'The silent emergencies:' 1987 State of World's Children.

"The Silent Emergencies'

WHILE the media focus onAfrica from 1984 to 1986 brought extraordinary assistance to that crisis-ridden continent, it may have tended to obscure everyday emergencies wrought by disease and malnutrition elsewhere in the world.

Recent events in Africa have alertedUnited Nations agencies once again that ways must be found to sensitize politicians as well as the press to what the United Nations Children's Fund (UNICEF) Executive Director James P. Grant has called the "silent emergencies'--the less dramatic continuum of death and human suffering imposed by poverty and ignorance.

In the UNICEF State of the World'sChildren Report for 1987, Mr. Grant notes that over the past two years, more children died in India and Pakistan than in most nations of Africa combined. "In 1986, more children died in Bangladesh than in Ethiopia, more in Mexico than in the Sudan, more in Indonesia than in all eight drought-stricken countries of the Sahel', he says.

It makes no moral difference, headds, that these millions of children did not die in any one particular place at any one particular time. "But it does matter that their suffering cannot be framed in the viewfinder of a camera, and it does mean that their deaths are therefore not news and that the world is not shamed into action on their behalf.'

Mr. Grant calls for a new political,economic and moral ethic to address the global reality that each year more than 14 million children die "almost without notice'.

He declares: "They are dying in thefinal coma of dehydration; dying in the extremities of respiratory infections; dying in the grip of tetanus spasms; dying in the distress of measles; dying in the long, drawn out process of frequent "ordinary' illnesses which steadily weaken and malnourish the body until it has nothing left to fight the next cold, or the next fever, or the next bout of diarrhoea.'

UNICEF does note, however, thatglobal communications and the media have helped generate a major change in morality over the past 40 years.

"In the early 1940s, for example, anestimated 3 million men, women and children, starved to death in Calcutta and Bengal, while the world knew little and did less . . . Today, our world no longer allows millions of its children to die in the sudden emergencies of drought or famine anywhere on the planet.'

Whether the crisis be Kampucheain 1979-1980, or Africa in 1984-1986, the report states, the attention of the mass media ensures that enough of the world's Governments are moved to the kind of action which, at the very least, prevents mass deaths. "Such a change is a significant step towards a more truly civilized world.'

UNICEF, in its report, proclaimsthat its message to the world in 1987 is that the time has come to take the next step.

"By far the greatest emergency facingthe world's children today is the "silent emergency' of frequent infection and widespread undernutrition', and report states. "No "loud' emergency, no famine, no drought, no flood, has ever killed 280,000 children in a week. Yet that is what this "silent emergency' is now doing--every week. The time has come for Governments and peoples to decide that it is just as unacceptable for so many millions of children to die every year of needless malnutrition and infection as it is for them to die in sudden droughts and famines.'

The "good news'

The good news in a decade largelyovershadowed by economic stagnation and declining aid budgets is that agencies like UNICEF and the World Health Organization (WHO) are already providing proven low-cost technologies which can defeat infection and undernutrition among the world's children.

Countries like Egypt, Bangladesh,Ecuador and Bolivia have successfully introduced the oral rehydration therapy (ORT) to combat dehydration caused by severe diarrhoea. Just three years ago diarrhoeal dehydration was the leading cause of death among young children in Egypt, claiming some 130,000 children under two years of age annually. Fewer than 2 per cent of Egyptian mothers had heard of ORT and less than 1 per cent had administered rehydration salt solutions to their children. A nationwide ORT campaign in 1980 reached 90 per cent of the public through posters, billboards, newspapers, magazines, radio and television. As a result, more than 75 per cent of Egyptian mothers now give oral rehydration salts to children with diarrhoea. The British Medical Journal has commented that the UNICEF campaign against diarrhoeal dehydration "may be the world's most successful health programme'.

Countries such as Colombia, Turkey,Burkina Faso and India have mobilized major immunization drives to protect their children against the six main child-killer diseases; 74 developing countries have officially registered their commitment to immunize all children against diphtheria, whooping cough, tetanus, polio, tuberculosis and measles by 1990. Many have committed themselves to broad-based health strategies employing both ORT and immunization. Some like El Salvador, have called cease-fires on internal conflicts to carry out national immunization campaigns.

"What we are now seeing in manynations is the beginning of a new approach to meeting basic human needs', says Mr. Grant. "We are seeing an approach based on the mobilization of already existing resources to communicate already existing knowledge.'

Mr. Grant estimates that the promotionof universal immunization and knowledge about ORT could save as many as 7 million young lives each year, and he insists that what is needed most at the present time is for "morality to catch up with capacity.' The world, he states, must be made to understand that with proven remedies at hand it is no longer "normal' for 280,000 children to die every week due to easily preventable situations.

Progress curve dips

Part of that moral adjustment mustinclude changes in economic and political perceptions, he says. The UNICEF report repeats earlier warnings that the economic adjustment policies of bodies like the International Monetary Fund (IMF), a precondition of assistance for about 70 developing nations during the 1980s, has had heavy impact on the poor. National census statistics have begun to confirm the feared human fallout from inflation, falling commodity prices and declining development budgets.

The progress curve which was sostriking through the fifties, sixties and seventies has flattened out and dipped alarmingly in countries like Barbados, Belize, Bolivia, Brazil, Chile, Jamaica, the Philippines, Uruguay and some African countries beset by drought. A UNICEF study in progress shows that low birth weight and child deaths are increasing in those countries and that other nations will join the list as further results become available.

According to the report: "Presentadjustment strategies usually include cuts in government expenditure (especially on consumer subsidies such as food); credit restrictions and currency devaluation to cut demand for imports; increased producer prices to stimulate production (especially in agriculture); and the liberalization of imports and privatization of state-owned assets to try to improve economic performance.'

The predominance of deflationarypolicies, the report notes, has depressed employment and lowered wages while raising the price of basic commodities--shifts which have hit hardest at those with the least scope to economize. The poor have also been greatly affected by cuts in government spending on health and education. UNICEF warns that "policies which undermine a nation's most valuable resources--its human resources-- weaken its future economic capacity'.

UNICEF argues for adjustment"with a human face' which would incorporate debt rescheduling, improved aid flows, increased lending and "greater access to the rich world's markets for the poor world's goods'. Adjustment policies, "which allow children to be sacrificed for the sake of financial stability', are unacceptable, it stresses.

"An essential part of any policydesigned to meet the minimum needs of the poorest sections of society must be some method of monitoring whether or not that policy is in fact achieving that aim', says Mr. Grant. "Throughout the 1980's Governments and economic institutions have produced a confetti of statistics about declining GNPs, rising inflation rates, and deteriorations in the balance of payments. Yet we have very few facts and figures about the human consequences of such trends--about household food supplies, or changes in the percentage of people living below the poverty line, or increases in the numbers of children who are undernourished. Whether in good times or in bad, it is therefore necessary to monitor what is happening to human development as well as economic development.'

Photo: The silent emergencies continue . . .

Photo: Children in every corner of the world . . .

Photo: . . . Need understanding and assistance.

Photo: Oral rehydration therapy--given here to a baby in Equatorial Guinea--aids recovery from life-threatening diarrhoeal diseases.

Photo: Child of drought

Photo: Regular growth monitoring is highly recommended.