DRC Monthly Humanitarian Bulletin Jan - Feb 2000
January and the beginning of February 2000 brought about substantial evidence of staggeringly changing pattern of the DRC conflict. The reporting period was marked by unprecedented diplomatic activity over the settlement of the Congolese crisis, culminating with the UN Security Council’s Special session. The equilibrium of forces that had brought belligerents on equal terms to the Lusaka Agreement in summer 1999, does no longer prevail on the battlefield as it does not at the negotiation table. The successful January campaign on the northern front embodied a period of unexpected fortune for the Government, which also gained the exclusivity to represent the DRC at the UN Special Session, a prerogative lost six months earlier in Lusaka. Equally, Kinshasa’s retrieved popularity in the east is nourished by population’s overwhelming exasperation at foreign troops and the absence of peace dividends but also by a vocal, church-led non-violent resistance campaign. Furthermore, the concept of negative forces defined in the Lusaka Agreement is undergoing an evolution, whereby Mayi-Mayi warriors become the DRC army’s outpost in the Kivu, while ex-FAR and Interahamwe insurgents remain an element largely rejected by the society. In this environment of legitimised anger, outright stands are taken among segments of the Kivu civil society resorting to unequivocal threats against Rwandans and Congolese Tutsi communities. Meanwhile, the long-awaited inter-Congolese dialogue is taking shape with Mr. Ketsumile Masire’a arrival in Kinshasa (11 February) to initiate comprehensive consultations that would subsequently lead him to rebel-held eastern DRC.
A logic of war is reigning throughout the country where DRC authorities are mobilising youth in Government-held territory to replenish their armed forces, MLC is taking a defensive posture; RCD-Goma tries its best not to trigger havoc in managing civil disobedience campaigns in major towns and Uganda is one-sidedly handling the Hema-Lendu conflict that has led to a deadly cycle of violence.
In this tumultuous environment the announced UN Security Council resolution on the deployment of up to 5,500 peace-keepers is at best seen as preliminary phase. Meanwhile, the deployment of the UN military observers (MLO) is over and by mid-February 2000 some 90 MLOs have begun preparatory activities in nine locations of the DRC (Gbadolite, Kindu, Goma, Bunia, Boende, Lisala, Kananga, Gemena, Isiro and Kinshasa).
Exchange rates of CF against US $1 in eastern and western DRC. January 2000
The DRC wartime economy continued its spectacular decline during the reporting period. A fluid political situation compounded with dramatic military developments led to an unprecedented devaluation of the Congolese Franc (CF) causing a major harm to the demonetised food economies of the Kivu and Orientale. Although foreign exchange rates are still fluctuating and significantly vary from Kisangani to Bukavu, the January depreciation, followed by a sizeable increase in the overall price levels, was a major blow to food security of the local population.
Inflationary trends continued their galloping pace in Government held regions. The Central Bank of the DRC devaluated CF on 21 January and fixed it at the level of 9CF against US $1 while the parallel exchange rate climbed slightly above 31 CF. The threefold difference between the official and real exchange rates continued to affect humanitarian agencies, some of which are no longer capable of disbursing their limited project budgets to obtain goods and services fixed at the parallel exchange rate. Compared to November-December 1999, the overall inflation in December-January 2000 slightly slowed down, but was still significant in Kinshasa (20 percent). No positive changes were observed in the food market which remained largely lopsided with an estimated 60 percent deficit.
All the above factors strongly contributed to the shrinking of humanitarian space both in eastern and western DRC. The number of critical humanitarian issues currently confronted by the relief community is way beyond its capacity to reach and deliver emergency assistance. All-out war and re-emerging resort of the signatories to the Lusaka agreement to military solutions make the task of protecting civilians in the armed conflict highly complex and often unfeasible. Although reduced to a bare minimum, emergency humanitarian activities and advocacy for humanitarian principles were pursued in five of the DRC provinces (North and South Kivu, Orientale, Katanga, and Bas Congo).
Population Movement, Overview by Province
The reporting period saw a 15 percent increase, representing almost 260,000 persons, in the numbers of IDPs and Congolese refugees in third countries. By mid-February 2000 internal movements of the civilian population were affecting all 11 provinces and the capital of the DRC
Refugees: 72,000 Sudanese, 3,200 Ugandan
First reports of disastrous humanitarian situation in and around Djigu were made by OCHA in August and October 1999. Greater international attention to the Hema-Lendu conflict was drawn by the publication of a footage taken in September 1999 by the NGO Christoffel Blinden Mission which gave a gruesome account of violence both Hema and Lendu are being subjected to.
wThe unsettled and long-simmering inter-ethnic conflict between Lendu and Hema tribes that had degenerated into an all-out war in June-July 1999, currently represents a major source of instability in eastern DRC. The epicentre of the conflict (Djigu) has rapidly expanded and by mid-January 2000 affected several adjacent densely populated districts of the province (Mahagi, Nioka, Mangbwalu, and the vicinity of Bunia). The alleged partiality of Ugandan military authorities currently controlling much of Orientale province is, in the view of local observers, one of the major factors fuelling the confrontation which has already resulted in a heavy death toll and the displacement of an estimated 180,000 civilians. The displaced populations are said to be in dire need of protection but also shelter, food, medical assistance and safe water. The malnutrition observed among accessible IDP communities is alarming: 11.6% global and 9.1% severe malnutrition. Widespread insecurity impedes adequate humanitarian response that would cover the displaced and affected communities in their entirety. In addition to diminishing accessibility, relief agencies operating from Bunia often encounter a hostile attitude of beneficiary communities suspecting humanitarian agencies of one-sidedness. After the withdrawal of MSF teams from the district (Access chapter), there are only two NGOs (OXFAM-UK and MedAir) and ICRC remaining in the area. All humanitarian aid outside Bunia town, however, is at a halt as a result of poor security. w The security situation is rapidly deteriorating in other areas of the province as well: the major eastward shift of the frontline (approaching Opala – regions bordering with Equateur province) is, according to religious sources, prompting civilians to flee into the forest. Major waves of displacement must be anticipated in the direction of Opala-Kisangani should the frontline further move eastward. w Mayi-Mayi activity is increasingly spreading towards Orientale, south of Bunia. In the beginning of January Mayi-Mayi allegedly supported by Ugandan Allied Democratic Front (ADF) rebels raided and captured Boga settlement –safe haven to 200 Ugandan refugees. According to the Anglican Church of Boga, Ugandan refugees as well as a considerable number of local residents fled the town in the direction of Mitego (14 km. south of Boga). Although the area was shortly retaken by UPDF (6 January), the population still remains scattered.
|On 12 February 2000,OCHA DRC held a workshop in Bunia with humanitarian partners, donors, local authorities and community leaders. The main outcomes of this initiative are: parties to the conflict, and RCD-ML authorities:
Recognised the absolute need for substantial humanitarian action in the region and made a commitment to promote humanitarian principles such as access and security of relief workers.
IDPs: 190,000 (ongoing significant rise)
Refugees: 18,000 Burundians
Internal and external displacement of South Kivu’s population remained consistently high throughout 1999, reaching peak levels at the times of intense hostilities (e.g. 1000 refugees fleeing to Tanzania a day) and suddenly diminishing during short periods of appeasement marked by the emergence of inter-community reconciliation attempts. For much of 1999 humanitarian agencies were able to trace and reach most of IDP communities, since their movement was generally stable once away from insecure areas, i.e. IDPs were on the move for some time and making efforts to stay near their villages and fields. The displacement patterns of South Kivu noticeably changed starting from November-December 99, but especially in January 2000 when the frontline stretched from western parts of Maniema province down to Shabunda and even Kalonge. The dramatic shift of the frontline that has also led to significant changes – the Mayi-Mayi activity is now perceived by the civilian population, especially in towns, as a resistance movement, with which it overwhelmingly sympathises. Thus a qualitative change in the patterns of displacement- in search of security and in anticipation of an all-out war, affected communities flee on far greater distances. If the current levels of tension were to be sustained for another month, the majority of rural areas of South Kivu might be deserted and a significant rise in refugee numbers in Tanzania might occur. Relief agencies on the ground observe a continued movement of IDPs (over 10,000) from the north-eastern edge of the Kahuzi-Biega National Park and Kalonge towards Bukavu. WFP estimates the number of IDPs in and out of Kalonge at 100,000 as of 1 February. Large numbers (50,000) of displaced are said to be concentrated between Makobola, Luberizi and Bwerega (Fizi zone). Tensions also reported between Rwandan/RCD authorities and the Banyamulenge community of South Kivu leading to a complete isolation of the latter in a very hostile environment.
IDPs: 195,000 (does not include arbitrary displacement)
Refugees: estimated 10,000 (Rwandan)
New waves of internal displacement were observed in North Kivu as well. An estimated 25,000 IDPs arrived in and around Minova as a result of renewed clashes both on South/North Kivu border and in Masisi region. Also there are reports of 14,500 newly displaced in Kanyabayonga area. Displacement is a new phenomenon in northernmost areas of North Kivu, a region that remained relatively stable since the beginning of the war and local observers attribute it to Mayi-Mayi/Interahamwe clashes. w There have been concerted efforts by Rwandan troops to move large groups of civilians out of Rutshuru territory deep into the interior of North Kivu. Available reports indicate that the entire commune of Bwito (300,000 persons) has been already “evacuated” in order that a security zone be created to control infiltrations into Rwanda. Arbitrary displacements in North Kivu/Rwanda bordering areas have been known since 1997, however the ongoing one is being implemented by Rwandan military without civilian authorities’ consent or involvement.
Since the fall of Kindu in October 98, the humanitarian situation in this enclave-province was fairly stable. The majority of displaced persons, with the exception of an estimated 20,000 residents of areas bordering with Walikale (North Kivu) and Haut Plateaux (South Kivu), progressively returned and resumed their activities. Since mid-December 99, Mayi-Mayi activity started to spread in a number of directions throughout eastern DRC, including Maniema. Compounded with the DRC forces’ attempt to recapture Kindu in mid-January 2000, it created panic among the civilians in Kindu, but especially in Kalima and Kasongo. In addition, there is a considerable number of long-distance IDPs, coming mostly from war-affected zones of Eastern Kasai and Katanga (24,000). Local sources suggest that the situation of this particular group of IDPs is highly precarious. An estimated 70,000 persons fled these locations. Increased insecurity and imminent hostilities prompted humanitarian agencies to scale-down the already diminished humanitarian activities. After the withdrawal of Merlin expatriate personnel, FOMETRO an international medical NGO, is the only international institution remaining on the ground. Attempts are being made to trace the newly displaced populations with the help of Xaverien catholic mission in Kasongo.
Refugees in 19,000
12,800 in ROC; 6,000 in CAR
w Much of Equateur’s civilian population residing in Sud-Ubangi, Mongala and Tshuapa districts was on the move starting from the end of December 1999 but especially in early January 2000 when sporadic cease-fire violations transformed into an intense fighting on two fronts. In the direction of Ikela the DRC and allied forces launched a major offensive resulting in recapture of besieged town of Ikela and further advance towards Opala. The catholic parish of Ikela-Bokungu reports widespread devastation of this relatively densely populated region (over 550,000 persons) of Equateur. Although a large majority of civilians are reportedly returning to their home after having spent several weeks in the forest, there is still a considerable number of IDPs that would not be able to return soon mainly because of their long-distance displacement. The situation is especially critical around Ikela where an estimated 12,000 civilians remained besieged for almost six months along with the Zimbabwean troops. w Systematic air-bombings of MLC positions in north-western Equateur (Djombo, Dongo, Mobambo, Kake, Port Siforcal, Basankusu and Likwanga) forced an estimated 12,800 persons to stream across the Congo River and seek refuge in the Republic of the Congo (areas around Ipfondo). Thousands of civilians fled their villages and spontaneously settled along the Congo River, away from military positions. No figures could, however, be provided due to the ensuing widespread insecurity on the river. UNHCR teams that assessed the newly arrived refugees in the ROC reported a considerable number of wounded supposedly as a result of air raids.
|A rapid assessment mission followed by delivery of some 350 tons of relief supplies to Bokungu-Ikela zone is planned for mid-February 2000 within frameworks of Emergency Humanitarian Interventions (EHI). This project is funded by the Government of the Netherlands.|
Refugees: 45,500 (Angolan)
Refugees in Zambia: 36,000
No major changes in IDP numbers and those seeking refuge in Zambia were noted in the course of January in this province. The situation is much more worrisome in the RCD controlled northern parts of Katanga, where rebel/insurgent confrontation was said to be intense. The shrinking accessibility of IDPs in central regions subsequent to renewed fighting in the direction of Manono and Mobanga via Piana, resulted in a sharp reduction of humanitarian interventions. MSF/Belgium is currently the only organisation systematically providing medical and nutritional assistance to displaced, but the area of its intervention is basically limited to the north-eastern axis (Pweto) and Malemba Nkulu. Humanitarian situation among IDPs and their host communities remains precarious and necessitates an urgent intervention. w At the end of 1999, provincial authorities of Katanga allocated land plots (in Lubumbashi suburbs) to displaced willing to cultivate and settle down temporarily. This initiative was supported by an inter-agency joint action through which over 10,000 persons were provided with se eds and tools (UNDP Humanitarian Unit/FAO); food packages (WFP/Governor’s Office/Italian Co-operation); and non-food items (UNICEF and ICRC).
Military activity in the province intensified especially in the second half of January 2000. In spite of claims by local media in Kinshasa, no any other source confirmed the capture of Lodja by Government forces. Unable, in their own words, to undertake any major activity in the direction of Mbuji-Mayi and Kabinda, the RCD and Rwandan forces made several attempts to isolate these towns from each other by cutting off the main axes. On the other hand, forces loyal to the Government considerably advanced eastwards from Dekese (Western Kasai) and are reportedly at 300 km west of Lodja, a strategic position on the road to Kindu (Maniema). In spite of the intensified activities, humanitarian and missionary sources reported no increase in IDP numbers on either side of the frontline. Currently humanitarian activities are being implemented by CRS/MEMISA in Kabinda (approximately 15,000 IDPs), Lodja and most health zones of Sankuru district (30,000 IDPs).
IDPs: estimated 80,000
The intensity and frequency of skirmishes in north-eastern regions of the province in the course of January was highest since the signature of the cease-fire agreement. According to missionary sources and reports by military, the January military campaign seriously affected civilians whose panic-driven flight was difficult to trace. The same sources indicate several areas of IDP concentration – Ilebo, Mushenge, Demba, Bulape, Tshikaji and Dibaya. The numeric evaluation of this group is largely speculative, as no humanitarian assessment has been possible to carry out. Nevertheless, a figure of 80,000 persons (calculation is based on heath zone statistics recently used for national immunisation days) is put forward for planning purposes. The humanitarian presence in the province is limited to the provincial capital and is minimal (UNICEF). Escalation of hostilities and military build-up is the province is still going on with regular skirmishes in and around Anga, Idumbe and Boganga.
Population Movement, Summary
In-country and cross border population movements during the first month of the year 2000 amply mirrored the unstable military situation in the DRC.
1. IDPs- Increase by 230,000 compared with December 1999. Once again, the internal displacement was on the rise, due to renewed fighting in Equateur and Kasai provinces; and sustained high level of inter-ethnic tensions in Ituri district of Orientale. Of estimated 1.12 million displaced persons throughout the DRC humanitarian assistance is systematically provided to 115,000 IDPs in the Kivus and Orientale (MSF, ICRC, WFP, FAO); 30,000 in Katanga (ICRC, FAO, WFP – mainly in Lubumbashi and MSF on eastern axis);and to 15,000 IDPs in Kinshasa (IRC).
2. Refugees in DRC- No significant refugee influxes into the DRC occurred during the reporting period. Repatriation of the Congolese (ROC) refugees continued and it is estimated that their return will be boosted as a result of reviving national reconciliation efforts. It is now estimated that some 10,000 Congolese refugees have spontaneously returned to North Kivu from their camps in Rwanda since mid-1999.
3. DRC Refugees in third countries – increase by 30,000 compared with December 1999: Indiscriminate and systematic bombardment of several regions in western Equateur caused a significant waves of internal displacement but also uprooted several thousands of civilians who fled to the Republic of the Congo. Climate of widespread violence prevailing in South Kivu and tensions heightening as military activity approaches large urban settlements incited additional thousands of South Kivu residents to flee across the Lake Tanganyika to Tanzania.
Humanitarian Principles and Human Rights
While compliance with the rules of international law has been a perennial problem since the beginning of the DRC regional conflict, January 2000 produced an ample evidence of a dramatic deterioration because of changing pattern of the conflict. Entire communities are mobilised for war thus making it difficult to distinguish between combatants and non-combatants. Civilian populations are being deliberately targeted and arbitrary displacements are now an immediate objective, rather than a consequence of the conflict.
Access and Security of Relief Personnel
No-go zones (areas of hostilities, rebel/insurgent activity, air bombings, etc.) in January 2000
Access to war-affected and other vulnerable populations was significantly reduced on both sides of the frontline in January 2000. While the dramatically diminished accessibility in Eastern DRC is a result of intensified fighting and activity of disparate insurgent groups, in the Government controlled areas lack of access is stems from bureaucracy. Although there were no cases of refusal, the uneven character of the clearance granting process makes it practically impossible to carry out a complete cycle of evaluation, programming and implementation in many Government held regions, most notably in the Kasai provinces.
There were several cases of harassment of relief personnel, including detention of expatriate aid workers (MSF/Belgium in Bas Congo), attacks on humanitarian convoys (MSF/France in Ituri, Orientale), AICF (Ruzizi plaine, Uvira zone), attempts to requisition humanitarian supplies and material (Agro Action Allemande, Goma). Although the above incidents were possible to address and ensure safety of the workers, their increasing numbers and seriousness constituted a real impediment often causing interruptions in the delivery of assistance. Heightening insecurity in Maniema province prompted MERLIN to evacuate its international staff from Kindu and Kalima. Likewise, the hostile attitude of vying Hema and Lendu communities that often suspect relief agencies of partiality, created unfavourable security conditions leading to withdrawal of MSF teams from the area.
|Lack of access badly impacts relief community’s capacity to assist the needy. It also has budgetary implications: 30% of ECHO funding is destined to Government controlled areas of the DRC, the rest goes to eastern DRC where the inaccessibility is mainly due to factors out of RCD control.|
Protection of Minorities
Over 100 Congolese Tutsi, Rwandan and Burundian nationals seeking protection near the ex-UN compound in Kinshasa since 13 January.
Protection of ethnic minorities and individuals at risk both in eastern and western DRC, is perhaps one of the most daunting challenges in the actual context of the DRC, as it involves courageous stands in an environment of adversity, resentment and incredulity. The issue of minorities at risk is highly delicate when cast into the broader context of tremendous sufferings of the majority of the country’s population inflicted by the effects of a war which is inter alia triggered by the question of minority rights.
The international community highly appreciated efforts of the DRC Government in protecting and evacuating hundreds of Rwandan, Burundian and Ugandan nationals as well Congolese citizens of Rwandan origin in 1999. Through evacuation exercises sponsored by the US, Belgian and Canadian Governments, over 1,500 exposed persons have safely left the DRC and are currently being resettled in third counties. There are, however, hosts of persons whose origins, accent or features blatantly expose them to outright acrimony. In hope for an evacuation, a number of such persons came out their hiding in a capital which is by far more tolerant than in August 98 but where social control is gaining strength. More than a hundred persons whose claim to stay in the official protection side was turned down, gathered near the UN’s former premises seeking protection.
A screening exercise conducted by OCHA in conjunction with HCHR confirmed that the overwhelming majority of evictees are in dire need of protection, including international protection. While proven foreign nationals are eligible for repatriation to Rwanda and Burundi (Congolese authorities are approaching ICRC for a possible exercise), the more difficult cases of mixed marriages and Congolese citizens remain without solution. Discussions are underway with the Ministry for Human Rights to allow over 200 exposed persons to return to the protection site, pending alternative options. Humanitarian needs of evictees are covered by the Xaverien Catholic Mission and Medecins du Monde (MDM), supported by OCHA.
In December 1999 the DRC Government officially recognised child recruitment practices by its armed forces and made a commitment to promote demobilisation at a UNICEF sponsored international technical forum on the problem of child-soldiers. In January 2000, however, the Government refused to sign a decree of demobilisation of child-soldiers and establishment of a national committee on demobilisation and reintegration of children. It was further announced that the implementation of resolutions of the Kinshasa forum would entirely depend on international community’s willingness to provide the Government with funds to reintegrate demobilised children into civil society.
Meanwhile, in the course of January converging reports mentioned a significant presence of child-soldiers among regular forces in Government areas. However, currently there is no evidence of child recruitment into the armed forces within the ongoing large-scale conscription. The DRC Defence Ministry appealed to the Congolese youth, aged 18-25 to join on a voluntary basis the DRC armed forces.
The proliferation of uncontrolled armed forces and presence of several foreign armies, which often resort to local recruitment, have created fertile ground for enrolment of minors. Although officially, RCD rebels supported UNICEF’s appeal to halt engaging children in the armed conflict, reports of such practices in eastern DRC are rife. According to a report issued by a catholic news agency- MISNA, at least 1,000 young children, many of whom are 11-14 years old, were recruited by Ugandan forces in North Kivu and are currently undergoing a military training at the Nyaleke military camp in the vicinity of Beni.
Food Security and Nutrition
In the absence of reliable statistics and consistent surveillance of affected populations the efforts of the humanitarian community remained limited to macroeconomic analysis. Although this analysis was accurately depicting trends, it failed to identify precise numbers of vulnerable persons and device remedies.
Starting from the end of 1999, a series of attempts were made by specialised organisations to quantify food needs in the DRC and envisage humanitarian interventions in a diversified manner to meet both war-inflicted needs and consequences of an economic collapse. It is now believed that some 10 million Congolese on both sides of the frontline face food shortages of varying degree. Furthermore, the current food crisis will inevitably lead of a sustained deficit for a relatively long period since: a) the majority of food producing and processing regions of the DRC (the Kivus, Northern Katanga, parts of Maniema, western and eastern Orientale, central Equateur) are seriously affected or devastated by the ongoing war; over 800,000 farmers have been displaced and lost their production capacity in eastern DRC alone; b) food importers are disengaging from western DRC; and c) road, fluvial and railway infrastructure is crippled by insecurity and appalling dilapidation.
An EU sponsored study- "Food Economy Zones in Eastern DRC" conducted by the Food Economy Group in conjunction with SCF indicated that already now there is an obvious decline in the quality and quantity of foodstuff consumed by farmers in traditionally wealthy agricultural regions of the Kivu. Most evidence suggests that malnutrition is on the increase, particularly amongst displaced populations in Eastern DRC. Evidence from Ituri ‘province’ is particularly worrying: up to 11.6% global malnutrition and 9.1% severe malnutrition with the status amongst displaced populations being up to 40% worse than the resident population. As an indicator of the severity, of the estimated populated of 326,672 there are 7,578 malnourished children in Bunia Health Zone under the age of five, of whom 5,900 are candidates for therapeutic feeding. A food security survey conducted by AICF/US in several districts of Kinshasa in September-December 1999 revealed an 8,7 percent global malnutrition (2.9 percent severe) among children under five. It is believed that the decline continues at a geometrical progression. The most recent study of AICF suggested that residents of poorest districts of Kinshasa eat one meal a day and that the only daily meal for a family of 6 members averages 5,000 kcal. which is by far below all acceptable norms. Food supply and reserves in western DRC are at exceptionally low levels, meeting only 45 percent of the demand and propelling high inflation rates at the market (22 percent increase in overall food prices in December).
The relief community, however, is unanimous that large-scale food injections would not counteract immense food shortages and the lopsided market in the DRC. While geared to partially restoring farmers’ production capacity and reinforcing coping mechanisms of urban residents during the emergency, a differentiated approach to food security accepted by relief agencies includes targeted feeding projects for displaced and refugees (approximately 2,000,000 persons).
Compared to 1999, there are currently slight improvements in the resourcing of feeding and food security projects. Of 45,000 metric tons of food needed (UN Consolidated Appeal) for feeding of 350,000 IDPs and vulnerable persons over 40 percent have already been received or are in the pipeline. WFP plan, via international structures, to distribute food to 30,000 children in supplementary and therapeutic feeding institutions throughout the next six months and give targeted assistance to their families. Of the estimated 100,000 families in the Kivu in need of seed and tool assistance, 30,000 would receive assistance thanks to donor support of FAO initiatives (CAP 2000). Pledges of bilateral food assistance in the course of 2000 were also made by Belgian, French and Italian Foreign Co-operation institutions.
Dynamics of admission of children into nutritional centres of Kinshasa. Data by Bureau Diocesan des Oeuvres Medicales (BDOM).
The chart indicates new cases of malnourished children in 39 therapeutic and 80 supplementary feeding centres. Phase III is the most severe under-nourishment cases. The level of October 1998 (caused by the Kinshasa war in August-September 1998) war reached in August 1999. Since then numbers of institutionalised malnourished children are on the rise
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