|4th Report on the World Nutrition Situation - Nutrition throughout the Life Cycle (ACC/SCN, 2000, 138 p.)|
|CHAPTER 5: NUTRITION OF REFUGEES AND DISPLACED POPULATIONS|
Emerging Policy Issues
There is a long and established tradition of principles of humanitarian action (notions such as humanity, impartiality, independence, and neutrality) and the broader humanitarian principles that are intended to mitigate the destructive impact of war and that must be upheld by warring parties.14
Recent years have seen a blurring of humanitarianism. There is, for example, real pressure to include conflict prevention as an explicit objective of humanitarian aid. The Nobel Peace Prize was awarded to MSF in 1999, and this step may be a mark of real change. Questions persist, however, about the extent to which this expanded humanitarianism is appropriate and the risks it poses in terms of the humanitarian-military interface.55, 56 Aid itself is increasingly blamed for fuelling conflict, the act of providing aid in complex emergencies is losing its aura of neutrality, and increasingly, outside agencies are considered fundamentally incapable of affecting the basic causes of humanitarian crises.14
The global availability7 of food for distribution as relief assistance or in support of recovery and rehabilitation has decreased considerably over the last decade.57 In addition donors require evidence of greater efficiency in food aid programming. This has led to debate about the feasibility and appropriate-ness of focused targetting, the need for more appropriate monitoring for accountability, and evidence of positive beneficiary impact.33
Regional differences in the provision of humanitarian assistance are now obvious. The recent experience in the Balkans emergency has shown how the international humanitarian system can be successfully mobilized to prevent such emergencies from developing into acute nutritional crises. In stark contrast, however, are the complex emergencies, for example, in Angola and central Africa, where political solutions to protracted wars and internal conflict prove all too elusive and funding for humanitarian response programmes is limited, with devastating consequences for the nutrition of the civilian population.
Further complicating factors in the response to emergencies are the level of media interest that broadly determines (1) the ability of NGOs and to some extent the UN to attract funds directly from the public; (2) the level of political interest (as governments are responsive to the media) and therefore the availability of donor funds; and finally, (3) the pressure on agencies to be involved in high-profile emergencies.
Operational and Managerial Issues
TRAINING AND CAPACITY BUILDING
The development of appropriate training curricula and materials to allow for wide-scale training and capacity building in nutrition assessment, planning, and programme management and evaluation (including the treatment of severe undernutrition) among international relief organizations, governments (especially those of vulnerable countries), and indigenous NGOs is required. Managers and technicians outside the nutrition sector should be included in parts of these training exercises.
FOOD SECURITY ASSESSMENTS
There is a need to review the strengths, weaknesses, and prognostic precision of different approaches to food security assessments and develop a consensus on the more effective methodologies and ways of working for a given set of objectives in a specific setting.
There has been an increase in the number of international humanitarian workers targetted for violent crimes. The protection of humanitarian workers presents a further operational challenge.
Technical Issues Requiring Further Research
Donor agencies must direct more support to applied research on the assessment and response to nutritional emergencies. Current issues related to nutritional emergencies have emerged from the operational experience of relief agencies over the past 25 years, as described. Recent achievements such as the increase in applied health and nutrition research have also helped clarify the remaining technical and operational problems. Some of the issues requiring further research are outlined below. Further issues are described in RNIS 25 and the WHO report Applied Health Research Priorities in Complex Emergencies.50
· The assessment and management of acute undernutrition in adolescents and adults re quires research. ACF is undertaking studies in Burundi looking at both body mass index (BMI) and MUAC as predictors of mortality in adults without oedema. This will help to determine thresholds to admit adults to therapeutic feeding programmes. In the meantime, BMI and MUAC values have been proposed as thresholds for screening adults when food is scarce.58 Further studies are needed to develop consensus on this issue. UNHCR and CDC are currently conducting studies on adolescent undernutrition in Nepal and Kenya.
· The assessment and management of undernutrition in older people (over 50 years) presents a further challenge (see also Chapter 1). Research is needed in a wide range of areas, including appropriateness of conventional cutoffs for this population group.
· The prevention of micronutrient deficiencies in large food aid-dependent populations requires more consideration. Field techniques to detect early vitamin and mineral deficiencies need to be further developed and validated. Operational research is required to assess the various strategies that are currently recommended to ensure that adequate levels of micronutrients are included in food consumed by these people.
· Reasons for the low coverage and ineffectiveness of feeding programmes, particularly supplementary feeding programmes, must be identified. Potential research topics include programme evaluation methods, reasons for poor coverage, and mechanisms to enhance performance.