Médecins Sans Frontières started its response to the crisis in Mosul in November 2016. Since March 2017 our teams have treated more than 900 children with malnutrition. A high proportion of these children has been malnourished infants less than six months of age.
We urgently opened a nutrition program in Qayyarah, about 60 km south of Mosul city, comprising an inpatient feeding centre of 12 beds. This unit very quickly became overwhelmed. The immediate life-saving response needed to be provision of a breast milk substitute (BMS) because many mothers were not lactating for a number of reasons. These include breastfeeding not having been standard practice in the community prior to the current conflict, as well as maternal nutritional and general health problems directly linked to the conflict. Relactation — stimulation of the production of breast milk—is a process that takes time and skilled staff, both of which were initially lacking due to the emergency context.
Provision of infant formula was therefore an essential first step of re-nutrition, and was accompanied by promotion of breastfeeding and training of staff to provide the necessary support to mothers. At no stage did our teams provide formula to mothers who were successfully breastfeeding. An in-depth assessment was made as to whether infant formula was needed for each individual mother-infant pair. Médecins Sans Frontières’ approach in Qayyarah does not run counter to World Health Organization and UNICEF policy on infant feeding in emergencies as at no stage did we undertake blanket distribution of infant formula.
We have recently launched a Baby Friendly Space (BFS) as a component of the nutrition response intervention, to help the family to adapt their infant feeding practices to the emergency and post-emergency context. BFS is used as a model to prevent and detect acute malnutrition in infants, young children and pregnant and lactating women, as well as to identify a mother or caretaker in emotional distress who could receive psycho-social support. BFS is considered as an adequate space for the protection and promotion of breastfeeding as well as for the identification of needs in the use of breast milk substitutes.
Médecins Sans Frontières has a strong commitment to breastfeeding. The situation in Qayyarrah, however, shows that the response must always be adapted to the specific context.
Dr Myrto Schaefer is Head of Medical Unit, Médecins Sans Frontières Australia