UNICEF Cameroon Situation Report Reporting Period: August 28–September 27, 2012

UNICEF Cameroon Situation Report Reporting Period: August 28–September 27, 2012.

Highlights • Widespread flooding in the North and Far North districts of Cameroon is now causing extreme hardship for the local populations. Crops have been destroyed, especially millet, rice and sorghum, which may lead to serious food shortages. Intense monsoon rains have continued to fall in the latter half of August and September.

• The Sahel Nutrition Crisis remains a challenge in both of the northern Sahel regions of Cameroon; the extreme flooding has elevated nutritional vulnerability, reduced access and added to existing risks of waterborne diseases such as cholera.

• An audit on nutritional data has been completed, as inaccuracies in data compiled previously provided errors in the number of new severe acute malnutrition cases. The result of the audit is that revised number of children under 5 suffering from Severe Acute Malnutrition (SAM) admitted in the CNA and CNTI is 16,656 (Jan-August 2012). The revision of the national protocol and harmonization of tools is planned to take place in the next three months.

Two brothers displaced by flooding wait with their family under a thatch roof in Guirvidig, Far Northern Cameroon, with nowhere to go. UNICEF ©September 2012/Jorgensen.

1. Situation overview and humanitarian needs

The North and Far North regions are affected by the Sahel crisis. More than 6 million live in those regions; up to 1,148,000 are children under five years. The percentage of the population suffering food insecurity is above 15% in the two regions with 160,128 acute malnutrition cases predictable in 2012. With the arrival of the rainy season there are floods and population displacements in localised areas, an increased risk of a cholera epidemic, an increase in incidences of diseases such as malaria as well as possible losses in agricultural production and harvest resulting in food shortages further aggravating nutritional status and thus increasing the vulnerability of children.

Estimated Affected Population From the nutritional Crisis Sources: UNICEF Humanitarian Action Update February 2012 Cameroon General Census 2010 Cameroon PEV 2012 Ministry of Health March 2012 Total Male Female Total Population 6,897,000 3,397,761 3,499,239 Children (Under 18) 2,868,177 1,412,988 1,455,189 Children (Under 5) 1,148,000 565,555 582,445 Children (6 to 23 months) 459,200 286,938 295,508 Pregnant women 344,850 344,850 Children Under Five with Severe Acute Malnutrition (SAM) 55,119 27,154 27,965 Children Under Five with SAM and medical complications 5,512 2,715 2,797 Children Under Five with Moderate Acute Malnutrition (MAM) 105,009 51,732 53,277 Population affected by floods 69,841 33,524 (48%) 36,317 (52%)

2. Inter-agency cooperation

• Bi-weekly coordination meetings continue to be held between UNICEF, WFP, WHO, FAO and UNHCR to better coordinate actions in the field. The last meeting was held at UNICEF in Yaoundé on September 20. • UNICEF supplies are being stored in WFP and UNHCR warehouses in Garoua, Maroua and Kousseri. • In cooperation with UNICEF, WFP is implementing general food distribution and a targeted blanket feeding (6-23 month old children) in three sub regions of the Logon and Chari Department until September 2012. • In cooperation with UNICEF, WHO has ordered medical supplies (complementing supplies donated by UNICEF) for severe acute malnourished children with medical complications to be distributed in the inpatients nutrition therapeutic centres of the two affected regions. • UNICEF, UNFPA and WHO are developing a communication for development interagency strategy in the North region in order to increase awareness of the problem and to prevent malnutrition. • UNICEF, UNHCR, WHO, UNFPA and WFP in Garoua (North region) were involved in a joint assessment of the displaced populations affected by floods. • In the Far North UNICEF performed the assessment of the displaced populations affected by floods in unison with the local government. • UNICEF has activated weekly WASH and Child Protection coordination group meetings at the regional level in the North region.

3. Emergency Response

3.1 Emergency Response Nutrition

3.1.1 Overview The UNICEF nutrition response is focused on providing supplies and strengthening capacities of 392 CNAs (outpatient clinics) and 43 CNTIs (inpatient hospitals) in the North and Far North. The acute malnutrition program (managed and established as a continuum of care) screens and treats children suffering from malnutrition in all forms (severe and moderate).

As flagged in the July 2012 Sit Rep, data inaccuracies were discovered: An audit of nutrition data was conducted by UNICEF Cameroon Nutrition Section in August and September supported by Regional Office, Dakar, to resolve gaps and inaccuracies in the data for both the North and Far North region.

The external evaluation by UNICEF WCARO Nutrition section held in August in 4 regions of Cameroon (North, Far North, Adamawa, East) recommended: 1. To revise the national protocol and harmonization of tools to address the above issues going forward. 2. As a priority, to agree on means of communications between CNTIs and CNAs that are inaccessible in the Far North region. 3. To do a mapping of the functional CNTIs/CNAs with a predefined grid including gaps in information. 4. To develop a progressive training plan including specific training on monitoring of SAM and MAM (tools and indicators).

The Nutrition team is being reinforced to do the above, thus, one existing nutrition specialist will cover North region and another the Far North region. A TOR has been sent out for a specialist to be deployed in Yaoundé to assist government in revision of the national protocol and to strengthen partners and coordination of CMAM (Community management of acute malnutrition) activities.

UNICEF & Operational P artners Estimated coverage North & Far North regions UNICEF Cumulative % of Target Target Results ( #) Achieved Children <5 with Severe Acute Malnutrition 16,656 55,119 30% admitted to Therapeutic Feeding programs (Jan to August) Children <5 in Therapeutic Feeding Programmes of 6,306 41,250 15,29% who have recovered. (Jan to August) Recovery rate 70%(*) 58,21% Defaulter rate <15% 34,27% Number of health centres with severe acute 435 353 80% malnutrition treatment (*) as per national protocol of management of acute malnutrition

UNICEF and Partners programming: UNICEF is supporting the Ministry of Public Health and regional delegations in the North and Far North to improve quality of nutrition interventions by; (i) Supporting the distributing of RUTF (Ready to Use Therapeutic Foods), therapeutic milk and other medical equipment to the CNAs and CNTIs. (ii) Reinforcing capacities with the training of 55 trainers to train up to 480 community volunteers. Nutrition training was conducted alongside the training of WHO, 6 sessions were undertaken in the North Region. (iii) Providing technical expertise in nutrition and formative supervision and monitoring in Mokolo, Maroua rural, Maga, Kolofata, and Mora in the Far North. (iv) Doing a rapid assessment of nutrition in Maga (Far North) and Lagdo (North) health districts that were affected by floods, and a list of needs has been created, and RUTF and drugs and equipment have been prepositioned, in 2 health districts. (v) Strengthening of synergy with HIV interventions in CNTIs. A joint assessment is being done in North and Far North in order to increase screening and appropriate treatment amongst severely malnourished children.

The last meeting of the national cluster dedicated to strengthening coordination in nutrition and food security in the assessments and nutrition response for displaced populations affected by floods in the North and Far North was held on September 7. The next monthly meeting will be organised to take place in early October. Sub clusters in Maroua (Far North) and Garoua (North) are also meeting each month, last meetings being held on September 11 in the Far North, and September 20 in the North, both committing to monitoring the situation of populations affected by floods.

3.1.2. Distribution of Supplies Distributions of RUTF, essential drugs and equipment continue in the North and Far North regions. The distribution is done progressively to reach all the CNA and CNTI, however, rains have increased inaccessibility of some health districts. Where possible, alternative transport (boats) is used but the supply chain is not performing well.

3.1.3 Training of local partners and training of trainers UNICEF supports community management of acute malnutrition for doctors and nurses working in inpatient (CNTI) and outpatient (CNA) nutrition centres. Far North Region: Training of 55 trainers was held in Maroua from September 18-21. These participants will be able to train 480 community volunteers on community management of acute malnutrition in a few days North Region : Nutrition training was conducted alongside the training of WHO, 6 sessions were undertaken in the North Region.

3.1.4 Gap Analysis • Due to the rainy season access to remote and isolated districts is a main constraint. The creation of a continuous RUTF distribution pipeline is needed in these areas. Lack of telecommunication and road access between local health centres and the heads of health districts is a limitation, and as a consequence referral and information systems are not working in many remote areas. • Logistic support to increase continuous supervisions and visits of up to 70% of CNAs for UNICEF staff and for support of government decentralised supervision. • A staff member dedicated to strengthening the capacity of government and NGO in CMAM (technical support, coordination and supply).

3.1.5 Requests for additional resources/support. • Support to encourage International NGOs to participate in the response and community management of acute malnutrition in order to scale up interventions (Medecins Sans Frontieres- MSF, Helen Keller International-HKI, Plan, International Medical Corps-IMC). • Increase of vehicles for nutrition UNICEF staff in the field that could contribute to monitoring of up to 70% of CNAs and in order to supply them with RUTF. • Funds to ensure the process of revision of the national protocol and production of tools and the training of trainees. • One additional staff member (logistics) is urgently required to provide support for the nutrition emergency programmes in the two regions as well as support a review of storage conditions and distribution points at the health centre level. • Funds for one nutrition staff member are needed in Yaoundé, for the reviewing process of the national protocol of acute malnutrition and for the establishing a monitoring system (TOR for CMAM specialist sent to regional office). • Funds to ensure technical assistance by nutrition specialists in the field, from the beginning of 2013, or alternatively the deployment of 2 nutrition specialist standby partners.

3.2. Emergency Response WASH

3.2.1 Overview Due to flooding, open wells used by the population have been polluted. In areas such as Maga, Faro, Mayo Louti and Mayo Rey, human excreta came out when flood water flowed in and filled the family latrines. Thus there is a risk of a cholera outbreak epidemic though no deaths have yet been registered since the beginning of the year in the regions. According to the Governor’s Office, 16,147 persons (1,899 families) were displaced as of 10 September in the Far North. In the North, the Regional Delegation of the Ministry of Water Resources and Energy reported that 47,591 people (7,254 families) have been displaced in areas south of Garoua along the Benoue River basin (5 September). A rapid needs assessment was conducted within days of the first reported IDPs (Internally Displaced Persons) on 27 and 31 August at Maga. In response, UNICEF provided wash kits to 990 families, 35,250 aquatabs for water purification and 17 buckets of chlorine for disinfection.

UNICEF & operational partners 2012 Estimated coverage North UNICEF % of Target and Far North regions (43 UNICEF Cumulative results ( #) Initial Target Achieved April – districts) New Target* April – September September Emergency affected population provided with 16,000 55,000 6,339 11,5% access to safe water Emergency affected population provided with key 16,000 55,000 6,339 11,5% hygienic supplies Emergency affected population provided with 5,000 10,000 2,588 25,9 % access to appropriately designed toilets

Number of Nutritional centers with the minimum WASH 195 435 177 41 % Package Implementing partners: Ministry of Water Resources and Energy, Ministry of public Health A WASH Kit contains ; 1 bucket with lid, 1 cup 500ml, 1 cup 200ml, 5 pieces soap, 1 plastic kettle, Packet (2) of water purification tabs. *In order to scale up the WASH response in the nutritional crisis there has been between 100% to 243% increase in targeted population.

Monitoring and evaluation in the North & Far North regions of Cameroon is ongoing but is now extremely difficult due to the very heavy rainfall and flooding over the past month. Despite this set back, the WASH response to the nutritional crisis has been scaled up now covering 28 Health districts (up from 10 in the last reporting period) in the Far North region.

Due to flooding, IDPs and difficult access to some areas, the amount of kits distributed since last SitRep has increased, as seen in the table above, but remain lower than expected.

UNICEF and Partners programming: • Monitoring and evaluation field missions were conducted in Maga ,Guirvidig and Pouss respectively on 27, 29 and 31 August 2012; • Field visits were conducted from 21 August to 24 August in Pette, Koza, Mora and Moulvoudaye to identify and select local communities members to be trained in door to door education on WASH good practices; • As the WASH cluster lead, UNICEF took part in coordination meetings at the UN coordination level (1 September 2012); • As WASH cluster lead, UNICEF collaborated with the Government and NGOs in coordination meetings at the national level (4 and 7 September) and at regional levels (5 September); • Participation in three coordination meetings with Government partners chaired by the Governor of the Far North; • Inventory of all at-risk water contamination issues and a water quality assessment was conducted in eight localities of Lagdo (10 September); • An inter-ministerial committee conducted an evaluation mission of the WASH situation in both regions with the support of UNICEF(13 to 19 September);

3.2.2 Distribution of Supplies By August 2012, 9,000 wash kits were prepositioned at regional level. During the reporting period 15,000 more wash kits was prepositioned. Thus a total of 24,000 wash kits have been made available at the regional level to be distributed to household through health centers.

Household Level: The number of kits distributed from the 24,000 prepositioned has increased by only 630 due to accessibility issues from flooding for a total of 6,339 WASH kits distributed. A total of 17,661 is still available in both regions. These WASH kits have been distributed as follows to malnourished children families: Far North: A total of 4,339 WASH Kits have now been distributed to families. In this region: Kaele (483), Guere (350), Vele (190), Mada (485), Kousseri (737), Goulfey (100), Kar-Hay (485) Makary (587), Yagoua (732) and Maga (190).

North: A total of 2,000 WASH Kits have been delivered at the household level in In this region; Golombe (267), Guider (261), Figuil (186), Poli (318), Tchollire (405), Bibemi (201), Rey-Bouba (157), Touboro (205).

Due to the flooding more WASH kits were provided to population as follows: Far North: UNICEF provided support to government in distributing 140 WASH Kits, and 35,250 tablets Aqua-tabs to IDP’s in Pouss (21,250 distributed and 14,000 included in WASH kits);

North: WASH family kits (each kit is made up of 1 jerry can, 7 pieces of soap of 110 grs, one bucket of 14 litres, 50 Aquatabs) were distributed to 850 families. 17 buckets of 45 kg of chlorine each have been provided for disinfection and 931 water flocculation and disinfectants sachets; Prepositioning of cholera supplies: All of the 20 targeted health districts in the North and Far North regions have received Chlorine Hypo chlorine of calcium (45kg per health district), chlorine pool testers (2 per health district), hand washing facilities (2 per health district) and communication tools as part of a national cholera awareness and prevention campaign.

3.2.4. Training of community workers .

Far North Region : A total of 176 community workers were trained in Maroua, Mokolo and Mora (10 to 14 September), leading to a total of 797 WASH community workers trained at the district level, in charge of door to door education on WASH good practices. The community workers have been trained on the prevention of diarrheal diseases, cholera and malnutrition; the use of WASH kits and water purification methods; as well as how to monitor the WASH response at the community level.

North Region: WASH trainers at district level have to date trained 1,600 community workers responsible for hygiene education promotion at the household and community levels.

3.2.5. Gap Analysis. • Supplies of 31,000 WASH kits still needed in the Far North (16 districts) and North (7 districts) regions; • Limited access to transportation imposes limitations on monitoring and evaluation missions across North and Far North regions; • There is a need to reinforce WASH staff team in order to provide appropriate support and response to the Government and its partners; • Health centers and education facilities remain without water and sanitation facilities.

3.2.6 Requests for additional resources/support. • Funds for construction and rehabilitation of latrines and bore-hole wells at the community level; • Funds to purchase WASH kits to fill the gap and coordinate distribution; • Funds for construction and rehabilitation of borehole wells and latrines in health centers; • A WASH emergency consultant; • A CERF request has been developed to address some urgent needs related to flooding.

3.3. Emergency Response Health

3.3.1. Overview The displaced population of the two flood affected regions are living under very poor conditions aggravated by standing water in the environment. These expose them to epidemics such as cholera and measles; and especially expose vulnerable pregnant women and children to diseases such as malaria, diarrhoea and respiratory tract infections. A rapid assessment conducted in the two regions by UNICEF shows vulnerability is higher in the Far North region, where victims are settled in camps in Maga and Vele health districts. In the North region victims initially settled in schools are now returning to families and relatives in villages.

3.3.2. Immunization Targets and immunization coverage January to July 2012 in the North and Far North regions. Routine immunization Immunization North Far North Cumulative estimated routine vaccination Target 0-11 months 58,366 85,509 Jan- July 2012 Coverage target by end of 2012 88% for penta 3 Number Number Vaccinated % Vaccinated % Penta 3 41,571 71 74,865 88 Poliomyelitis 3 41,218 71 73,375 86 Measles 40,084 69 73,774 86 Yellow Fever 38,228 65 73,694 86 Reports completeness: 100% (*Discrepancies are due to lack in coordinated pipeline supply at the health clinic level.) Routine vaccination coverage in July remained lower in the North compared to the Far North region.

UNICEF and Partners programming: • UNICEF partners involved in the flood response are: WHO, UNICEF, UNFPA, PAM; HCR, French Red Cross, Plan Cameroon, International Medical Corps, Médecins Sans Frontières Switzerland, Cameroon Red Cross, French Red Cross, Care Cameroun, International Federation of Red cross and Red Crescent, ACAMAS (Turkish NGO), Government. • UNICEF took part in five health cluster meetings at regional level (Garoua: 2 , 7 and 14 September 2012, Maroua: 13, 17, 18 September) and one at central level in Yaoundé at WHO on 7 September.

Health interventions • A mobile treatment unit has been put in place to provide health services to the displaced population in all the three settlements of Maga Health district in the Far-North region to help children suffering from malaria, respiratory tract infection diarrhoea and other diseases. • Support from UNICEF to the 2 regions in terms of medicines Doxycylin 80 packets, ORS 4 packets, 500 bottles of Amoxillin syrup), Equipment and materials (Midwivery Kit 2- Equipment, Syringe disposable 5 ml / PAC 100, Feeding tube CH 08, L40 cm 30 Tarpaulins, 7000 Long Lasting Insecticidal Mosquito Nets) have been provided.

3.3.4. Epidemiological surveillance The epidemiological surveillance of diseases with epidemic potential show no cases of death recorded due to measles or cholera at the 35 th week (until September 2nd) in both regions.

Cumulative number of cases notified at the 35 th week in both regions: North Far North Number of Number of suspected Number of Fatality suspected Number of Fatality cases deaths rate cases deaths rate Measles 4,048 17 0.4 3,925 31 0.8 Meningitis 139 42 30 230 12 5.2 Yellow fever 36 2 6 58 0 - Cholera 1 - - 0 0 - AFP 12 - - 41 0 - Tetanus 4 1 25 18 3 16.7

Strengthening Health response A consultant, recruited to follow up health interventions in North and far North regions within the Sahel crisis response, took office on Monday 10 September. Additional health need in terms supplies have been submitted to the regional office on 14 September.

3.4 Emergency Response Education

3.4.1. Overview In a nutritional emergency it is critical to ensure continuous access to schools of children. The recent floods in the North and Far North regions have prevented 40,682 children from starting school as planned in September due to large number of schools being occupied by displaced populations or affected (in some cases destroyed) by floods.

UNICEF and Partners programming: • UNICEF supported the Ministry of Basic Education with an evaluation of the situation and needs of schools in the 15 affected districts of both regions. The Evaluation team (comprising 5 staff from Ministry of Basic Education, 1 UNICEF staff and 2 staffs from partner organizations: Plan Cameroon and VSO assessed 91 schools in both regions. • UNICEF has deployed two staff (one to each region) to assist local education authorities with immediate response and supply distribution. • The Emergency Education Cluster group headed by UNICEF met on 5 September. • For resources mobilization purposes, an experienced media consultant was hired and sent to the field to capture the scope and response to the current emergency.

3.4.2 Summer school programs • 2,559 pre-schoolers (5-6 year olds) in 15 districts in the North and Far North reported to have begun in last Sit Rep have now completed the summer accelerated school readiness program. • 1,832 out-of-school children in 12 districts in North and Far North, reported to have begun in last Sit Rep, have now completed the summer accelerated re-entry program.

3.4.3 Supplies • In addition to enrolment incentive packages (comprising slates, chalk, pens, pencils, exercise books and bags) distributed to 2,559 children who have completed the accelerated school readiness program, UNICEF has provided, within the first week after the floods, supplies (tarpaulins, hygiene kits, toilet paper, water container, plastic mats, recreation kits, Early Childhood Development kits, School in a Box, exercises books, slates, pencils, pens, plastic bags) for school population of affected schools and displaced population occupying schools. • 40,000 of “School Kits (slates, chalks, exercise books, pens, pencils, soap, cups and school bags) have been ordered to assist children with basic necessary material to start the school year in the affected zones. • Temporary classrooms have been built with tarpaulins in Zokok Laddeo and Guiridivic but these temporary classrooms are unlikely to resist heavy rains and should quickly be replaced by proper tents.

3.4.4 School attendance reporting protocol • The floods have severely delayed the school attendance reporting system (put into place by UNICEF) and while baseline references (attendance monthly rates for 2011-12) are available and being analyzed, monthly rates for this school year are not expected before October or November.

3.4.5 Gap Analysis • Temporary classrooms are urgently needed in 31 schools in the Far North. • Before the floods, water and sanitation services in schools were already severely lacking in 8 districts in North and Far North regions with only 54% of pupils having access to quality water at school and an average ratio of 1 latrine for every 406 pupils. It is estimated that 25% of available latrines in the 91 floods affected schools (in 15 districts) are dysfunctional, that 84% of them need to be disinfected, and that 66% of them require rehabilitation and/or construction to replace destroyed/damaged infrastructure. Only 15% of these schools currently have access to quality water. Given the high risk of cholera, additional resources for infrastructure rehabilitation and hygiene education are urgently needed. • Basic school supplies and equipment for classrooms in flooded schools are needed to attract and retain children • Community grants to support school garden and other nutrition projects for school communities. • The added dimension of floods has drastically increased the need for field based staff. Numerous missions from Yaoundé are not sufficient to provide the necessary technical support, ensure efficient field-based program monitoring and evaluation and lead the Education Cluster group at local level.

3.4.7. Requests for additional resources/support. • Funds to provide temporary safe learning environment (school tents) in 31 schools • Funds for WASH rehabilitation/construction of 664 latrines and 72 wells in schools in the North and Far North. • Funds for distribution of 500 ‘School In A Box’ (comprising basic teaching and learning materials) and 4125 benches for 91 schools in North and Far North. • Funds for community grants (USD 1,000 per community) to support development of school gardens and other nutrition projects for school communities in 64 schools in North and Far North. • One additional temporary education technical staff member based in the North to support program implementation, oversight and data collection and monitoring & evaluation in both regions.

3.5. Communication for Development (C4D)

3.5.1. Overview C4D promotes, develops and implements activities that benefit communities and build capacity of local government and NGO partners, to effectively, efficiently and sustainably develop programs for the promotion of changing behaviours. Activities include the launch of a community campaign on ‘Essential Family Practices’ (exclusive breastfeeding, complementary feeding practices, use of impregnated mosquito nets, hand washing, use of latrines and potable water, control of diarrhoea at home and antenatal care).

UNICEF and Partners programming: • Educational materials on prevention of cholera and waterborne diseases, promotion of hand washing and safe nutrition have been developed. • A monitoring and planning meeting of the regional C4D trainers and local partners was held in Maroua on September 7 for the Far North and in Garoua on September 6 for the North.

3.5.2. Gap Analysis • The flood emergency in the North and Far North regions emphasises the need for educational and information materials (posters, brochures etc.) to support community outreach to reinforce key health, nutrition, HIV and hygiene messages, so as to reduce the risk of preventable diseases in the affected populations. • There is a significant need for a strategy to harmonize and coordinate activities between the different partners across programs to avoid districts being left out.

3.5.3. Requests for additional resources/support. • Funding is needed for the design, printing and distribution of communication materials.

3.6 Emergency Response Child Protection

Through the information collected by the members that participated in the meeting of the humanitarian coordination on protection in Yaoundé (namely: Ministry of Social Affairs, Ministry of Territoriality and Decentralized Administration; UNHCR, central and local NGOs from the North and Extreme North) and field visits of the UNICEF child protection staff in the field (Garoua, Maroua), key concerns were mentioned by partners related to the flooding namely psychosocial impacts on children and family members, high risks of violence of the general population including children and women in particular in the sites/camps, and loss/damages of civil registration documents (including birth certificates) by the population and the civil registration centre of Garoua II. So far, there is no case of unaccompanied and separated children reported.

To get a full picture of the situation and needs, a child protection rapid assessment in some of the affected areas by the nutritional crisis and floods has been supported by the Ministry of Social Affairs and UNICEF as a result of their field visits in the North and Extreme North (16-26 September). The results will be available by 10 October.

The coordination mechanism to tackle child protection at the central level as well as in the North and Extreme North was weak prior to the emergencies, and not well structured, and thus the prevention and response have not appropriately addressed the children needs, including those in situations of emergencies. The humanitarian coordination mechanism to respond to the protection and child protection concerns - which is being put in place at the central level as well as in the North and Extreme North - could serve to leverage the child protection mechanism for the early recovery and development programme.

On 26 September, UNICEF surge capacity has been deployed for a month to respond to the emergencies as a result of agreement with standby partner – NRC. This staff will be specifically responsible to set up a solid coordination mechanism to address protection and child protection issues, supervise and complete the on-going data collection, and develop an inter-agency strategy and plan to respond to protection issues of the emergencies in the North and Extreme Nord. She is based in the office of HCR in Garoua.

UNICEF and Partners programming: • Through an initial data collection of the number of affected population including children in some of the flood affected areas of Garoua I, Garoua II, and Garoua III,and the analysis was finalized on 17 September. Thus, 2,300 children (1,074 girls and 1,226 boys) were surveyed and their problems and needs were identified, and the list of partners and associations has been mapped out. This will be strengthened by the results of the child protection rapid assessment as mentioned above. • A Joint team composed of UNICEF-Ministry of Social Affairs travelled from the Central level to the Far North and North Regions (17 September- 26 September) to meet with partners, and affected population to get additional information and data, and identify possibly partnership in the area of psychosocial response, violence prevention, and recreational space and activities for affected children and their families. • UNICEF is working with Colombia University to conduct a national mapping and analysis of the child protection services (17 August – 22 December, 2012). Interviews with more than 50 state and non-state actors and the data collection tools were validated by all key stakeholders during the workshop on 20-21 September. • The conception of the pilot project to register all children from 2 sites, namely from Garoua II, through SMS and immediate registration in hospitals, is being designed with the support of international experts from the Civil Registration Centre from Netherlands, and the Ministry of Territoriality and Decentralized Administration. A field visit (22 September-26 September) to the civil registry office, and main hospitals (with high number of deliveries) in order to get data to finalize the pilot project concept paper by the end of October 2012.

3.6.2 Standards, tool development and trainings • The needs assessment of the training for social and community based workers, training plan, and M & E tools, were validated by key stakeholders from the Ministry of Social Affairs and other partners. • The development of the communication strategy and plans for birth registration in the Far North region is on-going (September-December).

3.6.3 Gap Analysis • Lack of data and information on the impact of nutritional crisis on child protection • The referral and coordination system to identify and respond appropriately to child protection cases, including family tracing, reunification and reintegration, is not functioning well as it is not standardized. • As local capacity to provide appropriate psycho-social support to children and their families in the two regions is very limited, there is a need to identify trainers that will train others to better deliver psycho-social services to all vulnerable children. • A revision is needed on the M & E tools used to report effects of the campaigns on child exploitation and trafficking in the two main cities of Far North and North [Maroua and Garoua], and community based workers and data collectors need to be trained on the reporting tools. • Lack of recreational spaces and activities in the flood affected areas and for traumatized children • According to the UNICEF-partners rapid assessment 14% of the surveyed flood affected children lost their birth certificates, thus they need to be reconstructed. • Due to displacement caused by flooding, there is an increased risk for children of abuse, violence, rape, and contracting HIV/AIDS and other diseases.

3.6.4 Requests for additional resources/support • Re-printing of educational materials, providing financial and technical support to the Department of Social Affairs and their local partners, to support the implementation of the two local action plans on child exploitation and trafficking that aim to strengthen previous prevention activities in the cities of Maroua and Garoua, and extend them to at least 8 districts in the North and Far North, and revising of reporting tools and system on child trafficking and exploitation in the North and Far North. • 8 trainers to conduct training for 160 social workers and community based workers on psycho-social support including psycho-social support in emergencies in key districts of the Far North and North regions. • Support local associations for violence prevention activities in flood affected communities and sites, including development and printing of communication materials • Support for the setting up of two recreational spaces where children can play safely and families can receive information and support

• Providing integrated social protection service delivery (including psychosocial support, income generation, reconstruction of birth certificates, etc) to the most vulnerable children (3,000 children) who are victims of abuse, violence, exploitation and discrimination as a consequence of the floods and nutritional crisis in the North and Far North regions. • Supply of recreational kits, tents, first aid kits, and ECD kits

3.7 Emergency response HIV

3.7.1 Overview: Cameroon faces a generalized HIV epidemic with a prevalence estimated at 4.3 %. (2012 UNAIDS) The North and Far North regions have a lower prevalence (2.4 % and 1.2 % respectively) although figures remain high in pregnant women with 4.9% in the North and 4.3 in the Far North.

Table1: Pregnant women tested and treated for HIV in the emergency zone (2011) # of # of pregnant ANC # of pregnant # of HIV # of HIV Regions expected women seen frequentation women positive positive women in in ANC rate (%) tested for women women ANC HIV under ARV Extreme-North 178545 52005 29,1 34742 1327 72

North 105177 26232 24,9 9286 328 105

Source: National PMTCT progress report (CNLS, 2011)

Malnutrition and HIV form a deadly combination. Malnutrition negatively affects the clinical outcome of HIV and vice versa. UNICEF through it country program supports the government to alleviate the burden of HIV in children, adolescents and their parents, The program, aims at ensuring that they protect themselves against HIV and AIDS and have access to comprehensive prevention, care, support and treatment services. UNICEF HIV program has four pillars; It focuses on awareness rising, prevention and life skills strengthening for youth and adolescents, promoting and strengthening to youth-friendly services, prevention of mother to child transmission of HIV, and pediatric HIV care, care and support for orphans and vulnerable children.

3.7.2 UNICEF and Partners Programming: The HIV program is jointly implemented with the National Aids Control Committee (NACC) with four key ministries participating as direct implementing institutions.

• Prevention of mother to child transmission and pediatric treatment are led by the ministry of Public Health while OVC care is under the leadership of the ministry of social affairs. The youth component is jointly implemented by the ministry of youth and the ministry of secondary education. Youth associations are also involved as field implementing partners. • As member of the Joint United Nations’ country team on AIDS (JUNCTA) UNICEF works closely with UNAIDS, WHO, UNFPA, ILO and other agencies involved in the national response to HIV/AIDS. We also collaborate with CDC, PEPFAR; EGPAF and other international organizations who run HIV programs in Cameroon • UNICEF has established operational partnership with regional delegations in the ten regions for program implementation.

Activities carried out during the reporting period • In the north and far north regions, UNICEF team has worked with regional teams and authorities to assess the situation and identify unmet HIV needs and gaps in the response within the framework for the emergency and the Sahel nutrition crisis. • The rapid assessment conducted helped to analyze the specific needs of women, children, and healthcare providers in one hand and on the other hand the logistical needs of health facilities including CNAs (outpatient health facilities) and CNTs (in the two Health Districts of Maroua Urbain and Maroua Rural (far North region). The activity was carried out 9–13 September jointly with WHO, UNFPA, and The Clinton Foundation. • A second mission was carried out with support from the Regional HIV emergency specialist 1-2 September to supplement the outcome of the first mission. Recommendations were made particularly for Severe acute malnourished children and their mothers. Action points include: training of service providers, supply of HIV tests for adults and early diagnosis for new born,

sensitization for young people in schools and out of school, Mobilization and sensitization of pregnant women within CNTI and at community level for service utilization and HIV testing. • Various meetings were held with the French Red Cross, Association de “Solidarite International,” VSO, EFA international, the MOH, the regional drugs procurement center to discuss outcomes of mission and agree on actions to be taken and how coordination and synergies will be built. • Resources have been allocated to care for orphans and vulnerable children as part of the comprehensive response to the crisis

3.7.2 Procurement of Supplies : • An assessment was conducted from 12-21 September by UNICEF PSM specialist in the affected districts. The assessment included visit of facilities, CNTI and CNA and technical meetings and discussion with services provides, management teams and partners within the two health Districts of Maroua Urbain and Maroua Rural. Supplies stocks have been assessed taking into account needs to be covered. The main outcomes led to the following estimates of commodities in required for an effective needs oriented response: • 20,000 first HIV screening tests (Determine test kits ) and 3,000 second HIV screening tests(colloidal gold test kits) for malnourished children, • Fascount reagents for 600 women and Cyflow reagents for 300 women, • 200 packets of 120mg tablets of children’s cotrimoxazole, • 216 packets of 960mg tablets of adults’ cotrimoxazole • 20 boxes of Paper, dry blood spot, box/100

3.7.3 Training of local partners • 20 healthcare providers of the two health districts of Maroua Urbain and Maroua Rural were trained to screen severely malnourished children for HIV. 2 support groups (HIV positive mothers) with 20 members each were trained as peer educators, in Maroua. They will lead on mobilizing and encouraging pregnant women to attend antenatal clinics and be screened for HIV. They also work as community volunteers to provide psychosocial support to those infected/affected by HIV, and carry out other community based supportive activities.

3.7.4 Gaps Analysis • The coordination mechanism does not function properly between HIV stakeholders and beneficiaries do not know that PMTCT tests or therapy are free of charge. Local associations of People living with HIV did not know that early diagnostic test for 6 weeks new born is available for free at the district hospital • The referral system is fairly weak and counter referral does not exist between PMTCT and CNTII/CNA. Mothers and children are referred to paying tests used for PLHIV instead of free PMTCT services for which commodities have been purchased. Linkages should be analysed and put in place to incorporate PEV and CNTI as major entry points to HIV testing in addition to ANC. • Training on PMTCT and paediatric treatment, Prevention with youth and adolescents, care and support for OVC in emergencies is required for service providers as it was noted the last training on HIV took place in 2009, This was done by the Government. In the CNTI of Maroua, only 1 staff out of 12 had received training on paediatric infection. • Weak health promotion: there is not a well-established and dynamic interaction between the hospital and communities system and vice versa. Therefore the utilization rate of ANC is very low and chances to detect HIV in pregnant women are extremely weak. • Weakness in the decentralization system: according to the regional HIV AIDS Coordinators, The NACC has stopped sending funding to the regional branch (GTR) since 2009. Communication between authorities and programme managers is poor which undermines an efficient coordination and performance of the response. • Many orphans and vulnerable children still have poor access to services because of lack of resources in north and Extreme-North as part of the HIV response • Chaotic situation with the procurement and supply of antiretroviral therapy: shortages of reagents and ARV drugs are frequent. The national authorities and programme managers fail to regularly send the requested quantities to the regional levels to ensure service continuity. Therefore, patients are put under second treatment regimens whereas there are still eligible to the first line regimen. CD4 tests are not done systematically and patients are put under ARV therapy even if there is no need. • Despite a tremendous work done by youth associations to mobilize their peers, many adolescent still do not access testing services because of shortage in tests.

3.7.5 Requests for additional resources/support • Financial means to supplement the training for service provides on HIV in general and integrating PMTCT service into MCH package at health facility level • Financial means to strengthen active and regular supervision of regional health authorities and also to enable national NACC team to provide active assistance and supervision to affected districts • Technical assistance to support the NACC to address PSM urgent needs especially for the two affected regions in a sustainable manner and to set up a PSM system that works for emergencies • Financial means to fill the commodity gap as highlighted by the assessment report shown above and improve the management system in the field with the districts • Financial assistance to involve community groups and youth associations in awareness rising, prevention, testing promotion. • Financial assistance and collaboration with protection section to assess children right situation and propose coordinated actions that incorporates children affected by HIV.

3.9 Emergency response M&E

UNICEF has developed and begun implementation of an Information Management capacity building strategy to reinforce the Ministry of Water and Energy and the Ministry of Public Health at the regional and national levels dealing with data treatment, mapping, and monitoring and evaluation of the WASH, nutrition and health coordination groups.

4. Supply and Logistics

Total Value of Supplies in USD by Sector Delivered to Total Delivered to Total Amount Total Amount In UNICEF Partners – Sector In pipeline* Amount Partners -- Committed PGMs Warehouse** Since Last Received Cumulative Report Nutrition 2,223,262.13 723,788.30 288,787.50 410,156.93 992,362.65 Health 168,329.22 75,173.78 192,349.18 48,663.16 WASH 285,773.83 337,796.70 337,796.70 52,353.26 192,184.47 86,816.90 Education 6,819.26 54,242.93 48,679.40 11,365.54 57,004.19 50,174.93 Cross - 10,801.50 10,802 Sectorial Total 2,694,985.94 1,115,827.93 675,263.60 0.00 549,049.51 1,444,702.49 185,654.99 * In Pipeline defined as PGM raised, not yet in UNICEF Warehouse

**Current inventory in Warehouse made up of previous Sit Rep figure (including pre-positioned stock) + new receipts in reporting period

5 Emergency Response Funding The country office hosted the Spanish NATCOM team of 7 people to Maroua in Far North Region from September 8 to September 15 and facilitated the film shooting.

Country Nutrition crisis Total needs for Funds received Gaps VS total % funded vs HAU 2012 (HAU) needs Cameroon 13, 183, 970 7,771,554 5,412,416 59%

UNICEF wishes to express its deep gratitude to all public and private sector donors for the contributions and pledges received, which have made the current response possible. UNICEF would especially like to thank National Committees and donors who have contributed ‘unearmarked’ funding. ‘Unearmarked’ funding gives UNICEF essential flexibility to direct resources and ensure the delivery of life-saving supplies and interventions to where they are needed most – especially in the form of longer- term and predictable funding and in strengthening preparedness and resilience building. Continued donor support is critical to continue scaling up the response.

Across Sahel, UNICEF received financial and material contributions from: Andorra, Australia, Canada, CERF, Denmark, Estonia, European Commission/EC, Finland, Japan, Netherlands, Norway, Republic of Korea, Spain, Sweden, United Kingdom, United States of America; and the Danish Committee for UNICEF, Finnish Committee for UNICEF, French Committee for UNICEF, German Committee for UNICEF, Hong Kong Committee for UNICEF, Iceland National Committee for UNICEF, Italian national committee for UNICEF, Japan Committee for UNICEF, Netherlands Committee for UNICEF, New Zealand Committee for UNICEF, Spanish national committee for UNICEF, Slovakian national committee for UNICEF, UNICEF Belgium, UNICEF Bulgaria, UNICEF-Chile, United Kingdom Committee for UNICEF, United States Fund for UNICEF.

6 Emergency Response Human Resources The initial plan was to have two teams with a base in Maroua and Garoua, each composed of specialists in Nutrition, WASH and Health. Due to the scarcity of human resources and insufficient funds, UNICEF has revised its strategy to having only one office in Maroua, serving both regions. Currently the team consists of twelve professionals. Eight of them are already in place in Maroua and one in Garoua, and three other at the CO in Yaoundé. Four professionals of the team came as standby partners. Unfortunately, the duration of their assignment is short (between 4 and 6 months). Therefore UNICEF has started looking for other professionals to replace them.

UNICEF Humanitarian Staff positions Total Sectors Mobilized and in country 12 Emergency Coordinator (1) Emergency WASH Specialist (2) Emergency Nutrition Specialist (2) Nutrition Data manager (1) C4D Specialist (1) Communication Specialist (1) HPM Specialist (1) Health Specialist (1) Drivers (2) Not yet funded 2 Supply Logistics Specialist CMAM nutrition Specialist Locally Mobilized (In negotiations with 16 Agreement with Yaoundé university for local university) medical residents to support ongoing emergency response

Date of next Sit Rep: 26 October, 2012

For further information, please contact:

Name: Geoff Wiffin Name: Zakari Adam Name: Laure Bassek Representative Deputy Representative Communication Officer Country Office: Yaoundé CountryOffice: Yaoundé Country Office: Yaoundé Country: Cameroon Country: Cameroon Country: Cameroon Telephone:+23722223182 Telephone:+23722223182 Telephone: +23722223182 Facsimile: +23722231653 Or +23779523052 Or +23775296971 Email:[email protected] Facsimile: +23722231653 Facsimile: +23722231653 Email: [email protected] E-mail: [email protected]