By: Shiromi Perera
The Syrian Crisis continues to be one of the worst humanitarian and protection crisis of our time. As the Crisis continues in its sixth year, the ongoing conflict has taken a significant toll on the lives of the Syrian people, having led to significant displacement of over half of the population, with 4.8 million seeking refuge in neighboring countries and 6.3 million people having been internally displaced. About 13.5 million people within Syria require urgent humanitarian assistance, this includes 1 million in camps/ shelters and 4.5 million people that are living in besieged and hard-to-reach areas.[1],[2] The conflict has impacted the basic needs of the population, such as nutrition, health, and access to safe water, sanitation and hygiene.
Despite the immense challenges, humanitarian partners continue to deliver immediate lifesaving assistance to conflict-affected communities. The Nutrition Cluster and its partners have been promoting and supporting optimal infant and young child feeding (IYCF) practices, as well as maternal nutrition, as priority lifesaving interventions in Northern and Southern Syria. To harmonize programming efforts of partners, a Nutrition Cluster IYCF Strategy was developed, which led to the need for a more in-depth understanding of nutrition practices. A Knowledge Attitudes and Practices (KAP) survey, conducted in February 2017, indicated that despite the extensive programming, the prevalence of certain IYCF and maternal nutrition behaviors were either low or largely unchanged, warranting further investigation.
The Tech RRT Deputy Program Manager was deployed to Gaziantep, Turkey to coordinate the first Barrier Analysis (BA) to ever be conducted in Syria. The BA assessed 3 IYCF and maternal behaviors that have been promoted among internally displaced people (IDP) in camp and urban settings in the Aleppo, Idlib and Dar’a Governorates, but were found to be performing sub optimally: 1) exclusive breastfeeding (EBF), (2) diet diversity during complementary feeding and (3) eating an extra meal during pregnancy. Based on this formative research and 2 workshops with Cluster Partners, a Social Behavior Change (SBC) strategy was developed to be integrated into the Syria IYCF Strategy.
Key components of the deployment and BA Included:
- Barrier Analysis (BA) Training of Trainers was provided to participants of 5 Nutrition Cluster partner organizations implementing activities in North or South Syria. The training was then cascaded, either directly or remotely, to their data collection teams in the field.
- In total, 551 Mothers were interviewed in North Syria (n=271) and in South Syria (n=280).
- The BA’s identified 11 determinants in the North and 5 determinants in the South to be significant for EBF, 11 determinants in the North and 8 determinants in the South for complementary feeding, and 11 determinants in the North and 9 determinants in the South for an extra meal during pregnancy.
- There were many barriers and facilitators experienced by mothers in practicing these 3 behaviors, these included:
-Exclusive Breastfeeding: Stress experienced by mothers due to displacement, lack of food for the mother to eat, misconceptions related to milk production and baby satisfaction, and issues related to latching.
-Diverse Diet: Lack of time to prepare meals, lack of ability to prepare foods (lack of electricity, clean water, food storage, appliances, etc) misconceptions around proper complementary feeding practice (sick child feeding), difficulty in accessing markets, lack of food diversity in markets, and lack of support from relatives.
-Extra Meal during pregnancy: Regular displacement, lack of ability to prepare foods (lack of electricity, clean water, food storage, appliances, etc) lack of time to prepare meals, lack of access to markets, lack of food diversity in markets, lack of enough money to afford food, no privacy because of crowded households and lack of family support.
- Findings of the BA were presented during a workshop with Cluster Partners for validation and discussion about recommended activities. A report was developed specifying how evidence from these assessments should be used to inform activity planning by Nutrition Cluster partner programs.
- Two workshops were held with Cluster Partners to understand what is currently being done in IYCF programming related to SBC, what gaps exist and what is possible for future programming. This feedback, as well as the BA results, were incorporated in the development of a Whole of Syria SBC Strategy.
[1] Humanitarian Response Plan Syria 2017 https://docs.unocha.org/sites/dms/Documents/2017_hrp_syria_170320_ds.pdf
[2]UNOCHA http://www.unocha.org/country/syrian-arab-republic/syria-country-profile/about-crisis