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Posts Tagged ‘Unicef

Health care data from the districts

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This page contains the district data available in the District Level Household and Facility Survey (DLHS-3) which was a country-wide survey covering 601 districts (at that time) from 34 states and union territories of India.

As an essential part of the continuing district development index – which concentrates on agriculture and food – the sectors of population and demographics, health, education, water and sanitation, land use, finance and credit, will be linked. I have started this link with health data for Maharashtra.

DLHS-3 was the third round of the district level household survey which was conducted during December 2007 to December 2008 (funded by the Union Ministry of Health and Family Welfare, the United Nations Population Fund (UNFPA) and the United Nations Children’s Fund (UNICEF)).

This third round was designed to collect data at district level on various aspects of health care utilisation for reproductive and child health, accessibility of health facilities, assess the effectiveness of ASHA and JSY in promoting RCH care, to assess health facility capacity and preparedness in terms of infrastructure.

An important objective of DLHS-3 was to assess the contribution of decentralisation of primary health care at the district level and below by involving village health committees under panchayats in the implementation of health care programmes.

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Pakistan, India and people’s responsibility

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Relief work in the districts of Jaffarabad and Nasirabad in Balochistan. Photo: UNOCHA

Relief work in the districts of Jaffarabad and Nasirabad in Balochistan. Photo: UNOCHA

For a month the government of India, aided by its media and propaganda units (urban-centric English language dailies and magazines, and a dangerously partisan group of television channels) has bombarded the Indian public with its view of Pakistan.

This is a view that is full of threat and anger. There is in no communication of the government of India (not from the office of the prime minister of India, not from the cabinet, not from Parliament, not from its major ministries which share concerns, such as water and food, and not from its paid servants, a wastrel gaggle of self-important think-tanks) that says, in effect, yes we understand the troubles your peoples have, for we have the same, and let us find ways to aid one another.

There is plenty of reason to do so.

Let us look first at floods and natural disasters, which India has a great deal of experience in dealing with, both through those government agencies that possess an iota of integrity and through voluntary groups and NGOs. Hundreds of thousands of people displaced by September monsoon flooding in Pakistan have not yet moved back into their homes, according to aid groups. Three of Pakistan’s four provinces were hit, affecting over 4.8 million people and damaging over 630,000 houses, according to the latest situation report by the National Disaster Management Authority (NDMA).

Humanitarian Snapshot Pakistan - Complex Emergency and Floods 2012 (as of 18 December 2012). The 2012 monsoon floods affected 4.8 million people, according to the National Disaster Management Authority (NDMA). Western Balochistan, southern Punjab and northern Sindh provinces were the worst affected. As of 18 December, more than 774,594 people remain displaced in Khyber Pakhtunkhwa due to a complex emergency that has affected region since 2008. Moreover, 1.7 million refugees require assistance as do many of the 1.3 million people who returned to FATA since 2010. Source: UNOCHA

Humanitarian Snapshot Pakistan – Complex Emergency and Floods 2012 (as of 18 December 2012). The 2012 monsoon floods affected 4.8 million people, according to the National Disaster Management Authority (NDMA). Western Balochistan, southern Punjab and northern Sindh provinces were the worst affected. As of 18 December, more than 774,594 people remain displaced in Khyber Pakhtunkhwa due to a complex emergency that has affected region since 2008. Moreover, 1.7 million refugees require assistance as do many of the 1.3 million people who returned to FATA since 2010. Source: UNOCHA

Three months after the floods, 97 percent of those displaced have returned to their towns and villages. Nearly all of them, however, continue to live in makeshift shelters next to damaged homes. Aid groups and government officials say they still need critical assistance to help them through the winter. In the absence of adequate shelter and provisions, aid workers say, the cold weather in flood-hit areas is likely to put the affected population under more stress. [You can download a full-sized version of the Humanitarian Snapshot map above, from here (png, 1.8MB).]

Next is the matter of population, economic support for a growing population and sustainable alternatives to the ‘growth is best’ nonsense that South Asian ruling cliques foster with the help of their industrialist compradors. Internal pressures in the country with the world’s sixth largest population are likely to get worse before they get better: At 2.03 percent Pakistan has the highest population growth rate in South Asia, and its total fertility rate, or the number of children born per woman, is also the highest in the region, at 3.5 percent. By 2030, the government projects that Pakistan’s population will exceed 242 million.

“The failure to adequately manage demographic growth puts further pressure on the current population, who already lack widespread basic services and social development,” said the IRIN analysis. Pakistan’s health and education infrastructures are poorly funded, and experts have questioned the quality of what is being provided with existing budgets. With a weak economy and low growth, food insecurity and unemployment present further challenges. “The problem is that if you have a population that is illiterate and does not have proper training, a large segment cannot participate meaningfully in the economy,” IRIN quoted economist Shahid Kardar, a former governor of the State Bank of Pakistan, as having said.

A polio worker on the outskirts of Peshawar in Pakistan delivers vaccine drops, but many workers are now too scared to go into the field. Photo: IRIN, Tariq Saeed

A polio worker on the outskirts of Peshawar in Pakistan delivers vaccine drops, but many workers are now too scared to go into the field. Photo: IRIN, Tariq Saeed

And then there is the very worrisome aspect of violence, against the poor and vulnerable as much as against women. I find it a macabre coincidence that during the weeks when polio workers in Pakistan were being shot at and killed, women in various parts of India were being gang-raped and murdered.

Over the past few weeks there has been an upsurge in attacks on aid workers in Pakistan, many of them linked to a national polio eradication campaign in one of the world’s last three countries where the disease remains endemic. In December 2012 the UN Children’s Fund (UNICEF) and the World Health Organization (WHO) suspended their anti-polio vaccination campaign after nine workers were killed in attacks in Karachi and Khyber-Pakhtunkhwa.

Polio workers, including those working for the UN, were also targeted earlier in 2012. Beyond the polio campaign, aid workers in general are starting to feel more hostility to their work. In an attack on 5 January, two aid workers with Al-Khidmat Foundation, an NGO working in education, were shot dead in the northwestern city of Charsadda. There was similarly no warning when gunmen killed seven aid workers with local NGO Support With Working Solution (SWWS) in the Swabi District of Pakistan’s Khyber-Pakhtunkhwa (KP) Province on 1 January.

And still the same old tiresome drums continued to beat, as they still do, Look at the reactions from India (and the jingoistic treatment given them by a rabid media):

India Today – “Military encounter on the LoC last week is threatening to erode the hard-fought gains in relaxing trade and visa regimes by India and Pakistan in recent times. The rhetoric is shrill in India, which claims it has been grievously wronged.”

Economic Times“India has ruled out high-level talks with Pakistan to de-escalate hostilities and normalise bilateral relations, people familiar with the situation said. The position is in line with Prime Minister Manmohan Singh’s statement…”

Times of India“India will maintain a tough outlook on Pakistan even as the LoC quietened after a fortnight of bruising skirmishes. At a meeting of the Cabinet Committee on Security (CCS) on Thursday, it was agreed that India would not respond immediately…”

BBC“India’s foreign minister says he will “not rush” into talks with his Pakistani counterpart to defuse military tensions in Kashmir. Salman Khurshid’s remarks came after Hina Rabbani Khar’s call for a dialogue between the two ministers.”

DNA“India’s army chief threatened to retaliate against Pakistan for the killing of two soldiers in fighting near the border of the disputed region of Kashmir, saying he had asked his commanders there to be aggressive in the face of provocation.”

Lost altogether in this teeth-gnashing mêlée of trouble-making are the efforts made by Pakistani and Indian people, such as the India Pakistan Soldiers Initiative (IPSI) for peace when they met at the Pakistan Red Crescent Society offices in Pakistan. Peace between the peoples of Pakistan and India that has nothing to do with the red-eyed posturing over the Line of Control and over Jammu and Kashmir will be our own responsibility.

Food crisis in the Sahel

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UN-OCHA map of vulnerability to food insecurity in the Sahel.

ReliefWeb has a series of backgrounders, assessment reports and maps to explain the malnutrition and food crisis in the Sahel. The UN Office for the Coordination of Humanitarian Affairs has said that the Sahel is characterised by long standing chronic food insecurity and malnutrition, poverty and extreme vulnerability to drought. “The localised deficit recorded for the agropastoral season 2011-12 and increasing cereals prices in Mali and Niger could bring millions of people at risk of food insecurity,” said the UN-OCHA briefing.

Throughout the Sahel, acute malnutrition in children reaches its annual peak during the hunger season. Children under two years of age have the highest risk of becoming sick or dying during this period. Malnutrition is caused by inadequate food quality and quantity, inadequate care, as well as unhealthy household environment and lack of health services.

The prevalence of global acute malnutrition met or exceeded the critical threshold of 10% in all of the surveys conducted in the hunger season of 2011 (from May to August). If food security significantly deteriorates in 2012, the nutrition conditions for children could surpass emergency levels throughout the Sahel region.

Affected countries are: Burkina Faso, Cameroon, Chad, Gambia (the), Mali, Mauritania, Niger (the), Nigeria and Senegal.

Food insecurity and malnutrition chronically affect a significant part of the Sahel population. However, several events came in 2011 which exacerbate this vulnerability:

1. In 2011 many parts of the region received late and poorly distributed rains, resulting in average harvests and serious severe shortfall in some areas. Consequently, the Government of Niger as an example has estimated that the 2011 agro pastoral season will record a deficit of 519,600 tons of cereals and of over ten million tons of fodder for livestock.
2. In Mauritania, authorities expect a decrease of more than 75% of the agriculture production and a strong fodder deficit.
3. In areas where harvests are weak, households will run out of food stocks faster than usual and will be forced to rely on markets for supplies, contributing to maintaining the already high prices at the same level.

UN-OCHA map of expected cases of severe acute malnutrition in the Sahel.

Furthermore, the purchasing power of the most vulnerable populations is likely to deteriorate. In addition the lean season is estimated to begin earlier than usual, probably as early as January 2012 in Chad, two months in advance. As the situation gets worse by spring 2012, there will be an increase of infant acute malnutrition, already beyond emergency thresholds in four wilayas in southwestern Mauritania.

Several countries in the Sahel have already announced measures taken to curb the negative effects of the food insecurity and malnutrition on vulnerable populations; who have not had enough time to recover from the 2009-10 crisis, despite the good harvest registered last year. Three countries (Burkina Faso, Mauritania and Mali) have also requested for assistance from the humanitarian community. In late November, the United Nations Central Emergency Response Fund (CERF), administered by OCHA, allocated US$ 6 million to three organisations in Niger – the World Food Program, UNICEF and the Food and Agriculture Organization – for emergency operations to fight food insecurity and malnutrition.

According to a ‘Humanitarian Dashboard – Sahel’ dated 12 January 2012 released by UN-OCHA, early indicators point to a likely food crisis in localised areas of the Sahel in 2012, with people at particularly high risk in Mauritania, Niger, Burkina Faso, Mali, Chad, and localized areas of Senegal. These are:

1. Acute food insecurity already noted in southeastern Mauritania.
2. Deficits in 2011, in agro-pastoral production led to higher market prices, resulting in an earlier than usual need for food aid.
3. Resilience to food insecurity is low in most vulnerable groups.
4. High poverty level in Sahel (51%) impacting on food accessibility due to high prices.

Floods in Pakistan displace 5.4 million

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A man carries a child through the flood waters in Digri, Sindh province. Southern Pakistan has been struck by severe monsoon floods 12 months after last year's devastating flood emergency that affected most of the country. Photo: IRIN / UNICEF Warrick Page

Torrential monsoon rains have triggered severe flooding in Pakistan, primarily in Sindh Province, Reliefweb has reported. Before the monsoon season began, forecasts predicted 10% below normal rains for Sindh and the southern parts of the country for the 2011 monsoon season. However, by 10 August, heavy rains began affecting districts of southern Sindh and extended to the northern regions of the province and adjoining areas of south Punjab and north-eastern Balochistan. While this spell lasted till mid-August, another more debilitating and sustained rain spell heavily affected areas across the entire Sindh Province from the end of August until 14 September. Concurrent impact in adjoining vast areas of Balochistan has resulted in serious humanitarian consequences including in South Punjab. In Sindh, the central and southern districts have been the worst affected.

These rains caused widespread breaches in the agricultural and saline water canals, particularly in the Left Bank Outfall Drain, which exacerbated flood impact in Badin, Mirpurkhas and Tharparkar districts, among others. Continued rains have seriously impeded delivery of emergency services and flood impacted mitigation works. Outflow of the draining flood water is compromised due to poor infrastructure and lack of maintenance of the drainage routes. Some parts of Karachi and Hyderabad have also experienced urban flooding. Flood waters are likely to stagnate in most of the affected regions for the foreseeable future.

As the monsoon season continues, the impact upon the population is intensifying with 5.4 million people affected to date. In Sindh, in particular, the concentration is most severe and all 23 districts have been affected to some degree. It is expected that the population will continue to be uprooted from their homes to seek refuge in the short term as more areas are affected. While some are housed in Government appointed shelters, more seek higher ground along bunds and roads. In Balochistan, five districts are affected and notified (considered seriously affected by the national authorities).The Government of Pakistan, through the National Disaster Management Authority (NDMA) and utilising the Armed Forces’ logistical capacity, has taken the lead in responding to the disaster with the deployment of rescue and life-saving relief operations.

IRIN News has reported that heavy monsoon rain in southern Pakistan is in many ways hitting children worst of all, according to the UN Office for the Coordination of Humanitarian Affairs, which says five million people are affected. The UN Children’s Fund (UNICEF) says children are among the most vulnerable in the kind of situation that prevails now in Sindh Province: “Up to 2.5 million children have been affected by severe monsoon floods in southern Pakistan – and with many still recovering from the worst floods in the country’s history just a year ago, UNICEF says more help must reach them fast before the situation worsens.”

Media in Pakistan quoted disaster management authorities in Sindh as saying at least 270 people have been killed in the province’s 23 districts. The provincial government, which has called on international agencies to help, says 1.2 million homes have been washed away, while the aid agency Oxfam has reported that more than 4.2 million acres of land (1,699,680 hectares) has been flooded and 1.59 million acres (643,450 hectares) of standing crops destroyed in Sindh. It also warned the “situation could worsen” over the coming days.

“The nature of this disaster in some ways poses challenges that are more complex than those of 2010,” Kristen Elsby, a spokesperson for UNICEF, told IRIN from Islamabad. She said the main factor in this was that displaced populations were scattered, with many based along roadsides. “We did not know where to go when the rains swept in, took away our goats and destroyed the vegetable crop we had cultivated,” said Azrah Bibi from Badin District. She and her extended family of eight are currently camped along a roadside near the town of Badin. “We saw some people here and joined them. Some people delivered one lot of food, but there has been very little since, and it is hard to cook anyway since we have no facilities other than a fire from bits of timber and scrap,” she said.

Once again, people living in Sindh and nearby provinces have been hit by floods and forced to flee the waters. Photo: IRIN / Abdul Majeed Goraya

“Children, in particular, need access to clean water and also sanitation to prevent illness from breaking out.” Like many others affected by this year’s flood, Azrah Bibi and her husband, Gulab Din, 45, were also affected by the floods of 2010, widely rated as the worst in the country’s history, which partially damaged their home and also their rice crop. “This year things seem equally bad to me. The wrath of Allah has hit us twice,” she said.

Another IRIN report has said that Sindh is facing disaster once more with heavy rains over the past five days, according to the Provincial Disaster Management Authority (PDMA). “Two million people in 15 [out of 23] districts have been affected,” PDMA Director of Operations Sajjad Haider told IRIN. He also said crops had been devastated. Eighty-five people are reported to have died and provincial authorities have announced disaster relief measures, including compensation packages for victims. Haider said crops had been devastated.

“My sugarcane crop, which was ready for harvesting, has been lost. I am still recovering from last year’s losses of crops and livestock. Who knows what will happen now,” said Majeed-ud-Din, 40, from his village in Khairpur, one of the worst-hit districts. In the remote Kohistan District of Khyber Pakhtoonkhwa Province (KP) flash floods triggered by heavy rain last week are now confirmed by District Coordination Officer Syed Imtiaz Ali Shah as having killed at least 33 people. Media reports put the death toll at almost double that figure, with dozens of houses including an entire village swept away by torrents pouring down hillsides.

[See the earlier post, ‘Pakistan floods six months later’]

The UN Rapid Response Plan has said that in Sindh, of the approximately 5.44 million people affected, 49% are women. The number of deaths has increased to 223, of which 60 are women and 37 are children. To date, 665,821 family homes have been damaged or destroyed. Nearly 297,041 people (77,175 women, 139,661 children) are currently living in 2,150 relief sites.

The situation of the people who have been forced to leave their homes is dire, and there is clear evidence of growing humanitarian needs. People have sought refuge on higher ground, along roadsides and on bunds, while others are housed in public shelters. Access to safe drinking water is compromised, although health services are reaching out. Due to damaged infrastructure, however, it is difficult for the population to access existing services and efforts to avoid a major disease outbreak must continue. With an increasing number of people uprooted as a consequence of the situation, ensuring emergency shelter and food for the population is critical.

Across both provinces, Sindh and Balochistan, there has been a significant impact on people’s lives, especially related to the loss of livelihoods, most predominantly those related to agricultural activities. The UN Rapid Response Plan has said that approximately 80% of Sindh’s rural population’s livelihood is dependent upon agricultural activities, such as crops, livestock, fisheries and forestry. According to preliminary information from NDMA, 1.6 million acres of crop area have been destroyed by the floods, and pre-harvest crop losses include rice, vegetables, cotton, and sugarcane. The survival and health of animals in flood-affected areas are at risk due to loss of fodder reserves and animal feeds. These combined effects are likely to severely affect the availability of and access to adequate food for a large proportion of the affected population over the coming months.

The floodwaters have devastated towns and villages, washed away access routes, downed power and communications lines, and inflicted major damage to buildings. Many key roads and major bridges are damaged or destroyed. The prevailing socio-economic conditions along with flood have exacerbated the living conditions of women, men, boys and girls residing in the flood-affected districts. Additionally, female and children are not always able to access basic services or humanitarian aid. Vulnerable people in general are potentially experiencing a higher risk of disease, in addition to the challenges of limited access and mobility.

Food, climate, conflict – all that caused the Horn of Africa refugee crisis

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New arrivals from Somalia waiting to be registered at Dagehaley camp, in Dadaab. Photo: Kate Holt/IRIN

IRIN News has reported that about 1,300 Somalis are arriving at the Dadaab refugee camps in northeast Kenya every day. The help they are seeking – refuge from a severe drought and the effects of years of conflict – is being handed out as fast as possible. But in a camp complex that has already been stretched well beyond its limits, the new arrivals need more assistance than can be provided. The nutritional state of older children, as well as under fives, is of concern, but the local Kenyan population is faring little better.

“The number has skyrocketed,” a registration expert with the UN Refugee Agency, UNHCR, told IRIN. The official said UNHCR had had to hire more employees, who now work in shifts, to accommodate the rush. The three Dadaab refugee camps – Dagahaley, Ifo and Hagadera – were originally meant to cater for 90,000 refugees, but housed at least 380,000 people, according to UNHCR. Despite the overcrowding, the government of Kenya has yet to allow people to move into a fourth camp, known as Ifo II, which stands empty.

“Water systems, latrines and healthcare facilities are ready to use but are standing idle,” Oxfam said in a statement. Oxfam reported that 60,000 new arrivals were living in basic tents outside the camp boundaries, with limited access to clean water or latrines, risking an outbreak of disease. Those living in these informal settlements are some of the worst-off. In the settlements on the outskirts of Dagahaley camp, 17.5 percent of children between six months and almost five years old are severely malnourished, three times the emergency level, according to Caroline Abu-Sada, a research unit coordinator with Médecins Sans Frontières (MSF).

Newly arrived Somali refugees waiting to be registered at Dagahaley camp, Dadaab in Kenya. Photo: Al Jazeera/EPA

The lack of water in the outskirts was a real concern. Refugees are only able to obtain up to three litres of water a day, 80 percent less than they need according to the Sphere Standards, which are already based on emergency situations. Some are only receiving 500ml for drinking, bathing, washing clothes, and everything else. By comparison, in North America and Japan most people use 350l a day, according to the World Water Council. Water is now being trucked to the camp outskirts by MSF and CARE, but there were previously only 48 taps for 20,000 people. Abu-Sada said diarrhoea was already rampant, along with skin rashes and respiratory infections.

More than 11 million people are estimated to be in need of humanitarian aid across the region, a UN News report has said. Almost 500,000 children in Somalia, Ethiopia and Kenya are suffering from imminent, life-threatening severe malnutrition. In addition, over 1.6 million children under the age of five are acutely malnourished, according to UNICEF.

In addition to the thousands of people from Somalia seeking refuge in Ethiopia and Kenya, millions more are living on the brink of extreme poverty and hunger, suffering the consequences of failed rains and the impact of climate change, said the agency. UNICEF has appealed for $31.8 million to ramp up assistance to the Horn of Africa over the next three months, especially for children, who are suffering the brunt of the crisis. It says the most urgent needs include therapeutic feeding, vitamin supplementation, water and sanitation services, child protection measures and immunization.

In Geneva, two UN human rights experts appealed to the global community to take “concerted and urgent” measures to assist the millions who are suffering in the region, warning of large-scale starvation if international intervention is not forthcoming. Shamsul Bari, the Independent Expert on the situation of human rights in Somalia, noted that drastically increasing food prices and continuing conflict and insecurity have caused a huge displacement of the population, with thousands of Somalis fleeing to Ethiopia, Kenya, and Djibouti every day. Bari, who last week visited Somalia and Kenya, said the situation was markedly worse than in March, when he had expressed concerns over the slow response of the humanitarian community to the situation.

The UN Special Rapporteur on the right to food, Olivier De Schutter, said the international community should be prepared for more such droughts. “This crisis looks like a natural calamity, but it is in part manufactured,” De Schutter said, adding that climate change will result in such events being more frequent. He called for, among other measures, emergency food reserves in strategic positions, and better preparedness for drought, for which Governments must be held to account.

“With a rate of child malnutrition above 30 per cent in many regions of these countries, the failure of the international community to act would result in major violations of the right to food,” De Schutter said. “International law imposes on States in a position to help that they do so immediately, where lives are at stake.”

Shokuri Abdullai like most mothers in Bisle feeds her family boiled maize in the Somali region's Shinile zone (Ethiopia). Photo: Jaspreet Kindra/IRIN

Al Jazeera has reported that Kenya has agreed to open a new camp near its Somalia border to cope with the influx of refugees fleeing the region’s worst drought in 60 years. The lfo II camp in Dabaab will open its doors to 80,000 refugees within 10 days, the Kenyan government said. Prime Minister Raila Odinga agreed to the opening to the new camp, after visiting Dadaab’s three existing camps where an estimated 380,000 refugees are now living at facilities intended to cope with a population of 90,000 people.

A spokesman for the charity Save the Children, said “more children have died in Dadaab in the first four months of the year than all of last year”. Many Somali refugees at the camp have travelled through harsh conditions with little food or water, and no humanitarian assistance, often abandoning members of their family who have died or are so weak to travel. Al Jazeera’s Azad Essa, who reported from the Dabaab camp, said, “Over the past month, around 20,000 have made their way to Dadaab, many of them through similar means”.

Dadaab’s existing camps were set up in 1991 to host refugees fleeing war in Somalia. Between 40,000 and 60,000 are thought to be living outside the boundaries of the complex – existing as refugees beyond the current scope and control of the UN. Somalis have been fleeing from war for years now, but the drought, affecting 12 million people across the Horn of Africa, has brought the threat of a new humanitarian catastrophe to the region, with many people also seeking refuge in Ethiopia. Al Jazeera has more on the refugee crisis in the Horn of Africa here.

The U.N. Office for the Coordination of Humanitarian Affairs  (OCHA) has provided a ‘snapshot’ of the humanitarian crisis in the Horn of Africa country:
* 2.85 million Somalis require urgent aid – that’s one in three people
* At least one in three children are malnourished in parts of southern Somalia
* More than 460 Somali children have died in nutrition centres in Somalia between January and May this year
* Malnutrition rates among new arrivals in refugee camps in Ethiopia and Kenya range between 30 and 40 percent
* As of late June, 60,200 Somalis were registered in Kenya this year — a more than 100 percent increase compared with the same period last year
* Life expectancy is 50.4 years, according to the U.N. Development Programme (UNDP)
* Women dying in childbirth: 1,000 per 100,000 live births reported, according to UNICEF
* One in 10 Somali children dies before their first birthday
* Primary school enrolment rate is 23 percent
* Average HIV prevalence level estimated at 0.5 percent of the population aged 15 to 49
* Percentage of people with access to safe, clean water: 29 percent

(Sources: OCHA, UNICEF, UNDP)

It is not just Somalis who are suffering, Euronews has reported. Famine is affecting all countries in the Horn of Africa. Now 11 million people need help to survive the food shortages. In Habaswein in the far north of Kenya there has been no rain for a year. Many animals have died. Others have been taken further north in search of water. Only women, children and the elderly remain in the village.

Like many others, Fatuma Ahmed depends on rations of maize, beans and oil provided by aid agencies and the government. She said: “I have no husband. I’m raising my children alone. We had some animals but they’ve all died. Now we’re depending on aid from charities. What I’m cooking now is the only meal my family will eat today.” In the village of Fini, farmers try to move a dying cow into the shade. The animal will only last a few days. This is not the first time this area has been hit by drought, but according to villagers like Mori Omar, it has never been this bad.

“I’ve never experienced anything like this. I’m 56 years old, but I look more like 80 because of many years of not having enough food. During the droughts, there’s no meat or milk,” she said. There is a growing consensus that climate change is to blame for the driest period in 60 years. The UN says droughts are becoming more frequent – before they used to be every five or 10 years, now it is every two.

IRIN News has a report, ‘Somalis living from drought to drought’, on the perilous state of food availability in Bisle, the Somali region. Every day, 500g of boiled wheat is divided up between two adults, four children, a calf, a goat and a donkey in the Farah household. It is the only food they have had after rains failed for the past two seasons. The 15kg sack of wheat is provided to about 1,200 people in the Bisle area, which has four settlements, under the government-run Productive Safety Net Programme (PSNP) as payment for work, such as digging water holes.

“It is boiled wheat for breakfast and for the main meal – we don’t have anything else – no milk, no meat, no vegetables, no oil,” says Maria Farah, the mother. Not surprisingly, two of her children are severely malnourished. The calf and goat that share their “ari” – a collapsible egg-shaped hut made of sticks and covered with sheeting – are emaciated. It is too hot for them outside, in temperatures that soar beyond 40 degrees Celsius. There is no water in their settlement, about 54km north of Dire Dawa town in the Somali region, one of the worst hit by drought in Ethiopia. More than a million people have been affected.

Universal health coverage in India, economic growth, and social justice

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The Lancet, 08-14 January 2011 issue, India health coverageThe Lancet has published, in its 08-14 January 2011 issue, a series of papers on India’s path to full health coverage. Taken together, the papers and comments show that a failing health system is perhaps India’s greatest predicament. The papers (pay only, the comments are free to read) reveal the full extent of opportunities and difficulties in Indian healthcare, by examining infectious and chronic diseases, availability of treatments and doctors, and the infrastructure to bring about universal health care by 2020. This Lancet issue with the India health coverage special brings together a rapidly growing body of evidence to show that Indian health is in grave crisis. As the country with the largest democracy in the world, India is well positioned to put health high on the political agenda.

Introduction to the Lancet Series – Indian health: the path from crisis to progress – Can India’s vibrant political process and civil society create the public demand for health reform? Do Indian health institutions — the Ministry of Health and Family Welfare and the health professions, for example — have the capacity to lead reform? In India, community identity rivals individual identity in importance. How do community identities shape attitudes and policies towards health? – Richard Horton, Pam Das (The Lancet)

The Lancet, 08-14 January 2011 issue, India health coverageUniversal health care in India: the time is right – India’s record in expanding social opportunities has been uneven. The health and nutritional status of children and women remains poor, and India is routinely ranked among countries performing weakly on overall health performance. But there is good reason for hope. The country has withstood the recent global financial crisis and quickly returned to rapid economic growth. There is a refreshing openness to participation by civil society and to the power of ideas to improve performance and governance. We are enthused by India’s recent commitments to invigorate the public health-care system to address health disparities. – Vikram Patel, A K Shiva Kumar, Vinod K Paul, Krishna D Rao, K Srinath Reddy (London School of Hygiene and Tropical Medicine, London, UK and Sangath Centre, Goa, India; UNICEF India; All India Institute of Medical Sciences; Public Health Foundation of India)

Securing the right to health for all in India – The health status of people transcends the health-care sector, and the social determinants of health, such as food, water, sewerage, and shelter, still elude large numbers of the poorest citizens in India. Inequity in social determinants of health and health care in a market-based system itself becomes a pathogenic factor that drives the engine of deprivation. These inequities are set to increase even further in the near future even as major investments are being projected and planned in the health sector from 0·9% to 3·0% of the gross domestic product. The stunted public health system is hardly geared up to absorb this increased allocation; already state governments are returning allocated money because of the inability to absorb increased allocations. – Binayak Sen (Christian Medical College, Tamil Nadu, India) (The Lancet writes: “One notable absentee from the launch of the Series on Jan 11, 2011 is paediatrician and Comment author Binayak Sen. He remains in prison, an appalling situation discussed in an Editorial in the Jan 8-14 issue of The Lancet.”)

Gender equity and universal health coverage in India – The findings presented on health-care coverage in India emphasise that maternal health concerns, such as fertility and maternal mortality, continue to affect large numbers of women and girls in India. Although these concerns are diminishing, present trends indicate that India is not on target to reach national and Millennium Development Goals. Too many Indian women and girls are unnecessarily affected by gender-based violence and inequities in health-care access and use. – Anita Raj (Department of Social and Behavioral Sciences, Boston University School of Public Health)

The Lancet, 08-14 January 2011 issue, India health coverageIndia: access to affordable drugs and the right to health – Competition from generic companies is the key to affordable drugs. Generic companies in India can therefore produce drugs at prices that are among the lowest in the world. This cost advantage means more than 89% of the adult antiretroviral drugs purchased for donor-funded programmes in the developing world are supplied by companies in India. The European Union and India free-trade agreement seeks to introduce TRIPS-plus and other measures, such as patent term-extensions, data exclusivity, increased border and enforcement measures, and investment protection agreements, all of which would impede generic competition. – Anand Grover, Brian Citro (Lawyers Collective HIV/AIDS Unit, Mumbai)

Good governance in health care: the Karnataka experience – The health sector, with high public interaction and large societal impact affecting almost the entire population, was the second most corrupt sector in India. Bribes related to health care comprised the highest portion of all bribes paid in the state of Karnataka in 2008, at 40%. More than 150,000 estimated households below the poverty line paid bribes for seeking basic health care in 2005 in the state. In 2008, 64% of all bribes paid in the state for basic services was by people living below the poverty line and amounted to INR650 million. – Hanumappa Sudarshan, N S Prashanth (Karuna Trust, Karnataka, India; Institute of Public Health, Bangalore, Karnataka, India)

Research to achieve health care for all in India – Many of the leading causes of disease burden across communicable diseases, non-communicable diseases, and injuries continue to be under-represented in this published research output, indicating that even among the limited papers on public health research, a large proportion do not address public health priority conditions in India. Distinct from published papers, an analysis of public health research reports produced in India also showed that the leading chronic non-communicable diseases and injuries were under-represented between 2001 and 2008. – Lalit Dandona, V M Katoch, Rakhi Dandona (Public Health Foundation of India, New Delhi, India; Institute for Health Metrics and Evaluation, University of Washington; Department of Health Research and Indian Council of Medical Research, Ministry of Health and Family Welfare, Government of India)

The Lancet, 08-14 January 2011 issue, India health coverageUniversal health care in India: missing core determinants – India’s growing economic strength is based on an economic model that has enhanced the very disparities that the call is concerned about. Promotion of medical tourism at the cost of universal primary health care has not been accidental, but the result of a policy that places the market above people’s basic needs. All health-care reforms have to respond to this political dichotomy in the economy of health. Any health-care reforms, including the national health bill and integrated national health system suggested, have to be placed within a national effort to provide food, water, shelter, sanitation, education, and other basic needs. – Ravi Narayan (Centre for Public Health and Equity, Society for Community Health, Awareness, Research and Action, Bangalore, India)

Towards a truly universal Indian health system – The current framework of economic growth is not designed to address the concerns of very large sections of the population, for whom it has directly perpetuated the situation of ill health and inadequate health care. This position is not one of mere semantics, since any sustainable recommendation needs to be set in an honest and robust analysis of the causes of ill health in India. Little mention is made of the severe, persistent, and near ubiquitous poverty that has characterised this era of so-called economic growth, in which 77% of Indians live on less than INR20 a day. – Amit Sengupta, Vandana Prasad (People’s Health Movement-India [Jan Swasthya Abhiyan], Uttar Pradesh, India)

Please see this page on the Lancet series for longer summaries of the comments.

Deadly floods, torrential rain hammer Pakistan

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Children sit among the rubble of their house in Khyber-Pakhtunkhwa

Children sit among the rubble of their house in Khyber-Pakhtunkhwa Province. REUTERS/Fayaz Aziz

Torrential rain and floods in usually dry regions of South Asia are continuing to kill hundreds, maroon thousands and destroy the homes and livelihoods of many hundreds of thousands. The situation in northern Pakistan and adjoining Afghanistan is very serious.

The UN News wire has reported that with monsoon rains expected to continue pummeling Pakistan for several more weeks, the United Nations warned today that the country’s south could also be affected by deadly flooding, which has already affected millions of people. Martin Mogwanja, UN Humanitarian Coordinator for Pakistan, told reporters that the devastation wrought by the current flooding is on par with that caused by the earthquake that struck the country in 2005.

Damage Overview of Flood-Affected Towns In Nowshera District, Khyber Pakhtunkhwa, Pakistan. This map presents the preliminary findings of a damage assessment over sixteen flood-affected towns and cities along the Kabul and Kalpani Rivers including the main city of Nowshera, Nowshera District, Khyber Pakhtunkhwa, Pakistan. UNOSAT

Damage Overview of Flood-Affected Towns In Nowshera District, Khyber Pakhtunkhwa, Pakistan. This map presents the preliminary findings of a damage assessment over sixteen flood-affected towns and cities along the Kabul and Kalpani Rivers including the main city of Nowshera, Nowshera District, Khyber Pakhtunkhwa, Pakistan. UNOSAT

He said that the floods – the worst in Pakistan in living memory – have affected 4 million people so far, with at least 1.5 million people having lost their homes. Mr. Mogwanja said that 1,400 people have been killed so far, “but this number may rise as new bodies may be found.” The monsoon season, he pointed out, could last up to four more weeks, with the possibility that the flooding – currently concentrated in northern Pakistan – could move south towards the Indian Ocean, affecting millions more people. Already, the central areas of Sindh province in the south have felt the effects of flooding.

The search-and-rescue and evacuation phase has come to an end, with many people having been moved to safer areas by helicopters and boats. UN agencies have been rushing relief to the area since the early days of the disaster. The World Food Programme (WFP) has provided 500 metric tons of food, while the UN Children’s Fund (UNICEF) has distributed enough clean drinking water for 700,000 people. The UN High Commissioner for Refugees (UNHCR) has supplied 11,000 tents and the UN World Health Organization (WHO) has distributed dozens of cholera kits for health centres.

The Hindu of India has reported that the death toll in the Leh cloudburst has climbed to 130, with 600 more people feared washed away in the calamity that was followed by torrential rains and flash floods devastating this Himalayan town in the Ladakh region. Sources in Ladakh, of which Leh is the district headquarters, fear that the death toll could cross over 500 as several far flung villages were yet to be accessed by rescue teams in this high-altitude terrain. Ladakh is a high mountainous region in northern India, in the western Himalaya. A small village before Choglumsur, which bore the brunt of the incessant rains, was completely wiped out as rescue workers were looking for survivors in the mud slush and debris. Over 200 people were still reported to be missing from the village.

Updated Overview of Flood Waters in Punjab Province, Pakistan. This map presents the standing flood waters over the affected Provinces of Punjab, Pakistan following recent heavy monsoon rains. UNOSAT

Updated Overview of Flood Waters in Punjab Province, Pakistan. This map presents the standing flood waters over the affected Provinces of Punjab, Pakistan following recent heavy monsoon rains. UNOSAT

The United Nations health agency said today that it has begun sending medical supplies to aid thousands of people affected by recent flooding across Afghanistan, where the major health concerns right now are water contamination and the spread of waterborne diseases. The Afghan government estimates that the floods have left several thousand individuals homeless in northeast Kapisa, central Ghazni, Laghman, Nangarhar, Kunar, Logar, Khost and northern Parwan provinces, where at least 2,500 houses have been destroyed. An estimated 80 people have reportedly died in the floods, and much of the arable land, where crops were planted, has been inundated.

Pakistan’s Express Tribune reported that news coming in from many parts of Khyber-Pakhtunkhwa, especially Swat because of its mountainous terrain, describes people displaced by the floods being desperately short of food, medicines, drinking water and other supplies essential to their survival. There is talk of starvation with no food available and international relief agencies are also warning of outbreak of diseases in the relief camps-mainly because clean drinking water and sanitation facilities are in short supply. In other parts of the flood-stricken region there are accounts of disease breaking out. Things could become worse in the coming days if the relief effort is not quickly streamlined. In Swat, many of those hit have already withstood many months of conflict. This Reuters AlertNet news feature describes the situation.

Russia wildfiresThe unfolding tragedy in Pakistan and Afghanistan comes alongside extreme weather events in Moldova, China and Russia. In Moldova, authorities have been evacuating people and goods from the flood-hit zones and to carry out prevention works. Xinhua News reported that in China, more than 4 million people have been affected since the flood season began in June and some 700,000 people have been evacuated. Additionally, about 62,000 houses have collapsed and 193,000 others have been damaged, along with 1.2 million hectares of cropland having been inundated. In the hardest-hit areas, flash floods have cut roads, isolated villages, and disrupted communications and water supplies. In the industrial city of Tonghua, torrential rains have damaged water pipelines, leaving 300,000 people without tap water for two days. The Voice of Russia has reported that wildfires are still burning in a number of Russian regions, including Moscow, Nizhny Novgorod, Voronezh and Ryazan. Hundreds of homes have been destroyed, and the air is thick for smog. Dozens of people have been killed by fires.

[The maps from which these images have been posted are from UNOSAT, the UN Institute for Training and Research (UNITAR) Operational Satellite Applications Programme, implemented in co-operation with the European Organization for Nuclear Research (CERN).]

The global water trade, by ship from Alaska to India

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Niger-Men draw water

Niger: Men draw water from a deep well in Zinder. They must make tough decisions as to how to divide the scarce resource between cattle, people and crops. Photo: Anne Isabelle Leclercq/IRIN

The ecological crimes committed in the name of trade and for the benefit of the ‘market’ grow in outrageousness. The latest example of utter irresponsibility, both regulatory and environmental, comes from a company headquartered in the state of Texas, USA, which plans to ship water from Alaska, USA, all the way across the Pacific Ocean, to India, where it plans to set up what it calls its ‘global water hub’.

The alert came on the Triple Pundit site, which quickly explained that the Texan company, S2C Global Systems, plans to ship 11.35 billion litres of water every year from the Blue Lake Reservoir in Sitka, Alaska to the west coast of India and other Asian countries. From there, S2C Global Systems plans to sell the water via “smaller ships that can deliver to shallower ports, like Umm Qasr in Iraq”. Do you smell the hand of US defence contractors like Halliburton here? S2C said the project is expected to begin moving water within six to eight months.

There are a number of obvious questions here. How has a Texan company gained conttrol of an entire lake in Alaska, which is a common property resource? How have the communities and settlements there in Alaska permitted this, or have they? How can US environmental regulation – the EPA for example – permit such commercial exploitation? Who is funding this obscene project – India may be a way-station for S2C now, but the company categorically says India is going to be an important market for its water. But at what cost to Alaska and to India?

S2C says it will sell the water in “20-foot containers with flexi-tanks suitable for pharmaceutical/high tech manufacturing and packaged water (18.9 and 10L) for the consumer markets anywhere containers are delivered in south and west Asia from India.” In a statement dated 07 July 2010, the company said that for “security reasons” the Indian port which is to serve as its “world water hub” will not be disclosed. It will “include a berth for a Suezmax vessel (156,000 cubic meters/41Million USG), an offloading system to a dedicated tank farm and a distribution complex for packaged water. Within 18 months after that we will be able to switch to a very large class vessel (302,833 cubic meters/80 Million USG), as both the ship and the berth for her will be completed within this time frame. Contracts for the distribution hub and ships are being finalised.”

Nepal-children fetch water

Nepal: In some places, children have to walk more than five hours to fetch water. Photo: Naresh Newar/IRIN

The company says: “India itself provides a particularly significant growth market for the packaged waters with a current population of 1.15 billion people, an emerging middle class and an increasing clean water shortage. Sales efforts throughout south and west Asia will continue with travels planned immediately through the region.”

Rod Bartlett, managing partner of Alaska Resource Management and President of S2C Global Systems, USA, is quoted in the statement as saying: “S2C Global has an exciting future in India and the region. After recently spending time in India meeting port authorities and potential distributors, our vision to distribute water globally became real. We fully expect the India World Water Hub to fulfill our minimum expectations of a half a billion gallons sold annually”.

Export Development Canada (EDC), Canada’s export credit agency, announced in March 2010 up to US$10 million in equity commitments to XPV Water Fund Limited Partnership, a venture capital fund focused on investing in the water sector. The press release described the water sector as an “area of significant growth potential for Canada”.

I can’t imagine this profiteering being part of a ‘growth’ strategy that the average Canadian would subscribe to. Meanwhile, what are conditions in countries which companies like S2C say are its world water market?

In India, figures from the Ministry of Rural Development show that the country had enough drinking water for its people in 1951 at 5,177 cubic metres per person per year. But by 2000 India had become a water-deficient country. In 2003, the country had a 25 per cent deficit, at a rate of 1,500 cubic metres per person per year. The deficit is projected to rise to 33 per cent by 2025, unless measures are taken to resolve it.

In Liberia, three out of four Liberians have no access to safe drinking water and six out of seven cannot access sanitation facilities, such as toilets, according to Oxfam. A further US$93.5 million is needed to boost clean water access to 50 percent of all Liberians; and to improve access to toilets to 33 percent – goals set out in the government’s 2008-2011 poverty reduction strategy.

Children draw water in Chad

Chad: Chadians receive US$3 in water aid per capita annually. Photo: WaterAid

In Iraq, there is an acute shortage of water nationwide and a collapsed economy, which makes it very difficult for farmers to do other work. Tribal sheikh Ali Ismael al-Zubaidi from Diwaniya Governorate, about 200 km south of Baghdad, said in an IRIN report he had been having “tough negotiations” over water allocations with another tribe that lives upstream from his. “We have daily problems with water. They are siphoning water with huge electric water pumps and leave only drops for us. Government officials can’t control the regulation of irrigation and stop those who violate their regulations either because of corruption or because they fear for their lives. So we have to solve this issue ourselves.”

In Nepal, according to government statistics, more than 4.4 million people do not have regular access to safe drinking water in rural and urban areas, be it via piped water, wells, rainwater or bottled water. Public health concerns are increasing as a result. Already, more than 10,500 children die before their fifth birthday from diarrhoea, mainly due to inadequate access to safe drinking water, sanitation and hygiene, according to WaterAid. More than 80 percent of diseases are the result of unsafe drinking water and poor sanitation, according to its 2009 report, ‘End Water Poverty in Nepal’.

In 2000 the world pledged that half the 2.6 billion people without safe drinking water and basic sanitation would have access to these basic facilities by 2015, but poor countries will need US$18.4 billion more a year to reach this Millennium Development Goal (MDG), which at this rate will only be met in 2200. In 1997, 8% of overall development aid went to water and sanitation; in 2008 this dropped to just 5%-less than commitments for health, education, transport, energy and agriculture, according to the Global Annual Assessment of Sanitation and Drinking Water (GLAAS) report by the UN Children’s Fund (UNICEF) and the World Health Organization (WHO). Moreover, the bulk of this global aid went to middle-income countries, with low-income countries receiving just 42%, said WaterAid, an international NGO working to provide access to clean water, sanitation and health education.

A global week’s food

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One week of food for the Aboubakar family in Chad (Menzel and D'Aluisio, 2005)

One week of food for the Aboubakar family in Chad (Menzel and D'Aluisio, 2005)

How much food does your family need in a week? That depends on where you are (Ecuador or Mexico, Bhutan or Egypt, Chad or Germany) and what you can afford. These pictures below are a remarkable sociological inquiry into what the global food price crisis can mean for families around the world. They can be found in the presentation by Ricardo Uauy (Institute of Nutrition, University of Chile) who draws on the world-spanning work of Menzel and D’Aluisio in 2005.

His presentation can be found in the very timely book, Mitigating the Nutritional Impacts of the Global Food Price Crisis, by Elizabeth Haytmanek and Katherine McClure (Institute of Medicine), which can be read as a pdf from the National Academies Press.

One week of food for the Namgay family in Bhutan (Menzel and D'Aluisio, 2005)

One week of food for the Namgay family in Bhutan (Menzel and D'Aluisio, 2005)

What does this series of pictures tell us? In situations such as Egypt and Ecuador, if it is necessary to make do with a reduced income, it is possible to decrease food quantity without necessarily sacrificing the food quality. Ironically, a reduced income might cause the family to cut out the unnecessary processed foods and soft drinks, which would improve this family’s nutritional status.

A family in Chad spends only US$1 on food each week. The essence of their meagre diet is cereals and some legumes, and almost exclusively features plant foods. A family in Bhutan can only afford US$5 per week for its food. There is less food overall, and it is basically plant foods, including fresh fruits and vegetables. There are less animal foods, as grains figure prominently.

One week of food for the Ayme family in Ecuador (Menzel and D'Aluisio, 2005)

One week of food for the Ayme family in Ecuador (Menzel and D'Aluisio, 2005)

In Quito, Ecuador, however, families spend about US$32 on food, and sacks of cereals, wheat, and some legumes are featured prominently. Less fruits and vegetables are seen as compared to the previous families’ diets. In this scenario where there is less variety, if some foods are eliminated from the picture, the family’s consumption will suffer in nutritional quality. In Cairo, a family spends US$69 dollars per week on food. This amount of weekly expenditure in Egypt still enables a fairly varied diet, with fruits and vegetables seen as prominent in their mix.

In Cuernavaca, Mexico, families spend about US$189 per week. Here fruits and vegetables are abundant, although processed foods and sweetened beverages figure prominently. In Germany, families spend about US$500 per week to feed a family of four. There is much variety, including a great deal of processed foods, although fresh fruits and vegetables are also prominent in the household.

One week of food for the Ahmed family in Egypt (Menzel and D'Aluisio, 2005)

One week of food for the Ahmed family in Egypt (Menzel and D'Aluisio, 2005)

These pictures demonstrate what foods people buy with the amount of money they have to spend on food each week. While these photos convey the present status of these populations, they suggest what people might stop buying if they had less money, during a food crisis, for example.

In crisis situations, families preserve diets based on less expensive foods. If their income is sharply reduced, families do away with animal foods and nonstaple foods. They eat less meat, less dairy, less processed foods, less vegetables, and less fruits; they are predominately dependent on cereals, fats, and oils. They find ways to get adequate energy at a very low price, but may forego appropriately nutritious foods, which results in poor quality diets that are inadequate in terms of micronutrients.

One week of food for the Casales family in Mexico (Menzel and D'Aluisio, 2005)

One week of food for the Casales family in Mexico (Menzel and D'Aluisio, 2005)

Peter Menzel and Faith D’Aluisio’s book is an around-the-world exploration of average daily life in 24 countries, focusing on food. Hungry Planet: What the World Eats, details each family’s weekly food purchases and average daily life. The centerpiece of each chapter is a portrait of the entire family surrounded by a week’s worth of groceries accompanied by interviews and detailed grocery lists.

What about South Asia? In Mitigating the Nutritional Impacts of the Global Food Price Crisis, Josephine Iziku Ippe, Nutrition Manager with Unicef (United Nation’s Children’s Fund) in Bangladesh, explained that issues affecting prices at the regional level include trade barriers, especially with India, and export bans.

One week of food for the Melander family in Germany (Menzel and D'Aluisio, 2005)

One week of food for the Melander family in Germany (Menzel and D'Aluisio, 2005)

The large flood of 2007 also affected food prices. Despite this, in 2007, the percentage of food grain imports dramatically increased and reached 6% of total imports compared to 3% in previous years. The food price shock clearly worsened the food security situation in 2008 with 40% of households in Bangladesh reporting that they were greatly affected.

Due to the higher food prices, a majority of households in Bangladesh lost purchasing power. In 2008, the real monthly income per household decreased by 12% when compared to 2005 incomes. Real wage rates remained stable while the terms of trade (daily wage/rice price) further decreased in 2008. Moreover, expenditures (particularly for food) increased to an unprecedented level of 62%. of the total expenditures for households. Overall, about one in four households nationwide was affected.