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Large nutritional crises: an unresolved man-made problem

21 Jun 2017

Overall, more than 20 million people - nearly the entire population of Australia- risk starving to death in the coming months in the four countries, according to the UN [2].

  • Yemen: The largest humanitarian crisis in the world, with 17 million people severely food insecure. 6.8 million people at risk of famine. Two thirds of the population (18.8 million people) needed assistance and more than 7 million did not know where their next meal would come from. Every 10 minutes, a Yemeni child dies from malnutrition, while the country’s overall death toll had recently reached 10,000.
  • North-Eastern Nigeria: 5.2 million people severely food insecure. 1.5 million people at risk of famine.
  • Somalia: 2.9 million people severely food insecure. 439,000 people at risk of famine. Cholera outbreaks have killed hundreds of people. Looming famine threatens 6.2 million—more than half the population. It threatens to bring back the grim reality of the famine in 2011, when 260,000 Somalis died.
  • South Sudan: 100,000 people currently in famine. 5.5 million people (half of the population) facing severe food insecurity by July 2017 (lean season). 1 million people at risk of famine [3]. More than 7.5 million people needed aid, up by 1.4 million from last year. Continued fighting had displaced some 3.4 million people and more than 1 million children were estimated to be acutely malnourished across the country. That included 270,000 children who faced the imminent risk of death if they were not reached in time.

Large nutritional crises, always a man-made disaster, killed nearly 75 million people in the 20th century, but had virtually disappeared in recent decades. Today, in an era of declining poverty and hunger worldwide [4], the United Nations (UN) have recently declared famine in South Sudan [5] and launched a common appeal to raise funds for also three other countries at risk of famine. According to the UN Humanitarian Chief “the world faces the largest food crises in 70 years, with more than 10 million people in four countries — north-eastern Nigeria, Somalia, South Sudan and Yemen — on the brink of famine, and a further 30 million severely food insecure [6]”.

Overall, there is no consensus of the definition of famine among humanitarian agencies and organisations globally [7]. MSF teams on the ground in Nigeria, Somalia, South Sudan and Yemen are seeing distinct conditions that are not fully comparable. However, there is a common denominator: political crises and protracted armed conflicts have been present in all four countries for several years. Violence has caused the collapse of the economic and agricultural systems – with tragic consequences for the population’s secure access to food.

How should we react to this clear failure of local and international authorities to protect lives? Does the reappearance of the spectre of famine signal the need for radical change in humanitarian action? Whilst the UN’s call for huge investment but no reform of the humanitarian system generates some scepticism, a disappointment with the performance of the humanitarian system should not lead to a withdrawal by states and civil society from the hard job of delivering effective humanitarian relief.

Emergency humanitarian response

There is an urgent need to facilitate a rapid and unhindered emergency response to address these dark predictions in all four countries. However, the global response has, so far, been insufficient. Understanding these failures is an essential step to improving the response tomorrow and in preventing future crises. To be successful the following major constrains need to be overcome:

  • Funding – a necessary but not sufficient condition for success: The UN has set funding requirements to $4.4 billion needed by July to address the food crisis in these countries [8]. The US Government recent announcement on cuts to the UN and USAID budget, reportedly looking at cutting up to half of its funding, will have a major impact in the provision of aid globally [9], and need a collective and coordinated global effort to scale up the appropriate response and cover this gap [10]. There is a common trend for funds to come late for emergency relief due to bloated bureaucracy and slow provision of funds. However, even if these UN appeals were entirely funded, the following factors will complicate their impact.
  • Secure access: Security issues - including attacks on humanitarians, with 82 aid workers killed since December 2013 in South Sudan alone- have significantly hindered the delivery of much-needed aid. Peace agreements in South Sudan and Yemen have failed. Due to the lack of access it is not currently possible to even map the nutritional situation in these countries. It is then difficult to define and prioritize interventions, and even more complicated to launch a humanitarian response. Also, humanitarians strive to engage neutrally with every side in a conflict to reach populations in need. Further, recent attacks in hospitals and civilian infrastructure targeting aid workers and civilians have deterred humanitarian actors from providing the appropriate response. Global norms that are intended to protect and facilitate such humanitarian work are under pressure – if not outright ignored.
  • States have a clear role to use their influence to ensure safe humanitarian access and protected humanitarian action. International norms, including international humanitarian law, refugee law, the Kampala convention relating to internally displaced people, must be constantly reaffirmed, defended, and championed if they are to allow humanitarians to work.
  • Timely and coordinated response: When funding and access is possible emergency humanitarian aid is a race against the clock. Timely response saves lives today and prevents crises deteriorating into deeper emergencies. However, this requires emergency specialised leadership, flexible funding, and high levels of humanitarian ambition.
  • Comprehensive response: Since the 1950s, food aid has been the main tool for responding to food crisis. However, to address the immediate needs, a comprehensive humanitarian intervention, including early surveillance and needs assessment, nutritional support, screening and treatment of malnutrition (especially in children), vaccination campaigns, and management of infectious diseases. These are the main component of MSF’s response to this crisis in the north of Nigeria, South Sudan and Yemen. Additionally, water and sanitation, essential non-food supplies distribution, and shelter is required as part of the early response in all four contexts.

Inadequate sustainable response from the outset

The current levels of food insecurity in the four affected countries reflect continued underinvestment in agriculture and livelihoods. The new paradigm in humanitarian policy the ‘new way of working’ emphasises the conflation of emergency humanitarian interventions with longer term development work, seeking to immediately address this and other causal elements of the crisis. Unfortunately, this move brings the risk that, in the attempt to tackle causes, treating the symptoms will be deprioritised thus increasing the danger for affected populations. In extremis, lifesaving humanitarian action must be prioritised and distinguished from the understandable desire to invest in long lasting solutions.


[1] At risk: IPC Phase 4.
[3] At risk: IPC Phase 4.
[7] There is no consensus of the definition of famine among humanitarian agencies and organisations. The IPC (Integrated Phase Classification, in which level 5 corresponds to a ‘famine’ situation) was created in 2012 by a consortium of NGOs, UN agencies and donors, to provide a solid and coherent tool for analysing and classifying nutritional crises in different contexts. It’s a technical tool, but the idea of famine – and the way the term is used – also has a strong political meaning.
[8]  As note 2
[10] The United States spends about $10bn a year on the UN. That is about 22 percent of the world body's total budget. It contributes 28 percent of the peacekeeping budget. Plans to cut on USAID is of around 30%