IV. What has been done to improve response?

A. Exchanging ideas and raising awareness
B. New practices and policies
C. Food distribution modalities
D. Combating micronutrient deficiencies
E. Gaining a better understanding of the context
F. Considering care of the vulnerable, especially young children

A. Exchanging ideas and raising awareness

There have been a number of initiatives aimed at improving response to emergencies. The RNIS project has contributed to improved understanding and cooperation by providing a forum for discussion and exchange of ideas.

One outcome was the ‘Workshop on the Improvement of the Nutrition of Refugees and Displaced People in Africa’, which took place in Machakos, Kenya in December 1994. This was an initiative of the ACC/SCN Working Group on Nutrition in Emergencies. The workshop was organised by UNHCR and the Applied Nutrition Programme, University of Nairobi, Kenya, with support from the German bilateral agency, GTZ. Approximately 100 participants with technical, policy and managerial responsibilities for nutrition of refugee and displaced populations working with host governments, non-governmental organisations, and international agencies attended. The meeting considered five specific topics - quality and quantity of food rations, prevention of micronutrient deficiencies, selective feeding programmes, health issues in the prevention and treatment of malnutrition in refugees and displaced persons, and health and nutrition information systems - with the objective of defining areas for follow-up. Two issues highlighted at the meeting were the need for a two-stage approach to ration setting, and the need for better training for those working in emergencies. Both of these issues are discussed in more detail below.

In addition to the RNIS, other initiatives have been undertaken over the past five years to facilitate communication among humanitarian workers and improve the quality of response to humanitarian crises.

The Emergency Nutrition Network (ENN), based at Trinity College, Dublin, began in November 1996. The Network produces the quarterly publication of “Field Exchange”, a newsletter primarily containing short articles written by field personnel working in the food and nutrition sector of emergency response. The ENN aims to:

· provide a forum for the exchange of field level experiences between staff working in the food and nutrition sector in emergencies;

· strengthen institutional memory amongst humanitarian aid agencies working in this sector;

· help field staff keep abreast of current research and evaluation findings relevant to their work;

· better inform academics and researchers of current field level experiences, priorities and constraints thereby leading to more appropriate applied research agendas.

NGONUT is an internet discussion group moderated by Dr. Michael Golden at Aberdeen University, Scotland. This forum has stimulated discussion and disseminated information on technical issues related to nutrition in emergencies.

All of these new initiatives are interagency efforts that bring together interested people from the UN and NGOs and involve those from the North and the South.

B. New practices and policies

A number of new policies and operational practices for humanitarian response have been agreed upon or adopted in the past 5 years.

1. Coordination

Memoranda of understanding among UN agencies are implemented to improve coordination by clearly defining areas of responsibility for agencies. An example of this is the memorandum of understanding signed by WFP and UNICEF that applies to ‘situations caused by natural or man-made disasters, in which people affected by the emergency remain in their country of origin, including internally displaced’. This MOU defines WFP’s responsibility for the supply of basic food commodities and UNICEF’s responsibility for sanitation, water, health and protection (WFP/UNICEF, 1998).

UNHCR and WFP recently signed an MOU which sets out responsibilities for each agency in emergency situations, along with areas of joint responsibility. Some of the joint responsibilities highlighted in this MOU include:

· assessment of numbers eligible for food assistance;

· establishment of modalities of food assistance, composition of the food basket, ration size, duration of assistance and related non-food inputs;

· periodic food assessment missions for the purpose of reviewing food needs;

· public information activities to promote awareness of beneficiaries’ needs;

· promotion of food and non-food aid to encourage and support the self-reliance of beneficiaries;

· coordinated appeals to donors.

· determination of the nutritional status of refugees and the implementation of selective feeding programmes;

· enumeration and registration of refugees as potential beneficiaries of food aid;

· mobilisation of complementary food commodities: fresh foods, spices, tea, dried and therapeutic milk;

· transport and distribution of the food from extended delivery points to the beneficiaries.

· mobilisation of basic food commodities: cereals, oils and fats, pulses and other sources of protein, blended foods, salt, sugar and high-energy biscuits;

· timely transport of food to extended delivery points;

· mobilisation of necessary resources for milling and the provision of milling facilities.

2. Ration Planning

A recommendation of the Workshop on the Improvement of the Nutrition of Refugees and Displaced People was a two-stage approach to ration planning in emergencies. This approach was adopted by WFP and UNHCR (WFP/UNHCR 1997). In the first stage, 2100 kcals/person/day is used as an initial planning figure for food aid rations. This allows for rapid planning and response before detailed information on the beneficiary population is available. In the second stage, the estimated per capita requirements should be adjusted according to demographic, health, nutritional and food security information.

WFP has solicited an agreement from USAID that all oil received from the US will now be fortified with vitamin A. Other donors, including Canada and Sweden, are already supplying vitamin A-fortified oil.

Allowance for making up ration shortfalls was introduced in the new WFP/UNHCR MOU. While retroactive entitlement will not be automatic, allowance was made for retroactive distribution when UNHCR and WFP jointly agree. The decision will take into account the nutritional status of the beneficiaries, measures taken by them (i.e., the beneficiaries), liabilities incurred in coping with the shortfall, the economic impact, and the future availability of resources (WFP/UNHCR 1997, Section 5.6)

The MOU also puts forward new policy that may serve to safeguard ration levels by stipulating that any change in ration levels or beneficiary numbers can no longer be made unilaterally. Both WFP and UNHCR must agree on any change, and pending resolution, food assistance will be provided at the level established by the last agreed assessment (WFP/UNHCR 1997, Section 3.14-3.15).

This MOU also specifies that food resources received from donors should be accompanied by full cash resources needed to cover transport and other related support costs, including milling (WFP/UNHCR, Section 6.4).

3. IDPs

Guiding Principles on Internal Displacement, put forward in the 54^th Session of the Commission on Human Rights, identify rights and guarantee protection to those displaced within their own countries. Specifically, Principle ten discusses the elimination of starvation as a method of combat and Principle 18 states that displaced people have the right to safe access to:

· essential food an potable water;
· basic shelter and housing;
· appropriate clothing;
· essential medical services and sanitation.

UNHCR has taken responsibility for IDPs in certain situations at the request of the Secretary-General of the UN or other principle organs of the UN (from Refugees and others of concern to UNHCR 1997, pg. 9). OCHA will determine a need to be involved in IDP situations on a case by case basis (OCHA, 1998). However, in the absence of an international agency with a clear mandate to assist and protect IDPs, it will be difficult to put these guiding principles into practice.

Operation Lifeline Sudan (OLS), is a consortium of UN and NGO agencies ‘assist[ing] internally displaced and war-affected civilians during and on-going conflict within a sovereign country’ (Operation Lifeline Sudan -A Review July 1996, pg. 1). OLS members work to support displaced and war-affected populations in-country. The formation of this consortium established a model for other coordinated humanitarian efforts that followed, such as Angola and Somalia.

4. Improved standards and accountability

In response to a need for more consistent, effective humanitarian relief, the development of a set of minimum standards in the core areas of humanitarian assistance of nutrition and food security, health services, shelter and site management, and water and sanitation is underway. The Sphere Project, a collaborative process initiated in July 1997, is led by the steering committee for humanitarian response (SCHR)³ and InterAction⁴, and involves front-line NGOs, interested donor governments and UN agencies. The objectives are to improve the quality of assistance provided to people affected by disasters (whether natural or man-made) and to improve the accountability of agencies to their beneficiaries, their membership, and their donors.

³ An alliance for voluntary action of: Care International, Caritas Internationalis, International Federation of Red Cross and Red Crescent Societies, International Save the Children Alliance, Lutheran World Federation, Médecins sans Frontières, Oxfam International and World Council of Churches.

⁴ InterAction is a coalition of over 150 US-based non-profit organizations (“private and voluntary organizations,” or PVOs) working to promote human dignity and development in 165 countries around the world).

C. Food distribution modalities

For efficient food distribution, modalities must take local culture into account. Recent guidelines from UNHCR and policy statements from WFP⁵ on involvement of refugee women in distributions intend to raise awareness and give practical advice on how to implement equitable distribution systems.

⁵ Commodity Distribution A Practical Guide for Field Staff, Provisional Version, UNHCR June 1997 and WFP Policy Commitments to Women: 1996-2001.

Photo courtesy of UNHCR. Tanzania/Refugees from Rwanda

UNHCR/24153/07.1994/L. Taylor

On the other hand, in Nepal distributions to sub-sector representatives of about 500 individuals who divide and distribute to families works efficiently and equitably (ACC/SCN, 1997).

D. Combating micronutrient deficiencies

The use of fortified food commodities has been effective in combating micronutrient malnutrition, (e.g. Nepal and Bangladesh throughout the RNIS Reports). However, poor supply of blended foods has led to reduced distributions in some situations such as in Kenya (1997), Tanzania (1994) and Zaire (1994-95).

Distributions of fresh foods have also been effective (Nepal, Kenya, and Bangladesh), but only rarely have sustained distributions been logistically possible.

The WFP/UNHCR Memorandum of Understanding, recognising the difficulty of meeting micronutrient requirements through general rations, stipulates that ‘UNHCR will assume responsibility for the provision of the necessary micronutrients until the ration can be adjusted or fortified to meet the needs.’ (WFP/UNHCR 1997, Section 4.5).

Only in one instance (Mozambique) has nutrition education been reported as a preventive measure. At least with the new WFP/UNHCR MOU, UNHCR has accepted responsibility for providing guidance to beneficiaries on how to prepare food in a manner that safeguards its nutritional content (WFP/UNHCR MOU, 1997 Section 5.4).

E. Gaining a better understanding of the context

Increasingly, we have tried to present reports of food security and livelihood assessments in the RNIS Reports. Presentation of information on food security assessments have been received from our contacts in Kenya, Burundi, Tanzania, and Angola. These reports provide insight into how refugees try to meet their own needs and, when they can not, how they could be assisted. With this information aid can be more appropriately targeted to more effectively meet the needs of the beneficiary populations.

An example of an on-going assessment was highlighted in RNIS#22 in 1998. In Liberia, humanitarian agencies are trying to coordinate food security assessments in many parts of the country, but particularly in areas of likely refugee return. A WFP-initiated ‘Food Security Forum’ whose members - both UN and NGO - are concerned with food security are developing common assessment methods and sharing results. This should inform programming decisions and identify location-specific food security indicators that can be monitored for early warning. Better monitoring and targeting will become critical as emergency food aid is phased out.

Segments of populations have sometimes achieved different levels of self-sufficiency. In two cases, different rations were distributed to the same population (e.g. Cote d’Ivoire - 1995, Sudan -1997). Newer arrivals received a larger ration than their counterparts who had been in the camps longer. This was based on the assumption that the longer-term refugees had developed some level of self-sufficiency.

Under the new Memorandum of Understanding, WFP and UNHCR maintain joint responsibility for overall food aid and relief requirements. Both agencies will agree on the modalities of food assistance programmes, composition of the food basket, ration size, duration of assistance, and directly related non-food inputs.

Assessments will take into account a number of factors including socio-economic and nutritional status, cultural practices, overall food availability, prospects for self-reliance, availability of cooking fuels, and the environmental impact. The MOU stresses that the views of the beneficiaries, particularly women, should be sought (WFP/UNHCR, 1997, Section 3.6).

F. Considering care of the vulnerable, especially young children

Care of the nutritionally vulnerable was considered at a recent interagency meeting entitled Caring for the Nutritionally Vulnerable in Emergencies (Feb. 98). At this meeting, a set of guiding principles (attached as Annex II) was drawn up to inform programme planning to promote the best caring behaviours.

‘Experience has taught that even when there is adequate food in the house and a family lives in a safe and healthful environment and has access to health services, children can still become malnourished.’
(UNICEF, 1998, pg. 27)

Caring practices, as defined in UNICEF’s State of the World’s Children (1998) are behaviours that translate available food and health resources into good child growth and development. These include feeding practices (including breastfeeding), protection of children’s health, cognitive stimulation and support for mothers. In our experience, caring practices are infrequently assessed during anthropometric surveys, but this is beginning to change. As one example, a survey carried out among war-affected people in Sierra Leone found higher levels of wasting in the 6-29 month group than in the 30-59 month group (June 1998). This was because complementary foods were introduced too early and were being watered down to compensate for reduced ingredient availability on local markets.