February 1998 Issue 6 Field Exchanges3.ennonline.net/attachments/1653/FEX-6.pdf · February 1998 Issue 6 Field Exchange Network Special Focus: South Sudan Wild Foods Targeting Food

February 1998 Issue 6

Field ExchangeEmergency Nutrition Network

Special Focus: South Sudan

Wild Foods

Targeting Food Aid to Women

Sudan Vulnerability Study

HIV and Infant Feeding

Special Focus • Co-ordinating a Humanitarian

Response in Sudan . . . . . . . . . . . . . . . . 4• Making Famine in Sudan . . . . . . . . . . 6

Field Articles• Partnership and Disaster

Response . . . . . . . . . . . . . . . . . . . . . . . . . . 12• An Ongoing Omission:

Adolescent and Adult Malnutritionin Famine Situations. . . . . . . . . . . . . . 19

• Is Targeting of Food AidDirectly to Women anAppropriate Response?. . . . . . . . . . . 22

• Supplementary Feeding inMandera: The RightIntervention? . . . . . . . . . . . . . . . . . . . . . . 26

• Wild Foods . . . . . . . . . . . . . . . . . . . 3 & 16

Research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8• Measuring Hunger in the Russian

Federation• Improving the Efficiency of Food

Aid• The Southern Sudan Vulnerability

Study• Full Recovery Means More Than

Nutritional Recovery• The Changing Nature of Livestock

Raiding and its Role in Famine• Targeting Emergency Food Aid –

Experience in Ethiopia• Dietary Treatment of Severe

Malnutrition in Adults

News & Information . . . . . . . . . . 14 & 18• Solar Cookers come to Loki• Nutrition Survey in the DPRK• HIV and Infant Feeding – A

Programme Challenge• New Humanitarian Assistance at

Tufts University• Workshop Announcement• New Web Site by Lille University

Letters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Agency Profiles. . . . . . . . . . . . . . . . . . . . . . 24• SUPRAID• SRRA

Evaluations . . . . . . . . . . . . . . . . . . . . . . . . . . 28• Task Force Review• Pilots the Unsung Heroes• WFP Assessment Mission

People in Aid . . . . . . . . . . . . . . . . . . . . . . . . 29• Pilots – the Unsung Heroes• Photo Gallery

The Backpage . . . . . . . . . . . . . . . . . . . . . . . 31

Contents

Lecteurs de Langue Française!Nous souhaitons avoir vos commentaires,

questions et surtout vos comptes rendus en français.

N’hesitez pas a nous envoyer vos textesen francais et nous en ferons la traduction.

A vos plumes !

Dear readers

This issue of field exchange heralds the second phase of the ENN. Our firsttwo years appear to have been sufficiently successful to prompt continuedsupport and participation from partner agencies and donors. In order to

launch the second two year phase of the ENN Fiona O’Reilly visited Nairobi tomeet many of the agencies working in East Africa. This was an interesting anduseful trip in that it brought more agencies and personnel into the networkwhile informing the ENN about the types of emergency programme currently beingimplemented in the region. More field trips will be undertaken in future. Wewould like to thank all those who took time out of busy schedules to talk withFiona about your projects and will be following up with many of you to encourageyour contributions to Field Exchange on project experience.

This edition of field exchange highlights the southern Sudan 1998 crisis. DavidKeene provides an historical and political analysis of events leading up to thesouthern Sudan crisis. Paul Murphy and Peter Salama wrote an overview of thecrisis and resulting interventions focusing in particular on the difficultiesaround co-ordinating the humanitarian response. There is also an article aboutthe inattention to providing emergency selective feeding programmes specificallyfor severely malnourished adolescents and adults in southern Sudan The authors,Steve Collins and Peter Salama, analyse why there is a history of neglecting thespecific nutritional needs of this demographic group during acute emergencies.Another field article by Cassandra Chapman describes the evolution of generalration distribution methods in southern Sudan and the gradual, and generallysuccessful move towards targeting general rations to women.

Our research section includes the SCF vulnerability study in southern Sudanwhich gives us a better understanding on how the Dinka themselves definevulnerability and the implications for targeting food aid resources - aperennially difficult issue in the context of southern Sudan. This study, in linewith another piece by Kay Sharpe on targeting experiences in Ethiopa alsoincluded in this edition of Field Exchange, pragmatically advocates self-targeting within communities but area selection by ‘objective’ outsiders.Caroline Gullick writes about the importance of wild foods and addresses head onwhat she sees as many of the myths and stigmas associated with these foods. Shealso provided the wild food photos for which we added colour inside pages toField Exchange in order to do them justice

We have two evaluation pieces in this edition. The first is the SRRA-OLS TaskForce Review of the southern Sudan intervention while the second is a WFPNutrition Assessment which focuses on the nutritional adequacy of the emergencyfood aid ration allocated during this emergency.

Our two agency profiles are on agencies working in southern Sudan - SUPRAID andSRRA.

Finally, although the vast majority of this edition of Field Exchange isconnected with southern Sudan, there are some un-related pieces. For example, wehave an article by Tracy McGhee on SCF’s response to the recent floods inBangladesh where the experience of mounting a response through local partners ishighlighted. Another article by Lourdes Vasquez examines the MSF Spain strategyof prioritising selective feeding programmes in Mandera, north east Kenya. Theauthor asserts that the area has been in the grip of a chronic multi-causalnutritional emergency for a number of years and that nutritional security cannotbe addressed through feeding programmes alone. Implications for emergency feedingguidelines are clearly spelt out. Enjoy this issue of Field Exchange and lookout for yourself on the back page. Once again thanks to all who facilitated me(Fiona) in Nairobi.

Looking forward to reactions and correspondence on this issue. Pictures alwayswelcome. If you write do send a picture of either yourself or something to dowith your article.

Editors,

Fiona O’ReillyJeremy Shoham

Wild Foods

ENN, Field Exchange, February 99 — Page 3

From the top:Digging for tubers – Collecting leafy greens – Childrenusing long poles to knock figs from the tree – Collectingwater lily seed – ‘Thou’ kernels being used as a savouryfood – Dried fruit ‘Dhiot’ (Nandea Latifonda) made intocakes and sold in the market – Women Collecting ‘dhiekdhietz’ leaves (Pterocarpus Lucerus). The leaves have amucilagineous sap which gives the food a slimy texture,a recognised way of easing ingestion of accompanyingfoods.

For more on wild foods see page 16.

Special Focus

Page 4 — ENN, Field Exchange, February 99

THE 1998 FAMINE IN SOUTHERN SUDAN:

Tragically, 1998 has now been added to thecatalogue of Sudan’s history of recurringhumanitarian crises. Southern Sudan yet

again became a focus of attention for theinternational community and its media. Themagnitude of the crisis, in terms of both thepopulation size and geographical coverage wasstaggering, with up to 2 million people considered atrisk, i.e., dependent on some form of externalassistance to survive. Furthermore, the complexnature of the emergency, both politically andlogistically, required a response from theinternational community that was not only massivebut also well planned, co-ordinated and cognisant ofthe possible unintended harmful consequencesoperating in such an environment can produce. Over50 organisations, the majority members of theUnited Nations led consortium Operation LifelineSudan (OLS: a tripartite agreement for humanitarianaccess between the UN, the government, and rebelmovements), as well as a growing number ofagencies operating outside of the formal UNframework, contributed to the humanitarianresponse. This task was fraught with difficulties,some of which were external and therefore outsidethe influence of the humanitarian programme, whileothers were linked to its inherent structure andrelations. The following highlights some of the keypoints relevant to the background of the crisis; to the

humanitarian response that ensued, particularly as itrelates to the Bahr el Ghazal region; and how themechanisms for co-ordination and setting of standardsfared under the stress of such a large scale operation.

Background to the CrisisOne of the key determinants of the currenthumanitarian crisis is the civil war betweengovernment forces, the Sudanese People’sLiberation Army (SPLM/A), and southern groupingsloosely aligned to the government of Sudan. Theroots of the conflict are found in a dispute over theidentity of the Sudanese state; over issues ofgovernance of the south, central and eastern regionsof the country; and over control of its naturalresource base and economic system. The conflict isfuelled by local ethnic divisions and interests, whichhave often been manipulated by political andmilitary elites on all sides, in an attempt to garnersupport for territorial and ideological objectives.Even before the war, the basic economy of southernSudan constituted subsistence production, withfarmers selling their surplus for cash in good yearsand using a variety of other livelihood strategies toreduce vulnerability to recurrent drought and fooddeficit. The delicate livelihood systems, which varygreatly according to specific locations, encompasseslivestock, agriculture, fishing, wild foods and tradepractices. However, due to the violent politicaldispute, these livelihood systems are experiencing

frequent stress. The past few years in particular have seen anintensification of these shocks upon livelihoods,culminating in widespread malnutrition andmortality among the civilian population.Characteristics of the crisis, and typical of thefactors that have undermined the ability of people tosurvive adequately, include:• Looting and deliberate crop destruction which, in

combination with three consecutive years of poorcrop harvest (floods of 1996, drought of 1997,and flooding again in 1998), have caused anincrease in both the severity and duration of thehunger gap in recent times.

• Curtailment of trade routes and exchangerelationships.

• Military attacks on areas of populationconcentration.

This has resulted in:• Abandonment of agriculture and loss of key

assets such as cattle and goats.• Reduced sources of secured storage.• Displacement of people and increased abnormal

migratory patterns: up to 4 million are estimatedto have been internally displaced.

• Loss of technical expertise and educationfacilities generally.

• Ill health and lack of adequate health services.

Co-Ordinating a HumanitarianResponse in Sudan

Paul Murphy, Regional Policy Adviser, Nairobi CONCERN and Peter Salama, Emergency Medical Co-ordinator, Dublin CONCERNprovide an overview of the 1998 crisis in south Sudan and the humanitarian response.

A man unloading a sack of ‘Super Unimix’ – aprotein-rich nutritional supplement – suppliedby UNICEF, from a World Food Programmeplane.UNICEF/HQ97-0751/Radhika Chalasani

Special Focus


As a consequence, livelihood resilienceand food security have deteriorated on achronic basis, while removing availableopportunities to recover from extremeforms of stress.Among the most visible signs of thecrisis in 1998 was the prevalence of acutemalnutrition in many areas, especially inBahr el Ghazal. For example,malnutrition in some of the acutelyaffected sites such as Ajiep and Panthou(Gogrial county), were reported to be inthe region of 80% and 70% respectively(Epicentre survey, August 1998). Repeatassessments in September/October,despite intensive inputs, showed that theprevalence of global malnutrition inAjiep was persistently high (48%). Rapidassessments in other areas indicated thatlevels of malnutrition were abnormallyhigh throughout Northern Bahr el Ghazal(e.g. 30% wasting in the county of AweilWest County). Alongside this went veryhigh crude and under five mortality rateswith CMRs as high as 20-30/10,000/daybeing recorded frequently in the earlystages of the crisis. What shocked manypractitioners and commentators was how quickly thesituation seemed to have deteriorated and how theestimated number of at risk people went fromthousands to almost two million in less than sixmonths.

An Evolving Humanitarian ResponseGiven the existence for over nine years of ahumanitarian response mechanism for southernSudan (OLS), some have questioned - includingthose who were part of the crisis response - whether‘the assistance community could have detected thetragedy developing sooner; reacted more quickly;and responded more effectively’. The answershowever are complex and deserve greater, andperhaps more distant reflection than thisintroduction offers. The decline in livelihoodresilience, mentioned above, was essentially theprecondition. In particular, the presence of agovernment backed warlord-type commander,Kerubino Kwanyin, who had inflicted terror andwidespread displacement in northern Bahr el Ghazalfor the previous 2/3 years, was significant. Poorreturns on the harvest for two consecutive years hadalso negatively impacted on the food securitysituation. Other factors that contrived to intensify thecrisis included the defection of the same renegadeleader (Kerubino) to the SPLM/A and thesubsequent unplanned attack his forces launched onthe government garrison town of Wau. This actprecipitated civilian deaths and further displacement.Restricted aircraft access by the Government ofSudan during the months of February and March,effectively blocked humanitarian assistance at acritical time. Finally, the humanitarian programmescaled up at a time when access to Sudan wasproblematic, both in terms of the effects of heavyrains and flooding, the availability of aircraft overdemand, and restricted access. The conditions oftendefeated the very best of available logistics.By March, a sharp slide in the nutrition status hadcommenced, but its pace and intensity wasinterpreted differently by the humanitarian actors onthe ground. Early projections of a crisis on a largescale were being heard. Some members of theinternational media picked up these messages andran with them. Other agencies argued againstsimplistic interpretations, and stressed the oftenunacknowledged coping mechanisms peoplepractice and how they should be strengthened. By May, the crisis was ‘visible’ in certain areas andstress clearly evident. Throughout this time, the at-

risk numbers estimated by WFP rose monthly, andthe same organisation launched the largest foodairdrop in history, with 17 aircraft aiming to deliverup to an average of 15,000 MTs of food per month.A scramble to obtain emergency seed inputsintensified in June, spurred by the late arrival of therains and therefore an unexpected extended lead-intime to distribute. The other mainstay of thehumanitarian response was selective feeding: at thisstage, a small number of agencies (mostly thosewith a presence already established on the ground),were addressing a rapidly growing nutrition problemthrough feeding interventions. By July, the famine was advanced and the scale ofthe problem was acknowledged widely among theassistance community, though there were growingdifferences of opinion over the quality of dataavailable and the design of the emergency response.A number of agencies admitted for the first time thatthey were not coping with the size of the problem,and the task of matching additional resources withgrowing need was problematic. New agencies wereappearing on the scene and other already establishedones were offering their services to assist inemergency nutrition rehabilitation. General rationdistributions had been substantially increasedhowever, though targeting mechanisms came understress as the project expanded. By September, the programme had massively scaledup and a vast quantity of resources was beingdelivered. Sudan was a flurry of aid agencies. ByNovember, early signs of improvement were evidentand the agencies who had been advocating exitstrategies for emergency interventions werebeginning to be heard. By December, the situationwhile fragile, was stabilising in many areas.

The Burden of Co-ordinationDespite the obvious successes and the impressivestatistics that generally focus on indicators such asamount of food delivered and number ofbeneficiaries targeted, there were many problemswith the humanitarian response. The practicalconstraints facing implementing agencies wereindeed monumental, but the quality of the responsewas uneven. For instance, a lack of rigorousassessment and analysis often led to standarduncritical responses without adequate recognition ofthe lack of homogeneity from one location to thenext. In Bahr el Ghazal region alone, 45supplementary and therapeutic feeding centres wereestablished reaching some 35,000 beneficiaries. Theagencies reacted as rapidly as they could,responding to the familiar blend of obvious need;

media attention; encouragement from the OLSconsortium body and, in many cases, pressure fromtheir own head offices to mount a high profileemergency intervention (most typically, selectivefeeding for children). The number of agencies thatstruggled over what was an appropriate interventionto mount was striking. This led to argumentsbetween, but mostly within agencies.A common criticism cited was the lack of adequateco-ordination, always a target for post-mortemassessments. The principal delivery mechanism isOLS, which began in 1989. UNICEF serves as itslead agency in southern Sudan and had theformidable task of co-ordinating over 40 separateorganisations in the south. This is a very difficult ifnot near impossible task considering not only thesheer number of agencies involved, but also thecrucial differences between them. These include forexample, levels of professionalism, areas oftechnical expertise, attitudes towards advocacy andfinally towards relations with official localcounterparts, principally the Sudan Relief andRehabilitation Association (SRRA) and the ReliefAssociation for South Sudan (RASS): bothhumanitarian wings of the insurgent movements. Relations with local counterparts deserve particularattention when addressing the effectiveness of co-ordination. In many respects, the humanitarian crisisand the subsequent international response eclipsedthe capacities of indigenous humanitarian agenciesand accentuated the weaknesses inherent in theirorganisations. Take the SRRA: essentially a(humanitarian) part of the SPLM, which as a rebelmovement lacks formal international recognition andlegitimacy. Yet the SRRA is the official point ofcontact for agencies operating under SPLM/Acontrol. The fact that the SPLM is introducing acivil administration, and transferring powers fromSRRA to them, further complicated the co-ordination relations among the players.The position of individual agencies, vis à vis theSRRA for example, differed greatly. Some withinOLS distance themselves, reluctant to acknowledgetheir role as partners in the humanitarian response:wary of compromising their professed neutrality.The diversion of aid, another controversial issueduring the crisis and which deserves a separateanalysis, deepened the rift between someinternational agencies and the counterparts. Othersargued differently, that although the SRRA has itsproblems, particularly in terms of resources andcapacity, it is only through constructive engagementthat such an organisation can build its capacity toassist in co-ordination, improve its accountability

Nuer Cattle-camp, Koch,

upper Nile(Anne Nosten)

and represent the community more effectively.Finally, there were those who appeared unsure whattheir position was towards counterpart organisations.The lack of a consistent and constructive approachhas had its impact on co-ordination and the creationof a problem solving environment in theprogramme.Similar variances exist among agencies operatingoutside of the OLS framework. Some agencieschoose to be outside the OLS umbrella because itallows greater flexibility, especially in reachinggeographic areas that lie outside the UN agreementand consequently receive far less resources andservices from the international community (e.g. theNuba Mountains). These agencies may still co-ordinate closely with OLS both informally andformally. Other agencies prefer independence as aconsequence of their mandate, e.g. ICRC, while afew make no apology for their explicit support ofthe people of southern Sudan and indirectly ordirectly, the SPLM/A. There is in fact very little that binds the non-OLSorganisations together and the extent to which theyco-ordinate with each other andthe OLS consortium dependsvery much on individuals andvaries from agency to agency. Onthe other hand, save for security,ready access to OLS flights (until1999), and regular meetings,there appears little more thatbinds the OLS agencies together. Another tendency found amongNGOs with particular technicalknowledge and long-standingexperience in emergencies, is thatthey consider rightly or wronglythat they have superioroperational expertise to the co-ordination agency, and aretherefore reluctant to submit toany genuine co-ordination. Thescale and complexity of theprogramme has placedunderstandable pressure on itsoverall co-ordination function and has contributed toperceptions that OLS co-ordination lacks sufficienttechnical authority to be able to conductcomprehensive assessments, effectively direct NGOsto areas of greatest need, monitor and evaluate NGOprogrammes, and advise them on how to improve ifnecessary. The result is that despite a lot of time andresources spent on co-ordination, many NGOs stillguard their autonomy jealously and go largelyunregulated. This introduces another dominant and controversialtheme raised by the 1998 crisis: the issue ofminimum standards. Most agencies currentlyworking in southern Sudan have expressed acommitment to minimum standards in emergencyintervention by either publishing technicalguidelines and recommendations or subscribing toinitiatives such as SPHERE1. The experience ofhumanitarian intervention in Sudan clearly bringswith it an important message for the steeringcommittees of bodies like SPHERE. Without anindependent technical body of authoritativeexpertise with a mandate to monitor and evaluateNGO performance, as well as mechanisms toenforce standards, these initiatives may not have thedesired effect of fixing shared norms in emergencyresponses. Once faced with difficult operationalcircumstances, there is a risk that standards oncedescribed as minimum become optimal or evenunrealistic in the minds of practitioners. Sudan, as ithas so often done in the past, again posed achallenge for many NGOs as the line between‘contextualisation’ and below standard performance

became obscure. A frequently cited example of the costs ofinadequate co-ordination on both strategic andoperational levels in southern Sudan in 1998, wasthat of Ajiep in northern Bahr el Ghazal. Ajiep wasquickly described as the epicentre of the famine,received a great degree of media attention andmaterial inputs and became an important touchstonefor the humanitarian response. The population ofAjiep swelled from approximately 3,000 to 21,000in the course of the crisis. The reasons for this werecomplex but included the relative degree of securityand the intensive inputs brought into the area: i.e.general food ration, selective feeding interventions,blanket feeding and health services. Rates of global malnutrition reached 80% andreported crude mortality rates were amongst some ofthe highest ever recorded. The adverse operationalconditions in Ajiep (flooding) put additional strainon the few agencies based there. Despite massiveinputs in Ajiep and perhaps to some extent becauseof them, mortality rates remained unacceptably highfor some months into the crisis. The general ration

was adequate in terms of absolute number ofbeneficiaries targeted and content, but it was clearafter some weeks that many of those families whomost needed it were not gaining access to a fullration. The coverage of selective feedingprogrammes remained low for too long andsanitation concerns were not addressed quicklyenough. An epidemic of shigella (sd1) dysenterycompounded the problem in July and August,resulting in further loss of life. According to the OLS Annual Needs Assessment2

for 1998, poor coverage by the humanitarianagencies and the lack of early funding impeded aswift response. The view of the SRRA AnnualAssessment Report3, is that UNICEF as thedesignated lead agency failed to effectively co-ordinate and monitor feeding programmes in Bahr elGhazal. This report also goes on to lament the factthat the SRRA also failed in its co-ordination andfacilitation duties, but contends that these failureswere partially due to a lack of resources and a lackof formal recognition in a binding agreement of itsdeclared mandate.

Tragically, the crisis is not over. 1999 threatens tobring similar conditions for the many Sudanesepeople at risk. However, it is possible that withimproved strategic planning and better operationalco-ordination, the effectiveness of the humanitarianresponse will be enhanced and situations like theone described above will be mitigated moreeffectively in the future. There are lessons to belearned.

Special Focus


Airport in Lokichockio(Logistic base for southSudan in Kenya) (Fiona O’Reilly)

In the post-independence period (and to a largeextent under British rule, political and economicpower in Sudan has been concentrated in the

hands of a northern minority. Particularly afterindependence, this elite has been able to manipulatetraditional religious loyalties to maintain its ownhold on political power and its near monopoly onthe most profitable commercial enterprises. Particularly when suppressing rebellion, divide andrule has been a key tactic for financially strappedgovernments (including the British) attempting toassert control over the largest country in Africa.After the Addis Ababa agreement that ended thefirst civil war in 1972, protection for the peoples ofsouthern Sudan was dangerously dependent onNimeiri’s manoeuvrings in Khartoum. This systemof protection fell apart in the late 1970s whenNimeiri began to reconstruct his power base turningaway from the south and towards Islamicfundamentalist interests and the Umma andDemocratic Unionist Party (DUP). The militarygovernment of Nimeiri faced a growing threat fromthe supporters of these traditional parties fromIslamic fundamentalists as well as an economiccrisis that encouraged him to step up attempts atextracting resources, notably oil from the south. The old tactic of divide and rule was revived oncemore, this time in its most vicious and destructivemanifestation. Critical to this strategy in the early1980s was Khartoum’s policy of turning thepolitically restive and increasingly well-armedwestern Sudanese Baggara against the south. Many Baggaras access to grazing had been hit by amajor expansion of mechanised farming in southernKordofan and (to a lesser extent) southern Darfur inthe 1970s and 1980s. Drought in the 1970s andearly 1980s added further pressure on Baggaragrazing. Meanwhile, the prosperity of significantnorthern groups came to depend increasingly ontheir ability to exploit the resources of the south(whether these took the form of land, cheap labour,cheap livestock or cash exchanged for northerngrain).Partly in order to cut off Nimeiri from his politicalsupport in the south, the northern parties pressurisedhim into abrogating in 1983 the Addis Ababaagreement. Crucially, oil revenues were now to goto central government. This helped to prompt arebellion in 1983. Facing pressure to repayescalating international debts and unable to afford alarge, salaried army, the Sudan government resortedto a strategy of turning the dissatisfaction ofeconomically marginalised Baggara against theDinka. In these circumstances the arming andencouragement of Baggara militias offered centralgovernment a cheap means of quelling southernopposition. The government provided militias withimmunity to prosecution for theft, killings and otherviolations of the law. Partly through inducing man-made famine, the useof Baggara and Nuer militias in particular offeredthe prospect of depopulating oil-rich lands anddecimating the Dinka, who were seen as theprincipal supporters of the rebel SPLA. The militiastrategy also offered an opportunity to confuse theinternational community and to deflectrecriminations away from the Sudan governmentitself. Increasingly through the 1980s the rebellion came

Making Faminein Sudan

1 The Sphere Project is a programme of the Steering Committee for Humanitarian Response (SCHR) and Interaction with Voice, ICRC andICVA. The Sphere project is responsible for the production of the Humanitarian Charter and Minimum Standards in Disaster Response,ISBN: 92-9139-049-6.2 SRRA Annual Needs Assessment Report, 1998/99, November 1998.3 OLS Annual Needs Assessment November 1998.

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to be used by a coalition of politicians, traders,soldiers and discontented Baggara to portray theDinka and the Nuba and other non-Arab groups asrebels and as people who could legitimately beattacked, exploited and deprived of relief. Raids onthe Dinka, Nuba and other ethnic groups oftenpreceded and precipitated affiliation with the SPLA.The desire to exploit Sudan’s oil reserves was acritical factor both in alienating the south and inmotivating northern militia attacks on southernSudanese. Following the discovery of oil in 1978,the idea of a ‘Unity Region’ was proposed ingovernment circles. This region was intended toembrace the major oil-rich areas of Bentiu andGorgrial councils in the south and Abyei areacouncil (where additional oil deposits had beendiscovered) and some other parts of southernKordofan. Precisely those areas (together with thegarrison towns of Aweil and Wau which served as arefuge for those displaced by militia attacks) werethe most severely affected by famine in 1986-8. Thiswas more than a coincidence. The policy of using militias to create famine led tomore immediate economic benefits. These includedthe profits from escalating grain prices and fromplummeting livestock and labour prices. A furtherset of economic gains from violence centred onmechanised farming interests in areas subject toattack and depopulation (such as Renk and the NubaMountains). Prominent among the beneficiaries ofland ‘clearances’ have been traders and armyofficers.Famine was a political, military and economicweapon for the government of Sudan and itscoalition of allies in civil society. In Sudan, thepattern of famine relief – concentrating on refugeecamps in Ethiopia and on government garrisontowns in the south – tended to assist the Sudanesegovernment’s attempts to depopulate parts of thesouth (notably, the oil–rich areas).With backing from Mengistu in Ethiopia, Garangwas able to unify these ethnic militias to a largeextent. However, when Mengistu was toppled in1991 and Ethiopian support was withdrawn from theSPLA, the southern coalition rapidly unravelled. Divisions within the south were growing. In 1993,African Rights described the SPLA as “essentially acoalition of ethnic militias - a fact disguised by itsnational political aspirations”. The removal of theprotection from Ethiopia (and the active co-operation between the Ethiopian and Sudanesegovernments) posed particular dangers for SPLAforces and commanders near the Ethiopian border.These new dangers came on top of a growingresentment within the south at human rights abusesby the SPLA and at the slowness of progresstowards democratising the SPLA as it consolidatedits administration over much of southern Sudan. Abreakaway faction under Riek Machar was formedin Agust 1991. The ‘SPLA mainstream’ underGarang was the dominant faction in Bahr el Ghazal,Equatoria and part of Upper Nile. Riek Machar andhis ‘SPLA United’ also known as ‘the Nasir faction’and the South Sudan Independence Movement orSSIM attracted support from the Nuer in UpperNile. Just as the government has consistently targetedcivilians, this pattern has been repeated in fightingbetween factions in the south. These have repeatedlyattacked civilian populations affiliated with their

opponents – both to reduce support for theopposition and to get supplies for their own soldiers.The split in the SPLA had apparently removed someof the previous restraint on the Nuer–Dinka tensions

that had been achieved with the Anyanya 11–SPLApact of 1987. It is widely believed that all of the‘SPLA’ factions except Garang’s Mainstream SPLAhave, at some point, received arms form theKhartoum government. From the mid–1990s, the military balance in Sudanbegan to tilt back in favour of the SPLA and theother armed groups participating in the NationalDemocratic Alliance (NDA) which succeeded inbringing together the SPLA and northern politicalopponents of el Beshir’s military government. TheSudan Allied Forces of the NDA benefiting fromEritrean support became active across northernSudan from Ethiopia to Darfur. The Sudan Peace Agreement (SPA) of April 21 1997seems to have been an attempt by Khartoum todivide the opposition, to buy time for governmentforces that have suffered a series of militaryreverses, and to end the increasing isolation ofMachar. It also offered a distraction from thegovernment’s rejection of the peace processsponsored by the Inter-governmental Authority ofDrought and Development (IGADD). The Sudangovernment was apparently continuing with itsattempts to turn the North-South element in the warinto a South-South conflict by its strategy of armingand strengthening the forces of Machar and those ofKerubino, and indeed by including them in a peacesettlement. Kerubino had been a former political prisoner ofGarang, as well as second in command and SPLAfounder. He escaped at the end of 1992 and then

with assistance from Khartoum and Machar, heembarked, as Africa Rights puts it “ on a career ofdestruction and looting in Bahr el Ghazal”. Heconcentrated on looting relief food distributions andraiding civilians.Arming and strengthening such forces held out theprospect of liberating government forces for fightingin the far south and east, of blocking the SPLA’sattempt to push northwards through Upper Nile andBlue Nile provinces and of securing the oil fieldsaround Bentiu in Upper Nile. The SPA did not imply peace in northern Bahr elGhazal. A paramount concern for the Baggara hasbeen ensuring access to grazing and water, and thisappears to have prompted a partial reconciliationwith the SPLA from 1989. However, in July 1997,Baggara militias resumed raiding on the Dinka, withencouragement from Khartoum. The GoS (government of Sudan) has regularlybanned access to different air-strips. This is onlysupposed to be done on grounds of insecurity but inpractice the pattern of airstrip bans reflects thepolitical and military priorities of the GoS andfactions allied with it. In response to a major SPLAmilitary offensive in early 1997, Khartoum banned334 of the airstrips requested by UNICEF for March1997. The pattern of the bans was very significant.All except one fell in territory administered by theSPLA/M. There were no flights bans in the areacontrolled by Kerubino’s SPLA Bahr el Ghazalgroup, and only one in the area controlled by theSSIM.This discriminative banning was part of a broaderand continuing pattern of discrimination in aiddistributions. The Nuba Mountains and the SouthernBlue Nile have never been accessible to OLS relief.But the government has provided relief to displacedNuba in so–called ‘peace villages’, which have alsoserved as centres for the economic and sexualexploitation of the Nuba as well as militaryrecruitment into the Popular Defence Forces (PDF),created in 1989 as a co-ordinated governmentmilitia.The GoS has tried to isolate the Nuba Mountainsand Southern Blue Nile from all humanitarianassistance, and they have only had access to limitedand illegal cross-border efforts. In northern Bahr el Ghazal in March 1997 - beforethe traditional hungry season - aid workers foundacute malnutrition level in excess of 30 percent.MSF staff in the area reported that the degree ofstarvation was critical and the whole area was on theverge of a major disaster. The GoS had helpedcompound the effect of Kerubino on the localpopulation by banning the use of the C–130 (theonly plane viable for responding to the scale of theemergency) and by banning most airstrips in thearea where the war-affected displaced people wereliving. Selectively withholding aid has createdadditional pressures for southern factions to allywith Khartoum. By October 1997, on almost everyfront, government forces appeared to be in retreat,with army officers continuing to defect to the rebels,and garrisons increasingly cut off. After the fightingin Wau in January 1998, Khartoum banned allflights until the end of the March. Drought was alsocausing shortages in some area. However, as tenyears earlier, it was a largely man-made famine in1998 which appeared on the world’s televisionscreens.

David Keene, researcher and author of ‘The Benefits of Famine’gives the political history and context surrounding the crisis insouthern Sudan 1998.

Queueing in the PakorSupplementary Feeding Centre

(Wendy Stone)

Between February 1992 and May 1994 CAREUS responded to the health and food securitycrisis in the former Soviet Union by

establishing a survey unit whose task was to identifynutritionally vulnerable groups and to assess theirneeds. CARE conducted nutritional surveys inMoscow, St Petersburg and Ekaterinburg and theirsurrounding rural areas (Oblasts).The survey involved an assessment ofanthropometric and iron status and also used theRadimer/Cornell hunger scale to measure theprevalence of hunger. This scale was first used inNew York State in 1988 and 1993 to identifyhouseholds experiencing hunger defined in terms of“the inability to acquire or consume an adequatequality or sufficient quantity of food in sociallyacceptable ways or the uncertainty that one will beable to do so”. Figure 1 gives questions from thesurvey. A recently published article presents theSoviet Union survey results and compares thesewith those from the New York survey. Surveyfindings and value of the methodology are alsodiscussed.

MethodologyThe Russian study design was based on a cross-sectional representative sample of 4860 childrenunder 2 years of age. Two stage cluster samplingwas used in the cities and three stage sampling inthe Oblasts. Approximately 800 mothers werequestioned in each of six study sites. The surveyincluded questions on the socioeconomic status ofthe household, dietary assessment, anthropometryand the Radimer/Cornell hunger scale. The 12 itemsin the scale measured hunger at three levels:household, women, and children. If the motheranswered positively to one of the four items at aparticular level, hunger was established for thatlevel.

ResultsThe prevalence of hunger in the Russian Federationwas very high: approximately 77% of the womensurveyed, 70% of the households, and 32% of the

children were classified as hungry. Thecorresponding estimated prevalence of hunger inNew York State in 1993 were 46.8%, 25.9% and18.3% respectively. In both surveys children werethe least likely to be classified as hungry and, if theywere, their mothers and households were almostalways hungry. Basic indicators of householdsocioeconomic and demographic wellbeing werehighly related to the three levels of hunger. Thehigher level of hunger in the Russian survey can beexplained by the very low incomes. However, thenutritional measurements found less than 3% below-2 SD weight for age and 25% anaemia as measuredby a haemoglobin level of less than 11g/dl in undertwo year olds.

DiscussionThe authors postulated that the low prevalence ofchild underweight indicated that energy needs werebeing met while the high level of anaemia showedthat food quality was deteriorating. Mothersreported marked reductions in consumption of meatand fruit. The authors suggest that theRadimer/Cornell hunger scale may be useful inproviding early warning that dietary quality anddiversity in a population are worsening before frankmalnutrition (as measured by anthropometry)becomes prevalent and that this hunger scale seemsappropriate for measuring hunger in the RussianFederation.

Also, classifying individuals on the basis ofhousehold and individual hunger is a simple andstraightforward way of identifying those householdsthat would benefit from different kinds ofintervention. The authors concluded that the scaleshould be studied further as a rapid assessment orearly warning tool.

Measuring Hunger in the Russian FederationUsing the Radimer/Cornell Hunger Scale:K.J.Welch, N.Mock, and O.Netrebenko: Bulletin ofthe World Health Organisation, 1998, Vol 76 (2),pp143-148

Measuring Hunger in the Russian Federation

Summary of published paper.

% in Russian Federation

Cities Oblasts % in New York

Prevalence of household hunger 71.9 67.1 46.8

Household hunger items1. I worry whether my food will run out before I get money to buy more (qualitative) 56.3 58.6 39.02. The food I bought just didn't last and I didn't have money to get more (quantitative) 42.6 44.6 22.33. I ran out of the foods that I needed to put together a meal and didn't have money to get more food (quantitative) 42.5 41.9 29.64. I worry about where the next day's food is going to come from (qualitative) 54.0 50.2 13.2

Prevalence of women's hunger 79.1 75.0 25.9

Women's hunger items1. I can't afford to eat the way I should (qualitative) 70.8 66.3 22.62. I can't afford to eat properly (qualitative) 58.9 60.5 23.23. I am often hungry, but I don't eat because I can't afford enough food (quantitative) 11.9 11.9 9.84. I eat less than I think I should because I don't have enough money for food (quantitative) 28.2 24.9 14.8

Prevalence of children's hunger 33.3 29.8 18.3

Children's hunger items1. I can't afford to feed my child(ren) a balanced meal because I can't afford that (qualitative) 25.0 26.1 15.12. I can't afford to feed my child(ren) the way I think I should (qualitative) 29.7 28.0 26.93. My child(ren) is/are not eating enough because I just can't afford enough food (quantitative) 15.2 12.0 7.14. I know my child(ren) is/are hungry somtimes, but I just can't afford more food (quantitative) 2.8 2.6 8.5

Research


DANIDA recently financed a study toanalyse the impact of an earlier deskstudy carried out in 1991 on the

management and cost-effectiveness of Denmark’scontribution to WFP. One of the findings of the1991 desk-review was that a change in thecomposition of the Danish food basket providedto WFP would greatly improve the impact of thecontribution on the poor and their food security.The Danish food basket in the 1980s and early1990s contained canned meat, processed cheeseand peas. The earlier study showed that a foodbasket of basic commodities such as peas, maizeand soy flour would be able to feed many morepeople. Following consultation with WFP theDanish government supported a gradual change inthe food basket from animal commodities towardsmore basic, cost-effective commodities. However,the contribution was to continue to comprise oftwo thirds commodities procured in Denmark andone-third cash.

The 1991 study recommendations to change thefood basket and the resulting new food aid policywere met with strong opposition between 1992-5from the Agricultural Council of Denmark, theFederation of Meat Producers andSlaughterhouses and the Danish Dairy Council.Among their arguments was the idea that WFPneed protein-rich animal products for the foodbasket and that Danish commercial interestsshould also be taken into account in food aidpolicy. However, the Danish government heldsteadfast in its new policy direction.

The recent DANIDA study has shown that sixtimes more people were fed with Danish food aidin 1997 than in 1990 largely as a result of thispolicy change and that three times more proteinwas provided at unchanged total cost.

One concern voiced by opponents of the changewas the expected negative effect on incomeearning and employment in Danish agriculture.However, the 1998 study asserts that since Danishagriculture continues to be the sole source of foodfor Danish food aid, the sector did not loserevenue – although some sub-sectors have lostwhile others have gained. The main conclusion of the study is that theDanish government has achieved a six-foldincrease in the impact of Danish food aid to WFPfrom 1990-1997 even though the real value of theregular contribution has decreased slightly overthe period. The information that contributed tobringing about this dramatic improvement camefrom a desk study which cost the Danish Ministryof Foreign Affairs $16,000.

Ref:A Six-Fold Increase in the Impact of FoodAid: Denmark’s Contribution to the WorldFood Programme: Bjorg Colding and Per-Pinstrup Andersen (April 1998). [email protected]

Improving theEfficiency ofFood Aid Summary of report prepared withfinancial support from DANIDA, Ministryof Foreign Affairs, Denmark.

Figure 1

Research


Summary of published paper

Protein Energy Malnutrition decreasescellular immunity yet immune recoveryhas rarely been investigated during

nutritional rehabilitation. In a recent study, 110malnourished children from low income familiesof Cochabamba (Bolivia) with a mean age of16.9 months were hospitalised for 2 months inthe Centre for Immune and NutritionalRehabilitation (CRIN), of the German UrquidiMaterno-Infantil Hospital. They received aspecial four-step diet. Nutritional status wasdetermined by daily clinical examination andweekly anthropometric measurements. Immunestatus was assessed by weekly ultrasonographyof the thymus gland. The thymus glanddemonstrates certain pathological changes inresponse to immune deficiency secondary tomalnutrition.

FindingsThe classical criterion for discharge fromnutritional rehabilitation units in Bolivia (90% ofmedian reference weight for height) was reachedafter the first month, whereas a 2-month periodwas required for complete recovery of immunity.The children belonged to a poor populationgroup with high exposure to disease. In this typeof environment discharge based only onnutritional status after one month of treatmentcould explain the frequent relapses noted at theCRIN because the children were still immuno-depressed.

It was also noted that MUAC only reachednormal values after the second month at thecentre. There was a much better correlationbetween MUAC and thymic recovery thanbetween weight for height and thymic recovery.The study concluded that to prevent frequentrelapses and to reduce the high case-fatality ratesobserved in many rehabilitation centres,practitioners should consider immune recoveryas part of the management of severemalnutrition. For example, immunostimulatingfactors like zinc should be used to reduce thetime required for immune recovery. A previousstudy showed that physiological doses of zincsupplement during the 2 month CRINhospitalisation significantly reduced the immunerecovery period. As a result, anthropometric andimmune recoveries coincided so that the childrencould be discharged after only one month ofhospitalisation to face a pathogenic environmentwith confidence.

Reference:Immune Recovery of Malnourished ChildrenTakes Longer than Nutritional Recovery:Implications for Treatment and Discharge (Oct1998): Chevalier. R, et al, Journal of TropicalPaediatrics, Vol 44, pp 304-307.

Full Recoverymeans morethan Nutritionalrecovery

USAID have funded a study on vulnerability insouthern Sudan. This largely anthropologicalstudy was carried out between May 1997 and

June 1998 and is intended for the use of humanitarianaid workers. The final report describes the political,kinship, religious and economic structures amongst theDinka, before going on to look at the welfare structure,the circumstances surrounding vulnerability, andpossible ways of addressing that vulnerability inwelfare interventions. It ends with case study examplesof the situation on the ground (from the Paliau area ofnorth Bor and the Thiek Thou area of northern Bahr elGhazal) and concludes with a section on theimplications of the research for better reliefinterventions. The researcher spent eleven months collecting dataacross the seasonal calendar and acquiring fluency inDinka language. The methodology involved ‘observingrather than disturbing’ with much information gleanedfrom being present at court cases and local discussions,as an observer rather than part of the discussion or anactive question-asker. The main findings of the studywere as follows.Vulnerable individuals are defined in Dinka terms asthose without an adequate kinship structure to protectthem. Within the kinship system the unit that is mostsignificant is the ‘mac thok’ meaning the extendedfamily or specifically those who share in the bride-wealth contributions for the marriage of a daughter. Inthis unit there is unquestioning sharing of resources butthere are also obligations to the wider lineage group andto a much lesser extent to the unit (wut) that occupies apiece of territory and grazes cattle together.Understanding that there are groups among whomsharing is expected and groups between whomcompetition for resources is also expected, isfundamental when it comes to planning for equity inrelief distributions. Most distributions in the south take place at payamlevel (the administrative level below the county)through the wut chiefs. A chief at the lowest level onlyhas authority as a senior member of a group of relatedpeople - his lineage. This is the level at which a chief ismore accountable. Higher up the order of seniority, achief must represent (as a member of court and as adistributor of relief items) a group of unrelated peoplewho share common grazing rights and forms ofalliances by marriage. Aid agencies can choose theappropriate chief to represent different groups of peopleif they have a knowledge of the different degrees ofloyalty and impartiality he is expected to show thesegroups.The study found that in the past, targeting aid to thevulnerable reflected mainly the logistical and financialconstraints of the relief operation in the south. This hasbeen a ‘sham’, according to the study, as in most cases,where locals accepted the conditions outsiders put onthe relief, they subsequently redistributed it to allsections of the population who then redistributed itwithin their lineages to those who were most in need.The researcher found that at a higher level in thecommunity, it was strongly felt that aid should bedistributed to all lineages in the area fairly (according totheir numbers rather than their absolute need), so thatthey can then each take part in the socially importantpractice of giving to their own weak members - aprocess that strengthens the whole welfare structure thatpeople must rely upon when there is no relief.

The author concluded, “that local people should beallowed to target relief, rather than targeting beingdictated by the international community”, and that thisconclusion is arrived at for pragmatic reasons. First,local people will redistribute relief whether we like it ornot. One must therefore trust local people to care fortheir own vulnerable as well as understanding whatbehaviour the local culture expects vis a vis sharing.Second, the kinds of people who are seen as vulnerablein Dinka society, for example those who do not have alarge immediate family such as a childless widow or aman who has no sisters to bring in cows for hismarriage, are very difficult for someone not from thecommunity to identify. There are no easily definedsocial categories of vulnerable people in the south, onlycertain counties and payams that are more in need thanothers. The report concludes that prioritisation by areashould be undertaken by ‘neutral’ outsiders on a needsbasis, while internal targeting should be (and is in anycase) carried out within the groups that definethemselves as ‘communities’.

Ref: The Southern Sudan Vulnerability Study ,Simon Harrigan Chol Changath Chol, Published bySCF (UK) South Sudan Programme PO Box 48700Nairobi Kenya. June 98

TheSouthern Sudan

VulnerabilityStudy

Published Report

This study attempts to provide some analysis of the1998 crisis in Sudan and the response mounted. Itattempts to capture emergency humanitarian activities,famine assessment indicators used by agencies and theco-ordination of the response.

The author describes this crisis as one of the worstever experienced by the Sudanese people and one ofthe worst to be responded to by OLS in a climate ofsevere financial constraints. Agencies interviewed aspart of the study highlighted lack of effectiveleadership, co-ordination and analysis, slow response,poor preparation and lack of strategic approaches toco-working as major flaws to be corrected as a matterof urgency. Donor involvement was described also as‘donor disengagement’ at the beginning of the crisis-and lack of commitment to addressing the constraintsfacing implementing agencies to reduce the severeeffects on the population were mentioned. The authorrecommended a more thorough analysis of the issuesunderlying the poor response should be conductedwithin the OLS and non-OLS agencies. She alsoasserts that the failure of the United Nations toencourage an effective peace and conflict resolutionwith rebels and GoS plays a large role in the genesisof the crisis and should be addressed separately.

Ref: Humanitarian Assistance in Sudan in 1998,Una Macaskill. SWP-CPN Analysis and EvaluationPaper (AEP)I/VII, January 1999. Will be availableshortly Through Tanja Schumer: [email protected]

Humanitarian Assistancein Sudan in 1998Published paper

Research


Anewly published paper in ‘Disasters’examines a specific form of conflict:livestock raiding in Turkana district. The

case is made that the context of famine in Turkanahas changed in recent years as the role played bylivestock raiding in contributing to famine hasincreased. External responses to famine in Turkanahave largely been drought driven, for example, foodassistance and livestock restocking programmes.These responses have failed to meet the real needsof herders while the role of armed conflict in theform of raiding has been overlooked as a commonfeature of societies facing famine and foodinsecurity. More recent studies argue that raidingand generalised insecurity played a key role in the1979-81 famine in north Turkana and confirm thatraiding is a prominent feature of famine and chronicfood insecurity in the district. In the paper, the traditional livelihood enhancingfunctions of livestock raiding are contrasted with themore predatory forms common today. Predatoryraiding occurs on a very large scale, is extremelyviolent and is sponsored by actors from outside thepastoral sector with criminal motives. It is largelyinitiated by people outside Turkana including armedmilitary or bandit groups in Kenya or surroundingstates as well as economic entrepreneurs. Themotives are commercial - to procure cattle in vastquantities either to feed warring armies or to sell onthe market for profit. This contrasts with moretraditional redistributive raiding which carries with itnotions of balance and reciprocity. In the past thistype of raiding has been a sophisticated means ofreallocating pastoral resources between rich andpoor herders and has been an equally commonfeature of both intra-tribal and inter-tribal relations.Raiding has served to rebuild herds after livestockhave been killed by drought or seized in raids andits incidence is thus often closely tied to climaticconditions and the prevailing state of the tribalpeace. It has been governed by very complex ruleswithin the context of an indigenous conception oflivestock as a collective property.The authors assert that the direct impact ofpredatory raiding on livelihood security can bedevastating, while the threat of raids and measurestaken to cope with this uncertainty undermineherders livelihood strategies. Self-imposedrestrictions on mobility negatively affect thevegetation of both grazed and ungrazed pastures andrestrict available survival strategies. A 1985 studyfound that 47 percent of Turkana district - includingmuch of the best grazing land, was virtually unusedduring the 1982-4 period due to the mere threat ofraiding faced by local herders. Predatory raidingalso leads to a collapse in the moral economy, i.e.the rights of herders to make claims on other herderson goods such as cattle and grain in times of crisis. Some implications of this for relief and developmentpolicy are considered, including approaches toconflict resolution. The authors argue thatdistinction needs to be made between droughtinduced food insecurity and that caused by raiding,in identifying most appropriate interventions. Forexample, re-stocking may not be an appropriateresponse if it simply attracts marauding ‘predators’.Some agencies recognise this and have becomeinvolved in the area of conflict resolution and

building local capacity to manage conflict. Theauthors worry, however, that there is a danger thattwo key issues will receive inadequate attention. Thefirst is that the state must be brought into any debateon the problem of insecurity in the pastoral sector,as in the long run the state offers the best forum formediating in conflicts where outside actors areinvolved and for enforcing any settlements whichare reached. The second is to do with theappropriate balance between outside and localapproaches to conflict resolution. Conflict resolutionmechanisms are already embedded in local culturaland institutional norms and evolve continuously tomeet changing demands. While the nature ofconflicts in the pastoral sector today is changingdramatically, the starting point for addressing themis to examine how this local knowledge can bedeployed in new ways.

Reference:The Changing Nature of Conflict and Famine andVulnerability: The case of Livestock Raiding inTurkana District Kenya: Hendrickson D., Arman J.and Merns R. (1998): Disasters, volume 22, No3, September 1998.

The Changing Nature of LivestockRaiding and its Role in Famine

Summary of published paper

The Relief and Rehabilitation Network(RRN),has recently published a network paperentitled ‘Between Relief and Development:

targeting food aid for disaster prevention inEhtiopia’. This paper focuses on the question ofhow food aid can best be targeted to the neediesthousehold in food-insecure areas. This is looked atin the context of the 1993 National Policy onDisaster Prevention and Management (NPDPM) andits central strategy of channelling relief foodthrough employment generation schemes (EGS) inplace of general free distributions. In addition tocontributing to the development of infrastructure therequirement to work for relief food (or for cashwhere available) is expected to discourage the lessneedy from seeking aid, i.e. to function as atargeting mechanism.The debate about providing emergency food aidthrough employment provision centres around thechoice between self (e.g. community targetingmechanisms) and administrative targeting (e.g.selecting beneficiaries on the basis of data collectedby an external agency). The author asserts thatself/community targeting has received littleattention in the literature. A review of previous Ethiopian experiences withtargeting through public works shows little evidencethat it successfully self-selects the poorest andexcludes the relatively better off even at lowpayment rates.Two conditions essential for self-targeting areoutlined ; an appropriate wage (in terms of food)policy and ability of the scheme to employ thosewho want work . However, in Ethiopia there areproblems with both, particularly in crisis situations.Unlimited job provision on the scale needed to copewith Ethiopia’s recurrent food security problems,may not be possible (given resource andmanagement constraints) or desirable (given thegovernment and donor policy objectives of limitingaid).Also the strategy of setting low wage rates withthe objective of targeting the poorest may backfireas it may be only the slightly better off who canafford to have a hoousehold member working forbelow subsistence wages. Poorer families who aretypically smaller require all manpower forsubsistence activities. The little evidence that isavailable indicates that the relatively rich oftenvolunteer as readily as the poor even at lowpayment rates. Examples of this happening aregiven from WFP, IFPRI and SOS Sahel employmentcreation projects. A summary of views expressed by beneficiaries andimplementing staff in areas receiving food aid shedsfurther doubt on the potential of pure self-targetingto meet the objectives of the NPDPM. It alsosuggests that this form of targeting is not easy orcheap. Within Communities there seems to be astrong preference for sharing aid as widelyas possible - this applies to employmententitlements.

TargetingEmergency FoodAid – Experiencesin Ethiopia

Summary of a Published Paper

Turkana woman posing with the editor’s son(Fiona O’Reilly)

Research


In almost all cases encountered, household leveltargeting was administered by communityrepresentatives or committees of various kinds underthe authority of Peasant Associations There was aremarkable level of participatory decision makingwith great efforts at fair targeting. However,community leaders found it an extremelyburdensome task which tended to generate conflict.Everywhere it was maintained that all the peoplewere poor and it was difficult to exclude some. Awidespread opinion was that targeting invariablycreates conflict but if there must be selection it isbest done by the people who should gather togetherand select ‘just elders’ who can in turn identify thepoor. Each village should select one or two elders.Four key elements for successful communitytargeting were identified:• transparency of decision-making

• free availability of information to community members• accountability of decision makers to constitutents • an outside auditing or monitoring authority to

detect corruption and support decision-makerswhen they have to make unpopular decisions.

The paper drew the following importantconclusions:i) The self targeting elements of EGS will not aloneachieve the targeting objectives of the NDPDM.Given the scarcity of other employmentopportunities there is always likely to be a highdemand for EGS/FFW participation for all incomegroups. ii) A combination of self-targeting elements withsome additional system for household screening isneeded. The realistic mechanism for this is not ahighly administered selection system with centrally

determined criteria and costly informationrequirements, but development of existingcommunity structures for prioritising the poorest.However, community targeting is not a cheap oreasy option. The costs to the community decision-makers themselves, in time and trouble are alsoconsiderable. A final conclusion of the author is that area leveltargeting is is an essential first stage in thedistribution system for countries like Ethiopia and isprobably where the greatest potential gains ineffectiveness and efficiency can be made

Ref: Between Relief and Development: targetingfood aid for disaster prevention in Ethiopia, KaySharpe: RRN Network Paper No 27, September1998.

Arecently published paper reports the resultsof a study conducted by Concern Worldwideon severely malnourished adults in Baidoa,

Somalia, a town at the epicentre of the 1992 famine.The severity of the famine was reflected in the largenumbers of severely malnourished adults admitted totherapeutic feeding centres. Because adult energyrequirements are proportionately less than those ofchildren, the peak incidence of severe malnutritionand death in adults generally occurs later than inchildren. Up until this famine there had been verylittle rigorous research on the dietary treatment ofseverely malnourished adults. Results from studiesperformed in less severely malnourished subjects,usually in hospital settings, had until recently beenextrapolated to the very different circumstancesfound during war and famine. The conventionalwisdom was that adult subjects with body massindexes of 17-18 respond well to diets with protein-to-energy ratios >19%. Such diets were used in allConcern Worldwide therapeutic feeding centres(TFCs) during the Somali relief operation in 1992-3. However the adults admitted to these TFCsgenerally had BMIs of 10-13, far less than thosewho had been studied. They also often had oedema.It was observed that many of these patients,particularly those with oedema were refusing thehigh protein diets. This led to the hypothesis that thehigh protein diets may be inappropriate during theinitial phase of rehabilitation. Therefore, the aim ofthe study was to compare the immediate and short-term effects of a lower-protein diet with those of theconventional higher protein diet.The response to treatment in 573 patients wasstudied. Mortality, appetite, rates of oedema loss andweight gain in two groups of patients receivingeither a higher protein (16.4% of energy fromprotein) or lower protein (8.5% of energy fromprotein) diet were compared.

Findings and conclusionsAmong oedematous patients the use of the lowerprotein diet during the initial phase of treatment wasassociated with a threefold decrease in mortality andaccelerated resolution of oedema. Among marasmic

patients, no differences inmortality or rate of weight gainwere observed. The lowerprotein diet used in this studywas much cheaper and moreeasily obtained than theconventional higher protein dietsin Baidoa Somalia (92 -93). Oedema in adults was associatedwith a much poorer prognosis.The maximum rates of weightgain, typically 10-20 g/kg/dayrecorded in children recoveringfrom severe malnutrition, areconsiderably higher than the rate of weight gainreported among adults in this study. However, thepattern of recovery is broadly similar. Initially witha low protein maintenance energy intake,oedematous children often lose oedema within oneweek. Appetites return and this together withoedema loss heralds the recovery phase. Among theoedematous adult patients, the rates of oedema losswere variable and often much slower. With the lowprotein diet, some patients lost most of their visibleoedema and ascites within a few days, the rapid lossgenerally being accompanied by watery diarrhoea.In these patients care had to be taken to avoidintravascular hypovolemia (shock occurring fromloss of fluid from the circulation). In the absence ofguidelines for adults the team aimed at a loss ofapproximately 0.25 -0.5 litres per day, equivalent toa weight loss of 0.25-0.5 kg per day. Regulation of

the rate of oedema loss was achieved by diluting thehigh energy milk with ORS to an extent dictated bythe severity of diarrhoea. In other patients,particularly those receiving the high protein diet, therate of loss of oedema was much slower and pedaloedema or ascites persisted for weeks. This wasaccompanied by persistent anorexia and debility.

The study team suggest that the low protein dietbased on milk, oil sugar and locally available foods,with a relatively low protein to energy ratio shouldbe offered to all severely malnourished adults inboth the initial and recovery phase of rehabilitation.

Reference:Steve Collins, Mark Myatt, Barbara Golden:American Journal of Clinical Nutrition (1998), Vol68, pp 193-199

Somalia – Standing in the mudnear the edge of the Sabelle River

a boy watches the arrival of thevillagers from a neighbouring

Bulomano which, while not underwater, is suffering from food

shortages(UNICEF/HQ97-0746/Radhika Chalasani)

Dietary treatment of

Severe Malnutrition in Adults

Field Article


Background

Save the Children Fund (SCF UK) has beenworking in Bangladesh since the Bholacyclone of 1970. The agency has a long term

development programme dedicated to helpingpeople prepare for floods, an annual hazard in thecountry. Working in partnership with localgrassroots organisations, this is largely based aroundcredit and savings and income generation projects,with the long term objective to help families tosecure themselves against disaster. It also focuses onimproving children’s participation in communitylife.It was obvious from a fairly early stage that the1998 floods were far worse than the norm, and that

emergency assistance would be required. However,SCF (UK) took the decision to use its existingnetwork of Bengali organisations to reach childrenaffected by the flood, instead of mounting a separateUK-managed disaster relief operation. SCF (UK)’s Programme Director for Bangladesh,Martine Billanou, managed the process. “From theonset of the emergency, we decided to work throughour existing partners. By doing so, we believed wecould contribute to the longer term capacity of ourpartners and build up skills. In our view, this isimportant in a country where severe floods are arecurrent event.”But this strategy, vital for delivering aid effectivelyand economically, was not without its problems. MsBillanou explains: “It was the first time SCF (UK)in Bangladesh had organised a response to disasterthrough partners. It proved much more difficult thanour previous direct intervention, in the sense that itrequired much more preparation and monitoring

work. It was sometimes tricky to achieve consensuson issues such as the type of activities required inorder to have the best impact and the focus onchildren. It also meant that we had to play a strongsupport role especially with regard to our weaker oryounger partner organisations.”

The SCF(UK) AssessmentIn the early stages, SCF (UK) kept close contactwith its partners in the flood affected area to monitorthe situation, to prevent any major outbreak ofdiarrhoeal diseases and malnutrition among thechildren. Then between 26 August and 6 September,prior to stepping up its relief effort, SCF (UK)undertook a survey on the nutritional status ofchildren under five years.

The survey’s objective was to assess whether it wasnecessary to set up emergency feeding centres orwhether a more general approach to supportingfamily livelihoods would better address their needs.SCF surveyed more than 2000 children under fiveyears in seven flood affected areas about theperceptions of the damage done by the floods andthe priorities for relief and rehabilitation by theaffected communities. This proved to be vitalinformation for SCF (UK) and other NGOs andgovernment institutions engaged in the relief effort.The survey showed a level of malnutritioncomparable to that of the same period in 1996,suggesting that the enormous efforts in the previoustwo years by government and donors to reducemalnutrition had already been eroded. The surveyalso indicated an abnormal incidence of diarrhoealdiseases as well as uncovering restricted access tohealth care services. The survey also identified thepopulation’s relief and rehabilitation requirements,enabling SCF to plan their response. Several factors helped to avert a more severeincidence of malnutrition. Bangladesh had anestimated stock of more than 5 million tonnes of

food grains at the beginning of July. By the end ofAugust free food distribution for flood affectedpeople had been undertaken by NGOs andgovernment agencies.But while starvation was averted, at least for thetime being, it was obvious that the flood wascausing serious disruption to people’s livelihoods.The rising water level led to prolonged inundation ofcrop fields, houses, tubewells and roads. Farmerslost jute, rice and seedlings, while labourers lostopportunities for work that would have been createdby harvests. Adults’ incomes were also reducedbecause they were forced to protect and shift theirhouses instead of working, while having to pay forhouse repairs and the replacement of householdassets that had been damaged or lost.SCF (UK) were concerned that those affected by theflood were facing a cash flow problem. People hadbeen forced to borrow, purchase on credit, sellpoultry and some household assets, and stretchavailable food over a longer period. Prolongedflooding had also led to increased incidence offlood-related diseases, such as fever, respiratoryinfections, diarrhoea, dysentery, skin infections, eyeinfections and ear infections. Many people werefinding it impossible to visit health clinics due tolack of money and difficulties in travelling around.

SCF(UK)’s Response StrategyOn the basis of the survey findings, SCF (UK)focused its intervention on the provision of much-needed services in the flood affected area where itspartners usually provide long-term developmentassistance, i.e. in Dhaka, Shariatpur, Dewanganj andKurigram districts.In Dhaka, SCF’s partner is the Ad Din hospital formothers and children. During the emergency, mobileclinics, organised from the hospital base, visitedflood-affected communities where families could notget access to health care. The hospital alsocoordinated volunteers in a water distributionprogramme in flood-affected areas of Dhaka.SCF has worked in the charland area of Shariatpurfor many years. This area is intensely prone tofloods as it is largely formed by river sediments,which emerge (and are swept away) by the tides.SCF (UK) now works through three localorganisations which were set up three years ago withex-SCF staff who previously worked on the 1988flood emergency programme. The partners now have28 staff members and 7 community practitionerstrained by SCF (UK). Rehabilitation and relief wereprovided to existing credit scheme members, and tothose in the area of the credit scheme who were toopoor to be able to join the scheme.In Kurigram, another charland area, SCF (UK)works with local NGO Solidarity, providing healthcare in tandem with local paramedics of Terre desHommes. This is a vulnerable area at the best oftimes, but with such large scale flooding, it wasobvious that extra support was needed urgently. Oneof the first actions was to distribute seeds, to enablefamilies to plant fast-growing crops, such aspumpkin, radishes and spinach. These kitchengardens would help to tide people over until the nextrice crop could be harvested.Martine Billanou explained how Solidarity managedto observe the longer-term development objectives,particularly with regard to children’s participation,even while responding to the crisis:“Solidarity decided to distribute the seeds via achildren’s committee. We are always looking forways to involve the children more fully incommunity life, and to increase their respect amongthe adults. We talked it over with their parents andthey were happy for the children to run this project,with the help of Solidarity, as long as thedistribution was organised at a village meeting.”

Partnership and Disaster ResponseBy Tracy McGhee, Press officer SCF(UK).In August last year, as news reports began to show that Bangladesh was suffering the worstflood in its history, aid agencies went on the alert to help try to prevent the spread ofmalnutrition and disease. By September, more than 75 percent of the country had beenflooded, including half of the capital Dhaka. More than 23 million people were affected bythe unfolding crisis.

Teenage girl distributing seeds ata village meeting in Kurigram (Save the Children Fund)

Field Article


The children’s committee also compiled a map ofthe village. Solidarity encouraged them to conductresearch on how the floods affected theirneighbours. The result was a graphic mapdocumenting exactly the losses suffered by eachhouse in the village, helping Solidarity to target aidcorrectly. The map also took into account remaining

assets, such as whether the villager owned any landor livestock, and the size of their family. Whenfinished, Solidarity used the research to assess whoto prioritise for cash grants.Working children were particularly badly affectedby the floods in Kurigram and, in addition tosupporting their families, they were also targeted forextra grants aimed at encouraging them to savemoney as a buffer for future emergencies or illness.In Dewanganj, SCF (UK)’s partner is Prodipan,

which has 30 staff members, including 8paramedics. Prodipan distributed food to female-and single-headed households, those headed by adisabled person and households with malnourishedchildren. Emergency credit support was targeted atmembers of Prodipan’s credit and savings scheme.Vegetable seeds were distributed to all families who

have only small areas of land, meaning that theycould not qualify for government support plannedfor farmers.By mid October, flood waters had receded and theneed for continuing emergency assistance began todecline. The government of Bangladesh continued tocoordinate the relief effort and distribute supplies offood, with the support of the United Nations WorldFood Programme (WFP). In all, 163 national andinternational agencies were involved in various reliefactivities in response to the floods. Goodcoordination meant that emergency needs wereswiftly met. Save the Children is certain that working throughpartners helped the success of its emergencyoperation. By virtue of having been based at agrassroots level for several years, partners are wellintegrated in the local community and know thesocio-economic status of each family. This made thetask of providing appropriate aid easier, moreefficient and more cost effective. Says Martine Billanou: “Despite the difficulties andsome minor delays, the approach has proved usefulas some of the smaller partners - especially thewomen organisations in Shariatpur - havedemonstrated good leadership capacity and thereforegained increased respect from the communities inwhich they work.”

The organisation continues to monitor the situationin Bangladesh while supporting partners inconducting rehabilitation plans. Martine Billanou:“We have always been concerned that many of theeffects of the floods would not be seen immediately.Longer term problems may be seen in the months tocome, as people have to start repaying their loans.Our follow-up nutrition surveys, (December andMarch), should help us monitor the longer termeffects of the floods, particularly on children, andalert the aid community in case we identify anaggravation of the household food insecurity.”

The 1998 flood in Bangladesh was the longest lastingflood of the century. It’s immediate impact lasted formore than two months, directly affecting more than 75%

of the country. A massive intervention from both governmentand NGO sectors was required. SCF’s strategy to monitor thesituation and collect coherent information from an early stagewas important. Other valuable strategies and activities that wereundertaken by SCF were:• implementation of timely nutrition survey to ascertain baseline

information on prevalence of malnutrition,• using local partners as a means to target resources,• the involvement of children in assessment and response,• ongoing monitoring after flood waters receded.

Concern Worldwide, operational in Bangladesh since 1972, alsoresponded to the flood disaster by implementing a countrywideemergency programme targeted at up to 200,000 families.Concern has developed in-country expertise as part of it’s widerorganisational policy to respond more effectively to emergenciesparticularly with respect to appropriate skills, local resources,timeliness and preparedness. The bulk of Concern’s response was outside it’s ‘normalworking areas due to the tremendous needs countrywide. Thiswas made feasible by working through local partners. Concernmanaged to access populations and work effectively under verydifficult circumstances by using knowledge and expertise oflocal resources. Concern implemented the emergency responsewith both established and new local NGO partners throughoutthe country and provided training to these partners inappropriate logistical systems (master rolls, goods delivery andgoods received notes etc.). One of the key problems of access tothe target group due to remoteness and travel restrictions due toflooding, was overcome to a large extent by the establishment ofpartnerships with local NGOs. Concern’s interventions were multidimensional, addressing boththe short-term and medium term effects of the flood. Concern’sresponse included:• distribution of food and non-food materials to the target

population,

• provision of basic health care services, in partnership with thelocal government and CBOs (Community BasedOrganisations), through both mobile and satellite healthcentres,

• assistance to communities to clean out tubewells,• working with the MoH on a large de-worming campaign in

one of the worst affected areas in Dhaka (Zinzira), and • assistance to communities with shelter and housing

reconstruction.

Some key issues in the overall response to the flood disasterresponse are summarised as:• The continued rising of water levels over a prolonged period

was not anticipated (duration and geographic areas affected)and therefore the required capacity to respond wasunderestimated by both government and NGO bodies. Aswater levels rose unusually slowly a rapid emergency responsewas not initiated in the early stages. Furthermore, water levelsreceded very slowly, exacerbating the effects of the flood.

• Co-ordination, was in general weak. ADAB (Association ofDevelopment Agencies in Bangladesh), held regular meetingsand circulated information on a weekly basis. Internationalmember agencies of DEC (Disaster Emergency Committee)did meet to informally share information. Many NGOscollected information separately which suited their own needsrather than a collective need. An exception to this wasinformation collected and shared by SCF. However, what wasnotable, was the tremendous response from all levels ofBangladesh including individual families, clubs, religiousgroups, schools, artists etc., as well as the international andlocal NGOs and government.

• The significant health and sanitation problems which wereanticipated following receding of the flood waters did notoccur. Despite an increase in the incidence of diahorrealdiseases, (normally closely associated with flooding periods),no significant epidemic outbreak was reported.

Shelter needs were an immediate priority during the floods aswas the assistance with rebuilding houses when the flood waters

receded. Due to the slow onset of the floods, many familieswere able to retain household items. • The lack of a coherent emergency preparedness plan was as

much due to the nature of this emergency as any other factor.However many small and local NGOs do not have the capacityto develop emergency preparedness strategies.

• The problem of targeting limited resources was a challengeduring the flood response. Targeting the right groups and areain an emergency situation is not easy. This was partially overcome by working through local NGOs and CBOs and the useof effective targeting assessments and household surveys.

In conclusion, the ongoing work in the areas of emergencypreparedness and post flood monitoring as outlined below willbe essential in the future:• While many local organisations and CBOs working in

Bangladesh may not have enough expertise in specific areas ofdisaster response, their knowledge and understanding of localneeds and people is essential for an effective response. Thiswas clearly demonstrated by the key role that local NGOsplayed in the overall response to the flood. Emergencypreparedness and disaster response management programmeswill be essential for developing the capacity of local NGOsand CBOs in a country which is prone to cyclones and floodson an annual basis.

• Medium and longer-term food security problems caused as aresult of the flood, are serious concerns. For example, twosuccessive rice-planting opportunities were lost during the tenweeks of the floods, this is expected to have an impact on foodavailability in early 1999. Another significant widespreadproblem that is expected to arise is the inability of families torepay credit loans to NGOs. Local NGO capacity to continueto operate will be increasingly difficult with this current andexpected lack of repayment. Due to the longer-term impact ofthe floods, it will be necessary to continue to monitor andassess the situation for a prolonged period. Bench-mark data,such as that collected by SCF, will be useful as baseline datato monitor the situation over time and identify priority areas ofneed.

Post–Script by Siobhan Boyle, M. Nurul Amin, Rehana Amin Lovely – CONCERN

A group of children working on a village map, to helpproject workers identify households who needassistance after the floods — Kurigram(Save the Children Fund)


Mark Thür, aSwissNational and

resident Kenyan,arrived in Lokichokioat the invitation ofUNICEF for themonthly nutritionmeeting. He came todemonstrate the SolarCooker to nutritionprofessionals workingin southern Sudan.The Solar Cooker,which is crafted andsupplied by the KabiroInstitute of Technical Training in Nairobi, is anenvironmentally friendly, cost effective way to cookand sterilize. It operates by trapping sunrays throughtwo ordinary glass panes and a reflecting cover-lid.The cooker then changes the sunrays into heat andcooks the food. It does not require any other kind offuel. It is clean, safe and saves time, as it does notrequire supervision or regulation. Several foods canbe cooked at the same time. Mark demonstrated itsuse by cooking a lunch of beef, vegetables and rice.A Swiss couple donated a small amount of fundingto get the initiative off the ground. Thirty cookerswere made available free of charge for NGOs whowanted to try them out. It was suggested that thesecookers could be used to sterilize water in feedingcentres for use in the treatment of dehydration.There is also a possibility that the design could be

adapted to facilitate the cooling of larger volumes offood necessary in Feeding Centres. The cookersthemselves can be bought for a small sum. TheKabiro Institute who manufacture the cooker is anon profit making organization established in 1990“to enable the youth in Kenya and outside generatetheir own income by providing them with technicalskills”. The light and easy to assemble cooker couldbe of particular use in refugee situations where thereis concern about environmental degradation due todeforestation as refugees scavenge for fuel.

For more information contact: Kabiro Institute ofTechnical Training, Kawangware Location P.O.Box 21679, Nairobi. Tel: 02 568023

Two previous articles in Field Exchangefocused on the food emergency in DPRK.The first article (Field Exchange Jan. ‘98)

highlighted the fact that lack of access and theconsequent absence of any rigorous surveys madeit difficult to verify claims of widespread starvationand famine. The second article (Field ExchangeOct. ‘98) based on the first hand experience of anECHO monitor travelling extensively in 6 of the 9provinces cast doubt on claims of ‘widespreadmalnutrition’. However, a nutritional surveyconducted in September/October 1998 hasconfirmed the existence of a serious nutritionalsituation in the DPRK. This survey is the mostrepresentative one carried out during the course ofthe current DPRK crisis. The sample selection for the survey was based on130 counties to which access could be guaranteed,representing 71% of the country’s population and61% of all counties. Multi-stage sampling was used

to identify clusters at the level of the

Ris/Dongs. Household selection took place at theoffice of the RI/Dong where a complete and up todate list of all households was made available tothe teams. Systematic sampling was used to selectthe 30 households from each cluster. The survey found that moderate and severe wastingor acute malnutriton, affected approximately 16%of the children including three percent withoedema. Male children were almost twice as likelyto be malnourished as female ones (20%versus11%). Moderate or severe stunting (or chronicmalnutrition), affected about 62% of all childrensurveyed, while the prevalence of moderate andsevere underweight or low weight for age, wasapproximately 61%.These data indicate that underweight was moreprevalent in this surveyed population than in themost severely affected countries in East Asia (40%in Cambodia and Laos) . The prevalence of chronicmalnutrition is even higher than levels found inIndia (56%)and Bangladesh (53%)

For more information contact Peter Dijkhuizen

Solar Cookers Come to LokiNews

Nutrition Surveyin the DPRK

Mark Thür presenting the solar cooker in Loki(Fiona O’Reilly)

Infant Feeding inEmergencies An international meeting on infant feeding in emergencies was organised by

IBFAN in Split, Croatia in October. Members of the UK Infant Feeding inEmergencies Group (IFEG) (including Baby Milk Action, Save the Children

and Children’s Aid Direct) joined participants from 23 countries to develop actionplans to improve co-ordination between agencies and prevent commercial exploitation.Dr Aileen Robertson, of WHO Europe, used events in Bosnia and Russia to explainhow “emergency situations can be public health opportunities” and stressed theimportance of protecting local food production. Breastmilk, of course, is the mostlocal food possible.

For further information contact:Baby Milk Action23 St. Andrew’s StreetCambridge CB2 3AXEnglandTel: 01223 464420Fax: 01223 [email protected]/babymilk

WFP/UNHCR Guidelines onSelective Feeding inEmergencyare published February 1999. Contact:

UNHCR: [email protected]. 2500CH-1211 GenevaDepot 2Switzerland

WFP: [email protected] Cesare Giulio Viola, 12Parco dei Medici00148 RomaItaly

News


Among the greatest programme challenges ofrecent years for United Nations agenciesworking in child health and nutrition,

especially in sub-Saharan Africa, has been theprevention of transmission of the deadly HIV virusfrom mother to infant. The majority of thattransmission occurs during childbirth, butbreastfeeding is also a mechanism for mother-to-child transmission (MTCT). The co-sponsoragencies of UNAIDS, including UNICEF andWHO, have not retreated in their commitment tosupport, protect and promote breastfeeding – in fact,they recognise that the HIV pandemic makessupport to breastfeeding more important than ever.But they have also recognised that HIV-positivewomen have a right to be supported in trying tominimise the chances of passing HIV to theirinfants.

Before 1998, it was virtually impossible to design afeasible programme for MTCT reduction for low-income countries. It was known that the risk oftransmission in utero and during childbirth could bereduced by a long and expensive course of the drugzidovudine (AZT) – costing about $1000 for thedrug alone – but this was unaffordable in manycountries. In February 1998, however, it was shownin a study in Thailand that a much shorter course ofAZT during the last weeks of pregnancy couldsignificantly reduce the risk of MTCT with noadverse side effects for the woman or child. The costof the drug for the short-course regimen is about US$50-80, and the manufacturer of the drug has sincemade a limited quantity of AZT available freethrough UNICEF for UN-supported start-upprogrammes in certain countries. The manufacturerhas also indicated its willingness to negotiate furtherwith UNICEF and with national authorities to makethis drug treatment widely available. With thesedevelopments, it became possible to talk aboutaffordable programmes for MTCT reduction.

The results of the Thailand trial relate totransmission up to the time of childbirth. There is asyet no evidence that continuing a course of AZTpost-partum period would reduce the risk oftransmission during breastfeeding. In order to allowwomen to take best advantage of the risk reductionassociated with the AZT, something needs to bedone about the infant feeding options of HIV-positive women. WHO and UNICEF working withUNAIDS have published guidelines for healthworkers and policy-makers to support HIV-positivewomen in making the best-informed decisionpossible on whether to breastfeed. That decisiondepends on a host of factors, many of which onlythe woman herself can weigh. For HIV-positivewomen who cannot be sure of having regular accessto adequate water (and time) even if they can getaccess to infant formula in adequate quantities,breastfeeding may still be the best option. For otherwomen, it may be possible to minimise the risks ofartificial feeding and thereby come up with a betteralternative than being forced to face the risk ofpassing a fatal illness to their infants. There is alsogood evidence to suggest that the risk oftransmission increases with duration of

breastfeeding, so early cessation of breastfeedingmay be a useful measure in some cases, though theUN agencies have not recommended a particularcut-off point.The UN agencies working on HIV/AIDS havedecided collectively that there is a moral imperativeat least to try to support HIV-positive women infinding alternatives to breastfeeding in cases wherethey choose this option. WHO and UNICEFworking with UNAIDS have supported severalcountries over the last ten months to designintegrated programmes for the reduction of MTCT.Such programmes already exist in Latin America,Thailand and South Africa, but these programmesare of course more challenging in poorer countriesin Africa, where health services are often inadequate

and access to breastmilk substitutes is difficult. Inspite of the programme challenges, eight countriesin Eastern and Southern Africa have worked hard todesign such programmes in selected health facilitieswhere pregnant women can benefit from a range ofservices to reduce the likelihood of MTCT. Theseservices include:• HIV testing and counselling, a prerequisite foraccess to the AZT short course. • Well informed and sensitive post-test counselling,including on infant feeding choices.• A well adminstered AZT regimen• Obstetric services that include best practices forminimising the risk of MTCT• Nutritional support for women.• Support for ensuring access to adequate breastmilksubstitutes where women decide not to breastfeed.(UNICEF is ready to assist countries with theacquisition of a good quality generic infant formulaat a price well below the lowest commercial formulaprices where government partners deem itnecessary.)

Funding is available from several sources, andadditional funds are being sought to move these

programmes forward in 1999. One of the mostdifficult aspects of this kind of programme in Africais likely to be having adequate capacity forcounselling and testing. The co-sponsor agencies ofUNAIDS have designed training materials to createan army of HIV counsellors who can also providewell informed counselling on infant feeding issues.In addition, communication strategies are needed toimprove community-level acceptance of personsliving with HIV.It may be possible to provide some of the servicesrelated to reduction of MTCT risk in emergencysituations, particularly in situations where provisionof clean water may help reduce risks associated withnot breastfeeding. These risks may also soon bereduced in emergency and other situations by theuse of the new rotavirus vaccine, which is likely toreduce transmission of a significant portion ofdiarrhoeal disease.

Programmes to reduce MTCT under anycircumstances require great vigilance to ensure thatthe life-saving practice of breastfeeding for the greatmajority of children is not compromised.

For further information contact Joanne Csete [email protected]/

Beginning September last the Tufts UniversitySchool of Nutrition Science and Policy(SSNP) and the Fletcher School of Law and

Diplomacy now offers a one year degree - a Masterof Arts in Humanitarian Assistance for mid-careerprofessionals with significant field experience in theareas of famine, conflicts and complex emergencies.The M.A. in Humanitarian Assistance consists oftwo semesters of academic work totalling eightsemester courses approved by SNSP and Fletcher.Students are expected to complete the followingcore courses:1) Humanitarian Aid in Complex Emergencies,2) Nutrition in Complex Emergencies,3) Independent Seminar in Humanitarianism,4) One course selected from the other core coursesoffered by the program. The remaining four coursescan be chosen from SNSP/Fletcher offerings.

Students are required to write a Master’s thesis aspart of the second semester requirement. Typicallythe thesis applies theory and analytical skills learnedin the program to the professional’s previousexperience.

This program is available to mid-careerprofessionals with varied backgrounds and fromdifferent countries to enhance learning from eachother’s experiences. The candidate must have anundergraduate degree, be mid-career, havedemonstrated leadership qualities and have apotential to make a substantial contribution in thefield of humanitarian assistance.

For further information, contact:Admissions Committee for Masters in HumanitarianAssistance Feinstein International Famine Centre,Tufts University ,96 Packard Avenue, Medford, Ma02155 Phone: 1-617-627-3423 Fax: 1-617-627-3428email: [email protected]/nutrition/famine

New HumanitarianAssistance Course at

Tufts University

HIV and Infant Feeding:A Programme Challenge

By Joanne Csete, Regional Programme Planning OfficerUNICEF Regional Office for Eastern and Southern Africa

Wild Foods


For the purposes of the research wild foodswere defined as ‘naturally growing plants’(although the author recognised that some of

these plants have become domesticated). Theresearch focused on the contribution of these foodsto food security and the nutritional needs of womenand children, and a number of preconceptionsregarding wild foods. A key output of the researchwas a database on wild foods which is availablefrom the Food Economy Analysis Unit at the WorldFood Programme offices in Nairobi andLockichockio. The database has information on; the

wild plants available in four areas of SouthernSudan (vernacular and the scientific names),seasonal availability, consumption patterns, nutrientcontent, economic value, extent of domesticationand a break down of which household memberscollect and consume the foods. Photographs are alsoavailable. Research is ongoing and the existingdatabase is due to be merged with another databasecompiled by Brigitta Grosshinsky which coversother areas of Southern Sudan. During her fieldresearch the author also tested a number ofassumptions about wild foods. Her findings belowrelate to the Dinka in southern Sudan.

Wild food gathering – an exhausting task?For the most part, gathering and preparing wildfoods is an every day activity for many households.The collection of wild foods is mainly carried out bywomen and children. It does not necessarily involveexpending a great deal of extra energy. Many foods

are collected along the wayside whilst going aboutother chores while wild leafy greens can be foundgrowing (and are encouraged to grow) in thecultivated areas around the home. Collection of wildfoods at a greater distance from the homestead willbe undertaken by women who will go in groups overa period of days leaving their children in the care ofa relative. These trips can become something of asocial event for women, particularly for those wholive on the more remote homesteads and have littletime for visiting friends and relatives. Gatheringsome wild foods can be labour intensive, e.g.

digging for wild tubers and for grain from termitestores, but people may choose to collect these foodseven in normal years for the sake of dietary variety.Wild plant production only involves labour at thetime of harvesting and may fit in well with otheractivities. In the case of grass grains for instance,which start to ripen at a time when agricultural workis at a minimum, prior to the main crop harvest,there is little conflict of labour priorities. Thecollection of wild food may become burdensomewhen these foods become the major part of the diet,e.g. during periods of food scarcity and famine,especially when the foods need to be foraged for atgreat distances from the home.The role of children in wild food collection should

also be considered. Whilst out on their errands theywill often forage for these foods. During this timethey learn about the different wild foods and theiravailability which can stand them in good steadduring food deficit periods. Also, as growing

children need food regularly throughout the day,wild foods can provide snacks between their mainmeals.

Are wild foods labour intensive to prepare?Of the 150 wild foods consumed in Northern Bahr

el Ghazal only 15% could be considered to belabour intensive to prepare. Furthermore, these arepredominantly grass grains and tubers whosepreparation takes no longer than cultivated grains ortubers.

Do wild foods taste bad?The Dinka do not think so. For example, everyoneasked asserted that the ëakuadhaí grass tasted betterthan sorghum or maize. Likewise many of the wildvegetables seem to be preferred to their cultivatedcounterparts. A testament to this is that even duringtimes of non-food shortage many of these plants areregularly included by all socio-economic groups indaily meals in order to enhance variety and taste.

Bad taste is often confused with bland taste. Forexample, in the case of water lily seed furtherinvestigation established that it was not so much thatit tasted bad but rather that it just didn’t taste. Onceit was mixed with fish and ëayaakí (Corchorus sp.) itthen tasted delicious and was more than acceptable!Some foods are actually favoured for their bittertaste such as ëakiyaí (Gynandropis gynandra). Thereare of course plants, which taste unpleasant whichare eaten only in extreme emergency situations, ortaken medicinally, but these tend to be relativelyfew.

Are wild foods nutritious?The nutritional analysis of wild plant foods from all

over Africa has shown them to be very nutritiousand not inferior to domesticated varieties.

Wild grains, seeds and kernels provide significantamounts of calories, protein and oil. Their calorificvalue is frequently greater than that of the cultivatedvarieties. The results of analysis of the grass grainsare impressive with a range of 310 - 391 kcals per100 gms which compares favourably with sorghumand maize - 355 and 363 kcals/100gms respectively.

Fruits, leaves and tubers, particularly thoseconsumed raw, all contain vitamin C. For example,baobab fruits and ‘Ziziphus contain 360mg./100gand 1000mg./100g of vitamin C whilst an orangeonly contains approximately 57 mg./ 100g. Whenpeople become ill in southern Sudan it is a commonpractice to increase consumption of wild fruits orwild fruit juices such as ‘cuei’ (Tamarindus indica),‘lang’ (Ziziphus sp.) or ‘tuuk’ (Borrasusaethiopicum) which are believed to help recovery.

Many wild leaves are rich in iron and have a highercontent than the cultivated varieties. e.g.Gynandropis gynandra. Tamarindus indica has aniron content of up to 6.2mg per 100g. Potassiumlevels tend to be high in all leafy vegetables andfruits.

Wild Foods — Blessing or Burden?

Caroline Gullick recently completed an MSc project looking at different aspects of wild foods. The field research was conductedamongst the Dinka (Monjeng) Tribe of Northern Bahr el Ghazal in southern Sudan.

Women returning from collecting water lily seeds and roots (Nymphea Sp.)

Wild Foods


Information from food economy assessmentscarried out over the last eighteen months by theWorld Food Programme indicate that thepercentage caloric contribution of IndigenousWild Food Plants (IWFPs) in the total annual dietvaries from 15% - 60%.

Wild foods also enhance palatability. The popularuse of leaves with a mucilaginous sap which givesthe food a slimy texture is a recognised way ofeasing ingestion of accompanying foods. Theimprovements of texture and taste from wildfoods are of particular importance to children,who are often unable to consume the quantity ofthe bulky staple foods needed to meet theirnutritional requirements.

Have wild foods any economic value andcan they be shared or exchanged in theway other foods can?The perception of the economic importance of

wild foods appears to be gender specific. Forwomen, these foods are an important source ofincome with the small amounts of cash that theyearn being used to buy important non-food itemssuch as soap. For example, during the field workit was found that the cost of 6.5 kgs of ‘Balanitesaegyptiaca’ was 20,000LS which compares with30,000LS for a year and a half old bull. Incomegenerating activities for men tend to be focusedon livestock and cash crops, though some willalso sell wild foods but usually only if otheroptions are very limited. Most women interviewedduring the field research claimed to have soldwild foods at sometime. One reason which maylead people to believe that there is not much tradein wild foods is that these foods are not usuallysold in a prominent place in the market but on theperiphery with a significant amount of barter tradebeing undertaken at village level.

Does wild food consumption carry asocial stigma? Generally, it does in southern Sudan where maleguests will be given sorghum because it isconsidered more prestigious while wild foods, andany other less prestigious foods, would be eatenby the women and the children of the householdin a separate place. Allocating best food to a guestis common to most cultures but does not meanthat other household foods are nutritionallyinferior or that they are not liked. There are somewild foods, which have a high prestige value, suchas the wild grass grains and rice which areparticularly favoured and will be given to themost important guests at ceremonies. Also, somewild foods are used to make relishes that giveflavour and texture to other foods and areacceptable for male guests, e.g. cuei Tamarindusindica, dhiot Nauclea latifolia, lung Portulacaoleracea, akiya Gynandropis gynandra’. Femaleguests will however tend to eat whatever the restof the household eats.

Within the family men will be given the mostprestigious foods first. Even in 1997, which was ayear of food scarcity in Bahr el Ghazal, thestigma concerning consumption of wild foods stillprevailed and the best food in the house was givenfirst to the man, then the children and lastly to thewomen. In general, it is less culturally acceptablefor a man to eat wild foods as this would beperceived as an indication of poverty and lowsocial status.

Rak kernels(ButrospermumParadoxum)Extensively used foroil production andan importantincome generatorfor women

Children preparing greens to accompany thestaple for the evening meal. Akija

(Gynandropis Gynandra) and Amera (PortulacaAnadrifida) both of which are rich in calcium

and iron.

A selection of wild foodsfound in Luo Areas

News


WorkshopAnnouncement:EnhancingNutritional Qualityof Relief Foods

An international workshop willbe held in April, inWashington DC, to discuss

recent research and practice relatedto improvement in the nutritionalvalue of ration foods given inhumanitarian aid programs includingemergencies, refugee/IDP camps, andtransition situations. The coreparticipants will be NGO staffresponsible for food aid programs,with the workshop focusing onexchanging experiences of fortifyingand improving ration quality. Therewill also be discussions aboutpotential future field research to testnew technologies for fortifyingfoods.

The workshop is being organized byFood Aid Management, theCongressional Hunger Centre, theAmerican Red Cross, Sustain, TheMicronutrient Initiative of Canadaand USAID

The organizers welcome papers, data,perspectives, or questions which maybe added to the agenda.

For more information, or to sendsuggestions/papers, etc. pleasecontact any of the following:

Congressional Hunger Centre [email protected] Aid Management [email protected] -- [email protected]

The Partners and Food in Emergency andDevelopment Aid (PFEDA) web site has nowbeen launched. (http://www.univ-lille1.fr/pfeda/).

This web site provides two interactive databases on thedifferent actors involved in emergency and developmentaid, and the foods allocated as part of this work. PARTNERS is a data base on the institutions,

private/public companies and individuals involved in theemergency and development sector. Over 2200 addressesand a classification of the organisa-tions/individualswork are currently available on this database. All youhave to do is enter the name of the organisation youwant to find out more about and all the details appear.Alternatively enter the country or region and the list of

organisations in that country will appear.FOOD is a database on the food products used inemergency and development projects as well asdetailed features about the food, e.g. origin(processor, supplier, broker), commercial nameand generic name, category of product, detailedformulation, nutritional constituents,microbiological characteristics, technologicalcharacteristics, commercial or logisticalspecifications.

The site offers three types of service:

• on line consultation of the databases• downloading the original Microsoft Access

databases• modification/updating the database content

It is also hoped that the site will serve as a forumfor discussion on subjects pertaining to emergencyand development aid e.g. along the lines of NGO-Nut. Indeed, NGO-Nut contributions are sortedthematically and published on this website. Thereis also other useful information – check it out foryourself and see.

Great New Web Site from Lille University

Highlights

During January 1999, WFP provided 7,099 MT of relieffood to 1,050,310 targeted beneficiaries in SouthernSector OLS. The tonnage distributed represents a 23%

decrease from December 1998. Graph 1 show WFP distributionsand beneficiaries over the past twelve months since February1998.

The nutritional status in parts of Bahr el Ghazal, especially inGogrial, Tonj and Aweil East counties, continued to improve anda number of agencies are closing or scaling down theirsupplementary feeding programmes. Falling numbers in feedingcentres and decreasing crude mortality rates in locations such asAjiep (Gogrial County) are proof of significant gains in meetingbeneficiary food needs in the region. However, food economyassessments in Bieh State and Kapoeta County for examplereveal a precarious food security situation where there are largeconcentrations of displaced persons.

The cease-fire in Bahr el Ghazal was extended for a further threemonths from 15 January to 15 April 1999. Increased insecurityalong the rail corridor going north of Wau town in the Bahr elGhazal region resulted in the evacuation of a number ofsurrounding WFP locations.

Table 1 provides a breakdown of WFP beneficiaries anddistributions by region in Southern Sector OLS during January1999 and shows that the focus continues to be on Bahr el Ghazal,with smaller, similar quantities being provided to the other threeregions.

WFP Southern Sector OLSMonthly Report January 1999

Region Beneficiaries Distribution (MT)

Bahr el GhazalEquatoriaJongleiUpper Nile

759,718107,128

94,24289,222

5,694607512285

TOTAL 1,050,310 7,098

Graph 1: WFP Distribution and Beneficiaries: Southern Sector OLS 1998

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan

MT

0

200,000

400,000

600,000

800,000

1,000,000

1,200,000

1,400,000

Ben

efic

iarie

s

MT

Beneficiaries

Table 1: WFP Actual Beneficiaries and Distribution inSouthern Sector OLS - January 1999

Field Article


The year of the 1998 famine will go down asanother disastrous period in the history ofsouthern Sudan. Once again aid agencies

rushed in to deliver services as Operation LifelineSudan (OLS) and non-OLS agencies alike, eitherinitiated or expanded operations in response to thehumanitarian crisis. The international donors pouredmillions into OLS, which expanded into one of thelargest emergency operations in history. As the rainsend and the cease-fire, that has allowed the responsein Bahr el Ghazal to continue, draws to a close itwill be important to evaluate the quality of thehumanitarian intervention in southern Sudan. Inparticular the prioritisation of resources is a key areathat should be closely examined. This article focuseson one aspect of this; the choice of target groups forselective feeding interventions.

The focus on child malnutritionBy August 1998, according to UNICEF figures,there were 18 NGOs operating 50 SFCs and 21TFCs in Bahr el Ghazal with anticipated numbers ofbeneficiaries of 40,753 and 6,430 respectively1. Toour knowledge, not one of these centres providedservices tailored towards older children and adults.Although some centres did include small numbers ofadults, particularly if they were categorised as‘vulnerable’ (disabled, elderly, pregnant andlactating women), the inclusion of adolescents andadults was generally on an ad hoc basis. This focuson child malnutrition did not always correspondwith the mortality patterns in a given location. In anumber of areas these were typical of a late stage ina severe famine, with adult and adolescent deathsout-numbering those of children under the age offive2. The inappropriately low amount of resourcestargeted towards acutely malnourished adults andadolescents indicates a failure to rationally prioritiserelief interventions in order to address the vitalneeds of this population.

Past lessons forgottenLessons, supposedly learnt in Somalia and Angola,about the importance of treating malnutrition in allsections of the population appeared to have beenforgotten. The inattention to the plight ofmalnourished adults and adolescents, characteristicof most humanitarian responses to famine and warsince the Second World War, returned. During 1992in Baidoa, Somalia, although adults and adolescentsaccounted for two thirds of recorded deaths, therewere almost no specialised nutritional services forthese age groups, who were instead, expected torecover on a basic ration of rice and beans3. Thesuccess of the single adult therapeutic centre in thetown prompted a rethink as to the importance ofadult and adolescent malnutrition in famine. By thefollowing year some lessons had been learnt. In thetown of Melange, Angola, where the mortalitypicture was again similar, with 75% of the bodiesburied during the first few months of the aidoperation aged more than 10 years,4,5 adult

therapeutic services figured strongly in the response.This increased attention towards adult feedingcontinued, and in more recent relief operations, forexample in the Great Lakes region since 1994, or inLiberia during 1996/7, specialised adult feedingcentres have played important roles in thehumanitarian response.

An Ongoing Omission: Adolescent and AdultMalnutrition in Famine SituationsBy Peter Salama and Steve Collins. (December ‘98)

Peter Salama is medical co-ordinator for emergencies for Concern and was the emergency co-ordinator for southern Sudanbetween August to December 1998. Steve Collins is an independent consultant in nutrition and health who was involved in thedesign of the Concern programme for adolescents and adults in Ajiep.Thanks to Annalies Borrel for comments.

A boy sits under a tree awaiting a distribution by theUN World Food Programme in the southern villageAcum Cum. The food is part of and airdrop of 16tonnes of food meant for 15000 people.(UNICEF/HQ98-0246/Radhika Chalasani)

Field Article

Why were malnourished adults andadolescents neglected?In view of these recent experiences and successeswith feeding programmes targeted towards adults,why was this target group neglected in southernSudan? The reasons are complex. Many factors,such as the inadequacy of the literature on theproblems of starving adults, the focus of nutritionalepidemiology on the under five age group,inexperience, the short history of contemporaryadult selective feeding programmes, mediaexpectations and funding pressures, are allimportant. These are explored in the followingparagraphs.

Diagnosis and treatment of malnourishedadolescents and adults still in its ‘infancy’There is little good scientific literature available onthe diagnosis and treatment of malnourishedadolescents and adults and the tools for assessingthese age groups in the field remain primitive. Asrecently as 1996, Mason et al were unable to findany studies on the relative risk of mortality fromunder-nutrition in adults6. There is still littleuniformity in the international standards andaccepted protocols for adult nutrition programmes.BMI, in vogue for the assessment of chronicmalnutrition in adults is problematic. Largeindividual variations in body shape, particularly therelative lengths of the legs and back can alterindividual BMIs by as much as 4 kg/m2 irrespectiveof nutritional status. Whilst these differences can becorrected on a population level , by adjusting BMIvalues using the “Cormic Index” (sittingheight/standing height), such adjustments are notpractical on an individual basis for screeningadmissions to feeding centres. The height andweight measurements required can also be difficult

to obtain in severely malnourished adults. Althoughadmission indicators based upon a combination ofMUAC and clinical criteria are being developed,measurement error can be significant and theproblem of appropriate discharge criteria remains.For adolescents, especially post-pubertal adolescents(and particularly in the ‘nilotic’ people of southernSudan) the level of knowledge is even more basic.Extended weight for height charts are poorpredictors of mortality and extended BMI for heightcharts have as yet been little used, remaininvalidated and are likely to suffer from similarproblems as BMI in adults. The use of MUAC foradolescents, although promising, has not yet beenadequately explored and no cut-off values exist.Much research on screening and assessment tools isstill needed.The focus of nutritional epidemiology in faminesituations on the under five age group, drawsattention away from adults. As a result, the extent ofadult malnutrition may not be so apparent toplanners. This is particularly so in areas, such assouthern Sudan, where famine oedema is uncommonand severe malnutrition in older people, therefore,less easily recognised. The exclusive focus ofnutritional surveys on the under five age group (inSudan less than 115cm) also means that there isusually no baseline indicator against which adultnutritional programmes can be monitored and theirimpact assessed. This makes it difficult to judgeeffectiveness or decide when to close programmes.We feel that older age groups should be included innutrition surveys, especially in locations wherefamine has been present for a longer period of time.

InexperienceInexperience, at both individual and agency levels isanother important reason behind the disregard for

malnourished adults. In the absence of clearepidemiological data and agency guidelines, theexperience of field workers and co-ordinatingagencies is all the more important. Generallyhowever, NGO and UN field co-ordinators,managers (as well as funders), are less familiar withimplementing adult feeding programmes. Not onlymay the problem remain unrecognised, but alsoexpectations and the specific difficulties involved inthem may be poorly understood.

Complexity of adult feeding programmedesignThe design of adult feeding programmes is oftenmore complicated than that of child programmes.The potential for adult centres to become quasi-hospices, to contribute significantly to populationdisplacement, or undermine survival strategies andcontribute to adverse outcomes for children of themalnourished are factors that need to be taken intoaccount at the design stage7. Frequently, other illness, particularly chronicinfectious diseases such as TB, and HIV willcomplicate a high proportion of cases. On admissionit is extremely difficult to differentiate betweenmalnutrition secondary to these illnesses andprimary malnutrition, itself often complicated byother illnesses. These two forms of malnutrition ,however, require different approaches to treatment.The absence of tools to quickly identify TB, and theethical problems involved in the spot diagnosis ofHIV, or the treatment of TB in unstable populations,therefore complicate programme design andimplementation. Even in cases where rehabilitation is relativelystraightforward, primary malnutrition respondsslower to treatment, with a mean length of stay ofaround 30 days and a mean increase in weight of


A severely malnourished elderly man waitsfor seeds, provided by the NGO WorldVision and distributed by local officials, inthe southern Town of Tonj.(UNICEF/HQ98-0140/Radhika Chalasani)

Field Article


less than 10 g/kg/day8. Furthermore in somecountries socio-economic factors, such as thepressure on beneficiaries to leave centres to plantcrops, or problems of compliance with a milk-baseddiet and inpatient care, result in higher default ratesin adult centres than in those providing care forchildren. Addressing food preferences throughsupplementation of diet with local foods in therecovery phase may improve compliance.Appropriate care must be taken at all times tomaintain adult dignity especially in the TFC setting.These differences mean that adult nutritionprogrammes often require more involved planningand more intensive medical interventions than underfive programmes. Even with this, programmeresults, as defined by successful exits, may be lesspositive than for childhood programmes. It will benecessary to evaluate adult nutrition programmesusing different reference standards, since successfulrecovery rates of more than 75% or mortality ratesof less than 10% are probably unrealistic9.

Media and public relationsLastly nutrition programmes for adolescents andadults may not meet media expectations. Amongstthe media and the increasingly influential ‘agencypublic relations officers’, images of starving infantsare deemed to be more powerful in eliciting westernsympathies than images of starving adults. Thejournalist who visited a Concern adult TFC in Sudanand requested ‘to see the starving babies’ was not anisolated simpleton, but represented a mainstreamconception of what the media considers ‘sexy’.

Certainties and failure of responseAmidst all this confusion, inadequate informationand inexperience, there are some certainties. Thefirst is that in a severe famine, particularly towardsthe end of its evolution at a time when humanitarian

interventions are up and running, severe malnutritionamongst the adolescent and adult population isfrequently a major public health problem. Secondlywith the correct treatment; 24-hour therapeutic care,with the careful titration of calories given to theweight and stage of recovery, rehabilitation is oftensuccessful. Even the most emaciated adults cansurvive and thrive. Thirdly, it is vitally important tosave the lives of adults and older children as theseage groups are the most economically productiveand, in agrarian or agricultural communities, themajor food producers10. The deaths of mothers andolder children have dramatic ramifications forsurvival of other children and the structure ofsociety. Furthermore the elderly and elders in manycommunities, particularly where traditions andculture are transmitted orally, are critically importantto community and cultural integrity and coherence. We feel that in southern Sudan particularly in Bahrel Gazal, the omission of supplementary andtherapeutic feeding, specifically targeting adults andadolescents was a major failing of the humanitarianresponse. It is time that attention to these age groupsin planning and programme design was built intofamine relief responses in a systematic andstructured manner. The need for targeted adult andadolescent feeding programmes should always beinvestigated as part of any famine relief responseand when necessary specialised services should beset up. In addition, the many areas of uncertaintyoutlined above will only be clarified if suchprogrammes are accompanied by operationalresearch to assess the effectiveness of the differentindicators and treatment regimens used. For this toprogress efficiently, good inter-agency co-ordinationis required to ensure the utilization of existingknowledge in this field, standardize protocols anddevelop a common research agenda.

To the editor of ENN Field Exchange:

We find Mr. Gettier’s letter concerningour article, “Sales of food aid as signof distress, not excess” (FieldExchange Issue 4), distressing. Itraises several issues that we wouldlike to address, including: reasons forthe ration reduction in Uvira, over-enumeration of the caseload,acceptable response to extortion byrefugee ‘terrorists’, reasons for theappearance of donated maize and oilin the market, and the discrepancybetween policy and itsimplementation.Our claim that the ration cut in Uvirain March 1996 was due to donordissatisfaction with refugee exchangeof food aid was based on the reasongiven by WFP to UNHCR when theyunilaterally implemented the cut.Normally decisions about ration levelsare the joint responsibility of WFP andUNHCR, and an explanation wasneeded. The local WFP officer saidthat the donors were unhappy that somuch food was being traded. Theopinion was that the refugees had beenin Uvira so long that they probablyhad found other means of acquiringfood, so a full ration was no longernecessary.With regard to refugee numbers, thereis in Mr. Gettier’s letter an error offact. In Uvira, the only re-registrationexercise of 1996, conducted in June-July, showed no significant reduction

in the caseload figures. The assertionof a 32% reduction is entirely false.Although WFP during the earlymonths of 1996 expressed discontentat HCR’s delay in conducting censusexercises, they did not directly relatethe lack of verified figures to theMarch ration cuts. If numbers hadbeen a primary factor, then WFP’sacceptance of the figures from the re-registration exercise should have beenfollowed by an immediate restorationof full rations. It was not until wepresented the results of this study thatWFP agreed to restore rations. Eventhen they refused full restoration of themaize ration because, they said, therewas just too much maize in themarket. Concerning possible extortion of foodby the Interahamwe and ex-FAR, weremind Mr. Gettier that the Uvirapopulation was largely (>67%)Burundian, not Rwandan (norgenocidalists!), and, Burundians werenot vulnerable to intimidation by thesetwo bodies. We also looked forevidence of ‘taxation’ by any branchof refugee leadership, but found none,hence we had nothing to report. What was evident, both through directobservation, and discussions withrefugee women and Zairian andrefugee traders, was the widespreadsale and exchange of small quantitiesof food aid as households attempted tobalance their diets, to improve thetaste of a bland monotonous diet, and

to satisfy basic needs.Of most serious concern to us is thepolicy Mr. Gettier proposes forsituations where terrorists are exactingfood from refugees. He says that it is“quite correct to effectively limit thedepredations of in-camp terrorists byreducing the amounts of excess foodthat ... genocidalists could tax andskim”. Usually there is no ‘excessfood’ in such situations, so thissuggestion is no different fromwithholding ‘food as a weapon’ – apolicy that has been denounced by theUnited Nations and its member statesand numerous non-governmentalagencies. There are more efficient andhumane means of curtailing ‘terrorist’activities than by denying sufficientand adequate food to a largelyinnocent population! The basic conclusions of our studyprovided concrete evidence in supportof the many written and spokenstatements and policies, includingthose of the primary donor to theGreat Lakes emergency, thatacknowledge that sales of food aid canbe a normal part of refugees’ copingwith their unfortunate situations.However, the response to the saleswith a ration cut showed that thesepolicies were not implemented.

Yours etc.

Barbara Reed and Jean-Pierre HabichtNovember 12, 1998

References:

1OLS Southern sector update 21/8/98, emergency nutritionprogramme Bahr el Ghazal, southern Sudan.2In Ajiep, the epicentre of the famine in southern Sudansurprisingly the death rates of the adult and under five populationregistered in August were quite similar. In fact, of the last 513deaths registered prior to 28/8/98, 231 were less than 20 years ofage and 282 were more than 20 years of age. Furthermore in someareas where cattle camps still exist, anecdotal evidence suggeststhat the under five population may be less vulnerable than olderchildren (who may not have access to cow’s milk and milkproducts).3Collins S. 1993 The need for adult therapeutic care in emergencyfeeding programmes JAMA 270 *5: 637-6384Concern 1993b, Data from Concern’s adult feeding centre,Melanje, Angola.5Davies, AP. Targeting the Vulnerable in Emergency Situations:Who is Vulnerable? Lancet, 348 (9031): 868-71 Sept 1996.6MasonJB et al. (1996) Undernutrition. In: Murray CJL, Lopez AD, eds.Malnutrition and the burden of disease; the global epidemiology ofprotein energy malnutrition, anaemias and vitamin deficiencies.Cambridge, Harvard University Press.7In some situations it may be appropriate to combine adult andchild TFCs or at least situate them on adjacent sites. If this is done,the integration of adults into the programme should be plannedfrom the outset.8Collins, S. The limit of Human adaptation to starvation. Nat. Med.1995; 1:810-4.9See Sphere minimum standards in nutritional interventions.10Murray CJL and Lopez AD, eds. The Global Burden of Disease,1996, Harvard School of Public Health, Harvard University Pressfor the World Bank and World Health Organization.8Collins, S. Thelimit of Human adaptation to starvation. Nat. Med. 1995; 1:810-4.9See Sphere minimum standards in nutritional interventions.10Murray CJL and Lopez AD, eds. The Global Burden of Disease,1996, Harvard School of Public Health, Harvard University Pressfor the World Bank and World Health Organization.8Collins, S. Thelimit of Human adaptation to starvation. Nat. Med. 1995; 1:810-4.9See Sphere minimum standards in nutritional interventions.10Murray CJL and Lopez AD, eds. The Global Burden of Disease,1996, Harvard School of Public Health, Harvard University Pressfor the World Bank and World Health Organization.

LettersDear Editors,

I would like to comment on the Article India, ‘TheSilent Emergency’ published in the June 1998 editionof Field Exchange.

I share the author’s concerns about the nutritionalsituation among the poorest of the poor in India. Asstated in the article, in spite of economic developmentand notable advances in agricultural production, thesituation seems very grave. The underlying causesmay be inequitable distribution of, and access toresources within the country and at household level.But, the widespread malnutrition, which constitutesone of the highest rates in Asia, is also aggravated bypoverty and high population density.

From the authors viewpoint, it appears that theInternational Community response should be toprovide aid to combat this chronic problem. However,as far as I can see the answer to this ‘silentemergency’ is not aid but strong advocacy by theInternational Community on behalf of the have–notswith the Governments of India.

India is one the developing countries graduallyphasing out of dependency on external aid -especially food aid.

Yours etc.

Rita BhatiaNutritionist, UNHCR

Sales of food aid as sign of distress, not excess

Field Article


This article was edited from an article byCassandra Chapman.

In this article I would like to examine thecomplex process of ‘targeting’. I will usesouthern Sudan as an example and draw on my

experience of targeting food aid while working forthe World Food Programme (WFP). Like manyorganisations, WFP has been faced with limitedresources and as a result has sought appropriatetargeting procedures to reach the most vulnerablewithin a population. As an organisation, which hasmainstreamed gender, the idea of targeting food aiddirectly to women is very appealing. In fact, at theFourth World Conference on Women, the ExecutiveDirector of WFP stated that among many otherstrategies, WFP would ‘distribute relief food directlyto a household’s senior female, where possible,using participatory approaches’. Subsequent WFP strategy and policy papers havereinforced this approach. However, althoughcommendable, I would like to caution that suchpolicies may ignore other relations and processes atplay within communities which can result incommunity opposition and sabotage. I would like toemphasise that the following account is myexperience in Bahr-El-Ghazal and that the samearguments cannot necessarily be carried over intoother regions of the operation, likewise, the

arguments presented here are my views and notthose of WFP as an organisation. I will argue that the options of targeting resourcesthrough the chief structure or male head ofhousehold are not appropriate solutions and thatwhile there is a strong case for targeting food aiddirectly to women based on their gender roles, sucha strategy by itself is ineffective. Finally, I willdescribe the system that was created throughdiscussion and participation of various communityactors.

Targeting through the Chieftancy StructureProponents of targeting resources directly to orthrough the chiefs argue that chiefs have knowledgeabout their communities and are in the best positionto make decisions concerning limited resources. Inaddition, many are still democratically elected andthus are accountable for their actions. However,change in recent years has resulted in additionalroles and new pressures for these individuals.Southern Sudan serves as a very good case exampleof these changes where chief structure differs fromregion to region and has been affected by the war.The on-going civil war has had a profound impactupon the community and has led to changes intraditional values, roles, and community institutions.In fact these traditional structures are now oftenmanipulated to serve the interest of various parties.

WFP initially used the chief structure for fooddistribution in southern Sudan. However, with timeit was discovered, that while these bodies hadtraditionally served as judicial bodies and settleddisputes among community members and ran thehunger courts during the ‘hunger gap’ periods theyhad never had to distribute ‘free’ resources amongsttheir community. It was therefore found that thisadditional role created a number of problems. Forexample, the concept of ‘targeting’ the mostvulnerable was foreign to the community and provedto be problematic when dealing with limitedresources such as food aid. In addition the warbrought new pressures that limited the capacity ofthese structures to carry out effective distributions tothe most vulnerable, e.g. new political and socialfactors, taxation, family or extended family requestsand demands. This centralised system of targetingtherefore resulted in very little trickle down ofresources to vulnerable households. Furthermore, it became obvious that even without

Women carry sacks of maize on their heads after afood distribution in the southern village of Acum

Cum. The maize is part of a UN World FoodProgramme airdrop of 16 tonnes of food meant for

15,000 people(UNICEF/HQ98-0258/Radhika Chalasani)

Is Targeting of Food Aid Directly to Women Basedon Gender Roles an Appropriate Response?Lessons from Southern Sudan

Field Article


these pressures, the chief system could noteffectively identify vulnerable households. Forexample, in NBEG (North Bahr El Gazal), thecommunity hierarchy might be represented asfollows:

Chiefs

Sub-Chiefs

Ghol Leaders

Headmen

Women at HH level.

Each level had a responsibility and a limitedunderstanding of vulnerability within theirjurisdiction. For example, sub-chiefs wereresponsible for a geographic location and couldidentify vulnerable areas but not households, whileonly ghol leaders could identify affected villageswithin communities. However, it was not until onereached the headmen that targeting of householdscould take place. Even this proved to beproblematic since these men were not in a positionto know about intra-household conflicts or problemsin meeting household consumption needs. It becameobvious that women at the household level held theinformation needed for targeting within theirvillages. Also, women found it difficult to speak toa man about intra-household problems. Therefore,by using the chief structure a great deal ofinformation was lost further limiting the capacity totarget the limited resources to vulnerablehouseholds.The headmen often distributed the proportion offood that finally reached village level equallyamongst the entire community in an effort to avoidfurther conflicts. This ‘diluted’ the ration and meantthat vulnerable households received only a smallproportion of their nutritional needs. With limitedresources, the only option was to explore analternative targeting method.

Targeting Households as a Unit In southern Sudan most women are involved inpolygamous relationships. This system allows for aman to have as many wives as he can afford throughpayment of a dowry. While a man may have threewives, each of these spouses will normally have herown tukle (grass hut) where she and her childrenare based (along with any additional extendedfamily members). A polygamous union does notmean they are wholly dependent upon men for theirhousehold’s survival. In terms of agriculturalproduction and consumption, each woman issomewhat responsible for her own household unit.The amount of sharing varies widely and dependsvery much on the husband and needs of eachhousehold. Although women have little bargainingpower within the household, conflict does exist dueto the different aims and concerns of familymembers. For example, men are always striving toincrease their wealth so they can increase theirnumber of wives, while women are more concernedwith household consumption levels. All familymembers participate in cultivation activities, butmen are still solely responsible for the care of largelivestock while women control small livestock andbudget the household grain. The household structure therefore makes it harder todistribute to the most vulnerable, as the omnipotenthead of household (commonly assumed to be amale figure) will have responsibility for dividing thefood amongst his wives or household units. Fromprevious studies we also know that hierarchiescommonly exist amongst wives which may result in

unequal distribution amongst these household units.

Targeting of food directly to women basedon gender rolesWith the above findings a strong case can be madeto distribute resources directly to those responsiblefor them within the household. For example, in thesouthern Sudan context a project aimed atrestocking cattle herds would be targeted at men.Several discussions at community level reinforcedthe idea that food aid should be given directly to thewomen. All parties argued that women were moreresponsible when it came to consumption needs athousehold level and that the men often hadconcerns outside the household unit which wouldresult in alternative uses of grain, e.g. increasingherd size, trade, etc. However, a strategy fortargeting was needed which would not alienate thechiefs, elders or other interest groups and wouldinclude women in the decision making process.

An Alternative OptionFollowing many discussions between WFP,members of the Sudan Relief RehabilitationAssociation (SRRA), and area chiefs, the idea oflocally based relief committees (RCs) emerged. Itwas decided that these RCs would be elected by thecommunity and would consist of 7 women and 6men who would be representative of theirgeographic region. A chairwoman was to be electedas the leader. The initial role of the RC was to helpidentify the most vulnerable in the community andhelp manage the logistics of running a fooddistribution in partnership with WFP and SRRAstaff (these roles have since expanded to includeother responsibilities such as informationgathering/research and education activities). It wasbelieved that the RCs would work with the chiefsand relieve them of some of their tasks. However, itsoon became obvious that RCs couldn’t identify themost vulnerable and that women belonging to aparticular village were in a much better position todo so. The system then changed so that RCsprovided information on geographic area andsupervised the targeting process while women ofeach village elected a representative who had theknowledge to identify needy households. Where thevillage was too large or divided on clan lines two ormore representatives would be chosen.The first of these committees was created inFebruary 1995. Later these committees extendthroughout NBEG. However, as with any system

there are weaknesses:i) the process of identifying the vulnerable is very

time consuming and involves lengthy discussionbetween women

ii) the new role for all those involved in targeting isvery stressful

iii)although many of the head chiefs or sub-chiefssupported these RCs many of the headmen andghol leaders felt that their power had been takenaway and preferred the previous system.

Despite these problems there were a number ofbenefits:i) women continuously stressesd that more of the

food was able to reach household levelii) it re-empowered women as managers of the food

and allowed for women’s participation in thedecision making process

iii)it provided female role models through a systemthat allows men and women to work together fortheir community

ConclusionWFP viewed this targeting strategy as a successstory. However, the challenge remains to find a wayto identify and target the most vulnerable with theparticipation of the community without alienatinggroups or creating conflict. It is important that WFPdoes not view the NBEG experience as a blueprintfor success and try to replicate it in other areas ofoperation without careful analysis of the social andcultural circumstances. Each context may requiredifferent targeting strategies. I would recommendthat WFP staff continue to acknowledge genderroles in an effort to design more appropriateinterventions. I would also encourage all staff toacknowledge local relationships and structures andfind ways to include all members of the communityin creating and fulfilling a shared agenda. Finally,the inclusion of women in this process shouldcontinue but not as targeted recipients who serve asa proxy for poverty, but as active agents who arepart of a large community and thus have veryvaluable contributions to make.

Contact the ENN for full paper.

Children and Women sit on the ground awaiting aweekly supplementary feeding session in the

southern village of Pakor(UNICEF/HQ98-0250/Radhika Chalasani)

Agency Profile


Name: SUDAN PRODUCTION AID (SUPRAID)Headquarters: AIRPORT VIEW ESTATE, HSE NO.80PO BOX 77901, NAIROBI KENYATelephone: 254 2 604565Fax: 254 2 605 952E-mail: [email protected]: 1993Chief Administrator: ACUIL MALITH BANGGOLNo. of Headquarters staff: 5No. of Field Staff: 25Operational in: TWIC COUNTY, SOUTH SUDANBudget: US$ 893,919

Iarrived at the modern SUPRAID offices atAirport View, Nairobi to be greeted by the Chiefadministrator: Acuil Malith Banggol, a 6 foot 9

Twic Dinka who is impressive not only in stature.Acuil, good humored and energetic, establishedSUPRAID in 1993 in order to empower thedisadvantaged in agricultural technology. Havinggraduated from Alexander University in animalhusbandry, he worked as part of the SRRA beforebranching out into the NGO world. Links with theSRRA remain strong and SUPRAID utilises SRRApersonnel on the ground to implement many of itsprojects. Acuil is philosophical about Sudan, its needs andSUPRAID’s enabling role. He explains that thesouthern Sudanese are ‘disadvantaged’ rather thanpoor and illustrates this with the image andjuxtaposition of a malnourished man sitting on awealth of resources. He explains that ‘advantage’will only come with peace, infrastructure andcapacity to utilise available resources to improvefarming productivity. Acuil asserts that relief is notthe answer to southern Sudan’s plight and recallstwo specific incidences that prompted him to placeso much emphasis on the transfer of agriculturaltechnology. The first was a relief assessment, whichresulted in a poor farmer getting the wrong seed:Sudan grass instead of sorghum. The second, acomment from his nephew when asked by Acuilwhile flying with him to Nairobi, whether he wouldlike to be a pilot when he is older. The boy repliedthat he didn’t want to do anything when he is older.When Acuil pressed him on this issue by asking himhow he expected to feed himself and his family, hewas discouraged to hear the boy say that therewould be no cause to worry as the UN wouldsupply the necessary food.Prominent amongst SUPRAID’s activities isagricultural technical training. Contact farmersare trained and successes then demonstrated tothe rest of the community through the exampleof good results and experiences. SUPRAID isalso involved in improving water and sanitationby; installing and maintaining hygienicdrainage around water pumps, encouraging theproper use of water facilities, and empoweringcommunities to take responsibility for theirwater sources. Plans are under way to involvewomen in training to repair pumps and to ‘sayno’ to those who misuse the pumps. Thecommunity is also educated about water bornediseases and the use of simple techniques likefilter cloths. In the future SUPRAID want toinclude hand drilling as part of the water andsanitation activities. The plan is to bringVondor rigs (manual rigs) from Zimbabwe andto install them with the help of the community. Education is the other major activity in which

SUPRAID is involved. As Acuil puts it ‘conflict candestroy material inputs but raiders can not take awayabcs’. SUPRAID, in collaboration with the SRRAand the UN Dept for Education, are providingteacher training in a number of counties. Though SUPRAID is more of a ‘developmentagency’ the events of 1998 demanded reliefinterventions. SUPRAID therefore responded byestablishing feeding programmes in two payams inTwic County and were supported in this newendeavor by Christian Aid, DFID and UNICEF whohelped establish the required technical proficiencywithin the agency. Two international consultantsworked along side SUPRAID. Acuil describes theexperience as very positive and a success in terms ofcapacity building within the orgainsation.I asked Acuil about one aspect of relief interventionwhich is currently emerging as a key issue insouthern Sudan, - targeting of emergency food aid.Acuil felt that firstly there was an over-focus onfood aid. He gave anecdotes of assessment missionshe had gone on with donors and internationalagencies where his understanding of local dialectsallowed him to observe how people withincommunities, and even those translating forassessment teams, often express need in terms ofwhat respondents believe a particular donor oragency can supply, (there is no point asking a cardealer for a camel). In this way actual needs, whichare multi-sectoral may be overlooked and the

universal response – food – is applied. Second, foodaid should be targeted through the use of communitysocial structures rather than parallel decision-makingbodies established from outside. While communitystructures involving chiefs, sub chiefs, ghols, andhousehold heads, may not be fool proof in terms ofensuring equity, these systems and structures areknown by the community and have mechanisms forappeal if community members feel unfairly treated. Acuil kept coming back to the overall importance oftraining and capacity building for the people ofsouth Sudan. After all, when the security situationworsens, and international NGOs evacuate, it is theindigenous organisations that must provide servicesfor their people. Furthermore, he is confident thatpeace will eventually come, and that when it does,the management skills should be present to createthe capacity to utilise the abundant natural resourcesof southern Sudan. Donors, he feels, shouldtherefore give greater emphasis to capacity buildingwithin the southern Sudanese administration. One last element of SUPRAID’s work is thepromotion of peace and reconciliation throughadvocacy and other initiatives. Recently one suchinitiative brought together Nuer local leaders withspiritual leaders as a precursor to a gatheringbetween the Bul Nuer and Dinka Twic who havebeen at war with one another for a number of years.The ears were cut from a ram to signify ‘ A Nonaggression pact’ to be ratified in the gatheringbetween the two communities the following month.As part of this initiative, SUPRAID distributed 2500relief kits to Nuer households and 2500 to Dinkahouseholds.

SUPRAID is linking its deliveries to Neur andDinka with efforts to promotea peaceful co-existence. Support in the form of farming andfishing inputs shelter material and veterinaryservices are provided to help resumenormallivelihoods. SUPRAID require donor supportfor peace activities and are committed to supportingcommunities as long as “they work hard for localpeace” explains Acuil. Communities are encouragedto resort to their traditional conflict resolutionmethods to ensure that common grounds, fishingzones and farming land plus cross border movementare protected and allowed.SUPRAID also advocate for good governance andjustice plus empowerment of the local community.Acuil describes this kind of activity as an obligationrather than a programme.

SUPRAIDby Fiona O’Reilly

SUPRAID implementing an ox plough programme in Twic County

SUPRAID Chief Administrator Acuil Malith Banggol

Agency Profile


Name: Sudan Relief andRehabilitation Association(SRRA)

Headquarters: New Cush, New SudanLiaison Office: Nairobi, Kenya. Telephone: 254 2 448075 / 440156Fax: 254 2 448078Formed: 1985Secretary forHumanitarian Affairs: Kosti ManibeHead quarters staff: 46Field Staff: 300Budget: $400,000 – 600,000

The Sudan Relief and RehabilitationAssociation (SRRA) describes itself as anautonomous humanitarian agency of the

Sudan People’s Liberation Movement (SPLM). Itwas established in 1985 and mandated to co-ordinate and facilitate humanitarian assistanceprogrammes in SPLM areas. Its headquarters are inNew Cush with liaison offices in Nairobi, Kampala,Addis Ababa and Loki. Presently, the SRRA co-ordinates and facilitates humanitarian activities in 23counties covering an area of some 400,000 squarekilometres, with an estimated population of 6.5million. Joint relief and Rehabilitation Committeeson which all functional humanitarian organisationsin an area sit, serve as bodies to plan jointly, shareinformation and resolve problems at the local level.The stated objectives of the SRRA are to:i) Improve access to and delivery of humanitarianassistance to affected populations in SPLMadministered areasii) Increase managerial, technical and institutionalcapacity of SRRA, civil authorities and communitygroupsiii) Improve co-ordination with humanitarianagencies, civil authorities and community groups atall levels iv) Enhance the operating environment

SRRA functions therefore include:– co-ordination of all humanitarian interventions inSPLM administered areas; facilitation; liaison andmonitoring and evaluation of assistanceprogrammes. – ensuring efficient and equitable delivery ofhumanitarian assistance to beneficiaries, e.g.providing passes permits, work permits and relevantinformation to humanitarian organisations– liasing with and seeking the co-operation of allorganisations on issues relating to or affectinghumanitarian interventions– monitoring and evaluating all assistanceprogrammes

I interviewed a number of SRRA staff on behalf ofthe ENN. In Nairobi, Kosti Manibe the Secretary forHumanitarian Affairs and Mabior Deu, trainingofficer and staff member since 1989, explained howin the early days of the SRRA there were only a fewNGOs to deal with. The main ones were the NPA,the Red Cross, and the church based agencies butover the years numbers increased dramatically. Thisproliferation and diversity of NGOs thoughwelcomed to meet increasing need has apparentlyposed problems for the SRRA particularly over thelast year of the crisis when the professional abilityof these agencies has varied enormously. Theproblem has been that the SRRA have lacked the

capacity to effectively co-ordinate and monitor themany agencies on the ground. A number of agenciesthat came in simply lacked the capacity to do the jobthey came in to do, but at the same time the SRRAdid not want to deny them access, as every resourcewas potentially useful given the scale of need.

Mabior described other constraints and frustrationsfor the SRRA. For example, the SRRA had knownwell in advance about the impending crisis insouthern Sudan but had their hands tied as donorsonly eventually responded to images of starvingchildren. Financial support, explained Kosti, hasalways been a problem for the SRRA. The millionsprovided to OLS dwarf their budget of between400,000-600,000 dollars per year. The SRRAreceives no direct government support andundoubtedly suffer under-financing partly as a resultof their linkage to the SPLM/A.

The SRRA are currently re-structuring theirorganisation with an emphasis on closer supervisionand a move towards decentralised decision making.Staff will be re-deployed for better utilisation ofmanpower and to avoid politicisation of the SRRA.Kosti explained the development options open to theSRRA at present: to continue as a kind of para-statalorganisation carrying out regulatory functions for

NGO activities etc. or to move more into the field ofhumanitarian action and relief itself therebyoperating increasingly like an NGO. Kosti musedthat in a way the latter is bound to eventually occurwhen the war ends and civil structures emerge toreplace much of SRRA’s work.

An interview with Philip Aquer, the SRRA Liaisonofficer in Lokichokio provided other interestinginsights into SRRA’s experience of the recentemergency. Philip described how the SRRA hadstarted raising the alarm about the pending crisis in1997. He also described how the initial strategies ofmany agencies, namely opening up feeding centreswas like ‘a drop in the ocean’ and that there was noway of providing adequate standards and services atthese centres as thousands of people would descendon a new centre the day after its opening. Capacitywas therefore immediately overwhelmed. Philip wasof the view that by August 1998 agencies had begunto get their act together. By that time howeverhundreds of thousands had died.

Kosti Manibe suggested that if a humanitariantragedy similar to that of last year is to be averted inthe future there needs to be a commitment from theinternational community to prevent rather thansimply respond.

SRRABy Fiona O’Reilly

Kosti Manibe the Secretary for Humanitarian Affairs and Mabior Deu, training officer

Philip Aquer,the SRRA

Liaison officerin Lokichokio

Field Article


Background

Central Mandera is located in northeasternKenya, 2 km west of Somalia and 5 kmsouth of the Ethiopian border. The estimated

population is 37,900, distributed in eight mainlocations, within a 12 km radius. The population ismainly ethnic Somali, practising traditionalnomadic-pastoralism. Central Mandera has been asettlement for refugees since 1991 when manypeople in the west of Somalia fled to Kenya insearch of security and food. About 10,000 refugeesstill live there in the former refugee camps ofShafshaefi and Handadu, although these are nowconsidered official locations. During the severedrought of 1991-1992 animal holdings weredrastically reduced in some population groups in thedistrict rendering many families destitute, andforcing them to migrate to Central Mandera. Thesedisplaced pastoralists increased the numbers ofurban poor as the limited economic growth inMandera has been insufficient to absorb the‘unskilled’ pastoralist labour.

Evolution of MSF Spain interventionIn March 1996 Northern Aid (a local NGO)contacted MSF Spain out of concerns for thepastoralist population of Mandera district who hadbeen badly affected by the prolonged droughtaffecting the area over the previous two years. Anassessment of the general situation and a nutritionsurvey were carried out in May 1996 in CentralMandera, as this was considered the most affectedarea where the majority of the district populationwere settled.The nutrition survey results showed 32.4% globalacute malnutrition (GAM) (weight for height<–2SD) with 4.6% severe acute malnutrition (SAM)(<–3SD). The assessment also showed food priceinflation occurring from December 1995, anincrease in animal morbidity and mortality rates, arising number of female–headed households,reduced purchasing power, large numbers ofdestitute people around the market and a smallmigratory movement to the town. All thesephenomena were indicative of an acute and severefood crisis amongst the population.However, another assessment in June 1996concluded that the situation was not quite as bad asoriginally thought in terms of food security in thedistrict; although the situation in Central Manderawas found to be more critical.In response to the situation in Central Mandera,MSF Spain began a nutritional intervention in theform of feeding centres with the objectives of:

• Decreasing malnutrition–related infant mortality.• Preventing a deterioration of the nutritional

situation and reducing the malnutrition rate to halfthat found in the May nutritional survey.

Based on the assumption that twenty percent of thewhole population were under five (7580 children)and the survey results, five Curative SupplementaryFeeding Centres (SFC) were opened (three on-siteand two take–home). The take home feeding centres

were established in order to facilitate accessibilityfor those in more distant locations (see Table 1). Inaddition, a Therapeutic Feeding Centre (TFC) wasopened in Mandera town.Between September–October 1996 a subsequentfood assessment in conjunction with risingreadmission rates in the feeding centres confirmed adeterioration in the situation, and led to theimplementation of a Targeted Food Distribution(TFD) to vulnerable families in Central Mandera,and a General Food Distribution (GFD) in Finodivision. These additional programmes were alsoimplemented by MSF Spain.In Central Mandera families were targeted throughthe SFCs (any family with a malnourished child wasconsidered at risk). The family ration consisted of1100kcal/person/day and the commodities dispensedwere beans, maize and oil which were distributed ona monthly basis. A total of 3,000 families benefitedfrom the TFD, accounting for 18,000 people in thearea (six members per family).Heavy rains finally came in April 1997. It was atthis point that the Kenyan government recognisedthe emergency situation and applied for help to theinternational community (it was coincidentallyelection time in Kenya). MSF handed over the TFDto the government in July 1997 which had started toreceive food from the World Food Programme(WFP). But continuing monitoring confirmed thatmuch of this food did not reach the target populationalthough it should be noted that food aid pledges to

WFP were limited so that the amounts of foodwould in any case have only lasted for a short periodof time. At the time of writing this article (August1998), MSF still continue to operate SFCs inMandera. Although there were substantialimprovements in the nutritional situation in the firstsix months of the programme, malnutrition rateshave not fallen below 20% since then.

What follows is a summary of my personalevaluation of the programme and discussions withthe MSF team about the programme that started onmy arrival in Mandera.

The Supplementary Feeding ProgrammeWhen children are discharged from SFCs theyreceive Unimix (1000kcal/day) for the first twomonths. As a way of targeting vulnerable groups,every pregnant or lactating woman having amalnourished child also receives the Unimix.

Performance of the Feeding CentresThe number of children who attended the SFCsfrom July 1996 up until March 1998 was 11,250. Evaluation of feeding centre performance showedthat targets (using MSF reference values) weregenerally met over the 21 months period studied,except for some months in which aggravatingfactors (cholera outbreak, heavy rains and floods,malaria epidemic) influenced the outcome or whencertain operational problems occurred (Figure 1 & 2).

Design Onsite SFC Take Home

Target group <5yrs <5yrs

Food type Porridge (unimix, oil, sugar) premix (maize, dry skimmedmilk, oil and sugar)

Kcals 600kcals/day 1300kcals/day

No. meals / day 2

Other programme inputs education health

Nutrition, hygiene educationVit A, dewormingMeasles vaccination Measles vaccination

Discharge criteria

View of theMandera Camp

Supplementary Feeding in Mandera:The Right Intervention?

Lourdes–Vazquez–Garcia worked for MSF Spain in the Mandera feeding centres during the period covered by this article. Shesubsequently qualified with an MSc in Human Nutrition at the London School of Hygiene and Tropical Medicine in September1998 writing this article shortly after finishing her summer dissertation which was based on her analysis of the MSF Spainintervention.

Table 1

Field Article


At all feeding centres, attendance by beneficiarieshas been above 80%, and estimated coverage hasbeen 90%. Also, 80% of those discharged monthly(450 to 943 children) had reached 85% of thereference median WFH, reflecting the overalleffectiveness of the feeding centres.In spite of the overall adequate performance of thefeeding centres there were a number of issues andquestions about the programme which concerned theMSF team:i) were the same children continuously being re-admitted and if so, why?ii) why did malnutrition rates not improve followingthe TFD?iii)did the high prevalence of malnutrition reflect achronic problem and, if so, is the MSF strategy ofestablishing feeding centres the most effective use ofintervention resources?

Are the same children continuously being re-admitted?

Re-admissionsSome re-admissions are to be expected due to poorfeeding practices at home or recurrence of disease.Figure 3 shows the percentage of re-admissions overa period of months. Readmission were defined asany child who was re-admitted to the programmewithin two months of discharge. However, wesuspected that these figures underestimated theextent of re-admissions as a survey in June 1997,found that 33% of malnourished children hadpreviously been in the programme. Under–estimatesmay have occurred for two reasons: The definitionitself (which only accounts for children enrolledwithin the previous two months), and the reluctanceof mothers to tell the truth because of fear of notbeing admitted again or being ‘punished’ by thestaff. These high levels of re-admissions inconjunction with the evidence for ‘doubleregistration’ (large numbers of double registrationswere discovered during a follow up survey ofdefaulters in June 1997) suggests that the feedingcentres may be used to provide an income/foodtransfer to the entire household. In other wordschildren may be intentionally under-fed so thathouseholds can gain access to programme foodresources. Once enrolled children may then remainunder–fed as a means of ensuring increased foodintake for other family members and in order torelease or create income for household expenditure.Gaining access to the supplementary feedingprogramme effectively becomes part of the overallhousehold coping strategy.

Why malnutrition rates did not improve followingthe TFD

Although the TFD was implemented for a six monthperiod in Mandera malnutrition rates remained thesame. However:

• beneficiary families were selected on the basis ofhaving a malnourished child at SFCs, while studiessuggest that such households may not necessarilybe the most food–insecure. This targeting method

was used as it was felt to be the only feasibletargeting strategy, i.e. it would limit the degree of‘leakage’ and corruption and would be accepted byleaders.

• the distribution of family cards only took placeover a one month period so there was only partialcoverage of vulnerable groups.

• only a half ration was distributed (based on theperception that a full ration was not needed).

• rations were shared through community socialnetworks.

Furthermore, although the primary objective of theTFD in Central Mandera was the alleviation ofmalnutrition in children it does not follow thatbeneficiaries were using that food to tackle problemsof malnutrition. They might well have had otherpriorities, such as preserving animals or buyingseeds, or maintaining the work capacity of the adultincome–earning members of the household. It wasnot unusual to see “MSF food” (mainly Unimix andbeans) in the markets.

Did the high prevalence of wasting reflect achronic problem and is the MSF strategy ofestablishing feeding centres the most cost-effective use of intervention resources?

A more detailed analysis of the causes ofmalnutrition led MSF to the conclusion that chronicfood insecurity and poverty are the key factorsdetermining the high prevalence of wasting with thesituation further aggravated by environmentalconditions (cholera outbreaks have occurred everyyear for the past 3 years while this year there hasbeen a malaria epidemic). Lack ofavailability/accessibility to health servicesaggravated conditions still further. In CentralMandera high wasting rates are a permanent feature.

Given this fact, what are thesolutions?Reducing food aid now withouta parallel expansion in genuinedevelopment activities will serveto increase further thevulnerability of the population.At the same time it needs to beappreciated that there may benegative long–term effects offood aid provision, e.g. thediversion of agency resources

which might be used for other priority activities andthe possibility of free food handouts becoming adisincentive to self–help activities.In this case supplementary feeding programmes areacting more as a food/income transfer equivalent tofamilies. My view is that interventions shouldaddress economic as well as food needs at thefamily level. At the present time, SFCs in CentralMandera are seen by MSF as a ‘holding’ operationwhereby under–five mortality is reduced, by keepingmalnourished individuals at a weight associated withminimum risk of illness or death and as an efficientform of damage control preventing a furtherdeterioration of the nutritional status.However, in this type of situation nutritioninterventions need to combine a number ofactivities. The association of poor nutritional statuswith poverty, indicates long–term developmentneeds, including income–generating activities andpublic health measures.In order to come up with specific and appropriatesolutions, on site research into the root causes of theproblem (malnutrition being the symptom) needs tobe conducted in conjunction with the community.This would involve collaboration betweenbeneficiaries, Government, and humanitarianagencies.

Guidelines should be expanded to include different‘famine’ scenarios as the type of chronic emergencyfound in Mandera is becoming increasinglyprevalent in many parts of Africa. Guidelines needto acknowledge this and provide alternative and newresponse options based more on an analysis ofunderlying problems and chronic/structural povertyrather than by advocating the use of trigger levels ofwasting to stimulate automatic implementation ofemergency selective feeding programmes.

Post–Script by Amaia EsparzaA nutritional survey was carried out in Manderabetween the 16th and 20th of November and found aGAM of 20.4%. Food distribution was subsequentlychanged so that children received 4kg ofpremix/week instead of 2kg. Children above 75%were being discharged and got 8kg of unimixinstead of 4kg.The programme was closed in mid–December ‘98.

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Figure 3: : Re-admissions after discharge at feeding centres (August 1996–March 1998)

Figure 1: Exit indicators Dry SFCs (August 1996 – October 1997)

Figure 2: Exit indicators Wet SFCs (August 1996 – March 1998)Supplementary Feeding in Mandera

Evaluations


In response to the humanitarian crisis whichunfolded in Bahr El Ghazal (BEG) last year, anSPLM/SRRA - OLS task force was set up to

answer the question ‘why are not all of the people inneed receiving any or enough food?’. Theassessment findings were that the intervention wasrestricted and constrained by an extremelycomplicated set of interrelatedsocial/anthropological, political, economic, militaryand humanitarian factors and that these factorscombined in various ways and in varying degrees atdifferent phases of the crisis. The task force reportfound that the most vulnerable groups in BEG werealso the most marginalised and as a result the leastlikely to receive the relief food that is actuallyintended for them. The following is a summary ofthe main findings and recommendations of the taskforce.

The people most in need of assistance were:• Displaced people without representation of a chief,

ghol leader or some other authority figure whowere being excluded from general distributions.The displaced include those displaced due toinsecurity, those known as the ‘C-130 invitees’,who were continually traveling within the regionbetween airstrips in the hope of receiving food,and those who move to relief centres in the hope ofsecuring a general ration.

• Families or households with a member in a feedingcentre who were being excluded from the generaldistribution. Reasons for this were that somecommunity decision makers were unwilling totarget this group and some did not understand thatfeeding centre rations were meant to besupplementary to the general ration. Somebeneficiaries also lacked knowledge of theirentitlement.

• Widows were also among the most marginalisedand were often excluded from the distributionsystem

• Those at the lower end of the social hierarchy wereoften excluded from relief distributions. Theirplight had been made worse by changing patternsof traditional coping strategies caused by years ofcivil war, e.g. changes in livelihood strategies,

breakdown of kinship ties and changes in therepresentational role of traditional communityleaders.

Why Not All People in Need Are ReceivingAny or Enough FoodThe task force found that no single factor or partycan be held solely responsible for the crisis. Theproblems had been:

i) chronic under funding that OLS had suffered since1995ii) The flight suspension imposed by the GoS at themost critical moments of the crisis and thesubsequent delays in granting clearance foradditional heavy lift cargo aircraftiii) the clearance of only four locations on Feb 26thattracted many people in from long distances,overwhelming poorly equipped centresiv) OLS agencies were late in their capacity torespond to the rapidly deteriorating situation.Reasons include lack of contingency planning byOLS and their underestimation of the total numberof people in need as it relied on their own limitedassessment and distribution coverage to makeprojectionsv) the Relief Committee and/or Chief distributionsystems did not cope with distributing a limitednumber of resources during the period ofdramatically increasing and wide spread needvi) the practice of redistributing relief food equallyamong the majority of the population by Chiefs andlocal communities so that the most needy got lessthan intendedvii) the lack of accurate and/or agreed populationfigures. OLS agencies and the SPLM/SRRA wereconstantly disputing each others population figures,making coordinated and joint planning very difficultviii) application of a modified version of thetraditional and socially accepted practice ‘tayeen’ (acontribution by the community to the governmentwhich includes the army) of relief foodix) problems with law and order and militarydiscipline leading to chaos at distribution sites andmany beneficiaries being robbed of their relief food.

RecommendationsThe task force report made many recommendationsto assist in ending the crisis. Each recommendationwas matched with the actor it believed shouldinitiate the action. In view of the large number ofrecommendations made in this report, only a fewexamples are given here.

• The SPLM/A must increase the amount ofattention and resources given to issues of law andorder in areas where OLS and independent NGOsare operating.• The lack of programme co-ordination presence inthe field severely hampered UNICEF’s ability to co-ordinate and assess the situation and to carry out itsfunctions as the southern sector lead agency.UNICEF must therefore fully re-introduce theRegional Programme officer positions• There is a need for collaboration between theNGOs and UNICEF to review the quality of existingfeeding centres within the region of BEG. UNICEFshould develop more flexible protocols for feedingcentres but with clearly defined minimum standards. • A Joint OLS/SRRA population survey/registrationis essential for future planning and implementationactivities. • A review of community perceptions of targetingand distribution systems must take place as soon aspossible. This should include SRRA/WFP/UNICEF/relevant NGOs and should be facilitated byan external consultant who has a broad backgroundin distribution methodologies and no vested interestin any one particular methodology.

Finally, the report highlighted the many stepsalready taken by agencies to improve matters andexpressed appreciation for the courage and initiativetaken by the SPLM, SRRA and OLS agencies toopen themselves up to critical examination of thecomplex issues pertaining to why people in need inBEG were not getting any or enough food.

Reference:SPLM/SRRA – OLS Joint Targeting andVulnerability Task Force in SPLM ControlledAreas of Bahr el Ghazal: August 27th 1998 -Executive Summary

Task Force ReviewSummary of a Report by SPLM/SRRA–OLS

Bahr el Ghazal Displaced people arriving from Wau(Mariantonietta Pieterse – UNICEF ‘98)

Child picking up grains from thedropsite in Koch, upper Nile

(Anne Nosten UNICEF ‘98)

Evaluations


About the most exciting thing to do in Loki isan airdrop – so Vito in the flight co-ordination office organised that I go on the

flight drop to Longochock. A flight drop is where 16tonnes of food are dropped from a Hercules inmid–flight. This is the way most of the food isdelivered to south Sudan. Obviously where areas areaccessible by road food is transported over land,however, this is not an option in the majority ofcases because of poor infrastructure, seasonal rainsand insecurity. At the height of the crisis in 1998,food-rations of up to 12,000 MTs were flown ineach month to south Sudan. In January 1999>8MTs<check with fiona> were delivered by air.

Pat Repka (ex US airforce) was my pilot for theairdrop. Pat has been flying around this part of theworld and in and out of war zones for more yearsthat he would care to admit. Recently he lost two

colleagues who were shot down in Angola. One ofthem was the chief pilot for TRANSAFRIK –leaving Pat to take over this position. Pat and his co-pilot Derek got into the usual gung-ho banterintended to shock, surprise, or just entertain guestslike myself. They told me they hadn’t lost too manypassengers while dropping the food. When we reached the drop site I put on the harnessand stood at the back of the plane. As the dooropened the plane went into a 45-degree suddenincline and half the load was dropped.While flying over the huge expanse of cracked landbelow, I was struck by the monumentalenvironmental constraints facing people trying tosurvive and those endeavouring to help them.Longochock is in upper Nile region about 400 milesnorth east of Lockichockio on the Kenyan borderand as we approached it was possible to see floodedareas due to the effects of El Niño. Longochock

from the air looked like a small village. I wasimpressed (whether or not I should have been), thatunder OLS not only did a sufficiently sophisticatedlogistics system operate to locate and target thissmall village with food dropped from a C–130Hercules, but also that there was a WFP foodmonitor on the ground to receive and attempt todistribute that food. Another thing that impressed me(I was having a good day), was the extremelyhumble attitude of the pilots exemplified by thecomments “just doing a job” and “I just like to fly”(in an American accent). The pilots considerthemselves as foot soldiers and rarely get intophilosophical discussions, as aid workers frequentlydo, about the bigger picture and ‘what happens tothe food’ and ‘what it is all for anyway’. Sure their task might be considered straight–forwardand uncomplicated but there are very likely as manydos and don’ts in flying a plane and in running thelogistics of the air operation as there are inimplementing a TFC or SFC. The point is that thereis probably only one way to do it right. The pilotslike their job. Yes, they get well paid and there is anabsolute necessity for technical precision. They dotheir job to meet the standards of their profession,unaffected by humanitarian principles and codes ofconduct. As I enjoyed the hospitality of theTracmark camp in Loki where a lot of the pilotsstay, I wondered if my fellow humanitarians still(after 10 years of operation) living in the make–shiftand decidedly un–luxurious OLS compound, couldnot learn something from the pilots. Thehumanitarian effort might do better with a few morefoot soldiers aiming for technical precision andstandards, ready and able to implement these at theheight of a crisis. Also, better pay and livingconditions probably contributed to the longer timemany of the pilots had been based in Loki comparedto their relief–worker counterparts.

Pilots – the Unsung HeroesBy Fiona O’Reilly

Athree month assessment mission to Bahr El GazalRegion in Southern Sudan was undertaken by WFPbetween August and November 1998. The main

findings were as follows.

i) Nutrition surveys revealed a highly variable situation.Some locations were showing an improved nutritionalstatus of their registered programme participants leading toanticipation of selective feeding programme closure. Forexample, global malnutrition rates in Yirol decreased from26% in May to 10.9% in September. This has been theresult not only of increased quantities of food beingdelivered into the region by WFP but also of the openingof numerous selective feeding programes. However, othersareas still experienced alarmingly high levels of globalmalnutrition (21.1% severe malnutrition aroundMalualkon) so that agencies were gearing up to commenceselective feeding programme support. ii) The current food basket energy level must be increasedfrom 1900 kcals per capita to the standard 2100 to ensureadequacy for populations that have no other foodresources. Distribution alternatives may be implemented atseventy five and fifty percent levels depending on whatother food sources are available to those recipients.iii) The commodities distributed in the food basket (agrain, pulse, oil, blended food and iodised salt) are wellaccepted by the population. Whole grains were generallyan expressed preference over milled grain. Reasons givenwere the better long-term keeping properties of grain,especially if air-dropped onto wet ground. Another reasonwas that women felt better able to manage/budget thequantity required for a days consumption as, if given in

flour, they would tend to prepare larger quantities whilegrain which needed to be pounded would be prepared insmaller quantities and therefore budgeted to last longer.Other advantages were that various products at thepounding stages were utilised. For example, the chaff ofmaize may be set aside and used for brewing or reservedfor longer term if food shortages are anticipated. Appropriate preparation methods for newly introducedcommodities such as brown lentils, and potentially bulgurwheat in the coming year, need to be communicated torecipients in order that essential nutrients are not lost.Proper preparation also means less work and fuel savings.Food preparation methods employed for brown lentils havebeen ill-advised. Women were soaking the lentils, rubbingoff the skins and discarding them , thus throwing awayvaluable vitamins and minerals. Discussions with womenalso indicated that they did not know what bulgur wheatwas or how to prepare it. Although the taste should be wellaccepted (it is similar to sorghum) preparation methodsshould reflect the fact that it has a short cooking time.Food monitors should explain food preparation methods torepresentatives of the local relief committees. Theserepresentatives should then discuss these matters withwomen at the distribution points.iv) There have been no reports of micro-nutrient

deficiency disease. This is theorised as being due to theconsumption of wild foods collected and prepared,especially during times of great hunger. The contributionof these foods has been under-estimated and furtherinformation is needed on their uses and nutrient analysis tobetter document their importance. v) Careful attention may be needed at static relief sites toensure that nutrient deficiencies do not develop as a result

of dependence on too little dietary variation. Certain sitessuch as Ajiep, Thikthou, etc have had a magnet effect forpeople as food has been distributed. The longer displacedpopulations remain in these locations, there will be fewerwild food resources for all to gather and greaterdependence on a narrow range of distributed foods.Fortified cereals and increased rations of blended foods,may be warranted for these populations. The situationneeds careful monitoring. vi) The consistent use of a single formulation of UNIMIX

within OLS should be discussed. It is confusing to havemultiple formulations being referred to by the same name.

Ref: Nutrition Assessment Mission Sudan EMOP5826.01, WFP Southern Sudan, A. Hudacek, Nov. 98.E-mail: [email protected]

WFP Assessment Mission

Children Posing next to a flag made out of the sacksused by WFP to drop food in Koch, upper Nile(Anne Nosten)

People in AidPat Repka on the Lockichockio airstrip

People in Aid


Caroline Gullick and Brigitta Grosshinsky

Fiona O’Reilly andAcuil Malith Banggol

Susan Lillicrap andNick Ireland (Merlin)organising thewithdrawal fromSudan due tocessation of DFIDfunding

Willie Norton (Lokiairport manager with

assistant Phelix Edwards

UNICEF nutritionistLinda Ethangatha

Jason Matus, WFP Loki

Charlie Maine UNICEFPreparedness andResponse Officer(Southern sector OLS)

NGO personnel attending the monthly OLS Nutrition meeting in Loki

Dianne de Guzman, SCF(UK)Loki – ‘Blinking’

Michael Medley (Nairobi) Marten Kvist (WHO) and KillianForde (Ex–ENN) in Sarajevo

The Backpage


Field Exchange

Cartoon Corner by Jon Berkeley

UNHCR

The

is currentlyfunded by:

The Emergency Nutrition Network (ENN)grew out of a series of interagency meetings focusing onfood and nutritional aspects of emergencies. The meetingswere hosted by UNHCR and attended by a number of UNagencies, NGOs, donors and academics. The Network is theresult of a shared commitment to improve knowledge,stimulate learning and provide vital support andencouragement to food and nutrition workers involved inemergencies. The ENN officially began operations inNovember 1996 and has widespread support from UNagencies, NGOs, and donor governments. The network aimsto improve emergency food and nutrition programmeeffectiveness by:

• providing a forum for the exchange of field levelexperiences

• strengthening humanitarian agency institutional memory

• keeping field staff up to date with current research andevaluation findings

• helping to identify subjects in the emergency food andnutrition sector which need more research

The main output of the ENN is a quarterly newsletter, FieldExchange, which is devoted primarily to publishing field levelarticles and current research and evaluation findings relevantto the emergency food and nutrition sector.

The main target audience of the Newsletter are food andnutrition workers involved in emergencies and thoseresearching this area. The reporting and exchange of fieldlevel experiences is central to ENN activities.

The ENN is located in the Department of Community Healthand General Practice, Trinity College, Dublin, Ireland.

The TeamFiona O’Reilly is the ENN Co-ordinator, and Field Exchange co-editor.Fiona has been involved in the area of nutrition, health anddevelopment for the past 10 years, half of which has beenspent working in emergency situations.

Jeremy Shoham is co-editor for Field Exchange and the ENNtechnical consultant. Jeremy has been working in the area ofemergency food and nutrition for the past 13 years. He runsthe Emergency Nutrition M.Sc. unit at the Centre for HumanNutrition, London School of Hygiene and Tropical Medicine.

Kornelius Elstner works part time with the ENN.

Thanks to the Department of Community and GeneralPractice, especially Professor John Kevany, Trinity College forsupport for this project.

GENEVA FOUNDATIONto protect health in war

EditorsFiona O’ReillyJeremy Shoham

Layout & WebsiteKornelius Elstner

Contributors for this issuePaul MurphyPeter SalamaDavid KeeneTracy McGheeKay SharpeCassandra ChapmanLourdes–Vazquez–GarciaCaroline GullickSteve Collins

Special Thanks for assistance with this issue to:Paul Murphy and Peter Salama (Concern)David Keene

Thanks for the Photographs to:Gillian WilcoxUNICEFMSF–Spain

Thanks for hospitality and assistance in NairobiNoreen Prenderville and Gote HertzBuzz and Jacki SharpeCaroline GullickPhilip Winter

As always thanks for the Cartoon to:Jon Berkeley, who can be contactedthrough www.holytrousers.com

Emergency Nutrition NetworkDepartment of Community Health & General PracticeTrinity College, 199 Pearse Street, Dublin 2, Ireland

Tel: 353 1 608 2676 / 608 1087Fax: 353 1 670 5384e-mail: [email protected]: www.tcd.ie/ENN

February 1998 Issue 6 Field Exchanges3.ennonline.net/attachments/1653/FEX-6.pdf · February 1998 Issue 6 Field Exchange Network Special Focus: South Sudan Wild Foods Targeting Food

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