|Nutrition Guidelines (MSF, 1995, 191 p.)|
|Part I: Nutrition Strategies in Emergency Situations|
In emergency situations, food security is often severely threatened causing increased risk of malnutrition, disease and death.
Emergency health workers/organizations have the responsibility to try to cure the malnourished, prevent malnutrition amongst the vulnerable and promote adequate distribution of food to allow a healthy existence.
The complexity of food and nutrition as an issue means that the best response to a situation depends on the context.
Part I attempts to define emergency nutrition needs (Chapter 1), to outline the information needs critical for decision making (Chapter 2), and some of the essential tools for assessing nutrition problems (Chapter 3). A range of potential interventions for alleviation of nutritional emergencies is then discussed (Chapters 4 and 5). The final Chapter deals with the necessity of evaluation as a means to manage programmes, monitor population needs and adapt programmes over time (Chapter 6).
Malnutrition, food insecurity and famine
Household <<food security>> is a concept that refers to the ability of a household to feed its members, enabling them to live full and active lives.
Inadequate household food security for a population, on short or long term basis may lead to different forms of chronic and or acute malnutrition.
While malnutrition is a disease of the individual, the causes of malnutrition are often complex and multi-sectoral, and are linked to different social and economic factors (see Figure 1).
Action to improve household food security (improve availability and access to food) may need to cover a broad range of sectors (agricultural, land ownership, price supports, inflation, taxation, etc.).
In emergency contexts, there is often a sudden and massive reduction in food availability (drought, conflict, isolation, siege, transport problems) or reduction in food accessibility to some sections of the community (displacement, reduced purchasing power, increased prices). The result is often acute and severe food insecurity, which may lead to high levels of malnutrition and mortality.
In acute food crises the extent of global acute malnutrition means that nutrition becomes an emergency health issue.
However, even in emergencies, nutrition and food accessibility is a complex social issue and population groups may envolve complex coping strategies to deal with reduced availability/access to food.
A complete breakdown in food security systems leads to acute food shortages which may lead to famine (a time of destitution and increased mortality).
The process of food shortage leading to famine has been described in different phases:
1. Change of behavior to cope with hard times (rationing of food, sale of excess cattle, etc.).
2. Sale of capital and income earning assets - which means future prospects are damaged (loans, sale of essential tools, land or cattle).
3. Break down of established life patterns and destitution (distress migrations, reliance on aid, etc.).
4. Starvation and death - famine.
Emergency food interventions
Under emergency conditions, General Food Distributions (GFD) aim to bring the nutritional value of the diet, for the whole population, up to a "sufficient" level for survival.
GFDs are often insufficient to meet the needs of all members of the population and/or distribution of food is unfair, so that certain vulnerable groups (growing children, pregnant and lactating women, elderly, handicapped) are at particular risk of becoming malnourished.
Different types of selective feeding programmes aim to cover special needs of certain vulnerable groups:
· Blanket supplementary feeding provides a quality or energy supplement in addition to the normal ration which is distributed to all members of identified vulnerable groups to reduce risk (preventive).
· Targeted supplementary feeding provides energy or quality dietary supplements and basic health screening to those that are already moderately malnourished to prevent them from becoming severely malnourished and improve their nutritional status (curative).
· Therapeutic feeding provides a carefully balanced and intensively managed dietary regimen with intensive medical attention, to rehabilitate the severely malnourished (curative) and reduce excess mortality.
Thus, the range of nutritional interventions vary from population based GFD to intensive, highly managed, curative, individual level interventions (intensive therapeutic feeding).
Health organizations working in food crisis situations have an obvious responsibility towards the curative rehabilitation of acutely malnourished individuals. However, the rehabilitation of malnourished individuals can become a pointless and frustrating task in a situation where the population simply cannot get sufficient quantities or quality of food.
Thus, emergency health workers also have a very great responsibility to promote the nutritional welfare of populations by advocating adequate GFD and other complementary interventions (see Figure 2).