Malnutrition in Vulnerable Refugee Populations: Report on Syria
The civil war in Syria started almost three and a half years ago. As a result of the conflict, roughly 2.9 million people have fled Syria, and another 6.5 million are displaced within Syria (estimates from UNHCR news story from 18th July 2014). The majority of the international refugees now live in neighboring countries such as Jordan, Iraq, Lebanon, Egypt and Turkey, in refugee camps and also in the general community in these countries. Refugees are at increased risk of malnutrition, especially in protracted conflicts such as in Syria. Refugees in camps in particular have restricted movement and limited possibilities to provide for themselves or their families. High rates of malnutrition and micronutrient deficiencies have been found in refugees, particularly those living in camps for an extended period of time. A recent report from the CDC investigates rates of malnutrition in Syrian refugees living in and outside of a refugee camp in Jordan.
The report focuses on the area around the Zaatari Refugee Camp. Children aged from 6 months to 5 years, and reproductive age women tend to be at greatest risk. The survey was conducted in April and May of this year. In total, 1754 refugee women and children were surveyed, roughly one third from within the Zaatari camp and two thirds as a representative sample from refugees in the surrounding communities in Jordan. Weight-for-height z-scores were used to assess acute malnutrition and height-for-age z-scores were used to assess chronic malnutrition in the children, according to standards from the World Health Organization. In both women and children, hemoglobin measurements gave an estimate of micronutrient (iron) deficiency.
The survey found a low prevalence of acute malnutrition in the Syrian refugee children. This is unusual in humanitarian crises and may reflect a better population nutritional status at the start of the crisis than is normally seen, and also the effectiveness of food assistance from international organizations UNICEF and the World Food Programme.
On the other hand, stunting was found both within and outside of the refugee camp in 17% and 9% of children aged 6 months to 5 years. Stunting reflects chronic malnutrition from insufficient nutrient intakes. Inside the camp, almost half of women and children were anemic (45% and 48%). For displaced women and children outside the camp, anemia levels were lower at 31% and 26%. In both cases, these high levels of anemia reflect a serious public health issue. Anemia in children affects their physical and mental development, and can irreparably damage a child’s ability to reach their cognitive potential as an adult (see Kotecha’s review). Anemia in women of childbearing potential increases the likelihood of birth complications; their infants have a higher risk of preterm delivery and small birth weight. Both women and children with anemia feel tired and weak, and have a higher risk of infections.
Anemia and stunting in Syrian refugees are a small part of the overall problem. Large parts of Syria are a warzone. Millions of people have been displaced, had their homes destroyed, with families separated, and uncertain futures. Ending the conflict is vitally important. In the meantime, humanitarian support to citizens during the crisis has received only one third of the funding that it requires. A little less than half the Syrians needing assistance are being reached. Neighboring countries that have absorbed most of the refugees are struggling to cope with providing infrastructure and services to support the large numbers of people in need that have crossed borders to escape the crisis. The United Nations Refugee Agency has outlined different ways for individuals, groups or corporations to help with the crisis while a more lasting resolution is being sought.
Reaching aid milestones today could be considered a stop-gap measure today, but can help alleviate some of the suffering that is occurring during the crisis. Using a long term view, preventing malnutrition in refugees now also mitigates the negative effects that micronutrient deficiencies have on children’s futures.
Bilukha OO, Jayasekaran D, Burton A, Faender G, King'ori J, Amiri M, Jessen D, Leidman E. Nutritional Status of Women and Child Refugees from Syria — Jordan, April–May 2014. July 21, 2014 / 63(Early Release);1-3. CDC Morbidity and Mortality Weekly Report (MMWR). http://www.cdc.gov/mmwr/preview/mmwrhtml/mm63e0721a1.htm?s_cid=mm63e0721a1_x
Kotecha PV. Nutritional Anemia in Young Children with Focus on Asia and India. Indian J Community Med. 2011 Jan-Mar; 36(1): 8–16. doi: 10.4103/0970-0218.80786. PMCID: PMC3104701
UNHCR and WFP, Malnutrition in Protracted Refugee Situations: A Global Strategy. January 2006. http://www.unhcr.org/45fe62642.html
World Health Organization. Global Database on Child Growth and Malnutrition. Cut-off points and summary statistics. http://www.who.int/nutgrowthdb/about/introduction/en/index5.html