Chad les Humanitarian Humanitarian Situation

A. Diguera A. Situation Report Report

UNICEF/Chad/Fafin ©

©UNICEF/Chad/ SITUATION IN NUMBERS

Highlights 31 October 2018

 Preliminary results of the national nutrition survey show that 4% 2,500,000 of under 5 children suffer from severe acute malnutrition (SAM). Children in need of humanitarian assistance (UNICEF HAC 2018)  UNICEF WASH programme supported the production of 380 268,837 subsidised SanPlat slabs for the construction of household latrines Under-5 children with Severe Acute in the Lake region. Malnutrition targeted in 2018  408 army officers trained on grave child rights violations in out of the burden of 362,682 (Nutrition Cluster 2018) preparation for their deployment to support MINUSMA in Mali.  As of the end of October, UNICEF HAC has only received 44% of 162,755 the US$54 million appeal for 2018. An additional US$ 30.4 million People displaced (IDPs, returnees, is required for UNICEF to meet the needs of vulnerable children refugees, third country nationals) in the Lake Region (UNHCR October and women through an integrated multisectoral response. 2018)

UNICEF Appeal 2018 UNICEF’s Response with Partners US$ 54 million

UNICEF Sector/cluster Funding available UNICEF Cluster Cumulative Cumulative Target Target US$ 23.5 million WASH: Number of crisis-affected people who have access to safe potable water and hygiene 126,672 83,529 638,900 164,620 promotion activities in line with the Funding status 2018* (US$) standards (15L/per/Day). Nutrition: Number and % of children 6-59 months with Severe Acute Malnutrition (SAM) admitted 268,837 196,814 (73%) 268,837 196,814 (73%) for therapeutic care and benefitting Funds from promotion of nutrition received: 16.5 M practices Child Protection: Number of Required: displaced children with access to 53.9 M Funding 37,550 13,347 77,257 13,347 gap: 30.4 psychosocial support, including in M Carry child-friendly spaces over: Education: Number of school-aged 7.0 M boys and girls (3 to 17) affected by 202,435 198,065 489,301 200,754 crisis receiving learning materials

UNICEF CHAD Humanitarian Situation Report October 2018

Situation Overview and Analysis Food security and Nutrition Preliminary results of the national nutrition survey (SMART method) reveal a stable nutritional situation with the prevalence of global acute malnutrition (GAM) and severe acute malnutrition (SAM) of 13.5% and 4% respectively. However, there are regional disparities with 12 out of the total 23 regions in Chad with GAM prevalence above WHO emergency threshold (15%) and 13 regions with SAM prevalence greater than the WHO emergency threshold of 2%. The thirteen regions with SAM prevalence greater than 2% are Barh El Ghazel, , , Chari Baguirmi, West, Guéra, Hadjer Lamis, , Wadi, , Sila, , Tibesti. A workshop to validate the survey results is scheduled to take place in the second half of November 2018.

Epidemic Outbreaks The measles outbreak declared in May 2018 continues with a total of 3,657 cases reported and 86 deaths (Case Fatality Rate 2.7%), spread across 36 out of 117 districts in the country. This number is more than ten times the number of cases recorded during the same period in 2017 (301 cases with 33 deaths). By the end of October 2018, only 14 out of the 36 districts had responded to the outbreak by organising mass vaccination campaigns targeting children aged 6 months to 9 years. A total of 546,307 children have been vaccinated to date.

Humanitarian Leadership and Coordination The WASH, Education and Nutrition Clusters have defined their sectoral framework and response plan for the 2019 Humanitarian Cycle Plan (HPC) with the participation of its members. Three crises were considered for the targeting of the beneficiaries, namely the population movement, health emergency and nutritional crisis, as well as the operationalisation of cross-protection and gender. The strategic objectives have been defined by the cluster as well as the indicators that will be used to monitor the response in 2019. In addition, the Education Cluster held working sessions with the Education Cannot Wait (ECW) mission to design the multi-year programme for resilience in Education. The Global Cluster and ECW will offer technical support to the national Education Cluster for the development of the strategy and needs assessment in the field, which are intermediate steps in the development of the multi-year programme.

Humanitarian Strategy As part of its 2018 humanitarian strategy, UNICEF Chad is putting forward an integrated and coordinated approach to provide life-saving assistance to children by offering preventive care such as infant and young child feeding support alongside curative nutrition interventions, including SAM treatment to under-5 children in the Sahel belt and the south of the country. Some of these children and their families are receiving a life-saving WASH package, including hygiene promotion and supplies. UNICEF is reaching conflict-affected people with access to water but also people affected by displacement and epidemics with hygiene information, including illness prevention and locally-adapted solutions to water access. The health system is being reinforced with personnel and supplies in the Lake region and the south, and nutrition data management is being strengthened using rapid SMS. UNICEF is reaching children in displaced communities with access to education and learning materials, and roll out sustainable solutions for compensating community teachers and standardising alternative learning. Furthermore, UNICEF is supporting unaccompanied and separated children with protection and family reunification measures. UNICEF’s efforts to bridge humanitarian and development programming remain paramount, including through support to the Government’s emergency preparedness capacity, and building community and institutional resilience.

Summary Analysis of Programme Response Nutrition In the reporting month, UNICEF supported the treatment of 23,042 severely malnourished children under-5. A total of 196,814 cases have been admitted in UNICEF supported health facilities from January 2018 to date, representing a 20% increase compared to the same period in 2017. Approximately 55% of these cases were admitted in four regions; N’Djamena (18.6%), Lake (12.3%), Kanem (12.1%), and Guera (11.1%). The capital N'Djamena has recorded a 40% increase in admissions compared to 2017. To monitor the nutritional situation in N'Djamena, a series of screening 2

campaigns were organized which revealed a SAM prevalence between 1.2% and 1.15%. The high admission in N’Djamena may be due to the cases coming from the surrounding regions that do not have health facilities offering nutritional treatments such as Hadjer Lamis and Chari Baguirmi. UNICEF continued to reinforce the capacity of health workers through joint missions in the different regions and the training of 28 health workers on the integrated management of acute malnutrition (IMAM) protocol in Goz Beida health District.

Health With reference to the above-mentioned measles outbreak in Chad, UNICEF in collaboration with WHO supported the Ministry of Public Health in drafting a proposal to the Measles and Rubella Initiative (MRI) to cover remaining districts and additional districts that are at risk of a measles epidemic outbreak. The proposal was approved, and with the funds, 34 additional districts will be covered during a mass vaccination scheduled for 13 November 2018. Additional UNICEF support will include provision of vaccines, cost for social mobilisation and staff travels to participate in field monitoring.

Water, Sanitation and Hygiene (WASH) UNICEF continues to promote good hygiene practices in areas affected by crisis through its NGO partners. In October 2018, 23,081 people were sensitised on good hygiene practices in the Ouaddaï, Tandjile, Lake region and N’Djamena. In addition, in the Lake region, UNICEF and partners assisted communities in producing 380 subsidised SanPlat slabs for the construction of household latrines. In the Lake region, through one of its NGO partners, UNICEF finalised the construction of 14 blocks of latrines, 18 shower blocks and fifteen incinerators. Two boreholes were also rehabilitated and the drilling of four additional boreholes was completed, providing water to 3,000 people. In the Ouaddaï region, through the same NGO partner, UNICEF built four blocks of latrines, eight shower blocks and four new incinerators. As part of IMAM activities in health centres, UNICEF distributed WASH kits to 6,646 severely malnourished children; 1,817 in the Ouaddaï, 781 in the Lake, 373 in the Tandjile and 3,675 in N’Djamena. To improve the quality of service in nutritional centres, UNICEF and partners trained 130 health agents and community volunteers on the WASH in Nut strategy in the Ouaddaï region.

Education Classes officially resumed on 29 October 2018, and UNICEF is set to continue distribution of school materials across the country. In the Moyen Chari, Mandoul and ; regions affected by the CAR crisis, UNICEF, in partnership with the international NGOs, trained 359 men, 177 women and 111 youth including 33 girls on the income generating activities and bookkeeping. 19 animators including three women were trained in conducting adult learning activities, teaching techniques in reading, writing and numeracy and the management of a literacy centre. A campaign to raise awareness on the importance of schooling children especially girls was organised in the department of , province of Moyen Chari. 840 parents of students including 437 women were present during the campaign. 80 community teachers and teacher college graduates, were trained in the fight against violence and inequalities in school and life skills in the Moyen Chari region. In the Lake region, UNICEF in partnership with NGO partners organised a refresher training of 120 community teachers and teacher college graduates from the Bol Inspectorate department, on psychosocial support, children’s rights, HIV / AIDS and support for children with mental and physical disabilities.

Child Protection In October, efforts to strengthen the monitoring and reporting system on grave child rights violations (MRM) continued. From 23 – 28 October, UNICEF in collaboration with other UN agencies and partners from the Ministry of Defence, Ministry of Social Affairs and Ministry of Justice, trained 408 Officers and senior non-commissioned members of Chad’s National Army in Loumia. During the training, participants were equipped with basic knowledge of child protection in armed conflicts in preparation for their deployment to Mali to support MINUSMA. Also, two Child Protection Units were formed to monitor and report on child protection violations as well as continue to raise awareness on child protection issues following deployment to Mali.

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During the same period, 52 child protection volunteers including 12 women were sensitised on MRM in Bol and additional MRM awareness raising activities are under preparation. Meanwhile, UNICEF and partners continue their efforts to support unaccompanied and separated children (UASC) and children associated armed forces and groups (CAAFAG). In the Lake region, three unaccompanied boys who had left an armed group received specific support in order to be reunited with their families eventually. In total, 621 unaccompanied and separated children (348 girls) have received support since the beginning of 2018. Through four Child Protection in Emergency (CPiE) consultants based in areas affected by the recent refugee influx from CAR, UNICEF is supporting the documentation of UASC as well as alternative care arrangements for these children. In an effort to strengthen CPiE-related data collection and analysis, UNICEF trained 37 persons including 12 women from Chad’s child protection community on the principles and tools for CP data collection in emergencies. Regarding psychosocial support, UNICEF and partners have provided support to some 13,347 children (6,231 girls) through their CFS. Throughout the month of October, 282 children including 113 girls were sensitised on child protection issues including child marriage and mine risk.

HIV/AIDS HIV screening of pregnant women continued through the month of October. Of the 3,901 women that came for their first prenatal visit, 3,554 were counselled and screened for HIV. 56 women (46 in the Lake region) were found to be positive and are receiving Antiretroviral (ARV) treatment. 30 children born to HIV-positive mothers were put on prophylactic treatment within the required 72 hours. 231 youths were sensitised on HIV prevention and reproductive health issues, 124 were referred and screened, of whom one was found to be HIV-positive and put on treatment. In addition, UNICEF organised a workshop in N'Djamena in preparation for a family-centred HIV screening campaign that will take place in the second half of November 2018. Two workshops were organised for PMTCT focal points in nine regions including the Lake and N’Djamena, on the new data collection tools and the new database. A total of 95 focal points including those in emergency sites and medical doctors attended the training session. With these new tools, health centers will be able to collect robust data that will provide more information about the demographics of people seeking treatment. Activities for the early detection of children exposed to HIV using GeneXpert machines that were configured by UNICEF, started in the regional hospitals of Moundou and Sarh in the south of Chad with a view to increasing access to antiretroviral therapy. 66 children were screened, of whom one was found to be positive and put on ARV treatment.

Communication  A report by the NGO Plan International highlighted the vulnerability of adolescent girls in three particularly unstable regions: Rohingya teenagers in a camp in Bangladesh, as well as in the Lake Chad Basin and Chad. Forced marriages, abuses or school deprivation are all manifestations of their fragility.  The camp of refugees and Chadians returned from the Central African Republic, located in Gaoui, in the 8th district of the capital N'Djamena, was closed, decided the Chadian government in a note on Friday, October 12th.  @UNICEFChad ‘s support for the launching of large-scale meningitis and measles-linked immunisation campaign (that will cover twelve provinces) to the Government of Chad was highlighted in an article of China.French.com.  @ECW support to Education in Irdimi Refugee Camp in the East of Chad has been highlighted in @UNICEFChad Social Media.  @EuropeanUnion support to Education was highlighted in @UNICEFChad Twitter account.

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Funding UNICEF wishes to express its deep gratitude to all the donors whose contribution continue to make a difference in the lives of children and women affected by humanitarian crises. As of October 2018, 43% of the US$ 53.9 million required to respond to the needs of children affected by emergencies in Chad, is available. For the humanitarian response in the Lake Chad Basin (LCB), 24% of the required US$ 12.6 million is available. Significant gaps in funding remain in the Lake Chad Basin and all the zones affected by humanitarian crises. Without sufficient funding, UNICEF will not be able to continue providing nutritional assistance, access to basic sanitation and supply drinking water, provide access to education as well as offer psychosocial support to the most vulnerable women and children in Chad.

Total HAC Funding

Funding Requirements (per Humanitarian Action for Children Appeal, 2018)

Funds Available* Funding gap Appeal Sector Requirements Funds Received Carryover Total funds available US$ (%) Nutrition 28,997,102 13,557,494 3,419,181 16,976,675 11,967,322 41% Health and HIV 2,698,103 161,229 193,235 354,464 2,364,239 87% WASH 6,055,878 1,388,3241 211,125 1,599,449 4,456,429 74% Child Protection 6,858,465 286,655 719,156 1,005,811 5,852,654 85% Education 6,656,082 421,006 2,423,836 2,844,842 3,811,240 57% Non-food items 1,218,900 0 0 0 1,218,900 100% and shelter Emergency 52% 1,412,140 562,1532 80,346 642,499 769,641 preparedness Total 53,896,670 16,376,861 7,087,983 23,464,844 30,431,826 56%

LCB Funding Funding Requirements (per Humanitarian Action for Children Appeal,

2018)

Total Funds Funding gap Appeal Sector Requirements Funds Received Carryover Funding gap (%) Available* (US$)

Nutrition 2,637,049 362,010 1,235,635 1,597,645 1,039,404 39% Health and HIV 775,117 0 0 775,117 100% WASH 2,054,000 19,712 0 2,054,000 99% Child Protection 3,878,155 11,906 427,530 439,435 3,450,625 89% Education 2,085,530 0 955,515 955,515 1,130,015 54% Non-food items and 1,218,900 0 0 0 1,218,900 100% shelter Total 12,648,751 393,628 2,618,678 3,012,306 9,636,445 76%

UNICEF Chad Facebook: https://www.facebook.com/UnicefChad/ UNICEF Chad Twitter: @UNICEFChad UNICEF Chad Instagram: @unicef.chad UNICEF Chad Humanitarian Action for Children Appeal: http://www.unicef.org/appeals/chad.html

Whom to contact Viviane Van Steirteghem Aissata Ba Sidibe Benny Krasniqi Representative Deputy Representative Chief Emergency and Field Operation for further UNICEF Chad UNICEF Chad UNICEF Chad information: Tel: +235 22 51 75 10 Tel: +235 22 51 75 10 Tel: +235 66391014 Email: [email protected] Email: [email protected] Email: [email protected]

1 The funds received by the WASH programme have been corrected to reflect the right figure 2 Funds received had an additional $41,000 that was supposed to appear in the carry-over. The amount has been added to the right column. 5

Annex A SUMMARY OF PROGRAMME RESULTS

Overall Cluster UNICEF needs Response Change since Change since 2018 Target Total Results the last 2018 Target Total Results the last report report

NUTRITION Number and % of children 6-59 months with Severe Acute Malnutrition (SAM) admitted 362,682 268,837 196,814 23,042 268,837 196,814 23,042 for therapeutic care and benefitting from promotion of nutrition practices3 % of children with SAM 85% 91% 85% 91% discharged who recovered Number of Health Centers with an integrated SAM 1,132 632 625 708 625 management programme HEALTH Number of children in humanitarian situations aged 6 513,994 147,000 610,1575 50,255 months to 14 years vaccinated against measles4 WATER SANITATION &

HYGIENE A number of children under 5 admitted in SAM treatment who received a lifesaving package including messages 200,952 42,293 18,1496 5,198 169,174 41,522 6,646 about appropriate hygiene practices and Nutrition supplies. Number of crisis affected people who have access to basic sanitation facilities (latrines) in 1,627,814 108,868 14,270 1,650 344,274 67,065 1,770 accordance with the WASH Cluster s standards and norms Number of crisis affected people who have access to safe potable water and hygiene 1,627,814 126,672 83,529 4,865 638,900 164,620 6,500 promotion activities in line with the standards (15L/per/Day). CHILD PROTECTION Number of unaccompanied and separated children that have access to alternative care, NA 10407 621 3 1,060 621 3 family tracing and reunification services Number of displaced children with access to psychosocial NA 30,2508 13,347 26 77,257 13,347 26 support, including in child- friendly spaces

3 data is collected by the national health system and normally takes more than a month to be reported 4 This indicator includes results from routine vaccination in refugee camps and returnee sites. The cluster indicator considers only children from 6 to 59 months 5 This number includes children that were vaccinated during the response to the measles outbreak. The outbreak had not been anticipated during planning 6 The figure has been modified to reflect corrections made by the partner 7 The figure has been adjusted to correspond with the figure in the HAC 8 The figure has been adjusted to correspond with the figure in the HAC

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Number of UAC reunified with NA 115 16 0 115 16 0 families EDUCATION

Number of out of school boys and girls (3 to 17) affected by 623,579 18,0009 17,285 0 468,161 19,455 0 crisis accessing education Number of boys and girls aged 3 to 17 years affected by crisis attending education in a 421,016 8,00011 7,053 0 295,539 9,750 0 classroom where the teacher has been trained in psychosocial support 10 Number of school aged boys and girls (3 to 17) affected by 489,301 202,43512 198,065 0 489,301 200,754 0 crisis receiving learning materials HIV and AIDS Number of pregnant women that have access to HIV and AIDS screening services and 580,631 40,000 44,89913 3,554 prevention of mother-to-child transmission services NON-FOOD ITEMS (NFIs) &

SHELTER Number of displaced persons who received non-food items 634,009 29,260 18,000 138,175 22,000 and shelter kits

UNICEF and partners’ response in the Lake Region

NUTRITION Number and % of children 6-59 months with Severe Acute Malnutrition (SAM) admitted for 12,702 22,335 24,173 2,005 22,335 24,173 2,005 therapeutic care and benefitting from promotion of nutrition practices % of children with SAM discharged recovered 85% 96% 85% 96% HEALTH Number of children in humanitarian situations aged 6 months to 14 years vaccinated against 40,000 6,279 measles 14 WATER SANITATION & HYGIENE Number of children under 5 admitted in SAM treatment who received a lifesaving package 12,702 2,136 827 781 10,693 827 781 including messages about appropriate hygiene practices and Nutrition supplies. Number of crisis affected people who have access to basic sanitation facilities (latrines) in 279,887 75,852 8,310 1,650 172,649 38,640 1,770 accordance with the WASH Cluster s standards and norms Number of crisis affected people who have access to quantity potable water and hygiene 279,887 77,988 13,664 3,000 193,425 72,950 6,500 promotion activities in line with the standards (15L/per/Day). CHILD PROTECTION

9 This number was revised during the HAC revision (final approval October 2018) 10 UNICEF targets 6 to 11 years 11 This number was revised during the HAC revision (final approval October 2018) 12 This number was revised during the HAC revision (final approval October 2018) 13 Includes results that had not been previously reported 14 Includes results from routine vaccination in refugee camps and returnee sites. The cluster indicator considers only children from 6 to 59 months 7

Number of unaccompanied and separated children that have access to alternative care, NA 450 149 3 890 149 3 family tracing and reunification services Number of displaced children with access to psychosocial support, including in child NA 10,150 7,556 26 23,200 7,556 26 friendly spaces Number of UAC reunified with families NA 60 5 0 110 5 0 EDUCATION Number of out of school boys and girls (3 to 17) 176,082 10,000 4,490 0 176,082 6,660 0 affected by crisis accessing education Number of boys and girls aged 3 to 17 years affected by crisis attending education in a 192,879 43,200 7,053 0 153,881 9,750 0 classroom where the teacher has been trained in psychosocial support 15 Number of school aged boys and girls (3 to 17) 192,879 60,023 51,476 0 192,879 54,165 0 affected by crisis receiving learning materials NON-FOOD ITEMS (NFIs) & SHELTER Number of displaced persons received non- 172,493 20,900 0 82,000 0 food items and shelter kits

15 UNICEF targets 6 to 11 years 8