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RNIS 43, November 2003 GREAT LAKES REGIONBurundiThere was an upsurge in violence in August and September 2003, which, among other things, has led to the displacement of about 53,000 people in Bujumbura rural Province and 21,000 people in Bubanza Province (OCHA, 29/08/03; WFP, 26/09/03). After the signature of a peace agreement between the Burundian President and the country's largest Hutu rebel group, the Forces for the Defence of Democracy (FDD), in early October, the situation has calmed down but has remained volatile (AFP, 07/10/03; UNICEF, 06/11/03). An enlarged government with members of the FDD, should be formed by the end of November 2003 (AFP, 07/11/03). However, the other Hutu rebel group, the National Liberation Force (FNL) was not part of the cease-fire negotiations (AFP, 08/10/03). The deployment of about 3,000 peacekeepers from Ethiopia, Mozambique, and South Africa, to help in the demobilisation, disarmament, demobilisation and reintegration of rebel troops and to monitor the transition to democracy, has been completed (OCHA, 02/11/03). As of end October 2003, UNHCR reported 26,690 facilitated returns of Burundian refugees and 42,103 spontaneous returns in 2003 (OCHA, 02/11/03). Nutrition situation Admissions to TFCs and SFCs diminished slightly in July and August 2003, compared to June 2003, which is in line with the seasonal patterns. However, in some Provinces, the diminution in admissions might be due to a decrease in accessibility caused by insecurity (UNICEF-B, 09/03). Rains have been inadequately distributed and the 2004 A agricultural season might be difficult (SAP-SSA, 09/03). A random sampled nutrition survey was done in Karuzi Province in July 2003 (MSF-B, 07/03). The nutrition situation was not critical: the prevalence of acute malnutrition was 4.8% (3.3-6.2), including 0.8% (0.3-1.6) severe malnutrition, and was in the same range as malnutrition rates in September 2001 and March 2002 (see RNIS 36/37 and RNIS 38). Crude and under-five mortality rates were average (respectively, 0.5/10,000/day and 1.8/10,000/day) and were similar to the mortality rates recorded in March 2002. Democratic Republic of the CongoWhilst the peace-process continues, with the recent authorization for former rebel groups to function as political parties (IRIN, 06/10/03), violence is still widespread in Eastern DRC. The mandate and means of the UN peace keeping force (MONUC) have been expanded (ISS, 19/09/03). In Ituri region, Orientale Province, which has known an incredible level of violence over the past months, the peace-keeping forces will eventually number 5,000. The troops took over Bunia town from the French-led Interim Emergency Multinational Force, in September, and they have begun to deploy outside Bunia town (Reuters, 08/10/03; Reuters 23/10/03). High insecurity has prevented humanitarian access to needy populations around Bunia town for months. Oicha and Mutwanga, Beni, North Kivu About 50,000 people arrived in Beni area, mostly from Orientale Province, around April 2003. The are settled in host communities, in camps or in public buildings. Two random sampled nutrition surveys were carried out in Oicha and Mutwanga health zones in June 2003 (WV, 06/03). Both surveys included a significant number of displaced families (see table). The prevalence of malnutrition was of concern (see table) but had improved since the last surveys carried out in December 2002. It seemed that children of displaced families had a higher risk of malnutrition than children of resident families. The main source of food was agriculture (76% in Oicha, 93% in Mutwanga), followed by food aid (15.7% in Oicha, 1.4% in Mutwanga) and purchase (7.3% in Oicha, 4.0% in Mutwanga). Food aid was mostly received by IDPs. Prevalence of acute malnutrition, Beni area, North Kivu, DRC, June 2003 (WV, 06/03)
Kabala, Kalemie, Katanga Province The area has been prone to insecurity for years; the situation seems to have recently stabilised. A random-sampled nutrition survey was carried out in Kabalo health zone in April 2003 (MSF-S, 04/03). Because of insecurity, 40% of the health zone was not included in the survey. The survey was carried out during the harvest period; people had access to agriculture, fishing and hunting. The prevalence of acute malnutrition was average: 7.7 % (5.7-9.8) acute malnutrition, including 1.8% (0.5-3.1) severe malnutrition. Crude and under-five mortality rates were, however, worrying (1.9/10,000/day and 5.4/10,000/day, respectively). The major causes of under-five mortality were fever (malaria) and measles. Measles vaccination coverage was low; only 37.9% of the children had been vaccinated, according to cards and mothers' statements. Overall The nutrition situation seems to be mixed in DRC and malnutrition seems to be highly related to insecurity and population displacement. Recommendations: From the WV survey in Beni
From the MSF-S survey in Kalieme:
United Republic of TanzaniaTanzania hosts about 500,000 refugees, of whom 150,300 are Congolese refugees in the camps of Lugufu and Nyarugusu, and 350,000 refugees from Burundi hosted in Kasulu, Kibondo and Ngara districts. As at 4 September 2003, UNHCR estimated that about 55,500 Burundi refugees had returned home since the beginning of 2003; 20,000 benefited from facilitated repatriation by UNHCR, whilst 35,000 returned spontaneously (OCHA, 14/09/03). Spontaneous returns have especially increased since May 2003, and have probably been due to the reduction in aid assistance in the camps combined with a restriction of movements outside the camps imposed by the Tanzanian government; this has undermined the ability of the refugees to fulfil their basic needs (see RNIS 42). The impact of hosting refugees A study on the impact of hosting refugees, commissioned by humanitarian organisations, was carried out by the Centre for the Study of Forced Migration, University of Dar el Salaam, (OCHA, 15/10/03). The main findings of the study were: that the high insecurity prevailing in the regions hosting refugees could not be mainly attributed to refugees, the ratio of criminals among refugee population being comparable to the ratio of criminals among local populations; that, although environment degradation has occurred in the years following the influx of refugees, recent environmental programmes have redressed former negative impacts; that, in the same way, the initial burden on infrastructure, health services and education has been reversed after the setting up of humanitarian operations; that although the lack of internal security may have contributed to the lack of productivity in agriculture, local purchase by WFP has supported producers and suppliers, business has increased due to increased disposable income and agricultural activity in the area has been expanded due to the presence of a cheap workforce of refugees. Tax collection from humanitarian agencies is also a non-negligible source of income. However, aid to the Tanzanian authorities for local governance and administration has been far too low. Nutrition situation A nutrition survey was carried out by UNHCR in 13 refugee camps, in August 2003 (UNHCR/UNICEF, 08/03). The nutrition situation of under-five children was under-control, although the prevalence of malnutrition had increased slightly compared to July 2002 (see table). There has been report of an increase in admissions to TFCs and SFCs. Average crude and under-five mortality rates in 2003 were below the threshold: CMR was 0.10/10000/day and under-five mortality rate was 0.29/10000/day, as recorded by routine surveillance. Full vaccination coverage among infants under one year old was reported to be more than 90% in most of the camps. Acute malnutrition, Tanzania refugee camps, 2002-2003
Food security Refugees are meant to receive 1857 Kcal/pers/day, which is less than the full 2,100 recommended ration; this was based on the assumption that refugees were able to complement the food ration distributed, with other sources of food or income (WFP/UNHCR, 06/03). Because of food shortage, food rations were halved from January to March 2003. Food rations were then increased but some food items were, however, only distributed at 50 to 75% of the full ration. WFP/UNHCR mission found that the decrease in food ration led to an increase in social unrest at household level and in banditry in and outside the camps (WFP/UNHCR, 06/03). Full ration distributions at about 1,800 Kcal resumed in October 2003 (WFP, 26/09/03). Because of restrictions of movement outside the camps, refugees have had difficulties in obtaining fresh food (OCHA, 10/10/03) and they have no longer been able to carry out income-generating activities or the collection of fire-wood. Refugee were selling part of their food rations for other food items (cassava, banana, vegetables) or for non- food items (WFP/UNHCR, 06/03). Availability of non-food items Non- food items, such as blankets, jerry cans or cooking sets, are distributed on arrival at the camp but they are not replaced when worn; sanitary material and soap should be distributed regularly, although there are recurrent breaks (WFP/UNHCR, 06/03). Firewood is not distributed and the collection of firewood is one of the main problems. Women can go as far as 30 km two to three times a week to collect firewood, which also expose them to security problems (WFP/UNHCR, 06/03). Public health There were no reports of particular health or water and sanitation problems in the camps, although a funding shortfall and decrease in sources of income may have an impact. Breaks in distribution of sanitary material and soap are recurrent (see above). Social and care environment According to the survey, 75% to 85% of the 6-24 month olds were breast-fed, depending on the camp. The majority of the children were receiving three to four meals a day, but a significant proportion (varying from 7% to 70%, depending on the camp) was only receiving one to two meals a day. It seems that the overall social behaviour has deteriorated, for example, there was a high degree of domestic violence in June 2003. Overall The recent restrictions of movement outside the camps and the reduction in assistance and especially of food assistance seemed to have had a slight impact on the nutrition status of children underfive, which is, however, still under-control (category III). Moreover, thousands of refugees have left the camps, partly because of the hardship conditions. Had they remained, the nutrition status may have been worst. Recommendations: From the UNHCR nutrition survey:
From the WFP/UNHCR joint assessment:
UgandaAttacks on the civilian population by the Lord's Resistance Army (LRA) have spread from northern Uganda to Teso region over the past months. It is estimated that, in addition to the 800,000 displaced in the north, about 300,000 people are displaced in the east (see map): 150,000 in Katakwi district, 80,300 in Soroti, 33,800 in Kaberamaido and 21,100 in Kumi (WFP, 25/09/03). The health status of the displaced people in the east has been reported as deteriorating(IRIN, 25/09/03). Concerns about the fate of the IDPs are growing. Despite an increase in funds dedicated to this crisis, additional funds are needed, and the UN agencies have been called to increase their action towards the IDPs (RI, 15/10/03). New cash contributions are urgently needed for WFP to continue carrying out highly-needed food distributions (WFP, 14/11/03). On the other hand, food security has normalised in Karamoja, following a normal crop harvest. Prices of cereals were decreasing and prices of livestock were on the rise (FEWS, 10/10/03). Kalongo town, Pader district A random-sample nutrition survey was conducted in Kalongo town in August 2003 (GOAL, 08/03). About 70% of the households surveyed were displaced. The nutrition situation and the mortality rates were worrying (see table). Results of a nutrition survey, Kalongo town, Pader district, Uganda, August 2003 (GOAL, 08/03)
1 According to cards The IDPs seemed to be at higher risk of malnutrition. The food security situation was poor and the public health system was inadequate (see box). Food security and public health, Kalongo town, Pader district, 08/03 (GOAL, 08/03)
Overall Increased commitments in terms of funding, humanitarian action and crisis resolution are needed to mitigate the dire situation in northern/eastern Uganda. Recommendations: From the GOAL survey in Pader district:
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