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)

% Acute
Malnutrition
(95% CI)  
% Severe
Acute Malnutrition
(95% CI)  
Crude Mortality
(/10,000/day)  
Under 5 Mortality
(/10,000/day)  
Measles immunisation
coverage (%)*
Kabul
4.2 (2.6-6.5)   0.5 (0.1-1.8)   0.49   0.63   84.6
Shadayee camp
4.0   0.4   0.3   0.9   69.5
Maslakh camp
2.8 (1.4-4.3)   0.5 (0.0-1.1)   0.3   0.8   90.1


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)

Survey Area   Date   % Acute Malnutrition (95% CI)   % Severe Acute Malnutrition (95% CI)   Crude Mortality (/10,000 /day)   Under 5 Mortality (/10,000 /day)   Measles immunisation coverage (%)
Northern Shamali - southern Pansheer   08-03   18.5
(16.1-21.2)  
2.3
(1.2-4.2)  
0.24   0.74   80.7
Southern Kapissa   08-03   14.5
(11.5-18.1)  
1.0
(0.4-2.6)  
-   -   83.8
Kabul city   08-03   8.1
(5.8-11.2)  
1.1
(0.4-2.7)  
0.47   0.59   90.1

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)

Household food security
  • Food distribution
    • 2,000 Kcal, 16% protein, 19% fat
    • Regular monthly distribution
    • Some families, arrival after March 2002, are not registered
    • Trade of distribution cards
    • Free bakery services provided in Shelmann and New Shamshatoo
  • Market availability
    • Shops selling vegetables, fruits and meat available at camp level
  • Sources of income
    • Depending on the camp; for example: daily work in brick factories
      or shop in bazaars, carpet weaving in New Shamshatoo camps
    • Very few work opportunities in Shelmann camp
  • Assets
    • Distribution of a basic set upon arrival (tents, mattress, blankets
      and kitchen set)
    • Monthly distribution of charcoal and soap stopped in March 2003
    • Ad hoc distributions of clothes, shoes…

Public health

  • Health care
    • Basic Health Units in each camp
    • Referral system to hospitals
  • Nutrition care
    • Screening for malnutrition in the BHU
    • Supplementary feeding in five camps (interruption between August
      2002 and April 2003 because of a lack of food)
    • No reference for the treatment of severe malnutrition
  • Water
    • Availability of drinkable water of more than 15 l/person/day, meeting
      the minimum standard
  • Sanitation
    • Availability of one latrine/household in most of the camps, meeting
      the minimum standard
    • Washing areas available
    • Collection of waste water
  • Hygiene and health education
    • Widely dispensed through home visiting or sessions

Social and care

  • Availability of community services (social mobilization, skills development,
    protection…)
  • Availability of schools
  • Child feeding practices
    • Introduction of food at 1-4 month age: 9%; 4-6 month age: 56%;
      more than six months: 35%

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)

Better-off (may be able to cope without food distribution)
  • At least three workers in the family
  • The household is supported by people working outside the camp
  • Represents 20% of the families in New Shamshatoo, 10% of the
    families in Shelman

Middle wealth group (manage to have a decent life, could hardly
cope without humanitarian assistance)

  • One or two workers in the family
  • Represents 60% of the families in New Shamshatoo, 50% of the
    families in Shelman

Poor (completely dependant on aid)

  • No regular worker in the family
  • Represents 20% of the families in New Shamshatoo, 40% of the
    families in Shelman

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)

   Acute malnutrition (%) (95% CI)   Severe acute malnutrition (%) (95% CI)   Oedema (%)   Measles vaccination coverage* (%)   Under-five mortality rate (/10,000/day)
Dara 1, Dara 2, Rhogani and Landi Karez camps   4.5 (2.8-6.9)   1.3 (0.5-3.0)   1.0   75.8   0.7
Mohamed Khail and Latif Abad camps   3.7 (2.2-6.0)   1.1 (0.4-2.7)   0.7   83.3   0.3

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)

Food intake*
Sources of food
75% from the food distribution
20% (22%) from the market (At the camp shops for the
majority of people interviewed)
3% (5%) from loans/charity
Number of meals/day
3 meals 70% (87%)
2 meals 30% (13%)
Food consumed beside the general food distribution
Fresh vegetables: 97% (100%) of the interview families
Meat: 30% (78%) (in average once a month)


Diseases
Most common illnesses are respiratory infections (33% of
the consultations) and diarrhoea (10%).

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.

Afghanistan

La situation reste tendue en Afghanistan où les agences humanitaires sont de plus en plus prises pour cible. Une étude a mis en avant le fait que le rapatriement massif des réfugiés en 2002 aurait été trop rapide, les réfugiés ne trouvant pas des conditions de vie décentes à leur retour. La situation alimentaire s'est améliorée par rapport à 2001, essentiellement dans le nord-ouest du pays, alors qu'elle est restée stable ou s'est légèrement détériorée dans le sud (voir carte). Les besoins en aide alimentaire varient selon les régions et sont particulièrement importants dans le sud du pays (voir carte).

 


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)

   Number
March   122,000
April   298,000
May   413,000
June   292,000
July   303,000
August   197,000
September   107,000
October   49,000
November   15,000
December (as at 24 Dec)   7,000

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)

Type of programme   Beneficiaries   Number of people
Food   Isolated rural populations (including returnees and IDPs) Vulnerable returnees and IDPs in accessible areas Vulnerable population in Urban centres   1,700,000
Shelter / Non food items   Returnees and displaced Urban destitute cases Extremely vulnerable cases (handicapped, elderly)   72,000-500,00
The Kuchi   The Kuchis nomads   300,000-400,000

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)

Acute malnutrition   7.0 %
Severe acute malnutrition   0.7 %
Crude mortality rate   0.4/10000/day
< 5 mortality rate   1.21/10000/day

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)

Number of children   MUAC1 < 11 cm   MUAC < 12.5 cm
1685   0.7%   16.2%

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
Afghanistan

Des incidents de sécurité se produisent toujours en Afghanistan. Dans certaines régions, des persécutions ethniques forcent des populations à fuir ou les empêchent de se réinstaller ; environ 724,000 personnes seraient toujours déplacées. Depuis mars 2002, 1,8 millions de réfugiés seraient revenus en Afghanistan. Les retours ont fortement diminué dans les derniers mois de l'année, probablement en raison de l'hiver. Un plan spécial a été mis au point afin d'aider les populations vulnérables durant l'hiver. Il inclut une distribution de nourriture pour les populations vivant dans les zones rurales isolées, les populations urbaines vulnérables et les personnes déplacées ou rapatriées, ainsi que la distribution de matériel devant aider les populations à se protéger contre le froid (voir tableau). Cependant, à la fin de l'année 2002, ce plan n'avait été que partiellement mis en place. Des milliers d'Afghans s'étaient installés dans des camps à la frontière avec le Pakistan, dans le dis-rict de Spin Boldak du côté afghan et dans la zone de Chaman du côté pakistanais, lorsque le Pakistan avait refusé l'entrée de nouveaux réfugiés en février 2002. D'après une enquête réalisée en septembre 2002, la situation nutritionnelle dans les camps situés en Afghanistan était acceptable, alors qu'elle était plus préoccupante dans les camps situés au Pakistan. De plus, il semble que la mortalité aie augmenté chez les enfants depuis le début de l'hiver. Une enquête réalisée dans la plaine de Shamali et dans le sud de la vallée du Pansheer a montré une situation nutritionnelle préoccupante, bien que meilleure qu'en août 2000 (voir graphique) ; cette zone avait particulièrement souffert durant la guerre civile. Plusieurs enquêtes réalisées dans le nord du pays ont montré une situation nutritionnelle moyenne.

 


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

Afghanistan

La situation sécuritaire reste instable avec de nombreux combats sporadiques entre les forces gouvernementales et certains seigneurs de guerre. De plus, un attentat à Kaboul a fait plus de 20 morts et une centaine de blessés et le président afghan a essuyé une tentative de meurtre.

Environ 1,8 millions de réfugiés sont retournés en Afghanistan, principalement du Pakistan (voir tableau), excédant grandement les estimations faites par les agences humanitaires. La plupart des réfugiés reviennent en ville et particulièrement à Kaboul, même s’ils n’en sont pas originaires. Cet afflux rend difficile la prise en charge de ces populations et les rapatriés vivent souvent dans des conditions difficiles, qui risquent de se dégrader encore durant l’hiver. L’évaluation des récoltes et des besoins alimentaires pour 2002-2003, réalisée par le PAM et la FAO, estime les besoins en céréales à 467 725 tonnes devant bénéficier à environ 6 millions de personnes (voir tableau). Les récoltes de 2002 ont généralement été bien meilleures que celles de l’année passée. Il semble par contre que jusqu’à 60% du bétail ait été décimé pendant les années de sécheresse. Une enquête nutritionnelle à Kaboul a révélé un taux de malnutrition de 11,7 %, incluant 1,6 % de malnutrition sévère, le taux le plus élevé jamais constaté à Kaboul depuis 1995 (voir graphique). Plusieurs facteurs peuvent expliquer ce phénomène. D’abord, cette enquête a été réalisée au mois d’août, période où les diarrhées sont les plus fréquentes. De plus, les conditions de vie à Kaboul semblent défavorables, avec une augmentation du coût de la vie de 30% depuis le début de l’année, incluant une augmentation du coût du logement. Une évaluation au centre d’accueil des rapatriés à Kaboul a d’autre part montré que 20% des enfants mesurés étaient malnourris; ceci est difficile à expliquer car les taux de malnutrition des populations réfugiées au Pakistan étaient plutôt faibles. La situation des populations rapatriées, en particulier à Kaboul, est préoccupante (catégorie II). Les programmes visant à améliorer leurs conditions de vie, doivent rapidement être renforcés, surtout durant l’hiver. D’un autre côté, une enquête nutritionnelle réalisée en juillet, après la récolte de blé, dans la province de Faryab, a révélé une prévalence de malnutrition aiguë assez faible, de 6,3 % dont 1,3 % de malnutrition sévère. Par contre, les taux de mortalité étaient assez élevés.

De nombreuses déficiences en micro-nutriments ont aussi été mises en évidence, en particulier des carences en Iode (voir tableau) et vitamine C. Des campagnes de distribution de vitamine C dans les zones isolées seront mises en place durant l’hiver.

 


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 Charak district of Sar-e-Pol that showed an estimated prevalence of malnutrition of 3.6 % (W/Ht <-2 Z scores and/or oedema), including 0.6 % of severe malnutrition (W/Ht <-3 Z scores and/or oedema) (ACF 30/03/02). The low levels of acute malnutrition are surprising given the extent of the food crisis in the area, the dependency on food aid and the findings of previous surveys and assessments in the area. However, the results appear to be born out by the mortality rates from the survey, which estimated CMR as 0.55/10,000/day and under-five mortality as 1.31/10,000/day. These both remain below emergency thresholds. The survey points to a number of factors including the very strong coping strategies practised in the area. The survey also points out that the last full nutrition survey, showing a poor situation, was conducted in August 2001, during the period when diarrhoeal morbidity is at its highest. There is a large seasonal variation in nutrition rates strongly linked to diarrhoea. It is likely that the poor food security of the area and the inevitable summer increase in malnutrition will lead to an increase in malnutrition rates over the summer.

Western Afghanistan

The situation in Western Afghanistan remains extremely precarious largely as a result of drought and insecurity. Many of the small-scale farmers in the area have been particularly badly affected and the emergency needs of both non-displaced and displaced populations are high. UNICEF and CDC recently conducted a nutrition survey in Maslakh camp, near Hirat, which has seen unprecedented numbers of people seeking shelter and assistance over the past few years. This number has grown enormously over the past year and today Maslakh is the largest IDP camp in Asia and Europe (UNICEF/CDC 04/02). The survey indicated that the estimated prevalence of acute malnutrition (W/Ht <-2 Z scores and/or oedema) was 2.9 % including 1.2 % of severe malnutrition (W/Ht <-3 Z scores and/or oedema). These prevalences are extremely low, particularly given the current situation, and in fact are not significantly different from the standard reference population (UNICEF/CDC 04/02). The survey also measured mortality and found that the crude mortality rate over the previous four months was 1.5/10,000/day and the under-five mortality was 6.1/10,000/day. The mortality figures are extremely alarming as they are above emergency thresholds and, in the case of the under five mortality, very greatly so. The main causes of death were determined to be watery diarrhoea and pneumonia, with malnutrition reported to be an aggravating factor among 51.4 % of the total deaths and 46.9 % of the under-five mortality (UNICEF/CDC 04/02).

The very high under-five mortality rate could be masking a more serious nutritional crisis in the under- five population, however other information on the nutritional situation in the camp would seem to indicate that malnutrition is not a widespread problem. The prevalence of micronutrient deficiencies was deemed not to be a problem of public health importance and the prevalence in women of reproductive age was also not seen to be greatly elevated. The main cause of both morbidity and mortality seems to be preventable communicable diseases, which would indicate that the camp suffers from an extremely poor public health environment (UNICEF/CDC 04/02). This is particularly concerning given the upcoming diarrhoeal season.

Southern Afghanistan

Almost one half of Afghanistan’s IDPs live in Southern Afghanistan, with the majority being drought displaced. A large proportion of these come from the Ethnic Kuchi population, traditionally nomadic pastoralists whose livelihoods have been decimated by the drought and conflict. Many of the IDPs and returnees are concentrated in camps in the south of Kandahar province. This includes about 40,000 people waiting in the Cha-man ‘no man’s land’ area, hoping to cross into Pakistan. They have been refused entry and it is hoped that they will be relocated to about 10 community-based settlements in Kandahar province (WFP 31/05/02). There are also estimated to be about 44,000 IDPs in five camps at Spin Boldak. The situation in the Spin Boldak camps is currently uncertain due to the withdrawal of the main NGOs from the camp. The UNHCR has stepped in for a period but suffers from its own funding constraints. The hope is that many of the camp residents will return to their areas of origin but many feel currently unable to do so as a result of continuing insecurity and loss of livelihoods. It has also been noted that there is considerable persecution of ethnic Pashtuns, which make up the majority of the IDPs in the south, and they are unlikely to return until it is clear that they are able to do so safely (UNHCR 26&06/02). The RNIS has not received any recent nutritional reports on the area but the nutrition situation is thought to be precarious.

The Iranian government finally closed the two IDP camps of Mekaki and Mile 46 in Nimruz province on 8 May 2002. The camps had been just one kilometre inside the border with Iran and were established because Iran would not open its borders to Afghans seeking refugee status. At their height, the camps housed approximately 10,500 people. The IDPs have since returned to their places of origin.

Afghan refugees in Pakistan

Years of conflict and drought have driven many Afghans to seek refuge in Pakistan in search of food and employment. This led to a total caseload of in excess of 2 million Afghan refugees in the country. Some of these refugees are based invarious camps in the North West Frontier Province(NWFP), particularly around Peshawar, as well as in Balochistan. Many more are dispersed around the country in various cities living independently or with urban host families.

The recent military action within Afghanistan resulted in further influxes of people into the country and UNHCR estimated that upwards of 250,000 people entered the country in the period after 11 September 2001. However, dramatic changes in the situation in Afghanistan have led to an unprecedented return of both old and new refugees. It is currently estimated that 1,038,000 refugees have been officially assisted to return since the beginning of 2002, with a further 180,000 returning spontaneously (USAID 03/07/02). As of 1 June 2002, UNHCR reported that there were 271,062 refugees in camps, with 146,735 in the Balochistan area and 124,062 in the NWFP.

MSF conducted a nutrition survey in the Roghani refugee camp in the Chaman area of Pakistan, close to the Afghan border. The camp is one of 5 camps opened in November 2001 and was officially closed in December 2001 when capacity had been reached with a total population of 17,112. The survey estimated that there was a prevalence of acute malnutrition (W/Ht <-2 Z scores and/or oedema) of 7.1 % including 1 % of severe malnutrition (W/Ht <-3 Z scores and/or oedema). This prevalence is not indicative of a major nutritional problem in the camp and is comparable to other surveys done in Afghanistan at around the same time. The needs of the population within the camp were relatively well catered for and refugees received a regular and adequate food ration of 2428 Kcal along with essential non-food items, access to medical care and water and sanitation. The CMR was estimated to be 0.35/10,000/day and the under-five mortality 0.68/10,000/day. Both these mortality rates are below emergency thresholds and reinforce the impression that the situation within the camp remains under control (MSF-H 12/01/02).

Further nutritional surveys were recently conducted by UNICEF/UNHCR/PDH in April and May 2002 in the camps and urban areas in the NWFP. The NWFP has sheltered a large number of Afghan refugees since at least 1978 and it was expected that in excess of 600,000 new refugees would enter the region after 11 September 2001. However, it was estimated that 138,000 had crossed the border by late December 2001 (UNICEF/UNHCR/PDH 05/02). A total of nine new camps were erected in response to the new influx and to house relocated "old" refugees. The first survey assessed refugees living in camps and estimated that the prevalence of acute malnutrition was 4.7% (W/Ht <-2 Z scores and/or oedema) including 0.7 % severe malnutrition (W/Ht <-3 Z scores and/or oedema). CMR was estimated at 0.27/10,000/day and under-five mortality at 0.61/10,000/day. Both the prevalence of acute malnutrition and the mortality rate are not greatly elevated and do not indicate a particularly concerning situation. However, it is important to note that the refugees remain largely dependent on food aid and food purchase as they have no access to land for cultivation or livestock. Wage labour was the most common form of income generating activity and this has proven to be extremely seasonal.

The next survey was conducted amongst refugees in urban communities and estimated that the prevalence of acute malnutrition was 7.7 % (W/Ht <-2 Z scores and/or oedema) including 1.3 % of severe malnutrition (W/Ht <-3 Z scores and/or oedema) (UNICEF/UNHCR/PDH 05/02). The CMR was 0.21/10,000/day and the under-five mortality was 0.55/10,000/day. Again, the prevalence of malnutrition and the mortality are not above emergency thresholds. In general, the urban communities can be assumed to have slightly greater prospects for income generation. The surveys indicated that the incidence of diarrhoeal disease was high in the study population and that there was a problem of inadequate feeding practices that was directly linked to cases of malnutrition in young children. The overall conclusion from both surveys is that the level of malnutrition was not unusually high for the time of year and was unlikely to deteriorate in the near future (UNICEF/UNHCR/PDH 05/02).

Overall

The overall situation within Afghanistan remains extremely precarious with continuing drought conditions and an apparent increase in insecurity, despite the creation of a fully functioning Afghan government. Acute food insecurity continues to be a problem in many areas of the country and humanitarian needs will remain high for some time. IDPs and non-displaced populations, as well as returning refugees, are considered to be acutely vulnerable (category II). In general the nutrition situation is not critical, reflecting the robustness of current coping mechanisms and the magnitude of assistance that has been supplied. However, it is likely that there will be a seasonal increase in malnutrition over the summer months in line with the diarrhoeal season. As a result, the situation requires careful monitoring.

Recommendations

From the UNICEF/UNHCR/PDH survey of refugees living in camps and urban host communities in NWFP of Pakistan May 2000

  • Conduct a Knowledge, Attitude and Practice (KAP) study on breast-feeding and weaning to address inadequate infant feeding practices.
  • Implement essential water and sanitation activities to address issues of poor hygiene in the camps.
  • Strengthen the existing nutritional surveillance programme, including the continuation of growth monitoring beyond one year of age.

From the ACF survey in the Panjsheer valley and Shomali Plains, April 2002

  • Strengthen the referral system between clinics and feeding centres through staff training.
  • Improve the outreach programmes and health screening for remote households.
  • Implement a distribution of iodised salt.

From the UNICEF nutrition survey in Maslakh camp, Herat, April 2002

  • Further investigations are needed into the prevalence of diarrhoea and ARI.
  • All wheat flour distributed should be fortified with iron.
  • Adequate preventive and curative health services should be available and accessible in areas of return of IDPs.
  • There is a need for better mortality and morbidity surveillance.

From the ACF survey in Sang Chark district, Sar-I-Pul Province, March 2002

  • Conduct training for midwives and TBAs and on health and hygiene promotion.
  • Introduce a nutritional surveillance system in health centres.
  • Improve water and sanitation infrastructure in health centres.
  • Distribute wheat seed for the coming October planting season.

From the ACF survey in Mazar city, March 2002

  • Continue monitoring of the nutrition situation, particularly with the onset of the diarrhoeal season.
  • Improve the use of maternal and child health services, in particular for per-natal care, immunisation and the treatment of childhood disease.
  • Introduce Cash for Work or Food for Work activities targeted at vulnerable families.
  • Improve the water and sanitation infrastructure.

 


RNIS 36/37, April 2002

Afghanistan Region

For decades Afghanistan has suffered from the effects of environmental, political, social and economic hardships brought on by an interplay of conflict, destructive political processes and natural disaster. This has led to the breakdown of basic infrastructure such as health and education facilities, as well as transportation and trade networks, and has led increasingly to the impoverishment of large portions of the society. The situation has worsened over the past three years as a result of a wide scale drought widely acknowledged to be the worst in over thirty years. The drought has compounded the effects of years of insecurity and impoverishment, and has resulted in a very profound deterioration in the humanitarian situation within the country. The result for many has been the breakdown in normal patterns of coping and an increasing reliance on unsustainable crisis coping strategies. As a direct result, there has been an ever-increasing reliance on external assistance for many poor Afghans. One example of this has been the number of people displaced both within the country and externally to neighbouring areas. Afghanistan has the world s largest refugee community with an estimated 3.6 million living in Iran, Pakistan and other neighbouring countries (UNHCR 02/10/01).

The chronic crisis in Afghanistan was further compounded by fears of retaliatory action, by US led forces, following the terrorist attacks in the United States on 11 September 2001. This resulted in huge movements of population both within the country and to neighbouring countries, in addition to the withdrawal of all foreign humanitarian staff. This greatly complicating the delivery of much needed assistance. The ensuing American led military campaign began on 7 October 2001, targeting both the Taliban authority and the Al Qaeda network. Given the scale of emergency prior to the military campaign there has been considerable concern over the fate of nearly nine million Afghans, including over one million internally displaced, all deemed to be acutely food insecure and in dire need of lifesaving humanitarian assistance (UN 01/02).

Recent events

The situation has changed enormously over the past months since the beginning of the military campaign. The Taliban began to collapse in November 2001 with the key towns of Mazar-e-Sharif falling on 9 November2001, Kabul on 13 November 2001 and the southern Taliban stronghold of Kandahar on 7 December 2001 (USAID 19/04/02). International humanitarian agency staff began to return on 17 November 2001 (WFP 23/11/01) enabling the scale of the humanitarian operations to increase considerably. The political situation has further developed with the establishment of an Interim Afghan Administration at an important meeting in Bonn, Germany on 22 December 2001 (UNSC 31/01/02). The Bonn agreement also led to the establishment of an International Security Assistance Force (ISAF) to be stationed in Kabul. The ISAF reached its full operational capacity of 4,500 troops on 18 February 2002 and has been mandated to assist the Interim Authority in maintaining peace in Kabul and the surrounding areas (UNSC 15/03/02). The final stage in the development of a new Afghan government will be the convening of the Loya Jirga, or grand council, from 10-16 June 2002, where 1,450 representatives, two thirds of whom will be elected, will convene to vote in a Transitional Afghan Government (USAID 05/04/02).

The humanitarian situation

The humanitarian situation has changed considerably over the past months but remains extremely serious. The years of conflict and drought preceding the most recent crisis have resulted in the breakdown of coherent political structures, social networks and the economy. As a result, the country remains at the bottom of human development indicator tables and the ability of the population to cope with both old and new crises is considerably constrained. Basic infrastructure is almost non-existent in many areas with up to one third of the population having no access to primary health care and the remainder chronically under supplied. Afghanistan has the second highest maternal mortality rate in the world with an estimated 16,000 deaths per year due to pregnancy related causes. One quarter of Afghan children do not live to their fifth birthday and are dying from preventable causes such as respiratory infections, diarrhoea, measles and malnutrition (WHO 05/12/01). It is further estimated that only 23 % of the population have access to safe water and only 12 % to sanitation facilities. Over 50 % of the existing 3000 Km of primary road network requires rebuilding, severely limiting transportation. Afghanistan remains the country most affected by mines and unexploded ordinance (UXO) (UN 01/02). It is estimated that over 800 Km2 of potentially productive land is currently inaccessible due to mines (UNDP 15/01/02).

The drought crisis of the past three years has added to the severity of the situation, with current estimates foreseeing a further 12-18 months of drought (Feinstein 02/02). This has profound implications for the food and livelihood security of the population and is likely to mean that many will remain dependent on external assistance to meet their basic subsistence needs. The most drought-affected areas remain the rain fed areas of the north and central regions but all parts of the country are affected. It is estimated that the drought has resulted in a 50 % drop in staple grain production (UN 01/02). The drought continues to have a profound impact on the health situation in the country as people rely increasingly sacrifice hygiene practices and rely on contaminated water sources. It is important to note that the summer period is normally associated with an increase in di-arrhoeal disease and the potential for epidemic outbreaks is high. This could have serious implications for the health and nutritional status of the population.

The security situation has improved considerably as the main thrust of the coalition led military campaign is drawing to a close, ending months of acute nationwide insecurity. This is facilitating access to areas which have been previously inaccessible, however insecurity still remains and continues to pose problems of access for humanitarian agencies. One cause of continued insecurity is factional fighting between various armed groups, particularly around the cities of Gardez, Khost, Kunduz and Mazar-e-Sharif. Fighting has also been reported in the northwest and in the Kandahar area (USAID 29/03/02). This has prevented access for assessment missions to the areas and the implementation of humanitarian programmes. The continued insecurity is also restricting the return of both IDPs and refugees to their areas of origin. In Eastern Afghanistan, UNHCR has recommended that up to 18,000 Afghan refugees halt returns as a result of violence along the road from Torkham to Jalalabad (UNHCR 09/04/02). The continued insecurity has also been sited as a direct reason for the continued large numbers of people seeking refuge in Pakistan.

The insecurity has also led to the looting of aid and the targeting of aid workers. WFP have reported incidences of their trucks being looted and armed men have also been reported to be disrupting food distributions in Maslakh camp near Hirat (WFP 23/11/01; MSF 06/02/02). There have also been concerning incidences of aid workers being targeted directly. In February, a UNICEF employee was shot in the northern city of Mazar-e-Sharif whilst, in a separate incident, another employee in the same area was abducted (IRIN 18/02/02). The general security situation continues to be of great concern to the international community but it is anticipated that the establishment of the Interim Government will lead to a centralised and stable political structure, which will facilitate greater security and begin the task of rebuilding the country.

It is estimated that 9 million people remain acutely vulnerable within the country (UN 01/02), including 920,000 (420,000 in the south and 500,000 in the north) internally displaced (USAID 19/04/02). The majority have moved from rural areas, particularly in the north, to urban centres in search of some form of employment and relief assistance. The current situation is characterised by very large movements of population both within the country and to areas outside as people either return to their areas of origin or flee further insecurity and drought. It is difficult to know how many have fled externally, but UNHCR reports that a further 250,000 entered Pakistan since the September attacks on the US (UNHCR 19/02/02). In 2002 agencies are preparing for the return of 1.2 million people from surrounding areas, with a total of 320,000 having returned to date (UNHCR 23/04/02).

Food insecurity

The food security situation remains extremely precarious. The extremely poor humanitarian backdrop has resulted in a population that has been living in a coping economy where the aim has been to employ diverse livelihood strategies in order to mitigate the effects of living in a high risk environment (ILO 03/01). As the humanitarian situation has deteriorated, the ability to cope has been further eroded. The drought has had a huge impact on food security for the whole population as access to adequate water has become increasingly difficult. It has especially affected 85 % of the population estimated to be reliant on agriculture for their subsistence. This has made access to water a key element in food security with households having to make choices between sufficient water for survival and water for their animals and crops (Feinstein 02/02). As a direct result, many people who were formerly self-sufficient are no longer able to meet their own food needs and are being forced to rely on the market for food, fuel and income. However, as the availability of food has diminished, so too has its accessibility. This is primarily a result of the loss of income and the general erosion of livelihoods.

Some of the main coping mechanisms have been the borrowing of money on future harvests and the taxing of kinship social networks, which have traditionally ensured the redistribution of resources. There is also evidence of people turning to illicit income generating activities such as opium production. The general impoverishment of the population as a whole has meant that both debt and kinship networks are less and less accessible, particularly to those already heavily indebted. People have increasingly been forced to turn to non-sustainable crisis coping strategies. Some of these strategies include the reduction of dietary intake, skipping meals, eating poverty foods, forgoing medical treatment, and sacrificing hygiene practices. As the crisis has unfolded many have turned to selling their productive assets such as their land, remaining animals and their houses (Feinstein 02/02). This is an extreme survival strategy and although aiding immediate survival, it effectively leaves people without livelihoods. Consequently they are a good indication of the extent of the current crisis.

The immediate food crisis is likely to continue for some months. The period from April to July is traditionally seen as a hunger season, because it precedes the July harvest, and reliance on emergency food aid will be high (WFP 15/02/02). Furthermore, the harvest is expected to be poor due to drought and to the lack of access to land and crucial agricultural inputs such as seed and fertiliser. The period of most intense military action and large-scale population movement in October and November coincided with the last planting and land preparation period (RNIS #35). Whilst so much of the population remains critically impoverished there is likely to be poor accessibility to what food is available and the presence of emergency food distributions will be very important until people are able to rebuild livelihoods. The presence of insecurity is also likely to be a considerable constraint to food security. Insecurity is expected to prevent humanitarian agencies accessing some vulnerable population groups and may discourage the return of people to their lands.

The current situation does not appear to have resulted in greatly increased levels of acute malnutrition although some pockets of nutritional decline do exist. As an indicator of the current situation the use of anthropometry on the under five population has been called into question, particularly as mortality rates appear to be high and are possibly masking declining nutritional status. Several surveys and assessments have also highlighted high levels of maternal malnutrition, possibly as a result of mothers preferentially feeding their children to the detriment of their own nutritional status. Worryingly, there is increasing evidence of micronutrient malnutrition and there have already been reports of an outbreak of scurvy (vitamin C deficiency) in Ghor province in northern Afghanistan (WHO 16/04/02). This is particularly concerning as the outbreak would suggest a far wider problem of micronutrient deficiency in the area, which will have an effect on levels of both morbidity and mortality. The poor food security, the widespread water shortages and extremely poor health environment all combine to make the marginal nutritional status extremely alarming. It is likely that without considerable outside assistance, the nutritional status of large sections of the vulnerable population will continue to decline.

Vulnerable population groups

As a result of the severity of the situation many people remain vulnerable to acute food insecurity and nutritional status decline. An overview of WFP Rapid Emergency Food Needs Assessments (REFNAs) conducted in the north and west of the country indicate that all medium and poor families suffer from food insecurity, with the landless and female-headed households being the most vulnerable (WFP 04/02). Rain fed villages, where both food availability and access is at a minimum, are also acutely vulnerable and people in these areas remain almost totally reliant on food aid. IDPs and returning refugees are also vulnerable because many do not have access to land or other livelihood activities. The Kuchi nomads, many of whom have lost their livestock, which represents their main productive asset, are also acutely vulnerable. Female-headed households are also considered vulnerable because many do not have adult male household members to provide income and family support. Their vulnerability stems from their inability to access kinship and social networks which offer an essential form of assistance in times of crisis. There is also growing evidence to suggest that vulnerabilities are also falling along political and ethnic lines with Pashtun groups in some northern areas suffering from harassment and persecution. This is seen in the large number of Pashtuns currently seeking to move to Pakistan, fleeing violence in the areas from which they have been living. The Taliban were predominantly Pashtun and it is thought that this represents a backlash against associated population groups (WFP 08/03/02; 04/02).

Humanitarian response

The humanitarian response to the current situation has been enormous. In response to continued needs, the UN has released its largest ever humanitarian aid appeal of 1.8 billion dollars for 2002 (IRIN 05/03/02) and has indicated that the requirements for the next five years are likely to be 10.2 billion dollars (UN 01/02). A crucial element of the emergency response has been the provision of food assistance and WFP has done an incredible job of both maintaining and increasing the food pipeline under very difficult security and climatic conditions. WFP have brought 407,643 MT of food into the country since October 2001, 326,230 MT of which have been distributed (USAID 19/04/02). This is particularly impressive given the constraints imposed by the harsh winter conditions that have effectively cut off areas, in addition to the continuing insecurity. This has been possible as a result of cooperation from surrounding areas that have allowed multiple routes into the country to be opened using trucks, rivers and planes.

1 April 2002 saw the beginning of a new nine-month, 285 million US dollar operation for WFP, which will continue until the end of December 2002. The operation is designed to address the needs of 8.8 million people in Afghanistan. This is an increase of 2 million people from the previous six-month programme that began in October 2001 and reflects the increased needs during the hunger season until July 2002. The programme will address the immediate emergency food needs of the population but will also start to shift the emphasis of interventions from relief towards recovery. It is estimated that food requirements until the end of the year will be 544,000 MT (WFP 05/02/02). It is concerning to note that the overall cash and commodity resources remain far below the immediate requirements. WFP have announced that the appeal requires immediate funding in order to avoid a major food shortfall in June (WFP 19/04/02).

An important element of the food and nutrition response has been the establishment of a nutritional surveillance programme involving many agencies, with UNICEF taking a lead role. The aim of the surveillance is to monitor nutritional status, food security and other important indicators in order to identify and explain any deteriorating trends (SCNS 01/02). Work has already begun by UNICEF with CDC (UNICEF/CDC 03/02). Another important element has been the use of helicopters by WFP for the purpose of conducting Emergency Food Needs Assessments. Many assessment missions have taken place in the north and west of the country, allowing WFP to investigate particularly inaccessible areas and assess the true needs of vulnerable populations (WFP 07/02/02). This has greatly improved the capacity to identify pockets of acute needs requiring immediate humanitarian intervention.

WFP have undoubtedly done an amazing job of getting very large amounts of food aid into the country. However, an important issue surrounding the emergency food assistance is the apparent inadequacy of the current food ration in terms of both quantity and quality (UNICEF 05/02/02). The basic food ration consists of 50 Kg of wheat flour supplied per family, assumed to be made up of five people, to last for one month. Current international guidelines stress that the food ration for populations dependent on food aid should be 2100 Kcal with an extra 100 Kcals added for every 5 degree drop in temperature below 20 degrees centigrade (UNHCR/WFP). This would require a ration of at least 2500 Kcal for the Afghan population, particularly during the freezing temperatures of the winter period. The food ration should also supply a diet that is balanced in terms of both the major macro and micronutrients. An examination of the current ration indicates that it provides a total of 920 Kcal per person per day and does not meet the required daily intake of fat, proteins or micronutrients. This is extremely concerning given the current state of acute food insecurity and the extremely high dependence of many Afghans on emergency food assistance. The lack of fortified foods is also concerning given the increasing evidence of micronutrient deficiencies.

Another cause for concern has been the mixing of the military and humanitarian relief. In a letter to the US government, a coalition of U.S humanitarian agencies expressed their concern that the distinction between military and civilian humanitarian agencies was becoming increasingly blurred. Considerable concern was expressed over the US military s use of army personnel dressed in civilian clothes to provide relief services (USAID 05/04/02). It is felt that this compromises basic humanitarian principles of neutrality and transparency and could compromise future humanitarian relief work.

Central Afghanistan

The Central Highlands and, in particular, the Hazarajat area are considered to be particularly vulnerable to food insecurity. The traditional livelihood activities of the area have been the sale of livestock and labour, either locally or abroad. However, both of these activities have been curtailed by the drought and insecurity. The Hazara populations of central provinces, such as Bamyan, have traditionally suffered from economic, political and social oppression from the Taliban authorities and faced a series of blockades from 1996-98 (WFP 01/02). There was grave concern for the area over the winter months, as it remained physically inaccessible, with many villages lying in remote mountainous valleys. Winter temperatures are reported to have plunged to between 10 and -15ºC. Recent months have seen the return of some Hazara, but conditions still remain extremely poor with little food availability other than from humanitarian aid. Reports also indicate that up to 80 % of houses in the province have been destroyed (IRIN 18/02/02). The RNIS does not have any recent nutritional information for the area but the population is believed to remain extremely vulnerable to the effects of continued acute food insecurity and nutritional decline.

Kabul

As the capital of Afghanistan, Kabul has remained at the centre of humanitarian activity in the country. Humanitarian agencies evacuated in the days immediately after the September 11th bombings, making the continued provision of aid and control of programmes extremely difficult. Many residents fled in fear of US reprisals, with the city subsequently suffering extensive bomb damage during the US led bombing campaign., Kabul was recaptured on 13 November 2001 and humanitarian staff returned on 17 November 2001 (WFP 23/11/01). The creation of the Interim Government and the ISAF has brought some stability to the area and laid the foundations for a secure administration. However, problems with security do still exist and there have been reports of plots against the Interim government and attacks against ISAF. The security fears have implications both within the city and for other areas of the country.

The resumption of humanitarian activities in the city has resulted in continued food distributions to the population but the number of vulnerable groups remains high. UNHCR estimate that 64,750 IDPs and 41,900 refugees have returned to the city, whist a further 31,360 IDPs have left the capital (WFP 05/04/02). WFP has also restarted the women s bakery programme, which provides subsidised bread to poor female-headed households. In general, the humanitarian situation has improved, however many groups in the city remain impoverished and find it very difficult to access food sources. As a result, food aid has been an essential source of food for large sectors of the city s population. Reports indicate that people are heavily indebted and have resorted to selling essential household items to raise sufficient cash to purchase food and water. However, there is some evidence to suggest that the rates of distress sales are falling (Feinstein 02/02). Underemployment and high prices have continued to make life difficult for many impoverished groups.

For years, members of the civil service in Kabul have not received payment, leaving them extremely vulnerable as their livelihood options are greatly reduced in comparison to other groups. On 19 February 2002, WFP signed a letter of agreement with the Interim Authority to supply a monthly ration of 12.5 Kg of pulses and one can of cooking oil for 60,000 civil service employees. The rations are worth about 50 % of their cash salaries. WFP expect to extend this to other provinces where it is hoped that it will help foster stability in government structures (UN OCHA 21/02/02).

The massive destruction that the city has suffered over years of conflict has left many areas of the city in ruins with very little working infrastructure. This has important implications for the population of IDPs and residents alike. It is estimated that only 20 % of the city have access to clean water and 70 % are without regular access to water (UN OCHA 11/02/02). The poor water security and lack of adequate sanitation does raise the fear of disease outbreaks, particularly as there is normally a seasonal increase in diarrhoea during the summer months (RNIS 32/33 and 34).

Northern Afghanistan

The north is home to 30 % of the national population and has traditionally been the breadbasket of the country. The region is considered to be one of the areas worst affected by drought and conflict. The three-year drought has seen the wide scale failure of all rain fed agriculture and, as a result, decimated food production. It is estimated that production of the staple, wheat, has fallen by over 50 % since 1999. This has had very profound effects on food security in an area dependent on the sale of agricultural products as the chief source of income (WFP 01/02). As a result of acute food insecurity, many people have resorted to distress migration to find employment or food. Much of the displacement has been from rural areas to large towns such as Mazar-I-Shariff. It is estimated that there are 450,000 IDPs with a further 900,000 acutely vulnerable (UN 01/02).

The humanitarian situation is exacerbated by the continuation of insecurity in some areas between various groups. Typically this fighting has been between ethnic Uzbek and Tajik forces (AFP 17/02/02) and the relative ethnic diversity of the northern region makes the continuation of sporadic insecurity likely (Feinstein 02/02). This continues to have implications for issues of access to vulnerable groups by humanitarian agencies. The area also has a history of natural disaster. On 25 March 2002 and 12 April 2002 there were major earthquakes that caused wide spread destruction of property and loss of life (AFP 12/04/02; IRIN 29/03/02). A massive earthquake affected the same area in 1998, resulting in the death of between 10-14,000 people. This illustrates the vulnerability of the population in the north to all forms of external shock, including natural disaster.

IDPs in Mazar-I-Sharif

SCF-UK conducted a rapid MUAC assessment in Arzana and Rhor Dhor camps in Mazar-I-Sharif in January 2002. The assessment indicated that the prevalence of acute malnutrition was not above emergency thresholds but that the general public health environment of the camps and lack of access to food made the population extremely vulnerable to nutritional decline. The camps had not received food assistance for several months although a registration exercise had recently taken place. The camp occupants were undertaking petty trading activities and begging in order to raise cash for food purchases and there were also reports of the collection of wild food plants for consumption. Manure, cotton branches and roots were being collected for fuel. A retrospective mortality assessment was undertaken and under-five mortality rates did not appear to have exceeded emergency thresholds. Needs in the camp appeared high but, whilst the population remains vulnerable, it is hoped that their proximity to Mazar I-Sharif and various operational agencies will ensure that they receive important food and health assistance.

Faryab and Sar-e-Pol Provinces

MSF carried out a series of assessments in six areas of Faryab and Sar-e-Pol provinces in late 2001 and early 2002 (MSF/Epicentre 01/02). The assessments indicated an extremely serious situation where the majority of both the displaced and non-displaced had exhausted their coping mechanisms. An MSF nutrition survey in August 2001 had already indicated a poor nutritional situation with reports of extensive micronutrient deficiency (RNIS 35). A WFP food security assessment in August 2001 classified the areas as acutely food insecure, where the population was only able to cover between 0 and 50% of their annual food requirements. This highlights the nutritional vulnerability of the populations. This vulnerability has been exacerbated by insecurity, inaccessibility to these areas and harsh winter weather conditions. As a result, general food distributions have been irregular. The assessment indicated that the availability and access to food sources was extremely poor and that household food stocks were negligible. In an attempt to retain access to food sources many households have sold their livestock as well as household items, and girls were being sold for marriage at a much earlier age than is normal. As a last resort many families had turned to distress migration in search of food and employment. The population of Sar-e-Pol displaced camp grew from an estimated 15,000 in November 2001 to 23,000 in January 2002 (MSF 21/02/02).

Rapid nutrition assessments indicate that the nutrition situation is extremely poor in all areas and, although the assessment methods are not comparable with the previous MSF nutrition survey in August 2001 (RNIS 35), the assessment concluded that the nutrition situation appeared to have deteriorated. It is also worrying to note that the assessment also found indications that scurvy (vitamin C deficiency) was on the increase. This reinforces the observation that the diet is of extremely low quality and is worrying because it probably indicates a high prevalence of sub clinical deficiency, which is associated with increased morbidity and mortality. Assessments of both Crude and Under-Five mortality indicated that rates were significantly raised above emergency thresholds, again indicating the severity of the situation (MSF/Epicentre 01/02). The overall situation in the area is extremely concerning and further nutritional decline is to be expected unless additional external assistance can be provided.

North Eastern Afghanistan

The humanitarian situation in north eastern Afghanistan is precarious. It has been badly affected by drought, conflict and natural disaster and recent assessments indicate a very poor situation for IDPs, returnees and non-displaced local populations. The area is extremely inaccessible and there has been little humanitarian agency activity in many areas. Concern conducted an assessment in the provinces of Baghlan and Takhar in November 2001. The first assessment was in Khost wa Fereng in Baghlan province, where means of access is via a road that crosses a mountain pass at about 4,000 m. The population in the surrounding area is approximately 80,000 people and WFP s VAM unit has estimated that 80 % of the population face a food deficit. The assessment highlighted the vulnerability in the area, where large proportions of those questioned had very small food stocks, little access to land or livestock and very poor economic opportunities. In response, many males had left the valley in search of work, leading to a high rate of female-headed households, which represents a considerable risk factor for both food insecurity and nutritional decline. The situation was further exacerbated by a lack of access to water and the risk of decreased supplies in the coming year. Health infrastructure was also extremely poor with only one clinic in the area, inaccessible to most due to distance. Illness was considered to be a problem with reports of diarrhoea, ARIs and malaria. An examination of nutritional status indicated that prevalences were not highly elevated in the under-five population but were worryingly high amongst mothers. It has been suggested that this is a result of preferential feeding of children by mothers. This may partially explain the relatively low levels of acute malnutrition amongst children under five, however it has also been suggested that high infant and under-five mortality rates may be masking the extent of acute malnutrition (Concern 12/01).

Concern also conducted an assessment in Rustac region of Takhar province, which was the epicentre of the 1998 earthquake. The assessment revealed a very poor nutritional situation with the nutritional status of mothers being of particular concern. Very few of the households were female-headed, but the area had not fully recovered from the devastating earthquake in 1998 and the environment appeared to be extremely hostile with little visible signs of agriculture. The nutrition situation is a result of poor food security and lack of opportunities for obtaining cash income. The assessment also noted that many IDPs had started to return to the area and were being supported by the local populations. This proved a further drain on existing resources (Concern 12/01).

Merlin undertook a follow up assessment in Khost wa Fereng in February 2002 and it was noted that no food distribution had taken place since mid November 2001. The assessment also indicated that the nutrition situation was extremely poor with particularly a high prevalence of acute malnutrition amongst mothers. Crude and under-five mortality were also measured and were above emergency thresholds (Merlin 02/02). Although the two assessments used differing methodologies, it appears as if the nutrition situation had deteriorated in the intervening months. The reason for the continued decline was attributed to the lack of both availability and access to food sources. This is a result of drought, conflict and inaccessibility of the area. The lack of general food distribution is a concern. There was also a high burden of infectious disease with no access to medical services. It is concerning to note that mortality rates appear to be high and the population must be considered to be acutely vulnerable to further nutritional decline.

Western Afghanistan

The situation in Western Afghanistan remains extremely grave and has continued to suffer the effects of the devastating drought and insecurity. This has made it one of the worst affected areas of the country, with the most severely affected being the small scale farmers from drought affected rural areas in Ghor, Badghis and Hirat. The severity of the situation in many areas has resulted in the virtual depopulation of rural areas, with an estimated 400,000 displaced possibly living in and around the regional city of Hirat. As a result of the acute needs of the populations in Mazar-I-Sharif, the area has received much attention from humanitarian agencies. In January 2002, the WFP launched a major food distribution to the city, targeting 78 % of the population who received 50 Kg of wheat to last for one month (UN OCHA 08/01/01).

The IDP camp of Maslakh, some 20 Km outside of Hirat city, is the largest IDP camp in Afghanistan and was originally established by the ICRC in the winter of 2000. The International Organisation for Migration (IOM) has since taken on coordination of camp activities. The camp has received large amounts of relief assistance, with the WFP delivering 90 Mt of food aid a day to the camp. This was to fulfil the needs of an estimated population of 300,000 people. However, concern over the validity of the population figures prompted a re-registration of camp inhabitants in February 2002. The re-registration exercise indicated that the actual population figures amounted to less than half of the original number (IRIN 18/02/02). The readjustment of the population figures highlighted abuses of the registration and distribution system and the need for much closer monitoring of distributions. An MSF MUAC survey conducted in January 2001 found alarmingly high levels of acute malnutrition amongst the under-five population with a prevalence of acute malnutrition estimated at 26.4% (MUAC <124 mm) with 6.6% severe (MUAC <108 mm) (MSF-H 26/01/02). MUAC tends to give higher prevalences than Weight for Height surveys but is a very good indicator of risk of mortality and the results indicated an extremely severe situation. It was noted that weekly surveillance of the nutrition situation did not indicate such high levels and mortality in the camp remained low. The explanation for the high levels found in the survey was unequal access to food as a result of high levels of crime, corruption and ethnic tensions inside the camp. As a result, much of the food aid was not reaching those most urgently in need (MSF 06/02/02). This would seem to be corroborated by the results of the re-registration, which indicates that more than twice the amount of food needed was delivered to the camp.

The most recent developments at the camp have been the return of many of the IDPs to their places of origin. This has been facilitated by the supply of return kits to returning families. As of 14 April 2002, the IOM have reported that 20,800 IDPs have chosen to return to their places of origin (WFP 19/04/02). This represents a policy to prevent further distress migration to centres like Hirat and an attempt to support people in their own places of origin.

MSF conducted a further nutritional assessment in Shaidai IDP camp near Hirat. The camp is much smaller than Maslakh and relatively well served for health, sanitation and food. The survey was exhaustive and indicated a prevalence of acute malnutrition of 3.9% (MUAC< 125 mm) including 0.7% severe (MUAC < 110 mm). The results do not indicate a serious situation and morbidity and mortality statistics also reveal that the camp is stable in terms of both health and nutritional status (MSF 07/02/02).

Badghis

The situation in Badghis is extremely concerning and many people have left to find assistance in IDP camps such as Maslakh in Hirat. The area relies on rain fed agriculture and has suffered the failure of most food crops as a result of the drought. An exploratory mission by MSF in February 2002 confirmed that the humanitarian situation is extremely poor with the majority of people relying on donated wheat and the gathering of wild leaves to survive. Most people have also sold all valuable assets to procure food (MSF 12/02/02).

UNICEF and the Centre of Disease Control (CDC) recently conducted a nutrition survey in Badghis province to establish baseline data on malnutrition in women and children. The survey found an estimated prevalence of acute malnutrition (W/Ht < -2 Z scores and/or oedema) of 6.5% including 2% of severe malnutrition (W/Ht <-3 Z scores and/or oedema). Chronic malnutrition was also measured and the prevalence was found to be 57.5% (Ht/age <-2 Z scores) including 30.9% of severe chronic malnutrition (Ht/age <-3 Z scores). It is notable that a greater proportion of the children had severe chronic malnutrition than moderate (UNICEF/CDC 03/02). The results indicate that acute malnutrition is not an overwhelming public health problem in the area. However, the prevalence should be interpreted within the wider food security and public health context. The general food security situation in the area is known to be extremely insecure and the survey also showed that only 5.2% of households are using safe water sources. This is very probably a contributing factor to the high proportion of children reporting to have had a diarrhoeal disease in the two weeks prior to the survey. It was also noted that acute respiratory infections were common. Very few children with illnesses had been taken to health facilities and the coverage of childhood vaccination was very poor. Children were also assessed for micronutrient deficiencies and the signs and symptoms of vitamin A and vitamin D deficiencies were common. Other possible deficiencies were also noted but are difficult to confirm without biochemical testing. It was also observed that whilst breast-feeding practices were generally good, the introduction of complimentary foods was not well conducted, possibly explaining the relatively higher proportion of malnutrition in the 12-23 month age group.

Anthropometric measurements were also conducted on women of reproductive age but prevalences of acute malnutrition were not found to be greatly elevated. However, it was noted that there was a high prevalence of goitre (11.5%), indicative of iodine deficiency. This is related to the very low consumption of iodised salt and is worrying because it is associated to an increased incidence of cretinism. Crude mortality (CMR) was estimated and found to be 0.72/10,000/day and under-five mortality was 2.51/10,000/day. The CMR is not above emergency thresholds but is slightly elevated and the under-five mortality is above emergency thresholds, but not to the degree that it could account for the relatively low estimated acute malnutrition amongst children. In conclusion, the nutrition situation of the population is extremely marginal and the high rates of chronic malnutrition indicate that this has been the case for some time. The population should be considered to be extremely vulnerable.

Ghor

Ghor province has also suffered from drought and insecurity and many people are known to have left rural areas to go to cities such as Hirat in search of food and possible employment. In early March, reports were received of a possible outbreak of scurvy (vitamin C deficiency) and in response a WHO investigative team was dispatched to the area. Scurvy has been noted in Afghanistan before, with an outbreak occuring last year in Faryab province. The investigation concluded that an outbreak had occurred in the two districts visited and that a substantial number of people were affected, including a number of mortalities. Scurvy is indicative of an extremely poor diet devoid of fresh foods, particularly vegetables. This would appear to correspond to diet histories taken from amongst the affected communities, which indicate that people have been surviving over the winter months on a diet of bread and tea (WHO 16/04/02), and with observations of little food available in the market. The investigation noted that very few animals were present and that the only food available was from food distributions. It was also noted that up to a quarter of some of the villages had left the area for the camps in Hirat (WHO 16/04/02). The emergence of spring plants gives greater access to potential sources of vitamin C and a distribution of vitamin C tablets will be conducted this sentence doesn t make sense. However, the emergence of overt clinical deficiency is a strong indication of the nutritional vulnerability of the group and, without improved access to food, sub clinical deficiencies are likely to remain high and are associated with increased morbidity and mortality.

Southern Afghanistan

The preceding months have seen a general improvement in the situation in the south of Afghanistan. Pockets of insecurity still exist but, in general, the security situation is better and the higher reliance on irrigated agriculture has meant that the area is less affected by the drought of the past three years. At the end of February 2002, UN OCHA announced that out of the 300,000 people that had fled from Kandahar, an estimated 98 % had returned. Food security remains a concern but aid agencies do have access to the area and food distributions are taking place (UN OCHA 21/02/02). The south of Kandahar province, close to the border with Pakistan, has high numbers of remaining IDPs in camps such as Spin Boldak and Killi Faizo. Many are Kuchi nomads or farmers from the provinces of Kandahar, Zabol and Nimruz who have collected in displaced camps, having exhausted their coping strategies in their places of origin. Many IDPs are waiting to cross into Pakistan in the hope of an improved situation. There is a fear amongst agencies that if the drought continues many will be unwilling to return home. It is currently estimated that 250,000 people remain displaced in the south (IRIN 14/03/02). The RNIS does not have any recent nutritional information for the area.

Mekaki and Mile 46 camps, Nimruz Province

ACF conducted nutrition surveys in the IDP camps of Mekaki and Mile 46, which lie close to the Iranian border, in January 2001. The camps were established when Iranian authorities refused to open the border to people fleeing the U.S led bombing campaign. The surrounding area of Nimruz has suffered from huge reductions in livestock and agricultural output as a result of the continued drought. This has also had implications for water availability for consumption and for hygiene. The camps are well served in terms of food distribution with a well-balanced general ration calculated to supply 2427 Kcal. There is also relatively good access to water and to health services. In Mekaki camp, the prevalence of acute malnutrition (W/Ht < -2 Z scores and/or oedema) was calculated from an exhaustive survey and found to be 4.7% including 0.6% severe (W/Ht 3 Z scores and/or oedema). In Mile 46 camp, the prevalences were 4.9% acute and 0.7% severe acute. The prevalences do not indicate a nutritional problem and on 4 March 2002 the Iranian government announced plans to close the camps and begin repatriation in April 2002.

Eastern Afghanistan

The eastern region of the country remains food insecure and recent WFP assessments indicate that 46% of the population in Nangahar province will require food assistance for the next 3 months. In response, WFP is planning to use a range of food for asset creation (FOODAC) projects and general food distributions in Nangahar, Lagam and Kunar provinces (WFP 05/04/02). The area continues to receive a large number of returnees from Pakistan and other areas of the country. The large number of returns can potentially prove a problem for existing resources in the area but so far they are being assisted as they transit through towns such as Jalalabad, Assadabad and centres in Nangahar, Kunar and Lagman provinces. One of the major constraints for the returns has been the emergence of insecurity, with reports of UN staff being threatened and violence erupting along important transit roads. The tension has resulted in roadblocks and UNHCR has recommended that 18,000 potential Afghan returnees should delay their return (UNHCR 09/04/02). The RNIS has received no recent nutritional information from this area.

Afghan Refugees in Pakistan

The drought and years of civil war have resulted in many Afghans moving into Pakistan in search of security, food and employment. As a result, it is estimated that the total caseload of Afghan refugees in Pakistan is 2 million (USAID 26/04/02). The upsurge in insecurity saw a large rise in the number of people crossing the border and UNHCR has estimated that up to 250,000 Afghans entered Pakistan since September 2001 (UNHCR 12/02/02). A major issue for the humanitarian community has been where to accommodate the refugees. There has been considerable concern in Pakistan over an uncontrolled influx by Afghans into the country and as a result the border areas have remained very tightly shut, with the border crossing at Chaman being one of the only crossing points. The closures continue to affect potential refugees and there are frequently large numbers of people waiting on the Afghan side of the border for registration prior to entering the country. Despite the need to create new camps and provide for the influx of refugees, the humanitarian response has managed to address the needs of new refugees. Many of the new camps have been placed close to border areas and on 6 April 2002 there were 158,400 refugees residing in 9 camps in Balochistan. 41,000 refugees were reported as waiting to cross the border pending local authority approval (WFP 12/04/02).

The RNIS does not have any recent nutritional data from newly established camps, however PDH, UNICEF, UNHCR and Mercy Corps International conducted a nutritional survey in the long-term camps in Balochistan province in December 2001 (UNHCR 12/01). The camps have existed for some years but there has been a significant influx of new refugees since September 2001, fleeing the insecurity and drought. A previous nutrition survey in 1997 had revealed a low prevalence of acute malnutrition. However, it was felt that there was a risk of nutritional decline as a result of the extra burden on existing systems posed by newly arriving refugees. General food rations had been stopped 6 years previously. The survey revealed low levels of acute malnutrition, probably as a result of the well-established camp systems where many can be regarded as settlements. As a result, livelihood activities are well established and ongoing.

Although refugees are still trying to enter the country, there has also been a considerable repatriation movement back to Afghanistan. On 1 March 2002, a voluntary repatriation programme was established to facilitate returns and it is currently estimated that 370,000 people have repatriated to Afghanistan since 1 March 2002 (UNHCR 30/04/02). The main factors governing the decision to repatriate are security and continued drought. There has been some concern that people will not be able so survive in some areas without considerable assistance and so UNHCR is providing a return kit which includes $100 per family, 150 Kg of wheat to last for three months and some essential non food items. Poor security, particularly in eastern areas, has hampered the return of some refugees

Afghan Refugees in the Islamic Republic of Iran

Along with Pakistan, Iran has traditionally hosted the majority of Afghan refugees. There are currently estimated to be 1.5 million long-term refugees in the country. The Iranian government has taken a very strong stance on refugees over the past months. Afghan refugees have been stopped from officially crossing the border into Iran, with many staying in camps in Afghanistan situated close to border areas. However, their presence close to the border has facilitated the distribution of aid from Iran. With the change in government and improving security within Afghanistan, it has been hoped that many refugees will chose to return. UNHCR have estimated that 45,900 people have returned from Iran to Afghanistan since January 2002 (WFP 26/04/02). Some of these have been spontaneous repatriations but on 9 April 2002, a major effort to assist Afghan refugees to repatriate was started (IRIN 11/04/02). UNHCR report that 23,000 Afghans were repatriated in the first three weeks of the programme (UNHCR 30/04/02). The RNIS does not have any recent nutritional information from Afghan refugees in Iran but they are assumed to be vulnerable.

Afghan Refugees in Tajikistan

The overall humanitarian situation in Tajikistan is extremely poor as a result of the region wide drought. A recent nutrition survey by ACF indicates that the nutrition status of children under five years appears to be deteriorating when compared to similar surveys conducted in 1999 and 2000 (ACF 11/01). The RNIS will not cover the drought in Tajikistan but it will undoubtedly have an effect on refugees in the country and the ability of already impoverished local populations to assist them. A voluntary repatriation of 10,000 refugees on the Tajik/Afghan border on island # 9 on the Pyanj river began on 8 April 2002. The refugees are receiving a return package of 100 Kg of wheat flour, hygienic items and plastic sheeting and assistance to return to their places of origin (UN OCHA 12/04/02). It is reported that aid to the area will cease and that any remaining refugees will be able to access aid from the Afghan side of the border. The RNIS does not have any recent nutritional information from this group.

Overall

There has been some improvement in the overall context of the Afghan emergency, particularly with the appointment of the Interim Authority and a general improvement in the countrywide security situation. However, it is clear that acute needs still exist and that an enormous proportion of the population will continue to require assistance to meet short term emergency needs and in the long term to restart livelihood activities. Insecurity does still exist in many areas as a result of fighting between factions and pockets of resistance to the Interim Authority and coalition led troops. The continuation of the three-year drought conditions will also have serious implications for the next 12-18 months. As a result of the insecurity and drought, acute food insecurity will continue in many parts of the country and displaced and non-displaced populations should be considered to be acutely vulnerable (Category I).

In general the prevalence of acute malnutrition is not greatly elevated, although there is some evidence to suggest that there are higher prevalences amongst adult women. It is important to question whether surveys, by concentrating on the under-five population, are missing high rates of acute malnutrition. It is also important to note that rates of crude and under-five mortality appear to be elevated and, in many instances, above emergency thresholds. This could be a mechanism for skewing observed prevalences of acute malnutrition.

The food ration being supplied to many people is insufficient, a reason for great concern given the degree of food insecurity. The recorded outbreak of scurvy and other micronutrient deficiencies is a strong indication of how fragile the nutritional status of parts of the population is. Finally, it is clear that many people have resorted to crisis coping and that their current survival has taken place at the expense of their productive assets and livelihoods, where the ability to cope has turned into the ability to survive.

Recommendations

From the RNIS

  • Support the establishment of the national nutritional surveillance project.
  • Improve the general food ration to include oil, beans and fortified blended foods.
  • Support the regeneration of livelihoods by supporting agriculture and livestock and facilitate income generation.
  • Standardise the collection of nutritional data through the adoption of common methodologies, indices and cut-offs.

From the UNICEF/CDC survey in Badghis province 03/02

  • Regular supplies of food should be assured to acutely food insecure areas. One-off blanket distributions have little effect.
  • Programmes should target both mothers and children.
  • All wheat flour should be fortified with micro-nutrients.
  • The iodine intake of women should be increased, possibly with the use of iodised oil.
  • All edible oils should be fortified with retinal.

From the Feinstein food security report 02/02

  • Agencies should prepare for at least one more year of emergency assistance to Afghanistan.
  • Emergency water projects should be implemented to ensure the health and food security of poor and marginalised groups.
  • Widespread cash for work programs are needed to ensure that people can access commercial food.
  • There is a need for emergency livestock programmes that include health, water and fodder support.

 


RNIS 35, October 2001

Afghanistan Region

Following the terrorist attacks of September 11th, Afghanistan has become the focus of world attention as the target of retaliatory American air strikes against the ruling Taliban authorities and the terrorist network assumed responsible for the events of September 11th. This has very profound implications for the scale of the humanitarian emergency within and around Afghanistan and the ability of the humanitarian community to provide essential humanitarian assistance where it is most needed.

Afghans constitute the largest single refugee population in the world with an estimated 3.6 million people, representing thirty percent of the global refugee population (UNHCR 02/10/01). Large numbers of Afghan refugees have been present in neighbouring countries particularly Iran and Pakistan, as a result of more than twenty years of conflict within the country, which has left much of the state infrastructure destroyed and has brought the economy to an almost total standstill.

For a country that has consistently remained near the bottom of human development indicator tables, the past year has seen a further alarming deterioration in the overall humanitarian situation. The affects of long-term internal conflict have been worsened by three years of severe drought, claimed to be the worst in thirty years, which has resulted in the wide scale failure of much of the country’s staple wheat production. Successive years of crop failure, conflict and a critically poor economy have left many Afghans increasingly unable to meet their basic nutrition and health needs. For many, the last resort has been to use increasingly unsustainable forms of coping such as the selling of important assets. For many the final coping mechanism has been migration to areas both within and outside the country in an attempt to seek assistance and sustain themselves and their families. The most recent estimates available to the RNIS are that over one million people internally displaced in the country with at least 200,000 having crossed into neighbouring areas, although these are likely to change daily as a result of the rapidly changing context (OCHA 27/09/01).

As previously reported (RNIS # 34) the most drought affected and vulnerable areas of the country are the northern and central regions close to frontlines which are heavily dependent on rain fed agriculture. However, the mass internal displacement of population, that has occurred pre September 11th, and universally poor harvests have affected the entire country. Within this context the humanitarian community has been conducting a major aid effort hampered by increasingly bad relations with the ruling Taliban authority that has seriously hampered access to vulnerable populations. The increasing severity of the situation prompted WFP on 6th of September, to launch a new appeal for an emergency operation to address the needs of an estimated 5.5 million people for a twelve-month period. The appeal was a substantial increase over the original plans to feed 3.8 million people in the country until the end of March 2002 and reflected the urgency with which the humanitarian community viewed the deteriorating situation (IRIN 06/09/01).

Increasing numbers of vulnerable people

As a direct result of the rapidly emerging crisis in Afghanistan the numbers of people either partly or fully dependent on international assistance for their survival, has now increased by two million to a total of 7.5 million both within and outside the country (OCHA 27/09/01). Six million of these people are expected to remain in Afghanistan and 1.5 million are expected to become refugees in Pakistan and other neighbouring countries (OCHA 27/09/01). This represents almost a quarter of the entire population. Areas of particular vulnerability remain the northern and western, rain fed agricultural regions of the country such as Herat, Badhgis, Balkh and Takhar in the Taliban controlled areas and the north eastern province of Badakhstan in the Northern Alliance controlled area.

The current conflict brings new threats to those living near front lines between the Taliban and the northern alliance, particularly in the north eastern region of the country but also in Ghor and Bamian provinces in the central region. The escalation of fighting has seen a major shift in the front lines, which appear to move on an almost daily basis. The American bombing has also forced many people to evacuate the cities with WFP reporting that up to 50% of Kabul have fled the city and in Jalalabad only 20% of the population are still resident (WFP 05/10/01; 12/10/01). Over the past year, the pattern of displacement has been from badly affected rural areas to the cities, in an attempt to find work. It is therefore concerning that recent displacement is a reversal of previous trends and is taking people into already badly affected rural areas unlikely to be able to sustain the growing population.

Limited Humanitarian Access

Highly restricted humanitarian access, particularly beyond the main cities, is seriously affecting the ability to get much needed assistance to the most vulnerable populations within the country. The security situation is now critical as a result of American air strikes and an increase in ground conflict. This is causing panic and a break down of order across the country.

International UN staff were evacuated immediately following the terrorist attacks of September 11th. Increasing insecurity, has meant all international staff were evacuated from the country for a while, although some have now been able to return (IRIN 01/10/01). In their absence, international assistance programs are usually run locally by national staff, with support from neighbouring countries. However, this has been severely hampered by a break down in communications, which has also made it extremely difficult to get information on what is happening on the ground. Poor security is also preventing many national staff from working, either as a result of displacement or out of a fear of being associated with western international organisations. There appears to have been a breakdown in law and order in many areas and there are reports of the looting of both UN and NGO offices and other resources, further destroying existing agency infrastructure and their operational capacity (IRIN 19/10/01). MSF have reported that the looting of several of their compounds in Mazar-ISharif and in Kandahar forced them to suspend relief activities in six provinces for a while (OCHA 19/10/01).

Traditionally, much of the food entering Afghanistan has been trucked across the border from Pakistan and Iran but this has become extremely difficult as commercial trucks are increasingly afraid to load or unload food, to drive deep into Afghanistan or to stay overnight in cities or towns (Oxfam 17/10/01). Islamic Relief have announced that they have 1000 MT of food in Quetta, Pakistan, designated for Afghanistan but are unable to find commercial truckers prepared to carry it into the country. WFP were seriously constrained in their capacity to transport food as a result of truck shortages in September and some of October. At one point they announced that they required 190 trucks to transport the 52,000 MT they needed per month, but only had the use of 90 (IRIN 19/10/01; WFP 18/10/01). Food assistance must be prepositioned before the onset of winter, which is in little more than a few weeks, as bad weather, snow and ice will seal off roads in many areas, especially the central region. However, the magnitude of the needs compared with the volumes that can realistically be moved in the current circumstances, indicates a crisis of epic proportions is to come, much of which will unfold unseen by the outside world. This has prompted a call by a group of NGOs to have a pause in the bombing to allow humanitarian agencies to be able to access the country with much needed food aid (Oxfam 17/10/01).

Worsening Food Security

In June 2001 the FAO/WFP Crop and Food Supply Assessment mission observed that rain fed crops had almost totally failed as a result of another year of severe drought (RNIS # 34). This is particularly serious as more than 85% of the country are dependent on agriculture for their livelihoods. As a result many families are both acutely and chronically food insecure and coping mechanisms which in normal years would have allowed many to find alternative modes of generating income have been exhausted, leaving many unable to meet basic food and non food needs. A series of surveys and assessments over the last year (see RNIS 32/33 and 34) have documented increased evidence of emerging famine conditions in the country with food stocks in many areas exhausted. Some of the observed coping mechanisms have been; the widespread distress sales of livestock and other forms of household assets, a dramatic increase in the number of people taking out high interest loans, the migration of males of working age, increased consumption of wild foods and as a final resort, distress migration of entire families to areas where they hope to receive assistance (FAO/WFP 08/06/01).

Many of the observed coping mechanisms are non sustainable and whilst providing short term income and access to food, will leave families close to destitution and unable to meet future needs. The sale of livestock is particularly worrisome as livestock products, including milk and milk products, traditionally contribute to dietary diversity and improved nutritional intake. The RNIS reported on cases of scurvy (vitamin C deficiency), possibly complicated by other micronutrient deficiencies in RNIS #s 32/33 and 34. All cases of scurvy occurred over the winter months when dietary quality was at its lowest. In the current circumstances further outbreaks of micronutrient deficiencies are highly likely, with associated increased morbidity and mortality. Loss of livestock also limits access to dried animal dung which is an important fuel source. Its absence for many is likely to be critical during the sub zero temperatures of winter (Concern 09/01).

The increase in insecurity within the country has come at a time when people would normally be putting aside provisions for the winter period and planting the winter wheat crop for harvesting in May 2002 (FAO 20/09/01). Food stocks for winter are crucial because the harsh winters provide very little opportunity to acquire fresh sources of food. Living in lower temperatures increases dietary energy requirements i.e. people need to eat more food. The current insecurity has and will continue to force many people to move and disrupt what coping mechanisms remain. There are also reports that the agricultural activities that normally take place at this time of year have also been disrupted meaning that the total planted area and production of cereals will be further reduced. This will have profound implications for people’s food security for next year and is likely to mean that widespread reliance on food aid will continue for some time to come.

Particularly vulnerable groups

With the extent of the present crisis the entire population remains at greatly elevated risk but the most vulnerable remain the internally displaced. The majority of the IDPs are no longer able to cope with their situation without substantial assistance and must somehow find the means to survive during the winter months when temperatures are below zero. One such group are the Kuchi nomads who lost large numbers of livestock which are the basis of their livelihoods, providing both food and income. It is important to note that they are generally not thought of as IDPs because of their nomadic lifestyle and this has left them particularly vulnerable in the current situation. There is also concern for women and children because of the subordinate and severely oppressed position of women in Afghan society, and also because many families have lost men folk to the war and enforced conscription. Males are the major income generators in Afghanistan and severe restrictions on female work in Afghanistan make it very difficult for families without male members to sustain themselves.

Humanitarian Response

The humanitarian response to the crisis has been huge. On the 27th of September the UN launched a global appeal for over half a billion US dollars (584,035,652 USD) to deliver emergency assistance to 7.5 million Afghans deemed acutely vulnerable, both within and outside the country (OCHA 27/09/01). Central to the appeal is the figure of 7.5 million vulnerable Afghans. It is assumed that six million of these will remain in Afghanistan whilst the remaining 1.5 million will cross borders into neighbouring countries. The response to the appeal has been huge but WFP have reported that out of the 230 million US dollars they require, they face a shortfall of 97 million US dollars (WFP 02/11/01). The response has also been severely constrained by the security situation, which has made access to many areas of Afghanistan extremely difficult. With the continuation of the US air campaign and advances made by the Northern Alliance, there is a possibility that areas will start to become more accessible to humanitarian agencies. To this end WFP has developed a series of humanitarian corridors through Pakistan, Turkmenistan, Tajikistan and Iran and has increasingly succeeded in trucking aid in to many areas. The transportation of aid has grown enormously but was severely constrained for much of September. By the 29th of September there were 500 MT a day going into the country and WFP reported that a convoy had reached Kabul on October 1st, which had previously proved difficult (IRIN 01/10/01; WFP 05/10/01). For the first part of October, WFP succeeded in transporting 900 MT and estimated that it had trucked 5,000 MT of food by October 16th. October saw the capacity for transporting food grow enormously and WFP have recently reported that they are transporting 1,525 MT a day (WFP 02/11/01). On November 9th WFP reported that they have delivered 49,000 MT of food to the country since the beginning of October and over 40% of that has been delivered since the beginning of November (WFP 09/11/01). The increased capacity is a result of greater access to commercial trucks, the use of different aid corridors, the local purchasing of food. WFP has calculated that it needs to be transporting 52,000 MT of food aid per month to meet the needs of six million vulnerable people (WFP 04/10/01).

Another aspect of the food response has been the use of air dropped “humanitarian daily rations”( HDR). These are packets of energy dense food designed to meet the daily nutritional needs of a moderately malnourished individual. The HDRs have been used extensively by the American military as part of the operation Enduring Freedom’s Humanitarian Relief Mission. This has involved the “snowdropping” of the HDRs over areas of Afghanistan. As of October 16th the US Department of Defense had air dropped 397,020 HDRs, valued at 1,480,920 US dollars, into Afghanistan (USAID 17/10/01). This has been severely criticised by the aid community because the rations cannot be targeted at the most vulnerable. There is very little way of following up on their impact and most worryingly they are contributing to a link between the military action and humanitarian aid. This is likely to severely compromise the independence and neutrality of aid agencies and could affect their ability to work freely inside Afghanistan.

The humanitarian response in neighbouring countries has also suffered from poor security as a result of anti American sentiment particularly in the North West Frontier Province of Pakistan. In preparation for the influx of a possible 1.5 million refugees, UNHCR has been preparing camps along borders with Afghanistan, however these too have met with some opposition from local populations. The challenge remains to prepare sufficient sites in secure locations and with sufficient facilities to meet the needs of potentially hundreds of thousands of refugees.

TALIBAN CONTROLLED AREAS

Central Afghanistan

The central highlands and particularly the Hazarajat area have been designated as being at particular risk. OCHA have reported that security in Hazarajat is currently stable and aid offices in the region are able to function. However, the humanitarian situation in the area is deemed to be critical because the ice and snows of winter will cut off access to roads in the area in mid November. This will leave 100,000 families, who are dependent on outside assistance, without sufficient food supplies (IRIN 19/10/01). There are also reports that night time temperatures are now below zero across all high altitude areas and OCHA is reporting that there are already reports of increased rates of mortality (OCHA 17/10/01). The central region has also received a great deal of in-migration from large cities such as Kandahar and Kabul with people moving to rural areas in search of safety (UNHCR 17/10/01). This is adding to the burden of areas already impoverished by conflict and drought. The RNIS has not received any recent reports on the nutritional status of people in this region but given the severity of the situation it is almost certain to deteriorate over the winter months without sufficient outside intervention.

Kabul city

Areas both within and around Kabul have been heavily bombed and the resultant fear and chaos in the city has resulted in up to 50% of the city having fled to safer rural areas. OCHA currently estimate that there are about 100,000 IDPs and 900,000 vulnerable people within the city (OCHA 20/09/01). There is no new nutritional information, but the humanitarian situation is thought to be extremely poor.

WFP have reported that food prices in the city have risen by 30% as a result of the insecurity (WFP 2/09/01). Humanitarian activities are ongoing with the continued arrival of WFP food and the continuation of bread distributions to 51,000 families as a part of the WFP General Bakery programme (WFP 05/10/01). Medical NGOs such as ACF are also reporting that their nutrition centres are still being run by national staff (ACF 19/10/01). ACF reports admissions of acutely malnourished children to their therapeutic feeding centres were 120 in July 2001 compared to 80 in July 2000, with the major causes being attributed to the poor economic situation and the low quality food being eaten (WHO 09/01). There have been numerous reports of UN and NGO offices being looted and the WFP warehouses in the city were commandeered by the Taliban for a while raising fears for the 5,300 MT of food they contained. They were subsequently returned (WFP 19/10/01).

Eastern Afghanistan

The RNIS has received no recent nutrition information from the Eastern region. Jalalabad in the Eastern region lies close to the border with Pakistan and has been a major staging post of food and other aid deliveries from Pakistan. The UN estimates that there are currently 350,000 vulnerable people in the city (OCHA 27/09/01) and is expecting that a further 250,000 may become vulnerable. Already there are reports that many people are fleeing cities such as Kabul, Jalalabad and Kandahar seeking refuge in the Eastern area possibly as a result of its proximity to the Pakistani border and the prospect of being able to escape into Pakistan or at least be close to sources of humanitarian relief. WFP report that between 40 and 60% of the population of Jalalabad have fled the city to rural areas or to Pakistan (WFP 05/10/01). OCHA has also reported that the number of patients in rural clinics in the eastern region has doubled in recent weeks as a result of the inflow of people (OCHA 03/10/01). The continued insecurity and greatly elevated influxes of IDPs into the area are likely to increase the vulnerability of people in this region.

Southern Afghanistan

The southern city of Kandahar has been a centre for the Taliban for some time and has suffered heavily from American air strikes. It is estimated that up to 80% of the population of the town have fled to rural areas (OCHA 19/10/01). Prior to American attacks the UN estimated that there were approximately 700,000 vulnerable people including 200,000 IDPs. The number of vulnerable is likely to increase by a projected 310,000 people (OCHA 27/09/01). The RNIS has received no new nutritional information from the area but the humanitarian situation continues to deteriorate as a result of extreme insecurity, the drought and the poor economic status of many of the area’s population. Commercial activities have reportedly decreased by 90% since September 11th (OCHA 03/10/01) and the price of flour has reportedly risen by 30%, which make access to food even harder for many within the city (WFP 05/10/01). Particularly alarming is the breakdown in law and order in the city with some reports of looting. International organisations have been particularly affected and this has had severe repercussions for their ability to remain operational. The Taliban authorities in Kandahar have also told the aid community that they are not in a position to assure their safety (OCHA 17/10/01). The Taliban occupied the WFP warehouse in Kandahar and the 1640 MT that it contained along with various vehicles, all of which are currently not available for humanitarian use (WFP 19/10/01). The extreme lack of humanitarian space to address the needs of the vulnerable and the deteriorating situation makes the population of Kandahar and the surrounding area extremely vulnerable to nutritional decline and further acute food insecurity

Northern Afghanistan

The northern region of Afghanistan is made up of eight provinces and has an estimated population of over six million (ACF 0/01) and is considered to be amongst the worst affected regions in the country. The region has suffered the brunt of the drought and conflicted related insecurity and the OCHA estimates that there are 1.4 million vulnerable people including 500,000 displaced (OCHA 27/10/01). Results of a WFP survey in August and September revealed that the areas most in need of assistance were Badghis, Faryab and Ghor provinces (WFP 28/09/01). WFP has also expressed concern that at least 400,000 people are imminently about to run out of food in Faryab and Balkh provinces (OCHA 03/10/01) and is trying to get urgent food aid to the region through Turkmenistan.

- Balkh Province

It is estimated that between 15 and 17,000 families (90-102,000 individuals) are displaced within Balkh province (ACF 08/01) and this is likely to have increased. The current situation is extremely serious as a result of American air strikes on Mazar-I-Sharif and the resultant push by Northern Alliance forces to take the city. The extreme insecurity in the area is hampering aid efforts to get food and essential supplies to many thousands of vulnerable people who have become increasingly dependent on outside assistance. It would seem likely that the insecurity it also forcing further displacements and curtailing what coping mechanisms existed. On top of the fierce fighting taking place in the province, there are many reports of looting of aid agency assets and on October 19th the Swedish Committee for Afghanistan (SCA) announced the closure of its offices in northern Afghanistan after offices in Mazar-I-Sharif and Pul-I-Kumbri were looted and in one case burnt (OCHA 19/10/01). Recently, there has been a Taliban edict ordering the return of stolen property and the UN has been able to retrieve some vehicles but looting has severely constrained the operational ability of humanitarian agencies.

The food security of the area has been poor for some time and a rapid assessment by ACF in August 2001, indicated that many of the displaced hoped to generate income and improve their access to food by finding jobs within the traditionally important agricultural sector of the province and in the city of Mazar-I-Sharif.

Some of the displaced moved in with families but many moved into more than thirty spontaneous camps in the province. A food distribution was available to those in camps and provided an average of 50kg of un-milled wheat per six person family per month (a full ration of whole grain cereals is usually 15kg per person per month, or 75kg for six people). Between ten and twenty percent of the wheat would have been lost during the milling process and a further ten percent on average went toward paying for the milling process. ACF estimated that only twenty percent of families received additional items to the food basket in the form of dahl (lentils), sugar and oil. As a result, the diet of many was extremely poor in terms of both quality and quantity with many reporting that they were eating bread and water with even tea being beyond their means (ACF 08/01). For the majority of the displaced, their arrival in the camps was a result of having eroded their household assets and having nothing left with which to survive. As a result they were almost totally reliant on begging and humanitarian aid (ACF 08/01).

The RNIS does not have any nutritional surveys from this region but rapid assessments from a number of agencies indicate high levels of acute malnutrition in numerous camps (ACF 08/01). The ACF assessment also reports that micronutrient deficiencies appear to be a problem with wide scale anaemia and possible cases of scurvy. At the end of last winter MSF-B and Save the Children (See RNIS # 32/33 and 34) found numerous cases of scurvy in the area and it is extremely likely that this winter will produce even more cases. There is little access to health facilities in the area and there have been worrying reports of diarrhoeal outbreaks, including cholera, as well as widespread respiratory infections. The RNIS has not seen mortality figures for the area but agency reports indicate that they have been above emergency thresholds in many camps (ACF 08/01). Given the current insecurity, acute food insecurity of the area and dependence of many of the displaced on humanitarian assistance, the situation appears to be extremely serious and steep declines in nutritional status can be expected leading to greatly elevated morbidity and mortality.

- Faryab Province

The situation remains critical in Faryab and the latest nutritional survey information from the province is from an MSF survey in August in Qayser and Almar districts. The survey reports that a food distribution took place as well as a Food For Work program. The food distribution targeted 60% of the population, particularly vulnerable groups such as women headed households, and consisted of 50 Kg of wheat per family per month (MSF-H 06/08/01). The province has been suffering from both drought and conflict, and many people have been forced to move their families to other areas of the country such as Balkh province. The province has had two full nutrition surveys in the past year, which have both shown relatively low levels of acute malnutrition, particularly when compared to food security indicators. However the surveys have also shown mortality levels above emergency thresholds and have highlighted the presence of vitamin C deficiency (See RNIS # 32/33 and 34). The survey follows standard methodologies but was limited to villages within a four hour radius by car and donkey, from the towns of Qayser and Almar by insecurity and the rugged terrain. Because of the rugged terrain and insecurity, many areas of the country are extremely difficult to reach with any ease and this makes the implementation of a full nutrition survey in an open population extremely difficult. With clusters chosen at random it would be easily possible for a cluster to be chosen that was many hours or even days, by foot or donkey, from a logistical centre. This makes the implementation of surveys very costly in terms of both time and resources. The MSF survey illustrates the necessity of restricting the area of the survey but this does mean that some care must be taken when extrapolating the results to the wider area.

The survey estimated a prevalence of acute malnutrition (W/Ht < -2 Z-scores and/or oedema) of 9.8% including 0.8% of severe acute malnutrition (W/Ht < -3 Z-scores and/or oedema). These levels are not above alert thresholds and indicate that malnutrition is not a problem of public health significance. However, it is concerning to note that the ration of 50 Kg per family will work out at less than 10 Kg per person with no other food items included. This represents an insufficient ration and it is likely that in the absence of alternative food sources, the nutritional status of the population will decline. The crude mortality rate was estimated at 0.6/10,000/day and the under five mortality at 1.4/10,000/day. Neither of these figures are above alert thresholds but the survey authors make the point that it is likely that the most vulnerable have already left the area, possibly hiding a more serious situation. Many of the displaced have gone to Balkh province where the mortality rates have been considerably higher (MSF-H 06/08/01). The discovery of micronutrient deficiencies over last winter are a good indication of how marginal the nutrition of this population group is. The current situation in Afghanistan is likely to further compromise the nutritional status of this population and without increased assistance there is likely to be a severe deterioration in their nutritional status.

Western Afghanistan

Herat city

Herat has continued to receive some of the highest numbers of displaced with over 8,000 people arriving in camps a month. There are currently estimated to be 300,000 IDPs in camps in and around Herat city, many housed in little more than simple shelters affording very little protection from the weather. WFP has reported that the security situation is deteriorating in the region and that UNICEF and the International Organisation for Migration (IOM) have ceased all deliveries from Iran (WFP 19/10/01). The majority of the IDPs are almost totally dependent on humanitarian relief and regular food distribution have been taking place with a family ration of 65 Kg comprising of 50 Kg of wheat and 15 Kg of split peas. However, the ability of the humanitarian community to keep pace with the ever increasing numbers of IDPs has been severely constrained. The RNIS does not have any new nutrition survey information but MSF, who are running therapeutic feeding centres in Maslakh camp, have reported “unacceptable” levels of acute malnutrition and their centres saw a 3% mortality rate during July and August (WHO 09/01).

In light of the poor food security of the population, it is concerning to note that there is a grave need for sanitation, health services and shelter. Many of the camps have suffered from high rates of diarrhoea with some cases of cholera being reported. The crowded conditions and lack of adequate sanitation make the camps ideal breeding grounds for cholera infection. MSF have suggested that conditions within the camps could easily see attack rates of as high as 5%, resulting in 7,500 cases in Maslakh camp alone (WHO 12/09/01). The other great concern for the camps is the provision of appropriate shelter and fuel for the upcoming winter. Last winter saw temperatures plummet to -25 °C with more than 150 people dying in one week (WHO 12/09/01). The supply of blankets, warm clothing and fuel will be critical. There have been reports of deaths from land mines as people venture out into areas of the countryside in search of wood for fuel. There is a grave need to provide people with basic food and non food needs in order to prevent excess loss of life.

NORTHERN ALLIANCE CONTROLLED AREAS

North Eastern Afghanistan

The province of Badakhstan in the north east of the country is under the control of the Northern Alliance. The province has been badly affected by both the drought and conflict but recent reports indicate that the security situation remains relatively calm with no reported movements of population or clashes reported. The current round of air strikes against Afghanistan are focused on the Taliban and their absence from Badakhstan has protected it from bombing and has made it slightly more accessible to humanitarian organisations. However, WFP operations are being affected by a lack of commercial transportation (WFP 19/10/01). There are currently estimated to be approximately 100,000 IDPs in the province with a further 200,000 vulnerable people (OCHA 27/09/01).

In August and September 2001, Concern Worldwide conducted a nutritional anthropometric survey in several provinces in the north of Afghanistan. The survey was interrupted by the events of September 11th and the survey was halted. However, data from the Khosh valley in Badakhstan had already been collected and an analysis was possible. The survey measured the nutritional status of non displaced children under five and their mothers. The estimated prevalence of acute malnutrition amongst these children was 11.5% (W/Ht < -2 Z-scores and/or oedema) including 3.2% severe acute malnutrition (W/Ht < - 3 Z-scores and/or oedema). Maternal nutrition was measured using MUAC (< 21.5 cm) corresponding to a BMI of below 16.0 Kg/m2 and was estimated to be 21.2%. The rates of child malnutrition are slightly above alert thresholds, and the authors conclude that this was a result of an extended and severe hungry season compounded by a poor public health situation. The results of the maternal survey are alarming and were attributed to limited availability of food. They are a good indicator that coping strategies are near exhaustion (Concern 09/01). The results are considered particularly alarming because the survey came after the end of the hunger gap with the availability of the summer harvest. It is also concerning to note that the next harvest is nine months away in May/June 2002. Prevalences of diarrhoea and fever were also estimated and found to be high and significantly associated with acute malnutrition. Diarrhoea was found to be an important cause of acute malnutrition and followed a seasonal pattern with the highest prevalence being seen over the summer months (see ACF data in RNIS # 32/33).

The survey also collected information on the food economy of the area and the coping mechanisms employed by the villagers. An agricultural assessment revealed that the rain fed winter and spring wheat crops had universally failed and any harvested grain was described as poor quality. Most farmers claimed that they did not have sufficient staple food to last them through the winter and had next to no seed to plant for future harvests. A food economy analysis examined the impact of different forms of coping strategies on the ability of farmers to access food over the winter months. In the worst case scenario, 80% of families will be without access to food by January 2002 and in the best case scenario, which included relief distributions covering 22% of the annual food requirement, 50% will be able to meet their food requirements by January of next year (Concern 09/01).

There were many coping strategies employed by families but it was striking how many are totally unsustainable such as the sale of household goods, livestock and land and the use of high interest loans. It was also widely reported that there had been a reduction in food intake and in dietary variety both of which have and will continue to have severely adverse effects on nutritional status.

From informal interviews with different groups, as a part of the qualitative study, it was acknowledged that there was considerable preferential feeding of children by mothers who reduced their own intake before that of their children or husband’s (Concern 09/01). This observation can only be reliably be applied to the survey population but if it is a coping mechanism that is widely used in other areas of the country, then it would sheds some light on the relatively low levels of acute malnutrition amongst child populations that have been observed by numerous surveys across the country. The relatively low rates amongst the underfive population have been puzzling given the apparent severity of the food security situation, although few if any surveys prior to this have considered all three groups of underlying causes, including food, health and care practices. This finding clearly shows the importance of including care-giving behaviours in a nutrition survey.

Afghan refugees in Pakistan

The current situation in Afghanistan is having a huge effect on the numbers of refugees seeking asylum in Pakistan. However, even before the crisis started, Pakistan had one of the largest Afghan refugee populations in the world with over two million people. Many of these have been living in the country for a number of years in camps such as Shamshatoo, or in cities such as Peshwar, in the North West Frontier Province. Many refugees have been driven by a mixture of drought and the protracted conflict within Afghanistan which has left them unable to cope with the resultant grinding poverty and insecurity. The safety, economic opportunities and the presence of an existing sizeable Afghan community have made it an important destination for refugees. It is estimated that over 200,000 new refugees have arrived in Pakistan over the past year with 60,000 alone settling in the Jalozai refugee camps near Peshwar (WFP 28/09/01). However, as the numbers of refugees have mounted, the position of the Pakistani government hardened. The government has increasingly stated that it is unable to accept further refugees and has closed the border with Afghanistan to further refugee influxes. For much of the year it has also prevented the screening, and therefore the access to humanitarian assistance, of refugees in the Jalozai camp near Peshwar. On the 2nd of August 2001, UNHCR and the government of Pakistan signed an agreement to initiate screening of 180,000 residents in the Nasir Bagh, Jalozai and the new Shamshatoo camps in and around Peshwar (IRIN 20/08/01).

With the advent of the current crisis in Afghanistan the number of Afghans attempting to enter the country is growing by the day and the UN regional appeal for the crisis has estimated that as many as one million refugees could enter the country, fleeing an increasingly desperate humanitarian situation with Afghanistan (OCHA 27/09/01). It is extremely difficult to keep track of numbers of refugees entering Pakistan but the UNHCR has estimated that over 1,000 a day (UNHCR 15/10/01) have been finding their way across the borders and from Friday 19th to Sunday 21st of October, an estimated 13,000 people crossed the Chaman border post between Quetta in Pakistan and Kandahar in Afghanistan despite the border being officially closed. A further 15-20,000 are reported to be waiting across the border (UNIC 22/10/01).

As a result, there is tremendous pressure on the Pakistani government to open its borders and allow refugees to cross but to date the borders remain closed. In preparation, considerable effort is being put into building camps to receive possibly hundreds of thousands of refugees in extremely poor condition. In the direct aftermath of the American air strikes, efforts to identify and develop the camps were severely hindered by the security situation which saw mass anti US protests. In some cases these turned violent and resulted in attacks on various international organisations (IRIN 11/10/01). The situation has since calmed and preparations are under way to create camps for new refugees in Baluchistan province, bordering southern Afghanistan and the North West Frontier Province (NWFP) bordering eastern Afghanistan. The Pakistani government has stipulated that sites must be situated close to the border to prevent the uncontrolled entrance of refugees to the rest of the country. As a result, numerous sites have been examined and many found to be unsuitable. Some of the constraints have been a lack of proximity to water sources, the insecurity of some of the tribal areas and objections by local communities (IRIN 11/10/01). As of 19th of October, three to four sites will be ready in Baluchistan province with a total capacity of between 70-90,000 people and further sites are being prepared in the NWFP to accommodate 150,000 people (WFP 19/10/01).

A recent meeting between WFP, UNHCR and the Pakistani government has greatly clarified the refugee situation in Pakistan. The meeting agreed the establishment of eleven new sites for refugees can be opened for use with three in Baluchistan province and eight in the North West Frontier Province (UNHCR 08/11/01). The sites in Baluchistan are all near the Chaman border crossing and are expected to have a maximum capacity of 70,000 people. The meeting also agreed to include the estimated 135,000 people who have entered the country since September 11th but who have not been officially recognised. A third category of refugee to be included are the refugees currently in the New Jalozai camp near Peshwar. Many of these refugees arrived pre September 11th but have been joined by others after September 11th. The status of the camp has been in doubt and now the entire camp will be moved closer to the border (UNHCR 08/11/01). The RNIS does not have any recent nutritional information on either refugees since or before September 11th but it can be assumed that they remain extremely vulnerable.

Afghan refugees in the Islamic Republic of Iran

Iran shares the brunt of the world’s Afghan refugee population with Pakistan. Very few of the refugees live in camps and many have been resident in the country for many years. However, the Iranian government has taken an increasingly hard line on the refugees in the country and many have opted to return to Afghanistan. The border with Afghanistan currently remains closed and there are no reports of influxes of refugees. Any possible refugee influx would be likely to come from Herat where there are 300,000 IDPs in makeshift camps. Iran is an important staging point in the current Afghan crisis, particularly for getting food and other relief items into the northern region of Afghanistan and is being used as one of the major food corridors for the transportation of humanitarian aid (IRIN 08/10/01). Relief agencies are currently stockpiling food, medicines, tents and blankets in the town of Mashhad which lies close to the border, in preparation for the influx of a possible 400,000 people who may flee violence and the worsening humanitarian situation in Afghanistan (OCHA 27/09/01). The Iranian government has been loath to create camps inside Iran but have identified sites on the Iranian side of the border opposite to Afghan areas where refugees are likely to collect. Taliban officials have also just given permission to the Iranian government to set up a refugee camp at Makhaki on the Afghan side of the border. The camp has a capacity of 7,000 people and there are currently estimated to be about 600 hundred people in the camp (OCHA 22/10/01). The RNIS has no nutrition survey information on refugees in Iran but it would seem likely that the nutritional status of new refugees entering the country would be poor.

Afghan refugees in Tajikistan

Tajikistan is currently suffering from its own drought emergency and WFP has recently launched an appeal for 67,000 MT of food to cover the needs of those most severely affected (WFP 19/10/01). To date the borders with Afghanistan remain closed and the government continues to move existing Afghan refugees from the capital Dushanbe. There continues to be refugees on islands of the Pyanj river which makes up the border with Afghanistan. The refugees have been in the location for some time and numbers do not appear to have grown in recent months or as a result of wider conflict within Afghanistan. AAH-UK and Merlin are currently addressing the nutritional and medical needs of the populations and a recent AAH-UK rapid assessment survey on Island # 13 indicated that malnutrition was not a problem of public health significance in itself but that the diet quality of the refugees was extremely poor and was exacerbated by the poor health status and food security of the population (AAH-UK 03/08/01). WFP report that a recent assessment indicated a need for food assistance for between 6-8,000 people along the Pyanj river, requiring an input of 128 MT of mixed food commodities monthly. The current refugee situation in Tajikistan seems very calm but the current drought crisis in the country would make a significant influx of refugees extremely alarming and it can be assumed that they would be at high risk of nutritional decline in the absence of significant humanitarian intervention.

Overall

The situation in and around Afghanistan has markedly deteriorated over the last year. The events of September 11th and the subsequent American air strikes have resulted in a massive further deterioration in the humanitarian situation. The already harsh food security situation of last winter has generally deteriorated. Growing numbers of displaced people, combined with restrictions on humanitarian access and immediately prior to the onset of winter, is having a very profound effect on the severity of the humanitarian situation. It will also greatly affect the ability of the humanitarian community to reach and address the needs of vulnerable populations. It is feared that excess morbidity and mortality will be the inevitable result of the harsh winter and a lack of access to basic needs such as food, water, shelter and health care, unless there is a major change in the current security situation.

Those displaced by drought and conflict within Afghanistan, and to neighbouring countries, are regarded as very acutely vulnerable (category I). The plight of the IDPs within Afghanistan itself deserves special mention because of the present lack of access to many of these groups. The refugees who have entered into neighbouring countries are equally vulnerable but are potentially better off because they are accessible to humanitarian agencies. However, the vulnerability of many is likely to remain high until appropriate facilities such as water and sanitation are established in the new and proposed refugee camps that are being built along border areas. The severity of the current situation is extreme, and likely to get worse. This means that many hundreds of thousands of people will not be able to satisfy their basic needs such as food, water, shelter and health care, over the winter period and will require some form of outside assistance to survive. The scale of the humanitarian appeal has been huge, but key UN agencies are yet to have their appeals met in full. The current situation is severely constraining the ability of the humanitarian community to provide sufficient support to the enormous numbers of vulnerable. The ability to provide assistance is highly contingent on how the security situation develops and its impact on humanitarian access to the Afghan population.

Recommendations and priorities

From the RNIS

  • Funding appeals must be met in full to ensure that humanitarian needs are addressed
  • Every effort must be made by operational UN agencies to coordinate their nutrition activities on the ground
  • Nutrition activities should be fully prioritised according to a comprehensive analysis of the needs on the ground
  • In light of the strong link, made by the media, of the US and UK government’s combination of military, diplomatic and humanitarian action, humanitarian agencies must endeavour to keep their neutrality and independence.
  • Once security allows, assess the impact of food insecurity on all members of the household, in particular on household care-giving behaviours and also their anthropometric status.

From MSF survey in Faryab province (MSF 06/08/01)

  • Food distributions should continue and be improved in terms of both quality and quantity
  • Selective feeding capacity should be boosted and should include outreach screening where possible

From the ACF Rapid assessment report from the northern region (ACF 08/01)

  • Implement a full General Food Distribution and give people seeds and tools to facilitate planting for next years crops

From the Concern survey in Badakhstan (Concern 09/01)

  • Implement an emergency intervention to provide urgently needed food before winter.
  • Conduct a distribution of seeds prior to the planting period for spring wheat in March 2002. (It is already too late to provide for the planting of rain fed winter wheat and barley)
  • Distribute blankets and winter clothes before the onset of the severe winter weather

From Refugees International (RI 16/10/01)

  • Develop safe humanitarian corridors to get food into Afghanistan
  • Utilise the existing cross border trade routes. Central Asian traders are famously flexible and could be used to deliver aid. Monitoring mechanisms would have to be put into place
  • Initiate an air service into some Afghan cities using planes from neutral countries
  • Planning for air drops should go ahead as they may prove the only feasible way of getting food into the country

 


RNIS 34, July 2001

Afghanistan Region

The humanitarian situation in Afghanistan continues to deteriorate as the country suffers from the combined affects of more than twenty years of conflict and a third consecutive year of extreme drought conditions. The conflict has destroyed infrastructure and decimated the economy while the drought has caused wide scale failure of much of the staple food production in the country. The chronic nature of the twin insults has systematically eroded people’s capacity to cope with the deteriorating situation. A recent FAO/WFP Crop and Food Supply Assessment Mission has estimated that even with the current planned food aid, the country can expect a cereal deficit in excess of one million tonnes, and warns of an extremely serious situation (FAO/WFP 08/06/01).

As previously reported (RNIS 32 and 33), within the Taliban controlled parts of the country the most affected areas seem to be the northern and western rain fed agricultural regions such as Herat, Badghis, Balkh and Takhar, where much of the displacement has taken place. Displacement continues to take place both within the country and to neighbouring countries such as Pakistan, Iran and Tajikistan. Current estimates of internally displaced put the number at over 700,000 people (IRIN-CA 22/06/01) with the majority making their way to urban areas having exhausted all possibilities in the rural areas. It has been estimated that with the current rate of displacement the number of internally displaced will top one million during the course of 2001 (IRIN 11/06/01).

Humanitarian Access

The onset of the summer has also seen renewed fighting between Taliban government forces and the Northern Alliance, with up to 60,000 people displaced as a result from the Hazarajat region alone (UN OCHA 24/05/01). The heightened insecurity has resulted in a decrease in access to some areas, particularly the north where the UN has been forced to curtail trips outside of main towns (WFP 18/05/01). Humanitarian access has been further affected by a marked deterioration in relations between the Taliban authorities and the international community. There are reports of increasing harassment of staff from international organisations and violations of the Memorandum of Understanding that exists between the UN and the Taliban. Some of the harassment includes the arrest of essential medical staff, the cancelling of UN flights and the cutting of electricity to the UN office in Jalalabad (IRIN 06/06/01). As relations have deteriorated there have been fears of a forced withdrawal of international staff from the country.

Food Security

The FAO/WFP Crop and Food Supply Assessment mission observed in June this year that rain fed crops (wheat and barley) had almost totally failed as a result of another year of severe drought. The mission estimated that the rain fed wheat production was 40% less than even last years low output (FAO/WFP 08/06/01). The mission also reports that Afghanistan’s extensive system of irrigation is also suffering from the decreased precipitation and that years of war have rendered up to 30% of all irrigation systems useless. In a country where as much as 85% of the population depend on agriculture for their livelihoods, the continued failure of crops has destroyed crucial own production of food and left many without their normal purchasing power, effectively blocking access to food through markets. The severity of the situation has left many without the means to cope and the mission reported mounting evidence of pre famine indicators such as reduced food intakes, collapse of purchasing power, decimation of livestock herds, depletion of personal assets, rapidly increasing food prices and the ever swelling number of destitute and displaced (FAO/ WFP 08/06/01). Concern has also been expressed for the future food production prospects with a reported decrease in the area of land planted for the next harvest. This is a result of continued insecurity, the chronic drought and the lack of seeds or other agricultural inputs. This has severe livelihood implications for huge amounts of people, many of whom have failed to cope and have abandoned their land to move to the cities.

The poor state of the Afghan economy has been another key factor in the deterioration of the humanitarian situation with almost no manufacturing and export sectors to speak of. In July 2000 the Taliban banned the production for opium of poppies. This otherwise positive action was taken without an offer of any alternative economic replacement crop. This has had very serious economic implications for many involved in the farming, production and trading of the crop. A great many people are dependent on opium production as a major component of their economic income and it has been estimated that the resultant loss of income from the ban has had adverse livelihood implications for upwards of 2.8 million people (FAO/WFP 08/06/01). The ban is a very significant step forward in the war against opium production. However, it has come at a time when the majority of people are at their most economically vulnerable and have no viable alternative economic means exist. FAO have pointed out that it is essential that replacement crops are made available to ensure that people do not return to opium production (FAO/WFP 08/06/01).

Particularly vulnerable groups

The Taliban have implemented strict edicts that govern the role of women in Afghan society. Unable to work or to study, women are totally dependent on the support of male relatives and particular concern has been raised over the fate of women headed households. These women have weak or non-existent links to the labour market and typically rely on charity to feed themselves and their families. However, increasingly there are fewer resources left to share and there is genuine concern for how many will be able to cope (FAO/WFP 08/06/01). A minority group that has generated considerable concern is the Kuchi, traditional nomads who follow traditional livestock migration routes in search of grazing. The drought and insecurity have disrupted the migration routes, destroyed pasture and decimated livestock herds, leaving the Kuchi not just without livelihoods but bringing to an end a traditional way of life, with the majority being forced to settle in makeshift camps along major highways (FAO/WFP 08/06/01).

Humanitarian Response

With the continuing deterioration of the situation there has been a greatly increased international awareness of the emerging crisis and increased donor commitment with greatly increased pledges. The current WFP EMOP is scheduled to finish in March 2002 but the increased demands mean that it will be exhausted in October 2001 and already a new EMOP is being drafted (WFP 25/05/01). WFP has established a considerable food pipeline and general distributions are being affected in many areas particularly where there are high concentrations of displaced people around Mazar-e-Sharif in the north, and Herat in the west. An initial strategy was to try and prevent the huge rural to urban migration and response was designed not to encourage the establishment of large camps. However, with the continued deterioration of the situation, particularly in the north of the country, more structured camps with capacities for over 5,000 families are being established in Mazar-e-Sharif in Balkh province. One of the primary reasons for this is that the host families with whom many displaced had been staying are simply no longer able to cope (IRIN-CA 22/06/01).

Central Region

There has been a significant reduction in the area planted with wheat, particularly in the east central provinces of Bamyam and Ghor. This is a result of insecurity and the poor irrigation systems (FAO/WFP 08/06/01).

Kabul City

The RNIS has no new nutrition information on Kabul. The last figures for numbers of displaced reported by WFP are from December 2000 and suggest numbers from 100-500,000 people (RNIS 32 and 33). No surveys have been conducted since October 2000, which showed relatively low levels of acute malnutrition (RNIS 32 and 33). ACF have indicated that they have seen the usual seasonal rise in malnutrition with the onset of diarrhoea during the summer months but the increase has not been greater than previous years (ACF 09/07/01).

There was a serious breakdown in relations between the Taliban authorities and WFP earlier in the year when the Taliban refused to allow WFP to employ women to conduct a survey of beneficiaries enrolled in bakery projects throughout the city. For a time it looked as though WFP would close the programmes affecting 282,000 vulnerable people, however a compromise was eventually reached. The incident sharply outlined the deterioration in relations between the international community and the authorities and raised fears of further reductions in humanitarian space (IRIN 30/05/01).

Eastern Region

The RNIS has received no new nutrition information from the eastern region but the last survey conducted in December showed uncritical levels of acute malnutrition and low mortality rates (RNIS 32 and 33). The FAO/WFP crop assessment mission indicate that the east has seen an increase in the irrigated crop area planted and that there has been an increase in wheat production, however the region continues to see influxes of IDPs and general countrywide drought conditions are likely to mean that the area remains vulnerable to continued food insecurity (FAO/WFP 08/06/01).

Southern Region

Rain fed wheat did not fair as badly in the south as in other areas but the area is considered to be a very minor producer. There is concern over the fate of farmers in the southern region who have established considerable debts as a result of the ongoing drought. As a result the UN is expecting further internal displacement as people are forced off their land. The RNIS reported 42,000 displaced in Kandahar in the last RNIS 32 and 33 and recent IRIN reports indicate that this number has increased considerably with as many as 23,000 families or 161,000 individuals currently displaced from traditional areas. The vast majority of these are Kuchi nomads (IRIN 14/06/01).

North Eastern Region

The RNIS has not received any recent surveys on the populations of the northeast but UN and NGO reports indicate that the situation remains extremely precarious. The province of Badakshan remains a front line between Taliban and opposition forces and fighting has forced many people to flee into neighbouring countries and further west into provinces such as Baghlan and Kunduz (IRIN 20/06/01). RNIS 32 and 33 reported a nutritional survey in Khodja Baodine, Takhar province which indicated relatively low prevalences of acute malnutrition but elevated mortality. Numbers in the camp have been increasing steadily with 300 families arriving in the week before the end of June this year (UN OCHA 27/06/01).

Northern Region

The northern region is arguably the area most affected by both drought and conflict related insecurity. WFP estimate that there are close to 33,000 families or 198,000 people displaced in the northern region (WFP 04/05/01) with many converging on large cities such as Mazar-e-Sharif in Balkh province in search of casual labour and charity.

Balkh Province

An estimated 14,000 families have entered Balkh province over the past six months all in search of some form of work, water and food. Balkh has always been regarded as an economic hub within Afghanistan but the pressure on resources from the influx of so many displaced is creating huge pressures for the communities already there (IRIN 21/06/01). The RNIS has no new nutrition information for the province, however a MEDAIR assessment of the Chemtal district to the south west of the province has highlighted the extremely poor situation. Access to health facilities in the region was found to be very poor with no doctors or health posts recorded. Access to food is very greatly reduced with the almost total failure of crops and with most of the livestock having been sold off or slaughtered already. Access and availability to water was highlighted as the biggest challenge to the area and coupled with the other factors the nutritional situation is likely to deteriorate (MEDAIR 07/06/01).

Faryab Province

The RNIS reported a very poor nutritional situation in Faryab province (RNIS 32 and 33) with confirmed cases of vitamin C deficiency (scurvy) and alarming crude and under five mortality rates. A recent survey in Kohistan district of Faryab province by SCF-US in April of this year indicated that although acute malnutrition was not yet a problem of public health significance with a prevalence of 7% acute malnutrition (W/Ht < -2 Z-Scores and/or oedema), including 1.1% severe acute malnutrition (W/Ht < -3 Z-Scores and/or oedema), the crude mortality rate of 2.6/10,000/day and an under five mortality of 5.9/10,000/day, were both significantly above emergency thresholds. The major cause of death for the under 5 children was measles (24%) followed by bloody diarrhoea (22%), and respiratory diseases (13.5%). The outbreaks of measles were especially worrying given the absence of health care in the district, and subsequently no routine EPI nor vitamin A distribution. The poor prospects for the next harvest, the lack of available coping mechanisms and the relatively high morbidity and reported mortality all suggest that acute malnutrition could increase substantially in the near future (SCF-US 10/04/01).

The survey reported that attempts to cope with the poor situation were almost exhausted and people were resorting to crisis strategies such as selling land, begging, taking very high interest loans or becoming displaced. The survey also reported very poor access to drinking water for almost all villages in the highlands (SCF-US 10/04/01).

The survey reported a reduction in the number of reported cases of scurvy with the peak having been in mid-December to mid-February. UN OCHA report that up to 5% of the population in affected areas had symptoms of scurvy. The presence of scurvy indicates just how poor the quality of the diet has been with people relying on tea and bread during the winter months when normally they would be eating a variety of foods including dried raisins, mulberries and tomatoes, all containing vitamin C (UN OCHA 24/04/01). The onset of summer months has seen a fall in the incidence of scurvy, with the population able to access some wild foods (SCF-US 10/04/01).

Western Afghanistan

Herat City

Herat continues to receive some of the highest numbers of displaced with between three to four hundred families arriving daily in April (IRIN 16/04/01). There are currently six camps around the city with the largest holding an estimated 120,000 people. Food distributions are ongoing with the sixth round of distributions taking place in the first week of July. However, as more and more people arrive the capacity to cope is severely strained. The need for adequate water and sanitation grows and in April there was an estimated shortfall of 2000 latrines in Maslakh camp raising fears about the greatly increased risk of epidemics (IRIN 16/04/01). In an attempt to cope with the increasing numbers a Registration Liaison Unit (RLU) has been established by international organizations to monitor and control numbers through the establishment of check posts outside of the city (WFP 22/06/01). The RNIS does not have any recent nutritional surveys from Herat but acknowledges the considerable aid effort currently being undertaken to provide the displaced with food. The sheer number of people, the poor sanitation and limited access to clean water, are extreme causes for concern and could lead to epidemic outbreaks.

Afghan refugees in Pakistan

Pakistan has been host to a sizeable Afghan refugee population for some years and as the crisis in Afghanistan continues to escalate, refugees continue to cross the border into the northwest frontier province of Pakistan, particularly around the city of Peshawar. Camps, such as Shamsha-too, Akora Khattak and Jalozai have been receiving refugees in large numbers since the beginning of the year. One of the most difficult problems facing the refugees in Pakistan is the increasingly hard line of the government. The Pakistani government has attempted to close its borders to further influxes of refugees and has sought to deport unregistered refugees in an attempt to gain some control over the huge numbers of recently arrived Afghans requiring assistance. There are estimated to be nearly 200,000 recently arrived refugees in the area (IRIN-CA 14/05/01).

The status of refugees in the camp of Jalozai has been the cause of much argument between UNHCR and the government of Pakistan who have refused to allow the registration and the systematic delivery of relief aid to more than 80,000 IDPs currently in the camp. The reason for this would appear to be the government’s determination and insistence to the international community that it is unable to provide for the refugees and that they ought to be returned and provided for within Afghanistan. This has resulted in a stalemate for much of the early part of this year. The government eventually allowed the WFP to access the camp in May to begin much needed food distributions which have continued up to the present day (IRIN-CA 24/05/01). Food distributions have been ongoing in the other camps of Sham-shatoo and Akora Khattak.

Plans for the refugees in Jalozai have developed and the government has granted permission for an official registration of the refugees to take place with a view to repatriating those that are able and moving those that are not to other camps. The screening was officially scheduled for the 21st of June but has been postponed (WFP 06/07/01).

The refugees in Jalozai are considered extremely vulnerable as a result of difficulties in access to the population. The latest nutrition survey results as reported in RNIS 32 and 33 were of concern. The RNIS does not have recent information but since the survey, general food distributions have occurred and access to the refugees has improved. However, a UNHCR report on the health of new refugees in Jalozai highlights high morbidity with respiratory infection and diarrhoea being leading causes of sickness. A heat wave has caused a number of related mortalities, however the mortality rates for both the general and under five population are within emergency thresh-olds (CMR 0.12/10,000/day and under five mortality 0.56/10,000/day) (UNHCR 15/05/01).

Afghan refugees in the Islamic Republic of Iran

Iran has been home to a huge body of long-term Afghan refugees and the last few months have seen upwards of 200,000 new refugees crossing the border into Iran. The majority of the refugees are fleeing the drought and the continued fighting. The government of Iran has expressed its concern at the numbers and the need for assistance to deal with the increased burden of refugees. An extensive registration of both documented and undocumented refugees was undertaken and the total has been given as 2.5 million, both new and old. The government has announced that all non-registered refugees will be considered illegal immigrants and will be refused the right to stay in the country (WFP 29/06/01). There is no nutritional information on the refugees in Iran but it is likely that nutritional status will decline as numbers increase without the resources to deal with them.

Afghan refugees in Tajikistan

Tajikistan has not received large influxes of Afghan refugees in the past although it is believed to be an important route for the transportation of drugs from Afghanistan via central Asia (IRIN 15/06/01). Despite the Taliban ban on opium production, considerable stock piles exist and the drug trade does still continue. The Tajik government has recently ordered all Afghan refugees out of the capital Dushanbe to outlying areas where they will be given temporary residency. Figures for the number of refugees are contested with the government claiming that 16,000 reside within the city and the Committee of Afghan Refugees claiming that there are only 4,000 with many of them being long term residents (IRIN-CA 24/05/01).

On the Afghan border there are two camps of about 12,000 Afghan refugees on two islands in the Pyandj river. Island #9 is the first camp with 9,000 people and island #13 with 1026 people. Aid to the refugees was stopped in March as a result of claims that food was going to fighters but it was resumed at the end of May after a UNHCR investigation (IRIN-CA 31/05/01).

The health and food needs of the refugees are being met and an AAH MUAC screening of all children under five years of age revealed extremely low levels of acute malnutrition in February. A more recent screening in April has revealed a slightly increased rate but still within acceptable levels. However AAH point out the deterioration in nutritional status has been rapid and there is a need to watch the situation closely (AAH 10/04/01).

At Afghan refugee camp post 13, a nutritional assessment/ screening exercise of all children under 5 years of age found that 7.8% of children between 6 months and less than 60 months were acutely malnourished (<125mm) in April 2001, as compared to 0.62% in February 2001. Although the overall rates are not alarming the rapid deterioration was cause for concern (AAH 10/04/01).

Overall

The first half of 2001 has seen the situation deteriorating within Afghanistan. The ongoing drought and fighting as well as the extremely poor economic situation in Afghanistan, has meant that many are simply unable to cope with the increasingly harsh situation. As a result internal displacement has continued and it is estimated that the number of internally displaced will reach one million this year. The RNIS does not have much new nutrition information but numerous situation reports, including the FAO/WFP crop assessment, all point towards a dramatic deterioration in the humanitarian situation with many people resorting to non sustainable, crisis coping mechanisms. For many the final option has been the abandonment of their land and the move to urban areas in the hope of obtaining some form of work and assistance. The humanitarian community has launched a considerable response to the crisis but is suffering from a reduction of humanitarian space as a result of poor relations with the Taliban authorities. Future prospects for the many displaced are extremely bleak and look set to deteriorate further. Further displacement is to be expected and a very considerable humanitarian effort is required to alleviate the crisis. Of additional concern is the general unwillingness of neighbouring countries to continue to accept and host increasing numbers of Afghan refugees within their countries, who therefore are at high/ moderate nutritional risk.

The relatively low rates of acute malnutrition in the Kohistan (Faryab Province) presents a very unusual situation of acute food insecurity, where coping mechanisms are near exhaustion, combined with outbreaks of very serious diseases like measles, which at the time of the survey were not reflected in the prevalence of acute malnutrition. This raises several questions. There is no explanation as to why nutritional status does not reflect these events; either a fall in nutritional status of the population was imminent or there was a hidden means by which nutritional status of young children was being maintained. For example, high quality or preferential care for younger children and or undiscovered food or income sources. An interesting question for the RNIS is whether adult nutritional status is similarly unaffected by the prevailing poor situation or whether it is compromised at the expense of preserving child health.

Recommendations and priorities

From the RNIS

  • Address the immediate emergency needs of displaced populations focusing on the provision of food, medical relief and water and sanitation.
  • Conduct nutritional anthropometric surveys on adults to help determine the degree to which children are being preferentially fed at the expense of adults

From the FAO/WFP Crop and Food Supply Assessment (FAO/WFP 08/06/01)

  • Rehabilitate the water supply and irrigation systems that are in a state of large-scale disrepair.
  • Supply farmers with much needed agricultural seeds.

From the SCF-US Survey Kohistan District, Faryab Province, Northern Afghanistan (SCF-US10/ 04/01)

  • Assess, monitor and respond to the short-fall in food needs (food gaps).
  • Assess the impact of the drought on coping strategies, in order to inform programming decisions.
  • Provide complimentary food items (oil, pulses and blended food) to the general ration of wheat, to help prevent further out-breaks of micronutrient deficiencies.
  • Implement emergency measles immunization up to the age of 12 years, combined with vitamin A distribution.
  • Address health needs.
  • Establish a standardised methodology for collecting and analysing data to allow for meaningful spatial and temporal comparison of data.

RNIS 32/33, April 2001

Afghanistan Region

Ongoing conflict between the ruling Taliban government and an alliance of factions drawn mainly from Afghanistan’s minority communities based in the north, has forced repeated displacement, both internally and externally, particularly to the neighbouring countries of Iran and Pakistan. The Taliban, who are drawn from the Pashtun majority, control 90% of Afghanistan. Twenty years of conflict have left the economy and infrastructure in ruins.

Afghanistan is in the grip of a third successive year of countrywide drought, which is being hailed as the worst for thirty years. The combined effects of the drought and ongoing conflict have resulted in the internal displacement of an estimated 600,000 people over the last year alone. Many of them have moved from badly affected rural areas to the large cities of Mazar-E-Sharif and Faizabad in the North, Herat in the West and Kabul and Jalalabad in the East. At least 170,000 of those displaced have fled over the border into the North West Frontier Province of Pakistan (OCHA 05/03/01).

Drought

The nation wide drought and resultant food crisis in Afghanistan has particularly affected the rain dependent farmers of the northern provinces destroying nearly all the rain fed crops and decimated livestock. The drought has been further exacerbated by a very harsh and extended winter. Estimates suggest that 12 million Afghans are affected by the drought with three to four million severely so (UN 2001). The cereal deficit has now exceeded 2.3 million tons. The next harvest is due in May to June but it is already clear that it will not meet the food needs of the people. A WFP survey conducted in 24 provinces shows that almost a third of farmers intend to plant less than half of the land they normally sow, citing lack of seeds and fear of continued drought losses as the main reasons (FAO/WFP 08/06/00; UN Inter Agency- 2001, OCHA 14/03/01 WFP 16/03/01; WFP 27/04/01).

Eighty five percent of Afghanistan’s population depend on agriculture. Land ownership tends to rest with a relatively rich elite with many of the poorer and more vulnerable groups depending on agricultural labour for an income (for example the landless, sharecroppers, and wage labourers) (FAO/WFP - 08/06/00).

The wide scale displacement is a clear indication that many people have chosen to leave the land and move to densely populated urban centres in an attempt to get casual labour work. This is a trend that is rapidly depopulating drought affected rural areas and which many agencies are currently desperately trying to prevent. There is a lack of detailed knowledge on food security at the household level but it would seem that many families rely on remittances from relatives working outside of Afghanistan, as well as the highly refined redistribution network, called zakat (FAO/WFP -08/06/00; ACF-F - 2000).

From February to December 2000, ACF conducted seven nutritional surveys among children and their mothers in the six main cities of Afghanistan. Where there were IDPs in the cities, they were included as part of the sample. These provide information on the nutritional status and also the underlying causes of malnutrition related to food, health and care. They are summarised below together with the other available reports.

Central Region; Kabul City

The number of displaced in Kabul has increased markedly since the last RNIS (No 31), from about 81,000 IDPs in August 2000, to between 100 -500,000 estimated by WFP in December, 2000 (WFP 15/12/00).

ACF have a nutritional surveillance system in Kabul city based on bi-annual surveys, and since the last RNIS have conducted nutrition surveys in February and again in October, 2000. The February survey estimated the prevalence of acute malnutrition at 2.8 % with 0.2 % severe acute malnutrition. No difference was found between the nutritional status of children of the displaced and residents children. According to ACF this represents a surprising improvement in nutritional status as compared to the past five years, which was attributed to greater economic and political stability since the Taliban took over Kabul following the Taliban conquest of the south eastern regions of Afghanistan 1996/1997. This had allowed increasing NGO activity including the reopening of 18 ACF supplementary and 17 therapeutic feeding programmes. Despite this good result, ACF expected nutritional status to decline in the summer months, as a result of a seasonal increase in diarrhoea which coincided with an increase in admissions to feeding programmes (see Figure below). By October the prevalence of acute malnutrition had increased to 8 % with 0.6 % severe malnutrition. The coverage rate of the feeding programmes were estimated was 22.2%. (ACF-F - 02/00; ACF-F - 10/00; WFP -15/12/00).

Percentage of paediatric consultations for diarrhoea in ACF Maternal and Child Health clinics, and number of admissions in SFCs between May 99 and September 2000

In February 2000, the main source of income was casual or daily labour, with more vulnerable households without an able-bodied man relying on handicrafts, processing of dried fruits, child labour and begging as the main source of labour. Other sources of income include food assistance - including WFP cereals through WFP bakeries, remittances from relatives in other regions, sale of assets, and borrowing of money (ACF - 02/00). Price of wheat and bread did not rise in Kabul City between Feb and October, 2000.

Eastern Region;

Nangahar Province, Jalalabad

Jalalabad is on the road between Kabul and Peshwar and has always been an important trade centre. This contributes to better food security, as does agricultural production from the rural hinterlands, market gardening, and good job opportunities in agriculture, commerce or with international organizations. Health services are also more available from NGOs or the government. However, ACF report that the health environment was extremely poor - with narrow streets, overflowing open drains, piles of litter etc. Families hygiene practices also seemed to be extremely poor. A large influx of IDPs from rural areas increased population density.

A recent ACF-F nutritional from December 2000 estimated the prevalence of acute malnutrition at 5.8 % with severe malnutrition at 0.3 %. The CMR for the preceding month was estimated as 0.57/10,000/day and the under five mortality as 0.58/10,000/day. Both rates are below acceptable limits (ACF-F - 12/00). The CMR is approximately two times normal rates, while the under five mortality is within the expected range.

Southern Region;

Kandahar

Latest figures put the IDP population at 42,000 people. ACF-F conducted a nutritional survey in Kandahar city in May 2000 and estimated the prevalence of acute malnutrition at 5.7 % with 0.7 % of severe acute malnutrition. MSF-Holland have nutritional programmes in the province and are conducting systematic nutritional screening during measles vaccination (see table below). The RNIS does not have dates for the screening but they are believed to be from this year.

Results of nutritional screening during measles vaccination campaigns

MUAC

<125 mm

<110 mm

Number of children

Maywand

9.3 %

2.0 %

10,920

Damam

8.5 %

3.1 %

6,903


Although these are not survey results, the large sample sizes provide a preliminary indication of the nutritional status of the population although there is no indication how good the coverage of this screening exercise was. The supplementary feeding centre had only 135 admissions in five weeks of being open. The anthropometric results are at odds with food security indicators (wide scale displacement, high food prices and a saturated labour market) which suggest a serious food crisis (ACF-F - 05/00; MSF-H - 02/01).

North Eastern Region;

Badakhshan province, Faizabad

Faizabad, the regional capital, is reportedly one of the most food insecure cities in the country. The province is relatively remote and is in general a food deficit area, and vulnerable to food shortages, irregular food supplies, and high prices. The price of wheat in Faizabad, has reached an all-time high and few can afford it. Terms of trade between wheat and labour deteriorated since September 1999 (ACF - 09/00).

The latest reports suggest that there are 44,000 displaced in the area. In September 2000 ACF-F estimated the prevalence of acute malnutrition at 8.9 % with severe malnutrition of 0.6%. The same survey also estimated a CMR of 0.68/10,000/day and an under five mortality rate of 1.1/10,000/day (ACF-F - 09/00) The under five mortality rates are above normal for Asia (0.7/10,000/day).

Takhar province

MSF-Holland conducted a nutritional survey in Khodja Baodine, Northern Takhar province, in November 2000 amongst displaced children, and The survey estimated the prevalence of acute malnutrition at 5.9 % with 0.3 % severe acute malnutrition. A retrospective mortality survey showed a CMR of 1.66/10,000/day and an under five mortality rate of 5.97/10,000/day. The anthropometric results do not indicate a serious nutritional problem, but the under five mortality rates are several times normal (0.7/10,000/day), and easily exceed the threshold of 2.0 for ‘an emergency out of control’. However, MSF indicates states that more recent prospective mortality monitoring of the same area has not revealed such catastrophic figures (MSF-H - 11/00).

Northern Region;

Balkh Province, Mazar-e-Sharif

Mazar-E-Sharif is the main city in the north of Afghanistan. Although traditionally a rich trading and business center, since 1997 when fighting broke out between rival opposition forces, the economic situation in Mazar has taken a massive downturn. The Taliban took the city in 1998. Based on figures compiled by UNCHS/HABITAT ACF estimate the population at 467,000 (ACF -11/00). The areas around Mazar have been badly affected by the drought or by fighting in neighbouring provinces, hence the influx of an estimated 30,000 IDPs in the last four months.

Acute and severe malnutrition by ACF survey, Afghanistan, 2000 (with 95% confidence intervals)

WFP bakeries have provided bread for 20,000 families in Mazar. Other food assistance projects include a ‘pasta’ project run by Habitat, whereby low income women produce pasta in a wheat or cash or food for work framework, and this pasta is then distributed to over 2000 vulnerable families. Habitat also run a school feeding programme, where 1500 children are given breakfast and food-for-work programmes for some 1,500 men over 2 months (ACF -11/00).

A nutritional survey by ACF-F in November 2000 estimated the prevalence of acute malnutrition at 5.6% with 0.6% severe acute malnutrition. Eight percent of the sample were IDPs, although there was no statistical difference between the nutritional status of IDPs and residents. The survey also estimated a crude mortality rate of 0.68/10,000/day and an under five mortality rate of 0.96/10,000/day, both of which are approximately normal. Measles vaccination coverage was estimated at 18% by card and 41.9% by history. ACF report that the general health environment in Mazar is better than other Afghan cities, with less rubbish heaps, clearer waste water channels and fewer livestock defecating in the streets, where children play (ACF 11/00).

A more recent survey by MSF-Belgium, which focused on the IDP population, estimated the prevalence of acute malnutrition to be between 10-13 % although the RNIS has no further information regarding the survey methodology employed. These results have caused some controversy, as they would appear to be at odds with the acknowledged food crisis.

Faryab Province

MSF-Belgium undertook a rapid nutritional assessment in south east Qaisar, Faryab province at the beginning of the year, in response to reports of cases of severe malnutrition in the MSF supported clinics in Qaisar town. Eight severely affected villages were chosen, in which 554 families were living. A systematic MUAC screening of 697 children under five indicated a prevalence of 13.6 % acute malnutrition (less than 125 mm) and 3.4 % severe malnutrition (less than 110 mm). A CMR of 2.1/10,00/day and an under five mortality rate of 5.2/10,000/day indicated a very alarming situation. Villagers presented a dire picture of exhausted coping strategies; livestock was sold or died, valuables had been sold, young men had left for the cities or to Iran, daughters were sold and families were surviving on wild foods (MSF-B -01/01)

A recent rapid assessment by SC-US in March in Kohistan District, has further highlighted the plight of people in the district. This has destroyed the primary source of income for the area and left people highly dependent on a series of coping mechanisms that have severe long term consequences. These include the selling of primary assets such as animals and land. For many the primary source of income is from borrowing cash and food against their expected harvest in July. The survey also showed clear evidence that children were being preferentially fed over adults. The most concerning discovery of the assessment was overt micronutrient deficiency in the form of scurvy (vitamin C deficiency). People presented with blackened legs, gum swelling and bleeding and joint pain. There was also presentation of angular stomatitis suggesting a complex of vitamin deficiencies. Anecdotal reports from the population suggested that the outbreak had been higher two months before the assessment but that the people had resorted to wild foods that may contain some vitamin C. MSF-B have conducted follow up assessments and have provided a clinical confirmation of scurvy in the village of Khaja Khan (MSF-B 03/01; SCF-US 03/01).

Western Afghanistan;

Herat city

Herat city has received among the highest numbers of displaced. Current estimates put the total of IDPs at 150,000 individuals, with 1,500 arriving each day. In the first half of December 130 families were arriving daily. A recent WFP/UNHCR/IOM food security assessment was carried out to identify the reasons for the massive out migration from Badghis and the initial observations indicate very poor crop prospects with an acute shortage of water forcing people to travel up to 15 km a day to meet their daily needs. The wide scale sale of productive assets such as livestock was also noted.

ACF-F conducted a nutritional survey in July 2000 and estimated the prevalence of acute malnutrition at 7.3 % with severe malnutrition at 0.5 %. The survey also showed a retrospective CMR of 0.98/10,000/day and an under five mortality rate of 3.2/10,000/day. The under five mortality rate exceeds the threshold of 2.0 for a very serious situation. The survey report remarked on the wide disparity in economic wealth within the sample, but did not disaggregate the data for IDPs. MSF-Holland, has conducted nutritional screenings using weight for height in Maslagh camp which is for new arrivals. Based on two screening exercises of 460 and 157 children, they found prevalences of acute malnutrition of 5 % and 6.5% and severe acute malnutrition of 0.7 % and 0 % respectively. The reports are currently unavailable to the RNIS. Despite obvious acute food insecurity in the area the anthropometric data does not yet point to an acute food crisis (ACF-F -07/00; MSF- -02/01; WFP-05/01/01; 27/04/01).

Opposition held areas:

Panjshir Valley and Shamalle Plain

The Panjshir valley is one of the strongholds of opposition forces to the Taliban. Food supply and trade are limited by the front line to the south, the harshness of the climate, and the tense political position in the north.

The most recent nutritional survey was conducted by ACF-F in August 2000 in the southern part of the valley and the northern part of the plains. Fourteen percent of the sample were displaced people. The survey estimated a prevalence of acute malnutrition of 18.2 % and 2.8% severe malnutrition. The crude mortality rate was 2.3/10,000/day and the under five mortality rate of 5.5/10,000/day, which are several “times greater than normal” and well above the rates classified as “an emergency out of control”. ACF attribute this to the high seasonal incidence of diarrhoea amongst the population, with half of the reported mortalities being from diarrhoea. (ACF-F -08/00). Water and sanitation are reported to be deplorable, with the river as the main source of drinking water.

Measles vaccination was 6.8% (by card) or 22.6% (by history) and partly attributed to the proximity of the frontline limiting the activities of aid agencies. The very low measles vaccination coverage and high incidence of diarrhoea are major cause for concern, and most likely contributing to the exceptionally high mortality. ACF have two supplementary feeding centers in the Shamalle Plain and three in the Panjsheer Valley. Given the difficulties of access the low coverage of selective feeding programmes at 17.3% was expected (ACF - 08/00).

The part of the sample drawn from Charikar District in the Shamali plains had a significantly worse nutritional status (6% severely malnourished as compared with 2% malnourished). Only 2.7% of mothers had a BMI less than 16.0 (chronic energy deficiency grade III), which is similar to other survey results in Afghanistan. The frontline in the Shamalle Plains, combined with the tense political situation in the north, and the harsh climate restricts the supply of food and other products (ACF - 08/00). These results are by far the highest found in any ACF nutritional surveys in Afghanistan since 1995 (ACF - 08/00).

Afghan refugees in Pakistan

Pakistan has long been host to about 2.1 million Afghan refugees, most in the North West Frontier, Baluchistan, Sind and Punjab provinces. The largest concentration of the most recent refugees is around the northern town of Peshwar, with reports of 170,000 having crossed into the country since September last year when a Taliban offensive in north east Takhar province displaced upwards of 70,000 people. Many of the most recent arrivals are in camps such as Shamshatoo and Akhora Khattak. There are an estimated 72,000 people in the transit camp of Jalozai, however the speed of the influx suggests that some may be from the resident refugee population in the surrounding area. As a result of the substantial increase in numbers of Afghan refugees entering the country, the government of Pakistan has halted efforts to officially register the refugees and is insisting that they should return to Afghanistan, leaving them temporarily in limbo (WFP-05/01/01; WFP-02/02/01; OCHA-01/03/01)

The speed and rate of the influx has threatened to overwhelm resources and there has been much concern over the fate of Afghan refugees. The RNIS has received some survey results from the camps near Peshwar. An MSF-Holland survey from Shamshatoo camp, in November 2000, estimated the prevalence of acute malnutrition at 7.7% with 2.0 % of severe acute malnutrition. A later survey in February found a prevalence of 6 % acute malnutrition and 1.1% severe but the details and methodology of the survey are unavailable to the RNIS. The results do not indicate a nutritional emergency but given the likelihood of further influxes as the spring thaw opens fresh routes into the country, it is important to follow the situation closely (MSF-H - 11/00).

The Government of Pakistan’s insistence that the 70,000 IDPs in Jalozai camp are not registered as refugees and forced to return to Afghanistan, has hampered efforts to supply relief in the camp. Rapid nutritional screening based on MUAC was conducted by MSF-Holland during mass measles vaccination campaigns, and found an estimated 16.4% acute malnutrition (based on a MUAC <125 mm) and 5.6% severe acute (based on a MUAC <110 mm). Given the general food distribution in the camp the situation would appear very serious and is likely to deteriorate further (MSF-H - 02/91).

Afghan refugees in the Islamic Republic of Iran

There are an estimated 1.4 million Afghan refugees in the Islamic Republic of Iran and some 580,000 Iraqi refugees. An agreement on February 14th, 2000 was made on a joint programme between UNHCR and the Government of the Islamic Republic of Iran. The joint programme is designed to facilitate the voluntary repatriation of refugees or to normalise the status of those with legitimate claims of asylum. The drought and continued conflict in Afghanistan have prompted an influx of new Afghan refugees into the country, which has prompted attempts by the government to close the border areas with Afghanistan. There are no recent reports on the nutritional situation of refugees in the country but it seems likely that numbers will continue to grow and the vulnerability of refugees would seem likely to increase.

Tajikistan

Tajikistan has not received large influxes of Afghan refugees in the past. On the border between Afghanistan and Tajikistan there are 10,000 Afghan refugees stranded on two islands in the Pyandj river, Island #9 with 9000 people and Island #13 with 1026 people. The lack of access to the refugees and the supposed poor conditions has rasied concerns. An assessment from January 18 - 21 reported that the situation seemed to have stabilised and that families had been able to bring assets with them. Relief operations were commenced but have subsequently been suspended for fear of supporting armed fighters within the population. The RNIS has no nutritional survey information for the population (OCHA - 13/03/01)

Overall

IDPs in Afghanistan are extremely nutritionally vulnerable as a result of a severe drought situation superimposed on continued conflict and a state of near economic collapse in the country. In general the food security indicators show a very serious nation wide food crisis, with particularly worrying rises in the cost of basic foodstuffs and the almost total saturation of labour markets in cities. The appalling food security situation is not reflected in rising prevalences of acute malnutrition in the cities at least, and several reports suggest a more in-depth and localised analyses of food security is needed. In addition many of the surveys were based on representative samples in cities, of which only a relatively small proportion were IDPs. Little information is available about the differential nutritional vulnerability of the population. The IDPs in the Panjshir valley and Shamalle Plain are at very high nutritional risk (category I). Of particular concern is the recent discovery of micronutrient deficiencies that highlights the poor nutritional quality of the diet in many regions. It is important to note that nutritional data on the under five population in cities seems to be a very poor predictive indicator of acute food insecurity in Afghanistan.

There is less information on the nutritional situation of Afghan refugees in other countries in the area, but the high rate of influx and a perceived reluctance on the behalf of recipient governments to address the increasing burden of the refugees, means that the situation should be followed closely.

Recommendations and priorities:

From WFP and FAO reports

  • Provide assistance to drought affected populations to prevent further deterioration of the situation.
  • Focus assistance on rural areas in an attempt to prevent further mass depopulation of rural areas and attract people back to the land.

From the ACF Afghan city surveys (ACF-F 2000)

  • Collect detailed information on food security at the level of the household and to identify particularly vulnerable areas in cities.
  • Encourage systematic screening of children in MCH clinics.
  • Organise health education campaigns targeted towards hygiene and the reduction of diarrhoeal morbidity.
  • Encourage families to have kitchen gardens and to use the products for their own consumption.
  • Invest in water and sanitation projects.

From the survey in Panjshir Valley and Shamalle Plain (ACF-F 08/00)

  • Maintain existing feeding centres and open new where necessary.
  • Continue nutritional surveillance through regular village screening
  • Improve access to Primary Health Care.
  • Improve the water and sanitation situation
  • Focus on the promotion of food security through the distribution of seeds and FFW programmes.

From the survey in Khodja Baodine, North Takhar Province (MSF-H11/00)

  • Continue close monitoring of the nutritional situation.
  • Gather food security information for the area.
  • Lobby for sufficient and regular general food distributions.

From the rapid assessment in Faryab Province (MSF-B 01/01)

  • Implement an immediate blanket food distribution in the region to assist the population until at least the next harvest.
  • Establish a seeds and tools distribution to provide material for subsequent harvests.

From the SCF-US Rapid Assessment in Faryab Province (SCF-US 03/01)

  • Support the population with emergency food distribution.
  • Provide treatment to those with clinical deficiencies.
  • Boost people’s coping strategies to mitigate the detrimental long term impacts.
  • Develop and understanding of the inter and intra village differences between livelihood systems.

RNIS 31, July 2000

The most recent overview of the numbers of refugees and displaced people in Asia (as of end of 1998) estimates that there are 4.7 million refugees on the continent. Over 1.2 million of these were Afghans in Pakistan and Iran (1.4 million). There are reported to be approximately 500,000 Iraqis in Iran. Accurate estimates of the number of displaced people in Asia are unavailable.

This section of the report gives updated information on some of these situations. The current nutritional situation of the Afghan refugees/displaced persons is described. Information on the Bhutanese refugees in Nepal and refugees is included. There is also information on the nutritional situation of the population in East Timor, the refugees in West Timor and displaced people in other parts of Indonesia although this section is not comprehensive.

Afghanistan Region

The conflict in Afghanistan has been ongoing for more than twenty years, leading to massive displacement both within the country and, as refugee movements, into Iran and Pakistan. An estimated 300,000 people are internally displaced in Kabul, the Panjsheer Valley, Hazajarat, Darri Souf, Khoja Ghar and Khunduz (OCHA - 11/05/00).

Drought

Afghanistan is facing a very serious food crisis due to a second year of severe nationwide drought, shortages of irrigation water as a result of the mildest winter for 40 years, combined with its continuing political and economic problems. Initial assessments showed the southwest of the country to be the most affected area, but recent reports confirm the whole country has been severely affected. Preliminary estimates suggest that until June 2001 at least half of the country's population will be affected; 3 to 4 million people severely and a further 8 to 12 million more moderately. Those most affected are rain-fed wheat producers whose crop, normally harvested between May and June, has almost totally failed. Livestock owners are also affected (FAO/WFP - 08/06/00; OCHA - 06/06/00).

About 85% of Afghanistan's estimated 21.9 million people are directly dependent on agriculture. The most vulnerable people in these communities are those with weak links to the land and livestock (for example, the landless, sharecroppers and wage labourers). Urban populations are primarily dependent on cereals purchased from the market with income earned. Hence the most vulnerable groups are those that have weak links to labour markets (for example, female-headed households). 1998/9 was not a normal year for Afghanistan, with a reduction in the amount of grain produced. This eroded traditional social security systems, forced the distress sale of assets and, critically, reduced the ability of households to cope with this year's drought (FAO/WFP - 08/06/00).

Most households who are able to do so have sent able-bodied males to Pakistan to earn what they can in the casual labour markets. Emigration of entire families has not been widely reported, but it is reasonable to expect that some households will have no choice but to move as a matter of survival (FAO/WFP - 08/06/00; UNHCR - 06/07/00).

Kabul

Three thousand families (approximately 16,000 people) displaced from Shamalle since August continue to be housed in the ex-Soviet Embassy compound. WFP, other UN agencies and NGOs, continue to provide assistance to this group. A further 65,000 IDPs in Kabul are housed by relatives, who are often poor and vulnerable themselves. No reports on the nutritional situation of the IDPs in Kabul are currently available to the RNIS. WFP supports soup kitchens in the city (OCHA - 11/05/00).

IDPs in Panjshir Valley

Displacement from the Shamalle Plain into the Panjshir Valley and Kabul began in August 1999 as a result of fighting between the Taliban Government and opposition forces in the area. Panjshir is one of the main strongholds of the government opposition within Afghanistan. A WFP assessment in February identified some 7,600 displaced families in the valley. IDPs sheltered in Gulbahar City, Jabal-Seraj and Charikar were not included in the assessment. There is some concern that, should another offensive occur, new IDPs and people displaced previously will once again be forced to flee to the valley (OCHA - 12/07/00).

The IDPs are living in either official or unofficial camps, public buildings or with host families. New shelters have been constructed for some families. Some of the IDPs are reported to have moved back to their land, if it was not mined or too close to the frontline, to farm this summer. The assistance provided to the IDPs is minimal, but is reported to be adequate. The most recent nutritional survey estimated the prevalence of acute malnutrition at between 7.5 and 12%. A further survey is planned for August (OCHA - 12/07/00).

Hazarajat

Mazarajat comprises Bamiyan province and parts of adjacent provinces. It is one of the poorest parts of Afghanistan with some of the coldest, most mountainous and least productive agricultural land. An estimated 22% of the population is landless. Conflict and poor food security have lead to population movement, both temporary and permanent. Population movements include emigration to find employment; returnees from Iran (usually forced); and internal displacements. There are an estimated 100,000 IDPs in Hazarajat (OCHA - 11/05/00, 23/05/00).

The food security situation is poor. Diets are reported to be limited to bread and tea: meat is only consumed for religious events. Land-holdings are usually very small. Environmental degradation, land loss and the consequent reduction in the food supply are serious problem. Cash labour opportunities are also limited. In addition, access to health care services is very restricted (OCHA - 23/05/00).

Return of Refugees

Since the UNHCR programme to assist Afghans to repatriate started in April, some 41,400 refugees have crossed the Islam-Qala border between Iran and Afghanistan with UNHCR's assistance. Rehabilitation and monitoring projects have been initiated in various districts of Heart and Kabul (OCHA - 05/07/00). Refugees also continue to return from Pakistan.

The drought, however, is affecting the rate of return of the refugees. UNHCR advises against return to drought-affected areas (OCHA - 23/05/00; UNHCR - 06/07/00).

Pakistan

Pakistan hosts 1.2 million refugees in 203 villages in the northwest frontier, Baluchistan, and Punjab provinces. The RNIS has not received any new reports on a change in the adequate nutritional status of the approximately 320,000 Afghan refugees who receive food assistance in Pakistan. The remaining refugees are considered self-sufficient and receive no food assistance, although UNHCR helps to sustain government activities in health and education in the villages where they live.

UNHCR is making plans to consolidate refugee villages in the province of Baluchistan, which is considered one of the most affected by the drought, to other areas within the province where adequate water and other services are available (OCHA - 23/05/00; UNHCR - 06/07/00).

Islamic Republic of Iran

An estimated 1.4 million Afghan refugees and some 500,000 Iraqi refugees remain in the Islamic Republic of Iran. UNHCR and the Government of the Islamic Republic of Iran have reached an agreement to allow unregistered refugees a choice to return home or to normalise their presence in Iran. Afghans who opt for voluntary repatriation will receive assistance. Those who are unable to return will have their claims examined jointly by UNHCR and the Government (OCHA - 22/05/00).

There is no new information on the nutritional situation of these refugees, the most recent reports indicated that the situation was not critical (see RNIS 28).

Overall, the IDPs in Afghanistan are considered nutritionally vulnerable (category III); however this may change given the severity of the drought situation, and the scale of the required humanitarian assistance. The nutritional situation of the refugees in Pakistan and the Islamic Republic of Iran remains uncritical (category IV), but may also be affected by the drought.

Recommendations and priorities:

For the drought-affected populations (FAO/WFP - 08/06/00):

  • Provide assistance to the drought-affected populations in Afghanistan to prevent a deterioration of the nutritional situation and large-scale migration to Pakistan or over-crowded cities within Afghanistan.

For the IDPs in Afghanistan:

  • Continue to monitor the nutritional situation of the IDPs.

For the refugees in Iran and Pakistan:

  • Obtain information on the nutritional and health status of the refugees in Pakistan and the Islamic Republic of Iran.

 


RNIS 30, March 2000

The most recent overview of the numbers of refugees and displaced people in Asia (as of end of 1998) estimates that there are 4.7 million refugees on the continent. Over 1.2 million of these were Afghans in Pakistan and Iran (1.4 million). There are reported to be approximately 500,000 Iraqis in Iran. Comprehensive figures on the number of displaced in Asia are unavailable.

This section of the report gives updated information on some of these situations. The current nutritional situation of the Afghan refugees/displaced persons is described. Information on the Bhutanese refugees in Nepal and refugees is included. There is also information on the nutritional situation of the population in East Timor, the refugees in West Timor and displaced people in other parts of Indonesia although this section is not comprehensive.

Afghanistan Region

The conflict in Afghanistan has been ongoing for more than twenty years, leading to massive displacement both within the country and, as refugee movements, into Iran and Pakistan. Although large parts of the country remained relatively peaceful in 1999, fighting continued in Bamiyan, Shomali, and in north-eastern parts of the country (OCHA-31/12/99).

Food assistance

WFP is planning to provide food assistance to approximately 1.5 million people under a newly approved relief operation. A poor harvest in 1999 (the first year since 1995 to show a decrease in total cereal production) and a drop in flour imports (partially due to more vigorous border controls curtailing smuggled food from neighbouring countries, particularly Pakistan) have resulted in spiraling wheat flour prices. The price of wheat flour in Kabul has increased almost 50% since October 1999. The impact of these price increases has been exacerbated by a simultaneous drop in people’s purchasing power as a result of a rise in unemployment (WFP - 11/02/99).

The UN is assisting approximately 300,000 IDPs in Kabul, Panjshir, Hazarajat, Dara Souf, Kunduz, and Khojar Ghar (OCHA - 07/12/99).

Kabul

Three thousand families (approximately 16,000 people) displaced from Shamalle since August continue to be housed in the ex-Soviet Embassy compound. WFP, other UN agencies and NGOs, continue to provide assistance to this group. The majority of the displaced population in Kabul are housed by relatives, who are often poor and vulnerable themselves. A programme has been launched in the city to provide employment for some 4,000 families in the winter. No reports on the nutritional situation of the IDPs in Kabul are currently available to the RNIS. WFP-supported bakeries feed some 266,000 people in the city.

IDPs in Panjshir Valley

Displacement from the Shamalle Plain into the Panjshir Valley and Kabul began in August 1999 as a result of fighting between the Taliban Government and opposition forces in the area. Panjshir is one of the main strongholds of the government opposition within Afghanistan. There is some controversy surrounding the actual number of displaced people remaining in the Panjshir valley. WFP estimates that there are 42,000 IDPs (6,000 families with an average of 7 people per family). IDPs are living in either official or unofficial camps, public buildings or with host families (ACF-F-12/99).

ACF-F undertook nutritional and food security assessments among the IDPs in Panjshir Valley in late 1999 (see annex). The nutritional assessment was not a survey, as it was not considered representative of the total population due to the difficulty of obtaining reliable population figures (partially because the IDPs were constantly moving around the valley during the time the assessment was conducted). The table below shows the results of the nutritional assessment. No comparative national survey data is available, however the most recent ACF-F survey in Kabul estimated the prevalence of acute malnutrition at 8.7%(see RNIS 27). Vaccination rates confirmed by card were relatively low at 40.7%, although a further 33.3% of carers reported that children had been vaccinated and that the cards were lost (ACF-F - 12/99).

Results of Panjshir nutritional assessment


Official camps
(n=158)

Public buildings
(n=159)

Unofficial camps
(n=160)

Acute malnutrition
(<-2z scores and/or oedema)

12.0%

12.6%

7.5%

Severe acute malnutrition
(<-3z scores and/or oedema)

1.9%

3.8%

1.3%


The findings of the food security assessment are summarised below (ACF - 12/99):

  • Forty-two percent of the IDP households came from rural areas, the remaining 58.2% were from urban settlements. The average length of displacement at the time of the assessment was 4.5 months.
  • The majority of the displaced from southern Shamalle, who were displaced before those from northern Shamalle, were living in official camps. This group were forced to flee their homes with very little warning and as a result were unable to bring many of their possessions with them. They have received both food and non-food items since arriving in Panjshir. In contrast, the displaced from northern Shamalle who were displaced later and were able to bring some of their assets with them were more likely to live in the unofficial camps and public buildings. At the time of the survey, this group had received less assistance than those from southern Shamalle and had had to sell larger quantities of their assets in order to maintain a basic quality of life. Assets were sold to obtain food, wood and medicines.
  • Coping mechanisms other than sale of assets for both groups included working for food-for-work projects, working in the bazaar, obtaining loans and begging. (Begging was not widely reported but the assessment team observed that many women were begging; it was thought that the 12% of female-headed households were particularly dependent on begging for their survival).
  • Both groups of IDPs were considered ‘vulnerable’ at the time of the assessment. It was estimated that only 20% of the IDPs from northern Shamalle could be considered self-reliant and 10% of those from southern Shamelle. The IDPs in the official camps had smaller food stocks than the other groups, although they were consuming a greater diversity of food types. All households (except one) possessed basic commodities such as cooking utensils etc.
  • Water consumption for all groups was far below the basic requirement of 20l/person/day (average consumption 4.8l/person/day in camps and 7.5l/person/day in the public buildings). Water is mainly collected from rivers, unprotected springs and irrigation channels, except in one of the official camps where chlorinated water is available. Latrines were present only in the official camps and some of the public buildings, but lack of privacy meant that some of the latrines were not socially acceptable. The scarcity of latrines presents a serious public health risk.
  • The main source of fuel for all households was bushes collected from the mountains, although some coal powder has been distributed in the public buildings and official camps. Collection time for bushes averaged between 3-6 hours/day and was mainly undertaken by older children.
  • More interventions have been planned for the group from southern Shamalle than for those from the north. Given the depletion of the latter group’s assets this programme could result in increased vulnerability among those from northern Shamalle.
  • Nearly all the IDPs interviewed expressed a desire to return to their homes, however this is dependent on security conditions and it is not possible to predict when security in Shamalle will improve sufficiently to allow people to return. Furthermore, reports suggest that many of the displaced’s homes have been destroyed by looting and fighting.

Emergency Food distribution in southern Afghanistan

WFP has been registering the most vulnerable families in Kandahar, Helmand and Zabul provinces during the reporting period. It is estimated that WFP will provide 250 kg of wheat per household to an estimated 200,000 people in Kandahar City and Zabul province (OCHA - 15/02/00).

Return of Refugees

A meeting in Kabul has endorsed UNHCR’s repatriation plan that envisages the return of 200,000 Afghan refugees from Pakistan and Iran in 2000. UNHCR will provide logistical support to all those who express the desire to return home and will assist the returnees with shelter and water. Surveys to assess the needs of potential returnees will be conducted shortly (OCHA - 25/02/00).

Pakistan

Pakistan hosts 1.2 nillion refugees in 203 villages In the north west frontier, Baluchistan, and Punjab provinces. In 1999, some 92,000 Afghan refugees voluntarily repatriated from Pakistan (OCHA - 25/02/00).

The RNIS has not received any new reports on a change in the adequate nutritional status of the approximately 320,000 Afghan refugees who receive food assistance in Pakistan. The remaining refugees are considered self-sufficient and receive no food assistance, although UNHCR helps to sustain government activities in health and education in the villages where they live.

Islamic Republic of Iran

An estimated 1.4 million Afghan refugees and some 500,000 Iraqi refugees remain in the Islamic Republic of Iran. There is no new information on the nutritional situation of these refugees, the most recent reports indicated that the situation was not critical (see RNIS 28).

UNHCR and the Iranian government have agreed on ways of facilitating the repatriation of Afghan refugees remaining in Iran, in order to better organise the return process and put an end to the deportations (OCHA - 29/02/00).

Overall, the IDPs in Afghanistan are considered nutrition-ally vulnerable (category III) and continue to need humanitarian assistance. The nutritional situation of the refugees in Pakistan and the Islamic Republic of Iran remains uncritical (category IV).

Recommendations and priorities:

  • Obtain information on the nutritional and health status of the refugees in Pakistan and the Islamic Republic of Iran.

From the ACF-F assessment in Panjshir:

  • Open one therapeutic feeding centre and five supplementary feeding centres in the area.
  • Improve the sanitation facilities.
  • Continue to monitor the nutritional situation of the IDPs, including undertaking a nutritional screening of all children aged 6-59 months.

 


RNIS 29, December 1999

he most recent overview of the numbers of refugees and displaced people in Asia (as of end of 1998) estimates that there are 4.7 million refugees on the continent. Over 1.2 million of these were Afghans in Pakistan and Iran (1.4 million). There are reported to be approximately 500,000 Iraqis in Iran. Comprehensive figures on the number of displaced in Asia are unavailable.

This section of the report gives updated information on some of these situations. The current nutritional situation of the Afghan refugees/displaced persons is described. Information on the Bhutanese refugees in Nepal and refugees from Myanmar in Bangladesh is also included. There is also information on the situation of displaced groups in West and East Timor, although this section is not comprehensive.

There has been on-going conflict in Afghanistan for the last twenty years, leading to massive displacements both within Afghanistan, and as refugee movements, into Iran and Pakistan. Ten years after the withdrawal of the last Soviet soldiers in 1989, armed conflict between opposing political factions still continues. Currently the Taliban control approximately 85% of the country, and the Northern Alliance forces, led by Commander Ahmad Shad Masood, control about 15%.

Food assistance

The UN is assisting approximately 300,000 IDPs in Kabul, Panjshir, Hazarajat, Dara Souf, Kunduz, and Khojar Ghar (OCHA - 07/12/99). In 1999, food aid has been distributed to approximately 60,000 vulnerable households in the central highlands and to some 8,000 households in the northeast of the country. Vulnerable groups are provided with food through urban bakeries, institutional feeding programmes in hospitals, orphanages and health centres, and through food-for-work activities (FAO/GIEWS - 03/11/99).

The RNIS has not received any new nutritional surveys or assessments concerning the displaced populations in Afghanistan during the reporting period.

Cross-border trade restrictions with Pakistan

Restrictive measures on cross-border trade imposed by the Pakistani authorities since the military coup in Pakistan on 12 October 1999 have been closely linked with a dramatic increase in wheat flour prices in several major urban centres across Afghanistan. The restrictions come at the end of a year where cereal production was poor in Afghanistan, and it is estimated that the welfare of up to 2 million people may be seriously threatened if restrictions on commercial wheat flour trade from Pakistan to Afghanistan continue. There is particular concern that the most vulnerable households (e.g.: those headed by women, older persons, the handicapped and the unemployed) will be the most seriously affected by the restrictions, given the greater predominance of wheat in their diet (OCHA -23/11/99; WFP-10/12/99).

Panjshir

In the Panjshir valley there are an estimated 65,000 IDPs who were displaced from the Shomali in August and September. There are indications that the number of IDPs may be reducing due to the cold weather and improved security situation. Fifty thousand people are in need of food and a further 30,000 require shelter. UN negotiations with the Taliban to allow the establishment of a humanitarian corridor from Kabul to Panjshir have succeeded, and the first convoy has successfully made the trip. However, access to the displaced population in the winter months continues to be problematic, as only one of the two passes into the valley is open sporadically when weather conditions permit (OCHA - 23/11/99,07/12/99; WFP - 29/10/99).

Kabul

Some 16,000 IDPs, 10,000 of whom are children, are housed in the ex-Soviet compound. A one-off distribution of non-food items has been given to this group and WFP and the local authorities continue to provide food assistance (CSB and bread). The situation in the compound is reported to have improved significantly since August when the IDPs first occupied the building (OCHA - 07/12/99; WFP -10/12/99).

The IDPs who have sought refuge with their relatives or have rented rooms or squatted in empty homes in the city are now of more concern than those in the Soviet compound. This is particularly true during the winter months when the need for shelter and heating intensifies. It is difficult to estimate the exact numbers of these people, although more than 20,000 families were registered entering Kabul between August and October (OCHA - 17/11/99, 07/12/99).

The most recent nutritional survey in Kabul estimated the prevalence of wasting and/or oedema at 8.7% among children (see RNIS 27).

Darra Souf, Samangan Province

A UN assessment of Darra Souf in October reported that up to 35,000 people may still be displaced in the area as a result of fighting. A further 14,000 have left the area. The displaced are spread out in different villages; some living with friends and relatives and others occupying makeshift shelters and caves. Most were able to take some possessions with them when they fled the fighting, but the poorest have largely exhausted whatever resources they had. As many as 1,000 households may require immediate food and non-food assistance. In addition, WFP will provide the displaced with wheat (OCHA -14/10/99, 26/10/99; WFP -10/12/99).

Bamiyan

Between March and May some 115,000 people were displaced in Bamiyan fleeing to the neighbouring provinces, Kabul, north Afghanistan and Pakistan. From June to September some 87,000 people returned to their places of origin while about 28,000 continue to be displaced. There is a high level of conflict-related damage in the area, almost no potato or wheat crops were harvested and the population have lost most of their assets. Principal needs include emergency food assistance, employment opportunities for those who rely on cash income or have lost heir crop, reconstruction of houses, and agricultural inputs. WFP has completed the first round of distributions to those who have returned to their homes (OCHA -14/10/99).

Pakistan

UNHCR provides indirect assistance to 1.2 million people in at least 200 refugee villages in Pakistan. UNHCR helps to sustain government activities in health and education by providing medicine and salaries etc. There are no reports on a change in the adequate nutritional status of the approximately 320,000 Afghani refugees requiring food assistance in Pakistan. The remaining refugees have established themselves in Pakistan and are considered to be self-reliant and self-sufficient.

Voluntary repatriation from Pakistan to Afghanistan is ongoing. The refugees are provided with wheat, plastic sheeting and an entitlement of cash. The repatriation programme from Pakistan is slowing down due to the winter. An estimated 15,500 families (88,500 individuals) received repatriation grants and returned from Pakistan to Afghanistan in 1999 (OCHA-23/11/99).

Islamic Republic of Iran

An estimated 1.4 million Afghan refugees and some 500,000 Iraqi refugees remain in the Islamic Republic of Iran. After the recent hostilities (1998/9) between Afghanistan and the Islamic Republic of Iran, most Afghan refugees have been under pressure to leave the country, and many have been forced out. Between January and September UNHCR has registered 41,000 people who crossed into Afghanistan. This includes those who benefited from organised repatriation, individual voluntary returnees and deportees. Deportees make up almost one third of 41,000 people who have returned. Among the deportees, women and children in particular are faced with shelter problems, inability to make contact with family members left in the Islamic Republic of Iran and difficulty in finding relatives in Afghanistan. This is particularly so for those whose original homes were in the north or in distant parts of Afghanistan (OCHA -19/10/99).

UNHCR has observed the forcible return of Afghan families during the reporting period (OCHA - 23/11/99).

There have been no new nutritional surveys conducted among the refugee population in the Islamic Republic of Iran during the reporting period. The most recent WHO report suggested that their nutritional situation was not critical, although this may change (see RNIS 28).

Overall, the IDPs in Afghanistan are nutritionally vulnerable (category III), although those in the Panjshir valley are considered to be at heightened risk (category II). The nutritional situation of the refugees in the Islamic Republic of Iran and Pakistan remains uncritical (category IV).
 


RNIS 28, September 1999

There has been ongoing conflict in Afghanistan for the last twenty years, leading to massive displacements both within Afghanistan, and as refugee movements, into Iran and Pakistan. Ten years after the withdrawal of the last Soviet soldier in 1989 an armed conflict between opposing political factions still continues. Currently the Taliban control approximately 85% of the country, and the Northern Alliance forces, led by Commander Ahmad Shad Masood, control about 15%.

An upsurge in the fighting in late July has led to the forced internal displacement of up to 100,000 people in the northeast part of the country. According to first-hand accounts, Taliban fighters forced men, women and children out of their houses in the Shamali valley and told them to walk to Kabul (a 40 kilometre journey). The fighters intentionally set many houses on fire. There are no reports of the IDPs moving closer to either the Tajik or Pakistani borders and it is generally believed that there are unlikely to be large outflows, either to Pakistan or Tajikistan, unless the military situation in the Panjshir were to change drastically (UNDPI - 14/08/99, 16/08/99; UNHCR - 27/08/99).

New displacement - Kabul

The displacement from the Shamali Valley continued on a daily basis throughout much of August. By the mid-September it was estimated that up to 50,000 individuals had arrived in the capital since the fighting. The new arrivals confirmed that houses and crops have been destroyed. They also report systematic destruction of the agricultural system - boundary walls are being demolished and irrigation systems wrecked. This has resulted in the destruction of trees, including the important fruit crops which were ready for harvest. If widespread, this destruction will have a devastating effect on local communities (OCHA - 31/08/99, 14/09/99).

The diplomatic compound in Kabul is now occupied by 12,300 IDPs. WFP has begun providing them with 150g CSB, 20g edible oil and 20g sugar per person per day, and the local authorities are providing two loaves of bread per family per day. Basic non-food items have also been distributed and CARE has completed 52 latrines. Drinking water is available (OCHA -31/08/99, 14/09/99: UNHCR - 27/08/99; WFP - 20/08/99, 03/09/99).

In addition to those families accommodated within the diplomatic compound, a large number of IDPs have found refuge with friends and relatives in the capital. No serious deterioration has been reported in the condition of the IDPs living in the city outside the compound. Although, ACF has reported that there is an increase in the number of children attending the four supplementary feeding centres in district 11. (A survey reported in RNIS 27 estimated that the prevalence of wasting and/or oedema was 8.7% in children in Kabul aged 6-59 months). Animal prices have fallen in the main markets as some of the IDPs were able to bring their livestock to the city. While the sale of these animals will help the IDPs financially in the short-term, it will inevitably affect their ability to provide for themselves over the winter (OCHA - 24/08/99, 31/08/99).

New displacement - northern areas

There are an estimated 100,000 IDPs in the 150 km long Panjshir Valley, although the situation remains very fluid and thus a definitive estimate is currently difficult. While most of the displaced have found temporary housing with local families or public buildings, an estimated 20% are without shelter (OCHA - 24/08/99, 31/08/99; WFP - 03/09/99).

The displaced currently receive food from limited food distributions by local authorities (although stocks are believed to be dwindling), food stocks brought from their homes (e.g.: wheat), and from casual labour or picking fruits, maize and vegetables from crops planted by the residents of the valley. This early picking will reduce the crops for the upcoming harvest. A UN mission to the area in late August predicted that these sources of food will be severely reduced in the coming weeks. As an initial response WFP has begun to provide wheat flour distributed in the form of bread to the most vulnerable groups.

The mission identified major concerns. The weather will become progressively colder and snow is expected in the higher valley from October onwards. This is of great concern for the 20,000 people without shelter. In addition, access to the valley is extremely difficult - the northern routes are in bad condition and trucks can take up to three days to reach the main groups of displaced people from Faizabad. The southern routes pass through the areas of intense military fighting (WFP - 03/09/99).

A further 10,000 new IDPs are in Kunduz, Takhar, Badakhshan and Pulikhumri. The IDPs are accommodated in damaged public warehouses, government buildings, schools and homes of relatives, while some are in the open. UNHCR have provided them with drinking water. Anecdotal reports suggest "some incidence of diarrhoea, skin diseases and malnutrition" (OCHA - 24/08/99, 31/08/99).

Food security

According to an FAO/WFP report based on a recent crop and food assessment mission to Afghanistan, more than one million people in Afghanistan will need relief and rehabilitation assistance over the next 18 months because of a sharp reduction in cereal production this year. The report forecasts that the cereal production average will be 16% below average. The drop in production is due to a shortage of irrigation water as a result of the mildest winter in 40 years with very low snowfall, late and erratic spring rains. High incidences of yellow rust and sunpest have also damaged crops in the north and west of the country. In addition, agricultural recovery remains severely hindered by damage to irrigation structures and land mines (FAO/WFP - 07/07/99).

Despite stable prices and well-stocked food shops in the first half of 1999, access to food is severely limited by a scarcity of income-generating activities and lack of employment opportunities outside agriculture. This problem appears to be increasing as many displaced people add to the supply of casual labour while few additional employment opportunities are created. Low purchasing power is the single most important impediment to food security (FAO/WFP -07/07/99).

In urban areas, typically the major determinant of a household's ability to meet the minimum requirement per person per month is its male labour. If the major sources of household income are children's or women's work at home, then these households are more likely to have per capita income below the necessary for minimum food expenditure. The same is true for males employed in government service, or as daily wage labourers, or those in petty trade (see RNIS 27 for more detail). In rural areas, the landless, particularly in the highlands, are among those who have the most difficulty attaining minimum food needs (FAO/WFP - 07/07/99).

Cholera outbreak

Over 4,700 cases of cholera, including at least 50 deaths, were reported in Jaghori district of Ghanzi, Kabul city, Spin Boldak in Kandajar and Kunduz over the reporting period. Cholera task forces have been set up in all areas of the country and an oral re-hydration therapy and hygiene education and sanitation campaign has been officially launched. Work also continues on community-based water improvement schemes in various parts of the country (OCHA - 06/07/99; WHO - 07/09/99).

Funding

The response to the 1999 UN consolidated Appeal for Afghanistan has been disappointing. Although the level of activity in Afghanistan has been restricted by problems of access, opportunities to deliver assistance and thereby reduce vulnerability have been limited by low levels of funding. At the end of June only $41 million had been pledged out of a total of $112 million identified as high priority funding (OCHA - 22/07/99).

Returnees from Iran/Pakistan

Voluntary repatriation from Pakistan is ongoing. The refugees are provided with wheat, plastic sheeting and an entitlement of cash. More than 50,000 refugees have returned to their places of origin in different regions of Afghanistan since January 1999 (OCHA - 06/07/99).

UNHCR has reported that nearly 2,000 Afghans have returned to their country from Iran since the beginning of this year. As an agreement has not yet been reached between the Government of Iran and UNHCR, the expected return of 120,000 Afghans for 1999 has been decreased to 60,000. WFP provides 300 kg of wheat per returning family (OCHA - 14/07/99; WFP - 09/07/99).

Pakistan

UNHCR provides indirect assistance to 1.2 million people in at least 200 refugee villages in Pakistan. UNHCR helps to sustain government activities in health and education by providing medicine and salaries and other support. There are no reports on a change in the adequate nutritional status of the approximately 320,000 Afghani refugees requiring food assistance in Pakistan. The remaining refugees have established themselves in Pakistan and are considered to be self-reliant and self-sufficient.

Islamic Republic of Iran

The most recent estimate of the refugee population in the Islamic Republic of Iran was 1.9 million in December 1998 of which 1.4 million were Afghani and 0.5 million were Iraqi refugees. This is the largest refugee population hosted by any country in the world. Approximately 5% of the refugees are in camps, the remainder are dispersed throughout the country.

There have been no nutritional surveys conducted among the refugee population in Iran during the reporting period. However, WHO have recently conducted a review of the health situation of the refugees. The review reported that the provision of primary healthcare facilities in both camps and non-camp settings was of high quality with well-trained Iranian and refugee health workers, well-equipped facilities and a good supply of drugs. In terms of nutrition, the report quoted MOH statistics from within the camps of camp refugees. 4% of children under five years were below the third centile of weight-for-height compared to 11% in 1994; 45% of children were below the 3rd and 50th centile; and 51% between the 50th and 97th centile. In 1998, 8% of infants were born with low birthweight (<2500g) compared to 16% in 1994. No information on the nutritional status of non-camp refugees was available (WHO - 9/99).

Since 1998, the economy of Iran has been in recession due to a 39% decrease in its export revenue. Consequently the Government is finding it difficult to assist refugees. The unemployment rate is officially 9.1% but estimates place it as high as 25%. This crisis has reduced public expenditure, adversely affecting the heavily subsidised economy and worsening the living conditions of both Iranians and refugees. These hardship conditions have greatly limited economic opportunities for refugees outside camps, who have difficulty in finding even temporary jobs. The situation has resulted in a rising number of vulnerable refugees among the non-camp refugee population (WHO - 9/99).

Overall, the situation of the newly displaced, in particular, in Kabul City (50,000 from Shamali valley) and the 100,000 IDPs in the Panjshir Valley, is cause for concern. Despite a lack of specific information on their nutritional situation, those in the Panjshir Valley are considered to be at high risk due to their inaccessibility as the winter months approach (category Ha). The situation of people displaced earlier and those in Kabul is likely to be somewhat better, and thus they remain at moderate risk (category IIb). The refugees in Iran and Pakistan are considered to be at low risk (category IIc).

Priorities and Recommendations:

  • Rehabilitate agricultural infrastructure, particularly irrigation facilities in Afghanistan.
  • Provide assistance to the newly displaced people in Afghanistan.
  • Provide more financial assistance to the Government of Iran to assist the refugees in the country.

RNIS 27, July 1999

There has been conflict in Afghanistan for the last twenty years, leading to massive displacements both within Afghanistan, and as refugee movements, into Iran and Pakistan. Ten years after the withdrawal of the last soviet soldier in 1989 an armed conflict between opposing political factions still continues. Currently the Taliban control approximately 85% of the country and the Northern Alliance forces, led by Commander Ahmad Shad Masood, about 15%. Fighting has been reported in the front-line areas of the Central and North regions including Bamyan and Faizabad during the reporting period. The fighting has resulted in civilian casualties and humanitarian assistance to these areas has been interrupted (WFP - 23/04/99, 30/04/99).

As a consequence of the war, several million refugees are scattered throughout the region, mainly in Pakistan (1.2 million) and Iran (1.4 million). Repatriation is ongoing. WFP estimates that there are up to 2.5 million IDPs in Afghanistan: the agency assists some 1.25 million people in the country (WFP - 29/09/98).

UN presence is returning slowly to Afghanistan. WFP, FAO, UNHCR and UNICEF have all increased their presence and some NGOs are beginning to return. WFP continues to run bakeries in Kabul and other areas, as well as food for work programmes. An emergency feeding programme is underway in Bamyam province targeting the landless and female-headed households as well as IDPs in Panjao (OCHA - 02/06/99; WFP -23/04/99). The recently returned UN staff have undertaken several assessment missions around the country, the results of which are summarised below.

Food Security

Initial results from an FAO/WFP crop and food supply assessment mission suggest that the country's crop production is likely to be low for 1999, particularly in the northern regions. The main problem seems to have been a lack of snow and rainfall in the surplus crop production areas. In addition, there are indications of a serious problem of rust infection in the north and reports of red locusts in the north-east (WFP -04/06/99). Anecdotal reports from Mazar (a province in the north of the country) indicate that the food security situation of the most vulnerable people is deteriorating. Household assets are continuing to be sold and begging is on the rise. Labour wages have decreased as a result of an increased amount of labourers available. Although crop prices are currently low, preliminary indications are that many households are finding it difficult to buy enough (OCHA - 27/05/99).

A WFP food security study for Jalalabad reported that the most vulnerable families are those without a male wage earner. Without assistance these households earn only 70% of the minimum cash income required for food and non-food items. Thus they cannot afford to buy essential items such as fuel and clothing. Households with only one man, working in casual labour or as a government employee, were the next most vulnerable group. This group earn about 85% of their minimum requirement. In these circumstances WFP food boosts the low income and allows poor households to achieve minimum income requirements. Begging and the sale of assets in Jalalabad are reported to be less visible than in Kabul or Mazar (OCHA - 27/05/99).

In the provinces of Parwan and Kapsia (central region) market prices for cereals are now reported to have increased by 100% over normal inflation since a military-blockade was set up by the Taliban in 1997. Due to a lack of agricultural input and rust infestation of the wheat, the 1998 crop production was much below average in this region. If the 1999 crop production does not improve families dependent on purchasing their food will be unlikely to maintain their minimum needs (WFP - 04/06/99).

A recent report from WFP stated that the agency is preparing to introduce corn-soya blend (CSB) into selected programme activities throughout Afghanistan in order to "improve the nutritional status of the people in Afghanistan". Acceptability testing in Kabul suggested that CSB is well accepted by Afghan beneficiaries. In order to ensure the correct use and understanding of the commodity WFP's implementing partner's are conducting information campaigns which highlight CSB' nutritional value and show the various ways it can be used (WFP-02/07/99).

Kabul

ACF undertook a study of the nutritional situation of mothers and children under-five in Kabul in February (see Annex). Amongst children under-five, the prevalence of acute wasting was estimated at 8.4%, including 0.7% severe wasting. Oedema was found 0.3% of the children surveyed. The level of stunting (height-for-age) was much higher: 61.3% of the children were stunted, including 32.2% severe stunting. The authors, however, cautioned that the validity of the data on the children's ages was questionable. The prevalence of acute wasting in infants who were longer than 49cm (n=132) was 6.1%. Amongst those infants who were less than 49cm long (n=20), most of whom were less than a month old, 85% weighed less than 3.5kg which is considered to be a "normal" birthweight. Of these, 4% were actually below the low birthweight cut-off (2.5kg).

Using the chronic energy deficiency (CED) classification scheme, 17.2% of the mothers were defined as undernourished (BMI < 18.5 kg/m2), 5.4% of these more severely undernourished (BMI < 17.0 kg/m2). Analysis of the mothers' MUACs gave a similar result, 20.2% were classified as undernourished (MUAC<22.0 cm). 10% of the women had both low BMI and low MUAC (BMI < 18.5 kg/m2 and MUAC<22.0cm). 10.3% of the women were classified as overweight (BMI > 24.9 kg/m2) and 2.3% as obese (BMI > 29.9 kg/m2).

For the month prior to interview, CMR was estimated at 0.74/10,000/day and the mortality rate of children under-five at 0.61/10,000/day. The main causes of death amongst the general population were heart disease, hypertension and complications arising from child delivery. Amongst the under-fives measles, heart disease and delivery complications accounted for equal numbers of deaths. The major (72.3% of all children surveyed) cause of morbidity in the under-five age group were acute respiratory infections (as would be expected in a survey conducted in the winter), diarrhoea (20.9%), measles (2.4%) and "other symptoms" (43%).

The graph below compares the results of this survey to others conducted in Kabul in previous years. It can be seen that the prevalence of malnutrition in children under-five has increased incrementally since December 1996. The prevalence of mildly undernourished women remains below that found in December 1996, but the number of severely undernourished (BMI<16.0 kg/m2) women has increased from 1.1% to 2.5% over the same time period.

The authors of the survey conclude that the nutritional situation of the population in Kabul remains precarious. The general standard of living remains low for the majority of households and their nutritional status does not appear to have improved since late 1996. In general, the food security situation is fragile. The markets in Kabul are well supplied, but the prices of basic food and non-food stuffs have been increasing continuously since 1995. This is partly due to the decreased value of the Afghani (local currency) compared to the dollar. Another reason is that many of the items in the Afghans' diet are imported from Pakistan and the closure of the border between the two countries pushed up the prices of many foods. In addition, some Pakistanis have been speculating on various foods produced within Afghanistan itself (e.g.: onions) resulting in an increased price of local foods. One result of these price increases is that the bakers have decreased the weight of a standard nan, the basis of most households' meals, from 200 to 120g whilst maintaining the price.

The prevalence of wasting and/or oedema in Kabul between November 1995 and February 1999

Concurrent with price increases are decreases in many households' income. Unemployment levels have risen dramatically and many households are now dependent on income earned on a daily basis. Government employees are vulnerable as they do not receive their salary (which has not been properly adjusted to inflation rates) on a regular basis. Thus the purchasing power of Kabul's citizens has decreased. This is evidenced by an increased amount of selling of household goods - an unsustainable coping strategy. The withdrawal of the NGOs and UN has also had a poor effect on the nutritional situation of this population.

Women and infants are at particular risk of malnutrition in this population because of social beliefs and traditions in Afghanistan. Weaning practices are not well-adapted to young children's needs: the supplementary foods traditionally given to children during weaning (tea, biscuits, bread) are not suitable or well-balanced in terms of nutrients for this age group. It was also observed that some infants are given tea which may increase their exposure to infectious diseases. There is some evidence that women, whose activities are restricted by the Taliban, may have a lower daily intake than men because of social constraints imposed on them.

Additional risk factors for poor health in this population include a low immunisation coverage. The immunisation programme coverage (all valid doses) was estimated to be 34.2% in children under two years old. Nearly half the children had not been vaccinated for measles. 69.5% of the children had BCG scars. 31.1% of the women interviewed had been immunised for neonatal tetanus. In general, it was noted that women were unaware of the benefits of vaccination for themselves. UNICEF, WHO and the Ministry of Public Health are currently conducting a country-wide immunisation campaign aimed at eradicating polio and giving vitamin A supplementation to children between 6-59 months of age. The most recent report suggests that they have reached over 3.6 million children out of a target 4.3 million (OCHA - 30/04/99, 02/06/99).

Returnees from Iran and Pakistan

UNHCR anticipates that 220,000 refugees from Iran and Pakistan will return to Afghanistan in 1999. WFP has allocated food for repatriation packages for 130,000 returnees expected in four areas of the country. The returnee package consists of 300kg of food aid to be shared between a family, no individual returnees are assisted. The returnees are expected to settle in the areas of Heart and Kandahar initially (WFP - 23/04/99, 07/05/99).

Pakistan

UNHCR provides indirect assistance to 1.2 million people in at least 200 refugee villages in Pakistan. The agency helps to sustain government activities in health and education by providing medicine and salaries etc. It s also active in other areas such as helping start community services run by the refugees or Pakistan government officials (UNHCR - 08/06/99).

There are no reports of a change in the adequate nutritional status of the approximately 320,000 Afghani refugees requiring food assistance in Pakistan. 20,000 of the newest (most recently registered) refugees are provided with a ration of 2,102/kcal/day by WFP and are given non-food inputs by UNHCR. One of the problems with this method of targeting is that it encourages the recycling of refugees, i.e., many of new arrivals are not new arrivals at all. A further 300,000 (targeted) vulnerable refugees receive assistance under a Social Safety Net and Environmental Rehabilitation Programme. A well organised community network which has been set-up identifies the most vulnerable groups which are then targeted. The remaining refugees have established themselves in Pakistan and are considered to be self-reliant and self-sufficient (UNHCR - 08/06/99).

Iran

There are some 2 million refugees in Iran including 508,000 Iraqi Kurds, 58,000 Iraqi Arabs and 1,425,000 Afghans. In most cases the refugees are not in camps and are allowed to live and work alongside Iranians; only the most vulnerable 94,000 are hosted in official camps (UNHCR- 02/99).

There is no new information on the nutritional situation of the refugees in Iran. A joint WFP/UNHCR mission which visited Iran in December 1998 reported that there were no discernible nutritional deficiencies (either observed or reported) amongst the refugees, although there were a number of vulnerable refugees who were housed outside the camp.

Overall, the IDPs in Afghanistan are considered to be at moderate nutritional risk (category IIb). The 40,000 refugees in Iran who outside the camps are also considered to be at moderate risk of malnutrition. The other refugees in Iran and those in Pakistan are considered to be at low nutritional risk (category IIc).

Recommendations and Priorities:

  • A stronger UN and NGO presence is required in Afghanistan in order to fulfil the populations' humanitarian needs.

Recommendations from the ACF survey in Kabul include:

  • Continue the close monitoring of the nutritional status of mothers, children under-five, infants and the new born in Kabul to prevent a nutritional crisis situation developing.
  • Perform active Mother and Child health preventative activities, especially reinforce pre- and post-natal care follow-up.
  • Screen all children under five (particularly those less than 29 months) for malnutrition when they pass through the Health Services clinics in Kabul. Refer those with poor nutritional status to the Therapeutic Feeding Centres or Day Care Centres in order to prevent them becoming more severely undernourished.
  • Continue to constantly enforce/renew health education activities within all medical community based structures. Focus particularly on weaning practices, breast feeding and the prevention of diarrhoea and acute respiratory infections. Train mobile health workers and home visitors to give health education.
  • Expand and strengthen the immunisation programme for women and children. Routinely check the vaccination status of women when they bring their children to a clinic. Make the benefits of maternal vaccination more widely known through an education campaign.

RNIS 26, March 1999

Twenty years after the 1979 Soviet invasion in support of the communist regime in Afghanistan, and ten years after the withdrawal of the last Soviet soldier in 1989, an armed conflict between opposing political factions still continues in Afghanistan. Currently, the Taliban control approximately 90% of the country, although they are not recognised as the legitimate Afghan government by the UN. Politically, the Taliban continue to issue and maintain restrictive edicts many of which affect women's employment, education and health care. The anti-Taliban alliance, in which the veteran military commander Ahmed Shah Massoud is prominent, is based in the North of the country.

A UN-mediated agreement between the Taliban and opposition representatives in the Turkmen capital of Ashkabad took place in March 1999. The two sides had agreed in principle to set up a shared executive, judiciary and legislature, as well as to work out details at future negotiations. However, reports of continued fighting were received just a few days after the accord was reached (AFP - 18/03/99).

As a consequence of the war, several million refugees are scattered throughout the region, mainly in Pakistan (1.2 million) and Iran (1.4 million). Repatriation is ongoing and in 1998 UNHCR assisted about 107,000 refugees to return to Afghanistan (93,000 from Pakistan and 14,000 from Iran). In addition to the refugees, there are approximately 2.5 million displaced persons living away from their homes within Afghanistan (WFP - 29/09/98).

No new reports on the nutritional situation of the IDPs in Afghanistan are available. Anecdotal accounts refer to the "horrendous" breakdown in living conditions in Kabul and the effects of the twenty years of conflict on "health and nutrition" and other socio-indicators (AFP - 18/03/99). Since August 1998 (following a series of security incidents) no international UN-staff have been present in the country and thus information on the nutritional status of the population is difficult to obtain. However, local WFP staff have been able to provide much essential aid to the population (WFP - 19/03/99).

As a result of the agreement reached on 25th January between the UN Humanitarian Co-ordinator and the Taliban authorities, a gradual return of international UN-staff is proceeding (UNDPI - 12/03/99; WFP - 19/03/99). This should result in the availability of more detailed information on the nutritional situation. The most recent reports available suggest that 1.25 million people require humanitarian assistance (WFP - 29/09/98).

Pakistan

There are no reports on a change in the adequate nutritional status of the approximately 328,000 Afghani refugees requiring aid in Pakistan. 28,000 of the newest (most recently registered) refugees are provided with a ration of 2,102/kcal/day by WFP and are given non-food inputs by UNHCR. A further 300,000 targeted vulnerable refugees receive assistance under a Social Safety Net and Environmental Rehabilitation Programme. The remaining refugees have established themselves in Pakistan and are considered self-reliant and self-sufficient.

Iran

There are some 2 million refugees in Iran including 508,000 Iraqi Kurds, 58,000 Iraqi Arabs and 1,425,000 Afghans. In most cases the refugees are not in camps and are allowed to live and work alongside Iranians; only the most vulnerable 94,000 are hosted in official camps (UNHCR - 02/99).

Whilst the Government of the Islamic Republic of Iran continues to accommodate large numbers of refugees, recent economic pressures have caused it to demand greater international assistance and responsibility in handling/resolving the refugee situation. The downslide of the global oil price has dramatically lowered Iranian oil revenues and the current annual export revenue is down 39% compared to the previous year. This crisis has put severe limits on public expenditure, adversely affecting the heavily subsidised economy and worsening the living conditions of both Iranians and refugees.

Under these circumstances, a joint WFP/UNHCR mission visited Iran in December 1998 to assess the food need of the refugees in Iran (WFP - 03/99). Currently, WFP provides a ration equivalent to 1,900/kcal/person/day to 84,00 of the most vulnerable refugees in the camps. Refugees who can provide a livelihood for their families are not on the beneficiary list. A full ration is not provided as there are a number of mechanisms through which the refugees are able to obtain alternative food resources (for example: temporary jobs in the vicinity of the camps and assistance from national Iranian NGOs). The mission noted that:

  • There were no discernible nutritional deficiencies (either observed or reported) amongst the refugees.
  • The main concern of the refugees was the irregularity of the food distribution rather than the insufficiency of the rations.
  • Although the condition of the refugees in the camps had not fundamentally changed, some of the camp inhabitants no longer required food assistance.
  • The number of vulnerable refugees outside the camp had increased because of the harsh economic conditions and some of these people require food assistance.

In response to these finding it was recommended that:

  • Food assistance should be based on vulnerability as a criterion, rather than be focused on camp populations.
  • In order to facilitate this and to improve targeting of vulnerable refugees, it was proposed that a socio-economic survey should be undertaken in 1999. The results of this survey could be used to provide baseline data for planning and targeting future (food) assistance. The data may be used to exclude refugees who receive food aid but have already obtained financial stability as well as allow those outside the camps to benefit from assistance programmes.
  • In the meantime, until the survey has been completed, an additional 40,000 vulnerable refugees outside the camps who have been registered with Government authorities will receive food assistance.

Overall, the IDPs in Afghanistan are considered to be at moderate nutritional risk (category IIb). The 40,000 refugees in Iran who outside the camps are also considered to be at moderate risk of malnutrition. The other refugees in Iran and those in Pakistan are considered to be at low nutritional risk (category IIc).


RNIS 25, October 1998

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.


RNIS 24, June 1998

The most recent overview of the numbers of refugees and displaced people in Asia (as of the end of 1996) is as follows. There were an estimated 4.8 million refugees in Asia, of whom over 1.2 million were Afghans in Pakistan and in Iran (1.5 million). There were reported to be 600,000 Iraqis in Iran. Other large groups were refugees from Viet Nam in China (289,000), and Bhutanese in Nepal (92,000). No comprehensive data were available on the numbers of internally displaced populations in Asia, but they were certainly in the millions (UNHCR, 1997 'Populations of Concern to UNHCR').

This section of the report aims to give updated information on some of these situations. The current situation for the Afghan refugees/displaced populations, the largest single group in Asia with approximately three million affected people, is described. Available information on the Bhutanese refugees in Nepal and refugees from Myanmar in Bangladesh are included because of reports of micronutrient deficiencies. A section on the situation in Sri Lanka is also included. As in the past, we also include information on Southern Iraqi refugees in Iran.

Afghanistan Region

There has been on-going conflict in Afghanistan for the last twenty years, leading to massive displacement both within Afghanistan, and as refugee movements principally into Iran and Pakistan. The most recent developments have been the take-over of the capital city Kabul and two-thirds of the country by the Taliban, a fundamentalist Islamist group, in 1996. The continuous state of war had left most of the country's infrastructure in ruins. Fighting continues to the north of Kabul and recent reports are of fresh population displacements as a result. Much of the countryside remains calm. Talks between Taliban and representatives from the opposition Northern Alliance had begun with the main objectives set out as follows:

  • the appointment of a Council of Islamic scholars to move the peace process forward;
  • an end to the Taliban blockade of the Hazerajet region;
  • agreement on a cease-fire;
  • further release of prisoners.

However, the talks broke down earlier this year in Islamabad.

Some reconstruction and rehabilitation is being envisaged. Assessments of the priority needs are also being undertaken. It is currently estimated that 1.25 million people require humanitarian assistance in Afghanistan, Iran, and Pakistan [BAAG 30/04/98, OCHA 29/04/98, 05/05/98, WFP 22/05/98].

Wasting in Afghanistan (in children, 6-35 months old)

taken from: 'The 1997 Afghanistan Multiple Indicator Baseline', UNICEF 1997.

A multiple indicator baseline survey was carried out in Afghanistan in 1997. It was the first national-level survey carried out in 25 years, and gives baseline information for development and relief programmes including health, nutrition, education, food security, and the water and sanitation sector. Particular attention was paid to gender issues in the survey and potential biases in questionnaire response [UNICEF 1997].

The survey showed that 25% of children between the ages of 6-35 months were wasted, although there were variations between regions (see Annex I (12a)). Fifty-two percent of children in this age category were stunted (graph). This is very high, placing Afghanistan's children among the worst off in the world. Vitamin A deficiency, as defined by night blindness, was reported in about 3% of the children surveyed in Jalalabad and Kandahar; in other regions vitamin A did not appear to be a problem. Goitre was seen in Kabul where 13 cases were seen for every 1000 people [UNICEF 1997].

Stunting in Afghanistan (in children 6-35 months old)

taken from: 'The 1997 Afghanistan Multiple Indicator Baseline', UNICEF 1997.

Some factors likely to have an impact on the nutritional status of children were believed to be:

  • water and sanitation: time to fetch water varied, and was generally longer in rural areas. Protected supplies of water were inadequate, and there were inappropriate sanitation facilities;
  • women estimated that 20% of children benefit from exclusive breastfeeding;
  • measles immunisation coverage varied amongst regions, but in no cases was it greater than 60%;
  • care of common childhood illness needed to be improved. Specifically noted were inappropriate home treatment of ARI and diarrhoea [UNICEF 1997].

A survey in Kabul showed 7.2% wasting with 0.2% severe wasting. Oedema was measured at 0.3% (see Annex I (12b)). Wasting and/or oedema for the 6-29 month age group was significantly higher than in the 6-59 month age group. This difference was attributed largely to the introduction of poor quality complementary foods in the younger age group. Stunting was measured at 63% in the 6-59 month age group. However, probable inaccuracies in determining ages mean that these results must be interpreted with caution [ACF Dec. 97].

Malnutrition in Kabul over time children 6-59 months

taken from: Nutrition and Mortality Survey, Action contre la Faim, Dec. 1997.

Rates of wasting over time in Kabul have been relatively stable, despite a number of factors likely to negatively impact on nutritional status. Food prices have continued to rise while the currency has been devalued. Furthermore, the employment situation in the city has not improved. This stable situation is thought to be due in large part to the continuing humanitarian aid in the city, in particular the subsidised bakery programme. However, there has been a deterioration in nutritional status (as seen by a greater percentage of children with wt/ht <-1 SD) amongst children with an increasing number of children therefore at risk of acute malnutrition. Also, the under-five mortality rate was measured at 2.2/10,000/day with main causes of death reported by mothers as ARI and diarrhoea. The high mortality is thought to be partly related to declining nutritional status and reduced immunity. This is likely to indicate a need for improved care for these common illnesses as mentioned in the multiple indicator survey. Coverage of selective feeding programmes in the city is poor (< 20%) and shows no improvement since the previous survey. This may be explained by a number of factors including the long hard winter and the high level of population movements to and from the city [ACF Dec. 97, UNICEF 1997].

Earlier RNIS reports (Nos. 22, 23) described a desperate situation for the 1.2 million people in Hazarajat region. Food deliveries from the south, east and west have been blockaded by the Taliban, who say the supplies delivered would feed the opposition in the north. As the snow melted and roads opened up to villages in the region, reports from missions in the area were of people in a very serious condition. Food stocks in many areas are depleted and markets are empty. It is estimated that up to 167,000 persons in the outlying regions of Hazarajat have food stocks for only a few weeks. However, the Taliban have temporarily lifted the blockade for a small quantity of food to get through on condition that some food is also sent Ghorbund located at the front lines of fighting in Parwan Province. WFP has recently distributed foods in the two areas [WFP 01/05/98, 08/05/98, 29/05/98].

A recent earthquake in Faizabad, Badakhshan province, and Rustaq, Takhar province has destroyed many villages and killed at least 2,000 people. Urgent needs appear to be for shelter, medicine and clean drinking water [MERLIN 01/06/98, WFP 29/05/98].

Iran There are approximately 1.4 million Afghan refugees in Iran, the majority of whom arrived during the 1980s during the Soviet occupation of Afghanistan. Approximately 88,000 people receive food aid, 25,000 of whom live in camps. Most of the non-camp refugees receive indirect assistance through government subsidies for education, health services, and some commodities. A decline in the Iranian economy has resulted in the withdrawal of some of these subsidies, which is likely to have a negative impact on health and nutrition status. There are a small number of Afghans repatriating [UNHCR 16/05/98, 1997-9].

Pakistan There are approximately 1.2 million Afghan refugees in Pakistan, 25,000 of whom require assistance. Repatriation is picking up momentum [UNHCR 16/05/98].

Overall, there are reports of malnutrition and starvation among some people in Hazerajat, and these people are considered to be at high risk (category IIa in Table 1). The remaining affected population in Afghanistan can be considered to be at moderate nutritional risk (category IIb in Table 1) while the refugees in Iran and Pakistan are not currently considered to be at nutritional risk (category IIc in Table 1).

On-going interventions The multiple indicator survey highlights some areas where development programme activities would be likely to improve nutritional status of the population nationwide. These include:

  • water and sanitation - improving access to clean water and improved sanitation facilities;
  • education to improve exclusive breastfeeding and treatment of common childhood illnesses;
  • continued immunisation campaigns as were carried out in 1996 (see RNIS 17), and are on-going in some areas. Landmine clearance remains a major priority.

In Kabul, coverage of selective feeding programmes needs to be improved. On-going, effective monitoring of IDD programmes is needed, which would include the monitoring of iodine in locally available salt. Technical input from the international community is needed. The prevalence of vitamin A deficiency in Jalalabad and Kandahar constitutes a public health problem and should be addressed. The multiple indicators survey summarised above showed under 25% of children less than three years old had received vitamin A capsules, indicating a need for wider distribution.

There is also a need for on-going health education to improve home care for common childhood diseases like diarrhoea and API. This is particularly important as prevalence of diarrhoea is likely to increase in the coming summer months, further jeopardising nutritional status in the capital. Funds need to be urgently provided so that WFP can purchase food locally to set up distributions, access permitting, for the emergency affected Hazerajat area.
 


RNIS 23, March 1998

The most recent overview of the numbers of refugees and displaced people in Asia (as of the end of 1996) is as follows. There were an estimated 4.8 million refugees in Asia, of whom over 1.2 million were Afghans in Pakistan and in Iran (1.5 million). There were reported to be 600,000 Iraqis in Iran. Other large groups were refugees from Viet Nam in China (289,000), and Bhutanese in Nepal (92,000). No comprehensive data were available on the numbers of internally displaced populations in Asia, but they were certainly in the millions (UNHCR, 1997 'Populations of Concern to UNHCR').

This section of the report aims to give updated information on some of these situations. The current situation for the Afghan refugees/displaced populations, the largest single group in Asia with approximately three million affected people, is described. Available information on the Bhutanese refugees in Nepal and refugees from Myanmar in Bangladesh are included because of reports of micronutrient deficiencies. A section on the situation in Sri Lanka is also included. As in the past, we also include information on Southern Iraqi refugees in Iran.

The conflict in Afghanistan, which had been ongoing for almost twenty years, took a new direction when the Taliban, a fundamentalist Islamic group, swept across most of the country in 1996. Fighting has continued throughout 1997 and early 1998, but has largely been concentrated in the northeast of the country. The continuous state of war has led to a steady decline in the economy. Government salaries have all but disappeared, trade has been markedly reduced and food prices have become grossly inflated. In addition, women are rarely allowed to work outside their homes in Taliban-controlled areas. However, in some parts of the country, particularly in the south and west which have been relatively quiet, reconstruction and rehabilitation work is being carried out. Signs are beginning to emerge that the warring parties may be acknowledging that a military solution to the conflict is unrealistic.

Despite some repatriation, there are at least 2.5 million Afghan refugees remaining in neighbouring Iran and Pakistan. It is thought that 650,000 of these people require emergency assistance, the rest being largely self-sufficient. There are 1.5 million people in Afghanistan requiring emergency aid.

In Kabul, food assistance in the form of subsidised bread is continuing and ICRC distributes bi-monthly rations to vulnerable families. Over 70% of food commodities distributed in 1997 were provided through subsidised bread sales projects in Kabul, Mazar, Jalalabad, Kandahar and Faizabad. A recent assessment of household food security in two districts of Kabul was undertaken. Recommendations from the assessment included the need to support food production activities and increase people's access to food. This could be achieved by improving the economic circumstances of the urban population by, for example, revitalising existing food-processing factories, setting up green houses for vegetable gardens and establishing other micro-projects for income generation. Although a random sample anthropometric survey was not conducted, stunting appeared to be widespread [ICRC 21/01/98].

Aid deliveries outside of the capital city have been hindered by heavy snowfalls leading to impassable roads. For example, relief provision for victims of an earthquake in February 1998 were made difficult by the inclement weather. Relief supplies had to be airdropped into the region [WFP 13/02/98, 20/02/98].

The last RNIS report (no. 22) described a desperate situation for 1.2 million people affected by a blockade around Bayman in Hazarajat region, 160,000 of whom were thought to be facing starvation. Since that time food has been airlifted to the population. A more recent report has stated that although there is no Visible evidence of actual starvation, affected families are clearly in need of emergency food aid in order to supplement household food stocks to survive the winter' [WFP 02/01/98].

Overall, those requiring aid in the Hazarajat region, where access has been sporadic, are likely to be at heightened risk (category IIa in Table 1), particularly with the winter season making access difficult. The remaining population in Afghanistan is likely to be at moderate risk (category IIb in Table 1), while the refugees in Iran and Pakistan are not currently considered to be at heightened risk (category IIc in Table 1).

On-going interventions

A recently launched Consolidated Appeal for Afghanistan highlights humanitarian relief and rehabilitation projects planned to benefit 1.5 million Afghans in 23 provinces during 1998. Relief assistance will be distributed mainly through subsidised bread sales and other channels used effectively during 1997. Food-for-work and food-for-training projects will be continued to promote rehabilitation activities. Quick impact projects will also be utilised to promote the rapid re-integration of returnees.

Some of the other needs outlined in the appeal include:

  • rehabilitation of health facilities;
  • improvement in the supply of safe drinking water and sanitation - as a consequence of poor sanitary conditions it is estimated that 42% of all deaths in Afghanistan are due to diarrhoeal diseases and that 85,000 children under five die annually from diarrhoeal diseases;
  • clearance of landmines, along with education/awareness campaigns;
  • understanding the extent of chronic malnutrition in Afghanistan with a view to devising interventions to address the problem;
  • improvement in the immunisation coverage, particularly of measles and polio.

RNIS 22, December 1997

The most recent overview of the numbers of refugees and displaced people in Asia (as of the end of 1996) is as follows. There were an estimated 4.8 million refugees in Asia, of whom over 1.2 million were Afghans in Pakistan and in Iran (1.5 million). There were reported to be 600,000 Iraqis in Iran. Other large groups were refugees from Viet Nam in China (289,000), and Bhutanese in Nepal (92,000). No comprehensive data were available on the numbers of internally displaced populations in Asia, but they were certainly in the millions (UNHCR, 1997 'Populations of Concern to UNHCR').

This section of the report aims to give updated information on some of these situations. The current situation for the Afghan refugees/displaced populations, the largest single group in Asia with approximately three million affected people, is described. Available information on the Bhutanese refugees in Nepal and refugees from Myanmar in Bangladesh are included because of reports of micronutrient deficiencies. A section on the situation in Sri Lanka is also included. As in the past, we also include information on Southern Iraqi refugees in Iran.

Fighting is continuing in Afghanistan, with the front line now about 30-40 kilometres north of Kabul. Much of the rest of the country is calm. UN buildings have been looted and at the end of October in one area - Hairaton - 50,000 tons of food per day were being taken to feed troops. This has, reportedly, since stopped [DHA 28/10/97].

Access to some services for women in Kabul is improving. For example, a recent report confirmed that women were being admitted to Kabul's hospitals, and that many female staff have returned to work. However, after a visit to the country, the UN Assistant Secretary-General and Special Advisor on Gender Issues concluded that 'the situation of women in Afghanistan is...a very dire one' [ICRC 26/11/97, UNDPI 26/11/97].

A survey carried out in June 1997 in Kabul showed 6.7% wasting with 0.5% severe wasting. Oedema was measured at 0.1% (see Annex I (14a)). These results are comparable to those obtained in previous surveys (see graph).

Malnutrition in Kabul over time

However, closer analysis of the data shows that a greater proportion of children have low weights (although they are not malnourished as defined by -2 SD < WHZ) than in any previous survey since November 1995. There are a number of factors at play here. The fact that prevalence of wasting has not increased is likely to be attributable to the existence of feeding centres and the bakery subsidy programmes. However, the food security situation in the capital is still precarious for most people. The country has had to face a blockade from Iran and Pakistan who have been the major exporters of food to Afghanistan. This has contributed to an increase in the price of wheat flour at a time when there has been no increase in wages. Coverage of the selective feeding programmes in Kabul was low at only 224% [ACF Jun. 97].

Permission from the Taliban to import food aid into the Hazarajat region has so far not been granted and it is estimated that 1.2 million people are affected by the blockade, with 160,000 of the most vulnerable facing starvation unless food supplies reach the area. A combination of the blockade and poor harvests due to frost and flooding has meant that many households are anticipated to run out of food by December. The more expensive option of airlifting food supplies into the area is now planned [DHA 13/11/97, WFP 26/11/97].

There are reports of some returnees from Pakistan to Kandahar [DHA 28/10/97].

Pakistan There are no reports to change in the adequate nutritional status of the approximately 330,000 Afghani refugees requiring aid in Pakistan.

Iran There are no reports on the nutritional status of the approximately 322,000 assisted Afghani refugees in Iran.

Overall, those requiring aid in the Hazarajat region, where access has been denied, are likely to be at heightened risk (category Ha in Table 1), particularly with the beginning of the winter season. The remaining population in Afghanistan is likely to be at moderate risk (category IIb in Table 1), while the refugees in Iran and Pakistan are not currently considered to be at heightened risk (category IIc in Table 1).

Ongoing interventions: Resources should be made available for the urgent airlift programme to Hazarajat region. In Kabul there is a need to continue close monitoring of the population's nutritional status and to keep open the existing feeding centres in the capital city. There is also a need to increase home visiting by community health workers in order to improve prevention and detection of malnutrition. Increased co-ordination between humanitarian agencies may help to ensure all vulnerable individuals and families are receiving adequate aid.
 


RNIS 21, September 1997

The most recent overview of the numbers of refugees and displaced people in Asia (as of the end of 1996) is as follows. There were an estimated 4.8 million refugees in Asia, of whom over 1.2 million were Afghans in Pakistan and in Iran (1.5 million). There were reported to be 600,000 Iraqis in Iran. Other large groups were refugees from Viet Nam in China (289,000), and Bhutanese in Nepal (92,000). No comprehensive data were available on the numbers of internally displaced populations in Asia, but they were certainly in the millions (UNHCR, 1996 'Populations of Concern to UNHCR').

This section of the report aims to give updated information on some of these situations. The current situation for the Afghan refugees/displaced populations, the largest single group in Asia with approximately three million affected people, is described. Available information on the Bhutanese refugees in Nepal and refugees from Myanmar in Bangladesh are included because of reports of micronutrient deficiencies. A section on the situation in Sri Lanka is also included. As in the past, we also include information on Southern Iraqi refugees in Iran.

Civil strife has been continuing in Afghanistan for almost twenty years. The most recent upsurge in fighting led to an almost complete sweep across the country of the Taliban, a fundamentalist group who now controls most of the country, including Kabul. Fighting is continuing north of Kabul [ICRC 28/08/97, WFP 19/09/97].

This ongoing conflict has led to large-scale displacement within Afghanistan and refugee movements into neighbouring countries. It is estimated that 1.75 million people in Afghanistan are in need of food aid. There are a further 330,000 refugees in Pakistan and 322,000 in Iran in need of assistance.

Afghanistan Heavy fighting outside of Kabul has led to fresh waves of displacement and the situation north of the city remains tense. The security situation in the south is calmer, and some return to normalcy is being seen. It is currently estimated that there are over 200,000 displaced people in the capital. Emergency aid is needed for a total of 1.75 million people in Afghanistan. Those in need include internally displaced persons, the sick and elderly, households headed by women, and returnees. Food aid is mainly provided in the form of subsidised bread at bakeries and through food-for-work projects [ICRC 28/08/97, UNDPI 22/07/97].

Agriculture has been disrupted due to damage to irrigation systems, mines in fields, and market disruptions. However, in many areas, particularly in the south, some return to normalcy is being seen. Yields from the harvest in July are estimated to be higher than last year, although there are problems anticipated with transporting food from surplus to deficit areas. Partial closure of the border with Uzbekistan has let to massive inflation of fuel prices so that commercial transporters are now charging ten times the rate they were charging previously. The Uzbek authorities have allowed food into Afghanistan by barge, however the road bridge linking Afghanistan with Uzbekistan remains sealed [FAO 07/08/97].

It is estimated that a mere 26% of the population have access to health care services and only 12% have access to safe drinking water [FAO 07/08/97].

Iran There are no recent nutritional data on the approximately 322,000 assisted Afghani refugees in Iran. Previous reports were of an adequate nutritional status among this population.

Pakistan There are estimated to be 330,000 Afghani refugees in Pakistan currently requiring aid. General rations were phased out in October 1995 and replaced by a safety net programme which began providing assistance to vulnerable groups. A survey carried out six months after this change showed an adequate nutritional status among children [UNHCR 26/06/97]. children [UNHCR 26/06/97].

A follow-up survey was carried out in May 1997. The survey showed levels of wasting varying from 2.6-3.8% (see Annex I (14a-c)), similar to those found during the previous survey. This compares with a prevalence rate of 9% wasting amongst the local population. The malnutrition seen was felt to be mainly as a result of cases of diarrhoea, not of food shortages. The underlying causes for the high number of diarrhoea cases was believed to relate to feeding practices, care and hygiene, particularly at the time of weaning. [UNHCR 26/06/97].

Overall, those requiring emergency assistance in Afghanistan can be considered to be at moderate nutritional risk (category IIb in Table 1) due to insecurity hampering relief efforts. The refugees in Pakistan and Iran are not currently thought to be at heightened risk of malnutrition and associated mortality (category lie in Table 1).

Ongoing interventions: Resources should continue to be made available for food for work programmes in Afghanistan. These programmes are currently needed to support food production initiatives and food for seeds, rehabilitation of irrigation networks and drainage, agricultural land rehabilitation, flood control and agro-forestry. Other priorities include the need to support reintegration and resettlement of the displaced and rehabilitation of health delivery systems.

As most of the existing malnutrition in Pakistan seems to derive from inadequate caring practices (especially poor weaning methods) this needs to be addressed through training and education at basic health unit and school level.
 


RNIS 20, June 1997

The most recent overview of the numbers of refugees and displaced people in Asia (as of the end of 1995) is as follows. There were an estimated 4.5 million refugees in Asia, of whom over 800,000 were Afghans in Pakistan and in Iran (1.5 million). There were reported to be 600,000 Iraqis in Iran. Other large groups were refugees from Myanmar in Bangladesh (36,000), Vietnamese in China (286,000), and Bhutanese in Nepal (90,000). No comprehensive data were available on the numbers of internally displaced populations in Asia, but they were certainly in the millions (UNHCR, 1995 'Populations of Concern to UNHCR').

This section of the report aims to give updated information on some of these situations. The current situation for the Afghan refugees/displaced populations, the largest single group in Asia with approximately three million affected people, is described. Available information on the Bhutanese refugees in Nepal and refugees from Myanmar in Bangladesh are included because of previous reports of micronutrient deficiencies. As in the past, we also include information on Southern Iraqi refugees in Iran.

The fifteen year long conflict in Afghanistan continues and approximately 2.1 million people are affected regionally. This includes at least 1.5 million people in Afghanistan, 300,000 of whom are in Kabul, 330,000 people in Pakistan, and 322,000 refugees in Iran who require assistance.

The Taliban have made major advances in northern Afghanistan and now control two thirds of the country. Fighting is continuing in northern and central areas of Afghanistan, in particular in the Badghis region and is leading to population displacements. For example, there are at least 34,000 displaced people in Herat. There are also reports of increasing opposition in some parts of the eastern region with an increase in military activity in the area. While this fighting is reported to be intense, some areas of the country are relatively calm so that plans for reconstruction and rehabilitation are being made [DHA 15/04/97, DHA 30/04/97, ICRC 09/04/97].

A nutritional survey conducted in Kabul during the second half of December 1996 found 5.1% wasting with 0.8% severe wasting and/or oedema (see Annex I (16a)). Since that time, food shortages have been acute and food security is generally reported to be deteriorating throughout the country. The price of wheat, the staple of the Afghani diet, has increased dramatically and the price of bread in Kabul had shot up by 350% over the last year. Signs of hardship have been increasing with the number of people begging on the streets for bread rising. Many households have now sold everything that can be sold in order to purchase food [ACF 30/12/96, DHA 15/04/97, 30/04/97, ICRC 09/04/97, WFP 11/04/97].

Shortages are mainly due to two factors. First, a shortage of wheat in Pakistan has reduced imports and led to the closure of the border in March and second, this is traditionally the lean season just before the June harvest. It was hoped that the coming wheat harvest would improve matters, but a combination of factors like flooding in western and northern areas, a shortfall of rain and snowfall in Mazar-i-Sharif and widespread displacement of farmers due to fighting north of Kabul, will lead to a greater deficit in the harvest than last year [DHA 15/04/97, 30/04/97, ICRC 09/04/97, WFP 11/04/97].

In the meantime, WFP will continue to expand its bakery subsidy programme aimed at providing low cost bread to the poorest people in Kabul and Jalalabad, where it already feeds 450,000 people every day. Authorities in the Taliban controlled areas have requested WFP's help in dealing with the situation to prevent starvation among the most vulnerable parts of the population. However, WFP's own stocks, if not replenished will run out by early summer [DHA 15/04/97, 30/04/97, ICRC 09/04/97, WFP 11/04/97].

Pakistan There are a total of 330,000 Afghani refugees in Pakistan requiring assistance. Most of these (300,000 people) receive assistance through a "safely net" rehabilitation programme. Thirty thousand newer arrivals receive emergency food assistance. There has been a serious shortfall of wheat due to failure of rains and delays in import shipments [WFP 11/04/97].

Iran There are no reports of change to the generally adequate nutritional status of the approximately 322,000 Afghani refugees in Iran.

Overall, the affected population in Afghanistan can be considered to be at moderate nutritional risk (category IIb in Table 1) due to problems with food security. The refugees in Iran and Pakistan are not currently thought to be at heightened nutritional risk (category IIc in Table 1).

How could external agencies help? As detailed in a recently launched Consolidated Appeal for Afghanistan, there is scope for much rehabilitation work to be carried out in the country, as many areas are now relatively calm. A widespread problem throughout the country is inadequate supplies of safe water, and rebuilding the water and sanitation systems in the country should be a priority. The health care system is also barely functioning, and there is an increase of communicable diseases throughout the country. Rebuilding and restocking medicines and vaccines in the health care system would be likely to have a profoundly positive effect on the Afghani population.

Donors should now come forward to provide food commodities for monetization to markets in Afghanistan, either directly or through traders. Given the deteriorating food security currently being seen in many parts of the country and reflected in massive food price inflation, nutritional surveys should be carried out in large urban centres such as Kabul and Jalalabad where so much of the population depends on markets. Furthermore, WFP food stocks for vulnerable group feeding programmes urgently need to be replenished.
 


RNIS 19, March 1997

The most recent overview of the numbers of refugees and displaced people in Asia (as of the end of 1995) is as follows. There were an estimated 4.5 million refugees in Asia, of whom over 800,000 were Afghans in Pakistan and in Iran (1.5 million). There were reported to be 600,000 Iraqis in Iran. Other large groups were refugees from Myanmar in Bangladesh (36,000), Vietnamese in China (286,000), and Bhutanese in Nepal (90,000). No comprehensive data were available on the numbers of internally displaced populations in Asia, but they were certainly in the millions (UNHCR, 1995 Populations of Concern to UNHCR').

This section of the report aims to give updated information on some of these situations. The current situation for the Afghan refugees/displaced populations, the largest single group in Asia with approximately three million affected people, is described. Available information on the Bhutanese refugees in Nepal and refugees from Myanmar in Bangladesh are included because of previous reports of micronutrient deficiencies. As in the past, we also include information on Southern Iraqi refugees in Iran.

Fighting is continuing in various locations outside of Kabul and has reportedly led to fresh population displacements. For example, it is estimated that 30,000 new arrivals in Pakistan require emergency aid, and a further 90,000 people are said to have fled fighting in the north of Afghanistan and have moved to Kabul. The capital has also been under attack with several bombing and rocket attacks carried out by opposition forces resulting in a number of civilian mortalities. It is estimated that 1.5 million people in Afghanistan require emergency food aid. There are at least a further 900,000 Afghan refugees in Pakistan, 350,000 of whom are believed to require assistance, and 1.4 million in Iran, 322,000 of whom require assistance [ABC 28/01/97, WFP 31/01/97, 10/02/97, DHA 14/01/97].

Kabul The population in Kabul continues to swell due to the arrival of people newly displaced by fighting north of the city. Most recent estimates are of at least 115,000 new arrivals. Although many of the IDPs are staying with relatives, others are living in schools and other public buildings. Many of these are overcrowded. There is reportedly a major food shortage in the whole Kabul region. Food prices have recently risen by 25%. This, coupled with the severe winter weather has resulted in increasing numbers of Afghan people relying on the international community to survive. There are now thousands of destitute people in the capital who are being targeted with food and non-food relief items. It is estimated that at least one fifth of the city's population are poverty stricken. The disabled, war widows and orphans are considered to be the most vulnerable groups. Humanitarian operations have restarted in many areas, after a suspension due to restrictions placed on women by the Taliban. For example, provision of subsidised bread through the capital's bakeries has been re-introduced [DHA 22/01/97, 13/02/97, 25/02/97, ICRC 22/01/97, WFP 03/01/97).

Jalalabad Earlier in 1996, a nutritional survey carried out in Jalalabad City showed 4.5% wasting with 0.4% severe wasting. In the camps for internally displaced people (population estimated at 150,000) wasting was measured at 3.3% with 0.3% severe wasting (see Annex 1 16(a,b)). While this is not a particularly recent survey, anecdotal reports are that the situation has remained stable over the past six months, and that existing programmes are coping with the influx of people from Kabul. The provision of a full general ration for IDPs in Jalalabad was stopped in June 1995 and replaced with a monthly 50 kg ration of wheat for each family. This provides on average less than 1,200 kcals/person/day. The low levels of wasting in the camps therefore indicate that this population have other sources of food and income apart from the wheat ration. [WHO July 1996].

Survey carried out in other camps for internally displaced people outside of Kabul and excluding Jalalabad showed low levels of wasting varying from 3.4-5.8% (see Annex I 16(c-e)) [MSF-H 05/03/97].

Pakistan Fighting between government and Taliban forces in Afghanistan has led to an influx of at least 30,000 people into Pakistan. Conditions for these new arrivals are described as "harsh"; more than 1,000 families are said to be living in the open, without shelter, food or warm clothes [DHA 29/01/97].

Iran There are no reports of change for the 322,000 Afghan refugees requiring assistance in Iran.

Overall, an estimated 20% of the population of Kabul who are thought to be poverty-stricken are in category IIa in Table I. The remaining population in Kabul, along with the new arrivals in Pakistan can be considered to be at moderate nutritional risk (category IIb in Table 1). The remaining refugees in Pakistan, along with those in Iran and internally displaced people outside of Kabul are not currently considered to be at heightened nutritional risk (category IIc in Table 1).

How could external agencies help? Humanitarian agencies must continue to argue for gender equality in Taliban controlled locations, particularly in education and work opportunities as this policy now seems to be paying off. Agencies must also focus efforts on improving the water supply and sanitation conditions in Kabul, as this is a major cause of health problems in the city. There is also a need to establish a national nutritional surveillance system in order to monitor nutritional conditions throughout the country more effectively.
 


RNIS 18, December 1996

The most recent overview of the numbers of refugees and displaced people in Asia (as of the end of 1995) is as follows. There were an estimated 4.5 million refugees in Asia, of whom over 800,000 were Afghans in Pakistan and in Iran (1.5 million). There were reported to be 600,000 Iraqis in Iran. Other large groups were refugees from Myanmar in Bangladesh (36,000), Vietnamese in China (286,000), and Bhutanese in Nepal (90,000). No comprehensive data were available on the numbers of internally displaced populations in Asia, but they were certainly in the millions (UNHCR, 1995 ‘Populations of Concern to UNHCR’).

This section of the report aims to give updated information on some of these situations. The current situation for the Afghan refugees/displaced populations, the largest single group in Asia with approximately three million affected people, is described. Available information on the Bhutanese refugees in Nepal and refugees from Myanmar in Bangladesh are included because of previous reports of micronutrient deficiencies. As in the past, we also include information on Southern Iraqi refugees in Iran.

Sporadic fighting continues between warring factions north of Kabul, while the city itself is reportedly calm. Peace initiatives and conferences brokered by Pakistan, Iran and the UN Special Envoy continue. As the fundamentalist Taliban forces progressed across Afghanistan to Kabul, women were originally forbidden to work and attend school but these restrictions are now being relaxed in some areas. For example, WFP’s women’s projects, including the subsidised bakery project for women, have resumed. WFP have lifted the suspension of WFP food shipments into areas such as the north and parts of the south, west and eastern provinces, where relief activities in favour of men and when can continue largely unaffected by the Taliban pronouncements on women. However, UNHCR recently temporarily suspended their work in Kabul after what they described as ‘weeks of harassment’ [Agence France Press 21/11/96, DHA 20/11/96].

Kabul Thousands of people are reportedly leaving Kabul; for example over 6,000 people left the city between 20-26th of October, and over 3,000 departed in mid-November. There are a smaller number of returnees, some of whom are passing through Kabul on their way north. Programmes in favour of women, such as the bakery project have now resumed in the capital [DHA 12/11/96, WFP 01/11/96].

There are no new reports on the nutritional situation of the estimated 600,000 vulnerable people in Kabul. As winter approaches, aid agencies are stockpiling relief items which will be needed over the coming months.

Jalalabad The number of internally displaced people in the Jalalabad area is estimated at 160-200,000. There are a number of new arrivals who are either in the two camps or living among the local population. There are no recent reports on the nutritional situation of these people.

Pakistan There is a slight increase in the number of Afghan refugees in Pakistan due to new arrivals from Kabul.

Iran There are no reports of change in the situation for the 1.4 million Afghani refugees in Iran.

Overall, the vulnerable population in Kabul is at moderate nutritional risk (category IIb I Table 1), and the remaining affected population is not currently though to be at heightened nutritional risk (category IIc in Table 1).

How could external agencies help? It is essential to stock enough relief items to last through the winter months. Important items include food aid, fuel for heating, and blankets. There is also a need to resupply hospitals ahead of the winter snows.

Some longer term projects, as outlined in the Consolidated Appeal for Afghanistan, focus on reconstruction and include:

  • improving water and sanitation, particularly in Kabul;
  • increasing agricultural production through the provision of farm inputs and the continuation of the defining process;
  • rehabilitating of health infrastructure.

RNIS 17, September 1996

The most recent overview of the numbers of refugees and displaced people in Asia (as of the end of 1995) is as follows. There were an estimated 4.5 million refugees in Asia, of whom over 800,000 were Afghans in Pakistan and in Iran (1.5 million). There were reported to be 600,000 Iraqis in Iran. Other large groups were refugees from Myanmar in Bangladesh (51,000), Vietnamese in China (286,000), and Bhutanese in Nepal (90,000), No comprehensive data were available on the numbers of internally displaced populations in Asia, but they were certainly in the millions (UNHCR, 1995 ‘Populations of Concern to UNHCR’).

This section of the report aims to give updated information on some of these situations. The current situation for the Afghan refugees/displaced populations, the largest single group in Asia with approximately three million affected people, is described. Available information on the Bhutanese refugees in Nepal and refugees from Myanmar in Bangladesh are included because of previous reports of micronutrient deficiencies. As in the past, we also include information on Southern Iraqi refugees in Iran.

The security situation in Kabul remains tense, as rocket and artillery shelling continue to be exchanged between government forces and the Taliban. Most recently, it has been reported that the Taliban forces have taken control of the capital city. Prior to this development, it was reported that people continued to return to Kabul from Jalalabad and Pakistan. The Taliban has taken control of Jalalabad, a western urban centre where camps for internally displaced people are located.

Kabul It is too soon to assess the impact on the health and nutritional status of the population of the takeover of Kabul by Taliban forces. Prior to this development, humanitarian aid agencies continued to provide relief goods to the capital. There were reports of increasing numbers of returnees. For example, over 9,000 people were observed to return to Kabul from 21 July to 1 August [UNAA 12/08/96].

A recent nutritional survey carried out in the city showed a low prevalences of wasting in the population under five years old, despite what is considered to be a precarious food security situation. The survey showed 6.7% wasting with 1.4% severe wasting, and no cases of oedema were seen (see Annex I 17(a)). These results are similar to those seen in a survey conducted in October 1995 when wasting and/or oedema was measured at 6.2%. However, only 10% of eligible children were attending feeding centres. Since this survey, there have been anecdotal reports of a deterioration in the nutritional status of this population [ACF May 96, ICRC 25/09/96].

Although many different foods were available on the markets, prices have risen without a corresponding rise in wages thereby reducing the purchasing power of the people. This is mostly due to the continuing devaluation of the Afghani currency. The fact that there is no apparent decline in nutritional status despite price inflation and the hardships of winter is believed to reflect the positive impact of a number of interventions. These include targeted feeding of families with disabled or widowed heads of households, distribution of foods to orphanages, hospitals and kindergartens, food-for-work programmes, opening new feeding centres, and subsidies given to bakeries [ACF May 96].

Jalalabad Recent fighting and the installation of the Taliban in Jalalabad led to temporary disruptions in food deliveries to the approximately 160,000-200,000 internally displaced people in two camps. There were also reports of some people arriving in the camps fleeing insecurity. The security situation has calmed to the point that food distributions are now taking place [UNAA 10/09/96].

Refugees in Iran A nutritional survey planned for July has been postponed as authorisation was not given [MSF-F 16/09/96]. There are therefore no nutritional data on the 1.4 million Afghani refugees in Iran.

Refugees in Pakistan Refugees are reportedly returning from Pakistan to Kabul. For example 1,500 people returned from 12-18 July and 1,400 from 23-29 August [UNAA 04/08/96, 10/09/96].

Overall, the war affected population in Kabul can be considered to be at moderate nutritional risk (category IIb in Table 1), while the remaining refugee and internally displaced populations are not currently considered to be at heightened risk (category IIc in Table 1).

How could external agencies help? Although the nutritional situation in Kabul appears to remain stable, there is a need to increase coverage of feeding centres, and also to continue support for the existing programmes which have undoubtedly safe-guarded food security and contributed to the relatively low levels of wasting currently being seen. These include food-for-work programmes, subsidies for bakeries and targeted feeding of vulnerable groups. This will become increasingly important as winter approaches.

The first round of a mass immunization campaign was successfully carried out in June 1996, and the second round in July. Over 5 million children were immunized against polio, measles and DTP and vitamin A capsules were also distributed. Over two million women of child-bearing age were to be immunized against tetanus. These types of programmes will continue to need external agency support until such time as the health infrastructure in Afghanistan is restored and self-supporting.
 


RNIS 16, June 1996

The most recent overview of the numbers of refugees and displaced people in Asia (as of the end of 1994) is as follows. There were an estimated 5.0 million refugees in Asia, of whom 1.1 million were Afghans in Pakistan and in Iran (1.6 million). There were reported to be 610,000 Iraqis in Iran. Other large groups were refugees from Myanmar in Bangladesh (120,000), Vietnamese in China (290,000), Chinese (Tibet) in India (110,000), and Bhutanese in Nepal (100,000). No comprehensive data were available on the numbers of internally displaced populations in Asia, but they were certainly in the millions (UNHCR, 1994 ‘Populations of Concern to UNHCR').

This section of the report aims to give updated information on some of these situations. The current situation for the Afghan refugees/displaced populations, the largest single group in Asia with approximately three million affected people, is described. Available information on the Bhutanese refugees in Nepal and refugees from Myanmar in Bangladesh are included because of previous reports of micronutrient deficiencies. As in the past, we also include information on Southern Iraqi refugees in Iran.

There are approximately three million people affected regionally by this fifteen year old conflict. Many of those affected are refugees either in Iran or Pakistan, and are currently considered to be self-sufficient.

Kabul Fighting between government and Taliban forces continues in areas south and southeast of Kabul. Despite this, people are returning to the capital city. For example, over 4,000 people returned to Kabul during the last week in May. Food convoys continue to enter the city, and markets are likely to be adequately stocked [UNHAA 06/06/96].

A massive immunisation campaign, which began in November 1994, is continuing, and the next round of immunisations is scheduled for June, then July. The July campaign will immunise and also distribute vitamin A [UNHAA 06/06/96].

Displaced in Jalalabad There are approximately 160-200,000 displaced people in five camps near Jalalabad city. The majority have fled Kabul and surrounding areas since 1992.

Nutritional surveys were conducted between December 1995 and February 1996 in two camps as well as in Jalalabad city and Shenwar district, to determine if there had been any adverse nutritional effects since the reduction in general ration programme for the displaced. The surveys showed a reasonable nutritional status amongst the displaced and local populations. In New Hadda camp (estimated population of 30,000) low levels of wasting and/or oedema of 4.0% with 0.6% severe wasting and/or oedema were measured (see Annex I (17a)). Measles immunisation coverage was estimated to be 79%. In Sarshahi camp (estimated population of 80,000) wasting and/or oedema was measured at 4.7% with 1.6% severe wasting and/or oedema (see Annex I (17b)). Measles immunisation coverage was estimated at 80.7%. These rates were slightly higher than those measured in the surrounding local population living in Jalalabad city (3.2%) and Shenwar district (2.6%) [MSF-H.28/03/96].

According to food basket monitoring data, general rations received by those in the camps in the previous three months supplied 25% of caloric needs. Food stocks at household level seemed satisfactory but the survey was conducted immediately after a general ration distribution. Selling assets, borrowing money and goods and selling labour were observed to be the main sources of cash income for the camp populations. The average income only covered about 63% and 47% of the cost of the minimum diet in Sarshahi and New Hadda camp respectively. The survey concluded that the way internally displaced people are coping at present by selling personal assets is increasing their vulnerability; that the food security situation of the IDPs is precarious especially in New Hadda where income earning opportunities and food security are very poor [MSF-H 28/03/96]. More recently, food for work opportunities are being offered to improve food security [WFP 20/06/96].

The observed incidence of diarrhoea recorded in the camps and among the local population is very high especially given that March is not a peak season for diarrhoea. The main reasons are thought to be poor environmental sanitation and lack of knowledge of hygiene and cleanliness practices [MSF-H 28/03/96].

Refugees in Pakistan There remain approximately 860,000 Afghan refugees in Pakistan. It is expected that 250,000 will repatriate in 1996 and a further 300,000 in 1997. Most of the remaining refugees are considered to be self-sufficient so that general ration distributions have been replaced by a targeted feeding programme called a “safety net programme”. This programme provides edible oil to refugee mothers attending Basic Health Units and female children attending primary schools. Oil rations are also provided to women involved in NGO-assisted training centres, the handicapped and new arrivals [UNHCR 21/05/96].

Approximately 8,000 refugees in Pakistan who arrived since 1994 are not yet considered to be self-sufficient and this group receives a more comprehensive general ration [UNHCR 21/05/96].

A nutrition survey conducted in refugee villages in Pakistan carried out in March and April 1996 showed a relatively adequate nutritional situation amongst the refugee population with overall levels of wasting having declined since October 1995. Levels of wasting and/or oedema varied from 1.8-3.6% with 0.6-1.1% severe wasting and/or oedema (see Annex I (17 c-f)). In all surveyed areas, children between 60-77 cms in height (less than 2 years) were found to have highest levels of wasting, which were attributed largely to poor weaning practices [UNHCR Mar-Apr 96].

The survey also found that the occurrence of diarrhoea had declined compared to October 1995 and that all refugee populations had reasonable access to water although maintenance of supplies was sometimes difficult [UNHCR Mar-Apr 96].

Refugees in Iran There are approximately 1.4 million Afghan refugees in Iran of whom 20,000 live in camps and receive assistance. The remaining refugees live and work amongst the local population. It is possible that deteriorating economic conditions in Iran will place an increasing strain upon those refugees living outside the camps. Rising prices, limited job opportunities and dwindling purchasing power may begin to adversely affect the nutritional status of this population. In 1996, the ration to those refugees in camps has been increased by including sugar and rice. A nutritional survey is planned for the end of June 1996 to determine whether there has been any change in the nutritional status of these refugees [MSF-F 04/06/96, WFP 20/06/96].

Overall, the population affected regionally is not currently considered to be at heightened nutritional risk (category IIc in Table 1), although the population in Kabul will need to be monitored if there are further disruptions to the food supply.

How could external agencies help? Considerable support has already been received for a national immunisation project in Afghanistan. However, some additional support and initiatives are still needed for this project. For example:

  • there remains a budget shortfall of US$600,000;
  • a substantial publicity campaign is needed within Afghanistan to help mobilise communities through broadcasting the benefits of immunisation;
  • publicity aimed at convincing the warring factions of the need for a period of tranquillity so the immunisation campaign can be carried out.

Current general ration levels should be maintained in the camps for the internally displaced around Jalalabad in order to avoid any deterioration in nutritional status. Furthermore, agencies should focus on saving limited assets of IDPs by providing other opportunities of earning income/food. There also needs to be an expand EPI coverage and an investigation into the reasons for high levels of diarrhoea in the camps. A follow-up nutrition survey should be undertaken in six months time to allow establish a different seasonal baseline.

There is a need to expand the “safety net system” food ration system amongst Afghan refugees in Pakistan so that families with malnourished children also receive the edible oil. This would necessitate developing a nutritional surveillance programme to serve the dual purpose of estimating the prevalence of wasting and identifying malnourished children for inclusion in the programme. Simultaneously, the ‘basic health unit' system needs to be strengthened so that is can act as a channel for the provision of edible oil to all families identified with malnourished child. This will involve identifying additional CHWs to conduct nutritional monitoring in order to refer malnourished children to local health unit.
 


RNIS 15, April 1996

The most recent overview of the numbers of refugees and displaced people in Asia (as of the end of 1994) is as follows. There were an estimated 5.0 million refugees in Asia, of whom 1.1 million were Afghans in Pakistan and in Iran (1.6 million). There were reported to be 610,000 Iraqis in Iran. Other large groups were refugees from Myanmar in Bangladesh (120,000), Vietnamese in China (290,000), Chinese (Tibet) in India (110,000), and Bhutanese in Nepal (100,000). No comprehensive data were available on the numbers of internally displaced populations in Asia, but they were certainly in the millions (UNHCR, 1994 ‘Populations of Concern to UNHCR’).

This section of the report aims to give updated information on some of these situations. The current situation for the Afghan refugees/displaced populations, the largest single group in Asia with approximately three million affected people, is described. Available information on the Bhutanese refugees in Nepal and refugees from Myanmar in Bangladesh are included because of previous reports of micronutrient deficiencies. As in the past, we also include information on Southern Iraqi refugees in Iran.

There are approximately three million people affected regionally by this fifteen year old conflict. Many of those affected are refugees either in Iran or Pakistan, and are currently considered to be self-sufficient.

Kabul Since the resumption of hostilities between the Taliban forces and government in September 1995 over 60,000 people have fled Kabul. Most recent reports are that fighting is continuing around the capital resulting in numerous civilian casualties. The current round of fighting has disrupted normal patterns of trade and commercial deliveries to the city so that there is concern that high food prices in the markets of Kabul are making it increasingly difficult for residents to feed themselves properly. Although some of the main roads leading into Kabul are now open, heavy taxes are being levied at certain entry points with the cost being passed onto consumers thereby keeping prices high. It is generally felt that the situation will continue to worsen unless the factions agree to allow the access routes to Kabul to open permanently.

In January 1996, the roads leading to Kabul were once again blocked by the warring parties, and food prices consequently began to rise. These price increases meant many staple foods, although available on the markets, are outside the purchasing power of many people. Information from dispensaries in Kabul showed that 42% of the children attending were wasted (using arm circumference measurements - QUAC stick). Although this is not representative of the population of Kabul, it does point to a downward trend in the nutritional status as compared to data gathered from dispensaries in 1990 (22.3% wasting) [ICRC Feb 96].

The winter distribution of relief food, which started at the beginning of February, has almost been completed. The main target groups have been the elderly, widows, orphans, and other needy groups including families whose main income earner is disabled. The original planning figure for this vulnerable population was 100,000 people although 160,000 people were eventually targeted [BAAG 28/02/96, UNHAA 27/02/96, 06/03/96, 11/03/96].

A subsidised bakery project which aims to assist 200,000 people with daily bread at reduced price. This is reportedly working well in reducing the basic cost of living for many families [ICRC Feb 96].

Displaced in Jalalabad There are no reports of change in the situation for the 120,000-200,000 displaced people in two camps in Jalalabad. The most recent nutritional survey recorded in the previous RNIS report was in New Hadda camp where prevalence of wasting was only 4%. However, with the continued fighting around Kabul it can be assumed that displacement to Jalalabad is continuing. There are no current data on the nutritional status of new arrivals to the area.

Refugees in Pakistan There remain approximately 860,000 Afghan refugees in Pakistan. The steady decline in numbers of this population is due to repatriation. Most of the remaining refugees are considered to be self-sustaining and thus the general feeding programme has been replaced by a targeted feeding programme. Vulnerable groups such as the disabled, children, the elderly, families without an able-bodied adult males and refugees who arrived in 1992-3 (approximately 180,000 people) will benefit from this programme. There is a concern that not all vulnerable groups have access to the feeding programmes, and ways of improving implementation are being investigated [UNHCR 19/03/96].

A nutritional survey carried out in September/October 1995 in Baluchistan, NWFP and Punjab found overall levels of wasting of 6.0%, 5.3% and 2.7% with 0.9%, 1.1% and 0.7% levels of severe wasting respectively. These rates are considerably lower than those found amongst children in Pakistan (9% in 1995), but do show a slight deterioration compared to a survey carried out in April 1994. The decline in nutritional status is not being solely attributed to the gradual withdrawal of food rations which began in 1990. Other factors, such as high levels of diarrhoea, are also believed to have played a significant role [UNHCR Oct 95].

Refugees in Iran There are approximately 1.4 million Afghan refugees in Iran. While an estimated 20,000 live in camps and receive assistance, the remaining population is scattered among the local population and receive no general ration support [UNHCR 19/03/96].

Recently, food prices for most commodities in Iran have increased and this is believed to pose a particular problem for Afghan refugees, especially for those living outside the camps. The worsening economic situation in Iran is making even low paying jobs difficult to find and capacity to increase expenditures on essential foods is limited in this population [UNHCR 19/03/96].

How can external agencies help? In Kabul, the main problem appears to be a lack of purchasing power. Therefore, interventions that aim to increase the real income are needed. In light of this, it would be useful to:

  • continue to support subsidised bakeries;
  • increase the number and scope of income generating projects in Kabul.

There is a need to review the basis for targeting the general ration to refugees in Pakistan with a view to determining whether all vulnerable groups are included. It may prove appropriate to select additional target groups for ration distribution. Given the possible decline in nutritional status, it may be prudent to implement more frequent surveys (e.g. every six months instead of annually).

The recent removal of the government subsidy on bread in Iran is likely to adversely affect the nutritional well-being of those refugees who are not supported in camps and who may not be able to afford any extra expenditure on food. Consideration should be given to strategies for protecting the food security of this population. Possibilities include the establishment of fair price shops or food coupons.
 


RNIS 14, February 1996

The most recent overview of the numbers of refugees and displaced people in Asia (as of the end of 1994) is as follows. There were an estimated 5.0 million refugees in Asia, of whom 1.1 million were Afghans in Pakistan and in Iran (1.6 million). There were reported to be 610,000 Iraqis in Iran. Other large groups were refugees from Myanmar in Bangladesh (120,000), Vietnamese in China (290,000), Chinese (Tibet) in India (110,000), and Bhutanese in Nepal (100,000). No comprehensive data were available on the numbers of internally displaced populations in Asia, but they were certainly in the millions (UNHCR, 1994 ‘Populations of Concern to UNHCR').

This section of the report aims to give updated information on some of these situations. The current situation for the Afghan refugees/displaced populations, the largest single group in Asia with approximately three million affected people, is described. Available information on the Bhutanese refugees in Nepal and refugees from Myanmar in Bangladesh are included because of previous reports of micronutrient deficiencies. As in the past, we also include information on Southern Iraqi refugees in Iran.

Fighting has escalated in and around Kabul, although elsewhere the situation in Afghanistan is reportedly calm. Overall regional estimates of those affected by events in Afghanistan remain at 3.1 million.

Kabul The Taliban forces have continued to attack Kabul city throughout December and January inflicting many casualties. Since the fighting between government and Taliban forces recommenced in September 1995 approximately 60,000 people have left Kabul. Prior to the renewed fighting an estimated 200,000 people had returned to Kabul from Peshawar and Jalalabad since April 1995. Current fighting has disrupted the normal pattern of trade and commercial deliveries to the city resulting in food price inflation and shortages of essential food commodities. International aid agencies in Kabul have come together to implement an Emergency Winter Relief Plan [UNHAA 04/01/96, 14/01/96]. WFP have been delivering food to the capital via Jalalabad with much of the food being used to feed orphans, widows, and the disabled.

Although an assessment of the nutritional situation in Kabul in November found a much improved situation compared to ICRC surveys conducted earlier in 1995, the situation for many is still believed to be precarious, especially with the advent of winter. Much of the noted improvement has been due to the displaced being housed properly and assimilated into the economy. The survey found that levels of wasting in children under five were 5.6% with 1.2% severe wasting. Prevalence of oedema was 0.6% (see Annex 1 17(a)). There was no significant difference in levels of wasting between resident and displaced populations. Most people were exclusively dependent on the local market with only a small proportion of families having access to parcels of land or owning animals. Only 3% had received food aid in the previous month. Although the vast majority of resident and displaced families had some form of employment, income was insufficient to provide even minimum food requirements. Many families have therefore been forced to sell assets or borrow money [AICF 08/11/95].

Displaced in Jalalabad The situation around Jalalabad is reportedly calm. However, the fighting in and around Kabul has led to large scale displacement of people to Jalalabad. Recently up to 5,000 people per week have been arriving although it is not clear whether these people are settling in the local communities or the camps for the displaced [UNHAA 04/01/96].

A recent nutritional survey in New Hadda showed 4% wasting and/or oedema with 0.6% severe wasting and/or oedema. The crude mortality rate was 0.11/10,000/day (lower that a usual level) and the under-five mortality rate was 0.17/10,000/day (see Annex 1 17(b)). These indicators show a relatively good situation [MSF-H 13/02/96].

Refugees in Pakistan Repatriation is continuing for the 1.2 million refugees in Pakistan, many of whom are considered self-sufficient and are no longer assisted with a general ration distribution. Assistance is targeted to vulnerable groups including the disabled, the elderly, primary school children and families without an able-bodied adult male. It is estimated that 153,000 Afghan refugees repatriated in 1995. Plans for the further repatriation of 250,000 in 1996 are underway [UNHAA 26/12/95, UNHCR 07/12/95, 12/02/96].

Refugees in Iran Repatriation of the approximately 1.5 million Afghan refugees in Iran is continuing. Over 195,000 people repatriated in 1995. It is expected that repatriation will slow down over the winter as travel becomes more difficult [UNHAA 13/12/95, 26/12/95, UNHCR 12/02/96].

Overall, the population of Kabul can be considered to be at nutritional risk (category IIa in Table 1). The remaining population affected regionally is not currently thought to be at heightened nutritional risk (category IIc in Table 1).

How could external agencies help? Funding is required to help repair hospital and dispensary infrastructure throughout Afghanistan. In Kabul, nutrition monitoring is necessary given the precarious nature of food security for most residents in the city. Also, supplementary feeding programmes need to be better targeted than is currently the case, e.g. to moderately malnourished children. The recent nutrition survey in Kabul identifies the need for more therapeutic feeding facilities for the severely malnourished.
 


RNIS 13, December 1995

An overview of the situation for refugees and displaced people in Asia as of the end of 1994 is as follows. There were an estimated 5.0 million refugees in Asia, of whom 1.1 million were Afghans in Pakistan and in Iran (1.6 million). There were reported to be 610,000 Iraqis in Iran. Other large groups were refugees from Myanmar in Bangladesh (120,000), Vietnamese in China (290,000), Chinese (Tibet) in India (110,000), and Bhutanese in Nepal (100,000). No comprehensive data were available on the numbers of internally displaced populations in Asia, but they were certainly in the millions(UNHCR, 1994 ‘Populations of Concern to UNHCR’).

This section of the report aims to give updated information on some of these situations. The current situation for the Afghan refugees/displaced populations, the largest single group in Asia with approximately three million affected people, is described. Available information on the Bhutanese refugees in Nepal and refugees from Myanmar in Bangladesh are included because of previous reports of micronutrient deficiencies. As in the past, we also include information on Southern Iraqi refugees in Iran.

There has been little new information received on the situation in Afghanistan since the last RNIS report. This report described periodic outbreaks of hostility as the Talaban, who control two thirds of the country, resumed offensives against the government and civilian populations in Kabul.

The main problem identified in this report was the effect of the resettlement of refugee returnees upon local populations. An estimated 500,000 resident Afghans are affected as many refugees return to urban areas rather than resuming agricultural activities [DHA 09/10/95].

There are approximately 3.1 million people affected regionally, either as refugees or internally displaced people [UNHAA 06/08/95]. An estimated 2.7 million are refugees in neighbouring Iran and Pakistan. There are a further 500,000 returnees and resident populations affected by their return.

Nearly 200,000 displaced persons continue to live in the Jalalabad camps in Afghanistan, relying on the international community for food and basic services. Efforts are being made towards promoting self-sufficiency amongst this population through income generating projects and vocational training with a view to phase out food distribution in the spring of 1996 [DHA 09/10/95]. The most recent nutritional information on this population comes from a survey in July in New Hadda camp (population 80,000) which found 11.1% wasting with 1.5% severe wasting.

Overall, the affected population in Afghanistan can be considered to be at heightened nutritional risk due to insecurity (category IIb in Table 1), while the refugees in Iran and Pakistan are probably not currently at heightened nutritional risk (category IIc in Table 1).
 


RNIS 12, October 1995

An overview of the situation for refugees and displaced people in Asia as of the end of 1993 is as follows. There were an estimated 5.2 million refugees in Asia, over a half of whom were Afghans in Pakistan (1.4 million) and in Iran (1.3 million). There were reported to be 650,000 Iraqis in Iran. Other large groups were refugees from Myanmar in Bangladesh (52,000), Vietnamese in China (290,000), Sri Lankans in India (115,000), as well as considerable numbers from the conflicts in Cambodia, Laos and Vietnam in other countries. No comprehensive data were available on the numbers of internally displaced populations in Asia, but they were certainly in the millions. Figures of 600,000 Afghans internally displaced were quoted. In addition there were considerable numbers of internally displaced people in Iran and Myanmar.

This section of the report aims to give updated information on some of these situations. The current situation for the Afghan refugees/displaced populations, the largest single group in Asia with approximately three million affected people, is described. Available information on the relatively small populations of Bhutanese refugees in Nepal and refugees from Myanmar in Bangladesh are included because of previous reports of micronutrient deficiencies. As in the past, we also include information on Southern Iraqi refugees in Iran.

Although the overall security situation in Afghanistan has generally remained stable, periodic outbreaks of hostility are still reported in some provinces, e.g. Badghis and Herat. Observers now believe that the political situation is once again deteriorating and that the Talaban, who control two thirds of the country, have now decided to resume offensives against the government. The situation in Kabul is therefore said to be very tense. Repatriation from Pakistan and Iran is continuing but it is anticipated that the rate of return will decrease as the winter months make travel more difficult. The main problem continually identified in Afghanistan is the resettlement of returnee populations and their impact on local populations. There are approximately 3.1 million people affected regionally, either as refugees or internally displaced people [UNHAA 06/08/95]. There are at least an additional 500,000 returnees and resident population affected by their arrival throughout the country. WFP support a wide variety of activities in Afghanistan including food for work projects, food relief distributions and subsidised bakeries in urban centres. However, food resources currently available to WFP Afghanistan are well below requirement with stocks in the North almost depleted. Donor pledges are needed immediately to prevent a shortfall in the coming months [WFP 06/10/95].

Displaced in Kabul The relative stability in Kabul since April 1995 has led to the spontaneous return of over 160,000 persons, mainly from Jalalabad and from Peshawar in Pakistan. Many agencies have implemented "Quick Impact Projects" involving infrastructure repair in order to assist the process of re-integration. Diarrhoeal diseases have reportedly increased due to the hot weather and in some areas of the country, such as in Ghazni, the problem is said to be of epidemic proportions [UNHAA 06/08/95].

Displaced in Jalalabad Past fighting in and around Kabul has led to large scale displacement of people to Jalalabad, although the recent stability in Kabul has led many families to return to the capital city.

Recent survey data from New Hadda camp (estimated population 80,000) shows 11.1% wasting with 1.5% severe wasting (see Annex I 18(a)) [MSF-H 14/09/95]. These levels of wasting are similar to those measured at the end of May 1995 (9.3% wasting with 2.2% severe wasting). However, rations have been estimated at approximately 1600 kcals/person/day which may not be adequate to maintain this nutritional status.

Mazar-I-Sharif Camps for Displaced Reports from three camps for the displaced in Northern Afghanistan (total population approximately 20,000) show very low rates of mortality but there is a high prevalence of diarrhoea and dysentery. Furthermore, in one camp (Kamaz) there have been confirmed reports of vitamin B2 deficiency which is apparently responding well to multi-vitamin treatment [MSF-B Jul 95].

Refugees in Pakistan There are approximately 1.2 million Afghan refugees in Pakistan, many of whom are reportedly self-sufficient. General ration distributions to this population have been phased out, although programmes aimed at assisting vulnerable groups (e.g. supplementary feeding and food for work programmes) are continuing [UNHCR 19/09/95].

Refugees in Iran There are approximately 1.5 million Afghan refugees in Iran. Only 20,000 of this population reside in camps, with most living and working among the local population. The recent reduction and/or elimination of food subsidies is leading to fears that many of these refugees will no longer be able to support themselves, and may therefore be forced to move to refugee camps in their area [UNHCR 19/09/95].

It is anticipated that 500,000 refugees will repatriate between March 1995 and March 1996. At the end of August, an estimated 86,000 had returned [UNHAA 06/08/95, UNHCR 19/09/95].

Returnees to Afghanistan Formal repatriation began in 1992 when there were approximately six million Afghan refugees in neighbouring countries. The number of refugees is now less than three million and it is hoped that the remaining refugee population will repatriate over the next three years [UNHCR Feb 95]

An example of the possible nutritional situation of returnees and the impact the returning population may be having on residents is shown by a survey recently conducted in Kandahar city. South East Afghanistan. This city has received over 250,000 returnees, many from Pakistan, since 1992 and it is expected that the current population of 350,000 (returnees and residents) will increase further as repatriation continues. The survey findings indicate a variety of nutritional and food related problems which may well be indicative of the situation in other returnee impacted areas of the country [MERLIN 15/06/95].

The prevalence of wasting were measured at 13.4% in the villages around Kandahar and 9.3% in the city itself (see Annex I 18(b-c)). The under five mortality rate was 4.8/10,000/day (6x the usual level). Although the survey methods prevent these results from being extrapolated to the whole population in the province, the results are believed to be indicative of more general nutrition related problems which may be derived from a rapidly fluctuating exchange rate and price inflation. There is concern that as more refugees return home, food stress may increase and effect even higher levels of wasting [MERLIN 15/06/95].

Overall, renewed instability and some survey results lead to the impression that the population inside Afghanistan (internally displaced and returnees) could be at moderate nutritional risk (category IIb in Table 1).The refugee populations in Iran and Pakistan are not currently considered to be at heightened nutritional risk (category He in Table 1).

How could external agencies help? There is an urgent need for additional resources to prevent disruption to relief programmes in Afghanistan. In view of heightened levels of conflict, other additional assistance may soon be needed. There is also a general need to establish nutritional surveillance in those areas where large numbers of returnees are settling. The high levels of diarrhoea in many parts of the country suggest a need to support MCH services and associated health out-reach programmes. The fluctuating food security indicates a need to continue food price monitoring and support for food for work projects and also to support bakeries in a way which effectively subsidises bread consumption.
 


RNIS 11, July 1995

As of end-1993, over half the estimated 5.2 million refugees in Asia were Afghans in Pakistan (1.4 million) and in Iran (1.3 million). There are reported to be 650,000 Iraqis in Iran. Other large groups are refugees from Myanmar in Bangladesh (100,000), Vietnamese in China (290,000), Sri Lankans in India (115,000), as well as considerable numbers from the conflicts in Cambodia, Laos and Vietnam, in other countries (data from UNHCR, Statistical Overview, 1994).

No comprehensive data are available on the numbers of internally displaced populations in Asia. The numbers are certainly in the millions. Figures of 600,000 Afghans internally displaced are quoted, and over one million each in Iran and Pakistan.

In this section of the report, the current situation for the Afghan refugees/displaced populations, the largest single group in Asia with approximately three million affected people, is described. Available information on the relatively small populations of Bhutanese refugees in Nepal and refugees from Myanmar in Bangladesh are included because of previous reports of micronutrient deficiencies. As in the past, we also include information on Southern Iraqi refugees in Iran.

There are approximately 3.1 million refugees and internally displaced people who are still affected by the 15 year long war in Afghanistan. The situation for the majority of this population appears stable with some optimism that many refugees could soon be repatriated and that others are now considered to be self-reliant and will no longer require general ration support.

Displaced in Kabul Fighting in Kabul has reportedly slopped and although exact numbers are not known, it is felt that many of the displaced have returned home. The food security situation has most likely continued to improve as market availability of food increased. There are no recent nutritional data, but it is likely that the high levels of wasting shown among the displaced population in a survey in November/December 1994 have decreased, [WFP 24-25/07/95].

Displaced in Jalalabad Past fighting in and around Kabul has led to large-scale displacement of people towards Jalalabad. Two of the largest camps for the displaced from Kabul are Sarshahi and New Hadda camp. Information from Sarshahi camp in February (estimated population 80,000 with food distributed for a case-load of 120,000) was that wasting levels were 1.8% - 4.6% with 0.1-1.9% severe wasting. At that time the ration provided 1,250 kcals per capita and the under-five mortality rate was 0.54/10,000/day, In May 1995 the situation was little changed with 2.5% wasting and 0.3% severe wasting (see Annex I (18a-b)) [MSF-H Jun 95].

Rates of wasting in New Hadda camp (estimated population of 80,000) are consistently slightly higher. In March wasting was measured at 6.7% with 1.7% severe wasting. Logistical problems at the time were preventing over 60% of the camp population from receiving more than 1600 kcals per capita in their general ration. At the end of May wasting had increased to 9.3% with 2.2% severe wasting (see Annex I (18c-d)) [MSF-H Jun 95].

Refugees in Pakistan There are approximately 1.2 million Afghan refugees in Pakistan, many of whom are reportedly settled and becoming self-sufficient. It is planned to phase out general food distribution for this population by October 1995 for ail except the vulnerable groups and the approximately 80,000 newer arrivals (since 1992) who are not yet fully self-sufficient [UNHCR-a 29/06/95].

Refugees in Iran There are approximately 1.6 million registered refugees in Iran, and it is hoped tat 500,000 may repatriate over the next year. There are no reports of change to me stable nutritional situation of this refugee population [UNHCR-a 29/06/95].

Overall, the refugee populations in Iran and Pakistan are not at heightened nutritional risk (category IIc in Table 1) while in the absence of current nutritional survey data and in order to err on the side of caution the displaced population in Kabul are probably best defined as being at moderate risk in spite of improved food security (category 11b in table 1). The populations in the Jalalabad camps are probably not at heightened nutritional risk although slight increases in levels of wasting in New Hadda camp suggest a need for close monitoring (category IIc in Table 1).

How can external agencies help? The last nutritional survey on the displaced in Kabul, which found high levels of wasting, was conducted at the end of 1994, there is therefore a need for more current nutritional status information. Some attention should also be given to improving the equity of the food distribution system in New Hadda camp in Jalalabad while closer nutritional monitoring of this population is also needed given the slight increase in levels of wasting noted in the most current nutritional survey.
 


RNIS 10, April 1995

As of end-1993, over half the estimated 5.2 million refugees in Asia were Afghans in Pakistan (1.4 million) and in Iran (1.3 million). There are reported to be 650,000 Iraqis in Iran. Other large groups are refugees from Myanmar in Bangladesh (100,000), Vietnamese in China (290,000), Sri Lankans in India (115,000), as well as considerable numbers from the conflicts in Cambodia, Laos and Vietnam, in other countries (data from UNHCR, Statistical Overview, 1994).

No comprehensive data are available on the numbers of internally displaced populations in Asia. The numbers are certainly in the millions. Figures of 600,000 Afghans internally displaced are quoted, and over one million each in Iran and Pakistan.

In this section of the report, the current situation for the Afghan refugees/displaced populations, the largest single group in Asia with approximately three million affected people, is described. Available information on the relatively small populations of Bhutanese refugees in Nepal and refugees from Myanmar in Bangladesh are included because of previous reports of micronutrient deficiencies. As in the past, we also include information on Southern Iraqi refugees in Iran.

The situation for the approximately 3.1 million people affected by the continuing war in Afghanistan remains largely unchanged, although there are signs of improvement in access to food in Kabul.

Displaced in Kabul The recent confrontation between government and Taleban forces in Kabul led to the displacement of up to 100,000 people within the city. Prior to this, Kabul hosted approximately 400,000 displaced people. Government forces pushed Taleban forces out of Kabul and thus, for the first lime in several years, effectively taking control of the entire city. The front line is now currently about 30 km outside of Kabul and so not within military striking distance of the city. Consequently, Kabul is said to be quiet with supply trucks arriving more frequently. Thus, while food is still very expensive, it is more readily available. There have been no nutritional surveys since November/December 1994 when levels of wasting were recorded at 40% amongst the displaced and 35% among the resident population [ICRC 01/01/95, ICRC 13/04/95].

Displaced in Jalalabad The on-going conflict in and around Kabul has, over many months, displaced large numbers of people to camps in Jalalabad. Most of the displaced population have settled in Sharashahi and Hadda camps where previously high levels of wasting were reported as declining in the last RNIS report. However, an anecdotal report from another camp in the area (an ICRC administered camp) indicated that levels of wasting may be as high as 28% with 3% severe wasting (see Annex 1 (18a)). Full general rations are still distributed in this camp so that these high levels of wasting are attributed mainly to endemic diarrhoea which is apparently related to difficulties in providing adequate supplies of potable water [ICRC 13/04/95].

Refugees in Pakistan There are no reports of any change in the satisfactory nutritional situation of approximately 1.4 million Afghan refugees in Pakistan. Plans are currently being developed for the repatriation of approximately 200,000 of these refugees although no timetable has been announced [UNHCR 28/02/95].

Refugees in Iran There are no reports of any change in the satisfactory nutritional situation of approximately 1.3 million Afghan refugees in Iran. Although no timetable has been announced, plans are currently being developed for the repatriation of approximately 500,000 refugees [UNHCR 28/02/95].

Overall, with increased access to food in Kabul, this population is not currently thought to be at heightened nutritional risk (category IIc in Table 1).
 


RNIS 9, February 1995

The situation for the majority of the approximately 3.1 million people in the region affected by the continuing civil war in Afghanistan remains largely unchanged since the previous RNIS report, but if a UN sponsored transfer of power succeeds it is hoped the situation will improve. However, there appears to have been some deterioration in nutritional status of the large displaced population in northern Kabul in the latter part of 1994, while the nutritional situation of the displaced population in camps in Jalalabad appears to have improved significantly.

Displaced in Kabul There are approximately 600-700,000 people living in Kabul. An estimated 400,000 have been displaced by the continuing civil war. The majority of this displaced population live in private buildings for which they pay rent while an estimated 20,000 live in public buildings, In the Southern mainly rural districts of Kabul, nearly 60% of the population appear to be refugee returnees from Pakistan while 25% of the population are internally displaced. In the northern part approximately two thirds of the population are internally displaced [ICRC 01/01/95].

The city of Kabul is effectively divided into two parts with the six northern rural districts controlled by government while the southern rural districts are held and controlled by the Herb-i-Islami. Except for some locally grown fruits and vegetables, all foods sold on the northern markets have been purchased on the Herb-i-Islami controlled markets in the south and transported to the north by thousands of Kabulis crossing the front line daily. Food has therefore been reaching the northern part of the city in spite of the year old blockade. However, this has inevitably meant more expensive foods in the north [ICRC 01/01/95].

In general, prices of food and other essentials have doubled and in some cases tripled over the past twelve months. This inflation has succeeded abandonment of the “limits coupons”, which provided the entire population with non-food items at subsidized prices, closure of the government shops in 1992, which provided subsidised foods to specific target groups, and most importantly, removal of subsidies for government bakeries in 1992 making the flat bread “nan” the most expensive staple rather than the cheapest [ICRC 01/01/95].

Periodic surveys have strongly suggested that the nutritional status of the displaced population of northern Kabul has deteriorated with the trend continuing in the last half of 1994. The most recent survey shows that the proportion of cases of moderate wasting has risen since the previous survey in April 1994 with 40% wasting among the displaced and 35% among residents see Annex 1 (22a)). This deterioration is believed to reflect greater food scarcity with over 75% of the population without food stores and reliant on daily food purchases. The increasing cost of nan (consumed daily) is known to be very problematic [ICRC 01/01/95].

The last week of 1994 heralded signs of potential improvement in the food security situation for northern Kabul with the announcement that the northern population would be granted free access to three large food markets in the south [ICRC 01/01/95].

The food security and nutritional situation in the south is reportedly better than in the north with only 28% levels of wasting (see Annex 1 (22b)) and the majority of the population having food stores. Furthermore, there is less reliance on the markets as nan is often made at home. However, child mortality rates in southern Kabul appears far higher with major causes of death due to measles, dysentery and dehydration [ICRC 01/01/95].

Displaced in Jalalabad Fighting in Kabul has displaced large numbers of people many of whom have fled towards Jalalabad. Most of the displaced population have settled in Sharashahi and Hadda camps.

Information from Sharashahi camp in November showed 6.2% wasting with 1.4% severe wasting (see Annex 1 (22c)). The crude mortality rate was less than 0.5/10,000/day and the under-five mortality rate was less than 1/10,000/day. These indicators are satisfactory and are an improvement over the 18.6% wasting measured in August 1994. There was also a marked decrease reported in the incidence of diarrhoea which has in the past been exacerbated by over-crowding in the camp. Food basket monitoring showed that there had recently been no sugar or beans distributed in the general ration and that rice was heavily insect infested. Furthermore, there had been no fuel distribution even though winter was approaching [MSF-H 24/01/95].

A screening conducted in Hadda camp in November recorded 11.7% wasting with 2.9% severe wasting (see Annex 1 (22d)). A subsequent nutritional survey in December found overall wasting levels of 6.2% with 1.0% severe wasting (see Annex 1 (22e)). However, measles immunisation coverage was only 34.7% [MSF-H 24/01/95].

Kamaz Camp for the Displaced There are approximately 2,500 families displaced from Kabul who are currently living in Kamaz camp in northern Afghanistan near the border with Tajikistan and Uzbekistan. The camp was originally set up in 1993, but received a further influx of displaced people when renewed fighting broke out in Kabul at the beginning of 1994. A nutritional survey carried out in September 1994 found 8.3% wasting with 2.2.% severe wasting (see Annex 1 (22f)). Measles immunisation coverage was 77.4% [UNICEF/MSF-B 11/09/94].

Refugees in Pakistan There are no reports of any change the satisfactory nutritional situation of approximately 1.4 million Afghan refugees in Pakistan reported in the previous RNIS report.

Refugees in Iran There are no reports of change in the satisfactory nutritional situation of approximately 1.3 million Afghan refugees in Iran reported in the previous RNIS report.

Overall, the displaced population in Kabul can be considered to be at high risk (category I in Table 1) with high levels of wasting and limited food security, while the population in Sharashahi and Hadda camps in Jalalabad can be considered to be at moderate risk (category IIa in Table 1) due to erratic general ration distributions in the former and low levels of measles immunisation coverage in the latter. The remainder of the population affected by the Afghan civil war cannot be said to be at heightened nutritional risk (category IIc in Table 1).

How could external agencies help? Increasingly high levels of wasting in Kabul, especially in the northern part of the city, indicate the need to bolster up food security of the internally displaced. The most convenient method of doing this may be to support bakeries thereby effectively subsidising the prices of “nan” for the whole population. Other measures to improve food security might also be considered such as establishing food for work schemes. In Southern Kabul, there appears to be a need for increased support for medical facilities to reduce high rates of child mortality. Measles vaccination programmes are a priority in Southern Kabul and also in Hadda displaced persons camp in Jalalabad. In Sharashahi displaced persons camp in Jalalabad, there is a need for improved deliveries of the general ration and for supplies of fuel.
 


RNIS 8, December 1994

The situation for the approximately 3.1 million people in the region affected by the continuing civil war in Afghanistan remains largely unchanged since the last RNIS report The "Consolidated Inter-Agency Appeal for Emergency Humanitarian Assistance for Afghanistan" covering the period October 1994 - October 1995 envisages the provision of assistance to some 1 million internally displaced persons and covers relief activities, mine clearance and voluntary repatriation programmes.

Displaced in Kabul The level and intensity of fighting between forces loyal to the President, and those of the Supreme Coordination Council, increased dramatically in August Over 6,000 casualties were reported during the month with many families fleeing towards the relative safety of Jalalabad. Given the continuing blockade of the city and absence of government stocks or subsidized food, it can safely be presumed that the 32% level of wasting recorded amongst the displaced in May 1994 (approximately 440,000) has not changed significantly.

Displaced in Jalalabad The overall security situation in the Eastern region of Afghanistan has remained stable. During August over 20,000 people arrived in Jalalabad fleeing the fighting in and around Kabul. There are two large camps for the displaced in Jalalabad (population over 180,000) and a number of smaller ones. One camp (Sarashahi) is now said to be over-full so that efforts are being made to locate a new camp site. There are no new nutritional survey data since August when levels of wasting in Sarashahi camp were recorded at 14.6% and 18.6% in two different camp sections [UNHCR 16/09/94].

Refugees in Pakistan There has been a marked reduction in the rate of voluntary repatriation of the approximately 1.4 million Afghan refugees currently residing in Pakistan. With widespread fighting in Afghanistan it is expected that this trend will continue into 1995. Despite the border closure policy of the Government of Pakistan, it is expected that just over 100,000 new Afghan refugee arrivals will be registered by the end of 1994.

A nutritional survey carried out in May 1994, showed that the proportion of acutely malnourished children in the refugee camps in Baluchistan has almost doubled since 1991 and 1992 and was significantly higher (3.7%) than in North West Frontier Province and Punjab (1.7%) (see Annex 1 (22a)). The higher prevalence of diarrhoea in Baluchistan (25.1%) than in NWFP/Punjab (12.7%) may be an important contributory factor in explaining this difference [UNHCR May 94].

The general ration for refugees will be halved from the beginning of 1995 and will contain 5 kgs of wheat and 300 gms of oil per person per month. Prior to this, efforts are being made to provide vulnerable group feeding and targeted food for-work programmes to act as safety nets once the ration is reduced [UNHCR 31/08/94, SCF 29/11/94].

Refugees in Iran The rate of repatriation of the approximately 13 million Afghan refugees in Iran has also markedly slowed and is not expected to speed up significantly without an improvement in security in Afghanistan. In August only 11,013 people returned which is a 47% decrease compared to July.

Overall, the displaced population in Kabul can be considered to be at high risk (category I in Table 1) with high levels of wasting, and the population in Jalalabad could also be considered to be at high risk (category IIa in Table 1) due to over-crowding. The refugees in Pakistan and Iran are probably not currently at heightened nutritional risk (category IIc in Table 1).

How can external agencies help? There is a continued need for a general ration programme for the displaced in Kabul and those in camps in Jalalabad. Given the rate of influx into the Jalalabad camps there is a need for more regular nutritional and mortality surveillance. The significantly higher levels of diarrhoea in the Baluchistan camps compared to the NWFP camps in Pakistan suggest the need for improving sanitation conditions in the former. Furthermore, given the planned general ration reduction for 1995 in the Afghan refugee camps in Pakistan, it will be important to implement more regular nutritional surveys in order to detect as early as possible any adverse effects of the ration reduction upon nutritional status.
 


RNIS 7, October 1994

There has now been war in Afghanistan for over 15 years. With the ending of the cold war and Soviet withdrawal in 1989, it was hoped that Afghans would have the opportunity to re-build their devastated country and that refugees in Pakistan and Iran would return to help the process. Unfortunately, the situation rapidly degenerated into further conflict between opposing ethnic and religious sectors of society. At the height of the conflict during the 1980s, there were almost 6 million Afghan refugees in Pakistan and Iran. The estimated number of refugees is now approximately 2.5 million with somewhere around 600,000 internally displaced in Afghanistan.

Displaced in Kabul Since the fall of President Najibullah's regime in April 1992 Kabul has been the scene of heavy clashes between the various parties struggling for power. Hostilities flared up again on the 1st of January 1994. It is now estimated that there are approximately 440,000 displaced people within Kabul, 380,000 of whom are living with relatives or friends and 60,000 others who have taken refuge in abandoned public buildings (i.e. schools, mosques, etc). The blockade of Kabul has led to limited choice of foods in the local markets and soaring prices. Contrary to previous years, there are now no government stocks or subsidized foods available. As a result, nutritional status appears to be deteriorating. A survey carried out in May 1994 showed 32% wasting with only 1% severe wasting (see Annex 1 (22a)). These results are significantly worse than those obtained between 1988-90 [ICRC 6/07/94].

Displaced in Jalalabad Fighting in Kabul has displaced large numbers of people, many of whom have fled towards Jalalabad. There are two large camps (approximately 163,000 people) and a number of smaller ones housing the displaced population from Kabul. Large numbers of people have also chosen not to settle in camps.

Data from February 1994 from Sarashahi camp indicated a level of wasting of 17.9% with 3.9% severe wasting (see Annex 1 (22b)). At the time, the food basket provided 1,500 kcals/person/day [MSF-H 18/02/94]. In August, the level of wasting was recorded at 14.6% and 18.6% in the two sectors of the camp, with severe wasting in 1.5% and 2.3% of children under five years of age (see Annex 1 (22c)). The food basket in June provided between 1,600 and 1,800 kcals/person/day. It is clear that families are often able to supplement their ration on the market. In June water availability in the camp was only 13.5 litres per person per day, which is well below the recommended amount of 20 litres/person/day. The continued high prevalence of wasting in the camp is thought to be due to both the inadequate food basket and the high incidence of diarrhoea [MSF-H Jun 94, MSF-H 23/08/94, UNHCR 26/06/94].

Refugees in Pakistan There are about 1,360,000 Afghan refugees still living in Pakistan including 20,000 who fled in early 1994. There is very little repatriation at this time, and the numbers are not expected to change considerably before the end of 1994 [IFRC 2/03/94, WFP/UNHCR 12/05/94].

A nutrition survey carried out in April showed levels of wasting between 1.7-3.7% (see Annex 1 (22d)) and a clear relationship between wasting and diarrhoea was observed [UNHCR May 94].

Refugees in Iran In May 1994 it was estimated that there were 23,000 Afghan refugees living in the camps in Iran. A further 1.3 million people are estimated to be living amongst the local population. Repatriation is proceeding slowly due to the continuing insecurity in Afghanistan [UNHCR 20/09/94, WFP 23/05/94].

How external agencies can help? In Kabul, a full ration for those living in mosques and other public buildings and a partial ration for other displaced persons is needed. Food for work programmes would also be useful as would support for the bakeries. In Jalalabad, an improved water supply is needed and a review of the general ration is also needed due to the levels of wasting reported in the camps.