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Postscript to 'Therapeutic Feeding in an insecure area'

We asked Yvonne Grellety of ACF to comment on this article. A summary of her comments follow: Rather than responding to the specific experience described in the article, I would like to respond to some of the more general issues and principals that this very interesting article raises. I will draw from the considerable experience that ACF have of working in insecure areas.

In any food emergency situation the most important priority is to provide an adequate general food ration for the population, even if the area is highly insecure. The general ration needs to be distributed in an adequate form, according to the needs, culture and wishes of beneficiaries. This type of information on beneficiaries can be very difficult to gather when the population is suppressed, repressed or terrified. It may therefore be necessary to avoid group interviews as individuals might expose themselves to risk if they speak too openly. Also, information should be collected where people are actually living and not from those who have had the means and political connections to flee: to be able to see actual living conditions will allow collection of all key data. It is critical, although often very difficult, to recruit a proficient but neutral translator. International agencies with a long-standing presence in a country or region can usually help to locate such a person.

In general, it is probably not sensible to focus solely on selective feeding programmes when there is little or no basic ration available to the affected population. If the whole population is starving, SFPs/TFPs are likely to become overwhelmed and the numbers that are actually going to be treated in 'special programmes' in relation to the numbers that require additional food/treatment (the coverage) will be very low. This is especially true if there is poor access to the feeding centres because of insecurity. Where possible, attempts should always be made to set up centres (especially TFCs) in areas that are relatively stable and secure and bring the patients and caretakers to the TFC rather than bring the TFC to the patients. ACF set up two feeding centres in Tubmanbourg, Liberia in secure areas and successfully treated 640 severely malnourished individuals. Many more were transported away from areas of active fighting and treated in three centres in Monrovia.

While recognising the enormous difficulty of establishing adequate general rations in an insecure environment, the experience of Somalia, where a huge number of kitchens were opened in many geographical sites at a time of intense fighting is a good example of how agencies can proceed in a complex food emergency. Overall, the programme was judged to be a success despite the looting, threats and gun battles which occurred. A number of lessons were learnt from the Somalia programme.

A kitchen providing two meals a day can provide beneficiaries with an adequate ration enriched with minerals and vitamins, avoid looting from fighters and reduce cooking time and the need for pots and fuel all of which may be critical for war affected peoples in enclaves or camps - particularly when there are curfews or the area outside the enclave is a no-go area for inhabitants. In this type of situation the amount of cooking required for cereals and particularly, legumes can be very problematic for starving families. The initial assessment of a war affected population should therefore determine what beneficiaries are capable of doing for themselves in terms of food preparation and any security implications. If take home rations can be given, enriched, easily prepared nutrient dense food with a high fat content can be life-saving. The use of blended foods has been shown to be particularly convenient, especially for the elderly, children, and even the moderately malnourished. This kind of food is generally not valued highly by fighters - an important consideration in countries like Liberia and Somalia where food rations are easy and desirable pickings for anyone carrying arms.

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Yvonne Grellety (1997). Postscript to 'Therapeutic Feeding in an insecure area'. Field Exchange 2, August 1997. p17. www.ennonline.net/fex/2/postscript4

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