Let's look first at the risk of malnutrition in disasters and its causes. The first question I want to raise with you is, why is nutrition important in a disaster context? But perhaps before that, let's focus first on nutrition in general. What is the importance of adequate nutrition in any context, disaster or not? In order to live healthy, all human beings need proteins, carbohydrates, and fats or lipids. We call them macronutrients. We also need vitamins and minerals. Those we call micro-nutrients. Both groups of nutrients fulfill many roles in the human body. I won't go in detail on this but what I do want to mention is that only macronutrients can provide calories. And to keep it simple, calories you need in order to remain warm and to be physically active. If we don't meet all the nutritional requirements, there will be consequences for our health. Without adequate intake of these macro and micronutrients, there is a risk that a person gets sick quicker or does not recover from illness, does not grow or has very little energy. Nutritional deficiencies can also cause mental impairment. There is also a risk that for instance a malnourished pregnant woman gives birth to an infant that is very small and perhaps has nutritional deficits at start of life, and this might have consequences for example to development of organs, not to mention what the consequences will be for the malnourished pregnant woman herself. In this slide, you see humans in different biological phases of life. If malnutrition occurs, the consequences vary and they depend upon what biological phase the human being is in. The earlier in life malnutrition occurs, the more devastating and longer-lasting the consequences will be. Regardless of the age or gender of a person, inadequate nutrition might become a threat to his or her survival. This count for small children, for adolescents, for adults including elderly people. You hear me using the term malnutrition so easily, but do we know what it means? Let's look at the definition. This slide gives you a kind of textbook definition of what malnutrition is. Malnutrition is a "state in which the physical function of an individual is impaired to the point where he or she can no longer maintain adequate bodily performance processes, such as growth, pregnancy, lactation, physical work, and resisting and recovering from disease." Technically, if I need to be 100% correct, malnutrition includes both undernutrition and overnutrition. And yes, this means that overweight or obesity is also a form of malnutrition. However, in this module, I will refer always to undernutrition when I speak about malnutrition. In other words, I will discuss only the impact of not having enough nutrients, being it the macro or micronutrients. So far, we've only dealt with the question: What is the importance of adequate nutrition in any context? We know that malnutrition puts at higher risk the well-being of any human being. So let's now go back to our first question, why is nutrition important in a disaster context? The answer is, because the risk of malnutrition can be very high in a disaster context. And why is there a higher risk of malnutrition in disasters? Well, imagine one of these circumstances, whether population is affected by a natural disaster or by conflict, people will endure hardship physically, economically, and mentally. In a disaster context, people's livelihoods might be affected, often in a negative way, and families have lost assets which they would normally use to buy food or medicine. Imagine if all your belongings have been washed away by floodwaters and you have no other assets. You might be completely dependent on what others give you for your food and water. People might be exposed to physical hardship and are more exposed to cold weather, wind, rain, or cramped and small areas and therefore get sick easier. People might not have access to safe drinking water – this might lead to diarrheal diseases. People might be injured or sick and therefore have higher nutritional needs to recover from that. People might not have access to sufficient quantity or quality of food. In other words, their diet lacks all or some nutrients they need for a healthy life. People might have lost loved ones and are in such a emotional stress that it's difficult for them to prepare a meal or eat. I remember a child in Burundi. She had all the food available in our nutritional center, yet she did not eat. She was apathetic and could only stare in front of her. She had seen so many atrocities. Her mother was killed in front of her. And there are many other reasons, all of which increase the risk of becoming malnourished. I want to introduce to you an important framework called the conceptual framework for causes of malnutrition. It was designed by UNICEF in the 90s. This framework is particularly useful explaining causes of malnutrition in a humanitarian context. Malnutrition can be caused by not consuming enough food in terms of quantity or quality. For example, a person can consume enough calories, but if the diet lacks certain vitamins, this person can become malnourished. As opposed to what some people think, malnutrition is caused not by only lack of adequate food, disease can be important to. A sick person has often higher nutritional needs, whether to fight an infection or to recover from an injury. However, a sick person often has less appetite and will eat less exactly when he or she needs more nutrients. In another situation, a person might be suffering from diarrheal disease and perhaps she or he eats sufficient food but the nutrients will not be well absorbed because of the diarrhea. This could also lead to malnutrition. To summarize, malnutrition is directly caused by either inadequate food intake and/or by disease. Let us look at each of the underlying causes using our conceptual framework. Food insecurity – and we looked already at this in a module on livelihoods – can be an underlying cause for inadequate food intake. For example, food prices are very high due to limited availability of food. For instance, food storages might be destroyed in a flood or there is limited food available because of a bombardment of food storages or markets or of roads used for food deliveries. Droughts also often drive up food prices, leading to food insecurity. People can also be food-insecure because of having very few means to purchase food. This can be caused by pure poverty but also because of a disaster. Due to fleeing, families, wealthy or poor, might have left most of their belongings behind and the cash they have might not be enough to buy food, and whatever assets they have they might need that for transport to go to safer areas or for paying for drinking water or a place to sleep. The social and care environment might also be changed in a way that causes indirectly malnutrition. This is a cause that some might find difficult to understand. I will try to illustrate this with an example. Imagine families have limited access to fuel or cooking utensils because of a flood. They might therefore only be able to cook a limited amount of food for their children, and instead of five small meals that smaller children normally eat, they are only provided one or two meals per day. It might also be difficult to feed children if caregivers spend most of the time searching or queuing for food or other commodities, or if families are all on the move, fleeing. Psychosocial stress can be another cause. Mothers that breastfeed might be grieving because they just lost a family member or a friend. This might affect their breastfeeding as they feel they cannot do it. This will certainly result in higher risk for an infant to become malnourished. Inadequate public health is also an underlying cause of malnutrition. Imagine how the routine immunizations will be affected by a major disaster leaving many children at high risk for an outbreak of infectious diseases. An outbreak such as measles will have devastating consequences for their nutritional status. Lastly, a disaster might weaken or even destroy health systems and services could be suspended. For example, health staff might not be available in their posts. Medical supplies might not arrive anymore at the health center or health facilities might have been ransacked. Safe water supplies could be disrupted, and this combined with inadequate sanitation can be a major threat to increasing the spread of diseases. And then there are basic causes that contribute to increased malnutrition. A government can decide to hold, for example, subsidies, bread, or flour because of political unrest or budget deficits or political decisions result in reducing the budget for healthcare if the country suffers from major inflation, or a country can divert a large part of its budget towards the military, away from basic civil services because it is engaged in an armed conflict. This conceptual framework is very important to remember. It gives, at a glance, the possible causes of malnutrition, and you can apply this in any situation, floods, earthquakes, conflicts, tsunamis or any other disaster. But of course, causes of malnutrition will vary by context and also the severity can vary in place and in time. In the next section, you will practice how to use this conceptual framework.
