Aid Continues to Ignore Host Communities

Summary of published paper^*

In June 1998 fighting between rebels and government forces in Guinea Bissau forced 300,000 inhabitants to flee the capital (Bissau). As many as 50,000 moved to villages in the nearby Prabis peninsula which previously had a population of less than 7,000. Most displaced people stayed with friends, relatives or strangers. At the height of the conflict, houses in Prabis had on average more than 100 inhabitants. The first relief activity implemented by the national health authorities was a rice distribution using WFP stocks in Bissau. This was distributed by the 'Bandim health project' team. However the food distribution was restricted to displaced persons only. Many local Guineans, as well as expatriate aid workers, thought this strategy was unfair as the whole community had been affected as a result of the displacement and needed support.

After three weeks of conflict members of the 'Bandim health project' in Bissau began surveying children aged 9-23 months in the Prabis peninsula. The overall aim of the survey was to study the effect of restricting food aid to displaced families only. Data were collected on vaccination status, MUAC and family levels of rice consumption, food expenditure and food aid receipts. Thirty clusters with 14 children each were selected including children from displaced and non displaced families.

Results

During the crisis there was a general nutritional deterioration and mortality was high. Rice consumption was higher in non displaced families compared to the displaced from Bissau but there was no difference in expenditure on food. Nutritional status was not associated with rice consumption levels in the family. The nutritional decline was significantly worse for residents compared to displaced children. Mortality rates were 4.5 times higher for resident children than for displaced children. Mortality for both resident and refugee children was 7.2 times higher during the displacement in Prabis compared with the period after the departure of the displaced persons. A profound improvement in nutritional status and mortality occurred for both displaced and resident children once the displaced had left, despite the fact that there was no improvement in food availability.

Discussions and Conclusions

As nearly all children under two are still breast fed and consume specially prepared porridges in Guinea Bissau it is unlikely that the general food distribution had a profound effect on survival of under-twos. Nutritional status seemed to be related more to morbidity. This is not surprising given the extreme crowding and unhygienic conditions that existed in the area.

No simple explanation can explain why resident people were affected more than displaced people. While it is true that nutritional status is normally better in urban than rural areas, the difference registered during the survey was larger than usual. This could have been related to differences between residents and the displaced in health and treatment practices and in disease exposure.

Food distributions affected displacement patterns, i.e. many people remained in Prabis to receive the expected food aid so delaying their return. WFP continued to distribute food in the interior of the country even though the 'Bandim health project' team transferred food distribution to Bissau in mid-August to prevent people living in the over-crowded and unhealthy conditions. However, UN safety regulations did not permit UN employees to stay in Bissau making it more convenient to continue the operation in the interior of the country. In the 'Bandim health project' area in Bissau all those who had gone to Prabis had returned by the end of August while many of the IDPs who had gone to areas where the WFP continued distribution had yet to return by October.

The study authors concluded with a number of points:

• in non-camp settings (common in the early phases of an emergency) displacement is likely to lead to increased crowding and deterioration in hygiene and consequently to increased morbidity and mortality for both residents and displaced people. It is therefore important to disperse concentrations of displaced people as quickly as possible
• In this case international agencies were clearly unaware of the risks of over-crowding as they insisted on distributing aid only to the displaced.
• the most important consequences of general rations may be the indirect effects on movements and social behaviour which have consequences for exposure to disease rather than the direct impact on nutritional levels
• humanitarian agencies should be aware of movement patterns and be capable of encouraging dispersal of populations when it is possible for them to return home by making food available in their home areas rather than prolonging displacement in over-crowded and unhygienic conditions.

^*Aaby. P et al (1999) Nutritional status and mortality of refugee and resident children in a non-camp setting during conflict; follow up study in Guinea-Bissau: BMJ volume 319, 2nd October 1999.