Inpatient treatment of SAM

VEHA - Field Implementation Guidance

Welcome

Nutrition

Management of wasting

Management of acute malnutrition

Inpatient treatment of SAM

Context

Overview

Environmental factors causing/contributing to the needs and affecting the humanitarian activity

Hunger and malnutrition are rampant among refugees, displaced populations, and people living in humanitarian emergencies. Many of them suffer from one or more of the multiple forms of malnutrition. This is often connected to over use of, damage to or conflict over natural resources, and can also force people into unsustainable use of natural resources as they compete for food, nutrition, and cooking fuels.

Hospitals and other nutritional treatment centers have an impact on the environment and the environment impacts them. People accessing services are impacted by the environment, with environmental changes driving malnutrition.

Malnutrition is also increasingly being affected by the impacts of climate change – changing temperatures, temperature extremes, storms, rainfall patterns, and crop pest and disease spread.

Implications

Gender, age, disability and HIV/AIDS implications

Identify the most at-risk members of households.

Impacts

Environmental Impact Categories

Air pollution
Soil pollution
Water pollution
Climate change
Natural resource depletion

Cultural acceptance
Impact on wellbeing / mental health
Increased intensity of storms/hurricanes
Increased drought/flood

Summary of Impacts

Summary of Potential environmental impacts

Provision and use of inpatient treatment of SAM, whilst life-saving, can harm the environment or expose affected people to environmental risks, which can ultimately drive further subsequent malnutrition.
Air, water, and soil pollution can be caused by the accumulation of waste and spills from piled wasted items. Waste can be caused by the provision of items that are unfamiliar or unwanted. Accumulation of packaging may result in contamination of waters sources and end up in rivers, lakes, and the ocean. This can lead to disease spread and cause harm to flora, fauna, and ecosystems.

Buildings and vehicles create greenhouse gas emissions by using electricity or fuel for heating, cooling, lighting, pumping, etc. Sewage, solid waste and clean water, and disinfection and cleaning all have environmental impacts that whose environmental impact should be assessed and minimised.

Impact detail

Detailed potential environmental impact information

Provision and use of inpatient treatment of SAM, whilst life saving, can have negative effects on the environment, or expose affected people to environmental risks, if activities are not well planned or the needs and behaviour of individuals and communities are not appropriately assessed. This can ultimately drive further subsequent malnutrition. When delivered items do not match with the cultural preferences of affected communities, items may be unused and may be discarded. Also, when items are used but the resulting waste is not properly managed by people accumulation of waste can occur in places that have limited waste management and recycling capabilities and wasted items can be disposed of by open burning, causing air pollution. Improper disposal and management of breastmilk substitutes waste can harbour disease vectors. For example, ready-to use infant formula in liquid form will have individual packaging, thus, increasing the amount of waste per user.

Air, water and soil pollution can be caused by accumulation of waste and spills from piled wasted items. Waste can be caused through provision of items that are unfamiliar or unwanted. Accumulation of packaging may result in contamination of waters sources and end up in rivers, lakes and the ocean. This can lead to disease spread and cause harm to flora, fauna and ecosystems.
Buildings and vehicles create greenhouse gas emissions in using electricity or fuel for heating, cooling, lighting, pumping, etc.. Sewage, solid waste and clean water and disinfection and cleaning all have environmental impacts that whose environmental impact should be assessed and minimsed.

Guidance

Summary

Summary of environmental activities

The following activities can reduce the environmental impact of inpatient treatment of SAM:

Source all ingredients, fuel, packaging, utensils from sustainable sources.
Source locally with no plastic packaging if quality can be assured
Store and transport products to minimise the risk of deterioration
Remove excess packaging
Encourage families to return solid waste
Plan efficient distribution routes, using efficient vehicles and driving methods
Raise awareness of environmental drivers of food insecurity and malnutrition and of the impacts of climate change
Source electricity from renewable or less polluting sources
Ensure lights, heating, and cooling are used efficiently
Ensure vehicles are used efficiently.

Detail

Detailed guidance for implementing suggested environmental activities

Source all ingredients, fuel, packaging, utensils from sustainable sources. This should be locally produced if quality can be assured. Locally sourced RUSF can use fresh ingredients and avoid plastic packaging where transport and storage are minimal so quality can be ensured. Store and transport products well so as to minimise the risk of deterioration.
Remove all excess packaging prior to distribution. Provide facilities for families to return solid waste to you so it is less likely to be burned or discarded in a way that causes pollution.

Plan efficient delivery/distribution routes, using efficient vehicles, with drivers trained inefficient driving methods
Raise awareness of environmental drivers of food insecurity and malnutrition and of the impacts of climate change on food security and malnutrition, and on steps, people can take to become more resilient.
Ensure all building facilities, including lighting, heating, cooling, sanitation, cooking, water supply, are all assessed and used efficiently.

Lessons Learnt

Lessons from past experiences

In South Sudan, Humanitarian agencies provided nutritional supplement feeding and found that over time waste was accumulating on land and in watercourses, causing pollution. Agencies responded by setting up feeding centers and removing packaging prior to distribution where possible; providing safe comfortable feeding areas and encouraging their use, followed by encouragement to return all waste packaging prior to leaving the feeding center.