* Reduced food intake leading to protein-energy malnutrition micro-nutrient deficiency, especially iron and iodine which are already existing deficiencies * Communicable diseases: * Water borne diseases such as diarrhoea diseases (including cholera) and typhoid fever which are epidemic in the area * TB - a major existing problem, increased risk for young children, very old, and immuno-suppressed * Malaria - endemic in the area since 1990 and epidemic since 1996.