Ivory Coast report: Malnutrition

In the mobile clinics, MSF is seeing many severely malnourished children who emerge from the bush as Internally Displaced Persons (IDPs). On the other side of the problem, the response to malnutrition has been seriously insufficient. MSF is concerned that its observations made during clinic activities are only a muted reflection of the reality beyond what is learned from consultations. To date there have been no other in-depth assessments of malnutrition patterns in the West.

a. Displacement as an accelerating factor of malnutrition* Total of children presenting themselves at the mobile clinics

Today MSF takes care of more than 500 severely malnourished children in its Therapeutic Feeding Centres (TFC) in the West. Although no general nutritional survey has been conducted, MSF fears that these numbers are indicative of a nutritional crisis.

They suddenly came one morning and started shooting, we fled in all directions, into the bush. We returned the next morning to pick up our belongings, but everything was burnt: our rice, our tools, our clothes and documents.

-Male IDP, 31 years old, at the Zouan-Hounien mobile clinic

Families forced to flee and disperse into the bush without warning were immediately cut off from their regular food sources. Those who chose to remain in their villages or towns have faced the destruction and looting of existing food reserves, including livestock.

Infants under 5, which are the most vulnerable to malnutrition, have been the first to be affected. MSF is concerned that if the food situation is not addressed, malnutrition will also be seen in older children. In any case, the moderately malnourished children that MSF screens in the clinics cannot be dealt with adequately.

Survival in the bush can be problematic in the longer run, with children being affected the most.

  • The gathering of food in the bush (e.g., manioc, roots and mangos) does not provide a complete diet. Seventy-two percent of the malnourished children referred to the TFC in Man during the month of June were affected by Kwashiorkor (generally associated with an acute protein deficiency).
  • Those who find relief from extended families soon find that such community food resources begin to run low, particularly when the host community is a resource-scarce environment due to the conflict. MSF has observed that communities with high numbers of IDPs fare worse in terms of malnutrition.

b. Contributing and worrying factors

"We see a considerable number of low-end moderately malnourished children that will become severely malnourished if they are not fed properly. It's absurd. We are actually waiting for them to get worse so they can be treated. The hospital has very limited capacity and can only take care of the very severe cases."

-MSF nurse, Man.

Over 80% of the malnourished children who are screened and referred at the mobile clinics are also affected by malaria. Although the disease is endemic to the region, malnutrition causes a decline of the immune system, whereby children become more sensitive to the disease. Inversely, malaria has a more serious impact on a child already weakened by malnutrition.

Finally, the cultivation of cash crops (cacao and coffee), which normally provides a large source of revenue for the purchase of certain food items, is no longer possible due to insecurity and lack of seeds and tools.

c. Lack of response

After Zouan-Hounien got attacked, I fled to Fiapleu but I came to Danané to find work. I am worried about the food situation, it is already too late to plant pluvial rice. The swamp rice can be planted till end of July but with the first harvest in November. People are still scared to return to their villages though.

-Male IDP, 48 years old, at the Danané mobile clinic

MSF is addressing the severely malnourished, but has limited capacity to deal with the entire region and can not address the many moderately malnourished children. Families need to receive food now in order to stem the progression of children and others towards increasing levels of malnutrition.

In response to moderate and at-risk levels of malnutrition, key actors such as the World Food Program (WFP) and Action Contre la Faim (ACF) have just become operational. The Food and Agriculture Organisation (FAO) has not yet done an evaluation in the at-risk area along the border with Liberia and it appears that they have already missed the opportunity to distribute seeds so that people can plant before the end of the planting season.

General food distributions have also been slow to start. WFP's intervention in the West has been hampered by pipeline and transport problems. Furthermore, WFP's strategy targets only IDPs in the short-term. This approach misses the key fact mentioned above, that host communities share overstretched resources with IDPs, and complain they are themselves in need of relief food. In addition, security concerns, the lack of implementing partners and weak links with the population has further diminished WFP's effectiveness.

Another concern is that the promise of food distributions in certain locations, particularly in Danané, Ganleu and Zouan-Hounien, has created a relief magnet. Basically, populations expecting to receive food distributions (or awaiting verification of their registration) are reluctant to return to their villages.

As food is not distributed in an organized and timely fashion, this exacerbates the negative effects of displacement, delaying the return to home areas. MSF is hopeful that this situation will be redressed as WFP has promised to give the West priority attention.

Meanwhile, neither the Government of Côte d'Ivoire nor the de facto authorities on the ground seem willing to acknowledge their responsibilities to address this problem, preferring to rely on international actors.