VZCZCXRO8322
PP RUEHMA RUEHROV
DE RUEHGI #0207/01 2731719
ZNR UUUUU ZZH
P R 301719Z SEP 09
FM AMEMBASSY BANGUI
TO RUEHC/SECSTATE WASHDC PRIORITY 1043
INFO RHMFISS/AFRICOM
RUEHBZ/AMEMBASSY BRAZZAVILLE 0208
RUEAIIA/CIA WASHINGTON DC
RUCNFUR/DARFUR COLLECTIVE
RHEFDIA/DIA WASHINGTON DC
RUEHKH/AMEMBASSY KHARTOUM 0313
RUEHKI/AMEMBASSY KINSHASA 0324
RUEHLC/AMEMBASSY LIBREVILLE 0223
RUEHLO/AMEMBASSY LONDON 0164
RUEHNR/AMEMBASSY NAIROBI 0159
RUEHNJ/AMEMBASSY NDJAMENA 0512
RHEHAAA/NSC WASHINGTON DC
RUEHFR/AMEMBASSY PARIS 0500
RUCNDT/USMISSION USUN NEW YORK 0151
RUEHYD/AMEMBASSY YAOUNDE 0485
RUEHGI/AMEMBASSY BANGUI 1309

UNCLAS SECTION 01 OF 02 BANGUI 000207 
 
SENSITIVE 
SIPDIS 
 
DEPT FOR AF/C 
PARIS FOR RKANEDA 
LONDON FOR PLORD 
NAIROBI  FOR AKARAS 
AFRICOM FOR JKUGEL 
INR FOR CNEARY 
DRL FOR SCRAMPTON 
 
E.O. 12958: N/A 
TAGS: PGOV PREL PHUM PINR CT
SUBJECT: MALNUTRITION IN WESTERN CAR ALARMING, BUT NOT A CRISIS 
 
BANGUI 00000207  001.2 OF 002 
 
 
¶1. (SBU) SUMMARY: The diamond-rich southwest of the Central 
African Republic (CAR) is currently suffering from a wave of 
malnutrition brought on by a lack of nutritional education, the 
aftereffects of regional insecurity,  the global drop in the 
price of diamonds, and most fundamentally, the government 
closure of eight of the eleven diamond buying houses in 
September 2008. Medecins Sans Frontiers (MSF) and Action Contre 
La Faim (ACF) report at least 1,000 cases of moderate to severe 
malnutrition in and around the town of Carnot and 555 in the 
regional capital of Berberati. Children ages newborn to five 
make up 95 percent of the cases. First identified in May 2009, 
the affected area stretches south to Nola and east to Boda - 
encompassing approximately 1500 square kilometers and at least 
200,000 people. While the numbers are troubling and the root 
causes deeply entrenched, MSF and ACF believe they have the 
scope of the problem under control in the major population 
centers. Nevertheless, while the problem seems contained, they 
admit that there may remain surprises in this very rural and 
isolated area. END SUMMARY. 
 
¶2. (SBU) On September 21, 2009, CDA and POLOFF visited the 
Mambere-Kadei prefecture in western CAR to meet with members of 
local government, nongovernmental organizations (NGOs) and 
healthcare workers. It became immediately clear that the 
prevalent malnutrition is not due to natural hazards but is 
instead manmade and is striking the poorest of the region's 
inhabitants. There are five principles causes: 
 
-- Nutritional health education is nonexistent. The average meal 
is a soup of salt, coco leaves, and hot peppers consumed with 
manioc/cassava (a root crop with little nutritional value). 
Though there is fish and game meat to be found, poorer families 
often sell what they find for disposable income. 
 
-- Beef, the staple meat, is widely available but is 
prohibitively expensive for many farmers and unemployed diamond 
minors due to the insecurity that pushed the traditional cattle 
herders, the Peuhl, across the border into Cameroon in 2007. The 
last reports of banditry in the region date to early 2008, but 
the Peuhl have not returned and are reportedly demanding 
start-up money to re-stock their herds before they do so. 
 
-- The drop in the global demand for diamonds, and the region's 
secondary mineral product, gold, has put a severe pinch on the 
economy. Though the land is fertile, the vast majority of the 
population is invested in the mining sector. As a result, the 
drop in prices struck the whole region - with those at the 
bottom being hit hardest. The doctor at the hospital in Carnot 
informed POLOFF that people are starting to make the move back 
to agriculture, but estimated that production would not be 
sufficient to sustain the economy until mid 2010 to 2011. 
 
-- MSF estimates that in and around Carnot, the rate of AIDS/HIV 
is particularly elevated and has led to a disproportionate 
number of orphans. This in turn results in a disproportionate 
number of malnourished children as they have fewer means and 
many lack education. 
 
-- As post will elaborate in SEPTEL, it is clear that the 
government's (CARG) decision to shut down all but three of the 
diamond buying houses has caused a precipitous fall in the 
economy and is the ember that has sparked this catastrophe. 
 
¶3. (SBU) MSF has set up temporary clinics in the towns of 
Carnot, Gamboula (MSF France) Boda, and Nola (MSF Belgium/Spain) 
and ACF is established in Berberati. Some statistics: 
 
-- In Carnot, the 20 percent of children are reported to be 
malnourished and 10 percent are considered to be severely so 
 
BANGUI 00000207  002.2 OF 002 
 
 
(NOTE: Two percent of the population suffering from severe 
malnutrition is considered emergency END NOTE).  There have been 
22 fatalities due to malnutrition registered since late May 
¶2009. MSF estimates that there are about 2,000 cases of 
malnutrition in the whole Sub-Prefecture, but have not reached 
all points to confirm their estimate. 
 
-- In Berberati, the initial ACF study revealed a malnutrition 
rate of 7 percent among children 6-59 months with 1.5 percent in 
dire need.  ACF suspects the problem could be substantially 
worse in the villages surrounding the town.  They plan to have a 
report completed by November. 
 
-- MSF estimates that there are 500 cases of malnutrition in 
Gamboula. 
 
¶4. (SBU) The CARG has been slow to react.  Both ACF and the 
doctor in Carnot resorted to broadcasting the extent of the 
problem on local and national independent radio. The doctor in 
Carnot received threatening phone calls about his ``loyalty'' to 
the government for giving the story to Radio Ndeke Luka. Yet as 
a result, the Ministry of Health, MSF and ACF have all since 
become involved. The  Minister of Mines Sylvain Ndoutingai, 
Minister of Public Health Andre Nalke Dorogo and the local 
member of the National Assembly recently visited Carnot and 
donated one  million Francs CFA (2,250 USD) to the hospital to 
help treat the victims of malnutrition.  The prefect and 
agricultural director of Mambere-Kadei claim to have begun a 
program urging young people to return to agriculture, but admit 
limited success. The government is by in large depending MSF and 
ACF to address the issue. It is the two international NGO's that 
have stabilized the cases of malnutrition in the towns and who 
are now trying to visit the more remote villages to help those 
with no access to the hospitals. 
 
¶5. (SBU) COMMENT: Both ACF and MSF are in the process of a 
comprehensive review of the situation and should have full 
reports by November, thus the complete extent of the problem 
will be clearer later in the year. This said, there are two key 
takeaways: 
 
-- The government's lackadaisical response has engendered 
resentment from the affected population. Two sources estimated 
that half to three quarters of the population blames the 
government for exacerbating the crisis by shutting down the 
diamond houses. Despite protestations to the contrary by 
visiting ministers and resident officials, the government 
remains the focus of their discontent. Yet there are no signs of 
popular upheaval, and government control, nonexistent in many 
places of the CAR, remains strong. 
 
-- The problem is limited to the areas that are over dependent 
on mining, and it is highly unlikely that the wave of 
malnutrition will spread to other parts of the CAR. Thus, while 
worrying, the malnutrition striking the southwest in unlikely to 
have national ramifications. END COMMENT. 
SMITH