nutrition crisis

Niger 2005, une catastrophe si naturelle

elba.msf — Thu, 12 Aug 2021 10:35:32 +0000

01/10/2007

elba.msf Thu, 08/12/2021 - 12:35

To cite this content :
Xavier Crombé, Jean-Hervé Jézéquel, Niger: A Not-So Natural Disaster, 1 October 2007, URL : https://msf-crash.org/index.php/en/publications/natural-disasters/niger-not-so-natural-disaster-0

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Xavier Crombé & Jean-Hervé Jézéquel

Xavier

Crombé

Xavier Crombé was Director of Studies at MSF-Crash from 2005 to 2008. He is currently working at the Research Unit on Humanitarian Stakes and Practices (UREPH) of MSF in Switzerland to publish a collective essay dealing with issues related to violence in healthcare facilities. He is also teaching humanitarian and migration issues at Sciences Po Paris.

By the same author

Jean-Hervé

Jézéquel

Deputy Project Director for West Africa at International Crisis Group.

Jean-Hervé Jézéquel first worked as a Consultant for Crisis Group in Guinea in 2003, before joining as the Senior Analyst for the Sahel region in March 2013. He has also worked as a Field Coordinator in Liberia, a West Africa Researcher and a Research Director, for Médecins sans Frontières.

By the same author

Twenty years after the charity concerts for the Sahel Nigerien politicians, institutional donors, aid agencies and humanitarian organisations clashed on the nature and substance of the crisis affecting Niger in 2005. Identifying the causes of, and adequate responses to, the situation also gave rise to profound disagreements. Having set up their most ambitious emergency nutrition programme to date, Médecins Sans Frontières found itself at the forefront of these controversies.

This book, an MSF initiative, is a collection of contributions from researchers, consultants and humanitarian actors. Each contributor gives a different perspective of the Nigerien crisis and discusses what they consider to be the key issues involved. In particular, the authors examine and question the conflict that arose during the summer of 2005 between the 'development' and 'emergency' camps. They also discuss the nature and durability of the changes that occurred in the wake of the crisis, and call for further reflexion on the preconceptions and implicit choices that condition relations of assistance and aid in Africa. One consensus however stands out: the death of tens of thousands of children every year, like the pauperisation and marginalisation of an ever increasing number of Nigeriens, are not the result of natural disasters: still less a fatality.

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Niger: A Not-So Natural Disaster

Corne de l’Afrique : les faiblesses d’une intervention en question

babayaga — Thu, 19 Jan 2012 01:00:00 +0000

Date de publication

19/01/2012

Anonymous (not verified) Thu, 01/26/2012 - 13:44

nutrition crisis

drought

early warning systems

perverse effects and limits of aid

Michaël Neuman

Michaël

Neuman

Director of studies at Crash / Médecins sans Frontières, Michaël Neuman graduated in Contemporary History and International Relations (University Paris-I). He joined Médecins sans Frontières in 1999 and has worked both on the ground (Balkans, Sudan, Caucasus, West Africa) and in headquarters (New York, Paris as deputy director responsible for programmes). He has also carried out research on issues of immigration and geopolitics. He is co-editor of "Humanitarian negotiations Revealed, the MSF experience" (London: Hurst and Co, 2011). He is also the co-editor of "Saving lives and staying alive. Humanitarian Security in the Age of Risk Management" (London: Hurst and Co, 2016).

By the same author

In a report titled "A Dangerous Delay", Oxfam and Save the Children rebuke everyone - governments, humanitarian organisations, the United Nations - who participated in the humanitarian response to the food crisis that struck the Horn of Africa in recent months. The subtitle says it all, highlighting the cost of the delayed response to the early warnings of drought in the Horn of Africa in 2011. The two NGOs explain why they believe the humanitarian response to the crisis was delayed - a crisis whose nature, if not scope, is no longer questioned. The arguments advanced for the seriousness of such food crises and the best ways to combat them, however, remain subject to debate.

Save the Children and Oxfam believe the international response system failed and that it will be possible to save more lives during future crises by improving its ability to act in time and conduct long-term efforts. Some of the recommendations in the Oxfam and Save the Children report sound appropriate such as, for example, taking early warning systems in the Horn of Africa (FEWS, FSNAU, FSNWG, etc.) more seriously even though they are not foolproof. They did prove effective at anticipating the effects of climate variations, prices and political changes on the population's medical and nutritional status. But other recommendations are more akin to fantasy, such as those asking governments to support a "Charter to eradicate extreme hunger".

One of the report's most striking features, however, lies in its lack of a political perspective, regarding both the origin of the crisis, which is reduced to a weather phenomenon, and the recommended response. The sole focus falls on the technical failures, which could be remedied with systemic solutions. The report assigns no responsibility to the Somali al-Shabaab Islamist militants or the transitional government, who nevertheless made humanitarian work in the areas they control extremely difficult. Nor does it blame the region's governments - Ethiopian and Kenyan - for hindering the delivery of food aid and the population's ability to gain access.

Regardless of the type of crisis humanitarian groups are facing, the quality of their response always depends on the balance of forces they are able to establish with the authorities. Faced with political authorities determined to restrict aid, it cannot be denied that during this event, the balance of forces did not operate to the advantage of the humanitarian community.

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To cite this content :
Michaël Neuman, Horn of Africa: the weaknesses of a controversial operation, 19 January 2012, URL : https://msf-crash.org/index.php/en/blog/humanitarian-actors-and-practice/horn-africa-weaknesses-controversial-operation

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Horn of Africa: the weaknesses of a controversial operation

Nourrir les enfants dénutris : pas si simple

babayaga — Fri, 23 Jul 2010 00:00:00 +0000

Date de publication

23/07/2010

Anonymous (not verified) Fri, 07/23/2010 - 19:23

Jean-Hervé Bradol

Jean-Hervé

Bradol

Medical doctor, specialized in tropical medicine, emergency medicine and epidemiology. In 1989 he went on mission with Médecins sans Frontières for the first time, and undertook long-term missions in Uganda, Somalia and Thailand. He returned to the Paris headquarters in 1994 as a programs director. Between 1996 and 1998, he served as the director of communications, and later as director of operations until May 2000 when he was elected president of the French section of Médecins sans Frontières. He was re-elected in May 2003 and in May 2006. From 2000 to 2008, he was a member of the International Council of MSF and a member of the Board of MSF USA. He is the co-editor of "Medical innovations in humanitarian situations" (MSF, 2009) and Humanitarian Aid, Genocide and Mass Killings: Médecins Sans Frontiéres, The Rwandan Experience, 1982–97 (Manchester University Press, 2017).

By the same author

Using Niger as an example, this text seeks to explore the dilemmas involved in medical responses to child malnutrition when such malnutrition is endemic (strong, permanent presence) and gives rise to seasonal peaks (epidemics) each year. It is this form of malnutrition that continues to have a major impact on mortality in nearly 40 countries, where a phenomenon persists that once was common to all of humanity but that has gradually disappeared over the past two centuries in four out of five countries.

Since 2005, the most recent year in which Niger was identified as having a food and nutrition crisis, efforts have largely focused on treating severe acute malnutrition - the serious marasmus of a skeletal child whom the most minor complication (usually an infection) can kill. Progress has been impressive in this area: home treatment of severe cases with a new generation of therapeutic foods led to a sharp increase in the number of cases treated during the 2005 crisis (from several thousand to tens of thousands) and an unprecedented cure rate. These results rank Niger among the leading countries fighting malnutrition. But waiting to intervene until the disease's last stage does not achieve the same results as an earlier intervention. If, as anticipated in this year's action plan, 340,000 severely malnourished children are treated and, optimistically speaking, the mortality rate is limited to 4%, the number of deaths would still reach 11,000.

Furthermore, restricting the distribution of a therapeutic food to cases of serious marasmus poses other problems, especially in places where malnutrition is already highly endemic and where a major seasonal peak magnifies the phenomenon every year. While treating these severe cases in the home rather than in hospitals is given priority, we must not forget that about one child in six presents complications requiring a hospital stay. When incidence is high during the annual seasonal peak, the number of hospitalisations quickly becomes unmanageable for health care centres and hospitals. Late treatment of frequent and fatal malnutrition means condemning ourselves to overcrowding at feeding centres. In such conditions, qualified medical personnel cannot concentrate on the most complicated cases, which have the highest risk of death.

Ending the rationing of food supplements

To avoid an excessive number of severe cases and partially reduce hospitalisation costs, it would be preferable to avoid limiting treatment only to severe acute cases of malnutrition and to distribute a food supplement at a less advanced stage of nutritional deficiencies.

A pilot project was conducted in 2006 and 2007 in Guidam Roumji district in Maradi province. In 2006, the results demonstrated that using triage (measuring height, weight, etc.) to differentiate cases of moderate acute malnutrition from other cases is so cumbersome that it alone monopolises a large share of the available resources. All that remains is one-third of the budget for purchasing food for children.

The option of no longer using anthropometric measurements to select patients (weight, size, brachial circumference), but instead treating all children in the age group most at risk, was implemented in the same district in 2007. This effort has resulted in a more balanced distribution of costs, two-thirds of which can then be devoted to purchasing food for children. Both operating methods have had the same impact on reducing the anticipated number of severe cases. But treating the entire age group is better relative to Niger's epidemiological data. In a population of children, a large proportion of acute malnutrition cases indicates the existence of nearly ubiquitous nutritional deficiencies.

Despite a body of scientific and experimental evidence, however, early treatment of malnutrition does not have the consensus it needs to become a common and ongoing practice. As a result, the lack of sufficient pilot projects demonstrating the efficacy of this approach could lead to abandoning a practice whose funding cannot be guaranteed after the few one-off operations have ended.
In spite of this difficult situation, Niger's innovative approach again stands out on the world stage. In 2010, the administration and humanitarian organisations set a goal of distributing food aid to some 500,000 children before they reached the stage of acute severe malnutrition.

A review of the planned operation raises several issues about the conditions necessary for ensuring the success of such an initiative. The first concern is biological in nature: young children's rapidly growing bodies require a food supplement that meets all of their needs and that is distributed during the entire period when the risk of death and permanent sequelae is at its peak. Available epidemiological data indicate that the 6-24-month age group is the prime target. The second issue is social. The plan to distribute aid to a specific group does not guarantee that it will be carried out. The first stage involves creating a consistent list of beneficiaries and setting an initial health objective. Distribution must then comply with the established list. Lastly, the food supplement must be consumed by the distribution's target beneficiary rather than by another person - a family member, for example. The last issue is economic. The economic model underlying the programme must cover all costs related to the key factors necessary for successful outcomes throughout the expected duration of the programme.

Covering all of an infant's nutritional needs

For the time being, the product selected by the World Food Programme (WFP) for temporary distributions lasting several months is a mixture of micronutrient-enriched flower, CSB Plus, which does not cover the requirements for animal proteins essential for the healthy growth of children this age.

UNICEF would have preferred a food covering all of an infant's nutritional needs. In order to move in this direction, MSF proposed several months ago providing a food product adapted for some 200,000 children. The idea is to supplement the distribution of flour, which has demonstrated its effectiveness for the other family members during periods of scarcity. In fact, the crucial interest of the product's quality is the absence of milk, which is too expensive, both for families and the institutions fighting malnutrition.

The lack of an adequate economic model for current programmes weakens the food supplement's quality and limits the amount of time children can receive it. The change in political regime and persistent food problems, which grew even worse in 2010, have created an opportunity to try new ways of combating malnutrition in early childhood. Proposed responses to malnutrition, which previously held no interest for a regime coming to the end of its term, can now be discussed. Organisations have become strongly tempted to seize this opportunity. Yet we must not forget that it is necessary to meticulously prepare for and carry out mass distributions if we are to achieve positive public health outcomes. Public health initiatives that fail are often based on solid arguments from a biomedical perspective, but are viewed quite differently by the supposed beneficiaries due to social and cultural factors. Moreover, when dealing with a highly charged issue, success cannot be dictated by fiat but must be proven with epidemiological data that organisations must take sufficient time to gather. The lack of serious scientific evidence will only embolden the sceptics and deprive many children of nutrients essential to their growth and sometimes even their survival.

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To cite this content :
Jean-Hervé Bradol, Feeding malnourished children: not so simple!, 23 July 2010, URL : https://msf-crash.org/index.php/en/blog/medicine-and-public-health/feeding-malnourished-children-not-so-simple

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Feeding malnourished children: not so simple!

Avis de recherche : on a perdu la malnutrition en Ethiopie

babayaga — Wed, 29 Jul 2009 00:00:00 +0000

Date de publication

29/07/2009

Anonymous (not verified) Wed, 07/29/2009 - 16:06

perverse effects and limits of aid

Jean-Hervé Jézéquel

Jean-Hervé

Jézéquel

Deputy Project Director for West Africa at International Crisis Group.

By the same author

In 2008, Southern Ethiopia was the epicentre of a vast nutritional intervention: more than 100,000 malnourished children received assistance from a mix of actors including both international actors and local health facilities. Given the structural factors affecting levels of malnutrition in this part of Ethiopia, most humanitarian actors expected similar problems in 2009. Thus UNICEF ordered a few months ago enough RUTF (Ready-to-Use Therapeutic Food) to treat more than 100,000 patients suffering from acute malnutrition (a number equivalent to the 2008 operation).

Yet, so far this year, there has been little mention of malnutrition in the country outside a small circle of specialists: neither international media nor NGOs have raised a public alert about high levels of malnutrition in Ethiopia. While MSF teams treated more than 38,000 severely malnourished children last year, MSF nutritional activities in 2009 have been almost inexistent so far.

Did malnutrition disappear in Ethiopia somewhere between 2008 and 2009? Should we be pleased with the absence of nutritional emergency this year in Ethiopia? Or should we be asking what changes have arisen in Ethiopia since 2008?

It is unfortunately difficult to answer this last question. The Ethiopian government has erected a wall of silence by strictly controlling the production and diffusion of nutritional data. No information, no crisis. The authorities have authorized only a very restricted number of rapid nutritional assessments. Moreover, they did not renew the working agreement of three international NGOs in SNNPR, the epicentre of the malnutrition crisis in 2008. Rumour has it that, in desperation, there have been NGO volunteers disguised as 'tourists' visiting health centres in suspected malnutrition hotspots.

Is there a deliberately hidden crisis? Some believe than one year ahead of national elections, Ethiopian authorities want to avoid the problems of 2008 and are therefore seeking to exert tighter control on NGOs. It is very difficult however to affirm that the government is denying malnutrition. It has set up a national system for treating malnutrition that is probably one of the most elaborate in Africa. With the support of UNICEF, this network of health facilities claims to have treated more than 45,000 severely malnourished children between January 2009 and May 2009. There is no other African state than can claim such a high level of curative activity. Is this fact or a 'technological smokescreen' as stated by François Enten to describe the Ethiopian Food security system François ENTEN, Food Aid and The politics of Number in Ethiopia (2002-2004), Cahiers du CRASH, 2008?

The situation in Ethiopia is a reminder that, more than the actual nutritional status of the population, it is the production of numbers and the control of information that determine the emergence or disappearance of nutritional crises.

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To cite this content :
Jean-Hervé Jézéquel, Missing : malnourished children in Ethiopia, 29 July 2009, URL : https://msf-crash.org/index.php/en/blog/medicine-and-public-health/missing-malnourished-children-ethiopia

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Missing : malnourished children in Ethiopia

L’aide alimentaire et la politique des chiffres en Ethiopie 2002-2004

denisa — Thu, 15 May 2008 00:00:00 +0000

Date de publication

15/05/2008

denisa Thu, 05/15/2008 - 02:00

early warning systems

perverse effects and limits of aid

François Enten

This study sheds light on the mechanisms producing the official data used by humanitarian aid decision makers. It views Early Warning Systems (EWS) as tools that facilitate consensus between the decision-makers involved in the allocation of food aid, enabling them to reach institutional agreements. This argument is strengthened by a socio-theoretical analysis and by ethnographic observation of experts' practice in Ethiopia (2002-2004), whose results of food aid evaluations appear as a combination of empirical and political factors.

Chapitres

Introduction

Cartography

PART 1 Early warning systems (EWS)

PART 2 The Ethiopian EWS at ground level: expert practice, statistical production and the influence of politics

Conclusion

APPENDIX. THE MAIN EARLY WARNING SYSTEMS

Abbreviations

Bibliography

To cite this content :
François Enten, Food aid and the politics of numbers in Ethiopia, 15 May 2008, URL : https://msf-crash.org/index.php/en/publications/humanitarian-actors-and-practice/food-aid-and-politics-numbers-ethiopia

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