Asia - Selected situations

11. Afghanistan Region
12. Bhutanese Refugees in Nepal
13. Indonesia/East Timor Region
14. Balkans Region

The most recent overview of the numbers of refugees and displaced people in Asia (as of end of 1998) estimates that there are 4.7 million refugees on the continent. Over 1.2 million of these were Afghans in Pakistan and Iran (1.4 million). There are reported to be approximately 500,000 Iraqis in Iran. Comprehensive figures on the number of displaced in Asia are unavailable.

This section of the report gives updated information on some of these situations. The current nutritional situation of the Afghan refugees/displaced persons is described. Information on the Bhutanese refugees in Nepal and refugees is included. There is also information on the nutritional situation of the population in East Timor, the refugees in West Timor and displaced people in other parts of Indonesia although this section is not comprehensive.

11. Afghanistan Region

The conflict in Afghanistan has been ongoing for more than twenty years, leading to massive displacement both within the country and, as refugee movements, into Iran and Pakistan. Although large parts of the country remained relatively peaceful in 1999, fighting continued in Bamiyan, Shomali, and in north-eastern parts of the country (OCHA-31/12/99).

Food assistance

WFP is planning to provide food assistance to approximately 1.5 million people under a newly approved relief operation. A poor harvest in 1999 (the first year since 1995 to show a decrease in total cereal production) and a drop in flour imports (partially due to more vigorous border controls curtailing smuggled food from neighbouring countries, particularly Pakistan) have resulted in spiraling wheat flour prices. The price of wheat flour in Kabul has increased almost 50% since October 1999. The impact of these price increases has been exacerbated by a simultaneous drop in people’s purchasing power as a result of a rise in unemployment (WFP - 11/02/99).

The UN is assisting approximately 300,000 IDPs in Kabul, Panjshir, Hazarajat, Dara Souf, Kunduz, and Khojar Ghar (OCHA - 07/12/99).

Kabul

Three thousand families (approximately 16,000 people) displaced from Shamalle since August continue to be housed in the ex-Soviet Embassy compound. WFP, other UN agencies and NGOs, continue to provide assistance to this group. The majority of the displaced population in Kabul are housed by relatives, who are often poor and vulnerable themselves. A programme has been launched in the city to provide employment for some 4,000 families in the winter. No reports on the nutritional situation of the IDPs in Kabul are currently available to the RNIS. WFP-supported bakeries feed some 266,000 people in the city.

IDPs in Panjshir Valley

Displacement from the Shamalle Plain into the Panjshir Valley and Kabul began in August 1999 as a result of fighting between the Taliban Government and opposition forces in the area. Panjshir is one of the main strongholds of the government opposition within Afghanistan. There is some controversy surrounding the actual number of displaced people remaining in the Panjshir valley. WFP estimates that there are 42,000 IDPs (6,000 families with an average of 7 people per family). IDPs are living in either official or unofficial camps, public buildings or with host families (ACF-F-12/99).

ACF-F undertook nutritional and food security assessments among the IDPs in Panjshir Valley in late 1999 (see annex). The nutritional assessment was not a survey, as it was not considered representative of the total population due to the difficulty of obtaining reliable population figures (partially because the IDPs were constantly moving around the valley during the time the assessment was conducted). The table below shows the results of the nutritional assessment. No comparative national survey data is available, however the most recent ACF-F survey in Kabul estimated the prevalence of acute malnutrition at 8.7%(see RNIS 27). Vaccination rates confirmed by card were relatively low at 40.7%, although a further 33.3% of carers reported that children had been vaccinated and that the cards were lost (ACF-F - 12/99).

Results of Panjshir nutritional assessment

	Official camps (n=158)	Public buildings (n=159)	Unofficial camps (n=160)
Acute malnutrition (<-2z scores and/or oedema)	12.0%	12.6%	7.5%
Severe acute malnutrition (<-3z scores and/or oedema)	1.9%	3.8%	1.3%

The findings of the food security assessment are summarised below (ACF - 12/99):

· Forty-two percent of the IDP households came from rural areas, the remaining 58.2% were from urban settlements. The average length of displacement at the time of the assessment was 4.5 months.

· The majority of the displaced from southern Shamalle, who were displaced before those from northern Shamalle, were living in official camps. This group were forced to flee their homes with very little warning and as a result were unable to bring many of their possessions with them. They have received both food and non-food items since arriving in Panjshir. In contrast, the displaced from northern Shamalle who were displaced later and were able to bring some of their assets with them were more likely to live in the unofficial camps and public buildings. At the time of the survey, this group had received less assistance than those from southern Shamalle and had had to sell larger quantities of their assets in order to maintain a basic quality of life. Assets were sold to obtain food, wood and medicines.

· Coping mechanisms other than sale of assets for both groups included working for food-for-work projects, working in the bazaar, obtaining loans and begging. (Begging was not widely reported but the assessment team observed that many women were begging; it was thought that the 12% of female-headed households were particularly dependent on begging for their survival).

· Both groups of IDPs were considered ‘vulnerable’ at the time of the assessment. It was estimated that only 20% of the IDPs from northern Shamalle could be considered self-reliant and 10% of those from southern Shamelle. The IDPs in the official camps had smaller food stocks than the other groups, although they were consuming a greater diversity of food types. All households (except one) possessed basic commodities such as cooking utensils etc.

· Water consumption for all groups was far below the basic requirement of 20l/person/day (average consumption 4.8l/person/day in camps and 7.5l/person/day in the public buildings). Water is mainly collected from rivers, unprotected springs and irrigation channels, except in one of the official camps where chlorinated water is available. Latrines were present only in the official camps and some of the public buildings, but lack of privacy meant that some of the latrines were not socially acceptable. The scarcity of latrines presents a serious public health risk.

· The main source of fuel for all households was bushes collected from the mountains, although some coal powder has been distributed in the public buildings and official camps. Collection time for bushes averaged between 3-6 hours/day and was mainly undertaken by older children.

· More interventions have been planned for the group from southern Shamalle than for those from the north. Given the depletion of the latter group’s assets this programme could result in increased vulnerability among those from northern Shamalle.

· Nearly all the IDPs interviewed expressed a desire to return to their homes, however this is dependent on security conditions and it is not possible to predict when security in Shamalle will improve sufficiently to allow people to return. Furthermore, reports suggest that many of the displaced’s homes have been destroyed by looting and fighting.

WFP has been registering the most vulnerable families in Kandahar, Helmand and Zabul provinces during the reporting period. It is estimated that WFP will provide 250 kg of wheat per household to an estimated 200,000 people in Kandahar City and Zabul province (OCHA - 15/02/00).

Return of Refugees

A meeting in Kabul has endorsed UNHCR’s repatriation plan that envisages the return of 200,000 Afghan refugees from Pakistan and Iran in 2000. UNHCR will provide logistical support to all those who express the desire to return home and will assist the returnees with shelter and water. Surveys to assess the needs of potential returnees will be conducted shortly (OCHA - 25/02/00).

Pakistan

Pakistan hosts 1.2 nillion refugees in 203 villages In the north west frontier, Baluchistan, and Punjab provinces. In 1999, some 92,000 Afghan refugees voluntarily repatriated from Pakistan (OCHA - 25/02/00).

The RNIS has not received any new reports on a change in the adequate nutritional status of the approximately 320,000 Afghan refugees who receive food assistance in Pakistan. The remaining refugees are considered self-sufficient and receive no food assistance, although UNHCR helps to sustain government activities in health and education in the villages where they live.

Islamic Republic of Iran

An estimated 1.4 million Afghan refugees and some 500,000 Iraqi refugees remain in the Islamic Republic of Iran. There is no new information on the nutritional situation of these refugees, the most recent reports indicated that the situation was not critical (see RNIS 28).

UNHCR and the Iranian government have agreed on ways of facilitating the repatriation of Afghan refugees remaining in Iran, in order to better organise the return process and put an end to the deportations (OCHA - 29/02/00).

Overall, the IDPs in Afghanistan are considered nutrition-ally vulnerable (category III) and continue to need humanitarian assistance. The nutritional situation of the refugees in Pakistan and the Islamic Republic of Iran remains uncritical (category IV).

Recommendations and priorities:

· Obtain information on the nutritional and health status of the refugees in Pakistan and the Islamic Republic of Iran.

· Open one therapeutic feeding centre and five supplementary feeding centres in the area.

· Improve the sanitation facilities.

· Continue to monitor the nutritional situation of the IDPs, including undertaking a nutritional screening of all children aged 6-59 months.

12. Bhutanese Refugees in Nepal

An estimated 83,000 ethnic Nepalese fled Bhutan between 1990 and 1993 in fear of the enforcement of new citizenship laws and the “one nation, one people” policy of cultural assimilation passed by the Government of Bhutan in the late 1980s. These refugees were settled into seven camps in the Jhapa and Morang districts in south-eastern Nepal. There are currently some 97,600 Bhutanese in these camps. There has been no effective resolution of their plight to date.

In general, the health and nutritional situation in these camps is adequate. The most recent nutritional survey among children aged 6-59 months estimated the prevalence of wasting at 9.9% (see RNIS 28).

UNHCR/CDC adolescent survey

At the request of UNHCR and WFP, CDC undertook a survey of protein-energy and micronutrient malnutrition among adolescent (10-19 years of age) Bhutanese refugees in October 1999. The results of the protein-energy survey were reported in RNIS 29. Although micronutrient deficiencies had been noted since these camps were created in 1990, there had been an increase in the number of cases, especially of angular stomatitis (AS), since March and April, 1999.

The key finding from the micronutrient survey was that AS, which was found in 29% adolescents examined, was found to be statistically associated with low riboflavin status and low serum folate, therefore confirming bio-chemically and clinically the presence of micronutrient deficiency diseases.

The results of the micronutrient survey are summarised below (see annex for methods):

· AS was found in 133 (29%) of 463 adolescents examined. The prevalence of AS was not significantly associated with age or sex. Biochemical analyses showed that both low riboflavin status and low serum folate were significantly related to AS. AS was not related to serum vitamin B12 or vitamin A status.

· Eighty-six percent of the 183 adolescents chosen at random that had not received recent vitamin B complex supplementation had abnormally low serum riboflavin level. Low riboflavin status was not related to age or sex; however, low riboflavin status was related to camp of residence. Adolescents with a riboflavin level at or below the survey population mean average were 2.3 times more likely to have AS than those with riboflavin levels above the mean.

· Of the 190 adolescents without recent iron and folate supplementation, 67 (35%) had subnormal serum folate levels (< 2.6 ng/ml). Low serum folate was not related to sex or camp; however, the prevalence of low folate levels increased with age. AS was 1.6 times more likely among those with low serum folate levels than those with normal levels.

· Among the 154 adolescents without recent vitamin B complex supplementation, 32 (21%) had subnormal serum levels of vitamin B12 (< 201 pg/ml). Low serum vitamin B12 status was not related to camp or sex; however, as with folate, the prevalence of low vitamin B12 increased with age. There was no significant association between low serum vitamin B12 status and AS.

· Twenty-four percent of the adolescent sample were anaemic using the WHO recommended age and sexspecific definitions. Seven percent of the sample had haemoglobin levels less than 11 g/dl and one adolescent was found to be severely anaemic (haemoglobin < 7 g/dl). The prevalence of anaemia rose sharply after 11 years of age, with females aged 12 and older having an anaemia prevalence of 33%. Females who had experienced menarche had significantly more anaemia than their pre-menarche counterparts. Among males the prevalence of anaemia peaked at 14-15 years of age and then fell in older age groups, Anaemia was not related to riboflavin, folate, or vitamin B12 status; however, it was related to low vitamin A status.

· Among the 190 adolescents who underwent phlebotomy and who denied recent iron supplementation, 109 (57%) had an elevated serum transferrin receptor level (TfR > 8.0 ug/mL) indicating decreased iron stores. High TfR was related to being anaemic. Elevated serum TfR was not related to age, sex, or camp; however, it was more common in girls who had achieved menarche than those who had not.

· Among the 190 adolescents assessed, 26% had retinol levels below 20 ug/dl suggesting low vitamin A status and 83% had retinol levels below 30 ug/dl. There was no association between low serum retinol status and night blindness. Low serum vitamin A status was not related to age, sex, camp of residence, or AS.

Overall, the nutritional situation of the Bhutanese refugees in Nepal is not considered critical (category IV). However, the biochemical results of the October 1999 survey suggest that the micro-nutrient status of the adolescent refugees is marginal and that surveillance measures need to be continued.

Recommendations and priorities:

· Because a high proportion of adolescent females are anaemic, and an even higher proportion is iron deficient, it is recommended that all adolescent females should receive iron supplementation. Such supplementation could be through distribution of tablets containing iron and folate, or through distribution of iron pots for home cooking, or other means.

· Providing fortified flour in place of part of the rice ration. If acceptability of fortified flour is not immediately assured, there may be a need for communication/education program to create demand for fortified flour.

· Reassessing the feasibility of the poultry project that has already been pilot tested.

13. Indonesia/East Timor Region

East Timor
Indonesia

East Timor

Following the violence and population displacement after the 30 August 1999 referendum, the situation in East Timor has continued to improve. An estimated 108,500 people have been assisted by UNHCR/IOM to return from West Timor, other parts of Indonesia and Australia (UNHCR - 21/03/00). A further 45,000 people have returned spontaneously (UNTAET - 20/03/00).

Agriculture

An FAO/WFP crop and food supply assessment mission to East Timor in December 1999 found that the level of destruction of agriculture was less than anticipated. The major damage was to livestock, food and seed stocks. The main constraint to agriculture was population displacement; in some areas a relatively large proportion of farmers were unable to complete sowing their maize crop in November/December. The most vulnerable areas include Bobonaro, Covalima and Oecussi Enclave (FAO/WFP - 21/12/99).

WFP has recently moved from a general distribution to as many as 600,000 people in November (from an estimated total population of 750,000) to targeted group feeding and food-for-work activities. The vulnerability of particular geographic areas in East Timor is determined directly by the extent of public and private infrastructure as well as the presence of community markets and baseline poverty indicators. Targeted groups include those who have no access to food due to a lack of money, destruction of livelihoods, or those who live in areas where no food is available (FAO/WFP - 21/12/99; WFP - 28/01/00).

The RNIS has not received any new nutritional surveys or assessments for East Timor. The most recent assessments did not report elevated levels of malnutrition, although isolated pockets of acute malnutrition may exist.

Overall, the agricultural situation is not as bad as anticipated and the security situation has now improved. The situation has stabilised and hence the population is not considered to be at elevated nutritional risk (category IV).

Recommendations and priorities:

· Monitor the nutritional situation in Dili and the surrounding areas.

Various interventions will be required to enhance productivity and food production. These include:

· Seed multiplication programmes for maize and rice.

· Rehabilitating irrigation facilities.

· Reducing post harvest losses.

· Improving rice-milling facilities.

· Investing in small-scale machinery.

· Breeding, vaccination and extension campaigns to increase livestock numbers.

· Providing basic equipment to increase fish production.

Indonesia

Refugees in West Timor, Indonesia

UNHCR estimates that some 145,000 refugees from East Timor remain in West Timor. The majority of the refugees are living in one of more than 200 sites in Belu district; most of the remainder are in Kupang district. The number of people per site varies from 60 to 4,000. According to UNHCR, large numbers of East Timorese in West Timor wish to return to East Timor (and are being encouraged to do so by the Indonesian authorities), but are prevented from doing so by either intimidation or their own apprehensions concerning their safety and/or financial security on their return. UNHCR continues to assist those refugees who wish to repatriate. It is anticipated that approximately 50,000 East Timorese will ultimately decide to remain in Indonesia (WFP/UNHCR - 03/00; USCR - 22/02/00).

The humanitarian situation of the refugees is reported to be very poor in some of the camps. High prevalences of acute malnutrition have been recorded. Infant mortality rates are also elevated, mainly because of increased incidence of malaria, diarrhoea and tuberculosis. In addition, local and international human rights organisations have documented cases of extortion, abduction, sexual violence, and unlawful killings by the militia (RI - 23/02/00).

UNHCR/WFP joint assessment mission

A UNHCR/WFP joint assessment mission to West Timor in January reported the following findings (WFP/UNHCR - 03/00):

· Food aid is currently being provided to the refugees by a number of relief agencies including WFP and local and international NGOs, although the Government of Indonesia has provided the largest share of food assistance (400g rice/person/day) and also a cash stipend of 1,500 rupiahs/refugee/day (equivalent to 14 US cents) to purchase additional necessities. Distributions of both rice and cash have been sporadic and not in sufficient quantities to cover the refugees daily needs. (The ration only provides 1440 Kcal and 28g of protein, which is well below the recommended minimum). No systematic monitoring of the basic food distribution was in place. The responsibilities for the distribution of rice and cash are being transferred from the Department of Social Affairs (DEPSOS) to the provincial government level in March. However, there are uncertainties about future commitments on the part of the Government of Indonesia to ensure continued assistance to refugees in West Timor (WFP/UNHCR - 03/00).

· Most refugees brought a substantial quantity of personal possessions with them to West Timor, including various household items, livestock (pigs, chicken, cattle), food items and even cash/savings. However, most food and luxury items appear to have been consumed or sold and therefore no longer represent a sizeable resource.

· Some of the refugees have family or blood ties with the West Timorese and are living with, or nearby, relatives who have been willing to share resources. West Timor, however, is one of the poorest provinces in Indonesia and the burden on local resources is becoming apparent.

· Few job opportunities are available to the refugees - Indonesia remains entrenched in a severe economic crisis with high levels of unemployment.

· Approximately 50,000 of the refugees are Indonesian government civil servants, police, military personnel, pensioners and their families. These people continue to benefit from basic government salaries and pensions, although other benefits normally provided to them have been discontinued. It is this group of people who are most likely to remain in West Timor.

· Very little land has been allocated to the refugees, other than that within the environs of the camps where some households have established kitchen gardens. Refugees living with relatives have greater access to farmland.

· All refugees have some form of shelter ranging from pre-fabricated barracks to loosely constructed shelters made of plastic sheeting and branches. Many households received cooking/kitchen sets, blankets, water containers, mosquito nets etc, (there are no exact data on these items). Water sources, latrines and bathing facilities have been established in most of the larger camps, but some of the smaller camps are not as well equipped. The quality of the drinking water is unknown. Soap distributions have been erratic.

· Current health care services tend to be more based on a curative rather than a preventative approach, this factor combined with delays before seeking assistance may be contributing to the higher incidence of preventable diseases, such as diarrhoea and scabies. Malaria, diarrhoea, acute respiratory infections and measles were the most common causes of deaths reported by mothers (UNICEF - 12/99). The incidence of malaria and diarrhoea are attributable to the recent rainy season conditions.

UNICEF undertook two nutritional surveys on refugee children aged 6-59 months in West Timor during the reporting period: one in mid-December in Belu district and the other in January in Kupang district (see table and annex) (UNICEF - 12/99, 02/00).

Oedema was not assessed in the Belu survey. No oedema was found in the survey in Kupang. The sampling technique employed in the Belu district survey resulted in an overestimate of the prevalence of wasting in this area as younger children were over-represented. However Belu does appear to have a higher prevalence of wasting than Kupang (see different age group comparisons) and also a higher prevalence of wasting than that estimated by a national survey conducted by UNICEF in 1995. There were no significant differences in the prevalence of stunting (low height-for-age) between the two districts or the national survey.

Results of surveys in Belu and Kupang Districts

	Belu District Dec 1999 (n=842)	Kupang District Jan 2000 (n=892)	Baseline data 1995**
6-59 months
Wasting*	23.6%	12.1%	12.9%
Severe wasting*	3.6%	1.0%	2.8%
Stunting*	46.8%	43.1%	42.2%
Severe stunting*	17.9%	17.5%	19.2
6-23 months
Wasting*	28.2%	20.7%
Severe wasting*	5.2%	1.8%
24-59 months
Wasting*	19.5%	8.6%
Severe wasting*	2.0%	0.6%

* all measurements converted to z-scores
** UNICEF national survey on children aged 0-59 months

The main explanation given for the high prevalence of malnutrition was the irregular and infrequent distribution of the general ration. A blanket wet-supplementary feeding programme for children aged 6-59 months had been established, but this is only a temporary, emergency measure. Until the general ration improves (in both quality and timing of distribution - prior to the survey there had been no food distribution in the camp for two months), so that households may plan their food needs, the supplementary feeding programme will remain relatively ineffective in decreasing the prevalence of malnutrition. Other explanations given for the high prevalence of malnutrition included; no structured system for screening, referring and treating the severely malnourished (which was partly a result of lack of medical expertise); low birthweights; and relatively high levels of illness. In addition, the survey was undertaken during the lean/hungry season (as a result of limited availability of crops) (MSF-H - 03/00).

Other parts of Indonesia

Sectarian violence continues to claim lives in other areas of Indonesia. During 1999 and into the first quarter of this year, the two provinces of Maluku and Morth Maluku have experienced high levels of conflict. Starting in Ambon in January 1999, the conflict escalated at various periods of the year, spreading to other areas of Maluku. Some 440,000 persons (more than 20% of the population) have escaped or been evacuated within Maluku, North Maluku or to the neighbouring provinces in Sulawesi. Smaller numbers have also gone to Irian Jaya and elsewhere in Indonesia. (OCHA - 03/00; USCR - 22/02/00).

The needs of the IDPs vary depending on the intensity of the conflict in the area where they are located and also on their living arrangements. Some IDPs living with host families are able to cope, but are placing a heavy burden on their hosts who may need assistance. IDPs in areas that have stabilised (e.g., Ambon Island and South-East Maluku) are better off than those in areas still affected by conflict (e.g., Halmahera Island, the Island of Bacan and a number of other islands in North Maluku) or those living in poor camp conditions (OCHA - 03/00).

ACF-F is currently distributing food to 135,000 IDPs in Central Maluku including the islands of Ambon, Seram, Serarua, Haruku and Bum. The NGO is also considering starting a new distribution in North Malukus where the violence has escalated since late December 1999. This includes the island of Ternate where there are currently 72,000 IDPs and the island of Halmahera where fighting continues (hence there has been no reliable survey of the numbers of displaced people, but 40,000 are estimated) (ACF-F - 07/03/00). WFP has been supporting ACF’s programme by providing the rice needed for their feeding programmes (OCHA - 03/00).

The RNIS has not received any nutritional assessments for the displaced outside of West Timor during the reporting period.

Overall, the patchy performance of the humanitarian assistance programme, in terms of irregular food distributions, weak health services, etc., is of concern, and combined with the relatively high rates of malnutrition suggest that the refugees in West Timor are at high risk of malnutrition (category II). The nutritional situation of the IDPs in the rest of Indonesia is currently unknown (category V).

Recommendations and priorities:

· Improve the quality and co-ordination of humanitarian assistance programmes within West Timor (including the nutritional surveillance programmes).

· Monitor the nutritional situation of the displaced outside of West Timor.

· Improve the quality of the general ration and ensure that it is distributed regularly.

· Provide seeds and tools for kitchen gardens.

· Provide support and training in the management and identification of malnutrition.

· Increase the general food distribution to a standard ration of not less than 1,900 Kcal/person/day (this figure was calculated using the demographic profile of the population which has a high proportion of young children).

· Ensure that the ration includes a food basket of cereals, pulses and oil.

· This ration should not be provided to those receiving regular income from the Government of Indonesia (UNHCR must determine who is eligible before the distributions start and introduce a ration card system).

· Implement a blanket dry-supplementary feeding programme for all children under five.

· Organise targeted feeding programmes for other vulnerable groups including moderately malnourished children.

· Establish a nutrition and food basket monitoring system.

· Redirect health care services towards community outreach programmes.

14. Balkans Region

One year after the start of NATO air strikes on the Federal Republic of Yugoslavia (FRY) and the massive humanitarian relief effort that followed, the level of violence in the region remains very high, particularly in the southeastern and northern regions of Kosovo (UNMIK - 14/01/00, 10/03/00).

Kosovo

The violence continues against ethnic Serbs, Roma and Moslem Slavs who have remained in the province, as well as moderate ethnic Albanians. The current rate of “murder, abduction, violent attack, intimidation and house burning” has nearly reached the levels of June 1999 when the international administration began. A protracted face-off between the ethnic Albanian and Serbian communities in Mitrovica has epitomised the problems of the community. Two of the major problems associated with the security situation are the virtual absence of job prospects for minorities and the demobilisation of the former Kosovo Liberation Army (Al -13/03/00; USCR - 10/01/00).

Returns and Displacement

From a total of 900,000 people who fled the province in 1999, UNHCR estimates that only 70,000 refugees from Kosovo are still living outside the province. UNHCR has continued to register ethnic Albanians who arrive in Kosovo from southern Serbia following security incidents in the area. These IDPs tend to settle in small villages along the border. Typically, they are absorbed by host families. An estimated 7,000 ethnic Albanian IDPs have registered since last June, but the total number of displaced may be considerably higher as not all have registered for assistance. There are some 60-70,000 Albanians living in southern Serbia in the Presevo valley area (USAID - 24/03/00; UNMIK - 10/03/00). In addition to the newly-arrived ethnic Albanians, many of the remaining Serb populations in Kosovo are living in newly formed ethnic enclaves rather than in their original homes and hence may also be considered displaced.

Nutritional survey

AAH-UK undertook a nutritional survey of children aged 6-59 months, mothers, and older persons in January 2000 (see annex). The prevalence of acute malnutrition was low in all groups. There has been a slight (non-significant) increase in the prevalence of acute malnutrition in children aged 6-59 months since December 1998 and July 1999 (see graph). The prevalence of stunting was 7.5%, including 1,9% severe stunting (see graph) (AAH-UK - 03/00).

The prevalence of acute malnutrition (defined using z-scores and/or oedema) in children aged 6-59 months in Kosovo

The prevalence of stunting (defined using z-scores) in children aged 6-59 months in Kosovo

The mean age of the mothers measured was 31 years. Their mean BMI was 24 kg/m². The prevalence of maternal undernutrition was low when diagnosed using either the BMI (see table) or the MUAC or both in conjunction. (The prevalence of maternal malnutrition was estimated at 4.9% using a MUAC<220mm, 5.4% using BMI<18.5 kg/m² and as 3.2% using BMI and MUAC in conjunction.) These prevalences are lower than those found in the UK. In fact, the prevalence of overnutrition, and obesity, was considered to be a greater public health risk than that of under-nutrition in this group (10.7% of the sample had a BMI>30kg/m²). There was no statistical association between maternal and child malnutrition (AAH - 03/00).

A low prevalence of undernutrition was also reported for the older age group (defined as aged 65 years or over). Overweight and obesity were more common than underweight (see table). In similar studies in Bosnia-Hercegovina in 1995 older persons were found to be at higher nutritional risk than either young children or adults, particularly in the elderly who lived alone. Possible explanations for the low prevalence of malnutrition in Kosovo are the traditional practice of family co-habitation with older people, and also the fact that the conflict period was shorter in Kosovo than in Bosnia-Hercegovina (AAH - 01/03). It should be noted that the number of elderly per household was lower than expected. The survey in Macedonia also showed a lower than expected proportion of elderly people.

Results of nutritional surveys for adults and older persons in Kosovo

	Maternal prevalence (%) (n=798)	Older people Prevalence (%) (n=224)
Severe undernutrition (BMI<16kg/m2)	0.2	1.3
Moderate undernutrition (BMI 16-16.9 kg/m2)	0.9	0.4
Marginal undernutrition (BMI 17-18.4 kg/m2)	4.2	3.6
Normal (BMI 18.5-24.9 kg/m2)	60.7	46.4
Overweight (BMI 25-29.9 kg/m2)	23.6	32.0
Obese (BMI >30 kg/m2)	10.4	16.0

The results of these surveys do not suggest an alarming nutritional situation. However, the author observed that the urban IDPs, marginalised minority groups, people living in isolated mountain areas, and families with social problems appeared to be more vulnerable to malnutrition. These problems were compounded by poor shelter and the cold. Chronic malnutrition remains a cause for concern (AAH - 03/00).

Nutrition Strategy

There is no longer a need for food aid on the same scale provided since June 1999 when the population first returned to Kosovo. This is in part due to the harvest that will take place in July, the establishment of social welfare structures and the recovery of business and employment opportunities in the province (UNMIK - 10/03/00; UNHCR - 02/00).

As Kosovo continues to be rebuilt and the UNMIK (United Nations Interim Administration in Kosovo) structures become more established, more responsibility for food distributions is being given to UNMIK, away from the international agencies. The current WFP/UNHCR food distribution system will remain in place until the end of June 2000. Up until the end of March, beneficiary figures will remain at approximately 900,000, but this figure will be downscaled incrementally from April to June, with a 20% reduction occurring on aver age each month. The majority caseload should stand at approximately 460,000 by the end of June (this does not include the minorities) (UNHCR - 02/00,29/03/00).

From May onwards, food assistance will gradually be provided through a new system whereby beneficiaries will be identified and registered with the Social Welfare Centres (CSWs) of the Social Welfare Department (UNMIK). Those registered with one of the 25 CSWs will be able to collect food rations from a distribution point associated with the CSW. The criteria for eligibility to food will be based on “the problem of a lack of access to food”. There may be families who are entitled to financial assistance who do not necessarily require food assistance, so the financial and food assistance components will be separate to some extent. The food/financial assistance scheme will be gradually phased in with Category I applicants (households with noone in the family capable of working) being processed by the CSWs first and then Category II applicants (households with people able to work, but unemployed) etc. (UNHCR - 02/00, 29/03/00).

The problems of access to food currently faced by minority communities are different from those faced by the majority of the population (see RNIS 29). All ethnic groups will be included in the selection process for food eligibility on an equal basis. However, it is likely that some minority groups will not be able to physically access the distribution points because of the insecurity; hence it is probable that a system of direct delivery will be required until at least the end of the year (UNHCR - 02/00). Some of the minorities now receive food aid through the Yugoslav Red Cross or the Orthodox Church. This solved some of the problems associated with distribution through the Mother Theresa Society, whose members are mainly ethnic Albanians. In some cases, food is distributed directly by international NGOs (UNMIK - 10/03/00).

Health

WHO and UNMIK are planning the development of a primary health care system in Kosovo that will take between 3-5 years to create. Sites for family health centres, with ambulantes serving this function, are currently being identified. The creation of the new health structure directly affects the issue of access to adequate health care for minorities. Minorities may have limited access to health care if their community does not have an ambulanta (USAID - 24/03/00; UNMIK - 10/03/00).

Shelter

The majority of emergency shelter programmes have concluded, There is a currently a shift in the programmes away from shelter to reconstruction in the spring (UNMIK - 14/01/00).

Serbia and Montenegro

UNHCR estimates there are some 200,000 IDPs from Kosovo in Serbia and Montenegro, up to a quarter of whom are Roma. They have joined more than half a million long-term refugees from Croatia and Bosnia and Hercegovina who fled the 1991-95 wars in the former Yugoslavia. The registration of IDPs in Serbia is in progress and is scheduled to be completed by mid-April (OCHA - 17/03/00; UNICEF - 21/03/00; UNMIK - 10/03/00).

IDPs in Montenegro

ACF-F undertook an anthropometric screening of displaced Roma children aged 6-59 months, living in tents and pre-fabricated barracks of Konik camp, Podgorica, Montenegro in November 1999 (see annex). These children and their families have lived in Konik camp since the conclusion of the NATO air raids (i.e., 0-7 months at the time of the survey). The prevalence of acute malnutrition was not abnormally elevated (see table), although some malnutrition was recorded in the younger age group, which may indicate poor feeding and care practices in this population (ACF-F - 11/99).

The prevalence of stunting was considerably higher, particularly in the older group. The authors of the survey cautioned that age in months was relatively difficult to obtain accurately in this population and hence the prevalence of stunting may not be very accurate (ACF-F - 11/99).

Results of nutritional screening in Konik Camp

	Prevalence (%)
Acute malnutrition (<-2 zscores W/H and/or oedema)	2.9
Severe acute malnutrition (<-3 zscores W/H and/or oedema)	0.96
Stunting (<-2 zscores height-for-age)	16.1
Severe stunting (<-3 zscores height-for-age)	1.9

Vulnerable groups in Serbia

The FRY economy has continued its downward spiral. At the end of 1999, GDP was 30% lower than in the previous year. Inflation has increased and the value of the dinar has dropped, resulting in a decrease in the real value of wages. The Yugoslav Red Cross (YRC) provides daily meals through soup kitchens to 100,000 vulnerable people in the FRY. Eligible beneficiaries are registered by the Social Welfare Centre and receive a meal coupon worth one meal a day. The most vulnerable people include: the disabled or chronically ill, older people with low pensions, residents of institutional homes, vulnerable families (those headed by a single-parent or with many children) and people with no earning potential - particularly those in the urban areas without rural ties (OCHA - 31/12/00). There is currently no information on the nutritional situation of these groups, but a WFP mission has begun a household food economy assessment in Belgrade (OCHA - 17/03/00).

The YRC also provides assistance to IDPs, predominantly from Kosovo, in Serbia and Montenegro. This programme provides an individual food parcel of 10kg of wheat flour to each beneficiary on a monthly basis and a family hygiene parcel per family every second month (ICRC - 07/03/00).

Macedonia

UNHCR estimates that some 24,000 Kosovar Albanians are still living with host families in Macedonia. By the end of March they will lose their refugee status and the Macedonian authorities will no longer assist in their repatriation (USAID - 24/03/00). The RNIS has not received any new information on the nutritional situation of these refugees, which was previously described as adequate.

Overall, the nutritional situation of the majority Albanian population in Kosovo is satisfactory (category IV). The minorities are more vulnerable and are therefore described as category III. The nutritional situation of the IDPs in Serbia is unknown (category V). The nutritional situation of the displaced populations in Montenegro is not currently critical (category V).

Recommendations and priorities:

From the AAH-UK survey in Kosovo:

· Monitor the new distribution systems carefully, particularly their effects on minorities.

· Continue to undertake assessments of the population’s nutritional status, in particular to monitor the effect of increased targeting from June 2000.

· Initiate public health initiatives to reduce the prevalence of obesity.

· Continue to provide supplementary food distributions to the children aged 6-36 months.

· Monitor the growth performance and nutritional status of the children.

· Provide parent and care-givers with information about the patterns and aetiology of malnutrition.

· Information on the nutritional situation of the vulnerable, including IDPs, is needed.