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15 May 2000

Don’t let them eat cake

Kosovar refugees were suffering from obesity, not malnutrition, writesSusanne Jaspars

By Susanne Jaspars

This time last year, I was cooking spaghetti for 300 new arrivals at a camp for Kosovar refugees in Albania. The camp itself, on the Adriatic coast, was like any overcrowded European campsite: rows of tents, car parks, vendors’ stalls and ice-cream vans. I looked at the people I was about to feed, and saw groups of plump-cheeked children, heavy men and heavier women. They did not look like the refugees I was used to, the victims of African crises whose skeletal limbs and emaciated figures haunt television viewers the world over.

I worked as an emergency nutritionist, first in Albania and later in Macedonia. By July 1999, it became clear that the main nutritional problem among Kosovars was not under-nutrition, but obesity. This was confirmed by a nutritional survey in January 2000 in Kosovo which found that, while only 5.3 per cent of adult women were undernourished, 23.6 per cent were overweight and 10.4 per cent were obese. Among the elderly (both sexes), 32 per cent were overweight and 16 per cent obese.

Nor is obesity restricted to the Kosovars; a Bosnian doctor working in Sarajevo recently confirmed that obesity is a growing problem in Bosnia, too – and that it is more prevalent now than before the war.

Obesity is associated with hypertension, diabetes and heart disease. Although the condition has increased in all European countries in the past ten years, it is particularly affecting the peoples of the Balkans and eastern Europe. This is probably due to the high level of animal products in their traditional diet. Since the war – during which there seems to have been a temporary reduction in obesity – these countries have witnessed an upward trend in obesity.

The international community re-sponds to any disaster with food aid, and the Kosovo crisis was no exception. However, the quantity and types of food provided to some Kosovars while they were refugees was exceptional. The UN used the same procedures to work out food-aid needs as elsewhere, but numerous agencies decided to use private funds to purchase food. Meanwhile, many donor countries provided funding direct to non-governmental organisations (NGOs) to buy additional foods; and donations – ranging from Mars bars, Italian cakes, pains au chocolat, Turkish delight, as well as healthier alternatives such as milk, cheese, fresh fruit and vegetables – arrived in Nato planes.

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Not all refugees received these foods. Some refugees in Macedonia lived off bread, tinned fish and vegetables for months, and others received almost nothing (for example, refugees living with Albanian hosts). Some clearly inappropriate and potentially harmful foods found their way to the camps – infant formula and baby foods, for instance, were distributed there, despite the international codes against the promotion of such products.

As a nutritionist, my job was to ensure that potentially harmful foods were not distributed, and that there was a fair distribution of the rest of the food. Given the number of agencies involved in the operation, this proved an almost impossible task.

Nutritional surveys show no significant increase in the prevalence of undernutrition in Kosovars from December 1998 to January 2000. This could be interpreted as a successful relief operation; or, alternatively, that people had sufficient fat stores to deal with a period of shortage.

Two key questions emerge from the food response to the Kosovo crisis. First: why was such an emphasis placed on food aid? And second: how can we justify providing high-cost food items to Europeans who were not undernourished when, in most African crises, we cannot even provide undernourished populations with a basic survival ration?

Food aid forms part of the basic package of relief interventions to any population in an emergency situation. Handing out food to hungry people also provides good images for the media. The problem is, when the public is kept in the dark about the real needs of the refugees, as it was during the Kosovo crisis, well-meaning people end up sending often inappropriate gifts.

It is true that Kosovar refugees were cut off from their normal sources of food supply and needed food aid. Nutritionists usually recommend food rations that are culturally acceptable. This alone would have justified a different food ration for Kosovars than for Ethiopians. But did it justify chocolate and cake? The issue is one of equity and impartiality. As humanitarians, we claim to provide assistance on the basis of need. The aid community did not do this in 1999, when the need was clearly greater in places such as Somalia, Sudan and Angola.

It is difficult to be truly impartial in responding to emergencies. It is not surprising that western individuals feel greater compassion for victims of a crisis that is closer to home. Governments and NGOs, however, have a responsibility to respond according to need. As for the famine victims elsewhere, I am sure they heard about the response to the Kosovo crisis, and I hope that they will demand their Mars bars, Turkish delight and cake. I doubt they will get it.

The writer is an independent consultant nutritionist

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