Disparate responses to need in Southern Africa

By Gaëlle Fedida

Blanket food distribution in Bunjei, Angola, August, 2002

Since 1993, Gaëlle Fedida has worked in humanitarian aid in a wide variety of countries, including Croatia, Burundi, Cameroon, Congo Brazzaville and Afghanistan. Now based in Paris, she is in charge of the Food Aid Programme for MSF France operations. In this article, the author describes how recent experiences in Angola and Southern Africa have led her to challenge how the humanitarian community define and prioritise need in emergencies.

Since 1995, MSF France has had a food aid cell at their headquarters in Paris. The role of the food aid programme is to analyse underlying or complicating factors influencing MSF relief operations and, where possible, formulate operational food strategies. Areas currently under scrutiny include Sudan, Ethiopia, Kenya and Madagascar, where there is a recurring pattern of nutritional deterioration and, consequently, of MSF food aid intervention.

Despite decades of experience in dealing with famine, and increasingly clear insights into the political factors which often trigger mass starvation and mortality, a dominant conceptualisation of famine remains which relies on its explanation in terms of natural disasters (e.g. drought and HIV). It appears that political analysis still comes a poor second to the applied disciplines of meteorology and epidemiology, in terms of understanding causes and lack of solutions. This biased perception has implications for humanitarian interventions, and is reflected in our recent experiences and analysis of the Southern Africa situation.

The Angolan experience

Peace came to Angola in April 2002. As a result, MSF gained access to a population that had previously been held captive by the fighting. In several locations, early rapid assessments¹ revealed rates of acute global malnutrition as high as 30% to 35%, while severe acute malnutrition affected as many as 15%. With 4.5 deaths per 10,000 inhabitants per day in some areas (levels far above emergency thresholds), MSF rapidly expanded its programme to operate in 12 out of the country's 18 provinces. As a result, an estimated 1.5 million people (including 570,000 displaced) had access to MSF therapeutic, supplementary and blanket feeding programmes.

The political players in Angola were quick to congratulate themselves on achieving peace, and claimed to be supporting it with food aid distributed in the camps reserved for UNITA² fighters. Overall there were an estimated 85,000 demobilised UNITA fighters, together with 300,000 relatives, in 36 government-managed camps³. Given the major political importance of the demobilisation, these camps were the first priority when international aid distribution finally began - in July for the camps in the north of Huambo province. However, for the remainder in need - the thousands of civilians who did not have sufficient connection to the troops to be classified as "families of demobilised troops" - the wait was much longer (Sept/Oct, 2002). Indeed, some were still without food distributions at the time of writing this article (Nov, 2002). Furthermore, in the camps of Chiteta and Esfinge Fazenda where MSF are operational, food distributions did not occur monthly (more likely every 45 days), and distributed rations did not meet the standard 2100 kcal requirement.

The World Food Programme (WFP) did not mobilise emergency resources to meet the urgent and growing need, i.e. no emergency operation (EMOP) was initiated. Instead, the agency expanded its on-going programme (PRRO⁴), by 120,000 recipients in June and then by a further 80,000 in late October, when at least 500,000 individuals in appalling conditions became accessible.⁵ Past experiences demonstrate that there are other agencies capable of deploying parallel food pipelines alongside WFP, particularly when there are huge emergency needs. This was not the case in Angola and, in spite of the tardiness and inadequacy of response, the WFP were the only agency to increase the volume of assistance for this rapidly evolving crisis. Whilst MSF were not dependant on WFP for resources, the absence of an adequate food distribution network initially led MSF to deploy food aid (Unimix) to meet the obvious acute needs of the population.

The Southern Africa appeal

Blanket food distribution in Bunjei, Angola, August, 2002

At around the same time but further to the east, a number of food shortage alerts were made across the Southern Africa region, and in July 2002, the WFP launched an international appeal (EMOP 10200). Worth $507 million, they aimed to assist 10,255,880 people through a variety of food aid activities across the region, from Malawi to Lesotho, including Zambia, Zimbabwe, Mozambique and Swaziland. In Zimbabwe, the degree of economic and food insecurity did indeed reach alarming levels. However, in Malawi and Zambia, MSF did not encounter anyone starving to death. Although MSF was not operational in the drought-affected areas of Zambia, rapid MUAC assessments in the south did not reveal a problem. This view was later supported by nutrition surveys (MSF Holland) in May 2002, which found 3.5% global acute malnutrition (GAM) and 0.9% severe acute malnutrition (SAM) in the south, and 3.9% GAM and 1.2% SAM in the west⁶. Surveys conducted by Oxfam in July also showed nonemergency levels of wasting, ranging from 4.3-5.8% GAM and 1.2-1.9% SAM.⁷

In Malawi, the MSF therapeutic feeding centre in in Chiradzulu, near Blantyre, did not receive any more children than usual (30-50 admissions per month), despite a reactivated screening strategy. Furthermore, rigorous and large-scale nutrition surveys since show the prevalence of malnutrition remains largely below critical thresholds, despite the claim by many that the 'hunger gap' would start by August 2002. Yet, the WFP is expending considerable energy in opening a regional office and an emergency logistics centre in South Africa, and continues to mobilise international opinion and funders for an emergency operation. Indeed, donors are responding quickly to the famine in Southern Africa, with $362.7 million contributed to WFP since May⁸. In stark contrast, the WFP has received only $86 million for Angola since April 2002. Experiencing peace for the first time in years, Angola is expected to redirect its oil dividends from a war economy into social services for the well being of its population as, it is argued, "the country is rich."

Analysis of aid response

What are the factors that contribute to these famine alerts in southern Africa and ultimately, lead to such disparity of response in the face of evident need? One factor may be that the early warning systems, in operation since the 1980s and specifically intended to avert famine, are anchored in the national agricultural information systems. As a result, the most objective data are meteorological, whilst the agricultural data (estimates of cultivated cropland and of harvests) come from local ministries and are of questionable accuracy. For example, over a period of three weeks, MSF observed a 20% reduction in the official crop estimates for the 2002 agricultural campaign in Malawi, although Ministry of Agriculture field personnel had no means to conduct any studies within such a short time frame. Yet, this official information is used by relief agencies as a basis for determining the levels of food aid required. Questions must be asked about how and why this occurs.

The explanation may lie in a form of stakeholder analysis. For years, national governments have found it increasingly difficulty to obtain structural economic aid. Some donors have simply put an outright halt to such assistance because of poor governance, while agencies like the International Monetary Fund (IMF) have implemented draconian control mechanisms on authorities and demanded repayment of budget amounts that have, apparently, 'evaporated without explanation'. Under these circumstances, a national disaster is the ideal occasion to generate massive funds in a short time, and compensate for the shortfall.

Donor government response may be understood in a different way. Western governments have often been notoriously difficult to convince of emergency needs, even when a high prevalence of malnutrition can be demonstrated, such as in Sudan. In some instances, this has resulted in very restricted food baskets with limited amounts of cereal. The question, therefore, must be asked - why has there been such a readiness to respond in southern Africa, where most of the data suggests that nutritional status has not declined significantly? One explanation may be that donors are trying to create regional stability, through the injection of emergency funds into the countries bordering the explosive Zimbabwe.

The explanation regarding international nongovernmental organisations and United Nations agencies may be more connected with their substantial dependence on institutional financing. Declarations of "famine" are, therefore, a significant financial opportunity for them.

There are more questions than answers here, and demonstration or proof of the above hidden agendas cannot be given. Ultimately, the disparity in response between southern African and Angola undermines the credibility of humanitarian action in the region.

The 'humanitarian imperative'

MSF do not deny that it will be especially difficult for some families in the southern Africa region to meet their food needs this year, nor that we must respond to these needs. However, it is our responsibility to question the way these needs are analysed and identified, and the way in which operations are mounted in response. There is definitely a crisis, but how large is it? Nowadays, it appears that in order to raise funds, you have to use the word 'famine', and that such famines are conceptualised in terms of causes over which we have no short-term control e.g. AIDS and drought. Some causes may lie, more uncomfortably, closer to home. What about the responsibility of national governments to conduct a policy that ensures sufficient revenues for their rural populations? What about the sale of strategic grain reserves in Malawi and the disastrous agrarian reforms in Zimbabwe? We are presented with the indisputable argument of the 'humanitarian imperative,' which seems to mean that the 'needs' declared by authorities as arising out of natural disaster are invariably justified and therefore must be met by emergency assistance.

MSF conceives of the humanitarian imperative in another way. Needs must be evaluated in the field from an independent standpoint so assistance can be allocated impartially, i.e. according to priority needs. In 2002, this priority was clearly in Angola. Failure to make full use of good quality data, or to question data where quality is suspect, ultimately means that responses will be determined by the internal logic of organisations and institutions. This cannot be an acceptable modus operandi for the humanitarian community.

For further information, contact Gaëlle Fedida, Head of Operations, Food Aid Programme, MSF France at: email: gfedida@paris.msf.org

¹Early assessment data are from unpublished figures from MSF rapid assessments based on MUAC screening and new grave monitoring. Whilst not 'scientifically' valid methods of assessment (Ed), these data were considered to reflect observations on the ground which were later substantiated by elevated attendance at feeding programmes.

²Angolan rebel group, Unia O Nacional para a Independencia Total de Angola (UNITA).

³OCHA estimates.

⁴Protracted Relief and Rehabilitation Operation (PRRO)

⁵This figure is based on interviews with Eric De Mul, head of OCHA. A subsequent USAID situation report in July 2002 increased this figure to 815,000.

⁶Global and severe acute malnutrition rates using weight-forheight z scores.

⁷Oxfam surveys, July 2002: Choma: GAM 5.5 %, SAM 1.9 %; Monze: GAM 5.8 % , SAM 1.5 %; Mazabuka: GAM 4.3 %, SAM 1.2 %.

⁸WFP resourcing update, www.wfp.org