|Famine, Needs-assessment and Survival Strategies in Africa (Oxfam, 1993, 40 p.)|
|3 Survival strategies and their 'costs'|
Perhaps surprisingly, going hungry has been widely observed to be a strategy that is frequently preferred to selling productive assets (Rahmato on Wollo, 1984-85; de Waal on Darfur 1984-85; Young on Darfur; Jodha on Rajasthan, India, in 1963). A concrete example of how 'going hungry' may work in practice is provided by recent research in the Red Sea Hills. Here, the Beja peoples are reported to have reduced their consumption from three meals a day (consisting of sorghum, milk and milk products) to two (one with milk and one with meat) and then again, as animal numbers and productivity dwindled further, to one meal of meat and another of only salt and water, and finally to just one meal for adults. The leaves of the wild doum palm-tree were used as a substitute for sorghum. When wheat was distributed, it was eaten instead of sorghum, but many Beja believed that the consumption of wheat was the cause of the increasing incidence of illness among them.
De Waal argues that there is little elevated risk of mortality with moderate malnutrition (70-80 per cent weight-for-height). However, this is a matter of some dispute. It is worth quoting a study of the literature by Wilson at some length. After noting the existence of eight data sets on the relationship between mortality and weight-for-height, Wilson writes:
Though one study examining this variable found no relationship with mortality until it was 'severe'below 70 per cent of international standards(Chen et al. 1980a), four of the other studies found that mortality was elevated between two and four fold the 'well nourished' levels, when at a level of 'moderate' malnutrition, between 70 and 80 per cent weight-for-height (Heywood, 1983; Kielmann and McCord, 1978; Kasongo Project Team, 1983; Alam et al., 1989), one recorded it double between 60 and 80 per cent (Handayani et al., 1983), and one found mortality double in the group less than 90 versus those over 90 per cent (Sommer et al., 1983). Where populations have been examined below 60 or 70 per cent weight-for-height, mortality rates have been observed to be very greatly elevated (Chen et al., 1980a; Handeyani et al. 1983; Kielman and McCord, 1978). The most interesting data was that of Bairagi et al., 1985, which compared the relationships both during and after the 1974-5 famine in Bangladesh. During the famine even at 85 per cent weight-for-height, mortality was four times that at 95 per cent, and at 76 per cent it was around ten times as high. Some months after the famine, mortality was still elevated at 85 per cent, and was worse at 75 per cent, but the effects were much less dramatic than for the same levels of nutritional status (during) the famine.
Young and Jaspers have hypothesized that the same level of malnutrition (say, 80 per cent weight-for-height) may lead to no great increase in the risk of mortality among people who have remained in their villages but may constitute a major mortality risk once people have migrated to an environment where increased susceptibility to disease through malnutrition may interact with increased exposure to infective organisms through overcrowding and poor water supplies. This could also explain why so many people seem to choose to go hungry whilst they are still at home in their villages. There is a question about who, within a household, decides who goes hungry. Those bearing the greatest risk, for example, small children, are unlikely to be those making the decision. People are not necessarily selfish, however. One report from Red Sea Hills in October 1991 said: 'When there is a small amount of food, the priority is for the children, the mother, and lastly the father.,
Relief operations may themselves encourage certain kinds of hunger. Oxfam staff report that there have been casesfor example, Harbu, Wollo, at the height of the famine in 1984-85when individual children have been discharged from feeding centres having reached 85 per cent weight-for-height, only to be readmitted shortly afterwards. It appeared that some children were being deprived of food in order to make them once more eligible for feeding programmes, something that presumably released resources for the rest of the family.
Apart from the issue of vulnerability to disease and death, going hungry may affect a person's ability to produce. For example, in Darfur in 1991, a severe shortage of seeds and physiological weakness meant that people in Kebkabiya area council were able to plant only around one-third of the area they would normally have planted, Oxfam field staff reported.
Furthermore, when households are short of food, they may be unable to organise a communal work party to prepare their fields (a practice known as nafir in Sudan). Reports from Red Sea Hills during harvest time in 1991 said that, with food supplies extremely short, people were not organising nafir.
Finally, if people are going hungry, this in itself implies that people are suffering. Avoiding suffering may be a legitimate aim for those engaged in relief, as is preventing mortality.