Dietary Assessment of Camp Refugees

Summary of published research¹

Mother breastfeeding twins in Mae La camp

Approximately 140,000 refugees from Burma (Myanmar) live in ten camps along the Thailand-Burma border. They receive basic food and relief assistance from the Burmese Border Consortium (BBC), as well as a variety of health and education services provided by various non-governmental organisations (NGOs). The food basket provided by the BBC is meant for short-term survival and it is assumed that refugees living in camps for an extended period should be able to supplement the food basket through some form of subsistence activity. The BBC's basic food basket includes rice, split yellow hulled mung beans, fermented fish, soybean oil, dried chillies and iodised salt, and averages 2200 kcals per person per day (children under five receive half the amount of rice, beans and oil).

A recent study set out to determine how the BBC ration is used, the ability of households to supplement the food basket, and the nutritional status of the refugees. The study was meant to provide information to assist BBC and other organisations in identifying appropriate amounts and types of food for long-term refugee situations.

The site for the study was Mae La Camp in Tak province on the northern border between Thailand and Burma. The camp has been in existence since 1995 and is home to close to 40,000 refugees. Space and water are very limited within the confines of the camp. Some residents find day labour in neighbouring farms, although the movement of refugees in and out of the camp is increasingly restricted by Thai border officials. Households established for one or more years with children under 15 years of age were sampled. A questionnaire was used to determine economic, food consumption, and dietary intake patterns. Foods consumed were weighed and measured using a 24-hour recall for the household unit and nutritional status was determined using scales and a measuring tape. In total, 182 households containing 1,159 people were surveyed.

Mae La camp where the study took place

The main findings included:

• Average household energy and protein intakes were 96.6% and 111.4% respectively, of the recommended daily allowance (RDA) for healthy Thais.
• Twelve percent of protein was derived from animal sources. Carbohydrate, protein and fat accounted for 84%, 9% and 7% respectively, of total energy. The intake of vitamins A, B1, B2 and C and of calcium ranged from 24.2% to 53.1% of RDAs.
• Among children under five, one-third (33.7%) were underweight, 36.4% were stunted and 8.7% were wasted. This compared unfavourably with Thai children under five from a reported NCHS survey in 1996 where just under one-fifth (18.6%) were under weight, 16% stunted and 5.9% wasted.
• Among older children, 41.2% of those aged 5-9.9 years, 31.5% of those aged 10-13.9 years and 19.9% of those aged 14-17.9 years were underweight. Over half (61.6%) of those aged 5-9.9 years, 51.6% of those aged 10-13.9 years and 51.5% of those aged 14-17.9 years were stunted.
• Among a sample of 345 adults, 18.8% were thin (Body Mass Index (BMI) 18.5-19.9) and 7.2% were very thin (BMI < 18.5).
• Examination for clinical signs of micronutrient deficiency found that among children up to 13 years, none had Bitot's spots, 5% had active angular stomatitis wounds, 7.6% had scars from previously active wounds, 9.2% had pale eyelids and 3.6% had pale fingernails. Among 7-13 year old children who were examined for goiter, 2% had grade 1 goitre.

The study concluded that although the refugees were able to procure some non-ration foods by foraging, planting trees and vegetables, raising animals and purchasing and exchanging ration foods for other items, the quantity and quality of these foods were not sufficient to compensate for the nutrients that were low or lacking in the ration. This contributed to a high prevalence of underweight and stunting. The pattern of stunting in children under 18 years reflects the long-term insufficiency of essential nutrients necessary for optimal skeletal development and growth. The rate of stunting among children aged 2-5 years was two to three times higher than that among children under the age of two. This might be explained by the excellent rates of breastfeeding in the postpartum period, so that infants have a steady supply of essential nutrients.

In response to these findings, the BBC is considering implementing a series of options to address the high proportion of carbohydrate and low proportion of animal protein and fat in the diet, as well as to improve the micronutrient balance in the diet. The options include implementing a comprehensive plan to support gardens and animal husbandry, fortifying or providing fortified foods in the food basket, and initiating nutrition education via existing community health workers and teachers.

¹Banjong O et al (2003). Dietary assessment of refugees living in camps: A case study of Mae La Camp, Thailand. Food and Nutrition Bulletin, vol 24, no 4, pp 360-367