CAR REFUGEES IN CHAD: INCREASE IN MALNUTRITION

UNCLAS SECTION 01 OF 02 NDJAMENA 000329 SIPDIS SIPDIS, SENSITIVE STATE FOR AF/C, PRM/AFR:MLANGE,S/CRS:PNELSON-DOUVELIS/JVANCE/ JBEIK E.O. 12958: N/A TAGS: PREF PGOV KCRS CD CT SUBJECT: CAR REFUGEES IN CHAD: INCREASE IN MALNUTRITION NDJAMENA 00000329 001.2 OF 002 ¶1. (SBU) Summary. An end-March monitoring visit to the three refugee camps for Central African Republic (CAR) refugees near Gore found that the malnutrition rate at Amboko Camp - the oldest of the three (established mid-June 2003) - had tripled from December to March. While the malnutrition rate is still much lower than the maximum acceptable standard for refugees (10%) and below malnutrition rates for Chadians reported by WFP in Chad's 14 departments, the increase is troubling. The proximate cause would appear to be the cut in refugee food rations that has been implemented pursuant to the October 2006 Joint Refugee Food Security Assessment Mission (JAM). The current refugee assistance strategy is to locally integrate the refugees pending their return to the CAR by helping them achieve self-sufficiency in food production and capacity to pay for health care and schooling. However, available land and agricultural inputs are not yet sufficient for refugees to have achieved food security. The JAM recommendation -- which was not/not endorsed by the local UNHCR, WFP, or implementing partners - to cut food rations in advance of there being adequate land under cultivation, is difficult to understand but may have resulted from the structure of the JAM that allowed only a cursory field visit. In any event, the impact of premature ration cuts is being borne particularly by the refugee children. With any harvests seven months away and the annual "hungry season" still ahead, it is likely that malnutrition will keep increasing. Options for putting assistance back on track could include: ramp up therapeutic feeding centers with a quick infusion of appropriate feeding materials such as CSB (for those who cannot/will not eat plumpynut); provide a blanket supplemental take away dry or moist ration for all under fives with careful follow up to ensure that the food is not shared among all hungry children in a family; revisit/reverse the decision to dramatically cut the rations and instead wait until all/the majority of the refugees have had a fair chance to plant and harvest at least one crop before eliminating the rations. State/PRM and USAID/FFP should urgently work with WFP on modifying the feeding program in order to reverse the malnutrition trend. End summary. ¶2. (U) State Bureau of Population, Refugees, and Migration/Africa team of Margaret McKelvey and Geoff Parker, accompanied by S/CRS Charles Wintermeyer, visited the three camps of Central African Republic refugees located near Gore in southern Chad from March 29-31. Amboko (established mid-June 2003),Gondje (established mid-December 2005),and Dosseye (opened December 2006 to decongest other sites and for new arrivals - over 600 in March 2007) are all doing reasonably well in terms of working toward international standards for protection and basic assistance. Water and sanitation are approaching standards; education is still lagging badly in terms of getting 100% of primary school kids enrolled; health care is pretty good with over 90% of pregnant women delivering at the clinics. However, food security is very much threatened by the 2007 cut backs in food rations that World Food Program instituted following the last Joint Refugee Food Security Assessment Mission (October 2006). The ration for Amboko Camp was cut from 1,400 kcals per person per day last year to 900 kcals this year. The ration for Gondje Camp went from 1,900 to 1,200 kcals. Legumes and CSB have been removed. The new arrivals at Dosseye Camp are to receive a full ration of 2,100 kcals. ¶3. (U) Nutrition surveys are reported to be done every quarter in the camps using community health workers to check children under the age of five. In December, the global acute malnutrition rate in Amboko Camp was measured at 0.92 %. At 3.0%, the March GAM has tripled. The PRM team questioned the camp doctor about factors other than ration size that might account for the increase such as an epidemic, increase in anemia and/or malaria, any change in breastfeeding/weaning practices, unusual diversion of food. Nothing had changed except the ration size. ¶4. (U) Ironically, even as increasing numbers of children were being taken to the central therapeutic feeding center (TFC) (8 feeds daily) at Amboko Camp, food stocks were being loaded on to WFP trucks to be taken to eastern Chad to help repay loans of commodities made last year when the southern program was dramatically under-resourced. As is sadly often the case, not all mothers were following up on referral of their children where the mother judged that she could not afford to leave her other children/husband alone to stay with the one malnourished child. ¶5. (U) The overall assistance strategy for the CAR refugees in southern Chad is to push for refugee self sufficiency - i.e., to be able to produce sufficient food for themselves largely through agriculture and to be able to pay fees for health care and for schooling. Such local integration is to be achieved through provision of seeds and tools and some modest investment in income generating activities. Some of the 11,834 refugees (2,376 families) in Amboko, who began arriving in mid-2003, have already acquired access to land from the surrounding Chadian population and have been planting. At present, 1,074 refugees are reported to be cultivating 914 hectares. The target number of hectares being used NDJAMENA 00000329 002.2 OF 002 for a family to be food self-sufficient is 2.7. A community kitchen garden project supported by Africare presently has some 1,550 direct beneficiaries (hence up to 1,550 families) broken into 115 groups of ¶10. Each group has received about 400 square meters (or 0.04 hectares) of land, which is insufficient for providing an adequate food source for the beneficiaries even if it were planted in cereals rather than vegetables. More land access is being slowly negotiated with local Chadians in close collaboration with UNHCR and Chadian traditional leaders. Clearly there is a considerable way to go before the Amboko camp will be food self-sufficient. Gondje, whose inhabitants have been in Chad for only some 15 months are of course still further away from the goal with only four hectares in kitchen gardens for the whole camp of 12,000 and no cereal crops yet. Some refugee women in Gondje displayed wild yams that they had been digging up in the bush in view of the ration cuts, complaining that the yams required three days worth of cooking/preparation to mitigate their poisonous properties. ¶6. (U) At the March 30 weekly coordinating meeting among local authorities and the implementing agencies, Africare, which is in charge of agricultural self reliance, reported that some 7,000 hectares was the target for preparation and planting with all inputs needed by April 15 at the latest. Prospects did not look good, however, as Africare reported that against a need of 400 plows, only 246 were promised by UNHCR/WFP/Africare. Against a need for some 940 oxen, only 20 had been found to be available in the area; it was hoped that those refugees with some cattle might train them to plow quickly. (Comment. A tall order. End comment.) Failing that, refugees would need to use hand hoes to prepare the fields. (Comment. Another tall order. End comment.) ¶7. (U) The strategy of local integration is to be applauded. However, the international community needs to follow through on assisting refugees to become self reliant through advocating with locals for sufficient land and through provision of adequate seeds and tools. The JAM recommendation -- which was not/not endorsed by the local UNHCR, WFP, or implementing partners - to cut food rations in advance of there being adequate land under cultivation, particularly in the case of Gondje where the refugees would have had only one planting season even if they had received land and inputs, is difficult to understand. A possible explanation is that the way the JAM was set up did not give the JAM team adequate time and/or information on which to make its judgments. The actual field visit involved only a couple of days with hurried short briefings that did not allow time for team members to fully absorb and analyze information. Anecdotes about refugees selling parts of their rations - which is almost always true as refugees seek to diversity their diet - may have substituted for systematic study of household use of food through post distribution monitoring. One health care provider claimed to have been dismissed as "dangerous" by some team members for having argued on nutritional grounds against a ration cut. COMMENT AND ACTION REQUESTED -------------- ¶8. (U) In November 2006 WFP published GAM malnutrition rates across Chad's 14 regions/departments. These numbers indicate that malnutrition rates in the Amboko refugee camp are still below Chad malnutrition rates country wide (from a low of 4.7% in Bahr Koh to high of 13.4% in Bahr el Gazel.) At 3%, the GAM for Amboko refugee children is well below the maximum acceptable standard for refugees (10%). That being said, the rapid increase in malnutrition since the rations were cut is troubling since the goal of the refugee assistance efforts is to minimize malnutrition rather than seeing it rise. However the plan to cut food rations came about (and however much the refugees may now be trying to create some fields through cutting trees and burning underbrush),it does not appear that self-reliance with food security can be achieved in the immediate term without a significant boost in external assistance. In the meantime, it is the refugee children (though some adult malnutrition has also been identified) that are bearing the impact of the ration cuts. With any harvests seven months away and the annual "hungry season" still ahead, it is likely that malnutrition will keep increasing. Options for putting assistance back on track could include: ramp up TFCs (will likely need to be done anyway) with a quick infusion of appropriate feeding materials such as CSB (for those who cannot/will not eat plumpynut); provide a blanket supplemental take away dry or moist ration for all under fives with careful follow up to ensure that the food is not shared among all hungry children in a family; revisit/reverse the decision to dramatically cut the rations and instead wait until all/the majority of the refugees have had a fair chance to plant and harvest at least one crop before eliminating the rations. State/PRM and USAID/FFP should urgently work with WFP on modifying the feeding program in order to reverse the malnutrition trend. ¶9. (U) Tripoli minimize considered. Wall