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Author: Fakhri Al-Arashi
Publisher & Chief Editor
Category: Health, Date October 22nd, 2012

The current reality of malnutrition in Yemen



National Yemen

Rural women receive emergency donation

By Jihan Anwar

Considering that no less than 10 million people in Yemen suffer from severe to moderate malnutrition, U.K. Development Minister Alan Duncan wasn’t exaggerating when he recently referred to malnutrition as a “death sentence for tens of thousands” of Yemenis.

Food insecurity comes in different degrees of seriousness. Severe food insecurity means that people cannot produce their own food – nor do they have the necessary money to buy it at the marketplace.

The most affected regions of Yemen are the 13 poorest governorates which run through the country’s highlands. According to the Comprehensive Food Security Survey, CFSS, published last May by the World Food Programme (WFP), 5 million people in Yemen have been estimated to be suffering from malnutrition, based on a sample size of 2000 people interviewed across the country.

A further 5 million people are food insecure, living without a constant supply of adequate food items. Although placed at a lower imminent threat level than the severely food insecure, following Yemen’s 2011 humanitarian crisis, the situation for this last category has worsened. High food and fuel prices have further worsened their state, so that they risk becoming severely food insecure, according to Mr. Barry Came, WFP Yemen’s spokesman.

Caroline Gluck, an Oxfam Humanitarian Press Officer, remarked, “With Yemen, we are dealing with a long-term chronic emergency situation. People have very little in the best of times and these are not the best of times; these are some of the worst times Yemeni people have faced.” Caroline spoke about families she had visited in Hodeida and Haradh in which sons or daughters had died, and it was believed the reason for the children’s deaths was as simple and tragic as a lack of basic nutrients.

“In early January, WFP planned to feed 1.2 million people. In May, we had to revise the figure to 1.8 million, and in September to 3.9 million. We are planning to feed almost 4 million this year,” declared Barry Came.

What is malnutrition?

Malnutrition refers to the condition in which the nutrient intake of an individual has consistently been so low that the body’s physical activities have slowed down, been impaired or altogether arrested. This condition ultimately leads to death.

Malnutrition is measured by taking the weight-height ratio and circumference of the middle upper arm.

One WFP program has 675,000 women and children who have been diagnosed with a moderate form of malnutrition. They are provided with both curative and preventative measures; children and mothers are given specialized micronutrient-enriched food products. UNICEF treats cases of acute malnutrition.

Mr Came has noted that malnutrition in Yemen has seen an age-related trend. A UNICEF Yemen Situation Report for September 2012 estimated that children under the age of five suffered from a normal chronic malnutrition level of 16.7%, a seriously underweight ratio of 24.4%, and critically acute malnutrition rate of 18.9%. These figures add up to a total of 47% of Yemen’s children under the age of five.

Looking at the statistics, Mr. Came said, “47% under 5 is almost half of the children under the age of five in the country. There are about 4 million children in Yemen under five years of age, which means that about two million of them are chronically malnourished and another one million of those acutely malnourished. That’s a huge number of children.”

It was also found that around 13% are acutely malnourished, which was assessed using wasting measurements. WHO sets the critical wasting threshold at 15%. In Hodeida, the number is almost doubled, at 28%. “They could die at any time,” said Mr. Came.

Causes

One of the problems in the country is that less than 5% of the land is arable, which leads Yemen to import about 90% of its staple foods. As fuel prices rise, the cost of food increases.

The situation has been progressively worsening because of population growth, post–revolution conflict, political instability and massive population displacement, mostly Yemen’s northern and southern reaches.

While in previous years people had been able to get through difficult periods by selling land or animals, the current crisis has affected them so gravely and for such a relatively extended timeframe that their economical and material reserves have progressively and drastically thinned down. People are now left with close to nothing.

Gluck said, “Many farmers told me that they haven’t planted any seeds. Because diesel prices have gone so high, they can’t afford to hire a tractor, they didn’t have the money to pay for water to irrigate the crops. In some cases, they ate the seeds because they had absolutely nothing else to feed themselves.”

Came provided the example of a man in Aljabin, in Raymah. “He was a laborer who used to go to Sana’a to work, but he hasn’t had a job for about a year now. There was absolutely no money for him and his seven children to get by on and he was so happy to receive the modest ration we distributed as part of our programs that he kissed me.”

The reasons for child malnutrition are complex. Poor sanitation, the lack of a variety in diets, general illiteracy and ignorance concerning proper types of diet all contribute to the current level of malnutrition.

For instance, the CFSS has revealed that 40% of children below six months’ old were breastfed in the 24 hours preceding the taking of the survey; only 32% of children aged 6 to 23 months had been breastfed and had consumed at least one other food item.

Child malnutrition needs to be tackled early; if it goes uncured, it will set a trend for a child’s future development. The first thousand days of a child’s life are considered to be the most critical in this regard. With this in mind, troubling statistics concerning breastfeeding practices should be regarded as causes for real concern.

In addition, many communities don’t have access to clean, drinkable water, and are thus left to drink water which is unsafe and contaminated. “Sometimes even dirty water from which they risk suffering of diarrhea, and when you are 5 and undernourished that’s a potentially life threatening illness,” said Came.

Malnutrition is not necessarily connected only with poverty. UNICEF, WFP and Save the Children have taken food surveys throughout the country and found that malnutrition was also present in families that were relatively wealthy.

Education plays a role. Many women have not had the opportunity to study. Their notions of hygiene or eating practices are influenced by the environments in which they live, and knowledge of best practices are often absent.

Impact

If malnutrition is present in an infant from around birth to 24 months of age, the damages caused by under-nutrition on a child’s physical and mental development will likely be irreversible and result in permanent consequences.

Gluck emphasized that if the humanitarian crisis isn’t addressed immediately, it will jeopardize both Yemen’s short and long-term development. “Malnutrition affects future generations; it will affect their development and IQ and it will be the generation which is expected to be leading Yemen in the future.”

Stunting has been a generational problem, present in Yemen for decades. It’s usually experienced by infants whose mothers are malnourished and who had had a poor diet in early childhood. Since organs haven’t fully developed, stunting is also believed to be a factor in premature death.

“Nearly half of that generation of future-builders face stunted growth and delayed mental development as a result of under-nutrition, and over a quarter of a million more face an immediate risk of death,” declared Alan Duncan in a press release from his recent visit to Sana’a.

“It will negatively affect the child’s ability to concentrate in school, his thinking faculties and that, in turn, will reduce his ability to work and, as a consequence, his potential income,” added Came.

Coping Mechanisms

Some very extreme coping mechanisms have been adopted across the most afflicted governorates. People have resorted to purchasing food items on credit, particularly in rural areas, where it was estimated that the practice is common in 28% of the households. People are left indebted to shopkeepers, in some cases for a sum of several hundred dollars.

The situation is even worse in Abyan, Shabwa, and Lahj, where close to half of food items are bought on credit. Meanwhile, children have been pulled out of school to work for their families, selling bottles and tins or performing casual labor.

Caroline Gluck recalled a 14-year-old boy who lived near the Saudi border: “He showed me the bruises he had on his legs. He had been caught by border guards and beaten up and ordered not to trespass the border again. What he confessed to me was that there was no other choice for him – at 14, he had a father who was disabled, his mother couldn’t work, and his family relied on him to provide them with food.”

Though already present in Yemeni culture, another phenomenon which has become increasingly widespread is the marriage of young girls. Mrs. Gluck reported that families justify the practice by saying that they needed the dowry money to feed their families. Moreover, by marrying off one daughter, they would have one person less to provide for.

Programs

Several programs have been launched to tackle malnutrition. WFP has projects that join the treatment of child malnutrition with UNICEF and the Ministry of International Planning and Coordination, the Ministry of Health and Population, and the Ministry of Education.

While Oxfam doesn’t specifically deal with the nutritional and health sector, it has recognized that malnutrition is a factor in current crises and developed Emergency Response programs. Cash transfers represent one of the largest current responses undertaken by Oxfam. Officially launched in July, the Cash Life Line has targeted over 103,000 people by providing them with $50 a month.

The money allows them to meet a few basic needs. In some cases, they spend some of the money on medicine or clothes, but through monitoring how beneficiaries use the money, it has been discovered that in 97% of cases it is used to buy food. Actually, many instances have been registered in which poor households don’t buy food directly but instead use the money to clear the debt they owe to shopkeepers so that they may again purchase food using credit.

While Caroline admits that giving cash is not the solution to the wider problem – and that people need to be able to earn their own money – she argued that the situation is so precarious at the moment that it demands an emergency response. She expressed the NGO’s plans to replicate the same program in Haradh in November provided there are sufficient funds.

In an attempt to prevent malnutrition, Oxfam is working with farmers, providing them with tools and seeds, hiring tractors and paying for diesel so that they can plant crops. Women are being trained to sew and weave so as to allow them to have a source of income and an opportunity to earn money. Community veterinarians are also given courses so that they may rear and cure cattle.

Obstacles

Barry Came illustrated the Emergency Safety Net WFP has designed. It has 6 thousands ratio distribution points, with most of them elementary schools. In September alone, two million people throughout the country have been reached by the program.

Despite the fact that the major road network is a good one, once you deviate from it, sometimes there are no roads at all sometimes; otherwise, they may be very poorly constructed. This creates difficulty for trucks, especially considering that some locations are situated in mountainous areas, which leads to challenging logistical issues.

There is also an absence of quality infrastructure, trained staff, midwives, nurses and health clinics. This is especially true for the most affected areas.

“You go to these clinics in Hodeida, Mahwit and Raymah and they don’t have water, they don’t have sewage, and there’s no qualified staff. The room capacity is too limited, the place is mostly too hot and crowded,” said Came.

Even with support from the government, local infrastructures are inherently weak, with staff changing continually, thus necessitating the training of newcomers every six months.

A lack of funding is an additional issue. “In addition to our other programs, we are also feeding 500,000 IDPs and 50,000 refugees, most of whom are Somalis. The total cost of our operation this year is $223 million, but we are about $50 million short,” said the WFP spokesman.

Kelly Gilbride, Policy Advisor for Oxfam in Yemen, stated, “Friends of Yemen met in New York on the 27th September, this is the second meeting in four months. The international community has pledged 7.9$ billion. This is a generous amount. We think that they should be directed to the people who need it, to get on the ground to help people who cannot afford to eat”.

Minister Alan Duncan urged donors to follow the U.K.’s newly launched long-term program and provide predictable, long-term funding, without which agencies wouldn’t be able to commit to tackling the root causes of malnutrition as it occurs when funding is stopped half way through.

“Now is the time to invest in the future, in the children who will help to rebuild and stabilize Yemen over the next 20 or 30 years.”



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