Food vouchers and diet diversity among refugees from Syria

The ongoing armed conflict in Syria has contributed to what many observers describe as the worst humanitarian crisis since the Second World War. The statistics related to those displaced from their homes are staggering and grow on a daily basis as families abandon their communities and livelihoods in search of safety.

More than 1.2 million refugees from Syria have sought safe haven in Lebanon. The recently arrived refugees face a myriad of challenges, including steep housing prices, limited employment opportunities and dwindling humanitarian assistance from international agencies such as the United Nations High Commissioner for Refugees (UNHCR), the World Food Programme (WFP) and, for Palestinians from Syria, the United Nations Relief and Works Agency (UNRWA). This article explores the impact of an MCC-funded food voucher project on household diet diversity among refugees from Syria.

As resources held by displaced Syrian families become scarce, many IDPs
face the difficult decision of deciding between spending their limited funds on food or on shelter. While households experiencing food insecurity typically employ a number of strategies to save money on food, a commonly-employed tactic used by refugee families is reducing the diversity of their diet by increasingly relying on low-cost, carbohydrate-heavy foods such as rice, oil and sugar. While cheaper and more filling in the short term, the long-term consequences of a poorly balanced diet can quickly result in poor health outcomes such as stunted growth, diabetes or cardiovascular issues. In the fall of 2013, MCC, with funding from MCC’s account at the Canadian Foodgrains Bank, launched a food voucher program to address the food insecurity faced by the newly arrived refugees. In particular, the voucher program sought to increase diet diversity and the nutritional value of food consumed by refugee families.

Cross-sectional surveys were conducted of refugee households at six month intervals to evaluate the food consumed by household members. The survey asked respondents to report which of 12 pre-defined food groups had been consumed by anyone in the household in the previous 24 hours to calculate a Household Diet Diversity Score (HDDS). The food groups included:
• Cereals—bread, pasta, rice, couscous, bourghul
• White tubers or roots
• Vegetables—dark leafy greens, spinach, cilantro, onions, tomatoes, etc.
• Fruit—apples, oranges, bananas, strawberries, mangoes
• Meat—beef, chicken, lamb, liver
• Eggs
• Fish—canned fish (tuna), fresh fish, dried fish
• Legumes—beans, hummus, chickpeas, fuul, lentils, nuts
• Milk—full portion of milk, cheese, lebneh, yogurt, processed cheese
• Oil, fat, or butter
• Sweets and sugar
• Coffee, tea and spices

The surveys found that the food vouchers contributed to refugee households consuming a more diverse diet. Surveys from July 2013, administered before households began receiving food vouchers, indicated that the average HDDS was seven. In June 2014, after families had received food vouchers for nearly 11 months, the average HDDS had risen to 7.7, a significant increase, indicating that refugee households were eating a more diverse diet as a result of receiving the food vouchers. More tellingly, the median HDDS rose from seven in July 2013 to eight in February 2015, indicating that more than half of households receiving food vouchers consumed at least eight food groups in the 24 hours prior to being surveyed. The impact of the vouchers was greatest on the families who initially reported the worst dietary diversity. By February 2015, the minimum HDDS doubled from two to four, suggesting that the food voucher program allowed the most vulnerable families to access and consume a more diverse diet.

Households were also classified as having low dietary diversity (three or fewer food groups consumed), medium dietary diversity (four to five food groups consumed) or high dietary diversity (more than six food groups consumed). By February 2015, 86% of households were classified as having a highly diverse diet.

Families who received the vouchers reported in focus groups the impact that the vouchers had on the household diet. One mother reported that prior to receiving the voucher, “We usually ate one small meal of grains a day, if we ate at all. My daughter was malnourished because we couldn’t eat a diverse diet, and she became anemic.” After receiving the vouchers, however, the family was able to purchase enough food to eat three meals a day. The mother reported, “Our children are able to get the nutrition they need.”

This voucher program has aided some of the most vulnerable refugees who have few other options, allowing them to follow a healthier diet and freeing up their other limited income to use on other pressing expenses such as rent. Food vouchers can play a critical role in helping newly arrived families access the food necessary to maintain a healthy diet. Vouchers afford heads of households the dignity of choice when shopping and, just as importantly, empower them to protect the health and promote the well-being of family members through a diverse diet.

Rashid El Mansi is the program coordinator for Popular Aid for Relief and Development. Maggie Goble is a former MCC worker now in Kansas City, KS. Zenobia Taylor-Weiss works for MCC.

Learn more:

UNHCR Syria Regional Refugee Response. Inter-agency information sharing portal. Available at

Fisk, Robert. Pity the Nation: The Abduction of Lebanon. Oxford: Oxford University Press, 1990.

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