Sahrawi refugees' double trouble: obesity and malnutrition

A quarter of families living in refugee camps in Algeria suffer from the seemingly contradictory conditions of obesity and malnourishment, according to a study published in PLoS Medicine.

The researchers found that 9% of children suffer from global acute malnutrition (GAM), a measurement of nutritional status used for long-term refugee camps, while 29% had stunted growth and 18% were underweight. The majority of women were overweight or obese, with 71% having abdominal obesity, and 15% stunted growth. A third of families were classified as overweight, a quarter as malnourished, with a further quarter suffering from the double burden of both.

The camps in southern Algeria near the city of Tindouf provide shelter for Western Sahara (Sahrawi) refugees that fled fighting in Morocco during the Western Sahara War over 40 years ago. The study is a collaboration between the United Nations High Commissioner for Refugees (UNHCR), Institute of Child Health, part of University College London, and Emergency Nutrition Network.

The study relied on a routine nutrition survey that recorded the weight and height of over 1,600 children and 1,700 women from over 2,000 households. Women also had their waists measured. The study's authors called for a review of World Food Aid policies in long-term asylum cases worldwide, and greater variety of healthy food that help protect against non-communicable diseases, such as diabetes, hypertension and obesity.

Chafik Meziani, associate public health officer at UNHCR in Tindouf, criticized the standards of services adopted by international organizations at these camps, noting that they are not adequate for long-term refugees.

Our goal is to guarantee a healthy and balanced diet to ensure the survival of these refugees.

"The contradiction experienced by Sahrawi households between obesity and malnutrition is due to the shift from the diet they ate in their original Bedouin environment and their new environment," explains Meziani, who was involved in the study. "The types of food — beans and vegetable oils — popular in the camps are the main reason for the appearance of this double burden of obesity and malnutrition."

Mezian says aid organizations should diversify the food distributed in the camps, especially dried fruits and vegetables, to provide refugees with a more balanced diet. Switching to local food substitutes could also help address this problem. Encouraging countries, non-governmental organizations and refugees to establish agricultural projects within the camps would also increase nutritional diversity and streamline food deliveries.

Culture within the camp may also be a contributing factor. Ahmed Malha, a nutritionist working with the Algerian Ministry of Agriculture, suggests that the prevalence of obesity among the Sahrawi women is a sign of their customs and traditions, in which overweight women are seen as coming from more prosperous families, making overweight women more likely to find a husband than their slimmer counterparts. As such, Sahrawi women resort to a starch, sugar and fat-based diet called tablah to improve their chances of marriage. Malha points to these dietary habits as an added cause to the spread of non-infectious diseases such as diabetes and high blood pressure.

According to Meziani, the importance of this study is in the challenges it raises for organizations and food donor countries, which must now reconsider dietary policies governing long-term refugee campsites.

"Our goal is to guarantee a healthy and balanced diet to ensure the survival of these refugees, who for two generations have been eating food based on one [unhealthy] dietary programme," he adds.

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