Famine Is Only the Beginning

Famine has been declared across six regions in Somalia. Currently more than 50 percent of Somalia is affected by the crisis and 250,000 people are at risk of dying from starvation. Catholic Relief Services’ Regional Technical Advisor for Health, Jennifer Norman, explains the long-term impact famine can have on people, especially children.

Can you please explain exactly what constitutes a famine?

Jennifer Norman: Death and malnutrition rates and people’s access to food are the criteria used to declare a famine. Famine is declared when: acute malnutrition rates among children under 5 are greater than 30 percent; at least 20 percent of the population is unable to meet the minimum 2,100 calorie requirement per day for proper nutrition and there are more than 2 deaths per day per 10,000 people.

Who are the most vulnerable in this type of crisis? Why?

Norman: Children under five years of age and women (especially pregnant and lactating women) are the most vulnerable during a crisis such as this. For all children under five, malnutrition weakens their immune system, making them much more susceptible to dying from illnesses such as measles, malaria, pneumonia and diarrhea. There is also a reciprocal relationship between illness (especially diarrhea) and malnutrition whereby a malnourished child is more at risk for becoming ill and a sick child is more at risk for becoming malnourished. Pregnant and breastfeeding women are also vulnerable as they require more calories and nutrients during these times both for themselves and for the proper growth and development of their babies. In cases of severe maternal malnutrition, a mother won’t produce enough breast milk. Also, because of gender inequality, women are often the last to receive food. In Somalia there were already high levels of child and maternal malnutrition when the famine was declared.

UNOCHA reports that around 450,000 children in Somalia are malnourished, of which 190,000 are severely malnourished. What is the long-term impact of childhood malnutrition?

Norman: Under-nutrition in expectant mothers and young children is estimated to contribute to 35 percent of all deaths in children five and under. Malnutrition can be acute and/or chronic. The immediate effects of acute malnutrition, also known as wasting, puts children 5 years of age and under at a substantially higher risk of death. Inadequate nutrition over a longer period can lead to chronic malnutrition; children who suffer from chronic malnutrition do not have enough nutrients to grow and develop to their full potential. Children under two are especially vulnerable because this is the time of most rapid growth. Without optimal nutrition during what is called the ‘window of opportunity’ (from conception until two years of age – or referred to the first 1,000 days of development), a child is placed at risk for irreversible impact on both physical and cognitive development. This often results in shorter stature (stunting), poor performance in school, lower productivity and less earning potential, which makes it more difficult to rise out of poverty.

There are also inter-generational effects of chronic malnutrition, whereby a chronically malnourished women is more likely to give birth to an underweight baby.

How can a child’s nutrition before the age of five impact his or her adult life?

Norman: Healthy nutrition requires diverse foods to ensure that key macronutrients (protein, carbohydrates and fat) and micronutrients (vitamins and minerals) are consumed. Good nutrition is essential for a child to grow and develop to their ideal potential and it is also essential for them in developing a strong immune system.

What type of emotional and mental trauma can acute malnutrition cause?

Norman: There are various situations that can result in acute malnutrition. Very often, such as in the case of Somalia, the causes for acute malnutrition are very complex and have been overshadowed by long-term insecurity and conflict. Children and adults exposed to the level of insecurity and conflict that has been ongoing in Somalia for decades are already at risk for emotional and mental trauma from the atrocities they have witnessed. Based on my own experience working in Somalia over 18 years ago, a crisis such as this forces mothers, in particular, to make very difficult decisions one should never have to make. When faced with a situation so dire, women sometimes have to choose which child to feed because there is not enough for everyone to survive. This undoubtedly affects them in the longer-term.

Is food assistance enough to help these communities? If not, what other types of help are required to meet the needs of an affected population?

Norman: The importance of sufficient and safe water and basic sanitation cannot be underscored enough. A person requires a minimum of approximately 2.5 – 3 liters per day to survive, and water must be safe for drinking or it can lead to diarrheal disease. The most common reason for unsafe water in emergency settings is improper sanitation, which leads to the contamination of water sources. In crowded settings with unsafe water and poor sanitation, diarrheal epidemics (such as cholera) can quickly spread to already weakened children and adults, rapidly increasing their risk of death. Basic hygiene practices such as hand washing – ideally with soap- can prevent transmission of pathogens that cause diarrhea, but this requires access to additional water, over and above what is required for survival. Access to basic medical care is equally important as the leading causes of death in young children are either preventable or easily treatable. A sick child is at a higher risk for becoming malnourished and a malnourished child is more susceptible to illness. In crowded settings, the risk of a measles outbreak is also increased particularly in populations with low levels of immunization coverage.

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