The State of the World's Children 1998: Focus on Nutrition

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Panel 19

Protecting nutrition in crises

Photo: Health workers vaccinate two girls at a camp for unaccompanied Rwandan refugee children in the Democratic Republic of the Congo.

When refugees stream into a country, when families lose their homes, fields and crops in war or disaster, when children cry from hunger, it is not surprising that food can seem like the only priority and the only answer to averting widespread malnutrition.

But in emergencies as well as in other situations, food, health and care are all crucial to saving lives. Access to basic health services and water and sanitation facilities is essential in emergencies not only to keep children alive, but also to protect their growth and development. To prevent outbreaks of measles, mass immunization usually along with the distribution of vitamin A supplements has become standard practice in emergencies. In Haiti, for example, a measles vaccination campaign in 1994-1995 reached almost 3 million children, helping end an epidemic that began when the country was in the midst of civil unrest.

Preventing death and malnutrition from cholera and other diarrhoeal diseases - through adequate sanitation, access to safe water and oral rehydration therapy - saved thousands of children's lives in the recent emergencies in Rwanda and Somalia. This is standard practice in the current emergency in Burundi, for example.

Breastfeeding is an important element of nutrition-related 'care' in emergencies. There has been marked progress in this area as governments and agencies become increasingly sensitive to supporting women's abil ity to breastfeed. Workers with some NGOs that specialize in preventing malnutrition in times of crisis have had success in recent years in promoting relactation - helping women who may have been separated from their children to begin breastfeeding again after having stopped.

Sometimes infant formula must be used in emergencies - for instance, when young children have been separated from their mothers. In these cases, all UN agencies working in emergencies and many NGOs have committed to supplying only generically labelled (no brand name) formula, to prevent commercial exploitation of emergency situations. During the conflict in Bosnia and Herzegovina, UNICEF and other UN agencies jointly urged that infant formula distribution be severely limited, and relief organizations subsequently ended mass distribution programmes in January 1995. UNICEF and WHO strongly promoted breastfeeding, targeting health workers and joining with local health professionals during and after the war to develop a national policy on infant feeding.

Children ages 6 to 18 months, pregnant women and women who are breastfeeding all need energy-dense, nutrient-dense foods. In emer gencies, the approach to meeting these special needs varies. Agen cies that are part of the International Fed eration of Red Cross and Red Cres cent Societies, for example, try to provide a family ration to meet every one's requirements, including those of children and pregnant and breastfeeding women. The World Food Pro gramme and some other agencies generally distribute a ration that meets minimum needs and, in addition, they cover vulnerable groups with supplementary feeding programmes. The comparative benefits of the two approaches need to be evaluated.

Triple A - assessment, analysis and action - is an essential approach in emergencies as well as in other situations. Monitoring children's nutritional status, with weight-for-height a commonly used indicator, is crucial during emergencies to help target resources and reach the most affected.

Early warning systems and emergency preparedness are cost- effective means to prevent mal nutrition in emergencies. The United Nations Department of Humanitarian Affairs' early warning system draws on the work of similar systems within and outside the United Nations in preparing comprehensive assessments of potential emergency situations, and UNHCR and other agencies have set up rapid deploy ment mechanisms for emergencies. None theless, early warn ing systems and emergency planning and preparedness remain sadly underfinanced, a shortfall that endangers children in particular when crises loom.

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