1. Food crises
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
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
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
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).