Dirty water, not food shortage, blamed for malnutrition among refugees

More than a quarter of the Sudanese refugees in eastern Chad suffer from acute malnutrition, but lack of access to clean drinking water rather than a shortage of food is the main cause of this alarming situation, according to a survey conducted last month by the United Nations and other relief agencies operating in the area. The survey, a draft copy of which was made available to IRIN, linked the rate of high malnutrition detected to rampant diarrhoea. It blamed the diarrhoea, in turn, on poor water supplies in the semi-arid region which lies on the southern edge of the Sahara desert. "Incidental prolonged cases of diarrhoea could cause and exacerbate the malnutrition," the survey team said in its draft report. The underlying causes of diarrhoea likely relate to lack of access to and availability of clean water," it added. The survey, conducted in June, covered 896 children aged between six months and five years living in three official refugee camps near the border town of Tine and in spontaneous refugee settlements nearby. It detected a global acute malnutrition rate of 27.0 percent within the refugee camps and 29.2 percent among refugees living outside them. The survey team also sampled the health of 175 Chadian infants living in 11 villages in the same area. It found the local farming population to be in as poor a state of health as the refugees they were hosting, with an acute malnutrition rate of 24.0 percent. Three hours per trip to fetch water Most of those questioned said they relied on traditional wells a long way from their homes which were often crowded with other people waiting to draw water. The survey team found that even refugees living in official camps organised by the UN refugee agency UNHCR took an average of three hours to fetch water every time they went to replenish their supply. In the refugee camps, 59 percent of children had suffered diarrhoea during the two weeks prior to the survey. The rate fell to 43.5 percent among refugees outside the camps and 46 percent among the local Chadian population. "The main cause of malnutrition in the camps is not really lack of food, but the availability and accessibility of clean water," Philippe Guyon Le Bouffi, the head of the UN World Food Programme (WFP) in Chad told IRIN by telephone from N'djamena. He said the WFP had sufficient food stocks in place in eastern Chad to feed 180,000 refugees till the end of August. A further 8,000 tonnes of food was expected to arrive soon from Cameroon in time for distribution in September, he added. People are defined as suffering from global acute malnutrition when their weight for height ratio falls to less than 80 percent of the median for a healthy population. The survey showed that three per cent of refugee children and Chadian infants living in frontier settlements suffered from severe acute malnutrition because their height for weight ratio had fallen to less than 70 percent of normal. The situation was a little better inside the refugee camps, where a rate of only 1.7 percent was recorded. Special feeding centres for children are needed "Global malnutrition, when it passes 10%, becomes a public health problem. In our case, the situation is three fold that number, which shows how serious the situation is," Jean Laokole, the Director of the Chadian National Centre for Nutrition and Technology, who took part in the survey, told IRIN.

Chadian farmer

The survey team recommended the immediate establishment of more therapeutic and supplementary feeding centres to treat the worst cases of malnutrition. Two therapeutic feeding centres exist at present in the area studied. This lies at the northern end of a 600 km stretch of frontier, where refugees have been crossing into Chad from Sudan's troubled Darfur region. One therapeutic feeding centre is operated by Medecins Sans Frontieres (MSF) Belgium in the town of Iriba. The other, in Konoungo refugee camp, is run by International Medical Corps. Stephane Heymens, the head of MSF-Belgium in Chad, said the Iriba centre provides emergency feeding for 220 severely malnourished children. MSF Belgium also runs supplementary feeding centres for nearly 1100 children in two of the refugee camps covered by the survey, he added. Heymens said the state of malnutrition among young children reflected that of the general population, so this is why they are generally targeted by malnutrition surveys. "To know the nutritional situation, you focus on children as they are the very vulnerable, the first ones to be affected. Then you relate this to the whole population," he said. Heymens agreed that the shortage of clean drinking water was a serious problem, alleging that in two of the three refugee camps covered by the survey water was not yet chlorinated before distribution. This was disputed by Norwegian Church Aid, which provides water to the camps, although it admitted that the standard of chlorination was still unsatisfactory. Change of diet also induces diarrhoea Heymens said another key cause of the high rate of diarrhoea among refugees was a change in diet. He noted that they were now forced to rely on foodstuffs handed out by relief agencies, rather than the locally grown millet with which they were familiar. "WFP does not always provide the refugees with the food they are used to eating," the MSF representative said. Laokole, the Chadian nutrition expert, urged donors not to forget the local population in eastern Chad, which made substantial sacrifices to help the Darfur refugees before international relief agencies arrived on the scene. "These people living in impoverished desert zones were already at risk of being malnourished, but they have seen their nutritional situation worsen with the massive influx of refugees since they have shared with them the little they had," he said.

Sudanese displaced in Tine, eastern Chad

The nutrition survey was conducted by an inter-agency team comprising representatives of the WFP, UNHCR, the United Nations Children's Fund (UNICEF), the World Health Organisation (WHO), the Chadian Health Ministry, MSF-Belgium, International Rescue committee, International Medical Corps and epidemiologists from the Centre for Disease Control and Prevention, an organisation based in Atlanta, Georgia. It focussed on the refugee camps of Iridimi, Touloum and Kounoungo, which together contain over 40,000 people. The survey found that Chadian residents in the district, who live mainly from agriculture and animal husbandry, spent an average of three hours per trip to collect water - an hour longer than last year, before the mass influx of refugees. Four out of five households said they shared their food and local water source and food with the refugees, who mostly belong to the same Zaghawah ethnic group. Problems in supplying enough water UNHCR has so far established nine refugee camps away from the border, hosting a total of 123,000 refugees, but officials of the agency say they have encountered severe problems finding sites with adequate underground water which can be accessed through boreholes. Aid workers in eastern Chad say that as a result, many refugees receive less than 15 litres of water per day, the minimum recommended by international guidelines. However, Tor Valla, the head of mission of Norwegian Church Aid, which provides water to several refugee camps in the area covered by the survey, said the situation had improved since mid-June when the survey was conducted. “Refugees in Iridimi and Touloum now receive the standard 15 litre ration," he told IRIN by telephone. "Water is chlorinated, but often in tanks, which is not really appropriate," he added. Laokole, the Chadian government expert who took part in the nutrition survey, said the team had recommended the collection of carcasses of dead animals who had died of hunger and thirst in dried-up river beds to prevent them from polluting surface water and causing epidemics of cholera and typhoid. He said the team also called for the digging of more wells and the establishment of a surveillance system to keep tabs on the needs of vulnerable groups such as children, pregnant women and the elderly. “Emergency intervention is required to rectify the problem” he stressed. UNHCR currently estimates there are now 170,000 refugees from Darfur in eastern Chad, but recent estimates by other relief agencies have ranged up to 200,000.