Issue 16 Editorial

Failure to learn lessons from past experience is a recurring theme in this issue of Field Exchange. Alain Mourey, the long-serving headquarters nutritionist from ICRC, laments the continued practice of implementing emergency supplementary feeding programmes in the absence of adequate general rations. Alain describes his recent experience in Burundi where agencies rushed headlong into implementing emergency SFPs when what was really needed was a good basic ration for the affected population. One reason offered by Alain to explain what happened in Burundi was the over-specialisation of agencies such that no one was responsible for taking an overview of the situation and co-ordinating ALL necessary food security activities. Predictably, the nutritional status of the children at the feeding centres did not improve (and in many cases started to decline sharply). This was simply because there was insufficient food at home. Either the take away supplementary ration was shared by the whole family or those entitled to a meal at the centre (on-site feeding) did not receive enough food at home. The rate of re-admission also increased sharply, the centres became over-crowded and the food supply could not keep pace with the influx. Frustration amongst feeding centre staff was high and the 'beneficiaries' became quite desperate.

MSF Holland's experience in Maslakh camp for drought and conflict affected IDPs in Western Afghanistan during 2001/2 is also described in this issue. Saskia van der Kam highlights the failure to set up an adequate food distribution system in the camp resulting in exclusion of some from the system. The extent to which this was a cause of the apparent deterioration in nutritional status for those residing in the camp for long periods is unclear as an analysis of the health and care environments was not included. Food was however being poured into the camp for far larger numbers than actually existed. Arguably, the politicised nature of the camp should have given a clear lead a lot earlier for establishing a distribution system which could not be abused by more powerful groups, i.e. food distribution to household heads. Once again it appears that lessons from the past may have been drawn on earlier. It is only eight years ago that international humanitarian agencies witnessed the appalling effects of inequitable food distribution systems in the Rwandan refugee camps in Zaire. In this instance, the highly politicised nature of the camps meant that certain groups, including female headed households, received very little food while others received up to 10,000 kcals per person per day. It was only after changing the food distribution, so that rations were allocated to household heads rather than representatives of groups of households, that nutritional status started to stabilise and improve. On the positive side for Maslakh a recent survey has shown minimal malnutrition. Whether this is due to the change in distribution policies i.e bread is made in bakeries and distributed daily, or due to the massive outflow of refugees back to their areas of origin, is unclear.

In the research section we carry the findings of a study carried out by a WHO intern to determine the awareness and progress in the field on detecting and/or preventing micro-nutrient deficiency outbreaks in emergencies. The study found that agencies lack capacity to diagnose mild and moderate states of deficiency disease. Also, very few agencies actually monitor the food basket amongst refugees and IDPs with particular reference to risk of micro-nutrient deficiencies.Yet the need for assessment and monitoring of the nutritional content of food baskets has been acknowledged and widely proclaimed in international fora from as far back as the 1980s when largescale outbreaks of scurvy and pellagra affected refugee populations in Somalia, Malawi and Zimbabwe.

The address at the symposium on Nutrition in times of conflict and crisis, at the 29th ACC/SCN session given by Austen Davis, General Director of MSF Holland, in Berlin earlier this year, may offer some explanation for our seeming inability to learn lessons and translate these into more effective programming. Austen asserts that the humanitarian imperative is all too frequently tainted by political agendas. However, this can only be part of the explanation. Agencies seem to be devoting more resources to documenting experiences so that lessons can be learnt - indeed Field Exchange was set up specifically for that purpose.Yet there appear to be other impediments to translating lessons gleaned from hard experience into practice.

In the recent emergency in Afghanistan, the high turn-over of agency expatriate staff, lack of effective co-ordination, the mistrust amongst NGOs, UN agencies and donors and the proliferation of new players have certainly not made for an ideal learning environment. There have also been additional impediments to implementing best practice e.g. the harsh physical environment, the political manipulation of humanitarian space and the unstinting efforts to manipulate the system by powerful groups and needy people. But such explanations are impressionistic and not backed up by 'evidence.' Surely it is time for a more systematic exploration of why the 'humanitarian community' seems to be such a slow learner and what can be done in the short-term to rapidly strengthen field level learning. It may well be time to try out some new ideas like the 'on-site learning offices' being proposed in certain quarters. It is certainly time that editorials such as this became redundant.