Acute malnutrition and micronutrient deficiencies are major public health concerns following disasters. To eliminate the complications of malnutrition, adequate and balanced nutritional services should be provided in disaster-affected areas.Reference Young, Borrel and Holland 1 According to the Türkiye Disaster Response Plan, the leading solution partner of the nutrition service group is the Turkish Red Crescent (TRC). TRC is a voluntary humanitarian aid organization affiliated with the International Committee of the Red Cross. This association has power in committees and movements to collect, distribute, and store social aid on behalf of the Republic of Türkiye. 2
On February 6, 2023, 2 earthquakes with magnitudes of 7.8 and 7.6 occurred along the Eastern Anatolian fault line, resulting in thousands of deaths and causing severe destruction in Türkiye and Syria. 2 Millions of earthquake victims received food aid from TRC, nutrition platforms, and other institutions. This study aimed to address the nutrition service management of TRC in the Kahramanmaraş earthquakes.
Narrative
This retrospective study was carried out with the TRC General Directorate’s permission and the TRC Academy’s support. In this context, nutrition aid service-related data in earthquake regions were obtained from the data analysis and reporting unit of TRC. All data covered food aid between February 6, 2023 and October 2, 2023. Accordingly, nutritional services distributed food to the provinces of Adana, Adıyaman, Diyarbakır, Gaziantep, Hatay, Kahramanmaraş, Kilis, Malatya, Osmaniye, and Şanlıurfa. There were approximately 450 nutrition stakeholders in the Kahramanmaraş earthquakes. Distributions of donated hot meals were TRC (24.6%), nutrition platforms (10.4%), and governmental institutions and some non-governmental humanitarian organizations (65%). A data gap concerning the hot meal distribution by nutrition platforms and other institutions was identified in Adana. In addition, the number of various food items donated is given in Table 1.
Numbers of food parcels, soups, snacks, bottled water, drinks, and bread distributed by TRC and numbers of hot meals distributed by TRC, nutrition platforms, and other institutions in the earthquake provinces
* Others cover mostly governmental institutions and some non-governmental humanitarian organizations.
Apart from these data, the distributed breakfast and hot meals numbers in the earthquake region were Adana (n = 2 166 447), Adıyaman (n = 52 096 455), Diyarbakır (n = 7 828 772), Gaziantep (n = 37 077 991), Hatay (n = 141 898 723), Kahramanmaraş (n = 111 621 866), Kilis (n = 1 954 065), Malatya (n = 56 328 565), Osmaniye (n = 10 945 789), and Şanlıurfa (n = 3 561 581). The number of distributed food aid packages were Adana (n = 2243), Adıyaman (n = 25 764), Diyarbakır (n = 4047), Gaziantep (n = 41 905), Hatay (n = 86 809), Kahramanmaraş (n = 60 418), Kilis (n = 771), Malatya (n = 98 363), Osmaniye (n = 25 605), and Şanlıurfa (n = 267). Lastly, food manufacturing facilities were established in Hatay (n = 19), Gaziantep (n = 7), Kahramanmaraş (n = 6), and Adıyaman (n = 4).
Discussion
TRC, the nutrition platforms, governmental institutions, and humanitarian organizations supported nutritional aid to earthquake regions. TRC delivered food baskets, food aid packages, soup, snacks, bottled water, drinks, bread, breakfast, and hot meals to earthquake victims. TRC could not provide nutritional support for all settlements in the short term because the affected area was large-scale. However, TRC coordinated the transportation and management of all nutritional aid in the long term. Regarding these disaster experiences, risk management must be prioritized to minimize disaster damage and accelerate the transfer to normalization.
The disaster management system has been established based on each country’s accumulation of disaster experience.Reference Song, Park and Lee 3 The coordinator organization responsible for emergency and disaster management in the United States is the US Federal Emergency Management Agency. 4 However, private sector and volunteer organizations also assume responsibility for responding to disasters alongside the US federal government. Emergency management is part of the political governance structure in the European Union and varies significantly from country to country. 5 In many European countries, coordination is maintained between civil defense and state authority. 6 In Latin America, many national disaster management systems have been established as formal units for emergency response. 7 The Japanese government has determined that one of the most effective methods of dealing with disasters is early warning and prediction, and it has reached an advanced level in taking adequate precautions.Reference Suganuma 8 Nevertheless, major natural disasters experienced in recent years have emphasized the need for a more comprehensive disaster management system that includes prevention, mitigation, preparation, response, and recovery activities in some countries. Disaster nutrition management in Türkiye is carried out like that of other countries.
National standards should determine the recommended daily intake for disasters. For instance, “Nutritional Reference Values for Evacuation Shelters” provided by Japan’s Ministry of Health, Labor, and Welfare is a landmark in managing post-earthquake nutrition services.Reference Sudo, Matsumoto and Tsuboyama-Kasaoka 9 This model provides reference values for calories, protein, thiamin, riboflavin, and vitamin C, which are revised every 5 years.Reference Sudo, Shimada and Tsuboyama-Kasaoka 10 Regarding disaster and emergency nutrition in Türkiye, 2 documents have been highlighted in the literature. Firstly, the Ministry of Health published a document regarding nutrition in disaster situations in 2007. This document outlines nutritional requirements for infants aged 0-1 years, pregnant and breastfeeding women, and elderly individuals. 11 Secondly, the Nutrition Services in Disasters Guideline of TRC, which covers solid and hot food, distribution of supplies, equipment used in these services, and organization of services, was published in 2017. 2 The TRC guideline was compatible with the requirements of Sphere Project in terms of calories, protein, and fat. 12 The nutrition service implemented during the Kahramanmaraş earthquakes is compatible with the TRC guideline.
Adequate and safe food should be provided to earthquake victims to reduce morbidity and mortality rates. According to Günalan et al. (2024), the TRC menus provided during the Kahramanmaraş earthquakes were consistent with the Sphere Project standards and TRC guidelines in terms of energy (2100 kcal), protein (10%-12%), and fat (17%) content.Reference Gunalan, Yoldas and Turgut 13 This criterion is for people entirely dependent on food aid.Reference Gunalan, Yoldas and Turgut 13 This paper has shown that nutrition platforms, other non-governmental organizations, and philanthropists provided food aid to earthquake-affected regions, apart from the TRC. Consistently, Atasoy et al. investigated earthquake menus distributed in 13 locations in Malatya.Reference Atasoy, Kurt and Beckerman-Hsu 14 Accordingly, the differences in the nutritional services offered by different centers led to the intake of different nutritional contents between consumption groups.Reference Atasoy, Kurt and Beckerman-Hsu 14 Compared to TRC menus, micronutrient deficiencies in earthquake menus were higher in Atasoy et al.’s study.Reference Atasoy, Kurt and Beckerman-Hsu 14 This situation also made the evaluation of nutritional intervention difficult. All governmental and humanitarian organizations should manage and standardize nutritional aid in line with this common goal.
After natural disasters, acute malnutrition and micronutrient deficiencies attract attention, especially in infants, pregnant women, lactating women, and elderly individuals.Reference Dong, Ge and Ren 15 , Reference Fan 16 The TRC reports included organizing aid for baby nutrition. However, this aid was directed to the general population rather than individualized dietary plans. In this context, designing ready-to-eat, energy-dense products can play an essential role in eliminating malnutrition for babies and children in disasters.Reference Young, Borrel and Holland 1 Following the Kahramanmaraş earthquakes, Yilmaz F.Ç. suggested producing a special biscuit for malnourished children. This product should be designed to be local, low-cost, healthy, and easy to supply, store, produce, and consume.Reference Yılmaz and Yücetaş 17 In the future, TRC may produce disaster foods and supplements to serve vulnerable populations during earthquakes.
One of the most overlooked issues after a disaster is the nutrition of disaster victims with chronic diseases. The TRC provided a separate menu for diabetic and celiac patients in the acute period of the Kahramanmaraş earthquakes.Reference Gunalan, Yoldas and Turgut 13 Additionally, TRC menus included different snack alternatives for kidney disease. However, the oral intake of all patients may not be suitable for food consumption. Therefore, enteral nutritional support products should also be offered to some patients as nutritional assistance. According to field research and activity reports of aid organizations, it was determined that there was no enteral product support in earthquake regions.
Disaster management aims to prevent existing dangers and risks, if not to weaken and reduce the effects of this situation as much as possible, and ultimately to create a safe living space. Part of creating a safe life must be providing adequate and balanced nutrition for every need group. Based on the current data, post-disaster nutrition interventions need improvement. A multi-level nutrition service management model, which addresses a disaster’s before, during, and after phases, can accelerate the transition to normalization following the earthquake by ensuring a high-quality food supply and nutrition services. According to this model, nutritional support teams should include registered dietitians from mass feeding services, community nutrition, and medical nutrition therapy for emergency operations. Each unit should be trained in food supply, hygiene and safety practices, and medical nutrition.
Acknowledgements
This study was carried out in collaboration with the Turkish Red Crescent Academy, Başak Yıldız and Burkay Durak.
Author contribution
EG designed, investigated, wrote, supervised, reviewed, and revised the study. RT and HI designed the study, and prepared and revised the draft.
Funding statement
This study has not been funded by any institution.
Competing interests
All authors declare that they have no conflicts of interest.
Ethical standard
This study did not require ethical committee approval.
