Supporting refugees - what is needed, what is available?

1. Supporting refugees - what is needed, what is available? • By Maria Fertaki • Kalli Malamatou • Anastasia Kapsali

2. Refugee route

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5. Arrivals in Mitilini- Lesvos • Total arrivals in Lesvos (01 Jan 2015 - 29 Feb 2016): 573,625 • Total arrivals in Lesvos during Feb 2016 30,531 • Average daily arrivals during Feb 2016 1,053 • Average daily arrivals during Jan 2016 1,374 • % of arrivals in Lesvos compared to total (2016): 59%

7. Percentages of men, women and children • 40%children in Feb. vs 35% children in Jan. • 23% women in Feb. vs 21% women in Jan. • 37% men in Feb. vs 44% men in Jan.

8. Response • Professional NGOs- paid staff (Medicines du Monde, Medicines without Frontiers, etc) • Mixed NGOs – paid staff and volunteers • Small NGOs- volunteers • UNHCR • Government

9. Differences between response to emergencies and transit Emergencies transit • Numbers static • Beginning very abrupt and difficult but improvement over next months • Has beginning and end • Refugees at one place makes it easier to assess their needs and intervene • Numbers flactuating every day • Constant flow • Flactuating population • Moving so fast that there is little time to assess and intervene

10. Optimal infant and young child feeding recommendations Early initiation of breastfeeding (within 1 hour of birth) Exclusive breastfeeding (0-<6m) Safe and appropriate infant and young child feeding in emergencies Continued breastfeeding (2 years or beyond) Complementary feeding (6-<24m) Complementary foods

11. The most effective intervention to prevent under 5 deaths

12. Reasons for risky feeding practices Reasons for risky feeding practices A proportion of infants may not be breastfed when an emergency hits Pre-emergencyfeeding practices may be sub-optimal During an emergency, inappropriate aid may increase artificial feeding.

13. What is IFE (Infant Feeding in Emergencies) concerned with? • Protection and support • Breastfed infants: Early initiation, exclusive and continuous breastfeeding • Non-breastfed infants: minimize the risks of artificial feeding • All infants and young children: appropriate and safe complementary feeding • Well- being of mothers: nutritional, mental and physical health

14. Need for assessment • Age of baby • How is baby currently fed? • If you have stopped breastfeeding when did you stop and why? • Have you any concerns or difficulties feeding your baby/child? • How long are you staying here?

15. Directions for the use of powdered formula in transit (from Fbgroup Infant Feeding Support for Refugee Children) Powdered formula should be mixed with clean, boiled water. If you can’t get boiled water then you can use bottled water. • Do not add extra water to dilute • Do not add extra powder to thicken Formula that is mixed with too much water or too much powder can make a baby very sick. Throw out unused formula; do not save it to feed later. Bacteria grow quickly in formula once it is mixed and can make baby sick.

16. Milk station at Pireaus

17. Baby with bottle and formula in Pireaus

18. Ready to feed liquid formula Ready to feed liquid formula does not need dilution and is easier to use. Once containersof ready to feed formula are opened theymust be drunk immediately and any leftover milk must be thrown out. Once ready to feed formula is opened bacteria can quickly grow and can make your baby sick. READY TO FEED FORMULA IS SAFERTHAN POWDERED

20. Directions for feeding a baby with a bottle in transit Washing feeding bottles is very difficult while you travel. If you are formula feeding, don’t use bottles if you can help it. Use a cup because they are easier to clean and dirty bottles can make babies very sick. If you must use a bottle try to clean it after each feed with hot soapy water. If you can’t clean it right after feeding your baby, make sure you dry it very well with clean paper towel. DON’T USE BOTTLES IF YOU CAN HELP IT

21. Feeding baby with a cup Cup and spoon feeding are cleaner than using a bottle: • Use a small cup. Try to clean it after each feed with hot soapy water. If you can’t clean it right after feeding your baby, make sure you dry it very well with clean paper towel.

22. Directions for milk feeding after 6 months After 6 months, your baby can have animal milk instead of formula. This milk might be easier to obtain and is safer to use than powdered infant formula. Recommended: • Full-cream pasteurized animal milk (goat; cow; sheep) including UHT milk. • Fermented milk or yoghurt Avoid: • Juices, teas • Evaporated or condensed milk

23. Situation in Greece regarding IFE • Disorganization • Lack of leadership • Most organizations either have no policy or strict policy regarding infant feeding (ex. IRC, PIKPA, CARITAS) • They were so overwhelmed by numbers that were happy to provide something and move them forward • They didn’t see the impact of their action. • Lack of background knowledge on bf • Consider such considerations a luxury • No one takes responsibility because soon they are gone • Need not properly measured because moms don’t go to clinics. • Strong myths around breastfeeding

24. Actions taken so far by LLLGreece • Distribution of carriers, snacks , clothes, leaflets and safe infant feeding support by 7 leaders on the field and on the phone. • Preparation of packages by leaders not able to go to the refugees • 3 day assessment visit to Lesvos by one leader • Visits to camps and hotels that host families (Moria, Afghan hill, PIKPA, Caritas, Eleonas, Galatsi, Athens) • Visits to the ports (Kavala, Pireus) • Visits to the borders • Training in “Safe Infant Feeding in Transit” in Mitilini and Athens • Contacts with other organizations (Amurtel, Save the Children, Caritas, Solidarity now, Diasillogiki, Oikopoli, Metadrasi, Nostos, Greenpeace, WWF, Doctors without frontiers, ) • Creation of mother –baby areas (Kavala, Athens)

25. Distribution of carriers, snacks , clothes, leaflets and safe infant feeding support by 7 leaders on the field and on the phone.

27. Sling wearing in Galatsi -Athens

28. Fitting carriers in Eleonas camp in Athens

29. Visit to the Mitilini camp

30. Afghan mom with sling in Mitilini-Lesvos

31. Syrian mom with carrier in Mitilini-Lesvos

33. Challenges for LLL Greece • Small organization • Not well known • Had to invest time to meet the other “actors” • No budget for refugee work • Not used to asking for money. No need until now!

34. Challenges for LLL leaders • Used to working a few hours a week on a steady rhythm • Many have small children • Little experience with other ethnicities • Language barrier • No training in safe infant feeding in transit • No training in handling formula • No training in the unique challenges of formula use in transit • Difficulty in describing who we are to the refugees • Lack of LLL material on safe infant feeding in transit

35. Strong points of LLL leaders • Strongly believe in the IFE guidelines • Good interpersonal skills • Experience with connecting with moms and children • Experience in assessing bf situations • Responsible

36. Development of Goals of LLL leaders: Initial goal: to do something!!! Intermediate goal: to help with breastfeeding and bottle feeding Latest goal: to set up mother baby areas and to train other organizations

37. Save the Children Mother –Baby Area in Mitilini

38. Save the Children Mother Baby Area in Mitilini

39. What is needed: • Guidelines for LLL leaders working with transit refugees • Leaflets in arabic, farsi and kurdish • Posters with simple messages • Key messages in different languages • International LLLleader group where knowledge and resources can be shared • Possibility of experienced leaders to travel to other areas and train local leaders • Funding

43. Thank you