GIHEMBE CAMP, Rwanda – The elderly woman cupped maize in her outstretched hands, raising her arms up high in the air and crying out as if pleading for help. Then, she crouched down and swayed her hips, while spitting at the ground to recreate the sound of explosive, gassy diarrhea.
The woman – I will call her Mama Solange to protect her identity – is one of some 14,000 Congolese refugees living in the Gihembe camp in Rwanda, established in 1997 to shelter people fleeing conflict in the eastern Democratic of Republic of the Congo.
For almost two decades, refugees living in the United Nations-administered camp have complained that the food rations distributed by the World Food Program (WFP) are making them sick.
This is what Mama Solange was trying to tell me with her bold bodily performance when I met her in 2011. I had been in Gihembe since 2010 conducting ethnographic fieldwork on how the absence of sufficient clean food affects the lives of people who are stuck indefinitely in the camp.
While public attention has recently oscillated toward the new crises fueling displacement, especially in Syria, a significant number of the world’s refugees live in camps for years on end.
For the residents of Gihembe, protracted displacement has meant accepting less than hygienic or sufficient food rations, even though the refugees and humanitarian workers alike recognize that sickness is widespread and hunger is routine.
Food rations of maize and beans often arrive in a moistened state, slowly rotting, with a decaying stench and festering with weevils. While rarely deadly, the ensuing sickness causes unpleasant bouts of illness and longer-term health problems.
Several logistical dilemmas and ethical lapses contribute to this problem.
Sometimes, food shipments are damaged by rain over long transit routes across multiple countries. At other times, farmers illegally swap out their rotting food with the clean food on the delivery trucks. Competition for food among the local population and the refugees has exacerbated the struggle.
It is also hard to get good sources of protein in the camp. Milk, eggs and other vitamin-rich foods are luxury items that are impossibly expensive to purchase on a regular basis. Even if refugees are able to purchase a chicken or a goat to raise them for eggs and milk, they lack the tools and resources to feed and maintain such animals.
The refugees I met in Gihembe repeatedly referred to kwashiorkor, a form of malnutrition related to protein deficiencies.
They know the symptoms well: children with severe kwashiorkor will turn red in color, and their hair takes on an amber glow. In the worst cases, their hair becomes straight “like the white peoples!” as refugees described the symptom to me.
Refugees also use other indicators for self-diagnosis: the way a child’s ankles, cheeks and bellies puff out, giving the illusion of health or even of excess weight, until other indicators of sickness begin to show. Doctors notice that the severely malnourished children’s heads are large relative to their bodies and their body parts swell up against their fragile skeletal frames. Many children in Gihembe are much smaller than same-aged healthy children across the globe.
It is alarming to note that the immediate neighbor to the WFP’s food ration distribution facility is the camp’s malnutrition center. But on most days when I visited the small concrete building was empty, with unused beds lined up in tidy rows.
In a place where there are so many food deficiencies and hunger-related illnesses, how does humanitarian intervention deal with insufficient food rations and the simultaneous need for centers to treat those suffering from the lack of clean food?
Despite my time spent there, answers about long-term solutions were scarce.
Humanitarian health workers told me that only when multiple children come into the center with fatigue, cold or flu-like symptoms, or diarrhea and vomit, are they able to tally the numbers of these cases. Following initial visits by the sick children, health workers will likely ask the mothers to visit the center. In cases where the mother is the one who is most sick, workers have observed she often brings along a small baby, who will usually receive an extra protein powder or maize porridge, beyond the regular rations.
The efforts of the malnutrition center are not enough to protect the children’s health. The work of the center is at best a humble humanitarian attempt to correct a problem that is well known among larger humanitarian agencies like the U.N. refugee agency (UNHCR) and WFP, and one that even local government officials acknowledge.
There is simply not enough food in Gihembe and clean food is particularly lacking.
Gihembe residents also routinely discuss other challenging and often embarrassing signs of poor food quality in the camp.
For instance, I noticed older children in the camp cutting their smaller siblings’ hair, and in the process rubbing off the scaly patches of fungi that grow on their scalps. The patches are rough and whitish, and do not just wash off with water or soap. Such skin fungus is ubiquitous among the younger children in the camp. A few of the luckier children receive small amounts of cream or Vaseline to diminish the external appearance of the infection.
Neither the refugees nor the health experts in the camp know what causes the fungus, besides malnutrition and what they describe as “the bad life.”
After spending time in the camp, it became evident to me that the various chronic illnesses are an embodiment of the perpetuating conditions of hunger. It is not the case of one specific disease that can be precisely diagnosed or cured, especially given the resource constraints of administering the camp in the long term.
While there are no easy remedies to improve the quality of lives in Gihembe, refugees often claim that the “real solution” to their current problem is to return home to North Kivu in the Congo and to resume their old lives where, they say, they “never lacked anything.”
Meanwhile, Mama Solange was left with little choice but to narrate the bodily perils of living in the camp to me, perhaps taking me for a humanitarian worker or at least a new person to share her problems with. She attracted a crowd of young children who applauded and giggled at her performance.
Then, she finished, got up and without speaking a word, released us from her intense gaze and silently entered her house made of mud and plastic. The door slammed shut.
The views expressed in this article belong to the author and do not necessarily reflect the editorial policy of Malnutrition Deeply.
This article originally appeared on Refugees Deeply.