Addressing malnutrition during a humanitarian crisis

Addressing malnutrition during a humanitarian crisis

Oxfam India is a rights-based organization that fights poverty and injustice by linking grassroots programming by partner NGOs to local, national and global advocacy and policy-making. All of Oxfam’s work is influenced by its commitment to five broad rights-based aims: the right to a sustainable livelihood, the right to basic social services, the right to life and security, the right to be heard and the right to equality: gender and diversity. 

Oxfam India's role during a humanitarian crisis
Oxfam India provides humanitarian assistance to communities at risk in times of natural disasters and conflict. Our aim is to ensure that affected people realize their right to clean water, food, sanitation, and other fundamental needs. In particular, we reach out to women, adolescent girls, children, persons with disability and elderly people among affected communities. Special attention is given on reaching out to the most vulnerable and worst affected communities who remain outside the coverage of any humanitarian assistance.

During the last ten years, Oxfam India responded to more than 30 major disasters including Nepal earthquake. During the year 2018, Oxfam India responded to 6 major disasters with humanitarian response and rehabilitation work to more than 30,000 worst affected households or approximately 1,50,000 people.

The enormous impact of disasters on children and women are evident with the overwhelming number of deaths and injuries to children. Children’s vulnerability increases with the decrease in age and existing ill-health conditions. Among lives lost in disasters, at least one out of three is a person below 18 years. Children are the worst affected during disasters due to physical, psychological and social vulnerabilities. The major impact remains due to physical vulnerability as children bear the brunt of shock due to any disaster. 

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An individual affected by floods in Assam receives Oxfam's Relief Bucket 

How vulnerable are children during a disaster?
In India 444 million (0-18-year-olds), almost 20 percent of the world’s child population has been impacted by flood and drought across one-third of Indian States. The north-eastern and western parts of India witnessed multiple sequences of riverine flooding, especially in seven states – Assam, Bihar, Gujarat, Manipur, Rajasthan, West Bengal, and Uttar Pradesh in 2017. Over 1,200 lives were lost and 35 million people, including 13 million children, reeled under the multidimensional impact of the floods in 103 districts. Flooding destroyed or severely damaged 12.2 million homes, 8,443 Anganwadi centres (early childhood development/nutrition centres) and 24,782 schools. While the 2017 floods saw a sharp rise in severity and scale of damage and losses compared to earlier years, 225 districts in 17 states in the country were facing drought because of insufficient rain, according to the National Agricultural Drought Assessment and Monitoring System. 

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Photo taken with consent during Flood Response in Thoubal district, Manipur
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WASH assessment in Wayanad, Kerala during the Kerala Floods of 2018

What are the possible health risks in the event of a disaster?
There is a greater risk of contracting communicable diseases and vector-borne illness, neonatal causes, malnutrition, and micronutrient deficiencies also have a significant impact on child mortality. This is not only from the direct effects of the deficiency but also due to reduced resilience caused by nutritional deficiencies that makes children more susceptible to increase health risks.

The provision of a mid-day meal to the school children has been introduced by the Government of India to reduce undernourishment among school children. Additionally, it has acted as a powerful incentive for school enrolment and attendance throughout the year. During a disaster, the continuity of provision of ‘mid-day meal in school’ gets disrupted. This exposes the children towards further risks of malnutrition and starvation.

Currently, the Mid-Day Meal Scheme (MDMS) in India is the largest school-feeding program in the world.  But, an assessment conducted by the Planning Commission revealed the following:

  • Cooked Mid-Day Meal Program has been successful in addressing classroom hunger in sample schools. 
  • It has helped create a platform for children of all social and economic backgrounds to have meals together, thereby facilitating and achieving the objective of social equity. 
  • It has been observed that the programme has resulted in the diversion of the attention of teachers towards teaching and learning activities, which has resulted in a loss of productive study time.
  • All the states suffer from the unavailability and poor functional condition of storerooms.
  • Most of the states do not follow the guidelines of Government of India to deliver the food grain at the school point by PDS dealer resulting in leakage in the supply of food grain in general. 
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Food distribution underway in Imphal East, Manipur

During our assessment, we have come across schools located in river basins and flood-prone areas that were submerged in flood water for more than a month. But any focused attempt or recommendation for ensuring the Mid-Day Meal during emergency situation were not found in the areas where we implemented our disaster response and recovery projects.

Malnutrition is a common consequence of emergencies, disproportionately impacting women and young children. Those affected often have poor nutritional status prior to the crisis, which then worsens as disaster strips communities of their infrastructure, livelihoods and social structures. 


The affected communities are forced to displace from their origin and take shelter in either relief camps or at a neighbour's house or rent a temporary shelter near the river embankment. The children are the most vulnerable during this time. The children neither go to school nor get Mid-Day meal as schools and are unable to get nutritious food at the shelter. This situation leads to child malnutrition and major health risks. 


However, the local government distributes the dry ration immediately after a disaster to meet the nutritional deficiency, in many cases, children from the most vulnerable and marginalized population remain outside the coverage of intervention.

Oxfam India’s interventions against malnutrition
Oxfam India implemented post relief in early recovery phase in 3 Gram Panchayat of Karimganj district in Assam, 2017; and one of the activity was designed to address the nutritional requirement of children during the emergency period. “Complementary food basket support to the SAM (Severe Acute Malnutrition) and MAM (Moderate Acute Malnutrition) children” was adopted to ensure the nutritional intake of children in emergencies, given the fact that Karimganj is one of the severely malnourished districts in Assam (rank-23 out of 27 districts). 

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Distribution of Mosquito nets and halogen tablets in Karimganj, Assam


The community mobilizers, Oxfam India staff were engaged for MUAC survey. A total of 76 children were identified for food basket support. A post-distribution monitoring survey was conducted on a sample comprising of 18% families. They were happy to receive the support from Oxfam. They expressed that the support was very necessary, it was on time. The food support helped them to ensure the nutritional requirement for the children. Continued and quality functioning of the ICDS system was reported as the best possible solution towards ensuring nutrition and well-being of children in disasters. 
Oxfam India also implemented the Cash transfer (CTPs) programme which is an increasingly popular social protection mechanism to improve the food security and nutritional status of families from lower socio-economic strata of the affected community. Through this Oxfam India aims to meet immediate food needs and protect livelihoods, whilst contributing to the long-term economic recovery of disaster-affected populations and increasing their resilience to future shocks. Oxfam India believes that these aims are achieved most effectively and sustainably by working through existing structures in order to reinforce local capacity with an approach of doing no harm. 

Provisions by the government for safeguard against malnutrition and hunger during disasters
Disaster Management Act-2005 clearly mentions the provision of food, drinking water, sanitation and basic healthcare services [Section 34 (c)]. The act always emphasizes awareness, general education also proper plans and coordination with all the line departments with the purpose of emergency response rescue and relief. [ Section-10 (2)]. There is a clear instruction of appropriate funds for prevention of disaster, mitigation and capacity building [ Section-35 (2-C)].


Local government and communities together can manage risks to children’s health in disasters through effective implementation of governance, advocacy, and policy. School, health and disaster risk management sectors should work closely together and prioritize children when planning for disasters. This includes identifying and addressing the health risks for children in their policies, programmes, and plans. Health and child-care facilities including schools should receive early warning messages, allowing them to plan and prepare to copy the situation. 
The multi-sector working coordination, preparedness, proper planning, and execution are one of the key features to maximize the effectiveness of DRR activities by working with other sectors such as water and sanitation, shelter, nutrition and food security and livelihoods before, during and after a disaster. The health of a child is dependent on sectors beyond health alone. Children need access to food, clean water, shelter, housing and education in safe buildings that are appropriately placed in order to be resilient to disaster. It is also important to empower communities and families by raising awareness of risks and actions related to food, nutrition, water, and sanitation to protect health from local hazards. Improving the baseline health of children through the provision of primary health care increases the resilience of children in disasters.

However, Oxfam India works with local and state government during emergency relief, rehabilitation, DRR, and development work. Also constant efforts to influence the interaction between active citizens and accountable states as fundamental to human development. Oxfam mainly focuses on the first of these, saving lives, helping to build the organizational capacity of the organizations of poor people but it also engages directly with the local and state government, for capacity building for replication and build a resilient society with assurance for a starvation- free future for children during the disaster as well as throughout the year. 

Source:

  1. National Disaster Management Plan
  2. UNICEF Annual Report 2017
  3. Disaster Management Act
  4. Child Health Fact Sheet: World Health Organisation
  5. Evaluation Study of Performance Evaluation of Cooked Mid-Day Meal (CMDM)
  6. Coalition for Food and Nutrition Security: Assam 
  7. Children most vulnerable during disasters

North-East India witnesses perennial floods. Oxfam India is on ground responding with immediate relief and long term livelihood support. DONATE NOW to help save lives. 
 


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