PROJECT INFORMATION DOCUMENT (PID) APPRAISAL STAGE Report No.: PIDA18 Public Disclosure Copy Project Name Horn of Africa Emergency Health and Nutrition Project (P127949) Region AFRICA Country Africa Sector(s) Health (100%) Lending Instrument Emergency Recovery Loan Project ID P127949 Borrower(s) Implementing Agency Environmental Category B-Partial Assessment Date PID Prepared 18-Aug-2011 Estimated Date of Appraisal Completion 12-Aug-2011 Estimated Date of Board Approval 15-Sep-2011 Decision I. Project Context Country Context The proposed regional grant would help finance costs associated with addressing the emergency health and nutrition needs in the Horn of Africa. This humanitarian crisis is a result of the worst drought in 60 years and has yielded a severe food crisis. While the current famine declaration only pertains to Somalia, large parts of Ethiopia and Kenya also are experiencing severe food insecurity, as a result of drought and high food prices, and also increasing inflows of refugees fleeing catastrophic conditions in Somalia. The proposed project will contribute to the overall on-going international response through the provision of complementary resources for emergency health and nutrition interventions to vulnerable populations in targeted refugee areas in Kenya and Ethiopia. Outcomes expected to be achieved through activities supported with IDA financing include the treatment and prevention of malnutrition and infectious diseases (including respiratory tract infections, diarrheal disease, and malaria) among children, in addition to nutritional and micronutrient support for pregnant or lactating women. Public Disclosure Copy II. Sectoral and Institutional Context The drought in the Horn of Africa has yielded the most severe food crisis in the world today. Over 12 million people are severely affected and in urgent need of humanitarian aid across Kenya, Ethiopia, Somalia, and Djibouti. Two consecutive poor rainy seasons in this sub-region have resulted in one of the driest years since 1950/51 in many pastoral zones, and there is no likelihood of improvement until at least 2012. The crisis has been escalating dramatically in recent months. The estimated figure of affected people in the Horn of Africa has increased by nearly 40 percent between March and July 2011. As previously noted, although famine has only been declared in Somalia, large parts of Ethiopia and Kenya are experiencing both severe food insecurity and increasing inflows of Somali refugees. Over the past six months, an estimated 25 percent of Somalia#s 7.5 million population has been displaced, either within Somalia or to neighboring countries (primarily Kenya and Ethiopia). Unable to receive assistance in the most heavily impacted areas of Somalia, people are being forced to travel long distances under difficult conditions. As a result, Somali refugees# and particularly women and children # are arriving in camps in Kenya and Ethiopia in urgent need of health and nutrition services. As of July 28, 2011, the daily arrival rate to Kenya and Ethiopia was 2,000. Given continued high arrival rates, the population of the Dadaab camp in Kenya has swelled to 391,014 by late-July 2011, granting it the dubious distinction of being the largest refugee settlement in the world. Ethiopia#s Kobe camp, which only opened in late-June 2011, has already reached full capacity. Given the sub-regional emergency context, refugee populations are overcrowding and overwhelming existing response capacity in Kenya and Ethiopia, given the pre-existing food security emergencies in both countries. The current food security emergency across the sub-region is expected to persist until at least 2012. The number of individuals in need of urgent humanitarian aid could increase by an additional 25 percent during this period. The areas of highest concern for the coming six months have been identified as southern and central Somalia; the north, south and south-east of Ethiopia; north-eastern and southeastern Kenya; and the refugee camps in Djibouti, Kenya and Ethiopia. By late-2011, food security levels in the worst-affected areas of Ethiopia and Kenya are expected to ease from "emergency" to "crisis" levels. However, the crisis in southern Somalia is expected to continue to worsen throughout 2011, with all areas of the south slipping into famine. As previously noted, the proposed project will contribute to the overall international response through the provision of financing for health and nutrition interventions to vulnerable populations in targeted refugee areas in Kenya and Ethiopia. Camps and their surrounding areas in Kenya and Ethiopia have been the destination of 98 percent of Somali refugees. III. Project Development Objectives To support the emergency response in targeted refugee camps in the Horn of Africa by expanding implementation of a health and nutrition package of services in targeted refugee camps, in a manner consistent with the sub-region's medium term human development goals. IV. Project Description Component Name Treatment and prevention of malnutrition and provision of basic health services. Public Disclosure Copy Project Management and M&E V. Financing (in USD Million) For Loans/Credits/Others Amount BORROWER/RECIPIENT 0.00 International Development Association (IDA) 30.00 Total 30.00 VI. Implementation The proposed project will be implemented by UNHCR, which is governed by the UN General Assembly and the Economic and Social Council (ECOSOC). The UNHCR Representation in Kenya and Ethiopia will be responsible for implementation of the project In the UNHCR country office, the senior management, the programme officer and the technical staff for health, nutrition and WASH will coordinate and monitor the implementation of the project in the two targeted camps. The project will be also be partially implemented through sub-contracts with implementation partners, using the UNHCR standard Sub-Project Agreements. VII. Safeguard Policies (including public consultation) Safeguard Policies Triggered by the Project Yes No Environmental Assessment OP/BP 4.01 ✖ Natural Habitats OP/BP 4.04 ✖ Forests OP/BP 4.36 ✖ Pest Management OP 4.09 ✖ Physical Cultural Resources OP/BP 4.11 ✖ Indigenous Peoples OP/BP 4.10 ✖ Involuntary Resettlement OP/BP 4.12 ✖ Safety of Dams OP/BP 4.37 ✖ ✖ Public Disclosure Copy Projects on International Waters OP/BP 7.50 Projects in Disputed Areas OP/BP 7.60 ✖ VIII.Contact point World Bank Contact: Sheila Dutta Title: Senior Health Specialist Tel: 473-8390 Email: sdutta@worldbank.org Borrower/Client/Recipient Name: Contact: Title: Tel: Email: Implementing Agencies Name: Contact: Title: Tel: Email: IX. For more information contact: The InfoShop The World Bank 1818 H Street, NW Public Disclosure Copy Washington, D.C. 20433 Telephone: (202) 458-4500 Fax: (202) 522-1500 Web: http://www.worldbank.org/infoshop Public Disclosure Copy