Mozambique Humanitarian Situation Report No

©UNICEF/2020/Lima

Mozambique Humanitarian Situation Report No. 3

Reporting Period: January to December 2020

Highlights Situation in Numbers • UNICEF dispatched 3,317 kg of cargo to Palma in Cabo Delgado to 363,120 address the WASH, nutrition and education needs of both IDPs and host children in need of communities. humanitarian assistance

(source) • Over 57,250 children 6-59 months received Vitamin A supplementation

and screened for severe acute malnutrition (SAM); of those 719 children were admitted to therapeutic support. Over 71,660 mothers and 712,000 caregivers of children 6-23 months received IYCF-related messages. people in need

(OCHA 2020) • UNICEF continued providing life-saving health services to children and their families. This year, UNICEF supported the government Integrated Mobile Brigades 9,782 children under five received health consultations, 500,000 32,206 children received DTP3, 74,892 children were vaccinated for internally displaced people measles, and 1,406 pregnant HIV+ women received antiretroviral therapy. (IOM)

• In 2020, UNICEF supported over 75,870 people to access safe water, over 161,740 people accessed appropriate sanitation facilities and 2,441 received hygiene messages, and 45,088 families received point-of-use Fatalities (ACCLED) water treatment and purification materials/products.

UNICEF’s Response and Funding Status UNICEF Appeal 2020

SAM Admission 150% US$ 11 million

Funding status 13% Funding Status (in US$) Nutrition

Measles Vaccination 83%

Health Funding status 109% Funding gap Safe Water 152% $5M

WASH Funding status 105%

People with MHPSS 103% Funds Receiv Child Funding status 79% ed in Protection 2020 Children learning 48% $6M

Funding status 28% Education People reached 197%

C4D Funding status 39%

0% 20% 40% 60% 80% 100%

Funding Overview and Partnerships To support humanitarian action in 2020, UNICEF appealed for $11.1 million to provide life-saving services for children and their families affected by the ongoing conflict in northern Mozambique. As of 31 December 2020, UNICEF received a total of $6.5 million from donors including the United Kingdom, U.S. Agency for International Development, Central Emergency Response Fund, and the European Civil Protection and Humanitarian Aid Operations, to support its humanitarian response for the Cabo Delgado crisis. With the activation of UNICEF’s Level 2 Corporate Emergency Activation Procedure (CEAP) for the response, UNICEF headquarters allocated $2.5 million—including $500,000 for the Prevention of Sexual Exploitation and Abuse—from its Emergency Programme Fund to support the scale up of the response. The funding gap remaining at the end of 2020 was 41%. This gap is significant heading into 2021, where UNICEF requires $52.8 million for its Humanitarian Action for Children (HAC), of which over $30 million is for the Cabo Delgado crisis response.

Situation Overview & Humanitarian Needs Since 2017, the Cabo Delgado province, located in the north of Mozambique, has been facing an increasing humanitarian crisis caused by ongoing conflict by non-state armed groups (NSAGs). The situation deteriorated significantly in 2020 with increased attacks, internal displaced people (IDPs) and access constraints in the northern districts. According to the Armed Conflict Location and Event Data Project (ACLED), by the end of 2020, there were over 720 violent events and 2,441 reported fatalities from attacks on civilians. According to the seventh round of the data tracking matrix (DTM) of the International Organization for Migration (IOM) conducted in November 2020, there are at least 527,9751 people displaced due to insecurity in Cabo Delgado of which approximately 45%2 are children, distributed among five provinces namely Cabo Delgado, Nampula, Niassa, Zambezia and Sofala provinces. About 59,4853 IDPs are in hard to reach areas of Cabo Delgado including Palma, Muidumbe, Macomia and Quissanga districts. Over 90 per cent of the IDPs are located in 16 districts of Cabo Delgado, mainly southern districts due to safety and security as well as access to humanitarian assistance and living in host families; there is no information about Mocimboa da Praia district. The top three priority needs identified for

IDPs were food assistance, shelter, and non-food items.

Additional priority needs identified in localities hosting IDPs included: access to income-generating activities, potable water, documentation and education. The Government, through the National Institute for Disaster Management and Risk Reduction (INGD), reported higher displacement figures—over 600,000 people in ©UNICEF/2020/Biso seven provinces. There have been recurrent informal reports and allegations of serious human rights abuses, killings and maiming; widespread destruction and burning of property including public facilities; looting and (forced) displacement; abductions, and sexual and gender-based violence. Over 1,900 unaccompanied children were reported in the most recent DTM. Due to the conflict and insecurity in 2020, there was destruction of key infrastructure—health facilities and water supply systems—impacting the provision of basic services such as health and nutrition as well as safe water. Of the health facilities, 41 out of 130 are non-functional in nine districts while 12 water systems and 56 boreholes were reported as not operational in seven districts. Nearly 74,250 students and 1,486 teachers in 171 schools have been affected in the nine districts, forcing many to flee to other districts for safety. Access to affected populations in hard to reach areas remained challenging in five districts of the province due to poor security. Palma District has recently become accessible thanks to the UN Humanitarian Air Service (UNHAS) facilitated by the World Food Programme and Logistics Cluster. As a result, humanitarian partners have been able to access Palma and Ibo districts to conduct assessments, transport life-saving supplies and provide assistance. Disease outbreaks such as cholera, acute watery diarrhoea (AWD) and COVID-19 affected Cabo Delgado throughout the year. By end December, there were over 2,400 cumulative cases of cholera in Cabo Delgado with a case fatality rate of 1.5% reported in five districts and over 450 cases of AWD were reported in three districts. UNICEF provided safe

1 IOM/DTM round 7 as of November 2020 2 IOM/DTM round 7 as of November 2020 3 IOM/DTM round 7 as of November 2020 2 water, sanitation materials, hygiene promotion, household water treatment products, medicines (cholera and AWD kits) and other supplies to respond to the needs. The province has reported 1,374 cases of COVID-19, since the onset of the pandemic.

Summary Analysis of Programme Response Nutrition Throughout 2020, UNICEF has supported the screening and treatment of severe acute malnutrition (SAM) in children under five years of age including through the government’s Integrated Mobile Brigades. Between June and December, the brigades carried out 621 site visits in Ancuabe, Ibo, Balama, Namuno, Pemba, Montepuez, Mecúfi, Metuge, and Meluco Districts of Cabo Delgado. In addition, UNICEF, with partner CARITAS, strengthened active case finding, SAM screening and referrals. UNICEF supported the Provincial Health Directorate (DPS) in conducting supervisor visits and identification of nutrition sites for implementation of integrated nutrition programs, online and in person mentoring/training on in-patient treatment of acute malnutrition, and the provision of equipment including portable ©UNICEF/2020/Biso stadiometer, scales, in-patient and out-patient kits, and mid-upper arm circumference tapes. Through UNICEF support, a total of 57,257 children 6-59 months were screened for SAM and provided Vitamin A supplementation, 11,000 more than our target for the year. Of these 719 children admitted for SAM treatment while 40,525 children 6-23 months were dewormed, and 71,661 mothers and caregivers of children 6-23 months received IYCF-related messages. UNICEF was able to achieve significantly more people than original targeted as figures the displacement changed significant during the year, necessitating a more significant response. The Nutrition team was also able to use non-emergency funds which provide nationwide support, to cover some of the costs of reaching children with both SAM treatment and Vitamin A distribution. Wherever possible, UNICEF leveraged resources to address the increasing needs in the province as the fluid situation evolved throughout the year. In December 2020, UNICEF prepositioned supplies in Palma District with local health authorities to support provision of services for IDPs and host communities. The supplies included 20 cartons of ready-to-use-therapeutic food (RUTF) and 800 cartons of micronutrients as well as 15,000 Vitamin A and E tablets for children—enough to top-up existing stocks to avoid pipeline breaks through mid-2021. UNICEF leads the Nutrition Cluster in Cabo Delgado as well as at the national level. As part of the Inter-Cluster Coordination Group (ICCG) established in Cabo Delgado, the nutrition cluster participated in different inter-agency rapid assessments including in Ancuabe, Palma, Montepuez, Metuge and Meluco Districts. In addition, during the month of December, the Nutrition Cluster began its preparatory planning and consultations with partners and the Global Nutrition Cluster to undertake a Rapid Nutrition Survey in early 2021. The Cluster Coordination Performance Monitoring (CCPM) started on 18 December and is expected to be finalised mid-February 2021. Health During 2020, UNICEF strengthened the capacity of the Provincial Health Directorate (DPS), participated in interagency rapid needs assessments to identify immediate health needs, and supported supervision visits to assess services provided by community health workers (i.e. APEs4). To ensure continued service delivery, UNICEF increased support for government-run Integrated Mobile Brigades (IMB)

which travelled to 621 sites this year. Through the IMBs, 9,782 children under five years received health consultation, 32,206 children received DTP3 immunizations, 74,892 children were vaccinated for measles, and 1,406 pregnant HIV positive women received anti-retroviral therapy in Balama, Namuno, Chiure, Montepuez, Mecufi, Metuge, Meluco, Ancuabe, and ©UNICEF/2020/Biso Ibo Districts of Cabo Delgado.

4 Agentes Polivalentes Elementares 3

As result of cholera outbreaks, mainly affecting six districts hosting IDPs, UNICEF provided support to partners and the government to ensure a coordinated response. UNICEF dispatched 300 Community Health Workers’ Kits, 200 cholera treatment charts, 52,200 sachets of oral rehydration salts, 35 Acute Watery Diarrhoea Periphery Drug kits (which contain Zinc and ORS), 15 tents, and 30 cholera beds for managing cholera. UNICEF also provided 1,299 insecticide-treated mosquito nets and 22 malaria kits to partners to support case management of malaria and reinforce prevention and awareness-raising measures in the community. Similarly to nutrition, the Health Section modified the programming throughout the year to address the increasing needs in Cabo Delgado. HAC targets were originally developed in late 2019 when IDPs numbered only 60,000 while at the end of the year, over 500,000 people were displaced.

WASH UNICEF’s WASH response for Cabo Delgado includes the provision of emergency water, provision of water treatment chemicals for both households and communities, expansion and rehabilitation of existing water supply networks, installation of new water supply systems, hygiene promotion, and the provision of hygiene kits with menstrual hygiene items. By the end of 2020, through UNICEF-supported WASH interventions, a total of 75,873 people accessed safe water; 161,744 accessed appropriate sanitation facilities and received hygiene messages; and 45,088 families received point-of-use water treatment and purification materials/products; thus for two of the three indicators, UNICEF exceeded planned targets.

In December, UNICEF and partner Joint Aid Management (JAM) providing two new boreholes and constructed 20 emergency latrines in the resettlement sites in Montepuez District ensuring 11,350 people were reached with safe water. Additionally, 1,340 hygiene kits were distributed to IDPs by UNICEF and partners. In Metuge District, UNICEF supported temporary accommodation sites hosting more than 40,000 IDPs with construction and decommissioning of emergency latrines with partners Ayuda en Accion and MSF in overcrowded sites. In the 25 de Junho site, UNICEF supported water trucking through partners Ayuda and Accion, provided three water bladders with a capacity to store and supply 120 cubic meters of water per day. To provide a longer-term ©UNICEF/2020/Biso solution, UNICEF worked with the Water Supply Investment and Heritage Fund (FIPAG) to purchase a pump to improve the water pressure on the Metuge Water Supply System. In Ancuabe, through the public works department and private contractors, UNICEF installed two new water point platforms in Nanjua B, a new permanent resettlement site that received 800 IDP households. A third borehole was drilled by UNICEF partner Helvetas to construct a Solar-Powered Water Supply System.

UNICEF drilled 51 out of the planed 69 boreholes and 17 have not yet been fitted with handpumps in ten resettlement sites; the remainder will be completed in early 2021. UNICEF also provided 10,000 bottles of household water treatment chemicals to help stop the spread of cholera. In hard to reach areas UNICEF prepositioned supplies and provided assistance to IDPs. In Palma district, UNICEF prepositioned supplies to provide assistance to IDPs during rainy season, including one water bladder of 10,000 litres which will support approximately 1,250 IDPs in an accommodation centre. In addition, 750 cartons (36,000 bottles) of household water treatment (certeza) were prepositioned as well as non-food items—including jerry cans and soap—for up to 500 households. In the Mueda district, UNICEF supported 150 households in Negomano with Hygiene and Dignity Kits and household water treatment products (Certeza).

WASH Cluster Coordination also continues at the national and sub-national levels through UNICEF staff to harmonize approaches, provide technical leadership, identify and address gaps in the response, and provide assistance.

Child Protection With the escalation of conflict and insecurity, children have borne the brunt of the Cabo Delgado crisis, experiencing psychological trauma, physical trauma and/or injury, sexual violence, and being forced to flee their homes. Some children have been separated from their families and many lack access to water, sanitation, education, nutrition and health services which would allow them to survive and thrive. Children remain in immediate need of psychosocial support, case management and other services to build their resilience and respond to their protection needs. Child rights violations were persistently reported over the course of 2020, including over 200 boys and girls who were kidnapped, abused and returned to the community to instil terror and fear. 4

UNICEF’s Child Protection team and its partners provided psychosocial support to 9,239 children affected by the conflict in ten child friendly spaces (CFS) in Ibo, Metuge, Montepuez and Pemba districts. UNICEF supported guideline development to safely reopen CFS’ which outlined guidance on social distancing and other COVID-19 mitigation measures. UNICEF and its partners supported community awareness activities attended by 12,659 people, as part of community-based child protection, in the context of COVID-19. Case management services registered were provided to 1,600 children (769 girls) and over 200 unaccompanied and separated children were supported. UNICEF, in close ©UNICEF/2020/Biso collaboration with Government social services, ICRC, partners and community structures, initiated family tracing activities.

Partners AVSI and Save the Children, as well as government technicians, were trained by UNICEF on disability inclusion with a specific focus on child protection issues. In partnership with the NGO AIFO, UNICEF is strengthening disability inclusion in the Cabo Delgado response, including identification and provision of services to children with disabilities, as well capacity building of local actors and community sensitization on disability rights.

Education Through the support of UNICEF, 17,355 children aged 6-15 years accessed education—about 48% of the 2020 target. Education services in Cabo Delgado, as with much of the country, were impacted by COVID-19 which caused the closure of schools. In parts of the province where schools have been able to open, UNICEF supported the provision of Temporary Learning Spaces, teaching and learning materials, training of teachers, provision of hygiene and dignity kits, and technical and operational support for school enrolment campaigns. Where schools were not able to open, UNICEF supported children to access distance learning, radio education, and alternative learning opportunities, including vocational training for out of school children/adolescents.

UNICEF provided 170 “school in a box” kits, 15,403 learners’ kits, 600 tarpaulins, and 298 chalkboards to the Cabo Delgado district education offices with a focus on the districts hosting large number of IDPs. UNICEF also supported teacher training on psychosocial support (PSS) for 363 teachers in Pemba, Metuge, Ancuabe, Chiure, Namuno, and Balama Districts in collaboration with the Provincial Education Directorates. To support the safe reopening of schools, UNICEF provided 920 bars of soap and 11,500 face coverings to the provincial education authorities. UNICEF also worked to address logistical and operational impediments to ensure education supplies were transported by the Provincial Education Director into hard-to-reach areas. In Palma, UNICEF prepositioned “school in box” and learner kits to cover 500 children as well as tarpaulins and chalkboards for 10 classrooms. This will allow the Palma District Education Authority to support schools and improved learning spaces for children in the IDP sites.

Through support of the Global Partnership for Education (GPE) and a partnership with We World/GVC, 61 teachers in Pemba were trained in distance education methodology, and 1,360 children—both IDPs and host community—were supported in their distance learning, and 84 teachers trained in PSS. UNICEF initiated a partnership with Helvetas to support non-formal education, including vocational training, targeting ©UNICEF/2020/Biso 850 out of school adolescents.

Social Protection/Cash-based Programming UNICEF, through partnerships with government ministries as well as the National Institute of Social Action (INAS), was able to provide 2,428 households with humanitarian cash transfers—approximately 22% of 2020 target. In late January 2020, Quissanga residents fled to safer areas outside the district due to escalation of conflict and insecurity. UNICEF, with partners, worked to locate the Quissanga residents enrolled in the social protection programme among the IDPs in Pemba, Metuge, Chiúre, Montepuez and Mecufi Districts. Out of 2,595 families enrolled in Quissanga in 2019, 1,593 were located and received 4,500 Meticals—approximately $60 USD for three months support. In late December, and additional 835 households from Quissanga who relocated were registered and received the cash transfer. In total, all 5

2,428 households received 9,000 Meticals providing up to six months support. Despite these achievements, the social protection response in Cabo Delgado remained significantly underfunded in 2020, impeding achievement of target results.

In December, UNICEF supported the training of 685 “Permanentes” or neighbourhood secretaries and community workers on the prevention of sexual exploitation and abuse. UNICEF also worked with our partner INAS on the registration of beneficiaries for potential relocation into resettlement sites. By end December, about 1,500 families were registered; the process is ongoing.

Communications for Development (C4D), Community Engagement & Accountability During 2020, UNICEF and partners reached 917,968 people with lifesaving and behaviour change messages on a variety of topics including health, nutrition, sanitation, hygiene practices, and child protection. Messages were provided through a variety of means including door-by-door visits, community dialogues and public announcements.

UNICEF supported the Provincial Health Directorate (DPS) during the two rounds of the Oral Cholera Vaccine campaign action plan development covering community mobilization and use of community radio. UNICEF also supported production of materials, radio spots and training of community mobilizers for the campaign in the targeted districts of Palma, Metuge, Pemba, Ancuabe, Macomia and Ibo. Broadcasts and community mobilization sessions were provided both before and during the campaign. UNICEF also supported DPS on acute watery diarrhoea and cholera response activities through provision of 5,000 leaflets on hygiene promotion and cholera prevention, 50 flipcharts and 25 megaphones which were distributed in the affected districts of Montepuez, Pemba, Ancuabe, Namuno, Balama and Metuge. UNICEF also supported the Social Communication Institute (ICS) to conduct community dialogues with 225 community leaders and key influencers in small groups, projecting videos on diarrhoea and cholera explaining modes of transmission and promoting best practices for prevention in Metuge and Ancuabe.

With ICS and Radio Mozambique, UNICEF supported the production and broadcast of 54 radio programs and 187 radio spots in local languages, addressing topics related to the AWD/cholera prevention as well as child protection topics reaching some nearly 500,000 people in Montepuez, Chiure, Namuno, Palma and Mueda districts.

With the reopening of religious events and the adoption of COVID-19 prevention measures ensured by religious leaders, UNICEF renewed its partnership with the Inter- Religious Programme Against Malaria (PIRCOM). In coordination with government counterparts, 80 religious leaders from Namuno, Balama, Metuge and Mecufi Districts of Cabo Delgado were trained to conduct ©UNICEF/2020/Biso community engagement sessions on promotion of lifesaving behaviours and protective practices with a focus on AWD/cholera prevention.

UNICEF continued to promote the use of accountability services including Linha Verde, complaint boxes, public announcements, radio programs and during the community engagement (CE) activities. At end December, it was agreed UNICEF and UNHCR would co-chair the Cabo Delgado CE/Accountability to Affected Populations Working Group under the Cabo Delgado Area Humanitarian Country Team (AHCT).

Humanitarian Leadership, Coordination and Strategy The Government of Mozambique through provincial authorities led by the Secretary of State, supported by the National Institute for Disaster Management and Risk Reduction (INGD), provided the overall leadership and coordination of humanitarian actors in the Cabo Delgado and neighbouring provinces. The Secretary of State of Cabo Delgado established a Technical Commission, to act as the main interlocutor with the humanitarian agencies which meets regularly with the humanitarian community under the joint chairmanship of the Secretary of State and Provincial Governor.

OCHA in Cabo Delgado provided overall coordination support to humanitarian agencies. All clusters/sectors have been represented in the province and UNICEF is leading/co-leading WASH, Education, Nutrition and the Child Protection 6

Area of Responsibility together with government counterparts. Government-led coordination in Nampula is in place and UNICEF is providing leadership and coordination support.

UNICEF continued to play a key role within the PSEA network, serving as co-chair since 2019 at the national level and collaborating with other UN agencies and partners to ensure that the PSEA network continued to be operational and able to respond to emerging PSEA issues. UNICEF is working in Cabo Delgado to strengthen accountability, victim assistance, and prevention and risk mitigation strategies by humanitarian workers, including government.

UNICEF Mozambique Press Releases: https://www.unicef.org/mozambique/en/stories/displacement-leaves-its-traces-health-and-nutrition-children-cabo- delgado https://reliefweb.int/report/mozambique/rapid-response-plan-cabo-delgado-province-mozambique-may-december- 2020?fbclid=IwAR0q2dgiC_QXwpVRWIcEnlOFXygx75uwEbqVN2fDVquD4CWhXtMD4X0Txpc

Social Media Posts: https://twitter.com/UNICEF_Moz/status/1316766326162161664 https://m.facebook.com/story.php?story_fbid=3595587190526191&id=119248088160136 https://m.facebook.com/story.php?story_fbid=3487053621379549&id=119248088160136 https://m.facebook.com/story.php?story_fbid=3478268125591432&id=119248088160136 https://m.facebook.com/story.php?story_fbid=3442799295804982&id=119248088160136 https://m.facebook.com/story.php?story_fbid=3439504356134476&id=119248088160136 https://m.facebook.com/story.php?story_fbid=3392502320834680&id=119248088160136

Next SitRep: April 2021

UNICEF Mozambique: https://www.unicef.org/mozambique/en UNICEF Mozambique Facebook: https://www.facebook.com/unicef.mozambique/ UNICEF Mozambique Humanitarian Action for Children Appeal: https://www.unicef.org/appeals/mozambique

Whom to contact for Maria Luisa Fornara Katarina Johansson Claudio Julaia further information: Representative Deputy Representative- Emergency/DRR Specialist Mozambique Programmes Mozambique Tel: (258) 21481104 Mozambique Tel: : +258 21 481 150 Email: maputo@unicef.org Tel: (258) 21481104 Email: [email protected] Email: [email protected]

Annex A: Summary of Programme Results UNICEF and IPs Cluster Response Change Change 2020 Total Since 2020 Total Since Sector Last Last Target Results Report Target Results Report ▲▼ ▲▼ NUTRITION # of children aged 6 to 59 months 46,000 57,257 6,429 46,000 57,257 6,429 screened for SAM and receiving Vit A

# of PLW that access IYCF services 87,000 71,661 12,346 87,000 77,475 12,346

# children 6-59 months admitted for 480 719 137 480 761 137 SAM treatment HEALTH # children 6 months to 15 yrs 90,000 74,891 1,500 vaccinated against measles

# children vaccinated with DPT3* 4,150 32,206 2,538

Pregnant women 15-49 living with 950 1,406 340 HIV receiving ART

Children under 5 receiving consult 6,630 9,782 1,285 WATER, SANITATION AND HYGIENE PROMOTION

# of people with access to safe water 50,000 75,873 47,916 90,000 106,547 19,590

# of people with access to sanitation 180,000 161,744 8,868 180,000 161,744 8,868 and hygiene messages # families with POU water treatment 30,000 45,088 16,000 30,000 45,088 16,000 products CHILD PROTECTION # people with access to psychosocial 9,000 9,239 - 12,000 9,239 - support # children accessing case 600 1,600 - 800 1,600 - management services EDUCATION # of children (6-15 years) accessing 36,500 17,355 14,355 41,694 41,817 28,137 learning # children (3-5 years) accessing play- 7,300 - - based learning SOCIAL PROTECTION # HH reached with cash transfers 11,000 2,428 835 COMMUNICATIONS FOR DEVELOPMENT # people reached with lifesaving and 467,000 224,230** 277,884 behavior change messages PREVENTION OF SEXUAL EXPLOITATION AND ABUSE # children and adults with safe/accessible channel to report 164,488 119,213 - SEA *This figure was based on a much lower number of IDPs at the end of 2020. As a result of increased displacement, UNICEF reached additional children. **This figure represents the monthly estimated reach through C4D programmes including radio spots and mobile units.

Annex B Funding Status Funds available Funding gap 5 Sector Requirements Received Current Carry-Over $ % Year Nutrition $1,143,072 $151,217 - $991,855 87% Health $1,376,352 $1,506,490 - 0 0% WASH $2,533,607 $2,656,738 - 0 0% Child Protection $1,813,752 $1,425,713 - $388,039 21% Education $1,573,822 $447,145 - $1,126,677 72% Social Protection $2,239,488 $150,343 - $2,089,145 93% C4D $373,248 $145,133 - $228,115 61% Total $ 11,053,341 $ 6,482,779 - $ 4,823,831 44%

5 As stated in the HAC 2020 9