Nutrition Information in Crisis Situations - Timor
RNIS 32/33, April 2001
Since the crisis of 1999, the security in East Timor has
largely stabilised. There have been reports of various security incidents, but
most have been along the border areas with West Timor. To date the security in
East Timor is described as stable. In the wake of wide scale humanitarian
interventions in Timor, most of the internally displaced populations returned
spontaneously to their places of origin and there are no official IDPs left.
There continues to be a return of refugees to East Timor from Indonesian West
Timor, but refugee fears over their safety and wide scale intimidation by
pro Indonesia militias, have meant that many have not yet returned. The UN Transitional Authority in East Timor (UNTAET) has taken
responsibility for establishing a functioning administration and the transfer of
administrative power to Timorese hands. UNTAET, in conjunction with other
international organisations, has also taken on the responsibility of rebuilding
the shattered infrastructure. The scale of the destruction in 1999 has left the
Timorese people and the various organisations working there with a huge task.
Most of the infrastructure has to be rebuilt from scratch and those elements
that still stand suffer from long term neglect. One of the biggest problems
facing the reconstruction teams is the lack of human capital. On the arrival of
UNTAET there were fewer than 30 doctors left to tend the needs of the entire
population. The East Timorese civil service once employed 34,000 people and is
currently staffed by less than 10,000. This leaves a great deal of work to be
done in all spheres (UNICEF 15/01/01). Reports indicate that the overall food security situation in
East Timor has improved markedly in the last year. Maize and rice crop yields
were satisfactory in 2000 and recent reports indicate relatively good maize and
rice harvests for the year 2001. The reason for increased yields are; an
extended period of regular rainfall, the increased availability of seeds and a
larger area of planted agricultural land. There are also encouraging reports of
an increased numbers of farm animals. The development of the agricultural sector
is hampered by a poor market for produce, largely as a result of the change from
the Indonesian protectionist market system to the current market driven system,
which has left many farmers confused over prices and market outlets. Farmers are
unlikely to grow more until they understand and feel assured of market outlets.
There is also a great deal of cheap imported rice from Thailand and Vietnam
which makes the production of surplus rice unprofitable (ACF 4/05/01). The RNIS has not received any new information about the
nutritional status of people in East Timor. There are reports that many of the
clinics have stopped collecting routine screening information on children, which
makes the routine surveillance of the nutritional situation extremely difficult.
There are no reports of wide scale acute malnutrition and there has been nothing
to suggest that nutritional status in the population is declining. There are still considerable economic problems in East Timor,
related to the shattered infrastructure and the high rate of unemployment. This
has created a large group of economic migrants who have moved to Dili in search
of job opportunities. The harvest outlooks are good and agricultural
improvements are noted (NRC 2001). Recommendations:
- Encourage
the resumption of routine nutritional surveillance at the local level.
- Try to identify areas of
particular vulnerability to assist in the provision of assistance.
- Continue with income
generation programmes, particularly in urban areas containing a high number of
economic migrants.
RNIS 31, July 2000
Before the crisis last year, the population of East Timor was
estimated at 890,000 people. Almost the entire population was either internally
displaced or sought refuge in West Timor as a result of the violent conflict. At
least 750,000 people have now returned (FAO/WFP - 19/04/00). The UN Transitional Authority in East Timor (UNTAET) and
humanitarian organisations continue to implement projects based on six main
priorities: facilitating the voluntary return of East Timorese from West Timor
and other locations; ensuring food security through the provision of daily
rations, seeds and tools; providing a basic health-care network; ensuring
potable water where the water system has been damaged or destroyed; revitalising
communities through education programmes, counselling and micro-credit schemes;
and repairing and reconstructing approximately 35,000 residential
shelters. Nutritional situation The RNIS has not received any new nutritional surveys from
East Timor. The most recent data did not indicate an elevated level of
malnutrition. ACF has recently initiated a nutritional surveillance system that
should provide more information. Food Security An FAO/WFP crop and food supply assessment mission to the
country in April observed that East Timor's agricultural operations have
suffered less disruption than at first predicted. The territory's infrastructure
was badly damaged, food and seed stocks were destroyed, and most of the
population was displaced during the violence. The rate of return to farms to
commence planting was a major concern, but although maize planting was later
this season, compared to the optimum planting date, the delay itself did not
matter as overall rainfall has been favourable and extended. In spite of the
obvious difficulties, maize and rice yields are expected to be satisfactory, and
certainly better than the severely reduced crop in 1997/8 due to the El Nino
drought. The mission estimated that, from July, 285,000 people will remain
vulnerable and need to be targeted for food aid (FAO/WFP - 19/04/00). Normal economic activity in the territory continues to be
hampered in many areas due to the disruption of internal markets, absence of
small traders and merchants, poor roads and decimated commercial and private
transport systems. The situation is compounded by the sudden cessation of access
to trading, distribution and supply routes to West Timor and the rest of
Indonesia. Previously, these were essential for a wide range of economic
functions such as wage labour, input supply and trading. Income-generating
possibilities are limited and formal employment has been greatly reduced by the
lack of public sector jobs. Following Indonesia's withdrawal last September,
various government support measures, such as the sale of subsidised rice to poor
rural households, no longer exist. Market surveys conducted in several locations
indicate that prices are higher than they were at the same time last year
(FAO/WFP - 19/04/00). Since their return from West Timor or within East Timor, many
households have had, and are continuing to rely heavily on the production of
kitchen gardens rather than on farming. The gathering of wild forest foods,
particularly tubers of various types, has provided substantial amounts of food.
In the absence of rice (the preferred staple) or maize in rural areas there is
reported to be an increased reliance on tubers (cassava, sweet potato, yam and
taro). In some western areas close to the border with West Timor, fear of
militia activity remains pervasive and people are reluctant to clear land to
farm. The most vulnerable households are those that rely primarily on cash
income from non-export crops, for which the internal market has collapsed due to
unemployment and the lack of effective purchasing power, while no trade exists
across the border with West Timor. The most vulnerable area is the Oecussi
enclave (FAO/WFP - 19/04/00). As the political situation has stabilised, WFP and its
partners have tried to provide emergency aid towards reconstruction and
development. Food aid agencies have begun distributing food through a variety of
programmes including: seed for food exchanges; food for work; food for training;
school feeding and vulnerable group feeding (FAO/WFP - 19/04/00). Clearly the
objectives of such programmes reflect a dramatic shift from relief to
rehabilitation and reconstruction. Overall, given the wide array of food sources
available to the population, the nutritional situation of the returnees to East
Timor is not considered to be critical (category IV). Recommendations and priorities: From the FAO/WFP mission to East Timor (FAO/WFP -
19/04/00):
- Continue
to closely monitor the situation and improve vulnerability mapping in order to
better define food insecure areas.
- Continue to
utilize food as a catalyst for rehabilitation activities.
RNIS 30, March 2000
Following the violence and population displacement after the
30 August 1999 referendum, the situation in East Timor has continued to improve.
An estimated 108,500 people have been assisted by UNHCR/IOM to return from West
Timor, other parts of Indonesia and Australia (UNHCR - 21/03/00). A further
45,000 people have returned spontaneously (UNTAET - 20/03/00). Agriculture An FAO/WFP crop and food supply assessment mission to East
Timor in December 1999 found that the level of destruction of agriculture was
less than anticipated. The major damage was to livestock, food and seed stocks.
The main constraint to agriculture was population displacement; in some areas a
relatively large proportion of farmers were unable to complete sowing their
maize crop in November/December. The most vulnerable areas include Bobonaro,
Covalima and Oecussi Enclave (FAO/WFP - 21/12/99). WFP has recently moved from a general distribution to as many
as 600,000 people in November (from an estimated total population of 750,000) to
targeted group feeding and food-for-work activities. The vulnerability of
particular geographic areas in East Timor is determined directly by the extent
of public and private infrastructure as well as the presence of community
markets and baseline poverty indicators. Targeted groups include those who have
no access to food due to a lack of money, destruction of livelihoods, or those
who live in areas where no food is available (FAO/WFP - 21/12/99; WFP -
28/01/00). The RNIS has not received any new nutritional surveys or
assessments for East Timor. The most recent assessments did not report elevated
levels of malnutrition, although isolated pockets of acute malnutrition may
exist. Overall, the agricultural situation is not as
bad as anticipated and the security situation has now improved. The situation
has stabilised and hence the population is not considered to be at elevated
nutritional risk (category IV). Recommendations and priorities:
- Monitor the
nutritional situation in Dili and the surrounding areas.
From the FAO/WFP assessment:
Various interventions will be required to enhance productivity
and food production. These include:
- Seed
multiplication programmes for maize and rice.
- Rehabilitating irrigation
facilities.
- Reducing post harvest
losses.
- Improving rice-milling
facilities.
- Investing in small-scale
machinery.
- Breeding, vaccination and
extension campaigns to increase livestock numbers.
- Providing basic equipment to
increase fish production.
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 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.
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