Household Food Economy Assessment in Kakuma Refugee Camp

Based on SCF (UK) field team experience in Turkana District, north west Kenya. Report by Mark Lawerence, Tanya Boudreau and Alexandra King summarised below.

Over the past five years SCF UK have been working on a research programme to develop a famine early warning tool called Risk Mapping. Part of this work has involved the development of a method for investigating how refugee families survive once conditions have stabilised. The method which is known as the Household Food Economy Analysis can be used for assessing food needs. In October 1996 SCF carried out an assessment using this approach in Kakuma refugee camp on behalf of WFP/UNHCR Kenya. The assessment pinpointed an unusually high incidence of severe anaemia in the camp, particularly amongst 8-20 year old males. The nutritional vulnerability of this group raised a number of interesting issues about emergency food aid planning. It also highlighted the need for improved understanding of camp population economies. The following is a summary of the main findings of the SCF food economy assessment.

Kakuma Camp

Kakuma refugee camp is located in Turkana District of north-western Kenya, 95 km south of the Sudanese border. The camp was established in July 1992 to accommodate an influx of refugees into Lokichokio from southern Sudan. The influx followed the Government of Sudan's offensives against a number of key Sudan People's Liberation Army (SPLA) strongholds. Refugees have continued to arrive due to refugee camp closures in Kenya and continuing conflict in southern Sudan.

The General Ration and Other Food Sources:

All groups within the camp still remain heavily dependent upon the general ration as their main source of calories as there are hardly any realistic alternative sources of food. Insufficient access to land and the locally very unreliable rainfall mean that, except for a minority who can cultivate vegetables within the camp boundary using waste water from the camp taps, the majority of refugees cannot cultivate any food. Also, hostility from the neighbouring Turkana prevents the refugees from keeping livestock and there are no significant local sources of employment. The hostility from locals also prevents attempts to leave the camp area in search of firewood, effectively blocking a source of income while limiting the collection of wild foods.

There are unusually large numbers of young people in Kakuma camp, particularly males in the 8-20 age range. This has led to the creation of 20 primary schools for a registered school population of 16,500 out of a population of 33,707.

Amongst the 8-20 year olds there are 3,000 unaccompanied minors (now 15-19) living under an NGO group care programme. Many of these boys trekked from Ethiopia through southern Sudan to Kakuma during 1991 and 1992. This group now face a deficit in their food intake of at least 20% as their energy needs are a minimum of 2,200 kcals/day which is not being met by the 1,900 kcal per capita general ration. Caloric intake is further reduced as they need to sell part of their ration for items they are not provided with, e.g., firewood, clothes, etc. There are another 5- 6,000 boys living outside group care whose energy requirements are also not being met by the general ration.

The Anaemia Problem

Although data from nutrition surveys generally show an adequate nutritional status in the camps (prevalence of wasting less than 7%), data from health centres show a significant and long-standing problem of very severe anaemia (less than 4gms % of haemoglobin) particularly, and rather unusually, affecting teenage boys. This is probably caused by a variety of factors including malaria, intestinal worm infestation and the very poor micronutrient content of the diet which lacks absorbable iron and vitamin C. The peak in the incidence of severe anaemia towards the end of the long dry season, when vitamin C is in shortest supply, suggests that the lack of vitamin C may be a particularly important factor (vitamin C significantly enhances iron absorption from the diet). The fact that the peak incidence of anaemia does not occur towards the end of the main rains, when one would expect malaria to be most prevalent, suggests, that malaria is not a main cause of the problem.

Unaccompanied minors may be especially vulnerable to anaemia as they do not have enough access to green leafy vegetables available within the camp. The general ration, which comprises a mixture of milled and whole grain cereal, (either wheat, maize or sorghum), a pulse, vegetable oil and salt, is grossly deficient in vitamins A, B2, C, B3 and absorbable iron. Most refugee families supplement their diet with purchases of very small amounts of milk, sugar, meat and vegetables. 'Kudra', a green leafy vegetable grown around the tap stands in the camp by a small proportion of the refugees, is sold in the market and provides a very important and affordable source of vitamins A and C. However, even Kudra is too expensive for most families to buy in sufficient quantities.

Incentive Payments and Ration Cards

The 1,500 refugee employees of NGOs working in the camp receive not a wage but an incentive, averaging 33 dollars per month. Incentives play a pivotal role in the camp economy. An estimated 35-45% of people live in households with at least one family member earning an incentive. Poor families (those with no direct source of incentive payments) and less poor families (those with the least direct income from incentives) are also heavily dependent on the incentives which are redistributed via gifts and the patronage of small businesses and petty traders. Unaccompanied minors without relatives in the camp have minimal access to incentive income.

The importance of incentive payments in the camp economy has grown in the past few months. This is largely due to the recent head count which greatly reduced the income obtained from the sale of surplus rations. The head count was implemented in August 1996 and brought the registered population down from 50,000 to 33,707. The limited available evidence suggests that the additional 16,000 ration cards were distributed reasonably 'equitably' throughout the refugee population. It seems likely that part of the extra ration was consumed and the remainder sold, providing a source of cash income which enabled many refugees to improve the variety, palatability and nutritional adequacy of their diet. The loss of this source of income means that the majority of refugees are now living more precariously. One means of getting an extra ration card was to 'recycle', that is, to return to Lokichokio and re register. Most or all of the recycling was done by the minors and was linked to the school term, i.e., they returned to Sudan during the school holidays and re registered on the way back to the camp.

The assessment team acknowledged that minors could probably solve the problem of their deficit themselves by 'recycling' to obtain additional ration cards over the coming months. But they put forward a number of arguments as to why this was not an acceptable solution; 'it would oblige them to run the risk of returning to southern Sudan and would also tend to keep them out of school', 'refugees should not be forced to cheat the system in order to survive' 'it would take at least 6 months for 20% over-registration to be achieved and for the deficit among the minors to be eliminated'.

Recommendations of the Assessment Team

In order to improve matters as quickly as possible, the following recommendations were made by the assessment team:

• To target additional food to the 3000 unaccompanied minors and 5-6,000 extra boys through a school feeding programme providing a mid-moming meal of 300 kcals/day to all school children.
• To rapidly establish an emergency programme for addressing the severe anaemia among teenage boys including the immediate provision of anti-helminthic drugs to all unaccompanied minors and the provision of iron and multi-vitamins including vitamin C to the same group.
• To provide mosquito nets throughout the camp and to conduct a rapid study of existing hospital records aimed at finding out whether the anaemia problem is largely restricted to these groups.
• To support efforts to cultivate green leafy vegetables around tap stands in the camps and to supply multi vitamin and mineral supplements to all camp residents in August (halfway through the dry season). Vitamin A fortified oil should be supplied on a regular basis.