Isabel Portillo
Screening Coordinator at Osakidetza -Basque Health Service, researcher in the Cancer Biomarkers group at the Biobizkaia Health Research Institute, and secretary of the Board of Directors of the Spanish Epidemiology Society
The data are detailed, and the method used in this case is an observational study with the methodology for measuring child malnutrition standardized by both UNICEF and WHO. Screening has been carried out systematically with vaccination, visits to an UNRWA center for malnutrition and/or other diseases. Despite the difficulties in its development (displacement, UNRWA's capacity for care), it presents a solid methodology with statistical analyses adjusted for period, population, sex, and age.
Malnutrition and its measurement in countries with low socioeconomic status or in armed conflict and displacement has been carried out by NGOs and international agencies such as UNICEF and WHO for decades. In this case, what is new is the relevance of this conflict in child malnutrition due to the conflict, forced displacement, and, fundamentally, the blockade of humanitarian aid, as it decreases when aid is allowed to pass and increases significantly in the last months of the study.
Limitations: working conditions in clinics and forced displacement may skew the prevalence, which is acknowledged by the authors, as well as recruitment bias, which has not been population-based.
The main recommendation is to continue epidemiological surveillance of all cases, achieve a ceasefire, and allow humanitarian aid to pass through, given that child malnutrition, which is higher in older children (priority is given to younger children), is a risk of morbidity and mortality that can be avoided in the short and medium term, in addition to long-term sequelae.