Bringing Nutrition Support to Malnourished Displaced Children in Pakistan
By Antonia Paradela
Katcha Garhi Camp, Peshawar – Ataullah cries as the nutritionist measures his mid-upper arm circumference. Weighing only 7.7 kilos against the recommended 9.4, the two-year-old boy is declared severely acute malnourished. His brother Matiullah, less than a year older, is moderately malnourished.
Mina Gul, the mother of the two children, lifts her burqa to follow the nutritionist's instructions with attention: how to complement the meals of both boys with PlumpyNut (a nutritious nut-based food supplement that needs no refrigeration or preparation and that helps weight gain amongst severely wasted children) and Unimix (a flour-based food supplement rich in vitamins and minerals) for moderately malnourished children.
It has been a very difficult year for Mina who, like many women in rural Pakistan, does not know her age. First was the marriage against her will of her 12-year-old daughter as the second wife of a 40-year-old man. “My father-in-law and sister-in-law insisted. I did not want her to get married so soon. I also got married when I was her age and know how difficult it is,” says Mina. Soon after that conflict displaced her family from their home in Bajaur Tribal Agency, near the border with Afghanistan, and brought them to a camp in Peshawar, the capital of the North-West Frontier Province (NWFP).
Already belonging to one of the least developed regions of Pakistan, the Federally Administered Tribal Areas (FATA) –where one out of 10 children die before reaching five years of age – Ataullah and Matiullah's health suffered. According to recent data, 33 per cent of children in the tribal areas are underweight and 16 per cent severely malnourished.
Nutrition interventions like the one supported by UNICEF in Katcha Garhi Camp have screened more than 12,000 children under five years of age. Over 20 per cent were found to have either moderate or severe global acute malnutrition. About 2,500 moderately malnourished children and 1,100 pregnant or lactating women are registered in the supplementary feeding programme and provided with Unimix, micro nutrients supplements and deworming. About 400 severely malnourished children without medical complications are registered in the outpatient therapeutic programme where they receive ready to use therapeutic food as PlumpyNut, medicines, vitamin A and deworming.
For the cases with medical complication requiring urgent medical attention, UNICEF has established stabilisation centres for IDPs in two major public hospitals of Peshawar and one satellite hospital. The total number of children treated so for in the stabilisation centres are 50.
Women working for UNICEF’s implementing partner, Centre for Excellence in Rural Development, go from tent to tent in Katcha Garhi Camp to identify children under five and pregnant and lactating women who need to be referred to the nutrition clinic. They are amongst more than 200 government and NGO staff trained by UNICEF in community management of acute malnutrition.
The women find in a tent an eight-month old orphan baby who is severely malnourished. The family has just moved into the camp and his grandmother is only feeding the baby tea with milk and sugar. Alamzeb Mohmand lost his mother in the bombing of his village during fighting between government forces and militants. The baby’s father, who is traumatised, decided to stay in the destroyed home and sent his six children with their grandmother to the camp. The women quickly explain to the grandmother that the baby’s health is in danger and refer her to the nutrition clinic, where she will receive food supplements for the baby and information about complementary feeding.
UNICEF leads the nutrition cluster which aims to ensure that all mothers and children in IDP camps and host communities receive appropriate nutrition for their age and needs, and those suffering from malnutrition receive supplemental food or treatment. Families affected by conflict are especially vulnerable to inadequate nutrition, especially with food prices increasing by 22 per cent in the area.
At the Katcha Garhi Camp, many women and children from a conservative tribal society have had to learn to access information and services for the first time, and thus need culturally appropriate support. Literacy rates are very low, at only 3 per cent amongst women from the tribal areas, and the small proportion of children who were enrolled have had their schooling interrupted by conflict.
“For UNICEF and its partners in the nutrition cluster, IDP camps also provide an opportunity to provide information about young child feeding, including breastfeeding, to once unreached women,” says Dr Aien Khan Afridi, a Nutrition Specialist working for UNICEF in NWFP. By February 2009, over 5,000 mothers have been reached with such potentially life-saving key messages on infant feeding practices including early initiation of breastfeeding, exclusive breastfeeding for the first six months, timely and appropriate complementary feeding from six months and continued breastfeeding up to two years, feeding a sick child, as well as the importance of hygiene, sanitation and proper nutrition of pregnant and lactating mothers.