‘A forgotten crisis’

WITH eagerness glowing in her eyes, Joharra Samuel gulped down the last portions of the paste-like food her mother had squeezed out of a small, red rectangular sachet. Minutes later, the 13-month toddler showed little resistance as a medical worker and the mother weighed her.

“She’s six kilograms,” declares the female medical worker of an international aid organization who also measured the girl’s height and her arm’s girth inside the day care center in the town of Shariff Saydona Mustapha.

It was the first visit of the frail-looking girl to the health center, according to her mother, Noraima Samuel, 26.

The youngest in a brood of six, Joharra’s is among 44 cases of acute malnutrition among children below 5 years old in Maguindanao monitored by aid organization Action Against Hunger Philippines (AAHP).

Noraima had her first child when she was just 14. All of her children were born at home in Datu Salibo town.

Due to the remoteness of Noraima’s community and frequent clashes between armed groups, families in her community have not been to health facilities for so long.

“Ideally, it should be regular, weekly,” said Gretchen Amodian, nurse of AAHP, about the need for scheduled health checkups of women and their children.

AAHP is one of aid groups in the Autonomous Region in Muslim Mindanao (ARMM) that are involved in the war on hunger and malnutrition.
Battlefields

The family of Noraima lives in a community in the so-called SPMS Box, an area of marshlands, hills and cornfields covering Shariff Aguak municipality, Pagatin village (Datu Saudi town), Mamasapano town and Shariff Saydona town.

The area is a battlefield for government forces fighting Moro armed groups.

With help from the governments of Spain and Canada, the European Commission and United Nations Children’s Emergency Fund (Unicef), the AAHP is focused on the campaign to prevent hunger from slowly killing tens of thousands of people impoverished by the remoteness of their communities and armed conflict.

“They are the most vulnerable,” said Celna Mae Tejare, AAHP nutrition coordinator. These are people who regularly flee from their homes and need food supply most. “Their food intake dwindles and this results in malnutrition,” Tejare said.

According to 2015 data by the Food and Nutrition Research Institute, chronic malnutrition rate of children under 5 years old nationwide jumped to 33.4 percent, up from 30.3 in 2013.

This condition, which is manifested by growth stunting among children, is most prevalent in Central Mindanao, where the rate shot up to 45.5 percent in 2015 from 38.5 two years earlier.

Tejare said based on World Bank data, the cost of malnutrition for developing countries, like the Philippines, is huge—
3 percent of gross domestic product (GDP) or equivalent to the amount of damage wrought by Supertyphoon “Yolanda” (international name: Haiyan) in 2013.

“The child’s full potential could not be attained as a result. Physical and mental development is hampered,” she said.

Sustaining the effort

AAHP sees hunger and malnutrition in the Philippines, especially in areas wracked by armed conflict, as a “forgotten crisis.” International media and aid groups are focused on humanitarian crisis elsewhere, like Syria, Iraq and parts of Africa.

Javad Amoozegar, AAHP country director, said at least 43,000 people had been displaced by armed conflict in Mindanao. While efforts are being made to help these people, Amoozegar said “there is a need to sustain it.”

As part of its drive against malnutrition, AAHP has been strengthening its early childhood care and development program which focuses on maternal and young child health and nutrition, early child education and basic social services.

The program seeks to support the government campaign, through the Department of Health, to address chronic malnutrition and stunting in the most critical phase of a child’s growth and development.

“The first 1,000 days of the child’s life is crucial because these are considered a narrow window of opportunity when you can intervene and address stunting,” Tejare said. “After that, it would be irreversible.”

Stunting and malnutrition would haunt the child as she or he grows older.

Sickness would be common, which would prevent the child from going to school and, as the child becomes an adult, prevent him or her from getting a job.
According to Tejare, studies showed that children who had been malnourished would earn 20 percent less than those who grew up healthy. Children who grew up malnourished “could not get good jobs,” she said.

Initiatives, like that of AAHP, are welcome in ARMM areas where armed conflict is part of daily life and traditions and beliefs clash with modern health practices and prevent the delivery of basic social services.

Challenging task

In the town of Mamasapano, health workers have intensified their health education campaign by visiting communities and teaching women about proper nutrition and child care despite the task being made more difficult by rough terrain and frequent gunfights.
Mon Arvien Tungao, Mamasapano nurse, said health workers brave the conflict just to reach communities. Although malnutrition rate in the town is not as bad as in other areas, the main problem is the rising number of “defaulters,” or those who could not sustain regular checkups of babies in health centers.

The lack of proper health education and a distrust in professional medical care are the main reasons Jean Usman had never given birth in a health center.

The 37-year-old woman from Tukanalipao village—site of a deadly clash between government troops and rebels that killed 44 police commandos in 2015—said all her eight children were born at home and fed with infant formula.

As a result, three became malnourished, two seriously.

“I gave birth at home many times already so I thought it was just OK,” Usman said, cradling a year-old baby boy, who had weighed only 5.8 kgs when he was born.
Improvement

For more than a month, the baby boy had been fed with ready-to-use therapeutic food, a paste-like supplement made of peanuts mixed with skim milk and minerals, that is used to treat severe malnutrition.

The treatment worked and, by Aug. 17, Usman’s baby weighed 6.5 kg. His upper arm girth grew from 11.4 centimeters to 12.3 cm. (Technically called mid-upper arm circumference or MUAC, upper-arm girths are used as indicators of varying degrees of malnutrition).

Usman said she felt relieved at her child’s improvement, promising to have him regularly checked at the health center and heeding his treatment regimen.

Amoozegar said there is still much to do, particularly on the part of the government in the war on malnutrition.

Amoozegar said his group is calling on President Duterte to invest in nutrition programs and “hold nutrition stakeholders accountable” for targets in reducing cases of child stunting and wasting.

He said despite the growth in the country’s economy, which according to the government has jumped by 7 percent in the second quarter, the Philippines is lagging behind its counterparts in the region in terms of fighting hunger and malnutrition.
Something’s wrong

Since 1998, he said malnutrition in Asia actually fell by at least 50 percent, with nations in East Asia even posting up to an 80-percent decline.

“While the Philippine GDP is performing better than its neighbors like Cambodia and Vietnam, when you look at the malnutrition data, it doesn’t show the same,” Amoozegar told Inquirer. “It’s the other way around. Cambodia and Vietnam performed better in reducing malnutrition. It doesn’t make sense,” he said, adding the three countries are almost the same in terms of economic trend.

A study by the Inter-Agency Regional Analysts Network (IARAN) of the Paris-based Institut de Relations Internationales et Strategiques released in March showed that Vietnam had a rate of stunting among children under 5 years old of 23 percent in 2011 while Cambodia had 32.9 percent.

“The latest figures of national stunting rate show a relatively better situation in both Vietnam and Cambodia,” the IARAN report said.

Amoozegar said the numbers showed something must be wrong in how malnutrition is being addressed in the Philippines.

“It seems the (government) target of fighting malnutrition by 2030 is not working. The annual average rate of reduction of 3.9 percent can’t even be reached. It’s the other way around,” he said.