NUTRITION CLUSTER BULLETIN GAZIANTEP, JUNE MILLION INTERNALLY DISPLACED. 5.7 K The Hub Target MILLION PLW AND CU5 IN NEED

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1 NUTRITION CLUSTER BULLETIN GAZIANTEP, JUNE 2018 A delivery of lipidbased nutrient supplements arrives in an underground shelter in Humra on March 8, A child begins to consume a portion of the supplement TURKEY CROSS BORDER REPORTING PERIOD 01 JAN TO 30 JUN MILLION INTERNALLY DISPLACED 5.7 K The Hub Target 1 MILLION PLW AND CU5 IN NEED Highlights: The Nutrition cluster reached 504,210 girls, boys and pregnant and lactating women (PLWs) in need from January to June 2018 with curative and preventive nutrition services. This includes 234,769 girls and boys under five and PLW screened for acute malnutrition. 13,628 girls and boys under 5 were identified with MAM (7,788 out of them received treatment). 3,296 were identified with SAM, (1,913 out of them received treatment) and 6,300 PLWs were identified with MAM (6,570 out of them received treatment.) Additionally, 63,094 girls and boys underfive and 62,993 PLWs received micronutrients supplementation and 158,928 PLWs received IYCF massages and counselling on infant and young child feeding. 1

2 Achievement of the Gaziantep Hub Map Jan June 2018 Heath workers trained on CMAM and IYCF CU5 and PLWs receiving micronutrien ts CU5 & PLWs treated for MAM CU5 treated for SAM PLWs received appropriat e IYCF massages CU5 and PLWs Screened for malnutrition CU5 reached with LNS/ HEB 691 (46 %) 126,087 (32%) 14,358 (82%) 1,913 (120%) * * Increasing trends of acute malnutrition as indicated from both survey and surveillance with rapid increase of IDPs from different areas 158,928 (100%) 234,769 (59%) 54,064 (52%) Nutrition Reached beneficiaries for 2017 & 2018 From January to June 2018 the cluster has been able to admit total of 1,913 severely malnourished children aged 0 59 months 7,788 moderately malnourished children aged 659 months and 6,570 pregnant and lactating women with acute malnutrition to treatment programs. Treatment for severely and moderately malnourished children has been established in 80 communities. The graphs below show the comparisons between Jan to June 2017 and 2018 SAM Treatment CU5 MAM Treatment CU5 2,500 2,000 1,500 1, , ,000 8,000 6,000 4,000 2,000 7,788 2,829 8,000 6,000 4,000 2,000 MAM Treatment PLW 6, PLWs received micronutrients 80,000 62,993 60,000 40,000 20,000 11,109 Children U5 received multiple micronutrient 80,000 60,000 40,000 20,000 9,722 63,094 2

3 The paragraph showed that the number of reaching beneficiaries is increased in 2018, this result of cluster scale up plan to reach the newly IDPs coming from different areas, due to continues conflict in different areas in Syria. Overview of Nutrition Situation: Assessments and Surveillance: In January 2018, a SMART survey was completed in Ein Issa, Suluk and Tell Abyiad SubDistricts of Raqqa Governorate measuring 908 girls and boys between the ages of 6 59 months in 42 clusters. The results indicated the prevalence of global acute malnutrition (GAM) (<2 WFH Zscore and/or oedema) at 1.9% ( % C.I.) which is considered an acceptable level of acute malnutrition according to WHO cutoff values. The prevalence of moderate acute malnutrition (MAM) (<2 zscore and >=3 Zscore, no oedema) is 1.8% ( % C.I.) and the prevalence of severe acute malnutrition (SAM) is 0.1% ( % C.I.). The prevalence of GAM based on MUAC was 1.9% ( % C.I.), and SAM was 0.7% ( % C.I.). The prevalence of stunting (HFA <2 Zscore) was 32.4% ( % C.I.) which indicates a serious chronic nutrition situation according to WHO cutoff values.(1 Tell Abyiad SMART Survey Done by ACU) Nutrition cluster shared the report with north east nutrition working group to take the proper intervention In March 2018, a SMART survey was completed in Jarablus District of Aleppo Governorate measuring 462 girls and boys between the ages of 6 59 months in 30 clusters. The results indicated the prevalence of global acute malnutrition (GAM) (<2 WFH Zscore and/or oedema) at 0.2 % ( , 95% C.I.) which is considered an acceptable level of acute malnutrition according to WHO cutoff values. The prevalence of moderate acute malnutrition (MAM) (<2 zscore and >=3 Zscore, no oedema) is 0.2% ( , 95% C.I.) and the prevalence of severe acute malnutrition (SAM) is 0.0% ( , 95% C.I.). The prevalence of GAM based on MUAC was 1.1% ( , 95% C.I.), and SAM was 0.2% ( , 95% C.I.). The prevalence of stunting (HFA <2 Zscore) was 25.8% ( , 95% C.I.) which indicates a poor chronic nutrition situation according to WHO threshold.(2 Jarblus SMART Survey done by ACU + IDA) The survey indicate poor chronic nutrition the nutrition cluster strengthen the IYCF program as main intervention to prevent stunting, and scale up integrated program with health and other sectors. Surveillance snapshot report: Functioning the nutrition surveillance system in AthThawra (western Ar Raqqa) in coordination with Nutrition Cluster in 3 HFs, 643 children aged 659 months were screened and 32 GAM cases were detected. During June 2018, (102/102) 100% of the reporting HFs across 5 Governorates provided nutritional surveillance data, and 100 % of reporting HFs submitted their reports on time. The total number of detected malnourished cases is 1,690 out of 31,568 measured children (60% of them under 2 years old), the cases classified as follow: 1,157 MAM (3.67%) and 533 SAM (1.69%) including 5 bilateral pitting edema cases were diagnosed as a result of malnutrition, GAM prevalence was (5.35%). Pregnant and lactating women MUAC Screening continued in 64 health facilities in 5 governorates. 5,547 PLW were screened (2,687 pregnant and 2860 lactating women) 217 (3.9%) of them were classified as malnourished and referred for treatment. The nutritional status screening by measuring weight to height (Zscore) Continued in 46 HFs in 5 governorates. 15,997 children aged between 05 years were screened by all indicators, including 2,992 children aged between 06 months, 129 cases were classified as malnutrition (70 as MAM and 59 as SAM). Regarding to May referred cases follow up, 1,433 malnutrition cases were referred to treatment centres and 363 malnourished cases were not referred to treatment centres for the following reasons: absence / or far treatment centres in 294 cases (81%), all of them in Tell Abiad and Menbij, and other problems in 69 cases (19%). 3

4 The DNOs could reach 89% from the referred cases for follow up after 15 days, the main cause of not reaching the other cases (11%) is the absence of local communication tools (phone and internet). Only 982 of the reached cases (77%), have visited the treatment centres in their areas, 300 cases (23%) didn`t visit the treatment centres. (3) Trends of malnutrition from January to June (from surveillance Data) The trend of malnutrition increased in Idlib governorate tribble times due to increase of IDPs coming from different areas and in AlRraqa malnutrition is increased rapidly due to lack of access and lack of services. NUTRITION CLUSTER RESPONSE AND CHALLENGES (January June 2018): Low coverage in high severity locations (Severity 4: 33%, Severity 5: 11% and Severity 3: 44%) Underfunding with the need to increase efficiency. The nutrition cluster is 45.5% underfunded, which hindered the scale up of the nutrition intervention including I YCF in emergency strategy Continuous displacement of IDPs due to intensified fighting between the Government of Syria and its allies and NonState Armed Opposition Groups and another armed group to Aleppo and Idleb Governorate 4

5 IYCF advocacy and awareness raising campaign: Meeting with Reproductive Health technical working group to opportunities of integration and scale up the IYCF in Reproductive Health strategy. Nutrition cluster is continuing work with health cluster After the brilliants success of the last year's infant feeding campaign, the nutrition cluster decided to extend the campaign for this year, targeting 200 communities. The lunching was in 29 of May 2018 The camping divided to 2 rounds. last round was finished in 7 of June 2018 Delivering, integrated curative and preventive nutrition activities including, screening and referral for malnutrition, multiple micronutrients supplementation as well as IYCF individual counselling and awareness sessions to the communities. 8,060 children were screened for malnutrition using MUAC 151 children were found with MAM and 35 children with SAM, all malnourished cases were referred for treatment. 4,889 PLW screened for Malnutrition 155 cases were found with malnutrition and received treatment. 4,794 PLW received Micronutrients tabs and 7,592 Children 6 59 month receive multiple micronutrient powder. 3,242 PLW received individual IYCF counselling 438 IYCF sessions were conducted, 16,196 leaflet IYCf key messages were distributed. 5

6 Capacity building: Individual awareness sessions and MNPs Distribution 03/06/2018 Eastern Tal Aar / Aleppo 35 participants attended a 2day training on information management facilitated by the Turkey Hub Nutrition Cluster together with the WoS Nutrition Sector in March. 50 participants attended a workshop on Nutrition Concepts and Food Security Indicators organized by the FSL Cluster with the support of the Turkey Hub Nutrition Cluster. The FSL participants were trained on nutrition specific indicators and MUAC screening methodology. To support the scale up of curative and preventive nutrition interventions a total of 900 health staff were trained on CMAM & 1,150 were trained on IYCF inside Syria. IDP response through the cluster emergency response teams: During all the last 5 months nutrition partners with their emergency response teams continued responded to the IDPs arrived from Eastern Ghouta. Fourteen cross border nutrition partners provide curative and preventive nutrition response through 15 mobile clinics and 30 teams of community health workers to camps and reception centres and districts were IDPs have settled down. A total 45,105 children (659 months) were screened for malnutrition, using MUAC. 2,093 children were found to be MAM and 485 SAM, and all were admitted for treatment. In addition, 15,302 pregnant and lactating women were screened for malnutrition, 1,492 cases were identified as MAM and referred to the health facility for treatment. The proportion of malnourished PLW is 9.7%, and 5.7% for children (659 months). The rapid response team also provided preventative nutrition services to a total 49,982 children (659 months) benefitted 25,634 children received HEB, 24,348 received Plumpy DOZ, In addition, 20,976 PLW received micronutrients. Moreover, 19,819 PLW received messages / counselling on infant and young child. And in addition to that 5,099 infants (<6 months) were assessed for breastfeeding and supported as per the SOPs for breast milk substitute. 6

7 Latest Map of IDPs response and photos Nutrition Cluster Highlights: The nutrition cluster is led by UNICEF and coled by PAC and includes 8 INGOs and 20 LNGOs organizations, donors. The coordination is taking place at Gaziantep level. Cluster coordination highlights in the last Six month: nutrition cluster reformulated technical working group according to the change in situation, IYCFE and advocacy technical working group merged in group and Nutrition sensitive programming task force has been added. Nutrition cluster conducted 2day IYCFE three years Strategy ( ) year Review Workshop in Gaziantep with the support of the UNICEF Regional Nutrition Advisor, the WoS Nutrition Sector Coordinator and Save the Children Nutrition Advisor for Syria. This workshop reviewed indicators and achievements, IYCF materials and reports, and set a number of recommendations for Analysis of gaps, overlaps and operational planning per district is ongoing led by cluster coordinators. Development of preparedness & response plan for new waves of IDPS arrived to Idlib rural Aleppo and Afrin. Collaboration with health cluster for integration of nutrition indicators as part of the health information system (DHIS2) and costing of the primary health care package of service. The EWARN Cross border nutrition surveillance system expanded to include 15 additional health facilities: 3 in AlThawra subdistrict of Ar Raqqa Governorate; 5 in Menbij subdistrict of eastern Rural Aleppo Governorate; 1 in Hrak SubDistrict and 1 in Izr SubDistrict of Dar a Governorate bringing the total number of nutrition surveillance sites to 105 for this quarter. 7

8 Turkey Hub and WoS coordinators presented their experiences in Syria response at first High Level Technical Assessment Meeting for the Middle East Region in February. This meeting was organized by Action against Hunger Canada in Amman, Jordan with 13 participants from WoS Nutrition Sector and partners. This meeting was a platform for stakeholders to discuss nutrition assessments and information management of crisisaffected populations in the Middle East region. 50 participants attended a workshop on Nutrition Concepts and Food Security Indicators organized by the FSL Cluster with the support of the Turkey Hub Nutrition Cluster. The FSL participants were trained on nutrition specific indicators and MUAC screening methodology. Nutrition cluster in collaboration of health cluster finalizing nutrition manual for Community health worker packages, CHW manuals unified is part of unified package for north Syria this project leaded by WHO with participation of health and nutrition partner Success stories: A short time Ago17 month old Turfa Mukhles ALhusien was suffering from severe malnutrition With right medical support she now back on track and smiling 20/05/ /06/ /07/2018 Thanks for UOSSM Location:ALwadehe Camp_Deir Hassan Name of center: Deir Hassan Darhashan (ER) 8

9 UPCOMING EVENTS IYCF counselling training cluster coordination training Inpatient care training Table of Acronyms: UC5: Children Under five PLW: Pregnant and lactating women IYCF: Infant and Young Child Feeding SAM: Sever Acute Malnutrition MAM: Moderate Acute Malnutrition CMAM: Community Management of Acute malnutrition MUAC: Mid Upper Arm Circumference CHW: Community Health Wrokers HEB: High Energy Biscuits LNS: lipidbased nutrient supplements GAM: Global Acute Malnutrition Nutrition Cluster Coordinator Tarig Mekawii Phone: Nutrition Cluster Co Coordinator Mona Maman nutrition@pacturkey.org Phone: Nutrition Cluster Information management officer Abdullah Alismail nutrition.imo@pacturkey.org Phone: