The celiac disease, permanent gluten intolerance, has been considered for years a typical western problem. But recently it was observed in developing countries too, that up to now where considered immune to such disease. This phenomenon seems determined by a progressive westernization of their diet, often deriving from the food aid received from international organizations. In this perspective, a quintessential case-study is the one about the Sahrawi population, the majority of it living in refugee camps in Algeria, where the incidence of the celiac disease is ten times higher than in Europe.
Gluten intolerance is an enteropathy caused by a combination of genetic (especially referring to alleles DQ12 and DQ8) and environmental factors.
Up to some decades ago, it was thought to be a typical problem of western populations, especially Europeans, but recent studies highlighted a notable presence of such intolerance also in Northern Africa, India and the Middle East. Important organizations and agencies, such as the World Health Organization (WHO), interpreted the phenomenon as an effect of an increased and unusual consumption of gluten-containing foods. It is also to be considered the quality of the products and of the protein itself, which was selected and modified during time to have stronger flours, more suitable for industrial production. Symptoms to such intolerance are various and harmful for the health of the affected people: anaemia, intestinal disorders, bad assimilation of nutrients (dyspepsia, weight loss or growth deficiency in children, inflated stomach, anorexia, etc.), but also behaviour alterations and different forms of sclerosis.
In developing countries, already facing food insecurity and nutritional deficiencies, such disorders have huge negative impacts, often with deadly effects. The elimination of gluten-containing food, which is today the only viable option to treat the affected person, is not applicable in the most economically vulnerable countries, because they depend in great measure on humanitarian aid and don’t get to have a word on the majority of foodstuffs internationally commercialized. A resounding case of gluten intolerance spreading is the one of the Sahrawi people living in Algeria, where the incidence of the celiac disorder is ten times higher than in Europe.
The Sahrawi population has been living in exile for almost 40 years, since the occupation of Western Sahara by Morocco and Mauritania in the 70s, after the Spanish decolonization. This brought to a massive exile, which forced the Sahrawi people to set a campsite in a desert area in Algerian land, near the city of Tindouf. Today, 250,000 Sahrawis live as refugees in those camps, divided into wilaya, in turn organized in smaller districts called daira. The disadvantageous conditions of the desert land, soil and climate don’t allow the cultivation of the majority of agricultural products (only the 4% of the land is apt to cultivation), nor, as a result, the possibility to develop any kind of food production.
For this reason, Sahrawi refugees depend totally on humanitarian aid. Apart from various NGOs and voluntary associations, also UN Agencies such as the World Food Programme, the UNHCR and EU financed programmes (under the ECHO supervision) are operative in the field, and their aim is to grant food security and foodstuffs stock in case of need. The aid is mainly composed by products like flours, dried milk, protein powders and other protein-rich food (such as luncheon meat or fish), water canisters, legumes, rice. The programmes should be thought to meet the calorie and nutritional needs and to reflect local food habits, but often they must be adapted to logistic and monetary constraints.
In this way, humanitarian aid has been constantly and massively introducing such foods in a region which traditionally consumed very limited amounts of gluten-based flours in comparison to areas like Europe. This generated the development of a new widespread intolerance, also caused by the presence of a special genetic predisposition. In 2010, a follow-up study involved 975 people belonging to 212 different families. For each family, was taken into account a member who had already been diagnosed such intolerance. Blood tests showed an incidence of the same problem on first relatives too, highlighting a very common gene which eases the insurgence of the celiac disease. So, to environmental factors, like the gradual disorder introduced in the Sahrawi traditional diet, is to be added a great genetic predisposition, strengthened by the lack of regeneration of the people caused by 40 years of exile and isolation.
The only solution to reduce the negative effects of the celiac disease is to eat gluten-free foods, which is unfortunately very difficult in the case of Western Sahara. A second study, already in 2005, had documented the extraordinary recovery of Sahrawi celiac children thanks to a gluten-free diet. The study, conducted in Palermo by the department of gastroenterology of the hospital “G. Di Cristina”, examined 9 children, aged 10-14 years, who stayed 45 days in the city’s Istituto per Ciechi (institute for blind people). In each child, after just 45 days of treatment, height and weight increased together with the haemoglobin levels, reducing anaemia. The positive effects of these simple actions would solve many of the implications caused by the intolerance. But as was already said, the scarcity of food, the lack of information inside the organizations working in the field, the incapability to diagnose the disease, the lack of gluten-free food and the impossibility to receive it because of the dependence on humanitarian aid, make it impossible to implement treatments that change food habits.
For all previous considerations, the first step should be taken when planning actions, modifying food programmes to meet the local needs, which are very important on the medical-health point of view. There are many gluten-free foods which are not more expensive than others, like millet, rice, quinoa and amaranth, which are cultivated (or cultivable) and consumed in many areas of Africa.
The celiac disease, irreversible intolerance which can permanently jeopardize the health of the affected people, especially at a paediatric stage, implies much more worrying effects in situations that face malnutrition and constant scarcity, which is the case of the Sahrawi population. The only way to limit its negative effects is to eliminate gluten from the diet of the celiac people. In order to do so, international organizations should be more informed on the specific nutritional needs and, depending on them, change the composition of the food aid. A revision and upgrade of the food aid programmes and a greater awareness by all the organizations and actors involved should be implemented as soon as possible.
Bibliography:
Ilse-Maria Ratschi & Carlo Catassi, “Coeliac disease: a potentially treatable health problem of Saharawi refugee children”, Bulletin of the World Health Organization, 2001, 79: 541–545
Rodrigo L, et all., “Prevalence of celiac disease in multiple sclerosis”, BMC Neurology (Impact Factor: 2.17). 03/2011; 11:31. DOI:10.1186/1471-2377-11-31 – Source: PubMed
Teresi S, Crapisi M, et all., “Celiac disease seropositivity in Saharawi children: a follow-up and family study”, J Pediatr Gastroenterol Nutr. 2010 May;50(5):506-9. doi: 10.1097/MPG.0b013e3181bab30c
Scalici C, et all, “Celiac disease and the Saharawi. Clinical Experience with Saharawi Children”, Acta Pediatrica Mediterranea, Palermo, 2005, 21: 101
World Food Programme, “State of School Feeding Worldwide 2013″, WFP-UN, Rome 2013
Translation by Federica Soro
[Images by Tindouf ExPRESS]
This article was written by Francesca Zaccarelli and reviewed by Tindouf ExPRESS Staff.
Francesca Zaccarelli is Inter at the EU Delegation In Rome for FAO.