Health Intelligence Network for Advanced Contingency Planning (HINAP)
".... The Goma refugee problem pointed out that epidemiological, nutritional, environmental, economic, and social information required to effectively mobilise resources was not available in a timely fashion..." (Professor Nancy Mock, Tulane University In: 'Public health crisis prevention, mitigation and recovery: Linking relief and development', March, 1996).
The Rwanda crisis of 1994, resulting in an estimated 50,000 deaths from cholera amongst refugees in Goma, and the subsequent repatriation of over one million refugees back to Rwanda in 1997, clearly demonstrated the need for advance health information and risk mapping for effective contingency planning. Deaths from preventable diseases would be avoided if vital health data were available in advance.
WHO intends to provide such vital health data proactively for decision making and planning purposes through development of the Health Intelligence Network for Advanced Contingency Planning or HINAP. An abundance of valuable information already exists but implementing agencies such as IOM, ICRC, UNHCR and NGOs such as MSF are obliged to contact various sources (e.g., different programmes and offices of WHO) for advance planning purposes. This is not only inconvenient, but may be impossible under emergency circumstances.
A core team at WHO in Geneva is working to develop an information management system for those involved in complex humanitarian emergencies with sudden population displacements. The project's major objective will be to consolidate, filter, organise and redistribute background information and existing data to the right people at the right time in an easy-to-use format (e.g., World Wide Web, regular hard copy bulletins, CD-ROM, email, faxback, etc.).
ADMINISTRATIVE COMMITTEE ON
SUB-COMMITTEE ON NUTRITION
Secretariat: ACC/SCN, c/o World Health Organization
20, Avenue Appia, CH-1211 Geneva 27, Switzerland
Tel: 41-22 791 0456 Fax: 41-22 798 88 91 Email: email@example.com
REPORTS ON THE WORLD NUTRITION SITUATION
Third Report on the World Nutrition Situation,
Update on the Nutrition Situation 1996, November 1996
Update on the Nutrition Situation, November 1994
Second Report on the World Nutrition Situation, Volume II, County Data, March 1993
Second Report on the World Nutrition Situation, volume I, Global and Regional Results, October 1992
Supplement on Methods and Statistics to the First Report on the World Nutrition Situation, December 1988
First Report on the World Nutrition Situation, November 1987
ACC/SCN STATE-OF-ART SERIES (SOA)
NUTRITION POLICY DISCUSSION PAPERS
Nutrition and Poverty, by S. Gillespie, N. Hasan, S. Osmani, U. Jonsson, R. Islam, D. Chirmulay, V.Vyas & R. Gross. November 1997 (SOA No.16)
How Nutrition Improves Report based on ACC/SCN Workshop held on 25-27 September 1993 at the 15th IUNS International Congress on Nutrition, Adelaide, Australia by S. Gillespie, J. Mason, R. Martorell. (SOA No. 15)
Controlling vitamin A Deficiency Report based on ACC/SCN Consultative Group Meeting held in Ottawa July 1993. Prepared by Gillespie and Mason, January 1994. (SOA No.14)
Effectiveness of Vitamin A Supplementation in the Control of Young Child Morbidity and Mortality in Developing Countries, by G.H. Beaton, R. Martorell, K.J. Aronson, B. Edmonston, G. McCabe, A.C. Ross, B. Harvey. December 1993. (SOA No.13)
Nutritional Issues in Food Aid Report of symposium on "Nutritional Issues in Food Aid" held at the 19th Session of the ACC/SCN in Rome, February 1992. Includes papers on the support of public works by food aid as a nutrition intervention, which age groups should be targeted for supplementary feeding, effects of supplementary feeding in the growth of children with infection, experiences of feeding programmes, and protecting refugees' nutrition with food aid. August 1993. (SOA No. 12)
Nutrition and Population Links - Breastfeeding, Family Planning and Child Health. Papers from the ACC/SCN 18th Session Symposium, held at UNFPA, New York, February 1991. Papers include "Nutrition and Family Planning Linkages: What More Can be Done?" by Sandra Huffman, "Reproductive Stress and Women's Nutrition by Reynaldo Martorell and Kathleen Merchant, "Breastfeeding, Fertility and Population Growth" by Roger Short, "Nutrition and its Influence on the Mother-Child Dyad" by Prema Ramachandran, and with final comments by Miriam Labbok, Barry Edmonston, and Beverly Winikoff. (SOA No. 11)
Nutrition-Relevant Actions - Some Experiences from the Eighties and Lessons for the Nineties Book developed from the original background paper for the ACC/SCN ad hoc group meeting held in London in November 1990. Proposes a framework for the analysis of policies and programmes affecting nutrition, before reviewing experiences during the 1980s in several countries, and moving on to consider options for improving nutrition in the 1990s. Complements and expands on Supplement to SCN News No.7. Prepared by Stuart Gillespie and John Mason, October 1991. (SOA No. 10)
Controlling Iron Deficiency Report of ACC/SCN workshop held in Trinity College, Dublin, June 1990. Focuses on iron supplementation and practical means of improving large-scale programmes. Also introduces fortification and diet change. Gives information from six large-scale programmes. Prepared and edited by Gillespie, John Kevany, and John Mason, February 1991. (SOA No. 9)
Managing Successful Nutrition Programmes Report of ACC/SCN workshop held at IUNS meeting in Korea, August 1989. Includes reports on 16 large-scale nutrition programmes, and summary of discussions on targeting, staff issues, community participation, management information systems, sustainability and replicability. Edited by Joan Jennings, Stuart Gillespie, John Mason, Mahshid Lotfi and Tom Scialfa, October 1990. (SOA No. 8)
Appropriate Uses of Child Anthropometry Report based on workshop held by ACC/SCN, June 1989. Basic concepts, uses for screening, growth monitoring, population assessment, and surveillance. Prepared and edited by G. Beaton, A. Kelly, J. Kevany, R. Martorell, and J. Mason, December 1990. (SOA No. 7)
Women and Nutrition Background, and papers presented at SCN Symposium, held at UNICEF, New York, February 1989. Papers include "Beating the Zero Sum Game" by McGuire and Popkin, "Reflections from India and Pakistan" by Chatterjee and Lambert, "Grameen Bank Experience" by Quanine, "Improving the Nutrition of Women in Tanzania" by Kisanga, "Nutrition Security System at Household Level" by Bajaj, "Issues in Need of a Global Focus" by Ghassemi, October 1990. (SOA No. 6)
Malnutrition and Infection-A Review, A. Tomkins and F. Watson, October 1989, reprinted June 1993 (SOA No. 5)
Women's Role in Food Chain Activities and their Implications for Nutrition, by Gerd Holmboe-Ottesen, Ophelia Mascarenhas and Margareta Wandel, May 1989. (SOA No. 4)
The Prevention and Control of Iodine Deficiency Disorders, by Basil S. Hetzel, March 1988, reprinted June 1993. (SOA No. 3)
Delivery of Oral Doses of Vitamin A to Prevent Vitamin A Deficiency and Nutritional Blindness, by Keith P. West Jr and Alfred Sommer, June 1987, reprinted June 1993. (SOA No. 2)
SCN NEWS- a periodic review of developments in international nutrition compiled from information available to the ACC/SCN, published twice yearly. Contains features, news and views, programme news, and reviews of publications (Free of charge)
No. 16, July 1998 - features: Nutrition of the School-aged Child; A summary of Working Group discussions, Oslo 1998; Abstracts from the Symposium on Challenges for Challenges for the 21st Century: a Gender Perspective on Nutrition through the Life Cycle
No. 15, December 1997 - features: Effective Programmes in Africa for Improving Nutrition; the 10th Annual Matin J. Forman Lecture: How are we doing in International Nutrition?
No. 14, July 1997 - features: The Nutrition Challenge in the 21st Century: What Role for the United Nations? Meeting the Nutrition Challenge: A Call to Arms; Update on the Nutrition Situation, 1996; Poor Nutrition and Chronic Disease Part II; Effective Programmes in Africa for Improving Nutrition.
No. 13, late 1995 - features: Interview with Dr A. Horwitz, SCN Chair, 1986-1995; Behavioural Change and Nutrition Programmes; and Poor Nutrition and Chronic Disease Part I.
No. 12, early 1995 - features: The Role of Care in Nutrition - A Neglected Essential Ingredient; Summary of findings from the recently published ACC/SCN "Update on the Nutrition Situation, 1994"; Specific Deficiencies Versus Growth Failure: Type I and Type II Nutrients; and Enrichment of Food Staples Through Plant Breeding. A New Strategy for Fighting Micronutrient Malnutrition.
No. 11, mid 1994 - features focussing on Maternal and Child Nutrition: Adolescent Growth; Prepregnancy Nutritional Status and its Impact on Birthweight; Maternal Nutrition During Pregnancy as it Affects Infant Growth, Development and Health; The Consequences of Iron Deficiency and Anaemia in Pregnancy on Maternal Health, the Foetus and the Infant; Impact of Maternal Infection on Foetal Growth and Nutrition; Maternal Micronutrient Malnutrition: Effects on Breast Milk and Infant Nutrition, and Priorities for Intervention; Vitamin A Deficiency in the Mother-Infant Dyad; Maternal Protein-Energy Malnutrition and Breastfeeding; and Maternal Nutritional Depletion.
No. 10, late 1993 - features: Nutrition and Food Aid, Nutrition and Human Rights, The Nutrition Transition.
No. 9, mid 1993 - Focus on Micronutrients. Features: Addressing Micronutrient Malnutrition, Micronutrient Deficiency - The Global Situation, Effectiveness of Vitamin A Supplementation in the Control of Young Child Morbidity and Mortality in Developing Countries, Zinc Deficiency - Is It Widespread but Under-Recognized?
No. 8, late 1992 - features: Highlights of the World Nutrition Situation, Food Prices and Nutrition, Food Security and Nutrition 1971-91 - Lessons Learned and Future Priorities, Long-Term Effects of Improved Childhood Nutrition.
No. 7, mid 1991 - features: Refugees' Nutrition Crisis, Breastfeeding, Birth Spacing and Nutrition, Community-Based Development - From a Programme Towards a Movement, Micronutrient Intakes, Incomes and Prices. Supplement: Some Options for Improving Nutrition in the 1990s - Reviews experience of policies and programmes, and grouping nutrition issues, leads to identifying options as building blocks for future action.
No. 6, late 1990 - features: Preventing Anaemia, Policies to Improve Nutrition - What Was Done in the 80s, Weaning Foods - New Uses of Traditional Methods, (out of print).
No. 5, early 1990 - features: Nutrition and School Performance, Uses of Anthropometry, Malnutrition and Infection (Part II), Flows of External Resources for Nutrition.
No. 4, late 1989 - features: Update on the Nutrition Situation, Women and Nutrition, Malnutrition and Infection (Part I), Targeted Food Subsidies, (out of print).
No. 3, early 1989 - features: Does Cash Cropping Affect Nutrition?, Nutrition in Times of Disaster.
Nos. 1 and 2, March 1988 - features: Vitamin A Deficiency, Urbanization, World Nutrition Situation, Economic adjustment (limited number of copies remain available).
COUNTRY CASE STUDIES
Brazil. The improvement in Child Nutritional Status in Brazil: How Did it Occur? by R. F. lunes & C. A. Monteiro. September 1993.
Egypt Review of Trends, Policies and Programmes Affecting Nutrition and Health in Egypt (1970-1990), by H. Nassar, W. Moussa, A. Kamel &A. Miniawi. January 1992.
India: Nutrition in India, by V. Reddy, M. Shekar, P. Rao & S. Gillespie. December 1992.
Indonesia: Economic Growth, Equity and Nutritional Improvement in Indonesia, by I. T. Soekirman, G. S. Idrus Jus'at & F. Jalal. December 1992.
Tanzania: Nutrition-Relevant Actions in Tanzania, by F. P. Kavishe. April 1993.
Thailand. Nutrition and Health in Thailand: Trends and Actions, by Y. Kachondham, P. Winichagoon & K. Tontisirin. December 1992.
Zimbabwe: Nutrition-Relevant Actions in Zimbabwe, by J. Tagwireyi, T. Jayne & N. Lenneiye. December 1992.
REFUGEE NUTRITION INFORMATION SYSTEM
Report on the nutrition situation of refugee and
Published every threee months with an interim electronic mail update.
PUBLICATIONS ORDER FORM IS OVERLEAF
ADMINISTRATIVE COMMITTEE ON
SUB-COMMITTEE ON NUTRITION
PUBLICATIONS ORDER FORM
My full postal address is:
PLEASE PRINT CLEARLY
First Report on the World Nutrition Situation (1987)*
[_] Supplement on Methods and Statistics to the First Report on the World Nutrition Situation (1987)*
[_] Second Report on the World Nutrition Situation, Volume I, Global and Regional Results (October 1992)*
[_] Second Report on the World Nutrition Situation, Volume II, Country Data (March 1993)*
[_] Update on the Nutrition Situation (November 1994)*
[_] Update on the Nutrition Situation, 1996: Summary of Results for the Third Report on the World Nutrition Situation (Late 1996)
[_] Third Report on the World Nutrition Situation (December 1997)*
[_] SOA No.2 Vitamin A (1987) (Reprinted 1993)*
[_] SOA No.3/od/ne (1988) (Reprinted 1993)*
[_] SOA No.4 Women's Role in the Food Chain (1990)*
[_] SOA No.5 Malnutrition and Infection (1990)**
[_] SOA No.6 Women and Nutrition (1990)**
[_] SOA No.7 Appropriate Uses of Child Anthropometry (1990)*
[_] SOA No.8 Managing Successful Nutrition Programmes (1991)**
[_] SOA Ho.9 Controlling Iron Deficiency (1991)**
[_]SOA No. 10 Nutrition-Relevant Actions - Some Experiences from the Eighties and Lessons for the Nineties (1991)**
[_] SOA No.11 Nutrition and Population Links - Breastfeeding, Family Planning and Child Health (1992)*
[_] SOANo.12/Nutritional Issues in Food Aidi (1993)*
[_]SOA No.13 Effectiveness of Vitamin A Supplementation in the Control of Young Child Morbidity and Mortality in Developing Countries (1993)**
[_] SOA No 14 Controlling Vitamin A Deficiency (1994)**
[_] SOA No. 15 How Nutrition Improves (1996)**
[_] SOA No. 16 Nutrition and Poverty (1997)**
Please send me the following Country Case Studies
[_] Brazil, September 1993
[_] India, December 1992
[_] Tanzania, April 1993
[_] Egypt, January 1992
[_] Indonesia, December 1992
[_] Thailand, December 1992
[_] No. 1 and 2, March 1988
[_] No. 8, late 1992
[_] No. 11, mid 1994
[_] No. 3, early 1989
[_] No. 9, mid 1993
[_] No. 13, late 1995
[_] No. 5, early 1990
[_] No. 10, late 1993
[_] No. 14, July 1997
[_] No. 7, mid 1991
Checking a box [_] means you will automatically receive this/these document(s) when available if you are requesting from outside Australia, Europe, Japan, New Zealand, North America. However, if requesting from within Australia, Europe, Japan, New Zealand, North America, checking this box means you undertake to remit US$10*/15** to the ACC/SCN upon receipt of each publication.
PLEASE SEND THIS ORDER FORM TO:
ACC/SCN, do World Health Organization, 20, Avenue Appia, 1211 Geneva 27, Switzerland
Tel: 41 22 791 0456 Fax: 41 22 798 8891 EMail: firstname.lastname@example.org
Or use the order form on our website at http://www.unsystem.org/accscn/
HINAP will focus on country situations where latent or low-level tensions have not yet attracted significant attention but could escalate. It could assist decision-making in order to spur preven-tative measures where possible, and contingency planning where necessary. Examples of information that could be collected for countries of origin and countries of asylum include:
· health data such as epidemic risks, incidence and prevalence of communicable diseases and vaccination coverage, nutritional status and country health profiles;Some initial HINAP data is expected to become available on the Web in late 1998. The address will be http://www.who.ch/eha/
· basic ethnographic data on populations at risk of displacement;
· capabilities of in-country NGOs and UN Agencies;
· description of the country's disaster plan, if any;
· level of health professional training in the country of origin which may help in recruiting and training of refugee health workers;
· logistics information such as warehouse capacity, price and availability of fuel, air and road access and telecommunications capacity;
· local and regional laboratory capabilities;
· in-country production capacity for and/or availability of drugs, jerry cans, cooking kits and other needed items.
This project is supported by the US State Department's Bureau for Population, Refugees and Migration (BPRM), the British Department for International Development (DFID) and the US Centers for Disease Control and Prevention (CDC). For further information, please contact:
Eric K. Noji, M.D., M.P.H., Senior Medical Officer and HINAP Coordinator, Division of Emergency & Humanitarian Action, WHO, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland. Tel: 41 22 791 2705/2754 Fax: 41 22 791 4844 Email: email@example.com
New UNICEF/WFP MOU
A new memorandum of understanding (MOU) between UNICEF and WFP was signed in February 1998. The MOU details the working arrangements between the two organisations with respect to joint activities in emergency and rehabilitation operations. The MOU applies where WFP and UNICEF have agreed to work as partners in situations caused by natural or man-made disasters where people remain in their country of origin, and includes internally displaced people.
In these situations, WFP and UNICEF provide a comprehensive range of services to safeguard the health and nutrition of the affected population, with an emphasis on the most vulnerable groups. This joint approach is designed to make optimal use of each agency's strengths. The cooperation will maximise the efficiency of the agencies while avoiding duplication of efforts.
Some of the objectives of the WFP/UNICEF collaboration are to prevent famine-related deaths and malnutrition - including mi-cronutrient malnutrition - and to restore or provide access to health services, water supplies, sanitation and other basic services for families, with particular attention to unaccompanied children. This collaboration is also intended to improve the condition of women, on the premise that strengthening opportunities for women is a major factor in overcoming hunger and poverty.
Specifically, WFP is responsible for assessing overall food needs and logistics and will mobilise and provide non-food items necessary for the transport, storage and distribution of food commodities. UNICEF will be responsible for mobilising and providing non-food items (e.g., food cooking equipment, emergency shelter material, soap). Food commodities will be appropriately fortified, and UNICEF will be responsible for covering any unmet micronutrient needs through supplement distribution or the provision of vitamin and mineral mixes.
UNICEF, in consultation with WFP will also identify requirements for strengthening caring capacity, access to safe water, sanitation, health services, and education. Both organisations will promote, protect and support breastfeeding practices in emergencies.
For copies of the WFP/UNICEF MOU please contact Diana Populin at WFP.Tel: 396 6513-2214 Fax: 396 6513-2817 Email: firstname.lastname@example.org
IDPs and the Human Rights Commission
At the 54th Session of the Commission on Human Rights (Geneva, 16 March - 24 April 1998), the report 'Further Promotion and Encouragement of Human Rights and Fundamental Freedoms, Including the Programme and Methods of Work of the Commission: Human Rights, Mass Exoduses and Displaced Persons' was presented. The addendum to this report, 'Guiding Principles on Internal Displacement', addresses the specific needs of internally displaced people (IDPs)1 worldwide by identifying rights and guarantees relevant to their protection. The Principles reflect and are consistent with human rights law, and are intended to be a persuasive statement that should provide not only practical guidance, but also an instrument for public policy education and consciousness-raising.
¹Internally displaced people are defined, for the purposes of these Guiding Principles as 'persons or groups of persons who have been forced or obliged to flee or to leave their homes or places of habitual residence, in particular as a result of or in order to avoid the effects of armed conflict, situations of generalised violence, violations of human rights or natural disasters, and who have not crossed an internationally recognised State border.' (para 2, Guiding Principles E/CN.2/1998/53/Add.2).Specific reference to food and nutrition is made in principles 7, 10 and 18. Principle 7 sets out one of the guarantees to be met when authorities undertake displacement after having ensured that no alternative courses of action exist. This is to ensure "that such displacements are effected in satisfactory conditions of safety, nutrition, health and hygiene, and that members of the same family are not separated." (E/CN.4/1998/53/Add.2). Principle 10 discusses the elimination of starvation as a method of combat. Principle 18 specifies that all IDPs have the right to an adequate standard of living which, at a minimum, means safe access to:
· essential food and potable water;Regarding humanitarian assistance, Principles 24-26 stipulate that all humanitarian assistance be carried out in accordance with the principles of impartiality and without discrimination. The primary responsibility for providing assistance rests with the national authorities - international organisations and others can offer their services in support of IDPs. Assistance will not be diverted, in particular for military or political reasons, and persons engaged in humanitarian assistance shall be respected and protected from attack or other acts of violence.
· basic shelter and housing;
· appropriate clothing;
· essential medical services and sanitation.
Source: 'Further Promotion and Encouragement of Human Rights and Fundamental Freedoms, Including the Programme and Methods of Work of the Commission: Human Rights, Mass Exoduses and Displaced Persons', Report of the Representative of the Secretary-General, Mr Francis Deng, submitted pursuant to Commission on Human Rights resolution 1997/39, and Addendum, 'Guiding Principles on Internal Displacment'. (E/CN:4/1998/53, E/CN.2/1998/53/Add.2, Resolution 1998/50). Both documents are available on the UNHCHR website at http://www.unhchr.ch/html/menu4/chrrep/98chr53.htm and http://www.unhchr.ch/html/menu4/chrrep/98chr53a2.htm, respectively, or from High Commissioner for Human Rights/Centre for Human Rights, Palais des Nations 8-14, Avenue de la Paix 1211, Geneva 10, Switzerland. Or, High Commissioner for Human Rights/Centre for Human Rights, United Nations New York, NY 10017, USA.
USAID's Results Review and Resource Request (R4) process
As part of USAID's1 management-for-results efforts, the Food For Peace/Emergency Division (FFP/ER) is monitoring progress in achieving its objective of meeting the critical food needs of targeted groups in emergencies. This is done through its Results Review and Resource Request (R4) process which assesses factors affecting programme performance and summarises progress made during the fiscal year. Thirty-five programmes implemented by the WFP, private voluntary organisations and government agencies in 24 countries, primarily in Africa, were included in the review process in 1997.
¹USAID's Office of Food for Peace, Emergency Division (FFP/ER), administers the U.S.Government's P.L. 480 Title II emergency food aid. Title II development activities related to food security with a primary focus on household nutrition and agricultural productivity are undertaken by the Development Division.Most programmes assessed (76%) in the 1997 review were responding to complex emergencies, and undertook such activities as general free food distribution or targeted feeding of the most vulnerable groups, supplementary and therapeutic feeding, food-for-work/agriculture, rehabilitation and monitoring. It is estimated that emergency food aid reached more than 11.5 million beneficiaries during the reporting period (data was not available from four programmes). Efforts are underway to coordinate more closely with the ACC/SCN on monitoring nutritional status of beneficiaries through the Refugee Nutrition Information System.
The assessment found that significant progress was made through new programme approaches in 1997. FFP/ER introduced innovative measures to meet the challenge of timely food aid delivery within the context of an established system which normally take 120-150 days. These include the use of USDA procurements to ensure the arrival of food grains within two months of the start of the procurement process, and the prepositioning of $5 million worth of commodities at US ports for immediate loading in case of a sudden-onset emergency. This has been used successfully to meet EI-Niño emergency food aid needs in Sudan, Somalia and Central America. Other measures are a two-year planning for long-term or complex emergencies with funding requirements reviewed annually against needs. This will enable implementing partners to better address 'transition' and longer-term issues like rehabilitation, improving the programme planning and approval process by introducing a proposal guideline and checklist, and a new standardised grant document.
Accomplishments and lessons learned are illustrated by country case studies and data on various performance indicators. Expected "results" of the R4 process include:
· improved targeting of food aid to the most vulnerable populations;For further information on USAID's Food for Peace Emergency Programs, please contact: David Garms, Emergency Division, Office of Food for Peace, USAID, 1300 Pennsylvania Avenue, Washington DC 20523, USA, Tel: 1 202-712-5834 Fax: 1 202-216-3039 Email: email@example.com
· delivery of food aid target groups on schedule;
· improved planning and implementation from relief activities to development, including specific attention to avoid the negative impacts of food aid in programme design and implementation ('do no harm');
· strengthened capabilities of cooperating sponsors and host country entities to manage emergency food aid.
Vitamin C Fortification of Food Aid Commodities: Final Report (1997) Institute of Medicine
Over the last five years, there has been considerable interest in micronutrient fortification of rations provided in international food relief programmes. In 1995, a pilot programme was initiated by USAID to increase the vitamin C content of corn-soy blend (CSB) and wheat-soy blend (WSB) from 40mg/100g to 90-100mg/100g (see also SCN News No. 15 p36-7).
This new report reviews and evaluates the pilot programme, determines the cost-effectiveness of scaling up vitamin C fortification, makes recommendations concerning the advisability of increasing vitamin C fortification and discusses alternative mechanisms for providing vitamin C to refugee populations at risk for vitamin C deficiency.
Scurvy outbreaks have been reported among refugee populations who are wholly dependent on emergency relief rations. With the exception of a mild recurring scurvy outbreak among Bhutanese refugees in Nepal, all other outbreaks in the past two decades have been among refugee camps in the Greater Horn of Africa (Ethiopia, Kenya, Somalia and Sudan). As only about 7% of all US-supplied fortified blended foods is designated for use in these countries, the Committee concluded that the costs of increasing vitamin C levels in all (100%) US-supplied fortified blended foods could not be justified, and suggested alternative approaches for the prevention of scurvy. These include providing vitamin C-containing foods (such as locally available fruits or vegetables, or tomato paste) as part of the emergency ration package, increasing access to local markets, and local fortification of commodities in the country or region where the emergency is occurring. Specifically, the report recommends that:
· the level of vitamin C fortification of US-supplied blended food aid commodities should not be increased;100pp. US $15 (in the US); US $18 (international). Copies are available from the National Academy Press, 2101 Constitution Avenue, NX, Box 285, Washington, DC 20055, USA. There is a 20% discount when placing orders through the National Academy Press Web online bookstore (http://www.nap.edu). The report is also available to download free of charge from the same website.
· health surveillance systems in refugee camps should be strengthened to monitor populations at risk of scurvy;
· populations at risk should be targeted with appropriate vitamin C interventions;
· the uniformity of the vitamin and mineral fortificant throughout the blended foods should be improved.
Acceptability and use of Cereal-based Foods in Refugee Camps (1998)
An Oxfam Working Paper by Catherine Mears with Helen Young
Episodes of scurvy, pellagra, and beriberi among refugees during the 1980s were a startling reminder of the inadequacies and failures of the international humanitarian response. Fortification of the cereal staple and the provision of a fortified blended food are key strategies identified for prevention of micronutrient malnutrition in refugee settings. This report publishes the findings of a study, conducted by OXFAM-GB and funded by Ml through CIDA, and UNHCR, to investigate the use and accept ability of fortified blended foods, and the feasibility of cereal fortification at the local level in three refugee situations (Nepal, Ethiopia and Tanzania).
The report was presented and discussed at the meeting of the SCN Working Group on the Nutrition of Refugees and Displaced People during the ACC/SCN's 25th Session in Oslo, 1998. The following is taken from the Working Group report¹.
¹ A full report of the Working Group meeting (see also page 25) is available from the SCN Secretariat, do WHO, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland. Tel: 41 22 791 0456 Fax: 41 22 7988891 Email: firstname.lastname@example.orgThe nutritional situation and nutritional content of the rations for each of the three sites are included in the report to give background and context. Summaries of preferences at each site between items provided in the ration are described. In addition, preferences among ration and non-ration food items are included. Differences in preferences were found to be related to differences in age of the consumer, potential for sale, familiarity of food type, cooking time required, cooking methods and type of meal. The study also conducted a preliminary assessment of the opportunities for fortification of cereals at different levels (household, camp, regional, national).
The main findings of the report are as follows.
· Regional-level fortification of cereals would require adequate milling capacity close to the population, a medium-to long-term commitment to this by donors, and considerable technical and management expertise.135pp. UK12.95; US $18.95. Available from Oxfam, c/o BEBC, PO Box 1496, Parkstone, Dorset BH12 3YD, UK or in the USA, from Oxfam, c/o Humanities Press, 165. First Avenue, Atlantic Highlands, NJ 07716-1289.
· Camp-level fortification of cereals would be most appropriate where the distributed staple grain is acceptable and consumed in milled form rather than as whole grain.
· Household-level fortification of cereals during pounding or grinding did not appear to be feasible. However, a fortification powder (premix) could be added to family meals during cooking.
· The evidence suggested that selecting a food vehicle for fortification should be context-specific. Factors that need to be assessed include: familiarity and food, resale and cultural value.
· No evidence emerged of rejection on cultural grounds of any of the blended foods investigated. In general, where blended foods were familiar, they were accepted, however unfamiliarity did not indicate low acceptability. The report highlights some technical and operational issues of quality control and timely supply of local products.