Afghanistan Region
The humanitarian situation in Afghanistan continues to deteriorate as the country suffers from the combined affects of more than twenty years of conflict and a third consecutive year of extreme drought conditions. The conflict has destroyed infrastructure and decimated the economy while the drought has caused wide scale failure of much of the staple food production in the country. The chronic nature of the twin insults has systematically eroded people’s capacity to cope with the deteriorating situation. A recent FAO/WFP Crop and Food Supply Assessment Mission has estimated that even with the current planned food aid, the country can expect a cereal deficit in excess of one million tonnes, and warns of an extremely serious situation (FAO/WFP 08/06/01).
As previously reported (RNIS 32 and 33), within the Taliban controlled parts of the country the most affected areas seem to be the northern and western rain fed agricultural regions such as Herat, Badghis, Balkh and Takhar, where much of the displacement has taken place. Displacement continues to take place both within the country and to neighbouring countries such as Pakistan, Iran and Tajikistan. Current estimates of internally displaced put the number at over 700,000 people (IRIN-CA 22/06/01) with the majority making their way to urban areas having exhausted all possibilities in the rural areas. It has been estimated that with the current rate of displacement the number of internally displaced will top one million during the course of 2001 (IRIN 11/06/01).
Humanitarian Access
The onset of the summer has also seen renewed fighting between Taliban government forces and the Northern Alliance, with up to 60,000 people displaced as a result from the Hazarajat region alone (UN OCHA 24/05/01). The heightened insecurity has resulted in a decrease in access to some areas, particularly the north where the UN has been forced to curtail trips outside of main towns (WFP 18/05/01). Humanitarian access has been further affected by a marked deterioration in relations between the Taliban authorities and the international community. There are reports of increasing harassment of staff from international organisations and violations of the Memorandum of Understanding that exists between the UN and the Taliban. Some of the harassment includes the arrest of essential medical staff, the cancelling of UN flights and the cutting of electricity to the UN office in Jalalabad (IRIN 06/06/01). As relations have deteriorated there have been fears of a forced withdrawal of international staff from the country.
Food Security
The FAO/WFP Crop and Food Supply Assessment mission observed in June this year that rain fed crops (wheat and barley) had almost totally failed as a result of another year of severe drought. The mission estimated that the rain fed wheat production was 40% less than even last years low output (FAO/WFP 08/06/01). The mission also reports that Afghanistan’s extensive system of irrigation is also suffering from the decreased precipitation and that years of war have rendered up to 30% of all irrigation systems useless. In a country where as much as 85% of the population depend on agriculture for their livelihoods, the continued failure of crops has destroyed crucial own production of food and left many without their normal purchasing power, effectively blocking access to food through markets. The severity of the situation has left many without the means to cope and the mission reported mounting evidence of pre famine indicators such as reduced food intakes, collapse of purchasing power, decimation of livestock herds, depletion of personal assets, rapidly increasing food prices and the ever swelling number of destitute and displaced (FAO/ WFP 08/06/01). Concern has also been expressed for the future food production prospects with a reported decrease in the area of land planted for the next harvest. This is a result of continued insecurity, the chronic drought and the lack of seeds or other agricultural inputs. This has severe livelihood implications for huge amounts of people, many of whom have failed to cope and have abandoned their land to move to the cities.
The poor state of the Afghan economy has been another key factor in the deterioration of the humanitarian situation with almost no manufacturing and export sectors to speak of. In July 2000 the Taliban banned the production for opium of poppies. This otherwise positive action was taken without an offer of any alternative economic replacement crop. This has had very serious economic implications for many involved in the farming, production and trading of the crop. A great many people are dependent on opium production as a major component of their economic income and it has been estimated that the resultant loss of income from the ban has had adverse livelihood implications for upwards of 2.8 million people (FAO/WFP 08/06/01). The ban is a very significant step forward in the war against opium production. However, it has come at a time when the majority of people are at their most economically vulnerable and have no viable alternative economic means exist. FAO have pointed out that it is essential that replacement crops are made available to ensure that people do not return to opium production (FAO/WFP 08/06/01).
Particularly vulnerable groups
The Taliban have implemented strict edicts that govern the role of women in Afghan society. Unable to work or to study, women are totally dependent on the support of male relatives and particular concern has been raised over the fate of women headed households. These women have weak or non-existent links to the labour market and typically rely on charity to feed themselves and their families. However, increasingly there are fewer resources left to share and there is genuine concern for how many will be able to cope (FAO/WFP 08/06/01). A minority group that has generated considerable concern is the Kuchi, traditional nomads who follow traditional livestock migration routes in search of grazing. The drought and insecurity have disrupted the migration routes, destroyed pasture and decimated livestock herds, leaving the Kuchi not just without livelihoods but bringing to an end a traditional way of life, with the majority being forced to settle in makeshift camps along major highways (FAO/WFP 08/06/01).
Humanitarian Response
With the continuing deterioration of the situation there has been a greatly increased international awareness of the emerging crisis and increased donor commitment with greatly increased pledges. The current WFP EMOP is scheduled to finish in March 2002 but the increased demands mean that it will be exhausted in October 2001 and already a new EMOP is being drafted (WFP 25/05/01). WFP has established a considerable food pipeline and general distributions are being affected in many areas particularly where there are high concentrations of displaced people around Mazar-e-Sharif in the north, and Herat in the west. An initial strategy was to try and prevent the huge rural to urban migration and response was designed not to encourage the establishment of large camps. However, with the continued deterioration of the situation, particularly in the north of the country, more structured camps with capacities for over 5,000 families are being established in Mazar-e-Sharif in Balkh province. One of the primary reasons for this is that the host families with whom many displaced had been staying are simply no longer able to cope (IRIN-CA 22/06/01).
Central Region
There has been a significant reduction in the area planted with wheat, particularly in the east central provinces of Bamyam and Ghor. This is a result of insecurity and the poor irrigation systems (FAO/WFP 08/06/01).
Kabul City
The RNIS has no new nutrition information on Kabul. The last figures for numbers of displaced reported by WFP are from December 2000 and suggest numbers from 100-500,000 people (RNIS 32 and 33). No surveys have been conducted since October 2000, which showed relatively low levels of acute malnutrition (RNIS 32 and 33). ACF have indicated that they have seen the usual seasonal rise in malnutrition with the onset of diarrhoea during the summer months but the increase has not been greater than previous years (ACF 09/07/01).
There was a serious breakdown in relations between the Taliban authorities and WFP earlier in the year when the Taliban refused to allow WFP to employ women to conduct a survey of beneficiaries enrolled in bakery projects throughout the city. For a time it looked as though WFP would close the programmes affecting 282,000 vulnerable people, however a compromise was eventually reached. The incident sharply outlined the deterioration in relations between the international community and the authorities and raised fears of further reductions in humanitarian space (IRIN 30/05/01).
Eastern Region
The RNIS has received no new nutrition information from the eastern region but the last survey conducted in December showed uncritical levels of acute malnutrition and low mortality rates (RNIS 32 and 33). The FAO/WFP crop assessment mission indicate that the east has seen an increase in the irrigated crop area planted and that there has been an increase in wheat production, however the region continues to see influxes of IDPs and general countrywide drought conditions are likely to mean that the area remains vulnerable to continued food insecurity (FAO/WFP 08/06/01).
Southern Region
Rain fed wheat did not fair as badly in the south as in other areas but the area is considered to be a very minor producer. There is concern over the fate of farmers in the southern region who have established considerable debts as a result of the ongoing drought. As a result the UN is expecting further internal displacement as people are forced off their land. The RNIS reported 42,000 displaced in Kandahar in the last RNIS 32 and 33 and recent IRIN reports indicate that this number has increased considerably with as many as 23,000 families or 161,000 individuals currently displaced from traditional areas. The vast majority of these are Kuchi nomads (IRIN 14/06/01).
North Eastern Region
The RNIS has not received any recent surveys on the populations of the northeast but UN and NGO reports indicate that the situation remains extremely precarious. The province of Badakshan remains a front line between Taliban and opposition forces and fighting has forced many people to flee into neighbouring countries and further west into provinces such as Baghlan and Kunduz (IRIN 20/06/01). RNIS 32 and 33 reported a nutritional survey in Khodja Baodine, Takhar province which indicated relatively low prevalences of acute malnutrition but elevated mortality. Numbers in the camp have been increasing steadily with 300 families arriving in the week before the end of June this year (UN OCHA 27/06/01).
Northern Region
The northern region is arguably the area most affected by both drought and conflict related insecurity. WFP estimate that there are close to 33,000 families or 198,000 people displaced in the northern region (WFP 04/05/01) with many converging on large cities such as Mazar-e-Sharif in Balkh province in search of casual labour and charity.
Balkh Province
An estimated 14,000 families have entered Balkh province over the past six months all in search of some form of work, water and food. Balkh has always been regarded as an economic hub within Afghanistan but the pressure on resources from the influx of so many displaced is creating huge pressures for the communities already there (IRIN 21/06/01). The RNIS has no new nutrition information for the province, however a MEDAIR assessment of the Chemtal district to the south west of the province has highlighted the extremely poor situation. Access to health facilities in the region was found to be very poor with no doctors or health posts recorded. Access to food is very greatly reduced with the almost total failure of crops and with most of the livestock having been sold off or slaughtered already. Access and availability to water was highlighted as the biggest challenge to the area and coupled with the other factors the nutritional situation is likely to deteriorate (MEDAIR 07/06/01).
Faryab Province
The RNIS reported a very poor nutritional situation in Faryab province (RNIS 32 and 33) with confirmed cases of vitamin C deficiency (scurvy) and alarming crude and under five mortality rates. A recent survey in Kohistan district of Faryab province by SCF-US in April of this year indicated that although acute malnutrition was not yet a problem of public health significance with a prevalence of 7% acute malnutrition (W/Ht < -2 Z-Scores and/or oedema), including 1.1% severe acute malnutrition (W/Ht < -3 Z-Scores and/or oedema), the crude mortality rate of 2.6/10,000/day and an under five mortality of 5.9/10,000/day, were both significantly above emergency thresholds. The major cause of death for the under 5 children was measles (24%) followed by bloody diarrhoea (22%), and respiratory diseases (13.5%). The outbreaks of measles were especially worrying given the absence of health care in the district, and subsequently no routine EPI nor vitamin A distribution. The poor prospects for the next harvest, the lack of available coping mechanisms and the relatively high morbidity and reported mortality all suggest that acute malnutrition could increase substantially in the near future (SCF-US 10/04/01).
The survey reported that attempts to cope with the poor situation were almost exhausted and people were resorting to crisis strategies such as selling land, begging, taking very high interest loans or becoming displaced. The survey also reported very poor access to drinking water for almost all villages in the highlands (SCF-US 10/04/01).
The survey reported a reduction in the number of reported cases of scurvy with the peak having been in mid-December to mid-February. UN OCHA report that up to 5% of the population in affected areas had symptoms of scurvy. The presence of scurvy indicates just how poor the quality of the diet has been with people relying on tea and bread during the winter months when normally they would be eating a variety of foods including dried raisins, mulberries and tomatoes, all containing vitamin C (UN OCHA 24/04/01). The onset of summer months has seen a fall in the incidence of scurvy, with the population able to access some wild foods (SCF-US 10/04/01).
Western Afghanistan
Herat City
Herat continues to receive some of the highest numbers of displaced with between three to four hundred families arriving daily in April (IRIN 16/04/01). There are currently six camps around the city with the largest holding an estimated 120,000 people. Food distributions are ongoing with the sixth round of distributions taking place in the first week of July. However, as more and more people arrive the capacity to cope is severely strained. The need for adequate water and sanitation grows and in April there was an estimated shortfall of 2000 latrines in Maslakh camp raising fears about the greatly increased risk of epidemics (IRIN 16/04/01). In an attempt to cope with the increasing numbers a Registration Liaison Unit (RLU) has been established by international organizations to monitor and control numbers through the establishment of check posts outside of the city (WFP 22/06/01). The RNIS does not have any recent nutritional surveys from Herat but acknowledges the considerable aid effort currently being undertaken to provide the displaced with food. The sheer number of people, the poor sanitation and limited access to clean water, are extreme causes for concern and could lead to epidemic outbreaks.
Afghan refugees in Pakistan
Pakistan has been host to a sizeable Afghan refugee population for some years and as the crisis in Afghanistan continues to escalate, refugees continue to cross the border into the northwest frontier province of Pakistan, particularly around the city of Peshawar. Camps, such as Shamsha-too, Akora Khattak and Jalozai have been receiving refugees in large numbers since the beginning of the year. One of the most difficult problems facing the refugees in Pakistan is the increasingly hard line of the government. The Pakistani government has attempted to close its borders to further influxes of refugees and has sought to deport unregistered refugees in an attempt to gain some control over the huge numbers of recently arrived Afghans requiring assistance. There are estimated to be nearly 200,000 recently arrived refugees in the area (IRIN-CA 14/05/01).
The status of refugees in the camp of Jalozai has been the cause of much argument between UNHCR and the government of Pakistan who have refused to allow the registration and the systematic delivery of relief aid to more than 80,000 IDPs currently in the camp. The reason for this would appear to be the government’s determination and insistence to the international community that it is unable to provide for the refugees and that they ought to be returned and provided for within Afghanistan. This has resulted in a stalemate for much of the early part of this year. The government eventually allowed the WFP to access the camp in May to begin much needed food distributions which have continued up to the present day (IRIN-CA 24/05/01). Food distributions have been ongoing in the other camps of Sham-shatoo and Akora Khattak.
Plans for the refugees in Jalozai have developed and the government has granted permission for an official registration of the refugees to take place with a view to repatriating those that are able and moving those that are not to other camps. The screening was officially scheduled for the 21st of June but has been postponed (WFP 06/07/01).
The refugees in Jalozai are considered extremely vulnerable as a result of difficulties in access to the population. The latest nutrition survey results as reported in RNIS 32 and 33 were of concern. The RNIS does not have recent information but since the survey, general food distributions have occurred and access to the refugees has improved. However, a UNHCR report on the health of new refugees in Jalozai highlights high morbidity with respiratory infection and diarrhoea being leading causes of sickness. A heat wave has caused a number of related mortalities, however the mortality rates for both the general and under five population are within emergency thresh-olds (CMR 0.12/10,000/day and under five mortality 0.56/10,000/day) (UNHCR 15/05/01).
Afghan refugees in the Islamic Republic of Iran
Iran has been home to a huge body of long-term Afghan refugees and the last few months have seen upwards of 200,000 new refugees crossing the border into Iran. The majority of the refugees are fleeing the drought and the continued fighting. The government of Iran has expressed its concern at the numbers and the need for assistance to deal with the increased burden of refugees. An extensive registration of both documented and undocumented refugees was undertaken and the total has been given as 2.5 million, both new and old. The government has announced that all non-registered refugees will be considered illegal immigrants and will be refused the right to stay in the country (WFP 29/06/01). There is no nutritional information on the refugees in Iran but it is likely that nutritional status will decline as numbers increase without the resources to deal with them.
Afghan refugees in Tajikistan
Tajikistan has not received large influxes of Afghan refugees in the past although it is believed to be an important route for the transportation of drugs from Afghanistan via central Asia (IRIN 15/06/01). Despite the Taliban ban on opium production, considerable stock piles exist and the drug trade does still continue. The Tajik government has recently ordered all Afghan refugees out of the capital Dushanbe to outlying areas where they will be given temporary residency. Figures for the number of refugees are contested with the government claiming that 16,000 reside within the city and the Committee of Afghan Refugees claiming that there are only 4,000 with many of them being long term residents (IRIN-CA 24/05/01).
On the Afghan border there are two camps of about 12,000 Afghan refugees on two islands in the Pyandj river. Island #9 is the first camp with 9,000 people and island #13 with 1026 people. Aid to the refugees was stopped in March as a result of claims that food was going to fighters but it was resumed at the end of May after a UNHCR investigation (IRIN-CA 31/05/01).
The health and food needs of the refugees are being met and an AAH MUAC screening of all children under five years of age revealed extremely low levels of acute malnutrition in February. A more recent screening in April has revealed a slightly increased rate but still within acceptable levels. However AAH point out the deterioration in nutritional status has been rapid and there is a need to watch the situation closely (AAH 10/04/01).
At Afghan refugee camp post 13, a nutritional assessment/ screening exercise of all children under 5 years of age found that 7.8% of children between 6 months and less than 60 months were acutely malnourished (<125mm) in April 2001, as compared to 0.62% in February 2001. Although the overall rates are not alarming the rapid deterioration was cause for concern (AAH 10/04/01).
Overall
The first half of 2001 has seen the situation deteriorating within Afghanistan. The ongoing drought and fighting as well as the extremely poor economic situation in Afghanistan, has meant that many are simply unable to cope with the increasingly harsh situation. As a result internal displacement has continued and it is estimated that the number of internally displaced will reach one million this year. The RNIS does not have much new nutrition information but numerous situation reports, including the FAO/WFP crop assessment, all point towards a dramatic deterioration in the humanitarian situation with many people resorting to non sustainable, crisis coping mechanisms. For many the final option has been the abandonment of their land and the move to urban areas in the hope of obtaining some form of work and assistance. The humanitarian community has launched a considerable response to the crisis but is suffering from a reduction of humanitarian space as a result of poor relations with the Taliban authorities. Future prospects for the many displaced are extremely bleak and look set to deteriorate further. Further displacement is to be expected and a very considerable humanitarian effort is required to alleviate the crisis. Of additional concern is the general unwillingness of neighbouring countries to continue to accept and host increasing numbers of Afghan refugees within their countries, who therefore are at high/ moderate nutritional risk.
The relatively low rates of acute malnutrition in the Kohistan (Faryab Province) presents a very unusual situation of acute food insecurity, where coping mechanisms are near exhaustion, combined with outbreaks of very serious diseases like measles, which at the time of the survey were not reflected in the prevalence of acute malnutrition. This raises several questions. There is no explanation as to why nutritional status does not reflect these events; either a fall in nutritional status of the population was imminent or there was a hidden means by which nutritional status of young children was being maintained. For example, high quality or preferential care for younger children and or undiscovered food or income sources. An interesting question for the RNIS is whether adult nutritional status is similarly unaffected by the prevailing poor situation or whether it is compromised at the expense of preserving child health.
Recommendations and priorities
From the RNIS
· Address the immediate emergency needs of displaced populations focusing on the provision of food, medical relief and water and sanitation.From the FAO/WFP Crop and Food Supply Assessment (FAO/WFP 08/06/01)· Conduct nutritional anthropometric surveys on adults to help determine the degree to which children are being preferentially fed at the expense of adults
· Rehabilitate the water supply and irrigation systems that are in a state of large-scale disrepair.From the SCF-US Survey Kohistan District, Faryab Province, Northern Afghanistan (SCF-US10/ 04/01)· Supply farmers with much needed agricultural seeds.
· Assess, monitor and respond to the short-fall in food needs (food gaps).· Assess the impact of the drought on coping strategies, in order to inform programming decisions.
· Provide complimentary food items (oil, pulses and blended food) to the general ration of wheat, to help prevent further out-breaks of micronutrient deficiencies.
· Implement emergency measles immunization up to the age of 12 years, combined with vitamin A distribution.
· Address health needs.
· Establish a standardised methodology for collecting and analysing data to allow for meaningful spatial and temporal comparison of data.
