introduction to nutrition in emergencies

nutrition in emergency

1. Introduction to Nutrition in
Emergencies
Module 01

2. Learning Objectives
•Know where most nutrition emergencies occur
•Understand what causes nutrition emergencies
•Know which groups are most nutritionally
vulnerable in an emergency
•Be aware of the different types of malnutrition
that arise in emergencies
•Be aware of the range of emergency nutrition
responses and when they are appropriate
•Have a better understanding of the operational
challenges in Nutrition in Emergencies

3. What is an emergency?
•Various definitions exist such as: Any situation where there is an exceptional and
widespread threat to life, health and basic subsistence, which is beyond the
coping capacity of individuals and the community” (Oxfam Humanitarian Policy,
2003.)
•‘Complex emergency’ refers to a major humanitarian crisis of a multi-causal
nature, essentially from internal or external conflict and which requires an
international response that extends beyond the mandate or capacity of any single
agency
•Distinction between loud and silent emergencies stresses the fact that
there is often a serious disconnect between need and response
–Loud emergencies: catastrophic events such as natural disaster or war.
Receive considerable international publicity and massive humanitarian
response (of varying degrees of adequacy)
–Silent emergencies: protracted and receive limited international attention and
insufficient humanitarian response.

5. What types of Emergencies are common in
country x?
•Complex – conflict-related
•Droughts
•Floods (often with landslides)
•Earthquakes
•Famine

6. What is an emergency? (2)
Emergencies cover a wide variety of
different scenarios. They differ in
terms of:
•Length (short-term, chronic)
•Cause (natural, conflict-related
{‘complex’}, economic-political)
•Impact (destruction of
infrastructure, agricultural, health
and social systems)
•Affected groups (internally
displaced persons, refugees, stable
populations)
•Humanitarian response (large-scale
response, no response at all)

7. What is Malnutrition?

8. What is a nutrition emergency
•Many classification systems exist, which agree on the
definition of the situation through progressive stages,
the most severe being labeled “famine”
•Most systems combine CMR and wasting for classifying
the situation, as this 1995 UN SCN threshold system:
Classification systemLevel Mortality and malnutrition indicator
 
UN SCN thresholds
1995
Alert
CMR 1/10,000/day
U5MR 2/10,000/day
Wasting 5–8%
Severe
CMR 2/10,000/day
U5MR 4/10,000/day
Wasting >10%

9. Integrated Phase Classification system (IPC)
•Most recent classification system to be developed
•Builds significantly on other systems
•Aims to develop a common scale for food security
classification comparable across countries
•Facilitates identification of priorities for intervention
before situation becomes catastrophic
•Includes a much wider variety of non-nutrition
indicators such as disease, access to water and
conflict

10. Summary of IPC food crises and famine classification
system with thresholds
FSNAU/FAO
integrated
food security
phase
classification
(IPC), 2007
Generally food secureCMR < 0.5/10,000 /day
Wasting* < 3% (<-2SD WHZ)
Stunting < 20% (<-2SD HAZ)
Moderately/Borderline
Food Insecure
CMR < 0.5/10,000/day
U5MR < 1/10,000/day
Wasting* > 3% but <10%
Stunting 20-40% (<-2SD HAZ),
increasing
Acute food and
livelihood crisis
CMR 0.5-1 /10,000/day
U5MR 1-2/10,000/day
Wasting* 10-15% (>-2SD WHZ), > than
usual, increasing
Humanitarian
emergency
CMR <1-5 / 10,000/day, >2x baseline
rate, increasing
U5MR > 2-10/10,000/day
Wasting* > 15% (>-2SD WHZ), > than
usual, increasing
Famine/Humanitarian
catastrophe
CMR >2/10,000/day (e.g.,
6,000/1,000,000 /30 days)
Wasting* >30%

11. Where do Nutrition Emergencies occur?
•The largest famines in terms of excess deaths have occurred in Asia
–China (1958-1962) killed 30 million people
–Democratic People’s Republic of Korea (1990s) killed up to 3.5 million
people
–Root cause for both famines was government policies that led to
massive food shortages
•Africa has suffered more frequent famines but with fewer deaths
(lower population density)
–Ethiopia (1983-1985) famine due to drought killed 1 million people
•Famines in the the twentieth century killed more than 70 million
people
•Is there currently an ongoing famine, if yes where?

12. Where do Nutrition Emergencies occur? (2)
% of infants
with low
birthweight
% of under–fives (2003 –2009) suffering from:
underweight
(NCHS/WHO)
underweight (WHO)
wasting
(WHO)
stunting
(WHO)
moderate & severe
moderate &
severe
severe
moderate
& severe
moderate &
severe
SUMMARY
INDICATORS
2005–2009
Africa 13 24 20 6 9 40
Sub-Saharan Africa 14 27 22 7 9 42
Eastern and Southern
Africa
14 25 21 6 7 44
West and Central
Africa
13 28 23 8 10 40
Middle East and North
Africa
10 14 14 5 10 31
Asia 18 31 27 13 17 35
South Asia 27 47 42 15 19 48
East Asia and Pacific6 11 11 – – 22
Latin America and
Caribbean
8 7 4 – 2 14
CEE/CIS 7 5 4 1 3 16
Industrialized countries– – – – – –
Developing countries 15 26 22 9 12 34
Least developed
countries
16 33 28 9 11 44
World 15 26 22 9 12 34

13. Where do Nutrition Emergencies occur? (3)
% of under–fives (2003 –2009) suffering from wasting (WHO,
moderate & severe)
Timor-Leste 25Somalia 13
India 20Central African Republic 12
Bangladesh 17Ethiopia 12
Djibouti 17Niger 12
Sudan 16Burkina Faso 11
Eritrea 15Myanmar 11
Mali 15Nigeria 11
Sri Lanka 15Sao Tome and Principe 11
Yemen 15Democratic Republic of the Congo10
Indonesia 14Haiti 10
Pakistan 14Morocco 10
Maldives 13Sierra Leone 10
Nepal 13Syrian Arab Republic 10

14. Vulnerability to Nutrition Emergencies?
•Existing health and nutrition situation greatly affects
how vulnerable a population is to a nutritional
emergency
•HIV and AIDS increases food insecurity, poverty, and
even has negative effects on labour force and
agriculture at large scale
•Poverty and urban pressure overcrowding, inadequate
drinking water, substandard sanitation facilities and
infrastructure, exposure to urban pollution and
hazardous materials, landlessness, and frequent food
shortages
•Climate change may have an increasing impact leading
to more frequent famines in the future

15. Triggers for Nutrition Emergencies
•Natural disasters affect food availability and access,
disrupt health systems, destroy WASH systems
•Conflict can lead to Nutrition Emergencies in many ways
due to lack of access to food, health, WASH, etc.
•Political crises and economic shocks contribute to
Nutrition Emergencies through discrimination of ethnic
groups or inadequate political decisions (China famine in
the late 50s)
•Global food prices fluctuations have caused increased
levels of poverty, food insecurity and resulting
undernutrition

16. Who are the most vulnerable in emergencies?
•Physiological vulnerability: children less than 5,
older people, people affected by chronic
diseases, gender
•Geographical vulnerability: flood or drought-
prone areas, conflict front lines
•Political vulnerability: discrimination,
persecution
•Internal displacement and refugee status: 26
million IDPs, 16 million refugees at the end of
2010 (minus the Arab spring displacements).

17. What types of malnutrition occur in
emergencies?
•The major concern in emergencies
is the increased risk of moderate
and severe acute malnutrition
because acute malnutrition is
strongly associated with death
•In many long-term emergencies
levels of other forms of
malnutrition (stunting and
underweight) are often high
–Stunting inhibits a child from reaching
his or her full physical and mental
potential
–Can have a major impact on work
output and national development
–Is becoming an increasingly important
measure of nutritional wellbeing in
some emergencies
•Micronutrient deficiencies are
common in emergencies,
particularly in affected people
dependent on food rations

18. Nutrition assessments in emergencies
•Aims at establishing the prevalence of
malnutrition in emergency-affected populations
using internationally agreed upon standard
methods
•Anthropometric information and various
indicators are collected for identifying direct,
underlying and basic causes of malnutrition
•Will be covered in modules 6 & 7

19. Internationally used emergency thresholds
Based on NCHS reference
Acute Malnutrition level Nutrition classification
<5% Situation is acceptable
5 - 9% Situation is of concern
10 – 14% Situation is serious
≥ 15% Situation is critical
Aggravating Factors:
•Inadequate general food ration
•CMR > 1/10,000/day
•Epidemic of measles or whooping cough
•High incidence of respiratory or diarrhoeal diseases

20. Nutrition Responses
•A wide variety of response options exist for the different phases of food
and nutrition crises
•See Handout for detailed list See Handout for detailed list
•Working with the community All emergency related programming needs
to work with the support of the community
–Disaster-affected people possess and acquire skills, knowledge and capacities
to cope with, respond to and recover from disasters
–Local population is usually the first to react in a disaster and even early in a
response some degree of participation is always feasible
–Explicit efforts to listen to, consult and engage people at an early stage will
increase quality and community management later in the programme
• 
”
Active participation in humanitarian response is an essential foundation
of people’s right to life with dignity”
Code of Conduct for the International Red Cross and Red Crescent
Movement; Sphere handbook, 2011.

21. Challenges in Nutrition in Emergencies
•Lack of impartiality in responding to nutrition emergencies:
response does not match needs at global level
–Political and media focus often followed by higher rates of
response
–Most undernourished children are in “non emergency” countries
•Dominance of food aid: represents the most funded domain of
all humanitarian interventions. Changing slowly
•Constraints of the operational environment: access to the
populations in need is often difficult for many reasons such as
weak infrastructure, insecurity

22. Challenges in Nutrition in Emergencies (2)
•HIV and AIDS and Nutrition: stigma, discrimination
and lack of international guidelines remain common
challenges for humanitarian workers
•Lack of an evidence base for interventions: only a
few interventions are based on clear evidence
•Lack of skills and expertise in Nutrition in
Emergencies: national capacity is often missing in
many countries affected by nutrition emergencies.

23. Key Messages
•Protecting the nutritional status of vulnerable groups affected by
emergencies is essential to prevent acute malnutrition, disease and
death.
•Several systems exist for the classification of food and nutrition
crisis; the IPC system is one example which has been adopted by
several agencies and governments to analyse and design responses
to food insecurity
•Nutrition emergencies are primarily caused by severe shortages of
food combined with disease epidemics though underlying factors
such as poor care and feeding practices, and insufficient access to
health care and an unsafe environment all contribute
•While Asia and Africa have suffered significant famines over the
past 100 years, food and nutrition crises continue and many
countries on both continents have baseline levels of acute
malnutrition that indicate emergency response interventions are
required

24. Key messages (2)
•Acute malnutrition is a major concern during emergencies, but chronic
malnutrition and micronutrient deficiencies are also issues in certain
emergency affected populations. A range of nutrition interventions are
typically implemented in an emergency, both to prevent and treat
acute malnutrition as well as support livelihoods
•Existing challenges in the area of Nutrition in Emergencies include:
–Lack of commonly agreed classification system for nutritional crises
–Limited evidence for an effective model to treat moderate acute
malnutrition
–Constraints to the operating environment
–Inadequate skills and expertise in nutrition in emergencies at national
level
–Linking relief, recovery and development efforts
–Linking nutrition interventions with each other and with other sectors