1. Food and nutrition situation for refugees from Western Sahara in camps in Algeria Ingrid Barikmo Akershus University College (AUC) Norwegian Church Aid (NCA) Riksdagen - Stockholm, February 2010

2. Refugees in harsh environments in the Sahara desert more than 30 years Cease-fire in 1991 Total dependency on food aid as well as all other needs for survival Water: a considerable scarcity Health problems such as undernutrition, anaemia and goitre are common Background

3. Background (cont.) Reduced beneficiaries from 158.000 to 90.000 for 8 months in 2006 In November 2006 increased beneficiaries to 125.000 which still are the number of people given basic ration Undernutrition increased disturbingly in 2008 Indication of violation of the International Covenant on Economic, Social and Cultural Rights – article 11 on the right to adequate food

4. NCA and AUC in the Saharawi refugee camps Nutrition project at the hospitals (since 2000) Iodine Survey, 2007 (report 2008) Nutritional and Food Security Survey, (report 2008) Saharawi Nutrition Strategy, (report 2009) Increased nutrition education, 2009 Cooperation with MoH, UNHCR, WFP, MdM, PNSS in a Integral Program of Infantile Health Saharawi (PISIS), 2009 Food Basket research, 2009 Local milk research, 2009

5. Iodine Survey, 2007 Prevalence of enlarged thyroid gland measured by ultrasound:  Women (405, age 15-45): 22 % (cut-off volume thyroid gland > 12.5 ml)  Children (419, age 6-14): 86 % (international reference values (thyroid gland volume - Tvol) for BSA with cut-off point at the 97 percentile) Excretion of iodine in urine  Women: Median 466 µg/L (range 54-3.640)  Children: Median 565 µg/L (102-3.594)

6. 1100 µg/day: Tolerable upper level of daily iodine intake for adults (Food and Nutrition Board, USA, 2006). 600 µg iodine/day: Proposed safe upper level for adults (Scientific Committee on Food in the European Union, 2002)

7. Median iodine content (µg/L) in water and urine (women and children)

8. Local milk Goat milk (n=16)  Content of iodine: median 370 µ g/L, (70-13.071) Camel milk (n=3)  Content of iodine in the 3 samples 540 µ g/L, 4.170 µ g/L and 11.980 µ g/L

9. Sources of the iodine intake among women

10. Conclusion The prevalence of enlarged thyroid gland was severe, especial for the children The majority of the Saharawi refugee women (74 %) and children (84%) had excessive intake of iodine  It was differences between the camps: of those with iodine excretion more than 600 µg/L 88 % of the women and 91% of the children came from the two camps Ausserd and El Ajune The content of iodine in local milk was extremely high and need to be more investigated The high concentration of iodine in water are affecting the humans directly and probably also indirectly through the local milk

11. Nutritional and Food Security Survey, 2008 Prevalence of: Acute malnutrition (too thin) (wasting):  Global (total) 18.2 %  Severe: 5.4 % Chronic malnutrition (too short) (stunting):  Global (total) 31.4 %  Severe: 9.0 % Anemia, children  In total62 %  Severe 6% Anemia, non- pregnant women  In total54 %  Severe 11% Anemia, pregnant women  In total66 %  Severe15%

12. Trend in acute malnutrition (wasting) from 1997 to 2008

14. Trend in chronic malnutrition (stunting) from 1997 to 2008

15. Saharawi Nutrition Strategy

16. 1. To change the diet for all in line with the international recommendations of the FAO/WHO 2. To coordinate the nutritional work in the camps 3. To reduce malnutrition in children 4. To reduce anaemia and other type of micro-nutrient malnutrition, particularly among women in reproductive age, infants and young children and school age children 5. To promote healthy dietary habits in accordance with local food culture for an adequate food intake for all. 6. To strengthen the nutrition skills among the Saharawi public staff. General objectives Focused areas  Access to food for a healthy diet  Fight against malnutrition and nutritional deficiencies Capacity development

17. Food distributed Wheat and cereals distributed in the camps in 2006 and the first 4 month in 2007

18. Food distribution and acute malnutrition The quantity of distributed cereals/person/month in 2005, 2006, 2007 and 2008 when using number of 160.000 or 125.000 beneficiaries and the prevalence of acute malnutrition

19. Women needs and food distributed in 2008 Food distributed in 2008 to 160.000g/day Cereals281 CSB-blended13 Lentils/beans46 Oil, fortified24 Sugar23 Tuna fish2 Vegetables70 Fruit30 Meat5 Milk/Cheese9

20. Sources to the nutrients Nutrients in % EnergyProteinCalciumIronVitamin CVitamin A Cereals6366203900 CSB-blended3547232726 Lentils/beans922143321 Oil, fortified14000056 Sugar600000 Tuna fish010000 Vegetables22613315 Fruit2042381 Meat020100 Milk/Cheese119001

21. Adapted Food Basket Ration/ kg/month Food given monthly by WFP 8Wheat flour, fortified 2Barely 2Rice 1CSB-soya, fortified 2Lentils/beans/peas 1Oil fortified 1Sugar Suggested food items that can be given by other organisati ons 1Gofio 1Soya beans 1Pasta 5Milk 1Cheese 1Mackerel in brine 3Potato 3Carrot 2Onion 1Apple 1Orange 1Tomato in tetra pack

22. Highly recommended Food Groups as support to the refugees Vegetable and fruit Canned fish (mackerel or sardines) or meat Milk and cheese Other foods such as gofio and pasta and soya beans

23. How to improve the situation? Use the Saharawi Nutrition Strategy Increase the nutrition education Work in cooperation with MoH, UNHCR, WFP, MdM, PNSS in a Integral Program of Infantile Health Saharawi (PISIS) Continue to fill the Food Basket Contribute to the local milk research Other?

26. Hva slags matvarer og tilsetninger (forts)

27. Hva slags matvarer og tilsetninger For behandling av alvorlig akutt underernærte (wasting):  Før – F100  NÅ – PlumpyNut (olje og peanutbasert) For moderat akutt underernærte:  Hvete/mais-soya blanding + olje og sukker (CSB) For forebygging av kronisk underernærte (stunting):  Før – ingenting  NÅ – olje og peanutbasert produkt Anemi  Sprinkelprodukter