The most recent overview of the numbers of refugees and displaced people in Asia (as of the end of 1996) is as follows. There were an estimated 4.8 million refugees in Asia, of whom over 1.2 million were Afghans in Pakistan and in Iran (1.5 million). There were reported to be 600,000 Iraqis in Iran. Other large groups were refugees from Viet Nam in China (289,000), and Bhutanese in Nepal (92,000). No comprehensive data were available on the numbers of internally displaced populations in Asia, but they were certainly in the millions (UNHCR, 1996 '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 reports of micronutrient deficiencies. A section on the situation in Sri Lanka is also included. As in the past, we also include information on Southern Iraqi refugees in Iran.
14. Afghanistan Region
Civil strife has been continuing in Afghanistan for almost twenty years. The most recent upsurge in fighting led to an almost complete sweep across the country of the Taliban, a fundamentalist group who now controls most of the country, including Kabul. Fighting is continuing north of Kabul [ICRC 28/08/97, WFP 19/09/97].
This ongoing conflict has led to large-scale displacement within Afghanistan and refugee movements into neighbouring countries. It is estimated that 1.75 million people in Afghanistan are in need of food aid. There are a further 330,000 refugees in Pakistan and 322,000 in Iran in need of assistance.
Afghanistan Heavy fighting outside of Kabul has led to fresh waves of displacement and the situation north of the city remains tense. The security situation in the south is calmer, and some return to normalcy is being seen. It is currently estimated that there are over 200,000 displaced people in the capital. Emergency aid is needed for a total of 1.75 million people in Afghanistan. Those in need include internally displaced persons, the sick and elderly, households headed by women, and returnees. Food aid is mainly provided in the form of subsidised bread at bakeries and through food-for-work projects [ICRC 28/08/97, UNDPI 22/07/97].
Agriculture has been disrupted due to damage to irrigation systems, mines in fields, and market disruptions. However, in many areas, particularly in the south, some return to normalcy is being seen. Yields from the harvest in July are estimated to be higher than last year, although there are problems anticipated with transporting food from surplus to deficit areas. Partial closure of the border with Uzbekistan has let to massive inflation of fuel prices so that commercial transporters are now charging ten times the rate they were charging previously. The Uzbek authorities have allowed food into Afghanistan by barge, however the road bridge linking Afghanistan with Uzbekistan remains sealed [FAO 07/08/97].
It is estimated that a mere 26% of the population have access to health care services and only 12% have access to safe drinking water [FAO 07/08/97].
Iran There are no recent nutritional data on the approximately 322,000 assisted Afghani refugees in Iran. Previous reports were of an adequate nutritional status among this population.
Pakistan There are estimated to be 330,000 Afghani refugees in Pakistan currently requiring aid. General rations were phased out in October 1995 and replaced by a safety net programme which began providing assistance to vulnerable groups. A survey carried out six months after this change showed an adequate nutritional status among children [UNHCR 26/06/97]. children [UNHCR 26/06/97].
A follow-up survey was carried out in May 1997. The survey showed levels of wasting varying from 2.6-3.8% (see Annex I (14a-c)), similar to those found during the previous survey. This compares with a prevalence rate of 9% wasting amongst the local population. The malnutrition seen was felt to be mainly as a result of cases of diarrhoea, not of food shortages. The underlying causes for the high number of diarrhoea cases was believed to relate to feeding practices, care and hygiene, particularly at the time of weaning. [UNHCR 26/06/97].
Overall, those requiring emergency assistance in Afghanistan can be considered to be at moderate nutritional risk (category IIb in Table 1) due to insecurity hampering relief efforts. The refugees in Pakistan and Iran are not currently thought to be at heightened risk of malnutrition and associated mortality (category lie in Table 1).
Ongoing interventions: Resources should continue to be made available for food for work programmes in Afghanistan. These programmes are currently needed to support food production initiatives and food for seeds, rehabilitation of irrigation networks and drainage, agricultural land rehabilitation, flood control and agro-forestry. Other priorities include the need to support reintegration and resettlement of the displaced and rehabilitation of health delivery systems.
As most of the existing malnutrition in Pakistan seems to derive from inadequate caring practices (especially poor
15. Bhutanese Refugees in Nepal
There are estimated to be 92,000 Bhutanese refugees in Nepal. Most of these refugees arrived in the early 1990s, allegedly fleeing persecution in Bhutan. There are currently no plans for the repatriation of these refugees.
Levels of wasting in the camps have been low for quite some time. The figure on the right shows levels of wasting over time in the camps. Crude mortality rates (CMR) have also been quite low. For example, the CMR in June 1997 was 0.09/10,000/day and the under-five mortality rate was 0.15/10,000/day [SCF Jun. 97].
Token from: SCF(UK) (1997) Household Food Assessment of Khudunabari and Beldangi Refugee Camps, Jhapa District. South-east Nepal SCF(UK). London.Despite the regular provision of a food basket which provides approximately 2,200 kcals/person/day and included a fortified blended food and fresh vegetable, cases of micronutrient malnutrition continue to be reported at camp clinics. For example, in June 1997, cases of vitamin A, scurvy, vitamin B deficiency (seen as angular stomatitis, and beri-beri) were seen [SCF Jun. 97]. A study on the uses of blended food at the household level is being finalised, and it is hoped that this study will help identify reasons for the continued low-level incidence of micronutrient malnutrition.
A recent household food economy assessment was conducted in the camps to help improve understanding of food security and food needs. It was determined that an overwhelming proportion of the food supply for households was provided by the general ration, and that there is very limited access to other food sources. There is little opportunity for the refugees to farm, or keep livestock and little demand for labour outside of camps. Furthermore, levels of calcium, riboflavin and niacin fall seriously below minimum requirements. Based on these findings, a WFP/UNHCR
Joint Assessment Mission recommended that current ration levels be maintained and that blended food fortification levels should be re-assessed [SCF May 97].
Overall, this population is not considered to be at heightened risk of malnutrition and associated mortality (category lie in Table 1), despite the continued presence of low levels of micronutrient malnutrition.
16. Refugees from Rakhine State, Myanmar in Bangladesh
Between December 1991 and March 1992, approximately 250,000 people fled the Rakhine State (then called Arakan state) in Myanmar (then Burma) to Bangladesh. Repatriation began in 1994 and was planned to be completed by the end of 1995. The repatriation process was impeded by a number of factors, and currently there are 21,000 refugees remaining in two camps in Bangladesh [HRWA/RI Aug. 97].
The food basket is meant to provide just over 2100 kcals/person/day. However, in November 1996, the distribution of fortified blended food was stopped due to questions of its suitability for consumption. Efforts to replace the calories provided by blended food include the distribution of high energy biscuits in supplementary feeding programmes, a wet feeding programme for all children under five, and an increase in rations for pregnant and lactating women [UNCHR Aug. 97].
A nutrition survey was carried out in the two camps in Bangladesh, and the results confirm earlier survey results showing a decline in nutritional status among remaining refugees. Wasting was measured at 14.6%, with only 39.5% of malnourished children attending the feeding centres (see Annex I (16a)). The prevalence of angular stomatitis had increased to 8.9% from 5.5% measured in an earlier survey. Measles immunisation coverage was 92.8% [UNHCR 07/08/97]. A number of factors may have contributed to this decline in nutritional status. Blended foods have been absent from the food basket since November 1996 and no substitute has been provided in the general ration. Also, the most vulnerable families have been left following repatriation, and finally, refugees sell and trade food items in order to buy other necessary items. However, terms of trade are poor and many calories may therefore be lost from the ration.
Since the survey, there have been reports of new arrivals to Bangladesh, although these people are not registered and do not receive rations. Government officials claim that up to 15,000 refugees have crossed the border in recent months and that many are economic migrants. It is thought that in some cases, families are sharing rations with the new arrivals. Another recent development was the forced repatriation of over 400 refugees. This led to people refusing daily rations for up to two weeks. The boycott is now over, and forced repatriations have stopped [UNHCR 16/09/97]. Both of these recent developments are likely to have further adversely affected the nutritional situation of remaining refugees.
Overall, these refugees can be considered to be at high risk of mortality (category I in Table 1), with elevated levels of wasting and micronutrient malnutrition reported in recent surveys.
Ongoing interventions: The food security impact of the recent wave of refugees into the camps needs to be properly assessed and appropriate action taken. It also seems appropriate to review the kcal and micronutrient level of the ration given the decline in nutritional status. A substitute for corn soy blend which has been removed from the general ration should be found. It may also be that other initiatives to improve nutritional status are appropriate, e.g. deworming and efforts to establish home gardens. Attempts should also be made to increase supplementary feeding programme coverage through the outreach of community health workers and traditional birth attendants.
17. Marsh Arabs in Southern Iraq
An international embargo imposed on Iraq after the Gulf War in 1990 has resulted in a dramatic economic decline. Living standards throughout the country have deteriorated due to a combination of escalating prices, lower purchasing power, reduced food production and a breakdown of health services [UNICEF 01/06/97, MOH(GOI), UNICEF, WFP 14/04/97]. These adverse conditions are likely to adversely affect the Marsh Arabs in the south-east of the country even more profoundly since this group is traditionally neglected and marginalised by the government.
Security resolution 986 allowed the Government of Iraq to sell oil to buy food and medical supplies for distribution throughout the country. This has allowed the Government to make a food basket available to the population at heavily subsidised and affordable prices for most of the population. The responsibility to observe and ensure the equity, efficiency, and adequacy of distributions throughout the country falls under the United Nations Office of the Humanitarian Coordinator for Iraq under the overall authority of the Department of Humanitarian Affairs (DHA). In addition to food distributed through the 'oil-for-food' agreement, WFP is continuing its targeted feeding programmes to vulnerable groups whose needs are not otherwise being met [UNHCHR 10/09/97, WFP 29/08/97].
A nutritional survey was carried out in the southern governates in conjunction with a 'National Polio Immunisation Day' in April 1997 to provide baseline data. Over 15,000 children under five were weighed and measured at primary health centres when they arrived for polio immunisation. Wasting was measured at 8.9% (see Annex I (17a)). For comparison purposes, in 1990-95 wasting averaged 3%1 [MOH(GOI), UNICEF, WFP 14/04/97, WFP 08/08/97]. It is unclear to what extent the Marsh Arabs are represented in this survey.
1 from UNICEF (1997) State of the World's Children 1997. p.82. UNICEF. New York.A subsequent assessment in July 1997 noted that while the food supply situation had improved, malnutrition remained a serious problem for vulnerable groups. The second six month phase of the programme began in June 1997 and will be completed in December 1997 [UN 26/08/97, WFP 08/08/97].
In order to be eligible to receive the food basket, people must first register by showing a government issued identity card. In this respect, there are three possible reasons why citizens might not be receiving rations: the person is in the process of registering, the person has not chosen to register, or has been denied registration. Many of those in the marshes do not have registration cards for one of these reasons and are therefore not able to access the subsidised food which is available. This group remains isolated, and information is lacking on their health and nutritional status [UNHCHR 10/09/97].
Overall, the Marsh Arabs can be considered to remain at heightened risk of malnutrition (category IIb in Table 1), since it is unclear to what extent the general improvement in food availability is having a positive impact on this group. There are a further 28,000 Marsh Arabs in Iran whose nutritional status is thought to be adequate (category lie in Table 1).
Ongoing interventions: As in the past, access to the Marsh Arabs is limiting the information available on their health and nutritional status. It was hoped the monitoring of food distributions under the 'oil-for-food' plan would provide much needed information on this population. So far this has not been the case.
18. Sri Lanka
Apart from some notable periods of calm, the conflict in Sri Lanka has been ongoing in the north of the country for the past 14 years. The fighting has led to the displacement of large numbers of people, many of whom have been displaced several times. At least 135,000-210,000 people sought refuge in India, and those who are in government run camps are being assisted by the Government of India.
However, an escalation in fighting in the Jaffna peninsula which began in 1996 led to fresh waves of population displacement. The most recent upsurge in May 1997 is due to a government offensive which aimed at pushing the rebels back towards the peninsula. Although the numbers change rapidly as areas of intense fighting move, it is estimated that approximately 410,000 people are internally displaced. Many are in the rebel controlled Wanni jungle area just north of the peninsula. Most of those displaced within Sri Lanka are living with relatives or friends and while some assistance is needed, little food aid is necessary. There are approximately 150,000 people who live in welfare centres which are similar to open refugee camps. These people receive food distributions from either the government or WFP although they are not believed to be fully dependent on these distributions for all their food needs.
Recent reports are that the security situation is stable and calm. There are no new nutritional data on these populations, however there are reports of a cholera outbreak. Anecdotal accounts of the food security situation of the displaced in the Wanni region are often contradictory. One view is that there are far more displaced (as many as 700,000) than the government assessment of 400,000 and that many are not registered for government rations. Furthermore, government food distributions tend to be erratic and are affected by security and logistical factors. Many people are said to be surviving by employing coping strategies that cannot last indefinitely and that an estimated 35-200,000 people may be vulnerable and at risk. [USCR Mar 97, PROMED 20/06/97].
Overall, the affected population is not currently thought to be at heightened nutritional risk (category IIb in Table 1).
Ongoing interventions: In areas where it has responsibilities, the Government should undertake to supply food rations to all displaced people as well as providing adequate amounts of medicines, shelter material, water and sanitation facilities. If the government cannot supply these resources in a timely manner then they should enlist the support of NGOs, which has been offered and let them into areas containing internally displaced populations. For their part, the Liberation Tigers of Tamil Eelam (LTTE) should assume greater responsibility for providing for the needs of those under its control in Wanni region [USCR Mar. 97].