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Nutrition Information in Crisis Situations
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| Food items | Quantity (g/pers/day) |
| Rice | 450 |
| Pulses | 40 |
| Cooking oil | 20 |
| Salt | 10 |
| Sugar | 10 |
| Blended food | 50 |
Problems regarding food distribution have been reported for a long time, with families complaining about not receiving their intended food ration (FEG, 06/01). However, the measures which have been taken since 2001, such as the implementation of food basket monitoring, fortnightly distributions instead of weekly distributions, and involvement of refugees in distributions, seem to have improved the system (MSF, 03/02; GOB/UNHCR/WFP, 07/02).
Food basket monitoring showed that the amount of food distributed was slightly below the intended ration in 2002 and in the first semester of 2003 (see figure 6), but food distribution has improved compared to 2001, when the ration averaged 92-93% of the target (FEG, 06/01).
Figure 6 Food ration distributed vs intended food ration, refugee camps, Bangladesh
The Food Economy Group showed that even if the ration received by the refugees was 100% of the intended ration, families which have several older children would not have enough to cover their energy needs. If the full ration is not distributed, this worsens the situation of the above -mentioned families and also affects other families, depending on their composition (FEG, 06/01). Moreover, it seems that some families do not receive food, these are people who have had their family book confiscated; the number of families in such a situation is unknown. There are also some new-borns, which were not registered by the Government of Bangladesh, their families do not therefore receive the ration entitled to them (MSF, 03/02).
Small scale food for work and food for training are implemented for the most vulnerable families in the camps (GOB/UNHCR/WFP, 07/02).
Other sources of food
Almost all refugees (99%) reported using additional food to complement the general ration (Concern, 11/01). The most widely used additional foods were vegetables (96% of the families interviewed), followed by fresh or dried fish (63%) and poultry (43%).
Some small-scale gardening and poultry farming were introduced in the camps in 2000 (UNHCR, 08/03). 57% of the families reported gardening, 99% were gardening for their own consumption; 52% of the families were rearing poultry, of whom 80% reported eating chicken meat, 40% reported eating eggs and 16% and 9% reported selling chicken or eggs, respectively (Concern, 11/01). Most families bartered part of the food ration for other food or essential items (FEG, 06/01).
There are some small kiosks in the camps, which sell food, basic assets and medicines (FEG, 06/01). There are also significant markets at the entrance of the camps where food, and especially vegetables and fish are widely available. Markets are used by both refugees and the host population.
Sources of income
Refugees are prevented from accessing incomes. Aid agencies are prohibited to
pay cash incentives to refugee workers (GOB/UNHCR/WFP, 07/02), and refugees are
not allowed to work outside the camps. Although it is thought that some refugees
have access to work, data are difficult to obtain because of the illegality of
these activities.
According to the Concern survey, 86% and 90% of males and females respectively,
were unemployed in Nayapara and 81% and 76% of males and females respectively,
were unemployed in Kutupalong (Concern, 11/01). It seems that there are greater
work opportunities around Kutupalong camp than around Nayapara. The main
occupations for those who were employed were petty trading, tailoring, fishing
and fish net weaving/production. Another study roughly estimated that about 40%
of the refugees may have income opportunities (FEG, 06/01). It is believed that
work opportunities are likely to be part-time and wages to be below normal rates
(FEG, 06/01).
It is also thought that some refugees may receive remittances from relatives living outside the camps (FEG, 06/01).
Assets
It seems that refugees own very few assets; even if they had brought some assets from Myanmar, they have sold most of them during their stay in Bangladesh (FEG, 06/01).
Kerozene and cooking fuel (compressed rice husk) are distributed on a monthly basis; cloths and blankets are distributed yearly and other items are provided on a needs basis (GOB/UNHCR/WFP, 07/02). Soap, cloths and mosquito nets are produced by refugee women.
Refugees expressed their need for distributions of non-food items to be more regular and for non-food items to be of better quality (FEG, 06/01). The majority of refugees stated they never have enough firewood (81), whilst 37 said they sometimes have enough. The majority of them was therefore getting firewood from the forest, despite the risk of being harassed (MSF, 03/02).
Health care and nutrition care
Refugees have free access to health services; health care and nutrition services
are now provided by the Government of Bangladesh. Until mid-August 2003, NGOs
were providing health and nutrition services for children under ten years,
pregnant and lactating women.
It seems that the health status and mortality rate have remained under control
in the camps (MSF, 03/02).
Housing
Shelters are overcrowded and damaged. According to MSF interviews, housing was the second main concern of the refugees (MSF, 03/02). Almost all refugees said their shelters were too small and had leaky roofs.
The Government of Bangladesh has never accepted any notion of permanent structures, which has impaired realisations of a proper environment in the camps.
Water
Inadequate access to water has constantly been reported in Nayapara (UNHCR, 08/03). The water reservoir suffers shortage during the dry season and water has to be trucked in; in addition, it was reported that water taps were not being opened long enough for people to collect enough water (MSF, 03/02). According to MSF, the average daily availability of water was less than 10 litres/person. The infrastructure itself was reported as being worn. In Kupalong, 50 of the 59 refugees interviewed said they had enough water, whereas only 12 of the 59 refugees interviewed in Nayapara had enough water. The main reasons cited for insufficient water collection in Nayapara were that water taps were not opened long enough (36 people); that people had insufficient containers (25) and that there was short supply of water in the tank (27) (MSF, 03/02). People compensated for the shortage of water by going to another source (26) or by digging ponds in the camps (21). According to the Concern survey, whilst in Kutupalong almost all refugees were using the camp facilities for collecting water for drinking, washing and bathing, in Nayapara, 94% of the refugees were using the camp supply for drinking; the others were using tube wells. For washing and bathing 80% of the families were using the water supply, whilst 15% were using water from ponds or river (Concern, 11/01).
Sanitation
There is one latrine for 23 people in Nayapara and 1 latrine for 18 people in Kutupalong, meeting the minimum standard (GOB/UNHCR/WFP, 07/02). However, it seems that sanitation conditions are not optimal, structures being old and not adapted to the camp: latrines and bath houses are not designed according to sex and are located far from some refugees’ shelters (MSF, 03/02). The main reasons cited by the refugees for not using the latrines were that the latrines were too dirty, not private or too far.
There is a feeling of insecurity in the camps, about half of the refugees felt insecure, mainly because of fear of harassment by camp authorities or villagers (MSF, 03/02).
A majority of the refugees nevertheless think living conditions in the camps have improved (71 of 118) over the last ten years. The main reasons cited for improvement were: because schools have been made available (34); skills training has been implemented (25); and food ration distributions have been corrected (20). On the other hand, 28 people felt conditions were worse, mainly because the quantity and variety of food has decreased, and because of harassment (MSF, 03/02).
Children’s feeding practices and care
According to the UNHCR survey (UNHCR, 08/03), breastfeeding was initiated within
one hour after birth by 42% of the mothers, and within 2-3 hours after birth by
48% of the mothers. 95.5% of the 12-16 month olds were still breastfed, as well
as 48% of the 20-23 months. 53% of the minus 6 month olds were exclusively
breastfed, whilst 43% received water and 25% received food; infant formula was
not used. On the other hand, only 45.5% of the 6-10 month olds had received
solid or semi-solid food the day prior to the survey. 89% of the mothers of
children who had diarrhoea reported continuing to feed their children, and 18%
reported increasing feeding. 97% of the mothers reported giving Oral Rehydration
Salt when the child had diarrhoea (Concern, 11/01).
The mothers were in charge of food preparation and feeding of the children in
98% of the families in Nayapara and 91% of the families in Kutupalong. In the
other families, brothers or sisters were in charge of the children (Concern,
11/01).
A nutrition survey carried out in November 2000 in two townships, Maugdaw and Buthidaung, located in the north of North Rakhine state, revealed a precarious situation (ACF-F/WFP, 11/00). The prevalence of acute malnutrition was 22.3% (18.6-26.6), including 2.0 % (1.0-3.9) severe malnutrition. The situation seemed to be still dire in 2003.
The nutrition situation in the camps is of concern (category II). Refugees are highly dependent on external aid, which is insufficient for them being food secure. The Government of Bangladesh puts a lot of constraints on refugee movements and on the design of the camps’ infrastructure, which also limits the capacity of the refugees to fulfill their basic needs.
An estimated 22,260 Muslim refugees from Rakhine state in Myanmar live in two camps in southern Bangladesh. They were among the 250,000 people who originally fled Myanmar in 1992, claiming widespread human rights abuses. Repatriation began in 1992, and by April 1997 some 230,000 refugees had been repatriated. The repatriation programme was suspended in mid-1997 and resumed only in November 1998. Since then almost 1,000 refugees have repatriated, out of a list of 7,000 the Government of Myanmar has cleared for repatriation (UNHCR - 12/12/99).
Nutritional situation
These refugees are not allowed to undertake employment or income-generating activities and hence are completely dependent on WFP and UNHCR for their survival.
The RNIS has not received any new information on the
nutritional situation of these refugees. The most recent information from UNHCR
suggested that their nutritional status was not critical (RNIS 29).
An estimated 22,260 Muslim refugees from Rakhine state in Myanmar live in two camps in southern Bangladesh (UNHCR - 11/99). They were among the 250,000 people who originally fled Myanmar in 1992, claiming widespread human rights abuses. Repatriation began in 1992, and by April 1997 some 230,000 refugees had been repatriated. The repatriation programme was suspended in mid-1997 and resumed only in November 1998. Since then almost 1,000 refugees have repatriated, out of a list of 7,000 the Government of Myanmar has cleared for repatriation (UNHCR-12/12/99),
The Government of Bangladesh does not allow the refugees to undertake employment or income-generating activities. WFP food aid is thus the primary means of meeting the nutritional needs of this population. UNHCR continues to supply other non-food items to the refugees such as soap, compressed rice husk, plastic sheeting and clothing. The sanitation facilities in the camps are adequate and average water use is 21-22 litres/per person/day.
A nutrition survey completed in March 1999 by UNHCR revealed an increase in the prevalence of acute wasting to 14.3%, with 0.7% severe wasting. As one of the measures to remedy the situation the supplementary wet-feeding programme was replaced by High Energy Milk (2 feedings per day), in addition to full dry rations for all. It had previously been found that parents had kept their children from attending the supplementary feeding programme to receive a dry ration that could be sold. No new information on the nutritional situation of these refugees is currently available to the RNIS.
In September/October WFP 1999 undertook a vulnerability survey, to get a better understanding of the main reasons for the continuing poor nutrition situation in the camps. A report on the outcome of this survey will be made available in the next RNIS.
Overall, the refugees in Bangladesh are not considered
to be at heightened nutritional risk (category IIc).
An estimated 22,500 refugees from Rakhine state in Myanmar live in two camps in southern Bangladesh (UNHCR - 06/99). They were among the 250,000 people who originally fled Myanmar in 1992, claiming widespread human rights abuses. Repatriation began in 1992 and by April 1997 some 230,000 refugees had been repatriated. However, the repatriation programme was suspended in mid-1997 and, although a list of 7,000 refugees who wish to return from Bangladesh has been approved by the Government of Myanmar, no schedule has been set for their return.
The Government of Bangladesh does not allow the refugees to undertake employment or income-generating activities. WFP food aid is thus the primary means of meeting the nutritional needs of this population. UNHCR continues to supply other non-food items to the refugees such as soap, kerosene, plastic sheeting and clothing. The sanitation facilities in the camps are adequate and average water use is 21-22 litres/per person/day (UNHCR - 06/99).
A nutrition survey completed in March 1999 by UNHCR revealed an increase in the prevalence of acute wasting to 14.3%, with 0.7% severe wasting. No new information on the nutritional situation of these refugees is currently available to the RNIS.
Priorities and recommendations
Overall, the refugees in Bangladesh are not considered to be at heightened nutritional risk (category IIc).
An estimated 22,500 refugees from Rakhine state in Myanmar live in two camps in southern Bangladesh (UNHCR - 06/99). They were among the 250,000 people who originally fled Myanmar in 1992, claiming widespread human rights abuses. Repatriation began in 1992 and by April 1997 some 230,000 refugees had been repatriated. However, the repatriation programme was suspended in mid-1997 and, although a list of 7,000 refugees who wish to return from Bangladesh has been approved by the Government of Myanmar, no schedule has been set for their return.
The Government of Bangladesh does not allow the refugees to undertake employment or income-generating activities. WFP food aid is thus the primary means of meeting the basic nutritional needs of this population. UNHCR continues to supply other non-food items to the refugees such as soap, kerosene, plastic sheeting and clothing. The sanitation facilities in the camps are adequate and average water use is 21-22 litres/per person/day (UNHCR - 06/99).
A nutrition survey completed in March 1999 by UNHCR revealed an increase in the prevalence of acute wasting from 11.5% in February 1998 to 14.3%, with 0.7% severe wasting (see Annex). Oedema was reported in 0.2% of the population. The explanations given for the level of wasting found included: a monthly average under-distribution of food of 5-7%, selling of rations, certain food items such as pulses or blended foods were sometimes not available in the ration and were substituted with other items and the coverage of the supplementary feeding programmes was not complete. In addition it was suggested that the population may not have been adequately informed by the camp health workers about how to best cook and eat the food types given to them (UNHCR - 14/06/99, 28/06/99).
As part of a response to these findings, consultations between UNHCR/WFP and the NGOs have resulted in the abolition of the wet feeding programmes. Instead, the undernourished children are given High Energy Milk twice a day at the feeding centre twice a day.
Priorities and recommendations
Overall, the refugees in Bangladesh are not considered to be at heightened nutritional risk (category IIc).
An estimated 22,317 refugees from Rakhine state in Myanmar live in two camps in southern Bangladesh. They were among the 250,000 people who originally fled Myanmar in 1992, claiming widespread human rights abuses. Repatriation began in 1992 and by April 1997 some 230,000 refugees had been repatriated. However, the repatriation programme was suspended in mid-1997 and, although a list of 7,000 refugees who wish to return from Bangladesh has been approved by the Government of Myanmar, no schedule has been set for their return. As a result UNHCR will not be able to phase out its assistance programme for refugees in Bangladesh in 1999.
UNHCR's assistance within Bangladesh aims to ensure basic care and maintenance and to foster self-reliance. Programmes include regular food distributions, health care, sanitation and water projects and also therapeutic and supplementary feeding programmes for the malnourished. In 1999, nearly all refugee shelters will have to be extensively rebuilt as basic maintenance and repair work was postponed because of a breakdown of law and order in the camps in 1998.
The Government of Bangladesh does not allow the refugees to undertake employment or income-generating activities. WFP food aid is thus the primary means of meeting the basic nutritional needs of this population. A joint WFP/UNHCR food assessment mission undertaken in May last year reported that the overall nutritional status of the refugee population was satisfactory. The mission recommended the continuation of special feeding programmes and that the per capita daily ration be reduced to 2,007 kcal from 2,128 kcal in line with WFP/UNHCR guidelines. Fortified blended food is still provided as part of the general ration (WFP - 11/9/98).
No new information on the nutritional status of the population has been received since the assessment mission. However, a UNHCR/NGO nutritional survey for children under five years was conducted in February and the results should be available shortly. The latest health report (for February 1999) recorded a CMR of 0.61/1,000 /month. The average energy value of food provided over this period was 1,880/kcal/person/day -slightly lower than that recommended. This was due to a reduction of food commodities received at the delivery point (UNHCR - 03/99).
Overall, the refugees in Bangladesh are not considered
to be at heightened nutritional risk (category IIc).
RNIS 25 was devoted to reviewing some of the changes in emergency response over the last five years. We will first highlight situations where wasting was brought rapidly under control. We will then look at some of the factors that have led to less than optimal results, followed by what has been accomplished to improve response over the last five years. We conclude with some ideas for future improvements in the RNIS Reports that could even further enhance communication, stimulate thought, and promote improvement.
Approximately 250,000 people fled Myanmar - then Burma - to Bangladesh, claiming widespread human rights abuses. Most of these refugees have now returned to Myanmar, and only about 21,000 people remain in two camps in Bangladesh. Some problems involving refugees blocking access to food distributions and health centres were reported in March, but the situation has now returned to normal. Repatriation of these refugees, which was temporarily suspended will resume in the near future [UNHCR 18/05/98].
In line with government policy, refugees are not allowed to participate in the local economy, and home gardening is not approved at the refugee sites. This renders the population totally dependent on food aid. The planned food basket was to provide just over 2100 kcals/person/day. In the absence of fortified blended foods from the ration, efforts were made to replace the calories with high energy biscuits, but ration receipts were 1900 kcals/person/day for about a year. Blended foods have been re-introduced as part of the ration since March 1998. A recent Joint WFP/UNHCR Food Assessment Mission proposed a slight modification to the general ration according to new guidelines2 and available demographic data, activity level and temperature, to just over 2000/kcals/person/day. The supplementary feeding programme, which provides malnourished children with 3-4 cooked meals/day (described in RNIS 23) is working well and about 90% of malnourished children are enrolled. In addition, all pregnant and breastfeeding women receive high energy milk [WFP/UNHCR 25/05/98].
2 WFP/UNHCR Guidelines for Estimating Food and Nutritional Needs in Emergencies, Oct 1997. A summary can be found in RNIS 22.
Stunting (low height-for-age) in the camps was recently measured at 66.4%, although uncertainty in determining age means these data should be viewed with caution. To give context, stunting in Bangladesh is 55%. Levels of wasting were recently reported at 11% (see RNIS 23 for details). High prevalences of angular stomatitis have been reported in the camps. The mission noted that not all cases of angular stomatitis were attributable to riboflavin deficiency and many cases were due to bacterial infections. This was ascertained when most cases responded to antibiotics. It was suggested that in reporting, agencies desegregate the data by cause [ACC/SCN Nov. 97, WFP/UNHCR 25/05/98].
Non-food items distributed regularly include kerosene for lighting, soap and compressed rice husks for cooking. While in 1997, over 80% of the required compressed rice husk was made available to the refugees, during the first five months of 1998 the average distribution was only 25% of requirements. This was mainly due to a limited availability due to poor harvests. It is estimated that 39% of the families are female-headed, and that they are particularly affected by shortages in fuel. Efforts are being made to rectify the situation. The supply of soap has been regular, however with a distribution of one bar per family irrespective of family size, larger families do not have enough [WFP/UNHCR 25/05/98].
The mission also considered the issue of sale of ration commodities and found the proceeds of the sale of both food and non-food items would first be used for other food items (mainly vegetables and fish) to provide variety to the diet, then to buy fuel, to pay school fees, to buy clothes and finally, and to a lesser extent, to buy sweets for children and cigarettes [WFP/UNHCR 25/05/98].
Overall, there is a tendency towards improvement in the nutritional situation for these refugees with the re-introduction of a fortified blended food in the ration, and they are currently considered to be at moderate risk (category IIb in Table 1).
On-going interventions The Joint Food Assessment Mission had a number of recommendations:
Clothes be distributed, at least on an annual basis.
In 1992, an estimated 250,000 people fled Myanmar (then Burma) to Bangladesh, claiming widespread human rights abuses. Of this original group, most have returned home, and there are approximately 21,000 people remaining in two camps. There has been some further movement of people from Myanmar into Bangladesh who local authorities define as economic migrants [UNHCR Mar 98].
A recent survey carried out in the two camps showed 11.5% wasting with 0.7% severe wasting. No cases of oedema were seen (see Annex I 13a). Results from a survey carried out in June 1997 showed 14% wasting. The ration distributed provides 1900 kcals/person/day and does not provide adequate micronutrients. In the past, a fortified blended food was distributed as part of the general ration but this was discontinued in February 1997 due to problems with the quality of the blended food. The prevalence of angular stomatitis in the February 1998 survey was 9.9%. This is feared to be a general indicator of more serious micronutrient malnutrition and it has been suggested that the re-introduction of a micronutrient enriched blended food would improve the situation. Provision has now been made for the inclusion of 50 grams/person/day of blended food in the ration [MSF-H 27/02/98, WFP 16/03/98, UNHCR 22/02/98].
Stunting was also measured in the survey as was found to be 63.3% (ht/age <-2 Z scores). For comparison purposes, recent country wide estimates are that the prevalence of stunting is about 55% [ACC/SCN 1997, UNHCR 22/02/98].
The nutritional situation in the camps must be viewed in the context of several interruptions to the general ration programme which have occurred since May 1997 and which have lasted for several weeks. These interruptions have occurred due to strikes by refugees and other security problems [MSF-H 27/02/98].
There has been a high prevalence of low birth weight babies, premature births and neonatal deaths in the camps. This has been attributed to several factors, including the young age of mothers, very short birth spacing and lack of micronutrients in the ration. However, there is concern that when blended foods are re-introduced into the general ration the prime target group, i.e. pregnant and lactating women and children, may not get adequate access to it [MSF-H 27/02/98].
The supplementary feeding programme in the camps supplies wet rations, covering the entire daily nutritional needs of the beneficiaries with a reduction in the general ration for those families enrolled on the programme. This type of supplementary feeding programme was introduced as it was believed that a main cause of malnutrition in the camps was inappropriate and inequitable intra-camp and intra-household food distribution. Since November 1997, pregnant and lactating women enrolled in the supplementary feeding programme have been provided with 500 ml of high energy milk per day [MSF-H 27/02/98, UNHCR 03/24/98].
Overall, this refugee population can be considered to be at high risk (category I in Table 1) due to the presence of micronutrient malnutrition. The situation is likely to improve with the reintroduction of fortified blended foods into the general ration.
Ongoing interventions
The recent survey, which showed a 9.9% prevalence of angular
stomatitis, underscores the need to re-introduce a fortified blended food to the
general rations, which has been highlighted in earlier RNIS Reports. However,
there should be some investigation into how the blended food will be used and by
whom in order to ensure that the priority target group, pregnant and lactating
women and children, receive adequate quantities from the general ration. Further
suggestions that vitamins and minerals should be added to the diets at
supplementary feeding centres should also be acted upon. The caloric level of
the general ration should be increased from 1900 kcals to 2100 kcals. The large
ration size given out at the supplementary feeding centres should be continued
as a means of protecting against inequitable intra-camp and intra-household
distribution of the general ration.
Approximately 250,000 people fled Myanmar's Rakhine State in 1991 and 1992 to seek refuge in Bangladesh. Repatriation under UNHCR auspices began in 1994, and there are currently 21,000 refugees remaining in two camps in Bangladesh.
Refugees recently refused rations made available to them for several weeks in protest of the forced repatriation of approximately 400 people in July 1997. The boycott is now over and the ration distributed is providing approximately 1900 kcals/person/day and consists of rice, pulses, oil, salt, and sugar [UNHCR 21/11/97]. Fortified blended foods have been missing from the general ration since November 1996, and despite symptoms indicating micronutrient malnutrition (prevalence of angular stomatitis of 8.9% - see RNIS #21), no substitute has been found, although local procurement of the commodity is now being explored by WFP [UNHCR 08/12/97].
A survey in June 1997 showed 14.6% wasting (see RNIS 21). Efforts to address this malnutrition include increased outreach on the part of health workers in encouraging parent to enrol their children in feeding programmes. To compensate for a lack of blended foods in the supplementary feeding programmes for pregnant and lactating women, a wet feeding programme of high energy milk (whole milk powder, oil and sugar) was introduced in November 1997 for this group. It is likely that the nutritional situation is improving [UNHCR 08/12/97].
Overall, this population can be considered to be at heightened risk (category IIa) due to the presence of micronutrient malnutrition, although there is likely that the situation is improving.
Ongoing interventions: An assessment of feeding
programme coverage should be undertaken. If coverage is found to be low, an
investigation into reasons for this would be needed.
Between December 1991 and March 1992, approximately 250,000 people fled the Rakhine State (then called Arakan state) in Myanmar (then Burma) to Bangladesh. Repatriation began in 1994 and was planned to be completed by the end of 1995. The repatriation process was impeded by a number of factors, and currently there are 21,000 refugees remaining in two camps in Bangladesh [HRWA/RI Aug. 97].
The food basket is meant to provide just over 2100 kcals/person/day. However, in November 1996, the distribution of fortified blended food was stopped due to questions of its suitability for consumption. Efforts to replace the calories provided by blended food include the distribution of high energy biscuits in supplementary feeding programmes, a wet feeding programme for all children under five, and an increase in rations for pregnant and lactating women [UNCHR Aug. 97].
A nutrition survey was carried out in the two camps in Bangladesh, and the results confirm earlier survey results showing a decline in nutritional status among remaining refugees. Wasting was measured at 14.6%, with only 39.5% of malnourished children attending the feeding centres (see Annex I (16a)). The prevalence of angular stomatitis had increased to 8.9% from 5.5% measured in an earlier survey. Measles immunisation coverage was 92.8% [UNHCR 07/08/97]. A number of factors may have contributed to this decline in nutritional status. Blended foods have been absent from the food basket since November 1996 and no substitute has been provided in the general ration. Also, the most vulnerable families have been left following repatriation, and finally, refugees sell and trade food items in order to buy other necessary items. However, terms of trade are poor and many calories may therefore be lost from the ration.
Since the survey, there have been reports of new arrivals to Bangladesh, although these people are not registered and do not receive rations. Government officials claim that up to 15,000 refugees have crossed the border in recent months and that many are economic migrants. It is thought that in some cases, families are sharing rations with the new arrivals. Another recent development was the forced repatriation of over 400 refugees. This led to people refusing daily rations for up to two weeks. The boycott is now over, and forced repatriations have stopped [UNHCR 16/09/97]. Both of these recent developments are likely to have further adversely affected the nutritional situation of remaining refugees.
Overall, these refugees can be considered to be at high risk of mortality (category I in Table 1), with elevated levels of wasting and micronutrient malnutrition reported in recent surveys.
Ongoing interventions: The food security impact
of the recent wave of refugees into the camps needs to be properly assessed and
appropriate action taken. It also seems appropriate to review the kcal and
micronutrient level of the ration given the decline in nutritional status. A
substitute for corn soy blend which has been removed from the general ration
should be found. It may also be that other initiatives to improve nutritional
status are appropriate, e.g. deworming and efforts to establish home gardens.
Attempts should also be made to increase supplementary feeding programme
coverage through the outreach of community health workers and traditional birth
attendants.
There are approximately 21,000 refugees from Rakhine State, Myanmar remaining in two camps in Bangladesh. This decrease in total number is due to repatriation [UNHCR 06/06/97].
There are approximately 24,000 refugees from Rakhine State, Myanmar remaining in Bangladesh. Repatriation is continuing, and is expected to be completed early in 1997 [UNHCR 04/03/97].
The last RNIS described a precarious situation for these refugees, with increasing incidence of diarrhoea, and levels of wasting of 15%. Supplementary feeding programmes have now been established in response to these high levels of wasting [UNHCR 04/03/97].
The distribution of a fortified blended food (CSB), which is a usual part of the general ration, was discontinued due to questions over it's suitability for human consumption. Although it's suitability has now been demonstrated, CSB is still not being distributed. The general ration is therefore low in calories and micronutrients. This is particularly worrying for this population as micronutrient deficiency diseases, specifically vitamin B2 deficiency seen as angular stomatitis, has been endemic amongst this population.
Overall, this population can be considered to be at
high nutritional risk (category IIa in Table 1) due to elevated levels of
wasting and a low intake of micronutrients.
There remain approximately 36,000 refugees form Rakhine State, Myanmar in Bangladesh. This number continues to decease due to the ongoing repatriation programme. It is anticipated that a further 16,000 people will have returned home by the end of 1996 and that the repatriation process will be completed by mid-1997 [UNHCR 22/11/96].
Preliminary results of a nutritional survey in the camps in Bangladesh showed a significant deterioration since the previous two annual surveys. Wasting was measured at 15.4% with 0.7% severe wasting (see Annex I (18a)). These results compare unfavourably with rates of 7.2% and 9.5% in 1994 and 1995 respectively. Despite a decrease in the prevalence of angular stomatitis, cases are still being seen indicating vitamin B2 deficiency. Measles immunisation coverage was 98.4%. Coverage of selective feeding programmes remain low at 55% [UNHCR 01/09/96]. Details of actions to rectify this situation will be forthcoming.
An increase in the number of cases of both bloody and watery diarrhoea in the camps has been reported. At the same time, it was discovered that stocks of blended food kept at camp level were infested and it was felt that this could be associated with the increase in cases of watery diarrhoea. Distribution of blended foods was discontinued although in order to compensate the general ration was readjusted to contain an additional 10 gms of pulses, 10 gms of oil and 5 gms of sugar in addition to high protein biscuits [UNHCR 18/11/96]. These measures will maintain the caloric level of the general ration at previous levels although the micronutrient content of the ration will be lower.
Overall, this population could be considered to be at high nutritional risk (category I in Table 1) due to a elevated levels of wasting and the continuing diagnosis of new cases of micronutrient deficiency diseases, particularly vitamin B2. It is possible that the deterioration in the nutritional status of this population reflects the fact that the repatriation has left the most vulnerable households in the camps.
How could external agencies help? Stocks of
blended foods should be replenished as soon as possible. Furthermore, measures
to prevent future infestation should be taken. These might included fumigation
as a preventive measure and adherence by supplying agencies to the practice of
ensuring that the manufacture and expiry dates of the blended foods are clearly
marked on each bag. Also, while blended foods are absent from the general ration
particular attention should be given to methods of micronutrient deficiency
surveillance within the camps.
There remain approximately 50,000 refugees from Rakhine State,
Myanmar in Bangladesh. The decrease in total number is due to the continuing,
albeit slow, repatriation. There are no reports of change to the generally
adequate and stable nutritional status of this population, despite the continued
presence of some cases of angular stomatitis [UNHCR 19/09/96]. These refugees
are not currently considered to be at heightened nutritional risk (category IIc
in Table 1).
There are approximately 54,000 refugees from Rakhine State Myanmar in Bangladesh. There have been approximately 5,500 new arrivals from Myanmar during the months of April and May. The majority of these new arrivals appear to be fleeing poverty in their home country. It is currently being discussed whether these new arrivals should be considered as economic migrants (and hence not under the protection of the international community) or refugees.
A recent report on the security and human rights situation inside Rakhine State stated that “UNHCR is playing a key role in helping to ensure conditions in Rakhine State are conducive to the return of the refugees....” [ECOSOC 05/02/96], however, repatriation is still only continuing at a slow pace.
There is no reported change to the generally adequate nutritional and health status of this population although low levels of angular stomatitis persist despite the availability of blended foods, fish and dal in the general ration [UNHCR 21/05/96].
Overall, this population is not currently considered to
be at heightened nutritional risk (category IIc in Table 1), although a small
number of people are at high nutritional risk due to the existence of
micro-nutrient deficiency diseases.
There are approximately 50,000 refugees from Rakhine State, Myanmar in Bangladesh. Repatriation of this refugee population is continuing at a very slow rate. For example, in February 1996, only approximately 500 refugees repatriated [UNHCR 19/03/96].
A recent review of the assistance programme throughout 1995 showed a generally satisfactory nutrition situation for these refugees. The distributed general ration varied little during the year and contained on average about 2,200 kcals/person/day. The percentage of children enrolled in selective feeding programmes ranged from 10-15% during 1995. A slight increase towards the end of the year was attributed to improved case finding and the policy of discouraging repatriation for those families with malnourished children [UNHCR 1995].
The most recent nutritional survey was carried out in August 1995 and found 9.5% levels of wasting which is a slight increase from the previous survey which found 7.2% prevalence of wasting. This change in the populations' overall nutritional status was partly attributed to the ongoing repatriation of least vulnerable families as well as other factors affecting basic needs provision in the remaining camps [UNHCR 1995]. This population are almost entirely dependent on the food ration provided so that any small break in the general ration pipeline can have an adverse effect upon nutritional status.
Availability of blended foods, fish and dal in the general ration has undoubtedly had a role in reducing B vitamin deficiency (seen as angular stomatitis). Prevalence rates of angular stomatitis were 6.9% in August 1995 compared to 21.6% in the previous year. Subsequently, rates have further declined. It is not clear why signs of the deficiency persist among this population. One suggestion has been that certain families exchange vitamin B rich general ration commodities for other items thereby rendering their household vulnerable to deficiency [UNHCR 1995].
Measles immunisation coverage stood at over 98% in 1995 [UNHCR 1995].
Overall, this population is not currently considered to be at nutritional risk (category I Table 1), however, there is a small percentage of people at high risk due to the presence of micronutrient deficiencies.
How could external agencies help? As it is
difficult to supply fresh vegetables to this population the regular supply of
blended foods must be guaranteed. Its provision in recent months has probably
been the most important factor in reducing the incidence of micro-nutrient
deficiency disease. The general ration pipeline for blended foods must therefore
be ensured while support for the local production of blended foods must
continue. UNHCR should advise/request WFP to procure blended foods locally as
long as the price remains competitive. Reasons for the continued presence of low
levels of micronutrient deficiencies need to be investigated.
There are approximately 50,000 refugees form Rakhine State, Myanmar in Bangladesh. Repatriation is continuing, but at a very slow rate. It is hoped that the repatriation process will pick up speed and that many of the refugees will have returned home by June 1996, before the monsoon season [UNHCR 26/01/96]. A recent survey found that overall levels of wasting were 9.5% with 0.2% severe wasting and/or oedema (see Annex 1 19(a)). This compares favourably with wasting rates of 15% amongst the local population. Crude mortality rates were recorded at 0.25/10,000/day (normal) while under-five mortality rates were 0.58/10,000/day (normal). Morbidity data indicates the existence of angular stomatitis (associated with deficiency of riboflavin) with crude incidence rates of 11/1,000/month and under-five rates of 4.8/1000/month [UNHCR 06/02/96].
Overall, despite low levels of wasting, this population
is at high risk due to the presence of micronutrient deficiencies (category I in
Table 1).
Repatriation of these refugees is continuing slowly, and there are currently approximately 50,000 refugees from Myanmar remaining in Bangladesh. It is estimated that the repatriation process will be completed in 1996. Food supplies to the remaining camps continue to be adequate and nutritional status of the population appears stable [UNHCR 16/11/95].
There are approximately 52,000 refugees from Rakhine State, Myanmar remaining in Bangladesh. Repatriation is continuing although on a smaller scale than was seen earlier in the year. This is mainly reported to be due to a slow down in clearance of refugees for return by the government of Myanmar. It is hoped that the rate of repatriation will increase after the monsoon season, but there is some concern that the overall programme will take longer than originally planned [IFRC 12/07/95]. Food supplies to the remaining camps continue to be adequate and nutritional status of the refugee population appears stable.
How could external agencies help? Future support
for NGOs may be needed if programmes continue longer than planned due to a
lengthier repatriation process.
Repatriation to Myanmar is continuing, with an average of 15,000 people being repatriated per month in early 1995. By May, the number of people repatriating monthly had decreased substantially to just over 1,000 people and there were approximately 59,000 refugees remaining in Bangladesh [IFRC Mar 95, UNHCR 21/06/95].
The food and nutrition situation are described as normal and
satisfactory. The crude mortality rate in May was 0.29/10,000/day and the
under-five mortality rate was -0.63/10.000/day. Both these rates are within
normal limits [IFRC Mar 95, UNHCR 21/06/95].
Repatriation to Myanmar is continuing with almost 15,000 refugees voluntarily returning in February bringing the total number repatriated since September 1992 to 167,000 people. Returnees are given a 60 day food ration at the repatriation centre before departure to the village of origin. At the end of February 1995 almost 84,000 refugees remained in Bangladesh [UNHCR 16/03/95].
During February full general rations were distributed to remaining refugees with the addition of fish and blended foods. The numbers of children in selective feeding programmes in the camps decreased slightly during February and crude mortality rates measured in February were 0.3/10,000/day and the under-five mortality rate was 0.54/10,000/day. Both these rates are considered well within normal limits. Reviewed data for the whole of 1994 indicated that wasting rates amongst the refugee population were 7.2% [UNHCR 13/02/95].
There is still a reported shortage of funding for non-food
items for food-for-work projects which are planned for the current dry season as
part of the repatriation and reintegration programme. It is during this period
(November 1995-May 1996) that the bulk of returnee reintegration is envisaged
[WFP 16/02/95].
Repatriation to Myanmar is continuing for the refugees in Cox’s Bazaar, Bangladesh. During January over 19,000 refugees repatriated leaving just below 100,000 refugees in remaining camps. As a result of repatriation many camps are being closed [UNHCR 07/01/95].
Information on the remaining refugees in Bangladesh indicate a
stable and satisfactory situation (category IIc in Table 1). The crude mortality
rate in December was 0.02/10,000/day and the under five mortality rate was
0.04/10,000/day which are both very low. Approximately 13% of children are
registered in supplementary and therapeutic feeding facilities [UNHCR
7/01/95].
There are no new reports on the approximately 190,000 refugees from Myanmar in Bangladesh. It is assumed that repatriation is continuing and that this populations not currently at heightened nutritional risk (category IIc in Table 1).
The number of refugees from Rakhine State in Bangladesh decreased to just over 190,000 at the end of July. Large scale repatriation is now underway because of the “positive environment for repatriation on both sides of the border” [UNHCR 16/08/94].
The crude mortality rate for the month of July was 0.26/10,000/day and the under-five mortality rate was reported as 0.45/10,000/day. Both rates are within normal limits [UNHCR 16/08/94].
How could external agencies help? Ensure supply
of fortified blended food in the general ration and monitor its consumption at
household level.
The number of refugees from Rakhine State, Myanmar in Bangladesh remains fairly stable at just under 200,000 people. Reconstruction of the departure/reception facilities for repatriation that were destroyed by the cyclone in May is said to be virtually complete repatriation, which had been taking place on a small scale (i.e. 444 people in June) is increasing in volume over the summer (i.e. 4,000 in July) [UNHCR-a 30/06/94, WFP 5/08/94].
Food distributions to the fifteen camps and three transit centres are said to be regular with some minor disruptions due to inaccessible roads. The content of the ration is, however, of some concern. Blended foods were discontinued in the general ration in April due to unavailability and are not expected to become available before September or October. Sugar distributions were also temporarily discontinued due to a lack of this commodity. Efforts were made to redress the caloric shortfall by supplying an additional quantity of oil and lentils to the ration although this will not have replaced the amounts of micro-nutrient that would have been supplied by CSB [UNHCR 30/06/94]. As it is highly likely that micronutrient deficiencies still exist in this population, particularly angular stomatitis which was widely reported in early 1994, (see RNIS #5), the reduced quality of the current ration could exacerbate levels of deficiency.
A nutritional screening conducted after the cyclone in May showed 13.5% of the children were wasted and subsequently enrolled in either supplementary or therapeutic feeding programmes. This represents a slight increase over the 11.9% wasting measured before the cyclone. The crude mortality rate for June was 0.29/10,000/day and the under-five rate was 0.59/10,000/day. These mortality rates are considered normal for the region [UNHCR-a 30/06/94].
How could external agencies help? Donors should
support efforts to provide micronutrient fortified DSM in the general ration.
There should be careful monitoring to ensure its proper use at the household
level and that the incidence of diarrhoea does not increase once it has been
introduced into the general rations a result of poor preparatory
practices.
Towards the end of 1991 the Rohingya Muslim minority in Myanmar Rakhine state began arriving in South East Bangladesh. By June 1992 the refugee population had reached 250,000. This population was distributed between 15 camps in Cox's Bazar District which is a disaster prone area with regular flooding and occasional cyclones.
Within a short period of time data indicated that the population were experiencing a nutritional and health crisis as crude mortality rates as high as 2.1/10,000/day (7 times normal) and under five mortality rates of 5.6/10,000/day were being recorded. Nutritional survey data established wasting levels as high as 26.6% with 8.6% severe wasting [UNHCR 28/05/92]. Surveys also showed high levels of night blindness (1.2%) and angular stomatitis [H. Keller Jun 92].
By early 1994 the total refugee population had decreased to just under 200,000, mainly due to repatriation. At that time, the health status of the refugees had improved considerably. Crude mortality rates were recorded as 0.26/10,000/day and the under-five mortality rate was 0.33/10,000/day. These rates are comparable to those in the host community. However, angular stomatitis was still being seen amongst the population so that a decision was taken to increase riboflavin (B2) intake by adding fortified dried skimmed milk (DSM) to the supplementary feeding programme ration.
Most recent reports from two camps (total population of 32,000) indicate the continuing existence of riboflavin deficiency. Preliminary calculations, based on established requirement guidelines, estimate that the food basket, which is based upon parboiled rice, provides less than 50% of riboflavin and less than one third of vitamin C requirements (FAO). It is highly likely that other micronutrient deficiencies are also present, but are not being detected at the moment. SCF is currently exploring ways to address these deficiencies [SCF 6/06/94].
Voluntary repatriation is now a main focus of the refugee programme, although some questions remain as to security in Myanmar [SCF 6/6/94, UNHCR Dec 93]. However, early in May a cyclone caused extensive damage to the camps and dock area that was to be used as a point of embarkation for the repatriation programme. The reception centre in Myanmar was also completely destroyed. These have now been reconstructed and it is hoped that repatriation will now begin in earnest. A medical screening is planned for all departing refugees in the hope that those who are nutritionally and medically vulnerable will be identified and followed up once they have returned to their village of origin [UNHCR-a 6/05/94, UNHCR 31/05/94, UNHCR Dec 93].
How could external agencies help? Donors should support efforts to provide micronutrient fortified DSM in the general ration. There should be careful monitoring to ensure its proper use at the household level and that the incidence of diarrhoea docs not increase once it has been introduced into the general rations a result of poor preparatory practices.
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