In 2002, a crisis threatened southern Africa, with food insecurity occurring in a region seriously affected by HIV/AIDS. The humanitarian response focused on food aid but paid insufficient attention to public health. Health was seen as a long-term developmental issue that could not be addressed by short-term humanitarian action.

In March 2002 the United Nations estimated that 12.8 million people in six countries –  Lesotho, Malawi, Mozambique, Swaziland, Zambia and Zimbabwe – were threatened by starvation and communicable diseases. Although HIV/AIDS was identified as an important factor, the situation was labelled a food crisis.

A paper by the World Health Organisation, the United Nations High Commissioner for Refugees and the Overseas Development Institute, UK examines the appropriateness of the international response to the crisis in southern Africa. Acknowledging the ongoing debate about the severity of the crisis, the authors criticise the lack of understanding of the links between food insecurity, vulnerability due to HIV/AIDS, and failure to invest in primary healthcare.

The overall response to the crisis was dominated by food aid. Of the US$ 611million requested in the 2002 appeal, 83 percent was for food commodities. Only 31 percent of the amount appealed for in the social service sectors, including health, was met. The authors argue that there was a ‘health sector gap’ in the response to the crisis.

The authors note that:

• While the grouping together of six countries was logical for fundraising, logistical and coordination purposes, it overlooked the distinct needs of each country.
• Estimates of the extent and severity of malnutrition and mortality were difficult to make.
• Assessments generally failed to examine how ill-health or premature deaths in households (often due to HIV/AIDS) affected their ability to deal with the crisis.
• Most of the problems identified by the limited health assessments carried out by the humanitarian response existed long before the crisis: for example, health needs relating to the crisis were difficult, if not impossible, to distinguish from pre-existing gaps in healthcare provision.

It is estimated that at least US$ 30-40 per person per year is required to run a properly functioning health system in the developing world. Yet health expenditure in all countries in the region, except Swaziland, is considerably less – in Malawi it is only US$ 5. The need for basic health services has been increasing due to HIV/AIDS, but access has been declining.

In responding to future crises, aid agencies need to:

• realise that when people living with HIV/AIDS are malnourished they are even more susceptible to life-threatening conditions such as respiratory tract infections and diarrhoeal diseases
• realise that food insecurity and increasing acute malnutrition also leads to increased morbidity which can deteriorate nutrition levels further
• assemble crisis assessment and planning teams with representatives from a range of disciplines and concerned groups to ensure that all areas are adequately covered
• question traditional distinctions between relief and development, and thereby recognise HIV/AIDS as a long-term challenge that must be included in both humanitarian responses and development strategies
• accept that in addition to meeting food needs, the humanitarian system has a responsibility to call for unmet health needs and ensure adequate access to basic health care services, even provide for them in a short-term, limited manner compatible with existing national health policies
• assist states in coming up with disaster prevention and response strategies linked to nationally-developed health policies.

Distributing food cannot be the only answer to a complex crisis. Multisectoral short-term humanitarian interventions must be undertaken in cooperation with development strategies.

Source(s):
 ‘The Health Sector Gap in the Southern Africa Crisis in 2002/2003’, Disasters, 28 (4), pages 388–404, by Andre Griekspoor, Paul Spiegel, William Aldis and Paul Harvey, 2004

id21 Research Highlight: 22 December 2005

Further Information:
Andre Griekspoor and William Aldis
Department of Health Action in Crises
World Health Organisation
20 Avenue Appia
CH-1211 Geneva 27
Switzerland

Tel: +41 22 791 2761
Contact the contributor: griekspoora@who.int

World Health Organisation

Paul Spiegel
United Nations High Commissioner for Refugees
Case Postale 2500
1211 Geneva, 2 Depot
Switzerland

Tel: +41 22 739 8289
Fax: +41 22 739 7366
Contact the contributor: spiegel@unhcr.ch

United Nations High Commissioner for Refugees (UNHCR)

Paul Harvey
Humanitarian Policy Group
Overseas Development Institute
111 Westminster Bridge Road
London SE1 7JD
UK

Tel: +44 (0) 20 7922 0335
Fax: +44 (0) 20 7922 0399
Contact the contributor: p.harvey@odi.org.uk

Overseas Development Institute, UK

Other related links:
'Hunger crisis: learning from southern Africa'

'Food security – putting policy into practice'

'Living with variable climate in southern Africa'

'Equity and access to HIV/AIDS treatment: getting the balance right in southern Africa'

Southern Africa - Countries in crisis, UNICEF resources

Southern Africa Humanitarian Crisis, ReliefWeb documents