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Nutrition Information in Crisis Situations -
Balkans Region
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Maternal |
Older people |
|
Severe undernutrition |
0.2 |
1.3 |
|
Moderate undernutrition |
0.9 |
0.4 |
|
Marginal undernutrition |
4.2 |
3.6 |
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Normal |
60.7 |
46.4 |
|
Overweight |
23.6 |
32.0 |
|
Obese |
10.4 |
16.0 |
The results of these surveys do not suggest an alarming
nutritional situation. However, the author observed that the urban IDPs,
marginalised minority groups, people living in isolated mountain areas, and
families with social problems appeared to be more vulnerable to malnutrition.
These problems were compounded by poor shelter and the cold. Chronic
malnutrition remains a cause for concern (AAH - 03/00).
Nutrition Strategy
There is no longer a need for food aid on the same scale provided since June 1999 when the population first returned to Kosovo. This is in part due to the harvest that will take place in July, the establishment of social welfare structures and the recovery of business and employment opportunities in the province (UNMIK - 10/03/00; UNHCR - 02/00).
As Kosovo continues to be rebuilt and the UNMIK (United Nations Interim Administration in Kosovo) structures become more established, more responsibility for food distributions is being given to UNMIK, away from the international agencies. The current WFP/UNHCR food distribution system will remain in place until the end of June 2000. Up until the end of March, beneficiary figures will remain at approximately 900,000, but this figure will be downscaled incrementally from April to June, with a 20% reduction occurring on aver age each month. The majority caseload should stand at approximately 460,000 by the end of June (this does not include the minorities) (UNHCR - 02/00,29/03/00).
From May onwards, food assistance will gradually be provided through a new system whereby beneficiaries will be identified and registered with the Social Welfare Centres (CSWs) of the Social Welfare Department (UNMIK). Those registered with one of the 25 CSWs will be able to collect food rations from a distribution point associated with the CSW. The criteria for eligibility to food will be based on “the problem of a lack of access to food”. There may be families who are entitled to financial assistance who do not necessarily require food assistance, so the financial and food assistance components will be separate to some extent. The food/financial assistance scheme will be gradually phased in with Category I applicants (households with noone in the family capable of working) being processed by the CSWs first and then Category II applicants (households with people able to work, but unemployed) etc. (UNHCR - 02/00, 29/03/00).
The problems of access to food currently faced by minority communities are different from those faced by the majority of the population (see RNIS 29). All ethnic groups will be included in the selection process for food eligibility on an equal basis. However, it is likely that some minority groups will not be able to physically access the distribution points because of the insecurity; hence it is probable that a system of direct delivery will be required until at least the end of the year (UNHCR - 02/00). Some of the minorities now receive food aid through the Yugoslav Red Cross or the Orthodox Church. This solved some of the problems associated with distribution through the Mother Theresa Society, whose members are mainly ethnic Albanians. In some cases, food is distributed directly by international NGOs (UNMIK - 10/03/00).
Health
WHO and UNMIK are planning the development of a primary health care system in Kosovo that will take between 3-5 years to create. Sites for family health centres, with ambulantes serving this function, are currently being identified. The creation of the new health structure directly affects the issue of access to adequate health care for minorities. Minorities may have limited access to health care if their community does not have an ambulanta (USAID - 24/03/00; UNMIK - 10/03/00).
Shelter
The majority of emergency shelter programmes have concluded, There is a currently a shift in the programmes away from shelter to reconstruction in the spring (UNMIK - 14/01/00).
Serbia and Montenegro
UNHCR estimates there are some 200,000 IDPs from Kosovo in Serbia and Montenegro, up to a quarter of whom are Roma. They have joined more than half a million long-term refugees from Croatia and Bosnia and Hercegovina who fled the 1991-95 wars in the former Yugoslavia. The registration of IDPs in Serbia is in progress and is scheduled to be completed by mid-April (OCHA - 17/03/00; UNICEF - 21/03/00; UNMIK - 10/03/00).
IDPs in Montenegro
ACF-F undertook an anthropometric screening of displaced Roma children aged 6-59 months, living in tents and pre-fabricated barracks of Konik camp, Podgorica, Montenegro in November 1999 (see annex). These children and their families have lived in Konik camp since the conclusion of the NATO air raids (i.e., 0-7 months at the time of the survey). The prevalence of acute malnutrition was not abnormally elevated (see table), although some malnutrition was recorded in the younger age group, which may indicate poor feeding and care practices in this population (ACF-F - 11/99).
The prevalence of stunting was considerably higher, particularly in the older group. The authors of the survey cautioned that age in months was relatively difficult to obtain accurately in this population and hence the prevalence of stunting may not be very accurate (ACF-F - 11/99).
Results of nutritional screening in Konik Camp
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|
Prevalence (%) |
|
Acute malnutrition |
2.9 |
|
Severe acute malnutrition |
0.96 |
|
Stunting |
16.1 |
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Severe stunting |
1.9 |
Vulnerable groups in Serbia
The FRY economy has continued its downward spiral. At the end of 1999, GDP was 30% lower than in the previous year. Inflation has increased and the value of the dinar has dropped, resulting in a decrease in the real value of wages. The Yugoslav Red Cross (YRC) provides daily meals through soup kitchens to 100,000 vulnerable people in the FRY. Eligible beneficiaries are registered by the Social Welfare Centre and receive a meal coupon worth one meal a day. The most vulnerable people include: the disabled or chronically ill, older people with low pensions, residents of institutional homes, vulnerable families (those headed by a single-parent or with many children) and people with no earning potential - particularly those in the urban areas without rural ties (OCHA - 31/12/00). There is currently no information on the nutritional situation of these groups, but a WFP mission has begun a household food economy assessment in Belgrade (OCHA - 17/03/00).
The YRC also provides assistance to IDPs, predominantly from Kosovo, in Serbia and Montenegro. This programme provides an individual food parcel of 10kg of wheat flour to each beneficiary on a monthly basis and a family hygiene parcel per family every second month (ICRC - 07/03/00).
Macedonia
UNHCR estimates that some 24,000 Kosovar Albanians are still living with host families in Macedonia. By the end of March they will lose their refugee status and the Macedonian authorities will no longer assist in their repatriation (USAID - 24/03/00). The RNIS has not received any new information on the nutritional situation of these refugees, which was previously described as adequate.
Overall, the nutritional situation of the majority Albanian population in Kosovo is satisfactory (category IV). The minorities are more vulnerable and are therefore described as category III. The nutritional situation of the IDPs in Serbia is unknown (category V). The nutritional situation of the displaced populations in Montenegro is not currently critical (category V).
Recommendations and priorities:
From the AAH-UK survey in Kosovo:
From the ACF-F survey in Konik I DP camp:
For Serbia:
Kosovo
Security incidents have occurred on both sides during the reporting period. The overall situation of ethnic minorities in Kosovo remains precarious. There is a climate of violence and impunity, as well as widespread discrimination, harassment and intimidation, directed against non-Albanians (UNHCR - 03/11/99).
Nutritional status
There have been no new nutritional surveys in the reporting period. The most recent survey, in July, estimated a prevalence of wasting at 3.1%, including 1.0% severe wasting (see RNIS 28); there have been no reports of an increase in these prevalences. A survey on the nutritional status of older persons is planned for early next year.
Food distributions
Targeted distributions, which began in September, continue through WFP and its NGO and bilateral partners, via local implementing partners including the Mother Theresa Society. There continues to be a shift towards a gradual decrease in the total number of beneficiaries. Currently, the total number of beneficiaries is approximately 900,000 including some 300,000 IDPs. Beneficiaries are classified according to their access to food sources, income opportunities, social vulnerability and destruction levels of private housing. Priority is given to those hardest hit by the conflict (WFP -17/11/99). From October, food aid was also specifically targeted at minority groups (mainly Serb and Roma) by a number of UNHCR/WFP implementing partners. Agencies face a number of challenges in doing this; such as the feasibility of working through local partner’s and the dangers of creating an additional security risk (UNHCR-11/11/99).
Almost 15,000 tonnes of food was distributed through the main food pipeline in October. This was 100% of the target amount for the period. There has been a shift in the population from rural to urban areas and thus more food was distributed in urban areas, for example Pristina, than had been planned and less in rural areas (UNHCR - 29/11/99).
WFP has finalised the distribution of winter food stocks to some 130 villages considered as inaccessible during the winter. Rail transport is now used to deliver food aid to Kosovo and is expected to remain functional throughout the winter (WFP-10/12/99).
The food pipeline until the end of January is reported to meet 100% of all requirements, although on-going problems at Blace border may affect food aid planning (UNHCR-29/11/99).
Agriculture
FAO has estimated that 81% of the beneficiary families (70,000 households) requiring winter wheat seed had received the seed by the end of October. Several municipalities, however, were either under- or over-served, possibly because of inaccurate beneficiary numbers. Of particular concern was the lack of coverage in ethnic Serb areas. (FAO - 04/11/99; USAID - 08/11/99).
Although mechanisation programmes are proving successful on a local basis, humanitarian agencies are only replacing approximately 20% of the estimated 15,000 damaged or destroyed tractors and combines. FAO will soon start a programme on farm machinery. In order to prepare for the next (spring) planting season, a list of beneficiaries by ethnic group, agricultural zone and activity is being prepared (USAID - 08/11/99).
Due to success of the seed distribution programme, the harvest in June 2000 is expected to be only 15% less than in a “normal” year (FAO - 04/11/99).
Food assessment mission for minorities
Initial efforts to assess needs and provide humanitarian assistance in Kosovo focused on the majority Albanian population. Concerns about the minority populations soon arose as they became subject to increasing insecurity, losing their normal access to income and markets as a result. As a result of these concerns, a joint UNHCR/WFP food assessment mission of minorities was undertaken in November (UNHCR/WFP - 29/11/99).
The objective of providing food aid to these groups was not only to ensure access to 100% of food aid needs but also to minimise exposure to physical insecurity by reducing the need to access markets.
The assessment focused on the Serb and Roma minorities as these groups have the highest profiles. The Serb population in Kosovo lives in three geographic regions: the north-west is an almost exclusively Serb area, the Eastern Plateau (where the bulk of the pre-war Serbs lived) and Strpce, a municipality in the south of the province which borders Macedonia. Outside these areas there are few Serbs remaining. In all areas there has been a marked movement from urban to rural areas; 60% of the Serb population lived in rural areas before the war, now 80% live there. In addition, much of the younger and more active section of the population has left for Serbia, leaving behind a population with a relatively high proportion of older people and social cases (the handicapped, single parent families etc.).
The Serbs in urban areas outside the north-west of the province have very limited access to either income or markets. Many are older people. The mission recommended that these groups receive a full ration. In the rural areas the situation is somewhat better, as most families have access to their own fruit, vegetable, bean and livestock production. These products should cover approximately 50% of the population’s needs until the next wheat harvest (July 2000), except for the elderly and IDPs who cannot cover their needs. These groups are estimated at 20% of the population. The main factor affecting food security in rural areas is the availability of wheat flour derived from this year’s crop production. Access to mills for wheat milling has been a significant problem and many farmers have stocks of wheat grain that still need milling. Income for rural Serb families is much reduced, as is access to markets (this includes older people who need to collect their pension).
The effect of the conflict in the north-west of the province has been to accelerate the already existing economic decline, Linked to this decline has been a progressive increase in the social caseload. It seems unlikely that the north-west of the province will benefit from the general economic improvement expected in the rest of Kosovo in the coming year.
For the Roma, recent problems of insecurity are superimposed on chronic problems of poverty and disadvantage. The majority of families, in both rural and urban areas, relied on low-paid formal and informal employment for their main source of income before the conflict. The post-conflict situation of the Roma varies within the province and according to whether they were perceived to have supported the Serbs or not. All groups have suffered loss of income since the conflict, as they are regarded with suspicion by the majority Albanian population, which severely limits their movements, and also because there is less work available than before the conflict.
Projecting future food needs for the minority population is difficult. Currently, the main problem facing these groups is the prevailing insecurity. It is difficult to foresee how the security situation will develop and also to predict how the minority groups will react to any developments - if the security improves they may either stay, or take advantage of the situation, sell their homes and leave the province. It is unlikely that there will be major changes in security or food aids before the end of the winter. The mission, however, suggested that food aid needs will tend to decline with time if either (i) the security situation improves, leading to improved access to food and markets, or (ii) the security situation deteriorates or remains as it is, when it is likely that an increasing number of Serbs will leave the province. There may, however, be a slight increase in the number of Serbs in Kosovo as IDPs in Serbia are experiencing difficulty in finding employment and accommodation and hence may return home.
Winter, water and shelter
The coldest three months in Kosovo are December, January and February. This will increase nutritional requirements. Winter also presents many problems other than the cold. The delivery of assistance becomes more difficult logistically. De-mining organisations are working to strengthen the minefield marking systems for the winter, but snow or ice may obstruct or hide marking tape and fencing. Heavy snowfall can have an effect on trip-wire operated mines (UNHCR - 26/11/99).
Power remains a problem: although major repairs to the power system have been undertaken, there is still insufficient power. While some power has been imported, the extraction and stockpiling of coal and ensuring the availability of fuel oil remain crucial. The public water supply in Kosovo is dependent on electricity (UNHCR - 12/11/99, 26/11/99).
Roughly one third of the 365,000 homes in Kosovo have sustained major damage (defined as substantial or total roof and wall destruction) affecting an estimated 720-840,000 people. Efforts to provide shelter kits and repair roofs continue (USAID - 26/11/99).
Albania
As of 29 September 1999 there were 3,634 refugees remaining in Albania (USAID - 02/10/99). There is no new information on the nutritional situation of these refugees, which was reported to be adequate in the last RNIS.
Macedonia
Approximately 14,000 refugees remain in Macedonia, the majority of whom are housed with host families. The Government of Macedonia has agreed to permit the registration of previously unregistered refugees. These people will be issued with refugee documentation and permitted the same benefits as other refugees in Macedonia. There are estimated to be up to 8,000 unregistered refugees in Macedonia (USAID - 08/11/99; WFP -17/11/99).
There is no new information on the nutritional situation of the refugees in Macedonia, which was reported to be adequate in the last RNIS.
Serbia
According to the Yugoslav Red Cross (YRC), there are an estimated 243,000 IDPs in Former Republic of Yugoslavia (FRY) excluding Kosovo. UNHCR plans to carry out an IDP registration exercise in January 2000. ICRC provides food aid to over 200,000 IDPs. Family hygiene parcels are also distributed on a bi-monthly basis (OCHA - 20/11/99, 25/11/99).
The RNIS has not received any information on the nutritional status of the IDPs in Serbia.
FRY is experiencing a continuous economic decline and much of the population is sliding into deeper poverty. The increase in prices of basic food items (over 20% in October alone) and the decline in the purchasing power of the majority of the population have raised concerns that insufficient food will be available to many during the winter (OCHA-30/11/99).
Stocks available in the Balkans region are sufficient to meet requirements well into the second quarter of the year 2000, except in Serbia, where gaps in the food pipeline are expected during the first quarter of the new year (WFP-10/12/99).
Recommendations and Priorities:
For Kosovo:
For the minority population in Kosovo:
(i) Food aid:
· Urban communities: The mission recommended that a full ration be programmed for urban Serb and Roma communities and 80% of the population of other minorities.
· Rural communities: A 50% ration was recommended for 80% of Serbs in rural areas, as they have some access to own production. Full rations for 20% of the population; mainly elderly and IDPs.
· For Serbs in the north west, the mission recommended that the current WFP policy be maintained. This involves providing a full ration to the Serb IDPS living in collective centres and a further 20% of the rest of the resident population based on the criteria of the Yugoslav Ministry of Social Welfare (e.g., pensioners, households with nobody able to work due to disability and ill-health etc).
· 80 % of Roma communities that have some access to income and markets should be targeted with a 100% ration.
(ii) Non-food interventions:
· Provision of security by KFOR for agricultural activities.
· Provision of seeds, fertiliser, spare parts etc.
· Purchase of surplus agricultural production for humanitarian assistance.
· Integration of minorities into the Mother Theresa Society distribution system.
· Affirmative action by international organisations to ensure the equality of employment opportunities.
For Serbia
Overall, the nutritional situation is under control, there have been no reports of elevated prevalences of malnutrition in the region (category IV). Serb and Roma minorities in Kosovo are considered more vulnerable than others, mainly for political and security reasons. Little is known about the nutritional situation of IDPs in Serbia (category V). Winter will affect populations throughout the region, putting those without adequate shelter and access to fuel at greater nutritional risk.
One of the most striking phenomena about the emergency operation in Kosovo has been the scale and speed of events that have occurred, in terms of refugees leaving Kosovo as well as returning. This has required a swift and flexible approach to planning and implementation of the humanitarian response, including the implementation of effective and appropriate nutrition interventions. The latest UNHCR estimates suggest that 810,000 refugees have returned to Kosovo from neighbouring countries and abroad since June 15th. Thousands more continue to return each week (USAID - 15/09/99).
Kosovo
KFOR estimates that there are a total of 1,564,300 people now living in Kosovo. Of this total, 97,100 are ethnic Serbs, 1,294,200 are ethnic Albanians and the remainder are Croats, Roma and other minorities. The 97,000 ethnic Serbs represent only 51% of the 1998 estimate of ethnic Serbs living in Kosovo. In addition, the 73,000 other minorities are only 43% of the 1998 estimate for other minorities (USAID - 15/09/99).
A pattern of general unrest and systematic violence continues in Kosovo. The opposing parties vent their anger and hatred through reprisals, retribution killings and burning each other's property. These remain serious issues. The biggest other security difficulty faced by much of the population is the presence of mines, unexploded ammunition and booby traps in the areas most affected by the fighting (AAH - UK - 08/99).
Shelter and water
Shelter is currently one of the most crucial problems. UNHCR has estimated that 50,000 houses have been destroyed and a further 76,000 damaged in the last year. Approximately 300,000 people have lost their homes. Donors have already pledged enough materials to winterise the 76,000 damaged structures, but there are logistical problems in getting the materials into Kosovo. The cold weather is already affecting some Kosovars living in tents in the hills (USAID - 25/09/99).
Several major problems exist in supplying water to urban populations. The greatest problem is that the water boards are losing between 40-50% of the piped water to leaks in the system. The leaks continue to exist as there is no material to replace or patch up the pipes. In addition, the urban water board workers have not been paid for 3-6 months (USAID - 15/09/99).
Food and agricultural assistance
The general high level of preparedness of the international community resulted in the flow of food aid into the province being quick to start after the end of the conflict. In late June, a WFP/FAO EMOP was approved to provide emergency food assistance to some 2.5 million refugees, IDPs and war-affected persons in the Balkan region for a period of six months (July-December 1999). This includes the assistance required for approximately one million IDPs who remained within Kosovo throughout the conflict but, prior to the establishment of NATO peace-keeping forces, could not be accessed (FAO - 28/07/99).
Blanket food distribution by WFP and other donors was originally designed to reach 80% of the Kosovar population. Targeted food distributions began in mid-September. These will assist 900,000 beneficiaries (estimated 53% of the population) who were selected using criteria agreed by WFP, UNHCR and other organisations. The targeting takes into account both geographical and community-based systems. The introduction of targeted food aid will result in a general shift of focus to the west of the province where needs are greater (UNHCR - 27/09/99; WFP - 07/09/99, 24/09/99).
WFP sub-offices have reported that the implementation mechanisms of partner organisations are well established. Standardised reporting on a weekly basis has begun. Consultations are being held between WFP with technical assistance from UNHCR and implementing partners on the establishment of joint monitoring and impact assessments. A task group to monitor the selection criteria has been set up. This will aim to monitor the implementation of the criteria and will also focus on how the criteria are being monitored in practice, i.e.: how families are prioritised and how vulnerability is perceived by communities, and what arrangements or adaptations are made by local distribution partners in situations of food shortfalls (UNHCR - 27/09/99; WFP - 07/09/99).
A major challenge for the humanitarian operations in the winter months in Kosovo will be to reach the remote areas of the country, which become inaccessible due to weather conditions. WFP is currently identifying these areas in order to pre-position stocks with rations lasting at least 2-3 months. Other preparations include the distribution of firewood and the preparation of community shelters in urban areas with cooking facilities that allow individual families to cook for themselves (in preference to institutional food provision) (UNHCR - 15/09/99, 27/09/99; WFP - 07/09/99, 24/09/99).
Seeds, tools and machinery are being provided as agricultural assistance in Kosovo. There are concerns that insufficient seeds will be imported into Kosovo before the winter planting. As of mid-September only 18% of the total requirement had arrived. This could obviously affect the population's food security adversely (UNHCR -15/09/99).
Nutritional Survey in Kosovo
AAH-UK conducted a province-wide nutritional survey of children under five and their mothers in late July in order to assess any change in nutritional status since the last survey undertaken in Kosovo in December 1998, and in the camps in Macedonia and Albania in June 1999 (see Annex). The results of all four surveys can be seen below.
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Kosovo population |
Albania Camps |
Macedonia Camps |
Kosovo population |
||||
|
Acute |
Severe |
Acute |
Severe |
Acute |
Severe |
Acute |
Severe |
|
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Wt-for-ht* |
2.0 |
0.2 |
4.6 |
0.2 |
2.4 |
<0.1 |
3.1 |
1.0 |
|
Ht-for-age |
9.4 |
2.1 |
14.6 |
3.0 |
10.4 |
2.6 |
10.7 |
3.0 |
* these figures include oedema
The July 1999 prevalence of 3.1% wasting is the overall prevalence for the whole of Kosovo and corresponds to approximately 7,117 wasted children (assuming the under-five population is 229,583). The proportion of severely wasted children was high, accounting for almost one-third of all the wasted children. When comparing the surveys it can be seen that, between December 1998 and July 1999, there has been an increase in the prevalence of wasting among children under five in Kosovo, however the increase was not statistically significant. The most recent survey was carried out in the pre-harvest period. Given that the last planting season was disturbed by the conflict, and the predicted drop in harvest production, the yield is not expected to last as long as usual.
The problem of stunting (height-for-age) is a cause for concern. A prevalence of 10.7% corresponds to 24,565 children. An infant feeding and weaning survey performed alongside the most recent nutritional survey found that many of the common breast-feeding and weaning practices in the study sample were inappropriate, and did not follow internationally accepted recommendations. Cows' milk, tea and biscuits were introduced too early and formed too high a proportion of the diet. 35% of mothers stopped breast-feeding before six months, which was coupled with an increased uptake of infant formula. This was combined with a low intake of fruit, vegetables, meat, fish, and eggs. These practices have major implications for the growth of the child and also for iron deficiency anaemia and diarrhoea.
Amongst the mothers of children surveyed, 4.9% had a BMI<18.5kg/m2 and thus were classified as malnourished (see table below). Using a MUAC criteria (MUAC<220 mm) a smaller proportion (3.9%) of mothers were diagnosed as malnourished. If these indicators were combined (those mother with BMI less that 18.5 kg/m2 and MUAC < 220 mm) then 2.3% of mothers were classified as energy deficient and 4.7% as normal, but vulnerable. There was not a significant association between maternal and child nutritional status, which may be because the number of cases of malnutrition was small.
|
BMI<16 |
16<=BMI<17 |
17<=BMI<18.5 |
18.5<=BMI<25 |
25<=BMI<30 |
BMI>=30 |
|
0.0% |
1.0% |
3.9% |
64.4% |
21.6% |
9.1% |
The coverage of measles vaccination in Kosovo was very low
(14%) when a vaccination card was required as proof of vaccination. When family
history was taken into account the reported coverage increased to 71%, but this
result should be interpreted cautiously as there was some confusion as to which
vaccine the children had received.
Food security
This section is drawn from an AAH-UK study undertaken in July which investigated the possible impact of food insecurity on the nutritional status of the population and an FAO/WFP food assessment mission to Kosovo in late June The section includes a review of food security during the conflict as well as the more recent food security situation in Kosovo post-conflict.
Coping strategies during the conflict
Only two families of the 55 interviewed had not been displaced during the preceding months. A wide range of coping mechanisms enabled displaced people to survive (either in the mountains, or moving from village to village), without a significant impact on their nutritional status. For adults reducing the number of meals per day was common practice, although children were exempt. Families in tense areas pre-positioned food and cooking stoves or sag (special pans for baking bread) in hiding places in the mountains to be ready in case of evacuation. Where there was no time to pre-position, families escaped with food and sac, with men returning to the village after dark to take more supplies from their own homes or from the stocks of other empty houses - sometimes with a KLA escort. Assistance received prior to the mass exodus from AAH and other agencies was also important. Some villagers fled to the summer pastures on higher ground, where they survived on the milk from the cattle (AAH-UK - 08/99).
For those moving from village to village, they either depended on food stocks carried with them, or residents shared their resources. Special kitchens were sometimes made available for the displaced to cook collectively. Villagers developed systems of collecting excess harvest and distributing it to those less well off (AAH-UK -08/99).
In urban areas, state shops continued to trade but were mostly frequented by the Serbian population. Most markets were closed, although Prizren and Gjilan markets continued to trade. Meat was widely available and cheap (6 DM per kg) in Prizren because many of the animals that had been killed were sold. The most severe food shortages appeared to be suffered on the journey to escape Kosovo (AAH-UK - 08/99).
Post-conflict - Food Security in Kosovo
The food security situation for many is very poor and is expected to remain so for at least the next twelve months. In the worst affected areas the loss or destruction of food stocks is total, as they were either eaten by the displaced, resident, KLA or Serb forces - or were burned in houses or on bonfires (AAH-08/99). Massive disruption to agricultural activities has taken place in the province. Preliminary FAO and WFP analyses indicate that, in the worst affected areas, where food production was severely reduced, food aid will be required to cover the bulk of the food needs until at least spring 2000 (FAO - 28/07/99).
The area planted last autumn was sharply reduced due to insecurity and/or the basic lack of equipment and seeds. Compared to pre-war years, the reduction was between 40-60% although, in the worst affected zones the reduction was over 60% e.g., the Drenica triangle. Growing crops were damaged during the conflict from burning, bombing, grazing animals and lack of fertilisation and pest control. By harvest time (late June) many families were able to return to their farms, although the lack of serviceable machinery and the insecurity in many areas, due to mines and unexploded bombs, were expected to make harvesting extremely difficult this year (FAO - 28/07/99).
The spring crop of maize, vegetables, beans and potatoes has been sharply reduced because mass displacement coincided with the planting season. There has also been widespread loss of livestock. Before leaving their villages, farmers freed their animals to run loose and many were subsequently slaughtered by passing military and paramilitary forces. Tentative estimates put losses of larger ruminants at some 40%, and those for small livestock at over 50% (FAO - 28/07/99).
Trade in food items of commercial origin has resumed remarkably quickly in the few weeks since the end of the conflict, and prices are similar to those reported for 1997. The previously imposed ban on Albanian shopkeepers trading basic foodstuffs has now been lifted. However, more than 50% of shops in rural areas are still not trading, which is in part due to the greatly limited purchasing power among both the rural and urban populations. Only a fraction of the total needs can be met through purchases in the following year, especially as households have many essential non-food expenses (AAH-UK - 08/99).
The majority of households have suffered severe loss of livelihood as a result of loss of livestock; loss of work-horses for ploughing, reduced harvests, death of a wage earner in the family and loss of black market trade. This has had a significant impact on the diet as micro-nutrient and high quality animal protein intakes are seriously compromised, and will be even more so during the coming winter months (AAH-UK - 08/99). Humanitarian aid is the main source of food for the majority of households.
Albania
In early June, the Government of Albania estimated that 460,000 Kosovar Albanians had temporarily settled in Albania: 280,000 of these refugees were staying with host families, 83,000 were accommodated in tented camps, and 95,000 in collective centres throughout the country. There are currently 4,239 refugees in the country. The large majority of refugees returned spontaneously, while only a small minority relied on organised repatriation (UNHCR - 24/07/99, 15/09/99; USAID - 15/09/99).
It is anticipated that the residual caseload in Albania will be relatively small. The scale of food and nutrition interventions was reduced significantly during July and August. UNHCR now has exclusive responsibility for these refugees (WFP - 24/09/99).
Food Security in Albania
An FAO/WFP food supply assessment mission to Albania in June found that the impact of the Kosovo crisis on agricultural production, food prices, the local economy, and overall food security of the resident population appears to have been small. Indeed, there may have been a marginal, although very temporary, positive impact on some hosting families who have been able to benefit from emergency food parcels and additional income earned from renting to refugees. The mission concluded that the precarious food security, which is experienced by many Albanian households, is attributable mainly to the general economic and development difficulties that the country has experienced throughout the 1990s rather than the extraordinary circumstances created by the crisis (FAO/WFP - 07/07/99).
The potentially enormous burden of providing asylum to nearly half a million refugees was alleviated by the fast and adequate response of the international humanitarian community in supplying food and other types of emergency assistance. Had this effort not taken place, the crisis could have had "quite a severe impact" on the already poor Albanian population (FAO/WFP - 07/07/99).
Macedonia
Latest reports from UNHCR/Skoje indicate that there are currently some 5,125 refugees in camps and collective centres in Macedonia and 16,054 refugees with host families. (USAID - 15/09/99).
Food Security in Macedonia
An FAO/WFP food and crop supply assessment mission, which took place in mid-June, found that the impact of the refugee crisis on agricultural production, food prices, and the overall food security in Macedonia appears to have been small because of the quick response of the international humanitarian community in supplying food and other types of emergency assistance. The mission found no evidence of significant food shortage or malnutrition problems in the country (FAO/WFP - 07/07/99).
The crisis, however, undoubtedly aggravated the general economic instability already experienced by the country, and as a result there has been a significant increase in poverty levels. Affected households are finding it increasingly difficult to pay for everyday expenses, and changes in food habits were reported. The major factor causing this was the collapse of trade with Federal Republic of Yugoslavia (FRY), one of Macedonia's most important export markets and a vital source of raw materials. The loss of the fruit and vegetable market, and of lamb, in particular, is reflected in lower produce prices. Hence the financial situation of farmers has deteriorated. Non-agricultural households have also been affected due to the interruption in the supply of raw materials for the manufacturing industry, which has led to an increase in unemployment (FAO/WFP -07/07/99).
In May-June 1999, before the return of the refugees to Kosovo, AAH conducted a food security survey among host and non-host families in randomly selected villages in eight geographical areas in Macedonia (AAH -07/99). The study reported similar findings to that described above, in that the interruption of trade with FRY was the major indirect cost of the crisis to the Macedonian population. In addition, AAH assessed and compared the household income and expenditure of both host and non-host families. It was found that there was no difference in the income available for host and non-host household members (assuming that total household income is divided evenly between all members). The reasons given for this finding included: households originally chosen to be hosts had higher incomes; host-families were given money/food by the refugee families or aid agencies; and non-host families supported host families by giving them (directly, or indirectly through local NGOs) food and money. The AAH survey also found that income coming from relatives abroad was an essential coping strategy for 60% of the refugees and a large proportion of the host families.
Under a recently signed agreement, a consortium of donors will distribute a food basket to the current welfare recipients in Macedonia who are in the categories of "most vulnerable". This will include pensioners, partially employed and unemployed in selected hardest-hit towns. More than 60,000 families, all of whom already receive a cash benefit from the Government, will also receive a monthly ration (FAO/WFP - 07/07/99).
Serbia
The total number of non-Albanian (mostly Serb and Roma) displaced people from Kosovo in Serbia as of September 10th was 220,000. The vulnerability of these IDPs has recently been highlighted when several hundred were removed from the schools which served as their temporary collective center, but then found the alternative municipal facilities lacking in basic maintenance (OCHA - 10/09/99).
A joint WFP/UNHCR assessment mission to Yugoslavia confirmed that food assistance is needed in Central Serbia. The most food-insecure are the newly arrived IDPs, and population groups with minimal income, little family support and no link to rural areas. In August, ICRC provided food aid to 140,000 IDPs from Kosovo. The number of beneficiaries is expected to increase given the recent identification of 317,000 "social cases" in Serbia. These include people in institutions, handicapped people without income or property and pensioners with low income. Most towns in Serbia continue to experience shortages of basic food items (meat, oil, sugar). Controlled prices for food were recently raised (OCHA - 10/09/99; WFP - 27/07/99, 07/09/99).
Overall, the nutritional situation of the IDPs and returnees in the worst-affected regions of Kosovo (Drenica) are at moderate risk (category IIb) due to the widespread loss of livelihood and their dependence on humanitarian assistance until they can re-establish themselves. The other returnees are probably not at heightened risk (category IIc). The IDPs in Serbia may be at moderate risk but no information on their nutritional status is currently available and hence they are classified as unknown (category III). The refugees remaining outside Kosovo are not at heightened risk (category IIc).
Recommendations and Priorities:
Macedonia:
Kosovo:
Recommendations from the AAH nutritional survey:
Selected recommendations from the AAH food security survey (refer to original report for full recommendations)
Central Serbia:
The situation in the Balkans has changed significantly since the last RNIS update (May 12th). Large numbers of people are returning to Kosovo from the Former Yugoslav Republic of Macedonia, Albania and Montenegro since the signing of a peace agreement on June 9th and the deployment of Nato troops within Kosovo. The latest figures from UNHCR estimate that up to 606,000 people had returned by July 6th. Note that this number changes constantly as more refugees are leaving. UNHCR and other agencies had not established organised-repatriations, up until very recently as security remains a concern due to mines and booby-traps on roads and in dwellings. UNHCR-organised repatriations are now underway (UNHCR - 28/06/99, 06/0799; WFP -18/06/99).
Situation within Albania and Macedonia
The camps in Albania and Macedonia are (reported to be) emptying very quickly. Reports indicate that the more at-risk refugee caseloads, for example female-headed households, the elderly or those with limited financial resources, remain in the camps. Most camps in Kukes are now almost empty and are used as transit centres for refugees coming from the rest of Albania before going back to Kosovo. In Kukes WFP is providing a basic food ration for refugees going back to Kosovo (UNHCR - 27/06/99).
In Macedonia, 3 out of an initial 7 camps have now closed (as of 4th July), and UNHCR estimate the remaining camp population to be 12,598 (as compared with 110,000 refugees in camps in early June). At the height of the crisis the total caseload was almost 270,000, which according to most recent estimates has fallen to 26,972. Estimates of refugees in host families are estimated at 14,374, although this figure is disputed by the Macedonian government.
UNHCR recommends that all returnees are provided with food aid on arrival in Kosovo, and thus a repatriation ration is not provided. Reports from NGOs indicate that refugees in camps are stockpiling food to take with them. Refugees in host families usually collect their monthly ration before they return (distribution in camps is on a daily basis and in host families on monthly basis).
The distribution of WFP food commodities continues to those refugees remaining. These distributions are carried out by national and international NGOs, some of whom have an independent food pipeline which increases the complexities for effective food co-ordination. As a result rations vary according to geographical location. A lack of food distribution reports and adequate information about different food aid pipelines means that it is not possible to know what is actually distributed
The rations scales that are available in Macedonia indicate that some camps provide as little as 1700 or 1800 kcal, which in practice may be further reduced (because of leakage or under-distribution). Many refugees were unable to cook food and received bread, canned meat, milk, cheese and later fruit and vegetables for a period of 3 months (UNHCR - 03/07/99). During April WFP distributed some 1.5 million rations of bread, 290,500 'humanitarian daily rations', 250,000 rations of biscuits and 130,000 rations of canned fish to beneficiaries in Albania. In addition, some 32,600 weekly rations of basic commodities were distributed (WFP -11/06/99,22/06/99).
As bread is the main staple food for the refugee and host family population in the region, UNHCR and WFP have agreed to produce and distribute bread instead of wheat flour to refugees in camps on a daily basis. WFP is responsible for supplying the wheat flour and UNHCR is responsible for the cost of production, transportation and distribution of the bread. WFP produced bread through arrangements with some 71 bakeries in Albania by early June. This number will probably decrease as the refugees leave the country. Some mobile bakeries will soon be moved to Kosovo (WFP - 11/06/99; 22/06/99). Refugees in host families are generally provided with a monthly ration of wheatflour (UNHCR - 03/07/99).
Wasting does not appear to be an issue in this crisis. The nutritional situation of the refugees remaining in the camps in Albania and Macedonia is reported to be satisfactory and stable. A recent survey by UNHCR/AAH/IMCH/UNICEF (see Annex), reported that the prevalence of wasting was 2.3%, which is virtually identical to the NCHS/CDC/WHO reference population. The prevalence of stunting (height-for-age) was 10.4%. This prevalence was similar to that reported in a province-wide survey of Kosovo undertaken in December 1998 indicating that the protein-energy status of the refugees in the camps has not been negatively affected by the crisis.
The most worrying finding from the survey was that 23% of children less than 4 months received neither breastmilk nor infant formula. Anecdotal evidence indicates that cows milk is given to these children. This practice is reinforced by distribution of UHT milk in the general ration and through MCH without adequate warning of the dangers of providing this to children less than six months.
All agencies managing camps have agreed to stop the unsupervised distribution of infant formula. Remaining camp stocks will be collected by AAH and stored by UNICEF. AAH is also preparing instructions in Albanian for the use of infant formula and canned baby foods. There are still some agencies distributing infant formula, and milk powder, to refugees in host families.
Virtually all households were found to receive food in the general distribution. 56% of households bought food in the camps to complement the general ration. In camps with unrestricted access, almost one third bought food outside the camp. Also, whilst refugees were not permitted to cook in camps at the time of the survey, over 40% of refugees had the ability to cook.
It is also worth noting that both in the camp and host family refugee population, the proportion of elderly people is much lower than that found in the AAH survey in December 1998. This indicates that elderly people remained in Kosovo.
Less information is available on the nutritional situation of the refugees who are housed with host families. In some cases they have been hosted by these families for several months before the escalation of the crisis in March. The resources of the host families in the affected areas are normally only sufficient for their own needs and they are being stretched by the additional burden of providing for the essential needs of the refugees in their care.
Rations for host families and related refugees
An agreement between WFP, UNHCR and the Albanian Red Cross has resulted in the Red Cross being responsible for the provision of food parcels for the majority of the refugees living with host families and for the host families themselves for June and July (FAO - 29/04/99; WFP - 04/06/99). In Macedonia, the Macedonian Red Cross distributes WFP food rations to refugees in host families, and CRS (with OFDA funding) provides food rations for host families. A number of NGOs provide complementary foods, such as milk, fruits and vegetables, canned meat, baby-foods, pasta, beans etc.
Situation within Kosovo
Many agencies have now re-opened offices which had to be closed when the war broke out in the urban centres of Kosovo, and also in Serbia. Tensions in Kosovo remain high. Although NATO troops are attempting to protect both ethnic Serbs and Albanians, some deaths, mainly Serb, have been reported. Initial assessments in the rural areas of the province have reported that extensive rebuilding will be required in many areas before commercial or agricultural activities can resume as normal (UNHCR -28/06/99).
Anecdotal reports suggest that the some of the IDPs who remained in Kosovo during the bombing, often hiding in woods around villages, may have micronutrient deficiencies. Complementary feeding programmes are being established to target children under five years old and breast-feeding mothers (AAH - 21/06/99). No further information specifically on the nutritional status of the IDPs who remained within Kosovo is currently available to the RNIS.
The most recent reports from within Kosovo indicate that there are no diseases of public health importance with epidemic potential, or any significant incidence of malnutrition. Access to most rural villages, however, is still restricted and thus a complete and comprehensive assessment of the situation has not been made yet (UNHCR-27/06/99).
The commercial food supply in Kosovo is nearly non-existent therefore creating a huge demand for food assistance. Since June 13th WFP has been organising daily convoys of food from Skopje to Kosovo. In some of the more remote areas the organisation has had to use helicopters to drop the food as the roads are unsafe (WFP - 25/06/99). Eight food distribution points are now operational throughout Kosovo and other micro-distribution points are being set-up (UNHCR - 27/06/99).
NGOs are distributing return packages, for example, CRS and Doctors of the World (DOW), with OFDA funding, are planning to distribute 3 day ready to eat food packages to internally displaced and returnees who are unable to cook for themselves for the first few days. The European Community Humanitarian Office (ECHO) is also funding the distribution of return-packages.
IDPs in Serbia and Montenegro
On June 23rd WFP started to distribute food aid to some 50,000 Kosovan Serb IDPs in central Serbia and some 10,000 in FYR Montenegro (WFP - 25/05/99). An estimated 72,000 ethnic Serbs have been displaced from Kosovo to date (UNHCR - 06/07/99).
Overall, the international community has been successful in preventing acute wasting, among the Kosovan refugees. The situation of Kosovan refugees in the region is therefore category IIa - not critical. The continued provision of humanitarian assistance to Kosovan returnees inside Kosovo is expected to reduce their nutritional risk, however, until the full situation within Kosovo is assessed, it is possible that pockets of malnutrition, particularly micronutrient deficiencies associated with acute food insecurity remain. Hence the situation within Kosovo remains category IIb - moderate risk. Little information is available about the situation of the Kosovan Serbs, and given their recent displacement they are considered to be category IIb - moderate risk.
Recommendations and Priorities:
The international community has been successful in preventing wasting and associated humanitarian crises. However, there has been much criticism of the international community's handling of the Kosovo crisis. The main criticism has centred around the issue of co-ordination of humanitarian action, which is critical in order to plan a standardised response, which both integrates the main players, and takes a multi-sectoral approach to reducing risk and addressing humanitarian needs.
There are unprecedented number of agencies and institutions involved in this humanitarian operation, including for example, UN agencies, donor organisations, NATO and more than 350 non governmental organisations, all of whom are involved in delivery of humanitarian assistance.
An enormous (and possibly disproportionate) amount of financial and human resources have been spent on this situation. The distribution of these resources, however, has been uncoordinated and uneven; recently the United Nations Assistant High Commissioner for Refugees complained to donors that only about one third of the $400 million for refugees had been donated, and that UNHCR was operating on a 'hand-to-mouth' basis (BBC website, 1/7/99). Much of the assistance has been channelled bilaterally through NGOs working in the Balkans, for example, the food directed through CRS described above. This means that a substantial part of the humanitarian assistance programme in Kosovo falls outside UN co-ordination.
The effects of this lack of co-ordination have included:
The immediate task before the international community now is to focus on the current phase of humanitarian assistance and peacekeeping in Kosovo in order that internationally agreed principles, guidelines, and standards are adhered to by all parties - humanitarian, political, civilian and military. Proper assessments by appropriate technical staff will ensure that subsequent decision-making and response are based on sound analysis. The need for co-ordinated strategies based on humanitarian principles, should not be obviated by the wider political agenda.
Europe - Kosovo
The current crisis in Kosovo has resulted in widespread displacement of the population. Kosovo province lies in the south of the Federal Republic of Yugoslavia, bordering Albania and the former Yugoslav Republic of Macedonia. Its pre-crisis population of approximately two million was comprised of ethnic Albanians (90%) and Serbs (10%). Under the 1974 constitution of the Socialist Republic of Yugoslavia, Kosovo was one of two autonomous regions. In 1989, under the leadership of Slobodan Milosevic, that autonomy was revoked and since that time low-intensity conflict has continued in the province between the security forces of the Government of Serbia and groups favouring independence of the region (WFP - 10/11/98).
At the end of February 1998, a Serb offensive in Decani (a Kosovo Liberation Army stronghold) resulted in the deaths of many Albanian civilians. Since this event, the violence has continued across many parts of the country leading to significant population movements. At the time of going print it is estimated that 22% of Kosovo's pre-conflict population has been displaced (UNHCR - 19/03/99). Displacement is often precipitated by an attack or fear of an attack with villagers fleeing to nearby mountains or forest where they remain for up to 3 or more days prior to either returning to the village, or moving to stay with relatives or with a host family in safe areas. Several hundred thousand people who have not been displaced remain affected by the conflict.
Diplomatic efforts to secure a lasting peace agreement are underway, and the Kosovo Albaninan delegation signed a Peace Agreement on March 18th in Paris. However, the fighting continues and, in the absence of agreement from both sides, the spiral of violence, fear and displacement goes on. UNHCR (19/03/99) estimates that 240,000 people are displaced within Kosovo itself and that others are displaced to other countries and areas in the region (Montenegro: 25,000; other parts of Serbia: 30,000; the Former Yugoslav Republic of Macedonia: 10,000; Albania: 18,5000; other European countries: 100,000). A NATO airstrike was launched against the Serbs at the time of going to print (Releifweb - 24/03/99). It is not known what effect this will have on the crisis.
A UN Flash Appeal for the Kosovo crisis was launched in June 1998 and a Consolidated Inter-Agency Appeal for Humanitarian Assistance followed in August. The Appeal, led by UNHCR, was for basic relief needs including food, blankets, mattresses, stoves, cooking fuel etc. and was generously funded by the international community (OCHA - 12/98). WFP continues to provide food assistance, through the Yugoslavian Red Cross and the Mother Teresa Society, to approximately 400,000 people in Kosovo, and to 20,000 IDPS in Montenegro, 20,000 IDPs in Serbia, and 25,000 refugees in Albania (OCHA 12/98).
Despite the ongoing conflict, there is very little wasting among children in Kosovo. A province-wide survey conducted in December 1998/ January 1999 found that the prevalence of acute malnutrition was 2.0% and that of severe acute malnutrition was 0.2%. Only one case of low MUAC (<110mm) was noted. No cases of oedema were recorded. Chronic malnutrition rates were considerably higher - 9.4% of the under-five population were stunted, 2.1% of these severely (see annex I(17a)). These results, which are in the same range as those reported by a nationwide UNICEF survey in 1997, indicate that there was no immediate nutritional emergency in Kosovo at the time of the survey. The high prevalence of stunting, however, indicates that the availability and selection of nutrients, and the environmental conditions affecting nutritional status have been less than satisfactory for some time.
A food security assessment of the province was undertaken at the same time as the anthropometric survey described above (see annex I(17b)). The study found that access to, and availability of, foodstuffs had been severely restricted as a result of the impact of the emergency on trade, agriculture and population movements. Trade has been affected by the Serbian restriction of goods stocked by ethnic Albanian shopkeepers, including essential items such as flour, wheat, salt, sugar, oil, soap, drugs and fuel. Store-owners may only be able to obtain many of these items on the black market. This has resulted in an increase in prices (up to 70-80% in some areas) and a decrease in the range of goods. Many people can only afford to purchase the most essential items. The agricultural cycle has also been affected; a reduced wheat harvest was collected in July and the main winter-wheat planting in October was reduced by 40% (Ministry of Agriculture, Pristina). For much of the population humanitarian aid was reported to be the main source of food, although the frequency of distributions may be irregular at times. The effect of displacement has also meant an increased burden for relatives and other host families.
The main income sources were reported to be money from relatives abroad, sale of own food-production, salary from full or temporary employment, gifts, loans, pension payments, sales of assets and savings. The report noted that many of the poorer households may have exhausted any savings and have very little chance of recuperation of their assets without external help. Of particular concern are the agriculturalists who were unable to plant this year due to the conflict and hence, at best, will have no harvest until July 2000.
The recommendations from these surveys included:-
Overall, the food security situation of the population of Kosovo can probably best be described as acceptable, but fragile (category IIc). Should the peace process fail and the violence and displacement increase, then agricultural production and income will decrease further. This can only result in far greater food insecurity, with larger numbers of people affected.
United Nations System 
