a morte de que ninguém fala...

Photo: Elizabeth Dickinson/IRIN

Aid groups have poured in to Cameroon occasionally to help deal with refugee influxes, but aid officials say many local communities also face dire conditions (file photo)

DAKAR, 18 April 2009 (IRIN) - Each year in Cameroon at least 45,000 children die due to malnutrition.

The UN Children's Fund (UNICEF) says it has been difficult giving voice to Cameroon's "silent emergency", unfolding as it is in a relatively stable country in sub-Saharan Africa, overshadowed by conflicts and refugee crises elsewhere in the region.

"It is a silent emergency because we have children in the north, extreme north and east who are severely malnourished," Ora Musu Clemens, UNICEF representative in Cameroon, told IRIN from the capital Yaoundé.

In northern Cameroon global acute malnutrition (GAM) - weight deficit for height - stands at 12.6 percent, striking 115,000 children, according to UNICEF. Nearly forty percent of children - some 350,000 - suffer chronic malnutrition. The World Health Organization classifies a GAM between 10 percent and 14.9 percent as "serious", warranting supplementary feeding; 15 percent and above constitutes an emergency.

UNICEF says new nutritional and health surveys in Cameroon are planned for later this year.

"Often when it comes to malnutrition in the region we think only of the 'purely' Sahel countries," UNICEF-Cameroon nutritionist Denis Garnier told IRIN. "But Cameroon has high levels of malnutrition in its northern part equal to those in the Sahel; unfortunately this does not get the same attention."

The population of the north and extreme north regions is about 4.9 million - more than the entire population of Liberia or Mauritania.

The causes of malnutrition in Cameroon are many and varied, and similar to those in many Sahel countries, according to Garnier: lack of basic healthcare, food insecurity, poor access to essential child-survival services and poor infant feeding practices. Isolation of these zones is also a contributing factor. Exacerbating difficult living conditions in eastern and northern Cameroon are influxes of refugees from Central African Republic and Chad.

"To its great credit Cameroon has opened its borders to refugees from Chad and Central African Republic," UNICEF's Clemens told IRIN. "But refugees are putting a great deal of pressure on already scarce resources. The host communities are not rich, yet are sharing what little is there."

Nutrition and health

Nutritionist Garnier said the government is taking encouraging steps to integrate nutrition and malnutrition treatment into health services, but much remains to be done by all concerned, and resources are lacking.

Augustin Ndongmo Nanfack, head of nutritional monitoring and evaluation with Cameroon's Health Promotion Department, told IRIN that for the first time the government is placing nutrition coordinators around the country. "We have had a deficit of nutritionists in the field," he told IRIN. "Cameroon has not been seen as a country that has a problem of under-nutrition, but it clearly does."

Photo: IRIN

He added: "We cannot possibly fight for the health of the population without paying attention to nutrition."

What is needed, UNICEF's Garnier said, is for government, UN agencies and NGOs to collaborate on reducing malnutrition. "Part of the challenge in the north and far north regions is a lack of NGO partners, particularly to monitor nutrition activities and quality of health care."

He said many NGOs have come in to deal with refugee influxes in Cameroon. "But they leave after those emergency operations. It is difficult to mobilise NGOs for these regions because the problems are structural and because they are not well-known - we do not hear of them."

Garnier said there is an "urgent" need to reinforce communities' capacity to deal with and prevent malnutrition. UNICEF and the government plan to scale up malnutrition treatment services in the north. A training on community-based management of malnutrition in three northern districts is planned for end of April, Garnier said.

In a recent paper UNICEF says large sectors of Cameroon's population lack access to basic health services, safe water, sanitation facilities and basic education.

But UNICEF has received no funding to date for its humanitarian operations in Cameroon for 2009, according to head of office Clemens. "This is very concerning to us. Donors are more focused on development issues here in Cameroon. But within that future-oriented, development context you have a humanitarian situation that must be addressed."

The agency is appealing for US$650,000 to prevent and combat nutrition in 2009 and $2.48 million for humanitarian operations in all.