By Rose Cytryn, Winter 2020.

As natural disasters, wars, and stories of political and economic instability grace the front pages of newspapers around the world, the effects of these phenomena are less eye grabbing and often not included in headlines. While articles and accounts of malnutrition are less common as front page stories, the incidences are of epidemic proportions. According to UNICEF in 2019, malnutrition – which is defined as the deficiency, excess, or imbalance intake of energy or nutrients by the World Health Organization [1] –  affected over 200 million children. [2] This number consists of the most inclusive and comprehensive assessment of malnutrition to date, including undernutrition, lack of sufficient nutrition, and obesity. The breadth and depth of this health issue stems from a wide variety of causes from war to famine, economic disparity and instability to natural disaster.  

Instances of malnutrition arise in situations of long term societal and communal difficulties such as instances of mass immigration, as well short-lived global or natural phenomenon such as hurricanes or forest fires, and though causes can vary in such ways, the final state of peoples affected often goes less noticed. That is, any conversation surrounding malnutrition, the frequency of which should certainly increase, should necessarily also surround the cause and the most ideal solution. In recognizing the complexity of malnutrition, causes and potential solutions or aids, Dr. Francesco Branca, the director of Nutrition for Health and Development at the WHO, reminds the public that this “world health crisis” is “…the main cause of death and disease in the world…”. [3]

The conversation regarding solutions and steps to be taken is open and evolving.  Attention is increasingly being paid not only to deployment of food but increasing the nutritional density, behaviors surrounding breastfeeding, and nutritional education for those affected as well as parents. A look to various instances of malnutrition in the world and their respective roots clarifies the importance of the variance and diversity in modes of helping. And while no one instance of malnutrition, or any global issue really, can be traced to only one moment or one structure of society or nature, it is potentially interesting to notice situational similarities and differences.  

A study conducted looking at the Impact of Natural Disasters on Child Health and Investments in Rural India conceptualized the effects of natural disasters on child health into three compartments. Increasing in directness of or distance from immediate impact, this framework includes death or contraction of illness directly due to the disaster, destruction of or strains on health care or access to healthcare, and impact on demand for inputs: specifically through loss of income or rise in expenditures required by damages. 

This study built off previous explorations into the complex relationship between natural phenomena and decreasing health and increasing malnutrition of children around the world to find that exposure to a natural disaster within the previous year was associated with a greater likelihood of stunting and underweight persons nearing an increase of 7% when compared to those not exposed. [4] The combination of a lack of resources, monetary or otherwise, and access to necessary health care, in addition to immediate impacts of natural disasters, are heightened when exposed to hurricanes, typhoons, tsunamis, or other naturally detrimental disasters. 

In looking to common solutions within communities often exposed to natural disasters, this study found that children who were exclusively breastfed were less vulnerable to disease and undernutrition than their no longer breastfed counterparts. Breastfeeding has increasingly been at the center of the conversation among aid organizations. The Lancet peer review medical journal released a series surveying breastfeeding and the implications of potential increases in breast feeding as it relates to both child and mother health. In a study looking at prevention of child mortality, the Lancet estimated the global coverage of breastfeeding as a preventative intervention to be 90% of child survival interventions for the 42 countries with 90% of child deaths in 2000. [5]  That is, breastfeeding has a high coverage rate of intervention and in instances such as natural disasters offers perhaps an extra layer of protection against the vulnerabilities which such disasters reveal and cause. 

Countries in the Horn of Africa, the northeastern peninsula of the continent which extends into the Arabian Sea, having endured a period of economic, political, and health instability, experienced an increase in children suffering from malnutrition, which is considered “a great urgency” by Dorothy Rozga, UNICEF’s Deputy Regional Director for East and Southern Africa. [6]  Beginning in 2007, 870,000 civilians fled Mogadishu, the capital of Somalia, in response to the civil war and Ethiopian intervention. [7] This mass migration coupled with outbreaks of Cholera in surrounding Kenya, Ethiopia, and Eritrea, caused access to Cholera treatments to dwindle and contributed to acute malnourishment and child mortality.  The crossing of boundaries in such a way, as well as the increased common occurrence of hijacked ships off the Somali coast contributed to the inability of resources to spread, and the prevalence of malnutrition.  As movement of political unrest and other contributing infections create pockets of undernutrition, organizations like UNICEF cite access to safe water, strengthening of “nutrition surveillance systems”, and increasing and improving community based means of providing food, water, and sanitation. That is, in instances such as these, it is perhaps in some ways less that there is no food and more that communities are – because of instability and unrest in other aspects of their structure – unable to attain the resources they need.  

In understanding the ways in which malnutrition can be prevented, or at the very least dealt with, the conversation must eventually turn to the real causes of the prevalence of malnutrition.  While the immediate lack of nourishment and imbalance in diet and regulation of vitamins and nutrients causes malnutrition, the reasons these imbalances exist in the first place are often caused by a different grouping of factors.  And while providing better nourishment and safer conditions will never be a step in the wrong direction, it is perhaps significant to understand that there may be a difference in providing aid to a less developed country which has just experienced a massive typhoon or hurricane versus a country which has recently revolted against its own government and entered into a war or political conflict. This is to say nothing of the instances of malnutrition in countries like the United States where it is not natural disasters or political revolutions which are causing these imbalances in nutrition, but a fundamental lack of education surrounding health as well as poverty and socioeconomic barriers.  It occurs, within this conversation, that while the differing root causes of instances of malnutrition in the world are significant to the specific and most advantageous solutions, part of this conversation is remembering that 239.6 million children were considered stunted, wasted, or obese in 2018 according to the Global Nutrition Report. [8]  While recognizing the root of the issue is important, it is also necessary that we don’t let the boldfaced headlines take all the attention away from the individuals at the center of the issue. 

1. “Malnutrition.” World Health Organization. World Health Organization, n.d. https://www.who.int/news-room/fact-sheets/detail/malnutrition.
2. “The State of the World’s Children 2019: Children, Food and Nutrition.” UNICEF DATA, December 29, 2019. https://data.unicef.org/resources/state-of-the-worlds-children-2019/.
3. “Malnutrition Is a World Health Crisis.” World Health Organization. World Health Organization, October 15, 2019. https://www.who.int/nutrition/topics/world-food-day-2019-malnutrition-world-health-crisis/en/.
4. Datar, Ashlesha, Jenny Liu, Sebastian Linnemayr, and Chad Stecher. “The Impact of Natural Disasters on Child Health and Investments in Rural India.” Social science & medicine (1982). U.S. National Library of Medicine, January 2013. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3544338/#!po=2.27273.
5. Jones, Gareth, Richard W Steketee, Robert E Black, Zulfiqar A Bhutta, and Saul S Morris. “How Many Child Deaths Can We Prevent This Year?” The Lancet 362, no. 9377 (2003): 65–71. https://doi.org/10.1016/s0140-6736(03)13811-1.
6. “Chronic Food Insecurity, Conflict and Political Instability.” UNICEF, May 8, 2009. https://www.unicef.org/media/media_49619.html.
7. “World Report 2009: Rights Trends in Somalia.” Human Rights Watch, July 29, 2011. https://www.hrw.org/world-report/2009/country-chapters/somalia.
8. 8. “Executive Summary.” Global Nutrition Report, April 10, 2019. https://globalnutritionreport.org/reports/global-nutrition-report-2018/executive-summary/.