United Nations System
Standing Committee on Nutrition

Nutrition Information in Crisis Situations - Sierra Leone

NICS 6, May 2005

Sierra Leone is recovering from a ten- year civil war which ended in 1999. A random-sampled nutrition survey was conducted in the Capital of the country, Freetown, in September 2004 (ACF, 09/04). The nutrition situation was under control (table 10).

Table 10 Results of a nutrition survey in Freetown, Sierra Leone, September 2004 (ACF-F, 09/04)

NICS 3, August 2004

The programme of voluntary repatriation of Sierra Leonese refugees was completed at the end of July 2004, after about 178,000 refugees were repatriated and 92,000 returned on their own to Sierra Leone (UNHCR, 21/07/04). It is estimated that about 15,000 refugees have chosen to integrate locally.

NICS 2, May 2004

UNAMSIL mandate has been extended until September 2004 and a residual force will probably remain till June 2005 (OCHA, 12/05/04). The security situation is calm but inflation is still on the rise (OCHA, 12/05/04). Some 7,400 refugees have been repatriated from Guinea (6,276) and from Liberia (1,175) by UNHCR since the resumption of the repatriation programme in January 2004 (OCHA, 12/05/04).

However, there are some weaknesses in the reconstruction process. According to the URD group, there is still a strong presence of humanitarian organisations during this rehabilitation phase, as was the case during the crisis, and some creative programmes are being implemented (URD, 12/03). On the other hand, UNHCR’s assistance to the returnees seems limited, there is a lack of housing programmes and the funding of the rehabilitation of the health system is insufficient.

NICS 1, February 2004

The situation continues to improve. Economic performance has been doing well in 2003, with a 6.5% growth in real gross domestic product, resulting from growth in diamond production, a modest increase in manufacturing output, expansion in construction activities and recovery in agriculture (UNSC, 23/12/03). In 2003, rice out-put was 78% of its pre-war level, owing to an increase in areas planted and to major distributions of seeds. Other crops, such as cassava, sweet potatoes and groundnuts have also recovered. However, inflation rose in 2003, with, among others, the food index rising by 5% and medicine and medical care by 24%.

There have been no significant influxes of refugees into Sierra Leone over the past six months. As of first January 2004, Sierra Leone hosted an estimated 70,000 Liberian refugees, of whom, 55,000 were settled in camps, 7,000 in urban centres and 7,500 at the border area (OCHA, 06/11/03).

An estimated 14,000 Sierra Leonean refugees are still settled in Liberia and about 15,000 Sierra Leonean refugees are hosted by Guinea (UNHCR, 31/10/03; OCHA, 19/12/03). About 4,000 refugees were repatriated from Liberia in 2003 (UNHCR, 31/10/03), and about 25,000 refugees were repatriated from Guinea (see RNIS 42) in the first semester of 2003. Repatriations from Guinea were suspended during the rainy season and resumed in December 2003.

Contrasted nutrition situation in refugee camps

Random sampled nutrition surveys were carried out in eight Liberian refugee camps in Bo, Pujehun, Kenema and Mayamba districts in October 2003 (UNHCR/joint, 10/03). At the time of the assessment, 55,000 refugees were estimated to be living in the camps. Refugees were supposed to receive a full food ration (2,100 Kcal), although some problems in the distribution were reported, especially in Bandajuma camp. Refugees were considered to be almost dependent on food distribution, although some were engaged in income-generating activities or in agriculture. Health care was provided in all the camps, as well as access to safe drinking water and to sanitation facilities. However, a below standard amount of water was reported in Largo and Taiama camps during the dry season. There were supplementary feeding centres in Jimmi Bagbo, Bandajuma, Gondama, Jembe, Gerihun and Largo camps. Severely malnourished children were referred to therapeutic feeding centres.

The nutrition situation was contrasted depending on the camps; it was average in Gondama, Gerihun, Jembe, Jimmi Bagbo and Tobanda (category III), whilst it was of concern in Bandajuma and Taiama (category II), and serious in Largo (category I) (see table 9). The mortality rates were under-control (see table 9), except in Jimmi Bagbo, where a Lassa fever outbreak occurred.

No hypothesis regarding the difference in the nutrition situation between the camps could be drawn from the survey report. According to the people interviewed during the survey, more than 95% of the families in all the camps were receiving the general distribution. However, the actual amount of food received was not documented. In Largo camp, where the nutrition situation was the worst, the proportion of the refugees who arrived in 2003 was 34% and significantly higher than in the other camps (see table 9); this may play a role in the high prevalence of malnutrition recorded. Moreover, Largo is a newly established camp, refugees may have less access to food or income outside the camps, compared to refugees in long-term established camps.

When compared to the prevalence of malnutrition recorded in August 2002 in six camps (see RNIS 40; see figure 3), the nutrition situation was better in October 2003 in all the camps, except in Bandajuma, where it has not changed and in Taiama where it has worsened.

Table 9 Results of nutrition surveys, refugee camps, Sierra Leone, October 2003 (UNHCR/joint, 10/03)

Camp	% of the families interviewed who arrived in 2003	% Acute Malnutrition (95% CI)	% Severe Acute Malnutrition (95% CI)	Crude Mortality (/10,000/day)	Under 5 Mortality (/10,000/day)	Measles immunisation coverage (%)*
Gondama, Bo district	15	4.8 (2.8-6.8)	0.1 (0.0-0.4)	0.1 (0.0-0.3)	0.3 (0.0-0.6)	97.8
Gerihun, Bo district	1.8	5.9 (3.6-8.2)	1 (0.7-1.3)	0.3 (0.1-0.4)	0.7 (0.2-1.2)	88.3
Jembe, Bo district	9.0	7.6 (5.1-10.1)	1.6 (0.4-2.8)	0.3 (0.1-0.5)	0.5 (0.1-0.9)	95.5
Jimmi Bagbo, Bo district	1.6	7.6 (5.0-10.2)	1.8 (0.5-3.1)	0.9 (0.6-1.1)	1.2 (0.6-1.8)	97.8
Bandajuma, Punjehun district	10.9	14.3 (10.7-17.9)	2.1 (0.7-3.5)	0.2 (0.1-0.3)	0.4 (0.1-0.7)	98.8
Largo, Kenema district	33.9	29.2 (25.0-33.2)	3.7 (2.0-5.4)	0.3 (0.1-0.4)	0.5 (0.1-0.9)	88.3
Tobanda, Kenema district	1.8	5.8 (3.7-7.9)	1 (0.8-1.2)	0.2 (0.1-0.3)	0.5 (0.1-0.8)	94.4
Taiama, Moyamba district	1.8	12.9 (9.9-15.9)	1.7 (0.6-2.8)	0.2 (0.1-0.3)	0	98.7

* According to cards and mothers' statements

Figure 3 Prevalence of acute malnutrition, refugee camps, Sierra Leone

Recommendations

From the survey in the refugee camps:

Continue to provide a full food ration
Maintain monitoring of the general food distribution
Continue to run existing SFCs and implement SFCs in Taiama and Tobanda
Strengthen active case finding and growth monitoring in clinics
Give refugees better access to land cultivation

From NICS in the refugee camps

Investigate the causes of the high rates of malnutrition recorded in some of the camps

RNIS 43, November 2003

Refugee movement has been low over the past months. Most of the refugees are settled in eight camps and some live in host communities. Seeds will be distributed to refugees, both in camps and in host communities, in order that they can improve their access to food (OCHA, 31/08/03).

RNIS 41, April 2003

Despite on-going conflict in neighbouring countries, the situation in Sierra Leone continues to improve with an economic growth of six percents and low inflation (WB, 26/02/03). However, the country has still to recover from a 10 year war. The World Bank has approved US$ 40 m in grants for reconstructing the health sector, rehabilitating basic education and boosting social action programmes (WB, 26/02/03).

A survey conducted by the Ministry of Health and Food Security and the FAO concluded that 70% of the estimated seed requirements were distributed before the 2002 agricultural season. The main constraints affecting agricultural production were long distances to collect inputs; lack of knowledge of agricultural practice and lack of seeds (OCHA, 28/02/03).

The security situation is still tense at the border with Liberia with reported incursions of the Liberians United for Reconciliation and Democracy (LURD).

Bombali district

A nutrition survey was carried out in Bombali Sebora chiefdom, Bombali district, in November 2002 (ACF-F, 11/02). This area was one of the hardest hit during the war; nearly all the population had returned at the time of the survey. The survey showed a prevalence of acute malnutrition of 8.0%, which included 0.5% severe malnutrition. No oedema was recorded. The malnutrition rate is average and a little bit higher than the prevalence of malnutrition which was found during a survey conducted in the whole district except Bombali Sebora chiefdom in February 2002, where the prevalence of malnutrition was 4.9%. The number of admissions to the supplementary feeding centre which covers the chiefdom remained stable over 2002. The measles vaccination coverage was 39% proved by card and 73% according to cards and mothers' statements. Several humanitarian assistance programmes are being implemented in the district, including health, nutrition and agricultural programmes.

Refugees

A new wave of Liberian refugees has been reported to have entered Sierra Leone because of renewed fighting and the relaxation of border controls by the armed forces in Liberia. As of 23 February 2003, about 9,000 Liberian and a few Sierra Leonese have entered the country since the beginning of the year (WFP, 28/02/03), adding to about 35,000 who had already taken refuge in Sierra Leone. UNHCR has opened a new refugee camp in Kenema district (OCHA, 03/04/03). Some of the refugees prefer to stay in villages near the border, in areas humanitarian agencies have difficulties to access. Resources will be shared between the resident population and the refugees, which may lead to food insecurity for both populations. RNIS has not received any recent nutrition information on the new refugee population; the nutrition situation of the previously refugee population seems stable. The repatriation plan of Sierra Leonese refugees from Guinea has resumed since the beginning of the year; 4,500 Sierra Leonese have been repatriated in January and February 2003 (OCHA, 12/03/03).

Overall

Whilst the situation of the population of Sierra Leone is improving, refugees from Liberia are still seeking refuge in the country. Their nutrition situation is considered at risk (category II).

Recommendations

From the ACF survey in Bombali:

Continue supplementary and therapeutic feeding programmes
Promote identification of malnourished children at PHU level
Strengthen routine immunisation activities in the PHUs

Sierra Leone

La situation continue de s'améliorer en Sierra Leone, avec une croissance économique de 6%, bien que le pays soit encore loin d'avoir effacé les dégâts de dix ans de guerre civile.

Une enquête nutritionnelle dans le district de Bombali a montré une situation nutritionnelle moyenne. Une nouvelle vague de réfugiés est arrivée en provenance du Libéria. Les réfugiés se sont installés dans des villages près de la frontière avec le Libéria où ils sont difficiles à atteindre en raison des mauvaises conditions des routes et de la sécurité volatile. Le partage des ressources entre la population résidente et réfugiée risque de conduire ces populations à une insécurité alimentaire.

RNIS 40, Dec 2002

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)

Camps	Acute malnutrition	Severe acute malnutrition	Under-five MR (/10000/day)	CMR (/10000/day)
Jimmi	22.2	2.4	1.16	0.52
Bandaju-ma	14.5	3.5	1.4	0.48
Gondama	10.1	2.9	1.02	0.27
Gerihun	12.7	1.9	0.77	0.17
Jembeh	9.8	0.7	0.83	0.41
Taiama	6.6	0.4	0.31	0.12

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

Sierra Leone

Le flux de réfugiés en provenance du Liberia s�est fortement ralenti ces derniers mois. Des enquêtes réalisées dans les camps de réfugiés des districts de Bo, Pujehun et Moyamba en Août 2002, ont montré des taux de malnutrition assez élevés (catégorie II/III) dans pratiquement tous les camps (voir tableau). Par contre, les taux de mortalité restaient inférieurs au seuil de gravité. Depuis, un programme de nutrition supplémentaire a été initié dans les camps, et l�on peut penser que la stabilisation du nombre de réfugiés a permis d�améliorer leur situation.

RNIS 39, October 2002

The overall situation within the country remains stable, whereas the border area with Liberia is still insecure. Six chiefdoms of Kailahun district have been declared safe for repatriation in August, whilst two (Malama and Kissi Teng) remain unsafe (OCHA, 31/08/02). President Kabbah asked UN forces to stay longer than late September. He is concerned about the destabilisation of the whole country, which could result from the on-going fighting in Liberia. He is also concerned that security will deteriorate when a war-crimes tribunal begins next year (OCHA, 10-09-02). The UN mission mandate has been extended for six months (UNSC, 24/09/02). The Sierra Leone government seeks to boost the economy in the country. The President pronounced a ban on illegal diamond mining in order to assure total control of diamond sales (AFP, 29/08/02). Diamond exploitation was one of the major causes of the civil war in the country.

Refugees, returnees and IDPs

Repatriation of Sierra Leonan refugees continues. Repatriation from Guinea resumed mid-August following a 40 day interruption due to a shortage of trucks (UNHCR, 16/08/02). Sierra Leonan refugees were also repatriated by boat from Liberia. It is estimated that 30,888 Sierra Leonans have been repatriated by UNHCR from Liberia this year and more than 18,000 from Guinea. More than that have spontaneously returned. UNHCR temporarily suspended repatriation procedures at the beginning of September as not many people seemed to want to return (UNHCR, 10/09/02). 270 from the 2,000 who sought refuge in Nigeria have expressed a willingness to be repatriated. The unaccompanied and separated minors, many of whom were born in Liberia, constitute a special issue (IRIN 20-26/07/02).

Liberian refugees continue to enter Sierra Leone but the flow is less than in previous months. As of August, 33,576 Liberian refugees were registered (see table).

Numbers of registered Liberian refugees in Sierra Leone, (OCHA, 31/08/02)

Location

Registered population

Bandajuma

4,814

Taiama

6,383

Jimmi/Bagbo

6,048

Gondama

3,267

Jembe

6,401

Gerihun

6,663

Total

33,576

Some refugees have been relocated from the Liberian border into camps in Bo and Kenema (OCHA, 31/08/02).

The government wants to reclaim government land and asked 10,000 IDPs in the Clay Factory camp near Freetown to move within three months. IDPs want more discussion for proper planing and more time to prepare the move (PANA, 18/08/02).

Resettlement and re-integration of the returnees

The last returnees from a transit area in Bari have been resettled to their home in eastern Kono and Kailahun district (IRIN, 10-16/08/02). Relocation of returnees from the Freetown camps continues (OCHA, 31/08/02). There is deep concern about the living conditions of resettled returnees, particularly in the most war-affected districts of Kono and Kailahun, where in some areas more than 70% of homes have been destroyed. According to USCR, some homes are occupied by squatters. Women on their own face particular obstacles to re-integration; they have difficulties reclaiming property, which traditionally belongs to men. They also experience violence. During the war 72% had experienced human rights abuses and more than 50% were victims of sexual violence. There is a call for new programmes especially for women, to help them both psychologically and materially (USCR, 19/07/02).

Tonkolili district

A nutritional survey was carried out by ACF in February 2002 in Tonkolili district in the Northern part of Sierra Leone (ACF, 02/02). People began to come back to Tonkolili district from March 2001. Three main food economy zones coexist in the district: the gold-based zone in the northeast, the agricultural and livestock subsistence in the north and trading in the south. The survey revealed a dramatic improvement in the nutritional situation since October 1997 (see table), the last previous survey in this district, which was thereafter inaccessible for security reasons. Although Tonkolili was one of the most affected districts during the war, the nutritional situation now seems under control. The measles vaccination coverage, however, is low with only 27.5 % coverage confirmed by card and 66.9 % when also taking into account mother’s statement. Health structures re-opened gradually and are supported by NGOs but the district is still not totally covered for health and water facilities. However, a high number of returnees is still expected and the situation has to be carefully monitored.

Malnutrition rate, Tonkolili district, Sierra Leone (ACF, 02/02)

October 1997

February 2002

Acute malnutrition (95 % CI)

18.9 % (15.4 23)

5.6 % (3.7 8.3)

Severe acute malnutrition (95 % CI)

3.1 % (1.7 5.3)

0.6 % (0.1-2.0)

Kenema district

Internally displaced old people

A survey was undertaken by Help Age International in Kenema district, Nongowa chiefdom, on vulnerable internally displaced elderly (Helpage, 02/02). The survey targeted the most vulnerable (see annex), and is not representative of the entire population of the elderly. Those surveyed were aged 70 to 85 years. Among them, 80 % presented a BMI < 18.5, defined as malnourished, which included 46 % with a BMI < 16, defined as severe Chronic Energy Deficiency; 78 % presented a MUAC < 22 cm. Main food sources were relief food (41%), wood selling (27%) and gardening (8%). This pattern was completely different from that of 1990, defined as a normal year, when the major food sources were farming (57 %) and cash crop sales (24 %). The use of the available food also changed, 54 % of the food being eaten at the time of the survey versus 38 % before the war. Slightly more food is sold than before and only 3% of food is stored compared to 18% before war. The major income sources are wood selling (48%), relief items (25%), begging (9%) and gardening (8%). Before the war, the major sources of income were farming and cash crops (69%) followed by trading (10 %) and livestock (8%). This survey, even if only targeted on the most vulnerable of the elderly shows a poor nutritional status and reflects the change in the food security situation after ten years of war.

Resettlers

A joint assessment mission was carried out by UNOCHA, NaCSA and Africare in Dama, Koya and Gaura chiefdoms in August 2002. There were 6,000 IDPs who had resettled at that time, increasing the local population by 90% (OCHA, 31/08/02). According to former IDPs, they are struggling more for water or school fees for their children than previously. However, some reported enhanced well being, compared to when they lived in the camp.

Kailahun district

Kailahun district is hosting both refugees from Liberia as well as Sierra Leonean returnees from Guinea and Liberia. A food security survey was carried out by ACF in May 2002 in Kissi Tenge, Kissi Tongi, Kissi Kama and Luawa chiefdoms (ACF, 05/02). At the time of the survey, these areas had not been declared safe. Housing, water and sanitation facilities and health facilities had been destroyed.

Liberian refugees

Refugees are settled either in camps (Buedu, 1,268 people; Kailahun, 250 people) or in communities in temporary shelters. Most of refugees prefer to stay in the Northern area, because they are closer to home; they are waiting for relatives; they share the culture and language of the host population and they can cultivate fields. The newly-arrived refugees reports to have come with very few belongings, and with no food or seeds. Initially, they were provided with food and shelter by the host community on their arrival. However, this has not been the case for some time because the food stock of the host community has been exhausted. Both refugees and host communities rely on wild food. About 70 % of the refugees in camps are considered poor, whilst 20 % are considered as middle-income and 10% as better off. Wealth was mostly related to the number of people in the family (the largest families are poorer), the land cultivated (poor families have less land) and time of arrival; the newly-arrived being more vulnerable. Refugee income-generating schemes are numerous: palm fruit and kola nut harvesting and processing, collection of pepper bushes, farming, labouring for residents, casual labour, wood selling, stick collection for reconstruction and water collection. They are in competition with returnees for jobs.

Sierra Leonean returnees

Sierra Leonean returnees came back both from Guinea and Liberia, some because of the recent insecurity in Liberia. Returnees from Guinea have been able to come back with some food, unlike those from Liberia. The middle-income and better-off returnees from Liberia have been supported in terms of food and housing material by their families who had remained in Sierra Leone. They were also able to come back with some belongings. The poorest, including female headed households, came without anything. Most of the interviewed households spontaneously returned and did not receive any food assistance. The food sources varied (see table).

Food sources of Sierra Leonan returnees in Kailahun district (ACF, 05/02)

Poor

Middle

Better-off

From Liberia

From Guinea

From Liberia

From Guinea

From Liberia

From Guinea

Own crop (%)

0

20

0

20

0

30

Wild food (%)

25

25

20

10

10

5

Exchange/
labour (%)

20

30

0

0

0

0

Purchase (%)

15

15

40

40

40

50

Kinship (%)

10

10

20

20

30

5

Food aid (%)

10

10

10

10

10

10

Loan (%)

20

10

10

Sources of income were much the same as for Liberian refugees but also included petty trading. The better-off households coming from Guinea also received remittances from relatives in Guinea or other countries. This represented about 30% of their income.

Having seeds for plantation was one of the major issues for the returnees. The major source of seeds for the poorest households was labour exchange, followed by loans, family support and humanitarian aid. Middle-income households also mostly relied on labour exchange and loans, while the better-off were supported by loans and family support.

Depending on the date of their arrival, returnees face different problems. Returnees who arrived before January 2002 were able to cultivate different sorts of crops such as rice, cassava, groundnuts and vegetables. They have to share with newly-arrived members, which reduces food security in the long term and makes difficult to save seeds.

Those who came in April missed the registration for seed distribution. They had to borrow seeds and will have to reimburse these from their harvest.

People who came in April-August will mostly depend on relief food and casual work.

Kono district

Kono district has been one of the districts most affected by the war. Since the war ended, farming, cash crop plantation, trading and diamond mining have resumed. About 90% of the structures were destroyed during the war, including health facilities. Water and sanitation facilities are almost non-existent. Of the resettled community, 60% came from Guinea, 30% from Bo/Kenema and 10% from bush camps within Kono district. ACF carried out a food security survey in the district in May 2002 (ACF, 05/02)

The returnees have the same sources of income as before the war but they are carrying them out on a smaller scale because of a lack of means: farmers don’t have enough crops, diamond miners lost their equipment, cash crop farmers lost their marketing network. The majority of those who returned at the beginning of the year have been able to plant several crops and have also been involved in several kinds of income-generating activities.

The others did not plant upland rice (normally in May-June) because of a lack of seeds or late returns. They plan to plant swamp rice in September, obtaining seeds from relief or using their incomes. The large cacao and coffee plantations have suffered from the war and it will need some time to have yields similar to those before the war. The palm oil harvest from April to June is one of the major sources of income for returnees. Seeds were obtained mostly from purchase or labour exchange, followed by loans and humanitarian aid. The sources of income for the poor are mostly the sale of vegetables and bush crops. For others it is contract labour, wood selling and palm oil processing. Middle-income households derive their income mostly from palm oil processing and small trading, whilst the better-off rely on palm oil processing for 70%. Returnees mostly depend on purchasing their food (see table).

Source of food, returnees, Kono district (ACF, 05/02)

Poor

Middle

Better-off

Purchase (%)

35

50

65

Loan (%)

25

20

15

Gift (%)

20

15

5

Humanitarian aid (%)

10

10

10

Bush harvest (%)

10

5

5

Overall Returnees are facing difficult conditions in districts particularly affected by war. They lack basic services and infrastructure such as shelter, health care, water and sanitation. They are, however, considered at moderate risk of malnutrition (category III). The situation of the new Liberian refugees is unknown (category V).

Recommendations and priorities

From the inter-agency assessment in Kenema district

Support existing and resettling households with seeds and tools.
Continue efforts to re-unify families
Enhance the provision of basic services such as health, education and agriculture
Raise protection issues to combat and alleviate the abuse many have suffered.

From the ACF food security survey in Kailahun district

Food aid and rice seed distribution are not recommended along the border with Liberia because it could increase the risk of looting
Short season seeds (cassava, vegetables) should be distributed in non-border areas
Ensure registration of unassisted spontaneous returnees
Follow-up of the food security situation.

From the ACF food security survey in Kono district

Provide food and non-food assistance to spontaneous resettling households
Distribute food for agriculture
Distribution seeds and tools according to the planting seasons
Ensure registration of unassisted spontaneous return
Rehabilitate or construct water, sanitation and health facilities
Undertake a nutrition survey

From the RNIS

Ensure basic services access to the population
Strengthen livelihood of the returnees
Provide particular attention to female headed households

Sierra Leone

Le mandat des forces de maintien de la paix a été prolongé de 6 mois. Le rapatriement des réfugiés sierra léonais continue, environ 31 000 d’entre eux ayant été rapatriés du Libéria, et 18 000 de Guinée par le HCR, un nombre encore plus important étant revenu spontanément. 30 000 Libériens sont actuellement réfugiés en Sierra Leone, dont un nouvel afflux depuis le début de l’année 2002.

Une enquête nutritionnelle a été menée en février 2002 dans le district de Tonkolili par AcF. Les taux de malnutrition y étaient assez faibles: 5,6% de malnutrition aiguë, incluant 0,6 % de malnutrition sévère, montrant une nette amélioration depuis la dernière enquête réalisée en octobre 1997.

Néanmoins, de nombreuses personnes sont en train de se réinstaller dans le district et la situation doit être suivie de près.

Helpage a réalisé une enquête chez les plus vulnérables des personnes âgées déplacées. Cette enquête même si elle n’est pas représentative de toute la population âgée déplacée a révélé que 80% des personnes de l’échantillon présentaient un BMI inférieur à 18,5: il s’agit donc d’une situation très précaire pour cette population vulnérable qui vit essentiellement de vente de bois, d’aide alimentaire et de mendicité.

Les districts de Kailahun et de Kono ont été parmi les plus touchés par la guerre qui a causé la destruction d’un grand nombre de bâtiment et de maisons. De nombreux Sierra Léonais qui avaient fui s’y sont réinstallés. Il est urgent de mettre en place dans ces districts des infrastructures garantissant l’accès des populations aux services de base, avec une attention particulière pour les femmes seules, connaissant le plus de freins à leur réintégration. De nombreux Libériens trouvent aussi refuge dans le district de Kailahun, frontalier avec le Liberia. Bien que la situation nutritionnelle de ces réfugiés ne soit pas précisément connue, ils sont considérés comme à risque.

RNIS 38, July 2002

Sierra Leone has and is still suffering the effects of more than a decade of civil war that has left much of the country in ruins, destroyed the economy, resulted in the mass displacement of population, both within the country and as refugees in the region, and left many people in positions of extreme poverty and with limited ability to cope. The internal conflict has created a disastrous humanitarian situation, with Sierra Leone situated at the very bottom of the Human Development Index chart and its people amongst the poorest on earth.

The current outlook is greatly improved as a result of an ongoing peace process that has resulted in the official end of the war and the mass disarmament and demobilisation of the various warring parties. It is estimated that in total, in excess of 72,500 combatants, including 6,845 children, were demobilised (UNICEF 29/05/02). The peace process, and the stability that it has brought to the country, has been greatly facilitated by the presence of the largest UN peace-keeping force in world, the UN Mission in Sierra Leone (UNMASIL), which consists of 17,500 troops. The UN troops have played a vital role in overseeing the disarmament process in all areas of the country, ensuring the safe return of IDPs and Sierra Leonean refugees to their areas of origin.

An indication of just how far the peace process has come was given on 14 May 2002, when presidential elections were held with an estimated national voter turn out of 80 %. The elections were won by president Ahmad Tejan Kabbah with 70.6 % of the vote and were remarkable for their apparent transparency and peacefulness (UNOCHA 31/05/02). This bodes well for the ongoing internal stability of the country and paves the way for the essential tasks of reconstruction and rehabilitation that are now essential for the development and the general well being of the country and its population.

Humanitarian Situation

The humanitarian situation has continued to improve over the reporting period as a result of a generally good internal security situation. This has been greatly assisted by the presence of UN-MASIL troops and the injection of 2 billion US dollars. However, the UN has announced that the peacekeepers will be downsized significantly from December 2002, although there are currently no details as to how many troops will be withdrawn (UNOCHA 28/06/02). Some observers have warned that although the situation is currently extremely encouraging in terms of internal stability, the potential for deterioration in the overall situation exists. This is a result of underlying ethnic tensions in the country and the need to address the enormous human rights violations that took place during the civil war. The high number of demobilised militias is also cause for concern because, although they have received assistance, it is often woefully late and inadequate. Many are reported to be disillusioned with the lack of employment opportunities and there is real concern that there could be a return to violence if the re-integration process is not speeded up to provide suitable livelihood opportunities (ICG 15/07/02).

The ongoing internal stability has meant that all areas of the country have now opened up to both humanitarian agencies and the government. This has allowed essential humanitarian assistance to reach areas that have been inaccessible for years. The findings of many assessment missions indicate that fighting has destroyed much of the infrastructure and that the rebuilding and rehabilitation of basic infrastructure is essential. However, the overall food security situation in the country looks promising as a result of both the good security and an agricultural recovery. There are estimated to be 32,000 IDPs throughout the Bo and Kenema districts as well as approximately 23,000 IDPs in Freetown camps (UNOCHA 31/05/02). The number of IDPs in camps has continued to fall as many have returned to their areas of origin. Resettlement was briefly stopped over the period of the election but resumed on 4 June 2002 in the formerly inaccessible areas of Kono and Tonkolili (UNICEF 10/06/02). The greatest challenge to the current humanitarian situation is the continued need to provide support to the large number of returning IDPs and refugees, all of whom require assistance to support them whilst they establish sustainable livelihood activities in previously war ravaged areas.

There is cause for considerable concern with the upsurge in conflict within neighbouring Liberia. The reporting period has seen the continuation of fighting between the Liberian army and rebels. The escalation in the fighting has been particularly focused in the north and west of the country and has forced tens of thousands of people to flee the instability and seek refuge in neighbouring countries. Sierra Leone has received some of the highest numbers of Liberians and the greatly increased return of Sierra Leonean refugees from camps near the Liberian capital. It is estimated that 17,000 Liberian refugees and close to 8,000 returnees have crossed the border into Kailahun and Pujehun districts, during June 2002 alone (UNOCHA 01/07/02). The problem for the ongoing humanitarian situation is that the vastly increased numbers of refugees and returnees is placing a huge strain on the humanitarian system and is threatening to side track the ongoing efforts to reintegrate tens of thousands of IDPs and returnees from other countries. There is considerable concern that the arrival of so many refugees and the close proximity of the conflict in neighbouring Liberia could potentially destabilise what is still a very fragile situation within Sierra Leone. The border areas are already considered to be very unstable and local media have reported that Liberian army and rebels have raided across the border in search of food (UNOCHA 02/07/02).

Northern Province

The good security in the country has seen a continued improvement in the general humanitarian situation in the northern province. All districts have been assessed and are now safe for returnees. Thousands have returned to Koindugu and Bombali, particularly from the camps in the Port Loko area, as well as from camps in the west. Work is ongoing to reconstruct basic infrastructure to ensure that returnees have access to basic amenities such as health care facilities and schools. The RNIS does not have any recent nutritional information from the province but the situation is not deemed to be critical at this time.

Western Province

The western province, particularly around the capital of Freetown, has traditionally been the site of many displacement camps. The current good humanitarian outlook has had a very positive effect on the situation on IDPs and returnees, many of who have returned to their places of origin. The beginning of June 2002 saw the start of a programme to resettle in excess of 12,000 IDPs from western camps to the eastern districts of Kono and Tonkolili. A further 3,640 IDPs were resettled in the Mile 91 area and there are more than 20,000 waiting to be resettled in the Kono, Tonkolili and Bombali districts (UNOCHA 31/05/02). The RNIS does not have any recent nutritional information from the area but the population is not deemed to be at high risk and reports indicate that there is an overall improvement in the economic outlook, particularly in the capital Freetown. This is likely to have a beneficial impact on employment opportunities and on food prices and should improve the general food security outlook for many.

Southern and Eastern Provinces

The security situation in the southern and eastern provinces has remained good and the general humanitarian outlook is extremely positive. However, there is considerable concern over the up-surge in violence in Liberia and the large number of refugees that are being driven across the border as a result. The conflict and the refugees represent a considerable threat to the humanitarian situation as their numbers place increasing strain on existing resources. There is also concern that armed elements could enter the country with the refugees and could provoke direct conflict between Sierra Leone and Liberia.

It is estimated that 17,000 Liberians have entered the country in June 2002 alone (UNOCHA 01/07/02) and are being sent to six camps in Gerihun, Jimmi Bagbo, Bandajuma Sowa, Jembe, Taiama and Gondama. The influx of refugees increased enormously with the attacks on the Sinje refugee camp in Liberia, close to the Sierra Leonean border, on 20 June 2002. The attack drove thousands into Sierra Leone and threatens to push many more to seek refuge. The majority of the new arrivals are in extremely poor condition, with agencies reporting that malnutrition amongst children is visible, although the RNIS has not received any direct nutrition reports on this population group. Many are being housed, temporarily, in the Zimmi way station and there is increasing pressure to open new camps to accommodate the increasing number of refugees. UNO-CHA has reported that they have developed a contingency plan for 50,000 refugees in February 2002 and that the current situation in Liberia has prompted the development of contingency plans for up to 125,000 Liberian refugees (UNOCHA 01/07/02). Present activities centre on the development of Gondama and the creation of two new sites at Mano Junction and Tobunda for an additional 39,000 people (UNOCHA 01/07/02).

Kailahun

Kailahun has traditionally been one of the most insecure areas of Sierra Leone but has remained conflict free over the reporting period. The area contains a large local population that has been struggling to absorb around 45,000 former Sierra Leonean refugees who have returned over the preceding months. The largest threat to the stability of the district and the humanitarian situation is the influx of Liberian refugees. The refugee influx is straining the already stretched resources of the area and the need for continued assistance is crucial. The RNIS does not have any recent nutrition reports from this area

Kenema

Traditionally, Kenema has been one of the districts most affected by the conflict in Sierra Leone. However, a marked improvement in the security situation has allowed the rehabilitation of vital infrastructure, the development of agricultural activities and the development of coping strategies. Nutrition surveys in the area over the past couple of years have indicated significant improvements in the situation of IDPs with prevalence of acute malnutrition falling below emergency thresholds (see RNIS 36 and 37). The entire district is estimated to contain approximately 418,000 people, with the regional town of Kenema containing about 25,000 IDPs in three camps (Goal 05/02). Goal conducted a nutrition survey in Kenema district in May 2002 that revealed an estimated prevalence of acute malnutrition of 5.7 % (W/Ht < -2 Z scores and/or oedema) including 0.8 % of severe malnutrition (W/Ht < -3 Z scores and/or oedema). Mortality rates were also estimated and Crude Mortality was 1.15/10,000/day and under-five mortality was 1.96/10,000/day. The estimated malnutrition indicates that the nutritional situation is not critical with prevalences below emergency thresholds and very much in line with recent past surveys. The mortality rates give more cause for concern with the CMR being above the emergency cut off and under-five mortality fractionally below. However, the survey explains that the recall period is 12 months and that it is possible that poor recall, including people who died more than 12 months ago, has artificially elevated the mortality (Goal 05/02). In general, the survey indicates a situation that is well within control and that has remained stable for some time.

Overall

The overall humanitarian outlook in Sierra Leone has continued to improve over the reporting period with more and more people able to return to their places of origin as a result of the cessation of violence within the country. The majority of local populations, displaced and newly returned, appear to have benefited from the security and are deemed to be at reduced risk (category III). The one point of concern is for the large number of Liberian refugees who have been driven to seek refuge in Sierra Leone. Reports indicate that they are arriving in very poor condition and in great need of assistance and should be considered to be at greatly elevated risk (category II).

Recommendations

From the Goal nutrition survey in Kenema distrct, May 2002

Continue the monitoring of the nutrition situation via regular nutrition surveys.
Follow up of the high mortality rates should be conducted.
Routine vaccination coverage should be improved.

RNIS 36/37, April 2002

Sierra Leone has suffered the effects of a decade long civil war that has devastated much of the country, destroying infrastructure, bringing about economic collapse and destroying livelihoods. One of the foremost features of the conflict has been the mass displacement of hundreds of thousands of people as both IDPs and refugees into neighbouring countries. This has created an extremely serious humanitarian situation, where the people of Sierra Leone are amongst the poorest on earth, with the country ranking at the very bottom of the Human development Index chart. The humanitarian situation has been primarily affected by the conflict, which has resulted in the systematic destruction of people s ability to cope with the situation. Consequently, many have been simply unable to meet their basic subsistence needs. This has been further exacerbated by the lack of access to many areas of the country by humanitarian agencies, due to the conflict and insecurity. As a result, the needs of many have gone unmet.

Despite the chronically poor humanitarian backdrop, the past year has seen improvements in the overall situation in the country. This has been brought about by a peace process that took shape in May 2001 through a meeting between the government and the Revolutionary United Front (RUF). The meeting established a cease-fire agreement and set the agenda for a Disarmament, Demobilisation and Reintegration programme (DDR). The peace process, and in particular the DDR, has benefited from the firm support and commitment of the government, the RUF and the international community. The process has been greatly helped by the presence of peacekeeping troops under the auspices of the UN Mission in Sierra Leone (UNMASIL). The UNMASIL peacekeeping force is now the largest of its kind in the world and consists of 17,500 troops (UN OCHA 30/11/01).

The DDR process was not without its setbacks. The process was delayed by the RUF over their dissatisfaction with the outcome of a National Consultative Conference in November (ICG 19/12/01). The disarmament process was officially declared completed on 17 January 2002, when it was estimated that 47,076 combatants had disarmed between 18 January 2001 and 17 January 2002 (UNSC 14/03/02). This also marked the official declaration of the end of the civil war and the lifting of a curfew that had been in place for the last four years (WFP 01/02/02). Positive developments have also been seen, with the announcement of parliamentary and presidential elections to take place on 14 May 2002. Overall, the situation in Sierra Leone is extremely positive but there is call for some caution as the situation is far from stable. There is concern that the elections may be premature with the peace process still ongoing and it is feared that they may result in renewed conflict in some areas (ICG 19/12/01). It is also important to note that there is an upsurge in conflict in Liberia, with reports that some RUF fighters are currently involved in the fighting there, which could present a potentially destabilising influence (ICG 19/12/01).

Humanitarian situation

The continued development of the peace process has had an extremely significant and positive impact on the humanitarian situation. Humanitarian access is now possible throughout the country and it has been announced that all but 11 of the 150 chiefdoms are safe for resettlement. The greatly improved overall security has allowed humanitarian agencies to access many areas that have been without assistance for some time. The resultant emerging humanitarian picture is one of very differing degrees of needs, which vary from area to area. The needs appear to be particularly high in newly accessible areas where the level of destruction of housing and basic infrastructure has been very great. As agencies move into these areas they are finding that the populations are in extremely poor condition, with high rates of malnutrition, morbidities and mortality. IDPs, refugees and returnees represent particularly vulnerable groups, many of whom are highly food insecure and dependent on humanitarian assistance.

As of January 2002 it was estimated that there were 204,000 registered IDPs being assisted by the international community and, as a direct consequence of the improved security, many of these have been returning to their areas of origin spontaneously or as part of organised resettlement programmes. The organised returns have taken place in three phases to date. The first and second phases took place from May 2001 to February 2002 and resulted in the resettlement of approximately 65,000 people (UN OCHA 18/04/02). The majority of the resettlements took place in the Western Area, Southern Province and the north western districts of Port Loko and Kambia. The third phase of the resettlement process began in March 2002 and it is hoped that this will see the permanent resettlement of 155,000 IDPs in the North and in the Eastern districts of Kono, Kailahun and Kenema. There have also been large numbers of Sierra Leonean refugees in the surrounding countries that have either returned or registered to do so. To facilitate the return of refugees from Guinea, the UNHCR has negotiated a land bridge across the Guinean/Sierra Leonean border and increasing numbers are choosing to return. The conflict in Liberia is also leading to increased returns from Liberia.

The returnees are increasing the pressure on the capacity of the humanitarian community to assist those in need within the country. Many are returning to areas that have very little in the way of viable infrastructure. This includes housing, education, water and basic medical facilities. It is also concerning to note that much of the land, although now free, has been uncultivated for long periods and is likely to require a great deal of work before it is productive. This makes the returnees extremely vulnerable and will increase their reliance on external assistance. The returnees are given a two month food package to help the resettlement process, but this thought unlikely to be sufficient. The task of getting people to return is proving relatively easy but the problem will be to get them to stay. It has been reported that a great many of the newly resettled are moving from area to area in an attempt to find a place where they feel they can establish themselves. The situation is further complicated by the arrival of increasing numbers of Liberians fleeing the insecurity in the north and western areas of Liberia. WFP reports that 10,700 Liberian refugees have arrived in Jendema on the southeast border of Siera Leone. The refugees are being assisted but place an added pressure on already stretched resources (WFP 15/03/02).

Northern Province

The RNIS does not have any recent nutritional information from the northern province. However, the situation is assumed to have greatly improved as a result of the prevailing security situation. All districts in the northern district have been assessed and announced to be safe for returnees, leading to considerable returns to the area, particularly as part of the phase II of the resettlement programme. In particular, the camps at Port Loko have closed as the camp residents have moved back to areas in the Port Loko and Kambia districts. There have also been returns from the camps in the west of the country to the same area. Assessments of needs in the area reveal that there has been very great destruction of property and infrastructure and it is imperative that new housing, schools and medical facilities should be provided soon to meet the needs of the increasing numbers of people in the area. The humanitarian response has been large. In terms of immediate needs, WFP continues to supply a food ration to vulnerable groups and other emergency programmes have focused on issues such as access to clean water and the provision of housing and medical facilities. Other programmes have begun to address long-term needs by rebuilding schools and developing income generation schemes. It is hoped that this will provide the impetus for further returns and provide essential services to the populations present in the area.

Western Province

The RNIS has not received any recent nutritional information from the Western province but the situation is assumed to be stable. There have been some movements of both returned refugees and IDPs from the camps around the capital Freetown to their areas of origin and it is hoped that this will relieve some of the overcrowding. There have been reports of increased rates of crime in and around Freetown, indicative of the high rates of unemployment and poverty in the area. However, it is hoped that the upsurge in the economy, that the peace process has brought, will provide employment opportunities for many of the residents of the area. A great many IDPs remain in the area but it is hoped that the increased security of many areas will ensure that they resettle in their places of origin over the duration of 2002.

Southern and Eastern Provinces

The security situation in the south and east has remained good over the reporting period and this has encouraged the dismantling of camps and return of IDPs and refugees to the area. The conflict currently taking place in Liberia does offer some cause for alarm as some areas border conflict zones in Liberia and have received a number of Liberians seeking refugee status. UNMASIL and the Sierra Leonean Army have increased their patrolling of the border areas to insure that there are no incursions by armed groups. However, as a result of the potential insecurity, some chiefdoms in Kailahun district have not been declared safe for returns. The area has also been known as the main diamond producing area within Sierra Leone and control over the diamonds was largely responsible for much of the conflict. Despite some minor clashes, the peace and DDR programmes went ahead and do not appear to have sparked further insecurity.

Kailahun District

Kailihun district is the only district where some chiefdoms are still deemed too insecure to return. This is as a result of continuing insecurity in Liberia just over the border. As a result, there are fears that armed groups could cross the border and destabilise the area. This has affected 11 chiefdoms which all border Guinea and Liberia. Kailahun has traditionally been one of the worst affected areas in the country due to its proximity to the border and to key diamond mining areas within Sierra Leone. A recent assessment of needs in the district revealed that there were high levels of destruction in all chiefdoms, especially along the border areas. This has meant that the short-term priorities for the area are shelter, WATSAN, road repair, seeds, tools and food aid. It is hoped that a concentration on key areas of need will help facilitate further returns to the area (UN OCHA 28/02/02).

Kenema district

Kenema district has seen a great deal of violence over the duration of Sierra Leone s civil war. However, security has improved over the past few years and allowed the population to develop some coherent coping strategies. Consequently, recent nutrition surveys in the area have not shown high prevalences of acute malnutrition. Merlin conducted a series of nutrition surveys in the district during September 2001. The first survey concentrated on Kenema town where it was noted that almost 40% of the population were displaced. The survey revealed a prevalence of acute malnutrition (W/Ht < -2 Z scores and/or oedema) of 6.3% including 2.6% of severe malnutrition (W/Ht < -3 Z scores and/or oedema) (Merlin 09/01). There was also 1.5% of oedematous malnutrition. The survey also estimated the under-five mortality rate and found it to be 1.72/10,000/day. The nutritional data does not indicate a critical situation, with the prevalence being below alarm thresholds. However, it is concerning to note that there appeared to be a relatively high percentage of Kwashiokor (oedematous malnutrition), which is associated with high rates of mortality. The rate of under-five mortality rate does appear to be elevated although, again, below emergency thresholds.

The second survey took place in the three IDP camps around Kenema. The camps surveyed are Lebanese, Nandeyama and Gofer and it was determined that they contained predominantly IDPs who were long term residents of the camps for periods of over one year. The prevalence of acute malnutrition (W/Ht < -2 Z scores and/or oedema) was estimated to be 4.2% and included 1.7% of severe malnutrition (W/Ht < -3 Z scores and/or oedema) (Merlin 09/01). This indicates that the nutrition situation is stable and well below emergency thresholds. In general, the camp residents were well covered for food, medical and water. Surveys were also conducted in the near by town and camps of Blama, where the nutrition situation was found to be similar to that in Kenema. It has since been noted that the Blama camps have been closed and many of the residents relocated. It was noted that the situation in the area has been calm since 1999 and that the majority of IDPs had been in residence for over 12 months. As a result, it is likely that the population has managed to establish livelihood patterns that enable them to meet the majority of their basic subsistence needs. However, it is important to stress that the continued stability of the nutrition situation is dependent on continued good security and the improvement of markets and employment opportunities.

Kono district

Kono district is in the north east of Sierra Leone in one of the major diamond mining areas. As a result it has experienced extreme insecurity for a number of years and has been inaccessible to humanitarian agencies until the middle of 2001. The area has suffered massive destruction, and many settlements have been destroyed as well as most of the essential infrastructure such as health systems. It is reported that the area has had virtually no health care for the past 10 years. The continuation of the peace process has seen an opening up of the area and there have been large-scale returns of previously displaced populations. In September 2001, World Vision conducted a nutrition survey in three of the most southern chiefdoms of the district in order to assess the nutritional situation of the newly accessible area. The survey found an estimated prevalence of acute malnutrition (W/Ht <-2 Z scores and/or oedema) of 17.1% and included 4.7% of severe malnutrition (W/Ht < -3 Z scores and/or oedema) (WVI 09/01). The survey also indicated that the Crude Mortality Rate (CMR) was 1.4/10,000/day and the under-five mortality rate was 6.1/10,000/day. These data indicate that the nutrition situation is extremely poor in the area, with both nutrition and mortality indicators all above emergency thresholds. It is also possible that the high infant mortality rate may have resulted in an underestimation of the true malnutrition rate.

The fact that the area has only recently been accessible means that there is no baseline data to compare the survey results to. The reason for the observed high prevalence of malnutrition is the acute vulnerability of the population as a result of the violence in the area and the resultant food insecurity and lack of access to basic subsistence needs. In this respect, the results are highly alarming but not surprising. However, it is hoped that increased access to the area will facilitate the provision of emergency relief and the rehabilitation and reconstruction of infrastructure. The improved security and access to subsistence needs will hopefully result in a substantial improvement of the nutritional status of the population. However, the survey also notes that large numbers of people are returning to the area and as a result there will be increased pressure on the already poor resources, with immediate emergency needs likely to remain high for some time.

Overall

The reporting period has seen the continuation of improvements to the humanitarian situation in Sierra Leone. This has been a result of the ongoing peace process, which has allowed for the opening up of much of the country that had previously been closed to humanitarian assistance. The opening up of new areas has revealed very differing emergency needs, with newer areas generally having a poorer humanitarian situation. Peace has brought about the return of both IDPs and refugees to their areas of origin, with this process set to continue for the duration of 2002. The returnees will require continued assistance before they are able to re establish livelihood activities. They are not considered to be at high risk (category III), however some of the newly arrived refugees are thought to be considerably more vulnerable (category II).

Recommendations

From the Merlin survey in Kenema district

Conduct nutrition and health education to address problems of child weaning practices.
Facilitate the reconstruction of basic infrastructure.

From the World Vision survey in Kono district

Improve the coverage of medical facilities in the district.
Rehabilitate wells and other water sources.
Improve vaccination coverage.

RNIS 35, October 2001

The reporting period has seen the continued improvement of the situation in Sierra Leone. Regionally there have been encouraging signs of a thawing of relations between the Mano River Union countries and closer cooperation. An indication of the greater cooperation between the countries is the announcement that Guinea, Liberia and Sierra Leone would deploy joint patrols along the border areas in an attempt to stop the proliferation of small arms (WFP 12/10/01). There has been no cross border fighting reported between the Revolutionary United Front (RUF) and Guinean forces since fighting earlier in the year. This is largely a result of the ongoing disarmament of the RUF within Sierra Leone. The Abuja peace agreement of November 2000 has continued to be implemented and the ceasefire has held.

The peace process has not been without its problems and on October 4^th the UN Security Council expressed concern over the slow pace of disarmament by the RUF in the Bombali zone of northern Sierra Leone (IRIN 04/10/01). The Process has also been strained by an announcement by the Sierra Leonean government that elections would be delayed until May 14^th 2002 and that the government would extend its current state of emergency, for the second time, by a further six months (OCHA 30/09/01). The announcement prompted the RUF to boycott tripartite peace talks in protest, however the talks have since been rejoined. Despite some tensions, the programme of disarmament has continued all across the country with OCHA reporting on October 15^th that 20,284 combatants from various fighting factions had disarmed since May 18^th 2001 (OCHA 15/10/01). This has been greatly facilitated by the presence of UN peacekeepers in the form of UNMASIL. As new areas have opened up, UNMASIL have deployed across the country and, in recognition of their roles in the disarmament process and in the facilitation of the delivery of humanitarian assistance, the UN Security Council has extended their mandate for a further six months from the end of September 2001 until March 31^st 2002 (OCHA 30/09/01).

The most important affect of the disarmament has been the opening up of areas of the country, which have been largely inaccessible to humanitarian actors, some for a number of years. For example, in August UNMASIL deployed peacekeeping troops to the northern district of Koinadugu, which had been occupied by the RUF since 1996 (IRIN 09/08/01). This has enormous implications for the development of the humanitarian situation within Sierra Leone because it allows access to vulnerable populations and is promoting the increasing return of displaced to their places of origin. The current security within the country is also allowing people to access their land and conduct farming activities and this combined with improved economic opportunities is likely to have a positive affect on the food security of the population in general and the IDPs and newly returned in particular. It is also important to note that the opening up of new areas is also revealing areas of acute need where infrastructure, particularly the health system, has been destroyed for some years as a result of fighting. Despite the increased access and higher demands for assistance, the consolidated appeal for Sierra Leone remains badly under funded at just over 40% by midyear. WFP have announced that they are expecting food pipeline breaks in December, with an expected shortfall in cereal of 3427 MT (WFP 12/10/01). This has created concern because it will constrain the ability of humanitarian agencies to respond to both the short and long term needs of the population (UNSC 07/09/01).

Displaced Populations and Returnees

The displaced population remains hard to estimated but OCHA reported at the beginning of August that 127,000 IDPs remained in camps, with a further 120,000 living with host communities (OFDA 03/10/01). The majority of the registered IDPs are in or near urban areas such as Freetown, Kenema, Bo and Daru and also in the Tonkilili and Port Loko districts. The number of people returning from Guinea has also increased and it is currently thought that an estimated 75,000 returnees have arrived back in Sierra Leone since the beginning of 2001. The majority of those officially repatriated by UNHCR and IOM have arrived in transit camps around Freetown. Concern has been expressed over overcrowding in the camps as a result of the numbers of returnees. UNHCR and the Sierra Leonean government have taken the step of asking 8,000 returnees in Jui, Waterloo and Lumpa camps in the Freetown area to relocate to resettlement sites in eastern and southern Sierra Leone. The move is an attempt to alleviate the overcrowding in the transit camps (IRIN 13/08/01). However, MSF have warned that the influx of returnees could potentially trigger a new emergency in the country as many return to areas of the country which are deemed secure. They point out that nine years of civil war has almost totally destroyed the health facilities in many areas, leaving low rates of vaccination and regular outbreaks of infectious diseases such as malaria, yellow fever, lassa fever, cholera and measles (IRIN 28/09/01). The fear is that the lack of infrastructure in many areas will contribute to high morbidity and mortality rates and ongoing food insecurity. This will slow down the rates of return and serve to maintain a high dependency on external humanitarian assistance.

Northern Province

The RNIS does not have any new nutritional information from the northern province but the situation is assumed to be stable as a result of the greatly improved security and access to the area by humanitarian agencies. The districts of Kambia, Bombali and Koinadugu have all seen disarmament take place and as a result IDPs have continued to return to their areas of origin. A local NGO Community Action Project have registered 15,000 IDPs moving from Port Loko to their home towns in Samu and Magbema chiefdoms in Kambia district. In some cases the areas of return have been inaccessible for a number of years and concern does exist that little infrastructure remains to support the increasing numbers of returning people. A recent UNICEF assessment in the Tonkilili district, on the existing water and sanitation facilities available to the population, indicated a very high incidence of diarrhoea. Many of the communities lack protected water sources and as a result many existing sources are supposed to be suffering from contamination (OCHA 30/09/01). These findings are concerning because of the need for good and adequate sources of clean water to support the increasing numbers of returnees to newly opened areas.

In an effort to start the reconstruction of essential infrastructure UNDP has started the construction of 400 houses and various public facilities in the Kambia district. There is also considerable work going into the rebuilding of medical facilities, including the re training of medical staff. WFP and its partners are also supporting returnees to resume farming activities with the distribution of seeds and tools and the implementation of a program called Food for Agriculture. It is hoped that the improved access to land will positively affect the food security prospects for the area.

Western Province

The RNIS has not received any new nutrition surveys on displaced populations in the western province. The large number of IDPs still remaining in camps in and around the capital Freetown remain dependent on food assistance and the over crowding in some of the camps has caused concern that the public health of the displaced could suffer. However, the overall security in the country will hopefully allow many of the displaced in the west to return to their areas of origin and become less dependent on humanitarian assistance.

Southern and Eastern Provinces

The security situation in the south and east has remained good despite some delays in the disarmament process. Notably the diamond mining zone of Kono is no longer under rebel control and it is hoped that this will go some way towards diffusing one of the chief sources of conflict in recent years.

Kenema district

Goal conducted a survey in Kenema district in August 2001. The target group of the survey was not specifically IDPs but the results give an important indication of conditions in an area that is likely to receive continued influxes of returnees seeking to re-establish themselves. Some areas of the district were not accessible to the survey teams as a result of insecurity or of rain blocking road access. The survey was conducted on children under the age of five and estimated a prevalence of acute malnutrition of 6.2% (W/Ht <-2 Z scores and/or oedema) including 1.6% severe malnutrition (W/Ht <-2 Z scores and/or oedema). The survey also measured mortality and estimated an under-five mortality rate of 1.8/10,000/day. Both the acute malnutrition and mortality rates are below alert thresholds and the situation is not deemed to be critical (Goal 08/01). WFP report that both Merlin and Goal have seen a drastic drop in the number of admissions to their selective feeding programs and it is thought that this indicates an improvement in the overall situation in Kenema (WFP 02/11/01).

Kailahun

The situation in Kailahun is considered to be precarious as a result of its proximity to the conflict- ridden Lofa County in neighbouring Liberia. This has resulted in a stream of Liberian refugees entering the country, often in extremely poor condition. It is currently unclear how many have crossed into the country but the number is believed to be in the thousands with UNHCR reporting that over 2,500 are being temporarily accommodated in the township of Bandajuma before being moved to a new camp in Pujehun district. WFP have expressed concern over the fragility of the food security situation in the Kailahun district and in August reported that there was little or no rice in the major trading centres of Kailahun and Pendembu (IRIN 22/08/01). In a recent move, UNAMSIL have deployed in the district and it is hoped that this will enhance the security in the area and allow greater access by humanitarian agencies (IRIN 26/10/01). The RNIS has not received nutrition reports from the area but the nutrition situation is understood to be extremely poor.

Overall

The reporting period has seen an improvement in the humanitarian situation in Sierra Leone with the continued implementation of the Abuja peace accords and the disarmament of various rebel groups. This has led to the crucial opening up of many areas of the country to both returnees and to humanitarian agencies. As a result of the improved security and access, the food security outlook in the country is good although many still rely on humanitarian assistance. In general the situation of IDPs remains fair (category III) and if the security situation permits continued returns, the situation is likely to improve further. However, concerns about the poor infrastructure within the country and the affect this may have on returning populations still exist. Fighting in Liberia and the resultant flow of refugees into the east of the country has left some areas of acute vulnerability (category II).

Recommendations

Increase support of the inter agency appeal
Support efforts to rebuild the infrastructure of newly secured areas

From the Goal nutrition survey (Goal 08/01)

Phase out existing feeding centres when the number of beneficiaries drops sufficiently
Conduct a program of health promotion and in particular on malarial prevention
Implement water and sanitation activities.

RNIS 34, July 2001

Displaced Populations and Returnees

Northern Province

Western Province

Southern and Eastern Provinces

Kenema district

Kailahun

Overall

Recommendations

Increase support of the inter agency appeal
Support efforts to rebuild the infrastructure of newly secured areas

From the Goal nutrition survey (Goal 08/01)

Phase out existing feeding centres when the number of beneficiaries drops sufficiently
Conduct a program of health promotion and in particular on malarial prevention
Implement water and sanitation activities.

RNIS 32/33, April 2001

The past year has seen big changes in both the political and humanitarian contexts in Sierra Leone and the region at large. In May 2000 there was a breakdown of the Lomé Peace Agreement after the attack and detention of hundreds of UN peacekeepers by the Revolutionary United Front (RUF). This sparked a dramatic deterioration in the security situation in the country that displaced thousands of people and resulted in the evacuation of many international aid agencies and the temporary suspension of humanitarian activities. The spread of conflict to the south eastern forest area of Guinea, has resulted in the return of tens of thousands of Sierra Leonean refugees who had been staying in camps there (UN 2001).

Since the end of last year the security situation in Sierra Leone has been relatively calm with signs that rebels were seeking to re-enter the peace process and in November a new cease fire agreement was signed between the government of Sierra Leone and the RUF rebels. This has been accompanied by a more welcoming attitude by the rebels to humanitarian assistance with the RUF agreeing to allow humanitarian agencies to operate unhindered in RUF held areas of the country. However, some areas, particularly in the north and east of the country, remain humanitarian 'no go' zones. The insecurity in the north has continued to resulted in the unequal distribution of aid (UN2001).

Displaced populations

The insecurity in many areas and the fast changing situation make the estimation of numbers of internally displaced extremely difficult, but at the end of 2000 there were approximately 400,000 registered IDPs in the country with over 50 % of them newly displaced since May 2000. The critical developments on the Sierra Leone-Guinea border have prompted an armed response from Guinean security forces who have shelled Sierra Leonean territory in an attempt to prevent incursions from rebel groups. This has resulted in large-scale population displacement from the affected areas that have dramatically added to the IDP caseload. Original projections by WFP were for a caseload of 520,000 in 2001 and this has already risen to 544,050 which has major resourcing implications. There are 170,000 people in eighteen official camps in safe and accessible areas. The UN also estimates that there could be as many as a million more internally displaced, who have been absorbed by host communities. This means a current total of about 1.5 million people. Women and children make up to 70 % of the displaced caseload (NRC 2001; UN 2001; WFP 16/03/01).

The vast majority of the registered IDPs have sought refuge in the Tonkilili District (including Mile 91) and the Port Loko District (including the Lungi area). Other areas of concentration remain urban areas such as Freetown, Kenema and Bo that offer some protection from rebel attack. A registration of IDPs in Lungi has indicated 28,000 people who had fled areas in Kambia as a result of the conflict on the border with Guinea (NRC 2001; WFP 09/03/01).

In an attempt to relieve the pressure on camps, a National Resettlement Day was launched on March 20^th. IDPs and returnees volunteering for resettlement will receive a two months food ration, but inertia to the idea is very great due to a perceived lack of infrastructure in the areas concerned. WFP reported that 30,921 people in the Western Area and 12,458 people in Port Loko have currently registered for resettlement but it is unclear how many will actually follow it up (WFP 30/03/01).

Returnees

The outbreak of violence in the south eastern Forest Region of Guinea is a new development in an already tense regional situation, which has created an acute humanitarian emergency for thousands of Sierra Leonean refugees. However, the development of fighting within Guinea has resulted in considerable hostility towards the refugees, by both the Guinean authorities and the general population. This has resulted in the return of an estimated 50,000 to 60,000 refugees to Sierra Leone since fighting broke out in September. It is suggested that between 2,000 and 2,500 refugees are returning to Sierra Leone each week (NRC 2001; UN 2001 UNICEF 31/03/01; USAID 20/04/01).

Total numbers of returnees are difficult to follow because some are choosing sea routes from Conakry aided by the UNHCR and the International Organisation for Migration (IOM) whilst others have made their own way across the borders of both Liberia and Guinea and have not been officially registered. The IOM report that they have transported 22,000 returnees from Guinea since January this year. The situation for many remains critical as they find themselves unable to return to their areas of origin. Many come from areas such as Kambia, Kono and Kailahun which remain highly insecure. As a result returnees find themselves in vastly overcrowded camps or staying with host communities who are themselves experiencing great difficulties, and who can ill afford the added burden of a sharp population increase. (IOM 24/04/01; NRC 2001).

Northern Province

The Northern province is the site of much of the present insecurity with ongoing conflict between rebel groups and the Guinean security forces. This has greatly restricted access to areas within the province and it is assumed that the situation for many in outlying areas remains critical. Insecurity in Kambia district continues to displace large amounts of the population. Due to insecurity the RNIS has not received any nutritional information from the majority of areas (NRC 2001).

Port Loko

ACF conducted two nutrition surveys in the Port Loko area in December 2000. The first was in the town itself and the second in the camp (see table of results below).

The prevalence of malnutrition in the town and camp are similar and not unduly elevated, however mortality rates are alarming. The main causes of mortality are ARI, malaria and measles, while malnutrition also contributes to these high death rates (ACF 12/00).

The results corroborate the general impression of poor sanitation, overcrowding and lack of access to health facilities in the country. There have been considerable further displacements since December and it is likely that there has been a deterioration in the nutritional status of the populations. The authors of the survey stress that the results cannot be extrapolated to the area at large and indicate that much of the area to the north and east remains inaccessible due to insecurity (ACF 12/00).

Table of results for ACF surveys in Port Loko town and camp (December 2000)

Port Loko town

Port Loko camp

Acute malnutrition(<-2 z scores)

3.8 %

3.7 %

Severe malnutrition (<-3 z scores and/or oedema

0.3 %

0.9 %

Crude Mortality Rate

1/10,000/day

1.3/10,000/day

Under five Mortality Rate

3.1/10,000/day

4.1/10,000/day

Measles vaccination coverage*

76%

48%

* Determined from vaccination card and mother/carer report

Western Province

The security in the Western Province remains fairly stable with deployment of UNMASIL troops. The Freetown and Lungi peninsula continues to receive large influxes of both IDPs and returnees. There are currently about 30,000 IDPs in Lungi as a result of fighting in Kambia and the influx of returnees from Guinea continues.

In February 2001 ACF conducted post distribution monitoring in the displaced camps in Freetown to look at the reliance on food aid and to assess the livelihood strategies of the displaced populations. The survey indicated that the middle and better off families which represent 50 % of the total camp population, do not rely on food aid but use it as an additional source of income. The remaining poor households do have a stronger reliance on food assistance and are often forced to borrow from the richer groups. The loaned food is paid back in kind or with money and this forces poorer households into a vicious cycle of borrowing and repaying debts that prevents them from being able to use food aid for their sole consumption (ACF 02/01).

There is no new nutritional information for this area but given the stable security and the access to humanitarian aid, it is assumed that the situation remains fairly stable.

Southern and Eastern Provinces

The southern Province has remained relatively free of fighting since the latest outbreak of violence and the same goes for the Eastern province although areas bordering Liberia can be assumed less secure. An estimated 12,500 people have arrived by foot in Daru in the south east, after fleeing Guinea and Sierra Leone and the rebels have reported the presence of 4,500 Liberian refugees in Kailihun (IRIN-WA 25/04/01).

Bo District

ACF conducted a nutritional survey in Bo district in November 2000. 2.1 % of the sample were internally displaced and 0.2 % were returnees. The survey found and estimated a prevalence of malnutrition of 3.8 % (<-2 z score) including 0.9 % severe malnutrition (<-3 z scores and/or oedema).

The Crude mortality rate was estimated as 1.1/10,000/day and the under five mortality as 5.9/10,000/day. The vaccination coverage for measles was estimated as 83.4 %, but only 39.7 % were confirmed with a card. Whilst the malnutrition rates appear acceptable, the mortality rates are extremely high. Malnutrition is again given as one of the main causes of mortality, along with, ARI, malaria, and diarrhoea.

Kenema

Merlin has conducted a series of nutrition surveys over the past year in the towns of Kenema and Blama and their surrounding camps. The RNIS has only seen summary reports, which indicate a low prevalence of malnutrition in both July 2000 and January 2001. In July, the prevalence was 3.7% in Kenema town and 2.2 in the camp. In January 2001, this remained stable at 3.8 and 1.2 respectively (Merlin 08/00).

The mortality rate in January 2001, was estimated at between 1 and 2/10,000/day. The surveys indicated a good improvement in the rates of vaccination coverage in the area (Merlin 08/00).

Overall

The humanitarian situation in Sierra Leone is extremely poor. The upsurge in insecurity continues to displace the general population and strongly effects general food security. Whilst available information on nutritional status of displaced does not indicate an alarming situation, mortality rates do indicate a health crisis (category II). All surveys presented have been from relatively secure areas and there must be grave concern for the populations currently inaccessible to humanitarian aid. No information exists for those currently inaccessible but they are considered at high nutritional risk (category V).

Recommendations

Negotiate critical humanitarian access to populations in currently insecure areas.
Carry out more in depth investigations on the causes of high under five mortality.
Closely monitor the health situation of the population with particular emphasis of populations in camps.
Increase vaccination coverage in all areas.
Livelihood activities should be strengthened to enable poor households to break the cycle of borrowing and repayment of food aid.

RNIS 31, July 2000

The situation in Sierra Leone is constantly changing. Tracking displaced populations and their needs is therefore very difficult. More up-to-date information can be obtained from www.reliefweb.int

Sierra Leone has been embroiled in a civil crisis since 19991. The war has claimed at least 20,000 lives and caused massive displacement both within Sierra Leone and as refugee movement into neighbouring countries. Appalling civil rights abuses have been recorded. In July 1999, the warring parties signed the Lombe Peace accord. In November, a Disarmament, Demobilisation and Reintegration (DDR) programme was set-up and UN troops entered the country. However, in the first week of May 2000, the peace process was dealt a serious setback when Revolutionary United Front (RUF) fighters killed at least four UN peacekeepers and took others hostage in a series of attacks in the north and east of the country. There was a lull in the fighting in June, after the rebel leader Fodah Sankoh was captured, but recent reports suggest that the fighting between pro-Government forces and RUF rebels has escalated again (IRIN-WA - 09/06/00, 07/07/00).

The renewed fighting has resulted in a deterioration of the humanitarian situation. Two months after the resumption of hostilities, poor security in many parts of the country continues to trigger mass population movements. At the same time, the prevailing security situation severely hampers efforts to address the needs of those who are being forced to leave their homes. Agencies are still unable to ascertain the situation of civilians in most of the north as there is no formal contact with RUF officials to facilitate access initiatives (OCHA - 11/07/00).

Displaced population

Up to 150,000 new IDPs have been registered in accessible areas in southern and western Siera Leone since May. Some of these have settled in official sites (many of which are already overcrowded), others are occupying abandoned buildings or are living in squatter camps. A further 160,000 IDPs living in various parts of the country were registered before the recent fighting. An estimated 500,000 displaced people are thought to be living in communities in government-controlled areas with host communities. Many of the hosts in these areas (estimated at 500,000 people) are also considered to be in need of assistance as their resources are being shared with so many displaced people. In addition to these populations a further one million people may be affected by the war in rebel-controlled areas (either as IDPs or as hosts) and are inaccessible to humanitarian agencies. Thus an estimated total of more than two million people are in need of assistance in Sierra Leone. The total population of the country is less than 5 million (OCHA-11/07/00).

Nutrition and health situation

The RNIS has not received any nutritional surveys of the affected population during the reporting period. The country's food security situation was poor even before the resumption of hostilities (see RNIS 30). Reports indicate that the nutritional situation in Freetown and the surrounding areas are stable, but more problems are reported outside the capital. The nutritional situation of the population in rebel-controlled areas is unknown.

In spite of the insecurity, WFP in collaboration with NGOs are continuing to distribute food-aid commodities. The agencies reached approximately 100,000 beneficiaries, including some of the new IDPS, in the two weeks prior to publication of this report. A two-year expansion of a special operation providing logistics support for humanitarian operations, including the repair of roads and rehabilitation of bridges has recently been approved (IRIN-WA - 17/07/00; OCHA - 11/07/00).

The population's current health situation is poor. Large influxes of IDPs into urban centres are leading to outbreaks of diseases such as the recent outbreak of Lassa fever in Freetown. Malaria also remains a significant problem. An estimated one million people are without health care in the northern and eastern areas of the country (IRIN-WA - 09/06/00, 07/07/00; OCHA - 11/07/00).

Northern Province

The fighting between the rebels and pro-government forces has been most intense in this region, and hence the population living in the area is the most affected.

Mile 91

The situation in Mile 91 remains precarious and highly volatile. It is not clear how many IDPs remain in the area, as reports indicate that a significant number have moved out in search of food and safety. Prior to the most recent outbreak of fighting an estimated 45,000 displaced people were thought to require assistance. UNAMSIL troops reported that humanitarian conditions of the IDPs are dire, but security prevents interventions at the moment. Before the situation deteriorated, some of the IDPs in Mile 91 and surrounding villages had benefited from non-food and food distributions. As there is no official camp for the displaced in the area, shelter is reported to be the population's most pressing need (IRIN-WA - 23/06/00; 14/07/00; OCHA - 11/07/00).

The lack of basic health services is also a major concern, as many of the IDPs developed health problems due to exposure to harsh conditions during their flight. ACF continues to maintain one therapeutic and one supplementary feeding centre for the under-five population in the Mile 91 area (OCHA - 11/07/00).

Lungi/Pot Loko area

There are a total of 60,000 new IDPs in this area. WFP was able to distribute rations to these groups at the end of July. The population of the islands of Tasso and Kakum, and the 8,000 IDPs living there, are reported to be in facing severe food shortages. This is due to limited arable land and a curfew limiting fishing activities (OCHA - 11/07/00, 25/06/00).

Western Province

A 'horseshoe' of UNAMSIL deployment protects the Freetown and Lungi peninsular areas and hence this zone has been the least affected by the fighting. However, security remains poor in some locations of Western Province, including Waterloo. Some 48,000 IDPs were registered in Western Province before the latest hostilities (IRIN-WA - 30/06/00; OCHA - 26/06/00, 11/07/00).

Overcrowding is a serious problem in the Freetown IDP camps. Health facilities are limited. An inter-agency verification of needs, origin and numbers of IDPs is currently underway. ACF has reported that the nutritional status of vulnerable groups in the Freetown area has been relatively stable. The number of severely malnourished children decreased between April and June. Many of the admissions to the Therapeutic Feeding Centre were new IDPs (OCHA - 26/06/00).

In response to the overcrowding in Freetown, the camps in Waterloo are being expanded. The problem of land allocation remains (OCHA - 26/06/00).

Southern and Eastern Provinces

The Southern province is currently free of fighting, and has been the least affected area during this recent outbreak of hostilities. However, humanitarian access is hindered by the general security situation (IRIN-WA - 14/07/00).

Kenema and Bo

Approximately 72,000 IDPs were registered in Kenema and Bo before the current outbreak of hostilities. WFP has been able to distribute food in these areas intermittently. MERLIN has intensified outreach services for prevention and treatment of Lassa fever, which is prevalent in the area. They are also conducting a nutritional survey of IDPs in camps. ACF has reported a marked increase in admissions to their Therapeutic Feeding Centres in the past few weeks (IRIN-WA - 14/07/00; OCHA - 26/06/00, 11/07/00).

Liberian refugees

UNHCR is conducting a screening of over 6,000 Liberian refugees to determine those who are eligible for international protection, following the termination of the organized voluntary repatriation programme (OCHA - 11/07/00). The RNIS has not received any new nutritional information on these refugees.

Outflow of refugees

Some 420,000 Sierra Leoneans are refugees. Most of them are in Guinea and Liberia. The recent military clashes and other security incidents in the Kambia area have led to a further outflow of populations into Kalako camp in Forecariah, in Guinea. According to UNHCR, over 5,000 new Sierra Leonean refugees have been registered in the camp since May, arriving mainly from Kambia and Port Loko Districts (IRIN-WA - 22/06/00; OCHA - 11/07/00; UNHCR - 20/07/00).

Returnees

Some spontaneous returnees have been reported at a time when the security situation in the places of origin is not favourable. Already, 1,400 refugees who returned from Liberia since the end of 1999 have settled in IDP camps in Blama and Kenema and with host communities, as they are mostly from areas presently under rebel control. The situation may create more pressure in the already over-stretched camps. While UNHCR is prepared to provide limited relief assistance for the returnees in IDP camps, they do not encourage a situation where returnees become IDPs (OCHA - 11/07/00; UNHCR - 20/07/00).

Overall, the humanitarian situation in Sierra Leone is very poor. Huge numbers of people are affected by the war and are in need of assistance. The IDPs in Freetown and its immediate surroundings are at moderate risk (category III). Those in other Government-held areas are probably at greater risk (category I and II), as assistance can only be provided to them sporadically. The nutritional situation of the displaced (and resident) populations in the rebel-controlled areas is unknown (category V).

Recommendations and priorities:

UN to negotiate access to affected populations with the RUF.
Monitor the health status of the populations in displaced camps carefully. Improve sanitation and reduce overcrowding in these areas.
Continue to deliver food and other items where possible.

RNIS 30, March 2000

The civil war in Sierra Leone began in 1991. A Peace Agreement Accord was signed on 7 July 1999 in Lome. While some progress has been made towards the implementation of the accord, there are indications that the process is troubled. Security has improved in the south and west (particularly where the UN troops have been deployed), but the overall situation remains tense and volatile. Reports of atrocities against civilians continue to be received. The process of disarmament, demobilisation and rehabilitation of the rebels is slow. Achieving unhindered humanitarian access, one of the first major agreements signed by the parties to the conflict, has proved difficult. Despite the formation of the Government of National Unity, former RUF/AFRC (Revolutionary United Front/Armed Forces Revolutionary Council) fighters continue to lay claim to large areas of the country, obstructing free movement (OCHA - 07/03/00; RI - 01/03/00).

Humanitarian access

At this time humanitarian agencies still do not have unhindered and safe access to 7 out of 12 districts, which make up 80 of the country’s 149 chiefdoms, with a total population of 2.4 million from a total population of less than 5 million (according to 1997 projections). Current operations in these areas (mainly in the northern and eastern parts of the country) are carried out under very difficult circumstances, characterised by frequent disruptions and uncertainty. In contrast the Southern Province, the Western Area and some parts of the Eastern Province are relatively stable (OCHA - 07/03/00). As parts of the country that were previously closed are now accessible, assessments and deliveries of assistance are underway.

Returns, resettlement and reintegration

Estimates of IDPs living both in camps and with hosts vary from 750,000 to 1,000,000. Resettlement assessment committees have been established at district and national levels to undertake assessments (based on national criteria) that will determine whether chiefdoms can be declared safe for resettlement and reintegration. The phasing down of IDP camps in the Western Area has begun and food aid will be stopped to IDPs from safe areas. Resettlement rations, food-for-work, food-for-training and related projects will be provided to those who wish to resettle. Those that are from unsafe areas will retain the right to continued accommodation and support services within an IDP camp. Low-cost housing schemes are being set up for those IDPs whose homes have been destroyed (OCHA -07/03/00; WFP-10/02/00).

There are more than 450,000 Sierra Leonean refugees living outside their country. UNHCR has reported a small, but steady, increase in spontaneous refugee returns, mainly from Guinea and Liberia. According to the most recent estimates nearly 10,000 people have returned to the major towns in the southern and eastern provinces. UNHCR has made projections (based on the security situation and other factors including logistics, and the coming rainy season) for 108,000 refugees to return in the course of 2000. However, the implementation of the repatriation operation is closely linked to the progress made on the peace agreement (OCHA - 07/03/00; UNHCR - 27/03/00).

Agriculture

An FAO/GIEWS assessment mission to Sierra Leone in December 1999 (the first since November 1996) reported that the war has caused extensive disruption of the agricultural sector throughout the country including the southern region, which is currently peaceful. Only 12-15% of the total arable land is under crop-production. The staple food crop, which is rice, covers slightly less than half the cropped area. Other cereal crops grown include maize, sorghum, millet and benniseed. Cassava and sweet potatoes are now commonly accepted substitutes for rice as “crisis crops”, particularly in rebel-controlled upland areas. During the war the production of cassava increased by 70%, while that of sweet potato increased by about 20% (FAO - 04/02/00).

Sierra Leone, which was almost food self-sufficient before 1990, has become highly dependent on imports and food aid. Over the years, farmers have lost their productive resources including seeds, implements and other capital assets. There has been large-scale destruction of the marketing infrastructure and rural institutions (e.g.: agricultural research stations). As many rural farm families have been displaced, the availability of labour for planting and harvesting is a major constraint to recovery. Also, farmers’ holding capacity for whatever small harvest they have is low due to financial constraints and the fear of looting by rebels. Practically all farmers are dependent on the government or NGOs for the supply of seeds, and thus the amount of land planted is partially determined by the capacity of these agencies (FAO-04/02/00).

Southern Province

Freetown

No new reports on the nutritional situation of the population of Freetown have been received by the RNIS. WFP currently assists some 28,320 IDPs in six camps around Freetown. This assistance will be phased out as the displaced return to their communities. Those from areas that are declared unsafe will qualify for further assistance in Freetown (WFP -10/02/00).

Bo District

Bo, the largest district in the Southern Province, is an agricultural area. Most of the population are involved in rice farming. Other activities include cocoa and groundnut farming for cash and mining. An inter-agency verification of non-camp IDPs in Bo indicated that only 4,000 of the original 6,000 registered IDPs remain in Bo (most of whom live in Bo town). Not all of these people are considered vulnerable. A further 14,000 IDPs are registered in camps in Bo (OCHA -16/01/00).

ACF-F undertook a nutritional survey in Bo town among children aged 6-59 months in November 1999 (see annex). Thirty percent of the sample population were IDPs. The prevalence of acute malnutrition was estimated at 7.2%, including 0.7% severe acute malnutrition. Oedema was recorded in one child. No statistically significant differences were recorded in the prevalence of malnutrition for the displaced and residents. Retrospective CMR in the three months prior to the survey was estimated at 0.74/10,000/day and under-five mortality at 3.1/10,000/day. Bloody diarrhoea and malaria were the main causes of death in the population above five years old. Malaria was the primary cause of death in children under five. (Mortality was partially estimated during the rainy season, when the incidence of malaria is highest). Measles vaccination coverage was estimated at 33.6% according to card and increased to 87.3% if the child’s carer’s history was taken into account. The feeding centre coverage was low at 9,7% (ACF-F -11/99).

The prevalence of acute malnutrition (defined using z-scores and/or oedema) in Bo

Although not alarmingly high, the prevalence of malnutrition was higher than that estimated in the same, post-harvest, season in 1998 (see graph). This slight increase was attributed to continuing population movements in the area and an increase in the prices of basic food and nonfood items compared to 1998 (e.g.: local rice has increased by 60%, imported rice by 20%, cassava by 15%, and palm oil by 30%). The price increases were due to the devaluation of the Leone, excessive informal “payments” on the highway between Bo and Freetown, poor road networks and infrastructure and subsequent high transport costs. Analysis of the admissions to the feeding clinics in the town suggested that many of the malnourished were from the northern and eastern regions (ACF-F -11/99).

Eastern Province

Kenema

There are currently approximately 13,000 registered IDPs at the Lebanese camp. MERLIN has reported that the number of admissions to its feeding centre has decreased compared to last summer. The NGO is expanding its programme, however, in preparation for the coming hunger gap and also an increase in numbers as access from the outlying areas around Kenema improves (MERLIN -22/03/00). An outbreak of bloody diarrhoea (shigella) has been reported in the district by MSF-F (OCHA -16/01/00, 30/01/00).

Konta

A WFP/NGO assessment mission to Konta reported that the IDPs in the area are ready to resettle, but need assistance with resettlement packages. Some have started to return home. The IDP camp in Konta lacks water and sanitation facilities, blankets, shelter and healthcare. WFP has recently provided the IDPs with food. Konta is extremely difficult to access by road and the population had not received any assistance since April 1999 (WFP - 20/01/00).

Northern Province

Current operations in this area are carried out under difficult circumstances. Appropriate programming has been disrupted and interventions, where possible, are usually limited only to emergency relief, while assistance programmes aimed at rehabilitation and reconstruction await more favourable conditions (OCHA - 07/0300).

Liberian refugees

The residual caseload of Liberian refugees in Sierra Leone is about 7,000. They are currently being screened by UNHCR (OCHA - 30/01/00). The RNIS has not received any new information on the nutritional situation of these refugees, which is unknown.

Overall, the country continues to open up to humanitarian assistance, although there is little information available about the nutritional situation, with the exception of a single survey in Bo that indicated satisfactory nutritional status. However, given the recent upheaval and the approaching hungry season, the nutritional situation of the IDPs is likely to be precarious for the foreseeable future (category II or III). The nutritional situation of the Liberian refugees remains unknown (category V).

Recommendations and priorities:

In most assessed areas, priorities for urgent interventions include:

Agricultural support, particularly in the northern and eastern regions.
Close monitoring of the food security situation, especially in rural areas.
Rehabilitation of water and sanitation facilities, and the health sector.
Close monitoring of refugee and IDP returnees.
Reinforce bridges and arterial routes before the start of the rainy season (April).

From the ACF-F survey in Bo:

Maintain the therapeutic feeding programme to treat the malnourished from Bo and surrounding zones.
Strengthen nutritional screening process in order to increase the coverage of the feeding programmes.
Conduct a food security assessment.

RNIS 29, December 1999

The Lomé peace accord, which was signed in July between the Government of Sierra Leone and the Revolutionary United Front (RUF), has held although there have been reports of increasing numbers of security incidents and human rights abuses during the past three months (Al - 30/11/99; HRW-27/10/99).

Efforts towards the implementation of the peace accord are underway. President Kabbah has expanded his Cabinet, which now includes members of the former RUF. A disarmament, demobilisation and reintegration programme of former combatants has been set up. In addition, the UN Security council has established a peacekeeping force for Sierra Leone that will be deployed throughout the country for an initial period of 6 months to monitor the ceasefire agreement, support the implementation of the Lomé agreement, and facilitate the delivery of humanitarian assistance in Sierra Leone (OCHA - 23/10/99; UNDP - 29/11/99).

IDP Numbers

There has been an increase in the number of registered IDPs and vulnerable populations benefiting from a range of interventions since August. This may be attributed to the signing of the peace accord which has increased confidence and enabled people to come out of hiding in the bush. Humanitarian agencies are reaching previously inaccessible areas where they are conducting needs assessments. There were an estimated 308,000 registered IDPs at the end of September compared to 183,000 in August (the September figure does not include the IDPs from Kambia of whom there were an estimated 20,000 in August). Best estimates put the total number of IDPs in the country at between 700,000 and 1,000,000, although exact figures are not available currently due to the continuing inaccessibility of many regions. Almost 500,000 Sierra Leoneans are refugees living in neighbouring countries (OCHA - 30/09/99; WFP -17/12/99).

Food Assistance

Since the cease-fire, larger areas of the country have become accessible to humanitarian agencies, although more slowly than was hoped. There are concerns that the collective resources of food aid agencies will be insufficient to address increasing needs. There are reports of continuing food shortages in many areas of the north. Food continues to be regularly distributed to registered beneficiaries in all accessible areas including the IDP camps in Kenema, Bo, Blama and Freetown. In September, for which the most recent figures are available, WFP/CARE/CRS provided food aid to 268,000 IDPs and war-affected persons. WFP plans to provide food assistance to up to 580,000 people in the next six months, although this is dependent on access. In rural areas a significant portion of food aid is being distributed through food-for-work and food-for-agriculture programmes (OCHA - 09/10/99; USAID - 07/10/99; WFP -17/12/99).

Agricultural Outlook

An FAO/GIEWS analysis of food and crop shortages in Sierra Leone has reported that growing conditions have generally been favourable since the beginning of the season, despite reduced rains in late July and August. Output is expected to remain similar to the 1998 level despite the improvement in security following the Lomé agreement because insecurity earlier in the season prevented the delivery of agricultural inputs and disrupted farming activities. Even if the peace agreement does hold, the country will continue to rely on external food assistance for several years (FAO -10/11/99).

General health and nutrition

Outbreaks of malaria, measles and cholera have been reported in the past three months. The RNIS has not received any nutritional surveys or food security assessments from Sierra Leone during the reporting period.

Northern Province

The security situation over the reporting period was still tense in Northern Province; leading to the temporary suspension of humanitarian assistance in some areas. NGOs attempting to re-start relief activities have reported difficulties. Reports have also indicated that residents are forced to give food to armed combatants (OCHA - 09/10/99, 23/10/99).

Kambia District

There have been reports of armed groups attacking villages in the Kambia district. The harassment has reportedly led civilians (some of whom had just returned from refugee camps in Guinea) to flee their villages and head back to the refugee camps, or areas very close to the Guinean border. MSF-H is providing limited health and nutritional interventions in the district. WFP is planning to undertake a needs assessment in this area when security conditions allow (OCHA - 09/10/99,06/11/99; WFP - 29/10/99).

Makeni

The town of Makeni was temporarily occupied by RUF rebels during the reporting period (IRIN-WA - 20/10/99). ACF-F is treating a large number of malnourished people in its therapeutic and supplementary feeding programmes (OCHA - 30/09/99). The last RNIS reported on an assessment in Makeni in July that estimated the prevalence of malnutrition at 34% in Makeni town and even higher in areas outside the town,

Southern Province

The Freetown peninsula has remained relatively secure throughout the reporting period, with no major security incidents. MERLIN continues to provide mobile and normal clinics in Freetown: 1285 cholera cases were reported in Freetown in from September 1^st October 17^th, most of these have been from eastern or central parts of the city. The incidence of cases has been steady over the reporting period (MERLIN-12/99).

Eastern Province

Kenema

IDPs previously occupying school buildings in Kenema have been transferred to various camps including Nyandeyama and Blama. Construction of booths for the IDPs is underway. WFP has reported that 38% of IDPs have voluntarily returned to their place of origin (OCHA - 09/10/99, 23/10/99; WFP-05/11/99).

MERLIN has reported that the nutritional crisis in Kenema district has “continued to deepen” with the progression of the hunger season. There continues to be an increase in the number of admissions to the therapeutic and supplementary feeding programmes in Kenema town, I DP camps and in some chiefdoms within the district, Outreach programmes including nutritional screenings have recorded high rates of malnutrition, particularly in Nyawama camp and Dodo. The most recent survey in this area, in June, estimated the prevalence of wasting and/or oedema at 19.9% (see RNIS 27). Graveyard monitoring, however, has not shown particularly elevated mortality rates in Kenema town or camp, or Blama or Konta. Furthermore, prices of food commodities are beginning to decrease as the road transport becomes more reliable (MERLIN -12/99).

Kailahun

A WFP mission to Kailahun has established the need to provide vulnerable group feeding rations to the elderly and children in Segwema. In Daru, the nutritional situation was reported to be satisfactory compared to the situation in late September. The improvement may be attributed to ongoing harvests and increased access to previously held-RUF areas (WFP - 03/12/99). A nutritional survey is currently being undertaken in Kailahun (OCHA - 30/09/99).

Kailahun’s towns have suffered considerable structural damage during the war. WFP and World Vision have started to rehabilitate the Kenema-Kailahun road which runs through RUF controlled areas. The road will serve as a vital supply route for humanitarian operations and will also allow farmers to sell their produce at nearby towns more easily (OCHA -30/09/99; WFP-03/12/99).

Refugees

There is no new information on the nutritional situation of the approximately 8,000 Liberian refugees in Sierra Leone.

Repatriation of refugees

Over 3,000 Sierra Leonean refugees have spontaneously returned from Liberia during the reporting period. Most of the refugees are reported to be in relatively good condition. Lack of shelter is crucial, as many of the returnees’ villages have been damaged by the war. Given the poor security situation, UNHCR is unable to establish itself in the returnee areas and thus cannot monitor the situation or provide emergency assistance (OCHA - 23/10/99).

The time-frame of the organised repatriation operation is closely tied to the implementation of the Lomé peace agreement, particularly the disarmament, demobilisation and reintegration, and also humanitarian access. UNHCR has not started the repatriation programme yet because of the security conditions in Sierra Leone (UNHCR -12/12/99).

Recommendations and Priorities:

WFP’s operation to assist refugees and IDPs has only received 36% of the total funding required.

Overall, the IDPs in Kenema and the Northern Province are at high risk of malnutrition. The nutritional risk of the IDPs in the southern and western Provinces is moderate (category III). The nutritional situation of the other IDPs and the refugees is unknown (category V).

RNIS 28, September 1999

The signing of a peace accord between the Government of Sierra Leone (GoSL) and the Revolutionary United Front (RUF) in Lome on July 7^th 1999 has led to improved security conditions throughout much of the country. The accord maintains the previous commitments of the parties to guarantee safe humanitarian access and facilitate the fielding of independent assessment missions by registered agencies. Sierra Leone remains the least developed country in the world with a life expectancy of 37 years, and per capita income of less than US $200/year. It is hoped that the peace process may create an enabling environment for change and that, in turn, relief activities will contribute to the establishment of a durable peace (OCHA - 12/07/99; UNDP - 1999).

Security problems persist despite the accord and these have delayed humanitarian assistance in some areas. There have been reports of attacks on civilians and villages in the Northern Province. In Freetown, the GoSL continues to restrict movement at night. Given the significant problems with command, control and communication among the forces on both sides, it seems likely that there will continue to be problems even if the leadership of both sides make a good faith effort to adhere to the terms of the peace agreement (IRIN-WA - 01/09/99; USAID - 10/08/99).

Two of the most important challenges foreseen in the new environment are (1) assessing the conditions and needs of the population sections which have been inaccessible to relief organisations for long periods of time, and (2) re-settling and re-integrating the nearly half a million Sierra Leoneans who have become refugees in neighbouring countries.

Access

Assessment missions and emergency food distributions to many of the areas previously inaccessible have been undertaken during the reporting period. These include Bo, Kenema, Lunsar, Masakia, Tasso Island, Kandu Lieppiama Chiefdom and Dama Chiefdom. The opening of the road linking Freetown, Bo and Kenema was particularly important allowing traffic eastwards again (CARE -13/09/99; CRS - 19/08/99; OCHA - 18/08/99; WFP -10/09/99).

It is estimated that access to the currently closed areas could increase the beneficiary caseload by at least three times the present level of approximately 500,000. Although food aid agencies believe that sufficient stocks will be available to cover the projected needs of the currently targeted groups, WFP has proposed a further protracted relief and rehabilitation operation of assorted food commodities for the extra needs now anticipated. Current estimates put the number of displaced people at around 700,000-1,000,000 including some 370,000 in what were previously government-held areas (OCHA -12/07/99; USAID - 10/08/99; WFP - 10/09/99).

Freetown

In Freetown, relief organisations and the GoSL have sought to encourage people to return to their houses, rather than live in shelters, by providing assistance for rebuilding. Some shelter construction at IDP sites continues in order to stop IDPs residing in public buildings. There are currently 11 IDP sites in Freetown (USAID - 10/08/99).

Food aid in Freetown continues in the form of feeding for IDPs residing in officially approved shelters, and food-for-work activities to support the reconstruction of homes, schools and clinics. If peace holds, programmes for IDP shelters will be phased out by the end of the year. Food aid will continue for programmes such as hospitals and therapeutic feeding centres (USAID - 10/08/99; WFP -10/09/99).

Kenema

Due to improvements in the security situation there are more people coming into Kenema from rebel-held areas, and thus numbers of admissions to the feeding centres are still increasing. A survey in early June estimated the prevalence of malnutrition (<-2z scores and/or oedema) to be 19.9% (see RNIS 27). MERLIN is hoping to increase and decentralise the supplementary feeding to cope with the increased numbers, depending on logistics, funding and security (MERLIN - 27/07/99).

A survey among the resident and displaced population (estimated at 5,000) in Bo Town, conducted by ACF-F in early May, estimated the prevalence of acute wasting at 7.1%, which included 0.7% severe wasting. No oedema was recorded. These results represent an improvement in the prevalence of wasting when compared to April and October 1998. This is despite the fact that, between December 1998 and June 1999, Bo was cut off from Freetown, and unable to receive humanitarian assistance for many months, resulting in an increase in market prices of food. At the time of the survey, the market continued to function, and local foods were available, albeit in small quantities. The population of Bo has established coping mechanisms including: sending family members to live in rural areas to decrease household sizes in Bo township, developing gardens, and collecting 'bush yams' (ACF-F - 05/99).

The authors of the Bo survey stressed that the nutritional situation was fragile, particularly as the "hunger gap" approaches (prior to the harvest in October/November). The coverage of the feeding programmes was low at 18%. Moreover, mortality rates of the population surveyed were relatively high. CMR (estimated over three months prior to the survey) was 0.72/10,000/day and under-five mortality was 1.95/10,000/day. The main cause of mortality in the under-fives was malaria, despite health facilities being available in the town. Measles vaccination rates were low when confirmed by card (23.2%) but increased significantly when confirmed by parents/guardians (84.3%).

The displaced people living in camps around the town were not included in these surveys, and their nutritional situation is unknown.

Makeni

ACF-F returned to Makeni in late July for the first time since December 1998 when it had to evacuate the area after a rebel attack (ACF - 07/99). The evaluation mission team reported a catastrophic humanitarian situation. A rapid nutritional screening exercise in Makeni Town estimated that 34% of children under five were malnourished (see Annex). Of the 95 children assessed, 16% were moderately malnourished, and a further 18% were severely malnourished. Of the adults assessed, 25% were malnourished, 14% severely. These results were not based on a random sample, but nevertheless the authors suggested the nutritional situation had deteriorated in recent months. Further screening exercises were undertaken in the IDP camps on the outskirts of the town. In Magbenteh camp, which houses some 2,000 people, the MUAC of 97 children under five was measured; 52.6% were wasted, including 8% severe wasting. In addition, 52% of the adults assessed were wasted, 8.7% severely so.

The prevalence of malnutrition in four villages surrounding the town was crudely estimated, based on screening all children "around at the time". The average prevalence of malnutrition in the children under-five was 33.7%, 18% were severely malnourished. In one village, Makama, 45% of the children assessed were malnourished, 25% severely. The prevalence of oedema was very high in these villages. Of the 33.7% of children classified as malnourished, 76.3% had oedema.

The severity of the situation in Makeni is attributed to the fact that it has been cut off from commercial and relief supplies since December. A rapid food security assessment by ACF suggested that 75% of farmers in the area had been unable to plant this year, because seeds were in short supply due to looting. Fertilisers and tools were also lacking. The population was said to be eating only one meal a day consisting of cassava by-products, reptiles, larva (from composts and rotting trees), snails, rats, frogs and mushrooms. Rice, meat and fish were no longer available at the market. ACF predicted that the "hunger gap" between the two harvests will be particularly harsh this year in Makeni as the population has no food stores and hence are dependent on humanitarian assistance for survival. The report noted that the nutritional situation was worse in the villages surrounding Makeni than in the town itself, because the outlying areas have been subject to more looting in the past few months (ACF - 15/08/99).

The first inter-agency food aid convoy since late 1998 reached Makeni in mid-September. Distributions have started for 97,000 beneficiaries (WFP - 10/09/99).

Liberian refugees

No new information on the nutritional situation of the approximately 8,000 Liberian refugees in Sierra Leone is available. The last RNIS reported that their condition is not expected to differ from the local population.

Repatriation

UNHCR representatives from the four countries which house the majority of the 500,000 Sierra Leonean refugees met in early August. Organised voluntary repatriation, expected to last two years, will begin in February 2000. Half of the refugees are expected to repatriate voluntarily, 30% under a facilitated scheme, which does not involve transport and 20% under a scheme with transport. Currently not all returnee areas are accessible to humanitarian workers (IRIN-WA - 09/08/99; UNHCR - 20/09/99).

Overall, although the situation in Sierra Leone will, it is hoped, eventually improve as parts of the country become newly accessible it is probable that, in the short term at least, acute humanitarian needs will be uncovered as in Makeni. At present, information is still limited. In areas that were previously government-controlled, where surveys have been conducted, the population appears to vary between high risk (Makeni) and moderate risk (Bo) (category IIa and b). The nutritional status of the IDPs in the areas of the country where surveys have not yet been conducted is unknown (mainly previously rebel-controlled areas) (category III).

Priorities and Recommendations:

As agencies gain access to previously closed areas, a range of humanitarian interventions are likely to be required to improve public health and strengthen food security.

Public Health priorities include:

Measles immunisation.
Primary health care programmes.
Rehabilitation of water supplies and sanitary facilities to prevent cholera.

Nutritional priorities include:

Therapeutic and Supplementary Feeding programmes to rehabilitate malnourished children.
Increased attention to the conditions of secondary and tertiary roads. This will allow humanitarian assistance to be provided by road and generally make larger areas of the country accessible, and enable marketing networks to be re-established.

Recommendations from the survey in Bo:

Continue to treat children in the therapeutic and supplementary feeding centres in Bo.
Follow up nutritional surveillance through Health Centres, and continue intensive screening of under-fives to improve the coverage of the feeding programmes.
Promote immunization for children under five.

Recommendations from the survey in Makeni:

Supply a general food distribution (full ration) to the population of Makeni and the surrounding villages and camps.
Set up therapeutic and supplementary feeding centres.
Set-up medical facilities both in central and rural areas.
Assess the agricultural situation to decide what inputs/interventions are appropriate.

RNIS 27, July 1999

The fighting in Sierra Leone which broke out in December 1998 between the Revolutionary United Front (RUF) and ECOMOG, the West African peacekeeping force that backs Sierra Leone's government, has de-stabilised the country. The fighting was often accompanied by widespread looting and burning of property and appalling human rights violations during attacks on villages (IRIN-WA - 29/04/99, IRIN-WA - 17/05/99). Currently two thirds of the country (eastern, northern and western parts) are not controlled by the government. Approximately 2.6 million (55%) of the population live in these areas.

President Ahmed Tejan Kabbah, having long refused to talk to the rebels, has been under much pressure from the international community to make peace, and eventually government officials met with RUF representatives in May in Lome. A settlement is still to be determined. The RUF wants a transitional government, which includes its own representatives. The government has yet to agree to this (IRIN-WA - 18/06/99). Given the failure of the past two settlements, it is very possible that this set of negotiations may not succeed in finding a peace agreement acceptable to all those concerned (Oxford Analytica - 24/05/99).

A cease-fire between the two groups came into came force on May 24^th and it has generally held, with a few exceptions. Subsequently the two sides agreed to the principle of "safe and unhindered access" for humanitarian organisations throughout the country. Although neither of these agreements have translated into free access to much of the north of the country, it has enabled relief agencies to access some previously inaccessible RUF-controlled areas (IRIN-WA -18/06/99).

IDPs in Sierra Leone

It is estimated that there are 370,000 displaced people in government-held areas of the country, with the most significant displacement into Freetown, Bo, Kenema, Kambia and Blama. Estimating the numbers of IDPs in rebel-controlled areas is extremely difficult. These areas have remained inaccessible to aid agencies for many months and thus there is very limited information about the humanitarian situation, as few people are able to go in and out of the rebel-controlled territory. The most recent estimates suggest there may be up to 700,000 displaced people in the country. There are also approximately 450,000 refugees in other countries (OCHA -01/05/99,17/05/99; UNHCR - 08/06/99,25/06/99; USAID - 30/04/99, 18/05/99; WFP - 19/4/99, 26/05/99).

The lack of access and the destruction of infrastructure has been one of the main problems facing the humanitarian community trying to deliver assistance in Sierra Leone, Until very recently, humanitarian agencies were unable to transport substantial quantities of relief goods beyond Freetown. Food security has been compromised in many areas by looting or destruction of farmers' stocks. Many of the IDPs have not been able to farm at all (WFP - 19/04/99). The situation in large parts of the country is still unclear as assessments have not yet been undertaken.

Freetown

WFP reports state that available information indicates that the nutritional situation of the population in Freetown is relatively stable, including those living in IDP settlements. The reports refer to an ACF screening exercise in the IDP camps which revealed 11.3% acute malnutrition and 1.4% severe malnutrition in the 0-23 month age group (WFP - 01/04/99, 19/04/99). The other emergency health needs in Freetown are also generally considered to be under control. Much of the humanitarian effort in Freetown is now concentrated on providing shelter as the rains approach. Assistance is provided for the reconstruction and rehabilitation of damaged or destroyed buildings in areas that have recently become accessible and relatively safe for resettlement. Temporary shelter is being provided for the displaced whose area of origin remains unsafe. Cholera prevention activities are also underway (OCHA - 17/05/99, USAID - 30/04/99).

Kenema and Blama

Secure access to Bo, Blama and Kenema has been a critical problem for WFP and other agencies. WFP was unable to deliver food stocks between early April and early June to Bo, Kenema or Blama (Merlin - 05/99, 06/99; WFP - 07/06/99). More recently WFP was able to move 1,600MT of food by ship to the south of the country and from there by road to Bo and Kenema. Food has also been moved directly by road from Freetown to Bo and Kenema and 48,575 IDPs in Kenema, Blama and Ngofor have received rations (WFP - 24/06/99).

Merlin undertook a nutritional survey amongst the approximately 14,000 IDPs who came from the eastern part of Kenema district and had fled to Blama in late April (see Annex). The prevalence of acute wasting was 7.8% and severe wasting was 1.4%. Oedema was present in 1.3% of the children under five. CMR was relatively high at 2.5/10,000/day and the under-five mortality rate was 5.3/10,000/day. The major causes of death in the younger group were fever, diarrhoea and measles and in the older group, fever and malaria.

The authors considered the prevalence of wasting and/or oedema to be of concern because, although it was not yet extremely high, the population's food security was very poor. In particular, 70% of the households reported that they had no food stocks and 22% of the households' primary source of food was relief food. The majority of households' primary food source was the market, but prices in the market had fluctuated and increased greatly due to the inconsistent supply of commodities brought into the town. Other households relied either on collecting wild foods from around the town or on food donated by other people. The proportion of households which had land and were able to cultivate was low. The lack of seeds, tools, labour, land and fear of further rebel attacks were all given as reasons for not planting.

A survey conducted by Merlin in Kenema two months later (early June) seemed to bear out the concerns described above (see Annex). The prevalence of acute wasting was assessed to be 18.4% and severe wasting was found in 1.5% of the children under-five. Oedema was recorded at 3.8%. The CMR of IDPs was estimated at 1.2/10,000/day compared with 0.8/10,000/day for residents. The under-five mortality rates were 3.3/10,000/day in IDPs and 1.1/10,000/day in residents. The leading causes of death in the younger group were fever, diarrhoea and measles and in the older group, diarrhoea.

The basic data collected on food stocks and livelihood sources served only to confirm what was expected given such a high prevalence of wasting and/or oedema. The primary source of food (80% of households) was the market place. The last distribution of relief foods was in April. 16% of households were relying either on food collected from the bush or donated by other families. The vast majority of households had no food stocks and had only eaten one meal the day before interview. 85% of families stated that their primary source of income was the collection and sale of firewood, almost none had livestock. 96% of the households had no land to cultivate - a severely limiting factor for the self-sufficiency of the group.

The high mortality rates are cause for immediate concern. Many of the smaller camps have poor sanitation and limited access to water supply. A measles campaign has been undertaken in response to an outbreak in Kenema District by Merlin in collaboration with UNICEF and the MOH and a "significant reduction" in the number of children admitted to paediatric wards in the area has been reported (IRIN- WA - 04/05/99). Reported immunisation rates still remain low, but these figures are hard to verify as although the number of children with cards is low, evidence from BCG scarring and mothers histories indicate that figure is much higher.

Needs assessments in other parts of the country

As stated above access to much of Sierra Leone has been virtually impossible in many areas until the last few weeks. Needs assessments are currently being undertaken in parts of the country which have had no assistance since the outbreak of the latest round of hostilities. These assessments are reporting mixed results.

A recent UN assessment to Daru, in the Kailahun district, which is the furthest east that humanitarian agencies have been since late 1998, reported that the food situation is relatively stable but that immediate medical assistance is required. A supplementary feeding programme for the displaced children may also be required (WFP - 04/06/99). An assessment in Rogberi, some 60km east of Freetown, found a very poor situation in terms of food security and sanitation. Rebels had destroyed much of the previous year's supply of seeds so farmers were unable to plant. Much of the population had been subsisting on cassava and mangoes. In addition, the risk of waterborne diseases was "considerable" given that inadequate water and sanitation facilities were available and that overcrowding was severe (IRIN-WA - 16/06/99).

A WHO/Ministry of Health Epidemic Rapid Intervention Team undertook an assessment mission on Tasso Island in the Western Area to investigate reports of diarrhoea, dysentery and cholera. According to the report, the outbreaks were due to a lack of good water supply, poor environmental sanitation conditions and overcrowding compounded by a lack of medical supplies in the area. Some 5,000 IDPs hare reported to have joined the resident population on this small island (OCHA - 17/05/99).

Liberian refugees

WFP is providing assistance to approximately 8,000 Liberian refugees in Bo, Kenema and Freetown. Their condition has not been assessed recently. According to WFP field reports, their condition is not expected to differ from that of the local population (WFP - 19/04/99; 15/06/99).

Overall, it is extremely difficult to classify the nutritional status of the IDP population in most of Sierra Leone as there has been little or no access to much of the country since December 1998. An estimated 40,000 IDPs in Freetown are probably at moderate risk (category IIb). Higher prevalences of malnutrition in the IDPs in Kenema and other government-held areas outside Freetown have been recorded and these people may be at high risk, although they have received food rations from WFP very recently (category IIa). The nutritional situation of the remaining IDPs (an estimated 600,000) is unknown, as is that of the Liberian refugees.

Priorities and recommendations:-

Access to rebel-held areas remains a top priority, as until this can be assured, it will be impossible to fully assess and deliver humanitarian assistance to all the affected population.
Food agencies are prioritising emergency assistance to IDPs, therapeutic and supplementary feeding programmes and hospital feeding programmes. As more of the country becomes accessible regular programmes will also resume (WFP - 24/06/99).
Food security - seeds and other agricultural inputs (tools, fertilisers) are urgently required to allow farmers to start planting for the next agricultural season.
IDPs safety - IDPs and refugees cannot be expected to return to their homes without assurances for their safety. In the meantime, a high proportion of food aid resources will continue to be used for emergency programmes, and displacement will have severe consequences on the country's overall agricultural production.
Cholera preparedness - UNICEF and other NGOs anticipate that there will be a serious outbreak of cholera during this year's rainy season due to the large concentrations of people in areas with poor sanitation. Thus chlorine powder and cholera-prevention training is required (OCHA - 17/05/99, USAID - 30/04/99).
Infrastructure - destruction and damage to homes, roads and other infrastructure has been extreme in many parts of the country and the need for reconstruction is evident. In particular, shelter is required for the IDPs during the rainy season.
Regular surveys and surveillance activities - including surveys of urban residents and IDPs. Screening in order to identify and refer the undernourished to appropriate feeding programmes.
Government capacity - this has been diminished in recent years as many qualified personnel have left the country. WFP emphasises the importance of building Government counterpart capacity to progressively undertake responsibility for analysing and determining the uses of food aid in the country (WFP -19/04/99).

Additional recommendations from the MERLIN survey in Blama include:

Maintain and strengthen supplementary feeding programmes.
Maintain and strengthen the mortality and morbidity surveillance.

Additional recommendations from the MERLIN survey in Kenema include:

The registration and verification of IDPs which is currently underway and the subsequent distribution of food aid should be given the utmost priority. Distribution should be on the basis of full rations (2,100 kcal/person/day), rather than vulnerable group feeding. Note that since this survey was undertaken WFP has provided a ration for 48,575 IDPs in Kenema, Blama and Ngofor (WFP - 24/06/99).
Expand the targeted supplementary feeding programme and investigate the feasibility of providing blanket feeding to all under fives or other strategies should be investigated to prevent the situation worsening and strengthen the capacity for therapeutic feeding.
Prioritise diarrhoeal and malaria control.
Improve water, sanitation and shelter in the camps, alternatively move the displaced to where sufficient water, sanitation and shelter is provided.

RNIS 26, March 1999

Despite the return of the democratically elected Government of Sierra Leone led by President Ahmad Tejan Kabbah in March 1998, conflict continues to plague the efforts of the majority to recover from the effects of the junta period. The hostilities between the ECOWAS Cease-fire Monitoring Group (ECOMOG) and the remnants of the AFRC/RUC (Armed Forces Revolutionary Council/Revolutionary United Front) have spread over a larger area of the country. The junta forces have engaged in large scale looting, arson and serious human rights abuses as they have retreated. The terrifying nature of the atrocities have spread panic and fear among the local population and have provoked large-scale displacement. The number of refugees from Sierra Leone in neighbouring countries has increased to an estimated 450,000 of which 260,000 represent the new caseload since February 1998 (UNHCR-23/02/99; OCHA, 3/12/98). This number is probably increasing. There are reported to be between 700,000 and one million IDPs in Sierra Leone (USAID - 12/03/99).

Fighting broke out in Freetown in late December 1998, and continued sporadically until early-February when the rebels were forced out by ECOMOG forces. The damage to the city is reported to be colossal: up to 65-80% of housing in central parts of the city may have been destroyed (IRIN-WA - 09/02/99). Many households were forced to seek accommodation with friends and relatives or in abandoned buildings and makeshift camps. At the height of the crisis between 30,000 and 40,000 people were crammed into the main stadium without food and medical facilities (IRIN-WA - 22/01/99). By late January 117,000 displaced people had been registered by the authorities in the city (WFP - 29/01/99); more current data are not available.

Emergency food distributions organised by an inter-agency committee were started in mid-January 1999. Prices of basic commodities had risen sharply, with some items priced ten times higher than before the crisis (IRIN-WA -22/01/99, WFP - 18/01/99). The food distributions continued throughout February (WFP - 26/02/99). Following fears that the city's food stocks were diminishing and could run out and difficulties in delivering food aid by other means, WFP has begun airlifting supplies to Freetown. If food stocks do run out even more displacement might occur as people leave the capital in search of something to eat (IRIN-WA - 12/02/99, 05/02/99; WFP - 04/03/99).

Waterloo, a town 18km from the capital, has recently been re-captured by ECOMOG forces (IRIN-WA - 25/02/99). The rebels occupied the town for six weeks, during which, the civilian population fled to the bush. 7,000 IDPs have recently returned to the town - which was described as "literally burnt to the ground"- in order to receive humanitarian assistance (IRIN-WA - 01/03/99). Before the fighting broke out UNHCR was caring for approximately 5,000 Liberian refugees in the town. For a period their whereabouts were unknown as they scattered during the rebel attacks (IRIN-WA - 10/02/99). However, UNHCR has recently re-established contact with around 2,000 Liberians, 720 of whom have requested repatriation. The first group of some 120 refugees have recently been brought home by ship (UNHCR - 17/03/99).

Rebel activity near the south-eastern town of Kenema spurred fresh arrivals of IDPs into the city. An estimated 50,000 IDPs are currently in Kenema and nearby Blama (IRIN-WA, 01/03/99, 22/1/99). Rebel incursions into the town were also reported; these resulted in the IDPs fleeing. A MERLIN feeding clinic was attacked in a raid (IRIN-WA - 12/02/99). WFP food distributions in the two towns continued when possible, but fuel shortages have hindered the process of delivery (WFP-26/02/99, 12/02/99, 29/01/99, 15/01/99). At least 200,000 other IDPs may be stranded between Kenema and Bo and ECOMOG forces were reported to be reluctant to allow IDPs into Bo for security reasons (IRIN-WA - 12/02/99). WFP was able to distribute food in Bo, but may not have enough stores to feed the 200,000 IDPs (IRIN-WA - 12/02/99, 19/03/99).

The situation in Kambia was also critical following rebel attacks. Rebels from the RUF have crossed the Kolenten river, near Kambia, and attacked Pamlap in the Guinean territory. It is estimated that there are 23,560 IDPs in the border area who require assistance (WFP - 12/03/99).

For obvious reasons, no comprehensive surveys of the nutritional situation of people in Sierra Leone have been undertaken since December. With the continued fighting, looting, burning of homes, and other atrocities, however, it must be assumed that in the affected areas, access to food is severely restricted. For example, in Freetown residents were confined to their homes with little or no food, water or electricity, while all shops and markets were closed (WFP, 12/01/99). Commercial food imports have also been affected by the hostilities. The current disruptions to the agricultural cycle will adversely affect food security in the longer-term (IRIN-WA - 12/03/99). The population displacements and subsequent overcrowding combined with low measles immunisation coverage, mean there is a great risk of a measles epidemic which could cause increased mortality (IRIN-WA - 12/02/99). This combination of risk factors renders the population in affected areas highly vulnerable.

The most recent survey undertaken in the country was in the five chiefdoms of Porto Loko in October 1998, just prior to the harvest (see Annex I(6a)). The rate of wasting was 11.4%,with 3.6% severe wasting. This area had undergone considerable upheaval in the 18 months prior to the survey, which is reflected in the nutritional levels of the population. The results showed a significant impact of displacement on under-five mortality; displaced families were three times more likely to experience the death of an under-five child compared to non-displaced families. Displacement did not have a similar impact on malnutrition. It is likely that the prevalence of wasting will have increased in Porto Loko as rebels have raided the area according to recent reports (Reuters - 22/03/99).

Refugees leaving Sierra-Leone

Since the deterioration of the security situation in Sierra Leone in late December, a total of over 10,000 Sierra Leonean refugees have fled - mainly into Forecariah, Guinea. A small number of new arrivals have also been reported in Vahun, Liberia (IRIN-WA - 17/02/99). UNHCR has been assisting these new arrivals following their registration.

Overall, the situation in Sierra Leone appears to be critical. It is extremely difficult to estimate the numbers of people involved and the extent of their depravation as security restraints prevent humanitarian organisations from accessing the affected regions. It is probable that the IDPs in areas to which access is restricted are at heightened risk of malnutrition and mortality (category IIa). Those in areas which are less difficult to access are considered to be at moderate nutritional risk (category IIb).

Recommendations and Priorities

This acute stage in the emergency warrants, as far as security constraints allow, an assessment of the effects of the conflict on food security, public health and nutrition generally.
The mode and quantity of assistance required in Sierra Leone has changed dramatically in the past few months. Considerable emergency humanitarian assistance is required, but the actual form of the assistance must be determined locally. For example, measles immunisation campaigns remain a priority in upcountry areas (USAID - 12/03/99).

RNIS 25, October 1998

RNIS 25 was devoted to reviewing some of the changes in emergency response over the last five years. We will first highlight situations where wasting was brought rapidly under control. We will then look at some of the factors that have led to less than optimal results, followed by what has been accomplished to improve response over the last five years. We conclude with some ideas for future improvements in the RNIS Reports that could even further enhance communication, stimulate thought, and promote improvement.

RNIS 24, June 1998

Sierra Leone Sierra Leone has experienced many waves of violence since an offensive was launched in 1991 to overthrow the government. Kabbah was elected President in March 1996, and later that year a peace accord was signed. However, a coup d'etat in May 1997 led to a military take-over of the government and threw the country back into conflict. The coup was condemned by the international community and ECOMOG forces, a West African peace-keeping force, began a military campaign to oust the rebels and re-instate the President. Prior to this most recent upsurge in violence, there were estimated to be 200,000 internally displaced people requiring emergency humanitarian assistance.

Currently, Freetown, Bo and Kenema are calm, while the security situation in eastern and southeastern Sierra Leone remains poor with many clashes between ECOMOG and rebel forces. There are at least 100,000 newly displaced people in Sierra Leone. There are an estimated 244,000 new arrivals in Guinea and 54,000 in Lofa county in Liberia. There are many reports of appalling atrocities committed by the rebels including rape and mutilation of civilians. Refugees are reportedly arriving in Guinea traumatised and exhausted. There are also reports of high levels of malnutrition, malaria and diarrhoea amongst the new refugees [IRIN-WA 24-30/04/98, 15-21/05/98, OCHA 06/05/98, WFP 10/04/98].

Malnutrition in Bo Town, Sierra Leone, over time

taken from: Nutritional Anthropometric Survey in Bo, Sierra Leone April 1998.

A survey carried out in Bo in April showed levels of wasting similar to those seen in a previous survey in September 1996 (see graph). Wasting was measured at 10.9% with 1.2% severe wasting. Oedema was measured at 0.2% (see Annex I (7i)). This apparently stable situation was maintained despite decreasing food availability and increased insecurity. A clearer understanding of the food security situation and coping mechanisms employed by the population would help to target interventions in Sierra Leone [ACF 08/04/98].

There are reports of measles epidemics, particularly among the displaced populations. Mass immunisation campaigns are continuing in safe areas [UNICEF 22/05/98].

Insecurity remains a serious problem in the eastern part of Sierra Leone and the rainy season will make access to populations in need more difficult. In addition, the insecurity has prevented many farmers from planting crops meaning they will require humanitarian assistance for some time to come. Several NGOs are running out of food to continue programmes. There are also logistical problems because truckers are reluctant to travel to some areas for fear that their vehicles will be commandeered by the rebels [WFP 01/05/98].

RNIS 23, March 1998

There are at least 1.5 million people requiring humanitarian assistance in the region. In Sierra Leone, the humanitarian situation deteriorated significantly with the escalation of fighting in the early months of 1998. At present, the situation appears to be stabilising and the democratically elected president has returned to Freetown. However, skirmishes continue to be reported outside the capital and at the time of writing the magnitude of the crisis and the number of people requiring assistance remain uncertain.

Population estimates for refugee and IDP populations over time are summarised in the table below:

Location

Sep. 96

Dec. 96

Mar. 97

Jun. 97

Sep. 97

Dec. 97

Mar. 98

Liberia

1,800,000

1,800,000

1,100,000

710,000

700,000

700,000

726,000

Sierra Leone

609,000

609,000

548,000

453,000

453,000

200,000*

200,000*

Cote d'Ivoire

305,000

305,000

305,000

305,000

210,000

210,000

210,000

Guinea

536,000

536,000

536,000

545,000

405,000

405,000

405,000

Total

3,250,000

3,250,000

2,489,000

2,013,000

1,768,000

1,515,000

1,541,000

* Numbers requiring humanitarian assistance may be far higher than the current estimate.

Sierra Leone has experienced repeated waves of insecurity since an offensive was launched in 1991 to overthrow the government. Kabbah was elected as president in March 1996, and a peace accord was signed in November 1996. However, disagreements between the antagonists continued on many key issues, such as demobilisation, and in May 1997, the president was ousted and a military government took control. The international community including the Economic Comity of West African States (ECOWAS), Organisation of African Unity (OAU) and the United Nations (UN) demanded the restoration of the elected president, and ECOWAS Cease-fire Monitoring Group (ECOMOG) forces were deployed to this end [USAID 28/01/96].

An embargo was also imposed on the country. Humanitarian goods were supposed to be exempt, but in practice, this type of selective embargo proved difficult to implement. As a result of this and widespread insecurity, the food supplies in country became increasingly strained. Rice prices shot up although these have now begun to decline [IRIN-WA 02-08/01/98].

A survey in Freetown in December 1997 showed 8.7% wasting with 1.6% severe wasting (see Annex I 6a). No cases of oedema were seen. It was reported that living conditions continued to decline in the city since the coup d'etat in May 1997 and availability of food was increasingly problematic. The survey indicated that there had been no general ration distributions and only limited targeted feeding programmes since the coup [ACF 04/12/97].

Since this survey, there was a sustained military campaign in Freetown and in early February ECOMOG forces took control of the city. The president returned in mid-March 1998. During the period January 1998 - February 1998, fierce fighting was reported more or less throughout the country. Food shortages were noted in many areas of the country; for example in Bo the situation had been described as alarming. Food, medicine and shelter are said to be needed urgently in cities which have suffered massive destruction at the hands of the retreating fighters of the Armed Forces Revolutionary Council [ACT 19/03/98, CARE 05/03/98, IRIN-WA 12/02/98, 13-19/02/98, WFP 13/02/98].

The escalation in fighting led to further population displacements, both within Sierra Leone and into neighbouring Liberia and Guinea. Approximately 26,000 people arrived in Vahun in Liberia. These refugees are said to be in good health, although the supply of clean water is inadequate and a cause for concern [UNHCR 03/03/98]. There are no current estimates for numbers of people requiring humanitarian assistance in Sierra Leone, and estimates of 200,000 people before the upsurge in hostilities are most surely an underestimate.

Overall, the affected population in Sierra Leone can be considered to be at heightened risk of malnutrition (category IIa in Table 1) due to inaccessibility resulting for insecurity. The remainder of the affected population is not currently considered to be at heightened risk (category IIc in Table 1).

Ongoing interventions In Vahun, which has recently received a large influx of Sierra Leonean refugees, water supplies need to be urgently improved.

A recent Flash Appeal for Sierra Leone outlines some priority interventions over the next three months. These include:

restoration of the primary health care system;
rehabilitation of water and sanitation facilities;
support of agricultural activities;
resumption of food distributions to those in need.

More specifically, regular nutritional surveys should be carried out in large war-affected urban centres like Freetown and Bo. In Freetown, malnourished children should continue to be screened and referred to TFCs where appropriate. There should also be an evaluation of the nutritional status of children in Freetown and efforts should be made to increase measles vaccination coverage.

RNIS 22, December 1997

After almost twenty years of civil war, the peace process in Liberia seems firmly in place. Almost all areas in the country are now accessible. Internally displaced people are beginning to return home and repatriation is scheduled to begin before the end of 1997. In Sierra Leone, there is guarded optimism since the signing of a peace accord to end the fighting which has been ongoing since a coup d'etat in May 1997. Somewhat increased access to populations in conjunction with the recent harvest is likely to be having a positive effect on the nutritional situation of the population.

Population estimates for refugee and IDP populations over time are summarised in the box below:

Location

Jun. 96

Sep. 96

Dec. 96

Mar. 97

Jun. 97

Sep. 97

Dec. 97

Liberia

1,800,000

1,800,000

1,800,000

1,100,000

710,000

700,000

700,000

Sierra Leone

756,000

609,000

609,000

548,000

453,000

453,000

200,000*

Cote d'Ivoire

305,000

305,000

305,000

305,000

305,000

210,000

210,000

Guinea

536,000

536,000

536,000

536,000

545,000

405,000

405,000

Total

3,397,000

3,250,000

3,250,000

2,489,000

2,013,000

1,768,000

1,515,000

* Numbers requiring humanitarian assistance may be far higher than the current estimate.

Sierra Leone A coup d'etat in May 1997 threw the country back into a state of war, with widespread fighting and population displacements. As a result of the coup, sanctions were imposed by the Economic Community of West African States (ECOWAS), but humanitarian goods have been excluded from the embargo. A peace accord was signed on 22 October 1997. The peace accord made provisions for an immediate cease-fire, the restoration of the constitutional government, the return of refugees and internally displaced people, and the increased delivery of humanitarian aid. Although the cease-fire seems to have generally been holding there have been several reports of insecurity. There are at least 200,000 people internally displaced and requiring humanitarian assistance in Sierra Leone; many more who are not displaced are likely to need assistance [DHA-a 28/10/97, IRIN-WA 18-24/10/97, 06/11/97, WFP 24/10/97, 07/11/97].

Recent nutrition survey data points to a deteriorating situation in many areas. Makeni is a town in the Northern province where many have fled insecurity in surrounding areas. A survey conducted in Makeni town April 1996 showed 13% wasting and/or oedema with 4% severe wasting and/or oedema. These results led to the opening of a therapeutic feeding centre. A follow-up survey in October showed 13.2% wasting with 1.4% severe wasting. Oedema was measured at 0.8% (see Annex I (9b)). These results are comparable to those from the April survey. Measles immunisation coverage, confirmed by a vaccination card, was low at 39.1% [ACF 29/10/97].

In Bombali district wasting was measured at 14.2% with 1.3% severe wasting. Oedema was measured at 1.3%. Measles immunisation coverage, as confirmed by a vaccination card, was low at 35.4%. A further 35.5% of the mothers said their child had been immunised. In Tonkolili district wasting was measured at 17.7% with 1.9% severe wasting. Oedema was measured at 1.2%. Measles immunisation coverage, as confirmed by a vaccination card, was low at 28.2%. A further 26.5% of the mothers said their child had been immunised (see Annex I (9c-d)) [ACF 29/10/97].

These surveys were carried out just before the harvest, at the end of the 'lean period'. Since many of these people are farmers, an improvement in the nutritional situation is likely following the November harvest. It is expected that this harvest will be improved in many areas. This is due to a number of factors. First, the influx of the RUF into urban areas has made it safer to farm. Second, villagers have been living in the bush close to their farms making it more difficult for armed groups to loot crops, Third, the recent insecurity in Freetown resulted in the forced resettlement of many to their farms. However, there are still many areas where harvests would have been adversely affected by the displacements which occurred [IRIN 14-18/10/97, ACF 29/10/97].

The resurgence of insecurity in the country in May and a subsequent embargo led to a marked decrease in the humanitarian aid provided. Humanitarian aid is meant to be exempt form the embargo, but there are reportedly difficulties importing supplies. Agencies have been distributing supplies they had in stock, but these are mostly depleted. If problems and delays with importing humanitarian aid are not resolved, there is likely to be a negative impact on the nutritional situation in many parts of the country [ACT 23/10/97, IRIN-WA 14/11/97, WV 11/12/97].

In an attempt to have a comprehensive picture of the humanitarian situation in Sierra Leone, an inter-agency emergency monitoring system has been set up. This will track the health status of the population by collecting information on mortality, morbidity and malnutrition. The food security situation will be monitored by tracking market prices, population movements, and harvest data [DHA-a 28/10/97].

Overall, the affected population in Sierra Leone can be considered to be at heightened risk due to continuing insecurity and reduced humanitarian relief receipt (category IIa in Table 1). The rest of the population affected regionally is probably not at heightened nutritional risk (category IIc in Table 1).

Ongoing interventions: As repatriation to Liberia begins, the need to rehabilitate the country's infrastructure intensifies, i.e. schools, roads, water and sanitation and health services. Nutritional surveillance systems need to be established in country as agencies begin to consider withdrawing. More specifically, in Upper Bong County measles immunisation coverage needs to be improved and the efficacy of the present vaccination system should probably be re-assessed. Efforts to collect information on food security in the area should also be intensified.

The inter-agency food and health monitoring systems in Sierra Leone are critical initiatives and should be supported with resources as required. Measles immunisation coverage in Makeni town, and Bombali and Tonkolili districts needs to be increased. Furthermore, there is a requirement for regular nutritional surveillance in these areas and continuous screening of children for admission to feeding centres.

RNIS 21, September 1997

The security situation in Sierra Leone after a coup d'etat in May 1997 remains fluid. Displacement in Sierra Leone is widespread, and agricultural activities have been disrupted. Food is becoming scarcer and there are reports of increasing malnutrition. In contrast, the security situation in Liberia is stable and almost all areas of the country are now accessible. There are also greater opportunities for people to diversify their food sources and levels of malnutrition are falling. Repatriation of refugees back to Liberia is planned to begin in the near future.

Population estimates for refugees and IDPs over time are summarised in the box below:

Location

Apr 96

Jun 96

Sep 96

Dec 96

Mar 97

Jun 97

Sep 97

Liberia

1,800,000

1,800,000

1,800,000

1,800,000

1,100,000

710,000

700,000

Sierra Leone

756,000

756,000

609,000

609,000

548,000

453,000

453,000

Cote d'Ivoire

305,000

305,000

305,000

305,000

305,000

305,000

210,000

Guinea

536,000

536,000

536,000

536,000

536,000

545,000

401,000

Total

3,397,000

3,397,000

3,250,000

3,250,000

2,489,000

2,013,000

1,764,000

Sierra Leone A coup d'etat in May 1997 led to the military take over of the elected government and has thrown the country back into a state of war. The coup has been condemned by the international community and sanctions have been imposed by the Economic Community of West African States (ECOWAS). Humanitarian goods will be exempted from the embargo with prior approval from the Authority of Heads of State who are responsible for monitoring the embargo.

As a result of this insecurity, there have been widespread population displacements within country and to neighbouring Liberia and Guinea. Inaccessibility due to insecurity, looting of food stocks, and the current embargo have meant humanitarian assistance provided is inadequate. A number of humanitarian agencies have also had to suspend activities for security reasons. The situation is exacerbated by the fact that it is the rainy season, making what deliveries of food aid to the newly displaced are possible extremely difficult, and leading to high levels of disease. As a result, there are many reports of malnutrition, especially amongst the IDPs. For example, a survey in Kambia and Port Loko towns showed 10.8% wasting and/or oedema (see Annex I (9a)). An assessment in the southern part of Kenema district showed 30% wasting with 13% severe wasting (see Annex I (9b)) [DHA 22/08/97, 08/09/97. ICRC 25/08/97, UNICEF 11/09/97].

A survey carried out in Freetown showed 8.9% wasting and/or oedema, and 1.8% severe wasting and/or oedema (see Annex I (9c)). Rice, a staple of the diet under normal circumstances, has reportedly become scarce with prices tripling and people have resorted to eating cassava, which has comparatively less nutritional value [ACT 12/08/97, DHA 01/09/97].

The health situation is said to be deteriorating in all areas affected by the conflict. Assessments carried out at the end of July in the northern province and in the districts of Kenema, Pujehun, Bo and Kailahun confirmed a general shortage of drugs and adequate nursing care. The onset of the rainy season has led to a sharp increase in the number of cases of malaria, diarrhoea and pneumonia. Cases of measles are being reported. The Northern province of Sierra Leone has poor immunisation coverage, attributable to the difficulties of maintaining an effective cold chain [DHA 04/08/97, 01/09/97].

The upsurge in insecurity has disrupted agricultural activities. Crops are usually planted between April and June but current insecurity has prevented planting and led some farmers to abandon farms. Thus, despite the implementation of the rehabilitation programmes up until May 1997, the prospects for 1997 food production are not good. Although most recent estimates are of 453,000 people requiring humanitarian assistance, this is likely to be an underestimate and there will probably be a growing number of people requiring food assistance in the coming months [FAO 19/06/97].

Overall, the affected population in Sierra Leone is at heightened nutritional risk due to continuing insecurity (category IIa in Table 1). The refugees in Cote d'Ivoire and Guinea, along with the affected population in Liberia are probably not a heightened risk (category lie in Table 1) although low levels of measles immunisation are cause for some concern.

Ongoing interventions: In Sierra Leone, measles immunisation has proven difficult due to problems of access and of maintaining a cold chain. There is also a shortage of drugs and nursing care in many areas. Sanctions have exacerbated these problem. A review of the sanction policy should be undertaken in order to simplify and speed up the exemption of humanitarian items.

RNIS 20, June 1997

Despite a number of security incidents, the overall situation in Liberia is improving with signs of continuing stability. Although delayed, the electoral process is moving ahead in Liberia. A recent coup d'etat in Sierra Leone has meant humanitarian activities have been put on hold, however prior to the coup, people were returning home, either from within the country or from neighbouring countries. There are approximately 2 million people affected regionally.

Trend in numbers of refugees/displaced and proportion severely malnourished and at high risk (shaded area).

Current estimates of the numbers of people affected in the region are summarised below:

Location

Feb 96

Apr 96

Jun 96

Sep 96

Dec 96

Mar 97

Jun 97

Liberia

1,800,000

1,800,000

1,800,000

1,800,000

1,800,000

1,100,000

710,000

Sierra Leone

730,000

756,000

756,000

609,000

609,000

548,000

453,000

Cote d'Ivoire

305,000

305,000

305,000

305,000

305,000

305,000

305,000

Guinea

605,000

536,000

536,000

536,000

536,000

536,000

545,000

TOTAL

3,440,000

3,397,000

3,397,000

3,250,000

3,250,000

2,489,000

2,013,000

Sierra Leone After a year of relative calm, a coup d'etat occurred at the end of May 1997. Prior to this, there had been widespread violence in the country causing many agencies to close down operations. During May, there continued to be reports of occasional hostilities, particularly in eastern regions. For example, there were reports of an ambush near Makeni which left one person dead, and of fighting in Kenema which resulted in at least 25 deaths, and the evacuation of humanitarian agency staff. It is estimated that up to 25,000 people have been displaced by the renewed violence. Many of these people had returned, built houses and planted fields before being uprooted. It is further reported that about 8,000 people have crossed the border into Guinea [DHA 14/04/97, RI 30/05/97, WFP 02/05/97, 09/05/97, UNHCR 16/05/97].

Prior to the coup, efforts were being focused on setting the stage for the continued return of approximately 453,000 internally displaced people, and eventually refugees from neighbouring countries. During 1997, food aid provision was planned to focus more on targeted feeding in the form of food for work, food for training, emergency feeding, and vulnerable group feeding. These initiatives will be community based on the assumption that IDPs and refugees will continue to return home [UN Mar 97, Feb. 98, WFP 01/04/97. 09/05/97]. It is unclear to what extent and for how long this current crisis will disrupt plans to continue repatriation and reintegration programmes.

Overall, those affected regionally are not currently thought to be at heightened nutritional risk regionally (category IIc in Table 1) with the exception of the displaced in Monrovia and of those in Sierra Leone. These internally displaced people are likely to be at least at moderate nutritional risk due to the recent evacuation of some agencies.

How could external agencies help?

In Sierra Leone, prior to the recent coup d'etat, there was a shift away from emergency relief activities to more development oriented activities with a view to building capacity in communities so people don't return to areas devoid of services. Specific areas of concentration outlined in a recent UN Consolidated Appeal that will require support include:

agricultural support to help move toward self-sufficiency;
targeted feeding programmes, including food for work;
rebuilding health infrastructure and particularly re-starting measles immunisation programmes;
improvement of clean water supply and sanitation facilities.

Support for these initiatives once the current crisis is resolved will be essential to ensure a lasting peace and to help the population move towards self-sufficiency.

RNIS 19, March 1997

Continuing peace in Liberia is allowing the return of many internally displaced people and some refugees to their villages. It is also allowing access by humanitarian agencies to previously inaccessible areas and the implementation of emergency interventions where need dictates. The peace process also appears to be progressing in Sierra Leone with a relatively stable security situation allowing improved access to needy populations leading to marked improvements in their nutritional situation. If peace holds, it is expected that large numbers of IDPs and refugees will return home during 1997 and aid programmes are already beginning to shift their focus from emergency relief to resettlement and rehabilitation programmes.

Liberia/Sierra Leone

Trend in numbers of refugees/displaced and proportion severely malnourished and at high risk (shaded area).

Current estimates of the numbers of people affected in the region are summarised below:

Location

Dec 95

Feb 96

Apr 96

Jun 96

Sep 96

Dec 96

Mar 97

Liberia

1,900,000

1,800,000

1,800,000

1,800,000

1,800,000

1,800,000

1,100,000

Sierra Leone

730,000

730,000

756,000

756,000

609,000

609,000

548,000

Cote d'Ivoire

305,000

305,000

305,000

305,000

305,000

305,000

305,000

Guinea

605,000

605,000

536,000

536,000

536,000

536,000

536,000

TOTAL

3,540,000

3,440,000

3,397,000

3,397,000

3,250,000

3,250,000

2,489,000

Sierra Leone Despite some security incidents, e.g. clashes between Kamajors and government soldiers in Moyamba and Bonthe districts, the peace process in Sierra Leone appears to be moving forward. There has been a generally stable security situation in recent weeks and many observers are optimistic that this situation will endure. These events have set the stage for the demobilisation process to begin in February 1997 and significant numbers of internally displaced people are returning home. Aid programmes in Sierra Leone are beginning to shift their focus from emergency relief to resettlement and rehabilitation. The general ration programme was stopped at the end of 1996. There remain approximately 548,000 people in need of emergency assistance in Sierra Leone [WFP 10/02/97].

If the reigning peace in the country holds, it is feasible that most, if not all, of the internally displaced population (IDPs) could return home in 1997. Furthermore, initial plans are being made for the repatriation of the approximately 375,000 Sierra Leonean refugees in neighbouring countries. Food aid will be a critical component in supporting the processes of resettlement, reconstruction and rehabilitation. A one to three month ration will be provided to returning IDPs, while targeted feeding programmes, including therapeutic feeding, school feeding and food-for work will be established. Food for work activities will be implemented to aid in the reconstruction of village infrastructure and support agricultural production [FAO 15/01/97, UNHCR 17/01/97, WFP 24/01/97].

The relative peace in the country has allowed for improved access to needy populations. This has generally had a positive impact on the nutritional status of many populations. For example, a recent survey in Segbwema town in Kailahun district (estimated population 117,000) showed 5.6% wasting and/or oedema with 1.4% severe wasting and/or oedema. This compares favourably with a previous survey carried out in July 1996 when wasting and/or oedema were measured at 11.1% (see Annex I 9(a,b)). It should however be noted that the recent survey was conducted following what was described as a good harvest and that many of the displaced maintained some access to land for farming. The survey did indicate a low measles immunisation coverage of only 41% [CONCERN 06/12/96].

The majority of people fleeing the fighting in Sierra Leone moved to Bo and Freetown. It is estimated that 400,000 people went to the capital, approximately 300,000 of whom were living in camps. The remaining 100,000 people were living among the resident population. A nutritional survey conducted in January 1996 showed 7.6% wasting and/or oedema amongst the displaced living in Freetown, so that food aid was discontinued. A follow up survey was conducted in December 1996 to assess the nutritional status of this population since the discontinuation of food aid. Wasting was measured at 5.5% with 0.8% severe wasting. No cases of oedema were seen (see Annex 1 9(c)). Only 14% of malnourished children were enrolled in the selective feeding programmes while measles immunisation coverage was estimated at 53% [ACF Dec 96].

Government soldiers have recently rescued some 700 unaccompanied children living in the forest in Kailahun district. The children aged 9-15 apparently fled rebel attacks four years ago and are reported to be severely malnourished [WFP 28/02/97].

A major concern as displaced people return home will be the support necessary to resume farming activities. Returnees will require seeds, tools and other farm inputs to resume production. These families will also need food aid support until the next viable harvest in the second half of 1997. Such support is already being provided, as far as security has allowed, and will need to be continued and expanded to meet the needs of a growing returnee population [FAO 15/01/97].

Overall, internally displaced in Segbwema and Freetown in Sierra Leone can be considered to be at moderate nutritional risk (category IIb in Table 1), as are the children newly emerged from the forest. The remaining affected population in the region is not currently thought to be at heightened nutritional risk (category IIc in Table 1).

How could external agencies help? There is an on-going need in Liberia to reactivate health centres and rebuild bridges to enhance the movement of relief and rehabilitation material throughout the country. The need for expanding the immunisation programmes is beginning to be addressed as security permits. Specific needs have been identified in Rivercess country. These include improving the drug supply, dispatch of a tuberculosis health team, improving immunisation coverage and improvements in the water supply and sanitation facilities.

Throughout Sierra Leone a priority must be to support returnees in re-establishing themselves in the agricultural sector. Furthermore, immunisation coverage must be improved nationally. This should now be feasible given the current positive security environment. More specifically, immunisation coverage must be improved in Segbwema while in Freetown facilities for therapeutic feeding should be expanded and coverage improved, if possible, through home visiting and referrals from mother child health centres and health units. The vaccination programme must also be continued with efforts made to increasingly sensitise mothers to the importance of immunisation.

RNIS 18, December 1996

A fragile peace process in Liberia is holding although there have been some cease-fire violations. It is hoped that as the peace process advances with disarmament and demobilisation continuing, confidence will grow to a point where repatriation of refugees is possible. As hitherto insecure areas become accessible to humanitarian agencies, extremely high levels of wasting and mortality are being discovered. However, these situations appear to respond well to rapid emergency interventions. In Sierra Leone, there is a growing sense that despite some insecurity in the countryside and a continued need for targeted emergency relief, there is now scope to commence more developmentally oriented projects.

Trend in numbers of refugees/displaced and proportion severely malnourished and at high risk (shaded area).

Current estimates of the numbers of people affected in the region are summarised below:

Location

Oct 95

Dec 95

Feb 96

Apr 96

Jun 96

Sep 96

Dec 96

Liberia

1,900,000

1,900,000

1,800,000

1,800,000

1,800,000

1,800,000

1,800,000

Sierra Leone

730,000

730,000

730,000

756,000

756,000

609,000

609,000

Cote d’Ivoire

305,000

305,000

305,000

305,000

305,000

305,000

305,000

Guinea

536,000

605,000

605,000

536,000

536,000

536,000

536,000

TOTAL

3,471,000

3,540,000

3,440,000

3,397,000

3,397,000

3,250,000

3,250,000

Sierra Leone A cease-fire was signed on 30 November 1996, and it is hoped that the accord will pave the way for resettlement and rehabilitation programmes to begin. Inter-agency registration exercises in Kenema, Bo and Makeni have confirmed that while some internally displaced people have begun to return to their areas of origin, large numbers who are dependent on food aid still remain in camps and urban areas. For example, there are still 10,000 inhabitants in Gondama camp in Pujehun district [DHA Sep 96, DHA 11/11/96, WFP 06/12/96].

As rebel forces are increasingly being pushed to the west of the country, some alarming situations are being uncovered. For example, a group of 500 people who had apparently been held captive for up to four years and forced into slave labour by the RUF were recently discovered in Blama, near Kenema. Among this population, estimates of adult malnutrition were 25% (see Annex I (9c)). This group have now been moved to RTI camp near Kenema, where preparations had been made for their arrival. It is believed that there are at least a further 1500 similarly affected people hiding in the bush, whose nutritional status is likely to be deteriorating rapidly [MERLIN 07/11/96]. It is also believed that this situation is not unique and that there are many other brutalised captive populations throughout the country who will emerge from the “bush” in the coming months.

A recent survey in the camps for internally displaced around Bo (population estimated at 93,000) showed 21.8% wasting with 3.5% severe wasting; oedema was measured at 0.2% (see Annex I (9d)). These results are similar to those obtained from a January 1996 survey when wasting was measured at 23%. The ration provides approximately 1200 kcals/person/day, and it has been recommended that it be increased to 2100 kcals/person/day to improve the nutrition situation of this population. Measles immunisation coverage was almost 80% [ACF 03/09/96].

In Bo town (population estimated at 250,000), wasting was measured at 9.4% with 0.9% severe wasting; oedema was measured at 0.1% (see Annex I (9e)). Half rations of approximately 920 kcals/person/day have been provided for the past seven months. Since June 1996, CSB has also been distributed. Measles immunisation coverage was 74% [ACF 03/09/96].

Stocks of cereals are reportedly depleted in Freetown, and CSB and vegetable oil stocks are at extremely low levels. In addition, vehicles for implementing and monitoring programmes are urgently needed [WFP 08/11/96].

Overall, the population of Bo Waterside and the internally displaced population around Bo, Sierra Leone are at high risk (category I in Table 1) due to sharply elevated levels of wasting and mortality. The population outside of Monrovia in Liberia can be considered to be at moderate risk, while the remainder of the population affected regionally is probably not currently at heightened nutritional risk (category IIc in Table 1).

There remain many internally displaced people in Sierra Leone who are dependant on emergency food aid. Funds to support the continuation of these distributions, along with funds for monitoring and logistics, remain a priority. At the same time it is important to support programmes which will encourage internally displaced people to return home. For example, the distribution of seeds, tools and other agricultural input could be important incentives for potential returnees. To date, the response to consolidated appeals for returnee and rehabilitation programmes has been minimal, and in order to take advantage of the present opportunity to progress from relief to development, pledges are urgently needed from donor governments. Stocks of cereal, CSB and oil are in urgent need of replenishment.

RNIS 17, September 1996

Famine situations are being uncovered in many areas of Liberia which are now accessible due the most recent cease-fire. The peace, however, is described as fragile. The cease-fire in Sierra Leone is also holding and the overall situation is said to be improving as humanitarian agencies gain increasing access to affected populations. It is planned to phase out general ration distribution in Guinea and Cote d’Ivoire by the end of 1996, although targeted feeding for vulnerable refugee groups will continue.

Current estimates of the numbers of people affected in the region are summarised below:

Trend in numbers of refugees/displaced and proportion severely malnourished and at high risk (shaded area).

Location

Jul 95

Oct 95

Dec 95

Feb 96

Apr 96

Jun 96

Sep 96

Liberia

1,900,000

1,900,000

1,900,000

1,800,000

1,800,000

1,800,000

1,800,000

Sierra Leone

730,000

730,000

730,000

730,000

756,000

756,000

609,000

Cote d’Ivoire

227,000

305,000

305,000

305,000

305,000

305,000

305,000

Guinea

578,000

536,000

605,000

605,000

536,000

536,000

536,000

TOTAL

3,435,000

3,471,000

3,540,000

3,440,000

3,397,000

3,397,000

3,250,000

Sierra Leone A cease-fire declared after the installation of the newly elected president in March 1996 is generally holding, although security incidents continue to be reported. These generally involve banditry and looting and are not believed to be organized military activity. The overall situation in the country is said to be improving [UNHCR 10/09/96, USAID 06/08/96].

Although the emerging view is that the internally displaced should be encouraged to return home it is also recognized that as the planting season has already begun most will wait until the harvest before moving. There are now approximately 1.2 million internally displaced, of whom an estimated 609,000 require emergency assistance [USAID 06/08/96, WFP 09/08/96]. A serious shortfall of food aid contributions for 1996 of almost 50% was signaled by WFP in early August. WFP have stated that unless food aid pledges are confirmed, gaps in the food pipeline are likely to occur [WFP 09/08/96].

The cease-fire has allowed access to many areas that were previously cut-off from relief assistance. The war has ravaged the national health infrastructure and it is estimated that only 16% of the health centres are functioning. In Kambia district (Northern Province) for example, a recent assessment found that the health centres were poorly supplied with essential drugs and sanitation, while immunization coverage was inadequate. The nutritional status of children was, however, reported to be adequate [USAID 06/08/96].

A recent survey in Makeni township showed 7% wasting and/or oedema, with 0.4% severe wasting and/or oedema (see Annex 19(e)). This survey revealed low immunization coverage of the population, despite the availability of immunization services [DHA 03/06/96]. This suggests a need for better community outreach to improve immunization coverage.

A survey conducted in Gondama (population of the town and camps was 55,000) showed 8.1% wasting with 1.7% severe wasting. No cases of oedema were seen (see Annex I 9(f)). This compares very favourably with a survey conducted in October 1995 when rates of wasting and/or oedema were measured at 29.9%. This marked improvement has been attributed to a number of factors, including the regular provision of general rations throughout 1996, the establishment of additional feeding centres, and population movements. Measles immunization coverage was estimated at 88% [ACF 01/05/96].

Pujehun and Kalihun districts had also previously been inaccessible due to rebel activity, but seeds, tools, and food were distributed in Daru, Segbwema and Kalihun (villages in the districts) in June [USAID 06/08/96].

Overall, the affected population in Sierra Leone is likely to be at moderate risk (category IIb in Table 1) due to insecurity.

How could external agencies help?

In Sierra Leone, support for interventions to stimulate agricultural and livestock activities may be needed. Additional food aid pledges as signaled by WFP are required.

RNIS 16, June 1996

Liberia/Sierra Leone - Trend in numbers of refugees/displaced and proportion severely malnourished and at high risk (shaded area).

Recent violence in the Monrovia has led to large scale displacement within and from the capital to and serious disruption to relief and rehabilitation work throughout Liberia. In recent weeks most agency activity has been focused upon Monrovia. The current insecurity has meant that plans for voluntary repatriation of Liberian refugees have been put on hold. Recent attempts at political mediation have failed and the overall security situation is currently extremely fluid. In contrast, the security situation in Sierra Leone has improved in recent weeks. This has led to improved humanitarian agency access to populations resulting in signs of improving nutritional and health status amongst conflict affected populations.

Current estimates of the numbers of people affected in the region are summarised below:

Location

Apr 95

Jul 95

Oct 95

Dec 95

Feb 96

Apr 96

Jun 96

Liberia

1,900,000

1,900,000

1,900,000

1,900,000

1,800,000

1,800,000

1,800,000

Sierra Leone

500,000

730,000

730,000

730,000

730,000

756,000

756,000

Côte d'Ivoire

330,000

227,000

305,000

305,000

305,000

305,000

305,000

Guinea

603,000

578,000

536,000

605,000

605,000

536,000

536,000

TOTAL

3,333,000

3,435,000

3,471,000

3,540,000

3,440,000

3,397,000

3,397,000

Sierra Leone A cease fire announced just after the election of the new president is generally holding although some serious breaches in security have taken place such as the rebel attacks on villages in Bo district where over 100 civilians were killed in the first week of May [WFP 17/05/96]. The recent peace talks have made considerable progress but there still remain contentious issues that are stalling the move towards enduring peace [WFP 14/06/96]

It is currently estimated that there are 1.6 million internally displaced people in Sierra Leone, 756,000 of whom require emergency food aid assistance. The remaining approximately 800,000 people (not included in Table 1) are thought to be either living among local communities or with relatives and able to procure their own food [UN Mar 1996].

The generally improved security is allowing for greater effectiveness of humanitarian work. The main highways to Segbwema, Bo, Kenema and Makeni are now open and food is being delivered to up country. Affected populations in Segbwema and Zimmi had not received relief food for several months due to insecurity but distribution was planned to begin in May [WFP 19/04/96]. Nutritional surveys in Kenema town and the RTI camp (included in RNIS #15) showed improvement in nutritional status. As in Bo and Western area camps, resumption of general food distributions and NGO selective feeding programmes using WFP airlifted food are considered to be a contributing factor [WFP 17/05/96].

A survey carried out in the Bonthe Islands (estimated population 14,000) showed 5.6% wasting and/or oedema with 0.6% severe wasting and/or oedema (see Annex I (9a)). This compares favourably with a survey carried out in October 1995 when levels of wasting and/or oedema were measured at 13%. It is reported that many of the displaced people have returned to the mainland, and their nutritional status is not known. Measles immunisation coverage was estimated at 22.8% [MSF-B Mar 96].

The cease fire is also allowing for the return of some internally displaced people to their homes. Up to 85% of the residents of the RTI camp in Makeni have returned and significant numbers of people have reportedly returned to districts in Bo [DHA 18/04/96]. There are still areas, such as Kono district, where food security is believed to very poor and malnutrition is reported to be widespread [DHA 03/06/96].

Overall, those requiring emergency food aid in Sierra Leone can be considered to be at moderate risk (category IIb in Table 1) due to continued sporadic insecurity.

How could external agencies help?

Based on a recently launched UN consolidated appeal, the last RNIS report highlighted certain necessary activities in Sierra Leone, including the possible expansion of selective feeding programmes, and investment in rebuilding and extending health, sanitation and water infrastructure in the country. To date, the response to the appeal has been minimal; for example only 5% of the food needs projected by WFP have been pledged. If this situation persists, delays in programme implementation will be encountered.

Other specific needs in Sierra Leone include an immunisation campaign in the Bonthe Island area, and an assessment of the nutritional status of those populations who have recently returned home.

RNIS 15, April 1996

Trend in numbers of refugees/displaced and proportion severely malnourished and at high risk (shaded area).

Recent fighting in Monrovia is leading to large-scale displacement. It is too early to assess the nutritional impact of this most recent fighting. Elsewhere in Liberia, the security situation is making it difficult to establish a clear time frame for repatriation plans. Furthermore, several areas of the country remain periodically inaccessible to relief activity so that affected populations may be at nutritional risk. The recent election of a new president in Sierra Leone and subsequent talks with rebel leaders are giving rise to guarded hopes that the desperate situation in the country may begin to improve. However, given the shattered infrastructure, massive displacement to over-crowded urban centres and length of time that some populations have been cut-off from assistance, there will be a need for large-scale humanitarian support for many months to come even if political progress is rapid. Recent nutritional surveys in Sierra Leone (e.g. in Bo) continue to show extremely high levels of wasting amongst some urban populations.

Current estimates of the numbers of people affected in the region are summarised below:

Location

Feb 95

Apr 95

Jul 95

Oct 95

Dec 95

Feb 96

Apr 96

Liberia

1,800,000

1,900,000

1,900,000

1,900,000

1,900,000

1,800,000

1,800,000

Sierra Leone

506,000

500,000

730,000

730,000

730,000

730,000

756,000

Cote d’Ivoire

330,000

330,000

227,000

305,000

305,000

305,000

305,000

Guinea

568,000

603,000

578,000

536,000

605,000

605,000

536,000

TOTAL

3,204,000

3,333,000

3,435,000

3,471,000

3,540,000

3,440,000

3,397,000

Sierra Leone Despite a marked decrease in security in many parts of the country which resulted in continued population movements, elections took place as scheduled, and Ahmad Tejan Kabbah was elected president in mid-March. There are hopes that this election will mark the beginning of a new period of peace with talks between representatives of the new government and rebel leaders already underway. Following improvement in the overall security situation and the declaration of an unconditional cease-fire by the RUF in mid-March many internally displaced have returned to their villages of origin in Bo and Magburaka provinces. [DHA 07/03/96, UNHCR 22/03/96, WFP 28/03/96].

It is currently estimated that there are at least 1.6 million internally displaced people in Sierra Leone requiring some sort of humanitarian assistance. Only approximately 210,000 of this population are in camps with the remainder living amongst local communities whose coping mechanisms are reportedly stretched beyond reasonable limits in their efforts to support the displaced. Populations of urban centres have increased dramatically, for example the population of Freetown has almost doubled. Similar situations are reported for the towns of Kenema, Makeni, Matru, Bonthe mainland, Kailahun, Segbwema, Zimmi and Dam. In each case the influx is causing over-crowding, outbreaks of disease and overburdening of social services. Food distributions have begun in many areas, for example Dam, Segbwema, and Zimmi [DHA-a Mar 96, ICRC 09/04/96].

The violence in the country has displaced farmers and cut-off greater and greater areas of cultivatable lands. Food has therefore become increasingly scarce, and when available, often appears in markets at prohibitively high prices. It is hoped that approximately 756,000 people will receive a general distribution in 1996, although it is recognised that emergency food aid activities must be a part of a larger strategy to increase food security for the entire population not just the displaced. It is also critical that donors support the process in a timely manner as the capacity of relief organisations to deliver assistance is greatest during the first half of the year i.e. the dry season [DHA-a Mar 96].

Difficulties that currently exist in implementing general ration distributions include problems with identification and verification and registration of beneficiaries, inability to establish a strategic grain reserve, lack of consensus over composition of a food basket and weaknesses in the capacities of local NGOs to undertake traditional implementation roles [DHA-a Mar 96].

Public health, water and sanitation facilities are also in a critical situation in Sierra Leone. Only 16 percent of the country's health centres are said to be operational and during 1995, outbreaks of cholera and measles were reported in several urban centres [DHA-a Mar 96].

Reaching civilians in need outside the Western area has been enormously problematic as road transport has been severely disrupted due to insecurity. Airlifts have been under taken as the only viable option. One very positive development has been the governments permission to begin cross-border delivery of relief supplies from Guinea into Kailahun area.

An assessment in June 1995 showed a very bad situation in Kailahun. At that time, most of the population was living in the bush and wasting, as measured by QUAC stick, was 33% and severe wasting was 29%. Furthermore, kwashiorkor and wasting were seen among older children and adults. Government clearance for food distributions was granted in February 1996. The food situation by then had improved somewhat. Many people had moved back to the villages and therefore had greater access to food. Currently, the farmers are beginning to prepare the land for planting, and agricultural inputs are urgently needed [ICRC 31/03/96].

The nutritional situation in large urban centres appears to be extremely variable and dependant on recent humanitarian agency access, employable coping strategies and the scale of recent displacements. For example, a survey in Bo town (estimated population 250,000) in November 1995 found wasting levels of 13.1% with 1.2% severe wasting. In the camps for the displaced (estimated population 16,000) wasting and/or oedema was 25.3% with 4.3% severe wasting (see Anne I (9c-d)). The survey found that nearly 30% of families claiming to be displaced were not registered and that almost 60% claimed to have never received a general ration distribution. Up to 30% of malnourished children were not enrolled in selective feeding programmes [ACF 11/11/95].

A more recent survey in March 1996 found little change with wasting and/or oedema rates of 12% with 1.2% severe wasting and/or oedema in the town and 23.8% wasting with 3.5% severe wasting and/or oedema in the camps (see Annex I (9e-f)). Since this survey it has been reported that coverage of the general ration distribution has improved significantly [MSF-B 18/03/96, 05/04/96].

In October 1995, levels of wasting in Bonthe Islands were reported to be almost 13% (see RNIS #14). More recent information indicates that wasting levels have declined substantially, although precise figures are not available [MSF-B 05/04/96].

The main highways to Bo, Kenema and Makeni have now been re-opened and food is being distributed to these urban centres. Recent survey data from Kenema show wasting at 6.3% in the town, with 1.0% severe wasting and/or oedema. In RTI camp, just outside of Kenema, wasting was measured at 8.6% with 0.2% severe wasting. No oedema was seen in either the town or in the camp (see annex I (9g-h)) [MSF-H 04/04/96].

Overall, the remaining displaced population in Sierra Leone is likely to be at heightened nutritional risk (category IIa in Table 1) due to insecurity.

How could external agencies help?

A consolidated appeal for Sierra Leone, coordinated by UN/DHA, to be launched in April, along with the reports included here, suggest some needs. These include:

sporadic general ration distribution, due to insecurity, are a continuing problem; on some occasions in the past demonstrations of high levels of malnutrition have helped in obtaining agreement for food distribution, indicating that further surveys could be useful;
the coverage and equity of food distribution in large urban areas in being hampered by inadequate registration which needs improving;
because of the sporadic general food distribution, selective feeding centres, mainly for children, are in operation, and expansion of this coverage may need to be considered;
urgent distribution of farm inputs as in many areas the planting season will begin soon (April and May);
investment in rebuilding and extending health, sanitation and water infrastructure throughout the country.

Recent reports indicate that the food pipeline for the region which was reported as inadequate in RNIS #14 has improved substantially in recent weeks. However, cash needs for monitoring and logistics support remain an urgent priority. It appears that the needs for increased measles immunisation throughout both Sierra Leone and Liberia have still largely to be met.

RNIS 14, February 1996

Apart from one large-scale incident, the security situation has generally been calm in Liberia, allowing increased relief access to formerly inaccessible populations. Enduring peace is allowing some spontaneous refugee repatriation. Surveys in newly accessible areas often show extremely high levels of wasting and virtually non-existent health infrastructure. Recent crop assessments in Liberia have shown very poor aggregate levels of production. Until the recent cease-fire at the end of January in Sierra Leone, poor security had continued to disrupt provision of relief supplies and led to marked food price inflation. Nutritional surveys in areas that are poorly accessible due to insecurity repeatedly show high levels of wasting. A recent cereal crop assessment in Sierra Leone shows harvests to be well below averages of previous years.

Liberia

Trend in numbers of refugees/displaced and proportion severely malnourished and at high risk (shaded area).

Current estimates of the numbers of people affected in the region are summarised below:

Location

Dec 94

Feb 95

Apr 95

Jul 95

Oct 95

Dec 95

Feb 96

Liberia

1,615,000

1,800,000

1,900,000

1,900,000

1,900,000

1,900,000

1,800,000

Sierra Leone

506,000

506,000

500,000

730,000

730,000

730,000

730,000

Cote d'Ivoire

330,000

330,000

330,000

227,000

305,000

305,000

305,000

Guinea

534,000

568,000

603,000

578,000

536,000

605,000

605,000

TOTAL

2,985,000

3,204,000

3,333,000

3,435,000

3,471,000

3,540,000

3,440,000

Sierra Leone Until the recently declared RUF cease-fire, the security situation in Sierra Leone remained tense with main supply routes from Freetown to provincial capitals officially closed. Nevertheless, transporters still managed to move some food to main up-country warehouses without military escort. Rebel attacks on roads and villages continued and new influxes of displaced populations occurred. For example, 20,000 people fled to Bo town in early January. Closure of main transport routes inevitably affected delivery schedules. Thus, only a half ration of cereals without vegetable oil could be distributed to the displaced in Segbwema in December. The constraint on road transport led to increasing reliance upon air freight and cross-border operations from Guinea. Food prices also rocketed in certain areas as a result of transport constraints. Current estimates of the numbers affected by the fighting in country remain at 730,000 [WFP 15/12/95, 05/01/96, 19/01/96].

The continued insecurity and resulting lack of access to many populations undoubtedly had an adverse impact on the nutritional status of many people. For example, a nutrition survey conducted in Gondama (combined population of displaced and residents of 57,400) near Bo found 28.1% wasting with 5.7% severe wasting (see Annex 1 9(b)). These results compare unfavourably with a survey conducted in May 1994 when wasting and/or oedema were measured at 14%. An estimated 70% of the displaced in the camp were receiving the general ration of bulgur wheat. However, only 27% had any food stocks left over from the previous distribution three weeks earlier suggesting insufficient ration amounts. Prior to this there had been a three month gap in general ration distributions. The crude mortality rate was 2.7/10,000/day (9x normal) and the under-five mortality rate was 3.7/10,000/day (3x normal). Following a measles vaccination campaign in October, 97.7% of children were found to be immunised [AICF 13/10/95]. Malnutrition rates have reportedly gone down since the road has been opened to relief and commercial convoys [WFP 09/02/96].

A nutritional survey which was conducted in Bonthe islands was mentioned in the last RNIS report (#13). Details of the survey are included here. There are an estimated 33,000 displaced people on four islands in Bonthe district in the south of the country. Approximately 90% of this population are displaced. The survey found a prevalence of wasting of 12.9% with 2.3% severe wasting (see Annex 1 9 (c)). The prevalence of oedema was 2.4%. Only 25% of the sample population had enough food stocks for even a few days; 15% were involved in their own food production. Coverage of selective feeding programmes in the four islands was found to be low. Measles immunisation coverage was 24% but may be an under-estimate as only those presenting cards were considered to be immunised. The crude mortality rate was 2.6/10,000/day (6x normal) [MSF-B 26/10/96]. Emergency food supplies were shipped to the islands early in January, and the nutrition situation of this population has now reportedly improved [WFP 05/01/96, WHO 01/12/95].

Measles cases continue to be reported in virtually all clinics, but more so in the Western Area where plans to conduct a mass immunisation campaign have yet to be realised. A suspected outbreak of yellow fever is being investigated around the Kenema area. Immunisation programmes were begun while confirmation of the outbreak was awaited [WHO 03/01/96, 15/01/96].

Preliminary assessment of cereal production in Sierra Leone by FAO's GIEWS indicate that production at the end of 1995 was 66% of the average for the previous 8 years and that the food supply situation will therefore remain “tight”. Food assistance will be needed for the country, but it is hoped to shift the focus away from general food distributions to targeted feeding programmes, including school feeding, distributions for vulnerable groups and food for work [FAO Nov 95, WFP 09/02/96].

Overall, the affected populations in Gondama (Sierra Leone) are in category I in Table 1 due to high levels of wasting. Most of the population in Sierra Leone, are considered to be at moderate nutritional risk (category IIb in Table 1).

How could external agencies help? In Sierra Leone, it would be helpful to:

implement measles immunisation campaigns in Western areas;
set up selective feeding programmes and investigate the discrepancy between numbers displaced and number registered as displaced in Gondama camp;
evaluate the equity of the general ration programme in Gondama camp, possibly involving systematic food basket monitoring at distribution points and household level;
assess the nutritional situation in three to four months time in Gondama camp;
continue general ration provision in the Bonthe islands, open more selective feeding programmes, and increase measles immunisation coverage.

RNIS 13, December 1995

Liberia - Trend in numbers of refugees/displaced and proportion severely malnourished and at high risk (shaded area).

The present peace accord appears to be holding in Liberia, despite some skirmishes in the countryside. However, these security incidents mean that many areas remain inaccessible to relief activities. A few recent nutritional surveys indicate low levels of wasting in accessible areas. Intense fighting is continuing in Sierra Leone with only occasional periods of calm. Much of the country is inaccessible and it is reported that levels of malnutrition are particularly high in affected regions (southern and eastern).

Current estimates of the numbers of people affected in the region are summarised below:

Location

Oct 94

Dec 94

Feb 95

Apr 95

Jul 95

Oct 95

Dec 95

Liberia

1,692,000

1,615,000

1,800,000

1,900,000

1,900,000

1,900,000

1,900,000

Sierra Leone

300,000

506,000

506,000

500,000

730,000

730,000

730,000

Cote d’Ivoire

325,000

330,000

330,000

330,000

227,000

305,000

305,000

Guinea

534,000

534,000

568,000

603,000

578,000

536,000

605,000

TOTAL

2,851,000

2,985,000

3,204,000

3,333,000

3,435,000

3,471,000

3,540,000

Sierra Leone Recent reports on the security situation in Sierra Leone indicate that while the northern and eastern regions remain relatively calm, there has been an upsurge in rebel activities in the southern region. As a result, villages in the Bo and Moyamba districts have suffered devastation. These attacks have reportedly precipitated influxes into Bo at an average of 100 displaced persons a day since mid-October. WFP operations in the entire country are reportedly being adversely affected by problems of poor control over registration and insecurity at WFP stores. It is currently estimated that 730,000 people are affected in the country.

Over the past few months the nutritional situation has been alarming amongst the displaced populations in Kenema, Segbwema, Dam and Bonthe Island with rates of wasting and/or oedema as high as 27%. Even higher levels of wasting are feared in the districts of Kailahun and Pujehun which are under RUF control and therefore still inaccessible to relief assistance.

However, preliminary results from a more recent survey in Kenema showed a much improved situation over that seen in an August 1995 survey. At that time, wasting levels were measured at 23-37%. In this follow-up survey, wasting and/or oedema in Kenema town were measured at 1.8% with 0.5% severe wasting and/or oedema. In RTI camp for the displaced, wasting and/or oedema were measured at 5.6% with 0.9% severe wasting and/or oedema (see Annex 1 (9c-d)) [MSF-H 27/11/95]. These much improved levels of wasting are almost certainly attributable to recent general ration distributions to this population.

A survey in Bo (estimated population of residents and displaced 250,000) showed 19.8% wasting with 2.4% severe wasting. Oedema prevalence was measured at 1.3% (see Annex 1 (9e)). Measles immunisation coverage was estimated at 36.6% but as this was based solely upon presentation of a vaccination card, this may be an under-estimate [AICF Jul 95]. Since this survey general food distributions have been implemented in Bo as well as in Segbwema, Daru, Maken. It is therefore likely that the nutritional situation will begin to improve in these areas [WFP 27/10/95, WFP 10/11/95].

Overall, the population in Bo, Sierra Leone can be considered to be at high risk with high prevalence of wasting (category I in Table 1). The remaining population in Sierra Leone can be considered to be at high risk (category IIa in Table 1).

How could external agencies help? In Sierra Leone it is important that, security permitting, nutritional assessments are carried out in areas which are periodically cut off from relief activities, e.g. Bo, Kenema, etc. As in Liberia, support for primary health care infrastructure and activity is essential. For example, in Bo there is an urgent need to increase rates of measles immunisation coverage.

RNIS 12, October 1995

Liberia

Trend in numbers of refugees/displaced and proportion severely malnourished and at high risk (black area).

The signing of the peace accord in Liberia by all warring factions and the subsequent instalment of a Council of State is giving grounds for optimism that the present cease fire will hold and provide an opportunity for this war-ravaged country to rebuild itself. However, Liberian refugees in neighbouring Cote d'Ivoire and Guinea seem to be waiting to see how the disarmament process in Liberia progresses before repatriating. In contrast, the situation in Sierra Leone appears to be spiralling out of control as populations made inaccessible by fighting endure increasing hardship without outside relief assistance. This total population number is broken down by country as follows:

Location

Aug 94

Oct 94

Dec 94

Feb 95

Apr 95

Jul 95

Oct 95

Liberia

1,750,000

1,692,000

1,615,000

1,800,000

1,900,000

1,900,000

1,900,000

Sierra Leone

300,000

300,000

506,000

506,000

500,000

730,000

730,000

Cote d'Ivoire

250,000

325,000

330,000

330,000

330,000

227,000

305,000

Guinea

539,000

534,000

534,000

568,000

603,000

578,000

536,000

TOTAL

2,839,000

2,851,000

2,985,000

3,204,000

3,333,000

3 435 000

3,471,000

Sierra Leone The security situation in Sierra Leone remains tense with frequent reports of both government and rebel military action. There are currently an estimated 730,000 internally displaced people in Sierra Leone. While security in the Western and Northern parts of the country remains relatively stable, sporadic rebel attacks on both convoys and small civilian settlements continues in the east and south of Sierra Leone. Consequently, populations confined to towns or behind RUF lines are in an increasingly precarious situation as relief agencies risk attack in their efforts to bring assistance. Furthermore, private contractors are reluctant to transport relief to certain areas such as Kenema. This lack of access to civilian populations is reportedly leading to extremely high levels of wasting and there are unconfirmed reports of hunger-related deaths.

A recent survey conducted in Kenema in early August measured wasting both in the town and in the displaced camp. In the town (estimated population 100,000) wasting was recorded at 22.6% with 7.7% severe wasting (see Annex I 9(b)). The crude mortality rate was 2.4/10,000/day (8x normal) and the under five mortality rate was 5.6/10,000/day (almost 5x normal). Measles immunisation coverage was 69% [MSF-H 08/08/95].

In the camps for displaced people around Kenema (estimated population 26,000) wasting was measured at 37% with 11.5% severe wasting (Annex I 9(c)). The crude mortality rate was 5.2/10,000/day (17x normal) and the under-five mortality rate was measured at 19/10,000/day (16x normal). Measles immunisation coverage was 72% [MSF-H 08/08/95].

These high levels of wasting can largely be attributed to lack of food as the most recent relief food distribution was in May 1995. Furthermore, food distributions in May and previous months were only half rations. Food is reportedly available in markets but prices are very high so that many people are surviving on wild fruit, leaves and bush yam [IFRC 15/09/95].

Since the survey mortality has been reported to have increased due to a cholera outbreak. The condition is particularly prevalent in the IDP camp. Due to lack of drugs, medical material and limited in-patient facilities, the case fatality from cholera is believed to be high [IFRC 15/09/95].

A survey in August 1995 in Bo (population 250,000) found an overall prevalence of wasting of 22%. There was no significant difference in prevalence of wasting between residents and the displaced population. This population has been without a general ration for several months [MSF-B 10/10/95]

As only limited food has been delivered to Daru, Segbwema, Magburuka or Makeni (collective internally displaced population of over 250,000) due to insecurity, it can be assumed that the nutritional status of these populations is similar to that of internally displaced people in Kenema [IFRC 15/09/95].

Overall, the population in Bo and Kenema, Sierra Leone are known to be at high nutritional risk (category I in Table 1) and the remaining population is likely to be at high nutritional risk (category IIa in Table 1).

How could external agencies help? In Sierra Leone, efforts must continue to improve food supplies to insecure areas in the south and east of the country while nutrition surveys should be conducted when and as security allows. There is also an urgent need to establish cholera surveillance in many of these areas as well as drug supplies and in patient facilities for treatment of the condition.

RNIS 11, July 1995

Liberia - Trend in numbers of refugees/displaced and proportion severely malnourished and at high risk (black area).

The overall situation in the region appears to be deteriorating. There are continued reports of skirmishes in Liberia, and despite the expansion of ECOMOG control into Cape Mount and Bomi counties, much of the country remains inaccessible to relief activities. Intensive rebel activity in Sierra Leone is continuing and estimates of the number of displaced people in the country vary from 730,000 to over a million people. Food distributions in Sierra Leone have been severely disrupted by the insecurity. The total number of people in need of humanitarian aid in the region has increased since the last RNIS report by over 100,000 to 3.4 million largely due to further displacements in Sierra Leone. This total population number is broken down by country as follows:

Location

Jun 94

Aug 94

Oct 94

Dec 94

Feb 95

Apr 95

Jul 95

Liberia

1.750.000

1.750.000

1.692.000

1.615.000

1.800.000

1.900.000

1.900.000

Sierra Leone

300.000

300.000

300.000

506.000

506.000

500.000

730.000

Cote d’Ivoire

234.000

250.000

325.000

330.000

330.000

330.000

227.000

Guinea

628.000

539.000

534.000

534.000

568.000

603.000

578.000

TOTAL

2.912.000

2.839.000

2.851.000

2.988.000

3.198.000

3.333.000

3.435.000

Sierra Leone Rebel attacks have continued throughout the countryside in April and May with the anti-civilian characteristics that have come to be identified with this armed conflict, leading to further large scale civilian displacement. During June and early July there were reports that tension had eased in the Western Area and Freetown with unconfirmed news that the rebels had been routed from the rural western province, although there was also news of renewed rebel insurgence in Kono, Kenema and Kallahun. Attacks on highways have continued. Rough estimates are that there may be as many as 730,000 people internally displaced within Sierra Leone and a further 45,000 who have crossed the border into Guinea. As many as 40,000 people may have recently been displaced from Bo district while communities between Waterloo (only 25 miles from Freetown) and Lunsar have also reportedly had to move due to fighting [DHA 16/06/95, UNHCR 26/06/95].

Food convoys have regularly been looted and, based on the experience of last year, it has been suggested that rebel groups are stockpiling food for the rainy season. As a consequence food relief programmes are severely constrained. IFRC have reported that food is unavailable for distribution in Daru, Segbwema and Kenema as food stocks could not be positioned due to banditry and attacks on convoys. Food deliveries in June were therefore expected to be very poor. [WFP 23/06/95, DHA-a 15/05/95, IFRC 02/06/95]. It was also expected that distribution of foods in July for regions like Bo and Kenema would be delayed due to insufficient food available at WFP extended delivery points [WFP 21/07/95]. As security continues to deteriorate nationally, prices of basic food commodities are increasing daily.

A nutritional survey which was carried out in March 1995 in Freetown, showed 13.4% wasting with 7.2% severe wasting (see Annex 1 (9d)). No difference between the displaced and resident populations was found. Food was being distributed by different agencies in Freetown with allocated rations varying from 860 to 2240 Kcals per capita. The WFP assisted beneficiary caseload in the capital is still limited to less than 50,000 persons because of the difficulties of proper identification and registration. Measles immunisation coverage was found to be 53% [AICF 14/03/95].

Overall, The inaccessible populations Sierra Leone can be considered to be at high risk (category IIa in Table 1).

RNIS 9, February 1995

A Liberian peace agreement which contained a provision for an immediate cease-fire as well as a timetable for creation of buffer zones, safe-havens, demobilization of soldiers and eventual democratic elections was signed in Accra, Ghana, on the 21st of December 1994. There is optimism that this new agreement will hold as the principal signatories represent all Liberian warring factions. Apart from a few small-scale skirmishes, the cease-fire appears to be holding. Unfortunately, the situation in neighbouring Sierra Leone has continued to deteriorate during the new year period with greatly intensified rebel activities leading to massive internal displacement and a further refugee outflow into Guinea. The total number affected by the crisis regionally has, therefore, increased to just over three million people. The food pipeline for vegetable oil and beans for the region is said to be very weak with need for early provision of cash funds for staffing and logistic support costs to ensure necessary food aid logistics, co-ordination and monitoring [WFP 20/01/95].

Trend in numbers of refugees/displaced and proportion severely malnourished and at high risk (black area).

Current estimates of the populations affected by the conflict are summarized in the box below.

Location

Feb 94

April 94

June 94

Aug 94

Oct 94

Dec 94

Feb 95

Liberia

1,750,000

1,750,000

1,750,000

1,750,000

1,692,000

1,615,000

1,800,000

Sierra Leone

300,000

297,000

300,000

300,000

300,000

506,000

506,000

Cote d’Ivoire

250,000

250,000

234,000

250,000

325,000

330,000

330,000

Guinea

600,000

415,000

628,000

539,000

534,000

534,000

568,000

TOTAL

2,900,000

2,712,000

2,912,000

2,839,000

2,851,000

2,988,000

3,198,000

Sierra Leone Simultaneous rebel attacks on a number of large towns throughout the country during the Christmas week caused large scale displacement within Sierra Leone. Continued fighting has meant that all UN and NGO international staff working outside of Freetown have been moved into the city and the Southern, Northern, and Eastern provinces are said to be cut off from the Western area. Due to the deteriorating security situation, private transporters are reluctant to transport relief food into these areas without an army escort. WFP has only minimal stocks prepositioned in Bo, Kenema and Segbwema, available for distribution to the displaced and managed by a skeleton national staff [WFP 30/12/94, WFP 08/01/95, WFP 20/01/95, WFP 16/02/95].

Although the numbers and locations of the internally displaced and refugee population will have recently changed due to the increased insecurity, a food supply assessment mission completed in November 1994 estimated that there were 490,000 IDPs in the districts of Kenema, Daru, Makena, Bo town, Gondama and Gerihum areas and a further 7,000 Liberian refugees in Waterloo camp near Freetown [WFP/UNHCR 05/11/94].

Overall, the refugee/displaced population in Sierra Leone can be considered to be at high nutritional risk since food supplies are being disrupted by current levels of insecurity (category IIa in Table 1).

How could external agencies help? Unfortunately, the deteriorating security situation in Sierra Leone is currently preventing implementation of needed relief measures in most areas, although agencies will need to prepare for increasing numbers of displaced people in large towns, e.g. Freetown.

There is an urgent need for donors to pledge greater quantities of beans and oil for the whole regional programme as well as more cash to support staffing, logistical, co-ordination and monitoring components of the programme.

RNIS 8, December 1994

The security situation in Liberia and Sierra Leone has continued to deteriorate over the last two months and is now affecting an estimated 3 million people in the region. The increase in total population affected since the last RNIS report (2.8S million) is due to revised estimates of the number of internally displaced in Sierra Leone [UNHCR 24/11/94, WFP 11/11/94].

Trend in numbers of refugees/displaced and proportion severely malnourished and at high risk (black area).

Current estimates of the populations affected by the conflict are summarized in the box below.

Location

Dec 93

Feb 94

April 94

June 94

Aug 94

Oct 94

Dec 94

Liberia

1,750,000

1,750,000

1,750,000

1,750,000

1,750,000

1,692,000

1,615,000

Sierra Leone

150,000

300,000

297,000

300,000

300,000

300,000

506,000

Cote d'lvoire

250,000

250,000

250,000

234,000

250,000

325,000

333,000

Guinea

600,000

600,000

415,000

628,000

539,000

534,000

534,000

TOTAL

2,750,000

2,900,000

2,712,000

2,912,000

2,839,000

2,851,000

2,988,000

Sierra Leone It is currently estimated that there are 500,000 displaced people and 6,000 assisted refugees in Sierra Leone. This increase in the number of displaced (300,000 in the last RNIS report) is due to rebel attacks on all fronts in the South East and the North. As a result, large numbers of people have fled to "safe areas" under government control in Bo, Kenema, Makeni and Segbwema. The vast majority of this population are not in camps [WFP 27/11/94].

The level of insecurity continually interrupts relief efforts with food convoys being ambushed on major highways. However, in October successful food distributions were completed in Bo, Makeni, Kanema and Segbwema [WFP 27/11/94].

A nutrition survey in Girihun camp for the displaced (population 20,356) who have fled rebel incursions into Kenema and Kailahun district was carried out in August and found 8% levels of wasting (see Annex 1 (1d)). General ration receipts were 1,140 per capita per day while measles vaccination coverage was extremely low at 12.1% [AICF 26/08/94].

There are no further reports on the nutritional situation of the 6,000 Liberian refugees in Waterloo camp whose condition was reported to be deteriorating in the last RNIS. Reasons for this apparent deterioration were being looked into.

Overall, most of the displaced population in Sierra Leone is not currently at heightened risk (category IIc in Table 1) excepting the camp populations of Waterloo and Girihun, who are considered to be at moderate risk (category IIb in Table 1).

How could external agencies help? In Gerahun camp in Sierra Leone there is an urgent need to increase measles immunization coverage.

RNIS 7, October 1994

The security situation in both Liberia and Sierra Leone has deteriorated over the past two months leading to further movements of refugees and internally displaced people. However, the total number of people affected by the continuing conflicts in the region is thought to remain stable at approximately 2.8 million. In Liberia the increased level of conflict has led to the virtual suspension of international NGO activities in those areas not controlled by ECOMOG. Cross-line and cross-border food convoys have also been suspended while waiting for security guarantees. The elections that were scheduled for the 7th of September 1994 were not held and a new agreement was signed on the 12th of September providing for elections on the 10th of October 1995 [UNHCR 15/09/94, WFP 5/08/94].

Liberia

Trend in numbers of refugees/displaced and proportion severely malnourished and at high risk (black area).

Current estimates of the populations affected by the conflict are summarized in the box below.

Location

Dec 93

Feb 94

April 94

June 94

Aug 94

Oct 94

Liberia

1,750,000

1,750,000

1,750,000

1,750,000

1,750,000

1,692,000

Sierra Leone

150,000

300,000

297,000

300,000

300,000

300,000

Cote d'Ivoire

250,000

250,000

250,000

234,000

250,000

325,000

Guinea

600,000

600,000

415,000

628,000

539,000

534,000

TOTAL

2,750,000

2,900,000

2,712,000

2,912,000

2,839,000

2,851,000

Sierra Leone The security situation is reportedly deteriorating in the countryside with increased fighting between government forces and rebels. Prior to this escalation, there were an estimated 300,000 refugees and displaced people in Sierra Leone. During August food distributions to Segbwema/Kenema in the Eastern province were delayed by insecurity on the Bo/Kenema highway and rebel attacks in Northern and Southern provinces have led to influxes of displaced populations into Freetown where food assistance for 23,000 displaced is now being provided [WFP 05/09/94, WFP 19/09/94].

There is food available in Freetown, but serious shortages exist in many rural areas as most of the country side did not have a harvest last year due to the poor security. Some areas on the Guinea/Sierra Leone border have not had a harvest since 1991 [CAMA 29/07/94]. A cholera epidemic has reportedly broken out in Freetown with about 10,000 cases currently reported [WFP 30/09/94].

A recent nutritional survey carried out in Waterloo Camp (estimated population 6,000 Liberian refugees) showed 13.5% of those under five years old were wasted (see Annex 1 (1c)). In addition 11.2% of those measured were on the borderline of being wasted (between 80-85% weight for height). This is an increase compared to results from a similar survey conducted in 1992 where the level of wasting was only 4.0%. It has been suggested that the increased levels of wasting may be associated with a reduced ration which was implemented in 1993. Rice was reduced from 300 to 200 gms per day and pulses were eliminated from the food basket [UNHCRa Jul 94]. A joint WFP/UNHCR food assessment mission is scheduled to visit Sierra Leone at the beginning of November to investigate the causes of the degradation in nutritional status [WFP 20/10/94].

How could external agencies help? The evacuation of NGO's and subsequent looting of materials means that when it is possible for NGOs to return, they will need to start virtually from scratch. Donors should, therefore look favourably on requests for funds. It would also be useful to enhance/support ECOMOG operations for “hit and run” deliveries. In Waterloo camp, the ration should be reviewed and another survey would be useful to monitor any potential decline in the nutritional status of the camp population.

RNIS 6, August 1994

The disarmament process is at a standstill, and it appears likely that elections scheduled for September will be postponed. This will inevitably delay any substantial repatriation programme although an average of 1,000 people have been returning every month from Guinea, Cote D'Ivoire, and Sierra Leone to areas in Nimba and Bong Counties as well as Monrovia and its environs [UNHCR 18/07/94].

The Liberia National Transitional Government, which was installed in March, has yet to extend its authority outside of areas under ECOMOG control [UNHCR 29/06/94].

Current estimates of populations affected are as follows:

Location

Dec 93

Feb 94

April 94

June 94

Aug 94

Liberia

1,750,000

1.750,000

1,750,000

1,750,000

1,750,000

Sierra Leone

150,000

300,000

297,000

300,000

300,000

Cote d'Ivoire

250,000

250,000

250,000

234,000

250,000

Guinea

600,000

600,000

415,000

628,000

539,000

TOTAL

2,750,000

2,900,000

2,712,000

2,912,000

2,839,000

Sierra Leone Current estimates are that there remain 300,000 refugees and displaced people in Sierra Leone. Continued rebel attacks along major highways which act as major food aid supply routes have necessitated military escort for relief convoys and consequent delays to delivery schedules. An international NGO was forced to recall its staff to Freetown after one of its vehicles was ambushed in the Kenema area [WFP 17/06/94].

Given the security situation in Sierra Leone, no large scale repatriation programme is immediately foreseeable. There have however been some small scale spontaneous repatriations [UNHCR-a 18/07/94],

The populations of Liberia and Sierra Leone that are inaccessible due to insecurity can be considered to be at high risk (category IIa in Table 1). The remainder of the affected population can be considered to be at moderate risk (category IIb in Table 1) due to sporadic insecurity (Liberia and Sierra Leone) and registration problems (Guinea). Those in Cole d'Ivoire are not currently thought 10 be at particular risk (category IIc in Table 1).

How could external agencies help? NGO's and UN agencies should be encouraged and supported in efforts to maintain a capacity to rapidly respond to the needs of newly displaced populations, perhaps requiring a decentralization of staff where security allows.

RNIS 5, June 1994

While the estimated number of people in the region affected by the civil wars in Liberia and Sierra Leone remains virtually unchanged at 2.9 million the installation in March of a transitional government in Liberia may now have broken the political stalemate [WFP 9/05/94]. In accordance with the peace agreement signed in July 1993, general elections are scheduled to take place in early September. It is thought that these elections may encourage many refugees to return to vote [UNHCR 13/05/94], although if current levels of violence continue this may be open to doubt.

However, the disarmament process is proceeding slowly with approximately 3,000 soldiers out of an estimated 50-60,000 surrendering their weapons. Coupled with various political impasses leading to factionalism within ULIMO, this timetable for elections now appears optimistic. A positive aspect of this is that it may provide greater time to raise funds for a repatriation programme [UNHCR 13/05/94, WFP 3/06/94].

Current estimates of populations affected are as follows:

Location

Dec 1993

Feb 1994

April 1994

June 1994

Liberia

1,750,000

1,750,000

1,750,000

1,750,000

Sierra Leone

150,000

300,000

297,000

300,000

Cote d'lvoire

250,000

250,000

250,000

234,000

Guinea

600,000

600,000

415,000

628,000

TOTAL
2,750,000

2,900,000

2,712,000

2,912,000

Sierra Leone There are an estimated 300,000 refugee and displaced people in Sierra Leone. Sporadic fighting continues with government forces now on the offensive after earlier rebel gains in the South East in April. Some assistance has now reached the 82,000 people previously cut off in Kenema and Segbwema but insecurity prevents regular food aid deliveries [UNHCR 25/05/94, WFP 9/05/94].

Overall, the populations in Sierra Leone and Liberia with little or no food distribution are thought to be at high risk (category IIa in Table 1).

RNIS 4, April 1994

A large proportion of the population of Liberia continues to be affected by the civil war while the unstable situation in Sierra Leone is also affecting large numbers. Estimates for the region are that 2,600,000 refugees and internally displaced people will require emergency assistance throughout 1994.

Estimates of populations affected are as follows:

December 1993

February 1994

April 1994

Liberia

1,750,000

1,750,000

1,750,000

Sierra Leone

150,000

300,000

297,000

Cote d'Ivoire

250,000

250,000

250,000

Guinea

600,000

600,000

415,000

TOTAL

2,750,000

2,900,000

2,712,000

Sierra Leone The most recent estimates of numbers of refugees and internally displaced people in Sierra Leone is 297,000. However, given the lack of information on numbers of people fleeing Upper Lofa, this may now be an under-estimate of the actual population. Reports at the beginning of February indicated that intensification of rebel activities had cut off the main access route to Segbwema, a major food distribution site for 70,000 displaced persons in Eastern province. A further 12,000 Sierra Leoneans in Kenema were cut off from NGO assistance due to insecurity at the end of February. The general situation was described as unstable and generating concern about impact on relief operations throughout February and March [WFP 28/03/94].

Overall, there is a gleam of hope in the situation in the Liberia region with the recent disarmament agreement, already leading to the return of a reported 19,000 refugees to Liberia from Cote D'Ivoire and Guinea [UNHCR-A 24/03/49]. However, 350,000 people with known high mortality rates are at risk (category I in Table 2) especially with the rains due in May. Those in inaccessible areas, such as Upper Lofa, (estimated population of 145,000), South East Liberia (estimated population 120,000) and the 82,000 refugees and internally displaced in Sierra Leone are also believed to be at high risk, although precise details of their condition are not known (category Ha in Table 2). The remainder of the affected population in Liberia are considered to be at moderate risk (category IIb in Table 2) with a tendency to improvement if the current disarmament process continues.

How could external agencies help? Part of the affected population is inaccessible for security reasons, and thus external assistance is not currently a major issue. However, the infrastructure within such areas has presumably been damaged, and donors could consider future funding needs for reconstruction as a prerequisite for effective rehabilitation when security allows access; transport, food, medical supplies, and personnel will also be likely to be needed. This currently applies to a population of around 265,000 in Liberia, and another 82,000 in Sierra Leone.

For the population accessible in terms of security, nutrition is improving with the harvest and with external assistance, which is understood to be presently adequately funded. However, remoter areas, even if accessible from a security viewpoint, are reportedly under served with relief food and supplies. The low coverage of measles immunization remains a major risk; stepped up immunization has begun, but additional funding may be needed for wide coverage.

RNIS 3, February 1994

The refugee and displaced population affected by civil war in the region is approximately 2,900,000 although the fluid security situation - particularly in Liberia and Sierra Leone - causes some refugees to spontaneously repatriate to newly liberated areas while other groups are displaced as the front line changes, e.g. 3000 people recently moved from River Cess and Grand Bassa into Buchannan while 11,000 Liberian refugees returned from Cote d'Ivoire, 800 Sierra Leonean refugees returned from Guinea and most recently 1200 Liberians fled to Guinea from Upper Lofa.

Current estimates of refugees/displaced people in the region are:

Liberia

1,750,000

Sierra Leone

300,000

Cote d'Ivoire

250,000

Guinea

600.000

Total

2.900.000

There are still major shortfalls in food and cash pledges for the regional operation so that food stock levels are already low. There are worries that food shortages may occur as a result in one or more of the affected counties in February/March. In general, the security situation is reported as continuing to deteriorate. [WFP 11/2/94]

Sierra Leone The small Liberian refugee population in Sierra Leone (6,000) and larger war displaced population (approximately 150,000) are generally believed to be food secure although pockets of malnutrition may exist in areas where fighting prevents agency access and disrupts agricultural production. The main problems appear to be health related and although many NGOs are helping the government in providing health services, epidemics do periodically occur (e.g. measles). [AICF 4/11/93] Other major health problems are malaria, respiratory track and skin infections, sexually transmitted diseases and malaria. [WFP 13/12/93]

An assessment was conducted in Waterloo refugee camp (5590 Liberian refugees) in Sierra Leone in early November. Results were that the refugees received, on average, 1270 kcal/person/day which includes 21 grams of protein/person/day. A rapid assessment was conducted using mid-upper arm circumference (MUAC) (see Annex I(1d) for details). The results of the survey showed 5.8% wasting (MUAC<12 cm) and 1.7% severe wasting (MUAC<11 cm). Results from other districts housing displaced populations were similar wasting levels were between 4-13.1% and severe wasting was 0.2-5%. The rates in this reported range are similar to prevalences observed in the non-displaced population in Sierra Leone. [AICF 4/11/93]

There continues to be major food distribution problems in Sierra Leone caused mainly by faulty registration systems so that many beneficiaries are not receiving their full ration entitlement. However, the low levels of wasting reported above reflect a substantial level of self-sufficiency and market-accessibility among the refugees and displaced persons. [WFP 13/12/93]

Most recent reports indicate an intensification of fighting in the South East of Sierra Leone with strategic towns falling to rebels. As a result Catholic Relief Services (CRS) has had to suspend distribution in some camps. There are also reports of new influxes of refugees and latest planning figures are now 300,000 internally displaced and refugees although it is not clear how this population is distributed between the two categories. [WFP 3/2/94]

As there is very little survey data available from Sierra Leone, it is difficult to assess the situation. However, reports of new influxes of refugees and intensified fighting could indicate a situation coming out of control.

Liberia region It is estimated that 65,000 people in the Liberia region have high prevalences of malnutrition (category I in Table 2). This estimate includes half the population of Upper Margibi, Nimba, Bong, and Grand Bassa Counties based on survey data cited above. The other half of this population is considered to be at high risk (category IIa in Table 2). The population of Upper Lofa (175,000) can also be considered to be at high risk due to the departure of international personnel (category Ha in Table 2). An additional 45,000 people from Lac, Grand Bassa, and Riverine counties are also considered to be at high risk (category IIa in Table 2). As food has been reaching the other areas of the region, they are not currently considered to be in a critical condition (category IIc in Table 2).

RNIS 2, December 1993

Despite the signing of the cease-fire agreement in August 1993 the civil war in Liberia has continued unabated in certain areas. The usual population of Liberia is about 2.5 - 3 million. It is estimated that virtually the entire population is affected by the war and much of the population are now displaced or refugees. For example, WFP's current planning figure for emergency feeding is 2,675,000. Food is now reaching the majority of the displaced and war affected population in Liberia. However, there are substantial population groups who, due to insecurity, remain virtually inaccessible; such surveys as have been feasible show appalling levels of malnutrition and mortality among these.

Current estimates (November 1993) of the numbers of refugees and displaced people in the region are²:

Liberia

1,750,000

Sierra Leone

150,000

Cote d'Ivoire

250,000

Guinea

600,000

Total

2,750,000

² These numbers are compiled from many sources. They are intended to give a general idea of the distribution of refugees and displaced in the region. For this reason, they may not tie in exactly with other figures in the text.

The WFP current planning figure for emergency feeding in Sierra Leone is 300,000 of whom only 6000 are refugees. The remaining 294,000 are internally displaced due to civil conflict in Sierra Leone. Many of the displaced are in villages rather than in camps. A recently completed assessment (November 1993) found nutritional status was generally adequate. However, there may be small population pockets where lack of access due to insecurity prevents food aid delivery which is adversely affecting nutritional status. There are currently no hard data to verify this.

We have had no recent reports on the Liberian and Sierra Leonean refugees in Guinea and Cote d'Ivoire and assume that these populations remain in stable condition.

World Food Programme requests to donors for non-food aid requirements (administration, logistics etc, of $4.2 million for 1994) have largely remained unmet.

Based on the above information, the populations in the region are categorized in Table 2 as follows. 100,000 are currently severely malnourished in Liberia (Table 2, column I). This refers to Upper Margibi County and parts of Upper Lofa County. A further 260,000 are considered to be at high risk (Table 2, column IIa) as they are in areas where fighting continues and access is restricted. The remaining 2,205,000 people (Table 2, column III) represent: those receiving food aid in Liberia in relatively secure areas and with some access to harvests; internally displaced in Sierra Leone; and refugees in Guinea and Cote d'Ivoire.

RNIS 1, October 1993

The overall population of refugees/displaced people in this region is nearly two million (estimated as 1,986,000). The majority of this population are in a stable condition, not currently reported to be at unusual risk of malnutrition. However, the fighting that flared up again in the Liberian civil war in November 1992 prevented UNHCR from assisting a population of more than 100,000 Sierra Leonean refugees stranded in the isolated North of the country (Upper Lofa County). Surveys at that time found prevalence of wasting to be extremely high (34%) in some groups.

Very recently it was reported that a further 80,000 people in Upper Margibi County (see Map 1) are in "a catastrophic situation since several months" (see below).

Recent reports (20 August 1993) indicate a continuing nutritional and health crisis now affecting 175,000 Sierra Leonean refugees and displaced Liberians fleeing the conflict, in Upper Lofa County (see Map 1). Recent nutritional survey results in Vahun town (population of 20,000) gave levels of 30% wasting including 6% severe wasting in young children. Rough mortality estimates in the town of Yandehun (population of 10,000) are 3/10,000/day (10 x normal). Staple foods are unavailable and markets are non-existent. A lull in the fighting has allowed relief supplies to trickle into the area but transport vehicles and washed out roads and bridges prevent full emergency deliveries. There have been limited deliveries of rice in Vahun amounting to less than 20% of a full ration but there have been no distributions in villages along the road north of Vahun. Selective feeding established for vulnerable groups is at best a holding operation to minimize increased mortality but it is expected that the situation will deteriorate as the general food basket remains inadequate due largely to the logistical difficulties.

The situation is further aggravated by contaminated drinking water, and inadequate sanitary facilities. Cases of measles have been reported in all villages in this area.

WFP is currently planning an air-drop operation to assist this population cut-off by the rainy season.

Reports are also coming in of an emerging crisis in Upper Margibi County affecting 80,000 people, mostly displaced from Cape Mount, Bomi County and Kakata in February and March. Most of this displaced population (between 60-80% of the present population in Upper Margibi County) stay with relatives with whom they share available food resources. Extremely limited quantities of rice have been brought in "cross-line" by the UN but estimates are that this has barely provided food for five days. Rough nutritional surveys in July and August found prevalences of kwashiorkor (severe oedematous malnutrition) of 39% and 45% respectively. (Given the very high mortality risk of kwashiorkor, these rates if true are quite extraordinary, and do indeed indicate a catastrophic situation.) Severe wasting is estimated as 6%. Extremely high mortality rates of children between 0-15 years were recorded at 14.4/10,000/day (50 x normal -- at this rate half the population of that age would die within a year). This area, which is also close to the front line, has been cut-off from outside food and relief supplies for several months due to the embargo imposed by ECOMOG.

Information for September from Upper Margibi County indicates a crude mortality rate of 10.2/10,000/day (equivalent to 37% of the population dying within a year). The mortality rate for children under five was measured at 42.5/10,000/day. This rate indicates all children under five would die within eight months.

A nutritional survey done in a population affected by the war but not displaced, the South East region of Liberia (estimated population of 112,000), showed 10.4% wasting and 4.2% severe wasting. The prevalence of kwashiorkor was measured at 3.4%.

Reports are also coming in (10/9/93) of high levels of wasting in Nimba County (See Map 1).

United Nations System Standing Committee on Nutrition

Nutrition Information in Crisis Situations - Sierra Leone

NICS 6, May 2005

NICS 3, August 2004

NICS 2, May 2004

NICS 1, February 2004

Contrasted nutrition situation in refugee camps

Recommendations

RNIS 43, November 2003

RNIS 41, April 2003

Bombali district

Refugees

Overall

Recommendations

RNIS 40, Dec 2002

Refugees

Internally Displaced Persons

Recommendations and priorities

Sierra Leone

RNIS 39, October 2002

RNIS 38, July 2002

RNIS 36/37, April 2002

RNIS 35, October 2001

RNIS 34, July 2001

RNIS 32/33, April 2001

RNIS 31, July 2000

RNIS 30, March 2000

RNIS 29, December 1999

RNIS 28, September 1999

RNIS 27, July 1999

RNIS 26, March 1999

RNIS 25, October 1998

RNIS 24, June 1998

RNIS 23, March 1998

RNIS 22, December 1997

RNIS 21, September 1997

RNIS 20, June 1997

RNIS 19, March 1997

RNIS 18, December 1996

RNIS 17, September 1996

RNIS 16, June 1996

RNIS 15, April 1996

RNIS 14, February 1996

RNIS 13, December 1995

RNIS 12, October 1995

RNIS 11, July 1995

RNIS 9, February 1995

RNIS 8, December 1994

RNIS 7, October 1994

RNIS 6, August 1994

RNIS 5, June 1994

RNIS 4, April 1994

RNIS 3, February 1994

RNIS 2, December 1993

RNIS 1, October 1993

United Nations System
Standing Committee on Nutrition