When people are displaced from their homes and sources of livelihood, especially in poor countries, they rapidly become extremely vulnerable to malnutrition, ill health, and dying. Indeed, not only are the refugee and displaced populations the most vulnerable to malnutrition in the world today, but they are beginning to form a substantial proportion of the total numbers malnourished. The situation today shows a quantum shift from that of only 20 years ago: numbers involved are at least an order of magnitude higher, and now increasing rapidly and seemingly inexorably. Before reporting on the nutrition of refugees and displaced populations, a brief description of the population itself is needed.
The world was very different 20 years ago when the institutions intended to help with forced migration were established. The cold war was at its height, and decolonization far from complete. Political pressure in Eastern Europe, and conflicts associated with decolonization, were two of the main causes of involuntary migration (Newland, 1993, p12). But under these circumstances, it was both clear when people became refugees - crossing well-defined boundaries - and the situation which they fled, while often oppressive, was not usually one of chaos and famine. There were generally 1 -2 million refugees at any one time. Today, by far the most common cause of involuntary migration is war, often civil war, and cross-border refugees are often only one part of the overall displaced population - the others, often the majority, trying to survive as "internally displaced". Thus the distinction between refugee and internally displaced populations has become less clear, and in terms of nutrition they both face somewhat similar problems. Together, these populations now total more than 40 million worldwide.
In terms of the severity of the problems, there is also a discontinuity, not only in nutrition. Now the armed conflicts from which people are trying to escape can devastate whole economies and totally disrupt livelihoods of entire nations. They are leading to the highest rates of mortality measured in recent times, and generating famines.
The numbers of refugees reported by UNHCR is shown in Figure 1. This shows a remarkable take-off in numbers from around 1975, moreover this is not apparently related to any change in reporting or definition (UNHCR, pers comm). Data on refugees and internally displaced people for the Africa region alone show that over the past 24 years doubling time may have been as little as six years - a rate of increase of 12% per year (Payne, 1994). Recently in countries ranging from Ethiopia and Malawi to Pakistan and Iran, the refugee population rose by hundreds of thousands, or in the case of Iran, by millions. Although there is less certainty about the exact number of internally displaced in the world, it is certain that there are more internally displaced than refugees and that the trend in numbers has mirrored that of refugees.
Figure 1. Trend in the Global Numbers of Refugees 1960-1993.
Sources: 1960-1992 Data - UNHCR (1993), 1993 Data - UNHCR (1994)
The ACC/SCN in 1992 focussed attention on the serious problem of malnutrition amongst refugee and displaced populations, in a statement endorsed by the ACC (the Executive Heads of all UN Agencies) (ACC/SCN, 1992), and proposed some specific actions. Among these was enhanced monitoring of the nutrition of refugees, and in early 1993, a consortium of UN, bilateral and non-governmental agencies (through the ACC/SCN's Group on Nutrition of Refugees and Displaced People) helped to launch a series of two-monthly reports, referred to as the Refugee Nutrition Information System. Through these reports the SCN aims to raise awareness of the problem, and in particular to provide regular information to those who can respond, in the UN system and in governmental and non-governmental organizations. Much of the data in this section derives from these reports1 (ACC/SCN, 1993/4). A description of the indicators is included in each RNIS report, and reproduced in the box opposite.
1 Funding support for RNIS reports is gratefully acknowledged from CIDA, NORAD, UNHCR, USAID (United States Agency for International Development, Bureau for Global Programs, Field Support and Research, Office of Health and Nutrition and the Bureau for Humanitarian Response under The Food Security and Nutrition Monitoring [IMPACT] Project, Contract No. DAN-5110-C-00-0013-00.), and WFP, as are inputs in kind from UNICEF and Save the Children Fund, UK. UNHCR kindly provided most of the maps used, some of which are reproduced here. Agencies contributing information to the RNIS reports include: AICF, Amar Appeal, Amnesty International, CAMA, CARE, CDC, CONCERN, UN/DHA, FAO, GOAL, Iraqi Civilian Aid, ICRC, IFRC, LSHTM, MSF-Belgium, MSF-CIS, MSF-France, MSF-Holland, MSF-Switzerland, OXFAM, SCF-UK, UNHCR, UNICEF, WFP, WHO, and WV.Estimates as of end-1993 are that there are 16.4 million refugees and at least a further 25 million internally displaced people in the world. Trends in numbers of refugees by region from 1980-1993 are given in Figure 2. As of end-1993, some 6.4 million were in Africa, 5.2 million in Asia, and 2.6 million in Europe2. Numbers in the other regions were much lower: 1-3 million in North America, 126,000 in Latin America, and 50,000 in Oceania. The fall in numbers from end-1992 to end-1993 globally (see Figure 1) and by region end-1991 to end-1993 (see Figure 2) is largely in Asia, mainly due to decreased numbers of Afghan refugees in Pakistan and Iran, and Iraqis in Iran.
2 Data are available from relatively few sources. Generally, refugee statistics are taken from UNHCR (1993, 1994). Data on displaced populations are taken from Bread for the World (1992), US Committee for Refugees (1994), Newland (1993), MSF (1992, 1993). Additional sources are given in the text and under the figures. Data on Africa from mid-1993 onwards are taken from RNIS (ACC/SCN, 1993/4); the numerous sources given in these reports are not generally repeated here.This overall population of more than 40 million refugees and displaced people is equivalent to a medium-sized country, it would be among the largest in Africa - Ethiopia, the second largest, is around 55 million. Estimates of numbers of refugees and displaced people by region are given in Table 1.
This population has some of the highest rates of malnutrition and mortality ever seen. Only recently, mortality rates of 80 times normal were reported in Somalia (CDC, 1992), and wasting prevalences of more than 40% in Sudan, Angola and Liberia, for example. In the one month from 14 July to 14 August 1994, ten percent of the population that fled to Goma in E. Zaire died, some 50,000 deaths. Widespread outbreaks of micronutrient diseases such as scurvy, beri-beri, and pellagra have also regularly been reported amongst refugee populations over the past fifteen years.
Figure 2. Trends in Numbers of Refugees by Region (millions) 1980-1993 (December each year)
Note: Figure 2 does not include data for North America, Latin America, and Oceania, where there were recorded to be less than 1.5m refugees throughout the time period 1980-1993.Sources: 1960-1992 Data - UNHCR (1993), 1993 Data -UNHCR (1994).
