Ahead of World Nutrition Day on 28 May, the International Rescue Committee (IRC) is warning about the dire consequences of acute malnutrition - the most life-threatening form of malnutrition - on women and children in Uganda's refugee settlements, where the number of cases across five settlements has risen by nearly 50% from 2021 to 2022. 

According to data collected from different IRC-supported health facilities and service points across the five settlements, there were close to 6,300 acute malnutrition cases treated in 2021, while in 2022, the figure rose to more than 9,300, with the majority of cases being children and women. In the first quarter of 2023 alone, over 2,000 cases have already been recorded, indicating a worrying trend. (Datasource: DHIS2)

Additionally, according to the IPC Acute Malnutrition Analysis 2022, it is estimated that 36,590 children aged 6-59 months across all refugee settlements are expected to suffer from acute malnutrition and in need of treatment in the period of February 2022 to January 2023. Worryingly, over 4,000 pregnant and lactating women among the refugee population are affected by acute malnutrition and in need of treatment in the same period. 

The most recent Food Security and Nutrition Assessment report indicates that the main causes of this situation include the generally poor food consumption levels among children with the minimum acceptable diet as low as 8.5% across settlements; and the high cases of malaria and acute respiratory infections with more than 75% of children in settlements having tested positive for malaria in the past two weeks preceding the survey.

Susan, a mother of a 12-month-old child being treated for acute malnutrition at one of the IRC supported facilities had this to say,

“… I have failed to produce breast milk for my baby because I am not eating enough. Now my child is sick. I have a large family of 10 members, two of whom are disabled and need constant care – we can’t move the distance to where the land is to grow some food. Now with the food ration reduction, it is getting worse.”

The situation has been further compounded by significant humanitarian funding reductions for critical services, such as health and nutrition, as well as food ration cuts by the World Food Program (WFP). The WFP's universal food ration reduction to 70% of households' daily needs, which began in 2020, has resulted in refugee households receiving only 26-48% of the minimum daily needs, with dietary diversity sharply impacted. Refugees face challenges in accessing land to grow their own food, and the impact of climate change is also a contributing factor. Meanwhile, the overstretched health system is dealing with high rates of diseases such as malaria, acute diarrhea and pneumonia, as well as ongoing outbreaks of measles and mumps. 

Elijah Okeyo, the IRC Uganda Country Director, said:

“The world is set to mark World Nutrition Day to raise awareness about the importance of the right to nutrition for all, yet, the current situation in Uganda's refugee settlements paints a bleak picture. We need immediate action, and additional resources to fund critical service delivery, including health and nutrition, as well as more sustainable mechanisms such as improving livelihoods and environment-friendly agriculture.

"The consequences of failing to address the issue could be dire, including poor child growth and development affecting education outcomes, maternal health challenges, the premature return of refugees to their countries of origin, and movement across borders in search of basic needs such as food, exposing them to unsafe and conflict situations, among other long-term implications. This is a grim reality - the world cannot afford to stand back and watch.” 

It is critical to increase the ability of acutely malnourished children in places like Uganda to access lifesaving treatment by adopting simplified approaches that are effective and efficient. A scalable solution exists: treatment with ready-to-use therapeutic food (RUTF), an easy-to-administer, shelf-stable fortified peanut butter paste has shown to be highly effective for more than 20 years. The overwhelming majority of malnourished children who receive this treatment fully recover within weeks. And yet globally, 80% of children suffering from acute malnutrition cannot access this treatment. The IRC has proven innovations to deliver this solution at scale, increasing the number of children treated and lives saved at the same cost as the current approach. A simplified combined protocol using a single product, a simplified dosing schedule, and simplified diagnostic criteria is equally effective and in fact more cost-effective than the standard, more complex clinical approach.

Note: The DHIS2 figures shown here indicate the number of malnutrition cases recorded at IRC supported health facilities and service points across the settlements of BidiBidi, Imvepi, Rhino, Palabek and Kiryandogo. This doesn’t represent the absolute numbers on ground. 

The IRC in Uganda

The IRC began programming in 1998 in northern Uganda in response to mass displacement wrought by the Lord's Resistance Army. Since then, the IRC has expanded to provide critical services for refugees and vulnerable Ugandans throughout the country. The IRC started supporting refugees and vulnerable individuals in Kampala in 2012 and was one of the first organisations to respond in 2016 at the onset of the South Sudanese refugee crisis. As of 2019, the IRC entered the Tooro region to support refugees while also providing epidemic preparedness and response services throughout the region. In addition to emergency support, the IRC also invests in long-term stability for refugees and Ugandans through programs like immunisation, family planning, legal services, women's empowerment, education, and livelihoods.