Nearly one month after Typhoon Haiyan swept through the Philippines, displacing more than four million people, health experts are trying to lower the rising risk of malnutrition among 1.5 million children under five, and help hundreds of thousands of women continue breastfeeding.
“What is easily seen in the aftermath of the typhoon is the destruction [of facilities, and] injuries that require emergency care… malnutrition is a silent threat, as people often do not recognize the symptoms and it is left untreated,” said Katrien Ghoos, the World Food Programme’s (WFP) nutrition officer for the Asia-Pacific.
Before the typhoon struck, one out of every three children under the age of five in the regions of Tacloban, Central Visayas and Cebu in the central Philippines were chronically malnourished, 33.6 percent were stunted (having a low height for their age), and 7.8 percent were wasted (having a low weight for their height), according to the 2011 National Nutrition Survey, as cited in the recently released Multi-Cluster Initial Rapid Assessment (MIRA), produced by more than 40 agencies across nine provinces.
So far, in the aftermath of the typhoon the national nutrition “cluster” - comprising 30 partners, including NGOs, UN agencies and government ministries - is treating about 14 cases of acute malnutrition, which occurs “when children suffer severe wasting that [may be] accompanied by swelling of the body from fluid retention”, and 118 moderate cases. Up to 5 December some 21,000 children have been screened for acute malnutrition; 172 had severe acute malnutrition and another 531 had signs of moderate acute malnutrition.
“The nutritional status of young children and mothers may have significantly deteriorated,” Ayadil Saparbekov, the deputy coordinator for the Geneva-based Global Nutrition Cluster, told IRIN from the Philippine capital, Manila. He said diminished access to nutritious food, limited access to safe water and sanitation leading to a likely rise in water-borne infections, young children separated from their parents, and inadequate settings for breastfeeding were some of the aggravating factors.
Screening for malnutrition by specialized aid groups will be completed in the coming weeks, when informed post-disaster malnutrition rates will become available. Health service delivery has been hampered by the destruction of between 46 and 62 percent of all local clinics and hospitals in the Tacloban, Central Visayas, and Cebu regions, according to the MIRA released in November.
In addition, up to half of the medical personnel working in the affected regions were personally affected by the typhoon. “Because of the lack of food and water in the affected areas, some doctors abandoned their posts,” said Martin Parreno, the health and nutrition coordinator for the French NGO, Action Contre la Faim International (ACF).
"Ideally, an investment will be made [at the regional level] in the government health system, health workers, and larger-scale training for the delivery of community-based therapeutic care. [But] health services and infrastructure need to be re-established first,” WFP’s Ghoos said from Bangkok, Thailand.
Rallying support for breastfeeding
Humanitarian health workers will now be focusing on boosting supplementary feeding for children aged 6 to 23 months in 30 municipalities on the islands of Leyte, Eastern Samar, and Western Samar.
“Unless the situation in these areas is brought back to ‘normal’, a rise in acute malnutrition can be expected,” warned Ghoos.
Humanitarians are also worried about the uncontrolled distribution of infant formula and milk powder donations by charities and church groups, which occurs so frequently after disasters that in 1986 the Philippines government instituted a “Milk Code” banning donations of infant formula products in disasters.
“Donations of powdered infant formula discourage mothers to continue breastfeeding exclusively, and exacerbates the risk of morbidity and mortality among infants, which will in turn contribute to increased levels of acute malnutrition and disease,” said Saparbekov, from the global nutrition cluster.
Thirty breastfeeding tents will be put up this month in evacuation centres in Tacloban and the nearby region of Tanauan. Aid groups will also broadcast nutrition-related messages for half an hour on the radio each morning at 10 a.m., according to the national nutrition group.
Yet exacerbated malnutrition is only one aspect of the disaster’s impact on maternal and child health, say local health workers. “A newborn in [one of my colleague’s communities] died right after delivery due to lack of facilities that would attend to his condition,” Anna Sharmie Quezon, a local doctor in Central Visayas reported to the UK-based medical journal, The Lancet, on 30 November.
At a nutrition and food security conference held in the region in late November, health experts spotlighted the first thousand days of life after birth as critical for optimum nutrition.
ACF’s Parreno noted that “Damaged health facilities [are being] quickly repaired and made functioning to accommodate more patients.”