Attachments
Executive summary
School age and adolescence (5‒19 years) is a critical phase of growth and development, with significant implications for current and future generations. During humanitarian emergencies, these age groups, especially girls, are nutritionally vulnerable due to increased requirements and preexisting deficits. They face heightened risks of violence, early pregnancy, and disruptions to health and education services. Emergencies can lead to various forms of malnutrition, including micronutrient deficiencies, thinness/wasting, or overweight. These issues can have lifelong and intergenerational consequences. Data on malnutrition prevalence among school-age children and adolescents in humanitarian settings are scarce, particularly for boys and younger children. Some conflict-affected areas lack data entirely. There are no Sustainable Development Goals (SDGs) specifically addressing school-age nutrition, and we lack established indicators to assess malnutrition and its consequences in this age group.
While there are several evidence gaps on nutrition programming for this age group, there remains an urgent immediate need for interim practical guidance to inform relevant nutrition programming in humanitarian contexts. This report summarises existing policies, programmes, and evidence on nutrition, health, and wellbeing in children and adolescents aged 5‒19 years in humanitarian contexts. Evidence and experiences were gathered through the following: (1) a scoping of peerreviewed journal articles, grey literature, and policy documents; and (2) key informant interviews with relevant practitioners (the United Nations Children’s Fund (UNICEF), the World Food Programme (WFP), Save the Children, Médecins Sans Frontières (MSF), Action Against Hunger (ACF), Johns Hopkins, and the Centers for Disease Control and Prevention). We then used the information to create comprehensive practical recommendations to support the development of programming guidance in the future.
Key existing global policies and guidelines
In the main report, we signpost readers to many international guidelines. In particular, we highlight the following:
• The UNICEF Core Commitments for Children in Humanitarian Action (CCCs) cover the needs of school-age children and adolescents under the health and nutrition sections.
• Programming guidance from UNICEF (2024) on ‘Protecting the nutrition of women and adolescent girls in humanitarian settings’ has a strong focus on pregnant and breastfeeding adolescent girls.
• The World Health Organization (WHO) policy document for ‘Implementing effective action for adolescent nutrition’ (2018) is not specific to humanitarian contexts but has information on overarching priority nutrition actions for 10–19-year-olds. WHO also provides guidance for the management of acute malnutrition in adults and adolescents in its ‘Integrated management of adult and adolescent illness’ (IMAI) manual (2011).
• The multi-agency ‘Global Accelerated Action for the Health of Adolescents (AA-HA! 2.0)’ guidance document underlines evidence-based solutions for adolescents and presents strategies for priority setting, planning, implementing, and evaluating health and wellbeing programmes. It covers humanitarian as well as development settings.
• The Inter-Agency Standing Committee (IASC) document ‘With us & for us: Working with and for Young People in Humanitarian and Protracted Crises’ (2020) was created in consultation with over 500 young people (aged 10–24 years) from more than 20 crisis-affected countries. The guidelines provide an overall framework for working with and for young people, as well as action tips for adolescent-responsive programming.
Evidence review on key interventions
Interviews with implementing practitioners revealed very few interventions specifically targeting school-age children and adolescent nutrition in emergencies. There were other, broader nutrition programmes that also captured some adolescents in their targeting, such as interventions designed for people living with HIV, or those aimed at pregnant and breastfeeding women. There were also other sector interventions that sometimes included a small nutrition aspect, such as sexual and reproductive health (SRH) and education interventions. In the full report, we summarise some of the better-evidenced and recommended nutrition interventions for this age group, also considering information on different delivery platforms and how nutritional status is assessed. In particular, we focus on the evidence base for the following interventions:
1. the provision of nutritious foods, including school meals, the fortification of staple foods, and general food distribution;
2. wasting / thinness management;
3. micronutrient supplementation, including weekly iron and folic acid supplementation (WIFAS) and multiple micronutrient supplementation (MMS), and deworming;
4. nutrition education and physical activity;
5. healthy food environments, including regulating school vendors and marketing, and cash and voucher assistance (CVA); and
6. interventions for pregnant and breastfeeding adolescent girls, including nutritional screening, balanced energy-protein (BEP) supplementation, micronutrient supplementation, nutrition education and counselling, social assistance programming, and empowerment and gendertransformative programming.
The above interventions form part of a wider range of complementary services and interventions that are needed in humanitarian contexts, including child protection, health, gender-based violence prevention, SRH services, education interventions, and water, sanitation, and hygiene (WASH) services. Many barriers to nutrition programming for schoolage children and adolescents in humanitarian contexts were articulated in the literature and the interviews, as summarised in the figure on page 7