V. Where do we go from here?

A. Promotion of human rights
B. Improved presentation of evidence of successes and needs
C. Increased consideration of emergency context
D. Preventing and combating micronutrient deficiencies
E. Capacity building, including training
F. Increased geographic coverage

A. Promotion of human rights

A human rights approach to food and nutrition problems is fundamentally different from basic-needs-oriented approaches to development... A rights approach implies that ‘beneficiaries’ of development are active subjects and ‘claim holders’ and stipulates duties or obligations for those against whom such claims can be held... Such an approach introduces an accountability dimension not present in basic-needs strategies. The Right to Food Report of the High Commissioner for Human Rights (ECOSOC E/CN.4/1998/21 para 26)

Until now, humanitarian assistance has been provided to ensure survival. If we are to move past this minimalist approach toward a human rights approach, practices must be adjusted to achieve goals that guarantee emergency-affected populations a healthy environment in which they can live with dignity and their children can grow to their full potential. Measures of accountability can no longer be limited to mortality, malnutrition or morbidity.

The theme of the SCN’s 26^th annual session is ‘The Substance and Politics of a Human Rights Approach to Food and Nutrition Policies and Programming’. It is hoped that this session will generate practical ideas on how to operationalise actions to promote, protect and fulfil the human rights of refugees and internally displaced populations.

B. Improved presentation of evidence of successes and needs

1. Indicators of nutritional status

The prevalence of wasting in preschool children is a useful indicator for assessing the general health and nutritional status of a population during acute periods of emergency. However, additional indicators could be used to monitor underlying causes, the impact of relief assistance, and for signalling signs of nutritional distress. Some indicators worthy of consideration are low BMI in adults, low birth weight (LBW) and stunting in preschool children.

Populations affected by protracted emergencies may experience repeated periods of extremely restricted dietary intake separated by longer periods when intake is less severely restricted, but not fully adequate. The accumulation of the effects of these restrictions is reflected as stunting, that is, inadequate attained height-for-age. ‘Height-for-age reflects achieved linear growth and its deficits indicate long-term, cumulative inadequacies of health or nutrition’ (WHO, 1995). Childhood stunting is associated with lifelong reductions in individual capacities, both intellectually and in terms of work productivity. Precise determination of a child’s age is the primary barrier to accurate assessment of stunting. However, in camps and many emergency settlements, pre- and post-natal care should facilitate birth registration, making it easier to assess height-for-age.

Rates of stunting have rarely been reported to the RNIS Reports. In camps for refugees from Myanmar in Bangladesh, 63% of surveyed children aged 6-59 months were stunted⁶ in 1998. These children were most likely born and raised in the camps. In Ethiopian camps of displaced persons in 1995, a high prevalence of stunting can be inferred from the disparity between wasting (3.2%) and weight-for-age prevalence (38%). Indeed, national survey data from Ethiopia document very high rates of stunting.

⁶ For comparison purposes, national data from Bangladesh showed 56% of children 0-5 years were stunted.

In Bangladesh a high prevalence of low birth weight babies was noted in 1998. Birth weight is influenced by maternal nutrition during pregnancy. It can be reduced by inadequate energy intake during the last trimester. Micronutrient deficiencies may also be reflected in birth weights. As stated in a recent ACC/SCN publication:

‘Low birth weight is an important indicator of foetal/intrauterine nutrition and a strong predictor of subsequent growth and well-being’ (ACC/SCN, 1997 p.8).

We encourage agencies conducting surveys or routinely collecting data on nutritional status to consider including additional, appropriate indicators, depending on the population served. We would welcome this information for the RNIS Reports.

2. Monitoring ration adequacy

The RNIS could consider a method for systematic analysis of the adequacy of rations as planned, pledged, donated, distributed and received. This would involve tracking and reporting on: the planned ration (annual plan for ration and annual planned number of beneficiaries), the level of pledges received from donors, the actual rations distributed to the exact number of beneficiaries, and the results of food basket monitoring. This type of analysis, over time, would show what refugees are actually receiving.

3. Adequacy and effects of shortages of non-food items

We are aiming to include, wherever possible, information about non-food items in future RNIS, and encourage agencies to send information about distributions of such items in emergency settings. The potential impact of shortages of non-food necessities (e.g. fuel, cooking utensils, soap, land, agricultural inputs) on dietary practices, food aid consumption, or nutritional status should be considered in food security and food supply and crop assessments. We will welcome reports of any formal or informal observations.

C. Increased consideration of emergency context

Each circumstance is different. Effective intervention will depend on local resources and barriers. Emergencies are dynamic; interventions may need to change. Therefore, there is a need to establish processes for monitoring food availability, household food security, dietary practices, and purchasing power as a routine part of humanitarian assistance during emergencies, from onset to final resettlement.

In particular, more attention should be given to understanding a populations’ own efforts towards self-reliance. There must be an increased awareness among those working in emergencies that populations’ familiar coping mechanisms may no longer work - because they are weakened physically or materially and have moved to a new location where the resources for coping are no longer available or their activities are unusually constrained. Consequently they may require outside assistance to learn new methods of coping or initial inputs to catalyse known methods.

D. Preventing and combating micronutrient deficiencies

Humanitarian assistance should take into account the heightened risks of micronutrient malnutrition, be vigilant in watching for early signs of its appearance and be prepared to promptly control it. This requires information on the population’s food intake and how and why they change. A close examination of persistent cases may be necessary to understand whether the problems stem from unusual dietary restrictions or if the symptoms reflect factors other than diet. Health and nutrition workers should be equipped to identify and treat micronutrient deficiencies, and when symptoms of micronutrient deficiencies persist in the face of nutrition intervention, they should be prepared to do further assessment. We should always be looking for effective ways to promote:

· production of fruits, vegetables and animal products rich in vitamins and minerals missing from the general food aid basket;

· acquisition and intake of local foods that are rich in vitamins and minerals missing from the general food aid basket through nutrition education;

· income generation and exchanges that diversify intake.

E. Capacity building, including training

A major issue discussed at the Machakos Workshop in 1994 was the need for improved training for those working in emergencies. Participants stressed the need for technical training, including:

· training in aspects of information systems including assessment and monitoring methods, and production of easily interpretable reports and recommendations;

· training of decision-makers in technical matters related to nutrition;

· training in the diagnosis of micronutrient malnutrition.

It would be useful for RNIS to publish notices of workshops, bibliographies of training manuals and other resources to support training of international and regional aid workers. In addition, a special report on current procedures for pre-posting orientation and briefing within agencies could be a first step in improving training of personnel before going to the field.

Problems associated with poor nutritional status in emergency-affected populations could be addressed by building the capacities of the affected population to fully exploit and protect their few resources that remain. Examples of means for building capacity include:

· breastfeeding support, protection and promotion;

· nutrition education (e.g. about the relative nutritional value of food aid commodities and locally available foods, or the frequent, safe, preparation of complementary foods for breastfeeding children);

· and health education to promote environmental and personal hygiene.

F. Increased geographic coverage

The RNIS Reports focus mainly on Sub-Saharan Africa, plus a few situations in Asia. We intend to increase our coverage of situations in Central Asia, and add information on Eastern Europe and the Americas in due course.