NUTRITION SECTOR REPORT DARFUR NUTRITION COORDINATION GROUP Photograph by Shehzad Noorani April May 25 Update
The Darfur Nutrition Update is produced on behalf of the Sudan Ministry of Health by the UNICEF-Sudan Nutrition Office, with input from UNOCHA, FAO, WHO, WFP, WES, Sudan Ministry of Agriculture, MSF, ACF, Tear Fund, GOAL, NCA, Concern WW, SC-US, Relief International, MSF-H, MSF- B, MSF-F, MSF-CH, MSF-Spain, WVI, Islamic Relief, SUDO, CODAID and CARE. Sudan Ministry of Health NUTRITION SECTOR REPORT April-May 25 Nutrition Coordination Group 1. Overview 2. South Darfur Update 3. West Darfur Update 4. North Darfur Update 5. Treatment of Acute Malnutrition Training Workshop 6. Nutrition Surveillance 1. OVERVIEW During April and May 25, the nutritional situation has deteriorated for the vulnerable population of Darfur. This has been confirmed by various nutrition survey reports as well as the increased admissions in the Selective Feeding Programmes across Darfur. These increases have been most pronounced in South Darfur and in particular sites within North Darfur. New admissions to feeding centres in West Darfur have maintained a relatively steady level. The current deterioration in the nutrition situation is attributed to a combination of factors, including the early on set of the hungry season in many locations, inadequate access to safe water in some locations, poor sanitation and hygiene practices, and overall security problems that have imposed constraints on food delivery and intervention activities. WFP has reported that the number of people who received food during this period is less than the monthly target, due to insecurity and logistical problems faced by WFP and its implementing partners. Feeding centres are currently coping with the increased need. However, feeding programmes only treat the manifestations of malnutrition. The underlying causes of malnutrition must also be addressed in order to see longer-term positive changes in nutritional status. 2. SOUTH DARFUR UPDATE The already fragile overall food security situation in South Darfur has been worsened with the early start of the hunger gap this year. Prices of grain have increase by almost 1-17% in the main markets as reported by FAO. Security incidents, including those noted on Sania Afendu and Nyala road, continue to affect the sustainability of nutrition and other interventions and are causing interruptions in the impact that could have been made with these programmes. On the other hand, WFP has maintained general food rations at the same level i.e. 12 1 8 6 4 2 Trends in admission in SFP and TFP in South Darfur, May 2 - May 25 TFC Adms SFC Adms May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan-5 Feb-5 Mar-5 Apr-5 May-5 1
21 kcal. Yet for example in Kalma camp, the distribution for the whole month of May was missed as a result of delays in a verification exercise. In addition, new arrivals have still not registered for food aid in several camps, such as Ed Daein and Kalma. WFP has agreed with implementing partners to provide emergency rations to new arrivals. Yet, insecurity and logistics problems continue to constrain food delivery. There has been an increase in Feeding centres in Kass, Ed Daein, Gereida, Mershing, Manawashe and Duma, and Otash, El Geer and Dereg and El Sherif. Interventions have covered localities such as Nyala, Kass, Shariea and Ed Daein localities. Yet other localities, such as Buram, Ed El Fursan and part of Adilla localities, are not adequately covered. This is partially attributed to insecurity in that individuals from the different localities are drawn to the camps that are considered safe, which is a possible explanation to the growing number of new arrivals since January and February in Kalma and Nyala town (Otash, Sherif, and El Geer) camps. This scenario is expected to continue, unless the security situation allows services to be decentralised in those less safe localities. It is however worth noting that many more TFCs and SFCs have been opened in South Darfur compared to the same period last year. This relates to an increase in admissions, as a result of active case findings at the community level. Ed Daein IDP camp also has a high number of children in both the TFC and SFC and this is expected as high rates of GAM were recorded before the programme was established. A joint WFP/UNICEF/OCHA/WHO/HAC report indicates that access to already existing Feeding centres in El Ferdous is not the same for Dinka IDPs and host community. This has been discussed with Tear Fund and a solution is being sought to ensure that Dinka IDPs have access to the Feeding programme. Generally speaking, in South Darfur, the already established feeding programmes are coping with these increases. Yet further increases in Kalma will require the re-establishment of additional TFC and SFC sites. A better-suited solution would entail relief interventions providing adequate general ration, preventing and treating diseases, and providing adequate water and sanitation facilities. In the absence of an integrated approach to the service delivery, the feeding programmes will continue to treat the manifestations of inadequate food intake and diseases, with very little impact on the overall nutrition status in the community. A series of nutrition surveys conducted in South Darfur during the first quarter of this year and the information regarding emergency interventions indicate a critical nutrition situation and confirm that the malnutrition situation in South Darfur is serious and deteriorating. The most recent surveys were conducted in during April and May 25 in Otash, Sherif, El Geer and Sania Afendu. A global acute malnutrition rate (W/H <-2 Z score or oedema) of 22% and a % 3 25 2 15 1 5 Rates of GAM and SAM in South Darfur, Jan - May 25 Kalma Nyala Town Kubum Ed Daein Otash/Sherif/El Geer Sania Afendu Jan-5 Jan-5 Feb-5 Mar-5 May-5 May-5 severe acute malnutrition rate (W/H <-3 Z score or oedema) were reported in Otash and Sherif, while in Sania Afendu, a GAM rate of 23% and a SAM rate of 2.7% were reported. Malnutrition rates across the South Darfur appear to be on the increase and other nutrition surveys carried out in South Darfur since March 25 have found similar rates. Tear Fund found 25% malnutrition in El Daein in March and Feeding centres across the State have also been reporting a dramatic increase in admissions during the past two months. GAM SAM 2
3. WEST DARFUR UPDATE 25 2 15 1 5 Trends in admission in SFP and TFP in West Darfur, May 2- May 25 TFC Adms SFC Adms May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan-5 Feb-5 Mar-5 Apr-5 May-5 A steady deterioration of the comparatively improved nutrition situation recorded in December 2 and January 25 has also been reported in West Darfur. During April and May 25, there have been security incidents in Mornei, Kulbus, Jebel Moon and the Jebel Mara area, which did not only interrupt nutrition interventions but also general food distribution (GFD), health, water and sanitation. The situation is expected to further deteriorate given the start of the hungry and the rainy seasons, which are normally characterised by an increase in diseases and malnutrition. Although an increase in admissions has been reported throughout West Darfur, it has not been as pronounced as that in South Darfur. In El Geneina, Selea and part of Kulbus, there has been a steady increase in admissions to feeding centres. This increase has been noted in the Out Patient Therapeutic Feeding Program (OTP) and SFCs. In Mornei, mapping of the areas where the new admissions came from indicated that most of the affected children came from two areas beside the Wadi. Most households in the areas collect water from the Wadi; this could be the cause of the reported diarrhoea. The WES sector is currently investigating this report. In the Mesteri corridor, Tearfund resumed its activities after almost 2 months of interruption due to insecurity. The number of beneficiaries has increased in both the SFP and OTP. Several factors contributed to the increase in admissions within the Tear Fund area, including the start of the hungry season. In addition, an increase in admissions is partly attributed to the increase number of outreach workers responsible for active-case finding as well as an influx of nomads from Chad to Sudan. An increase in defaulters has also been reported as a result of increased insecurity and population movement. Feeding centres managed by SC-US in Krinding I and Sisi have reported that admissions seem to be stable. The slight increase in admissions reported is attributed to active case finding at the community level. In the Jebel Mara area, GOAL has also reported a steady increase in admissions, although insecurity has affected distribution of supplementary food. Yet in Garsila, Bindi, Um Kher and Um Dukkon, increases in admissions have not been pronounced and are considered normal during this period of the year. In the Selea and Kulbus administrative units, insecurity has disrupted the majority of scheduled feeding programs. Since the beginning of May, the Kulbus locality, which includes Jebel Moon, has been declared as safe. Concern WW has resumed its normal activities in the area. After a long period of insecurity, Tearfund resumed its program in the Mesteri corridor (Mesteri, Kongo Haraza, Beida and Arara). In Kerenic AU, World Relief is planning to expand its program by opening 2 new SFPs in addition to the 4 existing ones. In El Geneina AU, SC-US continues to support nutrition programmes in Krinding II; consultations between the SMOH and SC-US are ongoing to set up a new nutrition site in Krinding II. Problems with registration in Krinding II have interrupted food distribution and a nutrition survey planned for El Geneina town in May. Market prices surveys undertaken in April and May 25 revealed that shops and markets around El Geneina currently have very low food stocks. This information confirms that, overall, the hunger period has begun well before the peak, which is normally expected in July and August. 3
The nutrition situation seems to be slowly deteriorating, compared to the relatively stable situation recorded in surveys conducted in January 25. Two surveys have been conducted during April and May. The first survey was conducted by GOAL in Jebel Mara. At 16.2% <-2 W/H Z-Scores, the GAM is ranked as critical. This is not exceptionally high considering the seasonal timing post failed harvest, and the extremely infrequent and incomplete general food distribution in the area. CMR was recorded just above normal at 1.1 deaths per 1, per day. The CMR is a little elevated compared to the emergency threshold of 1 death per 1, per day. However, the SAM of 1.5% is acceptably low. A U5MR above the emergency threshold (3.2 deaths/1,/day) was recorded, which is clearly high. These core findings indicate a serious situation, which is likely to worsen during the hunger gap and before next October/November. The GOAL-led survey is the first in this area, so there is no baseline to compare the results against. The second survey was conducted by World Relief International in 4 areas of Kerenic AU and revealed that GAM is around 14% and SAM is 1.4 %. The reason for such a high GAM (in comparison with others surveyed areas in West Darfur) is that the area was considered highly insecure during the whole period between January and March 25, due to clashes between rebels and the GoS around Jebel Moon (North of Kerenic). As a result, the WRI feeding program in these areas was regularly interrupted. 4. NORTH DARFUR UPDATE 45 4 35 3 25 2 15 1 5 Mar- Apr- May- Trends in Admissions in TFCs and SFCs in North Darfur, March 2 - May 25 Jun- Jul- Aug- Sep- SFC Adms Oct- Nov- Dec- TFC Adms Jan- 5 Feb- 5 Mar- 5 % 18 16 14 12 1 8 6 4 2 Apr- 5 May- 5 Rates of GAM and SAM in West Darfur, Jan-May 25 Mornie Selea Furbaranga Mester/Arara Jebel Mara Kerenic Jan-5 Jan-5 Jan-5 Jan-5 Mar-5 May-5 In North Darfur, an increase in admissions into feeding centres has been reported across the state. Supplementary feeding has observed an estimated 3-4% increase in admissions every month since January, while TFP admission rates seem to be steadily increasing. High rates of default and subsequent readmissions, new arrivals into camps and the start of the hungry season have been sited as reasons for the increase in TFC and SFC admissions. The hungry season in North Darfur normally requires several household members, especially women, to seek out casual labour in exchange for cash or food. This usually affects the quality of care given to small children. Relief International (RI) has taken over the MSFE targeted feeding program in Tawilla and Dali camp areas. So far, RI has been able to admit about 25-3 anthropometrically-eligible, underfive children into their Dry Supplementary Feeding Program. RI also has a CTC model taking care of severely malnourished children as well as established health facilities that respond to health needs. MSF Belgium is planning a Blanket Supplementary Feeding intervention in the Korma areas to prevent children at-risk of getting malnourished; this would be a three-month response. Rapid Assessments in rural Mellit revealed that this area is becoming increasingly food insecure. GAA and GAM SAM 4
WFP are jointly planning to provide General Food Assistance to 19, affected residents. CHF International is currently providing a free milling service to IDPs in ZamZam camp. They have plans to expand this service to Abu Shouk in July 25, which could act as an income transfer strategy to improve the purchasing ability of IDPs in the two camps. Four nutrition surveys were conducted during 25 2 15 1 5 El Fasher Town Rates of GAM and SAM in North Darfur, March-May 25 Korma Zamzam Kabkebiya Kutum Mar-5 Apr-5 May-5 May-5 May-5 April and May 25. In ZamZam, the survey was carried out in May; GAM and SAM were at 23.6% and 3.1% respectively. In Korma, the survey was conducted in April; GAM and SAM were recorded at 19.6% and 1.6% respectively. In Kebkabiya, the survey was carried out in May; GAM and SAM were recorded at 17% and.7% respectively. In Kutum/Kassab, the survey was conducted in May; GAM and SAM were recorded at 17.7% and.8%. All surveys used the 3x3 cluster sampling method. GAM is expressed as <-2 Z score and SAM is expressed as <-3 Z score. The results of the surveys in all the sites covered could indicate that the overall malnutrition rate in North Darfur is serious. GAM SAM 5. TREATMENT OF ACUTE MALNUTRITION TRAINING WORKSHOP For UNICEF as the sector coordinator, the strengthening of coordination, reporting and standardisation of approaches for the treatment of acute malnutrition remains a priority. In order to build on the knowledge of practitioners and promote adherence to protocols, UNICEF has coordinated a workshop on the "Management of Severe Malnutrition." Professor Michael Golden (a world renowned specialist in the treatment of acute malnutrition) and Yvonne Grellety facilitated the workshop. An estimated 8 participants from eight states (including the 3 Darfur States) were trained. The workshop concluded with action points, including the national adaptation of the nutrition guidelines and the protocol on the treatment of acute malnutrition. Thereafter, follow-up lectures were given at three major universities to medical students and nutritionists. In addition, meetings were carried out with pediatric associations and the pre-service committee for universities. Yvonne Grellety also conducted a review of the feeding programme in Darfur and provided on the job training for MOH and NGO staff in North and South Darfur. 6. NUTRITION SURVEILLANCE To provide regular information for planning, monitoring and evaluation of the nutrition situation in Darfur, UNICEF has brought on board two consultants to develop the nutrition surveillance system. The information source for this system is from sentinel sites, feeding centres data, nutrition surveys information, secondary information on food security, and water and health surveillance information. To date tools for the sentinel site have been developed and are ready for field testing, which is expected to take place in July-August. The nutrition survey and feeding centre are almost finalised. In addition, the nutrition survey plans for 25 have been developed. The draft nutrition survey guideline has also been reviewed and is ready for finalisation by the FMoH. A summary of all surveys conducted and the main report will be provided on the OCHA website, where they can be easily accessible to all stakeholders. 5