Food and nutrition situation for refugees from Western Sahara

in camps in Algeria

Ingrid Barikmo

Akershus University College (AUC)Norwegian Church Aid (NCA)

Riksdagen - Stockholm, February 2010

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

Background

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

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

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)

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9

16

38

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13

38

34

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<100 100-199 200-299 300-600 601-1100 >1100

Urinary iodine excretion µg/L

%Iodine in urine, women

Iodine in urine, children

1100 µg/day: Tolerable upper level of daily iodine intake for adults (Food and Nutrition Board, USA, 2006).

600 µg iodine/day: Proposed safe upper level for adults (Scientific Committee on Food in the European Union, 2002)

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

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Iodine in water Iodine in urine,women

Iodine in urine,children

Iod

ine

µg

/L 2 camps (Ausserd, El Aiune)

1 camp (Dakla)

1 camp (Smara)

Local milk

Goat milk (n=16) Content of iodine: median 370 µg/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

Sources of the iodine intake among women

Salt7 %

Water48 %

Tea water6 %

Local milk38 %

Dairy products1 %

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

Nutritional and Food Security Survey, 2008Prevalence of: Acute malnutrition (too thin) (wasting):

Global (total) 18.2 % Severe: 5.4 %

Chronic malnutrition (too short) (stunting): 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%

Trend in acute malnutrition (wasting) from 1997 to 2008

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1311

8

19 18

24

2 2 35

0

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15

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25

30

Pre

va

len

ce

%

Total (WHZ<-2,00 SD)

Severe (WHZ <-3,00 SD)

Trend in chronic malnutrition (stunting) from 1997 to 2008

46

35 3339

2631

24

1411

16

7 9

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40

50

Pre

vale

nce

%

Total (HAZ<-2,00 SD)

Severe (HAZ <-3,00 SD)

Saharawi Nutrition Strategy

Saharawi Nutrition Strategy

1. To change the diet for all in line with the international recommendations of the FAO/WHO

2. To coordinate the nutritional work in the camps

3. To reduce malnutrition in children

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.

6. To strengthen the nutrition skills among the Saharawi public staff.

General objectives Focused areas

Access to food for a healthy diet

Fight against malnutrition and nutritional deficiencies

Capacity development

Food distributed

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2006 - 2007

Wheat

Sum cereal

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

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

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2002 2005 2006 2007 2008

Cereal (kg/person/month)if distributed to 160.000beneficiers

Cereal (kg/person/month)if distributed to 125.000beneficiers

Prevalence of acutemalnutrition

Women needs and food distributed in 2008

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70

Protein, g Iron, mg Vit C, mg

Needs for a women 19 -50 year/day

Received in 2008 if125000 beneficiaries

Received in 2008 if160000 beneficiaries

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Energy, kcal Calcium,mg Vit A,µg

Needs for a women 19 - 50year/day

Received in 2008 if 125000beneficiaries

Received in 2008 if 160000beneficiaries

Food distributed in 2008 to 160.000 g/day

Cereals 281

CSB-blended 13

Lentils/beans 46

Oil, fortified 24

Sugar 23

Tuna fish 2

Vegetables 70

Fruit 30

Meat 5

Milk/Cheese 9

Sources to the nutrients

Nutrients in %

Energy Protein Calcium Iron Vitamin C Vitamin A

Cereals 63 66 20 39 0 0

CSB-blended 3 5 47 23 27 26

Lentils/beans 9 22 14 33 2 1

Oil, fortified 14 0 0 0 0 56

Sugar 6 0 0 0 0 0

Tuna fish 0 1 0 0 0 0

Vegetables 2 2 6 1 33 15

Fruit 2 0 4 2 38 1

Meat 0 2 0 1 0 0

Milk/Cheese 1 1 9 0 0 1

Adapted Food Basket Ration/kg/month

Food given monthly by

WFP

8 Wheat flour, fortified

2 Barely

2 Rice

1 CSB-soya, fortified

2 Lentils/beans/peas

1 Oil fortified

1 Sugar

Suggested food items that can be

given by other

organisations

1 Gofio

1 Soya beans

1 Pasta

5 Milk

1 Cheese

1 Mackerel in brine

3 Potato

3 Carrot

2 Onion

1 Apple

1 Orange

1 Tomato in tetra pack

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120

Protein, g Iron,mg Vit C, mg

Needs for a women 19 -50 year/day

Adapted FoodBasket/day

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Energy, kcal Calcium,mg Vit A,µg

Needs for a women 19 -50 year/day

Adapted Food Basket/day

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

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?

Hva slags matvarer og tilsetninger (forts)

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Linse

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Fisk

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Pasta Ris

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Melk Olje

Kjøtt

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ukt

Grønn

sake

r

Produkter som kjøpes

% f

am

ilie

r

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