Défis Humanitaires: Hello Claire Fehrenbach and thank you for this interview for Défis Humanitaires. You are currently working for the Nutriset Group. You have previously held many humanitarian responsibilities over a long period of time. You have just returned from the International Congress for Nutrition which was recently held in Tokyo from 6 to 11 December 2022. The world is experiencing a serious food crisis, amplified by the Covid. 19 pandemic, climate change and the war in Ukraine. What are the links and consequences between the food crisis and nutrition or malnutrition?

Claire Fehrenbach: Hello Alain Boinet, thank you for this discussion on nutrition. Indeed, the International Congress for Nutrition was held in Tokyo where several subjects were discussed, including the current food crisis. The impact of the three C’s that were discussed a lot (crises, climate change and conflicts) have had a strong impact on the current situation of millions of people, especially from a food point of view. When we talk about nutrition security, we focus more specifically on being properly nourished. This is a further step beyond access to food, which is not enough. On the one hand, one must have the ability to procure food, and on the other hand, one must make the choice to procure, and consume, food that is of good nutritional value and in line with the person’s needs. While it is easy to provide additional means to people who need them to improve access to food (cash, vouchers/receipts, food distribution), it is more difficult to ensure what they consume, and the nutritional value of their food. This is more complex, more refined and will require multi-sectoral interventions to achieve the desired situation. This can be coaching, counselling, education, for example, to further explain and make people aware of this degree of finesse. It’s not just about eating, it’s about eating the right products, of good nutritional quality, in the right quantities, taking into account the person’s situation. Is it a child? A pregnant woman? This is a level of detail that goes quite a long way in understanding the effects of the food crisis.

Défis Humanitaires : Do we have a good understanding of the dynamics between the food crisis and malnutrition? Can we say that the food crisis is having an impact on nutrition – especially for young children and pregnant women?

Claire Fehrenbach: The malnutrition figures have exploded. In recent months, the Nutriset Group has worked extensively with the main humanitarian response actors responsible for the care of children, including UNICEF, the World Food Programme (WFP) and USAID. The number of children in care in 2022 has increased compared to last year and we are also looking at an increase in 2023. With regard to the production of Plumpy’Nut®, which is the nutritional solution that Nutriset produces to treat severe acute malnutrition, as well as solutions for moderate acute malnutrition, these three key players have spoken, with regard to the funding they have been able to receive, of an increase in demand of 60% in 2022 and another 60% in 2023. The food crisis is being addressed and the response is being organised. Substantial funds have been made available to meet the most urgent needs of children. Unfortunately, although budgets have increased, not all children in need will be covered. In general, less than half of the children in need are covered.

Défis Humanitaires: The World Food Programme (WFP) explains that food prices have risen, as have transport costs, and that a large part of the increase in budgets will be absorbed by price increases.

Claire Fehrenbach: Everything has increased. We see it here, but also everywhere in the world. Indeed, the most vulnerable people who have the fewest resources and the lowest resilience to shocks are bearing the brunt of this global price increase, whether it’s because of the rise in the price of raw materials but also of everything that makes it possible to produce these raw materials (fertilisers, energy, etc.). Everything has gone up, including the price of the nutritional solutions we produce.

Défis Humanitaires: You have just returned from the International Congress for Nutrition held in Tokyo where you represented the Nutriset Group. What were the reasons for your presence? And what did you retain from this congress?

Claire Fehrenbach: This is a reference congress that really deals with international issues in nutrition. This type of congress also exists at French and European level, but these generally cover more local issues. The Nutriset Group’s main focus is on malnutrition issues in the South. For this reason, we took part in this international congress in order to inform ourselves and discuss the issues that mobilise us. The congress lasts a week, there are many rooms where multiple sessions take place simultaneously. We can’t take part in the whole programme, but this wealth of interventions allows us to understand the different subjects tackled, to better understand certain mechanisms, to exchange with researchers from the North and the South, and also to maintain the network that was somewhat damaged by Covid. It also allows us to meet the personalities who play an impactful role in nutrition issues. For example, the heads of nutrition at the World Bank, the FAO, the coordinator of SCALE UP Nutrition, the Movement were also present in Tokyo. These are key people and institutions when it comes to nutrition.

What I learned from this congress is that nutrition is everywhere. It is a component of food systems that is inseparable from current thinking on their essential transformation. We talk about nutrition when we talk about the prevention and treatment of many diseases; we realise that non-communicable diseases are very often linked to the transformation of eating habits and to the depletion of quality nutritional inputs to the detriment of foods that are not adapted to needs. It is also an inseparable component of several Sustainable Development Goals (SDGs), such as SDG 2, which aims to eliminate malnutrition, and SDG 1, which deals with protection issues, and SDG 3, which deals with health issues. Nutrition is both a chemical issue and a very broad subject, with geographical, economic and sociological entry points… Nutrition is found at many levels.

Défis Humanitaires : Nutrition can be both curative and preventive. How can these two phases be best coordinated in humanitarian crises and in development actions? How can we coordinate these two levers of nutrition?

Claire Fehrenbach: From the moment a human being is conceived, good nutrition will allow the development of good cognition, good physical development such as height, weight, vision, etc. It will also allow the development of a robust immune system. Nutrition will have an impact on the overall performance of the individual in terms of learning ability, ability to work, and therefore a better ability to take care of oneself and one’s family. Throughout life, nutrition should be at the heart of development actions to prevent and limit risks as much as possible.

In fact, if we list the populations whose nutritional needs are the most important, pregnant and breastfeeding women come first, for the proper development of their child. This refers to the famous first 1,000 days from conception to around two years of age, when the child’s growth will be most intense. Children up to the age of five also have very high nutritional needs. Adolescents, then, because this is an important growth phase, especially for young girls who are still growing, especially if they are pregnant, because their nutritional needs are multiplied. Also, sick people are often the most at risk of undernutrition, and the elderly are often forgotten, even if now, in the countries of the North, we are beginning to take their (de)nutrition more and more into account.

In terms of development actions, the issue of nutrition can be addressed in specific or related programmes. I am thinking of education, for example, in WASH (water, hygiene and sanitation) projects, but also in the awareness-raising campaigns that are developed alongside these programmes or within health actions. What information is provided on nutrition and the importance of nutrition in the development of individuals?

On another note, the specificity of periods can also be taken into account. In particular, lean periods, which can be predicted fairly easily thanks to knowledge of the terrain; population displacements, when it is known that people will have difficulty obtaining sufficient quality food; or climatic disasters (cyclones, floods, etc.). Some actions can be implemented as part of risk reduction programmes.

Then, emergency NGOs mobilise if what has been put in place has failed or proved insufficient. If, in spite of everything, children find themselves in a situation of acute malnutrition, this implies that the actions developed beforehand in relation to agricultural development, market development, health systems, public policies, etc., have not achieved the expected results. In this case, emergency actions are then put in place to respond to the needs. For severe acute malnutrition, there are treatments and protocols. However, the response remains limited to a defined population and most often to a specific geographical area because it is an emergency response. In all cases, the first priority is to prevent risks and limit them as much as possible upstream.

Défis Humanitaires: We recently presented a book on the war and famine in Biafra in 1968, where the idea was born that led to the creation of Médecins Sans Frontières and then Médecins du Monde with Bernard Kouchner, Max Récamier, Pierre Fyot, Patrick Aeberhard, Louis Schittly and others. The description of skeletal children dying in large numbers is terrifying.

Claire Fehrenbach: At the time of Biafra, treatment for extremely malnourished children was not as effective as it is today. It was only in the 2000s, and therefore quite recently, that we were able to use Plumpy’Nut® on a large scale to meet the needs.

Previously, therapeutic milks were used to treat children. However, few children arrived in hospitals with the possibility of staying there for a long period of time, recovery took a long time before they could regain their full capacities, and the chances of success were limited because therapeutic milks could only be given in hospitals, with good quality water, drinking water. As a result, treatment was limited and on a very small scale.

Défis Humanitaires : Today, more than 828 million people in the world are hungry. At the same time, there are more than a billion people who are obese and this figure is rising. This seems paradoxical and calls into question situations that are the opposite of each other. What response can nutrition provide to reduce these two public health scourges?

Claire Fehrenbach: These are subjects that were widely discussed at the time of the congress in Tokyo. On the one hand, we are in the middle of a food crisis and there are almost as many children in a situation of severe acute malnutrition as there are obese children. Almost 5% of children under five are obese and 7% of children under five are severely malnourished. These are staggering figures.

The first entry point to actually think about this issue is that of failing food systems. On the one hand, we realise that people are starving or falling ill because of what they eat, what they consume, the way they eat (undernutrition, obesity, non-communicable diseases). On the other hand, small-scale farmers are among the poorest. Also in this failing food system, current agriculture, and especially industrial agriculture, has a huge impact on biodiversity, mainly on the loss of this biodiversity through the size of the crops, the nature of what is grown, the production methods. In the same vein, current agriculture has a high carbon footprint. Finally, this is without mentioning the tons of food lost or wasted each year at all stages of production and consumption. In concrete terms, the food system covers what goes from “fork to mouth”, or even “seed to bin”, and this system is dysfunctional. To work on this issue, a major summit was held in October 2021 on the proposed transformations to remedy these imbalances. This question of the dysfunction of the food system is not new, and many NGOs, researchers and institutions have been working on this issue for a long time.

Malnutrition refers to poor nutrition, to intakes that are unbalanced in relation to the body’s needs, either too much or too little, or in terms of quality. Malnutrition refers to both undernutrition and overnutrition. By changing eating habits, by consuming products of better nutritional quality, in line with needs, more local, the figures for malnutrition could gradually fall if a multitude of other programmes were developed in parallel in terms of health, access to water and education. And if, of course, the impact of the 3Cs remains manageable.

A second way to reduce these scourges is to emphasise the nutrition component in the various development sectors. For example, the integration of nutrition into health services, notably through universal health coverage. Nutrition is a key component of universal health coverage. However, one can ask whether nutrition is now properly aligned with the different pillars of health, which are: governance, staff and staff training on nutrition issues, services offered, access to quality products, financing and information systems. To address these issues of imbalance, both of people dying of hunger and the increasing number of overweight and obese people, the issue of integrating nutrition into health is paramount. I think we also need to link it to non-communicable diseases (diabetes, cardiovascular diseases) which are also linked to diet and on which lifelong nutrition can have a real impact. In the same vein, the nutrition component can also be better integrated into social protection schemes.

Défis Humanitaires: Can you remind us what the Nutriset group does in the field of nutrition?

Claire Fehrenbach: The Nutriset Group produces, designs and develops nutritional solutions to combat malnutrition at all ages. The main focus is on malnutrition in children, with the aim of treatment or prevention. I will only mention a few of the products developed by our Research and Development team, which works closely with NGOs, universities and institutions to develop and test products so that they can finally reach the maximum number of people.

Our flagship product is Plumpy’Nut®, which gave rise to RUTFs (ready-to-use therapeutic foods). At the moment, our factory in France operates 7 days a week to produce these nutritional solutions so that they can be distributed to as many people as possible, as quickly as possible.

We have also developed a whole series of products adapted to the different stages of life. For the first 1000 days, a nutritional supplement can be offered to pregnant and breastfeeding women, and then to children to support their physical and cognitive development beyond exclusive breastfeeding up to 6 months. These foods and supplements are presented in paste form. We also offer a reconstituted powder for oral or enteral nutrition for hospitalised adults, which was developed in close collaboration with MSF. Finally, we are concerned about the malnutrition of the elderly in France and have therefore designed a new high-calorie, high-protein solution that meets the specific needs of this age group.

The nutrition of vulnerable people throughout their lives and the fight against nutrition are the driving forces behind the Nutriset Group, a family business run by Adeline Lescanne, the founder’s daughter.

Regarding the model, Nutriset has developed a network of partners (PlumpyField® Network) which brings together 10 independent players based mainly in the countries of the South, where the needs are greatest. Our partners are based in Haiti, northern Nigeria, Sudan, Ethiopia, etc. These collaborators, which are NGOs, SSE companies and SMEs, produce solutions that meet the quality standards of our main clients (UNICEF, World Food Programme). This is a franchise system in which the Nutriset Group provides long-term technical assistance for its local partners. The production sites, and these products, are certified and available on the ground. It is a very specific model that allows production in often difficult conditions: developing a quality industry in northern Nigeria or Sudan, in Ethiopia or Haiti, remains a major challenge.

Défis Humanitaires: The Nutriset group has not chosen the easy way out but rather an urgent response, adapted to the contexts in which humanitarian and development actors operate. Within humanitarian action, we know the importance of the fight against malnutrition and access to drinking water. How does the Nutriset group approach this issue?

Claire Fehrenbach: Indeed, malnutrition requires a global response. It is not a waterborne disease per se, but unsafe water and poor hygiene conditions will aggravate or lead to malnutrition. Indeed, even if treatment for malnutrition is made available to children, if they are in an environment without safe water and sanitation, the treatment will be compromised.

Therefore, the issue of access to safe water is important, as are other programmes/services that I have already mentioned, such as education, health and social protection. It is for these reasons that nutrition issues are relatively complex because they need to be supported simultaneously by a whole range of pillars.

Défis Humanitaires: Hunger is part of the Sustainable Development Goals, the so-called SDGs. These goals (2015-2030) aim to eliminate hunger in the world by 2030. Where are we today, halfway to this deadline?

Claire Fehrenbach: There has been a lot of progress and good results in the past decade. However, with what is happening now (acceleration of climate change and its impacts at all levels, increasing conflicts – especially international conflicts such as the war in Ukraine, Covid), the good results in the fight against hunger tend to be reversed. With regard to hunger in the world in the broadest sense, we observe declines every year. Every year in July, the SOFI – the annual State of Food Security and Nutrition report – is published and reports on the number of people who are food insecure to a greater or lesser extent. Although progress is being made, improvements are not fast enough to meet the 2030 targets. The data points to deterioration rather than real improvement.

It is time to take a comprehensive, systemic approach. I am referring in particular to MDG 1, which deals with social protection, which can include nutrition, or MDG 3, which deals with health, particularly universal health coverage. Nutrition must be taken into account in a broader way, in the different approaches.

These are all areas that we need to be able to bring together and within which nutrition should be integrated. We work too much in silos and it doesn’t work well. However, it is always more complicated to align and be able to take these different axes simultaneously. Alone we go faster, together we go further…

Défis Humanitaires: What is the international research agenda on nutrition? And what are the next international deadlines and what could be the place of humanitarian and development actors working in this field?

Claire Fehrenbach: We are currently in the United Nations Decade of Action on Nutrition (2016 – 2025) and there are still a few years left to promote nutrition internationally. In 2021, Japan played a leading role with the organisation of the Nutrition for Growth Summit held in December 2022 where a large number of researchers involved in the field of nutrition gathered in Tokyo for this international congress. The idea is really to position nutrition as an essential lever for sustainable development in order to achieve the following objective: to secure new policies or financial commitments to act against malnutrition. All types of malnutrition!

France has been very active in the area of school feeding, particularly in the framework of the School Feeding Coalition, whose first meeting will be held in 2023. This is the first time that the issue of nutrition will be addressed.

Also in October 2023, but this time in the Netherlands, the Micronutrient Forum will be held. Micronutrients also have a big impact on the development of children. Then, in 2024 and 2025, again in France, the next edition of Nutrition for Growth will be held, which is a “pledging” conference during which the various actors, often categorised as States, private sectors, civil society and donors, will make commitments and secure funds with a specific nutrition objective. This next Nutrition for Growth will take place in 2024 in France, on the sidelines of the Olympic Games. We are waiting for the date chosen and the broad lines that will be given by France. In 2025, the next International Congress on Nutrition, like the one that has just taken place in Japan, will be held in France at the end of August. The congress is more related to research, whereas Nutrition for Growth is more focused on political and funding issues.

These are important moments to put nutrition in the spotlight, to communicate on this indispensable component of sustainable development, which must be specified. Often, local recommendations indicate that it is necessary to “include nutrition in…” and this remains very vague. There is a real need for clarification, especially from an operational point of view and for directly allocated funds.

Défis Humanitaires: In this context, what do you think is the role of humanitarian and development actors?

Claire Fehrenbach: Some medical NGOs, such as Action contre la Faim or Médecins sans Frontières, have the capacity and expertise to treat acute malnutrition. They are key players in the field of nutrition. What seems important to me is that the issue of nutrition needs to be more widely publicised so that a greater number of NGOs, development and humanitarian actors take ownership of this issue and can gradually integrate it into their actions, with a broader objective of prevention. These actors are in contact with populations and cover a multitude of sectors. Education and awareness-raising were mentioned. Are messages related to good nutrition often proposed in the field? We work a lot on issues such as cash or the provision of vouchers for the population. We know that people can have access to more food, but do they decide to buy better food with higher nutritional quality? All this is possible, but there are still links missing to connect the whole thing. In my opinion, these conferences should also give nutrition visibility and make it more accessible so that the various humanitarian and development actors integrate it more into their programmes at all levels.

Défis Humanitaires: How would you like to conclude?

Claire Fehrenbach: Investing in nutrition is one of the best opportunities to develop human capital, health, skills and know-how. This is what will allow us to have healthy societies and, hopefully, healthy economies. Good nutrition, from the very beginning, will improve the physical and cognitive development of individuals, reduce health risks through a stronger immune system, and therefore enable people to be more productive, to have better incomes, to take better care of themselves and their families.

This is a fundamental aspect when we talk about development in the broadest sense. Especially now that good nutrition is becoming a challenge in more and more communities, especially when we see the figures for obesity and non-communicable diseases.

Finally, there is a phrase that is often used in the nutrition world: “more money for nutrition, and more nutrition for the money”. This fundamental component must be better taken into account and better financed. Nutrition is often “shuffled” between agriculture and health. In the ministries, its place is not always clearly established. Yet it is an essential component for development issues.

Interview transcribed and edited by Inès Legendre

Claire Fehrenbach.

Groupe nutriset

Claire Fehrenbach worked for the largest French and international NGOs for twenty years before joining a private company that develops its actions in close collaboration with the world of research, medical NGOs and United Nations agencies.

After studying Political Science, Claire Fehrenbach began her career in Villa Souchet, at the headquarters of Solidarités International.

Later, after a spell at the AFD, she moved on to researching institutional funding at the headquarters of Médecins du Monde where she discovered the world of donors.

But the first organisation with which she became involved in a larger number of programmes was Handicap International: on the margins of the Kosovo war in Albania (Atlas Logistique), in Gabon in support of refugees from Congo Brazzaville, then in Angola where she led the team on actions related to anti-personnel mines. In Canada, she promotes the association, develops partnerships with Quebec institutions and raises funds from the general public.

With Oxfam later, she took over the management of the French affiliate which focused on advocacy (climate change, inequalities, ODA) and then joined the international teams dedicated to institutional fundraising. She will work mainly with Niger and West Africa.

Between these two NGOs, she spent a year working for Total in Paris to discover the private sector and how to take into account the company’s societal issues.

Now in Normandy, she is in charge of the “Engagement, Impact & Communication” department of the Nutriset Group, the company that created PlumpyNut®, the famous red and white sachet that treats severe acute malnutrition in children under 5. The Group, based in France, relies on a network of independent partners based where the needs are greatest (Burkina Faso, northern Nigeria, Sudan, etc.) and collaborates with MSF, ACF, Alima….

This is another way of pursuing its commitment to the most vulnerable.