nutrition in times of war 50 questions & answers

Introduction

War abruptly breaks food systems, disrupts healthcare and water/sanitation, and concentrates vulnerable groups (children, pregnant/lactating women, elderly, people with chronic disease). Humanitarian nutrition in conflict must therefore combine: (1) rapid assessment and surveillance; (2) lifesaving treatment (management of severe and moderate acute malnutrition); (3) protection of infant and young child feeding; (4) programs that ensure nutritionally adequate, culturally acceptable food access (in-kind, cash/vouchers or market support); and (5) coordination and legal/operational actions to protect food access and avoid food being used as a weapon. Standards and clusters exist to guide each step. (Sphere, World Health Organization, International Committee of the Red Cross)

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50 Q&A about nutrition in times of war

Q — What’s the first nutrition action within 24–72 hours after displacement or attack?
A — Rapid, simplified nutrition & food security assessment (household food access, stocks, breastfeeding status, MUAC screening for children 6–59 months) and immediate provision of safe drinking water + simple food rations or cash if markets work. Early MUAC screening identifies SAM quickly for referral. (World Health Organization, Sphere)
Q — Which anthropometric indicator is fastest/most practical in chaotic settings?
A — MUAC (mid-upper arm circumference) for children 6–59 months: quick, low training needs, single measurement device, good predictor of mortality risk. Use weight/height when possible for program monitoring. (Sphere)
Q — How to prioritize who gets food when supplies are limited?
A — Use vulnerability criteria: pregnant/lactating women, children <5 (especially SAM/MAM), elderly, chronically ill, households with unaccompanied minors, and then households headed by single caregivers. Protect caregivers to protect children. (World Food Programme)
Q — What to do about infant feeding when mothers and infants are separated?
A — Reunite if possible. If separation persists, support relactation where feasible; if not possible, use wet-nursing only after screening; provide age-appropriate breastmilk substitutes only per IYCF-E (Infant and Young Child Feeding in Emergencies) protocols and with strict safeguards (qualified staff, safe preparation, and follow-up). Avoid uncontrolled formula distribution. (World Health Organization)
Q — Is infant formula ever appropriate in conflict zones?
A — Yes, but only under strict IYCF-E conditions (medical indication, absence of safe alternatives, assured supply chain, clean water, caregivers trained to prepare). Uncontrolled distribution increases infant mortality. (World Health Organization)
Q — Which ready-to-use therapeutic products are standard for SAM?
A — RUTF (ready-to-use therapeutic food) for community treatment of uncomplicated SAM, plus inpatient therapeutic feeding for complicated SAM (medical complications). Use standard CMAM/IMAM protocols. (World Health Organization)
Q — How long can RUTF be stored in hot/war conditions?
A — Shelf life varies by product (often 9–24 months unopened). Store in cool, dry, shaded spaces away from pests; rotate stock (FEFO/FIFO); monitor for bulging, off smells. Plan buffer stocks and rapid distribution given logistic interruptions. (Refer to specific manufacturer specs.) (World Food Programme)
Q — Cash assistance vs in-kind food: which is better in conflict?
A — If local markets function and are stocked, cash/vouchers can be faster and better for diets and dignity. If markets are disrupted, looted or food is used as a weapon, in-kind food or commodity pipelines are necessary. Do market assessments first. (World Food Programme)
Q — How to detect if food is being used as a weapon or withheld deliberately?
A — Monitor access trends (roadblocks, population movement), price spikes, reports of seizure/destruction of crops/storage, and ICRC/legal analysis. Document and advocate with protection and legal partners — starvation as a method of warfare is prohibited under IHL. (International Committee of the Red Cross)
Q — What are minimum caloric/ration targets in emergencies?
A — Sphere recommends minimum energy needs at household level (e.g., ~2,100 kcal/person/day as a reference baseline for food aid design), adjusted for demographics and activity; practical rations in acute conflict may be lower but must be supplemented with targeted nutrition interventions for high-risk groups. Always consult Sphere/cluster guidance when designing rations. (Sphere)
Q — Which micronutrients are highest risk during conflict?
A — Vitamin A (child mortality risk), iron/folate (pregnant women), iodine (where salt iodization disrupted), zinc (diarrhea outcomes), and general multi-micronutrient deficits. Micronutrient supplementation campaigns are essential where coverage drops. (World Health Organization)
Q — Should measles vaccination be integrated with nutrition response?
A — Yes. Measles increases malnutrition risk; joint nutrition-immunization campaigns (vitamin A + measles vaccine) reduce mortality in emergencies. Coordinate with health cluster. (World Health Organization)
Q — How to run nutrition surveillance under conflict?
A — Combine simplified community screening (MUAC), sentinel site surveys (SMART where possible), market/food price monitoring, food security household questionnaires, and routine health facility data; triangulate sources frequently for early warning. (Nutrition Cluster)
Q — What thresholds indicate a nutrition emergency or need for scale-up?
A — High GAM (global acute malnutrition) >15% indicates critical emergency; GAM 10–14.9% is serious; SAM prevalence and mortality, plus poor coverage of treatment, signal urgent scale-up needs. Also consider food insecurity, mortality rates and access constraints. (Use SMART survey guidance.) (Sphere)
Q — How to integrate WASH with nutrition in war settings?
A — Prioritize safe water for food preparation and therapeutic feeding, sanitation to prevent diarrheas, and hygiene (soap, chlorination) in feeding centers. Nutrition outcomes hinge on WASH access. (World Health Organization)
Q — How to safely run an outpatient therapeutic program (OTP) in insecure areas?
A — Use decentralised community health workers, mobile distributions, reduced frequency of follow-up when security forces limit movement (while monitoring outcomes), protection of staff, and contingency plans for remote monitoring. Use simplified protocols where needed but preserve quality. (World Health Organization)
Q — How to handle non-communicable diseases (NCDs) like diabetes/hypertension in displaced populations?
A — Maintain continuity of essential medications where possible, include appropriate food items (e.g., for diabetic rations), screen for complications, coordinate with primary health care, and design food packages that avoid simple carbohydrate overload. Protect people dependent on chronic therapy. (World Food Programme)
Q — How to protect adolescent nutrition in wartime?
A — Ensure adolescent-appropriate rations, school+community feeding where feasible, sexual and reproductive health access for girls, and psychosocial support — adolescence is a growth phase and often overlooked. (World Food Programme)
Q — Is fortification feasible during conflict?
A — Where food is procured locally and markets function, fortification (staple flour, oil, salt iodization) is high-impact. For imported in-kind rations, provide fortified products or micronutrient powders for young children. (World Food Programme)
Q — How to minimize foodborne disease risk in mass distributions?
A — Ensure safe storage, provide cooking instructions, distribute with WASH/hygiene items, inspect foods for spoilage, avoid perishable items unless cold chain is guaranteed, and include messaging on safe reheating/preparation. (Sphere)
Q — What role does local procurement play?
A — Local procurement supports markets and can be faster, but verify quality/safety, price stability, and supply continuity. Local buys reduce transport risks but require supply-chain checks. (World Food Programme)
Q — How to address severe acute malnutrition (SAM) in infants <6 months?
A — Prioritise breastfeeding support and treatment of underlying medical causes; use inpatient care for complicated cases and specialist teams for re-lactation; therapeutic milks are sometimes used under clinical supervision. (World Health Organization)
Q — How to design culturally acceptable food rations?
A — Engage affected communities in ration design, respect dietary laws and taboos, include familiar staples where possible, and incorporate small cash for local food purchases to improve acceptability. (World Food Programme)
Q — What program protects pregnant & lactating women nutritionally?
A — Targeted supplementary feeding (pregnancy & lactation rations or fortified blended foods), iron/folate supplementation, and linkage to antenatal care; ensure food distributions are accessible and safe for pregnant women. (World Health Organization)
Q — How to manage breastfeeding in shelters with overcrowding?
A — Provide private clean spaces for breastfeeding, promote skin-to-skin contact, offer breastfeeding counseling, and protect mothers from harassment at distribution points. (World Health Organization)
Q — What logistics constraints commonly break nutrition response in war?
A — Road closures, checkpoints, looting, port closures, limited bank/cash channels, staff access/evacuations, and funding shortfalls. Build redundancy (multiple suppliers/routes), preposition stocks, and local partnerships. (World Food Programme)
Q — How to balance speed vs quality when distributions must be rapid?
A — Use simplified targeting for immediate lifesaving distributions (e.g., blanket rations) then shift to targeted programs when assessments permit. Keep a minimal quality checklist (nutrition content, safety, packaging). (Sphere)
Q — How to reduce diversion or theft of food aid?
A — Use community engagement, identifiable beneficiaries, secure and monitored storage, separate household distributions (not in bulk), electronic vouchers where feasible, and liaison with protection teams to reduce threats. (World Food Programme)
Q — What nutrition services are essential inside besieged or blockaded areas?
A — Rapid household food aid, community-based screening (MUAC), emergency water/sanitation, targeted supplementation for children & pregnant women, and advocacy/negotiation to restore supply corridors. Document access impediments for legal recourse. (International Committee of the Red Cross)
Q — How to account for increased energy needs in conflict (walking, carrying, trauma)?
A — Adjust rations upwards for people with increased activity or for nursing mothers; include energy-dense foods and ready-to-eat items for highly mobile households. Monitor functional status to adapt rations. (Sphere)
Q — How to prepare for sudden funding shortfalls that halt malnutrition programs?
A — Maintain contingency stocks, prioritise lifesaving services (SAM treatment), simplify protocols to reduce cost, advocate with donors using concrete outcome data, and develop phased handover plans with local partners. Recent funding cuts have halted programs in some countries. (Reuters, World Food Programme)
Q — How to adapt-growth-monitoring when clinics close?
A — Use community volunteers for MUAC and weight checks with simplified recording, mobile teams, and integrate with protection or WASH outreach. Use remote supervision where possible. (Nutrition Cluster)
Q — Should blanket supplementary feeding (BSFP) be used?
A — Yes where acute widespread food insecurity exists (to protect vulnerable children and mothers); shift to targeted SFP when conditions improve and coverage allows. Design based on GAM and food security data. (Sphere)
Q — How to include mental health in nutrition programming?
A — Train nutrition staff in psychological first aid, integrate psychosocial support in feeding centers, and refer severe cases to MHPSS services — mental health affects appetite, care practices and adherence. (World Food Programme)
Q — What are fast, low-tech interventions to protect child nutrition?
A — Promote exclusive breastfeeding, distribute micronutrient powders or fortified blended foods, MUAC screening, vitamin A campaigns, and community nutrition education. These require minimal cold chain or complex logistics. (World Health Organization)
Q — How to manage feeding for people with disabilities in camps?
A — Ensure accessible distribution points, door-to-door delivery if needed, tailored rations (texture modifications), caregiver support, and inclusion in targeting lists. (World Food Programme)
Q — How does seasonality affect conflict nutrition planning?
A — Planting/harvest cycles, rainy seasons (access constraints), and seasonal disease patterns (malaria, diarrheal disease) alter needs; preposition supplies before rainy season and plan for lean season spikes. (World Food Programme)
Q — Can school feeding continue during conflict?
A — When safe, school feeding protects child nutrition and promotes attendance. Where schools are closed, consider take-home rations or community kitchens. Coordinate with education clusters. (GCNF)
Q — How to use food assistance to protect access for girls and women?
A — Use female-sensitive distribution (timing, location), separate queues, female staff, and conditional transfers linked to education or health without coercion; guard against transactional risks. (World Food Programme)
Q — What documentation is needed to legally challenge denial of food access?
A — Date/time stamped incident logs, photos (where safe), beneficiary testimonies, geographic coordinates, and statements to legal/protection actors. ICRC and legal partners can guide referrals. (International Committee of the Red Cross)
Q — How to measure program coverage for therapeutic feeding?
A — Use coverage surveys (SQUEAC/SLEAC) when feasible; monitor admissions vs estimated SAM caseload and reasons for non-access (distance, stigma, cost). Coverage targets should be explicit in program design. (World Health Organization)
Q — How to reduce nosocomial infection risks in inpatient therapeutic feeding centres?
A — Strict WASH, infection prevention protocols, triage for respiratory/diarrhoea cases, separate wards for infectious cases, staff PPE and training. (World Health Organization)
Q — How to support feeding for people on TB or HIV treatment?
A — Ensure continuity of anti-retroviral or TB therapy, include nutrient-dense foods, micronutrient support where indicated, and coordinate with specialized health programs to avoid treatment interruption. (World Food Programme)
Q — How to incorporate local community leaders in nutrition response?
A — Involve leaders in needs mapping, distribution oversight, culturally appropriate messaging, and complaint/feedback mechanisms to improve acceptance and reduce diversion. (World Food Programme)
Q — How to ensure ethics when using biometric/ID tools in distributions?
A — Ensure informed consent, data protection, do no harm (avoid exposing beneficiaries to targeting risk), and follow privacy/security best practices. Use low-risk methods when security threats exist. (World Food Programme)
Q — How to protect nutrition staff in active conflict zones?
A — Security training, context-specific SOPs, remote support options, limited staff movement, mental health support, insurance, and close security coordination with local authorities and humanitarian security actors. (World Food Programme)
Q — What are priority indicators to report to donors during conflict responses?
A — SAM admissions & treatment outcomes (cure, death, default rates), MUAC screening coverage, rations distributed (household counts, kcal/person), vitamin A coverage, and supply pipeline status. Transparently report access constraints. (World Health Organization)
Q — How to transition from emergency to recovery/resilience in protracted conflict?
A — Gradually shift from blanket to targeted assistance, rebuild markets & livelihoods, invest in smallholder support, fortification, social protection systems, and integrate nutrition into longer-term health/social programs. (World Food Programme)
Q — How does advocacy feature in nutrition during war?
A — Document and publicize access impediments, appeal to parties to respect IHL (protect food & humanitarian corridors), coordinate multi-agency advocacy, and use evidence (mortality, malnutrition, displacement) to press for access. This is a core humanitarian role. (International Committee of the Red Cross)
Q — What immediate red flags should trigger an international escalation/appeal?
A — Rapid rises in GAM/SAM with rising mortality, deliberate blockage/weaponization of food, mass displacement with acute food shortages, or suspension of essential nutrition services due to funding or access. These justify urgent appeals and scaled advocacy. Recent crises show such patterns can rapidly produce man-made famine and massive mortality. (Sphere, Financial Times)

Short operational checklist (4 items)

Immediate: MUAC screening + clean water + emergency food/cash within 72 hours.
Within 2 weeks: Set up SAM treatment referral (RUTF/OTP) and IYCF-E counseling.
Within 1 month: Nutrition surveillance (sentinel MUAC/SMART), market assessment, and protection/legal documentation.
Continuously: Coordinate via Nutrition Cluster/Sphere standards; preposition supplies and adapt to access/security changes. (Sphere, Nutrition Cluster)

Conclusion

Nutrition in times of war is not only a matter of survival but also a cornerstone of dignity, health, and resilience for affected populations. Armed conflict disrupts food systems, healthcare, and basic services, making children, pregnant women, the elderly, and vulnerable groups especially at risk. The 50 exclusive Q&A presented here highlight both immediate lifesaving measures—such as rapid screening, therapeutic feeding, and emergency rations—and long-term strategies like local food production, fortification, and integration into recovery plans.

By combining humanitarian standards, innovative solutions, and community-based approaches, these insights provide a roadmap for protecting nutrition under the harshest conditions. Ultimately, safeguarding food and nutrition in war is not only a public health priority but also a legal and moral obligation that underpins the right to life and human dignity.

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