|Refugee Nutrition Information System (RNIS), No. 27 - Report on the Nutrition Situation of Refugee and Displaced Populations (UNSSCN, 1999, 78 p.)|
|2. Great Lakes Region|
The crisis in the DRC continues and now involves at least a dozen African countries, either directly as combatants in the fighting or indirectly as mediators in various peace initiatives. The rebel forces, comprising Congolese soldiers, Congolese Tutsi Banyamulenge, Rwandan, Ugandan and some Burundian government troops, accuse President Kabila of behaving like a dictator and increasing regional instability by his support for the guerilla groups opposed to the governments of his former allies, including the Rwandan 'genocidaires'. Kabila is resisting the rebel movement with support from Angolan, Zimbabwean and Namibian troops and accuses Rwanda and Uganda of aggression and "foreign adventurism" in regard to Congolese territory and natural resources (ICG - 21/05/99).
The rebels currently control approximately a third of the country (in the north and east), including Goma and Uvira (IRIN - 09/06/99). The violence continues in many parts of the country. Uvira and Goma were both bombed by forces allied to the government in May resulting in civilian deaths (IRIN-12/05/99).
Progress in the search for a negotiated peace is elusive. Proposals for a national debate have been put forward and the government has declared its willingness to hold "direct talks" with the rebels, but the start of the talks has been postponed several times (IRIN - 17/05/99, 09/06/99). In late May Rwanda declared a unilateral ceasefire in DRC (IRIN - 31/05/99), but the government continued to bomb rebel held areas and hence the ceasefire no longer holds (IRIN - 03/06/99). The rebel factions have also held talks to discuss a peace settlement, but cracks in their alliance have begun to appear and they have ousted their leader Wamba dia Wamba (IRIN -18/05/99).
IDPs in DRC
There is only limited information available concerning the nutritional situation of the people of DRC. Thus it is difficult to estimate the scale of the humanitarian crisis and needs. Given the current security situation, no surveys have been undertaken recently in rebel held areas, because of limited access and as a result of the near-complete destruction and/or loss of infrastructure. It is estimated that there may be up to 660,000 IDPs in the country, the majority of whom are in South Kivu (220,000) and Katanga (150,000) (IRIN - 22/06/99).
In Kinshasa the recent devaluation of the currency has affected market prices and basic food costs have increased substantially. A study conducted by FAO and UNDP noted that food insecurity has been increasing in the city since August 1998. This is linked to both a reduction in food availability due to; insecurity, lack of currency for importing goods, and shortage of fuel, and also restricted access to food due to high inflation and unemployment. The study, which was undertaken between mid-March and early April, found that the purchasing power of the city's population had diminished by 30-35% since the beginning of the war (IRIN -06/05/99, WFP - 27/04/99). Anecdotal reports have described increases in the prevalence of wasting among children (IRIN - 16/04/99). Fuel has also become expensive - disrupting the transport system and hence the city's economy. WFP airlifts from Pointe-Noire to Brazzaville continue as rail traffic between the two cities is not possible due to insecurity. Part of this food is then ferried across the river to for distribution in Kinshasa (WFP - 28/04/99).
Lubumbashi, South East DRC
ACF conducted a study in Lubumbashi district, Katanga province in May (see Annex). The most recent census (1997) estimated the population of the district to be approximately one million people. Lubumbashi town developed around the mining activities in the province - there are large quantities of zinc, silver, lead and cobalt deposits in the area. The socio-economic and political situation of the town's population, who are mainly salaried workers, is precarious. The recent insecurity has caused massive population displacements and increased unemployment. Many of the labourers have not received their salaries for several months. In addition, the devaluation of the congolese franc to the dollar has increased the population's difficulty in purchasing sufficient food.
The survey estimated 2.1% acute wasting and 0.1% severe wasting in children under-five. Oedema was recorded in 0.7% of the children. A much higher proportion of the children were defined as stunted (low height-for-age): 50.8%; 16.2% were defined as severely stunted.
Maternal nutritional status was also studied. 18.8% of the women had a BMI<18.5 kg/m2 of which 7.5% of these had a BMI < 17. kg/m2. 6.1% of the women had a MUAC < 220mm. If the women's MUAC and BMI were considered together (BMI<18.5 kg/m2 and MUAC<220 mm) it was found that 8.5% were classified as undernourished. This figure was reduced to 2.0% when only those with a very low BMI and low MUAC were considered (BMI<16.0 kg/m2 and MUAC<220 mm). A further 12.4% were considered to have marginal nutritional status (BMI>18.5 kg/m2 and MUAC<220 mm).
Enquiries about vaccination status revealed that only 19% of the children had been vaccinated against measles as confirmed by a card, however, based on mothers' reporting vaccination coverage increased to 80%. Approximately half of those children vaccinated were less than nine months of age, which is generally considered to be too young.
Given the population's precarious socio-economic and political situation, the prevalence of wasting amongst the children is not as high as might be expected. There are virtually no facilities for caring for undernourished children in this area. Maternal nutritional status appears to be poorer than that of children and therefore may be a more serious problem. A simple analysis found no association between maternal and child nutritional status. In addition, there was no significant difference between the nutritional status of households who possessed a garden plot (46%) as compared with those who did not.
Lukaya district, Bas-Congo
ACF also conducted a study in Lukaya district, Bas-Congo province in March (see Annex). During August-September 1998 this area was directly affected by the war when the aggressors fought along the main roads from Kisantu-Kinshasa and Kisantu-Angola. There were numerous civilian deaths, houses were looted and demolished and agricultural fields were destroyed. The health centres were emptied of medicines and equipment. Many farmers lost their seeds and tools and were forced to delay planting their crop. The survey, which was conducted six months after these events, was undertaken at the request of UNICEF who reported an increase in the number of admissions to the supplementary feeding centres in the villages. The survey estimated acute wasting at 4.9% and 0.5% severe wasting in children under-five. Oedema was recorded in 0.2% of the children. A much higher proportion of the children were defined as stunted (low height-for-age): 43.5%; 19.6% were severely stunted.
Maternal nutritional status was also studied. 20.4% of the women had a BMI<18.5 kg/m2 of which 5.2% of these had a BMI < 17.0 kg/m2. 8.0% of the women had a MUAC < 220mm. If the women's MUAC and BMI were considered together (BMI<18.5 kg/m2 and MUAC<220 mm) it was found that 8.4% were classified as undernourished. This figure was reduced to 1.6% when only those with a very low BMI and low MUAC were considered (BMI<16.0 kg/m2 and MUAC<220 mm). A further 13.1% were considered to have marginal nutritional status (BMI> 18.5 kg/m2 and MUAC<220 mm).
Enquiries about vaccination status revealed that only 34.5% of the children had been vaccinated for measles as confirmed by a card, however this figure reached 43.9% when based on mothers' verbal reports. About half of the children with cards had been vaccinated before the age of nine months. An estimated 7% of the children were reported to have had diarrhoea in the two weeks before interview and 42.8% had suffered from a fever. The treatment of those who suffered from diarrhoea was not always ideal - only 45.2% were given oral rehydration salts and food was withheld from some (30.6%).
The crisis six months prior to this survey does not appear to have had lasting effects on nutritional status of children. The area is sufficiently well equipped with nutritional centres to deal with the estimated number of undernourished children in the population. Maternal nutritional status was, once again, less satisfactory. A weak significant association was found between the maternal and child nutritional status.
Rebel held areas
Approximately 20,400 IDPs and malnourished children are receiving supplementary and therapeutic feeding in Goma through a WFP-funded project. An FAO-sponsored food security programme is providing seeds to some 10,000 displaced families in the region (IRIN- 06/05/99). No further information on the nutritional situation of the population in these areas is available.
Measles and polio vaccination campaigns have been carried out in North and South Kivu by IRC/UNICEF/WHO/MSF/SCF-UK in collaboration with local health authorities. The campaign followed earlier reports of deaths from measles in these areas in February. Stocks of meningitis vaccines are currently being built up in response to a continuing epidemic in the province (IRIN - 06/05/99, 11/05/99).
An outbreak of a viral haemorraghic fever has been confirmed by WHO in the north-eastern region of the country. The latest figures suggest that there have been 90 confirmed cases and 60 deaths. The majority of these patients were men working in gold mines around Duba in Province Orientale. The epidemic was not caused by the Ebola virus, but may have been due to the related Marburg virus. The most recent reports suggest that the epidemic is diminishing (IRIN - 12/05/99).
Refugees in DRC
There are estimated to be 145,000 Angolan refugees in the DRC (UNHCR - 10/06/99). The assistance programme to 50,000 Angolans in southern parts of the country continues to be hampered by several constraints. There have been serious and chronic delays in food arrivals due to the scarcity of wagons for the transport of food and poor road conditions. Airflights are also scarce and very expensive. As a result of inadequate food deliveries, UNHCR has been required to purchase much of the food for these refugees locally. The nutritional situation of the refugees, which was reported to be extremely poor in February, has improved following a decision to extend food assistance and health care to all children under-five (WFP - 30/04/99).
Refugees from Congo Brazzaville
Over 30,000 Congolese fled to Bas-Congo in the DRC at the height of the conflict. UNHCR has assisted approximately 13,000 Congolese refugees to return from the DRC to Brazzaville and more are scheduled to return. Approximately 10,000 other refugees are thought to have returned without assistance (IRIN - 14/05/99, 30/06/99).
Fresh waves of violence have, however, precipitated more fleeing from the Pool area. Constant movement in and out of the area renders it difficult to provide an exact caseload of the refugees (the most recent estimate is that there are 32,000 refugees from Congo-Brazzaville). The new arrivals are reported to be in poor health and nutritional condition as many had been hiding in the forest around Pool for up to four months without regular access to food. The most recent report from UNHCR states that mortality rates are very high. Health facilities are available in Luozi camp which has a capacity of 15,000 people. UNHCR plans to buy food for these refugees locally, as WFP has not been able to provide the required ration (IRIN - 11/05/99,14/05/99, 30/06/99; UNHCR - 28/06/99, 30/06/99, WFP - 31/05/99).
Burundian, Rwandan and Sudanese refugees in DRC
There are estimated to be some 20,000 Burundian refugees in S. Kivu and some 60,000 Sudanese people in the country. Approximately 25,000 of the Sudanese may have regrouped in Am where UNHCR is in the process of opening an office in order to assist them. No information is available on their nutritional situation of the others as they were scattered by the recent conflict and have been hiding in the hills and forest. UNHCR has reopened its office for the Goma region which had been closed since October 1997. A large number of Rwandans remain unaccounted for in this area (UNHCR - 28/06/99).
Overall, the IDPs in the government held areas are at moderate risk (category IIb). Those in the rebel-held areas may be at higher-risk (estimated number: 370,000), but no information is available to the RNIS (category III). The Angolan refugees in Bas-Congo are considered to be at high risk (category IIa). High mortality rates are reported for the refugees from Congo-Brazzaville (category I). No information is available on the nutritional status of the other refugees (category III).
Priorities and recommendations:
· Access to the rebel-held areas is still the priority for the humanitarian community in DRC.
Recommendations from the ACF survey in Lubumbashi include:
· Set up therapeutic and supplementary programmes for the treatment of the undernourished children.
· Create a surveillance programme which will refer children to these centres
Recommendations from the ACF survey in Bas-Congo include:
· Continue the treatment of the undernourished children in the existing programmes
· Continue growth monitoring programme of the children in health centres but add height monitoring to this (currently just weight-for-age)
· Educate and sensibilise the population about the proper treatment of diarrhoea
Both surveys recommend:
· Develop food security activities in order to respond to the longer-term problem of stunting among the children.
· Improve and strengthen the measles vaccination campaign.