Hi Vicky What great (can't think of a better word) questions. It sounds like you have a tricky situation on your hands. It might to go back to some health promotion theory and to take lessons from some other health promotion campaigns. In a place where animal milk is being given to infants <6m routinely (i) should we provide infant formula as a nutritionally better alternative during emergencies? Maybe not. I think the key is going to lie with providing skilled infant feeding support and education in the form of local women and health staff trained in IYCF support/counselling but possibly not in isolation. You have found that helping mothers to address the practical barriers to EBF improves EBF rates in Myanmar so I'd also be thinking about applying that approach here. Providing PIF might create a market for an expensive product that could in turn increase malnutrition prevalence by robbing the rest of the family of resources to spend on food. Borrowing from another health promotion area, providing PIF to replace animal milks seems a little like encouraging illicit drug users to switch to alcohol or tobacco - doesn't really achieve any health benefits. What you want to be doing is focusing resources on encouraging the whole community (an most importantly infants born after the disaster or flight) to switch from non-human milk to human milk feeding for infants under 6m. If so, when is an emergency over and so when should we stop giving it to newly identified infants? That's always the tricky question. Sphere provides some guidance about the parameters of an emergency for 6-60m children but very little regarding infants <6m. It might be an idea to use prevalence of EBF combined with anthro data to define 'emergency' in this age group. Once the decision is made to provide PIF, the family must be provided with it until the child reaches no longer needs it (up to 12 months). That's a huge drain on scarce humanitarian resources that might be better spent on devising and implementing a program to reduce the use of non-human milks in this age group. If we do stop giving formula then people will go back to using animal milk - is this acceptable, if not then what is the alternative? I think the bigger danger is that they won't go back to using animal milks but will try to buy commercial infant formula and potentially over-dilute or put the rest of the family at risk by spending so much on commercial infant formula. (ii) should we give guidance (and train staff) on making the modified animal milk safer e.g. how to dilute it or even provide micronutrient supplements? I know we did this in Myanmar after Nargis when there was delay in procuring commerical infant formula. I think could be viewed as conforming to a harm minimisation approach. If we do this does this imply that modified animal milk is safe when the feasibility and safety of this method is according to WHO not proved even in a pilot. I think it depends on the education and support for communities that goes with it. To push the analogy, I think it has been argued that providing needle exchange implies that illicit drug use can be made safe. Similarly, I think if it is inevitable that babies will be fed fresh animal milk - at least for a short time until a successful intervention can be devised and implemented to improve EBF rates - it is not unreasonable to teach families to reduce the risks associated with that practice. I think you have raised some really interesting ethical questions; questions that may have slightly different answers depending on the conditions in field in any given emergency. cheers Nina