18. Afghanistan Region
19. Bhutanese Refugees in Nepal
20. Refugees from Rakhine State, Myanmar in Bangladesh
21. Southern Iraq
An overview of the situation for refugees and displaced people in Asia as of the end of 1993 is as follows. There were an estimated 5.2 million refugees in Asia, over a half of whom were Afghans in Pakistan (1.4 million) and in Iran (1.3 million). There were reported to be 650,000 Iraqis in Iran. Other large groups were refugees from Myanmar in Bangladesh (52,000), Vietnamese in China (290,000), Sri Lankans in India (115,000), as well as considerable numbers from the conflicts in Cambodia, Laos and Vietnam in other countries. No comprehensive data were available on the numbers of internally displaced populations in Asia, but they were certainly in the millions. Figures of 600,000 Afghans internally displaced were quoted. In addition there were considerable numbers of internally displaced people in Iran and Myanmar.
This section of the report aims to give updated information on some of these situations. The current situation for the Afghan refugees/displaced populations, the largest single group in Asia with approximately three million affected people, is described. Available information on the relatively small populations of Bhutanese refugees in Nepal and refugees from Myanmar in Bangladesh are included because of previous reports of micronutrient deficiencies. As in the past, we also include information on Southern Iraqi refugees in Iran.
(see Map 18)
Although the overall security situation in Afghanistan has generally remained stable, periodic outbreaks of hostility are still reported in some provinces, e.g. Badghis and Herat. Observers now believe that the political situation is once again deteriorating and that the Talaban, who control two thirds of the country, have now decided to resume offensives against the government. The situation in Kabul is therefore said to be very tense. Repatriation from Pakistan and Iran is continuing but it is anticipated that the rate of return will decrease as the winter months make travel more difficult. The main problem continually identified in Afghanistan is the resettlement of returnee populations and their impact on local populations. There are approximately 3.1 million people affected regionally, either as refugees or internally displaced people [UNHAA 06/08/95]. There are at least an additional 500,000 returnees and resident population affected by their arrival throughout the country. WFP support a wide variety of activities in Afghanistan including food for work projects, food relief distributions and subsidised bakeries in urban centres. However, food resources currently available to WFP Afghanistan are well below requirement with stocks in the North almost depleted. Donor pledges are needed immediately to prevent a shortfall in the coming months [WFP 06/10/95].
Displaced in Kabul The relative stability in Kabul since April 1995 has led to the spontaneous return of over 160,000 persons, mainly from Jalalabad and from Peshawar in Pakistan. Many agencies have implemented "Quick Impact Projects" involving infrastructure repair in order to assist the process of re-integration. Diarrhoeal diseases have reportedly increased due to the hot weather and in some areas of the country, such as in Ghazni, the problem is said to be of epidemic proportions [UNHAA 06/08/95].
Displaced in Jalalabad Past fighting in and around Kabul has led to large scale displacement of people to Jalalabad, although the recent stability in Kabul has led many families to return to the capital city.
Recent survey data from New Hadda camp (estimated population 80,000) shows 11.1% wasting with 1.5% severe wasting (see Annex I 18(a)) [MSF-H 14/09/95]. These levels of wasting are similar to those measured at the end of May 1995 (9.3% wasting with 2.2% severe wasting). However, rations have been estimated at approximately 1600 kcals/person/day which may not be adequate to maintain this nutritional status.
Mazar-I-Sharif Camps for Displaced Reports from three camps for the displaced in Northern Afghanistan (total population approximately 20,000) show very low rates of mortality but there is a high prevalence of diarrhoea and dysentery. Furthermore, in one camp (Kamaz) there have been confirmed reports of vitamin B2 deficiency which is apparently responding well to multi-vitamin treatment [MSF-B Jul 95].
Refugees in Pakistan There are approximately 1.2 million Afghan refugees in Pakistan, many of whom are reportedly self-sufficient. General ration distributions to this population have been phased out, although programmes aimed at assisting vulnerable groups (e.g. supplementary feeding and food for work programmes) are continuing [UNHCR 19/09/95].
Refugees in Iran There are approximately 1.5 million Afghan refugees in Iran. Only 20,000 of this population reside in camps, with most living and working among the local population. The recent reduction and/or elimination of food subsidies is leading to fears that many of these refugees will no longer be able to support themselves, and may therefore be forced to move to refugee camps in their area [UNHCR 19/09/95].
It is anticipated that 500,000 refugees will repatriate between March 1995 and March 1996. At the end of August, an estimated 86,000 had returned [UNHAA 06/08/95, UNHCR 19/09/95].
Returnees to Afghanistan Formal repatriation began in 1992 when there were approximately six million Afghan refugees in neighbouring countries. The number of refugees is now less than three million and it is hoped that the remaining refugee population will repatriate over the next three years [UNHCR Feb 95]
An example of the possible nutritional situation of returnees and the impact the returning population may be having on residents is shown by a survey recently conducted in Kandahar city. South East Afghanistan. This city has received over 250,000 returnees, many from Pakistan, since 1992 and it is expected that the current population of 350,000 (returnees and residents) will increase further as repatriation continues. The survey findings indicate a variety of nutritional and food related problems which may well be indicative of the situation in other returnee impacted areas of the country [MERLIN 15/06/95].
The prevalence of wasting were measured at 13.4% in the villages around Kandahar and 9.3% in the city itself (see Annex I 18(b-c)). The under five mortality rate was 4.8/10,000/day (6x the usual level). Although the survey methods prevent these results from being extrapolated to the whole population in the province, the results are believed to be indicative of more general nutrition related problems which may be derived from a rapidly fluctuating exchange rate and price inflation. There is concern that as more refugees return home, food stress may increase and effect even higher levels of wasting [MERLIN 15/06/95].
Overall, renewed instability and some survey results lead to the impression that the population inside Afghanistan (internally displaced and returnees) could be at moderate nutritional risk (category IIb in Table 1).The refugee populations in Iran and Pakistan are not currently considered to be at heightened nutritional risk (category He in Table 1).
How could external agencies help? There is an urgent need for additional resources to prevent disruption to relief programmes in Afghanistan. In view of heightened levels of conflict, other additional assistance may soon be needed. There is also a general need to establish nutritional surveillance in those areas where large numbers of returnees are settling. The high levels of diarrhoea in many parts of the country suggest a need to support MCH services and associated health out-reach programmes. The fluctuating food security indicates a need to continue food price monitoring and support for food for work projects and also to support bakeries in a way which effectively subsidises bread consumption.
(see Map 19)
There are approximately 87,000 Bhutanese refugees in Nepal. Given the lack of progress in recent intergovernmental meetings between Bhutan and Nepal, most observers do not expect any significant repatriation of refugees in the near future [IFRC 05/07/95].
Towards the end of 1993, there were confirmed reports of widespread micronutrient deficiency diseases including beri-beri, scurvy, pellagra, and angular stomatitis among this population. Various curative and preventive measures were taken to bring the situation under control. These included the addition of blended foods and fresh vegetables to the ration. A follow up survey was conducted in June 1995 which showed wasting rates among children under five of 5.7% with 0.9% severe wasting (see Annex I 19(a)). In general, rates in central and western camps were higher than in northern camps, as ascribed by some as reflecting overcrowding in the former. Adult malnutrition using BMI measurements was recorded at 18.1%. A cut-off of BMI<18 was used to define malnutrition. These results only show a marginal increase in malnutrition compared to an equivalent survey conducted in Bhutan in 1989. Measles immunisation coverage was 97%. The under-five mortality rate was 0.17/10,000/day and has been declining for the past 6 months [IFRC 05/07/95, SCF/UNHCR 25/07/95].
There were no cases of pellagra seen among the population surveyed. However, there was a 2.3% prevalence of beri-beri which, although significant, was not considered to be an alarming rate as symptoms take some time to be alleviated and the incidence of the disorder has dropped from 0.55 new cases/10,000/day in January 1995 to 0.005/10,000/day in June 1995. There was more concern over the rates and apparent increase in the incidence of scurvy and angular stomatitis. The scurvy incidence was estimated at 0.62 new cases/10,000/day in June 1994 compared with 0.17/10,000/day in December 1994; the incidence of angular stomatitis was 2.49/10,000/day compared to 1/10,000/day in December 1994. While both rates are much lower than peak levels in May 1994 and seasonal factors are know to have an impact, the persistence of both these conditions is worrying [SCF/UNHCR 25/07/95].
Overall, although beri-beri and pellagra do not currently appear to be problems in this population, these deficiencies should be guarded against. Scurvy and angular stomatitis appear to remain a problem and the approximately 3-4% of the population affected can be considered to be at high nutritional risk (category I in Table 1).
How could external agencies help? The continued, although diminished incidence of micro-nutrient deficiency disease indicates the need to carefully monitor receipts of blended foods and vegetables in camps and to assess which groups remain vulnerable to these conditions.
(see Map 20)
There are approximately 52,000 refugees from Rakhine State, Myanmar remaining in Bangladesh. Repatriation is continuing although on a smaller scale than was seen earlier in the year. This is mainly reported to be due to a slow down in clearance of refugees for return by the government of Myanmar. It is hoped that the rate of repatriation will increase after the monsoon season, but there is some concern that the overall programme will take longer than originally planned [IFRC 12/07/95]. Food supplies to the remaining camps continue to be adequate and nutritional status of the refugee population appears stable.
How could external agencies help? Future support for NGOs may be needed if programmes continue longer than planned due to a lengthier repatriation process.
There is no evidence of any improvement in the situation of the 220,000 Marsh Arabs. This population has had to endure destruction of their traditional marsh habitat and consequent loss of livelihood and means of subsistence as well as various forms of persecution including arbitrary arrest, torture, executions and military attack. Some of the affected population has crossed the border into Iran attaining refugee status but most remain inside Iraq where they are largely inaccessible to aid agencies [UNECOSOC 04/09/95].
Although there have been no systematic nutritional surveys of this population and there is no current anecdotal information, a recent UN assessment mission in the country indicates an overall decline in food security and nutritional well-being for much of the Iraqi population. This deterioration must be particularly critical for the Marsh Arabs who are already known to be extremely vulnerable [WFP 15/09/95].
The mission found that an estimated 60% of the population in the centre/south of the country (which includes the Marsh Arabs) is in need of food assistance and that the government ration of 1100 kcals/person/day is proving insufficient to avert a major crisis. Widespread anaemia, marasmus, kwashiorkor and vitamin A deficiency have been reported [WFP 15/09/95].
The UN's emergency operation which targets over one million vulnerable beneficiaries is running into difficulties as food shortfalls have meant that only one third of the target population can be supplied [WFP 15/09/95].
How could external agencies help? A food aid shortfall is preventing WFP from supplying food rations to all identified vulnerable groups.
