Hunger's Silent Victims

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NISID HAJARICambodia is accustomed to the thunder of artillery, to death tolls thickened by war and disease. The quiet of peace, however, has begun to allow more subtle killers a hearing. The latest crisis: food security, or its shameful absence among the country's malnourished poor. The problem is hardly new, only newly appreciated. Earlier this year a joint survey published by UNICEF and the United Nations World Food Program (WFP) found that in Cambodia's poorest rural areas, nearly half the children under age five are physically stunted, while 20% suffer acute malnutrition. According to a separate U.N. study published last December, Cambodia has the highest malnutrition rates in East Asia, with an average daily intake of only 1,980 calories, even lower than that of famine-stricken North Korea (2,390 calories). Malnutrition in Cambodia is chronic, says the WFP's acting country director, Ken Noah Davies. You could call this a silent emergency, or you could call this a national crisis.

The scope of the problem bears out that dire warning. Although hunger is especially acute in the countryside, even Cambodia's relatively affluent urban population suffers disturbingly high rates of malnutrition. The most recent data released by the Ministry of Health reveal that in 1996, nearly 34% of children below the age of five in this upper-income group were moderately underweight and 21% severely stunted. The results suggest that not only income, but also sociocultural factors may contribute to the underfeeding of children. For traditional cultural reasons--breastfeeding from birth is seen as taboo--Cambodian women are often reluctant to suckle their newborns immediately, waiting several days and thereby depriving infants of highly nutritious colostrum, or first milk.

Much of the difficulty in feeding kids properly stems from the devastation wrought by the Khmer Rouge. Pol Pot's mad attempt at transforming the country into a vast agrarian commune destroyed its irrigation system, which had made Cambodia a net rice exporter in the 1960s. Since most farmers no longer hold formal title to their land--eliminated at the time, along with private property--their fields are vulnerable to takeover by soldiers and local thugs. And the sundering of countless families has disrupted the passage of traditional knowledge from mother to daughter. In some outlying districts, many women have 10 or more children; some are either unaware of birth control techniques or unable to afford condoms. Nobody comes to explain to them about healthcare, says Kao Chheng Huor, head of the WFP office for the provinces of Kampong Thom and Preah Vihear.

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But in Kampong Thom, which according to the joint UNICEF/WFP survey suffers the highest rates of child malnutrition in the country, it quickly becomes apparent that the heart of the problem is mind-numbing poverty. I had no choice. I had no other way except to send my children away, says Hol Ny, her eyes wet with tears. The 40-year-old widow, bereft of land or cattle, recently allowed three of her six children to go work for other families, some of them total strangers; the $15 she received per child must feed her and her three youngest for the next year. In her village of Srayou Cheung, at least six other families have similarly sold their children into bonded labor; some say they have had to forage in the forest for food. Hol Ny's neighbor, a 41-year-old divorcee named Pich Mom, sold her two sons for two years each. I was sick and couldn't earn any money, she says. It's hard for me to live without my children, but I think I did what was best for them.

For the past four years, Cambodia has actually recorded a small rice surplus--estimated to reach 30,000 tons this year. This bounty, however, is distributed poorly, and many farmers simply cannot afford to buy what is available. (In a country with a per capita income of only $300 a year, about 36% of Cambodians live below the official poverty line; last year the WFP assisted 1.4 million people, 15% of the population, with its food-for-work program.) Even those who have rice often have little else--perhaps a little salt, or the fermented fish paste called prahoc--to round out the dish. That little is not nearly enough: rice, while high in calories, has relatively few nutrients.

The WFP says Prime Minister Hun Sen was shocked by the U.N. surveys, and he now insists that eliminating malnutrition is a top priority. Now that the fighting is over, we expect everyone to work on this issue, says Nouv Kanun, the energetic secretary general of the newly created Council for Agriculture and Rural Development. A conference of Cabinet ministers and provincial authorities last month endorsed a 10-year, $90 million plan to tackle the root causes of malnutrition, focusing on crop diversification and awareness campaigns about nutrition, health and hygiene. Still, the damage that is already evident will plague Cambodia for years to come. If you are malnourished from six months until you are five, you are going to be handicapped for the rest of your life, warns Davies. You will never be able to develop your full mental or physical capacity. Perhaps now that warning can be heard.

Reported by Caroline Gluck/Kampong Thom

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