Sudan

Emergency food security and nutrition assessment in Darfur, Sudan 2006: Final report

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Assessment
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Acknowledgements

Those involved in the assessment are deeply grateful to the individuals, households and communities of Greater Darfur for their time and hospitality. This assessment report is the culmination of months' worth of effort of many individuals and organizations.

The assessment was truly an inter-agency food security and nutrition assessment, and many organizations were involved in its design, the collection of data and the production of this report.

The main agencies involved in the assessment were World Food Programme (WFP), United Nations Chidren's Fund (UNICEF), the Food and Agricltural Organization of the United Nations (FAO), the Ministries of Health (MOH) and Agriculture (MOA) of the Government of Sudan and the United States Center for Diesease Control and Prevention (CDC). We also appreciate our gratitude to the Humaintarian Aid Commission (HAC) who provided full-time staff.

We gratefully acknowledge the many organizations (too many to list here) that contributed staff, vehicles and other logistical support to ensre that everything went smoothly.

We are deeply appreciative for the helpful comments of various organizations on the design of the survey, its implementation and preliminary during the presentations in Khartoum and in the three Darfur States.

Chapter 1: EXECUTIVE SUMMARY

1.1 Background to the assessment

In September 2006, an Emergency Food Security and Nutrition Assessment (EFSNA) was conducted by the Food and Agriculture Organisation (FAO), the United Nations Childrens Fund (UNICEF) and the World Food Programme (WFP) in crisis-affected Darfur with the support of the Ministries of Health and Agriculture of the Government of Sudan (GoS), the Center for Disease Control (CDC-Atlanta) and several international and national nongovernmental organizations (NGOs). This assessment was undertaken in order to update knowledge on the food security and nutritional situation of internally displaced persons (IDPs) and residents in Darfur affected by three years of conflict. This data allows a comparison with the situation in 2005 and 2004. It also aims to re-assess access to services and coverage of assistance programmes among the crisis-affected population and offers recommendations for immediate, medium and longer term interventions to save lives and support livelihoods.

The Greater Darfur region of Sudan consists of 3 states (North Darfur, West Darfur and South Darfur) covering an area of 511 412 km2. The total population in 2005 has been estimated at 6.76 million, of which approximately 81% reside in rural areas. This assessment covered crisis-affected areas of North, South and West Darfur States, as defined by the humanitarian community. The sample frame included 3.74 million people in Greater Darfur.

The conflict in Darfur began in February 2003 with an insurgency campaign launched by the rebel Sudan Liberation Movement/ Army (SLM/A) and counter-insurgency action by the Government of Sudan (GoS). It quickly generated into widespread insecurity and displacement. The conflict results from several long-held grievances and underlying causes including (1): the perceived marginalisation and neglect of Darfur by the central government for decades as well as the marginalisation of non-Arab nomad tribes within Darfur; national and international strategies of arabisation; drought and competition over limited natural resources within Darfur; disagreements on land tenure rights; and previous tribal conflicts between Fur and Arab, Zagahwa and Arab, and Masalit and Arab in the late 1980s and 1990s, largely linked to the above factors.

The conflict has resulted in in major population displacements and severe disruptions to livelihoods (2). Looting of remaining livestock, violence and the restriction of movement of IDPs and some residents has been almost continual since 2003. The success of the African Union mission launched in 2005 in contributing to a secure environment and the protection of civilians has been limited. A Humanitarian Ceasefire Agreement was adopted in May 2004, and one-year later, the Darfur Peace Agreement was signed by some factions of the rebel movement and the GoS on 5 May 2006. Despite the signing of the DPA, the security situation in Darfur has deteriorated.

1.2 Assessment Objectives and Methods

For the purposes of this assessment, households were interviewed to assess their socioeconomic and food security situation. Specific information was collected on each mother of children under 5 years of age including their participation in income generating activities and decision-making, maternal antenatal care, child feeding practices and child health. Anthropometric measurements were taken on mothers (mid-upper arm circumference) and children under 5 years of age (mid-upper arm circumference, weight, height and oedema) to assess nutritional status. Key informant interviews were conducted in every community and focus group discussions on gender issues were held with men and women separately in each Darfur state. Information was collected on access to services, including health structures, water and sanitation services, cooking fuels access, agricultural markets, income generating opportunities and labour markets.

The survey included 2,155 households of which slightly more than half were IDPs. The displaced in camps represented 39% of the sample, of whom 9% were IDPs living in communities where they outnumbered residents and 5% were IDPs living in the minority. Residents living in communities with no IDPs represented 11% of the sample, 30% were residents in communities where IDPs are in the minority and 7% were residents in communities where IDPs outnumber residents.

1.3 General results

Security is clearly the main constraint impeding both residents and IDPs to conduct their usual livelihood activities, including food production (cultivation and livestock raising) and income-earning activities (sale of own production, seasonal migration, remittances). The presence of large numbers of IDPs is putting a serious strain on the availability of land, grazing areas, water for animals and humans and the labour market. This affects both residents and IDPs living in these communities.

There are no indications that the conflict will recede in the foreseeable future. The Darfur Peace Agreement has not succeeded in bringing about peace and on the contrary, heightened tensions, particularly in North and West Darfur. Attacks on humanitarian workers have also increased since May 2006, severely jeopardizing the ability of humanitarian agencies to reach the most vulnerable people in need of assistance.

The impact of the ongoing conflict was reflected in the assessment results: IDPs displaced for less than a year were found in North (38%), South (17%) and West Darfur (8%). Displacements during the past year had occurred in about half of the communities in North and West Darfur, compared to a quarter of communities in South Darfur, reflecting the more intense conflict in those regions. At the same time, more than two thirds of communities in Darfur reported the limited return of former IDPs, though the number of households concerned was low, at 10% of all residents.

There were slightly more female-headed households among IDPs (25%) than residents (19%). Female-headed households were found to be worse off in terms of income generation, security (for water, food and firewood collection) and ability to cultivate or own livestock. Female-headed households, and households whose head was illiterate, were more likely to have poor food consumption patterns (3). About 64% of the male heads of household were literate compared to only 13% of the female heads. Male-headed households owned, on average, twice as many animals as female-headed households. A similar proportion of male- and female-headed households received food aid since January 2006, however.

Accordingly, there were slightly more female-headed households among those severely food insecure and at high risk to lives and livelihoods (24%), than in the food secure/low risk households (18%). In addition, more than half of the female-headed households were severely food insecure and less than one quarter were food secure, compared to 45% and 30% respectively of male-headed households.

The average size of the household in Darfur was 6.2 members.

1.4 Mother/ Child Health and Nutrition

1.4.1 Mother/ Child Health and Nutrition Results

The prevalence rate of global acute malnutrition (GAM) and severe acute malnutrition (SAM) showed no significant differences from the 2005 survey. GAM rates were highest in North Darfur (16%). They did not differ from 2005 in North and South Darfur but were significantly increased in West Darfur although the level remained below the emergency threshold of 15% and was the lowest of the three states. There were no differences in results between boys and girls except in South Darfur where boys were more likely to be acutely malnourished than girls. The prevalence of acute malnutrition was significantly higher amongst children aged 6-29 months compared to children aged 30-59 months.

With regard to the nutritional status of residents and IDPs in Greater Darfur, there was no significant difference in GAM prevalence. In North Darfur, however, residents had a significantly higher rate of malnutrition than IDPs. This may be linked to the higher proportion of residents in North Darfur, and to differences between conditions in the camps and those in the open population, particularly with regard to access to safe sources of water and improved waste disposal facilities.

Stunting, reflecting chronic malnutrition, was high at 36.6% overall. Results showed that this is probably due to the poor health status of children caused by diarrhoea related to limited access to safe water and sanitation. Wasting prevalence was 15.6% for those consuming unsafe drinking water and 11.5% for the others, however it should be noted that overall there was a 10% increase in the proportion of households reporting access to a safe source of drinking water compared to 2005. There was a slightly higher prevalence of wasting in households using traditional latrines compared to improved latrines. Less than one quarter of all households were using improved latrines. Traditional latrines were more frequently used in North Darfur than in South or West Darfur. Residents are more likely to obtain water from unsafe sources and use traditional latrines than IDPs, which may explain trends observed of higher prevalence of child malnutrition among residents as compared with IDPs. IDPs also benefited from better coverage by supplementary and therapeutic feeding programmes, particularly in camps.

Importantly, household food consumption patterns and the overall household food security situation were not statistically associated with child malnutrition. Food insecure households were more likely to depend on food aid for consumption and it may be that food aid contributed to protect children's dietary intake. The results indicate that a high dependence on selling food aid for income generation was not associated with higher risks of acute malnutrition. However chronic malnutrition tended to be more widespread among children of these households - i.e. children of displaced, settled, food aid-reliant (poor) households. Acute malnutrition was higher in households with resident characteristics - households with higher numbers of animals, reliance on selling crops. This corresponds with the seasonal timing of the survey, which was carried out during the hunger gap: residents would still be feeling these seasonal effects whereas IDPs do not with the regular supplies of full rations of food aid. These results also reflected State differences: a higher proportion of acute malnutrition was recorded in North Darfur, where there are higher numbers of resident households, and where there have been problems with low rainfall, livestock disease and insecurity affecting market/ safe water access. South Darfur (mainly IDPs in camps) recorded the highest rates of chronic malnutrition. In West Darfur, however, the results show there are the highest number of households at risk to lives and livelihoods, a probable consequence of the high insecurity experienced by IDPs and residents alike.

The prevalence of reported illness in children (fever, cough, bloody/ watery diarrohea) was lower than in 2005. Measles vaccination coverage results were similar to those in 2005 and are insufficient to ensure community-level protection. Vitamin A supplementation had been received by almost 40% of children aged 6-59 months. The primary caretaker of children below 2 years of age was their mother, with about 10% inadequately cared for (by young siblings or by no one). Breastfeeding rates for babies less than 6 months of age was very high although only 60% of these mothers were breastfeeding exclusively.

According to key informants, Supplementary Feeding or Therapeutic Feeding Programmes could be accessed in 30% of the communities. Their availability was much higher in West Darfur (56% SFP, 52% TFP) than in the North (23% SFP, 29% TFP) and South Darfur (17% SFP, 20% TFP). Camps and communities with an IDP majority had much better access to feeding programmes than areas without IDPs. Both the availability of selective feeding programmes and enrolment of malnourished children in SFP or TFP were much lower than in 2005 in the three states.

Based on assessment results, an average of 10% of pregnant and lactating women were malnourished. Rates were highest in North Darfur at 14.5%. About 16% of mothers of children 6 to 59 months of age in the sample were pregnant at the time of the survey. More than half of all mothers interviewed were breastfeeding. Only 19% of mothers had received vitamin A following the birth of their last child. There were no differences in results between IDPs and residents. Iron-folate supplementation during pregnancy was reported by 31% of women overall. A slightly higher number of IDPs had received iron-folate than residents. Bed net usage by mothers (to combat malaria) was 44% (48% for pregnant women) overall, but there were significant differences between IDPs (37%) and residents (61%), possibly because of smaller IDP houses or because IDPs were unable to carry their bed nets with them when they were displaced.

Physical access to health facilities was found to be better in West Darfur than in South and especially North Darfur. More than half of the communities in North Darfur were located more than 2 hours walk from a health facility. As expected, IDPs living in camps with access to free healthcare were generally dedicating less of their monthly expenditures on health than residents.

1.4.2 Mother and Child Health and Nutrition Recommendations

Programmes aiming to reduce and/or prevent malnutrition must focus on increasing access to safe water and sanitation, and reducing disease incidence, particularly diarrhoeal disease, respiratory infections and fever. Health and hygiene promotion should be strengthened to include all populations, resident and non-resident, and be supported by provision of appropriate non-food items such as water containers, blankets, mosquito nets, where needed.

Nutrition programmes should focus mostly on children under the age of three years, since this is where the majority of acute malnutrition is found. Caring practices are a key factor in young child nutrition and health status: exclusive breastfeeding must be promoted and fully explained to mothers and midwives. Education on child caring practices should include other family members, particularly fathers, grandmothers and eldest daughters.

Routine immunisations and supplementation of vitamin A for all children should be strengthened, and health clinics supported to provide these vital services. Campaigns to maintain high levels of measles and polio immunisation are also necessary in situations of conflict such as Darfur.

Outreach and early case finding of malnourished children in the communities should be strengthened where possible, to improve coverage of therapeutic feeding programmes, especially in North Darfur. Supplementary feeding programmes should focus more on education for caretakers and be used as an opportunity to raise awareness of appropriate health, hygiene and caring practices, rather than simply as a distribution of food. Outreach should also be expanded to ensure early detection and treatment of moderately malnourished children and women.

Interventions to increase supplementation of pregnant women with iron/folate and to provide post-partum vitamin A to new mothers should be supported and expanded to include resident as well as displaced groups.

Routine surveillance activities should be strengthened to allow early detection of changes in nutrition and health status, and to remove the need for large annual surveys. Such surveillance systems should be integrated into government structures and include food security monitoring indicators.

1.5 Food availability, security and food/ non-food targeting results

1.5.1 Food availability results

Assessment results showed that there was no significant difference between the number of households who cultivated this year compared to 2005. Just over half of all households had cultivated in 2006, a low result given that more than 75% of the population normally rely on agricultural production in Darfur. Only 24% of IDPs cultivated this season compared to 80% of residents. IDPs living in communities cultivated more than those in the camps. The average area cultivated by households during this season was less than half the area of last year. By comparison, trends in vegetable production showed an increase. Less than half of the households owned a home garden (jubraka), however. Vegetable production by residents was more frequently undertaken in communities where many IDPs were present. A similar proportion of IDPs and residents were cultivating cash crops (groundnuts, watermelon and other vegetables), reflecting the preferences of IDPs with limited acreage at their disposal for income generation.

With regard to crop production constraints, insecurity, limitations in accessing agricultural inputs such as seeds, tools and animal traction and problems with weeds, pests and crop diseases were cited. Additionally, poor rainfall/ dry spells were a problem in North Darfur where rains were late and in some places, badly distributed.

Access to markets for agricultural inputs and produce was much better in West Darfur than in South Darfur, and worse in North Darfur, reflecting differences in size and population density between the three states. Most communities indicated that trade for agricultural inputs and produce has decreased compared with 2005, particularly in North and South Darfur. About 30% of households cultivating or gardening were located more than 2 hours walk from agricultural markets.

The proportion of households engaged in livestock production was similar to 2005 except for the ownership of donkeys, which increased. Livestock Tropical Units (LTU) ownership was found to be lower than the average of 3-5 LTU per household considered sufficient to support livelihoods and food security. More than half of the households in South Darfur, a quarter of households in North Darfur and a third of households in West Darfur did not own any animals. Residents owned on average a larger number of animals than IDPs living in communities. As expected, IDPs in camps owned the lowest number. IDPs displaced between 1 and 3 years ago were the least likely to own animals compared to those displaced before the conflict and those displaced less than one year ago.

The main constraints to raising livestock were linked to insecurity and violence, including looting. This problem was particularly acute in West Darfur, and slightly less in North Darfur. In North Darfur, low pasture quality and quantity as well as animal disease were problems most frequently mentioned. Most reported that the situation has got worse since 2005.

Food prices on rural markets were said to have increased compared to last year at this season, even though this was not confirmed by market prices collected from the three main state town markets. The number of traders seems to have decreased, reflecting lower market activity. Physical access to markets is particularly difficult in North Darfur, and easier in West Darfur.

IDPs and residents living in communities with many IDPs were less likely to access income earning opportunities, a reflection of the pressure caused by the IDP influx on host communities. The primary source of income was waged labour for 45% of the IDPs and 29% of the residents. Other income sources cited included selling firewood, cereals and food aid and petty trade. The main constraints to income generation for over half of households were cited as insecurity and limited employment opportunities.

1.5.2 Food Security results

The main coping mechanisms of the population are a combination of: (i) reliance on food aid both for direct consumption and as a source of income; (ii) expanding the sources of income and the level of income, by diversifying the income-earning base and sending members out in search of labour and income; (iii) indebtedness to relatives, neighbours and traders, mainly to purchase food; and (iv) decreasing the amount of food consumed. These mechanisms can be considered as relatively efficient in maintaining the status quo but they have a cost and short- and longer-term implications on nutrition and economic security.

Three household groups were defined on the basis of their current food consumption pattern (dietary diversity and food consumption frequency), their dependence on food aid for their food intake, and their level and share of food expenditures. These three categories were defined as severely food insecure, moderately food insecure and food secure.

Compared to 2005, the proportion of households with a poor food consumption pattern is twice as high. Residents living in communities with a majority of IDPs were less likely to have acceptable food consumption than the other residents. Almost half of the households (46%) were severely food insecure and at high risk to lives and livelihoods in the short-term, 24% moderately food insecure and at medium risk and 30% food secure and at low risk.

The food security situation and livelihoods of IDPs are worse than the residents, particularly for IDPs in camps and in communities where they outnumber the residents.

- 58% of the IDPs were severely food insecure and at high risk in the short-term, 25% moderately food insecure and at medium risk, and 17% food secure.

- 34% of the residents were severely food insecure and at high risk, 24% moderately food insecure and at medium risk, and 42% food secure and at low risk.

IDPs face more severe limitations with regard to food security constraints. A significant proportion of residents are also affected by food insecurity and risk to their livelihoods however, especially those living in communities where IDPs are in the majority. This is due to increased competition for limited natural and economic resources. Insecurity is clearly the biggest constraint to the livelihoods of both residents and IDPs, including crop cultivation, livestock production and waged labour.

1.5.3 Food targeting results

Of the households who did not receive food aid in August, almost 30% were food insecure and at high/medium risk to lives and livelihoods at that time. This can be taken as an approximation of the exclusion error of the food aid programme, but caution is required as food aid distributions coverage in August 2006 was particularly low due to insecurity impeding access to several hundred thousand beneficiaries in North and South Darfur. Moreover, due to insecurity, beneficiaries in some locations received double rations in July.

Of the households who did receive food aid in August, 77% were food insecure. This can be taken as an approximation of targeting efficiency, but again this is valid only for that point in time. The high proportion of food insecure beneficiaries also confirms that food aid alone is not sufficient to improve their food consumption and that it cannot be expected to resolve food insecurity if it is not accompanied by additional interventions in the political, economic, health, education and other social domains.

Accordingly, 23% of the households who received food aid in August 2006, were food secure. While this could be interpreted as an inclusion error for at that time, it should not be concluded that these food secure beneficiaries do not need food assistance. The assistance may be essential to protect food security and livelihoods, especially if unpredictable changes caused by the conflict and/ or environmental conditions impede current livelihood strategies.

1.5.4 Non-Food Aid/ Agricultural targeting results

About 20% of households reported that they received farming tools and 36% seeds, but less than 2% benefited from veterinary services. Residents were more likely to have received these services than IDPs, except in communities with no IDPs where fewer residents benefited from such support. Only one quarter of the households regularly cultivating benefited from seed distributions, but 68% of those with a jubraka (home garden) received seeds. The seed distribution had a positive effect, doubling the area cultivated in those households.

About 40% of households received soap, 30% blankets, jerry cans, plastic sheeting or sleeping mats, 23% buckets, 15% mosquito nets, and 7% cooking utensils. IDPs were more likely to benefit from this assistance than residents, especially those in camps. Residents living in communities with a majority of IDPs were more likely to have received non-food items than the other residents.

1.5.5 Food availability, security and targeting of food/non-food recommendations

General food distributions remain the best option to assist food insecure households considering (i) the current security situation that prevents the implementation of recovery programmes on a large-scale, (ii) the limited livelihoods options of the people, and (iii) the potential of food in-kind to improve the poor/borderline food consumption of more than half of the households. However food aid alone is not sufficient to ameliorate significantly and on the longer-term the diet and food security situation of affected households, especially given that a large part of the ration is being sold to acquire other foods or cover other essential expenses. To compensate for this, the levels of food assistance could be increased (though this is probably not cost-efficient) or food aid be complemented with cash/vouchers transfers and other assistance (agricultural inputs in particular) wherever the security conditions allow.

In accordance with expressed community priorities, consideration should also be given to the provision of food aid as food/cash/vouchers-for training for skills building and development of human capital, improvement of child feeding and care practices, and food/cash/voucher-for-work for the restoration of basic infrastructures such as roads, houses, and schools. Options for these programmes should be explored on a continuous basis and implemented on a pilot basis as soon as conditions allow, including in camps and in communities with large numbers of IDPs.

In terms of targeting, adjustments of the assistance should be made to: (i) account for the improvement of the food security situation that will take place with the forthcoming harvest; and (ii) minimize exclusion errors (priority) and inclusion errors. On an 'administrative' basis, targeting priorities are: (1) IDP camps, (2) communities where IDPs out-number the residents, (3) communities (with or without IDPs) facing security problems or suffering from specific climatic, pests/diseases or agro-ecological difficulties, (4) communities with small numbers of IDPs, and (5) communities with no IDPs and no major security problems.

Household targeting is currently not recommended in view of the potential internal and external security risks and low cost-benefits expected, however some criteria can be suggested should the conditions allow at a later stage.

There should be some flexibility to adjust the level of the ration at some periods of the year to account for changes in the food security situation linked to the harvest or to the security situation enabling or impairing households to carry out their livelihood activities.

The participation and membership of women in Food Aid Communities should be enhanced, in accordance with WFP's gender policy.

School feeding is already envisaged for up to 150 000 children, as a substitute to general food distributions in communities where the overall food security situation has significantly improved. Assessment results indicate that implementation of school feeding would have a strong impact in North Darfur where nut