VZCZCXRO7931
RR RUEHGI RUEHMA RUEHROV
DE RUEHNJ #0329/01 1071213
ZNR UUUUU ZZH
R 171213Z APR 07
FM AMEMBASSY NDJAMENA
TO RUEHC/SECSTATE WASHDC 5152
RUEHGI/AMEMBASSY BANGUI 1345
RUEHYD/AMEMBASSY YAOUNDE 1510
RUEHRN/USMISSION UN ROME 0024
INFO RUCNFUR/DARFUR COLLECTIVE

UNCLAS SECTION 01 OF 02 NDJAMENA 000329 
 
SIPDIS 
 
SIPDIS, SENSITIVE 
 
STATE FOR AF/C, PRM/AFR:MLANGE,S/CRS:PNELSON-DOUVELIS/JVANCE/ JBEIK 
 
E.O. 12958:  N/A 
TAGS: PREF PGOV KCRS CD CT
SUBJECT: CAR REFUGEES IN CHAD: INCREASE IN MALNUTRITION 
 
 
NDJAMENA 00000329  001.2 OF 002 
 
 
¶1. (SBU) Summary.   An end-March monitoring visit to the three 
refugee camps for Central African Republic (CAR) refugees near Gore 
found that the malnutrition rate at Amboko Camp - the oldest of the 
three (established mid-June 2003) - had tripled from December to 
March.  While the malnutrition rate is still much lower than the 
maximum acceptable standard for refugees (10%) and below 
malnutrition rates for Chadians reported by WFP in Chad's 14 
departments, the increase is troubling.  The proximate cause would 
appear to be the cut in refugee food rations that has been 
implemented pursuant to the October 2006 Joint Refugee Food Security 
Assessment Mission (JAM).  The current refugee assistance strategy 
is to locally integrate the refugees pending their return to the CAR 
by helping them achieve self-sufficiency in food production and 
capacity to pay for health care and schooling.  However, available 
land and agricultural inputs are not yet sufficient for refugees to 
have achieved food security.  The JAM recommendation -- which was 
not/not endorsed by the local UNHCR, WFP, or implementing partners - 
to cut food rations in advance of there being adequate land under 
cultivation, is difficult to understand but may have resulted from 
the structure of the JAM that allowed only a cursory field visit. 
In any event, the impact of premature ration cuts is being borne 
particularly by the refugee children.  With any harvests seven 
months away and the annual "hungry season" still ahead, it is likely 
that malnutrition will keep increasing.  Options for putting 
assistance back on track could include:  ramp up therapeutic feeding 
centers with a quick infusion of appropriate feeding materials such 
as CSB (for those who cannot/will not eat plumpynut); provide a 
blanket supplemental take away dry or moist ration for all under 
fives with careful follow up to ensure that the food is not shared 
among all hungry children in a family;  revisit/reverse the decision 
to dramatically cut the rations and instead wait until all/the 
majority of the refugees have had a fair chance to plant and harvest 
at least one crop before eliminating the rations.  State/PRM and 
USAID/FFP should urgently work with WFP on modifying the feeding 
program in order to reverse the malnutrition trend.   End summary. 
 
¶2. (U) State Bureau of Population, Refugees, and Migration/Africa 
team of Margaret McKelvey and Geoff Parker, accompanied by S/CRS 
Charles Wintermeyer, visited the three camps of Central African 
Republic refugees located near Gore in southern Chad from March 
29-31.  Amboko (established mid-June 2003), Gondje (established 
mid-December 2005), and Dosseye (opened December 2006 to decongest 
other sites and for new arrivals - over 600 in March 2007) are all 
doing reasonably well in terms of working toward international 
standards for protection and basic assistance. Water and sanitation 
are approaching standards; education is still lagging badly in terms 
of getting 100% of primary school kids enrolled; health care is 
pretty good with over 90% of pregnant women delivering at the 
clinics.  However, food security is very much threatened by the 2007 
cut backs in food rations that World Food Program instituted 
following the last Joint Refugee Food Security Assessment Mission 
(October 2006).   The ration for Amboko Camp was cut from 1,400 
kcals per person per day last year to 900 kcals this year.  The 
ration for Gondje Camp went from 1,900 to 1,200 kcals.  Legumes and 
CSB have been removed.  The new arrivals at Dosseye Camp are to 
receive a full ration of 2,100 kcals. 
 
¶3. (U) Nutrition surveys are reported to be done every quarter in 
the camps using community health workers to check children under the 
age of five.  In December, the global acute malnutrition rate in 
Amboko Camp was measured at 0.92 %.  At 3.0%, the March GAM has 
tripled.  The PRM team questioned the camp doctor about factors 
other than ration size that might account for the increase such as 
an epidemic, increase in anemia and/or malaria, any change in 
breastfeeding/weaning practices, unusual diversion of food.  Nothing 
had changed except the ration size. 
 
¶4. (U) Ironically, even as increasing numbers of children were being 
taken to the central therapeutic feeding center (TFC) (8 feeds 
daily) at Amboko Camp, food stocks were being loaded on to WFP 
trucks to be taken to eastern Chad to help repay loans of 
commodities made last year when the southern program was 
dramatically under-resourced.   As is sadly often the case, not all 
mothers were following up on referral of their children where the 
mother judged that she could not afford to leave her other 
children/husband alone to stay with the one malnourished child. 
 
¶5.  (U) The overall assistance strategy for the CAR refugees in 
southern Chad is to push for refugee self sufficiency - i.e., to be 
able to produce sufficient food for themselves largely through 
agriculture and to be able to pay fees for health care and for 
schooling.  Such local integration is to be achieved through 
provision of seeds and tools and some modest investment in income 
generating activities.  Some of the 11,834 refugees (2,376 families) 
in Amboko, who began arriving in mid-2003, have already acquired 
access to land from the surrounding Chadian population and have been 
planting.   At present, 1,074 refugees are reported to be 
cultivating 914 hectares.  The target number of hectares being used 
 
NDJAMENA 00000329  002.2 OF 002 
 
 
for a family to be food self-sufficient is 2.7.  A community kitchen 
garden project supported by Africare presently has some 1,550 direct 
beneficiaries (hence up to 1,550 families) broken into 115 groups of 
¶10. Each group has received about 400 square meters (or 0.04 
hectares) of land, which is insufficient for providing an adequate 
food source for the beneficiaries even if it were planted in cereals 
rather than vegetables.  More land access is being slowly negotiated 
with local Chadians in close collaboration with UNHCR and Chadian 
traditional leaders.  Clearly there is a considerable way to go 
before the Amboko camp will be food self-sufficient.  Gondje, whose 
inhabitants have been in Chad for only some 15 months are of course 
still further away from the goal with only four hectares in kitchen 
gardens for the whole camp of 12,000 and no cereal crops yet.   Some 
refugee women in Gondje displayed wild yams that they had been 
digging up in the bush in view of the ration cuts, complaining that 
the yams required three days worth of cooking/preparation to 
mitigate their poisonous properties. 
 
¶6. (U)  At the March 30 weekly coordinating meeting among local 
authorities and the implementing agencies, Africare, which is in 
charge of agricultural self reliance, reported that some 7,000 
hectares was the target for preparation and planting with all inputs 
needed by April 15 at the latest.  Prospects did not look good, 
however, as Africare reported that against a need of 400 plows, only 
246 were promised by UNHCR/WFP/Africare.  Against a need for some 
940 oxen, only 20 had been found to be available in the area; it was 
hoped that those refugees with some cattle might train them to plow 
quickly.  (Comment.  A tall order.  End comment.)   Failing that, 
refugees would need to use hand hoes to prepare the fields. 
(Comment.  Another tall order.  End comment.) 
 
¶7.  (U) The strategy of local integration is to be applauded. 
However, the international community needs to follow through on 
assisting refugees to become self reliant through advocating with 
locals for sufficient land and through provision of adequate seeds 
and tools.  The JAM recommendation -- which was not/not endorsed by 
the local UNHCR, WFP, or implementing partners - to cut food rations 
in advance of there being adequate land under cultivation, 
particularly in the case of Gondje where the refugees would have had 
only one planting season even if they had received land and inputs, 
is difficult to understand.   A possible explanation is that the way 
the JAM was set up did not give the JAM team adequate time and/or 
information on which to make its judgments.  The actual field visit 
involved only a couple of days with hurried short briefings that did 
not allow time for team members to fully absorb and analyze 
information.   Anecdotes about refugees selling parts of their 
rations - which is almost always true as refugees seek to diversity 
their diet - may have substituted for systematic study of household 
use of food through post distribution monitoring.  One health care 
provider claimed to have been dismissed as "dangerous" by some team 
members for having argued on nutritional grounds against a ration 
cut. 
 
COMMENT AND ACTION REQUESTED 
------------------------------ 
¶8.  (U) In November 2006 WFP published GAM malnutrition rates across 
Chad's 14 regions/departments.  These numbers indicate that 
malnutrition rates in the Amboko refugee camp are still below Chad 
malnutrition rates country wide (from a low of 4.7% in Bahr Koh to 
high of 13.4% in Bahr el Gazel.) At 3%, the GAM for Amboko refugee 
children is well below the maximum acceptable standard for refugees 
(10%).    That being said, the rapid increase in malnutrition since 
the rations were cut is troubling since the goal of the refugee 
assistance efforts is to minimize malnutrition rather than seeing it 
rise.  However the plan to cut food rations came about (and however 
much the refugees may now be trying to create some fields through 
cutting trees and burning underbrush), it does not appear that 
self-reliance with food security can be achieved in the immediate 
term without a significant boost in external assistance.  In the 
meantime, it is the refugee children (though some adult malnutrition 
has also been identified) that are bearing the impact of the ration 
cuts.  With any harvests seven months away and the annual "hungry 
season" still ahead, it is likely that malnutrition will keep 
increasing.  Options for putting assistance back on track could 
include:  ramp up TFCs (will likely need to be done anyway) with a 
quick infusion of appropriate feeding materials such as CSB (for 
those who cannot/will not eat plumpynut); provide a blanket 
supplemental take away dry or moist ration for all under fives with 
careful follow up to ensure that the food is not shared among all 
hungry children in a family;  revisit/reverse the decision to 
dramatically cut the rations and instead wait until all/the majority 
of the refugees have had a fair chance to plant and harvest at least 
one crop before eliminating the rations.  State/PRM and USAID/FFP 
should urgently work with WFP on modifying the feeding program in 
order to reverse the malnutrition trend. 
 
¶9.  (U) Tripoli minimize considered.  Wall