US embassy cable - 05NDJAMENA814

UNCLAS  NDJAMENA 000814 
 
SIPDIS 
 
 
DEPARTMENT FOR AF, AF/C, AF/SPG, D, DRL, H, INR, INR/GGI, 
PRM, USAID/OTI AND USAID/W FOR DAFURRMT; LONDON AND PARIS 
FOR AFRICAWATCHERS; GENEVA FOR CAMPBELL, 
ADDIS/NAIROBI/KAMPALA FOR REFCOORDS 
 
E.O. 12958: N/A 
TAGS: PGOV, PHUM, PREF, KAWC, CD, SU, Humanitarian Operations 
SUBJECT: REFUGEES IN EASTERN CHAD: MALNUTRITION RATES AND 
FOOD SUPPLIES 
 
REF: NDJAMENA 652 
 
1.  Summary: PRM Office Director for Assistance to Africa 
Margaret McKelvey and Program Officer Hazel Reitz visited 
Chad from May 4 to 18 to monitor the operations on behalf of 
the Sudanese refugees in the east of Chad. This cable, one of 
three reporting on the visit, focuses on efforts to 
understand the reasons for the spike in malnutrition rates in 
March/April and to develop a standard and regular monitoring 
and surveillance system. It also examines food pipelines and 
pre-positioning in the camps of sufficient food to cover the 
upcoming rainy season.  The PRM team recommended the urgent 
establishment of a monitoring system of surveillance and 
periodic surveys of malnutrition rates.  Reasons for the 
spike appear to be numerous, ranging from cultural and child 
care practices to poor public health practices to the poor 
performance of implementing partners.   ACF found a lower 
malnutrition rate in Oure Cassoni (12-13% GAM) than 
previously reported but a higher rate in Amnabak (26%).  WFP 
is working hard to ensure that adequate food is prepositioned 
now for the June to October rainy season.  The major issue is 
contracting sufficient trucks to ply the Libyan corridor.  As 
previously reported, Stefano Poretti, World Food Program's 
Director for Chad, said he needs 7,000 MT of food now to 
complete pre-positioning before the arrival of the rains. End 
Summary. 
 
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MALNUTRITION: MULTITUDE OF APPARENT REASONS 
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2.  One of the objectives of the PRM trip was to look into 
recent reports of higher global and severe malnutrition rates 
in the camps of Touloum, Iridimi, Djabal and Oure Cassoni, 
and to determine the reasons for the March/April spike. 
While the malnutrition rates are reported to have gone down 
in several camps (ACF, doing a tent-to-tent survey of all 
children under-five, was finding a GAM of 12-13% in Oure 
Cassoni after surveying 30 % of the camp) and the reported 
cases of kwashiorkor in Touloum camp (which appear never to 
have been confirmed as classic kwashiorkor) have responded to 
therapeutic feeding, an ongoing evaluation of malnutrition 
rates by ACF and IMC in Amnabak camp has discovered that 
earlier figures were incorrect and that the malnutrition rate 
is higher than reported - now really 26%.  . 
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THE PERFECT STORM 
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3.  UNHCR Nutritionist UNV Stefano Federle (longest serving 
UNHCR international staff member in Chad - 16 months) briefed 
PRM mission on the recent increase in the number of cases of 
malnutrition.  Federle made it clear that it may be difficult 
to achieve the international standard for malnutrition soon 
and to avoid periodic spikes in malnutrition rates.  He 
provided a number of reasons including the poor nutritional 
and traditional practices common among the refugees and the 
relative weakness of the implementing partners in this 
sector.  Describing it in terms of "the Perfect Storm", 
Federle said the confluence of many factors, including the 
above, as well as trading of food between refugees and locals 
(to pay off debts), the exchange of part of the ration for 
milling and NFIs, poor weaning practices, children being left 
unattended bu adults for as long as two weeks all affect the 
rate.  Several of the implementing partners (IRC, IMC and 
COOPI) have not performed up to standard in the nutrition 
sector.  Other more positive elements are improved screening 
and better community outreach, resulting in more cases coming 
to the medical centers.  When the issue was raised with WFP 
Country Director Poretti, he  was initially adamant that the 
reduced rations of October through March had nothing to do 
with the high malnutrition rate.  He blamed the reasons 
provided above.  Ultimately, he did acknowledge that perhaps 
reduced food rations were 10% of the problem. 
 
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MORE SUPERVISORY AND EXPERIENCED NUTRITIONAL PERSONNEL NEEDED 
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4. It seemed clear to the PRM team that more supervisory and 
experienced personnel are required in all agencies to work 
 
 
the nutritional issue.  UNHCR currently has one nutritionist 
based in Abeche who is single-handedly trying to cover both 
the nutrition and food sectors for UNHCR.  WFP, UNICEF and 
WHO (who were supposed to form an inter-agency management 
board on nutrition) are without nutritionists at present. 
IRC has suspended its 24-hour therapeutic feeding center, 
IMC's malnutrition data was found to be wrong, and COOPI was 
without a nutritionist for two or more months.  UNHCR is 
actively addressing the issue by contracting Action Contre le 
Faim (ACF) to get a better handle on the current situation in 
the camps.  ACF is currently conducting a statistically 
significant sampling of children under-five using MUAC and 
weight/height.  The inter-connected issues of parenting and 
cultural practices, public health, and good food management 
will take somewhat longer to impact but are being addressed 
through a multisectoral approach led by UNHCR's community 
services.  ACF will take over the nutrition sector from IRC 
in Bahai, a new COOPI nutritionist arrived and appears to be 
good, and IMC has replaced most of its team. 
 
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IMPROVED MONITORING 
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5.  PRM officers strongly urged the international and 
non-governmental organizations to set up a standard and 
regular operation-wide monitoring system of surveillance and 
periodic surveys, including the establishment of reliable 
base-line data.  There is still dissension among the agencies 
as to the reliability of the CDC data from last June and some 
of the data provided by NGOs over the last year.  PRM 
suggested an interagency approach where methodology would be 
agreed upon and standardized throughout all the camps.  Such 
surveys could be carried out every three months. Initial 
reaction appears to be positive but will require follow-up 
and possibly additional expertise from CDC and/or a medical 
institution such as Columbia University's School of Public 
Health. 
 
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BAHAI - IRC THERAPEUTIC FEEDING CENTER SUSPENDED 
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6.  The PRM team met with new IRC country director Antoine 
Dupluis and later participated in a joint meeting with him 
and ACF-USA Chad Program Coordinator Jason Stobbs to discuss 
the nutritional situation in the northernmost camp - Oure 
Cassoni.  Global malnutrition in the camp spiked in March and 
April and IRC had no local staff sufficiently competent to 
staff the therapeutic feeding center at night (international 
staff are not allowed to overnight in the camps for standard 
security reasons).  The newly arrived IRC nutritionist made 
the decision to send all cases of severe acute malnutrition 
to the 24-hour MSF center in Iriba (2 hours drive away) and 
to concentrate her efforts on dealing with cases that no 
longer required 24-hour care and on reorganizing the entire 
approach. 
 
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ACF IN ACTION 
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7.  An ACF team, which was present in Bahai during the PRM 
team's visit there, was undertaking a tent-by-tent assessment 
in Oure Cassoni camp and an assessment of the children among 
the 1,600 "new arrivals" who had been camped out in the wadi 
in Carieri right on the border with Sudan for up to two 
months.  ACF, using weight/height and MUAC measurements, 
identified 15 severely malnourished children among the 30% of 
the camp already surveyed (approximately 1.9%), and another 
15 cases in the wadi.  Of these, 17 were immediately referred 
to MSF-Iriba with their mothers, while the mothers of others 
refused to go - possibly because of their reluctance to miss 
the upcoming general food distribution, because their 
husbands forbade it, or because there were other children in 
the household who needed to be cared for.  Because of this, 
ACF, during meeting with PRM and IRC, made a quick decision 
to leave a nutritionist in Bahai to help care for those 
children whose mothers refused to go to Iriba - a very 
impressive and can-do performance on ACF's part.  The plan 
now is for ACF to take over the nutrition sector from IRC 
 
 
over the next few weeks (with full transition no later than 
early July) and to establish the therapeutic feeding center 
in the hospital in Bahai rather than in the camp to ensure 
24-hour care. 
 
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RECOMMENDATIONS 
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8.  The PRM team's recommendations are: 
 
-- Urge IOs and NGOs to strengthen their nutrition staff, 
including urging UNHCR to add a second person to its 
nutrition/food team (already discussed with UNHCR/N'Djamena). 
 
-- Support the transfer of the nutrition sector from IRC to 
ACF in Oure Cassoni and consider providing funding for 
ACF-USA. 
 
-- Press for a standardized and regular surveillance and 
monitoring system for all the camps - include this in trip 
report to UNHCR 
 
-- Look into the possible of assistance of CDC and/or some 
qualified school of public health such as that at Columbia 
University. 
 
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FOOD ISSUES: LIBYAN CORRIDOR 
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9.  WFP is working hard to ensure that adequate food is 
prepositioned now for the June to October rainy season.  The 
major issue is contracting sufficient trucks to ply the 
Libyan corridor.  As previously reported, Stefano Poretti, 
WFP's Director in Chad, said he needs 7,000 MT of food now to 
complete pre-positioning before the arrival of the rains. 
(Note it had already rained in and around Goz Beida when the 
team was there.)  He is looking into several possibilities to 
speed up the Libyan process: one being to look into a new 
route from El Kofrah through a spot near Faya Largeau in BET; 
another to transfer the food from the Libyan trucks to 
Chadian trucks at the border and then to deliver it directly 
to the camps (this would have the advantage of saving over 
$300 per truck in foreign truck fees); and a third to use 
Chadian truckers for the whole trip.  In response to 
McKelvey's question about WFP having its own fleet, since 
Libyan truckers may not want to dead head back from the 
border,  Poretti said that he would require 150 trucks which 
would be very expensive.   The maintenance of the Libya 
corridor also depends upon the ability to use it for food for 
Darfur as well as Eastern Chad, since the quantity of food 
needed for Eastern Chad is not large enough to sustain the 
Libyan corridor.  As previously reported by WFP/Sudan's 
Ramiro da Silva, in a test run, three weeks ago, WFP was able 
to move 400 tonnes.  Poretti was pleased that sufficient food 
had been pre-positioned in the southern camps of Goz Amer and 
Djabal to last through the rainy season.  PRM team was able 
to confirm that this was indeed the case for Djabal (except 
for oil, which Poretti said was on the way via the Douala 
route)) but was skeptical about all the food having reached 
Goz Amer yet.  More RubbHalls are needed in Bahai to hold 
food for Oure Cassoni camp. 
 
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WFP NEEDS 
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10.  Poretti said that WFP's pipeline for eastern Chad would 
be empty as of September.  (Note: He was very pleased with 
the just-received small PRM cash contribution of $350,000 for 
the refugees from the Central African Republic. End Note.) 
Ideally, he would like to have a buffer stock of two months 
but that has not been possible nor looks likely any time 
soon.   Poretti also said WFP would have to stop its air 
service at the end of August. He was also looking for money 
to fund CARE ($40,000) and ACF ($90,000) to conduct food 
basket and post-distribution monitoring (which, contrary to 
what we had initially understood, are not yet fully in 
place), for additional rubbhalls and for staff accommodation. 
 WFP had had no nutritionist on site since December 2004 and 
 
 
would welcome funding for this.  Poretti also wants to 
undertake a vulnerability survey ($30,000) in order to obtain 
a better picture of both the situation in the camps but also 
among the local population.  He cautioned that Chad may face 
a severe crisis next year if the rains are poor and noted 
that locusts have been sighted near Lake Chad.  Poretti had 
no record of PRM's 2004 contribution toward the humanitarian 
air services but it has since been provided to him. 
 
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FOOD DISTRIBUTION IN THE CAMPS 
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11.  The PRM team was able to see a general food distribution 
in Oure Cassoni camp which went smoothly and in an orderly 
fashion with full rations of all commodities.  Women were 
participating in the distribution. The scooping method is a 
more reliable and welcome method by all except for the 
refugee bloc leaders (it is more difficult for them to take 
extra for themselves).  PRM officers were somewhat concerned 
that the distribution in Farchana camp which took place May 
16 was only for a period of 15 days, in order to readjust the 
distribution calendar.  The PRM team felt that it risked 
causing a problem in a camp which had remained calm 
throughout the events of the previous week (septel) 
fortunately that proved not to be the case.  The refusal of 
refugees to be re-registered in Touloum and Iridimi and to 
present their entire families (i.e., all those included on 
the ration cards) at the general food distributions in 
Kounoungou and Mile is believed to be indicative of fraud and 
duplication of ration cards. See septel for information on 
the present volatility in the camps. 
 
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RECOMMENDATIONS 
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12.  The PRM team recommends the following: 
 
-- Consider additional funding for WFP for the Libyan 
corridor S.O., for the air service, and for food monitoring. 
 
-- Urge WFP to deploy a nutritionist soonest to Abeche to 
work with UNHCR and other agencies on nutrition surveillance 
and monitoring. 
 
 
13.  Khartoum and Tripoli Minimize Considered. 
WALL 
 
 
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