EAST NUSA TENGGARA: WHERE CHILDREN STARVE, A FAMINE OF

UNCLAS SECTION 01 OF 02 SURABAYA 000109

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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


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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

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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

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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

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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

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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

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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

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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