UNICEF Mali Situation Report Date: 28 August 2012

Highlights In an attempt to bring stability to Mali a national unity government was announced on August 21, 2012. However the country remains divided after Islamists seized northern regions following the coup earlier this year. There are an estimated 174,000 internally displaced people in Mali and over 200,000 people have registered as refugees in neighbouring countries. In Bamako 57% of IDPs are children and young teenagers (0-17 years old). Now in the height of the lean season, the worst is yet to come for children in Mali. Estimates predict 385,000 cases of moderate acute malnutrition and 175,000 cases of severe acute malnutrition in children under-five years old in Mali in 2012 with 87% of SAM cases expected in the south of Mali. A cholera outbreak in Gao region has to date led to 159 cases and 12 deaths in three communities. To mount a preventative response to the cholera outbreak, and reduce the risk of cases spreading, UNICEF has distributed supplies to treat 2,000 cases of cholera, as well as WASH kits for prevention of diarrhoea at the household level. As part of the regional UNICEF response to the cholera outbreak one diarrhoea kit was distributed to a UNICEF Field Office in Guinea Conakry near the border with Southern Mali. Child protection issues in the north continue to be a major concern with reports of unaccompanied children, association of children with armed groups, sexual violence and victims of unexploded ordinance. There is documented evidence of 137 children associated with armed groups. There were over 300,000 children in schools in the northern regions of Mali (Timbuktu, Kidal, and Gao) before the crisis, whose education has been affected. There are 10,000 students from northern regions in the south, 6,895 of whom are registered in schools. Other children are registered as refugees in neighbouring countries. UNICEF works across the north with established international NGOs and is deploying additional partnerships to access vulnerable children and women. An integrated package of medical supplies, household water, education and child protection in the north has reached 141,000 most vulnerable people (see inter-agency health kits). Specific interventions, such as household hygiene promotion have reached a greater number of beneficiaries, as highlighted in the indicator tables across this report. As of 27 August, UNICEF Mali has only received 34% of the 58 million U.S. dollars from its emergency appeal for 2012.

© UNICEF/ Harandane Dicko April 2012, School Sébéninkoro A, B, C, group of students wash their hands with soap, District of Bamako.

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SITUATION AND HUMANITARIAN NEEDS  On 20 August 2012 the interim Malian president, Dioncounda Traore, announced the formation of a national unity government in an attempt to bring stability to a country split in two after Islamists seized northern regions following the coup in March. The national unity government has 31 ministers from a broad range of political parties, including four women.  Armed Islamist groups remain in control of the three northern regions of Timbuktu, Gao and Kidal; Mopti region is divided in two with the government not operational in northern districts. The lack of Government allowed a significant degradation in respect of children and women's rights, particularly worrying trends are the continued association of children to the armed Islamist groups, and the start of imposition of sharia law. There have been popular uprisings in Niafunke (Timbuktu) and Ansongo (Gao) circles against perceived rights abuses. Neighbouring countries continue to express concern over the political instability in Mali and discussions continue regarding the deployment of ECOWAS and/or UN sanctioned troops.  Floods in Segou and Kayes regions followed the heavy rains. There were 11 villages particularly affected in Tominian and San areas, with 1,772 households made vulnerable, or an estimated at 11,663 people. In the affected areas five people died (drowning and house collapse), with 65 open wells and 523 latrines broken down.  Child protection issues regarding recruitment of children to armed groups in the north remain of high concern to UNICEF. There are 137 boys (aged 12 to 18 years) in Gao and Timbuktu regions, whose recruitment or association with armed groups is documented. However, according to unverified estimates the true number of children associated with armed groups is now estimated to be in the hundreds across the three northern regions.  Household incomes in northern Mali are lower than usual due to the impacts of food insecurity and conflict. Throughout the Sahel, local cereal prices are higher than the five year average, with market access particularly difficult for rural households*. However, imports of staple foods, primarily from Algeria have allowed urban markets to remain adequately supplied. Although trade volumes are expected to remain lower than usual, adequate quantities of staple foods are likely in urban markets. Prices are likely to drop with upcoming harvests but will remain higher than average. * http://reliefweb.int/country/mli?sl=environment-term_listing%252Ctaxonomy_index_tid_source-529 Estimated Affected Population Total population 1 Children under 18 Children Under Five Children 6 to 23 months Pregnant women Affected population (food insecurity) Children Under Five with Severe Acute 2 Malnutrition (SAM) Children Under Five with SAM and medical complications Children Under Five with Moderate Acute 2 Malnutrition (MAM) Total Displaced Population3 Population of Displaced Children (under 18 years) 3

Total 13,802,000 7,453,080 3,114,000 1,245,600 690,100 4,600,000 175,000

Male 7,070,697 3,818,176 1,595,287 638,115 Not applicable 2,346,000 96,250

Female 6,731,303 3,634,904 1,518,713 607,485 690,100 2,254,000 78,750

11,068

5,670

5,398

385,000

194,232

190,768

174,000 99,182

83,500 n/a

90,500 n/a

Sources: UNICEF Humanitarian Action Update June 2012; 1UNICEF State of the World’s Children 2010 (proportion of total population); 2Cluster Nutrition, June 2012 – CAP, based upon data from the June 2011 SMART survey; 3IOM estimates, the IDP report can be found at: http://mali.humanitarianresponse.info/document/iom-mali-newsletter-sit-rep. The gender and age breakdown of IDPs is an estimate based upon the proportion of IDPs identified through the IOM study in Bamako.

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INTER-AGENCY COLLABORATION 

UNICEF is leading the Nutrition, WASH, and Education (co-lead with Save the Children) clusters, and the Child Protection sub-cluster. The Nutrition cluster has launched regional sub-clusters in Kayes and Segou regions both lead by the Malian Red Cross with the Belgian Red Cross in Segou and the French Red Cross in Kayes. A regional

Child Protection sub-cluster has been established in Mopti led by UNICEF.  UNICEF, UNFPA and WHO are collaborating to cover children’s health needs in the northern regions. UNICEF continues to finance measles and polio vaccination campaigns for children through Groupe Pivot Sante, FENASCOM and MDM-B in Timbuktu, Gao and Kidal regions, integrating vitamin A supplementation and de-worming with Albendazole.

CHOLERA RESPONSE  To date there have been 159 cases of cholera and 12 deaths in 2012, a case fatality rate of 7.5%. During the same period in 2011 in Mali there were 844 cases and 35 deaths, a case fatality rate of 4.1%.  UNICEF has mounted a joint health, WASH, and communication response to cholera, including distribution of five diarrhoeal disease kits, three in Gao to MDM-B, one in Timbuktu to Alima, and the fifth to the UNICEF Guinea Conakry office to support them in their response to a cholera outbreak near the southern Mali border.  UNICEF has supported IRC and ACF-E to distribute 6,000 cholera prevention kits to households in Gao region. In Timbuktu a further 7,500 kits were distributed through Solidarités and Alima. To date UNICEF supported distribution of hygiene kits has reached 259,260 people in the northern regions. IRC with UNICEF

support has repaired the water distribution network of the city of Menaka benefitting 34,000 vulnerable people to access drinking water.  A cholera prevention communication plan has been developed with the Ministry of Health and partners targeting high-risk areas, particularly in Gao region. To kick start implementation of the prevention plan UNICEF is supporting a national TV and radio campaign running from July to September. There are also over 400,000 communication materials, including pamphlets, posters and stickers, which will be ready by next week for use in areas vulnerable to cholera. In Ansongo district, the centre of the outbreak, 25

community volunteers were trained and local radio stations are mobilized.  In partnership with Aidemet Antenna UNICEF has equipped 34 health centres in areas vulnerable to cholera for the local production of chlorine by electrolysis. This capacity is to maintain hygiene in the health unit and to promote household water treatment and sound conservation.  UNICEF is preparing to provide financial and material support to the government WASH response to cholera in high risk zones of Koulikoro, Kayes, Mopti and Gao regions. UNICEF, with WASH cluster partners, is analyzing how to strengthen the cholera response including through the use of mobile teams to evaluate areas with suspected cholera cases, and monitor the effectiveness of partners’ response and use of supplies in affected areas.  The national cholera taskforce led by the Ministry of Health coordinates Health and WASH partners’ activities nationwide to prevent and respond to cases of cholera in epidemic prone areas and coordinate medical and WASH actors. However, with the rainy season and 3

population mobility related to the instability of the country, a high risk of epidemic spread is feared. Affected Pop 159

Affected Pop under 5 n/a

No. of affected localities 4

Current Week No. of Related CFR cases deaths 16 0 0%

Cumulative cases No. of Related CFR cases deaths 159 12 7.5%

Cholera affected regions or districts Gao region, Ansongo district

UNICEF EMERGENCY RESPONSE  In 2012 UNICEF has finalised eight partnership agreements with Alima Nord, Alima-AMCP, Groupe Pivot Sante Population, MDM-B, Oxfam GB, RECOTRADE, Solidarites International and URTEL, for a total value of USD 4.9 million with NGOs for the emergency response. UNICEF additionally works with government institutions to finance activities and supplies.

NUTRITION  Nutritional data for the second quarter of 2012 was shared by the National Department of Health, with cumulative data from quarters one and two 2012 shows that 151,962 children under five years old were enrolled into programs to treat acute malnutrition. Of this total 104,107 children were enrolled in URENAM for treatment of moderate acute malnutrition (MAM), 41,503 children in URENAS for treatment of severe acute malnutrition (SAM), and 6,352 children in URENI for treatment of SAM with complications.  In the second quarter of 2012 (April-June) for the six southern regions there were: o 52,826 children under five in URENAM programs, of whom 23,902 children were newly admitted; o 23.018 children under five in URENAS programs, of whom 7,664 children were newly admitted; o 3,961 children under five in URENI programs, of whom 1,964 children were newly admitted.  In 2012 to date UNICEF has distributed 26,067 cartons of RUTF for treatment of SAM. However, a number of health districts recorded ruptures in nutrition supplies (therapeutic milk and RUTF). In August UNICEF began distribution under a plan to route nutrition supplies to Health Districts, facilitating supply continuity in community health centers. Under this plan 11,135 cartons of RUTF (of the total 26,067) were distributed in August.  In the last month a further 668 health personnel were trained on Community Management of Acute Malnutrition and Integrated Young Child Feeding, with 630 personnel in Kayes and 38 in Koulikoro.

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Estimated #/% coverage Children 0-59 months with Severe Acute Malnutrition (no complications) enrolled for therapeutic care Children 0-59 months with Severe Acute Malnutrition (with complications) enrolled for therapeutic care Health staff personnel trained in CMAM and IYCF protocol

UNICEF & operational partners UNICEF Cumulative % of Target Target results ( #) Achieved 175,0001 41,5032 27%

Cluster Target 175,0001

6,3522

2,965

940

Sector / Cluster Cumulative % of Target results (#) Achieved 41,503 27%

6,352

32%

2,965

940

32%

Children 0-59 months with MAM n/a3 385,0001 104,107 27% enrolled in supplementary feeding programmes List of UNICEF Operational Partners: Ministry of Health and their decentralized services at regional and district levels ACF-E, Alima, AMCP, ASDAP, Red Cross Belgium, Red Cross France, Red Cross Mali, IRC, MDM-B, Save the Children, RECOTRAD and URTEL. 1Annual targets. 2 Note: UNICEF and Cluster Target are the same with UNICEF the main supplier of RUTF and other therapeutic foods for cluster partners. UNICEF has distributed 20,287 cartons of Ready to Use Therapeutic Food to partners for the treatment of Severe Acute Malnutrition (MoH, ACF-E, Alima, Care, MSF-F and MDM-B). 3 UNICEF is involved in the response to Severe Acute Malnutrition and is not directly involved in the response to Moderate Acute Malnutrition; therefore the MAM targets for UNICEF have been removed.

Nutrition Cluster (http://mali.humanitarianresponse.info/fr/clusters/nutrition)  In 2012 Kayes and Koulikoro regions have recorded the greatest number of children enrolled in programs to treat acute malnutrition, with 38,415 and 35,082 children enrolled respectively. However, Sikasso region is the only one with over 10,000 children enrolled in URENAS in 2012, Sikasso also had the greatest number of new admissions in URENI, with 2,158 new admissions.  A follow up SMART survey on nutritional and mortality status of children under five will begin in the week of August 27th covering the six accessible regions of southern Mali. Due to the ongoing insecurity in the three northern regions, the SMART survey will not be conducted in the north.  Regular data collection from the Ministry of Health and NGO partners on admissions, recovery, deaths and abandonment in acute malnutrition programs remains a challenge. Nutritional data from the Ministry of Health is transmitted on a quarterly basis. However the nutrition cluster has engaged in considerable advocacy with the Ministry to transmit data on a weekly basis, and letter is with the Minister for signature.  Some health districts remain without ongoing support, or coming support, from NGOs partners, including Commune 2 and 3 of Bamako, the DS of Keinieba and Bafoulabe (Kayes), the DS of Kolondieba, Kignan and Kadiolo (Sikasso region). In order to ensure the most efficient and relevant coverage with regard to programs of management of acute malnutrition, DS mentioned above should be primarily targeted by the partners planning new nutritional programs in Mali.  On August 27th 2012 USD $17.9 million is required to address nutrition needs identified in Mali 2012 Consolidated Humanitarian Appeal.

WASH UNICEF and partners’ programming: North Mali  Since the beginning of the crisis, UNICEF has supported NGO partners Solidarités International, IRC, ACF, Alima, MSF, MDM-B, and Care to distribute 43,210 hygiene kits reaching 259,260 people at household level. In the past month these partners have reached an additional 220,000 people. These kits, with the complementary hygiene promotion, are designed to protect vulnerable people from diarrhea, cholera and malaria (where nets were part of the kits). In detail UNICEF has provided 2010 non-food item kits which include hygiene items for displaced families, 10,800 hygiene kits, and 30,400 kits composed of mosquito nets and soap.  In addition, UNICEF has initiated the construction of two small scale drinking water systems and four boreholes in Kidal region. In Gao work has begun on the construction of two small scale drinking water systems and 10 boreholes. This infrastructure will ensure access to safe drinking water to nearly 12,400 vulnerable people across both regions. 5

UNICEF and partners’ programming: South Mali  In partnership with Aidemet Antenna UNICEF has equipped 34 health centers for the local production of chlorine by electrolysis. This capacity is to maintain hygiene in the health unit and to promote household water treatment and sound conservation.  To prevent diarrheal diseases in vulnerable populations, UNICEF has adopted Community Led Total Sanitation in Mopti, Sikasso and Koulikoro regions, to date reaching over 72,000 people. While 61,456 students in 150 schools have benefitted from improved school environments including construction of latrines, boreholes and provision of hygiene kits. Estimated #/% coverage

UNICEF & operational partners UNICEF Cumulative % of Target results (#) Target Achieved 67,800 34,000 50%

Cluster Target

Sector / Cluster Cumulative results (#)

% of Target Achieved 13%

Emergency affected 268,650 34,000 population provided with access to safe water Affected population provided 1,536,000 259,2601 15% 2,139,568 259,260 11% with HH water treatment and storage material, key hygiene supplies and sensitised on key hygiene messages Affected population living in 140,000 72,175 52% 140,000 72,175 52% open defecation free environment School children benefiting 149,500 61,456 31% n/a from an improved learning environment Health/nutrition centres 150 342 23% n/a 150 n/a received WASH interventions (latrines/ safe water/ chlorine products/ hygiene promotion) List of UNICEF Operational Partners: Ministry of Water, Ministry of Environment and Sanitation, Civil Protection, Ministry of Health and their decentralized services, ACF-E, Alima, IRC, MDM-B, Oxfam GB, IRC, Solidarités International, RECOTRAD and URTEL. 1 Includes kits composed of simple soap and mosquito nets distributed to 184,200 persons. 2 These 34 health units were provided with chlorine production units to promote Household Water Treatment and Storage in areas vulnerable to cholera, with training provided in the health centers.

WASH Cluster (http://mali.humanitarianresponse.info/fr/clusters/water-sanitation-hygiene)  Of the 61 WASH cluster partners, currently nine are delivering humanitarian WASH programs.  In response to floods in Kayes, the local authorities and the Malian Red Cross have provided food and mosquito nets, 145 households were reached with key messages on hygiene practices, 41 wells and 81 latrines have been treated and 78 households received material for the purification of water at household level. A detailed needs analysis of is being finalized for the flood response in Kayes and Segou regions.  On the ground this map shows the current response capacity of WASH cluster actors to mount activities for cholera prevention and response, according to information on August 15 2012. 6

HEALTH UNICEF and partners’ programming  International NGO implementing partners continue service delivery for vulnerable communities in the north. A total of 40 health facilities have been reactivated with UNICEF support for human resources and medical supplies, benefiting 326,072 persons, a quarter of the pre-conflict population. In the Dire district of Timbuktu region, Alima has provided curative consultation services to 21,342 individuals over a four month period, with children 60 per cent of the beneficiaries.  A UNICEF supported campaign to vaccinate all the under-five children in the conflict affected north is progressing, with over 50% of area in the north covered to date. Timbuktu, the most populated region, is complete. Results for measles vaccine, vitamin A and deworming are in the table below. Additionally 155,925 children under five were vaccinated against polio. From early September the campaign is planned to start in Gao through MDM-B and FENASCOM, and in Kidal through MDM-B. An independent evaluation of the campaign will be organized.  A total of 47 Basic Inter-agency Emergency Health Kits have so far been released to implementing partners in Mopti, Gao, Kidal, and Timbuktu, to cover 141,000 consultations.  According to the National Cell for the Fight Against AIDS in the MoH as of 10 August the number of displaced HIV patients included in ARV services in the south is 75, of which 41 are women and 4 children. In Kidal there is one woman; in Gao 23 women and two children; in Timbuktu 12 women and one child; and in Mopti five women and one child. UNICEF is analysing a project with the Ministry of Youth to intensify HIV prevention with high risk groups including IDPs, sex workers and military in Mopti. Estimated #/% coverage

UNICEF & operational partners UNICEF Target Cumulative % of Target results (#) Achieved 276,4931 147,3802 53%

Children