Tag: stunting

Update about Hunger & War in Iran

July 26, 2026   By Stephen Sellers        What began as a single day of strikes on February 28, 2026 has become one of the longest and costliest U.S. military engagements in decades, and the humanitarian toll on Iran’s youngest children has deepened rather than resolved. Nearly five months on, the threat to child nutrition described in our initial briefing has moved from a fear we anticipated to documented reality, compounded by a currency collapse, a leadership crisis, and a war whose ceasefire has repeatedly failed to hold.

Hunger Notes reported large-scale population displacements in February.  Most of 3.2 million Iranians who were displaced have returned home.  A residual caseload of displaced remains from destroyed housing: 149,528 civilian units damaged (according to the Iranian Red Crescent, in June); ~400,000 people had homes directly affected. Only ~9,000 were still in tracked shelters in June.

Iran’s safety net appears to be effective at reaching vulnerable children, and preventing rates of wasting from increasing.  The Iranian Welfare Ministry food-basket program, Phase 34 (17–18 July 2026), which provides the most recent concrete figure, identifies 180,826 malnourished children aged 5–59 months who are enrolled for subsidized food baskets (152,788 in “very needy” households + 28,038 “moderate need”).

Malnutrition is worsening in the provinces Hunger Notes flagged as most vulnerable

Sistan-Baluchestan, which was named in our February briefing as an already-strained border province, remains the hardest hit by hunger.  Up to one-third of children under five in the province now face severe malnutrition. Many families subsist on little more than bread and tea, and the loss of free school meal programs has left some students too depleted to concentrate in class or attend at all. Nationally, child stunting continues to concentrate in Sistan-Baluchestan, Kerman, and Hormozgan, alongside a parallel crisis of; roughly 30% of pregnant women are failing to gain sufficient weight during pregnancy.

The war has not ended — it has cycled through ceasefires that collapsed

After more than five weeks of fighting, the United States and Iran agreed on April 7–8 to a ceasefire that also encompassed Israel.  U.S. President Trump extended it indefinitely on April 21, but both sides violated it almost immediately. A June memorandum of understanding sought to reopen the Strait of Hormuz and formally end the war within 60 days. Instead, fighting resumed in July after Iran struck three commercial vessels that had bypassed its pre-approved shipping route. By mid-July, the U.S. President had declared the ceasefire over following a new round of strikes after Tehran targeted vessels in the strait, and as of July 18 there was no sign the renewed fighting would end soon; a week of intensified strikes had left the ceasefire in tatters. Adding to the instability, Iran’s Supreme Leader Ali Khamenei was killed and buried after marathon funeral ceremonies. His son and successor, Mojtaba, has not appeared publicly since taking over leadership.

Overall food production is up this year, or near average according to the U.N. Food and Agriculture Organization.  The Government is purchasing large amounts of wheat, but remains constrained in being able to pay farmers.  Iran has imported 22 Metric Tons of food, with Russia as the main source.

Iran’s food supply (production plus imports) has recovered  over the six months, while household food security has deteriorated sharply due to inflation and the collapsing value of the Iranian currency, the rial.

A collapsing currency has turned food into a luxury for many

The economic backdrop against which malnutrition is now unfolding is far worse than in February. Iran’s currency, the rial, approached 1.95 million to the dollar on July 20  down in value by roughly a third since January,with the IMF projecting nearly 69% average inflation and a contracting economy for 2026, leaving the official minimum wage worth only about $87 a month. Iran has not published GDP data since 2024, and a nationwide internet blackout has made even the country’s own statistics hard to verify from outside.

Food prices have increased 140% year-on-year, with flour up 170% and rice up 220%.  One dollar bought roughly 1,350,500 rials on January 1; by July 20 it bought nearly 1.9 million.  This means a  household purchasing-power collapse layered directly on top of the wartime disruption to food imports described in our original briefing.

The blockade of the Strait of Hormuz is squeezing food and fertilizer supply chains region-wide

More than 90% of Iran’s annual trade passes through the Strait of Hormuz. The strait’s effective closure, combined with a subsequent U.S. blockade, has cut off up to 70% of Iran’s export revenue. The damage is not confined to Iran. Since the end of February, roughly 3.9 million tons of fertilizer exports, about 30% of the Gulf states’ annual fertilizer trade, have been suspended, and shortage risk keeps rising the longer the strait stays closed. The war continues to choke deliveries of fuel, fertilizer, medicine, and aid shipments transiting the Middle East, forcing the World Food Program and Save the Children to reroute aid around restricted waterways, adding weeks of delay and millions of dollars in cost.

The war’s humanitarian shockwaves have reached far beyond Iran’s borders

Perhaps the starkest change since February is how far the malnutrition impact has traveled. This past March, Hunger Notes projected that increases in fertilizer prices would result in reduced food production worldwide, and resulting hunger.

Save the Children, the nonprofit, projects that every $5 rise in oil prices tied to the conflict wipes out a month’s worth of life-saving humanitarian aid for nearly 40,000 children. . In Nigeria, children who had recovered from malnutrition are relapsing: hospital records in Sokoto show nearly 40 children previously treated since February back under treatment, with many more undocumented, as families lose income to war-driven fuel price increases. Hunger Notes,  UNICEF, Reuters, and the Financial Times have warned that a continued war will likely  push up to 23.4 million additional children worldwide into monetary poverty by year’s end.

What has changed, and what hasn’t

The core vulnerabilities identified in February include Iran’s large under-five population, pre-existing pockets of wasting and stunting concentrated in Sistan-Baluchestan and other border provinces, a food supply chain dependent on imports now vulnerable to blockade, and a government historically wary of Western humanitarian NGOs — have all held true and intensified. What has changed is the scale and duration: a war many observers once expected to last days or weeks instead approaches its fifth month with no durable ceasefire, a currency in freefall, a change in the country’s top leadership, and malnutrition effects now documented as far away as Nigeria and Somalia. Without a lasting cessation of hostilities and a functioning channel for food and medical imports, the compounding crisis facing Iran’s youngest children, and the children of countries dependent on the same shipping lanes and aid budgets, shows no sign of leveling off.

Humanitarian aid to Iran is relatively small.  Domestic organizations, such as the Iranian Red Crescent Society, provide most aid.  In April 2026, the ICRC delivered more than 170 tons of relief supplies, followed by another 18-ton shipment in June, UNICEF continues to provide child health, nutrition, vaccines and hygiene.

Further Reading:

FAO’s Global Information and Early Warning System

World Food Programme

 

 

U.S. Food Aid (Part 8): Nawiri in Arid Lands of Kenya

July 24, 2026    This is the eighth Hunger Notes article about Food for Peace programs to help inform the public and USDA about lessons learned during past decades about the design and evolution of US food aid, intended to inform USDA which has an outstanding request for information.

Nawiri was the most recent Food for Peace program for Kenya, with about $200 million to different NGOs, led by two groups, Catholic Relief Services and Mercy Corps, covering drought-prone arid lands with mixed pastoral and agricultural economies.  The CRS consortium included Caritas, Tufts University, IBTCI, Concern, Village Enterprise and Kenyatta University and worked in Isiola and Marsabit counties, while Mercy Corps worked in Samburu and Turkana counties, with Research Triangle Institute, AVSI, Viamo, Caritas and the African Population and Health Research Center.  Together these teams  reached some 550,000 people.

Program metrics showed that Nawiri achieved substantial positive impacts but the benefits were often uneven, context-dependent, and constrained by severe environmental shocks.   The implementing agencies found that acute (wasting) malnutrition varies significantly between neighboring wards, across different seasons, and over time, meaning that generalized regional approaches are often ineffective.  Also, screening methods like mid-upper arm circumference (MUAC) and weight-for-height z-scores (WHZ) behave differently across seasons, sex, and age groups.  Relying solely on MUAC can delay the identification of malnourished children; employing both metrics is necessary to accurately capture different characteristics and stages of malnutrition.  Not surprisingly, they found that dry climate correlated with worse malnutrition.

NGO evidence generally showed that where their interventions were concentrated, malnutrition measurably fell.   During the period of study, wasting malnutrition declined by over 20% in target areas, though it increased 40% in Turkana. Furthermore, longitudinal studies noted that stunting (long-term malnutrition) increased significantly over time for the sample as a whole, particularly in Laisamis.

Increased systematic screening and referral of malnourished children to health posts were an important reason for those declines seen in wasting.  In the  Turkana, Nawiri equipped 210 community health volunteers in 4 communities with dosage carts, pneumonia beads, and malaria test kits.  Concern piloted an integrated health intervention that added malaria, pneumonia and diarrhea case management with existing integrated-management of acute malnutrition.

Some 57 water systems were rehabilitated, important in a dry lands, and Nawiri fostered 35 local “Water Use Associations” for ongoing improvements for tanks, pipes and water points.  Crops were expanded with irrigation: sorghum, maize, watermelon, green grams, fodder. A 7 km canal was desilted.

“The primary pathway between water insecurity and malnutrition in the arid lands of Kenya is women’s time burden collecting water to meet the minimum drinking and hygiene needs of the household. Water collection is performed exclusively by women and girls and remains one of the pervasively gender inequitable elements of pastoral life. Nawiri aims to address the role of water system functionality through borehole rehabilitation.”

The project found that traditional pastoralist strategic mobility and social institutions (like sharing milk, food, and childcare) are the frontline of disaster response and foundational to community resilience.  Nawiri helped establish retail shops (dukas) in remote areas to stock better varieties of nutritious foods, bringing vibrant markets to communities that previously had to travel up to 7 kilometers for basic goods.  Nawiri promoted livestock health and livestock disease surveillance.

Applying the graduation model, some 500 households in 14 villages graduated with Village Enterprise assistance.  In The Isiolo pilot (600 households) launched 204 businesses and 20 savings groups; Food Consumption Score rose from 51.3% to 83.8% in 3.5 months and children (6–23 mo) meeting minimum acceptable diet rose from 6.38% to 31.65%.

The Double-Edged Sword of Diversification: While livelihood diversification provides alternative income, it can act as a maladaptive coping mechanism if it forces women into labor-intensive, low-return activities,. The program observed that as women spent more time on business activities, time spent on childcare decreased, which in some zones led to reduced breastfeeding and higher acute malnutrition.  While the drought pushed communities to diversify away from livestock, weak local economies meant many new businesses sold the same basic goods (like sugar and flour), fast-tracking local market saturation

Under CRS, 207 teenagers graduated the “Nawiri na Ujuzi” course (tailoring, masonry, plumbing, electrical, mechanics, driving), which was jointly funded by Nawiri and the County Government of Isiolo.  CRS Deputy COP Margaret Kahiga notes all beneficiaries come from households with under-five children facing malnutrition.  In a separate area, a randomized controlled tiral conducted with the Rural Entrepreneur Access Project (REAP) in Samburu revealed a limitation to these economic benefits:  if market saturation crossed a certain tipping point (over 60% enrollment in a specific locality), the income impact for individual businesses could reduce over time as businesses competed against one another

Resilience was highly dependent on informal safety nets, asset ownership, and access to savings.   The program emphasized layered, sequenced interventions (e.g., combining water with agriculture, nutrition education, and markets) and local ownership, leading to better resilience against shocks like drought. The partner county governments agreed to sustaining gains post-closeout, including asset handovers and policy integration. The NGOs also observed a chronic deficiency in prioritizing and budgeting of government resources for nutrition, and political leaders frequently lack awareness of the importance of multisectoral nutrition approaches.

Much of Nawiri intentionally focused on formative research and theory-of-change-analysis during the first two years.  The  Feinstein International Center at Tufts University managed a longitudinal study (bimonthly surveys) in four sentinel sites.  Tufts found that few individual/household variables predict malnutrition, whereas basic structural drivers (pastoralism under pressure, climate variability, weakening customary institutions) dominate.  Mercy Corps’ review of longitudinal data found that wasting malnutrition had persistently been above 15% for three decades, without improvement.

Notably, DOGE terminated the CRS program, despite positive progress and investments, because DOGE’s simplistic word search through the fun. ding agreement found politically-offensive words, like “gender”, and “climate.”  Because Nawiri was terminated early, a full, independent endline evaluation of final impact may be incomplete.

–  Contributed by WHES board member, Steven Hansch

 

 

U.S. Food Aid (Part 2): FAFSA – “Food Aid & Food Security Assessments”

July 13, 2026   This is the second of a series of Hunger Notes articles about the re-design of the U.S. Food for Peace (FFP) program,that is now in process at the U.S. Department of Agriculture, which just released a request for informational inputs this past week.

In past decades, USAID commissioned two expert teams to review experience with development food-aid programming: the first in 2002–2003 and the second in 2012–2013.   The first, the 2002 “Food Aid and Food Security Assessment“ (FAFSA 1) found that success in health, nutrition, and agricultural components was largely driven by U.S. Government (USG) complementary inputs, such as technical assistance (TA) and training, both of which were primarily financed through the monetization (sale) of food aid. FAFSA 2 reinforced this, emphasizing that distributing food alone is of reduced value for improving food security and should be combined with non-food resources to build durable livelihoods and community resilience.  Although styled as an ‘assessment,’ the 2002 report functioned primarily as a broad program review.  It addressed the wide variety of competing mandates being pursued, including support for microenterprise, education, HIV/AIDS and emergencies, all while achieving sustainability.

During the two decade period, 1993 – 2013, the US shipped an estimated 17 million metric tons of food, worth $4.5 billion (not adjusted for inflation) for development programs (not including the larger volume for emergencies)..

Both studies found that FFP exit strategies were weak and that project outcomes were often not sustained.  Both studies reported broad improvements in child nutritional outcomes across the countries reviewed though this was based on a mixed set of project evaluations that did not include randomized controlled trials (i.e., with control groups).   Measures of child (under five years of age) nutritional status focused on stunting (which is a long-term outcome) and weight-for-age, not weight-for-height (wasting) that is more critical for health.

FAFSA-1:  Implementing agencies “should continue to use growth monitoring and promotion as key strategies to improve the nutritional status of children under 3 years old and improve referral and follow-up of malnourished children. [They] should establish clear protocols for identification and referral of malnourished children to health facilities.”

  • ◊ Agricultural programs ought to be market-driven, not just production-driven. While early programs often focused merely on increasing staple crop yields, FAFSA-2 found that the most successful agricultural programs adopted a “Pull Plus Push Model.” This approach links farmers to promising, higher-value markets (the “pull”) while simultaneously providing them with  new technologies, TA, and training needed to compete in those markets (the “push”).  Furthermore, FAFSA-2 emphasizes that programs should target farmers who are “vulnerable and viable.” For food-insecure populations who lack sufficient land or assets to farm their way out of poverty realistically, programs should focus instead on creating off-farm jobs and non-agricultural income generation.

  • ◊  Maternal and Child Health and Nutrition (MCHN) should focus on prevention during the first 2 1/2 years of life.  A major finding in FAFSA-2 was that preventive supplementary feeding, targeting all pregnant/lactating women and children under two years of age, is significantly more effective at reducing stunting than recuperative feeding, which only treats older children who are already malnourished. Additionally, evidence suggests that providing food to individual people is more effective and cost-efficient than providing larger rations to whole families.

◊  Food-for-Work (FFW) should be focused on the creation of public goods such as roads and canals.  The authors viewed FFW as having poor sustainability.
…
◊  Income generation should be combined with behavioral change such as caretaker behavior for diets and improved hygiene.  Increasing a household’s income does not always  improve family diets or reduce child undernutrition.
…
◊ Program evaluations should be more independent, standardized, and professionalized.  FAFSA-1 noted the need to reduce variability in how performance indicators were defined and measured and recommended shifting the burden of complex evaluations away from those NGOs implementing programs.
Both study teams, composed of different individuals, were led by agricultural economists, so it was not unusual that both studies focused on gains in crop yields and supply chains.
…

Differences

Co-authored by Roberta van Haeften, Mary Ann Anderson, Herbert Caudill and Eamonn Kilmartin, the FAFSA-2 (2013) report goes further than the first report by:

  • » Quantifying impacts (e.g., stunting reductions, income improvements).  FAFSA-2 calculated that U.S. food aid led to reductions in underweight children by 0.63%/year. Asia/LAC outperformed Africa (1.53% vs. 0.98% annual stunting reduction).
  • »  Emphasizing water, sanitation and hygiene interventions:

“Ninety-four percent of the Title II programs with WASH interventions created and trained Village Water Committees. This very important step greatly improved the likelihood of successful operation and maintenance once the Title II programs ended.”

  • »  Introducing new frameworks (e.g., risk/vulnerability, Food Security Country Frameworks).
  • »  Aligning with broader U.S. initiatives (Feed the Future,  Global Health).
  • »  Documenting external critiques (e.g., monetization, urbanization).

Where the first report dwelled more on qualitative data, the second report tried to include a meta-analysis of nutritional impacts, standardized indicators (MAHFP, HDDS), and quantitative trends (e.g., stunting reductions).

The second (FAFSA-2) report reviewed total of 101 programs (projects) across 28 countries. These were distributed geographically with 64 programs in Africa, 23 in Latin America and the Caribbean (LAC), and 14 in Asia.  FAFSA-2: observed that the majority (57%) of food aid beneficiaries were women (2009), with a slightly higher female participation in health and nutrition programs (59%)

FAFSA-2 addressed supplementary feeding for families with AIDS and TB patients.  And it took a broader view of USAID programming, looking at alignment with non-FFP funding areas by Feed the Future (FTF) and Global Health Initiative (GHI), that had not yet been launched in 2002 when FAFS-1 was commissioned.  FAFSA-2’s review included some~80% of resources going to agriculture (49%) and household nutrition (35%).  A declining 8% went to food-for-education, which has been phased over USDA.

Using the conceptual model shown below, the FAFSA-2 report concluded that FFP programs were generally successful at increasing household access to food, with 92% of the reporting programs seeing improvements in the number of months of adequate household food provisioning. Furthermore, 79% of reporting programs saw improvements in household dietary diversity, and 80% exceeded their targets for increasing household income.  The FAFSA-2 report highlights that by identifying and applying the specific technical models, approaches, and practices that contributed to these positive food security impacts, and by learning from the strategies that did not work well, there is a tremendous opportunity to improve overall program performance in the future.

U.S. Food Aid (Part 1): Reflections about Food Aid by Long-Term Practitioner

July 7, 2026    by Mara Russell     This is the first in a series of articles by Hunger Notes about the U.S. Food for Peace (FFP) Program.  “Food for Peace Title II Non-Emergency Programs: What are they and Why are they needed?”

In the United States, government-funded “Food for Peace” (FFP) programs  transitioned from USAID to the State Department when the former agency was dissolved  in 2025. Several months later, the Food for Peace program was transferred to the United States Department of Agriculture (USDA), a large federal agency that had not managed this program previously. Soon after this transition, $452 million in FFP resources was awarded directly to the U.N. World Food Programme (WFP) for food activities in the Democratic Republic of the Congo (DRC), El Salvador, Ethiopia, Guatemala, Haiti, Kenya and Rwanda.[i]

Then, as recently reported in Hunger Notes, in 2026, USDA released a “Notice of Funding Opportunity” for nonprofits (NGOs) for new Emergency Food for Peace programs, naming the same set of countries that were eligible for food assistance.  These upcoming programs are scheduled to be worth $357 million in total.[ii]  Since a total of $1.2 billion was appropriated by Congress for Food for Peace in FY26,[iii], USDA is now considering how to implement the rest of the funding for “development” or non-emergency food programs, referred to during the past seven years as Resilience Food Security Activities or “RFSAs.”[iv].

One critical variable that non-emergency programs have leveraged during recent cycles of USG funding is timeframe. These NGO-administered programs are generally five years in length, while emergency programs only last for a maximum of two years. Emergency programs are designed to address the impacts of acute (wasting) malnutrition and severe food insecurity. Resources in emergency programs are provided to address short- to medium- term impacts of a severe shock. This can be due to a natural disaster such as an earthquake, a severe storm, drought, or  severe conflict. The spread of an epidemic or pandemic disease can also result in such impacts, either due to a breakdown of production and markets, or due to people being at greater risk of malnutrition due to the impacts of a disease. Or shocks can result from a combination of several things.

On the other hand, non-emergency programs focus on preventing emergencies.   They address the underlying causes of hunger that tend to become more serious when conditions are such that food supplies become limited, or people lose access to food due to the types of shocks outlined above. These underlying causes, such as poverty, cultivation practices that result in poor yields, inadequate services or limited safety-nets that result in food insecurity and malnutrition, lack of income earning opportunities, poor access to water for agriculture and for drinking and inadequate sanitation that can cause water-borne disease- a significant underlying cause of acute and chronic malnutrition, lack of attention to the special nutrition needs of women of childbearing age, pregnant women and young children, and lack of capacity to prepare for potential shocks that impact food security and nutrition. These are complex issues that call for a combination of access to goods and services, while adopting of behaviors and practices within households.  Programs also ensure that the food consumed meets the standards of a healthy diet, prevent water-borne disease, and build resilience to unexpected shocks.

This takes time. There is a limit to what can be done in only one or two years. This is especially the case because according to the 2026 USDA Emergency funding opportunity, it takes between 45 and 90 days from the award of a program until food aid from the Food for Peace program can be exported from the United States, and then up to another 6 months for commodities to arrive in the country where they will be distributed.[v]

A second factor has to do with geography.  Emergency food aid programs are in countries and locations where there is an active ongoing shock, and large concentrations of people, including refugees and internally displaced people, living in a situation of extreme food and nutrition insecurity that should be addressed immediately.  Identification of these locations is guided by early warning systems or methodologies that classify people based on the degree to which they are currently food insecure or malnourished. The system that tends to be most respected internationally is the U.N.’s Integrated Phase Classification or IPC system. During its existence, USAID utilized this system, and now USDA is using it also as a way of designating where and among whom an emergency program should be implemented. In its recent funding request, USDA stated that a minimum of 20% of the population to be targeted with food aid should be living at IPC 3 or higher. The IPC classifies populations at levels 1 through 5 based on the severity of food insecurity as follows: 1 = None/Minimal, 2 = Stressed, 3 = Crisis, 4 = Emergency and 5 = Famine. The “shorthand” clarification used for those populations needing immediate assistance are those at IPC 3+.[vi]

However, non-emergency programs aim to reduce the likelihood that people living in a particular geographic area will experience conditions at or above IPC 3. Countries prioritized for these programs may already have sizeable populations at IPC 3+, but there may not be significant active shock conditions causing this situation. Sometimes, populations may be at IPC 3+ due to a shock that has previously increased food insecurity and malnutrition. For instance, after the Haiti earthquake in 2010, there were emergency programs that addressed food insecurity, malnutrition, reconstruction and access to food for the people impacted by this shock.  However, by 2013, many of the immediate impacts of the quake, such as food insecurity and displacement were initially addressed, but there was a need to address long-term root causes of malnutrition and vulnerability.  At that time USAID implemented a non-emergency program that sought to address these underlying causes and increase the ability of the country to cope with severe shocks.[vii]

Many countries where non-emergency programs are implemented experience cyclical shocks that recur on a periodic basis. They do not always exist in shock situations but may be impacted by droughts or floods during serious weather events, such as El Niño or La Niña events. During the El Niño event in 2023-2024, most of the harvest of the country of Zimbabwe was ruined due to inadequate and poorly timed rainfall.[viii]  However, on-going non-emergency programs continued to increase yields, increase incomes and reduce malnutrition, while emergency programs supported households and communities as necessary with additional food and other emergency assistance. Most of these countries also experience an annual “hunger season”, which tends to occur anywhere from 3-6 months prior to the next harvest when food stocks and cash earned from the prior harvest have been depleted.  Thus, while non-emergency programs are not implemented in contexts where active shocks occur, they may be targeted within fragile environments where hunger seasons make life very tenuous for people living in those geographies.

Another important element in these programs are the participants who are targeted. In emergency programs, large portions of the population are highly vulnerable due to the impacts of a disaster, such as an earthquake, a hurricane or other cyclonic storm, or severe conflict. In these cases, those targeted for assistance may have been displaced, or otherwise lost everything – including their health. In such emergency situations, it does not matter whether people were rich or poor prior to such shocks.

However, Title II non-emergency program participants tend to be those who are poorest, receive the fewest services, and are at greatest risk of malnutrition and food insecurity.  Often the focus is on those who have the least to fall back on when shocks occur and tend to be those most impacted by annual hunger seasons and other severe shocks.  A case in point is the Ethiopia Productive Safety-Net Program (PSNP), which has been supported by Title II non-emergency food aid since its inception in 2005.[ix] The PSNP targets people who are impacted by the annual hunger season through a Cash or Food for Assets (FFA) activity that creates a safety-net during the period of greatest vulnerability in normal years while developing assets that communities can use during good years and fall back on in bad years. The PSNP is supported by the Ethiopian government as well as several other donors. During normal years, a certain number of households are targeted for the program based on their chronic food insecurity and malnutrition. However, during years when poor crop yields and impacts increase the number of households needing food assistance, the number of households targeted increases to also address the needs of those who would not normally be included in the PSNP program.

In addition to selecting participants based on their food insecurity, there is a difference between how emergency and non-emergency programs select participants when it comes to malnutrition. In the case of emergency programs, care is taken to address the needs of people who are acutely malnourished, mainly children under 5 and pregnant and lactating women. In the case of emergency programs, acute malnutrition, in which the body loses weight rapidly, becomes a major risk. Moderate acute malnutrition exists when body weight for height among children under 5 falls below 2 standard deviations from the global mean, and severe acute malnutrition exists when this falls to 3 standard deviations below the mean.  If the rate of wasting malnutrition in a population reaches or exceeds 10%, this is deemed a humanitarian emergency requiring immediate rehabilitation using ready to use therapeutic and supplementary foods  that provide concentrations of fat, calories, protein and other nutrients all aimed at ensuring survival and rapid weight gain. Women of childbearing age, including those who are pregnant or breastfeeding as well as men also benefit from rehabilitation with RUTF or ready to use supplementary foods (RUSF), designed to also rehabilitate people in these conditions. These products are available via Title II.

However, in the case of non-emergency programs, participants are targeted based on the rate of “Stunting”, or chronic malnutrition, which exists when height-for-age among children under the age of 5 falls below 2 standard deviations under the global mean. The logic behind this is that there are milestones for linear growth that children need to reach before the age of 2 to avoid being developmentally disabled and to ensure a healthy life. Infants and young children under age 2 in this condition can recover from this and their linear growth can catch up to normal levels before they reach age 2.  However, after these children reach age 2, it becomes extremely difficult for their growth to catch up.  It is possible for a child to be both chronically and acutely malnourished (also known as “wasted”). It is also possible for stunted children not to be wasted and wasted children not to be stunted. However, there are certainly connections between these different types of malnutrition.  Nonetheless, stunting and wasting are indicative of different situations based on how and when they occur within the population. High levels of acute malnutrition indicate the existence of an acute shock as it does not take long for children to become acutely malnourished. This occurs when children are deprived of the food they need for a period of days or weeks (at most). However, it can take a long time for a child to become stunted. Children become stunted because they lack sufficient nutrients in their diet (both macro- and micro-nutrients) to fulfill their daily requirements. It takes months for a child to become stunted, and it also takes a long time for them to overcome this problem. If there are a lot of stunted children in the population, this indicate that the population is chronically food insecure and poor.

Thus, non-emergency Title II programs target populations with high chronic malnutrition rates among children under 5 as this is a clear red flag that there is a significant poverty and food insecurity problem within these populations. Targeting participants from these areas indicates that while there may not an active shock situation, there may still be a lot of food insecurity – which left unaddressed – could lead to more serious problems.  People living in these contexts are on the edge, and one missed harvest due to a storm or drought or earthquake or locust swarm or violent attack could result in them becoming part of the emergency case load of Title II programs.

Non-emergency Title II programs focus on ensuring that infants are exclusively breastfed until they are six months old, and that beyond that time their diets consist of the types of diverse foods that children of their age need to meet their linear growth milestones by age two. At the same, these programs  also address the underlying causes of chronic malnutrition. They train mothers to feed their children properly, including exclusive breastfeeding, take care to prevent water-borne disease through handwashing and use of clean water. At the same time, these programs recognize that mothers will be unable to feed their children the types of food they need if they are not able to produce or purchase it throughout the year. Raising these issues among all community members can build support and solidarity to ensure that children’s and women’s dietary needs are met. In addition, creation of clean water access and sanitation – including installation of accessible working water points and household latrines – support practices such as frequent handwashing with soap, and reduction of open defecation. These practices in turn reduce water-borne disease from hindering the absorption of the nutritious food being consumed. And, integrating these practices into people’s lives takes a long time, thus the longer timeframe of these programs is critical.

Non-emergency programs also provide a few more benefits that make them important to reduce the emergency caseload of Title II. They target countries and regions that are fragile and shock prone. They can detect changes in conditions,  both positive and negative, which can reduce time lags on responses. If the number of acutely malnourished children begins to escalate – this could easily occur within the areas where populations are most food insecure. If harvests begin to fail due to weather impacts, many farmers in the geography where the program is implemented (they may or may not be participants) will experience these conditions first.  The presence of an implementer (NGO) in these areas can ensure the monitoring of IPC levels, levels of acute malnutrition, impacts on harvests and prevalence of diseases – including those that are water-borne.

At the same time, these programs seek to enable participants to anticipate and cope better with the types of shocks that normally impact these geographic areas. Reviewing the history of the targeted population, it is possible to learn more about the major shocks that typically impact them, and they are sometimes cyclical. For instance, locust swarms may occur every so often in parts of East Africa. Working with communities likely to be impacted by these swarms during years when they don’t occur to prepare for when the locusts return will help participants to cope more effectively when this happens. There are now many agricultural technologies that enable farmers to adapt to drought. This could range from water-harvesting, to irrigation, to use of drought-adopted seeds, to reorienting productive systems through methods such as Resilient Design and Perma-gardening.[x]  The last two types of systems prevented farmers from losing their crops during the El Niño drought event in Zimbabwe mentioned above.[xi] It was a non-emergency Title II programs that provided training to farmers to enable them to maintain their crops in the face of this severe drought.

Finally, one of the key underlying causes of food insecurity is poverty.  Farmers may depend on their crops for food, but they need cash to fall back on when their crops fail, and they need to purchase food from markets. Also, for farmers to maintain their land and plant crops, they need cash for inputs and often to pay for land,  either as the owner or as a renter or lease holder.  It also costs money for children to attend school, and it costs money to get to markets, visit health centers, buy fertilizers and crop-protection products. Maintaining water points and latrines can also cost money because spare parts and their installation is not free. And when the program is over after five years of investment, ensuring that people not only achieve but also sustain their food security will mean that people have a secure source of cash and savings to fall back on.  Otherwise, closing the program will be commensurate to a shock for those who have benefitted from it.

A methodology that has proven itself over the years, and within the past nine years in Title II non-emergency programs has been the Graduation Approach.[xii]  Developed and initiated by BRAC in Bangladesh, this approach has been tested throughout the world in fragile contexts where large numbers of poor and food insecure people live.[xiii] The approach targets extremely poor people, provides them with food assistance safety-nets  and then links them to a savings and loan group where they meet others in their situation and obtain peer group support. At the same time, they are provided training in a livelihood opportunity for which there is demand within their context. This livelihood training could be agricultural (crops or livestock) or non-agricultural in nature and offers people the opportunity to become employed or operate their own business. After their training is complete, participants  receive small grants or assets (such as equipment or animals) that enable them to start their activities until they become viable. During this time, they continue to receive coaching and mentoring so that they can be successful within their chosen livelihood. They also receive training and support with respect to nutrition, water and sanitation and learn to anticipate and respond effectively to shocks. The Graduation Approach has been shown to ensure a high return on investment and results are sustained over time after the end of the program.[xiv]

Now that the program has moved to USDA, the leadership is reviewing the program and will likely make changes that will increase the cost  of food and ocean freight versus what is provided to those in need.[xv]  The recent Emergency Program set of funding opportunities stipulated that at least 50% of program budgets must be devoted to commodities and ocean freight.[xvi] This reduced the funding that could be provided to internal transportation storage and handling to distribute commodities. It also reduced the funds that could be provided for technical interventions such as monitoring of severe food insecurity and levels of acute malnutrition, training mothers about how to monitor and refer their children, and enabling technical interventions that will help people to recover from emergency situations. It is possible that the same 50% requirement may be put in place by USDA for future Non-Emergency Programs, and this could reduce the resources available to enable the sustainable improvement of food security and nutrition in extremely poor and fragile contexts as described above.

Changes in the legislation over the years made it possible to integrate international disaster assistance funds  with emergency Food for Peace programs enabling the use of cash, vouchers and local, regional and international procurement  to ensure that the right resources were available at the right time to address peoples’ needs. This prevented the need to wait 6 – 8  months for U.S. commodities to arrive in country to begin addressing acute malnutrition.  As noted above, the impact of acute malnutrition is rapid and if not addressed quickly will lead to death.

Similarly, U.S. legislative changes enabled the coordinated use of Development Assistance funds with non-emergency Food for Peace programs, which covered the cost of the complex interventions discussed above. These resources also provided the opportunity for programs to transition people away from dependence on U.S. food aid and foreign assistance.  While food aid has been important for non-emergency programs to build stability for those suffering chronic food insecurity, we will not ultimately accomplish Title II’s objectives if people remain dependent on food aid at the end of each program.

As global conditions worsened around the turn of the century, the need for emergency food aid programs increased around the world.  These needs began to reduce the funds available to pay for non-emergency programs. Thus, in the 2008 U.S. Farm Bill, a Non-Emergency “Safe Box” was integrated into Title II legislation to establish minimum funding to ensure that these programs could continue to be implemented. Currently $365 million is designated for the implementation of these programs.  $700 million of USG  funding from FY26 and FY27 allocations may be made available soon for these programs.[xvii]

While much remains unclear about the future of U.S. Title II non-emergency food aid programs, the need for activities that reduce and prevent high levels of acute and chronic food insecurity and malnutrition has not diminished,  and perhaps has increased, during the 18 months since the 2025 Executive Order to pause foreign assistance was announced.[xviii] It is also clear that addressing the underlying causes of food and nutrition insecurity is still important. Hopefully, USDA will hold true to this fundamental mandate of these programs. This will entail implementing these programs over a 5-year timeframe, in fragile geographies where shocks are frequent, among participants who are chronically poor and/or malnourished, while increasing peoples’ ability to cope with shocks, and producing outcomes that are sustainable.  If these are not the Title II mandate’s parameters for non-emergency programs, they run the risk of violating legislation..

Further Reading:

Food for Peace / U.S. Food Aid

Global Hunger, IPC, and Malnutrition

Country-specific articles relevant to your examples (Haiti, Ethiopia, Zimbabwe, DRC, etc.)

REFERENCES:

[i] Miolene, Elissa, USDA takes over Food for Peace with $452M World Food Programme deal, 29 January 2026.

[ii] U.S. Department of Agriculture, Food for Peace Notice of Funding Opportunity, Fiscal Year 2025, May 13, 2026

[iii] Miolene, Elissa, House locks Food for Peace into USDA with 50% commodity requirement,1 May 2026,

[iv]  These progras were known variously as Development Activity Programs (DAPs), Multi-Year Activity Programs (MYAPs), Development Food Assistance Programs (DFAPs), Development Food Security Activities (DFSAs) and Resilience Food Security Activities (RFSAs). There were differences between these programs, but those differences were not necessarily associated with the names given to them.

[v] U.S. Department of Agriculture, Food for Peace Notice of Funding Opportunity, Fiscal Year 2025, May 13, 2026, https://grants.gov/search-results-detail/362375.

[vi] Integrated Phase Classification, https://www.ipcinfo.org/ipcinfo-website/ipc-overview-and-classification-system/en/?__cf_chl_f_tk=vmmArOlbSf51oWrK_G0UqCVyP0w6jSuy9SVydqdsIlk-1783098737-1.0.1.1-XKb_PsSY1mVf1b2u8K3Udd85lbGsjDgfDcO0yyY9UrE,

[vii] https://borgenproject.org/kore-lavi-provides-food-security-in-haiti/; accessed July 3, 2026.

[viii] United Nations, UN News, Zimbabwe faces worsening food crisis due to El Niño droughts, 7 August 2024, https://news.un.org/en/story/2024/08/1152936.

[ix] IFPRI, Productive Safety-Net Program, https://essp.ifpri.info/productive-safety-net-program-psnp/, accessed July 3, 2026

[x] FANRPAN, Scaling up Resilience Design in Zimbabwe: Position Paper, https://fanrpan.org/wp-content/uploads/2025/01/Takunda_CareSlideDeck-1.pdf.

[xi] Chitsa, Tanaka, Growing Hope: Community gardens flourish amidst El Nino challenges, 27 August 2024, https://www.carezimbabwe.org/growing-hope-community-gardens-flourish-amidst-el-nino-challenges/.

[xii] AVSI, Graduating to Resilience, https://www.avsi.org/en/graduating-to-resilience

[xiii] BRAC, Graduation Out of Ultra Poverty, https://www.brac.net/solutions/development/ending-poverty/ultra-poor-graduation/

[xiv] Abrams, William, Joshua Goldstein, Larry Reed, Carine Roenen, and Jean Francois Tardif, The Business Case for Investing in Graduation, September 2017, ultra-poverty.org, https://www.ultra-poverty.org/blog-post/the-business-case-for-investing-in-graduation/#.

[xv] Miolene, Elissa, House locks Food for Peace into USDA with 50% commodity requirement, 1 May 2026,

[xvi] U.S. Department of Agriculture, Food for Peace Notice of Funding Opportunity, Fiscal Year 2025, May 13, 2026,

[xvii] Miolene, Elissa, US Dept of Agriculture to reboot Food for Peace’s ‘safe box’ programs,

[xviii] The White House, Reevaluating and Realigning United States Foreign Aid, January 20, 2025, https://www.whitehouse.gov/presidential-actions/2025/01/reevaluating-and-realigning-united-states-foreign-aid/.

Mara Russell is a career programmer of Food for Peace Title II food aid including leading Food Aid Management, and spearheading CARE’s food aid for decades.

Nigeria’s Ongoing Nutrition Crises

July 4, 2026    In Nigeria, some 35 million people are projected to experience acute and severe food insecurity during the 2026 lean season, according to the most recent Cadre Harmonisé, representing the worst levels of hunger recorded in a decade.  The hunger crisis is worst in the country’s northeast, where an estimated 15,000 people in Borno State are at risk of catastrophic hunger.

In 2026, about 3 million children under five in Nigeria are projected to suffer from life-threatening severe acute malnutrition.  One million of these children are in the cluster of northeastern BAY States.  In addition to conflict and displacement, overcrowding, low maternal income and the use of infant formula are associated with a higher prevalence of wasting.  Nigeria has experienced near 30‑year‑high inflation, driven by rising food prices, supply‑side constraints, and exchange‑rate depreciation.  Food inflation has historically been the dominant driver of headline inflation.  The Government of Nigeria eliminated fuel subsidies and tightened monetary policy; these reforms may improve long‑term economic growth but have raised short‑term living costs.

Recently, displacement and flooding have also fueled cholera and measles outbreaks, with damaged water and sanitation infrastructure and low immunization coverage accelerating transmission.  In North and Central Nigeria, armed groups, rural bandits, and farmer-herder clashes have forced thousands of producers off their land, disrupting farming cycles and leaving large portions of farmland unused. Between 2022 and 2024, farmer-herder conflicts were recorded in 31 states, kidnappings in 10 states, and crop theft in 20 states. Over two million hectares of farmland in northern Nigeria are now inaccessible. 

this NE region borders Lake Chad where violence has increased.   UNHCR reports that more than 77,500 people have been displaced across the Lake Chad Basin since January 2026 as violence intensifies across Nigeria, Niger, Chad and Cameroon.  According to UNHCR, incidents of violence rose by about 80 per cent between January 2024 and April 2026.  Similarly,  nearly 1,800 attacks and more than 5,700 deaths were recorded between September 2025 and May 2026 alone, reflecting what the agency described as a deepening protection crisis across the basin.

The “maize belt” (Borno, Niger, Plateau, Katsina, Gombe, Bauchi, Kogi, Kaduna, Oyo, Taraba), which produces ~44% of national maize, contains nearly half of that unused farmland.  Between April 2024 and March 2025, Nigeria spent $2.39 billion on food imports, 11.6% higher than the previous year, despite government commitments to boost local production.

Nigeria’s population roughly doubled from ~95–97 million in 1990 to ~232–237 million by 2024–2025 (growth rate ~2.1–2.4% annually). The under-5 population surged similarly. Agriculture (now ~24–28% of GDP, down historically) has grown too slowly (~2–3% annually in recent periods) to match, leading to rising food imports, per-capita production shortfalls, and pressure on resources. Smallholder-dominated, rain-fed systems with high post-harvest losses cannot keep up.  Nigeria’s child population is so large that even a stable or slightly declining malnutrition rate can mean millions of children affected.

Stunting remained alarmingly high, ranging from 7.2% (Osun, South West) to 61% (Kaduna, North Central), while wasting was as high as 29% (FCT Abuja, Central).  Stunting (chronic malnutrition, measured as height-for-age) among children under 5 fell from around 42–45% in the early 2000s (e.g., ~43% in 2003 NDHS data) to roughly 37% in 2013–2018 surveys and around 31.5–32% in more recent UNICEF/WHO/World Bank Joint Child Malnutrition Estimates (JME).  The overall prevalence of anemia and vitamin A deficiency ranged between 55.2 to 75.1 % and 5.3 to 67.6%, respectively.

The World Bank estimated the number of impoverished Nigerians rose from 89.8 million at the start of 2023 to 104 million in roughly a year.

SOLUTIONS

The National Home-Grown School Feeding Program (NHGSFP) provides school meals.  The National Social Safety Nets Program (NASSP) Cash Transfer gives cash to poor households.  The Federal Government, with UNICEF and other partners, has committed $30 million to the Small Quantity Lipid-Based Nutrient Supplements (SQ-LNS) initiative, targeting 2 million children aged 6-23 months in high-burden states.

The U.N. Food and Agriculture Organization launched a $347 million Emergency and Resilience Plan (2026–2028). The strategy combines rapid agricultural assistance with long-term climate resilience, aiming to restore food production and reduce dependency on food aid for 12.6 million people across the north.

Médecins Sans Frontières (MSF) runs nutrition projects in seven states in Nigeria: Borno, Bauchi, Katsina, Kano, Sokoto, Zamfara, and Kebbi. IOM tracks displacement and manages humanitarian hubs; UNHCR co-leads protection and durable-solutions work; Intersos and Helen Keller Intl operate where others have withdrawn.

Other NGOs with long-standing programs in Nigeria include Action Against Hunger, Partners for Development, Malteser, Christian Blind Mission, Save the Children, Plan International, and Catholic Relief Services.

  –  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.

India’s Conquest of Famine

April 19, 2026     India’s growth from food dependence to food surplus is one of the most important development stories of the last half century.  At its heart was the science of agricultural research.

Following Paul Ehrlich’s passing away, there have been many articles about the change that have occurred since his publication of the Population Bomb, where he warned about trends in risk of famine in India.  Indeed, one of the greatest stories in human history of overcoming food insecurity and famine has been India over the last 50 years. Not only has India grown in terms of food production, but it has diversified its economy, built infrastructure, and increased its GNP, which also supports improvements in long-term resilience.  In the 1990s, India turned away the food assistance provided in large quantities by the US Government’s Food for Peace, and India became itself a food aid donor to other countries.

In the late 1960s, India began intensively experimenting with ways to improve yields of key food crops, particularly wheat.  A few Indian scientists played an historic, important role in feeding this country which today has more people than any other.  The most important was M.S. Swaminathan, an unassuming man who, in his own gentle way, revolutionized India’s agricultural sector.

Swaminathan started out in 1947 working on plant breeding at the Indian Agricultural Research Institute (IARI) in New Delhi. Swaminathan collaborated with US plant breeder Norman Borlaug touring India, breeding Mexican wheat with Japanese varieties. This new crop produced high yields of good quality.  In 1964 he earned funds to plant demonstration plots which convinced Indian farmers to experiment with its use.  Further experimentation led to wheat varieties which by 1968 increased wheat production to 17 million tons.

Swaminathan’s lifelong commitment to transparency pushed him to establish various systems of accountability of the institutions he headed; therefore, he placed the entire international rice collection under the supervision of an international rice board even though it was already a part of IRRI.  Swaminathan never tired of crediting that the seeds of the green revolution in India were actually sown far back in 1949 in the fields of the Central Rice Research Institute in Cuttack, India long before Norman Borlaug came to India.  Working with the UN’s Food and Agriculture Organization, he established a commission for plant-based genetic resources to address issues related to the conservation and sustainable use of genetic resources for food and agriculture. This included plants, animals, and aquatic organisms.  The commission’s focus was on the management of biodiversity.  In the 1980s, Swaminathan led, as Director General, the International Rice Research Institute (IRRI). Here he shone as a brilliant and dedicated scientist, an excellent leader, and kind-hearted.  Despite occasional setbacks, he persevered in promoting international cooperation in the utilization and conservation of genetic resources.  His vision extended beyond yield per hectare. He was a prophet of sustainability long before it became a buzzword of the 21st century. From championing greater participation of women in agriculture to espousing ecological balance, from advancing research in Russian attics to promoting sustainable coastal farming, from advocating for tribal food security to establishing gene banks for endangered crops, his canvas was vast, and his brush precise. Swami Nathan was generous and humane, embodying the best and noblest of the India into which he was born and by which he was shaped.

As shown in the graph at right, food production in India has more than kept pace with population growth due to ongoing improvements in applications of scientific methods. In these same last fifty years, India’s population hasalmost tripled, from 520,000,000 to about 1.5 billion today.

India’s agricultural geography has shifted from a northwest “Green Revolution core” (1970s) to a much more broad-based and increasingly central/eastern growth pattern (last decade).  In the 1970s, increases in production were largely in the Punjab, Haryana, and Western Uttar Pradesh.   More recently, Indian States with the strongest increases in food production:

    • * Madhya Pradesh – often cited as India’s fastest-growing agricultural state in the 2010s
    • * Chhattisgarh – rapid expansion in rice production and procurement
    • * Jharkhand – gains from irrigation and diversification
    • * Bihar & Eastern Uttar Pradesh – improvements in rice, maize, and horticulture.

The elimination of famine has not meant that there is no malnutrition in India.  Fifty years ago half of children were stunted (low height per age) from undernutrition, while today 1 in three are.

Meanwhile, rate of wasting malnutrition (as measured by weight for height) has remained stubbornly high over the last 50% years, by many estimates stuck in the range of 17-18%.

The government’s most current estimate for the national prevalence of wasting (low weight for height) among children under five in India for 2025 is estimated the 5.4% though estimates from prior years are closer to 18% among children.  Wasting malnutrition also varies across different areas.  For instance, the Union Territory of Lakshadweep reported the highest wasting rate at 11.6%, followed by Bihar (9.31%) and Madhya Pradesh (8.2%).

Much of the growth of production in India has been facilitated by increases in application of synthetic fertilizers. This is relevant today because, as reported yesterday, India’s food economy is seriously dependent upon fertilizers from the Middle East that are now blockaded and will be increasingly expensive, which may challenge food production in India this year.

Read more:   M.S. Swaminathan in conversation with Nitya Rao: The Ethics and Politics of Science, M.S. Swaminathan Research Foundation Centre for Research on Sustainable Agriculture and Rural Development, 2014.

Charles C. Mann, The Wizard and the Prophet: Two Remarkable Scientists and Their Dueling Visions to Shape Tomorrow’s World (New York: Alfred A. Knopf Inc., 2018).

Priyambada Jayakumar, M S Swaminathan: The Man Who Fed India,  HarperCollins India, September 10, 2025

Debate over Child Malnutrition in Gujarat, India

In his book Development as Freedom, Nobel-prize winning scholar Amartya Sen wrote that “no famine has ever taken place in the history of the world in a functioning democracy,” tying that claim to the presence of elections, opposition parties, and a relatively free press.

The press in Gujarat, India is giving a current example of how politicians are being held accountable to metrics of child malnutrition.

As reported in Indian news, quoting the independent, population-based National Family Health Survey (NFHS-5), the opposition party in Gujarat is criticizing the government for a 41% rate of stunting in Gujarat state (or some 260,000 children), whereas the government is quoting a lower rate based on self-selected clinic-based screening of children.  The NFHS also reports 19% of children under age 5 were wasted (acutely malnourished).

The opposition has claimed, “Despite this BJP government with more than 150 seats and 28 years of rule, only one figure comes on record, that 40 out of 100 children are malnourished. A very large section of them are tribals.”    In districts like Panchmahal and Banaskantha, the numbers are objectively worse than the state average, which is why they were the focus of the March 12th debate.

Over roughly the last two decades, Gujarat’s child malnutrition record has improved, but unevenly.  But wasting moved the wrong way for a long stretch: about 19% in 2005–06, 27% in 2015–16, and still about 25% in 2019–20/21; severe wasting also rose from about 7% to 11% and then stayed around 11%.  Several underlying determinants improved substantially over time in NFHS: by NFHS-5, Gujarat had higher coverage of improved sanitation (74.0% vs 63.6% in NFHS-4), clean cooking fuel (66.9% vs 52.6%), improved drinking water (97.2% vs 95.9%), and continued high use of iodized salt (95.6%).  Those changes usually point in the right direction for nutrition security.

Reference about the recent controversy:

https://www.thehindu.com/data/fact-check-are-40-out-of-100-children-malnourished-in-gujarat/article70744284.ece

Threat of Child Malnutrition in Iran Amid U.S.–Iran Conflict

February 28, 2026       The U.S.–Iran war that began today, 28 February 2026, threatens to sharply worsen malnutrition among children under five in low-income urban neighborhoods of strike zones (Tehran, Isfahan, Kermanshah) and in rural border provinces (e.g., Sistan-Baluchestan and Kurdistan) that already experience high malnutrition rates.

Iran, with a total population of 93 million people, has 7 ½ million children under five years of age, which is more children than Germany, the UK, Canada, Iraq, Syria, Italy, Turkey, or France.

Over the last few decades the occurrence of childhood stunting (a form of long-term malnutrition) and of wasting (short-term) malnutrition have declined in Iran, reflected by the government’s attention to treating malnutrition.   However, studies in southern Iran from 2018 to 2023 show a significant increase in underweight and wasting among young children, with the annual % change of severe wasting increasing by 8.9%.  Nationally, the rate of wasting has averaged 4.2%, which is medium for regional and peer countries.  Iran’s Ministry of Health and Medical Education (MoHME) manages child malnutrition programs through primary healthcare centers, hospitals, and nutrition initiatives.  Treatment follows protocols similar to WHO/UNICEF guidelines for community-based management of acute malnutrition, which emphasize outpatient therapeutic care using Ready-to-Use Therapeutic Food (RUTF) for severe malnutrition.

The most widespread micronutrient deficiency diseases in Iran include vitamin D (rickets), iron (anemia), vitamin A, and zinc deficiency.  Iran addresses these through national programs (e.g., supplementation, fortification of foods like flour with iron/folate, salt iodization, and targeted UNICEF-supported interventions in high-risk provinces), but challenges persist due to economic factors, dietary habits, and regional disparities.

Even before the current war threats, Iran’s food economy was struggling under the weight of international sanctions and mismanagement.  The conflict will further reduce Iranian families’ ability to afford food.  In fact, the protests that broke out in December 2025 were in part over increased food prices after the rial plunged against the U.S. dollar.   There has been criticism by Iranians that their government has failed to present a clear emergency response plan, leaving citizens to fend for themselves. 

Iran produces much of its own wheat, dates, barley, rice, pistachios, walnuts, citrus fruits, and saffron.  It imports rice, cooking oils, soybeans, sugar, tea, and dairy.  The fighting will disrupt Iran’s ability to import food commodities, tightening supply.  Agricultural supply chains, transportation networks, storage facilities, and water infrastructure are all vulnerable.  Damaged roads and ports will impede food distribution across the country.

Urban bombardment now underway in Tehran and other major cities will displace families.  Reuters today reports that Iranians have fled cities in search of safety, rushed to stock up on food, and formed long queues at fuel stations as attacks by the United States and Israel spread fear and panic throughout the country.  Iranian government messages have explicitly encouraged people to leave Tehran and other targeted cities to avoid attacks.  This kind of internal displacement typically leads to overcrowded towns, strain on services, and informal settlements on the periphery of safer cities.

Internally displaced populations lose access to stable food sources, income, and caregiving routines.  Young children are disproportionately harmed by the disruption of feeding practices and by unhygienic displacement conditions that compound malnutrition with infectious disease.

Iran is known as a country that takes care of refugees.  Estimates vary, but UNHCR and other agencies report roughly some 3.8 million refugees and people in refugee-like situations in Iran as of 2025, overwhelmingly from Afghanistan and a smaller number from Iraq and other countries.

Iran has been prone to disasters due to large earthquakes and famines.  As well, in February 1972, a week-long series of storms  brought up to 26 feet (8 meters) of snow in rural areas of western Iran which buried over 200 villages, killing thousands.

Iran also suffered severe famines in 1870-72 and during the First and Second World Wars.  The most recent UN Food and Agriculture Organization report about Iran (November 2025) notes that persistent dry weather has hampered winter wheat plantings, leading to an estimated cereal production nearly 10% below the five-year average in 2025.  It found that wheat prices in Tehran had risen 50% and rice prices had tripled, compared to the previous year.

Iran has a fairly extensive domestic social protection system by regional standards, though it has faced significant strains in recent years.  The Imam Khomeini Relief Committee (IKRC) is one of the largest non-governmental charitable organizations in the world by some measures. It operates under government supervision and provides cash transfers, food assistance, healthcare subsidies, and vocational training to millions of low-income Iranians. It draws on religious endowments (waqf) and public donations alongside state funding.   The State Welfare Organization (SWO) handles a broader range of social services including disability support, elderly care, and assistance for vulnerable families.

International aid agencies help Iran in disasters, including the Red Cross.  The national Red Crescent society of Iran, part of the global IFRC network, has deep roots in domestic disaster relief, rescue, and healthcare operations.  The International Committee of the Red Cross (ICRC) has been working in Iran since the late 1970s.  The ICRC provides humanitarian services related to conflict-affected populations, health, and protection.

Médecins Sans Frontières (also known as Doctors without Borders) has been operating health programs in Iran.  Many other international NGOs have been hesitant to work in Iran, where the government distrusts Western organizations.  An exception has been Relief International (RI), which was founded in 1990 following the catastrophic Manjil–Rudbar earthquake in northern Iran.

The convergence of active conflict, pre-existing economic strain, and disrupted supply chains creates a compounding crisis for Iran’s most vulnerable — particularly children under five.  International humanitarian organizations face their own obstacles operating in Iran, given longstanding government suspicion of Western NGOs. The children most at risk — those in strike zones like Tehran and Isfahan, and those in already-malnourished border provinces like Sistan-Baluchestan — are precisely the populations least able to weather further disruption to food access, clean water, and caregiving. Without rapid and coordinated humanitarian response, the malnutrition crisis that predates this conflict will deepen sharply, with consequences that will outlast the fighting itself.

 

–  Contributed by WHES board member, Steven Hansch

 

 

 

 

 

Low Height-for-Age Malnutrition Examined in the North of Rwanda

A study published this month, February 2026, about long-term malnutrition, measured by the degree of a child’s stunting (low height for age) in Rwanda found that despite economic progress, low growth rates were found in 27% of children in northern areas.

The authors note that “In addition to food deficit linked to poverty, stunting is associated with factors like inadequate diets, poor sanitation and hygiene, inadequate maternal and childcare practices, polluted water sources, limited healthcare access, low maternal education, and limited socio-economic opportunities.”

The authors set out to evaluate the how well geographically-weighted logistic regression (GWLR) enhances the understanding of spatially varying risk factors for malnutrition.

the authors found that key interventions such as vitamin A tablets or deworming medicine were, unexpectedly, associated with greater stunting.  Maternal autonomy was preventive of stunting.  “At the household and community level, the presence of a handwashing facility near the toilet and household electricity access were consistently associated with lower odds of stunting.”

The authors demonstrate that the patterns and causes of malnutrition and hunger vary within countries for a range of reasons, including livelihoods, terrain and local customs.  Therefore, “localised interventions should be prioritized to address specific needs identified in geographically distinct clusters, optimizing resource allocation and intervention effectiveness.”

See  “Spatial heterogeneity and spatially varying determinants of childhood stunting in Northern Rwanda: A cross-sectional study to inform targeted interventions” by Kagoyire, Ndagijimana et al, from the Universities of Lund and Umea Sweden.

Another review of this is found at:  https://www.devdiscourse.com/article/science-environment/3817025-why-children-in-northern-rwanda-are-still-stunted-despite-green-fields