Editorial

This issue of Nutrition Exchange is our sixth and we continue to profile the writing of those working at national and sub-national level. This issue contains 13 original articles from Bangladesh,
Chad, Democratic Republic of Congo, Ethiopia, Kenya, Niger and Somalia and two with a regional and geographical perspective.

For the first time, we received French articles from west Africa and have translated them into English for this issue. Every original article is the result of a close supportive collaboration with the author(s). ENN provides editorial support to get the best information possible from those working on different types of nutrition-related programmes and issues in different contexts.

There is a stronger focus in this issue of NEX on learning and experiences from Scaling Up Nutrition (SUN) Movement countries. We have carried out two interviews with key SUN Movement actors in Kenya and Somalia. In Kenya, the interview with an outgoing representative of the SUN Donor Network describes the experience of starting the network, their achievements and future priorities. In Somalia, the Government SUN Focal Point shared the challenges faced in bringing nutrition to the wider attention of key government actors and in maintaining this focus in light of the frequent disruption caused by conflict and insecurity. The role of the SUN Civil Society Network in supporting nutrition advocacy and, in particular, the ongoing work to support nutrition in a highly devolved context is described in Kenya. We also have a summary of the phase two SUN Movement Roadmap, the findings from a recent review into SUN country experiences with the Common Results Framework, and a brief description of a new ENN project providing knowledge management services to the SUN Movement in phase two (2016-2020). Two summarised Field Exchange SUN-related articles have been included in this section from Pakistan and Indonesia as they describe the progress made since joining the SUN Movement, highlighting the increasing need to focus on nutrition scale-up in highly devolving situations and to continue to foster multi-sectoral engagement at all levels. The double burden of malnutrition (where high levels of undernutrition and overweight/obesity are both present in a country) is also raised in the Indonesia article.

The original country article from Bangladesh describes ongoing work in the management of malnutrition in infants under six months of age. For many years these infants have been a neglected group, but today they are receiving more attention globally and in certain countries. ree articles from west Africa (Niger, Democratic Republic of Congo and Chad) give us insights into efforts to address contexts with high levels of acute malnutrition.

In Niger, an alliance of non-governmental agencies is looking to more sustainable/developmental ways to maintain treatment services; in Chad, mobile teams are being deployed to reach remote populations in need to treatment services; and in DRC the challenges of maintaining effective, community-based nutrition activities once they are mainstreamed into health service provision with lower budgets are exposed. All these articles highlight the practical challenges of applying the technical advances that have been made to prevent and treat acute malnutrition. Additional articles from DRC and Ethiopia describe the use of different agriculturally focused activities to increase dietary diversity in food-insecure areas. Keyhole gardens are one technology being used in Ethiopia to support year-round food availability in food insecure regions, while the education system is being used in DRC to promote dietary diversity and income-generation at household level. In Somalia, behaviour change and communication (BCC) is an approach being used to increase hand-washing and promote improved infant and young child feeding to prevent undernutrition. These articles describe a range of nutrition specific and nutrition-sensitive approaches. While most of the articles describe relatively small-scale projects, it is encouraging to see attention being given by some to measuring impacts: this is key if decisions are to be taken for replication or scale-up.

We feature an article (IFOAM) describing an approach to agriculture and nutrition in a number of countries with large populations living in remote, mountainous regions. This is being done by networking people through different platforms to access better evidence and knowledge about nutrition-sensitive agriculture and dietary diversity. In Ethiopia, the need to link research more explicitly in order to evidence policies and programmes is described, along with the way current obstacles to this are being addressed. For the first time, we include an article from the Americas, highlighting how the Latin America and Caribbean Nutrition Clusters are working together regionally and are using a tool for the standardised definition and monitoring of regional and national nutrition preparedness and response capacity in a context with recurring natural disasters.

As with previous issues, we have also included summaries of nutrition-related reviews, research, events and global developments that we hope are of interest to our readers. In particular, we have summarised the latest developments in the growing attention on the benefits of linking water, sanitation and hygiene (WASH) with nutrition.

In mid-2016, the third Global Nutrition Report will be published and we have included a summary (written by the coordinating team) of the focus this will take. Along with the recently announced Decade for Nutrition (also summarised), the forthcoming Nutrition for Growth Summit in Brazil and the launch of the new Sustainable Development Goals (see the summary), nutrition is still receiving the attention it deserves globally and, more importantly, across many countries where a wide array of policies and programmes is being shaped and implemented and which the NEX team is dedicated to trying to capture and share for the benefit of country actors.

We warmly thank all those who have contributed articles and news pieces and who have been available for interview for this issue. We are already looking for new content for Issue 7 and encourage anyone with experiences and learning to share about nutrition specific programming, nutrition-sensitive programming, nutrition governance, coordination and financing to get in touch with us. In keeping with our efforts to reach as many readers as possible, this year we will be publishing NEX in Spanish (so copy only), thanks to the UNICEF Regional Office in Panama and the financial support from USAID and DFID as well as our usual French and Arabic versions.
We warmly thank Valerie Gatchell for her early editorial role before handing over to Jacqueline Frize, who has capably stepped in to support the production of this issue while Valerie is away from ENN. We also thank Chloe for doing so much before taking her maternity leave. We appreciate the considerable support from Gwenola Deplats in supporting the French-speaking authors in west Africa and for adding to our French network and warmly thank Nick Mickshik for copy editing.

The Nutrition Exchange Editorial team,
Carmel, Valerie, Chloe and Jacqueline

Addis Ababa/Brussels, 1 August 2016: We have signed today an agreement on 50 million EUR support from the EU's "African Peace Facility" to the Lake Chad Basin Commission Multi-National Joint Task Force (MNJTF) in its fight against Boko Haram, as mandated by the African Union Peace and Security Council. This agreement comes at a time of renewed efforts by the member countries of the Lake Chad Basin Commission (LCBC) and Benin to eliminate the threat posed by the Boko Haram terrorist group and create conditions for the rehabilitation of the affected areas and people.

We commend the countries of the region for the progress made over the past months in ensuring a coordinated regional response through the MNJTF. The agreement we have signed today will further strengthen the regional coordination of the response.

Our support will allow for the construction and maintenance of MNJTF headquarters in Ndjamena as well as of sector Headquarters in Cameroon and Niger. We will also provide transport and communication assets to the force headquarters, allowing for effective coordination and command of military operations. These assets, including vehicles, aerial transportation and reconnaissance capacities and a command, control, communication and information system, will put the central command in a position to co-ordinate operations among troop contributing countries in their respective territories. This should prevent Boko Haram's ability to move across borders when fighting uncoordinated bilateral operations.

We reiterate our strong mutual engagement to contribute to restore a safe and secure environment to the civilian population in the areas affected by Boko Haram and other terrorist groups. Boko Haram attacks against the population have severely affected the North-east of Nigeria, Chad, Cameroon and Niger. More than 13,000 have been killed,

2.5 million people have been internally displaced, and an estimated 250 000 people fled to neighboring countries. The escalation of violence has disrupted regional agricultural production and unsettled local markets, causing increasing malnutrition.

PRINCIPAUX FACTEURS DE LA CRISE

• Les catastrophes naturelles récurrentes (sècheresses, inondations), combinées avec la volatilité des marchés, ont poussé les ménages et communautés vers une vulnérabilité chronique.

• Le conflit au nord du Nigeria et en RCA continuent à déplacer les réfugiés vers le Cameroun et causent des déplacements internes. De plus, l'insécurité grandissante dans l'extrême nord et à la frontière de la RCA entravent l'accès humanitaire.

• Faible couverture en assainissement et en accès à l’eau potable reste les principales causes de malnutrition et des maladies hydriques.

Key Drivers of the Conflict

• Recurring natural disasters such as droughts and floods combined with the volatility of markets, pushed many households and communities into chronic vulnerability.

• Conflict in northern Nigeria and CAR has displaced refugees to Cameroon, and caused internal displacements. In addition, increasing insecurity in the far North of Cameroon and along the border of CAR hampers humanitarian access.

• Poor coverage of sanitation and access to clean water remain the main causes of malnutrition and water-borne diseases.

By Martin Karimi

When conflict broke out in South Sudan in late 2013, hundreds of thousands of uprooted families fled across the country’s borders, heading toward Ethiopia, Uganda, Sudan, or to Kenya’s Kakuma refugee camp. Things had seemed to stabilize by the end of 2015, and fewer new refugees were arriving each day in most neighbouring countries. However, in the first half of 2016, the numbers gradually increased. Now, with the heightened tension in Juba and worsening food security, many more are fleeing the country.

NADAPAL AND KAKUMA, Northern Kenya – New refugees first arrive in Kenya via the Nadapal transit centre, along the Kenya-South Sudan border, before traveling onward to the sprawling Kakuma refugee camps.

“We travelled for three days in a truck, from Torit to Nadapal,” said 60-year old Estellina Igiju, reliving the 220-kilometre journey from her home district in South Sudan to the Kenyan border.

Since February, Nadapal has recorded a spike in the number of newly arriving refugees. A growing number of people, mainly women and children, have been making the journey to the border, heading for the Kakuma refugee camps 120 kilometres further south.

More than 8,000 South Sudanese have arrived in Kakuma since January, which is more than the number recorded in the whole of 2015.

Extreme hunger back home

About 90 percent of the refugees arriving in Kakuma now are coming from villages in the Eastern Equatoria and Jonglei states. Many people say hunger is one of their reasons for fleeing.

Estellina saved up for months so she could pay her way from Torit to Nadapal.

“There is no food. Everything has dried up and the conflict is not letting up,” she said.

Food security bulletins warn that the situation is getting worse across the country. Drought and high food prices are driving families out of their homes.

“I left Chagare village (in Torit district) because of hunger. We have not had good rains for about two years,” said 32-year old John Obleng, one of the few men at the transit centre.

Hundreds of people continue making the long journey to Nadapal. According to the Lutheran World Foundation, the trend suggests that families are pooling their resources to send family members – especially women and children – to Kenya in groups.

Assistance in Nadapal transit centre

At the transit centre, the refugees receive basic healthcare, shelter and household items. The World Food Programme is working with the Lutheran World Foundation to provide hot meals.

With a growing population and limited facilities, WFP is not able to provide three meals a day. The refugees get a morning snack, and then a double ration late afternoon to serve as lunch and dinner.

Life in Kakuma

Once refugees move on to the reception centre in Kakuma, WFP provides a nutritious porridge for children aged 6 months to 23 months, and three hot meals for the families awaiting registration and allocation of space in the camps.

Through a WFP initiative known as Bamba Chakula, refugees are also issued mobile phone SIM cards to enable them to receive cash transfers as a part of their monthly food rations.

“I settled here [in Kakuma 3 camp] two days ago,” said Margaret Idugo, a mother of three who fled hunger in Eastern Equatoria. “I was given a [SIM] card, which I will use to buy food.”

Margaret was proofing her new tent against flooding as her eldest child, a 10-year-old girl, prepared porridge from a blend of sorghum and maize flour they had received from WFP.

“I’m happy that we have some food, kitchen utensils, a stove, and a place I can call home. Kakuma is peaceful, and my children can go to school,” she said.

Author: Martin Karimi
A communications graduate with a Masters degree in International Relations

Dans la région de Mopti, 10% des enfants de moins de 5 ans souffrent de malnutrition aigue, liée en majeure partie à un manque de prévention mais également à des maladies directement imputables à la qualité de l’eau, de l’assainissement et des conditions d’hygiène. En réponse à ce problème, depuis mai 2016, ACTED, avec l’appui du Fonds des Nations unies pour l'enfance (UNICEF), met en œuvre un projet intégré d’amélioration des conditions, connaissances et pratiques liées à l’eau, l’hygiène et l’assainissement (EHA) dans les centres de santé et au sein des ménages.

Afin que les enfants et leurs accompagnants soient reçus dans les meilleures conditions possibles lors de la prise en charge de leurs soins, ACTED prévoit d’améliorer l’accès à l’eau potable en construisant ou en réhabilitant des points d’eau dans les centres de santé. Ces mesures seront accompagnées, toujours au sein des centres de santé, de travaux pour offrir des installations sanitaires propres et de qualité (douches, latrines, dispositifs de traitements des déchets) afin d’améliorer les conditions d’hygiène et d’assainissement. ACTED souhaite ainsi contribuer à la diminution de la malnutrition infantile dans la région de Mopti en soutenant une cinquantaine de centres de santé. En complément, ACTED mènera des sessions de sensibilisation communautaires pour de meilleures pratiques EHA, notamment aurès des femmes enceintes et allaitantes. ACTED distribuera également des kits d’hygiène dans les centres de santé. Le projet a été accueilli avec enthousiasme par les communautés locales qui voient dans cette initiative un pas de plus vers l’amélioration de la lutte contre la malnutrition qui touche un nombre accru de leurs enfants.

Key Achievements

• An immediate response was initiated in the Malakal PoC after the 17 February attack. IOM opened a temporary health clinic within 48 hours, and the IOM static health team and Rapid Response Team provided 7,591 health consultations within a month.
• One emergency health mission was deployed to Jonglei State, providing nearly 2,000 health consultations to Internally Displaced Persons (IDPs) and the host community.
• Reproductive health service provision was scaled-up in Renk County, with the team providing facility-based births, and antenatal and post-natal care.
• Tuberculosis (TB) activities were initiated in Bentiu. The laboratory tested 223 suspected TB cases and identified 37 positive cases, all of whom started on Daily Observation Treatment with zero defaulters.
• A Psychosocial Support Resource Centre was established in Bentiu PoC. Mobile response teams started to provide direct service delivery inside the PoC.
• As co-chair of the HIV/AIDS sub working group, IOM chaired the first meeting of 2016.
• As the chair of the Rapid Response Mission technical working group for health, IOM coordinated all national rapid response missions. Rapid response missions travel into hard to reach areas to help communities who have little access to health services.

Key Achievements

• The IOM Malakal clinic supported the polio National Immunization Days (NID), vaccinating 9,000 children in the PoC.
• The IOM Bentiu PoC clinic initiated a mass measles vaccination campaign with 45,897 children 6 months - 15 years vaccinated (94.3% of children in the site).
• In Bentiu PoC 40,000 malaria rapid diagnostic tests arrived as part of the malaria response plan, and 49,550 treated mosquito nets were handed out. There were 2,147 confirmed malaria cases (46.7% of consultations) in week 24.
• The first tuberculosis (TB) sputum samples were sent successfully to Nairobi for GenXpert and drug susceptibility testing, and TB specimen transportation Standard Operation Procedures were developed.
• Approval was obtained from Directorate of HIV to move forward with Prevention of mother-to-child transmission (PMTCT) of HIV in Renk County, and expanded PMTCT/antiretroviral treatment in Bentiu.

More than 2,000 girls and women have been abducted by Boko Haram in Nigeria. The international community continues to advocate for their safe return. But after the girls are back, what happens to them? What happens to the children of rape and their young mothers? Hussaina Dahiru, from north-east Nigeria escaped Boko Haram, but tragically died at child birth. A programme by UN Women is working with girls and women who have survived Boko Haram’s attacks and making sure that the humanitarian response addresses their specific and unique needs.

She was not even 16. Boko Haram rebels abducted Hussaina Dahiru from her home in the Madagali area of Adamawa State, Nigeria, in May, 2015. Ms. Dahiru, along with 13 other girls were taken to the Sambisa Forest and forcibly married off to one of the insurgents, who already had three other wives. Soon after, she became pregnant.

“Life in the insurgent’s den was oppressive and unbearable,” recounted Dahiru, when she met with UN Women representatives in Nigeria. She had recently escaped from Boko Haram.

Food was scarce and punishments were severe. “If your husband did not go for operation, you would not be given food.” The captive women and girls were frequently beaten. Attempting escape was nearly impossible and often fatal. Those who were caught trying to escape were butchered; their butchered body parts were shown to the others.

In February 2016, heavily pregnant and unable to bear the daily terror and hunger, Ms. Dahiru took a chance and managed to escape. She ran through the night and at daybreak, a soldier found her on the Midu road in Madagali and helped her find refuge. A member of the Child Protection Network (CPN) in Adamawa state eventually introduced Ms. Dahiru to UN Women.

Hussaina Dahiru’s story doesn’t have a happy ending. Two months after her escape, on 16 April, she died during childbirth. Her child survived and is being cared for by her aunt. The Ministry of Women’s Affairs has provided food and provisions for the child and for the foster mother. However, like most children of rape committed by Boko Haram insurgents, stigma surrounds him. The family and the community are yet to decide whether they would keep the child or give him up for adoption.

Ms. Dahiru's story is dismally common—a 2015 report by Amnesty International estimated that more than 2,000 women and girls had been abducted by Boko Haram and used as sex slaves. The consequences of this violence extend across generations and cripple communities.

Adjaratou Fatou Ndiaye, UN Women Deputy Representative of West and Central Africa, recently met with internally displaced women and girls during a field visit. “Most of them have lost the families that they could depend on…and may have children they now have to support,” she said. “While some of them expressed their desire for education, most pointed out that their immediate need upon returning to their respective communities is acquiring skills—such as tailoring, knitting, soap-making, farming and entrepreneurship—so that they can make a living,” Fatou Ndiaya added.

UN Women is working with girls and women who have survived Boko Haram's violence through the "Emergency Assistance to Internally Displaced Women/Girls and Survivors of Boko Haram Terrorism Attacks in Nigeria" programme funded by the Government of Japan. The programme is being implemented in Adamawa, Bauchi and Gombe states in Nigeria, where the majority of the displaced women and returning abductees go to find refuge, and focuses on rebuilding their lives through emergency assistance, psycho-social support and economic empowerment. It tailors and strengthens the humanitarian response in Nigeria by addressing the unique needs and realities of women and girls.

by Adaobi Tricia Nwaubani | Thomson Reuters Foundation
Monday, 1 August 2016 13:22 GMT

ABUJA, Aug 1 (Thomson Reuters Foundation) - Held for months by the Nigerian government and confined to a house in the capital for the foreseeable future, Amina Ali, a schoolgirl who was rescued after two years in Boko Haram captivity, may never be the girl she once was, her mother fears.

Read the story on the Thompson Reuters Foundation

1 August 2016 – Despite an attack on a humanitarian convoy in which one of its staff members was injured, the United Nations Children’s Fund (UNICEF) is scaling up its response to provide assistance to thousands of conflict-affected children in Nigeria’s Borno state, which has borne the brunt of violence by Boko Haram insurgents.

The agency estimates that 244,000 will suffer from severe acute malnutrition this year in Borno state alone and if they are not reached with treatment, one in five of them will die.

“We cannot let this heartless attack divert any of us from reaching the more than two million people who are in dire need of immediate humanitarian assistance,” said UNICEF Nigeria Representative, Jean Gough, in a news release issued by the agency.

“The violence has disrupted farming and markets, destroyed food stocks, and damaged or destroyed health and water facilities. We absolutely have to reach more of these communities,” she stressed.

Last week, unknown assailants attacked a humanitarian convoy returning from Bama in Borno state to the state capital Maiduguri after delivering desperately needed humanitarian assistance. The convoy included staff from UNICEF, the UN Population Fund (UNFPA), and the International Organization for Migration (IOM).

An IOM contractor was also injured.

UNICEF said that is already working at full strength in Maiduguri and has called on donors and humanitarian organizations to scale-up the response to the emerging disaster in the state.

“Our teams were finding people living on the brink of disaster,” said Jean Gough, “The violence has disrupted farming and markets, destroyed food stocks, and damaged or destroyed health and water facilities.”

Before the attack, security conditions had been improving in several areas but as a result of the attack, travel by UN staff to high risk areas has been temporarily suspended.

However, despite the temporary suspension, UNICEF plans to scale-up its response in Borno state. At the beginning of the year, the agency had appealed for $55 million for its emergency work, of which $23 million has so far been received.

The agency has provided two million people with health services and treated 56,000 children for malnutrition in the three conflict-affected states of northeast Nigeria. A quarter of a million people have improved access to clean water, and over 200,000 children have been able to go back to school.

By Eromo Egbejule
IRIN Contributor

ABUJA, 1 August 2016

The Boko Haram insurgency has led to a food crisis the extent of which is only now being uncovered

After his father, a welder from Bama, died in a camp for internally displaced people in Nigeria’s northeastern city of Maiduguri, 17-year-old Dauda began to cater for the two wives and eight other children who had survived him. Aided by the little money donated by one of the locals bringing food to the Dalori camp, home to 18,000 people rendered homeless by the Boko Haram insurgency, he now sells caps to provide two square meals a day for his family.

Read the full article on IRIN

“Worst humanitarian crisis in 20 years” is brought into sharp relief in Borno state

ABUJA, NIGERIA – As aid organizations in northeast Nigeria gain access to areas previously under Boko Haram control, alarming suffering, need and devastation is becoming increasingly evident, according to the global organization Mercy Corps . In what a United Nations official is calling the “worst humanitarian crisis in 20 years,” an estimated 7 million people are in need of lifesaving aid in the worst affected areas in the northeast; of those, an estimated 2.5 million people are malnourished and lack access to food and safe drinking water.

“This grave, overlooked humanitarian crisis is unfolding on our watch,” says Iveta Ouvry, Mercy Corps Country Director in Nigeria. “The world cannot sit by while innocent civilians who have survived unspeakable violence face acute hunger and the possibility of death.”

Due to constrained access in the region, humanitarian organizations have until recently focused primarily on providing assistance to those living in and around Maiduguri, the capital of Borno state. Recent assessments – including those conducted by Mercy Corps – show that an estimated 800,000 people are living in burned villages and unstructured camps in 15 different locations across Borno, facing widespread malnutrition, little-to-no food or assistance, non-existent markets and no means to earn a living.

Mercy Corps is working swiftly to respond to the crisis in Damboa and Sabon Gari, two of the heavily impacted and most vulnerable communities. The organization is planning distributions of food and other items essential for survival, hygiene assistance and protection for vulnerable civilians, particularly women and children.

“In these two locations alone, we identified more than 100,000 people who are in immediate need of food and other help,” says Michael Muazu, a Mercy Corps humanitarian projects manager who conducted the assessment. “Women are especially vulnerable because many have little to no ability to move safely outside the camps or conduct normal daily activities such as preparing food and bathing.”

Mercy Corps has been working in Nigeria since 2012 both to address urgent humanitarian needs and implement long-term solutions that help individuals and communities build resilience, with a particular focus on empowering adolescent girls, teaching conflict-mitigation skills and connecting people to financial services.

Key Points

• In Chad, food insecurity has deteriorated over the last three years in the Sahelian belt regions.
• Average rainfall to slightly surplus is very likely on the Sahelian belt.
• Alarming humanitarian situation continues in the Lake Chad Basin despite decreasing number of refugees and displaced persons.

This period is marked by the end of the off-season harvest and the gradual onset of the rains corresponding to the start of the 2016-2017 Agropastoral campaign. In the Gulf of Guinea countries, medium to normal rainfall are observed in this early season, while across the Sahel, average rainfall to slightly above average are very likely.

The pastoral situation is marked by an early depletion of forage resources with bad conditions of livestock’s in Niger, while in the rest of the region, farming conditions are generally average with deterioration of pastures and watering conditions.

Population movements associated with Nigerian and Malian crisis are continuing with an increasing number of returnees and decreasing number of refugees and displaced persons. These returns can be explained in part by an improving security condition in the areas of origin, and also by the presence of humanitarian actors.

The humanitarian situation in the Lake Chad Basin remains worrying. In Chad, about 2 million people are food insecure including 400 000 people in severely form in the eight regions of the Sahelian belt (Kanem, Lake, Bahr el Gazel, Batha, Wadi Fira, Sila, Guera, Ouaddai). The rate of Global Acute Malnutrition is above the emergency threshold in six of the eight regions. In Nigeria, more than 800 000 people (including 550 000 to Borno and 255 000 to Yobe) are severely food insecure and in need of immediate food assistance.

By Iain Overton on 2 Aug 2016

For over five years, Action on Armed Violence (AOAV) has monitored English language media coverage of explosive violence around the world. In our latest report, Patterns of Harm, AOAV presents data from over 188,325 recorded deaths and injuries – a result of 12,566 incidents of explosive weapons use between 2011 and 2015.

The most compelling pattern of harm highlighted in the data was that, year in and year out, when explosive weapons were used in populated areas, nine times out of ten those killed or wounded were civilians. AOAV strongly calls States to politically commit to refraining from using explosive weapons in populated areas given this predictable pattern of harm.

Our key findings show that:

• Of the 188,325 deaths and injuries recorded from 2011 to 2015, 145,565 (77%) were civilians. The remainder (42,760) were armed actors.

• When explosive weapons were used in populated areas, 91% of deaths and injuries were reported as civilians. This compares to 33% in areas not reported as populated.

• Every year since the monitor began AOAV has seen an increase in both total deaths and injuries and civilian deaths and injuries.

• In 2015, 43,795 deaths and injuries were recorded, 33,307 of whom were civilians; this was, respectively, 45% and 54% more than recorded in 2011.

• At least one death or injury was recorded in 110 countries and territories over the five years.

• Each year incidents were recorded in an average of 61 different countries or territories.

• Over the five years Iraq, Syria, Pakistan, Afghanistan and Yemen saw the highest levels of civilian harm.

• Of these, four – Iraq, Syria, Pakistan and Afghanistan – saw more than 10,000 civilian deaths and injuries.

• Improvised Explosive Devices (IEDs) consistently caused the most civilian harm of any weapon category. Over the five-year period, AOAV recorded 105,071 deaths and injuries as a result of IED incidents, of which 86,395 (82%) were civilians. This is 59% of all civilian deaths and injuries recorded.

• Whilst representing only 19% of reported IED incidents, suicide bombings appear throughout the data as particular cause for concern. Suicide bombings caused 39,717 deaths and injuries, of which 79% (31,447) were civilians. This represents a disproportionate 38% of all deaths and injuries from IED incidents. Of the ten worst explosive incidents over the five year period, half were suicide bombings.

• AOAV recorded 35,976 deaths and injuries caused by air-launched weaponry, of which 21,280 (59%) were civilians. When air-launched weapons were used in populated areas 86% of those killed and injured were civilians, compared to 19% in areas not reported as populated. Both 2014 and 2015 saw a worrisome spike in casualties of air-launched weaponry, with 9,200 civilian deaths and injuries recorded in 2015 – a rise of 4.5 times that recorded in 2013.

• Ground-launched weaponry caused 39,347 deaths and injuries, of which 32,903 (84%) were civilians. When used in populated areas, 92% of those killed and injured were civilians, compared to 38% in areas not reported as populated.

L’Urgence au nord-est du Nigeria restera la plus grande préoccupation jusqu’en janvier 2017 West Africa

MESSAGES CLES

• Des évaluations rapides récentes, bien que non statistiquement significatives, suggèrent qu’une insécurité alimentaire très élevée de type d’Urgence (Phase 4 de l’IPC) et même Famine (Phase 5 de l’IPC) pourrait se produire dans les poches les plus touchés par le conflit et moins accessibles et se maintenir jusqu’en janvier 2017. En outre, une «urgence nutritionnelle» a été déclarée dans l'Etat de Borno par le ministère nigérian de la Santé et de l'information. Un accès humanitaire amélioré et une augmentation significative de l'assistance sont nécessaires de toute urgence pour sauver des vies dans ces zones.

• Ailleurs et d’une manière générale, des précipitations moyennes à supérieures à la moyenne avec une bonne répartition se poursuivent excepté à l’extrême Ouest du Sahel, notamment en Mauritanie Ouest et au Sénégal. Les conditions sont en général favorables au développement des cultures et des pâturages. La soudure pastorale tire à sa fin dans la plupart des zones pastorales et l’intensification des activités agricoles, crée des opportunités de revenus pour les ménages pauvres.

• L’approvisionnement du marché continue à être normal dans la région suites aux déstockages opérés par les agriculteurs et les commerçants avec la progression satisfaisante de la saison et les échanges transfrontaliers normaux. Cependant, l'insécurité et les conflits continuent à perturber le fonctionnement des marchés au nord du Mali et autour du Lac Tchad. Aussi, la dépréciation de la Naira engendre une forte hausse des prix des céréales au Nigeria et perturbe les flux avec le Sahel.

• D’une manière générale, les conditions de sécurité alimentaires sont moyennes à bonnes. Elles favorisent un accès saisonnier au moins moyen aux aliments et aux revenus dans la plupart des zones agricoles et agropastorales. Les ménages sont en mesure de tirer les revenus à travers les stratégies habituelles favorisant ainsi le maintien d’une insécurité alimentaire Minimale (Phase 1 de l’IPC) en générale actuellement. Elle persistera jusqu’aux prochaines récoltes et se généralisera dans toute la région jusqu’en janvier 2017.

• Cependant, la Crise (Phase 3 de l’IPC) sévissant localement dans les zones de faible performance agro-pastorale du Sahel tchadien en 2016 et le Stress (Phase 2 de l’IPC) sévissant en Mauritanie, au Sénégal, au Mali, au Niger et au Tchad pourra persister jusqu’en la fin de la soudure en septembre et faire place progressivement à une insécurité alimentaire Minimale (Phase 1 de l’IPC) à partir d’octobre suite aux récoltes.

• Dans les pays sous menace Ebola, les conditions continuent à être favorables pour le maintien d’une insécurité alimentaire Minimale (Phase 1 de l’IPC) jusqu’en janvier 2016. Toutefois, en Sierra Leone, le Stress (Phase 2 de l’IPC) persistera de façon général jusqu’en septembre pour ne subsister que localement à partir d’octobre dans les zones de persistance de faible pouvoir d’achat limitant la satisfaction des besoins non alimentaires de base.

Worsening food insecurity in Juba as renewed conflict disrupts trade flows

Key Messages

• Fighting between Government forces and armed opposition fighters in Juba from July 8-10 has damaged infrastructure, disrupted trade, and caused displacement. Trade routes to Juba remain significantly disrupted, reducing commodity flows in to the capital. Prices continue to rise and food shortages are a major concern. Restricted movement and the evacuation of many UN and INGO staff members have reduced operational capacity to respond to food insecurity.

• Emergency (IPC Phase 4) food security outcomes remain in parts of Unity, Upper Nile, Northern Bahr el Ghazal, and Western Bahr el Ghazal States. Significant food shortages still exist and prices remain exceptionally high. A rapid food security assessment in late June found that a small number of households in Aweil East and Aweil North of Northern Bahr el Ghazal have exhausted their coping strategies and are likely in Catastrophe (IPC Phase 5).*

• In Juba, Lainya, and Yei of Central Equatoria, Magwi and Torit of Eastern Equatoria, and Mundri and Maridi of Western Equatoria, conflict and insecurity are disrupting livelihoods and market functioning. Some households in these areas are fleeing to safer locations and others are unable to access their farms. This is likely to negatively impact the ongoing harvest and reduce household food access.

• Food prices continue to rise as a result of low supplies, consistent depreciation of the South Sudanese Pound (SSP), and increased insecurity along major trade routes. Between May and June, the price of sorghum in Juba increased 29 percent and is 509 percent above the five-year average. In Aweil, the price of sorghum increased 38 percent over the same time period, as insecurity in Wau is limiting already low trade flows to Northern Bahr el Ghazal. The SSP depreciated 25 percent on the parallel market, to 61.6 SSP/USD, contributing to higher prices.

Integrated Food Security Phase Classification, or IPC, describes acute food insecurity at the household level and area level. At the household level, Catastrophe (IPC Phase 5) is described as: “Even with any humanitarian assistance, household group has an extreme lack of food and/or other basic needs even with full employment of coping strategies.” Famine (IPC Phase 5) applies to the area level and is declared when more than 20 percent of households are classified in Catastrophe, the prevalence of GAM exceeds 30 percent, and the Crude Death Rate exceeds 2/10,000/day.

FOOD SECURITY SNAPSHOT

• Early crop prospects are favourable due to adequate rainfall since beginning of cropping season
  
• Coarse grain prices seasonally increased in recent months but remain similar to year-earlier levels
  
• Humanitarian assistance continues to be needed mostly for Malian refugees in the northern Sahel region
  

Early prospects favourable for 2016 cropping season due to adequate rainfall

According to satellite images, rains have been generally adequate since the beginning of the growing season, allowing land preparation and planting of crops to progress. First significant rains were recorded in early April in the south and south-west. Precipitation progressed northwards over the entire country in May and June and remained generally widespread and sufficient since then. Crops are generally in the leafing stage in the Sudanian zone and emerging/tillering in the north and the Sahelian zone. Pastures are regenerating countrywide, improving livestock conditions.

The 2015 aggregate cereal production was estimated at some 4.2 million tonnes, 6 percent below the previous year’s output and 7 percent below average. Production of sorghum, the most important staple, dropped by 16 percent, while millet production declined slightly by 3 percent. Similarly, a below‑average harvest was gathered in 2014, owing to delayed plantings of rice and coarse grains in several parts of the country. The 2014 cereal output was estimated at about 4.47 million tonnes, 8 percent lower than the 2013 record crop gathered and 0.5 percent below the average of the previous five years.

Coarse grain prices have showed seasonal increases in recent months but are similar to year‑earlier levels

In spite of the reduced harvests, prices of locally grown millet, sorghum and maize, the main staples in the country, have shown a sustained downward trend from the beginning of the year to March 2016, reflecting adequate regional supplies. Prices seasonally increased in recent months but remain similar to their year‑earlier levels.

Continued assistance still needed, especially for vulnerable people

Food security conditions remain difficult in several regions, especially in Oudalan and Soum provinces, mostly due to rainfall and cereal production deficits in 2015. The food insecure people are located mostly in the Sahel and Northern regions. Moreover, the country continues to host a large number of refugees from neighbouring Mali. According to UNHCR, there were still about 33 000 Malian refugees in Burkina Faso, mostly in Oudalan and Soum provinces of the northern Sahel region, which has already been facing food insecurity and high malnutrition rates. About 126 000 people are estimated to be in Phase: 3 “Crisis” and above, according to the last analysis of the “Cadre Harmonisé” (Harmonized Framework) conducted in the country.

Briefer: Fadéla Chaib, WHO Spokesperson

WHO is concerned about the overall health needs of the people of South Sudan, especially the Internally Displaced People (IDPs) in Juba, Wau and other States as a result of the recent hostilities.

Coupled with the conflict, the country is battling threats to health due to outbreaks. This includes an ongoing cholera outbreak as well as measles and malaria cases. Limited access to health care services, safe water and sanitation, combined with poor hygiene practices, facilitates the spread of diseases such as malaria and measles, as well as acute diarrhoeal disease including cholera.

As of 30 July, a total of 586 cholera cases including 21 deaths have been reported nationwide. The majority of these have been recorded in Juba County, where an average of 35 new admissions is being recorded daily.

Nearly 30% of health facilities are not functional. Health workers are affected by both conflict and the current economic situation. Thus access to basic health services is severely restricted. Health facilities remain closed in large parts of South Sudan, especially in Wau.

In order to ensure that those affected have continued access to healthcare, a combination of mobile and fixed health units have been established in Juba.

Urgent funding is needed to respond to rising needs. WHO requires US$ 17.5 million of this total amount for 2016, of which US$ 4.3 million (25%) has so far been received. Without urgent funding, WHO and partners will not be able to implement most of the planned interventions.

WHO Response

WHO strategy aims to help not only the thousands who are living in IDP camps, but also the millions of people in the country who are currently deprived of basic life-saving health services. Donating medical supplies to treat the injured

WHO has delivered essential medicines and supplies to South Sudan, including surgical and intravenous infusions kits to save the lives of injured patients. On 16 July 2016, WHO provided anti-malarial, cholera and malaria testing kits, surgical and delivery kits, and tents to partners to Wau Teaching Hospital, and to Level-2 and Daniel Comboni Hospitals.

In response to the food security crisis, WHO has sent newly designed kits containing supplies for the medical management of severe acute malnutrition in children. Further supplies are on their way.

WHO has sent newly designed kits containing supplies for the medical management of severe acute malnutrition (SAM) in children.

Cholera

The case fatality rate for the current outbreak is high, which is likely to be a result of problems of access to health care. Currently, only the Juba Teaching Hospital has been designated as a Cholera Treatment Centre (CTC). At least 100 additional beds are needed to support the cholera response in the hospital.

Given the limited spaces at Juba Teaching Hospital to accommodate an increasing number of cases, preparations are underway to open a rehabilitation and stabilization centre at Al Sabah Children’s Hospital.

To increase access to oral rehydration therapy in Juba, 11 oral rehydration points have been set up in high transmission locations including: Nyakuron, Munuki, Gurei, Gumbo, Kator, Lologo, Mahad, Gorom, Al Sabah, Khor William, and El Giada.

Rapid response teams have been deployed to investigate new cholera alerts in Juba, Terekeka, Duk, and Malakal. WHO, together with the Ministry of Health and partners, is conducting an Oral Cholera Vaccination campaign that will initially target more than 14 000 people at the UNMISS Tongping transit IDP site, EL Giada, Gorom, and UN House PoC.

WHO, UNICEF and the MOH have developed cholera education materials for distribution in hotspots and for community engagement purposes. Messages are being aired on radio.

The risk of further spread of diseases is a major concern. With the coming rains, an increase in malaria and water-borne diseases is likely. WHO expects medical needs to increase in an already challenging environment.

Malnutrition

The nutrition situation in the country remains precarious; UNICEF estimates that about 600 000 children under-5 years are acutely malnourished.

WHO has introduced the first ever drug module kit for the management of Severe Acute Malnutrition and Medical Complications in children. The kit contains the most essential and basic medicine for the treatment of children with severe acute malnutrition and medical conditions.

The kit is a key strategy to support stabilization centres to manage Severe Acute Malnutrition (SAM) or Malnourished Children (MC), strengthening capacity to deliver effective and immediate nutrition and health response. The kits also provide a stop-gap measure for hospitals experiencing stock-outs of medicines.

Malaria

Since June 2016, South Sudan has reported 3316 case of malaria in Wau, Western Bahr El Ghazal State.

Malaria is the number one cause of morbidity in the country accounting for 54% and 39% of consultations in non-conflict affected states and IDP sites respectively. In recent weeks, malaria trends in Bentiu PoC and Northern Bahr el Ghazal have exceeded expected levels. WHO has despatched antimalarial drugs.

Measles

As of mid- July, 1564 suspected cases of measles haven reported with at least 17 deaths. Since the beginning of 2016, measles outbreaks have been confirmed in 12 counties. Most of the measles cases have been reported in camps for internally displaced people where families live in overcrowded conditions and many children are malnourished. WHO, with support from UNICEF and other partners, has vaccinated 13 029 people. A countrywide follow-up measles campaign is planned for November 2016.

WHO staff in South Sudan are working hard under difficult circumstances to reach affected populations with essential medical care and services. Nearly 100 staff members remain in the country to provide WHO support in various States.

What is Cholera?

Cholera is an acute intestinal infection caused by ingestion of food or water that has been contaminated with the bacterium Vibrio cholerae. It has a short incubation period, ranging from two hours to five days. Symptoms include copious, painless, watery diarrhoea that can quickly lead to severe dehydration and death if treatment is not promptly given.

Cholera is a virulent disease that affects both children and adults. Unlike other diarrhoeal diseases, it can kill healthy adults within hours. Individuals with lower immunity, such as malnourished children or people living with HIV, are at greater risk of death if infected by cholera.

Cholera prevention consists primarily of providing clean water and proper sanitation to populations who do not have access to basic services.

Strengthening surveillance and early warning is important to detect the first cases in an outbreak and to put in place control measures.

The risk of spread of cholera remains high in South Sudan due to increased population movement, crowded living conditions in camps which have inadequate basic services, low sanitation coverage, poor hygiene practices, malnutrition, food insecurity and anticipated flooding.

Visit the WHO website on South Sudan: http://www.who.int/emergencies/south-sudan/en/