National organizations and famine early warning the case of mali(1)

In the Sahelian countries of West Africa, the problems of drought and famine are sufficiently long term to justify the existence of permanent food security agencies. Yet donors are reluctant to fund these agencies when there is not a crisis, forcing poor countries to use their own resources for food security and famine early warning efforts. To make more effective use of limited resources and since the data needs for effective famine early warning are similar to those for basic rural development, information systems to provide data simultaneously for development projects and famine early warning should be developed and supported. In Mali, one of the larger and poorer countries of the West African Sahel, basic information systems which gather a range of appropriate data already exist, but there need to be improvements in the quality of design and the timeliness of analysis to make the information more useful for either development or famine early warning.     

Famine early warning systems and the use of socio-economic data

Famine early warning systems using socio-economic data suffer from several problems. One is that they cannot, and do not attempt to, distinguish between qualitatively different kinds of famine. The second is that they cannot predict these either accurately or early enough. This is because all the socio-economic indicators produce both false positives and false negatives, the indicators themselves are "late" and because interpretation of the data is complex and time-consuming. The third problem is that within the context of a famine that is occurring, these indicators cannot predict excess mortality. The argument is illustrated with examples from the 1984–5 famine in Darfur, Sudan.     

Monitoring and responding to famine: lessons from the 1984 - 85 food crisis in kenya

The geographic and temporal scale of institutional responses to food crises suggests three levels of food information or famine early warning system: a seasonal national food balance, baseline data on household food poverty and estimates of vulnerability to climatic and economic variations, and targeted interventions based on individual entitlements and food deprivation. Stimulating the demand for food information, beyond the need to forecast famines, is a crucial factor in the adoption of improved monitoring systems. Issues in the design of food information systems are illustrated by the experience in Kenya in 1984–85. The government of Kenya responded to the 1984 drought and ensuing food crisis to prevent widespread famine, largely through timely commercial imports of yellow maize. Although qualified by the nature of the drought and Kenya's economic development, this success story emphasises the need to improve food information systems.     

An Examination of the 1990-91 Famine in Sudan

Shortly before and during the harvest of 1990, a series of warnings were issued by concerned international and UN agencies that Sudan would experience a very poor harvest followed by an acute food shortage over the period 1990-91. The 1990 harvest was estimated to be similar to that obtained in 1984. After the very poor harvest in 1984, Sudan experienced a major famine during which deaths may have numbered in the hundreds of thousands. There were fears that this experience might be repeated in 1990 - 91. By the time of the subsequent 1991 harvest, it was clear to all that a severe food crisis had been experienced. There were severe shortages of water and food and very high malnutrition rates of children were noted by UNICEF across a wide range of areas. Despite these adverse indications, starvation deaths were probably numbered in thousands, rather than hundreds of thousands. Famine mortality, which may include deaths from famine associated disease, was similarly low. The initial predictions, it now seems, may have over-estimated famine mortality almost one hundred times. Several potential explanations of the over-estimate are examined. These include prediction errors, government and donor responses to the drought such as food aid and immunization, and traditional community and household level coping strategies in times of food shortage.     

Nutritional Assessments, Food Security and Famine

The widely held view that malnutrition is a late indicator of famine is challenged on the basis of evidence that people often deliberately reduce their food intake as an early response to inadequate food security. This broadens the possible interventions in response to high malnutrition rates to include measures to support livelihoods under threat of collapse. In the late stages of famine, social disruption and distress migration often result in a degraded health environment which may raise the threshold of nutritional status associated with an increased mortality risk. It is important to assess the underlying causes of malnutrition and the associated health risks. At present, the main objective of nutrition surveys is usually to obtain a reliable estimate of the prevalence of malnutrition among children under five years of age, with little analysis of the underlying causes of malnutrition. Experience from the 1984-85 famine in Darfur led to the development of an alternative approach to nutritional assessment which could be applicable elsewhere in Africa. The combination of quantitative and qualitative methods was particularly valuable as a means of gaining a wider and deeper understanding of the nature of the nutritional situation.     

Northern Sudan in 1991: Food Crisis and the International Relief Response

By the end of 1991, less than half the amount of relief food requested for North Sudan at the beginning of the year had been delivered. Despite ample evidence of social and economic stress and high rates of child malnutrition, many donors felt that relief needs had been exaggerated, and were unwilling to accept that relief assistance was urgently needed. The feeble response of the main food aid donors is explained initially by the politics of relief in 1990/91, which seriously delayed the launch of the relief operation. These problems were compounded by an oversimplified understanding of famine among some sections of the relief community, and by the orientation of the international relief system to crisis indicators. Toward the end of 1991, donors argued that despite the shortfall in relief assistance there had been no deaths from starvation, and therefore local people had 'coped' better than expected. This paper challenges that view by arguing that excess deaths did occur, but went unnoticed and unremarked. Local people's 'coping strategies', which supposedly 'saved the day', actually had very negative and sometimes fatal consequences.     

Famine intensity and magnitude scales: a proposal for an instrumental definition of famine

Ambiguities in current usage of the term "famine" have had tragic implications for response and accountability in a number of recent food crises. This paper proposes a new approach to defining famine based on the use of intensity and magnitude scales, where "intensity" refers to the severity of the crisis at a given location and point in time, while "magnitude" describes the aggregate impact of a crisis. The scales perform three operations on "famine": first, moving from a binary conception of "famine/no famine" to a graduated, multi-level definition; second, disaggregating the dimensions of intensity and magnitude; and third, assigning harmonised "objective" criteria in place of subjective, case-by-case judgements. If adopted, the famine scales should contribute to more effective and proportionate responses, as well as greater accountability in future food crises.     

The African food crisis of 1982-1986*

The crisis cannot be attributed to any one cause, but rather it was the product of a number of interacting factors whose precise combination varied between countries. Drought, internal political and economic factors and an unfavourable external economic environment were significant contributory factors. Civil war and externally financed insurgency were primarily responsible for propelling a food crisis into a famine in four out of the six worst affected countries. Within the literature, there is a tendency for writers to emphasize the relative contribution of factors within their own disciplines. So far the literature on the responses, both within country and internationally, is comprised of eye witness accounts by journalists and evaluations by aid agencies of their performance. The international response by governments and the public was massive and unprecedented, but the response by governments, indigenous NGO's and the public within affected countries is often overlooked by the journalistic literature. Generalizations about "the African food crisis" have obscured the considerable diversity amongst countries. This is well illustrated by the experiences of Ethiopia, Kenya and Botswana. This diversity indicates the biased perspectives that arise from focussing on the extreme famines, as in Ethiopia. Research priorities should include studies of systems that coped during the crisis, historical analysis of the crisis, the way early warning information is processed within bureaucratic institutions, environmental degradation and fully integrated analysis of food production and consumption systems.     

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.     

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.     

Reducing vulnerability to drought and famine: developmental approaches to relief

In this paper we present salient lessons learned through the International Relief/Development Project about the relationships between disasters and development. We discuss approaches to famine response and prevention, including the impact of global food distribution efforts on the capacities of people affected by famine and offer criteria for planning famine relief so that it will promote systemic, long term development of these capacities. We first describe a collaborative research project which showed that it is possible for international famine assistance either to promote the capacities of people who suffer from famine so that they are better able to handle future food crises, or to leave those it purports to help worse off and even more vulnerable to subsequent disasters. We then illustrate alternative strategies for promoting development in the midst of crisis by presenting information about a number of famine response programs and analyzing their impact on capacities and vulnerabilities.     

Getting the Scale Right: A Comparison of Analytical Methods for Vulnerability Assessment and Household-level Targeting

This paper introduces broad concepts of vulnerability, food security and famine. It argues that the concepts and theories driving development and implementation of vulnerability assessment tools are related to their utility. The review concludes that socio-geographic scale is a key issue, and challenge. It analyses three vulnerability assessment (VA) methods, using Ethiopia as a case study. Facing the challenges of vulnerability assessment and early warning requires providing accurate information at the required scale, useful for multiple decision-makers within realistic institutional capacities.     

Entitlements, coping mechanisms and indicators of access to food: wollo region, ethiopia, 1987-88

Vulnerability to famine and traditional responses to food insecurity in Wollo Region, Ethiopia are described. The timeliness of anthropometric and socio-economic indicators of access to food is then assessed, using data collected in Wollo by Save the Children Fund during 1987–88, a period of drought and subsequent food insecurity. The movements of different indicators are then examined for evidence of correspondence at sub-district level. The author concludes that although anthropometric status does not respond as early as crop yield or grain price, a deterioration in anthropometric status is detectable at a stage when livestock and migration indicators show little or no change and mortality rate remains unaffected. At sub-district level, changes in different indicators are not well-correlated.     

Food as an instrument of war in contemporary african famines: a review of the evidence

Famine is conventionally portrayed as a natural disaster expressed in terms of food scarcity and culminating in starvation. This view has attracted criticism in recent years as the political, legal and social dimensions of famine have become more clearly understood. This paper draws upon these criticisms to understand the particular conditions of famine creation in conflict situations. Following an examination of six contemporary African famines, it is suggested that the use of food as a weapon of war by omission, commission and provision has contributed to the creation of famine in recent decades. Despite the optimism for peace engendered by the demise of the Cold War, the momentum for conflict would seem to be sustained by internal factors, including economic and environmental decline, political instability and ethnic rivalry. Within these conflicts, the strategic importance of food is likely to remain central. This study highlights the need to link concerns with food security and public health to those of development, human rights and international relations.     

The social context of childcare practices and child malnutrition in Niger's recent food crisis

In 2004–05, Niger suffered a food crisis during which global attention focused on high levels of acute malnutrition among children. In response, decentralised emergency nutrition programmes were introduced into much of southern Niger. Child malnutrition, however, is a chronic problem and its links with food production and household food security are complex. This qualitative, anthropological study investigates pathways by which children are rendered vulnerable in the context of a nutritional 'emergency'. It focuses on household-level decisions that determine resource allocation and childcare practices in order to explain why practices apparently detrimental to children's health persist. Risk aversion, the need to maintain self-identity and status, and constrained decision making result in a failure to invest extra necessary resources ingrowth-faltering children. Understanding and responding to the social context of child malnutrition will help humanitarian workers to integrate their efforts more effectively with longer-term development programmes aimed at improving livelihood security.     

Food Aid and Nutritional Programmes During the Rwandan Emergency

In contrast to several other recent emergencies¹, the response of the international relief community to the Rwandan emergency appears largely to have prevented widespread malnutrition and related mortality. While it is true that aspects of the response in the food and nutrition sector were in various ways open to criticism and may have contributed to unnecessarily high levels of wasting in some camps at various points in time, the appalling excesses of famine witnessed in other recent African crises was not revisited during this emergency. Indeed, the main factors contributing to mortality and morbidity during the Rwandan emergency were violence and epidemics rather than lack of food and nutritional support.     

War and Food Security in Eritrea and Ethiopia, 1998–2000

This paper examines the 1998–2000 'border' war between Eritrea and Ethiopia and its continuing legacies from the perspective of food security.¹ Focusing on the food crisis that hit both countries during the same period and was allowed to develop into a famine in southeast Ethiopia, it argues that this was linked with the war in more ways than hitherto recognised. Such connections can be appreciated only by taking a longer-term view of the decline of the rural economy of which this food crisis was part, factoring in the role played by this and other conflicts that have flared up in the region. An analysis of this kind might have helped donors and aid agencies to respond more effectively both to short-term humanitarian needs in the midst of an inter-state war and to the need for longer-term support for food security in a region beset by endemic conflict.     

The health sector gap in the southern Africa crisis in 2002/2003

The southern Africa crisis represents the first widespread emergency in a region with a mature HIV/AIDS epidemic. It provides a steep learning curve for the international humanitarian system in understanding and responding to the complex interactions between the epidemic and the causes and the effects of this crisis. It also provoked much debate about the severity and causes of this emergency, and the appropriateness of the response by the humanitarian community. The authors argue that the over-emphasis on food aid delivery occurred at the expense of other public health interventions, particularly preventative and curative health services. Health service needs were not sufficiently addressed despite the early recognition that ill-health related to HIV/AIDS was a major vulnerability factor. This neglect occurred because analytical frameworks were too narrowly focused on food security, and large-scale support to health service delivery was seen as a long-term developmental issue that could not easily be dealt with by short-term humanitarian action. Furthermore, there were insufficient countrywide data on acute malnutrition, mortality rates and performance of the public health system to make better-balanced evidence-based decisions. In this crisis, humanitarian organisations providing health services could not assume their traditional roles of short-term assistance in a limited geographical area until the governing authorities resume their responsibilities. However, relegating health service delivery as a long-term developmental issue is not acceptable. Improved multisectoral analytical frameworks that include a multidisciplinary team are needed to ensure all aspects of public health are dealt with in similar future emergencies. Humanitarian organisations must advocate for improved delivery and access to health services in this region. They can target limited geographical areas with high mortality and acute malnutrition rates to deliver their services. Finally, to address the underlying problem of the health sector gap, a long-term strategy to ensure improved and sustainable health sector performance can only be accomplished with truly adequate resources. This will require renewed efforts on part of governments, donors and the international community. Public health interventions, complementing those addressing food insecurity, were and are still needed to reduce the impact of the crisis, and to allow people to re-establish their livelihoods. These will increase the population's resilience to prevent or mitigate future disasters.     

Mortality and morbidity in refugee camps in eastern Sudan: 1985-90

Civil war has disrupted life in Ethiopia since the 1960s and many people have sought refuge in Eastern Sudan, particularly during the famine emergency of 1984–85. UNHCR has provided the main financial support for the refugee programme, but began scaling down operations in 1990. Nearly 300,000 refugees still live in camps and benefit from food and health programmes. Health services are co-ordinated by the Sudanese Refugee Health Unit which operates a centralised health and nutrition surveillance system with the co-operation of the NGOs responsible for health care in the camps. A revision of the monthly reporting system and the establishment of a computer database in 1990 provided an opportunity to review the situation in the camps over the five years since the emergency. Child death rates for example, appear to have been reduced to levels below those expected in rural Africa. Patterns of mortality, morbidity, and nutritional status are outlined here and point to the general effectiveness of the health care programme. The surveillance system can, however, be used to identify those camps which have persistent problems, while monthly comparisons with the situation in previous years can provide early warning of deteriorating conditions.     

Nutritional status as an indicator of impending food stress*

Famine early warning systems benefit from a variety of indicators which together signal the initial stages of food stress for particular population groups. Anthropometry has been used as an indicator in early warning systems, but there are inherent problems in its use which should be understood. Using data from Turkana pastoralists of northwest Kenya, this paper discusses the problems of: time lag between food shortages and changes in body size and composition; use of reference points; accurate age assessment; and establishment of baseline data. Diet composition data are suggested to be an additional nutrition-oriented indicator of impending food stress and one in which problems associated with anthropometry are not inherent. Both measures may be useful in monitoring a population, but their strengths and weaknesses should be appreciated.