UNICEF Chad Situation Report 24 August 2012

Highlights  For 2012, the annual caseload of severe acute malnutrition (SAM) across the Sahel Band was estimated at 127,300 children under five years of age based on August 2011 nutrition survey results ; As of August 2012, 85,937 cases of SAM have been admitted for treatment (67.5%). As the number of implementation sites and number of admissions continue to increase, and GAM rate is 18.9% in June 2012 SMART survey across the Sahel belt, UNICEF estimates that the number of expected cases for treatment of severe acute malnutrition may exceed 2012 original.  In June of 2012, data collection was completed for the UNICEF supported Sahel Band Nutrition Survey. The results show a continuing nutritional emergency with 9 out the 11 total regions with a prevalence of global acute malnutrition over 15%.  A slight decline in admissions for severe acute malnutrition (SAM) between June and July 2012 (12,305 in July versus 15,888 in June 2012)  An additional 11 outpatient therapeutic program (OTP) centres were opened between June and July 2012. UNICEF is currently supporting 345 centers in the Sahel belt of which there are 31 inpatient facilities (IPFs) for treatment of SAM with complications and 314 OTPs for outpatient treatment.  On-going general government workers strike is affecting most of basic social and administrative sectors in the country.  As of August 1st 2012, one thousand two hundreds and seventy five (1660) students registered for the catch up classes in the three schools of Mao Centre (692 students registered), Mao Moto (593), and Al-Fallah (375), which are the three targeted schools in Mao where the project) is being piloted  Heavy rains provoked end of July / early August floods in Sila , Salamat, Lac and Mayo Kebi East. An estimated 10,000 people are affected and an evaluation mission is planned by the government under the direction of the office of the President with the support of UNICEF in N'Djamena and the flooded district led by the ministry of Urbanism. After the evaluation and mapping of the flooded areas we will be able to coordinate a holistic response.

Biltine, July 2012, ©UNICEF/Ferreiro

1. Situation Overview Estimated Affected Population

 Estimated Affected Population  (Estimates calculated based on initial figures from the General Population Census RGPH- INSEED 2009, SMART survey August 2011, EPI data) Categories Total Male Female Total Affected Population 6,252,536 3,170,036 3,082,500 Children Affected (Under 18) 3,588,956 1,819,601 1,769,355 Children Under Five 1,137,962 576,947 561,015 Children 6 to 23 months 340,763 172,767 167,996 Pregnant women 264,482 - - Children Under Five with Severe Acute 127,300 64,495 62,805 Malnutrition (SAM) Children Under Five with SAM and medical 12,730 6,454 6,276 complications Children Under Five with Moderate Acute 300,000 152,100 147,900 Malnutrition (MAM) Total Displaced Population 413,126 209,455 203,671 Children Displaced (projection / estimation) 237,134 120,227 116,907

 Amongst the poorest countries in the world, Chad is ranked 183 out of 187 countries in the 2011 UNDP Human Development Index. Children under 18 represent 59% of the population and face serious survival and development challenges.  In addition to the current alarming nutrition crisis, Chad has recurrent outbreaks of epidemics – including measles, meningitis, polio and cholera, which remain a major public health concern.  About 40% of children under five are affected by stunting. Malnutrition is also a chronic problem (including micronutrient deficiencies) in the country including the Sahel belt.

2. Inter-agency collaboration  UNICEF is engaged in working with OCHA, others UN agencies and NGOs to foster the Transformative Agenda (TA) in Chad.  UNICEF has dedicated cluster coordination staffs and emergency specialists for WASH, Nutrition, Education and Child Protection sectors.  Cluster and Inter-cluster coordination meetings continue to be held on a regular basis, although access to reliable and timely data continues to be a challenge.

3. Emergency response

3.1. Nutrition Overview

UNICEF & operational partners Sector / Cluster % of Cumula % of Estimated #/% UNICEF Cumulative Target Cluster tive Target coverage Target results ( #) Achieve Target results Achieve d ( #) d Children <5 with 127,300 85,937 67,5% 127,300 85,937 67,5% Severe Acute children Malnutrition admitted admitted to between Therapeutic January and Feeding July 2012 programmes Children <5 in At least 41896 44% 95,475 41896 44% Therapeutic 95,475 Feeding Programmes of who have recovered

# of health facilities 468 345 78% 468 345 78% offering SAM treatment # and % of children N/a N/a n/a 300,000 81611 27% 6-59 months with moderate acute malnutrition benefiting from feeding programmes List of UNICEF Operational Partners: MOH, FRC, Alima, IMC, Base, Bambini, Centre NDA, MSF-CH, MSF-H, MSF-F, IRC, ACF, Merlin, CRT, CHORA, Concern

UNICEF and Partner programming  New admissions decreased this month by 3,583 malnourished children admitted in nutrition therapeutic centres. This decrease was observed in seven of the ten Sahel belt regions; further analyses are underway by UNICEF, the MoH and the cluster technical group to explore reasons supporting the decline, looking at: incidence rates, access to screening, referrals and admissions during the planting season.

Chad-Number of new SAM admissions in the Sahel Band 18,000

16,000

14,000

12,000 2012 10,000 2010 8,000 2011 6,000

4,000

2,000

- JAN FEB MAR APRIL MAY JUNE JULY AUG SEPT OCT NOV DEC

Country Chad name of indicatorNumber of new SAM admissions in the Sahel Band JAN FEB MAR APRIL MAY JUNE JULY AUG SEPT OCT NOV DEC 2010 2,430 2,494 2,453 2,651 4,555 5,988 6,133 6,522 6,819 6,838 5,640 3,913 2011 3,474 3,833 5,205 4,834 6,866 9,244 7,839 5,207 5,939 5,515 5,521 6,459 2012 7,348 10,376 13,006 13,123 13,889 15,888 12,305

Figure 1: Monthly admission for SAM in the Sahel belt of Chad, 2010, 2011 and 2012.

UNICEF held a two day retreat (August 13-14) of the emergency response team (health/nutrition team, chiefs of sub-offices, operations and supply staff) was done to review the nutrition response, discuss gaps in program implementation and propose remedial actions to accelerate program delivery and improve the quality of the management of severe acute malnutrition program.

Nutrition Cluster

 The WASH in Nutrition package has been sent to cluster members for implementation; an upcoming support mission from the Global Cluster is planned at the end of August to strengthen the approach.  Inter-cluster meetings Nutrition/Wash; Nutrition/Food security were held to improve the exchange of information and facilitate collaboration.

3.2. WASH

Overview UNICEF & operational partners Sector / Cluster Estimated #/% % of % of UNICEF Cumulative Cluster Cumulative coverage Target Target Target results ( #) Target results ( #) Achieved Achieved Affected population with access to WASH 127300 38394 52% 331,559 62997 19% minimum package1 Nutritional centres delivering the WASH 285 99 35% 400 107 27% minimum package

UNICEF Operational Partners: Merlin, SIF, ACF, Oxfam GB, ADRA, French and Chadian Red Cross, CWW, WCDO,IRW , Premiere Urgence, ACTED, IRW,IAS, ADC, MOUSTAGBAL,NAGDARO, Intermon Oxfam, Solidarités Internationale, CHORA

WASH Program: . The program preceded with the provision of WASH material in the nutritional health centers in Sahel area to prevent diarrhea diseases with focus in mother and child package, 30 OTP in 4 districts ; Bol, Nguri , Massaget ,Bagassola were the recipient of the WASH in Nut packages.

. Training was conducted with 400 technicians and community outreach for the household water treatment and good hygiene practices in feeding centers in all six regions namely, Lac, Hadjer Lamis, Kanem, Batha, Guera and Bahr El Gazel to enable the quick delivery and follow up of mother and clid package safeguarding malnourished children from diarrheal diseases at nutritional centers and household.

. WASH program, Water and Sanitation for Africa (WSA) and the Department Ministry of Urban Water and Rural will organize a national workshop (29 - 30 August) on the NPRI approach (National Planning Initiatives for Results) to support the mobilization of funds for the WASH sector in Chad, focusing on country priorities which will include the Sahel Crisis.

. Rapid Assessment missions were conducted in Mayo Kebbi East/West, Tandjilé, Hadjer Lamis and Lake regions. The missions focused on Cholera prevention and WASH in Nut Activities. The purpose of the missions was to enhance the level of preparedness, increase WASH preventative activities, reinforce WASH stocks and to re-initiate local coordination mechanisms (crisis committees).

. Flooding in Sila, Salamat, Mayo Kebi Est/Ouest has affected at least 10,000 people; UNICEF is responding in Salamat and Sila regions,through the delivery of critical WASH supply as well as technical support for evaluation and to mitigate further deterioration.

. Planning underway for the launch the drilling of 100 boreholes in the areas affected by Nutritional crisis and cholera high risk villages. Hygiene promotion and construction of hygienic sanitary facilities will be integrated in the project.

. WASH program has deployed two mobile consultants to accelerate preventive cholera activities covering north axis Lac and Hadjer Lamis regions and the south axis in the Tandjilé, Mayo Kebbi Est and West regions working in collaboration with two C4D consultants for social mobilization with the local authorities.

. UNICEF signed Programme Cooperation Agreements (PCAs) with 3 NGOs , Merlin, AFDI and IAS to cover WASH in Nut intervention Hadjer Lamis and Wadi Fira regions; activities consist of building water points and latrines at nutrition centers, providing hygiene kits to malnourished children and hygiene and sanitation sensitization in communities.

Cholera preventive practice in Mandalia

WASH Cluster: . The WASH and Nutrition sections are coordinating an inter-sectoral response to the nutritional crisis in the Sahel to ensure the systematic distribution of WASH minimum package to the affected population.

. At the last meeting of the WASH Cluster, the Committee on Strategic Orientation was formally established and developed an operational plan for the second half of the year 2012.

. The RRT (Rapid Response Team) Cluster Coordination support person ended his mission in Chad having evaluated the performance of the WASH cluster and encouraged it to continue improving the level of coordination and preparedness in response to emergencies (nutritional crisis, epidemic and floods)

3.3. Health

UNICEF and Partner programming  Chad epidemic profile remains characterized by the circulation of Polio Virus particularly in the Lac region; 5 cases have been confirmed so far; UNICEF has deployed 25 staff to support the last round of immunization campaign with a coverage of 96%.

 UNICEF has trained and deployed 100 nurses to support the MoH in the Sahel belt. Two workshops were organized in Salamat and Hadjer Lamis to define detailed workplans in a participative manner with local authorities and beneficiaries.

3.4. HIV/AIDS  In Ouaddai, Wadi Fira and Sila UNICEF has worked over the first semester of 2012, with the MoH, IMC, BASE, COOPI and the CRT to set up 35 PMTCT clinical sites.  10,677 pregnant women have received ante natal services; among them 7,022 have undergone HIV testing. 6

 28 Pregnant women were tested positive and are receiving proper follow up and care.

3.5. Child Protection:

3.5.1 UNICEF and Partner programming

 In collaboration with the "Direction de l'Enfance" in Ministry of Social Action and “Centre National de Nutrition et de Technology Alimentaire” (CNNTA) and with others partners involved in the response to the food crisis in Chad, UNICEF will support the organization of 25 training sessions for building the capacity of 745 agents of health / nutrition and social agents working in the nutrition centers in 11 regions affected by the nutritional crisis, in September, on psychosocial stimulation and support.

 In partnership with the Regional Social Welfare Delegation in Ouaddai region, a psychosocial support project for undernourished children was launched in August 2012 in Abougoudam zone. About 20 traditional leaders attended the launch and expressed their full support to this initiative. The project shall reach 3000 children visiting the health center with emotionally stimulating activities to accompany their recovery process.

 In partnership with regional social welfare delegations, 3,010 children (1,831 boys and 1,179 girls) in nutrition crisis affected regions (Ouaddai, Sila) benefit from psychosocial support interventions in 11 child friendly spaces located in return villages and internally displaced sites. This is a medium and long term preventive intervention that is likely to protect children from abuse linked with family separation, early marriages, child trafficking which can be exacerbated during emergency situations.

 450 youth are actively engaged in community mobilization against sexual and gender based violence in Sila region by targeting community members with GBV prevention messages and monitoring and reporting GBV cases. This is a supportive intervention in regions where food crisis and other livelihoods deficit can lead to abuse and violence such as early marriages and child labor.

 UNICEF is supporting Income Generating Activities for 543 women across the Sahel belt to promote resilience and social protection.

3.5.2 Child Protection Sub-Cluster:

A Child Protection Sub-Cluster at the national level has been created with the support of OCHA in order to coordinate the Child Protection emergency response to the nutrition crisis in the Sahel belt and to develop a contingency plan for potential emergencies (such as natural disasters) in Chad. The sub-cluster will be co-led by the Ministry of Social Action and the first meeting is to be held on 04 September 2012

3.6. Education Overview

 UNICEF provided technical assistance and financial support for the preparation and implementation of the “Catch-up classes” (remedial classes) project which is being implemented in Kanem, one of the regions most affected by the nutritional crisis in the Sahel Belt. The course which began on August 1st in Mao aims at helping children who dropped out of school during the 2011/2012 school year because of the crisis to be ready to return to school, stay there and do well during the 2012/2013 academic year.

 An effective awareness campaign led by the Students’ Parents’ Associations and supported by UNICEF in collaboration with the local education authorities was launched. It resulted in a massive registration of targeted students.  As of August 1st 2012, 1660 students ( 6-12 years old) of which 590 are girls registered for the course in the three schools of Mao Centre (692 students of which 203 are girls registered), Mao Moto (593 of which 211 are girls), and Al-Fallah (375 of which 176 are girls), which are the three targeted schools in Mao where the project is being piloted.

Boys and girls gathering for registration

 UNICEF provided 25 school in a box and three recreational kits to the three (3) schools in Mao where the “Catch-up courses” are being conducted

 A joint UNICEF/Government of Chad team has undertaken a mission to Mao (August 21st – 28th 2012) for the (a) monitoring and evaluation of the “Catch-up course project” being implemented; (b) drafting of a work plan for the “back-to-school” campaign; and (c) preparation and participation in the visit of the Spanish Goodwill Ambassador to Mao, Kanem.

 A joint-review, assessment and updating of the impact of the Sahel belt crisis on education has been launched through a meeting held on August 20th 2012 in which Terms of References and data collection tools were examined and validated, and the technical committee established. A hundred and fifty (150) schools will be sampled in fifteen (15) “Inspection Pédagogiques de l’Enseignement Primaire” (IPEP) within five (5) regions of the Sahel Belt severely affected by the food/nutritional crisis. As an inter-cluster activity, the joint-review will contribute to strengthening collaboration mainly between WASH and Education clusters.

 Meetings aimed at preparing the 2012-13 school year in areas affected by the food/nutrition crisis has been conducted in N’Djamena, Abéché and Mao. Partnerships with the NGOs (ACRA, ADRA, and Lead Tchad) will be established to implement awareness raising campaigns to contribute to improving school-aged children enrolment in localities affected by the food/nutritional crisis and where IDPs, returnees and refugees live. Results of these reviews and assessments will supplement the previous evaluation undertaken and lead to responses, both for the immediate and medium terms as well as development activities in other UNICEF supported areas.

Education Cluster

 A cluster meeting was held on July 27 2012 where discussions have begun to explore ways of jointly holding bi-monthly meetings with the UNHCR coordination meeting.

3.7 Communication for Development (C4D)

 UNICEF trained 249 community health workers have been trained to promote cholera prevention activities in 6 high risk districts in the south regions and Lac Region  Celebration of the 20th world breastfeeding week during the first week of August 2012. Official launching ceremony held in Mao on August 1, 2012

 Communication for Development (C4D) Strategy for the integrated response to the nutrition crisis - Sahel belt of Chad has been developed by UNICEF and has been disseminated and discussed with the government and others partners for implementation

3.8 Nutrition supply and Logistics  UNICEF has strengthened the supply chain and procured two additional trucks to ensure timely supply of nutrition centers

UNICEF Input Meeting Needs 137,000 cartons of Ready-to-Use Therapeutic 127,000 cases of SAM for children 6-59 Food (RUTF) months 72,000 cartons of fortified nutrients supplements 200,000 children aged 6-23 months (Plumpy’doz) 280 pack-500 (Retinol 100,000UI and retinol 127,000 cases of SAM for children 6-59 20,000 UI) months 1,397 tabls-1000 Mebendazole 500 mg 127,000 cases of SAM for children 6-59 months

4. External Relations, Advocacy and Resource Mobilisation  Publication and dissemination of Press Kit for national media, press, radio, and television, on the Sahel crisis, “Emergency Response: the Nutrition Crisis in Chad”  Publication of press material focused on the new Nutrition survey results for international and national media, including video.  Preparation of UNICEF Good will ambassador from Spain in partnership with Spain Nat Com  Social Media: Weekly social media plan for Facebook, Twitter and YouTube to create awareness to the emergency situations in Chad, particularly for emergencies, i.e. Polio, Nutrition and Cholera.  Development of visibility materials and Media documents to portray support from donors: ECHO, Government of Japan, Australian Government., media and other partners.

5. Funding

Requirements as Funds Appeal Unmet requirements per HAU June Received to sector 2012 date Amount % Nutrition 25,200,000 17,577,847 7,622,153 30% Health 13,200,000 2,275,489 10,924,511 83% HIV 315,000 150000 165,000 52% WASH 6,400,000 1,496,570 4,903,430 77% C4D 2,000,000 212,580 1,787,420 89% Education 2,000,000 600,236 1,399,764 70% Protection 200,000 250,000 -50,000 -25% Emergency Coordination 2,685,000 1,864,090 820,910 & M&E 31% Total 52,000,000 24,426,812 27,573,188 53%

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, Japan Committee for UNICEF, Netherlands Committee for UNICEF, New Zealand Committee for UNICEF, UNICEF Belgium, UNICEF Bulgaria, UNICEF-Chile, United Kingdom Committee for UNICEF, United States Fund for UNICEF.

Date of next SitRep: 25 September 2012

For further information, please contact: Bruno Maes Marcel Ouattara Hector Calderon Guy Yogo Representative Deputy Communication Emergency UNICEF Chad Representative UNICEF Chad UNICEF Chad (+235) 66296060 UNICEF Chad (+235) 66360042 (+235) 66391014 [email protected] (+235) 66790096 [email protected] [email protected] [email protected]