estimated at around 130,000 refugees; about 37,000 in Dagahaley, 48,000 in Hagadera and 45,000 in Ifo. MSF-B undertook a nutrition survey in Dadaab camps in June 2002 (MSF-B, 06/02). The prevalence of acute malnutrition among 6-59 month- old children was 15.0 %, including 2.1% severe malnutrition; 1.2 % of the children had oedema. Malnutrition rates have remained high since 1997 (see graph).

Food distribution, Dadaab refugee camps (WFP Kenya, 11/02)

The amount of food distributed has not been more regular in Dadaab camps than in Kakuma camp. The average of food distributed was 1900 Kcal/kg/day in 2000 and fell to 1800 Kcal/pers/ day in 2001 and 2002 (see graph).

Acute malnutrition, Dadaab camps

Overall - The current nutrition situation of the refugees in Kenya can not be considered acceptable (category II/III). Refugees, especially the poorest, are highly dependent on external aid. The funding shortfall UNHCR is currently facing, as well as the food shortfall WFP is expecting from February , may worsen the situation.

Recommendations and priorities

From the IRC survey in Kakuma camp:

• Continue feeding programmes and improve coverage
• Ensure supplementation of vitamins and mineral through clinics and/or home visits
• Lobby to increase the food ration distribution in order to meet the basic nutritional requirements and to allow refugees to exchange part of the food from the general ration to micro-nutrient rich food
• Ensure the provision of non-food items in sufficient quantities
• Implement a comprehensive monitoring system of the nutritional status of the population

From the MSF-B survey in Dadaab camps:

• Ensure a full food ration distribution
• Monitor the nutrition status of the population

Somalia

The Somali reconciliation conference began in Eldoret, Kenya, on 15 October 2002. The conference is attended by representatives of the Transitional National Government (TNG), 20 armed factions, which control different parts of Somalia, the regional administration of Puntland and civil society groups. The first positive result of the talks was the signing of a temporary cease-fire on 27 October (OCHA, 28/10/02). The agreement also stipulated the commitment of all the parties to the establishment of a national federal government and to the improvement of the safety of aid workers (AFP, 27/10/02). On the 3rd of December, a ceasefire agreement was also signed between the TNG and five prominent Mogadishu-based factions to end fighting in the Somali capital (OCHA, 03/12/02). However, despite the truce, clashes continue to be reported.

Warlords and the TNG have made a joint appeal to the governments of the United States, United Kingdom, Saudi Arabia and the United Arab Emirates for an end to the freeze of the assets of the Barakaat bank. The bank was closed in November 2001 as a result of allegations of links with terrorist organisations. The freezing of the bank's assets has had a huge impact on economic activities in Somalia (BBCNews, 12/11/02).

Somaliland

Following the conclusions of a nutrition survey done in Sanag region in May 2002 (see RNIS 39), four health centres and mobile teams have been set up. Nutrition screening, high energy biscuit distribution to malnourished children, micronutrient supplementation and immunization have been implemented (UNICEF, 11/10/02).

A nutrition assessment was carried out in December 2002 in the Coastal Belt of Awdal and Sahil regions, in permanent villages and temporary pastoral settlements (FSAU/N, 01/03). The region has experienced poor rains over the last three years, which has had a major impact on this pastoral area. The results of the MUAC assessment showed that a significant number of children in the temporary settlements were affected, whilst the situation was better in the permanent villages (see table).

Results of MUAC assessment, Coastal Belt of Awdal and Sahil region, Somaliland, December 2002 (FSAU/N, 01/03)

1 No oedema were detected

The inhabitants of the permanent villages had better access to water and trading opportunities than the ones living in the temporary shelters. The region suffers from chronic water and food insecurity, which needs to be tackled through long term interventions: these have not been effectively implemented so far.

In the weeks following the survey, heavy Hais rains were recorded, which may lead to improvements in the food security of the population, but may also be detrimental if they were too heavy.

Puntland

A nutrition survey carried out in Bari region in September 2002, showed a prevalence of acute malnutrition of 12.6%, including 2.1% severe malnutrition (FSAU/N, 10/02). This mostly pastoral region is sparsely populated and has been experiencing repeated rain failure up to the last Deyr rainy season, in October 2002. Access to health services was also reported to be poor. Despite these facts, the population seemed to still have some ways of coping with the situation: the nutrition situation was not dramatic.

An integrated supplementary feeding programme was initiated in Bosaso MCH. After screening at the MCH, 34 IDP malnourished children were enrolled in the feeding programme (UNICEF, 14/11/02).

Southern Somalia

Gu cereal production and Deyr rainy season performance

The Gu harvest contributes on average 70% of the annual cereal crop yields in southern Somalia. The good Gu season in most parts of Somalia has led to an increase of 30% in crop production compared to the post-war average. However, a below average harvest occurred in Northern Gedo, Hiran, Bakool, Lower Juba and Togdher (see table).

Gu cereal production, southern Somalia, November 2002 (FSAU/FS, 11/02)

On the other hand, the Deyr rainfall (October - November) has been good in Hiran, Bakool and Gedo and will mitigate the effect of the low Gu crop production in these regions. Access to food and income-generating activities have increased, which will benefit especially the poorest (FSAU/FS, 12/02).

North Gedo

Belet Hawa

North Gedo is one of the most affected areas of Somalia. This region has experienced recurrent droughts over the past three years and a high level of civil unrest, which has prevented implementation of adequate relief aid. People have been obliged to sell household assets to survive (FSAU/FS, 10/02).

A nutrition survey was carried out by FSAU/GHC/ CARE in Belet Hawa district in October 2002 (FSAU/N, 11/02). The results showed a prevalence of acute malnutrition of 21.5 %, which included 2.2% severe malnutrition. This level is still high, although it has decreased since the last nutrition survey done in December 2001 (see graph). The survey results suggested that children from agro-pastoralist groups were the most affected.

Acute manutrition, Belet Hawa district, Somalia

The enhancement of relief aid in the region since the beginning of 2002 has probably played a significant role in the improvement of the situation. Food distribution has been extended to all women of child-bearing age, instead of only targeting vulnerable groups. Food rations were also diversified, with oil and lentils distributed together with sorghum. In addition, the Gedo Health Consortium has established supplementary and therapeutic feeding programmes. Health care seemed to have improved also. About 70% of the children surveyed were vaccinated against measles in October 2002, compared to 43% in December 2001 and disease prevalence was also lower in October 2002 than in December 2001. However, because of limited food availability and widespread insecurity, the population was still experiencing poor living conditions. Their main sources of food were food aid and purchases, whilst the major sources of income were casual work and selling of bush products. In addition, the volatile security situation has hampered humanitarian action; as a result of insecurity, Care was obliged to delay food distribution in October 2002 (UNCI, 24/10/02).

Hiran

Following poor Deyr rainfall in 2001 and Gu season in 2002, part of Hiran region is considered highly vulnerable. A nutrition survey carried out in Bellet Weyne district in May 2002 revealed a high malnutrition prevalence (see RNIS 39). MUAC assessments were subsequently conducted in Buloburti and Jalalaqsi districts in October 2002, on 570 and 400 6-59 month-old children respectively. The results showed that the nutrition situation was serious in Jalalaqsi but slightly better in Buloburti, though also of concern (see table) (FSAU/N, 10/02). However, heavy rainfall has been recorded in Bellet Weyne district, which will regenerate pasture and enable farmers to plant their crops. It is expected that the food security situation will improve, although the two most vulnerable groups (agro-pastoralists and riverine farmers) will still face difficulties (FSAU/FS, 10/02).

Middle Juba

Middle Juba received good 2002 Gu rainfall, except in some areas of Western Jilib. MUAC assessments have been conducted in some villages along the Juba river, which had experienced a very poor harvest. The poor people seemed particularly affected; they had lost their usual sources of food and income (cash crops and farm labour). They were also unable to fish in the Juba river because they lacked fishing nets. The very poor appeared to be mostly reliant on wild food. The results of the MUAC assessment revealed a situation of concern (see table). During October, SRCS/ICRC distributed seeds, food for seeds protection and fishing kits (FSAU/N, 10/02).

Results of MUAC assessments, Somalia, September-October 2002 (FSAU/N, 10/02)

Lower Juba

IDPs in Kismayo town Many IDPs, who fled insecurity in 1992/1993, are settled in Kismayo town, in about 20 camps. An inadequate water supply and poor sanitation conditions appear to be major problems in the camps. The production of charcoal and its exportation through the port of Kismayo generates some income opportunities for the IDPs. Their main sources of income are casual work (including being loaders at the port) and bush product collection (charcoal production).

A MUAC screening was undertaken by the FSAU in four IDP camps, in November 2002; 181 children were screened (FSAU/N, 12/02). The results showed that a significant proportion of the children were malnourished (see table). However, when compared to the nutrition situation of IDP children in Mogadishu (see RNIS 39), the IDP children in Kismayo seem to have a better nutritional status.

Overall - The different nutrition assessments performed in southern Somalia revealed nutrition situations which varied from precarious (category II) to very poor (category I), even if the good Deyr rainfall in some areas may temporarily improve food security. The nutrition situation of the children residing in temporary shelters in the Coastal Belt of Somaliland region is of concern (category II).

Recommendations and priorities

From the FSAU/GHC/CARE survey in Belet Hawa:

• Continue to provide adequate food distribution and selective feeding
• Continue to support health, livestock and water sectors
• Provide access to income generating activities
• Improve access to the population

From the FSAU assessment in the Coastal Belt of Somaliland:

• Implement targeted general food distribution in small temporary settlements for a period of three months
• Implement decentralised supplementary feeding programmes
• Rehabilitate Karurre borehole (on-going)
• Expand immunization services
• Promote longer term interventions to address water and food insecurity

Sudan

Peace talks were resumed in mid-October, after they had been halted as a result ot the Sudan People's Liberation Movement/Army (SPLM/A) taking of the garrison town of Torit, which was later regained by Karthoum troups. A cease-fire agreement was signed between the government of Karthoum and the SPLM/A on the 15 October 2002, and was further expanded by mid-November until 31 March 2003 (OCHA, 28/10/02; OCHA, 19/11/02). Negotiations on wealth and power sharing did not reach specific agreement before they broke off in mid-November. They were intended to resume in January (OCHA, 19/11/02).

On 26 October, both parties also signed an historic agreement with the United Nations system, allowing unimpeded humanitarian access to populations (OCHA, 28/10/02). Respect for this agreement would greatly help to provide relief to thousands of people in need. WFP estimates that improved access would enable it to provide aid to an additional 585,000 people (UNNS, 29/10/02). Denying flights by the government of Karthoum has prevented access to populations in need over the past years. In October, flights were denied to 61 locations in southern Sudan (OCHA, 14/11/02). Subsequent to the signing of the agreements, security and delivery of food aid have greatly improved over the reporting period. No objections to the November/ December delivery plans were raised by GOS or SPLM. The Sabat River Corridor in Upper Nile was accessed for the first time in three years. WFP distributed 600 MTs of food to over 88,000 beneficiaries. A very significant improvement to access was also noted in western Upper Nile (OCHA, 23/12/02). In Leech area, WFP has been able to reach an additional 200,000 beneficiaries (FEWS, 20/12/02).

Food security situation

The FAO/WFP crop and food supply assessment, conducted in November 2002, forecast a 30% decline in cereal production compared to last year. Livestock and pasture conditions were estimated to be stable in most parts of the country and it is expected that the lifting of the ban, by several countries, on imports of livestock from Sudan will improve pastoralist incomes. About 230,000 MTs of food will be needed to assist about 3.5 m people. Agricultural inputs will also be needed for the next agricultural season, beginning in April/May in the south and June/July in the north (FAO/WFP, 24/12/02).

Preliminary findings of the WFP-led Annual Needs Assessment also indicated lower than usual crop production in southern Sudan due to erratic rainfalls and insecurity (FEWS, 27/11/02). Although some areas will be food secure, others will face serious food deficits (see tables). Recent deterioration of the situation has occurred particularly in Latjor, Pibor and Torit , where 85% of the population were previously food secure. In the most affected areas, more than half of the population will be in need of food aid at least until the next harvest in September 2003.

Food insecurity in southern Sudan (FEWS, 27/11/02)

Main causes of food insecurity and estimated affected population in the most food insecure areas, southern Sudan (FEWS, 27/11/02; FEWS, 28/11/02)

Upper Nile

A nutrition survey was carried out by AAH-USA in Old Fangak district, Phou state, Upper Nile, in September 2002 (AAH-US, 09/02). This was the fourth nutrition survey carried out in the area. The survey showed very high rates of malnutrition: 31.4% of the children were acutely malnourished, including 10.2% severely malnourished. The trend over the past two years shows a regular increase in the prevalence of malnutrition (see graph). This is in line with the increasing food insecurity over the past two years (FEWS, 27/11/02). Unless there is an enhancement of relief activities, the situation in the area will probably not improve. About 40% of the population is expected to be food insecure in 2003 (FEWS, 27/11/02). Under-five mortality rate (4.0/10000/day) was also higher than in the previous survey done in April 2002 (2.2/10000/day). Major causes of deaths were bloody and simple diarrhoea, malnutrition and measles, which reflect the poor water, sanitation and health conditions in the area. Due to a low admission rate, the therapeutic feeding centre was closed; supplementary feeding programme was ongoing.

Acute malnutrition, Old Fangak district, Phou state, Upper Nile, Sudan

Jongley

The harvest was expected to be less than 60-70% of normal harvest in south Bor county, due to drought (OCHA, 14/11/02). In Dirror district, Bieh state, MSF reported an improvement of the nutrition situation. In October 2002, a survey showed a prevalence of acute malnutrition of 20%, which included 2% severe malnutrition, compared to a prevalence of 40%, which included 10% severe in May 2002. MSF was in the process of closing the feeding centres (MSF, 18/11/02).

Eritrean refugees in eastern states

UNHCR, in collaboration with COR, undertook a nutritional survey in five of the Eritrean refugee camps located in eastern states in August 2002 (UNHCR/COR, 08/02). A previous survey had been done in March 2002 (see RNIS 39). The present survey revealed high rates of malnutrition (see table). The prevalence of malnutrition has almost doubled in all of the camps since March 2002, except in Shagarab camp, where the prevalence of malnutrition was already high in March 2002 (see graph). Wad Sherifey and Shagarab camps are reception camps where people are totally dependent on food aid, whist refugees in Kilo 26 and Girba have access to labour opportunities on nearby farms, and refugees in Karkora have been provided with land. Different contributing factors may explain the increase in malnutrition rates. The period from April to June is considered by refugees as the hardest, because of fewer job opportunities, hot weather and the scarcity of food and green vegetables. The rainy season begins in June and corresponds to an increase in morbidity and to the hunger gap. Under five mortality surveillance revealed that mortality was twice as high in July and August than in June. Moreover, WFP food distribution was irregular, with delays up to one or more months. MCH growth monitoring also shows the highest rates of malnutrition from June to September.

Acute malnutrition, Eritrean refugee camps, Sudan, UNHCR/COR, 08/2002

 Acute malnutrition, Eritrean refugee camps, Sudan

Overall - The affected population in southern Sudan is still at high risk (category I). It seems, however, that access to the population has greatly improved over the last two months. Should the access continue to increase, it is expected that the situation may improve. Eritrean refugees in eastern Sudan faced difficult living conditions during the summer months (category II).

Recommendations and priorities

From the FEWS:

Short term:

• Mobilize sufficient food aid to ensure steady deliveries to avoid break in the pipeline
• Ensure unhampered delivery of food aid
• Carry out regular nutrition surveys in the most affected areas
• Incorporate or strengthen food security monitoring within all aid agencies workplans

Long term:

• Renew efforts to promote innovative, culturally acceptable and locally sustainable crop production

From the AAH-US survey in Upper Nile:

• Continue WFP distribution
• Support households with fishing equipment
• Continue supplementary feeding programmes
• Improve health care delivery
• Carry out continuous EPI
• Improve water and sanitation situation

From the UNHCR survey in Etitrean refugee camps:

• Consider blanket supplementary feeding to under-three year-olds from July to September
• Extend the full ration distribution to all refugees until September, instead of the current April-June period
• Ensure regular food distribution
• Intensify malnutrition surveillance and referral to nutrition centres
• Better address hygiene and sanitation issues at camp level