Over the past weeks, the MSF team in Karuzi (Burundi) has witnessed a rapid increase of the number of malnourished people in the feeding centre already active in Buhiga, where the number of beneficiaries has started to rise steadily since the end of last October.

"We treat over 300 beneficiaries in our therapeutic nutritional centres," said Luc Nicolas, MSF coordinator for the Great Lakes region programs.

"The second centre was opened last December and we are preparing to set up a third shortly as the number of patients continues to increase. We expect to see the number of patients rising steadily up to 600-700 by the end of March.

"We are preparing to further reinforce our nutritional program - both therapeutic and supplementary - over the next weeks, as we do not think that the situation will stabilise before July 2003: the next harvest foreseen at the end of May is not expected to be good".

The situation is not yet comparable to the nutritional emergency of January 2001, when more than 2,000 children were treated simultaneously for malnutrition in MSF feeding centres.

However, in January 2003, MSF organised a nutritional survey which recorded an acute malnutrition rate of 2.5%, well above the alert level and close to the pre-emergency (and post-emergency) levels of 2001.

"As the rainy season was especially meagre, the harvest was poor. This factor combined to the constant insecurity have contributed to the increase of malnutrition cases among the population", said Nicolas.

MSF has been providing medical and nutritional aid throughout the 10 health centres in the province of Karuzi, but during the nutritional survey an alarming number of malnourished children not yet integrated in a nutritional program was discovered.

Therefore MSF has put in place a mobile team to scan the hills in search of malnourished children, who are brought over to the feeding centres for nutritional and medical assistance. An average of 20 children are currently brought back everyday.

Every therapeutic centre is run by two expatriate volunteers, a doctor and a nurse, plus around 40 local staff. The overall number of international staff present in Karuzi for the nutritional emergency is now 8, in addition to the 10 people volunteering in the ongoing access to healthcare projects.

Alongside the nutritional emergency, MSF has been closely monitoring malaria in Burundi, and since November our teams witnessed a significant increase of cases especially in the provinces of Ngozi and Gitega. In Ngozi the number of cases quickly rose from 16,000 in September to 34,000 in November and over 48,000 in December 2002.

MSF decided to intervene in Ngozi Province and sent a medical team to provide medical assistance and to negotiate a plan for the intervention with the authorities. After negotiations with the local authorities, MSF was finally given the green light to import and distribute coartem.

This is a new combination drug that works also when the more commonly used fansidar proves ineffective. Coartem was therefore distributed and MSF also organised diagnosis via rapid diagnostic tests.

MSF plans to continue the intervention until the situation is back to normal. Against this background MSF is analysing the necessity of further imports of coartem.