Conflict in Sudan deepens malnutrition crisis

Poor nutrition, poor access to health, water, sanitation and hygiene, and food are threatening the health of the country’s children

By Proscovia Nakibuuka Mbonye
UNICEF/UNI409651/Sara Awad
20 July 2023

Even before conflict erupted in Sudan three months ago, malnutrition rates among children under 5 years were on the rise. Three million under five children suffered from acute malnutrition, of whom 612,000 were severely malnourished. But as the fighting continues, tens of thousands of families on the move now find themselves at particular risk of food shortages and poor nutrition. This has resulted into an increase in the overall estimates of acute malnutrition among under five children to 3.4 million, of whom 690,000 are severely malnourished. 

During the ongoing fighting, more than 1.5 million people have fled their homes and started to suffer the consequences of the interruption of access to essential services, such as nutritious and optimal food, limited access to basic health services, limited access to safe and adequate water, sanitation services, and other factors that led to a further deterioration of nutrition among children under five.  

At the Al-Dabbaghah Health Centre in Gezira state, located in the east-central region of Sudan, mothers with children are queuing for healthcare services. Some children look frail, small, and unwell as they are screened for malnutrition as part of the routine medical assessments being conducted here.  

One by one they are weighed, and their arms measured using a colour coded tape, known as mid upper arm circumference (MUAC) tape, to quickly identify those suffering from malnutrition. During the process, health workers, with support from UNICEF staff, explain to the mothers the meaning of the three colours on the tape using very simple terms – green for normal, yellow for moderate malnutrition and red for severe acute malnutrition.

Before the onset of the current conflict, the health facility registered 10-15 cases of malnutrition monthly. But the number has significantly increased.

“We have registered 56 cases this month (July) alone and the majority are displaced people,” Hanan Abdullah, a nutritionist at the centre, confirms.

Among them is 16-month-old Mona. 

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UNICEF/UNI409666/Sara Awad

A few weeks ago, Mona’s health suddenly deteriorated.  

“She had slowly stopped eating food and liquids and was no longer able to breastfeed like before. She was irritable and cried a lot whenever the breastmilk wasn't enough,” her mother Aisha explained. 

Unlike in the past, eating three meals a day is next to impossible for this displaced mother of seven who fled conflict in Khartoum. 

“Our lives were lovely, we had regular meals and my children went to school,” Aisha says. “But suddenly everything has changed.” 

“Meals are no longer sufficient. If we eat breakfast, we don’t have dinner, and if we have dinner, we don’t break the fast. Sometimes we just eat boiled potatoes,” she continued.

The irregular meals are not only affecting her children, but her own health. She has noticed a reduction in breastmilk, for example, which is greatly affecting Mona’s growth.

During a recent visit to the displaced camp Aisha is currently staying in, health workers referred Mona to a health facility for a medical assessment. Aisha was worried about her daughter, and for good reason – the MUAC reading was red. 

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UNICEF/UNI409669/Sara Awad

But within a few days of her treatment beginning at the health facility, Mona can already smile. She sits on her mother’s lap nibbling on a packet of ready-to-use therapeutic food (RUTF), which contains the nutrients malnourished children need to heal. While she struggled to finish her first packet, today she finds it so appetizing and eats a packet within a few minutes. 

Aisha is happy with her daughter’s progress. 

“Today, they informed me that she is recovering from a serious condition,” Aisha says, noting her MUAC measurement has improved.

While Mona is on the road to recovery, many more children around her and in Sudan are slipping into malnutrition. Displaced families like Aisha’s are struggling to feed their children, while other families remain trapped in conflict-affected areas like the Darfur regions and Khartoum. And as is the case in conflict and other emergencies, children are bearing the biggest burden. 

Sadly, the situation has been exacerbated by the lean growing season, which has seen malnutrition rates in Sudan climb even further. 

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UNICEF Sudan/2023/Awad
9-months-old Nasra is screened for malnutrition during the weekly follow up visit to the health facility. “Since she started treatment two weeks ago, her condition has improved,” said Hala, her mother.
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UNICEF/UNI409659/Sara Awad
Ibtihal, 1, sits on her mother’s lap after a malnutrition screening. She is severely malnourished. “My daughter’s health worsened when the conflict started,” says Lily, a displaced mother from Khartoum. “I can’t breastfeed her anymore. I don’t have milk.” Ibtihal is now receiving therapeutic milk after being admitted to the health facility.
malnutrition crisis, armed conflict, fighting, UNICEF, Sudan
UNICEF/UNI409656/Sara Awad
Fatima, 2, is screened for malnutrition by Yousra Mohammed, UNICEF Nutrition Officer at Wad Madani children’s hospital.

UNICEF is staying and delivering

UNICEF continues to deliver nutrition services through more than 1,500 nutrition sites across the states, with provision of essential therapeutic and nutrition supplies, equipment, support towards implementation of mass screening, capacity building, and monitoring activities. 

malnutrition crisis, armed conflict, fighting, UNICEF, Sudan
UNICEF/UNI409678/Sara Awad

An estimated 76 per cent of the OTPs are functional across Sudan, with Darfur, Khartoum and Kordofan having fewer OTP sites that are functional. So far, more than 1.7 million children under-five have been screened for malnutrition, including in Darfur, out of whom 82,000 children with severe wasting were identified and treated with UNICEF support. (Low reporting rates continue to be a challenge, with only 43 per cent of facilities reporting in May).

Hannah and other health workers are supplementing the care with nutrition counselling sessions where mothers are encouraged to breastfeed their infants and are sensitized on food combinations using available foodstuffs to protect children from malnutrition, especially during critical times like these. 

Thanks to the generous contributions of our partners – the United States, European Union Humanitarian Aid, the United Kingdom, the Netherlands, France and the Central Emergency Reserve Fund – UNICEF reached hundreds of thousands of severely acute malnourished children with lifesaving therapeutic food and treatment.