D. Food and Nutrition

Every effort should be made to provide familiar foodstuffs and to maintain sound traditional food habits. Expert advice on the appropriate food ration is essential and should take full account of local availability. Staple foodstuffs should not be changed simply because unfamiliar substitutes are readily available. Providing unfamiliar foods often leads to wastage and malnutrition and lowers the morale of the population.

The amount and quality of food provided must satisfy daily energy and protein requirements. A Survival Ration should provide at least 2,100 kcal (and 60 g of protein) per person per day. This is based on the Institute of Medicine’s 1995 report on Estimated Mean per Capita Energy Requirements for Planning Emergency Rations. Active adults may require considerably higher energy intakes, especially if part of the relief plan includes a Food-for-Work Program. Although a marked difference exists between the needs of a young child and an active adult, providing a standard ration for each DP without distinction is strongly recommended. A typical daily ration providing sufficient calories and protein should include selections from each of the following categories of food.

Fortified foods may also assist meeting micronutrient needs but should be combined with local foods and supplements.

Tables III-8 and III-9 provide information on examples of food rations in protracted crisis situations and planning figures to determine bulk food requirements during these situations.

If grains must be milled, the amount of food provided for rations must be increased, as a portion must be given to the miller and because of loss during milling. Vitamin B is lost in the milling process.

Other items such as vegetables, sugar, spices, condiments, fruits, and tea should be provided according to cultural and nutritional needs, if possible. Absolute priority, however, must be given to the delivery of the staple food. The regular delivery of a few staple items is better than an unpredictable delivery of hard-to-find items.

Essential vitamin and mineral requirements must also be met. Where adequate quantities of certain nutrients cannot be provided in the diet, the inclusion of seasonally available vegetables will usually prevent vitamin and mineral deficiencies. When possible, the population should be encouraged to grow gardens of vegetables for personal use or purchase vegetables at local food markets.

Particular attention must be paid to vitamin and mineral deficiencies. Two deficiencies are commonly seen among displaced people: vitamin A deficiency and anemia. Vitamin A deficiency in malnourished populations, especially children, leads to increased morbidity, blindness, and death. Anemia is commonly associated with certain parasitic diseases such as schistosomiasis and hookworm or an insufficient intake of iron and folate. In the most severe cases, anemia can lead to cardiac failure and death. Both deficiencies are preventable with a proper diet. Efforts must be made to include food items that are rich in the needed nutrients. The distribution of multivitamin tablets to the entire population may be useful to prevent some deficiencies but is expensive, labor intensive, and not effective for all deficiencies.

Table III-8. Examples of Food Survival Rations for Populations in Protracted Crisis Situations (quantity in g, based on 2,100 kcal/person/day)

Note: Fresh fruits and vegetables, cereals and legumes, and condiments or spices should be made available whenever possible. Fortified cereal blends, such as wheat-soya blend and corn-soya blend, are good sources of micronutrients. The addition of quantities of various micronutrients, through the inclusion of such fortified cereals and local fresh foods, is highly desirable.

Table III-9. Examples of Planning Figures To Determine Food Needs for Survival Food Rations for Population in Protracted Crisis Situations

(food quantity in metric tons, based on 540 g/person/day [2,100 kcal option])

Formula: Number of persons per day _ .540 / 1,000 kg

Vitamin A, however, should be given once every 4 months to children under 5 years of age. Infants less than 6 months should receive no vitamin A because of possible toxicity. Infants from 6 to 11 months should receive the equivalent of 100,000 international units (usually half of a capsule). Children from 1 to 5 years of age should receive the equivalent of 200,000 international units (usually one capsule). Women of reproductive age should not receive concentrated doses of vitamin A. Women should receive vitamin A through other strategies mentioned above such as vitamin-rich food or, in areas with a known dietary deficiency, a supplement not to exceed 25,000 international units per week.

The need for a fair, efficient, and regular ration distribution cannot be overemphasized. Normally, rations are issued in 7-to 14-day intervals. Distribution intervals must be continually reviewed based on continuing assessment of the affected population. An accurate census is needed and a monitoring system must be established to ensure that the food is actually reaching every person as intended. Potential for some waste, diversion, and corruption always exists, but if these problems are severe they may lead to discontent and unnecessary suffering by the population.

a. Types of Food Distribution

Two types of food distribution are available: dry rations and cooked or "wet" rations. Whichever is used, those distributing the food must have exact instructions on the size of the rations. If scales are not available or become an inconvenient way to measure out food, cans or containers with a known weight/volume comparison for each commodity should be used. The distribution of food as prepackaged rations is an unsatisfactory solution and should be avoided if possible, but in some cases it maybe the only available option.

(1) Dry Ration Distribution (Take Home)

This method has major advantages over cooked food distribution. Dry ration distribution allows families to prepare their food as they wish, permits them to continue to eat together as a unit, and is generally more culturally and socially acceptable. This method also assumes that the family units have access to potable water.

Distribution is usually made at 7-to 14-day intervals. Where an accurate census is available and families have food distribution cards, some form of group distribution is possible. A designated family member or group leader

becomes responsible for receiving and distributing the food. This method is fast and relatively easy to monitor. In the initial stages, however, the best way to guarantee a fair distribution may be to have every individual present.

The food distributor is responsible to the people and camp authorities. A standard measure (e.g., a can) should be used for distribution. Each person should understand how much he or she should receive.

Groups should remain fixed to a piece of ground when they first register to prevent multiple registrations. Simultaneous food distributions will prevent people from moving from one distribution session to the next.

In addition to cooking pots, fuel, and utensils, displaced people must have containers and sacks (e.g., empty cooking oil tins and grain sacks) to protect and store their food rations. Depending on the type of food distributed, there may be a need for grinding and milling facilities.

Food distribution to dispersed populations may present problems. For example, if the displaced camp is located in a food-deficit area, the local population may become intermingled with the displaced population. The local government may try to prevent a census that might cause the local people to be excluded from the food distribution. One solution to overcome this problem is to have the traditional leaders of the displaced population do the distribution. Another solution is to have a separate food distribution system in the local community located away from the displaced settlement. This method should keep the local population out of the settlement. Although locating the local food distribution system away from the DP settlement will cause a certain diversion of commodities, this is sometimes an acceptable loss considering the alternatives. Food distributions may also interfere with original planning assumptions. If the affected population is in a village, it may have access to other food sources. Relief managers should take this into account and provide only a portion of their food requirements.

In providing food to dispersed populations, one must be very careful not to destroy local markets and marketing systems. Two methods for food distribution can be used: providing food directly or using the food-for-work or cash-for-work methods. Village-based or nutrition-based distributions can also be used. The village-based method counts the number of people requiring food, determines the amount of food needed, and then gives that amount to everyone. This method is easy but expensive because no targeting is performed. These programs are difficult to end, and the local markets are disrupted by them. Nutrition-based food distribution programs target distribution to vulnerable groups and then decrease as the area’s nutrition level improves. Although a good system, this method is complicated and staff intensive. It requires home visits, good records, nutrition-monitoring equipment, and trained people to administer the program.

The quality and quantity of rations should be discussed regularly with the displaced people, and complaints should be investigated. Check that food is being properly distributed and used at the family level. Food basket monitoring, measuring the ration amount from a random selection of recipients just after they have received their ration, is a useful tool to ensure equitable and efficient distributions. Nutrition education can help with some problems and may prevent improper storage or spoilage, especially if the population is not accustomed to the type of food in their ration.

(2) Wet Ration Distribution

This method requires centralized kitchens with adequate utensils, water, fuel (although obviously less than the amounts required for family cooking), and trained, healthy personnel. At least two meals must be provided per day, and the efficient organization of wet ration distribution for large numbers is difficult. Such distribution may be necessary during the initial stages of an emergency, especially when families have insufficient cooking utensils or fuel.

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