Determinants of Complementary Food Handling Practices in Conflict-Affected Tigray, Ethiopia: A Qualitative Exploration

In many parts of the world, the safety of food depends on a simple chain of conditions: clean water to wash hands and utensils, fuel to cook meals thoroughly, and a cool place to keep leftovers from spoiling. When these basic elements are present, parents can follow hygiene rules to protect their young children from invisible germs that cause illness. However, in places where conflict has shattered daily life, this chain is often broken. When a family cannot access clean water, cannot afford soap, or lives in a crowded room where cooking and sleeping happen side-by-side, the standard rules of food safety become impossible to follow. This reality creates a difficult situation for mothers and caregivers: they may know exactly what they should do to keep food safe, but the world around them offers no way to do it.

Researchers recently set out to understand how mothers in the Tigray region of Ethiopia, an area deeply affected by recent war, navigate this impossible choice. They wanted to move beyond simple surveys to hear the actual stories of families trying to feed children between six months and five years of age. The team conducted in-depth conversations with forty-one people, including mothers, community health workers, and local officials. They listened to how these families managed the preparation of complementary foods—the solid meals introduced alongside breast milk—and what barriers stood in their way. The study, published in October 2026, reveals that the danger to children's health is not caused by a lack of knowledge, but by a lack of resources.

The researchers found that the mothers and caregivers in these communities are fully aware of the risks. They understand that washing hands with soap, boiling water, and keeping raw food separate from cooked food are essential steps to prevent sickness. Yet, the environment they live in makes these steps unattainable. In many households, the cost of a single bar of soap has become so high that families must choose between buying food to fill their children's stomachs or buying soap to wash the bowls. When money is this tight, hygiene becomes a luxury that cannot be afforded. As a result, mothers often wash feeding bowls with plain water alone, which removes visible dirt but leaves behind invisible bacteria.

Water presents another critical hurdle. The conflict destroyed many municipal water systems, forcing families to rely on rivers, open wells, or water carried from far away. Even when a mother manages to fetch water from a source that looks clear, the process of carrying it in large containers and storing it in wide-mouthed pots at home introduces new dangers. Without clean lids or taps, family members dip dirty cups into the water, or dust settles in, contaminating the supply before it is even used for cooking. The study notes that mothers know this water is unsafe, but they have no other option. They must use it to mix porridge and wash dishes because the alternative is having no water at all.

The physical space where families live also forces them to compromise on safety. Many displaced families now share single rooms that serve as bedrooms, kitchens, and living areas all at once. In these cramped conditions, there is no separate counter to prepare food. A mother might chop raw vegetables on the same mat where she later places a cooked meal for her baby. Flies and chickens often walk through the cooking area, and there is no way to keep raw and cooked foods apart. The researchers observed that this is not a failure of care, but a rational adaptation to a space that offers no separation.

Fuel scarcity adds another layer of difficulty. Cooking requires firewood, which has become expensive and dangerous to collect. To save fuel, mothers often cook a large batch of porridge in the morning and leave it at room temperature to feed the child throughout the day. Without a refrigerator to keep it cool, the food sits out for hours, allowing bacteria to multiply. When the time comes to feed the child again, the mother might warm the food slightly over a few embers, but she cannot afford to burn the limited wood needed to bring it to a full boil. Leftovers are never thrown away, even if they smell slightly sour, because the fear of wasting food is greater than the fear of illness. In a time of starvation, every calorie is precious.

The study also highlighted the immense mental and physical toll on the caregivers. The constant stress of war, the loss of livelihoods, and the anxiety for family safety leave mothers exhausted. When a person is in survival mode, worrying about where the next meal will come from or if the family is safe, the mental energy required to remember every step of hygiene—washing hands multiple times, scrubbing every utensil—simply fades away. The researchers found that this psychological strain is a major factor in why safe practices are not followed, even when the knowledge exists.

Furthermore, the health system designed to support these families is also struggling. The war damaged many health centers, leaving them without running water, soap, or functional toilets. Health workers, who are already overwhelmed with treating severe injuries and malnutrition, have little time to teach food safety. They cannot demonstrate proper handwashing in a clinic that has no water. Additionally, public health programs often treat nutrition and water safety as separate issues. A worker might tell a mother to feed her child a diverse diet of eggs and vegetables, but fail to explain how to prepare those foods safely when clean water and soap are unavailable. This disconnect leaves mothers with advice that is impossible to act upon.

The research team also looked at the role of gender and community. In these households, women are solely responsible for cooking, cleaning, and fetching water, while men usually control the family finances. Even if a mother knows she needs soap or a clean water container, she often cannot buy them without her husband's permission. If the husband does not see the value in spending money on hygiene, the money goes elsewhere. However, the study noted that while religious leaders and community elders hold significant influence and could be powerful allies, the research itself did not directly explore the perspectives of husbands or government partners, highlighting a gap for future research.

Ultimately, the paper concludes that the unsafe food handling practices observed in Tigray are not the result of ignorance or negligence. They are the logical outcome of a system where the basic tools for safety have been removed. Mothers are making the best possible choices in a situation where every choice carries a risk. They use wood ash to scrub pots because they cannot afford soap; they store food at room temperature because they cannot afford fuel to reheat it; they feed leftovers to their children because they cannot afford to waste a single grain.

The researchers argue that telling these mothers to simply "wash their hands" or "boil their water" is ineffective when they lack the means to do so. Instead, the solution requires fixing the broken systems around them. This means rebuilding water infrastructure, providing clean cooking fuel, and ensuring that health centers have the basic supplies needed to model good hygiene. It also means integrating food safety into nutrition programs so that advice is practical and realistic. Until the physical and economic environment is restored, the gap between what mothers know and what they can do will remain wide, leaving children vulnerable to preventable illnesses. The study serves as a reminder that in humanitarian crises, food safety is not just a matter of behavior, but a matter of survival and structural support.