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Journal of Tropical Pediatrics 1988 34(5):218-224; doi:10.1093/tropej/34.5.218
© 1988 by Oxford University Press
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The Association Between Inadequate Rations, Undernutrition Prevalence, and Mortality in Refugee Camps: Case Studies of Refugee Populations in Eastern Thailand, 1979–1980, and Eastern Sudan, 1984–1985

Michael J. Toole, MF, DTM&H*, Phillip Nieburg, MD, MPH** and Ronald J. Waldman, MD, MPH*

* International Health Program Office
** Division of Nutrition, Center for Health Promotion and Education, Centers for Disease Control

A review was conducted of nutrition and mortality data collected among Tigrayan refugees in Eastern Sudan (1984–85) and Cambodian refugees in Thailand (1979–80), two populations of comparable size. The Cambodian refugee population snowed a rapid decline in mortality rates during the acute phase of the emergency—from 10/1000 per month to less than 1/ 1000 per month within 1 month. These changes were associated with rapid improvement in nutritional status and the provision of adequate rations soon after the arrival of the refugees in Thailand. By contrast, mortality rates in the Tigrayan refugee population in late 1984 and 1985 were unusually high (14–24/1000 per month) and prolonged. The high mortality was associated with persistently high prevalence rates of undernutrition (14–50 per cent) among children less than 5 years of age. Inadequate amounts of food (1360–1870 kcal per person per day) were distributed to this population during the first 5 months after their arrival; in addition, a severe measles outbreak in the camps added to the high mortality. The reported high undernutrition prevalence in the Tigrayan refugee camps persisted despite supplementary feeding programmes, for which enrollment and attendance rates among identified undernourished children were low. The close association of mortality with undernutrition leads us to conclude that refugee relief programmes should give highest priority to ensuring that adequate rations are distributed. This requires better anticipation of, and more timely response to, refugee movements by international relief agencies.


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