Download PDF - Field Exchange - Emergency Nutrition Network

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