Malnutrition is once again in the Middle East’s headlines, along with images of infants with bony limbs and puffed bellies. But behind the humanitarian crisis in countries such as Yemen is a longer-term problem: The cognitive effects on the children who have grown up without enough food.
More than five million malnourished children live in the Arab world, according to the UNICEF Deputy Executive Director Justin Forsyth. In a recent statement, he said approximately 1.4 million of them are at risk of dying, but for those who survive, the effects of today’s hunger will last a lifetime.
Public health experts say that children who don’t get enough nutrients during the first 1,000 days of their lives can wind up struggling in their education through adolescence and into adulthood.
“We should be worried about this on a variety of levels,” says Aryeh Stein, professor of global health and epidemiology at Emory University, in the United States. “Children who are short of food are at increased risk of death and are less resistant to infections. But malnourished kids also don’t have the energy to work or learn as much. They don’t explore and so they learn less at a young age.”
“It’s a humanitarian issue in the shorter term and a social issue in the longer term,” he says.
There is no good time in a person’s life to be malnourished, but it’s especially damaging in the womb and the first two years when the brain is still developing.
“The long-term impact on stunting the brain can be devastating,” said Forsyth. “It cuts school performance, translating into a reduction in adult income by 22 percent on average.”
The complexity of other issues surrounding famine makes it difficult for researchers to be sure that malnourishment is the sole cause of these problems. Many of the young people in the region with stunted growth who are refugees may also have experienced violence, an interruption of their education or the loss of a parent.
“Malnutrition doesn’t happen in a vacuum. It’s impossible to rule out everything else because bad things tend to accumulate,” says Maureen Black, a pediatrics clinical professor at the University of Maryland School of Medicine.
In the Arab world, not surprisingly, it’s the countries in the midst of long-running conflicts with the highest proportion of malnourished children. Al-Fanar Media obtained data collected by country ministries and regional agencies. Put together in one map, the data paint a picture of widespread stunted growth among infants due to malnutrition throughout the region.
Use the interactive map below to see the percentage of young children stunted by malnutrition in each Arab country.
Yemen has the highest percentage of malnourished children in the region with 46.5 percent of children classified as stunted before their fifth birthday.
After Yemen comes Sudan. “We still have a serious problem in Sudan. We call it the forgotten emergency with over 500,000 children suffering from acute malnutrition,” says Vilma Tyler, UNICEF’s regional nutrition advisor.
Syria also suffers from high levels of child malnutrition with 27.5 percent of children under five deemed to be stunted in their growth due to malnutrition. But this data comes from 2009 before the war in Syria even began, which means the situation there is likely to be much worse than the data suggests.
It’s not just the region’s poorest and most conflict-ridden countries that are at risk.
Children in the wealthy Gulf states are unlikely to go hungry, but they could still be significantly undernourished due a diet lacking in fruits and vegetables, says Tyler. And whether all of the Gulf countries’ residents including immigrant laborers and their families are getting enough food is an open question.
But those questions can’t be answered without proper statistics, which are lacking in most Gulf countries. “We’re advocating for more data so that we can understand the current situation and how we can address it,” she says. “We call it hidden hunger sometimes.”
The harmful effects of not getting the right nutrients are clearly long lasting. One recently published study followed up on Ghana’s 1983 famine, the effects of which varied geographically. The researchers looked at whether intelligence tests conducted 20 years after the famine correlated with famine severity.
Their results imply a strong link between famine intensity and a loss of IQ, but that leaves open the question of whether the cause is malnourishment itself or other stress. But because two decades passed between malnourishment and the tests, the data do show that the effects of famine persist into adulthood. “It’s depriving a country of a generation of human capacity,” says Stein.
In countries like Yemen where more than 40 percent of children are undernourished, this means that the schools and universities will need to be equipped to deal with the after-effects of malnutrition.
The Ghana study found that investments in textbook availability and the quality of schools and classrooms had a limited effect once the cognitive damage was done. Instead the study’s authors suggest making investments in improving children’s health and nutrient intake at all ages.
The University of Maryland’s Black agrees. “Schools could ensure that kids have adequate nutrition while they’re in school because we know that regardless of a child’s feeding history, if they don’t have adequate nutrition at the time of education then they can’t concentrate.”
Just because a child has experienced malnutrition and their capacity is reduced, it doesn’t mean they can’t learn and go on to be accomplished in their careers. But it does mean they could find their education and early careers more of a challenge than they would have done if they had been properly fed as a child.
“Don’t worry about the student’s past because you can’t change that,” advises Black. “You want to have programs in place to ensure they get proper attention in class.”
Black recommends that students be taught to their ability. “They should have assessments and we could then put them in classes commensurate with their skill level.”
Tyler says schools and universities should be careful, however, not to create entirely separate “special education” programs that remove students with learning disabilities from the mainstream. “We always support the inclusion of children with disabilities. Don’t exclude them and worsen their problem,” she says.
Educators say the balance between inclusion and special attention is important to get right. One solution is to separate classes by ability and learning level, but to make sure there is overlap among all students of a similar age during the day in some classes. The ability-based classes should be flexible so that students can progress if their level improves or get the tutoring they need if their performance lags.
In countries struggling with malnutrition and its aftermath, Tyler says the first course of action should always be to make sure kids have access to food: “Nutrition itself has the best return on investment.”