Silent disasters of Africa / by Maniza S. Zaman

Silent disasters of A&ica whole spectrum of dis- asters regularly afflict the African continent. In terms of the harm they do to communities, they can be roughly ranked in this order: famine, war and civil strife, displaced populations, floods, cyclones, earth- quakes and, lastly, epidemics. Always lurking behind these newsworthy events, and in part a consequence of them, are the "silent disasters" of Africa: chronic conditions of malnut- rition, high death rates among children aged under five, a lack of health services and gross social inequality. When disasters strike, people die or are injured, they lose their possessions and their homes; basic services may be interrupted, and recovery from such events call urgently for often scarce resources and time. And alongside the health, economic and social conse- quences come the short-term and long-term effects on the food situation. Thousands of families may face hunger because floods have washed away all food stocks, while their land has been devastated, and there are no savings or income to buy such food as is available. It was with a view to counteracting some of these harmful effects that WHO's African Regional Office set up its Emergency Preparedness and Response Unit in 1987. The following year the Panafrican Centre for Emergency Preparedness and Res- ponse was created in Addis Ababa. The Centre offers training courses and also conducts operational research and policy analysis related to disasters and the chronic food crisis, as well as to the management of the health situation in times of disaster. Most of the disasters that afflict Africa call for large-scale food relief programmes. Such nutritional emer- gencies are epitomised by the unfor- gettable images of famine victims who congregated at relief camps in Ethiopia and Sudan during the mid-1980s. Famine is a slowly developing phe- Drought and desertilication: slow disasters that aHect many African countries. WORLD HEALTH. J an uary- February 1991 by Maniza S. Zaman nomenon which may be triggered by drought, uncontrolled pest infestation or the threat of warfare. Ms Maniza S. Zaman works with the WHO Pan- african Centre for Emergency Preparedness' and Response, Addis Ababa, Ethiopia. Even though there may be various early warning indicators - such as low rainfall , dwindling food reserves, toppling market prices - it is only when local coping mechanisms and external aid have both failed that people start to die from malnutrition and starva- tion. During the last decade, such countries as Kenya, Botswana and Tanzania have responded promptly to indicators of emerging food crises, and by mobilising internal resources have succeeded in averting famine situations. African countries are host to more than 4,500,000 refugees, most of whom are fleeing from war situations or repressive regimes. The majority of them carry only the minimum of food needed for survival before reaching the host camp, and are thus totally depen- dent on external aid for survival. Feeding them remains one of the biggest challenges in the care and management of refugees. Wars and civil strife often lead more directly to food crises. Financial, mater- ial and human resources are diverted from agriculture to fuel the war, local markets are disrupted, people migrate within the country or become refugees, and relief efforts may be deliberately blocked. The timing of a sudden disaster will have a critical bearing on the conse- quences. If it strikes during the lean pre-harvest period, communities will be more vulnerable than ever, since food stocks will be low and people's nutri- tional status relatively poor. Direct assistance in the form of food relief involves feeding or distribution of dry food rations. Sometimes only a short-term food distribution for not more than a few weeks may be called for in the wake of a disaster. Other situations require long-term food relief over months if not years (e.g. pro- tracted emergency situations). Even when food is physically avail- able, famine conditions may arise simply because poor people do not have access to the supply. At-risk groups in such circumstances have to be helped, either through food-for- work schemes or by providing em- ployment opportunities, for instance, on public works projects. Deficiency diseases The most common problem to be faced is protein-energy malnutrition. Added to that may be specific vitamin and mineral deficiency diseases - for instance, scurvy due to lack of vitamin C, anaemia through lack of iron or folic acid, or blindness and illness caused by vitamin A deficiency. Severe malnutrition rarely occurs in the immediate aftermath of disaster, but may develop slowly if preventive action is not taken. It usually arises among people subjected to long-term stress - where drought conditions lead to famine, or where refugees already facing chronic food shortages have to embark on long journeys. Ideally it is best to avoid the for- mation of settlement camps in case they become permanent. But more often than not such camps develop spontaneously, and the responsibility for running them falls on the relief workers. WHO has recently developed rapid assessment protocols for use in different types of emergencies, so as to determine the severity of the problem, the adequacy of food access and the local response capability. In the WHO publication The Man- When local resources and external aid fail, people start to die from mal- nutrition and starvation. s · WORLD HEALTH. January- February 1991 Training course in the computer la- boratory at CRED, in Belgium. agement of Nutritional Emergencies in large populations, four ways of food relief are recognised. General food distribution includes delivery of dry food to people (usually families) at regular intervals. Mass feeding means that prepared (cooked) food is served to everyone, usually in a camp setting. Supplementary feeding will ensure that extra rations reach groups more vul- nerable to malnutrition, such as child- ren under the age of five years, pregnant or lactating women, or old people, in addition to the general rations or meals so that their particular needs are met. Therapeutic feeding will provide high-energy, high-protein foods for people - in particular infants and young children - suffering from severe protein-energy malnutrition. One rule-of-thumb target is to pro- vide an absolute minimum of 1,900 kilocalories per person per day, regardless of age. Of course, this figure needs to be augmented for people with infectious diseases (who need more calories), or if clothing and ~ shelter are inadequate to keep people i warm. The Office of the UN High Commis-sioner for Refugees (UNHCR) recently issued strict policy guidelines about the W ORLD HEALTH. January- February 1991 acceptance, distribution and use of milk products in refugee settings. All too often, the composition of food aid is more a reflection of the surpluses available in the industrialised world than of the needs of the target population. The nutritional composi- tion of the aid then falls short of meeting specific vitamin and mineral requirements and may even create new hazards of deficiency diseases. There remains an urgent need to resolve the problem of providing nutri- tionally balanced and culturally accept- able rations to the beneficiaries of feeding programmes. An important component of any relief operation is a system of epidem- iological surveillance. This will enable health workers to quantify the prob- lems, identify specific health problems or groups needing special assistance, set priorities and monitor the effectiveness of what is being done. Finally, the management of relief has long since moved away from the notion of "givers" and "receivers." Instead the affected community must be involved as much as possible in decision-making ·and relief work. The ultimate yardstick to measure the success of a relief operation is whether the community has been able to recover at least to pre-disaster condi- tions, and is no longer dependent on external aid. • Silent disasters of Africa Epidemiology of disasters CRED, the Centre for Research on the Epidemiology of Dis- asters, was established in 1 973 as a research centre at the Catholic Uni- versity of Louvain, School of Public Health, in Brussels, Belgium. In 1980 it became a WHO Collaborat- ing Centre for WHO's global pro- gramme on Emergency Prepared- ness and Response (EPR). Its activities are mainly con- cerned with research, development of information systems, training for senior and mid-level health man- agers in disaster epidemiology, and documentation services. In the coming years, CRED will focus its activities on applied research pro- grammes, training courses and evaluation of projects within the ' framework of these priorities. Among its operational research activities, CRED has studied the impact of the 1979 Hurricane David on health and the economy in Dominica; mortality and morbi- dity after the 1980 earthquake in Italy; risk factors of famine in Chad in 1985; and an emergency surveil- lance system following floods in Bangladesh in 1988. With WHO's Division of Emergency Relief Operations (ERO), CRED has estab- lished a computer-based country information system on the manage- ment of disasters, which is installed in WHO/ERO's computer system. 9