Famine

by

Daniel Maxwell, Merry Fitzpatrick

• LAST REVIEWED: 24 July 2018
• LAST MODIFIED: 25 October 2012
• DOI: 10.1093/obo/9780199846733-0083

Introduction

Famine is now generally described as an extreme crisis of access to adequate food, manifested in widespread malnutrition and loss of life due to starvation and infectious disease. The use of the term is controversial, however, in part—at least until recently—because of the lack of a technical definition of famine but also because the term has the power to provoke political responses that similar terms such as “humanitarian emergency” or “food security crisis” do not. Not all perceptions of famine—particularly of those directly affected by it—involve widespread mortality but rather the experience of hunger and destitution by large numbers of people. Famines have long been thought of simply as food shortages and as time-bound events, usually the direct result of some triggering factor or shock. These shocks can be droughts or other “natural disasters,” wars or violent conflict, or they can be other political or economic shocks that don’t necessarily involve militarized conflict. Other characteristics of famine include destitution and distress migration in search of food or employment. More recent understandings of famine emphasize that heightened levels of malnutrition and mortality are the result of cumulative processes that can be predicted, and therefore prevented, through timely public action. Contemporary understandings of famine emphasize that while triggering factors can be “natural” or “human,” the actual emergence of famine represents a failure of public policy and collective action. Since the 1970s, major emphases have been on the establishment of famine early warning systems, investment in strategic food reserves, and the growth of humanitarian agencies capable of quickly intervening to prevent or mitigate the impact of famines. Nevertheless, famines continue, with several manifestations occurring already in the 21st century—the most recent and most severe of which was in Somalia in 2011.

Classification of Famines and “Famine Thresholds”

Though described in terms of inadequate availability of or access to food, famines are frequently technically defined in terms of malnutrition and mortality. Sophisticated classifications also consider morbidity, food consumption, and destitution. Famine classification is most often concerned with the prevalence of wasting—low weight for height of children under the age of five years (global acute malnutrition)—and the crude death rate. Howe and Devereux 2004 proposed a “famine scale,” suggesting a crude death rate greater than one person per 10,000 people per day and a prevalence of global acute malnutrition greater than 20 percent constitute “famine conditions,” with higher death rates and prevalence of malnutrition denoting more severe manifestations. They also suggest a scale for the magnitude of famine based on total mortality. The Integrated Food Security Phase Classification manual (Food and Agricultural Organization of the United Nations 2008) is the most widely used technical reference for famine classification. This system (see Integrated Food Security Phase Classification System) emphasizes three thresholds for famine: a crude death rate greater than two persons per 10,000 people per day; the prevalence of global acute malnutrition greater than 30 percent; and more than 20 percent of households facing extreme food deficits, with no ability to cope. Hakewill and Moren 1991 suggests that mortality, morbidity, and nutritional status should all be monitored but offers no specific threshold for prevalence of acute malnutrition or morbidity. The authors suggest a death rate of 5 per 10,000 per day as the cut-off point to determine famine conditions. Toole and Waldman 1988 focuses more on the change in indicators in comparison to a (pre-famine) baseline, noting that the doubling of a crude death rate constitutes a “serious crisis.” Young and Jaspars 2009 emphasizes in particular the exponential relationship between malnutrition and mortality (as the prevalence of malnutrition increases, the likelihood of death increases exponentially). Checchi and Roberts 2005 discusses various ways to calculate mortality and their implications for response. Extreme levels of both malnutrition and mortality have been reported in recent famines in which measurement of both was possible. The prevalence of global acute malnutrition (GAM) was reported to be as high as 73 percent in some areas of Ethiopia in 1984 (Kloos and Lindtjorn 1994). Howe and Devereux 2004 notes a crude death rate as high as 26 per 10,000 per day during the 1998 Bahr el-Ghazal famine. Each of these resources has added to the current protocols most often used in measuring famines.

• Checchi, Francesco, and Les Roberts. Interpreting and Using Mortality Data in Humanitarian Emergencies: A Primer for Non-epidemiologists Humanitarian Practice Network Paper 52. London: Overseas Development Institute, 2005.

  Chapter 2 of this report discusses at length different mortality thresholds used by various agencies. The authors question whether mortality thresholds should be relative to local baselines (“excess mortality”) or should use a universal empirical threshold. Other chapters discuss how mortality is measured, possible sources of bias, and political implications of mortality rates.

• Food and Agricultural Organization of the United Nations. Integrated Food Security Phase Classification (IPC) Technical Manual Version 1.1. Rome: Food and Agricultural Organization of the United Nations, 2008.

  This manual, developed with input from practitioners and academics, provides the first widely accepted thresholds for labeling levels of food insecurity, including a threshold for famine. The classification includes detailed thresholds for each phase, as well as descriptions for improving transparency in phase declaration to allow greater confidence in the declarations, and to enable timely, more appropriate responses. Version 2.0 was released in 2012.

• Hakewill, P. A., and A. Moren. “Monitoring and Evaluation of Relief Programs.” Tropical Doctor 21 (1991): 24–28.

  Hakewill and Moren emphasize the need for collecting health and nutrition data during a crisis and presenting it in easily understood graphics. They do not suggest a malnutrition threshold to define a famine, but suggested a crude death-rate threshold of 5 per 10,000 per day.

• Howe, Paul, and Stephen Devereux. “Famine Intensity and Magnitude Scales: A Proposal for an Instrumental Definition of Famine.” Disasters 28.4 (2004): 353–372.

  DOI: 10.1111/j.0361-3666.2004.00263.x

  Previous definitions of famine were no more than subjective descriptions. Howe and Devereux propose scales with clear benchmarks, showing that clarity in defining famine is necessary to ensure appropriate responses and accountability for creating or failing to respond to famine. These scales are the basis for the current IPC definitions.

• Integrated Food Security Phase Classification System.

  Classification of food security systems is the basis for setting objective thresholds to predict and declare famines. The Integrated Food Security Phase Classification System (IPC) website provides documentation about the phase classification systems and current information on each of the fifteen countries and two regions using the IPC.

• Kloos, Helmut, and Bernt Lindtjorn. “Malnutrition and Mortality during Recent Famines in Ethiopia: Implications for Food Aid and Rehabilitation.” Disasters 18.2 (1994): 130–139.

  DOI: 10.1111/j.1467-7717.1994.tb00294.x

  Kloos and Lindtjorn note that some of the highest levels of malnutrition ever measured occurred during recent Ethiopian famines. However, they do not translate their observations into suggestions for the future measurement or analysis of famine.

• Toole, Michael J., and Ronald J. Waldman. “The Association between Inadequate Rations, Undernutrition Prevalence, and Mortality in Refugee Camps: Case Studies of Refugee Populations in Eastern Thailand, 1979–1980, and Eastern Sudan, 1984–1985.” Journal of Tropical Pediatrics 34 (1988): 218–224.

  Whereas most discussions of thresholds rely on an absolute measure, Toole and Waldman suggest the emphasis should be on changes in undernutrition and mortality in relation to a pre-crisis baseline. Using this kind of analysis, they advocate for more attention to rations provided in refugee settings.

• Young, Helen, and Susanne Jaspars. Review of Nutrition and Mortality Indicators for the Integrated Food Security Phase Classification (IPC): Reference Levels and Decision-making. Geneva, Switzerland: United Nations Standing Committee on Nutrition, 2009.

  Young and Jaspars review a number of indicators to help define thresholds for the IPC (including but not limited to the definition of famine). Indicators include crude death rates; under-five death rate; low weight for height (wasting); low height for age (stunting); under-five mortality rate; and mid-upper-arm circumference (MUAC). They suggest a famine threshold of 5 per 10,000 per day. They also suggest looking at the duration of a crisis as an indicator.