Cover Story

When Hunger Bites

AASHA MEHREEN AMIN and AHMEDE HUSSAIN
Photographs: Zahedul I Khan

On May 21, millions of people from all over the world will take part in a historic event - 'Walk the World Fight Hunger'. It will be led by the UN World Food Programme and Partners and will symbolise the commitment of countries to break the cycle of poverty and hunger that affects around 800 million people all over the world. For Bangladesh nothing can be more important than being reminded of the challenge at hand - to combat hunger and malnutrition that affects half of its population. A visit to Kurigram in Northeast Bangladesh - one of the most poor and hunger-struck regions of the country, exposes the enormity of the problem. It also gives a glimpse of the efforts of some organisations to reduce the terrible repercussions of chronic hunger.

The rice fields we pass now are robust with crops and belie the bleak scenes of Monga a near famine situation which is part and parcel of living in North Bengal. During the Monga season, usually between Ashwin and Kartik (late autumn and early winter) there are no crops to be harvested and very little work for farmers to feed their families. Many farmers rush to the cities to become temporary rickshaw pullers or day labourers in the hope of earning enough to pay off the loans and bring home some much-needed cash. Many come back just as poor or poorer. Others don't come back at all, choosing to run away from all the hunger that awaits at home in the village.

Not surprisingly children and women are the worst victims of Monga and remain in a constant state of hunger, often barely being able to get one meal a day. The tragedy is that the Monga season creates a huge setback for the already poor families who remain in this state for the rest of their lives being unable to escape from the vicious cycle of hunger- impoverishment and more hunger. Chronic malnutrition is the most dangerous 'disease' in these areas having devastating consequences on the productivity and wellbeing of these communities.

The nutrient-rich biscuits have significantly improved energy levels and the ability to concentrate in class

Hunger comes easily in Kurigram, one of the most poverty-stricken districts of the country. It sharpens its claws during Monga, a seasonal unemployment, when majority of the people who work in the fields cannot get any job to feed their family. It is a time when the vast paddy fields are green with sheaves of paddy; harvest is three months away. Most of the villagers here are day labourers, the land belongs to a few Zamindars who can afford to sit idle and see clumps of green paddy ripen. These are agonising times; even when they work for the Maliks-- which means when they are employed-- with an income of 50 taka a day, the labourers cannot bring home a decent meal; saving for the rainy day is a daydream.

These people borrow, sometimes from Shylockesque moneylenders, sometimes from different NGOs, at an exorbitant interest rate. They remain in the margin of an economic system where to be born poor is the most heinous crime one can commit. Only a vicious cycle follows; borrowing leads to more borrowing; some NGOs who have substituted the Kabuliwalas in Bangladeshi villages become more active. People start selling whatever they have-- the goat goes first, or perhaps it is the gold nose ring that the wife has. They dwindle from "poor to ultra-poor". Life remains an uphill struggle for the next meal. It is a sad story where people who deal in poverty get fat and rich by the day; the poor on the other hand remain poor.

For seven-year-old Ainul, who lives in Tabakpur Union, the memories of these cruel months are still very raw . At that time his father, who works on a farm nearby, did not have any work to do. "It's because of Monga," he says, "It happens every year, especially in Ashwin and Kartik." The spectre of starvation looms large in the household as it is, for living by the father's meagre income of Taka 60 a day theirs is always a hand-to-mouth existence. And during Monga that nightmare of going to bed at night hungry and weak becomes a recurring phenomenon.

As it involves family pride, children in Monga- affected Kurigram feel shy talking about those hungry days. After a few persistent requests Ainul recalls how his family had to fast days and nights during the last Monga, in one instance it was for three consecutive days they survived on a marshy plant, which, in good times, was kept solely for feeding cattle. "I was the only person in the family who had food everyday," he says.

The "food" Ainul had in those days was a packet of biscuits that the World Food Programme (WFP) supplies to 4,000 schools in the poorest part of Bangladesh on every school day. Produced in WFP-run factories, these 75 grams of "Fortified Biscuits" with added vitamins like Vitamin A, iron, zinc, iodine and folic acid, give the children additional energy and 75 per cent of a child's every day nutritional need.

The curse of malnutrition begins long before they are born. It starts from their mothers' adolescence continuing throughout pregnancy

More and more parents in rural Bangladesh are sending their children to school. "Enrolment has increased dramatically," says Amirul Hossain, head teacher of Tabakpur Union School, where Ainul studies. Statistically this programme, dubbed "Nutrition for Education" is a major success: dropout rate has reduced dramatically to an all time low. A reason why this programme has increased student enrolment, says Anwarul Kabir, head of Rangpur regional office of the WFP, is that most of the parents in rural areas cannot afford a decent meal for their children. Kabir says that for most of the children these biscuits are the only regular source of nutrients. "We have always prioritised fighting hunger in the class room; and besides eradicating inanition this programme has become a major contributor to shaping the intellect of the future generation," Kabir continues.

Now the situation is such that if the supply of biscuits stops dropout rate will drastically increase. "Whenever there is a problem with the supply of biscuits, the number of attendance decreases," Hossain observes. He thinks that these biscuits have improved his "pupils learning abilities by reducing short-time hunger". Other teachers at the school agree: "Students are more dexterous and energetic because of the biscuits they have every day," says a teacher. "Earlier, the children would sneak out of class and go home during tiffin time because they were hungry but now they stay on because of the biscuits" says Umme Kulsum whose son and daughter go to the primary school in Tabakpur. "Before this programme the students used to come to school underfed and malnourished, says Hossain, "everything has changed after this programme has been introduced; students are keener to learn their lessons now. An empty stomach is the biggest hindrance to learning."

The government-run programme of giving stipend to meritorious students has not yielded any significant breakthrough. "The money is directly given to parents, and, poor as they are, they spend most of the money to repay debt or other non scholastic activities," a parent, whose son studies at Tabakpur Union School says. He says that hardly a taka of the miserly stipend that the government gives goes to the children, as most parents, buried in poverty, cannot help spend the amount on daily necessities. In contrast to that, WFP biscuits help develop students' body and mind because it goes directly to the children.

And it tastes good, says Ainul while finishing his daily tiffin with a packet of WFP biscuit and a glass of water. But the programme is gradually dwindling because of shifting focus of different donor countries. In 2004 the number of students the WFP used to feed was 12 lakh, which is now around 7,50,000. Many blame the gradual loss of interest of the donors on Tsunami and South Asian Earthquake. "The whole world has put its interest in helping the victims of these two natural calamities," says an independent development expert, "It is sad that the programme that keeps the educational life of so many children alive, may have to be stopped because of a fund crisis."

For most of the children in this primary school. These biscuits are the regular source of nutrients

In a little village called Apuar Katha of Pundul Union (Ulipur upazilla) Chinnomukul, a local NGO working for more than three decades mainly to improve health and nutrition of women and children in the poorest areas of the country, has opened a little tin-shed centre for the community. This is where children, adolescents and mothers and fathers have meetings with Chinnomukul staff to learn about proper nutrition and how to stay healthy. It is also the venue for a pre-school that is 50 percent funded by the community itself, the remaining 50 percent comes from Chinnamukul.

Apuar Katha is a particularly impoverished village of around eight to nine hundred mostly poor families. There are many widows with children to raise and feed and more adolescent girls than boys. At the centre there is a small group of children, members of a 'Child Brigade'; their primary task is to educate their families and others in the community, regarding basic health, hygiene and nutrition. Each 'Brigade' consists of 20 to 25 children. There are around 1200 children in the brigade with 48 groups.

"Our idea is to sensitize the young ones so that later these ideas will be instilled in them when they are parents", says a Chinnamukul staff.

The adolescent groups learn about reproductive health and good hygiene practices as well as other relevant issues: why early marriage increases health risks for women, why education is important, what the forms of contraception are available, what the risks of unsafe deliveries and abortion are and so on.

Twelve-year-old Shantona, a confident class 7 student, says that apart from discussing reproductive health, nutrition issues at the meetings, " we now plant vegetables around our houses which helps when there is liitle food." Shantana, the youngest of five children, says most of the time the family eats rice and vegetables and dal which they know is nutritious.

During the Monga season however, there is little scope for nutrition says Anjum Ara, Cmmunity Organiser Chinnomukul since 2001. " I know of families who survived only on rice and salt once a day. During the Monga season, they have to take loans usually from a local NGO.Then they go to Dhaka or Bogra to work to pay off the loans.They also sell off whatever they have and if that isnt enough they borrow from the mattabbors."

The WFP's School Feeding Programme has increased enrolment but lack of funds may lead to its closure putting the health of these children at risk

Young and older mothers, at the centre learn about good nutrion practices and health. Lolita Rani has only one seven-year-old son Narayan who goes to school. Most other women have around four to five children because explains Lolita, "women sometimes get sick using contraceptives like injections and pills or because they want a son". At the centre Lolita says she has learnt how important it is to eat vegetables and to cut and cook them in a way that retains all the nutrients. But, says Lolita, the reality is that sometimes they cannot even afford vegetables because of the soaring prices. Farm work or work in the paan fields are the only means of livelihood for people in this area paying a flat rate of around TK 40 a day. "We usually try to have three meals a day now, mainly rice, daal and shabji. If we earn more, we get to eat fish, maybe once in three weeks," says Lolita who also works at a farm.

The blended food supplied by WFB, provides essential nutrients to pregnant and nursing mothers and their babies at the village nutrition centres

A visit to the government-run Family Welfare Centre in Tabakpur reveals how a child's health is determined by the health of the mother. Dr. Mashiur Rahman, a doctor from RDRS , Bangladesh, a local NGO working in the country since the early 70s, says that most expecting mothers come with sever nutritional deficiencies that have adverse effects on their unborn babies. Every week RDRS sets up a Maternal Care Programme where for only TK 12 pregnant women get basic health care like regular check ups, tests and iron or vitamin supplements from the time they are expecting till 42 days after delivery. "Nutritional deficiency is more severe during Monga", says Rahman, "many mothers-to-be have acute iron deficiency and are anaemic which means that their babies will be anaemic and this hampers normal development of the foetus. Many babies are therefore born with low birth weight or have birth defects such as physical or mental disability."

Apart from anaemia, these women face other micro-nutrient deficiencies. Severe vitamin A deficiency increases the risk of post-delivery infection (sepsis). Iodine deficiency can lead to miscarriages and stillbirths. Lack of dietary calcium may increase the risk of high blood pressure and other symptoms of eclampsia.

According to FAO's State of Food Insecurity in the World 2005 report, malnourished mothers are far more likely to give birth to low-birth weight babies. So are women whose own growth was stunted by malnutrition during childhood. These low-birth weight babies, says the report, are more likely to die in infancy. States the report: 'They are also far more likely to suffer stunting during childhood that will greatly increase their own risk of dying during childbirth or giving birth to another generation of low-birth weight babies. Thus improving nutrition for women and girls throughout their lives could have far reaching benefits in terms of healthier mothers and healthier future generations.

At Tabakpur Village's Nutrition Centre, WFP has started a programme to address the problem of malnourished mothers-to-be. There are around 30 pregnant or nursing mothers at the centre under WFP's 'IFS-Community Nutrition Initiatives programme, all of whom along with their nursing babies receive an allotment of a nutritional supplement known as blended food. The powdered supplement supplied by WFP comes all the way from Denmark and has significantly improved the health of these women and their babies. The mothers get 250g of the blended food fortified with essential micronutrients, every 15 days and the infants get 200g. Mussamat Shazeda Khatun, who has a five month old baby boy says, "Before I was very weak and didn't see properly; I had a lot of sores in my mouth and they said I didn't have enough blood. I have been taking the fortified food since the last three months and give it to my baby also. Now I feel a lot stronger and the sores are gone."

The other mothers echo her endorsement of the powdered food. Mussamat Mumtaz, in her twenties, has a two-month-old baby girl. She says that she was very anaemic before she came to the Centre and having the blended food has made her better. " Here we are taught how to cook the powdered food. We make khichuri with it adding vegetables, we have also learnt how to make pitha and halwa."

All the wards have a centre with 3 centres for each union. When the mothers have a health problem they are referred to the government health centre or RDRS health centre. In addition RDRS paramedics come every 15 days to give check ups to the pregnant mothers.

Sixteen-month-old Marufa weighs only 6kg. Her ideal weight should be 9kg. She is a patient at the Special Nutrition Unit of a Chinnomukul clinic in Kurigram. She has been trying to recover for the last three months. When she came to the clinic says Mukta Begum, her mother, Marufa had a high fever, almost no appetite and could not even walk properly she was so weak. At the clinic the babies are fed a special French formula to help them recover from their severely malnourished state. Mothers, meanwhile, are given health and nutrition tips. " They can't give them the milk we give them so we teach them what to give instead so that the babies' nutrition is maintained" says Shondha Biswas the Nurse-in-charge.

But even a superficial look around the unit fills one with dismay at the number of stunted babies, their disproportionately small bodies struggling hard to survive. There is 16 month Hridoy, weak with a fever and cough, ten-month old Akash debilitated by a severe congestion and three year old Momota who is so frail she still cannot walk. Another depressing fact is that the mothers themselves are malnourished, poverty being a curse that never leaves them. Painfully thin and weak Mukta Begum says she has five other children besides Marufa. She cannot take contraceptives because they make her sick and her rickshawpuller husband refuses to use any himself.

Members of Chinnamokul's Child Brigade: These children raise awareness on health, hygiene and nutrition

This unfortunately is the norm rather than the exception. The reality is that the effects of malnutrition and hunger are multi-dimensional. Malnourished mothers often continue to have babies they cannot feed because contraceptives are too expensive or make them ill because they are so weak or because their husbands shove the whole burden of family planning on them. This just perpetuates the vicious cycle of poverty, hunger and more malnutrition.

Many of the projects to reduce hunger and malnutrition are indeed innovative, practical and have tangible benefits. But the truth is that they cover only a tiny proportion of the population and offer only partial solutions. Unless these efforts are kept alive through sustained funding, government support and more importantly, unless they are replicated on a wide scale, they will only remain a drop in the ocean.

Leaving Kurigram what haunts one the most is the sea of sad, weary and resigned faces of the people we have superficially met and to whom our visit will make precious little difference to their lives. "What will be the use of writing all this?" is the most pertinent question asked by one of the mothers at Tabakpur's Family Welfare Centre in Kurigram. For once the jaded journalists could not come up with an answer.

A famine-like situation hits north-eastern Bangladesh in late Autumn. Most of these labourers in Kurigram go hungry in these three months because of sheer unemployment and a rise in the price of essentials

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Children and women are the worst sufferers of Monga and remain in a constant state of hunger

Out of 130 million people in Bangladesh, 50 percent are below the poverty line consuming around 2100 kilo Calories per day; 30 million people are in NGO jargon, the 'ultra poor' who consume less than 1800 Kilo Calories per day.

In the year 2000, 189 countries endorsed 8 Millennium Development goals, all of which are linked to reducing hunger. The first five Goals are especially relevant for Bangladesh. They are: 1. Eradicate extreme poverty and hunger; his entails halving, the number of poor (those who earn less than US$ 1 a day) and hungry people by 2015. Hunger reduces productivity increasing poverty and preventing people from producing or acquiring the food they need.

2. Achieve universal primary education. This means ensuring that children everywhere, boys and girls alike, will be able to complete a full course of primary education by 2015. Hunger reduces school attendance and impairs learning capacity. Lack of education reduces the ability to earn and increases the risk of hunger.

3. Promote gender equality and empower women. This means eliminating gender disparity in primary and secondary education, preferably by 2005, and in in all levels of education no later than 2015. Hunger reduces school attendance more for girls than for boys. Gender inequality perpetuates the cycle in which undernourished women give birth to low-birth weight babies.

4. Reduce child mortality. This involves reducing by two-thirds, between 1990 and 2015, the under-five mortality rate. More than half of all child deaths are caused directly or indirectly by hunger or malnutrition.

5. Improve maternal health. This means reducing by two-thirds, between 1990 and 2015, the maternal mortality rate. Many mothers die because of under nourishment and nutrient deficiency.

Local women trained by WFP teach pregnant and nursing mothers basic health and nutrition facts

(In Bangladesh, the Walk will take place on Sunday 21 May, 2006 in 5 cities - Dhaka, Chittagong, Jessore, Rangpur and Rangamati.)

Source: WFP, FAO (The State of Food Insecurity in the World, 2005)

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