The world has woken up to the spectre of global food shortages as the war in Ukraine hits harvests and sends the price of food spiralling. With commodities such as wheat and sunflower oil priced globally, many countries highly dependent on imports, including developing countries, will be hit hardest.
Those most at risk are children.
It is against this increasingly difficult backdrop that Concern Worldwide is embarking on the third year of an ambitious three-year programme custom-designed to reduce levels of malnutrition, sickness and death among children aged under five.
The programme, Enhanced Responses to Nutrition Emergencies (ERNE), is funded by ECHO, the EU’s humanitarian organisation.
The World Health Organisation estimates that 45 million children under five are what is termed “wasted”, which means their weight is too low for their height as a result of malnutrition. A further 149 million children are “stunted”, which means they are short for their age.
Both wasting and stunting occurs when a child does not get enough good quality food to eat or is sick, or often both. Malnourished children will catch infections more easily and have a harder time recovering because their immune system is impaired. A severely wasted child is nine times more likely to die than one with a healthy weight.
With the right treatment, wasted children can recover and regain their health. Unfortunately, only an estimated 15 per cent of wasted children have access to the specialised food and care they need to recover.
Stunting, on the other hand, cannot be “treated”. If growth and development falter during the first two years of a child’s life, it is very difficult to catch up. Stunting can rarely be reversed after the age of two. This has lasting effects on brain function and organ development.
Malnutrition doesn’t just risk limiting the future academic or economic productivity of the affected child: it can threaten the health of the children they go on to have as well, as malnutrition narrows opportunities for the next generation.
As well as helping the children directly, Concern also supports women who are pregnant or breastfeeding, times when both they and their babies are especially vulnerable to poor nutrition. The aim of ERNE is to ensure that all children who need lifesaving treatment for wasting receive it.
To optimise its effectiveness, Concern works with local health systems to bring the treatment as close to communities as possible, enabling families to feed and care for their children at home until they are fully recovered.
Previously, a mother had to travel to an inpatient feeding centre, a journey that could take hours or even days, and then stay for a week or more for treatment. Where they had responsibilities for other children or vital livestock, such a journey became even more fraught.
The community-based approach to treatment at home has been made possible over the past 20 years by two innovations. The first has been the use of MUAC bands, a colour-coded bracelet used to measure a child’s mid-upper arm circumference. It’s easy to use and quickly enables a parent or community health volunteer to know their child is wasted.
The second has been ready-to-use therapeutic foods (RUTF) such as Plumpy’Nut, which are packed with lifesaving nutrition and can be eaten directly out of the packet with no risk of contamination and no need for cooking.
Many east and west African countries have a “hunger season”, when wasting among children increases due to lack of food, often made worse by seasonal increases in diarrhoea or malaria. Concern works to provide small cash payments directly to families to help them through these periods and short-term crises such as flood or drought.
Concern also supports government health workers to provide basic health and nutrition services, particularly during these peak periods when the demand for essential services, including treatment for malnutrition, is highest.
Finally, the programme promotes positive feeding and caring practices through peer-group support to be sure the very short window of opportunity to prevent wasting and stunting – just 1,000 days from conception to age two – is not missed.
Since the start of the three-year programme, Concern has reached half a million vulnerable people in Niger, Ethiopia, South Sudan, Sudan and the Democratic Republic of Congo. The aim is to reach up to 700,000 people by the end of the third year.
Unfortunately, what was already difficult work made more difficult by Covid has gotten even more challenging as prices for staples such as wheat and oil, the latter of which is also vital ingredient in therapeutic foods, have soared.
“Oil, milk powder, all the micronutrients these foods require have become more expensive,” says Kate Golden, senior nutrition adviser at Concern Worldwide. “So on a global level it is hitting our target groups really hard.”
Fears of low and even non-existent stocks of therapeutic rations are emerging in many countries.
It’s a desperate prospect, particularly for pastoralists who, because of failed and unpredictable rains as a result of climate change, must travel further and further to find grass and water for their livestock. In addition to crop losses, there are widespread losses among herds.
The Irish government has always placed huge importance on addressing hunger, and supporting NGOs such as Concern. But some other donor countries are cutting back, Golden points out.
“It’s already so hard for these women to get to our facilities,” she says, “sometimes walking overnight with their child. The idea that a woman would make such a journey only to find no rations there is just awful.”
One family's story
Amal Abdulahi and her family live in Salahad, a part of the Somali region of Ethiopia where temperatures reach the mid-30s most days.
Salahad is experiencing an ongoing drought that has dried up crops and water sources, killed livestock and forced many families to find new places to live right across east Africa.
Drought, hunger and disease all plagued Amal’s family.
Three of her six children needed life-saving treatment for severe acute malnutrition. It took several weeks receiving portions of nutritional pastes and vitamin supplements from Concern before their condition improved.
Concern also added Amal’s family to the list of more than 10,000 households in Salahad who have received three monthly cash payments of 1,200 Birr (€22) so that they could buy food and other essential items locally. Such cash transfers are designed to help vulnerable people at the outset of a crisis and prevent them from selling off any remaining assets to meet basic food needs.
The speed of the supports had an immediate outcome for Amal. Two of her children are no longer being treated for malnutrition and she has noticed a marked improvement in the mood of all of them.
“You can see it in their faces, they are brighter,” she says. “They are more mischievous now and they play more.”