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July 1999 Issue 7Field ExchangeEmergency Nutrition NetworkCommunity Targeting TanzaniaKosovo in CrisisALNAP assesses ParticipationEarly Warning in the Red Sea State

ContentsField Articles• Food Preparation an Obstacle toEducation ............................................3• Concern’s Initial Response to theKosovo Crisis.....................................14• The Collection of Early WarningInformation Through CommunityResource People – A Case Studyfrom the Red Sea State ...................16• Community Managed Targeting ofEmergency Food Aid:Does it Ever Work? ...........................18• Water, water everywhere but...The ‘98 Bangladeshi Floods............22Research.................................................5• Shopping for Answers in SouthernSudan• Supplementation Programmes forPregnant and Lactating Women• Aid and Erosion of HumanitarianPrinciples in Sierra Leone• Thiamin Deficiency and Malaria inAdults from Southeast Asia• Wild Foods – More Evidence for theirImportance in the Diet• The Potential use of Maternal Size inPriority Setting When CombatingChildhood Malnutrition• More Evidence in Favour of Iron PotsNews & Information ...................11 & 12• Workshop to explore the potential ofindigenous wild food plants (IWFPs)in Southern Sudan• Chronic Malnutrition: a Problem notAddressed by SFPs• Guiding Principles for Caring for theNutritionally Vulnerable DuringEmergencies• Jobs• Infant Feeding in Emergencies: Whatis your Experience?• Nutrition in Relief and EmergenciesCourseLetters...................................................21• Making a Difference for AfghanWomenAgency Profile .....................................24• Tanganyika Christian Refugee ServiceEvaluations...........................................24• Participation by the AffectedPopulation in Relief OperationsDear ReadersWelcome to Field Exchange 7. A strong theme running throughout thisedition is community participation in emergency surveillance,programme planning and response. We also have an article fromCONCERN describing its intervention in Kosovo, the author justifiesthe relative low interest given to this crisis by organisations andjournals dedicated to nutrition issues. This article also highlightsthe responde of neighbouring communities to the fleeing refugees.We have an article about the role of community resource people fromthe Beja tribe in the Red Sea State in northern Sudan in providingfamine early warning information. These information providersconstitute an invaluable resource for their isolated andmarginalised communities and provide an information outreach whichwould be hard to replicate through other means at such low cost.Another article details the success of a community managed emergencyfeeding programme in pest and flood-stricken central Tanzania.Limited food aid resources determined the need to target a maximumof 60% of households in the two regions. Targeting was successfullymanaged by the community who elected a village relief committeewhich developed village specific selection criteria. The system wasfound to be transparent, accountable and fair.Community efforts were also mobilised in response to the appallingBangladeshi floods last year. An article by the IFRC delegate forBangladesh documents how much of the distributed food came fromlocal benefactors while community knowledge of local seed varietieswas pivotal in the post-flood rehabilitation phase.This edition of field exchange carries a summary of the ALNAP studyon beneficiary participation in emergency programmes in southernSudan last year. The importance of community participation inprogramme planning and implementation is highlighted through anumber of case-studies.A visit by the ENN co-ordinator to southern Sudan in May lead to afurther field level article ‘Food Preparation an obstacle toeducation’. This article suggests that the amount of time spent inemergency situations manually pounding cereals and grinding grainconsumes much time spent by women and girls on food preparation. Thepopulation in question traditionally ate sorghum the provision ofunmilled grain as part of the general ration has opportunity cost interms of time spent in its preparation. As a result, girls whotraditionally carry out this type of activity, had less time toattend school.We also have a couple of pieces (including an agency profile) aboutthe role of Tanzanian church based agencies in emergency response.Such agencies, especially where they have a long history workingwith the community, often fulfil an important role duringemergencies but their work is rarely fully acknowledged while theyreceive little technical support from international humanitarianagencies.Finally, we would be very pleased to receive contributions from anyof you working in the Kosovo crisis for publication in the nextField Exchange. By all accounts there were many unusual aspects ofthe emergency and response which we are sure our readers would liketo hear about.Please drop us a line if you think you may have something for us.Editors,People in Aid.......................................25• Food Aid – On a Wing and a Prayer• Photo GalleryFiona O’ReillyJeremy ShohamThe Backpage......................................27

Field ArticleFood Preparation anObstacle to EducationThis article is written by Betty Kidan Muni who is a fieldofficer working for SCF with women’s groups in southSudan.*BackgroundBararud lies about 40 miles north west of Wautown in the Bahr el Ghazal region of SouthernSudan. In 1997 there was a drought and apoor harvest in the region, In 1998 there was anotherharvest failure. Insecurity and fighting as well asconstant raiding and looting by militias from thenorth continues to undermine food security so thatalthough life has to a large degree gone back tonormal since last years crisis, food as well as generalsecurity is precarious. Last night along with the restof the people in Bararud I fled to the hills on hearinggunfire which later turned out to be a drunken soldierreturning from his mother in law’s house. Howeverthe immediate flight to safety is a sign of the generalinsecurity and the level of nervous readiness, whichhas become part and parcel of everyday life.Bararud currently has a population up of about 3500which increased by about one third after fighting inWau in January 98. As one walks from the airstripthrough the dispersed toukels, there is a feeling thatnormal life is going on. People are cultivating theland immediately surrounding their toukels andwomen and girls are pounding grain in preparationfor the main meal of the day.Bararud is part of the ironstone plateau foodeconomy zone. This area is sparsely populated andcontains a range of ethnic groups. Bararud, which isin Wau County, is dominated by the Jurchol, a Niloticgroup, more commonly known as the Luo or Jur. Therelative importance of different food sources in anormal year for Wau County residents is representedin figure 1. Sorghum is the main crop but sesame andgroundnut are also of significant importance During abad year only 3 to 5 sacks of Sorghum are harvested(a quarter of household needs). Households plant anaverage of 4 feddans. In good years when droughtand insecurity have not prevailed the Ironstoneplateau is a self sufficient or food surplus producingarea.Walking past one compound comprising 3 touklesand a small amount of land the women were keen tostop their chores and talk. They explained that thecrops normally cultivated in the area were Sorghum,Maize, Simsim, ground nuts, cassava and Millet.Vegetables such as Cassava leaves, cowpeas pumpkinleaves and green peas also contributed significantlyto the diet. While we were sitting chatting with orhosts, children were collecting familiar wild foods,which although part of the normal diet are heavilyrelied on at times of extreme food stress. Samples ofsome wild foods picked and presented by thechildren were as follows; Uhding (Gynandropsisgynandra), arugo (Hibiscus) and root, kudera(Corchorus in arabic / ayaak in dinka), alana(petrocarpus lucens) and manyok (Commelinabenegalensis). All of these are leaves except arugowhich is both leaves and root.We ate lulu as we chatted (a delicious wild food withan avocado like outer layer and a hard nut inside - thenut is pounded for its oil) The women explained thatthey were planting serado, which takes about 3months to harvest, and maize, which takes longer.Dura (sorghum), which is a dry season crop takelonger again to harvest. In normal times cow andgoat meat as well as fish would also be part of theLeft: Betty Kidan (author of the article) withAngwet in the women’s association vegetablegarden in Bararud(Fiona O’Reilly)Above:Mali,Gao area – Two women pounding(C. Shirley/UNHCR)Figure 1: Household food economy of Wau County(Source: An Introduction to the Food Economies of SouthernSudan, WFP/SCF(UK), WFP FEAU ‘98)Normal year food economyWild food incl. fish35%Meat & milk5%Gift & exchange10%Non-grain15%Grain35%* This article was written with help from Fiona O’Reillywho was on a field trip in south Sudan

Field Articlediet but the level of insecurity has made it difficult tograze and access livestock or go on fishingexcursions.After the fighting in Wau in Jan 98 the resultingincrease in the population in Bararud put additionalstrain on the food economy of the area. Insecurity hasalso reduced access to land for cultivation. The Luowomen explained that last year some families wereworse hit than others and that large families have agreater capacity for cultivating land and weretherefore less likely to be amongst the most foodinsecure. Most food harvested last year was eatenalthough some was traded with SCF for WFP food sothat SCF could store these local seeds andredistribute them at planting time. This seedexchange strategy, which was undertaken in order topreserve local seed variety and support peoplesproductive capacity, involved the trade of WFP grainfor local seeds at a 3:1 exchange rate in favour of thelocal seeds.The main strategy to meet food needs as well assupport peoples coping mechanisms has been thegeneral food distribution. This is implemented byWFP who target General rations to the vulnerablehouseholds in the area on the bases of householdfood economy type assessments.A General ration distribution had taken place 2 weekspreviously. However, one of the women explainedthat she did not receive the food at this distribution asshe has no husband and was sick on the day so couldnot attend. She did not send her children as she wasafraid with all the people at the site that they may notbe safe in the crowds. Wheat was distributed, as hasbeen the case throughout this year, but the womencomplained that this was difficult to pound.Pounding is a time consuming activity which turnssome cereal grains like maize and sorghum into flour.– Wheat grain needs to be ground and the Luowomen pointed out that they can use stones to do thisbut that in some area there are no stones so that thegrain has to be pounded. This does not work well asit becomes sticky and takes a long time. (See pictureof girl pounding). Much of women’s and girl’s timeis taken up pounding grains. All food brought intosouthern Sudan by relief agencies is in whole grainform - none is pre milled. As can be seen from figure3, WFP recognised the potential loss through damageto bags of flour as higher than bags of grain. Also thesheer size of the operation and amounts of food beingbrought in would make milling before distribution acolossal and expensive operation.Some women expressed a preference for receivingunmilled cereal as in this form it is more suitable forbeer making. Sorghum and Maize is preferred overwheat and takes less time to pound into flour. Mostof the women however complained of the length oftime and energy that goes in to pounding the grain.The process takes from early morning till about 10 or11 when the first meal of the day is cooked, this canbe mandazy (a kind of bread) or kisera. Then afterthe other chores e.g., collecting firewood and waterand farming activities, pounding begins again for thepreparation of the evening meal. However at timesthe whole grain is boiled for the evening meal(Bollila). The girls in the family spend their timeassisting their mothers with the women’s work ‘ If awomen is unlucky enough to bear only boys shecould be pounding until they marry’, one womanexplained. If there is a chance to send someone toschool the boys will go, as the girls cannot bereleased from their heavy burden of duties.Young Girl pounding grain in BararudCommodities generally distributedCereals: Maize Sorghum Wheat.As the general ration is targeted at women thisinvolves one or two days spent at the distribution site.This takes them away from their household and careduties which predictably fall onto the shoulders of thegirls in the family. Even so, the women expressedsatisfaction that they were responsible for collectionof the food. At present the women said that food fromthe general ration distribution is not traded for othercommodities as ‘everything has been put into theground so there is nothing else to eat’. In good timessome of the ration may be traded for salt or sugar.This was confirmed by a trip to the very spartanmarket in which there was no sign of relief food.A brief visit to the local school revealed a clearmajority of boys attending. It also revealed otherobstacles to education, most importantly the lack ofqualified motivated teachers. Children wereenthusiastically turning up for school and stayingthere even though no teachers were present. Childrentake great pride in going to school and it is seen bythe community as a normalising factor, particularlypost conflict and while living in the midst of suchinsecurity. Another factor which reduces theattendance of girls at school is that they requireuniforms to attend school and are embarrassed to turnup with out appropriate clothingConclusionsAlthough provision of a small amount of milled grainas part of the general ration at particular times of yearmay help reduce women’s work load, this article isnot advocating a change in WFP policy on thedistribution of unmilled cereals as part of the generalration. The intention is rather to highlight theconsiderable amount of time taken in the pounding ofunmilled grains. This has consequences, on amongAcceptability: Maize and Sorghum are normally cultivated. Wheat will be eaten if there is nothing elseavailable.WFP found that the majority of women prefer to receive grain in its unmilled form. Advantages include:• Long term storage is better• During airdrops unmilled grain survives better than milled (particularly in the wet).• Better able to budget with unmilled grain as the preparation is so labour intensive that women will notprepare more than required so that it lasts longer.• Various products coming from the stages of pounding are utilised in differing ways e.g. the chaff formmaize may be set aside and used in brewing or preserved and put away for hard times.However, some women preferred to receive milled cereals, particularly in the dry season when much time isspent on water collection. The reason given was the large amount of time spent pounding the grain toprepare the daily meal interfered with other activities.Pulses: Yell peas, split green peas and brown lentilsAcceptability: goodMost appropriate methods of preparation are not generally understood by beneficiaries . For example, inthe case of brown lentils it is important to understand that skins should not be discarded while soakingprior to cooking reduces cooking time.OilAcceptability: Highly valuedCulturally preferred oil: ground nut, sesame, and shea butter oil.Source: A.Hudacek Nutrition Assessment Mission Sudan EMOP 5826.01, WFP, Southern Sudan, Nov’98.Page 4 — ENN, Field Exchange, July 99

ResearchPrimary school inBararud, predominantlyboys attending(Fiona O’Reilly)other things, girls’ education prospects. Women arethe managers of food in the home and are thereforebest placed to determine the value of introducinglocal level milling facilities. The consensus amongthe women interviewed was that a mill would be avery beneficial resource and would reduce the timespent by women and girls engaged in foodpreparation. This saved time would free girls forother important activities, in particular education.A way forwardWomen’s groups in other locations are attempting totackle the problem. In Mapel, the women aresupported by SCF in soap making, vegetable gardenproduction and tailoring. These activities generateincome and the women’s association already hasplans for what to do once they generate enough cash.Some of the ideas are as follows:• to buy a grinding mill so that girls can be releasedfrom the home and attend school• build a school with parents contributing to teacherspayment• help women who are in difficult circumstances (e.g.widows), to establish small businesses throughloans.Obviously it will take quite a time to get enoughfunds to realise all these objectives. To get the ballrolling, outside funding may be necessary. Thecommunity sees the purchase of a grinding mill as akey step in reducing the workload for women andreleasing girls for education.Resources used in writing this article: A.Hudacek Nutrition Assessment Mission SudanEMOP 5826.01, WFP, Southern Sudan, Nov’98.An Introduction to the Food Economies ofSouthern Sudan, WFP/SCF(UK), WFP FEAU ’98.The Wild Food Database, C Gullick,FEAU, WFPNairobi/Lokichokio.Shopping for Answers in Southern SudanDraft ReportThe two main purposes of recent research insouthern Sudan conducted by a member of theFeinstein famine centre were:• to elevate the approach to assessing trade andexchange options to the level of household foodsecurity,• to advance the discussion about the role of reliefin restoring and/or supporting trade and exchangein the context of southern Sudan.The purposes of the study were said to be in keepingwith a number of facts:i) the GoS has in the past used traders connected tothe military to carry out famine-creating policiesagainst the southern Sudanese peopleii) there is a widely held stereotype that traders areopportunistic and exploitative; a view thatunderestimates the vital role that traders play inregional economiesiii) humanitarians rarely display strong businessskills and therefore rarely take trade intoconsideration.The author of the study raises some interesting pointsabout the role of relief in trade and exchange.Through a number of examples, she argues that therole of relief should be to help restore (and notdisrupt) exchange and trade options that have alreadybeen temporarily interrupted by the emergency. Forexample:i) distribution of relief supplies to tradingcommunities may create conditions for abuse. Reliefitems may be sold by the recipient community. The‘buyer’ community may then resent having topurchase something that was free to others. This inturn can lead to thefts from the food aid recipientcommunity or disruption to future trade activities,e.g. when the time comes to exchange cattle forgrain. Relief agents therefore need to be aware ofthese networks before a distribution and consider adistribution to both trade–linked communities;ii) relief needs to focus more on legitimising tradewhich is taking place. For example, the SPLM couldbe held accountable for regulating cattle trade in amore formal fashion, including drawing up officialagreements and commitments from neighbouringgovernments that promise to allow cattle trade tocontinue. It is the responsibility of the reliefcommunity to come to know the authorities who areresponsible for regulating trade. This might requiresmall inputs such as sponsoring meetings betweenneighbouring county authorities to discuss regulatingtaxation or to hold frank discussions with all partiesto clarify the SPLM position in regard to protectingtrade routes, rehabilitating transportation links andimproving security;iii) there is hope amongst the relief community in thesouthern sector that more surpluses of grain and seedcan be mobilised from within southern Sudan to bedistributed as relief. While undoubtedly a good thingthe author has two reservations.First, because traditional patterns of subsistencecreated an impetus for exchange between two rivalcommunities, what will happen if those are replacedby mass production schemes of grain that continue tosupport a dependent relief economy and obliteratesany need to maintain mutual relationships withneighbours. Second, if the idea is to transport largequantities of grain/seed from places as far away fromWestern Equatoria as Bahr el Ghazal, then by usingrelief flights the system is not sustainable. Ideallythere would be an independent trucking cooperativesimultaneously supported so that after a number ofseasons the lorries become the property of the driversand farmers cooperatives are left to negotiate withthem without donor interference.On balance the author of the study believes that thereis not much that relief is suited to do in the areas oftrade and exchange other than come to anunderstanding of the trade and exchange optionsavailable and to do everything possible not to hinderthese.ReferenceChoosing to Trade: Shopping for answers insouthern Sudan by J. Martin, August 15th, 1998The report is available from the FeinsteinFamine Centre, 96 Packard Avenue, Medford,MA 02155email: jmartin@emerald.tufts.eduENN, Field Exchange, July 99 — Page 5

ResearchSupplementationProgrammes forPregnant and Lactating Women.In emergencies, a marginal or deficient diet for apregnant or lactating woman has repercussionsnot only for her own health, but also for thehealth of the unborn, and the young infant.Various international non–governmentalorganisations have a specific policy to address theneeds of pregnant and lactating women in reliefsituations.Oxfam and Save The Children Fund focus upon foodsecurity at household level as a criteria for selectingbeneficiaries for supplementation programmes. Thebasic assumption is that the economically vulnerableshould be targeted and that intra–householddistribution will benefit pregnant and lactatingwomen. In contrast, Médecins Sans Frontièresapproaches the assessment of needs for nutritionintervention in an ‘individual’ way e.g. all women intheir 3rd trimester of pregnancy are included in afeeding programme as well as (depending onavailable resources):• lactating mothers of malnourished infantsyounger than 6 months;• lactating mothers with young infants whosebreast–milk production has stopped, or isreduced;• all lactating mothers up to 6 months afterdelivery.However, the efficacy and impact of theseprogrammes are frequently unclear due to lack ofconsensus on admission criteria, lack of monitoringof the admitted women, and absence of criteria toassess the impact of the supplementation programme.Dr Mija Tesse Ververs investigated theappropriateness of various anthropometric indicatorsfor use in supplementation programmes for pregnantand lactating women in her thesis for an MSc coursein Public Health in Developing Countries at theLondon School of Hygiene and Tropical Medicine.The following is a summary of her findings.PregnancyMid Upper Arm Circumference (MUAC) is the mostuseful measurement for identifying pregnant womenwith increased risk of Low Birth Weight (LBW),Intra Uterine Growth Retardation (IUGR) or foetal/infant mortality compared to all other anthropometricindicators investigated (weight–for–gestational–age,weight gain, absolute weight, pre– or early pregnancyweight, BMI, pre– or early pregnancy BMI).MUAC is relatively stable throughout pregnancy andFigure 1. The relation between caloric intake, maternalweight and birth weight.Calories13 2Birth weightMaternal weightFamine conditions: 1,2 and 3 significantlycorrelated (p≤0.001)Non-famine conditions: 1 and 2 significantlycorrelated (p≤0.001)(smaller correlations than in famine conditions)Page 6 — ENN, Field Exchange, July 99

The following intervention model is proposed by M.T. Ververs, the author of the thesis:Criteria for inclusion of pregnant and lactating womenin a nutrition intervention programme in relief situations(in the form of supplementary feeding on top of general ration distribution)yesFood security*moderatenoin famine conditions, a direct relationship existsbetween maternal dietary intake and birthweight,without the intermediary step of increasing maternalweight. This shortcut seems to take place below athreshold in dietary intake of 1600 – 1750 kcal perday. The implication is that in famine situations allpregnant women should be supplemented regardlessof their anthropometric status. The supplementationshould be started as soon as possible, in order tofacilitate the growth of breast, uterus, blood volume,and fat stores.Include women only on basisof anthropometry:Pregnancy• weight gain of

ResearchAid and Erosion of Humanitarian Principles inSierra LeoneGuinea – Sierra Leonean refugees in theGueckeodou region(L. Jackson/UNHCR)Published paperDavid Keene’s article which is largely based on areview of humanitarian agency documents aboutSierra Leone written between 1992–5 andinterviews with agency staff, asserts that at least threerecent developments threaten further erosion ofhumanitarian principles in the provision of emergencyrelief.These developments are:i) a growing emphasis on the need to repatriate refugeesand the containment of would–be refugees within theirhome countriesii) pressure on aid budgetsiii) the changing nature of contemporary conflicts, i.e.conflicts are protracted and often highly factionalisedstruggles where immediate economic goals often takeprecedence over political objectives.According to Keene, aid agencies are having difficultyadapting to this combination of changing circumstancesand there is often a reluctance even to find out aboutcomplicated realities that may call into question triedand trusted responses. For aid organisations, the chosenresponses must be seen to be appropriate to the needsthat have been recognised and publicised. But it may beeasier to achieve this effect by misrepresenting theneeds, misrepresenting the crisis and indeed bymisrepresenting the response rather than by bringing theresponse into line with the actual needs and crisis.Using Sierra Leone as a case–study (1991–5), Keeneattempts to show that the aid system failed to deliver theneeds that had been assessed, but that this failure waseffectively disguised and accommodated through avariety of techniques. For example, the planning figureof 500,000 agreed in November 1994, was itself some300,000 fewer than the number WFP felt were displacedat that time. Also, although the severity of the conflictwas tending to increase over time the level of the rationwas progressively reduced from 350 gms of cereal perperson per day in 1992 to 300 in 1993 and again downto 200 in 1994 and 1995.Distribution was also a major problem. Apart from theproblem of insecurity, aid organisations were working toa tight budget and frequently did not have the flexibilityto match the rising fees that were paid to truckers bycommercial traders. WFP were facing a major fundingcrisis in Sierra Leone, with the crisis in Rwanda takingattention and resources away and donors supplying onlya fraction of what they had pledged.Keene identifies a number of methods that were used togive the appearance of a relief operation that wasmeeting assessed needs. Some of the arguments wereapparently made in good faith while others were not. Heasserts that these methods have been used much morewidely than in Sierra Leone and that understanding themmay help in appreciating how the erosion ofhumanitarian principles can be made to seem legitimate.Conflating the needy and the accessibleThis means conflating the assessment of needs with theassessment of numbers who can ‘realistically’ bereached. The 1994 plan to help only 500,000 peopleapparently took account of the limited NGO fooddistribution capacity and security constraints. Yet thisfigure took on a life of its own and according to onereport, there were only 500,000 displaced people inS.Leone.Accepting the constraintsSecurity constraints were never as immutable asclaimed.Neglecting the monitoring of aidIn spite of the diversion of aid, reported to be as much as60% for some agencies, food aid distributions andreceipts were not carefully monitored or recorded.Exposing impediments to the actual receipts of reliefwould have required investigation and discussion ofmany facets of the emergency that major donors wereanxious to dismiss., e.g. the diversion of food aid bygovernment soldiers and the emergence of economicinterests in continued conflict.Emphasising coping strategiesRation reduction it was said would boost copingstrategies and discourage dependence. Relief to SierraLeonean refugees in Guinea and Liberia appears to havebeen phased out prematurely on the assumption that theyhad become self–sufficient. In reality many returned toconditions of considerable danger as a result of rationPage 8 — ENN, Field Exchange, July 99

eductions. The failure to deliver the needs that hadbeen assessed was justified in part with thecontention that relief was not intended to meetpeople’s nutritional needs. The ration, claimed WFPand UNHCR, was simply an income supplement. Ifthis was its primary function it was difficult toexplain the move from distributing rice to bulgurwheat, a commodity that was a much less valuableincome supplement than rice. Keene argues that itwas clear that its adoption reflected resourceconstraints in light of the considerably lower price ofbulgur on international markets.Closely related to the discussions of coping strategieswere concerns about dependency – an enduringobsession with the UN system in particular. As insome other relief operations, the masterstroke ofthose in charge of faulty operations was to claimcredit for a lack of relief, a failing that could bepresented as cleverly avoiding the negative effectsthat relief could bring.Keene explains how amid ‘all this jargon and sloppylanguage’, no evidence was advanced to support thesuggestion that people were avoiding farming orother economic activities because of a dependencysyndrome, rather than because they had beensubjected to violence and feared for their safety. Healso describes the impression reading WFP orUNHCR documents that arguments – some of themgood, some bad and some merely incomprehensible,– were being picked up and dropped with a view tojustifying a response that has been dictated by moreprosaic resource constraints.ReferenceKeene. D (1998); Aid and Violence with SpecialReference to Sierra Leone; Disasters, 1998 22(4), pp 318–327.Thiamin Deficiencyand Malaria in Adultsfrom Southeast AsiaWild Foods – More Evidence for theirImportance in the DietPublished paperPublished PaperField Exchange 5 contained an article whichdescribed micro–nutrient deficiency problemsamongst Bhutanese refugees in Nepal and howin spite of marked improvements in the food basketlow levels of these disorders persisted. Althoughthere is no evidence to link the thiamin deficiencyproblem in these camps with specific illnesses, arecent piece of research in Thailand on the linkagebetween malarial infection and thiamin deficiencysuggests that non–dietary factors can play asignificant role in exacerbating thiamin deficiency.The prospective study recruited patients with malariaor other febrile illness to a hospital in Thailand. Theresearchers utilised transketolase (an enzyme whichis dependent on thiamin for activity) activity inerythrocytes as a measure of thiamin status. Twelveof the 23 patients with severe malaria and 10 of the54 patients with uncomplicated malaria where foundto have severe thiamin deficiency. The deficiencywas most severe in those patients with cerebralmalaria.The following conclusions were drawn in the study:i) although southeast Asian populations areparticularly susceptible to the development ofthiamin deficiency because of dietary factors likeconsumption of polished rice andthiaminase–containing foods, none of the controlshad thiamin deficiency which suggests that there isan important relation between malaria infection andthiamin deficiency.ii) the host response to malaria may result in thedepletion of thiamin stores. Malarial infection leadsto a large increase in metabolic demand for glucoseas well as a requirement for increased disposal oflactate. These stresses may exacerbate an underlyingtendency towards thiamin deficiency.iii) this type of study should be repeated in differentpopulations where malaria is endemic and wherecoincidental marginal thiamin deficiency may exist.ReferenceKrishna. S, et al (1999): Thiamin deficiency andmalaria in adults from Southeast Asia, TheLancet, vol 353, Feb 13th, 1999The last edition of Field Exchange carried aresearch item (see box below) on theimportance of wild foods, especially in timesof food insecurity, for the people of southern Sudan.The article debunked a number of myths about thesefoods by showing they are not labour intensive toprepare, are highly nutritious and have a significanteconomic value. Recent research in north–eastThailand mirrors some of these findings as well asproviding a number of other important perspectivesabout these naturally occurring food resources.Twenty rural villages in north–east Thailand weresurveyed and one village was studied in depth. Theobjective was to identify knowledge about thehunting and gathering of wild foods and detect anydifference in knowledge based on gender.The study found that rural people in north–eastThailand passed on knowledge of how to hunt andgather wild plants and animals from generation togeneration. They learn how to survive in the driestpart of the country by supplementing the main staple,rice, with these wild foods. Wild plants are animportant source of vitamins and minerals. Fish,small shrimp, snails, frogs, birds and insects are allgood sources of protein and energy. The availabilityof these wild foods varies with season and theyusually are important components of the diet whenthey are available. Women earn cash from sellingwild foods in the markets which they use to purchasecultivated and processed foods as well as other wildErratafoodsIt was noted in the study that villagers haveexperienced a decrease in the availability of wildfoods as a result of massive deforestation that hasbeen going on for years. Some species of plant andanimal have disappeared completely. Even thoughwomen have transplanted a number of species closerto their homes, many do not survive outside theirnatural setting.Indigenous knowledge of how to gather wild foods ismost critical to the poor. The knowledge is passeddown in the family. The study found major genderdifferences in knowledge of wild foods and methodsof procurement. Women had more knowledge ofgathering plants and insects and of scooping forshrimp, while men had more knowledge of fishingand hunting.The study concluded that women will be vital inidentifying threatened wild species and in subsequentconservation efforts, because they realise that forestsand other natural resources are critical to theirsurvival and the survival of future generations.ReferenceSomnasang. P, Moreno. G and Chusil. K (1998);Indigenous knowledge of wild food hunting andgathering in north–east Thailand; Food andNutrition Bulletin, Vol 19, no 4, pp 359–365.Dear Readers, please note that the research on which the article Wild Foods –Blessing or Burden? in the last issue of Field Exchange was based, wassupported by SCF(UK) and WFP. Also we made a special effort in this article todemonstrate our misspelling abilities, here’s our masterpieces (correct spellings inbold):eakuadhaieayaakieakiyaiNandea Latifondadheik dhietzPetrocarpus lucerusameraPortulaca anadrifidaakuadhaayaakakiyaNauclea latifoliadheik dheikPetrocarpus lucensanueraPortulaca quadrifidaThanks to Caroline Gullick for the correct spellings.ENN, Field Exchange, July 99 — Page 9

ResearchThe Potential use of Maternal Sizein Priority Setting When CombatingChildhood MalnutritionPublished paperavailability, poor parental care and/or the need forimproved public health measures.Ethiopia – Gambella region,Sudanese (Uduk) refugees in theKarmi refugee camp.(S. Errington/UNHCR)Aperennial problem for those conductingnutritional surveys in emergency situations isthe interpretation of high levels ofmalnutrition. Are high levels of wasting due to foodinsecurity, poor maternal care and/or inadequatepublic health measures? Without this knowledge it isdifficult to know which interventions are mostappropriate. A recent study on the potential use ofmaternal size in priority setting when combatingchildhood malnutrition may chart the way forwardand out of this confusion.The objective of the study was to devise a strategyfor assessing the nutritional status of a household andspecifying the major needs in combating childhoodwasting, distinguishing between inadequate foodThe study was designed to evaluate the relationshipbetween children’s wasting, stunting or underweightand mothers or adult women’s body mass index inthe same household. Data sets from past surveys inEthiopia, India and Zimbabwe were used.A household was designated as ‘malnourished’ on thebasis of a single child’s weight/height being < –2.0S.D. or at risk of being malnourished if the Z scorewas below – 1.5. Adult women’s BMIs were taken tosignify adequacy of household food availability.There is an extensive literature showing the responsein adult body weight to a reduction in food intakeand the seasonal fluctuations in adult weights indeveloping countries when food availability is knownto be limited. Possible alternative explanations, e.g.chronic intestinal disease, trace element deficienciessufficient to induce anorexia or HIV would have tobe very widespread to explain the patterns observedin these studies.ResultsThere were wide variations in prevalences of severe,(BMI

More Evidence in Favour of Iron PotsPublished PaperIn Field Exchange 5 we published a summary ofresearch conducted in Brazil which showed thatcooking in iron pots and pans might increase theiron content of foods and that this might be avaluable strategy to help reduce incidence of anaemiain emergency affected populations. A more recentstudy in Ethiopia produced similar results.The researchers undertook a community–basedrandomised controlled trial to assess the effects ofiron or aluminium cooking pots in young Ethiopianchildren. The primary outcomes were change inchildren’s haemoglobin concentration, and weight, orlength over the study period. The study also involveda laboratory analysis of total and available iron intraditional Ethiopian foods cooked in iron,aluminium and clay pots.Four hundred and seven children, one per household,were recruited to the study. The change inhaemoglobin concentration was significantly greaterin the iron pot group than in the aluminium–potgroup. The mean difference between the groups inweight and length gain to 12 months (of age) was 0.1Kg and 0.6 cm respectively. The laboratory studyshowed that total and available iron was greatest infood cooked in iron pots, except for available iron inlegumes for which there was no difference betweentypes of pot.Interpretation: Ethiopian children fed food from ironpots had lower rates of anaemia and better growththan children whose food was cooked in aluminiumpots. Provision of iron cooking pots for householdsin less–developed countries may be a useful methodto prevent iron deficiency anaemia.Ethiopia – Dimma refugee camp,demonstration of a fuel-saving cooker.(L. Taylor/UNHCR)ReferenceAdish. A et al (1999): Effect of consumption offood cooked in iron pots on iron status andgrowth of young children: a randomised trial.The Lancet, Vol. 353, pp 712–716, Feb 27th.1999Workshop to explore the potential of indigenouswild food plants (IWFPs) in Southern SudanNewsA workshop to explore the potential of indigenouswild food plants was held in Lokichoggio from 3rd –5th June 1999. The workshop was sponsored byUSAID and organised by WFP and CRS. Around 50participants from SRRA, SPLM, NGOs andrepresentatives from institutions working in projectsconnected with indigenous food plants attended theworkshop. Both Sudanese and internationalpersonnel made presentations on, different aspects ofthe use and potential of indigenous wild food plantsand research findings in this area.The workshop aimed to:• share knowledge on the use and the potential ofindigenous wild food plants within Southern Sudanand the region (Kenya, Uganda and Tanzania).• bring together people from different backgroundsand from agencies to better understand perceptionon indigenous wild food plants.• promote amongst relief and development workers apractical understanding and appreciation of anatural resource available which can be utilised bya wide range of people in South Sudan.The main theme throughout was the need forawareness raising amongst international and nationalstaff of the value of indigenous resources. Theimportance of recognising the value of, respectingand building on people’s local knowledge and sharingscientific and outside knowledge which willcomplement and build on local capacity throughformal and informal education. It was felt that failureto do this would result in programmes that may in thelong term jeopardise food security rather that enhanceit.For more information contact: BirgittaGrosskinsky or Caroline Gullick onCaroline.Gullick@wfp.org, or Lindsey Davies,Lindsey.Davies@wfp.orgENN, Field Exchange, July 99 — Page 11

NewsChronic Malnutrition:a Problem not Addressed by SFPsAn Appeal for a Development Programmeby MSF Spain in Mandera District, KenyaThe chronic nutritional emergency in Central Mandera,north east Kenya, was the subject of an article in the lastField Exchange. Lourdes Vasquez of MSF Spainasserted that emergency selective feeding programmes (SFPs)were no solution to the chronic problems in the area and thatwithout considerable development initiatives such measureswill remain nothing more than palliatives in a cycle of soaringrates of malnutrition temporarily reduced by sporadicemergency interventions. The dramatic results of a recent nutritionalsurvey conducted by MSF Spain lend considerable weight to herarguments and conclusions.The survey, which was conducted in May 1999 found a 39.2% rate ofglobal acute malnutrition with 6.9% severe wasting. This is comparedwith a global acute malnutrition (GAM) rate of only 21% in November1998 when MSF Spain stopped their emergency selective feedingprogramme. The results of this survey have prompted the MSF Spaincountry director to make an appeal for development programmes in thedistrict.He argues that the GAM of 21% recorded in November 1998 is anormal rate for the district where malnutrition has become a chronicproblem. This is caused by recurrent drought and floods over the lastdecade during which many pastoralists lost all their livestock. Thepopulation has therefore become destitute with many moving toMandera town to eke out a living selling firewood or grass. Many ofthe destitute are female headed households that have come fromSomalia years ago. An added problem is that the area has always beenneglected by the Kenyan government and humanitarian agencies. Fooddistributions by the government and/or WFP, if implemented, havebeen insufficient. In April 1999, people received a 1 kg distribution ofmaize per family! UNICEF have excluded the district from their new5–year plan for Kenya. In the appeal, the MSF Spain country directorcomplains that what happens in Mandera is what usually happens inthe “arid lands”; short term funds are being released to pull the areaout of an acute crisis phase (due to drought or flood) and back into itsusual chronic difficulties, and then left struggling without assistanceuntil the next emergency. He argues that what is needed is a joint effortof NGOs willing to work for a longer time frame in Mandera andco–ordination between these agencies to avoid duplication and to poolresources and knowledge.The MSF Spain appeal is for both short term measures, e.g. general ortargeted food distributions and medium/longer term programmes, e.g.livestock re–stocking, seeds and tool distributions, water projects andincome generating schemes.For more information contact:Graham Carrington, DFID East Africa, Upper Hill Road, PO Box30465, NairobiGuiding Principles for Caring for theNutritionally Vulnerable During EmergenciesThe International Conference on Nutrition (Rome, 1992)recognised food, health and care as fundamental componentsfor nutritional well–being. Although this conceptual frameworkhas been widely adopted in addressing nutrition problems worldwide,little progress has been made in applying the care component of thisframework to the design, implementation and monitoring ofinterventions during nutritional emergenciesWhy do some vulnerable groups fare better than others in similarcircumstances? To examine care–related and behavioural aspects ofnutritional vulnerability during emergencies, and to developconsolidated approaches for identifying, assessing and monitoringthese aspects of nutritional vulnerability, WHO and UNHCR organiseda joint technical consultation on caring for the nutritionally vulnerableduring emergencies (Rome, February 1998).The consultation provided experts, country representatives, NGOsworking in emergencies, and concerned international and bilateralagencies with a forum for exchanging information and experiences. Inaddition to compiling information on nutritional vulnerability and itscontributing factors, the consultation developed guiding principles forcaring for the nutritionally vulnerable during emergencies.As recommended during the consultation, further development of theguiding principles and practical tools for translating them into policyand programmes are under way. A background review documentprepared for the consultation (WHO/NHD/99.6) and an annotatedbibliography on caring for the nutritionally vulnerable duringemergencies (WHO/NHD/99.5) will become available soon.For more information contact:Chizuru NishidaDepartment of Nutrition for Health & Development (NHD)Sustainable Development & Healthy Environments (SDE)World Health OrganisationAvenue Appia 20CH–1211 Geneva 27Telephone: + 41.22.791.3317/3455Facsimile: + 41.22.791.4156Email: nishidac@who.intNHD website: http://www.who.int/nut/Page 12 — ENN, Field Exchange, July 99

Infant Feeding inEmergencies: What isyour Experience?JobsDoes your agency have an explicit policyon Infant feeding in emergencies? If notthis document will be of interest to you.This new publication formulates anappropriate and widely accepted policyand strategy statement on infant feedingin emergencies for humanitarianagencies. The document was the result ofseveral meetings in the UK. Participantsincluded individuals and representativesfrom a wide range of agencies concernedto promote positive and appropriate infantfeeding practices in emergencies. Thedocument contains original material,which tries to address some of theproblems and knowledge gaps around thisarea. Some examples include; a fact sheet(ready for distribution in emergencycontexts), a triage approach to decisionmaking (includes a flow chart of feedingoptions), a piece on monitoring and evaluation (including indicators which can beused in determining progress/impact of an intervention).The document was produced by and can be ordered from the ENN; costIR£3.00 per copy, discounts available for bulk orders. Limited copiesavailable.HelpAgeRegional NutritionistAfricaSalary £16,023Over the past seven years an extensiveresearch programme has developednew methodologies of assessing thenutritional status and vulnerability ofolder people. A nutritionist is nowneeded to disseminate the researchfindings and promote work that willimprove the nutritional status of olderpeople.Based in the HelpAge InternationalAfrica regional office in Nairobi, withextensive travel in the region, the postholderwill provide advice, trainingand support to NGOs, academicinstitutes and governments.Required: a qualified nutritionist withan in depth understanding of nutritionissues in a developing country and atleast 3 years relevant experience,preferably some gained with an NGO.Strong communication, andcoordination skills are important as arereport writing and budget managementskills. You will need to be fluent inEnglish and ideally have a workingknowledge of French or Arabic.Applicants should send theircurriculum vitae to: HelpAgeInternational, PO Box 14888,Westlands, Nairobi, Kenya. Fax:+254 2 441052 Email:helpage@net2000ke.comApplications should be received bythe 30th July 1999.Nutrition Positions starting as soon as possibleChildren’s Aid DirectNutritionistBubanza, Burundi6 month contractQualifications: Formal nutrition qualification (MSc or Bsc)Experience: ability to run supplementary and therapeutic feedingprogrammes; carry out nutritional surveillance; excellent communicationskills; ability to train staff; ability to develop community nutritioneducation.Experience: Minimum of two years overseas experience.Other requirements: Fluency in French and EnglishMERLINNutritionistKenema, Sierra Leone2-3 month contractQualification: Formal nutrition qualificationExperience: ability to run or take part in therapeutic and supplementaryfeeding programmes; ability to train staff; able to live and work in aninsecure environment; day-to-day budget management ensuring budgetallocations from UNHCR and OFDA grants are not exceeded.UNHCRTechnical Specialists in Health, Food and NutritionKosovoMinimum of six months or moreUNHCR are looking for candidates with extensive experience ininternational public health / epidemiology, and at least a considerablenumber of years in managerial and coordination functions. (Awaitingfurther details)Please send CVs indicating which positions you are interested in andquoting Field Exchange to Patrick Brooke, International Health Exchange,8-10 Dryden Street, London WC2E 9NA. Tel: +44 171 836 5833. Fax: +44171 379 1239. Email: info@ihe.org.ukInterested in what happens to infants during anemergency?Wondering what came out of theCroatia Conference on Infant Feeding inEmergencies in October ‘98? If so, you will beinterested to hear that a project has emerged from theCroatia Conference to produce practical trainingmaterial on the subject of infant feeding inemergencies.The aim is to inform field managers and fieldworkers about organisational and practical measuresthey can take to support mothers’ or carers’ optimalinfant feeding practices and to increase their capacityto take appropriate action. Support for the projectcomes from Linkages (USA), WHO, UNICEF, andIBFAN.As part of this project attempt to collect an“inventory” of different agencies’ and individuals’experience with infant feeding in emergencies. Inother words, let us know what your experience hasbeen: what has worked, what has not worked and anyother ideas or comments you have on the subject.Also let us know if you wish to take part in thereview process.Send comments asap to Kathy Carter, MaryLungaho or to Felicity Savage King, Division ofChild Health and Development, World HealthOrganisation, 10, Avenue Appia, CH–1211Geneva 27. Switzerland.Nutrition in Relief andEmergencies CourseThe International Health Exchange (IHE) andMerlin are offering a residential trainingcourse for health care professionals on thesubject of nutrition in relief and emergency situationstaking place at the Kingston University in Surreybetween the 15th and 18th of July.The course will try to provide health workers withthe skills and knowledge required when working inemergency and relief settings and focus on othernutrition related problems. The course includes anoverview of nutrition surveys and anthropometricmeasurement techniques followed by an outline ofresponse strategies, including general rationdistribution, supplementary and therapeutic feedingand strategies to support food security. Special coverwill also be given to social and political factorsaffecting food securityThe training will be given by members of NutritionWorks, a partnership of six independent nutritionistswho have extensive public nutrition experience.To apply for the course, please contact VeronicaJohnson at IHE, 8-10 Dryden St, London WC2E9NA. Note that the cost of the course is £220 forindividuals paying for themselves and £250 for thosepaid for by organisations; a deposit of £80 isrequired.For further information about the content of thecourse contact: Jacqui Dunn (MERLIN) on +44 0171487 2505.ENN, Field Exchange, July 99 — Page 13

Field ArticleDelivering WFP wheat to the CONCERN store in Gjimij(Pieternella Pieterse/CONCERN)Concern’s Initial Response to the Kosovo CrisisConnell Foley is part of the Concern Policy Development and Evaluation Directorate and went to Albania as partof Concern's initial team responding to the Kosovo crisis. He spent five weeks in the Kukes-Krume area as wellas in Tirana assisting in the management of the early stages of the programme.The Kosovo crisis and its deluge of refugees toneighbouring states have probably filled moretelevision screens and newspaper columninches per day than any other political crisis of whichrefugees were a major part. Many would argue that itwas disproportionate.Among organisations and journals dedicated tonutrition and nutrition issues, the crisis received lessattention than many others. The simple reason is thatthe Kosovo crisis, insofar as our interface with it inneighbouring states has been concerned, was not a“crisis” in terms of nutrition.Concern Worldwide sent an assessment team toAlbania on April 4 and it quickly became clear to theteam that there were obvious differences between thisand so many African and Asian emergencies of whichwe have had much experience.People were not dying in Albania; neither of hungernor from diseases.While there were nutritional issues in Albania, theywere not as critical or time-sensitive as in mostrefugee contexts. Concern did not call in its nutritionand health specialists because we were able to drawon the assessments carried out by other agencies suchas MSF, ACF.Concern based itself in Kukes in the North East ofAlbania and quickly found itself taking charge offood distributions to refugees in Hasi district north ofKukes and managing two refugee camps in Hasidistrict, one at the town of Krume and one in thecommune of Fajza. Concern also undertook to supplyfood to the notoriously dangerous district of BajramCurri where bandit gangs rule and previous robberyof agency equipment and supplies meant that noagencies currently worked there.One of the most interesting aspects of the crisis wasthe generosity of the Albanian people to the refugees.They considered them as brethren since the refugeeswere Kosovar Albanians. There exist many kinrelationships which cross the border but there wasalso a strong sense of ethnic solidarity whichmanifested itself in the welcoming of the Kosovarrefugees into the homes of ordinary, mostly poor,Albanians. Until the NGOs, the Red Crossorganisations and the World Food Programme (WFP)got their food supply chains running, it was theAlbanian host families who fed the refugees, drawingon their own usually meagre resources to do so. OneAlbanian we knew in Ginaj commune hosted 43Kosovars in his home!However, it soon became clear that exploitation wasquickly emerging and where refugees were notrelatives, many Albanian hosting families soon beganto charge significant rents and to evict Kosovarswhen they ran out of money to pay.Division of Food Responsibilities between theMain Agencies:In mid-April in Geneva, discussions were heldbetween UNHCR, WFP, ICRC and IFRC regardingthe division of labour in food distribution in Albania.It was decided there that WFP along with theirimplementing NGO partners would service thecollective centres and the refugee camps while theRed Cross would look after host families andrefugees staying with those host families.On the ground, as always, realities hold sway. TheRed Cross in Kukes felt that it did not have sufficientcapacity for a large workload and asked Concern tocontinue to distribute to the refugees staying withhost families in Hasi district. We have been doing sountil the present.Concern was one of the few organisations todistribute to internally displaced persons (IDPs) inAlbania. Serb shelling and incursions at villages suchas Vlahen and Dobruna in Golaj commune (Hasidistrict) resulted in displacements in population.Concern and WFP agreed that these IDPs should befed in the same way as the refugees and this ensuredharmony between the local population and therefugees which was crucial.Food Distributions and Registrations:Food distribution to refugees in the camps, othercollective centres (mosques, schools, barracks,cultural centres) and with host families wascomplicated by a UNHCR directive that NGOs werenot to issue any form of ID or registration cards.UNHCR protection officers were concerned thatrefugees would see any informal or ad-hocregistrations as formal ones and that it would confusethe organised registrations they were to carry outlater. The situation was unusual in that very many ofthe refugees had had all forms of officialidentification taken from them by the Serbs beforethey were allowed to leave Kosovo. Issues ofidentification and registration were more critical orimportant than usual.Concern used lists and simple paper ration cards toPage 14 — ENN, Field Exchange, July 99

Kukes – Dutch-NATO helicopter deliversUNHCR suppliesget around the problem and to ensure thatdistributions were fair, efficient and accountable.Basic Rations:In the early periods of the emergency, many refugeeswere existing on both bread and military rations. Themilitary rations were readily available from NATOand could be accessed quickly. In the Krume campwhich Concern managed, the refugees existedprimarily on the military rations, since they hadminimal cooking facilities. They were not beingprovided with much fresh produce but since the campwas on the edge of Krume town, refugees could beregularly seen walking back from the local marketwith bags of fruit and vegetables which were inreasonable supply.The WFP basic rations comprised the usual standardpackage but in the early weeks of the crisis we had tobe pragmatic and supply whatever was availablesince the supply chain from Durres port to themountains of Kukes was slow in getting up to thecapacity to match needs. The package was wheatflour, pulses, oil and sugar. Of course, there was aclear understanding that pork meat was inappropriatefor a refugee population which was largely Muslim.WFP brought in a supply of fortified or consolidatedfood (CSB) in late May and wanted NGOs to seehow it might be used or distributed.UNHCR Food Supplements:In early May, the UNHCR introduced a proposedsupplement to the existing food provision. Theyplanned to give each refugee a monthly ration of:Fresh veg./fruit (2 kg); Onions (2 kg); Potatoes (2kg); Canned fish/meat (1 kg); Pasta (1 kg); Tomatosauce (0.5 kg); Jam (0.4 kg).They wanted WFP’s implementing partners topurchase the fresh produce locally and then todistribute it. This resulted in a big discussion over theimpact on local markets, the fact that this was neverdone in Africa (so why in Albania?), localavailability, perishability of fresh produce and thelike. Nature of fresh produce would obviously entailat least a weekly distribution.In the end, for the first proposal period (8 May until30 June) we agreed to provide 2 kg of fruit andvegetables, 2 kg of onions and 2 kg of potatoes perperson per month. For the second proposal period (1July to 30 Sept.), this was revised to 1 kg of each perperson per month.Move to Kosovo:Concern sent a team into Kosovo itself on June 21and this team will assess needs with a view towardsproviding livelihood support in a specific area for alimited period of time, that is until refugees aresettled and livelihoods are once more secure.The 78-day NATO air campaign ended on June 9th.More than half of the 800,000 refugees have returnedas of 28th June. In addition to refugees, there areestimated to be as many as 500,000 internallydisplaced emerging from hiding that are returninghome also.Humanitarian aid responsibilities are roughly asfollows: UNHCR for humanitarian relief - EU forreconstruction - the OSCE for humanrights/protection and institution building.Kosovo has been devastated. Shelter, health,Impromptu trailer park in the centre of Kukes(Pieternella Pieterse/CONCERN)demining and food requirements are clear priorities.Initial reports suggest that 40-50,000 residentialhomes are severely damaged and uninhabitable.Houses are being assessed for damage. Mostagencies are looking at medium term repairs to getthe families through the winter - insulating a room -pitching temporary roofing on partly damagedhouses, providing heaters - repairing what we can fornow. Full scale rehabilitation and reconstruction willprobably not get under way until after the winter.Much of the livestock, cattle, horses, pigs werekilled, the corpses now rotting on the side of the roador in fields. Many wells have been polluted ordeliberately poisoned. Agricultural crop planting andharvesting have been severely disrupted. Kosovo’s1998-9 wheat crop, for example, normally on theorder of 300,000 tons was not planted. Very littledomestically produced supplies or produce areavailable in the markets. Emergency food aid may benecessary for as many as 1.5 million people for oneyear or longer.Concern has based itself in the Pec area of westernKosovo and is targeting extremely vulnerableindividuals. Our assessment recommended that weENN, Field Exchange, July 99 — Page 15

The Collection of Early Warning InformationThrough Community Resource People –A Case Study from the Red Sea StateBy Mahomed Dien, Fatma Musa, Alawia Osman who are field officers forthe Oxfam Community Situation Indicator (CSI) project since its inceptionin December 1994.*We have been working as field monitors onthe Oxfam Community Situation Indicator(CSI) project in the Red Sea State (RSS)for over four years. Oxfam set up this project at theend of 1994 in recognition of the need for goodinformation on the food security and livelihood of theBeja population in this extremely drought prone areaof Sudan. The RSS has a population of approximately600,000 (based on the 1993 census). The ruralpopulation are very dispersed with many living inremote and inaccessible areas.The CSI project operates largely as an early warningsystem for the RSS with information collected onprice of sorghum (dura), price of livestock, terms oftrade between goats and dura, agricultural production,income sources, health and nutritional information(from clinics) and, when there is food stress, copingstrategies employed to survive.The Beja people are extremely resourcefulWhen Oxfam began working in the RSS in 1985most of the population were pastoralists with largeviable herds of goats, sheep and camels. However, asuccession of drought and food emergencies (theworst being recorded in 1984) decimated thelivestock population so that the majority of Beja havehad to diversify food and income sources. Most nowcultivate sorghum and are also involved in incomeearning activities, e.g. port work in Port Sudan,charcoal production and other forms of petty trading.Food security in the RSS has been likened to thecarriage of a coffin, which needs four bearers to becarried. Similarly, food security and survival in theRSS now depends on four components:• livestock,• agricultural production,• income and reciprocity between family,• friends and neighbours.The CSI project produces a monthly bulletin whichsummarises the food security situation in the RSS.The information is collected as follows: CommunityResource Persons (CRPs) from 25 sites across theRSS collect food security and livelihood information.This work is carried out on a voluntary basis. TheseCRPs are selected on the basis of being:• literate,• being likely to remain in their area,• having the respect of the community.They receive training in Participatory RapidAppraisal (PRA) techniques and how to collectspecific kinds of information, e.g. market prices.Where possible one male and one female CRP areselected for each site. CRPs fill out a form once amonth. As OXFAM field monitors we visit CRPs ona monthly basis to collect these forms and to collectsimilar data so we can fill out our own ‘FieldMonitor’ forms. We also hold discussions withcommunity members and visit markets. We think thata major strength of this type of information system isthat the CRPs enable us to collect data from all overthe state at relatively little cost. In a state like RSSwhere infrastructure is so poor, this type ofstate–wide information collection is probably onlyreally feasible using CRPs.CSI information has regularly highlighted emergencyfood security problems and led to further assessmentsby agencies like WFP and the Humanitarian AidCommission (HAC). However, although the CSIidentified the major looming crisis in 1996 whenterms of trade between sorghum and goats declinedfrom 1:1 to 1:17 and there was widespread starvation,the CSI information was not immediately believed bydecision makers. This partly explained the very lateemergency response (starting in mid-1997).As field monitors we have many thoughts andfeelings about the use of CRPs in an early warningsystem which we would like to share with otherreaders who may be considering setting up a similartype of information system.Strengths of the CRP systemi) CRPs provide an outreach for collectinginformation which would be hard to replicate atcomparable cost by any other means. The CSIprogramme is substantially cheaper than comparableinformation systems operated in Kordofan and Darfurprovinces.ii) The process of selecting and training CRPs leadsto much discussion in the community regarding foodsecurity and disaster preparedness activities whichheightens awareness of these issues within thecommunity. Also, during training of CRPs otherliterate members of the community attend so that ifCRPs have to leave or relinquish their posts otherscan take their place.‘the CSI identified the major looming crisis in 1996 ... the CSIinformation was not immediately believed by decision makers’iii) The selection of female CRPs contributes to theempowerment of women in a society where womenare marginalised and vulnerable. Female CRPs leadby example and improve the status of women.Problems with the CRP systemi) CRPs spend between 3–4 days per monthcollecting information and many have requested someform of incentive payment.ii) Many CRPs ask for some form of transportassistance to visit more remote villages. They haveproposed that they be provided with bicycles orreimbursement for monies spent on buses or lifts.iii) CRPs are often refused information by otherNGOs or government agencies on the basis that theyhave no status.iv) CRPs complain that they continue providingcertain types of information (e.g. morbidity statistics)for which no feedback or follow-up action seems tooccur.Page 16 — ENN, Field Exchange, July 99* This article was written with help from JeremyShoham who was on a field trip in the Red Sea State

Right, Left & Below:Beja Nomads in the Red SeaState (Helen Young)v) all CRPs feel that they have not received sufficienttraining.vi) it is difficult to find women CRPs as so fewwomen are literate in Beja society. In the 25 sites weonly have 8 female CRPs.Conclusions and recommendationsi) We would argue for some form of incentivepayment for CRPs. Other NGOs in the RSS andSudan are known to pay community members whovoluntarily assist in village committees with cash orfood. CRPs may spend up to 4 days a month doingCSI work.ii) CRPs should be given an OXFAM identity cardand introduced to relevant agency officials so thatthey can access information more easily.iii) Greater effort needs to be made to select femaleCRPs. We do not think that illiteracy is a reason forexcluding women from this important job. Womenhave a perspective on household food security thatmen do not have. As they are more home-based theyhave a better sense of quality of pasture, localagricultural production and health and nutritionproblems. Men spend less time at home and are oftenfar away earning income. They tend to be better ableto give market information. Illiterate women havelearnt to store up and impart a lot of informationorally. They are quite capable of teaming up withliterate males and getting them to fill out the CRPforms. The more women CRPs the better.iv) CRPs should be given stationery and reimbursedfor any travel expenses incurredv) CRPs should be given regular training. Many haveover two years experience doing this job and are avaluable asset for their communities.vi) There is a big danger that CRPs and those whoprovide them with information will lose motivation ifinformation given is not acted upon. There needs tobe a better response mechanism for the informationprovided by CRPs and field monitors. The moresituations in which we and CRPs provide informationon impending crises to no avail the more we all loseheart. There could come a point at which the systemgrinds to a halt due to an exhaustion of good will. Alesson here surely has to be that there is aresponsibility incumbent on those who set up thistype of information system to ensure that responsemechanisms are in place before setting up the system.Also, communities should not be asked to collecttypes of information for which it is unlikely that therewill be a response. If agencies are not going toENN, Field Exchange, July 99 — Page 17

Field ArticleCommunity Managed Targeting ofEmergency Food Aid:Does it Ever Work?Malcolm Rideot is the SCF Country Programme Director for Tanzania. He has beeninstrumental in establishing the community managed targeting programmes which is thefocus of this article.As food aid budgets shrink, the concern tomake sure that food aid is utilised by thosewho most need it is a legitimate one, andthere is much ink spilt in trying to make sure thatthere is a rational, demonstrable and repeatable wayof targeting food to the needy and distributing it in anequitable way. These targeting systems tend to haveas their focus the need to account to the providers ofthe food or decision makers in Government, ratherthan ensuring an involvement with the communitiesserved. This is the case despite the stated aim of mostaid projects to be inclusive and responsive tocommunities, as is set out in the Red Cross Code ofConduct – now signed up to by many agencies.It is interesting to contrast the provision of food aidto food insecure populations in rural Africa with theadministration of Social Security benefits in adeveloped northern country. In the UK (the systemwith which the writer is most familiar) a hugeamount of effort is taken by the state to prescribewho is entitled to what. However, even with themassive resources and levels of information availablein the UK, there is still a significant amount of fraud,and politicians continue to make political capital outof introducing yet more levels of control into thesystem (vouchers instead of cash for example).In food distributions in rural Africa, the distributingagency will often have no power over an individual(except perhaps the withholding of benefits) andrelatively little information on the people in thecommunity served. Agencies are still under the samepressure to control and make sure that the scarceresources devoted to food aid are used well, and bythose who are most in need. The (usually unspoken)model by which these actions are judged come fromsocial security models, which are not appropriategiven the reality of emergency food distributions indeveloping countries. Distributing agencies have: nopower, knowledge that essentially comes fromoutside the community, limited time and a set ofassumptions about equity and entitlement. Theseassumptions are often driven by donor policies setthousands of miles away.From the perspective of potential food aid recipients,the whole process places the recipient in anuncomfortable position, as each person has to provethat their hunger is greater than their neighbourshunger, according to criteria set by outsiders usingrules that have not been discussed and may be poorlyunderstood. Furthermore, as the resources are seen asbeing provided from outside the community, there isno feeling of ownership and the resources arescrambled for by all, a situation where there is a realdanger that the poor and most needy will lose out.Given that food aid decisions are made by donors andgovernments remote from affected areas, the abilityof food distributions to be inclusive and centred onthe recipients of the aid is always going to bedifficult. People are subject to outside assessmentsand decisions about assistance. It is possible to beginto get away from the priorities of donors and theirprocedures and more towards the priorities ofaffected people by devolving as much decisionmaking as is practical. This is an idea that issometimes surprisingly hard to sell, even with thenear universal commitment to people–centreddevelopment. In the example below handing overpower has been shown to have advantages not only inthe efficiency and timeliness of distributions, but alsoin their accuracy and equity.Community Managed Targeting in TanzaniaIn Tanzania, Save the Children Fund and theTanganyika Christian Refugee Services (TCRS) haveused a community based approach to try and place asmuch power as possible in the hand of thecommunities in a food distribution in Singida Region.The distribution made 13,000MT available to about450,000 people between October 1998 and April1999.Community managed distributions are not a newidea, and various ways of carrying them out havebeen used. The basic idea behind them is that thepeople who receive the food should understand thetargeting criteria being applied, have a say in them,know how much food is coming, and have a directappeal and some control over decision makers.In Singida the decisions over who was to get the foodand its subsequent distribution was entirely in thehands of elected members of the community.Furthermore, distributions would not be given out ona month by month basis, forcing people to be onhand every month but be in as much bulk as waspracticable so that people could migrate, pay debts orwhatever was the best option for them.The methodology first had to be sold to WFP and thegovernment, as there were concerns expressed that ifthe community was left to get on with thedistributions that they would be hijacked by thepowerful, that the ‘needy’ would not get the food andthat the bulk distributions would encourage salerather than consumption of the rations.Once it had been agreed with WFP and centralgovernment, the methodology was introduced to theregional government. The strength of the method wasimmediately seen, and the Regional commissionergave instructions that the people in charge of thedistribution should not be ex officio villagegovernment members but an elected committee forthe purpose. This was an important step, as the wholemethodology relies on the communities havingconfidence in, and control over the distributionprocess.The decision over which areas were to get the foodwere decided on earlier assessments of crop failuresAlternativeDistribution Systems:Tanzania – Fooddistribution in theLumasi camp.(L. Taylor/UNHCR)and livestock numbers. This led to the production ofa list of ‘most affected’ villages.During the assessments, wealth ranking exercises hadgiven the impression that about 60% of thepopulation in the villages that were targeted weremost in need of relief food and so initially 87 villageswere targeted to receive rations for five months, afirst round of a three month ration and a secondround for two months. In the event, ongoingassessments of vulnerability and harvest prospects ledto the inclusion of more villages and a sliding scaleof ration provision based on anticipated harvest date.In the end, a total of 187 villages received food aid.Stages of ImplementationThe first stage of the community managed targetingprocess was to send a message through the localgovernment system giving notice of a public meetingto be held to discuss the provision of food aid. At themeeting, facilitators gave notice that food was tocome to the village, that the amount was limited andthat it was for distribution to poor people as there wasnot going to be enough to go round. The decisions asto who would get the food and the distribution was tobe left to an elected committee, which had to have aman and a woman from each sub–village on it. Themeetings were well attended and it is estimated thatat least one person from each household came. Theelection of the committee was by affirmation or ashow of hands and most often people other than thevillage government officers were chosen. Thecommittee then met with the facilitators, whodiscussed in more detail the wealth breakdown of thevillage and got the committee to come up withcriteria that described the poor of the village. Thesecriteria varied from place to place. The agreed criteriawere then presented to the meeting and a time set fora second meeting, to take place once the committeehad registered those to whom the criteria applied.A second public meeting was held at a later date(depending on the time taken to register the villagersby the committee ) at which the list of those whoPage 18 — ENN, Field Exchange, July 99

which was understood and accessible. There wereproblems, as many of the population figures werebased on centrally–held statistics that sometimesturned out to be wildly inaccurate. This necessitatedthe delivery of extra food to some places. In a villagewhere the population estimate had been too high, thevillage committee handed back to SCF the excess forre–allocation.The wealth breakdown in the villages gave thecommittees a hard job in registration as toughdecisions had to be made. There was some flexibilityin the proportion of the people to receive food, but itwas made clear that simply spreading the food toeverybody would mean that no one got anymeaningful rations.The committees by and large did a good job, as wasexpected, because they were chosen by theirneighbours and knew the people involved well. Therewas one case of a committee holding back food, butthis was sorted out by the villagers who promptlyarrested the committee and made them return thefood. In another instance the committee had to askpeople who had received food to give a proportionback as the committee had got the arithmetic wrong.This was done by the recipients without demur asthey had a clear understanding of the mechanics ofthe distribution and the entitlements of recipients.The Programme WorkedSCF and TCRS were keen to learn how thedistributions could be refined, and also whathappened to the food. There was therefore aprogramme of ongoing assessment and distributionmonitoring.The ‘food basket’ monitoring was aimed at findingout who had received the food and what they did withit. A sample of villages were monitored by visits afterthe distributions had taken place. It was found thatabout 62% of the population received food (targetwas 60%) and that most of the food was consumed inthe home, although a significant proportion (7%) wasserved to ‘guests’. The people who received foodwere the poorer members of the village. The tightnessand accuracy of the targeting exceeded expectations,although this is perhaps more a reflection of a lack offaith on the part of SCF and TCRS in the abilities ofcommunities to organise themselves effectively morethan anything else.The programme was judged a success mostimportantly by the people who participated in theprogramme and it was seen to be fair, honest andunderstandable.Alternative Distribution Systems:Tanzania – Benaco Camp, Ngara. (B. Press/UNHCR)were to receive food was read out and approved bythe village. The amount of food to be delivered wasagain publicly confirmed and a date set for delivery.The weight of standard scoops (provided) was alsopublicly discussed.The public meetings included the involvement ofSCF and TCRS in the process. The food wasconsigned direct to the village from the store andsigned for by the village committee It was thendistributed as per the agreed list.There Were Some DifficultiesThe system is deceptively simple but tying togetherthe need for public meetings, varying times forregistration in villages and the logistics of dispatch offood is a major organisational headache, and it wasimportant to keep the villagers and their committeesinformed of any changes as they are an integral partof the system.The system was much appreciated by the recipientsof food who saw it as a fair and dignified systemThe distributions were also cost effective, as therewas no need to engage large numbers of people tocarry out registrations and distributions. It was fast,as once villages had set up their committees andknew what to do, any number of villages couldsimultaneously register people and carry outdistributions.The programme worked well, and it is interesting tospeculate if it would work as well in a place wheresocial relationships are not as strong (e.g. in a refugeecamp). The problem with the system is more withagencies and donors rather than the recipients, as thesystem does not mesh well with some reportingrequirements. It is impossible to provide a list ofbeneficiaries until all food has been distributed andthe type and number of people that will be served canonly be estimated in advance. The agency managingthe distribution cannot account for the food to thelevel of recipient, as the responsibility for distributionENN, Field Exchange, July 99 — Page 19

Field Articlestops at the village.Donors, UN and NGOs alike all now share thelanguage of inclusiveness and communityinvolvement. If this is a real commitment it implies aletting go of power to the people that are served, withno holding back. The method above relies on the factthat people had information on which to decide andwere very clear that decisions on their resources weremade within their community. The dialogue anddevolution was as real as it could be. Why should webe surprised that communities manage to organisethemselves more fairly and with less fuss thanoutside agencies when they are given theopportunity?Alternative Distribution Systems:Tanzania – Rwandan refugees returning toRwanda, lined up for rations of biscuits.(R. Chalasani/UNHCR)Community Managed Targeting – TanzaniaPost–script, by Jeremy Shoham, ENNDFID commissioned an evaluation of thecommunity–managed targeting programme inSingida and Dodoma regions of CentralTanzania in May 1999. As a member of theevaluation team, I can confirm the very positiveimpression of the programme portrayed in the abovearticle. All stakeholders that I interviewed, e.g.beneficiaries, village relief committee members andstaff at different levels of government, were satisfiedwith the programme. They believed that the systemdid target the neediest households and that it wasequitable, transparent and accountable. The systemseemed to work even when only small amounts offood were available, for example, in Iramba districtwhere limited food availability meant that only thepoorest 20% of households could be targeted. Thesystem compared very favourably with the oneimplemented the year before which most people weredissatisfied with. The previous system operatedthrough village government structures and was not atall transparent. The result was that certain groupswere favoured above others and that more or lesseveryone was given a ration so that the per capitareceipts of food aid were very small and not thatuseful to those with genuine large food deficits.There also appear to have been some unintendedbenefits of this community-managed programme.First, women became more prominent in public lifeat village level and were seen by the men to havedone an excellent job. Many male members of thecommunity stated that they would vote for some ofthese women in subsequent village governmentelections. Up until now women have always been in aminority on village government committees. Second,regional governments of both Singida and Dodomawere hoping to retain these village relief committeesfor food security work during non–emergencyperiods, i.e. following up with vulnerable householdsto determine how the community could support thesefamilies.While not wishing to minimise the success of thisprogramme, there were of course some difficulties:i) as stated in the article, the limited availability offood aid determined that village relief committees(VRCs) were directed to register only 60% ofhouseholds. In many villages the perception was thatup to 80% of households fitted the selection criteria.The exclusion of some families therefore placedconsiderable strain on VRCs and in a few isolatedcases this led to insecurity at distribution sites;ii) population figures for each village were mainlytaken from district level data. These were oftenwildly inaccurate (usually under–estimates) so thatamounts of food allocated to villages were too small.VRCs then either reduced the per capita ration orunder–registered, e.g. only registered some membersof a household;iii) in a minority of cases, particularly in Dodomaregion, under–registration was carried out in adiscriminatory manner. For example, households ofthe same size would have different numbersregistered by the committee, i.e. those favoured bythe committee would tend to have more registered. InSingida region under–registration was systematic andtherefore fairer, e.g. if there was a shortage of food,infants in households would not be registered;iv) Members of the VRC would spend between 7–14days in their activities. This undoubtedly detractedfrom their ability to carry out their own work. ManyVRC members wanted some form of communitypayment, e.g. child care, cooked meals. Another formof payment suggested was that the committee shouldbe allowed to keep the food sacks which have aconsiderable monetary value.The success of this community managed targetingcontrasts with other recent experiences of communitytargeting, e.g. amongst pastoralists in Turkana andrecently in South Sudan, (see Field Exchange 6).There may be a number of factors specific to theTanzanian context which predisposed to the successof this type of community managed targeting system.These are as follows:• a well–established structure of villagegovernment and tradition of village level publicmeetings and decision making• the participatory approach is consistent withestablished national policy and initiatives alreadytaken in the region and strong high levelgovernment support at central and regional levelsdeflecting some local political resistance• peace and stability in an area of small cohesivevillage units (3–5,000) and an absence of anyserious inter–communal division• no excessive stress – the intervention waspreventive, i.e. to preserve livelihoods, and not aresponse to an acute crisis• availability of a pool of government extensionstaff and some NGO personnel experienced inworking at village level often with participatoryapproachesPage 20 — ENN, Field Exchange, July 99

LettersAfghanistan – Afgani CARE staff starting agenerator. (J. Matthews/CARE)Making a Difference for Afghan Women“We must be courageous and speak out on issues thatconcern us. We must not bend under the weight ofspurious arguments invoking culture and traditionalvalues. No value worth the name supports thesuppression and enslavement of women. The functionof culture and tradition is to provide a framework forhuman well being. If they are used against us, we willreject them and move on. We will not allow ourselvesto be silenced.”Dr. Nafis Sadik, Beijing 9/95By canonizing traditional and cultural restrictions onwomen and girls into official policy and law, theTaliban leadership of Afghanistan has created themost notorious example in the world of state denialof basic rights of women and girls. It is littleconsolation that these regulations are enforcedunevenly at different times and in different parts ofAfghanistan. The dilemma faced by concernedindividuals and agencies is in finding a strategy thatwill result in real and lasting improvements in thelives of Afghan women. Righteous indignation anddistant protests are inadequate.While Taliban restrictions on women bear someresemblance to apartheid in their denial offundamental human rights to a majority of thepopulation of a country, it is dangerous to use thelanguage of ‘gender apartheid’ to guide an advocacypolicy for women in Afghanistan. South Africa is notAfghanistan. Apartheid South Africa was aneconomically and technologically advanced country;it was dependent on foreign trade for survival, and itshared many cultural values with the West.Afghanistan is the least developed country in Asia.Devastated by decades of war, it has a primitiveagricultural economy and negligible trade links withthe rest of the world. Its culture and belief systemslook more to the “truths revealed” in the 7th centurythan to “international standards negotiated” in the20th.A prolonged social and economic boycott of SouthAfrica contributed to positive change within thecountry. An economic boycott of Afghanistan wouldhardly be noticed by its leaders. Were it to becompounded by a cessation of humanitarianassistance, there would definitely be suffering for thewomen and children already victimized by Talibanpolicies. There is also no reason to believe that suchsuffering would sway the convictions of the Talibanleadership or force them to comply with internationalstandards. The Taliban believe that they answer toGod and therefore are prepared to make inordinatepersonal and national sacrifices to follow their viewof the deity. For the international community to haveany impact on Taliban policies, dialogue andengagement at the most fundamental and pragmaticlevels is required.The experience of humanitarian aid agencies workingin Afghanistan is that there is hope and there is a wayforward. Through a patient process of activeengagement on practical and concrete issues,humanitarian success stories have been made.Examples include:• a Taliban edict prohibiting women from directlyreceiving humanitarian assistance has beennullified. Twenty thousand widows in Kabul arenow able to receive monthly rations of food fromCARE and ICRC without fear of reprisal;• a Taliban edict restricting all female health careto one dilapidated hospital in Kabul was resistedby international aid agencies. The Talibanamended their policy and now allow women to beseen in special sections of all hospitals.In at least five provinces controlled by the Taliban,provincial authorities have given permission for girlsto be educated and women to work in schools. Thirtyfive percent of the students in CARE–supportedschools in Taliban areas are girls and 14% of thestudents in Swedish Committee schools are girls.There are numerous examples of women beingallowed to work both inside and outside of the healthsector. Through CARE projects alone over 50 womenwork as clerks, distributors, monitors, communitydevelopment agents, teachers and teacher trainer.In response to queries from NGOs and the TalibanMinistry of Mines and Industry, the Taliban Ministryof Justice issued a fatwa (judicial decision) declaringthat widows are allowed to work outside the home aslong as they observe modesty in clothing, andmarried women can work if they have the permissionof their husbands.Building on what is known about the values andbeliefs of the Taliban, their organizational structure,and the positive lessons learned by relief anddevelopment agencies in Afghanistan, we can find away forward for a brighter future for Afghan women.Using a strategy of positive engagement, internationalrelief and development agencies can:• build appropriate roles for women into allprojects implemented in Afghanistan;• turn conflicts and problems with Talibanauthorities into opportunities for dialogue andchange;• understand the Taliban frame of reference andhelp them understand the social and humanitarianimplications of some of their policies;• practice and communicate international norms ofhuman rights in our own hiring and managementpolicies to show by example that they areconsistent with core Islamic teachings.One positive contribution that the Taliban have madeis in bringing to the attention of the world the brutaland repressive nature of many traditional genderpractices in Afghanistan. The Taliban did not inventthese practices and they would not go away even ifthe Taliban were to be removed from the scene.By living what we preach, international relief anddevelopment agencies can and do make lastingimprovements in the lives of women in Afghanistan.A cancellation of these programmes would be a truetragedy for the women of Afghanistan; they wouldlose the voice and support of the only agencies thatare able to make positive changes in their lives.Yours etc.Paul Barker,Country Director for CARE in AfghanistanENN, Field Exchange, July 99 — Page 21

Field ArticleWater, water everywhere but...The ‘98 Bangladeshi FloodsThe author, Julian Francis is Disaster Preparedness Delegate for the IFRCS in Dhaka. Hegives a first hand account of the effect of the devastating floods in Bangladesh last yearand the response of flood victims, local communities and indigenous and internationalhumanitarian agencies.During the last two weeks of August 1998 ithardly rained in Dhaka, the capital ofBangladesh. The floodwaters, which hadbeen affecting up to two thirds of the country for theprevious 50 days, were nevertheless still affecting thecomfortable residential area in which I lived, close toDhaka’s diplomatic area. Everywhere was full ofstinking stagnant water with small boats providing a‘taxi’ service in my road.Impact of the floodsTwo million people in the capital had been driven outof their homes by the floodwaters. The foul very slowmoving water all over Dhaka city and district werepotentially lethal, as sewage had overflowed into it.The thousands camping in the flood shelters werefacing horrific sanitary conditions. At least 30 millionpeople in the country had been affected in some wayand it was estimated that a minimum of 10 millionwould need assistance. Worst affected were thelandless labourers in the rural areas and the dailylabourers/slum dwellers in the towns and cities whohad both been without work for a long period. Theirfamilies stranded on embankments and ingovernment buildings had been forced to live intemporary and very unhygienic conditions.Effects on livelihoodsA landless agricultural labourer would, normally, atthis time of the year, be earning about 60-70 taka aday transplanting paddy (rice) seedling. The floodwaters had put that paddy land ten feet under watermaking this kind of work hard to find. If he ownedany animals he would have to spend his dayscollecting water hyacinth with which to feed them asthe price of cattle fodder has doubled in the last fewweeks. The fruit trees that his wife would normallytend close to their homestead would have beendestroyed by the floods. Rather than go in search ofthe elusive relief supplies of the government andNGOs, many of these people had decided to borrowmoney even if the ‘interest’ was as much as 8 percent per month. Many families had already resortedto panic selling of livestock so that the price of meatcame down on the Dhaka markets. Forlorn andsodden pointed stacks of rice straw (normally used asanimal fodder) stood in the water. It was unlikely thatany of this would be of much use except to plough into the soil for the next crop, and in any case most ofthe livestock had been sold or swept away by thefloods.The Relief ResponseMany thousands of the worst hit people received foodand medical assistance from the Bangladesh RedCrescent Societies (BDRCS). The food suppliesincluded flattened rice (which is ready to eat), withsome molasses, dal (lentils) and high-energy biscuits.These food items were distributed through the RedCrescent district units who were ably supported bymembers of Red Crescent Youth and other localvolunteers. The BDRCS had also organised anddeployed 100 medical teams, each consisting of adoctor, a paramedic and at least one male and onefemale volunteer. The problems they encounteredincluded diarrhoea, hepatitis, typhoid, skin diseasesand, in some places, measles. I visited Rampura Roadwhere invaluable clean water from CARE and mouthwatering‘kichuri’ from the Bangladesh Red CrescentSociety (BDRCS) were being made available toslum-dwellers who were still seriously affected bythe filthy stinking waist-deep water and who wereunlikely to get any work for some time to come. Thefood relief centre was expected to remain open for 3or 4 weeks. To come and go between their slumhouses and Rampura Road the people either wadedthrough the sewage-ridden water and risked seriousfungal and other infections or took a small boat at thecost of 3 to 5 taka each way, which they could notreally afford. Only the lucky ones received a rationcard from the BDRCS.Local community responseThe rice and dal (lentils), the base materials of‘kichuri’, had been provided through the internationalappeal launched by the International Federation ofRed Cross and Red Crescent Societies(IFRCS), butthe rest of the costs of the other nutritious ingredientshad been borne by some fifty local Life Members ofthe Red Crescent. These included, salt, spices, onion,potato, pumpkin and green papaya. Local fundraisinghas been very vigorous in Red Crescent Units up anddown the country. It is important to recognise that thebulk of assistance for the most vulnerable came fromthe local people themselves rather than from abroad.Food distributionsFood grains was in the country in sufficient quantity,and more than adequate supplies were in the pipelineas a result of the World Food Programme’s (WFP)quickly organised procurement programme. However,despite the flexibility of the World Food Programme,their suggestions to increase the numbers on thegovernment Vulnerable Group Feeding (VGF) from300 to 1000 per flood affected Union, thoughaccepted by the government, took a long time toimplement as food supplies were not allocated andmoved to Union level in time. Consequently, thenumber of VGF cards per flood-affected Unionremained at 300 families who during August andSeptember were each entitled to receive 16 kgs offood grains per month. In a visit to parts of thedistricts of Bogra and Jamalpur, I saw somedistributions under the VGF scheme. What I foundwas that most of the distributions were quite wellorganised, and that the hundreds of people, mostlywomen, waiting in the burning sun, were clearly poorand hungry. The amount of rice available, however,was insufficient for the number of beneficiariesalready identified and selected correctly by membersof the Union ‘Parishads’. The planned allocation of16 kgs per family per month had gradually beenreduced to 10 and then 5 kgs and at one centreallocations were of 5 or 3 kgs, depending on the sizeSlum stilt houses inthe outskirts ofDhaka(Pieternella Pieterse)of the family. This clearly seemed inadequate for afamily to survive based on nutritional guidelines,which recommend an adult maintenance diet of 400gms of rice or wheat per day along with othercommodities like pulses, oil and salt. These amountstranslate into some 42 kgs per month per family. Itwas obvious that until sufficient work was availableand/or the harvest came, there would be a lot ofhungry people looking for assistance.RecoveryAfter nearly 3 months, the floodwaters had gonedown and the levels in the rivers were all below theirrespective danger levels. There were no reporteddiarrhoeal epidemics. People who had been homelessfor many weeks were dismantling their temporaryshacks perched on embankments, or vacating floodshelters and going home. Though late, rice fieldswere being planted, where at all possible, and at afurious pace. Though the signs were of recovery, inareas I visited e.g. Bogra, Jamalpur and Kurigramdistricts, I can say that many people were still notgetting enough food to eat.Seeds and the special role of womenOnce the floodwaters had receded people were tryingto look to the future and immediately seeds of alltypes were being procured and sowed, especially thenutritious and fast-growing vegetables like spinach,radish etc. Many families did not have seeds as,farmers had already planted some of the seeds forseasonal vegetables in mid-July before the floods,and, most farming households do not keep seeds thathave already been planted. The damp damaged manyPage 22 — ENN, Field Exchange, July 99

higher. If the farmers keep seeds in their stores, whileother farmers have none, then it will bring misfortuneto the farmers since she/he deprives others. Theculture of sharing indeed ensures diversity, a systemthat also ensures in situ conservation. It follows,therefore, that women are likely to be very suspiciousof vegetable seeds in fancy packs, even though that isthe only way in which organisations can organiseseed distribution.ReflectionsIn a way I am in a privileged position to be able tolook back and see if we have learnt from the mistakeswe made at the time of the Bihar Famine (1966-67),the drought in western India (1972-73), the foodcrisis in this country in 1974 and the aftermath of the1988 floods. There is no doubt that the governmentadministration system now right down to Union levelis much better than in 1974, but it is in the area of coordinationwhere there is still much to do. In someThanas and Unions there is good co-ordinationbetween local authorities and NGOs, in others it doesnot exist at all, and we hear reports that NGOs stilldeliver relief supplies to flood-affected peoplewithout informing the Union Parishad or Thanaofficials. We must also make sure that those whohave nothing and cannot access anything are not leftout. Given a collective will and good co-ordinationthere need not be any starvation, but to ensure this alot of people need to wake up, sit up and take notice.The section on Seeds was taken from a reportby the research and policy organisation, UBINIGon the work being done by Naya KrishiAndolan.For further details, interested readerscan contact: UBINIG, 5/3, Barabo Mahanpur,Ring Road, Shaymoli, DHAKA-1207. Email:(Farida Akhter) ubinig@citechco.netseeds, which were still in the houses during the flood.Marginal farmers were forced to sell the Aman riceseeds when they were unable to cultivate them. Inmany areas women have always been the keepers orguardians of seeds, and as soon as the floodwatersbegan to recede they started assessing the situationand sharing the seeds available between them. Thecultural practice of ‘sharing’ has been crucial. Theunprecedented floods have been able to demonstratethe enormous importance of local seeds andindigenous varieties. For example, the disaster hasproved again the wisdom of rural women who are infavour of old Aman varieties that can be grown inflood conditions, instead of the dwarf varieties ofHYV (High Yielding Variety). In preparation for theRabi crop (winter season), the seeds theyrecommended were being accepted by others. Thewhole selection process of seed is profoundlystrengthening the indigenous knowledge of thecommunity to cope with disasters. The selection itselfis a highly technical task, and impossible for theformal sector to understand and rationalise because ofthe subtlety of the practice and logic to meet thediverse need of the different households. The resultis, there is no one single variety or one kind ofvegetable for everyone. Each and every farminghousehold has different and diverse needs. These aremet through reciprocal exchange and appreciation ofeach other’s specific needs. In case one woman has aparticular variety, which she cannot plant because ofstanding water in her field, she offers this seed toanother family. Sharing of seeds is part of thefarmer’s culture. They believe that if you share seedswith your neighbour and friends, the yield will beBangladesh – Woman thrashingrice on her patio in Shat Kira(Pieternella Pieterse)ENN, Field Exchange, July 99 — Page 23

Agency ProfileTanganyika Christian RefugeeServiceBy Jeremy ShohamAs Duane Poppe, the American director of theTanganyika Christian Refugee Service(TCRS) strode up the stairs, handsoutstretched to greet me, he apologised for being lateexplaining that he had been called to an urgentmeeting at the Prime Minister’s Office to discussTCRS’s role in this years food emergency. On sittingdown in his expansive but sparsely decorated officein Dar Es Salaam he commented on the irony ofTCRS starting over 35 years ago doing emergencywork in Tanzania, moving into development and nowseemingly coming full circle and back intoemergencies.TCRS was established in 1964 as an operational fieldprogramme of the Lutheran World FederationDepartment for World Service, at the request of, andon behalf of the World Council of Churches and theChristian Council of Tanzania. The agency wasinitially set up as an ecumenical institution forhumanitarian interventions in refugee situations.Currently, staff numbers exceed 600 people.During the first 20 years, TCRS mainly worked withRwandan, Burundian and Mozambican refugees.These programmes started off as relief interventionsand then gradually moved into developmentalactivities as Government of Tanzania (GoT) policyobjectives turned towards the encouragement ofrefugee self–sufficiency in settlements. TCRSpromoted self–sufficiency through a variety of inputs,e.g., provision of water, seeds and tools andagricultural extension services.In 1984 the GoT invited TCRS to take over thedevelopment activities of a departing NGO in Singidaregion. This was the first non–refugee programme theagency had taken on. The development activitiesestablished in Singida were similar to thoseundertaken in the refugee settlements. Otherdevelopment programmes quickly followed, e.g. inArusha.Once again the focus of TCRS activities changed inthe early 1990s following the 1993 and 1994 refugeeinflux from Burundi and Rwanda. This large influxrapidly caused a hardening of GoT attitudes towardsrefugees. Whereas before they had been providedwith abundant settlement land the GoT now wantedthem to receive the bare minimum of services in aneffort to “make life as uncomfortable as possible”and to get them to repatriate quickly. TCRSprogrammes therefore became quick impactemergency interventions in line with many of theinternational agencies working in the camps. Duaneargued that this was really short–sighted as many ofName: Tanganyika Christian RefugeeServiceHeadquarters: Dar Es SalaamFormed: 1964Telephone: 255 (051) 700579Fax: 255 (051) 700581Director: Duane PoppeNumber of Staff: 600+Annual Budget: $6,720,737 (1997)these refugees could make a considerablecontribution to Tanzania (which has an abundance ofland) in terms of agricultural production. The TCRSdirector was pleased that not everyone in governmentagreed with this policy citing the example ofKibondo district in Kigoma region where the localgovernment was defying GoT policy and providinglarge tracts of land for refugees. Duane argued thatthe GoT assertion that self–sufficiency for refugeesencourages permanent settlement runs counter to theevidence and that once conditions are suitablerefugees will in most cases want to go home. Forexample, many of the refugees from the 1960s whohad become fully self–sufficient returned home toRwanda following the change of government in 1994.The latest turn of events for TCRS is theirinvolvement in an emergency feeding intervention forresident communities in Singida region in partnershipwith SCF. SCF/TCRS made use of a newlydeveloped community managed approach to targetingscarce emergency food aid resources. The system(which is described in a field article in this edition ofField Exchange) proved to be more transparent andfairer than previous food distribution approaches inTanzania. It also incorporated a developmentalapproach into emergency work. The GoT are nowrequesting that TCRS staff with experience of thisprogramme are seconded to other emergency affectedregions to help implement the novel programmedesign.As the meeting neared its end, Duane interrupted theline of my questioning with a complaint directed atinternational humanitarian agencies. He told me“although there are notable exceptions, I don’t thinkthey (humanitarian agencies) invest enough time andeffort into strengthening the technical capacity ofchurch–based agencies like ourselves to mountefficient emergency interventions. We mainly have tolearn through partnership and ‘doing’ rather thanformal training”. Looking slightly wistful he went alittle further by saying: “ While I can understandpossible reasons for this, e.g. fear of partisanship orproselytising, as well as not having enough time inthe acute stage of an emergency, I think this isshort–sighted. The fact is church based agencies arealways there at the beginning of an emergency, plugthe gaps during the emergency response, and remainthere when all the international humanitarianagencies have gone home or moved on to the nexthigh profile disaster”. On saying good–bye to DuaneI noted my reluctance to tell him that in two daystime I too would be catching a flight home.Participation by theAffected Population inRelief OperationsDraft report for ALNAPAt its fourth meeting in October 1998, TheALNAP (the Active Learning Network forAccountability and Performance inHumanitarian Assistance) noted that a recurringtheme of discussion at its meeting had been the needto improve accountability to those affected bydisasters and humanitarian crisis. A number ofinitiatives were taken as a result of this meetingincluding a study to identify empirically types ofparticipation by beneficiaries and their communitiesover a geographically and socially limited area (i.e.south Sudan). The study was based on a descriptionof the experience of some of the 12 UK based NGOscovered by the Disasters Emergency Committee(DEC) evaluation of the South Sudan humanitarianprogramme and involved three weeks field work inNairobi, Lokichoggio and south Sudan. Among thequestions specifically addressed by the study werethe following:• What were the types of participation utilised andwhy?• Are programmes more effectively delivered ifparticipatory?• Is there value added beyond the programme ifhumanitarian assistance is delivered in aparticipatory fashion?Findings of the studyThe final report is a lengthy document coveringaspects of beneficiary participation in the manysectors of humanitarian relief provision. For thepurposes of this Field Exchange summary we willonly highlight some of the findings that relate to thefood and nutrition sector. For more information thereader is referred to the original report.The study draws an important distinction betweenbeneficiary participation which involves physicalenergy, e.g. constructing a feeding centre, andparticipation which involves engagement of thecommunity mind, i.e. planning the intervention. Theimportance of ‘social learning’ is also highlighted.For example, although women and children arestrictly the only beneficiaries of selective feedingprogrammes, men need to participate in a sociallearning sense. This became clear when for example,lack of proper information regarding the purpose offeeding centres resulted, during the early stages ofthe programme, in households who were receivingrations from the centre not being given the generalfood ration. The local distribution structure,dominated by men, failed to realise that feedingcentre rations were meant for malnourished underfives only and not for the whole household.A number of agency experiences of participation aresummarised in the report. For example:• Oxfam’s use of focus group discussions and keyinformant interviews to enable the agency toidentify vulnerable people for their emergencyfood and nutrition programme.• SCF work with local authorities and SRRAPage 24 — ENN, Field Exchange, July 99

Evaluationsrepresentatives who were given responsibility towork with communities to decide who wouldreceive assistance and draw up lists of vulnerableindividuals. Through a vulnerability workshop, acall was made by participants to improverepresentation on the relief committees andensure their involvement in distribution.Awareness of groups who were not receivingfood was also raised and one practical resolutionwas made to directly and separately targetfamilies of children in feeding centres.• Tear Fund’s unique mobile SFP allowingincreased beneficiary participation by making iteasy for volunteers to work in the feeding centres.Because centres were small, contact betweenagency staff and beneficiaries was close,increasing opportunities for social learning.Some Conclusions from the studyJustifications for a participatory approach toemergency aid provision:• decision making structures still exist in societiesaffected by emergencies and constitute a valuableresource for agencies implementing emergencyprogrammes;• limited involvement of beneficiaries or levels ofsocial learning can introduce inefficiencies intothe programme;• agencies have come to realise that it is almostimpossible to understand vulnerability withoutmaking concerted efforts to involve the affectedcommunities in the defining process.Understanding vulnerability is essential totargeting resources;• even if targeting is not necessary, participationoffers a channel for understanding and addressingissues such as gender relations and understandingthe impact of relief on the livelihood system andthe social structure in general.Arguments against a participatory approachThe general belief is that there are somecircumstances in which participation is notappropriate or desirable, e.g. in the acute phase of theemergency when there are high rates of mortality andmorbidity and it is obvious what needs doing.However, even if the decision about what to provideis not made in a participatory manner, the effectivedistribution requires some level of participation bybeneficiaries. Another issue that deservesconsideration is the extent to which particular typesof investigation, participation and social learningmight result in loss of time and introduceinefficiencies into the programme. It may also be thatagencies are reluctant to use participatory approachesfor fear of generating unrealisable expectations. Forexample, in south Sudan, beneficiaries of tools andseeds requested some agencies to give them the toolsahead of the seeds so that they had enough time towork in their fields. Invariably, the agencies statedthat they were not prepared to do the doubledistribution this request would involve. Another issueis whether some forms of participation are disruptiveto community relations in terms of say, gender andthe local political economy.ReferencePierson R.T. Nata. Participation by the AffectedPopulation in Relief Operations: A Review of theExperience of DEC agencies during the responseto the 1998 Famine in South Sudan.People in AidFood Aid – On a Wing and a PrayerBy Jeremy ShohamMore or less every one in the Singida regionof central Tanzania agrees that thecommunity managed emergency fooddistribution programme implemented over the lastyear, has been a great success. Thiscommunity–based approach to emergency food aiddistribution has allowed for transparency andaccountability at village level and ensured that theneediest households in a target village got the foodaid. However, the overall emergency response hasbeen criticised from the point of view of villagetargeting. Many have questioned whether the rightvillages were selected.As part of an evaluation team looking at theemergency programme in the region, I was stillundecided about this. After a particularly gruellingtrip to speak with a number of village committees(the roads in the region are amongst the worstanywhere I have visited in Africa), we happened tobe passing a Christian Mission station. One of myTanzanian colleagues remarked that this mission wasapparently involved in giving free food handoutsduring the height of the emergency. After somediscussion we decided it might be useful to get theMission’s view on the village targeting in the regionand also find out about their activities.After lengthy negotiations with a guard andnumerous messages back and forth about the purposeof our visit, a young man eventually appearedwearing a clerical collar and faded blue frock with awhite cross on the side. He announced himself asFather Antonius and immediately apologised that theSister simply did not have time to see us but that hewould attempt to answer our question on her behalf.He pulled out a scrap of paper on which he hadtranscribed some of the Sister’s answers to ourwritten questions.He then told us how starting in September last yearindividuals had begun turning up at the missiondesperate for food and that they had been providedwith cooked meals. It soon became obvious that thosecoming were the stronger ones and that they neededto return home with dry food for weaker members oftheir family. The mission subsequently provided theserations. By December, Mission food supplies, whichuntil then had been taken from their own fields, hadrun out. The Mission was then forced to buy food andbetween December and February an estimated 1200people were turning up each day for a food handout.Many were coming from villages over 20 kms awayand collapsing at the gates of the Mission. Womenand children were the most numerous. The Missionestimated that they supplied 3,050 MT of food over aseven–month period. Father Antonius described howmany children and the elderly had oedematousmalnutrition so that they had to be admitted to theMission hospital. He also explained how recipientswere asked if they had any money and that if they didthey were asked to buy the maize at a subsidisedprice (at the time maize prices were exorbitantlyhigh). Stronger individuals were also asked toundertake some work for the mission, e.g. landclearance, harvesting, and cultivating sweet potato.The mission did not want to encourage dependenceon free food handouts. The apparent extent of unmetneed confirmed our finding from other extensiveinvestigations that indeed many of those in need werenot being reached through the geographic targetingsystem.The Father then explained why the Mission gotinvolved in this work. “We did this for Christ as wesaw in the faces of those collapsing in front of theMission – ‘the face of Christ”.At the end of our discussion he explained that SisterAilsa had asked him to remind us not to mention thename of the mission in our report as they sought nocredit in undertaking their work and preferredanonymity. To say the meeting humbled me would bean understatement.While driving back to Singida town I found myselfwondering how often church missions had to step into fill the gaps when humanitarian agencies missedout destitute populations or simply failed to notice anemergency. It also occurred to me that we aid‘professionals’ are always so ready to criticise thetechnical proficiency of church based agencies whenthey enter the field of emergency relief but so rarelypraise their efforts when they act as the last resort.However, my enduring thought about all this was thatif I had been a Tanzanian in Singida regionoverlooked by government, UN and NGO responsebut had survived through the efforts of Sister Ailsaand Father Antonius, it would have been my faith inGod rather than in government that would havegrown out of the experience.The names of individuals in this article havebeen changed in accordance with Mission policynot to publicise or seek credit for workENN, Field Exchange, July 99 — Page 25

People in AidMangock Jamille Mangock relaxingin Bararud, south SudanJohn Noble security LokichockioPhilip Winter ECHO consultant - Bahr el GhazalWilliam FieldingFEAU ManagerWFP Nairobi/LokiThe Deng Brothers who keep avery nice SCF compund inBararudFront from the Left: Tobias Ogada,*Asaka Nyangaroa, Christopher Kiilu, DavidMwara, WFP field staff, south SudanSteven Mainah, Betty Kidan Muni, MangockJamille Mangock, SCF south SudanIaye Shneerson,reports/PI officerWFP LokiPage 26 — ENN, Field Exchange, July 99*Tobias is also a Blues composer, most known for ‘Distribution Blues’

The BackpageCartoon Corner by Jon BerkeleyField ExchangeEditorsFiona O’ReillyJeremy ShohamTheis currentlyfunded by:The Emergency Nutrition Network (ENN)grew out of a series of interagency meetings focusing onfood and nutritional aspects of emergencies. The meetingswere hosted by UNHCR and attended by a number of UNagencies, NGOs, donors and academics. The Network is theresult of a shared commitment to improve knowledge, stimulatelearning and provide vital support and encouragement tofood and nutrition workers involved in emergencies. The ENNofficially began operations in November 1996 and has widespreadsupport from UN agencies, NGOs, and donor governments.The network aims to improve emergency food andnutrition programme effectiveness by:Layout & WebsiteKornelius Elstner• providing a forum for the exchange of field level experiencesContributors for this issueAlawia OsmanBetty Kidan MuniConnell FoleyFatma MusaJulian FrancisMalcolm RideotMohamed DiemSaskia van der KamThanks for the Photographs to:Anne Kellner (UNHCR)CARE InternationalOn the cover:Outside the camps tractors and trailersprovide shelter for thousands ofrefugees. Kukes, Albania. ByPieternella Pieterse/CONCERNGENEVA FOUNDATIONto protect health in war• strengthening humanitarian agency institutional memory• keeping field staff up to date with current research andevaluation findings• helping to identify subjects in the emergency food andnutrition sector 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 relevantto the emergency food and nutrition sector.The main target audience of the Newsletter are food andnutrition workers involved in emergencies and those researchingthis area. The reporting and exchange of field level experiencesis central to ENN activities.The ENN is located in the Department of Community Healthand General Practice, Trinity College, Dublin, Ireland.As alwaysthanks for the Cartoon to:Jon Berkeley, who can be contactedthrough www.holytrousers.comThe TeamFiona O’Reilly is the ENN Co-ordinator, and Field Exchange coeditor.Fiona has been involved in the area of nutrition, health anddevelopment for the past 10 years, half of which has beenspent working in emergency situations.UNHCRJeremy Shoham is co-editor for Field Exchange and the ENNtechnical consultant. Jeremy has been working in the area ofemergency food and nutrition for the past 13 years. He runsthe Emergency Nutrition M.Sc. unit at the Centre for HumanNutrition, London School of Hygiene and Tropical Medicine.Kornelius Elstner works part time with the ENN.Thanks to the Department of Community and GeneralPractice, especially Professor John Kevany, Trinity College forsupport for this project.ENN, Field Exchange, July 99 — Page 27

Emergency Nutrition NetworkDepartment of Community Health & General PracticeTrinity College, 199 Pearse Street, Dublin 2, IrelandTel: 353 1 608 2676 / 843 5328Fax: 353 1 670 5384e–mail: foreilly@tcd.ieInternet: www.tcd.ie/ENN