Undoubtedly, to have a positive impact on the well-being of the assisted people should be the goal of any form of development assistance. It will, however, not be sufficient to achieve improvements in the economic basis of livelihood only (e.g. in terms of assets and other productive means). An improvement also has to occur at the very basic level of an individual's well-being - i.e. it has to result in good nutritional and health status.
Rehabilitation interventions and programmes to address emergency food and nutrition situations, need even more so to ensure that such far-reaching impact is achieved. This is because emergency situations in the food and nutrition sector are characterised by extreme and widespread breakdowns of household food security which is often accompanied by a corresponding decline in nutritional status. This requires not only the initiation of immediate action in order to reverse deteriorated nutritional status, but also to mitigate the deleterious effect which malnutrition has on the individual capacity for renewal and rehabilitation. Consequently, rehabilitation has to have a dual aim, a) the improvement of nutritional status and b) the restoration of the household's ability to produce or procure food at the same time.
“Rehabilitation” in FAO parlance has until recently meant technical assistance for recovery of agricultural production and food supply. Consideration of recovery of household food security has rarely embraced concerns of nutritional adequacy, and it has been, in general, taken for granted that an increase in food production is accompanied by a behavioural change towards better eating and better nutrition. This paper challenges such assumption and proposes that household food security and nutrition security should be recognised as distinct goals in the relief-to-development continuum and that both objectives have to be equally pursued in order to finally arrive at the intended effect of improving the beneficiaries nutritional status.
Food and nutrition interventions are not only those which are directly related to provision or production of food, but include the wider range of activities which can have an impact on food security and nutrition. Rehabilitation after man-made disasters in moderately favourable resource environments may be short lived because households can swiftly regain food security11. In conditions of chronic food insecurity, there is a greater need for integration of rehabilitation and development measures.
Three types of interventions involved in rehabilitation can be distinguished:
protective:
the intervention itself does not rehabilitate household
food security, but by protecting household resources from
further depletion; it aids recovery (e.g. distribution of
food aid),
promotive:
the intervention directly provides households with inputs
which have a beneficial effect on households ability to
restore food security (e.g. distribution of seeds, tools
and food aid),
facilitating:
the intervention facilitates household recovery by creating
the right conditions and opportunities (e.g. developing
market opportunities for sale of surplus, lowering rates of
taxation).
Rehabilitation does not necessarily imply a restoration of conditions which existed prior to the emergency. Where households were previously in conditions of surplus, rehabilitation interventions are limited to restoring food security not fully compensating for lost assets. More commonly, pre-emergency households may have been highly vulnerable to food insecurity or malnutrition. This particularly applies to areas of chronic food insecurity (e.g. drought prone regions of northern Ethiopia). In conditions of chronic food insecurity, rehabilitation needs to begin to tackle some of the underlying causes of food insecurity and malnutrition and address issues of development (e.g. poor infant feeding practises, lack of soil conservation techniques). This entails working towards creating food and nutrition security conditions which are more stable and sustainable than before the emergency.
11 SCOVILLE O.J. (1985) Relief and Rehabilitation in Kampuchea. J of Dev Areas. 20 Oct 23–36.
In post-emergency situations, although the nutrition condition of the population may be described in rehabilitation proposals, specific measures to improve nutrition status tend to be regarded as a relatively low priority given the immediate pressures on human and financial resources. This failure to see nutrition status as both an input as well as an output in the household food security/nutrition cycle may constrain recovery. Poor nutritional status affects the capacity of the household to produce food, as well as being the result of the household's access to food, its utilisation and health and social conditions (see figure 2).
Insufficient amount of food
Deteriorating nutrition statistics are often the trigger for instigating emergency relief measures, but also in the post-emergency period populations are still vulnerable to malnutrition. In some cases people continue to be entirely dependent on relief rations to meet their food needs. These rations may be inadequate and irregular, particularly in post-war conditions where transport infrastructure may have been damaged. More fundamentally, relief rations are not calculated to cover the food energy needs of physical labour involved in agricultural work. It is important to recognise that affected households may be unable to procure additional food because they have no remaining assets to sell, or would rather go with less food than be forced to sell assets essential for post-famine recovery12. This overall lack of sufficient food can lead to rising malnutrition statistics and weight loss in adults with reduced labour capacity resulting.
Poor dietary quality of food
The issue of diet quality in terms of food safety and nutrient composition also influences work output and morbidity. Poor nutrition increases vulnerability to illness and infections, and vice versa. Among the main causes in emergency situations are often damaged sanitary facilities (contaminated wells, lack of potable water) and poor food hygiene. The micro-nutrient composition of the diet influences disease resistance, child growth and development, and capacity to work. Anaemia due to low iron intakes is known to reduce the ability to do work and in female headed households can be a constraint because of the greater iron requirements of women of child bearing age. This is a particular concern in post-war conditions where there tends to be a large proportion of female headed households.
Post-harvest food losses and inapropriate food handling
Substantial amounts of food can be also lost because of inadequate storage facilities and inappropriate processing and preservation techniques. Losses may occur at any stage between harvesting and consumption, but a large portion occurs during storage.13 These food losses by insects, rodents, moulds, microbiological and chemical spoilage, etc. are especially unacceptable in emergency and post-emergency situations where the wasted food would be most needed to combat malnutrition and to support recovery. In some cases it will be, therefore, as important to stop these losses as it is to rehabilitate and/or increase food production.
Nutrition knowledge
The nutritional knowledge of household members will influence how scarce food resources are allocated between them, determining whether, for example, labouring adults get priority to food, or nutritionally vulnerable infants and children. Cultural practises may also play a role. In post-emergency conditions households may be exposed to unfamiliar foods from emergency food rations and have little access to traditional foods used for feeding vulnerable groups. Their ability to prepare suitable and safe meals with the foods available, and their prioritisation of growing appropriate crops in the immediate post-emergency period will depend on their nutritional knowledge.
Addressing the needs of groups vulnerable to malnutrition
In any discussion of vulnerable groups it is important to distinguish between physiologically vulnerable members of households and socio-economically deprived households:
Physiologically vulnerable due to condition and needs are the
following individuals:
infants, growing children and adolescents, pregnant and
lactating women, malnourished, elderly, mentally,
physically and sensory disabled,
Socio-economically deprived and therefore likely to be at
nutritional risk are mainly the following groups:
displaced people, refugees, female headed households, the
poorest households, the landless, chronically food insecure
households.
The most vulnerable members of society are the physiologically vulnerable individuals in socio-economically deprived households.
While the physiologically vulnerable can be readily identified and specific interventions targeted to meet their particular needs, the identification of households at risk for socio-economic reasons is more difficult. No single criterion can automatically be applied and the measures needed to address that vulnerability, will depend on each particular post-emergency situation.
Female headed-households are particularly vulnerable to food insecurity in both post-drought and post-war conditions, because of their very limited adult labour force (often only the woman herself being responsible for both farm work and household chores). This affects their capacity to engage in agricultural activities and to participate in public works. It is particularly acute for returnee households which may need to break land which has not been cultivated for many years. In post-war conditions female headed households can make up a large proportion of the population; e.g. in 1992 in Cambodia 40% of households were female headed, in some areas this proportion rose to 69%.14
