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Malnutrition in highly insecure areas: challenges in the response and the commitment to decentralized models of care. The cases of Baidoa (Somalia) and Zamfara (Nigeria)


MSF is deeply concerned about the impact of the malnutrition, food insecurity, and health crisis witnessed in 2022 and 2023 on the populations served. MSF programs cover a range of health interventions for vulnerable populations, especially in conflict and violent settings. This includes responses to the nutritional situation, and the scale of food security and malnutrition needs have necessitated a significant scale-up of activities in the past several years.

Globally, the volume of MSF’s malnutrition management activity increased by 50% between 2021 and 2022, with approximately 500,000 outpatient cases and 126,000 hospitalizations in 2022. This increased volume in MSF health response is, however, only indicative of much greater needs globally. In the contexts where MSF Spain operates, malnutrition, food security, and health services have been deeply impacted by climate, global economic shocks, reductions in humanitarian assistance, and the ongoing conflicts and displacement that characterize the areas of focus. A main driver of food insecurity is conflict, with 70% of persons who do not meet their daily nutritional needs living in areas impacted by conflict and violence.

Malnutrition and health responses have been particularly challenging in highly insecure contexts, such as Somalia, Nigeria, South Sudan, Sudan, and Yemen, among others, where teams face severe access issues impacting the ability to reach those in need. Despite the use of various care models adapted to the difficulties of responding in conflict settings, major obstacles persist in ensuring the provision of medical care to prevent and treat malnutrition. Some of the most severe humanitarian crises remain neglected, do not receive adequate responses to malnutrition and food insecurity needs, or the linked multi-sectoral needs (e.g., health and water, and sanitation). These challenges apply to the entire humanitarian sector, emphasizing the need for further investment and evolution in the overall response to this growing crisis.

This article explains the challenges faced in responding to malnutrition in highly insecure areas by focusing on two specific operations, including Baidoa (Bay region, Somalia) and Zamfara state (Nigeria). When MSF commenced health programs in these areas, the interventions focused on responding to the multiple health consequences of violence. Since 2022, there has been a scale-up of the malnutrition response to address the scope and urgency of the crisis in these contexts, as an important part of the response to the multi-faceted complex emergencies in these settings. Some highly insecure contexts where MSF works have among the highest levels of need globally, yet the humanitarian and health sectors have not adequately adjusted their programming to overcome the access issues and other specific challenges of these settings to align with the scale of the need. Without significant shifts, in light of the current and foreseen funding cliff for malnutrition in the next years, the situation remains dire.

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