1. The Syria cross border nutrition response
Lindsey Pexton: Nutrition Cluster Coordinator
Aileen Wynne: Information Management Officer
Generic contact info:

2. 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.

3. 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.

4. 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.

5. 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.

6. 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.

7. 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

8. 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

9. 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 s from partners

10. 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

11. 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 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.

12. 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

13. 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.

14. 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..

15. 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?