Brian Thompson is a Nutrition Officer in the Nutrition Planning, Evaluation and Assessment Service of FAO's Food and Nutrition Division 1
Southern Sudan has been affected by war for three of the last four decades; it is the region of one of the world's longest unresolved conflicts. More than 1 million people are estimated to have died since 1983, and 4 million have been displaced by fighting and famine. The humanitarian assistance that has been provided by Operation Lifeline Sudan (OLS) (see Box) since the crisis of 1989 was severely disrupted in 1998 by fighting and insecurity, and the overall situation deteriorated, especially in the region of Bahr al-Ghazal. Here, insecurity and the attendant famine were the most severe since 1988, but by October 1998 the humanitarian situation had begun to improve.
In November 1998, OLS requested that FAO send a team of food security and nutrition specialists to the Sudan to make recommendations for emergency programming. Innovative approaches were identified to help stabilize the humanitarian crisis and to ensure that the most vulnerable people were on the way to re-establishing their livelihoods. The focus was on programmes in household food security, food and nutrition, water and sanitation and non-food relief items. Special attention was given to community rehabilitation and preventive actions to mitigate and/or prevent future crises.
OPERATION LIFELINE SUDAN
Operation Lifeline Sudan (OLS) is a consortium of United Nations agencies and non-governmental organizations (NGOs) working with the people of southern Sudan, whose survival, protection and development are jeopardized by the complex emergency and extreme poverty. OLS was set up in 1989 following a devastating famine in southern Sudan - the result of drought and civil war which killed 250 000 people. Its mandate was to deliver humanitarian assistance to all civilians in need. Since that time, 360 000 tonnes of food aid have been sent to 4.7 million victims of war and drought in southern Sudan. In 1998, OLS was reaching 4 million people with essential relief and rehabilitation services and supplies, including food, basic health care, emergency relief and shelter, safe water, measures to improve household food security and basic education. As a result of poor infrastructure there is often little alternative but to provide assistance, where it is most needed, by air. Current costs for this air bridge are estimated at US$1 million a day.
The diversified climate and agro-ecosystems of Bahr al-Ghazal, in southern Sudan, include floodplains, riverbanks and the upper laterite plateau and make for a potentially food-secure area. Each area has it own production cycle, where crop cultivation, fishing and livestock rearing are practised. The major cereal grown is sorghum, while maize, millet and rice are minor crops in some areas. The importance of cereals in the diet varies greatly with agro-ecological zone. Livestock, used mainly as a source of milk and some meat, are important in the diet; groundnut, cassava, fish and wild foods also feature. The complementarity of these systems is the basis of very sophisticated barter and trade mechanisms, a crucial component of risk management. Although highly resilient to climatic hazards, these systems have been damaged by years of war and uncertainty and, when an additional shock occurs, coping mechanisms are strained and people become more vulnerable. This was the situation in Bahr al-Ghazal in 1998.
Despite relatively favourable agrometeorological conditions, in 1998 Bahr al-Ghazal was the site of one of the worst famines in recent history. The situation deteriorated rapidly following attack on the government-held town of Wau in early 1998. More than 100 000 people fled from the initial fighting and from the subsequent organized massacre of Dinka tribespeople that followed. This had disastrous spillover effects for the region's estimated 2.1 million population. Local food supplies were inadequate and the government-imposed ban on relief flights at that time prevented the delivery of food. The normal support systems of kinship and community obligations soon became exhausted and the crisis quickly turned into disaster. The World Food Programme (WFP) launched an emergency operation to provide food assistance to war- and drought-affected populations in both northern (government-held) and southern (rebel-held) sectors.
April 1998. Large numbers of people began to arrive in Wau as a result of the famine and the appalling security situation in the countryside. Many people who had initially fled Wau returned in a desperate condition. Others, from rural areas of northern and eastern Bahr al-Ghazal, were forced to come to the town in search of food. People struggled on foot to reach the feeding centres, many already too weak to be saved. Families were not able to feed the old, the infirm and the weaker of their children. In July and August, between 50 and 100 people were reported to be dying daily and malnutrition rates of 25, 50 and 70 percent were observed among residents, returnees and internally displaced persons (IDPs), respectively. The IDPs who were crowded in the centre of the town were destitute and likely to remain dependent on food aid and relief for some time. Most agencies were ill-prepared for this influx and, although feeding centres were set up, mortality rates continued to be very high. Marasmus was the most common form of severe malnutrition. The incidence of anaemia was high, owing to dietary deficiency which was exacerbated by malaria and intestinal parasites such as hookworm. Goitre was endemic, especially in the northern towns of Raga and Aweil.
In the southern sector, distribution points and feeding centres were established in response to the extremely high rates of malnutrition. In many cases, malnutrition seriously affected both children and adults, indicating prolonged and serious food shortages. The situation for IDPs who congregated in densely crowded, newly settled areas, such as Ajiep, was especially disastrous, owing to the combination of nutritional, sanitation and medical problems.
June 1998. After a ceasefire was declared in June 1998, the distribution of food aid and other items to the needy increased. Although the general food supply improved, the situation in families varied according to what they could harvest and their coping capacities. Some displaced farmers were able to graze livestock after the rains, collect wild foods and return to their homesteads to plant, if they had seeds. As a result, the health and nutrition situation in many areas improved significantly. However, because of continuing insecurity, most households avoided long-term production activities as they sought to avert or minimize risk. For example, cultivation of land rarely extended beyond a 20- to 30-m radius from the house, as farmers were not confident that they would be able to harvest and keep their crops because of looting and pillaging. In addition, acquiring food, seeds and tools was difficult as shortfalls could not be compensated by normal trade and exchange mechanisms, which had broken down.
November 1998. The nutritional status of all groups in both the northern and southern sectors had improved significantly, with the numbers of beneficiaries of the supplementary feeding centres (SFCs) and therapeutic feeding centres (TFCs) declining as discharges exceeded new admissions. However, the prevalence of malnutrition and rates of mortality remained unacceptably high, especially among IDPs. Malnutrition continued to be a major cause of death in hospitals and in the community. Adults and children with acute malnutrition were being treated in the feeding centres. The fact that many adults met the criteria for inclusion in the feeding programmes indicated that the food security problems that triggered the crisis were still present.
In November 1998, it was forecast that overall agricultural production in southern Sudan would be substantially higher than the previous year's harvest because of better rains and a season free from pests and diseases. In spite of this projected increase, Bahr al-Ghazal was expected to be deficient in cereals by about 55 000 tonnes, mainly because of a reduction in planting as a result of fighting and insecurity. Normally, there is a hungry period from April until September, but the situation was far worse than in previous years.
Post-acute phase. Throughout this crisis OLS concentrated on stabilizing populations, lowering mortality through food assistance and nutrition programmes, and preventing outbreaks of disease. Although mortality rates began to drop by late August, assistance was still needed, and OLS sought to design better programmes to respond to this phase of the famine.
The availability and access to food varied by location and among population groups. In some areas the recent harvest of cereals such as sorghum and maize, although poor, when combined with the seasonal availability of a variety of wild foods, had led to a noticeable improvement in the nutritional situation of many families. For those with livestock, the improved forage had fattened cattle, with benefits to milk consumption and nutrition. In various areas of southern Sudan, seed and tool distribution and veterinary programmes had been highly instrumental in re-establishing agricultural production. However, of great concern was the fact that in many areas populations were being maintained on the brink of survival with barely sufficient food and services to avoid the onset or recurrence of an acute nutritional emergency. It is clear that the post-acute phase of the emergency may also be the pre-acute phase of another crisis.
The war, and associated pillage, is the primary cause of the famine and an overwhelming obstacle to the efforts of the international community to provide relief assistance or to support recovery. Famine is not only the result of the conflict but is also a means by which the war is carried out. Clearly, without genuine peace and a programme strategy that encourages reconciliation, humanitarian efforts to save lives and protect livelihoods will only provide a temporary solution. As part of such a strategy, training courses on the UN Declaration on Human Rights should be provided as a priority.
Unfortunately, peace remains unlikely because of the north-south confrontation and the south-south interfactional, intertribal and intratribal fighting. In addition, many uncontrolled armed groups continue the war for selfish motives and to derive whatever benefits they can from it. There is a real risk of continued displacement of households as a result either of a flare-up of the fighting or of marauding and looting by militias. As the situation is already fragile and dependent on the ability to cultivate, harvest and trade, the nutritional conditions would deteriorate rapidly in the event of a flare-up in fighting. There is a strong possibility that there would be, once again, large numbers of people requiring emergency food assistance, including admission into the supplementary and therapeutic feeding programmes. The capacity to respond and adapt to changing needs is essential.
Resilience, the capacity to resist and absorb shock, can be viewed at the individual, family and community levels, as well as from the levels of the regions, aid programmes and institutional set-up. After the acute phase of the famine, there was the need to enhance resilience of the people who had been affected. In addition, ways were sought for avoiding further humanitarian catastrophe before a famine.
Climatic hazards, outbreaks of crop pests and diseases, erratic military and random breaches of law and order and the deterioration of roads and airstrips are features of daily life throughout Bahr al-Ghazal. These risks drastically affect both short- and medium-term household food security. Consequently, risk is the most important single obstacle to any operation in southern Sudan, and particularly to any asset-building programme.
Because of the multitude and magnitude of risks, the situation has moved, and continues to move, from one disaster to another, with crises of varying intensity and duration. In this context, sustainable recovery will not be a quick process. If fighting were reduced, the considerable resilience and coping capacity of the people of southern Sudan would go a long way to making them less dependent on external aid.
A number of practical measures to increase the capacity of agencies, institutions and staff to deal with the management of this complex emergency situation were recommended. The aim was to raise the level of alertness and disaster preparedness and ensure proper support to both life-saving and livelihood-protecting activities, with a focus on increasing the population's resilience to disaster. Some of the recommendations focused on:
In order to increase the credibility of assessments, which is essential for maintaining strong donor support and timely response, improvement in data quality was recommended. A simple yet comprehensive information management system was needed, which would be operated by a specific interagency neutral mechanism to ensure its transparency and objectivity. The system could draw on the work of WFP's Vulnerability Mapping Unit (VAM) and Food Economy Analysis Unit (FEAU).
As early warning systems are only as good as the timely and appropriate responses they elicit, the elaboration of a set of contingency plans to respond to the changing situation was recommended. The pre-stocking of supplies in safe areas and pre-positioning of items closer to the areas of distribution would be helpful. The staff in existing feeding centres need to be trained to cope with sudden influxes of people and to be capable of rapid expansion if the need arises. The quality of the working and living conditions of staff greatly affects the level of preparedness as well as the quality and efficiency, of programme implementation and both need to be improved urgently.
To achieve quality programming, greater cohesiveness and coherence of approach among agencies is required. The relationships between UN/OLS agencies, non-governmental organizations (NGOs) and national/local administrations were different in the northern and southern sectors. Improvements in operational coordination would ensure coherence of standards and codes of practice between the two sectors. Joint priorities should be set for programmes, along with technical guidance for their design.
Safeguarding the livelihoods of those in distress must include, as a priority, the building up of the nutritional status of individuals so that they can cope with the oncoming hungry season. It also serves to increase the resilience of the vulnerable to withstand further shocks and stressful situations. As part of such a nutrition programme, the distribution of a variety of good-quality, nutritious food rations and the operation of well-targeted feeding programmes for those undernourished or at risk are essential.
Reports of widespread and severe malnutrition in certain areas long after the commencement of food aid delivery led to suspicions that people were not receiving their rightful share. The high numbers of malnourished children returning to the feeding centres a few weeks after discharge also indicated that food security at the family level was not always being achieved. However, in many cases the "dilution" of the food ration was the result of voluntary decisions by beneficiaries to share food with others on the basis of kinship ties and traditional community obligations rather than by force and coercion. Family relationships and social obligations traditionally spread risks and serve as a communal coping mechanism for those who may become food insecure in the future. In this context, the targeting of food supplies to the most vulnerable and the policing of any such system to ensure that these groups directly benefit from it present particular difficulties. Priority should be given to ensuring that the food reaches those who need it most - the vulnerable and the physically affected - and the following approaches were suggested:
WFP-FEAU trains food monitors to calculate food deficits, assess food needs and conduct post-distribution monitoring and evaluation. Monitoring of the quality and quantity of food consumed by families should be particularly supported.
On many occasions, supply problems meant that the full ration could not be delivered, in particular vegetable oil and pulses were lacking. Urgent steps needed to be taken to ensure that a complete and nutritionally balanced food basket was provided. To ensure that the food supplied was of acceptable quality, an efficient food quality control mechanism was needed, with feedback to the supplier if quality fell below acceptable standards.
The length of time required for distributing the food rations to IDPs was excessively long, taking four days every two weeks. Measuring the amount of grain according to family size was time-consuming for aid workers and exhausting for beneficiaries. Pre-packaging an average family ration to be given directly to the woman of the household has been undertaken successfully in other UN emergency operations, and the mission suggested that this be explored.
A nutrition survey was undertaken of the residents of Wau and remedial measures were introduced for vulnerable households, including admission into feeding programmes and inclusion in the general food distribution. For IDPs who had been relocated, looting at night was a major problem and authorities were asked to step up security in the camp.
Nutritional recovery is a crucial factor for both pre- and post-crisis management. In this respect, great achievements were made under extremely difficult conditions in the course of the 1998 emergency.
Yet some centres were not performing well. Initially, the numbers of beneficiaries exceeded capacity and, as a result, standard operating procedures and treatment protocols were abandoned. Steps should be taken to maintain standards, with adequate monitoring and supervision, better reporting and feedback procedures and greater presence of OLS staff in the field. Bodyweights should be recorded adequately for monitoring purposes.
Generally, improvements were needed in the quality of care given and the level of attention provided by local and international staff. Standard operating procedures and protocols should be agreed upon in the areas of community-based nutrition improvement, including feeding centre treatment protocols, in-service training, education and outreach. Additional recommendations were suggested for increasing the quality and effectiveness of the feeding programmes including:
Strengthening household food security through efforts to diversify survival mechanisms simultaneously reduces pre-crisis vulnerability and crisis impact, and is an important element in dealing with the post-acute phase of emergencies. Many of the mission's recommendations support existing survival strategies and can be implemented even in the highly volatile situation in southern Sudan. Such efforts call for participatory community-based approaches, together with technical support from the specialized agencies. Only the essential elements of the proposals are mentioned in this article.
Support needs to be given to the resumption of the economy. Although asset-stripping is part of the war, and accumulation of goods or wealth in a specific site could make marketplaces attractive targets to looters of all kinds, small markets for formal trade, local exchanges or barter, which exist in most areas, should be encouraged. Bahr al-Ghazal is a crop-deficit area, but there are pockets where local surpluses are produced.
Trade with surplus areas should be encouraged and, for this purpose, the state and security of the road should be improved. Seed of local crop varieties should be bought for cash to stimulate the cash economy, obtained by barter or exchanged for food aid grain at attractive prices to encourage production.
Bahr al-Ghazal is a major producer of livestock, and trade in livestock could be eased by: training of staff in livestock marketing and through study tours to markets in Uganda and Kenya; establishing a veterinary laboratory near the border to certify freedom from notifiable diseases such as rinderpest; publishing regional price information to ensure that farmers receive a fair price for their stock; and monitoring taxation rates and reducing corruption.
The OLS Livestock Sector Programme has trained more than 600 Community Animal Health Workers (CAHWs) in the southern sector, and a further 400 in the northern sector of Bahr al-Ghazal. These achievements should be extended through further development of cost-recovery mechanisms, improved availability of drugs and veterinary medicines, including possible selling by pharmacies, and encouragement and training of able CAHWs, veterinary practitioners and private traders. Breeding, feeding, forage production and range management skills should be further supported and encouraged.
Every effort should be made to encourage farmers to replant crops as a means of recovery. More ploughing with oxen would increase the cultivated area, and improved soil preparation techniques would facilitate water penetration and storage, leading to increased yields.
Much of Bahr al-Ghazal depends on cereals, largely sorghum, with a little maize, millet or groundnut. Cowpea and sesame are grown on some farms. Cassava and sweet potato flourish around Wau, and planting material for these crops should be made available to all parts of Bahr al-Ghazal, together with a concerted extension campaign. Cassava and sweet potato are far higher yielding than cereals, and also more drought-resistant. These crops, especially cassava, could generate seasonal surpluses for processing into dried products that would find a ready market and obtain a higher price than sorghum. Education is needed on the use of cassava leaves as part of a balanced diet. The combination of short- and long-season sorghum and millet varieties, supported by cassava, sweet potato and various local and exotic vegetables, would insure people against hunger and offer opportunities to create surpluses in fresh and processed forms.
The lack of seed was farmers' main complaint. The region is short of certified seed, and even when seed is available, often at inflated prices, it was not always suitable for the various microclimates and environments of southern Sudan. Clearly, the best way to supply seed to farmers is to produce it locally, giving farmers a chance to produce for a guaranteed market at a good price. Local seeds have to be collected, inventoried and multiplied while they still exist. NGOs have been involved in the local production and marketing of seeds in Tambura and Yambio for more than five years, and their efforts should be supported and further expanded.
Some of the tools provided as aid did not fully meet local needs. For example, imported mallodas (push-hoes) have been extensively modified by blacksmiths to suit local demand. Providing local blacksmiths with the raw materials to make tools according to local design would be preferable. Improved technologies for metalworking should also be taught, and basic equipment such as anvils should be provided on a cost-recovery basis. However, tools that can be produced more cost-effectively in a factory should be imported. Where possible, farmers should be provided with tools of the highest quality. Quality and acceptability, not only price, should determine selection of the tools supplied.
The processing of cassava and sweet potato is well known in the Wau area; it could be extended to other centres in Bahr al-Ghazal and elsewhere in southern Sudan. The processing of fruits, many of which go to waste during years of abundant harvest, could be encouraged. Cheese-making is not practised in Bahr al-Ghazal, but it could be demonstrated by cheese-makers from Um-Rwaba, the main cheese-making centre of the Sudan. There is impressive scope for fishery activities, including processing which could shorten the hungry period and improve opportunities for trade and income generation.
In southern Sudan, storage structures are often unsuitable and inefficient in preventing post-harvest losses to rats, weevils and other pests. The use of rat-proof storage structures made from local materials could be encouraged. The use of neem as a locally available insect repellent could be introduced, as it is impractical to use commercial stored insecticides in remote areas.
In many parts of southern Sudan, the economy is at a virtual standstill. In order to improve people's livelihoods, the development of income-generating projects should be fostered, including fish processing, tailoring/making of mosquito nets, processing of cassava and sweet potato, beekeeping and woodcarving, while transport of the finished products to market should be facilitated. One possible project could be the production of prosthetic aids to meet the demand of the large number of amputees.
Projects and activities should be community-based, with the communities working together to prioritize their own problems and devise community strategies to solve them. This requires training in the approach, to enable field staff to plan coherent and lasting programmes in consultation with local communities and implementing partners. To encourage the development of good working relationships at the community level, staff should remain in the field for an appropriate amount of time. Technical support is available in the different programme areas from specialized agencies of the UN system and others.
Since this report was written, there has been a general improvement in the food and agriculture situation owing to favourable weather conditions. Relative peace in many locations has resulted in continuing improvements in food and nutrition with a decline in the numbers requiring admissions to feeding centres. However, food shortages continue to be experienced by many households in many locations mainly because of the continuing civil unrest. The disruption to agricultural production and the resultant loss of assets and access to markets has left thousands of people still in urgent need of assistance. Security remains particularly serious in the IDP camps in Wau, where rape and killings continue, and in those areas where cattle-raiders are abducting villagers. The capricious nature of the food and nutrition situation argues for the mission's recommendations to be fully implemented without delay.
1 This article is adapted from the mission report: The Sudan - Programme Design Consultancy Operation Lifeline Sudan (OLS) 11 to 30 November 1998 by F. Grunewald, Team Leader; B. Thompson, FAO Nutritionist; and J. Breen, FAO/UNICEF Agronomist and Food Security Specialist.
Coping with chronic complex emergencies: Bahr al-Ghazal, southern Sudan
One of the world's longest unresolved conflicts is taking place in the southern Sudan region. It is estimated that more than 1 million people have died since 1983, and 4 million have been displaced by fighting and famine.
In November 1998, the UN's Operation Lifeline Sudan (OLS) requested an FAO mission to the Sudan to recommend emergency programming after the Bahr al-Ghazal famine. The FAO team analysed the situation and reviewed the appropriateness of the OLS emergency response. The team identified innovative approaches for OLS that would stabilize the humanitarian crisis and ensure that the most vulnerable groups could re-establish their livelihoods. Programmes focused on household food security, food and nutrition, water and sanitation and non-food relief items. Recommendations for cost-effective and practical improvements to the current operation were made with the aim of improving the appropriateness and quality of programme delivery, coverage and targeting to the most vulnerable groups. Special attention was given to community rehabilitation and preventive actions to mitigate and/or prevent future crises. The observations of the mission team are described in this article. Some of the general findings and recommendations are relevant for the management of other post-acute emergency situations.
L'un des plus longs conflits non résolus du monde se déroule dans le sud du Soudan. On estime que plus d'un million de personnes sont mortes depuis 1983 et que 4 millions d'habitants ont été déplacés par les combats et la famine. En novembre 1998, l'«Opération survie au Soudan» des Nations Unies a demandé l'envoi sur place d'une mission FAO en vue de la programmation de l'aide d'urgence après la famine de Bahr al-Ghazal. La mission FAO a analysé la situation et examiné l'opportunité de la réponse «Opération survie au Soudan». Elle a identifié des démarches novatrices pour cette opération, qui permettraient de stabiliser la crise humanitaire et d'assurer que les groupes le plus vulnérables reprennent une vie normale. Les programmes étaient centrés sur la sécurité alimentaire des ménages, l'alimentation et la nutrition, l'eau et l'assainissement et les secours non alimentaires. Des recommandations, visant des améliorations rentables et pratiques de l'opération en cours, ont été faites concernant l'adéquation et la qualité de la livraison, de la couverture et du ciblage du programme destiné aux groupes les plus vulnérables. Une attention particulière a été accordée au relèvement des communautés et aux mesures préventives permettant d'atténuer et/ou d'empêcher de nouvelles crises. Les observations de la mission sont décrites dans cet article. Un certain nombre de conclusions et recommandations générales sont pertinentes pour la gestion d'autres situations d'urgence, passé la période la plus difficile.
En la región meridional de Sudán tiene lugar uno de los conflictos sin solucionar más largos del mundo: se calcula que, desde 1983, ha muerto más de un millón de personas y que hay cuatro millones de desplazados a causa de los combates y del hambre.
En noviembre de 1998, tras el período de hambre padecido en Bahr al-Ghazal, la Operación Supervivencia en el Sudán (OSS) de las Naciones Unidas pidió a la FAO que enviara una misión al Sudán para que recomendara una programación de emergencia. El equipo de la FAO analizó la situación y examinó si era adecuada la respuesta de emergencia de la OSS. El equipo identificó para la OSS modos innovadores mediante los cuales se podría estabilizar la crisis de índole humanitaria y garantizar que los grupos de personas más vulnerables puedan recuperar sus medios de vida normales.
Los programas se centran en la seguridad alimentaria en el hogar, los alimentos y la nutrición, el agua y el saneamiento, y los socorros no alimentarios. En cuanto a la operación actual, se hicieron recomendaciones para obtener mejoras tanto en la eficacia en función de los costos como en la práctica, con la finalidad de asegurar una mayor pertinencia y calidad en la ejecución de los programas, su cobertura y selectividad con respecto a los grupos más vulnerables. Se prestó especial atención a la rehabilitación de comunidades y a las acciones preventivas, a fin de paliar y prevenir crisis futuras. En este artículo se describen las observaciones del equipo que realizó la misión. Algunas de sus conclusiones generales y recomendaciones son útiles para afrontar otras situaciones posteriores a graves emergencias.