Designing nutrition programmes in emergencies

1. Emergency Phase

As refugees continue to arrive, it is crucial to implement a comprehensive nutrition response plan to address the needs of vulnerable populations. This plan outlines key points to ensure rapid screening, estimation of people in need, and appropriate interventions to combat malnutrition and improve the nutrition situation among refugees. Additionally, coordination with relevant partners and regular monitoring are essential to achieve successful outcomes. Lastly, certain risks and challenges need to be considered to ensure the plan's effectiveness and sustainability.

Rapid nutrition screening: To ensure the well-being of refugees, upon arrival, conduct initial rapid nutrition screening to identify individuals at immediate risk. Continuously screen for acute malnutrition at transit, reception centres, and within the community to monitor the nutrition situation and to identify individuals who need treatment. Refer to the sectoral coordination: UNHCR Public health tool kit for specific details.

Co-ordination with relevant sectors and partner/s: To facilitate a coordinated approach and maximize efficiency, establish strong coordination among public health subsectors including general health, reproductive health, mental health and psychosocial support and nutrition programs to ensure seamless coverage of all needs. Collaboration with education, WASH, Shelter, Protection is also crucial. Facilitate referrals and individual follow-ups to ensure continuity of care.

Estimating people in need: To accurately assess the scale of nutrition assistance required, gather relevant data from registration section or UNHCR ProGres to determine the target group proportions, including, children aged 0-6 months; children aged 6-23 months; children aged 0-59 months and pregnant and breastfeeding women. If disaggregated data for children aged 0-59 months is unavailable, assume this group represents 20% of the population. Assume that among children aged 0-59 months 10% are aged 0-6 months and 30% are aged 6-23 months. Assume 7% of the total population are pregnant and breastfeeding women, with 4% being pregnant.

Estimating the number of people in need of nutrition assistance: To determine the extent of nutrition assistance required, use the prevalence of Global Acute Malnutrition (GAM) along with standard thresholds and historical data to estimate the number of people in need. Focus attention on refugee situations categorized as of medium to extremely high concern for malnutrition, breastfeeding, and food consumption to guide decision-making. See the various severity categorisation under the standards and indicators annex.

Estimating the prevalence of Global Acute Malnutrition (GAM) for a response plan over 12 months: To plan for a sustained response, obtain prevalence estimates of GAM from reliable nutrition surveys such as SENS (Standardized Expanded Nutrition Survey), SMART (Standardized Monitoring and Assessment of Relief and Transitions), or MICS (Multi Indicator Cluster Survey). If only MUAC (Mid-Upper Arm Circumference) data is available from rapid assessments, use the proportion of children with MUAC <12.5cm (MUAC malnutrition) as the estimated prevalence. Use the prevalence and estimated incidence to calculate the total number of people to be included in the response plan for 12 months. If incidence data is not available at the beginning of an emergency, apply an incidence correction factor of 2.6 for both severe and moderate acute malnutrition. Calculate specific incidence estimates using longitudinal program data when programs have been running for 6-12 months, and heterogeneous conditions are expected. See additional details under the standards and indicators section.

Key nutrition-specific interventions: To ensure adequate nutrition for all refugees, ensure access to safe and sufficient nutritious food through in-kind or cash assistance. Provide dry ready-to-eat meals (e.g., high energy biscuits) and water in the first 72 hours at border points, hot meals at transit/reception centres, and general ration when cooking is possible at the household level. Offer targeted complementary food as indicated for groups with increased nutrition needs, such as pregnant and breastfeeding women, children under five, and people living with chronic diseases (e.g., HIV/TB). This can be through blanket supplementary feeding or cash for nutrition. Support optimal breastfeeding practices and appropriate complementary feeding for infants and young children. Micronutrients reduction initiatives like Vitamin A supplementation among children, iron and folate supplementation among pregnant and breastfeeding women and deworming should also be considered as indicated by the context.

Monitoring the nutrition situation: To track progress and respond to emerging needs effectively, regular monitoring should be established to track changes in nutrition status and effectiveness of interventions in place. Conduct follow-up assessments to measure the impact of interventions and adjust strategies as needed. Ensure collaboration with other sectors and stakeholders for integrated data collection, joint monitoring, analysis and feedback to inform coordinated responses.

Related risks:

• Inadequate resources or a shortage of skilled personnel will curtail an effective nutrition response including for example hindering comprehensive screening, leading to potential undetected cases of malnutrition and subsequent increased risk of disease and deaths.
• Lack of communication and collaboration among partners may result in fragmented services and gaps in the nutrition response.
• Reliance on incomplete or inaccurate data may lead to an underestimation or overestimation of the population in need, impacting resource allocation.
• Solely relying on historical data may not account for changing conditions or emerging nutrition challenges.
• Limited access to accurate survey data may affect the precision of prevalence estimates.
• Supply chain disruptions or logistical challenges may hinder the timely delivery of food and nutrition supplies.
• Inconsistent monitoring or insufficient data collection may impede the ability to track progress and identify emerging nutrition concerns.