Kirehe District, Rwanda – Save the Children is making significant strides in improving the nutritional status of mothers, infants, and children within the Mahama Refugee Camp. By implementing nutrition programmes, including the promotion of optimal breastfeeding practices and enabling appropriate and safe complementary feeding, the organisation has successfully addressed critical challenges faced by refugee families, particularly pregnant and lactating women.

At the heart of Save the Children’s efforts is a commitment to empower women like Speciose Kamaliza, a mother of twins who has resided in the camp since 2015. Upon realising that it was difficult to optimally feed her two newborns, she visited a nutrition centre in Mahama that is run by Save the Children. She was taken through crucial counselling, and education sessions and the provided with essential nutritional supplements. Through the services, Kamaliza has been able to overcome initial anxieties about raising twins in a challenging refugee environment.

"I visited a health Centre in the camp and learnt through the scans that I was expecting twins. The challenges of raising twins in the refugee camp context coupled with limited aid, caused me considerable anxiety. However, Save the Children provided invaluable counselling and support, and community health workers visited me regularly before and after giving birth emphasising the benefits of exclusive breastfeeding without stress,” Kamaliza shared.

Save the Children Rwanda’s nutrition and breastfeeding interventions have significantly mitigated the negative impact on pregnant and lactating mothers within the Mahama Refugee Camp. The Infant and Young Children Feeding (IYCF) programmes target children below two years who are at a critical age by ensuring proper lactation and feeding practices. For Kamaliza, breastfeeding twins in a refugee camp is a very complicated situation due to the demands for twins and the complex camp set-up.

Breastfeeding plays a crucial role in preventing various forms of childhood malnutrition, including wasting, stunting, underweight, overweight, and micronutrient deficiencies. Breast milk is the first and most critical food for infants and should be given exclusively in the first six months of life. It is not just readily available but also helps pass crucial immunity from the mother to the child thus providing the ability to fight childhood illnesses.

Community members like Kamaliza have reported that, in addition to learning about breastfeeding practices and balanced diet preparation through direct counselling, they have also benefited from knowledge sharing within mother-to-mother support groups.

Moreover, the provision of complementary and supplementary foods is crucial after the first six months of life. Supplementary foods such as nutritious porridge, during pregnancy and lactation have further enhanced maternal and child health. To address the heightened risk of undernutrition linked to poor hygiene and sanitation, lactating mothers in the camp receive comprehensive education on these essential practices.

"At birth, the twins presented with low birth weights of 2,100 grams and 2,500 grams respectively, classifying them as low birth weight infants. SCI team provided consistent care through the provision of nutrient-dense supplementary foods and exclusive breastfeeding for six months, they gained weight significantly, achieving age-appropriate weights by eight months of age. Continued supplementation with age-appropriate complementary feeding, including nutritious porridge, has supported their robust health and development”, she reported.

Kamaliza attributes her twins’ progress to the regular provision of complementary foods, which she believes have boosted her breast milk and contributed to preventing malnutrition and stunting.

This year, on August 7, Save the Children Rwanda, in collaboration with the Ministry of Health and the Rwanda Biomedical Centre (RBC), concluded its annual Breastfeeding Week campaign, which ran from August 1 under the theme "Closing the gap: Breastfeeding support for all.” The campaign aimed to raise awareness about the critical importance of breastfeeding and to advocate for increased support for lactating mothers.

"Breast milk has enough nutrients and antibodies that boost the immunity of a child’s body. Breastfeeding for the first months protects the child from different diseases including diarrhoea, and respiratory diseases, and helps in brain development as well as bonding between mother and child,” emphasised Claude Mambo Muvunyi, Director General of RBC, at the launch of a nationwide campaign that coincided with Breastfeeding Week.

Exclusive breastfeeding for the initial six months of an infant’s life is considered the golden standard for optimal growth, development, and immunity. Subsequently, the introduction of nutrient-dense complementary foods while maintaining breastfeeding is crucial for continued child health and development. These practices have been shown to reduce the incidence of infant morbidity, including gastrointestinal infections, and contribute to improved maternal health outcomes.

Despite the significant progress achieved through Save the Children Rwanda’s breastfeeding and nutrition interventions, the refugee population continues to face different challenges. The cutting of humanitarian budgets and assistance has resulted in a reduction of essential services, exacerbating the vulnerabilities of refugee families.

At the closing of the week, beneficiaries, including Kamaliza, shared their personal journeys and expressed gratitude for the programme's impact on their families well-being.

She noted that, despite support from Save the Children, refugees still face challenges. "My husband and I have no jobs to generate income to be able to afford all basic needs such as clothes, soap, food, and others for our children. We had six children and with twins, they are now eight. Any support for us is welcome,” she added.

Kamaliza’s account underscores the dire economic circumstances faced by many refugees, highlighting the urgent need for comprehensive support to address their basic needs and improve their overall livelihoods.

"My husband and I are currently unemployed, rendering us unable to meet the basic needs of our growing family. With the recent birth of twins, our family has expanded to eight children. We are in dire need of support to ensure the provision of essential items such as clothing, hygienic items, and food,” she said.

Niyonsaba’s story

Aline Niyonsaba, a lactating mother residing in Mahama Refugee Camp, experienced breastfeeding challenges due to post-partum breast engorgement. This is a condition where the breasts of a lactating mother swells causing discomfort and pain. She initially resorted to formula feeding, which is contraindicated in the first six months of life, she subsequently sought medical care at Save the Children Health facility and received counselling on the exclusive breastfeeding benefits for infants during the first six months of life.

"With support from Save the Children’s breastfeeding and nutrition programme, I have successfully breastfed my baby for four months. I am committed to exclusive breastfeeding for the first six months, as recommended. Additionally, the program provided me with nutritious supplements during pregnancy and education on optimal maternal nutrition to prevent infant malnutrition and stunting,” she reported.

Niyonsaba highlighted the critical need for continued support in providing free-of-charge complementary foods for mothers and children, particularly in light of recent aid reductions affecting the refugee population.

"We also need to ensure that our children have access to education. The rising cost of living and insufficient refugee aid leave us struggling to meet our basic needs. As a result, we often accumulate debt with local food vendors within the camp due to the insufficiency of the aid provided. With a small capital, I could sell vegetables like tomatoes and bananas, as well as fruits like avocados, within the camp to improve our situation,” she added.

Nurturing futures

For the last 30 years, Save the Children International (SCI) has worked alongside the Government of Rwanda, civil society organisations, and the media to protect and promote children’s rights. Our vision is a world in which every child attains the right to survival, protection, development, and participation. Our mission is to inspire breakthroughs in the way the world treats children and to achieve immediate and lasting change in their lives.

Civil society organisations and the local media protect and promote children’s rights. Our vision is a world in which every child attains the right to survival, protection, development, and participation. Our mission is to inspire breakthroughs in the way the world treats children and to achieve immediate and lasting change in their lives.

In response to the Burundi refugee crisis, Save the Children launched its health and nutrition services in Mahama Refugee Camp in 2016. Since then, the organisation has partnered with the Government of Rwanda, the United Nations High Commission for Refugees (UNHCR), the Bureau of Population, Refugees, and Migration (BPRM), and various other donors to support refugees in the camp.

Today, Mahama Refugee Camp is home to 63,942 individuals, including 50.2% of children who directly benefit from Save the Children’s comprehensive health and nutrition programmes.

In October 2022, UNHCR and the Ministry of Emergency Management (MINEMA) chose Save the Children as their sole implementing partner for 2023 in key areas of refugee support, including health and nutrition services across all camps, transit centres, and reception centres. This recognition has enabled Save the Children to broaden its efforts, extending to five additional refugee camps and two reception centres around the country.

The organisation’s initiatives in breastfeeding are a cornerstone of its community support. These efforts include providing counselling, Support for mothers with difficulties, training, and ongoing education for community health workers (CHWs) and leaders of Mother-to-Mother Support Groups (MMSGs) on the vital importance of breastfeeding.

Healthcare providers receive specialised training in Maternal, Infant, and Young Child Feeding Nutrition (MIYCN) and Infant and Young Child Feeding in Emergencies (IYCF-E) to provide compassionate and informed guidance. The organisation runs regular awareness campaigns on breastfeeding and complementary feeding practices, emphasising the critical importance of the first 1,000 days of a child’s life through programmes like Maternal and Young Child Health Week and Breastfeeding Week.

Monthly Information, Education, and Communication (IEC) sessions address essential topics such as optimal breastfeeding practices, food diversity, family-balanced diet, optimal baby care, hygiene, and immunisation. To ensure that lactating women receive the vital nutrients they need, Save the Children provides supplementary food through a blanket programme, reaching everyone in vulnerable groups.

Community health workers (CHWs) diligently follow up with mothers breastfeeding infants under six months, providing support and addressing any complications. Save the Children also conducts monthly nutrition screenings for children under five, with community health workers performing regular measurements to detect and address malnutrition early.

The mother-to-mother support groups are groups composed of mothers who are breastfeeding and are supported by SCI through our nutrition programmes. They offer a nurturing and conducive environment where mothers can share their experiences and challenges related to breastfeeding and complementary feeding. They also provide support for one another emotionally during breastfeeding. These groups also provide nutrition and health education, support initiatives like kitchen gardens and savings programmes, and offer cooking demonstrations.

Support group leaders play a crucial role in guiding and assisting teen mothers in the community. Additionally, Infant and Young Child Feeding (IYCF) rooms at health centres offer accessible support for breastfeeding, complementary feeding practices, and general nutrition issues, ensuring that all families receive the care and support they need during these critical times.

Transformative impact: Achievements in health and nutrition support for refugees

Through targeted interventions, significant progress has been made in reducing malnutrition rates among refugees and vulnerable groups. For Mahama Refugee Camp, the prevalence of stunting decreased from 41% in 2017 to 24% in 2021, as reported by the Standardized Expanded Nutrition Survey (SENS) of 2021.

The breastfeeding rates are notably high, with 94.2% of infants receiving timely breastfeeding from birth to 23 months, and 86% of infants being exclusively breastfed for the first six months.

Recent reports highlight those 4,334 lactating women received essential supplementary food and nutrition education, including 2,652 mothers from January to December 2023 and 1,682 mothers from January to July 2024. Additionally, 9,088 children aged 6 to 23 months benefited from supplementary food, nutrition education sessions, and regular malnutrition screenings.

Since January 2024, up to 31 lactating mothers with breastfeeding complications have received follow-up care at the nutrition centre. Furthermore, 3,305 pregnant women accessed antenatal care services and breastfeeding education, while at least 2,771 women received support from health providers during the postnatal period.

Monthly screenings for children under five are conducted to combat malnutrition, with an average of 8,279 children screened in Mahama. The program has also fully vaccinated 2,885 children, screened them for malnutrition at each visit, and integrated them into health and nutrition education sessions.

In addition, Save the Children has implemented the Integrated Management of Neonatal and Childhood Illnesses (IMNCI) approach, which plays a crucial role in diagnosing and treating common childhood illnesses such as pneumonia, diarrhoea, and malnutrition. This comprehensive strategy ensures timely and effective care, improving child health outcomes.

The report also indicates that 1,533 members of 51 Mother-to-Mother Support Groups (MMSGs) received guidance on breastfeeding and complementary feeding practices, participated in cooking demonstrations, and established kitchen gardens. Some group members have even initiated small businesses.

Maggie Korde, Save the Children International Country Director for Rwanda and Burundi said: "The humanitarian crisis in Mahama Refugee Camp has resulted in a precarious existence for families, with many struggling to meet basic needs for food, clothing, and hygiene. Children, the most vulnerable members of this community, are disproportionately affected.

"Save the Children is responding to this urgent situation by providing critical life-saving nutrition interventions. Our programmes include blanket supplementary feeding for over 1,000 children aged 6-23 months, support for approximately 1,800 pregnant and lactating women through the Blanket Supplementary Feeding Program, and treatment for over 50 cases of Moderate Acute Malnutrition (MAM) and 10 cases of Severe Acute Malnutrition (SAM) per month.

"Despite our efforts, the declining humanitarian aid poses a significant challenge. To effectively address the needs of these vulnerable children, we urgently require increased funding to implement comprehensive and sustainable health and nutrition programmes.”

In promoting breastfeeding, Save the Children ensures that its staff and volunteers receive maternity leave and extended paternity leave. The organisation also actively engages community structures in supporting health and nutrition activities for sustainable outcomes.