Food and nutrition situation for refugees from Western Sahara in camps in Algeria

1. Food and nutrition situation for refugees from Western Sahara in camps in Algeria Ingrid Barikmo Akershus University College (AUC)Norwegian Church Aid (NCA) Riksdagen - Stockholm, February 2010

2. Background • Refugees in harsh environments in the Sahara desert more than30 years • Cease-fire in 1991 • Total dependency on food aid as well as all other needs for survival • Water: a considerable scarcity • Health problems such as undernutrition, anaemia and goitre are common

3. Background (cont.) • Reduced beneficiaries from 158.000 to 90.000 for 8 months in 2006 • In November 2006 increased beneficiaries to 125.000 which still are the number of people given basic ration • Undernutrition increased disturbingly in 2008 • Indication of violation of the International Covenant on Economic, Social and Cultural Rights – article 11 on the right to adequate food

4. NCA and AUC in the Saharawi refugee camps • Nutrition project at the hospitals (since 2000) • Iodine Survey, 2007 (report 2008) • Nutritional and Food Security Survey, (report 2008) • Saharawi Nutrition Strategy, (report 2009) • Increased nutrition education, 2009 • Cooperation with MoH, UNHCR, WFP, MdM, PNSS in a Integral Program of Infantile Health Saharawi (PISIS), 2009 • Food Basket research, 2009 • Local milk research, 2009

5. Iodine Survey, 2007 Prevalence of enlarged thyroidgland measured by ultrasound: • Women (405, age 15-45): 22 % (cut-off volume thyroid gland > 12.5 ml) • Children (419, age 6-14): 86 % (international reference values (thyroid gland volume - Tvol) for BSA with cut-off point at the 97 percentile) Excretion of iodine in urine • Women: Median 466 µg/L (range 54-3.640) • Children: Median 565 µg/L (102-3.594)

6. 600 µgiodine/day: Proposed safe upper level for adults (Scientific Committee on Food in the European Union, 2002) 1100 µg/day: Tolerable upper level of daily iodine intake for adults (Food and Nutrition Board, USA, 2006).

7. Median iodine content (µg/L) in water and urine (women and children)

8. Local milk • Goat milk (n=16) • Content of iodine: median 370µg/L, (70-13.071) • Camel milk (n=3) • Content of iodine in the 3 samples 540 µg/L, 4.170 µg/L and 11.980 µg/L

9. Sources of the iodine intake among women

10. Conclusion • The prevalence of enlarged thyroid gland was severe, especial for the children • The majority of the Saharawi refugee women (74 %) and children (84%) had excessive intake of iodine • It was differences between the camps: of those with iodine excretion more than 600 µg/L88 % of the women and 91% of the children came from the two camps Ausserd and El Ajune • The content of iodine in local milk was extremely high and need to be more investigated • The high concentration of iodine in water are affecting the humans directly and probably also indirectly through the local milk

11. Nutritional and Food Security Survey, 2008 Prevalence of: • Acute malnutrition (too thin) (wasting): • Global (total) 18.2 % • Severe: 5.4 % • Chronic malnutrition (too short) (stunting): • Global (total) 31.4 % • Severe: 9.0 % • Anemia, children • In total 62 % • Severe 6% • Anemia, non- pregnant women • In total 54 % • Severe 11% • Anemia, pregnant women • In total 66 % • Severe 15%

12. Trend in acute malnutrition (wasting) from 1997 to 2008

14. Trend in chronic malnutrition (stunting) from 1997 to 2008

15. Saharawi Nutrition Strategy

16. Saharawi Nutrition Strategy General objectives Focused areas 1. To change the diet for all in line with the international recommendations of the FAO/WHO • Access to food for a healthy diet 2. To coordinate the nutritional work in the camps 3. To reduce malnutrition in children • Fight against malnutrition and nutritional deficiencies 4. To reduce anaemia and other type of micro-nutrient malnutrition, particularly among women in reproductive age, infants and young children and school age children 5. To promote healthy dietary habits in accordance with local food culture for an adequate food intake for all. Capacity development 6. To strengthen the nutrition skills among the Saharawi public staff.

17. Food distributed Wheat and cereals distributed in the camps in 2006 and the first 4 month in 2007

18. Food distribution and acute malnutrition The quantity of distributed cereals/person/month in 2005, 2006, 2007 and 2008 when using number of 160.000 or 125.000 beneficiaries and the prevalence of acute malnutrition

19. Women needs and food distributed in 2008

20. Sources to the nutrients

21. Adapted Food Basket

22. Highly recommended Food Groups as support to the refugees • Vegetable and fruit • Canned fish (mackerel or sardines) or meat • Milk and cheese • Other foods such as gofio and pasta and soya beans

23. How to improve the situation? • Use the Saharawi Nutrition Strategy • Increase the nutrition education • Work in cooperation with MoH, UNHCR, WFP, MdM, PNSS in a Integral Program of Infantile Health Saharawi (PISIS) • Continue to fill the Food Basket • Contribute to the local milk research • Other?

26. Hva slags matvarer og tilsetninger(forts)

27. Hva slags matvarer og tilsetninger • For behandling av alvorlig akutt underernærte (wasting): • Før – F100 • NÅ – PlumpyNut (olje og peanutbasert) • For moderat akutt underernærte: • Hvete/mais-soya blanding+ olje og sukker (CSB) • For forebygging av kronisk underernærte (stunting): • Før – ingenting • NÅ – olje og peanutbasert produkt • Anemi • Sprinkelprodukter