Letter on 'silent emergency' in India, by Rita Bhatia
Having read issue 4 of Field
Exchange I wish to comment on the article "Novel methods of food for work".
It was a surprise to me to
read that an agency getting involved in a rehabilitation programme would
start a project without having secured the necessary funds, thus compelling
the field staff to deploy a great deal of ingenuity (very commendable,
to be sure) and time in order for them to get the means to get on with
the job. What is even more surprising is the fact that having secured money,
they still pay their workers in kind, namely food. It has been the practice
of many agencies the world over to pay their local staff by the means
of food for work.This practice is in my view only justified in certain
exceptional circumstances, e.g. Cambodia in 1980 when the country had no
legal tender and the markets offered nothing that money could buy. Other
than in such like situations, I believe this practice as unfortunate and
even harmful. The food for work schemes imply that the human being is solely
a biological being (needing to be fed ) and ignores that humans are also
social and cultural beings who require a certain amount of material
means to fulfil their social and cultural needs.
These needs may take second
place at the height of a crisis but, two years after the event? Article
23.3 of the Universal Declaration of Human Rights states that "who ever
is working is entitled to remuneration that is both equitable and satisfactory,
assuring him and his family an existence in conformity with human dignity"
Where is the dignity of a person who is held in such a state of dependency
(or should I say subservience?) that he cannot set his own priorities,
cannot make free choices and decisions. Decisions are made for him. He
has to eat his 'income', all of it, and to add insult to injury, he cannot
even choose his food! Many agencies voice their concern as regards the
dependency that often appears in the wake of humanitarian actions. But
it is hypocritical to advocate for 'independence' whilst practising food
for work schemes. Many a country emerging from war finds itself with a
shattered economy, in dire need of rebuilding and stimulation. Food for
work schemes make no input at all. The food distributed will be imported
from Western Europe or the USA thereby resulting in the funds earmarked
for relief/ rehabilitation staying in the donor country
Food for work schemes contribute
to the undermining of the farming community. Local foodstuffs are devalued
and farmers find difficulty securing a price to pay for their harvest.
In the aftermath of major crises, it is often that humanitarian agencies
are the sole employers with resources in an otherwise depressed labour
market. Whilst post war rehabilitation should emphasise the revival of
systems (health, justice, education, etc), the repair of physical infrastructure
offers an opportunity to provide people with paid work rather than assistance.
Money is fungible and will produce a ripple effect by which the shopkeeper
and the craftsman etc. will benefit from wages paid. But for this to happen,
it requires that people are paid in money, not food. Finally, an individual
paid in kind will be unable to build up some reserves to protect himself
from further vulnerability.
In short, whilst food for
work may sometimes be an acceptable practice in the midst of a life threatening
crisis, to keep a fellow human being, who has provided a good day's work,
at a mere subsistence level, in the phase of rehabilitation, is unworthy
of a humanitarian organisation.
6, Route de Ferney
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I would like to say how difficult
it is to recruit experienced Nutritionists for emergency programmes. When
emergencies die down you cannot move without coming across a nutritionist
eager for employment. When an emergency hits the headline you cannot
see them for dust. Yet there is still a demand.
Is it that there are only
a few nutritionists with this type of experience or is it that we do not
know where to find them or where they look for jobs? Are the agencies
criteria too excessive?
Recently I have been looking
for Food Monitors for Sudan for Oxfam/WFP; a Senior Nutritionist for Sudan,
Oxfam; Nutritionist for Sudan, Christian Aid; Nutritionist for Tanzania,
Oxfam. I also know that Merlin are experiencing the same difficulty
and this must be the tip of the iceberg.
Can your readers shed any
light on this?
International Health Exchange,
8-10 Dryden Street, London WC2E 9NA
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Sudan Dilemma - Who Gets
To Eat ?
I have just returned from
an emergency response contract based at Ajiep, in the Bahr-El-Ghazal region
of Southern Sudan. The situation is disastrous. Food provision was a logistical
nightmare. The area could only be accessed by planes, which were in short
supply. Heavy rains further compounded problems of access leaving airstrips
frequently unsafe for landing.
We simply did not have enough
food to provide a supplementary ration to all those who needed it. Every
day I was faced with the decision as to who should receive these scarce
resources. The crux of my dilemma was in deciding whether food should be
targeted at the most severely malnourished, or at moderately malnourished
I would be interested to
know what others have done in similar situations of severely limited food
stocks. Should we provide food to those at greatest risk of dying and with
the poorest prognosis, or should we be attempting to rehabilitate those
who are less at risk and have a better chance of survival ?
This sort of basic dilemma
has faced aid workers repeatedly over the past two decades. When resources
are scarce for whatever reason there is a decision to make on who and how
to target. Some agencies tend to respond to this dilemma by targeting food
and medical resources to the most severely malnourished many of whom have
a poor prognosis and others to the moderately malnourished who are more
likely to survive. This is a difficult decision to make as those who are
not targeted run a high risk of dying. Some reviews of emergency feeding
programmes have highlighted this cruel dilemma in extreme famines but emergency
feeding guidelines still fail to address the issue. In short the
triage approach to emergency nutrition situations remains poorly developed.
Perhaps the lack of progress on this has been due to a reluctance to accept
the shortages which force field workers to negotiate such decisions or
simply the reluctance to accept responsibility for making decisions about
who should live and who should die. The reality is that shortages do occur,
decisions must be made and field workers should not be left alone in isolation
to make these decisions. More could be done to achieve consensus and develop
guidelines on this issue. (Eds.)
of the page
I saw Field Exchange for
the first time today. I was much impressed by its content and intent to
inform the field and to share feed-back concerning field views and reactions.
A much needed and important publication, if 25 years of from-the-field
I would like to offer comment
on a specific issue, namely the No. 4 (June, 1998) Issue's Research Section
article, "Sale of Food Aid: A Sign of Distress not Excess". While acknowledging
the professionalism and intensity of Drs. Reed and Habicht's nutritional
research, I find it surprising that, at least in the Field Exchange's summary
of the published paper, there was no mention of the possibility that diversion
of food by political/military groups may have detracted significantly from
the nutritional well-being of refugees in and around Uvira.
Concept: HCR was able to
launch a head-count in the Uvira Refugee Camp in 1996, one which reduced
the actual estimate of the refugee feeding caseload in the camp by about
32%. It is fairly well-established that the Interahamwe and ex-FAR
"taxed" camp inmates at will in the Great Lakes refugee camps.
Quick sale and export of
extorted corn and oil proceeds were easily done given Uvira's location
by Lake Tanganika. As UN rations were reduced to reflect lower headcount
totals, surplus food distributions were halted. The Interahamwe and
the ex-Far were compelled to dig deeper into refugees' rations to maintain
a required level of income. Hence, the perceived inadequacy of UN rations
and subsequent suffering of the Uvira Refugees. Refugees in actuality
had little to sell or barter after "taxes" were paid to armed "refugee"
bullies. End Concept.
The researchers conclude
that,"The fact that more than three-quarters of (Uvira Camp Refugees) did
not have sufficient diets and that rations were reduced because food sales
(in local markets) had been misinterpreted by donors and responded to by
WFP is disheartening".
There was never an inadequacy
of donor response to HCR and the WFP in the Lakes Crisis of the era. The
World Food Program was quite correct in effectively limiting the depredations
of in-camp terrorists by reducing amounts of excess food that the ex-Far
and Interahamwe genocidalists could tax and skim, presumably to pay militia,
buy arms and perpetuate warfare.
Donors did not react to
the presence of food in local markets and demand cutbacks. In fact,
the donor of 70% of the food aid distributed in the Lakes Camps recognises
that refugee bartering of rations for other necessities is a common and
ineluctable occurrence, one of little note or consequence.
Drs. Reed and Habricht may
have overlooked the impact of in-camp politics, the raw power and
ruthless aims of the forces then at-large in the Uvira Camp of 1996. Refugee
camp nutrition is not a stand-alone science; politics as well as economics
should be weighed in any assessment of what really causes refugee malnutrition.
Western tendencies to paternalism put aside, research into what varying
groups among refugees themselves cause should be considered in future H&N
In Uvira of the day, sinister
elements among camp refugees may well have been the efficient cause of
malnutrition sampled by the researchers.
Joseph E. Gettier
Taken from Field Exchange Issue 5, October 1998