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MEDAIR | news No. 1  | 2013 | medair.org

Invisible crisis, effective solutions Tackling childhood malnutrition FROM EXHAUSTION TO LIFE

Success in Somaliland NUTRITION PROGRAMMES

A lasting impact


VISION EDITORIAL

With each New Year comes opportunity to reflect on the year passed and look to the future: New challenges. Exciting plans. This is particularly true for me having recently taken over as Medair UK Director. However, planning for the year ahead with anticipation is a luxury that some do not have. This edition of Medair News focuses on the children and their families we work with who – due to malnutrition – are often unable to see further than the day ahead. In 2013, how can it be there are children across the globe without the essential food to sustain their health or in some cases, their life? We want to change this. So we’re working tirelessly to deliver life-saving treatment and prevention programmes for thousands of children. Children like Oba whose story is on page 11. As you read this magazine, my hope is you will catch a glimpse of how we’re working to transform young lives from Afghanistan to Somaliland and beyond. Your support in helping us is invaluable. Thank you.

Alex Day Director, Medair UK

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c r i s i s B RI E F I N G Nourish the children

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Th e i m pac t From exhaustion to life

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D o n a te N o w Give now. Give hope.

Sources: 1. World Health Organization. 2012. Children: reducing mortality. Fact sheet No. 178. 2. United Nations. The Millennium Development Goals Report 2012. 3. Black, R.E. et al. 2008. “Maternal and child undernutrition: Global and regional exposures and health consequences.” Lancet 371: 243-60. 4. Bhutta, Zulfiqar A. et al. “What works? Interventions for maternal and child undernutrition and survival.” 2008. Lancet 371: 41-50. 5. UNICEF. 2009. Tracking Progress on Child and Maternal Nutrition. 6. Valid International. 2006. Community-Based Therapeutic Care (CTC): A Field Manual. Funding Partners: Afghanistan, Swiss Solidarity, E.C. Directorate-General for Humanitarian Aid and Civil Protection. Somalia/Somaliland, Swiss Solidarity, Woord en Daad (NL), United Nations Children’s Fund, EO Metterdaad (NL), E.C. Directorate-General for Humanitarian Aid and Civil Protection, Help a Child (NL), Department for International Development (UK). South Sudan, E.C. Directorate-General for Humanitarian Aid and Civil Protection, United States Agency for International Development, Common Humanitarian Fund. Cover: In the remote village of Gumburu Xangeyo, Somaliland, a group of boys enthusiastically eat nutritious food from sachets 2  Medair December distributed | 2012 | medair.org by Medair’s therapeutic feeding programme. © Medair/Jaco Klamer.

M E D AIR U K

Unit 3 Taylors Yard 67 Alderbrook Road LONDON, SW12 8AD Tel: 020 8772 0100 united.kingdom@medair.org medair.org All photos © Medair unless otherwise stated Charity registering in England and Wales no. 1056731 Limited Company registered in England and Wales no. 3213889 The paper used in this publication is made using 100% ECF pulp from a sustainable source and is 100% recyclable.


NUTRITION

© Medair/Jaco Klamer

The Need for Nutrition Medair brings relief From September 2011 to August 2012, Medair treated more than 7,000 malnourished children under the age of five in Somaliland.

When Medair came to our village, they looked at Rahma and said she was malnourished. They said she should go to the stabilisation centre in Burao; the nurses there gave her special milk. Now Rahma is being fed by Medair – she takes the special food sachets that Medair brings. I also feed her with breast milk – I learned at the stabilisation centre that this is important. Rahma is doing better. Before, she was weak and hardly able to hold her head up. Now she can move around by herself. – Shukri Ali Yusuf, 22, and her daughter Rahma at home in Warrir, Somaliland. medair.org  | 2012 |  Medair December 

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CRISIS BRIEFING

Nourish the children We know the single best way to keep children alive and healthy. They need good nutrition. Why aren’t they getting what they need? © Medair/Stella Chetham

Undernourished children are weighed in hanging baskets at a malnutrition assessment in Somaliland.

Malnutrition kills. Did you know that malnutrition is the number one cause of child mortality and illness in developing countries? One in three child deaths worldwide is linked to malnourishment.

Children need quality, not just quantity. It doesn’t matter how much food children eat if they don’t eat the food they need. Children under the age of five need high-quality protein, vitamins, minerals, and essential fats and carbohydrates.

Malnutrition hurts. Many undernourished children suffer long-term physical and cognitive damage that limits their growth, causes frequent illness and health problems, and permanently impairs their ability to think and learn. Much of the damage is done by the age of two.

Children need protection from disease. Undernourished children have weak immune systems that make them more susceptible to deadly diseases. Even as their tiny bodies fight to survive, illness limits the absorption of vital nutrients, making their malnutrition worse. It’s a vicious cycle that’s hard to break.

Malnutrition wastes. Think of all those children, alive and bursting with potential, who never get a fighting chance. Think of the social impact on vulnerable countries when a generation of children struggles to grow and stay healthy so they can get an education and earn an income as adults.

Mothers need to be well-nourished. Women of childbearing age need good nutrition to ensure they pass on vital nutrients to their children at crucial stages of fetal and infant development.

The good news: It doesn’t have to be this way. Children’s nutrition can be dramatically improved with the right kind of interventions. 4 

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Mothers and caregivers need to be well-informed. Mothers and other caregivers need practical knowledge on everything from breastfeeding to hygiene to keep their children nourished and healthy.


CRISIS BRIEFING

“ Despite clear evidence of the disastrous consequences of childhood nutritional deprivation in the short and long terms, nutritional health remains a low priority. It is time for nutrition to be placed higher on the development agenda.” – U.N. Millennium Development Goals Report 2012 Medair delivers Community-Based Management of Acute Malnutrition (CMAM) — a proven treatment model that enables children under five to rapidly recover while promoting long-term nutrition improvements.

C m a m Includes:

C o m m un i t y Out r e a c h Services and programmes addressing MAM

Outpatient care for SAM without complications

Inpatient care for the most severe cases. Services and/ or programmes to prevent undernutrition

Inpatient care for SAM with complications

Valid International. 2006. Community-Based Therapeutic Care (CTC): A Field Manual.

Outpatient care in home communities. Supplementary food rations. Community outreach.

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Services or programmes to prevent undernutrition. SAM = Severe Acute Malnutrition MAM = Moderate Acute Malnutrition

Five Proven Ways To Reduce Malnutrition

Did you know that with breastfeeding,

Nourish acutely malnourished children with food and medicine to speed their recovery.

if done early and exclusively for the first six

Reduce disease through quality health care, safe drinking water, sanitary latrines, and hygiene awareness.

food until the child is two, the number of

Vaccinate children against common diseases. Nourish pregnant and lactating women with nutritious food and vitamins. Educate mothers on feeding habits, health, hygiene, and nutrition.

months and continued with complementary child deaths worldwide would be cut by 19 percent? Every mother needs to know that. Right now, only 38 percent of the

months world’s children are exclusively breastfed for the first six months.

medair.org  February  December    | 2012  | 2013  |  Medair | medair.org

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THE IMPACT FE ATU RE STO RY

From exhaustion to life In Somaliland’s Muruqmal displacement camp, children run around full of exuberant energy. It’s wonderful to see. © Medair/Ed Nash

T h e c r i s i s c o nt i nue s Thousands of children across Somalia/Somaliland are recovering from the harsh drought that left them malnourished and on the brink of death. Rainfall has helped fuel a fragile recovery, along with the determined efforts of humanitarian agencies like Medair to bring life-saving relief to some extremely hard-to-reach communities. What was once a catastrophic situation has begun to improve, but we must not relent in our efforts. More Children play in Muruqmal camp where Medair provides services in health and nutrition.

Not long ago, some of these children did not have the energy to walk, let alone run. They are recovering well from acute malnutrition. But take a walk around the camp and you’ll also see some of the younger children lying in their mothers’ arms, malnourished, their exhausted eyes glazing over. Most families in camps like Muruqmal have been hit hard by malnutrition. Milgo Hussein, for example, lives here with eight children. “I feed them twice a day,” she says. “They eat rice and, if we can afford it, a few vegetables.” The lack of nutritious food hurts the youngest children the most. Milgo’s one-year-old daughter, Fatha, became critically ill during the recent drought. Thankfully, our team run an integrated relief programme that helps reduce children’s malnutrition in camps like Muruqmal. We enrolled Fatha in a therapeutic feeding programme and gave her sachets of nutritious 6 

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food. “She was so weak she could not eat it herself, so I fed it to her, a little at a time,” says Milgo. With regular treatment, Fatha gained weight and became more active. “Fatha is now much better,” says Milgo. “The special food from Medair has been very good for her.” We also give out food rations to help mothers feed their whole families. “I am able to get rice, pasta, flour, dates, oil, and even a little sugar each month to feed my children,” she says. “The situation is difficult for us because we are so poor – this really helps us. My other children would also be malnourished without the food we receive.” As Fatha gurgles happily in her mother’s lap, she breaks into a sudden squeal of joy when her mother tickles her. In Muruqmal, you see firsthand the impact of Medair’s work: exhausted children brought back to life and families hopeful about the future once again.

than a million people remain in crisis and nearly a quarter million children are acutely malnourished. Child malnutrition continues to plague the impoverished families living in Somaliland displacement camps. With real progress being made, we must continue to reach out and nourish these children while they still have a chance to grow up strong and healthy.


THE IMPACT FE ATU RE STO RY

Q: How does Medair tackle childhood malnutrition in Somaliland? A: We use an integrated approach to address malnutrition, and we do what we say we will do. When we say we will support a health clinic, we really do it, providing medicine, training, and repairs when necessary. We support communities the hard way, visiting them again and again to check their progress. We don’t just hand out some food then disappear. We deliver quality assistance and are prepared to travel to distant places not visited by many NGOs. We involve local people in planning our programmes, and we invest a lot of effort in training. By transferring skills to the community, the people we have trained can continue, after we leave, to provide health care, restore berkads (water reservoirs), or teach mothers about the importance of exclusive breastfeeding. Our work also benefits the economy in the areas where we are based, with dozens of people employed and trained in places where sources of income are sparse. When I hear about how some of the biggest berkads we have rehabilitated have been filled in a single downpour, or when I see malnourished children recovering in the stabilisation centre we support, I realise we really are making a difference here. – Rhonda Eikelboom, Country Director for Medair in Somaliland

Rhonda Eikelboom, Country Director for Medair in Somaliland.

“I think it’s so encouraging that the prevention and treatment of malnutrition has such potential. Not just to save children’s lives, but to help them develop well physically and mentally and intellectually. The thing that I’m really encouraged by is the behaviour change work that we do has real potential to prevent malnutrition and lots of other illness.” – Dr. Hannah Pollard, Medair Senior Health and Nutrition Advisor

Treating and preventing malnutrition in Somaliland: An integrated approach

Therapeutic feeding programmes – immediate intensive medical and nutritional treatment for severely malnourished people. Education on breastfeeding, health, hygiene and nutrition through trained care groups and community mobilisers. Support for health clinics and stabilisation centre. Vaccinations against common childhood diseases. Wells, berkads (water reservoirs), water trucking, water filters. Distribution of essential non-food items soap, buckets with lids, ceramic water filters, and tarpaulins to make sturdier shelters. Training and supervision of local health professionals and Water, Sanitation and Hygiene technicians. February  | 2013 | medair.org 

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© Medair/Andrew Robinson

THE IMPACT

South Sudan Malnutrition on the rise From February to July 2012, Medair helped nourish more than 6,000 people in South Sudan. In February 2012, we started a nutrition programme in Pibor after inter-tribal conflict forced people to flee their villages and take refuge there. Far from their homes and fields, many children became malnourished. Indeed, malnutrition rose throughout South Sudan in 2012 because of long-term conflict and poor harvests due to repeated flooding and droughts. In response, Medair ran nutrition projects in four different communities, treating nearly 2,000 acutely malnourished children in the first half of the year and handing out food rations to another 4,000 people to prevent malnutrition.

Reflections from Pibor When Medair’s Heidi Giesbrecht visited the team in Pibor, she witnessed a food distribution firsthand. “My favourite part was the appetite test, where each child was given a small cup with cooked corn, soy bean, and oil to see if they were still interested in eating,” explains Heidi.

T H E IMPAC T O F WASH I N A F G HA N IS TA N In Afghanistan’s remote Bamyan province, Medair has been improving access to water, sanitation, and hygiene (WASH). As a result, children in the area have become healthier, with fewer

“Most of the kids lapped up every drop of the porridge, getting it all over their faces and hands — a good sign! This food is what it takes to help these kids go from being weak and thin to slowly gaining weight and energy and eventually being discharged from the programme.”

incidences of malnutrition, thanks to the safe water, latrines, and more awareness of health and hygiene. When a Medair survey team travelled through southern Bamyan, members visited villages that had benefited from our WASH projects and those that had not. They were amazed at the difference. “In areas where Medair has not run its WASH programme, the villages were dirtier, the people looked sicker, and the children had eye infections and skin disease,” reports Medair’s Alan

A little girl skips

Service. “In these

away from the food

communities we found higher

distribution site in

rates of malnutrition as well.”

Pibor, South Sudan.

“There are fewer cases of diarrhoea and malnutrition Mothers carry children

from communities that

on their backs and food

have benefited from WASH

on their heads as they

programmes,” confirmed Dr.

leave the supplementary

Abozer, head doctor at Panjab

food distribution in Pibor.

hospital. “The majority of the patients we treat for diarrhoea and malnutrition come from communities that have not had any water, sanitation, and hygiene assistance.”

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February  | 2013 | medair.org


DO NATE N OW

Every year, malnutrition robs

87 %

millions of children of their health

of Medair’s

UNICEF calls it an invisible problem.

incoming funds

We call it a tragedy.

are used in field

Improving nutrition in remote and

programmes

devastated communities is not always

and strength, impairs their brains, and snatches away their potential before they ever have a chance.

easy. Treating acutely malnourished

that serve our © Medair/Phil Moore

beneficiaries.

children in emergency situations is one of the most logistically challenging and complex things we do.

Give now. Give hope. Please spread the word. Support projects that nourish children. Make a donation to Medair today. Visit www.medair.org/donate or use the form enclosed with this magazine. We make the extra effort because we know just how effective our nutrition programmes can be. With your support, our nutrition work can produce profoundly life-changing benefits for children, their families, and their communities. Your gift nourishes young children and

© Medair/Jan-Joseph Stok

mothers in devastated communities and gives them the services, knowledge, and skills they need to stay healthy long into the future. medair.org  | 2012 |  Medair December 

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PROGRAMMES

Where we work:

HAITI Haiti continues to rebuild from its 2010 earthquake. Many communities lack access to safe water or sanitation, and Tropical Storm Isaac caused significant damage in Côtes de Fer in 2012.

SOUTH SUDAN As the world’s newest nation struggles to handle the recent arrival of hundreds of thousands of returnees and refugees, there are widespread needs for health, nutrition, WASH, and shelter.

SOMALIA/SOMALILAND Acute malnutrition remains high as the country recovers from severe drought. Displaced families live in poverty in camps, with very limited health care or access to WASH.

SYRIA CRISIS LEBANON

JORDAN

AFGHANISTAN Flooding, severe drought, and harsh winters leave remote, vulnerable farming communities in Bamyan province in need of food, safe water, sanitation, and protection from future disasters.

AFGHANISTAN

CHAD

SOUTH SUDAN SOMALIA/SOMALILAND

ACTIVITY KEY D.R. CONGO HEALTH & NUTRITION WASH

(Water, Sanitation, and Hygiene)

ZIMBABWE

MADAGASCAR

SHELTER & INFRASTRUCTURE

Where we work can quickly change due to sudden emergencies around the world. Visit medair.org for updates.

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ZIMBABWE

SYRIA CRISIS

D.R. CONGO

Deadly cholera outbreaks in recent years highlight the need

Syrian families are fleeing the war, arriving en masse

Militia attacks and occupations displace hundreds of thousands

for improvements to safe drinking water and hygiene awareness in urban and rural communities.

in neighbouring countries. Refugees and overwhelmed host communities face staggering needs.

in remote Orientale province. Poor roads limit access. Major needs include health care, safe water, and sanitation.

February  | 2013 | medair.org

MADAGASCAR Madagascar is highly vulnerable to cyclones. Remote communities need assistance to reduce risks from future disasters and improve access to safe water and sanitation.

CHAD Medair is now starting a new relief programme in Chad that will respond to the high levels of unmet need in the country.


UK NEWS

Thank you! A huge thank you to everyone who gave to our Give tomorrows without hunger campaign over Christmas. The generosity of Medair supporters across the UK means our double your donation for free event raised over £90,000 to help some of the world’s most vulnerable children. Children like Oba. She lives in Kosaar IDP camp, Burao, Somaliland. At just five months old, she contracted pneumonia. Her mother Khadar took her to the hospital and she was treated.

© Medair

But, just one month later, she was not breastfeeding well. Khadar had to express milk into a cup and feed her from it. And then Oba contracted diarrhoea – a massive blow to her already-weakened body. Medair’s Care Group Community operates in Kosaar camp. The Care Group model uses community volunteers to deliver health, nutrition, and hygiene messages to their communities. Volunteers screen children for malnutrition and make follow-up visits to children enrolled in our nutrition programmes. As part of their weekly routine, promoter Aisha Mohammed and volunteer Cibaado Dhinbiil visit families. “After assessment, we gave Oba some oral rehydration solution for the diarrhoea,” says Cibaado. Three days later the pair returned for a follow-up visit. Oba was much worse. “They advised me to take Oba to the Kosaar Health Centre for treatment and malnutrition screening,” says Khadar. “She was diagnosed as severely malnourished with persistent diarrhoea. She was referred to the Burao Hospital Stabilisation Centre which Medair supports.” Oba remained at the stabilisation centre for two months before being referred back to the outpatient therapeutic programme. After three months of ongoing treatment for severe acute malnutrition, Oba then received treatment for her moderate acute malnutrition. Thanks to Care Group promoters and volunteers, mothers like Khadar in 15 locations across Burao and its surroundings are receiving life-saving health, nutrition and hygiene messages. Six months on, Oba is gregarious, happy, and healthy: “My child was very sick. The Medair volunteers came and advised me what to do. This programme saved her life,” smiles Khadar, cuddling Oba in her arms.

“ It’s so encouraging to hear stories like Khadar’s. This is what the care group is about: neighbours looking out for each other. It proves that saving lives starts in the community, by the community. ” – Fabienne Ray, Health Project Manager

medair.org  | 2013 | February 

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Before Medair came, the children used to sleep all day and hardly moved. They were exhausted because we didn’t have enough food for them. We can see that they are happy now because they are always moving around. Without Medair, the children would have died. —Fadumo Mohamed, Gumburu Xangeyo village, Sool district, Somaliland

Malnourished children need you. Get involved today at medair.org.

Syria Crisis: Thank You! On behalf of the Medair team and all of the Syrian refugees and host families we’ve met in Lebanon and Jordan, THANK YOU for your generous donations. We asked for your help and you answered our call! Your support gave us what we needed to launch an emergency response that is now bringing urgently needed relief to Syrian families who had been caught in the crossfire. From the bottom of our hearts, we thank you. With this newly redesigned Medair News, we aim to bring you closer to the reality of life in the field, publishing more photos and behind-the-scenes insights into the lives of people who are courageously facing crisis. And why not check out our new website, which launched in December. You’ll find it at medair.org


Medair News UK 02/2013