Nutrition - European Commissionec.europa.eu/...nutrition_addressing_undernutrition...Undernutrition...

Humanitarian Aid and Civil Protection

NutritionAddressing Undernutrition in EmergenciesSeptember 2013

DG ECHO Thematic Policy Document n° 4

DG ECHO Thematic Policy Documents

N°1: Food Assistance: From Food Aid to Food Assistance

N°2: Water, Sanitation and Hygiene (WASH): Meeting the challenge of rapidly increasing humanitarian needs in Water, Sanitation and Hygiene

N°3: !?QF�?LB�4MSAFCPQ��'LAPC?QGLE�CȑAGCLAW�?LB�CȎCARGTCLCQQ�?APMQQ�?JJ�QCARMPQ

N°4: Nutrition: Addressing Undernutrition in Emergencies

N°5: Disaster Risk Reduction: Increasing resilience by reducing disaster risk in humanitarian action

N°6: %CLBCP��"GȎCPCLR�,CCBQ��B?NRCB��QQGQR?LAC

1

Table of contents

Introduction 2

Summary 3

1 BACKGROUND 51.1 The scale of the problem 51.2 Undernutrition as an increasing global priority 61.3 Undernutrition in crises 7

2 SCOPE OF NUTRITION IN EMERGENCIES 102.1 The conceptual framework of undernutrition 102.2�0CACLR�?BT?LACQ�GL�RFC�K?L?ECKCLR�MD�SLBCPLSRPGRGML�GL�APGQCQ� 122.3 Key Challenges in Addressing Undernutrition in Emergencies 14

3 OBJECTIVES, PRIORITIES AND PRINCIPLES OF THE EUROPEAN COMMISSION’S ASSISTANCE TO NUTRITION IN EMERGENCIES 16

3.1�.PGLAGN?J�M@HCARGTC�� 163.2�1NCAGȏA�M@HCARGTCQ� 163.3 Strategic priorities 173.4 Principles that guide the European Commission’s assistance to nutrition in emergencies 17

4 OPERATIONAL SCOPE OF ASSISTANCE 194.1 Entry and Exit Criteria 194.2��BBGRGML?J�?QNCARQ�LCACQQ?PW�RM�?AFGCTC�RFC�#SPMNC?L�!MKKGQQGML�Q�-@HCARGTCQ� 20

5 PROGRAMMATIC RESPONSES 245.1 Health and Nutrition 245.2 Humanitarian Food Assistance and Nutrition 315.3 Water, Sanitation and Hygiene (WASH) and Nutrition 33

6 HUMANITARIAN AND DEVELOPMENT ACTORS’ SHARED CONCERNS 36

6.1 Chronic undernutrition (stunting) in emergencies 366.2 HIV/AIDS 376.3 Coherence, Coordination and Complementarity 37

7 OPERATIONAL SCOPE OF ASSISTANCE 427.1�*GQR�MD��@@PCTG?RGMLQ� 427.2 Note on Technical Terms 437.3 Policies and Guidelines in Support MD�RFGQ�1R?Ȏ�5MPIGLE�"MASKCLR� 45

A d d r e s s i n g U n d e r n u t r i t i o n i n E m e r g e n c i e s

A d d r e s s i n g U n d e r n u t r i t i o n i n E m e r g e n c i e s A d d r e s s i n g U n d e r n u t r i t i o n i n E m e r g e n c i e s2

IntroductionIn accordance with the orientation of the Humanitarian Aid !MLQCLQSQ�?LB�RM�NPMKMRC�@CQR�NP?ARGAC� GL�RFC�NPMTGQGML�MD�humanitarian assistance for nutrition in emergencies, this 1R?Ȏ�5MPIGLE�"MASKCLR� �15"�� GQ� GLRCLBCB� RM� AMKNJCKCLR�Commission Communication on ‘Enhancing maternal and child nutrition in external assistance: an EU Policy Framework’ footnote ‘COM (2013) 141, March 2013’ to increase the CȎCARGTCLCQQ� ?LB� CȑAGCLAW� MD� FSK?LGR?PG?L� ?QQGQR?LAC�� 'L�particular, this document seeks to:

• !J?PGDW�RFC�M@HCARGTCQ�NPGMPGRGCQ�?LB�NPGLAGNJCQ�MD�RFC�Commission’s humanitarian assistance for nutrition with regard to populations facing humanitarian crises;

• Identify issues and approaches that enhance the CȎCARGTCLCQQ�MD�FSK?LGR?PG?L�?QQGQR?LAC�DMP�LSRPGRGML�in humanitarian crises whilst highlighting the necessary linkages with longer-term support;

• Contribute to the elaboration of an EU strategic framework ML�SLBCPLSRPGRGML�GL�BCTCJMNGLE�AMSLRPGCQ�

2FC� QAMNC� MD� RFGQ� BMASKCLR� AMTCPQ� RFC� QSNNMPR� ?JPC?BW�NPMTGBCB� @W� RFC� !MKKGQQGML� RM� GKNPMTC� RFC� LSRPGRGML�MSRAMKCQ� MD� GRQ� FSK?LGR?PG?L� ?QQGQR?LAC�� 'R� RFCPCDMPC�CK@P?ACQ�RFC�KSJRGNJC�QCARMPQ�RF?R�AMJJCARGTCJW�FCJN�?TMGB�?�LCE?RGTC�LSRPGRGML�GKN?AR�GL�QGRS?RGMLQ�MD�FSK?LGR?PG?L�APGQCQ�including health, humanitarian food assistance, and water, Q?LGR?RGML�?LB�FWEGCLC�PCQNMLQCQ��2FGQ�15"�K?PIQ�?L�GKNMPR?LR�QRCN�GL�RFC�NPMACQQ�MD�BCTCJMNGLE�guidelines for the Commission’s humanitarian assistance GL� RFC� ?PC?� MD� LSRPGRGML�� 'R� GQ� ?JQM� ?� DSPRFCP� QRCN� RMU?PBQ�CJ?@MP?RGLE�?�AMKKML�NCPQNCARGTC�ML�NPGLAGNJCQ�?LB�NPGMPGRGCQ�RF?R�QSNNMPR�RFC�GLRCEP?RGML�MD�LSRPGRGML�M@HCARGTCQ�?APMQQ�?JJ�RFC�QCARMPQ�MD�FSK?LGR?PG?L�?QQGQR?LAC��2M�RFGQ�CLB�RFGQ�15"�explores: The issues and trends that need to be considered (Section One); the conceptual framework and key challenges �1CARGML�2UM��RFC�M@HCARGTCQ�NPGMPGRGCQ�?LB�NPGLAGNJCQ�BPGTGLE�humanitarian assistance for nutrition (Section Three); the operational scope of assistance, with a focus on criteria for entry and exit (Section Four); the programmatic responses �1CARGML�$GTC��?LB�QF?PCB�AMLACPLQ��1CARGML�1GV��2FC�15"�?JQM�BP?UQ�ML�PCJCT?LR�CVNCPGCLACQ�DPMK�RFC�P?NGBJW�CTMJTGLE�ȏCJB�MD�FSK?LGR?PG?L�?QQGQR?LAC�DMP�LSRPGRGML��1SAF�CVNCPGCLACQ�?PC�presented as operational case studies throughout the paper, GL� MPBCP� RM�MȎCP� RFC� PC?BCP� T?JS?@JC� RCAFLGA?J� GLQGEFRQ� GLRM�GQQSCQ�MD�NPMEP?KKGLE�GKNJCKCLR?RGML�?LB�AMMPBGL?RGML�

Note on Terminology

A humanitarian crisis is an event or se-ries of events which represents a critical threat to the health, safety, security or wellbeing of a community or other large group of people. A humanitarian crisis can have natural or manmade causes, can have a rapid or slow onset and can be of short or protracted duration.

The term undernutrition covers short-term (acute) or long-term (chronic) situa-tions, and includes several physiological conditions which frequently co-exist: i) wasting (low weight for height) and nu-tritional oedema (a form of severe acute undernutrition); ii) stunting (low height for age, an indicator of chronic undernu-trition); iii) intrauterine growth restriction which leads to low birth weight; and iv) EFҨDJFODJFT� PG� FTTFOUJBM� NJDSPOVUSJFOUT��The causes of undernutrition are multiple BOE�DPOUFYU�TQFDJҨD��

The term malnutrition, in its exact mea-ning, refers to any form of physiological impairment caused by the body’s use of nutrients, i.e. overnutrition as well as un-dernutrition. However, in the past, it has been used synonymously with undernu-trition. It is for this reason that certain acronyms denote ‘malnutrition’ rather than the more correct term ‘undernutri-tion’ – such as CMAM, GAM, MAM and SAM (community-based management of acute malnutrition; global acute malnu-trition, moderate acute malnutrition; and severe acute malnutrition, respectively).

(In Annex A, the Glossary provides a fuller description of all technical terms used in this document.)

A d d r e s s i n g U n d e r n u t r i t i o n i n E m e r g e n c i e s3

Summary

*LOB�QE>K�>�QEFOA�LC�AB>QEP�FK�@EFIAOBK�RKABO�ȎSB�VB>OP�LIA�TLOIATFAB�>OB�attributable to undernutrition.

�K�BPQFJ>QBA��JFIIFLK� ��ϖ��@EFIAOBK�RKABO�ȎSB�VB>OP�LIA�>OB�T>PQBA��70% of them lived in Asia.1

Undernutrition in childhood makes children more susceptible to diseases and prevents proper brain development. Irreversible damages caused by undernutrition of individuals have indirect repercussions in terms of loss of national productivity and economic growth.

3LBCPLSRPGRGML�GQ�?L�GLAPC?QGLE�EJM@?J�NPGMPGRW��'L��RFC�*?LACR�QCPGCQ�ML�K?RCP-nal and child undernutrition played a crucial role in raising international awareness ML� SLBCPLSRPGRGML� GL� BCTCJMNGLE� AMSLRPGCQ�� #?AF� WC?P� RFC� #SPMNC?L� !MKKGQQGML�?JJMA?RCQ�UCJJ�MTCP�#30��KGJJGML�RM�FSK?LGR?PG?L�?QQGQR?LAC�?ARGMLQ�RF?R�?PC�CVNJGAGRJW� ?QQMAG?RCB�UGRF� QNCAGȏA� LSRPGRGML� M@HCARGTCQ�� 2FC�?JJMA?RGML� RM� LSRPGRGML�GLRCPTCLRGMLQ� GL� RFC� !MKKGQQGML� &SK?LGR?PG?L� ?QQGQR?LAC� F?Q� BMS@JCB� @CRUCCL��?LB��

Undernutrition and deaths related to under-LSRPGRGML� ?PC� J?PECJW� NPCTCLR?@JC�� )CW� FGEF�GKN?AR� LSRPGRGML� GLRCPTCLRGMLQ� F?TC� @CCL�AJC?PJW�GBCLRGȏCB��&MUCTCP�RFC�AMKKGRKCLR�the capacities and the resources to scale up RFC� GLRCPTCLRGMLQ� RM� ?BBPCQQ� SLBCPLSRPGRGML�QRGJJ� J?AI�� 5?QRGLE� F?Q� BCAPC?QCB� MLJW� @W��Ϥ�QGLAC��2

Undernutrition is the result of multiple immediate, underlying and structural causes, WGCJBCB� GL� T?PGMSQ� QCARMPQ�� DMMB� QCASPGRW� FC?JRF� U?RCP� ?LB� Q?LGR?RGML� A?PC� ?LB�RFCGP�CL?@JGLE�CLTGPMLKCLR��BBPCQQGLE�SLBCPLSRPGRGML�PCOSGPCQ�?�KSJRG�QCARMP?J�?N-NPM?AF�?LB�?�HMGLR�FSK?LGR?PG?L�?LB�BCTCJMNKCLR�DP?KCUMPI��

2FC�NPCQCLR�BMASKCLR�PC?ȑPKQ�RFC�!MKKGQQGML�Q�AMKKGRKCLR�RM�?BBPCQQ�SLBCP-LSRPGRGML�GL�FSK?LGR?PG?L�APGQCQ�?LB�QCRQ�RFC�DP?KCUMPI�DMP�RFCQC�GLRCPTCLRGMLQ�

The Commission’s objective is to reduce or avoid excess3 mortality and mor-bidity due to undernutrition in humanitarian situations. EU humanitarian policy is also concerned with addressing the immediate and underlying causes of SLBCPLSRPGRGML��

“ More than a third of deaths in DIJMESFO�VOEFS�ҨWF�ZFBST�PME�XPSMEXJEF�are attributable to undernutrition.

1 and 2 - UNICEF-WHO-WB joint child malnutrition estimates - 2012

��j&YDFTTz�JT�DPOTJEFSFE�UP�DPNCJOF�BCTPMVUF�NFBTVSFT�JO�SFMBUJPO�UP�FTUBCMJTI�FNFSHFODZ�UISFTIPMET�BT�EFҨOFE�CZ�UIF�41)&3&�IBOECPPL �6/*$&' �BOE�UIF�6/�4UBOEJOH�$PNNJUUFF�PO�/VUSJUJPO�4$/ �BOE�SFMBUJWF�NFBTVSFT�JO�SFMBUJPO�UP�DPOUFYU�TQFDJҨD�CBTF-lines, see Communication on Humanitarian Food Assistance


In addition to the humanitarian principles of neutrality, independence, impartiality ?LB�FSK?LGRW� RFC�!MKKGQQGML�SNFMJBQ�?�QCR�MD�KMPC�QNCAGȏA�NPGLAGNJCQ�?JPC?BW�MSRJGLCB�GL�GRQ�!MKKSLGA?RGML�ML�&SK?LGR?PG?L�$MMB��QQGQR?LAC�4

,SRPGRGML�GLRCPTCLRGMLQ�LCCB�RM��• 0CQNMLB�RM�RFC�LCCBQ�MD�RFC�GLBGTGBS?JQ�RFC�KMQR�TSJLCP?@JC�RM�SLBCPLSRPGRGML��

mothers and children under 5;• 3QC�KCRFMBQ�?LB�RMMJQ�UFGAF�F?TC�BCKMLQRP?RCB�RFCGP�CȑAGCLAW�?LB�AMQR�CȎCA-RGTCLCQQ�

• 0CQNMLB� RM� UCJJ�BCȏLCB� FSK?LGR?PG?L� PGQIQ� ?Q� UCJJ� ?Q� GKKCBG?RC� CKCPECLAW�needs;

• Promote a multi-sector approach, which is essential to tackle the causes of un-dernutrition;

• .PMKMRC�?�HMGLR�FSK?LGR?PG?L�?LB�BCTCJMNKCLR�?NNPM?AF�RM�FCJN�@SGJB�PCQGJGCLAC�� 1NCAGȏA?JJW� GL� CKCPECLAW� QGRS?RGMLQ� !MK-KGQQGML�GLRCPTCLRGMLQ�QRPGTCQ�RM��

• 0CBSAC� JCTCJQ� MD� KMBCP?RC� ?LB� QCTCPC�?ASRC�SLBCPLSRPGRGML�?LB�KGAPMLSRPGCLR�BCȏ-ciencies, to below-emergency rates, through RGKCJW� CȑAGCLR� ?LB� CȎCARGTC� FSK?LGR?PG?L�response;

• .PCTCLR�QGELGȏA?LR�?LB�JGDC�RFPC?RCLGLE�BCRCPGMP?RGML�MD�LSRPGRGML?J�QR?RSQ�@W�CL-QSPGLE� ?AACQQ� @W� APGQCQ�?ȎCARCB� NMNSJ?RGMLQ� RM� ?BCOS?RC� Q?DC� ?LB� LSRPGRGMSQ�food, through food and non-food responses depending on the context;

• 0CBSAC�RFC�QNCAGȏA�TSJLCP?@GJGRW�MD�GLD?LRQ�?LB�WMSLE�AFGJBPCL�GL�APGQCQ�RFPMSEF�the promotion of appropriate child care, with special emphasis on infant and young child feeding practices;

• 0CBSAC�QNCAGȏA�TSJLCP?@GJGRW�MD�NPCEL?LR�?LB�J?AR?RGLE�UMKCL�GL�APGQCQ�RFPMSEF�appropriate support of maternal nutrition;

• �BBPCQQ�RFC�RFPC?RQ�RM�RFC�LSRPGRGML?J�QR?RSQ�MD�NCMNJC�?ȎCARCB�@W�APGQCQ�DPMK�?L�GL?BCOS?RC�NS@JGA�FC?JRF�CLTGPMLKCLR�@W�QCASPGLE�?AACQQ�RM�?NNPMNPG?RC�FC?JRF�A?PC�Q?DC�U?RCP�Q?LGR?RGML�D?AGJGRGCQ�?LB�FWEGCLC�GLNSRQ�

-RFCP�?PC?Q�MD�NMQQG@JC�QSNNMPR�F?TC�@CCL� GBCLRGȏCB�?Q�ICW� RM� PC?AF� RFC�?@MTC�M@HCARGTCQ� L?KCJW� GLDMPK?RGML� QWQRCKQ�OS?JGRW�NPMEP?KKGLE� A?N?AGRW�@SGJBGLE�PCQC?PAF�?LB�?BTMA?AW��&MUCTCP� RFCQC�?PC�LCGRFCP�CLRPW�NMGLRQ�LMP�QR?LB�?JMLC�?ARGTGRGCQ�

4 - Communication from the Commission to the Council and the European Parliament on Humanitarian Food Assistance COM (2010) 126

“ Nutrition interventions need to […] promote a multi-sector approach […] (and) a joint humanitarian and development approach.


�� ?AIEPMSLB

1.1 The scale5 of the problem

The following information illustrates the extent to which undernutrition AMLQRGRSRCQ� ?� K?QQGTC� APGQGQ� GL� GRQ� MUL�right – one that is global and persistent GL� L?RSPC��3LBCPLSRPGRGML� IGJJQ� RFMSQ?LBQ�MD� NCMNJC� ML� ?� B?GJW� @?QGQ� ?JJ� MTCP� RFC�world, including in many countries that ?PC�UGBCJW�AMLQGBCPCB�RM�@C�QR?@JC�?LB�ML�?�NMQGRGTC�BCTCJMNKCLR�RP?HCARMPW��

• �JRFMSEF�SLBCPLSRPGRGML�GQ�J?PECJW�NPCTCLR?@JC�GR�GQ�RFC�SLBCPJWGLE�A?SQC�MD�MTCP�?�RFGPB�MD�RFC�BC?RFQ�MD�AFGJBPCL�SLBCP�ȏTC�WC?PQ�MD�?EC�UMPJBUGBC�R?IGLE�RFC�JGTCQ�MD�?L�CQRGK?RCB�RFPCC�KGJJGML�QK?JJ�AFGJBPCL�?LB�MTCP��UMKCL�CTCPW�WC?P��

• �PMSLB��KGJJGML��Ϥ��MD�RFC�UMPJB�Q�AFGJBPCL�SLBCP�RFC�?EC�MD�ȏTC�?PC�U?QRCB��Ϥ� MD� RFCK� ?PC� GL� �QG?�� PMSLB� ��KGJJGML� ��Ϥ�� MD� AFGJBPCL� QSȎCP� DPMK�QRSLRGLE�EJM@?JJW��

• 1RSLRGLE� QCTCPC�U?QRGLE� ?LB� GLRP?SRCPGLC� EPMURF� PCQRPGARGML� ?PC� CQRGK?RCB� RM�@C�PCQNMLQG@JC�DMP��Ϥ�MD�BGQ?@GJGRW�?BHSQRCB�JGDC�WC?PQ�JMQR��'L�?L�?L?JWQGQ�RF?R�accounted for co-exposure of these nutrition-related factors, together they were DMSLB�RM�@C�PCQNMLQG@JC�DMP�?@MSR��Ϥ�MD�RFC�EJM@?J�BGQC?QC�@SPBCL�

• 3LBCPLSRPGRGML� ?JQM� A?SQCQ� QS@�MNRGK?J� NFWQGA?J� ?LB� AMELGRGTC� BCTCJMNKCLR�JMUCP� PCQGQR?LAC� RM� GLDCARGMLQ� ?LB� FGLBCPQ� RFC� NPMBSARGTGRW� MD� ?BSJRQ� RFCPC@W�JMUCPGLE�RFC�CAMLMKGA�NMRCLRG?J�MD�QMAGCRGCQ�?LB�NCPNCRS?RGLE�NMTCPRW��

• +GAPMLSRPGCLR�BCȏAGCLAGCQ�CQQCLRG?J�DMP�RFC�EPMURF�?LB�BCTCJMNKCLR�MD�GLBGTGBS?JQ�?ȎCAR�?JKMQR�RUM�@GJJGML�NCMNJC�UMPJBUGBC�?JQM�GL�BCTCJMNCB�AMSLRPGCQ��

• 1S@MNRGKSK�@PC?QRDCCBGLE�CQNCAG?JJW�LML�CVAJSQGTC�@PC?QRDCCBGLE�GL�RFC�ȏPQR��KMLRFQ�MD�JGDC�PCQSJRQ�GL��KGJJGML�BC?RFQ�?LB�PCNPCQCLRQ��Ϥ�MD�RFC�BGQC?QC�@SPBCL�?KMLE�AFGJBPCL�SLBCP�RFC�?EC�MD�ȏTC�

• .PMEPCQQ� GL� RFC� ?AFGCTCKCLR� MD� RFC� PCJCT?LR� +GJJCLLGSK� "CTCJMNKCLR� %M?JQ�(MDG) (1,4 and 5) is still slow:

• +"%� �� ~#P?BGA?RC� CVRPCKC� NMTCPRW� ?LB� FSLECP�� F?Q� QFMUL� QMKC�NPMEPCQQ�?Q�CVRPCKC�NMTCPRW�BCAPC?QCB�GL�CTCPW�PCEGML�CTCL�GD�QMKC�PCEGMLQ�F?TC�QCCL�KMPC�NPMEPCQQ�RF?L�MRFCPQ��&SLECP�PCK?GLQ�?�EJM@?J�AF?JJCLEC��2FC�KMQR�PCACLR�$�-�CQRGK?RCQ�MD�SLBCPLMSPGQFKCLR�QCR�RFC�

��6OMFTT�PUIFSXJTF�TUBUFE �ҨHVSFT�QSFTFOUFE�JO�UIJT�TFDUJPO�BSF�GSPN�UIF�ҨSTU�QBQFS�JO�UIF�-BODFU�TFSJFT��#MBDL�3�&��FU�BM��.BUFSOBM�BOE�$IJME�6OEFSOVUSJUJPO��(MPCBM�BOE�SFHJPOBM�FYQPTVSFT�BOE�IFBMUI�DPOTFRVFODFT��-BODFU�� IUUQ��XXX�UIFMBODFU�DPN�KPVSOBMT�MBODFU�BSUJDMF�1**4��GVMMUFYU�

6 - UNICEF-WHO-The World Bank joint child malnutrition estimates (2012)

“ "SPVOE��NJMMJPO��PG�UIF�XPSMEȅT�DIJMESFO�VOEFS�UIF�BHF�PG�ҨWF�BSF�XBTUFE��PG�UIFN�BSF�JO�"TJB��"SPVOE��NJMMJPO��PG�DIJMESFO�TVҧFS�GSPN�

stunting globally.

A d d r e s s i n g U n d e r n u t r i t i o n i n E m e r g e n c i e s A d d r e s s i n g U n d e r n u t r i t i o n i n E m e r g e n c i e s�

K?PI�?R��KGJJGML� JGTGLE� GL�FSLECP� GL� RFC�UMPJB� GL� RFC�� NCPGMB��Ϥ�MD�RFC�UMPJB�NMNSJ?RGML��2FGQ�AMLRGLSGLE�FGEF�JCTCJ�MD�SLBCPLMSPGQFKCLR�PCȐCARQ�?�J?AI�MD�NPMEPCQQ�ML�FSLECP�PCBSARGML�GL�QCTCP?J�PCEGMLQ�CTCL�UFCPC�GLAMKC�NMTCPRW�F?Q�BCAPC?QCB�

• Although MDG 4 ‘Reduce Child Mortality’ has gained momentum, progress is still too slow to meet the target: Sub-Saharan Africa and -AC?LG?�F?TC�CVNCPGCLACB�AFGJB�KMPR?JGRW� PCBSARGMLQ�MD�MLJW�?PMSLB��Ϥ� JCQQ� RF?L�F?JD�MD�UF?R� GQ� PCOSGPCB�@W� RFC�+"%��1MSRFCPL��QG?�is also lagging behind with a 44% decline in the child mortality rate @CRUCCL��?LB��GLQSȑAGCLR�RM�?AFGCTC�?�RUM�RFGPB�PCBSARGML�@W��

• +"%�� ~'KNPMTC�K?RCPL?J� FC?JRF�� F?Q� QFMUL� NPMEPCQQ� ?Q�K?RCPL?J�KMPR?JGRW�F?Q�LC?PJW�F?JTCB�QGLAC��,MLCRFCJCQQ�ASPPCLR�K?RCPL?J�KMPR?JGRW�JCTCJQ�?PC�QRGJJ�D?P�DPMK�RFC�R?PECR�QCR�DMP��L�CQRGK?RCB��K?RCPL?J� BC?RFQ� MAASPPCB� GL��UMPJBUGBC� GLBGA?RGLE� ?��ϤBCAJGLC� DPMK�� JCTCJQ��1S@�1?F?P?L��DPGA?� �UGRF��NCPACLR�of these deaths) and South Asia (29 percent) together accounted for ��Ϥ� � MD� RFC� EJM@?J� @SPBCL� GL� �� UGRF� ?� HMGLR� RMR?J� MD� ��K?RCPL?J�BC?RFQ�7

1.2 Undernutrition as an increasing global priority

'L�PCACLR�WC?PQ�?LB�UGRF�RFC�EPMUGLE�PC?JGQ?RGML�MD� GRQ�QGELGȏA?LAC�GL�RCPKQ�MD�+"%�NPMEPCQQ� AMLQGBCP?@JC�?BT?LACKCLR�F?Q�@CCL�K?BC� GL� PC�CLCPEGXGLE� RFC�

ȏEFR� ?E?GLQR� SLBCPLSRPGRGML�� Q� ?� PCQSJR�LCU� QRP?RCEGCQ� ?LB� GLGRG?RGTCQ� DMP� R?AIJGLE�SLBCPLSRPGRGML� GL� BCTCJMNGLE� AMSLRPGCQ� ?PC�SLBCPU?W�GL�QCTCP?J�#3�KCK@CP�QR?RCQ��

"SC�?RRCLRGML�QFMSJB�?JQM�@C�BCTMRCB�RM�PC-cent publications9� NPCQCLRGLE� CTGBCLAC� ML�RFC�KMQR�CȎCARGTC�GLRCPTCLRGMLQ�RM�?BBPCQQ�SLBCPLSRPGRGML�� 'L� N?PRGASJ?P� ?� J?LBK?PI�NS@JGA?RGML� GL�2FC�*?LACR� GL�(?LS?PW��ȏTC�N?NCPQ� PCDCPPCB� RM�?Q� RFC�*?LACR�1C-

PGCQ�AGRCB�?@MTC��E?TC�LCU�KMKCLRSK�RM�RFC�ȏEFR�?E?GLQR�SLBCPLSRPGRGML��+SAF�MD� RFGQ�KMKCLRSK� GQ�CK@MBGCB� GL� RFC�1A?JGLE�SN�,SRPGRGML�KMTCKCLR� �13,��10 2FGQ�GLGRG?RGTC�?GKQ�RM�@SGJB�?�KSJRG�QR?ICFMJBCP�?LB�KSJRG�QCARMP?J�?JGELKCLR�RM�QSNNMPR�L?RGML?J�JCTCJ�QRP?RCEGCQ�?LB�CȎMPRQ�RM�?BBPCQQ�SLBCPLSRPGRGML�#?AF�WC?P�RFC�!MKKGQQGML�?JJMA?RCQ�UCJJ�MTCP�#30��KGJJGML�RM�FSK?LGR?PG?L�?QQGQR?LAC�?ARGMLQ�RF?R�?PC�CVNJGAGRJW�?QQMAG?RCB�UGRF�QNCAGȏA�LSRPGRGML�M@HCARGTCQ��

��IUUQ��NEHT�VO�PSH�VOTE�NEH�3FTPVSDFT�4UBUJD�1SPEVDUT�1SPHSFTT��&OHMJTI��QEG

��'PS�JOTUBODF��Ȅ5IF�OFHMFDUFE�DSJTJT�PG�VOEFSOVUSJUJPO��%'*%ȅT�4USBUFHZȅ�IUUQ��DPMMFDUJPOT�FVSPQBSDIJWF�PSH�UOB��IUUQ��EҨE�HPW�VL�%PDVNFOUT�QVCMJDBUJPOT�OVUSJUJPO�TUSBUFHZ�QEG��UIF�'SFODI�HPWFSONFOU�TUSBUFHZ��Ȅ/VUSJUJPO�EBOT�MFT�1BZT�FO�%¨-WFMPQQFNFOU� Ȃ� %PDVNFOU� Eȅ0SJFOUBUJPO� 4USBU¨HJRVFȅ� XXX�EJQMPNBUJF�HPVW�GS�GS�NJOJTUFSF@��QVCMJDBUJPOT@��FOKFVY�QMBOF-UBJSFT�DPPQFSBUJPO�JOUFSOBUJPOBMF@��EPDVNFOUT�TUSBUFHJF�TFDUPSJFMMF@��MFT�QBZT�EFWFMPQQFNFOU�OVUSJUJPO@�� IUNM��*SFMBOEȅT�)VOHFS�&OWPZ�3FQPSU��IUUQ��XXX�JSJTIBJE�HPW�JF�VQMPBET�)VOHFS@&OWPZ@3FQPSU�QEG��BOE�(FSNBOZȅT�TUSBUFHZ�3VSBM�%FWFMPQNFOU�BOE�JUT�$POUSJCVUJPO�UP�'PPE�4FDVSJUZ ��IUUQ��XXX�CN[�EF�FO�QVCMJDBUJPOT�UZQF@PG@QVCMJDBUJPO�TUSBUFHJFT�4USBUFHJFQBQJFS��@��@��QEG�

��'PS�FYBNQMF��8PSME�#BOL��4DBMJOH�VQ�/VUSJUJPO��8IBU�XJMM�JU�$PTU �#Z�4��)PSUPO�FU�BM��BOE�4BWF�UIF�$IJMESFO��)VOHSZ�for Change. An eight-step, costed plan of action to tackle global child hunger.

��IUUQ��XXX�TDBMJOHVQOVUSJUJPO�PSH

“ In recent years, […] considerable advancement has been made in SF�FOFSHJ[JOH�UIF�ҨHIU�BHBJOTU�undernutrition.


2FGQ�DSLBGLE�QSNNMPRQ�LSRPGRGML� GLRCPTCLRGMLQ� GL�CKCPECLAW�contexts implemented by United Nations Agencies, the Red !PMQQ 0CB� !PCQACLR� +MTCKCLR� ?LB� 'LRCPL?RGML?J� ,ML�%M-TCPLKCLR?J� -PE?LGQ?RGMLQ�� $SPRFCPKMPC� RFC� NPMKMRGML� MD�KMPC�CȎCARGTC�LSRPGRGML�MSRAMKCQ�GL�?JJ�PCQNMLQC�QCARMPQ�GQ�GLAPC?QGLEJW�PCAMELGQCB�?Q�?�AMPC�NPGMPGRW�

The Commission has adopted a Communication on Huma-nitarian Food Assistance which addresses undernutrition AMLACPLQ�?QQMAG?RCB�UGRF�GL?BCOS?RC�DMMB�AMLQSKNRGML��2FC�Commission has also adopted two other Communications11 (one on health and one on food security) that call for more AMKNPCFCLQGTC� QRP?RCEGCQ� RM� R?AIJC� SLBCPLSRPGRGML� ?LB� DMP�a strengthened link between health and food security (both RP?LQGRMPW� ?LB� AFPMLGA�� RM� @PGLE� ?@MSR�KMPC� CȎCARGTC� PCQ-NMLQCQ�Furthermore, a Commission Reference Document on Addres-sing Undernutrition in External Assistance12 was adopted, NPMTGBGLE�NP?ARGA?J�ESGB?LAC�ML�FMU�LSRPGRGML�M@HCARGTCQ�A?L�@C� GLAMPNMP?RCB� GLRM�BGȎCPCLR� QCARMPQ� RFCK?RGA� ?PC?Q�?LB�DSLBGLE�KMB?JGRGCQ�

In addition, the recently renegotiated Food Assistance !MLTCLRGML13� PCȐCARQ�RFC�LSRPGRGML?J�?QNCARQ�MD�DMMB�?QQGQ-R?LAC� ?LB� CȎCARGTCJW� GLRCEP?RCQ� LSRPGRGML� GL� GRQ� NPGLAGNJCQ�?LB�M@HCARGTCQ�

1.3 Undernutrition in crises

Crisis situations, whether acute or protracted, impact on a range of factors that can increase the risk of undernutrition, KMP@GBGRW�?LB�KMPR?JGRW��2FCW�K?W�GLTMJTC��RFC�J?PEC�QA?JC�destruction of property and infrastructure; the erosion of JGTCJGFMMB�QRP?RCEGCQ�?LB�NSPAF?QGLE�NMUCP��?�@PC?IBMUL�MD�?LB� PCBSACB� ?AACQQ� RM� CQQCLRG?J� QCPTGACQ� GLAJSBGLE� FC?JRF�QCPTGACQ� U?RCP� QSNNJW� ?LB� Q?LGR?RGML�� ?LB� BGQNJ?ACKCLR�MD� J?PEC�LSK@CPQ�MD�NCMNJC��#KCPECLAGCQ�A?L�?JQM�BGQPSNR�QMAG?J� QWQRCKQ� ?LB� RFC� OS?JGRW� MD� A?PC DCCBGLE� NP?ARGACQ��&MSQCFMJB�?AACQQ� RM�DMMB�K?W�@C�LCE?RGTCJW�?ȎCARCB�?LB�NCMNJC� K?W� ȏLB� RFCKQCJTCQ� GL� MTCP�APMUBCB� QCRRJCKCLRQ�UGRF�RFCGP�D?KGJGCQ�@CGLE�BGTGBCB��Q�?�PCQSJR�?R�RFC�GLBGTG-BS?J� JCTCJ�RFCPC� GQ�MȓCL�?L�GLAPC?QCB�PGQI�MD�BCRCPGMP?RGLE�health and nutritional status, resulting in a greater likeliho-MB�MD�BC?RF��QCC�$GESPC��!MLACNRS?J�DP?KCUMPI��Young children and pregnant and lactating women are N?PRGASJ?PJW� TSJLCP?@JC� RM� SLBCPLSRPGRGML� DPMK� ?� NFWQGMJM-

��5IF�&6�3PMF�JO�(MPCBM�)FBMUI�$0.��BOE�"O�&6�QPMJDZ�GSBNFXPSL�UP�BTTJTU�EFWF-MPQJOH�DPVOUSJFT�JO�BEESFTTJOH�GPPE�TFDVSJUZ�DIBMMFOHFT�$0.��

��3FGFSFODF�EPDVNFOU�Oo��j"EESFTTJOH�VOEFSOVUSJUJPO�JO�FYUFSOBM�BTTJTUBODFz�IUUQ��DBQBDJUZ-�EFW�FD�FVSPQB�FV�UPQJD�ҨHIUJOH�IVOHFS�

��%PDVNFOU�ȇ'PPE�"TTJTUBODF�$POWFOUJPO�ȁ��"QSJM��Ȉ�

Gender and nutrition vulnerability during crises

• When food is in short supply, women and girls are more likely to reduce (voluntarily or as a result of external pressure) their intake in favour of other household members, thus worsening their own nutritional status.

• Women may face constraints in acces-sing essential humanitarian services as a result of insecurity, cultural discrimi-nation and limited mobility.

• Pregnant and lactating women are par-ticularly exposed to undernutrition due to their increased physiological require-ments.

• While remaining the primary caregi-vers of children and other dependents, women undertake additional activities during crises, particularly where male heads of households are absent. This of-ten leads to the disruption of infant and young child feeding practices and care.

• Men who are single heads of households may be removed from their normal sup-port structures during crises and if they do not know how to cook or care for young children, this results in a greater risk of acute under-nutrition for them-selves and their children.

Bangladesh.

A d d r e s s i n g U n d e r n u t r i t i o n i n E m e r g e n c i e s A d d r e s s i n g U n d e r n u t r i t i o n i n E m e r g e n c i e s�

EGA?J� NMGLR� MD� TGCU� BSC� RM� RFCGP� GLAPC?QCB� LSRPGCLR� PCOSG-PCKCLRQ� DMP� EPMURF� ?LB� BCTCJMNKCLR�� 7MSLE� AFGJBPCL� ?PC�also exposed to a higher risk (compared to other population groups) of contracting infections, which can further increase LSRPGCLR�PCOSGPCKCLRQ�GKNCBC�LSRPGCLR�SQC�?LB�PCBSAC�?N-NCRGRC��$MP�RFGQ�PC?QML�WMSLE�AFGJBPCL�MȓCL�BCKMLQRP?RC�RFC�fastest nutritional deterioration in crisis contexts, as well as the highest rates of disease and undernutrition-related KMPR?JGRW��7MSLE�AFGJBPCL�?PC�RFCPCDMPC�AMLQGBCPCB�?�NPGK?PW�R?PECR�EPMSN�DMP�?QQGQR?LAC��$SPRFCPKMPC�MJBCP�?LB�BGQ?@JCB�NCMNJC�?Q�UCJJ�?Q�NCMNJC�JGTGLE�UGRF�AFPMLGA�GJJLCQQ�QSAF�?Q�&'4�?LB��'"1�K?W�?JQM�QSȎCP�DPMK�PCBSACB�?NNCRGRC�BGȑ-ASJRGCQ� GL�AFCUGLE�?LB�BGȑASJRGCQ� GL�?AACQQGLE�DMMB�UFGAF�GLAPC?QC�RFCGP�LSRPGRGML?J�TSJLCP?@GJGRW��

%CLBCP�?JQM�NJ?WQ�?L� GKNMPR?LR� PMJC� GL�BCRCPKGLGLE� GLBGTG-BS?J�TSJLCP?@GJGRW� RM�SLBCPLSRPGRGML��5MKCL EGPJQ�?LB�KCL @MWQ�D?AC�BGȎCPCLR� PGQIQ� GL� PCJ?RGML� RM� RFC�BCRCPGMP?RGML�MD�RFCGP� LSRPGRGML?J� QR?RSQ� BSPGLE� APGQCQ� ?Q� ?� AMLQCOSCLAC� MD�@MRF�RFCGP�BGȎCPCLR�LSRPGRGML?J�PCOSGPCKCLRQ�?LB�?�T?PGCRW�MD�socio-cultural factors related to gender:

Sudanese refugee mother waits with her sick child at UIF�.4'�ҨFME�IPTQJUBM�JO�4PVUI�4VEBO


• Undernutrition has particularly serious AMLQCOSCLACQ� DMP� UMKCL� ?Q� QRSLRCB�women face higher risks of complica-tions during childbirth; Anaemia (the most widespread nutritional problem ?ȎCARGLE�EGPJQ�?LB�UMKCL�GL�BCTCJMNGLE�AMSLRPGCQ��GQ�PCQNMLQG@JC�DMP�?�QGELGȏA?LR�NPMNMPRGML�MD�K?RCPL?J�KMPR?JGRW�

• Maternal acute undernutrition is asso-ciated with intrauterine growth restric-RGML�?LB�AMLQRGRSRCQ�?�PGQI�D?ARMP�DMP�NMMP�LCML?R?J�FC?JRF�

• Undernutrition has an intergenerational cycle, as undernourished adolescent ?LB�?BSJR�KMRFCPQ�?PC�KMPC�JGICJW�RM�EGTC�@GPRF�RM�JMU�@GPRF�UCGEFR�@?@GCQ��2FGQ�GL�RSPL�GLAPC?QCQ�RFC�PGQI�MD�SLBCPLSRPGRGML�GL�C?PJW�AFGJBFMMB�

“ Undernutrition has an intergenerational cycle, as

undernourished adolescent and adult mothers are more likely to give birth to

low birth-weight babies.

2.1 The conceptual framework of undernutrition

There are numerous possible causes of undernutrition, many of which impact ML�@MRF�?ASRC�?LB�AFPMLGA�SLBCPLSRPGRGML��2FCQC�A?SQCQ�?PC�SQS?JJW�?L?JWQCB�?R�RFPCC�JCTCJQ��GKKCBG?RC�SLBCPJWGLE�?LB�@?QGA��2FCQC�RFPCC�JCTCJQ�?PC�@?QCB�ML�RFC�

AMLACNRS?J�DP?KCUMPI�BCTCJMNCB�@W�3,'!#$�GL�RFC��Q�UFGAF�GQ�QRGJJ�PCE?PBCB�?Q�?�T?-JS?@JC�ESGBCJGLC�RMB?W��QCC�$GESPC��

The humanitarian assistance for nutrition NPMTGBCB�@W�RFC�!MKKGQQGML�GQ�NPGK?PGJW�?G-KCB�?R�NPCTCLRGLE�?LB�?JJCTG?RGLE�RFC�QFMPR�RCPK� AMLQCOSCLACQ� MD� K?RCPL?J� ?LB� AFGJB�undernutrition by addressing their imme-BG?RC�?LB�SLBCPJWGLE�A?SQCQ�?R�RFC�GLBGTGBS?J�?LB�FMSQCFMJB�JCTCJQ�

• Immediate causes ?PC�RM�@C�DMSLB�?R�RFC�GLBGTGBS?J�JCTCJ�?LB�F?TC�RUM�BGKCL-QGMLQ��BGCR?PW�GLR?IC�?LB�RFC�NPCQCLAC�MD�BGQC?QCQ��2FGQ�BGQRGLARGML�CKNF?QGQCQ�the limitation of the term ‘hunger’ in denoting undernutrition, as hunger may or K?W�LMR�@C�?�A?SQC�MD�SLBCPLSRPGRGML��2FC�!MKKGQQGML�Q�FSK?LGR?PG?L�GLRCPTCL-RGMLQ�?BBPCQQ�GKKCBG?RC�A?SQCQ�MD�SLBCPLSRPGRGML�@W�NPMTGBGLE�GKKCBG?RC�?AACQQ�RM�DMMB�GL�MPBCP�RM�GKNPMTC�DMMB�GLR?IC�?LB�DPCC�?AACQQ�RM�JGDC�Q?TGLE�FC?JRFA?PC�

• Underlying causes MNCP?RC�?R�RFC�FMSQCFMJB�?LB�AMKKSLGRW�JCTCJQ��2FCW�AMK-prise three categories: (i) household food security, (ii) care for children and wo-KCL� ?LB� �GGG�� FC?JRF� CLTGPMLKCLR� ?LB� FC?JRF� QCPTGACQ�� 'LAMKC� NMTCPRW� ?ȎCARQ�?JJ�RFPCC��&MSQCFMJB�DMMB�GLQCASPGRW�A?L�@C�?JJCTG?RCB�RFPMSEF�KC?QSPCQ�?GKCB�?R� BSP?@JW� GLAPC?QGLE�FMSQCFMJB� DMMB�?T?GJ?@GJGRW� ?AACQQG@GJGRW� �C�E�� NSPAF?QGLE�NMUCP��?LB�SRGJGQ?RGML��C�E��AMMIGLE��'L?BCOS?RC�A?PC�NP?ARGACQ�A?L�@C�?BBPCQQCB�through measures aimed at ensuring maternal nutrition and appropriate and re-ESJ?P� DCCBGLE�MD� GLD?LRQ�?LB�WMSLE�AFGJBPCL�?Q�UCJJ�?Q�NPMTGBGLE�Q?DC� DCCBGLE�QN?ACQ��3LFC?JRFW�CLTGPMLKCLRQ�A?L�@C�?BBPCQQCB�RFPMSEF�U?RCP�Q?LGR?RGML�?LB�FWEGCLC�KC?QSPCQ�?Q�UCJJ�?Q�RFPMSEF�RFC�NPMTGQGML�MD�?AACQQG@JC�FC?JRF�QCPTGACQ�?LB� BGQC?QC� AMLRPMJ� KC?QSPCQ� �C�E�� JMLE�J?QRGLE� GLQCARGAGBC�RPC?RCB� KMQOSGRM�LCRQ�CLTGPMLKCLR?J�GLRCPTCLRGMLQ��

• Basic causes include a range of factors operating at the sub-national, national ?LB� GLRCPL?RGML?J� JCTCJQ� P?LEGLE� DPMK� RFC� ?T?GJ?@GJGRW� MD� L?RSP?J� PCQMSPACQ� RM�QMAG?J�?LB�CAMLMKGA�CLTGPMLKCLRQ�RM�NMJGRGA?J�AMLRCVRQ�14� ?QGA�A?SQCQ�RF?R�?PC�linked to political, cultural, religious, economic, educational, demographic, and QMAG?J�QWQRCKQ�A?L�MLJW�@C�?BBPCQQCB�RFPMSEF�JMLE�RCPK�BCTCJMNKCLR�QRP?RCEGCQ�


��4PVSDF��3FGFSFODF�%PDVNFOU�Oo��j"EESFTTJOH�VOEFSOVUSJUJPO�JO�FYUFSOBM�BTTJTUBODFz

��1AMNC�MD�,SRPGRGML�� in Emergencies

“ Undernutrition therefore has to be understood as a multi-sectoral challenge, requiring a sound VOEFSTUBOEJOH�PG�UIF�TQFDJҨDJUJFT�PG�each context of intervention.


BASIC & STRUCTURAL

CAUSES AT COMMUNITY

/ NATIONAL /

INTERNATIONAL

LEVELS

Child malnutrition, death and disability

Inadequate dietary intake

Insu!cient access to food

Inadequate and/or

inapropriate knowledge and discriminatory attitudes limit

household access to actual

resources

Political, cultural,

economic and social systems,

including women’s

status, limit the utilization

of potential resources

Inadequate maternal and

child-care

Poor water/ sanitation and

inadequate health services

Quantity and quality of actual resources - human, economic and organizational - and the

way they are controlled

Potential resources: environnement, technology, people

Disease

MANIFESTATION

OF THE PROBLEM

IMMEDIATE

CAUSES AT

INDIVIDUAL LEVEL

UNDERLYING

CAUSES AT

HOUSEHOLD /

COMMUNITY LEVEL

Source: adapted from The State of UIF�8PSMEȅT�$IJMESFO �6/*$&'��

Figure 1: Conceptual Framework of Malnutrition showing the relationship between poverty, food insecurity, and other causes of maternal and child undernutrition

Figure 2: The underlying causes of undernutrition (adapted from the Communication on Humanitarian Food Assistance)

Household Food Insecurity-BDL�PG�TBGF�BDDFTT�UP�adequate and safe food throughout the year through:

• Food production

Ȍ�1VSDIBTF�CBSUFS

Ȍ�(JҬT �PUIFS�TPVSDFT

• Food safety and quality

• Cash transfers

Inadequate Care• Maternal nutrition• Maternal Care (workload, gender imbalance etc.)

• Child care

• Infant and young child feeding

• Eating habits

• Food preparation• Intra-household food distribution

• Capacity to care for dependent individuals

Unhealthy Household environment and lack of health services• Water quality and quantity

• Hygiene and sanitation

• (Free) access to and use of health services

A d d r e s s i n g U n d e r n u t r i t i o n i n E m e r g e n c i e sA d d r e s s i n g U n d e r n u t r i t i o n i n E m e r g e n c i e s12

Undernutrition therefore has to be understood as a multi-sectoral challenge, PCOSGPGLE�?�QMSLB�SLBCPQR?LBGLE�MD�RFC�QNCAGȏAGRGCQ�MD�C?AF�AMLRCVR�MD�GLRCPTCLRGML�

2.2 Recent advances in the management of undernutrition in crises

2FC�DMJJMUGLE�GKNMPR?LR�BCTCJMNKCLRQ�GL�PCACLR�WC?PQ�F?TC�R?ICL�NJ?AC�

i)� 2FC�NS@JGA?RGML�MD�LCU�5&-�EPMURF�QR?LB?PBQ��@?QCB�ML�RFC�EPMURF�MD�AFGJBPCL�SLBCP�AMLBGRGMLQ�MD�MNRGK?J�LSRPGRGML�?LB�FC?JRF�DPMK�?�T?PGCRW�MD�AMSLRPGCQ�NPMTGBCQ�?�@CRRCP�RMMJ�DMP�BG?ELMQGLE�SLBCPLSRPGRGML�?LB�BCȏLGLE�?LB�GBCLRGDWGLE�LSRPGRGML?J�PGQI�?LB�LSRPGRGML?J�LCCBQ�

(ii) The emergence and expansion of Community-based Management of Acute +?JLSRPGRGML��!+�+��#VRCLQGTC�CTGBCLAC�GQ�LMU�?T?GJ?@JC�ML�RFC�FCGEFRCLCB�CȑAGCLAW�?LB�CȎCARGTCLCQQ�MD�QSAF�?NNPM?AF�AMKN?PCB�RM�KMBCJQ�RF?R�MLJW�MȎCP� GLN?RGCLR� RPC?RKCLR�� 2FGQ� GQ� JGLICB� RM�?L� GKNPMTCKCLR� GL� RFC� GBCLRGȏ-A?RGML� MD� A?QCQ� ?LB� GL� RFC�KM@GJGX?RGML� MD� AMKKSLGRGCQ� ?PMSLB� QGRS?RGMLQ�

of undernutrition, as well as to a reduction in the barriers to accessing treatment as a result of better resourced and managed NPMEP?KKCQ�� 2FGQ� ?NNPM?AF� SQCQ� ?� LCU� AJ?QQGȏA?RGML�MD� QCTCPC� ?ASRC�K?JLSRPGRGML� �1�+�� UFGAF�A?RCEMPGQCQ� AFGJBPCL� CGRFCP� ?Q� QSȎCPGLE�from SAM with complications or without AMKNJGA?RGMLQ�@?QCB�ML�AJGLGA?J�QWKNRMKQ��The latter can be treated as outpatients

with ready-to-use therapeutic foods (RUTF), while children with medical com-plications are treated following specialised medical protocols through the ?BKGLGQRP?RGML�MD�RFCP?NCSRGA�KGJI�GL�GLN?RGCLR�D?AGJGRGCQ�

(iii) �L� GLAPC?QGLE� DMASQ� ML� RFC� OS?JGRW� MD� DMMB� GLCTGR?@JW� AMLRPG@SRCQ� RM� LSRPG-RGML?J�GKNPMTCKCLRQ��2FC�?B?NR?RGML�MD�RFCP?NCSRGA�KGJI�GLRM�032$�?LB�RFC�BCTCJMNKCLR� MD� GKNPMTCB� DMPKSJ?C�MD� DMPRGȏCB�@JCLBCB� DMMBQ�?LB� QNCAG?-JGXCB�PC?BW�RM�SQC�QSNNJCKCLR?PW�DMMBQ��031$��?PC�NJ?WGLE�?�ICW�PMJC�GL�RFGQ�QCLQC��3QC�MD�RFCQC�NPMBSARQ�F?Q�@CCL�CVRCLBCB�GLRM�MRFCP�?PC?Q�QSAF�?Q�RFC�RPC?RKCLR�MD�KMBCP?RC�?ASRC�SLBCPLSRPGRGML� RFC�NPCTCLRGML�MD�SLBCPLSRPG-RGML�RFC�LSRPGRGML?J�PCF?@GJGR?RGML�MD�?ASRCJW�GJJ�N?RGCLRQ�CRA��1SAF�?BT?LACQ�NPMTGBC�?L�MNNMPRSLGRW�DMP�RFC�BCTCJMNKCLR�?LB�?B?NR?RGML�MD�LCU�GLRCPTCL-RGML�QRP?RCEGCQ�

(iv) 2FC� PCAMELGRGML� RF?R� AFGJBPCL� SLBCP� ȏTC� WC?PQ� MD� ?EC� AMLQRGRSRC� RFC�KMQR�TSJLCP?@JC�?EC�EPMSN�GL�RCPKQ�MD�?ASRC�K?JLSRPGRGML��JRFMSEF�GL�FSK?LGR?-PG?L�QCRRGLEQ�RFC�NPMTGQGML�MD�?QQGQR?LAC�QFMSJB�@C�ES?P?LRCCB�RM�?JJ�LSRPGRGM-L?JJW�TSJLCP?@JC�?EC�EPMSNQ�N?PRGASJ?P�CKNF?QGQ�QFMSJB�@C�EGTCL�RM�AFGJBPCL�SLBCP�ȏTC�WC?PQ�MD�?EC��

(v) The understanding that the period between conception and 2 years of age is APSAG?J�GL�BCȏLGLE�RFC�DSRSPC�LSRPGRGML�?LB�FC?JRF�QR?RSQ�MD�RFC�GLBGTGBS?J��2FGQ�NCPGMB�NPMTGBCQ�?�APGRGA?J�UGLBMU�MD�MNNMPRSLGRW�GL�UFGAF�RFC�GKN?AR�MD�GLRCP-TCLRGMLQ�RM�GKNPMTC�K?RCPL?J�?LB�AFGJB�SLBCPLSRPGRGML��GLAJSBGLE�KC?QSPCQ�

“ The emergence and expansion of Community-based Management of Acute Malnutrition (CMAM).


RM� GKNPMTC�KGAPMLSRPGCLR� GLR?IC� GL� RFC�SLBCP� RUMQ� �3�Q�� ML� RFC�QSPTGT?J�EPMURF�?LB�BCTCJMNKCLR�MD�WMSLE�AFGJBPCL�GQ�K?VGKGQCB�15

(vi) ��DMASQ�ML�NMNSJ?RGML�@?QCB�QRP?RCEGCQ�RM�NPCTCLR�KMBCP?RC�SLBCPLSRPGRGML�GQ� AMK@GLCB�UGRF�KMPC� AMKKML� GLRCPTCLRGMLQ� R?PECRGLE� GLBGTGBS?JQ�� 2FCQC�P?LEC�DPMK�@J?LICR�BGQRPG@SRGMLQ�MD��DMPRGȏCB��QSNNJCKCLR?PW�DMMBQ�RM�QMAG?J�NPMRCARGML�QAFCKCQ�QSAF�?Q�A?QF�RP?LQDCPQ��$MP�CV?KNJC�RFCPC�GQ�GLAPC?QGLE�CTGBCLAC�MD�RFC�T?JSC�MD�GLRCEP?RGLE�FMSQCFMJB�?LB�AMKKSLGRW�DMMB�QCASPGRW�?LB�JGTCJGFMMB�QSNNMPR�UGRF�LSRPGRGML�PCF?@GJGR?RGML�GLRCPTCLRGMLQ��R�RFC�Q?KC�RGKC�?AACQQ�RM�DPCC�KCBGA?J�QCPTGACQ�F?Q�?JQM�NPMTCB�RM�F?TC�?�EPC?R�GKN?AR�ML�LSRPGRGML�?Q�LSRPGRGML�QCASPGRW�GQ�LMR�CVAJSQGTCJW�JGLICB�RM�DMMB�QCASPGRW�

(vii) 2FC�QR?LB?PBGQ?RGML�MD�QSPTCW�KCRFMBQ�RM�?QQCQQ�RFC�NPCT?JCLAC�MD�SLBCPLS-RPGRGML�GL�CKCPECLAGCQ�GL�N?PRGASJ?P�RFC�1R?LB?PBGXCB�+MLGRMPGLE�?LB��QQCQQ-ment of Relief and Transition (SMART) methodology, and progress towards LCU�QSPTCW�RCAFLGOSCQ�RM�?QQCQQ�NPMEP?KKC�AMTCP?EC��C�E��1/3#�!��

(viii) The recognition of the importance of acute undernutrition in non-emergency AMLRCVRQ�QSAF�?Q�?PC?Q�UGRF�NCPQGQRCLRJW�FGEF�JCTCJQ�MD�SLBCPLSRPGRGML�GL�RFC�long term, or during ‘seasonal hunger gaps’, and of the need, therefore, to GLRCEP?RC�SLBCPLSRPGRGML�NPCTCLRGML�?LB�RPC?RKCLR�GLRM�L?RGML?J�DMMB�QCASPGRW�?LB�FC?JRFA?PC�QWQRCKQ�?Q�UCJJ�?Q�APMQQ�QCARMP?J�BCTCJMNKCLR�NJ?LLGLE�

(ix) A consensus on the importance of Infant and Young Child Feeding practices in #KCPECLAGCQ��'7!$�#��GL�MPBCP�RM�Q?TC�JGTCQ�?LB�GKNPMTC�FC?JRF�?LB�RFC�BCTC-JMNKCLR�MD�AFGJBPCL��2FGQ�GLAJSBCQ�KC?QSPCQ�RF?R�?QQCQQ�RFC�'7!$�#�AMLRCVR��RFC� GLRCEP?RGML�MD�@PC?QRDCCBGLE�?LB�'7!$�#�QSNNMPR� GLRM�MRFCP�QCPTGACQ�DMP�KMRFCPQ� GLD?LRQ�?LB�WMSLE�AFGJBPCL��?LB�RFC�NPMTGQGML�MD�DMMB�RF?R� GQ�QSG-R?@JC�DMP�GLD?LRQ�?LB�WMSLE�AFGJBPCL��JRFMSEF�RFC�NPMKMRGML�MD�@PC?QRDCC-ding is a priority, in certain humanitarian situations it is preferable to support DMPKSJ?� DCCBGLE�� 2FC� GKNMPR?LAC� MD� NPCTCLRGLE� ?LB� ?TMGBGLE� BML?RGMLQ� MD�breast-milk substitutes, bottles, teats and other milk products in emergencies GQ�?JQM�PCAMELGQCB��

(x) 2FCPC�?PC�QCTCP?J�ICW�?PC?Q�UFCPC�NPM-gress has been made which, despite LMR�@CGLE�~LCU��F?TC�?�@C?PGLE�ML�FMU�undernutrition should be managed in APGQGQ� AMLRCVRQ�� 2FCQC� GLAJSBC�� ?� @CR-ter understanding of the multifaceted A?SQCQ� MD� SLBCPLSRPGRGML� RFC� GBCLRGȏ-cation of links between HIV and Tuberculosis and nutrition/undernutrition, RFC�GBCLRGȏA?RGML�MD�RFC�@CLCȏRQ�MD�?�FMJGQRGA�KSJRG�QCARMP?J�?NNPM?AF�?LB�?�heightened understanding of the importance of tackling micronutrient de-ȏAGCLAGCQ� GL�RFC�K?L?ECKCLR�MD�SLBCPLSRPGRGML�?LB�GL�RFC� GKNPMTCKCLR�MD�FC?JRF�AMLBGRGMLQ�

“ The recognition that children VOEFS�ҨWF�ZFBST�PG�BHF�DPOTUJUVUF�UIF�

most vulnerable age group in terms of acute malnutrition.

��)PXFWFS �UIJT�VOEFSTUBOEJOH�IBT�TFSWFE�UP�IJHIMJHIU�UIF�PQQPSUVOJUJFT�GPS�FOIBODFE�TZOFSHJFT�XJUI�MPOHFS�UFSN�FҧPSUT�CZ�UIF�$PN-mission to prevent undernutrition, by underscoring the crucial requirement to intervene both to save lives and to avoid long-term adverse PVUDPNFT�GPS�UIJT�BHF�HSPVQ��5IJT�VOEFSTUBOEJOH�IBT�BMTP�IFJHIUFOFE�BUUFOUJPO�UP�QPUFOUJBM�FWJEFODF�SFHBSEJOH�TQFDJҨD�DIBMMFOHFT�UIBU�can be associated with ensuring access to nutritional assistance for children under two years of age.

2.3 Key Challenges in Addressing Undernutrition in Emergencies

The following list presents the key challenges to be faced when addressing under-nutrition in emergencies:

• Good coordination,� UFGAF� PCOSGPCQ�CȎCARGTC� JC?BCPQFGN� ?LB� RFC� CQR?@JGQF-ment of mechanisms to build consen-sus for an appropriate and context-spe-AGȏA�QRP?RCEW��1SAF�?�QRP?RCEW�KSQR�@C�able to ensure multi–sectoral capacities ?LB� AMKKGRKCLR� RM� AJC?PJW� GBCLRGȏCB�LSRPGRGML�M@HCARGTCQ��

• Accurate analysis of the causes of undernutrition and interpretation of information from multiple sectors including gender and age disaggregated in-dicators of food and/or nutrition security, to feed into timely and appropriate PCQNMLQCQ�� !F?JJCLECQ� GLAJSBC� RFC� ?@QCLAC� MD� PCESJ?P� ?LB� PCJG?@JC�KMLGRMPGLE�mechanisms for nutritional status, especially in areas where, despite SAM being ?�NCPQGQRCLR�MP�PCASPPCLR�AMLACPL�GR�GQ�LMR�?BCOS?RCJW�PCAMELGQCB�MP�?BBPCQQCB�@W�AMLACPLCB�EMTCPLKCLRQ�MP�BCTCJMNKCLR�N?PRLCPQ�

•� �T?GJ?@GJGRW�MD�QIGJJCB�human resources (human resources shortage) and stren-gthened capacity to respond to nutrition emergencies (emergency prepared-LCQQ��

• -OLJLQFLK� >KA� P@>IFKDRM� LC� BȍB@QFSB� FKQBOSBKQFLKP such as commu-LGRW�@?QCB�?NNPM?AFCQ�DMP�RFC�NPCTCLRGML�?LB�K?L?ECKCLR�MD�?ASRC�SLBCPLSRPG-RGML�UFGJC�CLQSPGLE�?BCOS?RC�?RRCLRGML�?LB�PCQMSPACQ�DMP�MRFCP�APSAG?J�QCARMP?J�PCQNMLQC�MNRGMLQ�

• Promotion of quality management of humanitarian assistance for nutrition RFPMSEF� CTGBCLAC�@?QCB� BCAGQGML�K?IGLE� ?LB� GKNJCKCLR?RGML�� 2FGQ� PCOSGPCQ�cross-sectoral approaches; collection and analysis of gender and age disaggre-E?RCB�B?R?�� GLLMT?RGMLQ�GL�NPMEP?KKC�BCQGEL��GLAJSBGLE�DMP�CV?KNJC�?B?NRGLE�CȎCARGTC�JMA?J�NP?ARGACQ��QMSLB�K?L?ECKCLR��EMMB�BMASKCLR?RGML��?LB�GLTCQR-KCLR�GL�PCQC?PAF�RM�ȏJJ�CTGBCLAC�E?NQ�

• Ensuring a gender-sensitive approach to the assessment of needs and nutri-tion programming, particularly in the areas of community consultation and parti-AGN?RGML�?U?PCLCQQ�P?GQGLE�?LB�LSRPGRGML�CBSA?RGML�

•� !MLRPG@SRGLE�RM�CȎMPRQ�RM�build an evidence base, in order to assess the impact MD�GLRCPTCLRGMLQ��BCTCJMNKCLR�?LB�BGQQCKGL?RGML�MD�LCU�QSPTCW�KCRFMBQ�RF?R�?PC�C?QGCP�RM�SLBCPR?IC�GL�BGȑASJR�AMLRCVRQ��BG?ELMQRGA�RMMJQ�RM�?L?JWQC�KGAPMLSRPGCLR�BCȏAGCLAGCQ�UGRFMSR�PCOSGPGLE�QMNFGQRGA?RCB�J?@MP?RMPW�?L?JWQCQ��?LB�RPC?RKCLR�MD�GLD?LR�?ASRC�SLBCPLSRPGRGML�GL�CKCPECLAGCQ��

• Measuring impact GL� PCJ?RGML� RM� PCBSAGLE� ?LB� NPCTCLRGLE� SLBCPLSRPGRGML� ?LB�KMPR?JGRW� GL�CKCPECLAGCQ�?LB�BP?UGLE� JCQQMLQ�RM� GLDMPK�DSRSPC�PCQNMLQCQ��2FC�absence of standardised reporting mechanisms for programme performance (in-AJSBGLE�NPMEP?KKC�AMTCP?EC��GQ�?L�GKNMPR?LR�AMLQRP?GLR�ML�GKN?AR�KMLGRMPGLE�


“ Measuring impact in relation to reducing and preventing undernutrition and mortality in emergencies and drawing lessons to inform future responses.

•� 2?IGLE�?BT?LR?EC�MD�RFC�MNNMPRSLGRGCQ�?LB�PCQMSPACQ�RF?R�humanitarian assistance can bring to strengthen natio-nal capacity DMP�RFC�NPCTCLRGML�?LB�K?L?ECKCLR�MD�SL-BCPLSRPGRGML�z�UFGJC�?R�RFC�Q?KC�RGKC�QRPGTGLE�RM�QCASPC�JMLE�RCPK�QRP?RCEGA�NJ?LLGLE�?LB� GLTCQRKCLR� GL�A?N?AGRW�QRPCL-ERFCLGLE�

• Ensuring long-term, sustained support from develop-ment actors for tackling undernutrition prior to, during and ?ȓCP�?L�CKCPECLAW��

• Developing a holistic and integrated approach to un-dernutrition.

• Ensuring availability of appropriate capacities for sectoral and/or multi-sectoral coordination in addressing both existing and upcoming needs.

In the sections below, these challenges will be further dis-cussed and emerging experience regarding how best to ?BBPCQQ�RFCK�UGJJ�@C�NPCQCLRCB�RM�AF?PR�RFC�PM?B�?FC?B��


Burundi Health.


“ The principal objective is to reduce and avoid excess mortality and morbidity caused by undernutrition in humanitarian situations.

��-@HCARGTCQ�NPGMPGRGCQ� and principles of the commission’s assistance to nutrition in emergencies

!MLQGBCPGLE�?JJ�RFCQC�PCACLR�BCTCJMNKCLRQ�?LB�AF?JJCLECQ�?LB�@SGJBGLE�ML�CVGQRGLE�NMJGAGCQ�RFC�!MKKGQQGML�GBCLRGȏCQ�RFC�DMJJMUGLE�M@HCARGTCQ�NPGMPGRGCQ�?LB�NPGLAGNJCQ�DMP�GRQ�UMPI�ML�LSRPGRGML�GL�CKCPECLAGCQ�

3.1 Principal objective

2FC�NPGLAGN?J�M@HCARGTC�GQ�RM�PCBSAC�?LB�?TMGB�excess mortality and morbidity caused by SLBCPLSRPGRGML�GL�FSK?LGR?PG?L�QGRS?RGMLQ�

��1NCAGȏA�M@HCARGTCQ

2FC� NPGLAGN?J� M@HCARGTC� GQ� RM� @C� ?AFGCTCB�RFPMSEF�RFC�DMJJMUGLE�QNCAGȏA�M@HCARGTCQ�

• 2M�PCBSAC�JCTCJQ�MD�KMBCP?RC�?LB�QCTCPC�?ASRC�SLBCPLSRPGRGML�RM�@CJMU�CKCPECLAW�P?RCQ�?LB�NPCTCLR AMPPCAR�KGAPMLSRPGCLR�BCȏAGCLAGCQ�RFPMSEF�RGKCJW�CȑAGCLR�?LB�CȎCARGTC�FSK?LGR?PG?L�PCQNMLQCQ�

• 2M�NPCTCLR�QGELGȏA?LR�?LB�JGDC�RFPC?RCLGLE�BCRCPGMP?RGML�MD�LSRPGRGML?J�QR?RSQ�@W�Q?DCES?PBGLE� RFC� ?T?GJ?@GJGRW� MD� ?AACQQ� RM� ?LB� AMLQSKNRGML� MD� ?BCOS?RC� Q?DC�?LB�LSRPGRGMSQ�DMMB�UFGJC�NPMRCARGLE�JGTCJGFMMBQ�?LB�NPMKMRGLE�AMLBGRGMLQ�DMP�RFC�PCQRMP?RGML�MD�QCJD�PCJG?LAC�

• 2M� PCBSAC� RFC� RFPC?RQ� RM� RFC� LSRPGRGML?J� QR?RSQ� MD� NCMNJC� ?ȎCARCB� @W� APGQCQ�QRCKKGLE�DPMK�?L�GL?BCOS?RC�NS@JGA�FC?JRF�CLTGPMLKCLR�@W�QCASPGLE�?AACQQ�RM�?NNPMNPG?RC�FC?JRFA?PC�Q?DC�U?RCP�Q?LGR?RGML�D?AGJGRGCQ�?LB�FWEGCLC�GLNSRQ�

• 2M�PCBSAC�RFC�QNCAGȏA�TSJLCP?@GJGRW�MD�GLD?LRQ�?LB�WMSLE�AFGJBPCL�GL�APGQCQ�RFPMSEF�the promotion of appropriate child care, with special emphasis on infant and WMSLE�AFGJB�DCCBGLE�NP?ARGACQ�

• 2M�PCBSAC�RFC�QNCAGȏA�LSRPGRGML�TSJLCP?@GJGRW�MD�NPCEL?LR�?LB�J?AR?RGLE�UMKCL

A d d r e s s i n g U n d e r n u t r i t i o n i n E m e r g e n c i e s��


16 - Note: Throughout this document, where reference is made to pregnant and lactating women and their associated physiological nutrition vulnerability, it is acknowledged that this overlaps considerably with the nutrition vulnerability of ‘women of reproductive age’ and ‘adolescent girls’ BOE�UIBU�TVDI�DPOTJEFSBUJPOT�DBO�IBWF�TJHOJҨDBOU�PQFSBUJPOBM�JNQMJDBUJPOT�

UMKCL�MD�PCNPMBSARGTC�?EC��

• 2M�PCBSAC�RFC�QNCAGȏA�LSRPGRGML�TSJLCP?@GJGRW�MD�KMQR�?ȎCARCB�EPMSNQ��QSAF�?Q�RFC�CJBCPJW�BGQ?@JCB�&'4��NMQGRGTC�AFGJBPCL�MTCP�ȏTC�?LB�?BMJCQACLRQ��

• To strengthen the capacities of the international FSK?LGR?PG?L� ?GB� QWQRCK� RM� CLF?LAC� CȑAGCLAW� ?LB�CȎCARGTCLCQQ�GL�RFC�BCJGTCPW�MD�FSK?LGR?PG?L�?QQGQR?LAC�DMP�LSRPGRGML�

3.3 Strategic priorities

'L� NMNSJ?RGMLQ� ?ȎCARCB� @W� CKCPECLAGCQ� RFC� NPGMPGRW� DMASQ�GQ� ML� ?ASRC� �KMBCP?RC� ?LB� QCTCPC�� SLBCPLSRPGRGML�UFGAF� GQ�?QQMAG?RCB�UGRF�?�FGEFCP�PGQI�MD�KMPR?JGRW�?LB�KMP@GBGRW��

'L� JGLC�UGRF�RFC�?@MTC�M@HCARGTCQ� RFC�!MKKGQQGML�PCQNMLBQ�to underrnutrition and its causes in emergencies by funding GLRCPTCLRGMLQ�RF?R�KCCR�RFC�DMJJMUGLE�QRP?RCEGA�NPGMPGRGCQ��

i)� 'LRCPTCLRGMLQ�RM�RPC?R�+�+�?LB�1�+�

ii)� 'LRCPTCLRGMLQ� RFPMSEF� RFC� LSRPGRGML� FC?JRF� ?LB� DMMB�assistance sectors that tackle the immediate causes of SLBCPLSRPGRGML��GL?BCOS?RC�BGCR?PW�GLR?IC�?LB�BGQC?QC��

iii)� 'LRCPTCLRGMLQ�RFPMSEF�RFC�LSRPGRGML�FC?JRF�DMMB�?QQGQR?LAC�and WASH (water, sanitation and hygiene) sectors that tackle the underlying causes of undernutrition (food GLQCASPGRW� GL?BCOS?RC� A?PC� NP?ARGACQ� ?LB� GL?BCOS?RC�?AACQQ�RM�FC?JRFA?PC�?LB�CLTGPMLKCLR?J�FC?JRF��

iv)� 'LRCEP?RGML� MD� LSRPGRGML� GLRCPTCLRGMLQ� UGRFGL� ?L� MTCP?JJ�PCQGJGCLAC� QRP?RCEW� GL� AMMPBGL?RGML� UGRF� BCTCJMNKCLR�N?PRLCPQ�

3.4 Principles that guide the Commission’s assistance to nutrition in emergencies

'L�NSPQSGR�MD� RFC�?@MTC�KCLRGMLCB�M@HCARGTCQ� RFC� DMJJMUGLE�principles underscore the Commission’s support to nutrition in humanitarian situations:

i)� 2FC� LSRPGRGML� GLRCPTCLRGMLQ� ?GKGLE� ?R� RPC?RGLE� ?LB�NPCTCLRGLE�SLBCPLSRPGRGML�?PC�@?QCB�ML�GLBGTGBS?J�LCCBQ��2FC� GLBGTGBS?J� LSRPGRGML?J� QR?RSQ� GQ� ?QQCQQCB� SQGLE�

Fananehana: Well drilling using the well-jetting technique.

1BLJTUBO�ҩPPET�


QR?LB?PB� KCRFMBQ� KC?QSPCQ� ?LB� RFPCQFMJB�� 2FC� NPCTCLRGTC� GLRCPTCLRGMLQ� ?LB�GLBGPCAR� GLRCPTCLRGMLQ�ML�RFC�A?SQCQ�MD�SLBCPLSRPGRGML�?PC�@?QCB�ML�?NNPMNPG?RC�LCCBQ�?QQCQQKCLR�SQGLE�QR?LB?PB�GLBGA?RMPQ�QSAF�?Q�%�+�?LB�1�+�NPCT?JCLAC�

?AACQQ�RM�DMMB�?LB�?AACQQ�RM�@?QGA�FC?JRF�A?PC��

ii) The choice of the most appropriate GLRCPTCLRGML�Q��?LB�GLQRPSKCLR�Q��KSQR�@C�@?QCB�ML�CTGBCLAC��RFC�LCCBQ�?QQCQQKCLR�the nutrition causal analysis, the context ?L?JWQGQ� ?LB� RFC� PCQNMLQC� ?L?JWQGQ�� 2FC�design of any response should compare ?JRCPL?RGTC� ?ARGTGRGCQ� ?LB� KMB?JGRGCQ�ML� RFC� @?QGQ� MD� AMQR�CȎCARGTCLCQQ�

DMP�KCCRGLE� GBCLRGȏCB�LCCBQ�� 'LRCPTCLRGMLQ�QFMSJB�@C�PCESJ?PJW� PCTGCUCB�ML�RFC�@?QGQ�MD�JMA?J�BWL?KGAQ�?LB�QGRS?RGML�AF?LECQ��

iii)� ,SRPGRGML� GLRCPTCLRGMLQ� PCQNMLB� RM� UCJJ� BCȏLCB� FSK?LGR?PG?L� PGQIQ�� 2FCW� ?PC�R?PECRGLE�GLBGTGBS?JQ�N?PRGASJ?PJW�TSJLCP?@JC�RM�KMPR?JGRW�?LB�KMP@GBGRW�PCJ?RCB�RM�undernutrition: children under 5, the pregnant and lactating mothers, elderlies and AFPMLGA?JJW�GJJ��

iv)� 3LBCPQR?LBGLE�RFC�A?SQCQ�MD�SLBCPLSRPGRGML�?LB�CL?@JGLE�CLTGPMLKCLR�GQ�APSAG?J�RM�GBCLRGDW�RFC�?NNPMNPG?RC�AMK@GL?RGML�MD�?ARGTGRGCQ�RM�?BBPCQQ�SLBCPLSRPGRGML�?LB�GRQ�A?SQCQ��!?SQCQ�MD�SLBCPLSRPGRGML�?PC�MȓCL�KSJRGNJC��BMNRGLE�?�KSJRG�QCARMP�?NNPM?AF�?LB�AMMPBGL?RGLE�FSK?LGR?PG?L�?LB�BCTCJMNKCLR�?ARGMLQ�?PC�RFSQ�CQQCLRG?J�

v)� 2FC� !MKKGQQGML� QCCIQ� RM� GLAMPNMP?RC� QWQRCK?RGA?JJW� ECLBCP� NCPQNCARGTCQ� GLRM�GRQ�FSK?LGR?PG?L�LSRPGRGML�?QQCQQKCLRQ��'R�?JQM�AMLQGBCPQ�RFC�ECLBCP�GKNJGA?RGMLQ�MD� GRQ� CKCPECLAW� LSRPGRGML� GLRCPTCLRGMLQ� PCAMELGQGLE� RFC� GKNMPR?LAC� MD� ECLBCP�PMJCQ�GL�A?PGLE�?LB�DCCBGLE�NP?ARGACQ�JGTCJGFMMBQ�RFC�SQC�?LB�?JJMA?RGML�MD�DMMB�?R�FMSQCFMJB�JCTCJ�?LB�@CLCȏAG?PGCQ��SRGJGQ?RGML�MD�DMMB�?QQGQR?LAC�PCQMSPACQ�

vi) Nutrition assistance upholds the principles of Linking Relief Rehabilitation and "CTCJMNKCLR� �*00"�� 5FCPC� NMQQG@JC� ?LB� ?NNPMNPG?RC� RFC� !MKKGQQGML� UMPIQ�UGRF� GRQ� BCTCJMNKCLR� N?PRLCPQ� RM� K?VGKGQC� RFC� QSQR?GL?@GJGRW� MD� GLRCPTCLRGMLQ�@W�NPMKMRGLE�RFCGP�GLRCEP?RGML�GLRM�L?RGML?J�NMJGAW�DP?KCUMPIQ�?LB�NJ?LQ��C�E��GL�health policy, emergency response plans, national protocols for the treatment of SLBCPLSRPGRGML�CRA��

vii) 2FC�!MKKGQQGML�QRPGTCQ�RM�BM�LM�F?PK�RFPMSEF�GRQ�FSK?LGR?PG?L�?QQGQR?LAC�DMP�LSRPGRGML�� 2FGQ� GQ� CQNCAG?JJW� GKNMPR?LR� GL� PCJ?RGML� RM� RFC� Q?DCRW� MD� GLLMT?RGMLQ�?LB� RFC�SQC�MD� QNCAG?JGXCB�LSRPGRGML�NPMBSARQ�� 2FC�!MKKGQQGML�?JU?WQ�CLQSPCQ�RF?R�?JJ�?T?GJ?@JC�CTGBCLAC�GQ�AMLQGBCPCB�DSJJW�?LB�RF?R�RFC�@CQR�GLRCPCQRQ�MD�RFC�@CLCȏAG?PGCQ�PCK?GL�ACLRP?J��

viii) 2FC� !MKKGQQGML� NPMKMRCQ� RFMQC� NP?ARGACQ� RF?R� ?PC� CȑAGCLR� ?LB� CȎCARGTC� GL�K?L?EGLE� SLBCPLSRPGRGML�� 2FC� A?PC� EGTCL� OS?JGRW� MD� DMMB� NPMBSARQ� SQCB� ?LB�reliability of information17 that guides programme design follow international QR?LB?PBQ�z�QSAF�?Q�1NFCPC�5&-�MP�ESGB?LAC�DPMK�RFC�%JM@?J�,SRPGRGML�!JSQRCP�

“ The Commission promotes UIPTF�QSBDUJDFT�UIBU�BSF�FҪDJFOU�BOE�FҧFDUJWF�JO�NBOBHJOH�undernutrition.

��'PS�FYBNQMF �IJHI�DBTF�GBUBMJUZ�SBUFT�PG�TFWFSF�BDVUF�VOEFSOVUSJUJPO�IBWF�CFFO�BUUSJCVUFE�UP�JOBQQSPQSJBUF�DBTF�NBOBHFNFOU�BOE�QPPS�LOPXMFEHF�PG�NFEJDBM�TUBҧ��8JEFS�JNQMFNFOUBUJPO�PG�UIF�8)0�HVJEFMJOFT�UISPVHI�JO��TFSWJDF�USBJOJOH�BOE�JODPSQPSBUJPO�into medical and nursing curricula is the key to substantially decreasing case- fatality rates of SAM. Collins S. et al. Management of TFWFSF�BDVUF�NBMOVUSJUJPO�JO�DIJMESFO��5IF�-BODFU �7PM�� QBHF�� %FDFNCFS��IUUQ��XXX�UIFMBODFU�DPN�KPVSOBMT�MBODFU�BSUJDMF�1**4��BCTUSBDU



��-NCP?RGML?J�QAMNC� of assistance4.1 Entry and Exit Criteria

In line with the Commission’s Communication on Humanitarian Food Assistance, the Commission follows the entry and exit criteria for operations outlined below,

Entry criteria for operations

Exit criteria for operations• The Commission considers phasing out its humanita-

rian nutrition assistance when indicators of acute un-dernutrition and related mortality are stabilised below emergency levels, or are expected to stabilise there in the foreseeable future, independently of the Commis-sion’s humanitarian support.

• The Commission also considers phasing out or tran-sitioning its humanitarian support where non-huma-nitarian players (e.g. State or development actors) are able to respond to the nutritional needs of the popu-lations at risk, therefore mitigating the level of huma-nitarian risk associated with withdrawal; or when the humanitarian needs of the population are fully covered by other humanitarian donors and actors.

• The Commission, at all times, evaluates its humani-tarian exit strategies on the basis of its comparative advantage relative to other actors. The Commission seeks to avoid creating disincentives to the engage-ment of other actors by delaying its own exit. It ad-vocates instead for other, more appropriate, actors across the relief and development spectrum to res-QPOE �BDDPSEJOH�UP�UIF�TQFDJҨD�DPOUFYU�BOE�OFFET�

• The Commission also considers exiting from huma-nitarian nutrition assistance operations when its core principles cannot be respected, particularly if the risk PG�EPJOH�IBSN�PVUXFJHIT�UIF�QPUFOUJBM�CFOFҨUT�PG�SF-maining engaged.

• The Commission may trigger nutrition support when emergency rates of mortality or acute undernutri-UJPO� 6��NPSUBMJUZ� SBUF� �� EBZ � (".� �� BOE�(".�SBUFT��XJUI�BHHSBWBUJOH�GBDUPST�IBWF�been reached or exceeded, or are anticipated, on the CBTJT�PG�ҨSN�GPSFDBTUT��4VDI�ȇBOUJDJQBUJPOȈ�TIPVME�CF�based on early warning indicators that show a critical EFUFSJPSBUJPO� JO� UIF� GPPE� TFDVSJUZ� BOE�PS� IFBMUI� FO-vironment, which, unless responded to, will become life-threatening within a timeframe that is consistent with the Commission’s humanitarian remit.

Ȍ�3FDPHOJ[JOH�UIBU�B�GPPE�DSJTJT�TPNFUJNFT�CFHJOT �DBM-ling for a reaction before the nutritional status dete-riorates further, the Commission does not necessarily wait for rising rates of acute undernutrition before providing humanitarian food assistance and nutritio-OBM�TVQQPSU �BOE�SFTQPOE�UP�XFMM�EFҨOFE�IVNBOJUB-rian risks that pose a threat to life. The Commission does not require a formal disaster declaration in order to respond to an emergency.

• In considering whether and how to respond to a gi-ven crisis, the Commission pays close attention to

the comparative advantages and disadvantages of the humanitarian instruments at its disposal. This re-quires: a careful analysis of the existing needs and the causes of the crisis; a consideration of the type of res-ponse that will address those needs in the most ap-propriate way without causing any harm; and a close review of the alternative assistance mechanisms that are available.

• In this regard, the Commission’s humanitarian as-sistance does generally not respond to permanently high levels of undernutrition (whether stunting, was-UJOH� BOE�PS�NJDSPOVUSJFOU� EFҨDJFODJFT� FYDFQU�XIFSF�non-intervention poses an imminent humanitarian SJTL�PG�TJHOJҨDBOU�TDBMF�BOE�TFWFSJUZ�BOE�XIFSF�PUIFS�more appropriate actors are either unable or unwilling to act, and cannot be persuaded to act; and where, in spite of its comparative disadvantages, positive im-pact can be expected within the time limitations of the intervention by the Commission. In such cases, the delivery of humanitarian assistance for nutrition is anticipated by advocacy, dialogue and appropriate coordination with relevant development actors.



always mindful of the commitment to supporting appropriate transition through *00"��*GLIGLE�0CJGCD�0CF?@GJGR?RGML�?LB�"CTCJMNKCLR��

4.2 Additional aspects necessary to achieve the Commission’s Objectives

2FC� !MKKGQQGML�Q� FSK?LGR?PG?L�K?LB?RC� GRQ� A?N?AGRW� ?LB� NPGMPGRGCQ� ?JJ� EGTC�GR� ?� QNCAGȏA� AMKN?P?RGTC� ?BT?LR?EC� RM� PCQNMLB� RM� RFC� ?@MTC�KCLRGMLCB�SLBCPLSRPGRGML�AF?JJCLECQ�GL�APGQCQ��2FC�!MKKGQQGML�PCAMELGQCQ�FMUCTCP�RF?R�GL�MPBCP�RM�?AFGCTC�RFC�EPC?RCQR�@CLCȏRQ�GL�RCPKQ�MD�GKNPMTCB�LSRPGRGML�GR�GQ�?JQM�necessary to address two other persistent challenges in emergencies:

i) The production of reliable information to guide decisions, with special CKNF?QGQ�ML�QGRS?RGML�?LB�PCQNMLQC�?L?JWQCQ�RF?R�?PC�QCLQGRGTC�RM�ECLBCP�?LB�?EC�PCJ?RCB�GLCOS?JGRGCQ��?LB

ii) 2FC� QRPCLERFCLGLE� MD� A?N?AGRGCQ� DMP� CȑAGCLR� ?LB� CȎCARGTC� BCJGTCPW� MD�FSK?LGR?PG?L�?QQGQR?LAC�DMP�LSRPGRGML�

2FCQC�RUM�?PC?Q�?PC�RFCPCDMPC�GLAJSBCB�FCPC�QM�?Q�RM�CL?@JC�RFC�?AFGCTCKCLR�MD�RFC�!MKKGQQGML�Q�M@HCARGTCQ��&MUCTCP�RFCW�?PC�LMR�GLAJSBCB�?Q�QR?LB�?JMLC�?PC?Q�MP�CLRPW�NMGLRQ�DMP�PCQNMLQC��

4.2.1 Information Systems

Where they exist, health, nutrition and food security information systems regularly collect nutrition information (including anthropometric data) that

can be used in decisions about policies and/or guide strategies and monitor GLRCPTCLRGMLQ�

1SAF� GLDMPK?RGML� QWQRCKQ� PCOSGPC� JMLE�term support, with national or regional ownership and careful consideration MD� CAMLMKGA� ?LB� NMJGRGA?J� NCPQNCARGTCQ��'R� GQ� RFCPCDMPC� GKNCP?RGTC� RF?R� ?LW�humanitarian support in this area is coherent with a longer term strategy by the Commission and/or other donors and L?RGML?J�QWQRCKQ��

2FC�AJMQCJW�PCJ?RCB�?ARGTGRGCQ�MD�QGRS?RGML�analysis (including nutrition causal

?L?JWQGQ��?LB�PCQNMLQC�?L?JWQGQ�?PC�APSAG?J�GL�QCASPGLE�RFC�MTCP?JJ�CȎCARGTCLCQQ�MD�?L�GLRCPTCLRGML��

2FC� !MKKGQQGML� PCAMELGQCQ� RFC� T?JSC� MD� ?NNJWGLE� ?� LSRPGRGML� ~JCLQ�� RM�assessments, problem and response analysis, as well as to the monitoring and CT?JS?RGML�MD�?JJ�KSJRG�QCARMP?J�NPMHCARQ�

The Commission facilitates the integration of nutrition data into other information systems and projects, such as the IPC project (Integrated Food

“ Where they exist, health, nutrition and food security information systems regularly collect nutrition information that can be VTFE�JO�EFDJTJPOT�BCPVU�QPMJDJFT�BOE�or guide strategies and monitor interventions.


��IUUQ��XXX�JQDJOGP�PSH�

��IUUQ��XXX�TBWFUIFDIJMESFO�PSH�VL�SFTPVSDFT�POMJOF�MJCSBSZ�UIF�IPVTFIPME�FDPOPNZ�BQQSPBDI�B�HVJEF�GPS�QSPHSBNNF�QMBOOFST�BOE�QPMJDZ�NBLFST��IUUQ��XXX�TBWFUIFDIJMESFO�PSH�VL�SFTPVSDFT�POMJOF�MJCSBSZ�UIF�DPTU�PG�UIF�EJFU�

�� IUUQ��POFSFTQPOTF�JOGP�DSPTTDVUUJOH�HFOEFS�(FOEFS��.BSLFS��.BUFSJBMT�/VUSJUJPO��(FOEFS��.BSLFS��,JU�QEG

��IUUQ��TJUFT�UVҬT�FEV�GFJOTUFJO��TFY�BOE�BHF�NBUUFS��%(�&$)0��.BOVBM�1SP-ject Cycle Management. Brussels

�� 4VDI� BT� 4."35� 4UBOEBSEJ[FE� .POJUPSJOH� BOE� "TTFTTNFOU� PG� 3FMJFG� BOE� 5SBOTJUJPOT��IUUQ��XXX�TNBSUNFUIPEPMPHZ�PSH�JOEFY�QIQ PQUJPO�DPN@DPOUFOU�WJFX�BSUJDMF�JE��*UF-NJE��MBOH�FO

��4FF�&NFSHFODZ�/VUSJUJPO�"TTFTTNFOU��(VJEFMJOFT�GPS�ҨFME�XPSLFST��4BWF�UIF�$IJMESFO �/P-vember 2004.

1CASPGRW�.F?QC�!J?QQGȏA?RGML�� while continuing its support to the Household Economy Approach in relation to the Cost MD�"GCR�?L?JWQGQ�19

Finally, gender analyses should be integrated in any situation and response analysis, and it is crucial to ensure RF?R�QNCAGȏA�A?N?AGRGCQ�?PC�GL�NJ?AC�RM�?AFGCTC�RFGQ�EM?J�

2M�K?VGKGQC�RFC�OS?JGRW�?LB�CȎCARGTCLCQQ�MD�LSRPGRGML�PCJ?RCB�GLRCPTCLRGMLQ� RFC� !MKKGQQGML� CKNF?QGQCQ� RFC� T?JSC� MD�utilising the full project management cycle: needs assessment, PCQNMLQC� ?L?JWQGQ� NJ?LLGLE� �NPMEP?KKC� GBCLRGȏA?RGML��?NNP?GQ?J� ȏL?LAGLE� GKNJCKCLR?RGML� ?LB� KMLGRMPGLE� ?LB�CT?JS?RGML�22

The Commission, especially in crisis-prone countries, pays QNCAGȏA�?RRCLRGML� RM� RFC� AMJJCARGML�MD�OS?JGRW�LSRPGRGML�B?R?�and promotes implementation of nutritional assessments ?AAMPBGLE�RM�QR?LB?PBGQCB�KCRFMBMJMEGCQ�23 Such assessments may include, other than anthropometry, data that will help to identify the likely causes of undernutrition (most notably JGLICB�RM�FC?JRF�DMMB�QCASPGRW�?LB�RFC�CLTGPMLKCLR��24

4.2.2 Capacity Building

In the high-pressure context of humanitarian crises, the GKNCP?RGTC� RM� PCQNMLB� OSGAIJW� ?LB� NPMDCQQGML?JJW� PCOSGPCQ�RFC� NPCQCLAC� MD� A?N?AGRW� RM� BM� QM�� R� RFC� Q?KC� RGKC� RFC�LSRPGRGML�ȏCJB�GQ�?BT?LAGLE�TCPW�OSGAIJW�APC?RGLE�?BBGRGML?J�NPCQQSPC� ML� QR?Ȏ� RM� ILMU� RFC� J?RCQR� CTGBCLAC� RF?R� A?L�GLDMPK�RFC�BCQGEL�MD�FSK?LGR?PG?L�PCQNMLQCQ�DMP�LSRPGRGML��The Commission recognises the challenges and opportunity costs of such a widening gap between theoretical knowledge ?LB�MNCP?RGML?J�A?N?@GJGRW�?LB�UGJJ�QCCI�RM�NPGMPGRGXC�CȎMPRQ�RM�@PGBEC�RFGQ�E?N��

'L�MPBCP�RM�K?VGKGQC�RFC�CȎCARGTCLCQQ�MD�LSRPGRGML�?QQGQR?LAC�RFC�!MKKGQQGML�PCAMELGQCQ�RFC�LCCB�RM�GLTCQR�GL�QSNNMPRGLE�GLQRGRSRGMLQ�?LB�BCTCJMNGLE�RFC�A?N?AGRW�MD�ICW�QR?ICFMJBCPQ�GLTMJTCB�GL�RFC�K?L?ECKCLR�MD�?ASRC�SLBCPLSRPGRGML�GL�APGQCQ��While responding to humanitarian needs, it is possible to BCTCJMN�NMJGAGCQ�QWQRCKQ�?LB�QIGJJQ�RF?R�?PC�AMKN?RG@JC�@MRF�

5IF�TJHOJҨDBODF�PG�gender analysis in the planning of humanitarian assistance for nutrition

The commitment to strengthening a gen-der-sensitive approach is enshrined in the European Consensus on Humanitarian Aid which highlights the importance of: (i) integrating gender considerations, (ii) in-corporating protection strategies against sexual and gender-based violence, and (iii) promoting the active participation of women in humanitarian assistance.

3BUJPOBMF��$SJTJT�TJUVBUJPOT �XIBUFWFS�UIFJS�cause, are not gender neutral. Women, HJSMT � CPZT� BOE�NFO� GBDF� EJҧFSFOU� SJTLT�of deterioration in their nutritional status. 5IFTF�EJҧFSFOU�WVMOFSBCJMJUJFT�BSF�SFMBUFE�CPUI�UP�UIFJS�EJҧFSJOH�QIZTJPMPHJDBM�OVUSJ-tion requirements and to socio-cultural factors related to gender.20

Why gender and age matter:21 Gen-EFS�CMJOE� BDUJPOT� BSF� MFTT� FҧFDUJWF� CF-cause they neglect the diversity of needs, capacities and coping mechanisms of EJҧFSFOU� HSPVQT� PG� CFOFҨDJBSJFT�� (PPE�nutrition programming must take due ac-count of gender issues at all stages of the project cycle. In particular, there must be attention to ensuring a gender perspec-tive in situation and response analysis. Experience shows that poor child feeding practices, lack of access to health ser-vices, economic and livelihood insecurity, cultural practices and gender inequality more broadly tend to be inadequately incorporated into national vulnerability analyses and strategic programming. A gender analysis is undertaken to bet-ter understand the division of roles, res-ponsibilities, constraints and access to re-TPVSDFT �NPCJMJUZ � TQFDJҨD� WVMOFSBCJMJUJFT �needs and risks faced by women, girls, boys and men, including sexual and gen-der-based violence.

A d d r e s s i n g U n d e r n u t r i t i o n i n E m e r g e n c i e sA d d r e s s i n g U n d e r n u t r i t i o n i n E m e r g e n c i e s22

UGRF� CKCPECLAW� ?LB� BCTCJMNKCLR� AMLRCVRQ�� 2FC� !MKKGQQGML�Q� QSNNMPR� ?GKQ� RM�enhance local and national capacities to manage undernutrition in emergencies and to face seasonal peaks, and to build resilience to face existing and upcoming QFMAIQ�

Where possible and appropriate, the Commission works within the timeframe of its humanitarian operations to simultaneously enhance national capacities for: i) LSRPGRGML?J�QSPTCGJJ?LAC��GG��LSRPGRGML�QSPTCWQ��GGG��FC?JRF�DMMB�QCASPGRW��LSRPGRGML�B?R?�KMLGRMPGLE��GT��APMQQ�QCARMP?J�A?SQ?JGRW�QRSBGCQ�?LB�?QQCQQKCLRQ�?LB��T��CLF?LAC�RFC� A?N?AGRW� DMP� RFC� GKNJCKCLR?RGML� MD� LSRPGRGML?J� ?ARGTGRGCQ�� 1SAF� GLTCQRKCLRQ�should be coordinated with other Commission aid instruments to ensure continuity UFCL�RFC�FSK?LGR?PG?L� GLRCPTCLRGML� GQ�AMLAJSBCB� �QCC�QCARGML��ML�!MFCPCLAC�!MMPBGL?RGML�?LB�!MKNJCKCLR?PGRW��

4.2.3 Integration into national systems

�� ACLRP?J� AF?JJCLEC� D?AGLE� FSK?LGR?PG?L� ?QQGQR?LAC� DMP� LSRPGRGML� GLTMJTCQ� RFC�LCCB�DMP�RGKCJW�CLE?ECKCLR�?LB�P?NGB�GLRCPTCLRGML�UFGJC�CLQSPGLE�RF?R�KGLGKSK�QR?LB?PBQ�MD�OS?JGRW�?PC�AMLQGQRCLRJW�K?GLR?GLCB��#VNCPGCLAC�QSEECQRQ�RF?R�?Q�D?P�?Q�NMQQG@JC�RFGQ�AF?JJCLEC�A?L�@C�@CQR�KCR�RFPMSEF�CȎCARGTC�NPCN?PCBLCQQ�KC?QSPCQ�GL� RFC�DP?KCUMPI�MD�?L� GLRCEP?RCB� ~QWQRCK�QRPCLERFCLGLE��?NNPM?AF��"CQNGRC� RFC�D?AR� RF?R� FSK?LGR?PG?L� APGQCQ� BM� LMR� R?IC� NJ?AC� GL� ?� T?ASSK� RFC� FSK?LGR?PG?L�GKNCP?RGTC�RM�NPMTGBC�GKKCBG?RC�JGDC�Q?TGLE�PCQNMLQC�DPCOSCLRJW�JC?BQ�RM�?�DMASQ�ML�RFC�CQR?@JGQFKCLR�MD�LCU�KCAF?LGQKQ�DMP�BCJGTCPW�JC?BGLE�RM�RFC�LCEJCAR�MD�NPC�CVGQRGLE�JMA?J�QWQRCKQ��LMR�MLJW�GL�RFC�FC?JRF�QCARMP�@SR�?JQM�UGRFGL�MRFCP�PCJCT?LR�JMA?J�GLQRGRSRGMLQ�?LB�AMKKSLGRW�QRPSARSPCQ��

Where appropriate, the Commission therefore encourages the inclusion of programming to address nutrition within the broader context of national QWQRCKQ� �GLAJSBGLE� NPMTGQGMLQ� DMP� RFC� ?B?NR?RGML� MD� L?RGML?J� NPMRMAMJQ� DMP� QSPEC�NPMEP?KKGLE�� 2FGQ� GL� RSPL� FGEFJGEFRQ� RFC� LCCB� DMP� ?� RFMPMSEF� ?QQCQQKCLR� MD�L?RGML?J�A?N?AGRGCQ�?LB�PCQMSPACQ�NPGMP�RM�GLRCPTCLRGML�?Q�UCJJ�?Q�?�AMKKGRKCLR�RM� PCGLDMPAC� EMTCPLKCLR� MULCPQFGN� ?LB� A?N?AGRW�UFCPC� RFGQ� GQ� AMLBSAGTC� RM� RFC�?AFGCTCKCLRQ�MD�RFC�M@HCARGTCQ�MD�FSK?LGR?PG?L�?QQGQR?LAC��

4.2.4 Advocacy

The Commission recognises that both acute and chronic undernutrition and KGAPM�LSRPGCLR� BCȏAGCLAGCQ� ?PC� NPCT?JCLR� ?LB� MȓCL� AM�CVGQRGLE� RM� T?PWGLE�

BCEPCCQ� GL�K?LW� QR?@JC� AMLRCVRQ�� %GTCL� RFC�AMLQCOSCLACQ�MD�QSAF�NCPQGQRCLRJW�FGEF�@SPBCL�of undernutrition on infant and child mortality, AFGJB�BCTCJMNKCLR�?LB�JMLECP�RCPK�CAMLMKGA�growth prospects, the Commission insists that ?JJ�DMPKQ�MD�SLBCPLSRPGRGML�@C�ȏPKJW�NJ?ACB�?R�RFC�ACLRPC�MD�RFC�BCTCJMNKCLR�?ECLB?��

�BTMA?AW� ?LB� NS@JGA� ?U?PCLCQQ� @SGJBGLE�are essential to secure better policies and RFC� BCTCJMNKCLR� MD� ?NNPMNPG?RC� ?ARGMLQ� RM�PCQNMLB� RM� SLBCPLSRPGRGML�� )CW� R?PECRQ� GL�

RFGQ�NPMACQQ�?PC�L?RGML?J�EMTCPLKCLR�?SRFMPGRGCQ�AGTGJ�QMAGCRW�?LB�BCTCJMNKCLR�N?PRLCPQ��K?HMP�DMASQ�GQ�NJ?ACB�ML�GLGRG?RGTCQ�RM�GKNPMTC�RFC�SLBCPQR?LBGLE�MD�

“ The Commission recognises that both acute and chronic undernutrition and micro-nutrient EFҨDJFODJFT�BSF�QSFWBMFOU�BOE�PҬFO�co-existing, to varying degrees, in many stable contexts.


RFMQC�KC?QSPCQ� RF?R� ?PC� PCOSGPCB� GL� MPBCP� RM� ?AFGCTC� RFC�+"%Q�MD�PCBSAGLE�FSLECP�?LB�AFGJB�?LB�K?RCPL?J�KMPR?JGRW�

�JRFMSEF� RFC� !MKKGQQGML� F?Q� ?� QNCAGȏA� PCKGR� ?LB� ?�AMKN?P?RGTC�?BT?LR?EC�GL�FSK?LGR?PG?L�?ARGML�?Q�MNNMQCB�RM�QMKC�JMA?J�?ARMPQ� RFC�FSK?LGR?PG?L� GKNCP?RGTC�RM�Q?TC�JGTCQ� ?LB� PCBSAC� P?RCQ� MD� ?ASRC� SLBCPLSRPGRGML� QFMSJB� @C�PCQNMLBCB�RM�UFCLCTCP�DC?QG@JC�GL�?�K?LLCP�RF?R�BMCQ�LMR�SLBCPKGLC�JMA?J�A?N?AGRGCQ�MP�LCEJCAR�L?RGML?J�NMJGAGCQ��*MA?J�capacity for the routine management of persistent burdens of acute undernutrition and for the management of future crises, should therefore be supported and strengthened UFCLCTCP�NMQQG@JC�

4.2.5 Research

With a growth in awareness of the multi-sectoral causality of undernutrition and an expansion in the programmatic options to respond to the phenomenon, the collection of robust and SN�RM�B?RC� CTGBCLAC� ML� RFC� CȑAGCLAW� ?LB� CȎCARGTCLCQQ� MD�BGȎCPCLR�DMPKQ�MD�?QQGQR?LAC�@CAMKCQ�RMB?W�KMPC�CQQCLRG?J�RF?L�CTCP�@CDMPC�

The Commission acknowledges the need to contribute to the CTGBCLAC�@?QC�ML�RFC�CȑAGCLAW�?LB�CȎCARGTCLCQQ�MD�T?PGMSQ�GLRCPTCLRGMLQ� RM�?BBPCQQ�SLBCPLSRPGRGML� R?IGLE� GLRM�?AAMSLR�RFC�BGTCPQGRW�MD�AMLRCVRQ��SP@?L�N?QRMP?J�?EPGASJRSP?J�?ASRC AFPMLGA� QGRS?RGMLQ� MD� BGQNJ?ACKCLR� CRA�� ?LB� RFC� LCCBQ� MD�QNCAGȏA�NMNSJ?RGML�EPMSNQ��UMKCL KCL��BGȎCPCLR�?EC�EPMSNQ��persons with disabilities; ethnic and other socio-cultural EPMSNQ�� CAMLMKGA?JJW� BGTCPQC� EPMSNQ�� 2FC� !MKKGQQGML�therefore continues supporting operational research on nutrition under the following conditions:

• Research is not the entry point for any operation - operations QFMSJB� @C� HSQRGȏCB� @W� FSK?LGR?PG?L� LCCBQ� ?LB� LMR� @W�research

• The context should allow for research to be conducted CȎCARGTCJW��RFC�PCQC?PAF�JMA?RGML�QFMSJB�@C�?AACQQG@JC�?LB�stable for the duration of the research period in order to CLQSPC�?BCOS?RC�OS?JGRW�MSRAMKCQ

• .?PRLCPQ�KSQR�@C�PSLLGLE�MLEMGLE�OS?JGRW�MNCP?RGMLQ�GL�RFC�NPMNMQCB�NPMHCAR�?PC?�?LB�F?TC�RFC�RCAFLGA?J�CVNCPRGQC�RF?R�is necessary in order to conduct any proposed research

• Partners’ research should respect international research QR?LB?PBQ�GLAJSBGLE�RFC�T?JGB?RGML�MD�PCQC?PAF�NPMRMAMJQ�@W�?L�GLRCPL?RGML?J�CRFGA?J�PCTGCU�@M?PB�?LB�GD�NMQQG@JC�@W�?�L?RGML?J�MLC�RFPMSEF�RFC�?NNPMNPG?RC�GLTMJTCKCLR�MD�JMA?J�?SRFMPGRGCQ�?LB�AMKKSLGRGCQ�

• Transparent documentation and dissemination of research ȏLBGLEQ�KSQR�@C�CLQSPCB�?R�?JJ�RGKCQ�

.ZBONBS��6SHFOU�IVNBOJUBSJBO�OFFET�JO�3BLIJOF�4UBUF�

.BSLFU�JO�,BUJ�EJTUSJDU �.BMJ�

2FC� !MKKGQQGML� QSNNMPRQ� AMKNPCFCLQGTC� JGDC�Q?TGLE� LSRPG-RGML�QRP?RCEGCQ�RM�?BBPCQQ�CKCPECLAW�JCTCJQ�MD�SLBCPLSRPGRGML��2FCQC�GLAJSBC�GLRCPTCLRGMLQ�RF?R�F?TC�@CCL�BCKMLQRP?RCB�RM�@C�CȎCARGTC�?LB�CȑAGCLR� GL�R?AIJGLE�@MRF�KMBCP?RC�?LB�QC-TCPC� ?ASRC� SLBCPLSRPGRGML� ?Q�UCJJ� ?Q� QNCAGȏA�KGAPMLSRPGCLR�BCȏAGCLAGCQ��

-RFCP� NPMEP?KKCQ� ?PC� PCOSGPCB� RM� ?BBPCQQ� RFC� GKKCBG?RC�and underlying causes of undernutrition (see Conceptual framework), which also help to create the foundations and CL?@JGLE�CLTGPMLKCLR�RF?R�?PC�LCACQQ?PW�GL�MPBCP�RM�QSQR?GL�LSRPGRGML?J�E?GLQ�MTCP�RGKC��2FCQC� GLAJSBC� GLRCPTCLRGMLQ�RF?R�F?TC� @CCL� BCKMLQRP?RCB� RM� @C� CȎCARGTC� ?R� ?BBPCQQGLE� RFC�SLBCPJWGLE�A?SQCQ�MD�SLBCPLSRPGRGML�QSAF�?Q�GKNPMTGLE�?AACQQ�RM�Q?DC�U?RCP�?LB�GKNPMTGLE�FMSQCFMJB�DMMB�QCASPGRW�RFPMSEF�?EPGASJRSPC�?LB�JGTCQRMAI�GLRCPTCLRGMLQ��

5.1 Health and Nutrition

5.1.1 Management of moderate and severe acute undernutrition

Where indicated by an assessment of needs, and where not AMTCPCB�@W�CVGQRGLE�FC?JRF�NPMTGQGML� GR�A?L�@C�LCACQQ?PW� RM�QNCAGȏA?JJW� GLRCPTCLC� GL� RFC�K?L?ECKCLR� MD�KMBCP?RC� ?LB�QCTCPC�?ASRC�SLBCPLSRPGRGML� DMP� RFC�KMQR� TSJLCP?@JC� �ECLC-P?JJW�AFGJBPCL�SLBCP�ȏTC�?LB�NPCEL?LR�?LB�J?AR?RGLE�UMKCL��


��.PMEP?KK?RGA�PCQNMLQCQ

Operational Case Study - /JHFS��j$PTU�PG�%JFUz��BO�analytical tool to inform nutrition interventions*O�.BZ�� 4BWF�UIF�$IJMESFO�6,�4$�6,�DPOEVDUFE�B�j$PTU�PG�UIF�%JFU�$P%�BTTFTT-NFOUz�JO�UIF�;JOEFS�3FHJPO�PG�TPVUIFSO�/J-ger. The aim was to better understand the underlying economic causes of malnutrition.5IF�$P%�BOBMZUJDBM�UPPM �EFWFMPQFE�CZ�4$�6,�with support from the Commission, is de-signed to calculate the cost of the cheapest diet that meets the nutritional requirements of families and exclusively contains local-MZ� BWBJMBCMF� GPPE�� 5IF�$P%� DPNCJOFT�EBUB�on food prices, consumption, and availabi-lity with information from interviews with household members about their eating ha-bits and lifestyle. It can be used to estimate the proportion of households in a region that BSF�VOBCMF�UP�BҧPSE�B�OVUSJUJPVT�EJFU �BT�XFMM�BT�UIF�TJ[F�PG�UIF�HBQ�CFUXFFO�DVSSFOU�JO-come and the amount of money needed to meet the needs of a household.In Zinder, nutritious food was available in UIF�NBSLFU��$P%�BOBMZTJT� GPVOE �IPXFWFS �that during the lean season, the minimum cost of this diet is far beyond the income levels of poor households. By identifying UIF� TJ[F� PG� UIJT� JODPNF� HBQ � 4$� 6,� BOE�other partners could tailor programming accordingly (for example, through cash and voucher assistance).Lesson learnt: 5IFSF� JT�OP� jPOF�TJ[F�ҨUT�BMMz�BOTXFS�UP�B�TQFDJҨD�TJUVBUJPO�PG�VOEFS-OVUSJUJPO�JO�BOZ�HJWFO�FNFSHFODZ��%FQFOEJOH�on the social and economic situation of a household, the functioning of the market, the livelihood assets and the level of resilience, humanitarian interventions for nutrition can WBSZ��5IF�$P%�UPPM�DBO�CF�WFSZ�VTFGVM�GPS�VO-EFSTUBOEJOH�UIF�EJҪDVMUJFT�PG�DSJTJT�BҧFDUFE�households in accessing nutritious food, and particularly for the promotion of IYCF prac-tices for children older than 6 months based PO� BQQSPQSJBUF� DPNQMFNFOUBSZ� GPPETUVҧ�that is available at local markets.

Niger, Tolkobey village - May 2012.



��.PMEP?KK?RGA�PCQNMLQCQ Strategies to manage acute undernutrition in crisis contexts KSQR�@C�AJMQCJW� JGLICB� RM�CȎMPRQ� RM�NPMKMRC� RFC�LSRPGRGML?J�QCASPGRW�MD�RFC�CLRGPC�CKCPECLAW�?ȎCARCB�NMNSJ?RGML��

2FC� AFMGAC� MD� GLRCPTCLRGML� BCNCLBQ� ML� RFC� NPCT?JCLAC� MD�?ASRC�SLBCPLSRPGRGML��KMBCP?RC�?LB�QCTCPC��?LW�?EEP?T?RGLE�factors, the local context and the dynamic of the crisis (particularly in terms of the possi-@GJGRW�RM�E?GL�?AACQQ�RM�?ȎCARCB�EPMSNQ��2FC�!MKKGQQGML�CKNF?QGQCQ�RFC�PCJCT?LAC�MD��

• Early detection of acute undernutrition at RFC� AMKKSLGRW� JCTCJ� ?LB� GLRCLQGTC� A?QC�ȏLBGLE�RFPMSEF�AMKKSLGRW�KM@GJGQ?RGML�

•� .PMTGQGML�MD�MSRN?RGCLR� RPC?RKCLR� DMP� GL-BGTGBS?JQ� QSȎCPGLE� DPMK� QCTCPC� ?ASRC�undernutrition without medical complica-RGMLQ��2FC�A?QCJM?B�MD�1�+�UGRFMSR�AMK-NJGA?RGMLQ� GQ� CQRGK?RCB� RM� @C� ��Ϥ� MD� RFC� RMR?J� 1�+�caseload;

•� $?AGJGRW�@?QCB�RPC?RKCLR�MD�GLBGTGBS?JQ�QSȎCPGLE�DPMK�1�+�with medical complications (estimated at 10-20% of to-R?J�1�+�A?QCJM?B��2FGQ�KGEFR� GLAJSBC�RFCP?NCSRGA� DCCBGLE�centres, hospitals or stabilisation centres; appropriate iden-RGȏA?RGML�MD�KCBGA?J� AMKNJGA?RGMLQ�?LB�?AACQQ� RM� RFC�?N-NPMNPG?RC��JGDCQ?TGLE��RPC?RKCLR��?LB�?NNPMNPG?RC�DMJJMU�SN�?ȓCP� PCDCPP?J� ?LB� ?ȓCP� BGQAF?PEC� N?PRGASJ?PJW� GL� RFC�K?-L?ECKCLR� MD� QCTCPC� ?ASRC� K?JLSRPGRGML� �?R� QR?@GJGQ?RGML�centres and through outpatient programmes);

Burundi Nutrition.

“ Strategies to manage acute undernutrition in crisis contexts must

CF�DMPTFMZ�MJOLFE�UP�FҧPSUT�UP�QSPNPUF�the nutritional security of the entire

FNFSHFODZ�BҧFDUFE�QPQVMBUJPO��

• Supplementary Feeding Programmes treating those with moderate acute undernutrition;

•� !MLAMKGR?LR�?AACQQ�RM�DPCC�FC?JRFA?PC��

2FC� !MKKGQQGML� UCJAMKCQ� RFC� ?BT?LACQ� K?BC� GL� PCACLR�years through the introduction and scaling up of community @?QCB�?NNPM?AFCQ�DMP�!+�+��2FC�!MKKGQQGML�N?PRGASJ?PJW�PC-AMELGQCQ�RFC�T?JSC�MD�PC?BW�RM�SQC�RFCP?NCSRGA�DMMBQ�UFGAF�F?TC� @CCL� GLRCEP?J� RM� RFC� QSAACQQ� MD� RFGQ� ?NNPM?AF�� !+�+�?GKQ�RM�NPMTGBC�CȎCARGTC�RPC?RKCLR�DMP�?JJ�AFGJBPCL�UGRF�@MRF�QCTCPC�?LB�KMBCP?RC�?ASRC�SLBCPLSRPGRGML�@W�BCACLRP?JGQGLE�RPC?RKCLR� LC?PCP� RM� RFMQC� RF?R� LCCB� GR� PCKMTGLE� RFC� LCCB�for long inpatient stays and stimulating understanding and engagement of the target population around acute undernu-

A d d r e s s i n g U n d e r n u t r i t i o n i n E m e r g e n c i e s A d d r e s s i n g U n d e r n u t r i t i o n i n E m e r g e n c i e s��

Operational Case Study - Ethiopia: Strengthening of the capacity of UIF�.JOJTUSZ�PG�)FBMUI�GPS�NPSF�FҧFDUJWF�IVNBOJUBSJBO�SFTQPOTF�BOE�improved resilience&UIJPQJB�IBT�POF�PG�UIF�IJHIFTU�VOEFS�ҨWF�NPSUBMJUZ�rates in the world and is chronically vulnerable to food and nutrition crises.

*O� �� B� XJEFTQSFBE� GPPE� BOE� OVUSJUJPO� DSJTJT�highlighted the low capacity of existing Therapeutic Feeding Centres for the treatment of severe acute malnutrition. This situation prompted the Ministry of Health (MoH) to begin working with partners to scale-up services dealing with nutrition across the country. The international non-governmental organi-[BUJPO�$PODFSO�8PSMEXJEF�MBVODIFE�B�QSPHSBNNF�UP�support the MoH in establishing adequate services to treat a large number of children with SAM du-ring ‘normal’ times. The intervention included the strengthening of capacities in order to enable these services to rapidly scale-up at times of crisis. The project aimed to mitigate delays in setting up new therapeutic programmes in response to crises.

The programme provided a package of ‘minimal support’ to the MoH, consisting of training, joint su-pervision, experience-sharing visits, workshops and community mobilisation assistance. In addition, sup-port was provided for the incorporation of CMAM into the National Nutrition Strategy and its guidelines.

*O� �� B� ESBNBUJD� JODSFBTF� JO� UIF� QSFWBMFODF� PG�SAM was recorded across two regions in Ethiopia, QSJNBSJMZ� EVF� UP� UIF� FҧFDUT� PG� ESPVHIU�� *O� NBOZ�districts the magnitude of caseloads overwhelmed treatment capacities. The MoH made the decision to decentralise CMAM services to primary healthcare posts through the employment of health extension

workers. This was rapidly achieved by mobilising support from a number of agencies (UNICEF, WHO, and NGOs). The results have been striking:

Ȍ�8JUIJO��NPOUIT ��IFBMUI�QPTUT��PG�UIF�EJT-USJDUT� JO� UIF� UXP�BҧFDUFE� SFHJPOT�XFSF�NBOBHJOH�outpatient therapeutic programmes (OTP), reaching PWFS�� DIJMESFO�XJUI�4".��5IF�SFTVMUT�GVMҨMMFE�Sphere standards. This prompted an acceleration PG�NBKPS�FҧPSUT�UP�TDBMF�VQ�$.".�BDSPTT�PUIFS�SF-gions.

• Extensive CMAM scaling-up has enabled increased access to information on SAM admissions in a considerable proportion of the country. Programme monitoring data increases the potential for huma-nitarian actors to respond in a timely manner to increases in the prevalence of SAM, rather than having to rely on the longer-term completion of OVUSJUJPO� TVSWFZT�� *O� .BSDI�"QSJM� �� $.".� SF-QPSUT� TIPXFE� B� �� JODSFBTF� JO� UIF� OVNCFS� PG�admissions, which led UNICEF and implementing partners to trigger a humanitarian response using DPOUJOHFODZ�SFTFSWF� GVOEJOH�XIJMF� EJTDVTTJPOT� GPS�additional support were still under way.

Lesson Learnt: This case highlights the gains as-sociated with a «system approach» where nutrition interventions in emergencies build on existing capa-city. This approach is only possible in the presence of an appropriate funding mechanism that promotes bridges between humanitarian and development in-terventions.


RPGRGML�� ?PPGCPQ�RM�?AACQQGLE�RPC?RKCLR�?PC�PCBSACB�?LB�C?PJW�BG?ELMQGQ�MD�RFC�AMLBGRGML�MAASPQ�KMPC�DPCOSCLRJW��#?PJW�BG?-ELMQGQ�MD�?ASRC�SLBCPLSRPGRGML�GL�AMK@GL?RGML�UGRF�CȎCARGTC�RPC?RKCLR�?R�RFC�AMKKSLGRW�JCTCJ�A?L�J?PECJW�PCBSAC�D?R?JGRW�P?RCQ�?LB�GLAPC?QC�AMTCP?EC�MD�RFC�?ȎCARCB�NMNSJ?RGML��

The burden of undernutrition in emergen-AGCQ� GQ� DCJR� GL� RCPKQ� MD� LSK@CPQ� ?ȎCARCB��KMPC� AFGJBPCL� F?TC� KMBCP?RC� ?ASRC� SL-dernutrition) and in terms of mortality (the PGQI�GQ�EPC?RCQR�DMP�RFMQC�UGRF�QCTCPC�?ASRC�SLBCPLSRPGRGML�� 2FC�K?L?ECKCLR� MD� ?ASRC�undernutrition, therefore, needs to consi-der strategies for MAM alongside those for 1�+�QM�RF?R�RFCPC�A?L�@C�AMFCPCLAC�?LB�QSQR?GLCB�NPMEPCQQ��Crucially, a multi-sectoral approach is necessary to address KMBCP?RC�?ASRC�K?JLSRPGRGML�C�E��RFPMSEF�FSK?LGR?PG?L�DMMB�?QQGQR?LAC�GKNPMTCB�?AACQQ�RM�FC?JRFA?PC�?LB�GKNPMTCB�?A-ACQQ�RM�Q?LGR?RGML�?LB�BPGLIGLE�U?RCP��

Infant and young child feeding in emergencies (IYCF-E) In the context of humanitarian assistance for nutrition, IYCF PCDCPQ�RM�?�P?LEC�MD�LSRPGRGML�?LB�A?PC�GLRCPTCLRGMLQ�RF?R�GK-NPMTC� AFGJB� QSPTGT?J� ?LB� EPMURF�� 2FCQC� GLAJSBC� ?NNPMNPG?RC�?LB� CTGBCLAC�@?QCB� QSNNMPR� DMP� �CVAJSQGTC�� @PC?QRDCCBGLE�?LB�AMSLQCJJGLE�DMPKSJ?�MP�CKCPECLAW�DCCBGLE�GLRCPTCLRGMLQ�

Operational Case Study - Myanmar: The experience of a young mother EVSJOH�UIF��DZDMPOF�BOE�TVCTFRVFOU�ҩPPET�

Jasmine’s mother was nearing the end of her pregnan-cy when the cyclone hit. She and her four boys were hit by the storm while they were at several days’ walk from her village. She sought refuge in a monastery where she NFU�B�XPNBO�XIP�IBE�UISFF�CPZT�PG�IFS�PXO �BMM�PWFS��years old. When they were forcibly evacuated from the monastery, Jasmine’s mother knew she was too close to giving birth to make the journey back to her village with her boys. So she stayed with the family she had met at the monastery. When Jasmine was born, weighing 2.5kg, IFS�NPUIFS�EFDJEFE�TIF�DPVME�OPU�DBSF�GPS�IFS�BOE�MFҬ�her with the family she had been staying with. Six weeks later, Jasmine weighed 2.3kg.

Breastfeeding counsellors were supporting Jasmine’s foster mother to re-lactate for about 10 days. She was JOTUSVDUFE�UP�QVU�+BTNJOF�UP�UIF�CSFBTU�BT�PҬFO�BT�TIF�could during the day (at least every 2 hours) and to allow her unrestricted access to the breast all night (the whole family slept on one mat under the only mosquito net in the house). The foster mother was also instructed in the preparation of powdered infant formula and cup feeding.

She was told to feed Jasmine enough formula to satisfy IFS� BCPVU��PS��UJNFT�B�EBZ�BOE�UP�ESJOL�BOZ� MFҬP-vers herself or give it to one of the boys. When Jasmine was observed breastfeeding, it was evident that she was USBOTGFSSJOH�NJML�GSPN�UIF�CSFBTU�FҧFDUJWFMZ�BDUJWF�SPP-ting followed by long slow sucks, big swallows, relaxed expression, hand becoming more open through the feed, BOE�TMFFQZ�BҬFS� UIF�GFFE��)FS�CPXFM�NPWFNFOUT�BMTP�JOEJDBUFE�UIBU�TIF�XBT�HFUUJOH�B�TJHOJҨDBOU�BNPVOU�PG�breast-milk. From that point, Jasmine’s foster mother XBT�JOTUSVDUFE�UP�SFEVDF�UIF�OVNCFS�PG�UJNFT�TIF�PҧF-red her formula during the day. Under two weeks later, +BTNJOFȅT� GPTUFS�NPUIFS�TUPQQFE�PҧFSJOH�GPSNVMB�NJML�altogether. Jasmine is now exclusively breastfed, and has regained and exceeded her birth weight.

Lesson learnt: this example demonstrates the im-portance of prioritising IYCF-E. Through expert and de-dicated support, vulnerable infants can be prevented from deteriorating nutrition situations to the extent where therapeutic feeding would be required.

“ The burden of undernutrition in emergencies is felt in terms of

OVNCFST�BҧFDUFE�<Ȏ>�BOE�JO�UFSNT�PG�mortality.

UFCL�LCACQQ?PW�LSRPGCLR�BCLQC�AMKNJCKCLR?PW�DCCBGLE�GLRCPTCLRGMLQ�DMP�AFGJBPCL��KMLRFQ�QSNNMPR�DMP�GKNPMTCB�A?PC�NP?ARGACQ�AFGJB�BCTCJMNKCLR�?LB�AFGJB�NPM-RCARGML��'L�KMPC�ECLCP?J�RCPKQ�'7!$�AMTCPQ�K?RCPL?J�?LB�AFGJB�LSRPGRGML�GLAJSBGLE�RFC�K?L?ECKCLR�MD�?ASRC�SLBCPLSRPGRGML� GL� GLD?LRQ�� 1NCAG?J� ?RRCLRGML� QFMSJB�@C�paid to address any cultural practices surrounding breastfeeding and feeding that K?W�BGQAPGKGL?RC�EGPJQ�

2FC�!MKKGQQGML�QCCIQ�RM�SNFMJB�RFC�NPMTGQGMLQ�MD�RFC�'LRCPL?RGML?J�!MBC�MD�+?P-ICRGLE�MD� PC?QR�KGJI�1S@QRGRSRCQ�?LB�QS@QCOSCLR�PCJCT?LR�5&-�0CQMJSRGMLQ��?LB�PCOSGPCQ� GRQ�N?PRLCPQ�RM�SNFMJB�RFC�Q?KC�QR?LB?PBQ�� 'L?NNPMNPG?RC� GL�IGLB�BML?-tions (such as infant formula, powdered milk or bottles and teats) are discouraged by the Commission, in accordance with the Operational Guidance on IYCF-E and the 'LRCPL?RGML?J�!MBC�ML�RFC�+?PICRGLE�MD� PC?QR�KGJI�1S@QRGRSRCQ�

'L�?�FSK?LGR?PG?L�APGQGQ�MRFCP�JCQQ�PCAMELGQCB�GLȐSCLACQ�ML�'7!$�NP?ARGACQ�KSQR�@C�?BBPCQQCB�GLAJSBGLE�QCASPGRW�NPGT?AW�?LB�QFCJRCP�DMP�KMRFCPQ��2FC�NQWAFMQM-cial components of nutrition (including the psychological, emotional and social dimensions of a child and mother’s health and well-being) are of crucial impor-R?LAC� ?Q� RFCW� A?L� F?TC� ?� AMLQGBCP?@JC� GKN?AR� ML� LSRPGRGML?J� QR?RSQ�� ,SRPGRGML�has extremely close links with care practices and a child’s nutritional status is MȓCL�BCRCPKGLCB�?Q�KSAF�@W�DCCBGLE�NP?ARGACQ�FMKC�CLTGPMLKCLR�?LB�RFC�?R-RCLRGML�PCACGTCB�DPMK�NPGK?PW�A?PCR?ICP�?Q�@W�RFC�DMMB�AMLQSKCB��#TGBCLAC�?JQM�indicates that inclusion of psychosocial stimulation for mothers and children in NPMEP?KKCQ�DMP�RFC�RPC?RKCLR�MD�SLBCPLSRPGRGML�A?L� GKNPMTC�JMLE�RCPK�FC?JRF�?LB�BCTCJMNKCLR�MD�AFGJBPCL��

2FC� PCACLR� PCTGCU� MD� RFC� +?L?ECKCLR�of Acute Malnutrition in Infants (MAMI)27 AMLȏPKQ�RF?R�?�FGEF�NPCT?JCLAC�MD�U?QRGLE�GL� GLD?LRQ� @CJMU��KMLRFQ� MD� ?EC� GQ� ?� NS-@JGA�FC?JRF�NPM@JCK�PCOSGPGLE�?�FSK?LGR?PG?L�PCQNMLQC��2FCPC�GQ�?L�SPECLR�LCCB�RM�GLAPC?QC�our knowledge on how to diagnose acute un-BCPLSRPGRGML� GL� RFGQ� ?EC� EPMSN� GKNPMTC� SL-BCPQR?LBGLE� MD� A?SQCQ� ?LB� AMLQCOSCLACQ�?LB� GKNPMTC� GLRCPTCLRGMLQ� RM� RPC?R� GR��+MPC�QNCAGȏA?JJW� RFCPC� GQ� ?� LCCB� RM� CVNJMPC� RFC�

modalities, costs and impact of integrating IYCF support in CMAM programmes, ?LB� GLRCPTCLRGMLQ�?BBPCQQGLE�?ASRC�SLBCPLSRPGRGML� GL� GLD?LRQ�LCCB�RM�@C�SNB?RCB�RFPMSEF�GLLMT?RGML�PCQC?PAF�?LB�RFC�AMLQGBCP?RGMLQ�MD�N?QR�JCQQMLQ��

Acute undernutrition in adolescents and adults�JRFMSEF�RFC�K?L?ECKCLR�MD�?ASRC�SLBCPLSRPGRGML�GL�AFGJBPCL�SLBCP�ȏTC�WC?PQ�MD�?EC�F?Q�GKNPMTCB�AMLQGBCP?@JW�GL�RFC�J?QR�BCA?BC�RFCPC�?PC�QRGJJ�E?NQ�GL�CTGBCLAC�AMLACP-LGLE� RFC� RPC?RKCLR� MD� ?ASRC� SLBCPLSRPGRGML� GL� ?BMJCQACLRQ� ?LB� ?BSJRQ�� #VNCPGCLAC�QFMUQ�RF?R�RFC�QNCAGȏA�LSRPGRGML?J�LCCBQ�MD�?BMJCQACLRQ�?LB�?BSJRQ�PCOSGPC�?B?NRCB�JGDC�Q?TGLE�QRP?RCEGCQ�@CWMLB�DMMB�?QQGQR?LAC��'R�GQ�RFCPCDMPC�GKNCP?RGTC�RF?R�SLBCP-LMSPGQFCB�?BMJCQACLRQ�?LB�?BSJRQ�F?TC�?AACQQ�RM�?NNPMNPG?RC�RPC?RKCLR�?LB�QSNNMPR��


��/BIBS��#� �)BNBEBOJ �+�%� �"INFE �5� �5PGBJM �'��3BINBO �"��)VEB��4�/��FU�BM��&ҧFDUT�PG�QTZDIPTPDJBM�TUJNVMBUJPO�PO�growth and development of severely malnourished children in a nutrition unit in Bangladesh. European Journal of clinical nutrition; 4FQUFNCFS��

��.BOBHFNFOU�PG�"DVUF�.BMOVUSJUJPO�JO�*OGBOUT�.".*�1SPKFDU�DPNNJTTJPOFE�CZ�UIF�(MPCBM�/VUSJUJPO�$MVTUFS��4VNNBSZ�3FQPSU��&//��0DUPCFS��

“ Experience shows that UIF�TQFDJҨD�OVUSJUJPOBM�OFFET�PG�adolescents and adults require adapted life-saving strategies beyond food assistance.


��8PNFO�BSF�UIF�QSJNBSZ�DBSFST�PG�DIJMESFO�BOE�UIF�NBJO�EFDJTJPO�NBLFST�XJUI�SFHBSET�UP�UIFJS�DIJMESFOȅT�EJFUBSZ�DPOTVNQUJPO��Women’s education and status in society are directly linked to the nutritional status of the children in their care.

��4FF�UBCMF��JO��#MBDL �3�&��FU�BM �GPS�UIF�.BUFSOBM�BOE�$IJME�6OEFSOVUSJUJPO�4UVEZ�(SPVQ��-BODFU��

��4FF�8)0�'"0��IUUQ��XXX�XIP�JOU�OVUSJUJPO�QVCMJDBUJPOT�NJDSPOVUSJFOUT��FO��BOE�8)0��IUUQ��XXX�XIP�JOU�OVUSJUJPO�QVCMJDBUJPOT�NJDSPOVUSJFOUT�XIFBU@NBJ[F@GPSUJҨDBUJPO�FO�

��4FF�8)0��IUUQ��XXX�XIP�JOU�NBLJOH@QSFHOBODZ@TBGFS�QVCMJDBUJPOT�4UBOEBSET��/�QEG

��4FF�8)0�8'1�6/*$&'��IUUQ��XXX�XIP�JOU�OVUSJUJPO�QVCMJDBUJPOT�NJDSPOVUSJFOUT�8)0@8'1@6/*$&'TUBUFNFOU�QEG

5MKCL�?LB�?BMJCQACLR�EGPJQ�A?L�@C�N?PRGASJ?PJW�TSJLCP?@JC�BSC�RM�RFCGP�NPMBSARGTC�PCNPMBSARGTC�?LB�QMAG?J�PMJCQ�� Undernutrition in women contributes to maternal deaths and is directly related to faltering nutritional status and growth retarda-RGML�GL�AFGJBPCL��+?RCPL?J�SLBCPLSRPGRGML�GQ�?JQM�JGLICB�RM�JMU�@GPRF�UCGEFR�UFGAF�GL�turn results in higher infant morbidity and mortality as well as long-term disability ?LB� AFPMLGA� GJJLCQQ�� 2FC� !MKKGQQGML� RFCPCDMPC� CLAMSP?ECQ� QWQRCK?RGA� ?RRCLRGML�RM� GLRCPTCLRGMLQ� RF?R�?BBPCQQ�SLBCPLSRPGRGML�?KMLE�UMKCL� GL� PCNPMBSARGTC�?EC�particularly during pregnancy and lactation in the framework of all humanitarian AMLRCVRQ�?LB�AJMQCJW�KMLGRMPQ�RFC�OS?JGRW�MD�RFC�UMPI�MD�RFMQC�N?PRLCPQ�UFMQC�UMPI�F?Q�?�QNCAGȏA�GKN?AR�ML�RFGQ�EPMSN��

2FC�!MKKGQQGML�?JQM�CLQSPCQ�RF?R�RFC�QNCAG?J�LCCBQ�MD�MRFCP�QNCAGȏA�EPMSNQ�UGRFGL�GRQ�@CLCȏAG?PW�A?QCJM?B��C�E��BGQ?@JCB�CJBCPJW�AFPMLGA?JJW�GJJ��?PC�GLRCEP?RCB�GLRM�RFC�BCQGEL�MD�FSK?LGR?PG?L�LSRPGRGML�PCQNMLQCQ�

��*>K>DBJBKQ�LC�JF@OLKRQOFBKQ�ABȎ@FBK@FBP��*+!��

2FC�!MKKGQQGML�?AILMUJCBECQ�RFC�EPMUGLE�GLRCPL?RGML?J�CTGBCLAC�E?RFCPCB�GL�PCACLR�WC?PQ�GL�PCJ?RGML�RM�+,"�?LB�RFCGP�QNCAGȏA�GKN?AR�ML�AFGJBPCL�Q�KMP@G-BGRW�KMPR?JGRW�?LB�AMELGRGTC�BCTCJMNKCLR��-TCP��Ϥ�MD�BC?RFQ�?KMLE�AFGJBPCL�SLBCP�ȏTC�WC?PQ�MD�?EC�?PC�?RRPG@SRCB�RM�BCȏAGCLAGCQ�GL�4GR?KGL��XGLA�GPML�?LB�GMBGLC�29

On the basis of assessed needs, the Commission therefore supports nutrition QRP?RCEGCQ�RM�@MRF�RPC?R�?LB�NPCTCLR�+,"�BSPGLE�CKCPECLAGCQ��2FC�AMK@GL?RGML�MD�PCQNMLQC�MNRGMLQ�?BMNRCB�BCNCLBQ�ML�RFC�JCTCJ�?LB�QCTCPGRW�MD�RFC�NPM@JCK�

•� .PMTGQGML�MD�DPCQF�DMMB�GRCKQ�RF?R�?PC�AMKNJCKCLR?PW�RM�?�ECLCP?J�DMMB�P?RGML��C�E��RFPMSEF�DPCQF�DMMB�TMSAFCPQ��

•� .PMTGQGML�MD� DMPRGȏCB� DMMB�?GB� AMKKMBGRGCQ30� QSAF�?Q� DMPRGȏCB� ACPC?J� !1 ��AMPL�QMW?�@JCLB��JGNGB�@?QCB�LSRPGCLR�QSNNJCKCLR�?LB�GMBGXCB�Q?JR�?LB MP�NMU-BCPQ�MP�QNPGLIJCQ�DMP�FMKC�DMPRGȏA?RGML�GL�RFC�ECLCP?J�P?RGML�

•� 1NCAG?J�?RRCLRGML�RM�RFC�OS?JGRW�MD�AMKNJCKCLR?PW�DCCBGLE�DMP�AFGJBPCL�SLBCP�RUM�years of age;

• Distribution of micronutrient supplements31�CGRFCP�?Q�QGLEJC�KGAPMLSRPGCLR��C�E��4G-R?KGL��DMP�AFGJBPCL�GPML DMJGA�?AGB�DMP�NPCEL?LR�UMKCL��MP�NMNSJ?RGML�JCTCJ�QSN-plementation32�GL�RFC�A?QC�MD�UGBCQNPC?B�BCȏAGCLAGCQ�MD�QNCAGȏA�KGAPMLSRPGCLRQ�QSAF�?Q�QASPTW� �TGR?KGL�!�BCȏAGCLAW��NCJJ?EP?� �LG?AGL�BCȏAGCLAW��?LB�@CPG�@CPG��TGR?KGL� �?LB�RFG?KGLC�BCȏAGCLAGCQ��

•� 'LRCEP?RGML� MD�KGAPMLSRPGCLRQ� GLRM� RFC� NPCTCLRGML� ?LB� RPC?RKCLR� MD� ACPR?GL� BG-QC?QCQ��8GLA�F?Q�@CCL�QFMUL�RM�@C�CȎCARGTC� GL�RFC�K?L?ECKCLR�MD�BG?PPFMC?J�BGQC?QCQ��NPCTCLRGML�MD�DSRSPC�CNGQMBCQ�?Q�UCJJ�?Q�PCBSARGML�GL�RFC�BSP?RGML�MD�ASPPCLR�CNGQMBCQ��UFGAF�GL�RSPL�A?L�F?TC�QCPGMSQ�LSRPGRGML?J�AMLQCOSCLACQ�

•� .PMTGQGML� MD� TGR?KGL�� ?JMLEQGBC� DMP� CV?KNJC�KC?QJCQ� T?AAGL?RGMLQ� A?L� FCJN�RM�NPMRCAR�AFGJBPCL�?E?GLQR� GLDCARGML��2FC�!MKKGQQGML�RFCPCDMPC�QSNNMPRQ� GLRCP-TCLRGMLQ�?GKCB�?R� GLAMPNMP?RGLE�XGLA�?LB�TGR?KGL�� GLRM�BCJGTCPW�MD�FC?JRFA?PC�

QCPTGACQ��C�E��RFPMSEF�RFC�NPMTGQGML�MD�XGLA�UGRF�JMU�MQKMJ?JGRW�MP?J�PCFWBP?RGML�Q?JRQ��-01��

5.1.3 Prevention of disease-related undernutrition

3LBCPLSRPGRGML�A?L�@C�A?SQCB�?LB�?EEP?T?RCB�@W�BGQC?QCQ�RFCPCDMPC�QSNNMPRGLE�DPCC�?AACQQ�RM�FC?JRFA?PC�?LB�NPMKMRGLE�?�FC?JRFW�CLTGPMLKCLR�GQ�?L�CQQCLRG?J�AMKNM-LCLR�MD�RFC�NPCTCLRGML�?LB�RPC?RKCLR�MD�?ASRC�SLBCPLSRPGRGML�2FC� QWLCPEGQRGA� PCJ?RGMLQFGN� @CRUCCL� SLBCPLSRPGRGML� KGAPMLSRPGCLR� BCȏAGCLAGCQ�?LB�T?PGMSQ� GLDCARGMSQ�?LB�N?P?QGRGA�BGQC?QCQ� GQ�UCJJ�ILMUL��GLAJSBGLE�BG?PPFMC?J�diseases, HIV/AIDS, tuberculosis, Leishmaniosis, intestinal helminthic infection, PCQNGP?RMPW�GLDCARGMLQ�K?J?PG?�?LB�KC?QJCQ��3LBCPLSRPGRGML�?LB�KGAPMLSRPGCLR�BC-

ȏAGCLAGCQ� D?AGJGR?RC� GLDCARGML� ?LB� QMKC� GL-fections may result, directly or indirectly, in RFC�BCTCJMNKCLR� MD� SLBCPLSRPGRGML�?LB�KG-APMLSRPGCLR�BCȏAGCLAGCQ��&MUCTCP�GL�RFC�ASP-rent programmatic structure of nutritional programmes, the importance of underlying BGQC?QCQ�GQ�MȓCL�SL?BBPCQQCB�

While tackling undernutrition in emergen-AGCQ�RFC�!MKKGQQGML�QCCIQ�RM�NPMTGBC�?BC-OS?RC� CKCPECLAW� FC?JRFA?PC� R?IGLE� GLRM�?AAMSLR�RFC�QNCAGȏA�LCCBQ�MD�AFGJBPCL�@CJMU�

ȏTC�WC?PQ�MD�?EC�?LB�RFCGP�KMRFCPQ�?Q�UCJJ�?Q�NPCEL?LR�UMKCL��2FCQC�GLRCPTCL-tions may include:

• De-worming as part of integrated child health programmes,•� .PCTCLRGML�?LB�C?PJW�RPC?RKCLR�MD�BG?PPFMC?J�BGQC?QCQ33 •� .PCTCLRGML�?LB�C?PJW�RPC?RKCLR�MD�KC?QJCQ�?LB�K?J?PG?�34

Access to (basic) primary healthcare should be safeguarded for those who are most TSJLCP?@JC�RM�SLBCPLSRPGRGML��AAMPBGLE�RM�RFC�!MKKGQQGML�Q�NMQGRGML�ML�SQCP�DCCQ35 GL�FSK?LGR?PG?L�QGRS?RGMLQ�FC?JRFA?PC�QFMSJB�@C�DPCC�?R�RFC�NJ?AC�MD�BCJGTCPW� GL�order to ensure, as much as it is possible, that access to healthcare is guaranteed RM�?JJ�NMRCLRG?J�@CLCȏAG?PGCQ��

The Commission seeks to ensure appropriate procurement (taking into account pro-BSAR�OS?JGRW�?LB�Q?DCRW��?LB�QRMP?EC�MD�RFC�LCACQQ?PW�KCBGA?J�?LB�LSRPGRGML?J�GLNSRQ�PCOSGPCB�RM�NPCTCLR�BGQC?QC�PCJ?RCB�SLBCPLSRPGRGML��0CEGML?J�NPCNMQGRGMLGLE�MD�CQQCLRG?J�supplies, or support to national emergency preparedness stocks can facilitate timely PCQNMLQCQ�GD�?NNPMNPG?RCJW�K?L?ECB�?LB�QSNNMPRCB�@W�PCJG?@JC�GLDMPK?RGML�QWQRCKQ��


��4FF�+PJOU�8)0�6/*$&'�4UBUFNFOU��IUUQ��XIRMJCEPD�XIP�JOU�IR��8)0@'$)@$")@��QEG�

��4FF�$PODMVTJPOT�BOE�SFDPNNFOEBUJPOT�PG�UIF�8)0�$POTVMUBUJPO�PO�QSFWFOUJPO�BOE�DPOUSPM�PG�JSPO�EFҨDJFODZ�JO�JOGBOUT�BOE�ZPVOH�DIJMESFO�JO�NBMBSJB�FOEFNJD�BSFBT�� DVSSFOUMZ�VOEFS�SFWJTJPO�IUUQ��XXX�XIP�JOU�OVUSJUJPO�QVCMJDBUJPOT�NJDSPOVUSJFOUT�'/#WPM��/�TVQEFD��QEG

��%(�&$)0�QPTJUJPO�QBQFS�PO�VTFS�GFFT�GPS�1SJNBSZ�)FBMUI�TFSWJDFT�JO�)VNBOJUBSJBO�DSJTFT �"QSJM��j*O�BO�FNFSHFODZ�DPOUFYU �%(�&$)0�XJMM�QSPNPUF�BDDFTT�UP�IFBMUIDBSF�GPS�BMM�BOE�JO�QBSUJDVMBS�GPS�UIF�QPPSFTU�BOE�UIPTF�JO�HSFBUFTU�OFFE�BOE�XJMM�EJTDPVSBHF�partners to apply any user fee system. If no alternative source of income is guaranteed for payment of salaries or the recurrent DPTUT�PS�GPS�SFQMFOJTINFOU�PG�ESVHT�PS�NFEJDBM�TVQQMJFT �%(�&$)0�IBT�UP�NBLF�B�XFMM�JOGPSNFE�DIPJDF�BOE�UP�DPOTJEFS�DPWFSJOH�UIF�ҨOBODJBM�HBQ��"OZ�DIPJDF�TIPVME�CF�CBTFE�PO�DPOTJEFSBUJPOT�PG�UIF�OBUJPOBM�BOE�QPMJUJDBM�DPOUFYU�BOE�UIF�QPTTJCMF�DPOTFRVFODFT�of abolishing user fees.»

“ Access to (basic) primary healthcare should be safeguarded for those who are most vulnerable to undernutrition.


5.2 Humanitarian Food Assistance and Nutrition

0CQNMLQC�MNRGMLQ�KSQR�@C�AMLRCVR�BPGTCL�?LB�AMSJB�GLAJSBC�

General Food Assistance:•� .PMTGQGML� MD� DPCC� A?QF� MP� TMSAFCPQ� �AMKKMBGRW�@?QCB� MP�T?JSC�@?QCB��BGQRPG@SRCB�ML�?�@J?LICR�@?QGQ�

• Distribution of free food commodities on a blanket basis �ECLCP?J� DMMB�BGQRPG@SRGMLQ�� GLAJSBGLE�RFC�NPMTGQGML�MD�?N-NPMNPG?RC�DMPRGȏCB�DMMB�GRCKQ�QSGR?@JC�DMP�WMSLE�AFGJBPCL�

Targeted Food Assistance:Targeted Food Assistance (TFA) aims at reaching the most food insecure households (regardless of whether General $MMB�"GQRPG@SRGML�GQ�SLBCP�U?W��2FCQC�GLRCPTCLRGMLQ�QF?JJ�@C�informed by a Household Economy Analysis (HEA):

•� .PMTGQGML� MD� R?PECRCB� DPCC� A?QF� MP� TMSAFCPQ� �AMKKM-BGRW�@?QCB�MP�T?JSC�@?QCB��

• Distribution of free food on a targeted basis (targeted food distributions);

•� "GQRPG@SRGML�MD�DMMB�A?QF�MP�TMSAFCPQ�ML�?�R?PECRCB�?LB MP�QCJD�R?PECRCB�@?QGQ�GL�CVAF?LEC�DMP�?�@CLCȏAG?PW�Q�RGKC�MP�J?@MSP��C�E��A?QF�DMP�UMPI�DMMB�DMP�UMPI�DMMB�DMP�RP?GLGLE�food for assets);

Operational case study - Niger: The role of cash transfers in reducing undernutrition in extremely poor households

4BWF� UIF� $IJMESFO� 6,� 4$� 6,� QJMPUFE� B� DBTI� USBOTGFS�social safety net programme in the Tessaoua district of /JHFSȅT�.BSBEJ�SFHJPO�JO��*O�DPMMBCPSBUJPO�XJUI�MP-DBM�BVUIPSJUJFT�BOE�XJUI�$PNNJTTJPO�GVOEJOH �4$�6,�BT-sisted 1500 of the poorest households to close the gap between the cost of food they needed to purchase and their income during the lean season.

#FOFҨDJBSJFT�XFSF�JEFOUJҨFE�PO�UIF�CBTJT�PG�B�)PVTFIPME�Economy Analysis (HEA) and wealth ranking. Special consideration was given to households that included widows, people with disabilities, and mothers and care-HJWFST�PG�DIJMESFO�VOEFS�ҨWF��"MM�CFOFҨDJBSJFT�MJWFE�JO�TF-verely food insecure areas. One woman in each of the families received direct cash assistance in three equal distributions, contingent upon their participation in un-dernutrition and public health awareness sessions.

4$�6,�NPOJUPSFE��IPVTFIPMET�UISFF�UJNFT��QSJPS� UP�UIF�QSPKFDU � POF�NPOUI�BҬFS� UIF�ҨSTU� DBTI�EJTUSJCVUJPO�BU� UIF�QFBL�PG� UIF�IVOHFS�HBQ �BOE�POF�NPOUI�BҬFS�UIF�ҨOBM�EJTUSJCVUJPO��3FTVMUT�TIPXFE�UIBU�DBTI�USBOTGFST�allowed the poorest households to meet their minimum food needs while enjoying a more diverse diet. The injec-

tion of cash into the community stimulated petty trade and increased local wage rates as people receiving the USBOTGFS�XPSLFE�JO�UIFJS�PXO�ҨFMET�SBUIFS�UIBO�DPNQFUJOH�for work as wage labourers.

$IJMESFO�VOEFS�ҨWF�XFSF�GPVOE�UP�IBWF�FYQFSJFODFE�BO�improvement in their nutritional status. This phenome-non, however, was not sustained throughout time. An explanation could be that cash transfers to families with ZPVOH�DIJMESFO�NBZ�CF�NPSF�FҧFDUJWF�JG�BDDPNQBOJFE�CZ�micronutrient supplements and disease prevention mea-sures as cash alone might not address the complexity of nutrition insecurity. Nonetheless, families were better able to meet their energy requirements and less likely to take loans or mortgage assets during the hunger gap if they received cash transfers.

Lessons learnt: Cash transfers potentially have a po-sitive impact on the stimulation of local markets and dietary diversity. However, they need to be accompanied CZ�TQFDJҨD�OVUSJUJPO�IFBMUI� JOUFSWFOUJPOT�UP�BEESFTT�UIF�complexity of nutrition security, with a particular focus on DIJMESFO�VOEFS�ҨWF�ZFBST�PG�BHF�

"�ҨTI�TFMMFS�QSFTFOUJOH�GPPE�WPVDIFS�

Bangladesh - November 2012.

J?LICR�QSNNJCKCLR?PW�DCCBGLE�BGQRPG@SRGML�?GKQ�?R�PC?AFGLE�the most nutrition insecure individuals (particularly young AFGJBPCL�NPCEL?LR�?LB�J?AR?RGLE�UMKCL��2FCQC�GLRCPTCLRGMLQ�QF?JJ�@C�GLDMPKCB�@W�QMSLB�LSRPGRGML�QSPTCGJJ?LAC�$MMB�QCASPGRW�?LB�JGTCJGFMMB�GLRCPTCLRGMLQ�?PC�NMRCLRG?JJW�CD-DCARGTC��GLQRPSKCLRQ�DMP�RFC�NPCTCLRGML�MD�SLBCPLSRPGRGML��?Q�MSRJGLCB�GL�RFC�AMLACNRS?J�DP?KCUMPI��

Where response analysis is appropriately performed, existing CTGBCLAC� QSEECQRQ� RF?R� A?QF� RP?LQDCPQ� A?L� F?TC� ?� NMQGRGTC�impact on dietary intake and therefore should be considered ?Q�?�ICW�RMMJ�GL�RFC�K?L?ECKCLR�MD�SLBCPLSRPGRGML��&MUCTCP�as is also the case with in-kind food aid, assessing the exact impact of these transfers on changes in nutritional status re-K?GLQ�?�AF?JJCLEC�37


Operational case study - Somalia: Emergency cash transfer and food vouchers programme

The 2011 drought in the Horn of Africa had a very se-rious impact on vulnerable people in Somalia, who were BMSFBEZ�BҧFDUFE�CZ�UIF�MPOH�MBTUJOH�XBS��0O��+VMZ �GPS�UIF�ҨSTU� UJNF� JO�BMNPTU��ZFBST � UIF�6OJUFE�/BUJPOT�PҪDJBMMZ�EFDMBSFE�UIF�QSFTFODF�PG�B�TJUVBUJPO�PG�GBNJOF�in two regions in the southern part of the country (IPC Phase 5). Children in Somalia continued to be caught up in chronic and recurrent malnutrition crises with a country-wide median Global Acute Malnutrition (GAM) consistently and considerably above the emergency threshold. To respond to the urgent needs of the most vulnerable population, UNICEF, with support provided CZ�UIF�$PNNJTTJPO �MBVODIFE�JUT�XJEFTU�FWFS�DBTI�WPV-cher programme in an emergency situation:

The programme targeted 360,000 people (60,000 IPVTFIPMET��UIF�EJSFDU�CFOFҨDJBSJFT�CFJOH�UIF�TFWFSFMZ�VOEFSOPVSJTIFE� DIJMESFO� VOEFS� ҨWF� ZFBST� PG� BHF� BOE�ESPVHIU�BҧFDUFE�GBNJMJFT�JO�4PVUIFSO�4PNBMJB��

The objective was to reduce to (at least) below the emergency threshold excess mortality caused by nutri-UJPOBM�EFҨDJFODJFT�

The intervention was based on the provision of nutritio-OBM�TVQQMJFT�BOE�UIF�EJTUSJCVUJPO�PG�DBTI�USBOTGFS�WPV-chers. UNICEF completed 6 rounds of distribution worth B�UPUBM�PG��NJMMJPO�64% �FBDI�NPOUIMZ�SPVOE�DPNQSJ-TJOH��64%�JO�WPVDIFST�BOE��64%�JO�DBTI�HJWFO�UP�

individual households.

Given the high volume of funds devoted to cash trans-GFS�WPVDIFST�BOE�UIF�OPWFMUZ�PG�DBTI�JOUFSWFOUJPOT �UIF�expectation in terms of results was very high:

"ҬFS�UISFF�DBTI�EJTUSJCVUJPOT �UIF�ҨSTU�TJHOT�PG�SFTJMJFODF�recovery could be seen; the improvement of the pur-chasing power of the very poor households targeted caused an increase in the purchasing of food, livestock and small business investments.

The positive nutrition impact of the intervention was evident: the number of meals per day increased (from 1 to 2 for adults and 1 to 3 for children) and dietary di-versity improved as well. Furthermore, between October 2011 and February 2012, SAM prevalence decreased GSPN��UP��

Lessons learnt: Overall, large-scale cash-based pro-gramming can be successful.

-BSHF�TDBMF �DPMMBCPSBUJWF�NPOJUPSJOH�DBO�CF�EPOF�BMTP�JO�DPNQMFY�DPOҩJDU�BҧFDUFE�FOWJSPONFOUT

'VODUJPOJOH �FҪDJFOU�NBSLFUT�BOE�UIF�)BXBMB�TZTUFN�(local Western Union) were key factors that allowed for the rapid impact of the intervention.

Common monitoring improved programming and the assessment of the overall impact

��#IVUUB�;��FU�BM��8IBU�XPSLT �*OUFSWFOUJPOT�GPS�NBUFSOBM�BOE�DIJME�VOEFSOVUSJUJPO�BOE�TVSWJWBM�� .BUFSOBM� BOE� $IJME� 6OEFSOVUSJUJPO� 4UVEZ� (SPVQ�� 5IF� -BODFU� �� Q��ȁ��IUUQ��XXX�UIFMBODFU�DPN�KPVSOBMT�MBODFU�BSUJDMF�1**4��GVMMUFYU

��#BJMFZ �4 �)FEMVO �,�� 5IF� JNQBDU�PG�DBTI�USBOTGFST�PO�OVUSJUJPO� JO�FNFSHFODZ�BOE�USBOTJUJPOBM�DPOUFYUT �IUUQ��XXX�PEJ�PSH�VL�SFTPVSDFT�EPDT��QEG

"�XPNBO�CFOFҨDJBSZ�PG�IVNBOJUBSJBO�BJE�JO�$PMPNCJB�


The Commission is committed to addressing this gap through: (i) the promotion of a QWQRCK?RGA�GLAJSQGML�MD�LSRPGRGML�PCJCT?LR�M@HCARGTCQ�?LB�GLBGA?RMPQ�GL�RFC�FSK?LGR?PG?L�food assistance operations it supports (including food security information systems); ?LB��GG��AMLQGBCP?RGML�MD�MNCP?RGML?J�PCQC?PAF�RF?R�AMLRPG@SRCQ�RM�RFC�AMJJCARGML�MD�CTG-BCLAC�ML�AMKN?P?RGTC�NCPDMPK?LAC�@CRUCCL�BGȎCPCLR�QRP?RCEGCQ�?LB�NPMBSARQ��'L�RFC�A?QC�MD��G��RFGQ�A?L�@C�?AFGCTCB�DMP�GLQR?LAC�RFPMSEF�?LRFPMNMKCRPGA�KC?QSPCKCLRQ�MP�BGCR?PW�BGTCPQGRW�GLBGACQ�?LB�DMMB�AMLQSKNRGML�QAMPCQ�

5FCPC�?BBPCQQGLE�SLBCPLSRPGRGML�GQ�?L�GKNMPR?LR�M@HCARGTC�MD�DMMB�QCASPGRW�GLRCP-TCLRGMLQ�RFC�!MKKGQQGML�QR?PRQ�GLRCPTCLGLE�GL�RFMQC�?PC?Q�UFCPC�RFC�NPCT?JCLAC�MD�?ASRC�SLBCPLSRPGRGML�GQ�FGEFCQR�

5GRF�PCE?PB�RM�RFC�K?L?ECKCLR�MD�+�+�RFC�PCOSGPCKCLR�DMP�CTGBCLAC�BCKMLQRP?-RGLE�RFC�AMKN?P?RGTC�?BT?LR?EC�MD�QNCAG?JGQCB�LSRPGRGML�NPMBSARQ��GLAJSBGLE�031$�?LB�GKNPMTCB�DMPRGȏCB�@JCLBCB�DMMB��PCK?GLQ�?�NPGMPGRW��'L�ECLCP?J�FMUCTCP�QSN-plementary food – as the name indicates – is meant to supplement an existing BGCR� �UFCL�QSAF�BGCR� GQ�BCȏAGCLR� GL�OS?LRGRW�?LB MP�OS?JGRW��?LB�RFCPCDMPC�?� RFM-PMSEF�QGRS?RGML�?L?JWQGQ�GQ�PCOSGPCB�RM�HSQRGDW�RFGQ�QNCAGȏA�AFMGAC�MD�PCQNMLQC��2FC�!MKKGQQGML�PCAMELGQCQ�RFC�NMRCLRG?J�CȎCARGTCLCQQ�RF?R� GKNPMTCB�DMPRGȏCB�?LB MP�LSRPGCLR�BCLQC�DMMB�NPMBSARQ�AMSJB�F?TC�ML�RFC�RPC?RKCLR�?LB�NPCTCLRGML�MD�?ASRC�SLBCPLSRPGRGML��&MUCTCP� RFC�!MKKGQQGML�CVAJSQGTCJW�QSNNMPRQ�RFC�SQC�MD�QNCAG?-JGQCB�LSRPGRGML?J�NPMBSARQ�UFCPC�QNCAGȏA�AMLBGRGMLQ�?PC�BCCKCB�RM�@C�?NNPMNPG?RC�?LB�SNML�AJMQC�KMLGRMPGLE�MD�RFCGP�CȎCARGTCLCQQ�?LB�GKN?AR��

Furthermore, it is recognised that supplementary feeding should under no circums-R?LACQ�AMKNCRC�UGRF�MP�AMKNPMKGQC�@PC?QRDCCBGLE��DMP�AFGJBPCL��KMLRFQ�CTCL�RFMSEF�LM�JMLECP�CVAJSQGTCJW�@PC?QRDCB��2FCPCDMPC�GR�GQ�GKNMPR?LR�RF?R�QSNNJCKCL-tary feeding is accompanied by measures aimed at promoting and monitoring the AMLRGLS?RGML�MD�@PC?QRDCCBGLE��

5.3 Water, Sanitation and Hygiene (WASH) and Nutrition

#LTGPMLKCLR?J�D?ARMPQ�A?L�@C�K?HMP�AMLRPG@SRMPQ�RM�RFC�MAASPPCLAC�?LB�QCTCPGRW�MD�SLBCPLSRPGRGML��*?AI�MD�Q?DC�U?RCP�NMMP�Q?LGR?RGML�?LB�GL?BCOS?RC�FWEGCLC�NP?A-RGACQ�?JJ�AMLRPG@SRC�RM�RFC�QNPC?B�MD�GLDCARGMSQ�BGQC?QCQ��Q�QSAF�RFCW�?PC�BGPCARJW�linked with faltering growth, lowered immunity and increased morbidity and mor-R?JGRW�39�2FC�!MKKGQQGML�RFCPCDMPC�NPMKMRCQ�RFC�GLAMPNMP?RGML�MD�LSRPGRGML�QNCAGȏA�M@HCARGTCQ�GLRM�5�1&�FSK?LGR?PG?L�PCQNMLQCQ�GL�APGQGQ�AMLRCVRQ�UFCPC�SLBCPLSRPG-RGML�GQ�?�K?HMP�FSK?LGR?PG?L�AMLACPL�40

'L�RFCQC�AMLRCVRQ�RFC�!MKKGQQGML�QSNNMPRQ�RFMQC�@?QGA�Q?LGR?RGML�?LB�@CF?TGMSP?J�AF?LEC�GLRCPTCLRGMLQ�RF?R�?PC�AMLQGBCPCB�RM�@C�CQQCLRG?J�DMP�RFC�APC?RGML�MD�?�Q?DC�CLTGPMLKCLR�41 These include:

��.JOJNVN�TUBOEBSEJTFE�NPOJUPSJOH�F�H��41)&3&�PS�OBUJPOBM�QSPUPDPMT��.JOJNVN�3FQPSUJOH�1BDLBHF�XXX�NSQ�TX�DPN�

��5IF�-BODFU�4FSJFT�JODMVEFT�IBOE�XBTIJOH�BOE�IZHJFOF�JOUFSWFOUJPOT�BNPOH�UIF�DPSF�NFBTVSFT�UIBU�SFEVDF�UIF�SJTL�PG�EJBS-rhoea. The hygiene and hand washing dimensions of food preparation are an important part of the ‘childcare’ component of nutri-UJPO�QSPHSBNNFT �FTQFDJBMMZ�JO�BSFBT�XIFSF�XBUFS�BOE�TBOJUBUJPO�BSF�QPPS��(VJEFMJOFT�PO�IBOE�XBTIJOH�BOE�IZHJFOF�BSF�BU��IUUQ��XXX�VOJDFG�PSH�XFT�JOEFY@��IUNM

��5IF�-BODFU�4FSJFT� JODMVEF�IBOE�XBTIJOH�BOE�IZHJFOF� JOUFSWFOUJPOT�BNPOH�UIF�DPSF�NFBTVSFT�UIBU�DBO�SFEVDF�UIF�SJTL�PG�diarrhoea. The hygiene and hand-washing dimensions of food preparation are an important part of the ‘childcare’ component of nutrition programmes, especially in areas where water and sanitation are poor. Guidelines on hand-washing and hygiene are at: IUUQ��XXX�VOJDFG�PSH�XFT�JOEFY@��IUNM��

��8)0�'"0��(VJEFMJOFT�PO�GPPE�GPSUJҨDBUJPO�XJUI�NJDSPOVUSJFOUT��"U��IUUQ��XXX�XIP�JOU�OVUSJUJPO�QVCMJDBUJPOT�HVJEF@GPPE@GPSUJҨDBUJPO@NJDSPOVUSJFOUT�QEG�

b� 5?RCP�QSNNJW�GLRCPTCLRGMLQ�?GKCB�?R�CLQSPGLE�RFC�NPMTGQGML�MD�?�AJC?L�?LB�Q?DC�U?RCP�QSNNJW�GL�QSȑAGCLR�OS?LRGRGCQ�?LB�GL�?�QFMPR�RGKCDP?KC�

b� 1?LGR?RGML�GLRCPTCLRGMLQ�DMASQGLE�ML�GKKCBG?RC�?LB�Q?DC�CV-APCR?�BGQNMQ?J��.PGMPGRW�GQ�EGTCL�RM�RFC�NPMRCARGML�MD�BPGLIGLE�water sources from possible contamination, particularly RFPMSEF�FSK?L�?LB�?LGK?J�CVAPCR?��

• Hygiene Promotion focusing on immediate actions that F?TC�RFC�EPC?RCQR�NMRCLRG?J�RM�PCBSAC�RFC�PGQI�?LB�QNPC?B�MD�CLTGPMLKCLR?J�FC?JRF�PCJ?RCB�MSR@PC?IQ��GL�N?PRGASJ?P�F?LB�U?QFGLE��

Where possible, these actions are designed and implemented GL�AMMPBGL?RGML�UGRF�?JJ�PCJCT?LR�QR?ICFMJBCPQ�GLAJSBGLE�AMK-KSLGRW�JC?BCPQ�?LB MP�PCNPCQCLR?RGTCQ�?LB�GL�?AAMPB�UGRF�JM-A?J L?RGML?J�?SRFMPGRGCQ��

#OS?J� N?PRGAGN?RGML� MD� KCL� ?LB� UMKCL� GL� NJ?LLGLE� BCAG-sion-making and local management of Emergency WASH operations helps to ensure that the entire population obtains Q?DC�?LB�C?QW�?AACQQ� RM�5�1&�QCPTGACQ�?LB� RF?R�?AACQQ� RM�RFCQC�QCPTGACQ�BMCQ�LMR�LCE?RGTCJW�GKN?AR�ML�RFC�LSRPGRGML?J�QR?RSQ�MD�TSJLCP?@JC�EPMSNQ�N?PRGASJ?PJW�UMKCL�?LB�AFGJBPCL��There are important gender dimensions related to WASH that UMSJB�LCCB� RM�@C� DSJJW� AMLQGBCPCB� QM�?Q� RM�NPCTCLR� AMLQC-OSCLACQ� RF?R� AMSJB� @C� BCRPGKCLR?J� RM� UMKCL�Q� �?LB� AFGJB-PCL�Q��UCJJ�@CGLE��1SAF�ECLBCP�?LB�LSRPGRGML�QCLQGRGTC�BCQGEL�supports, for instance, reduced burden and a shorter water


1BLJTUBO�ҩPPET�

&BTUFSO�$IBE��6OJWFSTBM�$IJMESFOȅT�%BZ�


“ There are important gender dimensions related to WASH that would need to be fully considered

so as to prevent consequences that could be detrimental to women’s (and

children’s) well-being.

42 - The humanitarian priority is that any user fee must be accompanied by a commitment to ensuring that the needs of the most vulnerable are covered and that no one shall be excluded from accessing WASH services.

AMJJCARGML�RGKC�DMP�UMKCL�?Q�UCJJ�?Q�GKNPMTCB�NPMRCARGML�DMP�UMKCL�?LB�WMSLE�girls to be attained through an appropriate design of WASH facilities in refugee or BGQNJ?ACKCLR�A?KNQ�

1NCAGȏA�KC?QSPCQ�RM�QRPCLERFCL�RFC�JGLI?EC�@CRUCCL�5�1&�?LB�LSRPGRGML�GLRCPTCL-RGMLQ�?LB�GKNPMTCB�LSRPGRGML�MSRAMKCQ�GLAJSBC�

• The promotion of a Minimum WASH Packages in health facilities (including mo-@GJC�AJGLGAQ��RM�GKNPMTC�RFC�FC?JRF�CLTGPMLKCLR�

• Ensured access to water for the poorest RFPMSEF�RFC�?TMGB?LAC�MD�SQCP�DCCQ�MP�DMP�CV?KNJC�RFC�NPMTGQGML�MD�A?QF�RP?LQDCPQ�RM�AMTCP�RFC�AMQRQ�?QQMAG?RCB�RM�KGLGKSK�JC-TCJQ�MD�AMLQSKNRGML�42

b� *?RPGLC�AMLQRPSARGML�QFMSJB�?TMGB� RFC� PGQI�MD� AMLR?KGL?RGML� @W� CLQSPGLE� ?BCOS?RC�distance from food preparation, drinking U?RCP� QRMP?EC� MD� SRCLQGJQ� CRA�� *?RPGLCQ�QFMSJB� @C� NPMNCPJW� AMLQRPSARCB� �C�E��AMLAPCRC�QJ?@��RM�NPCTCLR�FCJKGLRFGA�GLDCA-RGMLQ�

• The integration of nutrition awareness in hygiene promotion strategies;

b� �L?JWQGQ�MD�RFC�QGELGȏA?LAC�MD�U?RCP�QMSPACQ�DMP�JGTCJGFMMBQ�?LB�RFC�FMSQCFMJB�CAMLMKW�NPGMP�RM�GLRCPTCLRGMLQ�GL�MPBCP�RM�CQR?@JGQF�BPGLIGLE�U?RCP�QSNNJW�QCP-TGACQ�?LB�?TMGB�RCLQGMLQ�@CRUCCL�RFC�NMRCLRG?JJW�AMKNCRGLE�NPGMPGRGCQ�MD�BGȎCPCLR�groups;

• Harnessing humanitarian WASH operations as an opportunity for conditional cash MP�DMMB�RP?LQDCPQ�RFPMSEF�RFC�CLE?ECKCLR�MD�@CLCȏAG?PGCQ�GL�RFC�AMLQRPSARGML�MD�RFCGP�MUL�5�1&�QCPTGACQ�


5FGJC�GR�GQ�GKNMPR?LR�RF?R�NPC�CVGQRGLE�FGEF�JCTCJQ�MD�AFPMLGA�undernutrition are taken into account in the design of any emergency response, this alone does not generally grant the RPGEECPGLE�MD�FSK?LGR?PG?L�KCAF?LGQKQ� RM�NPMTGBC�LSRPGRGML�?QQGQR?LAC��'L�AMLRCVRQ�RF?R�?PC�AF?P?ARCPGQCB�@W�CGRFCP�AFPM-nic undernutrition (stunting) or persistently high rates of acute undernutrition (wasting), or both, a longer- term approach is PCOSGPCB� GL� MPBCP� RM� CLQSPC� NPCBGAR?@JC� DSLBGLE� KMB?JGRGCQ�?LB�AJMQC�AMMNCP?RGML�UGRF�L?RGML?J�EMTCPLKCLR�?SRFMPGRGCQ��

Understanding that such contexts are primarily the outcome of serious structural factors lying outside the scope of humanitarian ?QQGQR?LAC�GQ�CQQCLRG?J��&MUCTCP�GR�GQ�?JQM�APSAG?J�DMP�?JJ�?ARMPQ�GL-TMJTCB�RM�PCAMELGQC�RF?R�FGEF�JCTCJQ�MD�NCPQGQRCLR�SLBCPLSRPGRGML�imply an increased risk of morbidity and mortality and that the @SPBCL�MD�SLBCPLSRPGRGML�?QQMAG?RCB�UGRF�SLBCPBCTCJMNKCLR�GQ�D?P�EPC?RCP�RF?L�RFC�MLC�?QQMAG?RCB�UGRF�APGQCQ�MD�QFMPR�BSP?RGML�

This section of the paper discusses those aspects of nutrition APGQCQ�RF?R�?PC�@CQR�?BBPCQQCB�@W�AMK@GLGLE�GLRCPTCLRGMLQ�MD�FSK?LGR?PG?L�?LB�BCTCJMNKCLR�?ARMPQ�

6.1 Chronic undernutrition (stunting) in emergencies

�JRFMSEF�GR�GQ�PCAMELGQCB�RF?R�FGEF�JCTCJQ�MD�QRSLRGLE�A?L�JC?B�to an increased risk of morbidity and mortality, stunting is RFC� CȎCAR� MD� QSQR?GLCB� LSRPGRGML?J� BCȏAGR� ?LB� BCTCJMNKCLR�D?GJSPC�?LB�GR�GQ�LMR�@W�?BBPCQQGLE�GRQ�CȎCARQ�?JMLC�RF?R�RFC�NFCLMKCLML�A?L�@C�F?JRCB��!MLRP?QRGLE�QRSLRGLE�PCOSGPCQ�?�long-term approach, with predictable funding modalities and AJMQC�AMMNCP?RGML�UGRF�L?RGML?J�EMTCPLKCLR�?SRFMPGRGCQ��

&SK?LGR?PG?L�?QQGQR?LAC�DMP�LSRPGRGML�MȎCPQ�LM�AMKN?P?RGTC�?BT?LR?EC�GL�RFGQ�PCE?PB��2FCPCDMPC�RFC�!MKKGQQGML�GL�NPGL-ciple, does not resort to humanitarian assistance in order to ?BBPCQQ� AFPMLGA� SLBCPLSRPGRGML� ?LB� GLQRC?B� ?BTMA?RCQ� DMP�MRFCP�GLQRPSKCLRQ ?ARMPQ�RM�PCQNMLB�

��&SK?LGR?PG?L�?LB� � BCTCJMNKCLR�?ARMPQ�� shared concerns

#VSNB�.ZBONBS��8B�4UBUF�



��&SK?LGR?PG?L�?LB� � BCTCJMNKCLR�?ARMPQ�� shared concerns

�JRFMSEF�LMR�HSQRGDWGLE�?L�CKCPECLAW�PCQNMLQC�NPC�CVGQRGLE�FGEF�JCTCJQ�MD�AFPMLGA�undernutrition are taken into account in the design of responses, as they can indi-A?RC�RFC�TSJLCP?@GJGRW�MD�?LW�EGTCL�NMNSJ?RGML��

6.2 HIV/AIDS

&'4�GLDCARGML�A?L�A?SQC�LSRPGRGML?J�BCȏAGCLAGCQ�GL�RFC�DMPK�MD�PCBSACB�GLR?IC�FGEFCP�KCR?@MJGA�LCCBQ�?LB�GKN?GPCB�LSRPGCLR�SQC��.MMP�LSRPGRGML?J�QR?RSQ�K?W�?AACJCP?RC�the progression towards AIDS-related illness, undermine the use of and response RM�?LRGPCRPMTGP?J� RFCP?NW�?LB�CV?ACP@?RC� RFC� QMAGMCAMLMKGA� GKN?AR�MD� RFC�TGPSQ��2FGQ� GL� RSPL�K?W�F?TC�CTCL�@PM?BCP� GKN?ARQ�?Q�&'4� GLDCARGML�PCBSACQ�CAMLMKGA�NPMBSARGTGRW�?LB�RFSQ�DMMB�QCASPGRW��

2FC�!MKKGQQGML�PCAMELGQCQ�RFC�NMQGRGTC�GKN?AR�RF?R�?BCOS?RC�DMMB�?LB�LSRPGRGML�A?L� F?TC� ML� RFC� K?L?ECKCLR� MD� &'4� ?LB��'"1�43�&'4�GLDCARCB�AFGJBPCL�PCOSGPC�QNCAG?J�attention to secure their additional needs DMP�EPMURF�?LB�BCTCJMNKCLR�GL�JGLC�UGRF�RFC�5&-�ESGBCJGLCQ�44

In accordance with its guidelines on support RM� NCMNJC� JGTGLE� UGRF� &'4 �'"145 in huma-nitarian situations, when nutrition or food APGQCQ� MAASP� GL� ?PC?Q�UGRF�FGEF�NPCT?JCLAC�of HIV/AIDS, the Commission considers expanding its nutrition support to HIV/�'"1�?ȎCARCB�NCPQMLQ��RFPMSEF�?B?NRCB�LSRPGRGML�GLRCPTCLRGMLQ�MP�RFPMSEF�DMMB�QSNNJCKCLRQ�GL�AMLHSLARGML�UGRF�?LRG�PCRPMTGP?J�RPC?RKCLR��2FC�CLRPW�NMGLR�DMP�RFC�FSK?LGR?PG?L�?QQGQR?LAC�DMP�LSRPGRGML�FMUCTCP�KSQR�@C�RFC�RFPC?R�MP�NPCQCLAC�MD�?�DMMB�MP�LSRPGRGML�APGQCQ�?LB�LMR�RFC�NPCT?JCLAC�MD�AFPMLGA�GJJLCQQ�UGRF�LSRPGRGML?J�GKNJGA?RGMLQ�

6.3 Coherence, Coordination and Complementarity

�� CGLE�KMPC�CȎCARGTC� GL� AMMPBGL?RGLE�FSK?LGR?PG?L�?LB�BCTCJMN-ment aid: steps towards Resilience

In line with the new political framework on resilience and the Commission Com-munication on Resilience,�� the Commission stresses the need to maximise sustai-L?@JC� GLRCP�QCARMP?J�KSJRG�QR?ICFMJBCP�QSNNMPR� RM�SLBCPLSRPGRGML�MTCP� RFC� JMLECP�RCPK�?LB�RM�?TMGB�RFC�GQMJ?RGML�MD�CȎMPRQ�UGRFGL�FSK?LGR?PG?L�PCQNMLQC�UGRF�RFC�?GK�MD�QRPCLERFCLGLE�RFC�PCQGJGCLAC�MD�RFC�KMQR�TSJLCP?@JC�AMKKSLGRGCQ�

'L� N?PRGASJ?P� UFGJC� PCQNCARGLE� RFC� BGȎCPCLAC� GL� NPGLAGNJCQ� ?LB� M@HCARGTCQ� RFGQ�

“ The Commission stresses the need to maximise […] and to

BWPJE�UIF�JTPMBUJPO�PG�FҧPSUT�XJUIJO�humanitarian response.

��5IF��6/�(FOFSBM�"TTFNCMZ�4QFDJBM�4FTTJPO�%FDMBSBUJPO�PG�$PNNJUNFOU�PO�)*7�"*%4�BOE�UIF��1PMJUJDBM�%FDMBSBUJPO�PO�)*7�"*%4 �SFDPHOJTF�UIBU�GPPE�TFDVSJUZ�BOE�OVUSJUJPO�BSF�JOUFSMJOLFE�XJUI�)*7��*O�QBSUJDVMBS �"SUJDMF��PG�UIF�1PMJUJDBM�%FDMBSBUJPO�SFTPMWFT�ȇUP�JOUFHSBUF�GPPE�BOE�OVUSJUJPOBM�TVQQPSUȈ�JO�SFTQPOTFT�UP�)*7 �ȇXJUI�UIF�HPBM�UIBU�BMM�QFPQMF�BU�BMM�UJNFT �XJMM�IBWF�BDDFTT�UP�TVҪDJFOU �TBGF �BOE�OVUSJUJPVT�GPPE�UP�NFFU�UIFJS�EJFUBSZ�OFFET�BOE�GPPE�QSFGFSFODFT�GPS�BO�BDUJWF�BOE�IFBMUIZ�MJGF �BT�QBSU�PG�B�DPNQSFIFOTJWF�SFTQPOTF�UP�)*7�"*%4Ȉ��

��8)0��(VJEFMJOFT�GPS�BO�JOUFHSBUFE�BQQSPBDI�UP�OVUSJUJPOBM�DBSF�PG�)*7�JOGFDUFE�DIJMESFO��NPOUI��ZFBST��IUUQ��XXX�XIP�JOU�OVUSJUJPO�QVCMJDBUJPOT�IJWBJET��FO�JOEFY�IUNM

��%(�&$)0�)*7�(VJEFMJOFT �BEPQUFE�PO��0DUPCFS��

��IUUQ��FD�FVSPQB�FV�FVSPQFBJE�XIBU�GPPE�TFDVSJUZ�EPDVNFOUT��DPNN@FO�QEG��


5IF�MJOL�CFUXFFO�)*7�"*%4�BOE�OVUSJUJPO

Important activities to be supported

4QFDJҨD�SFDPNNFOEBUJPOT�GPS�NBUFSOBM�BOE�JOGBOU�IFBMUI�BOE�GFFEJOH

)*7�DBO�FYBDFSCBUF�UIF�FҧFDUT�PG�IVNBOJUBSJBO�DSJTFT��-JLFXJTF � EJTQMBDFNFOU� GSPN� B� TUBCMF� FOWJSPONFOU �food insecurity and poverty may increase vulnerability UP�)*7��)VNBOJUBSJBO�EJTBTUFST�PҬFO�PDDVS�JO�BSFBT�PG�IJHI�)*7�QSFWBMFODF��*O�FNFSHFODJFT �UIFSF�JT�SFEVDFE�access to basic food, health services, water and sani-tation. These factors represent particular problems for QFPQMF�MJWJOH�XJUI�)*7�XIP�IBWF�TQFDJҨD�OVUSJUJPO�OFFET��1FPQMF�MJWJOH�XJUI�)*7�FWFO�UIPTF�XJUIPVU�TZNQUPNT�have increased energy requirements, so access to food is of particular importance for them. In emergencies, UIF� FTTFOUJBM� IFBMUI� TFSWJDFT� BOE� )*7� TVQQPSU� BOE�USFBUNFOU� TFSWJDFT� BSF� PҬFO� EJTSVQUFE�� "OUJSFUSPWJSBM�treatments, home-based care programmes, nutritional

support programmes, and palliative care programmes are therefore likely to be in disarray. The health sta-UVT� PG� QFPQMF� MJWJOH� XJUI� )*7� DBO� EFUFSJPSBUF� SBQJEMZ�under these conditions, causing an additional burden on already strained emergency services. As gender inequalities may also be exacerbated in emergencies, there is a considerable probability that such inequalities may result in a disproportionate increase in the vulne-SBCJMJUZ�PG�XPNFO�UP�)*7 �BT�PQQPTFE�UP�UIF�SFTU�PG�UIF�QPQVMBUJPO��'VSUIFSNPSF �FNFSHFODJFT�PҬFO�SFTVMU�CPUI�in the separation of families and the breakdown of so-cial support systems for individuals outside traditional family structures, which can have a particular impact PO�QFPQMF�TVҧFSJOH�GSPN�)*7��

�� *OUFHSBUJPO�PG�)*7�JOUP�BMM�BTQFDUT�PG�FNFSHFODZ�DBSF��prevention, education, health, basic services, plan-ning and management;

2. Targeted food support;

3. Maternal and infant health and feeding;

�� 5SFBUNFOU�BOE�DBSF�PG�)*7�

5. Treatment of severe acute malnutrition;

6. Support networks, including livelihood support and home-based care;

�� 'PPE�IZHJFOF �TBOJUBUJPO �XBUFS �TIFMUFS�

�� 1SPUFDUJPO

Ȍ�&YDMVTJWF�CSFBTUGFFEJOH�GPS�UIF�ҨSTU��NPOUIT�TIPVME�CF�SFDPNNFOEFE�GPS�BMM�JOGBOUT�SFHBSEMFTT�PG�)*7�FY-posure (note: minimum requirements for safe formula GFFEJOH�GPS�CBCJFT�CPSO�GSPN�)*7�QPTJUJWF�NPUIFST�BSF�usually not applicable in crisis settings).

Ȍ�)*7� UFTUJOH� TIPVME� CF� QFSGPSNFE� XJUIJO� NBUFS-OBM� IFBMUI� TFSWJDFT� UP� JEFOUJGZ� )*7�QPTJUJWF� XPNFO��)*7�QPTJUJWF�XPNFO�TIPVME�SFDFJWF�"35�BOUJSFUSPWJSBM�therapy) during pregnancy and delivery to reduce the likelihood of transmitting the virus to their children.

Ȍ�)*7�QPTJUJWF�XPNFO�TIPVME�CF�FODPVSBHFE�UP�DPOUJ-nue breastfeeding for 12 months along with the introduction of complementary feeds. When breast-GFFEJOH�XPNFO�BSF�)*7�QPTJUJWF �CPUI�NPUIFST�BOE�JOGBOUT�TIPVME�SFDFJWF�"35�GPS�UIF�EVSBUJPO�PG�CSFBTU-GFFEJOH�BOE�GPS�POF�NPSF�XFFL�BҬFS�CSFBTUGFFEJOH�has stopped.

• Because these women and children are at increased risk of malnutrition, they should be regularly screened for growth, nutritional status and illness.

"EBQUFE�GSPN��(MPCBM�/VUSJUJPO�$MVTUFS �)BSNPOJ[FE�5SBJOJOH�1BDLBHF�.PEVMF��


“ The Commission ensures as far as possible that short term and longer-term nutrition-related needs are addressed in an integrated and

articulated way to prevent gaps in assistance, avoid duplication, ensure continuity and maximise

sustainability..

�� "T� BO� FYBNQMF � TFF� UIF� Ȅ)VNBOJUBSJBO� %FWFMPQNFOU� 'SBNFXPSL� ȁ� B� KPJOU�NFUIPEPMPHZ�CFUXFFO�%(�&$)0�BOE�%&7$0 ��

QFMSJB�GLAJSBC�HMGLR�?L?JWQGQ�?LB�NJ?LLGLE�UGRF�BCTCJMNKCLR�N?PRLCPQ�GL�MPBCP�RM�GLAPC?QC�QWLCPEGCQ�47

The Commission ensures as far as possible that short term and longer-term nutrition-related needs are addressed in ?L� GLRCEP?RCB�?LB�?PRGASJ?RCB�U?W�RM�NPCTCLR�E?NQ� GL�?Q-QGQR?LAC� ?TMGB� BSNJGA?RGML� CLQSPC� AMLRG-LSGRW� ?LB� K?VGKGQC� QSQR?GL?@GJGRW�� 2M� BM�this, close coordination is promoted with other international donors and national ?ARMPQ��$MP� GLQR?LAC� RFC�UMPI� RF?R� GQ�ASP-rently underway in global and regional ini-RG?RGTCQ� QSAF�?Q�13,�K?W�NPCQCLR� QGELGȏ-A?LR�MNNMPRSLGRGCQ�DMP�KMPC�CȎCARGTC� HMGLR�NJ?LLGLE�� 'L� MPBCP� DMP� GLRCPTCLRGMLQ� RM� @C�CȎCARGTC� FMUCTCP� C?AF� AMSLRPW� QGRS?RGML�QFMSJB�@C�?L?JWQCB�GLBGTGBS?JJW�?LB�GLRCP-TCLRGMLQ�QFMSJB�@C�BCQGELCB�?AAMPBGLE� RM�LCCBQ�?LB�RFC�AMKN?P?RGTC�?BT?LR?ECQ�MD�?T?GJ?@JC�?ARMPQ�

Operational Case Study - Pakistan: Joint humanitarian-development programming in a natural disaster situation

5IF�NBKPS�ҩPPET�JO�1BLJTUBO�JO��TIFE�MJHIU�PO�UIF�serious situation of undernutrition that was already prevalent in the country, both at chronic and acute le-vels.

In this context, most of the international humanitarian responses were usually concentrated on addressing acute undernutrition through food-based responses, with limited attention to those longer-term invest-ments that are necessary in order to prevent such decline. Support to food security, livelihoods and agri-culture was not explicitly linked to combating under-nutrition.

%(�&$)0�BOE�UIF�%FMFHBUJPO�PG�UIF�&VSPQFBO�6OJPO�%&6�JO�1BLJTUBO�BDLOPXMFEHFE�UIF�OFFE�GPS�NPSF�FY-plicit attention on programme design in order to better address undernutrition.

On the «Humanitarian side», the Commission’s in-terventions in nutrition and food assistance are based on a comprehensive mix of activities addressing the MJLFMZ� DBVTFT� PG� UIF� VOEFSOVUSJUJPO� JO� ҩPPE�BҧFDUFE�areas of Pakistan. These include:

• Support to the CMAM programme through UNICEF

and NGOs

• Support to WFP for large-scale food and cash distri-butions (mostly conditional on work programmes)

• Flexible food security programmes designed accor-ding to the local context through an alliance of 6 in-ternational NGOs

On the «Development side» the following inter-ventions are supported by the Food Security Thematic Programme (FSTP)

Ȍ�$POEJUJPOBM� DBTI� USBOTGFST� GPS� ҩPPE�BҧFDUFE� DPN-munities

Ȍ�*OUFHSBUFE� QSPUFDUJPO � PҧFSJOH� XPNFO� BOE� UIFJS�children a safe place where they could take part in nutrition and childcare related discussions

• Monitoring of child acute undernutrition and wo-men’s diet

Challenges: this ongoing experience indicates that systematic, informed and structured exchanges between humanitarian and development actors are necessary for addressing the immediate, underlying and basic causes of undernutrition.


2FC�!MKKGQQGML�QRPGTCQ� RM�MNCP?RGML?JGXC� RFC�AMKKGRKCLRQ�and principles laid out in the 2007 Consensus on EU Hu-manitarian Aid�� and in the Commission Communication on 0CQGJGCLAC��'L�N?PRGASJ?P�?RRCLRGML�GQ�EGTCL�RM�?PRGASJ?RGLE�RFC�BGȎCPCLR� !MKKGQQGML� ?GB� GLQRPSKCLRQ� ?LB� CLQSPGLE� ?NNPM-priate consideration of nutrition issues in the Commission’s BCTCJMNKCLR�NMJGAGCQ�?LB�NJ?LLGLE�UGRF�?�QNCAGȏA�DMASQ�ML�RFC�PCJCT?LR�AMSLRPW�QRP?RCEW�N?NCPQ��

2FC�!MKKGQQGML�RFCPCDMPC�QRPGTCQ�RM�?AFGCTC�@CRRCP�AMFCPCLAC�?LB� AMKNJCKCLR?PGRW� @CRUCCL� FSK?LGR?PG?L� ?LB� BCTCJMN-KCLR�GLRCPTCLRGMLQ��2M�RFGQ�CLB�?LB�R?IGLE�GLRM�AMLQGBCP?RGML�RFC�FMJGQRGA�?NNPM?AF�PCOSGPCB�UFCL�R?AIJGLE�?ASRC�SLBCPLS-RPGRGML� RFC�!MKKGQQGML�CLAMSP?ECQ�UFCLCTCP�NMQQG@JC� RFC�adoption of a robust policy and the promotion of programme

0QFSBUJPOBM�$BTF�4UVEZ��.BMJ��+PJOU�)VNBOJUBSJBO�%FWFMPQNFOU�programming in NutritionThe separation between emergency and development can create challenges in the design of appropriate res-QPOTFT�UP�BOZ�HJWFO�DPOUFYU��*O�.BMJ �GPS�FYBNQMF �B�ҨSN�distinction between emergency and development inter-ventions is not always possible for several reasons:

• Nutrition crises triggered by a shock (e.g. increases in food prices or droughts) are the result of both entrenched chronic poverty and vulnerability. The TBNF�TIPDL�JO�B�MFTT�QPPS�WVMOFSBCMF�DPOUFYU�NBZ�OPU�lead to any crisis (or to crises of a similar magnitude).

• Given their frequency, these crisis situations have become ‘chronic’ and a regular feature of the Malian landscape.

• The ordinary levels of wasting in Mali, outside crisis conditions, tend to be above commonly accepted emergency thresholds.

In Mali, it is of paramount importance that a package of measures be implemented to respond comprehen-sively to the existing situation. Such measures shall in-clude addressing chronic poverty, food insecurity and WVMOFSBCJMJUZ�BMPOHTJEF�TQFDJҨD�BDUJPOT�UP�QSFWFOU�BOE�treat undernutrition. Such a package has been provided through the combination of European Humanitarian BOE�%FWFMPQNFOU�BTTJTUBODF�

• The European Humanitarian assistance funds the treatment of acute undernutrition; the provision of nutrition information and advocacy, calling on the government and development actors to give greater priority to nutrition.

Ȍ�5IF�&VSPQFBO�%FWFMPQNFOU�BTTJTUBODF�GVOET�6/*$&'�to:

• continue to support nutrition information and the treatment of acute undernutrition;

• enhance prevention work through, for instance, a HPWFSONFOU�6/*$&'�CSFBTUGFFEJOH�DBNQBJHO�

• expand advocacy work (e.g. through a series of national and international media events) to in-crease awareness on the existing nutrition pro-blem and mobilise actors to address it (e.g. at cen-tral and decentralised government levels, among community networks); and

• strengthen the institutional setup and strategic environment that govern nutrition in the country.

These practical links between humanitarian and de-velopment interventions were made possible through the coordination of European development assistance in the health sector and humanitarian assistance for nutrition.

Lesson learnt:�&ҧFDUJWF�DPPSEJOBUJPO�PG�IVNBOJUBSJBO�and development aid is not limited to technical comple-mentarity, but requires a strong political commitment UPXBSET�MPOH�UFSN�TUSBUFHJD�QSJPSJUJFT�JO�UIF�ҨFME�PG�OV-trition.

To this end, the Commission is actively involved in the JOJUJBUJWF�"(*3�"MMJBODF�(MPCBMF�QPVS�MB�3¨TJMJFODF�JO�UIF�Sahel.

��&6�)VNBOJUBSJBO�$POTFOTVT ��4FDUJPO�� "SUJDMF��4FDUJPO�� "SUJDMF��4FDUJPO�5; Annex.

Humanitarian assistance to displaced and host communities in Mopti, central Mali.


BG?JMESC�@CRUCCL�?JJ�CKCPECLAW�?LB�BCTCJMNKCLR�QR?ICFMJBCPQ�UFM�?PC�BGPCARJW�MP�GLBGPCARJW�GLTMJTCB�GL�RFC�LSRPGRGML�ȏCJB�

.PCN?PCBLCQQ�KC?QSPCQ�NJ?W�?�TGR?J�N?PR�GL�CLQSPGLE�RFC�AMLLCARGTGRW�@CRUCCL�RFC�ȏCJBQ�MD�BCTCJMNKCLR�?LB�FSK?LGR?PG?L�?ARGML��#ȑAGCLR�?TCLSCQ�MD�UMPI�QFMSJB�emphasise training, capacity-building, awareness-raising, the establishment or im-NPMTCKCLR�MD�JMA?J�C?PJW�U?PLGLE�QWQRCKQ�?LB�AMLRGLECLAW�NJ?LLGLE�z�?JJ�MD�UFGAF�?PC�FGEFJW�PCJCT?LR�RM�LSRPGRGML�?QQGQR?LAC��

6.3.2 Global Governance and Coordination for Nutrition in Emergencies

#ȎCARGTC�AMMPBGL?RGML�GQ�N?P?KMSLR�DMP�RFC�QSAACQQDSJ�K?L?ECKCLR�MD�SLBCPLSRPG-RGML�GL�CKCPECLAGCQ��2M�RFGQ�CLB�RFC�!MKKGQQGML�QSNNMPRQ�RFC�UMPI�MD�RFC�%JM@?J�Nutrition Cluster49 (with UNICEF as the lead agency), the Food Security Cluster and RFC�&C?JRF�!JSQRCP��

2FC�!MKKGQQGML�?BTMA?RCQ�DMP�AMFCPCLAC�?LB�QSNNMPRQ�GKNPMTCB�AMMPBGL?RGML�DMP�LSRPGRGML�?APMQQ�?JJ�PCJCT?LR�QCARMPQ�?LB�RFPMSEF�RFC�CLE?ECKCLR�MD�?JJ�GLRCPL?RGM-L?J�?ARMPQ�UFM�?PC�GLTMJTCB�GL�CKCPECLAW�LSRPGRGML�?ARGTGRGCQ��

In addition, coordination and cooperation need to go beyond operational contexts, in MPBCP�RM�CLQSPC�AMFCPCLAC�GL�RFC�QAGCLRGȏA�CTGBCLAC�@?QC�RF?R�GLDMPKQ�NMJGAGCQ�?LB�NP?ARGAC��$MP�RFGQ�PC?QML�RFC�!MKKGQQGML�AMKKSLGA?RCQ�UGRF�MRFCP�EJM@?J�KCAF?-nisms which are concerned with nutrition such as the UN Standing Committee on ,SRPGRGML��3,1!,��13,�?LB�RFC�5&-�Q�,SRPGRGML�%SGB?LAC�#VNCPR��BTGQMPW�%PMSN��,3%�%��?Q�UCJJ�?Q�RFC�!MKKGRRCC�ML�5MPJB�$MMB�1CASPGRW��!$1��

��IUUQ��POFSFTQPOTF�JOGP�(MPCBM$MVTUFST�/VUSJUJPO�1BHFT�EFGBVMU�BTQY


7.1 List of Abbreviations

AIDS �AOSGPCB�GKKSLMBCȏAGCLAW�QWLBPMKC

ART �LRG�PCRPMTGP?J�RFCP?NW

BMI MBW�+?QQ�'LBCV

CFS Committee on World Food Security

CFW Cash for Work

CMAM Community-based Management of acute Malnutrition

CoD Cost of Diet

CSB (+/++) !MPL�1MW� JCLB�� PCDCPQ�RM�RFC�?BBGRGML�MD�KGAPMLSRPGCLR�KGV KGAPMLSRPGCLR�KGV�?LB�BPGCB�QIGK�KGJI�NMUBCP�z�PCNJ?AGLE�RFC�@?QGA�!1 �

DALYs Disability adjusted life years

DEU Delegation of the European Union

DFID "CN?PRKCLR�DMP�'LRCPL?RGML?J�"CTCJMNKCLR�z� PGRGQF��GB

DG ECHO "GPCARMP?RC�%CLCP?J�DMP�&SK?LGR?PG?L��GB�?LB�!GTGJ�.PMRCARGML

EDF #SPMNC?L�"CTCJMNKCLR�$SLB

EU European Union

Fe Ferrous/Ferric - Iron

FSTP Food Security Thematic Programme

GAM Global Acute Malnutrition

GFD General Food Distribution

HEA Household Economy Analysis

HIV &SK?L�GKKSLMBCȏAGCLAW�TGPSQ�GLDCARGML

IASC Inter-agency Standing Committee

INGO 'LRCPL?RGML?J�,ML�%MTCPLKCLR?J�-PE?LGQ?RGML

IPC 'LRCEP?RCB�.F?QC�!J?QQGȏA?RGML

IYCF(-E) Infant and Young Child Feeding (in emergencies)

LRRD *GLIGLE�0CJGCD�0CF?@GJGR?RGML�?LB�"CTCJMNKCLR

MAM Moderate Acute Malnutrition

MAMI Management of acute Malnutrition in Infants

MDG +GJJCLLGSK�"CTCJMNKCLR�%M?JQ

MN Micronutrient

MND +GAPMLSRPGCLR�"CȏAGCLAW

MoH Ministry of Health

MUAC Mid-upper arm circumference

NGO ,ML�EMTCPLKCLR?J�-PE?LGQ?RGML

NUGAG ,SRPGRGML�%SGB?LAC�#VNCPR��BTGQMPW�%PMSN

ORS Oral Rehydration Salt

OTP Outpatient Therapeutic Programme

��LLCVCQ



��(SPTT �3��FU�BM��JO�$PNNVOJUZ�/VUSJUJPO��%FҨOJUJPO�BOE�"QQSPBDIFT��&ODZDMPQBFEJB�PG�)VNBO�/VUSJUJPO��&E��CZ�4BEMFS �.� �4USBJO�4��BOE�$BCBMMFSP�#��-POEPO�

��8PSME�'PPE�4VNNJU ��

RUSF Ready-to-use supplementary food

RUTF Ready-to-use therapeutic food

SAM 1CTCPC��ASRC�+?JLSRPGRGML

SC UK 1?TC�RFC�!FGJBPCL�3LGRCB�)GLEBMK

SQUEAC 1CKG�/S?LRGR?RGTC�#T?JS?RGML�MD��AACQQ�?LB�!MTCP?EC

SUN 1A?JGLE�SN�,SRPGRGML��GKGR?RGTC KMTCKCLR�

TFA Targeted Food Assistance

TB Tuberculosis

USD United States Dollar

U2s/U5s 3LBCP�RUM�Q��AFGJBPCL�SLBCP�RUM ȏTC�WC?PQ�MD�?EC�

UNICEF United Nations Children's Fund

UNSCN United Nation Standing Committee on Nutrition

WASH Water, Sanitation and Hygiene

WFP World Food Programme

WHO 5MPJB�&C?JRF�-PE?LGX?RGML

7.2 Note on Technical Terms

Nutrition is the science of how nutrients and other substances in food act and GLRCP?AR� GL� PCJ?RGML� RM� FC?JRF��Nutrition security50 encompasses good health; ?� FC?JRFW� CLTGPMLKCLR�� EMMB� A?PC� NP?ARGACQ� ?LB� FMSQCFMJB� DMMB� QCASPGRW� �QCC�$GESPC��

Food security�MAASPQ�UFCL�NCMNJC�?R�?JJ�RGKCQ�F?TC�NFWQGA?J�?LB�CAMLMKGA�?A-ACQQ�RM�QSȑAGCLR�Q?DC�?LB�LSRPGRGMSQ�DMMB�RF?R�KCCRQ�RFCGP�BGCR?PW�LCCBQ�?LB�DMMB�NPCDCPCLACQ� DMP� ?L� ?ARGTC� ?LB� FC?JRFW� JGDC�51 A family (or country) may be food QCASPC�WCR�GLAJSBC�GLBGTGBS?JQ�UFM�?PC�LSRPGRGML?JJW�GLQCASPC��$MMB�QCASPGRW�GQ�RFC-PCDMPC�?�LCACQQ?PW�@SR�LMR�QSȑAGCLR�AMLBGRGML�DMP�LSRPGRGML�QCASPGRW��Hunger is an MSRAMKC�MD�DMMB�GLQCASPGRW�UFCPC�BGCR?PW�GLR?IC�?R�NMNSJ?RGML�JCTCJ�D?JJQ�@CJMU�KGLGKSK�PCOSGPCKCLRQ��RWNGA?JJW�?TCP?ECB�?Q��IA?J�NCP�NCPQML�NCP�B?W��

Nutritional status is the physiological condition of a person resulting from the @?J?LAC�@CRUCCL�LSRPGCLR�PCOSGPCKCLRQ�GLR?IC�?LB�RFC�@MBW�Q�?@GJGRW�RM�SQC�RFCQC�LSRPGCLRQ��Anthropometry is human body measurement used as a proxy for nutri-RGML?J�QR?RSQ��?Q�NCP�LSRPGRGML�QSPTCWQ��

Malnutrition�GQ�?�NFWQGA?J�AMLBGRGML�PCJ?RCB�RM�RFC�@MBW�Q�SQC�MD�LSRPGCLRQ��2FCPC�?PC� RUM� DMPKQ� MD� K?JLSRPGRGML�� SLBCPLSRPGRGML� ?LB� MTCPLSRPGRGML�� 2FGQ� BMASKCLR�deals only with undernutrition, since it is that form of malnutrition that is of spe-AGȏA�NS@JGA�FC?JRF�AMLACPL�GL�CKCPECLAGCQ��

An emergency or humanitarian crisis� GQ�?L�CTCLR�Q��UFGAF�APGRGA?JJW�RFPC?RCLQ�RFC�FC?JRF�Q?DCRW�QCASPGRW�MP�UCJJ@CGLE�MD�?�J?PEC�EPMSN�MD�NCMNJC��2FC�!MKKGQ-QGML�BCȏLCQ�?L�CKCPECLAW�@?QCB�ML�?�AMK@GL?RGML�MD�?@QMJSRC�RFPCQFMJBQ��QSAF�?Q�1NFCPC�MP�5&-��?LB�PCJ?RGTC�GLBGA?RMPQ�QCR�?E?GLQR�?�AMLRCVRS?J�LMPK��APGQGQ�GQ�


52 - Z-score (or standard deviation score) is the deviation of the value for an individual from the median value of the reference population, divided by the standard deviation of the reference.

��5IF�UFSNT�SFBEZ�UP�VTF�GPPE�36'�BOE�SFBEZ�UP�VTF�UIFSBQFVUJD�GPPE�365'�BSF�PҬFO�VTFE��

��#MBDL�3��FU�BM��.BUFSOBM�BOE�$IJME�6OEFSOVUSJUJPO��(MPCBM�BOE�SFHJPOBM�FYQPTVSFT�BOE�IFBMUI�DPOTFRVFODFT��-BODFU�� IUUQ��XXX�UIFMBODFU�DPN�KPVSOBMT�MBODFU�BSUJDMF�1**4��GVMMUFYU

��8FJHIU�EJWJEFE�CZ�UIF�TRVBSF�PG�IFJHIU�LH�N�

RPGEECPCB�@W�?�F?X?PB�RF?R�K?W�@C�L?RSP?J�MP�K?L�K?BC�UGRF�P?NGB�MP�QJMU�MLQCR�?LB�MD�QFMPR�MP�NPMRP?ARCB�BSP?RGML��

Undernutrition includes: i) intrauterine growth restriction which leads to low birth UCGEFR��GG��QRSLRGLE��GGG��U?QRGLE�?LB�LSRPGRGML?J�MCBCK?��?LB�GT��BCȏAGCLAGCQ�MD�CQQCL-RG?J�KGAPMLSRPGCLRQ��2FC�A?SQCQ�MD�SLBCPLSRPGRGML�?PC�KSJRGNJC�?LB�AMLRCVR�QNCAGȏA��

3LBCPLSRPGRGML�A?L�@C�QFMPR�RCPK��?ASRC��MP�JMLE�RCPK��AFPMLGA��Acute undernu-trition in children under 5 years of age is characterised by wasting (low weight AMKN?PCB�RM�FCGEFR��?LB MP�LSRPGRGML?J�MCBCK?��Wasting (marasmus) is a condi-RGML�PCQSJRGLE�DPMK�P?NGB�UCGEFR�JMQQ�MP�?�D?GJSPC�RM�E?GL�UCGEFR�MTCP�?�QFMPR�NCPGMB�MD�RGKC��ASRC�SLBCPLSRPGRGML�A?L�@C�KMBCP?RC�MP�QCTCPC��2MECRFCP�RFCQC�AMLQRGRSRC�RFC�RMR?J��MP�~EJM@?J��P?RC�MD�?ASRC�K?JLSRPGRGML��%�+��+MBCP?RC�?ASRC�K?JLSRPGRGML��+�+��GQ�BCȏLCB�?Q�U?QRGLE��?LB��8�QAMPCQ52 of the median weight-for-FCGEFR�MD�RFC�PCDCPCLAC�NMNSJ?RGML��QCTCPC�?ASRC�K?JLSRPGRGML��1�+��GQ��8�QAMPCQ�?LB MP�LSRPGRGML?J�MCBCK?��@GJ?RCP?J�NGRRGLE�MCBCK?��,SRPGRGML?J�MCBCK?�K?W�K?QI�U?QRGLE�?LB�RFCPCDMPC�UCGEFR�DMP�FCGEFR�K?W�LMR�@C�M@QCPTCB��L�?JRCPL?RGTC�P?NGB�way to estimate acute undernutrition in children as well as in pregnant and lacta-RGLE�UMKCL�GQ�RFC�KC?QSPCKCLR�MD�RFC�KGB�SNNCP�?PK�AGPASKDCPCLAC��+3�!��

2FC�K?L?ECKCLR�MD�?ASRC�SLBCPLSRPGRGML�K?W�GLTMJTC�RFC�SQC�MD�QNCAG?JGQCB�nu-tritional products53�BCQGELCB�RM�QSNNJCKCLR�RFC�BGCR�UGRF�QNCAGȏA�KGAPMLSRPGCLRQ�CLCPEW NPMRCGL�MP�@MRF��2FCQC�DMMBQ�?PC�SQS?JJW� GLRCLBCB�DMP�FMKC�AMLQSKNRGML�and are distributed through general rations, blanket distributions (to groups at risk) MP�NPMEP?KKCQ�R?PECRGLE�?ASRCJW�SLBCPLMSPGQFCB�GLBGTGBS?JQ�

Chronic undernutrition results in stunting�G�C��JMU�FCGEFR�AMKN?PCB�RM�?EC��BC-ȏLCB�?Q��8�QAMPCQ�MD�RFC�KCBG?L�FCGEFR�DMP�?EC�?AAMPBGLE�RM�5&-�EPMURF�QR?L-B?PBQ� DMP� AFGJBPCL�� 2FC� JMLECP� RGKC�QA?JC� MTCP�UFGAF� FCGEFR�DMP�?EC� GQ� ?ȎCARCB�K?ICQ�GR�?�@CRRCP�GLBGA?RMP�DMP�NPMRP?ARCB�LSRPGRGML?J�BCȏAGCLAW��2FC�KC?QSPCKCLR�MD�QRSLRGLE�GQ�KMPC�SQCDSJ�DMP�JMLE�RCPK�NJ?LLGLE�RF?L�DMP�CKCPECLAGCQ��

*F@OLKRQOFBKQ�ABȎ@FBK@FBP (MND) are a form of undernutrition that is related to TGR?KGLQ�?LB�KGLCP?JQ��"CȏAGCLAGCQ�MD�GPML�GMBGLC�TGR?KGL��?LB�XGLA�?PC�?KMLEQR�RFC�RMN��JC?BGLE�A?SQCQ�MD�BC?RF�RFPMSEF�BGQC?QC�GL�BCTCJMNGLE�AMSLRPGCQ�54 Other BCȏAGCLAGCQ�UFGAF�?PC�KMPC�QNCAGȏA�RM�CKCPECLAGCQ�GLAJSBC�RFMQC�MD�RFG?KGLC�� PG@MȐ?TGL�� LG?AGL�� ?LB�TGR?KGL�!� Underweight� GL�AFGJBPCL�GQ�?�LML�QNCAGȏA�GLBGA?RMP�MD�SLBCPLSRPGRGML�QGLAC�GR� GL-cludes children with low weight-for-height (wasting) or low height-for-age (stun-RGLE��'R�GQ�BCȏLCB�?Q��8�QAMPCQ�MD�RFC�KCBG?L�UCGEFR�DMP�?EC�MD�5&-�EPMURF�QR?LB?PBQ��%PMURF�AF?PRQ�@?QCB�ML�UCGEFR�DMP�?EC�?PC�SQCB�DMP�EPMURF�KMLGRMPGLE�GL�FC?JRF�ACLRPCQ��'L�CKCPECLAGCQ�UCGEFR�DMP�?EC�A?L�@C�SQCB�RM�GLBGA?RC�RFC�NPC-QCLAC�MD�?�NPM@JCK�GD�B?R?�ML�?ASRC�SLBCPLSRPGRGML�GQ�LMR�?T?GJ?@JC��

Adult undernutrition�GQ�SQS?JJW�?QQCQQCB�SQGLE� MBW�+?QQ�'LBCV�� +'�55 or Mid 3NNCP��PK�!GPASKDCPCLAC� �+3�!��3LBCPLSRPGRGML� GL�NPCEL?LR�?LB� J?AR?RGLE�KM-


RFCPQ�GQ�GBCLRGȏCB�RFPMSEF�+3�!�?LB�AJGLGA?J�QGELQ��J?AI�MD�?NNPMNPG?RC�UCGEFR�E?GL�BSPGLE�NPCEL?LAW��1FMPR�QR?RSPC�GL�UMKCL�PCQSJRGLE�DPMK�N?QR�QRSLRGLE��FCGEFR�@C-JMU��AK�GL�DCK?JCQ�?ECB��WC?PQ��A?L�PCQSJR�GL�NMMP�NPCEL?LAW�MSRAMKCQ�

3LBCPLSRPGRGML� ?LB�KMPR?JGRW� ?PC� J?RC� GLBGA?RMPQ� MD� ?� APGQGQ�� 'R� GQ� GKNCP?RGTC� RF?R�information on health, food security, water, sanitation and hygiene is used to inter-NPCR�CQRGK?RCQ�MD�SLBCPLSRPGRGML��2FC�5&-�BCȏLGRGML�MD�thresholds�� to guide such GLRCPNPCR?RGML�T?PGCQ�?LB�F?Q�RM�@C�SQCB�UGRF�A?SRGML�?LB�QNCAGȏAGRW�RM�RFC�AMLRCVR��?JQM�RFPCQFMJBQ�DMP�RFC�NPCT?JCLAC�MD�KMBCP?RC�?LB�QCTCPC�?ASRC�SLBCPLSRPGRGML�GL�AFGJBPCL�SLBCP�ȏTC�WC?PQ�MD�?EC�?PC�QS@HCAR�RM�?BHSQRKCLRQ�GL�JGEFR�MD�RFC�PCTGQCB�5&-�EPMURF�QR?LB?PBQ�DPMK��2PCLB�?L?JWQGQ�A?L�PCTC?J�?�UMPQCLGLE�QGRS?-RGML�CTCL�GD�RFPCQFMJBQ�F?TC�LMR�@CCL�APMQQCB��,CTCPRFCJCQQ�RFC�5&-�BCȏLGRGMLQ�NPMTGBC�?�PC?QML?@JC�QR?PRGLE�NMGLR�GL�?QQCQQGLE�RFC�QCTCPGRW�MD�?�APGQGQ�

��.MJGAGCQ�?LB�%SGBCJGLCQ�GL�1SNNMPR�MD�RFGQ�1R?Ȏ�5MPIGLE�Document

This document draws on numerous internal and external policies, norms and gui-BCJGLCQ��2FCQC�?PC�JGQRCB�FCPC�QM�RF?R�RFC�NPCQCLR�BMASKCLR�A?L�@C�PC?B�?LB�SL-BCPQRMMB�UGRFGL�RFGQ�AMLRCVR�

Internal

2FC�JCE?J�@?QGQ�MD�#3�FSK?LGR?PG?L�K?LB?RC�GQ�BCȏLCB�GL�RFC�Humanitarian Re-gulation��(SLC��57��'L�JGLC�UGRF�RFGQ�LSRPGRGML�GLRCPTCLRGMLQ�GL�APGQCQ�?PC�NPMTG-BCB�RM�KCCR�FSK?LGR?PG?L�LCCBQ�@SR�GLAJSBC�QSNNMPR�RM�NPCTCLR�MP�KGRGE?RC�BGQ?Q-RCPQ�?LB�QFMPR�RCPK�NMQR�CKCPECLAW�PCAMTCPW��

2FC�NMQGRGML�N?NCP�GLAMPNMP?RCQ�RFC�AMPC�NPGLAGNJCQ�M@HCARGTCQ�?LB�QR?LB?PBQ�DMP�#3�FS-manitarian action which are delineated in the Humanitarian Aid Consensus��

The Commission Communication on Humanitarian Food Assistance Policy >KA�FQP�0Q>ȍ�4LOHFKD�!L@RJBKQ59NPMTGBCQ�?�DP?KCUMPI�DMP�QCASPGLE�?BCOS?RC�DMMB�AMLQSKNRGML�LCACQQ?PW�DMP�LSRPGRGML�QCASPGRW�

The Commission Communication on The EU Role in Global Health and its 0Q>ȍ�4LOHFKD�!L@RJBKQ��

The Commission Communication on An EU policy framework to assist de-veloping countries in addressing food security challenges.��

2FC�LSRPGRGML?J�LCCBQ�MD�QNCAGȏA�TSJLCP?@JC�EPMSNQ�?PC�?BBPCQQCB�GL�DG ECHO HIV Guidelines��-ARM@CP��?LB�RFC� LJJFPPFLK�0Q>ȍ�4LOHFKD�->MBO�LK� EFIA-ren in Emergency and Crises Situations��?LB

��(".�FNFSHFODZ�UISFTIPME��.PSUBMJUZ�FNFSHFODZ�UISFTIPME�� EBZ �8)0�

��$PVODJM�3FHVMBUJPO�&$�/P��PG��+VOF��DPODFSOJOH�IVNBOJUBSJBO�BJE��0+�-�� Q��ȁ��&4 �%" �%& �&- �&/ �'3 �*5 �/- �15 �'* �47

��&VSPQFBO�$POTFOTVT�PO�)VNBOJUBSJBO�"JE ��0+�-�$��

��$0.��ҨOBM �.BSDI��




The Commission Communication on Disaster Risk Reduction ��GBCLRGȏCQ�the strengthening of capacities in disaster-prone contexts as an appropriate objec-RGTC�BSPGLE�FSK?LGR?PG?L�PCQNMLQC�

External

The Sphere Project��&SK?LGR?PG?L�!F?PRCP�?LB�+GLGKSK�1R?LB?PBQ� GL�"GQ?QRCP�0CQNMLQC��

International Code of Marketing of Breast-milk Substitutes, WHO 1977WHO (2004) Guiding Principles for Feeding Infants and Young Children du-ring Emergencies

UNHCR/UNICEF/WFP/WHO (2004) Food and Nutrition Needs in Emergencies

Management of Acute Malnutrition in Infants��+�+'��.PMHCAR�0CTGCU��.PMHCAR�AMKKGQQGMLCB�@W�RFC�'�1!�%JM@?J�,SRPGRGML�!JSQRCP��1SKK?PW�0CNMPR�#,,�-ARM@CP��

Guidelines on Infant and Young Child Feeding in Emergencies��'$#�!MPC�%PMSN�Feb 2007

Community Based Management of Severe Acute Malnutrition. A Joint State-ment by the World Health Organisation, World Food Programme, the United Nations 1WQRCK�1R?LBGLE�!MKKGRRCC�ML�,SRPGRGML�?LB�RFC�3LGRCB�,?RGMLQ�!FGJBPCL�Q�$SLB��+?W��

-OBSBKQFKD�>KA� @LKQOLIIFKD�JF@OLKRQOFBKQ�ABȎ@FBK@FBP� FK�MLMRI>QFLKP�>C-fected by an emergency. Joint statement by the World Health Organisation, the 5MPJB�$MMB�.PMEP?KKC�?LB�RFC�3LGRCB�,?RGMLQ�!FGJBPCL�Q�$SLB��

4%,� EFIA�$OLTQE�0Q>KA>OAP�>KA�QEB�&ABKQFȎ@>QFLK�LC�0BSBOB��@RQB�*>I-nutrition in Infants and Children. A joint statement by the World Health Orga-LGQ?RGML�?LB�RFC�3LGRCB�,?RGMLQ�!FGJBPCL�Q�$SLB��

NutritionNutrition web page

https: www.facebook.com/EuropeanCommission

https://twitter.com/eu_echo

https://twitter.com/kgeorgievaeu

All c

redi

ts ©

ECH

O

Nutrition - European Commissionec.europa.eu/...nutrition_addressing_undernutrition...Undernutrition...

Documents

Transcript of Nutrition - European Commissionec.europa.eu/...nutrition_addressing_undernutrition...Undernutrition...