Humanitarian agencies battle drought, poverty and HIV/AIDS

Lying on a mat outside her crumbling mud hut, 20-year-old Eva Matos gasps for breath, her skeletal chest heaving under a grimy sheet. Her niece, 12-year-old Silvia, looks on helplessly as she cuddles her young cousin, three-year-old Emanuel. The eldest children in the household, a boy aged 15 and a girl aged 14, already with a baby of her own, are out looking for food. It is two days since the family of six has eaten anything. "I had to sell my machamba (plot of land)," Matos says, tears rolling down her cheeks as she grimaces in pain. Matos, whose name and that of her nieces and nephews have been changed to protect their privacy, has been head of the household since she was 15 years old. She had to drop out of school to look after her parents, who were sick for months on end with AIDS-related illnesses. With no opportunity to return to school, she got married and, although she has no children of her own, is now caring for her late sisters' offspring. All three of her sisters recently died of ailments caused by AIDS, leaving behind the four children. Three years ago she also became sick, and her husband abandoned her. Now she is dying from AIDS-related diseases, including tuberculosis, and suffering severe malnutrition and anemia. "I haven't taken my tablets for five days because I'm too hungry," she says in a wavering voice. Twelve-year-old Silvia was also feeling weak because it was the Monday of a long-weekend break from school. She relies on a daily free school meal (usually rice or porridge, peas, oil and canned fish) provided by the World Food Programme (WFP) in cooperation with the Ministry of Education, an initiative to help promote girls' education. She also gets a take-home ration of 50 kilos of maize and five litres of oil at the end of each school term. However, apart from holidays, she sometimes has to miss school as her aunt's condition rapidly deteriorates. "Some days I can't attend classes because I have to take care of my aunty," says Silvia. "She is now too ill to walk to the hospital." The girls' education initiative usually recommends 90 percent school attendance. Asked what the most difficult thing was for her these days, Sylvia, who does most of the domestic chores around the house, replied, "not having a machamba." HIV/AIDS has reached 13.6 percent of Mozambicans aged between 15 and 49 years and, combined with existing poverty, pushed many families in similar circumstances over the edge. The Matos family represents the extent of the humanitarian challenge. Although they are clearly suffering, they live in the northern province of Zambezia, regarded as the breadbasket of the country, which has a relatively low HIV infection rate - 12.5 percent compared with 26.5 percent in next-door Sofala. The tragedy is that there are other parts of the country worse off, and the bulk of humanitarian assistance is focused on communities that are both drought- and AIDS-affected in six southern and central provinces - Maputo, Gaza, Manica, Sofala, Inhambane and Tete. A multi-agency Vulnerability Assessment Committee confirmed in November last year that 659,000 people, mostly in the south of the country, were "extremely food insecure" and unable to cope without continued emergency support until the March/April 2004 harvest. The period just before the harvest is worst in terms of hunger and is known as the 'lean period'. In 2003, WFP provided targeted emergency food assistance to a monthly average of 440,000 people affected by a debilitating combination of poverty, several years of erratic weather conditions, and HIV/AIDS. Assisiting people living with HIV/AIDS requires a rethink of traditional aid programmes, because they not only need food but also a consistently nutritious diet to prolong their lives. "Everyone understands that nutrition is vital for people living with HIV/AIDS - how to make it work is not easy," says Tom Shortley, WFP emergency coordinator. "The biggest challenge is to link this provision of nutritious food with programmes run by the ministries and other organisations, such as NGOs who are assisting people with HIV/AIDS, without overburdening them with too many more activities. "The few organisations which provide medical assistance, antiretroviral drugs and home-based medical and health care, have limited capacity to also distribute food," Shortley told IRIN. "Nor can we expect a person weakened with AIDS-related illnesses to carry a 25-kilo bag of maize over long distances to their home." The government's strategy for the gradual provision, over a five-year period, of antiretroviral drugs in provincial hospitals makes the need to ensure that people receiving these drugs are eating a balanced diet even more critical. One initiative to address the problem was begun in 2001 when WFP launched a safety net scheme in cooperation with a range of NGOs, including Medecin Sans Frontiers, Medicos do Mundos and Health Alliance International, to provide nutritious food - maize, beans and corn-soya blend - to people living with HIV/AIDS, while the NGOs performed their normal health-related activities. So far, 35,000 people in Maputo, Gaza, Manica, Sofala and Tete provinces are benefiting from the project.