- EXECUTIVE SUMMARY
The World Food Programme (WFP) conducted an emergency food security and nutrition assessment in the Darfur Region of Sudan in September 2004 in collaboration with U.S. Centers for Disease Control and Prevention (CDC), Food and Agriculture Organization (FAO), UNICEF, Save the Children UK and USA with the support of Government of Sudan. The objectives of this assessment were to:
- Provide WFP and humanitarian partners
with data on the food security and nutritional status of the conflict-affected
population in Darfur.
- Estimate the prevalence of acute malnutrition
in children 6-59 months of age as well as the prevalence of anemia, vitamin
A, and other micronutrient deficiencies among children and their mothers.
- Provide an understanding of changes
in the profile of vulnerability of internally displaced persons (IDP) and
resident populations due to the conflict.
- Determine food security and nutritional
needs of the crisis-affected population during the last quarter of 2004
and for 2005.
- Provide the basis for contingency planning and a baseline for the humanitarian community to monitor the evolving situation.
Methods
The nutrition assessment was designed to statistically represent the known crisis-affected population residing in an area covering all three states of Darfur. The sample universe was taken from the most updated population figures of the crisis-affected population available from the United Nations as of August, 2004. At the time of the survey, this population consisted of 1.2 million internally displaced persons (IDP's) and 400,000 residents believed to be vulnerable. A two-stage cluster sampling method was used, and 55 clusters were randomly selected using a population-proportionate to size (PPS) method.
The nutrition survey collected data from 46 sampled clusters, covering 880 households with 5339 individuals, 602 mothers, and 888 children. Anthropometric measurements were obtained from 844 children and blood samples were drawn from a random sub-sample of 319 reproductive-age women and 429 children to determine the prevalence of anemia and vitamin A deficiency. Data was also collected on mortality using a seven month recall of household deaths.
The food security assessment followed the sampling of the nutrition survey but also added purposively selected sites from the WFP Annual Needs Assessment to better capture any differences in the food security situation of IDPs and residents. The food security survey covered 705 households in 56 locations throughout Darfur. Community interviews were also conducted in 18 predominantly resident sites, 21 IDP sites and 17 mixed IDP/resident sites.
Several variables were analyzed to assess the food security situation of resident and displaced populations. Building from the research work carried out by the International Food Policy Research Institute (IFPRI) on the use of dietary diversity as a proxy measure for food security, household food consumption data was analyzed to identify different levels of food (in)security and estimate percentages of households falling into different food security profiles. The analysis focused on three main variables:
- Dietary diversity, defined as number
of unique foods
- Weekly consumption frequency of selected
staple and non-staple foods
- Main sources used to acquire the selected foods
Data on food and non-food expenditures, income diversity, assets ownership and coping strategies were analyzed to further characterize the household vulnerability profiles and project -- together with crop forecast and market information -- the likely food security situation over the coming months.
In contrast to the analysis of the health and nutrition situation, food security lacks of a benchmark indicator. In order to estimate the extent of the problem and quantify the gap between the current and the "minimum" food security situation, a reference food consumption indicator was created. This indicator was built on the accepted notion that the typical minimum household food basket in the Darfur context should include cereals, beans, vegetable oil and sugar. Households lacking one or more of these commodities in their daily diet were considered to have inadequate access to food and thus face a food gap. This gap will be proportional to the number of missing staples and number of days not covered by their consumption. In order words, the fewer staples consumed and the fewer days these staples are consumed, the higher the food gap.
Key findings
For almost half of the households in Darfur, food consumption was found to be inadequate, that is, not meeting the minimum requirements for an active and healthy life. One in six households was severely food insecure with a food gap greater than 50% while twice as many struggled to meet minimum levels of food intake.
The prevalence of global acute malnutrition (wasting and/or oedema) was 21.8% among children aged 6-59 months [95% Confidence Interval (CI) 18.2-25.3]. This figure markedly exceeds the 15% threshold used in emergencies to define a 'serious situation'. Severe acute malnutrition (severe wasting and/or oedema) was present in 3.9% of children [95% CI 2.3-5.6]. Among children with moderate acute malnutrition, only 18% were enrolled in supplementary feeding. None of the children identified by the survey to have severe acute malnutrition were enrolled in therapeutic feeding. Measles vaccination coverage for children aged 9-59 months was also very low, at 66.7% [95% CI 56.8, 77.6].
More than half of children had anemia (55.2%) a condition that is often indicative of iron deficiency. Among non-pregnant mothers, anemia prevalence was 28.0%, and the prevalence of iodine deficiency among adult women, as determined by visible goiter, was 25.5%. The prevalence of diarrhea in children was 41.0% and acute respiratory infection was 18%.
The crude mortality rate (CMR) for the period February to August 2004 was 0.72 deaths/10,000 persons/day and the under-5 mortality rate (U5MR) was 1.03 deaths/10,000 persons/day. Both of these figures fall below the emergency benchmarks. Due to the different sample population and a different recall period, it would be incorrect to compare these findings with previous mortality surveys conducted in IDP camps, such as the recent survey by the World Health Organization. Data from this survey suggest that mortality is highly clustered. For example, although not statistically significant, mortality rates appeared higher among the displaced population compared with residents. The CMR was also found to be significantly higher for males than for females, whereas there was no significant difference between boys and girls under-5.
As in the case of mortality, food security averages too mask a marked difference between IDP's and residents. For example, while nearly half of the resident population was found to have the means to secure adequate food intake, the same was true for only six percent of IDPs.
By the time of the survey, food aid had reached 70% of IDP households and 20% of resident households in conflict affected areas. Food aid has ensured basic food intake levels for about half of the IDP households, while strengthening the food intake of another six percent to reach levels above the bare minimum. However, nearly one quarter of IDP households were found in a critical food security situation. Food aid had not reached 16% of these families in adequate amounts, and eight percent were not reached at all.
The food security situation for resident households was found to be strongly influenced by their exposure to the conflict and the presence of IDP's. Resident households hosting or residing next to IDP's were found to be the worst affected, followed by resident communities who had their livelihoods impacted by the conflict. In communities hosting IDPs food aid reached and ensured basic food intake for 31% of resident households while for another 24% food aid had strengthened their food security.
Households in residential communities have received limited amounts of food aid although the bottom nine percent would have been in critical need of assistance (fewer than 1 in 6 were actually reached with less than adequate amounts).
Given the reported loss of productive assets by a significant share of resident households (39% have lost animals and 18% grain stocks due to the conflict), a 40% reduction of planted area as compared to 2003, current food prices that are overall 60% above normal levels and sharply increased competition for wage labour opportunities due to a reduction of other income sources, coping capacities have already come under increased stress. A more up-to-date picture of the food security and nutrition risks ahead should result from the crop estimates and food gap calculations of the FAO/WFP Crop and Food Supply Assessment Mission in November/December 2004 and also from studies such as the on-going assessment of the crisis impact on livestock trade.
Conclusions
The findings of this emergency food security and nutrition assessment indicate that a serious situation exists in Darfur. High rates of child malnutrition are reflective of food insecurity, the poor health status of the population, and inadequate access to health services. The vast majority of the IDP population is totally dependent on international assistance given their loss of productive assets and income earning opportunities. However, food alone is not sufficient to reduce the prevalence of malnutrition. A basic minimum package of public health must accompany food and nutrition assistance.
With a poor crop year ahead the nutrition and health situation of the poorest decile of the resident population is at risk of further deterioration and the basic livelihoods for at least another decile is seriously threatened unless food and other assistance can be provided. An additional quarter of the resident population would require close monitoring as they fall slightly below the minimum food requirement and heavily rely on food purchases from the market. Also the environmental impact of the large scale population displacement and livelihood disruption will need monitoring as well as the food security impact of any continued disruption of trade routes.
However, there are also inherent dangers in protracted humanitarian assistance. As humanitarian services and stability of food supplies in IDP camps improves, these locations may soon constitute a pull factor where nutrition and health standards surpass the surrounding areas. Poor residents would be tempted to move into the camps. Thus parallel assistance to the poorest residents and the most affected (infrastructure, housing) residential areas must receive high priority.
Recommendations
Provision of life saving general food rations for an estimated 1.35 million IDPs in camps and in mixed IDP/resident locations with a predominant IDP population will have to remain the core component of humanitarian response to the Darfur crisis. (According to the sample survey, 6.6% or approximately 100,000 of the IDPs reside in predominantly resident or mixed communities where residents are the majority. Targeting these relative dispersed families is difficult. Moreover, the number of IDP households in these communities classified as having adequate food consumption due to own procurement is 2.5 times higher than in camps.)
The current general food ration will have to be adjusted to compensate for milling losses of sorghum and to address the lack of iodine and micronutrients in the diet. Sugar should be added in line with the local diet and the amount of salt to be doubled and distributed in small packets.
Given the global acute malnutrition rate well above the emergency threshold, blanket and targeted supplementary feeding for 270,000 under-five children (17%) and pregnant and lactating women (three percent) of the IDP population should complement the general food ration. Therapeutic feeding would have to be targeted to 10,800 severely malnourished children (four percent of under-five children). The continued need for supplementary and therapeutic feeding should be reviewed after six months of implementation.
The very high prevalence of diarrhea (40%) among children needs to be addressed through improved access to basic primary health care, water and sanitation. Water and sanitation challenges are greatest in mixed IDP/resident locations whereas the standards in most IDP camps have already improved due to the humanitarian effort. To prevent measles outbreaks health partners should immediately top up the vaccination campaign.
Assistance to highly food insecure resident households will require a dual track approach. Host populations in mixed IDP/resident locations should be targeted with general food rations (complemented by supplementary feeding for under-five children and pregnant and lactating women) based on registration and verification of their needs status through the local administration and aid agencies. According to the sample survey 93.4% of IDPs reside in settings (camps, mixed communities) where they heavily outnumber the resident population. The host population in these communities is estimated at nearly 200,000 people. In targeting needy resident households care must be taken to base this on the specific local conditions with priority given to rural locations and clearly demarcated urban neighbourhoods where IDPs outnumber the original resident population. Continued attention will be required to ensure that in these mixed locations resident populations do not receive the lion share of food assistance at the expense of IDPs. According to this survey, in mixed settings IDPs are slightly more vulnerable then the residents but have been less adequately reached with food aid (48% IDPs vs. 59% of residents received food aid).
The second track of assistance for the resident population most in need (i.e. the two deciles at the bottom) should be in the form of productive and preferably self-targeting food aid schemes. Residents impacted by the crisis have been calculated based on demographic data (estimating a non-IDP population for Darfur of 3.85 million) coupled with key informant information on the affected areas/populations (one quarter severely, another one third moderately) and the analysis of food insecurity categories (see above). In proposing target numbers for the food aid schemes informed assumptions were also made on existing implementation capacities and constraints in enhancing these.
- Food for work (labour intensive public
rehabilitation) for 30,000 households or 180,000 people.
- School feeding (rural and urban) for
150,000 children (initially 2/3 in the form of take home rations and the
rest as school meals).
- Food transfer programme for 50,000 vulnerable
(elderly, infirm) people.
- Outreach of the supplementary feeding programme to 50,000 resident children and pregnant/lactating women in the vicinity of IDP camps.
The aggregate target number of food aid beneficiaries until end 2004 is thus calculated to be 1.7 million. In 2005, with increased levels of targeted assistance to vulnerable resident households, including school children and a fully performing Food for Work programme, the target number should increase to two million people. Total food aid needs are approximately 34,000 tons per month. Additional food assistance targeted to selected severely affected resident communities is anticipated from agencies such as ICRC. This assistance may cover some 200,000 of needy residents.
Targeted food assistance will be difficult organize and not even necessarily appropriate for another quarter of vulnerable residents who are currently affected by the high food prices. With the very poor harvest expected in many areas of Darfur and the resulting food availability gap, these households would be likely to further slip in their food security status. Open market supplies of sorghum as of early 2005 up to the next harvest will be an appropriate response. The magnitude of intervention requirements may range from as little as 5,000 tons to over 200,000 tons, depending on more reliable crop estimates and gap calculations of the FAO/WFP Crop and Food Supply Assessment Mission in November/December 2004.
It should be noted that the above numbers of populations in need of food aid are based on the situation at the time of the assessment i.e. during the first 20 days of September 2004. While the percentage figures and vulnerability profiles for resident and IDP households should have validity for programming in 2005, the absolute numbers of people in need may require adjustment more frequently depending on any new developments. Major variables to watch in this respect are any new displacement of people or their return to residential areas, the economic and livelihood impact of continued insecurity and the final estimates for the crop towards the end of the year.
Regular up-dates on changing needs and effects of the humanitarian intervention should be assured through establishing a system for on-going monitoring of food prices and flows, household food frequency and diversity, agricultural and livestock production and migration. Ad-hoc assessments, e.g. of natural resource depletion or nutrition may have to complement the food security monitoring system.
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