MALNUTRITION IN WESTERN CAR ALARMING, BUT NOT A CRISIS

UNCLAS SECTION 01 OF 02 BANGUI 000207

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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

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(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