Highlights UNICEF Mauritania Monthly Situation Report May 2013 Mauritania is the single largest recipient of refugees fleeing the conflict in Mali. 74,108 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. A storm damaged school tents and child friendly spaces and as the rainy season commences, there is a higher risk of diseases including malaria and diarrhoeal disease. 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 1,152 children at four child friendly spaces. In 2013, 1,175 children have been treated for Severe Acute Malnutrition (SAM) by UNICEF and others. 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. 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 being implemented alongside life-saving nutrition interventions providing therapeutic food and medicines. A multi-sectorial package of services is being scaled up from 291 to all 488 nutrition centres. These children are attending a tent school in Mbera refugee camp. Due to a lack of funds, only 23% of the almost 30,000 school age refugee children are enrolled in school. The school tents get damaged in strong desert winds and the children don t have desks or chairs. More schools and more stable structures are needed along with basic furniture and equipment. The first prototype semi-permanent school structure has now been built. *<www.data.unhcr.org/malisituation/country.php?id=132>, updated 5 May 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 74,108 refugees, 60% children. Life-saving interventions, such as treatment for malnutrition, measles vaccinations and the provision of clean water continue to be needed. Between July 2012 and January 2013, 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 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 5 Mai 2013; and SMART Nutrition Survey, January 2013) Total Male Female Total Affected Population 74,108 40,761 33,347 Children Affected (Under 18) 44,479 22,239 22,239 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, feeding practices and 2
lack of education on nutrition. Addressing the drivers of malnutrition requires longer term funding for resilience programmes to be implemented alongside emergency programmes. 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 Consolidated Appeal Process (CAP) for Mauritania was launched by OCHA in December 2012. The mid-year review process has commenced. <www.unocha.org/cap/appeals/bycountry/results/taxonomy%3a69> 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 UNICEF and partners results % of results % of 860 511 59% 3,430 1,175 34% 690 162 23% 2,745 989 36% 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 16,361 59% 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 * 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 between July 2012 to January 2013. 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. Results from a qualitative analysis of local determinants of malnutrition in Mbéra, conducted jointly by UNICEF, UNHCR and WFP, 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 due to what is available in the camp o high prevalence of acute respiratory infections, diarrhea and malaria o poor understanding of medical treatment for malnutrition In response, UNICEF, in collaboration with the Ministry of Health, WFP and others will: o actively screen children under five for malnutrition o improve follow-up defaulter cases o run community education sessions with women on how to use Plumpy Nut rations o meet with local authorities to prepare the Vitamin A supplementation campaign and active screening of all children under 5 years of age. UNICEF continues to support management of acute malnutrition by providing therapeutic food (RUFT), medicine and technical assistance to public health units treating SAM. Supervision visits and on-the-job training was carried out by the Government to improve management of severe and moderate malnutrition in both Mbera and for the host community in Bassiknou health district. WASH 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. Led by UNHCR, UNICEF supported emergency preparedness for cholera with Solidarites International, the Health Department of Bassiknou and others. The materials provided 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. Health A Child Health Week 24-29 April resulted in the immunisation of 16,688 children under 5 years, of which in 2,915 under 1 year, in the camp and host communities against tuberculosis, polio, measles, diphtheria, tetanus, whooping cough and meningitis. A second round will be undertaken in the first week of June. The vaccination coverage against measles for children under 5 is now 98.7%. 2,154 pregnant women have been vaccinated against maternal and neonatal tetanus. Follow up will be conducted in June. An integrated immunisation campaign for polio, Vitamin A supplementation and deworming was undertaken 28-30 May. Results will be reported next month. 4
Child Protection 277 additional malnourished children under five years 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. A storm destroyed 2 child friendly spaces in Mbera camp. This has caused the suspension of activities. Measures are being put in place to repair both locations. 164 newly arrived children from Mali have been assisted with non-food items including tents, blankets and recreational kits. UNICEF is developing psychosocial support activities in host communities around Mbera 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 camp, but these have been hampered by under-funding. This is currently a 53% funding gap for education in 2013. The tents used for schools are not adapted to the storms and strong desert winds in the camp and this month more than 20 tents were damaged, which affected the attendance rate in schools at the end of the month. Semi-permanent school building structures are being constructed as funding is becoming available. Construction of the first prototype has just been completed. Before the storm damage, 23 new tents were established for 249 secondary school students and 1,120 for primary school students. The literacy programme targeting 13 to 17 year olds is giving 527 youth (71% girls) a chance to catch up. Attendance rates are 90% and demand continues to outstrip supply as only 15% of youths aged 13-17 years are able to access the literacy program. Model lessons are held weekly to enhance the capacity of the 17 non-formal education teacher on this component and graduates of this programme will need to be supported through training in trades or other generating income activities. 6,380 children (49% girls) are enrolled in primary schools, around 37% of primary school age children. Only 249 children (22% girls) are enrolled in secondary school. 209 out-of-school youth are being accompanied in community sensitization and association management. 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. A two day-workshop for education partners was held in Nouakchott to clarify conditions of certification of apprenticeship and management for national exams under the coordination of the education ministries of the Mali and Mauritania. 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. NUTRITION RESPONSE 2013 Nutrition Estimated # / % coverage Children < 5 years with Severe Acute Malnutrition admitted to Therapeutic care UNICEF UNICEF and partners results ( #) % of Cluster results ( #) % of 23,901 2,309* 10%* 23,901 2,309* 10%* 5
Estimated # / % coverage Children < 5 years with Severe Acute Malnutrition discharged recovered Number of health centres with SAM treatment UNICEF UNICEF and partners results ( #) % of Cluster results ( #) % of 17,925 1,478* 8%* 17,925 1,478* 8%* 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 3,508** 15%** 23,901 3,909** 16%** 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 4,850 31% 15,400 4,850 31% 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 with a corresponding increase in the admission rates for children suffering SAM. The January SMART survey also showed that northern regions (namely, Adrar, Inchiri, Tiris-Zemmour) have shown an alarming prevalence of stunting, an indicator of chronic malnutrition, which needs to be addressed. 1 These underlying chronic nutrition problems increase vulnerability to acute malnutrition and other shocks. A mixed approach integrating emergency response with longer term programmes is needed. Longer term funding is needed to support this approach. Post-harvest prevalence of Global Acute Malnutrition (green if < 5%, yellow if <9 %), chronic malnutrition/stunting (black) and underweight (grey) by region (SMART Survey, Mauritania, January 2013) 1 SMART Survey, January 2013 6
The lean season is commencing and a blanket feeding campaign has been prepared to cover 50,106 children (6-24 months) living in four highly vulnerable regions (Assaba, Tagant, Hodh el Chargi and Hodh el Garbi). WFP will cover the regions of Brakna, Guidimakha and Gorgol as well as Mbera refugee camp. The Ready to Use Supplementary Food (RUSF) for the blanket feeding has been delivered and distribution will start in June. 95,519 under five children will also be screened for malnutrition and any cases referred during the first distribution of RUSF. UNICEF has hired seven national consultants, in collaboration with the Ministry of Health, to provide close support to regional health authorities to scale-up nutrition actions and improve data collection and management. Training of trainers on management of acute malnutrition was carried out in Nouakchott, Kaedi and Aioun. 71 health providers were trained including: 48 medical doctors, 19 nurses and paramedic staff and 4 health officers who work for NGOs. Training of nurses on management of acute malnutrition is on-going in all regions. A Nutrition Coordination meeting led by the Government was held on 23 May with participation from UN agencies and national and international NGOs. A partnership with the national Ministry for Children, Family and Social Affairs will scale-up nutrition interventions at the community level. 232 community workers will be trained on essential nutrition actions and active screening in three regions (Tagant, Assaba and Gorgol). Vitamin A supplementation is under preparation as well as the July SMART survey at both national level and in Mbera. 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. 7
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 543 malnourished children under 5 years old, including 243 suffering SAM, at 6 health and nutritional centres. 3,627 children aged 3-17 years attended psychosocial activities organised in 24 child friendly spaces established in response to the nutritional crisis. Early marriage is one of the consequences of food insecurity as this means that there is one less mouth to feed. 1,155 people have attended education sessions on child protection, including the consequences of early marriage, in Hodh el Chargi and Guidimakha regions. Together with the Ministry of Social Affairs and Childhood, 32 participants from international and national NGOs, and public technical services were trained on psychosocial support on gender based violence. SUPPLY & LOGISTICS Supplies with a value of USD 3,079,840 have been provided in 2012 and 2013 to respond to the Mali 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. Funding Update In the 2013 Humanitarian Action for Children (HAC), UNICEF s requirements for Mauritania are of USD 18,885,937, of which USD 14,614,470 are included the CAP. UNICEF is currently participating in mid-year reviews of the CAP and HAC. It is anticipated that UNICEF s funding requirements will increase. Funding Requirements Appeal Requirements as per HAC January 2013 Funds received in 2013 Funding gap $ $ $ % NUTRITION 5,840,558 3,616,503 2,224,055 38% 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 2,173,769 (1,355,019) -165% Total* 18,885,936 10,701,225 8,184,711 43% * 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 8
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 9