This paper investigates whether the food consumption of refugees in protracted displacement responds to the timing of food aid distribution cycles, and whether the interval since the last distribution affects the short-term nutritional status of children under five. The study is set in three refugee camps (Amboko, Gondjé, and Dosseye) in southern Chad, near the border with the Central African Republic (CAR). These camps were established between 2003 and 2006 and house refugees who fled violence in CAR and had been in protracted displacement for up to seven years at the time of the survey. At the time of data collection, there were about 32,000 in the three camps. Refugees received in-kind food rations (cereals, cooking oil, and salt) calibrated to approximately 1,200 calories per person per day and distributed every 1-2 months, covering roughly half of daily adult caloric requirements.
The primary data were collected in September 2010 across the three camps, funded by CARE International and UNHCR. The refugee sample comprises 969 households, randomly selected from UNHCR’s camp registration list and stratified by residential block and ethnicity. An additional comparison sample of 502 households from nine neighboring Chadian villages was surveyed to support the falsification tests. Consumption data were gathered using a 24-hour dietary recall survey covering the three main meals of the day prior to the interview. Anthropometric measurements (height, weight, and mid-upper arm circumference, MUAC) were collected for 712 children under five years old.
The authors use an econometric approach to estimate the association between the number of days elapsed since the last food distribution and both household caloric intake and children’s short-term nutritional status. The main outcomes of interest are the log of adult-equivalent caloric intake the day before the interview and the short-term nutritional status of children. The identification strategy relies on exogenous variation in the timing of interviews relative to a food distribution event: households within the same residential block were randomly assigned to be interviewed either in the first or the third week of the survey, generating interview dates that ranged from 17 to 46 days after the distribution (average of 31.8 days). The main specifications include block-level fixed effects and control for household and child characteristics. Robustness checks include enumerator fixed effects, excluding the last three days of the survey (to account for survey fatigue), and a falsification test applied to the host community, who do not receive food aid and for whom the distribution cycle timing would be expected to have no effect.
Main findings:
- Cereals dominate the refugee diet, accounting for 78 percent of total caloric intake, with 92 percent of households having consumed cereals the day before the interview. Sorghum (locally produced) and rice (from aid rations or purchased) are the primary staples.
- Refugee households have substantially lower caloric intake than host community households, with fewer than half meeting the minimum daily energy requirement of 2,100 kcal per capita. Among refugees, average individual caloric intake the day before the interview was 1,542 kcal from cereals alone and 2,136 kcal overall, compared to 1,925 kcal and 2,595 kcal respectively for host households. Only 42 percent of refugee households exceeded the 2,100 kcal threshold, against 57 percent in the host community.
- Borrowing is widespread but occurs predominantly at the end of the distribution cycle, consistent with constrained rather than strategic intertemporal smoothing. 34 percent of refugee households reported borrowing in the two months prior to the survey compared to 27 percent in host communities. Borrowing is predominantly food-motivated: half borrow in kind, and among cash borrowers, 62 percent used funds to buy food, with most borrowing occurring toward the end of the cycle. Only 24 percent of refugee households had precautionary savings (72 percent of those kept savings at home), compared to 33 percent of host communities.
- Most households sell part or all their food ration shortly after distribution, primarily to diversify their diet rather than as a savings strategy. 55 percent of households reported selling part or all their most recent ration, with 87 percent of sellers doing so in the week immediately following distribution. This behavior reflects the gap between the ration composition and dietary needs rather than an intent to smooth consumption over time.
- Stunting rates among refugee children under five are high, and short-term malnutrition indicators point to recent food insecurity. Some 37 percent of refugee children are stunted, a rate similar to that in the host community. Refugee children have a higher prevalence of wasting than host children (12 percent versus 7 percent), though the host community shows a higher rate of low MUAC (15 percent versus 9 percent falling below the 12.5 cm cutoff). Notably, MUAC-for-height z-scores are significantly lower for refugee children measured later in the survey period, suggesting that food consumption cycles may translate into cycles of short-term malnutrition.
- Refugee household caloric intake declines significantly with each passing day since the last food distribution, at a rate of 1.1 to 1.5 percent per day. This implies an estimated 15 to 20 percent reduction in cereal consumption over a two-week period. The decline is non-linear, being most pronounced between 25 and 35 days after distribution and tending to slow toward the end of the two-month cycle. As cereal consumption declines over the distribution cycle, there is no evidence of countercyclical substitution toward other food categories such as animal products or vegetables.
- The short-term nutritional status of children under five, measured by mid-upper arm circumference (MUAC) for height z-scores, also declines with days elapsed since the last distribution, at a rate of 0.025 standard deviations per day. Children’s age is associated with slightly better nutritional status whereas having experienced a recent illness diminishes the MUAC-for-height z-score.
- Heterogeneity analysis by wealth finds no evidence that better-off refugee households are better able to smooth consumption across the distribution cycle. When interacting time since distribution with a household wealth index, no significant heterogeneous effect is found, suggesting that inability to smooth consumption is a common condition across the welfare distribution within the camps.
- The consumption and nutrition cycles are specific to the food-aid-dependent refugee population and not driven by common seasonal or environmental factors. Applying the same empirical model to the host community—assigning them the artificial time-since-distribution of the nearest camp—yields no significant association between the distribution cycle timing and either caloric intake or children’s nutritional status.
The authors conclude that refugee households in these protracted camp settings do not smooth their food consumption between distributions, resulting in recurrent and predictable periods of food shortage toward the end of each distribution cycle, with attendant declines in child nutritional status. The authors warn that these recurrent food shortage cycles may have lasting consequences for children’s long-term nutritional status and health. The authors suggest a number of reasons why refugees do not smooth their consumption between food distributions including: (1) the ration covers only half of caloric needs with limited alternative income sources and uncertainty about distribution dates makes planning difficult; (2) uncertainties about duration in the camp may inhibit investments in livelihoods activities; (3) food aid is perishable and subject to theft and social pressure to share, creating incentives to consume early.
The paper identifies several implications for aid design, including: (1) increasing the frequency of food distributions to reduce the severity of end-of-cycle shortages, and ensuring greater predictability in aid delivery dates; (2) transitioning to cash or voucher-based transfers to enable households to purchase food according to their own consumption needs, provided local markets are functional; (3) supporting self-sufficiency and livelihoods strategies in the medium to long term by promoting integration in the economic network of host communities and sustainable agricultural practices; and (4) policies that strengthen financial inclusion and credit access in camp settings. The authors also flag a methodological implication for nutritional monitoring: because MUAC-for-height measurements reflect the cyclical phase of the distribution calendar, surveys conducted near the end of a distribution cycle may systematically understate average nutritional status.