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Renzaho, Andre M N --- "Human Right to Food Security in Refugee Settings: Rhetoric Versus Reality" [2002] AUJlHRights 4; (2002) 8(1) Australian Journal of Human Rights 43

Human right to food security in refugee settings: rhetoric versus reality

André M.N. Renzaho[*]




Abstract

Despite recent advances in the area of humanitarian responses and the publication and dissemination of various guidelines with regard to nutritional interventions, there is, however a paucity of studies which have examined the human right to food in complex emergencies. 186 countries including those affected by both human made and natural disasters and countries who are donors of humanitarian relief aid adopted the Rome Declaration on Food Security and World Summit plan of Action reaffirming “ the right to adequate food and the fundamental right of everyone to be free from hunger”. The human right to adequate and nutritious food in refugee settings implies that every refugee has physical and economic access to sufficient food to provide the necessary nutrients for effective physical and physiological functions and achieve well being. There are many grounds for believing that the current humanitarian responses to disasters more often violate than respect the human right to adequate and nutritious food. Using elements of household food security as our working framework this paper focuses on the complex ethical and moral questions raised by the conventional humanitarian assistance framework and in particular the issue of human right to food and household food security in refugee settings.

Introduction

Over the last three decades the number of people requiring and receiving humanitarian assistance has exploded. With war raging in Afghanistan, war and ethnic conflicts in the great lakes, flood in Mozambique and earthquake in India, the proportion of refugees and internally displaced people needing humanitarian relief programs worldwide is increasing. Whether it is a natural or a human-made disaster, the consequences are enormous and interventions have varied from rehabilitation and reconstruction (eg. East Timor) to emergency relief programs (eg. Somalia or Sudan) among which food and nutrition programs are high on the agenda.

Depending on the nature and the extent of the population movement, food and nutrition programs as part of the humanitarian response to emergencies have been categorised into three different forms (WFP 1991; Borton 1998; Maxwell 1999)

  1. The World Food Program (WFP)’s Emergency Operations: this is a short-term instantaneous food assistance relief and should not last more than 18 months. Foods are provided to either the whole population or a targeted population identified according to pre-defined selection criteria. This is the kind of nutritional intervention that is implemented in case of “recent displacement emergencies”. That is, due to ethnic conflict or war, a certain proportion of the population is forced out of their homes for a short period of time, leaving their belongings behind.
  2. The WFP’s Protracted Relief and Recovery Operations: Food emergency relief, implemented as part of the humanitarian response, is provided to refugees or internally displaced people (IDP) who have been integrated into the host country because they cannot return to their country of origin due to insecurity or any other factor such as fear of persecution.
  3. Humanitarian response and developmental programs: programs that have both an emergency response component (eg. general food ration-GFR) and a developmental approach (food-for-work, school feeding) which are implemented either simultaneously or in linear transition to alleviate the affected population’s hunger; therefore preventing malnutrition and mortality. These kinds of programs are implemented in case of complex emergencies, that is, situations where human right abuses by the military are prevalent as a consequence of failure of state structures or rebellion.

These humanitarian responses have been contextualised and implemented within the conventional humanitarian assistance framework. Theoretically, this approach is based on apolitical principles and principles of neutrality and the universal right to relief aid in times of crisis. In this instance, people affected by war, ethnic conflicts or natural disasters are provided with food, medical care and non-food aid to alleviate their suffering and prevent the deterioration of their health and nutritional status.

In contrast, a paradigm shift is occurring towards an approach known as “new humanitarianism”, which emphasises human rights and development relief. Using this approach, programs should be planned and implemented using a rights-based and goal oriented approach (Fox 2001). The stress is on the protection, promotion of human rights and a legal framework that both specifies duties and responsibilities and presents a benchmark against which to evaluate relief aid providers’ accountability to beneficiaries (Office of the United Nations High Commissioner for Human Rights 2002; Häusermann and Swift 1999; Tankovic 1998).

The use of a rights-based approach in emergency situations is relatively new and has been receiving a lot of attention lately. The withdraw of Médecins Sans Frontières (MSF) from Katale camp in Zaire for refusing to feed suspected genocidaires (Toole 1997) and the non-distribution of relief aid in Afghanistan (Afghanistan Support Group 1999) due to women’s rights abuses represent the current development in rights-based approaches. While proponents of “new humanitarianism” have labelled conventional humanitarian responses as morally ambiguous for failing to report and take a stance against witnessed human right abuses (Conrad N. Hilton Foundation 1999), as well as for failing to prevent refugee community leaders and local authorities in host countries from using relief aid to promote their own political agenda or to fund activities that instigate and promote human rights abuses (Toole 1997; Fox 2001) and for lacking accountability to beneficiaries (Tankovic 1998), it is worth questioning the merit of the new humanitarianism per se. Wouldn’t withholding humanitarian assistance to people affected by human made disaster or ethnic conflicts, regardless of their criminal culpability, be in violation of human rights? Would withholding relief aid for political reasons be morally and ethically acceptable? Would refusing relief aid to “suspected” criminal or human rights abusers as opposed to criminals “convicted” by a legitimate international court or judicial body be rightful and justifiable? How would one segregate human rights abusers from those innocent vulnerable clusters during a humanitarian crisis? Would the complexity of integrating norms, standards and principles of the international human rights system into the plans, policies and processes of development allow for program evaluability? Are there operational tools to guide those Non-Government Organisations (NGOs) interested in implementing a rights-based approach in their daily activities; or experience to draw on? The list of questions related to “new humanitarianism” can go on and on, but it is not the aim of this paper to debate the merit of this approach. The author would like to refer those interested in this new paradigm to Fox (Fox 2001) and Maxwell (Maxwell 1999).

The point is, whichever approach is implemented, the preservation of human rights and providing accountability to beneficiaries are essential for a successful response. These two factors have been the downfall of conventional humanitarian response due to the fact that NGOs have been working hard to achieve accountability to donors at the expense of the beneficiaries. In the main, refugees have been doubly deprived. They have not been informed about their rights on the one hand and while at the other hand the dealings between NGOs and donors have become sort of a business. This observed trend is due to competing needs, declining funding, increased complexity of emergencies and the humanitarian response, donors’ unwillingness to embrace strategies and policies that promote greater accountability, a paucity of monitoring initiatives of humanitarian codes and practices and the growing number of NGOs (Callamard and Van Braband 2002). Quoted by Ed Schenkenberg van Mierop (Ed Schenkenberg van Mierop 2001:2) in his introductory speech at the “Response Strategies of the Internally Displaced: Changing the Humanitarian Lens” seminar held in Oslo on 9th November 2001, Hugo Slim advocates for a new approach, noting that: ‘rights dignify individuals, rather than patronising them, and victims of conflict become claimants of rights rather than objects of charity’.

In essence, humanitarian response is shaped around international humanitarian law while the rights-based approach is grounded in international human rights law (Slim 2000). By virtue of their natures, both laws are complementary as far as complex emergencies are concerned and their integration could provide us with a working framework defined under one compilation of standardised principles that could be implemented across the field. Signs of such integration are there and dozen of forums and seminars have been organised over the last five years to debate this issue. In this paper, however, we examine the complex ethical and moral questions raised by the conventional humanitarian response and in particular the issue of the human right to food and household food security.

The recognition that access to adequate and nutritious food is a basic human right constitutes our analysis framework, and has been ratified by both the World Food Summit and the consultation of the High Commissioner for Human Rights in their forums held in November 1996 and November 1998 respectively (Rosset 1996; UNHCR 1997; Marchione 2001).

Human right to food

58 state members of the UN General Assembly adopted the declaration of Human Rights on 10 December 1948 (UNHCR 1997). The declaration accepted and established fundamental rights for every human and these include the right to an adequate standard of life including rights to food, medical care, clothing and housing, the right to life, liberty and security of person, rights to freedom of expression and opinion, rights to education and many more.

In November 1996, 186 countries adopted the Rome Declaration on Food Security and World Summit plan of Action and the declaration reaffirmed “ the right to adequate food and the fundamental right of everyone to be free from hunger” (Marchione 2001:1). In November 1998, the Second Expert Consultation on the Right to Adequate Food as a Human Right was held from 18-19 November to discuss two points (Bidmon 1998):

  1. The integration of human rights into operational approaches for development and emergency relief
  2. The relationship between the international committee for Covenant on Economic, Social and Cultural Rights and international agencies.

Despite these developments, it is all easy for stakeholders to forget the most fundamental elements of the well-publicised notion of adequate and nutritious food. The human right to adequate and nutritious food in refugee settings implies that every refugee has physical and economic access to sufficient food to provide the necessary nutrients for effective physical and physiological functions and achieve well-being. There are many grounds to prove that the current humanitarian responses to disasters more often violate than respect the human right to adequate and nutritious food. These grounds could be elucidated using the elements of household food security which are grouped into three categories:

  1. Food availability and access
  2. Cultural, economic and social factors
  3. Food utilisation

Food availability and access

The notion of human right to food is not separable from household food security. One could not achieve one without guaranteeing the other. The most widely accepted definition of household food security is:

“Access by all people at all times to enough food for an active healthy life. Includes: ready availability of nutritionally adequate and safe foods; and assured ability to acquire acceptable foods in socially acceptable ways (e.g. without resorting to emergency food, scavenging stealing or other coping strategies)” (Tuttle 1999: Slide 2 of 14, online)

In refugee settings, the availability of nutritionally adequate and safe foods is achieved through food aid. Such food aid is given in different forms but the most commonly implemented program is “the general food distribution (GFD) program” (MSF 1995; WHO et al. 2000). A GFD program aims at meeting the minimum food and nutritional needs of the whole affected population through the distribution of a standard general ration. There are a myriad of published papers and guidelines defining slightly differently what a GFR should be but as a rule of thumb a GFR provides theoretically at least 2100 Kilocalories per person per day; of which 10% come from protein and at least 17% come from fat (The Sphere Project). However, various studies over time indicate that this theory is commonly not reflected in practice:

Kakuma camp, Kenya: Kakuma camp is a refugee camp situated on the border between Kenya and Sudan. The camp has refugees from Sudan (71%), Somalia (22%) and Ethiopia (4%). A food economy assessment in September 1999 by Save the Children (SCF-UK 1999) indicated that the World Food Program (WFP) provided 90% of the pledged ration (2100 Kcal) per day for 95% of households. Because refugees were totally reliant on food aid, 40% of the refugee population sold at least 25% of their ration to obtain cash to buy extras such as milk, firewood or charcoal. The source of income of the remaining 60% was limited to trade involving buying and selling the GFR.

Gueckadou refugee camp, Guinea Conakry: A report by the United Nations High Commissioner for Refugees (UNHCR) in December 1999 indicated that Gueckadou refugee camp held 360,000 refugees from different countries including Liberia, Sierra Leone and some internally displaced persons from Guinea Conakry (UNHCR 1997). The same report indicated that, in this camp, there was inequity in access to GFR: the so-called “new refugees” received 2100K cal per day while 60% of the total population of the camp received only 1750K cal per day (83.33% of the pledged ration)

Wanding and akobo refugee camps, Jongelei Province, Sudan: A survey by MSF in September 1999 found that the food distribution was reaching only 53.2% of the refugee population in Wanding and 68.7% in Akobo (MSF-B 1999).

Katale refugee Camp, Zaire: The Katale refugee camp held Rwandan refugees who fled after the 1994 genocide. In 1996, an evaluation of the nutritional situation found that the GFR provided only between 1200-1770 kcal per person per day (Renzaho et al. 1996), far less than the minimal nutritional requirements.

Conforming to the demand-supply curve, not only is food access influenced by availability of food, it is also influenced by the household’s purchasing power and access to resources that allow the household to pursue activities that meet its income and food security objectives. In addition, access to food alone does not necessarily mean that a household or individual members of that household are food secure. Unless the available food is nutritious and can be accessed by all household members, unequal food distribution within a household could in itself lead to malnutrition. Similarly, given that refugees are totally dependent on food aid, unemployed and involved at a minimum level in the planning and implementation of health and nutritional programs, the access to adequate food for those with special or higher requirements is constrained, leaving a certain proportion of vulnerable groups (especially children and women) with unmet nutritional needs.

Cultural, economic and social factors

There are many nutrition guidelines published annually by NGOs. All published nutrition guidelines advocate for access to and the provision of adequate and nutritious food to ensure adequate nutritional status- a determinant of refugee and IDP’s survival in complex emergencies. However, while the initial needs assessment takes into account structural, political, security, economic, demographic and environmental issues (MSF 1995), it fails to consider cultural dimensions and their impact on nutritional interventions. It is well documented that refugees are quite often put on monotonous diets and are given food that is not culturally desirable. In addition, the planning of the nutrition interventions in refugee settings is based on assumptions and stereotypes such as ”starving people can eat anything” (Mason 1999). Indeed, if the food is culturally unfamiliar, it will end up in the market, prompting refugees to trade the nutritionally adequate food for less adequate but more culturally acceptable food. Such unvaried relief diets are often composed of “fortified blended food” such as corn soya blend (known as CSB), cereals (often maize grain or flour), pulses (often beans or lentils), oil, sugar and salt. This diet allows mainly for two to three meals of gruel a day. While this may be nutritionally adequate, it is often culturally inappropriate and consequently, recipients are more likely to trade the food or sell it, resulting in refugees not being able to meet their daily nutritional requirements; hence exposing them to the risk of micro- and macronutrient deficiencies. It should be born in mind that trading the food aid does not mean that refugees have plenty; rather it raises the question of food acceptability and self-sufficiency in other non-food commodities. Some of the problems related to cultural acceptability of food aid and socio-economic factors in refugee settings include:

  1. The design of nutritional interventions is often based on generic published guidelines and is not relevant and sensitive to the culture of the beneficiaries
  2. Nutritional programs in refugee settings are usually designed by people who have little experience with cultures other than their own
  3. While the design of nutritional programs in refugee settings has been concentrating on meeting the nutritional requirements of the affected population, little attention has been paid to different people’s understanding of food. Indeed, in the western culture, food is about maintaining physical and physiological functions, but in traditional cultures such as refugee camps, food performs a number of functions and has an important role in maintaining social relationships and cultural identity.
  4. The planning of nutritional programs does not consider that the refugee population learns 5. an entirely new system of food procurement behaviour. In other words, refugees or internally displaced people receive free food on a weekly and bi-weekly basis rather than traditionally producing their own food, usually stored on a yearly basis for each commodity between the planting-harvesting cycles.

Food utilisation

Food utilisation is the individual refugee’s capacity to biologically maximise or make the best of foods that are available to them (King and Burgess 1992). This implies that refugees have access to a diet that is meeting individuals’ recommended daily intake for essential nutrients and are free of disease outbreaks, have access to clean water and adequate sanitation. However, providing adequate foods does not necessarily equate to adequate intake and utilisation of the available nutrients by the body. There are a number of factors that impact on adequate intake and utilisation of nutrients. These are physical losses of nutrient during the food passage from harvest and processing to the final recipient and malabsorption as a result of nutrient interaction and diseases.

Physical losses of nutrients

There are losses that occur during transportation, during processing (where this is done locally), at the distribution sites and within households as a consequence of meal sharing resulting in variations of the quantity of food eaten by individuals. In refugee settings, refugees are exposed to new food items, and have to learn new cooking skills that preserve nutrients. However, cooking demonstrations have rarely been implemented alongside nutritional interventions. Furthermore, refugees have no access to storage facilities and quite often their food rations are exposed to rodents at the household level. Hence, losses can also occur during storage of food and as a result of inappropriate cooking.

Malabsorption of nutrients

Rarely are refugees given foods from animal origin such as meat or fish. They are often given grains, legumes, oil and blended and fortified foods. These foods contain some nutrient absorption inhibitors that have the potential to expose individuals to micronutrient deficiencies. Cereals and nuts predominantly given as part of the GFR have been shown to contain phytates- ‘salts of inositol haxaphosphates, which are a storage form of phosphates and minerals in all kind of grains, seeds, nuts, vegetables and fruit’ (Garrow and James 1993:179) and these compounds strongly inhibit iron absorption. Although ascorbic acid is known to be the most potent enhancer of non-haem iron absorption (Hallberg et al. 1989), it is regrettably the same vitamin that is most deficient in food aids given to refugees. Indeed, clinical vitamin C deficiencies have been a major problem in complex emergencies over the last three decades while humanitarian responses have equally been inadequate in addressing this life-threatening ailment. Clinical vitamin C deficiency outbreaks have been reported in refugee camps in Ethiopia, Kenya, Somalia, Bangladesh and Sudan (Mason 1999) and yet these outbreaks could have been prevented by cheap and cost-effective nutritional interventions using a community development approach such as promoting small vegetable gardens.

In the same line of reasoning, diseases including parasite loads and infectious disease outbreaks as a result of poor health care, non-clean water and inadequate sanitation can affect nutrient utilisation. As a consequence, the body’s ability to access and utilise the nutrients is constrained. Despite an advanced understanding of the direct relationship between infection and malnutrition (King and Burgess 1992), poverty and malnutrition (Bronner 19969), and food insecurity and malnutrition (Young 1992); humanitarian responses have failed to prevent the worst happening, with both micronutrient and macronutrient malnutrition common among refugees and internally displaced persons. For example, it has been shown that an adequate provision of vitamin A increases the chance of survival by reducing the overall mortality by 25-35% and the mortality from measles by 50% (WHO et al. 2000). Despite this knowledge, it did not prevent UN agencies and NGOs providing a GFR that was not only deficient in Vitamin A but also in vitamin C and iron to Rwandan refugees (Mason 1999). Furthermore, other studies have reported high mortality in refugee settings, with reported case fatality rates due to severe malnutrition as high as 30% in severely malnourished children in general and 60% for oedematous malnutrition admitted to therapeutic feeding centres (Schofield 1997). Acute malnutrition prevalence rates as high as 47-75% in displaced people in southern Somalia (Manoncourt et al. 1992) and 21.2% in refugee camps in southern Sudan (UN ACC/SCN 1997) have been reported in children less than 5 years. Micronutrient deficiency outbreaks such as scurvy, xerophthalmia, pellagra and anaemia have been reported in various refugee camps (Mason 1999) often complicating macronutrient malnutrition.

Conclusion

While it should be recognised that advances have been made in the area of publishing and distributing nutritional guidelines and the promotion of human right to food through different international forums and seminars, little has been done to ensure that such guidelines have been implemented. There is too much rhetoric about human right to food and this does not equate in practice to programs being implemented to promote both the household food security and nutritional well being of refugees and internally displaced people. Refugees have been made totally dependent on food aid and malnutrition-related mortality rates have been high in refugee camps. To match the rhetoric of human right to food, there needs to be a shift in the current thinking and refugee service delivery. Of particular attention is the need for ensuring and promoting a continuation of investment in integrated approaches between donor, implementing and research institutions. For instance, the dependency on food aid observed in refugee settings could be minimised if food given to refugees was bought and fortified locally. This would create employment opportunities for refugees, and address the issues of food acceptability, suppression of local market prices and promote nutritional well-being. In addition this initiative would involve a wide variety of stakeholders including the refugee community and the host population throughout the design, implementation and evaluation of each project. By encouraging partnering NGO’s and government organisations to involve community members at each level, the likelihood of the initiative being successful and sustained is increased. The maintenance and promotion of the human right to food as a basic human right should become a practical achievable objective in refugee and humanitarian assistance.

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[*] Andre Renzaho (MPH, B. Nutr &Diet) is currently employed at the Centre for Culture Ethnicity and Health as a Research and Evaluation Coordinator and is currently completing his PhD in Public Health Nutrition at Deakin University, School of Health Sciences. His main interests are in health program evaluation and refugee public health and nutrition. After an extensive career in public health nutrition in refugee camps, implementing nutritional programmes with the United Nations High Commissioner for Refugees, UNICEF and various Non-Government Organisations, André moved into the area of public health. In Australia, Andre has been teaching the “nutrition in complex emergencies” module for the Centre for International Health, Monash University, Melbourne and the Joseph L. Mailman School of Public Health, Columbia University, New York. André’s most recent past work included has also been very active in advocating for refugee public health. In 2000, he was the evaluation of the Commonwealth’s Partners In Culturally Appropriate Aged Care Project, the evaluation of the DHS’s Western Region Refugee Health Model and the documentation of how primary health care providers identify and prioritise the health and welfare needs of refugees and humanitarian entrants in Victoria. He is currently conducting an Ian Potter funded project, assessing the impact of acculturation on the nutrition and physical activity of sub-Saharan African refugee children living in Victoria.