MODULE 1

Introduction to nutrition in emergencies

PART 1: FACT SHEET
The fact sheet is part one of four parts contained in this module. It provides an overview of
nutrition in emergency situations. Detailed technical information is covered in part two.

Importance of nutrition in emergencies

Protecting the nutritional status of vulnerable groups affected by emergencies is crucial and a
humanitarian right. Individuals who suffer from acute malnutrition1 are much more likely to
become sick and to die. At the same time, sick individuals are more likely to become
malnourished.

Emergencies have an impact on a whole range of factors that can increase the risk of
malnutrition, illness (morbidity) and death (mortality). Unfortunately, high malnutrition and
mortality rates continue to occur during emergencies.

Broad-based approach to tackling malnutrition

Malnutrition does not result simply from lack of food but from a complex mix of factors.
These factors work on a number of levels affecting populations, households and finally
individuals. A conceptual framework has been developed to help understand the causes of
malnutrition which sets out the basic, underlying and immediate causes.

Hence a broad-based approach is required to address malnutrition. At one end of the scale,
interventions to ‘cure’ malnourished individuals and prevent death are essential. At the other
end of the scale, interventions to ‘prevent’ malnutrition rates from increasing are needed.
These interventions will range from those directed at protecting health and a healthy
environment, to ensuring food security (the ability of a household to access food). This broad-
based approach is referred to as a public nutrition approach.

Advances in nutrition in emergencies

Over the last 40 years, there have been many advances in key areas of nutrition in
emergencies. These include:
• Standardisation of nutrition assessments particularly nutrition surveys
• Understanding of the underlying causes of malnutrition
• Development of more sophisticated early warning systems to predict famine
• Standardisation of rations provided through food aid
• Greater emphasis on community-based targeting of food rations
• Development of ready-to-use-therapeutic-foods for severely malnourished children
• Greater understanding of the importance of micronutrients (vitamins and minerals)
and the development of blended foods that can be fortified with micronutrients
• Active promotion of breastfeeding during emergencies
• Expansion of non-food interventions
• Introduction of Sphere standards
1
Acute malnutrition is a measure of ‘thinness’ due to rapid recent weight loss. Clinical forms include marasmus
and kwashiorkor which is characterised by oedema (swelling). It is the type of malnutrition of special concern in
emergencies as it can quickly lead to death.

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 • Introduction of the coordination mechanisms
• More effective lesson-learning

What is an emergency?
Emergencies cover a wide variety of different scenarios. They differ in terms of:
• Length (short-term, chronic)
• Cause (natural, conflict-related, economic-political, ‘complex’)
• Impact (destruction of infrastructure, agricultural, health and social systems)
• Affected groups (internally displaced persons, refugees, stable populations)
• Humanitarian response (huge response, no response at all)

What is a nutrition emergency?

While there is no universally accepted definition of the term ‘nutrition emergency’, various
attempts have been made to classify the severity of an emergency using acute malnutrition or
wasting in the population as one indicator of distress. These classifications2 suggest that
emergencies can be divided into stages. In the most extreme stages, food insecurity,
malnutrition and mortality are so severe as to be labelled ‘famine’. Some of the systems have
attempted to set thresholds above which particular emergency interventions should be started.

At the moment, however, there are no agreed thresholds above which a situation is defined as
a nutritional emergency or when certain responses kick in. In practice, there is little
relationship between whether a particular situation is labelled a nutrition emergency and the
level of malnutrition suffered by an affected population.

Where do nutrition emergencies occur?

Historically, the largest famines in terms of excess deaths have occurred in Asia though
Africa has suffered more frequent famines. The distribution of acute malnutrition by country
suggests that most nutritional emergencies are chronic and ‘invisible’ i.e. they are not
declared publically as emergencies. In fact, the average level of wasting in South Asia is 14
per cent compared to 9 per cent in sub-Saharan Africa, suggesting that South Asia is in a
constant state of ‘acute food and livelihood crisis’ and requires emergency nutrition
interventions.

The allocation of emergency food aid is not based on the levels of wasting in a given country
but on a range of other factors including political motivations.

What are the causes of nutrition emergencies?

Emergencies where acute malnutrition rates rise are usually directly caused by severe
shortages of food combined with disease epidemics. Some populations are vulnerable as a
result of underlying factors such as poverty, chronic food insecurity and poor infrastructure,
i.e. nutrition emergencies are much more likely to occur in developing countries than in the
developed world. In addition, over the last two decades, two new underlying factors have
emerged; that of HIV and AIDs, and global climate change. Where there is underlying
vulnerability, sudden events such as natural disasters, conflict, political crisis or economic
shocks can trigger a nutrition emergency.

2
One of the most widely known is the FSAU/FAO Integrated food security phase classification 2006

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Who are most nutritionally vulnerable in emergencies?
The population groups most nutritionally vulnerable in emergencies can be categorised
according to their:
• Physiological vulnerability (e.g. young children, pregnant and lactating women, older
people, the disabled and people living with chronic illness such as HIV and AIDS)
• Geographical vulnerability (e.g. people living in drought or flood-prone areas or in areas
of conflict)
• Political vulnerability (e.g. oppressed populations)
• Internal displacement and refugee status (e.g. those who have fled with few resources)

What types of malnutrition occur in emergencies?

The main nutritional problems of concern in emergencies are:
• Acute malnutrition (wasting) especially in young children. The clinical forms of this are
kwashiorkor characterised by oedema (swelling due to fluid retention) and marasmus.
• Micronutrient deficiencies especially iron, vitamin A and iodine deficiencies (common in
disadvantaged populations) and vitamin C, thiamine and niacin deficiencies (outbreaks
have occurred in emergency-affected populations).

Nutrition assessment in emergencies

Nutrition assessments using standard methods are commonly conducted at the outset and
throughout an emergency. These include rapid assessments, surveys and nutrition
surveillance.

Nutrition responses in emergencies

Typical responses to nutrition emergencies include food responses (general food distribution,
emergency school feeding, food for work, supplementary feeding, micronutrient fortification
and supplementation, and therapeutic care) and non-food responses (support for livelihoods,
infant and young child feeding and health). Food aid remains the dominant form of response
to nutrition-related problems in emergencies.

Coordination of nutrition in emergencies

There has been a huge expansion in the number of organisations working in nutrition-related
areas during emergencies over the last few decades. Coordination has therefore become a
priority. A major step forward has been the initiative to set up technical ‘clusters’ so that
during an emergency, all agencies working in a particular technical area coordinate their
activities. There is a Nutrition Cluster with 35 agency members including United Nations
agencies, non-governmental organisations and the Red Cross Movement. UNICEF is the lead
agency. The Nutrition Cluster aims to improve nutrition co-ordination, capacity building,
emergency preparedness, assessment, monitoring and surveillance.

Standards, monitoring and evaluation

In the past 10 years, there have been several initiatives to set standards, and to monitor and
evaluate nutrition programmes to ensure that these standards are met during emergencies.
These include the development of Sphere nutrition, food security and food aid standards.
However, standards are lacking for some new types of intervention while there are concerns
that standards cannot be met in particular contexts, and there is no institution to oversee
information on programme effectiveness, impact and cost.

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Challenges in nutrition in emergencies
A number of major challenges remain in the area of nutrition in emergencies. These are
mainly operational and result from the political and institutional factors that have a major
influence on the outcomes of response to emergencies. They are:
• Lack of impartiality in responding to nutrition emergencies
• Dominance of food aid
• Constraints of the operational environment
• HIV and AIDS and nutrition
• Lack of an evidence base for interventions
• Lack of skills and expertise in nutrition in emergencies

Key messages
1. Protecting the nutritional status of vulnerable groups affected by emergencies is essential to
prevent acute malnutrition, disease and death.
2. Malnutrition does not result simply from lack of food but from a complex mix of factors.
3. There is no agreed definition of a ‘nutrition emergency’, though attempts have been made to
classify the severity of an emergency using acute malnutrition as one indicator of distress.
4. Nutrition emergencies are caused by severe shortages of food combined with disease epidemics.
5. Asia has historically suffered from the most severe famines, has the highest rates of acute
malnutrition true and is most prone to natural disaster.
6. Acute malnutrition is a major concern during emergencies but chronic malnutrition and
micronutrient deficiencies also arise and have negative effects.
7. Nutrition assessments using standard methods are commonly conducted at the outset and
throughout an emergency.
8. A range of food and non-food interventions are typically implemented during an emergency to
address and prevent malnutrition.
9. Existing challenges in the area of nutrition in emergencies include:
 Lack of impartiality in responding to nutrition emergencies
 Dominance of food aid
 Constraints of the operational environment
 HIV and AIDS and nutrition
 Lack of an evidence base for interventions
 Lack of skills and expertise in nutrition in emergencies

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