SUDAN Q DARFUR NUTRITION ASSESSMENT

UNCLAS SECTION 01 OF 03 KHARTOUM 001851 SIPDIS AIDAC SIPDIS STATE FOR AF/SPG, PRM, AND ALSO PASS USAID/W USAID FOR DCHA SUDAN TEAM, AFR/SP NAIROBI FOR USAID/DCHA/OFDA, USAID/REDSO, AND FAS GENEVA FOR NKYLOH NAIROBI FOR SFO NSC FOR JBRAUSE, NSC/AFRICA FOR TSHORTLEY USUN FOR TMALY BRUSSELS FOR PLERNER E.O. 12958: N/A TAGS: EAID PREF PGOV PHUM SOCI SU SUBJECT: SUDAN Q DARFUR NUTRITION ASSESSMENT KHARTOUM 00001851 001.2 OF 003 -------------- Summary -------------- ¶1. From July 17 to July 25, a USAID Office of U.S. Foreign Disaster Assistance (OFDA) Public Health and Nutrition Advisor traveled through North and South Darfur to assess the nutrition situation and monitor USAID/OFDA-funded nutrition programs. Factors that are contributing to the worsening nutrition situation in Darfur include a precarious security situation that has limited humanitarian access to affected areas, continuous large-scale population displacements, decreased funding that has led to a reduction in nutrition interventions, and eroding technical capacity. Recent gains in nutrition including the USAID/OFDA- funded U.N. ChildrenQs Fund (UNICEF) Nutrition Surveillance System and other U.N. and non-governmental organization (NGO) nutrition activities are being critically threatened by dwindling donor funding. Without improvements in security and an increase in funding, implementing partners may be forced to down- size or phase out nutrition programs. Feeding centers are closing down, and there are almost half the numbers of centers operating in Darfur now as there were at this time last year. While the reduction in feeding centers occurs, the admissions rate of malnourished children to feeding centers is increasing, causing a heavier burden on the few centers that remain open. The Sudanese government is incapable of sustaining these centers due to inadequate human resources and budgetary constraints. Donor support to a multi-sectoral approach, with a sharp focus on health care access, child care practices, water and sanitation, food security, and livelihood programs is urgently needed. End summary. -------------- Locations Visited and Contacts -------------- ¶2. From July 17 to July 25, a USAID/OFDA Public Health and Nutrition Advisor traveled through North and South Darfur to assess the nutrition situation and monitor USAID/OFDA-funded nutrition programs in Darfur. While in Khartoum, the Health and Nutrition Advisor met with the Darfur Field Office (DFO) team and representatives from the U.N. ChildrenQs Fund (UNICEF),the U.N. World Food Program (WFP),the U.N. World Health Organization (WHO),Save the Children/US (SC/US),Action Contre la Faim (ACF),and Tearfund. ¶3. In Darfur, the Advisor met with representatives from the State Ministries of Health (MOH),UNICEF, WHO, the U.N. Food and Agriculture Organization (FAO),WFP, Relief International (RI),the International Rescue Committee (IRC),ACF, CHF, Medecins sans Frontieres/Belgium (MSF/B),and MSF/Holland. The Advisor visited several internally displaced persons (IDP) camps including Al Salaam, Abu Shouk, and Zam Zam camps in North Darfur and Kalma camp in South Darfur. Due to the existing volatile insecurity situation, the entire state of West Darfur and rural sites in North and South Darfur were excluded. -------------- Surveillance -------------- ¶4. UNICEFQs operational nutrition surveillance system funded by USAID/OFDA, and launched by UNICEF in December 2005, is managed by a full-time international staffmember who is responsible for publishing a bi-monthly bulletin titled QDarfur Nutrition Update.Q The nutrition surveillance system collects information from 12 selected sentinel sites in each of the 3 Darfur states. These sites represent IDP camps and surrounding host populations in villages and provide information on a monthly basis. Periodic nutrition surveys are conducted by the Sudanese government, NGOs, and U.N. agencies. Feeding center data is incorporated, as well as food security information from FAO and WHOQs disease outbreaks detection system. KHARTOUM 00001851 002.2 OF 003 ¶5. WHO reports that its Early Warning and Alert Response System (EWARS) for disease outbreaks detection in IDP camps in Darfur is expanding in scope to include a surveillance system that will better cover local/host populations. Meanwhile, neglected areas, especially those that are inaccessible due to insecurity, continue to remain a challenge for data collection. The EWARS is linked to UNICEFQs nutrition surveillance through health disease statistics and sentinel sites data collation. Severe malnutrition is diagnosed in IDP health facilities through consultations using the weight for height (W/H),middle upper arm circumference (MUAC),and integrated management of childhood illnesses (IMCI) guidelines. -------------- Trend Analysis -------------- ¶6. Results of the 2005 Darfur Emergency Food Security and Nutrition Assessment conducted in September 2005 by UNICEF, WFP, FAO, and the Sudanese government, with technical support from the Centers for Disease Control and Prevention (CDC),indicates an improvement in the Darfur nutrition situation and attributes the overall decrease in malnutrition rates to the improvement in food supply, decrease in disease outbreaks, and functioning nutrition surveillance system. ¶7. Darfur is currently in the hunger gap season (April- August) when families have exhausted all or most of their food reserves, and the prevalence of acute malnutrition is high. Coverage by NGOs and U.N. agencies was quite good, as depicted in the 2005 results, until these agencies commenced a reduction in nutrition interventions as a result of reduced funding and insecurity. WFPQs reduction of rations by between 15 to 50 percent has further compounded the situation. The number of feeding centers in Darfur is half what existed during this same period in 2005. Admission rates, although increasing, are still lower than they were during this same period last year. The current low admissions number as compared to the higher admissions rate during 2005 could be directly related to the current low nutrition program coverage among IDPs and host populations. According to surveys conducted and data from sentinel sites, there are indications that the Darfur nutrition situation is sporadically deteriorating in pockets throughout the three Darfur states. -------------- -------------- Supplementary & Therapeutic Feeding Centers (SFC, TFC) -------------- -------------- ¶8. Reports indicate the number of TFC and SFC admissions in the three Darfur states in 2006 doubled from 2005, with May, June, and July seeing a continuous increase in admissions. The increase can be attributed partly to acute watery diarrhea (AWD),the arrival of new IDPs in camps from insecure areas, and the seasonal malnutrition that was seen in 2004 and 2005. For example, an outbreak of AWD and the large numbers of unregistered IDPs with no food support in Ed Daein caused admissions at the TFC to increase from 20 to 100 within a five-day period. Also, children with AWD in both Kalma and Gereida IDP camps largely accounted for the increase in severe malnutrition among new admissions. ¶9. In Zam Zam camp in North Darfur, an NGO recently phased out its nutrition activities. Malnutrition cases have been on the increase and are being referred to the Sudanese governmentQs TFC in El Fasher town. It is apparent that the Sudanese government has no capacity to absorb the increasing numbers of cases. Combined defaulter TFC and SFC rates in Darfur were higher in June and July. With sharp increases in admissions, NGOs phasing out programs partly because of declining funding, and escalating insecurity, coupled with only approximately 50 percent of TFCs and SFCs remaining operational, the strain becomes heavier on the few KHARTOUM 00001851 003.2 OF 003 centers that have to care for more beneficiaries. -------------- Technical Capacity -------------- ¶10. The MOH is also experiencing a high turnover of staff and is hampered by budgetary constraints. UNICEF is working with the MOH to build technical capacity in nutrition mainly through training workshops. In recent months, there has been an exodus of trained nutritionists from nutrition programs operated by NGOs. This is due in part to the prevailing insecurity surrounding areas where nutrition programs are hosted, cuts in funding which offer trained nutritionists no job security, burn-out rates, and the general perception that trained nutritionists are not valued. Similarly, community mobilizers, a valuable part of the nutrition team who implement community-based activities, are usually among the first to be relieved of their positions when funding is reduced and agencies downsize. -------------- Sustainability -------------- ¶11. Through training workshops on the prevention and management of malnutrition, UNICEF is enabling staff to eventually assume responsibilities for feeding centers. Positions for hygiene promoters and community mobilizers, who are already placed in the community and could fill in the gaps if and when NGOs and U.N. agencies leave, are drastically reduced as NGOsQ funding diminishes. According to WHO, the MOH is in a much better management position than it was a year ago, but financially, there would be difficulties if WHO was forced to phase out due to security or funding reasons. WHO brings medical specialists as consultants from other areas to fill staff gaps. ¶12. According to the USAID/OFDA Advisor, based upon conversations with various contacts, once NGOs leave Darfur, the TFCs may drop considerably, especially if IDPs are still in camps. Also, rural populations will drastically be affected, and morbidity and mortality rates will increase. By preparing more community mobilizers and strategically placing them among the population, the sustainability battle may be won. -------------- Conclusions -------------- ¶13. The USAID/OFDA Public Health and Nutrition Advisor offers the following recommendations based upon the assessments in South and North Darfur: a) Provide funding priorities to nutrition programs implementing a multi-sectoral approach that focus on the integration of health, child care practices, water, sanitation, food security, and livelihood programs. Integrated nutrition programs will keep malnutrition rates within an optimal range and decrease morbidity and mortality rates. b) Support UNICEF in the sustainability of the nutrition surveillance system that addresses critical information gaps on nutrition and morbidity. Engage UNICEF in progressively building national capacity to expand sentinel sites within the three Darfur states. c) Support and strengthen WHOQs sentinel epidemiological surveillance system that tracks diseases and the underlying causes of malnutrition. d) Support and encourage the prioritization and retention of community mobilizers and health promoters linked to nutrition feeding programs to follow-up on defaulters, screening, and sustainability. HUME