The Syria cross border nutrition response Lindsey Pexton: Nutrition Cluster Coordinator (lpexton@sy.goal.ie) Aileen Wynne: Information Management Officer (awynne@sy.goal.ie) Generic contact info: nutritionwg@sy.goal.ie

Current cross border nutrition programming in Syria 100 50 Km 100 50 Km TURKEY Ariha Jisr-Ash-Shugur Harim Idleb Al Ma'ra Quamishli Al-Malikeyyeh Ras Al Ain Al-Hasakeh Ath-Thawrah Tell Abiad Ar-Raqqa Shahba Salkhad As-Sweida Al Fiq Quneitra Al-Haffa Al-Qardaha Jablah Lattakia A'zaz Al Bab As-Safira Jebel Saman Jarablus Afrin Ain Al Arab Menbij As-Suqaylabiyah As-Salamiyeh Muhradah Hama Masyaf Ar-Rastan Al-Qusayr Al Makhrim Tadmor Tall Kalakh Homs Izra' As-Sanamayn Dar'a Abu Kamal Al Mayadin Deir-ez-Zor At Tall Az-Zabdani Al Qutayfah An Nabk Darayya Duma Qatana Rural Damascus Yabroud Sheikh Badr Banyas Dreikish Safita Tartous IDLEB AL-HASAKEH AR-RAQQA AS-SWEIDA QUNEITRA LATTAKIA ALEPPO HAMA HOMS DAR'A DEIR-EZ-ZOR RURAL DAMASCUS TARTOUS IRAQ Mediterranean sea The Syria crisis has reached its fifth year and to date there has been a very limited nutrition response, particularly when we speak of cross border operations into opposition controlled areas. This is where the bulk of current nutrition programming is. This time last year there were also programmes in Eastern Aleppo governorate and Raqqa however as ISIS consolidated their power there those agencies were forced to withdraw. LEBANON ISRAEL JORDAN Date: Data Source: COD/FOD Disclaimer: The boundaries, areas, and names shown and the designations used on this map do not imply official endorsement or acceptance.

Take home messages Nutrition technical capacity on the ground is thin (international and local) The operational space for INGOs to implement directly is limited (though by no means impossible) Regional/Syrian NGOs have greater reach inside Syria (to ‘hard to reach’ areas including Deir Ezzor, Hama and Homs) but little to no experience of nutrition programming We need to scale up but also consider alternative models; clusterwide technical trainings, partnership, mentoring, secondments to the cluster etc.. There are a lot of reasons for this, many of which come out in the ENN special edition on Syria. But the one I would like to drive home today is regarding lack of technical capacity. I know of only one long-term experienced international nutritionist on the ground at the moment working in programming. There are a handful of Syrian nutritionists on the ground but they are difficult to find as, unlike Lebanon there wasn’t a well-established university or college level nutrition degree or diploma available in Syria pre-crisis.

Humanitarian overview 12.2 million in need of humanitarian assistance: 7.6m IDPs, 5.6 million children in need, 4.8 million people in hard to reach areas. Water availability less than 50% of pre-crisis levels Tens of thousands of people living in collective shelters and informal settlements with poor sanitation and hygiene Outbreaks of communicable and vaccine-preventable diseases, including polio and measles 9.3% GAM >> 13.5% Hama 23% stunting 29.2% anemia in under 5s 12.9% iodine deficiency 42% EBF pre-crisis A series of Rapid Nutrition Assessments conducted by UNICEF Damascus in IDP settlements across 13 Governorates between March and July 2014 indicated a national GAM rate of 7.2% and SAM of 2.3%, again with higher rates found in Northern Governorates, especially Deir Ezzor, Hama and Aleppo.

Humanitarian overview Pre-crisis: 9.3% GAM (13.5% Hama) 23% stunting 29.2% anaemia in under 5s 12.9% iodine deficiency 42% EBF pre-crisis Now: March-July ‘14: Rapid Nutrition Assessments (UNICEF/MoH Damascus) in IDP settlements across Govt held areas in 13 Governorates indicated a national GAM rate of 7.2% and SAM of 2.3%, again with higher rates found in Northern Governorates, especially Deir Ezzor, Hama and Aleppo. 9.3% GAM >> 13.5% Hama 23% stunting 29.2% anemia in under 5s 12.9% iodine deficiency 42% EBF pre-crisis A series of Rapid Nutrition Assessments conducted by UNICEF Damascus in IDP settlements across 13 Governorates between March and July 2014 indicated a national GAM rate of 7.2% and SAM of 2.3%, again with higher rates found in Northern Governorates, especially Deir Ezzor, Hama and Aleppo.

Syrian Arab Republic: Number of organizations distributing BMS cross border in 2014 100 50 Km IDLEB AL-HASAKEH AR-RAQQA AS-SWEIDA QUNEITRA LATTAKIA ALEPPO HAMA HOMS DAR'A DEIR-EZ-ZOR RURAL DAMASCUS TARTOUS Such a national average is very concerning to Syrians but of course at a global level it is not considered sufficient to constitute an emergency. So why is there such a need to be concerned about the nutrition situation in Syria? This is one reason. This is the result of initial mapping conducted by the Cluster IMO using information from NGO websites and from a survey conducted by a Cluster member. 28 different organisations. Mainly type 1: less than 6 months. When “nutrition responses” started to be mapped last year many of them related to BMS distributions. BMS is often labelled a “critical need” by civilians, local councils and aid organisations. Preliminary attempts to provide information and guidance with regards to the Code and Operational Guidelines for IYCF-E have had some positive results and IYCF-E interventions are now being planned by various partners. A technical working group in IYCF-E is also currently being formed to deal with this issue systematically. Legend: number of organisations   No recorded distribution 1-5 6-10 11-15 >15 Date: Data Source: COD/FOD Disclaimer: The boundaries, areas, and names shown and the designations used on this map do not imply official endorsement or acceptance.

Types of BMS products identified Target age Producer Bebalac 1 < 6 months Danone Celia develop 1 <6 months  Lactalis company Babylait 1 babylait 2 6 -12 months Bebalac 2 Picot 2eme age Celia develop 2 Gallia croissance 3 > 12 months Nestle "Nido one plus stage 1-3" 12 months- 3 years Nestle Nestle p'tite cereale (cereal drink) >6 months French Companies

What has been done to date? 2013/14 Nutrition was a sub-working group of health Large scale multi-sector needs assessments did not integrate nutrition effectively Ad hoc assessments – agency specific RNAs, one SMART survey (Idleb) Ad hoc trainings (CMAM, IYCF) Some very limited direct nutrition interventions (predominantly camp-based IYCF, CMAM, Vitamin A supplementation during one polio round) Small number of orgs input into the nutrition section of the 2015 Syria SRP Ad hoc = not coordinated, usually one lead agency with little or no participation from other orgs

What do members expect from the Cluster in 2015? Assessments and strategic planning Coordinated nutrition assessments Situation analysis Development of an emergency nutrition action plan Information sharing & standard setting Technical documents including nutritional advice for specific population groups Standardised Nutrition indicators related to SRP Continuous monitoring and analysis of programme data (using standard indicators), learning from each other Record and report blanket distribution of BMS: develop guidelines, share & monitor. Community education on prevention and treatment of malnutrition/ awareness campaigns Capacity building Training on context-specific nutrition programming Training on nutrition sector proposal development Coordination Integration, coordination, information sharing between relevant actors Map the nutrition activities that are currently being carried out and identify the gaps Agriculture/FSL & nutrition sector collaboration Nutrition mainstreaming Advocacy for a broad nutrition response/strategy for mobilising stakeholders Funding Funding for and operationalization of the nutrition surveillance protocol Funding sources - donor mapping for nutrition activities This is a collection of the feedback from the Jan 2015 meeting plus subsequent emails from partners

Initial top priorities for the Coordination Team Support in the establishment of an evidence base for targeted interventions and facilitate situational analysis Map current nutrition actions and identify gaps Advocate and mobilise resources for a strengthened and broad-based nutrition response Ensure strategic vision and strong coordination for inter-sector and inter-agency collaboration focused on improving nutritional status of vulnerable groups Support partners by providing relevant technical advice and tools, and fostering capacity through training and mentorship initiatives Encourage partners to monitor and analyse programme data using standardized indicators There are huge gaps but a growing will for: Building an evidence base to assess the need, scope and priorities for intervention Situational analysis: understanding the context in which we work and which approaches may and may not be effective (e.g. IYCF-E/BMS, community outreach) Scaled up, well-targeted direct nutrition interventions Cross-sectoral coordination aimed at preventing (as well as treating) malnutrition Routine data gathering and integrated information management systems Capacity building efforts based on a coherent, multi-level CB strategy

What has been done to date? 2015 Since January 2015 there has been a dedicated coordination team (Coordinator + IMO + translator) Nutrition became a standalone sector and then a cluster Widespread advocacy and outreach to Syrian NGOs Ever-growing participation: meeting turnout averages 25-30 orgs Nutrition integrated into various multi-sector survey tools and response documents (e.g. Aleppo ‘freeze’) Engagement in ‘Whole of Syria’ processes >>> common 4Ws New TWG on IYCF-E (including BMS management) - supported short-term by IYCF-E consultant Two more trainings on IYCF-E “Showcasing” successful models and promoting international guidelines and toolkits FSL-Nutrition collaboration: food assistance recommendations, joint position paper on integrating nutrition and FSL, integration of nutrition criteria into HPF FSL technical review, kitchen gardening group established Health-nutrition collaboration: joint sector allocation priorities for HPF Nutrition Cluster coordination for the cross border Syria response is supported by GOAL through funding from OFDA. Currently GOAL provides a (100% dedicated) Nutrition Cluster Coordinator and a (100% dedicated) Information Management Officer. Recently UNICEF announced its intention to co-lead the Nutrition Cluster but as yet no UNICEF funded Cluster Coordinator has been identified.

Humanitarian Pool Fund 2015 (1st round) Of a total envelope of $20 million: $10 million has been allocated for nutrition and health projects focusing on: Comprehensive primary health packages (IMCI, screening and treatment of malnutrition, vaccinations/supplementation and reproductive health) Infant and young child feeding programmes (both community and facility based) Community health outreach and strengthened referral systems $8 million has been allocated for nutrition sensitive livelihoods projects (agricultural inputs and vouchers, home gardening, income generation) Other priorities include “hard to reach and besieged areas” and “building the capacity of local partners” Just finished Strategic Review (16 projects from 12 partners selected for nutrition/health) First disbursements by mid-April

Syrian Arab Republic: Integrated nutrition and health HPF projects that have moved on to technical review 100 50 Km 100 50 Km TURKEY Ariha Jisr-Ash-Shugur Harim Idleb Al Ma'ra Quamishli Al-Malikeyyeh Ras Al Ain Al-Hasakeh Ath-Thawrah Tell Abiad Ar-Raqqa Shahba Salkhad As-Sweida Al Fiq Quneitra Al-Haffa Al-Qardaha Jablah Lattakia A'zaz Al Bab As-Safira Jebel Saman Jarablus Afrin Ain Al Arab Menbij As-Suqaylabiyah As-Salamiyeh Muhradah Hama Masyaf Ar-Rastan Al-Qusayr Al Makhrim Tadmor Tall Kalakh Homs Izra' As-Sanamayn Dar'a Abu Kamal Al Mayadin Deir-ez-Zor At Tall Az-Zabdani Al Qutayfah An Nabk Darayya Duma Qatana Rural Damascus Yabroud Sheikh Badr Banyas Dreikish Safita Tartous IDLEB AL-HASAKEH AR-RAQQA AS-SWEIDA QUNEITRA LATTAKIA ALEPPO HAMA HOMS DAR'A DEIR-EZ-ZOR RURAL DAMASCUS TARTOUS IRAQ Mediterranean sea LEBANON ISRAEL JORDAN Date: Data Source: COD/FOD Disclaimer: The boundaries, areas, and names shown and the designations used on this map do not imply official endorsement or acceptance.

Recap: Take home messages Nutrition technical capacity on the ground is thin (international and local) The operational space for INGOs to implement directly is limited (though by no means impossible) Regional/Syrian NGOs have greater reach inside Syria – and now more funding - but little to no experience of nutrition programming We need to scale up but also consider alternative models; clusterwide technical trainings, partnership, mentoring, secondments to the cluster etc..

Questions How can the global nutrition community support the (cross-border) Syria response? What is currently holding INGOs back from starting/scaling up cross border nutrition programming?