The most recent overview of the numbers of refugees and displaced people in Asia (as of the end of 1997) is as follows. There were an estimated 4.7 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 Vietnam in China, and Bhutanese in Nepal. No comprehensive data were available on the numbers of internally displaced populations in Asia, but they were certainly in the millions (UNHCR, 07/98).
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 Democratic People's Republic of Korea is also included. This is intended to follow up on the Special reoprt published in RNIS 22.
13. Afghanistan Region
Twenty years after the 1979 Soviet invasion in support of the communist regime in Afghanistan, and ten years after the withdrawal of the last Soviet soldier in 1989, an armed conflict between opposing political factions still continues in Afghanistan. Currently, the Taliban control approximately 90% of the country, although they are not recognised as the legitimate Afghan government by the UN. Politically, the Taliban continue to issue and maintain restrictive edicts many of which affect women's employment, education and health care. The anti-Taliban alliance, in which the veteran military commander Ahmed Shah Massoud is prominent, is based in the North of the country.
A UN-mediated agreement between the Taliban and opposition representatives in the Turkmen capital of Ashkabad took place in March 1999. The two sides had agreed in principle to set up a shared executive, judiciary and legislature, as well as to work out details at future negotiations. However, reports of continued fighting were received just a few days after the accord was reached (AFP - 18/03/99).
As a consequence of the war, several million refugees are scattered throughout the region, mainly in Pakistan (1.2 million) and Iran (1.4 million). Repatriation is ongoing and in 1998 UNHCR assisted about 107,000 refugees to return to Afghanistan (93,000 from Pakistan and 14,000 from Iran). In addition to the refugees, there are approximately 2.5 million displaced persons living away from their homes within Afghanistan (WFP - 29/09/98).
No new reports on the nutritional situation of the IDPs in Afghanistan are available. Anecdotal accounts refer to the "horrendous" breakdown in living conditions in Kabul and the effects of the twenty years of conflict on "health and nutrition" and other socio-indicators (AFP - 18/03/99). Since August 1998 (following a series of security incidents) no international UN-staff have been present in the country and thus information on the nutritional status of the population is difficult to obtain. However, local WFP staff have been able to provide much essential aid to the population (WFP - 19/03/99).
As a result of the agreement reached on 25th January between the UN Humanitarian Co-ordinator and the Taliban authorities, a gradual return of international UN-staff is proceeding (UNDPI - 12/03/99; WFP - 19/03/99). This should result in the availability of more detailed information on the nutritional situation. The most recent reports available suggest that 1.25 million people require humanitarian assistance (WFP - 29/09/98).
There are no reports on a change in the adequate nutritional status of the approximately 328,000 Afghani refugees requiring aid in Pakistan. 28,000 of the newest (most recently registered) refugees are provided with a ration of 2,102/kcal/day by WFP and are given non-food inputs by UNHCR. A further 300,000 targeted vulnerable refugees receive assistance under a Social Safety Net and Environmental Rehabilitation Programme. The remaining refugees have established themselves in Pakistan and are considered self-reliant and self-sufficient.
There are some 2 million refugees in Iran including 508,000 Iraqi Kurds, 58,000 Iraqi Arabs and 1,425,000 Afghans. In most cases the refugees are not in camps and are allowed to live and work alongside Iranians; only the most vulnerable 94,000 are hosted in official camps (UNHCR - 02/99).
Whilst the Government of the Islamic Republic of Iran continues to accommodate large numbers of refugees, recent economic pressures have caused it to demand greater international assistance and responsibility in handling/resolving the refugee situation. The downslide of the global oil price has dramatically lowered Iranian oil revenues and the current annual export revenue is down 39% compared to the previous year. This crisis has put severe limits on public expenditure, adversely affecting the heavily subsidised economy and worsening the living conditions of both Iranians and refugees.
Under these circumstances, a joint WFP/UNHCR mission visited Iran in December 1998 to assess the food need of the refugees in Iran (WFP - 03/99). Currently, WFP provides a ration equivalent to 1,900/kcal/person/day to 84,00 of the most vulnerable refugees in the camps. Refugees who can provide a livelihood for their families are not on the beneficiary list. A full ration is not provided as there are a number of mechanisms through which the refugees are able to obtain alternative food resources (for example: temporary jobs in the vicinity of the camps and assistance from national Iranian NGOs). The mission noted that:
· There were no discernible nutritional deficiencies (either observed or reported) amongst the refugees.In response to these finding it was recommended that:· The main concern of the refugees was the irregularity of the food distribution rather than the insufficiency of the rations.
· Although the condition of the refugees in the camps had not fundamentally changed, some of the camp inhabitants no longer required food assistance.
· The number of vulnerable refugees outside the camp had increased because of the harsh economic conditions and some of these people require food assistance.
· Food assistance should be based on vulnerability as a criterion, rather than be focused on camp populations.Overall, the IDPs in Afghanistan are considered to be at moderate nutritional risk (category IIb). The 40,000 refugees in Iran who outside the camps are also considered to be at moderate risk of malnutrition. The other refugees in Iran and those in Pakistan are considered to be at low nutritional risk (category IIc).· In order to facilitate this and to improve targeting of vulnerable refugees, it was proposed that a socio-economic survey should be undertaken in 1999. The results of this survey could be used to provide baseline data for planning and targeting future (food) assistance. The data may be used to exclude refugees who receive food aid but have already obtained financial stability as well as allow those outside the camps to benefit from assistance programmes.
· In the meantime, until the survey has been completed, an additional 40,000 vulnerable refugees outside the camps who have been registered with Government authorities will receive food assistance.
14. Bhutanese Refugees in Nepal
There are approximately 98,105 assisted Bhutanese refugees in Nepal (UNHCR, 18/01/99), most of whom fled Bhutan in the early 1990s. Since 1996, the increase in the total number is due to births within the camp. Most of the refugees are ethnic Nepalese from the southern plains of Bhutan who fled the Citizenship Act of 1985 and the "One nation, one people" policy of cultural assimilation of 1968. A solution to the Bhutanese refugee problem does not seem apparent in the near future, given the absence of progress for the return of the refugees to Bhutan and the fact that the host Government still maintains its policy of non-integration of the refugees in Nepal (WFP - 18/09/98).
A joint WFP/UNHCR food assessment mission to the camps in May 1998 reviewed the level of the general food ration and determined that there was a basis for re-adjustment (WFP - 18/09/98). This decision was partly taken in response to the finding that although the refugees are not officially allowed to engage in any agricultural or income-earning activity, which is thought to have negative effects on the local economy and labour markets, many of the refugees obtained short term or seasonal work and that considerable interaction existed between the refugees and the host population. There was also considerable concern raised by all partners, including the refugees themselves, that greater self-reliance and less dependency needed to be encouraged. However, the degree of "self-reliance" and the extent to which the refugees were able to supplement their needs were felt by the Mission to be generally difficult to determine because of the official government policy of non-integration and strict 'camp rules'.
The mission concluded that the general ration could be reduced by withdrawing the blended food component, which had been introduced in 1993 as a response to an outbreak of beri-beri. This reduces the energy level of the ration to 2,022 kcal/person/day, and considerably reduces levels of micronutrients. The Mission advised that general micronutrient requirements should be met through the promotion of more fresh fruit and vegetables, although the source of these was not specified (the ration contains 100g of fresh vegetables). Other than the removal of blended food, the ration remains unchanged. UNHCR continues to supply non-food items such as kerosene, soap and cooking utensils. Additional items such as blankets, clothing and mosquito nets are distributed by other organisations.
The overall nutrition situation is reported as adequate and stable, and has been so in recent years. The most current CMRs available, which were for December 1998, were low at 0.08/10,000/day (UNHCR - 18/01/99). Growth monitoring of children under five, and supplementary feeding programmes are well established in the refugee camps and will continue. Nutrition surveys of the under-fives are conducted annually (see Annex I(15a)). The most recent survey, in June 1998, found 4.3% acute wasting (defined as <80% of the median weight-for-height) and 0.5% severe acute wasting (defined as <70% of the median). These prevalences are slightly lower than those recorded for 1997.
Coverage of the supplementary feeding programme was relatively low at 47.1%, indicating that the growth monitoring programme's role in referring malnourished children was not as successful as expected. Measles vaccination coverage was high at 97.4%, and an earlier vitamin A supplementation programme had benefited 98.5% of the children. 43% of parents of the children in the survey reported that their child had been ill in the 15 days before the survey. This figure was elevated to 58.8% among children who were acutely malnourished, which indicates the importance of disease as well as food, as the immediate causes of malnutrition in this context.
As in previous reports, a few cases of beri-beri (1.33/1,000/month in December 1998), angular stomatitis (5.46/1,000/month) and scurvy (0.4/1,000/month) have been recorded at health clinics (UNHCR, 18/01/99).
Overall, the Bhutanese refugees are not considered to be at heightened nutritional risk (category IIc).
Recommendations and priorities:
· There is a need for a more enabling environment for the refugees to pursue a greater degree of self-reliance. This widespread concern applies especially to the growing frustration of the large mass of youth in the camps with no prospects for an active life after having moved out of the educational system (WFP - 18/09/98).The survey's recommendations included:· Given the removal of the blended food component from the general ration and the occasional reporting of cases of beri-beri, albeit at very low levels, the incidence of micronutrient deficiency diseases should be closely monitored.
· Strengthening the growth monitoring programme to cover all malnourished children and maintaining the early referral of sick children15. Refugees from Rakhine State, Myanmar in Bangladesh· Increasing health education in the camps.
An estimated 22,317 refugees from Rakhine state in Myanmar live in two camps in southern Bangladesh. They were among the 250,000 people who originally fled Myanmar in 1992, claiming widespread human rights abuses. Repatriation began in 1992 and by April 1997 some 230,000 refugees had been repatriated. However, the repatriation programme was suspended in mid-1997 and, although a list of 7,000 refugees who wish to return from Bangladesh has been approved by the Government of Myanmar, no schedule has been set for their return. As a result UNHCR will not be able to phase out its assistance programme for refugees in Bangladesh in 1999.
UNHCR's assistance within Bangladesh aims to ensure basic care and maintenance and to foster self-reliance. Programmes include regular food distributions, health care, sanitation and water projects and also therapeutic and supplementary feeding programmes for the malnourished. In 1999, nearly all refugee shelters will have to be extensively rebuilt as basic maintenance and repair work was postponed because of a breakdown of law and order in the camps in 1998.
The Government of Bangladesh does not allow the refugees to undertake employment or income-generating activities. WFP food aid is thus the primary means of meeting the basic nutritional needs of this population. A joint WFP/UNHCR food assessment mission undertaken in May last year reported that the overall nutritional status of the refugee population was satisfactory. The mission recommended the continuation of special feeding programmes and that the per capita daily ration be reduced to 2,007 kcal from 2,128 kcal in line with WFP/UNHCR guidelines. Fortified blended food is still provided as part of the general ration (WFP - 11/9/98).
No new information on the nutritional status of the population has been received since the assessment mission. However, a UNHCR/NGO nutritional survey for children under five years was conducted in February and the results should be available shortly. The latest health report (for February 1999) recorded a CMR of 0.61/1,000 /month. The average energy value of food provided over this period was 1,880/kcal/person/day -slightly lower than that recommended. This was due to a reduction of food commodities received at the delivery point (UNHCR - 03/99).
Overall, the refugees in Bangladesh are not considered to be at heightened nutritional risk (category IIc).
16. Democratic People's Republic of Korea
This section is included as a follow-up to the Special Report on the Nutrition Situation in the Democratic People's Republic of Korea (DPRK) which was published as a supplement to RNIS 22 (29/11/97). In particular, this section aims to report on the findings of a joint Government/UNICEF/WFP/ECHO nutrition survey in DPRK conducted in September/October 1998.
The decline of industrial and agricultural output and successive natural disasters over the past several years, have exacerbated severe food shortages and further complicated the economic problems in DPRK. This has led to large scale food, agricultural and health input requirements. The existence of considerable security tensions in the country due to the absence of a peace agreement since the end of the Korean war, makes the implementation of humanitarian activities especially difficult (OCHA 12/98).
Although vast amounts of humanitarian resources have been poured into the country, verifiable information on the nutritional situation has been difficult to obtain. Much hardship and suffering is evident, but the ability to meaningfully monitor need and assistance has remained constrained (OCHA-12/98, RNIS - 29/11/97). Recent claims from North Korean defectors and some international relief organisations have raised the possibility that severe famines may have caused the deaths of huge numbers of people (AFP - 01/03/99). The survey reported here (WFP - 01/99) is important as it is the most comprehensive to have been published on the nutritional situation in the DPRK (see annex I(16a)).
The survey sample of 1762 children aged six months to seven years was drawn from 130 counties of a total of 212. The survey results should be representative of this age group in 61% of all the counties and 71% of the country's population. It is important to note that the nutritional situation in the counties not covered by this survey, which were mainly in the north (WHO - 03/99) may be very different (better or worse) than those reported below.
The main findings of the survey were:
· The prevalence of wasting was 15.6%. The prevalence of severe wasting was 5.2%.Put in context, these prevalences of wasting are higher than those recorded for any other national survey in East Asia, including Cambodia, Laos and Vietnam. The very negative mean of the weight-for-height z-score distribution implies that the whole population of children has been affected and that there may be pockets of extremely high prevalences of malnutrition in some areas. The levels of stunting are also very high and indicate that the nutritional problem has probably existed in the country for many years. These children may have been suffering from inadequate food intake most (or all) of their lives - thus WFP considers North Korea to be in the grip of a "famine in slow motion" (WFP - 01/99).· 62.3% of the sample were stunted, 40.3% severely.
· 60.6% of the children were underweight-for-age, 31.5% severely.
· While the distribution of weight-for-height was normally shaped, the mean Z scores was very negative (-0.95).
· The prevalence of wasting was highest in the 12-35 month age group. However, the prevalence of stunting and underweight increased up to the fourth year and did not tend to decrease after this.
· The prevalence of wasting in the 6-12 month aged group was high at 17.6%. This indicates that there may be a certain amount of maternal malnutrition in this population.
· The prevalence of malnutrition (as measured by all three indicators) tended to be higher in boys than girls.
· Urban/rural comparisons revealed significantly higher rates of wasting of children from rural areas.
WFP suggests that the non-food related potential causes of malnutrition include underlying infection and the incomplete rehabilitation of previously malnourished children. In an earlier survey, 80.6% of the children who were malnourished were reported to be suffering from diarrhoea compared to 2.8% of the children who were "normal" with respect to acute nutrition (Katona-Apte and Mokdad, 1998). Health problems and infections may, in turn, be associated with a breakdown in health services such as problems relating to contaminated water or declining immunisation rates.
It is difficult to explain the differences observed between the sexes as there is no evidence of gender-related discrimination in North Korea and WFP assumes that the children receive equal amounts of food. Possibly the male children are more active than the females. There could be a number of explanations for the urban/rural difference, such as the greater availability of food and/or health services in the cities and easier access for acutely malnourished children to nutritional rehabilitation facilities in major urban areas than elsewhere in the country (WFP - 01/99).
A UNICEF Mulitple Indicator Cluster Survey (MICS) was undertaken at the same time as the survey described above (see annex I(16b)). The preliminary findings of this survey are outlined below:-
· 34.7% of the children were anaemic (Hb<11g/dl); none were severely anaemic (Hb<7g/dl)Recommendations and priorities arising from the surveys:· Mean birthweight (largely based on mothers' recall) was 2.8kg. 9.3% of the children had low birth-weights(<2.5kg)
· General vaccination coverage was low. 63.9% of the children aged 12-23 months were vaccinated by BCG and measles was less than 40%.
· The rates of malnutrition are alarmingly high and food assistance is still required; food security assessments would facilitate the targeting of such assistance.· Factors other than the lack of food should also be considered (health services, immunisation rates etc.) and interventions should be planned accordingly.
· Given the high rate of malnutrition in children, the nutritional status of other vulnerable groups including the elderly, schoolchildren and pregnant/nursing women should also be studied.
