|Refugee Nutrition Information System (RNIS), No. 14 - Report on the Nutrition Situation of Refugees and Displaced Populations (UNSSCN, 1996, 45 p.)|
|ASIA - Selected Situations|
The most recent overview of the numbers of refugees and displaced people in Asia (as of the end of 1994) is as follows. There were an estimated 5.0 million refugees in Asia, of whom 1.1 million were Afghans in Pakistan and in Iran (1.6 million). There were reported to be 610,000 Iraqis in Iran. Other large groups were refugees from Myanmar in Bangladesh (120,000), Vietnamese in China (290,000), Chinese (Tibet) in India (110,000), and Bhutanese in Nepal (100,000). No comprehensive data were available on the numbers of internally displaced populations in Asia, but they were certainly in the millions (UNHCR, 1994 Populations of Concern to UNHCR').
This section of the report aims to give updated information on some of these situations. The current situation for the Afghan refugees/displaced populations, the largest single group in Asia with approximately three million affected people, is described. Available information on the Bhutanese refugees in Nepal and refugees from Myanmar in Bangladesh are included because of previous reports of micronutrient deficiencies. As in the past, we also include information on Southern Iraqi refugees in Iran.
(see Map 17)
Fighting has escalated in and around Kabul, although elsewhere the situation in Afghanistan is reportedly calm. Overall regional estimates of those affected by events in Afghanistan remain at 3.1 million.
Kabul The Taliban forces have continued to attack Kabul city throughout December and January inflicting many casualties. Since the fighting between government and Taliban forces recommenced in September 1995 approximately 60,000 people have left Kabul. Prior to the renewed fighting an estimated 200,000 people had returned to Kabul from Peshawar and Jalalabad since April 1995. Current fighting has disrupted the normal pattern of trade and commercial deliveries to the city resulting in food price inflation and shortages of essential food commodities. International aid agencies in Kabul have come together to implement an Emergency Winter Relief Plan [UNHAA 04/01/96, 14/01/96]. WFP have been delivering food to the capital via Jalalabad with much of the food being used to feed orphans, widows, and the disabled.
Although an assessment of the nutritional situation in Kabul in November found a much improved situation compared to ICRC surveys conducted earlier in 1995, the situation for many is still believed to be precarious, especially with the advent of winter. Much of the noted improvement has been due to the displaced being housed properly and assimilated into the economy. The survey found that levels of wasting in children under five were 5.6% with 1.2% severe wasting. Prevalence of oedema was 0.6% (see Annex 1 17(a)). There was no significant difference in levels of wasting between resident and displaced populations. Most people were exclusively dependent on the local market with only a small proportion of families having access to parcels of land or owning animals. Only 3% had received food aid in the previous month. Although the vast majority of resident and displaced families had some form of employment, income was insufficient to provide even minimum food requirements. Many families have therefore been forced to sell assets or borrow money [AICF 08/11/95].
Displaced in Jalalabad The situation around Jalalabad is reportedly calm. However, the fighting in and around Kabul has led to large scale displacement of people to Jalalabad. Recently up to 5,000 people per week have been arriving although it is not clear whether these people are settling in the local communities or the camps for the displaced [UNHAA 04/01/96].
A recent nutritional survey in New Hadda showed 4% wasting and/or oedema with 0.6% severe wasting and/or oedema. The crude mortality rate was 0.11/10,000/day (lower that a usual level) and the under-five mortality rate was 0.17/10,000/day (see Annex 1 17(b)). These indicators show a relatively good situation [MSF-H 13/02/96].
Refugees in Pakistan Repatriation is continuing for the 1.2 million refugees in Pakistan, many of whom are considered self-sufficient and are no longer assisted with a general ration distribution. Assistance is targeted to vulnerable groups including the disabled, the elderly, primary school children and families without an able-bodied adult male. It is estimated that 153,000 Afghan refugees repatriated in 1995. Plans for the further repatriation of 250,000 in 1996 are underway [UNHAA 26/12/95, UNHCR 07/12/95, 12/02/96].
Refugees in Iran Repatriation of the approximately 1.5 million Afghan refugees in Iran is continuing. Over 195,000 people repatriated in 1995. It is expected that repatriation will slow down over the winter as travel becomes more difficult [UNHAA 13/12/95, 26/12/95, UNHCR 12/02/96].
Overall, the population of Kabul can be considered to be at nutritional risk (category IIa in Table 1). The remaining population affected regionally is not currently thought to be at heightened nutritional risk (category IIc in Table 1).
How could external agencies help? Funding is required to help repair hospital and dispensary infrastructure throughout Afghanistan. In Kabul, nutrition monitoring is necessary given the precarious nature of food security for most residents in the city. Also, supplementary feeding programmes need to be better targeted than is currently the case, e.g. to moderately malnourished children. The recent nutrition survey in Kabul identifies the need for more therapeutic feeding facilities for the severely malnourished.
(see Map 18)
There are approximately 90,000 Bhutanese refugees remaining in Nepal. Although there are currently no plans for repatriation, it is hoped that talks about a potential repatriation programme will resume in the near future. Crude mortality rates are very low, with high birth rates. Agreement to implement improved health (including family planning) services in 1996 has been reached [UNHCR 26/01/96].
The nutritional situation of these refugees remains adequate. A recent screening of children under five years old found only 1.3% levels of wasting (see Annex 1 18(a)). Cases of micro-nutrient deficiency diseases such as scurvy, angular stomatitis and beri-beri, are reportedly declining, and fortified blended foods, fresh vegetables and par boiled rice are now being distributed and are apparently well accepted amongst the refugee population. The incidence rate of ARI, which was recorded as high in the last RNIS report, is now decreasing [SCF 19/01/96, UNHCR 26/01/96].
Overall, this population is not currently considered to be at heightened nutritional risk (category I in Table 1).
(see Map 19)
There are approximately 50,000 refugees form Rakhine State, Myanmar in Bangladesh. Repatriation is continuing, but at a very slow rate. It is hoped that the repatriation process will pick up speed and that many of the refugees will have returned home by June 1996, before the monsoon season [UNHCR 26/01/96]. A recent survey found that overall levels of wasting were 9.5% with 0.2% severe wasting and/or oedema (see Annex 1 19(a)). This compares favourably with wasting rates of 15% amongst the local population. Crude mortality rates were recorded at 0.25/10,000/day (normal) while under-five mortality rates were 0.58/10,000/day (normal). Morbidity data indicates the existence of angular stomatitis (associated with deficiency of riboflavin) with crude incidence rates of 11/1,000/month and under-five rates of 4.8/1000/month [UNHCR 06/02/96].
Overall, despite low levels of wasting, this population is at high risk due to the presence of micronutrient deficiencies (category I in Table 1).
There has been no updated information on the health and nutrition condition of the 220,000 Marsh Arabs in southern Iraq. The last RNIS reported a deteriorating situation for those remaining in country, while the small portion of this population who have crossed into Iran are not currently felt to be at heightened nutritional risk.