Over the past five years, Community-based Therapeutic Care (CTC) has carved a niche for itself as an effective and sustainable way of providing selective feeding services in emergencies. From its first implementation in Ethiopia in 2001, CTC has sought to break away from traditional centre-based, inpatient treatment of severe acute malnutrition. The results so far have been very positive; CTC programmes in Malawi, Ethiopia and South Sudan have consistently shown high coverage, high recovery and low defaulter rates. Much of this success can be attributed to the active role that beneficiary communities have played in the planning, implementation and handing-over of CTC programmes. Sceptics, however, doubt that this level of community involvement and participation is feasible during a complex emergency. These doubts stem from two fundamental, if not altogether evidence-based, assumptions: first, that communities disintegrate during complex emergencies, especially when population displacement is widespread; and second, that even if communities survive these conditions, community mobilisation is a time-consuming luxury for programmes struggling to address urgent needs. The CTC experience in Darfur shows that these issues are more complex than previously anticipated.
Communities in war and peace
In humanitarian circles, and emergency nutrition in particular, the feasibility of community engagement during conflict and population displacement (as in IDP or refugee camps) has been persistently questioned and contested. The critics main argument has centred on the belief that, as communities fragment under the shock of conflict and displacement, community participation and/or mobilisation becomes unfeasible. This commonly-held view has meant that community-based interventions such as Community-based Therapeutic Care (CTC), a domiciliary approach for treating severe acute malnutrition have met with scepticism from practitioners and donors. This scepticism, however, stems from a narrow definition of what communities are a definition that in practical terms bears little resemblance to the evidence and information emerging from humanitarian operations.
The notion of community is in reality so broad and multifaceted that it continues to divide social scientists and their disciplines. In its simplest sense, a community is a group of people that identify themselves with common ideas, beliefs and practices. Although physical places and localities play a role in the definition of a community, they are rarely fundamental to the sense of identity among its members. Community is, in other words, more about internal factors (shared ideas and relationships) than it is about external manifestation (home villages, landmarks, cultural sites). The manner in which communities react to famine, conflict and displacement attests to this and the current conflict in Darfur offers one of the clearest case studies in this respect.
Over the centuries, the traditional boundaries of Darfurs tribal groups, such as the Zaghawa, Fur, Massalit, Jebel and Arawga, have shifted and overlapped. The conflict in Darfur between different sections of these groups has led to cross-border migrations, as well as internal displacement and relocation around urban centres. The result has been the creation of socio-culturally heterogeneous IDP camps throughout Western Darfur. The camps in and around the town of El Geneina, for example, host an average of over ten different sub-groups, most of them with their own languages. The result of migrations, displacement and interaction between the groups has been mixed; although ethnic identities and communities (at village and camp level) have survived, new communities have also been created. Violence and displacement have forced the congregation of many previously unrelated and often antagonistic groups within the camps. Although there are occasionally tensions, groups and villages have re-formed to make large communities under common, or parallel, leaderships. The shocks to the social fabric of each group have not led to their disintegration as communities; rather, they have forced each community to reassemble and recreate itself around structures (such as leaders) and practices (language and beliefs) that lie at the centre of their identity. For emergency nutrition programmes such as CTC, the implications are clear and significant. Communities, in a broad sense, can endure social disruption. If appropriately approached, they can potentially be incorporated into community-based responses.
Mobilising communities during emergencies: old challenges, new responses
Accepting that communities can recreate themselves in order to outlast famine, conflict and displacement suggests that they could play a more direct role in humanitarian interventions. This leads to the critical and somewhat awkward question of why communities generally only play a marginal role in humanitarian interventions.
The first answer may be that we do not know enough about the communities we are trying to help. Engaging and mobilising communities carries potential risks, in that it may validate discriminatory or predatory political structures and politicise aid resources. This implies the need for a clear understanding of the population prior to, during and after the crisis, and a strategy that includes as wide a range of community representatives as possible. Many humanitarian programme staff, however, argue that it is virtually impossible to get an accurate picture of the situation on the ground, even through discussions with the local residents of displaced populations.
Another possible explanation may simply be that developing an effective and transparent relationship or rapport with communities is too time-consuming. Achieving genuine rapport over vast rural areas through conventional methods, such as community meetings, health education sessions, surveys and participatory rural appraisal (PRA) investigations, would be both prohibitively expensive and too slow for emergency programming. For community-based interventions such as CTC, however, establishing an effective relationship and creating a pool of accurate information about the community is central to the success of the programmes, even during complex emergencies. As a result, CTC has developed a strategy for cultural understanding and community mobilisation that is rapid, carefully targeted and specially designed to identify and link key features of the community such as local channels of communication and socio-political networks with nutritional interventions.
Community mobilisation and the CTC: the strategy in Western Darfur
The CTC programme in Western Darfur was jointly implemented by Concern Worldwide and Valid International in the summer of 2004. The programme initially focused on the area in and around El Geneina at present, the programme covers a number of IDP camps in El Geneina (such as Riyadh, Ardamatta and Abuzar), Krenig and in the Selea/Kulbus corridor. As with most CTC programmes, the concept of community has been vital: the communitys involvement in the identification and care of malnourished children is at the core of CTCs attempt to reach all eligible children. Recognising cultural differences and variations between communities is just as important, and community mobilisation strategies have therefore been tailored to the context. In Darfur, key aspects of the community had to be identified and incorporated into the planning, implementation and assessment of programme activities. These include the identification of key community figures, formal and informal channels of communication, community groups and organisations (to facilitate local integration), as well as gathering data on health attitudes and health-seeking behaviour. This process, often referred to as cultural understanding within the CTC, is complex at the best of times; in Western Darfur the challenges were considerable.
In the first three months of the CTC programme, from August to November 2004, CTC community mobilisers gathered sufficient data to enable a rapid social mapping of all the IDP camps in and around Al-Geneina, the main urban centre in Western Darfur. Mapping out IDP communities in Western Darfur was made possible by the unique operational arrangements of the CTC programme: while medical NGOs were in charge of in-patient treatment for complicated cases, other NGO partners were able to concentrate on the social aspect of the programme without jeopardising its health impact. The socio-cultural data collected facilitated the planning of activities designed to involve the community as widely and as comprehensively as possible in the dissemination of information about CTC, the target population and the services available. Primary health, health education and water and sanitation programmes carried out by other NGOs were also linked with the CTC programme, creating a network of volunteers and referral points (in the communities and at health centres). This two-pronged approach was designed to inform the community about the CTC programmes through local structures, and to actively identify malnourished children through these structures and other aid programmes.
The results of community mobilisation in Western Darfur were positive. In terms of resources, the process was led by a small local team (including an IDP) that was able to move widely throughout the area, and engage freely with key community members. For operational reasons the process of community mobilisation extended for over three months. In hindsight, the main core activities could have been effectively conducted over a 46-week period. The lessons learned in Darfur will help improve the mechanisms and the timeliness of future strategies. By relying on the community and existing volunteer networks, information about the CTC programme was spread widely and rapidly to those in need. By January 2005, only two months after the first round of mobilisation activities was completed, a coverage survey concluded that 75% of severely-malnourished children and 64% of moderately malnourished children in the El Geneina area (including the main IDP camps) had enrolled in the CTC programme. These results were comparable to CTC programmes in more stable settings, and may testify to the role of community mobilisation in increasing programme uptake.
The value of community mobilisation in CTC programmes lies not only in its practical applications (to increase programme coverage) but also in its ability to influence CTC programming at a higher level. The process of community mobilisation helps formulate an impression of the population that needs to be recognised as sufficiently reliable to directly inform CTC strategic planning. In Western Darfur, for example, discussions held with the community revealed that villages surrounding the larger urban centres needed to be more actively included in sensitisation and mobilisation activities. The constant population movement between the camps and the nearby villages and fields strongly suggested that the identification and follow-up of children had to be extended beyond the limits of the IDP camps and the larger settlements in order to remain effective. Such a response, however, has much wider implications most of the humanitarian assistance in Western Darfur, with the notable exception of ICRCs programmes, has focused on the IDP camps. Community mobilisation, by definition, will always be rooted in the ideas and needs of the community, and the conclusions drawn from engaging with communities may at times require significant changes in programming. The challenge for implementers will be to effectively respond to the situation presented, bearing in mind the programming objectives as well as the practical implications of such changes.
Lessons learned in Darfur are unlikely to change the CTCs focus on engaging with communities during nutritional emergencies instead, these lessons will help reformulate and strengthen existing community mobilisation approaches. As aid agencies begin to contemplate the next steps of their work in Darfur, understanding how to react to the complexities of the conflict will become increasingly necessary. For community-based programmes such as the CTC, the challenge will be to stay in tune with changes and shifts in communities. The groundwork laid by initial mobilisation efforts will require regular reappraisal, and plans and practices may occasionally need to be rewritten all in an effort to continue improving programme coverage and maximising its positive impact.
Meanwhile, we have learned much in Darfur about how community mobilisation can and should be integrated with programming decisions. Among these lessons is the need to see displaced people as active partners in any emergency response. This is likely to remain a daunting and difficult task, but the experience and lessons learned in emergencies such as Darfur will prove vital in developing effective mechanisms to bring this about in the future.
Saul Guerrero is a community and social development advisor with Valid International. Over the last two years, he has worked on community-related issues in CTC programmes in Ethiopia, Malawi and South Sudan. Since 2004, he has been involved with a number of CTC programmes in Western Darfur. His email address is: email@example.com.
Simon Mollisonalso works with Valid International. He has been involved in relief and development work for over 20 years. He first worked in Darfur between 1985 and 1990, and returned there in 2004. His email address is firstname.lastname@example.org.
References and further reading
Steve Collins, Community-based Therapeutic Care: A New Paradigm for Selective Feeding in Nutritional Crises, HPN Network Paper 48, November 2004.
Alex de Waal, Famine that Kills: Darfur, Sudan (Oxford: Oxford University Press, revised ed., 2005).
Carolyn Nordstrom, War on the Front Lines, in Carolyn Nordstrom and Antonius Robben (eds), Fieldwork Under Fire (Berkeley, CA: University of California Press, 1995).
K. B. Wilson, Internally Displaced, Refugees and Returnees From and In Mozambique (Uppsala: Nordiska Africainstitutet, 1994).