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 Fighting between government and Taliban forces continues in areas south and southeast of Kabul. Despite this, people are returning to the capital city. For example, over 4,000 people returned to Kabul during the last week in May. Food convoys continue to enter the city, and markets are likely to be adequately stocked [UNHAA 06/06/96].
A massive immunisation campaign, which began in November 1994, is continuing, and the next round of immunisations is scheduled for June, then July. The July campaign will immunise and also distribute vitamin A [UNHAA 06/06/96].
Displaced in Jalalabad There are approximately 160-200,000 displaced people in five camps near Jalalabad city. The majority have fled Kabul and surrounding areas since 1992.
Nutritional surveys were conducted between December 1995 and February 1996 in two camps as well as in Jalalabad city and Shenwar district, to determine if there had been any adverse nutritional effects since the reduction in general ration programme for the displaced. The surveys showed a reasonable nutritional status amongst the displaced and local populations. In New Hadda camp (estimated population of 30,000) low levels of wasting and/or oedema of 4.0% with 0.6% severe wasting and/or oedema were measured (see Annex I (17a)). Measles immunisation coverage was estimated to be 79%. In Sarshahi camp (estimated population of 80,000) wasting and/or oedema was measured at 4.7% with 1.6% severe wasting and/or oedema (see Annex I (17b)). Measles immunisation coverage was estimated at 80.7%. These rates were slightly higher than those measured in the surrounding local population living in Jalalabad city (3.2%) and Shenwar district (2.6%) [MSF-H.28/03/96].
According to food basket monitoring data, general rations received by those in the camps in the previous three months supplied 25% of caloric needs. Food stocks at household level seemed satisfactory but the survey was conducted immediately after a general ration distribution. Selling assets, borrowing money and goods and selling labour were observed to be the main sources of cash income for the camp populations. The average income only covered about 63% and 47% of the cost of the minimum diet in Sarshahi and New Hadda camp respectively. The survey concluded that the way internally displaced people are coping at present by selling personal assets is increasing their vulnerability; that the food security situation of the IDPs is precarious especially in New Hadda where income earning opportunities and food security are very poor [MSF-H 28/03/96]. More recently, food for work opportunities are being offered to improve food security [WFP 20/06/96].
The observed incidence of diarrhoea recorded in the camps and among the local population is very high especially given that March is not a peak season for diarrhoea. The main reasons are thought to be poor environmental sanitation and lack of knowledge of hygiene and cleanliness practices [MSF-H 28/03/96].
Refugees in Pakistan There remain approximately 860,000 Afghan refugees in Pakistan. It is expected that 250,000 will repatriate in 1996 and a further 300,000 in 1997. Most of the remaining refugees are considered to be self-sufficient so that general ration distributions have been replaced by a targeted feeding programme called a safety net programme. This programme provides edible oil to refugee mothers attending Basic Health Units and female children attending primary schools. Oil rations are also provided to women involved in NGO-assisted training centres, the handicapped and new arrivals [UNHCR 21/05/96].
Approximately 8,000 refugees in Pakistan who arrived since 1994 are not yet considered to be self-sufficient and this group receives a more comprehensive general ration [UNHCR 21/05/96].
A nutrition survey conducted in refugee villages in Pakistan carried out in March and April 1996 showed a relatively adequate nutritional situation amongst the refugee population with overall levels of wasting having declined since October 1995. Levels of wasting and/or oedema varied from 1.8-3.6% with 0.6-1.1% severe wasting and/or oedema (see Annex I (17 c-f)). In all surveyed areas, children between 60-77 cms in height (less than 2 years) were found to have highest levels of wasting, which were attributed largely to poor weaning practices [UNHCR Mar-Apr 96].
The survey also found that the occurrence of diarrhoea had declined compared to October 1995 and that all refugee populations had reasonable access to water although maintenance of supplies was sometimes difficult [UNHCR Mar-Apr 96].
Refugees in Iran There are approximately 1.4 million Afghan refugees in Iran of whom 20,000 live in camps and receive assistance. The remaining refugees live and work amongst the local population. It is possible that deteriorating economic conditions in Iran will place an increasing strain upon those refugees living outside the camps. Rising prices, limited job opportunities and dwindling purchasing power may begin to adversely affect the nutritional status of this population. In 1996, the ration to those refugees in camps has been increased by including sugar and rice. A nutritional survey is planned for the end of June 1996 to determine whether there has been any change in the nutritional status of these refugees [MSF-F 04/06/96, WFP 20/06/96].
Overall, the population affected regionally is not currently considered to be at heightened nutritional risk (category IIc in Table 1), although the population in Kabul will need to be monitored if there are further disruptions to the food supply.
How could external agencies help? Considerable support has already been received for a national immunisation project in Afghanistan. However, some additional support and initiatives are still needed for this project. For example:
· there remains a budget shortfall of US$600,000;Current general ration levels should be maintained in the camps for the internally displaced around Jalalabad in order to avoid any deterioration in nutritional status. Furthermore, agencies should focus on saving limited assets of IDPs by providing other opportunities of earning income/food. There also needs to be an expand EPI coverage and an investigation into the reasons for high levels of diarrhoea in the camps. A follow-up nutrition survey should be undertaken in six months time to allow establish a different seasonal baseline.
· a substantial publicity campaign is needed within Afghanistan to help mobilise communities through broadcasting the benefits of immunisation;
· publicity aimed at convincing the warring factions of the need for a period of tranquillity so the immunisation campaign can be carried out.
There is a need to expand the safety net system food ration system amongst Afghan refugees in Pakistan so that families with malnourished children also receive the edible oil. This would necessitate developing a nutritional surveillance programme to serve the dual purpose of estimating the prevalence of wasting and identifying malnourished children for inclusion in the programme. Simultaneously, the basic health unit' system needs to be strengthened so that is can act as a channel for the provision of edible oil to all families identified with malnourished child. This will involve identifying additional CHWs to conduct nutritional monitoring in order to refer malnourished children to local health unit.
There are approximately 90,000 Bhutanese refugees living in camps in Nepal and a further 15,000 living outside the camps who do not receive humanitarian assistance.
The nutritional and health situation of this population remains essentially adequate. 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 [UNHCR 21/05/96].
Overall, this population is not considered to be at heightened nutritional risk (category IIc in table 1), although a small number of people are at high nutritional risk due to the existence of micro-nutrient deficiency diseases.
There are approximately 54,000 refugees from Rakhine State Myanmar in Bangladesh. There have been approximately 5,500 new arrivals from Myanmar during the months of April and May. The majority of these new arrivals appear to be fleeing poverty in their home country. It is currently being discussed whether these new arrivals should be considered as economic migrants (and hence not under the protection of the international community) or refugees.
A recent report on the security and human rights situation inside Rakhine State stated that UNHCR is playing a key role in helping to ensure conditions in Rakhine State are conducive to the return of the refugees.... [ECOSOC 05/02/96], however, repatriation is still only continuing at a slow pace.
There is no reported change to the generally adequate nutritional and health status of this population although low levels of angular stomatitis persist despite the availability of blended foods, fish and dal in the general ration [UNHCR 21/05/96].
Overall, this population is not currently considered to be at heightened nutritional risk (category IIc in Table 1), although a small number of people are at high nutritional risk due to the existence of micro-nutrient deficiency diseases.
A report by the Special Rapporteur for Iraq in March 1996 is one of a recent series describing a constantly deteriorating situation for most of the population, especially the most vulnerable segments, comprised of children, pregnant and nursing mothers, the elderly, the disabled, and the increasingly large numbers of destitute. [ECOSOC 04/03/96]. The report describes how food prices increased by over 300% in 1995, while salaries and wages remained unchanged. Although the government has continued distribution of its subsidised food basket of five essential food items, a large percentage of the population is estimated to have a shortfall in calorie intake of over 50% of requirements. Recent nutrition surveys throughout the country have consistently found widely prevalent moderate and severe malnutrition and vitamin A deficiency among children.
It must be assumed that the nutritional and health status of the 220,000 Marshland Arabs in particular is being critically undermined by the economic situation in Iraq. This population have experienced 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 further stretched the survival capacity of this population.
A recent agreement between the international community and the government of Iraq that the latter will purchase food and medicine in exchange for oil has raised some cautious hopes that the nutritional and health situation of the Iraqi population will improve [WFP 24/05/96]. However, the Marsh Arabs have in the past been one of the most ostracised groups within Iraq so that it is unlikely that any increased availability of foods and medicine will directly benefit this highly vulnerable population.
There is no reported change to the adequate nutritional status of the approximately 28,000 Marsh Arabs who have fled the southern marshes and are now residing in camps in Iran [UNHCR 21/05/96].
Overall, Those remaining the marshes are likely to be at high nutritional risk (category IIa in Table 1) while those who have crossed the border into Iran are probably not at heightened nutritional risk (category IIc in Table 1).