|Refugee Nutrition Information System (RNIS), No. 27 - Report on the Nutrition Situation of Refugee and Displaced Populations (UNSSCN, 1999, 78 p.)|
|12. Afghanistan Region|
There has been conflict in Afghanistan for the last twenty years, leading to massive displacements both within Afghanistan, and as refugee movements, into Iran and Pakistan. Ten years after the withdrawal of the last soviet soldier in 1989 an armed conflict between opposing political factions still continues. Currently the Taliban control approximately 85% of the country and the Northern Alliance forces, led by Commander Ahmad Shad Masood, about 15%. Fighting has been reported in the front-line areas of the Central and North regions including Bamyan and Faizabad during the reporting period. The fighting has resulted in civilian casualties and humanitarian assistance to these areas has been interrupted (WFP - 23/04/99, 30/04/99).
As a consequence of the war, several million refugees are scattered throughout the region, mainly in Pakistan (1.2 million) and Iran (1.4 million). Repatriation is ongoing. WFP estimates that there are up to 2.5 million IDPs in Afghanistan: the agency assists some 1.25 million people in the country (WFP - 29/09/98).
UN presence is returning slowly to Afghanistan. WFP, FAO, UNHCR and UNICEF have all increased their presence and some NGOs are beginning to return. WFP continues to run bakeries in Kabul and other areas, as well as food for work programmes. An emergency feeding programme is underway in Bamyam province targeting the landless and female-headed households as well as IDPs in Panjao (OCHA - 02/06/99; WFP -23/04/99). The recently returned UN staff have undertaken several assessment missions around the country, the results of which are summarised below.
Initial results from an FAO/WFP crop and food supply assessment mission suggest that the country's crop production is likely to be low for 1999, particularly in the northern regions. The main problem seems to have been a lack of snow and rainfall in the surplus crop production areas. In addition, there are indications of a serious problem of rust infection in the north and reports of red locusts in the north-east (WFP -04/06/99). Anecdotal reports from Mazar (a province in the north of the country) indicate that the food security situation of the most vulnerable people is deteriorating. Household assets are continuing to be sold and begging is on the rise. Labour wages have decreased as a result of an increased amount of labourers available. Although crop prices are currently low, preliminary indications are that many households are finding it difficult to buy enough (OCHA - 27/05/99).
A WFP food security study for Jalalabad reported that the most vulnerable families are those without a male wage earner. Without assistance these households earn only 70% of the minimum cash income required for food and non-food items. Thus they cannot afford to buy essential items such as fuel and clothing. Households with only one man, working in casual labour or as a government employee, were the next most vulnerable group. This group earn about 85% of their minimum requirement. In these circumstances WFP food boosts the low income and allows poor households to achieve minimum income requirements. Begging and the sale of assets in Jalalabad are reported to be less visible than in Kabul or Mazar (OCHA - 27/05/99).
In the provinces of Parwan and Kapsia (central region) market prices for cereals are now reported to have increased by 100% over normal inflation since a military-blockade was set up by the Taliban in 1997. Due to a lack of agricultural input and rust infestation of the wheat, the 1998 crop production was much below average in this region. If the 1999 crop production does not improve families dependent on purchasing their food will be unlikely to maintain their minimum needs (WFP - 04/06/99).
A recent report from WFP stated that the agency is preparing to introduce corn-soya blend (CSB) into selected programme activities throughout Afghanistan in order to "improve the nutritional status of the people in Afghanistan". Acceptability testing in Kabul suggested that CSB is well accepted by Afghan beneficiaries. In order to ensure the correct use and understanding of the commodity WFP's implementing partner's are conducting information campaigns which highlight CSB' nutritional value and show the various ways it can be used (WFP-02/07/99).
ACF undertook a study of the nutritional situation of mothers and children under-five in Kabul in February (see Annex). Amongst children under-five, the prevalence of acute wasting was estimated at 8.4%, including 0.7% severe wasting. Oedema was found 0.3% of the children surveyed. The level of stunting (height-for-age) was much higher: 61.3% of the children were stunted, including 32.2% severe stunting. The authors, however, cautioned that the validity of the data on the children's ages was questionable. The prevalence of acute wasting in infants who were longer than 49cm (n=132) was 6.1%. Amongst those infants who were less than 49cm long (n=20), most of whom were less than a month old, 85% weighed less than 3.5kg which is considered to be a "normal" birthweight. Of these, 4% were actually below the low birthweight cut-off (2.5kg).
Using the chronic energy deficiency (CED) classification scheme, 17.2% of the mothers were defined as undernourished (BMI < 18.5 kg/m2), 5.4% of these more severely undernourished (BMI < 17.0 kg/m2). Analysis of the mothers' MUACs gave a similar result, 20.2% were classified as undernourished (MUAC<22.0 cm). 10% of the women had both low BMI and low MUAC (BMI < 18.5 kg/m2 and MUAC<22.0cm). 10.3% of the women were classified as overweight (BMI > 24.9 kg/m2) and 2.3% as obese (BMI > 29.9 kg/m2).
For the month prior to interview, CMR was estimated at 0.74/10,000/day and the mortality rate of children under-five at 0.61/10,000/day. The main causes of death amongst the general population were heart disease, hypertension and complications arising from child delivery. Amongst the under-fives measles, heart disease and delivery complications accounted for equal numbers of deaths. The major (72.3% of all children surveyed) cause of morbidity in the under-five age group were acute respiratory infections (as would be expected in a survey conducted in the winter), diarrhoea (20.9%), measles (2.4%) and "other symptoms" (43%).
The graph below compares the results of this survey to others conducted in Kabul in previous years. It can be seen that the prevalence of malnutrition in children under-five has increased incrementally since December 1996. The prevalence of mildly undernourished women remains below that found in December 1996, but the number of severely undernourished (BMI<16.0 kg/m2) women has increased from 1.1% to 2.5% over the same time period.
The authors of the survey conclude that the nutritional situation of the population in Kabul remains precarious. The general standard of living remains low for the majority of households and their nutritional status does not appear to have improved since late 1996. In general, the food security situation is fragile. The markets in Kabul are well supplied, but the prices of basic food and non-food stuffs have been increasing continuously since 1995. This is partly due to the decreased value of the Afghani (local currency) compared to the dollar. Another reason is that many of the items in the Afghans' diet are imported from Pakistan and the closure of the border between the two countries pushed up the prices of many foods. In addition, some Pakistanis have been speculating on various foods produced within Afghanistan itself (e.g.: onions) resulting in an increased price of local foods. One result of these price increases is that the bakers have decreased the weight of a standard nan, the basis of most households' meals, from 200 to 120g whilst maintaining the price.
Concurrent with price increases are decreases in many households' income. Unemployment levels have risen dramatically and many households are now dependent on income earned on a daily basis. Government employees are vulnerable as they do not receive their salary (which has not been properly adjusted to inflation rates) on a regular basis. Thus the purchasing power of Kabul's citizens has decreased. This is evidenced by an increased amount of selling of household goods - an unsustainable coping strategy. The withdrawal of the NGOs and UN has also had a poor effect on the nutritional situation of this population.
Women and infants are at particular risk of malnutrition in this population because of social beliefs and traditions in Afghanistan. Weaning practices are not well-adapted to young children's needs: the supplementary foods traditionally given to children during weaning (tea, biscuits, bread) are not suitable or well-balanced in terms of nutrients for this age group. It was also observed that some infants are given tea which may increase their exposure to infectious diseases. There is some evidence that women, whose activities are restricted by the Taliban, may have a lower daily intake than men because of social constraints imposed on them.
Additional risk factors for poor health in this population include a low immunisation coverage. The immunisation programme coverage (all valid doses) was estimated to be 34.2% in children under two years old. Nearly half the children had not been vaccinated for measles. 69.5% of the children had BCG scars. 31.1% of the women interviewed had been immunised for neonatal tetanus. In general, it was noted that women were unaware of the benefits of vaccination for themselves. UNICEF, WHO and the Ministry of Public Health are currently conducting a country-wide immunisation campaign aimed at eradicating polio and giving vitamin A supplementation to children between 6-59 months of age. The most recent report suggests that they have reached over 3.6 million children out of a target 4.3 million (OCHA - 30/04/99, 02/06/99).
Returnees from Iran and Pakistan
UNHCR anticipates that 220,000 refugees from Iran and Pakistan will return to Afghanistan in 1999. WFP has allocated food for repatriation packages for 130,000 returnees expected in four areas of the country. The returnee package consists of 300kg of food aid to be shared between a family, no individual returnees are assisted. The returnees are expected to settle in the areas of Heart and Kandahar initially (WFP - 23/04/99, 07/05/99).