Let Them Eat Plumpy'Nut

Does the food aid that goes to humanitarian crisis sites hurt more than it nourishes? And is the answer a peanut-flavored paste?

The recent disastrous earthquake in Indonesia has prompted a quick humanitarian response from Western countries, raising some key questions: Who decides what kind of emergency food aid is delivered, and should it be healthier? This argument is not new -- nutritionists and development workers have been debating it for years -- but improved food options are causing it to heat up again.

This is no abstract discussion. A child dies of malnutrition every six seconds. The World Health Organization estimates that, at any given moment, 20 million children are suffering from the most severe form of food deprivation -- frequently as a result of other crises, such as earthquakes, hurricanes, droughts, and civil unrest. Emergency food aid has to bring them back from the brink quickly and reliably. Unfortunately, serious questions have been raised about the healthful properties of the fortified, blended wheat, corn, or soy flours that are the mainstay of many emergency food programs. Is using these foods when better alternatives are available ethical?

A rising chorus is advocating that food-aid staples -- which have the advantage of being affordable and widely available -- be replaced with a highly nutritious, easily transportable paste, formulated in 1999 and now broadly distributed by Doctors Without Borders (MSF, for Médecins Sans Frontières). In 2006 and 2007, the organization treated more than 150,000 malnourished children in 22 countries with ready-to-use foods, including Plumpy'nut. Plumpy'nut, which is made from powdered milk, ground peanuts, oil, powdered sugar, vitamins, and minerals, comes in foil packets and doesn't need refrigeration. Its value was celebrated last year on 60 Minutes.

Plumpy'nut tastes like peanut butter, and kids love to eat it. But it's expensive, and critics say it's better to reach as many people as possible with a more affordable choice. And the need remains great.

The latest reports from Indonesia are horrific: more than 700 dead from the 7.6-magnitude earthquake and aftershocks that hit the Indonesian island of Sumatra last week. In some regions, nearly 90 percent of houses have been destroyed, leaving people homeless and hungry. In American Samoa and Tonga, a quake and accompanying tsunami have also taken many lives.

Save the Children, CARE, Mercy Corps, the International Rescue Committee, Catholic Relief Services, and World Vision are coordinating food aid, though early reports are that some has piled up, undelivered, at the airport and aid offices. Some aid, consisting of rice noodles, nutritional supplements, and mineral water, was reportedly looted from the regent office in Padang Pariaman for that reason. Other food aid was dropped by helicopter, causing people to scramble to retrieve it.

The problem for many critics of food aid is not the delivery method, though, but the food itself, which critics say is failing to address childhood malnutrition. Last year, MSF convened a seminar at Columbia University to discuss the problem. As Susan Shepherd, nutrition advisor for MSF's Access to Essential Medicines Campaign, put it, "It is unacceptable that current food aid is not providing adequate, nutrient-rich food for the most vulnerable children." MSF called for an expansion of malnutrition treatment with milk-based, fortified, and energy-dense therapeutic foods, including Plumpy'nut.

Action Against Hunger (AAH) has sometimes teamed with MSF to campaign for more nutritious food, including Plumpy'nut. "There is nothing inherently wrong with the standard corn-soy blend as long as it is enriched with micronutrients and vitamins, which isn't always the case," AAH's senior nutrition advisor, Marie-Sophie Whitney, says. "We shouldn't be feeding kids anything we wouldn't feed our own children."

There's also the extremely sensitive issue of where the food for aid comes from -- and what its effect may be on local trade. AAH charges that U.S. government food aid displaces local farmers by dumping cheap U.S. surplus grain. "Most countries have functioning markets and regional surpluses that go overlooked in the food aid equation," Whitney says.

This point is reinforced by Emi MacLean, U.S. manager of MSF's access campaign. She said that many corn-soy and other blends do not contain animal-sourced foods, such as dairy products. According to MacLean, the dairy component was removed about 20 years ago when the U.S. milk surplus ran out. "Almost all of the emergency food aid that the U.S. currently sends internationally is not appropriate for young children under the age of 2," she says, adding that the corn-soy blend was formulated decades ago based on available U.S. surplus. "But high-quality protein, such as in dairy and eggs, and micronutrients, are of critical importance for children under 3 if they are to recover from malnutrition," she says.

The charge -- that the U.S. dumps less nutritious surplus food -- is vehemently denied by Steve Hansch, a veteran aid worker who is also a board member of Relief International.

"It's just wrong to use words like 'surplus' and 'dumping,'" Hansch says. "That was the case with food aid in the 1960s, but now it's a market-driven operation. For example, an NGO in Tanzania will submit a proposal to the U.S. Department of Agriculture, which will then open bids and buy at the lowest price."

For Hansch, food aid is caught in a dilemma. "We spend most of our money sending basic grains, especially corn, because that reaches the largest numbers of people," he says. "If instead, we spent our money on ideal food formulations, our per-treatment record would go up, but the majority of kids in refugee camps would get no food at all."

Largely for the reason Hansch brings up -- the financial aspect -- movement among NGOs and governments to adopt a higher standard for nutrition in food aid has so far been limited.

Last year, following a World Health Organization experts meeting in Switzerland, a group of international nutrition experts proclaimed that food distributed to young children should be nutritionally tailored to them, which means including high-value, animal-sourced protein and adequate micronutrients. They also said that ready-to-use emergency foods should include dairy, eggs, and other animal-sourced foods instead of solely relying on fortified and blended flours as currently formulated. But an MSF representative also said that enforcing such a standard would cost 3.5 billion euros (more than $5 billion) annually.

However, current policy is costly, too. According to MacLean, $600 million could be saved annually if food aid were purchased locally instead of shipped as in-kind donations from the United States in U.S.-flagged ships.

The good news is that the Barack Obama administration is reviewing U.S. food aid policy. MacLean says she hopes a re-evaluation will "bring major modifications to the emergency food support provided to young children."

We do need to take a second look at our food policy. But with donor fatigue and a world economic crisis as obstacles, the fight to bring Plumpy'nut and other, healthier options to a broader population might be stalled for some time.



How to Manage a Nuclear Iran

Obama's diplomacy is the first step. Here are steps 2 through 5.

On Sept. 25, flanked by his French and British counterparts, Barack Obama announced that Iran was building a second underground facility for uranium enrichment. The U.S. president warned that Iran's decision to build yet another nuclear facility without notifying the International Atomic Energy Agency (IAEA) represented a direct challenge to the nonproliferation regime. The revelation gave a sense of urgency to the Oct. 1 negotiations between Iran and the P5+1 (the five permanent members of the U.N. Security Council plus Germany), the first in which the United States would actively participate.

Many thought that the announcement would scuttle the Oct. 1 talks. Yet, at their conclusion, Obama announced that Tehran had agreed to open the newly exposed facility near Qom to IAEA inspectors. He also announced Iran's agreement to transfer low-enriched uranium from its first enrichment facility at Natanz to another country for fabrication into fuel rods for peaceful purposes. Iran reportedly agreed to transfer 1,200 kilograms of the 1,500 kilograms it had stockpiled, meaning that the amount remaining would no longer suffice, if further enriched, to build a nuclear bomb.

The administration deserves congratulations for its adroit diplomacy. Most analysts, including myself, were not expecting substantial results from the Oct. 1 talks. We expected Iranian negotiators to deploy their well-developed tactics of delay and diversion. Securing agreement to convert most of Iran's low-enriched uranium to reactor fuel was unexpected -- and might represent an important diplomatic breakthrough.

Still, as Obama said, "This is a constructive beginning, but hard work lies ahead." The president was right in his sober assessment. To convert a potential diplomatic breakthrough to real diplomatic success, the United States and its P5+1 partners must engage the Security Council, demand complete transparency, deny Iran a rapid breakout capability, and guard against Iran's well-developed tactics of deception and delay.

One day before exposing Iran's second enrichment facility, Obama presided over a Security Council meeting that, at the outset, unanimously adopted Resolution 1887 on nonproliferation and disarmament. The resolution's very first operative paragraph emphasized that noncompliance should be brought to the attention of the Security Council.

The Security Council has already determined that Iran's nuclear activities and past violations pose a threat to international peace and security, thus providing the basis for the council's Chapter VII resolutions imposing sanctions. Certainly the threat is only increased by the revelation of the Qom facility, which Iran has been building in secret, in violation of multiple Security Council resolutions, and -- as the president said on Sept. 25 -- in a size and configuration inconsistent with a peaceful program.

Iran's leaders argue that they were not obliged to inform the IAEA of the facility's construction because they had suspended the associated reporting requirement. However, the IAEA's outgoing director general, Mohamed ElBaradei, repeatedly made clear that Iran had no right to suspend this requirement. With the facility revealed, ElBaradei has now said plainly that Iran is on "the wrong side of the law." When the IAEA board meets to receive the director general's report on the facility, it should find Iran in noncompliance with its safeguards agreement and report this to the Security Council. As Obama said last April in Prague, "Rules must be binding. Violations must be punished."

The IAEA's report will give the Security Council good reason to act, as will Iran's violation of Security Council direction to suspend all enrichment-related activities. Although the Security Council may wish to give the P5+1 a limited time frame to negotiate with Iran, the council should start to draft two possible resolutions: one welcoming and endorsing an agreement that brings Iran into compliance with its international obligations, and the other foreshadowing the "crippling sanctions" promised by the administration if Iran refuses.

Another requirement is total transparency. In his Oct. 1 statement, Obama insisted that Iran demonstrate its commitment to transparency. In particular, he called on Tehran to grant the IAEA unfettered access to the enrichment site near Qom. Iran's leaders have agreed, and the IAEA is preparing to send inspectors to the site later this month.

But the transparency shouldn't end there. First, Iran must commit to notifying the IAEA of the construction of any other nuclear sites, and Iran's leaders cannot be allowed to hide behind the argument that they "suspended" this requirement. Worryingly, Syria also violated this requirement by secretly constructing a nuclear reactor with North Korea's help. Clandestine construction of nuclear facilities cannot become a new norm in the Middle East, or anywhere else.

Second, Iran should give the IAEA permanent access to the workshops where it manufactures and assembles centrifuges for uranium enrichment. IAEA inspectors monitored these workshops during the enrichment suspension negotiated by the EU3 -- Britain, France, and Germany -- but were expelled when Iran broke that suspension four years ago. Renewed access would give the IAEA greater insight into the scale and nature of Iran's enrichment activities, better positioning the inspectors to uncover any other hidden sites and verify any agreement that comes from the talks between the P5+1 and Iran.

Third, Iran's leaders must disclose the full extent of past work on weaponization. IAEA reports have repeatedly expressed concern about the "possible military dimensions" of Iran's nuclear program. IAEA information points toward a covert program that, according to reports, apparently included detailed design and initial engineering work on a nuclear explosive device and its integration into a re-entry vehicle for Iran's Shahab-3 missile. Iran should meet the IAEA's long-standing requests to provide full access to the information, individuals, and sites involved.

In 2007, the Security Council decided in its Resolution 1737 that Tehran "shall provide such access and cooperation as the IAEA requests ... to resolve all outstanding issues, as identified in IAEA reports." The IAEA director general has never exercised this authority, choosing instead to make "transparency requests" on a voluntary basis. Following the latest revelation about Iran's nuclear program, the director general should now make clear that his requests are fully backed by the Security Council. If Iran still refuses to cooperate, the IAEA board must be ready to report this to the Security Council. This will give added reason for sanctions should Iran continue to defy its international obligations.


On Oct. 1, Obama said, "Iran must take concrete steps to build confidence that its nuclear program will serve peaceful purposes -- steps that meet Iran's obligations under multiple U.N. Security Council resolutions." It is highly important that Iran obey this injunction.

Doing so will require suspending all activities related to uranium enrichment and plutonium reprocessing -- pursuits that can be peaceful but can also be diverted to build nuclear weapons. "Suspension" has become a maligned term in Tehran, where it is seen as synonymous with "denial of rights." This was probably why Obama spoke of "obligations" rather than suspension. But maneuvering Iran into suspension, even if quietly, must remain an underlying goal.

There are three reasons why Iran shouldn't be allowed to enrich uranium anymore. First, doing so would allow Tehran to replenish the low-enriched uranium it has reportedly agreed to send to Russia, thus negating this confidence-building measure. Second, it would acquiesce in Iran's continued violation of Security Council resolutions, with IAEA inspectors relegated to recording the extent of Tehran's noncompliance. Third, and most worrisome, it would permit Tehran to further develop a rapid nuclear-weapons breakout capability, taking advantage of its clandestine work on weaponization. A breakout capability, particularly in the hands of leadership determined to dominate the region and eliminate Israel, could be just as destabilizing as actually assembling and testing a bomb.

Shipping Iran's low-enriched uranium to Russia for fuel fabrication shows a possible way forward. Rather than continuing to enrich indigenously, Iran could join Russia's international enrichment center -- an existing uranium enrichment facility at Angarsk that already has a number of international partners. This enrichment center could produce and store fuel for the Russian-built reactor in Iran and any future reactors. This would give Iran a legally binding assurance of fuel supply while allowing its leaders to boast domestically about preserving the right and demonstrating the capability to enrich uranium.

Offshoring enrichment, as part of a multinational venture, could give Iran's leaders an honorable way off the Security Council agenda while removing from their grasp a dangerous breakout capability.

The agreement reportedly reached on Oct. 1 has the makings of a diplomatic breakthrough, but Iran's leaders still have plenty of opportunities to backslide and delay. Although Obama insisted on access to the Qom facility in two weeks, Iran granted access in three -- perhaps not a major concern but still reminiscent of Iran's past practice of postponing cooperation. This delay will be of greater concern if Iran uses another familiar tactic -- using delayed access to sanitize a site.

Experience indicates that Iran's leaders see negotiations as a way to buy time and avoid international sanctions as they advance their nuclear capabilities. They will be inclined to continue this approach if they sense that the prospect of negotiations has sapped international will to impose further sanctions. Certainly they welcome the director general's praise of their "cooperation" during his recent visit to Tehran. One Iranian authority has already announced Iran's intent to fill the Qom site with advanced centrifuges in what would be a further violation of Security Council resolutions.

In the meantime, it is not clear how domestic opposition to the regime is influencing its negotiating stance. Iran's authorities could see negotiations as a way to build legitimacy for their troubled government. However, concerns about regime survival might only solidify a desire to obtain nuclear weapons. This argues for setting a definite time frame for negotiations and explaining to the Iranian public the opportunities on offer and the consequences of defiance. Iran's people must understand that if their leaders fail to negotiate seriously, any further sanctions will be on their heads.

ElBaradei, who is less than two months away from the end of his term as director general, has repeatedly stated that he has no evidence of an ongoing nuclear weapons program. His carefully chosen words should not reassure us. The IAEA had no evidence of Iran's first or second enrichment sites, or of its weaponization activities, until they were exposed to the world. Until we achieve complete transparency and a suspension of enrichment activities within Iran, we cannot be confident of the peaceful nature of Iran's nuclear activities.