Encyclopedia
Please note this is a comparison between Version 1 by Hassan Vatanparast and Version 2 by Jason Zhu.
There are 26 million refugees globally, with as many as 80% facing food insecurity irrespective of location. Humanitarian agencies continually provide assistance and evaluate their interventions in areas of refugee crisis. Researchers should adopt a standard feasible food security assessment tool which is needed to assess the effectiveness of interventions across locations and countries to develop best practices based on comparative results.
- food security
- food insecurity
- refugees
- intervention
1. Introduction
There are 26 million refugees (“someone who is unable or unwilling to return to their country of origin owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group, or political opinion” [1]) around the world (approximately 50% are children) along with another 45.7 million internally displaced people (“[those who] have not crossed a border to find safety. Unlike refugees, they are on the run at home” [2]) and 4.2 million asylum seekers (“someone whose request for sanctuary has yet to be processed” [3]) [4]. The top source countries of refugees as of 2020 include Syria, Venezuela, Afghanistan, South Sudan, and Myanmar [4]. While some refugees reside in camps, the vast majority live in makeshift cities and host communities in neighbouring countries, where rising tensions have been reported [5]. Some refugees are provided the opportunity to resettle in countries such as Canada or those in Europe and others are repatriated [6]. The instability of many countries around the world due to war, religious and cultural persecution, and environmental disasters continues to increase the numbers of people fleeing their homes every day.
Recent conflicts around the globe are creating larger numbers of refugees for more prolonged periods of time. In desperation, refugees pay to board unsafe, overloaded water vessels. Many do not make it across with the number of dead and missing at its highest of more than 5000 in 2016 [7]. Families are forced to separate, people are met with long wait times trying to enter refugee camps in neighbouring countries, and some countries close their borders forcing refugees to search for asylum elsewhere. The protracted nature of crises such as that of Afghanistan and Syria strains host countries and aid agencies, stretching resources thin and impacting health care, food security, and livelihoods.
The United Nations Refugee Agency (UNHCR) reports that 80% of the world’s displaced people are in locations suffering from acute food insecurity and malnutrition [8]. The COVID-19 pandemic continues to exacerbate the situation. Food security exists when all people at all times have access to safe and nutritious food appropriate for culture and lifestyle [9]. Food security must be examined across four pillars: physical availability of food, economic and physical access to food, food utilization, and stability over time [10]. The right to food and food security cannot exist without addressing the restrictive laws and policies refugees face in many countries such as those around employment and freedom of movement [11], yet food security remains a complex issue.
Particular consideration is needed for the most vulnerable, including women and girls; children; lesbian, gay, bisexual, transgender, queer and/or questioning, intersex, asexual, two spirit, and others (LGBTQIA2S+); the elderly; and persons with disabilities [12][13][12,13]. Women and children are particularly at risk of violence, sexual exploitation, and abuse as families are often separated during migration and refugees are forced to seek help from smugglers and others who take advantage of them, and refugee camps have high population densities with limited services. LGBTQIA2S+ populations are discriminated against, harassed, abused, and murdered, particularly in countries with anti-LGBTQIA2S+ legislation [14]. The elderly and persons with disabilities face barriers when it comes to accessing resources—such as water if collection points are far from their shelter—healthcare, and other services [15]. Gender roles are important in terms of household finances and food security. All over the world, women have a slightly higher prevalence of food insecurity compared to men [16]. Women are likely to prioritize food needs of spouses and children while compromising their own [17][18][17,18]. Culture is another important consideration because a lack of culturally available foods can destabilize cultural identity, affecting both physical and mental health [19]. Food insecurity results in a double burden of disease where malnutrition in childhood is followed by early establishment of chronic diseases later in life. The 2020 Global Nutrition Report indicates that 149 million children less than five years of age are stunted, 50 million are wasted, and 40 million are overweight [20]. Malnutrition is very common in refugee children [21]. Information is available on women and children; however, LGBTQIA2S+, the elderly, and those with disabilities are often overlooked in the design and implementation of humanitarian aid [14][15][22][14,15,22].
Some people live their whole lives in refugee camps with little hope of an autonomous future, yet they do what they can with their limited resources to survive. In camps, refugees are reliant upon aid, provided rations, vouchers, or cash for food. In makeshift cities, they can remain isolated from the host community where significant tensions exist [5][23][5,23]. Supplemental and therapeutic feeding centres are common for infant and young child feeding, target both refugees and host communities, and have proven to be successful in addressing malnutrition [24]. A vital strategy is to work with host countries to provide refugees with documentation to allow them the same rights as other citizens so they can access basic necessities like education, healthcare, and employment [25]. Such approaches improve self-reliance and mental health and provide training opportunities for refugees to build the gap between market demand and refugee skills, considering gender and other social and cultural contexts [26].
In resettlement countries, food security remains an issue. Migrants find cultural foods expensive, hard to obtain, and although people often have cooking skills, the unfamiliarity of new foods and how to prepare them pose challenges [19]. Refugees are provided aid for a short period of time, but many barriers such as language and lack of recognition of education from their home country makes it difficult to land jobs that pay well. For example, preliminary data indicates that 70% of Syrian refugees in Canada experience food insecurity [27].
Many countries around the world are welcoming refugees and donating money towards helping those in need. For example, United Nations Agencies and nongovernmental organization (NGO) partners pledged $5.5 billion USD to assist Syrian refugees in 2020 [28].
2. Intervention Types across Geographic Locations
Areas of Refugee Crisis
Most studies in areas of refugee crisis such as the Middle East and Southeast Africa report on interventions that include a mixture of cash, vouchers, and food transfers. Substantive literature exists on types of interventions, providing evidence for cash-based transfers as opposed to vouchers or food rations as cash provides choice, flexibility, sense of dignity, and empowerment [23][29][30][23,32,33]. However, in areas where markets are not developed, such as newly established refugee camps, rations seem to be the most beneficial until informal and/or formal economies are established, and markets stabilize. When providing assistance, it is important to consider gender, the inclusion of host communities in the interventions, and the accompaniment of livelihood strategies.
When examining intervention types by UN agencies, researchers observed that urban agriculture was a focus of the FAO, and cash/voucher interventions were implemented by the WFP; however, there was not much mention of these two agencies working together to combine efforts. The FAO aims to achieve food security for all, the mandate of the UNHCR is to provide international protection to refugees and other persons of concern, and the role of the WFP is to use food aid to support economic and social development, meet food needs in emergency and protracted situations, and promote food security based on FAO recommendations [31][32][87,88]. Despite documents such as the 2011 Memorandum of Understanding between UNHCR and WFP being in place, details of these collaborations are lacking, and evaluations of UN agency programs recommend collaboration [33][32][81,88]. For example, a 2016 evaluation of WFP programs in Liberia indicated that UNICEF and FAO are listed as partners in the project document, yet no evidence of theis collaboration could be found by the evaluation team in any other documentation. Inter-agency action-oriented collaboration could maximize resources, streamline services, and allow the development of successful plans for a transition from cash assistance to livelihood strategies and thus programmatic sustainability.
Based on recommendations from UN agency impact evaluations, in July 2020, the UNHCR and the WFP announced the launch of the “Joint Strategy for Enhancing Self-Reliance in Food Security and Nutrition in Protracted Refugee Situations” [34][89]. They will assess the refugee situation together, investigate the vulnerabilities, capacities and opportunities together based on their assessment, and set goals to improve self-reliance and livelihoods [34][89]. They will also evaluate their progress on self-reliance in food security together [34][89]. The new strategy has two main objectives that focus on empowering refugees and creating a supportive environment by engaging the local government and host communities [34][89]. Although the new joint strategy seems promising and focuses on empowering refugees by engaging all stakeholders, there is no evidence to evaluate its effectiveness.
In areas of refugee crisis, when host communities are not involved in interventions, it creates feelings of hostility towards refugees as host communities feel like refugees are being helped above their own most vulnerable. The refugee–host relationship can also be affected by country policies which limit the rights of refugees limiting freedom of movement, access to work visas, ownership of land, and more, which is beyond the scope of this review. Including host communities when targeting households for food assistance improves the refugee–host relationship [35][46].
Livelihood strategies are important to improve sustainability of the aid provided and assist refugees in becoming self-sufficient, particularly when aid is often reduced [11]. It is of note to mention that not all interventions are purposeful, and some are instigated by refugees themselves in the form of establishing informal economies and trading in and around refugee camps [36][90]. It is beneficial to take note of these interventions as well because researchers can learn from the entrepreneurial activities of refugees when planning interventions as it is indicative of what refugees need. By providing more livelihood opportunities with the support of humanitarian aid agencies, it may be possible to improve refugee self-reliance, empowerment, and gender equity [35][37][38][39][46,47,60,76].
A considerable amount of evidence is focused on Palestinian and Syrian refugees in Lebanon and Jordan [5][40][41][42][43][5,41,43,48,58]. While most interventions in refugee crisis areas are focused on cash, vouchers, and food transfers, studies in Lebanon reported more sustainable programs such as school-based nutrition, community kitchens and urban agriculture, which are in the line of main interventions in developed destination countries [40][41][44][42][43][41,43,45,48,58].
Destination Countries
Refugees are a vulnerable population that suffer unique challenges that often affect their food security status even after entering destination countries. The results showed few studies are being conducted on refugee food security interventions in developed destination countries despite similar levels of food insecurity between refugees in destination and nondestination countries [6][45][6,91]. For example, a Canadian study by Lane et al. (2019) reported that 50% of refugee households (from various countries of origin) were food insecure [45][91]. Similarly, 50% of Syrian refugees in Lebanon have been found to be food insecure [6]. It is also common to see studies in destination countries (e.g., Canadian Community Health Survey in Canada) grouping refugees with immigrants and excluding participants who cannot speak the country’s official languages, which portrays an inaccurate and underestimated image of refugee food security issues [46][92]. Only 17% of refugee food security intervention studies in destination countries measured food security status.
There is a significant difference in the types of interventions in developed destination countries focusing mainly on urban agriculture, gardening, animal husbandry, and foraging, and other nutrition programming such as nutrition education. In destination countries such as Canada, refugees are covered by direct cash support and housing programs in the first year of arrival [47][93]. Afterwards, based on their situation, they could be eligible for regular social assistance programs. An abrupt cessation to federal government aid may explain the high prevalence of food insecurity among refugees in destination countries a year after arrival [27].
3. Considerations for the Most Vulnerable
Gender is an important consideration when developing food security interventions. In many cultures, women are often in charge of food preparation for the household. Researchers know that women/mothers are more likely to cut back their intake and portion sizes so that other families, particularly children, can have enough to eat [17]. Women are more likely to be food insecure and women and girls are at greater risk of gender-based violence [48][49][50][51][50,82,85,94]. Although many UN agency interventions included gender considerations in the intervention plan (e.g., planned to target women as beneficiaries of cash/food transfers), evaluations showed that these considerations are lacking during implementation [33][50][81,85]. Evaluations often indicated a need for more security, oversight, monitoring, and evaluation in camp settings [33][52][81,84]. Equitable gender considerations can be difficult because many countries still lack women’s rights and their policies and social norms may prevent women from seeking employment outside the home, and other genders are not considered due to discrimination and oppressive laws [14][29][51][14,32,94]. Few studies mentioned other at-risk populations such as children not covered by IYCF programs, the elderly, LGBTQIA2S+, and persons with disabilities, and research shows that these people are often overlooked in the design and implementation of humanitarian aid, indicating a need to amend interventions to assist these at-risk groups [14][15][14,15]. Although not all interventions can affect policy change, it is important to work with governments to find ways to assist the most vulnerable.
4. Assessing Food Security
Less than half of the studies that aimed to address food security issues actually measured food security, and those that did used a variety of different tools with only some being validated. The most common tool used to measure food security was the UN’s Food Consumption Score used in 52% of the studies that measured food security, while all other tools were only used in one study each. A wide range of food security topics makes it difficult to assess the efficacy of interventions. A consistent tool that is validated in different languages is needed to accurately compare food security across locations and contexts, differentiating between adult and child food security and providing a more complete picture of food security issues in households, which would allow more targeted interventions. The WFP is evaluating the food security status of refugees in areas of refugee crises using the Consolidated Approach to Reporting Indicators of Food Security (CARI) [53][95]. Theis comprehensive tool incorporates the Food Consumption Score, economic capacity, and livelihood coping strategies, which has been widely accepted and is a good measure of food security [53][95]. The Household Food Security Survey Module (HFSSM) is a questionnaire containing 18 questions that assess income-related food security status at household, adult, and child levels [54][96]. The HFSSM has been validated and used in more than 19 languages in different countries, particularly developed destination countries [54][96]. The ability of the HFSSM to assess food security in households, adults, and children makes it a proper candidate as a standard tool that fills the gap in the ability to universally assess the efficacy of food security interventions in different settings. Destination countries such as Canada and the USA are using the HFSSM regularly in their nutrition and health national surveys [54][96]. Therefore, using either tool or a combination as a standard food security assessment tool will allow the comparison of food security status of refugees with host countries to identify the gaps and disparities.
5. Knowledge Gaps and Research Recommendations
A considerable number of studies in areas of refugee crisis evaluated the short-term interventions of international agencies individually [23][33][49][23,81,82]. There is a lack of evidence as to whether international agencies are working together on interventions they support collectively and, if so, how effective those initiatives are compared to interventions implemented by one agency alone. Further, it is not clear the extent to which international agencies work with local governments or NGOs on the sustainability of interventions that is necessary to empower refugees, enable them to be self-sufficient, improve their food security status, and contribute to local economies.
Research has shown that beneficiaries prefer cash to vouchers and rations and that cash often results in better outcomes compared to other modalities [29][30][55][56][57][32,33,39,40,56]. The lack of direct food security measures in many studies, along with insufficient methodologies (e.g., measures only in one time point, lack of food security measures, lack of control group), prevented an assessment of any improvement correlated with the intervention itself. The lack of a consistent tool used to measure food security prevents any comparison across studies, which goes beyond the scope of this review. Similarly, limited studies on cash, vouchers, and/or rations measured food security and considered gender in their implementation. Of those that did, none compared food security results across genders.
Grey literature indicates the role of community-based organizations and host communities in supporting and empowering refugees, particularly in destination countries [38][58][59][60,61,77]. Such organizations conduct interventions without proper pre- and post-evaluations, leading to lack of evidence on the impact and effectiveness of such initiatives. There is a need to identify, evaluate, and document best practices aimed to improve the food security status of refugees.
Although international agencies have clear policies and work plans with regards to food security in areas of refugee crisis, to the knowledge no study has evaluated the policies by local governments in areas of refugee crisis as well as destination countries [32][60][61][88,97,98]. Such studies will assist in identifying effective policies that aim to improve food security status of refugees while empowering them as new members of the host community.
The refugee generating situations around the globe, such as climate change, civil unrest and war, are on the raise. Most governmental and inter-governmental agencies are focused on immediate assistance with the essential needs. Short-term interventions are necessary to alleviate hunger and other short-term effects of food insecurity among refugees. However, many protracted refugees continue to live in unstable situations in host countries, which can impact their food security status. There is limited information surrounding food security interventions in protracted crises, likely due to limited resources and international aid agencies focusing efforts on acute crises. Thus, further efforts are required to address sustainability issues when it comes to food security interventions.
