Food and nutrition situation for refugees from Western Sahara in camps in Algeria

1. Food and nutrition situation for refugees from Western Sahara in camps in Algeria Ingrid Barikmo Akershus University College (AUC)Norwegian Church Aid (NCA) Kommittén för Västsaharas kvinnor,Stockholm, February 2010

2. Background • Refugees in harsh environments in the Sahara desert more than30 years • Cease-fire in 1991 • Total dependency on food aid as well as all other needs for survival • Water: a considerable scarcity • Health problems such as undernutrition, anaemia and goitre are common

3. Background (cont.) • Reduced beneficiaries from 158.000 to 90.000 for 8 months in 2006 • In November 2006 increased beneficiaries to 125.000 which still are the number of people given basic ration • Undernutrition increased disturbingly in 2008 • Indication of violation of the International Covenant on Economic, Social and Cultural Rights – article 11 on the right to adequate food

4. NCA and AUC in the Saharawi refugee camps • Nutrition project at the hospitals (since 2000) • Iodine Survey, 2007 (report 2008) • Nutritional and Food Security Survey, (report 2008) • Saharawi Nutrition Strategy, (report 2009) • Increased nutrition education, 2009 • Cooperation with MoH, UNHCR, WFP, MdM, PNSS in a Integral Program of Infantile Health Saharawi (PISIS), 2009 • Food Basket research, 2009 • Local milk research, 2009

5. Iodine Survey, 2007 Prevalence of enlarged thyroidgland measured by ultrasound: • Women (405, age 15-45): 22 % (cut-off volume thyroid gland > 12.5 ml) • Children (419, age 6-14): 86 % (international reference values (thyroid gland volume - Tvol) for BSA with cut-off point at the 97 percentile) Excretion of iodine in urine • Women: Median 466 µg/L (range 54-3.640) • Children: Median 565 µg/L (102-3.594)

6. 600 µgiodine/day: Proposed safe upper level for adults (Scientific Committee on Food in the European Union, 2002) 1100 µg/day: Tolerable upper level of daily iodine intake for adults (Food and Nutrition Board, USA, 2006).

7. Median iodine content (µg/L) in water and urine (women and children)

8. Local milk • Goat milk (n=16) • Content of iodine: median 370µg/L, (70-13.071) • Camel milk (n=3) • Content of iodine in the 3 samples 540 µg/L, 4.170 µg/L and 11.980 µg/L

9. Sources of the iodine intake among women

10. Conclusion • The prevalence of enlarged thyroid gland was severe, especial for the children • The majority of the Saharawi refugee women (74 %) and children (84%) had excessive intake of iodine • It was differences between the camps: of those with iodine excretion more than 600 µg/L88 % of the women and 91% of the children came from the two camps Ausserd and El Ajune • The content of iodine in local milk was extremely high and need to be more investigated • The high concentration of iodine in water are affecting the humans directly and probably also indirectly through the local milk

11. Nutritional and Food Security Survey, 2008 Prevalence of: • Acute malnutrition (too thin) (wasting, WHZ): • Global (total) 18.2 % • Severe: 5.4 % • Chronic malnutrition (too short) (stunting, HAZ): • Global (total) 31.4 % • Severe: 9.0 % • Anemia, children • In total 62 % • Severe 6% • Anemia, non- pregnant women • In total 54 % • Severe 11% • Anemia, pregnant women • In total 66 % • Severe 15%

12. Trend in acute malnutrition (wasting) from 1997 to 2008

14. Trend in chronic malnutrition (stunting) from 1997 to 2008

15. Trend in anaemia in children (6-59 months) from 1997 to 2008

16. Trend in anaemia in non pregnant women, from 1997 to 2008

17. Trend in anaemia in pregnant women, from 2002 to 2008

18. Saharawi Nutrition Strategy

19. Malnutrition/ Nutrition related diseases and early death or disability Symptoms and signs Inadequate dietary intake Disease Immediate Causes Inadequate prevention and control of disease, water and sanitation Food insecurity Inadequate “Care” Underlying Causes Inadequate education Control and management of resources Human, Economic, Organizational Basic Causes Political and Ideological Superstructure Economic structure Potential resources Conceptual framework for the causes of malnutrition (Adapted from Jonsson, 1995)

21. Saharawi Nutrition Strategy General objectives Focused areas 1. To change the diet for all in line with the international recommendations of the FAO/WHO • Access to food for a healthy diet 2. To coordinate the nutritional work in the camps 3. To reduce malnutrition in children • Fight against malnutrition and nutritional deficiencies 4. To reduce anaemia and other type of micro-nutrient malnutrition, particularly among women in reproductive age, infants and young children and school age children 5. To promote healthy dietary habits in accordance with local food culture for an adequate food intake for all. Capacity development 6. To strengthen the nutrition skills among the Saharawi public staff.

22. Care for the children • Breastfeeding in the camps: • 60 % started during the 1. hour, 8 % later than 12 h • 90 % were given water, sugar water, oil when they were new born • 2 % was exclusive breast feed to 6 month • 95 % of the children had been breast feed • 50 % breastfeed in 2 years

23. Children’s meal: • 3 meals/day – 11 % • 2 meals/day – 75 % • 1 meals/day – 6 % • 0 meals/day (only milk) – 3 % • “Between meals” – 33 % • Complementary feed by 6-7 months – 32 %

24. Figure 12 Effect of eating main meals on acute malnutrition among children 6-59 months, Saharawi refugee camps, March 2008

25. Figure 13 Effect of eating main meals on chronic malnutrition among children 6-59 months, Saharawi refugee camps, March 2008

26. Figure 14 Effect of eating main meals on anaemia among children 6-59 months, Saharawi refugee camps, March 2008

27. Diaré Figure 15 Effect of diarrhoea on acute malnutrition among children 6-59 months, Saharawi refugee camps, March 2008

28. Diaré Figure 16 Effect of diarrhoea on anaemia among children 6-59 months, Saharawi refugee camps, March 2008

29. Care for the women • Birth control – 60 % • Give birth at home – 72 % • Iron supplement when pregnant – 8 % • Have lost one or more child – 46 % • Eat as usual during the pregnancy – 41 % • Eat more than usual – 2 % • Eat less than usual– 55 %

30. What characterized the anemic women? • If they was pregnant or breast feeding • Had children less than 5 years • Their own age; less than 20 and more than 40 years old women had significant higher Hb than the other • Those that ate 1-2 meals/day had sign.lower Hb than the other

31. Possible causes of the under nutrition Food insecurityIn refugee camps, we saw that when access to food declined, sharply increased the under nutrition. Inadequate care In the refugee camps we saw that exclusive breastfeeding was almost absent, the special child feeding is not normal and that the feeding rate is low. Only slightly more than half goes to the maternity control, and most give birth at home Inadequate prevention and control of disease, water and sanitationIn refugee camps, we found that one of the causes of malnutrition among children was (in addition to inadequate food intake) diarrhea.

32. Measures • Food and supplements that meets the needs for pregnant, mothers and children • Training of health personnel how they can give advices to pregnant and mothers regarding: • health before, under and after pregnancy • breast feeding • good complementary feeding practice • Training of the mothers • Campaigns for good health and diet in the population.

33. How to improve the situation? • Use the Saharawi Nutrition Strategy • Increase the nutrition education • Work in cooperation with MoH, UNHCR, WFP, MdM, PNSS in a Integral Program of Infantile Health Saharawi (PISIS) • Continue to fill the Food Basket • Contribute to the local milk research • Other?

34. Takk for oppmerksomheten

35. Food distributed Wheat and cereals distributed in the camps in 2006 and the first 4 month in 2007

36. Food distribution and acute malnutrition The quantity of distributed cereals/person/month in 2005, 2006, 2007 and 2008 when using number of 160.000 or 125.000 beneficiaries and the prevalence of acute malnutrition

37. Women needs and food distributed in 2008

38. Sources to the nutrients

39. Adapted Food Basket

40. Highly recommended Food Groups as support to the refugees • Vegetable and fruit • Canned fish (mackerel or sardines) or meat • Milk and cheese • Other foods such as gofio and pasta and soya beans

41. Hva slags matvarer som flyktningene ønsker å kjøpe hvis de har penger

42. Hva slags matvarer og tilsetninger • For behandling av alvorlig akutt underernærte (wasting): • Før – F100 • NÅ – PlumpyNut (olje og peanutbasert) • For moderat akutt underernærte: • Hvete/mais-soya blanding+ olje og sukker (CSB) • For forebygging av kronisk underernærte (stunting): • Før – ingenting • NÅ – olje og peanutbasert produkt • Anemi • Sprinkelprodukter

43. Nutrition throughout the life cycle

44. “Window of Opportunity” for Improving Nutrition is very small…pre-pregnancy until 18-24 months of age Kilde: Shrimpton et al (2001)