Zimbabwe Humanitarian

Leon Muwoni Leon Situation Report #6 / / 30 June 2016

UNICEF 2016 UNICEF

© © SITUATION IN NUMBERS

Highlights 4 million  ’s food insecure population at the peak of the hunger People facing food and nutrition season has increased from to 2.8 to 4 million people based on the insecurity during the period January- preliminary results of the Zimbabwe Vulnerability Assessment March 2017 (ZimVAC, July 2016) (ZimVAC) of July 2016.This translates to approximately 42 per cent of rural households, representing a rise of 44 per cent compared to the lean season assessment results of February 2016. 2,468

2,468 children with SAM from 15  During the period January to May 2016 the total number of children drought affected districts admitted and under five admitted and treated for severe acute malnutrition (SAM) treated in CMAM program between under the community management of acute malnutrition programme (CMAM) in the fifteen most drought affected districts is 2,468. A total January - May 2016 (DHIS, June 2016) of 529 of these children were admitted in the month of May 2016. 1,485  In the month of May, UNICEF and partners responded to 7,707 new Cumulative typhoid cases, 74 laboratory child protection cases which were reported nationwide through the confirmed and 6 deaths reported national case management system. The drought affected districts accounted for most of the neglect, separated children, emotional (MoHCC, June 2016) abuse and child labor cases.

 Based on weekly epidemiological data, there was a marginal increase in new typhoid cases. To date, 1, 485 typhoid cases have been UNICEF Zimbabwe 2016 reported in the country, out of which 74 have been laboratory Humanitarian Requirements confirmed, with 6 typhoid related deaths reported. UNICEF is continuing its response to the typhoid outbreak with the provision of US $21.8 million Health and WASH services. Funding Gap 97% UNICEF UNICEF UNICEF’s Results with Partners 2016 Target Results Carry-forward WATER, SANITATION & HYGIENE Funds amount: # of people provided with access to safe water (7.5-15L per US$613,000 325,000 74,800 received: person per day) $47,000 HEALTH # of children with diarrheal diseases have access to life- Funding saving curative interventions, including oral rehydration 50,000 5,238 Requirement: therapy and zinc US$21.8 NUTRITION million # of children 6 to 59 months with SAM admitted to 14,711 2,468 community-based treatment programmes CHILD PROTECTION Funding gap: # of vulnerable children provided with child protection US$21.2 million 31,000 21,275 services

*Funds available includes funding received for the current appeal year as well as the carry-forward from the previous year.

Situation Overview & Humanitarian Needs The El Niño weather phenomenon’s negative impacts continue to affect vulnerable women and children in Zimbabwe, with the situation expected to worsen in the coming months. While the effects of the drought are already apparent the peak phase of this emergency is expected to start in October 2016 and last through to March 2017. Based on the preliminary results of the ZimVAC results of July 2016, approximately 42% of rural households, and over 4 million people will be food insecure during the peak of the hunger season running from January-March 2017. While the drought has impacted the entire country, the provinces of Manicaland, and Midlands are the most affected as shown in Figure 11.

Weather forecasts are predicting that there is a high chance (above 70%) that a La Niña event will occur by late 2016. For Southern Africa, La Niña is generally associated with above average rainfall during the period (December to March) particularly in the southern half of the region (although variability occurs). The prediction of La Niña implies an increased risk of floods in Zimbabwe especially in the flood prone areas. The drought affected, flood prone areas are at risk of other hazards and shocks namely flooding and disease outbreaks. In the month of May, the weekly surveillance data reported South to consistently report a high number of SAM cases each week as compared to the same period last year. Matabeleland North which has 6 out of 7 districts classified as drought emergency districts also reported an increase in the number of SAM cases. In terms of water availability across the country, the capacity of the dams as of 27 June 2016 is on average 51%, with Runde and Save catchments having below 50% of their full capacity (25% and 50% respectively). The total storage capacity is around 20% less than the historical average of the past 5 years (2011-2015).

Humanitarian leadership and coordination UNICEF and the Government continue to provide coordination and leadership for the water, sanitation and hygiene (WASH), nutrition and education sectors and the child protection sub-sector. UNICEF-led sectors supported the finalization of the SADC Appeal and the RIASCO regional El Niño Action Plan. A Humanitarian Country Team meeting was conducted in the Month of June, to discuss the current humanitarian interventions and areas of enhanced support. In the month of June, in collaboration with the Food and Nutrition Council (FNC), UNICEF provided support in the ZimVAC process, specifically focusing on data analysis and report writing. UNICEF and partners are currently conducting a Child Protection Rapid Assessment (CPRA) in selected urban areas and Growth Points in the country. The results of the Rapid Assessment are expected in the last week of July. In a bid to support sub-national WASH coordination, NGOs have been identified to assume a support role for the Provincial Water Supply and Sanitation Committees (PWSSC) through the WASH Sector Coordination and Information Management Forum and its Emergency Strategic Advisory Group.

Humanitarian Strategy As defined by the projects in the inter-agency humanitarian response plan and the UNICEF response plan, UNICEF is continuing to scale up its response interventions in additional food insecure districts. The scale up is being implemented through complementarity with ongoing development programmes in an effort to enhance sustainability and link humanitarian interventions with recovery and development programmes. UNICEF is working with the Government and NGOs to implement the current drought and typhoid response interventions.

1 ZimVAC,2016: Preliminary Assessment report, July 2016.

Summary Analysis of Programme response

Nutrition

Nutrition emergency programme interventions are primarily targeting 15 districts with high levels of food insecurity (above 40%) according to the Lean Season Assessment carried out in February 2016. In the month of May, health workers in district were trained on outpatient management of SAM and active screening bringing the total number of districts with trained health workers and community cadres on the emergency nutrition response to 5. Districts which have been trained include Binga, , Tsholotsho, Lupane and Kariba. A total of 529 SAM cases had been admitted in CMAM programme in the month of May 2016 in the 15 targeted districts. Buhera reported the highest number of cases, this is partly due to its size and active case finding interventions through the community cadres who were trained in active screening. The table below shows the breakdown by district of the number of children under 5 admitted for management of SAM in the 15 emergency districts.

Table 1: CMAM program coverage in 15 high risk districts from January to May 2016 (Source DHIS 2)

Total children admitted in the CMAM program No District Jan- April 2016 May Total 1 65 21 86 2 Umguza 63 17 80 3 Tsholotsho 181 27 208 4 Nkayi 96 27 123 5 Lupane 166 53 219 6 45 17 62 7 Binga 235 42 277 8 144 44 188 9 Gokwe North 91 48 139 10 Mudzi 79 21 100 11 Mbire 18 13 31 12 Buhera 604 133 737 13 Mwenezi 49 23 72 14 Kariba 45 11 56 15 Zvimba 58 32 90 Total 1,939 529 2,468

Figure 2 below shows the percentage of children cured by district in the 15 emergency districts. Three out of the fifteen districts managed to reach programme targets (> 75%) for cure rates according to the sphere standards in the month of May. The districts with alarming cure rates, that is, cure rates below (50%) include Umzingwane (45%), Umguza (12%), Hwange (45%), Zvishavane (20%), Gokwe North (47%), Mwenezi (38%) and Kariba (0%). The average cure rate for the 15 districts was at 59% which is below the acceptable standards.

Figure 2 : Percentage of children cured in the programme

100% 93% 90% 80% 75% 75% 79% 80% 64% 70% 59% 60% 54% 53% 45% 45% 47% 50% 38% 40% 30% 20% 20% 12% 10% 0% 0%

% CURED Sphere Standard

The programme interventions supported infant and young child (IYCF) in emergencies through establishing gender responsive IYCF support groups in the affected communities for exclusive breastfeeding during the first 6 months in four districts. The programme interventions reached out to 228 existing active community groups that were mobilized and sensitized on optimal infant feeding practices. A total of 10,245 (40 father baby pairs and 10,205 pregnant women and; mother and baby pairs) received counselling and support on optimal breastfeeding practices and the provision of age appropriate complementary foods. According to the LQUAS assessment implemented in April 2016 in 4 emergency districts, exclusive breastfeeding rates of children under the age of 6 months are as follows: 92% in ; 79% in Lupane district; 80 in ; and 76% in .

The average exclusive breast feeding rate in 4 priority districts were emergency programmes were implemented is now at 82% which is above the planned target of 60%. Data on the proportion of children 6-8 months receiving solids and semi- solid foods was not collected. The data collection tool for LQUAS captured complementary feeding data on consumption of a minimum acceptable diet for children aged 6 to 23 months instead. According to the LQUAS assessment the proportion of children 6 to 23 months consuming the minimum acceptable diet is as follows: 55% in Tsholotsho district; 34% in Lupane district; 52% in Binga district; and 42% in Buhera district.

The average proportion of children 6-8 months receiving solids and semi-solid foods in all 4 priority districts is at 46%.

WASH

The WASH sector continued the implementation of WASH emergency response interventions in most at risk areas, however the main limitation cited by WASH partners, including UNICEF, in expanding the geographical coverage of the response interventions is the lack of funding. Using the resources from the Emergency Programme Funds (EPF), UNICEF expanded the implementation of WASH related interventions in two additional districts, that is, Zvishavane () and Mwenezi (). These interventions aim to rehabilitate 78 boreholes to re-establish the access to water for 19,500 people and the distribution of non-food item (NFI) kits to 2,500 most vulnerable families.

Education

The Ministry of Primary and Secondary Education (MoPSE) started the implementation of the school feeding programme in selected high risk districts in the month of June targeting infants (early childhood development & Grade 1&2). With the availability resources MoPSE aims to scale up the school feeding programme to all districts in the country and reach all primary school children using a two-pronged approach focused on emergency school feeding and the development of a long term home-grown school feeding programme. Monitoring visits conducted in food insecure districts in 3 provinces, - Manicaland, Mashonaland West and Matabeleland South - indicate that the drought situation is worsening and its negative impacts on children’s education is increasing. In districts such as , most families are resorting to eating one meal a day which is negatively impacting the participation of children in class. School drop outs were reported to have increased in some schools.

Health

The cumulative cases for typhoid nationwide are 1,485 suspected cases, 74 confirmed cases and 6 deaths, with the epicentre of the outbreak being City. There has been a marked reduction in the number of typhoid cases as shown in Figure 3 due to regular health and WASH interventions. Early case detection, case management and early health seeking behaviours have also contributed to a very low case fatality rate.

Typhoid Cases, Zimbabwe ,2016 200 180 160 140 120 100

Cases 80 2016 60 Linear (2016) 40 20 0 1 3 5 7 9 11 13 15 17 19 21 23 25 Weeks

Figure 3: Typhoid Trends

Incidences of clinical dysentery continue to be reported throughout the country although outbreak threshold levels have not been reached. Manicaland and Mashonaland Central have dysentery incidence rates of 0.1 per 1000 people and in the rest of the country incidence is less than 0.1/1,000 people. The cumulative total for clinical dysentery nationwide is 21,575 with a case fatality rate of 0.18. Continued disease surveillance is being done in drought affected districts and to date, no new outbreaks of communicable diseases and diarrhoea have been reported.

HIV and AIDS

Information from the most drought affected districts is not showing a significant increase in cases lost to follow up however, Buhera, which has the highest food insecurity prevalence in the country based on the Lean Season Assessment of February, 2016 is still showing a higher number of cases lost to follow up followed by . The Ministry of Health and Child Care (MoHCC) is validating the data on lost to follow up using data from the Electronic Patient Monitoring System (EPMS) in comparison with information from the Demographic Health Information system DHIS-2. The programme is strengthening the integration of HIV and nutrition interventions as HIV remains one of the key underlying causes of malnutrition. The revised nutrition protocols clearly indicate that all malnourished children have to be tested for HIV. MoHCC is strengthening provider initiated testing counselling in health facilities targeting key entry points including malnutrition sites, to identify malnourished children that are HIV positive and linking them to ART early. In coordination with other implementing partners, the programme is continuing its advocacy for supplementary food to be provided to clients on HIV treatment.

Child Protection

In the month of May, UNICEF and partners responded to 7,707 new child protection cases which were reported nationwide through the national case management system. This is a significant increase from 3,042 child protection cases reported in April 2016, children are increasingly becoming vulnerable to protection risks as an effect of the drought situation. The drought affected districts accounted for most of the neglect, separated children, emotional abuse and child labor as shown in Figure 4 below.

Highest CP violations Reported May 2016 2500 2000 1500 1000

500 Number Number of cases 0 Neglect Sexual Physical Emotional Child Seperated Abuse Abuse Abuse Labour Children Type of CP Violation

Figure 4: CP violations reported in May 2016

UNICEF continues to work on strengthening coordination of the emergency response, strengthening situation monitoring and sensitizing government actors responsible for disaster management and response as well as civil society on the child protection risks that children are facing due to drought. UNICEF together with partners, started the Urban Child Protection Rapid Assessment. So far the assessment has been done in one urban site of Epworth, five more high density population areas in the drought affected districts will also be assessed with the aim of identifying child protection concerns as a result of the drought. UNICEF has provided technical assistance and training for the data collectors. The findings of the assessment will be the basis for implementing an appropriate response to the situation. UNICEF, the Government and NGOs are continuing their efforts to protect the most vulnerable children, particularly girls, from violence, abuse and exploitation, and are working to strengthen the capacity of child protection systems to provide timely and appropriate response. So far, UNICEF and partners have been able to support 21,275 children with child protection services.

Communication for Development (C4D)

UNICEF continues to support WASH partners with the provision of diarrhoeal prevention information, education and communication (IEC) materials for use in urban areas that are at risk to typhoid. Community volunteers who were trained on conducting hygiene promotion interventions in Harare and drought affected areas continue to provide health and hygiene information in their communities. In its work around ending child marriages UNICEF is supporting partners in messages and materials development – the focus being messages and participatory community dialogues that encourage families not to exchange their daughters for alleviating hunger and poverty but rather engaging families to find alternative livelihoods support.

Supply and Logistics

The WASH sector has replenished its contingency stock for hygiene kits and borehole rehabilitation materials. National distribution of 10,000 cartoons of ready-to-use therapeutic food (RUTF) started in the month of June. Most provinces have a small contingency stock of CMV for the preparation of F75 and F100 from local ingredients whilst awaiting distribution of the national supply tins. The therapeutic milk (F75 and F100) are expected in the month of July 2016.

Province Total RUTF Distributed Distributed RUTF RUTF in RUTF GAP NEEDS 1st Quarter 2nd GAP Pipeline (OCT - Quarter (expected DEC 2016) Sept 2016) Manicaland 2,852 797 1,322 733 733 0 Mash Cent 1,853 566 548 739 739 0 Mash East 5,170 811 1,319 3,040 1,142 1,898 Mash West 4,269 738 1,228 2,303 1,142 1,161 Mat North 3,814 577 753 2,484 1,142 1,342 Mat South 782 366 383 33 33 0 Midlands 5,268 865 1,042 3,361 1,142 2,219 Masvingo 4,865 767 1,097 3,001 1,144 1,857 Harare 1,394 311 382 701 701 0 1,775 758 434 583 583 0 699 0 200 499 499 0 National 32,739 6,556 8,708 17,475 9,000 8,475

Funding

UNICEF requires a total of US$ 21,812,946 to meet the increased humanitarian needs of children in Zimbabwe. UNICEF aims to respond to the protracted drought with critical health, nutrition, HIV/ AIDS, WASH, education and child protection services. If funded, interventions will focus on supporting vulnerable and disadvantaged women and children to withstand, adapt to, and recover from emergencies. UNICEF is grateful to donors that have supported the ongoing response and its regular development programmes that are contributing to resilience building.

UNICEF Zimbabwe Funding Requirements (as defined in Humanitarian Appeal for 2016)

Requirements Funds available* Funding gap Appeal Sector

$ % WASH 6,700,000 420,600 6,652,960 93% Education 3,388,000 88,388 3,388,000 97% Health 2,390,200 0 2,390,200 100% Nutrition 3,727,946 53,172 3,727,946 99% Child Protection 880,000 34,276 880,000 99% Social Protection 4,500,000 0 4,500,000 100% HIV/AIDS 226,800 0 226,800 100% Sector Coordination** 17,804 Total 21,812,946 660,401 21,152,545 97% *Funds available includes funding received against current appeal as well as carry-forward from the previous year. **Sector coordination Funding Requirements have been dispersed within each sector.

Next SitRep: 30 July 2016

UNICEF Zimbabwe Humanitarian Action for Children Appeal: www.unicef.org/appeals/zimbabwe UNICEF Zimbabwe Facebook: https://www.facebook.com/www.harareunicef.co.zw/ UNICEF Zimbabwe Twitter: https://twitter.com/unicefzimbabwe

Who to Dr.Jane Muita Peter De-Vries Victor Chinyama OIC-Representative OIC-Deputy Representative Chief of Communication contact for Zimbabwe Zimbabwe Zimbabwe further Tel: +263 4 703941-2 Tel: +263 4 703941-2 Tel: +263 4 703941-2 Fax: +263 4 791163 Fax: +263 4 791163 Fax: +263 4 791163 information: Email: [email protected] Email: [email protected] Email: [email protected]

SUMMARY OF PROGRAMME RESULTS

2016 Sector 2016 UNICEF Response Response UNICEF Zimbabwe Results Table 2016 Target Total Target Total Results Results WATER, SANITATION & HYGIENE # of people provided with access to safe water (7.5-15L per 853,000 74,800 325,000 74,800 person per day) # of people provided with critical WASH related information to 1,415,000 103,000 400,000 103,000 prevent child illness, especially diarrhoea HEALTH # of children with diarrheal diseases have access to life-saving curative interventions, including oral rehydration therapy and 50,000 5,238 zinc # of children 6-59 months vaccinated for measles* 347,800 # of people reached with key health promotional messages* 1,302,000 NUTRITION # of children 6 to 59 months with SAM admitted to community- 18,388 14,711 2,468 based treatment programmes # of children aged 6 to 59 months receive vitamin A 300,064 240,051 57,071 supplementation CHILD PROTECTION # of vulnerable children provided with child protection services 31,000 21,275 SOCIAL PROTECTION # of vulnerable families benefiting from social cash transfers* 73,000 EDUCATION # of school-aged children, including adolescents with access to 150,000 quality education* HIV and AIDS # of children, adolescents and pregnant and lactating mothers 13,200 retained on HIV treatment* *These activities are pending funding.