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Community Health Sciences 452

Management of Food and Nutrition in Major Emergencies
Spring Quarter 2013
Wednesdays, 1-3:50 p.m., CHS 61-262
Lecture/Seminar format

Instructor: Professor Gail Harrison

Office hours: Mondays 2-3:30 and by appointment. I will be in and out of
town and it will be more productive to set up an appointment than to drop
by. Appointments or reservations on the office-hours signup sheet can be
made through my assistant, Soraya Boumediene
(soraya.boumediene@gmail.com). My office is in the Global Health
Training Program suite - 21-245 CHS. If you need to send a time-
sensitive message such as cancelling an appointment or rescheduling, use
my cell phone # - 805-341-3826.
I do not check my office phone line regularly – don’t rely on it.
E-mail: gailh@ucla.edu

My Research Assistant, Dr. Pia Chaparro, can also be reached for general
discussions (she will not be attending class regularly). She is at mchaparro@ucla.edu.

Background

This course has been developed as part of the UCLA Disaster and Public Health
curriculum. More people die, globally, from mismanagement of complex humanitarian
emergencies than die from natural disasters. The management of food and nutrition
during complex emergencies is fundamental to successful outcomes and basic to the
delivery of other health and social services. Yet few medical or public health
professionals have had specific training in this area, and it is clear that the deployment of
well-trained and experienced health professional staff in emergencies is critical to good
outcomes.

Over the last two decades, complex humanitarian emergencies have become increasingly
common. International relief organizations are in serious need of highly trained
professionals and paraprofessionals who can coordinate and manage effective and timely
responses to emergencies. Because food and nutrition constitute a basic cornerstone of
emergency relief operations, the need for trained professionals in this area is particularly
acute.

This course is designed for public health and other graduate students interested in
humanitarian relief, to assist them in understanding the data and basic principles they
need to master in order to be able to design rational and cost-effective food and nutrition
emergency relief approaches and programs.

Prerequisite: Graduate standing.

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Learning Objectives (and map to Association of Schools of Public Health core

competencies – see http://www.asph.org/document.cfm?page=1083 for detail on these).
Key: B=biostatistics; E=Epidemiology; Env = Environmental Health; PHB = Public
health biology; S = Social and behavioral sciences; L = Leadership.

On completion of the course, the student should be able to:

 Describe the different situations that lead to populations living in crisis (Env
1,3,5, S2)
 Distinguish different types of crisis situations (population displacement, refugee
status, displaced person status, crisis in an in-place population) (S5, 9)
 Discuss the malnutrition-disease cycle (PHB 5)
 Describe the nutritional problems affecting populations living in crisis (E 1)
 Given the basic demography of a population, estimate requirements for dietary
energy (PHB7)
 Describe common micronutrient problems arising from limited diets, and sources
of micronutrients (Env 1,5)
 Identify vulnerable subpopulations needing special nutritional care
 Interpret basic/anthropometric nutritional assessment data (B7, 9, Epi 6, 7)
 Understand the use of supplemental feeding programs in crisis situations (S8,9,
L3)
 Understand the principles of rehabilitation of severely malnourished individuals
(PHB4)
 Identify major food safety concerns for crisis situations (Env 1)
 Produce a report, based on data to be supplied, describing the nutritional status of
a population and immediate priorities for action (S8,9, L3)
 Describe basic principles of preparedness for a domestic emergency resulting in
disruption of food supplies (Env8)

Requirements, Grading and Format for the Course

The student will be responsible for material contained in the readings; for regular
attendance and participation in class discussions; for additional reading to be assigned
and presented in class (once during the quarter); for a brief “consultant report” on the
nutritional situation of a population; and for preparation and presentation in class of a
written term-paper focusing on the nutritional aspects of a contemporary or historical
emergency situation. Evaluation will be based on:
In-class discussion based on readings to be assigned,
and class participation 40%
Consultant report on nutritional situation of a population
un crisis 20%
Term paper and presentation 40%

Each class session, the first 30-45 minutes will be devoted to students’ sharing
information they have gleaned about current crisis situations either from the general news
media and/or the current scientific literature. The next 30-45 minutes will be devoted to a

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student-led discussion of specific reading assigned for that student (see Week 1 for the
possible assignments). The scheduled lecture will commence after a brief break.

There will be no class web-site. Rather, materials will be sent as indicated via
my.ucla.edu, email.

The consultant report (due on May 22nd , Week 9) should be brief (three pages double
spaced, plus any figures/tables) and to the point, describing the situation of the population
and recommending immediate actions to be taken by the government and/or the
international community. Data on which to rely will be handed out ahead of time.

The term paper (due June 5th t, Week 10) will be an analysis of a real, contemporary or
historic complex population emergency and the impact on food supply and nutrition, and
will require investigation of peer-reviewed – and in some cases “gray” literature. If a
historic crisis is chosen, then the paper should draw conclusions about what worked or
didn’t work in terms of protecting nutritional status and health of the affected population.
If the situation chosen is ongoing, then the paper should focus on what is being done/can
be done to protect nutritional status and health. Papers should be no more than 15 pages,
double spaced, plus references and should follow a clear organizational outline. Papers
will be presented in class the last three sessions; presentations should include one-page
handouts (with references) and a powerpoint presentation.

No e-mailed papers or reports will be accepted. These must be turned in during the
allotted class time, as hard copies.

Readings

The following books for the course are required reading. The first will be available
through the Health Sciences Bookstore approximately mid-April or may be purchased or
downloaded directly from Oxfam. The second and third ones can be downloaded and
printed; you can also order hard copies from the respective organizations.

The Sphere Project: Humanitarian Charter and Minimum Standards in

Disaster Response. Oxford: Oxfam Publishing, 2011 edition.
Available from the UN Refugee Agency:
http://www.unhcr.org/refworld/pdfid/4ed8ae592.pdf
Or for download at http://www.sphereproject.org/ (click on ‘The Handbook’)

UNHCR, UNICEF, WFP and WHO. Food and Nutrition Needs in Emergencies.
Geneva: WHO, 2004. Access at: http://whqlibdoc.who.int/hq/2004/a83743.pdf.
57 pages

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Food and Agriculture Organization of the United Nations. Protecting and

Promoting Good Nutrition in Crisis and Recovery: Resource Guide. Rome
FAO, 2005, 162 pp. ftp://ftp.fao.org/docrep/fao/008/y5815e/y5815e00.pdf

In addition, students will be expected to access and read current and recent issues
of the Newsletter: Nutrition Information in Crisis Situations.
http://www.unscn.org/en/publications/nics/. Additionally, students will be expected to be
aware of the current news literature relevant to the course content.

We will spend some time in class in discussion of the material contained in these sources.

Other suggested readings (will be put on class reserve in Biomedical Library, unless
available online):

Institute of Medicine. High-Energy, Nutrient-Dense Emergency Relief Food

Product. Washington DC: National Academy Press, 2002. (available from the
National Academy Press website:
http://www.nap.edu/catalog.php?record_id=10347)

Checchi F, M Gayer, R Freeman Grais and EJ Mills. Public Health in Crisis-

Affected Populations: A Practical Guide for Decision-Makers. Humanitarian
Policy Group Network Paper Number 61, December 2007. London: Overseas
Development Institute. http://www.odihpn.org/documents/networkpaper061.pdf

Food and Agricultural Organization of the UN. Food Security in Protracted

Crises: What can be done? December 2008.
ftp://ftp.fao.org/docrep/fao/011/ak057e/ak057e00.pdf

Schedule of Class Topics

April 3rd (Week 1):

Introduction
Types of complex emergencies/crisis situations: refugees and displaced
populations, in-place populations; protracted emergencies
Responsibility for management of nutrition: UN agencies, NGOs, governments
Adequate nutrition as a basic human right
Evolution of concept of minimum standards: The Sphere Project

Access the SCN newsletter “Nutrition Information in Crisis Situations”:

http://www.unscn.org/en/publications/nics/. Search Nutrition information in crisis
situations. Access other literature as needed (not all listed countries below can be found
currently in the SCN publication)

Individual students will assume responsibility for presenting the information on the
following situations (with any updates that you may find). A signup sheet will be passed

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out on the first day of class. Should the class be large enough to include more than the
listed countries, we will add.

April 10th: Syria, Lebanon, Jordan

April 17th: Ethiopia, Kenya, Somalia, Sudan
April 24th: Niger, Sierra Leone, Chad, Democratic Republic of Congo, Uganda
April 31st: Pakistan
May 1st: Bangladesh, Yemen, Caribbean
May 8th: North Korea

April 10th (Week 2):

Minimum standards for food security, nutrition and food aid
Nutritional needs of affected populations
General population
Vulnerable subpopulations: Infants, pregnant and breastfeeding women,
elderly, persons living with AIDS, adolescents
Calculation of population-level energy needs
Micronutrient deficiencies and sources of micronutrients

April 17th (Week 3):

Minimum standards for Water, sanitation and hygiene;
Shelter, settlement, and non-food items
Health services

April 24thth (Week 4):

No class this week: Use the time to investigate the following continuing
education course, on bioterrorism and the US food supply. It will take about 2
hours of your time. http://elearning.mchtraining.net/course/view.php?id=15

Be prepared to discuss briefly in class next week.

May 1st: (Week 5): Guest lecturer: Dr. M. Pia Chaparro

Briefly discuss the bioterrorism module you reviewed last week.

Lecture topic: Food safety in emergencies
Assigned reading to be completed before the Week 5 class by all: chapter 3 of
FAO, Climate Change: Implications for Food Safety. Available at:
ftp://ftp.fao.org/docrep/fao/010/i0195e/i0195e00.pdf

May 8thh (Week 6):

Assessment and monitoring of nutritional status in emergency situations
Standard Indicators
Measurement
Interpretation.

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Download the “EpiInfo” program from the CDC website (it’s free -
http://wwwn.cdc.gov/epiinfo/7/index.htm) and look at the anthropometric
module. You will use this in writing your consultant report, due later in the
quarter.

May 15th (Week 7):

Preventing malnutrition
Assuring adequacy of general ration
Protecting production, trade and food security
Control of infectious disease
Correcting malnutrition
Management of moderate and severe malnutrition in children and adults
Selective feeding programs
Rehabilitation

May 22nd (Week 8):

In-class problem solving exercise and discussion for the entire class time;
some presentations of term papers possible depending on the number
of students enrolled in the class

May 29th th
(Week 9):
Consultant report on nutritional situation in a hypothetical population due
today.
No media/newsletter sharing this week!

Presentation of term papers.

June 5th (Week 10): Term papers due today!

Presentation of term papers in class