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RNA in Gulan Refugee Camp Khost province Final Report (June 2015)


In June 2014 thousands of families from Pakistan fled North Waziristan region in Pakistan to Khost and Paktya Afghanistan. Due to this huge influx of population displacement and movement of residents of Waziristan region in Pakistan the government of Afghanistan at provincial level established the refugee camp in Gurbuz district, Gulan area, near the border with Pakistan. It is estimated that there are currently 54,5821 individuals living in Gulan camp.

The camp is located approximately 20 km from Khost city. There is still an influx of population movement into the camp from Pakistan due to the on-going tensions and military operations by the Pakistan military in Waziristan region. This Rapid Nutrition Assessment (RNS) covers the total population of the camp. It is worthy to note that officially the camp was not divided into any zones but for the purposes of this assessment, data from Solidarities International has been acquired for stratification of the camp into zones to ease the sampling (as shown in Figure 1 below). The criterion for zoning the camp was based on Solidarities International’s current WASH activities.


Geographic target area and population groups
The target population of this assessment was families with children 0 to 59 months living in Gulan camp, in Khost province. However, the data was analyzed and the results presented only for children 6 to 59 months for the benefit of programming.

Survey organisation and team
The assessment took place right after a larger SMART survey carried out in 3 districts inKhost. The assessment was conducted by the same team from the SMART survey who received a 7-day training on data collection and standardization test. Data collection took three days, from 21st to 23rd 2015.

Survey design
The assessment was a cross-sectional transversal study with two stages cluster sampling.

The procedures of segmentation were used when necessary.

Sample Size
As per the RNA methodology for Afghanistan, a minimum sample size of 200 children from 6-59 months was fixed to get meaningful results with acceptable precision. . The sample also needs to be reached through collecting information from a minimum of 25 clusters out of 8 zones targeted in the assessment. The number of households per cluster was adapted following the reference percentage of under-5 population for Afghanistan, which was 15.6%2 . Therefore option “B” from the explanatory box below was used for selecting
the HH sample size for this RNA.

A. When the percentage of children under 5 is below 15%, 25 clusters of 12 households have to be selected
B. When the percentage of children under 5 is above 15%, 25 clusters of 10 households have to be selected

Key findings: 

The GAM rates defined by WHZ<-2 Z-scores can be classified as “serious” according WHO 2000 threshold classification of severity of the situation4 . Moreover, the rate of MUAC <125 mm confirmed the possible existence of critical situation. These high rates of acute malnutrition are combined with the high stunting rate (above 35%) which is an additional factor suggesting decreased resilience and increased risk of mortality and morbidity.

About 54.5% of the children were found to be both stunted and having low MUAC while 28.9% were found to be both stunted and wasted. A total of 18 children were presenting signs of all three indexes.

The results also indicated a high occurrence of diarrhea and acute respiratory infection/cough. About 30.21% of the children had an episode of watery diarrhea and 25.92% had an episode ARI/cough, two weeks prior to the survey. Around 15.17% of the children reported of having symptoms of both ARI and diarrhea.

The measles vaccination coverage was found to be extremely low in the camp. Only 28.67% of children above 9 months were immunized against measles. These rates fall far below the recommended Sphere 2011 minimum standards of 95%. This could increase a substantial risk of measles outbreak, especially in the camp where lack of access to the basic hygiene was observed.
Poor WASH practices (including open defecation) were also observed in zones of the camp.The access to health services was also limited, especially with the increased influx of
refugees and the limited number of facilities offering health services compared to the needs. Some of the respondents reported that they tried to seek health services in Khost
city (21 km away from the camp) but a high number of respondents reported of having difficulties to access such services due to the distance and also due to lack of
transportation between the camp and the city.

To best of our knowledge, there was no prior nutrition survey or assessment done in the camp (at least in the past year), to which the present results could be compared to. Therefore, given the serious severity of the situation, it is very relevant to establish a regular surveillance in the camp to monitor the situation. A second round of RNA is, therefore, proposed to be carried out in February 2016 in order to closely monitor any changes in the nutritional situation of the population in the camp and also to analyze how the trends of acute malnutrition evolves in the coming months.

Assessment Report: 
Assessment Questionnaire: 
Publicly Available
Assessment Data: 
Publicly Available
Assessment Date(s): 
09 Jul 2015
Report completed
Population Type(s): 
Leading/Coordinating Organization(s): 
Action against Hunger
Participating Organization(s): 
HealthNet TPO
Other location: 
Gulan Refugee camp