Strategic shift in battle against region's high death toll

Every year in the Sahel region of West Africa, hundreds of thousands of children die, and malnutrition means millions of others will live on with permanent mental disability and physical stunting.

The Sahel, which stretches from the shimmering orange dunes of Mauritania in the west to the harsh, sandy deserts of Chad in the east, has for decades been assessed by aid agencies in terms of regional cereal, sorghum and millet production. That was the yardstick by which emergency relief agencies worked out what they needed to do each year.

Using that benchmark, with 19 percent more production overall in 2006-2007’s growing season in the core Sahelian countries of Chad, Mali, Mauritania, Burkina Faso, Niger and Senegal, this year should be a quiet one for aid agencies.

But in Niger, the Permanent Interstate Committee for Drought Control in the Sahel (CILSS) recently warned that 376,000 people are “in an extremely vulnerable situation” in 459 villages. In Burkina Faso, hunger migrants from the east and north of the country have reportedly started flocking to gold mines as surveys identify 300,000 vulnerable people in 500 villages. Large pockets of problems in Chad, Mali and Mauritania have also been recorded.

And according to the United Nations children’s agency (UNICEF), death rates among children and infants in West Africa are still more than double the world average, substantially worse even than in eastern or southern Africa. Fifty-three percent of the two million children who die every year in the Sahel do so from malnutrition-related problems.

Poverty at the root

Christine Van Nieuwenhuyse, deputy director of the World Food Programme (WFP) in West Africa, explained that when determining who needs food aid measuring what people can afford is today seen as much more important than measuring what is grown.

“The problem of access of populations to the food remains, whether overall food production is good or not. Places can be very isolated, people live in extreme poverty. They cannot get the food, even if it is there,” she said.



Photo: Nicholas Reader/IRIN
There is almost always food in the Sahel region - the question is whether or not people can afford it

For WFP, providing food within the context of people’s economic problems is as big a part of the job as getting food into countries.

When there is food available but people cannot afford to buy it, WFP uses schemes such as providing food in exchange for work on community-related projects, and building cereal banks which villagers can borrow food from to avoid running up debts with local traders.

And that work continues, when crop production is good, and when regions are relatively wealthy.

“Even if cereal production is good, that doesn’t mean people have access to other types of food which has proteins, vitamins and minerals. In some countries there are very high levels of malnutrition in areas with good food security because people have poor nutritional habits - they only eat one kind of food, that which they grow.”

New thinking

Although poverty is at the root of the region’s problems and development is the main emergency, poverty-reduction strategies are not necessarily seen as the way to curb the unacceptably high death rate in the short term.

Nick Ireland, Oxfam UK’s regional humanitarian coordinator, said a brief media storm over child deaths in Niger in 2005 proved to be a “turning point” for how agencies want to work on the region’s problems.

“Before 2005, and even at the beginning of that year, there was a simple portrayal of malnutrition and hunger being related to the availability of food and production. Thinking has come a long way since then,” he said.



Photo: Nicholas Reader/IRIN
Nutritional feeding is just one approach among many

Thousands of children are estimated to have died in Niger in 2005 - many in front of film crews and cameras - but around 230,000 were given nutritional treatment by the more than 30 international nongovernmental relief organisations (NGOs) that flooded into Niger, buoyed by unprecedented funds from emergency and, especially, private donors.

Emergency assistance continued in 2006, and UNICEF announced this month that acute malnutrition rates in Niger had been cut from 15.3 percent in November 2005 to 10.3 percent in November 2006. Nonetheless, one-fifth of the 2.3 million children in the country die every year, almost 60 percent of them from malnutrition-related problems, according to UNICEF.

Aid agencies say part of the success at curbing the most acute malnutrition problems in Niger was a positive and proactive approach by the government, and the establishment of between 800 and 1,000 therapeutic feeding centres all over the vast country.

But aid workers also call Niger a “malnutrition laboratory” because of the number of innovative techniques that have contributed to curbing child deaths, including the promotion of better care for infants, improved obstetrics, injections of vitamin A and zinc supplements, and even the establishment of a factory to manufacture highly nutritional food for malnourished children in-country.

Although humanitarians proved in Niger that it is possible to open a window of relief to prop populations up while they wait for development, “the work is not finished”, warned Pierre Adou, head of the Helen Keller International NGO’s Niger office. Adou says more than 50 percent of Niger’s children still face a critical but not fatal level of malnutrition.

“Humanitarians worked hard to take the situation back to before 2005 when it was not seen as urgent,” he said. “Now development programmes must take their place, otherwise we will never solve the problems of Niger.”

Donors slow to catch up

Malnutrition still does not get an equal response in terms of donor funds and aid agency resources, even though officials agree there is a growing understanding that malnutrition and livelihoods are far more important indicators than food production.

The international NGO Save the Children earlier this month accused the British Department for International Development (DfID) and the European Commission globally of “neglecting millions of malnourished children”.

“Malnutrition is responsible for more child deaths than anything else, yet the UK government globally spends less than 1p (US$ 0.02) per day on each hungry child in the world,” the NGO said. Save the Children calculated that the EC globally spends just over US$0.03 per malnourished child. This EC spending includes money channeled through a range of partners including their own humanitarian office, ECHO, an important donor for tackling acute malnutrition and seeking longer-term solutions in the Sahel.


''My impression is considerably more money goes into the delivery of food aid than tackling chronic malnutrition.''

“My impression is considerably more money goes into the delivery of food aid than tackling chronic malnutrition,” said Anna Taylor, head of Save the Children’s global hunger team.

Ireland at Oxfam’s regional office in Dakar said the Sahel’s problems often fall between agencies’ own institutional gaps. “What is needed is not exactly full development or full humanitarian work - it’s something in between and so it falls between the mandates of some agencies,” he said.

A representative of a major donor, who asked not to be identified, told IRIN that institutional problem extends also to how donors fund projects, and especially to their ability and willingness to deal with malnutrition, which is the biggest killer of children and infants in the region.

“The tendency is to focus on poverty reduction and to think that if you do that malnutrition rates will naturally fall,” the official said, arguing that there is “no way to be sure” that having more money would prompt people to diversify their diets, and that poverty reduction, even if it is possible, will take years if not decades.

“Nutrition is seen as related to both health and food security, and often it falls in between. So can health programmes that ignore malnutrition, and food security projects that do the same. Malnutrition doesn’t fall into any sector’s mandate as it crosses into both,” the donor official added.

This is the first in a series of articles on hunger and malnutrition in the Sahel by IRIN.

In a future report, IRIN will ask what’s working and what’s not to cut the region’s high mortality rate in the short term, despite the semantics and the funding difficulties.

And in Niger, IRIN will take a closer look at how the dramatic cut in acute malnutrition was achieved, and whether it is sustainable in the longer term.

nr/cs