Operational value of anthropometric surveillance in famine early warning and relief: wollo region, ethiopia, 1987-88

In this article I examine the operational implications of the findings reported in 'Entitlements, Coping Mechanisms and Indicators of Access to Food: Wollo Region, Ethiopia, 1987–88' (Kelly, 1992). The usefulness of anthropometric and other indicators for early warning and relief planning in Wollo is assessed by comparing the findings of Save the Children Fund's nutritional surveillance programme with those of the Early Warning and Planning Service of the Ethiopian government's Relief and Rehabilitation Commission. Case studies are used to illustrate the value of anthropometric and other indicators for targeting relief food and monitoring its effects. The costs of monitoring various indicators are then considered, and the cost of the Save the Children Fund programme is compared with that of other programmes. It is argued that in Wollo, anthropometric surveillance is a cost-effective means of improving early warning, planning, targeting and monitoring.     

Malnutrition and Poverty in the Early Stages of Famine: North Darfur, 1988–90

In this article we report findings on the relationship between malnutrition and poverty during a period of acute food insecurity in Darfur, Sudan. Children of rich and poor families were equally likely to be malnourished, which is explained in terms of people's responses to the threat of famine. This finding has important implications for targeting interventions in the early stages of famine. Appropriate interventions at the early stages of famine are livelihood and income support to the most vulnerable. The entitlement theory of famine causation assumes that the poor are most vulnerable, and become malnourished and die during famines. In this article we show that this assumption does not hold. Even though poverty is the root cause of malnutrition, it does not follow that anthropometric status can be used to target individual poor families, or even that targeting the poor is appropriate in famine situations.     

Limitations of anthropometry during acute food shortages: high mortality can mask refugees' deteriorating nutritional status

Longitudinal comparison of anthropometric data from cross-sectional surveys is commonly used to assess nutritional status in relief operations. In a refugee camp in Sudan, assessment indicated a high level of childhood malnutrition, but nutritional status appeared relatively unchanged between cluster sample surveys in January (26.3% below 80% of median weight-for-height) and March 1985 (28.4% below 80% of median weight-for-height). However, in this interval, which was marked by irregular food supplies and relatively low energy (calorie) intake as well as by a high incidence of diarrhoeal disease and measles, nearly 13% of all children in the camp died. This deceptive appearance of stability in nutritional status in the face of high mortality may be explained by ongoing nutritional deterioration ("replacement malnutrition") among surviving children. These findings demonstrate that collection and analysis of mortality data are essential for the correct interpretation of anthropometric results during periods of uncertain food supply.     

Nutrition, Disease and Death in Times of Famine

In this article we review the relationship between malnutrition and mortality, and the interaction of morbidity, with the aim of clarifying the health risks of malnutrition in situations of famine and food insecurity. Apart from reviewing what is known about this relationship, we highlight areas where further research is needed. Among refugee and famine affected populations living in camps, there appears to be a close association between high rates of malnutrition and excess mortality. Results from communitybased prospective studies of malnutrition and mortality among individuals conclude that as nutritional status declines the risk of death increases, although the discriminating power of different nutritional indices and the strength of the association varies considerably in different locations and at different times. These differences are attributed mainly to the different prevailing patterns of morbidity and growth failure, which are influenced by both environmental and social factors. In situations of famine and population displacement, the deterioration in the health environment increases exposure to infection and is likely to raise the threshold of nutritional status which corresponds to an increased risk of mortality. This has important implications for nutritional assessments and interventions.     

Composite indicators for famine early warning systems

Traditional famine early warning systems use a host of indicators to predict food crisis situations, from rainfall and increased rate of marketing of household durables to the behavior of birds and animals. Although many of these indicators are valid in general, limited understanding of the sensitivity and specificity of the distress signals makes food crisis prediction a highly subjective exercise. In order to make the system more effective and credible, we need to identify a limited number of 'composite' indicators, which naturally summarize most relevant food-related information contained in the specific predictors of food crisis. Considering the chronology of the food production and consumption chain, three composite indicators specific to three different stages of the chain have been identified. The satellite data based Normalized Deviation of Vegetative Index (NDVI), prices of major food grains, and malnutrition rates are found to be correlated not only with the quality and quantity of inputs of this process but also with the final outcome. Both NDVI and price data are widely used as important predictors of food crisis by famine warning systems. What we have demonstrated is that improved sensitivity of the indicators is likely to be due to their inherent capability of summarizing information from various specific measures. Child malnutrition rates also summarize inputs and outputs of the food consumption process very effectively, and therefore should be able to predict community level food crisis in an efficient manner. The empirical results confirm this conjecture by showing that malnutrition rates can predict food crisis probability three months into the future with a high degree of specificity. The use of 'composite' indicators not only simplifies the problem of aggregation, but is also likely to yield forecasts that are highly specific and sensitive.     

Entitlements and the Wollo Famine of 1982–1985

The traglic recent events in Ethiopia and other parts of Africa have again foccussed attention on the different anaytical approaches to the problems iof famine. Perhaps the most important analytical contribution to this field has been Sen's "entitlements approach." One of the case studies Sen used to articulate this approach was of the 1972–1973 famine in Wollo Province, Ethiopia. This article provides a provisional assessment of the famine process in the Wollo during 1982–1985 to set against the analysis by Sen of the earlier famine. Some striking contrasts are revealed.     

Coping strategies developed as a result of social structure and conflict: Kosovo in the 1990s

The end of 1989 brought with it political and economic decisions which resulted in Kosovo being stripped of its autonomy and the Albanian population being expelled from their jobs. These facts combined with ethnic tensions created a decade of conflict and oppression affecting hundreds of thousands of innocent civilians. Thousands of Kosovars moved overseas to seek work to support families at home, altering the way of life of the population of Kosovo irredeemably. The loss of income had serious repercussions on food security throughout the 1990s; possibilities of purchasing food were diminished, control on goods in 1998 reduced availability of foodstuffs, conflict affected accessibility to markets and shops and consequently food intake and nutritional status was compromised. The most vulnerable were those who had no family members overseas. Mass displacement of population due to ethnic cleansing during the war of spring 1999, further jeopardised food security status. Destruction at this time rendered large parts of Kosovo useless and resulted in a shift in the determinant of vulnerability in the post-war period: destruction of houses, land, livestock and agricultural products as well as loss of family members, became a far more pertinent indicator of food insecurity. The strong and clear links between conflict, socio-economic issues and food security are highlighted and discussed in this paper.     

The role of socio-economic data in food needs assessment and monitoring

This paper reviews six case studies examined as part of a project to review targetting methodologies employed by non-government organisations in Africa during the 1984-6 food crisis. Most agencies have not yet fully evaluated the role of data in informing policy decisions during their respective emergency programmes. The case studies presented reflect a wide variety of approaches to targetting emergency food aid that are based largely on the use of 'socio-economic' data. The recent emergency relief operations in Africa seem to indicate a change in relief agencies' approaches to the assessment and monitoring of needs of the affected populations. Earlier dependance on nutritional data has given way to an increasing reliance on the use of socio-economic indicators. There was a wide variation in the case studies of the type of indicators collected and utilised in needs assessment and monitoring. There were those who relied almost exclusively on nutritional data to target resources during the 1984-86 African crisis, and others whose experiences during that period lead them to attach more weight to socio-economic data. Other agencies appear to have recognised the problems of relying solely on nutritional data to target food aid during their 1984–86 emergency programmes, and thus more or less abandoned classical anthropometric surveys in their needs assessment and monitoring methodologies during this period. Thus nutritional data has a less significant role in the decision making process than previously had been the case.     

Continue to blame it on the rain? Conceptualization of drought and failure of food systems in the Greater Horn of Africa

Food insecurity continues to be prevalent in parts of Africa. In December 2015, there were approximately 21.6 million food insecure people in the Horn and East Africa. Climate change is likely to exacerbate current volatility of agricultural production and lead to further food insecurity. Whilst the academic literature has acknowledged the complexity of food insecurity and systems, it is not clear to what extent this has been translated into practice. We argue that there is a tendency to explain complex failures of food systems as ‘droughts’, with insufficient attention paid to other drivers. We analyse humanitarian documents and climate outlook statements in Ethiopia, Kenya and Somalia and assess how these are reflected in the humanitarian responses to food insecurity in the region by analysing the financing of humanitarian operations. Our findings indicate that the continued evolution in understanding the complex causes of food insecurity and attempts to move away from emergency relief to a more sophisticated approach has not translated into an observable change in humanitarian responses. The reasons behind this persistence of short-term relief, which is being justified with reference to climatic factors, mainly drought, would warrant further research into the decision-making process that triggers humanitarian responses.

List of abbreviations: ACF: Action Contre le Faim; DCM: Drought Cycle Management; DEC: Disaster Emergency Committee; ECHO: European Commission Humanitarian Office; EU: European Union; EWS: Early Warning System; FAO: Food and Agricultural Organization; FEWSNET: Famine Early Warning System Network; FSNAU: Food Security and Nutrition Analysis Unit; FTS: Financial Tracking Service; GHACOF: Greater Horn of Africa Climate Outlook Forum; GIEWS: Global Information and Early Warning System; IASC: Inter Agency Standing Committee; ICPAC: IGAD Climate Application and Prediction Centre; IFRC: International Federation of Red Cross and Red Crescent Societies; IGAD: Inter-Governmental Authority on Development; IPCC: International Panel for Climate Change; LEWS: Livestock Early Warning System; ODI: Overseas Development Initiative; PASDEP: Plan for Accelerated and Sustained Development to Eradicate Poverty; PSNP: Productive Safety Net Programme; UNDRO: United Nations Disaster Relief Office; UNISDR: United Nations International; UN OCHA: United Nations Office for Coordination of Humanitarian Affairs; USAID: United States Agency for International Development; WFP: World Food Programme     

A cluster-based decision support system for estimating earthquake damage and casualties

This paper describes a Decision Support System for Disaster Management (DSS-DM) to aid operational and strategic planning and policy-making for disaster mitigation and preparedness in a less-developed infrastructural context. Such contexts require a more flexible and robust system for fast prediction of damage and losses. The proposed system is specifically designed for earthquake scenarios, estimating the extent of human losses and injuries, as well as the need for temporary shelters. The DSS-DM uses a scenario approach to calculate the aforementioned parameters at the district and sub-district level at different earthquake intensities. The following system modules have been created: clusters (buildings) with respect to use; buildings with respect to construction typology; and estimations of damage to clusters, human losses and injuries, and the need for shelters. The paper not only examines the components of the DSS-DM, but also looks at its application in Besiktas municipality in the city of Istanbul, Turkey.     

The Impact of a Reduced and Uncertain Food Supply in Three Besieged Cities of Bosnia-Hercegovina

Nutritional status and household food security were longitudinally monitored in three besieged cities of Bosnia-Hercegovina (Sarajevo, Zenica and Tuzla) during the winter and spring of 1993 to 1994. The objectives were to provide early warning of a deterioration in the food and nutrition situation and identify particularly vulnerable groups so that action could be taken to prevent potential undernutrition and target resources to the most needy. Before the cease-fire, which came into effect at the end of February 1994, trends in various indicators (weight loss, decline of household food stocks, rising food prices, reduction in food aid distribution, sale of possessions) suggested that the situation was deteriorating. Access to food improved as a result of the cease-fire, however, which was reflected in improvements in indicators of food security and weight gain. The impact of, and response to, the food emergency differed between individuals, households and locations; the elderly were found to be more nutritionally vulnerable than children or adults, households with the least access to resources were the most food insecure, while the city of Zenica appeared to be particularly hard hit. The findings show the effects of an uncertain and reduced food supply on a previously well-fed healthy population in an industrialised country. The value and constraints of an Early Warning System set up to monitor trends in an emergency in a European context are discussed.     

Food Security in Protracted Crises: Building More Effective Policy Frameworks

This paper considers the principal elements that underpin policy frameworks for supporting food security in protracted crisis contexts. It argues that maintaining the food entitlements of crisis-affected populations must extend beyond interventions to ensure immediate human survival. A 'policy gap' exists in that capacities for formulating policy responses to tackle the different dimensions of food insecurity in complex, fluid crisis situations tend to be weak. As a result, standardised, short-term intervention designs are created that fall short of meeting the priority needs of affected populations in the short and long term and only partially exploit the range of policy options available. The paper discusses key attributes of agency frameworks that could support more effective policy processes to address longer term as well as immediate food security needs. Additionally, it points to some main challenges likely to be encountered in developing such frameworks and, with the participation of beneficiaries, translating them into effective action.     

Effects of the 2008 flood on economic performance and food security in Yemen: a simulation analysis

Extreme weather events such as floods and droughts can have devastating consequences for individual well being and economic development, in particular in poor societies with limited availability of coping mechanisms. Combining a dynamic computable general equilibrium model of the Yemeni economy with a household‐level calorie consumption simulation model, this paper assesses the economy‐wide, agricultural and food security effects of the 2008 tropical storm and flash flood that hit the Hadramout and Al‐Mahrah governorates. The estimation results suggest that agricultural value added, farm household incomes and rural food security deteriorated long term in the flood‐affected areas. Due to economic spillover effects, significant income losses and increases in food insecurity also occurred in areas that were unaffected by flooding. This finding suggests that while most relief efforts are typically concentrated in directly affected areas, future efforts should also consider surrounding areas and indirectly affected people.     

The underutilization of street markets as a source of food security indicators in famine early warning systems: a case study of Ethiopia

Famine Early Warning Systems (EWS) are reliant on data aggregated from multiple sources. Consequently, they are often insensitive to localized changes in food security status, leading to delayed response or interventions. While price and infrastructural data are often gathered, this case study suggests that local street markets and vendor knowledge are underutilized. Few efforts have been made to monitor systematically the street markets as an indicator of local stressors. Findings from Ethiopia show that knowledge generated by expanding food security indicators in this sector can be used in combination with EWS to facilitate earlier intervention in, or to monitor more effectively, on-going humanitarian crises. Indicators developed from this study are accurate, cost effective, and sensitive to local climatic and food stressors.     

Looking beyond food aid to livelihoods, protection and partnerships: strategies for WFP in the Darfur states

The humanitarian crisis in Darfur remains extremely serious. The optimism that followed the signing of the Abuja Peace Accord was followed by a rapid deterioration in security on the ground in part associated with increasing factionalism in various rebel movements. This paper briefly reviews the evolution of the crisis, its impact on lives and livelihoods and the response by the World Food Programme (WFP) to June 2006. The major challenges and issues facing the food aid programme in the previous 18 months included: dealing with insecurity while maintaining or even extending programme outreach; the need to link protection with assistance more explicitly; and determining the wider impact of food aid programming on the processes and institutions linked with the conflict. The paper discusses the main strategic issues facing WFP in the future such as: integrating security and protection with needs assessments and operational decisions, broadening response strategies beyond food aid and bringing livelihoods to the fore, the need to review cost-efficiency, promoting partnerships and strengthening national and regional capacities.     

The Changing Nature of Conflict and Famine Vulnerability: The Case of Livestock Raiding in Turkana District, Kenya

The context of famine in Turkana has changed in recent years as the role played by livestock raiding in contributing to famine has increased. External responses to famine in Turkana have largely been drought driven, for example, food assistance and livestock restocking programmes, which have failed to meet the real needs of herders. The role of armed conflict in the form of raiding has been overlooked as a common feature of societies facing famine and food insecurity.The traditional livelihood-enhancing functions of livestock raiding are contrasted with the more predatory forms common today. The direct impact of raiding on livelihood security can be devastating, while the threat of raids and measures taken to cope with this uncertainty undermine herders' livelihood strategies. Self-imposed restrictions on mobility negatively affect the vegetation of both grazed and ungrazed pastures and restrict the available survival strategies. Predatory raiding leads to a collapse in the moral economy. Some implications of this for relief and development policy are considered, including approaches to conflict resolution.     

Environmental Causes and Impact of Refugee Movements: A Critique of the Current Debate

The relationships between insecurity, environmental change and population displacement are discussed in this paper. It argues that environmental change and concomitant population displacement are the consequences of war and insecurity rather than triggers for it — as postulated in so much of the recent literature. Additionally, the paper critically reviews the state of knowledge concerning the impact of refugees on the environment of host countries. The aim here is not to document the negative or positive impacts as such, but rather to de-mythologise some aspects of the state of knowledge which through repetition have become accepted as 'scientific truth'.     

HIV/AIDS among conflict-affected and displaced populations: dispelling myths and taking action

Conflict, displacement, food insecurity and poverty make affected populations more vulnerable to HIV transmission. However, the common assumption that this vulnerability necessarily translates into more HIV infections and consequently fuels the HIV/AIDS epidemic is not supported by data. Whether or not conflict and displacement affect HIV transmission depends upon numerous competing and interacting factors. This paper explores and explains the epidemiology of HIV/AIDS in conflict and addresses the unique characteristics that must be addressed when planning and implementing HIV/AIDS interventions among populations affected by conflict as compared with those in resource-poor settings. These include targeting at-risk groups, protection, programming strategies, coordination and integration and monitoring and evaluation. Areas for future HIV/AIDS operational research in conflict are discussed.     

A 'Principled' Approach to Complex Emergencies: Testing a New Aid Delivery Model in the Nuba Mountains

This paper provides an analysis of the Nuba Mountains Programme Advancing Conflict Trans-formation (NMPACT) as an example of an operational response in a complex emergency that innovatively addressed an incipient food security crisis. NMPACT is notable for having brought together an array of actors around a common principled agenda and for being the only operational programme in the Sudan to which both warring parties subscribed during the conflict. The key features of the programme are presented and the main innovative elements are reviewed, including the role of the principles of engagement and the 'political humanitarianism' of NMPACT. The paper looks at how NMPACT broke from traditional externally driven responses to food insecurity, and, drawing on lessons from Operation Lifeline Sudan, adopted an approach that focuses on capacity building, sustainable agriculture and market revitalisation, alongside conflict transformation and peace-building. The limitations of the model are also assessed, and preliminary lessons regarding its replication in other complex emergency contexts are presented.     

Targeting the vulnerable: a review of the necessity and feasibility of targeting vulnerable households

This article examines whether it is possible to target vulnerable households within a geographically defined area. It looks first at the justification for targeting and then reviews recent practical experience in actually trying to reach vulnerable groups. As complex emergencies increasingly last longer, strategies to target vulnerable households are common in the protracted phase of the emergency. While this is often necessary because of a decline in resources, it is not always justified by an improvement in nutritional status or food security of the beneficiary population. Common target groups are the poor and the malnourished, but in complex emergencies these are not always the most vulnerable. Moreover, recent practical experience has shown considerable difficulties in targeting the poor. Methods to target the poor rely on community-based relief committees, whose priorities are not necessarily the same as those of external agencies. This paper gives examples of such targeted assistance programmes in Kenya, south Sudan and Tanzania. The paper concludes that situations where targeting vulnerable households is justified and feasible are extremely limited. It is suggested that if targeting has to be done because of scarce resources, this should be done on a geographical basis and on the basis of nutritional status. Case-study material shows that it is essential to understand the political determinants of vulnerability and to design methods that will reach the most vulnerable.