EAST NUSA TENGGARA: WHERE CHILDREN STARVE, A FAMINE OF

UNCLAS SECTION 01 OF 02 SURABAYA 000109 SENSITIVE SIPDIS DEPT FOR EAP, EAP/MTS, IRN/EAP, DRL/PHD, INL E.O. 12958: N/A TAGS: TT PGOV PHUM ID PREF EAGR SUBJECT: EAST NUSA TENGGARA: WHERE CHILDREN STARVE, A FAMINE OF SOLUTIONS TOO REF: 07 SURABAYA 55 (WEST TIMOR'S PERFECT STORM) SURABAYA 00000109 001.2 OF 002 This message is sensitive but unclassified. Please protect accordingly. ¶1. (SBU) Summary: East Nusa Tenggara Province (NTT),at the extreme southeastern edge of Indonesia's archipelago, has long lacked food security and chronic malnutrition persists. While a flurry of spring 2008 media reports gave the impression that hunger is more acute than in previous years, local government, NGO and health sources agree that food insecurity and malnutrition is endemic. The province's weak, isolated economy is yoked to an arid and increasingly unpredictable climate. Making matters worse, NTT's traditional culture resists certain nutritious foods and eating habits that might mitigate the problem. Local sources say that insecure local food production and imbalanced food intake are proximate causes while tradition and the weak economy complicate long-term solutions. End Summary. 26 Children Dead, Thousands At Risk -------------- -------------- ¶2. (SBU) During Surabaya PolEcon Officer's September 15-18 visit to Kupang, the provincial capital of NTT, local government, health, and NGO officials described the province's battles to combat endemic malnutrition and improve food security. Dr. Stefanus Briaseran, Head of NTT's Health Service expressed pessimism about near term improvement in NTT's malnutrition efforts. Dr. Brianseran said that the health department is targeting food aid to children under five years old since their developing bodies are most at risk. According to NTT Health Service statistics, as of September 2008 among the 512,639 children under five living in the province, some 82,327 were diagnosed as undernourished. Of these, 69,770 were seriously malnourished but did not suffer additional clinical symptoms; while 12,452 suffered from additional clinical symptoms. Of these, 90 suffered from marasmus (severe protein energy deficiency) and 13 from kwashiorkor (protein deficiency, usually marked with a distended belly),while 2 children suffered both diseases. 26 children died as a result of malnutrition. ¶3. (SBU) Dr. Stefanus Brianseran stressed that the risk of infectious diseases remains acute due to the weakened health of the population. Infectious diseases such as malaria, dengue, tuberculosis and diarrhea-related diseases can be exacerbated by immune systems weakened by malnutrition. Without access to clean water, hand-washing campaigns can have little impact. This is particularly true on arid West Timor, home to over half of NTT's population and those displaced during neighboring Timor Leste's fight for independence. Dr. Brianseran noted that US assistance in Malaria research and assessment in NTT would be welcome. Health Service is Cash Starved -------------- ¶4. (SBU) Despite the fact that the Health Ministry first declared a malnutrition emergency in NTT in 2005, the problem remains intractable. Dr. Brianseran described a continuing low level of financial support from the national and provincial authorities to fight malnutrition. Brianseran explained that 75 percent of the Rp. 65.5 billion Rupiah (USD 7 million) provincial health budget is spent on operating expenses for the provincial hospital in Kupang. This leaves roughly USD 1.75 million to address the annual health needs of nearly 5 million NTT citizens. NTT's Health Department calculates that it will take Rp. 15,000 per day (USD 1.60) to supplement the diets of each of the 69,770 malnourished children under five years old in NTT. This notional daily expenditure of USD 111,632 (USD 3.35 million per month) is untenable given current provincial health budget allocations. Dr. Brianseran stressed that families with SURABAYA 00000109 002.2 OF 002 malnourished children generally also have malnourished parents --supplements for the family are needed too. Some families are reluctant to bring children for hospital treatment even when available because of the stress of travel and finding food away from home. Brianseran said that an augmented daily budget of Rp. 20,000 per family per day (roughly USD 2) would cover both a single family caregiver and malnourished child in treatment. Geographic, Economic and Cultural Factors -------------- -------------- ¶5. (SBU) Paradoxically, rates of malnutrition in the provincial capital Kupang are roughly equivalent to the poorest regions of the province, including those housing former refugees from Timor Leste. This is linked to several factors. First, the difference between living standards in the city and the interior among the at-risk population is not great. Job seekers from the interior of West Timor and other NTT islands come to Kupang. Those migrants who find work overseas often leave children behind with caregivers, who might not have resources to spare to care for the child. Remittances are typically brought back by the worker on an annual basis, leaving the family at risk. Attention of the provincial, national and international donor community has focused on the regencies nearest Timor Leste, traditionally the hardest hit by food insecurity: Timor Tengah Utara (TTU),Timor Tengah Selatan TTS and Belu. However, the rates of malnutrition in the regency and municipality of Kupang are statistically identical to these remote regencies. Agriculture and Water Management -------------- -- ¶6. (SBU) Agriculture is linked to the problem of malnutrition and traditional farming methods along with poor soil mean that slight delays in seasonal rains can push communities closer to the edge of crisis in a matter of weeks (reftel). Farmers have noticed a delay in the arrival of the monsoonal rains by nearly a month in recent years. However, most damaging is the uneven pattern of rainfall once the rains come. According to a Catholic Relief Services worker familiar with local agriculture, farmers might plant with the first days of rain, assuming the beginning of typical rainy season. However, days of rain might be followed by days or weeks of clear skies and hot sun, killing crops. Porous volcanic rock underlies most of Timor, so the rainy season also means flooding and landslides. Since the rocky porous ground cannot hold water, precious topsoil is easily washed away. Building catchments to hold the run-off and cisterns in West Timor is a government priority, according to the Vice Governor, Esthon Foenay. Local Culture is Key -------------- ¶7. (SBU) Health Department and NGO sources agree that other cultural biases unique to NTT exacerbate malnutrition. Many are reluctant to eat plentiful pumpkins and beans since they are commonly used as cattle fodder and thought unsuited to humans. Parents are reportedly reluctant to feed fish to children for fear that worms and bugs eaten by the fish might harm the children's health. One NGO worker familiar with NTT diet and custom said that such notions might go unchallenged during times of plenty, but put their children in danger of malnourishment when food supplies dwindle. The World Food Program provides biscuits to communities in West Timor near the border with Timor Leste. However, because the imported biscuits are intended as a stop gap measure, they can never become part of a sustainable daily diet. NGO workers fear that reliance on the biscuits will delay solutions to the complex underlying causes of malnutrition in NTT. MCCLELLAND