United Nations System
Standing Committee on Nutrition

Nutrition Information in Crisis Situations - Afghanistan
 

NICS 12, February 2007

Following last year’s drought, above normal precipitation took place from October to December 2006 (FEWS, 01/07). However, high temperatures in January caused an early snow melt that might have a negative impact on the availability of irrigation water for the upcoming growing season. Moreover, avalanches and floods have affected Uruzgan, Helmand, Badghis and Ghor provinces (IRIN, 20/03/07). Delivery of assistance were planned but might be hampered by bad road conditions.

A nutrition survey conducted in November 2006 in Miramor, Sharestan and Nili districts, Day Kundi province showed an acceptable nutrition situation (ACF-F, 11/06). The prevalence of acute malnutrition was 3.0% (1.4-4.5), including 0.8% (0.2-1.7) severe acute malnutrition. Death rates were average: CMR=0.19 (0.12-0.27) and U5MR=0.70 (0.39-1.02). The nutrition situation was under control despite the food insecurity in the area that followed several years of drought.

NICS 11, November 2006

In addition to the drought that resulted in a 50 to 80% percent loss of the rain fed harvest and caused water shortages in the north of the country, floods have damaged homes and agricultural land throughout the country, especially in the north-west that was already affected by the drought (Fews, 11/06). Crop losses and water shortages are the most acute in Badghis, Faryab, Jwazjan, Sari Pul and Samangan provinces. Deterioration of security in southern Afghanistan has led to the displacement of an additional 20,000 people. WFP has distributed food to the population affected by the floods and the drought as well as to 81,000 people displaced by insecurity in the southern provinces of Kandahar, Helmand and Uruzgan (BAAG, 30/11/06).

According to several reports, the fate of the Afghan population remains bleak (AAH, 10/06; AREU, 08/06).

NICS 10, August 2006

The security situation has remained volatile (BAAG, 31/08/06). Moreover, Afghanistan did not have adequate rainfall in April/May (IRA/UN, 07/06). Wheat production is estimated to be 3.71 m MT against 4.27 m MT last year. Rain-fed agro-ecological zones are the most affected. An appeal launched by the Islamic Republic of Afghanistan and the United Nations in July estimated that 2.5 m people will be affected by the drought, in addition to the 6.5 m people seasonally or chronically food insecure. As well as the 3.5 m people WFP already assists, 1.7 m people may need assistance each month until the next harvest. The appeal includes a call for 67,000 MT of cereals, 14,500 MT of other commodities, 4,500 MT of seeds, 6,750 MT of fertilizer, as well as water supplies, communicable diseases control and nutritional interventions.

NICS 7, August 2005

Security conditions are still highly volatile (BAAG, 31/07/05). The wheat harvest was expected to be very good and the second largest in nine years (Fews, 29/06/05). However, while surpluses are likely to occur in the northern area, 19 of 32 provinces, especially in the central, east and west regions will experience wheat deficits. Wheat prices were higher in 2005 than in 2004 (Fews, 29/06/05).

Pakistan has decided to close the refugee camps located in the "tribal region" of Pakistan for security reasons: to curb militancy in the tribal zone (AFP, 11/09/05). The refugees have been given the choice of being repatriated or moved to another camp in Pakistan. Most have chosen to return to Afghanistan. The closure within a short time frame has posed huge problems of repatriation. About 171,000 people have been registered for repatriation.

National anthropometric and micro-nutrient survey

The first ever national nutrition survey was conducted in Afghanistan in June-July 2004 (MOH/UNICEF/joint; 05/05). The prevalence of acute malnutrition was average: 6.7%. 20.8% of the women (non- pregnant women aged 15-49.9 years) had chronic energy deficiency (BMI < 18.5) and 15% were overweight. Anaemia was of medium public health significance among children and was of moderate public health significance among non-pregnant women (table 13).

Urinary iodine level was low among children and was even lower among women (table 13). Analysis of iodine in salt at household level showed that only 28% of the salt was iodised. It seemed that iodised salt was more present in urban households (especially in Kabul) than in rural households. Of 286 labelled salt packages, 62% were labelled as iodised. Only 88% of these, however, tested positive for iodine.

Table 13 Micro-nutrient status, national survey, June-July 2004, Afghanistan (MOH/UNICEF/joint, 05/05)

Although 85% of the oil and 96% of the ghee were labelled as vitamin A fortified at household level, testing for the presence of vitamin A of samples of oil and ghee labelled vitamin A fortified available in Afghan markets, showed that only 10% were actually fortified.

NICS 5, February 2005

The security situation has remained volatile. Following the presidential election won by Hamid Karsai, a new cabinet has been appointed (BAAG, 31/12/04). As of early January 2005, about 32,210 former soldiers had disarmed (UNAMA, 06/01/05).

UNHCR expressed concerns over arrests of refugees in Iran. Iran has launched a crackdown against illegal migrants and it seems that people who were granted refugee status have also been harassed (IRIN, 12/01/05).

Nutrition situation still precarious in Northern Shamali/Southern

Panjshir

A random-sampled nutrition survey was conducted in four districts of Kapissa province, three districts of Parwan and two districts of Panjshir in August 2004 (ACF-F, 07/04). The survey indicated a precarious situation: 14.3% (11.3-17.9) of the children were acutely malnourished, including 2.3% (1.2-4.3) severely malnourished. This seems to be a slight decrease when compared to August 2003, although the confidence intervals overlapped (figure 5). The prevalence of malnutrition is traditionally higher during summer than winter. Mortality rates were below alert thresholds: CMR = 0.39/10,000/day, under-five MR = 0.62/10,000/day. The presence of goitre was assessed among 6 month to 15 year-old children (2226) and among women from 15 to 45 years. Seventeen percent of the 6 month to 15 year olds had goitre; girls were significantly more affected than boys: 19.7% vs. 14.3%. Forty percent of the women had goitre, which is a very high level. The use of iodized salt seemed, however, to have increased in 2004.

Shamali plain is very fertile but the area was the stronghold of the resistance against the Taliban and has suffered from destruction and blockades. It seems that little assistance is delivered to the area, which would benefit greatly from food security interventions.

Figure 5 Prevalence of acute malnutrition, Northern Shamali, Southern Panjshir

NICS 4, November 2004

The presidential elections ran more smoothly than expected and Hamid Karzai, the former interim president was elected with 55.4% of votes (BAAG, 31/10/04; ICG, 23/11/04). There was a high turnout and it seems that voting was highly driven by regional and ethnic identity. The parliamentary elections are scheduled in April 2005.

The 2004 harvest was poor, due particularly to insufficient rainfall. The cereal harvest is estimated at 3.06 million MT, which is 43% down on the bumper harvest of 2003 and 18% down on the average harvest of 1998 (FAO/WFP, 08/09/04). In addition to reduced precipitation, a slight decrease in the area planted, inappropriate cereal seeds distributed in some parts of the country, crop diseases and diluted mineral fertilisers have also contributed to the poor crop. In some areas, crop failure affected between 50 and 75% of areas planted.

It is estimated that more than six million people will be food insecure and will require support. Among them, four million will have access to assistance through government programmes, while 2.3 million people will be targeted by WFP's emergency programme (FAO/WFP, 08/09/04).

The most affected provinces are Nimroz, Kandahar, Paktika, Zabul, Kunar, Logar and Faryab, with more than 50% of their population who will not be able to meet their basic food needs during winter and spring (MRRD, 09/04).

About 17,000 households were displaced during summer due to a lack of drinking water or irrigation water, or to food shortages (FEWS, 30/09/04).

Refugee repatriation continues. About 373,000 and 366,000 people were repatriated from Pakistan and Afghanistan so far this year: the total number of returns since 2002 amounting to about three million (UNHCR, 07/11/04).

Average situation in Kabul city

A random-sampled nutrition survey was conducted in Kabul in July 2004 (ACF-F, 08/04). Among the families surveyed, 65% were residents, 30% were returnees and 5% were displaced. The prevalence of acute malnutrition was 8.9% (6.6-12.0), including 0.6% (0.1-2.0) severe acute malnutrition. The mortality rates were under control: CMR= 0.3/10,000/day and under five MR= 0.63/10,000/day. Measles vaccination coverage was average: 85.2%. The prevalence of acute malnutrition is higher during summer months than during winter. Compared with the previous two years, at the same season, the nutrition situation seems to have been stable (figure 6).

Figure 6 Prevalence of acute malnutrition, Kabul, Afghanistan

A random-sampled nutrition survey was also carried out in May 2004, among the under six-month-olds as they represent a significant proportion of admissions to TFCs (ACF-F, 05/04). Among the 507 infants measured, 18 had a height of less than 49 cm and therefore their weight-height index could not be calculated. Seven of these children had a weight lower than 2.5 kg.

Among the remaining 489 infants, only two cases of moderate malnutrition and no cases of severe malnutrition were recorded. The mean weight-height was -0.15 Z-scores.

98.4% of the infants were breastfed, of whom only 44.1% were exclusively breastfed. The others received liquids such as tea, water, juice and powdered milk (20.2%) and/or solid food (34.2%). About 25% of the mothers reported using feeding bottles, most of the time for giving powdered milk.

Although not directly comparable, the results of this survey compare favourably with the results of a survey conducted in February 1999, in conjunction with an anthropometric survey of 6-59 month-old children, where among about 132 infants measured, 6.1% (1.8-15.7) were found to be malnourished.

A vulnerability mapping analysis conducted in Kabul in January 2004 showed that access to infrastructure and services was key to vulnerability and was not equally available throughout the city (ACF-F, 01/04). Neighbourhoods left out of the municipality master plan were especially at risk. It also appeared that the status of the families (residents, displaced or returnees) was a less important factor of vulnerability than the stability of income resources, the network, the composition of the household and the housing situation, with the highest vulnerability among those who had to rent a house. The study recommends that comprehensive long-term plans on urban planning, health care, transportation and sanitation network be put in place as soon as possible, and that in the short to medium-term, rehabilitation of destroyed housing, income generation schemes, and public infrastructure be enhanced in highly vulnerable areas.

NICS 3, August 2004

The security situation is still very tense with terrorist attacks and factional fighting (BAAG, 31/07/04). NGOs continue to be targeted and MSF withdrew from Afghanistan after 5 of its staff were killed (MSF, 29/07/04). Thirty-four aid agencies denounced the blurring between military operations and aid work in the country, which, they said, adds to the tension and danger face by the workers (AFP, 01/09/04).

The presidential election, in which 18 candidates will compete, is scheduled for the 9th of October 2004 (UN News, 07/09/04).

Refugees

About 450,000 refugees, 242,000 from Iran and 210,000 from Pakistan, have been voluntarily repatriated to Afghanistan so far this year (UNHCR, 20/07/04). The high number of returns from Iran may be linked to increased pressure from the government of Iran on the refugees, such as demanding high fees for education or health care (RI, 09/07/04). In Pakistan, UNHCR stopped the aid provided to 194,000 refugees settled in "new camps" established after the American intervention in Afghanistan along the border in unsafe areas (UNHCR, 20/07/04). 82,000 refugees were voluntarily repatriated to Afghanistan whilst others were moved to another camp (UNHCR, 07/09/04).

An estimated 20,000 refugees were obliged to flee Pakistani army operations in South Waziristan (AFP, 23/07/04). They were given a 72 hours notice to leave. They have fled to Paktika province, a stronghold of the Taliban, where UN and humanitarian agencies have little access (IWPR, 20/08/04).

Internally Displaced Persons

As of late July 2004, the IDPs' caseload was estimated at 145,000 in the south, 20,000 in the west, 9,000 in the north and 5,000 in both east and south-east provinces (BAAG, 31/07/04). Spin Boldak IDP camp was expected to close at the end of August. As of July, 20% of the IDPs wished to be transferred to Zhare Dasht camp; only 2% wanted to return home and the remaining wished to stay in Spin Boldak and were therefore no longer considered as IDPs (UNHCR, 05/07/04).

Drought

An appeal was launched by the Afghan government and the UN for combating the consequences of the drought (GTISA, 01/09/04). According to a recent study, 37% of the population are thought to be food insecure, a doubling in the past 12 months.

Poorly distributed precipitation and the early and rapid depletion of the snow pack owing to higher than normal temperature are responsible for ground water levels dropping, scarcity of access to water and to an expected crop failure (FEWS, 12/07/04). The south of the country is the most affected (see map).

Districts affected by water shortage, Afghanistan, July 2004 (FEWS, 12/07/04)

NICS 2, May 2004

The security situation has remained volatile.

The Berlin donors' conference, held at the end of March 2004, was promising in terms of funding the next seven-year budget presented by the Afghan government. Donors' pledges were secured for the first year ($US 4.5 billion) and were encouraging for the initial three years (BAAG, 31/03/04).

The preliminary results of the National Risk and Vulnerability Assessment, a multi-stakeholder initiative, conducted in summer 2003 (at a time of a bumper harvest), found that more than half of the rural population was under poverty line (FEWS, 03/04). Poverty seems to be concentrated in the central and northwest regions. In rural areas, about 40% of the households interviewed felt that the situation had improved compared to the previous year, whilst 25% felt it had deteriorated. The impression of improvement was higher among the better-off than among the poorest. The households were equally distributed between those saying they could meet their food needs often, sometimes or rarely. Unsurprisingly, the poor had more difficulty in meeting their food needs than the better-off. The proportion of families within Afghanistan who cannot meet their food needs (defined as 2047 Kcal/pers/day) is heterogeneous (see map).

NICS 1, February 2004

Afghanistan's constitution was ratified by the Constitutional Loya Jirga on 4 January 2004 (USAID, 08/01/04).

The security situation has further deteriorated over the last months, with an increase in terrorist activity and factional fighting (UNSG, 30/12/03). Civilians, and among others, humanitarian workers, are increasingly targeted. On the other hand, disarmament, demobilisation and reintegration of ex-combatants are on going in Kunduz and Paktia provinces (UNSG, 30/12/03). The NATO-led International Security Assistance Force has begun to deploy outside Kabul, taking command of the Kunduz Provincial Reconstruction Team (PRT) (NATO, 07/01/04). Provincial Reconstruction Teams are teams of civilian and military personnel, which deal with both security and reconstruction work. The implementation of these teams has been criticised by humanitarian agencies, for they mix military and aid action (RI, 07/07/03).

Attacks on the aid community have led to a reduction of activities, such as halting of UNHCR's repatriation programme from Pakistan and suspension of MSF's activities in Zhare Dasht camp, near Kandar (BAAG, 18/12/03; MSF, 04/12/03).

The winter plan is on -going. Food has been pre-positioned in areas which are not accessible during winter, and non-food items have been distributed to returnees and displaced populations (UNHCR, 11/12/03). Rehabilitation of public buildings, which accommodate displaced persons, has also been undertaken (UNHCR, 11/12/03).

Improved nutrition situation

Kabul city

A random sampled nutrition survey was conducted in Kabul in November 2003 (ACF-F, 11/03). Around 20% of the families interviewed were returnees and about 8% were displaced (arrived in Kabul over the last two years). The nutrition situation, as well as the mortality rate, were under-control (category IV) (see table 13). About 8% of the mothers were considered as malnourished (MUAC < 210 mm). The number of admissions to therapeutic feeding centres and to supplementary feeding centres was lower in 2003 than in 2002 and 2001. The nutrition survey was carried out in winter, when the prevalence of malnutrition is seasonally the lowest. The overall situation seems also to have improved in Kabul over the past months owing to favourable factors such as the country's recovery from drought, the limited number of returnees in 2003 compared to 2002 and the improvement in access to health care and in potable water. The percentage of returnees in ACF's feeding centres decreased from 18% between June and November 2002 to 2% during the same period in 2003. This can be explained by a decrease in the proportion of returnees in Kabul, by an improvement of the nutritional status of the returned children, or by both.

Displaced camps, Herat province

Humanitarian aid and especially food assistance was cut in Shadayee and Maslakh IDP camps in June 2003 (see RNIS 42). People living in Shadayee camp were encouraged to relocate to Maslakh camp, however some families have stayed on the Shadayee site. Nutrition surveys were undertaken in these camps in December 2003/January 2004 (MSF-H, 12/03; MSF-H, 01/04). The population of the camps dropped in 2003. At the time of the surveys it was estimated that about 13,300 people were settled in Maslakh; the exhaustive survey conducted in Shadayee camp found 3,550 people living there.
The nutrition situation in the camps could be considered acceptable (category IV); mortality rates were below the alert thresholds (see table 13). The major source of food during winter in both camps was labour (72% in Shadayee and 64% in Maslakh), followed by business in Maslakh (27%) and by wool spinning in Shadayee (14%).
It seemed that most of the households who remained in the camps could manage to get food by their own means. Their general living conditions are however unknown.
 
Table 13 Results of nutrition surveys in Kabul and in IDP camps, Herat province, Afghanistan, November 2003-January 2004 (ACF, 11/03; MSF-H, 12/03; MSF-H, 01/04)

Overall

It seems that the nutrition situation in Kabul City and in IDP camps in Herat province has improved and is under control. This may be due to the better rainfall patterns in 2003 and to the gradual resettlement of IDPs and returnees. However, these nutrition surveys have been done during winter, when malnutrition is seasonally the lowest. Follow-up of these populations is needed.

RNIS 43, November 2003

Insecurity, human rights abuses and attacks against aid workers are on the rise in Afghanistan (AFP, 09/10/03; Care, 07/10/03; IRIN, 14/08/03; IRIN, 19/09/03).

The UN security Council unanimously adopted a resolution that authorizes expansion of the NATO-led International Security Assistance Force (ISAF) outside Kabul (UNSC, 13/10/03). The expansion of ISAF had been asked for by the Afghan government, NGOs and the UN, for a long time. However, Afghan civilians and NGOs remain sceptical and wait to see how the resolution will translate into practice: will there be a substantial deployment of troops; will the troops deploy to high-insecurity areas, will they have the mandate to intervene in fighting and disarmament process (CARE, 16/10/03; IRIN, 09/10/03; RFE/RL, 22/10/03)? As of end of October 2003, no other country apart from Germany had formally announced troop commitments for the expanded ISAF (RFE/RL, 22/10/03).

A disarmament and demobilisation programme has been launched, with the aim of disarming 100,000 members of the Afghan Military Forces (UNDP, 24/10/03); 1,000 ex-soldiers have been voluntarily demobilised in Kunduz (UN NS, 30/10/03).

Land and housing tenure is one of the most crucial problems in Afghanistan today, with returnees having difficulty claiming their properties (see RNIS 41) and ongoing speculation in land and property, especially in urban centres. This leads to allocation of lands and housing to wealthy Afghans and to the hardest access to housing for poor Afghans (IRIN, 12/09/03). For example, 30 families have been violently evicted by the police from their homes in Kabul city and have seen their homes and some of their belongings destroyed (IRIN, 04/09/03). UNHCR has announced the rehabilitation of 24 public buildings in Kabul, that could house about 200,000 returnees, and the funding of the construction of 52,000 basic homes throughout Afghanistan this year (UNHCR, 24/10/03).

Refugees and IDPs

As of end October 2003, UNHCR announced that 223,000 Afghans had returned from Iran and 333,000 from Pakistan so far this year (UNHCR, 28/10/03). UNHCR estimates that about 1.1 m Afghans are still hosted in camps in Pakistan as well as an unknown but substantial number in towns; about one million Afghans might still be in Iran (UNHCR, 28/10/03).

The number of IDPs dropped in 2003, especially in the western provinces. According to UNHCR, about 40,000 people have gone home from the camps in Herat province (UNHCR, 15/08/03). The food assistance had been cut in some of these camps (see RNIS 42).

Economy and agriculture

A report from the International Monetary Fund stated that economic growth in Afghanistan reached about 30% during 2002-2003 and was anticipated at around 20% in 2003-2004. Growth was especially high in the agricultural sector and services fuelled by donor assistance (BAAG, 30/09/03).

The FAO/WFP crop assessment mission found that the cereal production in 2003, estimated at 5.37 m tonnes, is the highest on record and is 50% above last year (FAO/WFP, 13/08/03). The rain-fed production has increased by 130% whilst the irrigated production has increased by 43% compared to last year. The good production may be imputed to timely and well distributed precipitation, increased use of fertiliser and of improved seeds. However, whilst some areas have a surplus, others, especially in the south, are experiencing deficits. Bad road conditions and logistical constraints limit the transportation of cereals from surplus to deficit areas (FEWS, 30/09/03). In September, wheat prices declined slightly in surplus areas, but remained near or above last year’s level in the east and southern markets (FEWS, 30/09/03). There is a fear that low cereal market prices may result in financial difficulties for farmers and reductions in area planted next season.

Good precipitations also benefited vegetable production (FAO/WFP, 13/08/03).

The supply of livestock and livestock products has not yet recovered; animal prices have increased. In 2003, sheep and horse herds are estimated to be 60% less than in 1995; camels and goats are estimated to be respectively 18% and 37% less than in 1995; there has been no change in cattle herds, and poultry has increased by 60% (FEWS, 30/09/03).

Poppy production remains at the same level in 2003 as in 2002 and is the world’s leading production (FAO/WFP, 13/08/03). Poppy production seems to be linked with a high level of household debt.

Nutritional status

Several random-sampled surveys were carried out during the summer. The results showed average to worrying nutritional status (see table). In Kabul city, the nutrition situation has remained average since last year (see figure). In southern Kapisa and the northern Shamali-southern Pansheer, worrying levels of malnutrition have been recorded; in Pansheer valley, the nutrition status has deteriorated when compared to last year at the same period (see figure). RNIS does not have, however, sufficient information to be able to give an explanation about this high prevalence of malnutrition. Mortality was under-control (see table).

Malnutrition rate, Kabul, Afghanistan

Malnutrition rate, Pansheer valley, Afghanistan

Results of nutrition surveys, Afghanistan, 2003 (ACF, 08/03)

Refugees in the North West Frontier Province (NWFP), Pakistan

A random-sampled nutrition survey was carried out in seven “new” camps (Basu, Old Bagzaï, Ashagaro, Kokti, Bar Kalay, Shelmann and New Shamshatoo), which were established in NWFP, between 1999 and 2001 (ACF-F, 06/03); it was the first nutrition survey to be done since the camps were established. As of June 2003, the camps counted around 77,000 people; most of them sought refuge in Pakistan between 1999 and early 2002. The camps are located in remote areas and are far from any town, except for New Shamshatoo, which is only one hour from Peshawar city. All camps receive basic need services (see box). However, income generating opportunities were different in each camp, depending on the camp surroundings.

Food security, public health and social and care environment, "new" camps in NWFP, June 2003 (ACF, 06/03)

The prevalence of malnutrition was average: acute malnutrition was 7.2% (5.0-10.1), including 1.3% (0.6-3.0) severe malnutrition. Under-five mortality rate was under-control: 0.29/10,000/day. Measles vaccination coverage according to cards or mothers' statements was 90.9%. The prevalence of malnutrition varies probably according to camp.

Wealth groups have been defined in Shelmann and New Shamshatoo camps; wealth seems to depend on the workforce in the household and on work opportunities (see box). Few families seemed not to be reliant on food distribution.

Wealth groups, Shelmann and Shamshatoo camps, June 2003 (ACF, 06/03)

Overall - Whist the situation in Kabul city has remained average and stable since last year (category II/III), the nutritional status of children in southern Kapisa and northern Shamali-Pansheer valley is worrying and has deteriorated since last year in Shamali-Pansheer valley (category II). Living conditions in these areas need to be documented and adequate action to be taken, to prevent further deterioration of the situation. In the “new” camps in NWFP, in Pakistan, the nutrition situation was average.

RNIS 42, August 2003

Insecurity has increased over the last three months. The number of incidents doubled between April and May and has since remained on a high level (AFP, 02/07/03). Attacks against western targets have especially increased (BAAG, 31/05/03). This prompted NGOs, the UN and the Afghan government to call NATO, which will take over the command of the International Security Assistance Force (ISAF) on 11 August 2003, to expand the ISAF outside Kabul (BAAG, 30/06/03; OCHA, 18/07/03). It was not the first appeal for ISAF expansion.

Following several years of drought, crop prospects are especially good for 2003 and the harvest is expected to be the best in 25 years (AFP, 12/06/03). Good rains, use of new high yielding varieties of grain and widespread use of fertilisers have all contributed to this performance. Parts of the south of the country may, however, still experience deficits. WFP cereal pipeline is ensured until September 2003 (WFP, 13/07/03).

Refugees, returnees and IDPs

Refugee repatriation

According to UNHCR estimates, 200,000 Afghan refugees returned from Pakistan (facilitated by UNHCR) and 113,000 returned from Iran (67,000 facilitated by UNHCR and 46,000 on their own), over the first semester of 2003 (UNHCR, 11/07/03).

This is far below last year figures, when 1.1 m refugees returned over the same period (RNIS 38). Returns of Afghan refugees still raise concern among some NGOs which estimate that security and basic need services are not sufficient to allow the return of the refugees (AI, 06/03). In addition, the high returns caseload in 2002 (nearly two million) is still not absorbed by the country, which is just starting to recover from a 20 year war (see RNIS 41). Amnesty International also stated that some returns were the result of explicit or implicit pressures from the local or national authorities of host countries (AI, 06/03). Moreover, AI denounced forced repatriation from Iran (AI, 06/03).

Internally displaced persons

It is estimated that about 25,000 IDPs have returned home since the beginning of the year, with UN or NGO assistance (NRC, 01/07/03). According to different sources, the number of IDPs in the country varies between 300,000 (UNHCR estimates) and 600,000 (AI estimates) (NRC, 01/07/03). AI denounced the withdrawal of food assistance to Shaidayee and Maslakh camps. According to AI, the decision was taken in order to force people to move back to their area of origin and without taking into account IDP vulnerability. Shaidayee IDP camp was to be closed in a few months and IDPs not willing to return home were advised to relocate to the nearby Maslakh camp, where food distribution, however, also stopped (AI, 06/03).

Returnees vulnerability and sustainability of returns

A number of agencies stressed the fact that returnees still face hard living conditions. RI noted improvements of living conditions in rural areas compared to last year with improved shelter conditions and an increase in fields under cultivation. People's livelihoods have, however, not reached pre-war level and people complain they have no coping mechanisms possible were the harvest to be poor; they had lost most of their belongings, means of production and herds (RI, 09/07/03).

The situation seems to be far worst for the returnees who do not possess any house and/or land or who have difficulty claiming their properties, which is the case for a vast majority of the returnees (AI, 06/03). Disputes over land and property are one of the major current issues in Afghanistan. Unaccompanied women have the greatest difficulty claiming their properties.

Many people who did not possess land came to Kabul to try to find a job. The population of Kabul is estimated to have doubled over the past ten years. Many of the returnees could not afford to rent a flat or house because of the sharp increase of rent prices due to the influx of people. Consequently, they live in temporary shelters in abandoned buildings, sometimes in dangerous conditions.

Moreover, most of the shelter programmes have targeted people who can prove their property and donors are reluctant to found programmes in towns for fear of a rural exodus. It is, however, a fact that almost half of the returnees have settled in Kabul, in makeshift facilities for the most of them.

Lack of job opportunities also makes people's lives difficult. The government is however looking for increasing exportation of goods such as carpets, handicrafts, dried fruits, and nuts. In April, it had proved to be possible to export the same quantity of carpets as during the whole of 2002 (BAAG, 31/05/03).

From emergency to development

A mission conducted by the NGO "Urgence-Réhabilitation-Dévelopement" (URD) in early 2003, stressed that one of the most impressive facts, when compared to mid 2002, was the emergence of a state, even if ministries still faced major constraints. According to this report, one of the major challenges that NGOs must face is to shift from emergency programmes (even if they remain necessary in some locations) to mid-long term programmes, which should be sustainable by the Afghan structures. It seems that nutrition activities are well engaged in this process with increased coordination, and efforts to implement long-term strategies (URD, 02/03).

Maimana, Almar and Qaysar districts, Faryab province

A random sampled survey was undertaken in May 2003 in three districts of the northern province of Faryab (MSF-B, 05/03). The results showed an acceptable nutrition situation, which has gradually improved since 2001 (see figure). Admissions to the SFC and TFC implemented in the area have also regularly decreased since mid-2002, and MSF-B will close its nutrition programme.

Mortality rates have also improved over the past year but have remained high (see figure).

 Faryab province used to be prosperous with production of wheat, barley, corn, sesame, grapes…The province was badly affected by the past years' drought. The 2002 rainfalls were good but the surface of land planted was restricted because of a lack of seeds and problems over land ownership.

Prevalence of acute malnutrition and mortality rate - under-five children — Faryab province — Afghanistan

Food security however improved between 2001 and 2002 and it was estimated that populations in Maimana and Qaysar districts would be able to cover 50-75% of their food needs, whilst people in Almar province would be able to cover 25-50% of their food needs, before the 2003 harvest (WFP/VAM, 2002-2003). The 2003 crop is expected to be very good.

Food distributions were implemented during the winter 2002. Few families, however benefited from them: from 535 families interviewed during the survey, about 12% received food distribution during the 2002 winter.

About 60% of the families in the rural Almar and Qaysar districts owned land; about the same percentage owned livestock. In the urban Maimana district, 18% of the families owned land and 25% owned livestock. About 40% of the families sold some property (animals, lands, household assets) since 2002-2003 winter and 60% still had a debt at the time of the survey.

Whilst the nutrition situation is at an acceptable level and the 2003 crop should be good, the population has not yet entirely recovered from the past years drought.

Refugees in Pakistan

Closure of the waiting area, Chaman

After being denied entry into Pakistan, following the closing of the border in February 2002, about 30,000 people have settled in a "waiting area", in the Chaman area, at the Pakistan border. Assistance to this camp has been made difficult by the status of the "waiting area" which was not recognized as a long-term settlement, and by insecurity (see RNIS 40). Following the decision to close the "waiting area" by mid-July, refugees were given the choice of either being relocated to an already existing camp (Mohamed Kheil) in Balochistan, Pakistan; being relocated to the Zhare Dasht camp near Kandahar in Afghanistan or returning home. Forty percents of the families made the decision to go to Pakistan, whilst 60% wanted to go to Zhare Dasht; only approximately ten families were willing to return home. The relocation took place between mid- May and mid-July (UNHCR, 14/07/03; RI, 30/06/03).

Balochistan - "new refugee camps"

Following the military action within Afghanistan and the fall of the Taliban regime in November 2001, a new flux of Afghans took refuge in Pakistan. Before the closure of the border in February 2002, about 250,000 were settled in new camps in Balochistan and the North West Frontier Province (NWFP).

Two randomly sampled surveys were carried out in the six camps of Balochistan, hosting new refugees, accounting for a population of about 120,000 refugees, in April 2003 (ACF, 04/03). Surveys were carried out in the camps near Chaman town (Dara 1, Dara 2, Roghani and Landi Karez) and in the two camps (Mohamed Kheil and Latif Abad) located further inland. Whilst all of the camps are located in arid plains, camps located near Chaman town are less isolated than the others, which are furthest from any city.

The results of the surveys show that the nutrition situation seemed to be under-control (see table) and was similar to the nutrition situation in late 2001. The under-five mortality rates were also below acceptable thresholds (see table); routine mortality surveillance indicated the same range.

Results of nutrition and mortality surveys, refugee camps in Balochistan, Pakistan, April 2003 (ACF-F, 04/03)

Basic needs in term of food security and public health seemed to be covered (see boxes), which may explain the acceptable nutrition situation found in the camps.

Immediate determinants of nutritional status and mortality, refugee camps in Balochistan, Pakistan, April 2003 (ACF, 04/03)

Overall - Despite a very good harvest in 2003, the fate of some of the returnees is worrying, especially those who do not possess any land and/or houses and have to live in makeshift facilities in towns and have difficulty finding jobs due to poor economic conditions. These people need continued assistance. Implementation of mid-long term programmes will also be crucial for the reconstruction of Afghanistan.
The nutrition situation in three districts of Faryab province is acceptable (category IV), but people have still not fully recovered from the past years' drought.
The nutrition situation among refugees in Balochistan province, Pakistan, who fled Afghanistan at the end of 2001/beginning of 2002 seems to be under control (category IV) and their basic needs seem to be covered. Assistance has to continue being provided.

Recommendations and priorities

From the ACF-F survey in refugee camps in Baloschistan:

• Continue to provide basic needs assistance to the refugees as long as repatriation is not possible under good and safe conditions

From the MSF-B survey in Faryab province:

• Investigate causes of deaths

From the RNIS

• Provide assistance to the returnees, especially in terms of shelter, particularly in towns

RNIS 41, April 2003

The security situation remains tense in many parts of the country because of factional fighting and banditry. Humanitarian agencies have increasingly been targeted (WFP, 02/04/03).

Refugees and IDPs

Number of refugees returning was low at the beginning of 2003; only 8,800 people were voluntary repatriated in January /February 2003 (USAID, 13/03/03).

UNHCR signed a new agreement with the Pakistan and Afghanistan governments for the voluntary repatriation of 600,000 refugees in 2003 (GoP, 18/03/03). Facilitated refugee repatriation in 2002 has raised concern. According to an independent research and evaluation unit (Afghanistan Research and Evaluation Unit), encouragement of the return of refugees in 2002 has been premature, as refugees did not find adequate conditions at their destinations. The study cites pressure from host governments to see refugees repatriated, donors' tiredness in supporting refugees in host countries, and limited release of funds for development in Afghanistan (AREU, 31/12/02). Some of the report's recommendations are: increasing the amounts pledged for reconstruction and emergency aid and speeding up the release of funds for development; expanding the International Security Assistance Force to each of the 32 provincial capitals; investing more resources in monitoring returnees to provide reliable information about areas of return; increasing direct donor support for UNHCR's protection activities in Pakistan and Iran.

Pakistani authorities have planned to close Katcha Garhi camp, which hosts 600,000 refugees in the suburbs of Peshawar. Refugees will have no other choices than going back to Afghanistan or finding an other place in Pakistan (UNHCR, 25/03/03). About 700,000 people remain displaced throughout Afghanistan. IOM has assisted the return of 9,000 IDPs since the beginning of the year (IOM, 28/03/03). Notably some IDPs are still reported to be moving from the north to the south because of Afghanistan Region harassment and insecurity in the north (OCHA, 15/04/03).

Food security situation

WFP and partners conducted a food needs assessment of the rural settled population (WFP/ VAM, 2002-2003). Food security improved in 2002 compared to 2001, especially in the northwest of the country, whilst little improvement and even in some cases a deterioration has been experienced in the south (see map). Food through own production has increased in many districts, except in the south where drought has continued.

Many districts however remain moderately to highly food insecure, especially in the south (see map). Drought and war still have very negative effects on food security. Due to the loss of seeds, tools, and traction animals, it is estimated that the 2002 cultivation of land in the northern rainfed belt was only 10-30% of the pre-drought years. Underground aquifers are also still not replenished; this has hampered irrigated culture, which also suffers from infrastructural damage.

It is hoped that the improvement of pasture conditions in the north, west, and central Afghanistan, and the increase in livestock market prices will allow beginning of restocking. Labour opportunities in the agricultural sector are scarce as a consequence of the drought. Moreover, the closing of the borders with Iran and Pakistan will limit the traditional economic migration.

Whilst in the south and in some pockets throughout the country food aid is still needed for saving lives, in other parts of the country food aid will promote long-term food security by helping people rebuild their livelihoods.

RNIS 40, Dec 2002

Ethnic divides have continued to run deep in Afghanistan over the past months. Attacks against personnel from humanitarian agencies have also been reported.

Fighting erupted once again in eastern Afghanistan between government troops and Padsha Kahn forces (AFP, 17/10/02). On the other hand, the three main factions in northern Afghanistan reached an agreement, which stipulated that police should be based in the cities and fighters should be disarmed (Reuters, 28/10/02). However, attempts to disarm the fighters have failed (Reuters, 16/11/02).

Northern Afghanistan remains plagued by factional and ethnic rivalries. Refugees are reluctant to return to the North, and some people continue to flee (AFP, 20/10/02). It seems that return has been achieved safely in some areas whilst in others return was prevented by human rights issues (UNAMA, 17/10/02). A body has been set up by Afghan authorities and UN agencies to address this problem. A survey of the camps in the western province of Kandahar, where those newly displaced from the north have recently arrived, revealed that the ethnic Pashtun were obliged by commanders of local fighting forces to leave their area (DPA, 20/10/02).

Violence and repression in western Afghanistan have been documented by Human Rights Watch. These include political intimidation, arrests, beating, torture and denial of the rights to freedom of expression. According to the report, members of the Pashtun community are specially targeted. HRW advocates reinforcement of human rights monitoring and protection, and an expanded presence of international peace keepers (HRW, 05/11/02). Ethnic unrest against the nomadic Gujur has also been reported in north-eastern Afghanistan, including physical violence, house burning and restricted access to markets (AFP, 31/10/02).

The United Nations Security Council approved a one-year extension of the international force in Ka- bul (OCHA, 28/11/02).

The Interim Administration of Afghanistan has presented a working draft of the National Development Framework at the Implementation Group meeting, which brought together the government, donors, multilateral and NGO partners. Six priority national projects have been defined: National Solidarity and Emergency Public Works Programmes; Education and Infrastructure Project; Urban Infrastructure Project; Water Resource Investment Project; National Governance Infrastructure Project; and Transport Project. Allocations for human capital and social protection, physical infrastructure, and trade, investment, and rule of law/ security will be at the percentage ratio of 45:35:20 respectively (IAA, 12/10/02). President Karsai also called for a shift from humanitarian assistance through NGOs and the UN to reconstruction through state structures (UNAMA, 17/10/02).

The Asian Development Bank approved, for the first time since 1979, a loan for US$ 150 millions equivalent (ADB, 04/12/02).

Refugee and IDP movements

Since March this year, 1.8 m people have been repatriated to Afghanistan. The number of repatriates has dropped since August 2002 because of the prospect of a cold winter ahead (see table).

Assisted returns since March 2002, Afghanistan (UNHCR, 03/01/03)

It is estimated that 1.5 m people returned from Pakistan, 261,000 from Iran and 10,000 from Central Asia (UNHCR, 03/01/03). Four million Afghans remain outside the country.

UNHCR registered an increasing number of Afghans crossing back to Pakistan: 215 families were registered during the first week of October, compared to 100 in late August. This rise may be a consequence of hard living conditions returnees faced (USAID, 31/10/02). According to another source, 300,000 might have returned to Pakistan (DPA, 12/12/02).

According to UNHCR estimates, about 724,000 Afghans are still displaced throughout the country, which include 413,000 IDPs in the South, 124,000 in the Centre, 51,000 in the North, 70,000 in the East and 66,000 in the West (UNHCR, 03/01/03). Throughout 2002, 250,000 IDPs returned to their areas of origin under an assisted plan, whilst 200,000 returned on their own (UNHCR, 03/01/03). New displacements to Kabul for economic reasons have been reported from the drought-affected province of Bamiyan (USAID, 31/10/02).

Winter plan

A special plan, which includes food, shelter, and non-food items components has been designed to assist vulnerable populations during winter (UNAMA, 28/10/02).

Vulnerable populations have been identified as:

• Indigenous people and reintegrated returnees who lives in isolated areas due to snow or other physical obstacles
• Returnees and IDPs who lack their own means
• Urban groups who live outdoors, in dilapidated public buildings, or in derelict houses
• The Kuchi nomads

Food beneficiaries will include 1.3 m people living in rural areas, 200,000 people living in urban ar- eas and 200,000 newly displaced and returnees (see table). Depending on needs, between 72,000 and 500,000 people will be targeted with different shelter and non-food items (see table).

Winter programme beneficiaries (UNAMA, 28/10/02)

As of mid-January, the winter programme had started but had not been fully implemented (OCHA, 19/12/02). However, WFP had delivered 92% of the food requirements to areas inaccessible during the winter (WFP, 18/11/02).

Health

An outbreak of whooping cough has killed at least 61 children in Badakhstan province (AFP, 31/10/02). A UNICEF/CDC survey, carried out in Kabul, Laghman, Kandahar and Badakhstan Provinces showed a very high rate of maternal mortality (1,600 maternal death/100,000 live birth). Maternal mortality accounted for half of all deaths among women aged 15 to 49. In addition, the survey revealed that when the mother dies, a new-born infant has only a one in four chance of surviving until its first birth- day. Maternal mortality rates varied substantially by region and between urban and rural areas. UNICEF/CDC recommended the establishment of health care services in remote areas, increased access to quality antenatal care, efforts to increase women's use of such services, and training of birth attendants, nurses and midwifes (UNICEF, 06/11/02).

IDPs and refugees settled at the southern border with Pakistan

After being denied entry into Pakistan, about 50,000 people have settled in camps at the Pakistan border, in Spin Boldak district in the Afghan side and in Chaman area in the Pakistan side. An increase in the number of children's deaths because of cold weather has been reported in these camps (RFE, 06/12/02). Assistance to the Chaman area is made difficult by the status of the camp, defined as a "waiting area", when Pakistan refused to admit more refugees after February 2002. Aid agencies cannot provide refugees any assistance for long term stay. They were authorized to provide blankets but not stoves to heat tents (UNHCR, 09/12/02). People living in those camps are reluctant to relocate to Zarhe Dasht camp near Kandahar, although since mid-August, some 14,000 have been moved there (UNHCR, 05/11/02).

IDPS in Spin Boldak district, Kandahar province

A survey was undertaken by MSF-H in the five IDP camps of Spin Boldak district in September 2002 (MSF-H, 09/02). The prevalence of acute malnutrition was under control: 5.4% of the children surveyed were acutely malnourished, which included 0.3% with severe malnutrition; no children had oedema. The measles vaccination coverage was 69.2%, according to mother's statement and vaccination cards. It seems that there is a lot of business in the area and that therefore IDPs may find job opportunities. WFP general food distribution was on-going but each family received the same quantity whatever the family size. The water supply was not sufficient and sanitary conditions were not acceptable.

Refugees in Chaman area, Pakistan

MSF-H undertook a nutrition survey in Landi Karez refugee camp, Chaman, in July 2002 (MSF-H, 07/02). The camp was opened in December 2001 and the last influx of people was in April 2002. The results showed an average nutrition situation: the prevalence of acute malnutrition was 7.8%, including 1.9% severe malnutrition; 0.5% of the children had oedema. Refugees had few alternative sources of food and income other than relief aid. Regular food distribution was on-going and the water supply seemed to be sufficient, whilst hygiene practices were inadequate. Routine mortality surveillance indicated that mortality rates remained within an acceptable range.

Central Afghanistan

Refugee International raised awareness about the fate of returnees, especially in Kabul city. They recommend that donors accelerate shelter and cash and food for work projects, ensure that the national winter preparedness plan is fully financed and implemented and pursue emergency assistance at least for one year (RI, 04/12/02).

Northern Shamali plains and Southern Pansheer valley, Parwan and Kapisa provinces

A nutrition survey in northern Shamali plain, southern Pansheer, carried out in August 2002 showed a rate of malnutrition of concern: 13.8% of the 6- 59 month-old children were acutely malnourished, which included 1.7% severely malnourished (ACF-F, 08/02). The nutrition situation was better than in August 2000 and has remained stable since March 2001 (see graph).

The slightly higher prevalence of malnutrition observed in August 2002 could be partly explained by the higher prevalence of diarrhoea during summer. Some 7% of the families surveyed were returnees; it does not seem that they were more affected by malnutrition than the resident population.

According to a food security survey done in the area in July 2002 (see RNIS 39), the population of the region, which was cut from the rest of the country during the war, has suffered severely from the conflict. Most of the families sold assets and contracted debts during the war and much of the infrastructure, such as irrigation systems, and even households have been destroyed in the frontline area. Water and sanitation were also a big issue. However, house reconstruction has begun. About 19,000 houses have been reconstructed in the Shamali plain. However, an additional 26,000 still need to be reconstructed (OCHA, 19/12/02). Crude and under-five mortality over the past three months were respectively 0.68/10000/day and 1.19/10000/day, reported to be far less than in August 2000. This fact was partly explained by a better access to health services, mostly provided by NGOs.

Visible goitre affected a very high percentage (64%) of the women surveyed. Measles vaccination coverage was 11.9% according to vaccination cards and 84.1% when mothers' statement was also taking into account.

The prevalence of malnutrition in the area is among the highest recorded in Afghanistan, from the nutrition surveys which were made available to RNIS in 2002.

Northern Afghanistan

Mazar-e-Sharif

Mazar is the main city in northern Afghanistan. The city has seen a large influx of people from surrounding areas hit hard by conflict and drought in 2000-2001. As of August 2002, IDP camps were almost empty but a significant number of IDPs had settled in houses. A survey was undertaken by ACF-F in early September 2002 (ACF-F, 09/02). About 6% of the households surveyed were displaced and 7% were returnees. The prevalence of acute malnutrition was 7.2%, which included 1.0% of severe malnutrition; this was higher than in March 2002 (see graph).

This fact was largely attributed to the extremely poor sanitation situation in the city, and an in- crease in the prevalence of diarrhoeal diseases during summer.

Crude and under-five mortality rates were under- control and have remained in the same range since 2000. Measles vaccination coverage was 90.6%, according to vaccination cards and mothers' statement.

Visible goitre was recorded in 3.1% of the women surveyed.

Sar E Pul province

A nutrition survey was carried out by ACF-F in Sang Sharak district, Sar E Pul province in September 2002 (ACF-F, 09/02). The prevalence of malnutrition was average, whilst the under-five mortality rate was above the acceptable threshold (see table).

Acute malnutrition and mortality, Sang Charak dis- trict, Sar e Pul province, Afghanistan, September 2002 (ACF-F, 09/02)

Most of the children surveyed were from resident households. The prevalence of malnutrition was twice as high in the current survey than in March 2002, although confidence intervals overlapped. The increase in the rate of malnutrition was primarily attributed to high malaria and diarrhoea exposure during the summer. Several food distribution projects were implemented in the district throughout 2002. Some 14% of the mothers had visible goitre.

Samangan and Jwazjan provinces

Two nutrition surveys were undertaken by GOAL in Samangan and Jwazdan provinces in mid 2002 (GOAL, 04/02; GOAL, 06/02). The surveys targeted 0-59 months old children; the results are therefore not directly comparable with other surveys. However, the results indicated low levels of malnutrition, especially in Jawzjan province. Crude and under-five mortality rates were respectively 0.3/10000/day and 1.01/10000/day in Samangan province, and 0.28/10000/day and 0.76/10000/day in Jwazjan province. The measles vaccination cover- age for children 12-59 months, according to mother's statement was 63% in Samangan province and 75% in Jwaajan province. In both provinces, about 70% of the households reported to have received relief food since October 2001. 3% and 10% of the women showed physical signs of goitre in Samangan and Jwazjan provinces respectively.

Western Afghanistan

Shadaye camp, Herat city

A MUAC assessment was carried out by MSF-H in Shadayee IDP camp in October 2002 (MSF-H, 10/02). At the time of the survey, the population of the camp was estimated at 16,500. All the chil- dren between 6 and 59 months old were surveyed. The results showed that a significant number of children had a low MUAC (see table).

Results of MUAC assessment, Shaidayee IDP camp, September 2002 (MSF-H, 09/02)

¹ Presence of oedema was not assessed

About 200 families were interviewed regarding food security issues. About 80% of the families interviewed reported that at least one of the family members was involved in an income-generating activity. However, half of the families also reported having sold assets to buy food in the four weeks prior to the survey. General food distribution was on-going. Water supply seemed adequate whilst sanitation was poor. The main reason for staying in the camp was that people had nothing left in their villages (41%).

Overall - The nutrition situation seemed mixed. Whilst the situation is under-control in some regions where nutrition surveys have been done (category III), the nutrition situation was not satisfactory in Shamali plain and in some of the IDP/refugee settlements (category II). Winter is challenging, especially for the returnees.

Recommendations and priorities

From the MSF survey in Spin Boldak IDP camps:

• Improve sanitation in the camps
•  Implement food ration distribution according to family size
•  Consider health intervention in IIRO and WALMY camps
•  Address the vaccination coverage issue

F rom the MSF-H survey in Landi Karez refugee camp, Chaman district, Pakistan:

• Implement food distribution survey
• Continue the treatment of severe malnutrition through the Basic Health Unit
• Strengthen community basic health education

From the MSF assessment in Shaidayee camp:

• Continue the food distribution
• Implement distribution of non-food items, such as blankets, clothes
• Organise repair of damaged shelters
• Improve maintenance of the latrines
• Implement a comprehensive survey about conditions of return of the IDPs

From the ACF survey in Sang Charak district:

• Strengthen health services
• Implement malaria prevention
• Increase access to iodised salt

From the ACF survey in Shamali:

• Continue TFC and SFC programmes
• Improve access to water in relevant areas
• Address the issue of goitre and cretinism

RNIS 39, October 2002

The security situation remains unstable. The new government, which came to power in June 2002, is facing armed opposition from warlords in different areas. Tensions have been particularly high in the south-east where there has been fighting between government-backed forces and those of warlord Padsha Khan Zardan, and also in Samangan province in the north, controlled by warlords Abdulrashid Dostam and Ahmad Kahn (AFP, 03/10/02). A bomb attack in Kabul city caused more than 20 deaths and about 100 injured (WFP, 13/09/02) and there was an assassination attempt on the Afghan president (Reuters, 05/09/02).

The number of returnees has been far larger than expected. The humanitarian agencies have neither the capacities nor sufficient funding to provide the requisite assistance to returnees.

IDP and refugee movements

As of August 2002, an estimated 1.8 m refugees returned to Afghanistan, mainly from Pakistan and Iran. Another 600,000 displaced people were estimated to have relocated again within the country by the same date (see table). The number of returnees from Pakistan has markedly diminished over the past few months: 115,000 returnees were registered in September, compared to 196,000 in August and 412,000 in May (UNHCR, 10/09/02; OCHA, 03/10/02). Several explanations have been suggested for the decreasing numbers of returnees, which include the prospect of a cold winter ahead. Refugees themselves have expressed fears of finding living conditions in Afghanistan difficult including lack of job opportunities, insufficient infrastructure and basic services, and insecurity (OCHA, 03/10/02). Additionally, it seems that some of the refugees who have only recently returned to Kabul may have plans to return to Pakistan over the winter, or to move south to Jalalabad where it is warmer (OCHA, 19/09/02).

IDP and refugee returns (USAID, 16/08/02)

	IDPs (IOM)	REFUGEES (UNHCR)
		Pakistan	Iran	Central Asian states
Voluntary	218,286	1,370,000	136,000
assisted				10,000
Spontaneous	400,000	200,000	61,000
Remaining	858,500
August 2002

Despite the tripartite agreement signed between Iran, Afghanistan and UNHCR stipulating that repatriation must be voluntary, Iran is putting increasing pressure on Afghan refugees to leave (PHR, 08/08/02). Iran also expelled 12,000 Afghans considered to be living illegally in the country because they did not have refugee papers and has urged UNHCR to speed the repatriation of the 2 m who remain (AFP, 12/09/02). It has also been reported that 3,704 Afghan refugees were deported from Iran in the first three weeks of September, double the number in August (Reuters, 04/10/02).

Most of the refugees returning to Afghanistan have moved to the central or northern regions (UNHCR, 17/09/02). Many returnees are resettling to the cities, mainly Kabul, even if they are not originally from there, on the presumption that it may be easier to find jobs in the city than in the country (Eurasianet, 21/09/02). It has also been suggested that while refugees, the returnees experienced an urban lifestyle and hence would be more likely to be attracted to settling in cities rather than in the country on their return.

Concerns about IDP and refugee relocation

The number of returnees has been far larger than expected, leading to a shortage of funds for implementation of humanitarian programmes. UNHCR has been obliged to suspend distribution of non-food items to returnees and to cut its shelter programme by half (UNHCR, 09/08/02), despite shelter needs being particularly important (UNHCR, 27/09/02). WFP is also facing a funding shortfall of about 22% compared to requirements (WFP, 04/10/02).

The relocation of an estimated 56,000 people, who have settled at the Pakistan border because they are denied entry into Pakistan raises concerns among the humanitarian community. Most of those refused entry are either Pashtuns fleeing ethnic persecution or Kuchi nomads who have lost their herds. UNHCR has started to relocate them to a new settlement, Zhare Dasht, about 30 km from Kandahar in the south of Afghanistan. MSF is concerned that these people who were seeking asylum should have had the right to be registered and transferred to the official refugee camps in Pakistan (MSF, 27/08/02). ACF is also concerned about the appropriateness of the chosen settlement area because it is situated in an isolated desert area, where income sources are limited (ACF, 30/08/02).

Food security and nutrition situation

FAO/WFP has released their crop and food supply assessment for 2002/2003 (FAO/WFP, 16/08/02). Due to improved precipitation, cereal production markedly improved in 2002 compared to previous years of drought, and is estimated to be 82% up on last year and equal to 1998 production. All the regions were doing well apart from the southern region, which is still exposed to drought.

Livestock loss has however been very high; it is estimated that livestock numbers may have declined by over 60% since 1998 (see table). The condition of the livestock is reported to be far better this year than last, and trade in livestock is near normal.

Remaining livestock by province (from FAO/WFP, 16/08/02)

Province	Livestock in 2002, % of 1997-1998
	Cattle	Sheep and goats
Balkh	12.8	16.2
Juzjan	14	27
Saripol	30	27
Faryab	12.7	15.8
Average	16.3	20.9

It is estimated that 467,725 MTs of food aid will be required for 2002/3, with 6 m people dependent on food assistance. This includes 3.3 m persons affected by natural disaster and conflict, 1.2 m returnees, 400,000 IDPs and nearly 350,000 urban poor (see table).

Priorities for geographical and social group targeting have been defined as:

• High altitude mountainous areas, where the sedentary population have lost livestock
• Populations that have lost their sources of agricultural income, such as those previously dependent on irrigation systems that are no longer functioning and groups whose perennial crops have been destroyed.
• Remote mountainous areas where food for work activities will help open up the areas
• IDPs and returnees
• Families that have lost one or more essential earners during the conflict and families that take care of a large number of relatives
• Kuchi people, whose main source of income is still derived from livestock

Estimated food aid requirement (FAO/WFP, 16/08/02)

Programme Activity	Beneficiaries	Estimated cereal requirement (Mtonnes)
Relief to vulnerable population	3,143,000	235,725
Relief contingency reserve		60,000
Assistance to returnees	1,200,000	32,000
Assistance to IDPs	400,000	32,000
Assistance to nomads	200,000	16,000
Assistance to vulnerable urban population	350,000	42,000
Food for education	590,000	50,000
Total	5,883,000	467,725

Northern Shamali plains and Southern Pansheer valley, Parwan and Kapisa provinces

A nutrition survey undertaken in April 2002 by ACF revealed a significant prevalence of malnutrition: 10.5%, including 1.6 % with severe malnutrition (RNIS 38). A food security survey was carried out in the region during June-July 2002 (ACF, 06/02).

The area is comprised of various food economy zones:

• The fertile and densely populated Shamali plains where people used to rely on exports of fresh and dried fruits (mainly grapes) as well as on employment in local factories
• The hilly outskirts of the Shamali plains, mainly rain-fed agriculture with some livestock
• The mountainous, scarcely populated zones, with a mainly pastoralist population.

About 35% of the surveyed population were returnees, either former refugees or IDPs. This region has been particularly affected by war. Most of the region was under the control of the Northern Alliance and therefore very isolated from the rest of the country. The frontline also passed through the grape-growing areas of the Shamali plains.

Sources of income for the population have changed significantly over the past 20 years, as a consequence of both Russian occupation and the civil war. Two major factories which employed thousands of people were destroyed during the Russian occupation. The civil war hampered grape exports and led to the complete destruction of the irrigation systems.

Food and non-food prices were two to six times higher during the war than now. As a consequence, people were obliged to go into debts and sell assets. Almost all households interviewed reported they had contracted debts to pay for food or emigration, and two-third reported to have sold assets.

Although the entire region is suffering from food insecurity, the three most affected areas are:

• the former frontline zone as a result of the destruction of housing and irrigation schemes
• the Shotul valley, which has not yet recovered from herd losses, and has no access to alternative income sources
• the hilly outskirts still suffering from drought

The survey also showed that the most difficult period for food security is the end of winter and during spring. People exhausted their food stocks, daily wage labour is scarce, cereal prices are high. People who do not have their own fuel sources have to spent a significant amount of money on firewood during winter.

Kabul city

A nutrition survey undertaken in August 2002 by ACF (excluding the rural areas surrounding the centre) showed the highest rate of malnutrition recorded in the city since 1995, 11.7 % acute malnutrition, including 1.6 % severe malnutrition (ACF, 08/02) (see graph). This can be explained, firstly, by a high prevalence of acute diarrhoea. The survey was undertaken during the summer. Secondly, there is widespread poverty in Kabul. A market survey showed that cost of food and non-food items increased by 30% in 2002. Housing costs also rose due to a higher demand. People live in poorer housing, sanitation has deteriorated, and less than half the population have access to safe water.

The survey also showed high numbers of returnees in Kabul City with 18% of the children surveyed being from newly arrived families.

Mortality rates however seemed under control, with a crude mortality rate of 0.21/10000/day and an underfive rate of 0.47/10000/day. The measles vaccination coverage was better than the previous year with 86.3 % of children vaccinated as measured by cards or mothers reports.

A screening exercise in the returnee centre of Pol e Charkhi showed that about 20% of the children had W-H < - 2 Z-scores (ACF, 30/08/02). However, this was difficult to explain, because the malnutrition rate among refugee children in Pakistan was reported to be far below this (RNIS 36/37, RNIS 38). Nevertheless, the results indicate the situation of returnees in Kabul City is still of concern.

Acute malnutrition among 6-59 month olds in Kabul city, Afghanistan

Qaisar and Almar districts, Faryab Province

MSF-B carried out a nutritional survey in July 2002 in two districts of Faryab Province (MSF-B, 07/02). The survey was undertaken just after the wheat harvest, which was reported to be good, and showed a low rate of malnutrition of 6.3 % including 1.3 % with severe malnutrition (in August 2001, the malnutrition rate was estimated at 9%). Faryab Province has high agricultural potential and is prosperous in normal times, but is one of the most drought affected areas. The drought has led to loss of assets and livestock. About 70% of the families reported having a current debt. In addition, many poor families are unable to cultivate in 2002 because of a lack of seeds and tools. About 85% of the interviewed families had access to the general distribution of food carried out at the end of 2001 and early 2002, but only 60% received both of the intended distributions.

Mortality rates were reported to be high, with a crude mortality rate of 1.5/10000/day and an under five mortality rate of 4/10000/day. Measles vaccination coverage was 87.7% according to the card or the mother’s statement.

Pastoralists

There are estimated to be about two million pastoralists in Afghanistan. They have been severely affected by drought and war, and have lost significant portions of their herds. Livelihoods have changed significantly, depending on what assets remain and coping mechanisms. If they still possess livestock or are able to find other income activities in their previous grazing areas, they have remained there. In other cases, they have moved nearer to cities to find casual labour, or if coping strategies have been exhausted, they become reliant on charity or begging in cities, villages or IDP camps (AFSU/VAM, 08/02). The conclusions of the survey undertaken by AFSU/VAM provides numerous recommendations regarding interventions, which could benefit the different Kuchi groups and those interested are encouraged to read the full document (AFSU/VAM, 08/02).

Micro-nutrient deficiencies

Several outbreaks of scurvy were observed last winter. Various studies show that diets were deficient in fresh or dried fruits and vegetables during winter. In two villages of Ghor Province, a survey undertaken by WHO revealed that although wild green leaves, plants, and fruits are eaten during spring and summer months, there is little access to vitamin C-rich foods during the winter due to poor availability in the market. Also, growing vegetables is not widely practised, and not feasible during winter. A few farmers who have returned from Iran have introduced tuber and vegetable cultivation. Others prefer to cultivate the main wheat crop instead of vegetables due to scarce resources (land, water and time) (WHO, 05/02).

In the Shamali plain, the ACF food security survey reported that only 25% of the population could afford to buy fresh vegetables or fruits during winter, and indeed only 8% had sufficient dry vegetables for winter. The majority of families experienced a gap in fruit and vegetables supply: 17% experienced a three month gap, 17% a six month gap and 33% a nine month gap (ACF, 06/02). MOPH/UNICEF intends to begin an emergency vitamin C distribution from November in the North, North-East and in other isolated areas (MOPH/UNICEF, 09/02).

Iodine deficiency

Most of the population does not have access to iodized salt (MOPH/UNICEF, 09/02). Several surveys have reported high goitre prevalence and low iodized salt consumption (see table).

Goitre prevalence and iodized salt consumption (MOPH/UNICEF, 09/02)

Survey	Goitre prevalence (%)	Percentage of house-holds consuming iodized salt
Bagdhis, UNICEF, 03/02	-	2.4
Jawjzan, GOAL, 05/02	10.3 %	3.1
Kabul, ACF, 08/02	5.4 %	5.9
Panshir district, ACF, 08/02	63.7 %	1.0

Reports of paralysis

In the North and West of the country cases of acute paralysis, sometimes leading to death, have been reported. These are thought to be either poliomyelitis, or due to the consumption of badly prepared wild foods (MOPH/UNICEF, 09/02). An investigation into similar cases in the west of the country had suggested that these may be attributable to cyanide exposure resulting from improper cooking of a wild plant which is eaten only at the time of high food scarcity. This plant is a starchy white tuber referred to as tartran (ENN, 31/08/02).

Refugees in Pakistan

Before repatriation, refugees living in urban areas of Pakistan constituted about 50% of the refugee population. About 75 % of refugees who have returned to Afghanistan are from this group. Consequently the percentage of refugees in Pakistan still living in urban areas is now only about 27%, while the percentages for those living in long-term refugee settlements, and those settled in the new camps in the frontier region now represent 63 and 10%, respectively (UNHCR, 10/09/02).

The crude mortality and under five mortality rates of refugees in NWFP remains low, 0.2/10000/day and 0.5/10000/day respectively (UNHCR, 06/02).

Overall - Returnees, particularly when resettling in Kabul, experience poor living conditions and their nutritional status is troubling (category II). The situation may worsen further this wintertime. The overall population, particularly in remote areas, is still at high risk of micro-nutrient deficiencies.

Recommendations and priorities

From the ACF survey in Shamali plains

• Develop short term labour intensive work projects to enable people to re-capitalize

From the WHO survey of vitamin C deficiency

• Short-term strategies
  • Fortify food aid with micro-nutrients
  • Implement targeted vitamin C distribution
• Mid and long term strategies
  • Encourage the production and consumption of vegetables and tubers
  • Encourage the preservation of fruits, vegetables, and other suitable wild foods for consumption during the lean season

From the RNIS

• Carefully monitor the situation of the returnees, particularly in cities
• Strengthen programmes targeted the returnees, particularly in cities, with a special focus on:
  • Proper housing and sanitation conditions
  • Fuel access during winter time
  • Food access through food distribution and income generating activities

RNIS 38, July 2002

Afghanistan Region

Afghanistan continues to be a major complex emergency. Years of conflict in the country, coupled with frequent environmental disasters, have resulted in chronic social and economic hardship that have seen much of the population increasingly struggling to cope with the situation. This chronic emergency has been further exacerbated by three years of drought that has resulted in the almost complete failure of much of the country’s rain fed agriculture and the degradation of vital water resources. The years of insecurity and impoverishment have led to the internal displacement of many Afghans unable to cope in their places of origin, with many moving from rural areas to the urban provincial capitals in the hope of being able to secure employment and assistance. Many have also sought assistance outside of the country in neighbouring Pakistan and Iran, where they constitute the world’s largest refugee community at an estimated 3.6 million people.

The already desperate situation came to a head as a result of the September 11 th terrorist attacks on the United States and the subsequent military action within Afghanistan against the Taliban and Al Qaeda network. This resulted in the evacuation of aid agencies from the country and a dramatic increase in the number of internally displaced, which exceeded one million people. The fall of the Taliban regime in November 2001 opened up much of the country and a massive humanitarian intervention was implemented to provide emergency food and assistance for up to nine million people.

Recent events

The overall situation within Afghanistan has stabilised significantly over the duration of 2002, with particular strides in the political process of defining the future Afghan government. An interim Afghan Administration was created in December 2001, which governed the country until the convening of the Loya Jirga from 10 - 16 June 2002. The Loya Jirga brought together representatives from all over Afghanistan to form a nationally endorsed government, with Hamid Karzai voted in as head of state by an overwhelming majority (UNOCHA 14/06/02). Despite various tensions prior to the Loya Jirga, the outcome is extremely positive and bodes well for continued development of a stable political environment. It is hoped that the new government will oversee the regeneration of the country’s infrastructure and economy, both of which are essential for the mitigation of the current crisis.

Humanitarian situation

The humanitarian situation in Afghanistan continues to be extremely precarious. The effects of years of conflict and the recent three years of drought have resulted in the destruction of the country’s infrastructure and economy and have destroyed the livelihoods of much of the population. As a direct result, much of the population suffers from impoverishment and reports from across the country indicate that emergency needs remain extremely high. It is clear that many people have all but exhausted traditional coping mechanisms and are relying on non-sustainable coping strategies and on external assistance to meet the most basic of subsistence needs.

Humanitarian needs are expected to remain extremely high over the coming months and it has been suggested that the drought crisis could continue for a further 12-18 months (Feinstein 05/02), requiring continued humanitarian efforts. The period from April to July is seen as particularly critical as it is the pre-harvest hunger season when food stocks are normally at their lowest point, which is particularly concerning given the poor harvests of the past few years. As a result, the overall emergency food needs are at their highest during this period, with an estimated nine million people requiring assistance (WFP 03/05/02). The humanitarian response to these needs has been considerable, however it is worrying to note that the humanitarian appeal remains considerably under funded. WFP have estimated that they will require 544,000 MT of food for their current nine month operation from April to December 2002 and have recently reported that they face a shortfall of 175,000 MT, or 102 million US dollars (WFP 28/06/02). This has already resulted in some of WFP’s sub offices reporting pipeline breaks since early May 2002. The degree of under-funding and the projected pipeline breaks have worrying implications for the future of some programmes such as the Food for Asset Creation (FoodAC), Food For Work (FFW) and Food for Education. It is also concerning to note that the funding shortfalls are likely to affect key programmes designed to help with the reintegration of newly returned Afghans.

The situation has been made more difficult for the humanitarian community by the much greater than expected rate of return of IDPs and of refugees from neighbouring countries. Original planning figures estimated that up to 800,000 refugees would return during 2002, however this number was superseded in the first 15 weeks of the programme. At the end of June 2002, UNHCR estimated that 1,109,394 refugees had returned from neighbouring countries and it is now estimated that up to 2 million may return during the year (UNHCR 29/06/02). It is also estimated that there are still approximately 920,000 IDPs in various parts of the country. This is placing enormous strain on the already stretched resources and it has been suggested that rations, which make up a part of the essential return package for returnees, will be cut by up to a third of the intended amount (WFP 30/06/02). As a result, there is considerable concern over what will happen to people returning to areas with very little in the way of resources, infrastructure and essential livelihood opportunities, who will remain heavily dependent on external assistance.

Despite the improvements in security in the country, Afghanistan is still in a state of emergency and many areas of the country remain extremely insecure, which serves to hamper agency activities and humanitarian access. There has been a considerable rise in factional fighting, particularly in the northern regions of the country in the city of Mazar-I-Sharif and the surrounding districts of Sar-e-Pul and Sholgara. Much of the fighting has been between various warlords over control of key areas, and whilst the UN has served a key role in negotiating cease-fires, it has limited authority to enforce them (HRW 07/05/02). It is also alarming to note that rising insecurity in many areas has also resulted in increases in direct attacks on humanitarian aid workers and Afghan civilians, threatening the continued delivery of humanitarian aid. The attacks have included armed robbery, firing on clearly marked UN and NGO vehicles and the gang rape of a female NGO worker on 8 June 2002 (HRW 27/06/02). In some areas, notably in the north, this has resulted in the withdrawal of aid staff, the suspension of aid programmes and the complete withdrawal of at least one NGO from the country. The insecurity also severely threatens the fragile peace in the country, increases the possibility of more people being displaced, preventing returns of the population to their areas of origin, and could also serve to undermine the authority of the new government. The fragility of the current humanitarian situation coupled with the poor economic outlook and the number of people returning to the country could also serve to provoke further insecurity.

Food Insecurity

The food security situation in the country remains extremely poor. A pattern of general impoverishment within the population as a whole is emerging as a result of the drought and general degradation of livelihood activities. Numerous food security analyses have indicated that the traditionally robust coping mechanisms are breaking down and that nearly all medium and poor households suffer food insecurity, with land less and female headed households being the most vulnerable (WFP 05/02). In rain fed areas, those most affected by the drought, people are almost totally reliant on food aid. This reliance decreases slightly in the irrigated villages but the general lack of labour opportunities in all areas undermines people’s ability to purchase food (WFP 05/02). Indebtedness, a normal coping mechanism for many, is now widespread and many people are increasingly unable to repay debts or to take out new loans. As a result they are being forced to turn to increasingly untenable coping mechanisms involving the sale of essential livelihood assets such as land and livestock. This has very profound implications for people’s ability to restart livelihood activities in the near future. There are also widespread reports of people reducing their dietary intake and turning increasingly to wild "famine" foods in a bid to feed themselves and their families (AFSU/VAM 25/04/02; 05/05/02). The current state of indebtedness is concerning as many are unable to repay debts and this is thought to be one of the reasons for IDPs to become displaced whilst also preventing some from returning to their areas of origin (FAO 06/02).

Given the widespread food insecurity and the resultant emergency needs, it is surprising to note that there does not appear to be a greatly elevated prevalence of acute malnutrition in the population. However, there does appear to be a serious problem of chronic malnutrition, indicative of the long-term nature of the nutritional insult in Afghanistan. There is also increasing evidence of widespread micronutrient deficiency, which is of considerable public health concern as it contributes to increased morbidity and mortality. It is also important to stress that Afghanistan is entering the summer diarrhoea season, which has been clearly demonstrated to correlate very closely to increased levels of malnutrition in the under-five population (see RNIS 32 and 33) (ACF-UK 30/04/02). The current drought and scarcity of potable water sources has exacerbated the problem of diarrhoea and WHO estimates that between 20-40 % of all child deaths are due to diarrhoea (WHO 26/05/02). It is therefore likely that there will be an increase in rates of malnutrition over the summer period.

Central Afghanistan

The situation in the central highlands continues to be of great concern. A series of WFP rapid assessments have indicated that food insecurity is prevalent in many areas and reliance on external assistance is extremely high. The assessments indicate that people in many of the central regions have traditionally relied on their own agriculture and livestock as their main mode of livelihood. Surplus production was often sold, as were traditional handicrafts. The drought and conflict have resulted in the wide scale loss of harvests, livestock and essential assets and as a result most families now rely heavily on the need for cash to meet subsistence needs. Most income is now generated through labour and many men have left the area in search of work in order to provide for their families. This has left many landless and female-headed households who appear particularly vulnerable to further livelihood insecurity (AFSU/VAM 05/05/02).

Humanitarian organisations have been implementing various emergency programmes in the area, including the distribution of emergency rations. The period between April and July is particularly critical as it lies in the hunger season prior to the harvest in August. In general the security situation has been relatively stable but there have been various incidences of attacks on NGOs over the past three months and this has hampered the delivery of assistance in some instances (UNAMA 30/04/02).

Kabul

Since the ousting of the Taliban regime, Kabul has been the hub of humanitarian activities within Afghanistan. However, it remains heavily affected by years of war within the country and suffers from an economy that lies in ruins. The southern and western quarters of the city have been particularly affected and lie largely in ruins. The establishment of the new Afghan government is an encouraging step in the rebuilding of both the city and the country at large. Security in the city and its surrounding area has been tense, with reports of various attacks on the city itself, possibly by parties attempting to destabilise the fledgling administration and government. One of the greatest challenges ahead is the regeneration of the economy, which has been reduced to small traders and scattered market stalls. Industry is non-existent and much of the population remains unemployed. The enormous number of displaced and returnees are also serving to put additional pressure on the city’s already over stretched resources. In particular, the issue of water has been highlighted as being especially important, with much of the city suffering from vastly inadequate access to potable water. This is particularly concerning as past data has clearly demonstrated a clear correlation between diarrhoea, particularly during the summer months, and an increase in malnutrition (ACF 30/04/02). The RNIS does not have any recent nutrition surveys from the city but the situation is assumed to be poor and a rise in malnutrition over the summer period can be expected.

Shomali Plains and the Panjsheer Valley

The Shomali Plains and Panjsheer Valley have been at the centre of some of the fiercest fighting in Afghanistan. The area was, for a long time, a front line area between the Taliban and Northern Alliance and the various offensives resulted in the displacement of vast numbers of people. The conflict and displacement severely affected what was once a highly fertile area of the country, however the presence of large numbers of land mines continues to prevent access to some of the fertile farming land.

The area is much more accessible than previously and it now takes two hours to reach Kabul, whereas before it took at least 12 hours. The area is less drought-affected than other regions but the level of destruction and the large amount of land mines mean that many families find it difficult to meet their basic needs. ACF conducted a nutrition survey in the area during March and April 2002. The survey followed standard cluster survey methodology to measure children under the age of five years and found an estimated prevalence of acute malnutrition (W/Ht <-2 Z scores and/or oedema) of 10.5 %, including 1.6 % of severe malnutrition (W/Ht <-3 Z scores and/or oedema) (see table below).

Acute malnutrition rates (in Z-scores), from ACF survey in Panjsheer-Shamali

	Acute	Severe
August 2000	18.2 (14.8-22.2)	2.8 (1.5-4.9)
March 2001	8.3 (6.0-11.4)	1.8 (0.8-3.6)
March/April 2002	10.5 (7.7-13.3)	1.6 (0.5-2.7)

The survey also measured maternal malnutrition and showed that a significant proportion of mothers are at risk of acute malnutrition to the degree that they may not be adequately nourished to support a healthy pregnancy (ACF 04/02). In particular, the survey noted 50.9 % of mothers surveyed were observed to have visible signs of goitre, indicative of Iodine Deficiency Disorder (IDD). This is extremely worrying as IDD has very severe implications for maternal health and for fetal development and it is noted with concern that the prevalence amongst the surveyed population indicates a problem of very significant public health concern (ACF 04/02). The survey also measured mortality rates and estimated that the Crude Mortality Rate (CMR) was 0.43/10,000/day and the under- five mortality was 1.1/10,000/day. The results of the survey indicate that that there has been little change in nutritional status since March 2001 but, whilst prevalences are not alarming, they are close to emergency thresholds and will require careful surveillance, particularly as the survey linked high rates of childhood illness to malnutrition. It was noted with some concern that rates of diarrhoea are likely to increase over the summer period and with it rates of malnutrition.

Northern Afghanistan

Northern Afghanistan has been one of the worst affected areas of the country. Both the conflict and drought have taken a considerable toll on livelihoods in the area and decimated food production. As a result, many people remain extremely food insecure and, unable to support themselves in their places of origin, have resorted to distress migration to urban areas in search of charity and employment opportunities.

There has been a considerable humanitarian response to the crisis in the area, with agencies addressing both food and non-food needs of needy populations. The area has always been prone to insecurity as a result of factional fighting, however, it is concerning to note that the past three months have seen a deterioration in the overall security situation as a result of a security vacuum. Much of the insecurity has been around the town of Mazar-I-Sharif and surrounding areas, and is a result of conflict between various warlords. The insecurity has disrupted aid programmes and resulted in the withdrawal of some aid agencies in light of various incidents and attacks on the aid community. As a result of the insecurity, UNHCR has also suspended some of its return activities to parts of the north(IRIN 02/07/02).

Mazar-I-Sharif

Mazar is the main city in northern Afghanistan and the second largest city in the country. The city has been target of much in-migration from surrounding areas hit hard by conflict and drought. As a result, there is a substantial IDP community in and around Mazar that began arriving from February 2001. The last survey to be conducted in the town was in November 2000 (see RNIS 32 and 33), which showed low levels of acute malnutrition. Access to the city had been difficult until earlier this year when ACF under-took a nutrition survey in March 2002. The survey indicated a prevalence of acute malnutrition (W/Ht <-2 Z scores and/or oedema) of 2.9 % including 0.4 % of severe malnutrition (W/Ht <-3 Z scores and/or oedema). The results indicate that the nutrition situation is under control with levels being well below emergency cut-offs. The results are similar to those of November 2000 (ACF 03/02). The survey also measured mortality and estimated that the CMR was 0.2/10,000/day and the under-five mortality was 0.7/10,000/day. The mortality is also well within emergency thresholds and indicates that the overall health situation is under control. Given the poor food security outlook for many in the area and the dependency on humanitarian assistance, the low levels of acute malnutrition are surprising. However, the city has received a great deal of assistance and there is an increase in the number and variety of imported goods in the city, indicating an improvement in the overall economy. It is important to note that the survey took place before the summer, which is associated with a seasonal rise in diarrhoea and malnutrition, and it can be expected that rates of malnutrition will increase during the summer period.

Sar-e-Pol

The population of Sar-e-Pol is regarded as acutely food insecure as a result of drought. This has resulted in many families being forced to turn to ever more extreme methods of coping with the lack of food and employment opportunities. Access to cash for food purchase has become increasingly necessary and increasingly difficult and has led to families selling all or part of their assets to survive. In general the coping mechanisms in the area appear to be very strong and have allowed many to "cope", albeit at the very edge of their ability. However, people’s ability to cope is stretched to the very maximum. Many have traditionally relied on systems of charity and borrowing but, as the entire population now feels the effects of the past years, access to this traditional redistribution network is also becoming more and more difficult. As a last resort many have been forced to move from their areas of origin in order to meet their subsistence needs.

The situation has been exacerbated by recent reports of violence and factional fighting that has continued to displace people and has prevented others from returning. It is certainly difficult to see how the situation can improve without considerable long-term input to rebuild people’s livelihoods and to ensure that the security situation remains stable. Recent nutrition surveys have indicated a poor nutritional situation in the area. In March 2002, ACF conducted a further survey in Sang C