Angola + 2 more

RNIS Update - March 2000

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Report on the Nutrition Situation of Refugees and Displaced Populations
This update contains information on Angola and West Timor only. The next full report will be issued in early April.

Angola

The humanitarian situation in the country has not improved significantly during the reporting period. Latest estimates suggest that 3.7million of Angola’s population of 12.7 million people may be categorised as "war-affected". There has been an increase in the influx of Angolan refugees into Zambia and Namibia due to insecurity in the border regions. Security conditions continue to be one of the major constraints for the delivery of humanitarian assistance activities: most relief aid is still delivered by airlifts which are extremely expensive. The nutritional situation remains critical in some areas of the country.

Kuito, Bie Province

The nutritional situation of IDPs in camps in Kuito, Bie Province is precarious. Nutritional surveys on children aged 6-59 months in December 1999 by MSF-B and ICRC in both the town (population 157,000) and the IDP camps (population 68,000) recorded a deterioration in nutritional status since March. Mortality rates remain elevated in both resident and displaced groups (MSF-B/ICRC - 12/99).


March 1999
July 1999
December 1999
December 1999

Town
Town & camps
Town
Camps
% of IDP families
14%
53%
29%
100%
CMR
1.9/10,000/day
2.2/10,000/day
1.9/10,000/day
2.4/10,000/day
Under-five mortality
3.5/10,000/day
3.3/10,000/day
3.8/10,000/day
4.5/10,000/day
Acute malnutrition
(<-2z scores and/or oedema)
4.2%
12.7%
8.0%
16.1%
Severe acute malnutrition
(<-3z scores and/or oedema)
1.0%
3.5%
1.5%
1.3%
The authors of the surveys suggest that the relatively high prevalence of acute malnutrition in the camps is due to limited access to food as well as poor sanitation and health facilities. Only 23% of all the families interviewed (in town and the camps) reported having received a general food distribution in December, although a much higher proportion received food in November. WFP food deliveries were severely constrained during December due to the closure of the airport for almost two weeks. The current ration is 1,800/KCal/day. Coverage of the MSF-B feeding programmes was low at 27% in town and 34% in the camps. Reports suggest that an increasing number of older adults and children are becoming malnourished (MSF-B - 17/01/2000).

Recommendations from the survey include improving access to safe water and health facilities, strengthening the feeding programmes (particularly the coverage), initiating food basket monitoring and continuing to reinforce nutritional surveillance (MSF-B - 17/01/2000).

RNIS 29 reported on an outbreak of Pellagra (niacin deficiency) in Kuito between August and November 1999. WFP has since supplied niacin rich food supplements for the cases identified and also their families. The general ration, however, currently contains only 8-10 mg/person/day of niacin compared to the recommended daily allowance of 15-20 mg /person/day (WFP/MSF-B/ICRC/UNICEF - 01/2000). Vitamin B complex tablets were distributed to all women of 15 years and over in December by MSF. The MSF-B/ICRC survey estimated that 86% of women in the town and 90% of women in the IDP camps had received the tablets. However, compliance rates were relatively low for a variety of reasons. It is recommended that the displaced population should receive a supplemented ration (including either Corn Soya Blend or groundnuts) as soon as possible for at least the next four months. A more long term solution may be to set-up maize fortification schemes.

Matala, Huila Province

The nutritional situation of the IDPs in Matala, Huila Province has improved since October 1999 according to two ACH surveys conducted in January. In October a rapid nutritional assessment using MUAC had estimated extremely high prevalences of malnutrition. The recent surveys were conducted on children aged 6-59 months from both newly arrived displaced groups (defined as those who had arrived after August 1999, population approximately 15,000) and more established displaced groups (those who had arrived before July 1999, population approximately 35,000) (ACH - 01/00).


Newly arrived IDPs
More established IDPs
Acute malnutrition
(<-2z scores and/or oedema)
9.9%
6.7%
Severe acute malnutrition
(<-3z scores and/or oedema)
1.7%
1.3%
Vaccination coverage
Confirmed by card
Confirmed by history
Not vaccinated
79.9%
10.1%
10.0%
6.9%
17.5%
75.6%
Under 5 mortality rate
(October-December 199)
5.2/10,000/day
1.0/10,000/day
Proportion of households interviewed who received WFP food
98.8%
70.5%
The most significant differences between the two groups was the alarmingly high under-five mortality rate among the newly-arrived IDP group. This was largely due to a diarrhoea epidemic that accounted for 92% of all reported deaths in this age group. The more established IDPs had a slightly lower prevalence of malnutrition. A large proportion of this group have access to land and have managed to establish vegetable gardens. In contrast, the newly arrived group of IDPs are more dependent on the ration provided by WFP, as they do not yet have access to land (ACH - 01/00).

Recommendations from these surveys included continuing the supply of the WFP ration, but also improving the population’s food security through agricultural programmes and by setting-up income generating schemes. Nutritional surveillance should continue. Hygiene and sanitation programmes also need improving.

Ganda, Benguela Province

Two ACH nutritional surveys were conducted among children aged 6-59 months in Ganda, Benguela Province in February as a follow-up to a survey in October 1999. At the time of the survey the population of Ganda was estimated at about 36,000 residents, 3,000 IDPS in official camps and a further 6,300 IDPs living in the town either with host families or in rented accommodation. There have also been reports of further 1-2,000 displaced people arriving in the area (ACH - 02/00).


October 1999
February 2000
February 2000

IDP camp
(n=279)
Town
(n=900)
IDP camp
(n=225)
Acute malnutrition
(<-2z scores and/or oedema)
21.1%
10.1%
29.3
Severe acute malnutrition
(<-3z scores and/or oedema)
6.1%
2.5%
8.0%
The prevalence of acute malnutrition was extremely high among the IDPs in the official sites. Mortality rates for the IDP population (calculated by grave counting in the cemeteries around the displaced sites) were also elevated - CMR was estimated at 3.1/10,000/day and under-five mortality at 4.1/10,000/days. The IDPs in Ganda have very limited opportunities for self-reliance, their main source of income is from working on the resident’s farms but this work is infrequent and poorly paid. The displaced are able to plant on very limited plots around the camp sites, however this activity does not produce enough food for the majority of households. Residents are also suffering as both agricultural production and economic activities in the area have been limited by insecurity. A limited number of animals are still owned by the residents (ACH - 02/00).

Recommendations from the survey in Ganda include providing a general ration, shelter, washing, cooking and cleaning equipment to all IDP households in the official sites for three months. In addition, nutritional surveillance (home visits), nutrition education programmes and therapeutic and supplementary feeding programme should all be strengthened. Particular attention should be given to the 6-29 month age group, where the majority of the malnutrition was found.

Huambo

According to WFP, a nutritional survey in Caala in November estimated the prevalence of acute malnutrition at 23.3% and severe acute malnutrition at 5.8% (WFP - 13/01/00). This survey is currently unavailable to the RNIS. Previous reports have suggested that both the resident and displaced populations have poor nutritional status

Angolan refugees in Zambia and Namibia

Fighting has intensified in recent months along the Angolan border with Namibia and in other areas of the province of Kuando Kubango. UNHCR is currently assisting some 9,000 Angolan refugees in Osire camp, about 230km north of the capital Windhoek (IRIN-SA 28/02/99).

Fighting in south-eastern Angola has resulted in an influx of more than 24,000 Angolan refugees into Zambia’s Western province since October 1999. There are contingency plans to cope with an influx of a further 15,000 refugees. Some 10,000 of the newly arrived refugees had been stuck on the western bank of the Zambezi river at Sinjembela, however UNHCR is currently transporting them to a new camp 120 km inland away from the insecure border. Reports from Sinjembela indicate that the overall health situation among the refugees is not critical, although there have been increased cases of diarhoeal diseases - possibly due to the onset of the rainy season and the congestion in the camp area. There have been anecdotal reports of malnutrition. Logistical difficulties continue to make access to the camp difficult (IRIN-SA - 24/02/00, 21/02/00, 17/02/00; UNICEF - 21/02/00).

Refugees in West Timor, Indonesia

Following the violence and population displacement after the 30 August 1999 referendum in East Timor, an estimated 110-150,000 refugees from East Timor remain in West Timor. The majority of the refugees are living in one of more than 200 sites in Belu district; most of the remainder are in Kupang district. The number of refugees per site varies from 60 to 4,000. According to UNHCR, large numbers of East Timorese in West Timor wish to return to East Timor (and are being encouraged to do so by the Indonesian authorities), but are prevented from doing so by either intimidation or their own apprehensions concerning their safety and/or financial security on their return. UNHCR continues to assist those refugees who wish to repatriate. It is estimated that approximately 50,000 East Timorese will ultimately decide to remain in Indonesia (UNHCR - 01/00; USCR - 22/02/00).

Displaced populations in West Timor

Two nutritional surveys have been conducted on refugee children aged 6-59 months in West Timor during the reporting period. UNICEF conducted a survey in mid-December in Belu district and in January in Kupang district (UNICEF – 12/99, 02/00).


Belu District
December 1999
(n=842)
Kupang District
January 2000
(n=892)
Baseline data from UNICEF1995 national survey
(0-59 months)
6-59 months
Wasting (<-2z scores)
23.6%
12.1%
12.9%
Severe wasting (<-3z scores)
3.6%
1.0%
2.8%
Stunting (-2z scores)
46.8%
43.1%
42.2%
Severe stunting (-3z scores)
17.9%
17.5%
19.2
6-23 months
Wasting (<-2z scores)
28.2%
20.7%

Severe wasting (<-3z scores)
5.2%
1.8%

24-59months
Wasting (<-2z scores)
19.5%
8.6%

Severe wasting (<-3z scores)
2.0%
0.6%

Oedema was not assessed in the Belu survey. No oedema was found in the survey in Kupang. The sampling technique employed in the Belu district survey resulted in an over-estimate of the prevalence of wasting in this area as younger children were over-represented. However Belu does appear to have a higher prevalence of wasting than Kupang (see different age group comparisons) and also a higher prevalence of wasting than that estimated by a national survey conducted by UNICEF in 1995. There were no significant differences in the prevalence of stunting (low height-for-age) between the two districts or the national survey.

A UNHCR/WFP joint assessment mission to West Timor in January reported the following findings (UNHCR/WFP - 03/00):

Food aid is currently being provided to the refugees by a number of relief agencies including WFP and local and international NGOs, although the Government of Indonesia has provided the largest share of food assistance (400g rice/person/day) and also a cash stipend of 1,500 rupiahs/refugee/day (equivalent to 14 US cents) to purchase additional necessities. Distributions of both rice and cash have been sporadic and not in sufficient quantities to cover the refugees daily needs. (The ration only provides 1440Kcal and 28g of protein which is well below the recommended minimum). No systematic monitoring of the basic food distribution was in place.

  • Most refugees brought a substantial quantity of personal possessions to west Timor, including various households items, livestock (pigs, chicken, cattle) food items and even cash/savings. However, most food and luxury items appear to have been consumed or sold and therefore no longer represent a sizeable resource.
  • Some of the refugees have family or blood ties with West Timorese and are living with, or nearby, relatives who have been willing to share resources. West Timor, however, is one of the poorest provinces in Indonesia and the refugees burden on local resources is becoming apparent.
  • Few job opportunities are available to the refugees - Indonesia remains entrenched in a severe economic crisis with high levels of unemployment.
  • Approximately 50,000 of the refugees are government civil servants, police, military personnel, pensioners and their families. These people continue to benefit from basic government salaries and pensions, although other benefits normally provided to them have been discontinued.
  • Very little land has been allocated to the refugees, other than that within the environs of the camps where some households have established kitchen gardens. Refugees living with relatives have greater access to farm land.
  • All refugees have some form of shelter ranging from pre-fabricated barracks to loosely constructed shelters made of plastic sheeting and branches. Many households received cooking/kitchen sets, blankets, water containers, mosquito nets etc, (no exact data on these items). Water sources, latrines and bathing facilities have been established in most of the larger camps, but some of the smaller camps are not as well equipped. The quality of the drinking water is unknown. Soap distributions have been erratic.
  • Current health care services do not function properly, as the refugees do not seek appropriate assistance at the local health centres. Malaria, diarrhoea, acute respiratory infections and measles were the most common causes of deaths reported by mothers (UNCEF - 12/99).

Preliminary recommendations from the joint assessment and surveys included:
  • Increase the general food distribution to a standard ration of not less than 1,900Kcal/person/day (this figure was calculated using the demographic profile of the population which has a high proportion of young children).
  • Ensure that the ration includes a food basket of cereals, pulses and oil. This ration should not be provided to those receiving regular income from the Government of Indonesia (UNHCR must determine who is eligible before the distributions start and introduce a ration card system).
  • Implement a blanket dry-supplementary feeding programme for all children under-five.
  • Organise selective/targeted feeding programmes for other vulnerable groups including moderately malnourished children.
  • Establish a nutrition and food basket monitoring system

ACH 01/00 Nutritional survey report for Huila Province
ACH 02/00 Nutritional survey report for Ganda town, Benguela Province
IFRC 13/01/2000 Press release: Angolan refugees
IRIN-SA 17/02/00 News Brief
IRIN-SA 21/02/00 News Brief
IRIN-SA 24/02/00 News brief
IRIN-SA 28/02/00 Namibia: WFP called in to help refugees
MSF 17/01/2000 Angola: MSF concerned by cases of adult malnutrition
MSF-B/ICRC 12/99 Rapid nutritional assessment in Kuito, Bie Province
UNHCR 01/00 Status of East Timorese refugees in West Timor/Indonesia
UNHCR 04/02/99 Briefing notes
UNHCR/WFP 03/00 Joint Assessment Mission to West Timor
UNICEF 21/02/00 Internal report on refugees in Zambia
UNICEF 12/99 Nutritional assessment of displaced people from Timor Timur in Belu district
UNICEF 02/00 Nutritional assessment of displaced people in Kupang District
USCR 2/02/00 Indonesia: Situation in East/West Timor
WFP 13/01/00 Emergency report no. 2
WFP 27/01/00 Emergency report no. 4
WFP/MSF-B/ICRC/UNICEF 01/00 Recommendations for intervention in Kuito, Bie Province as a response to the Pellagra outbreak

This report is issued on the general responsibility of the Secretariat of the U.N.'s ACC/Subcommittee on Nutrition; the material it contains should not be regarded as necessarily endorsed by, or reflecting the official positions of the ACC/SCN and its U.N. member agencies.

Funding support is gratefully acknowledged from CIDA, DFA (Ireland), NORAD, UNHCR and WFP. This report was made possible through the support provided to the Food and Nutrition Assistance (FANta) Project by the Office of Health and Nutrition Bureau for Global Programs, Field Support and Research at the U.S. Agency for International Development, under the terms of Cooperative Agreement No. HNE-A-00-98-00046-00 awarded to the Academy for Educational Development (AED). The opinions expressed herein are those of the authors and do not necessarily reflect the views of the U.S. Agency for International Development.

If you have information to contribute to the forthcoming reports/updates, or would like to request back issues of the Reports on the Nutrition Situation of Refugees and Displaces Population (RNIS), please contact

Arabella Duffield
RNIS Co-ordinator
ACC/Sub-committee on Nutrition
20, avenue Appia
1211 Geneva 27
Switzerland

Tel: 41-22-791-0456
Fax: 41-22-798-8891
e-mail: accscn@who.ch