17. Afghanistan Region (see Map 17)
18. Bhutanese Refugees in Nepal (see Map 18)
19. Refugees from Rakhine State, Myanmar in Bangladesh (see Map 19)
20. Southern Iraq
The most recent overview of the numbers of refugees and displaced people in Asia (as of the end of 1994) is as follows. There were an estimated 5.0 million refugees in Asia, of whom 1.1 million were Afghans in Pakistan and in Iran (1.6 million). There were reported to be 610,000 Iraqis in Iran. Other large groups were refugees from Myanmar in Bangladesh (120,000), Vietnamese in China (290,000), Chinese (Tibet) in India (110,000), and Bhutanese in Nepal (100,000). No comprehensive data were available on the numbers of internally displaced populations in Asia, but they were certainly in the millions (UNHCR, 1994 ‘Populations of Concern to UNHCR’).
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 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.
There are approximately three million people affected regionally by this fifteen year old conflict. Many of those affected are refugees either in Iran or Pakistan, and are currently considered to be self-sufficient.
Kabul Since the resumption of hostilities between the Taliban forces and government in September 1995 over 60,000 people have fled Kabul. Most recent reports are that fighting is continuing around the capital resulting in numerous civilian casualties. The current round of fighting has disrupted normal patterns of trade and commercial deliveries to the city so that there is concern that high food prices in the markets of Kabul are making it increasingly difficult for residents to feed themselves properly. Although some of the main roads leading into Kabul are now open, heavy taxes are being levied at certain entry points with the cost being passed onto consumers thereby keeping prices high. It is generally felt that the situation will continue to worsen unless the factions agree to allow the access routes to Kabul to open permanently.
In January 1996, the roads leading to Kabul were once again blocked by the warring parties, and food prices consequently began to rise. These price increases meant many staple foods, although available on the markets, are outside the purchasing power of many people. Information from dispensaries in Kabul showed that 42% of the children attending were wasted (using arm circumference measurements - QUAC stick). Although this is not representative of the population of Kabul, it does point to a downward trend in the nutritional status as compared to data gathered from dispensaries in 1990 (22.3% wasting) [ICRC Feb 96].
The winter distribution of relief food, which started at the beginning of February, has almost been completed. The main target groups have been the elderly, widows, orphans, and other needy groups including families whose main income earner is disabled. The original planning figure for this vulnerable population was 100,000 people although 160,000 people were eventually targeted [BAAG 28/02/96, UNHAA 27/02/96, 06/03/96, 11/03/96].
A subsidised bakery project which aims to assist 200,000 people with daily bread at reduced price. This is reportedly working well in reducing the basic cost of living for many families [ICRC Feb 96].
Displaced in Jalalabad There are no reports of change in the situation for the 120,000-200,000 displaced people in two camps in Jalalabad. The most recent nutritional survey recorded in the previous RNIS report was in New Hadda camp where prevalence of wasting was only 4%. However, with the continued fighting around Kabul it can be assumed that displacement to Jalalabad is continuing. There are no current data on the nutritional status of new arrivals to the area.
Refugees in Pakistan There remain approximately 860,000 Afghan refugees in Pakistan. The steady decline in numbers of this population is due to repatriation. Most of the remaining refugees are considered to be self-sustaining and thus the general feeding programme has been replaced by a targeted feeding programme. Vulnerable groups such as the disabled, children, the elderly, families without an able-bodied adult males and refugees who arrived in 1992-3 (approximately 180,000 people) will benefit from this programme. There is a concern that not all vulnerable groups have access to the feeding programmes, and ways of improving implementation are being investigated [UNHCR 19/03/96].
A nutritional survey carried out in September/October 1995 in Baluchistan, NWFP and Punjab found overall levels of wasting of 6.0%, 5.3% and 2.7% with 0.9%, 1.1% and 0.7% levels of severe wasting respectively. These rates are considerably lower than those found amongst children in Pakistan (9% in 1995), but do show a slight deterioration compared to a survey carried out in April 1994. The decline in nutritional status is not being solely attributed to the gradual withdrawal of food rations which began in 1990. Other factors, such as high levels of diarrhoea, are also believed to have played a significant role [UNHCR Oct 95].
Refugees in Iran There are approximately 1.4 million Afghan refugees in Iran. While an estimated 20,000 live in camps and receive assistance, the remaining population is scattered among the local population and receive no general ration support [UNHCR 19/03/96].
Recently, food prices for most commodities in Iran have increased and this is believed to pose a particular problem for Afghan refugees, especially for those living outside the camps. The worsening economic situation in Iran is making even low paying jobs difficult to find and capacity to increase expenditures on essential foods is limited in this population [UNHCR 19/03/96].
How can external agencies help? In Kabul, the main problem appears to be a lack of purchasing power. Therefore, interventions that aim to increase the real income are needed. In light of this, it would be useful to:
· continue to support subsidised bakeries;There is a need to review the basis for targeting the general ration to refugees in Pakistan with a view to determining whether all vulnerable groups are included. It may prove appropriate to select additional target groups for ration distribution. Given the possible decline in nutritional status, it may be prudent to implement more frequent surveys (e.g. every six months instead of annually).
· increase the number and scope of income generating projects in Kabul.
The recent removal of the government subsidy on bread in Iran is likely to adversely affect the nutritional well-being of those refugees who are not supported in camps and who may not be able to afford any extra expenditure on food. Consideration should be given to strategies for protecting the food security of this population. Possibilities include the establishment of fair price shops or food coupons.
There are approximately 90,000 Bhutanese refugees living in camps in Nepal. An additional 15,000 refugees reside outside camps and do not receive humanitarian assistance. The next round of bilateral talks between the Bhutanese and Nepali governments concerning the refugee situation is scheduled to take place in April 1996.
Levels of wasting reportedly remain low among this refugee population. However, despite regular and complete general ration deliveries, including fortified blended foods, fresh vegetables and parboiled rice, a few cases of beri-beri, scurvy and angular stomatitis continue to be reported. The reasons for this are currently being investigated. The crude mortality rate amongst this refugee population in February 1996 was 0.11/10,000/day, and the under five mortality rate was 0.23/10,000/day. Both these rates are considered low [UNHCR 14/03/96, 19/03/96].
Overall, the population is not currently considered to be at heightened nutritional risk (category IIc in Table 1), although a small number of people are at risk due to micronutrient deficiencies.
There are approximately 50,000 refugees from Rakhine State, Myanmar in Bangladesh. Repatriation of this refugee population is continuing at a very slow rate. For example, in February 1996, only approximately 500 refugees repatriated [UNHCR 19/03/96].
A recent review of the assistance programme throughout 1995 showed a generally satisfactory nutrition situation for these refugees. The distributed general ration varied little during the year and contained on average about 2,200 kcals/person/day. The percentage of children enrolled in selective feeding programmes ranged from 10-15% during 1995. A slight increase towards the end of the year was attributed to improved case finding and the policy of discouraging repatriation for those families with malnourished children [UNHCR 1995].
The most recent nutritional survey was carried out in August 1995 and found 9.5% levels of wasting which is a slight increase from the previous survey which found 7.2% prevalence of wasting. This change in the populations' overall nutritional status was partly attributed to the ongoing repatriation of least vulnerable families as well as other factors affecting basic needs provision in the remaining camps [UNHCR 1995]. This population are almost entirely dependent on the food ration provided so that any small break in the general ration pipeline can have an adverse effect upon nutritional status.
Availability of blended foods, fish and dal in the general ration has undoubtedly had a role in reducing B vitamin deficiency (seen as angular stomatitis). Prevalence rates of angular stomatitis were 6.9% in August 1995 compared to 21.6% in the previous year. Subsequently, rates have further declined. It is not clear why signs of the deficiency persist among this population. One suggestion has been that certain families exchange vitamin B rich general ration commodities for other items thereby rendering their household vulnerable to deficiency [UNHCR 1995].
Measles immunisation coverage stood at over 98% in 1995 [UNHCR 1995].
Overall, this population is not currently considered to be at nutritional risk (category I Table 1), however, there is a small percentage of people at high risk due to the presence of micronutrient deficiencies.
How could external agencies help? As it is difficult to supply fresh vegetables to this population the regular supply of blended foods must be guaranteed. Its provision in recent months has probably been the most important factor in reducing the incidence of micro-nutrient deficiency disease. The general ration pipeline for blended foods must therefore be ensured while support for the local production of blended foods must continue. UNHCR should advise/request WFP to procure blended foods locally as long as the price remains competitive. Reasons for the continued presence of low levels of micronutrient deficiencies need to be investigated.
Although there is very little direct information, it can be assumed that the nutritional and health condition of the 220,000 Marshland Arabs continues to be undermined by the systematic destruction of their traditional habitat in conjunction with other measures of persecution. Loss of livelihood, arbitrary arrest, detention and torture, as well as attacks on habitats have stretched the survival capacity of this population. Approximately 28,000 people have managed to cross the border into Iran, and their nutritional status is reportedly adequate [UNHCR 19/03/96].
There have been a succession of reports describing a declining nutritional situation for the majority of Iraqi people partly as a result of economic sanctions. As the Marsh Arab population is currently one of the most vulnerable in Iraq, it can be assumed that their nutritional situation is worse than that of the rest of the country which is increasingly being described as very poor.
A very recent report describing the health and nutrition situation in the country since sanctions were imposed in 1991 described a catastrophic situation. “A large number of ad hoc nutrition surveys have been conducted on children in different governorates in Iran, and the results have been consistently dismal. Moderate and severe malnutrition is widely prevalent. Kwashiorkor and marasmus, the most alarming forms of protein-energy malnutrition reappeared in Iraq in 1991. Nutritional anaemia and vitamin A deficiency ....... are now common occurrences” Mortality rates have reportedly increased six-fold and incidence of malaria, cholera and typhoid, to cite a few examples have also increased dramatically [WHO Mar 96].
Overall, the Marsh Arabs who are refugees in Iran are probably not at heightened nutritional risk (category IIc in Table 1), while those remaining in the Marshes can be considered to be at high nutritional risk (category IIa in Table 1).
