An increasing number of young Syrian children in Lebanon  are at risk of dying from malnourishment, according to a report released Tuesday, prompting aid agencies to leap into action to tackle the “silent threat” before it reaches crisis levels.
Although the overall figure is still well below emergency levels, agencies are emphasizing the need to prevent the problem from snowballing,  pointing to the situation in the Bekaa Valley where extreme cases in kids younger than 5 doubled between 2012 and 2013.
“We are talking about almost 2,000 kids [under 5] who are suffering from acute malnutrition and need immediate treatment, more than half of which are in the Bekaa Valley,” said Annamaria Laurini, UNICEF’s representative in Lebanon.
“It is a new silent threat,” she added. “And we are afraid that the situation will only deteriorate.”
In a run-down building hosting 70 families in Ghazieh, south Lebanon, Syrian refugee Tourkia cradles her 15-month-old son. Abed weighs just 7 kilograms and is suffering from malnutrition, but Tourkia couldn’t afford to get him the care he needed.
“The boy became very weak,” she said as Abed writhed around on the ground crying. “But what could we do? We were watching him die, but we didn’t have money to take him to the hospital.”
“I can’t give him enough nutrition. I just feed him ... whatever I have here [at home].
“Where’s the childhood he’s supposed to have?” she asked with tears in her eyes. “I just watch him get weaker and weaker.”
Tourkia’s story, told in a UNICEF documentary released along with the report, is just one of thousands currently unfolding across Lebanon. Abed was treated in time, but UNICEF and its partners fear that if action isn’t taken, many will not be so lucky. Some 20 percent of the 936,000 official refugees in the country are under age 5, the group most vulnerable to malnutrition and its lifelong negative effects.
To clarify the extent of the problem, UNICEF , the World Health Organization, Lebanon’s Public Health Ministry, the U.N. High Commissioner for Refugees, the World Food Program and the International Orthodox Christian Charities conducted a nationwide study in October and November 2013. The results showed 5.9 percent of all Syrians under 5 are suffering from either moderate or acute malnutrition, well below WHO’s critical 15 percent level, but a significant increase from the 4.4 percent registered in 2012.
“We’re not experiencing a nutritional emergency, but we consider it to be a serious problem because there is already a clear need to prepare,” said Zeroual Azzeddine, UNICEF Lebanon’s chief of health and nutrition. “We don’t want to wake up one day and find ourselves facing a malnutrition crisis.”
The condition is linked to many factors common in crowded areas where impoverished refugees make their home.  These include subpar living conditions, spread of diseases, lack of immunization, rising food prices, poor hygiene facilities, use of formula milk rather than breastfeeding and unsafe drinking water. These factors are likely to deteriorate further as the refugee influx continues.
The report suggests that more than 10,000 children urgently need to be screened for undernourishment, which is easily missed by local doctors due to a lack of awareness of a condition that was previously rare in Lebanon and is not always obvious. For example, contrary to expectations, those suffering from malnutrition often display a lack of appetite and may look bloated due to increased water retention.
The problem is gravest in the Bekaa Valley, where the proportion of Syrians kids needing immediate treatment rises to 8.9 percent, with 1.7 percent displaying signs of edema, the fluid retention associated with the most extreme form of undernutrition.
“This for me is the real sign of the gravity of the situation,” Azzeddine said. “The presence of edema instantly shows the child is severely malnourished. WHO’s crisis level for this indicator is 2 percent, so I consider the Bekaa Valley  to basically be in a crisis.”
Those identified as being in desperate need of treatment during the course of the study – around 400 kids – were given immediate medical assistance last year, and the group of aid agencies and the Public Health Ministry are now putting together a screening system to identify other malnourished children and mothers who are not breastfeeding – crucial for babies. Staff at primary health care centers are also being trained to recognize and treat the condition, and an awareness campaign is being rolled out among refugee communities.
“Malnutrition doesn’t shout, it doesn’t cry – it is silent,” Azzeddine said. “This is why we need to watch out for it ... even mothers don’t always spot it.”