About the author(s):
Dr. Oche Joseph Otorkpa is a Public Health Specialist and Resource Person at the National Institute for Environmental Health. He is a Fellow of the Royal Society for Public Health and serves as an expert with several international organizations, including the World Health Organization and the European Union.
This post forms part of phase two of the Beyond Compliance Symposium: How to Prevent Harm and Need in Conflict, hosted by the Armed Groups and International Law blog. The introductory post can be found here. The symposium invites reflection on the conceptualisation of negative everyday lived experiences of armed conflict, and legal and extra-legal strategies that can effectively address both civilian harm and humanitarian need.
According to the Food and Agriculture Organization (FAO), in 2020 nearly one-third of children under five years of age in Sub-Saharan Africa were affected by stunted growth, and the region was the only one in the world where the number of stunted children was increasing. Research also shows that across the African continent, rates of child stunting, underweight and wasting are significantly higher in areas affected by armed conflict, such as the Democratic Republic of the Congo, Somalia, Nigeria and Sudan. We also know that child malnutrition, particularly during the first 1000 days of life, can have significant and potentially irreversible effects on development and possibly on mental health (see here and here). It can impair cognitive function, motor skills, and behavioural development, potentially leading to long-term challenges. A combination of malnutrition and lack of psychosocial stimulation can worsen outcomes, highlighting the importance of integrated nutritional and psychosocial interventions.
While there is considerable variation in rates of malnutrition between and within different Sub-Saharan countries, this blog post explores how four key factors – theatre of hostilities and protracted conflict, governance failures, a strained humanitarian landscape, and severe climatic disruptions – compound to exacerbate child malnutrition across the region.
The premise of the article is that, as Alex De Waal explained in Famine Crimes, the problem is not the availability of food but its accessibility – which is ultimately a political issue. Food insecurity is thus understood as the physical, social, and economic inability to access sufficient, safe, and nutritious food to meet dietary requirements for normal growth, development, and an active, healthy life. As such, the food security crisis in parts of Sub-Saharan Africa reflects deeper, interconnected problems of structure and agency.
The child malnutrition crisis in the region cannot be fully understood without considering the broader and lived dimensions of harm + need. Conflict disrupts access to health services, food supply chains, markets, and clean water. Climate-induced shocks such as droughts, floods, and failed harvests amplify this disruption. Together, climate change and conflict disrupt agricultural productivity, displace populations, and destroy critical infrastructure driving up food insecurity and worsening malnutrition among children. Families are often forced to move multiple times, eroding community support systems and leaving caregivers in constant survival mode.
These dynamics result not only in physical harm (stunting, wasting, susceptibility to disease) but also emotional and social harm, including trauma, school dropout, and long-term cognitive delays. Traditional humanitarian programming focuses primarily on immediate survival, yet the needs of children in these contexts go far beyond calorie intake. They need reliable access to safe shelter, psychosocial support, education, and livelihoods for caregivers, yet in conflict hotspots, these essentials are repeatedly disrupted and put out of reach.
Finally, it is important to note that in Sub-Saharan Africa the crises of conflict, poverty and climate challenges are both protracted and interconnected. Conflicts frequently spill across porous borders, drawing in multiple countries at once, whilst recurring droughts, floods and desertification intensify food insecurity in ways rarely witnessed elsewhere. For example, armed incursions in the Central African Republic (CAR) are linked to the conflict in Sudan and the Rapid Support Forces. Furthermore, the conflict in Sudan has driven an influx of Sudanese refugees into the CAR, illustrating the porosity of the parameters of conflicts in the region. These overlapping pressures create a cycle of vulnerability that is uniquely deep-rooted and exceptionally difficult to break.
Drivers of Child Malnutrition in Sub-Saharan Africa
Four powerful and intersecting forces collectively drive a worsening cycle of child malnutrition in the region. These drivers not only hinder the delivery of life-saving nutrition services but also dismantle the very structures families rely on to protect and nourish their children. Understanding these drivers is crucial to developing informed, effective responses that move beyond temporary relief towards resilience and sustainability. These drivers include:
Theatre of Hostilities and Protracted Conflicts
For several decades, Sub-Saharan Africa has been the stage of prolonged and often brutal hostilities. Across this region, countries such as Burkina Faso, Cameroon, the CAR, the DRC, Ethiopia, Mali, Mozambique, Nigeria, Senegal, Somalia, South Sudan and Sudan face overlapping crises in which protracted armed conflicts converge with extreme poverty, fragile governance, food insecurity and climate shocks. These conflicts are far from uniform: whilst some take the form of insurgencies driven by extremist groups, others are rooted in ethnic rivalries, competition over resources or long-standing political instability. What unites them, however, is the disproportionate toll they inflict on civilians, particularly women and children, who endure cycles of violence that perpetuate vulnerability across generations, one of which is exposure to food insecurity. In this context, research shows that children exposed to a long duration of armed conflict are 2.60 times more likely to experience wasting.
Although there are clear international obligations in this respect, many parties to armed conflicts continue to disregard them. More specifically, international humanitarian law (IHL) prohibits the use of starvation as a method of warfare and requires the protection of essential resources indispensable to the survival of the civilian population, including food, water, and health services. Furthermore, the UN Security Council Resolution 2417 reinforces these obligations by underscoring the direct link between conflict and hunger, reminding the parties that the use of starvation as a method of war constitutes a war crime.
Hostilities directly and indirectly undermine child nutrition in several ways. First, displacement forces millions of families to flee their homes, often without access to food, clean water, or basic healthcare. Camps for internally displaced persons (IDP) are frequently overcrowded, under-resourced, and unable to provide adequate nutrition, particularly for young children and pregnant or lactating women. In some IDP camps, such as the Bakassi Camp in Borno State, northeastern Nigeria, tens of thousands of people displaced by the Boko Haram insurgency face persistent overcrowding, poor sanitation, and food shortages. Similarly, the Bentiu Protection of Civilians (PoC) Site in South Sudan, once hosting over 100,000 people under UNMISS management and the Kalma Camp in South Darfur, Sudan, have both struggled with severe shortages of nutrition and health services. In the CAR, the M’Poko IDP Camp near Bangui has also been characterised by overcrowding and limited resources, reflecting the broader challenges of displacement in the country.
A second major factor is that conflict disrupts agriculture, the primary livelihood for most families in the region leading to extreme poverty. Farmers are driven from their land, while livestock is either stolen or killed. Cattle rustling has escalated both in scale and violence, increasingly serving as a source of income for organised criminal and terrorist groups, and often involving cross-border movements.
For example, cattle raiding has a long and entrenched history in Sudan and South Sudan, where cattle are not only a source of food and wealth but also central to cultural identity, marriage practices, and social status. Among pastoralist groups such as the Dinka, Nuer, and Murle, cattle raiding has been traditionally practiced as a rite of passage for young men and a way to acquire bride wealth. However, over the decades, cattle raiding has escalated from small-scale, traditional raids into large, militarised confrontations, fuelled by the proliferation of small arms, political manipulation, and competition over shrinking grazing land and water resources.
According to reports from the United Nations Mission in South Sudan, cattle theft has become the most rampant crime in Lakes, with over 112 deaths reported so far this year and around 10,000 stock stolen in the three months prior to June, 2025. Furthermore, the displacement of farmers leaves fields uncultivated, while markets and food supply chains are disrupted, resulting in shortages and soaring prices. In such conditions, adequate and nutritious food becomes a luxury beyond the reach of many households.
Governance Failures
Governance challenges in parts of Sub-Saharan Africa further entrench the malnutrition crisis. In some contexts, limited institutional capacity, corruption, or political instability weaken states’ ability to deliver essential public services such as health, education, and social protection. For example, delayed budget releases have disrupted food subsidy programmes in Nigeria, while contested land policies in South Sudan have fuelled tensions between communities already facing food insecurity. Such governance gaps can also hinder the enforcement of food safety and pricing regulations, exacerbating the combined pressures of hunger, conflict, and environmental stressors.
The inability of governments to stabilise food prices, support agricultural production or ensure access to basic infrastructure and nutritional supplements worsens food insecurity. Inflation, especially in conflict-affected areas, often renders even staple foods unaffordable. In some regions, poor roads, weak supply chains, and fuel shortages further isolate communities from food markets and health facilities. In places such as northeastern Nigeria and the CAR, humanitarian agencies have reported alarming increases in severe acute malnutrition (SAM)-a life-threatening condition due to the combined effects of violence, poor sanitation, and disrupted healthcare. Despite the availability of ready-to-use therapeutic foods (RUTF), many children never reach treatment centres due to insecurity in the area, logistical challenges, long distances to facilities, lack of transport, and in some cases, social stigma or limited awareness among caregivers.
A Strained Humanitarian Aid Landscape
The humanitarian sector faces immense operational challenges in addressing the nutrition crisis in Sub-Saharan Africa. Insecurity frequently prevents aid organisations from accessing high-need areas, especially where territorial control is disputed or shifting. Armed groups or powerful private individuals may restrict humanitarian access for political leverage or impose “taxes” on aid—as seen in Somalia—further complicating operations.
In addition, the funding environment remains unpredictable. Global humanitarian appeals are often underfunded, with nutrition frequently receiving less than 20% of the required resources. Donor fatigue, shifting geopolitical priorities, and new crises (e.g., in Ukraine and the Middle East) divert attention and funds away from Africa’s chronic emergencies. Recent reductions in contributions from some of the largest traditional donors have further strained humanitarian budgets, compounding the challenge of sustaining essential programs.
These challenges are compounded by bureaucratic and logistical hurdles, which aid agencies must overcome to operate in the region. In some countries (see for example here), restrictive government regulations delay approvals for food shipments or humanitarian personnel movements. In others, poor infrastructure (see here) and insecurity (see here) make last-mile delivery of supplies an enormous challenge.
Severe Climatic Disruptions
Climate change is a major force multiplier in the child malnutrition crisis, exacerbating food and water insecurity across Sub-Saharan Africa. Rising temperatures, unpredictable rainfall patterns, prolonged droughts, and more frequent floods are hampering food security by eroding agricultural productivity, undermining rural livelihoods, and intensifying vulnerabilities in communities already affected by poverty and conflict.
Many of the region’s farmers still depend on rain-fed agriculture, making them extremely vulnerable to changes in seasonal patterns. Droughts reduce crop yields and cause livestock deaths, while floods destroy homes, contaminate water sources, and displace entire communities. The Horn of Africa, for example, has experienced its worst drought in four decades, affecting more than 20 million people across Ethiopia, Kenya, and Somalia, where millions face starvation and severe malnutrition. In the Sahel, desertification and erratic rainfall are pushing once-productive lands beyond the point of recovery.
Water scarcity further undermines hygiene and sanitation, increasing the risk of diarrhoea, cholera, and other diseases that contribute to or worsen malnutrition in children. The burden regularly falls on women and girls, often having to walk longer distances to fetch water, exposing them to protection risks and reducing time for income-generating or caregiving activities.
While climate change does not directly cause violent conflict, it amplifies underlying drivers such as food insecurity, water scarcity, livelihood loss, and accessibility of healthcare systems. Fragile states and conflict-affected communities are especially at risk, as weak institutions struggle to manage growing competition over land and water. Intensifying climate stress can inflame existing tensions, fuelling intercommunal violence, forced displacement, and a cycle of environmental crisis that deepens the vulnerability of children. A Stanford-led study estimates that climate factors have contributed to 3–20% of armed conflict risk over the past century and warns that this influence is likely to rise sharply in the future. Full circle then, climate change and conflict will exacerbate malnutrition without comprehensive protection strategies.
What Comprehensive Protection Looks Like for Children in the Region
To address these interconnected drivers of harm + need in Sub-Saharan Africa, we must move beyond a narrow legal or humanitarian lens that views challenges only through legal frameworks or short-term humanitarian responses. Full(er) protection means going further than safeguarding survival; it requires ensuring that every child grows up with dignity, access to education and health, emotional and psychosocial support, and the opportunity to thrive. This broader approach acknowledges that protecting the future of children is not only about saving lives in the present but also about laying the foundation for resilience, stability, and long-term development.
Some actionable strategies that reflect this broader vision of protection include:
Integrated Humanitarian and Development Interventions
Malnutrition is rarely the result of a single failure. More often, it stems from a convergence of poor health, inadequate care, unsafe water, and lack of education. Thus, food aid alone is insufficient to address this crisis. A more effective approach requires linking humanitarian relief with long-term development goals. For example, nutrition programs should be integrated into broader systems of care, including early childhood education, maternal mental health services, and access to clean water and sanitation.
Therefore, therapeutic feeding centres, run by national governments, international organisations such as UNICEF and the World Food Programme (WFP), and non-governmental organizations (NGOs), should also integrate parenting support and psychosocial services, particularly for caregivers experiencing trauma or displacement. School feeding programs should be expanded to include pre-school aged children and be linked with health screening and deworming initiatives. In India (see, for example, here), the Integrated Child Development Services (ICDS) links early childhood feeding with regular health checks and deworming. Similarly, in countries such as Ghana (see here), the school feeding programme includes kindergarten children while coordinating with health partners to deliver nutrition and deworming interventions. These combined services reduce malnutrition while supporting cognitive development, school readiness, and emotional well-being especially for children in conflict-affected settings.
Community-Based Protection and Resilience Programs
The success of any intervention depends heavily on local ownership. Communities, particularly women, traditional leaders, and youth groups must be empowered to take part in designing and delivering solutions. Community-based protection programs can strengthen social cohesion, reinforce restraint from violence, and support grassroots responses to shocks. In areas prone to armed violence, community watch groups can work with humanitarian actors to ensure safe access to nutrition services and report early signs of tension. Local agricultural cooperatives can be mobilised to provide emergency food reserves and share climate-smart farming techniques. Faith-based and indigenous institutions, which often remain functional even when state systems collapse, can serve as conduits for aid delivery and trust-building.
Climate-Smart Nutrition Initiatives
Climate adaptation must be at the heart of nutrition strategies in Sub-Saharan Africa. With rising temperatures and unpredictable rainfall undermining traditional farming cycles, interventions must prioritise climate-resilient solutions. Introducing drought-resistant crops, promoting agro-ecological practices, and diversifying livelihoods are essential to help families maintain access to nutritious food year-round, despite disruptions triggered by conflicts and climatic factors.
Additionally, mobile feeding centres equipped with ready-to-use therapeutic foods (RUTFs) can be deployed to reach children in hard-to-access or newly displaced populations. Urban gardens, hydroponics, and regenerative farming practices offer promising opportunities in both rural and peri-urban settings. These innovations not only enhance food availability but also create jobs, improve soil health, and reduce dependence on climate-vulnerable crops.
Data-Driven Early Warning and Response Systems
In an increasingly volatile region, preparedness saves lives. Investing in early warning systems that monitor climate patterns, food prices, conflict dynamics, and health trends can help states and humanitarian actors respond proactively rather than reactively. Such systems allow for the pre-positioning of essential supplies such as therapeutic foods, water purification kits, and mobile clinics in regions predicted to experience shocks.
Real-time nutrition surveillance using digital tools and local health workers can identify hotspots of malnutrition before they spiral into famine. Partnerships with meteorological services, research institutions, and local communities are crucial for designing systems that are both accurate and actionable. When early warning translates into early action, the worst outcomes for children can be prevented. In Sudan, for example, child-centred community flood awareness has proven to be a good practice for strengthening early warning systems. Through School and Community Disaster Management Committees supported by Save the Children and partners, children and local leaders were trained to share disaster risk knowledge, develop action plans, and respond to floods and other hazards. This approach empowered communities to translate early warnings into early action, enhancing resilience at the grassroots level despite national challenges.
Policy Harmonisation and Multi-Sectoral Planning
National and regional policies must reflect the interconnectedness between nutrition, climate resilience, and conflict sensitivity. A study that reviewed 30 policy documents covering both past and current national policies from Ethiopia, Ghana, Malawi, Nigeria, and South Africa found that this linkage remains weak across the subregion. Ministries of health, agriculture, environment, education, disaster management, as well as justice and foreign affairs and humanitarian agencies must coordinate their efforts through joint action plans and shared indicators. This requires political will, cross-sector collaboration, and the inclusion of marginalised voices particularly women and displaced populations in decision-making processes.
Investments in child nutrition should be embedded into national climate adaptation plans and peace building strategies. Governments should incentivise nutrition-sensitive agricultural investments, ensure that social protection programs target malnourished households, and integrate malnutrition screening into primary healthcare. At the regional level, mechanisms such as the African Union should facilitate knowledge sharing and policy coherence across borders.
Conclusion
Addressing child malnutrition in Sub-Saharan Africa is not just about saving lives – it is about restoring hope, dignity, and opportunity. This requires a comprehensive strategy that goes beyond emergency food parcels to tackle the root causes of vulnerability. Integrated services, empowered communities, climate-smart solutions, real-time data, and responsive governance together form the foundation for change. In doing so, we can turn the tide on one of the region’s most persistent tragedies and secure a healthier future for its children.