May 2010 Edited Version ACF PAKISTAN DIR & SWAT – NWFP RAPID ASSESSMENT REPORT FOOD SECURITY & LIVELIHOODS WATER, SANITATION & HYGIENE NUTRITION MARCH 2010 EXECUTIVE SUMMARY Kabal and Khwazakhela in Swat) and in IDP settlements (Munda and Samarbagh in Lower Dir). These are linked to broad asset depletion at the time of the conflict and poor to minimal recovery to‐date, depending on the BACKGROUND area. Markets have substantially recovered, with pre‐ crisis trade flows of major commodities restored and From mid‐2008, in response to the militancy surge in systems of credit and procurement largely intact. its north‐western region, the Government of Pakistan Market activity remains dampened however by low scaled up its security forces offensive across the demand from buyers (who are still constrained by Federally Administered Tribal Area (FATA) and in income) and lack of cash for reinvestment in Malakand Division of North West Frontier Province businesses, in particular among small rural traders. In (NWFP). The insecurity triggered by the conflict led to addition 78% of food commodity dealers report being the largest population movement recorded in the affected by ongoing free food distributions. Market country since the partition of India in 1947 with over activity overall is fuelling recovery by supporting 2.7 million civilians from NWFP and FATA officially employment and the movement of food commodities, displaced at the height of the conflict. cash crop and labour into and out of the area. The rapid market assessment was conducted in winter This rapid assessment sought to evaluate Nutrition, when activity generally slows. It is likely that the arrival Water, Sanitation & Hygiene (WaSH) and Food‐ of summer and the harvest of the Rabi winter wheat Security & Livelihoods (FSL) needs across key conflict‐ crop will provide fresh cash infusion into the local affected areas of three adjoining districts of Malakand economy and reinvigorate systems. Division – Swat, Lower Dir and Upper Dir – nearly one year after the end of security forces operations in the Until then, livelihoods recovery is likely to be poor zone. unless significant support continues to be extended by humanitarian actors. Findings suggest that the The areas assessed were either directly affected by restoration of lost, looted or liquidated livelihoods operations, served as transit and host areas in 2009 or assets has been slow, with 18% of lost assets are currently serving as transit and host areas for recovered to‐date. The most rapid recovery is Bajauri IDPs in the wake of ongoing security forces observed in the return areas of Matta, Kabal and operations in FATA. Khwazakhela (Swat) with 22‐26% of lost holdings recovered. Recovery has failed in the return area of Maidan (L Dir) with just 3% of lost assets recovered to‐ METHODOLOGY date. Losses of assets in Maidan were roughly double those suffered in other assessed regions. The delayed 91 villages and settlements across 19 Union Councils in recovery is attributed to an acute depletion in Swat, Dir Lower and Dir Upper were assessed from 1st th household income sources combined with the relative to 14 February 2010. Seventeen enumerators isolation, poverty and continuing insecurity of some organized into sector‐specific teams carried out field areas. Female livelihoods in tailoring and data collection, led by team leaders and sectoral processing/sale of animal products have also been lost, managers. with 71% of communities now lacking opportunities for female livelihoods compared to 36% pre‐crisis. A mix of primary and secondary information sources Income portfolios have become more diverse out of and methods was used. Secondary sources included necessity, with remittances, various forms of income meetings at Province/District/UC and community level support (zakat, aid) and asset sales figuring with PaRRSA, DCO/ACO, EDOs, UN Agencies, ICRC and prominently. An estimated 35% of households rely on local and international NGOs. Primary sources and remittances, either national or foreign. Most of the methods included Key Informant Interviews, Focus new credit being sourced today by households is used Group Discussions (FGD), Household Interviews, to cover food and health‐related needs rather than Observation, Water Quality testing, MUAC screening asset restoration. and rapid Market Assessment. The bulk of sampling methods were non‐random as significant constraints Local social networks and food distributions have to primary data collection were faced on the field. supported the food security of the most vulnerable populations in recent months with gifts, sharing and FINDINGS borrowing of food contributing 32% of all sourced food. While overall dietary diversity was found to be Food security and livelihoods (FSL): Overall significant adequate, a small minority of the population (12%) livelihoods‐related needs were observed across return areas (Lal Quilal and Adenzai in Lower Dir; Matta, across IDP, returnee and stayee1 groups is especially magic and poor awareness of and access to existing vulnerable to food insecurity by their reliance on therapeutic nutrition programs. precarious food sources and unsustainable and damaging coping strategies. Knowledge and attitudes of medical and paramedical staff generally were found lacking in nutrition. Gaps Overall the analysis of findings reveals IDPs and were observed with regard to staff knowledge on returnees to be the most highly vulnerable groups. breastfeeding practice, maternal nutrition and proper Outstanding gaps and needs in FSL include: 1/ identification and referral of malnutrition cases. Cost restoration of farm and off‐farm livelihoods and food of injectable medications in therapeutic nutrition security of vulnerable stayee and returnee households, programs in Swat and Lower Dir is serving as a 2/ recovery of female livelihoods, 3/ enhancement of deterrent to treatment and a reason for default among income generating activities among IDP households, 4/ poor households. rehabilitation of vital community infrastructure, and 5/ revitalization of small businesses. Outstanding gaps in Nutrition concern 1/ the capacity of District‐level therapeutic nutrition programs to WASH: Water, sanitation and hygiene related needs provide adequate treatment according to accepted were identified, and these were generally greatest in standards, 2/ the capacity of local medical and rural areas of Lower Dir. The major problem was paramedical staff to support communities, pass health recognised as a lack of dry season water with 41% of and nutrition messages and refer cases, and 3/ the water sources providing insufficient yields during that knowledge base at community level. period. There were also some water quality issues, but bacteriological contamination was usually in the low or Rapid MUAC screening among surveyed host and medium range despite 53% of water points being displaced populations in Lower Dir show malnutrition unprotected. prevalence currently below emergency threshold (0.4% SAM and 3.2% GAM). Open defecation was widely practiced and 38% of visited communities had very low latrine coverage. Most vulnerable zones: Lower Dir district and Hand washing was widely practiced, but only 14% of specifically the areas affected by conflict in 2009 people washed their hands with soap after defecation. (Maidan, Adenzai) and those currently serving as host Latrine facilities were also limited in schools and health and transit areas to Bajauri IDPs (Samarbagh, Munda) structures with 16% of visited schools %and 25 of have the greatest needs, are experiencing the slowest visited Basic Health Units having non‐functioning or recovery and tend to be most underserved among the non‐existent latrines. assessed zones. Although a high incidence of scabies was noted, emergency WASH needs were not observed during the assessment. However at the time of the assessment the emergency needs were considered dormant as key informants described them as being likely to recur. During the previous year there had been seasonal cholera outbreaks and water scarcity as well as major IDP influxes. Nutrition: Community knowledge and practices around infant feeding are suboptimal on breastfeeding, use of breast milk supplements and introduction of complementary foods. Knowledge of nutrition, especially the nutritional needs of infants, young children and pregnant and lactating women, is low. Cultural practices around meal order and food restrictions will tend to exacerbate the nutritional vulnerability of these groups. The high levels of psychosocial stress reported among displaced and stayee populations is likely to further negatively affect maternal milk production and breastfeeding practice. There is a widespread belief in malnutrition as black 1 Stayee: population left “stranded” within the areas of conflict iii RECOMMENDATIONS The WASH recommendations involve a dual approach to address the ongoing and the emergency needs of The findings in FSL suggest an approach the area. It is recommended to rehabilitate and addressing the need for broad economic improve small scale rural water projects, to mobilise recovery in the affected areas coupled with communities to implement household latrines and to the provision of targeted support to very improve both water and sanitation facilities in vulnerable populations. Recommended institutional structures. All this should be underpinned activities involve cash‐based support for asset with hygiene promotion. Emergency needs should be restoration including restocking as