“In Pakistan and Palestine, un-dernutrition and micronutrient defi-ciencies are very prevalent, whereas Afghanistan, Djibouti, Iraq, Soma-lia, Sudan, and Yemen suffer fromrampant and severe child and mater-nal nutritional deficiencies” (Habib, Zein and Ghanawi, 2010).

What happens when immigrants and refugees from these locations come to the United States or another more developed nation? Popkin (2006) gives characteristics of the five patterns of the nutrition transition,included in Table 1. I explore his delineation of this transition and how it relates torefugees and immigrants. I conclude that his representation of this nutrition transition is severely inadequate for these vulnerable populations. The question is why? As given from the table, one can think that in the case of immigrants, is there really any pattern of receding famine? Consider the nutritional and diet-related issues found among immigrants and refugees to New Zealand (MOH, 2001):

  • Failure to thrive in children as a result of “nutritional factors could include insufficient breast milk or formula, inadequate introduction of solid foods, food allergies, and intolerance
  • Inadequate water intake
  • Lack of education about potentially harmful effects of food for which they are not accustomed to
  • Lack of local knowledge about shopping and food preparation among new refugees, especially young people and single men
  • Nutritionally inadequate diet, related to unfamiliar foods (remember, life-long and/or unstable famine to feast virtually overnight) which may or may not include important micronutrients including (see Khan and Bhutta (2010) for a listing ofother deficiencies specific to maternal andchild health):
    • iron (along with folic acid and vitamin B12) to produce red blood cells (a lack of which can lead to anemia, pica, etc.),
    • vitamin A (a lack of which can lead to immunocompromised systems and blindness, effects which are pervasive in Iraq and Afghanistan, as shown in Figure 2 from the World Health Organization),
    • vitamin D (reduced levels which are responsible for reduced immune function, leading to increased risk of cancer, heart disease, and increasing the probability of a previous infection becoming problematic (e.g.,tuberculosis)),
    • And iodine (which at prolonged periods of inadequate levels are responsible for development of goiter and possible mental retardation (Lazarus and Smyth, 2008)).

Post-migration is a very vulnerable period for refugees. Rondinelli et. al. (2010) showed how unhealthy weight gain is often prevalent among thee populations. Furthermore, food insecurity has been found to be prevalent among refugee populations in Australia (Gallegos, Ellie, and Wright 2008). If we consider that the above vitamins and minerals are potentially effective at containing spread  of infectious disease (i.e. vitamin D and tuberculosis (Nnoaham and Clarke, 2008)), there are multiple reasons why host countries such as the United States should sit up and take notice that immigrant health is vital to maintaining our own health. Therefore, all Americans should be concerned about global health.

Table 1



Gallegos, D., P. Ellies, and J. Wright. 2008.Still there’s no food! Food insecurity in a refugee population in Perth, Australia. Nutrition and Dietics 65(1):78-83.

Habib, R., K. Zein, and J. Ghanawi. 2010. Climate Change and Health Research in the Eastern Mediterranean Region.Eco-Health :1–20.

Khan, Y., and Z. Bhutta. 2010. Nutritional Deficiencies in the Developing World: Current Status and Opportunities for Intervention. Pediatric Clinics of North America 57(6):1409–1441.

Lazarus, J., and P. Smyth. 2008.Io-dine deficiency in the UK and Ireland.Lancet 372(888):61390–2.

MOH. 2001. Refugee health care: A handbookfor health professionals. 133 Molesworth Street, Thorndon, Wellington 6011: New Zealand Ministry of Health. Technical report.

Nnoaham, K., and A. Clarke. 2008.Lowserum vitamin D levels and tubercu-losis: a systematic review and meta-analysis. International journal of epidemi-ology 37(1):113.

Popkin, B. 2006. Global nutrition dynam-ics: the world is shifting rapidly towarda diet linked with noncommunicable dis-eases. American Journal of Clinical Nu-trition 84(2):289.

Rondinelli, A., M. Morris, T. Rodwell,K. Moser, P. Paida, S. Popper, andK. Brouwer. 2010.Under-and Over-Nutrition Among Refugees in San Diego County, California. Journal of Immigrant and Minority Health :1–8.


Water scarcity, food security, and nutrition all play their role in refugee populations. They all interrelate with one another and fuel each other to remain as major issues within these communities. So, naturally, the development and environment of the communities that refugee populations inhabit are severely affected, as well.

Read on in our refugee crisis story to see how refugee struggles relate to the challenge of development. . .