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ResearchField ArticleRevisiting ‘new variant famine’in southern AfricaSummary of published research 1S Roughneen, Dafur, 2006The ‘New Variant Famine’ hypothesis was firstpublished in 2003. It postulated four factorscontributing to worsening food shortages insouthern Africa and limiting recovery;i) household level labour shortages due toadult morbidity and mortality, and therelated increase in numbers of dependantsii) loss of assets and skills due to adultmortalityiii) the burden of care for sick adults andchildren orphaned by AIDS, andiv) the vicious interactions between malnutrition and HIV.A paper just published in HumanitarianExchange draws on recent published researchand two recent studies in Malawi andSwaziland to reassess the new variant faminehypothesis.Both Malawi and Swaziland are predominantlyagricultural, poor and vulnerable andare suffering high prevalence epidemics ofAIDS. In both countries, farming is labourintensive,reliant primarily on hoe-cultivatedmaize in a single farming season and food crisis,including chronic malnutrition and recurrentfamine, is common to many parts ofMalawi and Swaziland. Both countries also facea severe HIV/AIDS epidemic. Adult prevalenceof HIV/AIDS among ante-natal clinic(ANC) attendees in Swaziland – 42.6% - is thehighest in the world. In Malawi, prevalenceamong ANC attendees is 14.4%. Mortality inSwaziland has almost tripled over the past tenyears, from about eight deaths per 1,000 in 1994to about 23/1,000 in 2004. Adult mortality hasalso risen sharply in Malawi. In both countries,these increases are almost entirely due to AIDS.HIV/AIDS and loss of household labour,assets and skillsResults of household studies in both countriesduring the 2002-3 crisis clearly show thatHIV/AIDS was one cause of declining agriculturalproduction. Evidence from Swazilandfound a reduction in maize production of 54.2%in households with an AIDS-related death. InMalawi, households without an ‘active adult’suffered a 26% drop in tuber production, a 53%fall in cereal production and a 51% reduction incash crop income compared to households withat least one ‘active adult’. There is also animportant gender dimension to this impact. InMalawi, in households with a recent adult maledeath, the area planted is 32% lower than inhouseholds with a recent adult female death.HIV/AIDS and rural livelihood copingstrategiesA survey of HIV affected households in Malawifound that three quarters of householdschanged their usual crop mix towards lesslabour-intensive crops in response to labourshortages and lack of resources. In contrast, inSwaziland decreasing the area under cultivationwas a common response. According to onestudy, the area under cultivation decreased byan average of 51% in households with an AIDSrelateddeath, compared with 15.8% for householdswith a death that was not AIDS-related.In Malawi, one household study found thatsome 40% of those affected by chronic illnesssold a portion of their assets to buy food or topay medical or funeral expenses. In Swaziland,households with an AIDS death experienced a29.6% reduction in the number of cattle theyowned.HIV/AIDS and changing dependencypatternsIn 2003, UNAIDS estimated that about 500,000children (about 50% of the total number oforphans) in Malawi and 65,000 children (65% oftotal orphans) in Swaziland below 17 years ofage had lost one or both parents to AIDS.Caring for an increasingly large number oforphans is placing a tremendous burden onextended families and community networks. Atthe same time, kinship networks have provenresilient in providing at least a minimum levelof care and socialisation for children orphanedby AIDS.HIV/AIDS and malnutritionOverviews of nutritional surveys during the2002-3 drought found clear signs that doubleorphans have a much higher prevalence of malnutritioncompared with children with one orboth parents living. It also found that, althoughchild malnutrition rates were higher in ruralareas (which tended to have lower HIV prevalence),the decline in nutritional status wasmost marked closer to towns (which have higherprevalence of HIV/AIDS than rural areas).There is also preliminary evidence that therebound in nutritional status after the end ofthe drought in 2003 was less robust than expected.Other aspects of the relationship betweenmalnutrition and the HIV/AIDS epidemicremain speculative and under-researched.Little is known about the indirect impacts of theHIV/AIDS epidemic on the spread of childhoodinfectious diseases, and studies of adultnutrition and HIV infectivity and virulence arecomplex, contradictory and/or inconclusive.In conclusion, the authors state that recentresearch supports the view that AIDS is challengingrural livelihoods, underminingresilience to other shocks and stresses and creatingnew patterns of malnutrition. It is alsoargued that in many areas of southern and easternAfrica, each turn of the cultivating seasonsis seeing a small, significant and usually negativechange in rural livelihoods. While communitiesare resourceful and inventive in respondingto the stresses they face, a significant proportionof the rural population is being grounddown into chronic destitution. According to theauthors, this is preventable but it is not beingstopped and until it is, we face the prospect ofmajor, ongoing interventions to support socialwelfare in affected communities.Runde. D (2006). How to make development partnershipswork. OECD Observer, No 255, May 2006, pp 35-37View of Fata Borno IDP camp, North Darfur,temporary home to 18,000 IDPs.DeliveringSupplementaryand TherapeuticFeeding inDarfur:Coping withInsecurityBy Gwyneth HogleyCotes, GOALGwyneth joined GOAL in November, 2005as the Nutrition Coordinator for Darfur,Sudan. She has a BA in InternationalStudies and Master of Public Health (MPH)degree focusing on child health and survival.Her work experience includesresearching the barriers to therapeuticfeeding centre attendance in Eritrea in2001 and training Ministry of Health staffin Ghana in improved disease control andimmunisation information managementtechniques.GOALs Simon Roughneen assisted in conceptualising,framing and editing this article.This article would not be possiblewithout the professionalism and bravery ofGOALs nutrition workers and the rest ofthe Darfur field team.9
Field ArticleThis article describes the ongoing challenges thatinsecurity poses to the GOAL nutrition programmein Dafur and the strategies they have respondedwith.In February 2003, fighting erupted betweenSudanese government forces and theSudanese Liberation Army (SLA), a rebelmovement seeking to achieve greaterautonomy for the Darfur region and its people.Later the SLA was joined by the Justice andEquality Movement (JEM), a pan-Sudaneseopposition group. The conflict made headlinesaround the world when government-armed‘Janjaweed’ Arab militias conducted widespreadattacks and looting in Darfur villages,resulting in an estimated 200,000 deaths and thedisplacement of some 2 million residents.The fighting and displacement has slowedits pace somewhat since the start of the conflictbut, in late 2005 and into 2006, areas of westernand northern Darfur have seen renewed violence,resulting in new displacement. Currently,there are approximately 1.75 million Darfuriansliving in internally displaced persons (IDP)camps or host communities throughout Darfur,with another 200,000 refugees in Chad. Thehumanitarian situation has been further compromisedby the spread of the conflict acrossthe border into Chad. At the time of writing, aninternationally mediated peace agreement wassigned between the Sudanese government andone faction of the SLA. However, a second SLAfaction and the JEM party refused to sign, causingtension throughout the Darfur region andraising concerns that the split could cause aresurgence of fighting.As a result of the conflict, most residents ofDarfur have seen a complete disruption of theirlives and livelihoods, with access to land, markets,and services restricted by violence andfear. Productive assets have been depleted,either looted by warring factions, or sold as ameans to get food and shelter.Humanitarian situationDespite the influx of aid in 2004, the humanitariansituation has remained precarious. As aresult of widespread food aid and supplementaryfeeding, global acute malnutrition (GAM)rates have dropped from the critically highrates that were found at the height of the conflict,but are still alarming, ranging from 10-20%throughout Darfur. Even before the conflict,large portions of Darfur were characterised as‘chronically-destitute’ with wasting levels of20%, criteria that would have justified emergencyintervention long before the fightingstarted 1 . However, after three years of intensehumanitarian activity, international assistanceis beginning to wane. Starting in May 2006, theWorld Food Programme (WFP) will be forced tohalve its food aid to nearly 3 million residents ofDarfur, because of a shortage of donor funding.GOAL’s work in DarfurAfter the conflict began, GOAL set up twoemergency assistance programmes in Darfur.The first was started in February 2004, in theKutum region of North Darfur, an arid areasubject to food insecurity even before the conflict.The war in Darfur had further exacerbatedthe health and nutrition problems in the area,and rates of malnutrition were typically higherthan in other parts of Darfur. GOAL had a historyof involvement in the region, and wasalready monitoring the humanitarian situationbefore the conflict began.Approximately 45-50,000 IDPs are currentlyliving in host communities and in camps nearthe primary town of Kutum. GOAL currentlyprovides primary health care and water/sanitationservices throughout the region and incamps. GOAL’s nutritional services are providedusing the Community-based TherapeuticCare (CTC) approach, including supplementaryfeeding (SFP), outpatient therapeutic feeding(OTP), and inpatient care for complicated casesof severe malnutrition.In March 2004, GOAL began operating inJebel Mara, a contested area in a fertile mountainregion that once provided much of theregion’s food. After the war began, much of theland was abandoned following attacks on villages,and the food security and health of thepopulation declined rapidly. At that time,GOAL was the only agency working in the area.The programme distributed non-food reliefitems to IDPs and provided supplementaryfeeding, therapeutic feeding (TFP), primaryhealth care (PHC), and water/sanitation services.Due to a significant deterioration in the securitysituation, this programme was closed inJanuary 2006.The impact of insecurity on the provisionof nutritional servicesDifficulty providing servicesGOAL’s services are spread out over a widearea of North and West Darfur. Because populationmovements are restricted by insecurity,GOAL must travel to field sites on a daily basisto bring services to populations in need. As aneutral agency, GOAL provides nutrition servicesin both government and rebel-held areas ofDarfur.This presents logistical constraints in termsof transportation and communication, as GOALhas to coordinate all activities with all the variouspolitical factions before travel can be authorised.Access to programme sites is carefullyregulated, and authorities on all sides must benotified in advance of all programme staff andpatients who are to be transported across militaryboundaries.Table 1The purpose of advance notification and communicationprocedures is to determine if fightingor suspicious movements are occurring inthe travel areas. However it does not provide aguarantee of staff safety. Non-governmentalorganisations (NGOs) risk having their carshijacked or getting stranded by an outbreak ofviolence each time they enter the field. Specialcommunication equipment must be available,and all GOAL staff must adhere to very stringentsecurity procedures at all times. Every stepis taken to ensure, as much as possible, that personneland assets are not exposed to unnecessaryrisk.Rigid security protocols make it difficult tovisit local communities outside of the clinicareas. Thus assessments, screening, follow-upvisits, and community sensitisation cannotalways take place as planned. In rural areas,nutrition services are generally provided inconjunction with clinic services, and screeningis conducted among clinic attendees; activecase-finding is nearly impossible given thesecurity constraints. The coverage attainedusing this method is very low, and additionalmethods have to be developed in order to reachlocal communities.Service interruptionsGOAL provides SFP and CTC services on a biweeklyschedule, as weekly distributionsresulted in large numbers of caretakers defaultingfrom the programmes. Prior to each distribution,communication with authorities andadvance notification allows GOAL to identifyareas that are unsafe for travel. When fightingor troop movements occur, programme activitieshave to be temporarily suspended, and nostaff or food aid can be transported to field sites.In most cases, there is no way to communicateto beneficiaries when services have beeninterrupted – no telephone service is availablein rural sites. Beneficiaries sometimes travellong distances to reach the SFP/CTC site, onlyto find that staff and provisions have notarrived. This results in a serious lack of confi-1Assessing the Impact of Humanitarian Assistance, A Reviewof the Methods in the Food and Nutrition Sector. JeremyShoham, HPG Background Paper.The impact of various degrees of insecurity on population movement and programmingProblem Result Impact on programmeRestrictedaccess toconflictaffectedareasOccasionalserviceinterruptionsdue tofighting orinsecurityGeneralconflictLimited screening in rural communitiesLimited ability to conduct household visits onchildren who are absent from OTP/SFP servicesLow numbers of children followed up afterdefaultLimited numbers of staff allowed into programmesitesReduced confidence in programme servicesOccasional long gaps in-between food distributionsFrequent population movementsWomen fear travelling far from homesReduced programme coverageIncreased default ratesReduced ability to assess and respond toreasons for defaultIncreased costs, as additional staff mustbe hired and trained in field locationsIncreased default ratesReduced rate of weight gainIncreased length of stay in programmeReduced cure ratesIncreased defaulter ratesNeed for increased flexibility inprogramme responseDifficulty locating defaulters, largenumbers of children lost to follow-upIncreased defaulter ratesReduced coverage10
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