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, 1997 '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.
Fighting is continuing in Afghanistan, with the front line now about 30-40 kilometres north of Kabul. Much of the rest of the country is calm. UN buildings have been looted and at the end of October in one area - Hairaton - 50,000 tons of food per day were being taken to feed troops. This has, reportedly, since stopped [DHA 28/10/97].
Access to some services for women in Kabul is improving. For example, a recent report confirmed that women were being admitted to Kabul's hospitals, and that many female staff have returned to work. However, after a visit to the country, the UN Assistant Secretary-General and Special Advisor on Gender Issues concluded that 'the situation of women in Afghanistan is...a very dire one' [ICRC 26/11/97, UNDPI 26/11/97].
A survey carried out in June 1997 in Kabul showed 6.7% wasting with 0.5% severe wasting. Oedema was measured at 0.1% (see Annex I (14a)). These results are comparable to those obtained in previous surveys (see graph).
Malnutrition in Kabul over time
However, closer analysis of the data shows that a greater proportion of children have low weights (although they are not malnourished as defined by -2 SD < WHZ) than in any previous survey since November 1995. There are a number of factors at play here. The fact that prevalence of wasting has not increased is likely to be attributable to the existence of feeding centres and the bakery subsidy programmes. However, the food security situation in the capital is still precarious for most people. The country has had to face a blockade from Iran and Pakistan who have been the major exporters of food to Afghanistan. This has contributed to an increase in the price of wheat flour at a time when there has been no increase in wages. Coverage of the selective feeding programmes in Kabul was low at only 224% [ACF Jun. 97].
Permission from the Taliban to import food aid into the Hazarajat region has so far not been granted and it is estimated that 1.2 million people are affected by the blockade, with 160,000 of the most vulnerable facing starvation unless food supplies reach the area. A combination of the blockade and poor harvests due to frost and flooding has meant that many households are anticipated to run out of food by December. The more expensive option of airlifting food supplies into the area is now planned [DHA 13/11/97, WFP 26/11/97].
There are reports of some returnees from Pakistan to Kandahar [DHA 28/10/97].
Pakistan There are no reports to change in the adequate nutritional status of the approximately 330,000 Afghani refugees requiring aid in Pakistan.
Iran There are no reports on the nutritional status of the approximately 322,000 assisted Afghani refugees in Iran.
Overall, those requiring aid in the Hazarajat region, where access has been denied, are likely to be at heightened risk (category Ha in Table 1), particularly with the beginning of the winter season. The remaining population in Afghanistan is likely to be at moderate risk (category IIb in Table 1), while the refugees in Iran and Pakistan are not currently considered to be at heightened risk (category IIc in Table 1).
Ongoing interventions: Resources should be made available for the urgent airlift programme to Hazarajat region. In Kabul there is a need to continue close monitoring of the population's nutritional status and to keep open the existing feeding centres in the capital city. There is also a need to increase home visiting by community health workers in order to improve prevention and detection of malnutrition. Increased co-ordination between humanitarian agencies may help to ensure all vulnerable individuals and families are receiving adequate aid.
15. Bhutanese Refugees in Nepal
There are approximately 92,000 Bhutanese refugees in Nepal who fled their country of origin in the early 1990s. Reports over the last few years have been of an adequate and stable nutrition and health situation for this population, despite continual diagnoses of a few cases of pellagra, beri-beri, and scurvy.
In 1998, the general ration provided will be very slightly reduced with a small reduction in the amount of rice to be provided [UNHCR 21/11/97].
Ongoing interventions: The annual nutritional survey which is generally carried out in June, will be particularly important to verify whether there have been any effects of the general ration changes on the population.
16. Refugees from Rakhine State, Myanmar in Bangladesh
Approximately 250,000 people fled Myanmar's Rakhine State in 1991 and 1992 to seek refuge in Bangladesh. Repatriation under UNHCR auspices began in 1994, and there are currently 21,000 refugees remaining in two camps in Bangladesh.
Refugees recently refused rations made available to them for several weeks in protest of the forced repatriation of approximately 400 people in July 1997. The boycott is now over and the ration distributed is providing approximately 1900 kcals/person/day and consists of rice, pulses, oil, salt, and sugar [UNHCR 21/11/97]. Fortified blended foods have been missing from the general ration since November 1996, and despite symptoms indicating micronutrient malnutrition (prevalence of angular stomatitis of 8.9% - see RNIS #21), no substitute has been found, although local procurement of the commodity is now being explored by WFP [UNHCR 08/12/97].
A survey in June 1997 showed 14.6% wasting (see RNIS 21). Efforts to address this malnutrition include increased outreach on the part of health workers in encouraging parent to enrol their children in feeding programmes. To compensate for a lack of blended foods in the supplementary feeding programmes for pregnant and lactating women, a wet feeding programme of high energy milk (whole milk powder, oil and sugar) was introduced in November 1997 for this group. It is likely that the nutritional situation is improving [UNHCR 08/12/97].
Overall, this population can be considered to be at heightened risk (category IIa) due to the presence of micronutrient malnutrition, although there is likely that the situation is improving.
Ongoing interventions: An assessment of feeding programme coverage should be undertaken. If coverage is found to be low, an investigation into reasons for this would be needed.
17. Marsh Arabs in Southern Iraq
Living standards in Iraq have deteriorated sharply since imposition of the international embargo imposed following the Gulf war. The Marsh Arabs are believed to be amongst the most affected groups as this population have suffered persecution for many years. A programme implemented by the government to drain the marshes has deprived the Marsh Arabs of their livelihoods and their homes. This population has also had to endure extreme hardships as a result of arbitrary arrests and torture, as well as discrimination with regard to gaining access to resources.
The more recent oil-for-food arrangements which have been sanctioned by the international community now allows Iraq to sell oil providing the proceeds are used to purchase food and other goods for humanitarian purposes. However, in spite of this new arrangement, malnutrition remains a problem in the country. The food rations available through government programmes do provide a significant portion of energy needs but are deficient in other nutrients, particularly vitamin A and C. The extent to which the Iraqi population can supplement this ration to obtain a more balanced diet is not known [FAO 03/10/97, WFP 10/10/97]. Furthermore, as eligibility for this ration requires the beneficiary to show an identify card, it is likely that many families are missing out on this ration, i.e. families are in the process of registering, families choose not to register or families have been denied the right to register. It is probable that large numbers of Marsh Arabs are unregistered [RNIS #21].
Many Marsh Arabs have crossed the border and are living in a number of camps as refugees in Iran. New arrivals are continually being reported and it is currently estimated that there are 46,000 refugees living in the camps. A further 57,000 are living outside of the camps and are thought to be self-sufficient [OHRI 09/09/97]
There have been no new nutritional surveys on this population since 1994. At that time, wasting in children between 12-60 months was measured at 25% (see Annex I (17a)). There were many problems identified at this time, including an inadequate general ration, inadequate water and sanitation and inadequate medical care. These difficulties have now reportedly largely been resolved. There are however some residual problems with the regularity of food distributions and a lack of vitamins, particularly vitamin A and C in the ration. Also, the ration does not provide a commodity that is suitable as a complementary food. There is also a reported lack drugs so that antibiotic treatments are not always offered when necessary [OHRI 09/09/97, ICA 1994].
Overall, the Marsh Arabs in Iraq are thought to remain at heightened risk of mortality due to inadequate food and medical services (category IIa) although there are a lack of data to support this assertion. The refugees in Iran are not believed to be at heightened risk (category IIc in Table 1)
Ongoing interventions: The need for vulnerable group feeding in Iraq, e.g. orphanages, IDPs, social institutions, malnourished children under five, remains essential as the current food basket does not meet the special needs of these groups. These programmes, along with economic rehabilitation, particularly agricultural rehabilitation will help many Iraqi civilians. It is, however, unlikely to have a significant positive impact on the Marsh Arabs who remain a marginal population.
In the camps in Iran, consideration should be given to providing a fortified blended food which will improve vitamin intake and also make available an appropriate complementary foods. However, provision of such a food would necessitate some form of nutritional education to encourage most appropriate use of this type of food. There is also a need for more drugs and vitamin A and C distribution for under fives through camp clinics.
18. Sri Lanka
A civil war between government forces and the separatist Liberation Tigers of Tamil Eelam (LTTE) has been ongoing in Sri Lanka for the past 14 years. The security situation is very fluid, but at present, the government controls most of the country. The LTTE controls areas in the Wanni region. The number of people internally displaced by this fighting is difficult to determine with any precision, and best estimates are that they number around 410,000. Many displaced people are living with relatives or friends, and an estimated 21,000 are living in UNHCR-assisted open relief centres. In addition, there are approximately 65,000 people living as refugees in government-run camps in India.
Assistance to the displaced populations is being provided by the government of Sri Lanka as well as international agencies such as UNHCR, although insecurity sometimes hampers aid deliveries. A recent survey in Mulikulam, Mannar district, an open relief centre housing many who fled insecurity in June 1997, showed a worrying situation. Wasting was measured at 24.3% with 7.3% severe wasting. These high levels of wasting were thought to be attributable to many factors, including inadequate water supplies and irregular food distributions. Since the survey, water supplies have improved, and supplementary feeding programmes have been established [MSF-F 19/08/97, UNHCR 27/08/97].
Much of the country's infrastructure has been destroyed in the ongoing conflict. Micro-projects are being implemented in order to address these problems. These projects are designed to minimise the potential for further displacement for socio-economic reasons, and to stabilise populations by recreating community structures. Projects include:
· road construction;Overall, the affected population in Sri Lanka is not currently thought to be at heightened risk (category IIc in Table 1). There are likely to be pockets of high risk, such as in Mulikulam, Mannar district, but population breakdowns are not currently available.
· water and sanitation systems construction;
· school renovations and;
· assistance for small businesses.
Ongoing interventions: Security is the main impediment to improving the timelines of food distributions. However, there is room for improving the monitoring of food distributions. Furthermore, micro-projects should be continued and supported where security allows.
