CAMEROON: WEST AND LITTORAL REGIONS Multi-Sector Rapid Assessment (MIRA) October 2019

HIGHLIGHTS

• 200,189 persons, thus 76,880 in the Littoral and 123,309 in the West, are internally displaced as result of violence in North-West and South-West regions; • 60% of IDPs in the Littoral and West regions are living in host families; • More than 50% of IDPs are children of school age; • Around 75% of the IDPs do not have ID cards.

Source: OCHA The boundaries and names shown and the designations used on this map do not imply official endorsement or acceptance by the United Nations.

4.8M 428K 180K 200K 228K affected people People in targeted for internally Host Need assistance* displaced communities

OVERVIEW

What? The humanitarian crisis affecting the North-West and the South-West (NSWS) regions has a growing impact on the bordering West, Littoral and Adamaoua regions. The no school policy instituted by the Non-State Arm Groups (NSAG) continues to prevent children from accessing education. Population movements have been observed prior to the resumption the 2019-2020 school year, concerning mostly children of school-age. Information received from the field and from the education sector indicates several pupils asking to be enrolled in different primaries and secondaries schools. Based on this information and in line with the preparation of the 2020 HNO, the Humanitarian Country Team (HCT) commissioned an inter-agency needs assessment mission. Why? During the period preceding the beginning of the 2019 school year, more and more families were leaving the North-West and South-West regions to take refuge in the Littoral and West as a result of limited access to education for children due to the destruction or closure of schools resulting from the “No School” policy ordered by NSAGs. The situation has considerably evolved two weeks after school resumption because of • The failure of the back to school campaign launched by the Government; • Non-adherence to the major national dialogue;

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• Persistence of clashes between NSAGs and the Government army with insecurity as consequence; Consequently, there has been a major increase in the number of people leaving the two regions to seek safety and/or to access economic and educational opportunities. Preliminary findings indicate that there is an increase in the number of pupils displaced from the NWSW seeking enrollment in Littoral and West schools. Where? Based on the information received, most affected divisions within the Littoral region are Wouri and Moungo. In the Moungo; Nkongsamba and Mbanga are host to the highest number of IDPs while in the Wouri Divison, a majority are in Douala III and Douala IV subdivisions. meanwhile in the West Region Bamboutos, Menoua, and Noun divisions (Galim, Dschang and Bangourain) are hosting the highest number of IDP. Who? It was a Multi-Sector Initial Rapid Assessment (MIRA) commissioned by the HCT and led by OCHA. Humanitarian agencies including, OCHA, UNHCR, UNICEF, UNFPA, WHO, UN WOMEN, FAO the international NGO IMC, Intersos and Plan international and the Red cross movement took part, as did two representatives of Civil Protection (MINAT). The agencies and organizations involved were representing, Coordination, Protection, Wash, Child protection, Education, SGBV, Health, Gender, Early recovery, Food security, Shelter and NFI. a. The mission’s objectives • To gain a shared understanding of the humanitarian impact of the North-West and South-West crisis in the Littoral and West regions. • Evaluate the scale of population movements from the North-West and the South-West to the Littoral and West regions. • Identify the most affected divisions and subdivisions. • Identify priority needs and assess the living conditions of the displaced population, as well as the impact on the local population. • Inform the revision of the HNO/HRP 2020 in providing evidence-based information on the humanitarian needs and the emergency assistance needed. • Provide an overview on the availability and functionality of basic social infrastructures (health, education, markets, drinking water) and their access to beneficiaries. • Provide an overview of the humanitarian presence in the two regions.

b. Methodology • Data collection The data collection of was done in the form of group discussion or individual interviews with key informants. At least five interviews were organized in each subdivision. The key informants were composed of administrative authorities (Senior Divisional Officer (SDO), Divisional Officers (DO), line ministries; police Gendarmerie); traditional and religious authorities; community leaders; representatives of the IDPs, and women groups. • Analysis and severity ranking Based on the needs identified by the key informants, the survey team conducted an analysis. This analysis which determines the level of severity of needs is made based on direct observations, analysis of secondary data’s, the statements of the IDPs themselves. It is a qualitative analysis. • Data collection tools In addition to the hard copy of the questionnaire, the assessment team used KOBO to record the data collected.

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c. Situation Description The Littoral and West regions share boundaries with the North-West and South-West regions. Table 1: People in Need in the West and Littoral Regions The ongoing crisis in these two regions has displaced approximately 200,000 people to the Regions Divisions IDPs Host PIN Littoral and West regions according to the Bamboutos 16,292 18,334 34,626 mission findings. A large majority of these IDPs Haut-Nkam 4,617 5,212 9,829 are women and school-aged children. Hauts-Plateaux 1,357 3,086 4,443 Because of their proximity and cultural Koung Khi 676 797 1,474 connections with the North West and South West West regions, the bordering divisions of the Menoua 52,330 53,745 106,076 Littoral (Moungo and Wouri) and the West Mifi 9,361 10,758 20,119 (Bamboutos, Menoua and Noun) seem to be the Nde 4,029 5,569 9,598 most affected division by this influx of IDPs. Noun 34,646 53,801 88,448 However, there is currently no clearly established understanding with regards to the Total West 123,309 151,303 274,612 displacement situation outside the NWSW Moungo 31,880 32,267 64,147 regions. The arrival of IDPs has led to Littoral Wouri 45,000 44,047 89,047 overcrowded housing; there is a lack of sleeping materials. Some IDPs are reportedly sleeping in Total Littoral 76,880 76,314 153,194 huts in farms some others are living in other Total Littoral/West 200,189 227,617 427,806 precarious housing situations. Local sources also report that some IDPs are renting Source: OCHA, MINAT accommodation as they do not have any families/friends among the host population, leaving them unable to pay for other needs, such as food, education and health. The IDPs also face protection concerns; due to a lack of IDs and birth certificates they are being harassed by the police and gendarmerie. In parallel, basic social infrastructures are not functioning adequately; there are insufficient drug stock in health facilities, not enough water points etc. Technical schools of the English-speaking subsystem of education do not exist and there is also the language barrier that prevents children from integrating into the French-speaking school system. IDPs' search of livelihoods has reportedly led to an increase in abuse and prostitution in host cities and localities according to local authorities and other key informants. There is also a global increase of water-related diseases, including typhoid fever (suspected cases) and diarrhea. These diseases are more common in the Bangourain health district and indicating the use of unsafe drinking water and poor hygiene and sanitation conditions. At the market level, insecurity and limitation of movements of persons and goods have resulted in an increase in prices of food commodities. Most IDPs are living in urban areas (Bamboutos, Bafoussam, Dschang; Foumban Bangourain Douala; Mbanga; Nkongsamba) and therefore have access to food but they lack financial means. The HRP 2019 is not covering the Littoral and West region. However, the Red Cross Cameroon distributed food in the Wouri, Moungo, MIFI, Bamboutos, and Menoua divisions in 2018. Food was distributed only for one month, in November 2018 and since then, no substantive food assistance has been provided to displaced persons. The assistance provided by the Government could not cover all the population in need. Moreover, it was punctual in small quantity. The registration of IDPs is ongoing and the local authority’s humanitarian assistance has helped increase the registration rate. However, IDPs continue to be reluctant to come forward. Meanwhile, the number of IDPs and needs are increasing, especially because of the no school policy that pushed parents in the NWSW to move their children to seek education opportunities. It is reported that for some IDPs this is already their second displacement. They left their first displacement location because of poor living conditions. The destinations of these movements are unknown.

GENERAL FINDINGS Key Figures and areas affected The mission visited 12 subdivisions within two divisions (Moungo, Wouri) of the Littoral region. According to the information provided by the local authorities as well as IDPs, the estimated number of IDPs from the NW and SW in Littoral region stands at about 77,000 in 4 sub-divisions in Wouri and 8 sub-divisions in the Moungo. The most affected subdivisions are Douala IV-20800 and Douala III-11400 (Wouri), Mbanga-11600 and Nkongsamba-6000 (Moungo). 58% of this IDP are in the Wouri division. Data was provided by local authorities and confirmed by distribution figures of the DPC. Concerning the West Region, according to the information received. all 8 divisions of the region are hosting IDPs. However, due to limited time the team visited only 5 divisions (Bamboutos, Menoua, Mifi, Ndé and Noun) and had discussions with keys informant. Based on registration figures provided by the Region and considering data collected on the field, the estimate number of IDPs stands at 123,309 representing about 6% of the host community. Figures were provided by the office of the Governor and cross checked by the assessment team in the field with key informants using education data.

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The data of the registration (list of names per household) provided by local authorities were increased by 35% upon information received by the Governor. Priority needs of the displaced population In the Littoral, food security, shelter and livelihoods are the three top priority Figure 1: Ratio IDP vs Population of West and Littoral Regions needs cited by local authorities and IDP groups in both divisions. Most of the displaced persons were farmers who have lost their livelihoods. In host communities, access to arable land is limited for IDP families since they are expensive to rent. Also, prices of staple food have increased as a result of the disruption in regular supply from the SW. Most IDPs expressed the need for an income generating activity to be able to feed themselves and meet other needs such as healthcare and education and avoid reliance on assistance. While education was not amongst the top three priorities, local authorities repeatedly recommended the improvement of school infrastructure and the creation of more bilingual schools to host increasing number of schoolchildren from the NWSW. In the West region, shelter, education, protection and food/livelihood are the main priority needs cited by keys informants. It should be noted that most of the IDPs are school aged children: many of them are living without parents and are exposed to protection risk including abuse, sexual exploitation, prostitution and forced enrollment in NSAGs. The first source of food is the market: therefore, IDPs need a source of income to sustainably buy food in the markets.

Source: MIRA oct. 2019 Access and Security Concerns

Figure 2: Severity map vs IDPs population No access constraints were recorded in the Wouri and Moungo divisions. However, local authorities regretted the fact that most IDPs are reluctant to identify themselves as displaced persons largely due to fear and mistrust. The security situation is generally stable in the two divisions. IDPs generally reported they feel safe in their communities. However, incursions by armed groups were reported in the Moungo division particularly at Mombo subdivision were attacks in a village bordering the SW has seen school enrollment of English-speaking children drop by more than 80%. The West region is generally stable, but incursions of armed groups have been reported on the border with the North West at Bangourain subdivision and with the South West at Fongo Ndeng and Fongo Tongo Given these incidents the security measures were strengthened by the creation of additional checkpoints in Bangourian and FongoNdeng. The checkpoints do not have a major impact on access.

Source: MIRA oct. 2019 3. SECTOR OVERVIEW WEST AND LITTORAL

Education 1. General Overview

3-1-1 Education West: Severity 4&3 a. Bamboutos Division: Severity Level 4 The needs assessment mission carried out in Bamboutos mentions the presence of many IDPs in some subdivision, mostly those bordering the NW (Babadjou, Galim, Batcham). The majority of IDPs in those areas are children of school age, many of them are unaccompanied. The presence of children can be explained by the proximity and the sharing of a common culture. Information collected from keys informants present in this division reveals education as one of the most important need with a level of severity equivalent to 4.

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The level of severity is justified by structural factors: the English educational sub-system is not sufficiently represented in the division. In addition, there is a lack of teachers, teaching materials, and a poor studying environment. The team has also noted that due to the proximity with Bamenda many parents have left their children in the Bamboutos division for studies. They only visit them once a month. The massive influx of IDP pupils has worsened the situation by increasing the pressure on an educational service that was already struggling to meet the needs of host populations. The schools are overcrowded: data collected in the Galim subdivision is showing an average of 130 to 200 students per classroom rather than 45 to 50. Concerning access to education, no discrimination was mentioned between boys and girls by key informants. It should be noted, however, that there is a notable presence of out-of-school children. The main reasons given are: the lack of financial means, limited number of schools of the English sub-sector of education, the use of children for paid domestic work to meet family expenses, the lack of documentation, etc. b. Menoua Division: Severity Level 3 Education has also been identified as one of the priorities needs in the Menoua division. Although the level of severity is lower, the immediate causes remain the same as in the Bamboutos division. In addition to the overabundance of enrollments in the Menoua schools, the number of teachers trained to supervise students from the English-speaking sub- sector of education is limited; Anglophone and bilingual schools represent only 20% of the education offer meanwhile the demand in this subsector has almost doubled since 2017. It should be noted that in order to provide a response to the negative consequences of the NWSW crisis on education, the Cameroonian government has taken steps to facilitate access to education for IDP children in the Littoral and West regions. In public schools’ students are registered for free. However, students must pay the parent teachers association (PTA) fees. These fees are used by school officials to pay the salaries of temporary and contract teachers. Therefore, an IDP parents would see their child expelled from school if they cannot pay the PTA fees. In addition to the above-mentioned problems, IDP children who have been admitted to schools are at risk of not being eligible for official examination since they lost their national identity card and or birth certificate while fleeing. The above-mentioned issue has been raised in all divisions visited. Fortunately, only few children were signaled to be out of school in the Menoua division the reasons were like those mentioned in the Bamboutos: the lack of financial means, limited number of schools of the English sub-sector of education, the use of children for paid domestic work to meet family expenses, the lack of documentation, etc. However, girls’ prostitution has been clearly mentioned as one of the coping strategies used to survive, alongside with domestic work. c. Noun Division: Severity Level 4 For the Noun division, the situation is different from the other divisions. The team was told that about 30% to 40% of the school-aged children are out of school. The reasons given are identical to those mentioned in the other divisions (very few Anglophone and bilingual schools (11%), lack of documentation, no financial resources, long distances from houses to school, involvement in income generating activities (IGA). Beyond these observations, it should be noted that IDP children are also not going to school because they lack food: they do not eat enough and therefore cannot attend classes normally. Those children out of school, especially girls, are exposed to protection risks such as early pregnancy, early marriage, sexual exploitation and abuse, sexual and gender-based violence (SGBV). For boys, because of idleness and hunger, they often find themselves involved in petty thefts. They may also be exposed to the use of drugs and narcotics, forced recruitment in NSAG and become sources of violence in the community. 3-1-2 Education Littoral: Severity Level 3 The influx of displaced people from the North West and South West regions puts significant pressure on the various basic social services of the Littoral, particularly on education. In the various subdivisions observed, there is an increase in the demand for services that barely meets the available infrastructures. From the supply perspective, it is noted that displaced and host community students typically occupy overcrowded classrooms with no water and limited sanitation facilities (separate latrines, water points, handwash kits). In addition, students who are displaced very often do not have learning materials. Also, teachers often do not have the necessary skills to provide psychosocial care for these children, who are often traumatized. The language barrier forces these children to concentrate in bilingual or English-language schools, which remain limited despite an increase of this type of training reported by key informants, particularly in the private sector. The situation is even more critical for pupils in secondary technical education: the poor provision of the Anglophone specialty forces students to turn to bilingual high schools or drop out of school. In relation to the demand for education, although displaced parents do understand the importance of enrolling their children in school, they generally face economic barriers. Despite the official requirement to routinely admit displaced students from the North West and South West, according to parents, some school principals continue to charge fees for

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Parents Teachers Associations and registration. The fees charged in private training are higher than in the localities of origin and are increasing according to key informants. As a result, parents enroll only a portion of their children, thus favoring the oldest (already generally well advanced) and girls (more vulnerable than boys). On the other hand, most of the displaced children who are currently enrolled have a high propensity to be out of school, as parents are unable to pay the fees. Moreover, because of the high rate of non-possession of birth certificates, children enrolled in their final year may not be able to sit for the official exam. In terms of community-based response, few initiatives in support to out-of-school children have been noticed. For an instance, in Ndjombe, schoolchildren organize tutoring classes in the chief’s premises for the benefit of the youngest out- of-school children. Education was often classified by key informants as one of three key priorities. The administrative and sectoral education authorities conclude that due to the high economic vulnerability of the displaced, the drop-out of affected children will increase if specific support is not provided in terms of infrastructure, school materials and cash-based interventions. 2. Recommendations Short term (in 3 months) • Advocate for the reconstitution of birth certificate and ID cards for school children. • Develop a strategy to encourage school attendance. • Control by authorities of the effectiveness of free admission of displaced persons; • Rapid assessment of education needs to identify real needs and resilience mechanisms developed; • Distribution of learning and didactic material to displaced pupils and schools hosting displaced persons; • Continuous training of primary and secondary teachers in (Psychosocial Support) PSS for a better support of students; • Build temporary learning and protection spaces, as well as water and sanitation facilities (separate latrines, water points, handwash kits) to accommodate more students; • Explore accelerated curricula and community preschool for children outside of school. Medium term (Beyond 3 months) • Advocate with the authorities for the recruitment/ temporary redeployment of anglophone or bilingual section teachers for the Littoral and West; • Strengthen the supply of educational infrastructures, particularly for the Anglophone education sub-sector)

Food Security 1. General Overview 3-2-1 West Region: Severity Levels 3&2 a. Bamboutos Division: Food security: Severity Level 2 70% of the population of the Bamboutos division depends on agriculture activities and feeds over 95 % of the total population. This area is a basin of production that supplies big towns like Douala, Yaoundé and Garbon with food. The Bamboutos division hosts IDPs, with the majority coming from the North West especially from around the Santa sub-division and others from the South West. Key informants in the Bamboutos division and sub-divisions identified food as a priority need. Information from local authorities reported that the nutritional status of children going to school is precious since these children are heading households. IDPs obtained food from the various following sources: • Parents living in the NWSW are struggling to bring food for their children once per month; • Free will donations by persons of good will; • Agricultural work; • Relatives and host families, adding burden on the host communities; • Theft of farm products in the farmland - highlighting potential for security incidents. IDPs and host community’s food reserves are depleting, leading to a high risk of food insecurity in the next three months mainly among those host communities with limited food production capacity. If the socio-political situation ongoing in the NW and SW regions continues, this division will be impacted and could face limited food availability due the large quantity of food going out of the region combined with an increased number of IDPs to feed. Some abandoned farmland along the border with the NW has witnessed sporadic attacks by NSAG. b. Menoua Division: Food security: Severity Level 2

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This division hosts IDPs, with the majority coming from the South West especially from around the Lebialem sub-division and others from the North West. Local authorities reported that the nutritional status of children going to school is precious. These children are heading households. IDPs obtained food from the various following sources: • Parents living in the NWSW are struggling to bring food for their children once per month; • Free will donations by persons of good will; • Agricultural work; • Relatives and host families, adding burden on the host communities; • Theft of farm products in the farmland - highlighting potential for security incidents. IDPs lack farmlands and limited income generating activities for IDPs reduces their purchasing power, thus reducing food access. IDPs and their host families are therefore highly vulnerable to food insecurity. Moreover, in the Menoua division there is no additional food entering from the South West (Lebialem sub-division), traditionally a source for fresh produce that used to transit for Yaoundé and Douala. If the socio-political situation ongoing in the NW and SW regions continues for long, this division will be impacted and could face limited food availability due to the large quantity of food going out of the region combined with an increasing number of IDPs arriving seeking safety. c. Noun Division: Livelihood: Severity Level 2 IDPs lack or only have limited access to farmland in some sub-divisions of the Noun, such as in Foumbot, Bongourian etc. Some IDPs cope with the situation through moto bike riding, harvesting firewood, domestic work, survival sex, and provision of manual labour in farming activities such clearing, hoeing, planting, etc Others IDPs are managing to survive thanks to the community and family solidarity and support from relatives out of the division. Some IDP women and children were seen selling pufpuf, koki, fried groundnut etc while some men have openen garages without accessories for income generation. The situation will not be sustainable as there is little or no farmland for them and few or no income generating activities. If no assistance is provided, both IDPs and their host families/communities are at risk of food insecurity in the next couple of months since the number of IDPs is increasing. If the socio-political situation continues, IDPs will need support to embark on income generating and farming activities. d. Market All markets in the three divisions (Noun, Menoua and Bamboutos) visited are functional. However, scarcity of certain foods and a serious increase in prices are observed in all areas. Prices for staple food such has bean, maize, potatoes have doubled and tripled in some areas. For examples, a 15kg of bean are sold at 12,000 FCFA instead 4,000 FCFA. The price for 15kg of potatoes has increased from 3,000 FCFA to 6,000 FCFA etc. With the increasing number of IDPs, many new markets are opened in quarters and are operational daily. The doubling and tripling of staple food prices are due to the presence of heavy buyers from Gabon, Yaounde and Douala visiting Foumbot and other markets on a weekly basis. However, some crops were coming from neighboring divisions of the NW; for example, the Bui division cannot support the Noun market with beans and Irish potatoes because of insecurity. If the socio-political situation continues in the North West and South West regions for long, food prices are likely to triple in the affected areas of Noun, Menoua, and Bamboutos Divisions. In the localities of Fondonera (Santchou sub-division) and Fossong Ellelem (Fongo Tongo sub-division) of Menoua division and Bangourain village in Noun division only limited operations of village markets were noted, due to threats NSAGs. 3-2-2 Littoral region: Food security: Severity Level 4 In the Littoral region, it was revealed that food is amongst the 3 top priority needs in all the subdivisions. Families hosting IDPs have seen their family size more than double without any corresponding increase in household income. Also, displaced persons have not been involved in agricultural activities due to the high cost of renting or purchasing arable land. Hitherto, some IDPs in the Moungo division from Meme and Kupe-Manenguba divisions in the South West used to cross the border to harvest food in their farms. However, due to increased insecurity, this practiced has stopped as some IDPs have been tortured, abducted and/or their produced was seized by armed groups. While food is generally available in the markets in the Littoral region, displaced families cannot afford it because of the hike in prices of staple foods. IDPs have lost their livelihoods (livelihood was consistently cited among 3 top priorities) and only a few are involved in petty trade for survival. Negative coping strategies such as eating once a day have been developed by displaced families. In Njombe-Penja, IDPs have resorted to collecting thrown food at the Banana plantations for consumption. WFP distributed food in the Littoral region in November 2018. Since then no substantial food assistance has been given to displaced persons. Many rely on persons of goodwill for a daily bread. A deterioration of the food security situation is foreseen due to increasing prices at the markets and the strain placed on host community resources.

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2. Recommendations: Short-term (first 3 months) • Provide an immediate food assistance for 2 to 3 months to the most vulnerable IDPs to alleviate the deterioration of their food security situation. Food distribution agencies should create time to mainstream GBV and prevention of sexual exploitation and abuse messages as part of the pre-distribution activities; • Training in nutritional education and nutritional elements should be included in the food basket for IDP children attending school; • Conduct food security and vulnerability assessment of the IDPs and host families; and identify an adequate response mechanism as per needs; Mid-term (more than 3 months) • Support vulnerable households with inputs for them to restart their livelihood.

Health 1. General Overview 3-3-1 West region: Health: Severity Level 2 The populations are rural and semi-urban. There is one district hospital in each district with high admissions and a mixed technical plateau. a. Service offer: Inadequate human and logistical resources significantly limit service delivery and quality of service; there are frequently breaks in essential drugs. Surgical and effective care in all these districts through District Hospitals and other large private health facilities are limited; these interventions concern emergency caesareans and sometimes hernias and appendicitis. With the increasing number of displaced people, the demand for health services has considerably grown. There are no services to deal with psychosocial problems. There is a steady increase in the number of patients. b. Accessibility to health services: The lack of financial resources limits access to care for displaced people, most of whom have no means of livelihood. It therefore difficult for health facilities to take care of these cases of indigents while having normal functioning. c. Human resources: Human resources are clearly insufficient in quantity and quality. This lack of human resources is greater among paramedics. Although licensed practical nurses are recruited locally to fill this gap, most of the time they are not properly trained. On the other hand, the workload has increased with the arrival of IDPs. The situation is negatively affecting the quality of health care and services. d. Mortality and morbidity: Currently, information on the health system does not include data on the morbidity and mortality of IDPs. However, based on available mortality data, there is no evidence of the effect of IDP presence on the mortality rate. Analysis of routine data shows an overall increase in in Typhoid; Gastroenteritis; Measles Malaria over time (see Appendix). 3-3-2 Littoral region: Health: Severity Level 3 In all the subdivisions visited, local authorities declared that IDPs have access to healthcare. In some health districts, District Medical Officer (DMOs) reported a general increase in the number of cases received in the health district, hosting a significant number of IDPs. There is also an overall increase in cases of water related diseases including typhoid and malaria especially in the Moungo Division. However, IDP groups interviewed declared that access to healthcare is very limited due to the high cost of treatment at health centers. In the Moungo and Wouri divisions, cases of IDPs who were forced out of hospital because they were unable to meet the cost of health care were reported. In Nkongsamba and Mbanga, IDPs revealed that they are obliged to offer free cleaning services at hospitals to compensate for their inability to cover the cost of treatment for their family members. The situation is alarming as many more IDPs are resorting to self- medication or traditional methods of treatment which they consider affordable. Shortages of drugs, laboratory inputs and health personnel have been observed and they constitute a hindrance to the provision of quality healthcare. 2. Recommendations Short Term (First 3 months)

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• Conduct assessments to identify exact needs. • Set up a psychosocial support unit to assist IDPs, specially separated traumatized children. • Always ensure the continued availability of essential drugs and laboratory inputs. • Improve the availability of basic essential medicines and nutritional inputs. • Put in place strategies to reach displaced people living in areas that are difficult to access or have limited access to health care. Long Term (4-6 months) • Strong coordination with WASH sector to ensure better access to WASH services. • Strengthen community-based surveillance. • Contract additional staff at all health districts hosting large numbers of displaced persons. • Implement CLTS (Community-Led Total Sanitation) projects in host communities. • Strengthen community-based disease surveillance through the implementation of event-based surveillance (SBE).

Nutrition 1. General Overview 3-4-1 West region: Nutrition: Severity Level 2 Health system information does not collect data on the nutritional status of Internally Displaced Persons. However, it should be noted that, the diet of these IDPs has changed considerably, the number of daily meals has dropped from more than three to one meal per day. In addition, the quality of these meals is not always guaranteed. These presages problems of malnutrition.

3-4-2 Littoral region: Nutrition: Severity Level 2 The massif flow of people from the North West and South West regions into the Littoral region puts significant pressure on the various basic needs of the population (both IDPs and host), particularly in nutrition. All the groups of key informants reported that the nutritional status of children is a major concern. The majority of the women do not exclusively breastfeed their babies aged 0 to 6 months. The reason is that breast milk does not flow well due to the inadequate food intake of the mother, so they start giving liquid and semi liquid food to the babies, some from day 1. Although majority of the women do not exclusively breastfeed their babies, they continue breastfeeding till the child walks (12 to 15 months). In case of breastfeeding problems, mothers seek help from family members and traditional mid wives. From the focus group discussions, it came out clearly that inadequate feeding practices are observed among children aged 6 to 24 months. The most common foods given to these children are pap, rice, corn fufu and okra, spaghetti and potatoes. The composition of the pap is mainly corn, sugar and water. In the whole Littoral only IDPs from Douala V received once milk and flour for children from the catholic church. Key informants in all divisions and sub-divisions identified nutrition as a priority need, even though it wasn’t amongst the top three. All key informants affirm that if nothing is done, the nutritional status of these children and their mothers will keep worsening. There was no available data for children less than five years: none of the census forms seen in the field had a column for age.

2. Recommendations Short term (first 3 months) • Target mothers of new-borns with support of early initiative and exclusive breastfeeding. • Advocacy to prevent donation of BMS to breastfeeding women with infant less than 6 months. Long term (4-6 months) • Integrate breastfeeding counselling in interventions that target pregnant and breastfeeding women. • Integrate multi-sector interventions to protect and support safe and appropriate IYCF. • Implement the nutrition project program throughout the West region.

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• Identify and provide food assistance to the most vulnerable IDPs in the West region

Protection 1. General Overview 3-5-1 West region: Protection: Severity Levels 3&4 a. Bamboutous Division- Severity Level 3 Key informants report that the majority of the IDPs residing in this division come from the Lebialem division (living in the Batcham sub-division); the Santa sub-division (living in the Mbouda and Babajou sub-divisions) and the Bafanji from Ngoketunja divisions (living in the Galim sub-division). The following protection incidents were highlighted by key informants: Cross border attacks by NSAG in the locality of Galim are preventing IDPs from carrying out farming activities and fetching firewood. A significant number of IDPs do not have basic documents (birth certificate, national identification cards and academic certificates and diplomas) due to loss, destruction and expiration of documents during the crisis. Most of the IDPs are asked by the authorities to go back to their places of origin to get court judgments (for the birth certificates) and certificates of nationality (for the identification) in order to reconstitute these documents. Incidents of sexual and gender-based violence were also noted. Key informants explained that due to the precarious living conditions, IDPs engage in survival sex and an increase in prostitution amongst displaced women and girls is reported. This increased the risk of early and teenage pregnancy. Few cases of domestic violence among IDPs were also noted. The majority of the IDPs are children; many are unaccompanied and separated children. Some IDPs also complained of stigmatization by the local population. b. Menoua Division- Severity Level 4 The majority of IDPs in this area come from the Lebialem division. Key informants report that a good number of localities of the Menoua Division sharing borders with the South West region were subjected to attacks by NSAGs during the course of the year. This includes the Fongo-Tongo subdivision which was subjected to an incursion by a NSAG in April 2019 leading to displacement of IDPs to Dschang. In the Fondonera section of Santchou, most IDPs explained that they cannot carry out their farming activities because of constant incursion of NSAGs from Lebialem. Other protection incidents noted in this division include the following: Almost 75% of the IDPs do not have national identification cards and birth certificates. Though the Cameroon Government instructed school authorities to enroll IDP children without birth certificates at the primary and secondary school levels, this still poses a problem as these children are asked to present birth certificates during official examinations (common entrance, first school living certificate, GCE etc.) as this document is one of the basic requirement to register for these official examinations. Most IDPs complained of stigmatization by the local population and by some Anglophones who have been residing in the region before the crisis. Often they are insulted and called names such as “ambaboys, separatists,”les Bamenda”.

c. Noun Division- Severity Level 3 The following protection incidents were noted by key informants: In Bangourain, following the incursion and burning of houses in the Menkefou and Choupat neighborhoods in December 2018 by suspected elements of NSAG, IDPs and host families in some localities of Bangourain bordering Jakiri (Bui division) and Babessi (Ngoketunja division) of the North West, explain they live under constant fear and are under high alert. They explained they avoid their farming activities in those localities out of fear of attacks. Numerous checkpoints were erected in some localities of Bangourain by Cameroonian security forces. In the village of Koutopet located about 10km away from Bangourain town and few kilometers from Jakiri, the joint assessment team was informed by the traditional ruler that the village is considered a “red line” zone as it is frequently raided by NSAG from the Bui division. Some informants noted few cases in which IDPs were arrested in Foumban during police patrols for non-possession of national identification cards. In Foumbot some IDPs equally complained of being arrested at check points when travelling out of the division for lack of identity cards and are only released after paying sums of money. The majority of the children going to school do not have birth certificates. The various divisional delegates of education in the divisions visited explained that they are still waiting on the Central Administration in Yaounde to react to this issue concerning birth certificates.

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Another protection issue raised by key informants is that of exploitation of IDPs by employers. Most IDPs living in the West region are involved in the informal sector such as in farming activities (commonly called in pidgin as “bambe”), casual work in construction sites, mechanics, hair dressing and other petty jobs. Most often IDPs are employed by residents of the host population to work at wages lower than the normal rate that used to be paid before the influx of displaced persons into the region. Some explained that at times they are not paid after working and that they have nowhere to complain. Few cases of disputes between landlords and IDPs were reported because of unpaid rents. Due to financial difficulties, some IDPs are unable to keep up with rents which result into conflict between them and the landlords as IDPs are under threats of being evicted by the landlords. Incidents of sexual and gender-based violence were also noted.

3-5-2 Littoral Region: Protection: Severity Level 3 IDPs as well as host communities face various protection concerns although protection was not clearly identified by the stakeholders as a priority issue in the Littoral region. Indeed, other sectors such as food security, livelihood and education were more often mentioned by key informants and IDPs but almost all the concerns raised had a protection underpinning. IDPs in Wouri and Moungo reported the loss of identification documents including birth certificates, non-registration or expiration of registration deadline for new births. The loss of identification is a constraint to freedom of movement as IDPs fear being harassed by law enforcement agents. Furthermore, those with lost documents do not have access to basic services such healthcare, education and formal employment. In most of the divisions, it was reported that some school children risk not sitting in for Government official exams since having a birth certificate is a prerequisite to be registered for the exams. According to key informants, there are acute psychosocial needs amongst the displaced population – with specific impacts on children – due to violence witnessed and the trauma of displacement. All key informants in the Littoral region also insisted on the increase of survival sex and prostitution amongst displaced women and girls, given their vulnerability and the difficult living conditions they face. In Moungo, and especially in Nkongsamba, many heads of quarters mentioned an increase of quarrels between young women (IDPs and host community) because of “love affairs” with married men sponsoring them. This can affect the peaceful cohabitation between IDPs and host community. In parallel, many cases of teenage pregnancy were mentioned among the IDPs both in Wouri and Moungo. Almost all IDPs stated that they feel secure in the Littoral although in some areas their integration is challenged by the language barrier. An immediate consequence is that they are reluctant to request assistance from the competent authorities in cases of protection incidents as they will be forced to express themselves in French. The main protection problems identified in the Littoral region refer to documentation, child protection and SGBV.

2. Recommendations Short-term (first 3 months) • In-depth assessment on the protection risks, especially targeting children and women; • Provision of an appropriate psycho-social response such as group facilitation, continued interaction to release stress, etc. (with a focus on children and women); • Develop protection monitoring and referral mechanisms, mainly at detention centers and advocate for those who are arbitrarily detained and those who are detained because they lack identification documents; • Raise awareness among the IDPs on the need to establish birth certificates for children to the extent possible within the legal time frame; • Profiling of displaced populations to gain a clearer picture of statistics and dynamics at the level of quarters. • Support to reissue the lost ID documents potentially through mobile court hearings and as recommended by some key informants the implementation of article 26 of Ordinance N°81/002 of 26 June 1981 organizing civil status registration in Cameroon. This provision requires the civil status officer through the request of administrative authorities to reconstitute birth certificates and other civil status documents destroyed during periods of armed conflict and natural disasters. Medium-term (4-6 months) • Advocacy for children in detention and integrated support for children who were detained (psychosocial support, reintegration, etc.); • Develop livelihoods opportunities for young men and women; • Promote reception of public service users both in English and French;

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SGBV 1. General Overview 3-6-1 West Region: SGBV Bamboutos and Menoua: Severity Level 4; Noun: Severity Level 2 Nde: severity Level 2 In this context of crises and human insecurity, the living conditions of women and girls are even more precarious and difficult. In the communities visited during the assessment, an average of 10 persons live in one IDP household in one or two rooms. There are no spaces dedicated to women and girls or any confidential space to wash and change in privacy. People live in overcrowded areas and there is no separation between unknown families and individuals. Most houses observed in the area do not allow women and girls to carry out their intimate activities away from the eyes of other community members. Women and girls are often particularly at risk of violence, exploitation and sexual abuse, physical violence, forced marriage and denial of resources. Many IDP women and girls are involved in forced prostitution, domestic work and small business to make ends meet. Some have become victims of early pregnancies and school dropouts. Group discussions held with women and girls revealed that the collection of firewood in bushes is a risk factor of GBV due to physical and sexual aggression experienced by some women and girls especially in Foumbot. Toilets are not segmented for men and women and some are not safe in the night which exposes women and girls to risk of GBV and SGBV. In some cases, the septic tanks are already full and need to be drained. This also poses health problems to the entire community and especially to women and girls whose physiology exposes them more. There is a general problem of water shortage and the quality is bad especially in Galim and Bangorain. Community water points are very few and absent in some localities. The majority of IDPs depend on water from bore holes, protected and unprotected wells and running streams. Water points are overcrowded and sometimes results in people fighting to fetch water. Some are further away from the community and are unsecured thereby exposing more women and girls to GBV risks. Many women who have experienced violence do not denounce because of stigmatization and the fear of being identified in order not to be exposed to further violence from perpetrators. Some prefer to keep it as family secret especially sexual violence and when the perpetrator is a family member. Finally, all the women and girls encountered vehemently raised the need to have access to basic needs such as food, Non- Food Item (NFIs) to improve their living conditions and physical security in the immediate future. Violence against women has been identified as a major problem by those living in rented houses and those with no fixed accommodation. Most women engaged in the assessment expressed concerns on the difficulty of free movement in the evening and out of the localities due to lack of documentation (National Identity Cards) that were destroyed and the high level of insecurity especially in the border villages of Bangorain. 3-6-2- Littoral Region: SGBV: Severity Level 3 Throughout the assessment in the Littoral region (Wouri and Moungo divisions), information on SGBV was not sufficiently shared at all levels because of the following reasons: Key informants were dominantly men who had very little or no knowledge of GBV and human rights violations against women and girls. Interviews were conducted in environments that were not confidential and safe for women and girl survivors of GBV to report such traumatic experiences. The absence of GBV services providers and clear referral pathway for survivors to report cases did not allow to have clear statistics of reported GBV cases in all the divisions. Nevertheless, some cases of rape were reported in Manjo, Loum, and Mombo concerning IDP girls and women. In Manjo, a religious leader reported the cases of three IDP girls who ran and seeked refuge in the house of a boy from the community, who later took advantage of their vulnerability, got all of them pregnant and threw them out of their home. Also, cases of rape were reported to have been identified in Loum and Mombo by religious leaders. It was also stated that many of such cases are unidentified / unreported within the community due to fear of stigmatization and rejection. Throughout the assessment in the Littoral region, it was observed that IDP women and girls live in very vulnerable conditions. In all the assessment areas, an average of 12 persons live in one IDP household which are mostly one to two rooms. There is no distinction between men and women toilets. Despite this r, most women reported they feel safe in

Cameroon : West and Littoral regions Multi-Sector Rapid Assessment (MIRA) of October 2019 | 13 toilets/latrines. Both, boys and girls, women and men, were observed to be sleeping in the same room which do not permit women and girls to have privacy and constitutes a high-risk factor for GBVs against women and girls. In the Moungo Division (Mombo, Loum, and Souza) religious authorities clearly stated that rich men in the communities have been asking for sex in exchange for services from women and girls who come to seek for employment opportunities. Negative coping practices such as concubinage and prostitution were reported by all key informant groups in both divisions leading to many cases of unwanted pregnancies. IDP women and girls were reported to be undergoing psychological/emotional distress and trauma due to the crises. In Souza, the appellation “Jump Tanap” which means “Skip from one man to another” is now used to refer to IDP women and girls who exchange sex for money.

2. Recommendations Short term (first 3 months) • Strengthen the capacities of local actors and service providers (including technical ministries) on SGBV to allow a holistic and quality care of survivors of GBV; • Strengthen capacities of already existing GBV service providers in case identification, management and referral mechanism. • Provide family planning services and prevention activities to reduce undesired pregnancies, including for school-aged children. • Systematically integrate the distribution of dignity kits as part of the response as to build community trust and reduce exposure risk to GBV. Long term (4-6 months) • Put in place essential GBV prevention and response services such as psychosocial support services, medical care and train personnel for the clinical management of rape in health centers, establish socio-economic support services for IDP women and girls, strengthen legal assistance for IDP women and girls, put in place safe houses/spaces for women and girls, and a clear referral pathway for survivors of GBVs.

Protection 1. General Overview 3-7-1 West Region: Child protection: Severity Levels 3&4 According to key informants and information gotten from other groups, there are acute psychosocial needs amongst the displaced population with specific impacts on children due to violence witnessed and the trauma of displacement. Reports from Noun, Bamboutos and Menoua divisions reveal that there are many IDP children who moved to find schools to attend in the region. a. Bamboutos (Galim, Mbouda); Severity Level 4 a. Mbouda Most of these children face stigmatization from schools in the form of verbal abuse from both the host community and children from the NOSO region who had settled there a long time ago. About 70% of these children lost their civil documents while fleeing their homes resulting in complications during examination registrations and difficulties while moving out of their localities (also due to an increase in the number of checkpoints). There was no clear distinction between girls and boys, in the loss of documentation or accessibility to examination registrations and check points. There is also neglect and risk of abuse as some of these separated and unaccompanied children strive to fend for themselves and other siblings. In Mbouda, there were no significant cases of child headed homes. In most cases where this was predominant, they were quite close to the border with the North west region permitting their parents to check in on them when they saw fit. b. Galim A lot of child-headed households have been observed in this area. This is since some parents leave their children in these areas in quest for security and better education. More so, since this area is close to the borders with Awing in the North West region, there has been a case of attack in one of the schools close to the border in the year 2018. No major damage was recorded. In trying to flee their homes most children lost their documents resulting in complications during school registrations and their movements as most were held back at check points.

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Other child-related problems include limited access to education, vocational training opportunities, and health care as well as teenage pregnancies due to an increase in the cases of prostitution and some cases of sexual exploitation. b. Menoua (Santchou, Dschang, Penka Michel): Severity Level 3 a. Penka Michel Access to education and vocational training opportunities is a problem for the children (mostly of school age between 5 and 18) at Penka Michel as there are not enough English schools. Lack of civil documentation such as birth certificate and ID cards for adolescents, with no clear distinction between boys and girls, makes it difficult for them to register for public examinations as well as move around freely. b. Dschang Most of these children face stigmatization in the form of verbal abuse at schools from both the host community and children from the NOSO region who had settled there a long time ago. Other children are faced with other child related violence which include sex for survival, forced labor for boys and girls, sexual exploitation especially for girls aged between 14-21 and early pregnancies. c. Santchou Santchou has also seen an increase in child-headed households since 2018 due to the children’s quest for better education. Most of these children face stigmatization at schools from both the host community and children from the NOSO region who had settled there a long time ago. They too face other child related protection which include limited access to education, vocational training opportunities, and health care as well as early pregnancies. c. Noun (Bangourain, Foumbot, Foumban): Severity Level 3 In Choupa, there are over 200 unaccompanied and separated children (UASC) of school age from 5 to 14. With the difference of most of the UASC identified in the other divisions, those in Bangourain suffer from a great shelter problem. Most of them live in houses of over 15 per house headed by other children. Education remains one of the major child related issue which they face, due to the insufficiency in the number of English- speaking schools and technical schools. Neglect and risk of abuse as these children fight to survive. Sex for survival, early pregnancy and forced labour were identified as the major forms of violence in Noun. 3-7-2- Littoral region: Child Protection: Severity Level 3 Two categories of displaced children were identified in the Littoral region during the assessment. Those children who accompanied their parents or caregivers when they displaced and the children who left their parents or caregivers behind as they were sent to the Littoral region in search of education. The latter category of children are mainly boys aged between 14 and 17, although girls are also included. They live together in groups of up to 10 and share the cost of renting their accommodation. With little resources coming in from home, they engage in petty trade to pay rent and pay school fees. For the girls, it was reported that survival sex was one of the ways of raising funds. This not only exposes them to sexual exploitation and abuse but also to sexually transmitted infections such as “sugar, sugar” (most likely referring to the common sexually transmitted disease Trichomoniasis). With very limited access to productive assets, the issue of sex for survival was mentioned in most of the places where the assessment was carried out. While mostly affecting women, it was reported that young girls’ area also affected. Increasing promiscuity among young boys and girls was also mentioned, especially among those children not attending school. An interesting finding was that parents who, when limited by the available resources, are prioritizing sending their girls to school as a protective measure, especially against early pregnancies. They argue that boys could engage in income generating activities and pay their way through school. Lack of civil documentation was limiting the children’s access to basic services such as preventing the ones in school from taking official exams, because the documents are needed during registration. Those who have tried to obtain the documents in their areas of displacement are told to go back to the areas where they were born. This then becomes a dead-end for them and exposes such children to further protection risks. It was also reported that the older children without documentation generally fear venturing far from their accommodation for fear of arbitrary arrest and detention by law-enforcement agents. This mainly affects older boys due to suspicion of association with non-state armed groups. Girls are also affected, though to a lesser degree and this may expose them to the use of sex to negotiate their release or be exposed to sexual violence while in custody.

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The main protection issues affecting children in Littoral as given by key informants are as follows: • Psychological distress • Unaccompanied and separated children • Shelter • Child labour • Sexual exploitation • Limited access to education (not enough Anglophone schools and high school fees) • Lack of civil documentation (burnt in their homes, lost or confiscated during flight, or never issued) • Limited movement due to lack of documentation (fear of arrest or detention by security forces)

2. Recommendations: Short-term (first 3 months) • Carry out a Child Protection Rapid Assessment (CPRA). • Sensitize leaders and other community members on the need to establish community-based child protection mechanism for children in their communities. • Identification of Unaccompanied and Separated Children (UASC) and provision of appropriate support, family tracing and reunification. • Community sensitization on early signs of psychosocial distress in children and training of selected community members in Psychological First Aid (PFA) to respond to such signs. • Provision of life skills training sessions and activities for youth and adolescents to include HIV prevention. • Sensitization to students for de-stigmatization of students from the NW/SW, peace building, and prevention of recruitment. • Psychosocial support for children identified through referral system, including those who are identified at schools. • Provision of livelihoods skills training to adolescents of working age based on market opportunities in the areas of displacement. • Protect children from sexual exploitation and sensitize them on the health risks that girls are exposed to due to early pregnancies. Medium-term (4-6 months) • Put in place a referral pathway for child victims of violence, abuse, exploitation and neglect. • Psychosocial support services for children identified through the referral system • Advocate with authorities on behalf of children without identification documents. • Embark on family tracing and reunification for unaccompanied and separated children. • Set up a child rights violation monitoring system.

Shelter 1. General Overview 3-8-1-West Region Level of severity 4 Bamboutos, Menoua and Noun Divisions Analysis of the data collected from keys informants in the West region mainly in the Bamboutos, Menoua and Noun divisions, reveals shelter/NFI as a priority need of IDPs with a severity level 3 in all three divisions. This level of severity is justified by the fact that in localities visited, IDPs are living in abandoned house; in camps in rural areas near the fields where they are involved in farming activities, they are tenant; and the majority of them are living in host families. Houses inhabited by IDPs are overcrowded. Generally, houses are constituted of one to three bedrooms with a traditional private toilet, with a kitchen for an average of 8 to 15 persons. Decent houses are not affordable to IDPs. According to key informants, those who were most exposed to risks due to the lack of housing were the people living in rented accommodation. The price of rents has increased due to the presence of many IDPs. In the Noun division, for example, a single room which had cost 5,000 FCFA costs now 8,000 FCFA or 10,000 FCFA. In addition to the price increase, the homeowners are asking to pay a rent in advance of 6 months or a year. Apart from housing the IDPs also need NFI to equip their house. Concerning their NFI priorities, the majority of IDPs interviewed cited blankets, kitchen utensils, mattresses, menstrual hygiene equipment, jerrycans, soap and mosquito nets.

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3-8-2 Littoral level: Shelter/NFI: Severity Level 4 Shelter and non-food items were consistently amongst the top 3 needs in all the divisions visited. A majority of IDPs are hosted by families and friends, with a minority in rented accommodation. Another group of IDPs were identified to be living in uncompleted buildings (Bepanda-Douala II and New Bell-Douala IV) because they lack the resources to rent a more descent accommodation. Furthermore, rental prices have soared in both divisions because of the increasing numbers of IDPs. The situation is acute as households hosting IDPs and IDP rented accommodations have about 12 persons, an average of 5 persons living in a room. Also, the situation is worse as IDP households are wanting in basic material such as mattresses, mosquito nets, kitchen sets and buckets. 2. Recommendations Short-term (3 months) • Conduct in-depth shelter needs assessment • Provide NFI assistance (mattresses, mosquito nets, blankets, hygiene kit) in a timely manner by targeting vulnerability; • Advocacy to maintain cost of house rents; • Support host family’s effort. Long-term • Provision of transitional low-cost housing in urban centres and IDP hotspots.

Water, Sanitation and Hygiene 1. General Overview 3-9-1-West Region: WASH: Severity Level 2; (Kouoptamo (Noun): Severity Level 4) In the West Region, WASH issues were not generally highlighted as a major priority by key informants, except for Kouoptamo in Bangourain sub-divisions in the Noun. Nonetheless, the West region has, like other regions in Cameroon, pre-existing issues in terms of access to water in quantity and quality in remote villages and poorer neighborhoods of urban centres. The main problems include difficult access to water by users, as due to rough and mountainous terrain and high demography, the water points are sometimes far from the dwellings, water quality is low and there is limited availability of proper latrines. Despite these pre-existing challenges, key informants reported that most IDPs have access to water and sanitation facilities used by host families. During the rainy season (period of the rapid assessment) access to water (quantity) was not seen as problem by key informants. The water supply in localities consists in piped water, protected wells, rainwater, unprotected springs, and water catchment. According to key informants, the majority of IDPs, with some exceptions, and host communities have access to latrines. However, with overcrowded houses and promiscuity, the number and quality of latrines are no longer adequate. People line up to use latrines that are sometimes exposed; no partition, no separation between men and women (case of rural areas). Sometimes, the toilet is just two planks placed on a hole. The situation varies from one division to another. Few communities don’t have access to WASH facilities like Kouoptamo in the Noun, where the communities are facing some difficulties. Key informants in this sub-division emphasized that water and hygiene was the highest priority issue in the area. Generally, and despite the relative availability and accessibility of safe drinking water, it should be noted that IDPs left their area of residence without carrying with them cans, buckets and other container for collecting and conserving water. In addition, the lack of financial means limits access to hygiene supplies (soap, etc.). 3-9-2-Littoral Region: WASH: Severity Level 2 WASH did not appear among the priority intervention sectors in the region. Most of those interviewed mentioned that water is not a major issue in the communities. However, several underlying concerns were prevalent including but not limited to the following; • Overcrowding at water points which often steer conflicts and consequently increasing queuing time at water points beyond the recommended 30 minutes. • Cost of water 50Fcfa/20litres which is expensive for an IDP household; with an average of about 12 persons. Based on the sphere standards for daily water needs in an emergency setting (15 litres per person per day), it indicates that the household will spend about 450Fcfa per day on water which amounts to about 13,500Fcfa per month which is beyond

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the sphere’s recommended below 5% expenditure on water consumption considering that IDP households do not earn up to 270,000 Fcfa per month. • Reliance on unprotected wells. Most households depend on unprotected wells, especially in the Wouri division. • Reliance on streams particularly in Njombe where neither wells nor boreholes were present. • Above 60% of the communities especially in the Moungo division mentioned that typhoid fever was prevalent in the communities associated with bad water quality. Acute watery diarrhoea was equally mentioned, especially in Wouri Division. • Inadequate water storage capacities in households was equally mentioned. This is because most households’ capacities have increased without a corresponding increase in household items like jerry cans and buckets with lids as well as safe space inside the houses. 95% of the interviewees affirm that access to safe and dignified toilets is not a reality. The prevailing concern was that toilets are full in most neighbourhoods of both, Wouri and Moungo divisions. In some circumstances, IDPs in rented accommodations are asked to pay additional fee for the use of toilets. Open air defecation was mentioned as well as the use of gutters in both divisions. IDP families, especially in Wouri, resorted to the use of buckets to defecate which are emptied in runoffs after rainfall. Cat method and flying toilets were mentioned in Mbanga and Njombe as prevailing. A majority of IDPs indicated that toilets were very dirty, unhygienic and void of privacy especially for women and girls. Women and girls in these localities indicated that schistosomiasis was a prevalent disease caused by exposure to unhygienic conditions in and around latrines. Generally public toilets do not exist in both divisions to help curb down the pressure on the limited household latrines. Though basic hygiene was not assessed, it is evident that the situation is exacerbated by limited access to water, the sanitation situation as well as limited income to acquire soap and other hygiene related needs.

2. Recommendations Short-term (0-3 months) • Conduct in-depth needs assessment to identify potential needs in some localities of the 6 divisions visited. • According to the assessment findings, provide means to ensure clean and safe drinking water as appropriate (WASH kits). Long-term (4-6 months) • Provide public latrines around IDP hot spots. • Provide a comprehensive humanitarian WASH assistance based on needs assessment. • Immediate humanitarian WASH assistance in Kouoptamo in the Noun division for the dry season.

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4-RANKING OF THE NEEDS

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5-CONSTRAINTS AND OPPORTUNITIES

Operating environment • Apart from a few security incidents perpetrated by the armed groups in 2018, the two Littoral and West regions are globally secured. Both regions are freely accessible and more specifically in the subdivision visited. The roads are in good condition, especially in the Littoral region all the subdivisions are at the edge of the national road N 5. • In the West, distances from one division to another are not long. Roads are tarred, and economic activity is flourishing. There are many economic operators in transport, warehousing and markets are function well. Analysis of local crisis response capacities (local authorities, host communities, etc.) • In the subdivisions assessed constraints included the reluctance of displaced persons to be identified as IDPs as a result of fear and mistrust towards the Government. Also, displaced persons are disappointed with very little or no assistance received so far. • Opportunities include the excellent reputation built by faith-based organizations and some local NGOs. Faith-based organizations and local NGOs could serve as bridge between the humanitarian community and the IDP communities for further assessment and assistance. • Local authorities are receptive to humanitarian assistance. They started registering IDPs despite some reluctance on the part of IDPs. • The host community was very welcoming, sharing housing and meager resources with the displaced in the West. Arable land is available in the Noun. • Initial humanitarian response in progress • The government, through the emergency plan, assisted few people with NFI and food This was one-off assistance that did not cover the needs of IDPs. • Local organizations are hard at work in the field of psychosocial support for faith-based organizations, Caritas, Justice and peace; CBC their main intervention mobilize resources from believers to support IDPs and families who are hosting IDPs. Evaluations were conducted in the field, in particular by Agir Ensemble pour le Development Communautaire (AEDC) and Caritas.

6-CONCLUSION AND RECOMMENDATIONS

Humanitarian needs are growing throughout the two assessed regions, this is even more worrying as IDPs started complaining about stigmatization. In addition, conflicts for the management of arable land have been noticed in the Noun division for example. It is therefore necessary to salute the initiative of the Bamoun sultan who made land available in response to these conflicts. Due to the limited time granted for this mission and the number of departments to be covered, it is recommended that: • For partners intending to assist, further in-depth sectorial assessment could be required depending on the sector and area of intervention. • Follow up the situation in view of the 2020 legislative and municipal election. • Immediate humanitarian assistance taking into consideration host community to be provided in close coordination with Government officials. At the strategic level; • It is critical that humanitarian actors work with the persons or organizations trusted by the IDPs and communities, notably local and faith-based organization. • A coordination mechanism should be quickly put in place • Advocate for the reconstitution of IDPs ID cards and birth certificates. • Especially support the education sector knowing that children have spent 3 years out of school.

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7-ANNEXES

1. Tables and graphs of sanitary data in the West Region (Source: Regional Delegation of Health)

MIRA Assessment West region _Santé-Nutrition.pdf

2. Statistic of IDPs of the West region provided by the Governor’s office (Available on request at ocha- [email protected])

3. Statistic of IDPs in basic and secondary education

4. Assessment data (Available on request at [email protected])

5. Severity ranking scale

Echelle de sévérité MIRA.pdf 6. Questionnaire Mira

Questionnaire MIRA rev 4Oct19+EN.pdf

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7. List of assessment team

Organization sector Name and surname Email Equipe

UNFPA GBV KONGNYUY Julita [email protected] Littoral

UNICEF NUTRITION TCHUMBIEP NGOUENE Gaelle [email protected] Littoral

UNICEF Education SAM TOY François [email protected] Littoral

UNHCR Protection Henri Daniel Ewane [email protected] Littoral

MINAT Coordination MBARGA Constantin Jacques Michel [email protected] Littoral IFRC Shelter Jeffrey William WOODS [email protected] Littoral

UNICEF Child Protection Patrick MUSIBI [email protected] Littoral

UNICEF Wash /Education Faustin EKAH [email protected] Littoral

OCHA Coordination Arrey Divine [email protected] Littoral

OCHA IM Sultan Ahmed [email protected] Littoral

OMS santé Dr TSAFACK TCHABGOU [email protected] Littoral PLAN Wash Denis Afunwi [email protected] Littoral

UNFPA GBV NJUME Nange Pamela [email protected] Ouest

UNFAO Food security / Livelihood PENN EMMANUEL [email protected] Ouest

INTERSOS Protection Bella-Ann Ayuk Manyor pmm1.fako[email protected] Ouest

UNHCR Protection Deshanel EPIE [email protected] Ouest

MINAT Coordination NJOYA AMINATOU Sally [email protected] Ouest

IMC GBV/Protection Ms. Nancy Mua Nsih [email protected] Ouest

CRC Wash /Education Achille KOUANDJE [email protected] Ouest

OCHA Coordination Joseph AMOUGOU [email protected] Ouest

OCHA IM Francis Tchassem [email protected] Ouest

OMS Santé Dr Sa'a Fotso Pierre [email protected] Ouest

Pour plus d’informations contacter : Modibo Traore ; Chef de bureau OCHA Cameroun [email protected] Victoria Martinez ; Chef de l’unité Coordination OCHA Cameroun [email protected] Joseph Claude Amougou ; Chargé des affaires humanitaires [email protected]

For more information, please visit www.unocha.org www.reliefweb.int