|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|
Recent influx of refugees from DRC and Burundi
The surge in fighting in Eastern DRC has led to a dramatic influx of refugees into the country. More than 87,000 new arrivals have entered the country since the outbreak of hostilities in August 1998. The newly arrived refugees, who have consistently reported being caught in the middle of ongoing skirmishes in the DRC, are generally in good health and have a satisfactory nutritional status. Before this recent influx, there was one camp for Congolese refugees - Nyarugusu, refugees were then transferred to Lugufu (Kigoma). Recent reports have suggested that the present capacity of Lugufu camp is near to saturation and efforts are being made by UNHCR to secure alternative camps sites (UNHCR - 03/06/99, 11/06/99, 29/06/99).
New Burundian arrivals were also registered over the reporting period, with the influx peaking in late April-early May when some 5,000 Burundians entered the country due to hostilities in the Burundian province of Ruyigi. This influx was concurrent with the repatriation of smaller numbers of refugees - between January and April of this year 5,000 Burundians repatriated from Tanzania (UNHCR -29/06/99; WFP - 05/05/99, 27/05/99).
As part of an information campaign to encourage the voluntary repatriation of Rwandans in United Republic of Tanzania, a delegation of former Rwandan refugees recently visited the Ngara region. A small number of refugees decided to return voluntarily. A group of more than 60 refugees is due to return to their place of origin in order to report back to the camps on the situation in Rwanda. It is not known how many will eventually repatriate (IRIN - 28/04/99, WFP - 06/05/99).
Nutritional Status in Kagera and Kigoma camps
The nutritional status of the refugees in the Tanzanian camps is satisfactory. A recent survey conducted by UNHCR in the camps in the four districts in Kigoma and Kagera regions (i.e.: the camps in the west of the country) estimated the prevalence of acute wasting to be 1.8% and severe wasting to be 0.2% (see Annex). No cases of oedema were reported and no child was found with a MUAC<110 mm. The prevalence of chronic undernutrition - measured by stunting - was much higher at 44.1% with 18.8% severe stunting, and closer to that found in the resident population surrounding the camps. These results suggest that although the current nutritional situation is adequate the children's previous nutritional history may have been poor.
The survey report gives credit for the improved nutritional situation to WFP and its donors for providing a stable food pipeline to this refugee population and, indeed, in the current reporting period the food supply continued to be adequate, as did the supply of water (WFP - 05/05/99, 12/05/99). Credit is also given to UNICEF and the other agencies which have provided a series of preventative and curative health services including growth monitoring, malarial control and de-worming programmes as well as micronutrient supplements, post-natal care and selective feeding programmes.
The survey also examined the prevalence of anaemia in the refugee population. Among children under-five, 18.8% were found to have moderate/mild anaemia (10.0-10.9 g/dl) and 14.3% were suffering from severe anaemia (<9.0 g/dl). The mean haemoglobin level was 11.8 g/dl in this age group. No direct relationship between severe undernutrition and anaemia was found (possibly because only a very few cases of severe wasting were seen).
Haemoglobin levels were also assessed amongst the children's mothers and fathers. The mean haemoglobin level for the women was 13.2 g/dl; 13.8% of them were classified as mildly anaemic (11.0-11.9 g/dl) and 9.7% suffered from severe anaemia (<10.9 g/dl). The men's mean haemoglobin level was 14.9 g/dl and only 6.7% had haemoglobin levels < 12 g/dl. Thus the haemoglobin levels were better in men than in women or children.
A high (90.7%) proportion of the children had vaccination cards. The vaccination programme, however, is aiming for full coverage and hence problems such as the loss of cards (mainly in the older children), poor filing and misinformation on the cards, which are relatively common, need to be addressed. In addition, it was apparent that many of the children did not receive their vaccinations at the right age (e.g.: amongst those with cards it could be seen that 91.3% of children received a measles vaccination, however only 52.6% of these received their vaccination within one year of birth).
Acute respiratory infections in the two weeks prior to interview were reported among 43.1% of the children and 40% also reported fever in the same time period. The prevalence of diarrhoea was low in comparison - only 20%. These findings were supported by reports from the out-patients clinic. Analysis revealed an association between wasting and reported illness.
A health NGO in Matabila and Muyovozi camps in Kasulu reported that they are planning to commence an HIV test programme in the camps. This has arisen in light of reports received from Lukole camps where 25% of blood donors were found to be HIV positive (WFP - 05/05/99). HIV is a very serious problem in Tanzania, the latest UNICEF/Government estimates suggest that there will be between 800,000 and one million children orphaned by AIDs by the year 2000 (IRIN -17/06/99).
Nine regions of Tanzania are being targeted for food distributions under the WFP operation for assistance to drought affected persons. In some regions food allocations for a one month distribution, instead of the planned three months, are to be distributed to the most severely affected persons (WFP 26/04/99). WFP's targeted assistance to the population in drought affected areas of Singida and Dodoma (EMOP 6112) has been extended to June (WFP - 21/05/99, 27/05/99). A joint UN/Government crop and food supply assessment mission was scheduled for the end of May 1999 (WFP - 21/05/99). Initial reports from the mission in the field indicate that some areas in Dodoma will face food shortages after the harvest in July due to the rains stopping at the critical ripening stage of the crop (WFP -11/06/99).
Overall, the nutritional situation among the refugees in the western camps appears stable as a result of effective humanitarian response programmes, and hence their nutritional situation is not critical (category IIc). However, the funding shortfalls could place them at greater risk in future.
Priorities and Recommendations:-
· Funds are urgently needed for the WFP operation to provide assistance for the refugees in the United Republic of Tanzania. Breaks in the pipeline mean that rations will either be cut or distributions undertaken less frequently.
Recommendations from the UNHCR survey include:-
· Maintain levels of wasting at current levels through regular general food distributions. The referral of undernourished children to the feeding centres should be continued and improved if possible.
· Reinforce efforts to prevent and treat anaemia (although the levels found were lower than expected).
· Improve de-worming and immunisation programmes.