NARGIS ABDO, YEMEN: " “When I discovered that my little girl, Alhan, was malnourished, I was afraid"

The Yemeni people are facing multiple crises, including armed conflict, displacement and risk of famine and disease outbreaks, described as the world’s worst man-made humanitarian crisis. Four years of ongoing conflict and economic decline have exhausted the population’s resilience mechanisms, destroyed infrastructure and seriously disrupted the country’s economy. According to the Yemen Humanitarian Response Plan, in 2019, 24 million people – 80 percent of the population - are in need of humanitarian and protection assistance. A total of 230 out of Yemen’s 333 districts (69 percent) are at risk of famine, and in 45 districts an estimated of 2.8 million people are facing catastrophic food insecurity (IPC Phase 5). Around 16 million are in dire need of clean water, sanitation and hygiene.

In addition, fifty per-cent of health facilities are shut and more than 70 per-cent of those that are operational, do not have regular supplies of essential medicines. Since April 2017, cholera in Yemen has so far affected 1.7 million people and cost 3454 lives. Finally, around 2.1 million children and 1.1 million pregnant and lactating women are severely malnourished, including 400,000 children under the age of fifve who are suffering from severe acute malnutrition.

Action Contre la Faim has been implementing programmes in four governorates in Yemen, conducting multiple interventions to manage crises such as cholera outbreaks and displacement, as well as facilitating food security and nutrition projects. Since the beginning of the war in 2015, we put a special emphasis on alleviating the suffering of internally displaced people (IDPs) and vulnerable host communities. As the security and safety situation continues to decline due to the protracted conflict, the living conditions for the already destitute Yemeni population deteriorate further, with families struggling daily to secure basic food.

 Maintaining operational presence in some of the worst affected areas of the country and supporting those hardest to reach remains our greatest challenge. We are, however, continuing our nutrition and health programmes, especially our support for treating severe and moderate acute malnutrition in children under fifve and pregnant and lactating women. This also involves training of health workers and sensitization of vulnerable communities. The latter is of particular importance in light of recent waves of cholera that have affected over 1 million Yemenis. Our integrated humanitarian response also covers water, sanitation and hygiene programmes through rehabilitation of water points and latrines, hygiene promotion and distribution of hygiene kits. Furthermore, Action Contre la Faim implements various food security and livelihoods programming, primarily through distribution of cashtransfers to cover basic food and other needs.

Nargis Abdo Saeed is 25 and a mother of four: a nine-year-old boy, two girls seven and five, and her youngest daughter is only one year and eight months old. Nargis got married at the age of 14 and is currently pregnant with her fifth child.

 Two of her children were diagnosed with severe acute malnutrition (SAM) – a life-threatening form of acute malnutrition characterised by severe wasting. Children with severe acute malnutrition are very emaciated and are at high risk of catching other illnesses and/or of death. They received treatment at Al Soumita health facility in Tur Al Baha district in the Lahj governorate, that is supported by Action Contre la Faim.

 Married to a soldier, Nargis found herself being solely responsible for the care of her four children while her husband is away on his military duty. Balancing the demands of pregnancy and the care of two children who had been diagnosed with malnutrition, along with other household responsibilities such as daily collection of water and wood, was a major challenge for her.

 When she arrived at Al Soumita health facility, Nargis received training from health workers about how to measure the Middle Upper Arm Circumference (MUAC) for her children, which helped her recognise that her youngest child is suffering from moderate acute malnutrition (MAM), a condition which occurs in the early stage before deterioration to severe acute malnutrition. Nargis suddenly felt a heavy weight on her shoulders: she was pregnant with her fifth child, worried about her husband’s safety and having multiple malnourished children to take care of.

“When I discovered that my little girl, Alhan, was malnourished, I was afraid. I repeated my reading of the MUAC tape multiple times. I began asking myself what was I doing wrong? I couldn’t handle the situation anymore, my husband was fighting in the war to provide us a good life, yet I couldn’t keep my children healthy?”

Nargis was identififed by health workers who had been trained on Psychological First Aid as especially vulnerable, and she was encouraged to attend sessions on Mental Health and Care Practices at a dedicated Infant and Young Child Feeding (IYCF) space in the health facility. In IYCF spaces, child feeding and psychosocial difficulties are assessed, and women are given the opportunity to attend counselling sessions on Mental Health and Care Practices (complementary feeding and continued breastfeeding until the child is 2 years old). They are followed up for at least four visits to ensure that their challenges are resolved to the greatest extent possible. Health workers counselled Nargis about how to cope better with the daily stresses of life.

“After attending the first session, I realised that I am feeding my children without caring about food variety, and I am not taking enough time to breastfeed. I also realised that I am not alone, and there are a lot of women living with the same challenges that I am facing. Earlier, I was always angry and beating my children every day.

Now, I learned how to find other ways for releasing my emotions and stress.”After implementing the advice provided to her in the sessions, Nargis’s children grew healthier well. Her youngest, Alhan is also about to finish the MAM treatment. Nargis says that everyone notices that she is also much more at peace.