UNHCR mounts programme to combat malnutrition among Sudanese refugees

BAHAI, Chad (UNHCR) - The women came dressed in the bright green, yellow, blue, orange and red printed robes of their native western Sudan, creating a kaleidoscope of colours that contrasted sharply with the monotony of the surrounding desert. They waited and talked in the shade of the holding areas, children in tow. The Oure Cassoni refugee camp extended around them as far as the eye could see, its hundreds of tents an amber colour as a result of the frequent sandstorms.

The more than 5,000 women and children had come to receive a supplemental food ration that marked the start of a major programme by UNHCR and its partner World Vision, together with the World Food Programme, to combat alarmingly high levels of moderate malnutrition and severe malnutrition among refugee children from the western Darfur region of Sudan.

While they waited, aid workers scurried setting up an elaborate system to screen those eligible for the supplementary feeding - all children under five years old as well as pregnant and lactating women. A violent sand storm the previous afternoon had halted preparations, and now refugee women were frantically trying to make up for lost time, mixing the corn and soya blend with sugar and sunflower oil before putting it into plastic bags. The bags were then weighed to ensure that each child received 4.5 kg of the vitamin- and mineral-enhanced ration that will be renewed every two weeks.

"If we hadn't had the sandstorm, we would have least 3,000 bags ready," explained Michel Toko Puku of World Vision, UNHCR's operating partner in the project.

The programme that began at Oure Cassoni last Saturday is scheduled to last five months and benefit more than 50,000 refugees, the majority of them children under five. UNHCR moved quickly to put the blanket supplementary feeding in place after a joint study in June found high levels of malnutrition (up to 39 percent) in three of the nine refugee camps in eastern Chad and one area along the border where refugees had not yet been relocated to a camp, as well as among the local population. The survey was carried out by the Centers for Disease Control and Prevention in Atlanta, together with UNHCR, WFP, UNICEF, WHO and Chad's Centre National de Nutrition et Technique Alimentaire.

The study recommended immediate corrective action to avoid increases in serious illness and death. Recommended steps included increasing and expanding supplemental and therapeutic feeding programmes, increasing the general food ration provided by WFP for the entire refugee population, expanding measles vaccination, increasing treatment and prevention of diarrhoeal diseases, and increasing water, shelter, sanitation and health services. In late July, UNHCR and WFP sent senior nutritionists to Chad to follow up on the implementation of the recommendations and put in place the arrangements for the blanket supplementary feeding.

Three-and-a-half-year-old Hessen was one of the thousands of children who benefited from the programme at Oure Cassoni. Two weeks ago he began having diarrhoea, was vomiting constantly and weighed only 10 kg. "My child is very sick but he is getting better," said his mother, Seida Jaber. "I am hopeful because they have enriched milk and cooking oil here, but there is no meat because there are no animals."

Hessen, who arrived at the camp with his mother and twin brother Hassen one month ago after hiding for several months in the mountains and dry river beds known as wadis along the Sudanese-Chadian border, is starting to walk again. His weight has gone up to 11.5 kg since he arrived at the camp, but he still looks small for his age.

Jaber and many other mothers at the camp told the same story. In Sudan, they said, their children had plenty of meat and milk, but the gruelling trip to the border, often on foot, took its toll. There was little milk available, and many women said they can no longer breastfeed their children as a result of the psychological traumas they have suffered.

As is the case with many women, Jaber said her husband disappeared when the Janjaweed and regular Sudanese army troops attacked her village. "I have not seen him since," she said. The 19-year-old mother and her two young babies made the one-and-a-half-month journey alone, walking to Chad after their only donkey died.

The battle to combat malnutrition involves more than just extra rations. Under the programme, women will be given advice on breastfeeding and on how to efficiently utilise the food they receive. One of UNHCR's major goals is to increase food hygiene to prevent diarrhoea and other illnesses. Humanitarian workers also plan to take advantage of the programme to vaccinate the children they missed during previous campaigns against measles and polio, which have already increased the measles vaccination coverage to some 80 percent.

"It's an ambitious programme but we think that it presents an opportunity for us to be in touch with the target groups," explains Jean Paul Habamungo, a nutrition specialist with UNHCR based in Abéché, Chad. "Our principal objective is to prevent severe malnutrition."

Despite the sand storm, some delays in food deliveries, and the normal start up problems, the food distribution at Oure Cassoni went smoothly, a good omen for the upcoming programmes scheduled for the Breidjing and Iridimi camps. "Once the machine starts to work you can process 7,000 people in a day," said Nicholas Wasunna, an emergency officer with World Vision.

After waiting in the tents, the children passed under a measurement bar to check that they were indeed under five years old based on the 110 cm standard set by the World Health Organization. The women and children then walked on the sand down a cordoned-off corridor to another checkpoint. Here they were marked with an indelible ink while health workers measured their upper arm circumference with special meters.

If the measurement shows green, the child is eligible for the supplementary feeding. A red measurement indicates acute malnutrition and the child is then weighed and measured before being sent to a special therapeutic centre to receive daily care.

The blanket feeding is bolstering measures already taken by UNHCR and its partners, such as improving water supplies, increasing measles vaccination coverage, and deploying additional health and nutrition experts. The refugees included in the June survey who had not yet been relocated to a camp have now all been moved to Oure Cassoni, where they have access to shelter and purified water.

More work still needs to be done, however, particularly to find additional sources of water in this harsh desert environment. Meanwhile, refugees continue to come on foot from the border to the camps, straining the existing resources, while UNHCR is rushing to set up even more camps to accommodate all of those in need.

Dr. Basia Tomczyk, the CDC epidemiologist who led the June survey team, said in a press release on the final survey results: "The good news is that public health intervention now would save children's lives." The blanket feeding is a major part of the urgent interventions which are now well under way.

By Eduardo Cue in Bahai, Chad