displaced people around the world are facing a
Embedded Files
nutrition crisis
Page summary
Undernutrition in refugee camps is widespread and leads to negative health impacts.
In the face of food insecurity, refugees resort to negative coping strategies.
At the centre of this issue is a reliance on humanitarian food systems that:
fail to provide nutritious food (mostly provides non-perishable staples);
are unreliable (frequently scales back rations in times of funding constraints).
"90% of (medical) problems that we see are related to poor nutrition caused by diet."
- Doctor working in Vial Camp, Greece (2022)
This quote came from an interview I conducted while trying to understand the nutrition situation in the camp. The doctor went on to explain that the food people received was lacking in protein and vitamins. As a direct result, her team would frequently come across refugees in Vial suffering from various digestive health issues.
Sadly, Vial Camp was not an exception...
Vial Camp, Greece (2021)
... undernutrition in refugee camps is a common challenge
Many camps have high rates of chronic and acute malnutrition
A 2023 meta-analysis looking at 86 refugee camps across 18 countries determined that:
2 in 3 camps (66.0%) had 'high' rates of stunting amongst children under 5 years old. This demonstrates a high rate of chronic malnutrition in camps.
1 in 3 camps (36.3%) had 'high' rates of wasting (a sign of acute malnutrition) amongst children below 5 years old. This is a significant indicator of acute malnutrition across the camps.
Note: in emergencies, acute malnutrition in children below 5 is used as a proxy for nutritional status of the entire population
In a 2023 UNHCR survey of 21 out of 26 refugee camps in Ethiopia, 1 in 2 children below 5 years old were found to be undernourished.
Relevant details
There are four types of undernutrition:
wasting (low-weight-for-height)
^indicator of recent weight loss
stunting (low-height-for-age)
^indicator of chronic/ recurrent undernutrition
underweight (low-weight-for-age)
^typically, an underweight child is stunted or wasted
inadequate micronutrients
^micronutrient shortages can cause serious illness
Refugees living in camps have been found to be living in severe food-insecure situations
A 2021 study found 34.4% of Syrian refugee mothers in Lebanon to be food insecure, with a strong correlation to having low dietary diversity (63.3%).
In Türkiye, 23% of refugee households residing in camps were food insecure in 2024.
From 2022 to 2023, the number of Rohingya refugees without enough food rose from 44% to 70%. Almost half of children showed physical signs of malnutrition.
80% of refugees live in countries that are themselves food insecure.
Food insecurity has been linked to low diet diversity, which increases micronutrient and macronutrient deficiencies
Common deficiencies amongst refugees include: Iron, Vitamin D, Vitamin A, Zinc, B12, Niacin, Iodine, Thiamine, Vitamin C.
A 2024 meta-analysis determined that the global prevalence of anemia among refugee children is 36.5%
A 2022 study found 80.5% of Afghan refugee children in Pakistan to be Vitamin D deficient
There are four dimensions to food security:
food availability
^about food being present where one is
access to food
^about having physical, social, economic, access to the food
use of food
^about how food is kept, prepared, and its nutrients absorbed
stability
^about whether access to food is permanent or could be interrupted
Field hospital in Cox's Bazar, Bangladesh (2021)
Photo: Anadolu Agency
The health impacts are severe
Acute malnutrition increases the risk of mortality. In Zamzam Camp, Sudan, where 40% of children below two years were acutely malnourished, MSF estimated that there were 13 child deaths per day (2024).
Malnutrition compromises the immune system and leads to increased incidence and severity of disease and infection.
Conditions such as diarrhea, measles, and acute respiratory infections are exacerbated by malnutrition.
Childhood malnutrition has long-term health consequences for individuals as it impairs physical and cognitive development, and is linked to chronic diseases such as diabetes and cardiovascular disease later in life.
Food insecurity amongst refugee populations has been positively associated with mental health conditions, such as depression, anxiety, and stress.
Iron deficiency anemia, was found to cause pre-term birth for mothers and also impaired productivity and memory function of adults.
Also worrying are the coping methods of food insecure populations
Photo: ACW
Türkiye, 2024
84% of refugee households adopted a negative coping mechanism to manage the food insecurity. Some examples were:
borrowing money for food
limiting meal portions (especially amongst adults to provide for children)
relying on cheaper foods
Photo: SAFA
Ethiopia, 2023
98.2% of refugee households employed at least one negative coping strategy to cater for food needs. Strategies included:
skipping meals
early marriage
child labour
transactional sex
theft
Key points
Sub-par nutrition is causing devastating health impacts amongst refugees displaced for extended periods of times.
Out of necessity, refugees in difficult situations turn to coping mechanisms that are detrimental to them and their families in the long-term.
A hypothesis on what is going wrong
Key points (hypothesis)
Camps produce reliance on humanitarian food systems, which despite their different methods of delivery, are prone to providing refugees with insufficient and uncertain access to what is often low quality food.
This leads to malnutrition and the consequent negative impacts.
Mavrovouni Camp, Greece (2022)
Za'atari Camp, Jordan (2014)
Photo: ABC News
Why are camps causing reliance on humanitarian food systems?
Of the 43.7 million refugees worldwide, more than 6.6 million people reside in camps, with 70% residing in planned camps, and 30% in self-settled camps.
Refugee camps are designed to be temporary solutions, but if historical trends hold, most of these 6.6 million people will spend between 10 to 15 years of their lives in a camp.
Camps are largely aid dependent, and this is driven by a few factors.
Camps are frequently isolated (often geographically, but sometimes also because of tension with host communities). This results in little access to fresh food, and the isolated markets that do cater to camps are generally expensive.
Camps are often overcrowded, and thus there is limited space for each resident. In some countries they are also located in harsh desert environments. These factors combine to mean that there is limited viable land for cultivation by refugees.
In many countries, refugees are barred from working due to their legal status. In countries without such restrictions, refugees still find it hard to compete with the local labour market. As a result, refugees have few opportunities to earn an income and supplement their diet.
Key point
Common characteristics of camps combine to engender reliance on humanitarian food systems.
Photo: WFP
What methods of delivery do humanitarian food systems employ?
WFP is UNHCR's main partner in ensuring refugee food needs are met, and it is involved in food provision to refugees at sites where the population exceed 5000. Up to 5000 people, the UNHCR is responsible for meeting the food needs of the population.
These organisations tend to distribute provisions through in-kind food transfers, Cash-Based Transfers (CBTs), or a combination of the two. CBTs might include cash or food vouchers.
Since the early 2000s, the WFP has been moving away from in-kind food transfers and implementing more CBT programs. A large rationale for this is to encourage greater dietary diversity amongst beneficiaries and to give them more autonomy over their diet.
Nonetheless, in 2023, the WFP still reached twice as many beneficiaries via in-kind food transfers (100.6m) as they did through CBTs (51.6m). In-kind food transfers still form the bulk of the WFP's distribution.
The organisation is committed to assessing and choosing the modality of distribution (or the combination of modalities) that best suits each specific context.
In-kind transfers: the harsh reality
Zimbabwe, 2014
Monthly rations (1 person):
Maize meal 10kg
Rice 2kg
Sugar beans 2kg
Corn soya blend 2kg
Vegetable oil 750ml
Sugar 500g
Salt 125g
Sources: UNHCR & WFP Joint Assessment of Tongogara Refugee Camp (2014)
*note: it is possible that this camp has shifted entirely to CBTs since
Bangladesh, 2020
Monthly rations (1-3 people):
Rice 30kg
Lentils 9kg
Cooking oil 3l
Sources: Hoddinott J, Dorosh P, Filipski M, Rosenbach G, Tiburcio E. (2020) Food transfers, electronic food vouchers and child nutritional status among Rohingya children living in Bangladesh. PLoS One.;
The Telegraph; The New Humanitarian
*note: some groups in Bangladesh receive CBTs instead
Iran, 2024
Monthly rations (1 person):
Fortified wheat flour 12kg
Vegetable oil 810ml
Cash (male HH) $5.50
Cash (female HH) $6.60
Source: WFP Iran Country Brief (Dec 2024)
Reading the monthly rations distributed by the WFP in different countries, it becomes clear that a common feature is the staple-heavy diet and lack of fresh foods. In fact, the WFP frequently acknowledges that their rations often fail to meet micronutrient intake standards.
For instance, a report on their food provision in Liberia stated:
"On average, a refugee received about 78% and 64% of intended kcal and protein respectively. Micronutrients remained inadequate throughout the year distributed at an average of 0% for vitamin C, 13% for Riboflavin, 21% for Vit A and Iron at 41% of the daily recommended allowance. Therefore, the prevalence of micronutrient deficient diseases remained high."
In its 2023 Annual Performance Report (left), the WFP conceded that only 1.4% of their in-kind transfers were 'nutritionally adequate' in 2023.
One study suggests that because of the long distances that food needs to travel to reach refugees, it is not logistically feasible to distribute perishable foods, and thus it is inevitable that displaced populations are deficient in micronutrients such as iron, riboflavin, and Vitamin C.
Key points
While in-kind transfers are effective at providing sustenance in times of immediate need, in protracted situations they fall short of providing refugees with a balanced and healthy diet.
They seldom meet minimum nutritional standards, and therefore need supplementing.
Are cash transfers the answer?
The general view in the literature on this topic appears to be that beneficiaries receiving cash transfers generally appear to have increased dietary diversity outcomes, while those receiving in-kind food transfers have larger increases in calories consumed. Thus, depending on what the goal of the program is, both approaches could be appropriate.
As Bailey points out, the pertinent question as to whether cash transfers are an appropriate tool is whether undernutrition is an issue of availability or access. If the issue is access, then cash transfers can help people to overcome that access gap. If the problem is availability, for instance in an isolated market, then cash may simply drive up the price of goods.
Photo: UNICEF
Key point
Cash transfers may be effective at addressing the issue of diet diversity in specific scenarios.
However, funding gaps and budget cuts means dependence all forms of humanitarian food assistance is risky
In the last few years, global shocks such as COVID and the war in Ukraine have diverted funds away from other ongoing humanitarian situations. In turn, humanitarian organisations have had to cut back on their provisions to displaced populations, leaving many in precarious situations.
Aside from global shocks, humanitarian organisations often report large funding gaps that prevent them from meeting the needs of the populations they serve.
Food aid meant for displaced populations are cut with alarming frequency.
Refugees have limited voice, and in moments of budget cuts they often bear the brunt of the cuts directly. These populations live with the uncertainty of not knowing if they will be provided food support in the coming months.
As we have seen, the impacts are brutal - malnutrition and mortality spikes when too little food is available for populations in need.
Closing thoughts
Humanitarian food systems need to work to make themselves redundant. Any reliance that they create in their ability to meet the nutritional needs of refugees hurts the communities that they serve, because:
the food they make accessible to refugees is likely not reaching minimal nutritional standards or quantities;
the aid that populations grow to be dependent on can be reduced suddenly due to factors extrinsic to the population.
From Seed to Shelter aims to break this cycle of reliance, and find alternatives outside of this ecosystem.
It is important that refugee communities own the means of producing nutritious foods, so that external shocks, funding gaps, and logistical limitations, do not leave them facing dire health outcomes.
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