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Research© 1995 RENE VERHAGE/HELPAGE INTERNATIONALHandgrip strength measurement in theChabilissa II camp, Tanzania 1995Nutritional status and handgripstrength in older refugeesSummary of research 1Arecent study set out to demonstrate the relationship betweennutritional status and handgrip strength in older Rwandanrefugees. The nutritional status of older people has beenrelated to functional ability and strength, and handgrip strength isthe most common assessment method for upper extremity musclestrength.Nutritional status is particularly relevant to the survival of olderrefugees and their dependants. Older refugees can be a particularlyvulnerable group, as living conditions are harsh and social networksmay have broken down, yet consideration of older age groupsamongst refugees is rare. Indeed,in Bosnia-Herzegovina,undernutrition was found to be absent among children whereas theprevalence in older adults was 10-20%. Similar figures ofundernutrition have been demonstrated in older Rwandan refugees.This particular study was set in a Rwandan refugee camp located inthe Karagwe district of north-western Tanzania, and took placebetween 1995-96 (post-emergency phase). A total of 413 men and415 women, aged 50-92 years, participated in the study. Weight,height, mid upper arm circumference (MUAC) and triceps skinfoldmeasurements were obtained using standard techniques. Forparticipants with visible kyphosis (curvature of the spine), heightwas estimated from armspan measurements using regressionequations developed from non-kyphotic subjects within the samesample. Handgrip strength was measured using a mechanicalhandgrip dynamometer. Information regarding physical activity andhealth status was obtained through interviews and clinical screening.The study observed that about 40% of the sample (of whom twothirdswere female) lived without a partner. The prevalence ofunder-nutrition was 19.5% in men and 13.1% in women and washigher in those over sixty years of age for both sexes. The olderrefugees were still quite active in the camp. More than 70% wereengaged in work in kitchen gardens and light household activities,while 42% took part in heavy household activities, such as fetchingwater and firewood. Men performed heavy household tasks andundertook paid labour significantly more often than women.Reported health problems were mainly of a chronic nature, such asdentition and vision problems, non-specific poor general health(self-reported), poor mobility and depressive symptoms. Womenwere significantly more likely to suffer from these problems thanmen.The study found that handgrip strength was significantly higher inmen compared to women (30.3 versus 22.3) and was significantlylower in each older age group in both sexes. Handgrip strength waspositively correlated to calculated body mass index (BMI) and armmuscle area (AMA). Individuals with poor nutritional status (BMI

ResearchInfant feeding in emergenciesSummary of research 1The public health importance of infant feedingin emergencies has been highlighted incountries such as Iraq and Bosnia wherefeeding infants with breastmilk substitute is commonpractice. Although there are few epidemiologicalstudies on the impact of emergencies on infantfeeding, many anecdotal reports of adverse healthoutcomes exist. The displacement of suchpopulations has created new dilemmas for aidworkers on how best to assess and support feedingpractice.During the 1999 Kosovo Crisis an opportunity aroseto research humanitarian interventions in infantfeeding in the Former Yugoslav Republic (FYR) ofMacedonia.Indicators, recommended by international health andnutrition organisations for assessing infant feedingpractice, were compiled and analysed to evaluatetheir consistency and applicability for use in surveysof emergency-affected populations. These includedmeasures of breast-feeding status, use of artificialfeeding, anthropometric status and morbidity. Inaddition, health and nutrition status surveysperformed on the resident or refugee population ofKosovo during the years 1996-1999 were reviewed tocompare their use of infant feeding and morbidityindicators.Comparison of standard indicatorsIndicators recommended by the World HealthOrganisation (WHO), UNICEF Multiple IndicatorCluster Survey (MICS) Indicators for GlobalReporting, Wellstart International ExpandedProgramme on Breastfeeding (EPB) and MeasureDemographic Health Surveys (DHS) were compared.This revealed a number of inconsistencies, both intarget population and measurement method.For example:• The recommended age-group in which exclusivebreastfeeding rate was measured varied betweenless than four months (WHO, UNICEF), and lessthan six months (EPB, DHS), thus limitingcomparability of data.• The standard indicator for timely complementaryfeeding, recommended by both WHO and UNICEF,refers to breastfed infants only. Thus in apopulation where a proportion of the infants aresolely artificially fed, they would be excluded fromthis assessment.• There is currently no specific definition ofdiarrhoea for infants under six months. The WHOstandard definition of acute watery diarrhoea (threeor more loose stools in 24 hours) closely resemblesthe minimum number of stools normal for aneffectively breastfed infant (three or more stools in24 hours). 2 This greatly limits the interpretation ofmorbidity data in young infants.• Timely initiation of breastfeeding is not included asa MICS global indicator and definition variesbetween DHS and WHO, and Wellstarts EPB.Use of indicators during Kosovo crisisThe use of recommended indicators during theKosovo crisis was inconsistent, with many nonstandardindicators and methodologies used instead.For example, a large inter-agency nutrition and healthsurvey, carried out in seven refugee camps in FYRMacedonia in 1999, included no standard indicatorson infant feeding, while an infant feeding andweaning survey of the returned population in Kosovoincluded only one recommended infant feedingindicator. Seven of the reviewed surveys measuredexclusive and predominant breastfeeding rates,however only two actually used the 24 hour recallmethod as recommended by the WHO.Age-groups for which feeding and morbidity datawere gathered also varied widely and infants undersix months were often not included in anthropometricor feeding practice assessments. In some cases,feeding practice of young infants was inferred fromdata gathered from older infants and young children.These limitations did not prevent comparison,interpretation or conclusion on infant feeding practicein survey reports. Conclusions appeared to be basedon field perceptions and experiences rather than onactual data collected.DiscussionAbove and below: standard feedingindicators do not adequately assessartificial feeding practices of a population.Refugee camp, FYR Macedonia, 1999© ANDY SEALThe authors suggest that the inconsistencies observedmay reflect a lack of awareness by personnel ofcurrent recommendations. The widespread use ofnon-standard indicators may also reflect gaps in thescope of current assessment tools in emergingemergency situations. Although many standard infantfeeding indicators have been developed and arewidely used in non-emergency settings (e.g. UNICEFBaby Friendly Hospital Initiative), in reality theyhave not yet been operationalised in the context ofemergencies. Also, current indicators have beendeveloped particularly to assess breastfeedingpractice but few recommend how to assess the extentand nature of artificial feeding in a population. Theuse of a number of non-standard indicators in Kosovomay have reflected a need to assess artificial feeding6

ResearchPopulation movements in an emergencychallenge needs assessments - includinginfant and young child feeding practices© ANDY SEALFactors influencing deviance ingrowth of children in rural West BengalSummary of MSc Thesis 1By Chandrashekhar Pandey and Rosalyn O'Loughlinpractice, for which standard indicators donot exist.Although the benefits of appropriate infantfeeding in terms of child survival are wellknown, the evaluation of aid impact interms of morbidity and mortality may notbe practical or feasible in emergencies.Impact indicators, such as morbidity andanthropometry, have particular constraintswhen applied to young infants.Furthermore, there may be many indirectinfluences on infant and child feedingpractice in an emergency situation.Monitoring of the entire aid process isnecessary to evaluate impact, assignresponsibility and encourageaccountability. In particular, there is a needto broaden the field concept and practice ofevaluation to include process indicators(e.g. number of mothers enrolled in abreastfeeding programme) and outcomeindicators (e.g. breastfeeding rates) ofinfant and child feeding practice.RecommendationsThe authors conclude that during theKosovo crisis, an inconsistent approach toassessment and monitoring preventedconclusions being drawn about theeffectiveness of the international responsein protecting infant health and nutrition.Suggestions to improve future monitoringare made, including:• Recommended outcome indicators andsampling strategies for assessing infantand child feeding practice should bedeveloped and included in emergencyfield manuals for health, nutrition,logistics and donor personnel.• The scope of existing standard indicatorsis not sufficiently comprehensive toaddress all feeding issues in emergencysituations, particularly in relation toartificially fed populations. Furtherdevelopment and field testing of standardindicators for this population group isnecessary if appropriate and comparableassessments are to be made.• Ultimately, the presence of experiencedkey personnel in the field is essential toimplementing internationalrecommendations and guidelines. Thisrequires significant improvements in fieldtechnical support and, where resourcespermit, early field positioning of aninfant and child feeding co-ordinator inemergencies.1McGrath M, Seal A, Taylor A (2002). Infantfeeding indicators for use in emergencies: ananalysis of current recommendations andpractice. Public Health Nutrition: 5(3), 365-3722Evidence-Based Guidelines for BreastfeedingManagement during the First Fourteen Days,International Lactation Consultant Management(ILCA), 1999This study may have some relevance to emergencysituations where there is variation in the growthperformance of children enrolled in emergency selectivefeeding programmes (Ed).The term positive deviance has been used toidentify children who ‘...grow and develop wellin impoverished environments where mostchildren are victims of malnutrition and chronicillness’. 2 Negative deviants grow at the lower end of thegrowth spectrum and median growers grow at or aroundthe median of the growth spectrum. 2 The aim of a recentstudy was to identify the child-care, feeding behavioursand other factors associated with positive deviance in adeprived rural Indian community in order to improve thematernal and child health and nutrition programme runby the Child In Need Institute (CINI). MethodsA comparative study method was used. Growthvelocities were calculated for a sample (n=737) ofchildren, who had been enrolled at birth in the CINIprogramme in 1998 or 1999 (n=1500) using monthlyweight recordings from 6 to 24 months. Children wereclassified based on growth velocity as either positivedeviants >0.6 Z scores, median growers -0.3 Zscores or negative deviants 2 episodes 5 (6.9) 5 (7.7) 27 (36.5) 37 (17.6)Episodes of fever (n=210) (n=73) χ 2 tr = 6.0,p < 0.01None 49 (68.1) 37 (56.9) 35 (47.9) 121 (57.6)One or more 23 (31.9) 28 (43.1) 38 (52.1) 89 (42.4)Episodes of chest infection (n=210) χ 2 tr = 15.8,p < 0.0001None 52 (72.2) 41 (63.1) 29 (39.7) 122 (58.1)One or more 20 (27.8) 24 (36.9) 44 (60.3) 88 (41.9)Episodes of diarrhoea (n=210) χ 2 tr = 15.5,p

ResearchAngular stomatitis and riboflavin statusSummary of published paper 1Between 1990 and 1993, fear ofpersecution led 83,000 ethnicNepalese to flee from Bhutan torefugee camps in Nepal. Between December1998 and March 1999, reported cases ofangular stomatitis (thinning or fissuring at themouth angles) increased six-fold, from 5.5 to35.6 cases per 1000 per month. The highestrates were found in children and adolescents.This increase followed the removal of afortified cereal from food rations, withdrawnin January 1999 due to programmeconstraints. Consequently, the riboflavincontent of the daily ration fell from less than0.6 mg/day to 0.4 mg/day, well below theWHO recommended amounts of 1.35-1.8mg/day for adolescents.Angular stomatitis (AS) has classically beenlinked with deficiencies of riboflavin, other Bgroup vitamins and iron. Potential functionalconsequences of riboflavin deficiency inhumans include decreases in motor skills andattention span, and reduced absorption orutilisation of iron.In October 1999, 463 adolescent refugeeswere randomly surveyed to assess theprevalence of AS and the prevalence of lowconcentrations of riboflavin, folate, vitaminB-12 and iron. Interviews and physicalexaminations were made and blood samplestaken. Biochemical measures were used todetermine whether riboflavin status wasassociated with AS and to assess the potentialof using AS as a screening measure for lowriboflavin concentrations. Riboflavin statuswas assessed using the erythrocyteglutathione reductase (EGR) activitycoefficient (EGR is a riboflavin dependentenzyme).The main findings of the survey were that ASwas common (26.8%), the prevalence of lowriboflavin concentration was high (85.8%)and riboflavin status was associated with AS.Adolescents with AS had significantly lowerriboflavin concentrations than did adolescentswithout AS.The authors of the survey concluded that ASwas a good screening measure for lowriboflavin concentration. It had a highspecificity and positive predictive value (PPV)but a low sensitivity in detecting lowriboflavin concentration. Because PPVincreases with the prevalence of the condition,the PPV would be expected to be lower whereprevalence of AS is lower. The high PPV inthis survey (89%) shows that AS can be usedin conjunction with other relevant nutrientdata, e.g. data on the nutrient composition ofthe food basket, as a surveillance tool toindicate marginal riboflavin concentrations inrefugee or displaced populations. The lowsensitivity of AS, however, limits its utility asan individual screening measure for lowriboflavin concentrations.1Blank H et al (2002). Angular stomatitis andriboflavin status among adolescent Bhutaneserefugees living in south-eastern Nepal. AmericanJournal of Clinical Nutrition, vol 76, pp 430-435Severe angular stomatitisMild/moderateangular stomatitisScarred angular stomatitisPictures taken by research team members from UNHCR, WFP & LWF NepalMental health in emergenciesSummary of published papers 1,2Field Exchange has previously run articles onthe need to address the mental health of waraffected populations and to consider thepossible link between mental health, economic wellbeing and future food security. The importance ofmental health care during and following conflictappears to be increasingly recognised byhumanitarian agencies. For example, during 1995 inthe former Yugoslavia, 185 mental health projectswere being operated by 117 organisations.A recent article in the Lancet addresses the issue ofimproving psychosocial survival in complexemergencies. It illustrates how mental disorders aredifficult to measure and hence there are few robustdata that quantify their prevalence in war-affectedpopulations. Additionally, there are inadequatecomparative data on the prevalence of these disordersin stable low-income countries.Many mental health programmes have providedcounselling services based largely on tools developedin a western cultural context and have focused on theprevention and treatment of post-traumatic stressdisorder. Recently these services have been criticisedfor focusing on the medical disorders of individualsand failing to recognise that war and displacementare collective experiences that warrant communityresponses.Some researchers urge aid agencies to focus onsupporting the adaptive responses of communities todeal with widespread grief, anger, loss of identity andhelplessness. These emotions are normal humanreactions that are most commonly addressed throughreligious and cultural rituals, attention to continuedeconomic survival, and family cohesion. Ensuring alasting peace is probably the most effective externalintervention to support community restoration. Othersmay include support for rituals (such as reburials),employment, restoration of governance and a processto ensure justice.Public health programmes are often initiallyoverwhelmed by the task of reducing morbidity andmortality from infectious disease, malnutrition andinjuries. Thus, a phased approach to mental healthwould include an assessment of mental illness usingculturally appropriate tools, a study of communitycoping mechanisms, support to the communityadaptive systems and home-based care of thementally ill through local community basedorganisations.An example of community based mental healthsupport was described in the same issue of theLancet, through the work of the Amani Trust inMatabeleland, Zimbabwe. This local, nongovernmental,organisation rehabilitates survivors oftorture and of organised violence in the western halfof the country. Until 1987, civil war had raged inwestern Zimbabwe since independence, during whichtime 10,000-20,000 people are estimated to havedied. The Amani Trust initially approachedcommunities expecting to offer counselling services,in keeping with the western expectation that posttraumaticstress disorders would be the mostprevalent problem. However, it proved better to moveaway from one-on-one psychotherapy and instead,use traditional community conflict resolution, beliefsystems and public truth telling to restore socialfabric after community destruction.This community approach is reflected in Amani’sinvolvement with exhumations. Ancestral spirits arehugely important in regional belief systems inZimbabwe. For an ancestral spirit to protect a family,it needs an honourable funeral and a ritual in which itis officially inaugurated as an ancestor. The mainrequest made to Amani by community leaders andfamilies in rural districts has been for an interventionto appease the aggrieved spirits of people who hadbeen murdered and buried in unacceptable graves.This is how Amani first became involved inexhumations and for four years since, has beenworking with the same communities in five adjacentvillages in Gwanda district. Using longitudinal casestudies of communities and families, Amani assessthe consequences of exhumation and reburial fromcultural, psychological, individual and groupperspectives. The overwhelming perception offamilies and community leaders is that the processhad been both healing and progressive.1Toole M (2002). Improving psychosocial survival in complexemergencies. The Lancet, Vol 360, September 14th, pp 8692Eppel S (2002). Reburial ceremonies for health and healingafter state terror in Zimbabwe. The Lancet, Vol 360,September 14th, pp 369-3708

Minimum standards inpost-emergency phaseSummary of online published paper 1Supplementaryfeeding inZimbabweSummary of research 1ResearchIn the acute phase of complexhumanitarian emergencies,assessment data on service deliveryand health outcomes for interventions areincreasingly being gathered to develop anevidence base for policies. However, forthe post-emergency phase, there has beenlittle equivalent study and nocomprehensive programme guidelinescurrently exist. A recent study aimed toidentify associations between agespecificmortality and health indicators indisplaced people in post-emergencyphase camps, and to define theprogramme and policy implications ofthese data. It was hoped that the findingswould initiate a dialogue on minimumstandards for displaced people during thepost-emergency phase of complexhumanitarian emergencies.Between 1998 and 2000, the study teamobtained and analysed retrospectivemortality data for the previous threemonths in 51 post-emergency phasecamps in seven countries. The team alsocompleted field trips of 6-8 weeksduration to the following countries:Azerbaijan, Ethiopia, Myanmar, Nepal,Tanzania, Thailand, and Uganda.Inclusion criteria for camps were:displaced people residing in the campduring the post-emergency phase, lessthan 5% change in population size duringthe 3 months prior to data collection,camp population at least partly dependenton outside organisations for food aid andhealth care, and functioning healthinformationsystem.Multivariate regression analysis wascarried out using 18 independentvariables that affect crude mortality rates(CMRs) and mortality rates in childrenyounger than 5 years (U5MRs) incomplex emergencies. The results werecompared with recommended emergencyphase minimum indicators.The main findings were that recentlyestablished camps had higher CMRs andU5MRs, and fewer local health workersper person, than did camps that had beenlonger established. Camps that wereclose to the border or region of conflict,or had longer travel times to referralhospitals, had higher CMRs than didthose located further away or withshorter travel times. Camps with lesswater per person and high rates ofdiarrhoea had higher U5MRs than didthose with more water and lower rates ofdiarrhoea.The results support some policies andprogrammes that are already beingimplemented, such as provision of aminimum quantity of water and anemphasis on diarrhoeal diseaseprevention and treatment. Sphererecommendations include at least 15 L ofwater per person daily for drinking,cooking, and personal and domestichygiene during the emergency phase of acomplex humanitarian emergency.However, in the post-emergency phase,displaced people need water for morethan just survival as they return toaspects of settled lifestyles, such asagriculture, livestock care, and building.In this study, provision of more than 20 Lper person daily of water was associatedwith lower mortality rates in children.Hence the minimum standard for watersupply may need to be higher than 20 Lin the post-emergency phase.The study also identified factors whoseimportance has not been sufficientlyprioritised in guidelines and standards,such as the number of local health-careworkers per person and the distance thatcamps are situated from a border or areaof conflict.A consensus between internationalhumanitarian organisations, taking intoaccount budgetary constraints, will benecessary to establish optimum stafflevels in post-emergency camps. CurrentSphere recommendations should bereassessed, since it is likely that morehealth workers are needed in anemergency, than in a post-emergencyphase camp.The authors recommend that programmesin complex emergencies should focus onindicators proven to be associated withmortality. Humanitarian organisationsoften provide similar services in theemergency and post-emergency phases ofcomplex humanitarian emergencies,despite increasing evidence andconsensus that needs differ between thesephases.Research is needed to establish evidencebasedpolicies and programmes with theobjective of reducing mortality indisplaced people living in postemergencyphase camps. Spherestandards describe indicators andminimum standards for the emergencyphase of complex humanitarianemergencies, but a comprehensive andpractical set of minimum standards forkey indicators needs to be developed fordisplaced people in post-emergencyphase camps.1Spiegel P, Sheik M, Gotway-Crawford C,Salama P (2002). Health programmes andpolicies associated with decreased mortality indisplaced people in post-emergency phasecamps: a retrospective study. The Lancet.Published online November 19, 2002.http://image.thelancet.com/extras/01art11089web.pdfDuring the periods 1992-3 and 1995-6, a child supplementaryfeeding programme (CSFP) was used in Zimbabwe to combat childmalnutrition associated with times of drought. Evaluations in thepast have concluded that the CSFP was effective in preventing an increasein malnutrition among children under five years, especially during the1992-3 period. However, such evaluations made only cursory use ofavailable household survey data. A recently published article based on amore detailed analysis of household surveys presents evidence thatcontradicts previous findings.The objectives of Zimbabwe’s CSFP included feeding vulnerable children,so as to maintain or improve the nutritional status of children under five indrought affected areas and to assist in averting starvation-associated childdeaths. The CSFP aimed to provide children aged 6-59 months in all targetareas with a nutritious meal that met 40% of daily energy requirements and88% of daily protein needs. The official daily ration consisted of 66g ofmaize meal, 20g of groundnuts, 20g of beans and 12 ml of cooking oil.The programme comprised of wet feeding for five days a week, with localmothers providing the labour and water for cooking and cleaning up.Government and NGO officials managed the distribution and storage ofCSFP rations.Four nation-wide household surveys had previously been carried out inZimbabwe, one occurring at the beginning or towards the end of bothprogramme periods (1992-3 and 1995-6). Three of the national surveyswere implemented by government ministries with support from UNICEF,while the fourth was a poverty assessment study. Re-analysis of thesesurveys set out to establish the following:• the level of coverage of children under five in drought affected areasduring the two programme periods• the extent to which the CSFP reached children from poor andnutritionally vulnerable households, and how did this coverage compareto coverage of children from better-off households• the proportion of malnourished children who actually got fed by theCSFP.In order to check whether children from poor households got CSFPbenefits, several poverty indices were developed, based on income poverty,consumption poverty and asset poverty. Assessment was questionnairebased,although specific content varied from one survey to another. Usingmid upper arm circumference (the anthropometric index available in threeof the four household surveys), the proportion of currently malnourishedchildren receiving supplementary feeding was calculated.CSFP coverageIn establishing the CSFP coverage level (table 1), re-analysis observed that:• CSFP coverage was lower earlier in the life cycle of feeding programmeand rose towards the end.• Coverage was higher and more evenly spread in the 1992-3 period- theworst of the two droughts.• CSFP coverage was patchy, with between one-quarter and two-fifths ofareas without feeding programmes.• Even within those areas covered, large numbers of children were notreceiving supplementary feeding.On the positive side, the regularity of supplementary feeding of beneficiarychildren appeared high.Table 1 CSFP coverage of children under five according to household surveys,1992-3 and 1995-6Date of survey Proportion of Proportion ofunder fives in under-fives inCSFP for all CSFP whererural areas CSFP operationalOctober 1992 37.6% 45.7%March 1993 68.2% 69.0%Late 1995 23.9% 39.5%March 1996 28.0% 44.5%9

ResearchField articleTargeting vulnerable childrenWith the exception of the March 1993 surveyfindings, half or more of under-fives from poorand nutritionally vulnerable households were notenrolled in supplementary feeding. Coverage ofchildren from these households was lower in1995-6 compared to similar periods in 1992-3.Even in areas where CSFP was operational, largenumbers of children from poor and nutritionallyvulnerable households did not receivesupplementary feeding. It is not clear whetherunder-fives from poor households found it easieror harder to access supplementary feeding thandid children from non-poor households - theevidence is mixed. What is clear is that theprobability of children receiving or not receivingsupplementary feeding was not particularlydifferent between poor and non-poor households.CSFP impact on nutritional statusThe areas where CSFP was operational were notnecessarily where levels of malnutrition werehighest. Record keeping at feeding points onchildren’s nutritional status before, during andafter supplementary feeding was extremelyhaphazard. Large numbers of malnourishedchildren were not in supplementary feeding, evenin areas where CSFPs were operational. Lessthan half of malnourished children surveyed earlyin the life-cycle of both programmes were insupplementary feeding. Even at the height ofprogramme coverage in March 1993, one-quarterof children were not receiving feeding inoperational areas. Furthermore there was someevidence that malnourished children were lesslikely to be in the programme than other children.This could mean that the programme waseffective or that malnourished children had lessaccess. However, the reasons why children, evenmalnourished or poorer ones, did not attendremains obscure. One possible explanation putforward has been the opportunity cost to mothers.Disparate responses toneed in Southern AfricaBy Gaëlle FedidaSince 1993, Gaëlle Fedida has worked in humanitarian aid in a wide variety of countries,including Croatia, Burundi, Cameroon, Congo Brazzaville and Afghanistan. Now based inParis, she is in charge of the Food Aid Programme for MSF France operations.In this article, the author describes how recent experiences in Angola and Southern Africahave led her to challenge how the humanitarian community define and prioritise need inemergencies.Since 1995, MSF France has had a food aid cellat their headquarters in Paris. The role of thefood aid programme is to analyse underlying orcomplicating factors influencing MSF reliefoperations and, where possible, formulate operationalfood strategies. Areas currently under scrutinyinclude Sudan, Ethiopia, Kenya and Madagascar,where there is a recurring pattern of nutritionaldeterioration and, consequently, of MSF food aidintervention.Despite decades of experience in dealing withfamine, and increasingly clear insights into thepolitical factors which often trigger mass starvationand mortality, a dominant conceptualisation ofBlanket food distribution inBunjei, Angola, August, 2002© GAELLE FEDIDIA, MSF FRANCEfamine remains which relies on its explanation interms of natural disasters (e.g. drought and HIV). Itappears that political analysis still comes a poorsecond to the applied disciplines of meteorology andepidemiology, in terms of understanding causes andlack of solutions. This biased perception hasimplications for humanitarian interventions, and isreflected in our recent experiences and analysis of theSouthern Africa situation.The Angolan experiencePeace came to Angola in April 2002. As a result,MSF gained access to a population that hadpreviously been held captive by the fighting. InConclusionsA comprehensive evaluation of the CSFP impacton nutrition in Zimbabwe is not possible. No datawere collected at feeding points and noinformation is available on the regularity orquantity with which individual children were fed.Furthermore, it is inappropriate to move, as theoriginal evaluators did, straight into the analysisof impact indicators, while bypassing importantquestions about how many children got fed andwhat their socio-economic and nutritional statuswas.The re-analysis does show that the 1992-3 CSFPshould be distinguished from its successor in1995-6. Overall, programme coverage was higherin 1992-3, as was the proportion of malnourishedchildren who received supplementary feeding,especially in the latter part of the programme’slife cycle. However, the success of the 1992-3feeding programme was at best a qualified one.Even during peak coverage around March 1993,almost one-third of children, and one-quarter ofall malnourished children, were withoutsupplementary feeding.Children who were enrolled in the programmetended to get five meals a week and amongstthese, there is some evidence that feeding didprovide nutritional benefits.In essence, evidence from the household surveyscasts considerable doubt on previous evaluations,in particular claims that CSFP played a majorpart in controlling malnutrition rates andpreventing famine in Zimbabwe in 1992-3 and,especially, in 1995-6.1Munro L (2002). Zimbabwe’s child supplementaryfeeding programme: a re-assessment using householdsurvey data. Disasters, 2002, 26 (3), pp 242-261

Field articleBlanket food distribution inBunjei, Angola, August, 2002© GAELLE FEDIDIA, MSF FRANCEseveral locations, early rapid assessments 1 revealedrates of acute global malnutrition as high as 30% to35%, while severe acute malnutrition affected asmany as 15%. With 4.5 deaths per 10,000 inhabitantsper day in some areas (levels far above emergencythresholds), MSF rapidly expanded its programme tooperate in 12 out of the country’s 18 provinces. As aresult, an estimated 1.5 million people (including570,000 displaced) had access to MSF therapeutic,supplementary and blanket feeding programmes.The political players in Angola were quick tocongratulate themselves on achieving peace, andclaimed to be supporting it with food aid distributedin the camps reserved for UNITA 2 fighters. Overallthere were an estimated 85,000 demobilised UNITAfighters, together with 300,000 relatives, in 36government-managed camps 3 . Given the majorpolitical importance of the demobilisation, thesecamps were the first priority when international aiddistribution finally began - in July for the camps inthe north of Huambo province. However, for theremainder in need - the thousands of civilians whodid not have sufficient connection to the troops to beclassified as “families of demobilised troops” - thewait was much longer (Sept/Oct, 2002). Indeed, somewere still without food distributions at the time ofwriting this article (Nov, 2002). Furthermore, in thecamps of Chiteta and Esfinge Fazenda where MSFare operational, food distributions did not occurmonthly (more likely every 45 days), and distributedrations did not meet the standard 2100 kcalrequirement.The World Food Programme (WFP) did not mobiliseemergency resources to meet the urgent and growingneed, i.e. no emergency operation (EMOP) wasinitiated. Instead, the agency expanded its on-goingprogramme (PRRO 4 ), by 120,000 recipients in Juneand then by a further 80,000 in late October, when atleast 500,000 individuals in appalling conditionsbecame accessible. 5 Past experiences demonstrate thatthere are other agencies capable of deploying parallelfood pipelines alongside WFP, particularly whenthere are huge emergency needs. This was not thecase in Angola and, in spite of the tardiness andinadequacy of response, the WFP were the onlyagency to increase the volume of assistance for thisrapidly evolving crisis. Whilst MSF were notdependant on WFP for resources, the absence of anadequate food distribution network initially led MSFto deploy food aid (Unimix) to meet the obviousacute needs of the population.The Southern Africa appealAt around the same time but further to the east, anumber of food shortage alerts were made across theSouthern Africa region, and in July 2002, the WFPlaunched an international appeal (EMOP 10200).Worth $507 million, they aimed to assist 10,255,880people through a variety of food aid activities acrossthe region, from Malawi to Lesotho, includingZambia, Zimbabwe, Mozambique and Swaziland. InZimbabwe, the degree of economic and foodinsecurity did indeed reach alarming levels. However,in Malawi and Zambia, MSF did not encounteranyone starving to death. Although MSF was notoperational in the drought-affected areas of Zambia,rapid MUAC assessments in the south did not reveala problem. This view was later supported by nutritionsurveys (MSF Holland) in May 2002, which found3.5% global acute malnutrition (GAM) and 0.9%severe acute malnutrition (SAM) in the south, and3.9% GAM and 1.2% SAM in the west 6 . Surveysconducted by Oxfam in July also showed nonemergencylevels of wasting, ranging from 4.3-5.8%GAM and 1.2-1.9% SAM. 7In Malawi, the MSF therapeutic feeding centre in inChiradzulu, near Blantyre, did not receive any morechildren than usual (30-50 admissions per month),despite a reactivated screening strategy. Furthermore,rigorous and large-scale nutrition surveys since showthe prevalence of malnutrition remains largely belowcritical thresholds, despite the claim by many that the‘hunger gap’ would start by August 2002. Yet, theWFP is expending considerable energy in opening aregional office and an emergency logistics centre inSouth Africa, and continues to mobilise internationalopinion and funders for an emergency operation.Indeed, donors are responding quickly to the faminein Southern Africa, with $362.7 million contributedto WFP since May 8 . In stark contrast, the WFP hasreceived only $86 million for Angola since April2002. Experiencing peace for the first time in years,Angola is expected to redirect its oil dividends from awar economy into social services for the well beingof its population as, it is argued, “the country is rich.”Analysis of aid responseWhat are the factors that contribute to these faminealerts in southern Africa and ultimately, lead to suchdisparity of response in the face of evident need? Onefactor may be that the early warning systems, inoperation since the 1980s and specifically intended toavert famine, are anchored in the national agriculturalinformation systems. As a result, the most objectivedata are meteorological, whilst the agricultural data(estimates of cultivated cropland and of harvests)come from local ministries and are of questionableaccuracy. For example, over a period of three weeks,MSF observed a 20% reduction in the official cropestimates for the 2002 agricultural campaign inMalawi, although Ministry of Agriculture fieldpersonnel had no means to conduct any studieswithin such a short time frame. Yet, this officialinformation is used by relief agencies as a basis fordetermining the levels of food aid required. Questionsmust be asked about how and why this occurs.The explanation may lie in a form of stakeholderanalysis. For years, national governments have foundit increasingly difficulty to obtain structural economicaid. Some donors have simply put an outright halt tosuch assistance because of poor governance, whileagencies like the International Monetary Fund (IMF)have implemented draconian control mechanisms onauthorities and demanded repayment of budgetamounts that have, apparently, ‘evaporated withoutexplanation’. Under these circumstances, a nationaldisaster is the ideal occasion to generate massivefunds in a short time, and compensate for theshortfall.Donor government response may be understood in adifferent way. Western governments have often beennotoriously difficult to convince of emergency needs,even when a high prevalence of malnutrition can bedemonstrated, such as in Sudan. In some instances,this has resulted in very restricted food baskets withlimited amounts of cereal. The question, therefore,must be asked - why has there been such a readinessto respond in southern Africa, where most of the datasuggests that nutritional status has not declinedsignificantly? One explanation may be that donorsare trying to create regional stability, through theinjection of emergency funds into the countriesbordering the explosive Zimbabwe.The explanation regarding international nongovernmentalorganisations and United Nationsagencies may be more connected with theirsubstantial dependence on institutional financing.Declarations of “famine” are, therefore, a significant11

Field articlefinancial opportunity for them.There are more questions than answers here, anddemonstration or proof of the above hidden agendascannot be given. Ultimately, the disparity in responsebetween southern African and Angola undermines thecredibility of humanitarian action in the region.The ‘humanitarian imperative’MSF do not deny that it will be especially difficultfor some families in the southern Africa region tomeet their food needs this year, nor that we mustrespond to these needs. However, it is ourresponsibility to question the way these needs areanalysed and identified, and the way in whichoperations are mounted in response. There isdefinitely a crisis, but how large is it? Nowadays, itappears that in order to raise funds, you have to usethe word ‘famine’, and that such famines areconceptualised in terms of causes over which wehave no short-term control e.g. AIDS and drought.Some causes may lie, more uncomfortably, closer tohome. What about the responsibility of nationalgovernments to conduct a policy that ensuressufficient revenues for their rural populations? Whatabout the sale of strategic grain reserves in Malawiand the disastrous agrarian reforms in Zimbabwe? Weare presented with the indisputable argument of the‘humanitarian imperative,’ which seems to mean thatthe ‘needs’ declared by authorities as arising out ofnatural disaster are invariably justified and thereforemust be met by emergency assistance.MSF conceives of the humanitarian imperative inanother way. Needs must be evaluated in the fieldfrom an independent standpoint so assistance can beallocated impartially, i.e. according to priority needs.In 2002, this priority was clearly in Angola. Failureto make full use of good quality data, or to questiondata where quality is suspect, ultimately means thatresponses will be determined by the internal logic oforganisations and institutions. This cannot be anacceptable modus operandi for the humanitariancommunity.For further information, contact Gaëlle Fedida, Head ofOperations, Food Aid Programme, MSF France at: email:gfedida@paris.msf.org1Early assessment data are from unpublished figures fromMSF rapid assessments based on MUAC screening and newgrave monitoring. Whilst not ‘scientifically’ valid methods ofassessment (Ed), these data were considered to reflectobservations on the ground which were later substantiated byelevated attendance at feeding programmes.2Angolan rebel group, Unia O Nacional para a IndependenciaTotal de Angola (UNITA).3OCHA estimates.4Protracted Relief and Rehabilitation Operation (PRRO)5This figure is based on interviews with Eric De Mul, head ofOCHA. A subsequent USAID situation report in July 2002increased this figure to 815,000.6Global and severe acute malnutrition rates using weight-forheightz scores.7Oxfam surveys, July 2002: Choma: GAM 5.5 %, SAM 1.9 %;Monze: GAM 5.8 % , SAM 1.5 %; Mazabuka: GAM 4.3 %,SAM 1.2 %.8WFP resourcing update, www.wfp.orgPostscriptDisparate responses to need in Southern Africa: a WFP perspectiveby Judith Lewis, CoordinatorUnited Nations Regional Inter-Agency Coordination and Support Office in Southern Africa (RIACSO)WFP Regional Director for East & Southern AfricaThe United Nations World Food Programme(WFP) has worked for over 20 years in Angoladelivering food aid to the neediest people, evenduring the country’s darkest days when heavyfighting meant food had to be airlifted to millions ofembattled hungry people. In recent years, WFP hasfed, on average, one million Angolans each month,most of whom are internally displaced due to 27years of fighting. Throughout our presence in Angola,WFP has always stood by the Angolan people andstrived to reach the country’s poorest.As a result of the ceasefire agreement between thegovernment and UNITA rebels on April 4, 2002,WFP gained access to 60 new areas. These includedso-called Family Reception Areas, where families ofex-UNITA soldiers were entitled to receive food aidas part of a chance to start a new life. More than400,000 women, children and the elderly receivedfood in these areas. Six months later in December2002, WFP distributed food to former UNITAfighters.Now, hundreds of thousands of people are returninghome to start rebuilding their lives, and WFP isassisting them with basic food rations. We expect thenumber of people we feed to reach about 1.9 millionin the near future. However, several obstacles willcontinue to hamper efforts: near non-existentinfrastructure such as derelict roads, bridges andairstrips, millions of land mines, and most poignantly,scarce funding.When the peace treaty was signed, WFP seized theopportunity to move food quickly to help stabilise thepopulation. The fastest way to expand the number ofpeople we feed was to extend our current ProtractedRelief and Recovery Operation (PRRO) document.Preparing a new Emergency Operation (EMOP)would have taken longer, and at the end of the day,hungry people don’t care what the piece of paper iscalled, as long as they can eat. And that’s the bottomline. Our goal is to move food fast and efficiently tothose who need it. WFP distributes 85 percent of allfood aid in Angola, an indication of the continuingconfidence donors and the humanitarian communityhave in our ability to do the job quickly andeffectively.In Southern Africa, more than 15 million peopleacross six countries require food aid. Although thesituation is extremely severe, we have never declaredthe region a ‘famine’ zone. This is because the crisisis not one of widespread malnutrition, but rather oneof acute food shortages exacerbated by AIDS. WFP’sresponse is intended to save lives and preservelivelihoods so that people recover more rapidly oncethe acute emergency is over and are less vulnerable tofuture crises.Millions of people are unable to access their staplefood, maize. This is either because they lack thepurchasing power or because maize is simplyunavailable. This makes them vulnerable but does notmean that every single one of them is in imminentdanger of starving to death. Unfortunately manypeople survive by taking a variety of extrememeasures, such as selling off their meagre assets,taking their children out of school to work, eatingpotentially-poisonous wild fruits, migration andprostitution. Due to insufficient food aid, desperatelyhungry people across the region have resorted tothese measures to stay alive, initiating a downwardspiral of deprivation, extending the current crisis wellinto the future.The current crisis has been triggered by erraticweather patterns, structural economic problems, and,in Zimbabwe’s case, the land reform process amongothers. These factors have been clearly highlighted inevery WFP document issued since the agency becameinvolved in the crisis. As the world’s biggesthumanitarian agency, WFP strives to act beforepeople are pushed over the coping threshold. Our jobis to respond to emergency situations beforeemaciated images appear on television screensaround the world. WFP’s intervention has alreadysaved millions of people from starvation.However, one of the biggest challenges facing WFPand other relief organisations is the HIV/AIDs virus,which is wiping out an entire generation ofproductive men and women across southern Africa.In some countries, the agricultural sector has been sohard hit that recovery from the current food crisiscould be delayed. Simply put, if you don’t havepeople to plant crops, there’s not going to be anythingto harvest or eat. That’s why WFP’s response aims toaddress the impact of HIV/AIDS, as well as providefood to those who have nothing to eat.WFP and its partner organisations work hard to getassessments right. Three were carried out across theregion last year, and a fourth is planned for April/May. The last assessment in December involved ateam of more than seven internationally respectedorganisations, including the Regional AssessmentCommittee of the Southern Africa DevelopmentCommunity (SADC), FEWSNET 1 , Save the Children,the International Federation of the Red Cross,UNICEF, Food and Agricultural Organisation andWFP on a regional level, and on country-specificassessments, OXFAM, World Vision, Care, and inMozambique only, MSF. Local and donorgovernments also participated at many levels. These‘rolling assessments’ under the auspices of SADC arehighly sophisticated and involve the analysis of avariety of issues, including both food and non-foodcriteria. This unique process involves hundreds ofresearchers interviewing thousands of people.To further ensure transparency, not all assessmentpartners are involved in the implementing process,and therefore, have no self-interest in the outcome.WFP then bases its humanitarian response andprogramming on assessment findings.It would be interesting to have more informationabout the diversity of the assessment teams and theextent of fieldwork undertaken by MSF to reach theconclusions expressed in their article. More to thepoint, it is unfortunate that MSF has decided not tojoin the group of agencies that has been workingtogether to devise and conduct assessments in theregion in order to help strengthen analysis, butinstead, has chosen to remain on the outside, andcriticise.1FEWSNET: Famine Early Warning System Network12

News & viewsALNAP Annual Review 2002The ALNAP Annual Review 2002 1 provides asynthesis of the principal findings andrecommendations of evaluations ofhumanitarian action, completed and made available toALNAP in 2000-2001. Encompassing 46 evaluationsand 9 syntheses, it identifies crosscutting issues andtrends and the learning and accountability challengesfor those within the humanitarian sector, whetherpractitioner, policymaker or evaluator. The synthesisalso highlights the humanitarian sectors repeatedfailure to learn and implement lessons from pastexperience.The central theme of the review is learning within thehumanitarian system, including mapping of currentlearning mechanisms, an analysis of their strengthsand weaknesses, and key constraints to learning. Italso reviews learning mechanisms from other sectorsthat might be adopted or adapted to meet the specificcharacteristics and learning needs of the humanitariansector. The quality of individual evaluations isassessed using the ‘ALNAP Quality Proforma’. Thishighlights the strengths and weaknesses of currentpractice from conception and design, through theevaluation process, to the dissemination of findingsand implementation of recommendations.One of the main sectors evaluated was food aid andemergency agriculture (19% of the reports). Ingeneral this sector met the short-term objective of‘feeding mouths’, and successes were usuallyqualified. Problematic areas identified were rationlevels and inadequate attention to disadvantagedgroups, such as women and children. Water andsanitation, and health interventions were alsosuccessful in meeting their short-term objectives.Shelter, and in particular housing, was the leastsuccessful sectoral emergency intervention.In general, the evaluation reports tell of a job welldone, however a number of generic weaknesseswithin the humanitarian system are described by thereview. Overall, the quality of evaluation reports wasunsatisfactory. In particular, evaluation reports werepoor at explaining why interventions were successesor failures. Other problematic areas included failureto integrate short-term emergency objectives withlonger-term plans, poor co-ordination, limitedexploration of building on indigenous copingstrategies and the need to improve monitoring.Some keys to success were identified, includingdedicated staff, good needs assessment, and theability of international non-governmentalorganisations (NGOs) to work with well-establishedpartners. Dedicated staff were identified as central tothe success of humanitarian action. However theywere often hindered by agency institutional systemstypically fraught with poor communication,ineffective staff capacity building and inadequatetraining.A number of examples of good learning practicewere highlighted in the review, such as thedevelopment of common networks and sources oflearning, e.g. Reliefweb, Humanitarian PracticeNetwork and ALNAP. However, while the evaluationmechanism is well established in the humanitariansector, weakness lies in a failure to distinguishbetween learning and accountability approaches toevaluation. For example, external, independentevaluations (which may be undertaken primarily foraccountability purposes) are often not consideredconducive to learning at individual and team levels,while outside criticism is often handled defensivelyrather than constructively.Several constraints to learning in the humanitariansector were identified, in particular lack of clarity asto intervention objectives and desired outcomes, andpoorly defined responsibilities and relationshipsbetween individuals, teams and organisations. Inaddition, high rates of staff turnover create a severeobstacle to learning and knowledge transfer, whilemechanisms for cross-organisational learning arepoorly developed. Short-term funding, pressure tomaintain low overheads and competitive behaviouramongst organisations vying for profile and fundaccess, were considered the major barriers toeffective learning by, and within, the sector.Possible areas for action identified in the reviewinclude:Within organisations• Assessments of current organisational practices inlearning, knowledge management and training• Development of programmes to support learningand knowledge management• Need to commit to and prioritise learning, and worktowards culture of learning and self-criticalreflection.Across sector• Concerted action to reduce high staff turnover• Improved resource provision for learning anddevelopment of mechanisms to increase crossorganisationallearning, such as the Groupe URD(Urgence Réhabilitation Développement) approachused in Central America and ALNAPs LearningSupport Office in Malawi• Setting up of an annual sector award mechanism forinstances of outstanding learning practice• Development of an electronic library for the sector.Copies of the ALNAP Annual Review 2002, HumanitarianAction: Improving Performance through Improved Learning canbe ordered from the ALNAP Secretariat, ODI, 111Westminster Bridge Road, London SE1 7JD oralnap@odi.org.uk at £15 per copy (£12 to ALNAP members).1Active Learning Network on Accountability and Performance(ALNAP). Established in 1997, ≈is an international,interagency forum working to improve learning, accountabilityand quality across the humanitarian sector. Details of ongoingALNAP activities, new developments and publications can befound on ALNAP’s website http:\\www.alnap.org.International Code ofMarketing of BreastmilkSubstitutesMedicine inconflictFamine relief andhealth careThe International Code Documentation Centrewill hold its annual training course onimplementation of the International Code ofMarketing of Breastmilk Substitutes and subsequentrelevant World Health Assembly Resolutions inPenang, Malaysia from 14 to 23 September 2003.Intended for policy makers within nationalgovernments, the aim of the course is to supportgovernments in writing laws and other measures toimplement the International Code.Details and an application form can be found on theInternational Baby Food Action Network (IBFAN) website athttp://www.ibfan.org/english/activities/training/icdc01.htmlArecent supplement to The Lancet, entitledMedicine in Conflict, examines some of theeffects of conflict on individual health andhuman rights. It makes no attempt to becomprehensive, but presents an array of personalexperiences of those working in conflict zones.Topics range from mental health in Afghanistan andEast Timor, food shortages in North Korea, andreproductive health in emergencies, to gender-basedviolence in refugee settings, the link between warand infectious diseases, and the reality ofbioterriorism.The supplement is available free online, athttp://www.thelancet.com/journal/supplement/vol360/isss1/Medicine in Conflict. The Lancet, Vol 360, Issue 1, supplement(2002)The number of deaths caused by the ongoingdrought in southern Africa could be greatlyreduced by improving basic health care,according to the World Health Organisation (WHO).It argues that rainfall failure has triggered a crisis inhealthcare systems that were already suffering fromlong-term deterioration. Some countries in theregion, such as Malawi and Mozambique, arerunning health care systems on a budget of $10 perperson per year, so shortages of essential medicinesand other health supplies in health centres arecommon. Low salaries and difficult workingconditions for health care workers have led to a‘skills drain’, says the WHO. It suggests thatcountries, as well as distributing food aid, need tostrengthen their capacity to provide health care in theworst affected areas. Improving access to drugs andincreasing staff levels are key recommendations.Vass A (2002). Famine relief must also tackle health care.BMJ, Vol 325, 17th August 2002, pp 35513

News & viewsGenetically modified food inemergenciesEthiopia, Dried out maize harvestwith barely any crop on it© PIETERNELLA PIETERSE/CONCERNAn editorial in the Lancet draws attentionto the rapidly emerging issue of usinggenetically modified (GM) foods inemergency programmes. It highlights theZambian government’s decision to allow maizedonated by the United States of America (USA)to spoil in warehouses because it is geneticallymodified, despite the food crisis in the country.President Mwanawasa has even called GMmaize ‘poison’, saying he is not prepared “touse our people as guinea pigs”. In some areas,citizens have rioted and looted to get at thefood.According to the editorial, lack of safety is justone of the charges flying back and forth.Officials in the USA view the arguments asbaseless, pointing out that the donated food isthe same as what Americans have been eatingfor years. But critics claim that the USA ispromoting biotechnology companies, using theUN to do its protectionist bidding, andoffloading surplus food it cannot sell.Potential advantages of GM foods, achievedthrough improved crop protection, includeinsect and virus resistance and herbicidetolerance. Public health might be improved by agreater supply of hardier strains, or by productsthat have been enriched with vitamins andminerals. Disadvantages are that GM foods maythreaten biodiversity and decrease the richnessand variety of food. Also, farmers may becomedependent on chemical and biotech companiesthrough the use of sterile seed or chemicalproducts that would have to be purchasedannually. Health concerns include allergenicityand gene transfer, especially of antibioticresistant genes from GM foods to cells orbacteria in the gastro-intestinal tract.Furthermore, ‘outcrossing’, or the movement ofgenes from GM plants into conventional crops,may pose indirect threats to food safety andsecurity.The editorial states that recipients havelegitimate worries about being bullied intoaccepting something they perceive richernations to have rejected. According to the WorldHealth Organisation (WHO), all GM foodscurrently used have been assessed for safety and“are not likely to present risks for humanhealth”. But the editorial questions how soundthis evidence base actually is and suggestsconsumers are probably right to be sceptical atthe moment. Regulation varies from country tocountry, with no international regulatory system,and GM foods are produced in many differentways. WHO rightly cautions that foods must beassessed on a case-by-case basis and by mid-2003, the international food code (created bythe Codex Alimentarius Commission) isexpected to spell out specific principles forevaluating individual GM foods. The editorialconcludes that if these principles incorporaterigorous scientific analysis, particularly ofindirect effects on human health, and if theytake a holistic approach toward integrating thedisparate effects of GM foods, including theirsocial and ethical aspects, they will be animportant step towards strengthening theevidence for safety. Such evidence must bewidely communicated to people in thedeveloping and developed world alike.Lancet (2002): How safe is GM food? Vol 360, No. 9342,26 October 2002, editorial, pp 1261InternationalSummer School inForced Migration20037 - 25 July 2003: Oxford, UKThis three-week residential course provides abroad understanding of the issues of forcedmigration and humanitarian assistance.Participants examine, discuss and review theory andpractice, and develop communication and analysisskills useful for the workplace. Designed formanagers, administrators, field workers and policymakers in humanitarian fields, it combines lecturesand seminars with small group work, case studies,simulations and individual study.Course fees are £2300 sterling (incl. B&Baccommodation, lunches, tuition fees and coursematerials).For more information, contact the Summer SchoolAdministrator at Refugee Studies Centre, Queen ElizabethHouse, University of Oxford, OX1 3LA, UK.Tel +44 (0)1865 249745 or email:summer.school@qeh.ox.ac.ukNestlé’s demandson EthiopiaThe Swiss multi-national food giant, Nestlé,committed last week what may be the publicrelationsblunder of the decade, according to acommentary in The Lancet. Nestlé shocked many bydemanding from Ethiopia return of US$6 million thatthe company feels it is owed as “a matter ofprinciple”. In 1986, Nestlé bought the parent of aGerman company which the Ethiopian governmenthad nationalised in the 1970s. The government hadoffered Nestlé US$1.5 million (at today’s exchangerates) as compensation, but the company, using theexchange rate at the time of nationalisation, says thedebt is now US$6 million.The situation was brought to light on December 182002, in an Oxfam press release highlighting Nestle’sdemand. US$6 million would, Oxfam argued,provide safe water for 1.5 million families or antidiarrhoealmedicines for 750,000 children in one ofthe poorest countries in the world. In response, thereappeared to be some mellowing of the company’sposition, but not the principle that a debt wasoutstanding. Nestlé said they would invest anyrepayment proceeds in Ethiopia in a project that willbenefit the country. Last year, Nestlé made profits ofUS$3.9 billion.McNamee, D (2002). Commentary, The Lancet, Vol 361, Jan4, 2003, p12HIV/Aids,livelihoods andfood securityWith increasing concerns regarding theimpact of HIV/AIDS on people’slivelihoods, there is growing need to reorientateagriculture, food and nutrition securityprograms to take account of HIV/AIDS, and to fillcritical gaps in our knowledge where these exist.RENEWAL - the Regional Network on HIV/AIDS,Rural Livelihoods and Food Security - is a capacitydevelopment/action research initiative based in eastAfrica, which aims to foster proactive linkagesbetween national agricultural and public healthorganisations, and between academia and policymakers.The preparatory phase of this initiative is currentlyunder way in Uganda and Malawi, involving nationalmulti-sectoral stakeholder workshops that, in turn,generate priorities for action and for targetedresearch. Action research studies, focused on at leastone of the priority areas and directly involving localpartners, are selected and funded out of an ActionResearch Fund (ARF). Findings will be discussed insubsequent policy workshops. The initiative isfacilitated by the International Service for NationalAgricultural Research (ISNAR) and the InternationalFood Policy Research Institute (IFPRI).See the project website for more details(www.isnar.org/renewal) and the IFPRIs website for two linkedessays on AIDS and food security (www.ifpri.org/).

News & viewsNutritionNET: independentnutrition information exchangeBy Saskia van der Kam, chairperson of NutritionNet, and headquarters nutritionist in MSFHolland.Psychosocialtraining for aidworkersThe Refugee Studies Centre,University of Oxford, has releaseda revised second edition of theirpsychosocial training module, TheRefugee Experience. The 30-hour module,with associated resources, is designed tofacilitate the training of humanitarianassistance workers in response to thepsychosocial needs of refugees. Themodule targets the development of criticalcompetencies in the planning,implementation and evaluation ofpsychosocial programmes. Materials alsodeal with community participation, andcommunication and helping skills forhumanitarian workers.A range of topics are covered, including:• the effects of modern day conflict oncivilians• a cross-cultural understanding of theexperiences of refugees• an insight into gender issues forrefugees• the particular plight of refugee children.The module is available on the web, freeof charge:http://www.forcedmigration.org/rfgexp. Aprinted version (two manuals) and CD-ROM may also be available where webaccess is limited.The Psychosocial Group at the RefugeeStudies Centre has also produced anonline inventory of unpublished literaturethat allows ready access to project-relateddocumentation, exemplifying keymethods and principles of psychosocialinterventions. In addition, a researchguide on psychosocial assistance in aidand conflict has been developed whichlooks at key issues, interventions andresearch, and includes a review ofliterature not otherwise availableelectronically. See the guide online atwww.forcedmigration.org.For further information on any of theseresources, contact Maryannne Loughry, RefugeeStudies Centre, Queen Elizabeth House,University of Oxford, 21 St Giles, Oxford, OX13LA, UKemail: maryanne.loughry@qeh.ox.ac.uk tel: +44(0)1865 270268Evaluations of emergencynutrition programs haverepeatedly illuminated theneed for improvement in severaloperational areas including interagencyco-operation,communication, transparency andshared ownership of interventions.Humanitarian players need toshare information and experiencesin order to assure timely andappropriate action in nutritionalcrises.Attempts have been made toimprove communication betweennutritionists, field workers andpolicy makers. Whilst successful,the three-year run of NGONUT -a moderated e-mail exchange ofideas, question and answersbetween nutritionists - illuminatedthe need for a more extensiveforum of information exchangeand dynamic debate, and ademand for improved access togrey literature and distancelearning modules. NutritionNET,which is a web-based interactiveplatform, was created in responseto these needs.The aims of NutritionNET are toincrease the quality of nutritionand food security interventions bypromoting:• Coherent and consistent interorganisational policies- To contribute to policydiscussion- To promote transparency indecision making on all levels• Context specific guidance forstandards and strategies- To share context specificprogram strategies andprotocols- To share lessons learnedfrom field experiences• Capacity building indeveloping countries- To promote professionalinformation flow accessiblein developing countries- To promote networkingbetween individualprofessionals andorganisations- To disseminate informationof field staff, expert groups,policy makers• Active participatory learning- To participate in problemsolving- To facilitate subject specificin depth discussions andbuild data bases- To contribute to product(food, materials)development- To stimulate debateincluding differentperspectives e.g. disciplines• Discussions and disseminationof information in ‘grey’literature.As a working area rather than apure reference site, participantsactively contribute and respond tonew information and commentary,and can create their owndiscussion groups/clusters. Sharedinformation may range from thelatest news about emergencies andtechnical details onmicronutrients, to questions fromthe field and dilemmas about foodsecurity strategies. Moreover,professionals can advertise theirskills and identify potentialcolleagues, job vacancies andcourses.The benefit of a virtual meetingplace is that it is open toparticipants who are not part ofthe humanitarian aid ‘inner circle’of nutritionists. It also givesprofessionals from aid-recipientcountries the opportunity toparticipate in programmedecision-making andimplementation, and help developcontext sensitive strategies andprogramme accountability.There are a number ofcharacteristics of NutritionNET,which set it apart from many otherwebsites:Pure interactivity: Participantswork without the input of acommittee or board to check thevalue or quality of information.Specific expert groups may,however, be convened and workeffectively and safely, governed byinternal quality control.Subject driven: NutritionNET is aplatform to develop broader issuesaround nutrition and food security.It is hoped that it will evolve intoa regular first point of query forall those involved in nutrition andfood security interventions.User ownership: Responsibilityfor the operation and managementof NutritionNET lies completelywith participants themselves.Transparency: Processes aretransparent, since all informationand debates are directly shared onthe website.Independence: There is noparticular school of thinkingpromoted and all views areequally represented, without panelcensorship or donor influence(there is a broad funding base).The challenge of sharingAs a meeting place and a workingarea, NutritionNET must betreated as a safe zone. Participantsshould be able to challenge eachother and examine problems fromdifferent angles, without beingheld accountable or personallycriticised. There is no such thingas a ‘wrong’ answer, but onlyinteraction, exchange andlearning. Content quality iscontrolled by participants whotake the initiative, or not, torespond.During this first six months ofNutritionNET’s existence, therehas been much interest and use ofinformation available on the site.However there is a greaterhesitancy in contributinginformation. This may reflect fearof exposing lack of knowledgewith implications for personal andprofessional reputation. While thiscaution may be understood, it isonly through the contribution ofparticipants that nutritionalexperience and knowledge willaccumulate and become availableto others. With the development ofNutritionNET, sharing informationis now more of a mental challengethan a physical or logistical one.Can YOU rise to this challengeand dare to share?Join Nutritionnet athttp://www.nutritionnet.net or for furtherinformation or comment, contact Saskiavan der Kam, Nutritionnet Chairperson,email: saskia.vd.kam@nutritionnet.nl15

News & viewsShared experiences ofSouthern Africa crisisMalawi 2002, MedicalMissionaries of Marydistribute Concern fundedmaize to most needy inLilongwe© PIETERNELLA PIETERSE/CONCERNSummary of meetingBy Marie McGrath (ENN)On November 5th, 2002 a meeting wasconvened by MSF Belgium on the nutritionalsituation in Southern Africa. Representativesfrom Save the Children UK (SC UK), Oxfam GB,Action Against Hunger (AAH), MSF International,MSF Luxembourg (MSF Lux), MSF Belgium (MSFB), MSF Holland (MSF H), MSF France (MSF F),MSF UK, MSF Switzerland (MSF CH), and theEmergency Nutrition Network (ENN) were present.The impetus for the meeting was a growingperception that conflicting information was emergingregarding the nature and severity of the situation inSouthern Africa. The purpose of the meeting was toshare analyses and agency perceptions of the crisis, toidentify and explore any differences, and to build acommon understanding - with the aim of makingrecommendations for the future.To set the scene, an overview of the Southern Africacrisis was presented by MSF B. This was followed bya number of country-specific reviews by differentagencies, around which there were considerablediscussion and debate. The afternoon sessionfocussed on perspectives of the Angolan situation.Country reviews 1In terms of anticipated food shortages andpopulations affected in Southern Africa, it wasestimated that one-quarter of the population, nearly14.5 million people, in six countries (Zimbabwe,Mozambique, Malawi, Zambia, Lesotho, andSwaziland) were in need of food aid for the periodSeptember 1, 2002 to March 31, 2003. 2 In Angola, anadditional 1.4 million people were considered inneed. 3Summaries of agency experiences in Mozambique(MSF Lux), Zambia (MSF H), Zimbabwe (SC UK)and Malawi (Oxfam GB) highlighted, to varyingdegrees, increased livelihood vulnerability, decliningfood security, but relatively low levels ofmalnutrition. MSF-Hs review of the situation inZambia, for example, highlighted the considerableshortfall in maize supply, both through aid networksand government sources - a situation complicated byZambia refusing genetically modified maize inOctober. At the time of the meeting, nutritionsurveys 4 had demonstrated relatively low prevailinglevels of malnutrition. While MSF expected“pockets” of deterioration in nutritional status, OxfamGB’s experiences from the south were that copingmechanisms were already stretched (due to cropfailure), and the hungry season had started early.Although the rates of global acute and severe acutemalnutrition found in July 2002 were not atemergency levels 5 , they were higher than expected.Oxfam GB also described how HIV/AIDS was alsoimpacting on the population’s ability to cope, andrisk of infection was increased as women resorted tosex to secure food or income.How information was interpreted varied betweenagencies. Based on their experiences in Mozambique,MSF Lux expressed doubts over the predictednumbers in need and did not consider the situation acrisis, despite reports of deteriorating food security.However, SC UK suggested that there wasconsiderable variation between the north and south ofthe country. This view was shared by Oxfam GB,who voiced that the anticipated poor harvest andincreasing vulnerability of the population warrantedimmediate preventive interventions.The multi-sectoral and often complex influences ofindividual country situations were highlighted inreviews of both Zimbabwe (SC UK) and Malawi(Oxfam GB). SC UKs experiences in Zimbabwehighlighted how climatic, economic, political andsocial factors - not just land reform issues, had allcontributed to the emergency. Although prevalencerates of malnutrition have varied 6 , SC UK felt theprognosis until March 2003 was poor, with limitedexpectations for the winter harvest (estimated 40%reduction) and increasing government-imposed limitson NGO operational space. Meeting immediate foodneeds was only a stop-gap, and did not address theunderlying political and social reforms necessary toprevent the situation recurring - a point made byMSF, and reflected in SC UK and Oxfam GB’soutline of activities in regional advocacy andlivelihood support.In Malawi, Oxfam GB described how chronicpoverty, HIV/AIDS, erratic weather patterns (leadingto two consecutive poor harvests) and a steadydecline in national food security had all contributedto a crisis of livelihoods. Shortfalls in WFP funding(Emergency Operation (EMOP) only 50% funded),and limited supplies of expensive agricultural inputswere also compounding the issue. Estimatessuggested that 28.5% of the population (3.25 millionpeople) would be in need of food assistance for theperiod December 2002 and March 2003 7 . Althoughmalnutrition and mortality rates were low 8 at the timeof the meeting, Oxfam GB felt that multi-sectoralinterventions were essential to prevent furtherdeterioration.Outlining their recent experiences in Angola, MSFdescribed how, following the April 4th ceasefire,there was suddenly access to a population which hadbeen largely inaccessible for 3-4 years previous.Numbers presenting to MSF centres dramaticallyincreased and, between May and June 2002, MSF Bdoubled the number of feeding centres (30,000patients). Further indications of the scale of thesituation were reflected in a UN assessment in April/May 2002, which estimated 500,000 to 800,000people were affected by malnutrition. Also, aretrospective mortality survey, conducted in thefamine areas by Epicentre, showed that the situationhad passed the emergency threshold for almost ayear.By November 2002, the situation in Angola hadstabilised (malnutrition rates had fallen), but highmortality rates and poor vaccination coveragepersisted. A lack of harvest in 2002, considerableshortfall in the food pipeline supply to Angola, andinadequate funding of the WFP EMOP (27% funded)all contributed to an ongoing emergency situation.Furthermore, resettlement and closure of the FamilyQuartering Areas (FQAs) 9 , strongly promoted by theAngolan government, was placing agencies underconsiderable pressure to meet the needs of anincreasingly dispersed population.Topical issuesThroughout the day’s proceedings, a number ofissues emerged which were debated at length, inparticular, MSF’s experiences in Angola, howdifferent agencies quantify and define a crisis, thepoliticalisation of resource allocation in humanitarianresponse, and how information is communicated andinterpreted in a complex emergencies.The Angolan situationRegarding Angola, MSF voiced strong opinionsregarding the humanitarian response to the recentcrisis there. In particular, they felt that:* There was an unacceptably slow internationalresponse to this major crisis.• Delivery of essential aid to the population wasdelayed by 4-6 weeks, due to lengthy UNnegotiations at higher levels. In contrast, MSF hadsecured earlier access through negotiations at aprovincial level.• There was a lack of initiative and diversity amongstNGOs, with many operating as a homogeneousgroup within the UN system. According to MSF,this problem persists and could lead to a loss ofNGO neutrality and impartiality.• The WFP failed to grasp the scale and the urgencyof the crisis and although the WFP experiencedgenuine financial and logistical constraints, MSFfeel these did not entirely account for their slowreaction.• Considering the UN shortfall, more NGOs shouldhave become involved in food distributions.In response to the criticisms levied, a number ofagencies outlined their activities, which reflected thatAngola was a serious consideration for them evenbefore the current crisis. SC UK outlined their strongadvocacy role e.g. through the British OverseasAgencies Group (BOAG), demonstrating that Angolahas always been high on their agenda. It was alsocountered that strong co-ordination within the UNsystem had made several actions possible in Angola,particularly in light of the limited resource capacityof some agencies. In terms of food supply shortfalls,one unofficial source suggested that WFP were sopessimistic about meeting targets that they wereapproaching petrol companies to lobby donors forfunds, as any deterioration in the Angolan securityand food security situations might compromise accessto oil.16

News & viewsDefining a crisisMSF’s field experience of relatively low levels ofmalnutrition, which they initially thought might provecontrary to others, was shared by all those present.Based on these criteria, MSF felt the situation wasnot at crisis level. However, SC UK, Oxfam GB andAAH felt that elevated rates of malnutrition were nota pre-requisite for defining a crisis situation.‘Promising’ a famineThere were a number of interpretations of theappropriateness of the Southern Africa appeal, thelevel of crisis in Southern Africa, and whether thecrisis should have been defined as a famine. BothMSF and AAH felt the use of the term ‘famine’risked promising the world starving millions, while inreality, it has proved very difficult to predict theoutcome of the current fragile situation in SouthernAfrica. Furthermore, MSF suggested that potentially“crying wolf” at this point risked exhausting capacityto mobilise funds and response when a “real”emergency actually occurred. A case in point, theyfelt, was the Angolan situation which due to theSouthern Africa appeal, did not receive the level ofattention that it warranted.MSF also suggested that indicators of one type ofnutrition assessment approach should not be used todescribe or predict scenarios that they cannotaccurately measure. Thus, a food security assessmentcould not predict a famine with certainty.A different perspective was held by other agencies,such as SC UK and Oxfam GB. Rather thanpromising a famine, they felt the Southern Africaappeal anticipated a famine and could therefore beseen as ‘a preparedness measure’. As such, it wasjustified in securing resources to act before thenutritional situation deteriorated.CommunicationThe meeting questioned the extent to which NGOsshould use the media, and considered possiblerepercussions for other operations. For example, MSFfelt that the NGO instigated media attention aroundthe Southern Africa appeal negatively influencedcoverage of the Angolan crisis.All agreed that accuracy and transparency wereessential in any communications around anemergency. However, questions remained regardingthe aid communities’ capacity and required strategiesto maintain attention and mobilise resources forchronic emergencies.PoliticsConsiderable criticism was levied by MSF at the UNin Angola, in particular at how the UN framework foroperation allied humanitarian intervention andresponse too closely with political goals. MSFsuggested that since NGOs were co-ordinated by theUN system, they risked losing their own impartialityand neutrality. Furthermore, the high level of UNfunding in Angola gave them considerable controlover agencies, which may have discouragedfreethinking and action.Donor reluctance to fund interventions in Angola wascited as a problem by all agencies. Apparently, manydonors needed evidence of clear benefits beforecommitting funds and also argued that responsibilitylay with the Angolan government to use its resourcesto support its people. Many of those present at themeeting felt that this position was disingenuous, andwas a convenient smoke screen for the ‘political’basis of donor funding decisions.Validity of dataThe accuracy and interpretation of information wascalled into question, with particular reference to cropassessments in Malawi where predictions variedwidely from one week to another. For some, thisundermined the strength of the argument that a crisiswas looming. For others, irrespective of thedisagreement between figures or methods used (e.g.maize versus maize equivalents), there was enoughevidence to suggest a significant shortfall and aworsening trend. It was agreed that greaterstandardisation of assessment approaches wasneeded.ConclusionsGaining an insight into the rationale behind aidresponses and strategies in Southern Africa wasconsidered a valuable outcome of the meeting, andwas deemed essential to understanding diverseagency activities. Discussions also gave an insightinto the detailed conceptual frameworks and analysisthat underpin agency positions, communications andactivities in complex emergency situations.Irrespective of varying agency perspectives, andpersisting difficulties in ascertaining the level of“crisis” risk of different countries, it was felt that thesituation in Southern Africa was serious and likely todeteriorate. All of those present agreed that a similartype meeting, to share agency operational experiencesand strategies, would be valuable and should betimed for early 2003.1Country reviews were based on agencies experiences andactivities at the time of the meeting (5th November 2002).These may not necessarily reflect the situation current attime of publication.2Source of figures: USAID, October 4th, 2002. Anticipatedpopulation size affected and food aid needs are based onSADC (Southern African Development Community) FANR(Food, Agriculture and Natural Resources) assessmentsreleased on September 16, 2002.3Estimated figures have since been revised to 1.9 million byWFP (Dec, 2002)4Surveys in western (MSF-H) and southern Zambia (MSF-H,World Vision) have shown low levels of malnutrition, rangingbetween 3.3-4.3% global acute malnutrition and 0.7-1.2%severe acute malnutrition. The surveys covered variousperiods between May and July, 2002.5Oxfam GB nutrition surveys of Southern and WesternProvinces. Prevalence of global acute malnutrition

News & viewsEthiopia, Damot Weyde, December2002. Small whirlwinds add toerosion and soil degradation© 2002 PIETERNELLA PIETERSE/CONCERNEthiopia: another1984 famine?By Saul GuerreroSaul Guerrero has a background in Social Anthropology. He is currentlycompleting a Masters in Humanitarian Assistance at University CollegeDublin, while undertaking an internship with the ENN.This article is based on a review of recentliterature as well as a number of interviewswith humanitarian agency staff that have hadlong-term experience and knowledge of Ethiopia. Thebasic question that the ENN has tried to address inthis piece is ‘are we about to see another “1984” inEthiopia as various appeals have anticipated or havelessons been learnt which make this unlikely?’For almost a year, the government of Ethiopia and anumber of international organisations have beenwarning of widespread famine in the country, shouldthe international community not bring in sufficientfood aid to remedy the food-deficits left by the cropfailures of 2002. The result of erratic belg (short) andmeher (long) rains was a projected food deficit ofover 1.4 million MT for the first quarter of 2003,with the number of people requiring immediate foodassistance estimated at 11.3 million, or approximatelytwenty percent of the total population. Crop-failureestimates vary between regions, however the nationwideaverage is 15-20%. The impact of such failuresis even more significant in a country that is onlybarely self sufficient in the best of years. Nutritionalsurveys have demonstrated a serious situation insome areas, with 15% and 11% GAM (Global AcuteMalnutrition) reported in eastern Oromiya andeastern Tigray respectively. 1The scale of the situation has led many internationalagencies to compare the current situation with thehistoric famine that affected Ethiopia in 1984-85. Atthe heart of this comparison lie two main indicators.First, the estimates of people in need of foodassistance - a figure that stood at approximately 8million people in 1984 has risen to 11.3 million in2003. Secondly, the per capita income in Ethiopia hassignificantly declined from US$190 in 1981 toUS$108 in 2001, thus markedly reducing thepurchasing power of the population at large. Whilesuch statistics may not be sufficient for an accuratecomparison, the media attention that the presentsituation, is enjoying demonstrates the impact of suchcomparisons, and the paramount need to prevent arepetition of the traumatic 1980s experience. Alegacy of the horrors of 1984 may be that few havequestioned the real scale of the present situationwhile even fewer have attempted independentanalysis/estimates that may lead to lower estimates offood-deficits in the country than those in theEthiopian and UN appeals, and expose the uncertainbasis for the continual comparison with the events of1984.There are, however, certain comparisons with 1984that can confidently be made. These relate to theunderlying causes of the food crisis. Anne Callanan(who has extensive Ethiopia experience with the WFPand Concern) argued that climate-dependentagriculture, state-controlled land tenure, poorinfrastructure and high population density havecontributed immensely to both events, and moreimportantly, to the creation of a marginal and highlyvulnerable agricultural system in Ethiopia. Bothevents - the 1984 famine and the current food crisis -are also mainly the result of cumulative bad-harvestsdue to drought. “The cycles of drought” sayCallanan, “are coming closer and closer together; wecan count 1974 when there was obviously two, threedrought years before that because famine is never aresult of just one drought year. Then there was ‘84,which was again the end point of a five-year droughtcycle [...] the year 2000 was another extremely badyear and people are just not recovering”. The effectsof such droughts have been similar on all occasions;coping strategies are reduced, as cattle, personalpossessions and just about any marketable goods aresold or traded to satisfy short-term needs. “Save theChildren” explains Callanan, “have done a lot ofHousehold Food Economy Assessments (HFEA) inone particular area and they are documenting thegradual impoverishment of the population...HFEAsdivides people into wealth groups, and they areactually seeing shifts in people down through thewealth groups going from middle-income to poor andto very-poor”.While the succession of crop-failures prior to 2003,with all its effects on coping mechanisms, may becomparable to the 1984 experience, much haschanged in the way the government of Ethiopia, andperhaps more importantly, the internationalcommunity are responding to drought and its impacton the country. These changes - whether preventiveor in response to food-crisis - may prove vital in thecurrent situation.Dan Maxwell (CARE International) had this to sayon the subject; “the dimensions of the shock thattriggered the current crisis may well be comparable,but that is no reason why the humanitarian crisisneeds to be comparable. The shock, and the declinein domestic production - with all the knock-on effectsthis has for food access at the producer householdlevel as well as in terms of the market - may well beproportionately as big as what happened in 1984. Butthe entire emergency response has been geared topreventing the shock from translating into ahumanitarian disaster”. Maxwell identified a numberof mechanisms which have been introduced post-1984 and have been designed to identify and respondto recurrent ‘shocks’. Among some of the mostsuccessful are the Early Warning Systems (EWS)found working throughout Ethiopia, e.g. the USAIDfunded Famine Early Warning System (FEWS),which monitors a range of indicators of food securityincluding satellite imagery on crop and vegetationproduction. Similarly, the World Food Programme‘Vulnerability Assessment Mapping Unit’ and theEthiopian Disaster Prevention and PreparednessCommission (DPPC) monitor the food-security statusof regions throughout the country.The EWS have proven effective in identifying18

News & viewsproblems and in highlighting them sufficiently inadvance. Yet their signals do not guarantee aresponse. “The Early Warning Systems” saysCallanan, “were definitely sending out the alert in1999 and nobody was reacting at the time andcontinued to send out alerts in 2000 by which timethere was widespread suffering notably in Somaliregion. This time they are sending out the alertagain...”Another significant difference introduced in post-1984 Ethiopia has been the creation of theEmergency Food Security Reserve (EFSR) which iscapable of storing over 400,000 MT of food. Formany, including Maxwell, the EFSR has proved to beworking “better this time around [than in 1999-2000]” and thus could prove vital in addressing theidentified food-deficits for 2003. Yet, critics such asJohn Seaman (Save the Children, UK) have arguedthat the reserve has been repeatedly utilised andmanipulated for political purposes. Certainly thereserve has experienced a rapid decline in its physicalstocks from over 350,000 MT in early 2002 to anestimated 134,801 MT for March 2003. This declinehas jeopardised the stock which, if it does not receivestanding payments may cross the operationalthreshold of 100,000 MT when the delivery of furtherloans becomes impossible.Significant changes have taken place over the pasttwo decades on a wider political level which augur aDry river bed in ethiopia© PIETERNELLA PIETERSE, CONCERNdifferent outcome to 1984. The present Ethiopiangovernment appears more ready to acknowledge andact upon the crop-failures. This attitude is verydifferent from that of the Mengitsu governmentduring the 1980s. For Maxwell, this is noteworthy;“[Unlike the 1980s] the government in Ethiopia is nottrying to sweep it all under the rug [...] and there isn’ta war complicating relations with the donorcommunity or absorbing a lot of internal attention”.Callanan has also noted the impact of domesticpolicies on donor’s commitment. “The early 1980s”,says Callanan, “was the time of the Cold War andMengitsu was heavily supported by the Soviet Unionand of course the Soviet Union does not donatefood...and actually to get food at the time fromWestern donors was a big political battle”. Thispolitical reluctance to support Ethiopia no longerholds with a contextual change that, according toSeaman, makes the famine of 1984 and the currentsituation almost incomparable.All the positive developments since the 1984 faminedo not seem to have appeased the internationalcommunity’s fear of history repeating itself. Thecomparison between the current food crisis and thetraumatic events of the 1984-85 famine continues tobe utilised by the UN, Ethiopian Government and awide variety of NGOs’ appeals. Yet, if thehumanitarian sector responds to all the warningsignals in time there appears to be little risk ofanother 1984. The fact that the comparison has beenextensively used as an advocacy tool is perhapsunderstandable. After all, the 1984 experience was abenchmark in international humanitarianism, both interms of its traumatic effects on the attentive world aswell as the resulting commitment to prevent suchtragedies occurring again. For many, includingCallanan, the comparison has neither been usedinappropriately nor prematurely, considering theresults of harvest assessments and the lag timebetween donor pledges and the actual physicaldistribution of food to Ethiopia. Yet, the use of suchcomparisons inevitably raises the question should thesituation never reach the end point it did in 1984,what will happen if, and when, in the future if andwhen we do witness another serious food shortage inEthiopia? Will the donors be compelled to act? Orwill what may be seen in hindsight as a form of‘crying wolf’ this time round, cost the Ethiopiansprecious time and assistance in the future?I would like to express my sincerest gratitude toAnne Callanan, Dan Maxwell (CARE) and JohnSeaman (Save the Children UK) for their time,assistance and wisdom shared during our interviews.1Figures taken from the “Emergency Assistance Requirements& Implementation Options for 2003; A Joint Government-UNAppeal”, December 7th, 2002.19

Field articleBurundi Ngoziprovince. Survey toassess economicsecurity in a village© GASSMAN THIERRY, ICRCHousehold EconomyApproach in BurundiBy Sonya LeJeune and Julius HoltSonya Le Jeune is currently a programmemanager with SC UK in Liberia, working on afood security and livelihoods programme.Previously she has worked with SC UK inBurundi, where she was seconded to the WFP.Julius Holt is a full-time partner in the FoodEconomy Group consultancy, with an academicbackground in anthropology and human nutrition.He first observed drought and hunger as a VSOrelief assistant in Botswana in 1966, and becamemore involved with famine relief for SC-UK inEthiopia in 1973. Since then, he has specialisedin food security assessment and programmeplanning, with particular interest in the Horn ofAfrica and the Sahel.This article outlines key elements of the Save the Children UK HouseholdEconomy Approach and Food Economy Analytical Framework, anddescribes WFP’s successful adaptation of the methodology in Burundi.The field experiences described are based on a WFP report drafted in September1999. 1Since 1993, the World Food Programme (WFP) has provided food support inBurundi, with activities focused on the distribution of emergency food rations todisplaced people, vulnerable group feeding and food for work projects. SinceMay 1995, Save the Children UK (SC UK) has seconded food security advisorsto WFP-Burundi. The main role of these advisors has been to help WFP try outand adopt the Household Food Economy Assessment approach (HFEA), 4 as ameans of helping target beneficiaries within the displaced population.Making Sense of IDP SitesSignificantly, the displaced population have accounted for about two-thirds ofthe WFPs food aid in Burundi. In 1999, there were roughly 750,000 internallydisplaced people (IDPs) in approximately 300 sites, with numbers ranging fromfifty to several thousand people (almost all of rural origin) in each site. Somehad fled their homes spontaneously in the face of perceived danger and hadsought official protection in sites, whilst many more had been officially movedfrom their homes and ‘regrouped’ in sites for security reasons. At any givenmoment, while some IDPs would be newcomers, most would have been presentfor one or several years.Access to land has been the single most important determinant of economicstatus. However cash savings, realisable assets, remittances, capacity toundertake casual employment and the offer of employment are also keydeterminants of economic security. The majority of people in the IDP sites werenear enough to their own land to allow them convenient access for cultivationand, in some cases, those displaced could borrow nearby land. For others,however, distance or insecurity has prevented land access.The challenge for WFP was to devise an assessment process which wouldinform them whether or not food aid was needed in a given site, and if so, why,for how long and whether specific groups within the site were at particular risk.Two outstanding problems had to be faced from the start. First, the sheer numberof sites to be assessed limited the time that could be devoted to any one site andsecondly, there was an almost complete lack of documentation regarding thesites and their immediate hinterland.A hesitant beginningWhen the first food security advisor was seconded to WFP in May 1995, the20

Field articleSC UK Household Economy Approach (HEA) 2The main objective of the Household Economy Approach(HEA) is to identify the impact of a shock on the ability ofhouseholds to acquire food and non-food goods. The firststage in a food economy analysis is the development of abaseline profile, which involves:• defining the food economy/ household zones in the areaof analysis• socio-economic differentiation, defining wealth or‘access’ groups within each food economy zone• interviews to establish sources of food and income, andexpenditure, for households in each wealth group.The second stage involves collecting hazard information,such as changes in rainfall, crop production, pasturecondition or market prices. Outcome analysis involvesincorporating the hazard information into the baselineprofile.Both primary and secondary information is compiled, mostof which is collected at a community level. Primary data aregenerated through PRA/RRA, 3 focus group interviews, keyinformant interviews, ranking (including pair-wise) andproportional piling. Interviews are conducted withrepresentatives of particular wealth groups which are selfdefinedby the community. The interview then refers to a‘typical’ household in that group. Interview locations areusually chosen to include as much variation as possible.Interviews are highly structured and a typical interviewtakes about two hours. Secondary data are used to definethe food economy zones.Analysis aims to estimate the likely effect of a shock on theability of households within a population to:• acquire sufficient food• maintain its non-food consumption, e.g. education, health,fuel, soap and other goods.Food, cash income, and expenditure are converted into‘food equivalent’ units. For the baseline profile, sources offood and income must add up to an average of 2100kcals/person/day (the designated minimum foodrequirement for survival). The approach also assumes thatthere are minimum non-food requirements that need to besatisfied through income and production.There are two steps involved in estimating whether thehousehold faces a food deficit. The first requires calculatingthe likely household deficit resulting from the problem,while the second estimates the household’s ability toovercome this deficit.For example, if a household usually generates 50% of itsincome from food crops, a 50% fall in food crops will leadto an overall 25% fall in household income. An analysis ofthe ability of a household to overcome the deficit willinclude:• consumption of food stocks• expanding income from wild foods• receiving gifts• generating additional income through labour, sale oflivestock, and borrowing from kin.In determining the food gap and consequent requirement forfood aid support, certain types of coping strategy will notbe accounted for, e.g. sale of key assets, environmentallydamaging activities, and illegal activities.HEA profile - Wollocentral highlands (poor)Other0%Gift/relief12%Purchase44%Food crops22%Other0%Purchase45%Gift/relief12%Food crop de22%Food crops43%HEA profile with foodcrop deficit - Wollocentral highlands (poor)HFEA methodology had only recently beenformalised by SC UK and its first majorapplication (with WFP food monitors in southSudan) was at an early stage. Although theseconded food security advisor was aware of thetechnique, she had no direct experience of thefield procedures. Whilst proving a usefullearning experience for all involved, it did delaythe WFPs particular application of the approachuntil the arrival of a second more experiencedadvisor in October 1997.Throughout 1995, a strong commitmentdeveloped within WFP to use the methodologyand a process of documentation and trainingbegan in the latter part of the year. An initialworkshop was held in November 1995 tointroduce the food economy framework toeleven WFP field staff. The participants thencarried out assessments in a variety of settings,including amongst IDP and refugee populations.Findings from these assessments were presentedduring a second workshop in December 1995where participants considered the advantagesand disadvantages of the method and refinedprocedures accordingly. A third workshop washeld in July 1996 to introduce HFEA to newfield staff and assessments then continued as aperiodic duty of programmes and field officers.In early 1997, WFP established two permanentevaluation teams (three people each), who wereassigned responsibility for all site assessmentsusing HFEA. One team was based inBujumbura, the second in Ngozi. A third teamwas planned in 1997 but for variousadministrative reasons, was not created untilMarch 1999, again based in Bujumbura. Thearrival of the new food security advisor inOctober 1997 marked the beginning of a secondmore technically secure phase in the applicationof HFEA to the context of IDP sites.Donor requirementA donor requirement attached to food aidsupplied by the US was that WFP should notgive food to populations it had not seen.Therefore a visit had to be made to anypopulation identified as potentially needy. Thiscontributed to a high workload, since it was notpossible to group similar sites together forplanning purposes. Also, where a populationwas inaccessible due to insecurity or distancefrom a useable road, the teams had to arrangefor people to come to an accessible point, suchas a nutrition centre. This congregation limitedthe possibility of forming representative groupsand also increased expectations of a fooddistribution, potentially biasing answers morethan usual.The time factorThe large number of sites to be visited preventedteams spending more than one day at each sitefor a given exercise. Day length would befurther reduced by security considerations(security clearance would only be given at 9am).In Bujumbura, signatures for forms needed to beobtained which often delayed matters up until10am. During calm periods, vehicles had to beback by 4.30pm but when there was a ‘tense’situation, this would be brought forward to3.30pm. Given that it took an average of 1.5hours to travel between office and site, a day inthe field did not allow much time for interviews.As a result, teams generally forfeited their lunchbreak.Fieldwork was a continuous activity. To avoidunthinking routine, each team could onlyundertake two field visits per week, with theother days devoted to complete write-up ofresults. During a four month period (oneagricultural season), this amounted to approx.100 site visits (not allowing for staff holidays,illness, training, being grounded for insecurity,etc.). Generally, there were more than onehundred sites identified as being potentially inneed of assistance during an agricultural season.Clearly, there was a lot of pressure on teams toget enough information from just one limitedday of questioning.Population movementsHFEA depends on the target population havingbeen present long enough to establish someidentifiable pattern of life - perhaps a month ormore. This was the case for most people in mostsites. However, in some localities there wasmuch movement, depending on securityconditions and large numbers of recent arrivals(perhaps just coming out of hiding). Newarrivals in a poor state of health automaticallyreceived full rations for several months, howeverthe overall recommendations for the site werebased on interviews with long-term residents.First phase of HEFA (Early 1996 - October1997)From May 1997, the WFP carried out siteevaluations on a systematic basis. Personnelidentified provinces most in need andprogrammed a series of visits to cover all theaccessible sites. In order to get through thework, teams were sometimes obliged to do twoevaluations in a single day. Once the supervisorhad passed all site reports and recommendationshad been accepted, a summary table ofdistributions was prepared and agreed with thegovernor of the province. Distribution planningthen followed, which could be several weeksafter a site visit. However, for obviously urgentcases a distribution was carried out before all thesite visits were completed. Sometimes food aidcoincided with harvest time, or it was not givenduring the most food insecure months (timing ofdistribution was not planned to fit in with theagricultural calendar). There were occasionalunscheduled visits in response to urgentrequests.The initial food assessments were based onsemi-structured interviews, with questions aimedat the population as a whole rather than trying tocharacterise typical families. There was nowealth group breakdown. The evaluatorscollected information on current food andincome sources and how they differed fromnormal (a year from before the crisis - usually1992 when people were not displaced). Therelative importance of the different food andincome sources was estimated from proportionsstated by informants without proportional piling,or other verification or backup calculations. Piecharts were drawn to compare current food andincome sources to before the crisis. Theevaluators estimated actual consumption byasking about kilos of food consumed (convertedinto kcalories). Based on these findings aApplication of HEAAlthough qualitative descriptionscontained in baseline profiles may identifythe need for a range of responses, theassessment is mainly focused ondetermining or rationalising food aidneeds. However other potentialapplications can include vulnerabilityanalysis, modelling the impact ofinterventions, e.g. food aid, and estimatingthe effect of economic policy at thehousehold level. Indeed the approach isincreasingly being used to strengthenanalysis of livelihood patterns through thebaseline profiles, and to identify the natureof vulnerability of different Food EconomyGroups (FEG) and wealth groups.21

Field articlerecommendation was made for a number of monthlyrations or (if no urgent need was seen) for a Food forWork (FFW) project.Second phase of HFEA (October 1997onwards)The new food security advisor who arrived inOctober 1997 had been trained in HFEA and wasseconded to WFP specifically to provide technicalsupport to the evaluation teams. It soon became clearthat there were basic comprehension problems forthe teams, largely due to their incomplete initialtraining and lack of technical support. It wastherefore decided to allow teams participate in a realHFEA exercise in a rural area, so that they could seehow the various items of information are supposed tolink up, to practice hypothesis testing, to understandthe calculations and to appreciate the use ofsecondary sources. The opportunity was taken inJanuary 1998 to conduct a full HFEA in Gitega, tocoincide with a nutrition survey.The fact that the exercise bore little relation to theirusual assessment procedures served to confuse theteam initially, e.g. two weeks spent in the fieldinstead of a few hours, analysis on the basis ofwealth groups, the time period being a year ratherthan a few months. But the teams slowly grasped theapproach and the following six months were devotedto monitoring, correcting and reinforcing the teamswork. During this period, a visit from a technicalconsultant from SC UK helped to focus the timing ofevaluations and recommendations so they fitted moreappropriately into the seasonal calendar.By September 1999, WFP were prioritising site visitsbased on perception of greatest need, rather thansystematic coverage. During harvest time there werefew assessments of sites with access to land, asfarmers would be busy in fields and were also unableto make accurate assessments of crop quantities. Thisperiod was therefore used by teams to arrangeprovincial level meetings with key informants toidentify geographical areas where people had notbeen able to cultivate properly and where there waslikely to be a need for food aid in the comingmonths. A calendar of evaluations was prepared andvisits planned to fit in with the agricultural calendar.This process had to be flexible enough toaccommodate unscheduled urgent requests.The core framework of the HFEA was applied andadapted to the specific context in Burundi during thesecond phase. The chief differences from normalHFEA practice are outlined in table 1.RecommendationsFirst, there were some concerns aboutmaintaining data quality. During the second phasein particular, the teams gained a strong technicalbackground and sound work patterns developed.However, it was felt that sustaining this effortmight be difficult. HFEA depends on each teammember being intellectually ‘alive’, but repetitionweek in week out may encourage field workers‘to go onto automatic’. There is, therefore, a needto break routine. The authors suggest that thelengthy HFEA procedures used in revisits to sitesmight be curtailed (at least for the first two visitsafter the first full HFEA). Extended enquirywould only be necessary if some key factor hadchanged dramatically. Thus, two proximate sitescould be visited in a day. The ‘spare’ time couldthen be devoted to outstanding questions whichnever get answered, for example improvedunderstanding of access to land and itsconstraints, the casual employment market andthe time taken for new arrivals to gain aneconomic foothold.Secondly, in order for HFEA to be used toestimate the proportion of a site populationrequiring food aid, enquiry would need to beextended into an in-depth analysis of wealthgroups. This would require more field work time.The HFEA has proved an adaptable methodologyto the IDP site situation in Burundi. It is hopedthat this experience will have relevance forothers, beyond the Burundian situation.For further information, contact Sonya LeJeune, SC UK-Liberia, email: dambudzo@mail.com, or Julius Holt, TheFood Economy Group, Longview, Browns Spring, PottenEnd, Berkhamsted, Herts HP4 2SQ,UK. Tel: +44 (0)1442875 709 or email: feg.uk@foodeconomy.com1Le Jeune S and Holt J (1999): Making sense of IDPsites. A review of the use of household food economyanalysis to target food aid for internally displaced peoplein Burundi. World Food Programme, Bujumbura,September 19992The Household Economy Approach. A resource manualfor practitioners. Save the Children, 20003PRA/RRA: Participatory Rural Appraisal/ Rapid RuralAppraisal4Since this report was written, the term Household FoodEconomy Analysis (HFEA) has been changed toHousehold Economy Analysis (HEA) within Save theChildren, to reflect the fact that food is only part of thehousehold economy.5At the time of the 1999 WFP Report, HFEA calculationswere based on a 1900 kcal survival ration. This hassince been revised to a 2100 kcal minimum daily ration.Table 1 Adaptations made to usual characteristics ofHousehold Food Economy Analysis (HFEA)Sketch of a typical day in the fieldBefore arrival at the site there is a quick visit to thecommunal administration to get permission toproceed, for both protocol and security reasons. Onsite the first interview is with the site leaders. Thisis a discussion about the general situation such asagricultural conditions, details of recent populationmovements, the security situation. The teams askthe leaders to describe the main criteriacharacterising differences of wealth, and, byproportional piling, to estimate what percentage ofthe site population falls into each one. Based onthis, the teams identify the focus groups they wishto interview, e.g. men and women from the ‘activepoor’. There is usually time for each investigator toconduct 2 group interviews before it is time toleave, allowing for only six interviews in total onsite (assuming all three team members are present).However, sometimes an interview will have to endbefore information makes full sense - the cost oftime pressure. If possible, time is set aside forsome feedback between evaluators on site, in orderto check points and ensure coherence ofinformation.Back in the office, the team undertakes the analysisbased on a consensus of the data collected. Theanalysis allows the team to:a) calculate monthly income earned from differentsourcesb) calculate cost of the basic food basket usingaverage price information collected during visitc) calculate cost of monthly essential non-foodpurchasesd) calculate what percentage of the food basketcan be afforded after meeting other needse) convert kilos of food from different sourcesinto caloriesf) calculate the contribution of each food sourceas a percentage of family needsg) verify that they can afford to purchase thebalance of basic food which they need to meetan average minimum of 1900 kcals 5 per personper day.The information is represented as a hand drawn piechart to accompany the report. The team usuallymanages to finalise the reports within 2-3 days ofthe visit. Once checked the report is used by WFPto plan food distributions.ConclusionsItemUsual characteristicAdaptationi) The adaptations made to the HFEA approach havenot been fundamental and the basic field procedures,e.g. focus group interviews, have proven workable.As sites had more or less homogeneous populations,it was possible to identify typical households thatrepresented the greatest proportion of each site.ii) The first phase of the introduction of HFEA in1995 improved upon the previous rapid evaluations,since it added a new element of food-and-incomelogic to the exercise. But it was not until the secondphase from late 1997, with a fuller and more rigorousapplication of HFEA, that greater insights weregained into the economy of sites and the economicdifferentiation of groups so that better reasonedestimates of need were obtained.iii) The specific constraints of the context did limitscope and depth of analysis, e.g. lack of secondarydata to gain better knowledge of the physical andeconomic areas surrounding the sites. The sites wererather lonely places for evaluation teams and therewas little extraneous information to back up whatthey found out.iv) Time constraints and the large number of sites todeal with limited the depth of information obtained.Teams had just enough time to get a ‘convincingstory’ but more information, e.g. to help target withinsites, would have required more time at each site.Food economyzone‘Normal’ periodKey informantsWealth groupsA defined population in a geographic area,the majority of whom obtain their food andincome through a similar combination ofmeans.A former year or season which was neitherparticularly good nor bad.Give overall information about the foodeconomy zone itself.Three or more groups identified on criteriaand in proportions, as a result of discussionswith key informants.A single site of any size, e.g. administrative area.The past few months, or since the last harvest, orsome other logical time point.Identify geographical region where there may be aproblem, or identify specific sites, with reasons forchoice. Give permission for the site visits.In addition, identify an outstanding group withproblems. For example, those with no access to landbecause they come from insecure collines or peoplewho have recently arrived.Secondary datasourcesCensus, agricultural survey, price records, etcThe teams collect what they can from key informantsand group discussions. Limitations include nutritionsurveys conducted only occasionally and whichmight only include site population, minimal officialagricultural information due to lack of resources andpersonnel, and market price data which is notroutinely collected in the rural areas.ScenarioPredict the impact of a given event (e.g.prospective harvest failure) on people’sability to meet needs over a season or yearNo ‘event’ but rather prediction of how families willmeet their needs during the immediate future. Forthose without land, predict for the next 6 months andfor those with land, predict up to the next harvest.22

Learning from nutrition interventionsin Eritrea, Ethiopia and KenyaEvaluationsSummary of evaluations 1SC UK recently evaluated a number ofemergency nutrition responsesundertaken in Eritrea (Gash Barka andNorthern Red Sea), Ethiopia (Legambo andFik) and Kenya (Wajir) during 2000-2001.Reviewed programme interventions includedtargeted and blanket supplementary feeding,and therapeutic feeding.Whilst the content of the mainrecommendations from the evaluations are notground breaking, they do reiterate thefundamentals of good programming, and theimportance of respecting these principles inthe difficult circumstances in whichemergencies often present. In two of thecontexts considered (Wajir and Fik), theaffected pastoral populations presentedspecific programme challenges, while three ofthe contexts were affected by insecurity(Wajir, Fik and Eritrea). Moreover, since theemergencies coincided in terms of timing andregion affected, considerable pressure wasplaced on SC UK’s capacity to recruitadditional staff and provide necessaryprogramme support.The following brief highlights of the keylessons learned may prove useful to otheragencies operating in similar contexts.Preparation and decision-makingFrom the outset, investment must be made inestablishing management systems, such asfinance, logistics and administration. Failureto do this reduces the effectiveness oftechnical staff whose energies are diverted toadministrative issues, and risks compromisingboth programme effectiveness andaccountability to donors.Integration of therapeutic feeding centres(TFCs) into existing health structures such ashospitals, increases efficiency, is moreeconomical and builds upon the skill levels ofMinistry of Health (MOH) staff.Where a programme is predominantlynutrition focused, health outcomes cansometimes be poorly defined. The healthcomponent of the nutrition work must beclearly specified with measurable objectives.Particular attention should be given to ensurethat reasonable vaccination coverage isachieved in order to prevent further nutritionaldeterioration. Mass health education, as wellas individual advice and treatment, can also bebuilt into a nutrition programme.In pastoral areas, fixed feeding centres incentral locations may not be effective. In suchsettings, it may prove difficult to conductcluster sample surveys or to alert people inadvance when distributions are to occur. Also,people are not necessarily able to remain inone place for a long period of time. For thesereasons, alternatives need to be explored, suchas community based therapeutic feeding. Moreresources and attention are needed to monitorand supervise feeding programmes in such anenvironment.Difficulties in recruiting experiencedinternational staff need to be addressed. Thiscould be achieved through developing anapprenticeship scheme for on-job trainingunder the guidance of a mentor. Also,guidance on rapid, but fair and transparent,recruitment processes for national staff in anemergency is particularly important whenopening new operational bases. This helps toreduce future staff management problems andensure recruitment of the best available stafffrom the outset. Staff with local knowledgecan be critical in managing activities such asstaff recruitment, and in dealing with localmatters, e.g. clan issues and security.Nature of interventionsCriteria for withdrawal from a country or areamust be identified from the outset ofoperations, and the programme reviewedagainst these on a regular basis. These criteria,and the strategy for withdrawal, may need tobe revised but will provide a benchmarkagainst which the programme can bereviewed.Realistic timeframes for interventions shouldbe established from the beginning. This makesfor greater continuity of staff and allows formore effective planning. In particular, clearand consistent messages can be given topartners and local authorities aboutprogramme objectives, criteria for withdrawaland expected length of stay.High turnover of international staff,particularly project managers, placesprogrammes under considerable strain and canlead to:• lack of continuity and consistency inmanagement• inevitable gaps between international staffassignments, which lead to unsatisfactoryinterim arrangements for projectmanagement• poor relations and rapport with projectpartners• recruitment demands on programmemanagement.Wherever possible, the preparation andimplementation of national guidelines fornutrition in emergencies should be promoted,thus investing in intervention sustainability.Guidelines need to be updated regularly.Issues to consider regarding supplementarySC UK survey team in Eriteria© 2001 HASSAN TAIFOUR, SC UKfeeding programmes (SFP’s) include:• Staff numbers must be based on the numberof beneficiaries and the geographicalcoverage of the programme. The location ofa SFP needs to take into accountaccessibility for the population andbeneficiary numbers, which in turn willaffect coverage and defaulting rates.• Purpose built structures are resourceintensive and limit the opportunities forcapacity building among MOH staff.Existing health facilities can be used toassist health aspects of the programme, buttravel implications for beneficiaries andadditional demands on health centre staffmay reduce the quality of the programme.• Careful consideration should be given beforeopening a SFP in areas without an adequategeneral food ration (GFR). However, thereality is that SFPs will be set up even wherethere are no resources for a GFR, or theGFR is inadequate. In these instances, thesupplementary ration should take intoaccount the likelihood of the ration beingshared.• Blended foods must be fortified to ensureadequate supplies of micronutrients.• Targeting pregnant women during the lastsix months of pregnancy may proveproblematical, as determining gestationalage is time consuming and may not bepractical.• In general, a comprehensive SFP should beup and running prior to a TFC beingestablished. Supplementary feeding reachesmany more children and vulnerable groupsand should help prevent children frombecoming severely malnourished.Nutrition surveys can be used to establish theeffectiveness of interventions and provide thestimulus for programme improvement.However, surveys can be costly and timeconsuming exercises, and may be particularlydifficult to carry out in pastoral communities.Nutrition surveys should only be implementedwhere results will directly inform decisionsabout the type and scale of response.Furthermore, surveys should be standardisedto allow comparison over time and betweenregions, and should gather relevant

Evaluationsinformation on food security and health. Wherepossible, quicker and cheaper ways of making decisionsshould be explored. For example, SC UK is currentlyexploring the possibility of using lot quality assurancesampling 2 .Ensuring community involvement in establishingfeeding programmes helps in planning issues, such as:• Appropriate siting of centres.• Understanding and support of feeding programmeobjectives, including acceptance of targeting criteria.For example, the rationale for admission according toanthropometric criteria, irrespective of socio-economicstatus, may be difficult for communities to understandwithout proper explanation.• Participation of mothers/ carers throughout the lengthof stay in a feeding programme.• Reduction in defaulter rates by carers understandinghow the feeding programme works, better siting ofcentres, and advice on population movements.• Providing volunteer outreach workers who can screenchildren for referral to the centre.• Alerting the team to security risks and changes.Field articleNutrition causal analysis:planning and credibleadvocacyBy Paul Rees-ThomasBased primarily in Eastern Europe and the Horn of Africa, Paul Rees-Thomas worked for five years with Action Contre Le Faim (ACF),latterly in the food security department at the Paris headquarters.Since then, he has worked for Medecins sans Frontieres (MSF) inKenya.The contributions of MSF Spain and Manuel Duce in preparing thisarticle are gratefully acknowledged.Working with the governmentIn an acute emergency, it may be necessary to take amore directive role to ensure life saving responses. Acommitment to work through the MOH needs to betempered by a realistic understanding of local ministrycapacity. For example, giving full responsibility for themedical components of a TFC to a weak anddisorganised MOH will compromise programme quality.Thus, when planning a TFC the following steps shouldbe taken:• A comprehensive assessment of the MOH’s capacityto help, e.g. to receive sick children referred from aSFP, to provide lab facilities for TFC and availablenursing and clinical support for the TFC.• Where MOH skills are lacking, capacity building mustbe resourced, taking into account staff turnover (whichis often high). In the interim, the programme shouldemploy additional medical staff.• Ensure regular joint management meetings of the TFCwith the MOH.• Ensure that there is clarity regarding any incentivepayments for hospital staff.MonitoringThe impact of feeding programmes on settlement,displacement and migration in pastoral areas should bemonitored, and adapted in response to any negativeinfluences. Findings should also be weighed against theprogramme withdrawal criteria, which in turn should beperiodically reviewed and revised as necessary.Regular project review meetings enable the project toadjust to changing situations and context.Clear guidelines are required on how to use monitoringinformation to manage the performance of feedingprogrammes.Contextual analysis of the wider political, health, andfood security context is the key to responsiveprogramming. Without this, programmes will stagnateor fail to respond to changing conditions.The contribution of Elizabeth Stevens, Policy Officer at Savethe Children UK, in compiling this summary is gratefullyacknowledged.For further information, contact Anna Taylor - Nutrition Advisor,Save the Children UK, 17 Grove Lane, Camberwell, London SE58RD, UK. Email: a.taylor@scfuk.org.uk1Review of Save the Children UK’s Emergency NutritionProgrammes in Ethiopia, Kenya and Eritrea, 2000 by DianneStevens, August 2001 (then consultant to SC UK, currently SCUK Programme Director in Angola), and South Wollow targetednutritional support programme, Legambo Woreda: LessonsIdentified, October 2000-May 2001 by Kiross Tefera, November2002 (Emergency Nutrition Officer, SC UK Ethiopia programme)2Lot quality assurance sampling (LQAS) is a methodology thatoriginated in the manufacturing industry and has been applied tohealth contexts, such as immunisation coverage. Subpopulationsare divided into ‘lots’ and the sample size is thenumber of units that are selected from each lot. Beforesampling, a decision must be made on the number of “defective”items, e.g. children not immunised, that will deem a ‘lot’unacceptable, which in turn will influence sample size. Since theresponse for each sample is binary, i.e. acceptable or nonacceptable,smaller samples are required compared to othersurvey methods. By combining information from different ‘lots’,the LQAS method offers a less conventional means of stratifiedsampling. (WHO/V&B/0126(2001))This article outlines some of the keycomponents of nutrition casual analysis,and describes how this assessment methodwas successfully used to provide a multi-sectoraloverview of factors affecting nutritional statuswithin an urban community in Kenya.Since 1993, various sections of MSF have beenengaged in the region of Mandera, north-easternKenya, which has played host for up to 60,000Somali refugees displaced from the civil warraging in their own country. The district ofMandera has been described as suffering from‘chronic poverty compounded by successiveenvironmental pressures.’ 1In July 1996, MSF-Spain responded to the needsof a primarily local population affected bydrought, by establishing therapeutic andsupplementary feeding centres, and general fooddistributions. With few exceptions, nutritionalsurveillance since then has demonstrated how the‘usual’ rate of malnutrition within Manderadistrict has consistently remained between 20and 30% Global Acute Malnutrition (GAM 2 ) (seegraph 1).The MSF-Spain programme continued through1997 due to persistent drought, and into the mainpart of 1998 due to floods and heavy rainbrought on by ‘El Niño’. Although theprogramme was scaled down and eventuallyclosed in 1998 (GAM around 20%), a survey inMay 1999 found that the prevalence of GAM hadrisen to a new high of 39.2%, with 6.9% severemalnutrition. In response, selective feedingprogrammes were re-opened by MSF andGraph 1 Nutritional surveillance by MSF Spain inMandera Central (1996-2002)4035302520151050Jun-96Dec-96Jun-97Feb-98SAM % GAM %May-98Aug-98Nov-98May-99Sep-99Dec-99Jul-00Mar-01Mar-02continued until May 2001, when a cluster surveydemonstrated that GAM rates had again fallen to20%.In March 2002, a MSF nutrition survey,conducted in the urban area of Mandera Central,showed a significant decline in the nutritionalsituation 3 . Similarly, an Oxfam-Quebec surveyfound high levels of malnutrition in the easternflank of the district 4 . In light of these results anda subsequent influx of Somali refugees in midApril 2002 (recent surveys had shown high ratesof malnutrition), 5 MSF re-introduced boththerapeutic and supplementary feedingprogrammes.Mandera district currently endures significantenvironmental degradation, worsening pasturecoverage and declining quality of livestock, aswell as an increasing number of urban pastoraldestitute. This group is composed predominantlyof pastoralists who have lost their entire herd andis characterised by the households’ almostcomplete dependence upon ‘casual labour’ in theurban vicinity. As a result, the level of outrightpoverty within the division of Mandera Centralcontinues to increase. The increasinglycompetitive manual labour market hasheightened the levels of vulnerability for muchof this urban destitute group.In this context of successive extended dryseasons in an area of widespread chronic poverty,many actors have found it increasingly difficultto justify emergency responses (involvingselective feeding) following acute shocks, e.g.drought or flood. Many of these issues weremore recently highlighted and discussed during amulti-sectoral assessment conducted in the lastquarter of 2001. The findings of the assessment,which was overseen by the District SteeringGroup (DSG) and conducted by severalorganisations, formed the basis of the DistrictStrategic Development Plan for ManderaDistrict. A causal analysis has previously beenconducted in Mandera District 6 . However, it wasconsidered important to conduct such anassessment specifically for Mandera Central, inorder to gain the population’s perspective of thecurrent causes of malnutrition within this urbansetting and to generate a baseline advocacydocument.Basis of casual analysisA causal analysis investigates and presents a‘multi-sectoral’ overview of the contributingfactors affecting nutritional status within a givencommunity. Causal analysis first aims toestablish the relative importance, or the perceivedweight of contribution, of the underlying‘spheres’ or factors that influence nutritional

Field articlestatus (see diagrams 1 and 2). Secondly, and perhapsmore importantly, it investigates the relationshipsbetween these factors.While individual sector reports provide vitalinformation and recommendations, causal analysisprovides a greater insight through cross-sectoralmapping and by illustrating how the inter-connectednature of these factors contributes to malnutrition.Having established the ‘relative importance’, the typeof relationships, and hence the associated factors, amore integrated approach to project planning andimplementation is feasible.Causal analysis frameworkThe causal analysis methodology used wasqualitative and participatory, involving a number ofrapid assessment techniques and based upon the‘framework of causal analysis for malnutrition’ (seediagram 1). The first vital step of this analysis was toidentify the most recent and important ‘secondary’documentation relating to the area (e.g. reports ofprevious assessments and analysis in Mandera).Ideally, these reports would form the background tothe subsequent investigation, and provide baselineinformation with which to confirm, elaborate or evenadapt assessment findings.Goats being watered inMandera, Kenya. June 2002© PAUL REES-THOMASThe participatory data collection and analysisentailed two activities, household investigationsfollowed by workshops. Household investigationswere carried out using semi-directive interviewsrather than set questionnaires. This method allowedthose being interviewed to identify and prioritise theissues that they themselves felt were the mostpressing problems currently being faced in thecommunity. The technique relied on posing openquestions, with direction only given when detail andelaboration were required on issues that had alreadybeen highlighted. Households were purposivelyselected to represent the two previously identifiedlivelihood economies in the district, i.e. ‘pastoral’Diagram 2: Perceived RelativeImportance on Underlying CausesHousehold foodsecurityFood availabilityAccess to foodTeachers: 60%Larger landowners: 50%Mobile team: 65%Average: 58%NutritionalstatusPublic health andhygieneHealthy environmentAccess to health careAvailability, quality andaccess to waterTeachers: 15%Larger landowners: 30%Mobile team: 25%Average: 23%Diagram 1: Framework forcasual analysis ofImmediate causesInadequatedietary intakeMortalityMalnutritionDiseaseCare environmentSocial and organisational networksWomen’s role, status and rightsChild careTeachers: 25%Larger landowners: 20%Mobile team: 15%Average: 20%Underlying causesHousehold foodsecurityFood availabilityAccess to foodNutritionalstatusmalnutrition 7 Diagram 3 MSF Wealth Classification, Mandera Central (version 2).Public health andhygieneHealthy environmentAccess to health careAvailability, quality andaccess to waterPastoralAgropastoralAgriculturalCare environmentSocial and organisational networksWomen’s role, status and rightsChild care10%1-10 camels100-300 cattle1-100 goats30-105 acresRichBasic causesLocal prioritiesFormal and informalorganisations and institutions25%Medium 1(12.5%)1-60 cattle + goats0-30 acresMedium 2(12.5%)1-50 goats only0-30 acresManual labourMedium 1Medium 2Political, economic andhistorical factors65%

Field articleAgency profileand ‘riverine’ households who practice agriculture.Geographical variations, as well as poorer andwealthier households, were also taken into account.Any further distinction or categorisation of wealthwas deferred to the workshops. Essentially,households visits continued until the informationcollected became repetitive, and nothing significantlynew was being established or expressed.The workshops were typically comprised of five orsix individuals drawn from various ‘groups’, such asmothers, teachers, traders, pastoralists and farmers, aswell as the MSF mobile team. The overall purpose ofthe workshop was to cross-reference and, wherepossible, elaborate further upon the identified causes.The workshops also attempted for the first time, asfar as possible, to quantify the findings to date.Relative importance of causal spheresDuring the workshops, participants were initiallyasked to assign a percentage to their ‘perceivedrelative importance’ of the spheres representingunderlying causes of malnutrition in the ‘causalframework’ (see diagram 1). Only three ‘groups’were content to quantify importance of the spheres interms of percentage. Another three groups were onlyprepared to ‘rank’ the underlying causes. However,taken together, the results provided our first keyfinding - confirmation that household food securitywas the most significant factor contributing tomalnutrition.Other tools, such as mapping, timelines andagricultural calendars, further helped discussionabout the type of relationships between the spheresand how they had changed (primarily over theprevious three months). Household information wasnot presented to the workshops but was referred to, toencourage elaboration and clarification.It also proved possible to include previous workshopresults in order to facilitate and provoke discussion.The results of the ‘wealth classification’ exercise(diagram 3), that provided a socio-economiccategorisation of both poverty and wealth through thecommunities’ eyes, were presented within the finalreport.Process of wealth classificationThe wealth classification exercise, outlined indiagram 3, provided our second and vital finding.This was related to the continuously increasing urbandestitute caseload in Mandera Central. The variousworkshops almost unanimously agreed that fifty tosixty five percent of the urban population waspresently made-up of this ‘urban destitute’ group.Amongst these, vulnerability was linked to theinsecurity and irregularity of low-paid work thatforced households to purchase food daily at higherretail prices.The three key data sources (key informants,households and workshops) helped to triangulateinformation, thereby solidifying priorities, identifyingtrends and establishing connections between differentsectoral needs and expenditures. For example, thesethree data sources helped build a considerableunderstanding of expenditure on medication andhealth services. It was found that the price ofmedication for 75ml of cough syrup (250 shillings)or multi-vitamins (300 shillings) equated to 10 to 15days of the adult food basket. There was strongevidence pointing to a reduced availability of basicmedication within government structures, forcingthose in need to approach and spend available cash inprivate pharmacies.Wherever possible, the exercise endeavoured toinclude the food equivalents of basic expenditures, aswell as the food equivalents of casual wage labour.This illustrated potential food gaps from irregularcasual labour for a range of smaller or largerhouseholds. The analysis also determined that moreand more individuals were being forced into dailycasual labour, allowing less time to be spentsupervising younger children. Also, seasonal waterprice changes had forced vulnerable and remotehouseholds to draw water from the river, a sourceshared with livestock.Advocacy roleUndertaken correctly, qualitative and participatoryassessments have been increasingly accepted indecision-making fora. Improved credibility has givenadvocates greater confidence in approaching variousbodies, fuelled by a higher chance of being giventime to present findings.The strength of this type of assessment lies incomplementing, not replacing, existing forms orchannels of advocacy. It can provide additionalinformation and ‘capital’ for debate and discussion,as well as reinforcing more technical/ quantitativesurvey findings and improving their credibility. Inthis sense, causal analysis assists in ensuring a moreprofound discussion with regard to targeting andprogramme priorities.Clearly, there is a time limit as to how long anyparticular causal analysis study remains credible and‘active’ for advocacy purposes. At the same time, acausal analysis may provide the first step towards theinclusion of additional and more regular datacollection and analysis within national Early WarningSystems (EWS).One of the main aims of conducting the causalanalysis in Mandera was to provide a basis ofunderstanding to use for advocacy purposes.Subsequently, MSF-Spain intends to become moreinvolved in the EWS, primarily in the areas of healthand nutrition, and investigate further which civilsociety actors could act as partners in these activities.Under-pinning the entire advocacy potentialgenerated from the causal analysis, is the primaryaim of assisting the local communities and civilsociety, wherever and whenever possible, to advocatefor themselves. From the outset, participatorymethodologies aim to include the community andcivil society actors in the entire process, to ensurethat their opinions are heard and correctly noted.These voices are central to the decision makingprocess involved in combating the issues andproblems facing their community. Subsequently,whatever lobbying activities are undertaken, effortsshould be made to allow these local partners tobenefit and become actively involved in lobbyingnetworks, which are often only open to larger (andfrequently international) organisations.By developing a picture of the multiple challengesfacing a given community, causal analysis can assistorganisations and the communities with whom theywork, to identify and articulate why certainconditions are not improving or, in fact, aredeteriorating. Emergency orientated organisations cansometimes find themselves dealing with protractedemergencies or addressing acute shocks within anarea experiencing chronic poverty. Causal analysisprovides important information and opinions to assistthese organisations to either plan or advocate forappropriate medium term, higher impactinterventions aimed at reducing vulnerability.For further information, contact Paul Rees-Thomas at email:rees-thomas@tinyworld.co.uk1Alistair Blair, Health Assessment of Mandera District, MSF-Spain, 20012Global acute and severe acute malnutrition rates measuredusing weight-for-height z scores3MSF-Spain nutrition survey, Mandera Central: 26.7% GAM,4.7% SAM (March 2002).4Oxfam-Quebec nutrition survey, Eastern Mandera: 33.3%GAM, 5.3% SAM (March 2002).5FSAU Nutrition Up-date December 2001. FSAU led survey inBelet Hawa, Gedo Region, Somalia. Conducted withUNICEF, Care and Gedo Health Consortium. The resultsfound a prevalence of 37.2% Global Acute Malnutrition (Dec2001).6Causal Analysis for Mandera District, by Abagail Montani,Action Against Hunger.7Adapted from an Action Against Hunger version of theUNICEF original framework.Christian AidJeremy Shoham interviewsPhil Crane and Sarah KingNameAddressChristian Aid35 Lower MarshLondon SE1 7RT, UKTelephone +44 (0)207 620 4444Fax +44 (0)207 620 0719EmailInternetYear formed 1945/6Directorinfo@christian-aid.orgwww.christian-aid.orgDr Daleep MukarjiHQ staff approx. 300Overseas staffAnnual budgetapprox. 16 expats/100 localapprox. 55 million UK poundsPhil Crane and Sarah King from Christian Aid(CA) were interviewed in their LondonHeadquarters near Waterloo station. 1 Philworks in the Eastern and Central Africa team. Hisearly work experience included a job as anaccountant in the city, followed by two years with aPakistani non-governmental organisation (NGO)where he kept the accounts and did some teaching.He then returned home to the UK, to the moretranquil setting of a church book (and coffee) shop,before joining CA in 1990 as an accountant. Aftercovering for two maternity leaves he took up hispresent full-time post. Sarah, who works as anemergency capacity building officer in theemergency unit, joined CA towards the end of 2001.She has previously worked as a nutritionist forCARE and UNICEF in Kenya and brings nutritionalexpertise to the organisation.CA was created at the end of World War II by UKand Irish churches, in response to the devastation inEurope and the urgent need for reconstruction. Philremembers seeing an audit from 1946, which showedCA sending bicycles to Belgium and biscuits toHungary. Later, the wave of decolonisation andindependence in the 1960s led to a greater awarenessabout developing country problems, so that CAchanged its focus to emerging states in the ‘thirdworld’. It now works in 56 countries around theworld.Phil explained that there are a number of key internalpolicies which underpin the way CA works. CA isnot an operational agency - it works throughpartners. The belief behind this is that ‘local peopleare closer to the poor and will therefore have a bettersense of what the problems of poverty are and howbest to solve them’. CA has recently established anetwork of field offices. This process beganfollowing the Rwandan crisis in 1994, when anumber of partners were placed under tremendouspressure during the civil war and CA felt a need tobe present to provide extra support and capacity.However, these relatively new field offices are notimplementation offices but rather they are, supportpartners. They also make it easier to accessdecentralised funding sources, as well as monitorprojects more closely. Phil maintained that the valueof field offices was proven during 1998 in southSudan. Here, the Nairobi office was able to supportinformation flows and logistics, and ensure a morerapid response overall, than would otherwise havebeen possible. There are now 16 field offices with thegreatest concentration in Africa.Typically CA works with between 10 and 20 partners26

Agency profileSudanese cattle farmer© ADRIAN ARBIB/CHRISTIAN AIDin a country, of which, on average, approximatelyhalf are church based agencies. Essentially CA isopen to working with ‘whoever is doing the best antipovertywork’. “It is important to build up long termrelationships with partners” says Phil. Partnersapproach CA with a proposal which then undergoes arigorous appraisal procedure, including examiningthe track record of the agency. Often CA’s partner isthe national Council of Churches’ relief anddevelopment arm. In other instances, CA may workthrough individual churches at diocese level. Philreflected on how CA still occasionally getsapproached for support to buy hymn books or rebuildchurches, but was quick to point out that this was notsomething CA does.Much CA funding comes from the church sector, butalso from the public at large. For example, the secondweek of May each year - ‘Christian Aid Week’ - isgiven over to fund-raising at a local level whenvolunteers are each ‘allocated a street’. This event,which basically consists of distributing and thencollecting red envelopes (“hopefully filled”), usuallyraises about 12 million UK pounds a year, whichamounts to 20-25% of CA funds. The CA board hasrestricted governmental monies to 30% of theorganisation’s funding. The remainder comes fromindividuals, churches and non-church agencies. Thefact that the majority of funding comes from a widevariety of sources provides consistency of income,and prevents CA from being over-dependent onannual grants from government donors.According to Phil, “the CA partnership approachdoes not make fund raising easier with agencies likeDfID and EU, compared to say Oxfam or SC UK, asCA is the middle man and essentially puttingsomeone else’s proposal forward”. However, goodproject appraisal mechanisms and the recentintroduction of field offices is helping the process offund-raising from institutional donors.Advocacy seems to be a growing component of CAactivity. Perhaps 15-20% of income now goestowards advocacy. CA is especially involved in globaladvocacy messages, e.g. Jubilee 2000 advocacy workwas about debt. “CA can mobilise churches to getpeople out onto the street, while working throughpartners gives CA a legitimate mandate to saythings”, according to Phil. The ‘Trade for LifeCampaign’ is now the main advocacy issue for thenext few years, e.g. World Trade Organisationlegislation, import tariffs and quotas, and access towestern markets.Historically, CA have always resisted anemergency/development split in its work so that the‘desks’ are organised along geographic lines. Phil,therefore, deals with relief, development andadvocacy programmes within the east and centralAfrican region. There is, however, an EmergencyUnit (created in 1995) which operates as a technicalsupport mechanism for geographical teams andpartners at the onset of emergencies. The unitcurrently employs seven full-time staff withexperience in logistics, shelter, nutrition and disastermitigation, as well as general project management.There are also two trained SPHERE trainers in theunit.Like many other agencies, CAs involvement withemergencies really started with the Ethiopian faminesin the 70s and 80s. Involvement in general rationprogrammes is common, although CA may take theview that it can be more effective in advocating forthe international community to stump up thenecessary food aid pledges. CA also supportspartners in implementing supplementary feedingprogrammes and, on rare occasions, will supportpartner therapeutic feeding programmes. Accordingto Sarah, another common type of programme hasbeen ‘seed protection rations’ where the intention isto provide food as part of an agricultural supportprogramme, to prevent households consumingvaluable seeds before the next agricultural season.There have also been a number of general rationprogrammes where families, acting as hosts forinternally displaced people (IDPs), have beentargeted, e.g. in Kosovo/ Albania and more recently,in the Democratic Republic of Congo.CA generally plan for longer-term interventions onceinvolved in an emergency. For example, they havebeen supporting four clinics for IDPs in shanty townsaround Khartoum for a number of years, withpartners working under the Sudan Council ofChurches. In Wau in 1998, CA started working withIDPs through relief programmes, gradually movinginto provision of permanent housing, agricultural andfishery support, building clinics and schools. Phildescribed this as “post relief rehabilitation”. InCentral America, meanwhile, CA supportsorganisations dealing with the psychological andpyscho-social effects of disaster - a crucial aspect ofrecovery that is all too often overlooked. Capacitybuilding and disaster preparedness are other bigcomponents of their work. The Emergency Unit hasdeveloped a strategy for working with programmemanagers and partners to strengthen their disasterpreparedness activities, encourage them toincorporate risk reduction measures into ongoingdevelopment work, and encourage adherence tointernational guidelines. CA is a signatory to the RedCross/ NGO Code of Conduct and encouragesadherence to SPHERE standards among all partnersworking in humanitarian response.Phil highlighted two big challenges that CA faces.First, the temptation to take over and becomeoperational - which is especially strong inemergencies, and where partners are weak. Second,CA has to be careful not to set up over-demandingprogrammes (over-scale) with partners that appearcapable, only to find out later that they have taken onmore than they can handle. Phil gave an example of aseed multiplication and ox plough trainingprogramme where this happened. The programmeproved too large and complex for local partners tosustain. This problem is compounded by the fact thatemergencies can generate a lot of money, whichcreates a momentum for spending.Sarah identified co-ordination with other agencies asan issue, in that sometimes a local/ internationalNGO split occurs in the field, with the former feelingexcluded from international co-ordinationmechanisms. One of the roles of CA, especially inemergencies, is to help local agencies integrate intonational co-ordination mechanisms. CA is a memberof the Action by Churches Together (ACT) network,and all its activities are co-ordinated with other ACTmembers, as well as with the Disasters EmergencyCommittee, other agencies, governments and UnitedNations bodies, as appropriate.Sarah also identified a difficulty CA sometimes faceswhen partner agencies may be located in remoteareas of the country, making communication andsupport difficult. She cited the example of a partneragency working in Gaza province in Mozambique,which is 650 km from Maputo. However, “this canalso be a strength as the local agency is working inan area where there are no international agencies”.I asked Phil what he thought were the main strengthsof CA. His response was clear and to the point.“CA works with the poor through local partners andtherefore has the advantage of being a channel for theauthentic voices of the poor. It is the poor themselveswho have most knowledge about poverty and the bestsolutions. Being a channel for the voice of the pooralso gives us a legitimate and perhaps uniquemandate for advocacy”.1The ENN would like to state that the views expressed in thisarticle are those of the interviewees and do not necessarilyrepresent those of Christian Aid.

Field articleEvolutionof a Crisis:a Save theChildren UKperspectiveBy Mark WrightMalawi© SC UKMark Wright was the Save theChildren Programme Officerfor Southern Africa fromNovember 2000 to November2002.This article details Save the Children UK’s(SC UK) perception of the build up to theSouthern Africa crisis and charts keymoments in the response of theinternational humanitarian community. 1Largely using Malawi and Zimbabwe ascase studies, it looks at the roles of thedifferent actors and appraises howsuccessfully they fulfilled theirresponsibilities in responding to thesituation. The work of SC UK during thiscrisis, particularly in the realm of advocacy,is highlighted.The contributions of Daniel Collison,Deborah Crowe, Gary Sawdon and AnnaTaylor, Save the Children UK, in compilingthis article is gratefully acknowledged.In September 2002, Southern Africa was in thethroes of an acute humanitarian crisis that washaving countrywide impacts in Angola, Malawi,Zambia and Zimbabwe, as well as affectingsignificant populations in Lesotho, Mozambique andSwaziland. Across the entire region, it was estimatedthat 7.5 million people (plus a further 1.9 million inAngola) required immediate food assistance, a figureanticipated to rise to 16.3 million between Januaryand March 2003. Of those in need, at least 60% wereunder the age of 18 years.Southern Africa had suffered from erratic weatherover the previous two seasons such that, by thebeginning of the current crisis, many poorer farmershad already exhausted their coping strategies. Inaddition to adverse weather conditions, with drought,erratic rains, floods and tornadoes over successiveyears causing falls in production, other underlyingfactors had drastically destabilised food security.These included political instability in Zimbabwe anda fragile peace in Angola, poor macro-economicperformance in all countries in the region,inappropriate government policies, and theHIV/AIDS pandemic.In October 2001, SC UK conducted a training sessionin the SC UK Household Economy Approach (HEA)methodology in Malawi. This was carried out inseveral Food Economy Zones that overlapped thosedistricts (Mchinji and Salima) where SC UK isoperational. The results of this exercise suggestedthat the population was facing a potentiallysignificant food shortfall, well before the next harvestin March 2003 and even in Mchinji district which istraditionally a bread basket area. In response, SC UKhosted a donor meeting in Lilongwe in November2001, not only to alert interested parties but also totry and instigate a response strategy. The warningwas not accepted and many maintained that thesituation was less serious than was being described.Around the same time, the FEWSnet 2 was predictingsome increased vulnerability but felt that, whilstmaize was in short supply, overall food supply wasadequate once root crops were taken intoconsideration.Survey supportTo support the SC UK argument, nutrition surveyswere carried out in December 2001, which foundglobal acute malnutrition rates of 11.8% and 9.3% inMchinji and Salima, respectively. In themselves,these figures did not suggest a crisis. However, inlight of the HEA data and considering the time ofyear (at least 3 months before harvest), they werevery serious findings. Again, the response fromdonors was unenthusiastic. In contrast, a HEA surveyin Zimbabwe in May 2001, with no supportinganthropometric data, attracted funding from theDepartment for International Development (DFID)for a food intervention over the period September2001 to April 2002. This was an unusual case in thatthe intervention was designed specifically to supportlivelihoods rather than combat hunger per se. Thisdifferentiated response does show apparentinconsistencies in the DFID approach to the crisis inthese two countries.SC UK began intensive lobbying of donors and theinternational community to support a wide-scaleintervention in Malawi. Anecdotal evidence stronglysuggested that the situation was deteriorating rapidly,a situation compounded by a massive increase inmaize prices of 400%. To quantify the impact on thepopulation, SC UK conducted a follow-up nutritionsurvey in late February 2002. This found that globalacute malnutrition rates had increased to 12.5% inMchinji and to 19% in Salima. That suchdeterioration had taken place in the space of only tenweeks was indicative of the seriousness of thesituation.By February 2002 it became clear that the foodshortage was a regional issue and was not justrestricted to individual countries. The Food andAgricultural Organisation (FAO) issued a SpecialAlert warning of 4 million Africans being at risk, andhighlighted Malawi, Zimbabwe and Zambia as beingthe most affected. However, national governmentswere slow to admit that the problems were serious.Malawi did not declare a State of Emergency untilthe 27th February 2002, while Zimbabwe delayeddeclaration until the 26 April 2002.Within the UK, international non-governmentalorganisations (NGOs) were independently carryingout investigations into the extent of the problemwithin their own operational areas. SC UK called aco-ordination meeting in early April 2002, both topromote information sharing amongst active NGOsand to facilitate the development of a commonposition on the scale and needs of the crisis. This ledto the development of a joint position paper that waspresented by the British Overseas Agencies Group(BOAG) to the UK Secretary of State forInternational Development.28

Chronology of eventsDateOct 2001Key eventsHEA assessment identifies foodshortfall in areas of Malawi where SCUK operationalNov 2001 SC UK hosts donor meeting inLilongwe to highlight needsDec 2001 Nutrition surveys in two districtssupport HEA findingsIntensive lobbying of donors andagenciesFeb 2002 Repeat surveys show deterioration innutritional statusFAO special alert for regionBOAG group position paperDFID first donor to fund interventionMar 2002 Regional working group formedApr 2002 Angolan ceasefire and access topopulationApr- Crop and food supply assessmentMay 2002 missions to seven countriesJune 2002 Figures established for population inneed and predicted food shortfallSept 2002 Continued shortfall in WFP funding,targeting and supplyLimited information on nationalgovernment provisionsOnus on NGOs to establish parallelfood pipelinesAbbreviations: HEA (Household Economy Approach), FAO(Food and Agriculture Organisation), BOAG (BritishOverseas Advisory Group), DFID (Department forInternational Development), WFP (World FoodProgramme), NGO (Non-governmental organisation)Recognition of a crisisThe prospect of a massive food shortage was nowbecoming more widely accepted.DFID agreed to fund a one-month SC UK food aidintervention in Mchinji - the first donor to respond tothe food situation. The World Food Programme(WFP) and FAO were also increasingly concernedand, at the Inter-Agency Standing Committee PolicyWorking Group meeting in March 2002, invited SCUK to present on the regional food situation. As aresult of this meeting, and at the behest of WFP, aworking group was formed. Tasked with coordinatingthe Crop and Food Supply Assessmentmissions to the region, the group was charged with awider remit than normal. In addition to gatheringroutine information on food supply, there was anexplicit requirement to collect data on access to food,and vulnerability issues. The missions in each of theseven countries (Angola, Lesotho, Malawi,Mozambique, Swaziland, Zambia and Zimbabwe)took place throughout April and May 2002, and SCUK participated in both the Malawi and Zimbabwemissions. Assessment findings were reported to amulti-agency meeting on the 6-7 June 2002.Referring to three phases of activity between June2002 and April 2003, the meeting established agreedfigures for the food requirements of the region andgenerated indicative figures of the populations inneed.Continuing food shortfallThe situation was now described as a “crisis ofenormous dimensions”. It was agreed thatover 12 million people in six countries would requireassistance, to make up for a total cereal shortfall of 4million metric tonnes (MT). Of this, emergency foodaid would contribute 1.2 million MT until March2003, with national governments and the commercialsector needing to source the remainder.Coincident with these developments was the death ofSavimbi in Angola and the resultant cease-fireagreement on 4th April 2002, allowing contact with ahitherto inaccessible resident population in Angola.Almost overnight, the number of beneficiariesrequiring humanitarian aid mushroomed. OCHAfigures suggested that more than 3 million people inAngola would require humanitarian assistance, ofwhich 1.9 million people would require food aid.Within the Southern African DevelopmentCommunity (SADC) as a whole, maize productionstood at 16.3 million MT for the 2001/02 season.Whilst this represented only a 7% fall whencompared to the average over the previous five years,it masked significant country level declines. Theseincluded Zimbabwe (71% down), Zambia (-35%),Malawi (-18%), Swaziland (-22%), and Lesotho (-21%). At best, the harvest in April / May 2002offered only temporary respite.As of 24 September 2002, only 36% of the required$507 million funding had been pledged to the WFPand it was estimated that the WFP RegionalEmergency Operation (EMOP) was not going to meetall the emergency food aid needs, nor target all theidentified beneficiaries. Targeting 80% of the affectedpopulation (10.2 million people), the WFP couldprovide only 67% of the food aid cereal needs. Animplicit requirement of the EMOP was that otheractors, principally international NGOs, needed todevelop parallel food pipelines to make up for thisshortfall.Commercial and government importsIt was recognised that the international communitywould only partly meet the massive food needsidentified. National governments and the commercialsector would need to supply the bulk of the shortfall.To allow effective contingency planning to take place,it became all the more critical that availableinformation should be shared openly. Up untilSeptember 2002, country-specific information hadbeen poor - published figures did little to differentiateproposed purchases, active contracts or stocks alreadyreceived. No information existed regardingdistribution plans for government stocks oncereceived. In all cases, it was felt that nationalgovernments needed to be more transparent regardingtheir capacity to access food and their progress indoing so. This would allow the internationalcommunity to assess whether the needs of the hungrywere being met. Where data did exist, it was difficultto assess the reliability of the figures, although theydid prove useful in identifying relative import trends.For example, figures presented at the September 2002meeting in Johannesburg suggested that whileMozambique had imported 78% of its requirements,Zambia had imported only 9 per cent of its estimatedneed.Compounding issuesGenetically modified organisms (GMO) became animportant issue in 2002. At various times, Zambia,Zimbabwe, Malawi and Mozambique all expressedconcern or refused acceptance of geneticallymodified (GM) maize. Most of the concerns revolvedaround the potential contamination of localagricultural crops, although health risks were alsomooted. Zambia came out strongest by banning theimport of GM maize, though this may besubsequently reviewed pending more recent datacollation by Zambian scientists. Malawi announcedthat, from the first of October 2002, all GM maizemust be milled to prevent any potentialenvironmental contamination. However, the issue ofwho should incur the additional milling costs was notfully addressed. While SC UK accepts the right ofgovernments to question GMOs in principle, itbelieves that this crisis required greater pragmatism.If the only choice were accepting GM crops or seeingmany people starve, SC UK felt that countries in theregion should soften their stance and accept GMcrops -milled or unmilled - for the period of thisemergency.The effect of HIV/Aids has created a new kind ofcrisis. The structural decline that characterises theregion is now being compounded by HIV/Aids,which has implications for targeting, household foodsecurity and recovery. This is the first time we areseeing the livelihood impact of Aids on such a vastscale.Advocacy roleField articleMalawi, Salima district, May 2002. Largedistribution to about 1,000 beneficiaries.© CHRIS BOWLEY/SC UKSC UK was one of the first NGOs to alert theinternational community to the impending food crisisin Southern Africa. Using data from HEAassessments and nutrition surveys, it was possible tolobby vigorously key agencies with a strong degreeof confidence in our position. In many cases thisstrategy led to strained relationships with our targets(who were also, in a real sense, our potentialpartners), but it did successfully force the issues intothe public domain and encourage debate to takeplace.SC UK secured an early response from DFID for29

Field articleAid distribution in Chunga,Binga district, Zimbabwe inJuly 2002© BRENDAN PADDY/SC UKfood aid funding in Zimbabwe (August 2001), butdespite our attempts, could only achieve the samemuch later for Malawi (February 2002). Intensivelobbying had begun in Malawi in late 2001.Advocacy was conducted at national, regional andinternational levels, either directly or throughinfluential agencies such as OCHA. A variety ofmeetings, letters to key individuals and pressstatements were used to exert pressure for an earlyfood aid response in Malawi, in particular targetingthe WFP, the European Union (EU) and DFID.However eliciting a timely donor response provedunsuccessful. Eventually by early 2002, the WFP andDFID were responding to the crisis, however the EUcontinued to prevaricate.In Angola, SC UK has constantly lobbied the UnitedNations (UN) to be more effective in its humanitarianco-ordination, and for the donors to respond moregenerously to Angolan humanitarian appeals. Part ofthis lobbying work took SC UK to the UN SecurityCouncil in March 2002. Through conducting foodsecurity assessments in Malawi, Swaziland andZimbabwe, SC UK has remained an influential voicewith both the WFP and the member governments ofthe SADC. SC UK’s regional food security advisersits on the SADC Regional Vulnerability AssessmentCommittee in Harare, giving the agency a strongregional overview of food security and early warningissues.Locally, SC UK ensures its voice is heard at alllevels. For example, agency staff attend thefortnightly WFP/NGO meetings in Johannesburg.Key regional issues are continuously raised withOCHA and UNICEF. These include highlighting theplight of Zimbabwean farm workers and the need tosafeguard principles of neutrality, appropriateattribution of aid and safety of humanitarianpersonnel.SC UK has taken the lead within Zimbabwe inproviding guidance and information on food securityto the British NGO group. Meanwhile inMozambique, a group representing the DisastersEmergency Committee (DEC) agencies has also metregularly to examine food security and co-ordinationconcerns. SC UK is part of an influential NGOconsortium in Malawi, which works alongside theWFP and the United Nations DevelopmentProgramme (UNDP), and sits on severalgovernmental task force committees to address foodpolicy needs. Save the Children Swaziland currentlychairs the NGO Drought Consortium, which handlesall negotiations between NGOs, government and theWFP. These activities and meetings are mirrored bysimilar groupings and meetings held in the UKamongst the relevant agencies.Media coverageAs an international agency, the scale of the disastermade it incumbent on Save the Children to ensurethat the facts were made widely known, and that theywere subsequently acted upon. A key vehicle for thiscommunication was the media. Initially it wasextremely difficult to generate media interest, sincefor many it was ‘just another annual food crisis inAfrica’. During these early stages, media coveragewas sporadic and was nowhere near the level requiredto spur reluctant donors into prompt and decisiveaction. Interest from other agencies was alsorelatively limited, although by the beginning of 2002,Concern and the WFP were clearly doing what theycould.From the outset, SC UK had worked closely withother UK NGOs to increase the profile of the crisis -a strategy that had intermittent isolated successes. Toheighten awareness, SC UK decided to capitalise on apre-arranged trip by the Mirror newspaper to Malawi,inviting the journalist concerned for a specificbriefing on the crisis. The resulting coverage was of asensational, and occasionally quite critical, nature butit did provide the opportunity to dramatically increasethe profile of the issue.On the day the Mirror newspaper published the story(21st May 2002), SC UK took the decision to use anapproach that the agency had been debating aboutinternally, and which coincidentally, had beenindependently used by the Mirror. The line taken byboth parties compared the potential scale of theemergency in Southern Africa to the famine inEthiopia in 1984-85. SC UK was not suggesting thatthe same numbers of deaths would be seen, but ratherthat many millions of people over a hugegeographical area would be seriously affected andthat, without intervention, deaths would undoubtedlyoccur. Although this risked conflating two whollydifferent events, it did dramatically illustrate the scaleof the potential crisis and resulted in two days ofintense follow-up coverage from television, radio andprint media.Since then, media coverage has improved but remainssporadic, with two main peaks of attention in theperiod since. The first was the launch of the DisastersEmergency Committee (DEC) appeal on 25th July2002, using Save the Children spokespeople in bothLondon and Johannesburg. The second involvedcoverage around the land reform process inZimbabwe. Regarding the latter, the highly politicisedapproach taken by most of the UK media frequentlyresulted in misleading comments about the nature andthe causes of the humanitarian crisis in Zimbabwe.ConclusionsThe recent experience in southern Africa hasdemonstrated the following:i) The value of early and persistent lobbying withdonors/ UN agencies, as demonstrated in the eventualinternational recognition and humanitarian responseto the Southern Africa crisis.ii) The predictive power of the Household EconomyAssessment models to anticipate emergencysituations/ food crisis. The evidence suggests that thefirst warnings were accurate, that the householdeconomy approach used in these studies was sound,and the approach should be used as a basis for futureearly warning and monitoring. With its focus onaccess to food, income and other livelihoodresources, it is a valuable tool for linking povertyreduction strategies (and monitoring their impact)with disaster prevention. In view of the fact thatinadequate methods of analysis, based on foodavailability indicators, persist in the region, it isimperative that food access be incorporated as anintegral part of any analytical process.More detailed analysis is required of the way inwhich newly liberalised grain markets are operatingin the region. Also, to what extent was this a ‘freemarket famine’, and what steps are needed to ensurethat poor harvests do not, in future, result in a similarcollapse of the market system.iii) Communication strategies are an essentialelement of advocacy work. The media is a powerfulmeans of mass communication, howeverhumanitarian organisations do not have full controlover how their information is used or a situation isportrayed. This must be considered when engagingthe media and interpreting media coverage in anyhumanitarian crisis.For further information, contact Anna Taylor, Nutrition Advisor,SC UK, email: a.taylor@scfuk.org.uk1Experiences drawn from two SC UK reports: Evolution of aCrisis, a Save the Children UK perspective, September 2002and Responding to fragile livelihoods in Southern Africa,October 20022FEWSnet: Famine Early Warning System Network30

Nutrition survey inBinga, April 2002Field articleNutrition assessments in Zimbabwe:a local perspectiveBy George KararachFor the past two years, George Kararachhas worked as a consultant policy analystin Zimbabwe - for the last year working withUNICEF Zimbabwe.The support of UNICEF in preparing thisarticle is gratefully acknowledged.The opinions expressed in this article aresolely those of the author, and not of anyparticular organisation.This article outlinesthe author’s personal experience ofnutrition-related assessments in Zimbabweduring the recent emergency crisis, andprovides some recommendations for futureassessments.Following deterioration in the food securitysituation in Zimbabwe at the end of 2001, byDecember 2002, a number of emergencyassessments had been carried out in the country.Some of these have been multi-sectoral, coveringwater and sanitation, health, nutrition, food securityand adolescent reproductive health.The crisis in Zimbabwe is acknowledged to be acomplex emergency and is, at least in part, manmade.However, the argument by the humanitarianand international community that the crisis ofgovernance is a major contributor to the humanitariancrisis, has met with a lot of resistance, if not outrightdenial, by the government of Zimbabwe. This, inturn, has contributed to what can be described as thepoliticisation of data 1 , with the outcome ofassessments contested by both donors andgovernment, depending on who conducted theassessment. Attempts to create broad consensusaround assessment findings has meant the assessmentprocess has been slow, and in some instances painful,with technical considerations swept away in favour ofpragmatic political ones.In seeking to describe the dynamics around nutritionassessments 2 in Zimbabwe during this period, a broadanalysis is necessary in order to interpret nutritionassessment data - especially in an environment wheredata are likely to be ‘politicised’.Methods of nutritional surveillanceThe use of nutrition surveillance as a tool for earlywarning systems is fairly well understood. Manywould argue that nutritional status monitoring canprovide sensitive and timely information regarding‘human stress’. In particular, it crucially informswhen a food crisis does become a famine, or at leastbegin adversely to affect nutritional status.Nutrition surveillance has been perceived as crucialin monitoring trends in the humanitarian crisis inZimbabwe. Findings of assessments conducted in2002, along with the results from the demographichealth survey of 1999, are summarised in table 1.A number of different methods have been used inZimbabwe to collect national level nutrition data.Nutrition surveysIn May 2002, the Ministry of Health and ChildWelfare, and UNICEF carried out a nutritionassessment. Using a two-stage 30x30 cluster method,23,400 children were sampled in 28 districts ofZimbabwe and a prevalence of 6.4 % moderatemalnutrition (weight-for-height

Field articleMeasuring weightand height during thenutrition survey inBinga, April 2002districts (57 at the time) and a total of 1,460households were sampled. Results were scheduled foruse in targeting, and to determine the relativeimportance of food and non-food responses.Sentinel site surveillanceThis form of nutritional surveillance took placethrough the national Child Supplementary FeedingProgramme (CSFP), set up by the Nutrition WorkingGroup 3 , as well as through community based sentinelsites operated by the Ministry of Public Service,Labour and Social Welfare. The CSFP provides dataon weight-for-age through a clinic based growthmonitoring system, while the community basedsystem provides weight-for-age and height-for-agedata for children under-five from randomly selectedhouseholds (4,500). Owing to the humanitarian crisis,both of the systems were re-vitalised. In fact, thecommunity based sentinel site system arose from asurveillance system that operated in Zimbabwe in the1990s, which monitored the impact of structuraladjustment policies.While data from the CSFP sites are not nationallyrepresentative, they are perceived by many as suitablefor providing information on the impact of theblanket feeding of under-fives programme, in thecontext of the emergency. The community-basedsentinel site data provides more nationallyrepresentative data, since the sites were selectedrandomly across the various land-use systemsthroughout Zimbabwe.ConstraintsThere have been a number of constraints experienced,both in implementation of assessments and utilisationof the data collected.Politics: Only three major nutrition assessments tookplace in 2002 due to competing priorities amongstthe various stakeholders, most notably between thegovernment and the humanitarian community.Resisting pressure for more assessments, thegovernment argued that the priority was getting foodassistance to the communities (particularly when itwasn’t being delivered) and that there was a risk ofsurvey fatigue. The government’s position wasundermined by ‘hearsay’ amongst members of thehumanitarian community, suggesting that results ofthe May 2002 assessment (involving the Ministry ofHealth and Child Welfare) were unreliable. However,no hard evidence was produced to substantiate claimsthat the methodology was flawed, or that there was‘tampering’ during the data cleaning process.Political dynamics also affected security duringsurveys. Field worker teams, conducting surveysoutside the state system, attracted suspicion withthreatened attacks by vigilantes in rural communities.Lack of context for interpretation of results: Sometechnicians have suggested that since severemalnutrition levels could be classified as ‘normal’ forthe area (average prevalence 1.5% severemalnutrition), nutrition interventions, especiallytherapeutic feeding, were not justified. However,analysis of anthropometric data in conjunction withother factors such as coping strategies, makes itapparent that preventative nutritional interventionsare urgently required.Preparedness is also important. Currently, therapeuticfeeding is carried out within hospitals and, althoughthere is no increase in the percentage of severelymalnourished, the absolute numbers of severelymalnourished are still significant and could well rise.There is, therefore, a need to prepare for this, such astraining of health workers and improvement ofexisting facilities.Inter-agency co-ordination: Poor inter-agency coordinationhas impeded both the speed of surveyimplementation and the subsequent use of results byagencies. Since May 2002, the Nutrition WorkingGroup (NWG) has operated as the co-ordinationsecretariat for nutritional surveys/ surveillance.Despite its existence, there were instances whenagreements on the need for a survey were not readilysecured. There were also differences betweenagencies over the most appropriate surveymethodology. This lack of consensus affectedacceptance or endorsement of results by stakeholders.Limited government capacity: Government capacityto carry out large surveys has been gradually erodedsince the mid-1990s. A’ brain-drain’ of key workersout of Zimbabwe, the impact of the HIV/AIDSepidemic, and a weak economy have all beensignificant undermining factors. This has, in part,given impetus to the development of multi-agencyassessments/ large-scale surveys, the first of whichwas carried out in August 2002.Lack of geographical/area based assessments: InZimbabwe, there have been significant populationmovements as a result of the land reform process.Considering this, the various assessments carried outin Zimbabwe would have benefited greatly fromgeographical information on population densities. Abetter understanding of the new resettlement areaswould have complemented findings from the variousassessments and strengthened service delivery to thenewly resettled populations.Recommendations for future assessmentsThere is a need to strengthen the assessment/surveillance capacity in Zimbabwe, particularly in thecontext of emergency situations. Existing systemsneed to be reviewed and constraints associated withthe use of the data addressed.Furthermore, a system is required which marries thestrengths of the various survey/ monitoringmethodologies currently in use. Such a system shouldbe based on multiple indicators, which allowsmonitoring of the key factors that influencenutritional status, as well as demonstrating nutritionaltrends. This inevitably requires an analysis oflivelihoods and coping strategies. Critically, meansmust be identified to reduce the potential for politicalagendas to influence when surveys are implementedand how results are interpreted.Finally, any progress will require a strengthening ofgovernment capacity to plan and implement surveysand monitoring, and an improvement in the operationof co-ordination mechanisms between humanitarianagencies.For further information, contact George Kararach at email:gkararach@unicef.org1The term ‘politicisation of data’ is used here to mean thatdata are employed to further political aims.2The term ‘nutritional assessment’ is used in the broadestsense in this article, i.e. it encompasses assessments oflivelihood systems and food security. Furthermore, the termassessment may be used interchangeably with surveillance,since part of the nutrition assessment data in Zimbabwe isbased on on-going (routine) data collection (surveillance).3The Nutrition Working Group - this was made up of variousagencies working on nutrition issues including government,NGOs and UN agencies, chaired by UNICEF.32

PostscriptPost scriptUnderstanding the food crisis in ZimbabweBy Fiona WatsonFiona has recently been in southern Africa with the Overseas Development Institute (ODI), looking at the roleof needs assessments during the current crisisThe situation in Zimbabwe has spiralled intocrisis as a result of complex underlyingfactors. First, the political environment isunstable and the government has been accused ofpoor governance. The Presidential election thattook place in March 2002, and which returnedPresident Mugabe to power, was described byalmost all international observers as “unfree andunfair”. Gross human rights violations weredocumented throughout the election process andsince then, politically motivated, governmentendorsedviolence continues against thoseperceived to be supporters of the oppositionMovement for Democratic Change (MDC). 1President Mugabe has stated publicly that thegovernment intends to repress its politicalopponents and new laws have been passed whichseriously restrict freedom of expression,association and assembly.Secondly, the economic situation is deterioratingswiftly, with high inflation (144 per cent inOctober 2002 and predicted to rise to 400-500 percent during 2003), 2 high unemployment (50-60percent) and closure of factories and businessesdue to dwindling confidence in the investmentenvironment. The donor community has withdrawnaid to the country. This, together with a severereduction in foreign exchange earnings from salesof tobacco, gold and cotton, has led to a decline inforeign currency reserves to extremely low levels.Thirdly, the impact of HIV/ AIDS has beendevastating. Over 30 per cent of the population areaffected, which has had a detrimental effect on theeconomy and caused increased pressure on healthservices. There is a lack of drugs and, in somecases, health staff in the country.These underlying factors have had a major impacton food security. Domestic agricultural productionhas been reduced both by the land reformprogramme and adverse weather conditions. InJuly 2000, the “Fast Track” resettlement phase ofthe land reform programme was initiated. A lawwas passed that allowed for the compulsoryacquisition and resettlement of land. To date, over5,000 of Zimbabwe’s 6,000 commercial farmershave been issued with notice to leave and 150,000farm labourers and their families have already beenmade homeless and jobless due to farm seizures.This has reduced crop production significantly.Erratic rainfall (floods followed by drought in the2001/02 crop season) has reduced crop productionfurther. In May 2002, it was estimated that cerealproduction was down by 57 per cent from theprevious year’s poor harvest. 3Imports, however, have been insufficient to meetthe deficit. The Grain Marketing Board, thegovernment body with a monopoly on importinggrain, is unable to import enough grain to make upthe deficit. This leaves an estimated cereal shortfallof 1.5 million metric tonnes (MT) for themarketing year (April 2002 to March 2003), ofwhich the maize shortfall (the staple food inZimbabwe) accounts for 1.3 million MT. Privatesector commercial imports are believed to benegligible. Although maize is sold at controlledprices, there is an absolute shortage of maize andprices on the black market have soared.Thus while the crisis in Zimbabwe has beencaused by a number of interacting underlyingfactors, the symptomatic effect has been a growingfood crisis - both in terms of absolute lack of foodand lack of access to food. The latest emergencyfood security assessment 4 concluded that some 6.7million people (49 per cent of the population)would require emergency food aid up to March2003.Impact on nutritional statusDespite the dire food security situation inZimbabwe, the prevalence of malnutrition has notyet risen significantly. The data shown in table 1show a slight increase in acute malnutrition.Confidence intervals overlap, however, and itshould be noted that the VAC assessment usedpurposive sampling and so is not comparable withthe other two surveys. Furthermore, the methodsused to assess anthropometric status in the VACsurvey have been questioned and inaccuracies inmeasurement may have occurred. Thus, the dataavailable so far do not indicate a significantincrease in malnutrition.The concern in Zimbabwe must be to address thefood security crisis before a famine develops,causing untold misery and deaths. For this reasonthe importance of nutritional surveillance, asemphasised in the article by George Kararach, is ofparamount importance.Nutritional assessmentsWhile national level surveys are useful inproviding a ‘snap-shot’ view of malnutrition and incomparing provincial rates, their major constraintis that they are not carried out frequently enoughto measure trends. Furthermore, in Zimbabwe, thegovernment has not allowed a nationallyrepresentative nutritional survey to be conductedsince May 2002, arguing that people need food andnot more surveys. 5Sentinel site surveillance, on the other hand, hasthe advantage of allowing trends to be monitored.As pointed out in the article, however, the data arenot representative of the total population. InZimbabwe, sentinel surveillance of supplementaryfeeding programmes for children under five atcommunity level, is due to start. This will involvethe monthly weighing of children and possiblyinclude the collection of other indicators.Currently, the lack of measuring equipment andexperience in measuring height will precludemeasuring acute malnutrition, but weight-for-agewill be assessed.When used in conjunction, data from surveys andsentinel site surveillance are complementary.Surveys providing an indication of the overallprevalence of malnutrition in the population andsurveillance providing data on trends, should allowadverse changes to be noticed early. Clearly it isessential that nutritional data are linked withinformation on underlying causes, including dataon coping strategies and livelihoods. The VACassessment was unique in that it was a multiagencyattempt to link food security and nutritiondata. Until now, the use of the VAC data haslargely been confined to determining food aidneeds, but with further analysis, the informationcollected could be used to inform other types ofintervention.Politics of assessmentsCurrently, the political climate in Zimbabwe isuncertain. Besides the ‘politicisation of data’, foodis being used as a political weapon. There aremany reports of families being denied the right tobuy food from the government’s Grain MarketingBoard warehouses because of their support of theopposition. In October 2002, both Save theChildren and Oxfam were banned by thegovernment from distributing WFP food aid asthey were viewed as loyal to the opposition party.The responseThe crisis in Zimbabwe has received a certainamount of media attention and has been includedin various aid agency appeals. Food aid has beenviewed as a priority response. For example, over80 per cent of the UN consolidated inter-agencyappeal for July 2002 to June 2003 was for foodalone, while health represented less than 10 percent of the appeal total. Whilst food aid may servea vital role in protecting against food insecurityand so preventing malnutrition, it cannot addressthe underlying causes of the food crisis. Theseunderlying factors are likely to continue to impactnegatively in the long-term. The problem of HIV/AIDs, in particular, needs to be addressed as partof the emergency response.As the article notes, there is a need to prepare for apotential rise in severe malnutrition by building thecapacity of local hospitals in therapeutic care. InMalawi, a strong case is being made to set upcommunity therapeutic feeding systems. In view ofthe state of the crumbling health facilities inZimbabwe, this may be a way forward and perhapsneeds to be considered.ConclusionsThe food crisis in Zimbabwe has complex causes,which are unlikely to be solved in the short-term.Predictions are that food security may continue todeteriorate, coping strategies will be eroded andlivelihoods threatened. As yet, there has been nosignificant detectable decline in nutritional status.Nutritional surveillance is vital in such a scenarioin order to pick up as quickly as possible any signsof deterioration.The political environment in complex emergenciesis frequently fraught. In Zimbabwe, there areparticular problems concerning the collection andinterpretation of data, and impartial distribution offood. Agencies working in Zimbabwe need to bealert to these problems and to work together toensure that humanitarian principles are upheld.Since this postscript was written, the government haveallowed another national nutrition survey, conducted inFebruary 2003 and covering all 61 districts. Using multistage30x20 cluster survey methodology, these findingsshould be comparable to the 1000 DHS and May 2003surveys. This time, NGOs and donors participated in theplanning and supervisory filed visits. At time of print thesurvey was being analysed.1The politics of hunger in Zimbabwe by Physicians forHuman Rights, May 2002.2Economist Intelligence Unit cited in “Zimbabwe in grip ofnew hunger crisis” by Andrew Meldrum, The Observernewspaper (UK), Sunday 15th December, 2002.3FAO/ WFP Crop and Food Supply Assessment Mission toZimbabwe, May 2002.4Vulnerability Assessment Committee. Emergency FoodSecurity Assessment Report: Zimbabwe, September2002.5Personal communication, SCF-UK Zimbabwe Office.33

People in aidThe Sphere Project,Training ofTrainers - Course #7, January2003 GenevaFront row, from left to right:Haitham Baltaji (Syrian RedCrescent), Elly Proudlock (SphereProject Senior Assistant), SeanLowrie (Co-facilitator), Juan Saenz(Co-facilitator)Second row, from left to right:Everready Nkya (Lutheran WorldFederation), Fiona O’Reilly(Emergency Nutrition Network),Renata Jagustovic (InternationalCatholic Migration Commission),Susan Romanski (Mercy Corps),Annie Lloyd (IndependentConsultant), Wendwessen Kitaw(Save the Children)Third row, from left to right:Patricia Mansanganise (CatholicRelief Services), Emma Jowett (Cofacilitator),John West (World Vision),Marcel Vaessen (UN OCHA)Fourth row, from left to right:Elizabeth Hayward (The SalvationArmy), Bryan Walker (IndependentConsultant), Dave Heed(Independent Consultant), SarahKing (Christian Aid), Tilleke Kiewied(Oxfam Netherlands), AndyPendleton (Christian Children’sFund)Back row, from left to right: DerejeAdugna (CARE Ethiopia), RichardLorenz (RedR), Ron Ockwell(Independent Consultant), SeanKennedy (IRC – DR CongUpper row. Save the Children’s emergency nutrition team inNorth Darfur, from left to right: Rowida Hassan, Kate Sadler,Abdalla Adam Eisa, Ahmed Ishag, Abdalla Adam, JamalAbdalla Ali, Mohammed el Hafiz and Afaf Mohammed Breima |The 2 Seans (Sean Lowrie, training manager and SeanKennedy, IRC, DRC) showing off the new Sphere t-shirts atthe Sphere Training of trainers in Geneva, January 2003.Middle row, Sphere TOT. Nan Buzzard, Sphere projectmanager, distributes the first Sphere t-shirt | Ayman SadekTaqawi, CRS Egypt and Nkya Everready, LWF Tanzania |Dareje Adugna, Care Ethiopia.Bottom row. London, February 2003, Nutrition standardsreview meeting, Caroline Tanner (AED), Steve Collins, RitaBhatia (WFP), Paul Sherlock (Concern) and Alain Mourney(ICRC) looking down | Ann Callanan, same meeting, butlooking up | Homayoun Naseri Wardak, Assistant head ofmission, MSF France, Kabul, Afghanistan.34

The BackpageSphere TOT, Geneva, January 2003. From left to right: Wendwessan Kitaw(SC UK Ethiopia) and Patricia Masanganise (CRS Zimbabwe) | Bryan Walker(Ind.) | Haitham Baltaji (Syrian Red Crescent) and Elizabeth Haywood(Salvation Army UK).Field ExchangeEditorial teamSheila ConsidineDeirdre HandyJohn KevanyMarie McGrathFiona O’ReillyJeremy ShohamLayout and websiteKornelius ElstnerContributors for this issueGaëlle FedidaSaul GuerreroJulius HoltGeorge KararachSonya LeJeuneJudith LewisRosalyn O'LoughlinChandrashekhar PandeyPaul Rees-ThomasSaskia van der KamFiona WatsonMark WrightThanks for the photographs to:Naoise Kavanagh (Concern)Pieternella PietersePaul Rees-ThomasAndy SealOn the coverCamels being watered in Mandera,Kenya. June 2002 © Paul Rees-ThomasThe ENN is a company limited by guaranteeand not having a share capital. Companyregistration number: 342426ENN directors: Fiona O’Reilly, JeremyShoham, Prof. John Kevany, Dr. ShaneAllwrightThesupported by:GENEVA FOUNDATIONto protect health in warRoyal Danish Ministryof Foreign AffairsTEARFUNDThe Emergency Nutrition Network (ENN) grew out of aseries of interagency meetings focusing on food and nutritionalaspects of emergencies. The meetings were hosted by UNHCR andattended by a number of UN agencies, NGOs, donors andacademics. The Network is the result of a shared commitment toimprove knowledge, stimulate learning and provide vital supportand encouragement to food and nutrition workers involved inemergencies. The ENN officially began operations in November1996 and has widespread support from UN agencies, NGOs, anddonor governments. The network aims to improve emergency foodand nutrition programme effectiveness by:• providing a forum for the exchange of field level experiences• strengthening humanitarian agency institutional memory• keeping field staff up to date with current research andevaluation findings• helping to identify subjects in the emergency food and nutritionsector which need more researchThe main output of the ENN is a quarterly newsletter, FieldExchange, which is devoted primarily to publishing field levelarticles and current research and evaluation findings relevant tothe emergency food and nutrition sector.The main target audience of the Newsletter are food and nutritionworkers involved in emergencies and those researching this area.The reporting and exchange of field level experiences is central toENN activities.The TeamFiona O’Reilly (Field Exchangeproduction editor) and JeremyShoham (Field Exchange technicaleditor) are both ENN directors.Jeremy and Fiona established theENN in the Department ofCommunity Health in Trinity College, Dublin in 1996. Earlier thisyear the ENN incorporated as a not-for profit company limited byguarantee.Kornelius Elstner is responsible for Field Exchangedesign and layout. He is also the ENN I.T. specialistand works part time at the ENN while undertaking adegree in computer science.Marie McGrath is a qualified paediatricdietician/nutritionist. She has an abundance ofexperience in emergencies, working previously withMerlin and carrying out research with SC UK.UNHCR35

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