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.
12. Afghanistan Region
There has been on-going conflict in Afghanistan for the last twenty years, leading to massive displacement both within Afghanistan, and as refugee movements principally into Iran and Pakistan. The most recent developments have been the take-over of the capital city Kabul and two-thirds of the country by the Taliban, a fundamentalist Islamist group, in 1996. The continuous state of war had left most of the country's infrastructure in ruins. Fighting continues to the north of Kabul and recent reports are of fresh population displacements as a result. Much of the countryside remains calm. Talks between Taliban and representatives from the opposition Northern Alliance had begun with the main objectives set out as follows:
· the appointment of a Council of Islamic scholars to move the peace process forward;However, the talks broke down earlier this year in Islamabad.
· an end to the Taliban blockade of the Hazerajet region;
· agreement on a cease-fire;
· further release of prisoners.
Some reconstruction and rehabilitation is being envisaged. Assessments of the priority needs are also being undertaken. It is currently estimated that 1.25 million people require humanitarian assistance in Afghanistan, Iran, and Pakistan [BAAG 30/04/98, OCHA 29/04/98, 05/05/98, WFP 22/05/98].
Wasting in Afghanistan (in children, 6-35 months old)
taken from: 'The 1997 Afghanistan Multiple Indicator Baseline', UNICEF 1997.A multiple indicator baseline survey was carried out in Afghanistan in 1997. It was the first national-level survey carried out in 25 years, and gives baseline information for development and relief programmes including health, nutrition, education, food security, and the water and sanitation sector. Particular attention was paid to gender issues in the survey and potential biases in questionnaire response [UNICEF 1997].
The survey showed that 25% of children between the ages of 6-35 months were wasted, although there were variations between regions (see Annex I (12a)). Fifty-two percent of children in this age category were stunted (graph). This is very high, placing Afghanistan's children among the worst off in the world. Vitamin A deficiency, as defined by night blindness, was reported in about 3% of the children surveyed in Jalalabad and Kandahar; in other regions vitamin A did not appear to be a problem. Goitre was seen in Kabul where 13 cases were seen for every 1000 people [UNICEF 1997].
Stunting in Afghanistan (in children 6-35 months old)
taken from: 'The 1997 Afghanistan Multiple Indicator Baseline', UNICEF 1997.Some factors likely to have an impact on the nutritional status of children were believed to be:
· water and sanitation: time to fetch water varied, and was generally longer in rural areas. Protected supplies of water were inadequate, and there were inappropriate sanitation facilities;A survey in Kabul showed 7.2% wasting with 0.2% severe wasting. Oedema was measured at 0.3% (see Annex I (12b)). Wasting and/or oedema for the 6-29 month age group was significantly higher than in the 6-59 month age group. This difference was attributed largely to the introduction of poor quality complementary foods in the younger age group. Stunting was measured at 63% in the 6-59 month age group. However, probable inaccuracies in determining ages mean that these results must be interpreted with caution [ACF Dec. 97].
· women estimated that 20% of children benefit from exclusive breastfeeding;
· measles immunisation coverage varied amongst regions, but in no cases was it greater than 60%;
· care of common childhood illness needed to be improved. Specifically noted were inappropriate home treatment of ARI and diarrhoea [UNICEF 1997].
Malnutrition in Kabul over time children 6-59 months
taken from: Nutrition and Mortality Survey, Action contre la Faim, Dec. 1997.Rates of wasting over time in Kabul have been relatively stable, despite a number of factors likely to negatively impact on nutritional status. Food prices have continued to rise while the currency has been devalued. Furthermore, the employment situation in the city has not improved. This stable situation is thought to be due in large part to the continuing humanitarian aid in the city, in particular the subsidised bakery programme. However, there has been a deterioration in nutritional status (as seen by a greater percentage of children with wt/ht <-1 SD) amongst children with an increasing number of children therefore at risk of acute malnutrition. Also, the under-five mortality rate was measured at 2.2/10,000/day with main causes of death reported by mothers as ARI and diarrhoea. The high mortality is thought to be partly related to declining nutritional status and reduced immunity. This is likely to indicate a need for improved care for these common illnesses as mentioned in the multiple indicator survey. Coverage of selective feeding programmes in the city is poor (< 20%) and shows no improvement since the previous survey. This may be explained by a number of factors including the long hard winter and the high level of population movements to and from the city [ACF Dec. 97, UNICEF 1997].
Earlier RNIS reports (Nos. 22, 23) described a desperate situation for the 1.2 million people in Hazarajat region. Food deliveries from the south, east and west have been blockaded by the Taliban, who say the supplies delivered would feed the opposition in the north. As the snow melted and roads opened up to villages in the region, reports from missions in the area were of people in a very serious condition. Food stocks in many areas are depleted and markets are empty. It is estimated that up to 167,000 persons in the outlying regions of Hazarajat have food stocks for only a few weeks. However, the Taliban have temporarily lifted the blockade for a small quantity of food to get through on condition that some food is also sent Ghorbund located at the front lines of fighting in Parwan Province. WFP has recently distributed foods in the two areas [WFP 01/05/98, 08/05/98, 29/05/98].
A recent earthquake in Faizabad, Badakhshan province, and Rustaq, Takhar province has destroyed many villages and killed at least 2,000 people. Urgent needs appear to be for shelter, medicine and clean drinking water [MERLIN 01/06/98, WFP 29/05/98].
Iran There are approximately 1.4 million Afghan refugees in Iran, the majority of whom arrived during the 1980s during the Soviet occupation of Afghanistan. Approximately 88,000 people receive food aid, 25,000 of whom live in camps. Most of the non-camp refugees receive indirect assistance through government subsidies for education, health services, and some commodities. A decline in the Iranian economy has resulted in the withdrawal of some of these subsidies, which is likely to have a negative impact on health and nutrition status. There are a small number of Afghans repatriating [UNHCR 16/05/98, 1997-9].
Pakistan There are approximately 1.2 million Afghan refugees in Pakistan, 25,000 of whom require assistance. Repatriation is picking up momentum [UNHCR 16/05/98].
Overall, there are reports of malnutrition and starvation among some people in Hazerajat, and these people are considered to be at high risk (category IIa in Table 1). The remaining affected population in Afghanistan can be considered to be at moderate nutritional risk (category IIb in Table 1) while the refugees in Iran and Pakistan are not currently considered to be at nutritional risk (category IIc in Table 1).
On-going interventions The multiple indicator survey highlights some areas where development programme activities would be likely to improve nutritional status of the population nationwide. These include:
· water and sanitation - improving access to clean water and improved sanitation facilities;In Kabul, coverage of selective feeding programmes needs to be improved. On-going, effective monitoring of IDD programmes is needed, which would include the monitoring of iodine in locally available salt. Technical input from the international community is needed. The prevalence of vitamin A deficiency in Jalalabad and Kandahar constitutes a public health problem and should be addressed. The multiple indicators survey summarised above showed under 25% of children less than three years old had received vitamin A capsules, indicating a need for wider distribution.
· education to improve exclusive breastfeeding and treatment of common childhood illnesses;
· continued immunisation campaigns as were carried out in 1996 (see RNIS 17), and are on-going in some areas. Landmine clearance remains a major priority.
There is also a need for on-going health education to improve home care for common childhood diseases like diarrhoea and API. This is particularly important as prevalence of diarrhoea is likely to increase in the coming summer months, further jeopardising nutritional status in the capital. Funds need to be urgently provided so that WFP can purchase food locally to set up distributions, access permitting, for the emergency affected Hazerajat area.
13. Bhutanese Refugees in Nepal
There are approximately 94,000 assisted Bhutanese refugees in Nepal, most of whom fled Bhutan in the early 1990s. This small increase in the total number is due to births in the camps. As in the past, the overall nutrition situation remains adequate and stable, and mortality rates are low at 0.1/10,000/day [UNHCR 01/05/98, 18/05/98].
The ration of rice has been slightly reduced in 1998. Food distributions, including the distribution of vegetables and a fortified blended food (WSB), continue uninterrupted. However, micronutrient malnutrition continues to be reported at health clinics; for example the incidence of beri-beri was recently reported at 2.6/10,000/day. Incidences of angular stomatitis, a general symptom likely to indicate more serious micronutrient malnutrition, and anaemia were also elevated [UNHCR 01/05/98].
Non-food distributions including soap and kerosene, are also being carried out regularly, and water and sanitation facilities are adequate. A food assessment was recently conducted to establish the proposed food basket for 1999. The Assessment Mission recommended that fortified blended foods be omitted from general ration distributions starting in 1999. The Mission further recommended that the withdrawal of blended food from the general ration be accompanied by efforts to increase the access of refugees to fresh fruits and vegetables and that monitoring of micronutrient malnutrition should continue [UNHCR 01/05/98, 18/05/98, WFP/UNHCR 06/05/98].
On-going interventions Careful monitoring of nutritional status of the population is needed in light of slight change in rations in 1998. There is a continued need for more information on the causes of micronutrient malnutrition in the camp, and this could become particularly important if recommendations to discontinue the general distribution of fortified blended foods are followed in 1999.
14. Refugees from Rakhine State, Myanmar in Bangladesh
Approximately 250,000 people fled Myanmar - then Burma - to Bangladesh, claiming widespread human rights abuses. Most of these refugees have now returned to Myanmar, and only about 21,000 people remain in two camps in Bangladesh. Some problems involving refugees blocking access to food distributions and health centres were reported in March, but the situation has now returned to normal. Repatriation of these refugees, which was temporarily suspended will resume in the near future [UNHCR 18/05/98].
In line with government policy, refugees are not allowed to participate in the local economy, and home gardening is not approved at the refugee sites. This renders the population totally dependent on food aid. The planned food basket was to provide just over 2100 kcals/person/day. In the absence of fortified blended foods from the ration, efforts were made to replace the calories with high energy biscuits, but ration receipts were 1900 kcals/person/day for about a year. Blended foods have been re-introduced as part of the ration since March 1998. A recent Joint WFP/UNHCR Food Assessment Mission proposed a slight modification to the general ration according to new guidelines2 and available demographic data, activity level and temperature, to just over 2000/kcals/person/day. The supplementary feeding programme, which provides malnourished children with 3-4 cooked meals/day (described in RNIS 23) is working well and about 90% of malnourished children are enrolled. In addition, all pregnant and breastfeeding women receive high energy milk [WFP/UNHCR 25/05/98].
2 WFP/UNHCR Guidelines for Estimating Food and Nutritional Needs in Emergencies, Oct 1997. A summary can be found in RNIS 22.Stunting (low height-for-age) in the camps was recently measured at 66.4%, although uncertainty in determining age means these data should be viewed with caution. To give context, stunting in Bangladesh is 55%. Levels of wasting were recently reported at 11% (see RNIS 23 for details). High prevalences of angular stomatitis have been reported in the camps. The mission noted that not all cases of angular stomatitis were attributable to riboflavin deficiency and many cases were due to bacterial infections. This was ascertained when most cases responded to antibiotics. It was suggested that in reporting, agencies desegregate the data by cause [ACC/SCN Nov. 97, WFP/UNHCR 25/05/98].
Non-food items distributed regularly include kerosene for lighting, soap and compressed rice husks for cooking. While in 1997, over 80% of the required compressed rice husk was made available to the refugees, during the first five months of 1998 the average distribution was only 25% of requirements. This was mainly due to a limited availability due to poor harvests. It is estimated that 39% of the families are female-headed, and that they are particularly affected by shortages in fuel. Efforts are being made to rectify the situation. The supply of soap has been regular, however with a distribution of one bar per family irrespective of family size, larger families do not have enough [WFP/UNHCR 25/05/98].
The mission also considered the issue of sale of ration commodities and found the proceeds of the sale of both food and non-food items would first be used for other food items (mainly vegetables and fish) to provide variety to the diet, then to buy fuel, to pay school fees, to buy clothes and finally, and to a lesser extent, to buy sweets for children and cigarettes [WFP/UNHCR 25/05/98].
Overall, there is a tendency towards improvement in the nutritional situation for these refugees with the re-introduction of a fortified blended food in the ration, and they are currently considered to be at moderate risk (category IIb in Table 1).
On-going interventions The Joint Food Assessment Mission had a number of recommendations:
· The ration be set at just over 2000 kcals/person/day and that sugar be added to the fortified blended food and not distributed separately;Clothes be distributed, at least on an annual basis.
· Vegetable oil should be fortified with vitamins A and D, in line with WFP policy;
· Wet feeding be continued;
· Data on angular stomatitis be desegregated by cause. Some additional training of health workers in order to correctly identify causes may be needed;
· Investigate infant and child feeding practices especially the introduction of complementary foods;
· Female heads of households should be targeted with fuel distributions;
· In order to improve the quality of life, small-scale initiatives such as sewing and home gardening should be permitted;
15. Marsh Arabs in Southern Iraq
A new six-month phase of the 'oil-for-food' programmes was approved at the end of May. This next phase allows for an increase in the ration provided by the Government to residents, along with substantial increases in funds for the water and sanitation sector. The plan is contingent on Iraq selling about USD4.5 billion worth of oil. In order to achieve this, major rehabilitation of the oil sector will be needed. Ways of achieving this are being investigated [WFP 05/06/98].
A survey carried out in Iraq showed that the nutritional status of Iraqi children had not improved in the last year. Details are not currently available. Substantial improvement will only come when water and sanitation, along with food supplies, improve [UNDPI 22/05/98].
It remains unclear how much of this aid reached those in the southern marshes, who traditionally receive little assistance from the Government.
16. Sri Lanka
A civil war between government forces and the separatist Liberation Tigers of Tamil Eelam (LTTE) has been on-going in Sri Lanka for the past 14 years. The number of internally displaced is difficult to determine; best estimates suggest 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 65,500 people living as refugees in government run camps in India.
The last RNIS report (no 23) included details of a survey carried out in Trincomalee District where wasting was measured at 21%. Adequate access to safe drinking water was determined to be a significant problem in this part of the country. More recently, there have been reports of cholera in the city Trincomalee [PROMED 29/04/98, RNIS 23].
A survey carried out in the Wanni district showed a worrying situation. Wasting and/or oedema was measured at 21.6% with 2.9% severe wasting and/or oedema (see Annex I (16a)). This survey was carried out just before the harvest. Measles immunisation coverage, verified by a card, was only 45.6%; however a further 47% of children were said to be immunised but had no card [OXFAM/SCF 21/12/97].
The main source of income for this population is agriculture. Indications are of a good harvest, despite the high cost of some farm inputs and very heavy rainfall. This is likely to have a positive effect on the levels of wasting seen in the survey. Another source of income is the ration, some of which is consumed and some of which is sold in order to buy other necessary items. The survey noted that ration deliveries were irregular due mainly to transportation difficulties [FAO May 98, OXFAM/SCF 21/12/97].
It was also noted in the survey that sanitary facilities in the region were inadequate. Poor hygienic practices were likely related to high levels of diarrhoea and scabies noted during the survey [OXFAM/SCF 21/12/97].
Overall, these refugees can be considered to be at moderate nutritional risk (category IIb in Table 1), although there are very likely to be pockets of high risk.
On-going interventions: Some of the needs identified in the survey in Wanni may also be relevant to other war-affected populations. Some of these include:
· improved sanitation in newly crowded areas, along with some emphasis on improving hygienic practices;
· continued distribution of food rations;
· improvement of logistics infrastructure to allow ration deliveries.