Ukraine, 3-14 February 2015 GNC Scoping Mission to Assess Nutrition Needs, Response and Coordination

Objectives of Mission To review nutrition coordination structure To identify and map capacity of partners To map nutrition interventions To assess nutrition information needs and the possibilities for conducting nutritional assessment To identify programmatic and geographic areas of need and key NiE interventions Identify core advocacy concerns related to NiE interventions

Methodology Documents review (assessment reports, regional reports, surveys, situation reports, press releases, media articles) One-on-one consultations with 27 individuals Additional review of documents shared by key informants SRP workshop, two operational planning meetings, two FS&N Cluster meetings, two Health Cluster meetings and a WASH Cluster meeting attended

Nutrition Situation Pre-Crisis GAM prevalence 1.3% (2000) Anaemia prevalence pre-crisis 22.2% (2004); no information on other MND but expected to be common IYCF practices sub-optimal, ex. Exclusive BF 19.7% (2012), wide use of BMS No info on other population groups

Infant feeding patterns by age, Ukraine, 2012

Importance of Protecting Infant and Young Child Feeding in Emergencies Breastfed children healthier than non-breastfed children in all contexts – even non-emergency In emergencies disease & death rates for < 5s significantly higher due to: ↑ communicable diseases, ↑ undernutrition, lack of appropriate health care Difficult unsanitary conditions + risk of water borne disease BF confers critical protection from infection and death especially in emergencies when lack of safe water & poor sanitation Artificial feeding even riskier in in emergencies  significantly endanger infant & young children’s health and lives

Importance of Protecting Infant and Young Child Feeding in Emergencies Even when safe water guaranteed, infant formula use has high risks: - deprives infants of disease prevention/fighting action of breast- milk - retards development of the immune system - renders babies more susceptible to colonisation by pathogens BMS should only be provided to targeted infants who have been assessed by a qualified health/nutrition worker Additional resources, training and support for caregivers to minimise the risks of artificial feeding Once started, provision of BMS must continue as long as infant requires Spill over risks of BMS programmes high, so interventions to support non-breastfed infants should always include component to protect BF

WHO/UNICEF recommendation on IYCF infants should initiate exclusive breastfeeding within one hour of birth and continue exclusively breastfeeding for the first six months of life. After this time, infants should continue breastfeeding until they are two years of age or beyond while also receiving age-appropriate, nutritious and hygienic complementary foods.

Introduction of complementary foods at 6 months of age Semi-solid, nutritious foods providing not only required energy, but also vitamins, minerals and high quality (animal) protein Thick porridges, soft fruits and vegetables, minced meat/chicken/eggs Gradual transition to family foods around 1 year of age WHO/UNICEF recommendation on IYCF

Mission Findings – Nutritional status No info on acute malnutrition Expected to increase, due to aggravation factors (deterioration of food security, WASH and health situation, care practices, access to basic services) Reports that children are unhealthy, pale, not active, however no confirmed reports of acute malnutrition No info on MNDs Expected to increase due to very limited access to fruits, vegetables, fish and meat

Mission Findings – IYCF-E Lack of info on current IYCF practices Non-existent capacity of partners and gvt in NiE, incl. IYCF “Baby baskets” contradict WHO/UNICEF recommendations Widespread BMS distributions Reports that mothers stop BF because of the stress, strong believes that mothers do not have enough milk to BF Sub-optimal complementary feeding Early introduction of CF Very limited access to MN-rich food Limited access to protein-rich food Focus on industrial CF High demand for BMS and CF

Mission Findings – other factors Risks of increased morbidity, malnutrition amplified by current conditions: - deteriorated water quality and supply - decreased sanitation and hygiene - lack of safe and appropriate complementary foods - lack of available food, especially MN and protein- rich -decreased access to health services - low exclusive BF rates - lack of skilled support for appropriate IYCF

Mission Findings – Response and Coordination Nutrition was part of the FS and Nutrition Cluster No coordination/IM capacity for nutrition One NGO distributes BMS and one NGO distributes CF&BMS Some potential partners on the ground identified (local NGOs, INGOs, UN agencies, gvt) Non-existent capacity of partners and gvt in NiE No nutrition assessments conducted, Save was planning IYCF assessment SRP was revised during the mission

Recommendations – Response Technical capacity in nutrition of CLA and leading partners should be enhanced Build capacity of partners in NiE Conduct IYCF assessment, discuss need for other assessments Develop and agree upon cluster strategy, focus on quick wins Focus on children, PLW and older people Implementation in partnership with other clusters/sectors and gvt Orient hum. community on NiE IYCF statement and communication campaign

Recommendations – Coordination Create Nutrition Sub-group under Health cluster Bring everyone “on the same page” UNICEF start recruitment of NCC and deploy RRT Build sub-national presence Advocate to INGOs with NiE expertise to implement nutrition programming