Briefing Note – 20thMarch 2014 Nutrition, Food Security and Livelihood Emergency Tharparkar District, Sindh Province- Pakistan Nutritional Situation The national nutrition survey 2011 results for Sindh province1 indicated a very high rate of acute malnutrition (Global acute malnutrition rate-GAM of 17.5% and severe acute malnutrition rate – SAM of 6.6%) which is above emergency threshold of 15%. Analysis of the 2013 Routine programme data from nutrition information system also indicated very high acute malnutrition rate in 10 districts of Sindh with the one of the highest rates noted in drought affected Tharparkar district (GAM of 21% and SAM of 5%). The neighbouring districts of Tharparkar like Umerkot and Sanhgar also exhibited very high rates of acute malnutrition (GAM of 30% & 25 % respectively). In early March 2014, rising numbers of clinical admissions and child mortality due to malnutrition were reported anecdotally, but not confirmed by credible records. Rapid assessment was conducted by UNICEF and WFP from 10th – 14th March 2013 to get a quick snapshot of the The compromised livelihood situation2. 1,460 children were screened for malnutrition in situation, due to a combination Mitho Bhatti, Mithi, Malanharo Veena, Bhakou, Joruo, of factors including low level Dabhro and Khetlariunion councils of Mithi and Diplo Talukas monsoon rains in 2013 and its of Tharparkar districts and the GAM rate was 17% and SAM impact on food stocks and the livestock situation, together 6%. The malnutrition situation was aggravated by the with poor sanitary and hygiene deterioration of household food insecurity according to the facilities, limited availability of results of the rapid assessment. The outbreak of the sheep clean drinking water, limited and goat pox disease coupled with scarcity of feed access to health care services threatened the survival of more than 4.5 million animals in and likelihood of epidemics can affected areas, which is the main source of livelihood. deteriorate the nutritional situation further, rise in morbidity and mortality will be Hazard Livelihood, Vulnerability Baseline and Contingency the consequence. plan 2009 3states that the economy of Tharparkar is mainly rural and livelihoods are heavily dependent upon livestock and rain fed agriculture. Lack of food, fodder and water contributes towards malnutrition, disease and animal losses”. In low rainfall and crop failures, the only source of the livelihood remains livestock. Usually people sell their livestock in such conditions to meet their household needs, food and health, etc. The outbreak of sheep pox epidemic in small ruminants, is wiping their flocks rapidly which will create severe disaster situation in coming days if the root causes are not addressed properly. 1http://pakresponse.info/LinkClick.aspx?fileticket=Ao4s-rwdFVI%3D&tabid=117&mid=752 2 A QUICK SNAPSHOT OF SITUATION IN DISTRICT THARPARKAR By Nutrition Working Group - March 10th to 13th 2014. 3http://www.fao.org.pk/news/12/hlv_reports/tharparkar_baseline_report_final.pdf 1 Currently the livestock department is providing the veterinary care services with limited resources. The department is urgently looking for external help to protect the invaluable livestock in affected areas. The provision of vaccines, antibiotics, drenching and concentrated feed in time is critical; otherwise it will create long term food insecurity. The Food Security working group is closely monitoring the situation and coordinating with the local authorities, UN and NGO partners for the integrated approach in the response. There is limited availability of clean drinking water sources in many of the rural settings in Tharparkar. Communal wells more than 100 meters deep, are the main drinking water source. During the field assessment it was found that water sources are exposed and animals have direct access to same water source from which the population gets the water for drinking and there is little knowledge about water purification. Serious concerns remain in regard to the food and nutrition security situation in districts other than Tharparkar, including Sanghar, Umerkot and Badin, where over 200,000 people are affected according to the Provincial Disaster Management Authority for Sindh. Nutrition response initiated Nutrition response: The UN and NGO nutrition partners, are already Target: expansion of life saving nutrition implementing nutrition interventions in Tharparkar interventions covering all UCs (44 UCs) by since 2011.However, given the magnitude of the end of March 2014. nutritional problems and aggravating factors, plans have been prepared to scale up nutrition Progress: interventions significantly in the district. - WFP and UNICEF agreements in place with HANDs for 20 UCs. Interventions To date UN and partners have already responded- have already started. • UNICEF has established 20 OTP sites in 20 UCs of - A joint agreement between MERLIN, Taluka Diplo and Mithi where32552 (14% of WFP and UNICEF is under finalisation total population) children will be screened and (covering 17 UCs). 3,760 (6.6%) expected severely acute malnourished children will be provided with - A joint agreement between treatment. WFP will support targeted Provincial nutrition cell Government supplementary feeding centres (TSFP) in the of Sindh, WFP and UNICEF is under same locations where treatment will be preparation for remaining 7 UCs provided for 6, 197 children with moderate - Nutrition stabilization centre at acute malnutrition and 5,685 malnourished district hospital supported by WHO pregnant and lactating women. (increasing capacity is under • A blanket supplementary feeding is committed preparation). by WFP for an estimated 40,000 children and 20,000pregnant and lactating women for one month. iThis distribution will be initiated at hotspot areas of Diplo and Mithi where CMAM program is already operational through local partner HANDS. • WHO has provided 10 more beds and human resource for already supported stabilization center to enhance the capacity and to cope with high number of patients from regular hospital OPD and referrals from OTPs. WHO has also provided extra medicine kit to the stabilization center in Mithi with similar support to stabilization centers in UmerKot and Sanghar districts. 2 • Merlin has an already established TSFP program, supported by WFP in 6 UCs of Tharparkar , and is actively providing services to moderately acute malnourished children.Currently 1,687 children are enrolled in the program, IYCF counselling to mothers is also the strong part of intervention. • SECOURS ISLAMIQUE FRANCE- SIF was based in Tharparkar district implementing an 8 months WASH project in 2 UCs for the promotion of Rain Water Harvesting. After a rapid assessment in those UCs,currently, SIF is preparing to distribute 1500 family food packs containing 1 month ration supplies in UC Chelhar and Jurio. • Muslim Hands- is launching a relief package for 800 house hold in Taluka Chachro- which will include food items distribution and provision of clean drinking water. After an assessmen,t MH will propose a comprehensive program. Scaling up lifesaving nutrition interventions comprising various components of Community Management of Acute Malnutrition (CMAM) will be implemented jointly by the UN nutrition partners such as WFP, WHO, UNICEF and I/NGOS, under the stewardship of the Government. The response includes the following components: community mobilization, including screening of children and pregnant and lactating women for acute malnutrition, promotion and protection of breast feeding, promotion of infant and young child feeding practices, de-worming, provision of multi-micro-nutrients for children and pregnant and lactating women, preventive blanket supplementary feeding for children under 5 and pregnant and lactating women in selected UCs, community based treatment of severe and moderate acute malnutrition (Out Patient Therapeutic Programme-OTP, and Targeted Supplementary Feeding programme TSFP), referral and treatment of acutely malnourished children with medical complications to stabilization centers (SC). The scale up of the Tharparkar response aims to cover all 44 UCs to be reached by the end of March 2014 (more details, please see table below): • 2 Talukas (Diplo and Mithi, 20 UCs, HANDS as partner) have already started to increase the coverage of nutrition emergency response. • 1 Taluka (Chachro, 17 UCs, and MERLIN as partner): agreement is under finalization, intervention to start by the end of March. • 1 Taluka (Nagarparkar-7 UCS. provincial nutrition cell as potential partner through DoH counterpart) is in preparation. • WFP is planning to support a preventive blanket supplementary feeding, selection of beneficiaries will be based on high priority UCs identified through screening data of CMAM partner NGOs. Priority UCs are currently being identified and intervention to start by the end of March. Immediate Actions: a) An initial rapid nutrition assessment conducted, report available (Results: nutrition situation critical due to worsening of the food security and livestock situation, together with limited access to drinking water, limited health care capacities are adding to the deterioration). b) Immediate response options and partners for life saving nutrition response have been identified (HANDS, MERLIN, and Provincial Nutrition Cell(DOH)). Immediate implementation in Taluka Diplo and Mithi: c) Ready to Use Therapeutic and Supplementary Foods and other essential nutrition supply items have beensent to the locations through