MALNUTRITION IN WESTERN CAR ALARMING, BUT NOT A CRISIS

UNCLAS SECTION 01 OF 02 BANGUI 000207 SENSITIVE SIPDIS DEPT FOR AF/C PARIS FOR RKANEDA LONDON FOR PLORD NAIROBI FOR AKARAS AFRICOM FOR JKUGEL INR FOR CNEARY DRL FOR SCRAMPTON E.O. 12958: N/A TAGS: PGOV PREL PHUM PINR CT SUBJECT: MALNUTRITION IN WESTERN CAR ALARMING, BUT NOT A CRISIS BANGUI 00000207 001.2 OF 002 ¶1. (SBU) SUMMARY: The diamond-rich southwest of the Central African Republic (CAR) is currently suffering from a wave of malnutrition brought on by a lack of nutritional education, the aftereffects of regional insecurity, the global drop in the price of diamonds, and most fundamentally, the government closure of eight of the eleven diamond buying houses in September 2008. Medecins Sans Frontiers (MSF) and Action Contre La Faim (ACF) report at least 1,000 cases of moderate to severe malnutrition in and around the town of Carnot and 555 in the regional capital of Berberati. Children ages newborn to five make up 95 percent of the cases. First identified in May 2009, the affected area stretches south to Nola and east to Boda - encompassing approximately 1500 square kilometers and at least 200,000 people. While the numbers are troubling and the root causes deeply entrenched, MSF and ACF believe they have the scope of the problem under control in the major population centers. Nevertheless, while the problem seems contained, they admit that there may remain surprises in this very rural and isolated area. END SUMMARY. ¶2. (SBU) On September 21, 2009, CDA and POLOFF visited the Mambere-Kadei prefecture in western CAR to meet with members of local government, nongovernmental organizations (NGOs) and healthcare workers. It became immediately clear that the prevalent malnutrition is not due to natural hazards but is instead manmade and is striking the poorest of the region's inhabitants. There are five principles causes: -- Nutritional health education is nonexistent. The average meal is a soup of salt, coco leaves, and hot peppers consumed with manioc/cassava (a root crop with little nutritional value). Though there is fish and game meat to be found, poorer families often sell what they find for disposable income. -- Beef, the staple meat, is widely available but is prohibitively expensive for many farmers and unemployed diamond minors due to the insecurity that pushed the traditional cattle herders, the Peuhl, across the border into Cameroon in 2007. The last reports of banditry in the region date to early 2008, but the Peuhl have not returned and are reportedly demanding start-up money to re-stock their herds before they do so. -- The drop in the global demand for diamonds, and the region's secondary mineral product, gold, has put a severe pinch on the economy. Though the land is fertile, the vast majority of the population is invested in the mining sector. As a result, the drop in prices struck the whole region - with those at the bottom being hit hardest. The doctor at the hospital in Carnot informed POLOFF that people are starting to make the move back to agriculture, but estimated that production would not be sufficient to sustain the economy until mid 2010 to 2011. -- MSF estimates that in and around Carnot, the rate of AIDS/HIV is particularly elevated and has led to a disproportionate number of orphans. This in turn results in a disproportionate number of malnourished children as they have fewer means and many lack education. -- As post will elaborate in SEPTEL, it is clear that the government's (CARG) decision to shut down all but three of the diamond buying houses has caused a precipitous fall in the economy and is the ember that has sparked this catastrophe. ¶3. (SBU) MSF has set up temporary clinics in the towns of Carnot, Gamboula (MSF France) Boda, and Nola (MSF Belgium/Spain) and ACF is established in Berberati. Some statistics: -- In Carnot, the 20 percent of children are reported to be malnourished and 10 percent are considered to be severely so BANGUI 00000207 002.2 OF 002 (NOTE: Two percent of the population suffering from severe malnutrition is considered emergency END NOTE). There have been 22 fatalities due to malnutrition registered since late May ¶2009. MSF estimates that there are about 2,000 cases of malnutrition in the whole Sub-Prefecture, but have not reached all points to confirm their estimate. -- In Berberati, the initial ACF study revealed a malnutrition rate of 7 percent among children 6-59 months with 1.5 percent in dire need. ACF suspects the problem could be substantially worse in the villages surrounding the town. They plan to have a report completed by November. -- MSF estimates that there are 500 cases of malnutrition in Gamboula. ¶4. (SBU) The CARG has been slow to react. Both ACF and the doctor in Carnot resorted to broadcasting the extent of the problem on local and national independent radio. The doctor in Carnot received threatening phone calls about his ``loyalty'' to the government for giving the story to Radio Ndeke Luka. Yet as a result, the Ministry of Health, MSF and ACF have all since become involved. The Minister of Mines Sylvain Ndoutingai, Minister of Public Health Andre Nalke Dorogo and the local member of the National Assembly recently visited Carnot and donated one million Francs CFA (2,250 USD) to the hospital to help treat the victims of malnutrition. The prefect and agricultural director of Mambere-Kadei claim to have begun a program urging young people to return to agriculture, but admit limited success. The government is by in large depending MSF and ACF to address the issue. It is the two international NGO's that have stabilized the cases of malnutrition in the towns and who are now trying to visit the more remote villages to help those with no access to the hospitals. ¶5. (SBU) COMMENT: Both ACF and MSF are in the process of a comprehensive review of the situation and should have full reports by November, thus the complete extent of the problem will be clearer later in the year. This said, there are two key takeaways: -- The government's lackadaisical response has engendered resentment from the affected population. Two sources estimated that half to three quarters of the population blames the government for exacerbating the crisis by shutting down the diamond houses. Despite protestations to the contrary by visiting ministers and resident officials, the government remains the focus of their discontent. Yet there are no signs of popular upheaval, and government control, nonexistent in many places of the CAR, remains strong. -- The problem is limited to the areas that are over dependent on mining, and it is highly unlikely that the wave of malnutrition will spread to other parts of the CAR. Thus, while worrying, the malnutrition striking the southwest in unlikely to have national ramifications. END COMMENT. SMITH