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 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). 2 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 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.