Malnutrition and Mortality During Recent in : Implications for Food Aid and Rehabilitation

HELMUT KLOOS and BERNT LINDTJORN

The 1972—73 and 1984—85 famines varied significantly among different populations within areas at the regional, community and household levels. Political and social factors were crucial in this pattern. Evidence from both pastoral and farming areas indicates that the development of community-basedresources may be less disruptive sociall y and economically and result in less morbidity and mortality than dependence on relief shelters. Areas needing further study are identified.

Famine conditions are likel y to persist for strategies because social and economic many years in Ethiopia, despite the cur- activities, and psychological and physiolo- rent peace process and restructuring gical adaptation to poverty and crisis, have efforts. Mesfin Wolde Mariam (1984) iden- always been significant in reducing famine tified famine conditions in different awrajas risk in Ethiopia (Rivers, 1990; D'Souza, each year for the period 1958-1978 , and 1990). Analysis of the occurrence of mal- Kloos and Lindtjorn (1993) reported large nutrition and associated mortality in numbers of Ethiopians affected b y famine different ecological settings and relief for all subsequent years up to 1992. There shelters may contribute to an evaluation of is an urgent need for a better understand- the constraints experienced by communi- ing of the ecology of acute malnutrition, ties and relief organizations in providing particularl y the vulnerability to famine of an adequate food supply and viable pre- different populations and socioeconomic ventive measures. classes, as well as their coping strategies, Asmerom Kidane analyzed the results morbidity and mortality experience during of interviews in Metekel and Gambela times of disaster. The purpose of this resettlement schemes and concluded that paper is to contribute to the debate about the consequences of the 1984—85 famine differential drought and famine occurrence were general, affecting rural populations and nutritional impact during the 1973 - 74 in northern Ethiopia regardless of socio- famine, when an estimated 250,000 people economic status and place of residence died, and during the 1984-85 famine, (Asmerom Kidane, 1989). The perception when about 1,000,000 people died of an indiscriminately severe famine was (Asmerom Kidane, 1989). We review strengthened by the fact that mostly land- selected works on vulnerability and coping owning peasants were resettled during the DISASTERS VOLUME 18 NUMBER 2 © Basil Blackwell Ltd. 1994 , 108 Cowley Road, Oxford 0X4 1JF , UK and 238 Main Street, Cambridge, MA 02142, USA. government's resettlement programme. (Dewey, 1981). Other high-risk groups This, it was reasoned, was in sharp con- commonly identified by emergency relief trast to the resettlement programs in the programs include children, pregnant 1970s, when a few vulnerable groups, women, the old, the sick, the urban poor, mostly urban poor, landless peasants, and refugees. charcoal burners, and destitute pastoral The approach used by most emerg- nomads were resettled. Nation-wide mal- ency programs, namely to focus on the nutrition in 1984 — 85 was considered to be impact of famine rather than on its predis- largely the result of the supposedly equi- posing factors, has come increasingly table distribution of wealth after the 1975 under criticism in recent years as being less land reform. The persistence of many effective in the control of famine in the parameters of socioeconomic differentia- long term than community-based and tion after the revolution, as well as the equitable rural development programs. ecological and cultural diversity of Ethio- Examination of predisposing factors, or pia were not, however, considered, (Kloos vulnerability, and the coping behavior and Aynalem Adugna, 1989). The news developed by populations living in famine- media contributed to the view that starva- prone areas may identify still poorly tion was universal, not only during the known constraints and potential opportu- 1984—85 famine but also during the one in nities suitable for community-based pre- 1973 — 74, when the press first reported on vention and rehabilitation programs that an Ethiopian famine (McCann, 1987, pp. may be more effective and less disruptive 245-267; Alemneh Dejene, 1990, 73, 74). economically and socially than the hazar- But there is considerable evidence, dous journey to and stay in feeding both from Ethiopia and other developing centers. countries, that vulnerability to famine and malnutrition varies between and within FAMINE VULNERABILITY AND SURVIVAL different socioeconomic groups and geo- STRATEGIES graphical areas. Some investigators have argued that pastoral nomads are more The studies of McCann in northern vulnerable to famine and disease than and Wello administrative regions showed sedentary farmers due to their full depen- that famine risk varied significantly among dence on the natural environment for food households, primarily as a function of production (Meir, 1986; Holt et al., 1975), production capacity, particularly the while others consider them to enjoy a number of oxen owned. Other farmers at higher health status than farmers, at least risk were former tenants and less favored during less stressful periods. It is more offspring who cultivated more marginal commonly agreed, however, that there are land, and women alienated from land and wide variations in wealth among lineages property (McCann, 1987) . While endow- and households in pastoral societies ment and a higher social status provide a (Roboff , 1977; O'Leary, 1990). Nutritional certain degree of insulation from the advantages have been reported for many effects of the drought, there are other pastoralists who settled on commercial factors in famine vulnerability. They farms and characteristically maintained include pest infestation, soil exhaustion, some of their livestock (Bradbury, 1984; the ability of individual peasants to cope Meir and Ben-David, 1991; Kloos, 1982). with these crises and, after the revolution, Subsistence farmers turning to commercial the relations of individuals with their agriculture, by contrast, often suffered peasant associations and producer cooper- nutritionally from unbalanced diets atives, and the stepped-up civil war. Some

© Basil Black-well Ltd. 1994 DISASTERS VOLUME 18 NUMBER 2 of the survival strategies employed by disaster or could not be implemented, as many peasants included reduced food in the northern war zone. According to the consumption and dietary changes; the most extensive survey of foods needs consumption of famine foods, such as wild carried out in Ethiopia, conducted by plant products; the sale of household cadres of the EPLF in 1987, which covered goods, personal belongings, livestock and a quarter of all villages in Eritrea, military land; and temporary migration to towns activities and insecurity significantly and commercial farms to seek employ- increased famine risk through increased ment. If all failed, then farmers tended to social and economic isolation of both rural move to relief shelters, often sending their and urban communities. Specifically, wives and children first, the men staying sharp reductions in food production were behind in the hope of cultivating in the associated with lack of access to grazing event of rain. Many old and sick persons areas, fields, off-farm employment/ and were abandoned during these migrations markets (Cliffe, 1989), and many urban (Dessalegn Rahmato, 1991; Adhana Haile populations starved during military sieges Adhana, 1988; Wood, 1976; Mesfin Wolde and food blockages by the warring Mariam, 1985). The strategy of moving factions. spontaneously to better grazing areas in Social relations, marketing structures, nearby areas and adjacent administrative and agricultural activities were not regions, which involved thousands of pea- uniformly affected in northern Ethiopian sants from Wello, Tigray and in communities. Mesfin Wolde Mariam the 1960s and early 1970s, was no longer reported that one village in Raya Kobo, possible after the revolution, when the one of the most severely affected awrajas in registration requirements of the peasant Wello, did not experience food shortages associations prevented such movements. after 1972, despite its refusal to take relief Similar coping behavior was reported food , reportedly due to its strong social for several pastoralist groups, including organization and sense of economic self- the Mursi in the Omo Valley (Turton, sufficiency (Mesfin Wolde Mariam, 1984, 1977) and the Afar in the Awash Valley p. 188). In Ambassel Awraj a in 1985, 75 per (Kloos, 1982). But whereas the Mursi cent of the peasants had no harvest at all response to famine has been described as a and depended on food relief ; but 11 per success story (Turton, 1985), the Afar have cent had been able to obtain enough increasingly become marginalized econo- harvest and store food to last them for mically in the wake of the development of three months, 10 per cent had enough corporate farms (and later state farms) in food for six months; and 3 per cent for the their best grazing areas, new towns, roads, whole year. A similar situation existed in and Awash National Park, and the Kallu Awraja, and western Desse Zuria, encroachment by Isa Somali pastoralists Wore-Illu, and Borena awrajas , all of which and peasants from the Ethiopian High- experienced only minor production lands. Many Afar lost confidence in sub- shortfalls. sistence pastoralism after they had lost This pattern of famine distribution their livestock and many kinsmen to indicates that the woyna dega (middle famine in 1973 and 1974 and settled in and highlands) zone in the rain shadow of the around commercial irrigation farms high Wello Plateau was most severely hit (Rood, 1976; Voelkner, 1974). by the famine, similar to the situation in Most well-tried survival strategies 1973—74. But here, too, exceptions were used by farmers, pastoralists, and the reported. One lowland peasant association urban poor were not sufficient to avert near one of the few remaining perennial

DISASTERS VOLUME 18 NUMBER 2©Basil Blackwell Ltd - 1994 streams fared better than villages in the grain prices and lowered livestock prices in dega (highlands) above, which lacked 1972-74 prevailed again in 1984-85. Teff streams for irrigation (Dessalegn Rahmato, prices fluctuated between about 150 and 1991, pp. 141-142) . Interestingly, severe 300 Birr per quintal in most of Wello and effects of the 1973-74 famine were still felt Tigray in 1983 and between 150 and 400 in 1975 in the marginal areas at interme- Birr during the peak of the famine in 1984, diate elevations in Shewa, Arsi, Sidamo, compared to 42 to 85 Birr in the Lake Tana Gamo Gofa, and Bale, at a time when the Basin, where grain supplies were more rains and agricultural production else- plentiful and less hoarding took place where had normalized (Adhana Haile (Kloos and Lindtjorn, 1993). The strong Adhana, 1988, p. 2). Similarly, nutritional spatial correlation between severity of studies in Wello, Hararge and Sidamo famine and grain prices ensured that the reported higher mortality rates in human peasants who were hit hardest were also and livestock populations in lowland agri- those who could least afford to purchase cultural and pastoral areas than at higher food. But the market collapse affected elevations (Seaman et al., 1981; Seaman most severely the Afar, Somali and other and Holt, 1975; Lindtjorn, 1990). During pastoralist groups who had less access to the famines in the 1980s, relatively few highland markets but who depended to a peasants in central, southern, and eastern greater extent than farmers on the market Ethiopia's marginal areas, mostly mem- for food (Cutler, 1984; Kloos and Lindt- bers of producer cooperatives, had access jorn, 1993). to irrigation water and community labor, resulting in significant variations in food FAMINE SHELTERS, RESETTLEMENT, AND production at the community level (Alem- MORTALITY neh Dejene, 1990, pp 76-78; Kloos, 1991) . The observation by Alemneh Dejene Famine victims who were able to reach that vulnerability to famine was inversely relief shelters or who were resettled by the related to family size in several communi- government experienced some of the most ties in Wello raises the intriguing question severe forms of malnutrition and among pi the survival value of large families in the the highest mortality rates. Studies of context of famine aversion strategies (with shelter populations in Wello revealed the f urther implications for family planning strengths and weaknesses of emergency programs) (Alemneh Dejene, 1990, pp. relief programs reported also elsewhere. 74—76). This raises another unanswered Whereas well planned and organized relief question, namely whether or not house- shelters can provide for the efficient and hold size reflects the accumulated impact effective administration of food and medi- of earlier famines through mortality and cal assistance, particularly in more remote outmigration (Mesfin Wolde Mariam, areas beyond the reach of government 1985, p. 17). health services and food distribution The many people without food and points, they may also aggravate existing relief shelters, including the old, poor, health problems and make agriculturalists handicapped and bedridden patients and, dependent on food handouts (Mehari during the famines in the post-revolution Gebre-Medhin and Vahlquist, 1977). period, people in Tigray and Eritrea with- Crowded living conditions, poor sani- out access to kebele identification cards, tation, limited supplies of potable drinking experienced particularly great hardships water, and the poor nutritional state of and high mortality rates. older people reaching feeding centers have The same market forces that drove up facilitated the outbreak of fatal communic-

© Basil Blackwell Ltd. 1994 DISASTERS VOLUME 18 NUMBER 2 able diseases (particularly diarrheal dis- eases, acute coercion and inadequate food upper respiratory infections, distribution, and measl have been described b es) various nutritional disorders y different investi- in gators (Colchester and children, and malaria, louse-borne Luling, 1986; Pank- hurst, 1992; Porter, typhus, relapsing fever and 1986). The review by malnutrition Kloos (1990) in adults. Extremely hi identifies environmental and gh mortality rates sociopolitical (60-90 per 1,000 population factors impacting on the per month) health of were reported from settlers in western Ethiopia . The Korem shelter in nat Wello in 1985. ional villagization program These rates were 7 to 10 also exacer- times h bated the food crisis b igher than in nearby famine- y interfering with stricken agricultural production and communities and 30 to 40 times disturbing higher than social relations (Cohen and Isaks in the total Ethiopian popula- son, 1987; tion (Toole Alemayehu Lirenso, 1989), and Waldman, 1990). Mortality but its impact rates among on malnutrition has not the children of Boran pastora- been studied in lists under the new villages. five years of age living in relief shelters Although data on the increased three to four times, prevalence and largel severity of malnutrition y due to social disruption following in settlers are drought. In fragmen tary , they indicate stable Boran communities out- that rates were side shelters about twice as high ( , mortality rates in under-fives 21.5 per cent) in increased b Metekel, the scheme with y only about 50 per cent (Lindt- some of the best jorn, 1990) mortality data (Sivini, 1986) . Some of the highest mortality than in their rates were places of ori gin in Wello reported for Ethiopian refugee and Tigray children und (Asmerom Kidane, 1989) er five years in eastern Sudan and among (Shears, 52,274 representative 1991) . Extremely high mort households in Yifat rates ality and Timuga Awraja were also reported from in Shewa (Otten, shelter 1986). No clinical populations in the war zone studies of settler malnu- on Tigray and trition have Eritrea (Kloos/ 1993). been published/ but malnutri- tion apparently c The resettlement program, ontributed significantly to undertaken mortality as indicated by the regime in by the disappointing 1984—85 ostensibly harvests as a long-term , erratic relief food supplies famine prevention measure, , high resulted in settler defection rates, and severe malnutrition and morta- the obser- lity, not onl vations of the senior author y in the feeding and collection rese in three centers in Ti ttlement schemes in Keffa gray, Wello, and Shewa, but (Abdulha- also en mid Bedri Kello et al., route and in the resettlement 1989) . The rise of schemes nationalism in western . Bati shelter, one of the Ethiopia since the few fall of the Derg regime shelters keeping fairly reliable is further jeopardiz- mortality ing the economic data, registered 2,407 deaths and social position of among its settlers from northern population of 28,112 (8.6 Ethiopia and is said per cent) in to be a major November 1984. A factor in the return of many total of 7,844 deaths but settlers only 765 to their areas of origin. births were registered in this center between October 1984 and Sep- tember 1985 . In the collection centers in CAUSE-SPECIFIC MALNUTRITION Ambassel Awraja, 1,791 of 42 ,831 inmates The cause and the (4.2 per cent) died between incidence of specific November nutritional deficiency 1984 and April 1985 (Dessalegn diseases varied Rahmato, between geographical 1991, pp. Ill, 112). The areas, ecological logistic and zones, and operational problems population groups. Protein- of this controversial energy resettlement malnutrition, the form of malnutri- program, including the use of tion most frequently reported during DISASTERS VOLUME 18 NUMBER 2 © Basil BlarkwpH T ^ 100/1 famines in Ethiopia, was usually accompa- prevalence of wasting ranged from 5.7 to nied by vitamin deficiencies. Anthropo- 13.7 per cent among children of Boran metric measurements of protein-energy pastoralists in shelters but only 3.7 to 4.1 malnutrition are still deficient in determin- per cent among non-shelter Boran pastora- ing the nutritional needs of affected popu- lists and from 3.7 to 5.3 per cent in non- lations, hampering relief efforts in relief shelter agropastoralists. The correspond- camps.1 Kwashiorkor has not been ing mortality rates were influenced by the reported to occur in the areas of seed/plow occurrence of measles, diarrhea, and other agriculture and pastoral nomadism. communicable diseases, particularly in the During the 1984—85 famine, marasmus shelters. Rates declined after the famine in was the main form of protein-energy 1986, but the nutritional recovery rates malnutrition in the southern regions of were higher in pastoralists outside shelters Shewa, Bale, Sidamo, and Gamo Gofa. than in shelter populations. This study The occurrence of kwashiorkor was concluded that famine victims migrating to limited to Wolayta and Kembata awrajas emergency shelters are at an increased risk (Lindtjorn, 1987), both in the major ensete of death due to factors before, during, and growing areas of Ethiopia, where diets after migration and that adequate supplies have traditionally been protein-deficient of food in famine-affected communities (Selinus, 1971) . Marasmus mainly may reduce the scale of migration, social occurred among pastoral nomads and disruption, and mortality, as well as the agropastoralists whose predominantly need for emergency shelters (Lindtjorn, milk diet tends to be deficient in carbohyd- 1990). The variable success of emergency rates (Lindtjorn, 1990). shelters in reducing wasting in children The most serious health effects of was also reported in a shelter population protein-energy malnutrition are stunted in Gondar, among Ethiopian refugee chil- growth, body wasting, retarded mental dren in Sudan, and in non-shelter Surma development, and high mortality in pastoralist in Keffa (Godfey, 1986). younger children (Rivers, 1988). The Vitamin A deficiency, which is hyper- prevalence of stunting is generally higher endemic in the monocrop grain-growing in farmers than pastoralist, as reported not areas of Arsi, Bale, and Gamo Gofa (Lindt- only from Ethiopia but also Sudan and jorn, 1983), has also been reported from West Africa (Lindtjorn, 1991). Prevalence feeding centers and Ethiopian refugee of wasting reached 73 per cent among camps in Sudan (Pizzarello, 1986) . Vitamin Surma pastoralist children in Keffa in A deficiency aggravates measles, diarrhea, 1985, 43.5 per cent among farmers' chil- and acute respiratory infections, all major dren in Ibnat shelter in 1987 (Adugna causes of child mortality during famines Getahun, 1988), and between 15 and 46 (Shears et al., 1987) . Its role in blindness per cent in four Somali refugee camps in (xerophthalmia) is also well known. Hararge in mid-1991, when only about Scurvy, normally rare in Ethiopia, has one-third of the required food could be been reported from Ethiopian refugee supplied due to the war (UNHCR, 1991). populations in Sudan and Somalia and An extensive comparative nutritional from Somali refugees in Ethiopia. The study of 14,173 children aged 1—5 years at prevalence of scurvy increased with 24 food distribution centers inside shelters duration of stay in long-term relief camps and in their home areas in Boran and in Sudan (Toole and Waldman, 1990; Arero awrajas in Sidamo reported the Desenclos et al., 1989), illustrating the highest levels of wasting and mortality in problem of the nutritional deficiency of the shelter populations. Mean monthly many relief foods. Cereal grains, protein-

© Basfl BlackweU Ltd. 1994 DISASTERS VOLUME 18 NUMBER 2 fortified biscuits, and other manufactured from Wello (Mesfin Wolde Mariam, 1984, foods lack vitamin C and other micronu- p. 64). Adugna Getahun (1988) reported trients and are often rejected by camp on their nutritional benefits during the populations unfamiliar with such foods as recovery phase among Surma children in unfit for eating. These imported foods Keffa. The use of the water lily (Nymphaea have been produced to obtain quick results caerulae), highly valued by the Afar dec- in the battle against protein-energy malnu- lined during the 1973-74 and 1984-85 trition without due consideration to famines, when swamps dried up, and as a balanced nutrition and cultural accept- result of the construction of Koka Dam, ability (Desenclos et al., 1989; Centers for irrigation development, and the associated Disease Control, 1989; Mason et al., 1974). destruction of swamps (Kloos, 1982). Several other health hazards linked Only one study has been carried out with food consumption during famine on the psychological damage sustained by have been relatively neglected. They famine victims, among settlers in Gambela include neurolathyrism, ergotism, and the and Metekel resettlement schemes (Bhalla psychological impact of famine. Lathyr- and Woldetekle, 1988). The study con- ism, a disorder of the central nervous cluded that psychological damage to ber- system, is induced by the grass-pea (Lath- eaved relatives and to the members of yrus sativus) containing neurotoxins. Lath- households with missing or separated yrism occurs in Ethiopia mainly during members, was widespread in the popula- famines in the northern highlands (Redda tion. The first study of the psychological Tekle Haimanot et al., 1990). A study in impact of hunger itself is in progress in the three weredas in Gondar Region identified Department of Psychology at Addis Ababa 1,374 cases of lathyrism, (which is locally University . known as sebbere or breaker or paralyzer) during the 1974 famine (Tesfaye Gebre-ab et al., 1978). CONCLUSION Ergotism, caused by eating grain con- Malnutrition and associated mortality taminated with the ergot fungus, com- during the 1973-74 and 1984 - 85 famines monly results in gangrene of the upper varied significantly among different popu- and lower limbs, nausea, insanity, and lation groups at the regional, community, death. It occurs mostly during times of and household levels. Vulnerability to famine, and most cases have been famine varied similarly in both famines but reported from Wello (Teshoma Demeke et was exacerbated during the 1984—85 al., 1979) . Local peasants, some of whom famine by the strangulating economic are said to have consumed ergot-infected policy and the war waged by the Derg grain knowingly, can readily identify the regime. The health-lowering conditions in symptoms and call it libb agilt (heart emergency camps, as well as the inef- melting). In Lasta Awraja 47 of 140 infected ficiency of anthropometry in identifying adults died. Also, 40 to 50 infants and needy individuals, strongly argue for the small children died there because their development of famine prevention pro- ergot-infected mothers ceased to produce grams that enable affected populations to breast milk (Mesfin Wolde Mariam, 1985). deal with famine and its nutritional effects Roots, leaves, bark, grass seeds, and in their own communities. This approach the fruit of wild plants continue to be also promises to break the dependency on widely used famine foods in Ethiopia. handouts from outside institutions and Most cases of poisoning from wild plants encourage the confidence and self-reliance were reported during the 1973—74 famine of famine-prone populations. The advan-

DISASTERS VOLUME 18 NUMBER 2©Basil Blackwell Ltd. 1994 tages of distributing food to famine- Adhana Haile Adhana (1988) Peasant response affected people in their home areas was to famine in Ethiopia, 1975—1985. Journal of ian Studies 21 1-56. reported by Turton among Mursi pastora- Ethiop , lists in Gamo Gofa (Turton, 1985). There Adugna Getahun (1988) Aspects of health and famine in rural Ethiopia. In A. Penrose (ed.) is, of course, need for additional emer- Beyond the famine: an examination of the issues food relief during the present transi- gency behind the famine in Ethiopia. International tion period; but the typical knee-jerk Institute for Relief and Development and reaction of governments and relief organi- Food for the Hungry International, Geneva, zations, mounting massive famine relief 142-18 6. operations after characteristically delayed Alemayehu Lirenso (1989) Villagization and agri- and unreliable news broadcasts, must cultural production in Ethiopia : a case study of increasingly give way to more progressive two regions. IDR Research Report No. 37, long-term development plans. Addis Ababa University, Addis Ababa. The present peace initiative in Ethiopia Alemneh Dejene (1990) Environment, famine and politics in Ethiopia: a view from the village. may prove to be conducive to more sus- Lynne Rienner, Boulder. tainable rural development. Clearly, more Asmerom Kidane (1988) Mortality, fertility and research is needed in different ecological population projection of famine affected zones and cultural groups to provide regions of Ethiopia. Paper presented at the information on the changing ecology of Workshop on Famine Experience and food production, vulnerability, and mal- Resettlement in Ethiopia, sponsored by the nutrition during this crucial transition Institute of Development Research, Addis period. Such studies may elucidate the Ababa University, December 29—30, Addis antecedents of recurring famine which Ababa. were either inadequately recognized or Asmerom Kidane (1989) Demographic conse- simply ignored by donors and the Ethio- quences of the 1984 — 85 Ethiopian famine. h , 515-522. pian government. Reconstruction of the Demograp y 26 Bhalla, S.K. and Lakew Woldetekle (1988) The sequence of events from the beginning of psychological consequences of famine exper- the crisis may contribute to a better under- ience and resettlement. Paper presented at standing of the complexity of famine and the Workshop on Famine Experience and therefore a better basis for action. resettlement in Ethiopia, sponsored by the Institute of Development Research, Addis Ababa University. Note Bradbury, D. (1984) Volatility of animal wealth 1. The lengthy debate over the measurement of among southwest Asian pastoralists. Human protein-energy malnutrition is summarized Ecology 10, 85- 106. by Rivers (1988); problems of assessing Centers for Disease Control (1989) Nutritional seasonal energy requirements and energy status of Somali refugees in eastern Ethio- metabolism were addressed at a recent pia, September 1988-May 1989. MMWR symposium (Ferro-Luzzi, 1990); and difficul- Morbidity and Mortality Weekly Report, 38, ties of measuring Ethiopian pastoralist chil- 455- 456. dren were described by Pat Turton (1985). Cliffe, L. (1989) The impact of war and the response to it in different agrarian systems in Eritrea. Development and Change 20, References 373-400. Abdulhamid Bedri Kello, H. Kloos and Abdula- Cohen, J.M. and N.-H, Isaksson (1987) Villagi- ziz Addus (1989) Intersectoral collaboration to zation in the Arsi region of Ethiopia. Swedish improve the health status of resettlers in Keffa University of Agricultural Sciences, resettlement farms . IDR Research Report No. Uppsala. ' 38, Addis Ababa University, Addis Ababa. Colchester, M. and V. Luling (1986) Ethiopia s

© Basil BlackweU Ltd. 1994 DISASTERS VOLUME 18 NUMBER 2 bitter medicine: settling for disaster. Survival Kloos, H. and Aynalem Adugna (1989) Settler International, London. migration during the resettlement program Cutler, P. (1984) Famine forecasting: prices and in Ethiopia. Geof oumal 19, 113-127. peasant behavior in northern Ethiopia. Kloos, H. and B. Lindtjorn (1993) Famine and Disasters 8, 48-56. malnutrition. In H. Kloos and Zein Ahmed Desenclos , J.C., A.M. Berry, R. Padt, B. Farah, Zein (eds.) The ecology of health and disease in C. Segala and A.M. Nabil (1989) Epidemiolo- Ethiopia. Westview, Boulder, 103-120 . gical patterns of scurvy among Ethiopian Lindtjorn , B. (1987) Famine in Ethiopia refugees. Bulletin of the World Health Organi- 1983 — 1985: kwashiorkor and marasmus in o 67 zati n , 309-316. four regions. Annals of Tropical Medicine and DeSole, G., Yilma Belay and B. Zegeye (1987) Paediatrics 7 , 1—5. Vitamin A deficiency in southern Ethiopia. Lindtjorn, B. (1990) Famine in southern Ethio- American Journal of Clinical Nutrition 45, pia 1985 — 86: population structure, nutritio- 780-784. nal status and death among children. British Dessalegn Rahmato (1989) Rural settlement in Medical J ournal 301, 1123-1127. post-revolution Ethiopia. Paper prepared for Lindtjorn, B. (1991) Child health and nutrition: the Office of the National Committee for a study from drought prone areas in south- Central Planning, Addis Ababa. ern Ethiopia. Doctoral dissertation. Univer- D'Souza, F. (1990) Famine: social security and sity of Bergen, Bergen Norway . an anal ysis of vulnerability. In G.A. Ham- Mason, J.B., R.W. Hay and J. Holt (1974) son (ed.) Famine. Clarendon Press, Oxf ord, Nutritional lessons from the Ethiopian 2-56. drought. Nature 248, 646-650. Dewey, K.G. (1981) Nutritional consequences McCann, J. (1987) The social impact of drought of the transformation from subsistence to in Ethiopia: oxen, households, and some commercial agriculture. Human Ecology 9 (2), implications for rehabilitation. In M. Glantz 151-187. (ed,) Drought and hunger in Africa: denying Ferro-Luzzi, A. (ed.) Biology of adaption to famine a future. Cambridge University Press, seasonal cycling of energy intake. European Cambridge, 245-267. Journal of Clinical Nutrition 44, 1- 125. Mehari Gebre-Medhin and B. Vahlquist (1977) Flood, G. (1976) Nomadism and its future: the Famine in Ethiopia: the period 1973- 75. Afar. In Abdel Mejuid Hussein (ed.) Rehab: NutritionReviews 35, 194- 202. drought and famine in Ethiopia. International Meir, A. (1986) Demographic transition theory : African Institute, London, 64—66. a neglected aspect of the nomadism-seden- Godfey, N. (1989) Supplementary feeding in tarism continuum. T ransactions of the Institute refugee populations: comprehensive as of British Geograp hers, 11, 199-211. selective programs? Health Policy and Plan- Meir, A. and Y. Ben-David (1991) Socio-econ- ning 1, 283- 298. omic development and the dynamics of Holt, J.H., J. Seaman and J.P. Rivers (1975) The child mortality among sedentary Bedouins Ethiopian famine of 1973-74 . 2. Hararghe of Israel. Tijdschrift voor Econ. en Soc. Geogra- province. Proceedings of the Nutrition Society f ie S2, 139 - 147. 34, 115A-11 6A. Mesfin Wolde Mariam (1984) Rural vulnerability Kloos, H. (1982) Development, drought and to famine in Ethiopia, 1958—1977. Vikas, New famine in the Awash Valley of Ethiopia. Dehli. African Studies Review 25, 21- 48. Mesfin Wolde Mariam (1985) The social conse- Kloos, H. (1990) Health aspects of resettlement quences of famine. In Fasil Gebre Kiros (ed.) in Bhiopia. Social Science and Medicine 30, Challenging rural poverty. Africa World Press, 643-656. Trenton, 11-1 9. Kloos, H. (1991) Peasant irrigation develop- O'Leary, M.F. (1990) Drought and change ment and food production in Ethiopia. The amongst northern Kenya nomadic pastora- Geograp hical J ournal 157, 295- 306. lists: the case of the Rendille and Gabbra. In Kloos, H, (1992) Health impact of war in G. Paalson (ed.) From water to world making. Ethiopia. Disasters 16, 347-354. Scandinavian Institute of African Studies,

DISASTERS VOLUME 18 NUMBER 2©Basil Blackwell Ltd. -1994 Uppsala, 151- 175. Tesfaye Gebre-al, Zewdie Wolde-Gebriel, M. Otten, M.W. (1990) Nutritional and mortality Maffia, Zein Ahmed, Teklemariam Ayele aspects of the 1985 famine in north and and Haile Fanta (1978) Neurolathyrism: a central Ethiopia. Report to the Centers for review and a report of an epidemic. Ethio- Disease Control, Atlanta. pian Medical Journal 16, 1—11. Pankhurst, A. (1992) Resettlement and famine in Teshoma Demeke, Yemane Kidane and Eliza- Ethiopia: the villagers ' experience. Manchester beth Wubih (1979) Ergotism — a report of an University Press, Manchester. epidemic. Ethiopian Medical Journal 17, Pizzarello, L.D. (1986) Age specific xerophthal- 107-113. mia among displaced Ethiopians. Archives of Toole, M.J.and R.J. Waldman (1990) Prevention Diseases of Children 61, 110-11 03. of excess mortality in refugees and displaced Porter, A. (1986) Resettlement in Ethiopia. populations in developing countries. Journal Lancet 1, 217. of the American Medical Association 263, Redda Tekle Haimanot, Yemane Kidane, Eliza- 3296-3302. beth Wubih, Angelina Kalissa, Tadesse Turton, D. (1977) Response to drought: the Alemu, Zein Ahmed Zein and P.S. Spencer Mursi of south western Ethiopia. Disasters 1, (1990) Lathyrism in rural northwestern Eth- 275-287. iopia: a highly prevalent neurotoxic dis- Turton, D. (1985) Mursi response to drought: order. International Journal of Epidemiology 19, some lessons for relief and rehabilitation. 664- 672. AfricanAffairs 84, 331-346. Rivers, J.P. (1976) Lessons for epidemiology Turton, P. (1985) The use of mid upper arm from the Ethiopian famine. Annales Societe circumference in the assessment of nutritio- Belgique Medecine Tropicale 56, 345—357. nal status: the Mursi. Midwife Health Visitor Rivers, J.P. (1986) The nutritional biology of and Community Nurse 21, 81-87. famine. In G.A. Harrison (ed.) Famine. UNHCR (United Nations High Commissioner Oxford University Press, 57-106. f or Ref ugees) (1991) Information Bulletin No. 4 Roboff , F.V. (1977) The moving target: health on operations in the Horn of Africa. UNHCR, status of nomadic people. Economic Geo- Geneva, 6. graphy 33, 421-428. Voelkner, H.E. (1974) The social feasibility of Seaman, J., J. Holt, and J. Rivers (1981) The settling semi-nomadic Afar on irrigated agri- effects of drought on human nutrition in an culture in the Awash Valley, Ethiopia . Infor- Ethiopian province. International Journal of mal Technical Report No. 123, UNDP/FAO/ Epidemiology 5, 6-18. Eth 72.00 prepared for FAO, Rome. Selinus, R., Abesa Gobezie and B. Vahlquist Wood, C.A. (1976) Farmers' response to (1971) Dietary studies in Ethiopia. III. Die- drought in Ethiopia. In Abdel Mejuid Hus- tary patterns among the Sidamo ethnic sein (ed.) Rehab: drought and famine in Ethio- group: a study on villages in the ensete pia. International African Institute, London, monoculture in southern Ethiopia with spe- 67-87. cial attention to the situation in young children. Acta Societa Medico Upssa lensia 76, 158-178 . Helmut Kloos Shears, P. (1991) Epidemiology and infection in 2307 N. Backer Avenue famine and disaster. Epidemiology and Infec- Fresno tion 167, 241- 255. California 93703 Shears, P., A.M. Berry, R. Murphy and M.A. USA Nabil (1987) Epidemiological assessment of the health and nutrition of Ethiopian refu- Bernt Lindtjorn gees in emergency camps in Sudan, 1985. Centre for International Health British Medical 295, 314-318. Journal University of Bergen Sivini, G. (1986) Famine and resettlement Bergen program in Ethiopia. Africa (Rome) 41, 211-243. Norway

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