|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|
The agencies that make up the international nutrition humanitarian system are often classified under three broad headings: governmental donors, the United Nations, and nongovernmental organizations (NGOs). These organizations, although nominally independent, have a large degree of financial interdependence.6
· The governmental donors, including the European Commission (EC), supply most of the food used in emergencies and the larger part of financial resources used by international NGOs and the UN.
· Three UN agencies - the World Food Programme (WFP), UNHCR, and the United Nations Childrens Fund (UNICEF) - are most directly concerned with food and nutrition in emergencies. WFP supplies bulk food commodities and blended foods.a UNHCR is chiefly involved, although not exclusively, in supplying specialized food commodities in refugee emergencies. UNICEF supplies vitamin A and food and nonfood items for feeding programmes. In addition, the Food and Agriculture Organization of the United Nations (FAO) is increasingly taking on a more prominent role in emergency agriculture. The World Health Organization (WHO) is involved in setting nutritional norms.
a Blended foods are flours composed of precooked cereals and a protein source, mostly legumes, fortified with vitamins and minerals, such as corn soya blend and wheat soya blend.7
· The NGOs are a disparate group, ranging from the large established organizations with technical advisory staff and sometimes permanent country representation to NGOs that are set up specifically for particular operations, like the many groups that arose to provide aid in the Balkans region.
One of the most striking features of the international relief system is the absence of formal regulation. For all practical purposes (with some exceptions, including the International Committee of the Red Cross), the component parts of the international system are free of formal regulations that oblige them to observe any minimal technical standards or, indeed, oblige them to act at all. Government donors have no formal obligation to respond to any specific emergency in another sovereign state. The UN technical organizations are not autonomous and broadly act to support the government of the affected country. The NGOs are subject to the legislation of the country in which they work.6
Where the government of an affected country is strong and undisputed, formal coordination of the international system is possible. Where there is no government or only weak government - precisely the conditions under which an emergency is most likely - there is no system of authority. The UN has no authority over the NGOs, and no NGO has authority over any other, making coordination of relief efforts difficult.6 The need for improved coordination and coherence among the members of the international community, which is now widely recognized, is critical for planning a standardized response that takes a multi-sectoral approach to reducing risk and addressing humanitarian needs.8
Since the mid-1990s, various inter-agency initiatives have produced momentum towards greater transparency and accountability in the humanitarian system. The Code of Conduct for the International Red Cross and Red Crescent Movement and NGOs in Disaster Relief seeks to guard standards of operation for humanitarian agencies.9 The Sphere project, which developed the Humanitarian Charter and Minimum Standards in Disaster Response,10 aims to provide a practical framework for accountability by connecting the principles of humanitarianism to standards of service delivery.b
b For further information on Sphere, see www.sphereproject.org or reference 11. Linked with the recent initiatives (the Sphere project and Code of Conduct) to establish new structures and standards of humanitarian assistance is the pilot Humanitarian Assistance Ombudsman project (HAO), whose role will complement the previous codes by both enforcing the codes and facilitating their application in practice.12, 13
This effort comes at a time when there is concern that humanitarian principles are being eroded and that human rights (particularly protection) are ignored by humanitarian, state, and non-state actors.14 At the same time, there have been limited efforts outside the humanitarian system to promote respect for humanitarian principles among warring parties who are not signatories to the Geneva Conventions. The Ground Rules in South Sudan have been an important element in these efforts.14
One noteworthy recent change has been the formation of the Office of the Coordinator of Humanitarian Affairs (OCHA). As a non-operational UN body, it seeks to move on from the former Department of Humanitarian Affairs (DHA) with an increased emphasis on coordination within the UN system.
Partnership agreements between organizations are critical for ensuring coordination and delineating clear operational roles and responsibilities. These include memorandums of understanding (MoUs) and Letters of Agreement between UN organizations, intergovernmental and nongovernmental organizations, and national entities. The most important MoUs used in a wide range of emergency food and nutrition programmes are listed in Box 5.1.
MoUs of Most Importance to Emergency Food and Nutrition Programmes
· UNHCR and WFP. This MoU has a long history; the first formal agreement was signed in 1988. A formal MoU was signed in 1994 and revised in 1997. The revisions represent collaboration towards effective policies and procedures. The MOU covers the following areas: UNHCR/WFP cooperation, intervention mandates, needs assessment, registration, logistics, distribution, monitoring and reporting, and coordination mechanisms.
· UNHCR and WHO. A revision of the 1987 MoU between UNHCR and WHO was signed in 1997. The MoU covers the following areas: UNHCR/WHO cooperation in coordinated contingency planning, development of joint methodologies for assessing the health and nutrition situation, development of guidelines and training materials, development of applied research, and the integration of beneficiary health care activities within national (host country) health services.
· UNICEF and WFP. This MoU was signed in 1998. The MoU covers the following areas: needs assessment, monitoring, and evaluation of services in the areas of nutrition, health care, water, sanitation, child protection, and other social services. Of particular relevance to nutritional emergencies, UNICEF is responsible for providing therapeutic preparations and nonfood items related to food preparation and consumption, emergency shelter, nutrition monitoring, and selective feeding operations.
· MoUs between WFP and FAO and UNHCR and FAO are currently being developed In addition, other MoUs that concern emergency nutrition exist between NGOs and UN agencies such as Save the Children Fund (SCF), CARE, World Vision, and WFP.
MoUs are essentially management tools and as such spell out in detail the policies and procedures that are jointly agreed. An MoU is more than simply a framework for implementing programmes; it provides a tool for advocacy to ensure that the agreed needs and rights of the programme beneficiaries are met.
Categories of Displacement Emergencies
This chapter focuses on the nutritional consequences of, and humanitarian responses to, the following broad categories of emergenciesc:
c These categories are useful for the purpose of this chapter but are obviously not mutually exclusive, that is, recent displacement crises may also be complex emergencies.
1. Recent displacement emergencies, such as in Angola, the Balkans, and East Timor in 1999. In these situations large numbers of refugees or IDPs have been forced to flee their homes, sometimes over a very short period of time. At the beginning of the displacement much of the population has little or no food stores and no livelihood mechanisms with which to obtain food or non-food needs. Humanitarian responses to this type of emergency include WFPs Emergency Operations (EMOPs) which provide immediate food assistance to either the whole, or a selected segment, of the population for a short period. EMOPs last for a maximum of 18 months.15
2. Protracted refugee emergencies, such as in Iran, Kenya, Liberia, Nepal, Tanzania, and Uganda. In these situations a refugee population has been unable to return to their country of origin, be integrated into the country of asylum, or be resettled in a third country for at least two years. The population may be completely or partially dependent on humanitarian assistance. The level of dependence is determined by the level of self-reliance of the population, which is, in turn, limited by many factors, including constraints imposed on the refugees by the host government, land availability and quality, the local economy, and the ethnic and social ties between the refugee and the host populations. Humanitarian responses to these situations may, although not necessarily, include programmes with developmental aspects and are known as Protracted Relief and Recovery Operations (PRROs) by WFP.15
3. Complex emergency situations involving mainly IDPs, such as in Afghanistan, Burundi, Eritrea, Ethiopia, Rwanda, Somalia, Southern Sudan, and Uganda. These situations generally involve civil strife, the breakdown or failure of state structures, disputed legitimacy of authority (whether government or rebel), the deliberate targetting of civilian populations by military forces, and the abuse of human rights, all or some of which lead to population displacement within a country. Humanitarian responses to these situations involve both emergency and developmental programmes, although not necessarily in a linear transition.16, 17 Natural disasters are not generally associated with large-scale, long-term population displacement and are therefore not discussed in this chapter or in the RNIS reports.
Many of the definitions given in section 1.2 are also employed by nutritionists working in the field of displacement emergencies. In addition to the definitions given earlier, the following indicators are also used in this chapter:
Crude mortality rates are usually given as deaths/10,000/day.
Oedema is a key clinical sign of kwashiorkor, a severe form of protein-energy undernutrition, carrying a very high mortality risk in young children.
The Cycle of Assessment, Analysis, Project Implementation, Monitoring, and Evaluation
Humanitarian response programmes should be based on a cycle of assessment, analysis, project implementation, monitoring, and evaluation. To be effective and appropriate, programmes that meet the needs of emergency-affected populations must be based on a clear understanding of the situation. Analysis of the effects of the emergency on those factors that affect nutritional status, and eventually, the impact of the programme itself is therefore critical.10 This broad-based approach to addressing nutritional problems is frequently referred to as public nutrition.8
Assessment and analysis should consider the causes of undernutrition, including the available resources (human, economic, environmental, and infrastructural) and constraints that influence action (see Appendix 1). The process of assessment and analysis should lead to the development of appropriate nutrition policies and strategies, which should ideally include all relevant actions that will have a positive impact on nutrition in a socially and politically aware manner.8
Humanitarian programming in protracted emergencies raises a number of operational challenges. Short-term approaches continue to be the norm, and indeed are appropriate where contexts are changing rapidly, but a more strategic approach to planning is required to support longer-term progress. However, the challenges of engaging where there is no state or building local capacity amid civil unrest will persist.