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Layla, perhaps you have never been in a situation after a real disaster. There is NO electricity in many cases in the best of countries. In those such as Haiti, there is infrastructure issues in the best of circumstances, and this is hardly the best of circumstances. Boiling water is something we take for granted in or wealthy western world. Not everyone has the luxury of boiling water.

It is not about starving vs getting sick by being fed inappropriate food. It is about knowing this is an issue and preventing it completely by not donating what will not help. There is more than enough for relief workers to do without sorting and tossing what is not necessary at best and harmful at worst.

Pam

- Pam, USA

"Boil the water". With what? No fuel, no cookers, no storage, no equipment. Any infant formula use is a last resort in an emergency like Haiti, and needs skilled, well resourced assessment and support and close follow-up. Safer alternatives for orphans include wet nursing (another woman breastfeeds).
Breastfeeding is a lifeline in an emergency - it is secure, safe, nutritious, provides active immunity and protection and keeps an infant in the safest possible place - the arms of his/her mother. Breastfeeding mothers in emergencies are vulnerable but are not weak - breastfeeding is resilient, life sustaining. The key 'partners' to the well coordinated effort by UNICEF in Haiti on infant feeding in this emergency are mothers. There is no true 'breastmilk substitute' - you'll never get what breastfeeding offers in a tin, but many never really appreciate that in the 'developed' world. In most countries in the world, infant formula is not all husbands making night feeds, with soft lights and music and chuckling babies as we see in the ads. In resource poor settings, it's about malnutrition, diarrhoea, and death. It's not a moral judgement whether to breastfeed, it's pure and simply about child survival.
Support those agencies involved in infant feeding protection and support, like UNICEF, Save the Children, World Vision, Concern, Action Against Hunger.

- Marie Mcgrath, UK

The alternative is not starvation. Workers on the ground are supporting breastfeeding and complementary and will be providing formula to infants where this is necessary. To minimize the dangers of contamination, this formula will be ready to use and caregivers will receive cups for feeding (much easier to clean) and instruction on feeding with a cup.

- Judy Canahuati, Columbia, USA

The threat is not just from the water. Powdered infant formula is not sterile. Up to 14% of batches contain bugs that can cause serious illness, such as salmonella, and some contain a deadly bug called e.sakii, that can cause meningitis and death. So the water has to be boiled very carefully, in order to also kill off the bugs in the powder. Once made up, formula is a perfect medium for bug growth, so it has to be used within 2 hours, and then thrown away. If made up and not used, it must be put int he fridge, to prevent bug growth. Once baby's mouth has touched the teat, it has to be used within two hours, or the baby can get ill from the bugs growing in the bottle. The bottle and teat them have to be boiled in water too. Sickness and diarrhea is 5 times higher in the UK< in bottle fed than breastfed infants, for this reason. Formula is not benign - it carries risks. Only trained support workers should be in a position to decide to use formula in emergencies, and they are trained to do so with the smallest risk of illness and death to the child possible. Only formula companies benefit, when people talk about the 'need' for formula in emergencies. Formula kills babies in emergencies: send money, not 'stuff'. There are mothers will milk everywhere: the mothers with milk need to be given the babies without mothers. Mothers save lives in emergencies, formula kills in emergencies. It's a simple message... why does it cause so much fuss, to state simple truths?

- Morgan Gallagher, Eyemouth, Scotland

Layla - as well as the points about boiling raised by Alma, you need to know there are programmes on the ground in Haiti which are supporting women to breastfeed, to re-start breastfeeding if they have stopped, and to help other women feed displaced or orphaned infants - their work is being undermined by donations of formula and aid workers are being diverted from life-saving tasks by these unwanted and unusable donations. Tinned or ready-prepared milk can be used when necessary, but this is best acquired in-situ, avoiding transportation and storage issues, and the risk of 'flooding' with unsafe donations.

Send money, not stuff.

- Heather, Newcastle upon Tyne UK

To boil the water you need - water, fuel, cooking pots - which many people won't have in an emergency. But it is more than that powdered infant formula is not sterile and may be contaminated itself. The feeding implement (bottle / cup) needs to be sterilised - how in an emergency? There are no fridges so once formula is made it easily becomes contaminated with bacteria. All these things lead to diarrhoea (mainly) and death. Giving out formula without assessing the needs of the mother and other support have been proved to be very dangerous in emergencies. Breastfeeding is life-saving in an emergency and needs to be supported. Those infants that are orphaned or are assessed as needing other milk need specialised support. It is better to give monetary donations to organisations like Save the Children and UNICEF that know what saves infants lives on the ground.

- Alma, London, UK

The threat is not from the milk itself, it's from the dirty water. Why can't anyone say "boil the water"? I cannot believe the only alternative to simple instructions is starvation.

- Layla Gordon, Scotland

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