A recent paper in the journal PLoS One examined growth patterns of 982 refugee children (age 0-10 yrs) from 35 countries who were resettled in the state of Washington (Dawson-Hahn et al 2016). Using height and weight measured at the time of their overseas health examination, the authors calculated rates of stunting (low height-for-age), wasting (low weight-for-height), and overweight/obesity as markers of a child’s nutritional status. These statistics were also compared to low-income children in Washington.

To me, the most important part of the results was that rates of substandard growth were quite high among refugees. Overall, refugee children aged 0-5 years old were more likely to be wasted and stunted, and less likely to be obese in comparison to low-income children in Washington.

Figure 1 from Dawson-Hahn et al

The rate of wasting (14.3%) is particularly bothersome. Humanitarian organizations generally view prevalence rates of wasting of less than 5% to be ‘acceptable’ (CEDAT). Above that, severity of wasting is assessed as follows:

• 5% to 9.9% = poor
• 10% to 14.9% = serious
• >15% = critical

This would put the refugee children in the ‘serious’ category, and not far away from ‘critical.’ However, these are aggregate data from children from 35 countries, which doesn’t tell us much about the unique local circumstances faced by the various groups.

Luckily, the authors also included results for the three most represented countries in the sample – Iraq, Burma (Myanmar), and Somalia. These are some of the data from Table 3. I’m omitting the statistics on overweight/obesity to keep things simple, but there were some children who fell into those categories, particularly among Iraqis.

Rates of stunting and wasting in refugees from 3 countries, compared to low income children in Washington state. 

The patterns are not so clear across the board, varying by age group, country, and by whether one is looking at stunting or wasting. Burmese children had the highest rates of stunting (short stature), while Somali children had highest rates of wasting. I liked what the authors had to say about their results, being careful not to over-interpret them, and calling for more information on refugee backgrounds – as groups and as individuals.

“The difference in the nutritional status category prevalence estimates between children whose families originated from Iraq, Somalia and Burma is related to underlying country of origin level differences in nutritional status [31] and may be due to variation in the location and duration of time in transition from their country of origin to an eventual country of resettlement. In fact, some of the children in our sample may have never lived in their family’s country of origin. The families location and time in transition may have contributed to food insecurity, episodes of illness, and exposure to traumatic events [32], and these differences in living environments contribute to the child’s health profile [33]. For example, the increased conflict leading to a marked increase in the number of Iraqis seeking refugee status began in 2003 compared to the decades of conflict and persecution experienced by many families in Somalia and Burma. […]. Future larger studies should also explore differences between refugee camps, as well as between refugee camps and secondary resettlement to another city or region, because significant heterogeneity likely exists between individuals from the same country of origin based on differences in their pre-resettlement experiences.”

The heterogeneity in experiences is important and often overlooked. While it can be tempting to paint with a broad brush, not all displacement stories are the same. Of course, people have different pre-conflict backgrounds as well. But as a general rule, refugees are a disadvantaged demographic. This is apparent in their physical growth patterns, even in comparison to low income American children.

Reference

Dawson-Hahn EE, Pak-Gorstein S, Hoopes AJ, Matheson J. 2016. Comparison of the Nutritional Status of Overseas Refugee Children with Low Income Children in Washington State. PloS one, 11(1), p.e0147854. Link

Related post: The Biology of Forced Displacement