United Nations System
Standing Committee on Nutrition

 

Nutrition Information in Crisis Situations - Indonesia
 

NICS 9, May 2006

A random-sampled nutrition survey was conducted in 23 districts of Nanggroe Aceh Darussalam (NAD) and Nyas Island in September 2005 (MOH/UNICEF/joint, 04/06). NAD was dramatically hit by the Tsunami in December 2004, and a further earthquake affected Nyas Island a few months later. The survey was conducted among resident and displaced households. Displaced families represented 10% of the surveyed population. The nutrition situation was precarious with a prevalence of acute malnutrition of 9.8%, which seemed similar between displaced and resident populations. Only half of the children less than six months were exclusively breastfed and among the other half, 28.3% had received milk powder. Prevalence of anaemia was significant: 50.2% of the 6-59 month olds were anaemic (Hb < 11 g/dl) as well as 27.9% of non-pregnant women (Hb < 11 g/dl). It seems that children who had received sachets of micro-nutrient supplements were 25% less likely to be anaemic than children who had not. Vitamin A distribution coverage was 82%, but varied greatly between districts, while measles vaccination coverage (by card or recall) was only 49.7%. Women's BMI were measured and 8.3% of non-pregnant women had a BMI < 18.5, but 29% had a BMI ≥ 25, showing overweight or obesity. Housing and access to safe drinking water were poor. Forty-two percent of the IDP families were sheltered in temporary accommodation such as tents or communal buildings, but 62% had access to a protected water source, while only 28% of the resident families had access to protected water sources. Sixty percent of displaced and twenty one percent of resident families were receiving food aid. This survey showed a similar nutrition situation to the nutrition survey which was conducted in March 2005 in 13 districts of NAD (see NICS 6).

NICS 8, May 2006

An FAO/WFP food supply and demand assessment mission was conducted in Aceh province and Niah island at the end of 2005 (FAO/WFP, 22/12/05). The assessment estimated that damage of paddy production due to Tsunami will be only 7%. On the other hand, the fisheries sector was far from recovery with only 45% for marine fish and 28% for brackish water of "normal" output. While major food prices had remained stable between January and September 2005, an increase in fuel prices in October has significantly affected households' purchasing power. The number of IDPs seems not to have been firmly established.

According to the government, 371,700 people remained displaced in October 2005, the majority of them (about 250,000) living with host families. A significant number of families seemed not to have re-established their livelihood yet and humanitarian assistance is still required (FAO/WFP, 22/12/05; ACF-F, 10/05). However, FAO/WFP assessment recommended that use of market based options (cash/voucher) for food assistance be preferred. Shelter is still a major problem.

NICS 6, May 2005

An earthquake which hit, among others, the island of Nias, in March 2005 caused a further 1,650 deaths, 177 injured and 267,000 displaced people in addition to the 534,000 people previously displaced by the Tsunami (UNDP, 17/04/05).

The caseload for general food distribution was 814,000 beneficiaries as of May 2005 (WFP, 20/05/05).

New talks between the government of Indonesia and the Free Aceh Movement were held in Finland in April 2005 and seemed to have ended on a positive note (BBCNews, 18/04/05). A FAO/WFP assessment mission in Aceh province and Nias island showed that many farmers in the most affected areas have lost two consecutive paddy seasons and that the fishery output is estimated to fall 50 % for marine fishing and 41% for brackish water aquaculture (FAO/WFP, 05/05/05). On the other hand, rice production in Aceh is expected to be 200,000 tonnes surplus for the 2005/2006 season. Whenever possible, local purchase for food aid should be encouraged. The reconstruction of homes and infrastructure will be essential to enable people resuming their economic activities. Cash for work activities seemed to have been very efficient for the cleaning of waste (OCHA, 11/05/05).

A random-sampled nutrition survey was conducted in 13 districts of the West Coast, East Coast and North Coast of Aceh province in February 2005 (MOH/joint, 02/05). Among the households interviewed, 10.4% were displaced families living in camps, 9.2% were host households with IDPs present and 80.4% were resident households not hosting IDPs. The nutrition situation was precarious with 11.4% (6.7-17.2) of the children measured being acutely malnourished, including 1% severely malnourished. There seemed to be no difference in wasting between displaced and non-displaced children. 10.7% of the women measured showed sign of chronic energy deficiency (BMI < 18.5) while 29.7% were overweight (BMI > 25). Anaemia was diagnosed in 48.2% (23.6-70.7) of the children (Hb < 11 g/dl) and in 29.7% (15.9-46.0) of the women (Hb < 12 g/dl).

80% of the IDP households had received rice, noodles, fish and biscuits (the WFP regular food ration), and 40% had also received sugar and dried milk. It is worth remembering that dried milk should not be distributed to families in crisis situations.

Sanitary conditions were poor with more than half of households having unprotected source of drinking water and most households having no latrines. Vitamin A distribution and measles vaccination coverage was 60% and 35%, respectively. A measles vaccination campaign was on-going.

Following the survey, a blanket supplementary feeding programme was implemented for children under five years old, and pregnant and lactating women (OCHA, 29/04/05).

Helen Keller International is currently distributing sprinkles fortified with multi-vitamins and iron fortified soy sauce to affected families (HKI, 01/05/05).

NICS 5, February 2005

Aceh province on the island of Sumatra has been the hardest hit by the Tsunami. This province has experienced a civil rebellion for years, with the rebels claiming the independence of the province. Before the tsunami, aid workers and journalists had been prevented from accessing the area for at least 18 months (BBCNews, 24/01/05). The government and the GAM (Free Aceh Movement) have declared a ceasefire to help aid get through to survivors. They have also met for the first time in almost two years in order to discuss smoothing the path of aid to victims (BBCNews, 31/12/04).

Indonesia Districts affected by Tsunami and earthquake (Reliefweb, 02/01/05)

The government estimated that 417,124 IDPs were living in spontaneous settlements while 260,000 were thought to be residing with extended families (OCHA, 28/01/05). It seemed that many of the camps were well-organized but there were also some ad hoc makeshift settlements (WFP, 31/01/05). Relocation centres were being established by the government of Indonesia for an estimated 100-150,000 IDPs for a period of up to two years (Joint mission, 01/05).

Food distributions have been on-going in Aceh. They were mostly composed of rice and noodles in the first instance (WHO, 01/05). As of end January, the pipe-line was secured for a more diversified ration, including canned fish and oil (OCHA, 28/01/05).

Concern was raised by the MOH about the large quantities of milk powder coming to Aceh (OCHA, 02/02/05).

Overall food prices in Aceh have risen by 20%, except for fish, which people don't want to consume for fear of post-tsunami contamination, and for rice owing to supplies from non-affected areas (OCHA, 28/01/05).

A rapid assessment, using a convenience sample, was conducted among 614 6-59 month- old children in 19 sites (camps in the open, camps in communal buildings and households with displaced persons in Bandah Aceh and Aceh Besar by MOH/UNICEF/CDC in mid-January. It was not possible to conduct a random-sampled survey because of the lack of reliable population figures. 12.7% of the children surveyed were acutely malnourished, including 1.5% severely malnourished, which is worrying (UNICEF; 21/01/05). No oedema was seen. BMI measurements of 334 women aged 18 to 45 showed that 15.3% had a BMI < 18.5, while 25.9% were overweight (BMI >= 25). Dietary intake seemed poor for 37% of the children (not having consumed rice, biscuits, noodles, canned fish and oil (the intended WFP food ration) the previous day at least), adequate for 38% of the children (having consumed at least the above-mentioned items) and good for 25% of the children (having consumed at least the above-mentioned items plus meat or eggs). Morbidity (cough, fever and diarrhoea) was high.

Nutrition surveys and the establishment of a nutritional surveillance among the displaced population and the affected non-displaced population have been planned (OCHA, 02/02/05).

No significant outbreaks of diseases have occurred so far (WHO, 01/05), although some cases of measles, dengue fever and bloody diarrhoea have been reported (WHO, 01/02/05). A measles vaccination campaign has been conducted in IDP camps and was due to continue among the non-displaced population (OCHA, 02/02/05).

Sanitary conditions seemed to be one of the major problems, still being poor in most of the camps (WHO, 01/05). Soap and hygiene products were also greatly needed. The quantity of the water supply did not seem to be a problem, although the quality of water was not optimum (WHO, 01/05). Non-food items have begun to be distributed to IDPs and host families (OCHA, 28/01/05).

A livelihood sector coordination group has been established to work on common guidelines for cash-for-work, cash grants and micro-finance (OCHA, 28/01/05).

RNIS 32/33, April 2001

Large scale conflict-induced displacement is a relatively recent phenomenon in Indonesia. The toppling of Suharto and his 30 year dictatorship in 1997, closely followed by the Asian economic crisis of 1998, has left Indonesia in turmoil, politically, economically and socially. Since 1999 there has been a general worsening of the humanitarian situation in the country with the spreading of religious and ethnic violence along with increased calls for separatism in different regions of the country. The hoped for stability that democratic elections and the inauguration of President Abdurrahman Wahid would bring has failed to materialise and there are presently increasing calls for the impeachment of the president on charges of corruption (NRC 2001).

The number of people displaced as a result of conflict has almost doubled since the beginning of 2000 and the WFP/VAM unit in Jakarta have estimated the total number of IDPs as of February 2001 as 1,182,571 which represents an increase of 367,515 since January. A great proportion of the displaced are in the eastern Provinces of North and Central Maluku with others located in Aceh, Kalimantan and Central Sulawesi.

West Timor

The humanitarian situation in West Timor has changed drastically as a result of the killing of three UNHCR staff members at the beginning of September 2000. The killings took place in Atambua on the 6th of September and were carried out by pro Indonesian militia members who have retained a strong hold on the camp populations in the area. Tensions between the militias and the international community had been high for some time and had created an extremely difficult humanitarian environment. As a direct result of the killings there was an immediate cessation of humanitarian activities and the evacuation of humanitarian field staff. Only a few assessment missions have been undertaken since the withdrawal of humanitarian agencies and the vast majority of the agencies have not returned to the area as a result of the Indonesian governments inability to actively assure their safety. The UNHCR has lain out very specific conditions that have to be met by the Indonesian authorities before it will consider a redeployment in the West Timor (UNHCR 06/09/00; UNHCR 03/05/01).

The Indonesian government estimates that there are currently 151,159 East Timorese refugees left in the camps in West Timor although the army puts the figure at 119,092 people. It has been reported that up to 70 %, or 80,000 people, would like to return to East Timor, but many are concerned for their safety if they are perceived to have been pro Indonesian supporters during the separation clashes. It is estimated that up to 40,000 people will chose to remain in West Timor, including pro Indonesian militia members and those closely involved with the Indonesian administration and state infrastructure of pre independence East Timor. Repatriations have continued and a total of 5,000 people are reported to have returned since the start of the year as of 24th of April. The month of March saw a particularly high rate of return but there are reports of reduced rates in April and the continued intimidation of refugees in the camps to prevent large scale returns (AFP 19/04/01; 18/04/01; UNHCR 13/03/01; UNHCR 03/05/01).

Despite assurance by the Indonesian authorities that the general security situation has improved, it would appear that little has changed and that militia activities continue in many of the camps. As a result the UN security phase V, which prevents the return of the UN staff, still remains in place. This has also meant that many of the aid agencies have also not returned, which has drastically effected the coverage of aid to the refugees, in terms of both quality and quantity. There has not been a large scale food distribution since the withdrawal of agencies in September 2000. Those agencies which have returned have found that access remains very difficult in certain camps (UNHCR 03/05/01).

The health and food situation of the refugees in camps remains of concern but many IDPs have become involved in local trading and farming activities, and the government assistance programmes function sporadically. Agency withdrawals have meant that supplementary feeding programmes, put in place to address nutritional needs in the under five population, have been stopped and this does raise cause for alarm given the perceived needs in the under five age group. The Jesuit Relief Services has reported that conditions in some camps in West Timor remain poor as a result of the cessation of assistance by the government of Indonesia and many Humanitarian Aid agencies. The report indicates that there is diarrhoea and vomiting in some of the camps such as Tuapukan and Noelbaki but this is remains difficult to confirm. (FAC 23/01/01; JRS 10/04/01)).

The Maluku Crisis

Hostilities broke out between Muslim and Christian communities, on the island of Ambon, the administrative capital of central Maluku, in January of 1999. Since the initial hostilities the conflict has spread to include almost all islands in the Maluku region, including both central and North Maluku. It is estimated that up to 25 % of a total population of 2.5 million people have been displaced. The enormous displacement of population has had profound effects on all aspects of the economic and social spheres in the region and has severely disrupted the complex systems of trade and livelihood activities that are such an integral part of the area. The conflict has been characterised by periods of relative calm, punctuated by periods of intense fighting. Each new round of fighting has resulted in further displacement of population, some of which is very localised, adding to the segregation of the communities on islands, and some of the displacement has been further a field to the islands of Java, Sulawesi and Irian Jaya (NRC 2001).

Maluku Province

The last major round of fighting in Central Maluku was seen in June 2000 and resulted in further dramatic population displacement and a drastic reduction in humanitarian access to the affected people. However, current reports indicate that the situation is quieter and that the Indonesian army is taking a firmer stance to disarm militias on both sides and prevent further fighting. There are an estimated 220,000 IDPs in Central Maluku province. The improvement in the security situation has once more opened up humanitarian access and allowed food distributions to go ahead as well as ensuring the stabilisation of food prices and the reestablishment of trade activities. This has positively affected the food security situation but needs still remain, particularly amongst groups in the displaced community who have lost everything as a result of the conflict. Food distributions continue although there is an increasing effort to target the most needy, boost coping mechanisms and reduce the reliance on food aid (FAC 23/01/01; UNICEF 2001).

North Maluku Province

The situation in North Maluku has been stable for some time and the latest reports indicate that IDPs, particularly Muslim IDPs who have been on the island of Ternate, are beginning to return to their places of origin. The last estimates of numbers of IDPs indicated approximately 175,000 but the governor of the province announced recently that 40,000 IDPs have returned to their homes in the districts of Halmahera, Morotai, Bacan and other islands (UN OCHA 04/01).

Nutritional situation

The biggest concern for both the displaced and non displaced populations has been the prospect of acute food insecurity and malnutrition as a result of the wide scale destruction of property and disruption of livelihoods, which have left many living in displaced camps with little or no apparent means of support. There was considerable concern that the situation had become very grave for many forced for the second or third time to flee where they were living, and have to start from scratch once more. The disruption of trade resulted in dramatic price rises in many markets, which led to fears of acute food insecurity (ACF 12/03/01).

ACF began a nutritional survey in June 2000 which had to be abandoned as a result of the deteriorating security situation, but the very tentative preliminary results, coupled with continuous on the ground observations of the situation, strongly indicate that the nutritional status of the population remains non critical. This further suggests that the coping mechanisms of the population are very robust. The food security and nutrition prospects have been further improved by a long period of relative calm in the area, which has allowed continued food distribution to take place and coping mechanisms to be established. A primary feature of the current distributions has been the increased targeting of resources to beneficiaries (ACF 12/03/01).

Other areas of Indonesia

The political and economic turmoil in Indonesia has seen conflict break out in many new areas of the country. Aceh, in north Sumatra island, is a long standing conflict area and remains extremely volatile as a result of a strong separatist movement and frequent government-separatist clashes. Currently it is estimated that there are 30,000 IDPs residing in camps in North Sumatra (UN OCHA 04/01).

The island of Sulawesi has been a large recipient of IDPs particularly from the crisis areas in Maluku. These IDPs have been focused in the north and the south of the island. However, in the early part of 2000 sectarian violence broke out in the central area of Sulawesi around the towns of Poso, resulting in enormous destruction of property and mass displacement of population with an estimated 20-40,000 IDPs reported. The food security of the IDPs remains a concern but it would appear that much of the displacement is fairly localised and many people are able to access their land and/or obtain work, whilst hosted by sympathetic host communities who also provide material support. Recent reports indicate that the insecurity continues and this could have an extremely detrimental effect on the food security of both the displaced and the host communities (UN OCHA 04/01).

Most recently there has been a fresh outbreak of violence on the island of Borneo in the province of Central Kalimantan. The violence is between indigenous Dyak populations and populations of transmigrant Madurese, many of whom have been on the island for many years. There has been low-level violence and hostility between the groups for some years, but an escalation was seen in 1999 in the West Kalimantan districts of Sambas and Pontianak. The violence of 1999 was on a scale previously not seen and for the first time involved non Dyak Malayu peoples. The recent outbreak of violence has seen many Madurese forced from their homes and there are reports of up to 57,000 having returned to the island of Madura, where their presence is placing an increased burden on the communities and economy of the island. Current estimates of IDPs in Central Kalimantan put the number at 19,600 people. The RNIS currently does not have any information regarding the condition of IDPs in Central Kalimantan (AFP 01/03/01; WFP/VAM 26/02/01).

Overall

Indonesia is an extremely large, complex and diverse country currently gripped by severe economic and political turmoil. The outlook for the political and economic stability of the country remains extremely bleak. Local and regional violence continues within the backdrop of a deteriorating political and economic crisis. The likelihood for the continuation of existing conflicts and the outbreak of further wide scale outbreaks of violence seem high. This heightens the likelihood of further large scale displacements of population and will put further stresses on the food security of affected areas. Although local coping mechanisms appear robust, the protracted nature of the violence in many areas and the spiralling political and economic crisis, mean that the possibility for a deterioration in nutritional status within affected populations is very high.

Recommendations:

  • the provision of food aid to IDPs in conflict affected where possible the monitor the general health and nutritional status of East Timorese refugees in the camps of West Timor.
  • Continue areas, whilst searching for mechanism to establish self sufficiency.

RNIS 31, July 2000

West Timor

An estimated 120,000 East Timorese refugees remain in West Timor following the crisis in August 1999. UNHCR is currently undertaking a registration exercise, which has been repeatedly postponed because of insecurity, in order to obtain more precise population figures. The majority of the refugees are living in one of more than 200 sites in Belu or Kupang district (OCHA - 06/00; UNHCR - 11/07/00; WFP/UNHCR/UNICEF - 05/00).

The Government of Indonesia (GoI) is encouraging the refugees to return to East Timor. However, attempts will be made to settle those who do not wish to repatriate in West Timor and other parts of Indonesia. Resettlement plans are hampered by a lack of funds and suitable land. In May, repatriation movements had virtually come to a standstill, in part due to a reluctance of the refugees (the longer they stay in West Timor, the more likely they will be considered in East Timor as collaborators, or alternatively the more likely their homes will have been occupied or destroyed). It is therefore difficult to predict the rate of resettlement. UNHCR currently expects that 20,000 refugees will repatriate to East Timor by the end of the year and that a further 10,000 will be resettled within Indonesia (WFP/UNHCR/UNICEF - 05/00).

Approximately 40,000 refugees are known to be Indonesian National Armed Forces, police, civil servants and their families. This group are not currently eligible for UN assistance as the GoI continues to provide them with salaries and other benefits. The GoI is making plans to settle this group on other islands of NTT or elsewhere in Indonesia (WFP/UNHCR/UNICEF - 05/00).

Nutritional situation

A WFP/UNHCR/UNICEF mission to West Timor took place in mid-May in order to review the developments in the nutritional situation of the refugees since the last assessment mission conducted in January 2000 (see RNIS 30). The mission reported an improvement in the overall nutritional situation as evidenced by a decrease in the prevalence of malnutrition in Belu District and TTU (WFP/UNHCR/UNICEF - 05/00).

UNICEF undertook a nutritional survey of the refugees in Belu district in May. The prevalence of wasting was estimated at 8.8%, including 0.8% severe wasting. No oedema was reported. These prevalences are considerably lower than those reported in a survey conducted in December 1999 although the survey methodologies were not identical and therefore the data not strictly comparable (UNICEF - 05/00). The present survey results are likely to be more representative of the wider refugee community in Belu district than the former survey.

According to the mission report, the nutritional situation of the refugees in North Central Timor has also improved. A screening in mid-February had estimated the prevalence of acute malnutrition at 33%, but this has decreased to 8.2% (WFP/UNHCR/UNICEF - 05/00). This assessment is currently unavailable to the RNIS.

The improvement in the nutritional situation was attributed mainly to: (i) the distribution of general food rations in most areas (despite variable food baskets and ration scales), (ii) post-harvest season surpluses among local communities, (iii) access to employment during the harvesting season, (iv) successful supplementary feeding programmes, and (iv) improved water and sanitation. In addition some of the refugees were also able to benefit from living with or near by relatives. It is likely all these factors simultaneously contribute to nutritional improvements, although the report points out that some positive influences such as supplementary feeding have little impact if the general food ration is insufficient (WFP/UNHCR/UNICEF - 05/00).

More recently, however, reports have indicated that health and nutrition staff in West Timor are concerned that the refugees are not receiving an adequate diet. WFP provides only rice to the refugees and it is possible that the population will develop micronutrient deficiencies (UNHCR - 20/07/00).

Food Security

Most of the refugees are not restricted to the environs of a refugee camp, and hence have access to employment opportunities, although these are limited because of high unemployment in West Timor. Opportunities also exist for small-scale agricultural activities such as livestock raising (pigs, chickens, goats), kitchen gardening and subsequent trade. These activities need to be expanded. Access to more productive farmland, however, is virtually nonexistent and this may limit the refugees' ability to become self-sufficient in the long-term (WFP/UNHCR/UNICEF - 05/00). While supporting the GoI in the care and maintenance of refugees, the UN agencies recommend a strategy for phasing out international assistance, including a systematic reduction in food aid (WFP/UNHCR/ UNICEF - 05/00).

The UN Consolidated Appeal for West Timor has outlined various strategies to improve the food security of the refugees, including the provision of seeds and tools for more vegetable gardens, the provision of chickens, and the provision of maize seeds (in locations where land is available). WFP, UNHCR, ICRC and other NGOs will continue to provide food assistance to the vulnerable section of the population (OCHA - 06/00).

The Maluku Crisis

Clashes between members of Christian and Muslim communities in the Moluccan island region of Indonesia have lead to more than 3,000 deaths since the conflict first broke out in January 1999. An estimated 500,000 people have been displaced either within Malaku, North Maluku or to provinces in Sulawesi, Irian Jaya and elsewhere in Indonesia. The violence escalated in late June resulting in a complete break down in law and order in some areas, particularly Ambon (HRW - 29/06/00).

The latest round of fighting has resulted in the destruction of property and infrastructure and further mass population movements. This has taken place in areas both previously affected and unaffected by the conflict. In many cases people are being displaced for the second or third time (ACF-F - 30/06/00).

Gaining access to the population is currently a crucial issue. Many international organisations have been forced to withdraw due to insecurity. A state of civil emergency has been declared by the GoI, but the population distrusts the security forces, in large part because some members of the military and police units have taken sides in the conflict. It is unclear how a humanitarian corridor can be established given the current security situation (ACF-F - 30/06/00; HRW - 29/06/00).

The situation in North Maluku is less critical, where NGOs are still operational. ACF and MSF are providing assistance to approximately 3,500 IDPs on the island of Bacan (ACF-F - 30/06/00).

Nutritional situation

The displacement and destruction of property has profound implications for the population's food security. Coping mechanisms are severely hampered, particularly in areas that have suffered earlier in the crisis. Reports suggest that the cost of living has risen dramatically (some food items have more than doubled in cost), and widespread shortages of basic products (rice, noodles, fuel) are reported. ACF-F expects acute food insecurity and associated increases of malnutrition, morbidity and mortality to emerge in the area if a solution is not found soon (ACF-F - 30/06/00).

At an operational level, ACF-F was forced to abandon its food distribution in May for Ambon. Thus the beneficiaries in this area have not received any food aid for over a month (ACF-F - 30/06/00).

Other parts of Indonesia

Sectarian violence is also spreading to other parts of the country. Between 20-40,000 IDPs have been reported in Poso city and its surroundings in central Sulawesi. Others are present in Manadao, north Sulawesi. IDPs also remain in Aceh and west Kalimantan. Earthquakes have also caused displacement in Sulawesi and Sumatra (ACF-F - 30/06/00; WFP - 20/06/00). The RNIS has not received any new information on the nutritional situation of these groups.

Overall, the refugees in West Timor have a satisfactory nutritional status (category IV). There is no information on the nutritional situation of the IDPs in Maluku, but they are considered to be at moderate to high risk (category II and III). The IDPs elsewhere are at moderate risk (category III).

Recommendations and priorities:

From the WFP/UNHCR/UNICEF mission to West Timor (WFP/UNHCR/UNICEF- 05/00):

  • Continue with the current distribution system of food distribution until the UNHCR registration exercise is completed. Then distribute a full ration to all eligible refugees on a family-based ration card system.
  • Improve the monitoring of food distributions.
  • Implement a growth monitoring system in selected sentinel sites. Continue to undertake nutritional surveys regularly.
  • Supply vegetable seeds and gardening tools to refugees who live in areas that can sustain kitchen gardens.
  • Establish a system to phase out international assistance including a systematic reduction in ration size, increased dialogue with the GoI to better understand repatriation plans, promotion and support of local repatriation schemes and plans for repatriation food packages.

Elsewhere:

  • Monitor the situation as closely as possible.
  • Advocate the establishment of a humanitarian corridor to provide assistance to the population of Maluku.

RNIS 30, March 2000

Refugees in West Timor, Indonesia

UNHCR estimates that some 145,000 refugees from East Timor remain in West Timor. The majority of the refugees are living in one of more than 200 sites in Belu district; most of the remainder are in Kupang district. The number of people per site varies from 60 to 4,000. According to UNHCR, large numbers of East Timorese in West Timor wish to return to East Timor (and are being encouraged to do so by the Indonesian authorities), but are prevented from doing so by either intimidation or their own apprehensions concerning their safety and/or financial security on their return. UNHCR continues to assist those refugees who wish to repatriate. It is anticipated that approximately 50,000 East Timorese will ultimately decide to remain in Indonesia (WFP/UNHCR - 03/00; USCR - 22/02/00).

The humanitarian situation of the refugees is reported to be very poor in some of the camps. High prevalences of acute malnutrition have been recorded. Infant mortality rates are also elevated, mainly because of increased incidence of malaria, diarrhoea and tuberculosis. In addition, local and international human rights organisations have documented cases of extortion, abduction, sexual violence, and unlawful killings by the militia (RI - 23/02/00).

UNHCR/WFP joint assessment mission

A UNHCR/WFP joint assessment mission to West Timor in January reported the following findings (WFP/UNHCR - 03/00):

  • Food aid is currently being provided to the refugees by a number of relief agencies including WFP and local and international NGOs, although the Government of Indonesia has provided the largest share of food assistance (400g rice/person/day) and also a cash stipend of 1,500 rupiahs/refugee/day (equivalent to 14 US cents) to purchase additional necessities. Distributions of both rice and cash have been sporadic and not in sufficient quantities to cover the refugees daily needs. (The ration only provides 1440 Kcal and 28g of protein, which is well below the recommended minimum). No systematic monitoring of the basic food distribution was in place. The responsibilities for the distribution of rice and cash are being transferred from the Department of Social Affairs (DEPSOS) to the provincial government level in March. However, there are uncertainties about future commitments on the part of the Government of Indonesia to ensure continued assistance to refugees in West Timor (WFP/UNHCR - 03/00).
  • Most refugees brought a substantial quantity of personal possessions with them to West Timor, including various household items, livestock (pigs, chicken, cattle), food items and even cash/savings. However, most food and luxury items appear to have been consumed or sold and therefore no longer represent a sizeable resource.
  • Some of the refugees have family or blood ties with the West Timorese and are living with, or nearby, relatives who have been willing to share resources. West Timor, however, is one of the poorest provinces in Indonesia and the burden on local resources is becoming apparent.
  • Few job opportunities are available to the refugees - Indonesia remains entrenched in a severe economic crisis with high levels of unemployment.
  • Approximately 50,000 of the refugees are Indonesian government civil servants, police, military personnel, pensioners and their families. These people continue to benefit from basic government salaries and pensions, although other benefits normally provided to them have been discontinued. It is this group of people who are most likely to remain in West Timor.
  • Very little land has been allocated to the refugees, other than that within the environs of the camps where some households have established kitchen gardens. Refugees living with relatives have greater access to farmland.
  • All refugees have some form of shelter ranging from pre-fabricated barracks to loosely constructed shelters made of plastic sheeting and branches. Many households received cooking/kitchen sets, blankets, water containers, mosquito nets etc, (there are no exact data on these items). Water sources, latrines and bathing facilities have been established in most of the larger camps, but some of the smaller camps are not as well equipped. The quality of the drinking water is unknown. Soap distributions have been erratic.
  • Current health care services tend to be more based on a curative rather than a preventative approach, this factor combined with delays before seeking assistance may be contributing to the higher incidence of preventable diseases, such as diarrhoea and scabies. Malaria, diarrhoea, acute respiratory infections and measles were the most common causes of deaths reported by mothers (UNICEF - 12/99). The incidence of malaria and diarrhoea are attributable to the recent rainy season conditions.

Nutritional surveys in West Timor

UNICEF undertook two nutritional surveys on refugee children aged 6-59 months in West Timor during the reporting period: one in mid-December in Belu district and the other in January in Kupang district (see table and annex) (UNICEF - 12/99, 02/00).

Oedema was not assessed in the Belu survey. No oedema was found in the survey in Kupang. The sampling technique employed in the Belu district survey resulted in an overestimate of the prevalence of wasting in this area as younger children were over-represented. However Belu does appear to have a higher prevalence of wasting than Kupang (see different age group comparisons) and also a higher prevalence of wasting than that estimated by a national survey conducted by UNICEF in 1995. There were no significant differences in the prevalence of stunting (low height-for-age) between the two districts or the national survey.

Results of surveys in Belu and Kupang Districts

Belu District
Dec 1999
(n=842)

Kupang District
Jan 2000
(n=892)

Baseline data
1995**

6-59 months

Wasting*

23.6%

12.1%

12.9%

Severe wasting*

3.6%

1.0%

2.8%

Stunting*

46.8%

43.1%

42.2%

Severe stunting*

17.9%

17.5%

19.2

6-23 months

Wasting*

28.2%

20.7%


Severe wasting*

5.2%

1.8%


24-59 months

Wasting*

19.5%

8.6%


Severe wasting*

2.0%

0.6%


* all measurements converted to z-scores
** UNICEF national survey on children aged 0-59 months

MSF-H/MOH completed a nutritional screening of children aged 6-59 months in Naen Camp in North Central Timor in mid-February (see annex). Naen camp is made up of barracks, each with 20 small rooms - one per family. Water is provided by a shallow well, although some days none is available. All available children were screened with MUAC and a proportion also had their height and weight measured. The results of the MUAC screening revealed that 29.5% of the children were acutely malnourished (MUAC<135mm) and 10% were severely malnourished (MUAC<110mm). This prevalence may be somewhat elevated because children under 12 months were included in the assessment (it is not normal to measure arm circumference on infants less than 12 months as they would naturally have a smaller arm circumference measurement). Using weight-for-height, the prevalence of acute malnutrition was estimated at 33%, including 7% severe acute malnutrition (MSF-H - 03/00). These results are somewhat surprising given that the prevalence of low MUAC (<135 mm) is usually higher than that of low weight-for-height, particularly when children under six months are included in the MUAC assessment.

The main explanation given for the high prevalence of malnutrition was the irregular and infrequent distribution of the general ration. A blanket wet-supplementary feeding programme for children aged 6-59 months had been established, but this is only a temporary, emergency measure. Until the general ration improves (in both quality and timing of distribution - prior to the survey there had been no food distribution in the camp for two months), so that households may plan their food needs, the supplementary feeding programme will remain relatively ineffective in decreasing the prevalence of malnutrition. Other explanations given for the high prevalence of malnutrition included; no structured system for screening, referring and treating the severely malnourished (which was partly a result of lack of medical expertise); low birthweights; and relatively high levels of illness. In addition, the survey was undertaken during the lean/hungry season (as a result of limited availability of crops) (MSF-H - 03/00).

Other parts of Indonesia

Sectarian violence continues to claim lives in other areas of Indonesia. During 1999 and into the first quarter of this year, the two provinces of Maluku and Morth Maluku have experienced high levels of conflict. Starting in Ambon in January 1999, the conflict escalated at various periods of the year, spreading to other areas of Maluku. Some 440,000 persons (more than 20% of the population) have escaped or been evacuated within Maluku, North Maluku or to the neighbouring provinces in Sulawesi. Smaller numbers have also gone to Irian Jaya and elsewhere in Indonesia. (OCHA - 03/00; USCR - 22/02/00).

The needs of the IDPs vary depending on the intensity of the conflict in the area where they are located and also on their living arrangements. Some IDPs living with host families are able to cope, but are placing a heavy burden on their hosts who may need assistance. IDPs in areas that have stabilised (e.g., Ambon Island and South-East Maluku) are better off than those in areas still affected by conflict (e.g., Halmahera Island, the Island of Bacan and a number of other islands in North Maluku) or those living in poor camp conditions (OCHA - 03/00).

ACF-F is currently distributing food to 135,000 IDPs in Central Maluku including the islands of Ambon, Seram, Serarua, Haruku and Bum. The NGO is also considering starting a new distribution in North Malukus where the violence has escalated since late December 1999. This includes the island of Ternate where there are currently 72,000 IDPs and the island of Halmahera where fighting continues (hence there has been no reliable survey of the numbers of displaced people, but 40,000 are estimated) (ACF-F - 07/03/00). WFP has been supporting ACF’s programme by providing the rice needed for their feeding programmes (OCHA - 03/00).

The RNIS has not received any nutritional assessments for the displaced outside of West Timor during the reporting period.

Overall, the patchy performance of the humanitarian assistance programme, in terms of irregular food distributions, weak health services, etc., is of concern, and combined with the relatively high rates of malnutrition suggest that the refugees in West Timor are at high risk of malnutrition (category II). The nutritional situation of the IDPs in the rest of Indonesia is currently unknown (category V).

Recommendations and priorities:

  • Improve the quality and co-ordination of humanitarian assistance programmes within West Timor (including the nutritional surveillance programmes).
  • Monitor the nutritional situation of the displaced outside of West Timor.

From the MSF-H survey in Naen camp:

  • Improve the quality of the general ration and ensure that it is distributed regularly.
  • Provide seeds and tools for kitchen gardens.
  • Provide support and training in the management and identification of malnutrition.

From the UNHCR/WFP joint assessments and UNICEF surveys:

  • Increase the general food distribution to a standard ration of not less than 1,900 Kcal/person/day (this figure was calculated using the demographic profile of the population which has a high proportion of young children).
  • Ensure that the ration includes a food basket of cereals, pulses and oil.
  • This ration should not be provided to those receiving regular income from the Government of Indonesia (UNHCR must determine who is eligible before the distributions start and introduce a ration card system).
  • Implement a blanket dry-supplementary feeding programme for all children under five.
  • Organise targeted feeding programmes for other vulnerable groups including moderately malnourished children.
  • Establish a nutrition and food basket monitoring system.
  • Redirect health care services towards community outreach programmes.

RNIS 29, December 1999

During the two weeks of violence that followed the 30 August 1999 popular consultation in East Timor, more than 75% of the entire population was displaced. In addition, 70% of all private residences, public buildings and essential utilities were destroyed. The crisis was further deepened when all government departments, including public services and law and order, collapsed with the rapid and unexpected departure of the Indonesian authorities. Indonesia has now officially relinquished all legal claims to East Timor. The vacuum in East Timor was filled in the immediate term by the deployment of the multi-national, International Forces for East Timor (INTERFET), and by humanitarian agencies (OCHA-10/99).

There is an urgent need to return East Timorese displaced in West Timor and elsewhere in Indonesia to their communities of origin in order for rehabilitation, reconstruction and development to begin as safely as possible. As of mid-December some 117,000 people had returned to East Timor in an organised or spontaneous way, despite continued harassment by militiamen. The rate of repatriation slowed down in the first few weeks of December (IOM - 09/12/99).

Agriculture and Food assistance

The imminent onset of the rainy season means that it will be too late for many of East Timor’s displaced population to plant maize. Families who miss this year’s planting season will not be able to plant maize again until November 2000. FAO led a campaign to distribute maize grain to some 58,400 families before the onset of the rainy programme (WFP -19/11/99).

WFP has provided general rice distributions to the affected East Timorese during the reporting period (10 kg/month/person) More food-for-work, seed protection and school feeding programmes will be gradually introduced (WFP -19/11/99). WFP delivers some of its humanitarian aid via helicopters to areas that are inaccessible due to poor road conditions. As the monsoon progresses the demand for helicopter lifts is likely to increase, which represents a major constraint (WHO -13/12/999).

Dili

Although economic activity in Dili is increasing, widespread unemployment persists and continues to jeopardise a full economic recovery. A recent rice distribution in the capital indicated that the capital’s population is nearly 140,000. A significant percentage of the population is non-Dili residents who have yet to return to their original homes in the countryside. There is concern that limited housing and overcrowding will negatively affect public health, particularly in poorer neighbourhoods (OCHA - 01/12/99).

ACF conducted a quick nutritional assessment in Dili in mid-October using MUAC (see annex). They found that 0.4% of the children were severely malnourished (MUAC<110 mm) and that 2.2% were moderately malnourished (MUAC > = 110 mm, < 120 mm). No oedema was reported (ACF-11/99).

Nutrition and health situation outside Dili

A number of quick nutritional assessments were conducted by ACF outside of Dili in Manuato, Ermera and Liquisa districts during October. Elevated rates of malnutrition were not reported in any of these districts, although additional screenings may be required to assess the situation of the population who were hiding in the mountains (ACF-11/99).

Similarly, WHO has reported that the preliminary findings of an ICRC nutritional assessment in Los Palos were “unalarming”. The initial findings suggest that the quality of food, not the quantity, may be responsible for the malnutrition seen (WHO - 23/11/99).

WHO continues to monitor on a weekly basis any disease outbreaks. Some 68% of the medical consultations at the 48 health facilities in East Timor involved communicable diseases; malaria and other fevers being the most common (WHO-13/12/99).

West Timor

There remain an estimated 140,000 to 160,000 displaced East Timorese in West Timor (296,000 persons reportedly fled to West Timor originally). As many as 40,000 to 50,000 of these people may be former Government of Indonesia civil servants, military, police and their families. They may face an uncertain employment future in East Timor and hence many are undecided about repatriation. UNHCR expects that most of the displaced people who wish to return to East Timor will have done so by mid-December. There continue to be reports that the Indonesian military is not fully committed to facilitating the return of the displaced (USAID - 25/11/99).

Nutrition and health of the displaced

Conditions in some of the camps, particularly those in Tua Pukan, are reported to be unacceptable. Mortality rates in Tua Pukan Camp (population more than 4,000) are elevated; the CMR is estimated at 2.1/10,000/day and under-five mortality rate at 9.2/10,000/day. Unspecified diarrhoeas and malaria are reported as major causes of camp deaths. Environmental health conditions remain inadequate although the chlorination of the water supply and construction of new latrines has begun. UNHCR and other aid agencies had no access to the Kupang camps, which were controlled by militia, until late November. Since then, efforts have been made to improve the conditions especially given the imminent arrival of the rainy season. Security is still tenuous with continuing militia presence (UNHCR - 06/12/99,07/12/99; WHO -15/12/99).

OCHA has reported on an ICRC rapid nutritional assessment in the camps in Belo district. The RNIS has not received this report. According to OCHA, the ICRC nutritional assessment estimated the prevalence of severe malnutrition to be 11% in five camps in the Belo district. A nutritional survey in the area is planned shortly by UNHCR (OCHA - 02/12/99). Similarly, there have been reports of a CRS assessment of eight camps in Kupang district which suggests a “significant prevalence” of severe malnutrition (USAID-10/12/99).

UN agencies and NGOs have expressed concern about health needs in other camps in West Timor. Quantitative health data remain unavailable (WHO -15/12/99).

Recommendations and priorities:

· Continue to monitor the nutritional situation of the affected population in East Timor.

· Improve environmental health, and in particular the sanitation conditions of the camps in West Timor.

· Undertake full nutritional surveys in the camps in West Timor.

Overall, the nutritional situation of the population in East Timor is not currently considered to be critical (category IV). The displaced population in the camps in West Timor are at a greater risk of malnutrition, given the high incidence of diarrhoeal disease and elevated mortality rates (category II).

RNIS 28, September 1999

The following section describes the nutritional situation of IDPs in Ambon Island, East Timor and West Pontianak. These locations have been chosen as they have IDP populations which require food assistance, in addition the RNIS has received survey reports concerning the populations in these areas. This coverage is not comprehensive; other IDP populations in need of food assistance do exist in Indonesia.

Ambon Island, Molucas Province

Ambon island is situated to the east of the Indonesian archipelago and is the administrative capital of a chain of islands, known as the Molucas, stretching between the islands of Sulawesi and Irian Jaya. The population is both Christian and Muslim. In January 1999, there was an outbreak of violence between the Christian and Muslim communities that resulted in the widespread destruction of property and the subsequent forced migration of large sections of the two communities (approximately 20,000 people were displaced). The IDPs are now living in about 48 camps across the islands. Most of the camps are segregated by religion, although others are mixed. The camps themselves are diverse in nature. Some have communal accommodation in public buildings (e.g., churches and mosques) and others are groups of vacated houses. Further IDPs are housed with host families (ACF-F - 07/99).

ACF-F undertook a nutritional survey in May/June 1999 to obtain baseline data on the prevalence of malnutrition amongst the population in these camps. The survey estimated the prevalence of acute wasting in the under-five population at 11.2%, which included 0.8% severe wasting. No oedema was recorded. Chronic malnutrition or stunting (height-for-age) was estimated at 31.5, which included 9.0% severe stunting. No statistically significant differences in the prevalence of malnutrition were found between the different religious groups. It is probable that traditional weaning habits - children are given breastmilk and then rice porridge - has exacerbated the problems for the weaning age group which had a higher prevalence of malnutrition than the older groups.

This population is currently receiving 2,100 kcal/person/day from WFP (including rice, dry fish, oil, sugar and salt). The children under-five have recently started to receive a blanket supplementary distribution of WSB. The report suggests that the major cause of the malnutrition in this population is the IDP's lack of purchasing power. Food availability in the markets of Ambon, which is a fertile island, is good. The population displacement, however, was accompanied by wide-scale destruction of property and goods, leaving many of the IDPs with little in the way of assets, and divorcing people from their land and modes of livelihood. Thus, many of the IDPs do not have access to a constant/sufficient income. This "vulnerability" has been exacerbated by the difficult economic climate in Indonesia following the Asian financial crisis in July 1997. In addition, there has been a breakdown in access to normal health facilities, and many of the IDPs are living in poor conditions. This has resulted in a poor health environment which has impacted negatively on the nutritional situation.

East Timor

The first half of September saw a dramatic increase in human rights violations and violence in East Timor. Since the results of the ballot, in which over 78% of the voters opted for an independent East Timor, armed pro-integration militia members have erected roadblocks throughout the capital, Dili, and controlled the streets. According to reports received from, UNAMET (the UN mission for East Timor), militia members were terrorising and murdering unarmed civilians, burning houses, displacing large numbers of people, as well as intimidating, threatening, and attacking personnel of international organisations. The militias forcibly moved civilians out of East Timor into West Timor, while thousands fled into the surrounding hills and jungles of East Timor (UNHCHR - 17/09/99).

More recently, since the UN force (approximately 3,800 soldiers) has arrived in East Timor Dili is returning to normal and some people have already returned. However, UNHCR has received persistent reports about some of the camps in West Timor housing people displaced from East Timor being run by anti-independence militias who intimidate East Timorese, keeping them in West Timor against their will (GoA - 27/09/99; UNHCR -28/09/99).

Numbers Affected

The most recent estimates of the numbers of people displaced by the violence range from 300-400,000. As of September 23rd, the Government of Indonesia has registered 214,00 IDPs in 31 camps and shelters throughout West Timor and nearby islands, although UN estimates are slightly lower. According to the government, the majority of IDPs are located in Kupang, Belu and Timor Tengah Utara. There are an estimated 200,000 IDPs in East Timor (AAID - 21/09/99; USAID - 21/09/99, 27/09/99).

Food assistance

WFP has approved an EMOP to provide emergency rations to 150,000 IDPs within East Timor for two months (WFP - 20/09/99). The agency has also approved a Special Operations programme to finance a joint logistics cell for the crisis. The cell will receive, store and transport humanitarian aid. WFP and the Australian Defence Force have begun to air-drop humanitarian daily rations and high protein biscuits in Ermera and Bobonaro, and areas of East Timor known to have high concentrations of IDPs. (AAID - 21/09/99; USAID - 21/09/99, 27/09/99).

The most recent WFP estimates suggest that up to 740,000 people (out of a total population of 890,000) will require food assistance for six months. This includes 490,000 IDPs and 100,000 returnees who will require full rations and a further 150,000 IDPs requiring half rations. These figures are obviously preliminary and need to be confirmed through food assessments as soon as possible (WFP - 24/09/99).

Food security

USAID reports that their assessment team in Jakata has not received any anecdotal reports of starvation or critical malnutrition in Timor. Food stocks in West Timor are sufficient to meet current needs, but access to food may worsen without external assistance and/or if militia activity persists. In contrast, food availability is reported to be a growing problem in East Timor, particularly for IDPs in isolated locations. There are also concerns about micro-nutrient and protein deficiencies resulting from an extended bulk grain (rice) diet. A relatively high incidence of micronutrient diseases reported in Tomor in a UNICEF/MOH Mother and Child Health Survey for Indonesia in 1995 (MOH - 1995; USAID - 20/09/99)

The planting season in Timor should normally begin in six weeks. The displacement may disrupt this schedule and reduce planting which will lead to longer term food shortages.

Public Health Environment

The provision of water will be UNHCR's priority for the camps in West Timor as September is the peak of the dry season. UNHCR also reports that the camps are overcrowded and lack sanitation facilities (UNHCR -21/09/99).

West Pontianak, Kalimantan

Fighting between ethnic Madurese and Melayu in Sambas, West Kalimantan, resulted in the initial displacement of about 30,000 Madurese. Some 6,000 settled in camps in Singkawang and a further 11,000 went to Pontianak and the surrounding area. The majority of the IDPs in Pontianak are in 10 camps. These camps are either public/Government owned buildings such as football stadiums and badminton courts or are in army bases (ACF-F - 09/99).

ACF-F undertook a survey in these camps in late July in response to alarming reports of a poor health situation and high mortality rates, particularly amongst the under-fives. The prevalence of acute wasting was estimated at 14.1%, which included 2.3% severe wasting. No oedema was reported. This prevalence was not as high as expected, given the reports received prior to the assessment. Reasons given for this include the 2,300 kcal/person/day ration given the population by ICRC.

Overall, the nutritional situation of the IDPs in Ambon and Kalimantan are not considered critical at this time. Nor are there any reports of a nutritional emergency in Timor as yet. However, the IDPs in Timor are at moderate risk (category IIb) given that they have a poor food security outlook unless they are resettled before the planting season starts. Their public health environment is also inadequate.

Priorities and Recommendations:

Priorities for Timor:

  • Allow UNHCR access to the IDPs in West Timor who may be being held against their will.

Recommendations from the ACF-survey in Ambon include:

  • Continue the general food distribution and the recent addition of the supplementary rations to the under-fives, but change the additional supplementary ration from WSB to Vitadele, which is specially formulated for the Indonesian context.
  • Encourage the resumption of full medical facilities in Ambon, particularly Maternal and Child Health activities to ensure vaccination and weight monitoring.
  • Promote health education to mothers, focusing on weaning practices and the prevention of diarrhoea and acute respiratory infections.
  • Continue to monitor the nutritional status of the population by anthropometrical surveys.
  • Continue to monitor the food security situation through the use of post-distribution surveys, and the close monitoring of food prices in Ambon.

Recommendations from then ACF-F survey in West Pontanak include:-

  • Continue the general food distribution and treat the malnourished children.
  • Monitor the nutrition and health situation in the camps.
  • Train the health staff to cope with severe malnutrition.
  • Promote health education within the camps.