South West Assessment
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Cameroon Emergency Response – South West Assessment SOUTH WEST CAMEROON November 2018 – January 2019 - i - CONTENTS 1 CONTEXT ..................................................................................................................... 4 1.1 The crisis in numbers:.................................................................................................... 5 1.2 Overall Objectives of SW Assessment ........................................................................... 5 1.3 Area of Intervention ...................................................................................................... 6 2 METHODOLOGY .......................................................................................................... 6 2.1 Assessment site selection: ............................................................................................ 8 2.2 Configuration of the assessment team: ........................................................................ 8 2.3 Indicators of vulnerability verified during the rapid assessment: ................................ 9 2.3.1 Nutrition and Health ............................................................................................. 9 2.3.2 WASH ..................................................................................................................... 9 3.1.1 Food Security ......................................................................................................... 9 2.4 Sources of Information ................................................................................................ 10 2.4.1 Secondary Level: .................................................................................................. 10 2.4.2 Primary Level: ...................................................................................................... 10 2.5 Limits of the methodology .......................................................................................... 11 3 MAIN FINDINGS: ....................................................................................................... 12 General situation overview: ............................................................................................... 12 3.1 Indicators of vulnerability ........................................................................................... 13 3.1.1 Nutrition and Health ........................................................................................... 13 3.1.2 WASH ................................................................................................................... 20 3.1.3 Food security ....................................................................................................... 23 4 CONCLUSION: SYNTHESIS AND OPERATIONAL RECOMMENDATIONS: ........................... 0 4.1 Short-term response: (0 - 1,5 months) ......................................................................... 1 4.2 Middle-term response: (1,5 - 6 months) ....................................................................... 1 4.3 Long term response (6 months – 1,5 years) .................................................................. 1 - ii - EXECUTIVE SUMMARY The South West and North West regions of Cameroon have seen significant incidences of violence, disruption of public life and following displacements of population over the course of over two years. Thus far, the response has been minimal, while the precarious situation on the ground has worsened. The assessment carried out by Action Against Hunger in South West and Moungo division of Littoral region has aimed to identify a few of the key challenges at hand through a multi-sectoral assessment with supporting MUAC and oedema screening as well as informant interviews. Main findings from the assessment highlight previous concerns relating Food Security, WASH and Healthcare. While preliminary data does not reveal an immediate nutritional crisis, aggravating factors indicate warning signs for a possible deterioration of the nutrition status within the South West region, affecting considerably children between 6 and 59 months old. In Health, high levels of morbidity, including malaria, respiratory tract infections and diarrhea, combined with significant gaps in institutional health coverage paint a worrying picture. Close to 90% of the assessed population reported having no access to health facilities, with the far majority reporting financial barriers as their main obstacle. Access to water has been found to be reasonable, however the unreliable quality and quantity as well was irregular practices of water treatment and handwashing raise concerns about resulting morbidity in the forms of diarrhea and skin infections, possibly aggravating the prevalence of malnutrition. The assessment has also identified several levels of household hunger, reaching severe levels among some households. A clear lack in diversity of food intake, with over 75% of surveyed households accessing only 4 out of 9 primary groups, illustrates the difficulty of households to provide a balanced diet. In combination with delayed supplementary feeding for infants and unreliable quality of water further aggravate the already precarious situation. ACRONYMS AAH – Action Against Hunger CFP – Community Focal Point DTM – Displacement Tracking Matrix GAM – Global Acute Malnutrition FCS – Food Consumption Score HFIS – Household Food Insecurity Score HHS – Household Hunger Score IHC – Integrated Health Center MAM – Moderate Acute Malnutrition MUAC – Middle Upper-Arm Circumference OCHA – United Nations Office for the Coordination of Humanitarian Affairs PLW – Pregnant and Lactating Women SAM – Severe Acute Malnutrition SRN – State Registered Nurse SW/NW – South-West/North West regions RNA – Rapid Needs Assessment WFP – World Food Program Page 3 04/03/2019 1 CONTEXT The crisis in South Western / North Western part of Cameroon has been ongoing since 2016, and has seen several episodes of deterioration, the most recent following the elections in October 2018. Given the political situation, security aspects and access issues, the humanitarian response has thus far been limited. The UN agencies only activated the clusters in October 2018, declaring a Level 2 emergency due to the worsening situation in the regions a few months after.1 Only few international NGO are intervening most of which respond through a local partners which are already on the ground. The southwest region of Cameroon is one of the 10 regions in the country, with Buea as the regional capital. The region is divided into six divisions or departments: Fako, Koupé-Manengouba, Lebialem, Manyu, Meme, and Ndian. These are in turn broken down into subdivisions. The region of southwest shares an international boundary to the west with Nigeria and three national and administrative boundaries with North West, West and Littoral regions. In terms of health, the South-West health region comprises 18 health districts (Akwaya, Bakassi, Bangem, Buea, Ekondpo Titi, Eyumojock, Fontem, Konye, Kumba, Limbe, Mamfe, Mbonge, Mundemba, Muyuka, Nguti, Tiko, Tombel and Wabane ) and counts a total of 115 first-level health facilities. More details on health facilities are provided in the appendix. Some actors have started conducting primary assessments, while OCHA has reported a fatigue among some communities given these assessments and the lack of a subsequent response. The recommendation by OCHA was thus to no longer conduct assessments without joining implementation, to avoid further fatigue. Increased fatigue could also lead to reducing further the limited access available. While OCHA, UNDSS and other UN agencies are now starting to bring staff based in the regions in Location of Southwest Region within order to start coordinating a response (Buea in South-West; Bamenda in Cameroon North-West). The most recent 4W, dating from November 2018 is only available for South-West part (and is being conducted for North-West). The major challenges faced are notably access and lack of information. The regions are saturated with a plurality of active non-state armed groups, and ongoing operations by the armed forces bring about violence and insecurity. The armed conflict has affected an estimated 1.3 million people, of which roughly 437,500 people forced to flee their homes (246,000 in South-West region). 2 With the first assessments completed, the image arises of a steadily worsening humanitarian situation though data is sparse. Violence has resulted in the interruption or complete disappearance of many basic services including health care, education and access to functioning markets. Livelihoods have been disrupted and agricultural production been reduced. The first victims of violence are children and vulnerable populations that see their protective environments crumble, exposing them to risks and violations. The recently activated clusters indicate that priority areas for intervention are Protection, Food Security, WASH, Shelter and Healthcare, addressing the needs of vulnerable individuals and IDPs in the buss, improvised settlements, with host families or new rental accommodation. 1 UNOCHA Situation Report No.2 – Cameroon: North-West and South-West 2 UNOCHA Situation Report No.2 – Cameroon: North-West and South-West. Page 4 04/03/2019 1.1 The crisis in numbers: The two regions host an estimated population of 4 million people, of which around 1.3 million are currently in need of some kind of support.3 The most recent estimates, dating from November 2018, report roughly 437,500 internally displaced