The literature review and the field visits undertaken for the “Study on the Impact of Armed Conflict on Children” lead to the overall conclusion that armed conflicts in Africa and in other parts of the world have significantly worsened the nutritional status of children and their families. The effects of prolonged conflicts were even more serious and devastating: as noted earlier, two million children have been killed, four to five million became disabled, twelve million were made homeless, and more than one million became orphans or were separated from their families in the past decade. Ten million children have been psychologically traumatised in conflict during this time.
The nutritional status of children prior to the conflict had a significant protective effect on their status during the conflict. In those countries which had better economic, social and nutritional status before the conflict, child malnutrition has been less severe during the conflict. In most countries of Africa which are experiencing armed conflicts the nutritional status of children was very unsatisfactory even in normal times.
The multiple factors which cause malnutrition among children during normal times, including inadequate household food security and poor diet, insufficient health services, poor environment and poor maternal and child caring practices in the family, were accentuated and worsened during armed conflict.
Household food security during armed conflict was affected by loss of agricultural production due to physical insecurity, lack of agricultural inputs and extension services, destruction of infrastructure and markets, and loss of off-farm incomes. There was displacement or death of working family members and lack food to provide sufficient energy for planting an adequate area of land to grow food. All of these factors affected both the quantity and quality of food available to the children. In pastoral populations, loss of livestock during armed conflict had similar nutritional consequences.
When households were in danger of becoming food insecure, they employed three types of coping strategies. They took steps to increase access to alternative sources of food or income such as collecting wild foods, looking for credit, selling labour and reducing consumption. When these were inadequate, they started disposing of their nonproductive assets and then their productive ones, finally they became destitute. These strategies varied according to cultural habits, knowledge and beliefs and they had different effects on the nutritional status of children.
Armed conflict affected the health environment in three fundamental ways: loss of health staff due to flight, death or conscription by the army; destruction of health infrastructures, supplies and equipment, as well as deterioration of sanitation and water supplies. There was obstruction of delivery of health services, particularly preventive immunization and child care. These problems were usually imposed on the family whose food supply was already threatened, causing malnutrition and reducing resistance to disease. Thus, this precipitated outbreaks of infectious diseases among children with a serious impact on their nutritional status.
The destruction of health services and water supplies was exacerbated by population movements and displacement. Loss of basic household equipment for food preparation and saving water increased the risk of unhygienic food preparation and contamination of the water supply. Loss of mosquito nets and shoes during the movement of children increased the risk of malaria and hookworm infection. Loss of access to fuelwood affected preparation of food for the family. All of these factors affected the nutritional status of young people. Overcrowding in camps led to the rapid spread of disease and further aggravated the poor nutritional status of the children.
Armed conflicts seriously disrupted the caring capacity of the community and the family, especially the mothers, which was vital for the protection of the nutritional well-being of children. The mothers had little time to attend to caring activities during periods of armed conflict and often they had to take a different role to protect their family. Breast-feeding was disrupted and little or no time was available for preparation of weaning food or for looking after the health needs of children. The older children were left to fetch for themselves, making them more vulnerable to malnutrition and social vices.
Protecting the nutritional status of mothers was essential for protecting the nutritional status of both infants and children. In general, the presence of adults was essential for providing sufficient care for the children. Thus, preserving the integrity of the family was crucial for the nutritional welfare of children during armed conflict.
It should be acknowledged that conflicts differ substantially from acute emergencies such as drought. Conflicts can go on for years, and may affect various regions and population groups differently, according to the developments within the conflict. In addition, conflicts may be the cause of the increased severity of crises stemming from floods or drought due to the disruption of infrastructure, civil services and control mechanisms. The length of time that conflicts last has major implications for the types of response that should be implemented.
The current methods of assessment of the nutritional situation tended to concentrate on nutritional status and mortality data to initiate short term relief measures. Assessing the impact of responses on the nutritional status of children should not be limited to measuring the number of children who are malnourished at one point in time or recording the number who have died. It was most important in protracted conflict situations to measure the frequency with which a child suffered from repeated episodes of malnutrition. The prolonged nature of most of the internal conflicts occurring in the world requires that a long term developmental approach be taken both in terms of the response before and during the conflict and in terms of the reconstruction after the conflict. Many of the actions that are required to prevent people from becoming destitute are also fundamental to protecting the nutritional status of children in crisis situations.
Food relief was the common response wherever there were high rates of malnutrition and acute food shortages. There has been a shift to employ food relief as part of a wider strategy aimed at supporting communities' household food security mechanisms which would make a long-term impact on health and nutrition. Food aid contributed to household food security in several ways: by providing additional sources of food; by contributing to the development of markets; by reducing displacements of people; by making the return of displaced persons possible; and by reducing intra-tribal tensions and looting.
Two types of feeding programmes were commonly established when malnutrition rates were high during conflicts: therapeutic feeding was provided for severely malnourished children and supplementary feeding, that is, the distribution of either cooked food or dry rations, was given to moderately malnourished children. Both approaches had their usefulness and limitations. Whatever method was used, there was a need for proper implementation (according to criteria established for such programmes) to be more effective and beneficial.