Supplementary feeding for refugees and other displaced communities - questioning current orthodoxy.
Supplementary feeding programmes of one sort or another are an almost universal response to refugee displacements, particularly in Africa. The aim of this paper is to question some of the assumptions which underlie current approaches to providing this additional food. First, there is a brief description of recent general policy developments relating to refugee health care and an outline of the two main factors that are likely to affect the objectives of supplementary feeding programmes: the adoption of either the medical or the epidemiological model of malnutrition, and the identification of the major differences between refugees and stable communities in developing countries. The characteristics of vulnerable groups are then discussed, as is the need to place food supplements within a much broader context of appropriate interventions directed towards improving and maintaining the health and nutritional status of these vulnerable groups. At the same time, emphasis is placed on the non-nutritional value of food and the importance of allowing refugees to determine their own priorities and to use the available resources accordingly. Several unresolved questions about nutrition programmes are identified, in particular whether the focus of supplementary food should be high risk individuals or families, and whether supplements should be provided on a supervised or take home basis - or if they should merely be included as part of a basic ration determined by "need." Eight axioms of supplementary feeding programmes for refugees are stated and the implications of these for planning, training and research are discussed.
London School of Hygiene and Tropical Medicine Keppel Street London WC1E 7HT, U.K.
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Dick