Northern Sudan in 1991: Food Crisis and the International Relief Response

Northern Sudan in 1991: Food Crisis and the International Relief Response

MARION KELLY and MARGARET BUCHANAN-SMITH

~ _ _ _ _ _ ~ ~ ~

By the end of 1991, less than half the amount of relief food requested for North Sudan at the beginning of the year had been delivered. Despite ample evidence of social and economic stress and high rates of child malnutrition, many donors felt that relief needs had been exaggerated, and were unwilling to accept that relief assistance was urgently needed. The feeble response of the main food aid donors is explained initially by the politics of relief in 1990191, which seriously delayed the launch of the relief operation. These problems were compounded by an oversimplified understanding of famine among some sections of the relief community, and by the orientation of the international relief system to crisis indicators. Toward the end of 1991, donors argued that despite the shortfall in relief assistance there had been no deaths from stantation, and therefore local people had ’coped’ better than expected. This paper challenges that view by arguing that excess deaths did occur, but went unnoticed and unremarked. Local people’s ’coping strategies’, which supposedly ’saved the day’, actually had ve y negative and sometimes fatal consequences.

In December 1990, Sudan was visited by a food needs assessment mission made up of World Food Programme (WFP) representatives, advisers from non-govern- mental organisations (NGOs), and donor observers. The mission concluded that Sudan as a whole would need just over a million tonnes of relief food in 1991: requirements for northern and southern Sudan were estimated to be 859,000 h4T and 286,000 MT respectively (Winnubst et al., 1990). The total number of people in need of relief was estimated at 7.68 million (6.44 million in North Sudan). A year later, the quantity of relief food that had been distributed to northern Sudan stood at less than half a million tonnes, about 50 per cent of recommended requirements. In

Darfur, Sudan’s westernmost state and one of the most food insecure, barely one- fifth of estimated requirements had been delivered (Figures 1 and 2).

By the end of 1991, many in the donor community had begun to question the accuracy of the mission’s assessment. Donors argued that famine had not occurred, even though substantial increases in child malnutrition had been documented by a number of government and non-government agencies, including Concern, OXFAM, Save the Children Fund (UK), Christian Outreach and the Ministry of Health.’

Pointing to the gap between the assessed need and the amount of food actually distributed, donors concluded

DISASTERS VOLUME 18 NUMBER 1 0 Basil Blackwell Ltd. 1994, 108 Cowley Road, Oxford OX4 lJF, UK and 238 Main Street, Cambridge, MA 02142, USA.

Northern Sudan in 1991 17

1.2

1

0.8

0.6

0.4

0.2

0 I 711 191 2/7/91 1/12/91

9/4/91 29/9/91

Date

Deliveries to Sudan m Pledges Total requirements I I I

Source: WFP

FIGURE 1 Emergency food aid to Sudan, 1990191: record of availability and deliveries

that the assessed need must have been exaggerated, otherwise millions of people would have starved to death. Donors implied that they would not take seriously the needs assessment for 1992 unless confronted with evidence of widespread starvation; in the words of one donor representative, a ’body count’ would be needed.

Using information obtained during visits to North Sudan in November and December 1991, in this paper we try to answer three questions. First, why was the international donor response to early warning information so slow and inadequate? Second, was there famine mortality in 1991, or did people cope successfully with food insecurity? Third, was the original needs assessment so inaccurate as to justify the donors’ later scepticism?

The answers hinge on how famine is

understood, how early warning indicators are interpreted, how need is defined, and what relief assistance is meant to achieve. In the first part of the paper we consider each of these general issues in turn, drawing heavily on De Waal’s in-depth study of famine processes in Darfur during 1984185 (De Wad, 1989). Although there has been no comparable study for 1990/91, De Waal‘s research provides the context for interpreting the indicators and data which are available for this period. In the second part of the paper we look at how early warning information on Sudan was used in 1990191. This shows that the political context, and the strained relations between Western donor governments and the government of Sudan, were major obstacles to the launching of the relief operation; these difficulties were compounded by an inaccurate understanding

0 Basil Blackwell Ltd. 1994 DISASTERS VOLUME 18 NUMBER 1

18 Marion Kelly and Margaret Buchanan-Smith

of famine, as evidenced by the international relief system’s reluctance to respond in the absence of clear signs of full-blown crisis. In the third part of the paper we assess the impact of the 1991 food crisis on food-insecure people in North Sudan, focusing particularly on evidence of excess mortality. Implications emerge from this analysis for the future credibility of early warning and needs assessments.

UNDERSTANDING FAMINE

Famine mortality: evidence from Darfur, 1984185

Most people in the West understand drought-related famine as mass starvation caused by crop failure, but evidence from the Darfur famine of 1984185 shows this view to be inaccurate in at least three key respects.

First, famine is not an event that wipes out all - or even most - of those whose lives are touched by it. De Wad estimates that 95,000 excess deaths occurred in a population of 3.15 million over the two-year period June 1984- June 1986. Although this was Darfur’s most severe episode of food insecurity for 70 years, and the mortality rate rose to more than double what would be considered ’normal’ (De Wad, 1989, p. 176), the great majority of people survived.

Second, vulnerability to famine mortality can be highly age-specific. A dispro- portionately large majority of those who died during the 1984/85 Darfur famine were children between the ages of one and nine years; more than half of all excess mortality occurred in the one to four year age group. Death rates were also significantly increased among those over fifty,

300

250

200 - v)

m u E S

v, 150 zg v

100

50

0 7/9/91 291919 1

11/5/91 1 I1 2/91

Date

Source: WFP, SCF (UK)

FIGURE 2 Emergency food aid to Darfur, 1990191: record of availability and deliveries

DISASTERS VOLUME 18 NUMBER 1 0 Basil Blackwell Ltd. 1994


and especially in those over sixty. People between the ages of ten and fifty accounted for fewer than 10 per cent of the excess deaths (De Waal, 1989,

Third, although they may be hastened by malnutrition, most famine deaths are not caused directly by starvation. De Waal argues that, during 1984- 85, transmission of disease was expedited by the crowding of people into areas where water quantity and qualitj were poor, health services were inadequate and malaria was rife (ibid. pp. 185 - 93). Indeed, the health workers he interviewed attributed the majority of famine deaths not to starvation but to measles, diarrhoea and malaria.

Thus, the view of famine held by many Westerners is oversimplified and bears little resemblance to what actually happens on the ground. It is more appropriate to think of famine as the outcome of a process by which an acute episode of food insecurity leads to social disruption and to excess mortality among some or all sub-groups of the affected population (Kelly, 1992). Unlike mass starvation, which would be obvious to even the most casual observer, the actual processes and outcomes of many famines are difficult to detect without detailed monitoring and careful analysis. This is particularly important in relation to what happened in North Sudan in 1990191.

pp. 178-82).

Developments in famine early warning

Over the past ten years or so, most national governments, relief agencies and aid donors have come to share the belief that it is possible to prevent famine deaths by means of timely intervention prompted by early detection of the processes leading to famine. Thus, almost all drought-prone countries in Africa now have some kind of formal early warning system (EWS) (Buchanan-Smith et al., 1991). Many of these were set up in the wake of the

widespread famines of the mid-l980s, and their early design was driven by the desire to prevent famine on the same scale ever happening again (Davies et al., 1991). In practice, however, these EWS have more often warned of a deterioration in food security without the threat of large-scale famine, which is fortunately quite a rare event. Nevertheless, widespread famine is often the reference point for EWS, and this influences the terminology they use.

A wide range of early warning indicators has been developed over the past decade (Lambert et al., 1991). As well as the more traditional indicators of food availability and nutritional status, indicators of ‘coping’ have recently been added to the list and given increasing prominence. The terms ’coping mechanisms’ or ’coping strategies’ are used to describe actions taken by people whose access to food has been compromised or threatened. A coping strategy can include a whole range of diverse activities. Common responses include migration in search of food or work and the sale of livestock or other assets. Coping strategies are often thought of by outsiders as ways of maintaining a steady supply of food to the household, but research suggests that such actions are perceived by those who practice them as ways of maintaining the household’s way of life (De Waal, 1989; Young and Jaspars, 1992).

The cost of coping: Darfur in 1984185

‘Coping’ has a positive ring to it; it implies fortitude and the successful resolution of crisis. But famine is a crisis with many dimensions. Measured against the objective of ensuring the survival of the household economic and social unit, coping strategies are usually successful. Unfortu- nately, coping responses that enable the household unit to avert disintegration and destitution can have undesirable effects on individuals within the household.



In many populations prone to famine, including that of Darfur, coping strategies include reduction in the frequency of meals, diminution of dietary variety, and substitution of wild foods for habitual staples. Such dietary austerity measures, implemented in order to achieve the household’s overriding goal of preserving productive assets, often have adverse effects on the food and nutrient intake of some or all household members. Reduced energy and protein intake can result in more infants being born underweight and more children becoming wasted andlor stunted. Poor growth - be it in utero, in infancy or in childhood - is associated with impaired immune competence and increased risks of morbidity and mortality (Tomkins and Watson, 1989). Dietary austerity can also lead to micronutrient defi- ciencies; the commonest of these are anaemia, which leads to general weakness and is a common cause of maternal mortality, and Vitamin A deficiency, which heightens the risk of mortality from infectious disease (Glasziou and Mackerras, 1993) and can lead to irreversible blindness.

Likewise, migration, which is often undertaken by households striving to preserve their livelihoods and avoid destitution, can increase household members’ exposure to disease and heighten their risk of mortality, as occurred in Darfur in 19841 85. In other words, some of the behaviours that make up a household’s ’coping strategy’ can actually increase the risk of malnutrition, disease and even death.

The unintended and often invisible effects of ’coping’ are illustrated by events in Darfur in 1984-85. Since Darfur’s crude mortality rate did not increase significantly until early 1985, despite the fact that no relief assistance was committed until December 1984, it i s tempting to conclude that people coped with the effects of drought throughout 1984, and that no lives were lost until their coping capacity ran

out some months later. A closer look at the mortality data for Darfur belies this impression. As De Waal points out, the death rate among children aged one to four years was already elevated during the 1984 rainy season (June - September), although mortality among other age groups did not increase until three to six months later (De Waal, 1989, p. 179).

During the second half of 1984, the fact that unusually large numbers of children were dying was not recognised by people outside Darfur, simply because mortality data were not being collected. Had it not been for De Waal’s detailed retrospective investigation, which enabled him to estimate age-specific mortality rates, virtually no-one outside the communities con- cerned would ever have known that even at this early stage, well before the world woke up to the famine in Darfur, too many children were dying.

International food aid as an instrument of famine prevention and relief

The commonly held western view of famine influences - and is reinforced by - the strategies used by aid agencies to prevent and relieve it. If famine is equated with mass starvation, the ’obvious’ way to prevent it is to provide massive amounts of food aid. Although distribution of relief food is the commonest international response to famine, it is rarely timed to best advantage and its impact on the survival of the most vulnerable tends to be diffuse and indirect; in De Waal’s words, it is a ‘blunt instrument’ (De Waal, 1989, p. 220). This means that large quantities often have to be distributed in order to prevent deaths among the so-called vulnerable groups, who constitute a relatively small proportion of the population. The reasons are explained below.

Although all but the most severe famines claim lives mainly within certain age groups, it is rarely practicable when

DISASTERS VOLUME 18 NUMBER 1 0 Basil Blackwell 6 d . 1994


dealing with communities in situ to target relief food to individuals within the household. This is attributable not only to occasional (but inevitable) inaccuracies in the identification of individuals at risk, but also to practical difficulties in ensuring that food is delivered to and consumed by the target individual. Although it is possible to devise ‘supplementary feeding’ schemes targeted to individuals, an essential pre- condition for such programmes (one that must be met on semantic grounds alone!) is that general rations must first be supplied to the household.2 In the absence of a general ration, the ’supplement’ may be shared by the entire household, or the target child’s share of family meals may be reduced because slhe is consuming the ’supplement’. Hence, in times of food insecurity, it is usually necessary to provide food to an entire household in order to protect the dietary intake of just one or two vulnerable household members.

Household-level targeting might seem the obvious answer, but it is by no means easy to identify and selectively provide assistance to those households where deaths are most likely to occur. As a basis for targeting food to households, anthropometry has the theoretical advantage of being objectively verifiable; in practice, however, it is not without its drawbacks. Targeting according to anthropometric cri- teria turns thin children into family meal tickets. Relief workers in Ethiopia found that not only could this create an incentive to ensure that such children remained underfed (Bridie Russell, personal communication), it also led to borrowing (and even rental) of children thin enough to qualify for rations.

Experience of relief operations in Western Sudan has shown that the concept of targeting was not readily accepted by either local government officers or local beneficiary communities; blanket distribu- tions were preferred, even though this

meant that the relief was spread very thinly. Where targeting on the basis of geographical units was enforced, political lobbying was often more influential than evidence of need in determining the final distribution plans (Keen, 1991; Buchanan- Smith, 1989). Hence, accurate targeting of general rations below village level is very difficult to achieve in practice (Shoham and Borton, 1989).

Using a hypothetical example based on De Waal’s estimate of 1984-85 famine mortality in Darfur, it is possible to obtain a very crude order-of-magnitude estimate of the number of people that might need to be fed in order to prevent a given number of famine deaths. First, suppose that all excess deaths from the 1984/85 Darfur famine had been destined to occur in just 25 per cent of the region’s villages (and that these villages taken together accounted for 25 per cent of Darfur’s population). Now suppose that the at-risk villages had been correctly identified sufficiently early in 1984, that every household within them had then been supplied with relief food, and that all excess deaths had thereby been prevented. In these circumstances, the prevention of 95,000 deaths would have required the distribution of relief food to over 750,000 people. That is to say, the ratio of people fed to deaths prevented would have been about 8 : 1.

Whether or not the same quantitative relationship would hold true in real life depends on how closely the assumptions on which it is based resemble the conditions prevailing in any given real-life situation. On the one hand, if accurate targeting below village level is feasible, the ratio of people fed to lives saved decreases and the blunt instrument becomes sharper (although targeting at household level could still mean feeding four or five people for every death averted). On the other hand, even the assumption that all villages (let alone households) at risk of excess mortality can be correctly identified is an



optimistic one; in reality, identification of such villages is likely to be rather inaccurate, making the food relief instrument even blunter than the hypothetical scenario would indicate. Reduced cluster- ing of those in danger of dying would 'also increase bluntness (i.e., if the same number of individuals at risk of death had been scattered throughout 50 per cent of the affected region's villages - a more likely scenario - the ratio of people fed to lives saved would have been 16 : 1). This has important implications for the scale of food relief operations, if they are to succeed in preventing famine mortality.

Another important factor to bear in mind is that in the eyes of those affected by it, there is more to famine than the threat of death by starvation. When maintaining habitual food intakes is not the first priority for people threatened by famine, the impact of food aid on survival can be rather indirect. In these circumstances, lives may be saved not so much as a result of the consumption of relief food by at-risk individuals, as by the effect of the food aid resource transfer on the behaviour of the household and its members. If, for example, receiving food aid means the household is not compelled to migrate, its members are less likely to be heavily exposed to infectious disease; similarly, young children are less likely to suffer the kind of neglect that can lead to undernutri- tion or illness if access to food aid means that other household members are not obliged to spend long hours away from home collecting wild foods.

Although influencing the decisions and behaviour of households and household members may be an effective way to prevent famine deaths, distributing food aid is not necessarily the most effective way to influence decision-making and behaviour patterns. For pastoralists suffering from a collapse of purchasing power due to a slump in livestock prices, the most appropriate form of assistance may

be intervention in livestock markets to stabilise prices. As another example, sedentary farmers forced to migrate to towns to look for work to supplement dwindling incomes might be assisted most effectively by the establishment of public works schemes in their localities.

A final problem with the relief food response is that mobilising and distributing food aid from Europe or the United States generally takes at least four to six months, often longer (Borton et al., 1988; Buchanan-Smith, Davies and Petty, 1992). Under famine conditions, a surge in mortality can occur quite suddenly. Therefore, any response involving time-lags of this magnitude will almost inevitably be too slow, especially if crisis indicators are required to trigger the whole process in the first place (see below).

To summarise, it is inaccurate to think of international food relief as a highly specific measure for the prevention of famine deaths. Because of the practical problem of targeting individuals, food relief intended to save lives may have to be delivered in large amounts in order to have an impact. Other forms of intervention, which may be more effective and appropriate, deserve serious consideration, but food relief is, and will probably continue to be, one of the most readily available and widely used forms of international emergency assistance.

However, despite the fact that the direct and immediate life-saving effects of food relief are usually vastly overrated by those who donate and distribute it, food aid can have a positive - albeit indirect - impact on survival. Any transfer of resources that helps people to avoid destitution and preserve an independent way of life must enhance the long-term survival prospects of present and future members of the recipient household or community, so any calculation of the number of people fed per life saved in the short term underestimates the true live-saving poten-



tial of that resource transfer. The problem is that in the eyes of the donors, longer term benefits belong under the heading of ’development’ rather than ’humanitarian’ assistance, and some countries are not eligible €or both.

W H Y DIDN’T THE DONORS RESPOND IN 1990/91?3

The state of early warning in Sudan, and relief commitments

Unlike most of its neighbours in the Sahel and Horn of Africa, Sudan did not have a well-developed formal EWS by 1990/91. At national level, the EWS was poorly resourced and consequently very central- ised and geared to conditions in Central Sudan. Coverage of more remote regions like Darfur, which were often the most food insecure, was patchy. The food monitoring system that had been set up in Darfur in the mid-1980s was in a state of disarray and collapse just at the moment when it was most needed - at the end of 1990, when the most serious food crisis since its inception was imminent. Both national and state-level (in the case of Darfur) EWS had suffered from a ’stop-go’ pattern of donor funding, as a conse- quence of the politics of international aid to Sudan. This has proved very disruptive to the evolutionary process of developing an information system, to the consoli- dation of early warning experience, and to the accumulation of good baseline data.

In spite of these problems, throughout the second half of 1990, conventional macro indicators of food availability pro- vided alarming forecasts of food shortages and the threat of acute food insecurity in 1991 (FAO, 1990a, 1990b; FEWS, 1990). During 1991 the deterioration in food security was confirmed by rising rates of malnutrition, sometimes to very high levels. Yet this information had only limited impact on the international donor

community. Pledges of relief food aid, let alone actual deliveries, fell far below recommended levels for North Sudan, and particularly for Darfur State in the west. The slow response cannot be blamed entirely on the logistical difficulties of delivering food to Sudan; it was also due to the slow commitments of food aid. By December 1991, barely three-quarters of the recommended food relief requirement had been met by pledges for North Sudan (only half had been delivered), and only a third of recommended requirements had been pledged for Darfur.

Donor agencies did not seem to have taken the early warnings and monitoring data very seriously. There are a number of reasons why: first of all, external factors to do with the political climate and the antagonistic relations which existed between western governments and the government of Sudan; secondly, reasons associated with how the early warning information was presented to, and interpreted by, donor agencies. These two sets of explanations are closely linked.

Political factors

The relief operation in Sudan during 19901 91 was probably the most politically fraught of all relief operations launched in Africa that year. Relations between the new government of Sudan (which was barely a year old) and western donor governments were at an all-time low, exacerbated by Sudan’s support of Iraq during the Gulf crisis and growing pro- clivity towards Islamic fundamentalism. The relief operation became the focal point of the antagonism between donors and the Sudanese government.

The last few months of 1990, when planning for the relief operation should have been underway, were characterised instead by stalemate and deadlock in negotiations about relief between donors and the government. The government



refused to admit publicly that there was any danger of famine, as this would seriously undermine the policy of self- sufficiency it was actively pursuing, and would increase its dependence on western food aid donors. At the same time, the donors had stipulated a number of conditions which had to be fulfilled before they were prepared to commit large amounts of relief resources. One of these conditions was that the government of Sudan admit there was a ‘humanitarian emergency’ and issue a formal request for assistance, a condition incompatible with the government’s strategy of only talking about the problem in low-key terms. Other stipulations, concerning logistical aspects of the relief operation, were also set by the donor community. In the words of one agency representative, the result was a kind of ‘gladiatorial confrontation’, with both sides equally intransigent.

This continued until there was finally agreement over the size of the ’food gap‘, when the FA0 harvest assessment and WFP relief needs assessment had been carried out, at the end of 1990, at least four months after the ’food gap’ had first been identified by early warning signals. The government of Sudan endorsed the results showing a deficit in the order of one million tonnes, which had to be met by relief. But disagreement over the logistics of the relief operation continued.

Donor mistrust of government and how it might use the food aid meant that all relief food was allocated to NGOs for distribution, and none to WFP. This led to disagreement between government and donors over internal transport arrange- ments. These difficulties were compounded by strained relations between donors and WFP, which was seen to be too willing to cooperate with government and not sufficiently supportive of the donorlNG0 case. Eventually, a Logistics Coordination Plan was drawn up and agreed upon by donors, NGOs and the

government. Pragmatism began to replace antagonistic and inflammatory public statements. Political wrangling had, however, caused months of valuable time for planning and launching the relief operation to be lost. And disagreements and practical problems over logistics and internal transport contributed to further delays once the relief operation was underway.

From early warning to prophecy of doom

Knowing from past experience that donors might not be persuaded to act on the basis of agro-meteorological and socio-economic indicators alone, many agencies had meanwhile concentrated on documenting rates of malnutrition, an indicator regarded as the ultimate weapon for advo- cacy (Shoham, 1987). In the case of Sudan, however, the threshold between what donors regarded as ’normal’ and what they considered a ’crisis‘ had altered with the political climate: in 1984185, malnuti- tion rates of around 15 per cent had been regarded as serious enough to provoke alarm, and to trigger some relief response, but by 1990/91 the goalposts had moved and levels of 25 - 30 per cent seemed to be necessary to have the same effect.

All of this had a knock-on effect on how early warning information was com- municated to decision-makers, especially during 1991 when the operation should have been in full swing, but had seriously fallen behind schedule. Frustrations over the delays in delivering relief resulted in warnings of impending famine becoming ever more dramatic and sensationalised in desperate attempts to provoke action. Figures for the number of people requiring relief assistance, for example, were lifted from WFP reports and presented as numbers ‘at-risk of starvation and death’, especially in media report^.^

Soon it was widely bandied about that



between 7 and 8 million people in Sudan were on the brink of dying. Although this was an exaggeration of the message in the original documents (which had never actually attempted to quantify the excess mortality that would occur in the absence of assistance), these dramatic terms seemed to be necessary to engender a sense of urgency into the launching and running of the relief operation. In a BBC television programme in April 1991, a WFP representative coined the word ‘megadeaths’, to threaten what might happen if relief resources were not forthcoming. This evocative language ensured that the food crisis in Sudan had a higher profile and political importance in Western countries than might otherwise have been the case. It forced western governments to justify their actions to the western public, who had been alerted by the media to the possibility of terrible famine in Africa once again. Ultimately, it did encourage the pledging of relief food, although still far below target levels.

By the end of 1991, the sensationalised warnings of famine issued during the preceding months had not been forgotten. Having failed to deliver the quantities of food aid deemed necessary during 1991, donor agency representatives looked for evidence of the ’megadeaths’ that had been threatened.

WAS THERE FAMINE IN NORTH SUDAN IN 1991? EVIDENCE OF EXCESS MORTALITY

The weak state of early warning and food information systems in Sudan meant that there was little detailed information to show what was really happening during the food crisis of 1991. In this vacuum, uninformed assumptions were drawn and, by the end of the year, many came to believe that famine had not developed. But just because excess deaths were not

documented does not mean they did not occur.

Mortality estimates inferred from anthropometric data

Although the Sudanese authorities are not able to collect data on mortality routinely, child anthropometry has been well documented in many parts of Sudan over the past several years. Since the latter half of the 1980s, the Ministry of Health and various NGOs have carried out a great many anthropometric surveys, using a protocol developed by the Ministry of Health Nutrition Department (n.d.). For the period 1990-91, the results of these surveys showed a serious deterioration in children’s anthropometric status, from which an increase in mortality can be inferred.

Of the anthropometric indices commonly used for the assessment of children, weight for height (WFH) is the least powerful predictor of mortality. Even so, there is a significant association between low WFH and increased risk of dying. As with other anthropometric indices, the relative risk of mortality associated with low WFH varies somewhat from place to place, and declines as length of follow-up increases (Pelletier, 1991).

Although there is now evidence that even mild WFH deficits are associated with some increase in the risk of dying (Lindskog et al., 1988; Katz et al., 1989), the cut-off points of 80 per cent WFH and -2 SD (standard deviations) are still widely used to classify children as either ’malnourished’ or ’normal’. Such two- way classifications are somewhat mislead- ing (in that they imply the existence of clear-cut threshold values with distinct implications for health and survival), but they are still widely used in reporting of WFH survey results. In order to facilitate comparisons, the remainder of this section also makes use of these conventional cut-



off points. In Bangladesh, studies have shown

that children aged one to four years with WFH less than 80 per cent of reference median values are six times more likely to die in the coming three months than those with WFH above 80 per cent (Alam et al., 1989). Among Indonesian children less than six years of age, WFH < 80 per cent increases the risk of dying during the coming 18 months by a factor of four (Katz et al., 1989). In Malawi, under-fives with WFH < -2 SD (a cut-off point which, for this age group, corresponds to a level somewhat higher than 80 per cent of the reference median) were 3.4 times more likely to die during the coming year than those with WFH greater than -2 SD. Hence, it is not unreasonable to assume that in Sudan WFH < 80 per cent would carry a five-fold mortality risk for the months immediately following assessment.

Between October 1986 and July 1987 (a period spanning both pre- and post- harvest seasons), Sudan's Ministry of Health carried out three anthropometric surveys in each state.5 State-level results (averaged over the three survey rounds) show that during this period the percentage of under-fives with WFH < -2 SD varied from a low of 7 per cent to a high of 16 per cent (Ministry of Health, 1987). This range corresponds roughly to between 3 per cent and 10 per cent with WFH < 80 per cent of the reference median; the overall average for north Sudan during the period in question works out at 7 per cent < 80 per cent WFH.6 These values are shown in Table 1, together with the results of a number of surveys done in 1990 - 91. It is quite clear that in all provinces for which recent survey data are available, the prevalence of malnutrition was markedly higher in 1990191 than in 1986/87.

Given that in Sudan the mortality rate in the under five age group is normally 401 1000 per year (UNICEF, 1990), and assum-

ing that WFH < 80 per cent increases the risk of dying by a factor of five, it can be shown that mortality increases by about 25 per cent when the proportion of children with WFH < 80 per cent rises from 7 per cent to 15 per cent, and by 40 per cent when this pro ortion rises from 7 per cent to 20 per cent. Although such increases in mortality ought to give cause for concern, rises of this magnitude could easily go unnoticed in a place where mortality data are not routinely collected. The anthropometric survey results cited above, however, strongly suggest that in many parts of north Sudan child mortality rates did increase by at least 20 per cent during

F

1990 - 91.

Mortality estimates from other sources

Additional evidence from a variety of sources (summarised in Table 2) suggests that in some areas excess mortality due to food insecurity may have been considerably higher than the increase in malnutrition would indicate.

On visiting North Kordofan at the end of 1990, the WFP assessment mission had found 'some villages virtually deserted as families have migrated south' and reported that an estimated 14,000 rural people had come to the town of En Nahud, where the majority had ended up living in the bush surrounding the town (Winnubst et al., 1990, pp. 12-13). During 1991, however, large-scale population movements and camp formation were not widespread in north Sudan. This may be explained partly by the fact that in March 1991 there was 'an order from central government to all federal states to liqui- date camps for displaced population due to drought and famine by early July 1991' (UNDP, 1991, p. 3). Nevertheless, as of mid-June 1991, over 300 villages in North Kordofan were 'deserted because of shortage of water'; an estimated 76,000 people from North Kordofan were 'displaced . . .



TABLE 1 Prevalence of malnutrition in children under five*

SERlSS Surveys** October '86 -July '87 Surveys Curried Out in 1990-1991

Province < -2 SD (< 80%) Dute Agency < -2 SD c 80%

Khartoum Northern Nile Red Sea Kassala Blue Nile Gezira White Nile

North Kordofan

South Kordofan North Darfur South Darfur

14.2 13.0 13.3 13.9 10.0 11.8 6.7

11.2

10.2

10.9 16.0 15.6

7/91

12/90 10191

4/91 7/91

10191 11/90 10191 10191 3/91

MoH

MoH MoH

Concern Concern Concern

MoH CARE

FARlMoH MoH

17.7

31 .O 18.7

(15.3) (21.0) (21.0) 17.7

(20.3) 21.1 20.3

(11.4)

(21.9) (12.2)

9.0 14.0 14.0

(11.4) 13.3 10.9

(13.3)

*Because % < 80% median and % < -2 SD cannot be compared directly, equivalents have been estimated

**Sudan Emergency and Recovery Information and Surveillance Surveys; values shown are results averaged (see note 6) and are shown in brackets.

over three rounds.

due to drought and famine . . . and living in camps' within the region, while at least 10,000 (and perhaps as many as 23,000)

others had left North Kordofan heading either for Khartoum or the White Nile (UNDP, 1991, p. 3). Taken together, this

TABLE 2 Mortality estimates for 1991

DeuthsllOOO per year

Place Age Group Expected * Obsewed Source

El Obeid - drought camp < 5 40 76 MoH Um Ruwaba - village All 16 28 Villagers Khartoum squatter camps <1 107 240 MSF-H & SCC** Khartoum squatter camps 1-4 18.5 90 MSF-H & SCC** S. White Nile - villages <5 40 124 Concern

*Expected mortality rates are values given by (or calculated from) UNICEF (1990) **Medecins sans Frontieres (Holland) and Sudan Council of Churches



indicates that about 5 per cent of the people of North Kordofan migrated as a result of food insecurity.

The possible consequences of these population movements are illustrated by the following case study. In Septewber 1990, drought-affected families from rural North Kordofan began to congregate just outside El Obeid, on the same site they had come to in 1985 when destitution compelled them to leave their villages. Unpublished mortality data collected by the Ministry of Health during the first two months of 1991 show that in a camp population of approximately 38,000 people, children under five were dying at a rate of more than ten a week. Assuming that the under-fives comprised 18 per cent of the total camp population, this suggests a child mortality rate of more than 7611000 per year, almost twice the 4011000 per year that would be considered 'normal'. Although measles was the proximate cause of many of these deaths, food insecurity was clearly the reason for the crowded camp conditions which greatly exacerbated the measles outbreak.

Even the majority in North Kordofan who were able to remain in their homes may not have remained unscathed. One of us (MK) visited a village in Um Ruwaba province in November 1991. Although they were not asked about mortality, the residents claimed that during the year they had noticed an increase in deaths among small children and old people, and that recently there had been five or six deaths every month. There were 440 families in the village, and population figures for the Province put the average number of people per family at 5.4 (Sudan Ministry of Agriculture Representative for Kordofan, personal communication). This suggests a crude mortality rate of 2811000, which is 75 per cent higher than the 'normal' level of 16/1000 per year (UNICEF, 1990). Since it was not possible to obtain exact details of

recent deaths, the total village population and the age distribution thereof, this estimate must be considered tentative. Even if a fairly wide margin of error is assumed, however, it is likely that the mortality increase perceived by the villagers was a real one.

In September 1991, a survey by NGOs working in the squatter settlements around Khartoum showed that infant mortality was 24011000, which is more than double the expected level of 10711000 (UNICEF, 1990); mortality among children aged one to four years was estimated at 901 1000, more than four times higher than expected (van Bergen, 1991). These mortality rates were partly attributable to the effects of squalid environmental conditions and inadequate health care, but food insecurity was also an important factor. In Khartoum, as elsewhere in Sudan, food prices had risen dramatically, yet the displaced people living in the settlements had few employment opportu- nities, could not produce their own food, and were excluded from the government ration system.

Perhaps the best evidence of unusually high death rates comes from South White Nile Province, where child mortality data were collected by Concern in conjunction with their nutritional surveys (Supple and Morrison, 1991; Concern, 1991b). These indicate that mortality among under-fives was 12411000 per year, which is about three times the expected annual rate of 4011000.

To summarise, although the evidence cited in this section is fragmentary, it suggests that in many parts of north Sudan child mortality rose by well over 50 per cent during 1991; in some areas the rate appears to have more than doubled. In addition, it is likely that there was excess mortality among the elderly, although lack of data makes it impossible to come up with even a rough estimate of the magnitude.



HOW ACCURATE WERE THE EARLY WARNING AND NEEDS ASSESSMENT FOR 1990/91?

Although 7 to 8 million people in north Sudan were not - and never had been - at risk of death by starvation in 1991, excess mortality did occur; it went unnoticed, however, because there were few monitoring systems in Sudan which were able, or designed, to detect famine related deaths. Those agencies which had gathered evidence of excess mortality did not publicise it; indeed, a number of NGOs felt that documenting mortality would be politically unacceptable to the Sudanese government, which had vehe- mently refused even to countenance the terminology of famine.

In the absence of hard data on mortality, the belief that the crisis had been exaggerated gained currency among donor representatives, who could now claim that the shortfall in relief deliveries did not really amount to a failure, despite the abundance of unassailable evidence of widespread and severe malnutrition. Famine, meaning mass starvation, had not developed, because people had somehow 'coped' better than predicted.

This interpretation may have been motivated less by political cynicism than by failure to understand either famine, coping, or the bluntness of the food aid instrument. However, it is still a danger- ous interpretation because it misses the point about what really happened during the 1991 food crisis in Sudan. It fails to recognise that some 'coping strategies' were only partially successful, and that many had very serious and even fatal costs, especially for a population that had become increasingly vulnerable to drought and food insecurity over the few years that had passed since the major famine of the mid-1980s (Maxwell, 1989).

Failure to provide sufficient relief accelerated the downward slide on the

poverty spiral as assets were depleted and vulnerability increased (e.g. FEWS, 1991; FAO, 1991; Shutta and de Jonge, 1991~). A USAID assessment mission for 1992, for example, estimated that in Darfur approximately 40 per cent of livestock were lost in 1990/91 (USAID, n.d.). As well as increased destitution, great numbers of people were subjected to prolonged periods of malnutrition, from which they may never fully recover. These consequences are particularly worrying in Sudan, where almost all long-term aid investment in development has ceased, and humanitarian relief is the only form of international aid available.

Those who feel that the sole purpose of early warning and relief is the prevention of mass starvation may be justified in concluding that the amounts supplied to Sudan in 1991 were adequate and the needs assessment was too high. They are not, however, justified in concluding that everyone 'coped' and no-one suffered or died. Although famine mortality did not reach the levels threatened by the most alarming reports, it was almost certainly of much greater proportions than has generally been assumed. The donors' interpretation of events can therefore be turned on its head: the fact that a substantial number of excess deaths occurred despite delivery of half a million tons of relief food indicates that the international relief community failed to meet the needs of food-insecure people in Sudan. In other words, the original needs assessment was reasonably accurate.

SUMMARY AND CONCLUSIONS

Behind the establishment of most EWS is the implicit assumption that timely warnings of deteriorating food security will automatically lead to timely response. The reality is often rather different.

In Sudan, early warning proved incapable of triggering an adequate relief



response in the last half of 1990, or of convincing donor agencies that human suffering had reached unacceptable levels during 1991. The reasons were partly political, and partly bureaucratic. In Sudan in 1990/91, there were major political barriers tc galvanising both donors. and the governrlient of Sudan into action (although we have concentrated mainly on the donor side). Relations between the Sudanese government and western donor governments were at an all-time low, and early warning information became a pawn in political wrangling and negotiation.

Furthermore, despite expressions of support for the ideal of timely response prompted by early warning, the international relief system showed itself to be most responsive to evidence of a crisis already underway. Thus, when a realistic assessment of the situation failed to elicit the desired response, some disseminators of early warning information decided that their only option was to frighten the donors with the prospect of mass starvation.

Sensationalised early warnings had the intended short-term effect of instilling a sense of urgency into the relief operation, but the response still failed to meet the agreed targets. To some extent, these sensationalised warnings were counter- productive. They pandered to the notion that famine means mass starvation, and that Sudan was on the brink of it. This strategy back-fired when exaggerated pro- phecies were not fulfilled, and were used by donors instead to justify the sluggish- ness of their ‘purely humanitarian’ response. They did this by seizing on the fact that most of the millions identified as ‘at-risk‘ did not die despite receiving little or no relief food.

The ’obvious’ conclusion - that people had ’coped’ with food insecurity - allowed the early warning goalposts to be moved; only data showing excess mortality would have an impact. In effect,

’coping’ with acute food insecurity and famine was thrown back to the local people, who were already under a great deal of stress, despite all the public commitments to disaster preparedness and famine prevention. The kind of mortality threatened in the most alarmist reports did not occur. Instead, it served as a distraction: in the search for evidence of millions of famine deaths - the ‘mega- death’ syndrome - what had really happened during 1991 was overlooked. Within a population that was already vulnerable, asset depletion, impoverishment and malnutrition increased substan- tially; there was also excess mortality, directly and indirectly a result of acute food insecurity.

The data available indicate that mortality was considerably higher than is commonly assumed, and there are indica- tions that child mortality rates rose by at least 20 per cent on average, with increases of 100 per cent or more in certain areas. Although a deeper understanding of famine makes the question seem irrelevant and inappropriate, the predominant view of famine as mass starvation makes it necessary to ask how many people must die before famine is declared. In terms of mass death from starvation, famine did not occur in northern Sudan in 1991. In terms of acute food insecurity, increased mortality and impoverishment - conditions which have been described as famine before in north Sudan, in the mid- 1980s - the available evidence indicates that it did occur. The original needs assessment at the end of 1990 was probably, therefore, of the correct order of magnitude.

Although the establishment and operation of an EWS can be seen as a ‘technical fix’, a way of making famine prediction objective and scientific, this analysis has shown that the use and impact of early warning information is highly dependent on the political environ-



ment, as well as on the theoretical frame- work. Our findings strengthen the case for a clearer understanding of what famine means, and of what relief interventions can reasonably be expected to achieve. Also called for is a review of the concept of ’coping’, which is in danger of becoming an escape route for those at national and international levels who fail to respond adequately to food crises.

Despite the numerous studies that have contributed to our understanding of what happens during famine, the simplistic view of famine as mass starvation due to food shortage seems to prevail, at least within the international aid community. Aware of this, and knowing the com- plexity of the decision-making processes that must be activated in order to elicit a relief response, disseminators of early warning information may be tempted to simplify the famine message in order to send the strongest possible signal through the decision-making labyrinth, thereby triggering the ’usual’ and most straight- forward intervention, the distribution of free food aid. But this reinforces the logic by which the simplistic view of famine is perpetuated: if large-scale food relief is the solution, the problem is ‘obviously‘ one of mass starvation; and if mass starvation does not occur in spite of food insecurity, people are ’obviously’ coping.

The greatest danger of these over- simplifications is their failure to understand or acknowledge the costs - indeed, the failure - of various coping mechanisms. The very positive terminology of coping seems inappropriate to describe actions which can actually threaten the lives and well-being of individuals within a household, often young children. ’Coping’ is a rather indiscrimi- nate term, a catch-all phrase for both actions with positive outcomes which genuinely protect a household‘s food security, like long-term food storage, and actions with more negative outcomes

which may protect the household’s productive asset base at the expense of some of its members, for example, cutting back on food intake. The concept of ’coping’ needs to be refined and used with greater discrimination. A more generous interpretation is called for, which recognises and looks for the unintended and negative side-effects of ’coping’. A fuller understanding of ‘coping’ can then be used to find the most appropriate relief interventions, rather than to justify inaction and an inadequate relief response on the part of national government and international donor agencies.

Notes

Margaret Buchanan-Smith worked with Darfur Regional Government between 1987 and 1989. She returned to Sudan in December 1991 to carry out fieldwork for a collaborative IDSlSCF project on ‘Famine Early Warning and Res- ponse: The Missing Link?‘, funded by the EC and BandAid. Marion Kelly was a member of the World Food Programme needs assessment missions which visited Sudan in November/ December 1990, and again in November/ December 1991. She was seconded by the Save the Children Fund (UK). None of these agencies are to be held responsible for the views expressed, nor for any errors, all of which are ours alone.

We are grateful to Simon Maxwell, Susanna Davies and Helen Young for comments on earlier versions of this paper.

1. Anticoni, 1991; Christian Outreach, 1991; Concern, 1991a, 1991b; De Jonge, 1991a, 1991b; De Jonge and Shutta, 1991; FAR, 1991; Hassan, 1991a, 1991b; Ministry of Health Nutrition Department, 1991a, 1991b, 1991c; Shata, 1991; Shutta and De Jonge, 1991a, 1991b, 1991c; Supple and Morrison, 1991; van Bergen, 1991.

2. In fact, donors were extremely reluctant to supply any food commodities other than grain to Sudan in 1991, in spite of the assessment mission’s insistence that oil and pulses were essential just to provide a minimum basic ration. It is therefore



almost totally irrelevant even to mention supplementary feeding in this context.

3. Most of this section is based on Buchanan- Smith and Petty (1992).

4. For example, in The Financial Times of 111121 90, and in The lndependent of 15112190.

5. Round 1: October-November 1986; Round 2; January-March 1987; Round 3: May - July 1987.

6. During 1990-91, the Ministry of Health carried out over 150 sample surveys of WFH in children under five in the squatter settlements around Khartoum (MOH, 1991b). For each of these surveys, results were reported in terms of both percentage < -2 SD and percentage < 80 per cent median. Since there is a positive linear relationship and a strong and significant correlation (r = 0.96) between the two sets of results, the regres- sion equation has been used to estimate percentage < 80 per cent median for survey results that were reported only in terms of percentage < -2 SD, and vice versa.

7. If mortality rates are 31.211000 in children with WFH > 80 per cent and 15611000 (i.e., fivefold higher) in those with WFH < 80 per cent, mortality rates for the entire child population will be as follows:

% < 80% Mortality WFH per 1000

0 1 2 3 4 5 6 7 8 9

10 11 12 13 14 15 20 25 30

31.2 32.4 33.7 34.9 36.2 37.4 38.7 39.9 41.2 42.4 43.7 44.9 46.2 47.4 48.7 49.9 56.2 62.4 68.6

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Margaret Buchanan-Smith Institute for Development Studies University of Sussex Brighton BN1 9RE, UK


Northern Sudan in 1991: Food Crisis and the International Relief Response

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