United Nations System
Standing Committee on Nutrition

Asia - Selected Situations

Afghanistan Region

Ethnic divides have continued to run deep in Afghanistan over the past months. Attacks against personnel from humanitarian agencies have also been reported.

Fighting erupted once again in eastern Afghanistan between government troops and Padsha Kahn forces (AFP, 17/10/02). On the other hand, the three main factions in northern Afghanistan reached an agreement, which stipulated that police should be based in the cities and fighters should be disarmed (Reuters, 28/10/02). However, attempts to disarm the fighters have failed (Reuters, 16/11/02).

Northern Afghanistan remains plagued by factional and ethnic rivalries. Refugees are reluctant to return to the North, and some people continue to flee (AFP, 20/10/02). It seems that return has been achieved safely in some areas whilst in others return was prevented by human rights issues (UNAMA, 17/10/02). A body has been set up by Afghan authorities and UN agencies to address this problem. A survey of the camps in the western province of Kandahar, where those newly displaced from the north have recently arrived, revealed that the ethnic Pashtun were obliged by commanders of local fighting forces to leave their area (DPA, 20/10/02).

Violence and repression in western Afghanistan have been documented by Human Rights Watch. These include political intimidation, arrests, beating, torture and denial of the rights to freedom of expression. According to the report, members of the Pashtun community are specially targeted. HRW advocates reinforcement of human rights monitoring and protection, and an expanded presence of international peace keepers (HRW, 05/11/02). Ethnic unrest against the nomadic Gujur has also been reported in north-eastern Afghanistan, including physical violence, house burning and restricted access to markets (AFP, 31/10/02). 

The United Nations Security Council approved a one-year extension of the international force in Kabul (OCHA, 28/11/02).

The Interim Administration of Afghanistan has presented a working draft of the National Development Framework at the Implementation Group meeting, which brought together the government, donors, multilateral and NGO partners. Six priority national projects have been defined: National Solidarity and Emergency Public Works Programmes; Education and Infrastructure Project; Urban Infrastructure Project; Water Resource Investment Project; National Governance Infrastructure Project; and Transport Project. Allocations for human capital and social protection, physical infrastructure, and trade, investment, and rule of law/ security will be at the percentage ratio of 45:35:20 respectively (IAA, 12/10/02). President Karsai also called for a shift from humanitarian assistance through NGOs and the UN to reconstruction through state structures (UNAMA, 17/10/02).

The Asian Development Bank approved, for the first time since 1979, a loan for US$ 150 millions equivalent (ADB, 04/12/02).

Refugee and IDP movements

Since March this year, 1.8 m people have been repatriated to Afghanistan. The number of repatriates has dropped since August 2002 because of the prospect of a cold winter ahead (see table).

Assisted returns since March 2002, Afghanistan (UNHCR, 03/01/03)

It is estimated that 1.5 m people returned from Pakistan, 261,000 from Iran and 10,000 from Central Asia (UNHCR, 03/01/03). Four million Afghans remain outside the country.

UNHCR registered an increasing number of Afghans crossing back to Pakistan: 215 families were registered during the first week of October, compared to 100 in late August. This rise may be a consequence of hard living conditions returnees faced (USAID, 31/10/02). According to another source, 300,000 might have returned to Pakistan (DPA, 12/12/02).

According to UNHCR estimates, about 724,000 Afghans are still displaced throughout the country, which include 413,000 IDPs in the South, 124,000 in the Centre, 51,000 in the North, 70,000 in the East and 66,000 in the West (UNHCR, 03/01/03). Throughout 2002, 250,000 IDPs returned to their areas of origin under an assisted plan, whilst 200,000 returned on their own (UNHCR, 03/01/03).

New displacements to Kabul for economic reasons have been reported from the drought-affected province of Bamiyan (USAID, 31/10/02).

Winter plan

A special plan, which includes food, shelter, and non-food items components has been designed to assist vulnerable populations during winter (UNAMA, 28/10/02).

Vulnerable populations have been identified as:

• Indigenous people and reintegrated returnees who lives in isolated areas due to snow or other physical obstacles
• Returnees and IDPs who lack their own means
• Urban groups who live outdoors, in dilapidated public buildings, or in derelict houses
• The Kuchi nomads

Food beneficiaries will include 1.3 m people living in rural areas, 200,000 people living in urban areas and 200,000 newly displaced and returnees (see table). Depending on needs, between 72,000 and 500,000 people will be targeted with different shelter and non-food items (see table).

Winter programme beneficiaries (UNAMA, 28/10/02)

As of mid-January, the winter programme had started but had not been fully implemented (OCHA, 19/12/02). However, WFP had delivered 92% of the food requirements to areas inaccessible during the winter (WFP, 18/11/02).

Health

An outbreak of whooping cough has killed at least 61 children in Badakhstan province (AFP, 31/10/02). A UNICEF/CDC survey, carried out in Kabul, Laghman, Kandahar and Badakhstan Provinces showed a very high rate of maternal mortality (1,600 maternal death/100,000 live birth). Maternal mortality accounted for half of all deaths among women aged 15 to 49. In addition, the survey revealed that when the mother dies, a new-born infant has only a one in four chance of surviving until its first birthday. Maternal mortality rates varied substantially by region and between urban and rural areas. UNICEF/CDC recommended the establishment of health care services in remote areas, increased access to quality antenatal care, efforts to increase women's use of such services, and training of birth attendants, nurses and midwifes (UNICEF, 06/11/02).

IDPs and refugees settled at the southern border with Pakistan

After being denied entry into Pakistan, about 50,000 people have settled in camps at the Pakistan border, in Spin Boldak district in the Afghan side and in Chaman area in the Pakistan side. An increase in the number of children's deaths because of cold weather has been reported in these camps (RFE, 06/12/02). Assistance to the Chaman area is made difficult by the status of the camp, defined as a "waiting area", when Pakistan refused to admit more refugees after February 2002. Aid agencies cannot provide refugees any assistance for long term stay. They were authorized to provide blankets but not stoves to heat tents (UNHCR, 09/12/02). People living in those camps are reluctant to relocate to Zarhe Dasht camp near Kandahar, although since mid-August, some 14,000 have been moved there (UNHCR, 05/11/02).

IDPS in Spin Boldak district, Kandahar province

A survey was undertaken by MSF-H in the five IDP camps of Spin Boldak district in September 2002 (MSF-H, 09/02). The prevalence of acute malnutrition was under control: 5.4% of the children surveyed were acutely malnourished, which included 0.3% with severe malnutrition; no children had oedema. The measles vaccination coverage was 69.2%, according to mother's statement and vaccination cards. It seems that there is a lot of business in the area and that therefore IDPs may find job opportunities. WFP general food distribution was on-going but each family received the same quantity whatever the family size. The water supply was not sufficient and sanitary conditions were not acceptable.

Refugees in Chaman area, Pakistan

MSF-H undertook a nutrition survey in Landi Karez refugee camp, Chaman, in July 2002 (MSF-H, 07/02). The camp was opened in December 2001 and the last influx of people was in April 2002. The results showed an average nutrition situation: the prevalence of acute malnutrition was 7.8%, including 1.9% severe malnutrition; 0.5% of the children had oedema. Refugees had few alternative sources of food and income other than relief aid. Regular food distribution was on-going and the water supply seemed to be sufficient, whilst hygiene practices were inadequate. Routine mortality surveillance indicated that mortality rates remained within an acceptable range.

Central Afghanistan

Refugee International raised awareness about the fate of returnees, especially in Kabul city. They recommend that donors accelerate shelter and cash and food for work projects, ensure that the national winter preparedness plan is fully financed and implemented and pursue emergency assistance at least for one year (RI, 04/12/02).

Northern Shamali plains and Southern Pansheer valley, Parwan and Kapisa provinces

A nutrition survey in northern Shamali plain, southern Pansheer, carried out in August 2002 showed a rate of malnutrition of concern: 13.8% of the 6- 59 month-old children were acutely malnourished, which included 1.7% severely malnourished (ACF-F, 08/02). The nutrition situation was better than in August 2000 and has remained stable since March 2001 (see graph).

Acute malnutrition, Northern Shamali plains and Southern Pansheer valley, Parwan and Kapisa provinces, Afghanistan

The slightly higher prevalence of malnutrition observed in August 2002 could be partly explained by the higher prevalence of diarrhoea during summer. Some 7% of the families surveyed were returnees; it does not seem that they were more affected by malnutrition than the resident population.

According to a food security survey done in the area in July 2002 (see RNIS 39), the population of the region, which was cut from the rest of the country during the war, has suffered severely from the conflict. Most of the families sold assets and contracted debts during the war and much of the infrastructure, such as irrigation systems, and even households have been destroyed in the frontline area. Water and sanitation were also a big issue. However, house reconstruction has begun. About 19,000 houses have been reconstructed in the Shamali plain. However, an additional 26,000 still need to be reconstructed (OCHA, 19/12/02).

Crude and under-five mortality over the past three months were respectively 0.68/10000/day and 1.19/10000/day, reported to be far less than in August 2000. This fact was partly explained by a better access to health services, mostly provided by NGOs.

Visible goitre affected a very high percentage (64%) of the women surveyed. Measles vaccination coverage was 11.9% according to vaccination cards and 84.1% when mothers' statement was also taking into account.

The prevalence of malnutrition in the area is among the highest recorded in Afghanistan, from the nutrition surveys which were made available to RNIS in 2002.

Northern Afghanistan

Mazar-e-Sharif

Mazar is the main city in northern Afghanistan. The city has seen a large influx of people from surrounding areas hit hard by conflict and drought in 2000-2001. As of August 2002, IDP camps were almost empty but a significant number of IDPs had settled in houses. A survey was undertaken by ACF-F in early September 2002 (ACF-F, 09/02). About 6% of the households surveyed were displaced and 7% were returnees. The prevalence of acute malnutrition was 7.2%, which included 1.0% of severe malnutrition; this was higher than in March 2002 (see graph).

Acute malnutrition, Mazar-e-Sharif, Afghanistan

This fact was largely attributed to the extremely poor sanitation situation in the city, and an increase in the prevalence of diarrhoeal diseases during summer.

Crude and under-five mortality rates were under control and have remained in the same range since 2000. Measles vaccination coverage was 90.6%, according to vaccination cards and mothers' statement.

Visible goitre was recorded in 3.1% of the women surveyed.

Sar E Pul province

A nutrition survey was carried out by ACF-F in Sang Sharak district, Sar E Pul province in September 2002 (ACF-F, 09/02). The prevalence of malnutrition was average, whilst the under-five mortality rate was above the acceptable threshold (see table).

Acute malnutrition and mortality, Sang Charak district, Sar e Pul province, Afghanistan, September 2002 (ACF-F, 09/02)

Most of the children surveyed were from resident households. The prevalence of malnutrition was twice as high in the current survey than in March 2002, although confidence intervals overlapped. The increase in the rate of malnutrition was primarily attributed to high malaria and diarrhoea exposure during the summer. Several food distribution projects were implemented in the district throughout 2002. Some 14% of the mothers had visible goitre.

Samangan and Jwazjan provinces

Two nutrition surveys were undertaken by GOAL in Samangan and Jwazdan provinces in mid 2002 (GOAL, 04/02; GOAL, 06/02). The surveys targeted 0-59 months old children; the results are therefore not directly comparable with other surveys. However, the results indicated low levels of malnutrition, especially in Jawzjan province. Crude and under-five mortality rates were respectively 0.3/10000/day and 1.01/10000/day in Samangan province, and 0.28/10000/day and 0.76/10000/day in Jwazjan province. The measles vaccination coverage for children 12-59 months, according to mother's statement was 63% in Samangan province and 75% in Jwaajan province. In both provinces, about 70% of the households reported to have received relief food since October 2001. 3% and 10% of the women showed physical signs of goitre in Samangan and Jwazjan provinces respectively.

Western Afghanistan

Shadayee camp, Herat city

A MUAC assessment was carried out by MSF-H in Shadayee IDP camp in October 2002 (MSF-H, 10/02). At the time of the survey, the population of the camp was estimated at 16,500. All the children between 6 and 59 months old were surveyed. The results showed that a significant number of children had a low MUAC (see table).

Results of MUAC assessment, Shaidayee IDP camp, September 2002 (MSF-H, 09/02)

¹ Presence of oedema was not assessed

About 200 families were interviewed regarding food security issues. About 80% of the families interviewed reported that at least one of the family members was involved in an income-generating activity. However, half of the families also reported having sold assets to buy food in the four weeks prior to the survey. General food distribution was on-going. Water supply seemed adequate whilst sanitation was poor. The main reason for staying in the camp was that people had nothing left in their villages (41%).

Overall - The nutrition situation seemed mixed. Whilst the situation is under-control in some regions where nutrition surveys have been done (category III), the nutrition situation was not satisfactory in Shamali plain and in some of the IDP/refugee settlements (category II). Winter is challenging, especially for the returnees.

Recommendations and priorities

From the MSF survey in Spin Boldak IDP camps:

• Improve sanitation in the camps
• Implement food ration distribution according to family size
• Consider health intervention in IIRO and WALMY camps
• Address the vaccination coverage issue

From the MSF-H survey in Landi Karez refugee camp, Chaman district, Pakistan:

• Implement food distribution survey
• Continue the treatment of severe malnutrition through the Basic Health Unit
• Strengthen community basic health education

From the MSF assessment in Shaidayee camp:

• Continue the food distribution
• Implement distribution of non-food items, such as blankets, clothes
• Organize repair of damaged shelters
• Improve maintenance of the latrines
• Implement a comprehensive survey about conditions of return of the IDPs

From the ACF survey in Sang Charak district:

• Strengthen health services
• Implement malaria prevention
• Increase access to iodised salt

From the ACF survey in Shamali:

• Continue TFC and SFC programmes
• Improve access to water in relevant areas
• Address the issue of goitre and cretinism