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Module 2
Introduction to Nutrition in
Emergencies
 Overview

This module presents the basic

principles on how disasters and
emergencies affect the nutritional
status of individuals, households
and populations.
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 Learning Objectives
At the end of this module, the participants should
be able to:

• Explain basic concepts like nutrition

emergencies, types and levels of severity of
nutrition emergencies and their impact from
the levels of individuals to households and
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populations,

• Discuss the different developments in nutrition

in emergencies and which among these have
been adopted in the Philippines.
 SESSION 2.1
NUTRITION EMERGENCIES AND
NUTRITION IN EMERGENCIES
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 Nutrition Emergency

• Refers to the situation in which

food security is often severely
threatened causing increased risk to
malnutrition, illness, and death.
• Acute malnutrition or low weight for
height is an indicator used to
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classify the severity of nutrition

emergency.
 • individuals who suffer from acute
malnutrition are much more likely
to become sick and ultimately die.
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• sick individuals are more likely to

become malnourished.
 Difference between NE and NiE

Nutrition Emergencies

 refer to wasting, deficiencies in iodine,

vitamin A and iron which are common in
emergency-affected populations.
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• refer to conditions common in

emergency-affected populations and in
populations entirely dependent on food
aid
 Nutrition in emergencies
 refer to essential nutrition services that
are components of emergency
preparedness, response, and recovery
phases aimed at preventing death and
worsening of malnutrition in the affected
population, particularly in the most
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nutritionally vulnerable groups: infants,

children, pregnant women and
breastfeeding mothers, and older
persons.
 Nutrition in Emergencies

The minimum service package for NiE

includes assessment of the nutritional
and health needs of affected populations,
protection, promotion and support of
Infant and Young Child Feeding;
provision of essential micronutrients;
community-based management of acute
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malnutrition, and other cross-cutting

issues.
 SESSION 2.2
TYPES AND CAUSES OF
MALNUTRITION DURING
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EMERGENCIES
 Types of malnutrition

• acute malnutrition - wasting or low weight for

height especially in young children,

• chronic malnutrition - stunting or short/low

height for age
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• micronutrient deficiencies such as anemia,

Vitamin A deficiency and iron deficiency
 Most Vulnerable to Acute Malnutrition

Individuals most susceptible to

acute malnutrition are those affected
• physiologically,
• geographically,
• politically, and
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Those who are considered

• internally displaced and
• with refugee status.
 Causal factors affecting
malnutrition

• Direct causes

• Underlying causes
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• Basic causes
 Causal Framework of Malnutrition
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 Nutrition emergencies happen due to

• Triggers like natural disasters, conflict,

political and economic crisis.

• Vulnerabilities like HIV and AIDS and

climate change
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 Challenges in NiE

• The insufficient support in responding to

nutrition emergencies as nutrition is not
seen a priority by some local government
units.

• Dominance of food aid has been

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regarded as helpful by the majority

particularly during emergency situations
while to others, these can be problematic
since some of the donations do not fit
the local environment.
 Challenges in NiE
• Constraints of the operational environment such
as the inadequacy in the disaster management
plans, poor coordination arrangements,
insufficient preparedness and expertise, etc.

• Evidence-based interventions, sometimes do

not reach the local level as basis for emergency
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management plans due to inadequate

dissemination of scientific evidences to the local
government units and insufficient logistic
(funds, transport) support to implement the
interventions at the local level.
 Challenges in NiE

• Need for training in nutrition in

emergencies among health and nutrition
workers

• Increasing incidence of HIV and AIDS

and nutrition
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 SESSION 2.3
FOOD AND NUTRITION
INTERVENTIONS DURING
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EMERGENCIES
 Food and Nutrition Interventions
during Emergencies
• Food-based interventions

Food Ration or Family Food Packs –

Coordinated DSWD or local social welfare
offices, this includes distribution of food packs
targeted to families/household affected by the
emergency or disaster
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Emergency School feeding - Provision of food

for meal preparation at schools or take-home
ration to encourage families to send back their
children to school for learning even in times of
emergencies.
 Food for Work - Provision of standard amount of
food for certain number of work days. In
support of livelihood recovery, work norms are
being followed to ensure relevance of work for
early recovery needs at the community level.

Supplementary Feeding- Provision of

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supplementary food, either to prevent or treat

moderate acute malnutrition (MAM). This is
given to specific population group or identified
individuals with MAM.
 Therapeutic Care - Treatment of individuals
identified with severe acute malnutrition (SAM).
• This consists of therapeutic foods such as F75,
F100 and RUTF which are provided to the
severely malnourished.
• Those without medical complications are treated
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in the community while those with medical

complications receive specialised medical care
at health care units or stabilisation centers
 • Non Food-based interventions
Cash for Work - Maybe done through grants,
vouchers, and micro-financing, this supports
livelihood recovery that entail cash payments.
Infant and Young Child Feeding in
Emergencies –supports and promotes
breastfeeding through counselling and ensures
that refugees and displaced populations have
secluded areas for breastfeeding.
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Caregivers should be provided with easy and

secure access to water and sanitation facilities,
and appropriate foods for the preparation of
nutrient-dense food to older infants and young
children
 Health and Nutrition-related health
interventions include:
• provision of essential health services,
• provision of adequate and safe water supplies
and sanitation,
• prevention of overcrowding in refugee and
displaced camps,
• immunization, de-worming, prevention and
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management of communicable diseases (e.g.

HIV and sexually transmitted infections,
diarrhoea, pneumonia)‫‏‏‬
 Micronutrient Supplementation and
Food Fortification
• Food aid rations can be improved through the
inclusion of nutrient rich foods, complementary
fresh food items, and fortified foods or by
increasing the size of the general food ration to
facilitate diet diversification by exchange or
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trade.
• Food supplementation products for home
fortification or nutrient supplements can also be
distributed.
 Developments in NiE

• Standardization of assessment such as the use

of Mid-upper arm circumference (MUAC) in
rapid screening of acute malnutrition from 6-59
months children during emergencies.

• Nutrition causal analysis such as the adoption of

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the UNICEF conceptual framework. LGUs,

however may have different causal analysis
depending on the prevailing causes of
malnutrition in their areas.
 • Micronutrient supplementation such as the
introduction of multiple micronutrient powder
(MNP) or Vita Mix during emergencies.
• MNP is a premix of vitamins and minerals in
powder form which may be sprinkled once daily
into any semi-liquid foods without changing the
color, taste and texture of the food. Initial
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supply of MNP to the local government units

was made possible with the World Food
Program (WFP).
 • Infant feeding in emergencies which highlights
the importance of breastfeeding and timely and
safe complementary feeding especially during
disasters.

• Expansion of non-food interventions such as

cooking utensils which were not given proper
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attention before.
 • Standardized Monitoring and Assessment of
Relief and Transitions (SMART) Initiative –
adopted for monitoring and evaluation in
ensuring that reliable and consistent data are
available during humanitarian emergencies.

• SMART has identified three critical factors

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during emergency situations such as mortality,

nutritional status and food security. This system
has been conducted by an international NGO
 • Early warning systems were developed to
greatly improve forecasting and make it
possible to quickly alert people at risks. These
initiatives are being done in selected
municipalities.

• Standardization of ration scales through the

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efforts of international agencies was helpful in

determining general nutritional requirements,
specific needs of vulnerable groups and access
to alternative sources of food and/or income.
 • Targeting of food rations aim to protect the
nutritional/health status of specific sub-groups
within a population who are physiologically
vulnerable
- young children
- adolescents
- breastfeeding mothers
- pregnant women
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- elderly people and

- people with disabilities
 • Integrated Management of Acute
Malnutrition (IMAM) was adopted particularly
for children with acute malnutrition.

• seeks to address the challenges of traditional

feeding in which majority of children with acute
malnutrition are treated at home
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• aims to restrict inpatient care to only those

suffering from acute malnutrition with medical
complications.
 • CTCs - use decentralized networks of outpatient
treatment sites to provide a take-home food
ration known as Ready-to-Use Therapeutic Food
(RUTF) along with routine medicines.

• Although this has been done in countries like

Ethiopia and Malawi, it has not been done in our
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country yet.
 • Coordination and increase in number of
participating agencies were recognized with the
onset of several disasters and vulnerabilities
affecting people and resources in the country.

• Lesson-learning has been very effective in

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building the capacities of health and nutrition

workers on nutrition in emergencies. They
became more sensitive to the needs of the
communities during emergencies.
 Key Messages
• Protecting the nutritional status of vulnerable
groups affected by emergencies is essential to
prevent acute malnutrition, illness and death.

• Malnutrition does not result simply from lack of

food but from a number of different factors like
poor access to health and caring environment.
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• 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.
 Key Messages

• Nutrition emergencies are caused by severe

shortages of food combined with disease
epidemics and poor caring practices.

• Asia which has historically suffered from the

most severe famines has the highest rates of
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acute malnutrition and is most prone to natural

disaster.
 Key Messages
• Acute malnutrition is a major concern during
emergencies but chronic malnutrition and
micronutrient deficiencies also arise and have
negative effects.

• A number of developments along the area of

nutrition in emergencies have been useful in
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emergency management. Some of these include

the standardization of assessments such as
MUAC in nutritional assessment, introduction of
Vita Mix for micronutrient supplementation and
IYCF in emergencies.
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THANK YOU!