Significant nutritional and food security issues among children under five in Hatay, the southern Turkish city hardest hit by the February 2023 earthquakes, were uncovered by a joint study conducted by two prominent Turkish health organisations, underscoring the urgent need for intervention.

The Turkish Medical Association (TTB) and the Health and Social Service Workers’ Union (SES) shared findings from their malnutrition studies in Samandağ, Antakya, and Defne districts during a press conference on 9 January. The studies, focusing on children under five, uncovered severe nutritional deficiencies and food insecurity issues exacerbated by the earthquakes.

Dr. Şebnem Korur Fincancı, president of the TTB Central Council, highlighted the lack of governmental effort in addressing these issues, despite the TTB’s continuous fieldwork for 11 months. “It’s been over 11 months, yet no significant change has been observed. With household incomes not even reaching the poverty line, the disaster-stricken area faces severe deprivation. The government must act swiftly to resolve these issues, failing which it would be responsible for violating the right to a healthy life,” she stated.

Nazan Karacabey, co-president of SES, spoke of the voluntary efforts by the TTB-SES Coordination over the past 11 months. “Nearly a year has passed, yet there are still many people in the earthquake zone who cannot meet basic survival criteria. Our work will continue until the public has access to their right to a healthy life,” she added.

Dr. Mehmet Zencir from the TTB Public Health Branch initiated the presentation by stressing that disasters are the greatest threat to food security and safety, with malnutrition being one of the most significant long-term effects. He highlighted the vulnerability of children under five to acute malnutrition in emergency situations, indicating that high levels in this age group are indicative of acute malnutrition in the general population.

Dietitian Dicle Dilan Salman discussed the results concerning infants and children aged six months to two years, focusing on the lack of breastfeeding, insufficient consumption of food groups, and irregular access to food and water. The presentation also covered issues related to living conditions, chronic nutrition problems, health issues stemming from nutrition, food intake and storage conditions, aid, and hygiene issues.

Nurse Leyla Kalın, who participated in the fieldwork, condemned the imposition of inhumane living conditions and cited a recent fire in Samandağ, which resulted in the death of two children, as an example of the dangers faced. She also noted that the issues of inequality and insecurity are more acutely experienced by refugee children affected by the earthquake.

Dr. Sami Reyhan, a member of the Hatay Medical Chamber’s Board of Directors, summarised the situation in the city: “Living conditions are poor. Families of 5-6 are trying to live in 21 square meter containers where the toilet, kitchen and bedroom overlap. The infrastructure is inadequate. There are frequent power outages. Fires occur frequently, but very few are reported in the media. The income situation is insufficient. Unemployment is high. Public transport is virtually non-existent.”

Dr. Münevver Kaynak Türkmen, a retired faculty member of the Neonatology Department at Adnan Menderes University Medical Faculty, addressed the short and long-term health issues related to inadequate and unbalanced nutrition. She spoke about the health problems that can arise from cerebral developmental deficiencies and nutritional deficiencies in the long term, calling for urgent measures.

Key findings from the presentation included:

– Only one-third (33.5%) of families have regular access to food.
– One-third of families lack proper food storage conditions, with reasons including the absence of a refrigerator, its small size and power outages.
– Nearly half of the families have no or insufficient access to water, attributed to distribution issues and water cuts.
– The number of children without daily meals increases with age, reaching 7.2% at four years.
– Approximately half of the children affected by the earthquake are not breastfed during the first six months of life.
– 6.2% of children under five exhibit stunting (3.7% stunted, 2.5% severely stunted); 8.9% are underweight (5.5% underweight, 3.4% severely underweight), and 4.4% are overweight.
– Stunting is more prevalent in children under two years of age (11.3% in children aged 0-11 months and 10.5% in those aged 12-23 months).
– Underweight is most common in children aged 0-11 months.
– Overweight is significantly highest in children aged 0-11 months, with a total prevalence of 14.5% (13.3% in boys and 15.4% in girls).
– In the refugee population, the overall prevalence of stunting is 8.8%, with severe stunting at 3.8%. The overall prevalence of underweight is 6.3%, with severe underweight at 2.5%. The prevalence of overweight among refugee children is 5.7%.
– Regarding Body Mass Index (BMI), with 35 children (17%) showing no change in percentile, 119 children (57.8%) showing regression, and 52 children (25.2%) showing progress.

The recommendations included:

– Immediate improvement of kitchen conditions to ensure no household is without a kitchen.
– Provision of adequate, culturally and locally appropriate food support for children.
– Establishment of food support targeting the entire population but also focusing on high-risk groups.
– Monitoring of children’s nutrition in primary healthcare services in the context of disaster reality.
– Health monitoring for high-risk groups such as children with chronic diseases or vitamin and mineral deficiencies.
– Fair distribution of food and water support, embracing community participation and tailoring support to household needs.
– Acceleration of the transition from temporary to permanent living areas.
– Improvement of storage conditions and increased refrigerator support.
– Minimisation of electricity and water cuts.
– Support for breastfeeding women in terms of quality food.
– Provision of vitamin and mineral supplements.
– Avoidance of junk food in distributions.
– Ensuring environmental hygiene.
– Provision of water, sanitation and hygiene conditions.
– Economic empowerment of households and increased job opportunities.
– Prevention of the reconstruction of cities on agricultural lands in Hatay.