Dirty water, not food shortage, blamed for malnutrition among Sudanese refugees in Chad
DAKAR, July 14, 2004 (IRIN) — More than a quarter of the Sudanese refugees in
eastern Chad suffer from acute malnutrition, but lack of access to clean
drinking water rather than a shortage of food is the main cause of this
alarming situation, according to a survey conducted last month by the
United Nations and other relief agencies operating in the area.
The survey, a draft copy of which was made available to IRIN, linked the
rate of high malnutrition detected to rampant diarrhoea.
It blamed the diarrhoea, in turn, on poor water supplies in the semi-arid
region which lies on the southern edge of the Sahara desert.
“Incidental prolonged cases of diarrhoea could cause and exacerbate the
malnutrition,” the survey team said in its draft report.
The underlying causes of diarrhoea likely relate to lack of access to and
availability of clean water,” it added.
The survey, conducted in June, covered 896 children aged between six
months and five years living in three official refugee camps near the
border town of Tine and in spontaneous refugee settlements nearby.
It detected a global acute malnutrition rate of 27.0 percent within the
refugee camps and 29.2 percent among refugees living outside them.
The survey team also sampled the health of 175 Chadian infants living in
11 villages in the same area. It found the local farming population to be
in as poor a state of health as the refugees they were hosting, with an
acute malnutrition rate of 24.0 percent.
Three hours per trip to fetch water
Most of those questioned said they relied on traditional wells a long way
from their homes which were often crowded with other people waiting to
draw water.
The survey team found that even refugees living in official camps
organised by the UN refugee agency UNHCR took an average of three hours to
fetch water every time they went to replenish their supply.
In the refugee camps, 59 percent of children had suffered diarrhoea during
the two weeks prior to the survey. The rate fell to 43.5 percent among
refugees outside the camps and 46 percent among the local Chadian
population.
“The main cause of malnutrition in the camps is not really lack of food,
but the availability and accessibility of clean water,” Philippe Guyon Le
Bouffi, the head of the UN World Food Programme (WFP) in Chad told IRIN by
telephone from N’djamena.
He said the WFP had sufficient food stocks in place in eastern Chad to
feed 180,000 refugees till the end of August.
A further 8,000 tonnes of food was expected to arrive soon from Cameroon
in time for distribution in September, he added.
People are defined as suffering from global acute malnutrition when their
weight for height ratio falls to less than 80 percent of the median for a
healthy population.
The survey showed that three per cent of refugee children and Chadian
infants living in frontier settlements suffered from severe acute
malnutrition because their height for weight ratio had fallen to less than
70 percent of normal.
The situation was a little better inside the refugee camps, where a rate
of only 1.7 percent was recorded.
Special feeding centres for children are needed
“Global malnutrition, when it passes 10%, becomes a public health problem.
In our case, the situation is three fold that number, which shows how
serious the situation is,” Jean Laokole, the Director of the Chadian
National Centre for Nutrition and Technology, who took part in the survey,
told IRIN.
The survey team recommended the immediate establishment of more
therapeutic and supplementary feeding centres to treat the worst cases of
malnutrition.
Two therapeutic feeding centres exist at present in the area studied. This
lies at the northern end of a 600 km stretch of frontier, where refugees
have been crossing into Chad from Sudan’s troubled Darfur region.
One is operated by Medecins Sans Frontieres (MSF) Belgium in the town of
Iriba and the other in Konoungo refugee camp which is run by International
Medical Corps.
Stephane Heymens, the head of MSF-Belgium in Chad, said the Iriba centre
provides emergency feeding for 220 severely malnourished children.
MSF Belgium also runs supplementary feeding centres for nearly 1100
children in two of the refugee camps covered by the survey, he added.
Heymens said the state of malnutrition among young children reflected that
of the general population, so this is why they are generally targeted by
malnutrition surveys.
“To know the nutritional situation, you focus on children as they are the
very vulnerable, the first ones to be affected. Then you relate this to
the whole population,” he said.
Heymens agreed that the shortage of clean drinking water was a serious
problem, alleging that in two of the three refugee camps covered by the
survey water was not yet chlorinated before distribution.
This was disputed by Norwegian Church Aid, which provides water to the
camps, although it admitted that the standard of chlorination was still
unsatisfactory.
Change of diet also induces diarrhoea
Heymens said another key cause of the high rate of diarrhoea among
refugees was a change in diet. He noted that they were now forced to rely
on foodstuffs handed out by relief agencies, rather than the locally grown
millet with which they were familiar.
“WFP does not always provide the refugees with the food they are used to
eating,” the MSF representative said.
Laokole, the Chadian nutrition expert, urged donors not to forget the
local population in eastern Chad, which made substantial sacrifices to
help the Darfur refugees before international relief agencies arrived on
the scene.
“These people living in impoverished desert zones were already at risk of
being malnourished, but they have seen their nutritional situation worsen
with the massive influx of refugees since they have shared with them the
little they had,” he said.
The nutrition survey was conducted by an inter-agency team comprising
representatives of the WFP, UNHCR, the United Nations Children’s Fund
(UNICEF), the World Health Organisation (WHO), the Chadian Health
Ministry, MSF-Belgium, International Rescue committee, International
Medical Corps and epidemiologists from the Centre for Disease Control and
Prevention, an organisation based in Atlanta, Georgia.
It focussed on the refugee camps of Iridimi, Touloum and Kounoungo, which
together contain over 40,000 people.
The survey found that Chadian residents in the district, who live mainly
from agriculture and animal husbandry, spent an average of three hours per
trip to collect water – an hour longer than last year, before the mass
influx of refugees.
Four out of five households said they shared their food and local water
source and food with the refugees, who mostly belong to the same Zaghawah
ethnic group.
Problems in supplying enough water
UNHCR has so far established nine refugee camps away from the border,
hosting a total of 123,000 refugees, but officials of the agency say they
have encountered severe problems finding sites with adequate underground
water which can be accessed through boreholes.
Aid workers in eastern Chad say that as a result, many refugees receive
less than 15 litres of water per day, the minimum recommended by
international guidelines.
However, Tor Valla, the head of mission of Norwegian Church Aid, which
provides water to several refugee camps in the area covered by the survey,
said the situation had improved since mid-June when the survey was
conducted.
“Refugees in Iridimi and Touloum now receive the standard 15 litre
ration,” he told IRIN by telephone. “Water is chlorinated, but often in
tanks, which is not really appropriate,” he added.
Laokole, the Chadian government expert who took part in the nutrition
survey, said the team had recommended the collection of carcasses of dead
animals who had died of hunger and thirst in dried-up river beds to
prevent them from polluting surface water and causing epidemics of cholera
and typhoid.
He said the team also called for the digging of more wells and the
establishment of a surveillance system to keep tabs on the needs of
vulnerable groups such as children, pregnant women and the elderly.
“Emergency intervention is required to rectify the problem” he stressed.
UNHCR currently estimates there are now 170,000 refugees from Darfur in
eastern Chad, but recent estimates by other relief agencies have ranged up
to 200,000.