United Nations System
Standing Committee on Nutrition



 

RNIS 43, November 2003

ASIA - Selected Situations


Afghanistan Region

Insecurity has increased over the last three months. The number of incidents doubled between April and May and has since remained on a high level (AFP, 02/07/03). Attacks against western targets have especially increased (BAAG, 31/05/03). This prompted NGOs, the UN and the Afghan government to call NATO, which will take over the command of the International Security Assistance Force (ISAF) on 11 August 2003, to expand the ISAF outside Kabul (BAAG, 30/06/03; OCHA, 18/07/03). It was not the first appeal for ISAF expansion.

Following several years of drought, crop prospects are especially good for 2003 and the harvest is expected to be the best in 25 years (AFP, 12/06/03). Good rains, use of new high yielding varieties of grain and widespread use of fertilisers have all contributed to this performance. Parts of the south of the country may, however, still experience deficits.

WFP cereal pipeline is ensured until September 2003 (WFP, 13/07/03).

Refugees, returnees and IDPs

Refugee repatriation

According to UNHCR estimates, 200,000 Afghan refugees returned from Pakistan (facilitated by UNHCR) and 113,000 returned from Iran (67,000 facilitated by UNHCR and 46,000 on their own), over the first semester of 2003 (UNHCR, 11/07/03).

This is far below last year figures, when 1.1 m refugees returned over the same period (RNIS 38). Returns of Afghan refugees still raise concern among some NGOs which estimate that security and basic need services are not sufficient to allow the return of the refugees (AI, 06/03). In addition, the high returns caseload in 2002 (nearly two million) is still not absorbed by the country, which is just starting to recover from a 20 year war (see RNIS 41). Amnesty International also stated that some returns were the result of explicit or implicit pressures from the local or national authorities of host countries (AI, 06/03). Moreover, AI denounced forced repatriation from Iran (AI, 06/03).

Internally displaced persons

It is estimated that about 25,000 IDPs have returned home since the beginning of the year, with UN or NGO assistance (NRC, 01/07/03). According to different sources, the number of IDPs in the country varies between 300,000 (UNHCR estimates) and 600,000 (AI estimates) (NRC, 01/07/03). AI denounced the withdrawal of food assistance to Shaidayee and Maslakh camps. According to AI, the decision was taken in order to force people to move back to their area of origin and without taking into account IDP vulnerability. Shaidayee IDP camp was to be closed in a few months and IDPs not willing to return home were advised to relocate to the nearby Maslakh camp, where food distribution, however, also stopped (AI, 06/03).

Returnees vulnerability and sustainability of returns

A number of agencies stressed the fact that returnees still face hard living conditions. RI noted improvements of living conditions in rural areas compared to last year with improved shelter conditions and an increase in fields under cultivation. People's livelihoods have, however, not reached pre-war level and people complain they have no coping mechanisms possible were the harvest to be poor; they had lost most of their belongings, means of production and herds (RI, 09/07/03).

The situation seems to be far worst for the returnees who do not possess any house and/or land or who have difficulty claiming their properties, which is the case for a vast majority of the returnees (AI, 06/03). Disputes over land and property are one of the major current issues in Afghanistan. Unaccompanied women have the greatest difficulty claiming their properties.

Many people who did not possess land came to Kabul to try to find a job. The population of Kabul is estimated to have doubled over the past ten years. Many of the returnees could not afford to rent a flat or house because of the sharp increase of rent prices due to the influx of people. Consequently, they live in temporary shelters in abandoned buildings, sometimes in dangerous conditions.

Moreover, most of the shelter programmes have targeted people who can prove their property and donors are reluctant to found programmes in towns for fear of a rural exodus. It is, however, a fact that almost half of the returnees have settled in Kabul, in makeshift facilities for the most of them.

Lack of job opportunities also makes people's lives difficult. The government is however looking for increasing exportation of goods such as carpets, handicrafts, dried fruits, and nuts. In April, it had proved to be possible to export the same quantity of carpets as during the whole of 2002 (BAAG, 31/05/03).

From emergency to development

A mission conducted by the NGO "Urgence- Réhabilitation-Dévelopement" (URD) in early 2003, stressed that one of the most impressive facts, when compared to mid 2002, was the emergence of a state, even if ministries still faced major constraints. According to this report, one of the major challenges that NGOs must face is to shift from emergency programmes (even if they remain necessary in some locations) to mid-long term programmes, which should be sustainable by the Afghan structures. It seems that nutrition activities are well engaged in this process with increased co-ordination, and efforts to implement long-term strategies (URD, 02/03).

Maimana, Almar and Qaysar districts, Faryab province

A random sampled survey was undertaken in May 2003 in three districts of the northern province of Faryab (MSF-B, 05/03). The results showed an acceptable nutrition situation, which has gradually improved since 2001 (see figure). Admissions to the SFC and TFC implemented in the area have also regularly decreased since mid-2002, and MSF-B will close its nutrition programme.

Mortality rates have also improved over the past year but have remained high (see figure).

Prevalence of acute malnutrition and mortality rate - under-five children — Faryab province —Afghanistan

Faryab province used to be prosperous with production of wheat, barley, corn, sesame, grapes…The province was badly affected by the past years' drought. The 2002 rainfalls were good but the surface of land planted was restricted because of a lack of seeds and problems over land ownership.

Food security however improved between 2001 and 2002 and it was estimated that populations in Maimana and Qaysar districts would be able to cover 50-75% of their food needs, whilst people in Almar province would be able to cover 25-50% of their food needs, before the 2003 harvest (WFP/VAM, 2002-2003). The 2003 crop is expected to be very good.

Food distributions were implemented during the winter 2002. Few families, however benefited from them: from 535 families interviewed during the survey, about 12% received food distribution during the 2002 winter.

About 60% of the families in the rural Almar and Qaysar districts owned land; about the same percentage owned livestock. In the urban Maimana district, 18% of the families owned land and 25% owned livestock. About 40% of the families sold some property (animals, lands, household assets) since 2002-2003 winter and 60% still had a debt at the time of the survey.

Whilst the nutrition situation is at an acceptable level and the 2003 crop should be good, the population has not yet entirely recovered from the past years drought.

Refugees in Pakistan

Closure of the waiting area, Chaman

After being denied entry into Pakistan, following the closing of the border in February 2002, about 30,000 people have settled in a "waiting area", in the Chaman area, at the Pakistan border. Assistance to this camp has been made difficult by the status of the "waiting area" which was not recognized as a long-term settlement, and by insecurity (see RNIS 40). Following the decision to close the "waiting area" by mid-July, refugees were given the choice of either being relocated to an already existing camp (Mohamed Kheil) in Balochistan, Pakistan; being relocated to the Zhare Dasht camp near Kandahar in Afghanistan or returning home. Forty percents of the families made the decision to go to Pakistan, whilst 60% wanted to go to Zhare Dasht; only approximately ten families were willing to return home. The relocation took place between mid-May and mid-July (UNHCR, 14/07/03; RI, 30/06/03).

Balochistan - "new refugee camps"

Following the military action within Afghanistan and the fall of the Taliban regime in November 2001, a new flux of Afghans took refuge in Pakistan. Before the closure of the border in February 2002, about 250,000 were settled in new camps in Balochistan and the North West Frontier Province (NWFP).

Two randomely sampled surveys were carried out in the six camps of Balochistan, hosting new refugees, accounting for a population of about 120,000 refugees, in April 2003 (ACF, 04/03). Surveys were carried out in the camps near Chaman town (Dara 1, Dara 2, Roghani and Landi Karez) and in the two camps (Mohamed Kheil and Latif Abad) located further inland. Whilst all of the camps are located in arid plains, camps located near Chaman town are less isolated than the others, which are furthest from any city.

The results of the surveys show that the nutrition situation seemed to be under-control (see table) and was similar to the nutrition situation in late 2001. The under-five mortality rates were also below acceptable thresholds (see table); routine mortality surveillance indicated the same range.

Results of nutrition and mortality surveys, refugee camps in Balochistan, Pakistan, April 2003 (ACF-F, 04/03)

 

Acute
malnutrition (%)
(95% CI)

Severe acute
malnutrition(%)
(95% CI)

Oedema
(%)

Measles
vaccination
coverage* (%)

Under-five
mortality rate
(/10,000/day)

Dara 1, Dara 2,
Rhogani and Landi
Karez camps

4.5 (2.8-6.9)

1.3 (0.5-3.0)

1.0

75.8

0.7

Mohamed Khail and
Latif Abad camps

3.7 (2.2-6.0)

1.1 (0.4-2.7)

0.7

83.3

0.3

Basic needs in term of food security and public health seemed to be covered (see boxes), which may explain the acceptable nutrition situation found in the camps.

Immediate determinants of nutritional status and mortality, refugee camps in Balochistan, Pakistan, April 2003 (ACF, 04/03)

Food intake*
  Sources of food
   
75% from the food distribution
    20% (22%) from the market (At the camp shops for
      the majority of people interviewed)
    3% (5%) from loans/charity
  Number of meals/day
   
3 meals 70% (87%)
    2 meals 30% (13%)
  Food consumed beside the general food distribution
   
Fresh vegetables: 97% (100%) of the interview families
    Meat: 30% (78%) (in average once a month)

Diseases
  Most common illnesses are
    respiratory infections (33% of the consultations) and diarrhoea (10%)

Underlying determinants of nutritional status and mortality, refugee camps in Balochistan, Pakistan, April 2003

Household food security
  Food distribution
   
2,000 Kcal, 16% protein, 19% fat
    Regular monthly distribution
    Some families, arrived after March 2002, are not registered
    Trade of distribution cards
  Market availability
   
Shops selling vegetables, fruits and meat available at camp level
  Sources of income*
   
50% of the men had daily works (shopkeepers or teachers)
    70% (90%) of the women were making either handicrafts or whole thread
    11% (47%) have sold part of the food distribution
    5% have sold some of the distributed non-food items
  Assets*
   
Distribution of a basic set upon arrival (tents, mattress,
      blankets and kitchen set)
    Monthly distribution of charcoal
    Ad hoc distributions of clothes, shoes…
    23% (26%) of the families interviewed had livestock
    The majority (half) of the families had debts towards parents or shops
    The main use of the money was to buy food and some firewood in winter

Public health
  Health care
   
Basic Health Units in each camp (including nutrition activities)
    Referral system to the Chaman or Quetta hospitals
  Nutrition care
   
Screening for malnutrition in the BHU, but according
      to different criteria depending on the camp
    Supplementary feeding in some of the camps
    Treatment of severe malnutrition in Quetta hospital,
      which is not in accordance with WHO protocol
  Water

    Availability of drinkable water of 15 l/person/day,
      meeting the minimum standard
  Sanitation

    Availability of one latrine/20 persons, meeting the minimum standard
    Washing areas available
    Collection of waste water
    Damages of the structure due to inadequate use
  Hygiene and health education
   
Widely dispensed through home visiting or sessions
    Monthly distribution of soap

Social and care
 
Availability of community services
    (social mobilization, skills development, protection…)
  Availability of schools

*According to interviews of 30 people in Chaman camps, 23 people in Latif Abad and Mohammed Kheil (ACF-F, 04/03); first figures refer to Chaman camps, figures in brackets refer to Latif Abad and Mohammed Kheil

Overall

Despite a very good harvest in 2003, the fate of some of the returnees is worrying, especially those who do not possess any land and/or houses and have to live in makeshift facilities in towns and have difficulty finding jobs due to poor economic conditions. These people need continued assistance. Implementation of mid-long term programmes will also be crucial for the reconstruction of Afghanistan. The nutrition situation in three districts of Faryab province is acceptable (category IV), but people have still not fully recovered from the past years' drought. The nutrition situation among refugees in Balochistan province, Pakistan, who fled Afghanistan at the end of 2001/beginning of 2002 seems to be under control (category IV) and their basic needs seem to be covered. Assistance has to continue being provided.

Recommendations and priorities:

From the ACF-F survey in refugee camps in Baloschistan:

  • Continue to provide basic needs assistance to the refugees as long as repatriation is not possible under good and safe conditions

From the MSF-B survey in Faryab province:

  • Investigate causes of deaths

From the RNIS:

  • Provide assistance to the returnees, especially in terms of shelter, particularly in towns