WHO Liberia Situation Report No. 9

I. General
The City of Monrovia remains relatively calm during the day. At night there is an atmosphere of fear of looting and generalized lawlessness.

Most government agencies are yet to resume normal activities. Trade and commerce are gradually reducing as no import and export activities are on going. Prices continue to exponentially increase. The city is gradually running out fuel

Humanitarian aid workers continue to provide humanitarian services to IDPs with whatever that was salvaged after the looting. Those agencies and organization that have manager to bring in supplies by charter flights or by boats have had to pay in cash and not checks cost of cargo weight, airway bill, custom charges etc. In the wake of bank closure many have had to wait for cash to be flown in country. This has delayed services to IDPs in some instances.

A UN County Team/Liberia head by the UNDP/Liberia Resident Representative is currently on an assessment mission in the country.

We have just received report of fighting between LURD and government forces in the same direction of western suburb of Monrovia, site of the previous fighting in June.

II. Sector Reports

A. Sector Updates Of Activities During The Period 10 - 14 July 2003

Over 250 former combatants of the defunct National Patriotic Front of Liberia (NPFL) have threatened to attack their former front line commanders and also make Monrovia "ungovernable", if their compensation of L$5,000.00 each is not paid. They alleged that President Taylor (former leader of NPFL) has already paid the full amount to the front line commanders.

On Monday, 14 July 2003 the Government started deploying troops in the outskirts of Monrovia in readiness for a possible attack on Monrovia by the LURD forces, who claim that the government troops have been attacking their position. An other explanation of the government troops deployment is that the President Charles Taylor will be burying his mother next week; hence he want to make sure that LURD forces will not disrupt the burial activities, since the site of the burial is near the frontline between LURD and Government Forces. This movement of troops is forcing civilians to start moving back into central Monrovia for safety.

B. Health

In addition to MERLIN and MERCI, IRC has begun operating ambulance service. The Ministry of Health is to coordinate the operation of ambulance service by the NGOs.

The Ministry of Health in collaboration with WHO and UNICEF has concluded the first phase of measles/tetanus immunization campaign in 8 host communities and 25 immunization site in and around Monrovia. The immunization campaign is targeted at 52,000 children under five years of age for measles antigen and 84,000 child bearing age women for tetanus toxoid. During this first phase 40,000 (76.9% of the target population) children were immunized against measles and 45,000 (55.6% of the target population) women received TT antigen. UNICEF also donated essential drugs and medical supplies to clinics in and around Monrovia.

The severe diarrhea situation remains a concern in the health sector. MSF/B recorded 350 admission of severe diarrheal cases from their three operated diarrheal unit in Monrovia during week 28 of 2003; 7-13 June 2003. Two new dirreaheal units with a capacity of 190 beds have been established by MSF/B in the Central Monrovia to supplement the JFK Memorial Medical Center Cholera unit. A review of admission data from the cholera unit reveals the information in the table below.

The table above clearly demonstrates that about 93.7% (460 cases) of severe diarrhea admitted (491 cases) at the cholera unit, during the period under review originated from 6 communities in and around Monrovia. Out of the total 491 cases that were admitted, 68.6% (337 cases) originated from Central Monrovia and Bushrod Island.

Therefore the first phase of the proposed mass chlorination will be targeted at Central Monrovia, Bushrod Island and the Sinkor areas. These three locations account for 79% (389 cases) of all cases (491 cases) admitted during the period under review. Health promotion on diarrhea prevention and control will be carried out in all communities.

There appears to be proper case management as the CFR remains under one (1) at the cholera unit.

C. Food

WFP is continuing to distribute food at the IDP sites in Monrovia. It is still very risky to distribute food at the sites in the outskirts of Monrovia; for armed men could invade the sites to intimidate or rape the IDPs before taking away their food rations. Only 21 out of 89 IDP shelters have received food from WFP and other partner in the food sector.

Food distribution at the IDP sites even in Monrovia is becoming increasingly difficult; for non-IDPs tend to infiltrate the sites only to benefit from the food distribution. Unless the plight of the greater communities outside of IDP Center, who themselves are just as destitute as the IDPs more IDPs shelter will continue to be established in and around Monrovia

Agencies with high-protein biscuits have planned to collaborate in coordinating the process of distribution in order to prevent needless duplication.

In collaboration with ACF and SCF/UK, WFP is planning a rapid food security survey in and around Monrovia.

D. Nutrition

ACF has established a therapeutic feeding center in Mamba Point and supplementary feeding centers in SKD Sport Stadium, Newport Junior High School, D. Tweh High School and Clara Town communities and IDP Centers. Measles immunization is also carried at the therapeutic centers.

During the period 1 - 10 July 2003, ACF screened 1,733 children under five years of age within in Monrovia. The results are as follows: 183 (10.6%) children were term as at risk of malnutrition, 466 (26.9%) children were found to be moderately malnourished and 84 (4.8%) children were severely malnourished. World Vision is currently conducting a nutrition survey in Monrovia.

MSF/B at the Health Sector Coordination meeting reported that malnourished children over years of age are appearing at their clinic in Mamba Point. This situation should be further investigated as this is a sign of malnutrition in the general population.

E. Shelter

LWS has recently distributed 1,000 pieces of tarpaulins at the Greystone and Salala IDP sites.

The need for appropriate shelter is becoming more urgent among the IDPs, as the rainy season becomes more intense.

To date there 92 IDP sites in Monrovia with an approximate population of about 177,000.

F. Protection

There are plans to reactivate the two monitoring teams.

The number of protection monitors is small to cope with the growing number of IDP sites.

IDPs have alleged that reports of rape and harassment have not been thoroughly investigated by the humanitarian coordination committee.

E. Refugees

UNHCR is continuing to repatriate Sierra Leonean refugees in Liberia.

It is now very difficult to contact the refugees in Grand Gedeh County; and the refugees in Nimba County can be contacted only by radio communication.

G. Water and Sanitation (WATSAN)

The WATSAN Coordination Committee is reactivating the monitoring teams.

Monrovia City Corporation is appealing for sanitation tools, because all their tools have been looted.

EU is carrying out chlorination of wells; and UNICEF, WHO and MOH have finalized plans for mass chlorination of wells in and around Monrovia. Chlorination of wells is to be thoroughly coordinated to ensure efficiency. The exercise will be carried out in three phases.