Stephanie is an Action Against Hunger psychologist in the Central African Republic.
Malnutrition in Conflict: Treating the Psychological Causes of Hunger
Treating malnutrition in humanitarian crises, such as conflict and natural disaster, is far more complex than simply curing disease and providing children with therapeutic foods. Often, post-traumatic stress disorder (PTSD)—which is common in extreme situations—hinders the success of treatment. In Bangui, in the Central African Republic , the number of children suffering from life-threatening malnutrition has tripled since the outbreak of violence in December 2013.
The cause of severe acute malnutrition runs far beyond economic hardship and lack of food. Many of the hundreds of thousands of people displaced by fighting have been threatened, and have lost their family members, homes, and belongings. They are often exhausted by the harsh living conditions in camps. Such harsh conditions take their toll: In recent studies conducted by Action Against Hunger, 75% of parents of malnourished children surveyed presented symptoms of PTSD linked to their exposure to violence.
Post-traumatic stress provokes behavioral changes that—while understandable, normal, and usually temporary—can be disabling enough to impact a mother's ability to care for and nurse her child. Nurses helping women in the twelve health centers around Bangui have reported that some mothers suffering from PTSD can’t respond to their child’s needs, which can be dangerous for babies in an already challenging environment.
Children, while too young to fully understand what they have witnessed, may also develop physical PTSD symptoms, including refusing to eat. Even small babies can present signs of trauma. Some parents don't recognize these behaviors as signs of a larger problem, so they don’t react in a nurturing way. To combat this, we are providing malnourished children and their caregivers with psychological and social support.
At the therapeutic nutritional ward of Bangui's main pediatric hospital, our nutritional, psychological and social teams offer free specialized counseling and treatment for severely malnourished children. Children like six-year-old Jessica, who had been refusing food and not interacting with others when her father and sole caretaker, Dieumerci Tsongbele*, brought her to the hospital.
Tsongbele joined a welcome session led by psychological and social experts, where he and other parents learned about factors that exacerbate malnutrition, including trauma. This new information evoked an emotional response from him, because he had witnessed extreme violence and, as a result, had become irritable and unable to sleep. Overwhelmed, he admitted he had been less attentive to his daughter’s needs.
But there is hope for Jessica and her father. During treatment, Tsongbele and the other parents participated in activities with their children that provide both parents and children with a safe space to recreate natural and vital bonds that are essential for human development. These bonding sessions strengthen the parent-child relationship and help to limit the negative effects of malnutrition. Through these programs, we see that malnutrition treatment is not simply about filling stomachs, but also restoring the desire to eat.
*Names have been changed to protect identities.
Editor’s note: This piece was originally published in The Guardian on June 2nd, and has been adapted for our blog.