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


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Summary
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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.

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Locations Visited and Contacts
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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.

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Surveillance
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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.

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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.

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Trend Analysis
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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.

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Supplementary & Therapeutic Feeding Centers (SFC, TFC)
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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

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centers that have to care for more beneficiaries.

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Technical Capacity
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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.

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Sustainability
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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.

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Conclusions
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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