Responding to conflict: Does “Cash Plus” work for preventing malnutrition? New evidence form an impact evaluation of Yemen’s Cash for Nutrition Program

Abstract

C onflict has become a major driver of humanitarian crises globally. A dramatic increase in both the number of civilians affected by armed conflict and the length of humanitarian responses in recent years reflects the increased frequency and duration of civil wars and the fact that wars are increasingly fought in urban environments. 1 Of the 36 countries with the largest number of people in need of humanitarian assistance in 2016, 21 were countries in conflict-the countries receiving the greatest volume of international humanitarian assistance were Syria, Yemen, and Iraq. 2 Humanitarian assistance must address both food insecurity and malnutrition for people in conflict situations, but little is known about the best approaches for improving nutrition outcomes during crises. Our recent impact evaluation of Yemen's Cash for Nutrition program provides new evidence on the potential for "cash plus" programs to prevent malnutrition in conflict-affected communities.Humanitarian aid has traditionally focused on in-kind assistance, particularly food distribution, but cash transfers are now a popular alternative model for aid delivery in contexts where markets for basic goods are functional. Over the past 10 years, major NGOs and donor agencies have shifted toward the use of cash where possible because cash transfers are generally preferred by beneficiaries and allow for significant cost savings compared with in-kind assistance for large-scale programs. 3 Cash transfers have also been promoted as a way to address nutrition needs in humanitarian crises. 4 In the increasingly common case of protracted food emergencies associated with conflict, it is not enough to address the immediate need for calories at the household level: the humanitarian response must ensure that aid recipients, especially children and pregnant women, receive an adequate diet to avoid long-term consequences of malnutrition. Children who receive insufficient micronutrients during the first 1,000 days of life are at risk of stunting and long-term lowered human capital. 5Cash transfer programs are promising in this regard-observational studies suggest that cash transfers are associated with greater dietary diversity than direct food distribution is. 6 GAPS IN THE EVIDENCEGiven the challenges and ethical concerns of conducting randomized studies in crisis contexts, there is little rigorous evidence about how well cash transfers work in conflict areas. A recent comprehensive literature review identified only four empirically rigorous studies measuring impacts of cash-based approaches on nutritional outcomes during humanitarian emergencies, primarily focusing on methodologies for providing aid to internally displaced persons (IDPs) and refugees. 7Notably, only one of these studies, focused on a refugee population, was able to randomize a cash intervention compared to a pure control group. 8 The other three studies randomized KEY POLICY LESSONS• Cash transfers combined with nutritional education in a conflict setting can have significant positive impacts on ma...

Impact of financial assistance on stunting: Syrian refugee children under 5 in Türkiye

“…Fenn et al (2021) found that general food distribution significantly decreases stunting among all children in refugee camps in Chad and any interruption of the operation interferes with that positive outcome. In contexts where the modality of intervention is cash assistance, a significant impact is observed on growth and reduction in stunting among children in Mexico (Fernald et al, 2008), in Pakistan (Fenn et al, 2017), in Yemen (Kurdi et al, 2019), and in Ecuador (Paxson & Schady, 2010). Furthermore, a cross-sectional data from 70 refugee sites in 17 countries shows that humanitarian assistance decreases the mortality rate of children under the age of 5 years in refugee settings (Tan et al, 2016).…”