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The impact of explosive violence on child nutrition

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By Verity Hubbard

Between 2014 and 2017, the Syrian city of Deir ez-Zor found itself a place under siege. For three long years, Deir ez-Zor was shelled, starved and systematically destroyed. Food was already fast becoming scarce, but when ISIS fired rockets at Deir ez-Zor's airport, they severed the air bridge supplying the city with food. Hunger followed. Civilians later reported that they were forced to eat the "edible leaves found in the surrounding area".

The Deir ez-Zor siege starkly demonstrates the interrelationship between conflict and hunger in the modern age, and how food is today still used as a weapon of war.

In his book Mass Starvation, the author Alex de Waal argues that famine as a consequence of the weather has very nearly disappeared. Instead, he writes, almost all famines today are driven by war, blockade, hostility to humanitarian principles, and a volatile global economy. In recent years, the correlation between war and hunger has become even more pronounced. In an address to the UN Security Council in 2018, the Director of the World Food Programme (WFP) reported that "wars and conflicts are driving hunger in a way we've never seen before." According to the WFP: 'the single greatest challenge to achieving Zero Hunger is armed conflict.'

Certainly nothing can be taken for granted. After steadily declining for over a decade, global hunger is on the rise again. One of the main reasons for this increase is the use of explosive weapons in armed conflict. Such weapons damage food supply chains, creating food insecurity and instigating man-made famine. The insecurity that air-strikes, ground launched rockets, tank shells and improvised explosive devices (IEDs) create makes it sometimes a deadly mission for aid agencies seeking to reach those in need.

Children suffer the most. More than any other age group, babies, toddlers and teenagers are harmed by the lingering effects of explosive war: malnutrition, stunted growth, wasting and in the most acute cases, death stalk the battlefield. And it is the irreversibility of these effects on children that make war-fuelled malnutrition so pernicious.

Explosive weapons and food insecurity\ Explosive weapons damage agricultural assets and interrupt the food trade. Disruption in the chain of food production, transport, and distribution leads to a reduced food supply, causing prices to rise and families to go without. For example, during the siege of Deir ez-Zor, civilians reported that a bag of sugar would cost 100,000 Syrian pounds (over USD 450).

Food insecurity also arises from a sense of risk. If farmers think that there are explosive remnants of war (ERW) on their land, they will not farm. If couriers think that it is too dangerous to transport food, they will divert their ships or trucks. If aid agencies cannot protect their staff, they will not be able to provide the food services that families rely on.

The reverberations of explosive violence spread far and wide, contaminating supply chains and inhibiting the free flow of goods and services.

Food production\ Damage to food production sites is most frequently caused by air-delivered explosive weapons, though places like Eastern Ukraine have also seen farmers severely impacted by grad strikes and other ground-delivered weaponry. Explosive weapons cause severe damage to soil, crops, livestock, and agricultural infrastructure; they displace farmers and other experts essential to ensuring the smooth running of farms and other agricultural industries; and they can often lead to the destruction of irrigation canals and grain depots as seen in Syria.

ERW and unexploded ordinance (UXO) also cause harm long after the fighting has stopped. When scattered over cultivated land, crop production is reduced. Even when mines have not been laid, land remains unused by the local population because of perceived risk. Even de-mined land can suffer from infertility due to reduction in nutrient levels caused by the leaching of contaminants into the soil.

Food transport\ Aerial explosives have caused significant damage to food transport hubs which, in turn, damages the food supply. The port of Hudaydah in Yemen is offers up an illustration of how explosive weapons disrupt the chain of food production with devastating consequences. Yemen relies on imports for 90% of its food and Hudaydah is one of the country's most critical ports, handling over half of all dry bulk cargo. In the early days of the Saudi-led Arab Coalition intervention, transport around Hudaydah was targeted, but the port itself was spared because Saudi ships were operating out of there. According to Martha Mundy, when the Houthis refused to surrender, the Coalition altered their strategy and began to target economic infrastructure, including Hudaydah. The port and food storage facilities were struck first in air strikes in August 2015, and the port subsequently closed. The number of ships berthing in Yemen dropped from 75 in July to 34 in August; food prices subsequently rose by 28%.

Food distribution\ Food markets are deliberately targeted by both terrorist and state actors. An attack on a food market has a double effect: it causes a high number of casualties but also destroys food stocks and disrupts the local food trade. In discussing the Arab Coalition intervention in Yemen, Alex de Waal noted that "The [Arab] coalition air strikes are not killing civilians in large numbers, but they might be destroying the market and that kills many, many more people."

In November 2015, for instance, a bakery was hit by an airstrike in Saraqib in north-western Syria. According to the charity which ran the bakery in Saraqib, the factory supplied bread, daily, to around 45,000 internally displaced people (IDPs) before it was bombed. That supply was cauterised in a moment.

A United Nations Institute for Disarmament Research (UNIDIR) report notes that damage to food markets can be caused by a wider variety of explosive weapons such as airstrikes, shelling, IEDs and suicide attacks.

Access to humanitarian support\ When food is scarce, humanitarian agencies step in to fill the void. But tactics of modern conflict often prevent humanitarian agencies from accessing those in need. This may be caused by denial of entry, or by direct targeting of humanitarian support with explosive weapons. A particularly egregious example was the 2016 Russian airstrike on a humanitarian aid convoy of Syrian Red Crescent trucks carrying UN food supplies in Syria. The strike hit while food was being unloaded into a warehouse, killing 12 aid workers and destroying 18 aid trucks. The trucks were carrying urgent food supplies intended for tens of thousands of civilians cut off by the war in a rural area west of Aleppo.

All of these impacts, however harmful to adults, are most acutely felt amongst children.

Impact on children\ Nutrition is, clearly, the foundation for every child's growth and development; without a healthy diet and adequate quantities of food, the consequences manifest in micro-nutrient deficiencies and deficiency diseases, obesity, chronic malnutrition (stunted growth), and acute malnutrition (wasting). All of these have lingering and life-long effects.

Malnutrition\ Children are particularly vulnerable to malnutrition due to their greater susceptibility to infection and their slow recovery from illness. Around 45% of deaths among children under 5 are linked to undernutrition, making it the single biggest contributor to under-5 mortality. The impact of malnutrition on children is often irreversible and especially harmful in the first 1,000 days of a child's life. Meanwhile, older malnourished children may find themselves unable to focus on schoolwork which can, in turn, have lifelong effects.

Post-traumatic stress disorder (PTSD) caused by exposure to conflict and explosive weapons can also hinder the success of treatment against malnutrition. The NGO Action Against Hunger has reported that a symptom of PTSD may be children refusing to eat; even babies were reported presenting signs of this trauma.

More indirectly, attacks on healthcare centres using explosive weapons have often led to cases of malnutrition being left untreated; complications cannot be addressed, and assessments cannot be conducted. The malnutrition problem is further compounded by institutional and environmental fragility. When the State ceases to function effectively, the first victims are the most vulnerable.

Environmental contamination effects water quality, which is in turn linked to an increased risk of waterborne diseases and malnutrition among children.

Stunting, wasting and death\ Stunting is a major concern in conflict and post-conflict environments. This condition, indicated by impaired growth and development, is often seen in children suffering from poor nutrition, repeated infection, and inadequate psychosocial stimulation. Children are uniquely placed to suffer from stunting: globally, more than 1 in 4 children are affected by stunting and 80% of the world's 144 million stunted children live in countries affected by conflict. A 2020 study on the nutritional status of Iraqi children found that a child's cumulative exposure to violent incidents is negatively and significantly associated with child height. This was particularly the case in IED and direct fire incidents.

There is no cure for stunting. According to the WHO, stunting in the first 1,000 days of a child's life has adverse functional consequences such as "poor cognition and educational performance, low adult wages, lost productivity and, when accompanied by excessive weight gain later in childhood, an increased risk of nutrition-related chronic diseases in adult life". These are profound and life-long effects on the quality of life of the child.

Childhood wasting, or being too thin for one's height, reflects a recent and acute process that leads to weight loss and/or poor weight gain. In 2018, 17 million out of 49 million children under five years were affected by wasting in its severe form in 2018.

In the most extreme cases acute malnutrition results in child mortality. In October 2020, it was reported that 100,000 children under the age of five are at risk of dying in Yemen because of the hunger crisis. Up to a quarter of children were affected by acute malnutrition in areas such as Hudaydah and Taiz, both of which have suffered from explosive weapons, in particular shelling.

More research needs to be done on the impact of explosive violence and its link to stunted growth in children, but it is a phenomenon that stretches across the breadth of modern war.

In World War II, for instance, German children were often separated from their families during the final stages of war. Many of them lived in unforgiving forests, on the edge of starvation; they later became renowned as the "wolf children". Food shortages were so bad after the mass bombing of swathes of Western Europe that it has led some historians to conclude: "the construction of a postwar international order begins with food.'

It was a post-war concern about starving children that even led to the setting up of 'Save The Children' by Eglantyne Jebb and her sister Dorothy Buxton. Shocked at how rife stunting, rickets and malnutrition were in post World War I Germany and Austrian, the sisters set up the charity with the words "Every war is a war against children" at the forefront of its work.

Empty calories and obesity\ Child malnutrition, though, is not just about starvation. Often the types of food eaten by children in conflict and post-conflict zones is full of empty calories. During the siege of Deir Ezzur, families not only had to reduce portion sizes and ate only one or two meals a day, but were living off starchy foods, such as bread, macaroni, rice or potatoes.

When explosive weapons are used in densely populated areas, they destroy homes and displace families. Food supplies in IDP camps can be grossly inadequate, contributing very high mortality rates and severe malnutrition observed in camps. For those displaced abroad, refugees often have to queue for several hours to receive food, and there is anecdotal evidence that this frequently food lacks nutritional value. Anecdotal evidence also suggests that refugee camps can see an absence of specific foods essential for young children.

Easy-cook food like noodles might seem filling and sweets pleasurable to refugee children short on happiness, but such food lacks key nutrition and diets filled with sugar and starch can -- over time -- impact on health. Refugee parents might struggle, too, to find healthy food to give their children, or may find food-stuffs available in their new countries unsettling or hard to prepare, leading to an over-reliance on carbohydrates and other sugar-rich food.

These realities have long term impacts. In 2016, the nutritional information of 14,552 Syrian refugee children revealed a low prevalence of wasting (< 5%) and stunting (< 10%), and high prevalence of overweight or obese children (10.6%). The study concluded that the unexpected high prevalence of over-nutrition was due to the poor quality and variety of food provided to the children in refugee camps. Obesity in refugee or IDP camps is rarely a reflection of excessive or even adequate nutrition, rather the predominance of cereals, oils and fats, sweetened food and a lack of fresh fruit and vegetables. Research also shows that refugee children are likely to become less active and eat less healthily after resettling.

Conclusion\ Food is a weapon of war and, all too often, its victims are children. Explosive weapons damage the food supply chain, whether this be at the point of production or distribution. Either way the effect is the same -- the amount of food stocks are compromised and the first to suffer from thsi are children.

Research support provided by Sophia Park