Food crises and their coping strategies in war-affected communities in Tigray, North Ethiopia: A community-based study

Food crises and their coping strategies in war-affected communities in Tigray, North Ethiopia: A community-based study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Food crises and their coping strategies in war-affected communities in Tigray, North Ethiopia: A community-based study Hadush Gebregziabher, Amaha Kahsay, Gebretsadkan Gebremedhin Gebretsadik, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3537911/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 21 Apr, 2025 Read the published version in BMC Nutrition → Version 1 posted 13 You are reading this latest preprint version Abstract Communities afflicted by armed conflict are characterized by pervasive malnutrition and widespread hunger. For nearly two years, there has been an unbroken conflict in Tigray. However, little is understood about the coping mechanisms people used in reaction to a lack of food and a siege. This study was conducted to evaluate the coping mechanisms used by urban residents of Mekelle City in Tigray Northern Ethiopia. A community-based cross-sectional survey was conducted among 315 randomly selected households in Mekelle city. Data were collected from May to June 2022 using a pre-tested structured questionnaire and entered, cleaned, coded, and analyzed using Stata version 14. We used descriptive statistics to describe the mean, frequency distribution, and percentages. The t-test was used to analyze the consumption-based coping strategy index. According to the current analysis, 272 (87%) of the remaining households had food shortages. Meal size reduction was a consumption-based coping technique used by 101 (32.6%) households. Similar to this, 85 (27.3%) of the studied homes reduced the quality of their meals or substituted less favored dishes. Likewise, roughly 72 (23.2%) of the households skipped meals as a coping mechanism. In conclusion, the study revealed that the communities affected by the war faced a tough struggle due to the food crisis. The study highlights the food crisis in war-affected communities, highlighting coping mechanisms like reducing meal quantity, quality, and eating less desirable foods. Thus, targeted food ration distributions and blanket supplemental feeding programs should be in place to reduce acute malnutrition and mortality, enabling recovery and recovery. Siege Conflict Meal Skipping Shortage Coping Figures Figure 1 Figure 2 1. Introduction Food shortages and other hardships are common in communities devastated by conflict and sieges, which understandably makes it difficult for residents to live [ 1 ]. Food security deteriorates during conflict for a variety of reasons, including decreased agricultural output, supply chain disruptions, and trade restrictions. These factors include food production, damaged infrastructure, and disturbed access to food and electricity [ 2 ]. Due to the fighting, most markets in Libya were closed, which made it more difficult for people from conflict-affected areas to get food [ 3 ]. During the civil conflict in Syria, 200 or so citizens were reported dead from famine that resulted from severe malnutrition [ 4 ]. Before the start of the war, Tigray had been relatively food secure due to the support of diversified and sustainable smallholder agriculture, commercial sesame production, mining, industries, and various productive safety net program components [ 6 ]. The Tigray people have, nevertheless, experienced numerous shocks as a result of the armed conflict that has affected their market, food, and fundamental infrastructural systems. Furthermore, factors that contribute to food insecurity and malnutrition have gotten worse over time and still exist today. These factors range from direct active conflict and associated displacement dynamics to regional restrictions on the movement of people and goods, which have a significant negative impact on standard livelihood patterns. [ 7 ]. According to the UN, approximately three million Tigrians urgently require aid. They could be deprived of access to food, water, and medical care. Famine, a nightmare with specific historical resonance and political resonance in Ethiopia [ 8 ], is a serious possibility if these problems are not remedied. A serious humanitarian crisis has resulted from the breakdown of the health system, which has been exacerbated by a total blockage of food aid and medical supplies, disruptions to banking and transportation systems, and communications blackouts [ 9 ]. Food costs increased locally due to the crisis, and price controls were challenging due to inadequate government capacity and control. In times of war and siege, numerous coping mechanisms were used by different nations to lessen food shortages. Food compromise, asset compromise, shifting job and income creation, relying on food aid, and migration, for instance, were some of the coping mechanisms adopted in Libya. In Syria, households have turned to eating fewer meals each day, cutting portion sizes at meals, restricting adult intake, eating less preferred foods, and borrowing food from friends or family as coping mechanisms [ 3 , 5 ]. As a result, wasting and stunting were prevalent in conflict situations, which hurt children's nutritional status [ 10 ]. According to reports, severe acute malnutrition affected 6.1% of children and global acute malnutrition affected 27.6% of children during the armed conflict period, respectively, up from 1–6% and 10–22.6% before the conflict [ 7 ]. This was also in line with UNICEF's technical report, which showed that during the war in Tigray, the rate of acute malnutrition among children under the age of five ranged from 23.8–34.3%, corresponding to phase five of the Integrated Food Security Phase Classification (IPC), or "famine" [ 11 ]. The choice of foods eaten and the size of meals consumed are restricted among households in conflict-affected areas because they usually rely on less desirable goods. [ 12 ]. The full impact of the siege brought on by the Tigray conflict on the community's nutritional coping mechanisms is still frequently underdiagnosed and undertreated, despite the considerable financial and health expenses as well as the effects of hunger such as starvation and fatalities. In Tigray, evidence about the community’s dietary coping strategy is, however, lacking. Thus, we have conducted a community-based survey to assess the dietary coping strategies during war and siege in the urban communities of Mekelle, Tigray, North Ethiopia. 2. Methods and materials 2.1. Description of the study area This study was conducted in Mekelle City, the capital city of Tigray, at a latitude of 12°16' to 14° 49' N and a longitude of 36° 27' to 40° 00‘ E. It has a total area of 41,409.95 km2 and is found at an altitude of 500–4000 meters above sea level. Administratively, Mekelle has seven sub-cities with a total population of 555,769 and 126,323 households. The major livelihood sources of the residents of the city include trade, manufacturing, and employment in governmental and non-governmental organizations [13]. The study was conducted from May 20 to June 5, 2022. 2.2. Study design and participants A community-based cross-sectional study was conducted on Mekelle city residents. The source population, sample population, and sample unit were: all households in seven sub-cities, selected households, and single households, respectively. 2.3. Sample size determination and sampling procedure A total of 315 households were included in this study. The sample size was computed using a single population proportion formula, considering the 87% proportion of household food shortage coping strategies used by Eastern Tigray residents [ 9 ], 95% confidence level, and 5% margin of error. Considering the 10% nonresponse rate, the final sample size was 315. Mekelle City was purposefully selected due to accessibility. The researchers understood that the impact of the war and siege was not limited to Mekelle, but accessibility to other areas was quite difficult due to logistic issues following the siege. Samples were collected from the seven sub-cities of Mekelle residents; all sub-city households were considered for sample selection, and the final sample size was allocated proportionally based on the number of total households per sub-city. Finally, the proportionally allocated sample was selected using a simple random sampling technique. Figure 1 . Schematic presentation of sampling procedure households in Mekelle city, Tigrai , Ethiopia 2022. 2.4. Data collection procedure A structured interviewer-administered questionnaire was used. As much as possible, attempts were made to make questions suitable for the local setting. It was first prepared in the English language and later translated into the Tigrigna language. Back translation to English was done to compare the consistency, and amendments were made accordingly. Five degree-holder data collectors and two supervisors were recruited for the data collection process. Both the data collectors and supervisors were trained for two days on the objectives of the study, study instruments, and data collection procedure. The questionnaire was pre-tested on a 5% sample in a similar population to the selected households in the sub-cities. The questionnaire is designed to include data on household socio-demography, food situation, and livelihood sources prewar and during the siege. It also included a consumption-based household coping strategy to sustain lives during the full-scale siege in the study area. 2.5. Data analysis and presentation Data were entered, edited, cleaned, and analyzed using a statistical software package, Stata version 14. Data were analyzed using descriptive statistics, t-tests, and the coping strategy index. In the descriptive statistics, mean, standard deviation, percentage, and graphic analysis were used to summarize the profiles and responses of the surveyed households. We used a reduced coping strategy index to summarize food rationing and coping strategies adopted to sustain life during the full-scale siege of Tigray. A t-test was applied to compare the mean difference of the coping strategies adopted by the urban residents in response to the severe food crisis faced during the complete siege. Coping strategy index (CSI) : In times of man-made and natural shock, households have adopted different mechanisms to cope with challenges and sustain life. In line with this, we used CSI as a proxy variable to measure the extent of the food shortage among households in Mekelle during the siege. Technically, CSI combines two important elements: the frequency of each strategy (how many times each strategy was adopted in a specified time) and its severity (how serious each strategy is) in the eyes of households reporting food consumption problems. Technically, a higher CSI indicates a worse food shortage situation, and vice versa. The CSI score for each observation was computed based on the self-reported answer to the question that asked what coping strategies and how often a household adopts when the household does not have enough food to buy food during the siege. Finally, the CSI score is computed using [ 14 ] given in Eq. ( 1 ). 3. Results 3.1. Socio-demographic characteristics of the respondents Out of 315 household head respondents, 310 completed the interview with a response rate of 98.40%. The mean (SD) age of the household head was about 36.6 (9.81) years, and the average (SD) family size was 4 (1.82). About 65% of the households were male-headed, and 69% and 28% of the respondents were married and university graduates, respectively (Table 1 ). Table 1 Socioeconomic and demographic characteristics of the respondents, Tigray, Ethiopia, 2022 (n = 310). Variables Frequency (percent) Marital status of the household head Married 216 (69%) Single 71 (23%) Divorced 23 (8%) Gender of the household head Male 201 (65%) Female 109 (35%) Educational status of the household Not able to read & write 12 (4%) Primary school (1–8) 55 (18%) Secondary school (9–12) 51 (16%) Diploma 25 (8%) BSc/BA 87 (28%) MSc and above 80 (26%) 3.2. Livelihood sources of the surveyed households during the pre-war and full-scale siege periods The major livelihood sources of the respondents during the pre-war period were depicted accordingly: 45.8% of the respondents relied on government salaries, about 16.77% were employed in the private sector, 14.19% of them participated in retail trade, and 5.81% of the respondents engaged in construction work during the pre-war period. Moreover, 4.19% of the surveyed households depended on daily laborers, nearly 3.87% relied on metal and woodwork, and 3.87% were engaged in street vendors (Table 2 ). Table 2 Livelihood source of the surveyed respondents during the pre-war period Mekelle, Tigray, Ethiopia. Pre-war livelihood sources of respondents Frequency Percentage Government employees 142 45.80 Private sector employees 52 16.77 Retail trade 44 14.19 Construction works 18 5.81 Daily laborer 13 4.19 Metal and woodworks 12 3.87 Street vendors 12 3.87 Wholesale 7 2.26 Pension 6 1.94 Handicraft 4 1.29 Total 310 100 However, currently, most of the pre-war livelihood sources have collapsed due to the war and the siege imposed on Tigray. The majority (69%) of the surveyed households lost their sources of livelihood and were forced to depend on humanitarian food aid. 22% of the surveyed households engaged in trade activities like retail trade, wholesale, and street vendor or roadside trade. Besides, a proportion of pre-war government employees shifted their livelihoods to street vendors or roadside trade to cope with the economic shock they faced due to the siege. About 5% of the surveyed households relied on daily labor as a means of livelihood; however, it was not able to cover the household’s expenses. The other 4% of the respondents were hired in the private sector; nevertheless, they did not get a salary in cash following the collapse of the banking service in the region (Fig. 1 ). Figure 2 . Major livelihood source of the surveyed respondents during the full-scale siege Mekelle, Tigray, Ethiopia 2022 3.3. Food shortage and coping strategy This study revealed that out of the total 310 surviving households, 272 (87%) faced food shortages. About the consumption-based coping strategy adopted by the surveyed households, 101 (32.6%) reduced meal size. Similarly, 85 (27.3%) of the sampled households adopted reducing meal quality or relying on less preferred foods. Likewise, about 23.2% skipped the number of meals per day, and 22 (7.1%) reduced the meal size of adults so that children would have more. Moreover, 14 (4.5%) of the surveyed households adopted sending children to eat with relatives (Table 3 ). Table 3 Food rationing-related coping mechanisms adopted by households faced with critical cash shortage during the siege in Mekelle, Tigray, Ethiopia 2022 Coping Strategy Frequency Percentage Reducing meal size 101 32.6 Reducing meal quality or relying on less preferred foods 85 27.4 Skipping the number of meals per day 72 23.2 Reducing the meal size of adults so that children will have more 22 7.1 Skipping the whole day without food 16 5.2 Sending children to eat with relatives 14 4.5 3.4. Reduced Coping Strategy Index (rCSI) outcomes The mean reduced coping strategy index (rCSI) of the surveyed households who skipped meals is estimated to be 181.84 with a standard deviation of 112.5. While the mean rCSI of the surveyed households that did not adopt meal skipping as a response to the existing food shortage is 38.6. The technically higher value of rCSI indicates a severe level of food ስህ. Moreover, the mean rCSI difference between those who adopted meal skipping as a coping strategy and those who did not adopt is statistically significantly different at a 1% significance level. These signals of meal skipping as a coping strategy are practiced by the most severe food shortage households during the ongoing siege. Similarly, the mean rCSI value of households that adopted food content reduction is estimated to be 152.4. However, the mean rCSI value of the surveyed households that did not practice food content reduction to manage the food shortage faced during the siege was found to be 51.1. The mean comparison t-test for food content reduction is statistically significant at a 1% significance level between households that practice reducing food content and households that don't. This implies that households with severe food shortages practiced a reduction in food content to overcome the current food shortage in the study area (Table 4 ). Table 4 Mean comparison of coping strategy index between those who practiced meal skipping and those who did not in Mekelle, Tigray, Ethiopia 2022. Coping strategy Yes No t-value Mean SD Mean SD Meal skipping per day 181.84 112.52 38.62 52.20 12.86*** Reducing food content consumed 152.40 111.93 51.12 71.66 8.99*** 4. Discussion This community-based study determined the household coping mechanisms utilized during times of violence and food scarcity in Mekelle urban communities and discovered that 87% of households experienced artificial food shortages throughout the siege. This result is consistent with the study conducted by WFP [ 7 ] in the eastern zone of Tigray. The reason could be both the eastern zone of Tigray and Mekelle city are under complete siege and sociocultural similar. To overcome food shortage households employed several consumption-based coping strategies like reducing meal size reducing meal quality or relying on less preferred foods፣ skipping the number of meals per day reducing the meal size of adults so that children will have more and sending children to eat with relatives. These findings are consistent with the empirical findings of previous studies in Libya [ 3 ], and Syria [ 5 ] in which household food rationing-related coping strategies were used to overcome food shortages. Although the result of our study is consistent with the previous studies held in Libya and Syria in terms of adopting consumption-based coping strategies during conflict for food shortage, Libya and Syria allowed remittance from relatives, and friends living out of those countries and accessing humanitarian aid was easy but, in this study, the banking service, Telecom, internet access, transportation services within and out of Tigray, remittance from relatives, and friends living abroad and accessing humanitarian aids is not allowed by the federal government[ 9 ]. The complete blackout of these services made the food shortage more severe and tougher. The result of this study revealed that about 23.2% of sampled households skipped meals during the siege. The mean comparison of the reduced coping strategy index (rCSI) showed that households who skipped meals faced a severe or tougher level of food shortage than those who did not adopt meal skipping as a coping strategy during the study period the recommended daily dietary energy requirement considered adequate to meet the needs of most healthy people for adults is 2100kcal and + 350 and + 400 for pregnant and lactating mothers respectively [ 15 ]. However, when households skip a meal from their daily meal schedule they could not qualify for the daily minimum requirement of calories of the persons; which ends up in protein energy malnutrition risking high maternal morbidity and mortality. This was evidenced by the study finding [ 7 ] which confirmed that 61% of pregnant and lactating mothers in war-affected Tigray were severely malnourished. The mean rCSI value showed that households adopting reducing meal quality or relying on less preferred foods, faced more severe food shortages than those who did not practice in the study area. reducing meal quality or relying on less preferred foods as a coping strategy for food shortage during feeding affects women of reproductive age (15–49) because, the recommended daily allowance of protein, carbohydrate, and fat for reproductive age is 46g (0.75 g/kg/day), 130g, and 20–35 percent total energy respectively [ 16 ]. The reduction of foods containing protein, carbohydrates, and fat negatively affects the dietary intakes of these women, as dietary diversity recommendations for pregnant women emphasize the need for women to eat diverse foods with adequate energy [ 15 ]. Moreover, a reduction below the recommended daily allowance in food content like fatty food during pregnancy for instance will cause a nutritional deficiency in the fetus. Because the fetus has a limited ability to make long-chain polyunsaturated fatty acid it is dependent on placental supply. A poor supply will affect neonatal growth and development. Placental supply comes from the pregnant women's dietary intake of food containing the source of fat besides, the reduction of food containing carbohydrate and protein for women of reproductive age lead the mother to burn fat and then its tissue proteins which further could lead to energy deficiency [ 17 ]. Comparatively, before the outbreak of war in November 2020, Tigray had mostly achieved food security. However, since the breakout of the war, each of the pillars of livelihood and food entitlement in Tigray has been destroyed or damaged by the war and the deliberate actions of the belligerents. In addition to the Crisis and Emergency conditions prevailing today, these actions also sharply raise the risk of famine in Tigray which would entail an exponential rise in the rate of death [ 18 ]. Likewise, the United Nations International Commission of Human Rights Experts on Ethiopia found reasonable grounds to believe that the Federal Government have implemented a wide range of measures designed to systematically deprive the population of Tigray of material and services indispensable for its survival, including healthcare, shelter, water, sanitation, education, and food. In consequence, most of the population in Tigray must now survive on limited and nutritionally inadequate diets. Malnutrition rates, especially among children, pregnant and lactating mothers, and older people have reached alarming levels, leading to preventable deaths. By August 2022, UNOCHA estimated that 5.3 million people in Tigray, around 90% of the population, were in dire need of humanitarian assistance [ 19 ]. Hence, it should be the center of attention to the international community that as mentioned by [ 18 ], whatever political differences may have sparked the armed conflict in Tigray, it is abhorrent for starvation to be used as a weapon of war at the expense of the civilian population. This is because withholding adequate food from civilians as a method of warfare is prohibited under the Geneva Conventions. International humanitarian law also obliges to ensure adequate food for the population including importing supplies if those in the occupied territory are inadequate [ 20 ]. 5. Conclusions During the entire siege in Mekelle City, more than 80% of the households in the survey experienced food shortages, and households adopted consumption-based coping mechanisms to get through these man-made shocks. There is a severe level of food deficit among households that skipped meals, altered the quality of their meals, or used less desired foods as a coping mechanism. Urgent humanitarian aid, particularly the Blanket Supplementary Feeding Program, is recommended to prevent acute malnutrition among vulnerable populations. Targeted general food ration distributions are also recommended to reduce mortality rates and ensure recovery from post-conflict emergencies. Operational Definition Food shortage: Scarce of food in daily meals/diet. Reducing meal quality or relying on less preferred foods: consuming food items that are not diversified and no animal source of food. Reduced meal size: consumption of small portion size in a daily meal/diet of food on breakfast, lunch, or dinner. Meal skipping: missing meals the whole day, breakfast, lunch, or dinner in a daily meal/diet. Complete Siege: A siege with no banking service, network access, restriction of humanitarian aid, and transport facility to move in and out of the Tigray region. Declarations Acknowledgments The authors thank Mekelle University for supporting stationary materials and providing internet access. Authors’ contributions HG carried out the conception. TN, MY, AM, AK, GG, TB and AG designed the study and performed the literature search, selection, analysis, writing, and review of the manuscript. Finally, all authors read and approved the final manuscript. Funding There was no funding for this study. Availability of data and materials all data regarding this study are contained and Presented in this study. Ethics approval and consent to participate Ethical approval was obtained from the institutional review board (IRB) of the College of Health Sciences of Mekelle University, and permission was given by ACSH to proceed with the study. Informed written consent was obtained from the study participants, and confidentiality was maintained throughout the study. The verbal consent was approved by the ethical committee. The participants were well-informed and guaranteed that they had the right to participate, refuse, or stop at any time during the data collection process. The procedures of this study constituted a minimal risk to participants, and this was explained to them before the beginning of data collection. Moreover, all methods were performed following the relevant guidelines and regulations. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Author Details HG: MPH in Public Health Nutrition; AM: (Ph.D.) in Public Health Nutrition AK: MPH in Public Health Nutrition, GG: MPH in Public Health Nutrition, TB: MPH in Public Health Nutrition, TN: Master in Developmental Economics. MY: Master in Biotechnology, and AG: (Ph.D.) in Public Health. References Barakat S, Milton S, Elkahlout G. Reconstruction under siege: the Gaza Strip since 2007. Disasters. 2020 Jul;44(3):477-98. Egal F. Nutrition in conflict situations. Br J Nutr 2006, 96:S17–19 Swesi R, El-Anis I, Islam MM. Food insecurity coping strategies in conflict-affected Libya. Development in Practice. 2020 Apr 2;30(3):394-408. Buhari JA. STARVATION AS A METHOD OF WARFARE IN" YARMOUK CAMP" SIEGE IN SYRIA: A PERSPECTIVE OF INTERNATIONAL HUMANITARIAN LAW (Doctoral dissertation, President University). Enough (2014). Life under Siege: South Kordofan Needs Assessment. An Enough Forum publication. 2014. Clark, H(2021). Starving Tigray: How Armed Conflict and Mass Atrocities Have Destroyed an Ethiopia Region’s Economy and Food System and Are Threatening Famine: World Peace Foundation. 2021 World Food Programme (WFP). Tigray emergency food security assessment. Tigray region, Ethiopia. January 2022. Michelle Gavin, The Conflict in Ethiopia’s Tigray Region, Council on Foreign Relations, 2022 07:51 UTC https://www.jstor.org/stable/resrep31163. Berhe E, Ross W, Teka H, Abraha HE, Wall L (2022) Dialysis service in the embattled Tigray region of Ethiopia: a call to action. Int J Nephrol. https://doi.org/10.1155/2022/8141548. Kinyoki DK , et al . Conflict in Somalia: impact on child undernutrition. BMJ Glob Health 2017; 2 :e000262. doi:10.1136/bmjgh-2016-000262 http://gh.bmj.com/ Mulugeta A, Gebregziabher M. Saving children from man-made acute malnutrition in Tigray, Ethiopia: a call to action. The Lancet Global Health. 2022 Apr 1;10(4):e469-70. Lin TK, Kafri R, Hammoudeh W, Mitwalli S, Jamaluddine Z, Ghattas H, Giacaman R, Leone T. Pathways to food insecurity in the context of conflict: the case of the occupied Palestinian territory. Conflict and Health. 2022 Dec; 16(1):1-9. Central Statistical Agency (CSA) [Ethiopia] and ICF. Ethiopia demographic and health survey 2016: key indicators report. Addis Ababa, Ethiopia, and Rockville, Maryland, USA: CSA and ICF; 2016. Maxwell, D. and R. Caldwell. 2008. “The Coping Strategies Index”: A Tool for Rapid Measurement of Household Food Security and the Impact of Food Aid Programs in Humanitarian Emergencies. Food and Agriculture Organization of the United Nations (FAO), the right to adequate food in emergency programs, 2014, available online at http://hrbaportal.org/wp-content/files/ai4184e.pdf (visited 7 November 2019). Ministry of Health New Zealand 2008. Food and Nutrition Guidelines for Healthy Pregnant and Breastfeeding Women: A background paper. Wellington: Ministry of Health. Tela FG, Gebremariam LW, Beyene SA. Food taboos and related misperceptions during pregnancy in Mekelle city, Tigray, Northern Ethiopia. PloS one. 2020 Oct 13;15(10):e0239451. World Peace Foundation. Starving Tigray; How Armed Conflict and Mass Atrocities Have Destroyed an Ethiopian Region’s Economy and Food System and Are Threatening Famine. 2021. The Commission, 2022. Advance Unedited Version; Report of the International Commission of Human Rights Experts on Ethiopia; Distr. General 19 September 2022, A/HRC/51/46 Sphere Association. The Sphere Handbook: Humanitarian Charter and Minimum Standards in Humanitarian Response, fourth edition, Geneva, Switzerland, 2018. www.spherestandards.org/handbook Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 21 Apr, 2025 Read the published version in BMC Nutrition → Version 1 posted Editorial decision: Revision requested 06 Dec, 2024 Reviews received at journal 27 Nov, 2024 Reviewers agreed at journal 09 Nov, 2024 Reviewers agreed at journal 07 Nov, 2024 Reviewers agreed at journal 04 Nov, 2024 Reviewers agreed at journal 04 Nov, 2024 Reviews received at journal 27 Sep, 2024 Reviewers agreed at journal 26 Sep, 2024 Reviewers agreed at journal 19 Mar, 2024 Reviewers invited by journal 15 Nov, 2023 Editor assigned by journal 06 Nov, 2023 Submission checks completed at journal 01 Nov, 2023 First submitted to journal 01 Nov, 2023 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3537911","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":244973887,"identity":"16955613-91e7-4b5e-8fcc-06b7771b2a72","order_by":0,"name":"Hadush Gebregziabher","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0UlEQVRIiWNgGAWjYBACAxBibGBg4AfxEgpI0SLZANJiQIoWgwNQLkFgzn54m+TPHbXRxudXJ354YMAgzy92AL8Wy560MmneM8dzt914u1kC6DDDmbMTCDjsQI6ZNGPbMaCWsxtAWhIMbhPScv6NmeRPoJbNM85u/kGclhs5ZhK8bTW5G/h7txFpy41nxda8bQdyZ9zg3WaRYCBBhF/OJ2+8+bOtLre//+zmmz8qbOT5pQlogYLDDAwSYJUSRCkHgTpgijlAtOpRMApGwSgYYQAA1wRLM2sJbQkAAAAASUVORK5CYII=","orcid":"","institution":"Mekelle University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Hadush","middleName":"","lastName":"Gebregziabher","suffix":""},{"id":244973888,"identity":"236d492f-4b1f-4ccd-8131-73aa1c497ba8","order_by":1,"name":"Amaha Kahsay","email":"","orcid":"","institution":"Mekelle University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Amaha","middleName":"","lastName":"Kahsay","suffix":""},{"id":244973889,"identity":"193c0246-b3b8-4fa2-95b4-d6093ebe01de","order_by":2,"name":"Gebretsadkan Gebremedhin Gebretsadik","email":"","orcid":"","institution":"Mekelle University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Gebretsadkan","middleName":"Gebremedhin","lastName":"Gebretsadik","suffix":""},{"id":244973890,"identity":"82eb5fe8-54b1-43cf-b849-0f127936dc6b","order_by":3,"name":"Tedros Bereket","email":"","orcid":"","institution":"Mekelle University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Tedros","middleName":"","lastName":"Bereket","suffix":""},{"id":244973891,"identity":"a1ab14ae-0e97-40ed-a7d0-cf20ed5844a4","order_by":4,"name":"Teklay Negash Gebregziabher","email":"","orcid":"","institution":"Mekelle University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Teklay","middleName":"Negash","lastName":"Gebregziabher","suffix":""},{"id":244973892,"identity":"b83ae16d-a4c4-4332-abe9-a1c0221dcdf2","order_by":5,"name":"Micheale Yifter Weldemichael","email":"","orcid":"","institution":"Mekelle University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Micheale","middleName":"Yifter","lastName":"Weldemichael","suffix":""},{"id":244973893,"identity":"b99965fc-161b-4329-9882-ab60c98fcefa","order_by":6,"name":"Afework Mulugeta","email":"","orcid":"","institution":"Mekelle University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Afework","middleName":"","lastName":"Mulugeta","suffix":""},{"id":244973895,"identity":"05ce72c4-aa5b-48c5-bdb5-fec5f64f3b9e","order_by":7,"name":"Alem Gebremariam Aberha","email":"","orcid":"","institution":"Adigrat University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Alem","middleName":"Gebremariam","lastName":"Aberha","suffix":""}],"badges":[],"createdAt":"2023-11-01 19:29:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3537911/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3537911/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s40795-025-01068-4","type":"published","date":"2025-04-21T15:57:55+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":46009652,"identity":"8d3c7701-edb5-4b70-b438-817b66f160fe","added_by":"auto","created_at":"2023-11-07 13:53:58","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":39527,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSchematic presentation of sampling procedure households in Mekelle city, Tigrai,\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthiopia 2022.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-3537911/v1/2848e0f22858cca48b7130c2.png"},{"id":46009077,"identity":"035bec62-6132-4a00-b0f3-0fac1b04b392","added_by":"auto","created_at":"2023-11-07 13:45:58","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":9993,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eMajor livelihood source of the surveyed respondents during the full-scale siege Mekelle, Tigrai, Ethiopia 2022\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-3537911/v1/34f7f497d59f861a0981e929.png"},{"id":81570258,"identity":"35d48e26-7f86-4a0f-a4f2-4a2ce1e96a16","added_by":"auto","created_at":"2025-04-28 16:12:58","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1085658,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3537911/v1/cf114783-b743-4849-8897-22fc01b62aee.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Food crises and their coping strategies in war-affected communities in Tigray, North Ethiopia: A community-based study","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eFood shortages and other hardships are common in communities devastated by conflict and sieges, which understandably makes it difficult for residents to live [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Food security deteriorates during conflict for a variety of reasons, including decreased agricultural output, supply chain disruptions, and trade restrictions. These factors include food production, damaged infrastructure, and disturbed access to food and electricity [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Due to the fighting, most markets in Libya were closed, which made it more difficult for people from conflict-affected areas to get food [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. During the civil conflict in Syria, 200 or so citizens were reported dead from famine that resulted from severe malnutrition [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBefore the start of the war, Tigray had been relatively food secure due to the support of diversified and sustainable smallholder agriculture, commercial sesame production, mining, industries, and various productive safety net program components [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The Tigray people have, nevertheless, experienced numerous shocks as a result of the armed conflict that has affected their market, food, and fundamental infrastructural systems. Furthermore, factors that contribute to food insecurity and malnutrition have gotten worse over time and still exist today. These factors range from direct active conflict and associated displacement dynamics to regional restrictions on the movement of people and goods, which have a significant negative impact on standard livelihood patterns. [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. According to the UN, approximately three million Tigrians urgently require aid. They could be deprived of access to food, water, and medical care. Famine, a nightmare with specific historical resonance and political resonance in Ethiopia [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], is a serious possibility if these problems are not remedied. A serious humanitarian crisis has resulted from the breakdown of the health system, which has been exacerbated by a total blockage of food aid and medical supplies, disruptions to banking and transportation systems, and communications blackouts [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Food costs increased locally due to the crisis, and price controls were challenging due to inadequate government capacity and control.\u003c/p\u003e \u003cp\u003eIn times of war and siege, numerous coping mechanisms were used by different nations to lessen food shortages. Food compromise, asset compromise, shifting job and income creation, relying on food aid, and migration, for instance, were some of the coping mechanisms adopted in Libya. In Syria, households have turned to eating fewer meals each day, cutting portion sizes at meals, restricting adult intake, eating less preferred foods, and borrowing food from friends or family as coping mechanisms [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAs a result, wasting and stunting were prevalent in conflict situations, which hurt children's nutritional status [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. According to reports, severe acute malnutrition affected 6.1% of children and global acute malnutrition affected 27.6% of children during the armed conflict period, respectively, up from 1\u0026ndash;6% and 10\u0026ndash;22.6% before the conflict [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. This was also in line with UNICEF's technical report, which showed that during the war in Tigray, the rate of acute malnutrition among children under the age of five ranged from 23.8\u0026ndash;34.3%, corresponding to phase five of the Integrated Food Security Phase Classification (IPC), or \"famine\" [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe choice of foods eaten and the size of meals consumed are restricted among households in conflict-affected areas because they usually rely on less desirable goods. [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The full impact of the siege brought on by the Tigray conflict on the community's nutritional coping mechanisms is still frequently underdiagnosed and undertreated, despite the considerable financial and health expenses as well as the effects of hunger such as starvation and fatalities. In Tigray, evidence about the community\u0026rsquo;s dietary coping strategy is, however, lacking. Thus, we have conducted a community-based survey to assess the dietary coping strategies during war and siege in the urban communities of Mekelle, Tigray, North Ethiopia.\u003c/p\u003e"},{"header":"2. Methods and materials","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003e2.1. Description of the study area\u003c/h2\u003e\n \u003cp\u003eThis study was conducted in Mekelle City, the capital city of Tigray, at a latitude of 12°16' to 14° 49' N and a longitude of 36° 27' to 40° 00‘ E. It has a total area of 41,409.95 km2 and is found at an altitude of 500–4000 meters above sea level. Administratively, Mekelle has seven sub-cities with a total population of 555,769 and 126,323 households. The major livelihood sources of the residents of the city include trade, manufacturing, and employment in governmental and non-governmental organizations [13]. The study was conducted from May 20 to June 5, 2022.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n \u003ch2\u003e2.2. Study design and participants\u003c/h2\u003e\n \u003cp\u003eA community-based cross-sectional study was conducted on Mekelle city residents. The source population, sample population, and sample unit were: all households in seven sub-cities, selected households, and single households, respectively.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n \u003ch2\u003e2.3. Sample size determination and sampling procedure\u003c/h2\u003e\n \u003cp\u003eA total of 315 households were included in this study. The sample size was computed using a single population proportion formula, considering the 87% proportion of household food shortage coping strategies used by Eastern Tigray residents [\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e], 95% confidence level, and 5% margin of error. Considering the 10% nonresponse rate, the final sample size was 315. Mekelle City was purposefully selected due to accessibility. The researchers understood that the impact of the war and siege was not limited to Mekelle, but accessibility to other areas was quite difficult due to logistic issues following the siege. Samples were collected from the seven sub-cities of Mekelle residents; all sub-city households were considered for sample selection, and the final sample size was allocated proportionally based on the number of total households per sub-city. Finally, the proportionally allocated sample was selected using a simple random sampling technique.\u003c/p\u003e\n \u003cp\u003eFigure\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e. \u003cstrong\u003eSchematic presentation of sampling procedure households in Mekelle city, Tigrai\u003c/strong\u003e,\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eEthiopia 2022.\u003c/strong\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n \u003ch2\u003e2.4. Data collection procedure\u003c/h2\u003e\n \u003cp\u003eA structured interviewer-administered questionnaire was used. As much as possible, attempts were made to make questions suitable for the local setting. It was first prepared in the English language and later translated into the Tigrigna language. Back translation to English was done to compare the consistency, and amendments were made accordingly. Five degree-holder data collectors and two supervisors were recruited for the data collection process. Both the data collectors and supervisors were trained for two days on the objectives of the study, study instruments, and data collection procedure. The questionnaire was pre-tested on a 5% sample in a similar population to the selected households in the sub-cities. The questionnaire is designed to include data on household socio-demography, food situation, and livelihood sources prewar and during the siege. It also included a consumption-based household coping strategy to sustain lives during the full-scale siege in the study area.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n \u003ch2\u003e2.5. Data analysis and presentation\u003c/h2\u003e\n \u003cp\u003eData were entered, edited, cleaned, and analyzed using a statistical software package, Stata version 14. Data were analyzed using descriptive statistics, t-tests, and the coping strategy index. In the descriptive statistics, mean, standard deviation, percentage, and graphic analysis were used to summarize the profiles and responses of the surveyed households. We used a reduced coping strategy index to summarize food rationing and coping strategies adopted to sustain life during the full-scale siege of Tigray. A t-test was applied to compare the mean difference of the coping strategies adopted by the urban residents in response to the severe food crisis faced during the complete siege.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eCoping strategy index (CSI)\u003c/strong\u003e: In times of man-made and natural shock, households have adopted different mechanisms to cope with challenges and sustain life. In line with this, we used CSI as a proxy variable to measure the extent of the food shortage among households in Mekelle during the siege. Technically, CSI combines two important elements: the frequency of each strategy (how many times each strategy was adopted in a specified time) and its severity (how serious each strategy is) in the eyes of households reporting food consumption problems. Technically, a higher CSI indicates a worse food shortage situation, and vice versa. The CSI score for each observation was computed based on the self-reported answer to the question that asked what coping strategies and how often a household adopts when the household does not have enough food to buy food during the siege. Finally, the CSI score is computed using [\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e] given in Eq.\u0026nbsp;(\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n \u003cdiv id=\"Equ1\" class=\"Equation\"\u003e\n \u003cdiv class=\"EquationNumber\"\u003e\u003cimg src=\"data:image/png;base64,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\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.1. Socio-demographic characteristics of the respondents\u003c/h2\u003e \u003cp\u003eOut of 315 household head respondents, 310 completed the interview with a response rate of 98.40%. The mean (SD) age of the household head was about 36.6 (9.81) years, and the average (SD) family size was 4 (1.82). About 65% of the households were male-headed, and 69% and 28% of the respondents were married and university graduates, respectively (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocioeconomic and demographic characteristics of the respondents, Tigray, Ethiopia, 2022 (n\u0026thinsp;=\u0026thinsp;310).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency (percent)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital status of the household head\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e216 (69%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71 (23%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 (8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender of the household head\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e201 (65%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e109 (35%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducational status of the household\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot able to read \u0026amp; write\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary school (1\u0026ndash;8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55 (18%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary school (9\u0026ndash;12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51 (16%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBSc/BA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e87 (28%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMSc and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80 (26%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.2. Livelihood sources of the surveyed households during the pre-war and full-scale siege periods\u003c/h2\u003e \u003cp\u003eThe major livelihood sources of the respondents during the pre-war period were depicted accordingly: 45.8% of the respondents relied on government salaries, about 16.77% were employed in the private sector, 14.19% of them participated in retail trade, and 5.81% of the respondents engaged in construction work during the pre-war period. Moreover, 4.19% of the surveyed households depended on daily laborers, nearly 3.87% relied on metal and woodwork, and 3.87% were engaged in street vendors (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLivelihood source of the surveyed respondents during the pre-war period Mekelle, Tigray, Ethiopia.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-war livelihood sources of respondents\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGovernment employees\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrivate sector employees\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.77\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRetail trade\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConstruction works\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.81\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDaily laborer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMetal and woodworks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.87\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStreet vendors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.87\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWholesale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.94\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHandicraft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e310\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eHowever, currently, most of the pre-war livelihood sources have collapsed due to the war and the siege imposed on Tigray. The majority (69%) of the surveyed households lost their sources of livelihood and were forced to depend on humanitarian food aid. 22% of the surveyed households engaged in trade activities like retail trade, wholesale, and street vendor or roadside trade. Besides, a proportion of pre-war government employees shifted their livelihoods to street vendors or roadside trade to cope with the economic shock they faced due to the siege. About 5% of the surveyed households relied on daily labor as a means of livelihood; however, it was not able to cover the household\u0026rsquo;s expenses. The other 4% of the respondents were hired in the private sector; nevertheless, they did not get a salary in cash following the collapse of the banking service in the region (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. \u003cb\u003eMajor livelihood source of the surveyed respondents during the full-scale siege Mekelle, Tigray, Ethiopia 2022\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.3. Food shortage and coping strategy\u003c/h2\u003e \u003cp\u003eThis study revealed that out of the total 310 surviving households, 272 (87%) faced food shortages. About the consumption-based coping strategy adopted by the surveyed households, 101 (32.6%) reduced meal size. Similarly, 85 (27.3%) of the sampled households adopted reducing meal quality or relying on less preferred foods. Likewise, about 23.2% skipped the number of meals per day, and 22 (7.1%) reduced the meal size of adults so that children would have more. Moreover, 14 (4.5%) of the surveyed households adopted sending children to eat with relatives (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFood rationing-related coping mechanisms adopted by households faced with critical cash shortage during the siege in Mekelle, Tigray, Ethiopia 2022\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCoping Strategy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReducing meal size\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReducing meal quality or relying on less preferred foods\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSkipping the number of meals per day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReducing the meal size of adults so that children will have more\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSkipping the whole day without food\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSending children to eat with relatives\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.4. Reduced Coping Strategy Index (rCSI) outcomes\u003c/h2\u003e \u003cp\u003eThe mean reduced coping strategy index (rCSI) of the surveyed households who skipped meals is estimated to be 181.84 with a standard deviation of 112.5. While the mean rCSI of the surveyed households that did not adopt meal skipping as a response to the existing food shortage is 38.6. The technically higher value of rCSI indicates a severe level of food ስህ. Moreover, the mean rCSI difference between those who adopted meal skipping as a coping strategy and those who did not adopt is statistically significantly different at a 1% significance level. These signals of meal skipping as a coping strategy are practiced by the most severe food shortage households during the ongoing siege. Similarly, the mean rCSI value of households that adopted food content reduction is estimated to be 152.4. However, the mean rCSI value of the surveyed households that did not practice food content reduction to manage the food shortage faced during the siege was found to be 51.1. The mean comparison t-test for food content reduction is statistically significant at a 1% significance level between households that practice reducing food content and households that don't. This implies that households with severe food shortages practiced a reduction in food content to overcome the current food shortage in the study area (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMean comparison of coping strategy index between those who practiced meal skipping and those who did not in Mekelle, Tigray, Ethiopia 2022.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCoping strategy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003et-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMeal skipping per day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e181.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e112.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e38.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e52.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e12.86***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReducing food content consumed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e152.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e111.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e51.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e71.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e8.99***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis community-based study determined the household coping mechanisms utilized during times of violence and food scarcity in Mekelle urban communities and discovered that 87% of households experienced artificial food shortages throughout the siege. This result is consistent with the study conducted by WFP [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] in the eastern zone of Tigray. The reason could be both the eastern zone of Tigray and Mekelle city are under complete siege and sociocultural similar. To overcome food shortage households employed several consumption-based coping strategies like reducing meal size reducing meal quality or relying on less preferred foods፣ skipping the number of meals per day reducing the meal size of adults so that children will have more and sending children to eat with relatives. These findings are consistent with the empirical findings of previous studies in Libya [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], and Syria [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] in which household food rationing-related coping strategies were used to overcome food shortages. Although the result of our study is consistent with the previous studies held in Libya and Syria in terms of adopting consumption-based coping strategies during conflict for food shortage, Libya and Syria allowed remittance from relatives, and friends living out of those countries and accessing humanitarian aid was easy but, in this study, the banking service, Telecom, internet access, transportation services within and out of Tigray, remittance from relatives, and friends living abroad and accessing humanitarian aids is not allowed by the federal government[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The complete blackout of these services made the food shortage more severe and tougher.\u003c/p\u003e \u003cp\u003eThe result of this study revealed that about 23.2% of sampled households skipped meals during the siege. The mean comparison of the reduced coping strategy index (rCSI) showed that households who skipped meals faced a severe or tougher level of food shortage than those who did not adopt meal skipping as a coping strategy during the study period the recommended daily dietary energy requirement considered adequate to meet the needs of most healthy people for adults is 2100kcal and +\u0026thinsp;350 and +\u0026thinsp;400 for pregnant and lactating mothers respectively [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. However, when households skip a meal from their daily meal schedule they could not qualify for the daily minimum requirement of calories of the persons; which ends up in protein energy malnutrition risking high maternal morbidity and mortality. This was evidenced by the study finding [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] which confirmed that 61% of pregnant and lactating mothers in war-affected Tigray were severely malnourished.\u003c/p\u003e \u003cp\u003eThe mean rCSI value showed that households adopting reducing meal quality or relying on less preferred foods, faced more severe food shortages than those who did not practice in the study area. reducing meal quality or relying on less preferred foods as a coping strategy for food shortage during feeding affects women of reproductive age (15\u0026ndash;49) because, the recommended daily allowance of protein, carbohydrate, and fat for reproductive age is 46g (0.75 g/kg/day), 130g, and 20\u0026ndash;35 percent total energy respectively [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The reduction of foods containing protein, carbohydrates, and fat negatively affects the dietary intakes of these women, as dietary diversity recommendations for pregnant women emphasize the need for women to eat diverse foods with adequate energy [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Moreover, a reduction below the recommended daily allowance in food content like fatty food during pregnancy for instance will cause a nutritional deficiency in the fetus. Because the fetus has a limited ability to make long-chain polyunsaturated fatty acid it is dependent on placental supply. A poor supply will affect neonatal growth and development. Placental supply comes from the pregnant women's dietary intake of food containing the source of fat besides, the reduction of food containing carbohydrate and protein for women of reproductive age lead the mother to burn fat and then its tissue proteins which further could lead to energy deficiency [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eComparatively, before the outbreak of war in November 2020, Tigray had mostly achieved food security. However, since the breakout of the war, each of the pillars of livelihood and food entitlement in Tigray has been destroyed or damaged by the war and the deliberate actions of the belligerents. In addition to the Crisis and Emergency conditions prevailing today, these actions also sharply raise the risk of famine in Tigray which would entail an exponential rise in the rate of death [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Likewise, the United Nations International Commission of Human Rights Experts on Ethiopia found reasonable grounds to believe that the Federal Government have implemented a wide range of measures designed to systematically deprive the population of Tigray of material and services indispensable for its survival, including healthcare, shelter, water, sanitation, education, and food. In consequence, most of the population in Tigray must now survive on limited and nutritionally inadequate diets. Malnutrition rates, especially among children, pregnant and lactating mothers, and older people have reached alarming levels, leading to preventable deaths. By August 2022, UNOCHA estimated that 5.3\u0026nbsp;million people in Tigray, around 90% of the population, were in dire need of humanitarian assistance [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHence, it should be the center of attention to the international community that as mentioned by [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e18\u003c/span\u003e], whatever political differences may have sparked the armed conflict in Tigray, it is abhorrent for starvation to be used as a weapon of war at the expense of the civilian population. This is because withholding adequate food from civilians as a method of warfare is prohibited under the Geneva Conventions. International humanitarian law also obliges to ensure adequate food for the population including importing supplies if those in the occupied territory are inadequate [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e"},{"header":"5. Conclusions","content":"\u003cp\u003eDuring the entire siege in Mekelle City, more than 80% of the households in the survey experienced food shortages, and households adopted consumption-based coping mechanisms to get through these man-made shocks. There is a severe level of food deficit among households that skipped meals, altered the quality of their meals, or used less desired foods as a coping mechanism. Urgent humanitarian aid, particularly the Blanket Supplementary Feeding Program, is recommended to prevent acute malnutrition among vulnerable populations. Targeted general food ration distributions are also recommended to reduce mortality rates and ensure recovery from post-conflict emergencies.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOperational Definition\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eFood shortage: \u0026nbsp;Scarce of food in daily meals/diet.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eReducing\u0026nbsp;meal quality or\u0026nbsp;relying on less preferred foods: consuming food items that are not diversified and no animal source of food.\u003c/li\u003e\n \u003cli\u003eReduced meal size: consumption of small portion size in a daily meal/diet of food on breakfast, lunch, or dinner.\u003c/li\u003e\n \u003cli\u003eMeal skipping: missing meals the whole day, breakfast, lunch, or dinner in a daily meal/diet.\u003c/li\u003e\n \u003cli\u003eComplete Siege: A siege with no banking service, network access, restriction of humanitarian aid, and transport facility to move in and out of the Tigray region.\u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;The authors thank Mekelle University for supporting stationary materials and providing internet access.\u003cbr\u003e \u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003cstrong\u003e\u003cbr\u003e\u0026nbsp;\u003c/strong\u003eHG carried out the conception. TN, MY, AM, AK, GG, TB and AG designed the study and performed the literature search, selection, analysis, writing, and review of the manuscript. Finally,\u0026nbsp;all authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003cbr\u003e\u0026nbsp;\u003c/strong\u003eThere was no funding for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003cbr\u003e\u003c/strong\u003e\u003cbr\u003eall data regarding this study are contained and Presented in this study.\u003cbr\u003e\u003cbr\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the institutional review board (IRB) of the College of Health Sciences of Mekelle University, and permission was given by ACSH to proceed with the study. Informed written consent was obtained from the study participants, and confidentiality was maintained throughout the study. The verbal consent was approved by the ethical committee. The participants were well-informed and guaranteed that they had the right to participate, refuse, or stop at any time during the data collection process. The procedures of this study constituted a minimal risk to participants, and this was explained to them before the beginning of data collection.\u0026nbsp;Moreover, all methods were performed following the relevant guidelines and regulations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Not applicable.\u003cbr\u003e \u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;The authors declare that they have no competing interests.\u003cbr\u003e \u003cstrong\u003eAuthor Details\u003cbr\u003e\u0026nbsp;\u003c/strong\u003eHG: MPH in Public Health Nutrition; AM: (Ph.D.) in Public Health Nutrition AK: MPH in Public Health Nutrition, GG: MPH in Public Health Nutrition, TB: MPH in Public Health Nutrition, TN: Master in Developmental Economics. MY: Master in Biotechnology, and AG: (Ph.D.) in Public Health.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eBarakat S, Milton S, Elkahlout G. Reconstruction under siege: the Gaza Strip since 2007. Disasters. 2020 Jul;44(3):477-98.\u003c/li\u003e\n \u003cli\u003eEgal F. Nutrition in conflict situations. Br J Nutr 2006, 96:S17\u0026ndash;19\u003c/li\u003e\n \u003cli\u003eSwesi R, El-Anis I, Islam MM. Food insecurity coping strategies in conflict-affected Libya. Development in Practice. 2020 Apr 2;30(3):394-408.\u003c/li\u003e\n \u003cli\u003eBuhari JA. STARVATION AS A METHOD OF WARFARE IN\u0026quot; YARMOUK CAMP\u0026quot; SIEGE IN SYRIA: A PERSPECTIVE OF INTERNATIONAL HUMANITARIAN LAW (Doctoral dissertation, President University).\u003c/li\u003e\n \u003cli\u003eEnough (2014). Life under Siege: South Kordofan Needs Assessment. An Enough Forum publication. 2014.\u003c/li\u003e\n \u003cli\u003eClark, H(2021). Starving Tigray: How Armed Conflict and Mass Atrocities Have Destroyed an Ethiopia Region\u0026rsquo;s Economy and Food System and Are Threatening Famine: World Peace Foundation. 2021\u003c/li\u003e\n \u003cli\u003eWorld Food Programme (WFP). Tigray emergency food security assessment. Tigray region, Ethiopia. January 2022.\u003c/li\u003e\n \u003cli\u003eMichelle Gavin, The Conflict in Ethiopia\u0026rsquo;s Tigray Region, Council on Foreign Relations, 2022 07:51 UTC https://www.jstor.org/stable/resrep31163.\u003c/li\u003e\n \u003cli\u003eBerhe E, Ross W, Teka H, Abraha HE, Wall L (2022) Dialysis service in the embattled Tigray region of Ethiopia: a call to action. Int J Nephrol. https://doi.org/10.1155/2022/8141548.\u003c/li\u003e\n \u003cli\u003eKinyoki DK\u003cem\u003e, et al\u003c/em\u003e. Conflict in Somalia: impact on child undernutrition.\u0026nbsp;\u003cem\u003eBMJ Glob Health\u0026nbsp;\u003c/em\u003e2017;\u003cstrong\u003e2\u003c/strong\u003e:e000262. doi:10.1136/bmjgh-2016-000262 \u0026nbsp;http://gh.bmj.com/\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eMulugeta A, Gebregziabher M. Saving children from man-made acute malnutrition in Tigray, Ethiopia: a call to action. The Lancet Global Health. 2022 Apr 1;10(4):e469-70.\u003c/li\u003e\n \u003cli\u003eLin TK, Kafri R, Hammoudeh W, Mitwalli S, Jamaluddine Z, Ghattas H, Giacaman R, Leone T. Pathways to food insecurity in the context of conflict: the case of the occupied Palestinian territory. Conflict and Health. 2022 Dec; 16(1):1-9.\u003c/li\u003e\n \u003cli\u003eCentral Statistical Agency (CSA) [Ethiopia] and ICF. Ethiopia demographic and health survey 2016: key indicators report. Addis Ababa, Ethiopia, and Rockville, Maryland, USA: CSA and ICF; 2016.\u003c/li\u003e\n \u003cli\u003eMaxwell, D. and R. Caldwell. 2008. \u0026ldquo;The Coping Strategies Index\u0026rdquo;: A Tool for Rapid Measurement of Household Food Security and the Impact of Food Aid Programs in Humanitarian Emergencies.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eFood and Agriculture Organization of the United Nations (FAO), the right to adequate food in emergency programs, 2014, available online at http://hrbaportal.org/wp-content/files/ai4184e.pdf (visited 7 November 2019).\u003c/li\u003e\n \u003cli\u003eMinistry of Health New Zealand 2008. Food and Nutrition Guidelines for Healthy Pregnant and Breastfeeding Women: A background paper.\u0026nbsp;Wellington: Ministry of Health.\u003c/li\u003e\n \u003cli\u003eTela FG, Gebremariam LW, Beyene SA. Food taboos and related misperceptions during pregnancy in Mekelle city, Tigray, Northern Ethiopia. PloS one. 2020 Oct 13;15(10):e0239451.\u003c/li\u003e\n \u003cli\u003eWorld Peace Foundation. Starving Tigray; How Armed Conflict and Mass Atrocities Have Destroyed an Ethiopian Region\u0026rsquo;s Economy and Food System and Are Threatening Famine. 2021.\u003c/li\u003e\n \u003cli\u003eThe Commission, 2022. Advance Unedited Version; Report of the International Commission of Human Rights Experts on Ethiopia; Distr. General 19 September 2022, A/HRC/51/46\u003c/li\u003e\n \u003cli\u003eSphere Association. The Sphere Handbook: Humanitarian Charter and Minimum Standards in Humanitarian Response, fourth edition, Geneva, Switzerland, 2018. www.spherestandards.org/handbook\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nutrition","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nutn","sideBox":"Learn more about [BMC Nutrition](http://bmcnutr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nutn/default.aspx","title":"BMC Nutrition","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Siege, Conflict, Meal, Skipping, Shortage, Coping","lastPublishedDoi":"10.21203/rs.3.rs-3537911/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3537911/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eCommunities afflicted by armed conflict are characterized by pervasive malnutrition and widespread hunger. For nearly two years, there has been an unbroken conflict in Tigray. However, little is understood about the coping mechanisms people used in reaction to a lack of food and a siege. This study was conducted to evaluate the coping mechanisms used by urban residents of Mekelle City in Tigray Northern Ethiopia.\u003c/p\u003e \u003cp\u003eA community-based cross-sectional survey was conducted among 315 randomly selected households in Mekelle city. Data were collected from May to June 2022 using a pre-tested structured questionnaire and entered, cleaned, coded, and analyzed using Stata version 14. We used descriptive statistics to describe the mean, frequency distribution, and percentages. The t-test was used to analyze the consumption-based coping strategy index.\u003c/p\u003e \u003cp\u003eAccording to the current analysis, 272 (87%) of the remaining households had food shortages. Meal size reduction was a consumption-based coping technique used by 101 (32.6%) households. Similar to this, 85 (27.3%) of the studied homes reduced the quality of their meals or substituted less favored dishes. Likewise, roughly 72 (23.2%) of the households skipped meals as a coping mechanism.\u003c/p\u003e \u003cp\u003eIn conclusion, the study revealed that the communities affected by the war faced a tough struggle due to the food crisis. The study highlights the food crisis in war-affected communities, highlighting coping mechanisms like reducing meal quantity, quality, and eating less desirable foods. Thus, targeted food ration distributions and blanket supplemental feeding programs should be in place to reduce acute malnutrition and mortality, enabling recovery and recovery.\u003c/p\u003e","manuscriptTitle":"Food crises and their coping strategies in war-affected communities in Tigray, North Ethiopia: A community-based study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-11-07 13:45:53","doi":"10.21203/rs.3.rs-3537911/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-12-06T11:17:18+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-27T21:34:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"239955711353438131784516020086993868932","date":"2024-11-09T18:22:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"295530568861104957788493607166912434885","date":"2024-11-07T19:38:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"316887790226739073356588585950157204053","date":"2024-11-04T14:05:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"246568116002258111212183560661534112895","date":"2024-11-04T12:19:29+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-27T09:00:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"135301628684854145876180389796797031970","date":"2024-09-26T18:34:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"e0c9925d-0ee5-411c-bd1d-6c1318b2719b","date":"2024-03-19T16:51:37+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2023-11-15T09:55:02+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2023-11-06T16:05:36+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2023-11-01T21:03:49+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nutrition","date":"2023-11-01T19:16:21+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nutrition","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nutn","sideBox":"Learn more about [BMC Nutrition](http://bmcnutr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nutn/default.aspx","title":"BMC Nutrition","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"573f8be1-7f93-4c10-9099-c56616c737aa","owner":[],"postedDate":"November 7th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-04-28T16:09:39+00:00","versionOfRecord":{"articleIdentity":"rs-3537911","link":"https://doi.org/10.1186/s40795-025-01068-4","journal":{"identity":"bmc-nutrition","isVorOnly":false,"title":"BMC Nutrition"},"publishedOn":"2025-04-21 15:57:55","publishedOnDateReadable":"April 21st, 2025"},"versionCreatedAt":"2023-11-07 13:45:53","video":"","vorDoi":"10.1186/s40795-025-01068-4","vorDoiUrl":"https://doi.org/10.1186/s40795-025-01068-4","workflowStages":[]},"version":"v1","identity":"rs-3537911","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3537911","identity":"rs-3537911","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}