Madagascar El Nino/Drought SITUATION REPORT - June 2016

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Madagascar

El Nino/Drought Humanitarian

Situation Report

Response Cluster 2016

Target Cluster

Total Results UNICEF 2016

Target UNICEF Total

Results

NUTRITION

Number of children 6-59 months suffer from severe acute malnutrition (SAM) have access to treatment

El Nino/ drought

10,423

3,700

10,423

3,700

Number of children under 5 screened for severe malnutrition

El Nino/ drought

300,000 295,000 300,000 295,000

WATER, SANITATION & HYGIENE

Number of people living in the areas most affected by drought provided with safe water

El Nino 665,000 106,300 665,000 106,300

SITUATION IN NUMBERS

Highlights The population in Madagascar’s arid South currently faces extreme

humanitarian needs due to an extended drought exacerbated by El Nino. Nutrition screening data indicates that 39,000 children under 5 in the eight most affected districts in the South are suffering from acute malnutrition (GAM), among them 7,000 from severe acute malnutrition while water consumption has declined to a reported 1 liter/day in certain districts.

UNICEF has been working in the affected areas of the South through its’ nutrition, WASH, health, education and child protection programmes in support of Government line Ministries. In response to current increased vulnerabilities, UNICEF and partners have carried out periodic malnutrition screenings of 300,000 children under 59 months in the 8 most affected districts, and supported the SAM treatment of 8,300 children (2015) and 3,700 children (2016 to date) in over 150 UNICEF supported facilities. More than 106,300 people have gained access to safe water through 35 new boreholes and 550 water points rehabilitated by UNICEF and partners.

The response is constrained by funding limitations. As of 15 June 2016, UNICEF has received $2.7 million against its US$ 24.1 million HAC appeal to address the needs of the most vulnerable families and their children facing malnutrition, lack of water, school drop-out and exploitation through WASH, Nutrition, Health, Education, Child Protection and Emergency Cash interventions.

As of 15 June 2016:

7,000 children affected by SAM (UNICEF/ ONN/MoH Feb 2016 malnutrition screening)

32,000 children affected by MAM (UNICEF/ ONN/MoH Feb 2016 malnutrition screening)

1,140,000 population without

access to safe water

1 liter average daily water consumption

in 9 most affected districts*

25% increase in diarrhea among under-

5 children*

40% primary school drop-out rate

across the 3 affected regions*

UNICEF Appeal 2016*

US$ 24,161,485 million

Funds Recevied

Funding Gap

Carry Forward Funds

Funds Recieved $2.1 million

Carry Forward $300,000

Funding Requirement $18.5 million

Funding Gap $16 million

UNICEF/Madagascar/Silvia Gaya/2015

Madagascar El Nino/Drought SITUATION REPORT - June 2016

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Situation Overview & Humanitarian Needs The population in Madagascar’s arid South currently faces extreme humanitarian needs due to an extended drought exacerbated by El Nino which has further weakened previously low agricultural production and resulted in concerning increases in food insecurity and acute malnutrition levels. Nutrition screening data1 indicates that 39,000 children under 5 in the eight most affected districts in the South are facing acute malnutrition (GAM), among them 7,000 suffer from severe acute malnutrition, while water consumption has declined to a reported 1 liter/day in certain districts. Moreover rapid assessments in April 2016 report an increase in diarrhea in children under-five of up to 25% and dropout rates as high as 40% in primary schools. This situation compounds the extreme poverty level in Madagascar where approximately 91% of Malagasy people across the country live on less than 2 USD/day. Evidence from these assessment also indicate that this further livelihood shock due to the drought is leading to negative coping strategies involving children, including increase in sexual exploitation and child ‘marriage’ practices as well as involvement in robbery, increasesin family discord and violence and rising sentiments of marginalization among affected communities.

Humanitarian leadership and coordination Given the high frequency of natural disasters in Madagascar with cyclones and flooding occurring every season and a chronic drought in the South, humanitarian sectors/clusters – co-led by Government line Ministries and humanitarian agencies under the overall joint coordination of the National Disaster Management Office (BNGRC) and the HCT/OCHA - are established. UNICEF co-led clusters have been meeting regularly since 2015 to coordinate actions towards the joint objectives, included in the national Strategic Response Plan for the prolonged Drought in the South of Madagascar jointly elaborated by the national authorities and the Humanitarian Country Team.

Nutrition Cluster - UNICEF has been co-leading the response at central and field level jointly with the National Nutrition Office (ONN), through the Ministry of Health and the National Community Nutrition Programme. Community Nutrition and Health workers, trained with support from UNICEF, detect SAM cases routinely at health facility level. WASH Cluster: UNICEF co-leads with the Ministry of Water, Sanitation and Hygiene at national and regional levels with focus on data collection and planning of interventions.

1 UNICEF/National Nutrition Office/Ministry of Health Malnutrition Screening in 8 drought affected districts in the South of Madagascar, February 2016;

Table 2. Key figures

Indicator Value

# of people affected by drought 1,140,000

# food insecure (WFP, Rapid Assessment, Feb 2016)

665,000

# SAM Children Under-5 (UNICEF, Malnutrition Screening, 2016)

7,000

# MAM Children Under-5 (UNICEF, Malnutrition Screening, 2016)

32,000

# of population without access to safe water 1,140,000

Figure 1: Eight most drought- affected districts

Madagascar El Nino/Drought SITUATION REPORT - June 2016

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Education Cluster – UNICEF co-leads with the Ministry of National Education at the central and decentralized levels in the coordination and planning of integrated education interventions, including disaster risk management and school feeding programs Child Protection Sub-Cluster – UNICEF co-lead the Child Protection Sub-cluster with the Ministry of Population.

Humanitarian Strategy Given the extremely low development status and the chronic nature of the drought in the semi-arid South of Madagascar, UNICEF’s regular integrated programme interventions in health, nutrition, WASH, education and child protection have focused on the South. UNICEF’s humanitarian response therefore builds on the regular programme and aim to save lives and to strengthen resilience. UNICEF humanitarian response includes interventions in the areas of Nutrition: Screening, Treatment of SAM, Infant and Young Child Feeding; WASH: Drilling of boreholes, Distribution of ceramic filters; Water Trucking, Emergency Sanitation and C4D; Health: Distribution of antibiotics, Zinc and ORS; Education: Provision of temporary education structures; Child Protection: Prevention of negative family coping mechanisms through Emergency Cash Transfers

Summary Analysis of Programme response Nutrition - In response to the crisis, mass malnutrition screenings have been carried out periodically (April 2015, Oct 2015, Feb 2016, April 2016) and will henceforth be carried out monthly to ensure that accurate up-to-date data on the malnutrition situation is available to inform the response. The third joint UNICEF/ONN/MoH Nutrition

Screening covering nearly 95 % of all children 6-59 months in the 8 affected districts revealed a worsening nutrition situation, with global increases of 0.5% for SAM, 2.4% for MAM, and 3% for GAM over all 9 districts. Results also indicate that some districts (Tsihombe, Beloha, Bekily and Amboasary) are more affected than others, with SAM rates of up to 0.8% higher and GAM rates of up to 13.5% higher than the district with the lowest malnutrition rates.

Since the onset of the crisis, UNICEF has accelerated the response through its’ regular programme partners the Office of National Nutrition and the Ministry of Health with a special focus on re-enforcing the capacity of over 150 community nutrition sites and community health centres to address the acute malnutrition needs. UNICEF support to date includes: 1); provision of 12,000 boxes of Ready-to-Use Therapeutic Food (RUTF) - 3,700 in 2016, therapeutic milk and essential drugs; and (2) the strengthening of the SAM surveillance system, (3) counselling for 20,000 caretakers on supplementary feeding and Infant and Young Child Feeding practices, and (4) capacity building of health staff and community workers in the detection and treatment of SAM. As a result, since the onset of the malnutrition crisis in 2015, over 12,000 SAM cases, 3,700 of which were admitted in in 2016, were admitted for treatment in over 150 UNICEF-supported facilities. Of these cases, 71% were cured, 0.5 % died and 18% failed to complete treatment. Water and Sanitation (WASH) - According to a UNICEF-supported survey conducted by the WASH Regional Directorate in the three districts of Tsihombe, Beloha and Ambovombe, the average water consumption has dropped to about 1 liter per person, per day, which is below the Sphere Standards of 7.5 liters to 15 liters per person, per day. Limited access to water due to the worsening drought and difficult hydrological conditions has also created considerable speculation in the water prices charged by water vendors. This sharp price increase has a significant impact on the population, as up to 30% of the household budget is spent on water, limiting their ability to meet other livelihood needs, such as food and sanitation.2 The limited availability and the high price of water further exacerbates negative coping mechanisms such as the use of unsafe surface water sources and unhealthy hygiene practices.

UNICEF is working with the decentralized Ministry of Water directorates and the regional water service provider AES (Alimentation en Eau du Sud) to address immediate water needs through water-trucking intended to provide life-saving water to the most vulnerable segments of the population and to stop water price speculation, to date benefitting 3,300 households. UNICEF has further accelerated its regular programme response by increasing the number of rehabilitated and

2 Around 80% of the population in these regions live on less than 1.90 USD per day. A 20-liter container of water costs them 0.25 to 0.60 USD, or between

13% and 31% of their daily income.

Madagascar El Nino/Drought SITUATION REPORT - June 2016

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newly constructed boreholes and by building middle-size water schemes. To date, 550 water points have been rehabilitated benefiting an estimated 100,000 people, including at schools and health centers; 35 new boreholes equipped with hand pumps, benefiting 6,300 people, 20 boreholes and construction of 8-mid-level water supply systems in progress that will benefit an estimated 20,500 people. In light of the very challenging hydrogeological situation, UNICEF is also exploring alternative options, such as sand dams, desalinization plants and aquifer recharge. A sanitation and hygiene campaign covering all three regions in the South promotes much needed behavior change among the population considering the high prevalence of open defecation. UNICEF WASH interventions are supporting the nutrition response by ensuring that all families with children receiving therapeutic feeding have a handwashing kit, soap and a ceramic water filter for safe drinking water. 100 Community Health Workers have been trained as WASH kit trainers and 3,800 families with children suffering from SAM have benefitted to date.

Health –In the drought affected areas, diarrhea, malaria and pneumonia are on the rise among under-five children, while vaccination coverage rates are declining. The proportion of Malaria cases seen in the health centers has increased from between 4% (in Bekily and Beloha districts) to 10% (in Ambovombe district). Routine information systems show a 50% decline in visits to health centers (14% of CSB attendance)3. This information suggests that families’ meager resources are being prioritized to buy food over expenditure on health. The UNICEF response is building on UNICEF’s existing immunization and basic health care support interventions by ensuring special support to child immunization against the main childhood killers and by training Community health workers to provide a minimum package of health interventions (home based maternal and newborn care, management and treatment of malaria, pneumonia and diarrhea).

Education - Rapid assessments conducted by the Education Cluster in the drought-affected regions indicate that the current drought has had an alarming impact on school retention. Dropout rates in primary schools have climbed to around 40% in some of the most-affected communities. In those schools, several classrooms are almost empty and many families with their children are working in the field as a survival strategy. Children who are still attending these schools report being hungry and struggling to concentrate on their lessons. Teacher absenteeism is increasing as community teachers, who usually receive a stipend, also need to feed their families. The priority need in education is to prevent further dropouts (improving retention), while offering catch up and reinsertion opportunities for pupils who have left school in affected regions. In order to respond to the increasing number of school dropouts (up to 40% in certain primary schools) due to families’ loss of livelihoods and migration, UNICEF will support communities to develop school improvement plans with focus on retention, reinsertion, quality education, and strengthening linkages with WASH and health programming. UNICEF will also support regional and national education authorities to prepare and deliver catch up programmes before the new academic year. Child Protection - The rapid child protection assessment, undertaken in May 2016, noted a dramatic increase in negative coping mechanisms. Increases were reported in economic exploitation (children working in mines, leading cattle, working as domestics or transporting water), as well as sexual exploitation (including prostitution and child “marriage”). Moreover deteriorating family relations were linked to loss of livelihoods, manifesting in increased violence within the family and a feeling of marginalization among affected communities. Families in these communities, especially children, are in need of household income and targeted social services to address the growing violence, exploitation and negative coping strategies related to increasing poverty, loss of livelihoods and food insecurity. To respond to this increase in child protection violations, UNICEF will support a combination of cash interventions (see below) and increase the availability of counseling and support services for victims of violations. Emergency Cash Transfer/Social Protection –To provide rapid support for vulnerable families in a cost efficient manner, UNICEF will work with existing government, NGO and private sector partners to provide cash to vulnerable families with children under 5 over a period of 5 months in 3 districts. The districts targeted for the cash transfer interventions are already targeted through nutrition interventions and are selected based on MAM rates higher than 15% and GAM rate higher than 20%4. The sites have also been identified as among those where access to safe water is the most limited, but safe sources of water are possible.

3 HMIS 2016 4 According to preliminary results of the April 2016 Malnutrition Screening

Madagascar El Nino/Drought SITUATION REPORT - June 2016

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Communications for Development (C4D) All interventions are accompanied by relevant C4D activities. In particular WASH, Nutrition, Emergency Cash and Child Protection interventions are enhanced through communication messages passed from community health workers and community agents to affected families.

Supply and Logistics WASH – All kits for handwashing, soap and ceramic water filters have been provided to district medical services and distributed to health centers in the affected region. When families with SAM children arrive at health centers for therapeutic feeding, they receive the whole kit as well as an explanation from Community Health Workers on how to use and clean the equipment.

Nutrition - More than 12,000 boxes of RUTF have been supplied to over 150 treatment facilities since the beginning of 2015, to date 3,700 in 2016. Furthermore a buffer stock of 5,000 boxes of RUTF has been secured to anticipate further deterioration of the nutrition situation.

Media and External Communication UNICEF has facilitated media missions to the South from Sweden and a multi-country mission organized by the Action Advocacy Network in recent weeks.

Security The affected regions in the South are afflicted by traditional cattle rustling which has evolved into a more organized form which is often violent and has been responded to with increasing military action. The situation poses considerable security risks to affected communities, yet to date there has been no incidence of humanitarians being targeted.

Funding Funding Requirements

Appeal Sector UNICEF Requirements

Funds available for UNICEF (in 2016)*

Funding Gap

US$ %

Nutrition 2,330,000 1,559,112 770,888 33%

WASH 9,352,785 873,451 8,329,334 91%

Health 3,544,000 0 3,544,000 100%

Education 1,640,000 0 1,640,000 100%

Child Protection 700,000 0 700,000 100%

Emergency Cash/Social Protection

518,700 0 518,700 100%

Coordination 400,000 0 400,000 100%

Total 18,485,485 2,432,563 15,902,922 86%

Next SitRep: July 31, 2016

Internet : www.unicef.org/madagascar Facebook : http://www.facebook.com/pages/UNICEF-Madagascar Twitter : http://twitter.com/unicefmada

Who to contact for further information:

Elke Wisch Representative UNICEF-Madagascar Tel: +261 (0) 321139936 E-mail: ewisch@unicef.org

Jean Benoit Manhes Deputy Representative UNICEF-Madagascar Tel: +261 (0) 320541137 E-mail: jmanhes@unicef.org

Matthew Conway Media Relations UNICEF-Madagascar Tel: +261 (0) 320341131 E-mail: mconway@unicef.org

Madagascar El Nino/Drought SITUATION REPORT - June 2016

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Annex 15

5 Results reported against the drought related emergency response, not against all the year UNICEF Humanitarian Action for

Children (HAC) appeal 2016.

Response Cluster 2016

Target Cluster Total

Results UNICEF 2016

Target UNICEF Total

Results

NUTRITION

Number of children 6-59 months suffer from severe acute malnutrition (SAM) have access to treatment

El Nino/ drought

10,423

3,700

10,423

3,700

Number of children under 5 screened for severe malnutrition

El Nino/ drought

300,000 0 300,000 295,000

Number of women/caregivers of children less than 24 months who have access to Infant and Young Child (IYCF) counselling

El Nino/ drought

165,000 0 165,000 0

HEALTH

Number of cases of pneumonia in children under 5 years treated with antibiotics

El Nino/ drought

62,000 8,000

Number of cases of diarrhea in children under 5 years treated Zinc and oral rehydration salts

El Nino/ drought

75,000 13,000

# basic emergency obstetric care facilities per 100,000 people

El Nino/ drought 18 0

WATER, SANITATION & HYGIENE

Number of people living in the areas most affected by drought provided with safe water

El Nino/ drought 665,000 106,300 665,000 106,300

CHILD PROTECTION

Number of children receive psychosocial support El Nino/ drought 1,400 0

SOCIAL PROTECTION / EMERGENCY CASH

Number of vulnerable families receive cash transfers El Nino/ drought

8,000 0

EDUCATION

% of school-aged children including adolescents completing catch-up classes and effectively reinserted in school by the end of 2016

El Nino/ drought 70 0