Deployment 5

Name of sector: Assessments

Dates of deployment: 27 October – 20 December 2018

Reason for request:

The humanitarian context in Cox’s Bazar, in Ukhia and Teknaf Upazilla specifically is complex and highlights the huge needs of both existing population as well as the new influx. Adaptive humanitarian responses is required to address and mitigate the poor health and nutrition status of the most vulnerable population. As a consequence sounded nutrition assessments are necessary to enlight the response strategy.

ACF together with UNHCR, WFP, UNICEF, Save the Children and the Centers for Disease Control and Prevention, conducted an Integrated Nutrition Assessment (SMART) in Kutupalong Camp, makeshift and spontaneous settlements and Nayapara Camp from 22 October to 27 November 2017 (round 1).

The Emergency Nutrition Assessment Round 2 was conducted from 28th April to 28th May 2018 in Cox’s Bazar, Bangladesh as a multi-agency exercise carried out on behalf of the Nutrition Sector.

Then the Nutrition Sector agreed to conduct third round of assessments following six months interval from previous round and based on the findings from this round, frequency of this assessment will be determined. The survey aims to determine the nutrition status of women of child bearing age and children under five, as well as select indicators of morbidity, mortality and access to health services. Demographic data collected through the survey will also help in planning and targeting humanitarian interventions. The assessment is designed to provide estimates separately for Kutupalong Refugee Camp, Nayapara Refugee Camp, and the makeshift/informal settlements outside of the camps. WFP will conduct a large-scale food security and nutrition assessment concurrent to the SMART Survey. Refugee Influx Emergency Assessment (REVA) will be implemented concurrently with SMART survey to understand the linkages between food security and nutrition to meet programme information needs.

The Tech RRT Assessment Advisor was deployed to Cox’s Bazar to handle the external communication related to the survey with the UN Agencies, the Government and Partners.  A special attention was paid to the Assessment technical Working Group (ATWG) and the nutrition cluster. He has also provided support in the day-to-day data analysis and guide the team if adjustments are needed. Once the data collection was completed, he prepared the preliminary and final reports, presented to the Assessment Technical working group and partners.

Key achievements: 

  1. Preliminary SMART survey report
  2. Final SMART survey report
  3. Power Point presentation of the preliminary SMART survey findings
  4. Power Point presentation of the final SMART survey findings
  5. Training materials


Deployment 4

Name of sector: CMAM

Dates of deployment: 8 April – 8 July 2018

Reason for request:

Starting August 2017 and forceful population movement of the Rohingya community, two rounds of emergency health and Nutrition assessments were conducted in Oct-Nov 2017 as baseline and April- May 2018 for monitoring purpose using the SMART methodology in both Makeshift Settlements and Nayapara camp. The findings indicate the prevalence of Global acute malnutrition among children aged 6-59 months using weight-for-height (WHZ) has decreased significantly in Makeshift Settlements, from 19.3% in Round 1 to 12.0% in Round 2, and remains below the WHO Emergency threshold (15%) in Nayapara camp, from 14.3% Round 1 to 13.6% Round 2. Further more, the mortality are below the WHO emergency threshold of 1/10,000 persons/day in both sites in the two rounds. Chronic malnutrition (stunting) among children aged 6-59 months has declined but remains near the WHO critical threshold (40%) in both sites. The overall prevalence of anaemia among children 6-59 months has decreased significantly to below thresholds. However, the survey shows that over half of all infants and young children aged 6-23 months are anemic. In general, the improvements in acute malnutrition could be a result of the ongoing humanitarian responses including nutrition, Health WASH, and FSL. However, since the second week of June 2018 there is ongoing rain resulting in landslides, flooding and sewerage system destruction of some health & nutrition facilities and shelters of the refugee community, which could again deteriorate the overall camp situation, particularly the health and nutrition status of children and pregnant and lactating mothers. Outbreaks of waterborne diseases including cholera are expected which may increase the severity and magnitude of acute malnutrition.

The purpose of the Tech RRT CMAM Adviser deployment was mainly to provide technical support and to play an advisory role in improving the quality of CMAM programs by focusing on building capacity of partners and refining monitoring tools and analytical methods through bringing global best practices. By providing technical support and training to Government Counterparts, local and international nutrition implementing partners, the advisor worked to strengthen and improve service delivery and results of CMAM program activities in Cox Bazar. The CMAM Advisor was assigned primarily to the Nutrition Sector working closely with the CMAM working group and other relevant agencies.

Key achievements: 

  • Review and Harmonized CMAM Tools and Job Aids
  • CMAM Training Materials reviewed and TOT Training conducted
  • Joint supportive Supervision (JSS)
  • Development of guidance Note for Mobile Nutrition Team  (MNT)
  • SOP for Community Nutrition Volunteers
  • Standardization of service delivery for all CMAM (Minimum package)


Deployment 3

Name of sector: IYCF-E

Dates of deployment: 30 November 2017 – 21 January 2018

Reason for request: 

Since 25 September, more than  half a million Rohingya have crossed into Bangladesh, fleeing large-scale violence and human rights abuses in Rakhine state, Myanmar. This new wave of displaced Rohingya adds on to a pre-existing Rohingya community in Cox’s Bazar area, amounting to approximately 821, 055 in total.

Nutrition and IYCF-E Situation Analysis

The nutrition risks and vulnerabilities amongst the displaced Rohingya children under the age of five, pregnant women and mothers/caregivers of children under the age of 2 and adolescent girls are very high.

The findings from Kutupalong refugee camp and the makeshift settlements indicate the prevalence of acute malnutrition among all children 6-59 months of age significantly exceeds the WHO emergency threshold (15%) in all the three areas (24.3%, 19.3% and 15.8% respectively); particularly in Kutupalong refugee camp which was assessed earlier in the response and days after a large influx of new arrivals. All three surveys indicate that nearly half of children suffered from anemia (Hb<11.0g/dL), representing a severe public health problem according to WHO classification threshold (40%).

Results suggest the majority of children are breastfed, however, exclusive breastfeeding is dangerously low considering contextual and aggravating factors, particularly in the makeshift settlements. All three surveys indicate that less than 16% of children are achieving a minimum acceptable diet for their optimal growth and development.

Deterioration in infant and young child feeding practices puts young children at increased risk of acute malnutrition and therefore a linked and integrated response is needed and encouraged in the ongoing Cox Bazar emergency response. [i]

Bangladesh has been on the forefront in strengthening their Infant and Young Child Feeding Programming, major efforts are underway to ensure that also the IYCFE component will be strengthened.

A Joint Statement on Infant and Young Child Feeding in Emergencies, issued by the Institute of Public Health Nutrition (IPHN) and the Ministry of Health and Family Welfare and supported by all partners, reaffirms the importance of protecting, promoting and supporting infant and young child feeding practices among the affected populations, even for those few cases needing breast-milk substitutes support.[1]

The Terms of References agreed with the Nutrition Sector were as following:

  1. Establish a system and facilitate the implementation for the monitoring of the IYCF-E response plan, explore the possibilities of mainstreaming the IYCF-E in the IYCF programs.
  2. Plan and deliver orientations and trainings on IYCF-E, as per the capacity building plan within the IYCF-E response plan
  3. Ensure adequate coordination for IYCF-E through leading and providing substantial support to the IYCF-E technical working group and working with other sectoral and cross thematic working groups
  4. Provide support to humanitarian actors on minimum standards, tools and guidelines in place in Bangladesh for IYCF-E as major component of the national IYCF strategy.
  5. Reinforce the system for the monitoring and reporting of violations of the code of BMS,
  6. Advise on, advocate and actively support integration with other sectors (WASH, Food Security and Livelihoods, Child Protection, Health) using the IYCF framework
  7. Provide support to partners to strengthen monitoring and evaluation systems and tools to be used across the IYCF-E response to ensure quality, consistency and assist comparability and learning
  8. Conduct joint monitoring visits to IYCF-E activities to provide support and guidance to partners.

Key achievements: 

    • Finalized M&E tools
    • Finalized draft for endorsement to the Nutrition Sector of a technical guide to support the infants less than six (6) months that are not breastfed
    • Coaching done bilaterally with eight (8) partners implementing IYCF activities
    • Integration of IYCF reporting with CMAM reporting requirements
    • Trained 25 Trainers for IYCFE Counselling Training
    • Reviewed a draft of the 1st National IYCF-E guidelines and the full consolidated document
    • Coordinated the IYCFE TWG during the period of the mission
    • Represented the IYCFE TWG during the Nutrition Sector meetings
    • Agreements with Child Protection and GBV sub sector for integration of IYCF-E services in Women and Girls Safe Spaces (WFS) and orientation of 20 CP case workers.
    • Review and contributed in the adaptation of the 5-day IYCF-E training developed by SCI
    • Development of a rapid assessment tool to identify and refer infants less than six (6) months that are not breastfed
    • Supervise the ongoing rapid assessment to identify infants less than six months that are not breastfed
    • Engaged bilaterally with agencies reportedly providing BMS donations to affected populations (5 agencies)
    • Contributed in the drafting of the Joint Response Plan for 2018
    • Developed a proposal for the adaptation of the global health media video tools to be adapted in the local languages.

[1] Joint Statement: Infant and Young Child Feeding in emergencies, October, 2017

[i] UNICEF. Nutrition in Emergencies. Module 13: Management of Severe Acute Malnutrition. 2011.


Deployment 2

Name of sector: IYCF-E

Dates of deployment: 5 – 27 November 2017

Reason for request:

Key achievements: 


Deployment 1

Name of sector: IYCF-E

Dates of deployment: 21 October – 4 November 2017

Reason for request:

Key achievements: