UNICEF Mauritania Monthly Situation Report Highlights April 2013 Mauritania is the single largest recipient of refugees fleeing the conflict in Mali. 74,148 refugees are living in the Mbéra camp. 60% of the refugees are children and many have been in the camp for over a year, resulting in overlapping emergency and medium term needs. Refugee children face a range of threats to their health, nutrition, education and family lives. Many have experienced severe trauma and are suffering from malnutrition and need specialised attention and care. UNICEF, in coordination with UNHCR and partners, are providing education in the camp for 7,070 children (49% girls) in six schools and psychosocial stimulation for 1,028 children at four child friendly spaces. Since 2012, 1,538 children have been treated for Severe Acute Malnutrition (SAM). A Child Health Week focused on children under five in the camp and host communities immunization and malnutrition screening as part of African Vaccination Week. Communities hosting the refugees are very poor and suffer high levels of food insecurity and malnutrition. UNICEF is helping to reinforce basic services, including malnutrition treatment. More resources are needed to fill gaps, including almost 10,000 children, more than half of the school age children in the camp, not getting an education. In 2013, the expected national caseload of Global Acute Malnutrition (GAM) is 122,719 children under five years, including 23,901 cases of SAM. The post-harvest GAM prevalence was 5.6% and is expected to increase significantly in the summer lean season. Preventative blanket feeding, cash transfers and programmes to build longer term resilience are all being planned and will be implemented from May, ahead of the lean season. A multisectorial package of services is being scaled up from 291 to all 488 nutrition centres as part of the response to high rates of malnutrition. This child in Mbéra refugee camp is suffering from SAM. Preliminary results from a joint study by UNICEF, UNHCR and WFP into the causes of malnutrition in Mbéra showed that high rates of communicable diseases and a lack of understanding about the benefits of correct medical treatment for malnutrition both play a role. UNICEF, Ministry of Health and partners interventions are treating children affected by SAM and addressing these drivers of malnutrition. UNICEF/Mauritania/2013/Zanou *<www.data.unhcr.org/malisituation/country.php?id=132>, updated 7 April 2013.
Situation Overview & Humanitarian Needs Mauritania is the single largest recipient of Malian refugees and Mbéra is the most populous refugee camp established as a result of the conflict with 74,148 refugees, 60% children. Life-saving interventions, such as treatment for malnutrition, measles vaccinations and the provision of clean water continue to be needed. The malnutrition rate in Mbéra has decreased from 20% to 13% of children under five suffering GAM, but remains high. With the camp now more than a year old, there are also medium term needs, such as more stable education facilities, that UNICEF, in coordination with the Government, UNHCR and partners, are addressing. The remote area of Mauritania, which is hosting the refugees is very poor, suffers high levels of food insecurity and malnutrition and has limited natural resources and government services. The needs of these communities are also being addressed and assistance given to reinforce basic services. Malian Refugee Crisis Refugees Estimated Affected Population (Estimates calculated based on initial figures from: <www.data.unhcr.org/malisituation/country.php?id=132> updated 7 April 2013; and SMART Nutrition Survey, January 2013) Total Male Female Total Affected Population 74,148 40,781 33,367 Children Affected (Under 18) 44,489 22,244 22,244 Children Under Five 17,796 8,898 8,898 Children 6 to 23 months 5,339 2,669 2,669 Pregnant women 3,485 3,485 Children Under Five with Severe Acute Malnutrition (SAM) 523 349 174 Children Under Five with SAM and medical complications 52 35 17 Children Under Five with Moderate Acute Malnutrition(MAM) 1,661 822 839 Malian Refugee Crisis Host Communities Estimated Affected Population (Estimates calculated based on initial figures from: Mauritanian Census 2000; results from the SMART Nutrition Survey, January 2013) Total Male Female Total Affected Population 48,639 23,911 24,728 Children Affected (Under 18) 24,319 11,955 12,364 Children Under Five 8,999 4,424 4,575 Children 6 to 23 months 2,203 1,083 1,120 Pregnant women 1,175 1,175 Children Under Five with Severe Acute Malnutrition (SAM) 45 22 23 Children Under Five with SAM and medical complications 4 2 2 Children Under Five with Moderate Acute Malnutrition( MAM) 630 310 320 In 2013, the expected caseload for GAM in Mauritania is 122,719 children under 5 years, including 23,901 cases of SAM. This is higher than to 2012 caseload due to factors including increased vulnerability as household depleted their assets to buy food last year. Results for the January 2013 SMART nutrition survey show a post-harvest malnutrition rate of 5.6% GAM and 0.6% SAM. These rates are not significantly different from this time last year. Malnutrition is expected to peak in summer, following an annual pattern where families run short of food in the lead up to the September harvest. Chronic, recurrent malnutrition throughout the country is driven by underlying food insecurity, insufficient access to health care, clean water, sanitation and hygiene, and lack of education on nutrition. Addressing the drivers of malnutrition requires longer term funding for resilience programmes to be implemented alongside emergency programmes. 2
Nutrition in 2013 Estimated Affected Population (Estimates calculated based on initial figures from: Mauritanian Census 2000; results from the SMART Nutrition Survey, January 2013) Total Male Female Children Under Five with Severe Acute Malnutrition (SAM) 23,901 11,833 12,068 Children Under Five with SAM and medical complications 2,390 1,183 1,207 Children Under Five with Moderate Acute Malnutrition(MAM) 98,818 48,922 49,896 Inter-Agency Collaboration and Partnerships UNICEF continues to work closely with the Government of Mauritania, UN partners and NGOs. In January, a CERF was funded for rapid response actions in the first six months of 2013. <www.unocha.org/cerf/cerf-worldwide/2013> The 2013 CAP for Mauritania was launched by OCHA in December 2012. <www.unocha.org/cap/appeals/by-country/results/taxonomy%3a69> The Inter-Agency Contingency Plan is being updated in light of the recent developments in Mali. Malian Refugee Crisis 2013 Nutrition WASH Health Child Protection Education Estimated # / % coverage Children < 5 years with Severe Acute Malnutrition admitted to Therapeutic care Children < 5 years with Severe Acute Malnutrition discharged recovered UNICEF Target UNICEF and partners Cumulative results % of Target Achieved Target Cumulative results % of Target Achieved 860 219 26% 3,430 384 * 11%* 690 125 18% 2,745 299* 11%* Partners: Ministry of Health, WFP, UNHCR, Médecins Sans Frontières Number of people with access to functional latrines 24,930** 24,930** 100%** 74,148 74,490 105% Number of people with access to sufficient safe water 11,667** 11,667** 100%** 74,148 82,667 111% Partners: Ministry of Water Resources and Sanitation, UNHCR, Solidarites International, Intermon Oxfam, Mauritanian Red Crescent Children aged 6 months to 15 years vaccinated 27,629 8,668 31.4% against measles Households with two or more insecticide treated 7,309*** 0 0 mosquito nets (ITNs) Partners: Ministry of Health, UNHCR, WHO, UNFPA, Médecins Sans Frontières and NGOs Emergency-affected children who attend 7,377 1,152 16% 7,377 1,566 21% CFSs Partners: Ministry of Social Affairs, Ministry of Health, UNHCR, UNFPA, WFP, Intersos Children with continued access to formal or nonformal education 17,000 7,070 42% 17,000 7,070 42% Partners: Ministry of Education, UNHCR, Intersos, ESD, FLM, Mauritanian Red Crescent * These figures do not include MSF Belgium statistics which were not available. ** Results based on provision of materials. Construction and operation of facilities are led by UNHCR and implemented with partners in the camp. *** Distribution plans are in process. 3
UNICEF and partners programming Nutrition Results from the January 2013 SMART nutrition survey indicate that since July 2012, GAM rates in Mbéra have been reduced from 20% to 13% of children under five years. The rate of SAM is around 3%. While this is an improvement, the rates are still very concerning and actions are being undertaken by UNICEF, with UNHCR, WFP and partners, to address this problem. Preliminary results from a qualitative analysis of local determinants of malnutrition in Mbéra, conducted jointly by UNICEF, UNHCR and WFP, has identified a number of important factors underlying the persistently elevated rates of malnutrition including: o The fragile nutrition status of refugees arriving from Mali o Changes in diet available in the camp, the absence of milk (which is both culturally and nutritionally important) and unfamiliarly with the corn sugar blend o High prevalence of acute respiratory infections, diarrhea and malaria o Mistrust of the effectiveness of medical treatment for malnutrition 26 more community workers were hired to support the implementation of community mobilization activities including mass screening, homes visits, education and follow up of malnourished children. Active screening has been reinforced, the quality of care is being improved by close supervision and communications activities on nutrition, hygiene and sanitation continue. WASH Health Blanket feeding planned in Hodh El Chargi for all children ages 6-24 months from June. An agreement with a local NGO (AMAMI) will be finalized in May in order to reinforce mass screening and community sensitization in Mbéra and host communities. UNICEF continues to make a valuable contribution to the WASH activities in the camp, which are led by UNHCR. UNICEF supported the distribution of non-food items (NFIs) coordinated by UNHCR targeting 5,000 new arrival of refugees by contributing 6,402 collapsible jerricans, 626 hand-washing devices and 243 buckets. UNICEF supported the response to a suspected case of cholera at Mbéra camp by providing emergency cholera prevention items to Solidarites International and to the Health Department of Bassiknou. These materials have enhanced sanitation in public places and at latrines in the camp covering 37,500 people in order to reduce the risk of an epidemic occurring. Host communities are benefitting from the WASH in Nutrition programme being implemented across Hodh el Chargi, which is providing hygiene materials and education for children affected by SAM. Partners are currently conducting a further needs assessment for WASH interventions in the host communities. UNICEF will coordinate the response to these needs. 8,372 children under 15 years who arrived at Fassala have been systematically vaccinated against measles by the Ministry of Health and MSF with UNICEF support, prior to being transferred to the refugee camp at Mbéra. 296 children under 1 year have also been vaccinated in the camp during routine activities. 539 pregnant women, out of an expected 3,500 over the year, have been vaccinated against Tetanus. A Child Health Week launched on April 24 promoted immunisations for children under five in the camp and the host community in Bassikunou as well as tetanus vaccines to prevent maternal and neonatal tetanus. 4
As of April 30, a total of 8,629 children under five had been vaccinated against measles and 11, 042 vaccinated against polio in the camp and the host communities. Child Protection 691 malnourished children under five years (118 suffering SAM), received emotional stimulation care provided at a health centre and six nutritional centres in Mbéra camp. UNICEF is working with UNHCR and Intersos to support these activities. 1,028 children (653 girls) aged 3-17 years old attended psychosocial activities organized in four child friendly spaces in Mbéra. Along with UHNCR, Intersos, ICRC and partners, UNICEF drafted standard operating procedures for child protection interventions. The 38 members of child protection networks were trained on child rights and supported to elaborate key messages on child protection. The child protection network established 6 children s clubs, and 86 members of these clubs were trained on roles and activities. UNICEF is developing psychosocial support activities in host communities around Mbéra and Fassala as part of the response to high rates of malnutrition in the region. Education UNICEF in coordination with UNHCR and partners are strengthening efforts to provide education to children and youth in the refugee camps, but these have been hampered by under-funding. This is currently a 53% funding gap for 2013. The literacy programmes targeting 13 to 17 year olds is giving 527 youths (71% girls) a chance to catch up. Demand continues to outstrip supply as only 14.7% of youths aged 13-17 years able to access the literacy program. Model lessons are held weekly to enhance the capacity of the 17 non-formal education teachers on this component and graduates of this programme will need to be supported through training in trades or other generating income activities. 6,294 children (49% girls) are enrolled in primary schools, around 37.1% of primary school age children. Only 249 children (22% girls) are in secondary schools. Manuals have been produced in Mauritania for all 249 secondary school students as well as other materials (bags, boxes for manuals, dictionaries, etc.) have been distributed in schools. 209 out-of-school youth are being accompanied in community sensitization and association management. Four teacher training sessions were held for 95 teachers. Seven Parents Association Committees were refreshed on their terms of reference. Discussions are on-going with the Ministry of Education to finalise the rehabilitation and reconstruction of schools in two communities very close to the camp. C4D 48 community relays disseminate hygiene promotion messages through awareness sessions and households visits. More than 15,000 people have been reached by these sessions since the establishment of the Mbéra camp. A Child Health Week was launched on April 24 targeted 19,930 children under five in the camp and the host community in Bassikunou. It was part of the third annual African Immunisation Week and promoted immunization and malnutrition screening as well as providing education on key messages on health, immunization, WASH and nutrition. 5
NUTRITION RESPONSE 2013 Nutrition Estimated # / % coverage Children < 5 years with Severe Acute Malnutrition admitted to Therapeutic care Children < 5 years with Severe Acute Malnutrition discharged recovered Number of health centres with SAM treatment UNICEF Target UNICEF and partners Cumulative results ( #) % of Target Achieved Cluster Target Cumulative results ( #) % of Target Achieved 23,901 795* 3%* 23,901 795* 3%* 17,925 315* 2%* 17,925 315* 2%* 488 291* 60%* 488 291* 60%* Partners: Ministry of Health, Action Contre la Faim, French Red Cross, Terre des hommes, Counterpart, World Vision, AMAMI, WFP, WHO, FAO, Ministry of Social Affairs, Committee on Food Security, UNFPA Numbers of mothers and children affected by SAM who received a 23,901 1,632** 7%** 23,901 2,033** 9%** WASH kit and hygiene promotion WASH Number of nutrition centres delivering the 291 50** 17%** 291 70** 24%** WASH minimum package Partners: Government of Mauritania, AMAMI, Ecodev, Moundi, Action Contre la Faim Emergency-affected children who attend 15,400 3,919 25% 15,400 3,919 25% CFSs and psychosocial Protection stimulation Partners: Terre des Hommes Lausanne, Save the Children Espagne, Coordination des ONG et Associations de Nema (COAN), Actions * Based on partial data reported from health posts. Data is yet to be reported from some regions. National consultants have been hired to improve data collection and reporting on a regular basis ** This number includes distribution of WASH kits in Gorgol to children affected by MAM as well as SAM. The total number of WASH kits distributed by Croix-Rouge Française in the Gorgol Region to children suffering SAM or MAM is 1,027. UNICEF and partners programming Nutrition Mauritania s expected caseload of SAM in 2013 is 23,901 children under five, exceeding the 2012 caseload. Results from the last nutrition survey using the SMART methodology in January 2013 show a post-harvest (non-lean season) GAM prevalence of 5.6% and SAM of 0.6% in children under five years. The rates of SAM and GAM are expected to deteriorate throughout the year, peaking in summer before the September harvest. Malnutrition rates are worse in the south and east of the country, including the Hodh El Chargi region hosting the refugees from Mali where results show GAM at 7.5%. Other regions exceeding the GAM 5% threshold are Gorgol (8.0%), Hodh El Garbi (7.6%), Guidimakha (7.5%), Assaba (6.7%) and Brakna (5.7%). UNICEF will support blanket feeding with the Ministry of Health beginning in June for three months to cover the lean season. UNICEF will provide supplementary food for 50,107 children aged 6-24 months in four target regions. 6
This is part of a well-coordinated programme with WFP supporting blanket feeding for another 36,500 children in three additional regions and Counterpart International and Action Against Hunger assisting 16,000 children in and Nouakchott. The Integrated Management of Acute Malnutrition (IMAM) approach is being scaled up with training for doctors and health post nurses. The third Nutrition sector meeting, led by the Ministry of Health with UNICEF support, was held on 16 April with 28 national and international NGOs, government partners and UN agencies. The terms of reference and sector strategy were finalized. WASH Led by the National Department of Water Resources, UNICEF and partners are supporting a WASH in Nutrition programme in 113 nutrition centres. Nutrition centres are receiving 18 kgs of soap, 15 litres of bleach, chlorine, protective clothing for cleaning (boots, gloves and masks), buckets and hand washing devices. Latrines are also being constructed or rehabilitated as necessary. Parents of children receiving treatment for SAM receive enough soap and bleach for one month, collapsible jerry cans and cups for water storage/consumption, a hand washing device, and education on how to use the supplies provided and other hygiene promotion messages. 14,539 mothers and children have benefited from hygiene promotion in six regions. UNICEF is working with government officials and members of the civil society in order to increase understanding and cooperation in the WASH in Nut programme. A meeting with the Regional Directors of the Ministry of Hydraulic and Sanitation addressed strategy, results and needs. Child Protection Together with partners, UNICEF has supported emotional stimulation care for 415 malnourished children under 5 years old, including 120 suffering SAM, at 10 health and nutritional centres. 2,909 children aged 3-17 years attended psychosocial activities organised in 24 child friendly spaces established in response to the nutrition crisis. Early marriage is one consequence of food insecurity as it means that there is one less mouth to feed. 982 people have attended education sessions on the consequences of early marriage and female genital mutilation carried out by nationals NGO COAN and Actions in Hodh Chargi and Guidimakha regions. SUPPLY & LOGISTICS Supplies with a value of USD 2,731,478 have been provided in 2012 and 2013 to respond to the Malian refugee and Sahel nutrition crises in Mauritania. Supplies delivered contained essential commodities such as recreation kits, school-in-a-box kits, RUTF, hygiene kits, basic family water kits, water purification tabs, squatting plats and tarpaulins. 7
Funding Update In the 2013 Humanitarian Action for Children, UNICEF s requirements for Mauritania are of USD 18,885,937, of which USD 14,614,470 are included the CAP. Funding Requirements Requirements as per HAC Funds received Funding gap Appeal January 2013 $ $ $ % NUTRITION 5,840,558 2,274,452 3,566,106 61% HEALTH 2,565,815 1,247,042 1,318,773 51% WASH 3,856,056 1,096,987 2,759,069 72% C4D 160,027 110,000 50,027 31% EDUCATION 3,899,730 1,840,972 2,058,758 53% CHILD PROTECTION 1,745,000 615,952 1,129,048 65% SECTOR COORDINATION 818,750 1,081,606 (262,856) -32% UNALLOCATED* - 1,081,606 - - TOTAL** 18,885,936 9,414,674 9,471,262 50% * This funding was received immediately prior to the publication of the Situation Report and is yet to be allocated by sector. ** The total includes a maximum recovery rate of 7%. The actual recovery rate on contributions will be calculated in accordance with UNICEF Executive Board Decision 2006/7 dated 9 June 2006. UNICEF wishes to express its deep gratitude to all public and private sector donors for the contributions and pledges received, which have made the current response possible. UNICEF would especially like to thank National Committees and donors who have contributed unearmarked funding. Unearmarked funding gives UNICEF essential flexibility to direct resources and ensure the delivery of life-saving supplies and interventions to where they are needed most especially in the form of longer-term and predictable funding and in strengthening preparedness and resilience building. Continued donor support is critical to continue scaling up the response. For further information, please contact Lucia Elmi Representative Nouakchott Mauritania Telephone: +222 45 29 01 Facsimile: +222 45 25 13 46 E-mail: lelmi@unicef.org Aissata Ba Sidibe Deputy Representative Nouakchott Mauritania Telephone: +222 45 29 04 Facsimile: +222 45 25 13 46 E-mail: asidibe@unicef.org Anthea Moore Resource Mobilisation and Reporting Specialist Nouakchott Mauritania Telephone: +222 45 29 98 72 Facsimile: +222 45 25 13 46 E-mail: amoore@unicef.org Brahim Ould Isselou Communications Specialist Nouakchott Mauritania Telephone: +222 45 29 98 03 Facsimile: +222 45 25 13 46 E-mail: bouldisselmou@unicef.org 8