11. Afghanistan Region
12. Bhutanese Refugees in Nepal
13. Refugees from Rakhine State, Myanmar in Bangladesh
14. Marsh Arabs in Southern Iraq
15. Sri Lanka
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.
The conflict in Afghanistan, which had been ongoing for almost twenty years, took a new direction when the Taliban, a fundamentalist Islamic group, swept across most of the country in 1996. Fighting has continued throughout 1997 and early 1998, but has largely been concentrated in the northeast of the country. The continuous state of war has led to a steady decline in the economy. Government salaries have all but disappeared, trade has been markedly reduced and food prices have become grossly inflated. In addition, women are rarely allowed to work outside their homes in Taliban-controlled areas. However, in some parts of the country, particularly in the south and west which have been relatively quiet, reconstruction and rehabilitation work is being carried out. Signs are beginning to emerge that the warring parties may be acknowledging that a military solution to the conflict is unrealistic.
Despite some repatriation, there are at least 2.5 million Afghan refugees remaining in neighbouring Iran and Pakistan. It is thought that 650,000 of these people require emergency assistance, the rest being largely self-sufficient. There are 1.5 million people in Afghanistan requiring emergency aid.
In Kabul, food assistance in the form of subsidised bread is continuing and ICRC distributes bi-monthly rations to vulnerable families. Over 70% of food commodities distributed in 1997 were provided through subsidised bread sales projects in Kabul, Mazar, Jalalabad, Kandahar and Faizabad. A recent assessment of household food security in two districts of Kabul was undertaken. Recommendations from the assessment included the need to support food production activities and increase people's access to food. This could be achieved by improving the economic circumstances of the urban population by, for example, revitalising existing food-processing factories, setting up green houses for vegetable gardens and establishing other micro-projects for income generation. Although a random sample anthropometric survey was not conducted, stunting appeared to be widespread [ICRC 21/01/98].
Aid deliveries outside of the capital city have been hindered by heavy snowfalls leading to impassable roads. For example, relief provision for victims of an earthquake in February 1998 were made difficult by the inclement weather. Relief supplies had to be airdropped into the region [WFP 13/02/98, 20/02/98].
The last RNIS report (no. 22) described a desperate situation for 1.2 million people affected by a blockade around Bayman in Hazarajat region, 160,000 of whom were thought to be facing starvation. Since that time food has been airlifted to the population. A more recent report has stated that although there is no Visible evidence of actual starvation, affected families are clearly in need of emergency food aid in order to supplement household food stocks to survive the winter' [WFP 02/01/98].
Overall, those requiring aid in the Hazarajat region, where access has been sporadic, are likely to be at heightened risk (category IIa in Table 1), particularly with the winter season making access difficult. 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).
A recently launched Consolidated Appeal for Afghanistan highlights humanitarian relief and rehabilitation projects planned to benefit 1.5 million Afghans in 23 provinces during 1998. Relief assistance will be distributed mainly through subsidised bread sales and other channels used effectively during 1997. Food-for-work and food-for-training projects will be continued to promote rehabilitation activities. Quick impact projects will also be utilised to promote the rapid re-integration of returnees.
Some of the other needs outlined in the appeal include:
· rehabilitation of health facilities;
· improvement in the supply of safe drinking water and sanitation - as a consequence of poor sanitary conditions it is estimated that 42% of all deaths in Afghanistan are due to diarrhoeal diseases and that 85,000 children under five die annually from diarrhoeal diseases;
· clearance of landmines, along with education/awareness campaigns;
· understanding the extent of chronic malnutrition in Afghanistan with a view to devising interventions to address the problem;
· improvement in the immunisation coverage, particularly of measles and polio.
There are approximately 93,000 Bhutanese refugees in Nepal who fled their country of origin in the early 1990s. Reports over the past few years have indicated an adequate and stable nutrition and health situation for this population, although there have been continuous reports of a few cases of pellagra, beri-beri and scurvy. At the start of 1998, there was a small reduction in the amount of rice provided in the general ration. So far there have been no reports of any adverse effects of this reduction, and this population is not considered to be at heightened nutritional risk (category IIc in Table 1) [UNHCR 05/03/98].
The annual nutritional survey which is usually carried out in June, should be carefully scrutinised to determine whether there has been any adverse effect of the general ration reduction on the refugee population.
In 1992, an estimated 250,000 people fled Myanmar (then Burma) to Bangladesh, claiming widespread human rights abuses. Of this original group, most have returned home, and there are approximately 21,000 people remaining in two camps. There has been some further movement of people from Myanmar into Bangladesh who local authorities define as economic migrants [UNHCR Mar 98].
A recent survey carried out in the two camps showed 11.5% wasting with 0.7% severe wasting. No cases of oedema were seen (see Annex I 13a). Results from a survey carried out in June 1997 showed 14% wasting. The ration distributed provides 1900 kcals/person/day and does not provide adequate micronutrients. In the past, a fortified blended food was distributed as part of the general ration but this was discontinued in February 1997 due to problems with the quality of the blended food. The prevalence of angular stomatitis in the February 1998 survey was 9.9%. This is feared to be a general indicator of more serious micronutrient malnutrition and it has been suggested that the re-introduction of a micronutrient enriched blended food would improve the situation. Provision has now been made for the inclusion of 50 grams/person/day of blended food in the ration [MSF-H 27/02/98, WFP 16/03/98, UNHCR 22/02/98].
Stunting was also measured in the survey as was found to be 63.3% (ht/age <-2 Z scores). For comparison purposes, recent country wide estimates are that the prevalence of stunting is about 55% [ACC/SCN 1997, UNHCR 22/02/98].
The nutritional situation in the camps must be viewed in the context of several interruptions to the general ration programme which have occurred since May 1997 and which have lasted for several weeks. These interruptions have occurred due to strikes by refugees and other security problems [MSF-H 27/02/98].
There has been a high prevalence of low birth weight babies, premature births and neonatal deaths in the camps. This has been attributed to several factors, including the young age of mothers, very short birth spacing and lack of micronutrients in the ration. However, there is concern that when blended foods are re-introduced into the general ration the prime target group, i.e. pregnant and lactating women and children, may not get adequate access to it [MSF-H 27/02/98].
The supplementary feeding programme in the camps supplies wet rations, covering the entire daily nutritional needs of the beneficiaries with a reduction in the general ration for those families enrolled on the programme. This type of supplementary feeding programme was introduced as it was believed that a main cause of malnutrition in the camps was inappropriate and inequitable intra-camp and intra-household food distribution. Since November 1997, pregnant and lactating women enrolled in the supplementary feeding programme have been provided with 500 ml of high energy milk per day [MSF-H 27/02/98, UNHCR 03/24/98].
Overall, this refugee population can be considered to be at high risk (category I in Table 1) due to the presence of micronutrient malnutrition. The situation is likely to improve with the reintroduction of fortified blended foods into the general ration.
The recent survey, which showed a 9.9% prevalence of angular stomatitis, underscores the need to re-introduce a fortified blended food to the general rations, which has been highlighted in earlier RNIS Reports. However, there should be some investigation into how the blended food will be used and by whom in order to ensure that the priority target group, pregnant and lactating women and children, receive adequate quantities from the general ration. Further suggestions that vitamins and minerals should be added to the diets at supplementary feeding centres should also be acted upon. The caloric level of the general ration should be increased from 1900 kcals to 2100 kcals. The large ration size given out at the supplementary feeding centres should be continued as a means of protecting against inequitable intra-camp and intra-household distribution of the general ration.
There are no new reports on the nutritional situation for the Marsh Arabs, some of whom are in Southern Iraq and some of whom are living as refugees in Iran. The general deterioration in living standards in Iraq is though to more keenly affect the Marsh Arabs, who traditionally receive little assistance from the government.
The civil war in Sri Lanka between the Government and the Liberation Tigers of Tamil Eelam (LTTE) has continued for the past 14 years. Fighting has led to widespread displacement both within Sri Lanka and also to neighbouring India. Many people in Sri Lanka have been displaced several times. There are currently estimated to be 65,000 people living in government-run camps in India and 19,000 in open relief centres in Sri Lanka. There are likely to be many other people affected by the war, but who are not living in open relief centres.
A survey in 7 areas in Trincomalee District (estimated population 350,000) in Sri Lanka was carried out in September 1997. These areas were felt to be most seriously affected by the 14 years of civil war. Wasting was measured at 21.1% and severe wasting was 1.4%. No cases of oedema were noted (see Annex I 15a). It was noted that the 6-29 month age group was more severely affected by malnutrition than the 30-59 month age group. The survey found that food security had been significantly affected by displacement. Many people had lost their property and agricultural capital, including seed stocks, livestock, farming and fishing equipment, tools and sometimes also their houses. Constraints on movement and transport were also affecting food security. Furthermore, there had been three consecutive years of drought. The government systems of food stamps and 'Samurdhi', which aims to provide food aid to the poorest families, were also not functioning and only a low percentage of families receiving help [ACF Sep 97].
Stunting was defined as weight/age <-2sd and was measured at 24% (confidence interval 21.9%-27.6%). This compares with national level data from 1993 when stunting was measured at 23.8%, using the same definition [ACF Sep 97, ACC/SCN, 1997].
The assessment also found that access to safe drinking water in the district was far below the usual standards for the country. The reasons for this are varied, but include the presence of hard rock, salty water in the coastal parts of the district and seasonal variations in the water level aggravated by the drought [ACF Sep 97].
Overall, the affected population in Sri Lanka can be considered to be at moderate nutritional risk (category IIb in Table 1). Although there are likely to be populations at high risk, numbers of people are not currently available.
The following needs have been identified in Trincomalee District, and may well apply to other war-affected districts:
· the distribution of a blend of corn, soya, non-fat dried milk and micro-nutrients to the moderately malnourished should be improved to ensure a receipt of 800 kcals/person/day. Irregularity of distribution has meant that on average ration receipts only amount to 178 kcals per person per day;
· continue to encourage exclusive breastfeeding;
· seed provision for many households;
· construction of wells to support home gardening and rehabilitation of water tanks for paddy cultivation;
· evaluate the methods of selection, distribution and monitoring of the government food assistance programme and identify alternative mechanisms for food assistance.