United Nations System
Standing Committee on Nutrition

RNIS 41, April 2003

SUB-SAHARAN AFRICA

GREATER HORN REGION

Somalia

The Somali reconciliation conference, attended by representatives of the Transitional Government (TNG), 20 armed factions, which control different parts of Somalia, the regional administration of Puntland and civil society groups, has continued in Eldoret, Kenya, over the reporting period. Although agreement was reached in October 2002 on different issues such as cessation of hostilities, federal government structure and enhanced safe access for aid, little progress have been made since that time (AFP, 21/02/03). Fighting has still been widespread, especially in Baidoa, Mogadishu and Puntland over the last months (UNRC, 12/03/03; OCHA, 02/01/03).

As the Deyr cereal production has been very good on average (see below), as of March 2003, it is pastoral areas, and some areas in southern Somalia, because of insecurity and previous vulnerability, which are considered to be the areas of major food insecurity (see map).

Vulnerability map following Deyr assessement 2003 (FSAU/FS, 03/03)

Southern Somalia

Deyr cereal production performance

Because of good rainfall, the Deyr maize and sorghum production has been exceptionally good and was equivalent to an 80% increase on the average post-war (1995-2001) Deyr yields (see table). Whilst the Deyr production normally contributes to 25-30% of annual cereal production, the contribution is about 45% this year. Since the Gu production was also good (see RNIS 40), the total cereal production for the year was 51% higher than the post-war average (FSAU/FS, 03/03). In addition, the good Deyr harvest has improved food security in the areas where the Gu season was below average, i.e. Gedo, Hiran and Bakol.

2002/2003 Deyr cereal (sorghum and Maize) production, southern Somalia (FSAU/FS, 03/03)

¹ The negative figure is explained by the high production of sesame, which is a cash-crop, instead of maize

Gedo

Despite the good Deyr production, some groups remain highly vulnerable: the poor of the different food economy groups, the IDPs, the lower-middle of the riverine areas and the middle of the agro-pastoralist group. In addition, insecurity still disturbs provision of humanitarian aid. No food distribution has been carried out in the area since October 2002. A screening was undertaken in Garbaharey, Dolow and Burdhubo towns at the end of February 2002 (FSAU/N, 03/03). The results of the screening showed a very poor situation (see table).

Results of MUAC assessments, Gedo region, Somalia, February 2003 (FSAU/N, 03/03)

Puntland

Mudug region

Two nutrition surveys were carried out in Galgodob and Jeriban district, Mudug region, in December 2002 (FSAU/N, 02/03). The results of the survey revealed a precarious nutrition situation (see table). In both areas, food insecurity, poor water quality and lack of access to healthservices seemed to be determinants of malnutrition.

Results of nutrition surveys, Jeriban and Galgodob districts, Mudug region, Somalia, February 2003 (FSAU/N, 02/03)

Somaliland

Returnees in Hargeisa

About 200,000 Somali have been voluntary repatriated from camps in Ethiopia. About 80,000 have settled in Hargeisa suburbs. The fate of the returnees is of concern; a survey showed that they were lacking access to basic services and employment opportunities (see RNIS 39). A nutrition survey was conducted in the eight returnee/IDP settlement areas in Hargeisa, in February 2003 (FSAU/N, 03/03). The results showed that the nutrition situation is of concern and has not improved since June 2001 (see graph). Under-five mortality rate was high: 3.7/10,000/day. Incomes were very low and were mostly derived from casual work and petty trade. In addition, the price of water was more than triple the price in areas where residents are settled, the incidence of disease was high and childcare was inadequate.

Acute malnutrition, returnees in Hargeisa, Somalia

Overall

Despite a good Deyr harvest, the nutrition situation in three towns of the Gedo region was still very poor (category I). The nutrition situation of the returnees in Hargeisa town is also precarious (category II), and it is of concern in two districts of Mudug region (category II).

Sudan

The peace talks between the government of Karthoum and the Sudan People's Liberation Movement/Army (SPLM/A) resumed at the end of January 2003. At the beginning of February, both parties signed a memorandum of understanding to reaffirm their commitment to the total cessation of hostilities. They also agreed on a verification mechanism to monitor all cease-fire violations (OCHA, 04/02/03), and to ease the voluntary return of the displaced population in the Western Upper Nile (OCHA, 05/02/03). An agreement was also reached with the Operation Life Line Sudan (OLS) to allow it to provide aid in Kassala and Southern Blue Nile (OCHA, 22/01/03).

Regarding nutrition and food security assessments done in Southern Sudan (SPLA controlled area), 19 surveys were carried out in 15 locations in 2002. The surveys concentrated on Upper Nile and Northern Bar el Gazal, whilst the situation in other areas, like Equatoria or the Nuba mountains remains unknown. Food security assessments were conducted in 69 of the 147 accessible districts. It is recommended that nutrition and food security survey coverage be increased (WFP, 01/03).

Western Upper Nile

Despite the signing of the peace accord in October 2002 and the reaffirmation of this accord at the beginning of February 2003, cease-fire violations by the Government of Karthoum forces have been constantly reported in the oil-rich Western Upper Nile (ICG, 06/03/03). In January 2003, fighting in the northern part of Leech led to the displacement of 50,000 people (Fews, 20/02/03). The north part of Leech was already considered as food insecure (see RNIS 40); the new displacement will probably aggravate the situation.

Bentiu and Rob Kona

The area has been massively affected by insecurity. Many people have suffered displacement and have moved to towns such as Bentiu and Rob Kona where they are largely dependent on external assistance. A nutrition survey was conducted in the towns in December 2002 (ACF-F, 12/02). The survey revealed a high prevalence of malnutrition but the under-five mortality rate was under-control (see graph). The prevalence of acute malnutrition has remained stable over 2002 and has slightly decreased since 2001 (see graph). The measles vaccination coverage was 68.5% in Rob Kona and 77.1% in Bentiu, according to cards and mothers' statement.

Prevalence of acute malnutrition and mortality rate - under-five children - Bentiu and Rob Kona - Unity State - Sudan

Food security follow-up was also carried out by ACF-F (ACF, 01/03). Most of the population was dependent on markets and food distribution as main sources of food. Insecurity prevented people developing agriculture and rearing; only 20-30% of the population were able to cultivate small plots from which yields lasted for only one or two months. Despite good fishing potential, fishing was also hampered by insecurity. Petty trade was the major source of income. The intensity of petty trade developed by the families was dependent on the amount of food distributed. The amount of food distributed by WFP were more regular in the second half of 2002 than in the first semester, although the WFP ration was only designed to be half of the full ration between October and December because it is traditionally the harvest season. Post- distribution monitoring carried out in August, September, November and December showed that 90% of the population in Rob Kona and 83% in Bentiu were registered to receive a food ration. The last registration was carried out in April 2002, but the number of non-registered people had increased since September due to an influx of people from outside the town. In addition, the number of families who shared rations with relatives or who sent food to the rural areas had also increased from one third in August to one half in September and December. The number of meals eaten per day had decreased from August to October. In August, 83% of the families always ate 2 meals/day, whilst 15% only ate 2 meals a day when they had food from the general food distribution, and only one meal when they had none. In October, only 46% of the families were eating two meals a day, whilst 47% ate either two meals a day if they had food from the general food distribution or only one if they did not. Most of the patients admitted to the TFC were from families who do not receive food distributions, either because they were new comers or because they had missed the April 2002 registration. On the other hand, the markets were reported to be well supplied and prices remained stable.

Access to drinkable water was very poor, especially in Rob Kona town.

The prevalence of acute malnutrition has remained high in Bentiu and Rob Kona over the last three years and it is probably because people are highly food insecure. Insecurity and displacements are seriously affecting population food security. WFP should reconsider reducing the ration distributed from October to December. Rural areas neighbouring the towns also need to be considered as it appears there is a substantial population movement and the influx of people from the rural areas into the towns led to sharing of the general food ration.

Northern Upper Nile

Shilluk

A nutrition survey was conducted in Malakal town, IDP camps and surroundings by Goal in August 2002 (GOAL, 08/02). The survey revealed a high prevalence of malnutrition (see table). The rate of acute malnutrition was higher than in April 2001 (15.8%) but the 2002 survey was done in August, at the end of the hunger gap, whilst the 2001 survey was carried out at a time when food availability was better. Moreover, at the time of the 2002 survey, an increase in movement from outlying areas to the town in search of income, food and health services was reported. The measles vaccination coverage proved by cards was average (59.4%); the under-five mortality rate was under-control (0.7/10,000/day). More than 70% of the heads of households surveyed were working as government employees; 4% were farmers and 9% were engaged in petty trade.

Sobat

A nutrition survey was carried out in Panomdit and Chuei payams, Sobat county, by AAH-USA in January 2002 (AAH-USA, 01/03). The villages surveyed were mostly located along the river. A high number of IDPs had moved to the area in April 2002 following a government army attack in Thangriol; 40% of the households surveyed were displaced. On the other hand, at the time of the survey, one fourth of the population had moved to other areas because of hunger. According to the community, the food security situation was worse this year than the previous year. The crop production was very low because of drought, flooding and bird attacks. In addition, whilst livestock was one of the major sources of food and income in the past, the majority of the people had lost their livestock because of raids. According to the households interviewed, the poor group, defined as owning no livestock, represented 90% of the population. There was no difference in wealth between residents and IDPs. WFP did not distribute any food in the area, though some food and non-food items have been distributed sporadically by different NGOs. The malnutrition rate was high and a significant percentage of children had oedema, which is unusual in Sudan (see table). On the other hand, 0.2% of the mothers were considered as malnourished (MUAC < 185 mm) and 17.8 % were considered as at risk of malnutrition (MUAC >= 185 mm & < 220 mm). The survey also revealed exceptionally high rates of mortality, which need to be confirmed.

Prevalence of acute malnutrition, Northern Upper Nile, Sudan (AAH-USA, 01/03; GOAL, 08/02)

Kassala

Internally Displaced Persons

Kassala state hosts both refugees, mainly from Eritrea, and displaced people; it is estimated that 43,685 IDPs are settled in seven official camps. A nutrition survey was carried out in these camps by Goal in August 2002 (Goal, 08/02). The sources of income of the IDPs were mainly agricultural day labour, wood cutting and charcoal production. Some were able to cultivate on residents' land or on small plots adjacent to camps. There was strong competition between IDPs and refugees for sources of income. The survey revealed a high rate of malnutrition: 17.6% of the children were acutely malnourished, including 2.2% severely malnourished. Only one child had oedema. The measles vaccination coverage proved by cards was 66%. The under-five mortality rate was under-control (0.5/10,000/day). Some 40% of the heads of households were government employees, 10% were petty traders and another 10% were farmers. However, for 93% of the IDPs the main source of food was WFP distribution. By comparison, the prevalence of malnutrition in five of the refugee camps in eastern states in August 2002 varied between 17% and 23% (see RNIS 40), which is very close to the prevalence of malnutrition in the IDP population found in this survey. It has to be borne in mind that August is a hard period, which corresponds to the hunger-gap period and an increased morbidity because of the rainy season.

Refugees

The project of voluntary repatriation of Eritrean refugees has been suspended due to the closure of Sudan-Eritrea border. WFP has experienced a consistent shortfall of resources and was obliged to reduce the refugee rations (WFP, 14/02/03). Considering the already poor nutritional status of the refugee population (see RNIS 40), which shows their dependency on food aid, this reduction in food aid may have serious repercussions.

Jongley

Bieh

Water shortage in this normal dry season (December to May) has reached critical levels in Bieh state. Moreover, the traditional coping mechanisms, which were to move to Latjor and Phou in search of grazing, water and fishing is no longer possible because of ethnic hostilities on-going since 1999 (Fews, 20/02/03).

Southern Blue Nile

It is estimated that about 30,000 people are displaced in camps. A mission conducted at the beginning of February concluded that: displaced camps were insecure; shortage of water was critical; there was a high prevalence of malnutrition in one of the camps, food security situation varied between areas (Fews, 20/02/03).

Western Equatoria

Tambura and Ezo districts

There is concern about the fate of 50,000 returnees and refugees from DRC and CAR, who are mostly settled in camps. An inter-agency mission in January 2002 found that food, water, sanitation and health services were lacking (Fews, 20/02/03). Fews also recommends that food security and nutrition assessments be carried out in the camps in order to make appropriate interventions.

Eastern Equatoria

Juba town and surroundings

Juba town is a government enclave in Bahr el Jebel State. The town has seen a large influx of people from surrounding areas over the past years. The last wave of displacement into Juba occurred in 2002 because of fighting in Kapoeta, Torit and Lafon areas. Two surveys were carried out in Juba and surroundings in December 2002 (ACF-F, 12/02). The prevalence of acute malnutrition has remained stable since December 2001 and under-five mortality rates seem to have slightly decreased (see graph).

Prevalence of acute malnutrition and mortality rate - under-five children - Juba town and surroundings - Eastern Equatoria - Sudan

The measles vaccination coverage was 75.6% in Juba and 59.6% in Juba surroundings, according to cards and mothers' statement.

The nutrition situation is average but may be improved; the under-five mortality rate is under-control.

Overall

Results of nutrition surveys showed, as usual, dramatic situations (category I). Even if the cease-fire agreement is respected, it will take months for the population to restore their health status and livelihood.

Recommendations and priorities

From the GOAL survey in Kassala IDP camps:

• Increase the number of supplementary feeding centres
• Continue growth monitoring programme, nutrition education and outreach services
• Continue to provide food distribution
• Carry out an other survey in six months time

From the GOAL survey in Malakal:

• Strengthen the capacity of national NGOs to provide nutrition and health services
• Conduct bi-annual nutrition surveys

From the AAH-USA survey in Sobat county:

• Implement health services, nutrition programme and EPI activities, especially measles vaccination
• Distribute food rations covering at least 50% of the daily energy requirements
• Improve access to safe water
• Carry out non-food item distribution
• Continue nutritional surveillance

From the ACF-F survey in Bentiu and Rob Kona:

• Continue selective feeding programmes
• Implement water and sanitation activities
• Maintain food security analysis including post-distribution monitoring

From the ACF-F survey in Juba:

• Continue selective feeding programmes
• Promote health education
• Maintain food security programmes

From the RNIS:

• Support WFP appeal