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RNIS 42, August 2003 GREAT LAKES REGIONBurundiAt the end of April 2003 the former president, Pierre Buyoya, from the UPRONA, which leads the Tutsi political grouping, transferred power to the former vice-president Ndayizeye, from the FRODEBU, which is the biggest Hutu political party, (OCHA, 30/04/03). This is in accordance with the Arusha peace agreement. Talks about the revival of a cease-fire agreement, which was signed in December 2002, but has not been implemented, took place in August 2003 (AFP, 21/08/03). Nevertheless, insecurity has spread over the last months, leading to new population displacements. Among others, an attack in Bujumbura and surroundings at the beginning of July 2003 has led to the displacement of somewhere between 15,000 and 40,000 people (AFP, 14/07/03). They have been provided with humanitarian assistance (OCHA, 20/07/03). A majority has returned back home (OCHA, 15/07/03). Theft of goods, livestock and households also seems to have increased (OCHA, 03/08/03), as well as the abduction of humanitarian workers and looting of humanitarian agencies (OCHA, 10/08/03; OCHA, 20/07/03). Unexpected number of returnees from TanzaniaThe number of returnees from Tanzania has increased sharply since May 2003. As of mid-April, about 14,000 people had returned, since the beginning of 2003 (see RNIS 41). About 28,000 returned between May and July 2003. This sharp increase in refugee returns has raised concern. Massive returns of the refugees in a country which is not stable might be due to indirect pressure for departure. Refugee International stated that there is major pressure on the refugee population from the governments of Tanzania and Burundi, some international agencies and local populations (RI, 18/06/03). Refugees said that major reasons for leaving the Tanzanian camps were the diminution of aid assistance and a new restriction of movement outside the camps, imposed by the Tanzanian government (UNHCR, 03/06/03). Because of food shortages, food rations were halved from January to March and were 70% of the full ration in April (UNHCR, 03/06/03). Distribution of non-food items have been halted because of a lack of funding (RI, 18/06/03). Moreover, the government of Tanzania has imposed new restrictions on refugee movements, including a household curfew between 8 pm and 6 am, no movement outside some camps, no permits to any refugee to travel outside the camps (RI, 18/06/03). Refugees were previously able to move freely within a 4-km radius of the camps; they were carrying out some activities which enabled them to add to the humanitarian aid (UNHCR, 03/06/03). Refugee International calls for the UNHCR to fulfil its protection mandate, for the government of Tanzania to ease restriction on refugees' freedom of movement, and for the donors to fully fund appeals for Tanzania camps (RI, 18/06/03). The situation of the returnees, when back in Burundi, should be closely monitored and they should receive assistance if needed. Nutrition and food security situationThe assessment of the 2003 B agricultural season has shown a 1% decrease in production compared to the 2002 B agricultural season. It is anticipated that crops will not last until the next harvest (UNICEF-B, 07/03). Areas are variously affected by food insecurity. The number of admissions to TFCs (25 TFCs) and SFCs (212 SFCs) declined from January 2003 to June 2003, which is in line with the seasonal pattern (see figures); the nutrition situation has not improved in Bururi, Gitega and Ngozi provinces (UNICEF-B, 07/03). Admissions to both SFCs and TFCs were higher in 2003 than in the same period in 2002 (see figures). Admissions to Supplementary Feeding Centres, Burundi (UNICEF-B, 07/03)
Admissions to Therapeutic Feeding Centres, Burundi (UNICEF-B, 07/03)
Democratic Republic of the CongoThe peace process is on -going. The government of DRC and opposition forces signed an agreement on the country's military structure, on 29 June 2003 (USAID, 30/07/03). However, violence has renewed in Eastern DRC, and especially in Bunia town and surroundings, Ituri, Orientale province. Some improvements have been seen on the economic side. The resumption of the transport of goods on the Congo river will probably help to produce a drop in commodity prices. Moreover, it seems that there was a positive economic growth in 2002 and that inflation has dropped from 135% to 16% in one year (BBC, 05/08/03). Ituri, Orientale provinceThe withdrawal of the Ugandan troops from the area (in accordance with a previous accord between the governments of DRC and Uganda) in early May, has led to an escalation of violence between opposition forces, also affiliated to ethnic groups. It is estimated that several thousand people have been killed (MSF, 25/07/03). The number of people who have been displaced is difficult to know precisely, but there have been reports that at least 100,000 fled Bunia area (UNICEF, 19/05/03). The real number is probably more than that, as it has been reported that Bunia town (accounting for 200,000-350,000 inhabitants) was 80% empty in early June 2003 (AFP, 04/06/03). People have fled mostly to Uganda and south to the area around Beni in North Kivu (UNICEF, 19/05/03). The UN Security Council has authorised the deployment of an Interim Emergency Multinational Force (IEMF) of some 1,500 troops to Bunia town, and the reinforcement of the MONUC presence, in order to secure the zone and protect civilians (RI, 02/06/03). The IEMF began to deploy in early June. The relative calm, which has consequently prevailed in Bunia town, has led some of the displaced people to come back (AFP, 04/06/03; OCHA, 02/07/03). It seems that the returnees were not able to re-establish their houses, which were largely destroyed, but have settled in existing camps (MSF, 04/07/03). Food aid was inadequate (MSF, 04/07/03). The IEMF intervention has been seen as insufficient. The ICG has called for a bigger UN intervention force, operating in a wider geographical area (ICG, 13/06/03). MSF has also denounced insufficient protection and humanitarian aid for the populations in Bunia area (MSF, 25/07/03) and has especially expressed its concern about the fate of the population outside Bunia town, where the IEMF has no mandate to intervene. MSF has also deplored the insufficient aid deployed for the displaced people in Beni area. Lubumbashi, Katanga provinceAAH-USA has called attention to the situation in Lubumbashi, the capital of Katanga province. During the month of April 2003, 292 cases of severe malnutrition were admitted to TFC, compared to 88 cases admitted in December 2002 (AAH-USA, 28/05/03). The degradation of the situation may be attributed to several causes. The town has known an economic decline, with massive firing of employees, especially from the major copper mining company, which was employing several thousands of people and was also giving them benefits. Lubumbashi has also faced difficulties in supplying food. The main staples, cassava and corn, were coming either from an area in DRC, which is now under rebel control, or from Southern Africa (see RNIS 39). The drought in Southern Africa has probably had a major impact on food importation to Katanga. Mortality rates in Western and Eastern DRCIRC conducted a randomly -sampled retrospective mortality survey at the end of 2002 (IRC, 04/03). Two surveys were done; one was carried out in ten health zones, randomly chosen, in the west of the country and the other one was undertaken in ten health zones, randomly chosen, in the east of the country. The west of country was government controlled, whilst the major part of the east was rebel-controlled and has experienced a higher level of violence. The results showed high mortality rates, especially in the east of the country (see table), where they were above alert threshold. The difference between the mortality rates in the east and west was, however, not statistically significant. Crude mortality rate decreased in the east compared to the period of August 1998 to April 2001, when the CMR was 5.4 deaths/1,000/month. This reduction was attributed to an improvement in security conditions (peace accord between government of DRC , Uganda and Rwanda; MONUC deployment) and an increase in humanitarian assistance. Moreover, the deaths attributed to violence seemed to have decreased sharply and was one-tenth the rate in previous years. It is worth noting that in both surveys (2001 and 2002), areas inaccessible because of poor security conditions were not surveyed. Rates of mortality and deaths due to violence are probably far higher in these areas. Under-five deaths from diarrhoea, measles and malnutrition were slightly higher in the east than in the west. Crude and under-five mortality rates, DRC, 2002
1 Over the first 9 months of 20022 Calculated from the rate expressed as /1,000/month UgandaInsecurity in North Uganda, drought and raiding in Karamoja and Katakwi, and a new influx of refugees from DRC have worsened the situation in Uganda. The security situation is still very tense in northern Uganda with continuous attacks by the Lord's Resistance Army (LRA). IDP camps, holding about 800,000 people, have been increasingly targeted (IRIN, 07/07/03) and looted for food (Fews, 09/07/03). More and more people, especially children, have taken refuge at night in the urban centres in fear of abductions to enrol them in the armed forces; several schools have been closed in Kitgum district for the same reason (OCHA, 30/06/03). The LRA has also expanded its area of attacks in Adjumani, Katakwi, Soroti and Kaberamaido districts, which has led to the displacement of thousands of people (OCHA, 30/06/03). Access to the population is still severely limited for humanitarian organisations. The northern and eastern parts of the country are affected by food insecurity (see map, FEWSNET, 11/04/03).
WFP has launched an appeal for US$ 54 m to provide food aid to 820,000 IDPs, 655,000 drought victims and 147,000 refugees. WFP will run out of food in September if the appeal is not covered (WFP, 29/07/03). Northern UgandaGulu district A nutrition survey was carried out in 21 of the 31 IDP camps in Gulu district in May 2003 (AAH-USA, 05/03). The results revealed a nutrition situation under control, and which has remained stable over the past four years (see figure). Prevalence of acute malnutrition, IDP camps, Gulu district, Uganda
Mortality rates were, however, dramatically high (under-five mortality rate = 5.7 deaths/10,000/day; crude mortality rate = 2.3 deaths/10,000/day), and were the highest recorded in the camps for five years (see figure). Under-five mortality rates, IDP camps, Gulu district, Uganda
The main causes of under-five year old mortality were fever and diarrhoea. Measles vaccination coverage was 92.1% according to cards and mothers' statement. The survey was done in 21 camps, which remained accessible despite volatile security conditions, but did not target 10 camps where insecurity prevented access. The situation in these camps is probably worse than in the camps surveyed. A nutrition assessment, carried out in two camps in Gulu district in January 2003, found higher rates of acute malnutrition than the present survey (see RNIS 41). High percentages of oedema (4 to 8%) were recorded in January, which needed to be confirmed. Other reasons, which may explain the discrepancy between the two surveys, may be that the camps surveyed were not the same and that the amount of food distributed in the IDP camps has increased since March 2003. Whilst the nutrition situation seemed under control, which may be partly explained by the access to food distribution, mortality rates were extremely high, as a result of a major public health problem (see boxes). The situation may worsen further if attacks and looting increase. Immediate determinants of nutritional status and mortality, Gulu IDP camps, 2003
1 AAH-USA, 05/03 2 WFP/MoH, 01/03 Underlying determinants of nutritional status and mortality, Gulu IDP camps, 2003
1 AAH-USA, 05/03 Eastern UgandaKaramoja Karamoja (Kotido, Moroto and Nakapiripirit districts) is suffering from high food insecurity because of the very poor 2002 harvest (see RNIS 41). There have been reports of high rates of malnutrition. People are depending on highly priced market grains and wild foods until the next harvest, which is expected by September 2003. The crop season has progressed well so far. The most affected households (estimated at 30 to 55 % of the total population) are those relying on agriculture and labour to meet their food needs. The agro-pastoral population seems to be in a better position, with favourable terms of trade and improvement of livestock conditions (because of renewed pasture due to rains), which increases access to livestock products, such as milk (Fews, 09/07/03). WFP food distribution was targeting 95,400 households in June 2003. Katakwi Katakwi district has been threatened by insecurity due to Karamonjong raids for years (see RNIS 41), leading to the displacement of about 85,000 people. Katakwi district, as well as the nearby Soroti district, have also recently experienced incursions of the LRA. An interagency mission held in March 2003 (OCHA, 03/03), before incursions of the LRA, reported uncertain conditions in the camps. Food security Households were largely relying on the market for their food needs. The main sources of incomes for the poor (who represent the majority of the IDPs) were casual work and petty trade (beer brewing, charcoal and wood). Access to fields was made difficult by insecurity; moreover, the 2002 crop was poor because of the weather conditions. A food distribution has been implemented by the government but people have only received 2 kg of maize meal and 1 kg of beans per household per month, which is very low. In addition, it seemed that it has not been the more needy families who received the biggest quantities. About 40 to 50 % of the displaced populations in camps were able to meet only 70% of their daily consumption needs. Meanwhile, populations' livelihoods were limited, impairing their long-term food security (Fews, 09/07/03). Public health Supply of potable water was not adequate. There were no latrines in some camps, whilst availability of latrines was very poor in others (1 for 100 or 200 persons), some of the camps were, however, better covered and programmes of latrine construction were under-way. Hygiene conditions in the camps were generally bad, the camps were overcrowded and presence of animals in the camps worsened the situation, although hygiene promotion has been implemented. Health activities in the camps were poor, with shortage of medical staff and drugs; district health facilities were far from the camps. The situation is probably worsening, as the recent LRA incursions and the insecurity that has resulted have prevented families from harvesting, which will further impair their food security. The district is also less and less accessible due to insecurity. Refugees Former refugees in Acholi-Pii camp, temporarily settled in Kiryandongo refugee camp, after Acholi-Pii camp was attacked by the LRA, expressed their discontent with being relocated in the northern Arua and Yumbe districts (WFP, 25/07/03). Refugees from Ituri, DRC, have continued to arrive in districts bordering DRC, especially in Nebbi and Bundibugyo districts; they are estimated to be about 20,000. Refugees were hosted by families or were sleeping outdoors. They were managing to gather food by fishing, planting or doing daily labour. For several reasons (see RNIS 41), only 97 families agreed to be relocated to camps further inland (OCHA, 30/06/03). The situation of the refugees in the districts near the DRC border has raised more and more concern because some of them were lacking shelter and sanitary conditions were unsatisfactory (UNHCR, 19/05/03). Overall Whilst the prevalence of malnutrition is not at an alarming level in the most accessible camps in Gulu district, mortality rates are dramatically high as a result of a major public health problem. The situation of IDPs in Katakwi district is also alarming as the populations are facing both insecurity from Karamojongs and LRA. There is room for improvement in all basic need services and food availability. Recommendations and priorities:
Republic of CongoThe Republic of Congo has experienced political instability since its independence in 1960. The country especially suffered intermittent civil strife over the last decade (1993/94, 1997, 1998), between armed militia affiliated to different political parties: the "Ninjas", supporters of Bernard Kolela leading the MCDDI, the "Cocoyes", supporters of Pascal Lissouba, leading the UPADS and the "Cobras", supporters of Denis Sassou Nguesso, leading the PCT (RI, 21/05/03; EC, 14/04/03). Sassou Nguesso was president from 1979 to 1991, when Lissouba was elected as the head of the state. Sassou Nguesso overthrew Lissouba in 1997 and took power. A full-scale civil war broke out in 1998 involving the different factions. It has been estimated that about 800,000 people were displaced, most of them from the southern provinces, including Brazzaville; more than that were trapped in the fighting areas. Civilian suffering was extreme with large-scale killing and human-right abuses, including rape and sexual violence. The nutrition situation was desperate and both children and adults were suffering from acute malnutrition (see RNIS 28, RNIS 29). The number of people who have remained displaced in Brazzaville is unknown, as they have settled within the host community. A cease-fire agreement was signed in November/December 1999 and the situation stabilised until the recent outbreak of violence between the government army and the "Ninjas", in March 2002, affecting the Pool region. It is estimated that between 80,000 and 150,000 people from the Pool region have been displaced, of whom more than 60,000 sought refuge in Brazzaville, either in IDP camps (12,000) or in the host community (see map) (OCHA, 02/06/03). People who have remained in the Pool region were cut off from the rest of the country and from humanitarian assistance. A cease-fire agreement was signed on 17 March 2003, confirming the 1999 agreement (OCHA, 18/03/03). It is hoped that this will bring peace back.
Humanitarian operations have been under-funded in 2002 (RI, 21/05/03). IDPs in camps in BrazzavilleExhaustive nutrition surveys were carried out in the IDP camps near Brazzaville in March and June 2003 (MSF-H, 03/03; MSF-H, 06/03). The surveys revealed a precarious nutrition situation, which has remained stable since December 2002 (see table). IDPs are intended to receive a food distribution (RNIS does not know about the intended amount of food distributed). However, in March 2003, 75% of the people reported eating only one meal per day. Water and sanitation seemed to be under-control and health care has been supported by MSF since April 2003 (MSF, 09/04/03). Dry supplementary feeding was in place as well as a TFC. The displaced recently received non-food item distributions (ICRC, 15/07/03). Acute malnutrition in displaced camps near Brazzaville
* Not available from the survey reports Pool regionTotal access to the Pool region has been granted by the government to the humanitarian community in June 2003, for the first time since March 2002. The preliminary results of a joint assessment mission reported that the situation in the region is very poor, with very high level of destruction of villages, including infrastructure, lack of work in fields for more than one year, short supply of food and medicines and uncertain security conditions (WFP, 20/06/03). According to the MSF survey in the camps in March 2003, about 60% of the IDPs witnessed the destruction of their houses (MSF-H, 03/03). Aid to the returnees in the Pool has been planned, including reconstruction/rehabilitation of private houses and infrastructure, food for work and distribution of non-food items (WFP, 20/06/03; OCHA, 10/07/03). Some people have already returned but the scale of future returns is difficult to anticipate as some people may prefer delay to their returns until security conditions and basic needs are guaranteed. RNIS has not received any information on the nutrition situation of the population who has stayed in the Pool during the conflict. OverallThe nutrition situation of IDPs in Brazzaville is precarious (category II), as is probably the nutrition situation of the populations who have been trapped in the Pool region. Donor commitment to this crisis should increase, both to provide relief assistance to the IDPs in Brazzaville and to help the resettlement of the returnees in the Pool region by providing direct assistance to the returnees and infrastructure reconstruction/rehabilitation.
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