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 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. 2 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 3 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. 4 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. 5 . 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.