United Nations System
Standing Committee on Nutrition

Ethiopia—Alarming situation in Somali region and zone 2 and 4 of Afar— Nutrition surveys conducted early this year confirmed the serious situation in parts of the pastoral areas. This is partly due to the poor last deyr rainy season. About 1.5 m people, representing more than one third of the population, are in need of emergency food and non-food aid. The situation is likely to further deteriorate during the forthcoming dry season.

Kenya— Food insecurity still extremely severe in pastoral areas— About 3 m people are in need of emergency food aid , especially in Marsabit, Isiolo, Mandera and Turkana districts, but the food pipeline is only 50% resourced. The beginning of the rains has brought some relief but the overall performance of this rainy season will determine the future food security of the affected areas. Nutrition surveys conducted in Moyale, Samburu and Marsabit districts, three of the ten districts considered as the most affected by the drought, showed dire situations, especially in Marsabit.

Somalia—Situation still precarious—The food-security situation remains precarious for the estimated 2.1 m people affected by two poor rainy seasons, especially in the south of the country. Cereal prices had greatly increased and were much higher than within the same period last year. In areas where humanitarian food aid has been delivered, it seems that cereal prices have been controlled even if they were still higher than last year. The Gu rainy season has started favourably in most parts of the south which might be a positive factor for improvement of food security in the future. Nutrition surveillance has intensified in the south of the country and according to several random-sampled nutrition surveys conducted over the last few months, the nutrition situation was found to be highly precarious.

DRC—Appalling situation among IDPs in Katanga— Following an upsurge in violence in the north and the centre of Katanga province in November-December 2005, it is estimated that about 165,000 people have been displaced . Thousands of them, almost destitute, are gathered in displaced camps around towns, with makeshift shelters, poor access to basic needs, and lack of protection. Relief has been slow and needs are still not covered, despite a recent upscale in aid.

Malawi—Average situation— Malawi has faced a number of food and nutrition crises over the past five years, especially in 2001-2002. Again in mid-2005, an appeal was launched by the government of Malawi to support immediate humanitarian needs and to minimise the long-term impact of the current food crisis. According to nutrition surveys conducted in 26 districts of Malawi, prevalence of acute malnutrition varied widely depending on district, and was acceptable in ten districts, average in 12 districts and precarious in four districts.

Nepal—Worrying situation in Karnali province— Drought in some of the districts of the impoverished Karnali province has raised concern about a possible food crisis in the area. A nutrition survey conducted in Mugu and Humla districts, which are among the least developed districts in Nepal, in March 2006, showed a precarious nutrition situation. Further food security assessments were on-going.

DPR Korea—Persistence of food insecurity— It is difficult to analyse the food and nutrition situations in North Korea due to the paucity and uncertainty of the reliability of information. It seems however that the nutrition situation of the children surveyed in 2004 compares with the regional average. Although the economic and agricultural situation seems to have improved in recent years, it is still precarious. The food security and nutrition situations in the country are still very fragile and need continuous attention.

Risk Factors affecting Nutrition in Selected Situations

In the table below are classed into five categories relating to prevalence and or risk of malnutrition (I—very high risk/prevalence, II—high risk/prevalence, III—moderate risk/prevalence, IV—not at elevated risk/prevalence, V-unknown risk/prevalence; for further explanation see section "Indicators and classification" at the end of the report).

The prevalence/risk is indirectly affected by both the underlying causes of malnutrition, relating to food security, public health environment and social environment, and the constraints limiting humanitarian response.

These categories are summations of the causes of malnutrition and the humanitarian response, but should not be used in isolation to prescribe the necessary response.

J Adequate K Mixed L Inadequate

Greater Horn of Africa

Ethiopia

Alarming situation in Somali region and Zone 2 and 4 of Afar region

Nutrition surveys conducted early this year confirmed the serious situation in parts of the pastoral areas (table 1). This is partly due to the poor last deyr rainy season (see NICS 8). Under-five mortality rates were also high in most of the areas surveyed. About 1.5 m people, representing more than one third of the population, are in need of emergency food and non-food aid. The situation is likely to further deteriorate during the forthcoming dry season. Liben, Gode and Afder zones of Somali region and Zones 2 and 4 of Afar region are especially at risk of famine if interventions are not scaled up (FEWS, 03/06). So far, humanitarian aid does not seem to have been sufficient to avoid a crisis, and still remains short in terms of food distributions. Furthermore, crucial nutrition and non-food interventions seem to be lacking (FEWS, 03/06).

Table 1 Results of surveys in Somali and Afar regions, Ethiopia (ENCU, 30/03/06; GOAL, 10/05)

Improved harvest

At national level, the 2005/06 harvest is estimated to be 14% above last year and 46% above the average of the previous years, mainly because of improved rainfall and increased use of fertiliser and improved seeds (FAO/WFP, 24/02/06). However, 2.6 m people will still be in need of food aid, at least until June 2006, of whom 1.5 m are in Somali region (see above). On top of this, 7.2 m chronically food-insecure people will benefit from the Productive Safety Net Programme. Nutrition surveys showed average to poor nutrition situations in different areas of Ethiopia (figure 1). In Borena zone, Oromya region, the situation was not critical, despite the failure of last rainfall.

Figure 1 Results of surveys, Ethiopia (ENCU, 30/03/06)

Recommendations

Somali region, from ENCU bulletin (ENCU, 30/03/06) Carry out measles vaccination and Vitamin A supplementation campaign Support exiting health care system Provide timely general food ration in adequate quantity and quality targeted to the most affected areas and population groups Implement targeted supplementary and therapeutic feeding programmes Provide animal feed and veterinary services Dispense emergency sanitation campaign, water tankering and rehabilitation of dysfunctional water points.

Kenya

Nutrition situation still poor in Kakuma and Dadaab refugee camps

Kakuma refugee camp is located in Tukana district and hosts about 90,000 refugees, mostly from Sudan (80%) and Somalia (17%). A new wave of Somali refugees has begun to pour in to the camp as a result of drought in parts of Somalia (CARE, 27/04/06). According to a nutrition survey conducted in November 2005, the nutrition situation was still highly precarious in the camp and has not improved compared to previous years (figure 2) (IRC, 01/06). In 2005, the general food distribution was about 90% of the targeted 2,100 Kcal/pers/day full ration. Refugees seem highly reliant on the general ration and the poorest people sell part of it to buy other foods, such as sugar, vegetables and meat or non-food items which are not distributed regularly. Breast-feeding practices seem average with 89.3% of the 0-23 month olds being breastfed, and 95.5% of the 6-23 month olds receiving complementary feeding. On the other hand, only 20% of those less than six months old were exclusively breastfed, and dietary diversity of complementary food was poor.

Dadaab refugee camps in Garissa district host about 140,000 refugees, mainly from Somalia. The nutrition situation was highly precarious as of June 2005 and has remained stable compared to 2003 (BMZ/UNHCR/GTZ, 06/05). The food distribution for the first semester of 2005 had been near the targeted 2,100 Kcal/pers/day, except in May when it was lower. As in Kakuma, people sold part of their rations for other foods such as sugar, milk or meat. Anaemia was widespread in the camps among children and pregnant women and was indicative of a public health problem (table 2).

Table 2 Prevalence of anaemia, Dadaab refugee camp, Kenya, June 2005 (BMZ/UNHCR/GTZ, 06/05)

Food insecurity still extremely severe in pastoral areas

About 3 m people are in need of emergency food aid , especially in Marsabit, Isiolo, Mandera and Turkana districts (see map), but the food pipeline is only 50% resourced (FEWS, 10/04/06). The beginning of the rains has brought some relief but the overall performance of this rainy season will determine the future food security of the affected areas.

Food security status, Kenya , March 2006 (Fews, 10/04/06)

Random-sampled nutrition surveys conducted in Moyale, Samburu and Marsabit districts, three of the ten districts considered as the most affected by the drought, showed dire situations, especially in Marsabit (figure 2) (UNICEF, 03/06). Most of the households have reduced their food intake and were reliant on food aid. Almost all households reported receiving food in the three months prior to the survey. The survey report recommended, among other things, the continuation and scale-up of the food distribution, and the implementation of supplementary and therapeutic feeding programmes.

Figure 2 Prevalence of acute malnutrition, Kenya, March 2006 (UNICEF, 03/06)

Somalia

The food-security situation remains precarious for the estimated 2.1 m people affected by two poor rainy seasons, especially in the south of the country (Fews, 04/06). Cereal prices had greatly increased and were much higher than within the same period last year. In areas where humanitarian food aid has been delivered, it seems that cereal prices have been controlled even if they were still higher than last year. The Gu rainy season has started favourably in most parts of the south which might be a positive factor for improvement of food security in the future. However, continued provision of food aid and livelihood support is still important to protect the remaining assets. Nutrition surveillance has intensified in the south of the country and according to several random-sampled nutrition surveys conducted over the last few months, the nutrition situation was found to be highly precarious while under-five mortality rates were of concern (figure 3). In Rabdure and Wajid district, Bakool region, malnutrition rates were consistent with typical levels in these districts (FSAU/N, 02/06).

Figure 3 Results of nutrition and mortality surveys, southern Somalia (FSAU/N, 02/06; FSAU, 04/06; FSAU/N, 05/06; MSF-CH, 02/06)

Sudan

Darfur

Insecurity is still widespread in Darfur although a peace agreement was signed by the largest rebel group and the Government of Sudan, but not by the other rebel groups, in early May (USDS, 18/05/06). In addition, the food ration will be cut by half during the forthcoming hunger gap season due to WFP's severe funding shortfall (BBCNews, 28/04/06). Even if funding commitments were to be found, food aid would probably not be delivered on time due to transportation constraints. The decrease in food rations will probably compromise the stabilisation of the situation that has been seen over the last months. Although data are not directly comparable because some feeding centres have been closed due to low beneficiary numbers, or programmatic or funding constraints, admissions to feeding centres were far lower in April 2006 than in the same month last year (figure 4 & 5) (UNICEF, 04/06). This might be the result of improved humanitarian aid as well as a better harvest in 2005 than in 2004. Cereal harvest in 2005/2006 was estimated at about 190% of the 2004 harvest in the region (FAO/WFP, 15/02/06). Surveys conducted during the post-harvest season showed varied situations (figure 6). Where comparison with the same period in 2005 was possible, surveys showed a stable situation in terms of nutrition and mortality (figure 7 & 8).

Figure 4 TFC admissions in Darfur, Sudan (UNICEF, 04/06)

Figure 5 SFC admissions in Darfur, Sudan (UNICEF, 04/06)

Figure 6 Prevalence of malnutrition and mortality rates, Darfur, Sudan (ACF-F, 01/06; ACF-F, 02/06; ACF-F, 03/06; Concern, 02/06; Goal, 10/05; GOAL, 11/05; MSF-S, 11/05; MSF-S, 12/05)

Figure 7 Trends in prevalence of acute malnutrition, Darfur, Sudan

Figure 8 Trends in crude mortality rate, Darfur, Sudan

Food insecurity in Northern Bhar el Ghazal and pastoral areas of Kapoeta district

The 2005/2006 harvest was forecast at 55% higher than last year, and about 17% higher than the last five years average (FAO/WFP, 15/02/06). This good performance has been attributed to favourable rainfall, a low incidence of pests and diseases, and improved security. However 6.7 m people were estimated to be need of food aid, especially IDPs, returnees, and highly vulnerable residents. In Northern Bhar el Ghazal, the high number of returnees in Aweil East and West may further undermine the already precarious situation (Fews, 09/05/06). In the pastoral areas of Kapoeta county, Equatoria, inadequate recovery of pasture and water availability has raised concern. According to nutrition surveys conducted at the end of 2005 and beginning of 2006, the nutrition situation in the areas surveyed in Unity, Upper Nile and Bhar el Ghazal remained highly precarious (table 3), but stable compared to 2005 in areas where comparison was possible. It was slightly better in Kassala state, Eastern region, but still serious (table 3). On the other hand, mortality rates were under control (table 3).

Table 3 Results of nutrition and mortality surveys, Sudan (ACF-F, 11/05; AAH-US, 02/06; AAH-US, 03/06;GOAL, 11/05; GOAL, 12/05;GOAL, 01/06; Tearfund, 03/06)

Overall

Despite a generally good harvest in 2005/06, more than 6 million people remain in a highly precarious situation (category II), especially IDPs and returnees.

West Africa

Liberia

The return of 314,000 displaced people was completed by UNHCR at the end of April. Of the 22 camps and 13 spontaneous settlements, 22 have been closed (UNHCR, 21/04/06). More than 60,000 refugees have also returned. The majority of the returns took place in Lofa, Bomi, Bong, Capemount and Gbarplou counties. Reconstruction continues but needs, in terms of shelter, the availability of water and sanitation, health facilities, schools and food security, are still not covered (ACF-F, 12/05; ICRC, 04/06).

Niger

Despite a generally good 2005 harvest, some pockets of food insecurity have been identified in pastoral and agro-pastoral areas at the onset of the hunger-gap season (FEWS, 03/06). They result from insufficient food stocks, reimbursement of debts contracted during last year's crisis, cereal and fodder deficits and relatively high food prices. Two random-sampled nutrition surveys conducted just after the harvest in the rural surroundings of Zinder town and in Magaria department in Zinder region showed average to precarious nutrition situations (table 4). On the other hand, mortality rates were extremely high, probably due to the high number of malaria cases during this period (table 4). When compared to August 2005, which was during the hunger gap, the nutrition situation has significantly improved around Zinder town (see NICS 7).

Table 4 Results of nutrition and mortality surveys in Zinder region, Niger, December 2005 (MSF-CH, 12/05)

Central Africa

Democratic Republic of the Congo

Appalling situation among IDPs in Katanga

Following an upsurge in violence in the north and the centre of Katanga province in November-December 2005, it is estimated that about 165,000 people have been displaced (IRIN, 04/05/06). Thousands of them, almost destitute, are gathered in displaced camps around towns, with makeshift shelters, poor access to basic needs, and lack of protection (MSF, 01/06). Relief has been slow and needs are still not covered, despite a recent upscale in aid. With the rainy season hampering access by road, WFP has recently air dropped food to the province (WFP, 09/05/06). However, their operation has a critical fund shortfall of 36%. Registration of displaced people is on-going, which will facilitate estimation of needs and provision of aid (IRIN, 04/05/06). According to a random-sampled nutrition survey conducted in March 2006 in the IDP camps near Dubie, the nutrition situation was bad, and mortality rates were appalling (table 5) (MSF-H, 03/06). Causes of mortality were not recorded. Most of the displaced arrived in November and December 2005 and while they had been able to find some work during the planting season, they have had very few means of earning income afterwards. They reported they had sold most of their belongings for food and were relying mostly on cassava. Food distributions have been erratic and covered less than half of the minimum requirements.

Table 5 Results of a nutrition and mortality survey among displaced people in Dubie, Katanga, March-06 (MSF-H, 03/06)

Overall

Funds and an upscale in relief programmes are urgently needed to contain the appalling situation (category I) of the displaced in Katanga.

Uganda

The security situation has shown a marked improvement in Northern Uganda over the recent months (Fews, 22/04/06). This has prompted thousands of IDPs to return home, especially in Lira district (USAID, 26/04/06). The Uganda People's Defence Forces have announced that they would reduce military escorts to convoys delivering non-food assistance. It is thought that this could hamper provision of humanitarian aid since a significant degree of insecurity still prevails (Fews, 26/04/06). The Government of Uganda has also issued stringent measures on operations of NGOs (Xinhua, 13/04/06). A random-sampled nutrition survey conducted in Kalongo town, Pader district, in November 2005 showed a stable situation in 2005 (figure 9) (GOAL, 11/05).

Figure 9 Prevalence of acute malnutrition and mortality rates, Kalongo town, Pader district, Uganda

Chad

Contrasted situations in refugee camps

The nutrition situation seemed to have improved in some Sudanese refugee camps at the end of last year. Three surveys conducted in Djabal, Am Nabak and Ourre Cassoni camps showed an improvement of the situation compared to previous surveys, although the nutritional status was still precarious in two of the camps surveyed (figure 10) (AAH-US, 11/05). This might be due to an overall improvement in the provision of humanitarian aid. Mortality rates were under control. Another survey carried out in Farchana and Bredjing camps and in villages surrounding the camps in March 2006 showed a situation which was not critical and which has improved compared to last year (figure 10) (MSF-H, 03/06). The performance of nutrition programmes also showed an amelioration at the end of 2005 in all the camps (WFP/UNHCR/WHO/UNICEF, 01/06). In the South of the country, refugees from Central African Republic have continued to arrive. The situation in the two refugee camps seemed to be causing some concern (RI, 25/04/06).

Figure 10 Trends in prevalence of acute malnutrition in some Sudanese refugee camps, Chad

High deterioration of the security situation in Eastern Chad

The security situation has deteriorated considerably in Eastern Chad since the beginning of 2006, as a result of militia attacks on Chadian villages and refugee camps (IRIN, 17/05/06). It seemed that the government of Chad could not guarantee security in parts of Eastern Chad. There were also reports of forced and voluntary recruitment in refugee camps and of attacks on humanitarian workers (UNHCR, 16/05/06; UNNews, 08/05/06). Increased insecurity has prompted the displacement of about 50,000 Chadians within their country (WFP, 03/05/06). Their food situation as well as that of the 20,000 people who host them might deteriorate rapidly. Seed protection activities were planned but no general distribution was envisaged as of beginning of May. Displaced families have also been distributed non-food items (ICRC, 18/04/06). The situation was to be carefully monitored. About 13,000 Chadian have also been reported to have fled to Sudan, where some of them will be relocated in camps (UNHCR, 12/05/06).

President of Chad Idriss Deby was re-elected in the polls held at the beginning of May, which were boycotted by opposition parties (BBCNews, 14/05/06).

Southern Africa

Malawi

Malawi has faced a number of food and nutrition crises over the past five years, especially in 2001-2002. Again in mid-2005, an appeal was launched by the government of Malawi to support immediate humanitarian needs and to minimise the long-term impact of the current food crisis (OCHA, 30/08/05). This 2005 crisis was due to below average rainfall, lack of inputs because of difficulties in procurement, transport, and delivery, and low purchasing power for agricultural inputs among the majority of smallholder farmers. The appeal was revised in November 2005 and it was estimated that 4.9 m people will need food assistance until the March 2006 harvest (UNICEF, 18/04/06). Because of dry spell in the first quarter of 2006, and high malnutrition rates in some districts, food distributions have been continued to 1.4 m people in 14 districts in April 2006. The 2006 harvest has been estimated to be good overall, but some pockets of food insecurity may remain in the north where crop conditions have not been optimal (IRIN, 03/05/06). Furthermore, people's livelihoods have been depleted during the several years of hardship, and the high HIV prevalence also affects food security. Random-sampled nutrition surveys were conducted in 26 districts of Malawi in December 2005 (MOH/UNICEF, 03/06). Prevalence of acute malnutrition varied widely depending on district, from 13.1% (10.8-15.4) in Phalombe district, South region, to 2.6 (1.6-3.6) in Kasungu district in the north, and was acceptable in ten districts, average in 12 districts and precarious in four districts (figure 11). Overall, districts in the South region showed higher prevalence of acute malnutrition, while the Northern region seemed better off. Oedematous children represented about one third of malnourished children, which is a significant proportion. Wasting seemed to have remained stable at national levels since the beginning of this century. Stunting was very high, varying from 54.2% (50.9-57.5) in Dedza to 23.8% (21.2-26.4) in Kasungu. Mortality rates also varied widely but were below the alert rate in all districts but Ntcheu and Phalombe (figure 11).

Figure 11 Prevalence of acute malnutrition and mortality rates, Malawi, December 2005 (MOH/UNICEF, 03/06)

Asia

Bangladesh

About 20,000 refugees from the Rohingya minority of North Rakhine state in Myanmar are settled in two camps in Bangladesh. A random-sampled survey conducted in December 2005 showed a worrying situation, which has not improved compared to ten years ago (figure 12).

Figure 12 Prevalence of acute malnutrition, refugee camps, Bangladesh

Prevalence of micronutrient deficiencies such as anaemia and riboflavin deficiency was also high: 35.4% (60.0-70.6) of the 6-59 months children had anaemia (Hb< 11.0 g/dl), and 13.8% (9.0-18.5) riboflavin deficiency, respectively. On the other hand, under-five mortality seemed under control. Refugees are entitled to a full food ration. Food basket monitoring revealed that depending on the item, refugees received between 92% and 94 of the ration in 2004 and between 91% and 97% in 2005. However, the intended ration is deficient in most micronutrient, especially in calcium, riboflavin, iodine, vitamin A and iron. Food security and access to safe water and sanitation have always been limited in the camps (see NICS 1).

Myanmar

A random-sampled nutrition survey was conducted in Maungdaw and Buthidaung townships, located in the northern part of Rakhine state and mainly populated by the Rohingya community (ACF-F, 01/06). The area has poor infrastructure and is under-developed. The survey revealed a high prevalence of acute malnutrition, while mortality rates were under control (table 5). The nutrition situation has remained within the same range for the last few years.

Table 5 Results of a nutrition and mortality survey in Maungdaw & Buthidaung townships, North Rakhine state, Myanmar, Jan-06 (ACF-F, 01/06)

Indonesia

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).

Nepal

Following 19 days of pro-democracy protests called by the Seven Party Alliance, King Gyanendra announced that the parliament which had been dissolved in 2002 would be reconstituted (OCHA, 05/05/06). A new government was formed and peace talks between the new government and the Maoists were set to begin by end of May (IRIN, 26/05/06). Maoists and the government declared a three months cease-fire, starting at the end of April. It is hoped that these new developments will restore peace in Nepal. Meanwhile, drought in some of the districts of the impoverished Karnali province has raised concern about a possible food crisis in the area (IRIN, 08/05/06). A random-sampled nutrition survey conducted in Mugu and Humla districts, which are among the least developed districts in Nepal, in March 2006, showed a precarious nutrition situation, although mortality rates were under control (table 6) (ACF-F, 03/06). Further food security assessments are on-going.

Table 6 Results of a nutrition and mortality survey in Humla & Mugu districts, Karnali province, Nepal, January 2006 (ACF-F, 03/06)

Pakistan

The October 2005 earthquake causes a tremendous number of deaths and major destruction in eight districts of the North-West Frontier (NWFP) and Azad Jamud and Kashmir (AJK) provinces (see NICS 8). Two months later, four nutrition surveys were conducted. These were among non-displaced families in Mansehra district; NWFP, displaced camps in NWFP; non-displaced families in Muzaffarabad district, AJK; and IDP camps in AJK (UNICEF/WFP/WHO, 07/02/06). The surveys showed average nutrition situations in IDP camps and in Muzaffarabad, while it was more precarious in Manshera district (figure 13). Crude mortality rates within the period between the earthquake and the survey were under control (figure 13). About 70% of the families in Muzaffarabad received some of the food basket commodities, while less than 40% of the families received them in Manshera. This is in accordance with the targeting of food aid to the most affected families, as the level of destruction in Muzaffarabad was greater than in Manshera. However, the levels of acute malnutrition appeared higher in Manshera than in Muzaffarabad. When the full food basket was taken into account, only 50% in Muzaffarabad, and 26% in Manshera, respectively had received it. The percentage was slightly higher in IDP camps, where 61.8% of the families in NWFP, and 55.6% in AJK respectively, had received it. The winter was milder than expected and there was no major medical emergency (MSF, 24/04/06). With the spring, many displaced people returned home, either spontaneously or with facilitation. As of mid-May, it was estimated that about 76% of the displaced families had returned home (OCHA, 19/05/06), however, thousands of households remained displaced. Aid efforts in Pakistan has recently shifted from relief to recovery programmes (IRIN, 24/05/06).

Figure 13 Prevalence of acute malnutrition and crude mortality rate, Pakistan, Decmber 2005 (UNICEF/WFP/WHO, 07/02/06)

Democratic People’s Republic of Korea

The Democratic People's Republic of Korea (DPRK), with an estimated 23 million inhabitants in a territory of 120,540 km2, shares borders with South Korea, China and Russia (see map). DPRK has a centralised socialist economic system. Often referred to as a uniquely closed political system, the state exerts pervasive control over the population, the economy, and information (Becker, 1998; UNCHR, 2004; Eberstadt, 10/04). Following floods in 1995, DPRK requested humanitarian aid for the first time in its history and foreigners were allowed into the country (Becker, 1998). Ten years later, the government of DPRK declared the emergency over (AFP, 16/03/05; Concern, 20/09/05; Reuters, 10/10/05) and asked the UN agencies and NGOs working in the country to terminate their emergency programmes by the end of 2005 (Concern, 20/09/05; DPA, 22/09/05). The aim of this article is to review the trends in the nutrition situation and underlying factors such as food security over this decade and try to ascertain if the emergency is over, recognising that in the "Hermit Kingdom", the paucity of reliable information creates many challenges (Becker, 1998; ICG, 25/04/05; Noland, 07/03).

Background

Prior to being divided into two at the end of the Second World War, the northern part of the Korean peninsula was mostly industrialised, and the south was the bread basket which produced most of the food (USCHRNK, 2005). After the war, North Korea pursued a policy of food self-sufficiency (USCHRNK, 2005), but with only about 20% of arable land, and an adverse climate, significant yields could only be achieved by intensive farming, highly dependent on external inputs such as fertilisers and pesticides. Intensive farming together with increased deforestation eventually resulted in soil depletion and erosion. Areas under cultivation have been mostly concentrated in the south of DPRK, with South and North Phyongan and South and North Hwangae representing 60% of the cultivated areas (FAO/WFP, 25/11/1997).

It seems that North Korea did well in terms of economic development after the Korean war up to the 1970s, with remarkable economic growth, and rapidly improving living standards (ICG, 25/04/05). The harvest doubled from 3.5 m MT in 1966, to 7.7 m MT in 1984, as a result of expansion of land under cultivation, mechanisation, irrigation, and heavy use of fertilisers (ICG, 25/04/05; Woo-Cumings, 2002). Requisite inputs for agriculture, and shortfalls in cereal production, were mostly covered through the preferential system of trade with the USSR, which also provided most of North Korea's needs for coal and refined oil, and one third of its steel (Noland, 07/03).

North Korea's economy, farming, and people's entitlement to food, goods, and basic needs were centrally controlled by the state. Cereals were to be dispatched to the population by the Public Distribution System (PDS) at subsidised prices, after the collective farms had kept their part. This ensured the redistribution of cereals from surplus to deficit areas (Woo-Cumings, 2002). Entitlements seemed to be a function of worker categories and political status. North Korean society is apparently organised based on a classification of people within three broad strata, and 51 categories, which depends on their perceived loyalty to the party (FIDH, 11/03). The lower perceived "hostile" class is thought to represent about 27% of the population, while the "basic mass" (middle class) could represent 45%, and the "core mass" or upper class (staff of the party, government and army) 28%. This classification, although denied by the government of DPRK, seems to be confirmed by North Korean refugees and to serve as a basis for entitlement to basic needs such as food, housing, health care, and education. Occupation seems also to be allocated according to these categories, with the perceived less reliable people being employed in dangerous work and hard labour, and the upper class being recruited as staff for the party, government, and army. Families from the lower class seem mostly located in the inland regions (Seong-Ho, 03/03).

Onset of the crisis

The economic crisis and the related food shortages are thought to have begun in the late 1980s (Becker, 1998; Eberstadt, 10/04) and intensified with the collapse of the former USSR in the early 1990s that ended aid and subsidised trade with North Korea (Eberstadt, 10/04). At the same time, China, the other major trade partner, began demanding hard currency settlement for oil imports (ICG, 25/04/05). By 1993, imports from Russia were only 10% of their 1987-90 average (Noland, 07/03). Energy supply dropped from 24 m MT in 1990 to 14 m MT in 1998 (ICG, 25/04/05), which paralysed the industry, transport, and agricultural sectors. Moreover, the policy of the North Korean government which contracted debts in the 1970s towards Western countries, the former USSR, and China, without repaying them, discouraged these countries from providing further loans (Becker, 1998) and North Korea failed to establish new trade relationships. This economic crisis was compounded by heavy floods in 1995 and 1996 which damaged crops and the infrastructure for production of power (Woo-Cumings, 2002). Drought and tidal waves in 1997 further worsened the situation (Katona-Apte, 1998). While it is difficult to determine exactly when the crisis began, it seems likely that it was well before 1995 when humanitarian aid was first requested.

Impact of the crisis

The impact of these combined problems of debt, lack of external raw materials and energy imports together with natural disasters of flooding in 1995 and 96 followed by drought the next year provoked an enormous crisis in 1995/7. It is thought that as many as 70% of factories, mines, schools, hospitals, and other institutions had stopped functioning by 1997 (Becker, 1998).

Sharp decline in agricultural production

According to various estimates, there was a decline in agricultural production in the 1990s compared to the 1980s (Noland, 07/03), and the government failed to take action to guarantee adequate food supplies (USCHRNK, 2005). The sharp decline of fertilizer production, as a result of economic collapse, has been thought to be the main contributor to reduced crop yield (Woo-Cumings, 2002). The use of fertiliser dropped from 650,000 nutrient tonnes in 1989 to 100,000 in 1996 (FAO/WFP, 22/11/04). In 1998, it was estimated that only 20% of the tractors were operational, due to fuel and spare part shortages (FAO/WFP, 25/06/98). Floods and drought seem to have resulted in the loss of about 1.5 m MT of grains in 1995 and 1.6 to 1.9 million in 1997 (Katona-Apte, 1998), and livestock also seems to have decreased markedly (FAO/WFP, 22/11/04).

Public heath

The ability of the government to supply medicine and maintain the medical infrastructure seems also to have collapsed with the economic crisis (UNICEF, 12/99). Testimonies seem to confirm the collapse of the health structures which, at best, provided a diagnosis but no medication (GF, 03/04). Incidence of diarrhoea and acute respiratory infection seemed to have risen as well as cases of tuberculosis (UNICEF, 12/99). The quantity and the quality of water seemed to have decreased (UNICEF, 12/99).

Public food Distribution System

The rations provided through the PDS seem to have been cut as early as the late 1980s, and again in the early 1990s, when a campaign on "let's eat two meals a day" was launched (AT, 15/01/05; USCHRNK, 2005). The PDS seems to have virtually collapsed between 1994 and 1996, with the vestiges of its functionality depending on the regions and population categories (AT, 15/01/05; GF, 03/04; Seong- Ho, 03/2003; USCHRNK, 2005). The north-eastern areas (North and South Hamgyong, Yanggang and Kangwon provinces) are thought to have been affected two years earlier than other provinces (Noland, 07/03; Woo-Cumings, 2002), maybe partly because of the collapse of the transportation system (USCHRNK, 2005). Those areas were traditionally the poorest, and were food-deficit areas due to inhospitable growing conditions and high urbanisation (USCHRNK, 2005). According to a study, derived from testimonies of refugees mostly coming from North and South Hamgyong, government rations (including PDS, farmers and military rations) provided on average about 260 g/pers/day in 1994, and represented the main source of food for 60% of the families (Robinson, 1999). The rations however constantly declined afterwards and were only 42 g/pers/day in 1996 and 24 g/pers/day in 1997. They only represented the main source of food for 28.4%, 9.8%, and 5.7% of the families in 1995, 1996 and 1997, respectively. In 1996, the provision of food seems to have been decentralised to the county level, and distributions probably varied a lot depending on the county (Natsios, 08/99). The PDS is thought to have remained functional, mostly in the major cities, for high-ranking party members, officers, and soldiers (Becker, 1998; Noland, 07/03; Seong-Ho, 03/03), although the rations were cut by half (AT, 15/01/05). The military seemed also to have suffered from lack of food, and to have engaged in violence against civilians to get food (Becker, 1998; GF, 03/04). People categorised in the "hostile" strata seemed the most affected, and when the food distribution was limited, no food at all was provided to them (GF, 03/04).

Coping mechanisms

The population developed a number of coping mechanisms, which, at the peak of the crisis, were however often insufficient to prevent starvation and deaths.

According to Robinson's study among refugees, as the PDS ration decreased, people's main sources of food became purchase - for about 25% of the families in 1995,1996, and 1997 (it was 16% in 1994); barter - for about 15% of the families (vs. 4% in 1994); and self-grown for about 7% (Robinson, 1999). Foraging for wild greens, bark of trees, and roots increased the most significantly, from 11.9% in 1994 to 22.8%, 34.7%, and 40.2% in 1995, 1996, and 1997, respectively. According to these figures it seems that purchase, barter, and self-grown were stretched to their limits, as they didn't increase while government rations decreased, and then people seemed to have been more and more reliant on foraging. The consumption of unusual wild foods is thought to have led to a high number of deaths (Becker, 1998; GF, 03/04). The same pattern is observed from other testimonies stating that from 1995, as the PDS ration decreased, people began to sell their assets for food, but that by mid-1996, as no assets remained, it was harder and harder to get food (Seong-Ho, 03/03). People also seemed to rely on exchanging whatever could be stripped from places of employment for food diverted from cooperative or hidden plots (USCHRNK, 2005). Secret pre-harvesting seemed also to have been widespread (Natsios, 08/99), and unauthorised markets seemed to have proliferated in both towns and the countryside during the famine (Becker, 1998).

Most of the coping mechanisms which were developed for survival were not authorised by the government, which seemed to have reinforced punishments for trade and stealing of food (Becker, 1998). The lower stratum of the society seemed more at risk when caught, and more vulnerable to thieves (GF, 03/04). At the end of 1998, control of the population and population movement was reinforced (Natsios, 08/99).

The famine

At the peak of the crisis, probably somewhere between mid-1995 and mid-1997 (GF, 03/04; Natsios, 08/99), a famine certainly occurred, although it has not been witnessed by foreigners (who were prevented from accessing a number of areas) and its extent is difficult to determine (Becker, 1998).

Mortality rates seemed to have increased between 1996 and 1997, whilst the birth rate significantly declined within the same period (GF, 03/04). The same pattern is reported in another study conducted through interviews with refugees, who mostly came from the north-eastern province of North and South Hamgyong (Robinson, 1999). The birth rate was halved between 1996 and 1997, and crude death rate increased from 28.9/1,000 in 1995, to 45.6/1,000 and 56.0/1,000 in 1996 and 1997, respectively, that was far higher than the 5.5/1,000 derived from the 1993 census. According to the government, there were 220,000 deaths from starvation and related diseases between 1995 and 1998 (FIDH, 11/03; USCHRNK, 2005). Several studies attempted to quantify the number of deaths, relying on testimonies from refugees or extrapolation from demographic data; and estimates ranged between 600,000 and 3.5 m deaths, with one million, or about 5% of the total population, being regarded as a reasonable estimate (GF, 03/04; Goodkind, 2001). Mortality of children less than nine years old, and of the elderly more than 60 years old, seemed especially high (GF, 03/04). Widespread hunger oedema, and a typhus epidemic, were also reported (Becker, 1998).

It is not clear if the famine hit mostly urban or rural areas. It might have depended on the regions. Although there are some reports that people in rural areas had better coping mechanisms, as some were able to cultivate small plots (USCHRNK, 2005), testimonies from the northern area revealed that peasants were not better-off because of bad harvests and the required quota still being collected by the government (MSF, 02/05/02). It also seems that cities offered more coping mechanisms through widespread black markets. By the mid 1990s, conditions seemed to be very different according to geographical regions and social groups (Noland, 07/03). Pyongyang seemed to have been relatively protected, but still also to have experienced shortages (USCHRNK, 2005).

Humanitarian assistance

DPRK requested humanitarian aid in 1995, leading to a widespread response from countries, UN agencies, and NGOs. Food aid was about 500,000 MT in 1995 and 1996, rising to about 1 m MT, or about 15% to 20% of total minimum food needs, between 1997 and 2000 (INTERFAIS). WFP has mostly targeted aid to children, the elderly, and pregnant and nursing women, and has distributed fortified foods (WFP, 23/07/04). There has also been humanitarian aid in other sectors such as support to health infra-structure, agriculture, and water and sanitation.

The provision of humanitarian assistance has been highly controversial as the reclusive policies of the government render the monitoring of humanitarian aid very difficult (USCHRNK, 2005). Food was only authorised for channelling through the government distribution system. Only a few expatriates (who must not be able to speak Korean) were allowed into DPRK, and their movements were restricted. Monitoring visits had to be requested in advance and were sometimes refused. Expatriates were allocated official counterparts who accompanied them during their field visits but often had no specific technical or sectoral skills (USCHRNK, 2005). Except in Pyongyang, the capital, expatriates were generally not allowed to move freely out of their official compound. However, it seems that WFP expatriates were authorised to do so in the recent years (USCHRNK, 2005). Forty to 50 counties, representing about 16% of the population, have always remained out bounds for humanitarian workers (FAO/WFP, 22/11/2004).

Some NGOs pulled out of the country after a few years of operation, because of the difficulties in monitoring aid, arguing that humanitarian assistance was not reaching the most needy (MSF, 02/05/02). Other humanitarian agencies have continued their programmes. It has been argued that some of the humanitarian aid was diverted to the military (USCHRNK, 2005), or was sold on the markets (Natsios, 08/99). It has also been stated that, at least in the mid-nineties, the government concentrated external aid to some areas, and denied it to the northern provinces of North and South Hamyong and Ryangang, representing 5.4 million people (Becker, 1998; USCHRNK, 2005). It has also been claimed that when food aid began to arrive the government cut commercial imports of food, and relocated the funds to other priorities, such as military, even during the famine (USCHRNK, 2005).

Post crisis recovery

The situation appeared to have somewhat improved since 1999 (Eberstadt, 10/04). Although, some degree of recovery has been reported, it does not seem that agriculture and industry have markedly recovered (ICG, 25/04/05). The energy crisis also seems to have persisted (ICG, 25/04/05). The reported level of imports dropped sharply between 1990 and 1998 after which it increased again and by 2003 was twice the value of 1998. Exports were also known to have shown a sharp drop since 1990 and have only recovered somewhat since 1998, although to a much lower extent than imports. The trade deficit has therefore increased, and this is thought to have been financed by contributions from governments such as the US, China, South Korea, and Europe, in a mood of "engagement policy", and by illicit trade (Eberstadt, 10/04). Between 1999 and 2003, it is estimated that annual GDP growth was about 1 to 2% (ICG, 25/04/05), while it was -6.3 in 1997, and -1.1 in 1998 (FAO/WFP, 22/11/04).

Agriculture production

In 2003 and 2004, the amount of fertiliser used had doubled compared to 1996, mainly due to donations, and was slightly more than 200,000 nutrient tonnes, although still far lower than the 600,000 thought to be used in 1989 (FAO/WFP, 22/11/04). 55% of the tractors seem to have been operational since 2001, compared to 20% in 1998 (FAO/WFP, 26/10/01; FAO/WFP, 22/11/04), and the supply of power had also improved in farms (FAO/WFP, 22/11/04). Although agricultural production has stabilised since the mid-nineties, it has never returned to the quantities produced in the 1980, and is thought to have been below 4 m MT until 2002 (Noland, 07/03). In 2003/2004, the estimate of cereal-equivalent production was about 4.3 m MT (FAO/WFP, 22/11/04), and was again 4% higher in 2005 than in 2004 (USDA, 18/11/05). Livestock also seems to have recovered somewhat, with an increase especially in the number of goats and rabbits (by 260% and 540%, between 1996 and 2001, respectively) which the government had encouraged the rearing of as well as poultry (FAO/WFP, 26/10/01).

Economic reforms in 2002

Economic reforms, such as the increase in official prices and wages, and market reforms were announced in July 2002 (ICG, 25/04/05). Food, fuel, and electricity prices increased by 26 times on average, and rice increased by 550 times (ICG, 25/04/05); while wages only rose by an average factor of 18, but with discrepancies depending on the work categories (ICG, 25/04/05). Agriculture and industry were more decentralised, and markets were authorised (ICG, 25/04/05). It seems that well-supplied markets have flourished and that informal local markets have also increased (FAO/WFP, 22/11/04). There was also widespread development of cooperative activities, such as sale of handicrafts, snacks, or shoe or bicycle repair (FAO/WFP, 22/11/04).

Persistence of food insecurity

While some Koreans have prospered, the situation seems poor for most due, among other things, to hyperinflation. With the breakdown of the PDS and the development of a market economy, food insecurity had become more related to the capacity of the families to command resources (USCHRNK, 2005). People who could benefit from foreign exchange seemed more able to cope with the present system (USCHRNK, 2005). The physical proximity of surplus areas was also a factor affecting food security (Noland, 07/2003). According to WFP/FAO, at least 30% of the working age force was under-employed or unemployed, and wages were reduced to below subsistence levels in 2004 (FAO/WFP, 22/11/04). The unemployment rate was double for women compared to men. Moreover, even people with a stable job seemed to engage in commercial transaction to increase their income (Seong-Ho, 03/03). Coping strategies, such as receiving food from relatives in rural areas, gathering wild food (80% of families in urban, and 65% in rural areas), using alternative foods such as acorn flour, or sea and riverweed, cultivating small gardens, and bartering personal belongings were widespread (FAO/WFP, 22/11/04; USCHRNK, 2005). According to WFP/FAO, the most vulnerable were people dependent on the PDS with only one income and several dependents (FAO/WFP, 22/11/04).

Reinstallation of the Public food Distribution System in late 2005

It is unclear to what extend the PDS has remained operational for the majority of the population. The PDS seemed to have been only a marginal source of food for years, at least in the north, according to recent testimonies from refugees in China. The complete abolition of the system was denied by the North Korean government when it was raised by South Korean media in 2004, but it is thought that the PDS only continued to operate regularly in major urban centres (AT, 15/01/05). It seems that the PDS rations varied between 200 and 300 g/pers/day between 1998 and 2004, depending on the year, with important variations between counties and months (USCHRNK, 2005). In November 1998, the three best counties received an average of 350 g/pers/day, while the three worst counties only received an average of 125g/pers/day (WFP/FAO, 29/06/1999). Rations received by farmers at the collective farms seemed higher than rations distributed through the PDS (USCHRNK, 2005). The government of DPRK announced in October 2005 that the PDS will be reinstalled at a ration of 500 g/pers/day and that trade in grains was banned, which also suggests that prior to this the PDS was probably not fully functional (HRW, 05/06). There have since been reports that the ration distributed was smaller than 500 g/pers/day. Although grain trade has been banned, it seems that black markets have continued to operate, and that prices have markedly increased.

End of emergency food aid

Food aid has been significant since the beginning of this overall crisis with a peak at 1.5 m MT in 2001, and a decline afterwards to 0.68 m MT in 2004 (INTERFAIS) reflecting a tendency to fatigue by some donors due to diplomatic conflicts such as the nuclear programme developed by DPRK (USCHRNK, 2005).

In mid-2005, North Korea asked the UN agencies and the international NGOs working in the country to terminate humanitarian aid by the end of 2005 (Concern, 20/09/05; DPA, 22/09/05). North Korea also decided not to be part of the humanitarian Consolidated Appeal Process in 2005 (AFP, 16/03/05). The government stated that the emergency was over, and that the country currently needs long-term projects and development assistance, only occasionally monitored by expatriates (Concern, 20/09/05, Reuters, 10/10/05). It has been suggested that North Korea would get privileged aid from donors, such as South Korea and China, which might exert less monitoring (Chosun Iibo, 08/09/05). In 2006, North Korea has asked South Korea for 500,000 MT of food and 450,000 MT of fertiliser (Gov of RK, 27/04/06; Reuters, 02/05/06). WFP will continue its programme on a smaller scale with 150,000 MT of food to support 1.9 m people, compared to about 500,000 MT of food to support 6 m people previously (Reuters, 11/05/06; WFP, 11/05/06). WFP will only work in 30 counties, and its presence in the field will be reduced.

Nutrition situation

Before 1998, there were no comprehensive national nutrition surveys conducted in the country, but observations in orphanages, nurseries, and kindergartens seemed to indicate a worsening of the situation by mid-97 (see RNIS supplement on North Korea; Katona-Apte, 1998). From 1998 onwards, national nutrition surveys have been conducted every other year (CBS, 10/00; CBS, 11/02; CBS, 02/05; EU/UNICEF/WFP, 98), with a presence of expatriates in the field in the 1998, 2002, and 2004 surveys. However, a number of limitations render interpretation of the results and analysis of the trends of the surveys difficult. Firstly, access to the whole country was not available during the surveys (table 7). The 1998 and 2002 surveys were estimated to have covered about 71% and 75% of the total population, respectively. Coverage estimates were not available for the other surveys. Secondly the methodology of selection of clusters, families, and children, and the age range covered by the surveys, varied (table 7). In addition, in the 2002 and 2004 surveys, only the youngest child of the family was measured, although, when adjusted for the missing older children, the prevalence of acute malnutrition didn't change significantly.

Table 7 Methodologies used in the surveys conducted in DPR Korea, 1998-2004 (CBS, 10/00; CBS, 11/02; CBS, 02/05; EU/UNICEF/WFP, 98)

Although the surveys are not directly comparable due to the reasons cited above, trends seem to indicate a gradual improvement of the nutrition situation, with a diminution of acute malnutrition and stunting (table 8). Stunting in children is mostly determined by ante-natal and early childhood conditions in the first two years of life. The rate of stunting might then be taken to reflect the conditions at the time of birth and early childhood of these children. If rates of stunting recorded in the four surveys are plotted against the year of birth (figure 14), it would seem to indicate that conditions were already very poor at the beginning of the nineties and have improved since 97-98. The peak of the famine is not reflected in this figure, which might be due to a combination of different factors, such as the low birth rate during this period, especially in the more affected families. In any case, the above analysis should be regarded with caution due to the many uncertainties although the decrease in stunting rates from over 60% to less than 40% in 6 years is quite remarkable.

Figure 14 Stunting in children aged over two years by year of birth and survey

The results of the last survey, conducted in 2004, showed a situation which, although greatly improved, was still precarious with an average wasting rate, and a significant level of stunting (table 8). The wasting rate was comparable with Afghanistan and Vietnam, while the stunting rate was again comparable to Vietnam but lower than Afghanistan (Childinfo).

Table 8 Malnutrition in DPR Korea, 1998-2004 (CBS, 10/00; CBS, 11/02; CBS, 02/05; EU/UNICEF/WFP, 98)

Moreover, there were wide discrepancies between provinces (table 9). The lowest rates of wasting were found in Nampo and Pyongyang cities, while the highest rates, three-fold higher than in Pyongyang, were reported in Ryangang, North and South Hamyong and South Hwanghae. Stunting followed the same pattern. This is in line with the analysis of food security in the country (see above), and the food consumption of the mothers, who reported the lowest frequency of consumption of pulses/meat/fish/eggs in South Hamgyoung and Ryangang provinces.

Table 9 Malnutrition in DPR Korea by province, 2004 (CBS, 02/05)

Nutritional status of mothers of children aged less than two years, measured by MUAC, showed that about 32% of the women were thin (MUAC < 22.5 cm) in 2002 and 2004. Moreover, of the 25% and 50% of the women who authorised haemoglobin measurement in 2002 and 2004, respectively, about a third were anaemic (Haemoglobin < 12 g/L).

Child feeding practices although less than adequate with only 65% to 70% of the less than six-month olds exclusively breastfed, are still high compared to some other countries. About 90% of the children were still breastfeeding at one year but the percentage of breastfed children decreased rapidly after one year of age.

Overall

It is difficult to analyse the food and nutrition situations in North Korea due to the paucity and uncertainty of the reliability of information. It seems however that the nutrition situation of the children surveyed in 2002 and 2004 compares with the regional average. Although the economic and agricultural situation seems to have improved in recent years, it is still precarious. The food security and nutrition situations in the country are still very fragile and need continuous attention. Furthermore it is probable that the lower class, thought to represent about one third of the population, is still likely to be suffering the consequences of food insecurity more than the rest of the population.

Abbreviations and acronyms

AAH-US	Action Against Hunger USA
ACF-F	Action Contre la Faim France
AFP	Agence France Presse
AT	Asian Times
BMI	Body Mass Index
CBS	Central Bureau of Statistics
CMR	Crude Mortality Rate
< 5 MR	Under-five Mortality Rate
DPA	Deutsche Presse Agentur
DSA	Development Studies Associate
ENCU	Emergency Nutrition Coordination Unit
EU	European Union
FAO	Food & Agricultural Organization of the United Nations
FEWS	Famine Early Warning System
FIDH	Federation Internationale des Droits de l'Homme
FSAU	Food Security Analysis Unit for Somalia
GF	Good Friends
HIC	Humanitarian Information Centre
HRW	Human Rights Watch
ICG	International Crisis Group
ICRC	International Committee of the Red Cross
IDP	Internally Displaced Person
INRAN	National Institute of Research for Food and Nutrition
IRC	International Rescue Committee
IRIN	International Regional Information Network
MOH	Ministry of Health
MSF	Médecins sans Frontières
MSF-CH	Médecins sans Frontières - Switzerland
MSF-H	Médecins sans frontières - Holland
MSF-S	Médecins sans frontières - Spain
MUAC	Mid-upper arm circumference
NGO	Non-governmental Organisation
OCHA	Office for the Co-ordination of Humanitarian Assistance
RI	Refugees International
RK	Republic of Korea
UNCHR	United Nations Commission on Human Rights
UNHCR	United Nations High Commission on Refugees
UNICEF	United Nations International Children’s Emergency Fund
USAID	US Agency for International Development
USCHRNK	US Committee for Human Rights in North Korea
USDA	US Department of Agriculture
USDS	US Department of State
WFP	World Food Programme
WHO	World Health Organization

References