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November 2014 Issue 48 ISSN 1743-5080 (print) Programming experiences and learning from the nutrition response to the Syrian crisis Contents........................................................................... 1 Editorial Views Turkey 2 ENN’s perspective on the nutrition response in the Syria crisis Field Articles 67 DRC experiences of cash assistance to non-camp refugees in Turkey and Lebanon Lebanon 70 Experiences of the e-Food card programme in the Turkish Field Articles refugee camps 8 Designing an inter-agency multipurpose cash transfer programme in Lebanon Iraq 11 Postscript 12 Institutionalising acute malnutrition treatment in Lebanon Views 14 Infant and young child feeding support in Lebanon: 73 Syrians in Iraq: Refugee response within a major strengthening the national system humanitarian and political crisis 17 UNICEF experiences of the nutrition response in Lebanon 20 WFP e-voucher programme in Lebanon Regional 22 Characteristics and challenges of the health sector response in Lebanon Research 25 WFP experiences of vulnerability assessment of Syrian 75 International legal consequences of the conflict in Syria refugees in Lebanon Field Articles Views 79 The Syria Needs Assessment Project 28 Towards a 21st century humanitarian response model to the refugee crisis in the Lebanon Views Jordan 81 Nutrition response to the Syria crisis: UNICEF's perspective Field Articles Bonus articles online: www.ennonline.net/fex 30 Aid effectiveness: determining vulnerability among Syrian refugees in Jordan 33 Evolution of WFP’s food assistance programme for Syrian An Informal Settlement during Storm refugees in Jordan Alexa in December 2013 35 Responding to nutrition gaps in Jordan in the Syrian Refugee Crisis: Infant and Young Child Feeding education and malnutrition treatment 38 Managing infant and young child feeding in refugee camps in Jordan 41 Postscript 42 The situation of older refugees and refugees with disabilities, injuries, and chronic diseases in the Syria crisis Views 44 UN and INGO experiences of coordination in Jordan Syria Field Articles 46 WFP’s emergency programme in Syria 50 GOAL’s food and voucher assistance programme in Northern Syria 54 WHO response to malnutrition in Syria: a focus on surveillance, case detection and clinical management 57 Experiences and challenges of programming in Northern Syria 60 Non-food cash voucher programme for IDPs in Northern Syria 61 Emerging cases of malnutrition amongst IDPs in Tal Abyad district, Syria Views 65 Coordinating the response to the Syria crisis: the southern Turkey cross border experience 2013 SC Lebanon, Baroudi, Ahmad ..................................................................................................................................................... Editorial ............................................................................. Ahmad Baroudi, SC Lebanon, 2013 SC Lebanon, Baroudi, Ahmad pproximately two year aer the outbreak of civil war in Syria in April 2011, the ENN decided to compile a special issue of Field Exchange on the humanitarian Aresponse to the crisis that unfolded. is decision was based on the fact that there was (and remain) a number of unique features of this ongoing regional emergency and it presented an important opportu- nity to capture programming experiences and learn- ing. In particular, the massive and unprecedented scale of need amongst those displaced in Syria (there are now over 9 million displaced Syrians and it is the Children inside an improvised shelter biggest refugee crisis faced by UNHCR in its 64 year in Baalbek District, Bekaa Valley history) combined with the generosity of host gov- ernments and the donor community (including many non-traditional donors) in meeting needs; the tions. Many of these organisations/institutions have WFP in the region. Cash has largely replaced general programming challenges of remote management in not been part of the formal coordination structures food distributions in the regional response apart conflict affected Syria and of serving the needs of established as a response to this emergency and this from in Syria itself. Cash has also been used to sup- non-camp populations in refugee hosting countries is one of the reasons why we found it difficult to en- port access to other critical needs, such as health (the vast majority of refugees are not in camps); the gage with and capture the programming experiences care, shelter and livelihoods, with these ‘nutrition- substantial impact of the refugee population on host of these entities. By all accounts, the humanitarian sensitive’ programmes implemented by a variety of response of the Syrian community – at home and UN and INGOs. We have also broadened our hori- populations, and the unprecedented scale of cash abroad – has been huge, zons to feature articles from agencies specialising in and voucher programmes being employed in the re- water, sanitation and hygiene (WASH), shelter, and gion. At the outset of compiling this special issue, it e outcome of these efforts is in effect a triple edi- gender based violence related programming that was not clear to the ENN what, if any, nutritional tion of Field Exchange comprising 35 field articles touch on nutrition. Two articles were ‘commis- challenges were being faced. is only began to (plus four postscripts), nine views pieces, one research sioned’ by the ENN – one explores the legal basis for emerge as we engaged with key actors and under- article, on evaluation, one news piece and three military involvement on humanitarian grounds in took a number of country visits. e ENN views ar- agency profiles. e unprecedented number of arti- Syria, a pro bono piece of work by an international ticle that accompanies this editorial is an attempt to cles generated has meant that for practical and cost barrister, Natasha Harrington, enabled by A4ID3. set out the nutrition challenges of this crisis and purposes, we have produced it in two forms: a full on- e second article is an anthropological review of emerging issues as we see them. line edition (available at www.ennonline.net/fex) and the nutrition-related social aspects of the refugee ex- this smaller print edition. For print, we have selected perience in Jordan, which involved a month of field e ENN began the process of compiling this programme-oriented articles informed by consider- special issue a year ago, conducting over 100 tele- work by two anthropologists and an ENN volunteer. ations of geographic spread, range of sectors and ere are also a number of cross-cutting features in phone interviews (at headquarters, regional and ‘richness’ of learning. e online edition will feature country level) with agencies working in the region articles, such as coordination mechanisms, informa- on the UNHCR Syria response interagency informa- (UN, INGOs, NGOs, donors and research groups) tion management and challenges of remote pro- tion sharing portal, the ‘go to’ online destination for in order to obtain agency briefings, hear program- gramme management in Syria. What all these programmers in the region2. ming experiences and scope out potential areas of articles have in common is that they provide a rich interest for field articles. At the outset, in September A number of field articles have fallen by the way- font for learning. e accompanying ENN views 2013, ENN met with staff in UNHCR, IFRC, ICRC side, largely as agencies came to view the material as piece attempts to synthesise key themes emerging and OCHA in Geneva who provided overviews of ‘too sensitive’ for publication. Although disappoint- and lessons learned with respect to nutrition pro- their respective agency responses in the region and ing, some of the authors have stated that the process gramming and response. helped identify key issues to highlight in the edition. of writing the article was useful for internal lesson roughout this process, we have been genuinely ree ENN Technical Directors then visited the re- learning even though the material cannot be dissem- struck by the incredible engagement of humanitar- gion in March/April 2014 to meet with 45 country inated more widely. ere is also material in this ian staff with us to candidly share and write their offices in Jordan, Lebanon and southern Turkey, in- special issue that has been written anonymously to stories, typically in ‘out of office’ time in evenings, terviewing more than 60 staff involved in the re- protect the interest of agencies, as well as articles weekends and whilst on leave. e authors remained sponse. Efforts to conduct a short trip to Damascus where the authors have purposively omitted or eminently patient with our nagging for final dras. proved unsuccessful given the security situation. steered clear of information which could jeopardis- All the agencies were incredibly supportive of our Field visits, facilitated by WFP, Save the Children ing future programming. country visits. We extend a huge thanks to all. Jordan, IOCC and UNHCR, were conducted to see programmes first hand. On return to the UK, the e special issue provides a truly unique We hope you find this special publication of Field ENN team continued to work closely with authors overview of programming experiences in the region, Exchange to be useful for your work and an enjoy- to develop and finalise articles and met again with as well as insights into the institutional architecture able read. We welcome feedback including letters to Geneva based agencies in July 2014, to share the and challenges involved in supporting program- the editors (contacts below).