19. Bhutanese Refugees in Nepal
20. Refugees from Rakhine State, Myanmar in Bangladesh
21. Southern Iraq
The numbers of refugees in Asia grew from approximately 5.1 million in 1982 to 7.2 million in 1992. The single largest group of refugees comes from Afghanistan; in 1992 there were 4.1 million Afghans in Iran and 1.6 million in Pakistan, accounting for about 80% of the total refugee population of the region [UNHCR 1993], In this section of the report, we will start by including available information on the relatively small populations of Bhutanese refugees in Nepal and refugees from Myanmar in Bangladesh because of persistent reports of micronutrient deficiencies. As in the past, we will include information on Southern Iraqi refugees in Iran.
Late in 1990, people of Nepalese origin in Bhutan (some of whom had been in Bhutan for many generations) began fleeing to Nepal via India [IFRC 24/9/92]. While small numbers of refugees continue to arrive, the major influx appears to have stopped and the current population is approximately 86,000 in eight different sites. There are also large numbers of refugees (at least 20,000 in September 1992) living with relatives and friends outside the camps [UNHCR 27/01/93, UNHCR 12/08/93, UNHCR 31/05/94].
Mortality rates and levels of wasting are currently at lower levels than those found in the local/host community. Immunization coverage is reported to be "high". The refugees regularly receive a basic ration of rice, pulses, oil, salt and sugar with a complementary ration of fresh vegetables. Apart from minor interruptions, delivery of the basic ration commodities has been consistently adequate throughout the programme. However, there are continuing logistical problems with the speed of vegetable delivery thereby reducing the micronutrient value of these commodities. Approximately 20-25 litres of water per capita are available [UNHCR 27/01/93, UNHCR 31/05/94].
Since the second half of 1993 there have been numerous reports of micronutrient deficiencies occurring. A beri-beri outbreak reached its peak in November 1993 but is now reportedly under control [SCF Jan 1994, UNHCR 9/03/94]. In January 1994 the first cases of pellagra and scurvy were noted and recent anecdotal evidence in May suggest that people mainly between the ages of 10-30 years may be affected.
In early February the overall incidence rates measured by Save the Children for the various deficiencies were as follows;
|
Scurvy |
0.7/10,000/day |
|
Pellagra |
0.5/10,000/day |
|
Angular Stomatitis (primary) |
3.6/10,000/day |
|
Angular Stomatitis (secondary) |
3.1/10,000/day |
How could external agencies help? Donors should support any initiative to supply fortified blended food for the general ration while every effort to ensure the supply of fresh vegetables should continue to be made. Inter-agency coordination is improving and should greatly facilitate the on-going monitoring of the situation (i.e. quality of food basket, nutritional status etc).
Towards the end of 1991 the Rohingya Muslim minority in Myanmar Rakhine state began arriving in South East Bangladesh. By June 1992 the refugee population had reached 250,000. This population was distributed between 15 camps in Cox's Bazar District which is a disaster prone area with regular flooding and occasional cyclones.
Within a short period of time data indicated that the population were experiencing a nutritional and health crisis as crude mortality rates as high as 2.1/10,000/day (7 times normal) and under five mortality rates of 5.6/10,000/day were being recorded. Nutritional survey data established wasting levels as high as 26.6% with 8.6% severe wasting [UNHCR 28/05/92]. Surveys also showed high levels of night blindness (1.2%) and angular stomatitis [H. Keller Jun 92].
By early 1994 the total refugee population had decreased to just under 200,000, mainly due to repatriation. At that time, the health status of the refugees had improved considerably. Crude mortality rates were recorded as 0.26/10,000/day and the under-five mortality rate was 0.33/10,000/day. These rates are comparable to those in the host community. However, angular stomatitis was still being seen amongst the population so that a decision was taken to increase riboflavin (B2) intake by adding fortified dried skimmed milk (DSM) to the supplementary feeding programme ration.
Most recent reports from two camps (total population of 32,000) indicate the continuing existence of riboflavin deficiency. Preliminary calculations, based on established requirement guidelines, estimate that the food basket, which is based upon parboiled rice, provides less than 50% of riboflavin and less than one third of vitamin C requirements (FAO). It is highly likely that other micronutrient deficiencies are also present, but are not being detected at the moment. SCF is currently exploring ways to address these deficiencies [SCF 6/06/94].
Voluntary repatriation is now a main focus of the refugee programme, although some questions remain as to security in Myanmar [SCF 6/6/94, UNHCR Dec 93]. However, early in May a cyclone caused extensive damage to the camps and dock area that was to be used as a point of embarkation for the repatriation programme. The reception centre in Myanmar was also completely destroyed. These have now been reconstructed and it is hoped that repatriation will now begin in earnest. A medical screening is planned for all departing refugees in the hope that those who are nutritionally and medically vulnerable will be identified and followed up once they have returned to their village of origin [UNHCR-a 6/05/94, UNHCR 31/05/94, UNHCR Dec 93].
How could external agencies help? Donors should support efforts to provide micronutrient fortified DSM in the general ration. There should be careful monitoring to ensure its proper use at the household level and that the incidence of diarrhoea docs not increase once it has been introduced into the general rations a result of poor preparatory practices.
As food and medicine are still not available in southern Iraq, and the marshes, chief source of income for the people living there, continue to be drained, people continue to flee to Iran.
Current estimates are that there are approximately 22,000 people living in six camps in Iran, just over the Iraqi border. Most of these people have been in Iran for a few years and are fairly well settled - almost all have proper housing and some have work.
The situation is much worse for the approximately 2,200 new arrivals from Himmet living in tents, with no escape from the heat which sometimes reaches 50ºC. It is said that water supply is inadequate and of poor quality; many are forced to drink unclean water from a nearby river. Anecdotal reports state that diarrhoeal diseases are quite common and that many children are anaemic [Al-Hakim 6/6/94, WFP 23/05/94].
Some food is reported to be available to these refugees, but no milk is available for the children and vegetables are scarce. Anecdotal reports indicate that the number of marasmic children is growing [Al-Hakim 6/6/94].
No new information is available on the approximately 200,000 Marsh Arabs still inside Iraq.
