Caracas Chronicles

Global acute malnutrition is a cold, dry bureaucratic take on a hot, messy human horror. The concept was crafted up by humanitarian aid officials to dispassionately quantify just how bad a hunger emergency has gotten. GAM — of course the bureaucrats were going to give it an acronym — is designed to help concentrate minds and target resources as a country careens toward famine. 

You can think of GAM as the ghastly, famine-time doppleganger of the Body-Mass Index familiar to gordit@s everywhere.

GAM is a measure of the proportion of children aged between 6 months and 5 years old who suffer acute malnutrition. Acute malnutrition is considered “moderate” if a kid is at 70-80% of where he should be for his height. It’s said to be “severe” if a kid is at less than 70% of the right weight for his height. GAM — the global figure— includes both moderate and severe malnutrition. This includes the type of hunger we colloquially think of as morirse de hambre level: malnutrition severe enough to carry a high risk of death.

You can think of GAM as the ghastly, famine-time doppleganger of the Body-Mass Index familiar to gordit@s everywhere. Like BMI, GAM is built out of weight-to-height ratios. Unlike BMI, GAM describes a population — not a person. You measure an affected group’s weight-to-height ratios and compare them to those for the standard reference population. GAM, broadly, tells you how much less kids in a given group weigh relative to what they ought to for their height.  

The poorest communities in Zulia and Vargas States are already at or above the Serious Humanitarian Crisis threshold. 

GAM is one of the basic indicators for assessing the severity of a humanitarian crisis. According to the World Health Organization (WHO), when GAM reaches the 10% threshold, the crisis can be considered “serious”; and when 15% of kids are acutely malnourished, the crisis can be considered “critical”.

Now, thanks to a new study we know how bad things are getting in terms of child hunger in Venezuela’s hardest hit areas. In 25 of the poorest and most vulnerable parishes in Distrito Capital, Miranda, Vargas and Zulia, GAM reached 8.9% between October and December 2016, which just over 1 percentage point below the threshold for a “serious” humanitarian crisis.

The poorest communities in Zulia and Vargas States are already at or above the Serious Humanitarian Crisis threshold.

If all forms of weight loss are considered —from the child who lost one gram of weight to the most severe malnutrition— the number reaches a staggering 52%.

These troubling facts were identified through a Nutrition Surveillance System —known as SAMAN— put forward by Caritas Venezuela, the Catholic church charity, since September 2016.

Official data on child malnutrition used to come from the National Nutrition Surveillance System by the National Institute of Nutrition, but the last official posting from this source was in 2007.

SAMAN no a research tool, it’s a guide to action.

Unicef showed some preliminary figures in 2011 and FAO included Venezuela in the last report on the Food Security Situation of Latin America using figures from 2009. Due to this poor accountability from the official sector, as well as from the UN System in country, local NGOs have become an invaluable source of information to put our crisis into proper perspective.

SAMAN is a monitoring system based a sentinel surveillance system: it’s no research tool. Rather, it’s a guide to action, designed to guide relief efforts rather than to just observe the crisis. It was put in action back in September 2016 in 25 parishes in the four states where Caritas Venezuela is strongest on the ground. The parishes selected are relatively isolated and have poor access to public services and poor housing conditions, high records of poverty and chronic malnutrition and a recent history of disturbances and social unrest.

Working through volunteers, including pastoral youth and pediatricians, the system sets out to identify children at risk of malnutrition. It provides timely and prioritized care from a preventive and therapeutic approaches to reduce morbidity and protect children from malnutrition-related mortality; and coaching and support for the  families affected by malnutrition.  

The whole point of SAMAN is to detect malnourished children so it can put them under a proper care scheme, as well as to generate information for planning and mobilizing humanitarian responses. The results of SAMAN will be publicly displayed every two months.

SAMAN’S first results also showed that GAM in these 25 parishes reached 22.1% among kids between 6 months and 24 months of age and 14.3% among kids under 6 months old.

According to Caritas Venezuela, “malnutrition among young children predisposes them irreversibly to childhood diseases, educational lags in the short term, and to social, productive and psycho-affective lag in the medium term. It also leads to family destitution and fragmentation, and social tension and violence in society”.

And this is not a recent problem. SAMAN’s first results show that 1 in 5 kids not only lost weight recently, but already has a cumulative growth retardation (stunting) of at least 4 or 5 years. Children who fall below the fifth percentile of the reference population in height for age are defined as stunted, regardless of the reason -though malnutrition is generally the first cause considered. And according to UNICEF, “stunting is associated with an under developed brain, with long-lasting harmful consequences, including diminished mental ability and learning capacity, poor school performance in childhood, reduced earnings and increased risks of nutrition related chronic diseases, such as diabetes, hypertension, and obesity in future”.

In the words of Susana Raffalli, nutritionist with experience in emergency food security and humanitarian responses,  and Technical Coordinator of the project, “it’s not true that this [malnutrition] happened because oil prices fell, it is not true that this is due to the collapse of crops due to El Niño. Those threats have been there, but it has been the inadequate control of the food system by the State the main fuel for the installation of this slow onset crisis”.

Every malnourished child we find here will have protection and will come out of this.

Raffalli added: “we had a double responsibility. We had the responsibility of not evaluating children without being able to attend to them…and to break silence if the reality that we find surprises us”.

“Every malnourished child we find here will have protection and will come out of this,” Raffalli says. However, this is not a crisis CARITAS can address on its own.

The Government must do something and we should demand action. To borrow the words of Maduro recently to a high school senior complaining about the the suspension of the school lunch program, “ustedes no se pueden quedar en la solicitud, ustedes se tienen que movilizar, ir a la calle, que se sienta su palabra”.

“And you, what are you doing?” the President asked to the girl, demonstrating a catastrophic contempt for accountability, as he faced a child in acute hunger.

In addition to protesting, we can support the daily work of charities such as Caritas Venezuela. And to be truly helpful, check with them on how you can be of real service by going to their web page, by calling them up or by sending an email.