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