VZCZCXRO9286
PP RUEHMA RUEHROV
DE RUEHKH #1851/01 2151216
ZNR UUUUU ZZH
P 031216Z AUG 06
FM AMEMBASSY KHARTOUM
TO RUEHC/SECSTATE WASHDC PRIORITY 3998
INFO RUCNFUR/DARFUR COLLECTIVE PRIORITY
RUEHRN/USMISSION UN ROME

UNCLAS SECTION 01 OF 03 KHARTOUM 001851 
 
SIPDIS 
 
AIDAC 
SIPDIS 
 
STATE FOR AF/SPG, PRM, AND ALSO PASS USAID/W 
USAID FOR DCHA SUDAN TEAM, AFR/SP 
NAIROBI FOR USAID/DCHA/OFDA, USAID/REDSO, AND FAS 
GENEVA FOR NKYLOH 
NAIROBI FOR SFO 
NSC FOR JBRAUSE, NSC/AFRICA FOR TSHORTLEY 
USUN FOR TMALY 
BRUSSELS FOR PLERNER 
 
E.O. 12958:  N/A 
TAGS: EAID PREF PGOV PHUM SOCI SU
SUBJECT:  SUDAN Q DARFUR NUTRITION ASSESSMENT 
 
KHARTOUM 00001851  001.2 OF 003 
 
 
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Summary 
------- 
 
¶1.  From July 17 to July 25, a USAID Office of U.S. 
Foreign Disaster Assistance (OFDA) Public Health and 
Nutrition Advisor traveled through North and South 
Darfur to assess the nutrition situation and monitor 
USAID/OFDA-funded nutrition programs.  Factors that are 
contributing to the worsening nutrition situation in 
Darfur include a precarious security situation that has 
limited humanitarian access to affected areas, 
continuous large-scale population displacements, 
decreased funding that has led to a reduction in 
nutrition interventions, and eroding technical capacity. 
Recent gains in nutrition including the USAID/OFDA- 
funded U.N. ChildrenQs Fund (UNICEF) Nutrition 
Surveillance System and other U.N. and non-governmental 
organization (NGO) nutrition activities are being 
critically threatened by dwindling donor funding. 
Without improvements in security and an increase in 
funding, implementing partners may be forced to down- 
size or phase out nutrition programs.  Feeding centers 
are closing down, and there are almost half the numbers 
of centers operating in Darfur now as there were at this 
time last year.  While the reduction in feeding centers 
occurs, the admissions rate of malnourished children to 
feeding centers is increasing, causing a heavier burden 
on the few centers that remain open.  The Sudanese 
government is incapable of sustaining these centers due 
to inadequate human resources and budgetary constraints. 
Donor support to a multi-sectoral approach, with a sharp 
focus on health care access, child care practices, water 
and sanitation, food security, and livelihood programs 
is urgently needed.  End summary. 
 
------------------------------ 
Locations Visited and Contacts 
------------------------------ 
 
¶2.  From July 17 to July 25, a USAID/OFDA Public Health 
and Nutrition Advisor traveled through North and South 
Darfur to assess the nutrition situation and monitor 
USAID/OFDA-funded nutrition programs in Darfur.  While 
in Khartoum, the Health and Nutrition Advisor met with 
the Darfur Field Office (DFO) team and representatives 
from the U.N. ChildrenQs Fund (UNICEF), the U.N. World 
Food Program (WFP), the U.N. World Health Organization 
(WHO), Save the Children/US (SC/US), Action Contre la 
Faim (ACF), and Tearfund. 
 
¶3.  In Darfur, the Advisor met with representatives from 
the State Ministries of Health (MOH), UNICEF, WHO, the 
U.N. Food and Agriculture Organization (FAO), WFP, 
Relief International (RI), the International Rescue 
Committee (IRC), ACF, CHF, Medecins sans 
Frontieres/Belgium (MSF/B), and MSF/Holland.  The 
Advisor visited several internally displaced persons 
(IDP) camps including Al Salaam, Abu Shouk, and Zam Zam 
camps in North Darfur and Kalma camp in South Darfur. 
Due to the existing volatile insecurity situation, the 
entire state of West Darfur and rural sites in North and 
South Darfur were excluded. 
 
------------ 
Surveillance 
------------ 
 
¶4.  UNICEFQs operational nutrition surveillance system 
funded by USAID/OFDA, and launched by UNICEF in December 
2005, is managed by a full-time international staffmember who is responsible for publishing a bi-monthly 
bulletin titled QDarfur Nutrition Update.Q  The 
nutrition surveillance system collects information from 
12 selected sentinel sites in each of the 3 Darfur 
states.  These sites represent IDP camps and surrounding 
host populations in villages and provide information on 
a monthly basis.  Periodic nutrition surveys are 
conducted by the Sudanese government, NGOs, and U.N. 
agencies.  Feeding center data is incorporated, as well 
as food security information from FAO and WHOQs disease 
outbreaks detection system. 
 
KHARTOUM 00001851  002.2 OF 003 
 
 
 
¶5.  WHO reports that its Early Warning and Alert 
Response System (EWARS) for disease outbreaks detection 
in IDP camps in Darfur is expanding in scope to include 
a surveillance system that will better cover local/host 
populations.  Meanwhile, neglected areas, especially 
those that are inaccessible due to insecurity, continue 
to remain a challenge for data collection.  The EWARS is 
linked to UNICEFQs nutrition surveillance through health 
disease statistics and sentinel sites data collation. 
Severe malnutrition is diagnosed in IDP health 
facilities through consultations using the weight for 
height (W/H), middle upper arm circumference (MUAC), and 
integrated management of childhood illnesses (IMCI) 
guidelines. 
 
-------------- 
Trend Analysis 
-------------- 
 
¶6.  Results of the 2005 Darfur Emergency Food Security 
and Nutrition Assessment conducted in September 2005 by 
UNICEF, WFP, FAO, and the Sudanese government, with 
technical support from the Centers for Disease Control 
and Prevention (CDC), indicates an improvement in the 
Darfur nutrition situation and attributes the overall 
decrease in malnutrition rates to the improvement in 
food supply, decrease in disease outbreaks, and 
functioning nutrition surveillance system. 
 
¶7.  Darfur is currently in the hunger gap season (April- 
August) when families have exhausted all or most of 
their food reserves, and the prevalence of acute 
malnutrition is high.  Coverage by NGOs and U.N. 
agencies was quite good, as depicted in the 2005 
results, until these agencies commenced a reduction in 
nutrition interventions as a result of reduced funding 
and insecurity.  WFPQs reduction of rations by between 
15 to 50 percent has further compounded the situation. 
The number of feeding centers in Darfur is half what 
existed during this same period in 2005.  Admission 
rates, although increasing, are still lower than they 
were during this same period last year.  The current low 
admissions number as compared to the higher admissions 
rate during 2005 could be directly related to the 
current low nutrition program coverage among IDPs and 
host populations.  According to surveys conducted and 
data from sentinel sites, there are indications that the 
Darfur nutrition situation is sporadically deteriorating 
in pockets throughout the three Darfur states. 
 
--------------------------------------------- --------- 
Supplementary & Therapeutic Feeding Centers (SFC, TFC) 
--------------------------------------------- --------- 
 
¶8.  Reports indicate the number of TFC and SFC 
admissions in the three Darfur states in 2006 doubled 
from 2005, with May, June, and July seeing a continuous 
increase in admissions.  The increase can be attributed 
partly to acute watery diarrhea (AWD), the arrival of 
new IDPs in camps from insecure areas, and the seasonal 
malnutrition that was seen in 2004 and 2005.  For 
example, an outbreak of AWD and the large numbers of 
unregistered IDPs with no food support in Ed Daein 
caused admissions at the TFC to increase from 20 to 100 
within a five-day period.  Also, children with AWD in 
both Kalma and Gereida IDP camps largely accounted for 
the increase in severe malnutrition among new 
admissions. 
 
¶9.  In Zam Zam camp in North Darfur, an NGO recently 
phased out its nutrition activities.  Malnutrition cases 
have been on the increase and are being referred to the 
Sudanese governmentQs TFC in El Fasher town.  It is 
apparent that the Sudanese government has no capacity to 
absorb the increasing numbers of cases.  Combined 
defaulter TFC and SFC rates in Darfur were higher in 
June and July.  With sharp increases in admissions, NGOs 
phasing out programs partly because of declining 
funding, and escalating insecurity, coupled with only 
approximately 50 percent of TFCs and SFCs remaining 
operational, the strain becomes heavier on the few 
 
KHARTOUM 00001851  003.2 OF 003 
 
 
centers that have to care for more beneficiaries. 
 
------------------ 
Technical Capacity 
------------------ 
 
¶10.  The MOH is also experiencing a high turnover of 
staff and is hampered by budgetary constraints.  UNICEF 
is working with the MOH to build technical capacity in 
nutrition mainly through training workshops.  In recent 
months, there has been an exodus of trained 
nutritionists from nutrition programs operated by NGOs. 
This is due in part to the prevailing insecurity 
surrounding areas where nutrition programs are hosted, 
cuts in funding which offer trained nutritionists no job 
security, burn-out rates, and the general perception 
that trained nutritionists are not valued.  Similarly, 
community mobilizers, a valuable part of the nutrition 
team who implement community-based activities, are 
usually among the first to be relieved of their 
positions when funding is reduced and agencies downsize. 
 
-------------- 
Sustainability 
-------------- 
 
¶11.  Through training workshops on the prevention and 
management of malnutrition, UNICEF is enabling staff to 
eventually assume responsibilities for feeding centers. 
Positions for hygiene promoters and community 
mobilizers, who are already placed in the community and 
could fill in the gaps if and when NGOs and U.N. 
agencies leave, are drastically reduced as NGOsQ funding 
diminishes.  According to WHO, the MOH is in a much 
better management position than it was a year ago, but 
financially, there would be difficulties if WHO was 
forced to phase out due to security or funding reasons. 
WHO brings medical specialists as consultants from other 
areas to fill staff gaps. 
 
¶12.  According to the USAID/OFDA Advisor, based upon 
conversations with various contacts, once NGOs leave 
Darfur, the TFCs may drop considerably, especially if 
IDPs are still in camps.  Also, rural populations will 
drastically be affected, and morbidity and mortality 
rates will increase.  By preparing more community 
mobilizers and strategically placing them among the 
population, the sustainability battle may be won. 
 
------------ 
Conclusions 
------------ 
 
¶13.  The USAID/OFDA Public Health and Nutrition Advisor 
offers the following recommendations based upon the 
assessments in South and North Darfur: 
 
a)  Provide funding priorities to nutrition programs 
implementing a multi-sectoral approach that focus on the 
integration of health, child care practices, water, 
sanitation, food security, and livelihood programs. 
Integrated nutrition programs will keep malnutrition 
rates within an optimal range and decrease morbidity and 
mortality rates. 
 
b)  Support UNICEF in the sustainability of the 
nutrition surveillance system that addresses critical 
information gaps on nutrition and morbidity.  Engage 
UNICEF in progressively building national capacity to 
expand sentinel sites within the three Darfur states. 
 
c)  Support and strengthen WHOQs sentinel 
epidemiological surveillance system that tracks diseases 
and the underlying causes of malnutrition. 
 
d)  Support and encourage the prioritization and 
retention of community mobilizers and health promoters 
linked to nutrition feeding programs to follow-up on 
defaulters, screening, and sustainability. 
 
HUME