Q: What are the UNICEF nutrition priorities in severe humanitarian crises?

Tolvanen: The foremost goal in emergencies is always to prevent death and to reduce malnutrition in the affected population. UNICEF focuses on children, pregnant women and breastfeeding mothers who are particularly vulnerable in emergency situations. Children under five face a deadly combination of threats: measles, diarrhoea, respiratory infections and malnutrition. Another at-risk group are children orphaned by HIV/AIDS.

UNICEF does not go for a one-time response – we usually already have a country programme in place, with its own emergency plan. Our challenge is to figure out what additional support is needed in each situation, with the long-term goal being to establish, or strengthen, sustainable and effective nutritional programmes.

Q: How does UNICEF respond when an emergency occurs?

Tolvanen: We first do nutritional assessments and surveys of the food security situation with governments and non-governmental organizations. We assess basic water, food and shelter needs. For example, in the event of a flood, drinking water is the first thing we focus on, followed by shelter. In the event of war or conflict, where people are on the move or living in camps, our first response is a measles vaccine with vitamin A supplementation.

Generally we work in close cooperation with other United Nations agencies, such as the World Health Organization (WHO) and the World Food Programme (WFP), while we focus very much on therapeutic and supplementary feeding programmes and training health workers. In Afghanistan, for example, the WFP provided general food and UNICEF was involved in therapeutic feeding and buying supplementary foods.

Q: What are the various types of nutritional assistance?

Tolvanen: There are three types of food response. The first is general food distribution by WFP. The second, in the event of a prolonged conflict or natural disaster, is targeted food aid for pregnant and breastfeeding women and children under five. The third is a medical response, therapeutic feeding, used in cases such as marasmus, where the child is severely emaciated, and kwashiorkor, where the child has swelling of the face, feet and limbs due to lack of protein These children are at a very high risk of death.

Q:  What are some therapeutic and supplemental foods?

Tolvanen: I think of therapeutic feeding as the last chance to catch the train when we have missed it earlier. In many countries, the situation is very bad without emergencies. When one occurs, it creates life-threatening circumstances. Children become malnourished very quickly, develop diarrhoea or get measles and then need medical treatment. When a child is malnourished, there are many metabolic system changes and they can’t eat normally.

Foods given to these severely malnourished children, such as therapeutic milk, must be very finely-tuned so that they can be consumed by children with weakened bodies. Essential vitamins and minerals are added in the right proportions. Unimix, used in supplementary feeding, is a vitamin and mineral fortified product of 70 per cent corn and about 25 per cent soya protein. It makes a porridge that has 400 calories per 100 grams of flour.

Q: What are UNICEF strategies going forward?

Tolvanen: The number of conflicts and emergencies increased worldwide in the 1990s. UNICEF is trying to shift from a reactive to proactive mode by focusing more on emergency planning and preparedness within each country programme. In some countries there are reoccurring crisis each year, floods in Bangladesh or Viet Nam, for example. Thus the country programmes can anticipate these emergencies and prepare ahead of time.

A second strategy is to look more carefully at certain care and feeding practices which may be contributing to malnutrition in children or mothers. For example, in some countries we need to educate women about the importance of breastfeeding, which can become particularly important in the case of emergencies if people are on the move or if there is bad water.