Letter on 'silent emergency' in India, by Rita Bhatia

Geneva Foundation
Patrick Brooke
Janice Pritchard-Jones
Joseph Gettier

Dear Editors,

Having read issue 4 of Field Exchange I wish to comment on the article "Novel methods of food for work".

It was a surprise to me to read that an agency getting involved in a rehabilitation programme would start a project without having secured the necessary funds, thus compelling the field staff to deploy a great deal of ingenuity (very commendable, to be sure) and time in order for them to get the means to get on with the job. What is even more surprising is the fact that having secured money, they still pay their workers in kind, namely food. It has been the practice of many agencies the world over to pay their local staff by the means of food for work.This practice is in my view only justified in certain exceptional circumstances, e.g. Cambodia in 1980 when the country had no legal tender and the markets offered nothing that money could buy. Other than in such like situations, I believe this practice as unfortunate and even harmful. The food for work schemes imply that the human being is solely a biological being (needing to be fed ) and ignores that humans are also social and cultural beings who require a certain amount of material means to fulfil their social and cultural needs.

These needs may take second place at the height of a crisis but, two years after the event? Article 23.3 of the Universal Declaration of Human Rights states that "who ever is working is entitled to remuneration that is both equitable and satisfactory, assuring him and his family an existence in conformity with human dignity" Where is the dignity of a person who is held in such a state of dependency (or should I say subservience?) that he cannot set his own priorities, cannot make free choices and decisions. Decisions are made for him. He has to eat his 'income', all of it, and to add insult to injury, he cannot even choose his food! Many agencies voice their concern as regards the dependency that often appears in the wake of humanitarian actions. But it is hypocritical to advocate for 'independence' whilst practising food for work schemes. Many a country emerging from war finds itself with a shattered economy, in dire need of rebuilding and stimulation. Food for work schemes make no input at all. The food distributed will be imported from Western Europe or the USA thereby resulting in the funds earmarked for relief/ rehabilitation staying in the donor country

Food for work schemes contribute to the undermining of the farming community. Local foodstuffs are devalued and farmers find difficulty securing a price to pay for their harvest. In the aftermath of major crises, it is often that humanitarian agencies are the sole employers with resources in an otherwise depressed labour market. Whilst post war rehabilitation should emphasise the revival of systems (health, justice, education, etc), the repair of physical infrastructure offers an opportunity to provide people with paid work rather than assistance. Money is fungible and will produce a ripple effect by which the shopkeeper and the craftsman etc. will benefit from wages paid. But for this to happen, it requires that people are paid in money, not food. Finally, an individual paid in kind will be unable to build up some reserves to protect himself from further vulnerability.

In short, whilst food for work may sometimes be an acceptable practice in the midst of a life threatening crisis, to keep a fellow human being, who has provided a good day's work, at a mere subsistence level, in the phase of rehabilitation, is unworthy of a humanitarian organisation.

Yours, etc,

Elisabeth Nyffenegger
Geneva Foundation
6, Route de Ferney
Geneva, Switzerland
e-mail: gf@iprolink.ch

Dear Editors

I would like to say how difficult it is to recruit experienced Nutritionists for emergency programmes. When emergencies die down you cannot move without coming across a nutritionist eager for employment. When an emergency hits the headline you cannot see them for dust. Yet there is still a demand.
Is it that there are only a few nutritionists with this type of experience or is it that we do not know where to find them or where they look for jobs? Are the agencies criteria too excessive?
Recently I have been looking for Food Monitors for Sudan for Oxfam/WFP; a Senior Nutritionist for Sudan, Oxfam; Nutritionist for Sudan, Christian Aid; Nutritionist for Tanzania, Oxfam. I also know that Merlin are experiencing the same difficulty and this must be the tip of the iceberg.
Can your readers shed any light on this?

Yours, etc,

Patrick Brooke
International Health Exchange, 8-10 Dryden Street, London WC2E 9NA
E-mail: info@ihe.org.uk

Sudan Dilemma - Who Gets To Eat ?

Dear Editor,

I have just returned from an emergency response contract based at Ajiep, in the Bahr-El-Ghazal region of Southern Sudan. The situation is disastrous. Food provision was a logistical nightmare. The area could only be accessed by planes, which were in short supply. Heavy rains further compounded problems of access leaving airstrips frequently unsafe for landing.
We simply did not have enough food to provide a supplementary ration to all those who needed it. Every day I was faced with the decision as to who should receive these scarce resources. The crux of my dilemma was in deciding whether food should be targeted at the most severely malnourished, or at moderately malnourished individuals.
I would be interested to know what others have done in similar situations of severely limited food stocks. Should we provide food to those at greatest risk of dying and with the poorest prognosis, or should we be attempting to rehabilitate those who are less at risk and have a better chance of survival ?

Yours etc,

Janice Pritchard-Jones

This sort of basic dilemma has faced aid workers repeatedly over the past two decades. When resources are scarce for whatever reason there is a decision to make on who and how to target. Some agencies tend to respond to this dilemma by targeting food and medical resources to the most severely malnourished many of whom have a poor prognosis and others to the moderately malnourished who are more likely to survive. This is a difficult decision to make as those who are not targeted run a high risk of dying. Some reviews of emergency feeding programmes have highlighted this cruel dilemma in extreme famines but emergency feeding guidelines still fail to address the issue. In short the triage approach to emergency nutrition situations remains poorly developed. Perhaps the lack of progress on this has been due to a reluctance to accept the shortages which force field workers to negotiate such decisions or simply the reluctance to accept responsibility for making decisions about who should live and who should die. The reality is that shortages do occur, decisions must be made and field workers should not be left alone in isolation to make these decisions. More could be done to achieve consensus and develop guidelines on this issue. (Eds.)

Dear Editors,

I saw Field Exchange for the first time today. I was much impressed by its content and intent to inform the field and to share feed-back concerning field views and reactions. A much needed and important publication, if 25 years of from-the-field perspective serve.

I would like to offer comment on a specific issue, namely the No. 4 (June, 1998) Issue's Research Section article, "Sale of Food Aid: A Sign of Distress not Excess". While acknowledging the professionalism and intensity of Drs. Reed and Habicht's nutritional research, I find it surprising that, at least in the Field Exchange's summary of the published paper, there was no mention of the possibility that diversion of food by political/military groups may have detracted significantly from the nutritional well-being of refugees in and around Uvira.

Concept: HCR was able to launch a head-count in the Uvira Refugee Camp in 1996, one which reduced the actual estimate of the refugee feeding caseload in the camp by about 32%. It is fairly well-established that the Interahamwe and ex-FAR "taxed" camp inmates at will in the Great Lakes refugee camps.
Quick sale and export of extorted corn and oil proceeds were easily done given Uvira's location by Lake Tanganika. As UN rations were reduced to reflect lower headcount totals, surplus food distributions were halted. The Interahamwe and the ex-Far were compelled to dig deeper into refugees' rations to maintain a required level of income. Hence, the perceived inadequacy of UN rations and subsequent suffering of the Uvira Refugees. Refugees in actuality had little to sell or barter after "taxes" were paid to armed "refugee" bullies. End Concept.

The researchers conclude that,"The fact that more than three-quarters of (Uvira Camp Refugees) did not have sufficient diets and that rations were reduced because food sales (in local markets) had been misinterpreted by donors and responded to by WFP is disheartening".
There was never an inadequacy of donor response to HCR and the WFP in the Lakes Crisis of the era. The World Food Program was quite correct in effectively limiting the depredations of in-camp terrorists by reducing amounts of excess food that the ex-Far and Interahamwe genocidalists could tax and skim, presumably to pay militia, buy arms and perpetuate warfare.
Donors did not react to the presence of food in local markets and demand cutbacks. In fact, the donor of 70% of the food aid distributed in the Lakes Camps recognises that refugee bartering of rations for other necessities is a common and ineluctable occurrence, one of little note or consequence.
Drs. Reed and Habricht may have overlooked the impact of in-camp politics, the raw power and ruthless aims of the forces then at-large in the Uvira Camp of 1996. Refugee camp nutrition is not a stand-alone science; politics as well as economics should be weighed in any assessment of what really causes refugee malnutrition. Western tendencies to paternalism put aside, research into what varying groups among refugees themselves cause should be considered in future H&N assessments.

In Uvira of the day, sinister elements among camp refugees may well have been the efficient cause of malnutrition sampled by the researchers.

Yours etc,

Joseph E. Gettier