Breastfeeding among Refugee Mothers on the Balkan Route

By Vera Dimitrievska, PhD, MPH


Since the middle of 2015, an unprecedented number of refugees, asylum seekers and migrants daily have crossed the Western Balkan Route (Greece, Macedonia and Serbia) to get to their final destination in certain countries in the European Union. During this influx of 3000-5000 arrivals a day, high numbers of children and families have been recorded on this route, particularly from war zone countries like Syria, Iraq and Afghanistan. This influx has weighed heavily on local non- and governmental organizations capacities to handle and respond to the humanitarian needs of those transiting through the region, with more than 6000 refugees, asylum seekers and migrants crossing the Macedonian border into Serbia per day (UNHCR, end of October, 2015).

In November, 2015, UNICEF reported that 52% of those crossing the borders in the Balkans were women and children, up from 27% during the previous summer. The international actors have named this crisis as a crisis for children and their mothers. Coming in increasing numbers, women and children are among the most at risk of refugees and migrants.

Because of the difficulties of the perilous border crossings, these vulnerable mothers and children experience exhaustion from long periods of walking, carrying their personal belongings, and crossing rough seas. They are all are at high risk of being exposed to sickness, injury, violence, exploitation and trafficking – these are violations of their human rights and threaten their lives and well-being. Many are not able to satisfy their basic survival needs. With a lack of access of basic health services and a shortage of translators who speak their native language on this route, many mothers with babies also do not have access to information regarding recommended breastfeeding and safe infant and young child feeding in emergencies practices.

Breastfeeding corner in the safe space of the transit centers

In Greece, Serbia, and Macedonia, safe spaces have been established for mothers and children to find some relief and rest while transiting. The capacity of these safe spaces is for about 30 children and a few mothers, who are unwell and require time to rest. A dedicated breastfeeding corner for mothers and their babies/toddlers still is lacking; mothers who have newborn babies don’t have any private space for herself to clean or to wash the baby.

After observing the safe spaces in Serbia and Macedonia, it is clear that mothers don’t feel comfortable and relaxed to breastfeed their own babies in this setting. There are specific difficulties they have encounter: no suitable place to sit with their baby in the safe space, no quiet room to breastfeed, no hygienic conditions for mothers and babies to wash, no professionals to help mothers in providing information and support for breastfeeding difficulties. Many women need to breastfeed their babies in front of other people, and so they often manage to cover the whole baby and breast with a scarf while breastfeeding, or turn their back to others so as to retain some privacy.

Information sharing for breastfeeding

A recent assessment on feeding from UNICEF 2015 done in one Serbian transit center, indicates that, 86% of women refugees were breastfeeding their children. About 60% were exclusively breastfeeding, 26% are mixed feeding (breastfeeding and feeding with a substitute), while 14% do not breastfeed at all, and were exclusively reliant upon infant formula. Nevertheless, in all transit centers, women struggle to find an appropriate information for breastfeeding.

A lack of Arabic and Afghan translators and educational materials in these languages, women are not able to express their needs and get professional counseling in their own language. Even though some translators are in the field, most of them are men. Mothers  are refraining or don’t want to speak up about breastfeeding, because it is culturally problematic for women to discuss these topics with men. Women translators in Arabic can be found occasionally, however, the Afghan women are completely left without any caregiver that speak the dialects like Pashtu, Urdu from Afghanistan.

Apart of the language barrier in oral communication, written communication is an issue, too. Caregivers who are helping refugee mothers and children in the safe space often are not familiar with the content of the food (including infant formula) that they provide to the mothers. Many of the caregivers are in hurry to move the families through transit, as the influx is constant, and there is often no time to read and translate labels of the food/packages for infant feeding, which are often in languages from the countries where the refugees transiting, like Serbian or Macedonian.

Distribution of infant formula

Many of the safe spaces in the transit centers are run by UNICEF, but infant formula procedures are not often respected. As with many other donors dealing with mother-baby project activities, baby milk bottles are present and infant formula feeding  is occurring among refugees mothers and babies. As mentioned before, many refugees arrive from war zone countries have been using infant formula without any guidance or coordination with health care professionals. The infant formula milk is imported and then labeled in the Serbian and Macedonian languages. Thus, there is an urgent need for coordination of the international actors present in the field to finding mutual understating of the proper distribution the infant formula and supporting mothers to deal with the challenges of formula feeding in this difficult transit situation.


  1. UNICFEF 2015, unprinted assessment report, Serbia.
  2. UNHCR 2015, regular UNCT meeting in Macedonia.
  3. PUI 2015, Exploratory mission report

Dr. Dimitrievska is Regional Emergency Project Coordinator, Emergency Response for the Refugees’ Crisis on the Balkan Route, Terre des Hommes, Regional Office Budapest. You can learn more about her work at

Title photo credit: Tara Todras-Whitehill for the IRC

Medical Anthropologist | Lactation & Infant Feeding Researcher | IBCLC | Podcaster | Blogger. Opinions are my own.

3 thoughts on “Breastfeeding among Refugee Mothers on the Balkan Route

  1. Hello, thank you for the interesting article. I was interested to learn more about what you meant when you mentioned “The infant formula milk is imported and then labeled in the Serbian and Macedonian languages.” Could you possibly clarify this point? Thank you!


  2. My understanding is that one of the issues with untargeted formula distribution generally is that mothers may be given tins of formula that don’t have instructions provided in their native languages. A Syrian, Iraqi, or Afghan mother may not be able to read formula that is labeled in a foreign language. This is a big problem because preparing formula that it either too dilute or too concentrated, preparing it without having access to boiling water, saving unused formula to feed later, all present serious risks to infants. In this particular emergency, because of the rapid pace of transit and the large numbers of displaced families in transit as well as so few women who can serve as translators, providing mothers with instructions for how to prepare the formula appears very difficult. I am also curious why there isn’t more effort to distribute the single use UHT liquid formulas instead of powder, though, particularly in these transit areas.

    Liked by 1 person

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