Nutritional Implications of Displacement

The public health and nutrition consequences of war and population displacement have been well documented during the past 25 years. The major determinants of high death rate among affected populations and the major priorities for intervention have also been identified. Clean water, sanitation,

Refugee population by region

6,000,000" 5,000,000" 4,000,000" 3,000,000" 2,000,000" 1,000,000" 0

Refugee population by region

End-2001

End-2002

Asia Africa Europe North Oceania Latin America America and the Caribbean

Population of concern by category

12,000,00010,000,0008,000,0006,000,0004,000,0002,000,0000

End-2001

End-2002

Refugees Asylum- Retured IDPs Returned Others of seekers refugees IDPs concern

Figure 1 UNHCR Statistics, 2002.

shelter, and immunizations are essential components, but an adequate and diverse food supply remains the central factor in refugee nutrition. Today, it is acknowledged that acute malnutrition is a strong predictor of excess mortality among young children; even moderate malnutrition contributes to increased mortality in emergencies because a larger proportion of the affected population is usually moderately, rather than severely, malnourished; and; micronutrient deficiencies contribute significantly to diseases in emergencies.

Malnutrition results from a lack of food and/or prolonged inadequacies of food consumption, infection, or both. Malnutrition comprises a broad range of clinical conditions in children and adults that result from deficiencies in one or a number of nutrients. It has been defined as a state in which the physical function of an individual is impaired to the point at which he or she can no longer maintain adequate bodily performance processes, such as growth, pregnancy, lactation, physical work, and resisting and recovering from disease. The link between acute malnutrition and excess mortality has been documented for decades. The close correlation between these two factors was demonstrated during a Somali refugee operation in Ethiopia in 1988-89. During the period of peak incidence of mortality and prevalence of acute malnutrition, the food rations provided were less than 1400 kcal/person/ day instead of the recommended 1900kcal/person/day at the time (Figure 2).

Deaths/10 000/day % malnourished

Figure 1 UNHCR Statistics, 2002.

Deaths/10 000/day % malnourished

88 89 90

Month

88 89 90

Month

Figure 2 Relationship between malnutrition and mortality as seen in Ethiopia 1987-1990. Morbidity and Mortality Weekly Report (MMWR), July 24, 1992, vol. 41, page 10, Figure 8. Centers for Disease Control, Atlanta, Georgia.

Cycle Malnutrition
Figure 3 The life cycle and intergenerational transmission of malnutrition. (Adapted from James et al. (2000) The 4th Report on the World Nutrition Situation: Nutrition Throughout the Lifecycle. ACC/SCN January 2000. Geneva, Switzerland.)

Although the immediate aim of most food aid programs in refugee emergencies is to prevent excess mortality, there is also increasing evidence that malnutrition during critical periods of life has long-lasting effects. Malnutrition, or the risk of being malnourished, may be carried from one generation to another in an intergenerational cycle. Malnourished women give birth to malnourished infants who, in turn, are more likely to become malnourished adolescents and adults. Therefore, the nutritional status of refugees can have long-lasting effects on future health for individuals and generations (Figure 3).

Table 1 Types of malnutrition in refugees

Wasting (acute malnutrition)

Stunting (chronic malnutrition)

Marasmus

Kwashiorkor

Extreme thinness due to recent rapid weight loss; measured by weight-for-height z score Growth failure in a child that occurs over a slow, ongoing process; stunted children are short for their age; measured by height-for-age z score A form of extreme PEM identifiable by severe weight loss or wasting; often there is good appetite and alertness A form of extreme PEM characterized by oedema, loss of appetite, and apathy; hair thins and may lighten in color to a light brown or red

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