Food, nutrition and mortality situation of IDP’s in Dubie,
Katanga 23-25 March 2006
MSF

‘Ketudi Byakudya’We don’t have enough foodAbbreviations
AASF
ACF
CI
CMR
DRC
ICVA
IDP
MSF
MUAC
NGO
OCHA
U5MR
UN
UNHCR
UNICEF
WFP
WHO

Association Agricole Sans Frontieres
Action Contre la Faim
Confidence Interval
Crude Mortality Rate
Democratic Republic of CongoInternational Council of Voluntary Agencies
Internally Displaced Person
Medecins Sans Frontieres
Mid-Upper Arm Circumference
Non-Governmental Organisation
Office for the Coordination of Humanitarian Affairs
Under-Five Mortality Rate
United Nations
United Nations High Commissioner for Refugees
United Nations Children’s FundWorld Food Programme
World Health Organisation

Executive summary
At the end of 2005 militia attacks and government military operations caused large population displacement in theprovince of Katanga in the Democratic Republic of Congo (DRC). Among them, 16 000 people are temporarily
residing in three camps in Dubie, a town in Katanga Province.
MSF has been working in Katanga since 1988, supporting hospitals, fixed and mobile clinics in many locations,
including Dubie since 1996.
Due to decreasing food security in Dubie, Medecins Sans Frontieres (MSF) conducted a nutrition and mortality
survey among 563 households. In order to explore the issues from the perspective of the population further, thesurvey was complemented with 15 household interviews. Data from the World Food Programme (WFP) food
distributions was also reviewed.
The mortality rates over a 90-day recall period (since Christmas 2005) were:
Crude Mortality Rate (CMR):
4.3 / 10 000 / day (CI 3.5-5.3)
Under-Five Mortality Rate (U5MR):
12.7 / 10 000 / day (CI 10.1-16.3)
This is above the emergency threshold of CMR > 1 and U5MR > 2 and therefore indicates a catastrophic situation.
The prevalence of global acute malnutrition (< -2 z-score and/or presence of oedema), was 19.2% (CI 15.723.3%) and of severe acute malnutrition (< -3 z-score and/or presence of oedema) was 5.0% (CI 3.2-7.6%). A
global malnutrition of 10-15% indicates a crisis in food security.
Discussions with people in the camps underline the on-going lack of food, with sporadic and limited food
distributions compounded by limited working opportunities within Dubie and restrictions on movements. There isneither enough food in Dubie nor adequate access to any food that might be found outside Dubie.
WFP distributions have not only been untimely but insufficient – and significantly less than their own
recommended daily intake of 2,100 kcal / person / day. In WFP’s December / January distribution to the IDPs of
Dubie, only 9.9 days of food were given. The next distribution of 1,050 kcal / person / day for one month started
on 27th March – some seven weeks after the first distribution. At present, there are no plans being made to change
this situation – despite the obvious food insecurity, growing levels of malnutrition and catastrophic mortality rates
in Dubie.
MSF first reported on the situation in Katanga in December 2005, going as far as briefing the UN Security
Council. Since then, little has changed on the ground. WFP, the United Nations and donors have neglected both
Dubie’s displaced and host populations for too long. Immediate assistance is critical.

1. INTRODUCTION
1.1 Background to Population Displacement
Dubie is a community with a population of 10,000 in the Pweto district and Kilwa health zone of Haut Katanga.
The main occupation of the population is agriculture plus petty trading, although due to limited infrastructure,
insecurity and long distances, this occurs on a small-scale.
Between July and October 2005, as a result of conflict, banditry and violence against civilians in nearby villages,
approximately 1,000 displaced people settled in Dubie. They achieved a certain level of integration, providing
daily labour for the host population and acquiring small plots of land for their own agricultural activities. However,in the following three months (starting in mid-November), due to an intensified campaign by the Congolese
military against the Mai Mai and consequent looting and pillaging by both sides, the numbers of displaced rose
dramatically. Dubie became host to approximately 3 200 internally displaced people (IDPs) in November,increasing to 14 000 by the end of December and 16 400 by mid January.
Overall in central Katanga, in less then a year, approximately 92,000 persons have been displaced. Their
destinations are shown in Graph 1 below. This displacement has to be added to pre-existing levels ofdisplacement in these and adjacent zones in central and northern Katanga, much of which remains unknown.1
Graph 1
Destinations of Population Displacement in Central Katanga
40000

No's of People

35000

Mitwaba

30000

Dubie

25000

Pweto

20000

Upembe

15000

Lukona10000

Kabangu

5000
0
Mar05

Apr05

May05

Jun- Jul-05 Aug05
05

Sep05

Oct05

Nov05

Dec05

Jan06

Since January, Dubie’s IDP population has remained relatively stable at around 16,000 people, with another 3,000
living nearby in Lukona. In Dubie the IDP population is split between three camps. The older, more established
IDPs live in camp I (1100 families) while the more recent and more vulnerable arrivals live in camp II (810families) and camp III (3230 families).
1.2 The ProblematicOver the last few months, food insecurity and growing malnutrition have been identified as the main problems
seen by MSF. By the end of 2005, survival strategies available to the initial displaced people were not available
to the rapidly increasing IDP population. Almost all the available agricultural land was already utilised, the1

Population movements and context are documented in “Running For Their Lives - Repeated Civilian Displacement inCentral Katanga, DRC” produced in February 2006, MSF.

pressure on wild food collection increased and the opportunities for other forms of income generation throughcasual labor remained limited.
In November and December 2005, MSF conducted a measles vaccination campaign, which was accompanied by a
Mid Upper-Arm Circumference (MUAC) survey that indicated worrying levels of malnutrition2. In mid-February
2006 Action Contre la Faim (ACF) carried out a rapid survey of the nutritional status in Dubie that indicatedalarming levels of malnutrition.3
MSF observation also indicated that the population was experiencing a food crisis, being forced to sell possessions
necessary for basic survival in order to buy food in a limited market.
1.3 Reactions So Far
MSF responded initially to the influx in November by scaling up its medical intervention, adding shelter, waterand sanitation activities and distributing plastic sheeting, cooking sets, blankets, jerry cans and other small nonfood items, mostly supplied by the United Nations International Children’s Fund (UNICEF). Additionally MSF
requested more Non-Governmental Organisation (NGO) and UN assistance at an early stage, reinforcing thesecalls with a briefing of the UN Security Council in January 2006, a paper entitled “Running For Their Lives Repeated Civilian Displacement in Central Katanga, DRC” produced in February and on-going vigorous lobbying
at local, national and international levels.
In response to the worsening food situation, MSF increased capacity in the therapeutic feeding centre (specialised
unit for severely malnourished children)4 and distributed high-energy biscuits, donated by UNICEF. In January,
Caritas Congo (with a donation from Caritas Zambia) made a partial distribution of food to host and displaced
families. This was followed by another distribution by the World Food Programme in early February where theration equalled less than 10 days food, at the internationally recognised, and WFP recommended, requirement of
2,100 Kcal per person per day5. It only targeted around 13 000 people when the population estimate was closer to
16 000.
Despite on-going and constant demands for additional international intervention, donors and UN agencies havereacted inadequately. In order to encourage international agencies to respond, MSF conducted a nutrition andretrospective mortality survey complemented by qualitative semi-directive interviews. The information was
gathered between the 23rd - 25th March 2006 in the three camps of Dubie.

2

MUAC of all 1135 children aged 6 to 59 months: MUAC < 125 mm and /or oedema 12.8%; MUAC< 110 mm 2.1%; 0.2 %had oedema
3
MUAC sample of 647 children from 12 to 59 months: MUAC< 110 mm and / or oedema 14.7%; MUAC < 125 mm oroedema 39.7% ACF, 21/02/2006
4
At the time of writing MSF had 75 children admitted in the TFC.
5
Food and nutrition needs in emergencies, WFP, UNHCR, UNICEF, WHO; 2004

2. METHODOLOGY
An anthropometric and mortality survey was combined with semi-structured interviews and existing reports onfood aid.
The estimated population size was 15 682, living in 3 394 households which were numbered for the purposes ofthe survey. The proportion of children under 5 years of age was estimated at 17%, giving in total 2 666 children
and an average of 0.78 children under 5 years per household. The prevalence of malnutrition was estimated at
15%. The aim was to have a precision of 3% and standard error 0.5% which gave a required sample size of 450
children or 573 households.
A systematic sample was taken of every 6th (573/3394) household. In households without children only themortality questions were asked. No one refused to participate; when a household was empty, the team returned in
the afternoon and if unsuccessful, the next household was approached.
Local Red Cross volunteers who normally function as community health workers in the camps received a two-day
training on communication and documentation prior to undertaking the survey. Despite this training, there may
have been misinterpretations of language. There were 4 teams of 5 people including a supervisor.
The data was entered in Excel and later exported to Epiinfo version 3.02 for analysis of the anthropometric data.
To gain an impression of the IDPs’ perspective on general concerns, particularly food security, a semi-structured
interview (see annex for all data collection tools) was conducted with 15 households, 5 from each camp. The
households were chosen at random by spinning a bottle and then going to the seventh household. The person
interviewed was the household head or another adult. One household (headed by a girl of 15 years) refused toparticipate in the discussions.
The interviews were performed through a translator and an international staff member. It should be noted that thisinformation attempts to add a qualitative element to the survey findings and cannot be generalised.
Data on food aid was obtained from WFP and their implementing partner, Association Agricole Sans Frontières(AASF).

3. RESULTS
3.1 Population Characteristics
The total number of households interviewed was 563. These households equate to 1 980 persons, of whom 532
were children under five years, representing 27% of the sample population - higher than the expected proportionof under-fives.

Table 1. Description of the population
Description of the sample

NumberTotal Study Population
Number of families included
Number (percentage) of children under-five years
Average family size

1980
563
532 (27%)
3.5

Of those interviewed, the majority of families arrived in the months November and December 2005 (24% and
65% respectively).
Graph 2 Month of arrival of sample population

Date of arrival(n=563)500
365

number

400
300
200

136

100

24

18

4

8

3

3

2
ar
-0
6

M

-0
6
Fe
b

n06
Ja

D
ec

-0
5

-0
5
N
ov

-0
5
O
ct

-0
5
Se
p

-0
5
Au
g

Ju
l

-0
5

0

Date

3.2 Mortality
In the recall period of 90 days (26th of December 2005 - 24th of March 2006) 39 babies were born and 78 people
died, of whom 62 were under five years. The crude mortality rate is 4.3 / 10 000 / day and the under-five
mortality rate is 12.7 / 10 000 / day. These figures are catastrophic.
Table 2. Under-five and Crude mortality rates
NumberUnder-five mortality
Crude mortality

62
78

MR/10,000/day
12,7
4,3

CI*
10.1-16.3
3.5-5.3

Calculations:
CMR= deaths/mid-term population = deaths / (total population + half of deaths-half of births) x 10000 / 90 = 78 / {1980 +[(0.5 x 78) – (0.5 x 39)]} x 10000 / 90
U5MR= deaths/mid-term population = 62 / {532 + [(0.5 x 62) – (0.5 x 39)]} x 10000 / 90

*Confidence Intervals were derived using Epiinfo software.

3.3 Malnutrition
In total 442 children under five years old were included in the anthropometric survey, 52.3% were male and47.7% were female. This difference in gender is not statistically significant. The numbers of people per age groupis as expected. The gender and age distribution of the survey sample, indicate a representative sample.

Table 3. Breakdown by age of the survey sample
Age Group (months)
6 – 17
18 – 29
30 – 41
42 – 53
54 – 60
Total

Number
86
93
121
92
50
442

Percent
19.5
21.0
27.4
20.8
11.3
100

Regardless of how the malnutrition is defined, the prevalence of acute malnutrition is high, indicating a serious
nutritional situation. The prevalence of oedema also reflects an unbalanced nutritional intake.
Table 4. Prevalence of acute malnutrition among 6-59 months children expressed
as Z-score (n=442)
Z-scoreNumber of children

Global malnutrition

85

Severe malnutrition

22

Percentage(95% C.I.)
19.2( 15.7-23.3)
5.0( 3.2-7.6)

Definition:
Global malnutrition = weight/height: < -2 z-score and/or presence of oedema
Severe malnutrition = weight/height: < -3 z-score and/or presence of oedema

Table 5. Prevalence of acute malnutrition among 6-59 months children expressed as percent of the reference
median (Weight for Height Median) (n=442)% median

Number of children

Global malnutrition

72

Severe malnutrition

18

Percentage(95% C.I.)
16.3(13.0-20.1)
4.1(2.5-6.5)

Definition:
Global malnutrition= weight/height: < 80% and/or presence of oedema
Severe malnutrition = weight/height: <70% and/or presence of oedema

Table 6. Prevalence of oedema alone
Presence of Oedema

Number ofchildren13

Percentage(95% C.I.)
2.9(1.6-5.1)

The results of the MUAC findings (below) are presented for the sake of completeness; in the knowledge thatweight-for-height is a more appropriate measurement for acute malnutrition.
Table 7. Prevalence of acute malnutrition among 13-59 months children according to Mid Upper Arm
Circumference (MUAC) including oedema
Number of children

MUAC < 12.5 cm and/or
presence of oedema
MUAC < 11.0 cm and/or
presence of oedema

33
12Percentage(95% C.I.)
8.6(6.1-12.0)
3.1(1.7-5.5)

Definition:
Global MUAC malnutrition= MUAC < 12.5 cm and/or presence of oedema
Severe MUAC malnutrition = MUAC < 11.0 cm and/or presence of oedema

3.4

Food Security

From discussions with IDPs in the camps, the over-riding concern was lack of food. This was mentioned byeveryone – particularly among the relatively more recently arrived IDPs of Camps II and III.
All the IDPs with whom MSF discussed, mentioned only eating one meal the day before: either cassava meal
(fufu) and cassava leaves, or quite simply dried cassava skins – ‘something I would normally feed to the pigs’, inthe words of one man, or ‘throw away’ according to another woman.

3.4.1

Constraints on Survival Strategies

Many of the IDPs reported having initially been able to work in the fields of Dubie’s host community during theplanting season, on a part-time basis in exchange either for a small amount of money or food (usually cassava
roots). However, these opportunities progressively diminished. As one woman expressed: ‘now there is very little
employment. The owners of the food keep the food themselves…it’s the end of the rainy season and the cultivatinghas stopped’.
Others have attempted to go further afield in search of employment, perhaps 14 – 30 km away, but here too, they
complain of restrictions on movement and/or being forced to hand over part of whatever they have earned tosoldiers at checkpoints outside the camps. As one woman pointed out: ‘you always have to give something to thesoldiers – but it’s so difficult to hand over the food’.
Meanwhile, only a very small minority of people has managed to maintain some form of petty trade or semiskilled work (such as tailoring). Virtually all of the IDPs with whom MSF discussed, spontaneously reported
selling all their belongings including most of the non-food items they had received in order to purchase basic
staples on the market. In the words of one man:
‘We received clothes, but we remain with nothing because we exchanged everything for food. I exchanged
blankets, cooking pots, plates, cups, spoons and buckets. We remain with only one tent. We have kept ourmosquito nets because there are many mosquitoes and they will kill our children. Since we don’t have any foodand we don’t have any money, I might have to sell my tent’.

3.4.2 Inadequate Food Distributions
In a press release on 7th December, the UN committed to send 109 tonnes of food to Dubie.6 The World Food
Programme’s implementing partner (AASF), began a distribution that commenced on the 28th January and was
6

DRC: Military Activity in Central Katanga Displaced 25,000 Civilians; 7th December 2005; OCHA.

completed two weeks later. The latter targeted 12 993 people out of an IDP population of 15 686 people(according to the 15th February figures), for a period of one month. The distribution was a planned 50% ration for
one month – or 1,050 kcal per person per day – although the WFP states that 2,100 kcal is the baseline daily foodrequirement for each and every beneficiary. According to WFP’s local implementing partner’s distribution report,
the ration actually consisted of the following:

200g maize flour / person / day (18 days ration given)
60 g peas / person / day (29 days ration given)
15 g oil / person / day (18 days ration given)
3 g salt / person / day (30 days ration given)

This equates to 19.8 days of food at the WFP planned intake of 1,050 kcal per person per day – or 9.9 days of foodat the WFP recommended intake of 2,100 kcal. As one woman told us: ‘at the end of January we received food.
It was very good, but it didn’t last long…for the big families it lasted only one week, although for some it lasted
two weeks’.
According to WFP’s own reports, 108.397 tonnes were dispatched from Lubumbashi to Dubie for the first
distribution of December / January; of these only 94.775 tonnes arrived in Dubie, whilst even less – some 72.891
tonnes – were recorded as being distributed by WFP’s implementing partner – representing a shortfall of morethan 35 tonnes (or 30%) of food between dispatch and distribution. On the 24th March 2006, MSF international
personnel observed one of the WFP contracted trucks carrying food from Lubumbashi to Dubie being unloaded bymilitary personnel in the military base in Dubie.
Another half-ration distribution, also intended to last for one-month, was planned for March, and started on the27th March. This second distribution of half-rations comes at least seven weeks after the first which is late and too
little.

4.

DISCUSSION

According to the joint Office for the Coordination of Humanitarian Affairs (OCHA) and International Council of
Voluntary Agencies (ICVA) report: ‘the national and international response to the evolving humanitarian crisis in
the Congolese province of Katanga remains woefully inadequate’, despite implementation of the new UN ‘cluster
system’ for humanitarian emergencies which allocates lead responsibilities to different UN agencies in the
expectation that they coordinate the response to emergency needs and, in extreme cases, become ‘provider of lastresort’.
To date, only the IDPs’ capacity to obtain casual labour and sell donated non-food items to buy food have
prevented malnutrition from reaching greater proportions. This capacity is now exhausted. Given that the IDPs do
not have robust survival strategies to complement food distributions and are not likely to see a dramatic change intheir food security situation in the immediate-medium term, adequate and timely external assistance is needed
now. With the pressure on the host community increasing, their situation should not be ignored.
The mortality and nutrition data from the survey underline the appalling situation of this vulnerable and neglected
population. This survey did not attempt to look at the causes of mortality; therefore, the causes of death remain
unclear. However, there have been no major outbreaks of disease in the period of recall. MSF morbidity data
show that malaria is the most frequent reason for consultation, followed by diarrhoea. From the beginning ofDecember until the end of February in MSF clinics serving the Dubie camps, 35% of children under 5 years weretreated for malaria, while diarrhoea represented 21% of consultations.
Despite having set up health facilities to serve the population, MSF acknowledges that we have been unable toadequately address the high mortality although daily monitoring since February has shown a decreasing trend in
mortality. However, food needs remain to be addressed.

5.

CONCLUSION

Despite continuous lobbying for international assistance at the provincial, national and international levels
including at the UN Security Council by MSF over the past few months, the populations of Dubie remain
desperately neglected.
MSF has communicated both privately with WFP and publicly about the food insecurity in Dubie, and specifically,
the inadequacy of the WFP ration. Despite this, there has not been a revision of the half-ration policy. A fullmonthly ration general food distribution to the IDPs of Dubie is needed now, and should include the logisticalmeans necessary to manage and monitor it appropriately.
In the words of one woman: ‘I have nothing more to say. Just tell them that we are suffering from hunger’.

Annex Data collection tools

FAMILY QUESTIONNAIRE / RETROSPECTIVE MORTALITY SURVEY
Team n° ....... Camp .................................. Date ......../......../...........………....
Family Composition *Familyn°

Arrival date<month/year>

Total NumberChildren < 59monthsNumber of deaths since
Christmas
Total

Children < 59monthsBirths since
Christmas

Anthropometric Data collection sheet
Team n° .........

Familyno°

6 months – 59 months (< 5 years)
Camp: .................................. Date: ....../.......

Child No1 - 450
1
2
3
4
5
6
7
8
9

Date ofBirth
dd/mm/yyAgeyears/months

Sex
F/ M

Weightkg/g

Heightcm/mm

Oedema
Y/N

MUAC
mm

TFP
Y/N

SFP
Y/N

MSF March 200614