Household food and nutrition security is defined as access by all people at all times to enough food; the food must be safe and of good quality; and the environment should be conducive to the efficient utilization of food to allow individuals to lead active healthy lives (FAO, 1992). Frequently in armed conflict, access to food at the household level is seriously impaired and there is a reduction in both the quality and quantity of food available to the household. There is also an increased instability and uncertainty in the food supply.
The quality of the diet is especially important for small children who can only eat small quantities of food at one time. A two or three year old child can eat three meals a day, provided the energy and nutrients concentrated in the food are sufficient to cover his or her requirements. Where families lack the resources to provide oil or fat (energy dense foods) for the meals, the young child may only be able to get enough calories and nutrients if he or she eats four to six times a day. Thus, it is essential to ensure that the food that is given has a high concentration of energy and nutrients or that it is given frequently. Where the nutritional quality of food deteriorates due to conflict, families may not have the ability or the appropriate knowledge to make the necessary changes in the child's diet to ensure an adequate intake of energy and nutrients. A deterioration in the variety of food can lead to weight loss and vitamin and mineral depletion.
Similarly, a reduction in the food available to the household may leave the family with difficult decisions regarding the allocation of food within the family, especially at a time when normal food supplies and food habits are disrupted. Should more food be given to the family members who prepare and plant the land in the hope that the harvest in the coming year may be larger? Alternatively, should more food be provided to small children who will continue the family line and who are known to be physiologically vulnerable members of the family? How these priorities are perceived will greatly affect the child's nutritional situation.
In Figure 2 the factors that influence household food security are highlighted. These include production, access to employment, access to markets and in many situations, access to relief food. Relief food can make a significant contribution to household food security both during the initial crisis and later in helping families to strengthen their household food security. However, armed conflict also puts many constraints on the provision of food relief, and access to relief depends on a number of factors including physical safety and access to the population. The relative importance of each of these factors will depend upon the situation within a country at any point in time. In addition, local coping strategies will influence household food security (Section 2.3).
It should be emphasized that while inadequate household food security may be a major factor contributing to malnutrition in children, the existence of sufficient food at the household level does not necessarily guarantee that children will be well-nourished. The enabling conditions for food utilisation and assimilation must also be assured for better nutritional outcomes. The cooking practices, hygienic conditions, food distribution within the family, breast-feeding and weaning practices, access to health services, environmental sanitation and clean water all form a complex web of factors that determine nutritional outcomes.
Household Food and Nutrition Security
Domestic agricultural production is a major source of food supplies in most low-income countries. Armed conflict frequently has a disruptive effect on agricultural production and food availability, thus it has a direct impact on the nutritional status of children in many ways.
The factors which have an adverse effect on agricultural production in conflict situations are diverse. One of the coping strategies often used in rural areas is to plant on a variety of types of land (e.g. highland, lowland, swampy, dry land, etc.) to increase the potential of harvesting even when conditions are not very favourable. In addition, this strategy increases the variety of crops grown and improves the quality of the family diet. Insecurity due to conflict situations frequently leads to a reduction in the area of land planted as people either plant closer to the home for additional security or farther away from the main roads because of the threat of insecurity. There may be severe reductions in the area planted and type of land under production because of “taxation” by militia.
Conflict may lead to the destruction of agricultural infrastructure, such as irrigation and flood controls, and the lack of availability or drastic reduction of extension advice and services and subsidised inputs (e.g. fertilisers and seeds). Seeds may be eaten for lack of food. Trees, including those which provide crops, are cut down as part of the military's strategy to prevent ambush, or they may die through lack of care and irrigation water.
Reduced access or loss of markets as a result of the conflict also limits access to inputs (i.e. seeds, fertiliser, rental of machinery, etc.), while a reduction in production can limit the use that can be made of markets. Loss of access to other sources of income during the production cycle can significantly reduce access to food leading to consumption of insufficient food and less physical energy to plant enough land. Finally, food processing equipment may be looted or destroyed during the conflict, reducing the capacity to process and store food and at the same time increasing women's workloads.
All of the above factors may lead to a reduction in the quantity of food that may be available to the family and to their children. Also, the variety of foods grown is likely to be reduced, diminishing the child's access to a diversified diet containing vitamins and minerals, as well as to energy dense foods. The income available to the family, either to purchase other foods or to improve production will decrease. The amount of time that women can spend caring for children and ensuring that they receive sufficient food and health care is also reduced (Box 7). Food shortages during the planting season may mean that families are unable to prepare and plant enough land to meet their consumption needs in the next year. All of these factors produce a vicious circle for the family, leading to a downward spiral with negative repercussions for the nutritional status of children.
In pastoral or agro-pastoral populations armed conflict can have a dramatic impact on livestock numbers and on access to food in the family (Box 8). Animals may be killed, stolen or succumb to disease due to the collapse of the veterinary services in the area. This significantly reduces a family's direct access to food. It also implies a loss of income from the sale of animal products which is often used to purchase grain. This can lead to a deterioration of nutritional status in the family, an increase in health problems and impoverishment of the people.
Family members most “at risk” following the loss of livestock are children for whom milk is an important part of the diet, especially in the early years of life. Where livestock contributes substantially to people's daily food intake and livelihood, milk is not only a staple food, but it is also extremely quick to prepare, and it is either fed directly from the animal, or fermented and stored.
Milk is often fed to children in a fermented form, i.e. yoghurt. The acid produced by the bacteria in yoghurt acts as a preservative and prevents the growth of some harmful micro-organisms, particularly E. Coli, the cause of endemic diarrhoea in many places. Often, cereal forms the main ingredient of relief food. A child changing from a diet high in yoghurt to a cereal based diet may suffer from an increase in diarrhoea resulting from both the change in diet (low in fibre to high in fibre) and the loss of antibacterial properties in yoghurt (Kotz et al., 1990).
|BOX 7: The impact of conflict on agricultural production in the Juba Valley, Somalia|
In 1991, the Juba Valley was badly affected by conflict. A large proportion of the population was displaced to Mogadishu and Kismayo and to refugee camps in north eastern Kenya. From 1993 onwards, people started to return to their villages. However, the effects of previous displacement, the prevailing insecurity and low level conflict continued to hamper people's ability to cultivate and produce sufficient food. Production levels for the main harvest in 1995 were estimated to be 40–50 percent less than pre-war levels (WFP-Somalia, 1995).
When families returned to their land, it was over-grown with bushes. To clear the land was time-consuming and difficult. This reduced the land area that could be planted in the first year. Insecurity, particularly for the Bantu population, led to more cautious planting strategies. Farmers planted closer to their villages for fear that they might be attacked and looted and they were unable to take advantage of the different types of land in the area.
Many of the flood control systems and canals in the area were destroyed and looted or fell into disrepair. Some repair work was done by WFP and NGOs, but this was limited. This meant that the Juba River was no longer controlled and crops in many places were destroyed either by a lack or an excess of water. There was also limited access to tools and seeds. Extension advice and inputs previously provided by the Ministry of Agriculture were no longer available.
Many of the grinding mills in the area prior to the war were either stolen, looted or damaged and in many villages several families now shared one grinding stone. This was one of the factors that had contributed to an increase in women's workload (UNICEF-Somalia, 1994).
Opportunities for off-farm employment and income generation used to be available on banana plantations and in packing factories in the area but following the collapse of the irrigation system the banana trees died, and larger landowners in the Juba Valley have not been able to re-establish their plantations. Loss of transport and insecurity have reduced access to markets in Kismayo town as well. Purchasing power within town was also low.
Changes in diet may also lead to a deterioration in food hygiene and an increase in harmful micro-organisms causing diarrhoea. This results from poor preparation and storage of cereal based foods due to lack of familiarity with preparation techniques by the mother. The reduced access to food resulting from loss of livestock may also mean that the mother has to spend more time looking for food as well as preparing food for the child. This may reduce the number of feedings given to children and the length of time allocated to their feeding. Consequently, the energy and nutrient intake of the child may be reduced considerably.
Loss of livestock not only affects child nutrition directly through the loss of milk and meat products which are consumed, it also indirectly effects nutrition through the loss of a traditional reserve of food and cash6. In bad years, livestock are often sold or exchanged for grain. The loss of livestock is like losing all of one's savings, hence both the household's and the children's vulnerability to food shortages are increased as a result of drought, flooding and the impact of armed conflict. For this reason, even where livestock is not a major source of food, the loss of this resource can significantly reduce the quality of the diet by lowering the number of ways to get access to food.
|BOX 8: The impact of conflict on livestock production in Kongor, southern Sudan|
Prior to 1991, cattle made a major contribution to the diet of the Dinka inhabitants in the Kongor area of southern Sudan. On average, milk and meat provided about 40 percent of the food energy intake, wild foods provided 5 percent while fish provided 5 percent. Barter or exchange provided 10 percent and own crops accounted for 40 percent (Boudrou, 1995). In drought years when harvests were poor the local consumption of meat and milk would increase and both fish and cattle would be exchanged for grain. In flood years when crops were destroyed, fish and wild food consumption would increase, exchange would be limited as grain coming from the north to the local markets had stopped in 1983 at the beginning of the war.
In 1991 there was a massacre of both people and cattle in the Kongor area. In addition, most of the livestock were looted and taken to the Sobat area. Whilst livestock figures are difficult to collect, estimates prior to 1991 suggest that in the Bor/Kongor area there may have been as many as 1.5 million livestock. Following the massacres and looting in 1991, livestock numbers decreased to 50,000 (less than 5 percent of the original figures). Most of the population were displaced either to the swamps (toic) or to camps in Western Equatoria. Fifty thousand people were displaced and as many as 20,000 people died between 1991 and 1993 due to hunger and disease in the toic (Prendergast, 1993). Today, because of the loss of livestock, many families spend longer periods in the toic searching for food (mainly fish and water lilies). In the toic, there is no access to clean water and the incidence of diarrhoeal disease, malaria and respiratory infections is high. It is an extremely unhealthy environment which significantly affects the health and nutritional status of the population, particularly small children.
Livestock underpin the culture of the Dinka and the loss of livestock has had a serious impact on every aspect of life, most notably on the diet and nutritional status of the population. Several years later, this area continues to depend on relief for a part of the year. Milk used to make a major contribution to the weaning diet. Mothers were not able to manage the feeding of their children properly with food which was not from livestock for lack of knowledge. The loss of livestock resulted in both the slow development of the children and the high level of stunting. In a neighbouring area affected by high rates of malnutrition in 19937, many babies were severely malnourished and it has been reported that suitable food was available in the feeding centres yet mothers did not think that it was appropriate for small babies (CDC, 1993).
Food stored “on the hoof” for consumption during the planting season allows families to concentrate on increasing the area of land that they prepare and plant. Loss of livestock means that less land can be planted as some family members must travel in search of wild foods and fish to feed the family while others prepare the land. Families that suffer most are those with small children and an insufficient number of able-bodied adults to search for food, prepare the land and care for children.
Loss of access to employment, particularly in urban settings, may reduce the ability to purchase food, clean water and medicines, as is illustrated by the example of Mogadishu in Box 9.
|BOX 9: Unemployment and access to food in Mogadishu|
The population of Mogadishu is reported to be over one million people, including displaced people, Ethiopian refugees and squatter settlements. A nutrition survey conducted in Mogadishu in June 1995 reported that there was 20 percent moderate and severe malnutrition (wasting) among both the resident and the displaced populations living in Mogadishu. There was no significant difference between the nutritional status of the displaced and the resident population. These results were considerably worse than pre-war figures for malnutrition in Mogadishu, and markedly worse than the rates in 1993 following the large-scale interventions initiated by NGOs and UN agencies (Annex 3).
The nutrition survey highlighted the loss of employment and access to income as a major contributor to malnutrition in 1995. At the time of the nutrition survey, there had been no major fluctuations in market prices, however, employment opportunities were significantly reduced following the departure of the UN Operation for Somalia (UNOSOM) troops at the end of 1994 and beginning of 1995. It was estimated that UNOSOM directly employed between 4,000–10,000 people. There were large numbers of indirect beneficiaries in service industries such as cafes, bars, prostitutes, shoe shiners, taxis, etc.
Many of the people who benefitted from the UNOSOM presence supported several other families. However, due to the limited employment opportunities in Mogadishu a large proportion of these people have not re-integrated themselves back into the local economy. There is small-scale public sector employment and WFP has been providing Food for Work (FFW) but this has been limited due to insecurity. Benefits from petty trading are also limited as more people have entered into this activity. At the same time, purchasing power has been less. In Kismayo, it was even difficult for women to sell firewood.
Unemployment often contributes to an increase in insecurity and looting as people seek to meet food needs. This was the case in Mogadishu where the scarcity of food and its high price caused many young men to turn to banditry and looting in order to survive (Africa Watch, 1992). The increased insecurity makes it difficult to look for work or for food as people are trapped in their houses by fear. The time people spend looking for employment may detract from time spent on child care.
Unemployment may indirectly affect other families involved in petty trading because the loss of income limits the number of buyers and demand. It may lead to the sale of assets, especially in the earlier stages of a conflict, thus weakening people's resource base and making them more vulnerable to malnutrition in the future.
Markets play a crucial role in establishing and maintaining household food security. They are essential, especially in urban areas, supplying a variety of foods which improve the quality and palatability of the diet. In addition, markets may encourage the production of food to exceed home consumption needs, this can be exchanged for goods which are needed for the health and well-being of children. Markets provide money for services, education for example, that can eventually improve the nutritional status of children. They also provide access to commodities that will maintain or increase food production, such as seeds, tools, fertilisers, pesticides, animal feed, veterinary drugs, which can lead to increased food intake in the household.
Armed conflict often disrupts or destroys marketing activities having deleterious consequences for household food security and nutrition (Box 10). Increased insecurity reduces access to markets for the majority of people. In extreme cases, it can lead to the failure of markets as a result of lack of transport, fuel and spare parts, lack of safety, and deterioration of roads. This may cause a reduction in food production in an area since there is no place to market a surplus. Insecurity may prevent essential commodities from coming into the markets as businessmen will only bring in products if they can ensure security for their vehicles and goods as well as be assured of profits and customers. At the same time, prices may increase sharply, reflecting limited access and the small number of people with the resources to do business. Often black markets appear to obtain contraband or to sell stolen foods or relief goods.
|BOX 10: Constraints to marketing in Yambio, southern Sudan|
In 1995 in Yambio/Maridi in Western Equatoria, there was food self-sufficiency in 70–90 percent of households and most places produced a surplus (mainly sorghum, maize and groundnuts) (Sudanese Relief and Rehabilitation Association (SRRA)/Action Africa in Need (AAIN) Workshop, November 1995). It was estimated that there was a 16,000 Metric Tons surplus of cereals8 (OLS, 1995b). Before the war, the major markets which absorbed crop surpluses from the area were in Juba, Bahr el Ghazal and parts of Eastern Equatoria. Since the civil war, there has been no access to these markets because of insecurity, lack of transport, fuel and spare parts, poor roads and the lack of an official marketing agreement between the Government of Sudan and the rebel-held areas.
Marketing opportunities with Uganda were somewhat available until early 1995 when conflict between the Government and the SPLA cut-off all direct access to Uganda. Transport to Uganda then had to pass through Zaire, a notoriously difficult route, both insecure and expensive since there are numerous check points all of which require either fuel or dollars to pass through.
People coming from other parts of southern Sudan on foot or by bicycle to purchase goods in Western Equatoria are limited by the weight that they can carry back with them. This has meant that buyers from outside the area tend to purchase goods that are light to carry and have a high resale value, for example, second-hand clothes and batteries, rather than the more bulky food crops.
Before the war, livestock from other parts of the country were brought down to Yambio/Maridi and exchanged for grain. This has been severely reduced because cattle owners cannot carry the grain back home without transport. Lack of transport thus affected the marketing of cattle, leading to reduced access to meat products in the diet. It also affected the trade of food grains, reducing the energy available to the cattle sellers. Thus, the nutritional status of families which owned cattle and those which did not was affected.
A feasibility study which looked at the possibility of using the surplus to replace imported food relief in other parts of southern Sudan found that, with the exception of two areas accessible by road, all other options would be “less cost-efficient than the current way of distributing relief food” (OLS, 1995b). The report points out that other considerations might overrule a cost-efficiency option but that any “decision taken should be accompanied by a proper package of cash resources to purchase and transport the food surpluses” (Ibid), indicating a need for a major modification in much of the relief planning done by the major donors.
Despite obstacles, marketing often continues during conflicts and businessmen, military personnel and others can make large profits. In Somalia, for example, business cuts across most of the conflict lines in the country. In July 1995, the road between Kismayo and Mogadishu was controlled by two different clans. Goods were taken in one truck to the intersection and transferred into another vehicle which took the goods the rest of the way. Check points along the road charge a tax, but this was added to the sale price of the goods.
The lack of functional markets threatens the nutritional well-being of children directly. For instance, in 1990 the markets in Monrovia were so empty that a teaspoon of mayonnaise was selling for L$5 (approximately US$1). At this time, severe malnutrition rates increased dramatically from 1.6 percent prior to the war to 35 percent (see Box 2), the result of loss of access to income and food.