6.2 Refugee camps: stabilised populations

A situation may be said to have stabilised once the main refugee influx has taken place and the acute stage of the emergency has passed so that a minimum of basic services are being provided concomitant with low levels of malnutrition, morbidity and mortality. The World Food Programme and UNHCR distinguish between acute refugee emergencies of less than one year and protracted emergencies of more than one year. Stabilised or well-established refugee camps probably represent the most straightforward scenario for setting up an emergency SFP. Indeed guidelines on emergency SFPs tend to have been written with the well-established refugee camp situation in mind. A well-organised camp will be set out in discrete sectors with an established primary health-care infrastructure administered from health centres and by CHWs from the refugee population. Registration of all households will ensure that population numbers in each sector of the camp are known and general rations provided by the international aid community will be adequate for the number of refugees. In such a situation much of the practice advocated in existing guidelines on emergency SFPs is realisable. In particular, the relatively small distances involved in traversing the camp and the near-accurate census information will allow regular nutritional surveys to be easily carried out, which can be used to assess the need for an emergency SFP, e.g. if malnutrition levels rise above a trigger level and other data on food security indicate the need for an emergency SFP. The nutritional survey results can also be used for screening mildly and moderately malnourished children for the SFP as well as to estimate coverage of the programme. The adequacy of the general ration can also be relatively easily assessed (compared with a rural emergency affecting a resident population) to determine whether the SFP is really providing a supplement rather than acting as a partial replacement of the general ration. Furthermore, the CHWs can provide an outreach for locating possible SFP beneficiaries and can follow up recent discharges and defaulters.

However, another typical scenario for an established refugee camp is where a poor registration system has become institutionalised so that the number of registered refugees is greater than the actual number. Typically, after the failure of efforts to install a better registration system and to re-register the population, donors may adopt a second option of reducing their food aid pledges on the basis that too much food is being allocated to the population. While many refugees with excess ration cards are able to cope with the reduction in general rations, those with the legitimate numbers of cards may start to experience hardship. This scenario is all too common and has led to situations where the entitlement gained by possession of a single ration card becomes reduced to less than half a full ration. This tends to penalise the most vulnerable groups in refugee populations, who may include new arrivals who have not had an opportunity to obtain extra ration cards and have not become assimilated into local economic networks, and those other groups least able to enter into the ration card 'parallel economy'. These may include politically weak ethnic groups or households with high dependency ratios. In such situations it may become apparent that the majority of malnourished children presenting at feeding centres belong to a certain type of family with compromised food security. Arguments for increasing the size of the emergency supplementary ration in this type of situation may then be reinforced. The SFP ration then becomes a form of partial family ration which is accepted by the entire refugee community because it is targeted on apparently scientific criteria, i.e. on those families with malnourished children.

In this type of situation it is also more likely that micro-nutrient-deficiency diseases will be seen among certain vulnerable sections of the population. Where this is likely to occur or has already done so, particular attention will need to be given to the micro-nutrient content of the supplementary ration and also to the selection of appropriate target groups for the SFP. Although micro-nutrient deficiency should ideally be addressed by means of improving the general ration, this is often not within the sphere of influence of agencies responsible for supplementary and therapeutic feeding programmes. Thus, where, for example, scurvy or pellagra is threatened or is already evident, arguments for including the elderly, who appear to be most affected by these deficiencies, in the SFP become reinforced (Annex 4).