|Handbook for Emergencies - Second Edition (UNHCR, 1999, 414 p.)|
|15. Food and Nutrition|
· A mean figure of 2,100 kcal per person per day is used as the planning figure for calculating the food energy requirements of refugees in emergencies in developing countries6;
· Everyone in the population, irrespective of age or sex, should receive exactly the same general ration (i.e. same quantity and type of foods);
· The food basket should be nutritionally balanced and suitable for children and other groups at risk;
· Every effort should be made to provide familiar foodstuffs and maintain traditional food habits;
· The level of fat intake should provide at least 17% of the dietary energy of the ration. Protein intake should provide at least 10-12% of the total energy;
· The diet must meet essential vitamin and mineral requirements;
· Particular attention should be paid to locally prevalent nutrient deficiencies.
6 The Management of Nutritional Emergencies in Large Populations, WHO, Geneva, 1978.
35. Every effort should be made to provide familiar foodstuffs and maintain sound traditional food habits. Expert advice on the ration size and composition is essential and should take full account of local availability of food commodities. Staple food should not be changed simply because unfamiliar substitutes are readily available. Inappropriate foods often lead to waste and lower the morale of the refugees.
36. The first concern is to ensure that energy and protein requirements are met. The planning figure for the average minimum daily energy requirement per person per day for a developing country population at the beginning of an emergency is 2,100 kcal. See Annex 1 for examples of rations which meet this requirement. This average requirement is calculated on an average population containing men, women and children of different age groups. However, a complete ration should be provided to each refugee without distinction.
A minimum requirement of 2,100 kcal per person per day is used as the planning figure for a developing country population at the beginning of an emergency.
A population which contains mostly active adults may require considerably higher average energy intakes. In addition, a higher ration is vital for survival in a cold climate.
37. The daily energy requirement can be adjusted when the situation has stabilized7 and detailed data is available. Factors to be taken into consideration are:
i. Age and sex composition of the population;
ii. Activity level;
iii. Climatic conditions;
iv. Health, nutritional and physiological status;
v. People's access to other food sources e.g. agriculture, trade, labour.
38. The food basket should comprise: a staple food source (cereals), an energy source (fats and oils), a protein source (legumes, blended foods, meat, fish), salt and possibly condiments (such as spices). Fresh foods should be included in the food basket for essential micronutrients. The level of fat intake should provide at least 17% of the dietary energy of the ration, and protein intake should provide at least 10-12% of the total energy.
39. When certain food commodities are not available, they can be replaced for a maximum of one month by other available food items in order to maintain the adequate energy and protein level. Substitution in energy value, should an item not be available, is:
Corn Soy Blend (CSB) for beans
Sugar for oil
Cereal for beans
Cereal for oil8
E.g. the energy from 20 g of sugar can substitute for that from 10 g of vegetable oil.
40. Cereal flour, rather than whole grain, should be provided, especially at the beginning of an emergency. Considerable fuel savings are made by using milled rather than whole grain. If whole grains are provided, local milling should be made available and the cost compensated for.
41. Essential vitamin and mineral requirements must also be met. The basic food commodities distributed through the general ration do not normally cover the required amounts of vitamins and minerals. Therefore, deficiencies often arise among populations entirely dependent on external food aid and within a population among vulnerable groups like infants, pregnant women and nursing mothers. Particular attention should also be paid to locally prevalent nutrient deficiencies.
42. The risk of specific nutrient deficiencies can be estimated from the composition of the general ration and access the population has to other food sources in the area. Possible options for providing vitamins and minerals are:
i. Provide fresh food products;
ii. Promote the production of vegetables and fruits;
iii. Add to the ration a food rich in a particular vitamin and micronutrient such as fortified cereals, blended foods, or condiments;
iv. Provide supplements in tablet form, which is the least preferred option.
43. Wherever possible the refugees should be encouraged to grow vegetables themselves: the production of fresh food by refugees not only improves and diversifies the diet but saves fuel and provides an opportunity to generate some income. Larger plot sizes and the provision of appropriate seeds would facilitate this, however, it can be difficult to encourage refugees to produce fresh food because of their uncertainty as to the length of their stay and problems of access to land.
7 See for further information: WFP/UNHCR Guidelines for Estimating Food and Nutritional Needs in Emergencies, 1997.
8 One way only, note that oil cannot be used in place of cereal.
44. The need for a fair, efficient and regular food distribution cannot be over-emphasized. This is discussed in chapter 13 on commodity distribution. There are two main types of distribution: dry ration and cooked meals.
45. Dry food distribution (which is taken home) has major advantages over cooked food distribution. It allows families to prepare their food and to use their time as they wish, permits them to continue to eat together as a unit and is more culturally and socially acceptable. It also reduces the risk of the spread of infectious diseases.
46. Cooked meal distribution requires centralized kitchens with adequate utensils, water and fuel (the requirement is less than the amount required for family cooking), and trained personnel. The refugees usually sit together in a feeding compound, although in some circumstances families can carry the cooked meal to their accommodation. At least two meals must be served each day.
Cooked meals are much more difficult to organize efficiently than dry ration distribution, particularly for large numbers.
Cooked meal distribution to the whole population is therefore only provided under exceptional circumstances when the refugees do not have access to adequate water and/or cooking fuel and in insecure situations.
47. In addition to cooking pots, fuel and utensils, the refugees must have containers and sacks to protect and store their food rations. Oil tins and grain bags will be useful, and contracts with suppliers, at least for initial deliveries, should not require their return.
Monitoring the General Feeding Programme
48. The general feeding programme can be monitored by:
Food basket monitoring: Comparing the quantity and quality of food collected by the refugees at the distribution site on distribution days compared with the planned ration, Also by monitoring after the distribution at household level through house visits (on distribution day);
Discussing the quality and quantity of the rations regularly with the refugees;
For more information on how to monitor the general food programme see UNHCR's Commodity Distribution: A Practical Guide For Field Staff, and MSF's Nutrition Guidelines.