AA SS SS EE SS SS MM EE NN TT RR EE PP OO RR TT Clearing of site for returning refugees from Chad, Moyenne Sido, 18 Feb. 2008 Moyenne Sido Sous-Prefecture, Ouham 17 – 19 February 2008 Contents 1. Introduction & Context………………………………………………………………. 2. Participants & Itinerary ……………………………………………………………... 3. Key Findings …………………………………………………. ……………………. 4. Assessment Methodology………………………………………………………..... 5. Sectoral Findings: NFI’s, Health & Nutrition, WASH, Protection, Education ………………………. 6. Recommendations & Proposed Response…………. …………….................... 2 Introduction & Context The sous prefecture of Moyenne Sido came into creation in March 2007, making it the newest sous- prefecture in the country. As a result, it has a little civil structure and has not received any major investment from the governmental level, and currently there is only the Mayor who is struggling to meet the needs of both the returnees and the host population, the latter is estimated at 17,000 persons. During the course of the visit, he was followed by several groups of elderly men (heads of families) who were requesting food from him, or any other form of assistance. The Mayor was distressed that neither the governmental authorities nor humanitarian agencies have yet been able to provide him with advice or assistance. The returnees are mainly Central African Republic citizens who fled to southern Chad after the coup in 2003. Since then, they have been residing at Yarounga refugee camp in Chad. Nine months ago, they received seeds from an NGO called Africa Concern, which they were supposed to plant and therefore be able to provide food for themselves. However, the returnees have consistently stated that the land they were set aside for farming was dry and arid, and they were unable to grow their crops there. They have stated they did not receive WFP food rations for approximately nine months, and so hunger has driven them back across the border into CAR. Since arriving in CAR over the past two months, most have stayed in Moyenne Sido with the local population. However, the situation has now become strained; the host community are struggling to provide even for themselves. The mayor has taken the decision to “seize” some farming land, and clear it for the use of the returnees(housing). When the mission visit, the clearing of the site was ongoing and it was being divided up into 20m x 15m sites for each family, and the families were working to dig out the allotments. No farming land has been allocated. The organisation of this exercise is being carried out by the local Croix Rouge. Returnees in Moyenne Sido Security context: 3 Although no Coupeur de Route or banditry activities were reported in the location of Moyenne Sido, there were some incidents noted in the preceding weeks on the areas of Batangafo and Kabo as detailed below: 19 January 2008: Bogono, (Batangafo – Ouandago axe) – village looted 24 January 2008 : Kabo – Batangafo axe at Moissala, CDR attack 05 February 2008: Bogono, (Batangafo – Ouandago axe) – village looted Note that MSF do not go to these two locations due to insecurity in the area. The acting Gendarmerie commandant of Moyenne Sido, informed us there are about 67 rebels with their local gun manufacturers who are in the bush some 30 km from Sido. They wish to have some assistance to farm and abandon their rebelled activities. Participants & Itinerary - Dr. Kuotong Rogers, Techn.Off. EHA/HAC Chef de Sous Bureau OMS Bossangoa - Ettie Higgins, Chef de Sous Bureau, UNICEF Bossangoa - Anicet Demaldo, Community Development Officer, UNICEF Bossangoa Itinerary of Assessment mission Day One: Sunday, 17th February 2008 Route: Bossangoa, east through to Batangafo (Bac is functioning) Day Two: Monday, 18th February 2008 Route: Batangafo north to Kabo, Kabo to Moyenne Sido (return to Kabo) Day Three: Tuesday, 19th February 2008 Route: Kabo – Batangafo – Bouca – Bangui. Key Findings Central African returnees from Chad have begun to spontaneously return in the past two months from UNHCR supported refugee camps in Southern Chad (Yaroungo camp). The local Croix Rouge has registered almost 14,500 returnees; however, this assessment mission estimates the total figure to be closer to 2,000 returnees. The returnees this mission interviewed do not have any registration papers and stated they were confiscated in Chad. Most the returnees are being hosted by the local population, but are now however under pressure to find alternate housing. The main source of food is foraging for wild food in the bush, collecting firewood and producing charcoal to sale and buy food. The only sources of water are some open wells and two functioning hand-pumps in Sido town. Only 50 of the returnee’s children are attending school, since the local public school is under resourced and already full, and unable to accept any more children. The health and nutritional status of both the returnees and the local population is poor, with a prevalence of malaria, diarrhoea, ARI, skin diseases and conjunctivitis. The local authorities are unable to cope with the situation in Moyenne Sido, the central government has provided no support, and there has been no cross-border liaison or communication with the Chadian authorities or camp coordinators. As a result, the mayor of the town is under a huge amount of strain to provide for the community (both host population and returnees). (In the interviews carried out, there was no indication or incidents reported of intimidation by Chadian or CAR authorities, nor were any of the returnee’s attacked while making the 4 journey from across the border into CAR). There was no case of GBV reported to the mission. Assessment Methodology The team consisted of 2 staff from UNICEF Bossangoa and 1 staff (Technical Officer Chef de) from WHO Sub Office Bossangoa. The assessment was conducted by a combination of interviews, focus group discussions and first hand observation. The local community leaders and the Mayor of Moyenne Sido were the entry points for discussion. Separate groups of women and men were also met in Moyenne Sido to determine their most urgent needs and assess their living conditions. Clearing site for returnees, Moyenne Sido Sectoral Findings NFI’s The team spoke to several dozen returnees, and while people have been able to bring some items with them from Chad, it was only what they could carry. No livestock or donkeys were seen in Moyenne Sido, nor were there many farming tools. The most urgent need identified therefore was for shelter. Some of the population was living out in the open under trees (only thought to be a small number of families) while the others have been staying with host families. 5 Therefore, based on the analysis of the assessment team, and based on first hand observations, the most urgent needs identified were for the following items: 1. Shelter (i.e. Plastic Sheeting) 2. Blankets 3. Mosquito nets 4. Mats 5. Jerry cans 6. Kitchen sets 7. Soap Health & Nutrition The health condition outside the areas of coverage of MSF-Belgium/Spain activities in the extreme east of Ouham Health District is very poor. Moyenne Sido: The general health situation of the Sous-Prefecture prior to the arrival of the returnees was inadequate (a heath post of 5 rooms and a terrace, staffed by an auxiliary nurse and a pharmacy clerk). However, what is required in this area is a health Centre to serve the 17,000 inhabitants (projections from the 2003 census). Returnee women and children, Moyenne Sido 6 The arrival of returnees has increased the caseload massively and put an extra strain on the already limited resources. The auxiliary nurse was ill and the mission could only interview the pharmacy clerk. The health unit is understaffed. It has not received drugs since March 2007(patients consult and go to the market or Chad to buy their drugs with the prescription, and these drugs are frequently of very poor quality). Most of the equipment is in a bad state or not sterile (on the three available scales, only the infants Salter scale with pants was functional, there is an old microscope in a box, all the surgical instruments were dirty as well as the midwife delivery kit box, and sterilising equipment was absent). Universal precaution is also insufficiently applied. The utilization rate is very low and 25-30% of patients come from Chad. Most of the patients are women. EPI activities are sporadic and mostly associated with the campaigns; the refrigerator has not been functioning for 6 months and has not yet been repaired. The Poste de Santé has only one locally made bed which serves as delivery bed. There is neither observation bed nor room. The table below shows the frequency of most prevailing diseases diagnosed at the health post from December through February as well as some of the activities. Diseases or December January February(1-18) activities OPD Total 49 46 11 consultations 1 Malaria 6 7 1 2 Diarrhoea 7 6 1 3 ARI 7 5 2 4 Peptic ulcer 2 5 0 disease 5 STI & PID 6 3 1 6 Dental carries 2 5 1 7 Skin diseases 2 1 1 8 Trauma and 2 2 0 wounds 9 Worms 1 1 0 10 Abortion 0 1 2 11 Puerperal 1 1 0 infections 12 Measles 1 1 0 13 Malnutrition & 1 0 1 anaemia ANC Number of 9( with 1 2 7 consultations aged 16 years) DELIVERIES Number of 7 6 0 deliveries The only disease of epidemiologic potential the mission found in the register was measles in December 2007 and January 2008. The minimum Initial Service Package is not available and even condoms for demonstration on how to properly use it and individual kits for deliveries. This health post is insufficiently supervised by the health district team for security reasons.