United Nations System
Standing Committee on Nutrition

West Africa

Ivory Coast

Following a coup attempt on 19 September 2002, a cease-fire agreement was signed at the end of October between the government, which controls the south of the country, and the Ivory Coast Patriotic Movement (MPCI), which controls the north. At the end of November 2002, two new rebel groups, the Movement for Justice and Peace (MJP) and the Far West Ivory Coast People's Movement (MPIGO), began fighting in the west (AFP, 15/01/03). The presence of Liberian soldiers in their ranks has been reported (Reuters, 02/12/02). As of mid-January, the three rebel groups were controlling about half of Ivory Coast territory. French troops have been deployed along the front line. Although several clashes between the French troops and the rebels have since been reported on the western front line, a truce was signed by the MPCI and MPIGO in mid January 2003, and the three rebel movements, the government of Ivory Coast and the political opposition have also entered peace talks, brokered by France (Reuters, 15/01/03). At the time this report was written, peace talks were on-going. Human rights abuses and violence against civilians by all parties have been denounced (Reuters, 19/12/02; ICRC, 19/12/02).

Population movements

The conflict has led to major displacements. About 1.1 m Ivorians have probably been displaced. The first wave of violence in the north led to the displacement of an estimated 600,000 people, whilst the fighting in the west caused the displacement of about a further 500,000 people (OCHA, 10/01/03). Most of the IDPs are settled with relatives which renders accurate estimations difficult.

Shantytowns, which host many migrants and refugees, have continued to be razed by government troops. Thirteen shantytowns have reportedly been razed in Abidjan, displacing 40,000 people (UNHCR, 19/11/02). Many of the displaced families were reported now to be living in a precarious condition although some of them have taken refuge with friends or relatives. UNHCR was caring for 1,000 displaced refugees in Abidjan (UNHCR, 19/11/02). Sierra Leonan refugees have asked to return home but UNHCR was unsure of being able to facilitate returns, due to funding shortfalls.

Fear of persecution has also caused thousands of migrants to flee to their homelands. About 35,000 Burkinabe out of the 2.5 m settled in the country (OCHA, 04/01/03), plus thousands of Nigerians (Reuters, 12/11/02), Malians (PANA, 15/11/02), Guineans, and people from other nationalities, have already fled.

In addition, the Liberian refugees who had been mostly settled in western Ivory Coast have returned en mass to their country (see table). Most of them returned under their own means; UNHCR has begun to help with repatriations since mid-January 2003. Massive influxes of Ivorians into Liberia, and to a lesser extent into Guinea, have also been reported (see table). UNHCR has expressed fears for the fate of several thousands Liberian refugees who are still settled in western Ivory Coast, particularly those who are afraid to return to Liberia because of their ethnicity. About 5,000 are estimated to be settled in Nicla camp, near Guiglo. UNHCR has however, not yet succeeded in moving them to a safer location (UNHCR, 17/01/03).

Population movement, Ivory Coast, as of mid-January 2003

Humanitarian situation

Although access to the populations in central and northern rebel-held area has been unimpeded, access to western areas has seemed more difficult (OCHA, 04/01/03). The most pressing humanitarian needs are in the health sector, which lacks medicines, equipment and health staff, especially in rebel-controlled areas (OCHA, 04/01/03). Food insecurity will worsen in the coming months as reserves will be exhausted, and the next harvest, expected in March 2003, may be disrupted. Many people have lost their sources of income because of the insecurity. As IDPs are mostly settled with relatives, assistance should be provided to both refugees and host populations. WFP food distributions in January and February 2003 were intended to reach 61,200 beneficiaries in Buake, 34,600 in Yamousoukro and 5,300 in Nicla camp (WFP, 10/01/03). The ongoing conflict has had a major impact on the economy of the whole sub-region. Ivory Coast accounted for 40% of the gross domestic product of West Africa; millions of migrants from neighbouring countries were dependent on job opportunities in Ivory Coast. The loss from cash crops in the northern region is estimated so far at about 300 millions Euros/Dollars. In addition, neighbouring countries can no longer use the port of Abidjan; they are obliged to use more distant ports which had led to an increase in the cost of transportation. Prices in the whole region seem to have increased dramatically since September 2002 (AFP, 15/01/03).

Guinea

Guinea hosts about 100,000 refugees, mainly from Liberia and Sierra Leone. Repatriation of Sierra Leonan refugees has been suspended at least to the end of the year because of financial constraints (UNHCR, 12/11/02). Due to the civil war devastating Ivory Coast, some 40,000 Guineans are estimated to have crossed back into Guinea over the last two months; 2,000 Ivorians and 3,450 of other nationalities also have sought refuge in Guinea (OCHA, 04/01/03). The presence of unidentified armed elements in Kouankan camp has raised concern about the security of the refugees (OCHA, 01/10/02). Refugees settled in Kuankan camp will be relocated to the Kissidougou area (UNICEF, 12/12/02). It seems that all camps throughout Guinea are overcrowded, with far more refugees than their capacities should allow. Following a report which indicated evidence of "extensive" sexual exploitation of refugee children in Liberia, Guinea and Sierra Leone, which involved workers of NGOs and UN agencies, at the beginning of 2002 (UNHCR, 26/02/02), the Office of Internal Oversight Services of the United Nations conducted an investigation into this matter. The investigation did not confirm the allegation of widespread sexual exploitation, but it confirmed that sexual exploitation is a significant issue and urged humanitarian agencies to pursue corrective action (UN, 22/10/02).

Guekedou Prefecture

According to different estimates, Gueckedou prefecture was hosting 150,000 to 260,000 refugees, before an outbreak of violence which occurred from September 2000 to March 2001 (see RNIS 32/33) and led to the displacement of both refugees and host populations. Most of the refugees were relocated into camps further inside the country. However, it was estimated that about 20,000 refugees preferred to return to the area where they settled in villages. The majority of the Guineans also returned except in Guekedou town and in villages near the Liberian border. Although there is no precise figure, it is estimated that the number of refugees who remain in the area has decreased. No specific relief is provided to the refugees.

ACH-S undertook a nutrition survey in Guekedou prefecture in September 2002. About 73% of the population derived their major sources of food from their own crops, whist 24 % relied on purchase. The results showed that 7.9% of the children were acutely malnourished, including 0.7% severely malnourished. These results are very similar to the ones of a survey done in March 2002 (8.2% acute malnutrition, 0.3% severe acute malnutrition) (see RNIS 36/37). However, the 2002 malnutrition rates were higher than the malnutrition rates in the same region in July 2000 when the prevalence of acute malnutrition was respectively 4.2% for the host population and 2.6% for the refugee population (see RNIS 31). Although the prevalence of malnutrition found in July 2002 was average, the nutrition situation of this population has deteriorated significantly between 2000 and 2002.

Priorities and recommendations

From the ACH-S survey in Guekedou prefecture:

• Continue distribution of seeds and tools
• Continue the implementation of the nutrition programme
• Reinforce vaccination and public health awareness

Liberia

Fighting between the Liberians United for Reconciliation and Democracy (LURD) troops and the government forces continues in northern Liberia (OCHA, 30/11/02). The number of Liberians, who have crossed the border into Sierra Leone, has decreased over the last months; no entry was recorded at the end of December.

Following an upsurge in violence in western Ivory Coast, many Liberian refugees and Ivorians sought refuge in Liberia. Between mid-November 2002 and mid-January 2003, UNHCR recorded 62,000 new arrivals in Liberia from Ivory Coast, of whom 38,000 were Liberians, 21,000 Ivorians and 3,000 were from other West African countries. Liberian returnees were transported back to their areas of origin as far as possible; people originating from areas where the security situation did not allow resettlement were directed to Totota IDP camp in Bong county. The majority of Ivorians were settled in villages near the border; the others were gathered in transit centres. UNHCR was discussing with the Liberian authorities the possibility of establishing new camps for Ivorians (UNHCR, 14/01/03).

Internally Displaced Persons

IRC conducted an assessment in five camps in Montserrado county and six camps in Bong county in July 2002 (IRC, 07/02). MUAC was used to assess the nutrition situation; oedema were not recorded, which might have led to an underestimation of the nutritional problems. The nutrition situation seemed average, but requires attention, especially in Montserrado county (see table). Mortality rates were very high in both locations, and especially in Montserrado county, where they were twice as high as the emergency threshold.

Survey results, IDP camps, Liberia, July 2002 (GOAL, 07/02)

Poor sanitation services, as the rainy season started, may have played a major role in the high mortality rates; cholera cases were diagnosed at the same time the survey was done. Curative primary health services were considered adequate, but gaps at the community health level have been identified. Major food aid distribution problems identified were delays in the monthly food distribution, fraud, and difficulties in accessing food aid: newly arrived IDPs had to wait until the forthcoming distribution and IDPs in temporary shelters had no access to food. These issues seemed to have been raised by WFP. Shelter building was also identified as an issue of concern: IDPs faced difficulties to access land and building materials.

Overall - The situation of IDPs, returnees and newly-created refugees in Liberia is of concern (category II). The large new influx of vulnerable people, adding further to the already high number of IDPs and refugees, will be a difficult challenge for humanitarian agencies to respond to.

Recommendations and priorities

From the IRC survey in IDP camps:

• Increase the number of latrines and improve their maintenance
• Increase safe drinking water availability and regularly monitor water quality at all sources
• Conduct anthropometric and food basket surveys
• Implement a measles vaccination campaign
• Strengthen the standardization of health information
• Strengthen the night health referral system

Sierra Leone

The government of Sierra Leone has released a national strategy plan for 2002-2003. The plan has four main components: restoration of state authority, rebuilding communities, peace building and human rights, and restoration of the economy. The rebuilding of the community component includes IDP and returnee resettlement. Resettlement of some 10,000 remaining IDPs should be achieved by the end of 2002, while it is expected that 50,000 returnees will be repatriated and resettled in 2003.

Regarding the health system, the government's objective is that all community health centres and community health posts are rehabilitated and functional, that every district has a functional hospital, that the number of medical doctors outside of the western area is increased, and that the full immunization coverage is at least 60%. In 2002, 221 Peripheral Health Units were made functional, bringing the total number of PHU to 86% of the pre-war number. Two districts did not have a functional hospital. Full immunization coverage was low (34%) and maternal mortality rate had not decreased. A shortfall of qualified health staff outside of Freetown was one of the major problems of the health system. Access to PHU was worst in Kailahun, Kono, Bombali, Koinadugu and Kambia districts.

Access to safe drinking water and sanitation will also be increased, especially in Kailahun, Kono, Bombali and Tonkolili, which have particularly low levels of access.

Shelter destruction levels are highest in Kono, Kailahun, Pujehun, Kenema and Tonkolili districts. Of the 340,000 houses which have been destroyed during the war, the government's objective is to have at least 20,000 houses reconstructed. Agriculture will also be revitalised with the objective of reducing by half the need for food aid in 2004 (GSL, 28/10/02).

Refugees

A UNHCR funding shortfall has highly compromised the ability to cope with the needs of the growing numbers of Liberian refugees. Only essential food, water and health services could be provided. It seems that due to inadequate living conditions in camps, a growing number of Liberians returned home (OCHA, 31/10/02). No major influx has been reported over the last months.

Nutrition surveys were undertaken by ACF-F in the refugee camps in Bo, Pujehun and Moyamba districts in August 2002 (ACF-F, 08/02). The results showed that the nutrition situation was of concern in most of the camps, and especially in Jimmi camp, whilst it was better in Taiama camp (see table). Under-five and crude mortality rates were, however, under control (see table).

Results of nutrition and mortality surveys in refugee camps in Bo, Pudjehun and Moyamba districts (ACF-F, 08/02)

A therapeutic feeding centre was operating in Bo hospital. Following the survey, supplementary feeding has been implemented in all the camps but Taiama (WFP, 06/12/02).

Repatriation of Sierra Leonan refugees from Guinea has been suspended at least to the end of the year, due to financial constraints (UNHCR, 12/11/02).

Internally Displaced Persons

As of October 2002, a total of 12,800 registered IDPs remained to be resettled; 3,800 were in the western area and sought return to Kailahun and M91; 9,000 were in Tonkolili district and will return to Makeni, Magburaka and Koidu. A further 4,000 have not yet been registered for return (OCHA, 31/10/02).

Overall - The nutrition situation of the Liberian refugees in south Sierra Leone was precarious in August 2002 (category II/III). However, it is hoped that stabilization in the number of refugees has allowed an improvement in their living conditions since that time.

Recommendations and priorities

From the ACF-F survey in refugee camps:

• Strengthen/implement nutrition surveillance system in the camps
• Implement supplementary feeding
• Improve the capacity of Bo hospital to treat severely malnourished cases
• Implement a follow-up survey early 2003