Lessons on nutrition of displaced people.

Policies for protecting the nutrition of displaced people (including refugees) have evolved significantly since the sharp increase in numbers began in the 1970s. Food supplies have often been grossly inadequate, probably contributing to the very high mortality rates and severe malnutrition observed in camps. These are related, in part, to low estimates of food energy needs, moving from the idea of "survival" rations (1200-1800 kcal/person/day) through "minimum" (1900 kcal) to a current target level, likely to be usually adequate, of 2100 kcal. Some donors aim to provide 2400 kcal to preclude the need for supplementary feeding. Micronutrient needs in food supplies have received less attention, despite reemerging epidemics of micronutrient deficiencies (e.g., scurvy, pellagra) in camp populations. Supplied commodity baskets are still not routinely designed to meet micronutrient needs. The relative roles of different feeding programs need clarification; therapeutic feeding in severe malnutrition is well established, although experience of supplementary feeding is mixed. Better information on nutrition, health and survival is now routinely available; in particular, using trigger levels of mortality rates (e.g., 1/10,000/day as a crisis) has helped enhance action. The existence of severe wasting in children is highly predictive of increased mortality and could be tested as a readily observed indicator. Overall, procedures for alleviating and preventing malnutrition have indeed improved, but much more slowly than the scientific basis could allow. A general conclusion is that learning lessons and applying them more quickly could still prevent much malnutrition and save many lives among displaced people.