Author: Steve Hansch

“Poor Relief” a Book by Heath Henderson, Critiques Cash Handouts

June 22, 2026   In his recent book, Poor Relief:  Why Giving People Money Is Not the Answer to Global Poverty (Harvard University Press, 2025), author Heath Henderson challenges assumptions about the sustainability and effectiveness of cash transfers to remedy poverty.

During the last 20 years, aid agencies have increasingly experimented with giving out cash to poor families around the world, either as loans (microfinance) or as grants, as a new ideal for aid, including to refugees and famine victims.  It supposes two things:  1) that individual choices are more effective than infrastructure or market programs, or provision of health services or food aid;  2) that cash is the binding constraint in overcoming poverty, not jobs, social structures, doctors, food availability, housing, market access, security, or legal rights.

Heath Henderson, Associate Professor of Economics at Drake University (with prior experience at the Inter-American Development Bank, World Bank, and United Nations), examines the actual effectiveness of direct cash transfers, whether unconditional cash transfers (UCTs), conditional cash transfers (CCTs), or universal basic income (UBI)-style programs.

Henderson concludes that “cash transfers are a flawed way to address extreme poverty. Cash programs do not combat the deep, structural issues that serve to keep people poor, such as racism or sexism, lack of access to quality education or health care, and even political exclusion.  In addition, money can’t buy everything a person needs to escape poverty, like a stable climate, clean water, or access to markets. Furthermore, some people can be left behind or outright harmed by cash programs, particularly women and children.”

His evidence includes long-term results of large cash programs as well as surveys of the views of their beneficiaries.  He finds:

“Given the limitations of cash transfers, it is no surprise that people living in poverty often prefer other forms of support.  … impactful and respectful poverty alleviation requires being more responsive to the voices of people in poverty, rather than assuming markets know best. Stated differently, eradicating extreme poverty requires looking beyond one-size-fits-all solutions and toward a truly bottom-up, democratic alternative.”

The poor often say they prefer community-level, longer-term interventions, such as infrastructure, clean water or healthcare.

Henderson traces the bandwagon support for and rapid growth of cash transfer programs.  For example, GiveDirectly’s (a popular non-profit) transfers (and donations) grew from $3 million (2014) to $543 million (2024).  Some experts have called cash handouts “as close as you can come to a magic bullet in development”.  Like microfinance before it, cash transfers have become a very popular fad, with poor evidence to support its efficiency.

Henderson provides a global and historical view of cash schemes, from English Poor Laws through Speenhamland, the New Poor Law, Bismarckian social insurance, negative income tax experiments, the EITC, Alaska Permanent Fund, Mexico’s Progresa/Oportunidades, Brazil’s Bolsa Família, India’s NREGS, South Africa’s child grants, China’s Di Bao, and Indonesia’s programs. By 2013, 76% of developing countries had such programs.

One large example:

The 2017–2018 Direct Benefit Transfer (DBT) pilot in Nagri, Jharkhand, India. The National Food Security Act had long allowed eligible households to buy rice for 1 rupee per kilogram at ration shops. The pilot replaced this with equivalent cash deposited into bank accounts. The architects of this program expected greater autonomy and choice. Recipients, however, protested en masse.  Over 1,000 people marched miles to the governor’s residence in Ranchi in protest.  Practical failures abounded. A woman named Jamna Sanga spent significant time and money (32 rupees on rides + fees to banking correspondents) checking balances, missing work days that paid 150 rupees each, and forcing her daughter to miss school for water collection. A government audit of over 8,000 beneficiaries found the average person claimed only 3.6 of 6 entitled installments.  Famine expert Jean Drèze noted that “the elderly, the disabled, the ailing and the most vulnerable” were least likely to claim benefits.

Surveys reinforced the point.  In nine Indian states (~1,200 poor rural households), over two-thirds preferred in-kind transfers. A 60-year-old tribal widow, Aetwaribhai, explained: “It is very difficult to get rice in the market. I am too old to go and search for rice.” A Bihar poll (~3,800 respondents) found 86% preferring public health investments over cash and 65% preferring improved roads.  Henderson uses this to illustrate broader problems: implementation frictions, exclusion of the vulnerable, preference for public goods over individual cash, and the risk that cash programs can even exacerbate harms (e.g., one Indian program linked to a 1.0–2.3% rise in sex-selective abortions). He notes that even when the old in-kind system had corruption issues, many still preferred it to the cash experiment, which was eventually scaled back in Nagri.

Henderson recounts numerous other experiments in cash transfers with mixed outcomes, and where effects are poor, efficiency from large-money transfers seems particularly poor.  Particularly in regard to malnutrition, he finds that half of cash programs reviewed had negative effects on height-for-age (stunting of children), and the majority had negative effects on weight-for-age.  “The simple conclusion is that cash transfers just aren’t that powerful for fighting malnutrition.”

In the Philippines, the Pantawid conditional cash transfer program increased the local price of protein-rich perishable foods by 6-8% and had spillover effects for families not in the program.  Ineligible neighboring children showed increases in wasting malnutrition and stunting.

Many of the problems with cash, he details, come from blunt approaches to targeting, that do not reach those most in need.  For instance “most of Africa’s nutritionally deprived women and children were not…found in the most economically disadvantaged households.  .. roughly 75% of underweight women and undernourished children were not in the 20% of households with the lowest wealth levels.”

He explains “Cash transfers rely heavily on markets for poverty alleviation, but this approach is only effective to the extent that people can buy what they need to pull themselves out of poverty.  In short, cash transfers inherit the limits of markets, and we’ve seen that markets fail to deliver many goods that are vital to human well-being.  Safe blood, clean air, clean water, quality education and quality healthcare are just a few leading examples.”

He points to some positive examples, including programs that promote complementary feeding education, zinc supplementation, small-quantity lipid-based nutrients, ready to use supplementary food, family planning and insecticide-treated bednets to prevent malaria.

Overall, Henderson distinguishes between the individualist and the structuralist approaches to fighting poverty.  Cash transfers follow the individualist approach, which often perpetuates the status quo.  Henderson calls for decentralized structural change. He reminds readers of how Amartya Sen argued that famines do not occur in democracies because democracy creates channels for local knowledge to be passed on to policy-makers.

Since its publication, Henderson says

“I’ve been quite pleased with the reception of the book. The book has generated a fair amount of interest within the targeted audience, and I’ve also seen several positive reviews of it. Beyond that, I’ve had many conversations with people expressing to me that the book provides a much-needed reality check on the hype around cash transfers. All in all, the reception has definitely exceeded my expectations.”

Henderson has created a nonprofit, JustGive.  In place of paternalism, Just-Give uses democratic methods to identify the causes that people in need themselves judge to be valuable and impactful.  Its flagship initiative is the Iowa Food Security Forum, planned in partnership with the Des Moines Area Religious Council (DMARC) and scheduled for Des Moines in fall 2026. The forum is built around a “deliberative poll,” a methodology associated with Stanford’s Deliberative Democracy Lab (James Fishkin’s work).

The program in Iowa recruits a large sample of food-insecure Iowans, gives them briefing materials, expert plenary sessions, and small-group discussions, then surveys them before and after; the shift in informed opinion is meant to feed into how local policymakers and nonprofits respond to food insecurity.  It tests an approach to deliberative democracy, believing that lay participants, once informed and allowed to deliberate, produce more considered and legitimate preferences than a raw opinion poll would capture.

Study from China: Nutritional Deprivation Early in Life Has Long-term Consequences

June 20, 2026   A new Study in Social Science & Medicine, which tracks over 15,000 Chinese over many years finds that early childhood exposure to famine is associated later in life with poorer cognition, arthritis, rhemitism, job loss and early retirement.

The study by Qixin Zhu, Eleanora Fichera, Habtamu Beshir and Andrea Serna-Castano, “The Long-Term and Economic Impact of Childhood Early Life Shocks” (2026) (10.1016/j.socscimed.2026.119485) draws on longitudinal data from the China Health and Retirement Longitudinal Study (CHARLS), collected in 2014 and 2018, sampling 15,471 individuals born between 1941 and 1974.

The map at left shows the intensity of famine at the preficture level.

The authors studied “the long-run consequences of nutritional shocks associated with the Great Chinese Famine—the largest famine in human history, with an estimated 30 million deaths (Smil, 1999).”  They identified “individual-level starvation experience and fine-grained measures of famine intensity at the prefecture level, capturing substantial intra-provincial heterogeneity that is obscured in province-level analyses.”  They examined long-term effects including “less explored economic outcomes that are closely linked to health deterioration, namely joblessness due to poor health and early retirement.”

The abstract explains:  “exposure to famine represents a severe early-life shock that may shape health, cognitive, and labour-market outcomes across the life course. Yet evidence on its causal consequences in later life remains limited. This study examines whether early-life starvation during the Great Chinese Famine (1959–1961) affected later-life health, cognitive functioning, and labour-market outcomes. …We exploit prefecture-level famine intensity and famine exposure to instrument for self-reported childhood starvation, allowing for the identification of heterogeneous effects across childhood age stages. Our findings point to early childhood (ages 0–5) as a particularly sensitive period. Starvation during this stage is associated with poorer memory and a higher prevalence of arthritis and rheumatism, with more tentative evidence of adverse labour-market consequences, including health-related job discrimination and early retirement”

the Abstract  continues:  “Cognitive and physical outcomes are more pronounced for females, while economic penalties are concentrated among males, reflecting the gendered allocation of intra-household resources and labour pressures. Exposure during later childhood shows weaker effects. Overall, this study demonstrates that early-life nutritional shocks have long-lasting, age- and gender-specific consequences, emphasising the critical role of early childhood nutrition in shaping human capital, cognitive development, and labour-market participation in later life. These findings highlight the long-term costs of early-life deprivation and suggest that policies protecting children during periods of crisis may generate benefits across the life course.”

The authors distinguish between two “distinct forms of early-life nutritional shocks: famine exposure and childhood starvation experience. Famine exposure captures large-scale, region-wide shocks that disrupt food systems and living conditions, while childhood starvation experience reflects individual-level exposure to acute nutritional deprivation.”

They found that early-life nutritional shocks:

◊  Shape inequality even well into older age;

◊  Increase scores of mental depression and reduction in memory performance

◊  Increase by 15% the likelihood of arthritis or rhematism

◊   A lower probability of entering middle school.

◊  Affect women more than men, in terms of cognition and physical impacts,

◊  Affect men more in terms of jobs and economic penalties affect.

PDF version is available here.

The study’s authors are from the University of Bath, UK, and the Social Research Institute, UCL, UK.

–  Contributed by WHES board member, Steven Hansch

 

Ethiopia’s Decades-Long Malnutrition Crises

June 16,2026      In Ethiopia, Africa’s second-most populous country, roughly one in eight Ethiopians suffer food shortages in mid-2026 in many region-specific overlapping crises caused by fighting, drought, population displacements, refugees, sky-high prices, and sudden cuts in international aid.

A 2026 humanitarian analysis citing FEWS NET projected about 15. to 16 million Ethiopians in acute food insecurity, with IPC Phase 3 Crisis and Phase 4 Emergency conditions expected in parts of the country by this coming July 2026.  Large parts of eastern and southern Ethiopia are at “Crisis” level, meaning families are skipping meals, selling their animals, and running out of options. Some pockets near Harar, Dire Dawa, and the lowlands of East Hararghe in the east are Emergency level. Conflict-hit areas in Amhara and Tigray are also food insecure.

Children suffer most. Many are “wasted” (too thin for their height), which weakens their immune systems and can cause lifelong problems. In treatment centers in Gambella, the death rate for severely malnourished children reached 3.2%. . Similar death rates appear in Benishangul-Gumuz (2.7%) and South Ethiopia (2.8%). These are regions with almost no aid organizations working on nutrition, even though the need is urgent.

Tigray has repeatedly been a particular famine zone. SMART surveys and rapid nutrition assessments in Tigray and Amhara found child acute malnutrition above 15%, and 20% in four Tigray woredas.  From 2020 to 2022, a war between the government of Ethiopia and Tigray created a humanitarian crisis in Tigray.   Nutrition reporting from Tigray during the war was sparse.  Estimates of famine and civilian deaths during the war range from 96,000 to 378,000.

Causes for Ethiopia’s food crisis today:

  1. Conflict and displacement Fighting in Amhara, parts of Oromia (especially Wellega zones), and earlier wars in Tigray have forced more than 1.5 million people from their homes in Amhara and Afar alone. When people flee, they lose their farms, livestock, and access to clinics. Many health centers were looted or destroyed, so children cannot be screened or treated for malnutrition.
  2. Drought and climate shocks Pastoral communities in the Somali region (especially Doolo and Korahe zones), Afar, and South Ethiopia have suffered years of failed rains. Herders lose their animals — their main source of food and income. Some areas also face floods that destroy crops. These zones are often remote and “data-dark,” meaning they have not been properly surveyed recently, so the true scale of suffering is hidden.
  3. Aid cuts and supply breaks In 2023 a major scandal over stolen food aid led to a nationwide pause in deliveries. In 2025, big funding cuts (especially from the United States) caused the main program that feeds moderately malnourished children to stop across the entire country. Special peanut-paste treatment for severely malnourished kids also ran short. Refugee camps in Gambella region saw nutrition services shut down in several camps.

Foreign Assistance

Over the last fourty years, Ethiopia has received more food aid than any other country, around $20 billion worth, about half of it from the United States.  Most of the food aid has been to avert malnutrition among children or respond to famine.  Food aid was interrupted in 2023 over findings of food theft.

In the last decade, the U.S. Government has invested heavily in a single country-wide program called the Joint Emergency Operations Program (JEOP), led by Catholic Relief Services and including CARE, World Vision, Save the Children, Food for Hungry, ORDA, and REST.  Currently, the US Department of Agriculture is funding WFP in Ethiopia and reviewing proposals for new NGO emergency food and nutrition assistance, likely in the $80 million range.

Separately, the Joint UN Initiative for the Prevention of Wasting was launched in Ethiopia in August 2025 by the Federal Ministry of Health with WHO, UNICEF, and WFP, supported by FCDO. It is a five-year, multisectoral effort to prevent wasting among children 0–18 months in food-insecure settings.

The Ethiopia Nutrition Cluster (a group of UN agencies and NGOs) coordinates humanitarian assistance. dozens of high-need zones, especially in Gambella, South Ethiopia, parts of Somali, and conflict areas of Amhara and Oromia, have zero or only one nutrition partner. These “neglected gap zones” are the places where extra help could save the most lives.

In addition to the agencies mentioned above, aid nonprofits (NGOs) that address food and nutrition in Ethiopia include:  Oxfam, Welthungerhilfe, GOAL, Mercy Corps, Action Against Hunger, Project Hope, Tearfund, Plan International, Concern Worldwide, Islamic Relief, Cordaid, Terre des Hommes, and Norwegian Church Aid.

Many aid agencies work via networks such as the half-century-old  Consortium of Christian Relief and Development Associations (CCRDA).   In Tigray, a long-term relief agency that managed food aid in multiple famines is the Relief Society of Tigray, known as REST.

–  Contributed by WHES board member, Steven Hansch

 

Ebola Control Lessons from Past Outbreaks

June 18, 2026    Food insecurity the Democratic Republic of Congo (DRC) has formed a vicious circle this year with the latest Ebola virus outbreak, now the 17th recorded and the largest to date in terms of people infected.

The Adventist Development and Relief Agency (ADRA) is an example of an NGO that has been providing large scale food assistance in eastern DRC and has addressed the current and past outbreaks of Ebola with community education, hygiene promotion, and water, sanitation, and hygiene.

UPDATE:  nutrition specialists have now created a dedicated Ebola-nutrition response structure. Two new postings on September 4—an August Nutrition Cluster/UNICEF Ebola nutrition SitRep and a separate operational framework for the nutrition sub-pillar—show that nutritional management is being formally incorporated into the Ebola response rather than treated as an ancillary service.

Lessons from the earlier West African Ebola outbreak include the value of self-isolation (self quarantine of people who may have been exposed to Ebola) which was a critical measure to interrupt transmission, and, in turn, self-isolation depended on aid agencies providing ample food aid to compensate the family for lost income.   Today, the World Food Programme is doing the same thing, providing food aid to contacts and patients in DRC.

The map below shows the current spread, in 2026 of the virus, and possible future routes of spread.

In the West Africa outbreak there were 11,323 recorded deaths but probably over 30,000 actual deaths, where the majority of Ebola cases were never reported.  The United States Government alone spent some $2 billion on that earlier Ebola response.  The United Kingdom spent £667 million (roughly $850 million–$1 billion at 2014–2016 exchange rates), and the World Health Organization spent some $500 million.

The USAID evaluation of that outbreak response was commissioned by Jeremy Konyndyk, then Director of the Office of U.S. Foreign Disaster Assistance. Writing in the New York Times on June 13, he warned that the current DRC outbreak could become the worst ever.  He reports that the Centers for Disease Control and Prevention (CDC) projects that more than 20,000 cases may occur by late August. Konyndyk notes: “As bad as this situation is, we have a playbook for addressing such crises. But it requires a huge team effort.” He calls for specialized clinics, large‑scale contact tracing, safe burial management, and adequate personal protective equipment for health workers. However, he cautions that “security has deteriorated markedly as the government has lost control of large parts of the area.”

With clear relevance for the current global Ebola outbreak, a series of lesson‑learning roundtables were held in 2017 at George Washington University, Harvard University, and the Uniformed Services University of the Health Sciences. These discussions were part of a lessons‑learning evaluation requested by USAID and were intended to reflect on operational challenges during the West African Ebola crisis.  Each roundtable included seasoned emergency practitioners who had overseen or implemented programs in Liberia, Sierra Leone, and Guinea during the lethal 2013–2016 outbreaks.

The Harvard Roundtable concluded that the greatest challenges in the Ebola response involved trust, including community skepticism and occasional violence. One participant warned that “we are setting ourselves up for the same problems all over again.” Families were initially reluctant to cooperate with referral systems in which infected relatives were taken away with little explanation. As one participant noted, once treatment centers were introduced and communities saw that Ebola was not always a death sentence, and that patients could both enter and leave safely, community transmission began to decline. Another participant observed that promising “Community Care Centers” were denied or delayed funding unless the NGO also staffed a larger hospital. Others emphasized that faith‑based organizations were often more effective at face‑to‑face engagement with communities.

The 2016 lessons roundtable held with U.S. military representatives highlighted the indispensable role of the U.S. Navy’s Mobile Diagnostic Laboratories (MDLs) in West Africa. Operated by the Naval Medical Research Center (NMRC) in Guinea and Sierra Leone, these PCR‑based laboratories provided the only rapid diagnostic capacity early in the outbreak. The U.S. Air Force also played a critical role in airlifting doctors and epidemiologists across Liberia during the fall of 2014.

The roundtable at George Washington University’s Milken Institute School of Public Health, composed largely of NGO headquarters emergency coordinators—generated two major cautions about international response. First, although each NGO had developed new guidelines and standard operating procedures for Ebola‑type emergencies, there was no funding to package, archive, or preserve these materials for future use, and many were already being lost. There was no forward planning for how such lessons might be applied in future outbreaks, including today in the DRC.  Second, although not on the agenda, participants volunteered that their organizations now have serious reservations about having responded at all, given the massive legal and duty‑of‑care liabilities they incurred. Donors urged NGOs to respond, but were unable to shield them from punitive audits afterward.

Key lessons about reducing transmission of Ebola in West Africa in 2014-2016 were published from a USG-commissioned  evaluation  which looked at all donors, UN agencies, NGOs, academia and other actors.  The reports from that evaluation are linked below.

Four key lessons jump out from the research:

First, the aid response of separating family members with symptoms of Ebola had the unintended effect of discouraging honest reporting or referrals, such that the total official death count across West Africa was much lower than the true cause of death.

Second, what mattered the most in interrupting transmission was when local populations observed deaths of people they knew which led them to take seriously new changes in behavior (not touching the bodies of people wiht Ebola).  This was the essential change that had to occur.

Third, much of the efforts overall by aid agencies had less of an effect in “bending the curve” of the epidemic than the simple communications by the families and communities affected.

Fourth, while many health professionals died early in the outbreak, attention to protecting them, including provision of protective gowns/gloves and equipment was necessary for further work to be achieved.

Food and Nutrition:

Food aid functioned less as a nutrition intervention and more as an enabler of disease control.  Its main value was making isolation and quarantine viable. Qualitative data indicated that food distributions to isolation and treatment units, facilitated by Food for Peace (FFP), improved the effectiveness of isolation, quarantine, and  response actions at community-based sites of transmission. FFP food distribution played a critical role in supporting isolation and restrictions on mobility,  in response to warnings from implementing partners about food shortages among quarantined communities.

The scale was significant:  through the end of 2014, USAID awarded nearly $35 million in food assistance to WFP through the Office of Food for Peace.  Examples include WFP providing all patients discharged from the Guékédou treatment unit in Guinea with a 60-day food ration on leaving, and continuing general distributions of 45-day rations (rice, oil, pulses, salt) in affected communities.

 The proportion of quarantined households that received food support was roughly similar across all three countries, between 60 and 70 percent.  In Guinea, quarantined families with Ebola cases were more likely to have received food support in urban areas (89%) than in rural areas (53%),  part of a broader urban bias the evaluation flagged in how supplies were targeted. Notably, the reports treat food almost entirely as rations/in-kind support for isolation; there is essentially no analysis of nutritional outcomes per se.

Behavior change

Behavior change was identified as one of the most decisive factors in bending the epidemic curve — arguably more than clinical capacity. The most effective USG-funded activities were nationally-led incident management and coordination, social mobilization, and safe human remains management; as OFDA scaled up community engagement — health education, household isolation, hygiene kits, community outreach, adapting safe burial practices, and involving local leadership — a downward trend in new cases is clearly seen in the data.

The substance of the behavior change effort was straightforward but hard to achieve: much of the social mobilization effort was oriented toward changing simple behaviors such as shaking hands, other physical contact, washing hands, and the handling of infected persons and dead bodies. The key lesson was sequencing — which donors under-prioritized at first.  Whereas  early priorities focused on facility-based responses, case isolation, treatment, and safe burial, donors and NGOs failed to prioritize social mobilization and community-level responses.  Key lesson: social mobilization is the most relevant at the outset of the response.  Aid agencies should hire and deploy anthropologists.

When trusted local actors led it, the payoff was fast:  one Government of Guinea informant noted that within 1–2 months of accelerated social mobilization, the number of prefectures reporting social resistance dropped from 27 to 4.

A cross-cutting theme among evaluators were that while more than 90% of activity monitoring targets were reported as achieved, this reflected only activities and reveals little about actual change in bending the epidemic curve,  a major limitation in analyzing the USG contribution.

These reports, led by the independent evaluation organization IBTCI were available on the USAID Development Experience Clearinghouse until a year ago when the Administration dissoved it.  They are accessible via these links below:

 Synopsis:     https://www.worldhunger.org/wp-content/uploads/2026/06/Synopsis-of-Ebola-West-Africa-Evaluation.pdf

        Coordination:  https://www.worldhunger.org/wp-content/uploads/2026/06/Ebola-Response-Eval-4-Coordination.pdf

        Effectiveness:  https://www.worldhunger.org/wp-content/uploads/2026/06/ebola-ibtci-eval-effectivenes-1.pdf

         Relevance:   https://www.worldhunger.org/wp-content/uploads/2026/06/Ebola-evaluation-Relevance-of-response-3.pdf

        Components:   https://www.worldhunger.org/wp-content/uploads/2026/06/Ebola-evaluation-vol.-2-effectiveness-of-components-2018.pdf

A 2020 review of some selected lessons about the West Africa and DRC Ebola responses, largely non-medical, was commissioned by ALNAP here, focusing on community trust and messaging.

at the same time, ALNAP recommends these infection and control guidelines from WHO.

An earlier article about pandemics and hunger was published by Hunger Notes here.   A Hunger Notes interview about Covid-19 and hunger also addresses these relationships.

See also the review about public health communication campaigns.

–   Contributed by WHES trustee, Steven Hansch

Most of Yemen is Now Hungry, UN Declares

June 17, 2026    Yesterday, the UN was advised that the extent of food insecurity in Yemen had ratcheted up further:  “The hunger crisis in Yemen is worsening sharply, with the share of people unable to meet basic food needs rising from about half to nearly 60 percent within a month,” UN Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator Tom Fletcher warned on Tuesday, calling for urgent funding to prevent further starvation.  “The number of Yemenis facing the most severe levels of deprivation has increased from one in four to nearly one in three. More than 18 million people, …are now experiencing acute hunger, ” Fletcher told the UN Security Council during a June 16 briefing.

Over 2.2 million children under five are acutely malnourished, including more than half a million in the severe, life-threatening form. Nearly half of all children under five suffer chronic malnutrition (stunting), locking in lifelong disadvantages for a generation. In hard-hit areas, half of households with young children report at least one malnourished child, while one in four has a malnourished pregnant or lactating woman.

The Integrated Food Security Phase Classification System (IPC) of famine predicts and projects a growing number of regions moving into Phase 4 — Emergency, shown in red in the map at right — for the period September to December 2026.  The Orange Zones are very food insecure and Red are emergency.

The 2026 Yemen Humanitarian Needs and Response Plan of the U.N. requested $2.16 billion for aid in order to reach 12 million of the 22.3 million people in need of assistance.  Yet, donor fatigue and competing global crises threaten another shortfall. Recent floods have destroyed displacement camps and livelihoods, while economic pressures and regional shipping tensions continue to inflate food and fuel prices. In government-controlled areas alone, nearly half the population now are now suffering crisis-level acute food insecurity, with emergency levels expected to climb through the lean season.The country’s arid climate, limited arable land, and chronic water scarcity have always constrained domestic production. Yemen has long depended on imports for over 90 percent of its food, especially wheat, of which it imports around 96 percent, leaving it acutely vulnerable to global price spikes, shipping disruptions, currency collapse, and fuel shortages that drive up transport costs.  War has only deepened this dependency.

The current civil war, fueled by Iranian support to Houthi rebels, has made humanitarian aid more difficult.  NGOs that had been building long-term food resilience for years had to shift to more short-term life-saving aid.  Damaged irrigation, lost livestock, displacement of farmers, and soaring input costs have left cereal production well below average. Even when commercial imports through Red Sea ports remain adequate in volume, economic collapse and rial devaluation put basic staples beyond reach for millions.

The chart at right comes from the CEOBS Report: Yemen’s agriculture in distress – ceobs.org

What is new and especially alarming in 2026 is the sharp contraction of the humanitarian response itself. In January, the World Food Programme announced it was terminating operations and contracts for its 365 staff in Houthi-controlled northern Yemen, home to roughly 70 percent of the country’s humanitarian needs—after repeated obstructions, arbitrary detentions of aid workers, and an increasingly impossible operating environment. This followed earlier suspensions and adds to chronic underfunding.  The 2025 appeal was only 29 percent funded, forcing agencies to scale back nutrition, health, and food programs nationwide.

Yemen’s food insecurity has deep roots, but the convergence of aid cutbacks, operational halts in the areas of greatest need, economic freefall, and climate shocks risks erasing fragile gains in nutrition and pushing more families beyond their breaking point.

Aid agencies helping to address malnutrition in Yemen include:  the International Committee of the Red Cross, Action Against Hunger, Save the Children, the International Rescue Committee, Médecins Sans Frontières, CARE, Norwegian Refugee Council, Danish Refugee Council, Oxfam, Islamic Relief, Medair and the Adventist Development and Relief Agency.  Relief International is working with WFP in food aid in the south of Yemen.  UNICEF coordinates much of the nutrition programming for children and mothers, and the U.N. Nutrition Cluster (led by UNICEF), which reports for 44 operational nutrition partners in Yemen.

Further information, see:  https://www.nutritioncluster.net/country/yemen

and https://fscluster.org/yemen

–  Contributed by WHES board member, Steven Hansch

 

Strengthening Nutrition Action in “Field Exchange”

June 16, 2026   The latest (April 2026) edition of the “Field Exchange“ journal, by the Irish Emergency Nutrition Network, about combatting malnutrition in emergencies includes the following findings:

Relapse-inclusive costing of simplified CMAM protocols: Lessons from Mali (Original Article by Nina Firas et al.)  This non-randomized study in Gao, Mali, conducted a provider-perspective costing analysis of standard versus simplified community management of acute malnutrition (CMAM) protocols for uncomplicated severe acute malnutrition (SAM) in children aged 6–59 months, explicitly including costs of post-discharge relapses over an eight-month follow-up. Findings showed similar or slightly higher per-episode treatment costs for the simplified protocol due to longer length of stay, but substantially lower average cost per child treated when relapses were included (USD 139 vs. USD 169 for standard), driven by much lower relapse rates in the simplified arm; comorbidities strongly predicted relapse. The authors conclude that relapse-inclusive economic evaluations provide a more accurate measure of program efficiency and sustainability, and that investing in stronger post-discharge follow-up and relapse prevention yields both clinical and financial gains, even in fragile, insecure settings where pragmatic costing remains feasible and valuable.

 Keeping nutrition a priority in a constrained funding environment: A conversation with Lord Jonny Oates (Views)   Lord Jonny Oates, Chief Executive of United Against Malnutrition & Hunger, reflects on his early experiences with famine in Ethiopia that shaped his lifelong commitment to nutrition as foundational to human development, societal stability, and global security. He discusses the alliance’s efforts to rebuild UK leadership in nutrition advocacy amid aid cuts, stressing the need to link nutrition to high-priority government agendas (climate, migration, security, economic growth) and to balance immediate humanitarian response with long-term investments in food systems, health services, and climate resilience. Oates emphasizes that cutting nutrition funding is a false economy, advocates for fairer debt restructuring and innovation/research support, and advises nutrition professionals to communicate clear returns on investment while persistently aligning messages with policymakers’ priorities without giving up.

 Can artificial intelligence support infant feeding during conflict?  Lessons from Ukraine (Original Article by Olena Rozhenko et al.) In response to disrupted in-person breastfeeding support and rising misinformation during the Ukraine conflict, FHI360 implemented the Harmony of Parenthood initiative across four oblasts, integrating a closed-domain, Telegram-based AI chatbot for evidence-based IYCF-E and psychosocial support with facility-based counselling by trained health workers and a structured mentorship program. The chatbot reached over 2,000 unique users with high engagement and satisfaction (93–99% found information useful and clear), while combined services increased exclusive breastfeeding rates from 60% to 69% among mothers receiving repeated support and improved counselling quality and consistency through mentorship and feedback loops. The experience demonstrates that responsibly governed AI tools (with human oversight, pre-approved content, and clear referral pathways) can responsibly extend reach and reinforce messaging in humanitarian settings without replacing skilled human support, offering practical lessons for ethical digital innovation, content governance, and integration into national systems.

 Group relactation: Experiences from the Philippines (Original Article by Ines Avellana Fernandez et al.)  Arugaan, a women-led organization with decades of emergency experience in the typhoon-prone Philippines, supports group re-lactation in mother-baby areas during crises by helping mixed- or formula-fed mothers restart breastfeeding through culturally adapted techniques including cross-feeding (wet nursing), drip-drop feeding, full-body lactation massage, and peer support groups. Success stems from deliberately building breastfeeding self-efficacy by addressing misconceptions, educating mothers on lactation physiology (prolactin for supply and oxytocin for let-down), creating safe empowering environments, and leveraging existing cultural practices while providing practical skills and peer modelling. The approach has enabled thousands of mothers to successfully relactate, underscoring that intentional investment in community-based, gender-responsive support can protect breastfeeding as a safe, sustainable, life-saving feeding option in emergencies where formula feeding carries high risks.

 Private-public partnerships in action in India: Experiences from the Nand Ghar program (Original Article by Rohini Saran et al.)  The Nand Ghar initiative is a large-scale public-private partnership between Vedanta (through its CSR) and Indian government bodies to upgrade over 12,000 Anganwadi centers into modern “smart” centers providing enhanced early childhood development, nutrition, health, and women’s empowerment services across 17 states. It addresses systemic gaps in infrastructure, frontline capacity, service quality, dietary diversity (via nutri-gardens), and monitoring through upgraded child-friendly facilities, targeted training, digital tools/AI dashboards, community mobilization, and time-bound operational support, with government retaining ownership and scaling responsibility. Key lessons include the importance of early co-design with government, working within existing systems for legitimacy and scalability, combining infrastructure upgrades with capacity building and accountability mechanisms, and ensuring private support leads to sustainable institutionalization and community ownership rather than parallel structures.

Using Nutrition Impact and Positive Practice (NIPP) to address malnutrition: A decade of lessons (Original Article by Ellise Brennan et al.) NIPP is a grassroots, gender-responsive, positive-deviance-based approach implemented by GOAL over more than a decade in six countries that uses 12-week participatory learning circles (separate for men and women) featuring practical cooking demonstrations, micro-gardening, hygiene infrastructure, and behavior-change sessions to address underlying causes of malnutrition in households with moderate wasting or at risk. Program data from Sudan, Niger, Malawi, and Zimbabwe showed high cure rates at graduation (73–96% for children with moderate wasting) and very low relapse rates (<2% at 2–12 month follow-ups), alongside sustained improvements in dietary diversity, feeding practices, hygiene behaviors, and household food security, with the approach proving more cost-effective and sustainable than input-heavy interventions because it builds community capacity and self-reliance. NIPP has been successfully institutionalized within national systems in several countries, demonstrating its potential to complement treatment programs by reducing relapse and supporting long-term nutrition recovery through community-driven, low-input behavior change.

The nutrition emergency situation in Pakistan: A call to action (Letter by Dr Abdul Baseer Khan Achakzai)   Dr. Abdul Baseer Khan Achakzai outlines Pakistan’s severe and worsening nutrition crisis, marked by high stunting (40%), wasting (18%), underweight (29%), and anemia rates among children under five, alongside a double burden of malnutrition and limited access to services, especially in rural areas. He attributes the crisis to structural factors including low health expenditure (<2% of GDP), climate shocks (floods, droughts, heatwaves), rapid population growth, weak governance, provincial disparities, and slow operationalization of the 2022 National Public Health Nutrition Strategy amid fiscal constraints and competing priorities. The letter calls for protected nutrition budget lines, integrated multi-sectoral responses, strengthened provincial capacity, accountability mechanisms, and sustained international support aligned with SDGs and the Global Action Plan on Child Wasting, positioning Pakistan as a case study of systemic vulnerability in a climate-stressed, resource-constrained setting.

A shorter article is about policy alignment analysis of the MAMI approach in Senegal (largely aligned with national strategies but with identified gaps in maternal mental health and support for vulnerable/disabled infants),  Also included were Research Snapshots and Report Summaries cover topics such as relapse economics, WHO wasting guideline gaps, anticipatory action, and ultra-processed foods but are concise overviews rather than full articles.

–  Contributed by WHES board member, Steven Hansch

 

Kenya’s Arid Lands Face Persistent Hunger Crisis in 2026

June 14, 2026     Kenya continues to face severe hunger and malnutrition in its arid and semi‑arid lands (ASAL), where drought, high food prices, and weakened pastoralist livelihoods have pushed millions into crisis. According to the U.S. Famine Early Warning System (FEWS NET), 2.5–2.99 million people currently need food assistance, with needs possibly declining to 1.5–1.99 million by December 2026 if weather conditions improve.

However, more recent field data from Action Against Hunger (ACF) and partners show a sharper picture:   3.7 million people are in IPC Phase 3 (Crisis) or worse, including 400,000 in IPC Phase 4 (Emergency).  This represents a dramatic increase (a 52% jump) compared to early 2025.).

Where the Crisis Is Most Severe

Northern and northeastern counties remain the hardest hit. Nutrition assessments in early 2026 classified:

  • »  Mandera, Turkana South/East, and parts of Marsabit as Extremely Critical (IPC Acute Malnutrition Phase 5)
  • »  Garissa, Wajir, Isiolo, and Samburu as Critical (Phase 4)

These counties account for about 62% of Kenya’s total malnutrition burden.

Recent data from UNICEF, the Ministry of Health, and the National Drought Management Authority (NDMA) estimate:

  • »  810,871 children under five need treatment for wasting (up from 760,488 in 2025)
  • »  116,800 pregnant and breastfeeding women also require treatment

Malnutrition Levels Remain Alarmingly High

SMART surveys and community screenings show persistently high wasting rates:

  • »  Wajir: 14.95% GAM (2023)
  • »  Baringo/Tiaty: 21% GAM
  • »  Turkana (some areas): ~33% GAM in community screenings
  • »  Turkana (2024 SMART): GAM declined from 26.4% to 21.8%—still above the 15% emergency threshold

In several northern counties—Mandera, Turkana South/East, and North Horr—analyses in late 2025 and early 2026 indicated Extremely Critical levels, meaning wasting rates of 30% or more. As your text states, “Northern areas such as Mandera, Turkana South/East, and North Horr reportedly reached Phase 5 ‘Extremely Critical’… corresponding to a rate of wasting malnutrition of 30% or more.”

A major warning sign is the collapse in mass screening coverage, which fell from 75% of hotspots in 2023 to under 15% by August 2025 due to funding shortages. This means many children with acute malnutrition are simply not being identified.

Drivers of the Crisis

The hunger emergency is fueled by overlapping shocks:

  • »  Erratic rainfall and recurring drought
  • »  High food prices
  • »  Poor livestock‑to‑cereal terms of trade
  • »» Livestock deaths and reduced milk production
  • »  Insecurity along the Kenya–Somalia border and in parts of Turkana

These factors have eroded pastoralist livelihoods and reduced household access to food.

Refugee Camps Under Severe Strain

Kenya hosts roughly 720,000 refugees in Dadaab, Kakuma, and Kalobeyei. Food rations have been cut to 28% of standard levels, worsening malnutrition among Somali and South Sudanese refugees. Funding gaps have also caused stockouts of ready‑to‑use supplementary foods (RUSF) and therapeutic foods in several hotspot counties.

Mixed Outlook for Late 2026

FEWS NET projects that food insecurity may ease by December 2026 if rainfall and harvests improve. But high prices and the upcoming lean season mean many households will remain in IPC Phase 3 (Crisis) or worse without continued support. National‑level improvements risk masking localized Phase 4–5 emergencies in remote ASAL counties and refugee settlements.

Humanitarian Response

Several NGOs continue to deliver life‑saving assistance:

  • »  Action Against Hunger (ACF) operates across Samburu, Baringo, West Pokot, Isiolo, Tana River, Kwale, Mandera, and the refugee camps, often using UNICEF and WFP supply chains for last‑mile delivery.
  •   International Rescue Committee (IRC) leads nutrition programs in Kakuma.
  • »  Médecins Sans Frontières (MSF) supports health and nutrition services in Dadaab.
  • »  World Vision, Humanity & Inclusion, Cordaid, and Kenya Red Cross work with county governments on community outreach, CMAM programs, and cash support.

These organizations coordinate through the Kenya Nutrition Cluster to address both immediate treatment needs and the underlying drivers of hunger.

– Contributed by WHES Board member Steven Hansch

Salud (Health) Everywhere, a Valuable Educational Site

June 9, 2026       Hunger Notes recommends students and practitioners to refer to and read the website “Salud Everywhere”, which is an expanding source about nutrition, humanitarian aid and health.

See:  https://saludeverywhere.com/en/health-in-humanitarian-crises/nutrition-in-humanitarian-action/

It has pages about world hunger, stunting, micronutrient deficiencies, low-birthweight and other key topics of relevance.  It provides a list of List of NotebookLMs (AI information) about humanitarian action and development cooperation.

Each page or section of the site is available both in Spanish and English languages.  It grows by the day.

The site’s author is Dr. Bruno Abarca, who also works for Action Against Hunger in Spain, and teaches Public Health in Complex Emergencies at the School of Public Health at George Washington University.

Suggestions for this site can be given here.

Book Review: The End of Violence

June 6, 2026.     Dr. Gary Slutkin, in his new book The End of Violence  (published April 21, 2026), explains his early career experience working with the Somali Refugee Health Unit, helping malnourished refugees in East Africa, which inspired him in time to apply the skills he learned to take on global outbreaks of violence, which can lead to malnutrition and famine.

An epidemiologist, Slutkin has applied the tools and lessons of disease prevention to violence across the U.S. and in other countries.  The End of Violence:  Eliminating the World’s Deadliest Epidemic (Little, Brown and Company)  sums up his insights and experiences over several decades, particularly in Chicago, Illinois, including his key insight that violence is contagious.  He writes: “Violence is often regarded as an unavoidable fact of life… [but it] enters the brain and infects people, communities, and countries via the same process as other epidemics.”

Over several decades of pioneering fieldwork, Slutkin observed that violence is not primarily a moral failing, or a political inevitability arising from poverty, or about failures of policing. 

Instead, violence is a contagious, communicable disease that alters human brain biology, spreads by person-to-person transmission, and can be contained using the standard public health epidemic playbook that he had previously used to fight TB, AIDS, and other diseases.  He notes the threat of super-spreaders, such as authoritarian leaders who abuse their platforms to mass-infect populations with violent ideologies or behaviors.

Slutkin finds that transmission is “dose dependent:”  “Children who were exposed to intermediate or high levels of violence, especially those who experienced chronic exposure, were over 3,000 percent or 31.5 times more likely to engage in chronic violent behavior than those who were exposed to no or low amounts of violence.”

Violence not only directly hurts people; it has indirect harms.  For example, when there is violence in communities, it prevents student learning and discourages teachers.

“We already have the tools to protect ourselves, heal our communities, and end violence in our lifetime. It is now up to us to use them.”

He argues that the cutting edge of public health is prevention via interaction with people to move them away from heighted risks.

Slutkin’s program trains “violence interrupters” and credible messengers (often individuals who have transformed their own lives after involvement in street violence) to identify and mediate conflicts before they turn lethal (the rough health equivalent of contact tracing and quarantine).

“To interrupt the transmission… we need to follow a new playbook, one grounded in public health… our most formidable tool to limit spreading is helping a population adopt safer behaviors…  There is no epidemic control without changes in behavior.”

Dr. Ron Waldman, who worked with him in Somalia, writes: “Slutkin has taken incredibly innovative thinking, adapted from his experiences in global health, and applied it with remarkable dedication and even more remarkable results, to one of the most enduring and destructive social problems plaguing the U.S.  This is an important book.”

His program, formerly called Ceasefire, now “Cure Violence Global” (CVG), has been replicated in hundreds of communities across 17 countries, and major cities in the United States.  These includes:

  • *  West Garfield Park, Chicago, where deaths dropped by 31.4% in the first year;
  • *  San Pedro Sula, Honduras, where shootings declined by 94%;
  • *  South Bronx, East New York, Brooklyn;
  • *  Port of Spain / Trinidad and Tobago; and
  • *  Cali, Colombia, where 30-50% of homicides were reduced.

Dr. Manuel Carballo, who has worked with him for many years, says:  “Dr Gary Slutkin’s work to prevent violence has not only reminded us of the magnitude of this global problem, but more importantly has explored the complex of factors that contribute to what he has so rightly and innovatively defined as a communicable disease. His work and his book is a game changer. It reflects a social tragedy that is all too often taken for granted or that generates responses that simply skim over the insidious character of the problem. The insights he provides should now serve as a guide for policy makers and the public at large, and hopefully will lead to new and concerted action. Dr Slutkin has pioneered a whole new public health arena and has been able to demonstrate that the incidence of violent behaviour can be effectively reduced. The implications of this for public health and human security are far-reaching.”

CVG is a nonprofit that provides training, technical assistance, assessment, capacity building, hiring support, monitoring, and ongoing guidance rather than directly running every local program. Local community-based organizations or governments usually implement the on-the-ground work (violence interrupters, outreach workers, etc.).

Slutkin writes, “We needed locals who had firsthand experience with violence.  …This was equally true in the epidemic work I did… If we wanted to reach Somali refugees, we needed to hire other Somali refugees.  If [we] wanted to help change behavior among intravenous drug users, [we] needed to hire former intravenous drug users.  People trust people they recognize themselves in, and, ideally, already know.”

In his concluding Action Plan, he recommends:  “Every city and community needs a violence-prevenion program, just as it needs police departments, fire departments, schools and health services.”

The books end-notes and “Solutions by Violence Syndrome Annex alone are worth the price of the book’s purchase.

The dominant funding source for CVG has been municipal and state government budgets, increasingly treating the program as recurring line items rather than one-off grants. Baltimore’s Safe Streets, for instance, became part of the city’s budget; NYC’s tens of millions flow through the city’s Crisis Management System; St. Louis committed multi-year city money through its Board of Aldermen.

Local health departments frequently act as the fiscal intermediary.  Private donors also make a difference, such as Bader Philanthropies, which gave $100,000 to the City of Milwaukee to implement Ceasefire.  Other funders are the Robert Wood Johnson Foundation, and the MacArthur Foundation.  International work has involved the World Bank and Inter-American Development Bank.

Over the years, institutions like the Department of Justice, Johns Hopkins University, and the Centers for Disease Control and Prevention (CDC) have evaluated these interventions, frequently validating significant statistical associations between Cure Violence implementation and reduced violence rates.

The program is cost-efficient.  Costs of implementation have varied from site to site, from $80,000 for a one-year startup, to $64 million in New York City.  Societal savings of CVG are often estimated at $7–$33+ per $1 invested due to reduced medical, criminal justice, and other costs.

The strongest evidence comes from quasi-experimental evaluations: difference-in-differences, synthetic controls, interrupted time series, comparison neighborhoods, before/after analyses, and mixed-methods evaluations. The 2025 systematic review identified 13 papers, covering 27 program sites and 83 findings on shootings or killings. Overall, two thirds of findings showed reductions. Outside Baltimore, 95.8% of sites showed reductions and 54.2% reached statistical significance. Hunger Notes generated CVG’s Theory of Change diagram, shown here.

While the CVG has been effective at local gun violence at the community level the evidence is less compelling for larger systematic political violence, state violence, civil war, and international war.

The Nobel Peace Prize committee should consider Slutkin for candidacy.

See also:  TED Talk  “Let’s treat violence like a contagious disease”

See:  GarySlutkin.com

  https://www.youtube.com/watch?v=AWjq0tlq1bs

PBS/Frontline produced a documentary about “The Interruptors”, available here.

 

-Contributed by World Hunger Education Service Board member, Steven Hansch

Strait of Hormuz Fertilizer Disruptions and Increases of Malnutrition Risk Worldwide

June 4, 2026    News Analysis by Rohma Akhtar

The Middle East war continues to disrupt ship traffic through the Strait of Hormuz affecting shipments of urea, sulfur and phosphates for fertilizer.  As predicted, aid agencies are reporting increases in malnutrition as a result.

As reported here, in Hunger Notes in March, fertilizer prices increased by 6.5% in February.  They increased yet another 26% in March.  Because fertilizer is central to cereal and staple food production, these shocks are raising prices of basic foods and increase trade costs, with downstream effects on food security and nutrition in vulnerable low- and middle-income countries. Child wasting, a rapid, acute form of malnutrition characterized by severe weight loss, responds within months to food access shocks, unlike chronic stunting, which can take months to years.

India, Sudan, and Ethiopia are the countries most likely to experience the largest increase in child wasting following the fertilizer shock.

The fertilizer-to-wasting pathway does not operate in isolation from other conflict effects, as the closure of the Strait of Hormuz, which is driving up fertilizer and energy prices, is also disrupting broader maritime trade routes, especially impacting humanitarian aid.

As humanitarian access is already constrained by insecurity and damaged infrastructure in Sudan and parts of Ethiopia, higher transport and logistics costs further limit agencies’ ability to pre-position food and therapeutic supplies at the scale needed.

Since fertilizer shocks take 6-12 months to fully translate into food price increases and yield losses, the impacts  are likely to peak in late 2026 and early 2027.

Ministries of health, UN agencies, and donors should pre-position therapeutic supplies, expand nutritional surveillance, and front-load assistance now rather than waiting for confi rmed increases in the prevalence of acute malnutrition to trigger a response.

–  Contributor Rohma Akhtar, is a student of George Washington University Milken School of Public Health