Never throughout history has there been a time when there has not been a devastating famine in some part of the world. In our lifetime, widespread starvation in Asia, Europe, Africa and Latin America has taken the lives of millions of men, women and children. We know that somewhere, this year, there will be a new famine-the result of war or a major national catastrophe. Already there is starvation in the Sahel area south of the Sahara, and the threat of renewed serious crop failure in the Indian subcontinent. The presently bad-and worsening-state of the total world food supply, particularly the depletion of grain reserves in the United States and the shortage of the fertilizers needed to maintain the "green revolution" as a result of high oil prices, leads one to expect that the extent of any new famine will indeed be catastrophic. Historically we have proved ourselves ill-prepared to cope with famines. How well can we hope to deal with them in an even less propitious situation?

Up to now, individual nations, international voluntary agencies, and especially official international organizations have dealt with the specter of mass starvation as an unexpected crisis-as something to react to when it occurs rather than as a likelihood to be planned for in advance. Prevention has been the exception rather than the rule; Bihar in 1966-67, to be discussed later, remains the lone shining example of a large famine averted. Moreover, we act on the occasion of each famine as though mankind had no collective memory. Whoever is faced with the present famine usually acts as though there were no lesson to be derived from the melancholy succession of previous famines and previous efforts to cope with them.

Yet previous famines should have left one beneficial residue: there are individuals and organizations that have acquired firsthand knowledge of successful-and unsuccessful-ways of coping. So little is ordinarily taught of the physiological, psychological and social problems arising in famines, and of their solutions, however, that each new group of physicians and administrators who are generally called upon to deal with a new catastrophic situation tends to repeat some of the classic errors of omission and commission.

Today, we need, and are technically able to create, an organization that institutionalizes human memory in dealing with starvation. Over time we have made discoveries in compassion as well as in management and technology. For many centuries starvation was essentially inevitable, largely because means of information and means of transportation were not at hand. That there was some food somewhere else on the same or another continent was basically irrelevant: there was no way of delivering it when it was needed or of distributing it to the starving. We now have the technology to keep the whole world under surveillance and transmit early warnings of impending shortages; we can transport the food to the area of famine. Therefore we have obligations that did not exist in past generations.

II

For action purposes there is a sharp difference between a state of chronic starvation, which is endemic in some sections of certain populations, and a true famine. However precarious their previous state of nutrition may have been, the people involved feel and act differently in a famine; they become acutely conscious that something of a different order of magnitude is happening.

A true famine is unlike anything else. It can be defined as a severe shortage of food accompanied by a significant increase in the local or regional death rate. In a chronic starvation area people may suffer and be crippled mentally and physically; in a true famine they die in large numbers.

Almost all recorded famines have resulted from widespread crop failures.1 These, in turn, may be caused by drought, crop diseases or pests, the impact of war or civil disturbance, or a combination of disturbances hitting both crops and farmers, such as floods or earthquakes. All these four sets of causes have been at work in the famines that have occurred since 1950 alone: flood, drought and civil disorder in India and Pakistan; locusts and earthquakes in the Middle East; floods and dislocation of the agricultural system in China; earthquakes in Latin America (including the recent Peruvian disaster); and drought and civil war in Africa (the Sahel, the Congo and Biafra).

All of the causes of crop failure and famine are very much alive in the world today. The most threatening, and growing, is now drought. Some scientists are saying that changes in climate have shortened the growing season and reduced the rainfall that we may now expect in key areas such as India and northern Africa. Whether this is true or not, the large areas of the world where rainfall is highly variable and seasonal are inherently drought-prone. In Western Europe or New England a dry year differs from a wet year by less than 20 percent; in immense land areas elsewhere, the variation may be 80 percent, and drought years may alternate with years of flood, when gigantic continental rivers, swollen by excessive rains in the mountains, burst their banks and destroy all crops.

Apart from their climate and natural characteristics, many nations and areas are particularly vulnerable to famine by reason of lack of communications or social inequality. Chinese famines of the past were due largely to the then-primitive transportation system, and lack of adequate communication is a major aspect of the current Sahel famine. These problems exist in many poor countries. Virtually all such countries are examples of social inequality and of the resulting defects in nutrition for large sections of the population. It may be useful to remember that in as rich a country as Britain in 1935, with an average intake of 2,000 calories daily, at least ten percent of the population was underfed to the point of growth retardation, and 40 percent ate a diet that was demonstrably too low in certain vitamins. Obviously, in a country like Egypt, where biblical farming methods can still be seen in operation not many miles from the modern capital, social inequalities and malnutrition are even more acute.

To move from causes to consequences, by the above definition the main and most immediate effect of famine is widespread deaths from starvation. The number of deaths is a good index of the severity of the famine, and conversely a drop in that number an index of the effectiveness of the measures employed in combatting it. It has been observed repeatedly that in famines old persons and young children die first, and that women and adolescents tend to survive better than men (although adolescents suffering from prolonged undernutrition are particularly susceptible to tuberculosis). For purposes of dealing with a famine, "old age" starts at about 45 years old. From then on, there is a drastic increase in mortality as compared with adult men and women below that age.

A second, and dangerous, consequence is the state of social disruption, including large-scale panics, that usually accompanies a famine. Generally people who are starving at home tend to leave it if they can and march toward the area where food is rumored to be available. As a result, families are separated and children are lost. The small children often reach a suicidal state of mind from self-inflicted starvation, refusing to eat because of their grief at the absence of their parents. Adolescents, finding themselves on their own, band together in foraging gangs that create further disruption. (Prolonged and successful practice of banditry also makes members of these gangs difficult to rehabilitate when the famine is over.) This breakdown of the social order makes any relief measure that much harder to put into effect.

Contrary to popular belief, however, famines (and, for that matter, prolonged severe undernutrition) are rarely accompanied by revolution. The gravely underfed usually are too feeble and too preoccupied with problems of immediate survival to summon up the energy, single-mindedness and organization required to initiate and follow through with a revolution. The type of disruption accompanying famine is more likely to entail a large number of unconnected antisocial acts, or, at most, regional jacqueries. In turn, revolutions are more likely to take place when food has been again available for some time, but while the memory of the actual or supposed corruption or incompetence shown by the government in dealing with the famine is still fresh. The experience of flood in Pakistan in 1970 contributed directly to the secession of Bangladesh in 1971.

A third common catastrophic result of famines is the spread of epidemics. The combination of physiologically-weakened human organisms and a disrupted social organism, with the attendant breakdown of public-health institutions and crowding, lends itself to the explosive spread of infectious diseases. Louse-borne typhus has been the traditional post-famine disease of Europe, cholera and smallpox the post-famine diseases in Asia, although plague, influenza, tuberculosis, relapsing fever, and many other diseases have also followed famine. When famine is due to a drought, malaria is not usually rampant at the same time, but is often deadly on a particularly large scale when the rains finally come.

One last, long-term, consequence of many famines is the death of large domestic animals, often on a greater scale than that of humans, and the destruction of seeds for future crops, making it more difficult for farming to return to normal when the famine is over. (The Sahel famine is the most recent example of both points.) If one is to speak of coping with famine, one must include follow-on measures to restore the food supply and rehabilitate the area-or if this cannot be done, to resettle the population elsewhere.

III

To one degree or another, any famine situation has an element of politics. The nation or nations that contain the famine area must summon large quantities of help, which in an India or a China may come from other parts of the same country but which must usually come from outside. Thus international official organizations, notably UNICEF, the Food and Agriculture Organization (FAO) and the World Health Organization (WHO), are almost always involved at an early stage, while international voluntary agencies (such as CARE and church groups) may become substantial sources and channels for relief. Finally, there are the individual outside nations that alone can furnish really large quantities of food, medical supplies and transportation.

Unfortunately even a crisis such as famine does not mean that all these various political bodies necessarily work in harmony either with each other or within themselves. For professional men trying to get on with the job, these political frictions are acutely painful; I shall say more about them later, especially in discussing the good example of Bihar and the rather grim one of the Sahel, and the lessons to be learned. Suffice it for the moment to make the obvious point: some adjustment and cooperative arrangement between the political entities involved is the first essential for coping with a famine-if this is smooth, all else becomes much easier; if not, the drag is immense.

The second obvious requirement is the procurement of food in amounts adequate to stop the developing famine, maintain the population in balance, and eventually rehabilitate the population. Food must be obtained through buying or otherwise acquiring it and moving it to the affected area. In spite of the efforts by some of the leaders of FAO, such as John Boyd Orr and André Mayer in the late 1940s, a World Food Bank or regional food banks for emergency situations have not yet come into existence. There is thus no universal and automatic pathway for famine relief. In the past, the availability of large surpluses of cereals in the United States, Canada, France, and other countries made relief possible; yet in spite of the creation of such national organizations as Food for Peace in the United States, the actual process of relief was often slow and cumbersome. Now the sharp reduction in North American food surpluses has created a potentially serious situation for famine relief efforts.

The third fundamental element in any famine relief effort is a clear-cut line of command and assignment of responsibility. Even under the most advantageous political conditions, in a country at peace and with a stable government, starvation causes intense political pressures. Typically, the opposition says poor government planning is the cause of the famine, government incompetence and corruption the causes of its continuation. Government sources accuse the opposition of presenting a picture far worse than the reality, of minimizing the effectiveness of relief efforts, and of starting disruptive rumors which further complicate the carrying out of relief programs. Unlike the more distant government authorities, relief personnel rapidly find themselves in the middle of a difficult argument, in which they present the government's side to the victims, while they vehemently take the victims' case to the government. Even in a democracy, a famine is a special situation.

For these political reasons alone, the local authorities are usually in a poor position to run a relief operation properly. Moreover, such an operation, if it is of any significant size, requires able, decisive leadership with high managerial skills. Thus I, for one, am convinced that by far the best method of organization is to have the relevant political entities come together in the appointment of a single "relief dictator." Even fairly ancient history (to younger people) teaches us something here: Herbert Hoover's total control of relief to Belgium and Germany after World War I was by common consent largely responsible for the high degree of success of this pioneer effort in a threatened famine situation.

There is every possible advantage in the "relief dictator" being a member of the government or a high official of the country in the territory of which the famine is taking place. The U.N. country representative, or a person specially designated by the U.N. Secretary-General, can then coordinate, under the leadership of the relief chief, the work of the U.N. organizations and of the voluntary agencies. If a person not a citizen of the recipient country is put in charge, he should be detached from any previous tie-whether he comes from an international organization, a contributing nation, or one not directly involved. And while relief workers have to be dependent for pay and support on some single nation or organization, they should operate under the overall direction and control of the single director of relief. This would apply to the whole range of activities necessary to the relief organization, subject only to the obvious need to depend on cooperation from local government authorities who might be working at tasks (like running a railroad) not exclusively directed to the relief task. Similarly, although the director's word should ideally amount to a command to the supplying nations and organizations, in practice he (or she) would be dependent on their cooperation especially with respect to the furnishing and delivery of food and supplies as far as the affected area. For the most part, the commander of a relief operation must be on the spot.

IV

Whatever the command structure, the most immediate priority for the local administrator (or the representative of a benevolent power or organization) is to get a clear picture of the situation. With much of the structure of society breaking down, with rumors flying, with government sources generally minimizing the extent of the catastrophe and anti-government sources exaggerating it, it is often difficult to know where the most pressing needs are and what the scale of the need is. Certification of causes of death may be incomplete and late. Data on births may be unobtainable. The weakest persons, children and the elderly, in particular, may be staying indoors, so that the casual observer, seeing only adolescents and young adults walking about, may not realize the scope of the disaster.

All administrative and social agencies must be mobilized to gather and check statistical information. Hospitals and other health agencies must be asked to report causes of death as quickly as possible so that any increase in numbers of deaths due to starvation and the appearance of any deaths from epidemic infections can be detected early. Hospital admissions, numbers of persons in relief camps or in relief stations, are also important data. The rapid acquisition and analysis of such information are essential. At the same time, economic information is equally necessary: food stocks, prospects for harvest, rolling stock and trucks, fuel, repair shops, the state of roads and communications, money in private and governmental hands, and prices-all need to be followed closely.

Hence, the first requirement for a relief staff falls under the heading of intelligence. For this, enough persons with field training in statistics and epidemiology are needed, and use must be made of medical and paramedical personnel, teachers, and welfare workers for the rapid acquisition and analysis of information. Here computer techniques can be invaluable if the computers are manned by alert practical-minded personnel.

The next major job is of course the distribution of food and medical services. Here both method and personnel require comment.

Historically, distribution of available foods has been done through several methods. In the nineteenth century, and the first half of the twentieth, governments often attempted to improve the situation indirectly by conveying food to the merchants through the normal channels of trade, and making money available to the starving populace through public works projects. This policy was consistent with Adam Smith's laissez-faire philosophy, and enjoyed a certain degree of success when the shortages were local and foreseen. It failed miserably in large-scale disasters, such as the potato famine in Ireland, or the Bengal famine of World War II.

In such cases, it is a classic example of an error of commission. This method of relief benefits least the most vulnerable groups-the young, the very old, the pregnant and nursing women. In addition, the energy expenditure of men involved in the public works is increased, not only through the caloric cost of manual labor, but also because such works, usually road building, take place at some distance from their homes. The work is rarely useful: important public roads and other projects cannot be devised and executed properly on the spur of the moment. The roads usually lead "from nowhere in particular to nowhere in general."

Instead, the preferred method of food distribution should be to set up as many distribution points as possible close to the centers of starvation. These may pass out food commodities or prepared meals, and provision should also be made to allow such food to be doled out, under supervised conditions, to patients too weak to leave their homes.

The feeding system would deal with the particular local situation: food must be acceptable to the people in terms of food habits and religion. It should include special foods for special needs, also determined by the local situation. It would consist of a limited number of items, high in nutrients, and easy to transport, store and distribute.

Similarly, medical services must be decentralized just as much as possible. A large but distant hospital is an invitation to migration and thus makes relief more difficult. The creation of a mass of small "famine hospitals," even though they may be staffed only with auxiliary personnel and medical students, has proved to be invaluable in checking panic, vaccinating, delousing, disinfecting, distributing insecticides, informing the administration, and taking care of the greater number of the starving sick.

To man any system of distribution, both specialized and general-purpose personnel are needed. Obviously nutritionists and food scientists are important. Medical and public-health personnel should be used to working under difficult field conditions, and to diagnosing and treating those diseases which arise as the machinery of society breaks down. While a physician normally concentrates on the most gravely ill patients first, and then cares for those less affected, in a famine the goal is to keep alive as many as possible, and this may mean that a severely limited amount of time and attention may be given to desperately ill patients. The physician may have to learn to delegate much heavier responsibilities to medical students, nurses, or even intelligent laymen, than he would normally do. Here and all through the relief organization, there should, of course, be maximum use of local nationals who are still able to work.

This calls for a word about priorities in rationing. Ideally, food should be distributed (usually on a family basis) giving special consideration to the following priority groups: (1) the most physiologically vulnerable; (2) the main work force; and (3) the relief and administrative personnel. Inasmuch as intense work is going to be asked of relief and medical personnel, and because they will also have access to food in transporting and distributing it, it is unrealistic to expect a lot of work from people who are hungry and not expect them to worry first about themselves and their own families. Rather than have food disappear in all sorts of ways, it is better to have a policy in which rations are set midway between what these people would take on their own and what they would receive if they were on the same level as everyone else. You can then hope that this rule can be enforced.

The second aspect concerns an opposite effect. Experience has shown that particularly when you are dealing with conscientious and compassionate nurses, medical students and young relief personnel, you may actually have to make them eat. Otherwise your whole relief system disintegrates.

The next heading is logistics and communication. Sooner or later, transport becomes the limiting factor in any relief operation. Maintenance personnel are as essential as logisticians and drivers. Spare parts may have to have priority over food in some areas. I can think of no better way to turn swords into plowshares than to employ some top military personnel in this group. One thing a good general staff officer knows supremely well is how to move a lot of material and equipment and personnel in difficult situations and in a great many different localities.

In all this, it is vital not to neglect the importance of economic controls. Price control is an essential measure. Failure to institute or to enforce it vigorously is a classic example of error through omission when dealing with a famine. Without such controls, high prices discriminate against the persons most in need. Furthermore, inflation will create a motivation for traders to withhold food at what would normally be the end of the famine, in hope of perpetuating high prices.

We have already seen the need for economists in monitoring the famine, and the progress of relief. While a relief effort should never be directed exclusively by economists to the exclusion of nutritionists and public-health personnel, it is just as absurd to plan relief operations without considerable advice from different types of economists.

It is also crucial to maintain law and order, to prevent looting and other abuses. This means that local police units, like the relief and medical personnel, will be expected to contribute intense work, and should also be given preferential treatment as regards food distribution. The relief organization needs personnel for liaison with civil authorities, the police in particular. Police, as well as other civil authorities, are invaluable in carrying information flow in two directions: from the field to the central planning office, and back from the central authority to local authorities, to field personnel, and to the populace.

Finally, even while the crisis is at its most acute stage, planning should be going forward for rehabilitation and even development of the area. We should be fully cognizant that relief is not always enough, particularly when the situation is not transient, but of long-standing, as is the case in the Sahel. Long-term rehabilitation and development plans are essential, and it is equally essential that they not be conducted by personnel who are either unfamiliar with the local problems, or too highly specialized to take the entire situation into consideration. Rehabilitation and development are interlinked; whereas at the height of a famine both untrained enthusiasts and overspecialized experts can make significant contributions under competent supervision, for these broader tasks we require personnel with a global view as well as those with a specialized competence. People with backgrounds in soil management, development economics, agricultural economics, home management, and employment training come to mind.

All in all, a relief operation is an immensely complicated undertaking. In describing what is admittedly an ideal form of organization, I have left out any number of refinements that might be mentioned. Even the fundamentals I have listed are, unfortunately, terribly hard to achieve in practice. Let us look at a good case of famine relief and then at the relatively deplorable Sahel performance still underway.

V

A fine example of coping with and containing a famine was the national and international effort during the famine in India during 1966-67. What the Indian Ministry of Food and Agriculture feared would be "a natural calamity of a magnitude unknown in recent times" became instead the object of what The Washington Post later described as "one of the biggest and most successful relief operations ever undertaken." Of all the subcontinent, the eastern Indian state of Bihar was most affected by the drought and subsequent famine, and it was here that the relief activities were concentrated.

Bihar had at that time the second largest population of the Indian states-roughly equivalent to that of France. Its economy was, and is, almost entirely agricultural; about nine-tenths of its 52 million people were engaged in farming, and of the 27 million acres in crops, less than one-fifth were irrigated, and of these only about seven percent from sure sources. While Bihar sits on one of the world's largest reservoirs of ground water, digging of wells and irrigation schemes had been postponed or delayed for almost a decade; when the monsoon failed for two years in a row, crop failure was inevitable. Over the two-year period, Bihar fell short of needed grain by almost 30 million tons. Reserves of food grains, including those necessary for seeds, had been mostly consumed; the crop of the fall before was at best one-fourth of normal, the spring crop only one-half. In addition, the Bihar state's administrative apparatus was relatively unsophisticated, and it had no child-feeding program which could have been used as the base of a relief effort.

However, when the famine began, there were some bright spots. During the lesser drought of the previous year, the Indian government had set up fair-price shops and practiced the logistics of importing and transporting large quantities of grain; voluntary agencies had acquired experience in setting up mass feeding programs. Bihar itself had adequate storage and transportation facilities and an administrative structure that lent itself, especially in the Education Department, to relief operations. Moreover, ever since British times the Indian government had placed in the hands of its officials a comprehensive elementary guide to the handling of famines, called a Famine Code.

The basic priority of the Indian government was to obtain and dispense sufficient food. For this, three outlets were used: 20,000 fair-price shops distributed grain at fixed, subsidized prices; ten ounces of free grain were distributed each day to each aged or infirm person; and a child-feeding program provided one free meal each day to six million children and mothers. Members of the government, vividly aware, some of them for the first time, of the long-term personal and social effects of malnutrition, not only tended to favor the children in relief programs, but also speeded the development of a cereal-based, high-protein food, Bak Ahar, processed and packaged by Indian industry and distributed by the Indian government.

In the Bihar famine, the need for water was as great as the need for food. Lack of water threatened to cause the mass migration of villagers, thus destroying the food distribution system, in addition to posing health hazards in the hottest months of the year. To meet this need, the government began a program of well-drilling-some of the wells to be permanent, the rest of a more temporary nature, but each providing drinking water and irrigating half an acre of land through the driest period of the summer. Further needs for water were met by establishing an elaborate transport system, comprising modes of travel from railways to bullock carts.

Remembering the high death toll from cholera and smallpox during the Bengal famine of 1943, the government also disinfected wells and set up an immunization program. The response of the American government to the Indian request for vaccine, incidentally, was a model of promptness and efficiency-vaccine, injectors, and inoculation specialists to train Indians in their use arrived at Delhi five days after the formal request was made.

The government set up an information network that transmitted data by telephone or telegraph to a master control room where they were charted to give day-to-day information on food stocks and prices, water levels, disease rates and deaths, the numbers of people at free kitchens and on work projects, even the rate of local food looting. From this control center, field workers and the population were kept abreast of the changing situation by short-wave and public radio.

In addition, the government undertook to provide millions of dollars in loans to the Bihari farmers for the purchase of seeds, fertilizers, pesticides, and farm animals to rejuvenate the economy and prepare for the 1967-68 crop.

In all these efforts, the local Bihari government and the federal government of India were supported by supplies and cooperation from other nations, the United Nations, and international voluntary organizations. CARE alone set up 27,000 school feeding centers in Bihar to provide free meals to children and nursing mothers; the United States contributed one-fifth of its wheat crop.

In the end, the famine was contained. Instead of the millions of deaths predicted, the highest of the fairly reliable estimates was only a few thousand. It appears that among the poorest segments of society many were better fed during the famine than before-or perhaps afterward. The success of the emergency feeding program, especially in the health of the Bihari children (they were fed milk, and foods and food supplements high in protein, iron and other minerals, as well as vitamins, under fairly close supervision), led to a long-term commitment by the Indian government to the nutritional needs of the population. Even the work program, which certainly resulted, in some cases, in roads leading to and from nowhere, also sparked projects for more and better irrigation, field leveling, more efficient farming methods with higher yields, and better water conservation.

Despite the resolve of the Indian government to fight this famine with every possible resource, however, the struggle would have been hopeless without the dedicated cooperation of the international community. And even under these "ideal" conditions, as Alan Berg has pointed out, this "constitutes the first time in modern history that a government declared war on large-scale famine-and won." Despite its triumphant note, that is a melancholy statement.

VI

It is especially discouraging if we contrast Bihar with the disaster still taking place in the Sahel region in Africa. The area, just south of the Sahara, stretches from the west coast across the waist of the continent: about 4,000 miles across and 1,000 miles deep-approximately one-fifth of Africa. (Although Ethiopia is not geographically a part of the Sahel, it shares its climate and its problems.) The population of this area of advancing sand and dwindling vegetation has been estimated at about 50 million. About one-third have been affected by the drought; U.N. Secretary-General Waldheim estimates that as many as ten million people may be facing starvation throughout the area.

In all these figures, "estimate" is the proper word, for although there are many settled farmers in the region growing subsistence crops of sorghum and millet, the population is primarily nomadic, moving with their herds through the Sahel along centuries-old grazing routes. Even with sophisticated administrative machinery and experienced personnel, it would be difficult to determine the condition and needs of a population in motion. The governments of the Sahel area are newly independent, have very few highly educated or technically-trained personnel, and no administrative infrastructure ready to cope with the drought. (Ethiopia, of course, until recently existed as a medieval kingdom, and until U.N. officials and the world press forced it on their attention, the corrupt government of Premier Wold had refused to recognize the existence of the famine except as a money-making enterprise. Indeed, students had been killed in demonstrations asking help for the starving peasants.)

Of the 12 new African nations in the Sahel area, Mauritania, Senegal, the Sudan, Mali, Upper Volta, Niger and Chad are severely affected; and, to a lesser extent, Ghana, Togo, Dahomey, Nigeria, and the Central African Republic. Except for Nigeria, which is growing wealthy from its oil deposits, these are among the poorest nations in Africa. Niger's gross national product is $80 per capita, Upper Volta's only $60. And, in fact, their attempt at development of the Sahel in the 1960s was a precipitating factor in the subsequent disaster. Like Bihar, this area lies on a large reservoir of ground water. Much of the foreign-aid program consisted of digging small power-driven ground wells; in a dry area, this would seem logical. However, the water could not be used to expand irrigation and production of millet and sorghum, but instead went to support increasingly large herds of cattle, particularly goats, belonging to the nomads. No provision was made for increasing the supply of feed for the animals, or of food-other than milk and meat from the cattle-for the growing human population, made possible by the beginnings of public health care in the area.

When, five years ago, the yearly rainfall decreased to less than half of normal, the herds competed for increasingly scarce vegetation, the nomads cut trees to provide more feed, and the voracious goats ate even the roots of the plants, destroying growth permanently. Animals began to die of starvation around the waterholes. Finally even the farmers, faced with the seemingly inexorable southward march of the Sahara itself, and the devastation of the nomads' herds, deserted their hamlets in increasing numbers, until few are now left to plan or tend next year's crop even if the rains should not fail again. If the population remains, the European Development Fund estimates that even with adequate rainfall there will be less food per capita in 1982 than there was in 1973.

Even where the effects of the drought became obvious to the governments of the Sahel, they were slow to act for a number of reasons. As I have said, they have few resources and few technically-trained personnel; there is no inter- or even intra-government mechanism for dealing with drought; there is very little cooperation among the 12 nations, and no tradition of worrying about the fate of some elements of the population-particularly the nomads. Rather, there is a long history of conflict between the nomads and the fixed agriculturalists.

Today's nomads are descendants of Arab slave traders, who for over two centuries had preyed upon the other residents of the area; until the French colonialists left Africa, they maintained a series of forts in the Sahel to prevent nomadic brigands from raiding the settled inhabitants. In the light of this history, as long as the drought affected primarily the nomads, there was a strong tendency to ignore it. It was only when the refugees, nomad and subsistence farmers alike, began piling up in the towns, starving and ill, that enough publicity was given to the death of cattle and people to inspire (or impose) relief programs.

Over a year ago, the Sahel governments finally set up a relief-coordinating committee, designed to distribute supplies from the international community to the individual nations, and to estimate and plan against future needs. However, the committee has been given no decision-making authority, so has been able to do comparatively little to help the situation. What coordination of relief there is (and it is better than in some previous famines) has been done through the FAO. However, the large sources of supply, from the United States, France, and the Common Market countries, exist autonomously, and are still not terribly well coordinated. (I would like to add here that by far the most important and effective help has come from the United States. All reports I have received, both as a member of the United Nations' Protein Advisory Group, and as Director of the Child Nutrition Task Force for UNICEF, indicate that it has been given efficiently, modestly, and on a considerable scale.)

While there has been considerable criticism of the FAO Early Warning System, it would be more accurate to say, not that the system did not work, but that it was not heeded-either by the Sahel governments or by the international community. The climatic changes were certainly known. International airlines keep careful tabs on all changes in weather patterns and had informed the International Air Transport Association of the changes. The elements of knowledge were present, and there were warnings. That they did not result in action must be considered primarily due to a lack of interest on the part of the local governments, which, after all, must bear the first responsibility for the welfare of their own citizens.

However, in the final sense, it must also be said that neither France nor the United States, which had traditional or special responsibilities in the area-France in the Sahel and the United States in Ethiopia-did all they should have done to educate the local governments, either in competent administration or in the fact that a state must be concerned with the needs of every member of its population.

I may add that a sensitive early warning system should not only comprise information on climatic changes and the economic base. The report of the U.N. Task Force on Child Nutrition will recommend that there be regular, careful examination of the state of health of the children in a given area, since this is the most sensitive indicator of any change for the worse in the health of the general population. It also has the advantage of differentiating among population groups and economic classes. The poor in any area are generally worse off in respect to health and nutrition as in most other aspects of life. The state of their children's health will make visible their increased needs, even when the rest of the population, as in Brazil at the present time, has not suffered deprivation.

Even had the relief effort been as knowledgeable and well-organized as that in Bihar, however, the situation in the Sahel presents a much more difficult task. The distances in the area are gigantic. Transport of all kinds is inadequate. There are four old rail lines going up from the western ports to the southern part of the drought area. What roads there are are attacked by sandstorms in the dry season (so that driving is much like plowing through a succession of snow drifts), and washed out by rains during the rest of the year. In such conditions, maintenance is a huge problem-as always in dealing with a famine, a limiting factor is lack of spare parts and trained mechanics. To best utilize this transportation "network" such as it is, food and medical supplies from overseas should be shipped to the African ports in pre-agreed tonnage, planned for the dry season and the carrying capacity of transport; otherwise food piles up in the receiving areas and is partially destroyed by pests before being moved. So far, however, with difficulties of communication and coordination between international donors and the Sahel governments' relief coordinating committee, this has not been possible. This year, as last, much of the distribution is being done by airlift, the fuel competing with supplies for transport space and available funds.

At present, it appears that there are quite adequate supplies of food in the main cities, but the relief efforts have not solved the problems posed by the Sahel famine. Looking to the future, it is by no means clear what we are actually dealing with. Is it an irreversible natural phenomenon-the downward drift of the Sahara, coupled with the failure of the polar air mass to move as far north as formerly? If this is the case, then it is pointless to try to rehabilitate the Sahel. It may as well be left for dead, and its residents resettled in other areas.

Or is it an ecological catastrophe, for which the sudden explosion of the nomadic way of life is responsible? If this is so, it may be possible to reclaim the Sahel by revising aid programs. Instead of the small wells, dug primarily to water animals and the human population, large irrigation projects may renew and expand farming in the area. But it will be necessary to persuade the nomads to limit their herds, particularly the goats, and to recognize the relationship between their actions and the well-being of their environment. From all indications so far, this would be no easy task.

Or is it a complicated mixture of both causes? Before we can act wisely, we must know. So far, the Sahel has provided another tragic example of how not to approach development aid, and how not to deal with a growing famine.

VII

We should not leave a discussion of recent famines without at least a brief notice of the worst of all-the situation in which war is the cause, and where one or more of the combatants may argue that it is an "internal matter." In such cases the humanitarian instincts of the international community may be dulled by political motives. There is essentially no chance, under the present conventions of international behavior, for a war-related famine to end anything but tragically.

The war in Vietnam and Cambodia is not yet over. How much permanent damage to the food supply the years of defoliation have done is now under investigation. The famines in Biafra and in 1972 in Bangladesh are of very recent memory. In the case of Bangladesh, the government itself, although new and untried, did relatively well at coping with the situation, in spite of the disorganization and disruption caused by the war. The expertise of the Indian government was also a big factor. International aid to Bangladesh was hampered by the fact that more than one government was involved, each with its own foreign policies to protect or further. The U.S. government did relatively well with its relief effort, but while it was useful, it was in this case not really a deciding factor.

Biafra was a more difficult situation. Although the Biafrans had their own territory and government, the international community persisted in considering their rebellion, at least officially, as an internal affair of the Nigerians. The United States, fearing that giving aid to the Biafrans, even for famine relief, would be considered a hostile act by the Nigerians, gave food through UNICEF and the Red Cross, but tried not to be involved. Although the Biafran government was competent and attacked the problem with organization and imagination, there was little it could do against the Nigerian blockade and the indifference of other nations.

As one who was closely involved in the relief effort, I can state that much more could have been done had the United States and other national governments not lacked the courage. Even most of the U.N. organizations, in particular FAO and WHO, were as afraid of interfering as the United States. Indeed, in some instances they went to fantastic extremes not to be involved. UNICEF, alone of the U.N. organizations, worked without favor on both sides of the battle lines. And it is interesting and, I hope, instructive, that as a result it now has increased prestige and popularity throughout Nigeria, and elsewhere. This is a deserved tribute to the mixture of courage and goodwill that should have been uppermost in the entire international community even during a civil war.

Bangladesh is independent, Nigeria is at peace. Yet surely we need not repeat either of these man-made catastrophes.

While all men of goodwill recognize the need to outlaw chemical and biological warfare, is this enough? Both of these are indiscriminate in their effects, jeopardizing civilian bystanders as much as they do armed enemies. I would like to propose that starvation be similarly outlawed as a legitimate instrument of war, on the ground that it is worse than indiscriminate: it preferentially attacks small children, pregnant and nursing women, and the elderly.

Although starvation has been repeatedly defended by general staffs as an effective military weapon, history does not bear out this assertion. Sherman succeeded in arousing animosities that last to this day; it was the defeat of Robert E. Lee in battle that ended the Civil War. The French lost the Franco-Prussian War at Sedan and Metz, in the Loire Valley and on the Swiss border, while children died by the hundreds in the siege of Paris-and the garrison held. The German armies, during World War I, never lacked for abundant food, even while the Allied blockade was causing a high mortality from malnutrition in Berlin and Vienna. The children of Leningrad died by the tens of thousands in World War II, yet the Red Army kept its food supply going, and eventually broke out of the siege to join the advancing relief task force.

Yet for all this evidence, the attempt to starve enemies into surrender goes on. There is no sign that the crop destruction in Vietnam or the food blockade in Nigeria has had a decisive military result. As we have just seen, the effect on the civilian populations, particularly in Nigeria, was devastating.

The facts are that young, adult men are physiologically the most resistant to starvation, and that armed men rarely starve, particularly as they can always justify their requisitions by the nobility of their cause.

An international agreement to outlaw starvation as a weapon of war should be supplemented by one empowering suitable international organizations, such as UNICEF, the Food and Agriculture Organization, or the World Health Organization, to enter a famine area to feed the non-combatant victims of starvation without prior authorization. How many large-scale disasters do we need before we learn that famine and pestilence are not purely "internal problems"? The time has come when, through international agreement and action, man-created famines should be eliminated. Any use of starvation as a means of pressure or punishment against individuals in small or large population groups is a violation of the rights of man.

VIII

What more can we do to deal with famine? Apart from the specific suggestions contained in the body of this article, there are certain central steps that could much improve relief performance in the future.

At present the FAO has a warning system, and a small U.N. office has been set up in Geneva to keep track of impending famine (and other disaster) situations and of available relief resources. However, the impact of this office is still essentially negligible.

I believe we must have, on the international level, a much stronger system not only to warn of famines but through which the United Nations and international voluntary agencies, along with all interested nations, could keep each other informed as to their preparedness and plans for cooperation. There should be a permanent secretariat of an international relief organization devoted solely to famine relief, which will keep up-to-date records on available relief resources and continually add new data that may be relevant to predict any disaster. The office should be counseled by an advisory body consisting of experts with wide experience in this field. This group would be "on call" for rapid assessment of an impending disaster situation in order to estimate when there would be a need, and what the needs would be. Some of the members would have the highly important task of recording the ensuing operations for a later review of their effectiveness and efficiency.

A principal continuing task of such a central organization should be that of training. Here there is the greatest lag when a crisis occurs. Regional workshops arranged by the international organization should be held to train persons who would then conduct training courses in their own countries. Each country also should train a cadre of personnel who would remain in their normal jobs but be available for disaster and famine relief work.

Inasmuch as coping with a famine is not unlike a military general staff exercise, it is possible to utilize some of the methods of preparation and education that have proved to be helpful in such staff training exercises, such as conducting paper-based maneuvers, where a hypothetical situation is created and the staff is asked to write in sequence the orders that are considered to be responsive to the information, with the "umpires" manufacturing new information as needed for the development of the exercise. Using modern technology, computer-simulation exercises could also be devised.

Finally, I would recommend that a suitable manual be prepared for governments and relief agencies, both to guide relief activities and to facilitate training, along the lines of the longstanding Indian Famine Code. In effect, this manual would be a loose-leaf notebook, based on recent experience and continually brought up to date. It should give general principles, supplemented by national, regional and local notes adapted to each local area.

Next, on the external level, donor governments should have a permanent coordinator of foreign aid (as the United States does in the AID organization). Internally, governments should have a permanent secretariat or office for national relief coordination, at the level needed to get prompt action through the government. The body should be headed by an influential person, who would maintain close liaison with other ministries, voluntary agencies, and so forth, which might be involved in dealing with any disaster. In normal times, the secretariat's duties would be to keep up-to-date information on national resources for use in time of disaster and to serve as contact with other national and international bodies.

Such organizational steps will not accomplish miracles. As the Sahel experience has sadly demonstrated, the capacity of local government sets limits on any relief effort. But a well-organized world community could make a big difference. The creation of the embryonic International Disaster Organization in the office of the Secretary-General of the United Nations is a beginning, but much more needs to be done: a solid, though small organization, a "reserve" of trained relief workers, manpower at the international and regional levels to educate national and international civil servants to deal with the many variables in a famine.

In addition, a world food reserve must be created, along the lines proposed by Director-General Boerma of the FAO, and recently endorsed by many witnesses at the Senate Hearings on a National Nutrition Policy. Incidentally, the bulk of the reserves are best stored in cold countries (probably in the countries of such food producers as the United States and Canada) with regional stocks and possible diversion of grain ships at sea used to ensure the flexibility needed to take care of emergencies. As part of this preparation, it is obviously necessary that we reevaluate our national and international economic policies in regard to food. That this necessity for survival is no longer to be treated solely as a commodity for international exchange is shown by the convening this November of the World Food Conference which, we hope, will function at the very highest governmental level.

In the end famine is, of course, only the highly dramatic and destructive extreme example of malnutrition. Indeed, in this article I have found myself writing of rehabilitation after a famine as though the effects of malnutrition on Man were reversible. This may not be the case even for adults. It certainly is not the case for malnutrition affecting infants during the critical growth of the central nervous system; no amount of later education or training may be able to make up for such damage. The problem of malnutrition is much broader than that of famine alone; in terms of stunted lives and coldly economic costs, its impact may be even greater. Any wise efforts for development must seek to ensure that (as is not at all necessarily the case in many countries today) economic growth means at least equal increases in the nutritional levels of the poor.

We now live in a much smaller world, from which some of our contemporaries have stepped out to look at the space ship in which we are all traveling. There is greater realization that all human beings are born equal and are of equal value. However, we have not arrived there yet. Let us hope that we have at least reached the stage where famine, wherever it takes place, however it has arisen, is seen as the enemy of Mankind. For us to feel that way, and to act effectively, we need to educate ourselves in compassion, as well as in technology.

Footnote

1 A notable exception was the Great Plague of 1345-48 in Europe, in which 43 million people are said to have died. In that instance, the massive epidemic came first, totally dislocating society and bringing on famine.

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