A paper, presented at the Berlin symposium on Nutrition in the Context of Conflict and Crisis at the 29th session of the SCN, addressed the issue of disparity in the health and nutrition conditions of refugee and host populations in Tanzania.
The author described how the refugee operation in Tanzania aims at providing protection, care and maintenance assistance to about 500,000 refugees in 13 camps. The services provided include water, health, nutrition, food, shelter and sanitation. In the past, according to the author, the Government of Tanzania (GoT) has outlined the sacrifices made by local communities to host refugees at the expense of other risks to themselves. Such risks include insecurity, disease, poor nutritional status, scarce resources, environmental damage and land degradation. About one million local inhabitants live in the refugee-affected areas. They are comprised of subsistence farmers with very low income and relatively high malnutrition, morbidity and mortality rates. Poor farming practices are a major constraint to food production, coupled with poor road infrastructure and inadequate marketing systems. The proximity to refugee camps has influenced the prices of local foodstuffs, and has contributed to deteriorating security and destruction of the natural environment. Although donors continue to provide support for the refugee operation, the GoT bears the main responsibility for hosting the 500,000 refugees.
The health and nutrition situation in the refugee-affected areas, unlike the refugee camps, is a significant public health problem. Malaria, pneumonia and diarrhoea are the major leading causes of mortality and morbidity. The paper highlights the situation through a comparison of the similarities and differences between the refugee and host population, in terms of nutrition and health service provision and conditions (see table).
The author asserts that a number of constraints and dilemmas affect Tanzania's ability to respond adequately to this situation including:
- inadequate resources to support asylum
- increased insecurity and tensions between
the local population and refugees
- donor support is directed to refugees
while development support to refugee affected areas is given lower priority
- cross infections from countries of origin
to host population
- abrupt reductions in donor support which interferes with provision of basic services creating insecurity to the host population.
|Under-five mortality/1000/live births||54||137|
|Infant mortality/1000/live births||32||88|
|Neonatal mortality/1000/live births||11||32|
|Maternal mortality/100,000/live births||56||529|
|Child wasting, % <2SD||3.2||9.2|
|Special feeding programme||Available||Not available|
|Micronutrient supplementation||Available||Not available|
|Infant feeding in emergencies||- assessment done||- not done|
|- capacity building and community sensitisation||- capacity building and community sensitisation|
|Prevention of low birth weight (LBW) programme||Available||Not available|
|Nutrition survey||Conducted yearly||Rarely conducted|
|Control of malaria||Indoor spraying twice a year, community sensitisation||Only community sensitisation on use of insecticide treated nets|
|MCH services||- growth monitoring||- growth monitoring|
|- pregnant women receiving supplementary feeding and de-worming||- no supplementary feeding, no de-worming|
|Parasite control for children||Program available||No program|
|Water and sanitation||- water treated, safe and clean||- water not treated, not safe|
|- program for sanitation||- no program of sanitation|
|- latrine coverage >90%||- latrine coverage 30-40%|
|IMCI capacity building||> 80% of target||30-40% of target|
|HIV/AIDS program||Included in school health and youth programs||Included in youth programs only|
1 Ballart.A (2002): Humanitarian needs of refugees versus the chronic, although similar, needs of host population; the case of western Tanzania refugee camps. SCN News, vol 24, July 2002, pp 78-79.