War

Endemic disease of humanity. Catastrophe caused by adults, generally middle-aged and male, in which young people are sent to kill, rape and steal and which generates destruction of the social fabric, the health system, poverty, displacement of people, refugees and great mortality among children, women, the elderly and among the young combatants themselves. ^{(Ben Taleb 2014)}

War is associated with a decrease in the prevalence and duration of breastfeeding and an increase in the use of infant formula, which implies even more serious risks to children’s health. Formula-fed infants in disaster situations have high mortality. ^{(Rabbani 2020, Sumbele 2020, Diwakar 2019, MirMohamadaliIe 2019, Wagner 2019 and 2018, Habek 2016, Andersson 2010, Guerrero 2009, O’Connor 2001, Robertson 1995, Sapir 1993)} 

The consequences of a war are especially serious for children and women, with mortality, decreased life expectancy, anemia, nutritional and growth disorders, psychological disorders, sexual violence and greater suffering of women compared to men. ^{(Sumbele 2020, Diwakar 2019, MirMohamadaliIe 2019, Wagner 2019, Guerrero 2009, Sapir 1993)}

Although the lack of access to artificial formula could lead to an increase in breastfeeding as the only option ^{(Diwakar 2019)}, it has been observed that displacement, poor diet and stress suffered by mothers ^{(Summers 2018)}, separation, death or serious trauma to the mother ^{(O’Connor 2001)}, lack of promotion and support of breastfeeding by aid agencies ^{(Andersson 2010)}, poor training of health workers ^{(Robertson 1995)} and systematic free distribution of breastmilk substitutes by international and local humanitarian agencies ^{(Zakanj 2000)} in war-affected areas are the causes of the decline in the prevalence and duration of breastfeeding. ^{(Rabbani 2020)}

To mitigate the effects of conflict and improve child health, a humanitarian action is needed which focuses on helping mothers cope with conflict-related stress and displacement through support for maternal mental health and psychosocial support programs. ^{(Summers 2018)}

Protecting a woman’s right to breastfeeding in emergencies is associated with better maternal and neonatal outcomes ^{(MirMohamadaliIe 2019)}. Breastfeeding has enabled babies to survive even under the direst circumstances. ^{(Eidelman 2013)}

Specialized breastfeeding support for conflict-affected mothers is a matter of utmost urgency, both during and after periods of conflict, as it can provide more sustainable benefits and with fewer unintended consequences than the distribution of infant formula. ^{(Sumbele 2020, Diwakar 2019)}

Breastfeeding is the most effective way to provide perfect and adequate nutrients, even in emergency situations where the nutritional status of mothers is affected ^{(Nidzvetska 2017)}. Promoting and supporting breastfeeding and limiting the distribution of substitutes by international aid agencies prevents the increase in malnutrition that occurs during armed conflicts. ^{(Andersson 2010, Robertson 1995, Moro 1995)}

There are international protocols on infant and young child feeding in emergencies. ^{(CDC 2022, Save the Children 2020, IFE 2017)}

In war and natural disasters, the WHO “Guiding Principles for Feeding Infants and Young Children in Emergencies” ^{(WHO 2004)} should be followed:

• Principles 1 and 2: Infants born to emergency-affected populations should be exclusively breastfed from birth to 6 months of age. Every effort should be made to identify alternative ways of breastfeeding babies whose biological mothers are not available. Create and maintain an environment that encourages frequent breastfeeding for children up to two years of age or older.
• Principle 3: The quantity, distribution and use of breast milk substitutes should be strictly controlled in emergency settings.