1. Recent Emergencies: Impact on breast feeding – Tsunami and Conflict Experience in Sri Lanka Dr.Vinya S. Ariyaratne Executive Director Sarvodaya Shramadana Movement Sri Lanka

2. Recent Emergencies: Impact on breast feeding – Tsunami and Conflict Experience in Sri Lanka Introduction – Recent Emergencies in Sri Lanka Breast feeding – best practices and Sri Lankan context Tsunami Conflict Conclusions

3. Recent emergencies in Sri Lanka Natural Disasters –Floods –Cyclones –Landslides –Droughts –Tsunami Human-induced –Armed Conflict

4. Sri Lankan context Need to analyze in the larger context of health and social development in Sri Lanka “pre-emergency” status of the population

5. Tsunami – December 2004

6. Tsunami Disaster, 26 December, 2004 Last updated :16.00 hrs As at : 21/02/2005 ProvinceDistrictAffecte d Familie s Displace d Families Displaced PersonsDeath s InjuredMissin g Damaged HousesNo. of Camps In Welfar e Center s With Relativ es and Friends TotalComplet ely Partially Northern Jaffna14,76710,8277,62533,38141,0062,6401,6475406,0841,11412 ** Killinochchi2,29740701,603 5606700246-0 Mullaitivu6,7456,00711,99310,56422,5573,0002,5904215,03342423 Eastern Trincomale e30,54730,54514,85359,20874,0611,0781,328454,8303,83534 Batticaloa63,71712,49422,00235,04757,0492,9752,37534613,5305,83936 Ampara58,72938,86624,17975,32299,50110,4366,58116118,8898,64155 Southern Hambantota14,0693,3341,80345,19546,9984,5004341,3412,3031,74411 Matara19,3982,2352,8736,4059,2781,3426,6526082,3625,65922 Galle24,58323,2782,633119,301121,9344,2483135647,0327,68027 Western Kalutara9,4337,0592,42032,52734,947279401692,6833,83512 Colombo9,6478,1405,44630,61436,0607964123,3882,21026 Gampaha6,8273088765731,4496352784142 North Western Puttlam2321866 41323722 Total 260,991143,51896,769449,740546,50931,14723,0594,11566,68141,467262 Displacement due to Tsunami

7. Caring for Tsunami IDPs “Waves of Compassion” Immediate response by the community first wave of compassion Local organizations and volunteers second wave of compassion External aid agencies third wave of compassion

8. Provision of Health Care for the Tsunami IDPs Swift response by government and non- governmental organizations Exemplary performance by MOHs managing health issues with completely destroyed infrastructure

9. Breast feeding status post-tsunami Media appeals for infant formula and bottles giving a wrong message to the public, donors as well as to the affected population. –ie. Women are no longer able to breast feed because they are “traumatized”. No national guidelines were in existence at the time of the Tsunami. 18 Days after the Tsunami, the Family Health Bureau (FHB) issued comprehensive Guidelines. January 2005 study covering 40 camps revealed most mothers continuing breast feeding with out any problems. Others who were giving formula feeding found difficulties.

10. Observations by stakeholders High rates of bottle/formula feeding in non- emergency times Inadequate policy implementation Few government and NGO staff trained in or knowledgeable about infant feeding during emergencies Unsolicited donations of formula/milk powder Unsuitable foods for complimentary feeding during emergency food distribution

11. Conflict-induced emergency Qualitatively different to a natural disaster induced emergency Pre-displacement health and social status During displacement Post-displacement – conditions in the IDP camps

16. A New Reality

17. "  Shelter  Water  Sanitation & Hygiene  Food and Nutrition  Health  Child Care  Psycho-social  Care of the Vulnerable Groups Needs

18. Integrated Services Food – Communal cooking Nutrition Rehabilitation Programme Water Supply Sanitation Mobile Medical Service Mobile Library Service

19. Communal Cooking

20. Water Supply

21. Sanitation facilities

22. Mobile Library

23. Mobile Medical Unit

24. Observations on breast feeding/infant feeding Unsolicited (?) donations of infant formula Medical staff not fully knowledgeable on infant feeding in emergency setting World Breast Feeding Week – August – Training for the medical staff –Useful but with limitations

25. Conclusions and recommendations Need for capacity building in all sectors for effective IYCF during emergencies Complete ban of unsolicited donations of infant formula and feeding bottles Vigilance against promotion of infant formula

26. Thank You!